Factores predictores de días de hospitalización en pacientes con ictus

Introducción: La elevada morbilidad del ictus supone un gran coste tanto para los pacientes como para el sistema sanitario. Este estudio pretende determinar qué factores del paciente, de la enfermedad o del propio sistema sanitario se relacionan con un aumento en los días de hospitalización. Material y métodos: Estudio observacional longitudinal y prospectivo. Se analizaron todos los casos incidentes de primer ictus atendidos en un hospital comarcal durante un año (n=101). Las variables estudiadas se recogieron durante las 48 horas de ingreso de los pacientes en la unidad de Urgencias. Los factores estudiados fueron analizados mediante la comparación de las curvas de supervivencia (log-rank test) y análisis multivariante mediante regresión de Cox. Resultados: Se incluyeron 101 pacientes, permanecieron ingresados una mediana de 7 días (Media 10 días; rango 1-73), el 15,9% fueron hemorrágicos y el 84% isquémicos (29,5% infartos lacunares y el 54,5% infartos isquémicos cerebrales). Las variables que demostraron estar relacionados con los días de hospitalización fueron: edad, hipertensión, insuficiencia cardiaca, paresia o anestesia/hipoestesia facial y de las extremidades, alteración de la mirada conjugada y afectación visio-espacial. Las variables independientemente relacionadas con los días de hospitalización en el análisis multivariante fueron: infarto isquémico cerebral (HR=3,5; IC95%, 1,7-7,5), Ictus hemorrágico (HR=4,9; IC95%, 1,8-12,9), paresia de la extremidad superior (HR=4,5; IC95%, 2,3-8,8) y edad (HR=0,98; IC95%, 0,96-0,99) Conclusiones: La mayor permanencia en un hospital de agudos se relaciona principalmente con una menor edad, parálisis de la extremidad superior e ictus hemorrágico.Introduction: The high morbibity of stroke has a great economic impact in patients and healthcare. Since the main cost to healthcare is length of stay, the aim of this study was to analyse characteristics of patients, stroke and healthcare related to length of stay. Results: 101 patients were included, median length of stay was 7 days (Mean, 10 days, range 1-73), 15,9% were haemorragic strokes and 84% were ischemic strokes, (of those 25,7% were lacunar infarcts). 13% were patients with no tomographic sings of stroke. Variables associated to length of stay were: age, hypertension, heart failure, extremities and facial paresis or anesthesia/hipoesthesia, conjugate eye deviation and visual field loss. Variables independently associated to length of stay in the multivariate Cox regression model were: nonlacunar- ischemic stroke (HR=3,5; CI95%, 1,7-7,5), haemorragic stroke (HR=4,9; CI95%, 1,8-12,9) arm paresis (HR=4,5; CI95%, 2,3-8,8) and age (HR=0,98; CI95%, 0,96-0,99). Conclusions: Age, arm paresis and stroke subtype are strongly related to length of stay

Conservación de minitubérculos de papa con el uso de zeolita en polvo

The application of natural products in seed conservation plays an important role in countries with tropical climates. With the objective of to determine the effect of the powdered zeolite in the conservation of potato minitubers, it was carried out this work. Variables related with the quality of conservation of the minitubers were determined in the cold storage camera and in an area with natural ventilation. The results showed that the minitubers obtained in the culture house with application of zeolite after crop presented smaller losses, in the conservation in frigorific, than the rest of the treatments. Equally, the minitubers obtained in field and to which were applied zeolite after crop had significantly smaller losses than the non treaties. It was demonstrated that the conservation in an area with natural ventilation is an alternative. The application of powdered zeolite to the minitubers allowed the storage and conservation with the appropriate quality for a satisfactory response in field.Key words: biotechnology seed of potato, inorganic substrate, Solanum tuberosum L.La aplicación de productos naturales en la conservación de semilla desempeña un papel importante en países con climas tropicales. Con el objetivo de determinar el efecto de la zeolita en polvo en la conservación de minitubérculos de papa, se realizó este trabajo. Se determinaron variables relacionadas con la calidad de conservación de los minitubérculos en el frigorífico y en un área con ventilación natural. Los resultados mostraron que los minitubérculos obtenidos en la casa de cultivo con aplicación de zeolita postcosecha presentaron menores pérdidas en la conservación en frigorífico que el resto de los tratamientos. Igualmente, los minitubérculos obtenidos en campo y a los cuales se les aplicó zeolita postcosecha tuvieron significativamente menores pérdidas que los no tratados. Se demostró que la conservación en un área con ventilación natural es una alternativa. La aplicación de zeolita en polvo a los minitubérculos permitió el almacenamiento y conservación con la calidad adecuada para una respuesta satisfactoria en campo.Palabras clave: semilla biotecnológica de papa, Solanum tuberosum L., sustrato inorgánic

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Background: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity =50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration: ClinicalTrials.gov, NCT03136211. Registered 2 May 2017, “retrospectively registered”. © 2021, The Author(s)

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial

CDATA[CDATA[Background: Health promotion is a key process of current health systems Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two 01 more risk behaviours, that is why a multiple intervention might be more effective and efficient The primary objectives are to evaluate the effectiveness, the cost effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. CDATA[CDATA[Methods: This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care It will be carried out in 26 PHC centres in Spam The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the ''5A''s" It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community) Incremental cost per quality adjusted life year gamed measured by the tanffs of the EuioQo! 5D questionnaire will be estimated. The implementation strategy is based on the ''Consolidated Framework for Implementation Research, a set of discrete implementation strategies and an evaluation framework. CDATA[CDATA[Discussion: EIRA study will determine the effectiveness and cost effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness

Characterization of thermal oxide films formed on a duplex stainless steel by means of confocal-Raman microscopy and electrochemical techniques

In this work oxide films have been developed on the surface of a duplex stainless steel (UNS 1.4462) using high temperature confocal microscopy to follow their growth. The characteristics of these oxide films have been analyzed by means of weight-gain measurements, Raman microscopy and electrochemical techniques, namely potentiodynamic polarization curves and electrochemical impedance spectroscopy. The results show an increase in the amount of oxides (particularly γ-Fe2O3 and Fe3O4) with temperature. Regarding the electrochemical properties of these films, the corrosion resistance of the film tends to be lower with the heat treatment temperature, probably due to a more porous and heterogeneous scale. Mott–Schottky plots show the n-type semiconductive behavior of the films with donor densities that decrease with the enhancement of the temperature.We wish to express our gratitude to MICINN (CTQ2009-07518) (UPVO8-3E-012), to Universitat Politecnica de Valencia (CEI-01-11), to the Generalitat Valenciana for its help in the CLSM acquisition (MY08/ISIRM/S/100), and to Dr. Asuncion Jaime for her translation assistance.Sánchez Tovar, R.; Leiva García, R.; García Antón, J. (2015). Characterization of thermal oxide films formed on a duplex stainless steel by means of confocal-Raman microscopy and electrochemical techniques. Thin Solid Films. 576:1-10. https://doi.org/10.1016/j.tsf.2014.12.024S11057

Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization

peer reviewedBACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugre

Effect of temperature on the passive state of Alloy 31 in a LiBr solution: Passivation and Mott-Schottky analysis

The passive behaviour of Alloy 31, a highly‐alloyed austenitic stainless steel (UNS N08031), has been investigated in a LiBr heavy brine (700 g/l) at different temperatures using potentiostatic polarisation and Mott‐Schottky analysis. Cation vacancies have been found to be the dominant defect in the passive films formed on Alloy 31. An increase in temperature enhanced the generation of cation vacancies at the film/solution interface and raised the steady‐state passive current density. The density of defects within the passive film also increased significantly with temperature, making the film more conductive and less protective against localised attacks