La organización innovadora: el caso de los hospitales regionales de alta especialidad

En el ámbito mundial, la organización hospitalaria está experimentando transformaciones importantes, tanto en sus fronteras como en sus formas estructurales, de operación y gestión, debido, entre otros factores, a la innovación en servicios de salud que los avances en investigación científica y desarrollo tecnológico plantean y cuya aplicación en el hospital está dando como resultado aumento en la longevidad y calidad de vida de la población, incremento en la productividad del trabajador del hospital, pero también presiona los costos de operación y la inversión de las unidades médicas. En México, la Secretaría de Salud (SSA) del gobierno federal intenta crear 18 hospitales regionales de alta especialidad (HRAE) con el propósito de brindar servicios hospitalarios de calidad mediante unidades de “accesibilidad universal”, que presentan interesantes diferencias en materia de organización, gestión y financiamiento respecto a sus equivalentes en los organismos de salud. A partir de un proyecto de investigación desde una perspectiva metodológica cualitativa, que busca responder dos preguntas centrales: ¿Qué tan innovadores son los hospitales regionales de alta especialidad?, y ¿Cuáles han sido los principales obstáculos a los que se ha enfrentado en su instrumentación y operación?, en este artículo se reportan los primeros hallazgos, derivados de los avances alcanzados hasta el momento.At a global level, the hospital organizations are suffering important changes in structure, operation and management due to innovative services, scientific breakthroughs and technological development and their applications have brought longer-lasting and quality of people’s life and remarked increases in hospital workers productivity, but in the other hand, this is causing higher operation cost and affecting investment in medical units. In Mexico, the Health Department (SSA Spanish initials) and the Federal Government are trying to build 18 High-Specialty regional hospitals (HRAE Spanish initials) to give quality hospital services trough “Universal Access” units which must have interesting duties in organization, management and financing compared with other equivalent health organizations. From a research project with a qualitative methodological approach, which must answer 2 main questions: How innovative are the HRAE? And when the HRAE implement and operate changes, which have the main obstacles been? This document shows first findings from the advancing reports of the project

Do Fire Regime Attributes Affect Soil Biochemical Properties in the Same Way under Different Environmental Conditions?

Global change is altering fire frequency and severity in many regions across the world. In this work, we studied the impact of different frequency and severity regimes on the soil biochemical properties in burned areas with different environmental conditions. We selected three sites dominated by pine ecosystems along a Mediterranean-Transition-Oceanic climatic gradient, where we determined the fire frequency, and severity of the last wildfire. Four years after the last wildfire, we established 184 4 m2 plots. In each plot, we collected a composed soil sample from a 3 cm depth, and measured several ecological variables potentially affected by the fire frequency and severity (cover of bare soil, cover of fine and coarse plant debris, cover of vegetation, and vegetation height). From each soil sample, we analyzed the enzymatic activities corresponding to the biogeochemical cycles of carbon, nitrogen, and phosphorus (β-glucosidase, urease, and acid-phosphatase, respectively), and the microbial biomass carbon. The results indicated that fire frequency only played a significant role in soil biochemical properties at the Mediterranean and Transition sites. Specifically, we found that increases in frequency contributed to increased urease and phosphatase activities (at the Transition site), as well as microbial biomass carbon (at the Mediterranean and Transition sites). In relation to burn severity, we found opposite patterns when comparing the Mediterranean and Oceanic sites. Specifically, increased severity significantly decreased β-glucosidase, urease, and microbial biomass carbon at the Mediterranean site, whereas at the Oceanic one, severity significantly increased them. Burn severity also decreased microbial biomass carbon at the Transition site. Our results also indicated that, overall, fire frequency determined the studied ecological variables at the Mediterranean and Transition sites, but clear indirect effects on biochemical properties due to changes in ecological variables were not found. This study adds to the knowledge on the impact of shifts in fire regimes on soils in the current context of changeThis study was financially supported by the Spanish Ministry of Economy and Competitiveness; the Spanish Ministry of Science, Innovation and Universities; and the European Regional Development Fund (ERDF), in the framework of the GESFIRE (AGL2013-48189-C2-1-R) and FIRESEVES (AGL2017-86075-C2-1-R) projects, and by the Regional Government of Castile and León in the framework of the FIRECYL (LE033U14) and SEFIRECYL (LE001P17) projectsS

Disruption of trophic interactions involving the heather beetle by atmospheric nitrogen deposition

P. 436-445Elevated nitrogen (N) deposition impacts the structure and functioning of heathland ecosystems across Europe. Calluna plants under high N-inputs are very sensitive to secondary stress factors, including defoliation attacks by the heather beetle. These attacks result in serious damage or death of Calluna, its rapid replacement by grasses, and the subsequent loss of heathland. We know very little about the mechanisms that control the populations and trigger outbreaks of the heather beetle, impeding proper management measures to mitigate the damage. We investigated the effects of N deposition on the relationships between the heather beetle, its host plant, and two arthropod predators at building (rejuvenated through fire) and mature heathlands. The study combines field manipulation experiments simulating a range of N deposition rates (0, 1, 2, 5 g N m−2 year−1 for 2 years, and 5.6 g N m−2 year−1 for 10 years), and food-choice laboratory experiments testing the preferences of adults and larvae of the heather beetle for N-treated Calluna plants, and the preferences of predators for larvae grown on plants with different N-content. The larvae of the heather beetle achieved the highest abundances after the long-term (10-year) addition of N at mature Calluna plots in the field. Contrary to the adults, the larvae foraged preferentially on the most N-rich Calluna shoots under laboratory conditions. Predators showed no aggregative numerical responses to the accumulation of heather beetle larvae at high N-input experimental plots. During the feeding trials, predators consumed a small number of larvae, both in total and per individual, and systematically avoided eating the larvae reared on high-N Calluna shoots. Our study showed that the most severe defoliation damage by the heather beetle is inflicted at the larval stage under prolonged availability of high-N inputs, and that arthropod predators might not act as effective regulators of the beetle's populations.S

The role of prescribed fire in the provision of regulating ecosystem services of Spanish heathlands

We provide a synthesis of evidence of the effects of burning and N deposition on the provision of regulating ecosystem services of Cantabrian heathlands (NW Spain). We quantified carbon sequestration in litter, above and belowground biomass, root and soil compartments in heathlands after burning and burning plus N fertilization

Resultados perinatales en pacientes con edad materna avanzada que verificaron parto en el Hospital Nacional Especializado de Maternidad en el periodo Enero - Diciembre 2014

En la actualidad, el desarrollo tecnológico y el aumento de la esperanza de vida que conlleva a los seres humanos a aspirar a mejores condiciones y al deseo de superación de los seres humanos, ha llevado a la opción de las mujeres a postergar el momento de la maternidad. Debido a esto, las tasas de mujeres que se embarazan con una edad mayor de 35 años ha aumentado en nuestro medio; por lo que con este trabajo se pretende identificar las patologías más frecuentes que acompañan a este tipo de embarazo, así como las complicaciones maternas y neonatales y la vía de evacuación del producto en la población en estudio. Se realizó este trabajo en base a un estudio observacional, transversal, retrospectivo, en mujeres gestantes con edad materna avanzada, que cuenten con una historia clínica completa que consultaron el Hospital Nacional Especializado de Maternidad en el período de enero a diciembre 2014

Eficacia en la aplicación de las medidas de formación para los deportistas de alto nivel en el territorio español

Academic training and planning are fundamental in ensuring the integration of elite athletes into the labour market. The main goal of this study was to analyse the extent to which academic measures are applied by the system's different stakeholders. When the information process was analysed, certain shortcomings were noted. Most calls by athletes were for the dates of exams to be changed due to their coincidence with an official competition, as confirmed by requests to all bodies. The period from 20 to 30 years of age is critical in academic terms and a fully comprehensive service should be ensured for these top athletes in order to provide ongoing guidance.La formación académica y la planificación son fundamentales para una exitosa inserción laboral de los atletas de élite. El objetivo de este estudio fue detectar el nivel de aplicación de las medidas de formación por los diferentes agentes que participan en el sistema. Al analizar el proceso de información se apreciaron ciertas carencias en el mismo. El cambio de fechas de exámenes con motivo de competiciones/concentraciones oficiales fue el aspecto más demandado por los diferentes deportistas. Dado que el periodo de los 20 a los 30 años es crítico para la formación, sería necesario aportar un servicio de cobertura total para la población de deportistas de Alto Nivel, con el fin de dar un asesoramiento permanente y trazar una línea continua desde la vida deportiva a la vida laboral en los deportistas.A formação académica e a planificação são fundamentais para uma bem sucedida inserção laboral dos atletas de elite. O objectivo deste estudo foi detectar o nível de aplicação de medidas de formação pelos diferentes agentes desportivos que participam no sistema. Ao analisar o processo de informação foram identificadas algumas carências no mesmo. A mudança das datas dos exames por motivos de competições/concentrações oficiais foi o aspecto mais pedido pelos diferentes desportistas. Dado que o período dos 20 aos 30 anos é crítico para a formação, seria necessário adicionar um serviço de cobertura total para a população de desportistas de Alto Rendimento, com o objectivo de assessorar permanentemente e traçar uma linha contínua desde a vida desportiva à vida laboral dos desportistas