Efecto del sistema cannabinoide endógeno sobre la función de barrera intestinal

Aparte de su función digestiva, el tracto gastrointestinal (TGI) representa (junto con la piel y el aparato respiratorio) un punto crucial de interacción directa entre nuestro organismo y el medio ambiente, ejerciendo una función de barrera selectiva y efectiva al mismo tiempo entre el sistema inmune de la mucosa gastrointestinal y la virtualmente infinidad de agentes microbianos y antígenos alimentarios en la superficie mucosa. Las células epiteliales intestinales constituyen el elemento fundamental de esta barrera y ejercen un papel preponderante tanto en la generación de tolerancia hacia los antígenos alimentarios y la flora comensal como en la activación y orquestación de unas respuestas inmunes innatas y adquiridas efectivas. Sin embargo, la barrera intestinal es una estructura dinámica constituida no sólo por componentes celulares sino por una gran variedad de elementos no celulares como son la mucina, los péptidos antimicrobianos, la inmunoglobulina A (IgA) secretora y las uniones apicales entre las células epiteliales adyacentes. Las uniones estrechas (tight junctions, TJ) son estructuras moleculares dinámicas que constituyen el punto de control limitante de la barrera epitelial intestinal paracelular. Existen también cada vez más datos de estudios experimentales que demuestran el papel del estrés psicosocial en la inducción de cambios inflamatorios, tanto bioquímicos como histológicos, en la mucosa intestinal, lo cual es un elemento común en varias patologías. Múltiples estudios sugieren que la respuesta inflamatoria desencadenada por el estrés psicológico puede estar mediada, al menos en parte, por la inducción de disfunción en la barrera intestinal produciendo a su vez translocación bacteriana y un aumento de la captación de antígenos luminales..

Corporate sustainability, organizational resilience and corporate purpose: a triple concept for achieving long-term prosperity

Purpose: In this paper, we aim to narrow the gap caused by the lack of literature relating the three concepts of corporate sustainability, organizational resilience, and corporate purpose in the context of corporations. We want to present a framework that explains how these three concepts are related and effectively merged for long-term corporate survival. Design/methodology/approach: We present a systematic review. We first proposed initial search strategies to identify those documents that define each concept and to identify concepts with which each concept is associated. Subsequently, we designed a search strategy combining all three concepts and their associated concepts to gather and analyze all the possible studies that have tried to connect these concepts. We finally identify some gaps in the understanding of how these three concepts are related. Findings: We contend that corporate sustainability, organizational resilience, and corporate purpose merge to achieve long-term corporate survival. We explain that there exists a two-way relationship between these three variables. We also present gaps and future directions that should be addressed to foster an increase in knowledge about the relationships between corporate sustainability, organizational resilience, and corporate purpose. Originality: Nowadays, some authors do endeavor to explain how aspects such as corporate sustainability, organizational resilience, and corporate purpose are crucial in the dynamic environment facing corporations every day. Nevertheless, there needs to be more understanding of how these three concepts are related and effectively merged for long-term corporate survival. This paper contributes to the literature by closing this gap

Healthcare Experience and their Relationship with Demographic, Disease and Healthcare-Related Variables: A Cross-Sectional Survey of Patients with Chronic Diseases Using the IEXPAC Scale

Health Administration; Public Health; Quality of Life ResearchAdministración sanitaria; Salud pública; Investigación de calidad de vidaAdministració sanitària; Salut pública; Investigació sobre la qualitat de vidaBackground Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. Objectives Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. Methods A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). Results Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. Conclusions Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality.This project was funded by Merck Sharp and Dohme, Spain

Influència de la durada del set sobre les variables temporals de joc en el pàdel

L’objectiu d’aquest estudi va ser analitzar les variables temporals de temps de joc (TJ), temps de descans (TD) en pàdel de primera categoria regional i la seva relació entre elles, així com amb la variable contextual durada del set. Per a això es van analitzar 701 punts corresponents a semifinals i finals de diferents proves del circuit extremeny federat de primera categoria masculina disputats el 2014. L’anàlisi de les variables temporals corrobora que el pàdel és un esport on el TD predomina enfront del TJ, obtenint un temps real de joc del 45,92 % sobre el temps total; un TJ mitjà per punt de 12,70 segons i TD mitjà per punt de 14,95 segons. Es van trobar relacions significatives (p &lt; 0,05) entre les variables temps de descans i número de joc del set. Finalment, es pot concloure que el TD està més influenciat per la durada del set que el TJ, i augmenta a mesura que avança el set

COVID-19 and inflammatory bowel disease: questions arising from patient care and follow-up during the initial phase of the pandemic (February-April 2020)

COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was described in China in late 2019. There are currently more than three million diagnosed cases, constituting a pandemic which has caused a worldwide crisis. The devastating effects of this infection are due to its highly contagious nature and although mild forms predominate, in absolute values, the rates for severe forms and mortality are very high. The information on the characteristics of the infection in inflammatory bowel disease is of special interest, as these patients have higher attendance at health centres, which may increase their risk of infection. Furthermore, the treatments used to control the inflammatory activity may modify the disease course of COVID-19. The Spanish Working Group on Crohn's Disease and Ulcerative Colitis and the Spanish Nurses Working Group on Inflammatory Bowel Disease have prepared this document as a practical response to some common questions about the treatment of these patients

Abordaje de una vía aérea difícil conocida en paciente pediátrico con síndrome de Pfeiffer. Utilidad de la oxigenoterapia de alto flujo

Clinical case describing the use of high-flow oxygen therapy for induction and intubation of a known difficult pediatric airway.&nbsp; Pfeiffer's syndrome patient, requiring oral intubation and previous failure described in the use of supraglottic devices for airway management.Caso clínico en el que se describe el uso de la oxigenotarapia de alto flujo para la inducción e intubación de vía aérea difícil pediátrica conocida.; en paciente con síndrome de Pfeiffer, con necesidad de intubación por vía oral y fracaso previo descrito en el uso de dispositivos supraglóticos para el manejo de la vía aéra.&nbsp

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case-Control Study (COVID-19-EII)

COVID-19; Immunosuppression; Inflammatory bowel diseaseCOVID-19; Immunosupressió; Malaltia inflamatòria intestinalCOVID-19; Inmunosupresión; Enfermedad inflamatoria intestinal(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

The experience of inflammatory bowel disease patients with healthcare: A survey with the IEXPAC instrument

Inflammatory bowel disease; Patients experience; Chronic diseaseMalaltia intestinal inflamatòria; Experiència dels pacients; Malalties cròniquesEnfermedad intestinal inflamatoria; Experiencia de los pacientes; Enfermedades crónicasTo assess inflammatory bowel disease (IBD) patients' experience of chronic illness care and the relationship with demographic and healthcare-related characteristics.This cross-sectional survey used the Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC) questionnaire to identify parameters associated with a better healthcare experience for IBD patients. IEXPAC questionnaire responses are grouped into 3 factors - productive interactions, new relational model, and patient self-management, scoring from 0 (worst) to 10 (best experience). Scores were analyzed by bivariate comparisons and multiple linear regression models.Surveys were returned by 341 of 575 patients (59.3%, mean age 46.8 (12.9) years, 48.2% women). Mean (SD) IEXPAC score was 5.9 (2.0); scores were higher for the productive interactions (7.7) and patient self-management factors (6.7) and much lower for the new relational model factor (2.2). Follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines were associated with higher (better) overall patient experience score, and higher productive interactions and self-management factor scores. A higher productive interactions score was also associated with patients receiving medication subcutaneously or intravenously. Higher new relational model scores were associated with follow-up by a nurse, affiliation to a patients' association, receiving help from others for healthcare, a lower number of medicines and a higher educational level.In patients with IBD, a better overall patient experience was associated with follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines

Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry

COVID-19; SARS-CoV-2; inflammatory bowel diseaseCOVID-19; SARS-CoV-2; Malaltia inflamatòria intestinalCOVID-19; SARS-CoV-2; Enfermedad inflamatoria intestinalWe aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD

Different associations of intentional and non-intentional non-adherence behaviors with patient experience with healthcare and patient beliefs in medications: a survey of patients with chronic conditions

[Abstract] Purpose: To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications. Patients and methods: This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire). Results: Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection. Conclusion: The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence