El impacto de la satisfacción en la confianza del consumidor en establecimientos de autoservicios

En la última década se ha incrementado el interés de las organizaciones en crear relaciones duraderas con los clientes. Partiendo de dicha premisa fundamental, esta investigación tiene como objetivo analizar el impacto de la satisfacción en la confianza del consumidor en establecimientos de autoservicios. El ámbito geográfico considerado es la ciudad de Toledo, que constituye una de las localidades más importantes de Castilla-La Mancha, y con una tendencia creciente en el consumo en establecimientos de autoservicios. Para lo cual se utiliza una investigación de tipo cuantitativa, no experimental, causal y transversal simple. Por lo que después de la revisión de la literatura realizada así como el análisis empírico que se ha llevado a cabo, se concluye que existe una correlación positiva y significativa entre la satisfacción y la confianza del consumidor

El impacto de la satisfacción en la confianza del consumidor en establecimientos de autoservicios

En la última década se ha incrementado el interés de las organizaciones en crear relaciones duraderas con los clientes. Partiendo de dicha premisa fundamental, esta investigación tiene como objetivo analizar el impacto de la satisfacción en la confianza del consumidor en establecimientos de autoservicios. El ámbito geográfico considerado es la ciudad de Toledo, que constituye una de las localidades más importantes de Castilla-La Mancha, y con una tendencia creciente en el consumo en establecimientos de autoservicios. Para lo cual se utiliza una investigación de tipo cuantitativa, no experimental, causal y transversal simple. Por lo que después de la revisión de la literatura realizada así como el análisis empírico que se ha llevado a cabo, se concluye que existe una correlación positiva y significativa entre la satisfacción y la confianza del consumidor

Predictors of choice of initial antifungal treatment in intraabdominal candidiasis

IAC Study Investigators: F. Ansaldi, C. Scarparo, A. Diaz-Martin, I. Palacios-Garcia, C. Rosin, B. Almirante, G. Baldin, A. Vena, E. Bouza, V. de Egea, C. Tascini, F. Menichetti, E. Tagliaferri, M. Sanguinetti, A. Mesini, G. Sganga, M. Busetti, T. Pumarola, M. T. Martin, S. A. Nouér, T. Pelaez, E. Raise, S. Grandesso, V. Del Bono, P. Esteves, C. Trucchi, A. Sartor, G. De Pascale, B. Posteraro, C. Scarparo, P. Esteves.Intraabdominal candidiasis (IAC) is the second most frequent form of invasive candidiasis, and is associated with high mortality rates. This study aims to identify current practices in initial antifungal treatment (IAT) in a real-world scenario and to define the predictors of the choice of echinocandins or azoles in IAC episodes. Secondary analysis was performed of a multinational retrospective cohort at 13 teaching hospitals in four countries (Italy, Greece, Spain and Brazil), over a 3-year period (2011–2013). IAC was identified in 481 patients, 323 of whom received antifungal therapy (classified as the treatment group). After excluding 13 patients given amphotericin B, the treatment group was further divided into the echinocandin group (209 patients; 64.7%) and the azole group (101 patients; 32.3%). Median APACHE II scores were significantly higher in the echinocandin group (p 0.013), but IAT did not differ significantly with regard to the Candida species involved. Logistic multivariate stepwise regression analysis, adjusted for centre effect, identified septic shock (adjusted OR (aOR) 1.54), APACHE II >15 (aOR 1.16) and presence in surgical ward at diagnosis (aOR 1.16) as the top three independent variables associated with an empirical echinocandin regimen. No differences in 30-day mortality were observed between groups. Echinocandin regimen was the first choice for IAT in patients with IAC. No statistical differences in mortality were observed between regimens, but echinocandins were administered to patients with more severe disease. Some disagreements were identified between current clinical guidelines and prescription of antifungals for IAC at the bedside, so further educational measures are required to optimize therapies.MB serves on scientific advisory boards for Pfizer Inc, Merck Serono and Astellas Pharma Inc.; has received funding for travel or speaker honoraria from Pfizer Inc., Merck Serono, Gilead Sciences, Teva Inc. and Astellas Pharma Inc. ALC serves on scientific advisory boards for MSD and has received funding for continuing education programmes from Pfizer Inc., Gilead Sciences, United Medical, MSD and Astellas Pharma Inc. CT has been paid for lectures on behalf of Pfizer, Novartis, MSD, AstraZeneca, Zambon and Astellas

Cultura y personalidad. Experiencias en Investigación biopsicosociocultural

Esta obra es el resultado de diversas investigaciones que versan alrededor de la personalidad y el efecto de la cultura. Los tópicos abordan los componentes del yo o territorio personal, la presencia de emociones negativas básicas surgidas desde diferentes estímulos y contextos y su asociación con ansiedad y depresión, la medición de la depresión, los tipos, formas y reacciones del miedo, la apatía y sus implicaciones, la somatización como una consecuencia de vivir en el círculo del miedo, la personalidad entrópica y felicidad, el significado del talento, la resiliencia y los recursos psicológicos, así como los factores de riesgo y protección para la resiliencia. Lo anterior permite dar una explicación desde lo biológico, lo psicológico, lo social y el contexto de referencia, los cuales se retoman desde múltiples abordajes metodológicos, a partir de la Teoría de la paz o equilibrio y el modelo ecológico de Bronfenbrenner que confluyen de lo individual hasta el macrosistema, lo cual brinda un enfoque contemporáneo e integrador acerca del proceso salud-enfermedad, con el objetivo de contar con evidencia empírica para el desarrollo de futuras intervenciones en pro de la salud mental de los individuos

Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis

Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional “20 de Noviembre”—ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01–1.53] vs. +0.90 [OR = 1.90, CI95% 1.56–2.32] vs. 0.73 [OR = 1.73, CI95% 1.36–2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11–1.87] vs. +0.35 [OR = 1.35, CI95% 1.00–1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22–1.94] vs. +0.41 [OR = 1.41, CI95% 1.13–1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research