Quality of Life related to health in the morbidity of periodic hemodialysis patient

Foundation: chronic renal failure has a negative impact in the quality of life and constitutes a morbidity predictor in patients with periodic hemodialysis.Objective: to evaluate the influence of quality of life related to health in the morbidity of patients in intermittent periodic hemodialysis.Methods: a descriptive study was done in patients with three or more time of intermittent periodic hemodialysis at the Nephrology service of the Military Hospital Dr. Carlos J. Finlay. Havana, in a 12 month follow up period. The variables analyzed were: age, sex, time with the substituting renal function treatment, morbidity rate, type of morbidity in hemodialysis and hospital admission rate. A questionnaire for quality of life in patients with renal disease (version 1.3) was applied.Results: patients under 60 years old predominated, of high schooling level, with blood hypertension mainly due to renal failure.  The most frequent morbidities were: chills, arterial Hypotension, and complications related to vascular access. The admission rate was low. The summary physical component had the lower punctuation followed by the summary mental component. Among these and age there was found an inversely proportional correlation, so as the morbidity rate and the summary physical component.Conclusion: the results obtained are related to preceding studies. The physical component summary results with higher involvement, mainly in the older adult, considering the negative relation with the morbidity rate and hospital admission.</p

Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

<p>Abstract</p> <p>Background</p> <p>Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age.</p> <p>Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years.</p> <p>Methods/Design</p> <p>To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site.</p> <p>Discussion</p> <p>Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX™ tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX™.</p

EDUCORE project: a clinical trial, randomised by clusters, to assess the effect of a visual learning method on blood pressure control in the primary healthcare setting

<p>Abstract</p> <p>Background</p> <p>High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD). European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation) project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD;</p> <p>Methods/Design</p> <p>This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded;</p> <p>Discussion</p> <p>The EDUCORE method could provide a simple, inexpensive means of improving blood pressure control, and perhaps other health problems, in the primary healthcare setting;</p> <p>Trial registration</p> <p>The trial was registered with ClinicalTrials.gov, number NCT01155973 [<url>http://ClinicalTrials.gov</url>].</p

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Bienvenida sonrisa : Parte II

La Facultad de Odontología de la Universidad Nacional de La Plata, desde el año 1997, desarrolla un Programa de Salud Bucal en la ciudad de La Plata y sus alrededores, a través de la Asignatura Odontología Preventiva y Social. Esto ha permitido obtener datos estadísticos y de relevamiento de zonas, que impulsa la formulación de nuevas iniciativas en poblaciones vulnerables donde el índice de incidencia de enfermedades bucodentales, es elevado. Entendemos a la salud bucal como un valor que no debe ser considerado como un privilegio, sino como un derecho de todas las personas, reforzando el trabajo multidisciplinario de manera de que la salud recuperada, se mantenga a lo largo del tiempo, con el objetivo de disminuir las desigualdades en salud y con el propósito de brindar atención a poblaciones de difícil acceso, por este motivo, creemos que es fundamental la gestión del Trabajo Social , trabajando de forma efectiva con la comunidad, colaborando en la promoción de la salud y prevención de la enfermedad. Teniendo conocimiento de que la escuela es un espacio privilegiado y del encuentro con el otro, enfocamos nuestros esfuerzos en colaborar para modificar la realidad que se presenta.Este Proyecto surge debido a la necesidad de la Comunidad Educativa perteneciente a la Escuela Nº 45 “Manuel Rocha” del barrio El Mondongo de la Ciudad de La Plata, quienes manifiestan la carencia de información y atención de la comunidad educativa en cuanto a acciones preventivas. Este proyecto se lleva a cabo desde fines del 2019, atravesando el contexto de Pandemia por el virus causante de la enfermedad Covid-19, reacondicionando nuestras actividades.Facultad de Odontologí

Cualificación en los Objetivos establecidos en la Agenda 2030 de estudiantes y profesores en el Máster Universitario en Profesor de Educación Secundaria Obligatoria y Bachillerato, Formación Profesional y Enseñanza de Idiomas (MUPES)

Memoria ID2022-157 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2022-2023

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Métodos y técnicas de monitoreo y predicción temprana en los escenarios de riesgos socionaturales

Esta obra concentra los métodos y las técnicas fundamentales para el seguimiento y monitoreo de las dinámicas de los escenarios de riesgos socionaturales (geológicos e hidrometeorológicos) y tiene como objetivo general orientar, apoyar y acompañar a los directivos y operativos de protección civil en aterrizar las acciones y políticas públicas enfocadas a la gestión del riesgo local de desastre

Evaluation of the Interaction between Managerial Eco-efficiency and the Actors of the Sustainable Local Development

The general objective is to demonstrate the impact of the application of a methodology for the evaluation of the interaction between the managerial eco-efficiency and the actors of the local sustainable development. Were used the historical-logical methods, the analysis-synthesis and the general to the particular one methods, besides specifically techniques of the analysis of actors and of the work with experts. The application, in the shipyard DAMEX Santiago de Cuba allowed to obtain the following results: the acting of the company is eco-efficiency, indicating that its productive process doesn't affect significantly the environmental and social environment where it is located, although the economic efficiency possesses a falling tendency, what can commit the social efficiency and the environmental efficiency in a medium term; in an environment where the local actor that bigger influence has in the eco-efficient behavior is the Territorial Delegation of the CITMA

LA ECOEFICIENCIA EMPRESARIAL: SU CONTRIBUCIÓN AL DESARROLLO LOCAL SOSTENIBLE EN LOS MARCOS DE LA GLOBALIZACIÓN NEOLIBERAL

El trabajo tiene como objetivo analizar la contribución de la ecoeficiencia empresarial al desarrollo local sostenible en los marcos de la globalización neoliberal. Presenta los principales aportes de la investigación “Consideraciones generales sobre la ecoeficiencia empresarial y el desarrollo local sostenible” 2010, inmerso en un Proyecto de la Delegación provincial de Ciencia-Tecnología y Medio Ambiente de Santiago de Cuba. Se utilizaron como métodos, el histórico – lógico, el análisis – síntesis para estudiar la evolución del concepto de ecoeficiencia empresarial y sus características en las condiciones actuales.ecoeficiencia empresarial, globalización neoliberal, desarrollo local sostenible, recursos naturales, empresa, residuos, países en vía de desarrollo