Cambios en el apego al tratamiento farmacológico en pacientes con hipertensión arterial y/o diabetes mellitus tipo 2 mediante el uso de la agenda en los dispositivos móviles

Introducción: La no adherencia terapéutica imposibilita estimar el efecto de los tratamientos, aumenta las complicaciones y los costos en salud. La salud móvil crea un cambio en el paradigma del manejo de las enfermedades crónicas siendo útil para ayudar al paciente a aumentar su nivel de apego terapéutico. Metodología: Estudio observacional descriptivo, en el cual se utilizó el cuestionario Morisky Green-Levine para determinar los cambios en el nivel de adherencia al tratamiento farmacológico en pacientes con hipertensión arterial y/o diabetes mellitus tipo 2 mediante el uso de la agenda en los dispositivos móviles en el primer nivel de atención durante un mes, independientemente de la efectividad del tratamiento. Resultados: Se captaron 50 pacientes no adherentes de los cuales posterior a las cuatro semanas de intervención, finalizaron 46 pacientes adherentes y cuatro no adherentes. El nivel de adherencia incremento a través de las semanas en ambas patologías, en todos los niveles educativos, ya sea que consumían uno, dos o tres fármacos. Conclusiones: El uso de alarmas en las agendas de los dispositivos móviles permitió disminuir el factor olvido en los pacientes y el descuido con el horario de toma de la medicación, mejorando su nivel de apego terapéutico.Tesis presentada para optar al título de Doctorado en Medicin

Rescatando el Salto de San Antón. Una historia reciente de construcción institucional

This paper develops a chronicle of the arise and evolution of a communitarian and intersectional coordination web that for over five years has been looking forward to halt and revert the environmental degradation in San Antón, a urban community located at the shore of the Apatlaco river, one of the main watercourses in Cuernavaca, Morelos, which bears high pollution levels.The paper presents the communitarian development of an autonomous process of management and regulation, related to the local ecosystem in an urban frame. It focuses on socioeconomic institutional change and its possible role in the resolution of coordination failures and the internalization of environmental externalities.San Antón waterfall, local institutional development, water treatment, solid waste, social confidence.

Reporte de Mercados Financieros - cuarto trimestre de 2021

El año 2021 se caracterizó por una recuperación económica global más rápida de lo previsto a inicios del año. Esta recuperación trajo consigo aumentos en los precios de los commodities y en algunos casos, disrupciones de las cadenas globales de suministro dado la creciente demanda, lo que llevó a un aumento de las presiones inflacionarias a nivel global. Como respuesta a estas presiones, la mayoría de los bancos centrales a nivel global comenzó a retirar el estímulo monetario adoptado durante 2020 para afrontar la pandemia

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Creación y aplicación de un modelo de evaluación de la calidad del servicio orientado a 5 instituciones privadas según correspondan a la actividad económica "Asistencia social" en la ciudad de guayaquil

RESUMEN: El presente trabajo de investigación de campo tiene como objetivo principal diseñar un modelo de evaluación de la calidad del servicio a ser aplicado a la “Asistencia Social” en la ciudad de Guayaquil construido por medio de un análisis de Correspondencia y de Clúster para obtener índices de calidad. La evaluación de la calidad es una estrategia aplicable que permite incentivar e impulsar al grupo humano a ser mejores elementos dentro de la institución y así, contribuir con la sociedad y mantener una imagen empresarial que resalte ante los ojos de los clientes. Para ello, se llevaron a cabo 400 encuestas, las cuales, los clientes respondían en un tiempo de 25 a 35 minutos. La encuesta aplicada contiene un total de 119 preguntas basadas en los diez aspectos de los componentes de la calidad del servicio que mide lo que el cliente espera de la organización, las expectativas , percepciones y los 7 aspectos del modelo Malcon- Baldridge que promueve mejores prácticas para la administración de la calidad del servicio. Estos 17 aspectos fueron relacionados con las 8 P’s del marketing de servicios para realizar una evaluación al detalle en donde se consideró una puntuación por pregunta del 1 al 10. Podemos concluir que es posible realizar esta medición a través de la percepción en la actividad económica de la asistencia social, demostrando que con el 96.8% de los datos, los que representan a las treinta preguntas, que basadas en la escala de Likert, permite conocer la calificación mínima sobre diez de 10, siendo esta 8.41, y la calificación máxima de 9.72 lo que indica que los usuarios están en un grado de aceptación favorable con relación al servicio brindado