Análisis experimental de la relación entre los estilos de enseñanza y los estilos de aprendizaje en Educación Infantil

El objetivo de este trabajo es analizar experimentalmente la relación existente entre los estilos de enseñanza en docentes de Educación Infantil en relación con los estilos de aprendizaje por parte del alumnado. A partir de una muestra de 42 docentes pertenecientes al segundo ciclo de Educación Infantil en activo y utilizando dos tipos de escalas, por un lado una adaptación a los niveles de Educación Infantil de la escala de evaluación tipo ECAD-EP (Valdivieso, Carbonero y Martín-Antón, 2013) para la evaluación de la competencia autopercibida docente y la ECRA (Servera y Galván, 1997) para la evaluación del comportamiento y el rendimiento en el aula, haciendo mayor hincapié sobre los factores que influyen en la impulsividad del alumnado. Analizar dicha relación entre los elementos que influyen tanto en los estilos de enseñanza por parte de los docentes, como en los estilos de aprendizaje respecto a los alumnos, mejoraría el proceso de enseñanza-aprendizaje del alumnado perteneciente a la etapa de Educación InfantilGrado en Educación Infanti

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Association of Candidate Gene Polymorphisms With Chronic Kidney Disease: Results of a Case-Control Analysis in the Nefrona Cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2, 445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionizationtime of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P &lt; 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P &lt; 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P &lt; 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P &lt; 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

La salud de la mujer en condiciones de vulnerabilidad, pobreza y desigualdad social en Córdoba, Colombia

El hecho de analizar la salud de la mujer en una región con altos índices de pobreza, desigualdad social e inequidad, como el Departamento de Córdoba (1,2), obliga a determinar no solo la concepción que se asume frente a la vida, los padecimientos y su relación con las condiciones de existencia o el entorno social, económico y político, sino, también, la forma en que los hombres y mujeres entienden, sienten y reaccionan ante su propio proceso de salud-enfermedad. En otras palabras, se trata de comprender las distintas realidades de cada persona; de forma tal que puedan ser valoradas con una mirada de alteridad, desde las circunstancias y situaciones que vive y experimenta el otro.AGRADECIMIENTOS..................................................9PRESENTACIÓN..............................................10INTRODUCCIÓN..........................................................12CAPÍTULO 1: FACTORES SOCIALES Y EMBARAZO ADOLESCENTE EN UNA POBLACIÓN DESPLAZADA DE MONTERÍA, CÓRDOBA, COLOMBIA................................25INTRODUCCIÓN .........................................................26OBJETIVO...............................................................31BASES TEÓRICAS..........................................................31MATERIALES Y MÉTODOS .................................................39RESULTADOS.....................................................................42DISCUSIÓN.............................................................................53CONCLUSIONES.....................................................................54REFERENCIAS..................................................................56CAPÍTULO 2: EMBARAZO EN LA ADOLESCENCIA: EFECTO DE LOS DETERMINANTES SOCIALES DE LA SALUD........................................................................................................................................63INTRODUCCIÓN......................................................64MATERIALES Y MÉTODOS.............................................................73RESULTADOS Y ANÁLISIS........................................................80DISCUSIÓN........................................................................................................98CONCLUSIONES.................................................................................102REFERENCIAS........................................................................................104CAPÍTULO 3: CREENCIAS EN SALUD ORAL DE UN GRUPO DE GESTANTES DE MONTERÍA, DEPARTAMENTO DE CÓRDOBA, COLOMBIA ................................................................112INTRODUCCIÓN............................................113OBJETIVO..............................................................115BASES TEÓRICAS.............................................116RUTA METODOLÓGICA.....................................................124RESULTADOS Y DISCUSIÓN.............................................127CONCLUSIONES..............................................................145REFERENCIAS.............................................147CAPÍTULO 4: TUVE QUE VIVIR UN VERDADERO VIACRUCIS PARA PODER RESIGNIFICAR MI FUTURO REPRODUCTIVO...............................................................................156INTRODUCCIÓN.........................................................157OBJETIVO.............................................................159RUTA METODOLÓGICA...............................................159RESULTADOS.....................................................................165DISCUSIÓN............................................................................173CONCLUSIONES...................................................179REFERENCIAS..............................................................181CAPÍTULO 5: LA CONFIGURACIÓN SOCIAL DE LA SÍFILIS CONSTRUIDA POR GESTANTES DE MONTERÍA, DEPARTAMENTO DE CÓRDOBA, COLOMBIA...................190INTRODUCCIÓN..............................................................191OBJETIVO................................................................194BASES TEÓRICAS............................................................194RUTA METODOLÓGICA............................................202RESULTADOS...................................................206DISCUSIÓN................................................................212CONCLUSIONES...............................................................217REFERENCIAS...................................................................217CAPÍTULO 6: TRAZOS SOCIODEMOGRÁFICOS DE LA SÍFILIS GESTACIONAL EN CÓRDOBA........................................224INTRODUCCIÓN...................................................225MATERIAL Y MÉTODO.....................................................228RESULTADOS............................................................230CONCLUSIONES.................................................................235REFERENCIAS................................................................236CAPÍTULO 7: LAS VOCES DE LAS MUJERES QUE LOGRAN SALIR DEL CICLO DE LA VIOLENCIA DE PAREJA ÍNTIMA.......................................................................................................240CAPÍTULO 7: LAS VOCES DE LAS MUJERES QUE LOGRAN SALIR DEL CICLO DE LA VIOLENCIA DE PAREJA ÍNTIMA.......................................................................................................240INTRODUCCIÓN.........................................................................241BASES TEÓRICAS.......................................................................244RUTA METODOLÓGICA..............................................247DISCUSIÓN..........................................................................264CONCLUSIÓN...................................................................269REFERENCIAS........................................................................269CAPÍTULO 8: ESTRATEGIAS DE AFRONTAMIENTO Y PERCEPCIONES DE CALIDAD DE VIDA DE MUJERES CON DIAGNÓSTICO DE CÁNCER DE MAMA EN EL DEPARTAMENTO DE CÓRDOBA EN EL PERIODO 2013-2017..................................................................................................275INTRODUCCIÓN...................................................276OBJETIVO..............................................................................279BASES TEÓRICAS..........................................................279MATERIALES Y MÉTODOS...........................................286RESULTADOS Y ANÁLISIS................................................289DISCUSIÓN..............................................................................301CONCLUSIONES..............................................................................304REFERENCIAS.................................................................................306CAPÍTULO 9: FUNCIONALIDAD FAMILIAR EN MUJERES QUE HAN PADECIDO CÁNCER DE MAMA....311INTRODUCCIÓN...............................................................312BASES TEÓRICAS...............................................................316MATERIALES Y MÉTODOS...............................................323RESULTADOS..............................................................................328DISCUSIÓN.......................................................................333CONCLUSIONES............................................................334REFERENCIAS..................................................................33

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation

International audienc

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols