Lebesgue perturbation of a quasi-definite Hermitian functional. The positive definite case

16 pages, no figures.-- MSC2000 codes: 33C47; 42C05.MR#: MR1988489 (2004d:42042)Zbl#: Zbl 1032.42030In this work we study the problem of orthogonality with respect to a sum of measures or functionals. First we consider the case where one of the functionals is arbitrary and quasi-definite and the other one is the Lebesgue normalized functional. Next we study the sum of two positive measures. The first one is arbitrary and the second one is the Lebesgue normalized measure and we obtain some relevant properties concerning the new measure. Finally we consider the sum of a Bernstein–Szegö measure and the Lebesgue measure. In this case we obtain more simple explicit algebraic relations as well as the relation between the corresponding Szegö’s functions.First (A.C.) and third (C.P.) author's research was supported by Dirección General de Investigación (Ministerio de Ciencia y Tecnología) of Spain under grant number BFM2000-0015 and by Universidad de Vigo and Xunta de Galicia. Second author (F.M.)'s research was supported by Dirección General de Investigación (Ministerio de Ciencia y Tecnología) of Spain under grant BFM2000-0206-C04-01 and INTAS project INTAS2000-272.Publicad

Second kind functionals for the Laguerre-Hahn affine class on the unit circle

16 pages, no figures.-- MSC1991 codes: 33C47, 42C05.MR#: MR2032331 (2004j:33013)Zbl#: Zbl 1036.42024The aim of this paper is the study of some transformations in the Laguerre-Hahn affine class that do not preserve the class. Under very general conditions, we establish that the second kind functional associated with a Laguerre-Hahn affine functional does not belong to the Laguerre-Hahn affine class. The transformations related to the associated polynomials and quadratic decomposition of a sequence of orthogonal polynomials are also considered.The research of first (A.C.) and third (C.P.) authors was supported by Dirección General de Investigación (Ministerio de Ciencia y Tecnología) of Spain under grant number BFM2000-0015 and by Universidad de Vigo and Xunta de Galicia. The research of second author (F.M.) was supported by Dirección General de Investigación (Ministerio de Ciencia y Tecnología) of Spain under grant BFM2000-0206-C04-01 and INTAS project INTAS2000-272.Publicad

Orthogonal polynomials with respect to the sum of an arbitrary measure and a Bernstein-Szegö measure

24 pages, no figures.-- MSC2000 codes: 33C47, 42C05.-- Dedicated to Professor Dr. Mariano Gasca with occasion of his 60th anniversary.MR#: MR2350346 (2008m:33032)Zbl#: Zbl 1109.33010In the present paper we study the orthogonal polynomials with respect to a measure which is the sum of a finite positive Borel measure on [0,2π] and a Bernstein–Szegö measure. We prove that the measure sum belongs to the Szegö class and we obtain several properties about the norms of the orthogonal polynomials, as well as, about the coefficients of the expression which relates the new orthogonal polynomials with the Bernstein–Szegö polynomials. When the Bernstein–Szegö measure corresponds to a polynomial of degree one, we give a nice explicit algebraic expression for the new orthogonal polynomials.The research was supported by Dirección General de Investigación (Ministerio de Ciencia y Tecnología) of Spain under grant number BFM2000-0015, as well as BFM2003-06335-C03-C02.Publicad

Uso de los antisépticos en atención primaria

ResumenLas heridas se pueden clasificar, según el mecanismo de acción, en quirúrgicas o traumáticas (que pueden ser incisas, como las provocadas por un objeto cortante; contusas, causadas por un objeto romo; punzantes, provocadas por objetos afilados y largos; por desgarro, causadas por tracción de los tejidos; por mordedura, que tienen alto riesgo de infección, por lo que no se deben suturar) o, por la evolución del proceso de cicatrización, en agudas o crónicas (úlceras por presión, úlceras vasculares, úlceras neuropáticas, heridas agudas con tórpida evolución). El empleo de antisépticos en cualquiera de los casos suele estar limitado a la limpieza y cuidados iniciales (48–72h) y al lavado de manos e instrumental, y su uso en heridas crónicas o cronificadas es más discutible. En el caso de quemaduras sucede lo mismo, y es más recomendable el empleo de formulaciones que favorezcan la hidratación.En población pediátrica se suele recomendar el empleo de antisépticos con un perfil de seguridad conocido y baja absorción, especialmente en el caso del cuidado del cordón umbilical, donde la evidencia recomienda el empleo de gluconato de clorhexidina.Otro uso de los antisépticos es el cuidado de heridas producidas por la implantación de objetos dentro de la estética corporal (piercing y similares), siendo recomendable el empleo de antisépticos transparentes que permitan observar la evolución de la técnica.AbstractWounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care —up to 48 hours— and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended.In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate.Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique

Community Activities in Primary Care: A Literature Review

Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventionsS

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: A 3-year prospective cohort study

Introduction: The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion. Methods: We conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m2 and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test. Results: A total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m2) and the ITBVI (709 ± 254 mL/ m2). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m2). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/ kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels. Conclusions: Initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood pressure and hourly urine output. An adequate CI and tissue perfusion can be achieved with below-normal levels of preload. Early resuscitation guided by lactate levels and below-normal preload volume targets appears safe and avoids unnecessary fluid input

Trabajando con nuestros pacientes fumadores en atención primaria. Un análisis de coste-efectividad

ResumenObjetivoEl objetivo de este trabajo es realizar una evaluación económica de las intervenciones sobre tabaquismo en atención primaria.DiseñoAnálisis de coste-efectividad (ACE) comparando 2 estrategias de intervención: intensiva y breve.EmplazamientoPacientes de una consulta de medicina de familia en un centro de salud (CS) periurbano.ParticipantesTodas las historias con etiqueta de fumadores; 235 y 37 en el grupo de intervención breve e intensiva, respectivamente.IntervencionesLa intervención breve (IB) se realizó en el contexto de otro motivo de consulta (1-5 min). La intervención intensiva (II) fue exclusivamente para tabaquismo (10-15 min).Mediciones principalesLos datos de efectividad son obtenidos de la evaluación de la intervención sobre los fumadores de dicha consulta después de 6 años. Empleamos costes sanitarios directos. Excluimos fármacos, costes no sanitarios e indirectos. Aplicamos la tasa de coste-efectividad incremental (ICER) de las intervenciones breve, intensiva y total (breve+intensiva), comparando no intervenir con cada tipo de intervención e II respecto a la IB y análisis probabilístico para tratar la incertidumbre.ResultadosEl coste por paciente abstinente, globalmente, fue 406,74 €. Para la IB fue de 129,83 € y para la II, 1.034,99 €.ICER intervención total=498,87 €/paciente que deja de fumar.ICER IB=235,32 €/paciente que deja de fumar.ICER II=1.232,85 €/paciente que deja de fumar.ICER II/IB=7.772,25 €/paciente que deja de fumar.ConclusionesLas intervenciones sobre tabaquismo en AP son eficientes. Una propuesta para el abordaje del tabaquismo en AP, desde una perspectiva coste-efectiva, podría ser la IB sobre todos los fumadores e II sobre aquellos con más dificultad para abandonar.AbstractObjectiveThe aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC).DesignCost-Effectiveness Analysis comparing two intervention strategies; intensive and brief.SettingPatients in a general practitioner's list in a peri-urban Health Centre.ParticipantsAll the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively.InterventionsThe brief intervention (BI) was made in the context of consultation for another purpose (1-5minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15minutes).Main measurementsThe effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief+intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty.ResultsThe total cost per abstinent patient was 406,74 €: 129,83 € for BI and 1.034,99 € for I.I.ICER Total intervention=€498, 87/patient who stops smoking.ICER BI=€235, 32/patient who stops smoking.ICER II=€1.232, 85/patient who stops smoking.ICER II/BI=€7.772,25/patient who stops smoking.ConclusionsSmoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit

Association of patients' geographic origins with viral hepatitis co-infection patterns, Spain

To determine if hepatitis C virus seropositivity and active hepatitis B virus infection in HIV-positive patients vary with patients' geographic origins, we studied co-infections in HIV-seropositive adults. Active hepatitis B infection was more prevalent in persons from Africa, and hepatitis C seropositivity was more common in persons from eastern Europe.Ministerio de Sanidad. Instituto de Salud Carlos II

Trabajando con nuestros pacientes fumadores en atencion primaria. Un analisis de coste-efectividad

Objective: The aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC). Design: Cost-Effectiveness Analysis comparing two intervention strategies; intensive and brief. Setting: Patients in a general practitioner's list in a peri-urban Health Centre. Participants: All the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively. Interventions: The brief intervention (BI) was made in the context of consultation for another purpose (1-5 minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15 minutes). Main measurements: The effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief + intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty. Results: The total cost per abstinent patient was 406,74 : 129,83 for BI and 1.034,99 for I.I. ICER Total intervention = 498, 87/patient who stops smoking. ICER BI = 235, 32/patient who stops smoking. ICER II = 1.232, 85/patient who stops smoking. ICER II/BI = 7.772,25/patient who stops smoking. Conclusions: Smoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit. 2011 Elsevier Espana, S.L. Todos los derechos reservados