The Philippine Health Institutions: Some Problems, Approaches and Policy Issues

This paper presents a brief analysis of the current situation of Philippine health institutions using secondary data. It locates the different types of health institutions, describes its major problems, discusses recent approaches these institutions have adopted to improve delivery of health care services and extricates policy-related issues and data gaps from available literature.health sector, hospitals, hospital care, health centers

Gender differences in the decision-making process for undergoing total knee replacement

Acord transformatiu CRUE-CSICThis project was supported by Instituto de Salud Carlos III, Ministry of Health, Spain (grant number PI15/01264).Objective: To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). Methods: A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. Results: Women showed less knowledge (MD = −7.68, 95% CI: −13.9, −1.46, p = 0.016), reported less satisfaction (MD = −6.95, 95% CI: −11.7, −2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). Conclusion: The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. Practice implications: A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases

Propuesta de Supply Chain Management y Logística para la empresa Blend S.A.S

El presente proyecto de grado tiene como finalidad presentar una propuesta de administración y mejora de la cadena de suministro para la empresa Blend S.A.S, partiendo de la situación actual de la empresa, teniendo en cuenta el distinto tipo de relaciones que se tiene con los proveedores, los clientes y todos los actores que en cierta medida tienen influencia o conexión con la empresa. Dentro del desarrollo se proponen distintas medidas para optimizar los procesos de abastecimiento, de distribución, las relaciones y selecciones de los proveedores y la mejora de la relación con los clientes, todo esto partiendo e implementado las nuevas tendencias en cuanto a gestión de cadena de suministro en el mundo actual. Además, se proponen nuevas formas de distribución de la planta procurando disminuir tiempos y distancias de desplazamientos y sugiriendo herramientas digitales para gestionar el inventario e identificarlo.The current project has as a purpose to present a proposal for the management and improvement of the supply chain for the company Blend S.A.S., based on the current situation of the company, considering the different types of relationships it has with suppliers, customers, and all stakeholders who have some level of influence or connection with the company. Throughout the development, various measures are proposed to optimize the processes of sourcing, distribution, supplier relationships, and customer relations, all while implementing the latest trends in supply chain management in the current world. Additionally, new ways of distributing the plant are proposed, aiming to reduce travel times and distances, and suggesting digital tools for stock management and identification

El Papel del Centro Educativo con Estudiantes con Necesidades Educativas Específicas Asociadas a una Discapacidad

Nowadays, the education faces several challenges, one of which is the specific educational needs associated to a disability. Where the educational center (teachers, authorities and infrastructure) are the ones to give a significant responding through inclusive education. This research paper analyzes the role of "la maná" high school, "rafael vásconez gómez" high school, and "federación deportiva de cotopaxi" high school in relation to students with specific educational needs associated to an intellectual-psychosocial and physical disabilities, to obtain the results, an online interview was applied to teachers of these institutions, a classroom observation sheet was used, finally, 80% of teachers  apply strategies in their class in order to respond to the needs of the students and 20% do not, due to lack of time, materials and the large number of students in each classroom.Actualmente la educación enfrenta varios retos, uno de ellos son las Necesidades Educativas Específicas Asociadas a una discapacidad. Donde el centro educativo (docentes, autoridades e infraestructura) son los encargados de dar respuesta de manera significativa mediante la educación inclusiva. El presente trabajo de investigación analiza el papel de la Unidad Educativa “La Maná”, Unidad Educativa “Rafael Vásconez Gómez” y Unidad Educativa “Federación Deportiva de Cotopaxi” frente a los estudiantes con Necesidades Educativas Específicas asociadas a la discapacidad intelectual-psicosocial y física, para la obtención de resultados se aplicó una entrevista online a los docentes de estas instituciones se utilizó una ficha de observación áulica, finalmente, el 80% de los docentes si aplican estrategias en su clase con la finalidad de responder las necesidades de los estudiantes y el 20% no lo hacen, por la falta de tiempo, de materiales y el gran número de estudiantes en cada aula de clase

DIVERSIDAD GENÉTICA DEL VIRUS DE INMUNODEFICIENCIA

El Síndrome de Inmunodeficiencia Adquirida (SIDA), es considerado como una pandemia que al igual que otras enfermedades requiere del diagnóstico, vigilancia y tratamiento efectivos. En México como en el resto de los países del mundo, el SIDA es considerado como un serio problema de salud pública, ya que a pesar de todos los esfuerzos que se han hecho para difundir los conocimientos de los aspectos epidemiológicos, de diagnóstico, tratamiento y prevención, el número de casos reales es mayor que el informado por las autoridades; por lo tanto, las consecuencias socioeconómicas son mucho más graves. El VIH-1, es un virus que experimenta una alta variación genética, ésta, causa cambios en el tropismo, virulencia y transmisión de la infección. Nuevas variantes y/o subtipos del VIH-1 se encuentran circulando con un amplio rango de propiedades de virulencia y transmisión que están surgiendo y dispersándose alrededor del mundo en una forma alarmante. El VIH-1 predominante en México es el subtipo B, pero esto no excluye la presencia de otros subtipos en el país, como es la presencia del Subtipo C detectado en un individuo sudafricano. Una adecuada vigilancia epidemiológica del VIH/SIDA incluyendo la identificación, caracterización y análisis de los subtipos predominantes en nuestro país deben ser llevadas a cabo en un esfuerzo para evaluar su diversidad genética y comprender mejor la problemática sobre su diseminación, definir los patrones de distribución geográfica, su epidemiología, sobre el desarrollo de antivirales y sobre todo el diseño de vacunas.Palabras clave: SIDA, VIH, subtipos y formas recombinantes circulantes (FRC).        AIDS, HIV, subtypes and Circulating Recombinant Forms(CRF

Hypofractionated radiation therapy and temozolomide in patients with glioblastoma and poor prognostic factors. A prospective, single-institution experience

Background: Hypofractionated radiation therapy is a feasible and safe treatment option in elderly and frail patients with glioblastoma. The aim of this study was to evaluate the effectiveness of hypofractionated radiation therapy with concurrent temozolomide in terms of feasibility and disease control in primary glioblastoma patients with poor prognostic factors other than advanced age, such as post-surgical neurological complications, high tumor burden, unresectable or multifocal lesions, and potential low treatment compliance due to social factors or rapidly progressive disease. Material and methods: GTV included the surgical cavity plus disease visible in T1WI-MRI, FLAIR-MRI and in the MET-uptake. The CTV was defined as the GTV plus 1.5-2 cm margin; the PTV was the CTV+0.3 cm margin. Forty, fourty-five, and fifty grays in 15 fractions were prescribed to 95% of PTV, CTV, and GTV, respectively. Treatment was delivered using IMRT or the VMAT technique. Simultaneously, 75 mg/m2/day of temozolomide were administered. Results: Between January 2010 and November 2017, we treated a total of 17 patients. The median age at diagnosis was 68-years; median KPS was 50-70%. MGMT-methylation status was negative in 5 patients, and 8 patients were IDH-wildtype. Eight of 18 patients were younger than 65-years. Median tumor volume was 26.95cc; median PTV volume was 322cc. Four lesions were unresectable; 6 patients underwent complete surgical resection. Median residual volume was 1.14cc. Progression-free survival was 60% at 6 months, 33% at 1-year and 13% at 2-years (median OS = 7 months). No acute grade 3-5 toxicities were documented. Symptomatic grade 3 radiation necrosis was observed in one patient. Conclusions: Patients with poor clinical factors other than advanced age can be selected for hypofractionated radiotherapy. The OS and PFS rates obtained in our series are similar to those in patients treated with standard fractionation, assuring good treatment adherence, low rates of toxicity and probable improved cost-effectiveness

Brain connectivity and cognitive functioning in individuals six months after multiorgan failure

Multiorgan failure (MOF) is a life-threating condition that affects two or more systems of organs not involved in the disorder that motivates admission to an Intensive Care Unit (ICU). Patients who survive MOF frequently present long-term functional, neurological, cognitive, and psychiatric sequelae. However, the changes to the brain that explain such symptoms remain unclear. Objective: To determine brain connectivity and cognitive functioning differences between a group of MOF patients six months after ICU discharge and healthy controls (HC). Methods: 22 MOF patients and 22 HC matched by age, sex, and years of education were recruited. Both groups were administered a 3T magnetic resonance imaging (MRI), including structural T1 and functional BOLD, as well as a comprehensive neuropsychological evaluation that included tests of learning and memory, speed of information processing and attention, executive function, visual constructional abilities, and language. Voxel-based morphometry was used to analyses T1 images. For the functional data at rest, functional connectivity (FC) analyses were performed. Results: There were no significant differences in structural imaging and neuropsychological performance between groups, even though patients with MOF performed worse in all the cognitive tests. Functional neuroimaging in the default mode network (DMN) showed hyper-connectivity towards sensory-motor, cerebellum, and visual networks. DMN connectivity had a significant association with the severity of MOF during ICU stay and with the neuropsychological scores in tests of attention and visual constructional abilities. Conclusions: In MOF patients without structural brain injury, DMN connectivity six months after ICU discharge is associated with MOF severity and neuropsychological impairment, which supports the use of resting-state functional MRI as a potential tool to predict the onset of long-term cognitive deficits in these patients. Similar to what occurs at the onset of other pathologies, the observed hyper-connectivity might suggest network re-adaptation following MOF.This research was founded by Ministerio Economia, Industria y Competitividad, Spain and FEDER (grant no. DPI2016-79874-R) to JC and JCAL. ID's time was founded by the Department of Education of the Basque Country, postdoctoral program. JR's time was founded by the Ministry of Education, Language Policy and Culture (Basque Government). JMC's time was founded by Ikerbasque and the Department of Economic Development and Infrastructure of the Basque Country, Elkartek Program (grant no. KK-2018/00032). JCAL's time was founded by Ikerbasque and Fundacion Mutua Madrileña (grant no. AP169812018). IG's time was founded by the Instituto de Salud Carlos III for a Juan Rodes (grant no. JR15/00008 ) co-funded by the European Regional Development Fund/European Social Fund ‘Investing in Your Future’. AJM's time was partly founded by Euskampus Fundazioa

Beyond T2-asthma biomarkers: risk stratification for NSAID-Exacerbated Respiratory Disease

[EN]Type 2 (T2)-asthma is often associated with chronic rhinosinusitis with nasal polyposis (CRSwNP). Additionally, non-steroidal anti-inflammatory drug intolerance leads to NSAID-exacerbated respiratory disease (N-ERD). Previous transcriptomic data in non-CRSwNP T2-asthma patients showed differentially expressed genes (DEGs). Of them, we focused on ALOX15, CLC, CYSLTR2, HRH4, and SMPD3 to investigate their role in T2-asthma patients. The study included 100 healthy controls (HCs) and 103 T2-asthma patients, divided into asthmatics (54), asthmatics with CRSwNP (30), and N-ERD (19). Quantitative PCR analysis was performed on blood-derived RNA samples first to validate the five DEGs. The data were further analyzed to find potential associations and biomarkers. Patients, regardless of stratification, exhibited significantly higher gene expressions than HCs. The patterns of association revealed that ALOX15 was exclusively present in the non-comorbidity group, SMPD3 and CLC in the comorbidity groups, and HRH4 in all patient groups. ALOX15, CYSLTR2, and SMPD3 expression showed potential as biomarkers to confirm the diagnosis of T2-asthma using peripheral blood eosinophils (PBE) as the initial criterion. PBE combined with gene expressions, especially SMPD3, may improve the diagnosis. CLC and CYSLTR2 expressions play a specific role in discriminating N-ERD. We validated the transcriptomic data of five DEGs in T2-asthma. Different patterns of association were identified in patient stratification, suggesting different molecular mechanisms underlying the spectrum of T2-asthma. Potential biomarkers were also found and used to design an algorithm with practical diagnostic utility for T2-asthma, including risk stratification for N-ERD.Ministerio de Ciencia e Innovación; Junta de Castilla y León; Instituto de Salud Carlos II

Transcriptomics reveals new regulatory mechanisms involved in benralizumab response

[EN] Benralizumab, a monoclonal antibody targeting IL5RA, significantly improves asthma symptoms and quality of life in severe asthmatic patients. However, understanding the factors influencing treatment response remains a challenge. In this prospective observational study, we analyzed transcriptomic changes in peripheral whole blood samples from 15 severe asthmatic patients treated with benralizumab for 6 months. The study included patients with two frequent comorbidities: nasal polyposis (CRSwNP) and NSAID-exacerbated respiratory disease (N-ERD)Instituto de Salud Carlos III (ISCIII); European Union -NextGeneration EU; Junta de Castilla y Leó

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Background: Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods: We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results: Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions: U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach