Capital social rural: experiencias de México y Centroamérica

Incluye BibliografíaPresentación Este libro fue escrito por Margarita Flores, Directora Adjunta de la Sede Subregional de la Comisión Económica para América Latina (CEPAL) en México, y por Fernando Rello, miembro de la Facultad de Economía de la Universidad Nacional Autónoma de México (UNAM). Es una coedición de la CEPAL con la editorial Plaza y Valdés y la UNAM. Se terminó de imprimir en abril de 2002. El objetivo principal de este ensayo es analizar la manera en que los pequeños productores rurales han redefinido sus formas de organización, sus fines productivos, su inserción en el mercado conjugada con la producción de alimentos y, en general, sus métodos para cristalizar la aspiración de mejorar sus niveles de vida, en el contexto actual marcado por la globalización, la apertura y las reformas institucionales. A partir del estudio de experiencias seleccionadas en México y Centroamérica, se trata de identificar los factores que propician el fortalecimiento de las organizaciones rurales, mediante los cuales éstas ocupan nuevos espacios económicos y sociales. Se pretende reflejar cómo logran los productores emplear los activos a su disposición (sus recursos naturales, financieros, humanos y sociales) y cómo se vinculan con otros agentes económicos y sociales, a través de sus organizaciones. De este análisis se pretende extraer enseñanzas y recomendaciones útiles para los productores y para los gobiernos sobre la forma de propiciar una mayor participación de los pequeños productores en el desarrollo del sector agropecuario, por medio de esquemas institucionales novedosos, cuya promoción, si bien descansa principalmente en el Estado, se lleva a cabo también con el aporte de la sociedad. Muchos y diversos factores influyen en las organizaciones de pequeños productores, en particular el contexto macroeconómico y la política financiera. En este estudio no se subraya este factor, aunque se formulan algunos señalamientos sobre su relevancia. Nuestro enfoque consiste en estudiar el entramado institucional en el que se desenvuelven las organizaciones, así como los factores interno que contribuyen a explicar su desarrollo

Parquet multicapa de Eucalyptus globulus y Quercus robur . resistencia al impacto para diversas tipologías de fabricación

Utilizando el test de impacto, basado en la norma ASTM D1037-99, se compara la resistencia de diversas composiciones de fabricación de parquet multicapa de Eucalyptus globulus y Quercus robur, con distintos espesores de capa noble y utilizando para cada uno de ellos tres tipos diferentes de soporte base con el propósito de evaluar la aptitud de Eucalyptus globulus como parte destacada (capa noble) en la elaboración de un parquet multicapa. El resultado del ensayo de impacto resultó ser estadísticamente independiente de la especie utilizada (eucalipto o roble) como capa noble, habiéndose analizado con niveles de significación superiores al 95%, siendo, sin embargo, dependiente del tipo de elemento de soporte utilizado y del espesor de la capa noble. Un modelo lineal, que utiliza la densidad media en los 4 primeros milímetros de profundidad de cada pieza, permitió explicar hasta un 82% de la variación del diámetro de huella en el ensayo de impacto, lo que permite utilizar con suficiente garantía esta densidad como predictor del diámetro de huella del ensayo de impacto

Modelling of impact falling ball test response on solid and engineered wood flooring of two eucalyptus species

In this study, dynamic hardness tests on solid and engineered wood flooring specimens of Eucalyptus globulus Labill. and Eucalyptus grandis W. Hill ex Maiden hardwoods were performed because nowadays, these fast-growing hardwoods are still scarcely employed for this use. Furthermore, another two examples of hardwood commonly applied on wood flooring, Quercus robur L. and Hymenaea courbaril L., were also tested. To compare their properties, a dynamic impact hardness test based on the impact of steel balls, with several diameters, and drop heights was developed. Accordingly, 120 solid wood flooring specimens and 120 engineering wood flooring specimens were producing with these four hardwood species. Dynamic impact tests were made with three steel balls of different diameters (30–40–50 mm), and they were carried out from five different drop heights (0.60–0.75–0.90–1.05–1.20 m). The impact of the steel ball drew the size of the footprint on the surface and this mark was measured with a digital caliper for both dimensions, diameter and depth, as footprint diameter (FD) and indentation depth (ID). Data from 3000 samples, corresponding to 120 different individual groups (4 species × 3 ball diameters × 5 drop height × 2 floor type) were analyzed. Results indicated that the variability of ID (CV between 19.25–25.61%) is much greater than the values achieved for FD (CV between 6.72–7.91%). Regarding the fast-growing hardwood species tested, E. globulus showed a similar behavior to traditional hardwood applied on wood flooring in Europe, Q. robur, and it could be a promising growth in the flooring industry. However, E. grandis showed the worst values compared to traditional hardwood in all test configuration

Physical performance and quality of life in older adults: Is there any association between them and potential drug interactions in Polymedicated Octogenarians?

Producción CientíficaOlder adults are at increased risk of several cytochrome P450 (CYP) drug interactions that can result in drug toxicity, reduced pharmacological effect, and adverse drug reactions. This study aimed to assess the prevalence of potential CYP interactions referring to the most clinically relevant drugs and exploring the relationship between them and quality of life and physical performance in Spanish octogenarians. Institutionalized and community-dwelling octogenarians (n = 102) treated at three primary care centers, were recruited by a research nurse. Anthropometric measurements, chronic diseases, prescribed drugs, quality of life, physical performance, mobility skills, hand grip strength and cognitive status data were collected. Potential CYP drug-drug interactions (DDIs) were selected referring to the main CYP implicated in their metabolism. The 72.2% of recruited octogenarians presented potentially inappropriate CYP inhibitor-substrate or CYP inductor-substrate combinations. Analyzing the EuroQol Visual Analogue scale (EQ-VAS) results, patients with a potential CYP DDI perceived worse health status than patients without it (p = 0.004). In addition, patients with a potential CYP DDI presented worse exercise capacity, kinesthetic abilities, or mobility than those who didn’t present a potential interaction (p = 0.01, p = 0.047, and p = 0.02, respectively). To investigate and control factors associated with loss of muscle strength and poor quality of life, polypharmacy and DDIs could help institutions in the management of physical frailty.Fundación Científica Caja Rural de Soria (project 00200200227

MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure

Acute heart failure; Acute myocardial infarction; ElderlyInsuficiència cardíaca aguda; Infart agut de miocardi; Gent granInsuficiencia cardíaca aguda; Infarto agudo de miocardio; AncianoBackground Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF). Purpose To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI. Study Type Prospective. Population Multicenter registry of 759 reperfused STEMI patients (23.3% elderly). Field Strength/Sequence 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. Assessment One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%–49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33–7.54] years. Statistical Tests Univariable (Student's t, Mann–Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant. Results Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91–0.98]) and elderly patients (HR 0.94 [0.91–0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67–22.32]) and elderly patients (HR 7.55 [3.29–17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54–8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients. Data Conclusion MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group. Evidence Level 2. Technical Efficacy Stage 2.Grant sponsor: This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (grant numbers PI20/00637, PI15/00531, and CIBERCV16/11/00486, CIBERCV16/11/00420, CIBERCV16/11/00479, and CM21/00175 to V.M.-G.), Fundació La Marató TV3 (grant 20153030-31-32), La Caixa Banking Foundation (HR17-00527) and by Conselleria de Educación – Generalitat Valenciana (PROMETEO/2021/008). J.G. acknowledges financial support from the “Agencia Estatal de Investigación” (grant FJC2020-043981-I/AEI/10.13039/501100011033)

Predictive Value of Cardiac Magnetic Resonance Feature Tracking after Acute Myocardial Infarction: A Comparison with Dobutamine Stress Echocardiography

Ecocardiografía de seguimiento de manchas; Deformación del miocardio; Seguimiento de características de resonancia magnética cardíacaSpeckle-tracking echocardiography; Myocardial deformation; Cardiac magnetic resonance feature-trackingEcocardiografia de seguiment de taques; Deformació del miocardi; Seguiment de característiques de ressonància magnètica cardíacaIn acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine stress echocardiography (LDDSE) and speckle-tracking echocardiography (STE). Eighty patients underwent LDDSE and CMR within 5–7 days after STEMI and segmental functional recovery was defined as improvement in wall-motion at 6-months CMR. Optimal conventional and FT parameters were analyzed and then also applied to an external validation cohort of 222 STEMI patients. Circumferential strain (CS) was the strongest CMR-FT predictor and addition to LGE increased the overall accuracy to 74% and was especially relevant in segments with 50–74% LGE (AUC 0.60 vs. 0.75, p = 0.001). LDDSE increased the overall accuracy to 71%, and in the 50–74% LGE subgroup improved the AUC from 0.60 to 0.69 (p = 0.039). LGE + CS showed similar value as LGE + LDDSE. In the validation cohort, CS was also the strongest CMR-FT predictor of recovery and addition of CS to LGE improved overall accuracy to 73% although this difference was not significant (AUC 0.69, p = 0.44). Conclusion: CS is the strongest CMR-FT predictor of segmental functional recovery after STEMI. Its incremental value to LGE is comparable to that of LDDSE whilst avoiding an inotropic stress agent. CS is especially relevant in segments with 50–74% LGE where accuracy is lower and further testing is frequently required to clarify the potential for recovery.This research was supported by the Instituto de Salud Carlos III and co-funded by Fondo Europeo de Desarrollo Regional (FEDER) (grant numbers PI17/01836 and CIBERCV16/11/00486). JG and DM acknowledge financial support from the “Agencia Valenciana de la Innovación, Generalitat Valenciana” (grant) and from the “Conselleria d’Educació, Investigació, Cultura i Esport, Generalitat Valenciana” (grant number AEST/2019/037)

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project.

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Prevenció de la infecció respiratòria

Infecció respiratòria; Prevenció; Atenció sanitàriaInfección respiratória; Prevención; Atención sanitáriaRespiratory infection; Prevention; Health careMonografia sobre temes concrets relacionats amb la prevenció de la infecció respiratòria relacionada amb l‟atenció sanitària. Ha estat elaborada per un comitè d‟experts amb una àmplia trajectòria en el camp de l'atenció a pacients amb problemes respiratoris. El document comença fent una posada al dia de l‟epidemiologia i l‟etiopatogènia de les infeccions respiratòries nosocomials i, sense voler repetir capítols de la monografia d'aïllaments, continua fent una pinzellada de les mesures que cal dur a terme per evitar la transmissió de les infeccions respiratòries dins dels centres sanitaris. Tot seguit, s‟aborden de manera pràctica situacions quotidianes, com el maneig de la via aèria, i es fan algunes recomanacions sobre com dur-les a terme. Una part important i poc coneguda per molts professionals és la prevenció de la infecció respiratòria de causa instrumental, motiu pel qual en el darrer capítol es fa una revisió minuciosa de com procedir per reutilitzar aquests aparells.Monografía sobre temas concretos relacionados con la prevención de la infección respiratoria con la atención sanitaria. Ha sido elaborada por un comité de expertos con una amplia trayectoria en el campo de la atención a pacientes con problemas respiratorios. El documento empieza haciendo una puesta al día de la epidemiologia y la etiopatogenia de las infecciones respiratorias nosocomiales y, sin querer repetir capítulos de la monografía de aislamientos, continua haciendo una pincelada de las medidas que son necesarias para evitar la transmisión de las infecciones respiratorias dentro de los centros sanitarios. Seguidamente se tratan de manera práctica situaciones cotidianas, como el manejo de la vía aérea y se hacen algunas recomendaciones sobre como llevarlas a cabo. Una parte importante y poco conocida para muchos profesionales es la prevención de la infección respiratoria de causa instrumental, motivo por el cual en el último capítulo se hace una revisión minuciosa de como proceder para reutilizar estos aparatos

Host adaptive immunity deficiency in severe pandemic influenza

INTRODUCTION: Pandemic A/H1N1/2009 influenza causes severe lower respiratory complications in rare cases. The association between host immune responses and clinical outcome in severe cases is unknown. METHODS: We utilized gene expression, cytokine profiles and generation of antibody responses following hospitalization in 19 critically ill patients with primary pandemic A/H1N1/2009 influenza pneumonia for identifying host immune responses associated with clinical outcome. Ingenuity pathway analysis 8.5 (IPA) (Ingenuity Systems, Redwood City, CA) was used to select, annotate and visualize genes by function and pathway (gene ontology). IPA analysis identified those canonical pathways differentially expressed (P < 0.05) between comparison groups. Hierarchical clustering of those genes differentially expressed between groups by IPA analysis was performed using BRB-Array Tools v.3.8.1. RESULTS: The majority of patients were characterized by the presence of comorbidities and the absence of immunosuppressive conditions. pH1N1 specific antibody production was observed around day 9 from disease onset and defined an early period of innate immune response and a late period of adaptive immune response to the virus. The most severe patients (n = 12) showed persistence of viral secretion. Seven of the most severe patients died. During the late phase, the most severe patient group had impaired expression of a number of genes participating in adaptive immune responses when compared to less severe patients. These genes were involved in antigen presentation, B-cell development, T-helper cell differentiation, CD28, granzyme B signaling, apoptosis and protein ubiquitination. Patients with the poorest outcomes were characterized by proinflammatory hypercytokinemia, along with elevated levels of immunosuppressory cytokines (interleukin (IL)-10 and IL-1ra) in serum. CONCLUSIONS: Our findings suggest an impaired development of adaptive immunity in the most severe cases of pandemic influenza, leading to an unremitting cycle of viral replication and innate cytokine-chemokine release. Interruption of this deleterious cycle may improve disease outcome.The study was scientifically sponsored by the Spanish Society for Critical Care Medicine (SEMICYUC). Funding: MICCIN-FIS/JCYL-IECSCYL-SACYL (Spain): Programa de Investigación Comisionada en Gripe, GR09/0021-EMER07/050- PI081236-RD07/0067. CIHR-NIH-Sardinia Recherché-LKSF Canada support DJK.S

What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19?:A harmonised, global longitudinal observational study protocol

Introduction: Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge. Methods and analysis: This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO’s Clinical Characterisation Protocol, which includes patients with suspected or confirmed COVID-19 during hospitalisation. This protocol will follow-up a subset of patients with confirmed COVID-19 using standardised surveys to measure longer term physical and psychosocial sequelae. The data will be linked with the acute phase data. Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID-19. The open-access follow-up survey can be used as a data collection tool by other follow-up studies, to facilitate data harmonisation and to identify subsets of patients for further in-depth follow-up. The outcomes of this study will inform strategies to prevent long-term consequences; inform clinical management, interventional studies, rehabilitation and public health management to reduce overall morbidity; and improve long-term outcomes of COVID-19. Ethics and dissemination: The protocol and survey are open access to enable low-resourced sites to join the study to facilitate global standardised, longitudinal data collection. Ethical approval has been given by sites in Colombia, Ghana, Italy, Norway, Russia, the UK and South Africa. New sites are welcome to join this collaborative study at any time. Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriate. The tools are available on the ISARIC website (www.isaric.org)