¿Cuál es la actitud de los médicos hacia el actual modelo de atención primaria?

ObjetivoDeterminar cómo es la actitud de los médicos hacia el actual modelo de atención primaria de salud y estimar su relación con variables de tipo sociodemográfico y/o laboral.DiseñoEstudio multicéntrico, transversal.EmplazamientoCentros de salud del Área II de la Región de Murcia.ParticipantesTotalidad de médicos generales, de familia y pediatras de los centros de salud mencionados (54 en total).Mediciones principalesComo instrumento de evaluación se utiliza la «Escala de actitudes hacia los contenidos de atención primaria de salud», de Ballesteros et al. Esta escala proporciona una puntuación total, así como una puntuación específica para cada una de las 7 dimensiones que la componen.ResultadosEn general, la actitud de los médicos es favorable (4,1 puntos de media sobre 5). En la dimensión «Inclusión de los profesionales del segundo nivel en atención primaria» es donde hemos encontrado una actitud menos favorable, siendo los médicos de familia los que se muestran más de acuerdo. En cuanto a las demás variables asociadas, los profesionales que trabajan en centros periféricos y en situación de interinidad muestran una actitud más positiva hacia el actual modelo.ConclusionesEl conocimiento de las actitudes de los profesionales, así como de las variables relacionadas, puede servir de base para diseñar posibles estrategias de intervención dirigidas a la mejora de la calidad asistencial en atención primaria y para una evolución positiva de los profesionales que prestan sus servicios.ObjectivesTo determine the attitude of doctors towards the current model of primary care and to calculate its relationship with social and demographic and/or work variables.DesignMulti-centre cross-sectional study.SettingHealth centres in Area II of the Murcia region.ParticipantsAll general practitioners, family doctors and paediatricians in the health centres mentioned (54 in all).Main measurementsThe «Scale of attitudes towards the contents of primary health care» by Ballesteros et al. was used as the tool of evaluation. This scale provides both a total score and a specific score for each of its 7 dimensions.ResultsIn general, doctors´ attitudes were favourable (4.1 points average out of 5). We found a less favourable attitude in the dimension «Inclusion of second-level professionals in primary care», with family doctors most in agreement. The professionals working in centres on the periphery and those without tenure had a more positive attitude towards the current model, for the remaining variables.ConclusionsUnderstanding professionals´ attitudes and the variables related to them may serve as a basis for designing intervention strategies aimed at improving the quality of primary care and for the positive evolution of professionals working in PC

Microwave Background Anisotropies and Nonlinear Structures I. Improved Theoretical Models

A new method is proposed for modelling spherically symmetric inhomogeneities in the Universe. The inhomogeneities have finite size and are compensated, so they do not exert any measurable gravitational force beyond their boundary. The region exterior to the perturbation is represented by a Friedmann-Robertson-Walker (FRW) Universe, which we use to study the anisotropy in the cosmic microwave background (CMB) induced by the cluster. All calculations are performed in a single, global coordinate system, with nonlinear gravitational effects fully incorporated. An advantage of the gauge choices employed here is that the resultant equations are essentially Newtonian in form. Examination of the problem of specifying initial data shows that the new model presented here has many advantages over `Swiss cheese' and other models. Numerical implementation of the equations derived here is described in a subsequent paper.Comment: 10 pages, 4 figures; Monthly Notices of the Royal Astronomical Society (MNRAS), in pres

Microwave background anisotropies and non-linear structures II. Numerical computations

A new method for modelling spherically symmetric inhomogeneities is applied to the formation of clusters in an expanding Universe. We impose simple initial velocity and density perturbations of finite extent and we investigate the subsequent evolution of the density field. Photon paths are also calculated, allowing a detailed consideration of gravitational lensing effects and microwave background anisotropies induced by the cluster. We apply the method to modelling high-redshift clusters and, in particular, we consider the reported microwave decrement observed towards the quasar pair PC1643+4631 A&B. We also consider the effect on the primordial microwave background power spectrum due to gravitational lensing by a population of massive high-redshift clusters.Comment: 15 pages, 23 figures; Monthly Notices of the Royal Astronomical Society (MNRAS), in pres

Geotechnical behaviour of low-permeability soils in surfactant-enhanced electrokinetic remediation

Electrokinetic processes provide the basis of a range of very interesting techniques for the remediation of polluted soils. These techniques consist of the application of a current field in the soil that develops different transport mechanisms capable of mobilizing several types of pollutants. However, the use of these techniques could generate nondesirable effects related to the geomechanical behavior of the soil, reducing the effectiveness of the processes. In the case of the remediation of polluted soils with plasticity index higher than 35, an excessive shrinkage can be observed in remediation test. For this reason, the continued evaporation that takes place in the sample top can lead to the development of cracks, distorting the electrokinetic transport regime, and consequently, the development of the operation. On the other hand, when analyzing silty soils, in the surroundings of injection surfactant wells, high seepages can be generated that give rise to the development of piping processes. In this article methods are described to allow a reduction, or to even eliminate, both problems.Los procesos electrocinéticos proporcionan la base de una serie de técnicas muy interesantes para la remediación de suelos contaminados. Estas técnicas consisten en la aplicación de un campo actual en el suelo que desarrolla diferentes mecanismos de transporte capaces de movilizar varios tipos de contaminantes. Sin embargo, el uso de estas técnicas podría generar efectos no deseables relacionados con el comportamiento geomecánico del suelo, reduciendo la efectividad de los procesos. En el caso de la remediación de suelos contaminados con índice de plasticidad superior a 35, se puede observar una contracción excesiva en la prueba de remediación. Por este motivo, la evaporación continuada que se produce en la parte superior de la muestra puede provocar el desarrollo de fisuras, distorsionando el régimen de transporte electrocinético y, en consecuencia, el desarrollo de la operación. Por otra parte, al analizar suelos limosos, en el entorno de los pozos de inyección de surfactante, se pueden generar altas filtraciones que dan lugar al desarrollo de procesos de tubería. En este artículo se describen métodos para permitir una reducción, o incluso eliminar, ambos problemas

RELACIÓN ENTRE SOMNOLENCIA Y TURNOS DE TRABAJO EN UNA MUESTRA DE POLICÍA LOCAL.

Background: Excesive daytime sleepiness is a frequent in our socirty and a public health problem due to it association with work and traffic accidents. The aim of the present study is to evaluate the relationship between daytime somnolence, as measured by the ESS and shift-work in a sample of local policemen. Results: Our results show that policemen in permanent shift and morning shift present higher scores in daytime sleepiness. Besides, in this study 36,5% of the sample suffered a job accident, and in 9% of this sample, the accidents were associated to fatigue.Fundamento: La somnolencia diurna excesiva es un síntoma frecuente en nuestra sociedad y un importante problema de salud publica debido a su asociación con los accidentes laborales y de tráfico. El objetivo del presente estudio es establecer la relación entre somnolencia diurna medida con el ESS y los diferentes turnos de trabajo, en una muestra de policía local. Resultados: Indican que los agentes que se encuentran en el turno fijo y de mañana presentan mayores puntuaciones en somnolencia diurna. También se establece en este estudio que un 36,5% de la muestra padecieron un accidente laboral y que de ellos un 9% establecen que fueron debidos a la fatiga

Higher education segregation in Spain: Gender constructs and social background

The waning influence of ascriptive factors on occupational status has been related to the expansion of higher education systems and economic modernisation. The theory of Effectively Maintained Inequality observes that the horizontal stratification of university degrees is a strategy of social differentiation used mainly by the most advantaged social class to access the occupations that are better valued in the labour market. This article verifies the effectively maintained inequality theory by means of a statistical analysis of selected degrees, differentiated by gender and social class, carried out in a Spanish university during the period of expansion and consolidation of the higher education system. The results confirm the theory, but they are partially conditioned by the vertical stratification that alters the composition by gender of the contingent of students of less advantaged social class, in which women present a greater tendency to choose degrees that are less valued by the market

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) a-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions

Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks : The GR@ACE project

Introduction: Large variability among Alzheimer's disease (AD) cases might impact genetic discoveries and complicate dissection of underlying biological pathways. Methods: Genome Research at Fundacio ACE (GR@ACE) is a genome-wide study of dementia and its clinical endophenotypes, defined based on AD's clinical certainty and vascular burden. We assessed the impact of known AD loci across endophenotypes to generate loci categories. We incorporated gene coexpression data and conducted pathway analysis per category. Finally, to evaluate the effect of heterogeneity in genetic studies, GR@ACE series were meta-analyzed with additional genome-wide association study data sets. Results: We classified known AD loci into three categories, which might reflect the disease clinical heterogeneity. Vascular processes were only detected as a causal mechanism in probable AD. The meta-analysis strategy revealed the ANKRD31-rs4704171 and NDUFAF6-rs10098778 and confirmed SCIMP-rs7225151 and CD33-rs3865444. Discussion: The regulation of vasculature is a prominent causal component of probable AD. GR@ACE meta-analysis revealed novel AD genetic signals, strongly driven by the presence of clinical heterogeneity in the AD series

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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