Beyond the consultation room : Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers

Primary health care () is the ideal setting to provide integrated services centred on the person and to implement health promotion () activities. To identify proposals to approach in the context of primary care according to health-care users aged 45-75 years, key community informants and primary care centre () workers. Descriptive-interpretive qualitative research with 276 participants from 14 of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out. Participants consider that is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. , care in the community and demedicalization should be priorities for . Participants propose organizational changes in the to improve . workers are aware that falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that should be person-centred approach and empathic communication. activities should be appealing, ludic and of proven effectiveness. According to a socio-ecological and intersectoral model, services must get actively involved in together with community and through outreach interventions

Obstetric outcomes of sars-cov-2 infection in asymptomatic pregnant women

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER)Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial

CDATA[CDATA[Background: Health promotion is a key process of current health systems Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two 01 more risk behaviours, that is why a multiple intervention might be more effective and efficient The primary objectives are to evaluate the effectiveness, the cost effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. CDATA[CDATA[Methods: This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care It will be carried out in 26 PHC centres in Spam The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the ''5A''s" It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community) Incremental cost per quality adjusted life year gamed measured by the tanffs of the EuioQo! 5D questionnaire will be estimated. The implementation strategy is based on the ''Consolidated Framework for Implementation Research, a set of discrete implementation strategies and an evaluation framework. CDATA[CDATA[Discussion: EIRA study will determine the effectiveness and cost effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217

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

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

La Rábida 2018 International Scientific Meeting on Nuclear Physics

This book features material presented at the La Rabida 2018 International Scientific Meeting on Nuclear Physics, which was based on a well-known series of triennial international summer schools on Nuclear Physics organized from 1982 to 2003 by the Basic Nuclear Physics group at the University of Seville and latter, from 2009 to 2018, by the University of Seville and the University of Huelva. The meeting offered graduate students and young researchers a broad overview of the field of nuclear physics. The book includes contributions from invited speakers on topics such as a state-of-the-art nuclear shell model and selected aspects of mass spectroscopy. Other chapters present an introduction to shell model, a review of experimental nuclear reactions, a discussion of the theory of nuclear reactions and an overview of nuclear medicine. Further, the posters and seminars presented by students offer fresh perspectives on various problems current in nuclear physics

Relación entre actividad física y niveles de estrés en estudiantes de medicina de una universidad privada de Lima, Perú durante la pandemia del COVID-19 en el 2020

Antecedentes: Se ha encontrado un efecto protector de la actividad física sobre los niveles de estrés en publicaciones previas, por lo cual nuestro estudio tiene como objetivo probar si los niveles de estrés fluctúan en relación a la cantidad de ejercicio realizado durante la pandemia por COVID-19 Metodología: Estudio transversal analítico en estudiantes de medicina de una universidad privada mayores de 18 años que responderán preguntas relacionadas con la actividad física y la percepción al estrés basados en el GPAQ y EEP-14, respectivamente. La variable respuesta será la percepción del estrés. Se utilizará la prueba exacta de Fisher para variables categóricas. El análisis multivariado será realizado mediante un modelo de regresión de Poisson para el cálculo del PR con sus respectivos intervalos de confianza al 95% (IC 95%)

Factors associated with the diagnosis of tuberculosis in children and adolescents evaluated for chronic cough in a pediatric hospital in the years 2017 to 2019

Factores asociados al diagnóstico de tuberculosis en niños y adolescentes evaluados por tos crónica en un hospital pediátrico en los años 2017 a 2019 Introducción: La tos crónica es aquella que tiene una duración mayor a 4 semanas y se calcula que representa alrededor del 5% a 10% de las consultas en neumología pediátrica. En el 2018, la OMS reportó más de un millón de casos de tuberculosis infantil, con una mortalidad de 14%. Sin embargo, esta enfermedad no está incluída en la actualidad en los algoritmos de tos crónica, y su diagnóstico se dificulta por la tos paucibacilar presentada en niños y la variabilidad en la presentación clínica. Justificación: En la actualidad, no existe una guía para el diagnóstico diferencial de la tos crónica en el Perú que haya sido adaptada al diagnóstico clínico de tuberculosis en el país, a pesar de que esta enfermedad representa un alto costo y uso de servicios médicos. Asimismo, un diagnóstico precoz de la tuberculosis se asocia a una menor incidencia de complicaciones a largo plazo. Materiales y Métodos: Se realizó un estudio de tipo transversal analítico utilizando las historias clínicas recolectadas como muestreo no probabilístico por casos consecutivos tipo censo con motivo de consulta de tos por más de 4 semanas en el año 2019. Se calculó la razón de prevalencia según la regresión de Poisson. Resultados: Se analizó a 220 pacientes con una mediana de tos de 6 semanas (IQR 4-12). La mediana de la edad fue de 3.75 años (RIQ: 1.92 a 6.29) y 73 (60.8%) pacientes fueron varones. El antecedente de contacto epidemiológico tuvo una RP de 3.08 (IC95% 1.23-8.38, p=0.016). La pérdida de peso tuvo un RP de 3.06 (IC 95% 1.12-8.38, p = 0.03) y presentar una prueba de PPD positiva aumentaba en 2.71 veces (IC 95% 1.67-24.03, p=0.007) la probabilidad de tener tuberculosis en la población estudiada. Conclusiones: La baja de peso, el contacto epidemiológico y el PPD positivo fueron factores asociados al diagnóstico Sin embargo, estudios a mayor escala y con poblaciones diversas son necesarios para el desarrollo de una guía estandarizada.Introduction: Chronic cough is defined as a cough that lasts longer than 4 weeks, and it is estimated that it accounts for 5% to 10% of pediatric pneumology visits. In 2018, the WHO reported more than one million cases of tuberculosis in children, with a mortality of 14%. However, this disease is not included on the chronic cough algorithms and its diagnosis may be challenging due to the paucibacillary of the cough in children and the variability of the clinical presentation Justification: At the moment, there doesn’t exist a chronic cough differential diagnosis algorithm in Peru which is adapted to the diagnosis of pediatric tuberculosis despite the fact that this disease represents a high public health cost and use of medical services, likewise an early diagnosis of tuberculosis is associated with a decrease in long term complications. Methods: A transversal analytical study was carried out using the clinical histories collected as non-probabilistic sampling using consecutive census-type cases that had cough for more than 4 weeks as primary symptom in the year 2019. The prevalence ratio was calculated according to the Poisson. Results: 220 patients with a median cough of 6 weeks (IQR 4-12) were analyzed. The median age was 3.75 years (IQR: 1.92 to 6.29) and 73 (60.8%) patients were male. The history of epidemiological contact had a PR of 3.08 (95% CI 1.23-8.38, p=0.016). Weight loss had a PR of 3.06 (95% CI 1.12-8.38, p = 0.03) and presenting a positive PPD test increased by 2.71 times (95% CI 1.67-24.03, p=0.007) the probability of having tuberculosis in the population studied. Conclusions: Weight loss and epidemiological contact were associated with the diagnosis, as well as positive PPD. However, studies on a larger scale and with diverse populations are necessary for the development of a standardized guide.Tesi

Oenological Impact of the Hanseniaspora/Kloeckera Yeast Genus on Wines—A Review

Apiculate yeasts of the genus Hanseniaspora/Kloeckera are the main species present on mature grapes and play a significant role at the beginning of fermentation, producing enzymes and aroma compounds that expand the diversity of wine color and flavor. Ten species of the genus Hanseniaspora have been recovered from grapes and are associated in two groups: H. valbyensis, H. guilliermondii, H. uvarum, H. opuntiae, H. thailandica, H. meyeri, and H. clermontiae; and H. vineae, H. osmophila, and H. occidentalis. This review focuses on the application of some strains belonging to this genus in co-fermentation with Saccharomyces cerevisiae that demonstrates their positive contribution to winemaking. Some consistent results have shown more intense flavors and complex, full-bodied wines, compared with wines produced by the use of S. cerevisiae alone. Recent genetic and physiologic studies have improved the knowledge of the Hanseniaspora/Kloeckera species. Significant increases in acetyl esters, benzenoids, and sesquiterpene flavor compounds, and relative decreases in alcohols and acids have been reported, due to different fermentation pathways compared to conventional wine yeasts