Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Elaboración de una bebida utilizando subproductos de la industria láctea

La producción de suero a nivel mundial es de 180 a 190 millones de toneladas por año y genera 1.6 billones de litros de suero ácido como residuo. Ecuador destina el 40% de la producción de leche a la industrialización y a la elaboración de quesos artesanales. El suero presenta lactosa, sólidos totales, proteína, minerales y vitaminas; el suero ácido posee mayor cantidad de fósforo, ácido láctico y aminoácidos esenciales frente al suero dulce. Los nutrientes producen contaminación al generar altas cantidades de DBO y DBQ. El objetivo de este estudio fue evaluar la utilización de suero ácido y goma xanthan en la elaboración de un néctar de naranja. Se utilizó un diseño completamente al azar, con arreglo factorial 22 (suero ácido: 10 y 15%; goma xanthan: 0.05 y 0.1%) y cuatro repeticiones. Los datos fueron examinados mediante Análisis de Varianza y prueba de Tukey (5%).El tratamiento con 10% de suero ácido y 0.1% de goma xanthan fue el único que cumplió con las especificaciones establecidas para pH, acidez y sólidos solubles. Sensorialmente se ubicó entre “me gusta” y “me gusta mucho” (nivel de agrado del 85%). La intención de compra mostró que el 86% de consumidores compraría el producto

Topographic connection method for automated mapping of landslide inventories, study case: semi urban sub-basin from Monterrey, Northeast of México

By nature, slopes are conformed by forces that are in constant balance. Altering this natural balance causes the sliding of soil towards lower zones. Landslides are a constant danger that compromises the general welfare of society. Landslides mapping is especially important for urban areas or development plans. The innovative aspect of this study is the creation of the Topographic Connection Method (TPCM) to automatically map landslides using two types of landslides 1) falls and 2) flows. TPCM cartography results were compared to a previously proven method (Contour Connection Method), as well as to the manual inventory method. Each method was run four times to locate changes through time by using satellite imagery, digital elevations models and 3D relief visualizations with data covering a period from 2012 to 2017. Results showed both falls and flows with all three methods and demonstrated that TPCM can improve mapping accuracy by up to 14%

Assessing the relationship between contributing factors and sinkhole occurrence in Mexico City

AbstractSinkholes pose a significant hazard in Mexico City (CDMX), causing substantial economic damage. While the link between sinkhole formation and groundwater extraction has been studied, specific mechanisms vary by site. Our overall aim is to characterize the phenomenon of sinkholes in CDMX. To achieve this, we create a database with 13 influencing factors, including population density, well density, distance to faults, fractures, roads, streams, elevation, slope, clay thickness, lithology, subsidence rate, geotechnical zones, and soil texture. Sinkhole locations were obtained from CDMX’s Risk Atlas (2017–2019). We shaped a susceptibility map based on statistical regression methods derived from applying linear regression models. For the susceptibility map, results showed that 40% of variables are significantly correlated with sinkhole density. Despite the regression model explained 24% of sinkhole density variability, it helped choosing variables for the susceptibility map that correlate better (89.7%). Hence, we identified that the northeast CDMX was the most susceptible zone. Therefore, the compound assessment of environmental factors is useful for the evaluation of susceptibility maps to identify prone factors for the generation of sinkholes. This framework provides relevant information for better use of the territory throughout the development of public policies

Assessing vertical structure of an endemic forest in succession using terrestrial laser scanning (TLS). Case study: Guadalupe Island

Endemic species comprise 16% of the floral species on Guadalupe Island, including three arboreal species. Almost 96% of the forest coverage was lost due to impacts related to feral goats and wildfires. To date, goats have been eradicated and the restoration of the native vegetation communities is underway. The purpose of this study was to develop a 3D Structural Classification Method (3D-SCM) using Terrestrial Laser Scanner (TLS) for mapping the vertical structure of the forest and to automatically characterize its physical attributes. Several TLS scans were performed in July 2016 to assess this recovery, particularly the succession progression. The 3D-SCM used the Forest Condition Classification (FCC) based on radiometric intensity and height values, and the Individual Shape Index (ISI) based on geometry and intensity parameters. It was designed to classify vegetation by stratum using a trial-and-error model to semi-automatically identify impacted areas and succession. The 3D-SCM was able to differentiate the vegetation strata by each forest community at the stand level with a precision of 93% as well as the tree structure parts (stem, branches, and leaves) with a precision of 97%, it also fits the best characteristic shape for the Guadalupe cypress (decagon) and for the pine (droplet). The resulting 3D-SCM provide precise physical specifications, demonstrates a high correlation R2 = 0.949 for (Diameter Breast Height) DBH, R2 = 0.974 for the crown and R2 = 0.97 for heights between maximum laser pulse of tree heights and crowns with respect to field measurements. Mapping 3D vertical forest measurements are important for quantifying the success of management practices and to assist future restoration actions, as it will allow quantification of forest dynamics and carbon sequestration on this island

Development of a mobile application for the integral care and attention of elderly people

En los últimos años, el número de personas que alcanzan etapas de envejecimiento ha aumentado considerablemente, lo que refleja un grave problema público. No es suficiente alcanzar largas edades, sino garantizar el cuidado y la atención integral de cada individuo. Por lo tanto, teniendo en cuenta las dificultades que enfrentan los ancianos, los Estados implementan programas de seguridad social que buscan apoyar su desarrollo. Ecuador sigue esta tendencia y presenta propuestas que abordan una serie de derechos fundamentales, que se consideran servicios de atención médica prioritarios. Aunque las medidas implementadas mantienen la salud, esta realidad cambia cuando se pasa de un escenario urbano a uno rural. Esto se justifica por el hecho de que en Ecuador, los especialistas que atienden a los ancianos cambian constantemente su ubicación y, por lo tanto, a sus pacientes, en lugar de mantener un registro de datos no estandarizado en papel, lo que causa ineficiencia y pérdida de tiempo. Por estos motivos, este artículo explica una propuesta para una aplicación móvil que busca estandarizar y digitalizar la recopilación de datos médicos de las personas mayores en las zonas rurales para aumentar la eficiencia de los procesos médicos actuales. © 2020, Springer Nature Switzerland AG.In recent years, the number of people reaching stages of ageing has increased considerably, reflecting a serious public problem. It is not enough to reach long ages, but to guarantee the integral care and attention of each individual. Thus, taking into consideration the difficulties faced by the elderly, States implement social security programs that seek to support their development. Ecuador follows this trend and presents proposals that address a number of fundamental rights, which are considered priority health care services. Although the measures implemented maintain the health, this reality changes when moving from an urban to a rural scenario. This is justified by the fact that in Ecuador, specialists who care for the elderly constantly change their location and, therefore, their patients, rather than maintaining a non-standardized data record on paper, causing inefficiency and waste of time. For these reasons, this article explains a proposal for a mobile application that seeks to standardize and digitalize the collection of medical data from the elderly in rural areas in order to increase the efficiency of current medical processes. © 2020, Springer Nature Switzerland AG.Quit

Triose Phosphate Isomerase Structure-Based Virtual Screening and In Vitro Biological Activity of Natural Products as <i>Leishmania mexicana</i> Inhibitors

Cutaneous leishmaniasis (CL) is a public health problem affecting more than 98 countries worldwide. No vaccine is available to prevent the disease, and available medical treatments cause serious side effects. Additionally, treatment failure and parasite resistance have made the development of new drugs against CL necessary. In this work, a virtual screening of natural products from the BIOFACQUIM and Selleckchem databases was performed using the method of molecular docking at the triosephosphate isomerase (TIM) enzyme interface of Leishmania mexicana (L. mexicana). Finally, the in vitro leishmanicidal activity of selected compounds against two strains of L. mexicana, their cytotoxicity, and selectivity index were determined. The top ten compounds were obtained based on the docking results. Four were selected for further in silico analysis. The ADME-Tox analysis of the selected compounds predicted favorable physicochemical and toxicological properties. Among these four compounds, S-8 (IC50 = 55 µM) demonstrated a two-fold higher activity against the promastigote of both L. mexicana strains than the reference drug glucantime (IC50 = 133 µM). This finding encourages the screening of natural products as new anti-leishmania agents