Satisfacción de usuarias del servicio control prenatal en instituciones prestadoras de servicios de salud privadas.

Introduction: At present, the concept of satisfaction is widely applied in all dimensions of the health services. This concept configures the user’s complacency based on their expectations and is derived from the conditions in which the service is provided, the service quality and their characteristics, behaviors and functions, which generate wellness. Objective: To establish satisfaction level of users of the pregnancy control service attended by private health institutions of Cartagena. Materials and methods: Descriptive study, with a reference population of 5873 pregnant women. A sample size of 413 low-risk pregnant women, treated at private institutions in Cartagena, was estimated. For the gathering of information, a sociodemographic characterization survey and the questionnaire were used to assess satisfaction with pregnancy control services, proposed and validated by Colmenares F, which consists of two parts: the first includes 25 items that measure satisfaction with accessibility, infrastructure and the service process; the second includes 30 dichotomous questions to assess the educational orientation received by health personnel. The data was stored in a Microsoft Excel program datasheet and analyzed using the statistical program SPSSS version 17. Results: 412 women with a mean age of 26.4 (SD = 4.9) participated. Of these, 50.2% (207) were employed and 42.2% (174) coexist in free union. In relation to satisfaction, all women said they were completely satisfied with regard to accessibility, structure and health care, however, 8.5% (17) were dissatisfied with the stipulated hours of care. In addition, 20.1% (83) were moderately satisfied with the educational orientation received. Conclusions: Pregnant women treated at private institutions in Cartagena showed a good perception of satisfaction, mainly explained by the accessibility, infrastructure, and care of health care personnel. Rev.cienc.biomed.2017; 8(1-2):xxx-xxxIntroducción: En la actualidad el concepto de satisfacción es ampliamente aplicado en todas las dimensiones de la prestación de los servicios de la salud. Este concepto configura la complacencia del usuario en función de sus expectativas y se deriva de las condiciones en las cuales se brinda el servicio, la calidad en la prestación de estos y de características, comportamientos y funciones de los mismos, que generan bienestar. Objetivo: Determinar el nivel de satisfacción de usuarias del servicio de control prenatal atendidas en Instituciones Prestadoras de Servicios de Salud (IPS) privadas de Cartagena. Materiales y métodos: Estudio descriptivo, con población de referencia de 5873 embarazadas. Se estimó un tamaño de muestra de 413 gestantes de bajo riesgo, atendidas en IPS privadas de Cartagena. Para la recolección de información se utilizó una encuesta de caracterización sociodemográfica y el cuestionario para evaluar la satisfacción con los servicios de salud de atención prenatal, propuesto y validado por Colmenares F, que consta de dos partes: la primera incluye 25 ítems que miden la satisfacción con la accesibilidad, infraestructura y el proceso de atención; la segunda incluye 30 preguntas dicotómicas para evaluar la orientación educativa recibida por el personal de salud. Los datos se almacenaron en una hoja de cálculo del programa Microsoft Excel y se analizaron en el programa estadístico SPSSS versión 17. Resultados: Participaron 412 mujeres con un promedio de edad de 26,4 (DE=4,9). De estas el 50,2% (207) se encuentran empleadas y el 42,2% (174) conviven en unión libre. Con relación a la satisfacción, todas las mujeres manifestaron estar completamente satisfechas respecto a la accesibilidad, estructura y atención, sin embargo, un 8,5% (17) están inconformes con el horario de atención estipulado. Además, el 20,1% (83) están medianamente satisfechas con la orientación educativa recibida. Conclusiones: Las gestantes atendidas en las IPS privadas de Cartagena mostraron una buena percepción de la satisfacción, explicada principalmente por la accesibilidad, infraestructura, y atención del personal de salud. Rev.cienc. biomed.2017;8(1-2):xxx-xx

La atención a la diversidad de los menores en conflicto con la ley Penal desde una visión integradora

Responder a las necesidades del mejoramiento profesional y humano atendiendo a la diversidad, es una de las exigencias de los sistemas educativos. Estudios internacionales realizados por diversos autores han demostrado preocupaciones por la atención a los menores que se encuentran en conflicto con la Ley. El objetivo de este trabajo se refiere a un estudio de revisión por diferentes profesionales del orbe, acerca de la atención que reciben los menores que se encuentran en conflicto con la ley penal, así como las causas que lo originan, líneas de trabajo y estrategias a desarrollar para su prevención y atención en todos los niveles desde la intersectorialidad

Five Patients with Disorders of Calcium Metabolism Presented with GCM2 Gene Variants

The GCM2 gene encodes a transcription factor predominantly expressed in parathyroid cells that is known to be critical for development, proliferation and maintenance of the parathyroid cells. A cohort of 127 Spanish patients with a disorder of calcium metabolism were screened for mutations by Next-Generation Sequencing (NGS). A targeted panel for disorders of calcium and phosphorus metabolism was designed to include 65 genes associated with these disorders. We observed two variants of uncertain significance (p.(Ser487Phe) and p.Asn315Asp), one likely pathogenic (p.Val382Met) and one benign variant (p.Ala393_Gln395dup) in the GCM2 gene in the heterozygous state in five families (two index cases had hypocalcemia and hypoparathyroidism, respectively, and three index cases had primary hyperparathyroidism). Our study shows the utility of NGS in unravelling the genetic origin of some disorders of the calcium and phosphorus metabolism, and confirms the GCM2 gene as an important element for the maintenance of calcium homeostasis. Importantly, a novel variant in the GCM2 gene (p.(Ser487Phe)) has been found in a patient with hypocalcemia.This study was supported by three grants from the Department of Health (2017111014, 2018111097 and 2019111052) and one grant from the Department of Education (IT1281-19) of the Basque Government. This work is generated within the Endocrine European Reference Network (Project ID number of Endo-ERN: 739527). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Tarteso. Nuevas Fronteras (II)

El presente volumen recoge las contribuciones presentadas al II Congreso Internacional sobre Tarteso, Nuevas Fronteras, que tuvo lugar en Mérida entre los días 17 y 19 de noviembre de 2021. Su lectura permite un viaje desde el extremo oriental del Mediterráneo hasta el suroeste de la península ibérica, mostrando las diversas realidades históricas acontecidas en este territorio durante la I Edad del Hierro. El objetivo de esta publicación es mostrar la situación que atravesaba el Mediterráneo durante los años de surgimiento y desarrollo de la cultura tartésica para así comprender mejor la formación y evolución de dicha cultura. El conocimiento de Tarteso ha evolucionado sensiblemente en la última década, desde la celebración y publicación de las actas del I Congreso Internacional, Tarteso. El emporio del metal (Almuzara, 2013). La incorporación de nuevas voces y visiones enfocadas al conocimiento de la protohistoria peninsular, así como de algunos temas nunca antes abordados en el conocimiento de Tarteso, permiten presentar en este volumen una visión renovada, donde destaca la incorporación de unos nuevos límites territoriales para esta cultura.Esta publicación se ha beneficiado de las siguientes ayudas para su financiación: Proyecto de Investigación del Plan Nacional I+D+i: “Construyendo Tarteso 2.0: análisis constructivo, espacial y territorial de un modelo arquitectónico en el valle medio del Guadiana” (PID2019-108180GBI00), financiado por MCIN (AEI/10.13039/501100011033). Subvención global de la Secretaría General de Ciencia, Tecnología, Innovación y Universidad de la Junta de Extremadura al Instituto de Arqueología.Peer reviewe

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group