Problemas del proceso de peritaje psicológico de una persona adulta para determinar su internamiento en el área de inimputables en las instituciones de salud mental en el Ecuador.

El presente proyecto tiene como objetivo analizar los principales problemas para declarar a una persona adulta como inimputable en las instituciones de salud mental en el Ecuador. La investigación tuvo un enfoque cualitativo de tipo descriptivo y con diseño no experimental, en el cual se tuvo como participantes a diez profesionales, cinco de ellos profesionales de la salud mental; dos psicólogos y tres psiquiatras, también se contó con cinco profesionales del ámbito legal; cuatro abogados penales y un exjuez. Como técnica para la producción de datos se utilizó una entrevista estructurada ya que la misma permitió obtener información más precisa sobre la idea central de la presente investigación. Dicha entrevista se aplicó en una sola sesión mediante dos modalidades, de manera presencial se entrevistó a un psicólogo y un psiquiatra y de manera virtual a los demás de profesionales. Por último, la información que adquirimos permite evidenciar que los principales problemas dentro del proceso de peritaje son, la falta de profesionales certificados, el desconocimiento sobre el tipo de instrumentos que se deben aplicar, y finalmente pero no menos importantes los problemas tanto políticos como sociales.His research work aims to analyze the main problems in declaring an adult person as unimputable in mental health institutions in Ecuador. The research had a descriptive qualitative approach and a non-experimental design, in which the participants were ten professionals, five of them mental health professionals; two psychologists and three psychiatrists, and five legal professionals; four criminal lawyers and one former judge. A structured interview was used as a data production technique to obtain precise information about the central idea of the research. The interview was conducted in a single session in two modalities, face-to-face and virtual. The results acquired on the main problems within the expertise process are as follows; the lack of certified professionals, lack of knowledge about the type of instruments to be applied, political problems such as the lack of legislation in the country on this process, and social problems such as the lack of interest in rehabilitating the accused

Catalytic and molecular insights of the esterification of ibuprofen and ketoprofen with glycerol

The esterification of rac-ibuprofen and rac-ketoprofen with glycerol catalyzed with the commercial biocatalyst Novozym® 435 was investigated at 45 °C with various profen: glycerol molar ratios using 2-propanol as co-solvent in a batch type reaction. The conversion of rac-ibuprofen reached 46%, with an enantiomeric excess towards the S-enantiomer of 42%. When 1:4 ibuprofen:glycerol molar ratio was assayed, 75% of the R-ibuprofen reacted with glycerol towards the monoglyceride with 99% selectivity, which is highly relevant in the field of prodrugs synthesis. The conversion of rac-ketoprofen was lower, 17 % vs. 46 % of rac-ibuprofen, and the esterification afforded both the monoglyceride (70%) and diglyceride (30%) regardless of the ketoprofen:glycerol molar ratio. Investigations of the esterification at molecular level through concentration-modulated infrared spectroscopy, static ATR-FTIR and in situ Raman spectroscopy showed the continuous decay of the species belonging to rac-ibuprofen and glycerol providing further evidences of the reaction. Moreover, the interaction of CALB with ibuprofen modifies the contribution of the ordered structures of the lipase, which might be related with the improved catalytic performance in the esterification of that profen.Fil: Toledo, Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco". Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Ciencias Aplicadas; ArgentinaFil: José, Carla. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco". Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Ciencias Aplicadas; ArgentinaFil: Llerena Suster, Carlos Rafael. Facultad de Ciencias Exactas, Universidad Nacional de la Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco". Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Ciencias Aplicadas; ArgentinaFil: Collins, Sebastián Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Portela, Raquel. Consejo Superior de Investigaciones Científicas. Instituto de Tecnología Química; EspañaFil: Bañares, Miguel A.. Consejo Superior de Investigaciones Científicas. Instituto de Tecnología Química; EspañaFil: Briand, Laura Estefania. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco". Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Ciencias Aplicadas; Argentin

Integración de estrategias sobre la sostenibilidad en la Educación Superior

University students are constantly learning, so it is appropriate to integrate sustainable development strategies in higher education institutions, since it is a training environment where students can learn easily and transfer that knowledge to society in general. The purpose of this study is to know which strategies have been previously used in Higher Education Institutions and that have given effective and efficient results in the integration of sustainability. To this end, an investigation has been carried out using a bibliographic type and with PRISMA methodology, that is, a systematic review of the information presented by different authors was carried out, to develop a contrast of ideas and a synthesis of the knowledge acquired from the documents, identifying critical aspects, in order to answer questions and generate theories of how sustainability strategies can be integrated into higher education and what strategies higher education institutions can incorporate to comply with sustainable development objectives. The research concludes that it is important to mention the 2030 Agenda, which includes the sustainable development objectives and the goals that must be achieved in each of them, to propose an action plan that optimizes compliance time, involving multidisciplinary teams that analyze the different existing axes and create sustainable, inclusive and beneficial strategies to fulfill them.Los estudiantes universitarios están en constante aprendizaje, por lo que es oportuno integrar las estrategias de desarrollo sostenible en las instituciones de educación superior, pues es un ambiente formativo en donde el alumnado puede aprender con facilidad y trasladar ese conocimiento hacia la sociedad en general. El presente estudio tiene como objeto conocer cuáles son las estrategias que han sido utilizadas anteriormente en las Instituciones de Educación Superior y que han dado resultados efectivos y eficaces en la integración de la sostenibilidad, para ello, se ha llevado a cabo una investigación con modalidad de tipo bibliográfica y con metodología PRISMA, es decir, que se realizó una revisión sistemática de la información expuesta por diferentes autores, para desarrollar un contraste de ideas y una síntesis del conocimiento adquirido de los documentos, identificando aspectos críticos, con el fin de responder preguntas y generar teorías de cómo se puede integrar las estrategias de sostenibilidad en la educación superior y qué estrategias pueden incorporar las instituciones de educación superior para dar cumplimiento a los objetivos de desarrollo sostenible. La investigación concluye que es importante mencionar la Agenda 2030 que incluye los objetivos de desarrollo sostenible y las metas que se deben alcanzar en cada uno de ellos, para plantear un plan de acción que optimice el tiempo de cumplimiento, que involucre equipos multidisciplinarios que analicen los diferentes ejes existentes y creen estrategias sostenibles, incluyentes y beneficiosas para cumplirlos

Milder Alzheimer\u27s Disease Pathology in Heart Failure and Atrial Fibrillation

Introduction:Heart failure (HF) and atrial fibrillation (AF) have been associated with a higher risk of Alzheimer’s disease (AD). Whether HF and AF are related to AD by enhancing AD neuropathological changes is unknown. Methods:We applied network analyses and multiple logistic regression models to assess the association between HF and AF with severity of AD neuropathology in patients from the National Alzheimer’s Coordinating Center database with primary neuropathological diagnosis of AD. Results:We included 1593 patients, of whom 129 had HF and 250 had AF. HF and AF patients were older and had milder AD pathology. In the network analyses, HF and AF were associated with milder AD neuropathology. In the regression analyses, age (odds ratio [OR] 0.94, 95

High Plasma Glutamate and a Low Glutamine-to-Glutamate Ratio Are Associated with Increased Risk of Heart Failure but Not Atrial Fibrillation in the Prevención con Dieta Mediterránea (PREDIMED) Study

[Background] Although the association between glutamate and glutamine in relation to cardiometabolic disorders has been evaluated, the role of these metabolites in the development of atrial fibrillation (AF) and heart failure (HF) remains unknown.[Objectives] We examined associations of glutamate, glutamine, and the glutamine-to-glutamate ratio with AF and HF incidence in a Mediterranean population at high cardiovascular disease (CVD) risk.[Methods] The present study used 2 nested case-control studies within the PREDIMED (Prevención con Dieta Mediterránea) study. During ∼10 y of follow‐up, there were 509 AF incident cases matched to 618 controls and 326 HF incident cases matched to 426 controls. Plasma concentrations of glutamate and glutamine were semiquantitatively profiled with LC–tandem MS. ORs were estimated with multivariable conditional logistic regression models. [Results] In fully adjusted models, per 1-SD increment, glutamate was associated with a 29% (95% CI: 1.08, 1.54) increased risk of HF and glutamine‐to‐glutamate ratio with a 20% (95% CI: 0.67, 0.94) decreased risk. Glutamine-to-glutamate ratio was also inversely associated with HF risk (OR per 1-SD increment: 0.80; 95% CI: 0.67, 0.94) when comparing extreme quartiles. Higher glutamate concentrations were associated with a worse cardiometabolic risk profile, whereas a higher glutamine-to-glutamate ratio was associated with a better cardiometabolic risk profile. No associations between the concentrations of these metabolites and AF were observed.[Conclusions] Our findings suggest that high plasma glutamate concentrations possibly resulting from alterations in the glutamate-glutamine cycle may contribute to the development of HF in Mediterranean individuals at high CVD risk.Supported by NIH grant R01HL118264 (to FBH); Spanish Ministry of Health (Instituto de Salud Carlos III) and Ministerio de Economía y Competitividad-Fondo Europeo de Desarrollo Regional projects CNIC-06/2007, RTIC G03/140, CIBER 06/03, PI06-1326, PI07-0954, PI11/02505, SAF2016-80532, SAF2009-12304, and AGL2010-22319-C03-03; and Generalitat Valenciana PROMETEO 17/2017, ACOMP2010-181, AP111/10, AP-042/11, ACOM2011/145, ACOMP/2012/190, ACOMP/2013/159, and ACOMP/213/165. CP was the recipient of Instituto de Salud Carlos III Miguel Servet fellowship grant CP 19/00189. PH-A was supported by Juan de la Cierva-Formación postdoctoral fellowship FJCI-2017-32205. MG-F was supported by American Diabetes Association grant #1-18-PMF-029

Circulating Amino Acids and Risk of Peripheral Artery Disease in the PREDIMED Trial

Effective prevention and risk prediction are important for peripheral artery disease (PAD) due to its poor prognosis and the huge disease burden it produces. Circulating amino acids (AA) and their metabolites may serve as biomarkers of PAD risk, but they have been scarcely investigated. The objective was to prospectively analyze the associations of baseline levels of plasma AA (and their pathways) with subsequent risk of PAD and the potential effect modification by a nutritional intervention with the Mediterranean diet (MedDiet). A matched case-control study was nested in the PREDIMED trial, in which participants were randomized to three arms: MedDiet with tree nut supplementation group, MedDiet with extra-virgin olive oil (EVOO) supplementation group or control group (low-fat diet). One hundred and sixty-seven PAD cases were matched with 250 controls. Plasma AA was measured with liquid chromatography/mass spectrometry at the Broad Institute. Baseline tryptophan, serine and threonine were inversely associated with PAD (ORfor 1 SD increase = 0.78 (0.61–0.99); 0.67 (0.51–0.86) and 0.75 (0.59–0.95), respectively) in a multivariable-adjusted conditional logistic regression model. The kynurenine/tryptophan ratio was directly associated with PAD (ORfor 1 SD increase = 1.50 (1.14–1.98)). The nutritional intervention with the MedDiet+nuts modified the association between threonine and PAD (p-value interaction = 0.018) compared with the control group. However, subjects allocated to the MedDiet+EVOO group were protected against PAD independently of baseline threonine. Plasma tryptophan, kynurenine/tryptophan ratio, serine and threonine might serve as early biomarkers of future PAD in subjects at a high risk of cardiovascular disease. The MedDiet supplemented with EVOO exerted a protective effect, regardless of baseline levels of threonine

Plasma lipidome and risk of atrial fibrillation: results from the PREDIMED trial

The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevenci\uf3n con Dieta Mediterr\ue1nea (PREDIMED) trial participants and incidence of AF. We conducted a nested case–control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention. Forty-one individual lipids were associated with AF at the nominal level (p < 0.05), but no longer after adjustment for multiple-testing. However, the network-based score identified with a robust data-driven lipid network showed a multivariable-adjusted ORper+1SD of 1.32 (95% confidence interval: 1.16–1.51; p < 0.001). The score included PC plasmalogens and PE plasmalogens, palmitoyl-EA, cholesterol, CE 16:0, PC 36:4;O, and TG 53:3. No interaction with the dietary intervention was found. A multilipid score, primarily made up of plasmalogens, was associated with an increased risk of AF. Future studies are needed to get further insights into the lipidome role on AF. Current Controlled Trials number, ISRCTN35739639

Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial

BackgroundHypertension can be prevented by adopting healthy dietary patterns. Our aim was to assess the 4-year effect on blood pressure (BP) control of a randomized feeding trial promoting the traditional Mediterranean dietary pattern.MethodsThe PREDIMED primary prevention trial is a randomized, single-blinded, controlled trial conducted in Spanish primary healthcare centers. We recruited 7,447 men (aged 55 to 80 years) and women (aged 60 to 80 years) who had high risk for cardiovascular disease. Participants were assigned to a control group or to one of two Mediterranean diets. The control group received education on following a low-fat diet, while the groups on Mediterranean diets received nutritional education and also free foods; either extra virgin olive oil, or nuts. Trained personnel measured participants’ BP at baseline and once yearly during a 4-year follow-up. We used generalized estimating equations to assess the differences between groups during the follow-up.ResultsThe percentage of participants with controlled BP increased in all three intervention groups (P-value for within-group changes: P<0.001). Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group (−1.53 mmHg (95% confidence interval (CI) −2.01 to −1.04) for the Mediterranean diet supplemented with extra virgin olive oil, and −0.65 mmHg (95% CI -1.15 to −0.15) mmHg for the Mediterranean diet supplemented with nuts). No between-group differences in changes of systolic BP were seen.ConclusionsBoth the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP. However, we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group.Trial registrationCurrent Controlled Trials ISRCTN3573963

Morbid liver manifestations are intrinsically bound to metabolic syndrome and nutrient intake based on a machine-learning cluster analysis

Metabolic syndrome (MetS) is one of the most important medical problems around the world. Identification of patient ' s singular characteristic could help to reduce the clinical impact and facilitate individualized management. This study aimed to categorize MetS patients using phenotypical and clinical variables habitually collected during health check-ups of individuals considered to have high cardiovascular risk. The selected markers to categorize MetS participants included anthropometric variables as well as clinical data, biochemical parameters and prescribed pharmacological treatment. An exploratory factor analysis was carried out with a subsequent hierarchical cluster analysis using the z-scores from factor analysis. The first step identified three different factors. The first was determined by hypercholesterolemia and associated treatments, the second factor exhibited glycemic disorders and accompanying treatments and the third factor was characterized by hepatic enzymes. Subsequently four clusters of patients were identified, where cluster 1 was characterized by glucose disorders and treatments, cluster 2 presented mild MetS, cluster 3 presented exacerbated levels of hepatic enzymes and cluster 4 highlighted cholesterol and its associated treatments Interestingly, the liver status related cluster was characterized by higher protein consumption and cluster 4 with low polyunsaturated fatty acid intake. This research emphasized the potential clinical relevance of hepatic impairments in addition to MetS traditional characterization for precision and personalized management of MetS patients

Barriers, facilitators and success criteria in the implementation of eHealth solutions in healthcare

As a response to the need for efficiency and innovation that modern society hasplaced over healthcare organizations, they are constantly looking for more efficientand innovative tools that facilitate the daily practices for providers. In this context,the use of digital solutions or eHealth arises as an alternative for healthcare.Despite the potential benefits of eHealth solutions, healthcare leaders experiencedifficulties implementing them. For that reason, health services researchersacknowledge the critical role of implementation science in the sector. Seeking tomotivate organizations to embrace eHealth solutions and their benefits, thisresearch identifies the barriers and facilitators experienced by project managersduring the implementation projects of innovations in healthcare. Moreover, itproposes the clarification of concrete criteria to assess success derived from theoutcomes of an implementation project. Starting with a literature review, followedby qualitative research and a data collection through a total of ten semi-structuredinterviews with project managers. Moreover, the data analysis is made based onthematic analysis. The results identify three main facilitators for innovation: 1)maintaining a balanced level of understanding for all stakeholders, 2) to have opencommunication, and 3) to have a high involvement of the top management with theproject. Moreover, the most relevant barrier faced by managers is the lack of skilledand competent people within the organization. Regarding the success ofimplementation projects, the most relevant criteria are: 1) delivering in the righttime, budget, scope and quality (reach the project goals), 2) maintaining thecustomer and user satisfaction, and 3) increase in work efficiency in the healthcareorganizations. To some extent, the mentioned factors contribute to facilitating theimplementation of innovations in healthcare. The role of managers inimplementation is highly valuable since they represent the bridge between topmanagement and front-line employees. This research summarizes the experienceof the managers -from a consultancy company- while working in theimplementation of digital tools in healthcare. Therefore, the research provides abetter understanding regarding the barriers, facilitators and success criteria forimplementation