Care coordination, family-centered care and functional ability in children with special health care needs in the United States

Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children\u27s functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p \u3c 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality

The Succession in Firm Top Management and the Successor Origin: Moderating Variables

El objetivo de nuestro estudio es, por un lado, avanzar en el conocimiento de las causas que pueden provocar un cambio en la alta dirección de la empresa, y, por otro, conocer los factores que pueden influir en el origen del sucesor, considerando algunas de las variables que habitualmente han sido omitidas por la literatura previa: sucesión forzada o no forzada y poder del alto directivo dentro del gobierno corporativo de la empresa. Los resultados obtenidos indican que la principal variable que influye en la sucesión forzada y en el origen del sucesor, es el rendimiento previo. Esta relación, sin embargo, se encuentra moderada por el efecto interactivo o moderador que ejercen otra serie de variables indicativas del poder que dicho directivo posee dentro la empresa, como es el caso de la composición del Consejo de Administración, la participación de alto directivo en la propiedad de la empresa, su antigüedad en el cargo como directivo, el tamaño de la empresa o la edad de la empresa.The objective of our study is, on the one hand, to gain further knowledge into the causes that can bring about a change in firm top management, and, on the other, to know the factors that may have some influence on successor origin, considering some of the variables that have habitually been ignored by the previous literature: torced succession or non-forced succession and the power of the top manager inside the firm's corporative governance. The results obtained indícate that the main variable influencing the scenario of torced succession and the successor origin, is prior performance. This relation, however, is conditioned by the interactive or moderating effect exercised by another series of variables that are indicative of the power this manager has inside the firm, as is the composition ofthe board of directors, the top manager's participation in firm ownership, the number of years he has held the post, the firm size, or the age firm

Expression of BK-type calcium-activated potassium channel splice variants during chick cochlear development

The appearance of large-conductance, calcium-activated potassium (BK) current is a hallmark of functional maturation in auditory hair cells. Acquisition of this fast-activating current enables high-frequency, graded receptor potentials in all vertebrates and an electrical tuning mechanism in nonmammals. The gene encoding BK Α subunits is highly alternatively spliced, and the resulting variations in channel isoforms may contribute to functional diversity at the onset of hearing. We examined the tissue specificity of nine BK Α alternative exons and investigated changes in expression during chick cochlear development using quantitative polymerase chain reaction (qPCR). Each alternative was widely expressed in several tissues except for an insert near the C-terminus Ca 2+ sensing domain, which appeared brain-specific. The only alternative form in the membrane-bound core of the channel was expressed in brain and muscle but was undetected in cochlea. Of the remaining variants, three increased in expression prior to the onset of hearing and acquisition of BK currents. These three variants cause decreased Ca 2+ sensitivity or increased intracellular retention, traits that would not easily explain the advent of calcium-sensitive currents at embryonic day (E)18–19. Expression levels of other variants were mature and stable by E15, days before currents were acquired. Surface expression of C-terminal isoforms was examined using patch-clamp electrophysiology and immunocytochemistry. C-terminal variants that exhibit robust surface expression appeared in the membrane at E18, even though transcripts were unchanged during development starting from E12. These results indicate that delays in protein synthesis and trafficking/scaffolding of channel subunits underlie the late acquisition of BK currents in cochlear hair cells. J. Comp. Neurol. 518:2554–2569, 2010. © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75768/1/22352_ftp.pd

Developmental expression of BK channels in chick cochlear hair cells

<p>Abstract</p> <p>Background</p> <p>Cochlear hair cells are high-frequency sensory receptors. At the onset of hearing, hair cells acquire fast, calcium-activated potassium (BK) currents, turning immature spiking cells into functional receptors. In non-mammalian vertebrates, the number and kinetics of BK channels are varied systematically along the frequency-axis of the cochlea giving rise to an intrinsic electrical tuning mechanism. The processes that control the appearance and heterogeneity of hair cell BK currents remain unclear.</p> <p>Results</p> <p>Quantitative PCR results showed a non-monotonic increase in BK α subunit expression throughout embryonic development of the chick auditory organ (i.e. basilar papilla). Expression peaked near embryonic day (E) 19 with six times the transcript level of E11 sensory epithelia. The steady increase in gene expression from E11 to E19 could not explain the sudden acquisition of currents at E18-19, implicating post-transcriptional mechanisms. Protein expression also preceded function but progressed in a sequence from diffuse cytoplasmic staining at early ages to punctate membrane-bound clusters at E18. Electrophysiology data confirmed a continued refinement of BK trafficking from E18 to E20, indicating a translocation of BK clusters from supranuclear to subnuclear domains over this critical developmental age.</p> <p>Conclusions</p> <p>Gene products encoding BK α subunits are detected up to 8 days before the acquisition of anti-BK clusters and functional BK currents. Therefore, post-transcriptional mechanisms seem to play a key role in the delayed emergence of calcium-sensitive currents. We suggest that regulation of translation and trafficking of functional α subunits, near voltage-gated calcium channels, leads to functional BK currents at the onset of hearing.</p

Contribución al conocimiento de la flora bacteriana Gram negativa aerobia, aislada en apéndices fecales

Se estudian 27 casos de apendicitis infantiles, en los que se ha aislado como principal microorganismo al Escherichia coli (88,8%). No encontrándose al Yersinia enterocolítica, que era uno de los resultados que se pretendían obtener.The authors studied 27 cases of appendicitis. Escherichia co!i was isola­ted in 88.8% and the results trying to find Yersinia enterocolítica were negatives

Nueva etapa de la base de datos Bibliografía Histórica sobre la Ciencia y la Técnica en España

A description of the characteristics of and the changes experienced by the database, Bibliografía Histórica sobre la Ciencia y la Técnica en España produced by the Institute of the History of Medicine and Science López Piñero (UV-CSIC), with the aim of collecting the entire scholarly production concerning the history of science and technology published in Spain, as well as that carried out by Spanish authors, whether published nationally or internationallySe describen las características y cambios experimentados en la base de datos Bibliografía Histórica sobre la Ciencia y la Técnica en España, producida por el Instituto de Historia de la Medicina y de la Ciencia López Piñero (UV-CSIC), que tiene como objetivo principal recoger la totalidad de la producción científica de historia de la ciencia y de la técnica publicada en España, así como la realizada por autores españoles, publicada tanto a nivel nacional como internacional

Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis: a multinational, retrospective cohort study

Alcohol withdrawal syndrome; Alcohol-associated hepatitis; BenzodiazepinesSíndrome de abstinencia alcohólica; Hepatitis asociada al alcohol; BenzodiazepinasSíndrome d'abstinència d'alcohol; Hepatitis associada a l'alcohol; BenzodiazepinesBackground The prevalence and impact of alcohol withdrawal syndrome (AWS) in patients with alcohol-associated hepatitis (AH) are unknown. In this study, we aimed to investigate the prevalence, predictors, management, and clinical impact of AWS in patients hospitalized with AH. Methods A multinational, retrospective cohort study enrolling patients hospitalized with AH at 5 medical centres in Spain and in the USA was performed between January 1st, 2016 to January 31st, 2021. Data were retrospectively retrieved from electronic health records. Diagnosis of AWS was based on clinical criteria and use of sedatives to control AWS symptoms. The primary outcome was mortality. Multivariable models controlling for demographic variables and disease severity were performed to determine predictors of AWS (adjusted odds ratio [OR]) and the impact of AWS condition and management on clinical outcomes (adjusted hazard ratio [HR]). Findings In total, 432 patients were included. The median MELD score at admission was 21.9 (18.3–27.3). The overall prevalence of AWS was 32%. Lower platelet levels (OR = 1.61, 95% CI 1.05–2.48) and previous history of AWS (OR = 2.09, 95% CI 1.31–3.33) were associated with a higher rate of incident AWS, whereas the use of prophylaxis decreased the risk (OR = 0.58, 95% CI 0.36–0.93). The use of intravenous benzodiazepines (HR = 2.18, 95% CI 1.02–4.64) and phenobarbital (HR = 2.99, 95% CI 1.07–8.37) for AWS treatment were independently associated with a higher mortality. The development of AWS increased the rate of infections (OR = 2.24, 95% CI 1.44–3.49), the need for mechanical ventilation (OR = 2.49, 95% CI 1.38–4.49), and ICU admission (OR = 1.96, 95% CI 1.19–3.23). Finally, AWS was associated with higher 28-day (HR = 2.31, 95% CI 1.40–3.82), 90-day (HR = 1.78, 95% CI 1.18–2.69), and 180-day mortality (HR = 1.54, 95% CI 1.06–2.24). Interpretation AWS commonly occurs in patients hospitalized with AH and complicates the hospitalization course. Routine prophylaxis is associated with a lower prevalence of AWS. Prospective studies should determine diagnostic criteria and prophylaxis regimens for AWS management in patients with AH

Sexualidad animal y humana: análisis de un proyecto de formación no presencial

Se describe una experiencia de diseño y desarrollo de un curso virtual orientado a tratar cuestiones de sexualidad animal y humana con estudiantes pertenecientes de distintas carreras de la Universidadde Alicante (España). Se evalúan los recursos, las actividades desarrolladas, la participación en las mismas y el grado de satisfacción con los contenidos del curso

Quality of Life, Physical and Mental Health, and Economic Evaluation of Family Caregivers of Chronic Dependent Children: INFAPRINT Cohort Study Protocol.

Background: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group. Methods: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group. Conclusions and implications: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.Funding for open access charge: Universidad de Málag