Respectful Maternity Care interventions. What has been done?

For the last decade, there has been emerging evidence on experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth all around the world. Women suffering any of these negative experiences during labour are at 50-60% increased odds of developing severe postpartum depression, and these have also been proven to create a barrier for seeking both facility-based childbirth and postnatal health care. This is not only a quality of care issue, but a major violation of human rights. However, only a few studies have tried specifically designed interventions to reduce them. The aim of this scoping review is to synthetise all the evidence available to that respect, identifying successful initiatives that have been taken to eradicate the mistreatment, D&A women suffer during childbirth in health facilities. Published literature was searched in PubMed, and every original study assessing the effectiveness of any kind of intervention specifically designed to reduce these negative experiences was selected. Ten articles were included in this review. The publication years ranged from 2015 to 2022, and all were located in Africa except for two, whose settings took place in Mexico and the U.S. Five did a before-and-after intervention study, 3 used mixed-methods, one was a comparative study between birth centers, and another one, a quasi-experimental study. The most common feature was including some sort of Respectful Maternity Care (RMC) training for providers at the intervention center. Every study that did so, concluded that it resulted in an improvement of the care received by the delivering women. Physical abuse was the most consistently reduced. Other strategies that only a few articles explored were open maternity days, clinical checklists, wall posters and constant user feedback. The articles reviewed indicate that there are effective interventions to reduce D&A and promote RMC for women during facility-based childbirth. Specific types of training and different initiatives complementing them should be assessed by further scientific research, and RMC interventions applying these strategies should be implemented by health institutions to assure a human rights based maternity care for women giving birth in health facilities all around the world

Renovación intelectual y prestigio social: "Novatores", academias e instituciones públicas en la Valencia de finales del siglo XVII y principios del XVIII

Los partidarios de la renovación literaria, científica y filosófica alcanzaron gran prestigio e influencia en la Valencia de finales del siglo XVII. La fundación de academias de diferentes tipos y orientaciones constituye la más acabada expresión de esta realidad. El nacimiento de la Academia del Alcázar, las actividades desarrolladas por sus miembros como manifestación de una incipiente cultura cortesana durante la penúltima década de la centuria y la dimensión política que cabe atribuir a todas ellas son analizadas en la segunda parte de este artículo. (A

Enfermedad multi-valvular y eje renina-angiotensina-aldosterona en la era de las terapias valvulares a través de catéter.

The PhD thesis analyze several factors that may modify the prognosis in patients with valve disease. First of all, factors related to mitral regurgitation are evaluated in patients receiving a transcatheter aortic valve replacement (TAVR). A prospective validation of a score that predicts mitral regurgitation persistence after TAVR is performed. This score will help to plan the best treatment for these patients. Second, an analysis of the effect of renin-angiontensin system inhibitors (RASI) on patients with aortic stenosis after TAVR is done. The evaluated outcomes are the total mortality, the cardiovascular mortality and its effects on cardiac remolding. This study suggests that RASI may improve these outcomes in patients after TAVR. Finally, a subgroup analysis of patients with multi-valvular disease is performed. Patients with aortic stenosis and significant mitral or tricuspid regurgitation are included. RASI effects are evaluated in this sub-group of patients. Less improvement is observed compared to the global population with aortic stenosis. These worse outcomes may be related to a more advanced stage of the valvular disease and an adverse cardiac remodeling. In this scenario, RASI may no modify the evolution of the disease.El proyecto de tesis analiza varios factores modificadores del pronóstico en pacientes con enfermedad valvular. En primer lugar, se analizan los factores asociados a la persistencia de la insuficiencia mitral en pacientes a los que se decide recambiar la válvula aórtica de manera percutánea. Se valida una herramienta que busca predecir en qué pacientes la insuficiencia mitral será significativa tras el implante de la prótesis aórtica, con el objetivo de planificar mejor la estrategia terapéutica. En segundo lugar, se realiza un análisis de la influencia de los inhibidores del sistema renina-angiontensina en pacientes afectos de estenosis aórtica que se someten a un recambio valvular perctuáneo. Se analiza la influencia sobre mortalidad global, cardiovascular, así como su repercusión sobre el remodelado cardiaco en este grupo de pacientes. Los resultados sugieren un beneficio asociado a estos fármacos. Por úlitmo, se realiza un análisis específico en un subgrupo de pacientes especialmente complejo, como son aquellos que, además de la estenosis aórtica, presentan al menos, una valvulopatía significativa asociada como la insuficiencia mitral o la insuficiencia tricuspídea. Se ha sugerido que estos pacientes presentan una fase más avanzada de la enfermedad valvular, y esto se asocia a un peor pronóstico, hecho que se confirma en el presente trabajo. Se analiza la influencia de los inhibidores del sistema renina-angiotensina en estos pacientes, observándose un menor beneficio comparado con los pacientes que únicamente presentan estenosis aórtica. Este hallazago podría explicarse por encontrarse en una fase más avanzada de la enfermedad, en la que el remodelado adverso cardiaco ya ha tenido lugar y, por lo tanto, estos fármacos ya no modificarían la evolución de la enfermedad.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

Aplicación de herramientas Lean para el análisis y resolución de incidencias en una empresa del sector automovilístico

[ES] En primer lugar, se da una explicación de la empresa KH, describiendo su historia, como ha ido creciendo y evolucionando a lo largo del tiempo, así como sus objetivos principales y los valores que la rigen. También se explican las distintas unidades de negocio que forman parte de KH, definiendo de este modo los clientes a los que van enfocados los productos fabricados. Una vez realizada esta toma de contacto con el mundo del sector de la automoción y, en concreto, con las operaciones y productos realizados en KH, se define en qué se basa la cultura del Lean Manufacturing. Se centra sobre todo en aquellas herramientas Lean que se utilizarán para analizar las distintas incidencias ocurridas en la empresa, definiéndolas y documentándolas adecuadamente. La parte principal del trabajo se centra en el análisis de incidencias ocurridas en las distintas áreas que conforman la empresa, mediante su registro en la herramienta Lean 8D. Se analiza la causa raíz y los puntos de fuga del incidente, justificándolo mediante evidencias y el área de aparición del mismo. Además, también se analizan las distintas acciones implementadas para resolver el problema evitando así que el mismo incidente vuelva a ocurrir. Finalmente, se realiza un balance económico a raíz de las incidencias detectadas, conociendo el coste de las acciones implementadas y el ahorro que supone el hecho de evitar su aparición futura.[EN] First, an explanation of the KH company is given, describing its history and how it has been growing and developing over time, as well as its main objectives and the values that govern it. It also explains the different business units that are part of KH, defining the customers to whom the manufactured products are focused on. Once this contact has been made with the automotive world and, in particular, with the operations and products made in KH, the culture of Lean Manufacturing is defined. It focuses mainly on those Lean tools that we will use to analyse the different incidents that occurred in the company, defining and documenting them in the best possible way. The main part of the work is focused on the analysis of incidences occurred in the different areas that make up the company, through its registration in the 8D. The root cause and escape points of the incident are analysed, justifying it by documentary evidences, and the area of appearance of these. In addition, the different actions implemented to solve the problema are analysed, and how to prevent the same incident from happening again. Similarly, an economic balance is drawn up as a result of the incidents detected, knowing the cost of the actions implemented and the savings involved in avoiding these incidents.Palomares Catalá, P. (2019). Aplicación de herramientas Lean para el análisis y resolución de incidencias en una empresa del sector automovilístico. http://hdl.handle.net/10251/127757TFG

On Motzkin’s problem in the circle group

The version of record is available online at: https://doi.org/10.1134/S0081543821040039Given a subset D of the interval (0,1), if a Borel set A¿[0,1) contains no pair of elements whose difference modulo 1 is in D, then how large can the Lebesgue measure of A be? This is the analogue in the circle group of a well-known problem of Motzkin, originally posed for sets of integers. We make a first treatment of this circle-group analogue, for finite sets D of missing differences, using techniques from ergodic theory, graph theory and the geometry of numbers. Our results include an exact solution when D has two elements at least one of which is irrational. When every element of D is rational, the problem is equivalent to estimating the independence ratio of a circulant graph. In the case of two rational elements, we give an estimate for this ratio in terms of the odd girth of the graph, which is asymptotically sharp and also recovers the classical solution of Cantor and Gordon to Motzkin’s original problem for two missing differences.Peer ReviewedPostprint (published version

Elogio de la palabra : la obra ensayística de José Ricardo Morales

Obra ressenyada: Manuel AZNAR SOLER (ed.), José Ricardo Morales. Obras completas. Ensayos 2, Institució Alfons el Magnànim, Diputación de Valencia, 2012. 1316 pp

The death penalty in Valencia (1450-1500), numbers, urban spaces and funeral ritualities from the Brotherhood of Innocents and Helpless

Mediante una combinación de fuentes documentales de origen y procedencia diversa, se han computado fehacientemente 737 ejecuciones en Valencia entre los años 1450 y 1500. El artículo analiza este aspecto de la realidad social, judicial y política de la Valencia del Renacimiento a la luz de los recientes planteamientos historiográficos sobre la materia. Se destaca el impacto del Santo Oficio (a partir de 1482) dentro del contexto penal de la ciudad, se analiza el papel restaurador y reconciliador de la Cofradía de Inocentes y Desamparados, y se aborda la contribución de esta singular hermandad a la re-significación de los espacios urbanos y periurbanos.Through a combination of documentary sources of different origins and locations, 737 executions have been reliably computed in Valencia between the years 1450 and 1500. The article analyzes this aspect of the social, judicial and political reality of the Renaissance Valencia under the light of the recent historiographical approaches on the matter. The impact of the Holy Office (from 1482 onwards) within the penal context of the city is highlighted, the restorative and reconciling role of the Brotherhood of Innocents and Helpless is analyzed, as well as the re-signification of urban and peri-urban space by this singular institution.Estudio realizado en el marco del proyecto PURE (PUblic REnaissance: Urban Cultures of Public Space between Early Modern Europe and the Present) financiado por el programa HERA [Public Spaces: Culture and Integration in Europe (2019-2021)]. Ref.: PCI2019-103749

Epigenetics and periodontics : a systematic review

Despite decades of research, our knowledge of several important aspects of periodontal pathogenesis remains incomplete. Epigenetics allows to perform dynamic analysis of different variations in gene expression, providing this great advantage to the static measurement provided by genetic markers. The aim of this systematic review is to analyze the possible relationships between different epigenetic mechanisms and periodontal diseases, and to assess their potential use as biomarkers of periodontitis. A systematic search was conducted in six databases using MeSH and non-MeSH terms. The review fulfilled PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-analysis). 36 studies met the inclusion criteria. Due to the heterogeneity of the articles, it was not possible to conduct quantitative analysis. Regarding qualitative synthesis, however, it was found that epigenetic mechanisms may be used as biological markers of periodontal disease, as their dynamism and molecular stability makes them a valuable diagnostic tool. Epigenetic markers alter gene expression, producing either silencing or over-expression of molecular transcription that respond to the demands of the cellular surroundings. Gingival crevicular fluid collection is a non-invasive and simple procedure, which makes it an ideal diagnostic medium for detection of both oral and systemic issues. Although further research is needed, this seems to be a promising field of research in the years to come

Prevalence of burnout syndrome in physicians working in Spain: systematic review and meta-analysis

[ES] Objetivo: Analizar la prevalencia del síndrome de desgaste profesional o burnout en médicos que trabajan en España mediante una revisión sistemática con metaanálisis. Método: Se realizaron búsquedas en PubMed/MEDLINE, Embase y PsycINFO (hasta junio de 2023). Se incluyeron estudios observacionales realizados en España que presentaran la prevalencia de burnout en médicos. De cada estudio se extrajeron las características metodológicas y los resultados, y se evaluó su calidad. Se realizó una síntesis narrativa con metaanálisis de efectos aleatorios para el cálculo de proporciones. Resultados: Se incluyeron 67 estudios con 16.076 participantes. Para la variable principal, el metaanálisis reveló una prevalencia global de burnout en médicos del 24% (IC95%: 19%-29%; 46 estudios; 8821 participantes; I2 = 97%). A partir de análisis de subgrupos se observaron diferencias según el criterio diagnóstico utilizado: prevalencia del 18% (IC95%: 13%-23%) utilizando tres dimensiones de burnout, 29% (IC95%: 24%-34%) para dos dimensiones y 51% (IC95%: 42%-60%) para una dimensión. La heterogeneidad entre estudios no pudo ser explicada por completo a través de análisis adicionales, y no se encontraron diferen cias estadísticamente significativas con otras variables (p. ej., calidad de los estudios, ámbito de trabajo, categoría profesional o por especialidad médica). Conclusiones: Se aprecia una alta prevalencia del síndrome de burnout en médicos que trabajan en España. Estos resultados pueden contribuir a conocer mejor la carga asociada al burnout en médicos y al diseño de futuros estudios. Parecen ser necesarias estrategias para prevenir y mitigar esta situación. Registro del protocolo: Open Science Framework: https://osf.io/b2h4m/. [EN] Objective: To analyze the prevalence of burnout syndrome in physicians working in Spain through a systematic review with meta-analysis METHOD: We searched PubMed/MEDLINE, Embase, and PsycINFO (up to June 2023). Observational studies conducted in Spain reporting the prevalence of burnout in physicians were included. From each study, methodological characteristics and results were extracted, and their quality was evaluated. We performed a narrative synthesis with random effects meta-analysis to calculate proportions. Results: Sixty-seven studies with 16,076 participants were included. For the primary outcome, the meta-analysis revealed a global prevalence of burnout in physicians of 24% (95%CI: 19%-29%; 46 studies; 8821 participants; I2=97%). From subgroup analysis, differences were observed depending on the diagnostic criteria used: 18% (95%CI: 13%-23%) for three dimensions of burnout, 29% (95%CI: 24%-34%) for two dimensions and 51% (95%CI: 42%-60%) for one dimension. The heterogeneity between studies could not be fully explained through additional analyses where non-statistically significant differences were found with other variables (e.g., study quality, setting, professional category or medical specialty). Conclusions: A high prevalence of burnout syndrome was found in physicians working in Spain. These results can contribute to estimating the burden associated with burnout in physicians at a national level and to the design of future studies. Strategies appear to be necessary to prevent and mitigate this situation. Protocol registration: Open Science Framework: https://osf.io/b2h4m/.El Instituto de Salud Carlos III/CIBERSAM se ha hecho cargo de los gastos de publicación que permiten el acceso abierto a este artículo.S

Terapia antitrombótica en pacientes con hemorragia intracraneal. ¿Revertimos?

Realizamos una revisión de la guía de práctica clínica de la reversión de la terapia antitrombótica en pacientes con hemorragia intracraneal que hayan recibido terapia antiagregante, anticoagulante o fibrinolítica. Se analizan recomendaciones para la reversión de antagonistas de vitamina K, anticoagulantes orales de acción directa, heparinas no fraccionadas y de bajo peso molecular, trombolíticos y antiagregantes plaquetarios, en el contexto de una hemorragia intracraneal.  ABSTRACT Review the clinical practice guidelines for the reversal of antithrombotic therapy in patients with intracranial hemorrhage with antiplatelet, anticoagulant or fibrinolytic therapy. We analyzed the most important recommendations for the reversal of vitamin K antagonists, direct-acting oral anticoagulants, unfractionated and low-molecular-weight heparins, thrombolytics and platelet antiaggregants, in the context of an intracranial hemorrhage