Análisis sociológico de la Ley 4/2000, de 11 de enero, sobre derechos y libertades de los extranjeros en España y su integración social. Sus reformas (8/2000, 11/2003, 14/2003, 2/2009) y su implicación social

La conocida como Ley de extranjería ha sido y es uno de los elementos que mayor atención y debate ha suscitado en el marco de la política migratoria española. Sirvan como ejemplo las sucesivas reformas de las que ha sido objeto en la última década, puesto que se han llegado a contabilizar hasta cuatro. La última tuvo lugar en el mes de diciembre de 2009. Con el objeto de profundizar en esta realidad, se ha desarrollado el proyecto de investigación I+D concedido por el Ministerio de Ciencia y Tecnología y titulado SEJ 2006-05222. Inmigración y Bienestar Social, en cuyo contexto se enmarca el presente artículo. Se ha analizado el articulado de la Ley y sus implicaciones sociales a través de los principios de la Grounded Theory. Para cada reforma, se ha contextualizado, además, el marco político y social que justificaba la misma. Entre otras conclusiones, se observa que la Ley es un intento de dar respuesta a la nueva realidad de la extranjería en España desde un planteamiento meramente técnico, sin mayor pretensión ideológica. No obstante, la lógica discursiva pone el acento de manera mayoritaria en la necesidad de «controlar socialmente» al extranjero. Todo ello provoca una suerte de metonimia en el articulado de la Ley entre extranjero e inmigrante, lo que convierte a la Ley en coadyuvante de una fractura social cada vez mayor entre extranjeros y nacionales, con todas las implicaciones que ello supone en los procesos de identidad y alteridad.Act 4/2000, commonly known as the Aliens Act, has caused considerable debate in Spanish society about migration policy. The last decade, the Act has been amended repeatedly- a total of four amendments have been made. The most recent amendment was proposed in December 2009. This article reports the findings of research project I + D SEJ 2006-05222. Social Welfare and Immigration, funded by the Spanish Ministry of Science and Technology, and aims to examine this issue in depth. The provisions of the Act and their social implications were analysed using Grounded Theory. In addition, this article contextualises the political and social framework for justifying the Act for each set of amendments. We conclude, inter alia, that the Act is an attempt to respond to changes in the situation of aliens in Spain from a technical perspective, without an ideological objective. Nevertheless, the discursive logic of the Act focuses mainly on the need of "social control" over foreigners. The Act's provisions cause a sort of metonymy between foreigners and immigrants. Thus, the Act contributes to an ever greater social divide between foreigners and nationals, with wide-ranging implications on identity and otherness processes

El estado como dinamizador de la sociedad y la constitución como guardiana del derecho

A la fecha no se ha logrado consolidar la reglamentación que permita la intervención del psicólogo; como una ayuda fundamental para el juez en la solución de aquellos casos en los que deba profundizar en el conocimiento de la conducta de las personas implicadas en estos; lo que vislumbra un vacío en la aplicación del derecho en el ámbito psicosocial, con el fin de lograr restablecer el tejido social, como responsabilidad del Estado Social de Derecho

VINAGRES DE FOLHAS DE VIDEIRA: ASPECTOS SENSORIAIS

Três diferentes formulações de vinagre de folhas de videira foram elaboradas, mantendose a proporção de folhas e água, e variandose a concentração da sacarose. Realizouse análise sensorial das formulações, segundo os atributos aparência geral, cor, odor, sabor geral e acidez, além de análise química de acidez titulável. Vinagres comerciais de vinho branco e vinho tinto foram utilizados como padrões. Concluiu-se que somente a formulação com maior teor de sacarose apresentou porcentagem de ácido acético de acordo com os padrões recomendados para tais produtos. Considerando a avaliação sensorial, duas formulações não diferiram significativamente dos vinagres comerciais. Abstract Three different vinegar formulations from grapevine leaves were elaborated, maintaining the waterleaves rate and varying the saccharose concentration. Sensory evaluation of the formulations was realized by the characteristics: general appearance, color, odor, general taste and acidity, in addition to chemical analysis of titratable acidity. It was employed commercial vinegars of white wine and red wine, as standards. It was concluded that only the formulation with higher saccharose rate showed acetic acid percentage within the recommended level for this products, however, two of the formulations tested did not differ meaningfully from commercial vinegars

Ventilatory support in critically ill hematology patients with respiratory failure

Introduction: Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks. Methods: To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure. Results: Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated with NIMV success were age, congestive heart failure, and bacteremia. Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated. Conclusions: NIMV improves the outcome of hematology patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success

Prognostic heterogeneity of adult B-cell precursor acute lymphoblastic leukaemia patients with t(1;19)(q23;p13)/TCF3-PBX1 treated with measurable residual disease-oriented protocols

Programa para el Tratamiento de Hemopatias Malignas (PETHEMA) Group (Spanish Society of Hematology, SEHH).The prognosis of t(1;19)(q23;p13)/transcription factor 3-pre-B-cell leukaemia homeobox 1 (TCF3-PBX1) in adolescent and adult patients with acute lymphoblastic leukaemia (ALL) treated with measurable residual disease (MRD)-oriented trials remains controversial. In the present study, we analysed the outcome of adolescent and adult patients with t(1;19)(q23;p13) enrolled in paediatric-inspired trials. The patients with TCF3-PBX1 showed similar MRD clearance and did not have different survival compared with other B-cell precursor ALL patients. However, patients with TCF3-PBX1 had a significantly higher cumulative incidence of relapse, especially among patients aged ≥35 years carrying additional cytogenetic alterations. These patients might benefit from additional/intensified therapy (e.g. immunotherapy in first complete remission with or without subsequent haematopoietic stem cell transplantation).This work was supported in part by CERCA/Generalitat de Catalunya SGR 2017 288 (GRC), a restricted grant from ‘La Caixa’ and Healthcare Alliance for Resourceful Medicine Offensive against Neoplasms (HARMONY)

Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU

Information on the long-term effects of non-restrictive antimicrobial stewardship (AMS) strategies is scarce. We assessed the effect of a stepwise, multimodal, non-restrictive AMS programme on broad-spectrum antibiotic use in the intensive care unit (ICU) over an 8-year period. Components of the AMS were progressively implemented. Appropriateness of antibiotic prescribing was also assessed by monthly point-prevalence surveys from 2013 onwards. A Poisson regression model was fitted to evaluate trends in the reduction of antibiotic use and in the appropriateness of their prescription. From 2011 to 2019, a total of 12,466 patients were admitted to the ICU. Antibiotic use fell from 185.4 to 141.9 DDD per 100 PD [absolute difference, -43.5 (23%), 95% CI -100.73 to 13.73; p = 0.13] and broad-spectrum antibiotic fell from 41.2 to 36.5 [absolute difference, -4.7 (11%), 95% CI -19.58 to 10.18; p = 0.5]. Appropriateness of antibiotic prescribing rose by 11% per year [IRR: 0.89, 95% CI 0.80 to 1.00; p = 0.048], while broad-spectrum antibiotic use showed a dual trend, rising by 22% until 2015 and then falling by 10% per year since 2016 [IRR: 0.90, 95% CI 0.81 to 0.99; p = 0.03]. This stepwise, multimodal, non-restrictive AMS achieved a sustained reduction in broad-spectrum antibiotic use in the ICU and significantly improved appropriateness of antibiotic prescribing

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection

Prognostic heterogeneity of adult B‐cell precursor acute lymphoblastic leukaemia patients with t(1;19)(q23;p13)/ TCF3‐PBX1 treated with measurable residual disease‐oriented protocols

The prognosis of t(1;19)(q23;p13)/transcription factor 3-pre-B-cell leukaemia homeobox 1 (TCF3-PBX1) in adolescent and adult patients with acute lymphoblastic leukaemia (ALL) treated with measurable residual disease (MRD)-oriented trials remains controversial. In the present study, we analysed the outcome of adolescent and adult patients with t(1;19)(q23;p13) enrolled in paediatric-inspired trials. The patients with TCF3-PBX1 showed similar MRD clearance and did not have different survival compared with other B-cell precursor ALL patients. However, patients with TCF3-PBX1 had a significantly higher cumulative incidence of relapse, especially among patients aged ≥35 years carrying additional cytogenetic alterations. These patients might benefit from additional/intensified therapy (e.g. immunotherapy in first complete remission with or without subsequent haematopoietic stem cell transplantation)

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection