Factores de riesgo asociados a síndrome hipertensivo gestacional. Hospital Primario Carlos Centeno. Siuna, Región Autónoma del Atlántico Norte. Enero - Junio 2013

El síndrome hipertensivo gestacional es una de las complicaciones más frecuentes y graves del embarazo que se caracteriza por reducción de la perfusión sistémica, generada por el vasoespasmo y la activación de los sistemas de coagulación. El objetivo de este estudio fue evaluar la asociación existente entre los factores demográficos, ginecobstétricos, patológicos personales y familiares con el síndrome hipertensivo gestacional. Material y método: Tipo de estudio, cuantitativo, observacional, longitudinal, retrospectivo, analítico, de casos y controles. Realizado de enero a diciembre de 2013 con las pacientes embarazadas atendidas en el Hospital Primario Carlos Centeno del municipio de Siuna. El universo estuvo conformado por 416 embarazadas, la muestra fue de 34 casos y 102 controles a razón de 3:1. La muestra fue calculada en el programa EPIDAT VERSION 7. Las variables de riesgo que se analizaron en asociación con el síndrome hipertensivo gestacional fueron las características sociodemográficas, antecedentes ginecobstétricos, antecedentes patológicos personales y familiares. Resultados: Características Sociodemográficas; La escolaridad más frecuente fue primaria con 47.1% casos (16) y 44.2% (45) controles, con OR: 1.12, X2: 0.008, p: 0.38. Características Ginecobstétricas. En pacientes con antecedentes de aborto 26.5% (9) son casos y 11.8% (12) controles con OR: 2.7, X2: 4.22, p: 0.02. En pacientes con antecedentes de cesárea 26.5% (9) son casos y 2.9% (3) controles con OR: 11.8, X2: 17.54, p: 0.0001. Antecedentes patológicos: En pacientes con antecedentes de hipertensión arterial 23.5% (8) son casos y 2% (2) controles, produjo OR: 15.3, X2: 17.4, p: 0.0001. En este estudio los antecedentes de aborto, cesáreas anteriores son las características gineco - obstétricas que mostraron asociación estadísticamente significativa como factores de riesgo de síndrome hipertensivo gestacional y que aumentan la probabilidad de presentar dicha enfermeda

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Curso de especialidad en la carrera de Administración y Negocios Internacionales, de carácter teórico-práctico, dirigido a los estudiantes del 1er ciclo, que aborda los principios básicos de la teoría administrativa global y su evolución, naturaleza y funcionamiento, desde una perspectiva del libre comercio en el contexto de la globalización del Siglo XXI. Los contenidos teóricos, además, están asociados al estudio de factores internos y externos para la definición de la estrategia de negocios, midiendo y analizando variables vinculadas a la cultura, las relaciones laborales, los entornos empresariales, el mercado y las actividades de los competidores nacionales e internacionales. 1La globalización de los negocios significa que los decisores y el personal gerencial administrativo de una organización trabajen e interactúen con miembros de otras culturas, valorando los distintos entornos y siendo capaces de gestionarlo de manera eficiente para lograr los resultados de una organización empresarial

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Impacto del COVID-19 sobre el bienestar de la infancia, adolescencia y familias en Canarias: oportunidades para reforzar el sistema de prevención y protección

La pandemia del covid-19 producida por el virus SARS-CoV-2 es una emergencia sanitaria que se extiende en el tiempo sin una clara fecha límite, lo cual aconseja no solo hacer un relato de su impacto en el pasado sino también extraer lecciones de lo vivido que nos preparen mejor para lo que pueda pasar. Este estudio centrado en el impacto del covid-19 sobre el bienestar de la infancia, adolescencia y familias, ofrece una mirada integradora, constructiva y proyectada al futuro, con un doble objetivo. En primer lugar, examinar cómo han funcionado varios ámbitos, además de la familia, en su función preventiva y protectora de la infancia y adolescencia en este tiempo de pandemia, recogiendo el punto de vista de informantes significativos en la Comunidad Autónoma de Canarias. Así, además de contar con las voces de niños, niñas, adolescentes y figuras parentales, se cuenta con la opinión de las y los profesionales en los ámbitos de familia, educación, sanidad, servicios sociales y de protección de menores, entidades sociales, justicia y medios de comunicación. En segundo lugar, derivar de todas las aportaciones un conjunto de mejoras y recomendaciones para el futuro. El estudio adopta un triple marco conceptual basado en una concepción ecológico-sistémica de la familia, en la prevención de riesgos y la promoción de fortalezas y capacidades resilientes, y en una visión actual del ejercicio de la parentalidad positiva en su diversidad. Siguiendo una metodología cualitativa, que utiliza grupos focales con discusión dirigida de opinión y entrevistas individuales, los resultados muestran las múltiples realidades vividas por las personas informantes que aportan sus puntos de vista sobre cuatro ejes temáticos: a) Las dificultades de funcionamiento en los diversos ámbitos resultantes del impacto negativo de la pandemia. b) Los ajustes que se han realizado para hacer frente a estas dificultades. c) Las fortalezas o capacidades resilientes con que se cuenta tanto a nivel personal como a nivel del sistema o ámbito. d) Las recomendaciones para una mejora de su funcionamiento, seguidas de un resumen con las conclusiones. De todo ello, se extraen lecciones aprendidas donde se observan coincidencias entre varios ámbitos. Señalemos, entre otros aspectos, la necesidad de adoptar de modo generalizado la perspectiva de derechos de la infancia; reconocer las muestras de resiliencia ante la adversidad; incorporar las nuevas prioridades en el sistema de valores sociales así como la revalorización del papel de la ciencia en la sociedad; robustecer el sistema público de prevención y mejorar los servicios educativos, sanitarios y judiciales de atención especializada para afrontar las consecuencias de la pandemia; superar la brecha digital para que todos se beneficien por igual de los avances tecnológicos; ajustar la imagen social de la infancia y de la adolescencia a la evidencia contrastada; y potenciar la gobernanza en la coordinación intersectorial. En suma, este estudio ofrece claves para una toma de decisiones informada que permita desarrollar respuestas más efectivas ante esta u otras posibles crisis sanitarias y así asegurar el cinturón que protege el bienestar de la infancia, adolescencia y las familias.The covid-19 pandemic caused by the SARS-CoV-2 virus is a sanitary emergency that extends over time without a dear deadline, which advises not only to make an account of its impact in the past but also to draw lessons from what we have experienced that will better prepare us for what will happen. This study focused on the impact of covid-19 in the well-being of children, adolescents and families, offering an integrative, constructive and future-oriented approach with a dual objective. First, to examine how several areas have functioned, in addition to the family, in their preventive and protective role for children and adolescents in this time of pandemic, from the point of view of significant informants in the Autonomous Community of the Canary lslands. Thus, in addition to having the voices of children, adolescents and parents, there is also the opinion of professionals in the fields of family, education, health, social and child protection services, social entities, justice, and the mass media. Second, to derive from all contributions a set of improvements and recommendations for the future. The study adopts a triple conceptual framework based on an ecological-systemic conception of the family, on the prevention of risks and the promotion of strengths and resilient capacities, and on a current vision of the exercise of positive parenting in its diversity. Following a qualitative methodology, which uses focus groups with oriented discussion of opinion and individual interviews, the results show the multiple realities experienced by respondents who contribute with their points of view on four thematic axes: a) The functional difficulties in the various areas resulting from the negative impact of the pandemic. b) The adjustments that have been made to address these difficulties. c) The strengths or resilient capacities available both at the personal level and at the system or field level. d) Recommendations for improving their functioning, followed by a summary with conclusions. From all of this, there are lessons learned where coincidences are observed between several fields. Let us point out, among other aspects, the necessity of adopting widespread the child rights perspective; to acknowledge signs of resilience against adversity; to incorporate new priorities in the social value system as well the revaluation of the role of science in society; to strengthen the public system of prevention and to improve educational, health and judicial services for specialized care to deal with the consequences of the pandemic; to bridge the digital divide so that all benefit equally from technological advances; adjust the social image of children and adolescents to the evidence; and strengthen governance in intersectoral coordination. In summary, this study offers keys to informed decision-making that would allow developing more effective responses to this or other possible sanitary crises and thus ensure the belt that protects the well-being of children, adolescents, and families

La ilusión de la Libertad

El volumen que el lector posee en sus manos (o en su pantalla) constituye una selección de los estudios presentados en el congreso internacional “1820. La Ilusión de la Libertad. El liberalismo revolucionario en España y América en los años veinte”, realizado en Las Cabezas de San Juan y Sevilla en marzo de 2020, como forma de reflexionar (y celebrar, por supuesto) el bicentenario del Trienio Liberal español, atendiendo no sólo a sus implicancias en la Península Ibérica, sino especialmente a su impacto en América. La efeméride funcionó, entonces, como una excusa para analizar problemas relevantes del pasado y el presente. En este caso, los vínculos entre una sociedad estancada, y que ya nada más tenía para ofrecer, y una de las revoluciones más importantes que se desenvolvió a lo largo y ancho de Iberoamérica. Esto se hizo por medio de la presentación de un conjunto de investigaciones que atendieron a los aspectos económicos, políticos, sociales y culturales de la revolución de 1820. Se trató de un esfuerzo colectivo, que esperamos haber plasmado en esta compilación

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism

International audienceBackground: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P <0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018, P <0.001). Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation