[Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?] / ¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria?

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended.

Sewage pollution: genotoxicity assessment and phytoremediation of nutrients excess with Hydrocotyle ranunculoides.

The discharge of sewage effluents into low-order streams has negative effects on water quality. Macrophytes can be efficient in the treatment of this wastewater due to the removal of the main pollutants. The genotoxicity of sewage-polluted water discharging into La Choza stream was evaluated by testing with Allium cepa. Also, a phytoremediation assay with continuous recirculation of the residual water was conducted for 12 days. Three treatments were carried out. One treatment (Hr) was performed with a macrophyte (Hydrocotyle ranunculoides), and two treatments were conducted without macrophytes: with lighting (Ai) and without lighting (Ao). The wastewater was toxic according to all the evaluated indexes (mitotic index, frequency of chromosomal aberrations and micronucleus). High concentrations of ammonium, dissolved inorganic nitrogen (DIN), total (TP) and soluble reactive phosphorous (SRP) and indicators of faecal contamination were determined in the wastewater. The ammonium, DIN, SRP and TP loads at the end of the assay were significantly lower in the treatments with light (Hr and Ai). So, the nutrient removal was due to their absorption and adsorption by the periphyton and H. ranunculoides. Our results lead us to recommend the maintenance and planting of macrophytes in lowland streams subject to sewage pollution.

[Soil texture as a regulating factor of Escherichia coli adsorption in a Rolling Pampa basin (Argentina)]. / La textura del suelo como factor regulador de la adsorción de Escherichia coli en una cuenca de la Pampa Ondulada (Argentina).

Increase of bovine livestock rates in fragile areas of the Rolling Pampa entails a high risk of biological contamination. This biological contamination is regulated by edaphic variables such as texture, which control biological contaminants transport towards water bodies. In this work bacterial adsorption was correlated with individual particle sizes in 27 soils of a typical basin of the Rolling Pampa with slow centrifugation techniques. Bacterial adsorption values, using E. coli (ATCC 8739), ranged between 25.3 and 73.3% and significant correlation (R² = 0.6) was found between bacterial adsorption and clay content. This correlation was improved when particles smaller than 3 µm were considered (R² = 0.64) highlighting the capacity of very fine silt in adsorption mechanisms. Data obtained were compared with those proposed by Ling et al. (2002), finding similar slope but different intercept. This difference disappeared when a wild strain, isolated from bovine manures present in the basin, was used, since a bacterial adsorption increase of 48% was found.

The self-face captures attention without consciousness: Evidence from the N2pc ERP component analysis.

It is well established that stimuli representing or associated with ourselves, like our own name or an image of our own face, benefit from preferential processing. However, two key questions concerning the self-prioritization mechanism remain to be addressed. First, does it operate in an automatic manner during the early processing, or rather in a more controlled fashion at later processing stages? Second, is it specific to the self-related stimuli, or can it be activated also by other stimuli that are familiar or salient? We conducted a dot-probe experiment to investigate the mechanism behind the attentional prioritization of the self-face image and to tackle both questions. The former, by employing a backwards masking procedure to isolate the early and preconscious processing stages. The latter, by investigating whether a face that becomes visually familiar due to repeated presentations is able to capture attention in a similar manner as the self-face. Analysis of the N2pc ERP component revealed that the self-face image automatically captures attention, both when processed consciously and unconsciously. In contrast, the visually familiar face did not attract attention, neither in the conscious, nor in the unconscious condition. We conclude that the self-prioritization mechanism is early and automatic, and is not triggered by mere visual familiarity. More generally, our results provide further evidence for efficient unconscious processing of faces, and for dissociation between attention and consciousness.

[Qualitative evaluation of a participatory process of adaptation of a health promotion guide.] / Evaluación cualitativa de un proceso participativo de adaptación de una guía de promoción de la salud.

OBJECTIVE: In the last decades, in Spain, the interest shown towards community participation in health has been growing. However, there are no evidence-based guidelines to promote community participation in health. For this reason, between 2017 and 2018 the AdaptA GPS project was carried out through 10 working groups from 10 autonomous communities, to adapt the NG44 community participation guide in health from the NICE institute in the United Kingdom to the Spanish context. The objective of this article was to evaluate the adaptation process (the aspects to be improved and the resulting learning) of the AdaptA GPS project through the evaluation of its participants. METHODS: A qualitative evaluation was carried out through two questionnaires with open-ended questions, self-administered in each working group, one by the group coordinator and one by the whole working group (between 6 and 10 people per group), and the answers were analysed thematically. RESULTS: Three main themes were identified that reflect the perspectives of the participants about the adaptation process: positive factors (participatory methodology, collaborative work and diversity of participants), aspects that could be improved (scarce people's participation and lack of funding) and acquired learning (working in network and the importance of promoting research in this field). CONCLUSIONS: The AdaptA GPS project was an innovative project that favored the creation of networks and synergies, fostering co-production thanks to its participatory approach, which has laid the foundations for future collaborative processes of community engagement.

OBJETIVO: En las últimas décadas, en España, el interés mostrado hacia la participación comunitaria en salud ha ido creciendo. Sin embargo, no existen guías basadas en la evidencia para promover la participación comunitaria en salud. Por eso, entre 2017 y 2018 se llevó a cabo el proyecto AdaptA GPS a través de 10 nodos de trabajo en 10 comunidades autónomas, para adaptar al contexto español la guía de participación comunitaria en salud NG44 del instituto NICE de Reino Unido. El objetivo de este artículo fue evaluar el proceso de adaptación (los aspectos a mejorar y los aprendizajes resultantes) del proyecto AdaptA GPS a través de la valoración de sus participantes. METODOS: Se realizó una evaluación cualitativa a través de dos cuestionarios con respuestas abiertas, autoadministrados en cada nodo de trabajo, uno por la persona coordinadora y uno por las personas del nodo (entre 6 y 10 personas por nodo), y se realizó un análisis temático. RESULTADOS: Se identificaron tres temas principales que reflejan las perspectivas de las personas participantes sobre el proceso de adaptación: factores positivos (metodología participativa, trabajo multicéntrico y diversidad de participantes), aspectos mejorables (escasa participación ciudadana y falta de financiación) y aprendizajes adquiridos (trabajo en red y la importancia de impulsar investigaciones en este campo). CONCLUSIONES: El proyecto AdaptA GPS fue un proyecto innovador que favoreció la creación de vínculos y sinergias, fomentando la coproducción gracias a su enfoque participativo, que ha sentado las bases para futuros procesos colaborativos de participación comunitaria.

Unconscious perception of one's own name modulates amplitude of the P3B ERP component.

The P3 event-related potential has been known for over 50 years, but its function is still a matter of ongoing debate. Current theories interpret P3b either as a correlate of perceptual consciousness, or as reflecting cognitive processes, like working memory and executive functions. Unexpectedly, recent studies indicate that P3b might occur in response to unconsciously presented stimuli which, if further replicated, will be important for defining its functional role. Therefore, in the present study we investigated the P3b component in response to participants' own name - a stimulus which is subjectively extremely salient and known to evoke a robust P3b response. The self-name and control (other) names were presented supra- and subliminally (backward-masked), in a subjective rating task and in a forced-choice identification task. We found that a consciously perceived self-name evoked a P3b of larger amplitude than the other-name in both tasks, which confirms that the self-name was processed preferentially. When the self-name was presented subliminally it was associated with larger P3b amplitude than the other-name in the identification task, but not in the subjective rating task. This indicates that a salient stimulus can in principle modulate the P3b amplitude even when processed outside of awareness, but also that subliminal processing depends on the task-set and top-down factors. Taken as a whole, our results provide evidence against the interpretation of P3b as a correlate of consciousness (and more generally conflict with the Global Workspace Theory) and will allow a more precise description of the relation between P3b and cognitive processes.

[Networking: discussing community health and networks. SESPAS Report 2018]. / En-red-ando: dialogando sobre salud comunitaria y redes. Informe SESPAS 2018.

Four voices from around Spain discuss community health and networks. These voices understand that the networks are systems formed by interconnected people, with a common interest, that provide support. Networks require a common place and time, in order to generate trust and respect for horizontal work. Thus, networks are appropriate structures for health promotion, facilitating the exchange of knowledge, collaboration and innovation through the participation of those who form them. It is important that networks are evaluated by analysing their autonomy, leadership, quality of links, training, network projection, capacity for integrating groups and synergy.

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

PURPOSE: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. METHODS: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. RESULTS: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0-8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59-2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7-44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. CONCLUSIONS: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.

Ecotoxicological and genotoxic evaluation of Buenos Aires city (Argentina) hospital wastewater.

Hospital wastewater (HWW) constitutes a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. In the present work we investigated toxicity and genotoxicity of wastewaters from the public hospital of Buenos Aires (Argentina). The effluent from the sewage treatment plant (STP) serving around 10 million inhabitants was also evaluated. The study was carried out between April and September 2012. Toxicity and genotoxicity assessment was performed using the green algae Pseudokirchneriella subcapitata and the Allium cepa test, respectively. Toxicity assay showed that 55% of the samples were toxic to the algae (%I of growth between 23.9 and 54.8). The A. cepa test showed that 40% of the samples were genotoxic. The analysis of chromosome aberrations (CA) and micronucleus (MN) showed no significant differences between days and significant differences between months. The sample from the STP was not genotoxic to A. cepa but toxic to the algae (%I = 41%), showing that sewage treatment was not totally effective. This study highlights the need for environmental control programs and the establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system.

Clinical experience with thymoglobulin and antithymocyte globulin-Fresenius as induction therapy in renal transplant patients: a retrospective study.

OBJECTIVES: We describe our experiences with, and compare the outcomes of, 2 groups of renal transplant patients treated with thymoglobulin or antithymocyte globulin-Fresenius as induction therapy at transplant to reduce the incidence of acute rejection and prevent delayed allograft function. MATERIALS AND METHODS: Twenty-four recipients of deceased-donor or living-donor kidney transplants received thymoglobulin, and 23 patients received antithymocyte globulin-Fresenius. Patient and graft survival and efficacy and safety were assessed at 3 months. RESULTS: The demographic characteristics of both groups were comparable, but the predominant donor type was significantly different. Incidence of complications, delayed graft function, and creatinine concentrations were comparable in both groups. At 3 months after the transplant, patient survival rate was 92% in the thymoglobulin group and 96% in the antithymocyte globulin-Fresenius group (P > .05), and death-censored graft survival rate for both groups was not significantly different. Average hematocrit and lymphocyte, neutrophil, and platelet counts were comparable in both groups at 3 months' follow-up. Average white blood count at 1 month was significantly different between the groups: at 5.62 ± 2.45 × 103 cells/mm³ in the thymoglobulin group and 7.85 ± 4.10 × 103 cells/mm³ in the ATG-F group (P < .05). CONCLUSIONS: Considering the study design limitations, we observed that our group of treated patients, safety, and efficacy of thymoglobulin and antithymocyte globulin-Fresenius were generally comparable.

Use of bortezomib to treat anti-HLA antibodies in renal transplant patients: a single-center experience.

Donor-specific human leukocyte antigen (HLA) antibodies (DSA) are associated with decreased graft survival and may cause graft rejection. Bortezomib, a selective inhibitor of the 26S proteasome developed to treat multiple myeloma, has been used for its anti-plasma cell activity in patients undergoing transplantation. We describe our experience with bortezomib used to reduce anti-HLA antibodies in eight renal transplant patients. Patients received bortezomib (1.3mg/m(2)) on days 1, 4, 8, and 11 beginning when antibodies were detected. It was used alone in one patient and was complemented with plasmapheresis in five patients, with IVIG in one patient, and with IVIG and plasmapheresis in another patient. De novo DSA class II were detected in all eight patients and two also had DSA class I. Antibodies were entirely eliminated in five (62.5%) patients 90 days after treatment but only reduced in the other three (62.5%). Notably, they later increased in one patient. Five (62.5%) patients had AMR, two (25%) had mixed rejection, and one had no rejection. our results suggest that bortezomib is effective for reducing DSA avoiding chronic graft injury.

Use of belatacept as alternative immunosuppression in three renal transplant patients with de novo drug-induced thrombotic microangiopathy.

Thrombotic microangiopathy (TMA), a severe complication of renal transplantation, is a pathological process involving microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia. It generally appears within the first weeks after transplantation, when immunosuppressive drugs are used at high doses. De novo TMA may also be drug-induced when calcineurin inhibitors or proliferation signal inhibitors are used. We report three cases of de novo drug-induced TMA in renal transplant patients who were managed by replacing calcineurin inhibitors or proliferation signal inhibitors with belatacept, a primary maintenance immunosuppressive drug, which blocks the CD28 costimulation pathway, preventing the activation of T lymphocytes. To identify the cause of TMA, we ruled out HUS, hepatitis C serology, HIV serology, parvovirus B19, cytomegalovirus, anti-HLA antibodies, and prolonged activated partial thromboplastin time. We suspect that the TMA was caused by the calcineurin inhibitors or proliferation signal inhibitors. Belatacept treatment was initiated at a dose of 10 mg/kg on days 1, 5, 14, 28, 60, and 90; maintenance treatment was 5 mg/kg once a month for 1 year. Belatacept, in combination with other agents, prevented graft rejection in three patients.

Inusual causa de deterioro progresivo de la función renal / Uncommon cause of progressive renal function decline

Toda vez que a lo largo de 3 meses hay una caída del 50% del filtrado glomerular estamos en presencia de lo que se define como deterioro rápidamente evolutivo de la función renal. Si además es acompañado de un sedimento urinario activo, inferimos estar frente a una glomerulopatía rápidamente evolutiva, una microangiopatía trombótica, una enfermedad renal ateroembólica o una nefritis intersticial. La mayoría de las veces la celeridad con que se inicia el tratamiento impacta en el resultado del mismo, lo que con frecuencia obliga a realizarlo en forma empírica. No obstante, como la terapéutica a emplear no es inocua, debemos extremar las medidas diagnósticas para definir la etiología, este caso es un ejemplo de ello

Whenever there is a 50% drop in glomerular filtration over 3 months we are in the presence of what is defined as rapidly progressive deterioration of renal function. If it is also accompanied by an active urinary sediment, it is inferred that one of these may be taking place: a rapidly progressive glomerulonephritis, a thrombotic microangiopathy, an atheroembolic renal disease or an interstitial nephritis. In most cases the speed with which the treatment is initiated impacts on its result, which often requires that it is done empirically. However, as the therapy used is not innocuous, we must maximize diagnostic measures to define the etiology; this case is an example of this

Evaluación ecotóxica y genotóxica de aguas residuales hospitalarias / Ecotoxicological and genotoxic evaluation of hospital wastewaters

Los líquidos residuales provenientes de hospitales constituyen un riesgo potencial para los ecosistemas y la salud humana debido a la presencia de compuestos tóxicos y genotóxicos. El objetivo de este trabajo fue analizar la toxicidad y la genotoxicidad de los efluentes provenientes del Hospital de Clínicas José de San Martín (Buenos Aires). Las muestras del efluente se tomaron durante los días y horarios de mayor actividad del hospital y se separaron en dos fracciones: acuosa y orgánica (extractos). Los ensayos de toxicidad se realizaron en la fracción acuosa utilizando dos especies de algas verdes: Pseudokirchneriella subcapitata y Chlorella vulgaris. La genotoxicidad se evaluó en las dos fracciones mediante el ensayo de Salmonella/ microsomas en ausencia y presencia de mezcla S9, utilizando las cepas TA98 y TA100. Veintinueve muestras de un total de 53 muestras analizadas resultaron tóxicas para P. subcapitata (entre 18 y 55 % de inhibición), mientras que sólo 8 muestras lo fueron para C. vulgaris (entre 21 y 50 % de inhibición). Ninguna de las muestras resultó genotóxica para Salmonella, ni en los extractos ni en las fracciones acuosas. De los tres ensayos utilizados, P. subcapitata fue el más sensible, siendo el ensayo más apropiado para el monitoreo de estos efluentes.

Wastewaters from hospitals constitute a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. The objective of this work was to analyze the toxicity and genotoxicity of wastewaters from the "Hospital de Clínicas José de San Martín" (Buenos Aires). Wastewater samples were obtained during the days and hours of major hospital activities and they were separated into two fractions: aqueous and organic (extracts). The toxicity assays were performed for the aqueous fraction using the green algae species: Pseudokirchneriella subcapitata and Chlorella vulgaris. Genotoxicity was assessed for the two fraction samples using the Salmonella/microsome assay in presence and in absence of S9 mix, with the strains TA98 and TA100. Twenty nine of the 53 total analyzed samples were toxic to P. subcapitata (between 18 and 55 % inhibition), whereas only 8 samples were toxic to C. vulgaris (between 21 and 50 % inhibition). None of the samples resulted genotoxic to Salmonella. Of the three tests used, P. subcapitata was the most sensible, resulting in the most suitable species to be used in hospital wastewaters monitoring.

La textura del suelo como factor regulador de la adsorción de Escherichia coli en una cuenca de la Pampa Ondulada (Argentina) / Soil texture as a regulating factor of Escherichia coli adsorption in a Rolling Pampa basin (Argentina)

El aumento de la carga animal vacuna en la Pampa Ondulada asociado a áreas frágiles supone un importante riesgo de contaminación biológica. Dicha contaminación está regulada por variables edáficas, como la textura, que controlan el transporte de contaminantes biológicos hacia los cuerpos de agua. En el presente trabajo se correlacionó la adsorción bacteriana del suelo con distintos tamaños de partículas individuales correspondientes a 27 suelos provenientes de una cuenca de la Pampa Ondulada. Para ello se utilizó una técnica de centrifugación lenta. Los valores de adsorción bacteriana, empleando en la determinación Escherichia coli ATCC 8739, variaron entre 25,3% y 73,3%, y el tamaño de partícula que mejor se correlacionó con esta propiedad fue el correspondiente a la fracción de arcillas (R² = 0,6). Esta correlación mejoró al considerar conjuntamente a todas las partículas menores de 3 µm (R² = 0,64), lo que resalta la capacidad de los limos muy finos en el fenómeno de adsorción. La curva de ajuste elaborada con los datos experimentales se comparó con la obtenida de acuerdo con el modelo propuesto por Ling et al. (2002). Se encontraron similitudes en la pendiente, no así en la ordenada al origen. Esta diferencia desapareció al emplear en la determinación una cepa autóctona aislada de deyecciones animales provenientes de la cuenca estudiada, dado que dicha cepa evidenció una adsorción 48% superior a la observada con la cepa de colección.

Increase of bovine livestock rates in fragile areas of the Rolling Pampa entails a high risk of biological contamination. This biological contamination is regulated by edaphic variables such as texture, which control biological contaminants transport towards water bodies. In this work bacterial adsorption was correlated with individual particle sizes in 27 soils of a typical basin of the Rolling Pampa with slow centrifugation techniques. Bacterial adsorption values, using E. coli (ATCC 8739), ranged between 25.3 and 73.3% and significant correlation (R² = 0.6) was found between bacterial adsorption and clay content. This correlation was improved when particles smaller than 3 µm were considered (R² = 0.64) highlighting the capacity of very fine silt in adsorption mechanisms. Data obtained were compared with those proposed by Ling et al. (2002), finding similar slope but different intercept. This difference disappeared when a wild strain, isolated from bovine manures present in the basin, was used, since a bacterial adsorption increase of 48% was found.