Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness.

INTRODUCTION: Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective. METHODS: A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups. RESULTS: Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective. CONCLUSIONS: It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.

[Perceptive and praxic impairments in traumatic brain injury patients: significance in activities of daily living]. / Alteraciones perceptivas y praxicas en pacientes con traumatismo craneoencefalico: relevancia en las actividades de la vida diaria.

OBJECTIVE: The main goal of the present study is to describe the implication of different perceptive and praxic deficits in activities of daily living (ADL). We also review some assessing scales and intervention techniques used in the training of these mentioned alterations after a traumatic brain injury (TBI). DEVELOPMENT: There are three kinds of processes important for a correct ideation, motor planification and execution of a learned purposeful movement (praxis). Some of these processes are related to the visual basic perception of the objects (colour, form, size, etc). Others are related to the most complex perception functions (depth, location, recognition,etc). The third group of functions are those integrating the sensory information (discrimination right left side, corporal scheme disorders, etc). If ADL performance needs a suitable functioning of different structures of the nervous central system, then assessment and treatment will be necessary to obtain the best independence level of TBI patients. This is the main objective in Occupational Therapy. ADL may be separated in two different groups: basic abilities (feeding, grooming, dressing, etc) and instrumental abilities (meal preparation, managing money, shopping, using public transportation, etc). CONCLUSION: Impairments in both praxic and perceptive processes constitute one of the most prevalent deficits in TBI patients. From a clinical point of view, these deficits may lack the capacity to carry an independent life.

Pigment production by Streptococcus agalactiae in quasi-defined media.

A quasi-defined medium that supports the growth of Streptococcus agalactiae as pigmented colonies has been developed. The medium contains starch, a peptic digest of albumin, amino acids, nucleosides, vitamins, and salts. The presence of free cysteine, which could be replaced with other sulphur-containing compounds and to a lesser degree by reducing agents, was required for pigment formation.

Development and validation of an inventory to measure satisfaction of users of family medicine clinics in Mexico.

The object of this study was to construct and validate an inventory to measure the satisfaction of users of Family Medicine Clinics. The satisfaction construct was theoretically developed, then the semantic network technique was applied to write 45 items with a dichotomized response. The scale was validated for 4,134 users. Cronbach coefficient alpha was .78. In a factor analysis, 8 factors were obtained, which explained 43.3% of the variance. The content of the first factor referred to the Family Physician dimension, Factors 3, 4, and 5 to the Family Medicine Clinic, and Factors 2, 6, 7, and 8 to Other Services of the Clinic. The questionnaire is being integrated to the Quality of Care Evaluation System to assess satisfaction of users. It may be useful in other venues to assess cultural and organizational aspects of satisfaction with health care.

Identification of a peptide from mammal albumins responsible for enhanced pigment production by group B streptococci.

The peptide from peptones responsible for enhanced pigment production by Streptococcus agalactiae in culture media has been isolated from a peptic digest of human albumin and has been identified as Ile-Ala-Arg-Arg-His-Pro-Tyr-Phe. The related heptapeptide lacking the N-terminal Ile also had pigment-enhancing activity. A sequence similarity search showed that these sequences are present only in mammal albumins.

Maternal mortality regionalization and trend in Mexico (1937-1995)

BACKGROUND: The objectives were to establish regions by level of maternal mortality in order to evaluate its trend from 1937-1995 and to analyze characteristics of cases which occurred from 1990-1995. METHODS: Regionalization of the country by maternal mortality level was carried out using Poisson regression. Level and mortality trends were analyzed globally and compared by regions using Poisson and linear regression. Characteristics of cases were analyzed from 1990-1995 using proportions and X2 test. RESULTS: Four well-differentiated and independent regions were established. Low and medium maternal mortality rate regions were found in northern and northwestern Mexico. High and very high maternal mortality regions were found in the South and the Southeast of the country. Even when maternal mortality had descended, the speed of the descent has decreased and in the last few years, maternal mortality has increased. The quality of health care is a challenge for regions with low mortality rates, while the problem of accessibility is present in those with very high mortality rates. CONCLUSION: The employment of this regionalization approach in maternal mortality analysis would be useful to determine specific problems for each region. The establishment of programs according to this analysis could contribute to decrease in maternal mortality cases in Mexico.

[Adequate utilization of prenatal care at the Mexican Institute of Social Security]. / Utilización adecuada de la atención prenatal en el Instituto Mexicano del Seguro Social.

OBJECTIVE: To establish what proportion of women utilize antenatal care adequately and analyze obstetric, economic, social and cultural factors related to the adequacy of antenatal care use at the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: This cross-sectional study included 394 women from 12 to 49 years of age at twenty-eight to forty-two weeks of gestation. A questionnaire was applied that collected information on the following: demographic, social economic and cultural variables; knowledge about pregnancy and complications; gyneco-obstetric history, and barriers to use of antenatal health care services. Data were analyzed by using descriptive statistics, odds ratios and logistic regression modelling. RESULTS: Antenatal care was started during the first trimester by 75% of women, 23.8% of these made at least nine antenatal care visits (adequate utilization). Adequate utilization was associated to prenatal care in family medicine units with a computer system, knowledge and behavior regarding complications, parity, care by the same physician at IMSS, and the woman's occupation. CONCLUSIONS: The proportion of women who utilize prenatal care adequately is low at IMSS. Information about related factors could be used in order to improve institutional programs.

Development and validation of an inventory for measuring job satisfaction among family physicians.

The aim was to develop and validate a measure of job satisfaction among family physicians. The construct of job satisfaction was developed theoretically, then the semantic network technique was used for the construction of the items. 80 semantic differential items in a random order were related by nine physicians. Four dimensions integrated the construct: "job satisfaction," "health institutions where I work," "my patients," and "myself as a doctor." The average Cronbach alpha was .81. In the factor analysis, four factors were obtained in each dimension except that of "my patients," for which two were obtained. These factors accounted for at least 44% of the construct developed. The semantic network technique may be useful.