Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events, and hospitalizations: a cluster randomized controlled trial.

BACKGROUND AND HYPOTHESIS: Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevent complications and improve treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease (VD), fluid overload and insufficient dialysis efficiency. METHODS: In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: 1) Composite Index-1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and 2) Composite Index-2 comprising cardiovascular mortality, first adverse event and hospitalizations related to CVD, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits, and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing-risk analysis and restricted mean survival time (RMST) analysis. RESULTS: While time to reach Composite Index-1 did not differ between the groups, Composite Index-2 was reached earlier (ΔRMST: -0.85 months; p=0.02), and all-cause mortality (55 vs. 33 deaths, p=0.01; sHR 1.69 (95%CI 1.39-2.05), p<0.001) and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths (24 vs. 13 deaths, p=0.05; sHR 2.44 (95%CI 1.72 - 3.45), p<0.001) and rates of adverse events and hospitalizations related to CVD, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs. 110, p=0.048). CONCLUSIONS: This randomized controlled trial shows that remote monitoring may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.

Mathematical modeling in semelparous biological species through two-sex branching processes.

This research focused its interest on the mathematical modeling of the demographic dynamics of semelparous biological species through branching processes. We continued the research line started in previous papers, providing new methodological contributions of biological and ecological interest. We determined the probability distribution associated with the number of generations elapsed before the possible extinction of the population in its natural habitat. We mathematically modeled the phenomenon of populating or repopulating habitats with semelparous species. We also proposed estimates for the offspring parameters governing the reproductive strategies of the species. To this purpose, we used the maximum likelihood and Bayesian estimation methodologies. The statistical results are illustrated through a simulated example contextualized with Labord chameleon (Furcifer labordi) species.

Combination with Annual Deworming Treatments Does Not Enhance the Effects of PCV2 Vaccination on the Development of TB in Wild Boar Populations.

Vaccination against PCV2 has been proven to be an effective measure to reduce the severity of TB in wild boar. The combination of this measure with strategies focused on treating other key concomitant pathogens, such as nematodes, could be a useful strategy. This study assesses whether a combination of deworming treatments and PCV2 vaccination may reduce the prevalence and severity of TB in wild boar. The study was conducted on five game estates in mid-western Spain where four groups of wild boar were produced: control, vaccinated, dewormed and vaccinated-dewormed. Wild boars from all groups were hunted between 2017 and 2020, and all of them received a TB diagnosis based on pathological and microbiological tests. Generalised linear models were used to explore the effect of deworming and PCV2 vaccination on TB prevalence and severity. PCV2-vaccinated animals showed lower probabilities of suffering severe TB lesions. However, no differences regarding TB severity were found between dewormed and non-dewormed wild boar. PCV2 vaccination reduces TB severity in wild boar. However, annual deworming does not produce a long-term parasitological reduction that can influence the development of TB in wild boar, nor does it improve the effect of PCV2 vaccination on TB.

Utility of Remote Monitoring in Patients on Automated Peritoneal Dialysis

ABSTRACT Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.

Utility of remote monitoring in patients on automated peritoneal dialysis.

Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.

La pedagogía de la inclusión aplicada a la clase de Educación Física / The pedagogy of inclusion applied to the Physical Education class

La pedagogía de la inclusión persigue formar personas desde la perspectiva de su individualidad, teniendo en cuenta su interacción social. Para la escuela cubana es un reto porque requiere cambios en la forma de interactuar, investigar y ofrece oportunidades de aprendizaje considerando la diversidad de necesidades y las diferencias de contextos, como alternativa más viable para proporcionar una respuesta educativa individualizada, comprensiva y diversificada. La Educación Física es una de las materias del currículo que tiene una alta responsabilidad de educar desde la diversidad, pero para ello los docentes deben capacitarse en las exigencias educativas a satisfacer. Los autores proponen algunas acciones metodológicas ya aplicadas a fin de que constituyan experiencias compartidas entre los docentes de la especialidad en sus clases.

The pedagogy of inclusion seeks to train people from the perspective of their individuality, taking into account their social interaction. For the Cuban school it is a challenge because it requires changes in the way of interacting, investigating and offering learning opportunities considering the diversity of needs and the differences in contexts, as a more viable alternative to provide an individualized, comprehensive and diversified educational response. Physical Education is one of the subjects in the curriculum that has a high responsibility to educate from diversity, but for this, teachers must be trained in the educational demands to be met. The authors propose some methodological actions already applied so that they constitute shared experiences among the teachers of the specialty in their classes.

Marine heatwaves drive recurrent mass mortalities in the Mediterranean Sea.

Climate change is causing an increase in the frequency and intensity of marine heatwaves (MHWs) and mass mortality events (MMEs) of marine organisms are one of their main ecological impacts. Here, we show that during the 2015-2019 period, the Mediterranean Sea has experienced exceptional thermal conditions resulting in the onset of five consecutive years of widespread MMEs across the basin. These MMEs affected thousands of kilometers of coastline from the surface to 45 m, across a range of marine habitats and taxa (50 taxa across 8 phyla). Significant relationships were found between the incidence of MMEs and the heat exposure associated with MHWs observed both at the surface and across depths. Our findings reveal that the Mediterranean Sea is experiencing an acceleration of the ecological impacts of MHWs which poses an unprecedented threat to its ecosystems' health and functioning. Overall, we show that increasing the resolution of empirical observation is critical to enhancing our ability to more effectively understand and manage the consequences of climate change.

Toxic and essential metal levels in the hair of red deer (Cervus elaphus) and wild boar (Sus scrofa) for monitoring the contamination in protected areas of South-Western Spain.

Contaminant monitoring in tissues of wild species can help in the knowledge not only of their health, but also of the environmental health conditions in the zones where they live. In this study, concentrations of toxic metals (As, Cd, Hg, and Pb) and an essential metal (Zn) were measured in the hair of red deer (Cervus elaphus) and wild boar (Sus scrofa) inhabiting in protected areas of South-Western Spain. Zn (69.02 ± 1.03 mg kg-1, 70.31 ± 2.22 mg kg-1), Pb (0.61 ± 0.05 mg kg-1, 0.68 ± 0.08 mg kg-1), and As (0.33 ± 0.03 mg kg-1, 0.53 ± 0.08 mg kg-1) were detected in the hair of red deer and wild boar, respectively. The other metals (Cd and Hg) were under the quantification limit (0.1 mg kg-1). No differences in the level of elements between both species were found. The levels of the detected elements in the hair showed low concentrations and similar to those observed in animals of the same species from unpolluted zones, reflecting a lack of contamination by these elements in the studied areas. Based on critical values of these elements established for organs of mammals, red deer and wild boar from the studied territories did not suffer toxicosis by the studied elements. Age-related differences in the content of As in the hair of red deer and age- and gender-related differences in the content of As in the hair of wild boar were detected, which should be considered for biomonitoring purposes. Finally, positive (Pb-As in both species) and negative (Zn-Pb in wild boar) interrelationships between elements were found.

Peritoneal dialysis modality transition and impact on phosphate and potassium serum levels.

Peritoneal dialysis (PD) modalities affect solute removal differently. However, the impacts of switching PD modalities on serum levels of biomarkers of different sizes are not known. Our objective was to analyze whether a change in the PD modality associates with the levels of two routine biochemical laboratories. In this multicentric prospective cohort study. we selected all patients who remained on a PD modality for at least 6 months and switched PD modality. Patients were also required to be treated with the same PD modality for at least 3 months before and after the modality change. The primary outcome was change in potassium and phosphate serum levels. We identified 737 eligible patients who switched their PD modality during the study. We found mean serum phosphate levels increased during the 3 months after switching from CAPD to APD and conversely decreased after switching to from APD to CAPD. In contrast, for potassium the difference in the mean serum levels was comparable between groups switching from CAPD to APD, and vice versa. In conclusion, CAPD seems to be as efficient as APD for the control of potassium serum levels, but more effective for the control of phosphate serum levels. The effect of a higher removal of middle size molecules as result of PD modalities in terms of clinical and patient-reported outcomes should be further explored.

New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.

Estimation of parameters in biological species with several mating and reproduction alternatives.

With the purpose of modeling the demographic dynamics of biological species in which different mating and reproduction alternatives are feasible, in Molina et al. (2014) we introduced a new mathematical model based on discrete-time branching processes. Assuming that the reproduction phase is governed by probability distributions belonging to the power series family, some reproductive parameters for such species were estimated. In this work, in a more general statistical context, we generalize this research. By considering observations, until a given generation, of the number of female and male individuals in each generation, we now investigate several inferential questions about the parameters of biological interest included in the mathematical model. We study such questions using procedures based on Bayesian statistical methodology. We apply the proposed methods to describe the dynamics of salmonid species.

Clima educativo hospitalario y síndrome de burnout en internos de medicina / Hospital educational climate and burnout syndrome in foundation years

INTRODUCCIÓN: El clima educativo hospitalario facilita el aprendizaje significativo y depende de la percepción de los integrantes; el síndrome de burnout aparece en profesionales que trabajan de manera directa con otras personas: ambos pueden influir de manera importante en la formación y desempeño de los futuros médicos. OBJETIVO: Evaluar la correlación entre el clima educativo en los hospitales y el síndrome de burnout en los internos de medicina humana de la región Lambayeque en 2018. MATERIAL Y MÉTODOS: Estudio descriptivo, transversal y observacional. La muestra estuvo constituida por todos los internos de medicina de la región Lambayeque en 2018. Se utilizó la encuesta Postgraduate hospital educational environment measurement (PHEEM) para medir el clima educativo, la Maslach Burnout Inventory-Human Services Survey para el síndrome de burnout y una encuesta sociodemográfica-laboral. RESULTADOS: Se encontró que el 28% de los internos presentó síndrome de burnout. En 5 hospitales de la región Lambayeque se observó un clima educativo más positivo que negativo (PHEEM = 80-120) y solo en un hospital referencial del Ministerio de Salud hubo un clima educativo con muchos problemas (PHEEM = 40-80). Hay una correlación estadísticamente significativa (p = 0,019), inversa y baja (r = -0,19) entre el clima educativo hospitalario y el síndrome de burnout en internos de medicina de la región Lambayeque. Además, se encontró una correlación significativa de los factores sociodemográficos laborales con síndrome de burnout, inversa y baja con horas de sueño (r = -0,22 y p = 0,009) y directa y baja con horas de trabajo (r = 0,28 y p = 0,001). CONCLUSIONES: Existe una correlación baja e inversa entre clima educativo y síndrome de burnout

INTRODUCTION:The educational hospital climate provides meaningful learning, and is dependent on the perception of its staff. Burnout syndrome appears in professionals who work directly with other people, and both can have a significant influence on the training and performance of future physicians. OBJECTIVE: To evaluate the correlation between the educational environment of hospitals and the Burnout syndrome in the Foundation of doctors in the Lambayeque region of Peru during 2018. MATERIAL AND METHODS: A descriptive, cross-sectional and observational study was conducted on a sample that consisted of all foundation year doctors from the Lambayeque region during 2018. The Postgraduate Hospital Educational Environment Measurement (PHEEM) questionnaire was used to measure the educational climate, the Maslach Burnout Inventory-Human Services Survey to measure burnout syndrome, as well as a socio-demographic-occupational questionnaire. RESULTS: It was found that 28% of the foundation year doctors had burnout syndrome. A more positive than negative educational climate was observed in 5 hospitals in the Lambayeque region (PHEEM = 80-120), and only in a reference hospital of the Ministry of Health there was an educational climate with many problems (PHEEM = 40-80). There was a statistically significant correlation (p = 0.019), and an inverse and low correlation (r = -0.19) between hospital educational climate and burnout syndrome in foundation year doctors in the Lambayeque region. In addition, a significant correlation was found between the sociodemographic occupational factors and burnout syndrome, inverse and low with hours of sleep (r = -0.22 and p = 0.009), and direct and low with hours of work (r = 0.28 and p = .001). CONCLUSIONS: There is a low and inverse correlation between educational climate and burnout syndrome

Glomerular endothelial cells and podocytes can express CD80 in patients with minimal change disease during relapse.

BACKGROUND: Urinary CD80 has emerged as potential biomarker in idiopathic nephrotic syndrome (INS). However, its cellular source remains controversial. The aim of the study was to assess whether CD80 is truly expressed by glomerular cells in INS patients during relapse and in the LPS mouse model of podocyte injury. METHODS: The presence of CD80 in glomeruli was evaluated by combining immunostaining, immunogold labeling, and in situ hybridization techniques. RESULTS: CD80 was present along the surface of glomerular endothelial cells (GEC) and rarely in podocytes in six of nine minimal change disease (MCD) patients in relapse, two of eleven patients with focal segmental glomerulosclerosis in relapse, and absent in controls. In mice, CD80 was upregulated at mRNA and protein level in GEC and podocytes, in a similar pattern to that seen in MCD patients. CONCLUSIONS: Glomerular endothelial cells and podocytes can express CD80 in patients with MCD during relapse. A better understanding of the role of CD80 in glomerular cells may provide further insights into the mechanisms of proteinuria in INS.

Managing Peritoneal Dialysis Complications through Remote Patient Management Protocols.

Peritoneal dialysis (PD) has many advantages compared to in-center hemodialysis, which include technical simplicity, and being a home therapy it allows patients significant autonomy for all their daily activities. Nephrologists require trustworthy information from patients for the appropriate management of PD, that is, a careful record of adherence to the prescribed schedule, effective time of dialysis, and a detailed volume of ultrafiltration (UF) is required. All these tasks demand time and commitment from patients, resulting frequently in incomplete or inconsistent information. Development and incorporation of remote monitoring devices to machines for automated PD makes data recovery easy and safe, and provides the medical team the opportunity to be more proactive, and prevent complications due to under dialysis, catheter dysfunction or chronic and acute changes in UF. Remote monitoring devices/machines may be a useful tool in the early diagnosis of peritoneal damage and even in the initial manifestation of peritonitis.

La evaluación de riesgos en la prevención de enfermedades profesionales, incidentes y accidentes laborales en el cultivo intensivo de tilapia / The evaluation of risks in the disease prevention professional, incidental and occupational accidents in the intensive farming of tilapia

RESUMEN Introducción: el cuidado y preservación de la salud en los trabajadores es un factor clave para el incremento de la productividad, la sostenibilidad del trabajo realizado y el bienestar de todos sus empleados. El cultivo intensivo de la tilapia en Cuba es un proceso clave en la producción de alimentos saludables. Sin embargo, en esta actividad existen un conjunto de factores de riesgo que pueden provocar incidentes/accidentes laborales en las diferentes fases de su cultivo y que además pueden provocar enfermedades profesionales o comunes en los trabajadores involucrados. Objetivo: evaluar los factores de riesgos presentes en la actividad de cultivo intensivo de tilapia, desarrollada en una empresa pesquera. Materiales y métodos: e stán referidos a los tipos de investigación utilizados: exploratorios, descriptivos y explicativos. En cuanto a los métodos empíricos aplicados se incluyen la revisión bibliográfica, el método científico inductivo-deductivo y el análisis y la síntesis. Además de las herramientas propias del campo de investigación implicado (herramienta mapa del cuerpo y método binario de evaluación de riesgo). Resultados: s e identifican y evalúan los riesgos para la seguridad y salud de los trabajadores que laboran en el cultivo intensivo de la tilapia. Además, se identifican las principales dolencias en el cuerpo por la incidencia de las condiciones de trabajo y las tareas a desarrollar, considerando tres momentos: inicio, mediado y final de la jornada laboral. Se proponen las acciones preventivas a considerar para evitar problemas de salud, incidentes o accidentes laborales en función de las evaluaciones realizadas. Conclusiones: se destaca que el procedimiento utilizado y los resultados obtenidos constituyen una guía útil para las diferentes organizaciones que deseen conocer la incidencia que tienen los factores de riesgo encontrados en la salud de sus trabajadores, proponiendo un conjunto de medidas preventivas y correctivas para atenuar las situaciones desfavorables (AU).

ABSTRACT Introduction: care and preservation of the health in the workers is a key factor for the productivity improvement, the sustainability of the realized work and the well-being of all its employees. The intensive farming of the Tilapia in Cuba is a key process in the production of wholesome foods. However; In this activity there are a set of risk factors that incidents can provoke occupational accidents in the different phases of their cultivation and that besides they can provoke professional or common diseases in the implicated workers. Objective: evaluating the factors of present risks in the activity of intensive farming of Tilapia, developed in a fishing company. Materials and methods: they are referred to the types of investigation used: Exploratory, descriptive and explanatory. As to the empiric applied methods they include the bibliographic revision, the inductive deductive scientific method and the analysis and the synthesis. In addition to the own tools of the implicated line of research (tool map of the body and binary method of risk assessment). Results: they provide evidence of their identity and they evaluate security risks and health of the workers that labor in the intensive farming of the tilapia. Furthermore, provide evidence of their identity the main illnesses in the body for the incidence of the working conditions and the tasks to develop, considering three moments: Start, mediated and final of the workday. Actions for provisional remedy intend to consider to avoid health problems, incidents or occupational accidents in terms of the realized evaluations. Conclusions: he stands out that the used procedure and the obtained results constitute an useful guideline for the different organizations that they desire knowing the incidence that have the risk factors found in the health of their workers, proposing a set of measures preventive and corrective to attenuate the unfavorable situations (AU).

La evaluación de riesgos en la prevención de enfermedades profesionales, incidentes y accidentes laborales en el cultivo intensivo de tilapia / The evaluation of risks in the disease prevention professional, incidental and occupational accidents in the intensive farming of tilapia

RESUMEN Introducción: el cuidado y preservación de la salud en los trabajadores es un factor clave para el incremento de la productividad, la sostenibilidad del trabajo realizado y el bienestar de todos sus empleados. El cultivo intensivo de la tilapia en Cuba es un proceso clave en la producción de alimentos saludables. Sin embargo, en esta actividad existen un conjunto de factores de riesgo que pueden provocar incidentes/accidentes laborales en las diferentes fases de su cultivo y que además pueden provocar enfermedades profesionales o comunes en los trabajadores involucrados. Objetivo: evaluar los factores de riesgos presentes en la actividad de cultivo intensivo de tilapia, desarrollada en una empresa pesquera. Materiales y métodos: e stán referidos a los tipos de investigación utilizados: exploratorios, descriptivos y explicativos. En cuanto a los métodos empíricos aplicados se incluyen la revisión bibliográfica, el método científico inductivo-deductivo y el análisis y la síntesis. Además de las herramientas propias del campo de investigación implicado (herramienta mapa del cuerpo y método binario de evaluación de riesgo). Resultados: s e identifican y evalúan los riesgos para la seguridad y salud de los trabajadores que laboran en el cultivo intensivo de la tilapia. Además, se identifican las principales dolencias en el cuerpo por la incidencia de las condiciones de trabajo y las tareas a desarrollar, considerando tres momentos: inicio, mediado y final de la jornada laboral. Se proponen las acciones preventivas a considerar para evitar problemas de salud, incidentes o accidentes laborales en función de las evaluaciones realizadas. Conclusiones: se destaca que el procedimiento utilizado y los resultados obtenidos constituyen una guía útil para las diferentes organizaciones que deseen conocer la incidencia que tienen los factores de riesgo encontrados en la salud de sus trabajadores, proponiendo un conjunto de medidas preventivas y correctivas para atenuar las situaciones desfavorables (AU).

ABSTRACT Introduction: care and preservation of the health in the workers is a key factor for the productivity improvement, the sustainability of the realized work and the well-being of all its employees. The intensive farming of the Tilapia in Cuba is a key process in the production of wholesome foods. However; In this activity there are a set of risk factors that incidents can provoke occupational accidents in the different phases of their cultivation and that besides they can provoke professional or common diseases in the implicated workers. Objective: evaluating the factors of present risks in the activity of intensive farming of Tilapia, developed in a fishing company. Materials and methods: they are referred to the types of investigation used: Exploratory, descriptive and explanatory. As to the empiric applied methods they include the bibliographic revision, the inductive deductive scientific method and the analysis and the synthesis. In addition to the own tools of the implicated line of research (tool map of the body and binary method of risk assessment). Results: they provide evidence of their identity and they evaluate security risks and health of the workers that labor in the intensive farming of the tilapia. Furthermore, provide evidence of their identity the main illnesses in the body for the incidence of the working conditions and the tasks to develop, considering three moments: Start, mediated and final of the workday. Actions for provisional remedy intend to consider to avoid health problems, incidents or occupational accidents in terms of the realized evaluations. Conclusions: he stands out that the used procedure and the obtained results constitute an useful guideline for the different organizations that they desire knowing the incidence that have the risk factors found in the health of their workers, proposing a set of measures preventive and corrective to attenuate the unfavorable situations (AU).

Incidencia de la insatisfacción laboral en la eficiencia de la gestión. Caso Clínica Estomatológica / Incidence of the occupational dissatisfaction in the efficiency of management. Case Dental Clinic

Introducción: la calidad en la gestión de los servicios asistenciales, es una exigencia que produce beneficios tanto para la población como para las instituciones de salud, máxime en Cuba, donde "Los servicios de salud son gratuitos, pero cuestan". Los costos de calidad son indicadores de eficiencia, particularmente en las partidas asociadas a fallos que evalúan los recursos malgastados por una deficiente gestión y sobre lo cual deberán enfocarse las acciones para la mejora. Objetivo: identificar los costos por fallos, en estrecha relación con el análisis de sus causas y la satisfacción de los trabajadores. Materiales y métodos: se realizó un estudio descriptivo. La metódica radicó en la investigación de campo en base a encuestas aplicadas a los trabajadores, revisión de documentos, evaluación de partidas de costos por extensión del sistema contable o estimación, según el caso, así como el análisis causal desarrollado por un grupo de expertos de la organización, con representación de las diferentes áreas de la clínica objeto de estudio. Resultados: se evalúan monetariamente fallos incurridos durante el año 2014, ascendiendo a $ 12260,49, los mayores montos estuvieron asociados a reelaboraciones y desperdicios. El análisis causal mostró una fuerte incidencia de los trabajadores en la ocurrencia de dichas ineficiencias, predominando las negligencias. La insatisfacción de los trabajadores, fue de una media general de 2,94 (por debajo de 3), lo que se puede interpretar como que estos reciben menos de lo que esperan, esencialmente, en cuanto a salario, condiciones laborales y participación en la toma de decisiones. Conclusiones: se establecen los montos de los costos asociados a fallos en la gestión de los servicios de la Clínica Estomatológica III Congreso del PCC, en línea con el análisis de la satisfacción de los trabajadores como elemento causal fundamental que incide en la calidad de los servicios en dicha organización, la cual debe establecer plan de mejoras en su gestión (AU).

Introduction: the quality of management in health care services is an exigency producing benefits both for the population and for health institutions, especially in Cuba, where "health services are free, but they cost." The quality costs are indicators of efficiency, particularly in the items associated to failures assessing resources misspent for a deficient management, and on which the actions should be focused for getting improvement. Objective: to identify the costs by failures, in tight relation with the analysis of their causes and workers´ satisfaction. Materials and methods: a descriptive study was carried out. Methodologically, it was a field research on the bases of surveys applied to workers, documental reviewing, and evaluation of cost items by extension of the accounting system or estimation, according to the case, and also the causal analyses performed by an expert group of the organization, with representatives of the different areas of the clinic being studied. Results: the failures that occurred during 2014 are monetarily evaluated, coming to $ 12 260.49. The highest amounts were associated to re-elaborations and wastes. The causal analysis showed a strong incidence of the workers in the occurrence of those inefficiencies, predominating negligence. The workers´ dissatisfaction was in general average 2.94 (under 3), what may be interpreted like if they receive less than they expect, essentially as for salary, working conditions and participation in decision-making. Conclusions: the amount of the cost associated to failures in the management of the services in the Dental Clinic "III Congreso del PCC" is established, aligned with the analysis of the workers´ satisfaction as main causal element striking in the quality of the services in that institution; they should elaborate and carried out a plan for the improvement of their management (AU).

Incidencia de la insatisfacción laboral en la eficiencia de la gestión. Caso Clínica Estomatológica / Incidence of the occupational dissatisfaction in the efficiency of management. Case Dental Clinic

Introducción: la calidad en la gestión de los servicios asistenciales, es una exigencia que produce beneficios tanto para la población como para las instituciones de salud, máxime en Cuba, donde "Los servicios de salud son gratuitos, pero cuestan". Los costos de calidad son indicadores de eficiencia, particularmente en las partidas asociadas a fallos que evalúan los recursos malgastados por una deficiente gestión y sobre lo cual deberán enfocarse las acciones para la mejora. Objetivo: identificar los costos por fallos, en estrecha relación con el análisis de sus causas y la satisfacción de los trabajadores. Materiales y métodos: se realizó un estudio descriptivo. La metódica radicó en la investigación de campo en base a encuestas aplicadas a los trabajadores, revisión de documentos, evaluación de partidas de costos por extensión del sistema contable o estimación, según el caso, así como el análisis causal desarrollado por un grupo de expertos de la organización, con representación de las diferentes áreas de la clínica objeto de estudio. Resultados: se evalúan monetariamente fallos incurridos durante el año 2014, ascendiendo a $ 12260,49, los mayores montos estuvieron asociados a reelaboraciones y desperdicios. El análisis causal mostró una fuerte incidencia de los trabajadores en la ocurrencia de dichas ineficiencias, predominando las negligencias. La insatisfacción de los trabajadores, fue de una media general de 2,94 (por debajo de 3), lo que se puede interpretar como que estos reciben menos de lo que esperan, esencialmente, en cuanto a salario, condiciones laborales y participación en la toma de decisiones. Conclusiones: se establecen los montos de los costos asociados a fallos en la gestión de los servicios de la Clínica Estomatológica III Congreso del PCC, en línea con el análisis de la satisfacción de los trabajadores como elemento causal fundamental que incide en la calidad de los servicios en dicha organización, la cual debe establecer plan de mejoras en su gestión (AU).

Introduction: the quality of management in health care services is an exigency producing benefits both for the population and for health institutions, especially in Cuba, where "health services are free, but they cost." The quality costs are indicators of efficiency, particularly in the items associated to failures assessing resources misspent for a deficient management, and on which the actions should be focused for getting improvement. Objective: to identify the costs by failures, in tight relation with the analysis of their causes and workers´ satisfaction. Materials and methods: a descriptive study was carried out. Methodologically, it was a field research on the bases of surveys applied to workers, documental reviewing, and evaluation of cost items by extension of the accounting system or estimation, according to the case, and also the causal analyses performed by an expert group of the organization, with representatives of the different areas of the clinic being studied. Results: the failures that occurred during 2014 are monetarily evaluated, coming to $ 12 260.49. The highest amounts were associated to re-elaborations and wastes. The causal analysis showed a strong incidence of the workers in the occurrence of those inefficiencies, predominating negligence. The workers´ dissatisfaction was in general average 2.94 (under 3), what may be interpreted like if they receive less than they expect, essentially as for salary, working conditions and participation in decision-making. Conclusions: the amount of the cost associated to failures in the management of the services in the Dental Clinic "III Congreso del PCC" is established, aligned with the analysis of the workers´ satisfaction as main causal element striking in the quality of the services in that institution; they should elaborate and carried out a plan for the improvement of their management (AU).

FCERI and Histamine Metabolism Gene Variability in Selective Responders to NSAIDS.

The high-affinity IgE receptor (Fcε RI) is a heterotetramer of three subunits: Fcε RIα, Fcε RIß, and Fcε RIγ (αßγ2) encoded by three genes designated as FCER1A, FCER1B (MS4A2), and FCER1G, respectively. Recent evidence points to FCERI gene variability as a relevant factor in the risk of developing allergic diseases. Because Fcε RI plays a key role in the events downstream of the triggering factors in immunological response, we hypothesized that FCERI gene variants might be related with the risk of, or with the clinical response to, selective (IgE mediated) non-steroidal anti-inflammatory (NSAID) hypersensitivity. From a cohort of 314 patients suffering from selective hypersensitivity to metamizole, ibuprofen, diclofenac, paracetamol, acetylsalicylic acid (ASA), propifenazone, naproxen, ketoprofen, dexketoprofen, etofenamate, aceclofenac, etoricoxib, dexibuprofen, indomethacin, oxyphenylbutazone, or piroxicam, and 585 unrelated healthy controls that tolerated these NSAIDs, we analyzed the putative effects of the FCERI SNPs FCER1A rs2494262, rs2427837, and rs2251746; FCER1B rs1441586, rs569108, and rs512555; FCER1G rs11587213, rs2070901, and rs11421. Furthermore, in order to identify additional genetic markers which might be associated with the risk of developing selective NSAID hypersensitivity, or which may modify the putative association of FCERI gene variations with risk, we analyzed polymorphisms known to affect histamine synthesis or metabolism, such as rs17740607, rs2073440, rs1801105, rs2052129, rs10156191, rs1049742, and rs1049793 in the HDC, HNMT, and DAO genes. No major genetic associations with risk or with clinical presentation, and no gene-gene interactions, or gene-phenotype interactions (including age, gender, IgE concentration, antecedents of atopy, culprit drug, or clinical presentation) were identified in patients. However, logistic regression analyses indicated that the presence of antecedents of atopy and the DAO SNP rs2052129 (GG) were strongly related (P < 0.001 and P = 0.005, respectively) with selective hypersensitivity to ibuprofen. With regard to patients with selective hypersensitivity to ASA, men were more prone to develop such a reaction than women (P = 0.011), and the detrimental DAO SNP rs10156191 in homozygosity increased the risk of developing such hypersensitivity (P = 0.039).

Investigations into the seasonal presence of Mycoplasma species in fattening lambs.

The presence of infection with Mycoplasma species in association with lung consolidation, environmental temperature and relative humidity was investigated in 410 clinically healthy fattening lambs from five different feedlots in Extremadura (southwestern Spain). Isolates of Mycoplasma species were obtained (n= 117), including Mycoplasma ovipneumoniae (n = 18) and Mycoplasma arginini (n = 99). Two seasonal periods were identified. The first period, which included February, March, September, October, and November, had an average temperature of 17.5 ± 4.7 °C and a relative humidity of 61.3 ± 15.8%. The second seasonal period, which included the months from April to August, had an average temperature of 22.9 ± 5.5 °C and a relative humidity of 48.4 ± 10.7%. Most Mycoplasma species were isolated from the second seasonal period, indicating that higher temperatures and lower relative humidity favour the presence of Mycoplasma species. M. arginini was also associated with lung consolidation.