Advances in Material Modification with Smart Functional Polymers for Combating Biofilms in Biomedical Applications.

Biofilms as living microorganism communities are found anywhere, and for the healthcare sector, these constitute a threat and allied mechanism for health-associated or nosocomial infections. This review states the basis of biofilms and their formation. It focuses on their relevance for the biomedical sector, generalities, and the major advances in modified or new synthesized materials to prevent or control biofilm formation in biomedicine. Biofilm is conceptualized as an aggregate of cells highly communicated in an extracellular matrix, which the formation obeys to molecular and genetic basis. The biofilm offers protection to microorganisms from unfavorable environmental conditions. The most frequent genera of microorganisms forming biofilms and reported in infections are Staphylococcus spp., Escherichia spp., and Candida spp. in implants, heart valves, catheters, medical devices, and prostheses. During the last decade, biofilms have been most commonly related to health-associated infections and deaths in Europe, the United States, and Mexico. Smart, functional polymers are materials capable of responding to diverse stimuli. These represent a strategy to fight against biofilms through the modification or synthesis of new materials. Polypropylene and poly-N-isopropyl acrylamide were used enough in the literature analysis performed. Even smart polymers serve as delivery systems for other substances, such as antibiotics, for biofilm control.

El inicio precoz de la lactancia materna se ve favorecido por la realización de la educación maternal / Early initiation of breastfeeding is benefited by maternal education program

OBJETIVO: Determinar la influencia de la educación maternal (EM) sobre el inicio precoz de la lactancia materna (LM) y su mantenimiento hasta los dos meses de vida del recién nacido. Conocer la influencia de la EM sobre los motivos que argumenta la mujer para abandonar la LM. MÉTODO: Estudio multicéntrico observacional llevado a cabo en cuatro hospitales de Andalucía en 2011 sobre mujeres primíparas. Los datos se recogieron a través de una entrevista y la historia clínica. En el análisis se estimaron odds ratios crudas y ajustadas. RESULTADOS: La realización de EM por parte de la madre se asoció con el inicio precoz de la LM (ORa = 1.78, IC 95% = 1.14-2.78) y el mantenimiento de esta (ORa = 1.73, IC 95% = 1.15-2.61). No hubo diferencias en los motivos que las mujeres argumentaron para abandonar la LM. CONCLUSIONES: La EM favorece el inicio y mantenimiento de la LM.

OBJECTIVE: To determine the influence of maternal education (ME) on early initiation of breastfeeding (BF) and its maintenance during the first two months of the infant's life, as well as to understand the influence of ME on the reasons for BF discontinuation. METHOD: This was a multicenter observational study carried out with primiparous women in four hospitals of Andalucía during 2011. Data was collected through interviews and from clinical charts. Raw and adjusted odds ratios were estimated during the analysis. RESULTS: Mothers who attended ME classes showed early initiation of BF (aOR = 1.78, 95% CI = 1.14-2.78) and maintenance of BF (aOR = 1.73, 95% CI = 1.15-2.61). There were no differences related to women's reasons to discontinue BF. CONCLUSIONS: ME positively impacts the initiation and maintenance of BF.

[Early initiation of breastfeeding is benefited by maternal education program]. / El inicio precoz de la lactancia materna se ve favorecido por la realización de la educación maternal.

OBJECTIVE: To determine the influence of maternal education (ME) on early initiation of breastfeeding (BF) and its maintenance during the first two months of the infant's life, as well as to understand the influence of ME on the reasons for BF discontinuation. METHOD: This was a multicenter observational study carried out with primiparous women in four hospitals of Andalucía during 2011. Data was collected through interviews and from clinical charts. Raw and adjusted odds ratios were estimated during the analysis. RESULTS: Mothers who attended ME classes showed early initiation of BF (aOR = 1.78, 95% CI = 1.14-2.78) and maintenance of BF (aOR = 1.73, 95% CI = 1.15-2.61). There were no differences related to women's reasons to discontinue BF. CONCLUSIONS: ME positively impacts the initiation and maintenance of BF.

[Health care model focused on the humanization: obstetric results]. / Modelo asistencial centrado en la humanización: resultados obstétricos.

BACKGROUND: At present there a tendency towards a change to establish a new conceptual framework in perinatal health care which aims to give a more human and closer, where the woman is the protagonist of her own pregnancy and childbirth leaving behind a medicalized model OBJECTIVE: To determine perinatal outcomes that result from the new perinatal care model established and the degree of user satisfaction with this. METHODS: A multicenter observational conducted in four hospitals in Andalusia (Spain) in 2011 on primiparous. The data were collected through an interview and medical history. Data were expressed as absolute frequencies, relative frequencies, mean and standard deviation. RESULTS: 520 women participated. The 18.11% (94) ended in cesarean deliveries. It was established early skin-to-skin between the mother and the newborn in 74.95% (389) and 75.53% (392) initiated breastfeeding early. The 73.26% (378) are very or fairly satisfied with the care provided at delivery. CONCLUSION: The new model of care has the user satisfaction, lower cesarean rate and implementation of recommended clinical practices.

Circulating tumour cells in peripheral blood: potential impact on breast cancer outcome.

INTRODUCTION: In breast cancer, the metastatic process may involve the dissemination of circulating tumour cells (CTCs) through the blood and lymphatic system prior to the colonisation of distant organs. Here we demonstrate the predictive capacity of CTCs for detecting risk of death in breast cancer patients during established time intervals. METHODS: CTCs were identified by immunocytochemical methods following isolation by selective immunomagnetic cell separation of cytokeratin-positive cells. Serial blood samples from 65 patients were collected at roughly monthly intervals for up to 50 months. Follow-up was conducted at different intervals: 1-5, >5-12, >12-24 and >24-50 months. RESULTS: Both presence and number of CTCs were correlated to risk of death: patients with CTCs at any time during follow-up had a higher risk of death (p=0.035) than patients without CTCs. Furthermore, during the first 5 months of therapy, patients with >5 CTCs had a higher risk of death than patients with <5 CTCs (p=0.002). CONCLUSIONS: Our results show that the persistence of CTCs after chemotherapy, particularly during the first 5 months, could define a group of patients with a high risk of relapse.

Contribuciones del metanálisis a la mejora de la salud y del método científico / Contribution of meta-analysis to scientific method and health care

El metanálisis es fruto del paradigma inductista de investigación: ofrece un análisis del principio de consistencia para una asociación causal (segundo principio de Hill) y es una herramienta intermedia en el análisis de decisiones. No está exento de inconvenientes: la hipótesis que investiga se comprueba generalmente con la misma información que la genera y los estudios que se ponderan no son formalmente independientes, en la medida que la metodología influye en los resultados y los estudios del presente mejoran los del pasado. Ha motivado el desarrollo de cuestionarios y protocolos de evaluación de diferentes tipos de diseños, principalmente ensayos clínicos. Todo esto fue uno de los detonantes de la llamada medicina basada en la ®evidencia¼. Ha impulsado la creación de agencias de evaluación de tecnologías sanitarias y contribuido a la mejora de la salud. En el campo de la metodología de investigación ha profundizado en el estudio del sesgo de publicación y la búsqueda de variables que influyen en la discrepancia entre los estudios individuales. En la actualidad, se metanalizan efectos secundarios y adversos, muchas veces objetivos secundarios de los estudios originales, lo que ocasiona riesgos al combinar estudios con insuficiente potencia estadística y que comunican irregularmente esos resultados.

Meta-analysis can be considered a result of the application of the induction model of thinking given that it allows athorough analysis of the consistency of an association(2nd principle of Hill). Besides, its usefulness as anintermediate tool for decision analysis has also beenproved. However, meta-analysis has some drawbacks:(a) the hypothesis under analysis is usually proved usingsome of the data that generated it; (b) the studies to be assessed are not formally independent as research methods influence on results and the methodology of current studies is better than that of previous ones. Meta analysishas prompted the development of evaluationprotocols for different designs, mainly clinical trials. It has favoured the emergence and spreading of evidence based medicine, thus contributing to the developmentof agencies for technology assessment in health care. As regards to methodology, it has improved the knowledgeon publication bias and determinants of lack ofconsistency among primary studies. Currently, meta analysisis also applied to the study of secondary outcomes(e.g., adverse effects). This practice is risky due to the combination of studies with poor statistical data of these effects, apart from the fact that they report results inadequately.

Manual de epidemiología y salud pública para licenciaturas y diplomaturas en ciencias de la salud

Introducción a la salud pública y los servicios sanitarios. Epidemiología, estadística y demografía sanitaria. Estrategias epidemiológicas específicas y prevención de problemas de salud. Gestión sanitaria y programas de salud.

Manual de epidemiología y salud pública para licenciaturas y diplomaturas en ciencias de la salud

Introducción a la salud pública y los servicios sanitarios. Epidemiología, estadística y demografía sanitaria. Estrategias epidemiológicas específicas y prevención de problemas de salud. Gestión sanitaria y programas de salud.

Relación entre infecciones hospitalarias posquirúrgicas y mortalidad a largo plazo / Relationship between postoperative hospital infections and long-term mortality

Scarce information is available regarding the relationship between long-term mortality and nosocomial infection in surgical patients. A prospective study on 2 866 patients admitted to a service of general surgery and followed-up during a median 6.2-year period post-discharge has been carried out (16 004 person/years of follow-up). Information on underlying conditions, including severity of illness, and healthcare-related variables was collected. The relative rates of death and its 95% confidence interval (CI) were estimated using person-years as the denominator. Multiple-risk factor adjusted for relative rates (RR) were obtained by Cox regression analysis. 383 patients died during follow-up after hospital discharge (death rate: 0.024/ year). Follow-up was complete in 99.2% of the cohort. After adjusting for the main predictors of mortality, we found an effect modification by the presence of chronic disease (p = 0.01 for the product-term between hospital infection and the diagnosis of chronic diseases). Among patients without any chronic disease during their hospitalization, to acquire a nosocomial infection was significantly related to higher long-term mortality (RR = 1.79, 95% CI 1.14-2.81). In these patients, the relative rate for surgical wound infection was 1.49 (95% CI 0.93-2.39). Among patients with chronic diseases (cancer, coronary heart disease or diabetes) no association between hospital infection and long-term mortality was found. Patients without chronic disease developing nosocomial infection have an increased risk of long-term mortality.

Hay escasez de trabajos sobre las consecuencias de infecciones hospitalarias a largo plazo. El presente trabajo es un estudio prospectivo de 2 866 pacientes ingresados en un Servicio de Cirugía General que fueron seguidos durante un tiempo medio de 6.2 años tras el alta (16 004 personas/año de seguimiento). Se recogió información a cerca de la presencia de enfermedades subyacentes, incluyendo la gravedad de la enfermedad y variables relacionadas con la asistencia sanitaria. Se estimaron las tasas relativas de muerte utilizando como denominador las personas/año con el intervalo de confianza (IC) del 95%. En el análisis estadístico se calculó el riesgo relativo (RR) ajustado mediante la regresión de Cox. Durante el seguimiento tuvieron lugar 383 muertes. El seguimiento se completó en el 99.2% de la cohorte. No se observaron diferencias importantes entre las características demográficas de los pacientes seguidos y de los perdidos durante el seguimiento. En los pacientes sin enfermedad crónica subyacente, la infección hospitalaria mostró una relación estadísticamente significativa con mayor mortalidad a largo plazo (RR ajustado = 1.79, IC 95% = 1.14-2.81). En estos pacientes la infección de la herida quirúrgica mostró un riesgo relativo de mortalidad de 2.33 (IC 95% = 1.04-3.72) en el análisis crudo y de 1.49 (IC 95% = 0.93-2.39) en el ajustado. En los pacientes con enfermedad crónica subyacente no se encontró relación entre la infección quirúrgica y la mortalidad a largo plazo. En conclusión, los pacientes quirúrgicos sin enfermedad crónica que desarrollaron infección adquirida en el hospital tuvieron un riesgo incrementado de mortalidad a largo plazo.