Farm level bio-economic modelling of aquatic animal disease and health interventions.

A farm level bio-economic model, for aquatic animal production, of the relationships between inputs (e.g. purchased animals), outputs (e.g. harvested animals) and gross margin (GM) was developed to assess ex-ante the economics of disease and animal health interventions. Feed costs were calculated from estimates of food conversion ratio (FCR), animals harvested and mortality. The model was applied to a typical grow-out rainbow trout (Oncorhynchus mykiss) farm on Lake Titicaca, Peru and a typical shrimp (Paenus vannamei) farm in the Mekong Delta, Vietnam. The model was used in two analyses. Firstly, an approach to assess the burden of disease developed by the Global Burden of Animal Diseases (GBADs) project was adopted. Output under conditions of 'ideal health' was estimated by reducing mortality to zero and removing health costs. GM in both systems increased by approximately 25% when production was kept constant (and stocking rates reduced) and more than doubled if production was allowed to rise (and initial stocking increased). The increase in GM under conditions of ideal compared with current production provided an estimate of the maximum possible benefit from improved health management. Secondly, break-even analysis was used to assess the economics of vaccination against infectious pancreatic necrosis (IPN) vaccine (rainbow trout - RBT) and probiotics (shrimp). If initial stocking was kept constant, and production allowed to rise, break-even points for the intervention (when GM was the same with and without the intervention) were achieved when mortality was reduced by 16% in RBT fry and juvenile and 28% in shrimp. If production was kept constant and benefit realised by reduced initial stocking, the break-even point was achieved for i) vaccination of RBT when mortality in fry and juveniles was reduced by 39%, and ii) probiotics in shrimp production when there was a 15% reduction in mortality (nursery and grow-out), 10% increase in shrimp weight at harvest and 10% improvement in FCR. The results demonstrate how relatively simple models, parameterised with basic farm production data, can assess the burden of disease and quantify ex-ante the potential benefit of interventions. In the absence of trial data, these analyses support decision-making by farmers. The models can be adapted for many aquaculture systems. Farm level results can be extrapolated to estimate disease burden, and benefits of interventions, at regional or national level and thus support informed decision-making and allocation of resources to health management.

Prebriefing, herramienta clave en el aprendizaje por simulación: concepto, evolución y consideraciones / Prebriefing, key tool in learning by simulation: concept, evolution and considerations

El objetivo de este trabajo es realizar una revisión del concepto, y elementos del prebriefing como herramienta de aprendizaje basado en simulación, mediante criterios descritos en la literatura propuestos por expertos en simulación y con experiencia en la planificación de actividades y estrategias necesarias en el ámbito educativo. La simulación es una herramienta fundamental en la educación de los profesionales de la salud. En odontología se justifica su desarrollo ya que permite que los estudiantes experimenten una situación real con el propósito de aprender y obtener conocimientos que les posibilita desenvolverse en un ambiente seguro. Las experiencias de aprendizaje mediante simulación involucran tres etapas de aprendizaje: prebriefing (briefing/presimulación), participación (experiencia simulada/escenario) y debriefing (reflexión). La investigación proporciona evidencia de que el proceso de prebriefing es uno de los más importantes dentro de una experiencia de aprendizaje basado en la simulación (ABS) y se identifica como parte de una planificación que suele ser estimulada por un objetivo o conjunto de fines que se desea que los estudiantes logren. Sin embargo, en odontología existe falta de discusión basada en la evidencia respecto a su uso. Según la literatura revisada podemos concluir que el concepto de prebriefing como fase de planificación ha evolucionado a lo largo de su aplicación, utilizando diferentes términos y elementos. Entre ellos los más usados, el briefing descrito como la orientación inmediatamente antes de la actividad y la presimulación las actividades planificadas que deben ser completadas por los alumnos antes de dar inicio a un ABS

The objective of this work is to review the concept and elements of prebriefing as a learning tool based on simulation, using criteria described in scientific literature and proposed by experts in simulation and with experience in planning activities and strategies required in the educational field. Simulation is a fundamental tool for the education of professionals in the field of health. In dentistry, its development is justified since it allows students to experience a real situation with the purpose of learning and obtaining knowledge that allows them to gain skills in a safe environment. The learning experience through simulation involve three stages of learning: prebriefing (briefing / presimulación), participation (simulated experience / scenario) and debriefing (reflection). The research provides evidence that the preparation process is one of the most important in a simulation-based learning experience (ABS) and is identified as part of a planning that is often stimulated by a goal or set of goals the students have to achieve. However, in dentistry there is a lack of discussion based on the evidence regarding its use. According to the literature reviewed, we can conclude that the concept of prebriefing as a planning phase has evolved throughout its application using different terms and elements. Among them the most used, the briefing described as the orientation immediately before the activity and the presimulation of the planned activities that must be completed by the students before starting an ABS

Síndrome de burnout y satisfacción laboral en enfermeras españolas en tiempo de crisis económica / Burnout Syndrome and job satisfaction among Spanish nurses at a time of economic crisis

Objetivo: analizar el grado de burnout y de satisfacción laboral en enfermeras españolas en tiempos de crisis económica. Método: la población de estudio fueron enfermeras españolas que desarrollaban su actividad en España o en el extranjero. Se distribuyó una encuesta online a través de redes sociales desde octubre de 2017 hasta mayo de 2018 que contenía el cuestionario CUBO para valorar burnout y el de satisfacción laboral de Warr, Cook y Wall. El muestreo fue por conveniencia. Se llevó a cabo un análisis descriptivo y analítico con pruebas paramétricas y no paramétricas. Resultados: participaron 1.346 enfermeras. El 39,67% tenía síndrome de burnout, el 37,07% estaba en riesgo de padecerlo. La satisfacción laboral era de grado medio y se asociaba negativamente al grado de burnout. El 16,34% pensaba que se había equivocado de profesión, el 43,16% se había planteado comenzar otros estudios para orientar su vida profesional hacia otra área y el 59,29% pensaba que se había endurecido emocionalmente. Los profesionales de Enfermería estaban insatisfechos fundamentalmente con su salario, las relaciones sociales entre dirección y trabajadores, las oportunidades de promoción, la forma de dirección de la empresa, la atención que se presta a sus sugerencias y las horas de trabajo. Se encontró correlación negativa entre la satisfacción laboral y el síndrome de burnout. La mayoría consideraba que la crisis había afectado a sus condiciones laborales. Conclusiones: se ha detectado un elevado grado de burnout y de insatisfacción laboral en profesionales de Enfermería españoles. Se presenta asociación negativa entre el síndrome de burnout y la satisfacción laboral. Los profesionales de Enfermería consideran que la crisis económica ha repercutido negativamente en la profesión

Objectives: to analyze the level of burnout and job satisfaction among Spanish nurses at times of economic crisis. Methods: the study population consisted in Spanish nurses carrying out their activity in Spain or abroad. An online survey was distributed through the social networks from October, 2017 until May, 2018, including the CUBO questionnaire for burnout assessment, and the Warr, Cook, and Wall's Job Satisfaction Scale. Convenience sampling was used, and descriptive and analytical analysis was conducted with parametric and non-parametric tests. Results: the study included 1,346 nurses; 39.67% of them had Burnout Syndrome, and 37.07% were at risk of suffering it. Also, 16.34% of them thought that they had chosen the wrong profession, 43.16% had considered studying something different in order to orientate their professional life towards another area, and 59.29% of them thought that they had become emotionally tougher. Nursing professionals were essentially unsatisfied with their salary, the social relationships between management and workers, promotion opportunities, the way in which the company was managed, the attention paid to their suggestions, and their working hours. A negative correlation was found between job satisfaction and Burnout Syndrome. The majority considered that the crisis had had an impact on their working conditions. Conclusions: a high level of burnout and job dissatisfaction has been detected among the Spanish Nursing professionals. There is a negative association between Burnout Syndrome and job satisfaction. Nursing professionals consider that the economic crisis has had a negative impact on their profession

Intralymphatic Histiocytosis: A Report of 2 Cases. / Histiocitosis intralinfática, a propósito de 2 casos.

Intralymphatic histiocytosis is a benign condition characterized by poorly defined erythematous plaques (sometimes forming a reticular pattern) as well as the presence of nodules and vesicles. Its etiology and pathogenesis appear to be related to chronic inflammation in the affected area, prior surgery, or systemic disease, particularly rheumatoid arthritis. We report on 2 new cases, both associated with joint surgery in the affected area and osteoarticular disease (primary synovial osteochondromatosis and rheumatoid arthritis). This is a chronic disease and there is no specific treatment. Different treatment options were chosen in the 2 cases described. A spectacular response to treatment with oral pentoxifylline and topical tacrolimus was observed in 1 of the patients.

Macitentan in daily clinical practice: A single centre, 1-year experience.

The effectiveness and safety of macitentan, a dual endothelin-receptor antagonist (ERA) approved for the treatment of pulmonary arterial hypertension (PAH), were shown in an extensive clinical trial oriented towards morbidity and mortality events. Our aim was to describe a single centre's experience of the utilization of macitentan in patients with PAH in clinical practice settings. Thirteen patients with different aetiologies and previous PAH treatments were studied. After 12 months of macitentan treatment, 11 patients improved their functional class (FC), all patients improved their 6-minute walk distance (6MWD) test, and 10 patients lowered their NT-proBNP plasma levels. Additionally, cardiac imaging parameters were also improved. No cases resulted in hospitalization, septostomy, transplant or death.

¿Cuál es el mejor indicador antropométrico para el control del embarazo? / What is the best anthropometric indicator for the pregnancy control?

Introducción: La evaluación del estado nutricional de toda mujer que desee gestar es fundamental para poder optimizar la salud de la madre, ya que es necesaria para planificar correctamente tanto la ganancia óptima de peso, como la alimentación y suplementación que va a requerir. El estado nutricional materno, antes y durante la gestación, es un determinante fundamental para el crecimiento fetal y el peso del recién nacido. Objetivo: identificar los factores antropométricos que influyen en el peso al nacer para cada categoría de índice de masa corporal (IMC) pregestacional. Métodos: Se trata de un estudio observacional y prospectivo desarrollado en el Departamento de Salud de la Ribera entre el 1 de abril de 2012 y el 31 de marzo de 2014. Resultados: La muestra final alcanzada fue de 140 gestantes. Los pesos de los recién nacidos de madres obesas, fueron mayores que los de los recién nacidos de madres en otras categorías del IMC. En la categoría de bajo peso, el peso al nacer fue de 3176,5±456,6 kg, para la de normopeso 3216,3±451,3 kg, para la de sobrepeso 3343,6±507,6 kg y por último, para la obesidad fue de 4153,0±648,4 kg. Conclusiones: El IMC pregestacional materno es el predictor que mejor se asocia con el peso al nacer. Las mediciones de pliegues corporales, perímetro braquial y circunferencia muscular del brazo no fueron predictoras del peso al nacer. La altura uterina es la variable con más clara asociación significativa respecto al peso del recién nacido (AU)

Background: The assessment of nutritional status of every woman want to be pregnant is essential to optimize the health of the mother, since it is necessary to properly plan both the optimal weight gain, such as food and that will require supplementation. The nutritional status of the mother, before and during pregnancy, is a key determinant of fetal growth and newborn weight. Aim: identify anthropometric factors influencing birth weight for each category of prepregnancy body mass index (BMI). Findings: 140 pregnant women were studied. The weights of newborns of obese mothers were higher than those of newborns to mothers in other BMI categories. In the category of low birth weight, birth weight was 3176,5 ± 456,6 kg for normal-weight, 3216,3 ± 451,3 kg for overweight and 3343,6 ± 507,6 kg, and finally, obesity women were 4153,0 ± 648,4 kg. Conclussions: Maternal prepregnancy BMI is the best predictor associated to birth weight. Measurements of skin-folds, arm circumference and upperarm circumference were not predictors of birth weight. Symphysis fundal height is the best variable with significant association clearer on the birth weight (AU)

Influencia del programa de educación maternal en el cambio de preferencias del plan de parto en gestantes del Departamento de Salud de La Ribera / Influence of maternal education program in changing birth plan preferences

OBJETIVO: Observar si existen diferencias en las preferencias que las gestantes reflejan en el plan de parto (PP) entre antes y después de recibir el programa de educación maternal (EM). Personas y método: Se trata de un estudio observacional y prospectivo, donde se evalúan las variables (sociodemograficas, preferencias durante el periodo de dilatación, periodo expulsivo, atención al bebe y en todo el proceso del parto y nacimiento) en gestantes que acuden al programa de EM en distintos centros de atención primaria del Departamento de Salud de La Ribera desde enero hasta octubre de 2012. Se utilizó la prueba de McNemar para el análisis estadístico. RESULTADOS: Se estudiaron un total de 249 gestantes. Los elementos identificados más importantes en los PP analizados que mostraron diferencias estadísticamente significativas entre antes y después de recibir las sesiones de EM incluyen: evitar la episiotomía, medidas de comodidad (ingerir líquidos, ir al baño cuando lo deseen, libertad de movimientos, monitorización intermitente, posición de expulsivo cómoda) y otras preferencias como realizar pujos espontáneos, pinzamiento del cordón tardío y cortarlo su acompañante, contacto piel con piel y amamantamiento de la forma más precoz posible. No encontramos diferencias en elementos relacionados con el ambiente (por ejemplo, la privacidad y toma de decisiones) ni durante el periodo de dilatación con la administración de enema, administración de oxitocina, rasurado del pubis, epidural y amniorrexis. CONCLUSIONES: Existen diferencias entre las preferencias del PP que seleccionan las gestantes al termino de las sesiones de EM. Las matronas podrían influir en ese cambio

OBJECTIVE: To see if there are differences between preferences reflecting the pregnant women in the birth plan (BP), between before and after receiving the maternal education sessions. People and method: It's an epidemiological, observational, longitudinal, and prospective study, where we measure the variables of study in pregnant women attending the sessions of maternal education (ME) in different centres of La Ribera Health Department since January to October 2012. The McNemar test was used for the analysis of preferences before and after. RESULTS: We studied 249 pregnant women. The most important elements analyzed BP identified that showed statistically significant differences between before and after receiving the ME sessions include pain (avoid episiotomy) comfort measures (drink fluids, go to the bathroom, freedom of movement, intermittent monitoring, expulsive comfortable position) and preferences (e.g., spontaneous push, delayed cord clamping and cutting his companion, skin-to-skin contact, breastfeeding and as early as possible). Instead we found no differences related to the environment (e.g., privacy and decision making) and dilation (enema, oxytocin, pubic shaving, epidural and amniorrhexis) elements. CONCLUSIONS: There are differences between preferences of the selected BP pregnant at the end of maternal education sessions, and midwives could influence in the change

The usefulness of ultrasound imaging in digital and extradigital glomus tumors.

Recent years have witnessed an increase in the use of ultrasound imaging of the skin in the field of dermatology, as the technique reveals details of vessels and other structures that cannot be detected on physical examination. Extradigital glomus tumors are rarely seen in clinical practice and can pose a diagnostic challenge for dermatologists. We report on 4 patients with a clinical suspicion of extradigital glomus tumor and on 1 patient with a clinical suspicion of subungual glomus tumor. All 5 patients underwent ultrasound examination in B mode and color and pulsed-wave Doppler prior to surgical excision of the tumor and histologic examination, which confirmed the diagnosis in each case. Ultrasound imaging of the skin, combined with clinical findings, provided a simple, noninvasive way of making a prompt diagnosis and identifying the exact location of the lesion for surgical removal.

Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients.

The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.

Reacción granulomatosa a tatuaje permanente de las cejas / Foreign body granulomas after eyebrow tattoos

El tatuaje cosmético permanente de pestañas, cejas y labios, se ha convertido en una práctica habitual. Sin embargo, existen riesgos y complicaciones, adherentes a esta práctica. Presentamos el caso de una paciente, sin antecedentes personales de interés que a las 3 semanas de realizar un tatuaje permanente cosmético de sus cejas, comenzó con entumecimiento y quemazón, en el área tatuada. Tras la evaluación completa de la paciente, y las pruebas realizadas, hacemos el diagnóstico de reacción granulomatosa a cuerpo extraño (AU)

Cosmetic tattoing, including the eyebrows, eyelids, and gingiva, is increasingly popular in today’s society. Despite the wide popularity of tattoos, there are complications after the process of tattooing. The case report is a woman who had no drug allergies and was not taking any medication. The patient presented with a 3-week history of swelling and irritation at the sites accompanied by burning and itching, after receiving injections of permanent cosmetic inks to the eyesbrows. Histophatology and others laboratory test disclose foreign body granulomas (AU)

[Anti-fungal resistant hypopigmented macules in an adolescent]. / Máculas hipopigmentadas en un adolescente resistentes a tratamiento antifúngico.

Progressive macular hypomelanosis of the trunk is a disease of unknown origin that often goes unrecognized in the clinical setting. We present an adolescent with this condition initially diagnosed as tinea versicolor. She was asymptomatic, with hypopigmented macules located on the trunk and with no previous history of inflammation, infection or injury. Progressive macular hypomelanosis is a common disorder that has frequently been misdiagnosed, probably because it is often considered a post-inflammatory hypopigmentation or pityriasis versicolor.

Máculas hipopigmentadas en un adolescente resistentes a tratamiento antifúngico / Anti-fungal resistant hypopigmented macules in an adolescent

La hipomelanosis macular progresiva del tronco es una entidad de etiología desconocida, que a menudo pasa desapercibida en el entorno clínico. Presentamos el caso de un adolescente con esta enfermedad inicialmente diagnosticada como pitiriasis versicolor. Las lesiones estaban formadas por máculas, hipopigmentadas, asintomáticas y localizadas en el tronco, sin historia previa de inflamación, infección o lesión. La hipomelanosis macular progresiva es un trastorno común con frecuencia mal diagnosticado, probablemente debido a que a menudo se considera una hipopigmentación post-inflamatoria o una pitiriasis versicolor (AU)

Progressive macular hypomelanosis of the trunk is a disease of unknown origin that often goes unrecognized in the clinical setting. We present an adolescent with this condition initially diagnosed as tinea versicolor. She was asymptomatic, with hypopigmented macules located on the trunk and with no previous history of inflammation, infection or injury. Progressive macular hypomelanosis is a common disorder that has frequently been misdiagnosed, probably because it is often considered a post-inflammatory hypopigmentation or pityriasis versicolor (AU)

Epidemiological and clinical features associated with colonisation/infection by Acinetobacter baumannii with phenotypic heterogeneous resistance to carbapenems.

The objective of this study was to identify risk factors for the acquisition of Acinetobacter baumannii with phenotypic heterogeneous resistance (PHR) to carbapenems and to determine whether these factors are similar to those associated with A. baumannii not showing this phenotype. Microbiological and clinical data from 211 patients included in the GEIH-Ab 2000 project were used. Isolates of A. baumannii were studied for their susceptibility to imipenem (IPM) by microdilution and for PHR to IPM as determined by the presence of colonies growing within the inhibition zone of IPM disks. Isolates were divided into three groups: (i) IPM-PHR isolates, i.e. susceptible and non-susceptible A. baumannii displaying PHR to IPM; (ii) non-IPM-PHR isolates, i.e. susceptible A. baumannii showing an inhibition halo but no colonies growing within it; and (iii) IPM-FR isolates, i.e. fully resistant A. baumannii displaying no halo of inhibition. IPM-PHR isolates of A. baumannii were more commonly isolated from respiratory tract samples and less commonly from urine, and were more frequently causes of infection than were IPM-FR isolates. Independent risk factors identified in patients with IPM-PHR isolates were Intensive Care Unit admission, surgery, and previous use of piperacillin/tazobactam or carbapenems, whilst risk factors for IPM-FR and IPM-PHR were previous use of cephalosporins and isolation from a urine sample. In conclusion, risk factors associated with colonisation/infection by isolates of A. baumannii with PHR to carbapenems are similar to those previously described for isolates resistant to carbapenems.