[Evaluation of improved nutritional status in patients over 60 years with 6-month follow-up by a nutritionist in a hospital setting in Almería. The MOR-NUT study]. / Evaluación de la mejora del estado nutricional en pacientes mayores de 60 años con seguimiento de 6 meses por un nutricionista en el ámbito hospitalario de Almería. El estudio MOR-NUT.

Introduction: Background: non-institutionalized elderly patients who are prescribed an oral nutritional supplement (ONS) often have difficulties with compliance, which leads to physical deterioration and increases the risk of malnutrition. Objective: to assess improvement in the nutritional status of patients over 60 years of age, using the Mini Nutritional Assessment (MNA) score after the intervention of a nutritionist during a 6-month follow-up of malnourished patients with an indication for ONS. To demonstrate that the intervention of a nutritionist provides long-term improvements in the nutritional status of malnourished patients who are taking an ONS. Results: the nutritional intervention significantly improved BMI (from 22.9 ± 4.5 to 24.0 ± 4.1; p = 0.001) and the MNA score (from 14.7 ± 4.4 to 20.4 ± 5.8; p < 0.001) of the patients, as well as their perception of health (measured by VAS). Conclusions: the nutritional advice provided by a nutritionist to patients who were taking an ONS provided a high rate of adherence to treatment, which resulted in improvement in the nutritional status of patients.

Introducción: Antecedentes: los pacientes mayores no institucionalizados a los que se les prescribe un suplemento nutricional oral (SNO) suelen tener dificultades con el cumplimiento, lo que origina deterioro físico e incrementa el riesgo de desnutrición. Objetivo: evaluar la proporción de pacientes mayores de 60 años que mejoran su categorización de la versión completa del Mini Nutritional Assessment (MNA) desde el inicio hasta la visita final tras la intervención de un nutricionista en el seguimiento de pacientes desnutridos y con indicación de SNO a lo largo de 6 meses. Demostrar que la intervención de un nutricionista aporta mejoras a largo plazo en el estado nutricional de los pacientes desnutridos que están tomando un SNO. Resultados: la intervención nutricional mejoró significativamente el IMC (de 22,9 ± 4,5 a 24,0 ± 4,1; p = 0,001), y la puntuación MNA (de 14,7 ± 4,4 a 20,4 ± 5,8 p < 0,001) de los pacientes, así como su percepción de la salud (medida mediante una EVA). Conclusiones: el consejo nutricional proporcionado por un nutricionista en los pacientes que están tomando un SNO, consiguió una elevada adherencia al tratamiento, lo que produjo una mejora en el estado nutricional de los pacientes.

Circulating cervical cancer biomarkers potentially useful in medical attention (Review).

Cervical cancer (CC) is a public health problem worldwide, including Mexico. This type of cancer is the fourth most frequent in women worldwide; in Mexico it is the second most common type in women after breast cancer. The diagnosis of CC is based mainly on Pap smears and colposcopy and the identification of molecular tools that serve as a support for these methods is urgent. Regarding this, differential expressions of specific circulating biomolecules has been detected and, based on this, they have been postulated as potential biomarkers for CC diagnosis, prognosis, and/or to identify the response to treatments. Importantly, the combined analysis of these molecules considerably improves their efficacy as biomarkers and their potential use in the medical attention is promising.

Effect of Roux-en-Y Gastric Bypass on Lipoprotein Metabolism and Markers of HDL Functionality in Morbid Obese Patients.

PURPOSE: Morbid obesity represents the most severe form of obesity and surgical intervention would be its only successful treatment. Bariatric surgery could generate modifications in carbohydrate metabolism and in lipid profile plus lipoprotein-associated proteins and enzymes, such as lipoprotein-associated phoslipase A2 (Lp-PLA2), cholesteryl ester transfer protein (CETP), and paraoxonase (PON) 1. The aim of the present study was to analyze changes in inflammation markers, carbohydrate metabolism, and lipid parameters in patients who underwent bariatric surgery. METHODS: Thirty-seven patients with morbid obesity were recruited. Evaluations were performed before (T0) and 1 (T1) and 6 (T2) months after surgery. Glucose, insulin, high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoproteins (apo) A-I, and B plus Interleukin 1ß and 6 levels in addition to CETP, Lp-PLA2, and PON 1 activities were determined. RESULTS: Body mass index decreased at T1 and T2 (p < 0.01). An improvement in all markers of insulin resistance (p < 0.05) was observed at T1. hsCRP levels diminished at T2 (p < 0.05). Triglyceride levels decreased at T1 and T2 (p < 0.05). HDL-C and apo A-I showed a decrease at T1 which was completely reversed at T2 (p < 0.05). Lp-PLA2 activity increased at T1, which was reversed at T2 (p < 0.05), and CETP activity was diminished at T2 (p < 0.05). PON and ARE activities decreased at T1 and partially recovered at T2 (p < 0.05). CONCLUSIONS: These results would be indicative of a favorable effect of bariatric surgery on markers of carbohydrate metabolism and cardiovascular disease lipid risk factors.

Perceptions of Barriers and Benefits of HCV Treatment and Correlates to Treatment Intention in Methadone Patients.

While most methadone maintenance treatment (MMT) patients have hepatitis C (HCV), less than 11% initiate treatment. The objective of this study was to assess this population's perceptions of HCV treatment. We surveyed 100 HCV+ MMT patients from four urban programs, asking scaled attitude scores about factors that may affect treatment decisions. Using bivariate and ordinal regression methods, results indicated that while education level and previous discussion about treatment with providers were associated with treatment initiation interest, age, race, gender, insurance type, difficulty paying for health care, and time since screening were not. Those who (a) believed HCV treatment is easy to take and cures quickly, (b) have had positive interactions with physicians, and (c) feel they have had enough HCV education were more likely to indicate treatment willingness. Interventions must emphasize positive treatment attitudes and not only focus on structural barriers to move HCV+ MMT patients towards initiating care.

Primitive Old World monkey from the earliest Miocene of Kenya and the evolution of cercopithecoid bilophodonty.

Old World monkeys (Cercopithecoidea) are a highly successful primate radiation, with more than 130 living species and the broadest geographic range of any extant group except humans. Although cercopithecoids are highly variable in habitat use, social behavior, and diet, a signature dental feature unites all of its extant members: bilophodonty (bi: two, loph: crest, dont: tooth), or the presence of two cross-lophs on the molars. This feature offers an adaptable Bauplan that, with small changes to its individual components, permits its members to process vastly different kinds of food. Old World monkeys diverged from apes perhaps 30 million years ago (Ma) according to molecular estimates, and the molar lophs are sometimes incompletely developed in fossil species, suggesting a mosaic origin for this key adaptation. However, critical aspects of the group's earliest evolution remain unknown because the cercopithecoid fossil record before ∼18 Ma consists of only two isolated teeth, one from Uganda and one from Tanzania. Here we describe a primitive Old World monkey from Nakwai, Kenya, dated at ∼22 Ma, that offers direct evidence for the initial key steps in the evolution of the cercopithecoid dentition. The simple dentition and absence of bilophodonty in the Nakwai monkey indicate that the initial radiation of Old World monkeys was first characterized by a reorganization of basic molar morphology, and a reliance on cusps rather than lophs suggests frugivorous diets and perhaps hard object feeding. Bilophodonty evolved later, likely in response to the inclusion of leaves in the diet.

Mapping the Barriers and Facilitators of HCV Treatment Initiation in Methadone Maintenance Therapy Patients: Implications for Intervention Development.

An estimated 70-90% of current methadone users have Hepatitis C (HCV). Current treatments have few side effects and can cure infection in 8-12 weeks, but less than 10% of methadone patients initiate treatment. Engaging this group in treatment is an important strategy to lower both morbidity and mortality from liver disease and eliminate a significant reservoir of HCV in communities. To understand how to address this treatment gap we used commercial marketing techniques called perceptual mapping and vector message modeling to analyze survey data from 100 HCV+ methadone patients from four centers in Philadelphia. Results were used to understand barriers and facilitators to treatment initiation and to devise targeted message strategies to adapt to a mobile health communication intervention. Results indicate that focusing on how treatment can make one feel "in charge", positive interactions with healthcare providers, the positive attributes of the new vs. old HCV treatments, and providing strategies to address tangible barriers to getting treatment, would be important to address in a communication intervention. These marketing methods allow for focusing on specific variables to "move" the group toward a treatment decision, making them an innovative technique to use in developing highly targeted health communication messages.

[Modelling length of hospital stay in motor victims]. / Modelización del tiempo de hospitalización en lesiones por tránsito.

OBJECTIVE: To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. MATERIALS AND METHODS: In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. RESULTS: Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. CONCLUSIONS: Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

Modelización del tiempo de hospitalización en lesiones por tránsito / Modelling length of hospital stay in motor victims

Objetivo. Analizar los factores sociodemográficos y de las lesiones causadas por accidentes de tránsito que influyen en el tiempo de hospitalización de las víctimas. Material y métodos. Muestra transversal de 17 932 eventos de tránsito ocurridos en España entre 2000 y 2007. Se estimaron diferentes modelos de regresión para identificar y medir la influencia de los factores. Resultados. Los hombres tienen un tiempo medio de hospitalización 41% mayor al de las mujeres. La duración de la estancia hospitalaria media aumenta cinco veces cuando existen fracturas. Las lesiones en las extremidades inferiores, la cabeza y el abdomen se asocian con mayores duraciones hospitalarias. Conclusiones. El sexo de la víctima, su edad, la posición que ocupaba en el vehículo en el momento del evento, el tipo de vehículo causante y el tipo y zona de la lesión influyen significativamente en la duración de la estancia hospitalaria.

Objective. To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. Materials and methods. In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. Results. Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. Conclusions. Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

Ten years of preanalytical monitoring and control: Synthetic Balanced Score Card Indicator.

INTRODUCTION: Preanalytical control and monitoring continue to be an important issue for clinical laboratory professionals. The aim of the study was to evaluate a monitoring system of preanalytical errors regarding not suitable samples for analysis, based on different indicators; to compare such indicators in different phlebotomy centres; and finally to evaluate a single synthetic preanalytical indicator that may be included in the balanced scorecard management system (BSC). MATERIALS AND METHODS: We collected individual and global preanalytical errors in haematology, coagulation, chemistry, and urine samples analysis. We also analyzed a synthetic indicator that represents the sum of all types of preanalytical errors, expressed in a sigma level. We studied the evolution of those indicators over time and compared indicator results by way of the comparison of proportions and Chi-square. RESULTS: There was a decrease in the number of errors along the years (P<0.001). This pattern was confirmed in primary care patients, inpatients and outpatients. In blood samples, fewer errors occurred in outpatients, followed by inpatients. CONCLUSION: We present a practical and effective methodology to monitor unsuitable sample preanalytical errors. The synthetic indicator results summarize overall preanalytical sample errors, and can be used as part of BSC management system.

[Carbohydrate: current role in diabetes mellitus and metabolic disease]. / Hidratos de carbono: actualización de su papel en la diabetes mellitus y la enfermedad metabólica.

BACKGROUND: There is a prevalence of diabetes mellitus (DM), unknown DM and stress hyperglycemia among hospital patients, and the nutritional treatment is a key part of care, where carbohydrates (CH) intake is a controversial issue. There is also a discussion on the increase of prevalence for DM, obesity and metabolic disease with refined CH or sugar. OBJECTIVES: This review examines the recommendations from different scientific societies about the percentage of CH in the total calorie intake of the diabetic patient, the CH value in the glycemic index and glycemic load, the new CH included in enteral formulae and the association of refined CH with the high prevalence of DM and metabolic disease. METHODS: Systematic review of literature using the electronic scientific databases Pubmed, Science Direct, Scielo, Scopus and Medline. CONCLUSIONS: Scientific societies are flexible about the CH intake in the diet of diabetic patients, suggesting to customize it according to each metabolic profile. Using the glycemic index and glycemic load can provide an extra benefit in the postprandial glycemic control. The new diabetes-specific enteral formulae, with fructooligosaccharides, resistant maltodextrins and fructose-free show efficacy in improving the glycemic control, although more controlled and long-term studies are needed. There is still some controversy about the links between sugar intake and DM, obesity and metabolic disease, although this relationship would be more linked to an increase of the total calorie intake than to a specific nutrient.

Introducción: La diabetes mellitus (DM), la DM no conocida y la hiperglucemia de estrés en pacientes hospitalizados, es prevalente, y el tratamiento nutricional es una parte fundamental de su cuidado, siendo el aporte de hidratos de carbono (HC) uno de los aspectos controvertidos. Igualmente está a debate el incremento de la prevalencia de DM, obesidad y enfermedad metabólica con los HC refinados o azúcares. Objetivos: Esta revisión examina las recomendaciones de las distintas Sociedades Científicas en cuanto al porcentaje que los HC tienen que tener en el contenido calórico total de la dieta del diabético, el valor del índice y carga glucémica de los HC, los nuevos HC incluidos en las fórmulas enterales y la relación de los HC refinados con la alta prevalencia de DM y la enfermedad metabólica. Métodos: Revisión sistemática de la literatura usando las bases científicas electrónicas Pubmed, Science Direct, Scielo, Scopus y Medline. Conclusiones: Las Sociedades Científicas flexibilizan el aporte de HC en la dieta del diabético e indican individualizar la misma en función del perfil metabólico. El uso del índice y carga glucémica puede proporcionar un beneficio adicional en el control glucémico postprandial. Las nuevas fórmulas enterales específicas para diabetes, con fructooligosacáridos, maltodextrinas resistentes y sin fructosa son eficaces en mejorar el control glucémico, aunque necesitamos más estudios controlados y a largo plazo. Persiste controversia sobre la relación entre ingesta de azúcares y DM, obesidad y enfermedad metabólica, aunque la asociación estaría más relacionada con un aumento del aporte calórico total que con un nutriente específico.

Hidratos de carbono: actualización de su papel en la diabetes mellitus y la enfermedad metabólica / Carbohydrate: current role in diabetes mellitus and metabolic disease

Introducción: La diabetes mellitus (DM), la DM no conocida y la hiperglucemia de estrés en pacientes hospitalizados, es prevalente, y el tratamiento nutricional es una parte fundamental de su cuidado, siendo el aporte de hidratos de carbono (HC) uno de los aspectos controvertidos. Igualmente está a debate el incremento de la prevalencia de DM, obesidad y enfermedad metabólica con los HC refinados o azúcares. Objetivos: Esta revisión examina las recomendaciones de las distintas Sociedades Científicas en cuanto al porcentaje que los HC tienen que tener en el contenido calórico total de la dieta del diabético, el valor del índice y carga glucémica de los HC, los nuevos HC incluidos en las fórmulas enterales y la relación de los HC refinados con la alta prevalencia de DM y la enfermedad metabólica. Métodos: Revisión sistemática de la literatura usando las bases científicas electrónicas Pubmed, Science Direct, Scielo, Scopus y Medline. Conclusiones: Las Sociedades Científicas flexibilizan el aporte de HC en la dieta del diabético e indican individualizar la misma en función del perfil metabólico. El uso del índice y carga glucémica puede proporcionar un beneficio adicional en el control glucémico postprandial. Las nuevas fórmulas enterales específicas para diabetes, con fructooligosacáridos, maltodextrinas resistentes y sin fructosa son eficaces en mejorar el control glucémico, aunque necesitamos más estudios controlados y a largo plazo. Persiste controversia sobre la relación entre ingesta de azúcares y DM, obesidad y enfermedad metabólica, aunque la asociación estaría más relacionada con un aumento del aporte calórico total que con un nutriente específico (AU)

Background: There is a prevalence of diabetes mellitus (DM), unknown DM and stress hyperglycemia among hospital patients, and the nutritional treatment is a key part of care, where carbohydrates (CH) intake is a controversial issue. There is also a discussion on the increase of prevalence for DM, obesity and metabolic disease with refined CH or sugar. Objectives: This review examines the recommendations from different scientific societies about the percentage of CH in the total calorie intake of the diabetic patient, the CH value in the glycemic index and glycemic load, the new CH included in enteral formulae and the association of refined CH with the high prevalence of DM and metabolic disease. Methods: Systematic review of literature using the electronic scientific databases Pubmed, Science Direct, Scielo, Scopus and Medline. Conclusions: Scientific societies are flexible about the CH intake in the diet of diabetic patients, suggesting to customize it according to each metabolic profile. Using the glycemic index and glycemic load can provide an extrabenefit in the postprandial glycemic control. The new diabetes-specific enteral formulae, with fructooligosaccharides, resistant maltodextrins and fructose-free show efficacy in improving the glycemic control, although more controlled and long-term studies are needed. There is still some controversy about the links between sugar intake and DM, obesity and metabolic disease, although this relationship would be more linked to an increase of the total calorie intake than to a specific nutrient (AU)

Customising turnaround time indicators to requesting clinician: a 10-year study through balanced scorecard indicators.

AIM: The purpose of this study is, first to present a 10-year monitoring of postanalytical turnaround time (TAT) adapted to different clinicians and patient situations, second to evaluate and analyse the indicators results during that period of time, and finally to show a synthetic appropriate indicator to be included in the balanced scorecard management system. METHODS: TAT indicator for routine samples was devised as the percentage of certain key tests that were verified before a specific time on the phlebotomy day. A weighted mean synthetic indicator was also designed. They were calculated for inpatients at 15:00 and 12:00 and for primary care patients only at 15:00. The troponin TAT of emergency department patients, calculated as the difference between the troponin verification and registration time, was selected as the stat laboratory TAT indicator. RESULTS: The routine and stat TAT improved along the 10-year study period. The synthetic indicator showed the same trend. CONCLUSIONS: The implementation of systematic and continuous monitoring over years, promoted a continuous improvement in TAT which will probably benefit patient outcome and safety.

Determinantes sociales en salud y estilos de vida en población adulta en Concepción, Chile / Social determinants of health and lifestyles in adult population Concepción, Chile

Diversos son los factores que generan disparidades en el acceso al sistema de salud y en su utilización, lo que produce desigualdades tanto en la promoción de la salud como en las posibilidades del restablecimiento y supervivencia tras una enfermedad. El propósito del estudio fue determinar la relación entre estilo de vida promotor de salud y variables psicosociales, demográficas y de salud, en las comunas de Coronel y Concepción. Material y método: Corresponde a un estudio descriptivo y correlacional, de orientación cuantitativa. La población de estudio estuvo constituida por 441 adultos, de ambos sexos, entre 20 y 65 años, asistentes en el 2011 a establecimientos de atención primaria de salud. La muestra fue no aleatoria, con cuotas sexo y edad. El instrumento utilizado fue la Escala Health-Promoting Lifestyle Profile II. El procesamiento de la información se realizó con el Programa SAS. Resultados: Se encontró asociación significativa entre estilo de vida promotor en salud y determinantes estructurales como: el lugar de residencia, edad, sexo, educación, ingresos. Se encontraron asociaciones significativas en variables psicosociales como: percepción de problemas del entorno; satisfacción con aspectos de la vida; apoyo afectivo; apoyo y confianza; autoestima y autoeficacia. Conclusiones: Los resultados permiten reafirmar la relevancia de considerar, además de los factores estructurales, los factores psicosociales en la mirada y en la intervención en salud para potenciar estilos de vida promotores de salud. Los factores psicosociales se encuentran fuertemente asociados a estilos de vida promotores de salud...

There are many factors that create disparities in access and use of health systems, resulting inequalities in both health promotion and the possibilities of recovery and survival after an illness. The purpose of the study was to determine the relationship between lifestyle health promoter and psychosocial, demographic and health variables, in the communes of Coronel and Concepción. Methods: It is a descriptive and correlational study, quantitative orientation. The study population consisted of 441 adults, both sexes, between 20 and 65 years old users of primary health care in 2011. The sample was not random, with quotas for gender and age. The instrument used to measure was the Scale Health-Promoting Lifestyle Profile II. The information processing was performed with SAS program. Results: A significant association was found between the life style health promoter and structural determinants such as place of residence, age, sex, education, income. Significant associations were found in psychosocial variables such as perception of environmental problems; satisfaction with aspects of life, emotional support, support and confidence, self-esteem and self-efficacy. Conclusions: Results suggest the need of considering, besides to structural factors, the psychosocial factors at the gaze and health intervention for enhancing health promoting life styles. Psychosocial factors are strongly associated with health promoting life styles...

Bienestar psicológico: adultos mayores activos a través del voluntariado / Psychological well-being: active elderly through volunteering

Objetivo: Comparar el nivel de bienestar psicológico de adultos mayores voluntarios del programa "Asesores Seniors" del Servicio Nacional del Adulto Mayor, Región del Bío-Bío, Chile, y adultos mayores no voluntarios, usuarios de un Centro de Salud Familiar de la misma región. Material y método: Corresponde a un estudio descriptivo - comparativo. La población del estudio corresponde a 60 adultos mayores, 30 voluntarios en un programa gubernamental y 30 no voluntarios usuarios de un Centro de Salud Familiar. Los datos fueron analizados con el programa estadístico SAS 9.1. Se realizó análisis univariado y bivariado. Resultados: Los adultos mayores voluntarios presentaron un mayor nivel de bienestar psicológico en comparación con los adultos mayores no voluntarios, siendo esta diferencia significativa (p<0.0001). Conclusión: Los resultados del estudio permiten concluir que el vivir una vejez activa, específicamente participando de un voluntariado, otorga a los adultos mayores un mayor grado de bienestar psicológico...

Objective to establish the degree of psychological well-being in elderly volunteers of the "Senior Advisors" Program from the Bío-Bío National Senior Service and non volunteers, users of the San Pedro Family Health Center belonging to San Pedro de la Paz City Hall, Chile. Method: It is a descriptive, correlational and comparative study. Sample consisted of 60 seniors, 30 volunteers and 30 non-volunteers. SAS 9.1 statistical software was used for data analysis, performing univariate and bivariate analysis. Results: Elderly volunteers had a higher level of psychological well-being compared to non-volunteers, showing a significant diference (p <0.0001). Conclusion: Results showed a high degree of psychological well-being in the group of elderly volunteers compared with non-volunteers...

Comportamiento del bajo peso al nacer / Behavior of low birth weight

Introducción: el bajo peso al nacer trae consigo un aumento de la morbilidad y mortalidad del recién nacido, identificar los grupos de riesgo que aportan el mayor número, orientará a la búsqueda de posibles soluciones.Objetivos: caracterizar el comportamiento del bajo peso al nacer en el municipio de Güira de Melena en el período de enero de 2000 a diciembre de 2012.Métodos: se realizó una investigación observacional descriptiva, con todos los recién nacidos del municipio Güira de Melena en el período de enero de 2000 a diciembre de 2012. Se obtuvo una muestra de 309 bajo peso de un universo de 5 072 recién nacidos. Los datos fueron recolectados de los archivos de registro de nacimientos. Para el análisis de los resultados se utilizó el programa estadístico EPIDAT versión 3.0 para Windows, los cuales se expresaron de forma porcentual para su mejor comprensión.Resultados: del total de nacidos vivos, 309 fueron bajo peso para 6,1 porciento, el grupo con edad materna mayor de 35 años exhibió la mayor frecuencia. Se encontró que 217 fueron restricción del crecimiento intrauterino, lo que arrojó el 70,2 porciento, la edad superior a 35 años fue la de mayor aporte, 86,3 porciento; la morbimortalidad del bajo peso fue mayor en los de peso extremo.Conclusiones: las edades extremas en la etapa reproductiva de la mujer fueron las que mayores índices de bajo peso aportaron, la restricción del crecimiento intrauterino el tipo de bajo peso que predominó y dentro de este aquellos que se encontraron por debajo del tercer percentil para su edad gestacional(AU)

Introduction: low weight at birth brings about an increase of morbimortality of the new born child. Identifying the risk groups that supply the highest number of these cases will lead the search for possible situations.Objectives: to characterize the behavior of low weight at birth in the municipality of Güira de Melena in the period from January 2000 to December 2012.Methods: an observational descriptive research was carried out including all the new born children in the municipality of Güira de Melena in the period from January 2000 to December 2012. A sample of 309 low weights was taken from a universe of 5072 new born children. The data was collected from the birth register files and statistics EPIDAT program with 3.0 versions were reported in tables in perceptual form for their best understanding.Results: from the total number of new born children alive, 309 were low weight representing 6.1 percent. Mothers older than 35 years showed the highest frequency. From the total number of low weight 217 were found to be intra uterine slow growth for 70.2 percent. Ages higher than 35 years old supplied 86.3 percent of the cases. The morbimortality of low weight was greater in children with extreme weight.Conclusions: the limit reproductive stages of women were the ones that supplied higher rates of low weight. The intra uterine slow growth was the most outstanding type of low weight at birth, and within it, those which were found under the third percentage for their gestational age(AU)

Comportamiento del bajo peso al nacer / Behavior of low birth weight

Introducción: el bajo peso al nacer trae consigo un aumento de la morbilidad y mortalidad del recién nacido, identificar los grupos de riesgo que aportan el mayor número, orientará a la búsqueda de posibles soluciones.Objetivos: caracterizar el comportamiento del bajo peso al nacer en el municipio de Güira de Melena en el período de enero de 2000 a diciembre de 2012.Métodos: se realizó una investigación observacional descriptiva, con todos los recién nacidos del municipio Güira de Melena en el período de enero de 2000 a diciembre de 2012. Se obtuvo una muestra de 309 bajo peso de un universo de 5 072 recién nacidos. Los datos fueron recolectados de los archivos de registro de nacimientos. Para el análisis de los resultados se utilizó el programa estadístico EPIDAT versión 3.0 para Windows, los cuales se expresaron de forma porcentual para su mejor comprensión.Resultados: del total de nacidos vivos, 309 fueron bajo peso para 6,1 porciento, el grupo con edad materna mayor de 35 años exhibió la mayor frecuencia. Se encontró que 217 fueron restricción del crecimiento intrauterino, lo que arrojó el 70,2 porciento, la edad superior a 35 años fue la de mayor aporte, 86,3 porciento; la morbimortalidad del bajo peso fue mayor en los de peso extremo.Conclusiones: las edades extremas en la etapa reproductiva de la mujer fueron las que mayores índices de bajo peso aportaron, la restricción del crecimiento intrauterino el tipo de bajo peso que predominó y dentro de este aquellos que se encontraron por debajo del tercer percentil para su edad gestacional.

Introduction: low weight at birth brings about an increase of morbimortality of the new born child. Identifying the risk groups that supply the highest number of these cases will lead the search for possible situations.Objectives: to characterize the behavior of low weight at birth in the municipality of Güira de Melena in the period from January 2000 to December 2012.Methods: an observational descriptive research was carried out including all the new born children in the municipality of Güira de Melena in the period from January 2000 to December 2012. A sample of 309 low weights was taken from a universe of 5072 new born children. The data was collected from the birth register files and statistics EPIDAT program with 3.0 versions were reported in tables in perceptual form for their best understanding.Results: from the total number of new born children alive, 309 were low weight representing 6.1 percent. Mothers older than 35 years showed the highest frequency. From the total number of low weight 217 were found to be intra uterine slow growth for 70.2 percent. Ages higher than 35 years old supplied 86.3 percent of the cases. The morbimortality of low weight was greater in children with extreme weight.Conclusions: the limit reproductive stages of women were the ones that supplied higher rates of low weight. The intra uterine slow growth was the most outstanding type of low weight at birth, and within it, those which were found under the third percentage for their gestational age.

Patient identification errors: the detective in the laboratory.

BACKGROUND: The eradication of errors regarding patients' identification is one of the main goals for safety improvement. As clinical laboratory intervenes in 70% of clinical decisions, laboratory safety is crucial in patient safety. We studied the number of Laboratory Information System (LIS) demographic data errors registered in our laboratory during one year. METHODS: The laboratory attends a variety of inpatients and outpatients. The demographic data of outpatients is registered in the LIS, when they present to the laboratory front desk. The requests from the primary care centers (PCC) are made electronically by the general practitioner. A manual step is always done at the PCC to conciliate the patient identification number in the electronic request with the one in the LIS. Manual registration is done through hospital information system demographic data capture when patient's medical record number is registered in LIS. Laboratory report is always sent out electronically to the patient's electronic medical record. Daily, every demographic data in LIS is manually compared to the request form to detect potential errors. RESULTS: Fewer errors were committed when electronic order was used. There was great error variability between PCC when using the electronic order. CONCLUSIONS: LIS demographic data manual registration errors depended on patient origin and test requesting method. Even when using the electronic approach, errors were detected. There was a great variability between PCC even when using this electronic modality; this suggests that the number of errors is still dependent on the personnel in charge of the technology.

Should we customise critical value procedure according to patient origin and laboratory turnaround time?

INTRODUCTION: Our routine laboratory critical value notification procedure is based on a short list of six fundamental critical values. The report system for our Stat laboratory is not based on this 'short list'; instead, critical values are always reported according to the patient clinical context and the previous laboratory results. The aim of our work is to show how a critical value notification procedure based on a rigid list of values and thresholds can result in completely different results depending on whether the tests are requested in a stat or a routine manner. MATERIAL AND METHODS: We reviewed the number of critical value notifications based on the short list for the routine laboratory. For the stat laboratory, we studied the number of real notifications based on the pathologist validation of the individualised situation of the patient and calculated the number of notifications that would have been reported if the routine short list would have been used instead. RESULTS: The number of critical values that would have been reported if using the routine short list in stat laboratory was high when compared with the number of critical values that were really reported. CONCLUSIONS: Using a rigid list of laboratory values to notify critical values resulted in completely different results depending on whether the tests were requested in stat or routine. Reporting only really unexpected values through an individual custom-made reporting procedure may avoid the wasting of time and resources and raising false alarms among referring physicians and patients.

Alert value reporting: a new strategy for patient safety.

OBJECTIVES: The objectives of this study are to introduce the "alert value reporting" concept in primary care setting, to propose a list of chemistry and hematology alert limit tests that can be chosen for that strategy, to show how this notification procedure can be designed and established, and finally to evaluate the effectiveness and physicians' satisfaction regarding the proposed approach. In contrast to critical value reporting, alert value reporting would not allude to a result that may imply a life-threatening situation, but would indicate that an early diagnostic/therapeutic action would improve the patient's management and quality of life. DESIGN AND METHODS: A list of chemistry and hematology alert limit tests to be used for the strategy was agreed upon between laboratory professionals and general practitioners. Next, a retrospective 12-month study involving more than 1 million laboratory tests was made to check how many of these alert values would have been communicated if these theoretical alert values had been applied. A prospective analysis of every reported alert value during 6 months was carried out to assess the intervention effectiveness and the requesting physician's satisfaction with the new strategy. RESULTS: The alert value reporting was successfully executed. 20% of the reported alert values motivated the decision to reschedule the next patient's appointment. 90% of physicians considered alert value reporting as an interesting strategy to be continued. CONCLUSIONS: Alert value reporting strategy motivated changes in patient's management. Further studies are needed to test if this approach can contribute to enhance patient safety and decision-making.