Validación de una estrategia didáctica para las relaciones interdisciplinarias entre Farmacología y asignaturas clínicas estomatológicas

Introducción: La validación de estrategias didácticas para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje, resulta necesaria para su posterior aplicación en la práctica pedagógica y posible generalización. Objetivo: Validar una estrategia didáctica para las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología. Métodos: Se realizó una investigación educativa entre enero y junio de 2022. Se asumieron métodos teóricos (analítico-sintético, inductivo-deductivo y sistematización), empíricos (consulta a expertos) y matemáticos-estadísticos (estadística descriptiva). Se seleccionó a los expertos según el nivel de competencia. Se elaboró y aplicó un cuestionario para valorar 16 aspectos de la estrategia en términos de: muy adecuado, bastante adecuado, adecuado, poco adecuado y no adecuado. Los criterios valorativos emitidos por los expertos se procesaron mediante el modelo matemático de Torgerson y se determinó el nivel de consenso de los expertos mediante el cálculo del coeficiente de concordancia de Kendall. Resultados: El coeficiente de competencia promedio de los expertos fue alto. De los 16 aspectos valorados, uno resultó "bastante adecuado" y el resto, "muy adecuado". Se estimó concordancia significativa entre los expertos consultados. Conclusiones: Los resultados de la consulta a expertos apuntan al reconocimiento del valor científico, teórico y práctico, de la estrategia didáctica diseñada para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología y le otorgan validez.

Introduction: The validation of didactic strategies to favor interdisciplinary relationships in the teaching-learning process is necessary for their subsequent application in pedagogical practice and possible generalization. Objective: To validate a didactic strategy for interdisciplinary relationships in the teaching-learning process of clinical subjects, with Pharmacology in the Stomatology career. Methods: Educational research was carried out, between January and June, 2022. Theoretical methods (analytical-synthetic, inductive-deductive and systematization), empirical (consultation to experts) and mathematical-statisticians (descriptive statistics). The experts were selected according to the level of competence. A questionnaire was developed and applied to assess 16 aspects of the strategy, in terms of: very suitable, quite suitable, suitable, not very suitable and not suitable. The evaluative criteria issued by the experts were processed using the Torgerson mathematical model and the level of consensus of the experts was determined by calculating the Kendall concordance coefficient. Results: The average competence coefficient of the experts turned out to be high. Of the 16 aspects assessed, one was "fairly adequate" and the rest, "very adequate". Significant agreement was estimated between the experts consulted Conclusions: The results of the expert consultation point to the recognition of the scientific, theoretical and practical value of the didactic strategy designed to favor interdisciplinary relationships in the teaching-learning process of clinical subjects with Pharmacology in the Stomatology career, and give validity to the same.

Asociación plaquetas-factor de crecimiento epidérmico en pacientes con cáncer pulmonar de células no pequeñas tratados con quimioterapia / Platelet-epidermal growth factor association in patients with non-small cell lung cancer treated with chemotherapy

RESUMEN Introducción: la concentración plasmática del factor de crecimiento epidérmico pudiera encontrarse alterada en pacientes con cáncer de pulmón de células no pequeñas y trombocitopenia/trombocitosis por quimioterapia. Objetivo: determinar la asociación existente entre la concentración plasmática plaquetaria y la concentración plasmática de factor de crecimiento epidérmico en pacientes con cáncer de pulmón de células no pequeñas tratados con quimioterapia, entre marzo de 2019 y febrero de 2020 en el Hospital Provincial Saturnino Lora. Métodos: se realizó un estudio observacional descriptivo transversal en el Hospital Provincial Saturnino Lora, provincia Santiago de Cuba, Cuba, entre marzo de 2019 y febrero de 2020. El universo estuvo constituido por 54 pacientes con diagnóstico de cáncer pulmonar de células no pequeñas tratados con quimioterapia. Por muestreo probabilístico aleatorio simple se seleccionó una muestra de 12 pacientes. Se midieron las variables: concentración plasmática plaquetaria (pre y post-quimioterapia), concentración plasmática de factor de crecimiento epidérmico (pre y post-quimioterapia), y modificación de la concentración plasmática de factor de crecimiento epidérmico (castración, no castración). Para el procesamiento de los datos se empleó el test estadístico T student y la correlación lineal de Pearson, así como la media y desviación estándar como medidas de resumen y dispersión, respectivamente. Resultados: entre las concentraciones plasmáticas plaquetaria y del factor de crecimiento epidérmico se halló una relación lineal de -0,37 previo a la quimioterapia y de -0,51, posterior a esta; no se encontraron diferencias estadísticamente significativas. Conclusiones: se concluye que la modificación de la concentración plasmática del factor de crecimiento epidérmico no guarda relación aparente con la modificación plasmática plaquetaria, con posible relación espuria, dada por la quimioterapia.

ABSTRACT Introduction: the plasma concentration of epidermal growth factor may be altered in patients with non-small cell lung cancer and thrombocytopenia/thrombocytosis due to chemotherapy. Objective: to determine the association between platelet plasma concentration and epidermal growth factor plasma concentration in patients with non-small cell lung cancer treated with chemotherapy between March 2019 and February 2020 at Saturnino Lora Provincial Hospital. Methods: a cross-sectional, descriptive and observational study was conducted at Saturnino Lora Provincial Hospital, Santiago de Cuba province, Cuba, between March 2019 and February 2020. The target group comprised 54 patients diagnosed with non-small cell lung cancer treated with chemotherapy. A sample of 12 patients was chosen by simple probability-random sampling: platelet plasma concentration (pre- and post-chemotherapy), epidermal growth factor plasma concentration (pre- and post-chemotherapy), and modification of epidermal growth factor plasma concentration (castration, non-castration) were measured. For data processing, the statistical T-student test and Pearson's linear correlation were applied, as well as the mean and standard deviation as summary and dispersion measures, respectively. Results: a linear relationship of -0.37 before chemotherapy and -0.51 after the chemotherapy was found between platelet and epidermal growth factor plasma concentrations; no statistically significant differences were found. Conclusions: it is concluded that the modification of the plasma concentration of epidermal growth factor has no apparent relationship with the platelet plasma modification, with possible spurious relationship, given by chemotherapy.

Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery.

BACKGROUND: Spain has become a principal destination for immigrants and delivery is the major reason for hospitalization in this population. However, research about inequities between native and immigrant women regarding the quality of the care received during pregnancy and delivery is still scarce. One of the indicators used to evaluate the quality of the obstetric care is the rate of caesarean sections (CSs). METHODS: A cross-sectional study of 215 379 single deliveries from Spanish and immigrant women from Latin America, East Europe and Maghreb was carried out in Spain in 2005-06. Prevalence of CS according to maternal and neonatal characteristics was calculated by geographical origin. Two associations were explored by means of multiple logistic regression analysis. First, the association between geographical origin and the risk of CS in public or private hospitals separately, and, second, the risk of CS for women from the same geographical origin depending on whether they delivered at public or private hospitals. RESULTS: Overall, the risk of CS was lower for immigrants as a whole than for native women (odds ratio (OR) = 0.83 95% confidence interval (CI) = 0.80-0.85), but the risk varied markedly by area of origin, being higher for Latin Americans (OR = 1.09 95% CI = 1.05-1.13) and lower for East Europeans (OR = 0.61 95% CI = 0.57-0.66) and Maghrebians (OR = 0.60 95% CI =0.57-0.63). Public hospitals followed the overall pattern of risk. CS risk was higher in private than in public hospitals for all groups. However, the increase in risk was higher for immigrant than for natives. CONCLUSION: Immigrants in Spain are a heterogeneous population regarding the risk of CS. Geographical origin and type of hospital are key aspects underlying such a risk.

Recourse to induced abortion in Spain: profiling of users and the influence of migrant populations

Background: Social vulnerability implies a higher risk of induced abortion (IA). Immigrant status could be an additional factor. The objective was to identify the patterns surrounding which women resort to IAs, and to study the relationship between socio-economic and health system factors. Another aim was to determine the relationship between the patterns identified and the immigrant's country. Methods: A cross-sectional study was performed including all IAs notified during 2006 on women residing in three Spanish autonomous communities (the Balearic Islands, Catalonia and Comunitat Valenciana). We used sociodemographic, nationality and related variables, reproductive history and use of health services. A Categorical Principal Component Analysis was used to summarize the information and to identify profiles. Results: More than a third of IAs were performed on non-Spanish women. Four dimensions have been determined that define the profile of women resorting to IAs: age, reproductive history and marital status; type of health services used; social level; and earlier or late IA and its repetitive use. Age and related factors were important determinants. Economic status and knowledge of the health system were related to access to contraception and IA information. Spanish, Western European and South American women had a higher social level than Romanian and African women. Late IA use and a lower recurrence characterised Asian, North African and Spanish women. Conclusion: Differences on IA use between groups of different women seem to be related to vulnerability (economic, social, knowledge and use of healthcare services). There is a different situation among immigrants of differing nationalities (AU)

Objetivos: La vulnerabilidad social representa un riesgo de interrupción voluntaria del embarazo (IVE). La inmigración puede ser un factor adicional. Se pretendía identificar patrones que caracterizaran a las mujeres que abortan y estudiar la relación con factores socioeconómicos y de atención sanitaria. Otro objetivo fue determinar la relación entre los patrones identificados y el origen de las inmigrantes. Métodos: Se realizó un estudio transversal incluyendo todas las IVE notificadas durante 2006 a tres registros de IVE de comunidades autónomas: Illes Balears, Catalunya y Comunitat Valenciana. Se utilizaron variables sociodemográficas, de nacionalidad y relacionadas, historia reproductiva y de utilización de servicios sanitarios. Se realizó un análisis de componentes principales categórico para resumir la información e identificar perfiles. Resultados: Las inmigrantes representaron más de un tercio de las IVE. Cuatro dimensiones definieron el perfil de las mujeres que abortan: edad, historia reproductiva y estado civil; utilización de servicios públicos o privados; nivel social; IVE tardía o precoz y su recurrencia. Edad y factores relacionados fueron determinantes importantes. El nivel económico y el conocimiento del sistema sanitario estaban relacionados con el acceso a la anticoncepción y a la información sobre IVE. Españolas, europeas occidentales y latinoamericanas tenían mayor nivel social que rumanas y africanas. El uso tardío de la IVE y una menor recurrencia fue característico de españolas, norteafricanas y asiáticas. Conclusión: Las diferencias en el recurso a la IVE entre grupos de mujeres parecen relacionarse con la vulnerabilidad (económica, social, de conocimiento y uso del sistema sanitario). La situación varía entre inmigrantes de diferentes nacionalidades (AU)

Recourse to induced abortion in Spain: profiling of users and the influence of migrant populations.

BACKGROUND: Social vulnerability implies a higher risk of induced abortion (IA). Immigrant status could be an additional factor. The objective was to identify the patterns surrounding which women resort to IAs, and to study the relationship between socio-economic and health system factors. Another aim was to determine the relationship between the patterns identified and the immigrant's country. METHODS: A cross-sectional study was performed including all IAs notified during 2006 on women residing in three Spanish autonomous communities (the Balearic Islands, Catalonia and Comunitat Valenciana). We used sociodemographic, nationality and related variables, reproductive history and use of health services. A Categorical Principal Component Analysis was used to summarize the information and to identify profiles. RESULTS: More than a third of IAs were performed on non-Spanish women. Four dimensions have been determined that define the profile of women resorting to IAs: age, reproductive history and marital status; type of health services used; social level; and earlier or late IA and its repetitive use. Age and related factors were important determinants. Economic status and knowledge of the health system were related to access to contraception and IA information. Spanish, Western European and South American women had a higher social level than Romanian and African women. Late IA use and a lower recurrence characterised Asian, North African and Spanish women. CONCLUSION: Differences on IA use between groups of different women seem to be related to vulnerability (economic, social, knowledge and use of healthcare services). There is a different situation among immigrants of differing nationalities.

[Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study]. / Mortalidad poblacional por infarto agudo de miocardio. Estudio IBERICA.

BACKGROUND AND OBJECTIVE: The magnitude of the problem of myocardial infarction (MI) is better understood by assessing the population case-fatality than by analyzing only the number of patients attending hospitals. PATIENTS AND METHOD: Our data come from the IBERICA Study (Investigation, Specific Search and Registry of Acute Myocardial Ischemic Syndrome). Twenty eight-day MI population case-fatality is described in the population aged 25 to 74 years during 1997 and 1998 in the following Spanish autonomous communities: Castilla-La Mancha (Toledo and Albacete), Catalonia (Girona), Valencia Community (Valencia), Balearic Islands (Majorca), Murcia, Navarra and Basque Country. The relationship between case-fatality and other variables such as sex, age and geographic area is also analyzed. RESULTS: A total of 10,660 MI cases were registered, 4,106 of whom died within the period of 28 days following the onset of symptoms (38.5%; CI 95%, 37.6-39.4%). The overall case-fatality was 37.0% (CI 95%, 35.9-38.0%) in men and 44.3% (CI 95%, 42.3-46.4%) in women. Death occurred out of hospitals in 2,869 (69.9%) cases. An increased case-fatality in women was associated with a higher in-hospital case-fatality (45% higher than men). The proportion of patients who died before reaching a hospital was similar in both genders. Classical symptoms of MI were more common among men than women (82.7% vs. 77.6%, p < 0,001). The interval between symptoms' onset and hospitalization was 30 minute longer among hospitalized women as compared with men (p < 0,001). CONCLUSIONS: Population MI case-fatality is high in the seven Spanish autonomous communities studied. Approximately 2 out of 3 deaths occur without patients being able to reach a hospital. These results emphasize the importance of primary and secondary prevention measures and the necessity to design ready-access systems to defibrillation and resuscitation manoeuvres for patients with cardiopulmonary arrest.

Mortalidad poblacional por infarto agudo de miocardio. Estudio IBERICA / Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study

FUNDAMENTO Y OBJETIVO: El estudio de la mortalidad poblacional del infarto agudo de miocardio (IAM), que incluye las muertes ocurridas antes de llegar al hospital, ofrece una visión más completa sobre la magnitud del problema que la obtenida estudiando únicamente la mortalidad de los casos que reciben atención hospitalaria. PACIENTES Y MÉTODO: Los datos provienen del estudio IBERICA (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda). Se describe la mortalidad en los primeros 28 días desde el inicio de los síntomas de los episodios de IAM registrados, durante 1997 y 1998, en la población de 25 a 74 años residente en 7 comunidades autónomas españolas: Castilla-La Mancha (Toledo y Albacete), Cataluña (Girona), Comunidad Valenciana (Valencia), Islas Baleares (Mallorca), Murcia, Navarra y País Vasco. Además, se estudia la relación entre mortalidad y otras variables como el sexo, la edad y el área geográfica. RESULTADOS: Se registraron 10.654 casos de IAM de los que 4.105 fallecieron durante los 28 primeros días (38,5 por ciento; intervalo de confianza [IC] del 95 por ciento, 37,6-39,4 por ciento). La mortalidad fue del 37,0 por ciento (IC del 95 por ciento, 35,9-38,0 por ciento) en los varones y del 44,3 por ciento (IC del 95 por ciento, 42,3-46,4 por ciento) en las mujeres. La muerte se produjo fuera del hospital en 2.869 (69,9 por ciento) casos. La mayor mortalidad en mujeres estuvo relacionada fundamentalmente con una mayor mortalidad hospitalaria (45 por ciento superior a la registrada en los varones), siendo menor la diferencia en la proporción de casos que fallecieron fuera del hospital. La sintomatología típica de presentación del episodio fue más frecuente en varones (el 82,7 frente al 77,6 por ciento) (p < 0,001). Entre los pacientes que llegaron vivos al hospital, el tiempo transcurrido entre el comienzo de los síntomas y el inicio del tratamiento fue, en promedio, 30 min menor en los varones (p < 0,001). CONCLUSIONES: La mortalidad poblacional por IAM en estas 7 áreas españolas es muy elevada aunque inferior a la de otros países industrializados. Aproximadamente dos de cada tres muertes ocurren antes de llegar al hospital. Estos datos refuerzan el papel prioritario de la prevención primaria y secundaria, ya que los cuidados hospitalarios tienen un impacto limitado en el control de la mortalidad poblacional por IAM. También indican que una forma de reducir la mortalidad debería incluir el acceso rápido a la desfibrilación y a las maniobras de resucitación de los pacientes que presenten una muerte súbita (AU)