Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado / Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial

Objetivos. Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. Métodos. Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). Resultados. Un total de 1.001 pacientes ingresaron al estudio (GI=500 y GC=501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p<0,05). Conclusiones. La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios. (AU)

Objectives. To evaluate a clinical pharmacist’s inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. Methods. Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient’s discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. Results. A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist’s intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P<.05). Conclusions. Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction. (AU)

Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado / Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial

Objetivos. Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. Métodos. Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). Resultados. Un total de 1.001 pacientes ingresaron al estudio (GI=500 y GC=501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p<0,05). Conclusiones. La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios. (AU)

Objectives. To evaluate a clinical pharmacist’s inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. Methods. Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient’s discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. Results. A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist’s intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P<.05). Conclusions. Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction. (AU)

Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial. / Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado.

OBJECTIVES: To evaluate a clinical pharmacist's inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. MATERIAL AND METHODS: Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient's discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. RESULTS: A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist's intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P .05). CONCLUSION: Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction.

OBJETIVO: Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. METODO: Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). RESULTADOS: Un total de 1.001 pacientes ingresaron al estudio (GI = 500 y GC = 501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p 0,05). CONCLUSIONES: La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios.

Genetic Polymorphisms and Tumoral Mutational Profiles over Survival in Advanced Colorectal Cancer Patients: An Exploratory Study.

Colorectal cancer is a common disease, both in Chile and worldwide. The most widely used chemotherapy schemes are based on 5-fluorouracil (5FU) as the foundational drug (FOLFOX, CapeOX). Genetic polymorphisms have emerged as potential predictive biomarkers of response to chemotherapy, but conclusive evidence is lacking. This study aimed to investigate the role of genetic variants associated with 5FU-based chemotherapy on therapeutic response, considering their interaction with oncogene mutations (KRAS, NRAS, PI3KCA, AKT1, BRAF). In a retrospective cohort of 63 patients diagnosed with metastatic colorectal cancer, a multivariate analysis revealed that liver metastases, DPYD, ABCB1, and MTHFR polymorphisms are independent indicators of poor prognosis, irrespective of oncogene mutations. BRAF wild-type status and high-risk drug-metabolism polymorphisms correlated with a poor prognosis in this Chilean cohort. Additionally, findings from the genomics of drug sensitivity (GDSC) project demonstrated that cell lines with wild-type BRAF have higher IC50 values for 5-FU compared to BRAF-mutated cell lines. In conclusion, the genetic polymorphisms DPYDrs1801265, ABCB1rs1045642, and MTHFRrs180113 may serve as useful biomarkers for predicting a poor prognosis in patients undergoing 5-fluorouracil chemotherapy, regardless of oncogene mutations.

One Welfare: Assessing the Effects of Drought and the COVID-19 Pandemic on Farmers' Well-Being and Their Perception of Goats' Welfare.

Considering the interconnections between human well-being, animal welfare, and the environment, this study aimed to investigate the impacts of drought and the COVID-19 pandemic on small-scale goat farmers' well-being and their perception of goats' welfare following the One Welfare framework. Using a telephone survey, close-ended questions, and Likert scales, we assessed the impacts of drought and the COVID-19 pandemic on human well-being and animal welfare in the Coquimbo region of Chile. The DASS-21 questionnaire was used to evaluate farmers' mental health. Goat farmers perceived the scarcity of water and food for animals as factors that negatively affected animal productivity and welfare and caused an increase in farmers' stress levels. Farmers who had not been visited by a veterinarian showed higher levels of stress than those who received one visit during the year (M = 10 vs. 2, p = 0.025). Additionally, farmers who perceived better welfare of their animals showed lower levels of depression (rs = -0.17, p = 0.048), anxiety (rs = -0.21, p = 0.016), and stress (rs = -0.33, p < 0.001). These findings emphasize the importance of addressing farmers' mental health and veterinary support as crucial aspects to ensure both goat welfare and farm productivity.

Association between second mesiobuccal missed canals and apical periodontitis in maxillary molars of a Chilean subpopulation.

Background: To determine the frequency of missed second mesiobuccal canals (MB2) and apical periodontitis in maxillary molars of a Chilean subpopulation using cone beam computed tomography (CBCT). Material and Methods: Two previously calibrated operators evaluated CBCTs with a total of 588 upper molars, of which 179 endodontically treated molars were selected. Axial tomographic slices were used to study the frequency and association between the presence of apical periodontitis and untreated MB2 canals. Results: Of the 179 endodontically treated molars, 45.78% (84) presented MB2 missed canals. Of the upper molars that presented MB2 missed canals, 70% were associated with apical periodontitis, which was statistically significant (p< 0.0001). Sixty-two corresponded to first molars (74%) and 22 to second molars (26%). Of the first molars, 34 (54.8%) presented with apical periodontitis and MB2 missed canals (p< 0.0001), while 12 (54.4%) of the second molars presented this association (p = 0.081). Conclusions: MB2 missed canals are associated with a high degree of apical periodontitis and may be an important predictor of endodontic prognosis of upper molars. Key words:Endodontics, apical periodontitis, cone beam computed tomography, missed canals, maxillary molars.

Effect of Ultrasonic Activation on Dentinal Tubule Penetration of Bio-C Temp and Ultracal XS: A Comparative CLSM Assessment.

OBJECTIVE: The aim of this study was to compare the effect of ultrasonic activation (UA) on tubular penetration between Bio-C Temp and Ultracal XS intracanal medicaments. METHODS: Forty single-rooted human premolars were endodontically prepared and divided into 4 experimental groups (n=10): Bio-C Temp, Bio-C Temp+UA, UltraCal XS and UltraCal XS+UA. All medicaments were previously mixed with a specific calcium marker (Fluo-3) and passively injected into the canals. The samples were incubated for 7 days. For each tooth, 1 mm thick sections were obtained from the middle and apical thirds of the canals. The samples were examined by confocal laser scanning microscopy (CLSM) and the depth and area of penetration were determined for each group. The Student t test was used to compare results between groups (p<0.05). RESULTS: UA increased the depth and penetration area of Bio-C Temp and Ultracal XS, showing significant differences in the penetration area of the apical third for Bio-C Temp (p<0.0339). Bio-C Temp presented greater tubular penetration than Ultracal XS, showing significant differences in the depth of penetration in the apical third (p<0.0005), and in the penetration area in the middle (p<0.0016) and apical third (p<0.0339) after UA. CONCLUSION: UA increases tubular penetration (both depth and area) of Bio-C Temp at the apical third but has no significant effect on Ultracal XS. Bio-C Temp has a greater depth and tubular penetration area than Ultracal XS after UA. (EEJ-2023-02-024).

Phenotypic whole-cell screening identifies a protective carbohydrate epitope on Klebsiella pneumoniae.

The increasing global occurrence of recalcitrant multi-drug resistant Klebsiella pneumoniae infections warrants the investigation of alternative therapy options, such as the use of monoclonal antibodies (mAbs). We used a target-agnostic phage display approach to K. pneumoniae bacteria lacking bulky, highly variable surface polysaccharides in order to isolate antibodies targeting conserved epitopes among clinically relevant strains. One antibody population contained a high proportion of unique carbohydrate binders, and biolayer interferometry revealed these antibodies bound to lipopolysaccharide (LPS). Antibodies that bound to O1 and O1/O2 LPS were identified. Antibodies were found to promote opsonophagocytic killing by human monocyte-derived macrophages and clearance of macrophage-associated bacteria when assessed using high-content imaging. One antibody, B39, was found to protect mice in a lethal model of K. pneumoniae pneumonia against both O1 and O2 strains when dosed therapeutically. High-content imaging, western blotting and fluorescence-activated cell sorting were used to determine binding to a collection of clinical K. pneumoniae O1 and O2 strains. The data suggests B39 binds to D-galactan-I and D-galactan-II of the LPS of O1 and O2 strains. Thus, we have discovered an mAb with novel binding and functional activity properties that is a promising candidate for development as a novel biotherapeutic for the treatment and prevention of K. pneumoniae infections.

Engraftment of Bacteria after Fecal Microbiota Transplantation Is Dependent on Both Frequency of Dosing and Duration of Preparative Antibiotic Regimen.

The gut microbiota has emerged as a key mediator of human physiology, and germ-free mice have been essential in demonstrating a role for the microbiome in disease. Preclinical models using conventional mice offer the advantage of working with a mature immune system. However, optimal protocols for fecal microbiota transplant (FMT) engraftment in conventional mice are yet to be established. Conventional BALB/c mice were randomized to receive 3-day (3d) or 3-week (3w) antibiotic (ABX) regimen in their drinking water followed by 1 or 5-daily FMTs from a human donor. Fecal samples were collected longitudinally and characterized using 16S ribosomal RNA (rRNA) sequencing. Semi-targeted metabolomic profiling of fecal samples was also done with liquid chromatography-mass spectrometry (LC-MS). Lastly, we sought to confirm our findings in BKS mice. Recovery of baseline diversity scores were greatest in the 3d groups, driven by re-emergence of mouse commensal microbiota, whereas the most resemblance to donor microbiota was seen in the 3w + 5-FMT group. Amplicon sequence variants (ASVs) that were linked to the input material (human ASVs) engrafted to a significantly greater extent when compared to mouse ASVs in the 3-week groups but not the 3-day groups. Lastly, comparison of metabolomic profiles revealed distinct functional profiles by ABX regimen. These results indicate successful model optimization and emphasize the importance of ABX duration and frequency of FMT dosing; the most stable and reliable colonization by donor ASVs was seen in the 3wk + 5-FMT group.

Dentinal Tubule Penetration and Adaptation of Bio-C Sealer and AH-Plus: A Comparative SEM Evaluation.

OBJECTIVE: The aim of this study was to compare and evaluate the dentinal tubule penetration and adaptation of a premixed bioceramic sealer and an epoxy-resin based sealer in the three radicular thirds. METHODS: 30 wide roots, with single straight canals and totally formed apexes, were endodontically prepared and divided into two groups (n=14) according to the sealer used for root canal filling: AH-Plus (AHP) and Bio-C Sealer (BIOC). Two samples were left as controls. After the canals were filled, the samples were cut and viewed under Scanning Electron Microscopy by taking images to analyse the tubular penetration and adaptation of the sealers. The results were statistically analysed with the Shapiro Wilk, Levene and Mann-Whitney tests (P<0.05). RESULTS: BIOC showed significantly higher penetration in dentinal tubules than AHP in the cervical, middle and apical thirds of the root canal (P<0.05) and better adaptation to the dentinal tubule walls. CONCLUSION: Under the parameters of this study, BIOC exhibits higher penetration and better adaptation to the dentinal tubules compared to AHP.

PD-L1+ neutrophils contribute to injury-induced infection susceptibility.

The underlying mechanisms contributing to injury-induced infection susceptibility remain poorly understood. Here, we describe a rapid increase in neutrophil cell numbers in the lungs following induction of thermal injury. These neutrophils expressed elevated levels of programmed death ligand 1 (PD-L1) and exhibited altered gene expression profiles indicative of a reparative population. Upon injury, neutrophils migrate from the bone marrow to the skin but transiently arrest in the lung vasculature. Arrested neutrophils interact with programmed cell death protein 1 (PD-1) on lung endothelial cells. A period of susceptibility to infection is linked to PD-L1+ neutrophil accumulation in the lung. Systemic treatment of injured animals with an anti-PD-L1 antibody prevented neutrophil accumulation in the lung and reduced susceptibility to infection but augmented skin healing, resulting in increased epidermal growth. This work provides evidence that injury promotes changes to neutrophils that are important for wound healing but contribute to infection susceptibility.

Prevalence and Configuration of C-shaped Canals in Lower Molars from a Chilean Subpopulation / Prevalência e configuração de canais em forma de C em molares inferiores em subpopulação Chilena

Objective: To determine the prevalence of C-shaped canals in lower molars (first and second molars) in a Chilean subpopulation, and to identify root configuration and demographic characteristics using cone beam tomography.Materials and method: 912 molars (456 first and 456 second molars) resulting from the analysis of 228 mandibular CBCT scans (89 men and 139 women between 15 and 80 years old) were evaluated. Through panoramic reconstruction and axial tomographic sections, the root configuration was established, and the presence and type of C-shaped canal were classified, analyzing 5 levels along the root canal. Data were statistically analyzed with a 5% significance level. Results: Of the 912 molars analyzed, 69 were classified as C-shaped (7.57%), constituting 65.72% of those molars that presented fused roots. 100% of this configuration of canals was observed in lower second molars, presenting a higher prevalence in women (n = 49, 71.01%). 40.82% of the cases that presented a C-shaped configuration manifested bilaterally. The most frequent C-shaped canal configuration was C3 (n = 347, 66.10%), according to Melton's classification. Conclusion: The C-shaped canals in the studied population were observed entirely in lower second molars, showing a clear predilection for the female sex and a high rate of bilaterality (AU)

Objetivo: Determinar a prevalência de canais em forma de C em molares inferiores (primeiros e segundos molares) em uma subpopulação chilena e identificar a configuração radiculares e características demográficas utilizando tomografia feixe cônico. Material e Métodos: Foram avaliados 912 molares ( 456 primeiros e 456 segundos molares) resultando da análise de 228 tomografias de feixe cônico de mandíbulas (89 homens e 139 mulheres entre 15 e 80 anos). Através da reconstrução panorâmica e secções axiais de tomografias, a configuração da raiz foi estabelecida e a classificada a presença e tipo de canal em forma de C, analisando 5 níveis ao longo do canal radicular. Os dados foram analisados estatisticamente com significância de 5%. Resultados: Dos 912 molares analisados, 69 foram classificados como formato de C (7,57%), constituindo 65,72% dos molares que apresentavam raiz fusionadas. 100% dessas configurações de canais foram observados em segundos molares inferiores, com maior prevalência em mulheres (n=49, 71,01%). 40,82% dos casos presentes como formato de C manifestaram-se bilateralmente. A maior frequência das configurações do canal em forma de C no canal foram C3 ( n=347, 66.10%) de acordo com a classificação de Melton. Conclusão: Canais em forma de C no estudo populacional foram observados em sua totalidade nos segundos molares inferiores, demonstrando nítida predileção pelo sexo feminino e alto índice de bilateralidade. (AU)

Análisis interdisciplinar con perspectiva de género del alcoholismo en mujeres / Interdisciplinary Analysis with a Gender Perspective on Alcoholism in Women

Introducción: El alcoholismo, entendido en el marco del consumo con dependencia, es una problemática que afecta tanto a hombres como mujeres, sin embargo, con una tendencia al alza en estas últimas. Esto reviste una complejidad diferente al momento de ser abordado, asociada a la dimensión social, el género y el clandestinaje. Objetivo: Comprender las maneras en que opera la dimensión cultural y, en específico, el género, en las trayectorias de vida de mujeres alcohólicas. Métodos: Desde un enfoque cualitativo y transversal, la investigación propone el método etnosociológico sobre relatos de vida, basado en estudios de caso. Resultados: La experiencia del consumo de alcohol está marcada por: I- Consumo inicial en la niñez, que facilita el posterior acceso en una etapa adolescente, etapa asociada al consumo reiterado y vinculado a la aceptación social en términos de expectativas de género. II- Consumo adulto, periodo más problemático desde la perspectiva de la dependencia, clandestinaje y experiencias de violencia asociadas. III- Rehabilitación, proceso indefinido cuyo inicio se asocia a la experiencia de género. Todas las etapas del alcoholismo, en las historias de vida analizadas, tienen relación con el género, lo que se expresa principalmente en: el estigma; la vulnerabilidad; la violencia y el consumo clandestino. Conclusiones: los procesos de rehabilitación de alcoholismo en mujeres requieren de una perspectiva interdisciplinaria que integre el enfoque de género(AU)

Introduction: Alcoholism, understood in the s of consumption with dependence, is a concern affecting both men and women, although with is an upward tendency among the latter ones. This is approached with a different complexity, in association with the social dimension, the gender perspective, and concealment. Objective: To analyze the ways in which the cultural dimension affects several aspects, specifically gender, in the life paths of alcoholic women. Methods: A research with a qualitative and cross-sectional approach was carried out. The ethno-sociological method of life stories was used, based on case studies. Results: The experience of alcohol consumption is marked by 1) initial consumption in childhood, which facilitates subsequent access in a teenage stage, a stage associated with repeated consumption and linked to social acceptance in terms of gender expectations; 2) adult consumption, the most problematic period from the perspective of dependency, concealment, and associated experiences of violence; and 3) rehabilitation, an indefinite process whose beginning is associated with the gender experience. All stages of alcoholism, in the life stories analyzed, are related to gender, which is expressed mainly through stigma, vulnerability, violence, and concealed consumption. Conclusions: Alcoholism rehabilitation processes in women require an interdisciplinary perspective integrating the gender approach(AU)

Aproximación a la producción científica de la revista Finlay según la Web de la Ciencia / Assessment of the Finlay Journal Scientific Production According to the Web of Science

Fundamento: la bibliometría permite analizar la productividad científica de un país, institución o autor en particular. Las mejores revistas del orbe realizan estudios bibliométricos, para poder saber si son competitivas con sus pares en un área temática o del conocimiento. Objetivo: evaluar la producción científica de la revista Finlay en el período 2015-2017. Método: se realizó un estudio bibliométrico en el que la producción analizada es la realizada en los años 2015 a 2017, la información fue extraída hasta el 17 de enero de 2018, se utilizó la base de datos Web de la Ciencia. Los 144 artículos examinados fueron importados a una base de datos elaborada, para este fin, se utilizó Microsoft Excel. Se consideraron las variables: año de publicación, producción de autores, instituciones, países, temática, idioma, promedio de citas por artículo, promedio de cita de autores por año, promedio de artículo por autor, número de autores por artículo y promedio de autores por artículo. Además se utilizaron los indicadores h, g y e. Los resultados se presentaron en tablas para poder evaluar la producción científica de la revista. Resultados: predominaron las temáticas relacionadas con la especialidad de medicina interna, el autor más productivo fue Miguel Ángel Serra Valdés, también la institución más prolífera fue el Hospital General Universitario Dr. Gustavo Aldereguía, Cuba es el país con mayor aporte en artículos. Conclusión: la revista Finlay ha ido consolidando su calidad e impacto progresivamente en el medio de competencia dentro de la Web de la Ciencia.

Foundation: bibliometry allows to analize the scientific production of a country, institution or particular author. The best journals worldwide do bibliometric studies to determine if they are competitive with their pairs in a thematic knowledge area. Objective: to evaluate the scientific production of the Finlay Journal in the period 2015-2017. Method: a bibliometric study was realized in which he production analyzed is done during the years 2015 to 2017, the information was extracted up to January 7th 2018, data base from the Web of Science was used. The 144 articles examined were imported to a data base elaborated, with this purpose, using Excel Microsoft. The variables considered were: year of the publication, author's production, institutions, countries, topics, languages, average quotes per publication and number of authors per article. In addition indicators h, g and e were used. The results were presented in tables in order to be able to evaluate the scientific production of the journal. Results: topics related with internal medicine predominated, the most productive author was Miguel Serra Valdés, also the most prolific institution was the Gustavo Aldereguía Lima University Hospital, Cuba is the country with the highest contribution of articles. Conclusion: the Finlay Journal has progressively been consolidating its quality and impact in the competitive environment within the Web of Science.

Long-term care in Spain: Difficulties in professionalizing services.

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care-without specific skills, knowledge, and abilities.

[Confounding effect of prematurity in the neonatal death associated with obstetric maternal morbidity]. / Efecto confusor de la prematuridad en la muerte neonatal asociada con morbilidad obstétrica materna.

BACKGROUND: Prematurity is considered the main factor of neonatal mortality in developed countries (60 to 80% of cases). OBJECTIVE: To determine if obstetric morbidity and/or prematurity are associated with neonatal death. PATIENTS AND METHODS: A cohort of 25,365 live newborns since January 1st 2000 to December 31st 2004 was studied. Neonatal mortality was compared according to the number of prenatal visits, single or multifetal pregnancy, the presence or not of preeclampsia/eclampsia, cesarean section or vaginal delivery, and duration of rupture of membranes, stratifying by weeks of gestational age or by preterm and term gestation, as it was convenient. Chi-square test and Odds Ratio (OR) with 95% Confidence Intervals were calculated (CI). RESULTS: There was not significant statistical difference in neonatal mortality at less number of prenatal visits, between single and twin pregnancies, in the presence of preeclampsia/eclampsia and pregnancies without complications, when they were stratified by group of gestational age. When it was controlled gestational age, malformations and maternal-fetal and obstetrical morbidity, there was not difference in mortality of neonates born vaginally or by cesarean section. It was observed an increased risk or neonatal mortality in preterm neonates with 48 hours or more of rupture of membranes (OR 3.05 CI 95% 1.64-5.66) CONCLUSIONS: Performing and stratified analysis, prematurity was the factor associated with neonatal mortality, and not the number of prenatal visits, multifetal pregnancy, preeclampsia/eclampsia, or cesarean section. The duration of rupture of membranes is an independent factor of prematurity for neonatal mortality.

[Impact of maternal antecedents on neonatal mortality in a regional perinatal hospital]. / Repercusión de los antecedentes maternos en la mortalidad neonatal de un hospital perinatal.

OBJECTIVE: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs. RESULTS: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1). CONCLUSIONS: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors.

[Maternal history impact in neonatal mortality]. / Influencia de los antecedentes maternos en la mortalidad neonatal.

BACKGROUND: Perinatal clinical picture allows identifying psychosocial features in pregnant women, them medical, obstetrical, and pregnancy history, present delivery, and neonatal mortality risk factors. OBJECTIVE: To know prevalence of maternal risk factors and evaluates them impact on neonatal mortality. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal sociodemographic and obstetrical history was registered in a database; as well as weight, gestational age, and neonate discharge condition. Dead neonates were considered cases and controls those discharged alive. Mortality was compared with maternal history. Prevalence, odds ratio (OR) with 95% confidence interval, and exposed and population attributable fraction were calculated with the SPSS 8.0 and Epi Info 6.4 applications. RESULTS: Maternal factors associated with newborn mortality were: maternal age > or = 30 years OR 1.5 (1.37-2.0), less than seven prenatal consultations OR 2.17 (1.52-3.09), 53.5% of attributable fraction in exposed and 23.3% in population, eclampsia OR 4.66 (2.82-7.64), type 2 diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to HIV OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and premature separation of the placenta OR 42.18 (21.06-83.1). CONCLUSIONS: Risk factors history during delivery has a larger impact on mortality than pregnancy or pregestational factors.