Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Creation of a brand model through SEM to predict users' loyalty and recommendations regarding a public sports service.

Brand perception is a key element in achieving business success: how a brand is perceived by current and potential users determines what they think and their disposition towards the brand. The users' perception also determines whether they will perceive the sports service as offering a greater quality or value than other services, whether they will be more loyal, or whether they will recommend the service. This paper analyses the brand perception of users of a public sports service, creating a model of structural equations that analyses how credibility and trust influence a user's congruence with the brand and the generation of positive attitudes towards the brand and how these variables influence loyalty levels and recommendations. The results indicate that the proposed model can explain the variables of trust, congruence, attitudes, loyalty and word of mouth by more than 60%. The study finds that credibility influences trust but that credibility in itself does not cause a congruence with the brand, whereas trust does. Similarly, trust does not generate attitudes towards the brand but credibility and congruence do. Congruence generates loyalty but attitudes do not, and congruence, attitudes and loyalty influence recommendation to a similar extent, with congruence having the highest influence.

Meat quality in relation to swine well-being after transport and during lairage at the slaughterhouse.

Cortisol and corticosterone in saliva were evaluated as pig stress biomarkers, using pig genotype (Duroc, L62 or Pietrain) and lairage time in the slaughterhouse (0, 2.0, 4.0 or 6.0 h) as controlled variables. Although some pigs were found to be carriers of stress susceptibility, all were healthy heterozygous individuals. Pre-slaughter transport increased cortisol levels in saliva above 3.0 µg/L (medium stress), and 4.0 h of lairage in the slaughterhouse raised them above 6.0 µg/L, whereas corticosterone concentrations exceeded 4 µg/L, which are suggestive of high stress. The highest cortisol levels were detected in the Duroc genotype. Other factors such as food deprivation, background noise, the presence of a large number of animals waiting to be slaughtered, mixing with unfamiliar animals or recent mixing of genders may also influence stress. Corticosterone proved a reliable indicator of high stress only. Meat quality from the pig breeds studied was not affected by lairage in the slaughterhouse for up to 6.0 h.

Calidad técnico científica del cuidado de enfermería en el programa de planificación familiar / Scientific technical quality of nursing care in family planning program

Resumen Introducción: Identificar la aplicación de los requerimientos técnico científicos que los profesionales de enfermería tienen en cuenta en el desarrollo del programa de planificación familiar, es importante para orientar la calidad del cuidado y la reducción de riesgos que amenazan la salud de usuarios, acorde con el ideal de atención en salud sexual y reproductiva. Objetivo: Identificar el cumplimiento del profesional de enfermería de los aspectos técnico-científicos del programa de planificación familiar, en una institución de salud. Materiales y métodos: Estudio de corte transversal. Población: usuarios del programa de planificación familiar. Muestra: 345 usuarias, 11 enfermeros. Se aplicó un instrumento que evalúa la calidad del cuidado brindado en relación con: la humanización del cuidado, satisfacción con la atención, cumplimiento de aspectos técnico - científicos y disponibilidad de recursos. Procesamiento y análisis de datos: epidata 3, Stata v12. Resultados: El 97,9% de los profesionales diligencia adecuadamente los formatos de historia clínica y los hallazgos identificados en la consulta. El 98% de las usuarias no recibió asesoría en derechos sexuales y reproductivos. En el 98,5% de los casos de inserción de implante subdérmico, se aplicó el consentimiento informado a usuarias. El 84% de las usuarias no recibió información sobre: el uso del preservativo como método de doble protección, la importancia del autoexamen de mama el 90%, ni de la citología el 60,5%. Conclusiones: Es notoria la falta de información a usuarias sobre cuidados sexuales y reproductivos y los derechos relacionados con estos cuidados. Fue positivo el cumplimiento de aspectos éticos en la atención.

Abstract Introduction: Identifying the technical requirements that nursing professionals must abide when developing the family planning program, is relevant for the quality of care and the reduction of patients' risks, as well as users's health, according to the ideal of sexual and reproductive healthcare. Objective: To identify the nursing professionals' compliance of the technical and scientific aspects of the family planning program in a health institution. Materials and methods: Cross sectional study. Population: Users of the family planning program. Sample: 345 users, 11 nurses. An instrument was implemented for evaluating the quality of care provided in relation to humanization of healthcare, satisfaction with healthcare, compliance with technical and scientific aspects, and availability of resources. Data processing and analysis was performed with Epidata 3, Stata v12. Results: 97.9% of professionals adequately handled the clinical history formats and the findings identified in the consultation. 98% of the users did not receive counselling on sexual and reproductive rights. In 98.5% of cases of subdermal implant insertion, informed consent was obtained. 84% of the users did not receive information about condom use as a double protection method, 90% about the importance of breast self-examination, and 60% of cytology. Conclusions: It is notorious the lack of information to users on sexual and reproductive care and the rights related to this care. The fulfillment of ethical aspects in healthcare was positive.

Intraclonal variations of resistance and phenotype in Pseudomonas aeruginosa epidemic high-risk clone ST308: A key to success within a hospital?

Most multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa strains belonged to epidemic high-risk (EHR) clones that succeeded worldwide in the context of hospital outbreaks. In order to study the intraclonal diversity in EHR P. aeruginosa, we selected clinical and environmental strains of the EHR clone ST308 that caused outbreak clusters over five years in a hospital and then persisted in the hospital environment during four additional years, causing sporadic infections. Unexpectedly, resistance phenotype was very diverse within the population, independently of the origin (environmental or human) and the period of isolation (during or after outbreaks). Most MDR/XDR strains belonged to clusters in pulsed-field gel electrophoresis (PFGE) while singleton strains instead displayed susceptible or moderately resistant phenotypes. High diversity was observed for motility and biofilm formation without correlation with the origin and the period. Resistance to biocides was not linked to epidemic success or to environmental persistence. Finally, the EHR clone ST308 did not display common adaptive traits, nor traits related to an origin or a period of isolation in the hospital. The major character of this EHR clone ST308 is its intraclonal diversity that probably warrants its adaptation and persistence in hospital whatever the conditions and therefore its epidemic behaviour. This diversity could result from adaptive radiation with the evolution of multiple lineages that fill available niches within a complex ecosystem such as a hospital.

Pérdida de asignaturas en los estudiantes de enfermería: aspectos económicos, familiares y psicosociales / Loss of subjects in nursing students: economical, psychosocial and family related aspects

Introducción: El análisis de las asignaturas predice el desempeño académico y favorece la ejecución de intervenciones para el mejoramiento estudiantil. Objetivo: Evaluar la pérdida de asignaturas y la existencia de factores asociados; tales como los sociodemográficos, académicos, familiares, económicos y de salud, en estudiantes de enfermería de la Universidad Industrial de Santander durante el primer año de su carrera. Métodolos: Estudio de corte transversal analítico, realizado en estudiantes durante su primer año de estudios, a partir de información académica y psicosocial, recogida entre el 2005 y 2012. Se realizó una regresión binomial negativa para identificar los factores relacionados al número de materias no aprobadas. Resultados: 171 (63.33%) estudiantes no aprobaron alguna asignatura y en promedio un estudiante perdió 1,92 materias. La mayor pérdida se encontró en asignaturas de ciencias básicas. Como factores asociados a la disminución del número de materias reprobadas, se identificaron variables como trabajar antes de presentar el examen de estado para el ingreso a la educación superior, nivel educativo de la madre y depresión; en contraste, mayores ingresos, disfunción familiar, ansiedad y uso de cigarrillo, se asociaron a una mayor pérdida de materias. Conclusiones: Las materias de ciencias básicas son factores académicos que influyen en la pérdida de materias de estudiantes de enfermería; igualmente, aspectos familiares como su funcionalidad, ingreso económico, educación de la madre y condiciones psicosociales como depresión, ansiedad y consumo de cigarrillo, pueden afectar el éxito o fracaso en las asignaturas.

Introduction: The analysis of subjects predicts academic performance and promotes the implementation of interventions for student improvement. Objective: To evaluate the loss of subjects and the existence of associated factors such as socio-demographic, academic, family, economic and health in nursing students from the Industrial University of Santander during the first year of their career. Methods: Analytic cross-sectional study, perform in students during their first year of study, from academic and psychosocial information collected between 2005 and 2012. A negative binomial regression was performed to identify factors related to the number of subjects not passed. Results: 171 (63.33%) students did not pass a subject and a student lost an average of 1.92 subjects. The greatest loss was found in basic science subjects. As associated factors with the decrease in the number of subjects failed, variables such as work before presenting the state exam for admission to higher education, educational level of the mother and depression were identified; in contrast, higher income, family dysfunction, anxiety and cigarette use were associated with a greater loss of subjects. Conclusion: The subjects of basic science are academic factors that influence the loss of subjects of nursing students; equally familiar aspects as functionality, income, maternal education and psychosocial conditions such as depression, anxiety and cigarette smoking, can affect the success or failure in the subjects.

Influence of geometrical parameters on the linear stability of a Bénard-Marangoni problem.

A linear stability analysis of a thin liquid film flowing over a plate is performed. The analysis is performed in an annular domain when momentum diffusivity and thermal diffusivity are comparable (relatively low Prandtl number, Pr=1.2). The influence of the aspect ratio (Γ) and gravity, through the Bond number (Bo), in the linear stability of the flow are analyzed together. Two different regions in the Γ-Bo plane have been identified. In the first one the basic state presents a linear regime (in which the temperature gradient does not change sign with r). In the second one, the flow presents a nonlinear regime, also called return flow. A great diversity of bifurcations have been found just by changing the domain depth d. The results obtained in this work are in agreement with some reported experiments, and give a deeper insight into the effect of physical parameters on bifurcations.

Veterinary education in the area of food safety (including animal health, food pathogens and surveillance of foodborne diseases).

The animal foodstuffs industry has changed in recent decades as a result of factors such as: human population growth and longer life expectancy, increasing urbanisation and migration, emerging zoonotic infectious diseases and foodborne diseases (FBDs), food security problems, technological advances in animal production systems, globalisation of trade and environmental changes. The Millennium Development Goals and the 'One Health' paradigm provide global guidelines on efficiently addressing the issues of consumer product safety, food security and risks associated with zoonoses. Professionals involved in the supply chain must therefore play an active role, based on knowledge and skills that meet current market requirements. Accordingly, it is necessary for the veterinary medicine curriculum, both undergraduate and postgraduate, to incorporate these skills. This article analyses the approach that veterinary education should adopt in relation to food safety, with an emphasis on animal health, food pathogens and FBD surveillance.

Avances en el traumatismo craneoencefálico / Advances in the management of head injury

El traumatismo craneoencefálico (TCE) produce un gran impacto en nuestra sociedad al ser la primera causa de muerte en personas menores de 45 años y la tercera a cualquier edad, a lo que hay que añadir el problema familiar, el social y el financiero de los que sobreviven con secuelas. Dado que la mayoría de los cambios fisiopatológicos en el metabolismo y en el flujo sanguíneo cerebral ocurren en las primeras horas del traumatismo, el manejo inicial de estos pacientes por parte de los servicios de emergencias y en la sala de urgencias de los hospitales juega un papel fundamental en su pronóstico final. Si bien no podemos evitar en ese momento la lesión primaria, sí podemos actuar limitando su progresión mediante la minimización del daño cerebral secundario. Desde el primer contacto con el paciente y tras las medidas básicas de reanimación, el objetivo fundamental debe ser mantener una estabilidad global que evite principalmente la hipotensión y la hipoxia, que son factores pronósticos independientes de morbimortalidad. Además, los pacientes con traumatismo craneal grave deben ser trasladados en condiciones estables a un hospital de tercer nivel que disponga de servicio de neurocirugía y medicina intensiva con técnicas de neuromonitorización, como la presión intracraneal y la oxigenación cerebral. En esta revisión haremos varios apartados que son básicos para el actual manejo del TCE: inicialmente describiremos los conceptos fisiopatológicos en el traumatismo que inciden sobre el flujo sanguíneo cerebral, la presión intracraneal y el metabolismo cerebral, así como los tipos de lesiones primarias y secundarias; en segundo lugar, y de forma más extensa, la evaluación y el manejo pre-hospitalario, en la sala de urgencias y, por último, el tratamiento en la unidad de medicina intensiva basado en técnicas de neuromonitorización multimodal (AU)

Head injuries have a profound societal impact given that they are the leading cause of death in persons under 45 years of age and the third leading cause overall. To this, we must add the family, social, and financial burdens of survivors who suffersequelae. Most pathophysiologic changes in cerebral metabolism and blood flow occur in the first few hours after injury. Early management by emergency services and in hospital emergency departments therefore plays a key role in determining prognosis. Although the primary injury cannot be undone, we can limit its progression by minimizing secondary brain damage. From the moment of first response to the patient, once basic resuscitation measures have been taken, the main goal should be to stabilize the patient, especially preventing hypotension and hypoxia, which are independent risk factors for morbidity and mortality. Patients with severe head injury must be transported in stable condition to a tertiary care hospital with a neurosurgery department and an intensive care unit that can monitor such neurologic variables as intracranial pressure and cerebral oxygenation. This review of head injury management addresses 2 aspects that are essential for treatment. We first describe pathophysiologic concepts that influence cerebral blood flow and metabolism and intracranial pressure, and we also cover types of primary and secondary injuries. We then discuss evaluation and management more thoroughly, including measures in prehospital and emergency department settings, as well as intensive care unit treatment involving multimodal neurologic monitoring techniques (AU)

Elevación de la cabecera de la cama en el traumatismo craneoencefálico grave / Elevation of the bed headboard in severe cranioencephalic trauma

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El seguimiento farmacoterapéutico: un componente de la calidad en la atención al paciente / Pharmacotherapy follow-up: as a quality component in patient care

La gestión de la Calidad Total busca la satisfacción del usuario, la implicación activa de los profesionales responsables de su salud y la incorporación de estrategias para la mejora continua de las actividades clínicas, incorporando la búsqueda de la seguridad del paciente como componente principal. La gestión de la seguridad del paciente minimiza las lesiones no intencionadas atribuibles a procesos de la atención sanitaria, incluido el uso de medicamentos. Los principios de seguridad del paciente se aplican en ambos niveles asistenciales y a todos los profesionales sanitarios. Gestionar el riesgo es cuidar al paciente. La Seguridad del paciente pretende resolver problemas y prevenir errores. La aportación del farmacéutico a la seguridad del paciente se realiza con la Atención Farmacéutica y en concreto con el Seguimiento Farmacoterapéutico (SFT) que previene, detecta y resuelve Problemas Relacionados con los Medicamentos (PRM). Uno de los principales problemas para avanzar, es la dificultad para homogeneizar resultados; existen diferencias en las definiciones, al igual que ocurre en el ámbito del medicamento, donde se mezcla permanentemente proceso y resultado: Efecto adverso, Acontecimiento no deseado, Errores de medicación, PRM, etc. Se ha de homogenizar la taxonomia; disponer de una información común permitiría conocer mejor la prevalencia, sus tipos, sus causas, su gravedad así como sus consecuencias. Se quiere caminar hacia la seguridad del paciente evaluando tecnologías su efectividad y su seguridad, acreditando establecimientos y acreditando competencia profesional. Este es el camino también para el SFT que comparte los principios básicos de calidad de la seguridad del paciente. El farmacéutico tiene la responsabilidad profesional y ética de poner a disposición de los pacientes el conocimiento, la experiencia y el método, igual que las acciones emprendidas por los sistemas sanitarios. Existe la oportunidad de estar, de ser los responsables de esta aportación, porque la seguridad del paciente, en general, y en relación al uso de los medicamentos en particular, va a desarrollarse

The principal aim of management of the Quality of Care is to assure patient satisfaction, through the active involvement of health care staff and the incorporation of strategies, whose main aim is to achieve continuous improvement in clinical activities and to incorporate patient safety as one of its principle components. The management of patient safety is a means to minimizing any possible harm to patients in care processes, including the use of medicines. The principles of patient safety can be applied to both levels of patient care and involve all health care professionals. The risk management is an integral part of patient care. Patient safety depends on the solution of problems and the prevention of errors. The pharmacist’s role in patient safety is carried out through Pharmaceutical Care processes and especially through Pharmacotherapy follow-up (PF), which aims to prevent, detect and resolve Drug Therapy Problems (DTP). One of the main difficulties associated with this field is the lack of uniformity of the results obtained throughout the different studies carried out, where differences in definitions occur, as in the classification of drug problems themselves, where process and result are constantly intermingled: Adverse effect, undesirable events, medication errors, DTP, etc. The criteria for classifying such aspects should be uniform, so as to make common information available, which will enable pharmacists to obtain greater knowledge on prevalence, their types, causes, severity and consequences. There is a general desire to improve upon patient safety, to assess the technological processes involved in evaluating effectiveness and safety, and to certify the establishments and health care professionals responsible for such processes. This same approach should also be applied to PF, which is subject to the same basic safety principles. As in the case of all work carried out within the health system, the work of the pharmacist involves the professional and ethical responsibility of making his knowledge, experience and methodology available to his patients. Pharmacists now have the opportunity of making a significant contribution to patient safety, both in general terms and more specifically in the use of medicines, in a field which is currently set for future development

Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia / Therapy compliance, patient knowledge of medicines and self-medication as associated factors in negative clinical outcomes in pharmacotherapy

El paciente juega un papel primordial en la consecución de los resultados terapéuticos. El incumplimiento, la automedicación, o la falta de conocimiento del la farmacoterapia pueden ser causas de esos resultados clínicos negativos, denominados en ocasiones problemas relacionados con medicamentos (PRM). El método Dáder se utilizó para la evaluación, identificación y clasificación de PRM. La asociación de variables se estableció mediante el estadístico chi cuadrado. El conocimiento de la medicación, el cumplimiento y la automedicación fueron estudiados como causa de estos resultados negativos de la medicación. Fueron entrevistados 2556 pacientes durante el año de estudio, resultando 2261 casos válidos. El 33 % presentaron un PRM como causa de visita a urgencias. El conocimiento de la medicación, el cumplimiento y la automedicación fueron estudiados solo en la población que presentó un PRM y se demuestra que son aspectos asociados a las distintas dimensiones de PRM. No es posible establecer asociación entre la existencia o no de resultados clínicos negativos en los pacientes con el conocimiento de la medicación, el cumplimiento y la automedicación, debido a que estas variables no son atributos del paciente sino que están asociadas a cada medicamento

The patient plays a fundamental role in the attainment of good results in pharmacotherapy. Noncompliance, self-medication, or insufficient knowledge of the therapy being employed may provide a source for the causes of these negative clinical outcomes, otherwise known as medicine related problems (MRP). he Dader method was used in the evaluation, identification and classification of MRP. The association of variables was established through the statistical Chi square test. Patient knowledge of the medicine, degree of compliance to therapy and self-medication were studied as causes of the negative outcomes encountered. 2556 patients were interviewed throughout the year that the study took place, giving a total of 2261 of valid cases. 33% presented an MRP as the cause of his/her visit to the hospital emergency ward. Knowledge of the medicine, compliance and self-medication were only studied in the population that presented an MRP and in this work it is demonstrated that these are aspects that are associated with different dimensions of MRP. It is not possible to establish an association between the existence or not of negative clinical outcomes in patients with the factors of knowledge of medication, compliance and self-medication. This is due to the fact that these variables are not attributable to the patient himself, but rather are associated with the characteristics of each medicine

Nuevos criterios para determinar la evitabilidad de los problemas relacionados con los medicamentos. Una revisión actualizada a partir de la experiencia con 2558 personas / No disponible

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[Popular notions regarding "dengue" and "rompehuesos", 2 models of the disease in Colombia]. / Nociones populares sobre "dengue" y "rompehuesos", dos modelos de la enfermedad en Colombia.

OBJECTIVE: To deliver, through children, educational messages to families in Neiva, the capital city of the department of Huila, in Colombia. METHODS: An educational project was developed to include, in schoolchildren's natural sciences and environmental education curriculum, basic education on dengue, its vector, and its control. Through surveys and Likert scales, the knowledge and attitudes in the schoolchildren's homes were determined. This was complemented with open-ended interviews that reflected cultural aspects in the area of health and how dengue disease is a part of people's lives. Before and after the intervention, larval infestation indices were determined for the schoolchildren's homes. RESULTS: A cultural pattern was found for the disease that differentiated between rompehuesos (breakbone fever) and "dengue". Rompehuesos corresponds, in popular terms, to classical dengue, a disease that can be dealt with using family and community resources. Institutional medicine, by means of its health agencies and health workers, as well as the communications media, has managed to superimpose another model: that which is associated with dengue hemorrhagic fever. DISCUSSION: Alternatives are considered for prevention efforts that would be sufficient for the conditions in which the vector's cycle occurs in Neiva. Also presented are the community's disease model and the survey results. Together, these elements can guide the formulation and development of educational efforts.

El "signo de la inversión". A propósito de un caso / Reserval sign. A case report

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