The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. OBJECTIVE: The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. METHODS: Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. RESULTS: The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: -2.37, 95% CI: -3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: -0.79, 95% CI: -1.02 to -0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: -2.24, 95% CI: -4.17 to -0.32, Z = 2.29, p < 0.02). CONCLUSION: In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

Missed opportunities for HIV diagnosis among incarcerated people in the Federal District, Brasilia, Brazil

Objective. Evaluate the pattern of contact with the healthcare system, including prison health facilities, and HIV testing. Method. This was a quantitative case-control study of HIV infected and uninfected incarcerated people serving time in 2019 in the Federal District, matched by age. Results. There was no difference in the pattern of contact with the healthcare system or the pattern of testing between HIV-infected and uninfected incarcerated people. Most of the infected patients were diagnosed in the prison environment and had early infections, demonstrating the effectiveness of screening in this scenario. Conclusion: The pattern of contact with the healthcare system among the individuals in this study probably reflects that of young men in general, i.e., less contact with primary care outpatient services and trauma as the main reason for contact in emergency departments. 

Objetivo. Evaluar el patrón de contacto con el sistema sanitario, incluidos los centros sanitarios penitenciarios, y las pruebas del VIH. Método. Estudio cuantitativo de casos y controles de personas infectadas y no infectadas por el VIH que cumplían condena en 2019 en el Distrito Federal, emparejadas por edad. Resultados. No hubo diferencias en el patrón de contacto con el sistema de salud ni en el patrón de realización de pruebas entre personas encarceladas infectadas y no infectadas por VIH. La mayoría de los pacientes infectados fueron diagnosticados en el medio penitenciario y presentaron infecciones precoces, lo que demuestra la eficacia del cribado en este escenario. Conclusiones. El patrón de contacto con el sistema sanitario entre los individuos de este estudio probablemente refleja el de los hombres jóvenes en general, es decir, menor contacto con los servicios ambulatorios de atención primaria y traumatismos como principal motivo de contacto en los servicios de urgencias. 

Objetivo. O estudo avaliou o padrão de contato com o sistema de saúde e de testagem para HIV, incluindo as unidades de saúde prisionais.  Métodos. Trata-se de estudo quantitativo de caso-controle em detentos que cumpriam pena em 2019 no Distrito Federal, pareados por idade. Resultados. Não houve diferença no padrão de contato com o sistema de saúde e padrão de oferta de testagem entre detentos infectados ou não com HIV. A maior parte dos infectados teve o diagnóstico realizado no ambiente prisional e de maneira precoce, evidenciando efetividade do rastreamento nesse cenário. Conclusão. O padrão de contato com o sistema de saúde dos indivíduos neste estudo reflete provavelmente o de homens jovens como um todo: pouco contato com serviços ambulatoriais de atenção primária e trauma como principal motivo de contato, em prontos-socorros.  

Balance decisional sobre el uso del condón asociado a la conducta sexual de riesgo en universitarios / Decisional balance of condom use associated with risky sexual behavior in university students

Resumen La adquisición de alguna Infección de Transmisión Sexual (ITS) y los embarazos no planificados son riesgos a los que se enfrentan los jóvenes ante la decisión de no usar condón al tener relaciones sexuales. La aproximación del balance decisional enfatiza qué costos y beneficios están asociados a la conducta sexual de riesgo. Las decisiones acerca del uso del condón son un precursor de la conducta y este proceso puede estar influido por los beneficios que se perciban sobre él. El objetivo de la presente investigación es identificar la relación de las ganancias y pérdidas del uso del condón con la conducta sexual de riesgo. Se evaluó la conducta sexual de riesgo y el uso del condón masculino en sus relaciones sexuales. Se midieron las ganancias y las pérdidas del condón con una escala de medición, en una muestra de 257 universitarios, con una edad entre 18 y 39 años (. = 22.34; DE = 3.6) de Querétaro, México. La evaluación del balance decisional indica que las ganancias son mayores que las pérdidas (costos) del uso consistente del condón en las relaciones sexuales. Se encontraron asociaciones entre las ganancias y las pérdidas con indicadores de la conducta sexual de riesgo. Se observa que los universitarios que no utilizan condón manifiestan mayores pérdidas por utilizarlo. En las ganancias, se aprecia un aumento en las puntuaciones cuando se usa condón. Lo encontrado provee apoyo para el desarrollo de intervenciones que promuevan las ganancias o beneficios para incrementar el uso consistente del condón.

Abstract The acquisition of a Sexually Transmitted Infection (STI) and unplanned pregnancies are risks that young people deal when deciding not to use a condom when having sexual intercourse. During the decision-making process, individuals value the benefits (gains) and losses (costs) associated with a behavior. Cost-benefit analysis has been investigated to examine the differential impact of gains and losses on risky behaviours. The decisional balance approach emphasizes that costs and benefits are associated with risky sexual behavior. Decisions about condom use are a precursor to behavior, and this process may be influenced by perceived benefits. In the present study, it is proposed that the balance between the benefit and the loss of condom use contributes to consistent condom use. These factors as determinants of behaviour must be considered under the cultural context in which they are carried out. The objective of this research is to identify the relationship of gains and losses from condom use with risky sexual behaviour. It was hypothesized that: 1) Young people will evaluate the benefits (gains) with higher scores compared to the losses (costs) in deciding to use a condom in sexual intercourse. 2) The gains will be greater in those college students who use a condom more frequently and the losses will not be the same among those who use a condom. To evaluate risky sexual behavior and the use of the male condom in their sexual relations were considered. Condom gains and losses were measured with a measurement scale in a sample of 257 university students, aged between 18 and 39 years (. = 22.34; SD = 3.6) from Querétaro, México. With reference to sexual behavior, it was found that 89.1 % have started their sexual activity. The average age of initiation of sexual life is 15.41 years. The frequency of sexual activity is once or twice each month. The mean of sexual partners is 4.2, with a median of 3. The 68.5 % reported using some contraceptive method and regarding the use of condoms, 27.8 % always use it and 5.7 % never use it. To evaluate the decisional balance, subtracting the gain and loss factors created a net difference score. The gain factor was subtracted from its counterpart of the loss factor to indicate the preference for having sex with a condom. The decisional balance assessment indicates that the gains are greater than the losses (costs) of consistent condom use in sexual intercourse. Associations were found between gains and losses with indicators of risky sexual behavior. It is observed that university students who do not use a condom show greater losses from using it. In gains, there is an increase in scores when using a condom. Additionally, it is observed that university students, who sometimes use a condom, show greater losses for using it, unlike those who always use it, which show low scores in the losses of using it. In gains factor, there is an increase in the scores when using a condom, that is, those who never or almost never use a condom have the lowest scores and as the scores increase, the frequency of using a condom in their sexual relations also increases. In conclusion, gains and losses from male condom use are associated with risky sexual behavior (age of sexual activity, number of partners and condom use) in the university context. The findings provide support for the development of interventions that promote gains or benefits to increase consistent condom use. It is important to consider in specific interventions those young people who decide to continue having sex without using a condom despite the costs and possible consequences of not using it.

La visión de los profesionales sanitarios del proceso diagnóstico de las mujeres con cáncer de ovario en Catalunya: estudio cualitativo / Health professionals’ perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study

Objetivo: Identificar las oportunidades perdidas en el diagnóstico del cáncer de ovario (CO) en el sistema sanitario público de Catalunya mediante el análisis de la visión de los profesionales sobre el relato de las experiencias de las pacientes con CO. Diseño: Estudio cualitativo exploratorio-descriptivo, con dos grupos focales. Emplazamiento: Atención primaria, noviembre de 2017. Participantes: Treinta y cuatro profesionales en base a un muestreo teórico: 21médicos de familia, 8profesionales de centros de salud sexual y reproductiva y 5ginecólogos de hospital. Métodos: Los participantes debatieron sobre diferentes itinerarios de procesos diagnósticos de mujeres con CO mediante la exposición de tres flujogramas elaborados a partir de los relatos obtenidos en entrevistas a pacientes. Se realizó un análisis de contenido temático. Resultados: Se identificaron tres temas con diversos subtemas: a)falta de sospecha diagnóstica (desconocimiento de los síntomas, obviar la anamnesis y la exploración física, fragmentación de la atención y sesgos y prejuicios); b)dificultades para activar el proceso diagnóstico (acceso limitado a pruebas, accesibilidad desigual a ginecología y falta de seguimiento), y c)ausencia de circuitos rápidos preestablecidos. Conclusiones: Los resultados ofrecen una visión de las dificultades del diagnóstico precoz del CO en nuestro ámbito. Creemos que su identificación permitirá la elaboración de estrategias para mejorar la precisión diagnóstica y la calidad de la atención en las mujeres con CO en nuestro medio.(AU)

Objective: To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients. Design: Qualitative exploratory-descriptive study, with two focus groups. Setting: Primary Care, November 2017. Participants: Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists. Methods: Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients. Results: Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system.Conclusions: The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.(AU)

[Health professionals' perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study]. / La visión de los profesionales sanitarios del proceso diagnóstico de las mujeres con cáncer de ovario en Catalunya: estudio cualitativo.

OBJECTIVE: To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients. DESIGN: Qualitative exploratory-descriptive study, with two focus groups. SETTING: Primary Care, November 2017. PARTICIPANTS: Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists. METHODS: Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients. RESULTS: Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system. CONCLUSIONS: The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.

Resultados perinatales tras prueba diagnóstica invasiva en el embarazo / Perinatal outcomes after invasive diagnostic test in pregnancy

Introducción: Las técnicas invasivas de diagnóstico prenatal nos permiten realizar pruebas genéticas. El desarrollo de técnicas no invasivas ha reducido su uso. Clásicamente se ha afirmado que, tras realizar la técnica invasiva, la tasa de pérdida fetal se sitúa en torno al 1%. Los datos publicados son heterogéneos, y aunque todo indica que se ha sobrestimado el riesgo, necesitamos realizar nuevos estudios. Material y métodos: En nuestro estudio retrospectivo unicéntrico analizamos los procedimientos realizados mediante técnicas invasivas de diagnóstico prenatal entre 2011 y 2019, incluyendo 832 técnicas invasivas realizadas. Los resultados perinatales se comparan con el grupo control de mujeres embarazadas (n=1.734). Resultados: La tasa de pérdida fetal temprana para las diferentes técnicas fue de 1,1% para amniocentesis, del 1,6% para biopsia corial transvaginal y del 0,5% para biopsia corial abdominal, con una tasa total del 1,1%, sin diferencias estadísticamente significativas entre ellas (p=0,57). Encontramos diferencias en el desenlace fetal, en cuanto a la variable pérdida fetal temprana, en relación con los intentos realizados (cuando se hacían tres intentos aumentaba el riesgo). Al comparar los resultados perinatales posparto del grupo sometido a técnicas con el grupo control, se encontró una mayor tasa de cesáreas en el grupo estudio (28,9% vs 20,5%), además de una menor edad gestacional media al parto (38,33 vs. 38,95 semanas). Discusión: Cuando la técnica invasiva se realiza en el momento adecuado y con no más de dos intentos, consideramos que el riesgo de pérdida fetal no se ve afectado por su realización, siendo igual al de la población general.(AU)

Introduction: Invasive prenatal diagnostic techniques allow us to conduct genetic tests. The development of non-invasive techniques has reduced their use. The foetal loss rate following an invasive procedure is considered to be around 1%. The published data is heterogeneous however, although everything indicates that the risk has been overestimated, we need to conduct further studies. Material and methods: In our single-centre retrospective study we analysed the procedures carried out using invasive prenatal diagnostic techniques between 2011 and 2019. A total of 832 invasive techniques were performed. Perinatal results are compared with a control group of pregnant women (n=1734). Results: The early foetal loss rate for the different techniques were 1.1% for amniocentesis, 1.6% for transvaginal chorionic biopsy and 5% for abdominal chorionic biopsy, with a total rate of 1.1%, without statistically significant differences between them (P=.57). We found differences in foetal outcome, in terms of variable early foetal loss, related to the attempts made (when three attempts were made, the risk increased). When comparing the perinatal outcomes after delivery of the group that underwent techniques with the control group, a higher rate of caesarean sections was found in the study group (28.9% vs 20.5%), in addition to lower mean gestational age at delivery (38.33 vs. 38.95 weeks). Discussion: When the invasive technique is performed at the right time and with no more than two attempts, we consider that the risk of foetal loss is not affected, and is equal to that of the general population.(AU)

Identificando objetivos fast-track: oportunidades perdidas en el diagnóstico de VIH en la Comunidad de Madrid / Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid

IntroducciónLa oferta dirigida de la prueba de VIH está recomendada en personas con prácticas de riesgo y en enfermedades indicadoras de VIH. Las oportunidades diagnósticas perdidas (OP) son aquellas donde no se cumplen estas recomendaciones.ObjetivoConocer el porcentaje de OP según práctica de riesgo (OP dirigidas) y condiciones indicadoras (OP indicadas) en la Comunidad de Madrid.MétodosSe seleccionaron 109 personas con nuevo diagnóstico de VIH en 7 centros sanitarios (abril 2018-marzo 2019) mediante encuestas telefónicas. Se definió oportunidad diagnóstica como cualquier contacto con el sistema sanitario en el que debería haberse realizado la prueba de VIH. Se calculó la ocurrencia de OP en los 2 años anteriores al diagnóstico de VIH.ResultadosDe 32 oportunidades diagnósticas dirigidas e indicadas, un 96,9 y un 57,8%, respectivamente, derivaron en OP. Globalmente, el 83,8% de las oportunidades diagnósticas resultaron en OP.ConclusiónLas OP son una importante área de mejora en el diagnóstico precoz de VIH.

IntroductionIn Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed.ObjectiveTo characterize MO due to risk behaviors (directed) and due to indicator conditions (indicated) among people diagnosed with HIV in the Region of Madrid.MethodsA total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis.ResultsOf the 32 directed and indicated diagnostic opportunities, 96.9 and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO.ConclusionMO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

Supervivencia del trasplante renal en relación con la compatibilidad inmunológica en Cuba / Kidney transplant survival in relation to immunological compatibility in Cuba

RESUMEN Introducción: El trasplante renal es uno de los métodos de sustitución de la función renal y tiene como factor de mayor influencia en su supervivencia, la compatibilidad inmunológica. Objetivo: Definir la supervivencia del trasplante y su relación con el grado de compatibilidad. Material y Métodos: Estudio retrospectivo, del tiempo de supervivencia con base hospitalaria, de los 827 pacientes trasplantados entre los nueve centros del país, en el quinquenio 2015-2019. Para estimar las curvas de supervivencias se empleó el Método de Kaplan Meier, por el SPSS 22.0. Resultados: Supervivencia del injerto al año 72,9 % y paciente 89,0 %, con media de sobrevida de los injertos de 3,6 años y del paciente de 4,6. Para los pacientes con dos y más compatibilidad, la supervivencia del injerto al año fue mayor, 77,0 % v/s 69,2 % y menos, para el resto. Posterior al año, también son diferentes las supervivencias por grado de compatibilidad. El rechazo agudo inmunológico, que es una de las principales causas de pérdidas de injertos, tiene mucho mayor incidencia en los trasplantados sin compatibilidad que en los compatibles (17,4 % v/s 9,9 %). Para las causas de muerte de los pacientes, la infección fue la predominante, y muy significativo para los que no comparten compatibilidad v/s los que sí (56,9 % v/s 31,9 %). Conclusiones: La compatibilidad inmunológica entre donante y receptor, propicia diferencia en las supervivencias de injertos y pacientes, siendo mejor mientras más compatibles sean el donante y el receptor.

ABSTRACT Introduction: Kidney transplant is one of the methods of kidney function replacement, and immunological compatibility is the most important factor influencing survival. Objective: To define transplant survival and its relationship with the degree of compatibility. Material and Methods: Hospital-based retrospective study of survival time of the 827 transplanted patients in the nine centers of the country during the five-year period (2015 - 2019). The Kaplan Meier method was used to estimate the survival curves, using SPSS version 22.0. Results: The graft survival was 72,9 % and the patient survival was 89,0 % in the first year; the mean graft survival was 3,6 years, and the patient survival was 4,6 years. For patients with two and more compatibilities, graft survival was significantly higher in the first year (77,0 % versus 69,2 %), but it was lower for the rest. One year after, the survival rates related to the degree of compatibility are also different. Acute immune rejection, which is one of the main causes of graft loss, has a much higher incidence among the transplanted patients without compatibility than in the compatible ones (17,4 % versus 9,9 %). Infection was the predominant cause of death in these patients, which was incredibly significant in those who do not share compatibility as opposed to those who do share it (56,9 % versus 31,9 %). Conclusions: Immunological compatibility between donor and recipient results in differences between graft and patient survival rates, so the more compatibility between the donor and the recipient, the higher the survival rate.

Huevos de desecho en Chile: Estimación de las pérdidas en la cadena productiva y posibilidades para su uso

RESUMEN Chile presenta una alta producción y consumo de huevos, siendo considerado el quinto consumidor de huevos en Latinoamérica. Sin embargo, no se cuenta con datos acerca de las pérdidas de huevos en la cadena productiva. El objetivo de este estudio fue recopilar información acerca de las pérdidas de huevos a nivel nacional, mediante la consulta a productores y comercializadores de huevos, y revisar información acerca de alternativas de uso de los huevos de desecho con mayor enfoque en la cáscara. Se estimó que a nivel de granja las pérdidas fluctúan entre un 0,5 a 5% y durante la comercialización entre un 0,5% a 16,6%. El 80% de los productores consultados desechaban las cáscaras de huevo, y un 63% del total de productores no tenían conocimiento de productos basados en huevos de desecho. El principal uso de los huevos de desecho en Chile es para alimentación animal, también se produce huevo líquido pasteurizado o huevo en polvo. A nivel internacional se hacen esfuerzos por desarrollar nuevas opciones para dar un uso a los huevos de desecho, y es necesario contar con más estudios acerca del tema, enfocados en cuantificar las pérdidas económicas en los planteles, junto con promover la reutilización de los huevos de desecho para otorgarles un valor agregado y así reducir su desperdicio.

ABSTRACT Chile is a high producer and consumer of eggs, being considered the fifth consumer of eggs in Latin America. However, there are no data on production chain egg losses. The objective of this study was to survey information about egg losses at the national level, by consulting egg producers and traders and to review information about alternative uses of waste eggs with a focus on eggshells. It was estimated that at the farm level, losses range from 0.5 to 5% and during commercialization from 0.5% to 16.6%. Eighty percent of the producers consulted discarded eggshells, and 63% of total producers were not aware of products based on waste eggs. The main use of waste eggs in Chile is for animal feed; pasteurized liquid or powdered eggs. At the international level, efforts are being made to develop new options for alternative uses of waste eggs, and more studies are needed to quantify economic losses at the farm level and to promote the reuse of waste eggs, adding value to them and reducing waste.

Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid.

INTRODUCTION: In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions (IC) related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE: To characterize MO due to risk behaviors (directed) and due to IC (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS: A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS: Of the 32 directed and indicated diagnostic opportunities, 96.9% and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION: MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

New-born Hearing Screening Programmes in 2020: CODEPEH Recommendations.

Programmes for early detection of congenital hearing loss have been successfully implemented mainly in developed countries, after overcoming some conceptual errors argued against their implementation and some criticism of their efficacy. However, some difficulties and weaknesses are still identified in these programmes: the detection of late-onset hearing loss and the percentage of children who did not pass the screening and did not complete the process of diagnosis and treatment, these being cases that are lost in the process. The purpose of this Document is to analyse these problems to determine areas for improvement and to emphasize one of the basic principles for the success of the programmes: continuous training for the interdisciplinary team. The result of the review process carried out by CODEPEH has been drafted as Recommendations for updating the Programmes with the evidence of the last decade, including advances in screening technology, the impact of the present knowledge on congenital infection by cytomegalovirus, genetic hearing loss research and control systems of lost to follow-up cases, treatment and follow up.

Programas de cribado de la hipoacusia congénita en 2020: recomendaciones CODEPEH / New-born hearing screening programmes in 2020: CODEPEH recommendations

Los programas de detección precoz de la hipoacusia congénita se han extendido de forma exitosa, especialmente en países desarrollados, superando los errores conceptuales argumentados contra su implantación o las críticas a su eficacia. No obstante, aún se identifican algunas dificultades y debilidades: la detección de la hipoacusia de desarrollo tardío y el porcentaje de niños que no pasaron el cribado y no completan el diagnóstico ni el tratamiento, siendo casos que se pierden en el proceso son algunas de ellas.El objetivo del presente documento es analizar estos problemas para determinar puntos de mejora e incidir en un principio básico del éxito de los programas: la formación continuada del equipo interdisciplinario.El resultado del trabajo de revisión llevado a cabo por la CODEPEH se plasma en la formulación de unas recomendaciones orientadas a actualizar los programas con las evidencias aparecidas en la última década, incorporando los progresos de la tecnología, los conocimientos actuales sobre la infección congénita por citomegalovirus y los estudios genéticos de la hipoacusia en los programas, así como los sistemas de control de la pérdida de casos en el proceso, el tratamiento y el seguimiento. (AU)

Programs for early detection of congenital hearing loss have been successfully implemented mainly in developed countries, after overcoming some conceptual errors argued against their implementation and some criticism of their efficacy. However, some difficulties and weaknesses are still identified in these programs: the detection of late-onset hearing loss and the percentage of children who did not pass the screening and did not complete the process of diagnosis and treatment, these being cases that are lost in the process.The purpose of this Document is to analyse these problems to determine areas for improvement and to emphasize one of the basic principles for the success of the programs: continuous training for the interdisciplinary team.The result of the review process carried out by CODEPEH has been drafted as Recommendations for updating the Programs with the evidence of the last decade, including advances in screening technology, the impact of the present knowledge on congenital infection by cytomegalovirus, genetic hearing loss research and control systems of lost to follow-up cases, treatment and follow up. (AU)

Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid. / Identificando objetivos fast-track: oportunidades perdidas en el diagnóstico de VIH en la Comunidad de Madrid.

INTRODUCTION: In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE: To characterize MO due to risk behaviors (directed) and due to indicator conditions (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS: A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS: Of the 32 directed and indicated diagnostic opportunities, 96.9 and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION: MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

Entre las marcas de pérdidas y eventos arrasadores para el psiquismo: la esperanza del jugar en el vínculo transferencial. La historia de Margarita / Parmi les marques de pertes et dévastateurs pour le psychisme: l'espoir de jouer dans le lien transferentiel. L'histoire de Margarita / Between the scars of losses and devastating events for the psyche: the hope of playing in the transferential bond. Margarita's story / Entre as marcas das perdas e acontecimentos devastadores para o psiquismo: a esperança de brincar no vínculo transferêncial. A história de Margarita

El presente trabajo propone recorrer fragmentos del análisis de Margarita, desde los cinco hasta sus trece años, tomando como eje central la temática juego. La lectura fue realizada a partir de una secuencia de sesiones que hilvanan elementos significativos de su historia y permiten pensar la labor lúdica (si la hubiere) en términos teóricos, técnicos y clínicos y la posibilidad de construir aproximaciones acerca del cómo, para qué y del tipo de juego. A su vez, se apunta a reflexionar acerca de los avatares de la clínica actual: ¿sería posible el abordaje virtual con Margarita en caso de haberse desarrollado en pandemia? En esta línea de pensamiento, se consideran las particularidades del caso y los distintos momentos del proceso terapéutico. Se propone hipotetizar e inferir no solo lo posible, sino los límites y obstáculos de dicho recurso(AU)

Le présent ouvrage propose de parcourir des fragments de l'analyse de Margarita, de l'âge de cinq à treize ans, en prenant le thème du jeu comme axe central. La lecture a été effectuée à partir d'une séquence de séances qui tissent des éléments significatifs de son histoire et nous permettent de penser en termes théoriques, techniques et cliniques le travail ludique (le cas échéant) et la possibilité de construire des approximations sur le comment, le pourquoi et le type de jeu. En même temps, il vise à réfléchir sur les vicissitudes de la clinique actuelle: l'approche virtuelle de Margarita serait-elle possible si elle avait évolué en pandémie? Dans cette ligne de pensée, les particularités du cas et les différents moments du processus thérapeutique sont considérés. Il est proposé d'émettre des hypothèses et d'inférer non seulement ce qui est possible, mais aussi les limites et les obstacles de ladite ressource(AU)

The porpuse of the present study is to go through fragments of Margarita's analysis, from the age of five to thirteen, considering the playing theme as the central axis. The interpretation was made from a sequence of sessions articulated with significant elements of her story which allow us to think in theoretical, technical and clinical terms of the playful work (if any) and the possibility of making approximations about the how, the why of it and the type of game. At the same time, it aims to reflect on the vicissitudes of the current clinic: Would Margarita's virtual approach be possible if it had developed during pandemic? In accordance with this way of thinking, the particularities of the case and the different moments of the therapeutic process are considered. It is proposed to hypothesize and infer not only what is possible, but also the limits and obstacles of this resource(AU)

O presente trabalho se propõe a percorrer fragmentos da análise de Margarita, dos cinco aos treze anos, pegando o tópico do jogo como eixo central. A leitura foi realizada a partir de uma sequência de sessões que tecem elementos significativos de sua história e nos permitem pensar em termos teóricos, técnicos e clínicos o trabalho lúdico (se houver) e a possibilidade de construir aproximações sobre o como, o porquê e o tipo de jogo. Ao mesmo tempo, visa refletir sobre as vicissitudes da clínica atual: seria a abordagem virtual de Margarita possível no caso de ter se desenvolvido na pandemia? Nessa linha de pensamento, são consideradas as particularidades do caso e os diferentes momentos do processo terapêutico. Propõe-se hipotetizar e inferir não só o que é possível, mas também os limites e obstáculos desse recurso(AU)

Fermentative characteristics and nutritional value of sugarcane silage added with two types of urea / Características fermentativas y valor nutricional del ensilaje de caña de azúcar con adición de dos tipos de urea / Características fermentativas e valor nutricional da silagem de cana-de-açúcar aditivada com dois tipos de ureia

Abstract Background: Dry matter (DM) loss is high in sugarcane silage due to its high content of soluble carbohydrates which favors yeast growth and ethanol production, thus reducing the nutritional value of the preserved forage. Objective: To determine the effect of adding two types of urea at two concentration levels to sugarcane silage on the nutritional value and fermentative characteristics of the silage. Methods: A completely randomized 2×2+1 factorial design was used, based on two types of urea (conventional and protected), two urea concentration (0.5 and 1.0% of the natural matter), and a control (sugarcane silage with no additives). Six replicates were used. The mixture was placed in PVC silos and opened after 60 days. Results: There was no difference in DM content or effluent losses by the addition of urea. In regards to neutral detergent fiber, acid detergent fiber, and lignin, decreased levels were observed compared to the control, regardless of urea type. Urea type and concentration had an effect on ammoniacal nitrogen content, with higher values for conventional urea, but not affecting the pH. The addition of urea to sugarcane silage reduced gas losses and raised the levels of crude protein, ether extract, and effective degradability. Conclusion: Adding protected or conventional urea at 1% of natural matter at the time of sugarcane ensiling reduces gas losses and improves nutritional composition of the silage.

Resumen Antecedentes: La caña de azúcar ensilada presenta una elevada pérdida de materia seca (MS) debido a su alto contenido de carbohidratos solubles que favorece el crecimiento de levaduras y la producción de etanol, reduciendo así el valor nutricional del ensilado. Objetivo: Determinar el efecto de dos tipos de urea en dos concentraciones sobre las características fermentativas y el valor nutricional del ensilaje de caña de azúcar. Métodos: Se utilizó un diseño completamente al azar, en esquema factorial 2x2+1, basado en dos tipos de urea (común o protegida), dos concentraciones de urea (0,5 y 1,0% de la materia natural) y un control (ensilaje de caña de azúcar sin aditivos). Se utilizaron seis réplicas de cada tratamiento. El material fue ensilado en silos de PVC, los que fueron abiertos después de 60 días. Resultados: No hubo diferencia en el contenido de MS o en las pérdidas por efluentes con la adición de urea. En relación a la fibra detergente neutra, fibra detergente ácida y lignina, se observó disminución de éstos con respecto al control, independientemente del tipo de urea. Se observó un efecto de la concentración y del tipo de urea para el contenido de nitrógeno amoniacal, con mayores valores para la urea común, pero sin efecto sobre el pH. La adición de urea en el ensilado de caña redujo las pérdidas por gases y elevó los niveles de proteína bruta, extracto etéreo y degradabilidad efectiva. Conclusión: La adición de urea común o protegida, al 1% de materia natural, al inicio del ensilaje de caña de azúcar reduce las pérdidas por gases y mejora la composición nutricional del ensilaje.

Resumo Antecedentes: A ensilagem de cana-de-açúcar sem aditivos apresenta elevada perda de matéria seca (MS) devido ao alto teor de carboidratos solúveis, favorecendo o crescimento de leveduras e produção de etanol, reduzindo assim o valor nutricional da forragem conservada. Objetivo: Determinar o efeito do tipo de ureia (comun ou protegida) e diferentes concentrações nas características fermentativas e valor nutritivo das silagens de cana-de-açúcar. Métodos: Utilizou-se um delineamento inteiramente casualizado em esquema fatorial 2 x 2 + 1, sendo dois tipos de ureia (comun ou protegida), e duas concentrações (0,5 e 1,0% com base na matéria natural) mais o controle (silagem exclusiva de cana-de-açúcar); com seis repetições. O material foi ensilado em silos de PVC e abertos após 60 dias. Resultados: Não houve diferença no teor de MS e nas perdas por efluentes com adição da ureia. Em relação à fibra em detergente neutro, fibra em detergente ácido e lignina observou-se diminuição destes em relação ao controle, independente do tipo de ureia. Observou-se efeito das concentrações e do tipo de ureia para o teor de nitrogênio amoniacal, com maiores valores para a ureia comum, porém sem efeito no pH. A adição de ureia na ensilagem de cana reduziram as perdas por gases e elevaram os teores de proteína bruta, extrato etéreo e degradabilidade efetiva. Conclusão: O uso de 1% de ureia, independente do tipo, promove um incremento no valor nutricional da silagem de cana-de-açúcar e reduz as perdas por gases.

El cromo-levadura y la ractopamina afectan el perfil de ácidos grasos y la calidad de la carne en cerdos / Chromium-yeast and ractopamine affect the profile of fatty acids and quality of meat in pigs

RESUMEN Los consumidores de cerdo demandan productos bajos en grasa y sin aditivos que afecten la salud humana. El objetivo de este trabajo fue evaluar el efecto del cromo-levadura o ractopamina adicionadas a la dieta de cerdos, sobre el rendimiento, las características de la canal y la calidad de la carne. Se distribuyeron 20 cerdos de manera aleatoria en cuatro tratamientos: sin adición de cromo-levadura, ni ractopamina (T1); 10ppm de ractopamina (T2); 0,2ppm de cromo-levadura (T3) y 0,4ppm de cromo- levadura (T4). Se determinó el espesor de la grasa dorsal al inicio, al intermedio y al final del estudio. El rendimiento en canal caliente y fría se estimó en el frigorífico. Muestras de la cabeza del lomo fueron tomadas para evaluar pH, resistencia al corte, goteo, temperatura, retención de agua y contenido de ácidos grasos. Se realizó un análisis descriptivo de los datos y de Kruskal-Wallis, para determinar el efecto del tratamiento sobre las variables medidas. Ninguna suplementación afectó la ganancia de peso, peso final, conversión alimenticia, consumo alimento, rendimiento en canal caliente, rendimiento canal fría y grasa dorsal (P>0,05). La resistencia al corte aumentó con la ractopamina, pero disminuyó con el cromo-levadura. Las pérdidas por goteo fueron significativas con 0,2ppm de cromo-levadura, pero no lo fueron con 0,4ppm de cromo-levadura o ractopamina. No se encontró efecto de la ractopamina sobre los ácidos grasos, pero sí del cromo-levadura. Tanto el cromo-levadura como la ractopamina modifican características de la carne, como la dureza y el perfil de ácidos grasos.

ABSTRACT The consumers of pork demand products low in fat and free of additives that affect the human health. The objective of this study was to evaluate the effect of chromium-yeast or ractopamine added to the diet of pigs on the performance, characteristics of the carcass and meat quality. Twenty pigs were randomized to four treatments: without the addition of chromium-yeast or ractopamine (T1); 10ppm of ractopamine (T2); 0.2ppm of chromium-yeast (T3) and 0.4ppm of chromium-yeast (T4). The backfat thickness was evaluated at the beginning, at the intermediate and at the end of the experiment. Hot carcass yield and cold carcass yield was evaluated in the slaughter house. Loin samples were taken to evaluate pH, shear force, drip loss, temperature, water retention and fatty acid composition. A descriptive analysis of the data and Kruskal-Wallis was carried out to determine the effect of the treatment on the measured variables. Any supplementation affected significantly weight gain, final weight, feed conversion, feed intake, hot carcass yield, cold carcass yield and backfat thinkness (P>0,05). Shear force increased with ractopamine, but decreased with chrome-yeast. Drip losses were significant at 0.2ppm chromium-yeast, but were not significant at 0.4ppm chromium-yeast or ractopamine. There was no effect of ractopamine on fatty acids, but with chromium-yeast was significant. Both chrome-yeast and ractopamine modify meat characteristics such as hardness and fatty acid profile.

Pérdidas económicas y prevalencia de Fasciola hepática en bovinos sacrificados en dos provincias cubanas / Economic losses and prevalence of Fasciola hepatica in cattle slaughtered in two cuban provinces

RESUMEN Objetivo. Determinar las pérdidas económicas producidas por el decomiso de hígados afectados y la prevalencia de Fasciola hepatica en bovinos sacrificados en las provincias de Holguín y Camagüey, Cuba. Materiales y m étodos. Fueron utilizados los resultados del diagnóstico anatomopatológico realizado en los mataderos Felipe Fuentes y César Escalante durante el periodo comprendido entre enero de 2012 y diciembre de 2018. A partir de la cantidad de animales sacrificados y los afectados se calcularon las pérdidas que alcanzaron un valor de $80.312 USD (Holguín) y $32.7152 USD (Camagüey) para todo el período. Se realizaron análisis de comparación de proporciones para los animales afectados por F. hepatica y las pérdidas económicas por decomiso de hígados, mediante una prueba Chi-cuadrado para determinar la existencia o no de diferencias significativas entre las proporciones y un análisis de medias (ANOM) para determinar cuáles proporciones son significativamente distintas del promedio general. Resultados. Se observó que en 11 meses los animales afectados difirieron significativamente (p<0.001) entre los mataderos excepto en el mes de julio, mientras que las pérdidas totales por decomisos de hígados afectados mostraron diferencias significativas (p<0.001) en todos los meses para el periodo evaluado. Conclusiones. Los mayores valores para las pérdidas económicas y prevalencia por el decomiso de hígados afectados por F. hepatica se presentaron en la provincia de Camagüey lo que pudiera estar relacionado con las condiciones climáticas diferentes, por lo que se recomienda evaluar la dinámica de los hospederos intermedios y las etapas larvarias de este trematodo en las dos provincias estudiadas.

ABSTRACT Objective. To determine the economic losses resulting from condemnation of affected livers and the presence of Fasciola hepatica in slaughtered cattle in the provinces of Camagüey and Holguín, Cuba. Materials and Methods. This study was based on the results from an anatomo-pathological examination performed at Felipe Fuentes and César Escalante slaughterhouses between January 2012 and December 2018. The losses, which totaled $ 80 312 USD (Holguín) and $ 327 152 USD (Camagüey), were estimated from the number of slaughtered and affected animals throughout the period. Analyses for the comparisons of proportions were made to animals affected by F.hepatica, whereas the economic losses due to liver condemnation were analyzed by Chi-square to determine the existence of significant differences among the proportions. Analysis of means (ANOM) was made to determine the significantly different proportions within the general average. Results. Significant differences (p<0.001) were observed in animals from different slaughterhouses in 11 months, excluding July. Meanwhile, the total losses due to condemnation of affected livers underwent significant differences (p<0.001) in all the months of the evaluation period. Conclusions. The highest values of economic losses and prevalence due to condemnation of livers affected by F.hepatica were observed in the province of Camagüey, which may have been linked to varying climatic conditions. Hence, evaluation of intermediary host dynamics and the larval stages of the trematode in the two provinces studied were recommended.

Las pérdidas en la infancia y las consecuencias de la no elaboración de los duelos en el psiquismo / Les pertes dans l'enfance et les conséquences des deuils non-élaborés sur le psychisme / Childhood losses and the consequences of the non elaboration of the psychism mournings / As perdas na infância e as consequências da não elaboração do luto no psiquismo

En el presente trabajo se exponen dos casos clínicos del ámbito privado, un niño y un adolescente, ambos con pérdidas de familiares en la infancia, muertes reales que han quedado sin tramitar en su psiquismo. Se realizan articulaciones teórico- clínicas en relación con las consecuencias que estos duelos no resueltos han dejado en el psiquismo de estos sujetos, tomando en cuenta la importancia del ámbito familiar en la elaboración de los duelos y el momento evolutivo en que consultan, el niño en la conflictiva edípica, y el adolescente en la entrada a la vida adulta. Se presentan algunas líneas de trabajo realizadas en ambos casos, apuntando al trabajo de duelo, que al decir de Freud, se realiza "pieza por pieza" en pos de una liberación psíquica, trabajo que implica ayudar a los sujetos a salir de ciertos encierros y agujeros en los que quedaron coagulados con las pérdidas(AU)

Au cours de ce travail, on expose deux cas cliniques dans le domaine privé ; un enfant et un adolescent, tous les deux avec des pertes de proches pendant leur enfance, des deuils réels qui sont restés sans traitement sur le psychisme. On fait des articulations théoriques-cliniques par rapport aux conséquences que ces deuils nonrésolus chez ces sujets ont laissé sur le psychisme, compte tenu de l'importance du domaine familial dans l'élaboration des deuils et le moment évolutif où ils consultent, l'enfant dans la phase conflictuelle œdipienne, l'adolescent qui fait son entrée à la vie adulte. On présente quelques axes de travail réalisés dans les deux cas et visant au travail du deuil que selon Freud on le fait «pièce par pièce¼ en vue d'une libération psychique, démarche qui implique aider les sujets à sortir de certains emprisonnements et des trous où ils ont été figés avec les pertes(AU)

In the present work to clinic cases of the private area are exposed: a child and a teenager, both who had lost relatives during their childhood. Real deaths that had stayed without being unsolved in their minds. Theoretical-clinic articulation is made in relation to the consequences these non-solved mourning, taking into account the importance of the family ambiance in the elaboration of the mourning and the evolutive time in which they consulted, the boy during his Oedipus complex and the teenager at the beginning of his adulthood. Some traces of work taken in both cases are presented aiming at mourning's work which in Freud ´s words is done "piece by piece", so as to obtain a psychic liberation that implies helping the person to get out of certain lock ups and holes that stayed blocked with the losses(AU)

No presente trabalho expõem-se dois casos clínicos da esfera privada, uma criança e um adolescente, ambos com perdas de familiares na infância, mortes reais que ficaram sem processar em seu psiquismo. Realizam-se articulações teórico-clínicas em relação às consequências que estes lutos não resolvidos têm deixado no psiquismo dos sujeitos, levando em consideração a importância do domínio familiar na elaboração do luto e o momento evolutivo no qual consultam, a criança no conflito edípico, e o adolescente na entrada na vida adulta. Apresentam-se algumas linhas de pesquisas realizadas em ambos casos, abordando o trabalho do luto que, segundo Freud, é feito "peça por peça" em prol de uma libertação psíquica, tarefa que implica ajudar os sujeitos a saírem de certos encerros e buracos em que ficaram oprimidos com tais perdas(AU)

Infiltración periarticular y ácido tranexámico tópico para control de pérdida sanguínea en artroplastia total de rodilla / Periarticular injection and topical tranexamic acid for blood loss control in total knee arthroplasty

Introducción La pérdida sanguínea durante el remplazo total de rodilla es una de las principales variables que influyen en los resultados de esta cirugía para lo cual se han implementado varios métodos para reducirla. Objetivo Cuantificar el cambio en el hematocrito y hemoglobina a las 24 horas postoperatorias en pacientes a quienes se les realizó reemplazo total de rodilla primario entre marzo del 2016 y agosto del 2017. Metodología Se realizó un estudio observacional a partir de una cohorte retrospectiva. Los criterios de inclusión fueron aquellos pacientes a quienes se les realizó reemplazo total de rodilla primaria con infiltración periarticular con bupivacaina con epinefrina, ketorolaco y morfina e intrarticular con ácido tranexámico. Se midieron hemoglobina y hematocrito pre y post operatorio, cálculo de pérdida sanguínea y transfusiones. Resultados Se analizaron un total de 159 reemplazos totales de rodilla (75 prótesis convencionales, 84 prótesis navegadas). El porcentaje de transfusión fue de 0,69% (1 paciente). La disminución del hematocrito promedio fue de 7,36% y la disminución de la hemoglobina de 2,49 gr/dl para una pérdida sanguínea calculada de 780ml. Se usó torniquete en 147 pacientes. Discusión La combinación de uso de torniquete, infiltración periarticular e intra articular de ácido tranexamico reduce la pérdida sanguínea y la necesidad de tranfusiones.

Background The blood loss during the total knee replacement is one of the main variables that influence the outcomes of this surgery, and several methods have been implemented to reduce it. The aim of the study is to quantify the change in haematocrit and haemoglobin at 24hours post-surgery in patients subjected to a total primary knee replacement at the Clinica Colombia between March 2016 and August 2017. Methods An observational study was conducted on a retrospective cohort. The inclusion criteria were those patients who had a total primary knee replacement with periarticular infiltration with bupivacaine, with adrenaline, ketorolac, and morphine, and intra-articular with tranexamic acid. Haemoglobin and pre- and post-operative haematocrit, blood loss calculation, and transfusions were measured. Results The analysis included a total of 159 total knee replacements (75 conventional prostheses, 84 navigated prostheses). The percentage of transfusion was 0.69% (1 patient). The decrease in mean haematocrit was 7.36%, and the mean decrease in haemoglobin was 2.49g / dl for a calculated blood loss of 780ml. A tourniquet was used in 147 patients. Discussion The combination of tourniquet use, periarticular, and intra-articular injection of tranexamic acid reduces blood loss and the need for tranfusions.

Inherited thrombophilia and pregnancy loss. Study of an Argentinian cohort. / Trombofilia hereditaria y pérdidas de embarazo. Estudio de una cohorte de Argentina.

BACKGROUND AND OBJECTIVES: Thrombophilia might increase the risk of suffering from obstetric complications by adversely affecting the normal placental vascular function. Our aim was to study the distributions of five thrombosis-associated genetic variants: factor V Leiden, prothrombin G20210A, -675 4G/5G PAI-1, 10034C/T gamma fibrinogen and 7872C/T factor XI and the frequencies of the deficiencies of protein C, S and antithrombin in Argentinian patients with recurrent pregnancy loss (RPL) and, therefore, to analyse their association with the risk and timing of RPL and the risk of suffering other vascular obstetric pathologies. PATIENTS AND METHODS: We performed a case-control study that included 247 patients with idiopathic RPL (cases), 107 fertile controls and 224 subjects from general population (reference group). Cases were stratified according to the gestational time of the losses (early RPL, n = 89; late losses, n = 158; foetal losses, n = 107) and according to the type of vascular obstetric pathologies. RESULTS: No differences were found in the distribution of the genetic variants among RPL group vs. control/reference group (p >.05). Similarly, no differences were observed in their distributions when analysing RPL patients stratified according to gestational times or vascular obstetric pathologies (p >.05), except for the factor V Leiden carriage in patients with foetal growth retardation vs. controls (11.8%, 4/34 vs. 1.9%, 2/107; p = .04) (OR = 7.11 [1.24-40.93], p = .03). CONCLUSIONS: Factor V Leiden might have a significant impact on certain obstetric pathologies such as foetal growth retardation. The genetic variants, 10034C/T gamma fibrinogen and 7872C/T factor XI, associated with thromboembolic disease, would not have an impact on PRE.