Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia.

BACKGROUND: There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients' sociodemographic characteristics play a role in its continuity of care. METHODS: Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut-ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices. RESULTS: Indices' results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship. CONCLUSION: Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.

Evaluation of the Catalan Physical Activity, Sports and Health Plan: a nested case-control study.

BACKGROUND: Physical inactivity is one of the most important risk factors in modern society. Primary Health Care (PHC) interventions have been shown to be effective to increase physical activity (PA). This work evaluates the Catalan Physical Activity, Sport and Health Plan (PAFES). METHODS: Nested case-control design with risk-set matching based on a retrospective cohort of 22 450 physically inactive people registered between 2010 and 2018 in the Catalan electronic medical record (EMR). Confounder adjusted conditional logistic regression was used to estimate the probability that participants who had received PA advice became active between 2010 and 2018 compared to those who did not receive it. RESULTS: A lower probability to become active [odds ratio (OR) = 0.11, 95% confidence interval (CI) 0.10-0.13] was found for those people who had received PA advice only once. However, the probability to become active increased for people who had received advice two or more times (two times: OR = 1.43, 95% CI 1.32-1.55). A dose-response relationship was observed. CONCLUSIONS: This is the first study evaluating a PA promotion real-life intervention in PHC using a large cohort based on data from an EMR with more than 2 years of follow-up.

Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia.

BACKGROUND: To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. METHODS: Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. RESULTS: We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. CONCLUSIONS: The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.

Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial.

BACKGROUND: Numerous studies have analyzed the effectiveness of electronic reminder interventions to improve different clinical conditions, and most have reported a small to moderate effect. Few studies, however, have analyzed reminder systems targeting multiple conditions, and fewer still have compared electronic point-of-care reminders systems with other forms of feedback designed to improve delivery of care. METHODS: We performed an unblinded cluster randomized clinical trial to compare the effectiveness of an electronic point-of-care reminder system with that of a well-established system providing monthly feedback on adherence to clinical recommendations. The control group received monthly feedback only while the intervention group received monthly feedback in addition to on-screen point-of-care reminders for 10 clinical conditions. The study targeted all physicians and nurses at the 283 primary care centers managed by the Institut Català de la Salut (approximately 6600 professionals). RESULTS: Following exclusions and randomization, 132 primary care centers (328,728 patients with reminders) were assigned to the intervention group while 137 centers (317,117 patients with reminders) were randomized to the control group. A 20.6% improvement (OR 1.29, 95% CI: 1.25-1.34) in reminder resolution rates was observed in the intervention group. Results varied according to the clinical condition. The most effective reminder was screening for diabetic retinopathy (OR 1.51, 95% CI:1.46-1.57) while the least effective reminders were measurement of glycated hemoglobin (OR: 1.10, 95% CI: 1.07-1.13) and smoking cessation encouragement (OR 1.12, 95% CI: 1.09-1.16). CONCLUSIONS: Electronic point-of-care reminders were more effective than the existing monthly feedback system at resolving the 10 clinical situations. However, more studies are needed to investigate the variations of the effect observed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42391639, 08/10/2012. Retrospectively registered.

[Spatial distribution and ecological structure of Thalassia testudinum (Hydrocharitaceae) in two reefs of Veracruz Reef System National Park, Mexico]. / Distribución espacial y estructura morfométrica de las praderas de Thalassia testudinum (Hydrocharitaceae) en dos arrecifes del Parque Nacional Sistema Arrecifal Veracruzano, México.

Seagrasses in coastal environments have been threatened by increased human activities; these have negatively altered processes and environmental services, and have decreased grassland areas. The aim of this study was to generate knowledge of Thalassia testudinum distribution, state of the structure and fragmentation level in two reefs of the Veracruz Reef System National Park (PNSAV). Two different reefs were selected: Sacrificios in the North and near the coast, and Cabezo in the South and away from the coast. Shoot-specific and area-specific characteristics of submerged macrophytes meadows present were determined, and four morpho-functional groups were identified. Significant differences between plant coverage were tested through nonparametric ANOVA, Kruskal-Wallis test. A supervised classification of spatial high-resolution image verified with field data was performed (55 Sacrificios and 290 Cabezo). The fragmentation level was calculated using landscape metrics, class level and thematic maps were made based on four covers. The meadows were dominated by Thalassia testudinum; maximum densities were 208 shoot/m2 in Cabezo, and 176 shoot/m2 in Sacrificios. Cabezo presented grasses with short (9 cm) and thin leaves (0.55 cm) on average; while Sacrificios showed longer (23.5 cm) and thicker (1 cm) leaves. Sacrificios showed lower fragmentation degree than Cabezo; in both cases, the vegetation cover fragmentation corresponded to less than 50 %. Although Cabezo reef presents further fragmentation, which creates a large number of microenvironments, being recognized for its importance as recruitment area. This work serves as a baseline for the creation of an adequate management plan (formation of a core area of Cabezo). It is necessary to complement this work with new efforts for the recognition of seagrass prairies in all PNSAV reefs, as well as periodic monitoring and recognition of ecosystem services. .

Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial.

BACKGROUND: Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease. METHODS: This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP's quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables. DISCUSSION: The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.

Sequential detection of influenza epidemics by the Kolmogorov-Smirnov test.

BACKGROUND: Influenza is a well known and common human respiratory infection, causing significant morbidity and mortality every year. Despite Influenza variability, fast and reliable outbreak detection is required for health resource planning. Clinical health records, as published by the Diagnosticat database in Catalonia, host useful data for probabilistic detection of influenza outbreaks. METHODS: This paper proposes a statistical method to detect influenza epidemic activity. Non-epidemic incidence rates are modeled against the exponential distribution, and the maximum likelihood estimate for the decaying factor λ is calculated. The sequential detection algorithm updates the parameter as new data becomes available. Binary epidemic detection of weekly incidence rates is assessed by Kolmogorov-Smirnov test on the absolute difference between the empirical and the cumulative density function of the estimated exponential distribution with significance level 0 ≤ α ≤ 1. RESULTS: The main advantage with respect to other approaches is the adoption of a statistically meaningful test, which provides an indicator of epidemic activity with an associated probability. The detection algorithm was initiated with parameter λ0 = 3.8617 estimated from the training sequence (corresponding to non-epidemic incidence rates of the 2008-2009 influenza season) and sequentially updated. Kolmogorov-Smirnov test detected the following weeks as epidemic for each influenza season: 50-10 (2008-2009 season), 38-50 (2009-2010 season), weeks 50-9 (2010-2011 season) and weeks 3 to 12 for the current 2011-2012 season. CONCLUSIONS: Real medical data was used to assess the validity of the approach, as well as to construct a realistic statistical model of weekly influenza incidence rates in non-epidemic periods. For the tested data, the results confirmed the ability of the algorithm to detect the start and the end of epidemic periods. In general, the proposed test could be applied to other data sets to quickly detect influenza outbreaks. The sequential structure of the test makes it suitable for implementation in many platforms at a low computational cost without requiring to store large data sets.

[Hurricane impact on Thalassia testudinum (Hydrocharitaceae) beds in the Mexican Caribbean]. / Impacto por huracanes en las praderas de Thalassia testudinum (Hydrocharitaceae) en el Caribe Mexicano.

Hurricanes have increased in strength and frequency as a result of global climate change. This research was conducted to study the spatio-temporal distribution and changes of Thalassia testudinum, the dominant species in Bahia de la Ascension (Quintana Roo, Mexico), when affected by heavy weather conditions. To complete this objective, a 2001 Landsat ETM+ image and the information from 525 sampling stations on morpho-functional and coverage of T. testudinum were used, and the seeds generated for the classification of eight benthic habitats. To quantify the changes caused by two hurricanes, we used two images, one of 1988 (Gilberto) and another of 1995 (Roxanne); other three data sets (2003, 2005 and 2007) were also used to describe the study area without major weather effects. Six categorial maps were obtained and subjected to analysis by 8 Landscape Ecology indexes, that describe the spatial characteristics, structure, function, change of the elements (matrix-patch-corridor), effects on ecosystems, connectivity, edges, shape and patch habitat fragmentation. Models indicate that T. testudinum may be classified as a continuum (matrix), since the fragments were not observed intermittently, but as a progression from minimum to maximum areas in reference to their coverage (ecological corridors). The fragments do not have a regular shape, indicating that the impacts are recent and may be due to direct effects (high-intensity hurricanes) or indirect (sediment). Fragments of type "bare soils" have a discontinuous distribution, and are considered to be the sites that have remained stable over a long timescale. While more dense coverage areas ("beds", "medium prairie" and "prairie") have low fragmentation and high connection of fragments. Features have an irregular perimeter and radial growth of formal; suggesting that the impact of meteors has no effect on the resilience of T. testudinum in this ecosystem, indicating good environmental quality to grow in this bay.

Funcionamiento afectivo-motivacional de pacientes prediabéticos y diabéticos / Affective-motivational functioning in prediabetic and diabetic patients

Fundamento: El funcionamiento afectivo-motivacional influye en el control de las enfermedades crónicas y en la actitud que asumen los enfermos ante la enfermedad. Objetivo: Caracterizar las particularidades afectivo-motivacionales que diferencian la regulación del comportamiento en pacientes prediabéticos y diabéticos crónicos. Metodología: Se utilizó un paradigma mixto de investigación, con diseño exploratorio secuencial. La muestra quedó conformada por un total de 20 sujetos, distribuidos en dos grupos: uno integrado por pacientes prediabéticos y el otro por pacientes diabéticos. Se aplicó el RAMDI (S), la escala Dembo - Rubinstein, el test de completamiento de frases, la técnica de la composición. Resultados: Se revelaron diferencias afectivo-motivacionales entre ambos grupos, expresadas en la concientización o no de la enfermedad y la consecuente regulación del comportamiento. Predominó una tendencia a la sobrevaloración en la variable salud, en los pacientes prediabéticos y subvaloración en los pacientes diabéticos. Conclusiones: Los sujetos prediabéticos no se reconocen como enfermos, no valoran los riesgos que contraen con su condición y no se comprometen con un cambio de estilo de vida. El grupo de pacientes diabéticos se caracterizó por expresar conciencia de la enfermedad, compromiso afectivo y elaboración personal, como procesos que facilitan la regulación de su comportamiento.

Background: Affective-motivational functioning affects the control over chronic diseases and the attitudes that patients assume towards the disease. Objective: To characterize the affective-motivational specificities that distinguish behavioral adaptations in prediabetic and chronic diabetic patients. Methods: A mixed research paradigm was applied, with a sequential exploratory design. The sample was composed by a total number of 20 patients, distributed in two groups: one composed by prediabetic patients and the other by diabetic ones. The RAMDI (S), the Dembo-Rubinstein Scale, and the Sentence Completion Test were applied, the Composition Technique. Results: Affective-motivational differences between the two groups were detected, manifested in the consciousness or not of the disease and consequent behavior regulation. A tendency to overestimate the health variable prediabetic patients and underestimate diabetic patients prevailed. Conclusions: Prediabetic patients do not recognize themselves as sick, do not value the risks they take with their status and do not engage in a lifestyle change. The diabetic patient group was characterized by expressing disease self-consciousness, affective compromise and personal development, as the processes that facilitate the adjustment of their behavior.

Particularidades del funcionamiento afectivo-motivacional de pacientes prediabéticos / Particularities of the motivational and affective functioning in prediabetic patients

Introducción: La prevención en el progreso de la prediabetes hacia la diabetes, debe hacerse desde un enfoque holístico y considerar el funcionamiento afectivo - motivacional de quienes la padecen. Objetivo: Determinar las particularidades del funcionamiento afectivo - motivacional de pacientes prediabéticos. Métodos: Se desarrolló un estudio exploratorio descriptivo con metodología mixta, se integraron los análisis cuantitativo y cualitativo; la muestra quedó conformada por 10 sujetos prediabéticos. Para la pesquisa se realizó el análisis psicológico de los pacientes, según su historia clínica y se aplicaron el Registro de la Actividad. Método Directo e Indirecto (RAMDI), la Escala Dembo-Rubinstein, las Técnicas de Completamiento de Frases y de Composición, así como la entrevista semiestructurada. Resultados: Los sujetos prediabéticos no se reconocen como enfermos, no valoran los riesgos que contraen por esa condición y no se comprometen con un cambio de estilo de vida. Conclusiones: En los pacientes prediabéticos la categoría salud no es un motivo rector que oriente y regule su conducta de modo estable; predominó la actitud de «no aceptación de la enfermedad», con una marcada tendencia a la autovaloración inadecuada que limita la responsabilidad personal ante la condición mórbida.

Introduction: the prevention of the progression from prediabetes to diabetes must be done from a holistic approach considering the motivational and affective functioning of the patients who suffer from this condition. Objective: to determine the particularities of the motivational and affective functioning of prediabetic patients. Methods: a descriptive exploratory study was carried out with a mixed-method research where quantitative and qualitative analyzes were integrated; the sample was made up of 10 prediabetic subjects. A psychological assessment was made based on their clinical history and the Register of the Activity. Direct and Indirect Method (RAMDI in Spanish), the Dembo-Rubinstein Scale, the Sentence Completion and the Composition Techniques, as well as the semi-structured interview were applied for screening. Results: the prediabetic subjects do not recognize themselves as sick, do not value the risks they incur with their condition, and do not commit to a lifestyle change. Conclusions: health category in prediabetic patients is not a guiding motive that guides and regulates their behaviour in a stable way; a predominance of an attitude of "non-acceptance of the disease", with a marked tendency to inadequate self-assessment that limited personal responsibility for the morbid condition.

Particularidades de la esfera afectivo motivacional en pacientes diabéticos crónicos

Introducción : La diabetes mellitus, debe abordarse desde un enfoque holístico, donde se considere el funcionamiento afectivo motivacional de los pacientes que la padecen. Objetivo: Determinar las particularidades afectivo motivacionales en pacientes diabéticos crónicos. Métodos: Se realizó un estudio exploratorio descriptivo con un paradigma de investigación mixto, donde se integraron los análisis cuantitativo y cualitativo. La muestra quedó conformada por 10 sujetos diabéticos crónicos, no se pretendió que los hallazgos derivados de su estudio fuesen generalizados a la población, pero sí, por su carácter inductivo, reflejaran la perspectiva de aquel que vivencia el fenómeno objeto de estudio. Para la pesquisa se aplicó el análisis psicológico de la historia clínica, el RAMDI (S), la Escala Dembo -Rubinstein, el test de completamiento de frases, la técnica de la composición, así como la entrevista semiestructurada. Resultados: Se constató conciencia de la enfermedad, se manifestó una adecuada valoración de la misma, acompañado de un compromiso afectivo y una elaboración personal en sus reflexiones, donde se conjugan sus vivencias y experiencias de vida, que da una orientación afectivo-motivacional a su comportamiento. Conclusiones: La categoría salud aparece como un motivo central y jerárquico en estos sujetos, pero a pesar de esto no todos logran regular su comportamiento de una manera efectiva y saludable.

Introduction: Diabetes mellitus should be approached from a holistic approach, where the motivational affective functioning of patients suffering from it is considered. Objective: To determine the motivational affective characteristics in chronic diabetic patients. Methods: A descriptive exploratory study was carried out with a mixed research paradigm, where quantitative and qualitative analyzes were integrated. Responding to this approach, the sample was made up of 10 chronic diabetic subjects, not intending that the findings derived from their study were generalized to the population, but yes, due to their inductive nature, they reflected the perspective of the person experiencing the phenomenon under study. For the research, the psychological analysis of the clinical history, the RAMDI (S), the Dembo-Rubinstein Scale, the Phrase Completion Test, the Composition Technique, as well as the semi-structured interview were applied. Results: Awareness of the disease was found, showing an adequate assessment of it, accompanied by an emotional commitment and personal elaboration in their reflections, where their experiences and life experiences are combined, and giving an emotional-motivational orientation to their behavior. Conclusions: The health category appears as a central and hierarchical motive in these subjects, but despite this, not everyone manages to regulate their behavior in an effective and healthy way.

Relación entre variables psicológicas y lesiones deportivas en lanzadores de béisbol / Relação entre habilidades psicológicas e lesões desportivas em lançadores de beisebol / Relationship between psychological variables and sports injuries in baseball pitchers

RESUMEN Se realizó un estudio transversal, descriptivo y correlacional para determinar la relación entre variables psicológicas y lesiones en 34 lanzadores de béisbol de diferentes niveles competitivos. Se describieron las lesiones mediante análisis de frecuencias y distribución porcentual, así como media, desviación típica, asimetría y curtosis para las variables psicológicas; se realizó además la prueba de normalidad mediante K-S para una muestra. Se compararon las variables psicológicas entre grupos de lanzadores mediante Anova de un factor y se analizó la relación entre ambos grupos de variables mediante el coeficiente de correlación de Pearson. Se compararon las variables psicológicas en relación a las lesiones, empleando la prueba t para muestras independientes y Anova de un factor en cada caso, con un intervalo de confianza del 95 % donde p≤0.05. Fueron empleados el cuestionario de aspectos deportivos y lesiones, inventario de ansiedad rasgo-estado, inventario de ansiedad estado en competencia e inventario psicológico de ejecución deportiva. Se obtuvo una marcada presencia de lesiones y un perfil psicológico donde la ansiedad-rasgo, el control de la atención, la autoconfianza, el nivel motivacional y el control de afrontamiento positivo constituyen los puntos fuertes, existiendo diferencias en la ansiedad, según el nivel competitivo. Excepto el control de la actitud, las habilidades psicológicas mostraron relación con las lesiones. Los lanzadores con mayor cantidad y gravedad de lesiones durante las competencias presentan mayor ansiedad. Se concluye afirmando que la preparación psicológica del lanzador de béisbol debe poseer la finalidad de optimizar su rendimiento deportivo y preservar su estado de salud.

RESUMO Foi realizado um estudo transversal, descritivo e correlacional para determinar a relação entre variáveis psicológicas e lesões em 34 lançadores de beisebol de diferentes níveis competitivos. As lesões foram descritas por análise de frequência e distribuição percentual, assim como média, desvio padrão, enviesamento e curtose para as variáveis psicológicas; o teste de normalidade K-S também foi realizado para a amostra. As variáveis psicológicas foram comparadas entre grupos de pitchers através de um fator único. Anova e a relação entre ambos os grupos de variáveis foi analisada por meio do coeficiente de correlação de Pearson. As variáveis psicológicas foram comparadas em relação às lesões, utilizando o teste t para amostras independentes e um fator Anova em cada caso, com um intervalo de confiança de 95 %, em que p≤0.05. Foi utilizado o questionário de aspectos e lesões desportivas, inventário de ansiedade do estado do traço, inventário de ansiedade do estado na competição e inventário psicológico do desempenho desportivo; uma presença marcada de lesões e um perfil psicológico onde a ansiedade do traço, o controlo da atenção, a autoconfiança, o nível motivacional e o controlo positivo da resposta constituem os pontos fortes obtidos, com diferenças na ansiedade, de acordo com o nível competitivo. Com restrição do controlo de atitude, as capacidades psicológicas mostraram relação com lesões. Os lançadores com maior quantidade e gravidade de lesões durante as competições apresentam maior ansiedade. Conclui-se que a preparação psicológica do lançador de beisebol deve ter o propósito de otimizar o seu desempenho desportivo e preservar a sua saúde.

ABSTRACT A cross-sectional, descriptive and correlational study was carried out to determine the relationship between psychological variables and injuries in 34 baseball pitchers of different competitive levels. Injuries were described by frequency analysis and percentage distribution, as well as mean, standard deviation, asymmetry and kurtosis for psychological variables; the K-S normality test was also performed for the sample. The psychological variables were compared between groups of pitchers by means of a one-factor Anova and the relationship between both groups of variables was analyzed by means of Pearson's correlation coefficient. Psychological variables were compared in relation to injuries, using the t-test for independent samples and one-factor Anova in each case, with a confidence interval of 95 % where p≤0.05. The questionnaire of sports aspects and injuries, trait-state anxiety inventory, state anxiety inventory in competition and psychological inventory of sports performance were used; a marked presence of injuries and a psychological profile where trait-anxiety, attention control, self-confidence, motivational level and positive coping control constitute the strong points were obtained, with differences in anxiety, according to the competitive level. Except for attitude control, psychological skills showed a relationship with injuries. The throwers with greater number and severity of injuries during the competitions present greater anxiety. It is concluded by affirming that the psychological preparation of the baseball pitcher should have the purpose of optimizing his sports performance and preserving his state of health.

Partial characterization of digestive proteases in juveniles of Microphis brachyurus (short-tailed pipefish) (Syngnathiformes: Syngnathidae)

Short-tailed pipe fish (Microphis brachyurus) is a freshwater organism with high economic potential for the aquarium hobby, so it is necessary to implement methods to promote its culture through studies of digestive physiology. General activities of acid and alkaline proteases were evaluated, as well as the effect of pH, temperature and inhibitors. The optimal pH of stomach proteases was 2, while the optimal pH of intestinal proteases was 10. Optimal temperature for the acidic proteases was 35 ºC, while for alkaline proteases it was 45 ºC. Thermal stability showed high resistance at 35 ºC for both acid and alkaline proteases (above 100% residual activity). Acid proteases are resistant at pH 2 (50% of residual activity), meanwhile alkaline proteases were highly resistant at pH 10 (90% of residual activity). Acid proteases were inhibited by 80% with pepstatin A and alkaline proteases were inhibited with TLCK and TPCK for trypsin (75%) and chymotrypsin (80%), respectively. Finally, metallo-proteases were 75% partially inhibited some serine proteases by 75% with EDTA. In conclusion, M. brachyurus has a good digestive capacity, since they can degrade a wide variety of proteins due to their greater proteolytic activity.(AU)

El pez pipa (Microphis brachyurus) es un organismo dulceacuícola con alto potencial económico para la acuarofilia; sin embargo, es necesario implementar su cultivo a través de estudios de fisiología digestiva. Se evaluó el efecto del pH, temperatura e inhibidores sobre las actividades enzimáticas de proteasas ácidas y alcalinas. El pH óptimo de proteasas estomacales es de 2, mientras que el de proteases intestinales es de 10. La temperatura óptima de proteasas ácidas es de 35 ºC y las alcalinas de 45 ºC. La estabilidad térmica para proteasas ácidas y alcalinas es a los 35 ºC (más de 100% de actividad residual). La estabilidad a los diferentes pH de las proteasas ácidas es en 2 (50 % de la actividad residual), mientras que para las proteasas alcalinas es en 10 (90 % de la actividad residual). Las proteasas ácidas fueron inhibidas en 80% con pepstatina A y las proteasas alcalinas fueron altamente inhibidas con TLCK para tripsina (75%) y TPCK quimitripsina (80%). Finalmente, las metaloproteasas fueron inactivadas con EDTA en 70%. En conclusión, M. brachyurus tiene una buena capacidad digestiva al degradar una amplia variedad de proteinas debido a su alta actividad proteolítica.(AU)

Complicaciones crónicas en pacientes con diagnóstico reciente de diabetes mellitus tipo 2 / Chronic complications in patients recently diagnosed with type 2 diabetes mellitus

RESUMEN La diabetes mellitus tipo 2 representa un problema de salud actual con altos índices de morbilidad y mortalidad a escala mundial. Se realizó un estudio descriptivo, transversal y observacional con 200 pacientes que presentaban esta afección en el Hospital Universitario Clínico-Quirúrgico Arnaldo Milián Castro, Santa Clara, de enero a diciembre 2017, con el objetivo de describir las complicaciones crónicas en este tipo de paciente. El 80 % de los diagnósticos se realizó por glucemias en ayunas. Se detectó la presencia de complicaciones crónicas y enfermedades concomitantes, como: polineuropatía diabética, enfermedades de la piel y esteatohepatitis no alcohólica. Aunque el 100 % de los pacientes presentó algún factor de riesgo, la enfermedad no fue pesquisada precozmente; se detectó por exámenes indicados por otras causas y se realizó un diagnóstico tardío, en presencia de complicaciones crónicas. Se evidenció la necesidad del trabajo de prevención y promoción de salud, a fin de evitar las tasas de morbilidad y expansión de la enfermedad.

ABSTRACT Type 2 diabetes mellitus represents a current health problem with high morbidity and mortality rates worldwide. A descriptive, cross-sectional and observational study with 200 patients recently diagnosed with type 2 diabetes mellitus and admitted at "Arnaldo Milián Castro" Clinico-Surgical University Hospital in Santa Clara was done from January to December 2017 with the objective of describing chronic complications in this type of patient. The 80 % of the diagnoses was confirmed by fasting blood sugar tests. The presence of chronic complications and concomitant diseases such as diabetic polyneuropathy, skin diseases and non-alcoholic steatohepatitis were detected. Despite 100 % of patients had some risk factor, the disease was not diagnosed early; it was detected through exams indicated for other reasons and a late diagnosis was done when chronic complications appear. The necessity to health prevention and promotion activities was evidenced in order to avoid morbidity rates, as well as, the spread of the disease.

Desarrollo socio sanitario de un asentamiento rural desde la perspectiva de las ciencias sociales / Social sanitary development of a rural establishment from the perspective of the social sciences

RESUMEN Se aplicó una intervención socio sanitaria en el asentamiento rural El León de Camagüey basada en los resultados de un estudio anterior, desde la comunicación social, educativa, así como aspectos socioculturales evaluados que permitieron la realización de este estudio. Su objetivo fue implementar una estrategia de intervención basada en acciones sociales y educativas colectadas en un manual que organizó contenidos de antropología socio cultural, psicología, sociología de la salud y trabajo social comunitario, la que fue conducida por profesionales de enfermería como prestadores, cuyo encargo social les asigna una mayor permanencia e intercambio con los pobladores, potenciándose el trabajo comunitario a partir de febrero de 2016,como etapa de sostenibilidad . La investigación constituyó un diseño mixto, con un estudio cuasi experimental sin grupo control (pre-post prueba) combinado con métodos cualitativos. La evaluación final efectuada en el periodo 2017-2018 exhibió modificaciones positivas en indicadores de las historias clínicas familiares de los pobladores, repercutiendo en el Análisis de la Situación de Salud, realizado en abril de 2018 y el entorno comunitario. Se demostró la importancia de la aplicación de la estrategia de intervención comunitaria desde las disciplinas de las ciencias sociales, por el personal de enfermería como agente de cambio de desarrollo local y protagonista de sostenibilidad.

ABSTRACT A social sanitary intervention was applied in the rural establishment El León of Camagüey, based on social and educational actions collected in a manual that organized social cultural anthropology contents, psychology, sociology of the health and community social work, which was led by infirmary professionals like lenders, whose social order assigns a major permanence and exchange of them with the settlers. The investigation constituted a mixed design, with a study quasi experimentally without control group (pre-post trial) combined with qualitative methods. The final evaluation carried out in the period 2017-2018 exhibited positive modifications in indicators of the familiar clinical history of the settlers, what reverberated in the Analysis of the Situation of Health, carried in April, 2018 and the community environment. It was demonstrated the importance of the application of the strategy of community intervention from the disciplines of the social sciences, by the infirmary personnel as change agent of local development and protagonist of sustainability.

Promoción de salud y prevención de enfermedades de transmisión sexual en estudiantes universitarios / Health Promotion and sexually transmitted diseases prevention in university students

La promoción de salud se integra a la labor educativa en las universidades cubanas y se entrelaza con la prevención de enfermedades. En la etapa juvenil se registra una alta incidencia de infecciones de transmisión sexual, especialmente por el Virus de Inmunodeficiencia Adquirida, lo que avala la pertinencia de acciones extensionistas. El presente artículo de revisión tuvo como objetivo exponer ideas para trabajar los proyectos y programas de promoción de salud sexual en las universidades desde un modelo de expresión de disfrute pleno y crecimiento personal, que a su vez incida en la prevención de estas infecciones a través de la estabilidad en las relaciones de pareja establecidas por los jóvenes.

Health promotion is integrated into the educational work in Cuban universities and is intertwined with the prevention of diseases. In the juvenile stage there is a high incidence of sexually transmitted infections, especially due to the acquired Immunodeficiency Virus, which supports the relevance of extension activities. The objective of this review article was to present ideas to work on projects and programs to promote sexual health in universities, based on a model of expression of full enjoyment and personal growth, which in turn affects the prevention of the infections through the stability in the couple relationships established by the young people.

Creation of a synthetic indicator of quality of care as a clinical management standard in primary care.

INTRODUCTION: The development of electronic medical records has allowed the creation of new quality indicators in healthcare. Among them, synthetic indicators facilitate global interpretation of results and comparisons between professionals. METHODS: A healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) was constructed to serve as a synthetic indicator to measure the quality of care provided by primary care professionals in Catalonia (Spain). The project phases were to establish the reference population; select health problems to be included; define, select and deliberate about subindicators; and construct and publish the EQA. RESULTS: Construction of the EQA involved 107 healthcare professionals, and 91 health problems were included. In addition, 133 experts were consulted, who proposed a total of 339 indicators. After systematic paired comparison, 61 indicators were selected to create the synthetic indicator. The EQA is now calculated on a monthly basis for more than 8000 healthcare professionals using an automated process that extracts data from electronic medical records; results are published on a follow-up website. Along with the use of the online EQA results tool, there has been an ongoing improvement in most of the quality of care indicators. CONCLUSIONS: Creation of the EQA has proven to be useful for the measurement of the quality of care of primary care services. Also an improvement trend over 5 years is shown across most of the measured indicators. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/2193-1801-2-51) contains supplementary material, which is available to authorized users.

Actitud de psicólogos asistenciales del municipio Santa Clara en relación con la hipnosis como recurso terapéutico / Attitude of care psychologists of Santa Clara municipality in relation to hypnosis as a therapeutic resource

Introducción: En los últimos 50 años el estudio y la práctica de la hipnosis como recurso terapéutico han ganado mayor espacio dentro del campo de la salud. No obstante el desconocimiento de esta técnica y la existencia de creencias falsas sobre ella perjudican su óptimo empleo. Objetivo: Describir la actitud que tienen los psicólogos asistenciales del municipio Santa Clara en relación con la hipnosis. Métodos: La investigación posee un alcance descriptivo, a partir de un estudio transversal con enfoque cuantitativo, realizado de septiembre a noviembre del 2016. La muestra quedó conformada por 38 psicólogos asistenciales. Se utilizó una encuesta de 16 ítems, donde se abordaron los saberes vinculados a la hipnosis, las creencias atribuidas ella, el valor terapéutico asignado a la hipnosis y la experiencia en su empleo. Resultados: Se apreció un bajo nivel de conocimientos sobre la hipnosis. La principal vía de obtención de conocimiento resultó ser la autopreparación. La mayor parte de los encuestados no emplea la técnica, sin embargo, le otorgan un gran valor terapéutico. No prevalecen las creencias irracionales sobre la hipnosis. Conclusiones: Los psicólogos asistenciales del municipio de Santa Clara, Villa Clara, demandan mayor conocimiento y preparación a través de instituciones académicas sobre el empleo de la hipnosis como recurso terapéutico. No predominan las creencias relacionadas con las condiciones especiales del terapeuta y de pérdida de control de la conducta en los pacientes. Hay reconocimiento del valor terapéutico de la hipnosis, a pesar de no ser empleada por muchos de los profesionales encuestados(AU)

Introduction: In the last 50 years, the study and practice of hypnosis as a therapeutic resource has gained more relevance within the field of health. Despite of this, the ignorance of this technique and the existence of false beliefs about it prejudice its optimal use. Objective: To describe the attitude of care psychologists in Santa Clara municipality in relation to hypnosis. Methods: The research has a descriptive scope, based on a cross-sectional study, with a quantitative approach carried out from September to November 2016. The sample consisted of 38 health psychologists. A 16-item questionnaire was used to discuss the hypnosis knowledge, the beliefs attributed to hypnosis, the therapeutic value assigned to it and the experience in its use. Results: A low level of knowledge about hypnosis was noticed. The main way of obtaining knowledge resulted to be self-preparation. Most of those polled do not use the technique, however they grant to it a great therapeutic value. Irrational beliefs about hypnosis do not prevail. Conclusions: Care psychologists of Santa Clara municipality in Villa Clara province demand greater knowledge and preparation through academic institutions on the use of hypnosis as a therapeutic resource. Beliefs related to the therapist's special conditions and loss of behavioral control in patients are not predominant. There is recognition of the therapeutic value of hypnosis, despite not being used by many of the professionals surveyed(AU)

Enfermedades neurometabólicas: Orientación diagnóstica a partir de la clínica neurológica / Neurometabolic diseases: Diagnostic orientation based on neurological symptoms

Resumen Las Enfermedades Neurometabólicas (ENM) son trastornos bioquímicos en la estructura y/o función de proteínas, de origen genético, por mutaciones en el ADN, causando un déficit enzimático con acumulación del sustrato o producción de metabolitos anormales. Consideradas enfermedades raras por su escasa incidencia, en su conjunto constituyen un motivo de admisión, consulta y morbimortalidad infantil frecuente. Las formas clínicas de presentación incluyen la forma de "intoxicación", las que afectan el metabolismo energético y las que afectan las moléculas complejas con compromiso de las organelas celulares (lisosomas, peroxisomas). El diagnóstico preciso y oportuno de las ENM es crucial, especialmente para aquellos trastornos que son tratables o manejables, con menor impacto en los pacientes, evitando no solo la muerte sino secuelas irreversibles. El diagnóstico clínico es el primer paso para su abordaje partiendo de la elaboración de una adecuada historia clínica, recolección detallada de antecedentes familiares y personales, considerando la edad de la aparición de los síntomas, siendo el periodo neonatal donde la mayoría debutan. La exploración física completa por aparatos y sistemas con especial énfasis en el examen neurológico, permite solicitar con mayor precisión los exámenes complementarios correspondientes para realizar una aproximación diagnóstica más acertada. El uso de herramientas diagnósticas mediante programas electrónicos, algunos de ellos disponibles gratuitamente como el Programa NeurometPlus ( www.neurometplus.com ), permite alcanzar de forma rápida y efectiva el diagnóstico más probable, así como manejo médico y tratamiento disponible actual.

Abstract Neurometabolic Disorders are conditions caused by alterations in the biochemical structure and function of proteins resulting from changes in DNA, causing a lack or dysfunction of an enzyme leading to an accumulation of a substrate or production of abnormal metabolites. Though considered rare diseases, due to low incidence, together they constitute a frequent cause for pediatric admissions and consultations with significant morbidity and mortality in childhood. Neurometabolic disorders may be classified as disorders of intoxication, energy metabolism, or those disorders affecting complex molecules compromising the cellular organelles (lysosomes and peroxisomes). A timely and precise diagnosis is crucial especially in treatable conditions in order to avoid irreversible sequelae and even death. When encountering a child with a potential neurometabolic disorder, making a clinical diagnosis is the rst step which should include an adequate clinical history, taking into consideration the age of onset of symptoms, and a detailed family history. The neonatal period is when the majority of these conditions make their debut. A complete physical exam with special emphasis on the neurological exam allows for greater precision to help guide the complementary exams that correspond to each condition in order to reach the most probable diagnosis. The use of diagnostic tools including electronic programs and databases, some of which are free of charge such as NeurometPlus ( www.neurometplus.com ), allow a quick and effective diagnosis, along with a guide for medical management and current treatment regimens available.

Distribución espacial y estructura morfométrica de las praderas de Thalassia testudinum (Hydrocharitaceae) en dos arrecifes del Parque Nacional Sistema Arrecifal Veracruzano, México / Spatial distribution and ecological structure of Thalassia testudinum (Hydrocharitaceae) in two reefs of Veracruz Reef System National Park, Mexico

ResumenLos pastos marinos son ambientes costeros que se han visto amenazados por el incremento de las actividades humanas. Alterando de forma negativa los procesos y servicios ambientales que presentan, así como la disminución de praderas. El objetivo es generar conocimiento de la distribución, estado de la estructura y nivel de fragmentación en dos arrecifes del Parque Nacional Sistema Arrecifal Veracruzano (PNSAV). Se eligieron dos praderas en arrecifes con características distintas: Sacrificios en el Norte que se encuentra cerca de la costa y Cabezo en el Sur que está alejado de la costa. Se determinaron las características específicas de haz y área de las praderas de macrófitas sumergidas presentes e identificaron cuatro grupos de cobertura morfofuncionales. Se comprobaron diferencias significativas entre coberturas (ANOVA no paramétrico, prueba de Kruskal-Wallis). Se realizó una clasificación supervisada de una imagen espacial de alta resolución verificada con datos de campo (55 Sacrificios y 290 Cabezo). El nivel de fragmentación se calculó usando métricas de paisaje a nivel de clase y se realizaron mapas temáticos en función de las cuatro coberturas. Las praderas se encuentran dominadas por Thalassia testudinum; se tuvieron densidades máximas de 208 haces/m2 para Cabezo y 176 haces/m2 en Sacrificios. Cabezo presentó pastos de hojas cortas (9 cm) y delgadas (0.55 cm) en promedio; Sacrificios tuvo hojas más largas (23.5 cm) y gruesas (1 cm). Sacrificios mostró menor grado de fragmentación que Cabezo; en ambos casos la fragmentación de la cobertura vegetal corresponde a menos del 50 %. Aunque el arrecife Cabezo presenta una mayor fragmentación, que crea un gran número de microambientes, siendo reconocido por su importancia como zona de reclutamiento. Este trabajo sirve como una línea de base para la creación de un plan de manejo adecuado (formación de una zona núcleo de Cabezo). Es necesario complementar este trabajo con nuevos esfuerzos del reconocimiento de las praderas de pastos marinos en todos los arrecifes del PNSAV, así como de monitoreos periódicos y reconocimiento de sus servicios ecosistémicos.

AbstractSeagrasses in coastal environments have been threatened by increased human activities; these have negatively altered processes and environmental services, and have decreased grassland areas. The aim of this study was to generate knowledge of Thalassia testudinum distribution, state of the structure and fragmentation level in two reefs of the Veracruz Reef System National Park (PNSAV). Two different reefs were selected: Sacrificios in the North and near the coast, and Cabezo in the South and away from the coast. Shoot-specific and area-specific characteristics of submerged macrophytes meadows present were determined, and four morpho-functional groups were identified. Significant differences between plant coverage were tested through nonparametric ANOVA, Kruskal-Wallis test. A supervised classification of spatial high-resolution image verified with field data was performed (55 Sacrificios and 290 Cabezo). The fragmentation level was calculated using landscape metrics, class level and thematic maps were made based on four covers. The meadows were dominated by Thalassia testudinum; maximum densities were 208 shoot/m2 in Cabezo, and 176 shoot/m2 in Sacrificios. Cabezo presented grasses with short (9 cm) and thin leaves (0.55 cm) on average; while Sacrificios showed longer (23.5 cm) and thicker (1 cm) leaves. Sacrificios showed lower fragmentation degree than Cabezo; in both cases, the vegetation cover fragmentation corresponded to less than 50 %. Although Cabezo reef presents further fragmentation, which creates a large number of microenvironments, being recognized for its importance as recruitment area. This work serves as a baseline for the creation of an adequate management plan (formation of a core area of Cabezo). It is necessary to complement this work with new efforts for the recognition of seagrass prairies in all PNSAV reefs, as well as periodic monitoring and recognition of ecosystem services. Rev. Biol. Trop. 64 (2): 427-448. Epub 2016 June 01.