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The objective of this scoping is to explore the methodologies, strategies or practices implemented by groups that develop clinical practice guidelines (CPG) for rare or low-prevalence diseases, especially with regard to the type and quality of existing evidence in these diseases and how it is generate the recommendations

Scoping review that seeks to know the current state of the use of the design thinking methodology to promote patient safety in health services.

Se presenta el posicionamiento del grupo de trabajo latinoamericano de la Fundación Internacional para los Cuidados Integrados (1) (IFIC, por su sigla en inglés). Este reúne a diversos actores y organizaciones de América Latina, con el objeto de apoyar acciones que faciliten la transformación de los sistemas de salud en la Región hacia sistemas integrados y centrados en las personas, no como individuos aislados, sino como sujetos de derecho, en los contextos sociales y ambientales complejos donde viven y se vinculan. El grupo de trabajo plantea nueve pilares de la atención integrada para ser utilizados como marco conceptual en la elaboración de políticas y de cambios en las prácticas: 1) visión y valores compartidos, 2) salud de las poblaciones, 3) las personas y las comunidades como socias, 4) comunidades resilientes, 5) capacidades del talento humano en salud, 6) gobernanza y liderazgo, 7) soluciones digitales, 8) sistemas de pago alineados, y 9) transparencia ante la ciudadanía. Desde estos pilares se proponen líneas de trabajo en los ámbitos del fortalecimiento de alianzas y redes, la abogacía, la investigación y generación de capacidades, que contribuyan a materializar sistemas de salud y sociales efectivamente integrados y centrados no solo en las personas, sino también en las comunidades en América Latina. This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America.

The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PLAT (Primary Care Assessment Tools for lberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires' comprehension, carried out with health professionals and users of healthcare services. (C) 2020 SESPAS. Published by Elsevier Espana, S.L.U. Resumen La utilización de cuestionarios como instrumentos de medición implica el uso de procesos lingüísticos. La variedad intralingüística del español conlleva diferentes modos de percibir, analizar y actuar en el mundo que deben considerarse al diseñar o adaptar cuestionarios. La armonización de los cuestionarios IA-PCAT (Primary Care Assessment Tools para Iberoamérica) difiere de los escenarios de adaptación transcultural descritos en la literatura porque intenta obtener un único producto en español adecuado para numerosas poblaciones meta a partir la armonización de cuestionarios provenientes de diversas poblaciones fuente hispanohablantes, por lo que requiere innovaciones en las categorías de análisis que se utilizan. El objetivo de este trabajo es proponer definiciones discriminantes de equivalencia conceptual, equivalencia práctica y aceptabilidad lingüística como categorías de análisis para la comprensión de cuestionarios, y ofrecer ejemplos de pruebas de comprensión realizadas mediante entrevistas cognitivas con profesionales y personas usuarias de servicios de salud.

Objetivo Realizar las pruebas pre-clínicas por medio de herramientas de diseño óptico para simular la calidad óptica de una plataforma inteligente de iris artificial encapsulada en una lente de contacto escleral. Estas herramientas nos permiten generar modelos de ojo de aniridia y evaluar distintas métricas de calidad visual y de iluminación retiniana en función de la apertura del iris artificial basado en cristal líquido. Método Se utilizó la técnica de imagen de OCT para medir la geometría del segmento anterior en un paciente con aniridia y, a partir de estos datos, se generó el modelo de ojo con el programa de diseño óptico Zemax y programas específicos desarrollados en Matlab. Se calcularon las aberraciones oculares y se evaluó la función visual del modelo de ojo de anirida en tres escenarios: (i) sin corrección óptica, (ii) con la corrección con lente de contacto escleral comercial y (iii) con la corrección con lente de contacto inteligente basada en iris artificial. Resultados La calidad óptica en pacientes con aniridia está limitada por la magnitud de las aberraciones de alto orden. El diseño de lente de contacto escleral convencional corrige de forma precisa el desenfoque pero no es capaz de compensar las aberraciones oculares de alto orden, especialmente la aberración esférica. El diseño de lente de contacto inteligente basada en iris artificial permite compensar prácticamente la totalidad de las aberraciones de alto orden con un control activo del diámetro pupilar (activación de las celdas de cristal líquido en función de la iluminación ambiental). Además de minimizar las aberraciones de alto orden, al reducir el tamaño de pupila se aumentaría la profundidad de foco. Conclusiones Este artículo demuestra por medio de simulaciones ópticas el concepto de una plataforma inteligente de iris artificial encapsulada en una lente de contacto escleral y su posible aplicación en pacientes con aniridia. Además, nos permite anticipar los posibles resultados visuales en las pruebas clínicas con pacientes sanos (previa aplicación de agentes midriáticos) y en pacientes con aniridia. Los resultados demuestran una mejor calidad visual y una disminución de la iluminación retiniana. Objective To perform pre-clinical testing using optical design tools to simulate the optical quality of a smart artificial iris platform encapsulated in a scleral contact lens. These tools allow us to generate aniridia eye models and evaluate different metrics of visual quality and retinal illumination based on the aperture of the artificial iris based on liquid crystals. Method The OCT imaging technique was used to measure the geometry of the anterior segment in a patient with aniridia and, from these data, the eye model was generated with the Zemax optical design program and specific programs developed in Matlab. Ocular aberrations were calculated and the visual function of the anirida eye model was evaluated in three scenarios: (i) without optical correction, (ii) with correction with a commercial scleral contact lens, and (iii) with correction with an optical lens. intelligent contact based on artificial iris. Results Optical quality in patients with aniridia is limited by the magnitude of high-order aberrations. Conventional scleral contact lens design accurately corrects for blur but is unable to compensate for high-order ocular aberrations, especially spherical aberrations. The artificial iris-based smart contact lens design enables virtually all high-order aberrations to be compensated with active control of the pupillary diameter (activation of liquid crystal cells based on ambient lighting). In addition to minimizing high-order aberrations, reducing the pupil size would increase the depth of focus. Conclusions This article demonstrates by means of optical simulations the concept of an intelligent artificial iris platform encapsulated in a scleral contact lens and its possible application in patients with aniridia. Furthermore, it allows us to anticipate possible visual results in clinical trials with healthy patients (after application of mydriatic agents) and in patients with aniridia. The results demonstrate a better visual quality and a decrease in retinal illumination.

Intrauterine growth restriction (IUGR) is a fetal condition that affects up to 10% of all pregnancies and is associated with cardiovascular structural and functional remodelling that persists postnatally. Some studies have reported an increase in myocardial coronary blood flow in severe IUGR fetuses which has been directly associated to the dilatation of the coronary arteries. However, a direct measurement of the coronaries’ lumen diameter in IUGR has not been reported before. The aim of this paper is to perform, for the first time, a quantitative analysis of the effects of IUGR in cardiac geometry and coronary vessel size in a well-known rabbit model of IUGR using synchrotron-based X-ray Phase Contrast Tomography Imaging (X-PCI). Eight rabbit fetal hearts were imaged non-destructively with X-PCI. 3D reconstructions of the coronary arterial tree were obtained after semi-automatic image segmentation. Different morphometric features including vessel lumen diameter of the three main coronaries were automatically quantified. IUGR fetuses had more globular hearts and dilated coronary arteries as compared to controls. We have quantitatively shown that IUGR leads to structural coronary vascular tree remodelling and enlargement as an adaptation mechanism in response to an adverse environment of restricted oxygen and nutrients and increased perfusion pressure., PLoS ONE, 14 (6), ISSN:1932-6203

Objectives This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru. Methods A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers. Results The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers. Conclusion No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children. © 2019 Chávez-Zárate et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

For unknown reasons, humans appear to be particular susceptible to developing tau pathology leading to neurodegeneration. Transgenic mice are still undoubtedly the most popular and extensively used animal models for studying Alzheimer’s disease and other tauopathies. While these murine models generally overexpress human tau in the mouse brain or specific brain regions, there are differences between endogenous mouse tau and human tau protein. Among them, a main difference between human and mouse tau is the presence of a short motif spanning residues 18 to 28 in the human tau protein that is missing in murine tau, and which could be at least partially responsible for that different susceptibility across species. Here we report novel data using affinity chromatography analysis indicating that the sequence containing human tau residues 18 to 28 acts a binding motif for End Binding proteins and that this interaction could facilitate tau secretion to the extracellular space., Spanish Ministry of Economy and Competitiveness (SAF-2014-53040-P (Jesu´sA´vila), SAF2016-78603-R (Miguel Medina) and BFU2016-77885-P (Félix Hernández), the Centro de Investigasción Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED, ISCIII) (Jesús Ávila). Institutional grants from the Fundación Ramón Areces and Banco Santander

Background Human adult adipose-derived stem cells (hADSCs) have become the most promising cell source for regenerative medicine. However the prolonged ex vivo expansion periods required to obtain the necessary therapeutic dose promotes progressive senescence, with the concomitant reduction of their therapeutic potential. Aim and scope A better understanding of the determinants of hADSC senescence is needed to improve biosafety while preserving therapeutic efficiency. Here, we investigated the association between deregulation of the imprinted DLK1-DIO3 region and replicative senescence in hADSC cultures. Methods We compared hADSC cultures at short (P) and prolonged (P) passages, both in standard and low [O] (21 and 3%, respectively), in relation to replicative senescence. hADSCs were evaluated for expression alterations in the DLK1-DIO3 region on chromosome 14q32, and particularly in its main miRNA cluster. Results Comparison of hADSCs cultured at P or P surprisingly showed a quite significant fraction (69%) of upregulated miRNAs in P cultures mapping to the imprinted 14q32 locus, the largest miRNA cluster described in the genome. In agreement, expression of the lncRNA MEG3 (Maternally Expressed 3; Meg3/Gtl2), cultured at 21 and 3% [O], was also significantly higher in P than in P passages. During hADSC replicative senescence the AcK16H4 activating mark was found to be significantly associated with the deregulation of the entire DLK1-DIO3 locus, with a secondary regulatory role for the methylation of DMR regions. Conclusion A direct relationship between DLK1-DIO3 deregulation and replicative senescence of hADSCs is reported, involving upregulation of a very significant fraction of its largest miRNA cluster (14q32.31), paralleled by the progressive overexpression of the lncRNA MEG3, which plays a central role in the regulation of Dlk1/Dio3 activation status in mice., Ministry of Economy, Industry (SAF2015-70882-R; AEI/FEDER, UE), Comunidad Autónoma de Madrid (S2010/BMD-2420), Instituto Salud Carlos III (RETICS TerCel, RD12/0019/0018) and the European Commission (FP7-HEALTH-2009/CARE-MI)

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Follicular lymphoma is the second most common non-Hodgkin lymphoma in the United States and Europe. However, most of the prospective randomized studies have very little follow-up compared to the long natural history of the disease. The primary aim of this study was to investigate the long-term survival of our series of patients with follicular lymphoma. Patients and methods A total of 1074 patients with newly diagnosed FL were enrolled. Patients diagnosed were prospectively enrolled from 1980 to 2013. Results Median follow-up was 54.9 months and median overall survival is over 20 years in our series. We analyzed the patients who are still alive beyond 10 years from diagnosis in order to fully assess the prognostic factors that condition this group. Out of 166 patients who are still alive after more than 10 years of follow-up, 118 of them (73%) are free of evident clinical disease. Variables significantly associated with survival at 10 years were stage < II (p < 0.03), age < 60 years (p < 0.0001), low FLIPI (p < 0.002), normal 2 microglobulin (p < 0.005), no B symptoms upon diagnosis (p < 0.02), Performance Status 0-1 (p < 0.03) and treatment with anthracyclines and rituximab (p < 0.001), or rituximab (p < 0.0001). Conclusions A longer follow-up and a large series demonstrated a substantial population of patients with follicular lymphoma free of disease for more than 10 years.

Background The neurological manifestations of dengue disease are occurring with greater frequency, and currently, no information is available regarding the reasons for this phenomenon. Some viruses infect and/or alter the function of endothelial organs, which results in changes in cellular function, including permeability of the blood-brain barrier (BBB), which allows the entry of infected cells or free viral particles into the nervous system. Methods In the present study, we standardized two in vitro models, a polarized monolayer of mouse brain endothelial cells (MBECs) and an organized co-culture containing MBECs and astrocytes. Using these cell models, we assessed whether DENV-4 or the neuro-adapted dengue virus (D4MB-6) variant infects cells or induces changes in the structure or function of the endothelial barrier. Results The results showed that MBECs, but not astrocytes, were susceptible to infection with both viruses, although the percentage of infected cells was higher when the neuro-adapted virus variant was used. In both culture systems, DENV infection changed the localization of the tight junction proteins Zonula occludens (ZO-1) and Claudin-1 (Cln1), and this process was associated with a decrease in transendothelial resistance, an increase in macromolecule permeability and an increase in the paracellular passing of free virus particles. MBEC infection led to transcriptional up-regulation of adhesion molecules (VCAM-1 and PECAM) and immune mediators (MCP-1 and TNF- α) that are associated with immune cell transmigration, mainly in D4MB-6-infected cells. Conclusion These results indicate that DENV infection in MBECs altered the structure and function of the BBB and activated the endothelium, affecting its transcellular and paracellular permeability and favoring the passage of viruses and the transmigration of immune cells. This phenomenon can be harnessed for neurotropic and neurovirulent strains to infect and induce alterations in the CNS.

Background: The prevalence of childhood obesity is higher in Spain than in Northern European countries for reasons that are still unknown. The objective was to determine whether variables related to lifestyle habits and styles of parental care related to obesity in children differ between the countries of Northern Europe and Spain. Methods: Data were obtained from the ENERGY international project using questionnaires. We analyzed data from Spain, the Netherlands, Belgium and Norway including 1937 boys and 2061 girls aged 10-12 years old. We have studied the behavior of parents related to dietary variables, variables related to physical activity and ways of care. We calculated the mean and the proportions of all the variables and then calculated the association between different variables with the country of origin using the beta coefficient and the odds ratio (OR) as a measure of association. Results: Compared with parents in Northern Europe, Spanish parents consume significantly less days a week sugary drinks (Mean: 1.37 vs 2.16) but they consume more fruit juices (Mean: 2,61 vs 2,35). Spanish parents are more active going to their work, they are less sedentary but perform physical activity in their leisure time fewer days per week (Mean days per week they do physical activity in their leisure time: 1.88 vs 2.21). In addition, they are less negotiators with their children (Mean (0-4): 1.26 vs 1.68) and prevent less negative role models (Mean (0-4): 0.90 vs 1.29). However, they pay more attention (Mean (0-4): 3.42 vs 3.04) and encourage more healthy habits (Mean (0-4): 2.38 vs 2.06). Conclusions: The variables related to lifestyle habits and styles of care related to childhood obesity differ between Spanish parents and those of the countries of Northern Europe but these differences are not statistically significant. Therefore, differences in lifestyles and parenting practices might not explain the significant differences in childhood obesity between the Northern countries and Spain. Fundamentos: La prevalencia de obesidad infantil es más alta en España que en los países del norte de Europa por razones que todavía se desconocen. El objetivo fue comprobar si variables referentes a hábitos de vida y a estilos de cuidado de los progenitores relacionados con la obesidad infantil difieren entre los países del Norte de Europa y España. Métodos: Los datos fueron obtenidos del proyecto internacional ENERG. Se analizaron los de España, Países Bajos, Bélgica y Noruega, incluyendo a 1.937 niños y 2.061 niñas de 10 a 12 años de edad. Se estudiaron los comportamientos de los padres referidos a variables dietéticas, variables relacionadas con la actividad física y los estilos de cuidado. Se calcularon las medias y las proporciones de todas las variables y a continuación se calculó la asociación de las diferentes variables con el país de origen utilizando el coeficiente beta y la Odds Ratio (OR) como medidas de asociación. Resultados: En comparación con los progenitores del Norte de Europa, los progenitores españoles consumen bebidas azucaradas menos días por semana (Media: 1,37 vs 2,16) pero consumen más zumos de frutas (Media: 2,61 vs 2,35). Los progenitores españoles son más activos yendo a su trabajo, son menos sedentarios pero realizan actividad física en su tiempo libre menos días por semana (Media de días por semana que realizan actividad física en su tiempo libre: 1,88 vs 2,21). Además, son menos negociadores con sus hijos (Media (0-4): 1,26 vs 1,68) y evitan menos los modelos negativos de conducta (Media (0-4): 0,90 vs 1,29). Sin embargo, prestan más atención (Media (0-4): 3,42 vs 3,04) y estimulan más los hábitos saludables (Media (0-4): 2,38 vs 2,06). Conclusiones: Las variables referentes a hábitos de vida y a estilos de cuidado relacionados con la obesidad infantil difieren entre los progenitores españoles y los de los países del Norte de Europa aunque estas diferencias no son estadísticamente significativas. Por lo tanto, las diferencias en los estilos de vida y estilos de cuidado de los progenitores probablemente no expliquen las diferencias en la obesidad infantil entre los países del Norte y España.

BackgroundDying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether "the percentage of patients dying at home" and "the percentage of patients who died in their place of preference" are feasible and informative quality indicators.Methods and findingsA mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), The Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). "The percentage of patients dying at home" ranged between 35.3% (Belgium) and 50.6% (The Netherlands) in the four countries, while "the percentage of patients dying at their preferred place of death" ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55-13.23 and 2.30-6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (The Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases.ConclusionGPs know their patients' actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients' preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs.

In 2003 a pilot study was carried out in the rural area of the Bolivian Department of La Paz aiming at the identification of dietary patterns among a group of secondary school adolescents who have little or scarce contact with the urban centres. The study consisted of a food intake survey (24 h recall), the measurement of anthropometrics and sociodemographic information. Nine percent was the global prevalence of overweight, although it was more present in girls. No statistically significant differences were found between nutrients in the diets of boys and girls. The energy intake was distributed in the five usual eating times as follows: 22% breakfast, 20% break time at school, 24% lunch, 12% tea time and 22% dinner. Furthermore, the anthropometric measures of boys were compared with their urban counterparts, where the differences were only significant with students in private schools. The present study can be used for the formulation of nutritional policies in Bolivia.

El programa del médico y la enfermera de la familia, iniciado en 1984, resultó también afectado por la crisis económica desencadenada con la caída del campo socialista en Europa del Este en los años 90. Por considerarse el programa un pilar del sistema sanitario cubano, se definió la realización de un estudio descriptivo sobre aspectos relacionados con el funcionamiento de los equipos básicos de salud en los municipios de Centro Habana y San Antonio de los Baños, a partir del año 2003. Durante la investigación se aplicaron técnicas cualitativas y cuantitativas con cálculo de porcentajes para los grupos estudiados de médicos, enfermeras y pacientes. En los resultados se reconoció que la existencia de locales de consulta compartidos por varios equipos básicos de salud representa un elemento a considerar para el desarrollo de la atención primaria. Futuras medidas organizativas que se proponen podrían mejorar la labor que se desarrolla en estas estructuras sanitarias.

Following the development of the transverse rectus abdominis myocutaneous (TRAM) flap, the lower abdomen has been recognized as a prime source of high qualit...

No existen muchas publicaciones nacionales o internacionales que traten el tema de los estudios organizacionales como alternativa para evaluar el rol de los servicios de salud en el proceso de producción social de la salud y, en especial, como un determinante de la salud. En el presente artículo se expusieron aspectos relacionados con este tema, se plantearon las base conceptuales de los estudios organizacionales y se justificó la necesidad de implementar este tipo de estudio en los servicios de salud, para explicar a nivel local cómo se produce la mencionada contribución a la salud de la población, cuáles son sus factores de éxito y cuáles son las áreas susceptibles de mejora. Se expuso una metodología derivada de las lecciones aprendidas y de la experiencia que los autores han alcanzado en este campo, durante más de dos décadas de trabajo en el sistema de salud cubano.