Search

The objective of this research project is to determine the incidence of the “Crédito de Desarrollo Humano” on the quality of life of the beneficiaries through the differences in access to basic services, education, type of housing, and earnings in terms of income, purchasing power and economic situation. It is intended to contribute in the discussion between the bonus and the credit as social protection policies of which there is no generalized record of their effects on the beneficiaries according to the academic literature reviewed. The study population were the beneficiaries settled in the urban area of Loja city. The research was descriptive and deductive with a quantitative approach in which the use of the U test of Mann-Whitney and the t distribution w the statistic used to find statistically significant results that verify that the perceptions confirm the hypothesis: access to credit improves the quality of life of the beneficiaries compared to those with the economic bonus. In addition, the calculation of the probability of superiority PS made it possible to find the size of the effect of access to credit on the beneficiaries and to find out which of the groups is superior in terms of their perceptions. The results show that the beneficiaries of the credit are in a more precarious situation than the beneficiaries of the economic bonus and that the effect of access to credit on the perceptions of the beneficiaries is minimum., El objetivo de la investigación es determinar la incidencia del Crédito de Desarrollo Humano en la calidad de vida de los beneficiarios mediante las diferencias en el acceso a servicios básicos, educación, tipo de vivienda y las percepciones en cuanto a ingresos, capacidad de compra y situación económica. Se busca aportar en la discusión sobre bono y crédito como políticas de protección social de las cuales no se tiene un registro generalizado de sus efectos en los beneficiarios según la literatura académica revisada. La población de estudio fueron los beneficiarios asentados en las parroquias urbanas del cantón Loja. La investigación fue de tipo descriptiva y deductiva con un enfoque cuantitativo, en la cual el uso de las pruebas de t independiente y U de Mann-Whitney fueron los parámetros utilizados para encontrar resultados estadísticamente significativos que verifiquen que las percepciones confirmen la hipótesis: el acceso al crédito mejora la calidad de vida de los beneficiarios en comparación a los del bono. Además, el cálculo de la probabilidad de superioridad PS fue útil al encontrar el tamaño del efecto del acceso al crédito en los beneficiarios y determinar cuál de los grupos es superior en cuanto a sus percepciones. Los resultados arrojan que los beneficiarios del crédito se encuentran en una situación más precaria que los beneficiarios del bono, pero si se encuentra una mejor autopercepción de su situación en los que obtuvieron el crédito, y además el efecto del acceso al crédito en las percepciones de los beneficiarios es mínimo.

Altres ajuts: R. Alvarez-Velasco was supported by grant SLT008/18/00207 from the Health Research and Innovation Strategic Plan (PERIS). The NMD-ES Project and F. PlaJunca (data curator) are partially funded by the Centro de Investigacion Biomédica en Red de Enfermedades Raras (CIBERER)., To describe the clinical characteristics and outcomes in patients with refractory myasthenia gravis (MG) and to determine the effectiveness and side effects of the drugs used for their treatment. This observational retrospective cross-sectional multicenter study was based on data from the Spanish MG Registry (NMD-ES). Patients were considered refractory when their MG Foundation of America post-interventional status (MGFA-PIS) was unchanged or worse after corticosteroids and two or more other immunosuppressive agents. Clinical and immunologic characteristics of drug-refractory patients, efficiency and toxicity of drugs used, and outcome (MGFA-PIS) at end of follow-up were studied. We included 990 patients from 15 hospitals. Eighty-four patients (68 of 842 anti-acetylcholine receptor [AChR], 5 of 26 anti-muscle-specific tyrosine kinase [MusK], 10 of 120 seronegative, and 1 of 2 double-seropositive patients) were drug refractory. Drug-refractory patients were more frequently women (p < 0.0001), younger at onset (p < 0.0001), and anti-MuSK positive (p = 0.037). Moreover, they more frequently presented a generalized form of the disease, bulbar symptoms, and life-threatening events (p < 0.0001; p = 0.018; and p = 0.002, respectively) than non-drug-refractory patients. Mean follow-up was 9.8 years (SD 4.5). Twenty-four (50%) refractory patients had side effects to one or more of the drugs. At the end of follow-up, 42.9% of drug-refractory patients (42.6% of anti-AChR, 100% of anti-MuSK, and 10% of seronegative patients) and 79.8% of non-drug-refractory patients (p < 0.0001) achieved remission or had minimal manifestations. Eighty percent of drug-refractory-seronegative patients did not respond to any drug tested. In this study, 8.5% of MG patients were drug-refractory. New more specific drugs are needed to treat drug-refractory MG patients.

To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barré syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis. Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this. Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.

The article aims to analyze the effect of conditional cash transfers in Ecuador, which is a tool used to improve the levels of extreme poverty. It is also intended through research to identify whether it really benefits its recipients in Loja canton and the actual use of the voucher in families. We seek to draw attention to the dimensions of implementation and design of BDH programs that require further research, for this reason, we consider some relevant aspects from its allocation to the targeting of consumption, in a context of territoriality. An exploratory method with a mixed perspective is used, also using a qualitative approach that is relevant in the collection of information, which is integrated with a comparative descriptive analysis with studies of previous research applied to a sample of sixty people who respond to questions such as: How do you use the BDH money? How long do you receive the Bono? How do you rate the Bono process? The results show that women focus their spending on food, while men use it mostly for health and others. The average time they receive the voucher is between 1 and 10 years, a parameter that draws attention to whether the transfer really allows its beneficiaries to escape from extreme poverty., O artigo visa analisar o efeito das transferências condicionais de dinheiro no Equador, que é uma ferramenta utilizada para melhorar os níveis de pobreza extrema. Além disso, a pesquisa visa identificar se ela realmente beneficia seus beneficiários no cantão Loja e o uso real que o vale tem sobre as famílias. Ela procura chamar a atenção para as dimensões de implementação e concepção de programas BDH que requerem mais pesquisas, por este motivo, alguns aspectos relevantes são considerados, desde sua alocação até o direcionamento do consumo, em um contexto territorial. É usado um método exploratório com uma perspectiva mista, utilizando também uma abordagem qualitativa que é relevante na coleta de informações, que é integrada com uma análise descritiva comparativa com estudos de pesquisas anteriores aplicados a uma amostra de 60 pessoas que respondem a perguntas como Como você usa o dinheiro da BDH, Quanto tempo você recebe o Bono, Como você avalia o processo do Bono? Os resultados mostram que as mulheres concentram seus gastos na alimentação, enquanto os homens utilizam o dinheiro principalmente para a saúde e outros fins. O tempo médio de recebimento do comprovante é entre 1 e 10 anos, um parâmetro que chama a atenção para se a transferência realmente permite que seus beneficiários escapem da pobreza extrema., El artículo tiene por objetivo analizar el efecto de las transferencias monetarias condicionadas en el Ecuador, que es, una herramienta que se utiliza para mejorar los niveles de pobreza extrema. También, se pretende a través de la investigación identificar si realmente beneficia a sus perceptores del cantón Loja y el uso real que tiene el bono en las familias. Se busca llamar la atención sobre las dimensiones de implementación y diseño de programas de BDH que requieren mayor investigación, por tal razón, se considera algunos aspectos relevantes desde su asignación hasta la focalización en el consumo; en un contexto de territorialidad. Se utiliza un método exploratorio con perspectiva mixta, utilizando además un enfoque cualitativo el cual es relevante en la recolección de información, que se integra con un análisis descriptivo comparativo con estudios de investigaciones previas aplicado a una muestra de 60 personas que responden a preguntas como ¿En qué utiliza el dinero del BDH?, ¿Qué tiempo percibe el Bono?, ¿Cómo califica el proceso del Bono? Los resultados muestran que las mujeres enfocan el gasto hacia la alimentación, mientras que los hombres utilizan mayoritariamente para la salud y otros. El tiempo que perciben el bono promedio entre 1 a 10 años, parámetro que llama la atención en el sentido si realmente la transferencia les permite a sus beneficiarios salir de la pobreza extrema.

Background and Objectives Infections play a key role in the development of Guillain-Barre syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale. Methods We analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with Campylobacter jejuni, hepatitis E virus, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus. Results Serologic evidence of a recent infection with C. jejuni was found in 228 (30%), M. pneumoniae in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a C. jejuni infection. C. jejuni-positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir (p = 0.004) and a longer time to regain the ability to walk independently (p = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European C. jejuni-positive patients (p < 0.001, resp. p = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients (p = 0.004). Discussion Across geographical regions, the distribution o

Background and Objectives The clinical course and outcome of the Guillain-Barre syndrome (GBS) are diverse and vary among regions. The modified Erasmus GBS Outcome Score (mEGOS), developed with data from Dutch patients, is a clinical model that predicts the risk of walking inability in patients with GBS. The study objective was to validate the mEGOS in the International GBS Outcome Study (IGOS) cohort and to improve its performance and region specificity. Methods We used prospective data from the first 1,500 patients included in IGOS, aged >= 6 years and unable to walk independently. We evaluated whether the mEGOS at entry and week 1 could predict the inability to walk unaided at 4 and 26 weeks in the full cohort and in regional subgroups, using 2 measures for model performance: (1) discrimination: area under the receiver operating characteristic curve (AUC) and (2) calibration: observed vs predicted probability of being unable to walk independently. To improve the model predictions, we recalibrated the model containing the overall mEGOS score, without changing the individual predictive factors. Finally, we assessed the predictive ability of the individual factors. Results For validation of mEGOS at entry, 809 patients were eligible (Europe/North America [n = 677], Asia [n = 76], other [n = 56]), and 671 for validation of mEGOS at week 1 (Europe/North America [n = 563], Asia [n = 65], other [n = 43]). AUC values were >0.7 in all regional subgroups. In the Europe/North America subgroup, observed outcomes were worse than predicted; in Asia, observed outcomes were better than predicted. Recalibration improved model accuracy and enabled the development of a region-specific version for Europe/North America (mEGOS-Eu/NA). Similar to the original mEGOS, severe limb weakness and higher age were the predominant predictors of poor outcome in the IGOS cohort. Discussion mEGOS is a validated tool to predict the inability to walk unaided at 4 and 26 weeks in patients with GBS, a

Objective: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barre syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS).Methods: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis.Results: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this.Conclusions: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. Significance: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

[Objective] To describe the clinical characteristics and outcomes in patients with refractory myasthenia gravis (MG) and to determine the effectiveness and side effects of the drugs used for their treatment., [Methods] This observational retrospective cross-sectional multicenter study was based on data from the Spanish MG Registry (NMD-ES). Patients were considered refractory when their MG Foundation of America post-interventional status (MGFA-PIS) was unchanged or worse after corticosteroids and two or more other immunosuppressive agents. Clinical and immunologic characteristics of drug-refractory patients, efficiency and toxicity of drugs used, and outcome (MGFA-PIS) at end of follow-up were studied., [Results] We included 990 patients from 15 hospitals. Eighty-four patients (68 of 842 anti-acetylcholine receptor [AChR], 5 of 26 anti-muscle-specific tyrosine kinase [MusK], 10 of 120 seronegative, and 1 of 2 double-seropositive patients) were drug refractory. Drug-refractory patients were more frequently women (p < 0.0001), younger at onset (p < 0.0001), and anti-MuSK positive (p = 0.037). Moreover, they more frequently presented a generalized form of the disease, bulbar symptoms, and life-threatening events (p < 0.0001; p = 0.018; and p = 0.002, respectively) than non-drug-refractory patients. Mean follow-up was 9.8 years (SD 4.5). Twenty-four (50%) refractory patients had side effects to one or more of the drugs. At the end of follow-up, 42.9% of drug-refractory patients (42.6% of anti-AChR, 100% of anti-MuSK, and 10% of seronegative patients) and 79.8% of non-drug-refractory patients (p < 0.0001) achieved remission or had minimal manifestations. Eighty percent of drug-refractory-seronegative patients did not respond to any drug tested., [Interpretation] In this study, 8.5% of MG patients were drug-refractory. New more specific drugs are needed to treat drug-refractory MG patients.

OBJECTIVE: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barré syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS).METHODS: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis.RESULTS: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this.CONCLUSIONS: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions.SIGNIFICANCE: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.

Background and objectives: The clinical course and outcome of the Guillain-Barré syndrome (GBS) are diverse and vary among regions. The modified Erasmus GBS Outcome Score (mEGOS), developed with data from Dutch patients, is a clinical model that predicts the risk of walking inability in patients with GBS. The study objective was to validate the mEGOS in the International GBS Outcome Study (IGOS) cohort and to improve its performance and region specificity. Methods: We used prospective data from the first 1,500 patients included in IGOS, aged ≥6 years and unable to walk independently. We evaluated whether the mEGOS at entry and week 1 could predict the inability to walk unaided at 4 and 26 weeks in the full cohort and in regional subgroups, using 2 measures for model performance: (1) discrimination: area under the receiver operating characteristic curve (AUC) and (2) calibration: observed vs predicted probability of being unable to walk independently. To improve the model predictions, we recalibrated the model containing the overall mEGOS score, without changing the individual predictive factors. Finally, we assessed the predictive ability of the individual factors. Results: For validation of mEGOS at entry, 809 patients were eligible (Europe/North America [n = 677], Asia [n = 76], other [n = 56]), and 671 for validation of mEGOS at week 1 (Europe/North America [n = 563], Asia [n = 65], other [n = 43]). AUC values were >0.7 in all regional subgroups. In the Europe/North America subgroup, observed outcomes were worse than predicted; in Asia, observed outcomes were better than predicted. Recalibration improved model accuracy and enabled the development of a region-specific version for Europe/North America (mEGOS-Eu/NA). Similar to the original mEGOS, severe limb weakness and higher age were the predominant predictors of poor outcome in the IGOS cohort. Discussion: mEGOS is a validated tool to predict the inability to walk unaided at 4 and 26 weeks in patients with

[Background and purpose] Prognosis of myasthenia gravis (MG) in patients with thymoma is not well established. Moreover, it is not clear whether thymoma recurrence or unresectable lesions entail a worse prognosis of MG., [Methods] This multicenter study was based on data from a Spanish neurologist-driven MG registry. All patients were aged >18 years at onset and had anti-acetylcholine receptor antibodies. We compared the clinical data of thymomatous and nonthymomatous patients. Prognosis of patients with recurrent or nonresectable thymomas was assessed., [Results] We included 964 patients from 15 hospitals; 148 (15.4%) had thymoma-associated MG. Median follow-up time was 4.6 years. At onset, thymoma-associated MG patients were younger (52.0 vs. 60.4 years, p < 0.001), had more generalized symptoms (odds ratio [OR]: 3.02, 95% confidence interval [CI]: 1.95–4.68, p < 0.001) and more severe clinical forms according to the Myasthenia Gravis Foundation of America (MGFA) scale (OR: 1.6, 95% CI: 1.15–2.21, p = 0.005). Disease severity based on MGFA postintervention status (MGFA-PIS) was higher in thymomatous patients at 1 year, 5 years, and the end of follow-up. Treatment refractoriness and mortality were also higher (OR: 2.28, 95% CI: 1.43–3.63, p = 0.001; hazard ratio: 2.46, 95% CI: 1.47–4.14, p = 0.001). Myasthenic symptoms worsened in 13 of 27 patients with recurrences, but differences in long-term severity were not significant. Fifteen thymomatous patients had nonresectable thymomas with worse MGFA-PIS and higher mortality at the end of follow-up., [Conclusions] Thymoma-associated MG patients had more severe myasthenic symptoms and worse prognosis. Thymoma recurrence was frequently associated with transient worsening of MG, but long-term prognosis did not differ from nonrecurrent thymoma. Patients with nonresectable thymoma tended to present severe forms of MG.