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Para efectuar una comparación homogénea y equitativa de los esfuerzos productivos entre los distintos Centros de Atención Primaria de la Salud (CAPS) de la ciudad de Río Cuarto, es necesario considerar las características socio-económicas de la potencial población beneficiaria de los servicios que ellos brindan. Esto ocurre debido a que, un entorno más o menos favorable puede influir en el nivel de eficiencia de los mencionados centros. Por lo anterior, este trabajo -haciendo uso de la información obtenida del Censo Provincial 2008 y del Análisis de Componentes Principales- busca, en principio, hallar las coordenadas factoriales, que permitirán definir dos variables que proporcionen una medida del entorno de cada CAPS que, a los efectos de un estudio de eficiencia técnica, puedan considerarse como variables no controlables. Luego, en segundo término, se identifica con mayor precisión cómo se distribuyen los distintos tipos de ambientes dentro del radio de influencia de cada CAPS, pues pueden coexistir diferentes condiciones socioeconómicas entre sus potenciales beneficiarios.

El conocimiento del nivel de eficiencia de las provincias constituye una información relevante para la revisión de la gestión así como para el diseño de políticas que contribuyan a la mejora de sus resultados y, por tanto, a una mayor satisfacción de las necesidades de sus habitantes. Sin embargo, las características del sector público condicionan a que las técnicas de medición de eficiencia deban adaptarse a la incertidumbre y al desconocimiento que rodea a la tecnología de la producción pública. De las escuelas metodológicas, las aproximaciones no paramétricas aparecen como las más adecuadas y, dentro de ellas, DEA. El sector público provincial es el responsable de administrar el sistema de salud público y puede observarse en los presupuestos que los gastos más significativos corresponden a educación y a salud. Se coincide que el input más relevante, seguramente, es el gasto que cada una de las provincias realiza a efectos de prestar los servicios de salud. Pero también, se admite que existen otros inputs, que influyen en los resultados de los servicios de salud y que no se hallan bajo el control de la provincia. La presencia de estos inputs no discrecionales debe considerarse en un estudio de eficiencia, pues de otro modo, podría arribarse a conclusiones alejadas de la realidad. Lo anterior hace que en el presente se procure aproximar una medida de eficiencia técnica de los servicios de salud provinciales para el año 2009 mediante la aplicación de un método que, basado en DEA, permita reflejar los efectos de los inputs no discrecionales.

Objective The main study objective was to determine how giant cell arteritis (GCA) is diagnosed in our clinical practice and whether the EULAR recommendations have influenced the diagnostic procedures used.Methods ARTEritis of the Rheumatology Spanish Society -Sociedad Española de Reumatología (ARTESER) is a multicentre observational retrospective study conducted in 26 hospitals with support from the Spanish Society of Rheumatology. All patients diagnosed with GCA between 1 June 2013 and 29 March 2019 were included. The gold standard for the diagnosis of GCA was the judgement of the physician in charge, according to clinical criteria, supported by data available from laboratory tests, imaging studies (ultrasound, positron emission tomography (PET) and MRI/CT angiography) and temporal artery biopsy (TAB) when available.Results We included 1675 patients with GCA (mean age±SD (76.9±8.1) years, 1178 women (70.3%)). Of these, 776 patients had a positive TAB (46.3%), 503 (30.0%) positive ultrasound, 245 positive PET (14.6%) and 64 positive MRI/CT angiography (3.8%). These percentages changed substantially over the study. From 2013 to 2019, the use of ultrasound in diagnosis grew from 25.8% to 52.9% and PET from 12.3% to 19.6%, while use of TAB decreased from 50.3% to 33.3%.Conclusions Biopsy was the most widely used diagnostic test for confirming GCA, but use of imaging as a diagnostic tool has grown in recent years. Following publication of the 2018 EULAR recommendations, ultrasound has displaced biopsy as the first-line diagnostic test; TAB was performed in a third and PET in a fifth of cases.

Background: Increased pediatric COVID-19 occurrence due to the SARS-CoV-2 Omicron variant has raised concerns about the effectiveness of existing vaccines. The protection provided by the SOBERANA-02-Plus vaccination scheme against this variant has not yet been studied. We aimed to evaluate the scheme's effectiveness against symptomatic Omicron infection and severe disease in children., Methods: In September 2021, Cuba implemented a mass pediatric immunization with the heterologous SOBERANA-02-Plus scheme: 2 doses of conjugated SOBERANA-02 followed by a heterologous SOBERANA-Plus dose. By December, before the Omicron outbreak, 95.4% of 2-18 years-old had been fully immunized. During the entire Omicron wave, we conducted a nationwide longitudinal post-vaccination case-population study to evaluate the real-world effectiveness of the SOBERANA-02-Plus scheme against symptomatic infection and severe disease in children without previous SARS-CoV-2 infection. The identification of COVID-19 cases relied on surveillance through first line services, which refer clinical suspects to pediatric hospitals where they are diagnosed based on a positive RT-PCR test. We defined the Incidence Rate ratio (IRR) as IRvaccinated age group/IRunvaccinated 1-year-old and calculated vaccine effectiveness as VE = (1-IRR)∗100%. 24 months of age being the 'eligible for vaccination' cut-off, we used a regression discontinuity approach to estimate effectiveness by contrasting incidence in all unvaccinated 1-year-old versus vaccinated 2-years-old. Estimates in the vaccinated 3-11 years-old are reported from a descriptive perspective., Findings: We included 1,098,817 fully vaccinated 2-11 years-old and 98,342 not vaccinated 1-year-old children. During the 24-week Omicron wave, there were 7003/26,241,176 person-weeks symptomatic COVID-19 infections in the vaccinated group (38.2 per 10 5 person-weeks in 2-years-old and 25.5 per 10 5 person-weeks in 3-11 years-old) against 3577/2,312,273 (154.7 per 10 5 person-weeks) in the unvaccinated group. The observed overall vaccine effectiveness against symptomatic infection was 75.3% (95% CI, 73.5-77.0%) in 2-years-old children, and 83.5% (95% CI, 82.8-84.2%) in 3-11 years-old. It was somewhat lower during Omicron BA.1 then during Omicron BA.2 variant circulation, which took place 1-3 and 4-6 months after the end of the vaccination campaign. The effectiveness against severe symptomatic disease was 100.0% (95% CI not estimated) and 94.6% (95% CI, 82.0-98.6%) in the respective age groups. No child death from COVID-19 was observed., Interpretation: Immunization of 2-11 years-old with the SOBERANA-02-Plus scheme provided strong protection against symptomatic and severe disease caused by the Omicron variant, which was sustained during the six months post-vaccination follow-up. Our results contrast with the observations in previous real-world vaccine effectiveness studies in children, which might be explained by the type of immunity a conjugated protein-based vaccine induces and the vaccination strategy used., Funding: National Fund for Science and Technology (FONCI-CITMA-Cuba)., Competing Interests: MCRG, MMC, SFC, YCR, DSM, YVB, DGR and VVB are employees of the Finlay Vaccine Institute that developed and manufactures the SOBERANA vaccines. VVB, YVB, DGR, YCR, SFC and DSM are authors of two patent applications related with the vaccines. The other authors have no potential conflict of interest., (© 2024 The Author(s).)

A balanced and varied diet provides diverse beneficial effects on health, such as adequate micronutrient availability and a gut microbiome in homeostasis. Besides their participation in biochemical processes as cofactors and coenzymes, vitamins and minerals have an immunoregulatory function; meanwhile, gut microbiota and its metabolites coordinate directly and indirectly the cell response through the interaction with the host receptors. Malnourishment is a crucial risk factor for several pathologies, and its involvement during the Coronavirus Disease 2019 pandemic has been reported. This pandemic has caused a significant decline in the worldwide population, especially those with chronic diseases, reduced physical activity, and elder age. Diet and gut microbiota composition are probable causes for this susceptibility, and its supplementation can play a role in reestablishing microbial homeostasis and improving immunity response against Coronavirus Disease 2019 infection and recovery. This study reviews the role of micronutrients and microbiomes in the risk of infection, the severity of disease, and the Coronavirus Disease 2019 sequelae., Competing Interests: The authors declare no conflict of interest.

Neutrophils are the most abundant circulating innate immune cells and comprise the first immune defense line, as they are the most rapidly recruited cells at sites of infection or inflammation. Their main microbicidal mechanisms are degranulation, phagocytosis, cytokine secretion and the formation of extracellular traps. Neutrophil extracellular traps (NETs) are a microbicidal mechanism that involves neutrophil death. Since their discovery, in vitro and in vivo neutrophils have been challenged with a range of stimuli capable of inducing or inhibiting NET formation, with the objective to understand its function and regulation in health and disease. These networks composed of DNA and granular components are capable of immobilizing and killing pathogens. They comprise enzymes such as myeloperoxidase, elastase, cathepsin G, acid hydrolases and cationic peptides, all with antimicrobial and antifungal activity. Therefore, the excessive formation of NETs can also lead to tissue damage and promote local and systemic inflammation. Based on this concept, in this review, we focus on the role of NETs in different infectious and inflammatory diseases of the mucosal epithelia and skin.

In addition to physical barriers, neutrophils are considered a part of the first line of immune defense. They can be found in the bloodstream, with a lifespan of 6-8 h, and in tissue, where they can last up to 7 days. The mechanisms that neutrophils utilize for host defense are phagocytosis, degranulation, cytokine production, and, the most recently described, neutrophil extracellular trap (NET) production. NETs are DNA structures released due to chromatin decondensation and spreading, and they thus occupy three to five times the volume of condensed chromatin. Several proteins adhere to NETs, including histones and over 30 components of primary and secondary granules, among them components with bactericidal activity such as elastase, myeloperoxidase, cathepsin G, lactoferrin, pentraxin 3, gelatinase, proteinase 3, LL37, peptidoglycan-binding proteins, and others with bactericidal activity able to destroy virulence factors. Three models for NETosis are known to date. (a) Suicidal NETosis , with a duration of 2-4 h, is the best described model. (b) In vital NETosis with nuclear DNA release, neutrophils release NETs without exhibiting loss of nuclear or plasma membrane within 5-60 min, and it is independent of reactive oxygen species (ROS) and the Raf/MERK/ERK pathway. (c) The final type is vital NETosis with release of mitochondrial DNA that is dependent on ROS and produced after stimuli with GM-CSF and lipopolysaccharide. Recent research has revealed neutrophils as more sophisticated immune cells that are able to precisely regulate their granular enzymes release by ion fluxes and can release immunomodulatory cytokines and chemokines that interact with various components of the immune system. Therefore, they can play a key role in autoimmunity and in autoinflammatory and metabolic diseases. In this review, we intend to show the two roles played by neutrophils: as a first line of defense against microorganisms and as a contributor to the pathogenesis of various illnesses, such as autoimmune, autoinflammatory, and metabolic diseases.

Increased feed costs affect the livelihoods of dairy sheep farmers in the Middle East. Farmers endure high risks with large fluctuations in the price of grain used as animal feed, which is further affected by drought and declining range productivity. Using agricultural by-products and treated straw or vetch grazing for supplementing sheep diets would provide resource-poor dairy farmers with increased options to reduce feed costs, but the effects of such feeds on the quality of yogurt (the main product) need to be better understood. Two experiments were conducted to evaluate these effects. The first trial evaluated alternative diets using locally available feedstuffs, including agricultural by-products, compared with traditional diets used by dairy sheep farmers, and was conducted on-station at the International Center for Agricultural Research in Dry Areas (ICARDA, Tel Hadya, Aleppo, Syria). Milking Awassi ewes (n=56) were used to test 6 alternative diets against a traditional control diet containing barley, wheat bran, and barley straw. The 6 alternative diets contained 4 or more of the following ingredients: barley, sugar beet pulp, molasses, cotton seed cake, wheat bran, urea-treated wheat straw, and barley straw. Ewes on one of the alternative diets grazed vetch pasture, whereas ewes on the control diet and the 5 alternative diets grazed native range pasture. The milk fat content was higher in diets containing urea-treated straw. Yogurt firmness and adhesiveness were significantly lower in energy-rich diets (e.g., the control diet) and in the diets rich in soluble sugar (molasses). The effects of diet on yogurt color and on citric and succinic acid contents were significant. A yogurt produced from the milk of the group grazing on vetch was the most yellowish in color, which is appealing to Syrian consumers. The content of citric acid tended to be higher in yogurts produced from diets containing molasses. The second trial was conducted on 3 farms in northern Syria to assess an alternative diet (1 of the 6 tested in the first trial) on 15 milking ewes compared with the farmer's traditional diet (control). The alternative diet increased yogurt firmness and adhesiveness by 7 to 9% and 10 to 16%, respectively. The use of nonconventional feeds available in the region enhances yogurt quality, may reduce requirements for expensive grains, and thus, increase farmers' livelihoods by targeting expanding markets with better quality products., (Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

High feed costs are major obstacles for resource-poor dairy sheep farmers in West Asia, along with large fluctuation in grain and straw prices. Farmers need low-cost diets using locally available feeds that can provide sufficient milk of good quality. Two experimental trials were conducted on Awassi milking ewes to evaluate nonconventional and balanced low-cost diets against the traditional unbalanced diet used by farmers (control) on the total yields (milk, fat, protein, and total solids) and milk composition (fat, protein, total solids, and lactose), an important indicator of milk quality. The first trial was conducted at the research station of the International Center for Agricultural Research in the Dry Areas (ICARDA, Aleppo, Syria) to test 6 low-cost balanced diets using locally available feeds and agro byproducts against the control diet. Each diet was tested on 8 ewes that were kept on pasture as a basal diet, but received different supplements, including barley, wheat bran and nonconventional feeds (urea-treated wheat straw, molasses, sugar beet pulp, and cotton seed cake). Five balanced diets enhanced the total yields of milk, fat, protein, and total solids, in 2 cases, significantly. These diets increased total milk yield by 17.7 to 50.2% and decreased supplement feeding costs by 43% compared with the control. However, milk composition remained unaffected. The second trial was conducted on 3 different farms in northern Syria to assess in each farm a low-cost balanced diet on milking ewes (n=15) in comparison to the farmer's control (n=15). The balanced diet was a modification requested by farmers of the best performing diet in the on-station trial. Confirming the first trial's research results, the balanced diet outperformed the control in total yields; for instance, it increased total milk yield by 28 to 40% and raised net income by 30%, without affecting milk composition. Both trials showed that using locally available nonconventional feedstuffs, such as molasses, integrated into balanced dairy sheep diets can decrease feed costs of resource-poor farmers, while enhancing total yields of milk and milk constituents without compromising milk quality components. This will greatly improve the profitability of dairy sheep production in dry areas., (Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

To improve the effectiveness of community-based breeding programs for increased milk production, the values of different udder measurements for predicting milk production traits during the milking period were assessed over 3 yr on 273 Awassi ewes. Machine milking of ewes began after weaning, 56 d after parturition, and continued until the milk yield of the ewes was <200 mL/d. Milk yield obtained by hand milking and milk composition were measured weekly, and days in milk, total milk yield, and total yields of protein, fat, and nonfat solids in milk were calculated for each ewe. On d 70 of milking, morphological traits of the whole udder (circumference, width, height, and length), udder cistern (height), and teats (length, width, and position score) were measured. On the same day, the milk yield of ewes was recorded by hand milking. Positive and moderate to strong correlations (r = 0.36 to 0.76) between udder circumference and width, teat width, and milk production traits of total milk yield, and total yields of protein, fat, and nonfat solids were found. However, a more accurate predictor of milk production traits was milk yield on d 70, as higher positive correlations between this variable and the milk production traits were found (r = 0.63 to 0.89). Nine farmers were invited to independently estimate the hand-milked milk yield performance of a sample of 169 ewes (d 15 to 45 of milking) by visually observing each ewe and making a subjective linear score (1 to 5). Their assessments were significantly correlated with milk yield on the day of the observation (r = 0.52), total milk yield (r = 0.50), and days in milk (r = 0.45). Considering the perception details provided by farmers concerning each of the subjective linear scores, it was found that most predictive linear udder measurements of udder circumference and width and teat width identified in this study were implicit in these scores. The predictive ability of the measurements studied have practical implications for community-based breeding programs involving improvement of milk production-not just in Syria, but in other countries in dry areas as well-because it is possible for experienced farmers to visually assess milk production of dairy ewes or take simple udder measurements with predictive value.

This paper analyzes a storytelling workshop, an intervention based on the referential elements of oral narratives, held at an NGO in São Leopoldo, Rio Grande do Sul State, Brazil. The workshop was divided into three different stages: narration of a story with a focus on gender violence, a discussion based on the narrative, and an activity with body painting. The theoretical framework was based on discursive practices, and when workshop participants' discourse was assessed, at least two interpretive repertories were identified: one based on the gender category and the other on everyday life and recollections from participants' life stories. There was also considerable variety in the arguments, manifested in the contradictions and incongruence permeating the discourse. Narratives used as tools to work with abused women (especially for public health interventions) have received little attention thus far. In the current study, stories were analyzed as possible strategies to deal with gender inequalities, a powerful analytical tool for evaluating public health actions.

Blood donation is indispensable for quality health service provision. The stagnation of the number of donations in Catalonia prompted up an external evaluation of the system of blood collection that could orient the future policies. An evaluation of blood-donor services in Catalonia was designed adopting a qualitative methodology. The evaluation design included the use of a variety of techniques namely participant observation, individual interviews, group interviews and documentary techniques. The field work was carried out in all blood-donation sectors of Catalonia from the 23th November to the 4th December, 1998. Using Atlas/ti, a computer science tool for the qualitative analysis of textual data, the information analysis partially followed the prescriptions of "grounded theory" and of some modalities of thematic content analysis. The results show the basic characteristics and deficiencies of the process and its organization, describing their strong and weak points. The findings also detail arguments on blood donation that the agents implied in the process, donors an professionals, use. We also report what reasons the blood-donor service managers/providers gave for donating blood, and what perceptions they had of blood donors.

This histological study of the human ductus epididymidis in autopsy or surgical specimens revealed the presence of multiple intra-epithelial cavities or pits showing a variable degree of development. In their origin, cavities were surrounded by cells with the same staining affinity and ultrastructural features as the principal cells, except for the cavity basal surfaces that were supported by lower cells. The latter cells, although otherwise like the basal cells of the ductus epididymis, displayed short microvilli in the cavity lumen. When the cavities expanded the basal cells became principal cells, while the principal cells located at the top of the cavities degenerated, creating pits that opened into the lumen of the ductus epididymidis. The surface occupied by the pitted areas increased progressively between the end portion of the caput epididymidis and the corpus-cauda transition, where it decreased abruptly. This pitted pattern was observed in all the normal adult men studied and in the children with precocious puberty but not in the normal children or in the adult men with hypogonadotrophic hypogonadism. This observation suggests that the development of pitted cavities is androgen-dependent.

Five cases of cysts of the tunica albuginea and two cases of cysts of the testicular parenchyma are described. The cysts of the albuginea were located in the anterior, lateral, and inferior faces of the testis (distant from the epididymis) and covered by a thin albuginea. They extended toward the testicular parenchyma or toward the tunica vaginalis. Their epithelial lining varied from low cuboidal to columnar and consisted of ciliated or nonciliated cells. These cysts were probably of mesothelial origin. The cysts of the testicular parenchyma were also located distant from the mediastinum testis and were not in contact with the albuginea. Their epithelial lining consisted of flattened, cuboidal, nonciliated cells. The origin of the cysts of the testicular parenchyma is not clear. In one case the occurrence of spermatozoa in the cyst lumen and connections with seminiferous tubules suggests an origin in the rete testis.