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The EuroQol 5-dimensions 5-levels (EQ-5D-5L) is a generic patient-reported outcome measures (PROM) used for evaluating health-related quality of life (HRQoL). No data on its psychometric properties in COVID-19 survivors is available. We aimed to describe internal consistency, test–retest reliability, and construct validity of the EQ-5D-5L in people with long-COVID. Ninety-three (n = 93) individuals previously hospitalized due to COVID-19 with post-COVID symptoms completed the EQ-5D-5L questionnaire twice one year after hospital discharge in a three-week interval. Internal consistency (Cronbach alpha and Omega value), test–retest reliability (kappa and ICC2,1) and construct validity (factor analysis), and floor/ceiling effects were calculated. No ceiling effect was observed in any dimension whereas the floor effect ranged from 53.76 to 94.62%. The overall Cronbach’s α value was 0.75 (95%CI 0.64–0.83) and the Omega ω value was 0.77 (95%CI 0.66–0.84), showing good internal consistency of the questionnaire. Further, Cronbach’s alpha values the of each dimension ranged from 0.63 to 0.77 whereas those for Omega values ranged from 0.70 to 0.79. The test–retest reliability of the total score was excellent (ICC2,1 0.86, 95%CI 0.798–0.911). The agreement percentage ranged from 85.13 to 96.77%; but kappa coefficients ranged from fair (κ: 0.37) to good (κ: 0.61). The factor analysis showed factor loadings from 0.585 to 0.813 supporting good construct validity. The EQ-5D-5L has good psychometric properties to be used as a PROM to assess HRQoL in hospitalized COVID-19 survivors with long-COVID.

The application of additive manufacturing in the biomedical field has become a hot topic in the last decade owing to its potential to provide personalized solutions for patients. Different bioinks have been designed trying to obtain a unique concoction that addresses all the needs for tissue engineering and drug delivery purposes, among others. Despite the remarkable progress made, the development of suitable bioinks which combine printability, cytocompatibility, and biofunctionality is still a challenge. In this sense, the well-established synthetic and functionalization routes to prepare nanoparticles with different functionalities make them excellent candidates to be combined with polymeric systems in order to generate suitable multi-functional bioinks. In this review, we briefly discuss the most recent advances in the design of functional nanocomposite hydrogels considering their already evaluated or potential use as bioinks. The scientific development over the last few years is reviewed, focusing the discussion on the wide range of functionalities that can be incorporated into 3D bioprinted constructs through the addition of multifunctional nanoparticles in order to increase their regenerative potential in the field of tissue engineering., Authors acknowledge financial support from the ERC Grant CoG MagTendon nr 772817; FCT – Fundação para a Ciência e a Tecnologia for the PhD grant of SMB (PD/BD/129403/2017), for the contract to MGF (CEECIND/01375/2017); and for project SmarTendon (PTDC/NAN-MAT/30595/2017). AP is grateful to Xunta de Galicia for his postdoctoral grant ED481B2019/025. Some figures were created with BioRender.com.

(1) Background: Adverse events (AE) affect about 1 in 10 hospitalised patients, and almost half are related to surgical care. The aim of this study is to determine the prevalence of AE in operated and non-operated patients in surgical departments in order to determine whether surgical treatment is a risk factor for AE. (2) Methods: A cross-sectional design that included 3123 patients of 34 public hospitals in the Community of Madrid determining the prevalence of AEs in operated and non-operated patients in surgical departments. (3) Results: The prevalence of AE in non-operated patients was 8.7% and in those operated was 15.8%. The frequency of AE was higher in emergency surgery (20.6% vs. 12.4%). The 48.3% of AEs led to an increase in hospital stay, and surgery was involved in 92.4% of cases. The most frequent AEs were related to hospital-acquired infection (42.63%), followed by those related to a procedure (37.72%). In the multivariate analysis, being operated on represented 2.3 times the risk of developing an AE. (4) Conclusions: Surgical sites are particularly vulnerable to AE. Surgical intervention alone is a risk factor for AE, and we must continue to work to improve the safety of both patient care and the working environment of surgical professionals.

The use of magnetic nanoparticles as theranostic agents for the detection and treatment of cancer diseases has been extensively analyzed in the last few years. In this work, cubic-shaped cobalt and zinc-doped iron oxide nanoparticles with edge lengths in the range from 28 to 94 nm are proposed as negative contrast agents for magnetic resonance imaging and to generate localized heat by magnetic hyperthermia, obtaining high values of transverse relaxation coefficients and specific adsorption rates. The applied magnetic fields presented suitable characteristics for the potential validation of the results into the clinical practice in all cases. Pure iron oxide and cobalt- and zinc-substituted ferrites have been structurally and magnetically characterized, observing magnetite as the predominant phase and weak ferrimagnetic behavior at room temperature, with saturation values even larger than those of bulk magnetite. The coercive force increased due to the incorporation of cobalt ions, while zinc substitution promotes a significant increase in saturation magnetization. After their transfer to aqueous solution, those particles showing the best properties were chosen for evaluation in in vitro cell models, exhibiting high critical cytotoxic concentrations and high internalization degrees in several cell lines. The magnetic behavior of the nanocubes after their successful cell internalization was analyzed, detecting negligible variations on their magnetic hysteresis loops and a significant decrease in the specific adsorption rate values.

Aplastic anemia (AA) is a rare but serious disease that affects hematopoietic stem cells and is characterized by pancytopenia and a hypocellular bone marrow. It can be a hereditary or acquired condition. Acquired AA has an incidence of 2 per million per year in Europe, but the incidence is two to three times higher in Asia. In Latin America, there is little epidemiologic data on this disease. The most important treatments for AA are bone marrow transplantation and immunosuppressive treatment with antithymocyte globulin and cyclosporine. But access to these treatments is restricted in some areas of Latin America. At the American Society of Hematology (ASH) Annual Meeting in 2016, representatives of the Hematology Societies of Latin America, with the support of the ASH International Program, met to discuss possible collaborative efforts. Everyone agreed that lack of reliable information is one of the main barriers to designing significant clinical trials for the region; therefore, starting a registry of hematologic diseases for the region has become a main goal of the group. In April 2017, at the ASH Highlights meeting in Latin America, AA was selected as the first disease that would be used to begin the collaborative action. National hematology societies of Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Paraguay, Peru, Uruguay, and Venezuela have made a commitment to help develop the Latin American Registry for Aplastic Anemia (LARAA).

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is associated with a plethora of long-lasting symptoms (long-COVID). The presence of long-COVID symptoms causes decreased functionality. This study described the psychometric properties of the Functional Impairment Checklist (FIC), a disease-specific patient-reported outcome measure (PROM) used for evaluating the functional consequences of SARS in previously hospitalized COVID-19 survivors with long-COVID symptoms. The LONG-COVID-EXP-CM is a multicenter cohort study including patients hospitalized with COVID-19 during the first wave of the pandemic in five hospitals in Madrid. A total of 1969 (age: 61 ± 16 years, 46.4% women) COVID-19 survivors with long-COVID completed the FIC at a long-term follow-up after hospitalization (mean: 8.4 ± 1.5 months). Internal consistency (Cronbach alpha value), reliability (item-internal consistency, item-discriminant validity), construct validity (exploratory factor analysis), floor effect and ceiling effect were calculated. The mean time for fulfilling the FIC was 62 ± 11 s. The Cronbach’s alpha values reflecting the internal consistency reliability were 0.864 for FIC-symptoms and 0.845 for FIC-disability. The correlation coefficient between the FIC-symptoms and FIC-disability scale was good (r: 0.676). The ceiling effect ranged from 2.29% to 9.02%, whereas the floor effect ranged from 38.56% to 80.19%. The exploratory factor analysis showed factor loadings from 0.514 to 0.866, supporting good construct validity. Women exhibited greater limitations in all physical symptoms and disability-related domains of the FIC compared with men (all, p < 0.001). Further, younger patients (those aged

OBJECTIVE: To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG).METHODS: A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction-confirmed COVID-19 diagnosis and age- and sex-matched controls from the same sites. Clinical characteristics, polymerase chain reaction results, and raw electrocardiographic data were collected. A convolutional neural network was trained using 26,153 ECGs (33.2% COVID positive), validated with 3826 ECGs (33.3% positive), and tested on 7870 ECGs not included in other sets (32.7% positive). Performance under different prevalence values was tested by adding control ECGs from a single high-volume site.RESULTS: The area under the curve for detection of acute COVID-19 infection in the test group was 0.767 (95% CI, 0.756 to 0.778; sensitivity, 98%; specificity, 10%; positive predictive value, 37%; negative predictive value, 91%). To more accurately reflect a real-world population, 50,905 normal controls were added to adjust the COVID prevalence to approximately 5% (2657/58,555), resulting in an area under the curve of 0.780 (95% CI, 0.771 to 0.790) with a specificity of 12.1% and a negative predictive value of 99.2%.CONCLUSION: Infection with SARS-CoV-2 results in electrocardiographic changes that permit the artificial intelligence-enhanced ECG to be used as a rapid screening test with a high negative predictive value (99.2%). This may permit the development of electrocardiography-based tools to rapidly screen individuals for pandemic control.

The spread of the SARS-CoV-2 virus has transformed many aspects of people’s daily life, including sports. Social networks have been flooded on these issues. The present study aims to analyze the tweets produced relating to sports and COVID-19. From the end of January to the beginning of May 2020, over 4,000,000 tweets on this subject were downloaded through the Twitter search API. Once the duplicates, replicas, and retweets were removed, 119,253 original tweets were analyzed. A quantitative–qualitative content analysis was used to study the selected tweets. Posts dynamics regarding sport and exercise evolved according to the COVID-19 pandemic and subsequent lockdown, shifting from considering sport as a healthy bastion to an activity exposed to disease like any other. Most media professional sporting events received great attention on Twitter, while grassroots and women’s sport were relegated to a residual role. The analysis of the 30 topics identified focused on the social, sporting, economic and health impact of the pandemic on the sport. Sporting cancellations, leisure time and socialization disruptions, club bankruptcies, sports training and athletes’ uncertain career development were the main concerns. Although general health measures appeared in the tweets analyzed, those addressed to sports practice were relatively scarce. Finally, this study shows the importance of Twitter as a means of conveying social attitudes towards sports and COVID-19 and its potential to generate alternative responses in future stages of the pandemic.

A cross-sectional, prospective, between-subjects design was used in this study to establish the differences in sensory reweighting of postural control among different ages during adolescence. A total of 153 adolescents (five age groups; 13–17 years old) performed bipedal standing in three sensory conditions (i.e., with visual restriction, vestibular disturbance, and proprioceptive disturbance). Center of pressure displacement signals were measured in mediolateral and anteroposterior directions to characterize reweighting in the sensory system in static postural control when sensory information is disturbed or restricted during adolescent growth. The results indicate a development of postural control, showing large differences between subjects of 13–14 years old and older adolescents. A critical change was found in sensory reweighting during bipedal stance with disturbance of proprioceptive information at 15 years old. Adolescents of 13–14 years old showed less postural control and performance than older adolescents during the disturbance of proprioceptive information. Moreover, the results demonstrated that the visual system achieves its development around 15–16 years old. In conclusion, this research suggests that a difference of sensory reweighting under this type of sensorial condition and sensory reweight systems would seem to achieve stabilization at the age of 15.

Hybrid nanoparticles containing both structural and functional nanocomponents might result in higher success and increased quality of life for patients suffering a disease such as cancer. In this study, we combine chemotherapy of conventional drug doxorubicin (Dox) with gold nanorods (AuNR) for photothermal therapy using multifunctional human serum albumin nanoparticles (HSA NP's) fabricated via desolvation technique with high efficiency. Folic acid (FA) was conjugated to HSA NP's trough an amidation via carbodiimide reaction for a more specific nanoplataform to HeLa cancer cells. The loading efficiency of Dox into AuNR loaded-HSA NP reached up to 2 μg Dox/mg HSA. The HSA-AuNR-Dox NP experienced photothermal heating varying laser potency (1, 0.5 and 0.2 W); reaching the bulk particle solution an increment of 16, 8 and 6 °C after 10 min of near-IR laser exposure respectively. When HeLa cells were treated with this multifunctional nanoplataform containing only AuNR, cancer cells experienced 96% cell viability without irradiation and 55% cell viability after just one irradiation session. When Dox is present in the nanoplataform, viability were 60% and 24% for non-irradiated and irradiated nanoplataforms, respectively. This study demonstrates that HSA-AuNR-Dox nanoparticles are suitable systems allowing a synergic chemo and phothothermal therapy.

Background Improving the water solubility of hydrophobic drugs, increasing their accumulation in tumor tissue and allowing their simultaneous action by different pathways are essential issues for a successful chemotherapeutic activity in cancer treatment. Considering potential clinical application in the future, it will be promising to achieve such purposes by developing new biocompatible hybrid nanocarriers with multimodal therapeutic activity. Results We designed and characterised a hybrid nanocarrier based on human serum albumin/chitosan nanoparticles (HSA/chitosan NPs) able to encapsulate free docetaxel (DTX) and doxorubicin-modified gold nanorods (DOXO-GNRs) to simultaneously exploit the complementary chemotherapeutic activities of both antineoplasic compounds together with the plasmonic optical properties of the embedded GNRs for plasmonic-based photothermal therapy (PPTT). DOXO was assembled onto GNR surfaces following a layer-by-layer (LbL) coating strategy, which allowed to partially control its release quasi-independently release regarding DTX under the use of near infrared (NIR)-light laser stimulation of GNRs. In vitro cytotoxicity experiments using triple negative breast MDA-MB-231 cancer cells showed that the developed dual drug encapsulation approach produces a strong synergistic toxic effect to tumoral cells compared to the administration of the combined free drugs; additionally, PPTT enhances the cytostatic efficacy allowing cell toxicities close to 90% after a single low irradiation dose and keeping apoptosis as the main cell death mechanism. Conclusions This work demonstrates that by means of a rational design, a single hybrid nanoconstruct can simultaneously supply complementary therapeutic strategies to treat tumors and, in particular, metastatic breast cancers with good results making use of its stimuli-responsiveness as well as its inherent physico-chemical properties.

The administration of small interfering RNA (siRNA) is a very interesting therapeutic option to treat genetic diseases such as Alzheimer's or some types of cancer, but its effective delivery still remains a challenge. Herein, Au nanorod (GNR)-based platforms functionalized with polyelectrolyte layers were developed and analyzed as potential siRNA nanocarriers. The polymeric layers were successfully assembled on the particle surfaces by means of the layer-by-layer assembly technique through the alternating deposition of oppositely charged poly(styrene)sulfonate, PSS, poly(lysine), PLL, and siRNA biopolymers, with a final hyaluronic acid layer in order to provide the nanoconstructs with a potential targeting ability as well as colloidal stability in physiological medium. Once the hybrid nanocarriers were obtained, the cargo release, their colloidal stability in physiological-relevant media, cytotoxicity, cellular internalization and uptake, and knockdown activity were studied. The present hybrid particles release the genetic material inside cells by means of a protease-assisted and/or a light-triggered release mechanism in order to control the delivery of the oligonucleotides on demand. In addition, the hybrid nanovectors were observed to be nontoxic to cells and could efficiently deliver the genetic material in the cell cytoplasms. The GNR-based nanocarriers proposed here can provide a suitable environment to load and protect a sufficient amount of the genetic material to allow an efficient and sustained knockdown gene expression for long (up to 93% for 72 h), thanks to the slow degradation of PLL, without the observation of adverse side toxic effects. It was also found that the silencing activity was enhanced with the number of siRNA layers assembled in the nanoplatforms.

The aim was to assess dual- versus single-task training for motor performance and cognitive performance in adolescents. Two experiments were performed. In the first, 30 adolescents were randomized to three groups to determine the effect of dual-task difficulty on postural control: α-scaling and root mean square (RMS). In the second, 20 adolescents were randomized to two groups to determine the effect of dual-task practice to improve working memory. RMS in the post-test was lower than the pre-test in both dual-task groups, while α-scaling was lower in post-test than pre-test only in the high-difficulty dual-task group. A practice effect was observed on the percentage of correct answers only in the dual-task group (

In the field of tissue engineering and regenerative medicine, hydrogels are used as biomaterials to support cell attachment and promote tissue regeneration due to their unique biomimetic characteristics. The use of natural-origin materials significantly influenced the origin and progress of the field due to their ability to mimic the native tissuesâ extracellular matrix and biocompatibility. However, the majority of these natural materials failed to provide satisfactory cues to guide cell differentiation toward the formation of new tissues. In addition, the integration of technological advances, such as 3D printing, microfluidics and nanotechnology, in tissue engineering has obsoleted the first generation of natural-origin hydrogels. During the last decade, a new generation of hydrogels has emerged to meet the specific tissue necessities, to be used with state-of-the-art techniques and to capitalize the intrinsic characteristics of natural-based materials. In this review, we briefly examine important hydrogel crosslinking mechanisms. Then, the latest developments in engineering natural-based hydrogels are investigated and major applications in the field of tissue engineering and regenerative medicine are highlighted. Finally, the current limitations, future challenges and opportunities in this field are discussed to encourage realistic developments for the clinical translation of tissue engineering strategies., Authors acknowledge financial support from the European Union Framework Programme for Research and Innovation Horizon 2020 under European Research Council grant agreement No. 772817; FCT (Fundação para a Ciência e a Tecnologia) for individual fellowship CEECIND/01375/2017 (MGF); FCT for project PTDC/NAN-MAT/30595/2017; Xunta de Galicia for postdoctoral fellowship ED481B-2019-025 (AP); Norwegian Research Council (NFR) for project No. 287953.

Background Literature addressing the mechanical properties of kinesiology tape is quite scarce. There are no studies which focus on the mechanical characteristics of kinesiology tape, its mechanical properties, nor its adherence following the ISO international standard test methods for tape elongation. Methods This study quantified the mechanical characteristics of 380 samples of kinesiology tape from 19 different brands and in 4 different colors using a dynamometer. Mechanical testing was controlled by UNE EN ISO 13934-1. Results Significant differences were found between tape brands in terms of grammage, maximum force tenacity, work, pre-elongation and percentage elongation (P

In this work, we analyzed the effects of subtle changes in the synthetic conditions and synthetic parameters on the resulting size, shape, monodispersity, crystallinity and magnetic properties of iron oxide nanocrystals (IONCs) obtained through a modified one pot method for the production of mainly cubic-shaped nanoparticles (NPs). Cubic, octahedral and cuboctahedral shapes with different sizes and monodispersity could be obtained by slightly changing the stabilizer/precursor molar ratio, the precursor concentration, the reaction time and temperature and/or the heating rate. Their physical properties were evaluated using high-resolution transmission electron microscopy (HRTEM), X-ray powder diffraction (XRD), selected-area electron diffraction (SAED) and a superconducting quantum interference (SQUID) device. It was found that monodisperse cubic nanocrystals from ca. 25 to 94 nm could be obtained either by changing the precursor concentration, the heating rate or the reaction time. These cubic nanocrystals were ferrimagnetic in the whole temperature rage analyzed, with saturation magnetization values even larger than those of bulk magnetite. In addition, slightly truncated octahedral NPs could be achieved at relatively large heating ramp rates, whereas cubooctahedral NPs were derived by simply increasing the stabilizer/precursor molar ratio. The saturation magnetization of both types of NPs was slightly lower than the cubic ones, but they were still ferrimagnetic in the whole temperature range analyzed. Moreover, transfer to aqueous solution was possible by a ligand exchange with dimercaptosuccinic acid (DMSA) providing, at the same time, chemical groups for additional functionalization if required. The DMSA-coated cubic IONCs were fairly stable in culture medium, allowing their internalization by different cell types. The NPs inside the cells were located in the cytoplasm and most of them showed a perinuclear distribution. Moreover, a great cytocompatibility in a large range of particle concentrations was observed without the induction of morphological changes in the cultured cells.

[EN] Scientific production has increased exponentially in recent years. It is necessary to find methodological strategies for understanding holistic or macro views of the major research trends developed in specific fields. Data mining is a useful technique to address this task. In particular, our study presents a global analysis of the information generated during last decades in the Sport Sciences Category (SSC) included in the Web of Science database. An analysis of the frequency of appearance and the dynamics of the Author Keywords (AKs) has been made for the last thirty years. Likewise, the network of co-occurrences established between words and the survival time of new words that have appeared since 2001 has also been analysed. One of the main findings of our research is the identification of six large thematic clusters in the SSC. There are also two major terms that coexist ('REHABILITATION' and 'EXERCISE') and show a high frequency of appearance, as well as a key behaviour in the calculated co-occurrence networks. Another significant finding is that AKs are mostly accepted in the SSC since there has been high percentage of new terms during 2001-2006, although they have a low survival period. These results support a multidisciplinary perspective within the Sport Sciences field of study and a colonization of the field by rehabilitation according to our AK analysis.

The complexation process and underlying mechanisms that rule the interaction of DNA with the cationic block copolymer Tetronic T901 to form polyplexes and their potential transfection efficiency have been studied under different solution conditions. We noted that T901 favors the formation of self-assembled structures with partially condensed DNA at smaller polymer concentrations than other Pluronic™/Tetronic™-type copolymers previously analysed. The observed polyplexes display sizes from the nano- to the micro- range as derived from DLS, electronic and optical microscopies. Also, copolymer micelles are observed at concentrations below the copolymer critical micellar concentration (cmc) induced by the presence of DNA. The complexation process is dependent on solution conditions, with electrostatic and ionic interactions being more important at acidic pH thanks to the predominant diprotonated form of the block copolymer which is less aggregation-prone, whilst dispersive forces are increasingly enhanced under basic conditions or when rising the solution temperature. Whatever the case, the complexation is mainly governed by entropic contributions, as denoted from ITC data. In vitro transfection experiments after complexing T901 with a pDNA encoding the expression of green fluorescein protein, GFP, show a relative successful fluorescence of transfected HeLa cells, which confirms the uptake, internalization and release of the genetic material within the cells at suitable [N]/[P] ratios with relatively low cytotoxicity. Despite the observed successful outcomes, the obtained transfection efficacies are slightly lower than those obtained with Lipofectamine2000, so further optimization of the polyplex formation conditions is envisaged in future studies.

The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC.A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Be- fore each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (greater than or equal to 75% of positive evaluations) and opportunities for improvement (greater than or equal to 50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered.60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10.The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations.La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP.Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/ acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (mayor o igual al 75% de valoraciones positivas) y oportunidades de mejora (mayor o igual al 50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción.El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10.La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones.

Background Obesity is now a serious worldwide challenge, especially in children. This condition can cause a number of different health problems, including musculoskeletal disorders, some of which are due to mechanical stress caused by excess body weight. The aim of this study was to determine the association between body composition and the vertical ground reaction force produced during walking in obese children. Methods Sixteen children participated in the study, six females and ten males [11.5 (1.2) years old, 69.8 (15.5) kg, 1.56 (0.09) m, and 28.36 (3.74) kg/m 2 of body mass index (BMI)]. Total weight, lean mass and fat mass were measured by dual-energy X-ray absorptiometry and vertical forces while walking were obtained by a force platform. The vertical force variables analysed were impact and propulsive forces, and the rate of development of both. Multiple regression models for each vertical force parameter were calculated using the body composition variables as input. Findings The impact force regression model was found to be positively related to the weight of obese children and negatively related to lean mass. The regression model showed lean mass was positively related to the propulsive rate. Finally, regression models for impact and propulsive force showed a direct relationship with body weight. Interpretation Impact force is positively related to the weight of obese children, but lean mass helps to reduce the impact force in this population. Exercise could help obese persons to reduce their total body weight and increase their lean mass, thus reducing impact forces during sports and other activities.

Background: Promotion and protection of breastfeeding is a public health objective. In April 2009, health authorities in the Madrid region in central Spain signed a collaboration agreement with The United Nations Children’s Fund and created a breastfeeding committee. Objective: To report the creation and implementation of a plan to promote and improve the quality of breastfeeding care in public hospitals in the region of Madrid, according to the Baby-Friendly Hospital Initiative (BFHI) standards. Methods: The action plan included institutional commitment; creation of a breastfeeding committee in each hospital; outcome analyses, staff training, creation of educational materials; and dissemination of activities. The plan was adopted by the 19 non-BFHI-designated public maternity units in the Madrid region. Each hospital completed a modified version of the World Health Organization self-assessment questionnaire in 2009 (pre-intervention) and again in 2011. Results: Thirteen maternity units (68.4%) established a breastfeeding committee, and 32 months after implementation of the plan, the other 6 hospitals have created one. Nine training courses have been carried out to train professional experts on breastfeeding as trainers. The 271 trainers provided 18-hour breastfeeding courses for 1423 professionals. In 2009, there was only 1 BFHI-accredited hospital. Currently, 52.6% of the other 19 hospitals have some level of accreditation, and 2 are fully accredited. Conclusions: An intervention to improve the quality of breastfeeding care based on an organized regional approach to the BFHI was useful for BFHI implementation.

Norfloxacin is highly effective in preventing spontaneous bacterial peritonitis recurrence in cirrhosis, but its role in the primary prevention of this complication is uncertain.Patients with cirrhosis and low protein ascitic levels (15 g/L) with advanced liver failure (Child-Pugh scoreor = 9 points with serum bilirubin levelor = 3 mg/dL) or impaired renal function (serum creatinine levelor = 1.2 mg/dL, blood urea nitrogen levelor = 25 mg/dL, or serum sodium levelor = 130 mEq/L) were included in a randomized controlled trial aimed at comparing norfloxacin (35 patients) vs placebo (33 patients) in the primary prophylaxis of spontaneous bacterial peritonitis. The main end points of the trial were 3-month and 1-year probability of survival. Secondary end points were 1-year probability of development of spontaneous bacterial peritonitis and hepatorenal syndrome.Norfloxacin administration reduced the 1-year probability of developing spontaneous bacterial peritonitis (7% vs 61%, P.001) and hepatorenal syndrome (28% vs 41%, P = .02), and improved the 3-month (94% vs 62%, P = .003) and the 1-year (60% vs 48%, P = .05) probability of survival compared with placebo.Primary prophylaxis with norfloxacin has a great impact in the clinical course of patients with advanced cirrhosis. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of hepatorenal syndrome, and improves survival.

Objective To evaluate the effect of estrogen therapy (ET) on endothelial nitric oxide (NO) production and in flow-mediated vasodilation (FMV). Design Randomized, crossover, double-blind, placebo-controlled study. Setting Healthy postmenopausal women in an academic research environment. Patient(s) Forty postmenopausal women between 45 and 72 years of age. Intervention(s) Women received ET or placebo during two periods of 12 weeks that were separated by 2 weeks of washout. Main outcome measure(s) Flow-mediated vasodilation, nitrite and nitrate, lipid profile, creatinine, and glucose were measured at weeks 12 and 24. Student's t or Wilcoxon tests were used for comparative analyses, and κ test and limit analysis determined variability. Result(s) After placebo treatment, nitrate and nitrite mean concentration was 8.28 ± 1.17 mmol/L; it increased to 62.6 ± 12.82 mmol/L after ET. Percentage FMV was 18.8 ± 2.58 after the placebo period and did not change after ET (20.1 ± 1.92) in the whole sample, but in the subgroup (n = 15) of younger women (45–50 years of age), percentage FMV increased from 13.6 ± 3.6 after the placebo period to 22.2 ± 3.5 after ET. Conclusion(s) An increase in plasma concentrations of nitrite and nitrate after ET was observed in all the women studied, but the improvement in FMV was observed only in the younger ones. These age-related differences in FMV in response to ET must be further investigated.

To identify variability in the Patient Safety Indicators (PSI) of the Agency for Healthcare Research and Quality (AHRQ) among hospitals and by hospital level in the Madrid Health Service and to evaluate the contribution of the minimum basic data set (MBDS) records to the variability observed.Data on healthcare resources were obtained from the Specialized Care Information System and from MBDS records for 2006 from 20 public and state-assisted hospitals within the Madrid Health System. AHRQ PSI were obtained from the Health Information Area of the Madrid Health Council. Data analysis included correlation coefficients and multiple linear regression.Surgical complications and complications due to medical or postsurgical care showed significant differences among hospitals and by hospital level. These differences were positively associated with values in some of the MBDS records. We found correlations above 0.78 between decubitus ulcer and the average weight of medical diagnosis-related groups (DRG) and between failure to rescue and average length of hospital stay and the overall average weight. At least three of the variables analyzed explained the variability in decubitus ulcer, death in low-mortality DRGs and failure to rescue.The variability found in the Madrid Health System for the PSI is high and is associated with certain records of the MBDS. These findings should be confirmed in successive studies and in other regions, and the possible contribution of some variables of the MBDS to this variability should be assessed.

Even though comprehension of human physiology is crucial in the clinical setting, students frequently learn part of this subject using rote memory and then are unable to transfer knowledge to other contexts or to solve clinical problems. This study evaluated the impact of articulating the concept map strategy with the mediated learning experience on meaningful learning during the cardiovascular module of a medical physiology course at Universidad Autónoma de Bucaramanga. This research was based on the ideas of David Ausubel (meaningful learning), Joseph Novak (concept maps), and Reuven Feuerstein (mediated learning experience). Students were randomly allocated to either an intervention group (mediated learning experience articulated with concept mapping) or a control group (traditional methodology). The intervention group constructed concept maps related to cardiovascular physiology and used them to solve problems related to this subject. The control group attended traditional discussion sessions and problem-solving sessions. All students were evaluated with two types of exams: problem-solving and multiple-choice exams. The intervention group performed significantly better on the problem-solving exams, but the difference was not significant in the multiple-choice exam. It was concluded that intervention promoted meaningful learning that allowed the students to transfer this knowledge to solve problems. The implemented strategy had a greater impact on the students who came into the study with the lowest cognitive competence, possibly because they were empowered by the intervention.

A substantial epidemiologic change in the etiology of spontaneous bacterial peritonitis (SBP) has been observed in recent years. Gram-positive, as well as multiresistant bacteria, have emerged as an important cause of SBP mainly among hospitalized patients. In this setting, SBP caused by methicillin-resistant Staphylococcus aureus (MRSA) could become a major clinical problem in the near future. We present two cases of SBP due to MRSA without clinical response to vancomycin, even though in vitro sensitivity was observed in both cases. We review the current literature on the incidence and clinical significance of SBP due to MRSA infection in cirrhotic patients, as well as its prevention and treatment.

Upper GI bleeding (UGIB) is a common medical emergency that leads to a high consumption of medical resources and costs. We aimed to analyze the influence of physician specialty on the costs of nonvariceal UGIB care.We retrospectively assessed 350 nonvariceal UGIB episodes that were primarily cared for by gastroenterologists (n = 142), internists (n = 67), or surgeons (n = 141). Gastroenterologists followed evidence-based clinical protocols that included early endoscopy and early hospital discharge for uncomplicated bleeding. A risk score system was used to control for severity of illness. Linear regression analyses were performed to find out predictors of costs and the influence of specialist care on length of stay (LOS).The overall mean hospital cost was significantly lower in patients cared for by gastroenterologists (EUR 1,630) than in those managed by internists (EUR 3,745, p0.001) or surgeons (EUR 2,513, p0.05). The mean LOS was the variable with highest influence on total cost. Patients cared for by gastroenterologists had a mean LOS significantly shorter (7.3 days) than that of those treated by internists (16.2 days, p0.001) or surgeons (11 days, p0.001). Hospital costs and LOS differences were maintained when adjusting for severity of illness. In caring for low risk patients, nongastroenterologists had a higher probability of having a hospital stay longer than 4 days (odds ratio = 18.4, Cl = 4.6-73.6, p0.001).The implementation of specific evidence-based protocols by gastroenterologists reduces length of hospital stay and saves medical costs in patients with nonvariceal UGIB, especially those at low risk.