Resumen Introducción: El patrón epidemiológico de la hepatitis crónica por virus de la hepatitis B (HCVHB) en España ha cambiado por las migraciones y la vacunación. El objetivo es comprobar si también ha cambiado la prevalencia en presos de Cataluña y las posibles variables predictivas de la infección. Material y método: Estudio transversal y multicéntrico de prevalencia de HCVHB. Se incluyeron variables epidemiológicas y clínicas, calculándose su capacidad predictiva mediante un modelo de regresión logística multivariante. Resultados: Se estudiaron 6.508 reclusos. La prevalencia de HCVHB fue del 1,7%, mucho menor que en estudios realizados en años previos. En los presos del Magreb, Asia, Europa del Este y África subsahariana, la prevalencia fue 2,8, 4,2, 4,9 y 16,2 veces mayor, respectivamente, que en los españoles, que era del 0,6%, igual que fuera de prisión. La HCVHB se asoció con: a) ser extranjero (2,6%; razón de posibilidades u odds ratio [OR]: 4,18; intervalo de confianza [IC]: 2,50-6,90; p <0,001); b) no estar vacunado (0,3%; OR: 0,13; IC: 0,06-0,26; p <0,001); y c) estar infectado por el virus de la inmunodeficiencia humana (VIH) (3,9%; OR: 3,23; IC: 1,24-8,40; p = 0,016). Conclusión: La prevalencia de HCVHB en presos se ha reducido mucho en los últimos 30 años, debido a la vacunación, pero sigue siendo alta en extranjeros y en infectados por VIH. Se recomienda: a) mantener el cribado de virus de la hepatitis B (VHB) en los ingresados en prisión; b) continuar con el programa de vacunación; y c) derivar a los infectados a programas especializa- dos para estudio y, si se precisa, tratamiento.

Abstract Background: The epidemiology of chronic hepatitis B (CHB) in Spain has changed due to migratory movements and the implementation of vaccination programs. The objective is to determine if prevalence has also changed amongst in Catalonia and the potential predictive variables of the infection. Material and method: Observational cross-sectional multi-centre study of CHB prevalence. Epidemiological and clinical variables were included, and their predictive capacity is analysed by means of a multivariable logistic regression model. Results: A total of 6508 prisoners were studied. CHB prevalence was 1.7%, much less than in studies carried out in previous years. In inmates from North Africa, Asia, Eastern Europe, and Sub-Saharan Africa the CHB rate was 2.8, 4.2, 4.9 and 16.2 times higher, respectively, than amongst those born in Spain, which was 0.6%, the same as in the general population. CHB was associated with: a) being an immigrant [2.6%; OR: 4.18 (CI: 2.50-6.90; P <0.001); b) being unvaccinated (3.1%; OR: 0.13; CI: 0.06-0.26; P <0.001); and c) being infected by the human immunodeficiency virus (HIV) [3.9%; OR: 3.23; CI: 1.24-8.40; P = 0.016]. Conclusion: Vaccination against HBV (hepatitis B virus) has greatly reduced CHB prevalence in inmates over the past 30 years but remains high in immigrants and those with HIV. We recommend: a) maintaining HBV screening amongst inmates; b) continuing with vaccination programmes; and c) referring CHB cases to specialized programs for further study and treatment if needed.

Abstract Background The search for clinically useful methods to assess atherosclerotic diseases (ASCVD) with good accuracy, low cost, non-invasiveness, and easy handling has been stimulated for years. Thus, the atherogenic indices evaluated in this study may fit this growing demand. Objectives To assess the potential of atherogenic indices to evaluate patients with clinical atherosclerosis. Methods Single-center cross-sectional study, through which the Castelli I and II indices, the atherogenic index of plasma (AIP), the lipoprotein combine index, and the variation in the peripheral perfusion index between 90 and 120 seconds after an endothelium-dependent (ΔPI90-120) vasodilator stimulus were evaluated in the prediction of atherosclerosis. Statistical significance was set at p < 0.05. Results The sample consisted of 298 individuals with an average age of 63.0±16.1 years, of which 57.4% were women. Paired comparisons of the ROC curve analysis of the indices that reached the area under the curve (AUC) > 0.6 show that ΔPI90-120 and AIP were superior to other indices, and no differences were observed between them (difference between AUC = 0.056; 95%CI -0.003–0.115). Furthermore, both the ΔPI90-120 [odds ratio (OR) 9.58; 95%CI 4.71–19.46)] and AIP (OR 5.35; 95%CI 2.30–12.45) were independent predictors of clinical atherosclerosis. Conclusions The AIP and ΔPI90-120 represented better accuracy in discriminating clinical ASCVD. Moreover, they were independent predictors of clinical ASCVD, evidencing a promising possibility for developing preventive and control strategies for cardiovascular diseases. Therefore, they are markers for multicenter studies from the point of view of practicality, low cost, and external validity.

Resumo Fundamento A busca por métodos clinicamente úteis de avaliação de doenças ateroscleróticas, com boa acurácia, de baixo custo, sem invasividade e de fácil manejo, há anos vem sendo estimulada. Dessa forma, os índices aterogênicos avaliados deste estudo podem se encaixar nesta demanda crescente. Objetivos Avaliar o potencial dos índices aterogênicos como métodos de avaliação de pacientes portadores de aterosclerose clínica. Métodos Estudo transversal de centro único, por meio do qual foram avaliados os índices de Castelli I e II, índice aterogênico plasmático (IAP), índice de combinação de lipoproteínas e a variação do índice de perfusão periférica entre 90 e 120 segundos após um estímulo vasodilatador endotélio-dependente (ΔIPP90-120) na predição de aterosclerose. A significância estatística foi estabelecida em p < 0,05. Resultados A amostra foi composta por 298 indivíduos com idade média de 63,0 ± 16,1 anos, dos quais 57,4% eram mulheres. Comparações pareadas da análise curva ROC dos índices que alcançaram área sob a curva (ASC) > 0,6 mostram que ΔIPP90-120 e IAP foram superiores aos demais índices, sem diferenças observadas entre si (diferença entre ASC = 0,056; IC95% -0,003-0,115). Ademais, tanto a ΔIPP90-120 [odds ratio (OR) 9,58; IC95% 4,71-19,46] quanto o IAP (OR 5,35; IC95% 2,30-12,45) foram preditores independentes de aterosclerose clínica. Conclusões O IAP e ΔIPP90-120 apresentaram melhor acurácia para discriminar aterosclerose clínica. Além disso, foram preditores independentes de aterosclerose clínica, evidenciando uma possibilidade promissora para o desenvolvimento de estratégias preventivas e de controle para doenças cardiovasculares. Tratam-se, portanto, de marcadores adequados para estudos multicêntricos do ponto de vista de praticidade, custo e validade externa.

Resumen A casi dos años de la entrada en vigencia del Tratado México, Estados Unidos y Canadá (T-MEC), se presenta un análisis del sector automotriz mexicano, así como de las condiciones que caracterizan su integración con la región de América del Norte. En principio, se realizó un estudio de los elementos básicos que explican la evolución del sector automotriz instalado en México, cuyos antecedentes se remontan a casi un siglo de historia; de manera posterior, se evalúan las condiciones que dieron origen a la renegociación del Tratado de Libre Comercio de América del Norte (TLCAN), proceso que culminó con la firma del T-MEC. Se incorporó una explicación sobre las disposiciones relativas a la determinación del origen regional de los vehículos fabricados en América del Norte, para concluir con la enunciaación de resultados y perspectivas para el sector.

Abstract Almost two years after the United States-Mexico-Canada Agreement (USMCA) came into effect, the authors present an analysis of Mexico’s auto industry as well as the conditions of its integration into the North American region. First, they study the basic elements that explain the evolution of the industry, whose origins can be found in almost a century of history. Then, they evaluate the conditions that gave rise to the renegotiation of the North American Free Trade Agreement (NAFTA), a process that culminated in the signing of the USMCA. They continue, explaining the stipulations about the determination of the regional origin of vehicles manufactured in North America, and conclude with their perspectives for the sector.

Resumen Objetivo principal: Identificar la mejor evidencia disponible sobre intervenciones educativas que pueden ayudar a prevenir la aparición del Pie Diabético (PD) en Atención Primaria (AP). Metodología: Revisión sistemática de Guías de Práctica clínica (GPC) con recomendaciones acerca de intervenciones educativas para prevenir el PD. La búsqueda se ha llevado a cabo en bases de datos de fuentes terciarias, secundarias y primarias con los descriptores Diabetes mellitus, Pie diabético y Educación en salud. Para evaluar la calidad de las GPC encontradas se utilizó la herramienta AGREE II. Resultados: Fueron recopiladas las intervenciones educativas que, según las 10 GPC revisadas, pueden resultar más efectivas para prevenir la aparición del PD en AP. Estas recomendaciones, han sido incluidas como actividades de los NIC (Nursing Interventions Classification) relacionados con el tema. Conclusión: El resultado principal de este trabajo indica que las intervenciones educativas para prevenir la aparición del PD deben formar parte, de manera inexcusable, de los planes de cuidados en los pacientes diabéticos. Son unas intervenciones que parecen ser muy costo efectivas y que, estructuradas adecuadamente, pueden contribuir a disminuir la incidencia de PD y a reducir el número de amputaciones.

Abstract Main objective: Identify the best available evidence on educational interventions that can help prevent the appearance of Diabetic Foot (DF) in Primary Care. Methodology: Systematic review on 10 Clinical Practice Guidelines (CPG) with recommendations on education to prevent the DF. The search was carried out in databases of tertiary, secondary and primary sources with the descriptors Diabetes mellitus, Diabetic foot and Health education. The AGREE II tool was used to assess the quality of the CPGs found. Results: Were compiled the educational interventions that, according to the revised 10 CPG's, are more effective in preventing the appearance of DF in Primary Care. Have been included these recommendations as NIC (Nursing Interventions Classification) activities related to the topic. Conclusion: The main result of this work indicates that educational interventions to prevent the onset of DF must inexcusably form part of the care plans for diabetic patients. These are interventions that appear to be very cost-effective, properly structured, will help reduce the incidence of DF and reduce thenumber of amputations

ABSTRACT: Introduction: The extraction of permanent teeth can be due to various reasons, such as dental caries, periodontal disease, among others. Faced with this problem, dental implants arise, defined as an alloplastic prosthetic device implanted in bone tissue, providing retention and support for a fixed or removable dental prosthesis. Despite the high success rate, there are failures in implantology, due to postoperative infection. For this reason, different antibiotic therapy regimens have been included in the treatment; however, their effectiveness in avoiding perioperative and postoperative complications remains controversial. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 23 systematic reviews that together included 16 primary studies, of which 9 correspond to randomized clinical trials. We conclude that antibiotic prophylaxis compared to placebo probably reduces implant and prosthetic failure, however, it may make little or no difference in postoperative infections. On the other hand, it is not clear whether antibiotic therapy treatment (perioperative and postoperative) compared to placebo reduces implant failure and postoperative infection, because the certainty of the existing evidence is very low.

RESUMEN: Introducción: La extracción de dientes permanentes se puede deber a varias razones, como la caries dental, enfermedad periodontal, entre otras. Frente a este problema, surgen los implantes dentales, definidos como un dispositivo protésico aloplástico implantado en el tejido óseo, proporcionando retención y soporte para una prótesis dental fija o removible. A pesar de la alta tasa de éxito, existen fracasos en implantología, a causa de una infección postoperatoria. Es por esto, que se han incluido dentro del tratamiento distintos regímenes de terapias antibióticas, sin embargo, actualmente su efectividad para evitar complicaciones peri y postoperatorias es controversial. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 23 revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, de los cuales, 9 corresponden a ensayos aleatorizados. Concluimos que la terapia antibiótica pre operatoria en comparación a placebo probablemente reduce el fracaso de los implantes y de las prótesis, sin embargo, puede generar poca o nula diferencia en las infecciones postoperatorias. Por otro lado, no está claro si el tratamiento de terapia antibiótica (perioperatoria y postoperatoria) en comparación a placebo reduce el fracaso de los implantes y de infección postoperatoria, debido a que la certeza de la evidencia existente es muy baja.

Resumen Los hogares y empresas ubicadas en la rivera del río Cauca han alterado las condiciones de calidad del agua debido al desecho de aguas residuales. Por lo tanto, este artículo propone analizar las condiciones biológicas y fisicoquímicas de las aguas superficiales que cruzan el área urbana de Popayán, Colombia, con el fin de determinar si son aptas para consumo humano. Para ello, se recolectaron pruebas in situ en ambas estaciones. Los dos puntos fueron cubiertos teniendo en cuenta las temporadas seca y lluviosa. En cada punto, los parámetros fueron medidos con el fin de calcular los indicadores de contaminación. De igual manera, el Ph, el oxígeno diluido, las conductividad y la temperatura fueron medidos; así como otros parámetros fisicoquímicos como alcalinidad total, dureza total, fósforo total y sólidos suspendidos totales. También se midieron parámetros biológicos como la presencia total de coliformes. Se encontró que la fuente de agua contiene altos niveles de carga contaminante y que la descarga biológica es una de las principales razones por las que se altera la calidad del agua para su consumo. El número de macroinvertebrados en el río disminuye en un 48 % a medida que el río avanza por el área urbana de la ciudad. De acuerdo a los valores de BMWP, aguas carbonatadas altamente contaminadas ingresan a la ciudad. Sin embargo, debido al flujo a través de la fuente hídrica, el río Cauca puede regular su carga contaminante según lo que se evidencia en los índices Icomi, Icomo e Icosus.

Abstract The homes and companies located on the banks of the Cauca River have altered the conditions of the quality of the water generated by residual discharges. Therefore, this paper proposes to analyze the biological and physicochemical conditions of the surface waters that cross the urban area of Popayán, Colombia, and determine if they are suitable for human consumption. For this, an in-situ sampling was carried out in the two river stations. The two points were covered taking into account the dry and rainy seasons. At each point, the parameters were measured to calculate the contamination indicators. Likewise, Ph, diluted oxygen, conductivity and temperature parameters were measured, also other physicochemical parameters such as total alkalinity, total hardness, total phosphorus and suspended total solids were measured as well as the microbiological parameters like total coliforms. It was found that the water source contains high levels of pollutant load and that biological discharge is one of the main causes that alters the quality of the water for drinking. The number of macroinvertebrates in the river decreases by 48% as the river advances through the urban area of the city. According to the BMWP values, highly contaminated carbonated waters enter the urban area. However, due to the flow throughout the water source, the Cauca River can regulate the pollution load according to the result evidenced in the Icomi, Icomo, and Icosus indices.

Abstract The article presents a comprehensive analysis of the variables that explain the current situation of the automotive industry worldwide. At the outset, a description of the change of productive paradigm that the multinational companies of the sector adopted, going from "Fordism" to "Toyotism" is incorporated; an explanation is also given of the mechanisms that, through “Toyotism”, affect the installation of global chains of value, with more specialized links. Subsequently, the key indicators of the international market, that is to say, volumes relative to production and consumption, are evaluated. In particular, the main producing and consuming countries of cars are identified; also points out the current trend of the industry towards the formation of alliances and mergers between the multinational companies that lead the sector worldwide. Finally, the effects of the economic crisis of 2009 on the composition of the industry at world level are eplored; above all, the consolidation of China as the main automobile producing country, and the recovery process that the industry is experiencing in the United States.

Resumen El artículo presenta un análisis integral de las variables que explican la situación actual de la industria automotriz a nivel mundial. De inicio, se incorpora una descripción del cambio de paradigma productivo que adoptaron las empresas multinacionales del sector, pasando del “fordismo” al “toyotismo”; se presenta también una explicación de los mecanismos que, a través del “toyotismo”, inciden sobre la instalación de cadenas globales de valor, con eslabones más especializados. En seguida se evalúan los indicadores fundamentales del mercado internacional, es decir, los volúmenes relativos a producción y consumo. En particular, se identifican los principales países productores y consumidores de automóviles; también se señala la tendencia actual de la industria hacia la conformación de alianzas y fusiones entre las empresas multinacionales que protagonizan el sector a nivel mundial. Finalmente se exploran los efectos que originó la crisis económica de 2009 sobre la composición global de la industria; sobre todo, la consolidación de China como principal país productor de automóviles y el proceso de recuperación que está experimentando la producción de automotores en Estados Unidos.

Resumo Fundamento: O impacto da regurgitação paravalvular (RPV) após implante de valva aórtica transcateter (TAVI) permanece incerto. Objetivo: Analisar o impacto da RPV na mortalidade e re-hospitalização 1 ano após o TAVI. Métodos: Entre janeiro de 2009 e junho de 2015, 251 pacientes foram submetidos ao TAVI em dois centros cardiológicos com 3 diferentes próteses. Os pacientes foram analisados de acordo com a gravidade da RPV pós-procedimento. Resultados: RPV foi classificada como ausente/mínima ou discreta em 92,0% (n=242) dos pacientes e moderada/grave em 7,1% (n = 18). Os pacientes com RPV moderada/importante apresentaram maior grau de calcificação aórtica (22,0% vs. 6,0%; p = 0,03), creatinina sérica (1,53 ± 0,71 vs. 1,18 ± 0,43 mg/dL; p = 0,01), menor área valvar aórtica (0,61 ± 0,12 vs. 0.69 ± 0,17 cm2; p = 0,05) e menor fração de ejeção do ventrículo esquerdo (49,17±14,79% vs. 58,82±12,14%; p = 0,009). Nos pacientes com RPV moderada/importante a necessidade de pós-dilatação foi maior (p = 0,025) e eventualmente com balão de diâmetro maior (p = 0,04). Ao final de 1 ano, a mortalidade por todas as causas foi similar em ambos os grupos (16,7% vs. 12,0%; p = 0,08), assim como re-hospitalização (11,1% vs. 7,3%; p = 0,91). O grau de RPV ao longo do primeiro ano reduziu progressivamente (p < 0,01). A presença de RPV moderada/importante não foi associada a maiores taxas de mortalidade em 1 ano [RR (risco relativo): 0,76; IC (intervalo de confiança) 95%: 0,27-2,13; p = 0,864)], re-hospitalização (RR: 1,08; IC 95%: 0,25-4,69; p = 0,915) ou desfecho combinado (RR: 0,77; IC 95%: 0,28-2,13; p = 0,61). Conclusões: Nesta amostra, a presença de regurgitação paravalvular moderada/importante não foi um preditor de mortalidade ou reinternação a longo prazo. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Abstract Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Resumo Fundamento: Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Objetivos: Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Métodos: Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Resultados: Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos. A média de idade foi 56,8 ± 7,6 anos, sendo 71,4% da população estudada do sexo masculino e 26,5% composta por diabéticos. Considerando a apresentação clínica, a grande maioria (94%) tinha angina estável ou isquemia silenciosa. Obteve-se sucesso do dispositivo em 100% dos casos e do procedimento, em 96%. A taxa de eventos cardiovasculares maiores foi de 4% aos 30 dias, de 8,2% em 1 ano, e de 12,2% em 2 anos, sem mais eventos até 4,6 anos. Houve 2 casos de trombose (1 subaguda e 1 tardia) até o último seguimento. Conclusões: Nesta análise preliminar, o uso do SVB Absorb® mostrou-se seguro e eficaz no seguimento bastante tardio. Faz-se necessário estabelecer o perfil de eficácia e segurança destes dispositivos em cenários de maior complexidade.

Abstract Background: Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. Objectives: To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Methods: Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). Results: All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). Conclusions: In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary.

ABSTRACT Purpose To determine / establish the relationship between socio-demographic factors and dimensions of care quality of care and satisfaction in caregivers of elderly patients admitted to acute Hospital Virgen del Valle (Toledo, Spain). Methodology Design: Cross-sectional study. Field of study: Geriatric Hospital of Toledo (Spain). Study subjects: Main caregivers of elderly patients admitted to the Hospital Virgen del Valle de Toledo, in the acute care setting. Sample size: 267 caregivers (p = 0.5, confidence interval 95%, e = 0.06).Measuring instrument; Validated questionnaire, based on the SERVQUAL model to measure the satisfaction of the care provided. Determinations: To determine the effect of the predictor variables on the level of satisfaction, simple and multivariate analyzes were performed linear regression. Results The overall assessment of satisfaction with the attention of care is "immediately good", always getting higher scores on the assessment of care in care in general. In relation to the items surveyed on satisfaction and quality dimensions and caregiver profile, found statistically significant differences in gender, age, education level of the caregiver, hospitalization time, level of dependence of the patient, share home or not, and previous earnings. Essence/Conclusion There is an urgent need to increase the level of awareness of carers and meeting their expectations for care, care to develop strategies according to their preferences. Knowledge of deficiencies on caring professionals provides data on where to intervene to achieve favorable changes to increase satisfaction.

RESUMEN Objetivo Determinar/establecer la relación entre los factores socio-demográficos y las dimensiones de calidad de atención del cuidado y satisfacción en los cuidadores de los pacientes geriátricos agudos ingresados en el Hospital Virgen del Valle (Toledo, España). Metodología Diseño: Estudio descriptivo transversal. Ámbito de estudio: Hospital geriátrico de Toledo (España).Sujetos de estudio: Cuidadores principales de los pacientes geriátricos ingresados en el Hospital Virgen del Valle de Toledo, en las Unidades de Agudos. Tamaño muestral: 267 cuidadores (p= 0.5, intervalo de confianza del 95%, e= 0.06).Instrumento de medida; Cuestionario validado, basado en el modelo SERVQUAL, para medir la satisfacción con la atención recibida. Determinaciones: Para determinar el efecto de las variables predictoras en el nivel de satisfacción, se realizaron análisis de regresión lineal simple y multivariante. Resultados La valoración global sobre la satisfacción general con la atención y con los cuidados es “mediatamente buena”, siempre obteniendo puntuación más alta en la valoración de los cuidados que en la atención en general. En relación con los ítems estudiados sobre la satisfacción y sobre las dimensiones de calidad y perfil del cuidador, se han encontrado diferencias estadísticamente significativas en: género, edad, nivel de estudios del cuidador, tiempo de hospitalización, nivel de dependencia del enfermo, comparten domicilio o no, e ingresos anteriores. Conclusión-Esencia Existe una necesidad urgente de aumentar el nivel de conocimiento sobre los cuidadores y conocer sus expectativas sobre el cuidado, para elaborar estrategias de cuidado acordes con sus preferencias. El conocimiento de las deficiencias detectadas sobre el cuidado proporciona a los profesionales datos sobre donde se debe intervenir para conseguir cambios favorables para aumentar la satisfacción.

A artéria coronária única é anomalia rara, que pode estar associada à isquemia miocárdica e morte súbita. Apresentamos o caso de uma mulher jovem, com quadro de angina atípica, cujo cateterismo revelou artéria coronária direita que se originava do terço médio da artéria descendente anterior, uma variante da artéria coronária única.

The aim of this study is to define biomechanical causes of musculo-skeletal disorders for mechanical installations in buildings in order to pursue goals such as the validation and precision information for the benefit in accident preventions, and provide information for the musculoskeletal disorders treatments. By these means, this research analyzes the musculoskeletal disorders, injuries, and damages by applying descriptive and analytical epidemiological methods. The strategy consists in the following steps: 1) Analysis of occupational accidents as descriptive method. 2) The framework interview questions as a descriptive method in order to obtain data collection about work teams. 3) Reports in the scientific literature as analytical method with the influences of epidemiological clinical analysis review 4) Case-control study as analytical method for the untypical cases.

El objetivo de este estudio es definir las causas biomecánicas de los trastornos músculo-esqueléticos de instalaciones mecánicas en edificios con el fin de conseguir objetivos como la validación y la información de precisión para el beneficio de las prevenciones de accidentes, y proporcionar información para los tratamientos de los trastornos músculo-esqueléticos. Por estos medios, esta investigación analiza los trastornos, lesiones y daños músculo-esqueléticos aplicando métodos epidemiológicos descriptivos y analíticos. La estrategia consiste en los siguientes pasos: 1) Análisis de los accidentes de trabajo como método descriptivo. 2) Las preguntas de la entrevista marco como un método descriptivo, con el fin de obtener la recopilación de datos sobre los equipos de trabajo. 3) Informes en la literatura científica como método analítico con la influencias de la revisión de análisis clínico epidemiológico. 4) Estudio de caso-control, como método de análisis para los casos atípicos.

O hormônio de crescimento (GH), principal regulador do crescimento pós-natal, tem importantes ações metabólicas em diferentes tecidos, sinérgicas ou até antagônicas às do fator de crescimento semelhante à insulina tipo I (IGF-I), produzido sobretudo no fígado após ligação do GH ao seu receptor. Experimentos em modelos animais indicam um papel importante do GH na resistência a insulina, enquanto o papel do IGF-I nessa condição ainda não está completamente elucidado. Em humanos, o GH promove aumento da lipólise e da oxidação lipídica, enquanto o IGF-I desencadeia o aumento da oxidação lipídica apenas cronicamente. Enquanto as ações sobre o crescimento são tempo limitado, as ações metabólicas e cardiovasculares do eixo GH/IGF-I perduram durante toda a vida. Os potenciais efeitos anabólicos do GH têm sido utilizados em condições crônicas e hipercatabólicas, embora as investigações sobre os desfechos clínicos ainda sejam escassas. Neste artigo, pretendemos revisar as ações metabólicas do GH oriundas de modelos animais, os estudos em humanos normais e indivíduos com deficiência de GH, diabete melito tipo 1, síndrome metabólica, estados hipercatabólicos e a relação do eixo GH/IGF-I com as adipocinas, disfunção endotelial e aterogênese

Growth hormone (GH), the main regulator for post-natal growth, has important metabolic actions on different tissues, similar or opposite to insulin like growth factor I (IGF-I), mainly produced by the liver after the binding of GH to its receptor. Experiments with animal models indicate an important role of GH on insulin resistance although the IGF-I role is not yet completely established. In humans, GH promotes an increase on lypolisis and lipid oxidation, while IGF-I leads to an increase on lipid oxidation only in a chronic way. While growth actions are time-limited, metabolic and cardiovascular actions of the GH/IGF-I axis are throughout life. GH anabolic effects have been used on chronic and hypercatabolic conditions, although investigations on the clinical outcomes are still scarce. In this paper, we intend to review GH metabolic actions experienced by animal models, studies with normal humans and GH deficient individuals, individuals with diabetes mellitus type 1 and metabolic syndrome individuals, hypercatabolic states and the relationship between GH and adipokines, endothelial disfunction and atherogenesis

la hormona de crecimiento (GH), principal regulador del crecimiento postnatal, tiene importantes acciones metabólicas en diversos tejidos, sinérgicas o incluso antagónicas a las del factor de crecimiento, a semejanza de la insulina tipo I (IGF-I) producido, principalmente, en el hígado y después del vínculo del GH con su receptor. Experimentos en modelos animales indican un papel importante del GH en la resistencia a la insulina, mientras que el papel del IGF-I en esa condición, todavía no está completamente elucidado. En los humanos, el GH genera el aumento de la lipólisis y de la oxidación lipídica, mientras que el IGF-I desencadena el aumento de la oxidación lipídica solamente desde el punto de vista crónico. Mientras las acciones sobre el crecimiento son de tiempo limitado, las acciones metabólicas y cardiovasculares del eje GH/IGF-I duran toda la vida. Los efectos potenciales anabólicos del GH han sido utilizados en condiciones crónicas e hipercatabólicas, aunque las investigaciones sobre los desenlaces clínicos todavía sean escasas. En este artículo, pretendemos revisar las acciones metabólicas del GH provenientes de modelos animales, los estudios en humanos normales y en individuos con deficiencia de GH, diabetes mellitus tipo 1, síndrome metabólico, estados hipercatabólicos y la relación del eje GH/IGF-I con las adipocinas, disfunción endotelial y aterogénesis