Nivel de integración del Sistema Nacional de Salud Cubano López Puig, Pedro; Alonso Carbonell, Liuba; Fernández Díaz, Ivonne Elena ...
Revista Cubana de medicina general integral,
12/2011, Letnik:
27, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Introducción: En el Sistema Sanitario Cubano, la salud pública y la salud individual se integran bajo los principios de universalidad, gratuidad, accesibilidad, continuidad, responsabilidad e ...integralidad de la atención que se brinda a individuos, familias y comunidades. Objetivo: Identificar el nivel de integración del Sistema Sanitario Cubano en distintos niveles de complejidad en la gestión y prestación de servicios. Métodos: Se tuvieron en cuenta los atributos propuestos por la Organización Panamericana de la Salud en el 2008, para conformar redes integradas de servicios de salud. Se aplicó una escala cualitativa ordinal, propuesta por la Organización Panamericana de la Salud. Se aplicó un instrumento a 58 unidades de análisis, de estas 15 en el grupo I, considerado expertos; 13 en el II (directivos de nivel municipal) y 30 en el III (directivos de nivel provincial). Se diseñó ad hoc un sistema de evaluación por índices para analizar los resultados. Resultados: Predominaron los atributos considerados integrados o parcialmente integrados. Los atributos de la integración, con mayores debilidades, fueron los relacionados con la integración del financiamiento presupuestado a las necesidades del sector y la integración de los procesos formativos del recurso humano en cantidad y calidad suficiente para las necesidades actuales, así como su comprometimiento con los servicios que prestan. El índice de integración por atributo y global, fueron similares para cada grupo, e indican una tendencia del Sistema de Salud Cubano hacia la integración. Conclusiones: El Sistema Sanitario Cubano tiende a la integración. Existen reservas de mejora en todos los atributos para la integración.
SOBERANA 02 has been evaluated in phase I and IIa studies comparing homologous versus heterologous schedule (this one, including SOBERANA Plus). Here, we report results of immunogenicity, safety, and ...reactogenicity of SOBERANA 02 in a two- or three-dose heterologous scheme in adults.
Phase IIb was a parallel, multicenter, adaptive, double-blind, randomized, and placebo-controlled trial. Subjects (n = 810) aged 19-80 years were randomized to receive two doses of SARS-CoV-2 RBD conjugated to tetanus toxoid (SOBERANA 02) and a third dose of dimeric RBD (SOBERANA Plus) 28 days apart; two production batches of active ingredients of SOBERANA 02 were evaluated. Primary outcome was the percentage of seroconverted subjects with ≥4-fold the anti-RBD immunoglobulin G (IgG) concentration. Secondary outcomes were safety, reactogenicity, and neutralizing antibodies.
Seroconversion rate in vaccinees was 76.3% after two doses and 96.8% after the third dose of SOBERANA Plus (7.3% in the placebo group). Neutralizing IgG antibodies were detected against D614G and variants of concern (VOCs) Alpha, Beta, Delta, and Omicron. Specific, functional antibodies were detected 7-8 months after the third dose. The frequency of serious adverse events (AEs) associated with vaccination was very low (0.1%). Local pain was the most frequent AE.
Two doses of SOBERANA 02 were safe and immunogenic in adults. The heterologous combination with SOBERANA Plus increased neutralizing antibodies, detectable 7-8 months after the third dose.
https://rpcec.sld.cu/trials/RPCEC00000347 FUNDING: This work was supported by Finlay Vaccine Institute, BioCubaFarma, and the Fondo Nacional de Ciencia y Técnica (FONCI-CITMA-Cuba, contract 2020-20).
Procalcitonin is useful for the diagnosis of sepsis, but its prognostic value regarding mortality is unclear. Our objective was to determine the prognostic value of procalcitonin determined at the ...onset of sepsis, and to compare it with other markers of inflammatory response, malnutrition and organ dysfunction data.
We studied 253 hospitalized patients (146 men, 107 women) with a median age of 65 years. Sepsis was defined as infection, and at least two SIRS criteria. We assessed co-morbidities, nutritional status, bacteremia, procalcitonin and other inflammatory markers (PCR, TNF-alpha, IL6, TREM-1, IL-10, IL-1ra, CD14 and LBP), and organ function using the SOFA score. Mortality was assessed at 28 days after onset of sepsis.
At day 28, 49 (19%) patients had died. Inflammatory markers showed only moderate predictive value for mortality, with IL-10 and IL-6 being the best predictors. Mortality was mainly related to organ dysfunction indicators (SOFA and Glasgow scores), serum lactate, ferritin and LDH levels, and to nutritional data such as subjective assessment, handgrip strength and serum transferrin levels. The most frequent location of sepsis was the lung, with 140 cases (55%), which showed more comorbidity, worse nutritional status, less frequent bacteremia and lower inflammatory response. When the analysis was limited to patients with non-pulmonary sepsis, organ dysfunction, nutritional status and inflammatory markers showed the best prognostic value. Of the inflammatory markers, procalcitonin showed only moderate predictive value; however it showed the highest correlation with bacteremia and the ability to discriminate non-complicated sepsis from severe forms.
Procalcitonin only showed moderate predictive value for sepsis-related mortality, being surpassed by organ dysfunction, nutritional status, IL-10 and IL-6. However, it proved useful to discriminate between non-complicated and severe forms of sepsis.
Abstract Ethanol consumption may impair bone growth. Transverse radiopaque lines (Harris lines) have been interpreted as manifestations of bone growth arrest due to nutritional stress. It is possible ...that ethanol consumption during growth leads to Harris lines formation and to a shorter stature. Plain X-ray film of the right tibia was performed to 175 individuals, who were inquired about ethanol consumption, periods of perceived hunger, and protracted illness during growth period (from birth to 18 years of age). Stature was also recorded. Men who drank during growth showed a shorter stature than those who did not ( t = 3.65, P < .001). Differences were not statistically significant among women ( t = 0.95). Neither periods of perceived hunger nor illness were associated to differences in stature. Ethanol consumption during growth showed a significant association with the presence of Harris lines ( χ2 = 15, P < .001, Odds Ratio OR = 3.39, confidence interval CI = 1.81–6.33), an association which was more marked between having two or more Harris lines and drinking during growth ( χ2 = 23.19, P < .001, OR = 6.04, CI = 2.79–13.11) or having three or more lines and drinking during growth ( χ2 = 15.93, P < .001, OR = 7.41, CI = 2.47–22.21). Periods of perceived hunger during growth were also related to the presence of two or more Harris lines ( χ2 = 4.66, P = .031, OR = 2.055, CI = 1.065–3.965), but no association was observed between illness and Harris lines, two or more Harris lines, and three or more Harris lines. Multivariate analysis showed that only ethanol consumption during growth period was associated with Harris lines.
Rib fractures are common in alcoholics. This high prevalence might be due to ethanol-associated malnutrition, bone disease, liver dysfunction, or the peculiar lifestyle of the alcoholic with frequent ...trauma and altercations. In this study we try to discern the role of these factors on rib fracture (assessed on a plain thoracic X-ray film) in 81 consecutive alcoholic patients, 25 of them cirrhotics. Serum albumin, prothrombin aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyl transpeptidase, C-terminal cross-linking telopeptide of type 1 collagen, osteocalcin, insulin growth factor 1, 1,25-dihydroxyvitamin D, parathyroid hormone, estradiol, free testosterone, and corticosterone were measured, and the patients also underwent assessment of bone mineral density by a HOLOGIC QDR-2000 bone densitometer (Waltham, MA, USA). Body mass index, triceps skinfold, and brachial perimeter were also determined, and the patients and their families were asked about tobacco consumption, social and familial links, consumption of ethanol by other members of the family, kind of job, and feeding habits. Forty-two male nondrinker sanitary workers of similar age served as controls. Forty of the 81 patients showed rib fractures. There was a statistically significant association between rib fractures and disruption of social and familial links, irregular feeding habits (in bars or pubs, not at home), ethanol consumption by close relatives, and intensity of tobacco consumption, but not between rib fractures and liver function tests, nutritional parameters, or bone mineral density, besides a nearly significant trend (
p
=
.053) with the presence of osteopenia at the femoral neck. Patients with major withdrawal symptoms at admission also presented more frequent rib fractures. We conclude that rib fractures in alcoholics are related to the peculiar lifestyle of these patients rather than to bone alterations, liver dysfunction, or nutritional status.
Introducción: En el Sistema Sanitario Cubano, la salud pública y la salud individual se integran bajo los principios de universalidad, gratuidad, accesibilidad, continuidad, responsabilidad e ...integralidad de la atención que se brinda a individuos, familias y comunidades. Objetivo: Identificar el nivel de integración del Sistema Sanitario Cubano en distintos niveles de complejidad en la gestión y prestación de servicios. Métodos: Se tuvieron en cuenta los atributos propuestos por la Organización Panamericana de la Salud en el 2008, para conformar redes integradas de servicios de salud. Se aplicó una escala cualitativa ordinal, propuesta por la Organización Panamericana de la Salud. Se aplicó un instrumento a 58 unidades de análisis, de estas 15 en el grupo I, considerado expertos; 13 en el II (directivos de nivel municipal) y 30 en el III (directivos de nivel provincial). Se diseñó ad hoc un sistema de evaluación por índices para analizar los resultados. Resultados: Predominaron los atributos considerados integrados o parcialmente integrados. Los atributos de la integración, con mayores debilidades, fueron los relacionados con la integración del financiamiento presupuestado a las necesidades del sector y la integración de los procesos formativos del recurso humano en cantidad y calidad suficiente para las necesidades actuales, así como su comprometimiento con los servicios que prestan. El índice de integración por atributo y global, fueron similares para cada grupo, e indican una tendencia del Sistema de Salud Cubano hacia la integración. Conclusiones: El Sistema Sanitario Cubano tiende a la integración. Existen reservas de mejora en todos los atributos para la integración.Introduction: In the Cuban Health System, the public and individual health care integrated under the principles of universality, gratuitousness, accessibility, responsibility and completeness of the care offered to subjects, families and communities. Objective:To identify the integration level of Cuban Health System in different levels of complexity in the management and services provision. Methods: Authors took into account the attributes proposed by Pan American Health Organization in 2008 to create integrated networks of health services. An ordinal qualitative scale was applied, proposed by Pan American Health Organization. A kit consisting of 58 analysis units was applied, from these 15 in the group I, including experts; 13 in the group II (municipal level managers) and 30 in the group III (provincial level managers) . An ad hoc assessment system was designed by indexes to analyze the results. Results: There was predominance of attributes considered as integrated or partially integrated. Integration attributes with more weakness were those related to integration of financing budgetary to the needs of sector and the integration of formative processes of human resource in quantity and quality enough for current needs, as well as its involvement with its service provision. The integration indexes by attribute and of global type were similar for each group signaling a trend of Cuban Health System to integration. Conclusions:The Cuban Healthcare System trend to integration. There are signs of improvement in all the attributes for the integration.
Abstract
Fructooligosaccharides (FOSs)—fructose-based oligosaccharides—are typical prebiotics with health-promoting effects in humans and animals. The trisaccharide 1-kestotriose is the most ...attractive inulin-type FOS. We previously reported a recombinant sucrose:sucrose 1-fructosyltransferase (1-SST, EC 2.4.1.99) from Schedonorus arundinaceus (Sa) that efficiently converts sucrose into 1-kestotriose. In this study, Pichia pastoris PGFT6x-308 constitutively expressing nine copies of the Sa1-SST gene displayed fructosyltransferase activity in undisrupted biomass (49.8 U/ml) and culture supernatant (120.7 U/ml) in fed-batch fermentation (72 hr) with sugarcane molasses. Toluene permeabilization increased 2.3-fold the Sa1-SSTrec activity of whole cells entrapped in calcium-alginate beads. The reaction with refined or raw sugar (600 g/l) yielded 1-kestotriose and 1,1-kestotetraose in a ratio of 8:2 with their sum representing above 55% (wt/wt) of total carbohydrates. The FOSs yield decreased to 45% (wt/wt) when sugarcane syrup and molasses were used as cheaper sucrose sources. The beads retained 80% residual Sa1-SSTrec activity after a 30-day batchwise operation with refined cane sugar at 30°C and pH 5.5. The immobilized biocatalyst is attractive for the continuous production of short-chain FOSs, most particularly 1-kestotriose.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
RESUMEN El entrenamiento de las figuras en la natación artística constituye uno de los aspectos fundamentales en la preparación técnica de las nadadoras artísticas, su dominio es una condición para ...alcanzar el éxito deportivo. Sin embargo, en la actualidad son insuficientes los procedimientos y componentes que lo fundamentan. De ahí que la investigación está dirigida a comprobar el comportamiento de la aplicación de la metodología para el mejoramiento del entrenamiento de las figuras en las nadadoras artísticas. Con una población de ocho nadadoras artísticas de la categoría 11-12 años pertenecientes a la Escuela de Iniciación Deportiva Escolar "Capitán Orestes Acosta Herrera" de Santiago de Cuba. Se aplicó los métodos teóricos analítico-sintético y sistémico-estructural-funcional; con respecto a los empíricos el análisis documental y el diseño pre-experimental pretest-postest para un solo grupo y en los estadísticos la descriptiva con la media, moda y desviación típica; y la inferencial con la prueba de T Student para muestras relacionadas. En tal sentido, la propuesta se caracterizó por el empleo del enfoque sistémico a la reestructuración del contenido a partir de un plan de entrenamiento de las figuras. La calidad de la metodología quedó corroborada por los resultados obtenidos en la aplicación del pre-experimento confirmado por diferentes técnicas estadísticas que resaltan su funcionabilidad, sostenibilidad, pertinencia y factibilidad.
•First report of constitutive high-level expression of dextranase in recombinant Pichia pastoris.•The increase of transgene copies enhanced dextranase yield in high cell-density cultures.•A crude ...dextranase preparation removed dextran in cane juice samples from sugar mill.
A gene construct encoding the mature region of Talaromyces minioluteus dextranase (EC 3.2.1.11) fused to the Saccharomyces cerevisiae SUC2 signal sequence was expressed in Pichia pastoris under the constitutive glyceraldehyde 3–phosphate dehydrogenase promoter (pGAP). The increase of the transgene dosage from one to two and four copies enhanced proportionally the extracellular yield of the recombinant enzyme (r-TmDEX) without inhibiting cell growth. The volumetric productivity of the four-copy clone in fed batch fermentation (51 h) using molasses as carbon source was 1706 U/L/h. The secreted N-glycosylated r-TmDEX was optimally active at pH 4.5–5.5 and temperature 50–60 °C. The addition of sucrose (600 g/L) as a stabilizer retained intact the r-TmDEX activity after 1-h incubation at 50–60 °C and pH 5.5. Bacterial dextran in deteriorated sugarcane juice was completely removed by applying a crude preparation of secreted r-TmDEX. The high yield of r-TmDEX in methanol-free cultures and the low cost of the fed batch fermentation make the P. pastoris pGAP-based expression system appropriate for the large scale production of dextranase and its use for dextran removal at sugar mills.
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