A lack of cultural competence can negatively affect engagement among students, professionals, and countries worldwide. For the advancement of global health partnerships, pharmacy practice, and ...education, stakeholders, including pharmacy students, professors, and pharmacists, need to understand the political, cultural, economic, and health conditions affecting populations in all countries involved. This study explores the cultural factors necessary for fostering collaborations, specifically between the pharmacy faculties/schools in Cuba, Haiti, and the Dominican Republic, and their counterparts around the world. First, it provides general information about Caribbean countries and territories, based on bibliographic research. It then presents cultural and health profiles from Cuba, Haiti, and the Dominican Republic, aiming to inspire the establishment, enhancement, and support of alliances between these Caribbean nations and others worldwide.
Cultural competence is crucial for improved health outcomes in populations. In addition to knowledge and skills, cultural competence involves a confident attitude that underlines regard across all ...cultures. The importance of cultural competence training has been considered in several pharmacy education statements as part of the Pharmacists’ Patient Care Process. Nevertheless, there is a significant discrepancy in the implementation of cultural competence in a curriculum. There is no consensus on how this could be implemented from a view of logical and pedagogical coherence. Consequently, a cultural and interdisciplinary approach should be considered in the curriculum design process respecting the laws and pedagogical principles that guide the process of training professionals at the universities and pharmacy schools. The main purpose of the study is to describe a cultural background to implement cultural competence education in the Cuban pharmacy curriculum. The data for this study was collected through an overall literature review. Using terms specific to Cuban health care, culture, and education, combined with terms linked to cultural competence, global health, and pharmacy education. Relevant statements by the Pan American Health (PAHO) and World Health Organizations (WHO) were extracted. Electronic sites for the American Journal of Pharmaceutical Education, Currents in Pharmacy Teaching and Learning, and Pharmacy Education were reviewed. Scopus, Google Scholar, EBSCO Host, International Pharmaceutical Abstracts, and Web of Knowledge databases were examined. The outcomes of this study reveal that Cuba is a culturally rich country with complex and diverse perspectives on health. Cuban culture is the result of extremely broad and tedious transculturation processes; therefore, it is not possible to exhaust the subject in a single inquiry. Health and education in Cuba are politically entwined; statistical data, arguments, and related information are not always available to be studied or compared. This study identifies the need for a sincere effort toward global pharmacy education’s purpose; respect for religious values, traditional beliefs, historic and political factors were also taken into consideration to design a framework for cultural competence with Cuban pharmacy curricula. The repercussions of the current study will be valuable to developing curricular improvement processes aimed at implementing cultural competency in pharmacy education taking into consideration an essentially cultural perspective. Furthermore, this study offers a background to simplify culturally sensitive exchanges among practitioners, undergraduates, stakeholders, and other faculties of pharmacy members from Cuba and other nations when they involve health care and pharmacy practice or education.
This retrospective study assessed the biological intra-individual variability of the percentage of sperm with DNA damage (SDF) observed in subsequent ejaculates of the same individual. Variation in ...SDF was analyzed using the Mean Signed Difference (MSD) statistic based on 131 individuals, comprising 333 ejaculates. Either two, three or four ejaculates were collected from each individual. With this cohort of individuals two main questions were addressed; (1) does the number of ejaculates analyzed influence the variability in the level of SDF associated with each individual? and (2) is the variability observed in SDF similar when individuals are ranked according to their level of SDF? Results showed that the variation observed in mean SDF was not different when 2, 3 or 4 ejaculates were analyzed; consequently, we suggest that the assessment of SDF based on two ejaculates is likely to be representative of the mean SDF expected for the individual. In parallel, it was determined that the variation in SDF increased as SDF increased; in individuals presenting with an SDF value of lower than 30% (potentially fertile), only 5% possessed levels of MSD that could be considered as variable as that presented by individuals presenting with a recurrent high SDF. Finally, we showed that a single assessment of SDF in individuals with medium SDF (20-30%) was less likely to be predictive of the SDF value in the next ejaculate, and therefore, less informative of the patient's SDF status.
To assess the impact of a multimodal interventional project ("Zero Resistance") on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient's ICU stay.
Prospective, open-label, ...interventional, multicenter study.
103 ICUs.
Critically ill patients admitted to the ICUs over a 27-month period.
Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU.
Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection.
A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31-1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83-1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52-1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57-0.80, p<0.0001).
The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient's ICU stay.
Increased pregnancy after reduced male abstinence Sánchez-Martín, Pascual; Sánchez-Martín, Fernando; González-Martínez, Mercedes ...
Systems biology in reproductive medicine,
10/2013, Letnik:
59, Številka:
5
Journal Article
Recenzirano
Odprti dostop
This study was conducted to test the hypothesis that continuous epididymal sperm depletion after recurrent ejaculations (REC) in contrast to a period of abstinence (ABS) results in a decreased level ...of sperm DNA fragmentation (SDF) and a consequent increased rate of pregnancy. Forty couples undergoing intra-cytoplasmic injection (ICSI) were asked to abstain from ejaculation for a period of 4 days and then ejaculate once per day for a period of 4 days, followed by a period of abstinence for 12 hours; sperm samples obtained after ABS and REC were assessed for volume, concentration, motility, and SDF and compared in 25 of the patients. Additionally, and in a different experiment, the pregnancy rate of this experimental group (40 couples) was compared to a control group of 150 couples in which the males had abstained from ejaculation for 4 days prior to ejaculation. Sperm selection was performed using density gradient centrifugation prior to ICSI. Semen quality in the REC group that was assessed over the course of the ejaculation schedule showed a decrease in semen volume (67%) and SDF (27%) following sperm selection; there was no difference for sperm motility or sperm concentration. When the pregnancy rate between the 40 couples in the REC group and 150 couples in the control ABS group were compared, the REC group had a pregnancy rate of 56.4% (25 40), whereas the ABS rate was only 43.3% (65 150) (p = 0.030). We conclude that recurrent ejaculation every 24 hours for four days with a final abstinence of 12 hours, combined with sperm selection using density gradient centrifugation, produces a significant increase in pregnancy rate when using ICSI. As ICSI was the strategy selected for fertilization, we propose that the observed reduction in SDF was the primary factor leading to improved reproductive outcome.
Background: Chronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk ...factors (CVRF). Material and methods: We performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardized questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10 CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridemia, diabetes and sedentary lifestyle). Results: Prevalence of CKD was 15.1% (95% CI: 14.3–16.0%). CKD was more common in men (23.1% vs. 7.3% in women), increased with age (4.8% in 18–44 age group, 17.4% in 45–64 age group, and 37.3% in ≥65), and was more common in those with than those without cardiovascular disease (39.8% vs. 14.6%); all P < 0.001. CKD affected 4.5% of subjects with 0–1 CVRF, and then progressively increased from 10.4% to 52.3% in subjects with 2 to 8–10 CVRF (P trend <0.001). Conclusions: CKD affects one in seven adults in Spain. The prevalence is higher than previously reported and similar to that in the United States. CKD was particularly prevalent in men, older people and people with cardiovascular disease. Prevalence of CKD increased considerably with the accumulation of CVRF, suggesting that CKD could be considered as a cardiovascular condition. Resumen: Introducción: La enfermedad renal crónica (ERC) constituye un problema de salud pública a nivel mundial. Los objetivos de este estudio fueron estimar la prevalencia de ERC en España y evaluar el impacto de la acumulación de factores de riesgo cardiovascular (FRCV) en la prevalencia. Material y métodos: Análisis del Estudio de Nutrición y Riesgo Cardiovascular en España (ENRICA), estudio epidemiológico de ámbito nacional, de base poblacional, con una muestra de 11.505 sujetos representativos de la población adulta española. La información se recogió mediante cuestionarios estandarizados, exploración física y colección de muestras de sangre y orina que se analizaron en un laboratorio centralizado. La ERC se definió según las guías KDIGO en curso. Se analizó la relación de la ERC con 10 FRCV (edad, hipertensión arterial, obesidad, obesidad abdominal, tabaquismo, colesterol LDL elevado, colesterol HDL disminuido, hipertrigliceridemia, diabetes y sedentarismo. Resultados: La prevalencia de ERC fue del 15,1% (IC 95%: 14,3-16,0). La ERC fue más frecuente en varones (23,1% vs. 7,3% en mujeres), según aumentaba la edad (4,8% en sujetos de 18-44 años, 17,4% en sujetos de 45-64 años, y 37,3% en sujetos ≥65 años), y en sujetos con enfermedad cardiovascular (39,8% vs. 14,6% en sujetos sin enfermedad cardiovascular); todas las comparaciones con p < 0,001. La ERC afectó al 4,5% de los sujetos con 0-1 FRCV, con un aumento progresivo desde el 10,4 al 52,3% en sujetos con 2 a 8-10 FRCV (p de tendencia <0,001). Conclusiones: La ERC afecta a uno de cada 7 adultos en España, una prevalencia más elevada que la estimada en estudios previos en nuestro país y similar a la observada en Estados Unidos. La ERC afecta particularmente a los varones, a sujetos de edad avanzada o con enfermedad cardiovascular. La prevalencia de ERC aumenta de forma marcada con la acumulación de FRCV, lo que sugiere que la ERC en la población podría considerarse como un trastorno cardiovascular. Keywords: Chronic kidney disease, Prevalence, Cardiovascular disease, Epidemiology, Public health, Palabras clave: Enfermedad renal crónica, Prevalencia, Enfermedad cardiovascular, Epidemiología, Salud pública
Properties of biodiesel can be related to the chemical composition of the biomass source used in transesterification. Saturated fatty acids confer high oxidative stability, while unsaturated fatty ...acids improve the cold flow properties, which are also influenced by the chain length. In the present study, blends of biodiesel produced from different vegetable oils were evaluated in order to obtain the proper blend to fulfill the European Standard EN14214 in terms of oxidative stability and cold flow properties. Citric acid was used to purify the methyl ester phase. Oxidative stability resulted highly dependent on polyunsaturated fatty esters while fatty ester chain length is a determining factor in cold flow performance of the blends. A preliminary study of the effectiveness of a commercial additive (a Poly alkyl methacrylate) in improving methyl ester flow at low temperatures was done, but no significant changes were found.
Background
Medication safety has long been recognized as a key issue within the broader patient safety agenda. Errors can occur at any step along the way, from prescribing to the ultimate provision ...of the drug to the patient.
Objective
To study the nature, frequency and potential causes of medication errors in one Spanish community pharmacy.
Methods
A study was conducted over a 13-month period. The data included three types of written reports of incidents: prescribing errors, dispensing near-misses, and dispensing errors. Data for medication errors were collected through the internal records of the pharmacy.
Results
The sample consisted of 42,000 individual prescriptions, in which there were 2,117 medication errors consisting of 1,127 prescribing errors, 216 dispensing errors, and 774 dispensing near-misses. On the basis of the number of prescriptions handled during the study period, we calculated an error rate of 5.0 % (95 % confidence interval 4.8–5.2 %). The most common cause was illegible prescription (26.2 %).
Conclusion
This study has shown the incidence of medication errors in the health system and the possibility of detecting them in the community pharmacy. Most of the errors that occurred were reported in the prescribing stage; dispensing errors were reported less frequently.
Patients with antibody deficiency disorders, such as primary immunodeficiency (PID) or secondary immunodeficiency (SID) to B-cell lymphoproliferative disorder (B-CLPD), are two groups vulnerable to ...developing the severe or chronic form of coronavirus disease caused by SARS-CoV-2 (COVID-19). The data on adaptive immune responses against SARS-CoV-2 are well described in healthy donors, but still limited in patients with antibody deficiency of a different cause. Herein, we analyzed spike-specific IFN-γ and anti-spike IgG antibody responses at 3 to 6 months after exposure to SARS-CoV-2 derived from vaccination and/or infection in two cohorts of immunodeficient patients (PID vs. SID) compared to healthy controls (HCs). Pre-vaccine anti-SARS-CoV-2 cellular responses before vaccine administration were measured in 10 PID patients. Baseline cellular responses were detectable in 4 out of 10 PID patients who had COVID-19 prior to vaccination, perceiving an increase in cellular responses after two-dose vaccination (
< 0.001). Adequate specific cellular responses were observed in 18 out of 20 (90%) PID patients, in 14 out of 20 (70%) SID patients and in 74 out of 81 (96%) HCs after vaccination (and natural infection in some cases). Specific IFN-γ response was significantly higher in HC with respect to PID (1908.5 mUI/mL vs. 1694.1 mUI/mL;
= 0.005). Whereas all SID and HC patients mounted a specific humoral immune response, only 80% of PID patients showed positive anti-SARS-CoV-2 IgG. The titer of anti-SARS-CoV-2 IgG was significantly lower in SID compared with HC patients (
= 0.040), without significant differences between PID and HC patients (
= 0.123) and between PID and SID patients (
=0.683). High proportions of PID and SID patients showed adequate specific cellular responses to receptor binding domain (RBD) neoantigen, with a divergence between the two arms of the adaptive immune response in PID and SID patients. We also focused on the correlation of protection of positive SARS-CoV-2 cellular response to omicron exposure: 27 out of 81 (33.3%) HCs referred COVID-19 detected by PCR or antigen test, 24 with a mild course, 1 with moderate symptoms and the remaining 2 with bilateral pneumonia that were treated in an outpatient basis. Our results might support the relevance of these immunological studies to determine the correlation of protection with severe disease and for deciding the need for additional boosters on a personalized basis. Follow-up studies are required to evaluate the duration and variability in the immune response to COVID-19 vaccination or infection.
PDF
