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We report, to our knowledge, the first successful treatment of novel Influenza A (H1N1)/2009 chronic pericardial effusion in an adult. This patient presented on admission respiratory failure and cardiac tamponade which required non invasive ventilation and drainage. Pericardial fluid polymerase chain reaction sequences were positive for Influenza A (H1N1)/2009 virus. Any other etiologies were discarded. Recidivating pericardial effusion after medical treatment, firstly with Oseltamivir, and afterwards, with colchicine and corticosteroids during six months, was solved with pericardiectomy.

To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP).Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared.Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used.Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

Resumen Fundamento y objetivo El consumo cronico de benzodiacepinas es frecuente en los pacientes ancianos. El objetivo del estudio es evaluar posibles diferencias entre los pacientes que toman benzodiacepinas y los que no. Ademas, se analiza si hay diferencias entre los tratados con benzodiacepinas segun si el motivo del ingreso hospitalario era medico o quirurgico. Pacientes y metodo Se realizo un estudio prospectivo y multicentrico de 393 pacientes ingresados por causa medica en 6 unidades geriatricas de agudos y se compararon con datos previos de 1.225 ingresados por fractura de femur. Se recogieron datos sociodemograficos, la capacidad funcional mediante el indice de Barthel (IB), la comorbilidad (indice de Charlson), y de deteccion de deterioro cognitivo (test de Pfeiffer). Resultados Se incluyeron 1.618 pacientes, con una media (DE) de edad de 82,9 (6,5) anos. Tomaban de forma cronica benzodiacepinas un total de 581 (35,9%) pacientes, 132 (33,6%) de los ingresos por causa medica y 449 (36,6%) de los ingresos por fractura de femur (p = 0,27). En el analisis multivariante se asocio a la toma de benzodiacepinas una mayor edad, el estar institucionalizado y un mayor consumo total de farmacos. Entre los pacientes que tomaban benzodiacepinas de forma cronica destacaba que los que ingresaban por causa medica vivian mas en la comunidad, caian menos, tenian un peor IB, y mayor comorbilidad y polifarmacia. Conclusiones Mas de una tercera parte de los pacientes mayores ingresados por causa medica o traumatologica tomaban benzodiacepinas de forma cronica. Existen diferencias en los perfiles de los pacientes segun tomaran o no benzodiacepinas, asi como entre los que tomaban benzodiacepinas segun cual fuera el motivo de ingreso hospitalario.

Resumen Fundamento La antibioticoterapia intravenosa domiciliaria (AID) ha demostrado su seguridad y eficacia en un gran numero de infecciones comunes. Sin embargo, existen pocos trabajos publicados sobre su papel en el tratamiento de las infecciones causadas por bacterias multirresistentes. Los objetivos de este trabajo son definir las caracteristicas clinicas y epidemiologicas de los pacientes con infecciones causadas por microorganismos multirresistentes tratados con AID, asi como estudiar su utilidad en este tipo de infecciones. Material y metodo Analizamos todos los pacientes que por requerir AID ingresaron en nuestra Unidad de Hospitalizacion a Domicilio (UHD) desde marzo de 2007 hasta febrero de 2010. Los pacientes se dividieron en dos grupos: los pacientes con infecciones causadas por microorganismos multirresistentes fueron incluidos en el grupo a estudio, mientras que el resto de pacientes formo el grupo control. Resultados Se incluyeron 487 pacientes, de los cuales 82 formaron el grupo a estudio. La comorbilidad y la dependencia fisica en este grupo fueron mayores que en el grupo control (p = 0,000 y p = 0,002 respectivamente). La mayoria de los pacientes tuvieron una evolucion clinica satisfactoria. Sin embargo, 17 (20,7%) pacientes del grupo a estudio reingresaron durante el tratamiento y otros 22 (26,8%) reingresaron 3 meses despues del alta definitiva de nuestra unidad, siendo las diferencias entre ambos grupos estadisticamente significativas. Conclusiones Los pacientes con infecciones causadas por microorganismos multirresistentes y AID tienen mayor comorbilidad, dependencia fisica y frecuencia de reingresos hospitalarios. Sin embargo, la AID es util en el tratamiento de este tipo de infecciones en pacientes adecuadamente seleccionados.

Este estudio analiza la visibilidad que tiene la publicidad insertada a modo de product placement en los videojuegos. Para ello se ha realizado una investigación cualitativa experimental mediante la tecnología de eye tracking que determinó las zonas de pantalla más visibles y eficientes para la inserción de marcas, en un entorno eminentemente lúdico. Esta investigación se centra en la eficacia y el recuerdo de las ubicaciones en nueve zonas de pantalla correspondientes a tres áreas verticales (derecha, central e izquierda) y tres áreas horizontales (superior, inferior y central). El objetivo es averiguar cuáles son las de mayor visibilidad y su asociación con el recuerdo, por parte del usuario, de cada una de las marcas anunciantes., This study aims on the visibility the product placement has in video games scenes. A qualitative experimental study with eye tracking was made in order to determine the most visible screen areas and, therefore, the most efficient ones for the brands insertion in a joyful environment. This study centers on efficiency and memory related with nine screen area locations: right, center and left; and upper, lower and central. The goal is to find the areas of greater visibility, and also the ones that maintain a greater recall for the brands.

Resumen Objetivo Las ulceras por presion (UPP) constituyen uno de los efectos adversos ligados a la hospitalizacion. En consecuencia se plantean los siguientes objetivos: determinar la prevalencia de las UPP en pacientes ingresados en un hospital terciario, describir las caracteristicas de las lesiones, conocer la utilizacion de superficies especiales de manejo de la presion (SEMP) y establecer lineas de actuacion para su disminucion. Metodo Estudio descriptivo, trasversal, de prevalencia en pacientes adultos ingresados entre el 11 y el 15 de mayo del 2009. Variables: demograficas, numero de UPP, unidad de ingreso, nivel de riesgo (escala de Gosnell modificada), estadio, localizacion, causa, origen de la lesion, utilizacion de SEMP. Resultados Se estudiaron 682 pacientes, 70 (10,3%) de los cuales presentaron al menos una lesion. El riesgo de aparicion de UPP en los pacientes valorados como alto riesgo es muy superior al de los pacientes valorados sin o de bajo riesgo (OR: 6,26 IC 95% 3,54–11,08; p La mayor parte de las lesiones fueron estadio i (39,1%) y estadio ii (35,2%), localizadas mayoritariamente en talon y sacro. El 83,8% de las UPP tuvieron origen intrahospitalario y la causa principal fue la presion (99%). Solo se utilizaron el 28,1% de las SEMP disponibles. Conclusiones El porcentaje global es mas elevado con lesiones menos graves. Se debe identificar y aplicar medidas preventivas precozmente en los pacientes de mayor riesgo. En nuestro medio, la utilizacion de las SEMP es escasa en relacion a los pacientes de riesgo.

Sustainable energy supply models are needed to achieve the Millennium Development Goals established by the United Nations for 2015. However, sustainability of agricultural development in rural areas is a prerequisite to achieve the objective of halving the proportion of people who live in poverty, and productivity of such development is closely related to energy supply. This article analyses the results of a survey of experts, suggesting that there may be a good chance to innovate in the financing of agricultural electrification projects in developing countries. The experts' opinion suggests that new sources of financing could be mobilised and oriented towards the promotion of sustainable initiatives in developing countries. Financial mechanisms should be adapted to the characteristics of decentralised systems of energy production with renewable sources or with mixed technologies, in order to overcome barriers derived from the high initial price of the applications, and to the specific conditions of the a...

ResumenObjetivosComparar la satisfacción de los usuarios de 4 hospitales de agudos.MétodosLa población estuvo formada por sujetos que habían sido hospitalizados durante enero y febrero de 2002 en 4 hospitales del Servicio Vasco de Salud-Osakidetza. Se seleccionaron 650 pacientes de cada centro, a quienes se envoi un cuestionario de satisfacción compuesto por 34 ítems que se resumen en 6 factores. Se crearon puntuaciones independientes para cada factor. Se compararon las variables sociodemográficas y del episodio, algunas preguntas globales y las puntuaciones medias de los factores en los 4 hospitales.ResultadosSe hallaron diferencias entre los hospitales respecto a la edad, el número de ingresos anteriores, el tipo de servicio, los días de estancia y las preguntas que evaluaban el tiempo de espera desde que el usuario llegó al hospital hasta que fue ingresado. Aunque el grado de satisfacción en general fue alto, se pudieron detectar diferencias en función del hospital y el área evaluados. Así, los usuarios ingresados en el hospital 3 mostraron mayor grado de satisfacción en los factores «información», «trato» y «bienestar», y el grado de satisfacción más bajo en estos factores se detectó en el hospital 1. Los resultados observados en el análisis univariante apenas variaron en el multivariante.ConclusionesLa disponibilidad de un cuestionario de estas características ha permitido obtener resultados comparables entre los hospitales participantes en el estudio, convirtiéndose así en un instrumento que permite detectar areas de excelencia y de mejora.AbstractObjectivesTo compare patient satisfaction in 4 acute hospitals.MethodsThe sample was composed of individuals admitted to 4 hospitals in the Basque Health Service (Osakidetza, Spain) in January and February 2002. Six hundred and fifty patients were selected from each hospital and were sent a satisfaction questionnaire composed of 34 items summarized in 6 factors. Independent scores for each factor were created. Sociodemographic variables, those related to admission, as well as some global questions and the average scores of the factors were compared among the 4 hospitals.ResultsDifferences between the 4 hospitals were found in age, the number of previous admissions, type of service, length of hospital stay, and the questions evaluating satisfaction with waiting time between users’ arrival at the hospital and admission. Although the degree of satisfaction was high, differences were detected depending on the factor and the hospital. Thus, «information», «dealings with staff» and «comfort» were rated more highly by users of hospital 3 than by those of hospital 1. The results observed in the univariate analysis changed only slightly in the multivariate models.ConclusionsThe questionnaire used allowed comparable results to be obtained among the 4 hospitals participating in this study and identified areas of excellence and areas requiring improvement in each of the centers.

In this doctoral thesis, we apply premises of cognitive linguistics to terminological definitions and present a proposal called the flexible terminological definition. This consists of a set of definitions of the same concept made up of a general definition (in this case, one encompassing the entire environmental domain) along with additional definitions describing the concept from the perspective of the subdomains in which it is relevant. Since context is a determining factor in the construction of the meaning of lexical units (including terms), we assume that terminological definitions can, and should, reflect the effects of context, even though definitions have traditionally been treated as the expression of meaning void of any contextual effect. The main objective of this thesis is to analyze the effects of contextual variation on specialized environmental concepts with a view to their representation in terminological definitions. Specifically, we focused on contextual variation based on thematic restrictions. To accomplish the objectives of this doctoral thesis, we conducted an empirical study consisting of the analysis of a set of contextually variable concepts and the creation of a flexible definition for two of them. As a result of the first part of our empirical study, we divided our notion of domain-dependent contextual variation into three different phenomena: modulation, perspectivization and subconceptualization. These phenomena are additive in that all concepts experience modulation, some concepts also undergo perspectivization, and finally, a small number of concepts are additionally subjected to subconceptualization. In the second part, we applied these notions to terminological definitions and we presented we presented guidelines on how to build flexible definitions, from the extraction of knowledge to the actual writing of the definition., PhD Thesis. in Spanish. University of Granada. 2016

El objetivo de este trabajo es analizar el grado de armonización contable internacional, a través de la comparación simulada del ciclo contable y el balance final de una misma empresa sometida a las regulaciones nacionales de España y Canadá. Partiendo de los mismos elementos patrimoniales y realizando las mismas operaciones, se aplican las regulaciones nacionales de ambos países para comparar, al final de un ciclo contable, el balance resultante. La compañía sometida a esta comparación es una bodega de tamaño medio, basada en la empresa real Bodegasmasquevinos, dedicada a la producción de vinos en Castilla-La Mancha. Una vez analizados los resultados de esta comparación, se concluye que ambas regulaciones, aun perteneciendo a entornos económicos muy diferentes y partiendo de regulaciones propias dispares, presentan en la actualidad un alto grado de armonización contable. Esta circunstancia es debida a la influencia de la normativa IFRS internacional, incorporada parcialmente en ambos países. Sin financiación No data (2016) UEM

For the 2 billion people who lack access to electricity, renewable off-grid decentralized projects can be a viable solution. A survey by the Universidad Politecnica de Madrid suggests that renewable energy funds are regarded as the most suitable financial instrument, although innovation in the finance of renewable energy sources is also of enormous importance.

En este texto, el P. Antonio San Cristóbal, con gran rigor en el análisis arquitectónico y apreción artística, hará la descripción de la histórica Casa Hacienda Punchauca. Así, analizará la distribución de su planta, las fachadas, la distribución interna de la casa de vivienda, el conjunto de la capilla y sacristía. De ese modo, el autor concluirá con una exhortación al rescate de este importante recinto.

Fundamento y objetivo La antibioterapia domiciliaria es una modalidad asistencial alternativa a la hospitalizacion a domicilio que ha demostrado su seguridad en un gran numero de enfermedades infecciosas. Los objetivos principales de este articulo son: a) exponer nuestra experiencia, como unidad de hospitalizacion a domicilio (UHD) integrada dentro del servicio de medicina interna, en el tratamiento antibiotico intravenoso, y b) definer los parametros que pueden predecir un reingreso hospitalario. Pacientes y metodo Se incluyo en el estudio a todos los pacientes ingresados en nuestra UHD por enfermedad infecciosa subsidiaria de antibioterapia intravenosa desde marzo de 2006 hasta marzo de 2007. Resultados Se incluyo en el estudio a 145 pacientes. El 92% de los casos recibio el alta por buena evolucion clinica. Once pacientes ingresaron en el hospital durante el episodio clinico como consecuencia de la propia infeccion, y solo 2 presentaron algun tipo de reaccion adversa a causa del tratamiento. Veintidos pacientes ingresaron en el hospital 3 meses despues del alta de la UHD, fundamentalmente por enfermedad cronica. Conclusiones La antibioterapia intravenosa domiciliaria es una buena opcion asistencial en una gran variedad de enfermedades infecciosas. A pesar de ello, la propia infeccion y el estado basal del paciente influyen activamente en la probabilidad de reingresos hospitalarios.

Fundamento y objetivo El delirium es un problema frecuente durante el ingreso hospitalario. Estudiamos la prevalencia de delirium en los pacientes ingresados en unidades de hospitalizacion de medicina interna general. Un segundo objetivo fue analizar si habia diferencias entre los pacientes con o sin delirium. Pacientes y metodo Estudio transversal de 165 pacientes ingresados por procesos medicos en 6 unidades de hospitalizacion de medicina interna general. Se cuantifico la capacidad funcional mediante el indice de Barthel (IB) y la comorbilidad mediante el indice de Charlson. Se utilizo el Confusional Assessment Method para el diagnostico de delirium en forma de corte transversal. Resultados Se ha evaluado a 101 mujeres (61,2%) y 64 varones, con una media (desviacion estandar) de edad de 80,3 (12) anos. La media del indice de Charlson fue de 2,6 (1,7). La media del IB previo al ingreso fue de 71,5 (27) y en el momento de la valoracion era de 40,3 (30). Presentaban delirium en el momento de la valoracion 42 (25,4%) pacientes. La regresion logistica mostro como variables independientes asociadas a tener delirium un peor IB en el momento de la valoracion y el diagnostico previo de demencia. Conclusiones Un alto porcentaje de los pacientes ingresados en unidades de hospitalizacion de medicina interna general presentan delirium. El deterioro cognitivo previo y una peor puntuacion en el IB en el momento de la valoracion tienen relacion con mayor riesgo de tener delirium.

To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit.A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge.A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge.The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.

Purpose: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and olderwere randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. Results: 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (>= 10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR = 14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.81-4.28]. Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different. (c) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

En este trabajo se analiza el proceso de normalización y armonización contable de las legislaciones financieras de España y Brasil. Ambos países han desarrollado sus normativas contables desde contextos financieros y económicos diferentes, pero se han orientado hacia un objetivo común: la aproximación a la armonización contable internacional. Se trata del inicio de un estudio de mayor amplitud que pretende investigar el proceso de acercamiento de ambos cuerpos normativos, y valorar el grado de armonización contable entre dos países con importantes relaciones económicas. Partiendo de la definición y los objetivos de la contabilidad internacional y su proceso armonizador, se expone la evolución de la normalización contable en ambos países, al examinar la modificación de sus normativas y los organismos que las promovieron. Así mismo, se presenta una revisión de la literatura sobre ambos procesos de armonización contable. Ambos países participan en este proceso armonizador desde la década de los 70, como queda demostrado tras analizar la evolución de sus cuerpos normativos. Sin financiación No data (2014) UEM

Purpose: There are limited tools to assess potential prescribing omissions (PPOs) or underprescribing in the elderly. The ACOVE project defines comprehensive quality care indicators for older people and some of these indicators focused on appropriate use of medicines. The aim of the present study was to assess the inter-rater reliability between observers using the ACOVE 3 prescribing indicated medications indicators and compare it with the inter-rater reliability obtained for the Screening Tool of Older Person's Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Methods: In the context of an observational and multicentric study of a cohort of 672 patients 75 years and older who were hospitalized in Internal Medicine services of seven Spanish hospitals, an inter-rater reliability study using the ACOVE selected indicators and the STOPP/START criteria was carried out between April 2011 and March 2012. Three patients were randomly selected in each participating hospital, one for each four months of study. Results: A total of 21 patients (mean (SD) age of 84.3 (5.6) years, 57.1% female) were included in the inter-rater reliability study. For the STOPP, START and ACOVE criteria, the median kappa coefficient for the seven hospital analyses was 0.97, 0.92 and 0.95, respectively. Out of 123 total indicators in only 7 (5.7%) was the kappa coefficient value below 0.75. Only for 2 (5.6%) of the 37 studies selected ACOVE quality indicators was the kappa coefficient value less than 0.75. Conclusions: A high inter-rater reliability was obtained for the selected underprescribing quality indicators of ACOVE 3. These quality indicators may be considered a useful tool in detecting underprescribing to the elderly patients. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Different types of wooden vaults are described in the study texts. These vaults turned up in Lima as response to several earthquakes at the end of the Seventeenth Century. Wooden vaults replaced then Lime and brick vaults. The most popular and economic vault type was that one made of rushes and mud, which is called "quincha" vault. These roofing techniques were developed in the very artistic boundaries of the city, therefore they were not an "European non-Iberian contribution" as it has been said up until now. There is a comment on the vaults of the Prado Church which is supported by documentation that proves this affirmation.

Chronic consumption of benzodiazepines is common in elderly patients. The aim of the study was to analyse the possible differences between patients taking benzodiazepines and those without them. We also determined, among patients on benzodiazepines, if any differences were related to medical or surgical admissions.We performed a prospective and multicentre study of 393 patients admitted consecutively for medical reasons to 6 geriatrics acute units; these patients were compared to 1,225 patients hospitalized for a hip fracture. We collected sociodemographic data, functional capacity by the Barthel's index (BI), comorbidity by the Charlson's index and cognitive impairment by the Pfeiffer test.We evaluated 1,618 patients, with a median age of 82.9 (6.5) years. Among patients admitted for medical causes, 581 (35.9%) were taking benzodiazepines chronically as did 449 (36.6%) patients in the hip fracture group (p=0.27). In the multivariate analysis, factors associated with the use of benzodiazepines included older age, institutionalization and a higher number of drug consumption. Differences according to the admission reason showed that patients admitted for medical causes lived more frequently in the community and had less falls, worse BI as well as a higher number of comorbidities and polypharmacy.More than one third of elderly patients hospitalized for medical or traumatology causes were taking benzodiazepines chronically. Different patients' profiles can be observed according to whether they are or not taking benzodiazepines and to the admission's cause in the subgroup of patients on benzodiazepines.

Producción Científica, This article describes the rationale and design of a population-based survey of dementia in Valladolid (northwestern Spain). The main aim of the study was to assess the epidemiology of dementia and its subtypes. Prevalence of anosognosia in dementia patients, nutritional status, diet characteristics, and determinants of non-diagnosed dementia in the community were studied. The main sociodemographic, educational, and general health status characteristics of the study population are described. Methods: Cross-over and cohort, population-based study. A two-phase door-to-door study was performed. Both urban and rural environments were included. In phase 1 (February 2009 – February 2010) 28 trained physicians examined a population of 2,989 subjects (age: ≥ 65 years). The seven-minute screen neurocognitive battery was used. In phase 2 (May 2009 – May 2010) 4 neurologists, 1 geriatrician, and 3 neuropsychologists confirmed the diagnosis of dementia and subtype in patients screened positive by a structured neurological evaluation. Specific instruments to assess anosognosia, the nutritional status and diet characteristics were used. Of the initial sample, 2,170 subjects were evaluated (57% female, mean age 76.5 ± 7.8, 5.2% institutionalized), whose characteristics are described. 227 persons were excluded for various reasons. Among those eligible were 592 non-responders. The attrition bias of non-responders was lower in rural areas. 241 screened positive (11.1%). Discussion: The survey will explore some clinical, social and health related life-style variables of dementia. The population size and the diversification of social and educational backgrounds will contribute to a better knowledge of dementia in our environment. Keywords: Dementia prevalence, Epidemiology, Undiagnosed dementia, Population-based survey, Seven-minute screen, Anosognosia, Nutritional assessment

Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections.We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group.A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions.Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected.

Using the documentary evidence of the city of Lima, this paper analyses the careers of the main alarifes, or master builders, during the 17th century, as well as the regulations affecting them and the duties they performed. They are all featured in charts at the end of the article, covering the years in which they worked.

Objective. To assess the effectiveness of an intervention after comprehensive geriatric assessment (CGA) in reducing morbidity and mortality in patients over 74 years in primary care. Methods. Randomized controlled trial with 18 months of follow-up. Patients in the control group (CG) followed usual care. Patients in the intervention group (IG) were classified as at risk or non-risk of frailty based on the CGA. Patients at non-risk of frailty in the IG were provided with recommendations about healthy habits and adherence to treatment in group sessions, while patients at risk of frailty were visited individually by a geriatrician. Results. Six hundred and twenty patients were randomized to the IG (49.7%) or to the CG (50.3%), 83.2% completed follow-up. Cox’s proportional hazards model showed as covariates the study group (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.28–1.22), risk of frailty (HR 1.33; 95% CI 0.71–2.51) and the interaction between both (HR 3.08; 95% CI 1.22–7.78). Forty-nine percent of the patients in the IG and 43% in the CG were at risk of frailty at baseline. At the end of the study, 27.9% of the IG and 13.5% of the CG had reversed their initial at risk of frailty status (P = 0.027). Multivariate predictors of reversible risk of frailty were younger age, not being at risk of depression, low consumption of medications and the intervention itself. Conclusions. A specific intervention in patients over 74 years attended in primary care reduces morbidity and mortality in patients at risk of frailty and increases the proportion of patients that reversed their initial status at risk of frailty.

The pressure ulcers (PU) are one of the adverse effects associated with hospitalisation. The aims of this study are, to determine the prevalence of PU in patients admitted to a tertiary hospital, to describe the characteristics of the injuries, to find out the frequency of use of special surfaces for managing pressure (SSMP), and to establish lines of action for their prevention.This is a cross-sectional study of adults patients admitted to hospital between May 11 and 15, 2009. Collected variables are: demographic data, number of PU, admission unit, risk level (measured by modified Gosnell's scale), stage, location, cause, origin of the injury and SSMP.A total of 683 patients were studied, of which 70 (10.3%) of them had at least one wound. The risk of developing PU in patients evaluated as high risk, is more than those patients evaluated as no or low risk (OR: 6.26; 95% CI; 3.54-11.08; p0.001). Most of the wounds they were stage I (39.1%) and stage II (35.2%), located mostly in the heel and sacrum, and (83.8 %) of the PU were of hospital origin. Only 28.1% of the available SSMP were used.The overall percentage of PU is greater than that reported in other studies, but with less severe injuries. Patients at risk need to be identified and early preventive measures applied. In our hospital the use of SSMP is low in relation to the number of patients at risk.

Intravenous antibiotic therapy at home has showed its efficacy as an alternative to hospitalization care in many infectious pathologies. The objectives of this study are: a) to expose our experience, as hospital at home unit (HHU) integrated within a service of internal medicine, in the antibiotic treatment, and b) to define those parameters that can predict hospital readmissions.This study included all patients with infectious pathology and intravenous antibiotic therapy who were admitted in our HHU from March 2006 to March 2007.145 patients were included in this study. Successful treatment was observed in 92% of patients. Eleven patients were re-admitted at hospital during the episode by infectious disease, and only 2 of them showed adverse effects to treatment. Twenty-two patients were re-admitted at hospital 3 months after due to chronic pathology.Intravenous antibiotic therapy at home is a good alternative in many infectious pathologies. Infectious pathology and baseline state can be predictors of hospital readmissions.

Sustainable energy supply models are needed to achieve the Millennium Development Goals established by the United Nations for 2015. On the other hand, sustainability of agricultural exploitations in rural areas is a pre-requisite to achieve the objective of halving the proportion of people that lives in poverty, and productivity of such exploitations is closely related to energy supply. This article analyses the results of a survey of experts, suggesting that there may be good chances to innovate in the financing of agricultural electrification projects in developing countries. The experts’ opinion suggests that new sources of financing could be mobilised and oriented towards the promotion of sustainable initiatives in developing countries. Financial mechanisms should be adapted to the characteristics of decentralised systems of energy production with renewable sources or with mixed technologies, in order to overcome the barriers derived from the high initial price of the applications, and to the specific conditions of the agricultural sector. The participation of funds from the beneficiaries and the incorporation of the beneficiaries in the initial phases of project organisation would allow for the development of productive solutions with a higher potential to generate resources and to articulate sustainable proposals. r 2007 Elsevier Ltd. All rights reserved.

To compare patient satisfaction in 4 acute hospitals.The sample was composed of individuals admitted to 4 hospitals in the Basque Health Service (Osakidetza, Spain) in January and February 2002. Six hundred and fifty patients were selected from each hospital and were sent a satisfaction questionnaire composed of 34 items summarized in 6 factors. Independent scores for each factor were created. Sociodemographic variables, those related to admission, as well as some global questions and the average scores of the factors were compared among the 4 hospitals.Differences between the 4 hospitals were found in age, the number of previous admissions, type of service, length of hospital stay, and the questions evaluating satisfaction with waiting time between users' arrival at the hospital and admission. Although the degree of satisfaction was high, differences were detected depending on the factor and the hospital. Thus, "information", "dealings with staff" and "comfort" were rated more highly by users of hospital 3 than by those of hospital 1. The results observed in the univariate analysis changed only slightly in the multivariate models.The questionnaire used allowed comparable results to be obtained among the 4 hospitals participating in this study and identified areas of excellence and areas requiring improvement in each of the centers.