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The multimorbidity approach involves promotional and preventive strategies. The demand for rehabilitation services has grown exponentially in recent years, leading to the urgency of rethinking care delivery. In Chile, there are laws, programs, and guidelines that, from their theoretical basis, include a person-centered care focus. But in real practice, multiple barriers trigger important fragmentation of care. In response, a new strategy has been proposed to answer whether comprehensive rehabilitation care based on multimorbidity positively impacts the health system performance, people's functionality, and quality of life, which will be implemented as a pilot study with a national scale-up focus.

El enfoque de multimorbilidad implica estrategias promocionales y preventivas. La demanda de servicios de rehabilitación ha crecido exponencialmente en los últimos años, lo que ha llevado a la urgencia de repensar la organización y entrega de prestaciones. En Chile existen leyes, programas y lineamientos que, desde su base teórica, incluyen un enfoque de atención centrado en la persona. Pero en la práctica real, múltiples barreras generan una importante fragmentación de la atención. En respuesta, se ha propuesto una nueva estrategia para responder si una rehabilitación integral basada en el enfoque de la multimorbilidad impacta positivamente en el desempeño del sistema de salud, la funcionalidad de las personas y la calidad de vida, que se implementará como un estudio piloto con un enfoque de escalamiento nacional.

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Microalgae grow in diverse environments and possess a great biotechnological potential as they contain useful bioactive compounds. These bioactive compounds can be obtained by selective and energy-efficient extraction methods. Various industries are using the supercritical fluid extraction (SFE) method to extract these valuable bioactive compounds. Hence, for the first time, we evaluated the effects of SFE on the recovery of bioactive and antioxidant compounds using Coccomyxa onubensis, a eukaryotic acidophilic microalga of potential relevance which can be used in the field of nutraceutical and functional foods. It was isolated from the Tinto River (Pyritic Belt, Huelva, Spain), a mining region in Spain. Variables such as extraction yield, lutein purity (LP) and recovery (LR), total phenols, and antioxidant capacity (Trolox equivalents antioxidant capacity method) were studied using a Box-Behnken design based on a response surface methodology along with the overall extraction curve fitted to a spline linear model. The effects of temperature (30, 50, and 70 °C), pressure (25, 40, and 55 MPa), and the percentage of co-solvent (0, 25%, and 50% v/v ethanol) on SFE were analyzed, resulting in the co-solvent and temperature as the most significant factors followed by the pressure. Under 70 °C, 40 MPa, and 50% v/v ethanol, C. onubensis reached a maximum of 66.98% of LR. The extracts were richest in total phenols and showed the maximum antioxidant activity (36.08 mg GAEs/g extracts and 2.237 mmol TE/g extracts, respectively) under similar pressure and co-solvent percentage values and different temperatures (30 and 70 °C, respectively). The extracts obtained in this study may have potential applications in the food, nutraceutical, and cosmetic industries. SFE is a highly efficient method to valorize microorganisms living in extreme environments, which are so far unexplored using green extraction methods.

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Phaeodactylum tricornutum is the marine diatom best known for high-value compounds that are useful in aquaculture and food area. In this study, fucoxanthin was first extracted from the diatom using supercritical fluid extraction (SFE) and then using the extracted diatom-like substrate to produce bioenergy through anaerobic digestion (AD) processes. Factors such as temperature (30 °C and 50 °C), pressure (20, 30, and 40 MPa), and ethanol (co-solvent concentration from 10% to 50% v/v) were optimized for improving the yield, purity, and recovery of fucoxanthin extracted using SFE. The highest yield (24.41% w/w) was obtained at 30 MPa, 30 °C, and 30% ethanol but the highest fucoxanthin purity and recovery (85.03mg/g extract and 66.60% w/w, respectively) were obtained at 30 MPa, 30 °C, and 40%ethanol. Furthermore, ethanol as a factor had the most significant effect on the overall process of SFE. Subsequently, P.tricornutum biomass and SFE-extracted diatom were used as substrates for biogas production through AD. The effect of fucoxanthin was studied on the yield of AD, which resulted in 77.15 ± 3.85 LSTP CH4/kg volatile solids (VS) and 56.66 ± 1.90 LSTP CH4/kg VS for the whole diatom and the extracted P.tricornutum, respectively. Therefore, P.tricornutuman can be considered a potential source of fucoxanthin and methane and both productions will contribute to the sustainability of the algae-biorefinery processes.

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Background and objectives: When the drowning timeline evolves and drowning occurs, the lifeguard tries to mitigate the event by applying the last link of the drowning survival chain with the aim of treating hypoxia. Quality CPR (Cardiopulmonary Resuscitation) and the training of lifeguards are the fundamental axes of drowning survival. Mobile applications and other feedback methods have emerged as strong methods for the learning and training of basic CPR in the last years so, in this study, a randomised clinical trial has been carried out to compare the traditional method as the use of apps or manikins with a feedback system as a method of training to improve the quality of resuscitation. Materials and Methods: The traditional training (TT), mobile phone applications (AP) and feedback manikins (FT) are compared. The three cohorts were subsequently evaluated through a manikin providing feedback, and a data report on the quality of the manoeuvres was obtained. Results: Significant differences were found between the traditional manikin and the manikin with real-time feedback regarding the percentage of compressions with correct depth (30.8% (30.4) vs. 68.2% (32.6); p = 0.042). Hand positioning, percentage correct chest recoil and quality of compressions exceeded 70% of correct performance in all groups with better percentages in the FT (TT vs. FT; p < 0.05). Conclusions: As a conclusion, feedback manikins are better learning tools than traditional models and apps as regards training chest compression. Ventilation values are low in all groups, but improve with the feedback manikin.

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Ante la excepcionalidad de un paciente con presencia de múltiples estomas (colostomía, cistostosmía y nefrostomía), este trabajo indaga cómo le afecta su situación, y se completa con los propios cuidados de enfermería en pacientes ostomizados.La valoración del paciente se realizó a partir de los patrones funcionales de Marjory Gordon, planteando un plan de cuidados individualizado. La realización de un proceso de atención de enfermería (PAE) sirvió de guía para realizar los cuidados de manera dinámica, deliberada y ordenada. Además, se le facilitaron cuestionarios para valorar la esfera emocional, lo que ayudó a entender las debilidades del paciente.En cuanto al proceso de curación de las heridas quirúrgicas y los estomas, un seguimiento cercano, así como el uso de los materiales apropiados e involucrar al paciente y familiares en dichos cuidados, disminuye las complicaciones asociadas

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OBJECTIVE: To determine if gender and age are associated with differences in mortality in patients requiring critical care. DESIGN: Retrospective analysis of prospectively collected data over 6 consecutive years. SETTING: Polyvalent intensive care unit (ICU) of a tertiary hospital in the Canary Islands. PATIENTS: Adult patients who were hospitalized in the ICU, divided on the basis of gender and age (or=65 years). PRIMARY VARIABLES OF INTEREST: Demographic and clinical diagnosis data on ICU admission, APACHE II, days of mechanical ventilation, days of renal replacement therapy (RRT) and the mortality were collected. RESULTS: During the study period, 3786 patients were admitted to the ICU, 66.7% male and 2469 (65.2%)<65 years. Mortality in the ICU of the coronary group was greater in women (11.1% vs 6.7%; p=0.02), even though there were no significant differences between both genders in the APACHE II (p=0.56). No statistically significant differences were found according to gender in age (or=65 years), in the APACHE II, or in the need for mechanical ventilation or renal replacement therapy as well as in the ICU mortality. We also found no differences in the mortality between the diagnostic groups and gender even when the APACHE II was significantly greater on admission, as occurred for the women<65 years of the coronary and traumas group and for women with surgery>or=65 years. CONCLUSIONS: No significant differences were demonstrated in the outcome in relationship with gender except for in the coronary group in which mortality was greater in women. Age above or below 65 years had no influence on mortality in our patients.

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OBJECTIVE: To compare the degree of severity of burnout syndrome among the healthcare personnel of an intensive care unit (ICU) and admission wards. METHOD: We performed a cross-sectional, descriptive study with nurses and nurses' aides in the ICU and admission wards of the Hospital Universitario Insular de Gran Canaria (Spain). An anonymous survey was performed through the 22-item Maslach Burnout Inventory, which measures the three dimensions of burnout syndrome: emotional exhaustion, depersonalization and personal accomplishment. RESULTS: We interviewed 92 nurses (61% from the ICU and 39% from admission wards) and 80 nurses' aides (51% from the ICU and 49% from admission wards). In all groups, a moderate degree of emotional exhaustion was found, which was more severe in nurses' aides working on admission wards than in those working in the ICU (22.26, SD=7.47 vs 26.51, SD=7.12, p=0.011). High levels of depersonalization and emotional exhaustion were found in all groups, with no significant difference among staff working in the ICU or admission wards. CONCLUSIONS: No significant differences were found in the perception of burnout between staff in the ICU or in admission wards. The degree of emotional exhaustion was moderate, while degrees of depersonalization and lack of personal accomplishment were high.

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Objetivo. comparar el grado de severidad del síndrome de burnout entre el personal sanitario de una unidad de medicina intensiva (UMI) y de las plantas de hospitalización. Método. Estudio transversal, descriptivo, llevado a cabo entre el personal de enfermería y auxiliar de la UMI y de las plantas de hospitalización del Hospital Universitario Insular de Gran Canaria. Se realizó una encuesta anónima, utilizando como instrumento el Maslach Burnout Inventory, que consta de 22 ítems y que explora los 3 componentes del burnout, como el agotamiento emocional, la despersonalización y la falta de realización personal en el trabajo. Resultados. Se entrevistaron 92 enfermeras/os, el 61% de UMI y el 39% de las plantas de hospitalización, y a 80 miembros del personal auxiliar, el 51% de UMI y el 49% de las plantas. El agotamiento emocional se encuentra en el nivel medio en todos los grupos, y es mayor entre el personal auxiliar de la planta que el de la UMI (22,26; desviación estándar [DE]=7,47 frente a 26,51; DE=7,12; p=0,011). En cuanto a la despersonalización y el agotamiento emocional se encontraron elevados niveles de estrés en todos los grupos, sin encontrar diferencias significativas entre el personal de la UMI o de las plantas de hospitalización. Conclusiones. No se han encontrado diferencias en la percepción del burnout entre el personal de la UMI y de las plantas de hospitalización, que es moderado en cuanto al agotamiento emocional, y elevado en lo que respecta a la despersonalización y la falta de realización personal en el trabajo (AU)

Objective.To compare the degree of severity of burnout syndrome among the healthcare personnel of an intensive care unit (ICU) and admission wards. Method. We performed a cross-sectional, descriptive study with nurses and nurses′ aides in the ICU and admission wards of the Hospital Universitario Insular de Gran Canaria (Spain). An anonymous survey was performed through the 22-item Maslach Burnout Inventory, which measures the three dimensions of burnout syndrome: emotional exhaustion, depersonalization and personal accomplishment. Results. We interviewed 92 nurses (61% from the ICU and 39% from admission wards) and 80 nurses′ aides (51% from the ICU and 49% from admission wards). In all groups, a moderate degree of emotional exhaustion was found, which was more severe in nurses′ aides working on admission wards than in those working in the ICU (22.26, SD=7.47 vs 26.51, SD=7.12, p=0.011). High levels of depersonalization and emotional exhaustion were found in all groups, with no significant difference among staff working in the ICU or admission wards. Conclusions. No significant differences were found in the perception of burnout between staff in the ICU or in admission wards. The degree of emotional exhaustion was moderate, while degrees of depersonalization and lack of personal accomplishment were high (AU)

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It has been hypothesized that a Theory of Mind (ToM) deficit could be a vulnerability marker for psychosis. Recent studies, however, have shown ToM deficits in affective relapses of bipolar disorder as well as in the euthymic phase. This study analyzes the relationship between ToM and a previous history of psychotic symptoms in bipolar disorder. ToM, sustained attention and executive functions were analyzed in 75 bipolar euthymic patients with three or more previous relapses (42 of them had a history of psychotic symptoms and 33 did not) and 48 healthy subjects. ToM was assessed with the Advanced Test by Happé. ToM performance was similar in bipolar patients with or without a history of psychotic symptoms, and in both cases it was significantly reduced as compared with the healthy control group. Similarly, both bipolar groups showed impaired sustained attention and executive functions. This general cognitive deficit partially explains the differences obtained in ToM. The ToM instrument used shows low sensitivity for assessing ToM in bipolar patients and it could partially reflect general cognitive functioning rather than a specific deficit in psychosis. ToM deficit is not a trait marker for psychosis, given that it is present in bipolar disorder regardless of a previous history of psychotic symptoms.

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