El desgaste por empatía es un concepto relativamente reciente y en evolución que ha captado el interés de los profesionales sanitarios debido a que el trabajo en el ámbito de la salud implica un coste emocional que repercute en la misma salud del trabajador y en su labor profesional. Según la literatura revisada, los programas en prevención en todos los niveles de este tipo de estrés son escasos, por lo tanto, el objetivo de este trabajo es proponer un programa de prevención del desgaste por empatía en profesionales sanitarios de una unidad de diálisis de hospital. La idea surgió de la necesidad manifiesta por la Unidad de Diálisis del Hospital Universitario Infanta Sofía (HUIS), hacia la Unidad de Salud Mental del mismo Hospital y de la confianza depositada en la investigación académica, relacionada con la dificultad en el afrontamiento a la muerte de pacientes de la Unidad, por parte del personal asistencial. El propósito es entonces entrenar a los profesionales en estrategias de regulación emocional del desgaste por empatía, con el fin de disminuir los niveles de este tipo de estrés y prevenir su futura aparición, por medio del desarrollo de 6 módulos, que se llevarán a cabo a través de diferentes ciclos y que puede tener continuidad a través de una modalidad de Formación Continuada. Se ha diseñado una evaluación estandarizada con el fin de medir la presunta efectividad del programa para prevenir el desgaste por empatía. Se realiza una valoración sobre los resultados esperados, las conclusiones del diseño de la propuesta del programa, así como de sus limitaciones y sobre futuras líneas de investigación. Abstract: The compassion fatigue is a relatively recent and evolving concept that has captured the interest of health professionals because working in health implies an emotional cost that affects the health and the worker performance. According to the revised literature, prevention programs at all levels of this kind of stress are scarce, therefore, the objective of this work is to propose a program of prevention of compassion fatigue in healthcare professionals of a dialysis unit of a hospital. The idea came up from the necessity exposed by the Dialysis Unit of the Hospital Universitario Infanta Sofia (HUIS), towards the Mental Health Unit of the same Hospital and from the confidence placed in the academic research, related to the difficulty of facing death of patients of the unit, by the assistance personnel. The purpose is then to train professionals in strategies of emotional regulation of compassion fatigue, in order to reduce the levels of this type of stress and prevent its future emergence, through the development of 6 modules, which will be carried out through different cycles and that can have continuity through a continuous training modality. A standardized assessment has been designed to measure the presumed effectiveness of the program to prevent the compassion fatigue. An assessment is made of the expected results, the conclusions of the design of the program proposal, as well as its limitations and future lines of research.

Background: The effect of early surgery in elderly patients with hip fractures has been controversial during the last five decades due to equivocal evidence both in favour and against it. The objective of this thesis is to systematically assess all the available evidence on the effect(s) of early surgery compared with delayed surgery in elderly patients with hip fractures. Methods: Searches for randomised controlled trials (RCTs) or prospective observational studies were conducted from inception to July 2017 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), and they were complemented with list of references searching, review of both clinical trials registers and archives of orthopaedic meetings. Two reviewers independently selected studies for inclusion, extracted data and evaluated risk of bias; and a third reviewer resolved discrepancies. Risk ratios (RR) were calculated for dichotomous data, and mean difference (MD) or standardised mean difference (SMD) was calculated for continuous data. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: 39 studies were included with 51,857 participants (range of mean age: 74 to 93 years) comparing early versus delayed surgery. Three studies were RCTs and 36 were observational studies. The evidence from RCTs and observational studies showed that early surgery reduces risk of all-cause 3 mortality in elderly patients with a hip fracture (RR 0.73, 95% confidence interval (CI) 0.65 to 0.83; I2 = 67%; number needed to treat for benefit (NNTB) 20; low quality of evidence). Observational studies showed reduced risk of all-cause mortality by early surgery at 6 (RR 0.77, 95% CI 0.66 to 0.91; I2 = 56%; very low quality of evidence) and 12 months postoperative (RR 0.69, 95% CI 0.55 to 0.87; I2 = 76%; very low quality of evidence), and when surgery is performed within the first 48 hours upon hospital admission (RR 0.72, 95% CI 0.62 to 0.84; I2 = 65%; very low quality of evidence). Observational studies also showed a reduction of complications (RR 0.61, 95% CI 0.51 to 0.73; I2 = 64%; very low quality of evidence) and length of hospital stay (MD -5.06, 95% CI -6.52 to -3.60; I2 = 87%; very low quality of evidence) by early surgery, but the evidence was uncertain for functionality (SMD 0.05, 95% CI -0.04 to 0.14; I2 = 0%; low quality of evidence) and pain (RR 0.89, 95% CI 0.67 to 1.17; I2 = 0%; very low quality of evidence). RCTs showed that early surgery reduces length of stay (MD -6.73, 95% CI -12.92 to -0.54; I2 = 54%; very low quality of evidence) and improves functionality (SMD 0.32, 95% CI 0.04 to 0.59; I2 = 5%; low quality of evidence). Conclusions: Low-quality evidence showed that early surgery reduces all-cause mortality at 6 and 12 months post-surgery, especially when it is performed during the first 48 hours after hospital admission. There was very low-quality evidence of a reduction in complications including pneumonia and pressure sores, and low-quality evidence for a reduced risk of urinary tract infection for early compared with delayed surgery. Reductions in length of hospital stay and improvement of postoperative functionality with early surgery were also observed but with very low- and low-quality of evidence respectively. There was very low-quality evidence for no effect of early surgery on postoperative pain.

Colombia is an upper middle-income country with an estimated population of 49.2 million people, and road traffic collisions (RTCs) are the second most common cause of traumatic death. The government established the National Road Safety Plan (PNSV) for the period 2011-2021, to reduce RTC-related deaths by 26%. Study aim was to evaluate whether Road Safety Laws have had a long-term effect on road safety in the country. Data on RTC from January 1, 2001 through December 31, 2017 were collated from official Colombian governmental publications. Three periods were considered for analysis: 2001-2010 evaluating the Transit Code; 2011-2017 evaluating the PNSV; and 2001-2017 evaluating the full study period. A total of 102,723 deaths (12.7%) and 707,778 injuries (87.3%) were reported from 2001 through 2017. Transit Code period showed a 10.1% decline in deaths, 16.6% decline in injuries, and rates per 100,000 inhabitants and per 10,000 registered vehicles also declined. During the PNSV period, there was an increase in deaths by 16.6%, injuries decreased by 1.7%, and death rates per 100,000 inhabitants also increased. During the total study period, a 12.4% reduction in the total number of casualties was achieved, and death and injury rates per 100,000 inhabitants decreased by 12.4% and 27.5%, respectively. Overall, the absolute number of RTCs and deaths has increased. RTCs rates per 10,000 registered vehicles has decreased. Although the goals of the PNSV may not be realized, some laws may be having a beneficial effect. Further study is required to determine the longer-term impact of these initiatives.

El objetivo de este estudio es analizar la relación de las variables de rendimiento físico con los grupos de equipos ganadores, empatados y perdedores de los partidos de la Copa Mundial de la FIFA Rusia 2018. La muestra seleccionada para realizar el presente análisis fue de 32 selecciones nacionales participantes, examinadas por medio de 57 partidos en total. Los equipos fueron divididos en tres diferentes grupos, dependiendo del resultado obtenido: (0) equipos ganadores (N=48), (1) equipos que empataron (N=18) y (2) equipos perdedores (N=48). Los datos recogidos del presente trabajo de investigación han sido analizados a través de la página web https://www.fifa.com. Las variables utilizadas para el análisis de los datos fueron: distancia total recorrida, distancia recorrida con el balón en posesión, distancia recorrida sin el balón en posesión, sprints, posesión del balón lanzamientos a favor, diferencia de lanzamientos, tiempo empleado en la mitad del equipo oponente (OH), tiempo empleado en el tercio ofensivo (A3); Tiempo empleado en el área de penalti (PA), zona 1 de velocidad: 0-7 km/h, zona 2 de velocidad: 7-15 km/h, zona 3 de velocidad: 15-20 km/h, zona 4 de velocidad: 20-25 km/h, zona 5 de velocidad: > 25 km/h. Se realizó la prueba de Kolmogorov-Smirnov, para establecer la normalidad de los datos y posteriormente la prueba ANOVA de un factor para analizar los datos de distribución normal y la prueba de Kruskal-Wallis para muestras independientes, para datos de distribución no normal. Los datos observados no arrojaron diferencias significativas entre los grupos. La conclusión de la presente investigación es que ni las variables de rendimiento físico, ni las variables técnico-tácticas utilizadas, fueron determinantes para ganar, empatar o perder partidos en la Copa Mundial de la FIFA Rusia 2018.

In 2007, Mexico City legalized abortion in the first 12 weeks of pregnancy. By doing so, it became the first and only state in Mexico where abortion on demand is legal. In this paper, I use this natural experiment to estimate the effects of abortion legalization on child and maternal health. I perform Difference-In-Differences estimates using information from all births and deaths occurred between 2002 and 2012. My findings suggest that the change in the abortion legislation in Mexico City reduced the Infant Mortality Rate and the Under 5 Mortality Rate by approximately 2.3 and 2.4 deaths per 1,000 live births, respectively. Moreover, for the Maternal Mortality Rate I find that the estimations range from -5.49 to -6 deaths per 100,000 live births. These results are validated by the use of a more accurate control group generated by the Synthetic Control Method. To the best of my knowledge, this if the first paper that attempts to examine the effects of abortion legalization in Mexico City on child health. En el 2007, Ciudad de México legalizó el aborto en las 12 primeras semanas de gestación. Al hacerlo, se convirtió en el primero y único estado del país en donde el aborto voluntario es legal. En este artículo utilizo este experimento natural para estimar los efectos de la legalización del aborto en la salud materno infantil. Realizo estimaciones de Diferencias en Diferencias utilizando información de todos los nacimientos y muertes ocurridos entre 2002 y 2012. Mis hallazgos sugieren que el cambio en la legislación relativa el aborto en la Ciudad de México redujo la tasa de mortalidad Infantil y la tasa de mortalidad en menores de 5 años en aproximadamente 2.3 y 2.4 muertes por cada 1.000 nacidos vivos, respectivamente. Además, para la tasa de mortalidad materna, encuentro que las estimaciones oscilan entre -5,49 y -6 muertes por 100.000 nacidos vivos. Estos resultados se validan mediante el uso de un grupo de control más preciso, utilizando la metodología de control sintético. Según mi conocimiento, este es el primer artículo que intenta examinar los efectos de la legalización del aborto en la Ciudad de México sobre la salud infantil.

Abstract: Changes in demographics and epidemiology have made non-communicable diseases (NCDs) a global and highly relevant problem. Globally, oral diseases cause serious health and economic burdens, leading to a substantial reduction in quality of life for those affected. Oral diseases and other NCDs share modifiable risk factors, including tobacco use, harmful use of alcohol and unhealthy diets, as well as the same socioeconomic determinants. The oral cavity provides valuable insights into overall health, as systemic diseases such as diabetes, HIV/AIDS, and autoimmune disorders often presents oral manifestations. However, in prison settings, where access to healthcare is limited and challenging as a human right, individuals experience exacerbated oral health outcomes and complications. Oral health status serves as a mirror of overall health, highlighting the interconnectedness between oral health and general well-being. The involvement of health authorities in prison settings plays a significant role in promoting and maintaining optimal oral health, which in turn has a profound impact on the physical and mental health of PLP. The World Health Organization's Oral Health Report of 2022 emphasizes the importance of addressing oral health inequalities as a crucial step in achieving fairness and implementing preventive interventions. Therefore, coherent and comprehensive regulation and legislation in oral health are needed to achieve social justice, ethical public health policies and professional practice. This study used a combination of methods with a focus on qualitative research. The first phase involved following the guidelines set out in “Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA)” to conduct a comprehensive and systematic scoping review addressing the primary and secondary objectives of the study. The third objective was covered by semi structured interviews involving purposive sampling, identified by three target groups: dentist personnel working in prisons; prison health experts; harm reduction policymakers, to gain insight from global prison health experts on potential areas of improvement for oral health in prison. In the first phase of this study, scientific articles published between January and August 2022 were gathered and reviewed. Subsequently, in 2023, a series of interviews were conducted involving fifteen participants. Ethical approval for the study was obtained from the Ethics Committee of the Ruprecht Karls Faculty of Medicine in Heidelberg (S 288/2023). The data collection instrument was carefully designed to accommodate the specific profiles of the participants, all owing for necessary adjustments to ensure the relevance and effectiveness of the study. Online in depth semi structured interviews were conducted via Zoom with relevant health prison experts. The combination of inductive and deductive approaches was used to design the study, collect and analyze data, and answer the research questions. The major findings of this study shed light on the persistent neglection of oral health into the health systems across different settings. Challenges and limitations in addressing oral health in prison, remains with a focus on the provision of emergency treatments and dental mutilations as services provided instead of conservatives approaches. Comprehensive and specialized dental care is necessary to avoid burdens on the health system, mostly from preventable oral disorders. Oral care and basic dental hygiene are still on the list of necessities in prison settings, as well as lack of resources, committed staff, and infrastructure to support the delivery of comprehensive dental services in prisons. In order to increase access to quality dental care, address oral health disparities, and promote the overall well-being of PLP, policy reforms, capacity building, and collaboration are necessary.

Resumen: ¿Se puede lograr un buen libro académico cuando se percibe que la rabia es lo que ha llevado al autor a escribirlo? Esta es una pregunta que surge al leer Repensar la salud global. Marcos de poder,* pues la autora habla explícitamente de cómo comenzó su rabia hacia la inequidad (p. 72) y cómo de alguna manera todavía sigue teniendo esta rabia (p. 93). La respuesta a dicha pregunta la podrá tener el lector al finalizar el libro, des- pués de leer diferentes tipos de relatos. La autora menciona, entre otros casos, la epidemia del cólera en Haití, durante la cual se vivió una situación muy difícil, como se puede leer a continuación: “Se hicieron agujeros en la base de los colcho- nes para que el signo revelador del cólera, la diarrea constante e implacable, pudiera manejarse más fácilmente sin tener que trasladar a los pacientes” (p. 79). Lo cierto es que la doctora Rochelle Burgess dice que escribió este libro con la esperanza de llevar al lector en un viaje para iluminar la complejidad de cómo funcionan las di- námicas de poder en el ámbito de la salud global desde la posición de una psicóloga de salud comunitaria, en cuyo ejercicio profesional encontró su insatisfacción con la salud global. Abstract: Can a good academic book be achieved when it is perceived that anger is what drove the author to write it? This is a question that arises when reading Rethinking Global Health. Frames of Power,* as the author explicitly talks about how she began her rage at inequity (p. 72) and how in some ways she still has this rage (p. 93). The answer to this question can be found at the end of the book, after reading different types of stories. The author mentions, among other cases, the cholera epidemic in Haiti, during which a very difficult situation was experienced, as can be read as follows: "Holes were drilled in the base of the colchages so that the telltale sign of cholera, the constant and relentless diarrhea, could be handled more easily without having to move the patients" (p. 79). The truth is that Dr. Rochelle Burgess says she wrote this book in the hope of taking the reader on a journey to illuminate the complexity of how power dynamics work in global health from the position of a community health psychologist, in whose practice she encountered her dissatisfaction with global health.

Abstract: One of the great challenges for students of any discipline is to be able to put into practice the knowledge learned in theory. Public health does not escape this challenge. Research Methods for Public Health is a book that seeks to help students understand in a simple way how to enter into the practice of public health research. This book stands out for its easy reading, but especially because it emphasizes the existence of quantitative and qualitative methods, as well as the combination of both methods. On the other hand, the authors show between the lines, and sometimes more clearly, the importance of teamwork in research groups, a key element to avoid errors, validate procedures or instruments and increase the reliability of the results, as well as the importance of criteria of validity, reliability, precision, relevance, transparency and credibility, among others. Resumen: Uno de los grandes retos para los estudiantes de cualquier disciplina es poder poner en práctica los conocimientos aprendidos en la teoría. La salud pública no se escapa de este desafío. Research Methods for Public Health es un libro que busca ayudar a comprender de manera sencilla cómo introducirse en la práctica de la investigación en salud pública. Este libro se destaca por su fácil lectura, pero especialmente porque pone el énfasis en la existencia de los métodos cuantitativos y cualitativos, así como en la combinación de ambos métodos. Por otro lado, los autores dejan ver entrelíneas, y a veces más claramente, la importancia del trabajo en equipo en los grupos de investigación, elemento clave para evitar errores, validar procedimientos o instrumentos y aumentar la confiabilidad de los resultados, así como la importancia de criterios de validez, confiabilidad, precisión, relevancia, transparencia y credibilidad, entre otros.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and its incidence is rising. The introduction of new systemic therapies, including immune-based therapies and biomarker driven therapies, has improved survival in patients at advanced stages. However, overall survival is still poor, and recent advances in understanding of the molecular alterations of HCC have not translated yet into novel biomarkers. Over the past decade, major advancements in 'omic' technologies have enabled monitoring of a variety of molecular and organismal processes. A comprehensive analysis of single gene mutations in HCC might lead to detect biomarkers that improve our prognosis and treatment. We developed a bioinformatics pipeline capable of analyzing genomic data to identify key regulatory molecular changes in HCC development and their influence in patient’s prognosis. By looking at genetically determined subgroups of HCC in the TCGA Liver Cancer dataset, we managed to obtain 15 genes frequently affected by oncogenic mutations and analyzed their influence in patient’s survival, identifying CSMD1 as a prognostic biomarker candidate. Nevertheless, the validation in the ICGC HCC database showed that it did not have any statistically significant influence in overall survival. This work reveals that the most frequent single gene mutations are not enough for significant survival changes in HCC and that we should focus our efforts in integrative analysis of clinical information and multi-omics to maximize our clinical benefits in this devastating disease. Resumen: El carcinoma hepatocelular (CHC) es el tipo más común de cáncer de hígado y su incidencia está aumentando. La introducción de nuevas terapias sistémicas, incluidas las inmunoterapias y las terapias impulsadas por biomarcadores, ha mejorado la supervivencia de los pacientes en etapas avanzadas. Sin embargo, la supervivencia general sigue siendo escasa y los avances recientes en la comprensión de las alteraciones moleculares del CHC aún no se han traducido en nuevos biomarcadores. Durante la última década, los principales avances en las tecnologías "ómicas" han permitido el seguimiento de una variedad de procesos moleculares y orgánicos. Un análisis completo de las mutaciones de un solo gen en el CHC podría conducir a detectar biomarcadores que mejoren nuestro pronóstico y tratamiento. Desarrollamos un protocolo de bioinformática capaz de analizar datos genómicos para identificar cambios moleculares reguladores clave en el desarrollo del CHC y su influencia en el pronóstico del paciente. Al observar subgrupos genéticamente determinados de CHC en la base de datos TCGA-Liver Cancer, logramos obtener 15 genes frecuentemente afectados por mutaciones oncogénicas y analizamos su influencia en la supervivencia del paciente, identificando CSMD1 como un candidato a biomarcador pronóstico. Sin embargo, la validación en la base de datos ICGC-CHC mostró que no tuvo ninguna influencia estadísticamente significativa en la supervivencia global. Este trabajo revela que las mutaciones de un solo gen más frecuentes no son suficientes para cambios significativos en la supervivencia del CHC y que debemos centrar nuestros esfuerzos en el análisis integrador de la información clínica y la multi-ómica para maximizar nuestros beneficios clínicos en esta devastadora enfermedad.

Abstract: From brown algae species, it is a polysaccharide that have been studies due to their potential use in several biomedical applications. This is known as fucoidan. In this research the anti- cancer properties of a commercially available fucoidan (from Fucus vesiculosus) and different molecular weight fractions of fucoidan extracted from a brown algae found in the Colombian caribean coast (Sargassum filipendula, at LMW, (10–50 kDa), medium (MMW, 50–100 kDa) and high (HMW, >100 kDa)) were studied on osteosarcoma cells (MG-63). The results showed penetrability variation of the different fucoidan inside cells. Moreover, the focal adhesion and cell proliferation had a dose-dependent drop for all fucoidan types with strongest effects observed for HMW and F. vesiculosus fucoidan. G1-Phase arrest and accummulation in the sub-G1-phase was induced by F. vesiculosus. Simillarly, HMW and LMW caused G1-phase arrest. All fucoidan caused mitochondrial damage but mithochondrial fragmenttion was only observed with F. vesiculosus. Stress-induced apoptosis-like cell death was observed for F. vesiculosus fucoidan and stress-induced necrosis-like cell death for S. filipendula fucoidans by Annexin V/PI, TUNEL and cytochrome C stainings. As a results, These differences in anti-cancer activity of fucoidans are applicable for osteosarcoma treatment. Resumen: De las algas marrones, hay un polisacárido que ha sido estudiado debido a su potencial uso en diversas aplicaciones biomédicas. Estos se conocen como fucoidanos. En esta investigación, las propiedades anticancerígenas de los fucoidanos de una especie disponible comercialmente (Fucus vesiculosus)y de diferentes fracciones de peso molecular de fucoidanos extraídos de un alga marrón que se encuentra en la costa caribe colombiana (Sargassum filipendula, en bajo LMW, (10–50 kDa), medio (MMW, 50-100 kDa) y alto peso molecular (HMW,> 100 kDa)) se estudiaron en células de osteosarcoma (MG-63). Los resultados mostraron una variación de la penetrabilidad de los diferentes fucoidan dentro de las células. Además, la adhesión focal y la proliferación celular tuvieron una caída dependiente de la dosis para todos los tipos de fucoidan con efectos más fuertes observados para HMW y F. vesiculosus fucoidan. La detención y acumulación de la fase G1 y la fase sub- G1 fueron inducidas por F. vesiculosus. De manera similar, HMW y LMW causaron la detención de la fase G1. Todos los fucoidan causaron daño mitocondrial, pero solo se observó fragmentación mitocondrial con F. vesiculosus. Se observó muerte celular similar a la apoptosis inducida por estrés para el fucoidano extraido de F. vesiculosus y muerte celular similar a la necrosis inducida por estrés para fucoidanos de S. filipendula mediante tinciones con Anexina V / PI, TUNEL y citocromo C. Como resultado, estas diferencias en la actividad anticancerígena de los fucoidanos podrían ser aplicables para el tratamiento del osteosarcoma.