Estudio de la efectividad de una intervención terapéutica grupal cognitiva conductual en policías con depresión

El objetivo general de la investigación fue conocer la efectividad de un programa de corte cognitivo conductual grupal, en la disminución de los síntomas de depresión moderada y crónica en policías de la Zona de Policía de Veraguas. La muestra fue de ocho policías (siete hombres y una mujer), con edades entre 18 y 50 años, sobrevivientes de accidente laboral o enfermedad común, con diagnóstico previo de trastornos depresivos, que se atendían en servicios de psiquiatría (instituciones públicas y particulares), con poca o nula adherencia al tratamiento farmacológico, el cual reiniciaron seis meses antes de participar en la investigación. Se usó un diseño pretest-postest, con una entrevista individual más 13 sesiones de 90 minutos dos veces por semana. Los instrumentos fueron: Escala de depresión de Beck, entrevista clínica en profundidad. Los datos se analizaron con el estadístico “t” de “Student” y se rechazó la H0, y se aceptó la Hi. En consecuencia, a estos datos obtenidos, podemos suponer que la terapia grupal cognitiva conductual disminuyó los síntomas de depresión en esta muestra

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

La cueva de El Cierro (Fresnu, Ribasedesella). Campañas de excavación e investigación 1977-1979, 2014 y 2016

El Cierro se localiza en Fresnu, en el concejo de Ribadesella (Asturias). Sus coordenadas geográficas son 43º 27’ 26’’ de latitud N y 5º 06’ 20’’ de longitud O. Se sitúa a unos 83 m sobre el nivel del mar, del que dista en la actualidad 3,1 km en línea recta a la desembocadura del río Sella y 2,1 km a los acantilados de Tereñes. La cueva se encuentra en el extremo oriental del macizo asturiano de la Cordillera Cantábrica, en un sector formado por materiales paleozoicos de la Zona Cantábrica del Macizo Ibérico. Se trata de una cavidad kárstica situada en las calizas de La Escalada, del Carbonífero (Moscoviense), constituidas por calizas micríticas y bioclásticas de color gris y muy recristalizadas.info:eu-repo/semantics/publishedVersio

The Upper Palaeolithic record of Coímbre Cave (Asturias, northern Spain). A symbolic place, a place for living

57th Annual Meeting in Heidenheim, 7-11 April 2015. Erlangen: Hugo Obermaier-Gesellschaft für Erforschung des Eiszeitalters und der Steinzeit e. V. = Hugo Obermaier Society for Quaternary Research and Archaeology of the Stone Age, 2015Coímbre cave (135 meters asl) is located on the southwestern slope of Mount Pendendo (532 m), in the small valley of Besnes river, tributary of Cares river, in a medium-higher mountain are in the central-western Cantabria –northern Iberian Peninsula- (Álvarez-Alonso et al., 2009; 2013b). The landscape in the surroundings of the cave –situated in an interior valley but near to the current coast in a low altitude- can be described as a mountainous environment where valleys, small hills and steep mountains with high slopes are integrated, which confer a relative variety of ecosystems to this area. Coímbre contains an important archaeological site divided in two different areas. B Area, is the farthest from the entrance, and is the place where took place the excavations carried out to date, between 2008 and 2012 (Álvarez-Alonso et al., 2009, 2011, 2013a, 2013b). Coímbre B shows a complete and very interesting Magdalenian sequence (with Lower, Middle and Upper Magdalenian levels), and a gravettian level, that converts this cave in one of the biggest habitat areas in western Cantabria. Its rich set of bone industries, mobiliar art and ornaments, provide key information that shows the connections between this area, the Pyrenees and the south-west of Aquitaine. Moreover, Coímbre cave presents an interesting set of Magdalenian engravings, located in different places of the cavity, both in open and accessible areas, and in narrower and inaccessible places, which clearly define two different symbolic spaces. All this artistic expressions belong to the Magdalenian, and it is possible to establish a division between a set of engravings framed in the first stages of this period (the most abundant and remote); and a more limited set of engravings, in which stand out a block with a engraving of a bison with a deep trace of more than one meter long, that belongs to the recent Magdalenian. This work presents the preliminary results of the analysis of Magdalenian occupations in Coímbre, after the end of the excavations in B Area, and the study of its rock art, shaping this site as one of the most important places of Magdalenian human activities in western Cantabria.Peer reviewe

ICU-Acquired Pneumonia Is Associated with Poor HealthPost-COVID-19 Syndrome

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-1

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes