Influencia del estado nutricional en la prevención y evolución del cáncer de mama

Trabajo fin de grado en EnfermeríaContexto: El cáncer de mama es una de las primeras causas de morbi-mortalidad en la mujer a nivel mundial. Está influenciado por múltiples factores, entre los que destaca el estilo de vida y el estado nutricional, que pueden actuar como factores protectores, predisponentes u obstaculizando el tratamiento. Objetivo: Determinar la asociación entre el estado nutricional y un estilo de vida saludable con la prevención y evolución del cáncer de mama. Resultados: Diferentes estudios afirman que la realización de ejercicio físico junto con la adherencia a la dieta Mediterránea, disminuye el riesgo de padecer cáncer de mama. A su vez, el sobrepeso y la obesidad aumentan la predisposición, sobretodo en mujeres jóvenes. También parece existir unanimidad en la importancia de la evaluación del estado nutricional como parte fundamental de los cuidados multidisciplinarios en los pacientes oncológicos. No se ha encontrado relación entre la práctica de ejercicio físico durante el tratamiento quimioterápico y el riesgo de recidivas. Existe controversia respecto a las consecuencias de la sarcopenia y la ganancia de tejido adiposo durante la quimioterapia. Conclusión: Ante la escasa bibliografía encontrada respecto a la relación entre el estilo de vida y el estado nutricional con el cáncer de mama, sería necesaria la realización de más estudios de investigación. Con ello se conseguiría dar más visibilidad a los cuidados nutricionales, tanto de forma preventiva, como de recurso para abordar los problemas derivados de la enfermedad y su tratamiento, mejorando así la calidad de vida de los pacientes.Context: Breast cancer is one of the first reasons of morbi-mortality in the women worldwide. It is influenced by multiple factors, between which it stands out, the nutritional condition, that can be as a protective factor, as a predisposing factor, impeding the treatment, and for lifestyle, which plays an important paper in the prevention process. Objective: To determine the association between a healthy way of life and the prevention and evolution of breast cancer. Results: Several studies claim that the realization of physical exercise together with the adherence to the Mediterranean diet, reduces the risk of breast cancer. At the same time, overweight and obesity increase the predisposition, especially in young women. Also there seems to be unanimity on the importance of the evaluation of the nutritional status as a fundamental part of the multidisciplinary care in cancer patients. Relationship between physical exercise during the chemotherapy and the risk of recurrence is not found. There is controversy regarding the consequences of sarcopenia and gain of adipose tissue during chemotherapy. Conclusion: Due to the limited bibliography regarding the relation between the lifestyle and the nutritional status with breast cancer, it would be necessary to do more research studies. This would give more visibility to the nutritional care, no mean a preventive measure of addressing the problems coming from diseases and its treatment, contributing to improve the quality of life

Online multimodal rehabilitation programme to improve symptoms and quality of life for adults diagnosed with long COVID-19: a Randomised Clinical Trial protocol

Long COVID is a multisystemic condition which affects quality of life and implies a multidisciplinary treatment approach. There is still limited evidence on management techniques for this syndrome. “Telerehabilitation” could be an important tool when addressing the symptoms of this patients with the aim of increasing their quality of life. The purpose of this trial is to analyse the effectiveness of an online multimodal rehabilitation programme to improve the symptomatology of people with long COVID and their quality of life.MethodsA pragmatic randomised controlled trial will be performed with two parallel groups: (1) usual treatment by the primary care practitioner (Treatment as usual, TAU; control group) and (2) TAU plus the use of an online multimodal rehabilitation programme, including videoconferences and content published on a Moodle platform (intervention group). The data will be collected before and after the intervention. A follow-up will take place 3 months later.DiscussionThere is still a lack of knowledge regarding the management of the symptoms of long COVID. This creates the need to add scientific evidence about the care of this disease, considering that multidisciplinary social and health teams can offer the necessary care so that these patients can recover their previous quality of life.Clinical trial registration: The protocol for this study was registered with the ISRCTN Registry [registration number: ISRCTN15414370] on 28 December 2022

Online multimodal rehabilitation programme to improve symptoms and quality of life for adults diagnosed with long COVID-19: a Randomised Clinical Trial protocol

BackgroundLong COVID is a multisystemic condition which affects quality of life and implies a multidisciplinary treatment approach. There is still limited evidence on management techniques for this syndrome. “Telerehabilitation” could be an important tool when addressing the symptoms of this patients with the aim of increasing their quality of life. The purpose of this trial is to analyse the effectiveness of an online multimodal rehabilitation programme to improve the symptomatology of people with long COVID and their quality of life.MethodsA pragmatic randomised controlled trial will be performed with two parallel groups: (1) usual treatment by the primary care practitioner (Treatment as usual, TAU; control group) and (2) TAU plus the use of an online multimodal rehabilitation programme, including videoconferences and content published on a Moodle platform (intervention group). The data will be collected before and after the intervention. A follow-up will take place 3 months later.DiscussionThere is still a lack of knowledge regarding the management of the symptoms of long COVID. This creates the need to add scientific evidence about the care of this disease, considering that multidisciplinary social and health teams can offer the necessary care so that these patients can recover their previous quality of life.Clinical trial registration: The protocol for this study was registered with the ISRCTN Registry [registration number: ISRCTN15414370] on 28 December 2022

Usefulness of implementing the OHIP-14 questionnaire to assess the impact of xerostomia and hyposalivation on qualityof life in patients with primary Sjögren's syndrome

Background: The aim of this study is to analyze if the results of the Oral Health Impact Profile-14 questionnaire (OHIP-14) in patients with primary Sjögren's syndrome (pSS) are correlated with salivary flow and level of xerostomia. Methods: This observational cross-sectional study was conducted in 61 patients (60 women, one man, mean age 57.64 [13.52]) diagnosed of pSS according to the American-European Criteria (2002). After recording demographic, medical and dental data (decayed-missing-filled teeth index [DMFT]), unstimulated (UWS) and stimulated (SWS) salivary flows were collected. Subsequently, UWS flow was categorized into two groups (0.7 ml/min). Patients also filled out a visual analog scale (VAS) for xerostomia and OHIP-14 for self-reported quality of life (QoL). Results: Data showed positive and significant correlation between OHIP-14 and xerostomia, based on VAS results (r = 0.52; p = 0.001). Furthermore, there was a negative correlation between UWS and OHIP-14 scores (r = -0.34; p = 0.006) and VAS for xerostomia (r = -0.22; p = 0.09). No significant correlation was found between SWS and OHIP-14 or VAS neither between DMFT and OHIP-14. When assessing the level of QoL by the UWS and SWS flow categories a significant association was found for UWS (p = 0.001) but not for SWS (p = 0.11). The OHIP-14 values were higher in the groups with lower salivary flow. The multiple linear regression to predict OHIP-14 only selected VAS for xerostomia as a statistically significant predictor. Conclusions: Increased level of xerostomia and reduced UWS flow decrease oral health-related QoL in patients with pSS

Flu Vaccination Coverage and Predictors of Non-Vaccination in Military Health Corps Personnel 2016–2017 and 2019–2021

(1) Background: Vaccination is the most effective intervention to control seasonal influenza morbidity and mortality. The present study aimed to determine the influenza vaccination coverage in the Military Health Corps personnel in the 2020–2021 season, as well as the time trend and the possible influence of the pandemic on coverage, in order to study the reasons that led to the non-vaccination of health professionals and to analyze adverse drug reactions (ADRs). (2) Methods: A descriptive, cross-sectional study was conducted from February to May 2021. All FAS CMS personnel were included. A self-administered questionnaire was sent by e-mail to the selected personnel. (3) Results: Vaccination coverage in the 2016–2017 season was 15.8% (n = 276), in the 2019–2020 season it was 17.41% (n = 424), and in the 2020–2021 season it was 24.22% (n = 590). The percentage of vaccinated men was higher than the percentage of women. In 2019 and 2020 the most vaccinated group was 31–40 years old. Lieutenants had the highest vaccination uptake in 2019 and 2020. The personnel with the highest uptake of vaccines were those in the specialty of nursing in each of 2016, 2019 and 2020, with >30 years of time worked in 2016. In terms of factors leading to refusal of vaccination, the most reported was “not considered a risk group” (23.0%), and the least reported was “avoidance of vaccine administration” (2.2%). Eighty individuals presented adverse reactions after vaccine administration (9.6%). (4) Conclusions: The rate of influenza vaccination among healthcare professionals was lower during the 2020 season compared to the previous season, but was expected to increase in the upcoming 2021 season

Predictors of Loss of Functional Independence in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up and Comparison with a Control Group

COPPADIS Study Group.[Background and objective] The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson’s disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD).[Patients and Methods] PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%.[Results] In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; p < 0.0001; Cohen’s effect size = −0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; p = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; p = 0.009), have longer disease duration (OR = 1.152; p = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; p = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; p < 0.0001) and BDI-II (OR = 1.080; p = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; p = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; p = 0.0.29), FOGQ (OR = 1.348; p < 0.0001) and VAFS-Mental (OR = 1.177; p = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2.[Conclusions] In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.Fundación Curemos el Parkinson (www.curemoselparkinson.org).Peer reviewe

Incentivar y potenciar la generación colectiva de conocimiento y la participación del alumnado a través de herramientas digitales en línea

El surgimiento de herramientas en línea para la participación del alumnado constituye un recurso con enorme potencial de innovación para la docencia y los procesos de enseñanza y aprendizaje en la educación superior. Por un lado, porque aumenta las posibilidades de generar conocimiento de forma colectiva a través de la colaboración del alumnado con los y las docentes, no solo preguntando y respondiendo de forma anónima (si se quiere que así sea) a las cuestiones que puedan ir planteándose a lo largo del curso, sino también evaluando el propio desarrollo del mismo y las metodologías empleadas. Herramientas que posibilitan esta línea, mediante la llamada gamificación, tan motivante; y metodología de trabajo, como Kahoot o Mentimeter, presentan además una interfaz atractiva y muy fácil de utilizar, tanto por parte del alumnado como del profesorado, a través de cualqiuier dispositivo móvil con posibilidad de conexión a Internet. No obstante, la primera (Kahoot) es mucho más limitada en sus posibilidades que la segunda (Mentimeter). Por este motivo, en este Proyecto de Innovación Docente apostamos por utilizar Mentimeter Estos instrumentos en línea se adaptan de forma muy sencilla tanto a la docencia presencial y sincrónica, como a la docencia semipresencial o en línea (con una cierta asincronicidad), por lo que aparecen como un recurso muy útil en el contexto de incertidumbre respecto a la articulación de la metodología de enseñanza debido a la pandemia de la covid-19. Este proyecto congrega a un grupo de docentes interdisciplinar, interdepartemental, interfacultativo que incluye, además, la participación de un docente experto en la herramienta de otra universidad (URJC).

SARS-CoV-2-reactive antibody detection after SARS-CoV-2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group

This is a multicenter prospective observational study that included a large cohort (n = 397) of allogeneic (allo-HSCT; (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3–6 weeks after complete severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination from February 1, 2021, to July 20, 2021. Most patients (n = 387, 97.4%) received mRNA-based vaccines. Most of the recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS-CoV-2-reactive antibodies were observed in 242 (78%) of allo-HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo-HSCT recipients identified lymphopenia < 1 × 109/ml (odds ratio [OR] 0.33, 95% confidence interval [95% CI] 0.16–0.69, p = .003), active graft versus host disease (GvHD; OR 0.51, 95% CI 0.27–0.98, p = .04) and vaccination within the first year of transplant (OR 0.3, 95% CI 0.15–0.9, p = .04) associated with lower antibody detection whereas. In ASCT, non-Hodgkin's lymphoma (NHL; OR 0.09, 95% CI 0.02–0.44, p = .003) and active corticosteroid therapy (OR 0.2, 95% CI 0.02–0.87, p = .03) were associated with lower detection rate. We report an encouraging rate of SARS-CoV-2-reactive antibodies detection in these severe immunocompromised patients. Lymphopenia, GvHD, the timing of vaccine, and NHL and corticosteroids therapy should be considered in allo-HSCT and ASCT, respectively, to identify candidates for SARS-CoV-2 antibodies monitoring.Peer reviewe

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections