Factors associated with Chagas screening among immigrants from an endemic country in Madrid, Spain

INTRODUCTION: Approximately 120,000 people live with Chagas disease in Europe, 43% of whom are living in Spain. Early diagnosis and treatment are critical to improve outcomes for those living with Chagas, and also for the prevention of ongoing transmission. The decision to be tested for Chagas is affected by a range of factors. Studies have highlighted the need to consider the wider social determinants of healthcare seeking behaviour related to Chagas. In Madrid, 44% of Bolivians undergo Chagas screening, which is a higher rate than other European regions, but studies concerning the factors which determine testing have not been performed. This study aimed to assess, for a first time, the factors associated with screening for Chagas among Bolivians living in Madrid trying to help in developing strategies and health recommendations. METHODS: This was a cross-sectional survey about knowledge of Chagas and practices of Bolivians living in Madrid, Spain. A structured questionnaire was administered to 376 participants regarding Chagas health-seeking behaviour. Determinants were assessed by multiple logistic regressions adjusted by sex. RESULTS: After adjusting for others variables and sex, the factors shown to be associated with Chagas screening were to have between 35 and 54 years of age; coming from a department with high prevalence of Chagas (OR 2.17 95% CI 0.99-4.76); received information about Chagas in Spain (OR 2.44 95% CI 1.32-4.51); and received any advice to do the test, especially if the advice came from a professional. CONCLUSIONS: Health authorities should coordinate and promote strategies addressed to diagnose and treat Chagas taking into account all factors associated with screening. Our study suggests that professional advice appears to be the cornerstone to encourage Bolivians to undergo Chagas screening in Madrid. It is time to change the burden of the decision of being screened from the patient to the doctor. Being diagnosed for Chagas needs to become an institutional strategy.This study was funding by the Insituto de Salud Carlos III (www.isciii.es)PI15CIII/00047 to TBH. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Diagnostic pathways of Chagas disease in Spain: a qualitative study

Background: Due to the mobility of the population in recent years and the spread of Chagas disease (CD) to non-endemic regions, early diagnosis and treatment of CD has become increasingly relevant in non-endemic countries. In order for screening to be effective, health system accessibility must be taken into consideration. This study uses Tanahashi's Health Service Coverage model to gain a deeper understanding of the main diagnostic pathways for Chagas disease in a non-endemic country and the barriers and bottlenecks present in each pathway. Methods: This study used a qualitative design with a phenomenological approach. Twenty-one interviews, two focus group sessions, and two triangular group sessions were conducted between 2015 and 2018 with 37 Bolivian men and women diagnosed with CD in Madrid, Spain. A topic guide was designed to ensure that the interviewers obtained the data concerning knowledge of CD (transmission, symptoms, and treatment), attitudes towards CD, and health behaviour (practices in relation to CD). All interviews, focus groups and triangular groups were recorded and transcribed. A thematic, inductive analysis based on Grounded Theory was performed by two researchers. Results: Three main pathways to CD diagnosis were identified: 1) pregnancy or blood/organ donation, with no bottlenecks in effective coverage; 2) an individual actively seeking CD testing, with bottlenecks relating to administrative, physical, and time-related accessibility, and effectiveness based on the healthcare professional's knowledge of CD; 3) an individual not actively seeking CD testing, who expresses psychological discomfort or embarrassment about visiting a physician, with a low perception of risk, afraid of stigma, and testing positive, and with little confidence in physicians' knowledge of CD. Conclusions: Existing bottlenecks in the three main diagnostic pathways for CD are less prevalent during pregnancy and blood donation, but are more prevalent in individuals who do not voluntarily seek serological testing for CD. Future screening protocols will need to take these bottlenecks into consideration to achieve effective coverage.This study was funded by the Carlos III Institute of Health (www.isciii.es) PI15CIII/00047. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received no specific funding for this work.S

Mapping health behaviour related to Chagas diagnosis in a non-endemic country: Application of Andersen's Behavioural Model

Background: Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen's Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population. Methods: Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis. Results: The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours. Conclusions: Based on Andersen's Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.This study was funded by the Instituto de Salud Carlos III (www.isciii.es) PI15CIII/00047 to TBH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received no specific funding for this work.S

Evaluación de la composición nutricional de la maca y cañihua, procedente de diversos departamentos del Perú

The following study is for living knowledge about the chemical and nutritional content of maca and cañihua coming of the principal areas of production in our country, and for diffuseness of its nutritional value inside the population contributing to improve the level and quality of life of Peruvians.For this we took 25 samples of maca from the soils of Junín, Puno, Ancash y Cerro de Paseo. They were obtained at random from the cultivated fields. The circunstances of this work was when the crop of this species was carried out and taken to the regional markets.We proceed to the determination of the protein content by the method of Microkjeldhal, aminoacids content by liquid chromatography of high performance, fat, carbohydrates, ash, fiber, humidity determination according to Peruvian Thecnical norms and determination of mineral by spectrophotometric in atomic absortion.We obtained as conclusion that the samples of maca of different Departments of Peru, have different values of protein, and the best of them was from Cerro de Paseo with an average of 9,73 g/100g of food. The fat content as the aminoacids, lysine, valine, threonine, leucine, isoleucine and arginine content were good in maca of Cerro de Paseo. The values of magnesium, iron and cooper were proper.The studies of cañihua from Junin, Ayacucho, Cusco and Puno demonstrated good values of pro teins with averages between 13 and 14 g/100g of food, specia1ly from Ayacucho. The fat concentration was better in cañihua from Ayacucho and Junin than in that from Cusco y Puno. The same was with de aminoacids investigated. The values of magnesium of all the samples were very elevated, about 157 to 223 mg/100g of food, for cooper were 0,68 to 1,30 mg/100g of food. The studies of iron in cañihua showed us that the samples of Ayacucho and Cusco had 18,10 and 21,17 mg/100g of food, and it was the quarter of the 81,79 and 60,91 mg/100g of food we obtained with cañihua from Junin and Puno.We concluded that maca of Cerro de Paseo and the cañihua from Ayacucho are the most nutritive in Perú.El presente estudio tiene como propósito dar a conocer la composición química y el valor nutricional de la maca y la cañihua, procedentes de las principales zonas de producción del país, así como divulgar dentro de la población, su valor nutricional contribuyendo a mejorar el nivel y calidad de vida del poblador peruano. Para ello se tomaron 25 muestras de maca procedentes de los departamentos de Junín, Puno, Ancash y Cerro de Paseo, obtenidas directamente y al azar de los campos de cultivo, en circunstancias en las cuales se estaba realizando la cosecha de aquellas especies cuyo destino representa los mercados regionales. Asimismo se tomaron doce muestras de cañihua en los departamentos de Junín, Ayacucho, Puno y Cusco, con igual finalidad.Se procedió a la determinación del contenido de proteínas, aminoácidos por HPLC, grasas, carbohidratos, cenizas, fibra, humedad, de acuerdo a las normas técnicas peruanas y determinación de minerales por Espectrometría de Absorción Atómica.Se obtuvo como conclusión que las muestras de maca de distintos departamentos del país tienen valores variables de proteína, siendo la mejor de todas en este aspecto la de Cerro de Pasco con 9,73g/ 100g de alimento. En este caso una porción de maca de 100g puede cubrir el 20% de los requerimientos de proteínas de un adulto promedio y 75% de los aminoácidos esenciales estudiados. El contenido de grasa fue bastante bueno en la maca de Cerro de Pasco. Los valores de magnesio, hierro y cobre fueron bastante aceptables pudiendo 100g de maca cubrir el 20% de las necesidades de magnesio,. el 30% de las de hierro y el 40% de las de cobre. La maca nutricionalmente más completa proviene de Cerro de Pasco.En cuanto a los estudios de cañihua de los cuatro departamentos mencionados del Perú, el contenido de proteínas de todos ellos fue muy aceptable con valores de 13 a 14g/l00g de alimento, particularmente la de Ayacucho. Igualmente el contenido de grasa de la cañihua procedente de Ayacucho y Junín fue mayor que el de los departamentos de Cusco y Puno, así como el de todos los aminoácidos investigados. Una porción de 100g de cañihua cubre el 25% de los requerimientos proteicos de un adulto promedio y casi el 100% de las necesidades de los aminoácidos esenciales estudiados. Los valores de magnesio de todas las muestras fueron elevados, con cifras entre 157 y 223 mg/100g de alimento y los de cobre muy aceptables, con cifras entre 0,68 y 1,30 mg/100g de alimento. Los valores de hierro de las muestras de Ayacucho y Cusco 18,10 y 21,17 mg/100g de alimento fueron la cuarta parte de las de Junín y Puno del orden de 81,79 y 60,91 mg/l00g de alimento, respectivamente.Se llegó a la conclusión que la maca de Cerro de Paseo tiene las mejores condiciones nutricionales del país. Asimismo, la cañihua de Ayacucho, por su contenido de grasa, proteínas y minerales

Evaluación de la composición nutricional de la quinua (chenopodium quinoa willd) procedente de los departamentos de Junín, Puno, Apurímac, Cusco y Ancash

The following study has as purpose giving knowledge about the chemical and nutritional content of the vhite quinua coming from the main areas of production of our country, as well as it diffuseness of its nutritional value inside the population, contributing to improve the level and quality of life of peruvians.For this study, it was taken 30 samples of white quinua coming from different mountain soils of Junín, Puno, Apurímac, Cusco y Ancash deparments (six samples for each one).They were obtained at random from the cultivated fields. The circunstances of this work was when the crop of this species was carried out and taken to the regional markets.We proceeded to the determination of the protein content by the method of Microkjeldhal, aminoacids content by liquid cromatography of high performance, Fat determination, carbohydrates, ash, fiber, humidity and temperature according to Peruvian technical norms, and determination of mineral by spectrometric in atomic absorption. This work was done in the Medicine Faculty of San Martín de Porres University. We obtained as conclusion that it exist significant differences in protein content according to the origin, we obtained the highest value average in Junín, 13,71%, the same situation happened with the minerals, being the highest value averae the magnesium with 299 mg/100g of quinua, that covers 95% of the daily requiremente for an adult. The highest value averages of Iron were in Cusco with 8,21 mg/100 g of food, that covers 80% of the daily requirements for an adult. The highest value averages for copper were in Junín with 1, 16mg/100 g that covers 78% of the daily requirements for an adult which are from 1,5 to 3 mg.In relation to aminoacids, it exist significant differences between the lysine content in Junín which was 5,8% of protein and in Ancash which was 6,81 % of protein, in this case 100g of quinua would cover 82% and 92% of its daily requirements respectively. In the case of the threonine its values varied between 3,49% of protein in Cusco and 5.38% of protein in Ancash, being its differences statiscally significant in the same area of origin, it covers from 73% to 130% of the daily requirements of this aminoacid in an adult respectively.Acording to the methionine its values varied from 1,98% of protein of quinua in Junín and 2,69% of protein in Ancash, its values have statistic significance according to the same area of origin, this would cover from 27% to 34% of its daily Methionine requirements in an adult respectivley.We reached the conclusion that the quinua presented better levels of concentration in proteins in Junín, probably for the kind of crop used in the area, where pesticides are applied besides urea, the kind of soil, the kind of rotation applied in the area and also the environmental conditions of its production.In relation with minerals we could mention the concentration of magnesium and copper that would be related to the capacity that this plant has for capturing these minerals as well as the composition of the soil in the area of origin.I Puno our grain presented the lowest level of protein beig related with the kind of crop used at Titicaca lake, it uses only natural ferti1izer, they are extensive plantation only to sow quinua, that is why it is not possible that the soil enrich with Nitrogen.In Ancash the levels of lysine, methionine threonine and valine were the highest found. We know that in this area it is used to practicing the alternate crop with beans or potatoes, besides being a natural and unirrigated valley, which it gives characteristics of different crops.The quinua es nutritioanally very rich, specially in aminoacids that it would cover many of the requirements in the adolescents and adults, but not for the babies in process of lactation and school students, this would be a complement in their diet.El presente estudio, tiene como propósito el dar a conocer el contenido químico y nutricional de la quinua blanca procedente de las principales zonas de producción del País, así como la divulgación, dentro de la población, de su valor nutricional contribuyendo a mejorar el nivel y calidad de vida del poblador peruano. Para ello se tomaron 30 muestras de quinua variedad blanca de diferentes pisos altitudinales procedentes de los departamentos de Junín, Puno, Apurímac, Cusco y Ancash en número de seis para cada una, obtenidas directamente de los campos de cultivo, al azar, en circunstancias en las cuales se estaba realizando la cosecha de aquellas especies cuyo destino resultan siendo los mercados regionales.Se procedió a la determinación del contenido, de proteínas, aminoácidos por HPLC, grasas, carbohidratos, cenizas, fibra, humedad, temperatura de acuerdo a las normas técnicas peruanas y determinación de minerales por Espectrometría de Absorción Atómica.Se obtuvo como conclusión que existen diferencias significativas en el contenido de proteínas de acuerdo al origen, obteniéndose el valor promedio mas alto en Junín de 13,71%. En cuanto a minerales el valor promedio más alto de magnesio fue de 295 mg/100 g de alimento en Junín 10 que cubre el 95% de los requerimientos diarios de un adulto. Los valores promedios mas altos de hierro de acuerdo al origen fue en Cusco de 8,21 mg/ 100 g de alimento, 10 que cubre el 80% de las necesidades diarias de un adulto. El valor promedio más alto de cobre fue en Junin 1,16 mg, cubriendo el 78% de las necesidades diarias de un adulto que son 1,5 a 3 mg.En cuanto a aminoácidos existe diferencia significativa en el contenido de lisina entre la de Junín que es de 5.8 g/100 de proteína y la de Ancash que es de 6,81 g/100 g de proteína; en este caso 100 g de quinua cubriría el 82% y 92% de sus requerimientos diarios respectivamente. En treonina sus valores variaron entre 3,49 mg/100 mg de proteína en la de Cusco y 5,38 mg/100 g de proteína en la de Ancash, siendo sus valores estadísticamente diferentes entre las zonas de origen. Estaría cubriendo el 73% a 130% de sus requerimientos diarios de un adulto, respectivamente. En metionina los valores variaron entre 1,98 mg/100 g de proteína para la quinua de Junín y 2,69 mg/100 mg de proteína en la de Ancash. Los valores tienen significación estadísticamente diferente según la zona de origen; cubriría el 27% a 34% del requerimiento diario de un adulto, respectivamente.Se llegó a la conclusión que en el departamento de Junín la quinua presentaba mejores niveles de concentración de proteínas. En cuanto a minerales se refiere cabe destacar la abundancia de magnesio y cobre. En el departamento de Puno nuestro grano presentaba el nivel más bajo de proteínas. En Ancash los niveles encontrados de lisina, metionina, treonina y valina fueron los más elevados. Se demuestra que la quinua es un alimento de alto valor nutritivo y que podría cubrir, en gran parte, los requerimientos de aminoácidos de adolescentes y adultos

A space for the living and the dead: The Chalcolithic ditched enclosured settlement of Camino de las Yeseras (San Fernando de Henares, Madrid)

Se presentan los resultados preliminares de la excavación de un gran poblado de fosos calcolítico, cuya situación estratégica ayudó a ser un centro de producción e intercambio de excedentes en materias primas (sílex, granito y piedras metamórficas) y productos agropecuarios e industriales por otros foráneos (cobre, variscita, cinabrio, marfil y oro). Los rituales funerarios son de una gran variedad, individuales y colectivos, en covachas e hipogeos, con o sin ajuar campaniforme, algunos de los últimos con ricos ajuares áureos y ebúrneos. Los datos óseos de algunos inhumados campaniformes apuntan a un aspecto físico muy llamativo en vida, mientras los depósitos con fauna, en composición taxonómica variada, indican una compleja relación simbólica con el mundo animal. El yacimiento resulta clave para un mejor conocimiento del período calcolítico y el impacto campaniforme y sus rituales funerarios en la consolidación y diferenciación de las primeras sociedades metalúrgicas del interior peninsularThe preliminary results are presented of the excavations in a large, ditched enclosured Chalcolithic settlement. The site was probably a central place in the production and long-distance exchange of surplus. The accumulations found of raw materials (flint, granite and metamorphic stones) and agricultural, stockbreeding and industrial products were exchanged by other foreign products (variscite, cinnabar, ivory and gold). Ritual data are also remarkable: a significant number of individual and collective burials have been recorded in pits, small artificial caves and hypogeos, delimited in special areas. The richer burials had Ciempozuelos-style Bell-beaker elements and prestige items, such as gold and ivory beads. Osteomorphic and size features of some Bell-beaker individuals point out a remarkable physical aspect during their life time. The faunal deposits, which included mixed species associations, evidence a complex symbolic relationship with animals. The site is essential for the knowledge of the Chalcolithic period and the impact of Bell-beaker customs and funerary rituals in the consolidation of social inequalities amidst the first metallurgical societies of the interior of the Iberian Peninsul

Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study

Background: Heart failure (HF) and atrial fibrillation (AF) are common and coexistent conditions. Hypothesis: To investigate the adverse events and mortality risk factors in patients with AF and HF treated with rivaroxaban in Spain. Methods: Multicenter, prospective and observational study with a follow-up of 2 years, that included adults, with a diagnosis of nonvalvular AF and chronic HF, anticoagulated with rivaroxaban at least 4 months before being enrolled. Results: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, the mean age was 73.7 +/- 10.9 years, 65.9% were male, 51.3% had HF with preserved ejection fraction and 58.7% were on New York Heart Association functional class II. CHA2DS2-VASc was 4.1 +/- 1.5. During the follow-up, 11.6% of patients died and around one-quarter of patients were hospitalized or visited the emergency department, being HF worsening/progression the main cause (51.1%), with a 2.9% of thromboembolic events and 2.0% of acute coronary syndromes. Major bleeding occurred in 3.1% of patients, with 0.5% experiencing intracranial bleeding but no fatalities. Compliance with HF treatment was associated with a lower risk of death (hazard ratio: 0.092; 95% confidence interval: 0.03-0.31). Conclusions: Among patients with HF and AF anticoagulated with rivaroxaban, incidences of thromboembolic or hemorrhagic complications were low. The most important factor for improving survival was compliance with HF drugs, what strengths the need for early treatment with HF disease-modifying therapy and anticoagulation

Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero ([removed]2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16–0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26–0·57; p[removed]11 página

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio