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

Pautas de localización de las nuevas empresas y flexibilidad territorial

¿Por qué la localización de las nuevas empresas difiere según las características de las industrias? ¿Qué relación existe entre la intensidad tecnológica de las empresas y el entorno urbano donde nacen? ¿La autonomía de las nuevas empresas a la hora de decidir su emplazamiento difiere según las características del sector industrial y el tamaño del establecimiento? El presente trabajo aborda estas cuestiones para las manufacturas españolas entre 1980 y 1994. Partimos del supuesto de que los nuevos establecimientos industriales deciden localizarse en un determinado municipio descartando el resto de emplazamientos alternativos. Los resultados obtenidos indican que las decisiones de localización difieren según la intensidad tecnológica de las industrias y de su ciclo de vida

Energy efficiency determinants: an empirical analysis of Spanish innovative firms [WP]

This paper examines the extent to which innovative Spanish firms pursue improvements in energy efficiency (EE) within their innovation objectives. The increase in energy consumption and its impact on greenhouse gas emissions justifies the greater attention being paid to energy efficiency and especially to industrial EE. The ability of manufacturing companies to innovate and improve their EE has a substantial influence on reaching the objectives regarding climate change mitigation. Despite the effort to design more eficient energy policies, the EE determinants in manufacturing firms have been little studied in the empirical literature. From an exhaustive sample of Spanish manufacturing firms and using a probit model, we examine the energy efficiency determinants to those firms that have innovated. To carry out the econometric analysis, we use a panel data coming from CIS (Community Innovation Survey) for the period 2008-2011 that includes 4,458 manufacturing firms. Among firm characteristics, the empirical results underline the importance of size in facilitating the adoption of technology that improves energy efficiency; while among the factors related to companies’ behavior, the favorable influence of organizational innovations and innovations related with the reduction of environmental impacts stand out as the main factors in carrying out innovations with the objective of increasing energy efficiency

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

Energy efficiency determinants: An empirical analysis or Spanish innovative firms

This paper examines the extent to which innovative Spanish firms pursue improvements in energy efficiency (EE) as an objective of innovation. The increase in energy consumption and its impact on greenhouse gas emissions justifies the greater attention being paid to energy efficiency and especially to industrial EE. The ability of manufacturing companies to innovate and improve their EE has a substantial influence on attaining objectives regarding climate change mitigation. Despite the effort to design more efficient energy policies, the EE determinants in manufacturing firms have been little studied in the empirical literature. From an exhaustive sample of Spanish manufacturing firms and using a logit model, we examine the energy efficiency determinants for those firms that have innovated. To carry out the econometric analysis, we use panel data from the Community Innovation Survey for the period 2008-2011. Our empirical results underline the role of size among the characteristics of firms that facilitate energy efficiency innovation. Regarding company behaviour, firms that consider the reduction of environmental impacts to be an important objective of innovation and that have introduced organisational innovations are more likely to innovate with the objective of increasing energy efficienc

Evaluation of Physiological and Quality Parameters of Green Asparagus Spears Subjected to Three Treatments against the Decline Syndrome

Green asparagus (Asparagus officinalis L.) is a widely grown and consumed crop which provides high-level nutritional interest. In recent years, the decline syndrome in asparagus plantations has been rapidly augmenting. This syndrome causes the early death of whole plants, also negatively affecting the new replanting. Decline causes notable economic losses in the sector. The objective of this work was to verify the effect of different treatments against asparagus decline syndrome on the physiological parameters and nutritional quality of the spears. To meet the objective, four different treatments were applied to asparagus plots strongly affected by decline syndrome: (T1) untreated control soil, (T2) biofumigation with Brassica pellets, (T3) biofumigation with chicken manure pellets, and (T4) disinfestation of the soil with Dazomet. The cumulative yield and physiological and quality parameters of green asparagus spears were studied. Thus, malondialdehyde (MDA), photosynthetic pigments, glutathione (GSH), ascorbate (AsA), total phenols, flavonoids, anthocyanin, antioxidant test, mineral nutrients, and the amino acid profile were measured on asparagus spears. The results showed that the Brassica pellets and Dazomet treatments were the most effective against the damage caused by the decline syndrome. However, it would be necessary to monitor the evolution in the following years.INIA and ERDF 2014-2020Project RTA2015-00008-C02,State Training Subprogram of the State Program for the Promotion of Talent and its Employability, at the IFAPA. Grant number [BES-2017-080123].ES

Near infrared hyperspectral imaging and spectral unmixing methods for evaluation of fiber distribution in enriched pasta

[EN] Pasta is mostly composed by wheat flour and water. Nevertheless, flour can be partially replaced by fibers to provide extra nutrients in the diet. However, fiber can affect the technological quality of pasta if not properly distributed. Usually, determinations of parameters in pasta are destructive and time-consuming. The use of Near Infrared-Hyperspectral Imaging (NIR-HSI), together with machine learning methods, is valuable to improve the efficiency in the assessment of pasta quality. This work aimed to investigate the ability of NIR-HSI and augmented Multivariate Curve Resolution-Alternating Least Squares (MCR-ALS) for the evaluation, resolution and quantification of fiber distribution in enriched pasta. Results showed R2V between 0.28 and 0.89, %LOF < 6%, variance explained over 99%, and similarity between pure and recovered spectra over 96% and 98% in models using pure flour and control as initial estimates, respectively, demonstrating the applicability of NIR-HSI and MCR-ALS in the identification of fiber in pasta.This work was supported by the Coordenaçao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (CAPES) [Finance Code 001]; Sao Paulo Research Foundation (FAPESP) [grant numbers 2008/57808-1, 2014/50951-4, 2015/24351-2, 2017/17628-3, 2019/06842-0]; and by GVA-IVIA and FEDER funds through project IVIA-51918. The authors would like to thank Nutrassim Food Ingredients company for the donation of the fiber samples, the support provided by Mrs. Cristiane Vidal during NIR-HSI system operation and data processing and Dr. Celio Pasquini for promptly receiving us in the laboratory that he coordinates (Grupo de instrumentaçao e automaçao em quimica analitica, Instituto de quimica, Universidade Estadual de Campinas, Campinas-SP, Brazil) to data acquisition.Teixeira Badaró, A.; Amigo, JM.; Blasco, J.; Aleixos Borrás, MN.; Rios Ferreira, A.; Pedrosa Silva Clerici, MT.; Fernandes Barbin, D. (2021). Near infrared hyperspectral imaging and spectral unmixing methods for evaluation of fiber distribution in enriched pasta. Food Chemistry. 343:1-9. https://doi.org/10.1016/j.foodchem.2020.128517S1934

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

The Renal Range of the κ/λ sFLC Ratio: Best Strategy to Evaluate Multiple Myeloma in Patients With Chronic Kidney Disease

Background: Monoclonal serum free light chains (sFLC) are a well-known cause of renal impairment (RI) in patients with multiple myeloma (MM). As an indicator of monoclonality, sFLC ratio has acquired a key role in the diagnosis and monitorization of the disease. However, its interpretation is altered in patients with chronic kidney disease (CKD). This study aims to evaluate the modification of the sFLC ratio reference range in patients with CKD, and propose an optimal range for patients with CKD. Methods: Serum FLC κ/λ ratio and estimated glomerular filtration rate (eGFR) were retrospectively analyzed in 113 control patients (without hematologic disease), 63 patients with MM in complete remission and 347 patients with active MM. The three groups included patients with CKD (eGFR < 90). Results: In the group of patients without active MM (n = 176), the sFLC ratio increased at different stages of CKD without pathological significance, with an increase in the number of false positives specially when eGFR is ≤55 ml/ min. An optimal range was established for patients with eGFR ≤55 ml/min/1.73 m2: 0.82-3,6 with maximum sensitivity + specificity for that group with an improvement in the Area under the curve (AUC), 0.91 (0.84-0.97) compared with the current ranges proposed by Katzmann and Hutchinson. Conclusions: This study confirms the influence of eGFR on the interpretation of the sFLC ratio, showing a decreasing specificity in progressive CKD stages when using the reference sFLC range (Katzmann), especially in patients with eFGR ≤55. According to our results, we suggest a modified optimal range (0.82-3,6) for eGFR ≤55 ml/ min/1.73 m2. It is necessary to validate this modified range in larger and prospective studies