Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care : a pilot cluster-randomized-controlled trial

There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019

Altres ajuts: Departament de Salut. Generalitat de Catalunya ("Pla estratègic de recerca i innovació en salut (PERIS) 2019-2021"); Ministerio de Asuntos Económicos y Transformación Digital; Red Española de Investigación en Patología Infecciosa (REIPI).Background: Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim: To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods: A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000patientdays. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000patientdays and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results: During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate:0.20episodes/1,000patientdays). Patients' median age was 64.1years; 36.6% (3,403/9,290) were female. In total, 73.7% (n=6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n=5,822) were related to central venous catheter (CVC), 24.1% (n=2,236) to peripheral venous catheters (PVC) and 13.3% (n=1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR:0.94;95%CI:0.93-0.96), especially in the ICU (IRR:0.88;95%CI:0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR:0.88;95%CI:0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC:1.08;95%CI:1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions: Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards

La importancia de ser moderno. : Problemas de método e ideologia en el debate sobre la cognición y la conducta de los Neandertales

Some scholars defend that Neanderthals displayed a fully modern behavior, and they contend that those who do not share such a view are biased by an anthropocentric stance. We argue that the defense of a cognitive and behavioral asymmetry between Neanderthals and anatomically modern humans does not purport embracing an ideologically grounded position. In addition, we aim to explain that a methodological agenda, which we refer to as "radical continuism", underlies such a non-scientific derivation of the debate on recent human evolutio

La importancia de ser moderno. : Problemas de método e ideologia en el debate sobre la cognición y la conducta de los Neandertales

Some scholars defend that Neanderthals displayed a fully modern behavior, and they contend that those who do not share such a view are biased by an anthropocentric stance. We argue that the defense of a cognitive and behavioral asymmetry between Neanderthals and anatomically modern humans does not purport embracing an ideologically grounded position. In addition, we aim to explain that a methodological agenda, which we refer to as "radical continuism", underlies such a non-scientific derivation of the debate on recent human evolutio

¿Homo loquens neanderthalensis? En torno a las capacidades simbólicas y lingüísticas del Neanderthal

El reciente análisis de ADN fósil de dos Neandertales procedentes de la Cueva El Sidrón (Asturias) ha revelado que los Neandertales poseían las mutaciones del gen FOXP2 consideradas específicas de los humanos modernos. Dado que FOXP2 está implicado en el desarrollo y uso del lenguaje, tal hallazgo está provocando una revisión delas capacidades simbólicas y comunicativas atribuidas hasta ahora a la referida especie. El objetivo de este trabajo es triple: (1) aclaramos que dichas mutaciones no pueden considerarse causa suficiente para atribuir a un organismo una facultad lingüística compleja; (2) el hallazgo no puede, por tanto, usarse para defender que losNeandertales tenían una facultad lingüística de tipo moderno; (3) defendemos que la asimetría comportamental entre Neandertales y humanos modernos que muestra el registro arqueológico tampoco es compatible con tal visión.Two Neandertals from El Sidrón (Asturias) have been recently analyzed for possible mutations in FOXP2, a gene involved in the faculty of language. Although this gene was believed to be specific to modern humans, the analysis in question revealed otherwise. Such a discovery is raising a reassessment of symbolic and communicative capacities attributed to Neandertals so far. Our purpose is threefold: (1) to make the point that the relevant mutations do not suffice to attribute to an organism a complex linguistic faculty; (2) accordingly, the discovery cannot be used to defend that Neandertals had a modern linguistic faculty; (3) we contend that behavioral asymmetries between Neandertals and modern humans, as shown by the archaeological record, also argues against that view

¿Homo loquens neanderthalensis? En torno a las capacidades simbólicas y lingüísticas del Neanderthal

El reciente análisis de ADN fósil de dos Neandertales procedentes de la Cueva El Sidrón (Asturias) ha revelado que los Neandertales poseían las mutaciones del gen FOXP2 consideradas específicas de los humanos modernos. Dado que FOXP2 está implicado en el desarrollo y uso del lenguaje, tal hallazgo está provocando una revisión delas capacidades simbólicas y comunicativas atribuidas hasta ahora a la referida especie. El objetivo de este trabajo es triple: (1) aclaramos que dichas mutaciones no pueden considerarse causa suficiente para atribuir a un organismo una facultad lingüística compleja; (2) el hallazgo no puede, por tanto, usarse para defender que losNeandertales tenían una facultad lingüística de tipo moderno; (3) defendemos que la asimetría comportamental entre Neandertales y humanos modernos que muestra el registro arqueológico tampoco es compatible con tal visión.Two Neandertals from El Sidrón (Asturias) have been recently analyzed for possible mutations in FOXP2, a gene involved in the faculty of language. Although this gene was believed to be specific to modern humans, the analysis in question revealed otherwise. Such a discovery is raising a reassessment of symbolic and communicative capacities attributed to Neandertals so far. Our purpose is threefold: (1) to make the point that the relevant mutations do not suffice to attribute to an organism a complex linguistic faculty; (2) accordingly, the discovery cannot be used to defend that Neandertals had a modern linguistic faculty; (3) we contend that behavioral asymmetries between Neandertals and modern humans, as shown by the archaeological record, also argues against that view

The archaelogical record speaks : bridging anthropology and linguistics

This paper examines the origins of language, as treated within Evolutionary Anthropology, under the light offered by a biolinguistic approach. This perspective is presented first. Next we discuss how genetic, anatomical, and archaeological data, which are traditionally taken as evidence for the presence of language, are circumstantial as such from this perspective. We conclude by discussing ways in which to address these central issues, in an attempt to develop a collaborative approach to them

Impacto económico de las bacteriemias nosocomiales. Comparación de tres metodologías de cálculo

Resumen- Introducción: El coste incremental que comportan las bacteriemias nosocomiales (BN) se utiliza como medida del impacto de estas infecciones. Los métodos tradicionales de cálculo de coste sobrestiman este incremento al no contemplar variables confusoras. El objetivo de este trabajo es comparar 3 metodologías de cálculo del coste incremental de la BN para corregir los sesgos presentes en análisis previos. Métodos: Se compararon los pacientes que presentaron algún episodio de BN entre 2005 y 2007, con los pacientes con la misma patología sin BN. Los microorganismos causantes se agruparon según la tinción Gram y según si la bacteriemia era monomicrobiana o polimicrobiana, o producida por un hongo. Se compararon 3 métodos de cálculo: 1) estratificación por patología; 2) ajuste econométrico multivariante mediante un modelo lineal generalizado (MLG), y 3) un propensity score matching (PSM) antes del análisis multivariante para controlar los sesgos. Resultados: Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.515 € y 4.851,6 €, respectivamente. En la estratificación por patología, el coste incremental medio estimado fue de 14.735 €; el grupo de microorganismos que ocasionó menor coste incremental fue el de grampositivos, con 10.051 €. En el MLG el coste incremental medio estimado fue de 20.922 €, mientras que utilizando PSM se estimó un coste incremental medio de 11.916 €. En las 3 estimaciones hay diferencias importantes según el grupo de microorganismos. Conclusiones: Utilizar metodologías más elaboradas mejora el ajuste en este tipo de estudios e incrementa el valor de los resultados obtenidos