Clinical management and acute exacerbations in patients with idiopathic pulmonary fibrosis in Spain: results from the OASIS study

Clinical management; Acute exacerbations; Early treatmentGestión clínica; Exacerbaciones agudas; Tratamiento precozGestió clínica; Exacerbacions agudes; Tractament precoçBackground Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with decline in lung function and poor prognosis entailing significant impairment in quality of life and high socioeconomic burden. The aim of this study was to characterize clinical management and resources utilization of patients with IPF in Spain, according to predicted forced vital capacity (FVC) % at baseline. Methods Prospective, non-interventional, multicentric real-world data study in patients with IPF in Spain with 12-months follow-up. Clinical management and resources utilization during study period were recorded and compared between groups. FVC decline and acute exacerbations occurrence and associated healthcare resource use were also analysed. FVC decline after 12 months was estimated as relative change. Results 204 consecutive patients with IPF were included and divided according to baseline FVC % predicted value. At baseline, patients with FVC  10% in the more preserved lung function groups than in the FVC < 50% group, because of their already deteriorated condition. Conclusions We observed a significantly higher annual IPF-related resource use in patients with more impaired lung function at baseline. Since FVC decreases irrespective of FVC% predicted at baseline, slowing IPF progression to maintain patients at early disease stages is relevant to improve IPF management and to optimize resource use.The study was supported and funded by Boehringer Ingelheim España

Economic Burden of Idiopathic Pulmonary Fibrosis in Spain: A Prospective Real-World Data Study (OASIS Study)

Carga económica; Fibrosis pulmonar idiopática; EspañaCàrrega econòmica; Fibrosi pulmonar idiopàtica; EspanyaEconomic burden; Idiopathic pulmonary fibrosis; SpainBackground Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease associated with dyspnoea, cough and impaired quality of life affecting around 7500 patients in Spain. Objective Our aim was to estimate the economic impact of IPF according to forced vital capacity (FVC) % predicted level in adult patients. Methods We conducted a prospective, observational, multicentric study of patients with confirmed IPF in Spain. Total annual IPF-related costs were estimated per patient, and categorised according to the FVC% predicted value (FVC 80%) and total sample. Incurred direct health- and non-health-related costs and indirect costs were calculated considering the IPF-related healthcare resource use and the corresponding unitarian costs. Results were updated to 2023 euros. Results Two hundred and four consecutive patients with IPF were included: 77% male, average age (standard deviation) 70.8 (7.6) years. At baseline, FVC% was 80% of predicted value in 10.8%, 74.5% and 14.7% of patients, respectively. The final cost-evaluable population included 180 subjects. The mean (standard deviation) total annual IPF-related cost was €26,997 (17,555), with statistically significant differences (p = 0.0002) between groups: €44,412 (33,389) for the FVC 80%. Annual direct health costs had the greatest weight and included pharmacological treatments [€22,324 (13,773)] and hospitalisation days [€1659 (7362)]. 14 patients had ≥ 1 acute exacerbation of IPF during the study; mean total cost of an acute exacerbation of IPF was €10,372. According to the multivariate analysis, an impaired lung function (FVC < 50%) and use of antifibrotic treatment were determinants of cost (p < 0.0001 both). Conclusions We observed a significantly higher annual IPF-related cost at a lower level of predicted FVC%, the direct cost having the greatest weight to the total costs. Maintaining patients at early disease stages by slowing IPF progression is relevant to reduce the economic impact of IPF

El desarrollo de cartas de servicios en la Inspección de Educación. Factor de calidad en la atención al ciudadano

In this article we analyze the benefits of client service charters in improving the provision of inspection services for education. The development of client service charters in educational administration and, especially in Educational Inspection is a process that projects an image of public service essential for citizen services. Inspection Services are government entities whose functions, powers and liability civil covered in the legislation itself (Spanish Constitution, Organic Law of Education and regional legislation to that effect) require a new way to develop the functions and manage external and internal education inspection services.En este artículo analizamos los beneficios de las cartas de servicio en la mejora de la prestación de servicios de la inspección de educación. El desarrollo de cartas de servicio en la administración educativa y –especialmente en los servicios de Inspección de Educación– es un proceso que proyecta una imagen de servicio público fundamental para la atención al ciudadano. Los Servicios de Inspección son entidades de las administración pública que por sus funciones, atribuciones y responsabilidad civil y administrativa amparada en la propia normativa (Constitución Española, Ley Orgánica de Educación y normativa autonómica al efecto) precisan de una nueva forma de desarrollar las funciones y gestionar externa e internamente los servicios de inspección de educación

Using the emotional functioning in clinical practice to detect psychological distress in patients with advanced thoracic and colorectal cancer

Purpose: Patients with advanced cancer suffer significant decline of their psychological state. A rapid and reliable evaluation of this state is essential to detect and treat it and improve quality of life. The aim was to probe the usefulness of the emotional function (EF) subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EF-EORTC-QLQ-C30) to assess psychological distress in cancer patients. Methods: This is a multicenter, prospective, observational study involving 15 Spanish hospitals. Patients diagnosed with unresectable advanced thoracic or colorectal cancer were included. Participants completed the Brief Symptom Inventory 18 (BSI-18), the current the gold standard, and the EF-EORTC-QLQ-C30 to assess their psychological distress prior to initiating systemic antineoplastic treatment. Accuracy, sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were calculated. Results: The sample comprised 639 patients: 283 with advanced thoracic cancer and 356 with advanced colorectal cancer. According to the BSI scale, 74% and 66% displayed psychological distress with an EF-EORTC-QLQ-C30 accuracy of 79% and 76% in detecting psychological distress in individuals with advanced thoracic and colorectal cancer, respectively. Sensitivity was 79 and 75% and specificity was 79 and 77% with a PPV of 92 and 86% and a NPV of 56 and 61% (scale cut-off point, 75) for patients with advanced thoracic and colorectal cancer, respectively. The mean AUC for thoracic cancer was 0.84 and, for colorectal cancer, it was 0.85. Conclusion: This study reveals that the EF-EORTC-QLQ-C30 subscale is a simple and effective tool for detecting psychological distress in people with advanced cancer

Diagnostic delay of associated interstitial lung disease increases mortality in rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. 106 patients were included. The multivariate analysis showed that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01-1.23, p = 0.035). Also, age (HR 1.33, 95% CI 1.09-1.62, p = 0.0045), DLCO (%) (HR 0.85, 95% CI 0.73-0.98, p = 0.0246), and final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39-0.99, p = 0.0465) were independent predictor variables of mortality, as well as GAP index (HR 4.65, 95% CI 1.59-13.54, p = 0.0051) and CPI index (HR 1.12, 95% CI 1.03-1.22, p = 0.0092). The withdrawal of MTX or LFN after ILD diagnosis was associated with disease progression in the COX analysis (HR 2.18, 95% CI 1.14-4.18, p = 0.019). This is the first study that highlights the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF

Localización histórico-geográfica de las tierras explotadas por la familia de Cristóbal Colón en el puerto de San Juan (Huelva, España)

This research presents as novelty the geographical location of certain places that were part of the process of gestation of the discovery of America In addition, it also confirms the linking of the portuguese Briolanja Muñiz —sister in law of Christopher Columbus— with the port of San Juan (Huelva, Spain), and at the same time, offers unpublished data on the boundaries of the estate where the family of the famous discoverer was seated while he managed and organized his first overseas trip.Este trabajo de investigación presenta como novedad la localización geográfica concreta de lugares que fueron partícipes del proceso de gestación del descubrimiento de América Además, confirma la vinculación de la portuguesa Briolanja Muñiz —cuñada de Cristóbal Colón— con el puerto de San Juan (Huelva, España) y, al mismo tiempo, ofrece datos inéditos sobre los límites de la finca en la que estaba asentada la familia del famoso descubridor mientras que gestionaba y organizaba su primer viaje ultramarin

Forest Restoration in a Fog Oasis: Evidence Indicates Need for Cultural Awareness in Constructing the Reference

Background: In the Peruvian Coastal Desert, an archipelago of fog oases, locally called lomas, are centers of biodiversity and of past human activity. Fog interception by a tree canopy, dominated by the legume tree tara (Caesalpinia spinosa), enables the occurrence in the Atiquipa lomas (southern Peru) of an environmental island with a diverse flora and high productivity. Although this forest provides essential services to the local population, it has suffered 90% anthropogenic reduction in area. Restoration efforts are now getting under way, including discussion as to the most appropriate reference ecosystem to use. Methodology/Principal Findings: Genetic diversity of tara was studied in the Atiquipa population and over a wide geographical and ecological range. Neither exclusive plastid haplotypes to loma formations nor clear geographical structuring of the genetic diversity was found. Photosynthetic performance and growth of seedlings naturally recruited in remnant patches of loma forest were compared with those of seedlings recruited or planted in the adjacent deforested area. Despite the greater water and nitrogen availability under tree canopy, growth of forest seedlings did not differ from that of those recruited into the deforested area, and was lower than that of planted seedlings. Tara seedlings exhibited tight stomatal control of photosynthesis, and a structural photoprotection by leaflet closure. These drought-avoiding mechanisms did not optimize seedling performance under the conditions produced by forest interception of fog moisture. Conclusions/Significance: Both weak geographic partitioning of genetic variation and lack of physiological specialization of seedlings to the forest water regime strongly suggest that tara was introduced to lomas by humans. Therefore, the most diverse fragment of lomas is the result of landscape management and resource use by pre-Columbian cultures. We argue that an appropriate reference ecosystem for ecological restoration of lomas should include sustainable agroforestry practices that emulate the outcomes of ancient uses

Comparative severity of COVID-19 cases caused by Alpha, Delta or Omicron SARS-CoV-2 variants and its association with vaccination

[EN] Background: This study compares the severity of SARS-CoV-2 infections caused by Alpha, Delta or Omicron variants in periods of co-circulation in Spain, and estimates the variant-specific association of vaccination with severe disease. Methods: SARS-CoV-2 infections notified to the national epidemiological surveillance network with information on genetic variant and vaccination status were considered cases if they required hospitalisation or controls otherwise. Alpha and Delta were compared during June-July 2021; and Delta and Omicron during December 2021-January 2022. Adjusted odds ratios (aOR) were estimated using logistic regression, comparing variant and vaccination status between cases and controls. Results: We included 5,345 Alpha and 11,974 Delta infections in June-July and 5,272 Delta and 10,578 Omicron in December-January. Unvaccinated cases of Alpha (aOR: 0.57; 95% CI: 0.46-0.69) or Omicron (0.28; 0.21-0.36) had lower probability of hospitalisation vs. Delta. Complete vaccination reduced hospitalisation, similarly for Alpha (0.16; 0.13-0.21) and Delta (June-July: 0.16; 0.14-0.19; December-January: 0.36; 0.30-0.44) but lower from Omicron (0.63; 0.53-0.75) and individuals aged 65+ years. Conclusion: Results indicate higher intrinsic severity of the Delta variant, compared with Alpha or Omicron, with smaller differences among vaccinated individuals. Nevertheless, vaccination was associated to reduced hospitalisation in all groups. [ES]Introducción: El objetivo es comprar la gravedad de las infecciones por las variantes Alfa, Delta y Ómicron del SARS-CoV-2 en periodos de co-circulación en España, y estimar la asociación entre vacunación y gravedad en cada variante. Métodos: Las infecciones por SARS-CoV-2 notificadas a la red nacional de vigilancia epidemiológica con información sobre la variante viral y el estado de vacunación se clasificaron como casos si habían requerido hospitalización, o como controles en caso contrario. Alfa y Delta se compararon durante junio-julio de 2021, y Delta y Ómicron durante diciembre de 2021-enero de 2022. Se estimaron odds ratios ajustadas (ORa) mediante regresión logística, comparando la variante y el estado de vacunación entre casos y controles. Resultados: Se incluyeron 5.345 infecciones por variante Alfa y 11.974 por Delta en junio-julio y 5.272 infecciones por Delta y 10.578 por Ómicron en diciembre-enero. Los casos no vacunados por Alfa (aOR: 0,57; IC 95%: 0,46-0,69) u Ómicron (0,28; IC 95%: 0,21-0,36) tuvieron menor probabilidad de hospitalización comparados con Delta. La vacunación completa se asoció a menor hospitalización de forma similar para Alfa (0,16; IC 95%: 0,13-0,21) y Delta (junio-julio: 0,16; IC 95%: 0,14-0,19; diciembre-enero: 0,36; IC 95%: 0,30-0,44) pero menor para Ómicron (0,63; IC 95%: 0,53-0,75) y para individuos con 65+ años. Conclusión: Los resultados indican una mayor gravedad intrínseca de la variante Delta comparada con Alfa u Ómicron, con menor diferencia entre personas vacunadas. La vacunación se asoció a menor hospitalización en todos los grupos.In this study the identification of variants by genomic sequencing has been partially supported by HERA-Incubator ECDC/GRANT/2021/024-Enhancing Whole Genome Sequencing (WGS) and/or Reverse Transcription Polymerase Chain Reaction (RT-PCR) national infrastructures and capacities to respond to the Covid-19 pandemic in Spain.S

Reflecting on gender, power and empowerment through art. An educational tool for facili-tators, art educators and young people

En este manual, el lector y la lectora encontrarán cinco itinerarios temáticos que ofrecen la posibilidad de analizar cómo la cultura en general, y los museos en particular, interpretan el pasado. Las actividades proporcionan herramientas para comprender qué perspectivas se privilegian, y convierten a los y las participantes en visitantes activos y críticos para interpretar el pasado o el presente. Cada capítulo ofrece itinerarios que han sido diseñados para ser utilizados en museos específicos o en un aula mediante la proyección de las imágenes. Cada itinerario se compone de cinco pasos organizados en torno a: una obra de arte, información sobre la obra y dos actividades relacionadas con el tema específico. Estas actividades pueden tener lugar en el espacio del museo o fuera de él creando el marco para un diálogo entre el espectador o espectadora y la obra, por un lado, y entre pares, por otro (ya sean miembros de un grupo de visitantes, una persona o un grupo de apoyo que quiera desarrollar un mejor conocimiento de los sistemas de poder en relación con los roles de género en la sociedad).In this manual, the reader will find five thematic itineraries. They offer the possibility of analysing how culture at large, and museums specifically, interpret the past. The activities provide tools to understand what perspectives are privileged, and turn participants into active and critical visitors to interpret the past or the present. Each chapter offers itineraries that have been designed to be used either in specific museums or in a classroom by projecting the images. Each itinerary is composed of five steps organised around: a work of art, information about the work, and two activities related to the specific theme. These activities can take place in the museum space or outside the museum. They create the framework for a dialogue between the viewer and the work on one hand, and between peers on the other hand (be it members of a visitor’s group, a person or a support group who would like to develop better knowledge of the powers at stake regarding gender roles in society).Depto. de Didáctica de las Lenguas, Artes y Educación FísicaFac. de EducaciónTRUEComisión EuropeaErasmus+pu

Regulator of calcineurin 1 mediates pathological vascular wall remodeling

Angiotensin-II–driven calcineurin activation and regulator of calcineurin-1 (Rcan-1) expression is required for pathological vascular remodeling in mice