El cambio en los patrones de cohesión en España en el período 2007–2009 y su repercusión entre los usuarios de servicios sociales

La literatura referida a los Regímenes de Bienestar apunta al frágil equilibrio entre el empleo, la familia y la protección social. A través de las Encuestas de Población Activa (EPA), las encuestas de Condiciones de Vida (ECV) y las encuestas FOESSA se profundiza en los cambios experimentados por parte de la población española, ofreciendo una comparación con los hogares y personas que alguna vez han utilizado los servicios sociales en aquellos ámbitos relativos al mercado de trabajo, la protección familiar o la cobertura desempeñada por parte de los servicios de protección social. Este trabajo pretende indagar en el impacto que ha tenido el primer período de crisis en España, comprendido entre 2007–2009, y en qué medida ha repercutido en el aumento de la brecha entre usuarios y no usuarios

Assisting the Most Vulnerable Populations in the Regions of La Rioja and the Maghreb: The Human Rights-Based Approach and Social Work

This article examines the evolution of social assistance provided to the most disadvantaged populations in La Rioja, Spain and the Maghreb, going from charity to the human rights-based approach (HRBA). A case-analysis methodology was applied to two social interventions: the ABDEM project, which is part of the EU Tempus program, and the UNICEF program to combat poverty in the Spanish region of La Rioja. In these two cases, the HRBA represents a conceptual leap in the promotion of people’s autonomy and an effective means for sustainable progress in response to the inequality, discrimination and unjust power relations negatively affecting the most vulnerable members of society

Estudio de la exclusión social a través de registros de datos de servicios sociales : análisis a partir de la herramienta SiSo

Este artículo tiene como objetivo identificar los factores relativos a la exclusión social atendiendo a cuatro niveles de gravedad entre la población usuaria de programas de inclusión social. Para ello, se realiza un análisis de la base de datos perteneciente a la herramienta SiSo de valoración de las situaciones de dificultad social en el eje inclusión/exclusión. Dicha herramienta se emplea desde el año 2017 en la valoración y el estudio de casos en los servicios sociales de primer nivel en Castilla-La Mancha. En el momento de realizar este artículo, se han valorado un total de 18.968 unidades familiares. Para ello, se recurre a análisis bivariables con los que identificar las principales características en seis dimensiones o ámbitos vitales. Asimismo, los resultados recogen la adecuación del análisis de componentes principales a los respectivos ámbitos vitales. Finalmente, el apartado de resultados recoge un análisis multinomial para determinar su importancia según los niveles de dificultad analizados. Las conclusiones del artículo son relevantes para la segmentación en el primer nivel de atención de los servicios sociales según los niveles de dificultad, con repercusiones en la precisión de necesidades y en la intervención conjunta con otros sistemas de protección social.This article aims to identify factors associated with social exclusion among users of social inclusion programs according to four levels of severity. To this end, the SiSo tool was used to assess situations of social hardship on the inclusion/exclusion spectrum. This tool has been used since 2017 to evaluate and study cases in first level or primary care social services in the region of Castilla-La Mancha, Spain. At the time of writing, a total of 18,968 family units have been assessed. Bivariate analyses were performed to identify the main characteristics of users in six dimensions or life domains. The results show that principal component analysis is suitable for identifying the variables in the respective domains. Finally, a multinomial analysis was performed to determine the importance of the variables according to levels of hardship. The findings can be useful for segmenting family units and defining social services interventions by level of hardship, as well as for conducting joint interventions with other social protection systems

Homofilia, polarización afectiva y desinformación en Twitter : caso de estudio sobre la crisis migratoria #Openarms

El Mediterráneo es una de las rutas migratorias más mortíferas del mundo y se ha convertido una vez más en centro de la polémica en relación a la actuación del buque humanitario Open Arms. Este buque, tras rescatar migrantes del mar, estuvo en travesía durante diecinueve días, bloqueado institucionalmente y envuelto en disputas diplomáticas en la Unión Europea. Como reacción, la ciudadanía, distintos actores sociales y la propia ONG Open Arms hicieron uso de Twitter para intercambiar información y expresar opiniones y sentimientos en relación con el fenómeno migratorio. En este artículo se analizan pautas de conectividad e interacción de los usuarios de Twitter en torno al hashtag #Openarms. Tras recoger muestras masivas de tuits con técnicas de extracción, se identificaron los actores sociales con mayor liderazgo mediante análisis de redes sociales. Se han detectado comunidades por medio del algoritmo de modularidad, cuyo contenido ha sido interpretado mediante netnografía. Los resultados evidencian cómo los usuarios de Twitter tienden a congregarse con quienes comparten sus mismas creencias, formándose las denominadas cámaras eco. La interacción en base a este suceso despertó estados emocionales colectivos que dieron lugar a burbujas filtro que potenciaron la desinformación y la polarización entre comunidades.The Mediterranean is one of the deadliest migratory routes in the world and has once again become the center of controversy in relation to the performance of the Spanish ship Open Arms. This ship, after rescueing migrants from the sea, was on a crossing for nineteen days, institutionally blocked and involved in diplomatic disputes in the European Union. As a reaction, the citizens, different social actors and the NGO OpenArms made use of this social networking site Twitter to exchange information and express their opinions and feelings in relation to the migratory phenomenon. This study analyzes the connectivity and interaction patterns of Twitter users around the #Openarms hashtag. Massive samples of tweets have been collected using extraction techniques. Through the analysis of social networks, the social actors with the greatest leadership were identified. Communities have been detected by means of the modularity algorithm, whose content has been interpreted by netnography. The results show how users of the analyzed online social network tend to congregate around those who share the same beliefs, forming the so-called echo chambers. The interaction based on this event aroused collective emotional states that gave rise to filter bubbles that promoted disinformation and polarization between communities

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe