Smartphone and Tablet Usage during COVID-19 Pandemic Confinement in Children under 48 Months in Barcelona (Spain)

Pandèmies; Preescolar; Temps de pantallaPandemias; Preescolar; Tiempo de pantallaPandemics; Preschool; Screen timeBackground: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. Methods: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. Results: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. Conclusion: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence.The Group of Evaluation of Health Determinants and Health Policies (À.C.-H., C.L., A.D.-I., J.C.M.-S., and J.M.M.-S.) receives support from the Ministry of Universities and Research, Government of Catalonia (grant 2017SGR609) from the Government of Catalonia

Compliance Surveillance of the Tobacco Control Legislation in a Spanish Region and Characterization of Passive Exposure to Tobacco Smoke and E-Cig in Children in Outdoor Spaces

Children; Smoking signage; Tobacco control legislationNiños; Señalización de fumar; Legislación de control del tabacoNens; Senyalització de fumar; Legislació de control del tabac(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children

Influence of a Zeolite-Based Cascade Layer on Fischer–Tropsch Fuels Production over Silicon Carbide Supported Cobalt Catalyst

In this work, selective production of middle distillate from synthesis gas was conducted over a cascade catalytic system in a single unit. Co/β-SiC was chosen as an efficient Fischer–Tropsch synthesis (FTS) catalyst (first layer) while proton-type H-ZSM-5 and H-βeta zeolites (second layer) were tested for the subsequent hydroprocessing to produce middle distillate from waxes. Moreover, in order to compare, a prior FTS reference experiment was performed. Catalytic materials were characterized by means of Atomic Absorption, Thermogravimetric analysis, X-Ray diffraction, N2 adsorption–desorption, Temperature-Programmed Reduction and Temperature-Programmed Desorption. From catalytic results, a distinguishable enhancement of commercial fuels products was observed under the proposed cascade operation compared to the stand-alone configuration or physical mixture. Regardless the zeolite type, FTS over Co/β-SiC with subsequent upgrading was demonstrated to result in the complete elimination of waxes, solving the main weakness of a conventional fixed-bed reactor. Moreover, apart from a selective production of gasoline, the proposed concept provided a significant enhancement of both kerosene and diesel yields, particularly when zeolite H-βeta is incorporated to the cascade system due to its mild acidity and larger pore size.En este trabajo se realizó la producción selectiva de destilado medio a partir de gas de síntesis sobre un sistema catalítico en cascada en una sola unidad. Se eligió Co/β-SiC como catalizador eficiente de la síntesis de Fischer-Tropsch (FTS) (primera capa), mientras que las zeolitas H-ZSM-5 y H-βeta de tipo protón (segunda capa) se probaron para el subsiguiente hidroprocesamiento para producir un destilado medio. de ceras. Además, con el fin de comparar, se realizó un experimento de referencia FTS previo. Los materiales catalíticos se caracterizaron mediante Absorción Atómica, Análisis Termogravimétrico, Difracción de Rayos X, N 2adsorción-desorción, reducción a temperatura programada y desorción a temperatura programada. A partir de los resultados catalíticos, se observó una mejora distinguible de los productos de combustibles comerciales bajo la operación en cascada propuesta en comparación con la configuración independiente o la mezcla física. Independientemente del tipo de zeolita, se demostró que FTS sobre Co/β-SiC con mejora posterior da como resultado la eliminación completa de ceras, resolviendo la principal debilidad de un reactor de lecho fijo convencional. Además, además de una producción selectiva de gasolina, el concepto propuesto proporcionó una mejora significativa de los rendimientos de queroseno y diesel, particularmente cuando se incorpora zeolita H-βeta al sistema en cascada debido a su acidez suave y tamaño de poro más grande

BRCA1 and BRCA2 mutations in males with familial breast and ovarian cancer syndrome. Results of a Spanish multicenter study

Producción CientíficaMale breast cancer (MBC) is a rare disease that represents <1 % of all breast cancers (BCs). We analyze the results of a multicenter study performed in Spanish familial MBC including family history of hereditary breast and ovarian cancer syndrome (HBOCS) and clinicopathological features. We also study the relationship between BRCA1/BRCA2 mutational status in male relatives affected with cancer (MAC) and, family history and tumor types. The study included 312 men index cases with family history of HBOCS and 61 MAC BRCA1/2 mutation-carriers. Family history, histological grade (HG), clinicopathological and immunohistochemistry data were collected. BRCA1/2 mutation analyses were performed by direct sequencing or screening methods and the large rearrangements by multiplex ligation dependent probe amplification. We found 49 mutation-carriers (15.7 %), 95.9 % with BRCA2 mutations. BRCA2 mutation-carriers were associated with families with at least one MBC and one BC in female (type II; p = 0.05). Strong association were found between the presence of pathogenic mutations in MBCs and the advanced HG (p = 0.003). c.658_659delTG, c.2808_2811delACAA, c.6275_6276delTT and c.9026_9030delATCAT were the most prevalent mutations. In 61 MAC we found 20 mutations in BRCA1 and 41 in BRCA2. For MAC we show that mutational status was differentially associated with family history (p = 0.018) and tumor type, being BRCA2 mutations linked with BC and prostatic cancer (p = 0.018). MBC caused by BRCA1/2 mutations define two types of MBCs. The most frequent caused by BRCA2 mutation linked to type II families and the rarest one attributed to BRCA1 mutation. Tumor associated with MAC suggest that only BRCA2 mutations have to do with a specific type of cancer (BC and prostatic cancer); but the linkage to tumors is questionable for BRCA1 mutations

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

OBJECTIVES: To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. METHODS: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ?4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection. RESULTS: A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ?1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (?10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999). CONCLUSIONS: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.Spanish Foundation of Rheumatology. FIS/ISCIII (grant number PI11/02857). Dr. Pego-Reigosa is supported by Grant 316265 (BIOCAPS) from the European Union 7th Framework Programme (FP7/REGPOT-2012–2013.1)

Clinical, biological, and prognostic implications of SF3B1 co-occurrence mutations in very low/low- and intermediate-risk MDS patients

SF3B1 is a highly mutated gene in myelodysplastic syndrome (MDS) patients, related to a specific subtype and parameters of good prognosis in MDS without excess blasts. More than 40% of MDS patients carry at least two myeloid-related gene mutations but little is known about the impact of concurrent mutations on the outcome of MDS patients. In applying next-generation sequencing (NGS) with a 117 myeloid gene custom panel, we analyzed the co-occurrence of SF3B1 with other mutations to reveal their clinical, biological, and prognostic implications in very low/low- and intermediate-risk MDS patients. Mutations in addition to those of SF3B1 were present in 80.4% of patients (median of 2 additional mutations/patient, range 0–5). The most frequently mutated genes were as follows: TET2 (39.2%), DNMT3A (25.5%), SRSF2 (10.8%), CDH23 (5.9%), and ASXL1, CUX1, and KMT2D (4.9% each). The presence of at least two mutations concomitant with that of SF3B1 had an adverse impact on survival compared with those with the SF3B1 mutation and fewer than two additional mutations (median of 54 vs. 87 months, respectively: p = 0.007). The co-occurrence of SF3B1 mutations with specific genes is also linked to a dismal prognosis: SRSF2 mutations were associated with shorter overall survival (OS) than SRSF2wt (median, 27 vs. 75 months, respectively; p = 0.001), concomitant IDH2 mutations (median OS, 11 [mut] vs. 75 [wt] months; p = 0.001), BCOR mutations (median OS, 11 [mut] vs. 71 [wt] months; p = 0.036), and NUP98 and STAG2 mutations (median OS, 27 and 11 vs. 71 months, respectively; p = 0.008 and p = 0.002). Mutations in CHIP genes (TET2, DNMT3A) did not significantly affect the clinical features or outcome. Our results suggest that a more comprehensive NGS study in low-risk MDS SF3B1mut patients is essential for a better prognostic evaluation.This work was supported by grants from the following: Contrato Rio Hortega, CM17/00171; Gerencia Regional de Salud (Castilla y León) para proyectos de investigación año 2018, 1850/A/18; Spanish Fondo de Investigaciones Sanitarias, PI15/01471, PI18/01500; Instituto de Salud Carlos III (ISCIII); European Regional Development Fund (ERDF) “Una manera de hacer Europa”; Consejería de Educación, Junta de Castilla y León (SA271P18); Proyectos de Investigación del SACYL, Spain, GRS1847/A/18, GRS1653/A17; SYNtherapy, Synthetic Lethality for Personalized Therapy-based Stratification In Acute Leukemia (ERAPERMED2018–275); ISCIII (AC18/00093), co-funded by ERDF/ESF, “Investing in your future”, by grants from Red Temática de Investigación Cooperativa en Cáncer (RTICC) (RD12/0036/0069) and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC CB16/12/00233). JMHS is supported by a research grant from Fundación Española de Hematología y Hemoterapia. MM is currently supported by an Ayuda predoctoral de la Junta de Castilla y León from the Fondo Social Europeo (JCYL- EDU/556/2019 PhD scholarship)

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Evaluación de la exposición pasiva al tabaco (segunda y tercera mano), ambientes privados libres de humo e impacto en salud en la población pediátrica

El consumo de tabaco es la primera causa de morbimortalidad evitable en los países desarrollados, además la exposición al humo ambiental del tabaco (HAT) ha sido clasificado como carcinógeno tipo I según la Agencia Internacional de Investigación sobre el Cáncer (IARC según sus siglas en inglés) y produce más de 600.000 muertes anuales e importante morbilidad entre los no fumadores. La exposición al HAT perjudica especialmente a la población pediátrica y se puede producir desde el periodo prenatal, incrementando el riesgo de nacimiento pretérmino, asma, neumonía o alteraciones en el neurodesarrollo, entre otros efectos. En la actualidad, en la población pediátrica, la principal fuente de exposición al HAT son los ambientes privados, como las casas y vehículos privados, debido al incremento en las políticas de control del tabaquismo en los espacios públicos, que se han ido implementando por los diferentes países después del convenio marco para el control del tabaquismo de la Organización Mundial de la Salud (OMS). Por otro lado, en la última década, ha crecido el interés por los contaminantes residuales del humo del tabaco que permanecen en las superficies tras haber fumado, lo que se conoce como humo de tercera mano (HTM), y puede ser otra fuente de exposición pasiva al tabaco. Los objetivos de la presente tesis doctoral fueron: 1) Analizar la correlación entre las medidas de control del tabaquismo implementadas en Europa y la prevalencia de nacimientos pretérmino y nacimientos con bajo peso al nacer. 2) Caracterizar la prevalencia de hogares libres de humo y el apoyo social de la población adulta española sobre la regulación del consumo de tabaco en vehículos con y sin niños a bordo. 3) Describir la prevalencia de hogares libres de humo (con regulación total o parcial) y la prevalencia actual de exposición pasiva al humo del tabaco en niños menores de tres años en hogares y otros ambientes en España. 4) Realizar una revisión sistemática de la literatura científica sobre el humo de tercera mano. 5) Caracterizar la exposición al humo de tercera mano en hogares con niños menores de tres años en España y describir el conocimiento y las creencias de los efectos del mismo en niños. La presente tesis doctoral es un compendio de cuatro artículos científicos en revistas indexadas en Web of Science y un manuscrito en revisión en una revista indexada en la misma base (ver sección: Artículos científicos de la tesis doctoral). Las conclusiones principales de esta tesis doctoral podrían resumirse en: 1) El incremento las legislaciones para el control del tabaquismo en los países europeos se correlaciona, a nivel ecológico, con una disminución en la prevalencia de nacimientos pretérmino. 2) En España, existe un soporte poblacional elevado para favorecer una legislación que regule el consumo de tabaco en los vehículos privados con menores a bordo (9 de cada 10 adultos). 3) Más del 80% de hogares españoles aplican algún tipo de regulación voluntaria sobre el consumo de tabaco (45% regulación total), elevándose al 85% la regulación total en hogares con niños de 3 a 36 meses. Respecto al HTM, nuestra revisión sistemática muestra evidencias de los posibles efectos perjudiciales para la salud de esta exposición, siendo necesario más estudios a medio y largo plazo. El componente más analizado para determinar el HTM ha sido la nicotina, seguido por las nitrosaminas y la cotinina. Además, a nivel social, existe en la actualidad un desconocimiento sobre el HTM y sus potenciales consecuencias. Sin embargo, nuestros datos muestran que tras conocer la definición del mismo, la mayoría de los padres de niños menores de 3 años clasifican el HTM como dañino para la salud de sus hijos.El consum de tabac és la primera causa de morbimortalitat evitable als països desenvolupats, a més, l'exposició al fum ambiental del tabac (FAT) ha estat classificat com carcinogen tipus I segons l'Agència Internacional d'Investigació sobre el Càncer (IARC segons les seves sigles en anglès) i produeix més de 600.000 morts anuals i important morbiditat entre els no fumadors. L'exposició al FAT perjudica especialment a la població pediàtrica i es pot produir des del període prenatal, incrementant el risc de naixement preterme, asma, pneumònia o alteracions en el neurodesenvolupament, entre altres efectes. A l'actualitat, a la població pediàtrica, la principal font d'exposició al FAT són els ambients privats, com les cases i vehicles particulars, a causa del increment a les polítiques de control del tabaquisme en els espais públics que s'han anat implementant pels diferents països després del conveni marc pel control del tabaquisme de l'Organització Mundial de la Salut (OMS). D'altra banda, l'última dècada, ha crescut l'interès pels contaminants residuals del fum del tabac que romanen a les superfícies després d'haver fumat, el que es coneix com fum de tercera mà (FTM), i pot ser una altra font d'exposició passiva al tabac. Els objectius de la present tesi doctoral van ser: 1) Analitzar la correlació entre les mesures de control del tabaquisme implementades a Europa i la prevalença de naixements preterme i naixements amb baix pes al néixer. 2) Caracteritzar la prevalença de llars lliures de fum i el suport social de la població adulta espanyola sobre la regulació del consum de tabac als vehicles amb i sense nens a bord. 3) Descriure la prevalença de llars lliures de fum (amb regulació total o parcial) i la prevalença actual d'exposició passiva al fum del tabac en nens menors de tres anys en llars i altres ambients a Espanya. 4) Realitzar una revisió sistemàtica de la literatura científica sobre el fum de tercera mà. 5) Caracteritzar l'exposició al fum de tercera mà en llars amb nens menors de tres anys a Espanya i descriure el coneixement i les creences dels efectes del mateix en nens. La present tesi doctoral és un compendi de quatre articles científics en revistes indexades a Web of Science i un manuscrit en revisió a una revista indexada a la mateixa base (veure secció: Articles científics de la tesi doctoral). Less conclusions principals d'aquest projecte podrien resumir-se com: 1) L'increment les legislacions per al control del tabaquisme als països europeus es correlaciona, a nivell ecològic, amb una disminució en la prevalença de naixements preterme. 2) A Espanya, hi ha un suport poblacional elevat per afavorir una legislació que reguli el consum de tabac en els vehicles privats amb menors a bord (9 de cada 10 adults). 3) Més del 80% de llars espanyoles apliquen algun tipus de regulació voluntària pel consum de tabac (45% regulació total), elevant al 85% la regulació total en llars amb nens de 3 a 36 mesos. Respecte al FTM, la nostra revisió sistemàtica mostra evidències dels possibles efectes perjudicials per la salut d'aquesta exposició, sent necessaris més estudis a mig i llarg termini. El component més analitzat per determinar el FTM és la nicotina, seguit per les nitrosamines i la cotinina. A més, a nivell social, existeix a l'actualitat un desconeixement sobre el FTM i les seves potencials conseqüències. No obstant això, les nostres dades mostren que després de conèixer la definició del FTM, la majoria dels pares de nens menors de 3 anys ho classifiquen com nociu per a la salut dels seus fills

Tools for the elaboration and evaluation of teaching portfolios in Pneumology

Los portafolios educativos son unas herramientas cada vez más utilizadas en el ámbito de las prácticas clínicas. Resulta evidente su importancia en el ámbito de la NeumologíaDepto. de MedicinaDepto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte