Trabajando con nuestros pacientes fumadores en atención primaria. Un análisis de coste-efectividad

ResumenObjetivoEl objetivo de este trabajo es realizar una evaluación económica de las intervenciones sobre tabaquismo en atención primaria.DiseñoAnálisis de coste-efectividad (ACE) comparando 2 estrategias de intervención: intensiva y breve.EmplazamientoPacientes de una consulta de medicina de familia en un centro de salud (CS) periurbano.ParticipantesTodas las historias con etiqueta de fumadores; 235 y 37 en el grupo de intervención breve e intensiva, respectivamente.IntervencionesLa intervención breve (IB) se realizó en el contexto de otro motivo de consulta (1-5 min). La intervención intensiva (II) fue exclusivamente para tabaquismo (10-15 min).Mediciones principalesLos datos de efectividad son obtenidos de la evaluación de la intervención sobre los fumadores de dicha consulta después de 6 años. Empleamos costes sanitarios directos. Excluimos fármacos, costes no sanitarios e indirectos. Aplicamos la tasa de coste-efectividad incremental (ICER) de las intervenciones breve, intensiva y total (breve+intensiva), comparando no intervenir con cada tipo de intervención e II respecto a la IB y análisis probabilístico para tratar la incertidumbre.ResultadosEl coste por paciente abstinente, globalmente, fue 406,74 €. Para la IB fue de 129,83 € y para la II, 1.034,99 €.ICER intervención total=498,87 €/paciente que deja de fumar.ICER IB=235,32 €/paciente que deja de fumar.ICER II=1.232,85 €/paciente que deja de fumar.ICER II/IB=7.772,25 €/paciente que deja de fumar.ConclusionesLas intervenciones sobre tabaquismo en AP son eficientes. Una propuesta para el abordaje del tabaquismo en AP, desde una perspectiva coste-efectiva, podría ser la IB sobre todos los fumadores e II sobre aquellos con más dificultad para abandonar.AbstractObjectiveThe aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC).DesignCost-Effectiveness Analysis comparing two intervention strategies; intensive and brief.SettingPatients in a general practitioner's list in a peri-urban Health Centre.ParticipantsAll the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively.InterventionsThe brief intervention (BI) was made in the context of consultation for another purpose (1-5minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15minutes).Main measurementsThe effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief+intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty.ResultsThe total cost per abstinent patient was 406,74 €: 129,83 € for BI and 1.034,99 € for I.I.ICER Total intervention=€498, 87/patient who stops smoking.ICER BI=€235, 32/patient who stops smoking.ICER II=€1.232, 85/patient who stops smoking.ICER II/BI=€7.772,25/patient who stops smoking.ConclusionsSmoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit

Brote de Alta Mortalidad en Terneros Lecheros por Diarrea Neonatal Producida por Cryptosporidium sp Asociado a Bacteriemia en un Establo Lechero de Lima

This paper presents and discusses the clinical and pathological findings of an outbreak of neonatal diarrhea that caused a high mortality in a dairy farm in Lima, Peru. The diarrheas did not respond to antibiotics and occurred in calves less than one month old. The animals showed signs of dehydration, fluid feces, fever and marked depression of sensory. They were negative for coronavirus and rotavirus but were positive for Criptosporidium sp. In the post mortem study, a severe diffuse acute mucohemorrhagic enterocolitis was found and the histopathological diagnosis corroborated that it was a severe acute diffuse catarrhal enteritis associated with Cryptosporidium sp and bacterial nests. In the barn was found deficiencies in the management of colostrum and hygiene of the containers in which the milk was offered to the calves. The problem was solved introducing a series of good practices in calf handling.En el presente trabajo se presenta y discute los hallazgos clínicos y patológicos de un brote de diarrea neonatal que causó una alta mortalidad en un establo lechero de Lima, Perú. Los cuadros de diarrea no respondían a la antibioterapia y se presentaron en terneros menores de un mes de edad. Los animales presentaban signos de deshidratación, heces líquidas, fiebre y marcada depresión de sensorio. Fueron negativos a coronavirus y rotavirus, pero fueron positivos a Criptosporidium sp. Al estudio posmortem se encontró una severa enterocolitis mucohemorrágica difusa aguda y al diagnóstico histopatológico se corroboró que se trataba de una severa enteritis catarral difusa aguda asociada a Cryptosporidium sp y nidos bacterianos. En el establo se encontró deficiencias en el manejo del calostro e higiene de los recipientes en los que se ofrecía la leche a los terneros. El problema fue solucionado introduciendo una serie de buenas prácticas de manejo del terneraje

Antiretroviral therapy duration and immunometabolic state determine efficacy of ex vivo dendritic cell-based treatment restoring functional HIV-specific CD8+ T cells in people living with HIV.

Dysfunction of CD8+ T cells in people living with HIV-1 (PLWH) receiving anti-retroviral therapy (ART) has restricted the efficacy of dendritic cell (DC)-based immunotherapies against HIV-1. Heterogeneous immune exhaustion and metabolic states of CD8+ T cells might differentially associate with dysfunction. However, specific parameters associated to functional restoration of CD8+ T cells after DC treatment have not been investigated. We studied association of restoration of functional HIV-1-specific CD8+ T cell responses after stimulation with Gag-adjuvant-primed DC with ART duration, exhaustion, metabolic and memory cell subsets profiles. HIV-1-specific CD8+ T cell responses from a larger proportion of PLWH on long-term ART (more than 10 years; LT-ARTp) improved polyfunctionality and capacity to eliminate autologous p24+ infected CD4+ T cells in vitro. In contrast, functional improvement of CD8+ T cells from PLWH on short-term ART (less than a decade; ST-ARTp) after DC treatment was limited. This was associated with lower frequencies of central memory CD8+ T cells, increased co-expression of PD1 and TIGIT and reduced mitochondrial respiration and glycolysis induction upon TCR activation. In contrast, CD8+ T cells from LT-ARTp showed increased frequencies of TIM3+ PD1- cells and preserved induction of glycolysis. Treatment of dysfunctional CD8+ T cells from ST-ARTp with combined anti-PD1 and anti-TIGIT antibodies plus a glycolysis promoting drug restored their ability to eliminate infected CD4+ T cells. Together, our study identifies specific immunometabolic parameters for different PLWH subgroups potentially useful for future personalized DC-based HIV-1 vaccines. NIH (R21AI140930), MINECO/FEDER RETOS (RTI2018-097485-A-I00) and CIBERINF grants.NIH (R21AI140930), MINECO/FEDER RETOS (RTI2018-097485-A-I00) and CIBERINF grants. We would like to thank the NIH AIDS Reagent Pro- gram, Division of AIDS, NIAID, NIH for providing HIV-1 PTE Gag Peptide Pool from NIAID, DAIDS (cat #11057) for the study. We would also like to thank Alvaro Serrano Navarro, for his help on adapting the lin- ear mixed model previously described by Martin- C ofreces N. et al83 to our data. Graphical schematic rep- resentations were created with BioRender.com. EMG was supported by the NIH R21 program (R21AI140930), the Ramón y Cajal Program (RYC2018- 024374-I), the MINECO/FEDER RETOS program (RTI2018-097485-A-I00), by Comunidad de Madrid Talento Program (2017-T1/BMD-5396) and by Gilead becas de investigaci on (GLD19/00168). EMG and IDS are supported by Centro de Investigación Biomédica en Red (CIBERINF) de Enfermedades Infecciosas (CB21/ 13/00107). MCM was supported by NIH R21 program (R21AI140930), “La Caixa Banking Foundation (H20- 00218) and Gilead becas de investigaci on (GLD19/ 00168). MJB is supported by the Miguel Servet program funded by the Spanish Health Institute Carlos III (CP17/00179), the MINECO/FEDER RETOS program (RTI2018-101082-B-100), and Fundació La Marat o TV3 (201805-10FMTV3). EMG and MJB are both funded by “La Caixa Banking Foundation (H20-00218) and by REDINCOV grant from Fundació La Marat o TV3. FSM was supported by SAF2017-82886-R and PDI-2020- 120412RB-I00 grants from the Ministerio de Ciencia e Innovaci on, and HR17-00016 grant from “La Caixa Banking Foundation. HF was funded by PI21/01583 grant from Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III. MJC was supported by PID2019- 104406RB-I00 from Ministerio de Ciencia e Innovación. ISC was funded by the CM21/00157 Rio- Hortega grant. IT was supported by grant for the pro- motion of research studies master-UAM 2021.S

NLRC4 -mediated activation of CD1c+ dendritic cells contributes to perpetuation of synovitis in rheumatoid arthritis.

The individual contribution of specific myeloid subsets such as CD1c+ conventional dendritic cells (cDC) to perpetuation of Rheumatoid Arthritis (RA) pathology remains unclear. In addition, the specific innate sensors driving pathogenic activation of CD1c+ cDCs in RA patients and their functional implications have not been characterized. Here, we assessed phenotypical, transcriptional and functional characteristics of CD1c+ and CD141+ cDCs and monocytes from the blood and synovial fluid of RA patients. Increased levels of CCR2 and the IgG receptor CD64 on circulating CD1c+ cDC associated with the presence of this DC subset in the synovial membrane in RA patients. Moreover, synovial CD1c+ cDCs are characterized by increased expression of proinflammatory cytokines and high abilities to induce pathogenic IFNγ+IL-17+ CD4+ T cells in vitro. Finally, we identified the crosstalk between Fcγ Receptors and NLRC4 as a new potential molecular mechanism mediating pathogenic activation, CD64 upregulation and functional specialization of CD1c+ cDCs in response to dsDNA-IgG in RA patients.E.M.G. was supported by Comunidad de Madrid Talento Program (2017-T1/BMD5396), Ramón y Cajal Program (RYC2018-024374-I), the MINECO RETOS program (RTI2018-097485-A-I00), La Caixa Foundation (HR20-00218), CIBERINF (CB21/13/00107) and the TV3 Marató (REDINCOV). C.D.A. was supported by Comunidad de Madrid Talento Program (2017-T1/BMD-5396). M.C.M was supported by the NIH (R21AI140930). HR17-00016 grant from “La Caixa Banking Foundation to F.S.M also supported the study. D.C-F. is supported by the Fellowship “la Caixa” Foundation LCF/BQ/DR19/11740010. A.T.M. was supported by a PhD fellowship from the Autonomous Region of Madrid (PEJD-2019-PRE/BMD-16851) and the RD21/0002/0027 grant. R.L. and G.H.B. were supported by PI18/00261 AND PI20/00349 grants from Ministerio de Ciencia e Innovación and Instituto de Salud Carlos III, respectively. O.P. was supported by the TV3 Marató (REDINCOV) and I.T. was funded by grant for the promotion of research studies master-UAM 2021. S.C. was supported by PI21/01474 grant from the Instituto de Salud Carlos III and co-funded by The European Regional Development Fund (ERDF). I.G.A was supported by RD21/0002/0027 and PI21/00526 grants from the Spanish MINECO and Instituto de Salud Carlos III and co-funded by The European Regional Development Fund (ERDF) “A way to make Europe.S

MICa/b-dependent activation of natural killer cells by CD64+ inflammatory type 2 dendritic cells contributes to autoimmunity.

Primary Sjögren's syndrome (pSS) is an inflammatory autoimmune disorder largely mediated by type I and II interferon (IFN). The potential contribution of innate immune cells, such as natural killer (NK) cells and dendritic cells (DC), to the pSS pathology remains understudied. Here, we identified an enriched CD16+ CD56hi NK cell subset associated with higher cytotoxic function, as well as elevated proportions of inflammatory CD64+ conventional dendritic cell (cDC2) subtype that expresses increased levels of MICa/b, the ligand for the activating receptor NKG2D, in pSS individuals. Circulating cDC2 from pSS patients efficiently induced activation of cytotoxic NK cells ex vivo and were found in proximity to CD56+ NK cells in salivary glands (SG) from pSS patients. Interestingly, transcriptional activation of IFN signatures associated with the RIG-I/DDX60 pathway, IFN I receptor, and its target genes regulate the expression of NKG2D ligands on cDC2 from pSS patients. Finally, increased proportions of CD64hi RAE-1+ cDC2 and NKG2D+ CD11b+ CD27+ NK cells were present in vivo in the SG after poly I:C injection. Our study provides novel insight into the contribution and interplay of NK and cDC2 in pSS pathology and identifies new potential therapy targets.S

Ingeniería Forestal y ambiental en medios insulares

Las Islas Canarias a pesar de su reducida extensión y del relativo poco peso específico a nivel mundial, no es ajena a los problemas globales detectados en la conservación de bosques y en la importancia que éstos tienen para obtener beneficios económicos, socioculturales y ambientales. La gestión forestal sostenible es en este sentido esencial para asegurar y compatibilizar los diversos beneficios del bosque. El papel específico de los bosques y su gestión son sin embargo temas aún por conocer en nuestras islas, por lo que el Año Internacional de los Bosques ha representado una oportunidad única para dar a conocer el mundo forestal y acercarlo a nuestra sociedad. El presente libro consta de 25 capítulos donde se ha contemplado la mayoría de los aspectos a tener en cuenta en la planificación y gestión del medio forestal y natural. Desde la historia forestal del archipiélago, hasta el uso y técnicas de manejo de los recursos naturales, incluyendo el agua, la energía en forma de biomasa y la selvicultura

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Caminando en la ruta sentipensante: configuración de experiencias pedagógicas nivel inicial

494 páginasEste texto es realizado en el contexto del Plan de Desarrollo 2016 – 2020, “Bogotá mejor para todos”, en el que se señala: Bogotá es entendida como una ciudad educadora, en la que todos los ciudadanos son agentes educadores y todos los espacios pueden ser escenarios pedagógicos para el aprendizaje. Una ciudad educadora tiene como centro el conocimiento e inspira aprendizaje, formas y lenguajes para reconocernos, para reencontrarnos; los espacios para el aprendizaje son entendidos como espacios para la vida, en los que se posibilita la investigación y la innovación para vivir mejor, para reinventarnos como ciudad, una ciudad mejor para todos. Los dieciocho textos aquí presentados, fruto del acompañamiento pedagógico realizado por el IDEP en 2019, son base y referente para seguir aportando en la configuración y consolidación de comunidades de saber y práctica pedagógica de la ciudad, así como en la conformación de colectivos y redes de maestros. Son la evidencia de un potente trabajo de acompañamiento a experiencias de nivel inicial, caracterizadas por contar con ideas o avances para problematizar, estructurar, fundamentar, elaborar estrategias y un plan de acción

Métodos y técnicas de monitoreo y predicción temprana en los escenarios de riesgos socionaturales

Esta obra concentra los métodos y las técnicas fundamentales para el seguimiento y monitoreo de las dinámicas de los escenarios de riesgos socionaturales (geológicos e hidrometeorológicos) y tiene como objetivo general orientar, apoyar y acompañar a los directivos y operativos de protección civil en aterrizar las acciones y políticas públicas enfocadas a la gestión del riesgo local de desastre