A organização social do atendimento infantil vulnerável em Bogotá

Introducción: El cuidado de la infancia ha estado soportado en un modelo de familia judeo-cristiana, en la que la división de roles entre una pareja resulta funcional: el hombre provee y la mujer cuida. Sin embargo, esa división de roles no se ajusta a las nuevas configuraciones familiares y menos aún a las dinámicas sociales, económicas y políticas contemporáneas. Objetivo: Estudiar la organización social del cuidado de la infancia, desde la perspectiva de las madres de sectores vulnerables en Bogotá. Método: Diseño hermenéutico de corte narrativo, que utiliza las entrevistas individuales en profundidad que fueron sometidas a un proceso de codificación y categorización para la construcción final de la narrativa. Resultados: El cuidado de los infantes continúa siendo una responsabilidad casi exclusiva de las mujeres, ellas, en condiciones de pobreza, asumen también la proveeduría de familia en ausencia parcial o total del padre. Y aunque existen algunos programas estatales relacionados con el cuidado, estas mujeres no logran acceder a los beneficios por desconocimiento de su existencia o porque estos programas no tienen cobertura adecuada. Conclusiones: Las mujeres pobres deben asumir simultáneamente los roles de proveeduría y cuidado de los infantes sin que puedan resultar beneficiadas de los escasos programas de cuidado ofrecidos por el Estado.Introduction: Child care has been supported in a Judeo-Christian family model, so that the division of roles between the couple is functional: the man provides and the woman cares. However, this division of roles does not conform to new family configurations and even less to contemporary social dynamics. Objective: To study the social organization of child care, from the perspective of the mothers of vulnerable sectors in Bogotá. Method: Narrative hermeneutic design, which used in-depth individual interviews, which were subjected to a coding and categorization process for the final construction of the narrative. Results: The care of the infants continues being an exclusive responsibility of the women, they, in poverty conditions, also assume the family supply in partial or total absence of the father. And although there are some state programs related to care, these women do not get access to the benefits due to ignorance of their existence or because these programs do not have adequate coverage. Conclusions: Poor women must simultaneously assume the roles of providing and caring for infants without being able to benefit from the scarce care programs offered by the State.Introdução: O cuidado da criança tem sido apoiado em um modelo de família judaico-cristã, de modo que a divisão de papéis entre o casal é funcional: o homem fornece e a mulher cuida. No entanto, essa divisão de papéis não se ajusta às novas configurações familiares e muito menos às dinâmicas sociais contemporâneas. Objetivo: Estudar a organização social do cuidado infantil, na perspectiva das mães de setores vulneráveis em Bogotá. Método: Desenho hermenêutico narrativo, que utilizou entrevistas individuais em profundidade, as quais foram submetidas a um processo de codificação e categorização para a construção final da narrativa. Resultados: O cuidado dos lactentes continua sendo de responsabilidade exclusiva das mulheres, que, em condições de pobreza, assumem também a oferta familiar em ausência parcial ou total do pai. E embora existam alguns programas estaduais relacionados à assistência, essas mulheres não obtêm acesso aos benefícios devido ao desconhecimento de sua existência ou porque esses programas não possuem cobertura adequada. Conclusões: As mulheres pobres devem simultaneamente assumir o papel de prover e cuidar de bebês sem poder se beneficiar dos programas de atendimento escassos oferecidos pelo Estado

A organização social do atendimento infantil vulnerável em Bogotá

Introducción: El cuidado de la infancia ha estado soportado en un modelo de familia judeo-cristiana, en la que la división de roles entre una pareja resulta funcional: el hombre provee y la mujer cuida. Sin embargo, esa división de roles no se ajusta a las nuevas configuraciones familiares y menos aún a las dinámicas sociales, económicas y políticas contemporáneas. Objetivo: Estudiar la organización social del cuidado de la infancia, desde la perspectiva de las madres de sectores vulnerables en Bogotá. Método: Diseño hermenéutico de corte narrativo, que utiliza las entrevistas individuales en profundidad que fueron sometidas a un proceso de codificación y categorización para la construcción final de la narrativa. Resultados: El cuidado de los infantes continúa siendo una responsabilidad casi exclusiva de las mujeres, ellas, en condiciones de pobreza, asumen también la proveeduría de familia en ausencia parcial o total del padre. Y aunque existen algunos programas estatales relacionados con el cuidado, estas mujeres no logran acceder a los beneficios por desconocimiento de su existencia o porque estos programas no tienen cobertura adecuada. Conclusiones: Las mujeres pobres deben asumir simultáneamente los roles de proveeduría y cuidado de los infantes sin que puedan resultar beneficiadas de los escasos programas de cuidado ofrecidos por el Estado.Introduction: Child care has been supported in a Judeo-Christian family model, so that the division of roles between the couple is functional: the man provides and the woman cares. However, this division of roles does not conform to new family configurations and even less to contemporary social dynamics. Objective: To study the social organization of child care, from the perspective of the mothers of vulnerable sectors in Bogotá. Method: Narrative hermeneutic design which used in-depth individual interviews, which were subjected to a coding and categorization process for the final construction of the narrative. Results: The care of the infants continues being an exclusive responsibility of the women, they, in poverty conditions, also assume the family supply in partial or total absence of the father. And although there are some state programs related to care, these women do not get access to the benefits due to ignorance of their existence or because these programs do not have adequate coverage. Conclusions: Poor women mustsimultaneously assume the roles of providing and caring for infants without being able to benefit from the scarce care programs offered by the State

Effects of Sex, Age and Height on Symphysis–Ischial Spine Distance Measured on a Pelvic CT

Objective: To examine the influence of age, sex and height on the symphysis–ischial spine distance (SID) measured on pelvic Computed tomography (CT)images in subjects of reproductive age, and to determine the interobserver reproducibility. This measurement (SID) is of great importance because the use of intrapartum ultrasound is based on the assumption of a specific value (30 mm) of such a measurement. Methods: This was a cross-sectional descriptive study in which SID was measured in subjects aged 20 to 44 years who had been scheduled for pelvic CT at our centre from January 2018 to May 2021 for different reasons. Radiographic measurements of the pelvis were obtained through the multiplanar reconstruction of the CT image. The images obtained from all of the participants were independently assessed by three senior radiologists, and the SID measurements made by each one were blinded from those of the remaining observers. Correlations between the SID and patient age, height and sex were analyzed by univariate and multivariate linear regression. Results: The mean SID for 87 of the enrolled participants (45 women, 42 men) was 28.2 ± 6.25 mm. Among the observers, the mean difference in this distance was 1 to 2 mm, and was scarcely related to measurement size, with agreement being greater than 70%. The mean SID was significantly related to sex and height (SID = −24.9 − 6.51 × sex (0 or 1) + 0.34 × height (cm); p = 0.01; sex equals 1 for a man and 0 for a woman), such that it was a mean of 2.5 mm greater in women than men (29.50 mm vs. 26.99 mm). Conclusion: Measurements of SID on CT images show good interobserver reproducibility, and are related to sex and height.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEUnión EuropeaComunidad de MadridInstituto de Salud Carlos IIIHalekulani S.L.pu

Antitumor Necrosis Factor Agents to Treat EndoscopicPostoperative Recurrence of Crohn’s Disease: A Nationwide Study With Propensity-Matched Score Analysis

INTRODUCTION:Patients with Crohn's disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR.METHODS:Multicenter, retrospective, study of patients with Crohn's disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively.RESULTS:A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13-54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04-4.46; P = 0.03, and OR 2.34, 95% CI 1.18-4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65-6.05; P < 0.01, and OR 2.01, 95% CI 1.05-3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis.DISCUSSION:In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.Fiorella Canete received a research grant from the Societat Catalana de Digestologia

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery