Propiedades psicométricas de la versión espanola de la escala de motivación deportiva

This study aimed to analyse the psychometric properties of the Spanish version of the échelle de Motivation dans les Sports (EMS). The sample was made up of 496 athletes: 314 men and 182 women. The confirmatory factorial nalysis confirmed the scales seven-factor structure with method effects, the construct validity was supported by the correlations among the subscales. Furthermore, the results showed satisfactory levels of internal consistency and significant differences between genders were obtained in the end. These results support the use of the Spanish version of the SMS in assessing motivation within the context of sport

Clinical Characteristics and prognostic factors for Intensive Care Unit Admission of Patients With COVID-19. Retrospective Study Using Machine Learning and Natural Language Processing.

13 p.Background: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results: A total of 10,504 patients with a clinical or polymerase chain reaction?confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature 39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admissio

Nuevas tecnologías en Medicina

Varios sectores de la sociedad, y de forma especial la medicina, están en un momento de cambio que, apoyado en un gran desarrollo tecnológico, va a revolucionar nuestra forma de entender la gestión, investigación y asistencia clínica. Actualmente la medicina se basa en estudios, frecuentemente con pobre validez externa, cuyos resultados se trasladana un paciente concreto a pesar de estar basados en simples medias estadísticas. El avance hacia una medicina personalizada solo será posible con nuevos enfoques en los que el Big Data y la inteligencia artificial van a ser de gran ayuda a la hora de trasladar la mejor investigación clínica a nuestro paciente, sin olvidar todo lo que estas herramientas pueden aportar en la investigación básica. A nivel de gestión, el modelo asistencial presencial deberá complementarse con otras formas de trabajo mucho más eficientes que ayuden a consolidar la sostenibilidad del sistema sanitario actual. En este entorno, el desarrollo tecnológico proporcionará las herramientas necesarias para implementar estos cambios. El Big Data como fuente de información, la inteligencia artificial con todas las variantes, que incluyen desde el procesamiento de lenguaje natural hasta el desarrollo de técnicas de imagen, y el desarrollo de nuevas tecnologías en múltiples áreas, van a ser herramientas habituales para el médico, muy posiblemente antes de que finalice esta década. Aunque en esta revisión nos hemos focalizado en patologías respiratorias este planteamiento es plenamente extrapolable a cualquier otra área de la medicina.Several sectors of society, and especially medicine, are at a time of change that, supported by great technological development, is going to revolutionize our way of understanding management, research, and clinical care. Currently medicine is based on studies, often with poor external validity, whose results are transferred to a specific patient despite being based on simple statistical means. Progress towards personalized medicine will only be possible with new approaches in which Big Data and artificial intelligence will be of great help in transferring the best clinical research to our patients, without forgetting everything that these tools can contribute to basic research. In clinical practice, the face-to-face care model must be complemented with other much more efficient forms of work that help to consolidate the sustainability of the current health system. In this environment, technological development will provide the necessary toolsto implement these changes. Big Data as a source of information, artificial intelligence with all its variants ranging from natural language processing to the development of image techniques, and the development of new technologies in multiple areas are going to be common tools for the doctor, possibly before the end of this decade. Although in this review we have focused on respiratory pathologies, this approach can be fully extrapolated to any other area of medicin

Validación de la versión espanola de la escala multidimensional de orientaciones a la deportividad

The aim of this study was to translate into Spanish and validate the Multidimensional Sportspersonship Orientations Scale (MSOS), which was developed in English and validated by Vallerand et al. (1997). The MSOS consistsof five subscales that measure full commitment toward sport, respect for social conventions, respect and concern for rules and officials, respect and concern for opponents, and negative approach towards sportspersonship. The Spanish version of the scale showed acceptable levels of internal consistency and temporal stability over a four-week period. The results of a confirmatory factor analysis confirmed the five-factor structure of the MSOS. Correlations among the subscales confirmed the scales construct validity. Finally, gender differences were obtained. These findings support the use of the Spanish version of the MSOS for assessing individual differences in sportspersonship orientations

Exploring Polar Headgroup Interactions Between Sphingomyelin and Ceramide with Infrared Spectroscopy

Ceramide is a major actor in the sphingolipid signaling pathway elicited by various kinds of cell stress. Under those conditions ceramide (Cer) is produced in the plasma membrane as a product of sphingomyelin (SM) hydrolysis, and this may lead to apoptosis. Thus, SM and Cer coexist in the membrane for some time, and they are known to separate laterally from the (more abundant) glycerolipids, giving rise to highly rigid domains or platforms. The properties of these domains/platforms are rather well understood, but the underlying SM:Cer molecular interactions have not been explored in detail. Infrared (IR) spectroscopy is a powerful analytical technique that provides information on all the chemical groupings in a molecule, and that can be applied to membranes and lipid bilayers in aqueous media. IR spectra can be conveniently retrieved as a function of temperature, thus revealing the thermotropic transitions of SM and its mixtures with Cer. Four regions of the IR spectrum of these sphingolipids have been examined, two of them dominated by the hydrophobic regions in the molecules, namely the C-H stretching vibrations (2800-3000 cm(-1)), and the CH2 scissoring vibrations (1455-1485 cm(-1)), and two others arising from chemical groups at the lipid-water interface, the sphingolipid amide I band (1600-1680 cm(-1)), and the phosphate vibrations in the 1000-1110 cm(-1) region. The latter two regions have been rarely studied in the past. The IR data from the hydrophobic components show a gel (or ripple)-fluid transition of SM at 40 degrees C, that is shifted up to about 70 degrees C when Cer is added to the bilayers, in agreement with previous studies using a variety of techniques. IR information concerning the polar parts is more interesting. The amide I (carbonyl) band of pure SM exhibits a maximum at 1638 cm(-1) at room temperature, and its position is shifted by about 10 cm(-1) in the presence of Cer. Cer causes also a change in the overall band shape, but no signs of band splitting are seen, suggesting that SM and Cer carbonyl groups are interacting tightly, presumably through H-bonds. The 1086 cm(-1) band, corresponding to PO2- vibrations, appears more stable in SM than in DPPC, and it is further stabilized by Cer, again suggesting an important role of H-bonds in the formation of SM:Cer clusters. Thus, SM and Cer can interact through their polar headgroups, in a way that is not accessible to other lipid classes.This work was supported in part by the Spanish Ministerio de Ciencia e Innovacion (MCI), Agencia Estatal de Investigacion (AEI) and Fondo Europeo de Desarrollo Regional (FEDER) (grant No. PGC2018-099857-B-I00), by the Basque Government (Grants No. IT1264-19, IT1196-19 and IT1270-19), by the Fundacion Biofisica Bizkaia and by the Basque Excellence Research Centre (BERC) program of the Basque Government

Systemic Corticosteroids in Patients with Bronchial Asthma: A Real-Life Study

25 p.Objectives: The objective of the present study was to determine the use of systemic corti-costeroids (SCs) in patients with bronchial asthma using big data analysis. Methods: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was per-formed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. Results: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients at some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, ob-esity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%) and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. Conclusion: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care

Clinical management of COPD in a real-world setting. A Big Data analysis

9 p.Objective: The aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform. Materials and methods: A total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age. Results: In total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients: 4396 mild, 7100 moderate, and 6676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a long-acting anticholinergic (LAMA) in 74% of cases, were observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and an in-hospital mortality rate in this group of 10.74%. Discussion: This study identifies the main features of an unselected COPD population and the main errors made in the management of the disease

The Binding of Aβ42 Peptide Monomers to Sphingomyelin/Cholesterol/Ganglioside Bilayers Assayed by Density Gradient Ultracentrifugation

The binding of Aβ42 peptide monomers to sphingomyelin/cholesterol (1:1 mol ratio) bilayers containing 5 mol% gangliosides (either GM1, or GT1b, or a mixture of brain gangliosides) has been assayed by density gradient ultracentrifugation. This procedure provides a direct method for measuring vesicle-bound peptides after non-bound fraction separation. This centrifugation technique has rarely been used in this context previously. The results show that gangliosides increase by about two-fold the amount of Aβ42 bound to sphingomyelin/cholesterol vesicles. Complementary studies of the same systems using thioflavin T fluorescence, Langmuir monolayers or infrared spectroscopy confirm the ganglioside-dependent increased binding. Furthermore these studies reveal that gangliosides facilitate the aggregation of Aβ42 giving rise to more extended β-sheets. Thus, gangliosides have both a quantitative and a qualitative effect on the binding of Aβ42 to sphingomyelin/cholesterol bilayers.This work was supported in part by grants from the Spanish Ministry of Economy (grant FEDER MINECO PGC2018-099857-B-I00) and the Basque Government (grants No. IT1264-19 and IT1270-19)

Cost-effectiveness analysis of anti–IL-5 therapies of severe eosinophilic asthma in Spain

Asma eosinofílica greu; Comparació indirecta del tractament; MepolizumabSevere eosinophilic asthma; Indirect treatment comparison; MepolizumabAsma eosinofílica severa; Comparación de tratamiento indirecto; MepolizumabAim To analyse the cost-effectiveness of MEP with standard of care (SoC) versus other anti-IL-5 therapies approved for the treatment of severe eosinophilic asthma (SEA) patients, within the Spanish National Health System (NHS) perspective. Methods A Markov model with a 4-week cycle length was used to compare MEP with BEN and RES as therapies added to SoC in the management of SEA, in terms of cost per QALY gained and incremental cost-effectiveness ratio (ICER). Costs (€2019) were obtained from public sources, while utilities and transition probabilities were retrieved from literature, e.g. network meta-analysis. Continuation criteria for biological treatment and reduction of oral corticosteroids (OCS) was set at 50% minimum reduction of exacerbation rate. Adverse events related to chronic OCS use included diabetes, osteoporosis, cataracts, acute myocardial infarct, and peptic ulcer. The analysis was performed over a 5-year time horizon from the National Healthcare System (NHCS) perspective, with a yearly discount rate of 3% applied to both costs and QALYs. Probabilistic sensitivity analysis and univariate deterministic sensitivity analysis were performed to address uncertainty around the cost-effectiveness results. Results On top of SoC, the model indicates that MEP is dominant (lower cost, higher benefit) compared to BEN and RES: For BEN and RES, respectively, treatment with MEP had a point estimate of 0.076 and 0.075 additional QALYs, and savings of €3,173.47 and €7,772.95 per patient. The findings were robust to variation as estimated using sensitivity analysis. Conclusions MEP is a cost-effective treatment in comparison with BEN and RES added to SoC for patients with SEA in the Spanish setting.This study was funded by GlaxoSmithKline [Study code: HO-19-19968]

Characteristics and prognosis of COVID-19 in patients with COPD

Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher prevalence of coronary ischemia and other factors that put them at risk for COVID-19-related complications. We aimed to explore the impact of COVID-19 in a large population-based sample of patients with COPD in Castilla-La Mancha, Spain. We analyzed clinical data in electronic health records from 1 January to 10 May 2020 by using Natural Language Processing through the SAVANA Manager® clinical platform. Out of 31,633 COPD patients, 793 had a diagnosis of COVID-19. The proportion of patients with COVID-19 in the COPD population (2.51%; 95% CI 2.33–2.68) was significantly higher than in the general population aged >40 years (1.16%; 95% CI 1.14–1.18); p < 0.001. Compared with COPD-free individuals, COPD patients with COVID-19 showed significantly poorer disease prognosis, as evaluated by hospitalizations (31.1% vs. 39.8%: OR 1.57; 95% CI 1.14–1.18) and mortality (3.4% vs. 9.3%: OR 2.93; 95% CI 2.27–3.79). Patients with COPD and COVID-19 were significantly older (75 vs. 66 years), predominantly male (83% vs. 17%), smoked more frequently, and had more comorbidities than their non-COPD counterparts. Pneumonia was the most common diagnosis among COPD patients hospitalized due to COVID-19 (59%); 19% of patients showed pulmonary infiltrates suggestive of pneumonia and heart failure. Mortality in COPD patients with COVID-19 was associated with older age and prevalence of heart failure (p < 0.05). COPD patients with COVID-19 showed higher rates of hospitalization and mortality, mainly associated with pneumonia. This clinical profile is different from exacerbations caused by other respiratory viruses in the winter seasonGrant COVID-19 UAH 2019/00003/016/001/005 from Alcalá Universit