Global hypothesis test to compare the likelihood ratios of multiple binary diagnostic tests with ignorable missing data

In this article, a global hypothesis test is studied to simultaneously compare the likelihood ratios of multiple binary diagnostic tests when in the presence of partial disease verification the missing data mechanism is ignorable. The hypothesis test is based on the chi-squared distribution. Simulation experiments were carried out to study the type I error and the power of the global hypothesis test when comparing the likelihood ratios of two and three diagnostic tests respectively. The results obtained were applied to the diagnosis of coronary stenosis.Peer Reviewe

Influence of a Water-Based Exercise Program in the Rate of Spontaneous Birth: A Randomized Clinical Trial

The authors are very grateful for the collaboration received in the financing of the publication with the San Cecilio Clinical Universitary Hospital of Granada and especially thank the collaboration with the Research Coordinator of the San Cecilio Clinical University Hospital. The University of Granada collaborated by facilitating the pool facilities at the Faculty of Physical Activity and Sports Sciences.Introduction: Many women change their lifestyles and habits when they become pregnant, to avoid potentially harmful effects to themselves and their babies. This is especially so with respect to physical exercise, which is often greatly reduced due to ignorance of the benefits it provides during pregnancy. Aim: To evaluate the prevalence of spontaneous birth among women who participated in a water-based physical exercise program. Methods: A randomized clinical trial was conducted with a sample of 129 pregnant women (Control Group, CG = 64; Exercise Group, EG = 65). A physical exercise protocol, specifically designed for pregnant women, was created and applied. Those in the EG performed 60 min exercise sessions, three times per week for 17 weeks. The participants in the CG received routine check-ups and advice throughout their pregnancy. Findings: The women in the EG presented better results for the onset of spontaneous birth (OR = 2.060 (0.980–4.332)) and for neonate Apgar score of 10 at five minutes (OR = 8.53 (3.60–20.17)). Those who had normal weight at the start of pregnancy achieved better results for spontaneous delivery (OR = 2.099 (1.017–4.335)) than those with overweight/obesity. The rate of caesarean delivery was higher in the women with overweight/obesity (OR = 3.570 ((1.226–10.397)) than in those with normal weight. Conclusions: In our study, the women who followed the water-based exercise program gained less weight during pregnancy, which facilitated a better rate of spontaneous, non-instrumental childbirth, together with a better Apgar test score at five minutes

Quality of Life in the Postpartum Recovery ofWomen Who Practice Hypopressive Exercise: Randomized Clinical Trial

Background: Practicing physical exercise is a way of maintaining a healthy lifestyle and it has been demonstrated to provide benefits and improve quality of life after labour. Aim: The objective of this study is to determine if performing a moderate hypopressive exercise program after childbirth improves the HRQoL of women. Materials and Methods: A 12-week randomized clinical trial was carried out. The women in the exercise group followed a training program based on the hypopressive method, which comprises postural and respiratory exercises of moderate intensity. We used the SF-36v2 questionnaire to assess the Health-Related Quality of Life in women. Results: We found statistically significant differences (p < 0.05) in general health components, vitality, emotional role, and mental health in the sample group of exercise group of women, who obtained a higher score. We found statistically significant differences in all aspects between the groups. The interaction between time and group affect in general health components, vitality, emotional role and the score of mental components. In all of them, the score was higher at the end of the programme and in the exercise group. Conclusions: The training program with hypopressive physical exercise improves the quality of life after childbirth. According to the guidelines recommended by the ACOG, the hypopressive method is valid for the improvement of HRQoL in women who perform this method at 16 weeks of delivery. Further studies are recommended to start such exercises one week after delivery in postpartum women.Colegio Oficial de Enfermeria de Granada (CODEGRA

Water Exercise and Quality of Life in Pregnancy: A Randomised Clinical Trial

Background: Physical exercise helps to maintain a healthy lifestyle and its practice is recommended for women during pregnancy as a means of limiting the negative effects on the body that may take place and to optimise well-being, mood and sleep patterns, as well as encouraging daily physical activity, enhancing the ability to work and preventing pregnancy-related complications. Aim: To analyse the quality of life in pregnancy for women who complete a programme of moderate physical activity in water, following a designed method that the woman can perform physical exercise safely during pregnancy called the SWEP (study of water exercise during pregnancy) method. Materials and methods: A randomised clinical trial was performed. One hundred and twenty-nine pregnant women were randomly assigned either to an exercise class following the SWEP method (EG, n = 65) or to a control group (CG, n = 64). The trial began in week 20 of pregnancy (May 2016) and ended in week 37 (October 2016). Heath-related quality of life (HRQoL) was evaluated with the SF36v2 health questionnaire at weeks 12 and 35 of pregnancy. Results: The HRQoL score decreased significantly between weeks 12 and 35 of gestation, except for the mental health component, which in the CG fell by -3.28 points and in the EG increased slightly (p > 0.05). Among the CG, the score for the mental health component at week 35 was <42, indicating a positive screening risk of depression (39.20 +/- 4.16). Conclusions: Physical activity programmes in water, such as SWEP, enhance the HRQoL of pregnant women

Depression and Anxiety in Patients with Rare Diseases during the COVID-19 Pandemic

The research group behind this project wishes to thank the following associations for their collaboration in the distribution of the study questionnaire: Asogaf–Asociación Granadina de la Ataxia de Friedreich. Asociación de Enfermos Musculares de Granada. AGRADA Asociación de Ataxias de Granada. Asociación española de afectados por Epilepsia Grave. Phelan Mcdermid. 22q13. Asociación Síndrome Shy Drager–Atrofia Multisistémica. Adisen–Asociación Nacional de Addison y Otras Enfermedades Endocrinas. ASENCO, Asociación de Enfermedades Neuromusculares de Córdoba. Asociación 22 q Andalucía. Asociación Andaluza de Esclerosis Lateral Amiotrófica. Asociación Andaluza de Fibrosis Quística. Asociación Andaluza de Hemofilia. Asociación Cordobesa para la Investigación de Corea de Huntington. Asociación de Enfermedades Neuromusculares de Andalucía. Asociación de Enfermos con Neurodegeneración por Acumulación Cerebral de Hierro. Asociación de Familiares y Afectados Síndrome de Coffin-Lowry España. Asociación de Retinosis Pigmentaria de Andalucía. Asociación del Síndrome de Prader Willi de Andalucía. Asociación Española de Enfermos por Pseudoxantoma Elástico. Asociación Española de Familiares y Enfermos de Wilson. Asociación Española para la Investigación y Ayuda al Síndrome de Wolfram. Asociación Síndrome de Turner de Andalucía. Asociación Sindrome de Williams de Andalucía. Asociación Valverdeña de la Enfermedad de Andrade. DEBRA Piel de Mariposa (Asociación de Epidermólisis Bullosa de España). Federación Andaluza de Asociaciones de Ataxias. Asociación de Atrofia del Nervio Óptico de Léber. Acción y Cura para Tay Sachs. ACTAYS. Asociación 11q España. Asociación AMC–Artrogriposis Múltiple Congénita–España. Asociación de Afectados de Neurofibromatosis. Asociación de Afectados Síndrome Landau –Kleffner. Asociación de Apoyo e Investigación del Síndrome de 5p-. Asociación de Corea de Huntington Española. Asociación de Enfermedades Raras de Alcalá de Henares. Asociación de Enfermos de Patología Mitocondrial. Asociacion de Familias con Perthes. Asociación Española de Porfiria. Asociación Española del Síndrome de Beckwith– Wiedemann. Asociación Española del Síndrome de Joubert. Asociación Huesos de Cristal de España. Asociación Nacional Síndrome de Apert y otras Craneosinostosis Sindrómicas. Asociación de Enfermedades Raras D’Genes. FEGEREC–Federación Gallega de enfermedades raras. Asociación Chiari y Siringomielia del Principado de Asturias (CHySPA). Asociación Asturiana contra la Fibrosis Quística (F.Q.). Asociación Ataxias de Extremadura. Asociación de Retinosis Pigmentaria Extremeña. Asociación ELA Extremadura. Asociación Española de Cavernomas. Asociación Española de Lucha contra las Hemoglobinopatias y Talasemias. Asociación Española de Stickler. Asociación Extremeña contra la Fibrosis Quística. Asociación Extremeña de Enfermos de Huntington. Asociación La Vida con Hernia Diafragmática Congénita. Asociación PrincesaRett. Asociación Síndrome X Frágil de Extremadura. Alba, Asociación de Ayuda a Personas con Albinismo. Asociación “Síndrome de Microdeleción 5q14.3–MEF2C”. Asociación ADIBI. Asociación de Discapacitados y Enfermedades Raras de IBI. Asociación Afectados CDKL5. Asociación Conquistando Escalones. Asociación de Enfermedades Minoritarias de la Comunidad Valenciana. Asociación de Enfermedades Raras de Benidorm y Comarca. Asociación de enfermedades raras y discapacidad Sense Barreres de Petrer. Asociación de enfermos de FMF y síndromes autoinflamatorios de España. Asociación de Esclerodermia Castellón. Asociación de Fibrosis Quística de la Comunidad Valenciana. Asociación de lucha contra la Distonía Mioclónica de Valencia. Asociación de Microsomia Hemifacial. Asociación de Padres de Niños y Jóvenes con Enfermedades Reumáticas de la Comunidad Valenciana. Asociación CADASIL España. Asociación Catalana de Espina Bífida e Hidrocefalia. Asociación Duchenne Somriures Valents. Asociación Española de Enfermos del Síndrome de Camurati–Engelmann. Asociación Española del Síndrome de Cornelia de Lange. Asociación Microtia España. Asociación Síndrome STXBP1. Associació Catalana de la Síndrome de Rett. Associació Catalana de Malaltia de Huntington.Scientific knowledge on depression and anxiety in patients with rare diseases during the COVID-19 pandemic is scarce; however, it is essential to perform comprehensive management of these patients. The aim of this study was to research how the situation caused by the SARS-CoV-2 pandemic has influenced the lives of patients with rare diseases regarding depression and anxiety. This Spanish study considered a heterogeneous population sample of 86 patients with confirmed diagnosis of different rare diseases. Participants took part in a cross-sectional online study by completing specific questionnaires on the study topic. Depression was measured using the Patient Health Questionnaire (PHQ-9), and the General Anxiety Disorder Scale (GAD-7) was used for evaluating anxiety. Data collection through an online questionnaire allowed for a greater population scope and therefore the inclusion patients of other nationalities in the study sample. Finally, as a general result, this study found that, in the face of the pandemic, anxiety and depression remained at a higher level in this group than in the general population, making these patients a vulnerable population group

Evaluation of research on the Knowledge Building pedagogy : a mixed methodological approach

La Construcción de Conocimiento (CC) es un marco teórico que promueve la indagación colectiva para resolver problemas del conocimiento relevantes en una comunidad educativa. Hay un número cada vez mayor de autores que buscan los beneficios de este enfoque, por lo que se necesita una visión general de las tendencias de la investigación. El objetivo de este estudio es proporcionar el estado del arte relacionado con la producción de investigación sobre la pedagogía de la Construcción de Conocimiento, incluidas las tendencias y temas relevantes. En este estudio se aplicó un diseño explicativo secuencial que combina los enfoques cuantitativos (análisis cienciométrico) y cualitativos (revisión sistemática). La muestra se seleccionó de las producciones más recientes publicadas en revistas indexadas en la base de datos Web of Science. El análisis cienciométrico muestra una dinámica de publicación típica de un campo de investigación emergente. En la fase cualitativa, el análisis revela las tendencias de investigación sobre la creación de conocimiento, así como los beneficios de ponerlo en práctica en una amplia gama de contextos, exponiendo que la tecnología es un componente relevante del aprendizaje basado en la pedagogía. Estos beneficios se refieren principalmente a la profundidad de pensamiento de los individuos y las habilidades de colaboración dentro de entornos de aprendizaje sostenidos por computadora

Evolution of the COVID-19 Pandemic after the Introduction of School Referral Nurses in the Province of Granada—A Descriptive Study

The aim of this research is to describe the evolution of the pandemic in a school context, following the introduction of school nurses into the educational setting. Background: The first wave of COVID-19 in Spain prevented social interaction by imposing lockdowns on the population. All non-essential activities, including face-to-face education, were interrupted, affecting the school-aged population during the second and third trimester of the 2019/2020 school year. Schools are places where prevention, identification and case management measures should be rapidly implemented. Methods: This is a prospective and descriptive study using a quantitative method to study the school population of Granada and its province during the school year 2020/2021, from September 2020 to May 2021. The study participants were all schools under the jurisdiction of the Territorial Delegation of Education of Granada, whether public, private, state-subsidised or charter schools, including all educational stages. Results: The confirmation rate in Granada city (11.2%), in contrast to the Andalusian average (6.9%), places Granada as the province with the highest incidence rate. The infection rates among teachers show the same confirmation rate as the general population of Granada (9%); however, among students this rate is lower (7%). There is a higher incidence of outbreaks taking place outside school and a lower incidence of outbreaks occurring within the school environment. Both partial and total outbreaks are more frequent in early childhood education. Conclusion: The early identification and management of reported suspected cases of COVID-19 in schools is proving effective in preventing infection in the school population, achieving good pandemic control in schools, and reducing the number of outbreaks and people affected. Schools have been confirmed to be safe. Establishing screening for asymptomatic schoolchildren could be a tool to improve control in schools.Colegio Oficial de Enfermeria de Granada (CODEGRA

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 [...]