Analysis of Undergraduate Dermatology Syllabi at Spanish Universities: Does the Weight of Theoretical Content Match the Skin Conditions Seen in Primary Care and General Dermatology Practices?

Introduction: Undergraduate dermatology courses vary in the nearly 50 Spanish medical faculties that teach the subject. This study aimed to describe the characteristics of these courses and to analyze whether the weight assigned to dermatology topics reflects the caseloads of primary care physicians and general dermatologists in the Spanish national health system. Material and methods: Cross-sectional study of syllabi used in Spanish medical faculties during the 2021---2022 academic year. We determined the number of teaching hours in public and private university curricula and compared the weight of dermatology topics covered to the dermatology caseloads of primary care physicians and general dermatologists as reported in published studies. Results: Most medical faculties taught dermatology for one semester. The median number of credits offered was 4.5. On average, lectures covered 24 theoretical topics, and seminars and workshops covered 9 topics. We identified a clear disparity between the percentage of time devoted to dermatology topics in course lectures and the skin conditions usually managed in primary care and general dermatology practices

¿Cuánta carga asistencial suponen las dermatosispediátricas en la actividad ambulatoria en ladermatología espa˜nola? Resultados del muestreoaleatorio nacional DIADERM

Un total de 20.097 diagnósticos fueron efectuados en pacientes menores de18 a˜nos, lo que supone un 12% del total de los codificados en DIADERM. Las infecciones víri-cas, el acné y la dermatitis atópica fueron los diagnósticos más comunes (43,9% de todos losdiagnósticos). No se observaron diferencias estadísticamente significativas en la proporción dediagnósticos atendidos en las consultas monográficas frente a las generales, así como en losregistrados en el ámbito público frente al privado. Tampoco las hubo en los diagnósticos enfunción de la época de la encuesta (enero y mayo).Conclusiones: La atención a pacientes pediátricos por parte de dermatólogos en Espa˜na suponeuna proporción significativa de la actividad habitual. Estos datos nos permiten descubrir áreasde mejora en la comunicación y la formación de los pediatras de atención primaria, comola necesidad del refuerzo de actividades formativas dirigidas al mejor tratamiento de acné ylesiones pigmentadas (y manejo básico de la dermatoscopia) en este ámbito asistencial.SurveyAbstractBackground: Visits for skin conditions are very common in pediatric primary care, and many ofthe patients seen in outpatient dermatology clinics are children or adolescents. Little, however,has been published about the true prevalence of these visits or about their characteristics.Material and methods: Observational cross-sectional study of diagnoses made in outpatientdermatology clinics during 2 data-collection periods in the anonymous DIADERM National Ran-dom Survey of dermatologists across Spain. All entries with an International Classification ofDiseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collec-ted for patients younger than 18 years and classified into 14 categories to facilitate analysisand comparison.Results: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12%of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitiswere the most common, accounting for 43.9% of all diagnoses. No significant differences wereobserved in the proportions of diagnoses in the respective caseloads of specialist vs. generaldermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs.May) were also nonsignificant.Conclusions: Pediatric care accounts for a significant proportion of the dermatologist’s caseloadin Spain. Our findings are useful for identifying opportunities for improving communication andtraining in pediatric primary care and for designing training focused on the optimal treatmentof acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.El estudio DIADERM fue promovido por la Fundación Piel Sanade la AEDV, que recibió ayuda económica de Novarti

Spanish children's diet: compliance with nutrient and food intake guidelines

OBJECTIVE: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. DESIGN AND SETTING: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. PARTICIPANTS: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. MAIN OUTCOME MEASURES: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). RESULTS: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. CONCLUSIONS: Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.This study was partly funded by grants from the Inter-national Olive Oil Board (Consejo Oleı ́cola Internacional),Comunidad de Madrid, Fundacio ́n Pedro Barrie ́de laMaza, and Fundacio ́n Eugenio Rodrı ́guez Pascua

Greater dietary variety is associated with better biochemical nutritional status in Spanish children: the Four Provinces Study

BACKGROUND AND AIM: Although dietary variety has been associated with a better nutritional profile, its possible role in obesity raises doubts about its overall health benefits. In this study, we examined the association between dietary variety and anthropometric variables, food intake and various food intake biomarkers in Spanish children. METHODS AND RESULTS: This was a cross-sectional study of 1112 children aged 6-7 years from Cadiz, Murcia, Orense and Madrid, who were selected by means of the random cluster-sampling of schools. Information concerning food and nutrient intake was obtained using a food frequency questionnaire, and a dietary variety index (DVI) was calculated on the basis of the number of different foods consumed more than once a month. The anthropometric variables (weight and height), and plasma lipid and vitamin levels were determined using standardised methods. Our results show that the body mass index (BMI) did not vary substantially as a function of DVI: it was 16.9 in the lowest DVI tertile and 17.2 in the highest (p=0.20). Unlike BMI, the DVI positively correlated (p<0.05) with the plasma levels of alpha and beta-carotene, lycopene, retinol, alpha-tocopherol and vitamin E, with energy intake, and with most of the foods, particularly vegetables, fruit and sausages (respective correlation coefficients of 0.43, 0.26 and 0.23). CONCLUSIONS: Dietary variety is associated with a better food and nutritional profile in Spanish children. Nevertheless, the presence of a positive association between the DVI and energy intake, and the consumption of sausages and pre-cooked products calls for the recommendation of a varied diet of healthy foods, such as cereals (especially whole grains), fruits and vegetables

Alcohol intake and risk of breast cancer: the euramic study

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.Thc EURAMIC Study was supported as an European Community Concerted Action by the Commission of the European Communities (con-tracts number MR4*/265/NL and MR4*/CT91/0369[SSMA]). The natio-nal studies were financed by grants from the Dutch Ministry of Health, the Spanish "Fondo de Invcstigacioncs Sanitarias" (91E0575), the German Fe-deral Health Office, the Cancer Research Switzerland (AKT76), the Swiss National Science Foundation (32-9257-87), the Yrjö Jahnsson Foundation, the Ulster Cancer Foundation and Milk Intervention Board (co-responsibi-lity Levy Disbursement Reg EEC 110/90 Contract 77.2).S

Junin Virus Triggers Macrophage Activation and Modulates Polarization According to Viral Strain Pathogenicity

The New World arenavirus Junin (JUNV) is the etiological agent of Argentine hemorrhagic fever (AHF). Previous studies of human macrophage infection by the Old-World arenaviruses Mopeia and Lassa showed that while the non-pathogenic Mopeia virus replicates and activates human macrophages, the pathogenic Lassa virus replicates but fails to activate human macrophages. Less is known in regard to the impact of New World arenavirus infection on the human macrophage immune response. Macrophage activation is critical for controlling infections but could also be usurped favoring immune evasion. Therefore, it is crucial to understand how the JUNV infection modulates macrophage plasticity to clarify its role in AHF pathogenesis. With this aim in mind, we compared infection with the attenuated Candid 1 (C#1) or the pathogenic P strains of the JUNV virus in human macrophage cultures. The results showed that both JUNV strains similarly replicated and induced morphological changes as early as 1 day post-infection. However, both strains differentially induced the expression of CD71, the receptor for cell entry, the activation and maturation molecules CD80, CD86, and HLA-DR and selectively modulated cytokine production. Higher levels of TNF-α, IL-10, and IL-12 were detected with C#1 strain, while the P strain induced only higher levels of IL-6. We also found that C#1 strain infection skewed macrophage polarization to M1, whereas the P strain shifted the response to an M2 phenotype. Interestingly, the MERTK receptor, that negatively regulates the immune response, was down-regulated by C#1 strain and up-regulated by P strain infection. Similarly, the target genes of MERTK activation, the cytokine suppressors SOCS1 and SOCS3, were also increased after P strain infection, in addition to IRF-1, that regulates type I IFN levels, which were higher with C#1 compared with P strain infection. Together, this differential activation/polarization pattern of macrophages elicited by P strain suggests a more evasive immune response and may have important implications in the pathogenesis of AHF and underpinning the development of new potential therapeutic strategiesFacultad de Ciencias ExactasInstituto de Biotecnologia y Biologia MolecularCentro de Investigación y Desarrollo en Fermentaciones Industriale

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

INTRODUCTION: Radiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published studies on radiation toxicity have been performed retrospectively. Our prospective study was launched in 1996 to measure the in vitro radiosensitivity of peripheral blood lymphocytes before treatment with radical radiotherapy in patients with breast cancer, and to assess the early and the late radiation skin side effects in the same group of patients. We prospectively recruited consecutive breast cancer patients receiving radiation therapy after breast surgery. To evaluate whether early and late side effects of radiotherapy can be predicted by the assay, a study was conducted of the association between the results of in vitro radiosensitivity tests and acute and late adverse radiation effects. METHODS: Intrinsic molecular radiosensitivity was measured by using an initial radiation-induced DNA damage assay on lymphocytes obtained from breast cancer patients before radiotherapy. Acute reactions were assessed in 108 of these patients on the last treatment day. Late morbidity was assessed after 7 years of follow-up in some of these patients. The Radiation Therapy Oncology Group (RTOG) morbidity score system was used for both assessments. RESULTS: Radiosensitivity values obtained using the in vitro test showed no relation with the acute or late adverse skin reactions observed. There was no evidence of a relation between acute and late normal tissue reactions assessed in the same patients. A positive relation was found between the treatment volume and both early and late side effects. CONCLUSION: After radiation treatment, a number of cells containing major changes can have a long survival and disappear very slowly, becoming a chronic focus of immunological system stimulation. This stimulation can produce, in a stochastic manner, late radiation-related adverse effects of varying severity. Further research is warranted to identify the major determinants of normal tissue radiation response to make it possible to individualize treatments and improve the outcome of radiotherapy in cancer patients

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey

El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados.Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos.Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.Fundacion Piel Sana de la AED