Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe

Background: To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables. METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing. Results: There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81). Conclusions: Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.This work was supported by the Carlos III Health Institute (ISCIII) under the project Fundación BBVA.DGVI 256/22 "COVID 19 Urban Atlas Spain".S

Construction and content validation of a measurement tool to evaluate person-centered therapeutic relationships in physiotherapy services

Objectives: this study sought to develop a tool for evaluating person-centered therapeutic relationships within physiotherapy services, and to examine the content validity of the same. Methods: a mixed qualitative and quantitative study was performed in three distinct phases: 1) the items were generated based on a literature review and a content analysis of focus groups of patients and physiotherapists; 2) an e-Delphi survey process was performed based on three rounds to select and refine the proposed questionnaire; 3) two rounds of cognitive interviews were conducted to evaluate the comprehension of items, the clarity of language and the appropriateness and relevance of content. Results: thirty-one items were generated based on the seven domains identified after the analysis of four focus groups of physiotherapists and four patient focus groups. Nine experts participated in the e-Delphi survey. Fifty-five patients participated in the two rounds of the cognitive pre-tests. Participating patients were from public and private physical therapy services. Based on the participants' suggestions, four items were removed, and four were added, whereas 16 were reworded. Conclusions: the final tool comprised 31 items divided into seven domains. The response format was based on a 5-point Likert frequency scale. The response options ranged from "strongly agree" to "strongly disagree"

Evaluation of cervical cancer prevention plan in a remote rural area in Bolivia

Objetivos: Evaluar el plan de prevención del cáncer de cérvix en Roboré como ejemplo de zona rural remota de Bolivia e identificar los principales elementos favorables y desfavorables a la implantación del mismo para formular recomendaciones. Material y métodos: Estudio descriptivo transversal realizado mediante una combinación de métodos: análisis de indicadores relacionados con la cobertura de cribado, oportunidad de tratamiento y cobertura vacunal durante 2018 y 2019; cuestionario sobre conocimientos, actitudes y prácticas dirigido a usuarias del programa de cribado; cuestionario a profesionales implicados en el programa de cribado sobre los puntos fuertes y débiles del programa. Resultados: Las coberturas de cribado fueron bajas (41-46%) en los últimos 2 años, así como la oportunidad de tratamiento (13-16,7%). Las coberturas vacunales fueron altas (92-98%). Tras entrevistar a 82 usuarias se evidenció que un mayor conocimiento sobre el cáncer de cérvix está asociado a un mayor nivel de estudios y a una mayor frecuencia de citologías. Las mujeres tienen una actitud positiva hacia la vacunación a pesar del escaso conocimiento sobre el virus del papiloma humano (VPH) y la vacuna. Los profesionales sanitarios refieren contar con un personal implicado pero escaso, la falta de infraestructuras y la necesidad de incrementar las campañas de concienciación. Conclusiones: Recomendamos aumentar las campañas de concienciación y las estrategias de cribado móviles, disponer de un consultorio propio para la realización de las citologías, incrementar el personal a cargo del programa y mejorar el seguimiento de las mujeres.Objectives: Evaluate the cervical cancer prevention programme in Roboré as an example of a remote rural area of Bolivia, and identify its main strengths and weaknesses in order to formulate recommendations. Materials and methods: Cross-sectional descriptive study using a combination of methods: analysis of indicators related to screening coverage, treatment opportunities, and vaccination coverage during 2018 and 2019; questionnaire to users of the screening programme on their knowledge, attitudes and practices; questionnaire to professionals involved in the screening programme about the strengths and weaknesses of the programme. Results: Screening coverage was low (41-46%) in the last 2 years, as was the opportunity for treatment (13-16.7%). Vaccine coverage was high (92-98%). After interviewing 82 users, it was shown that a greater knowledge of cervical cancer is associated with a higher level of education and a higher frequency of cytologies. Women have a positive attitude towards vaccination despite poor knowledge of human papillomavirus (HPV) and the vaccine. Health professionals report having committed but limited staff, lack of infrastructure and the need to increase awareness campaigns. Conclusions: We recommend increasing the number of awareness campaigns and mobile screening strategies, having separate offices to carry out cytologies, increasing the staff in charge of the programme and improving the follow-up of women

Sex Differences and Predictors of In-Hospital Mortality among Patients with COVID-19: Results from the ANCOHVID Multicentre Study

Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised with COVID-19. An observational longitudinal study was conducted in the cohort of patients admitted to four hospitals in Andalusia, Spain, from 1 March 2020 to 15 April 2020. Sociodemographic and clinical data were collected from hospital records. The Kaplan–Meier method was used to estimate 30-day survival and multiple Cox regression models were applied. All analyses were stratified by sex. A total of 968 patients were included (54.8% men, median age 67.0 years). In-hospital mortality reached 19.1% in men and 16.0% in women. Factors independently associated with an increased hazard of death were advanced age, higher CURB-65 score and not receiving azithromycin treatment, in both sexes; active cancer and autoimmune disease, in men; cardiovascular disease and chronic lung disease, in women. Disease outcomes and predictors of death differed between sexes. In-hospital mortality was higher in men, but the long-term effects of COVID-19 merit further research. The sex-differential impact of the pandemic should be addressed in public health policies

Towards Carbon Neutrality in Higher Education Institutions: Case of Two Private Universities in Colombia

This paper addresses the path followed by two private higher education institutions (HEI) in Colombia towards achieving carbon neutrality. The methodology followed by these universities to achieve a carbon-neutral certification, based on the Greenhouse Gas (GHG) Protocol, is first described. The process of developing the GHG inventory, projected towards the carbon neutrality of these organisations while using the standard ISO 14064:2006, involved a series of steps that were consolidated in three phases: (i) definition of the scope, collection of data and emissions quantification; (ii) analysis of results and mitigation actions; and (iii) verification and compensation strategies. Results for the HEIs are shown in terms of the organisational context, carbon footprint measurement, reduction, verification, and compensation. The case is presented for Universidad Pontificia Bolivariana, a multi-campus university that became the first carbon-neutral university in Latin America in 2017, and Universidad Ean, a single-campus university that became the second carbon-neutral university in Colombia in 2021, as verified by the Colombian Institute of Technical Standards and Certification (ICONTEC). This work shows that universities can play a key role in regional and global agendas with their contribution through the incorporation of sustainability strategies, since HEIs can not only achieve carbon neutrality, but they can help other organisations by delivering graduates who are aware of sustainability and provide specific training towards building a sustainability culture, which is needed for regenerative development.

Teledermatology versus Face-to-Face Dermatology: An Analysis of Cost-Effectiveness from Eight Studies from Europe and the United States

(1) Background: The aim of this systematic review was to compare the cost-effectiveness of two follow-up methods (face-to-face and telemedicine) used in dermatology in the last ten years. (2) Methods: A search for articles that included economic analyses was conducted in August 2021 in the databases PubMed, Medline, Scielo and Scopus using the following keywords: “Cost–Benefit Analysis”, “Dermatology”, “Telemedicine”, “Primary Health Care”, as well as other search terms and following the PICOS eligibility criteria. (3) Results: Three clinical trials and five observational studies were analyzed, providing information for approximately 16,539 patients (including four cost-minimization or saving analyses, three cost-effectiveness analyses, and one cost–utility analysis) in Europe and the United States. They describe the follow-up procedures in each of the cases and measure and analyze the direct and indirect costs and effectiveness. All the articles indicate that teledermatology lowers costs and proves satisfactory to both patients and professionals. (4) Conclusions: Although it has been found that follow-up via teledermatology can be more efficient than traditional hospital follow-up, more work is needed to establish evaluation protocols and procedures that measure key variables more equally and demonstrate the quality of the evidence of said studies

Borderline Intellectual Functioning: Consensus and good practice guidelines

Objectives: To elaborate a conceptual framework and to establish consensus guidelines. Method: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Results: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is ‘‘Borderline Intelligence’’. The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. Conclusions: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual

Generation of organotypic multicellular spheres by magnetic levitation : model for the study of human hematopoietic stem cells microenvironment

Q4Q3Background and Objective: The characteristics of human hematopoietic stem cells are conditioned by the microenvironment of the bone marrow, where they interact with other cell populations, such as mesenchymal stem cells and endothelial cells; however, the study of this microenvironment is complex. The objective of this work was to develop a 3D culture system by magnetic levitation that imitates the microenvironment of human HSC. Methods and Results: Human bone marrow-mesenchymal stem cells, umbilical cord blood-hematopoietic stem cells and a non-tumoral endothelial cell line (CC2811, LonzaⓇ) were used to develop organotypic multicellular spheres by the magnetic levitation method. We obtained viable structures with an average sphericity index greater than 0.6, an average volume of 0.5 mm3 and a percentage of aggregation greater than 70%. Histological studies of the organotypic multicellular spheres used hematoxylin and eosin stains, and an evaluation of vimentin expression by means of immunohistochemistry demonstrated an organized internal structure without picnotic cells and a high expression of vimentin. The functional capacity of human hematopoietic stem cells after organotypic multicellular spheres culture was evaluated by multipotency tests, and it was demonstrated that 3D structures without exogenous Flt3L are autonomous in the maintenance of multipotency of human hematopoietic stem cells. Conclusions: We developed organotypic multicellular spheres from normal human cells that mimic the microenvironment of the human hematopoietic stem cells. These structures are the prototype for the development of complex organoids that allow the further study of the biology of normal human stem cells and their potential in regenerative medicine.https://orcid.org/0000-0002-9152-5552https://orcid.org/0000-0003-3075-9854https://orcid.org/0000-0002-0084-0339https://orcid.org/0000-0003-1881-9367N/

Pathogenic variants of DNAJC12 and evaluation of the encoded cochaperone as a genetic modifier of hyperphenylalaninemia

This is the peer reviewed version of the following article: Pathogenic variants of DNAJC12 and evaluation of the encoded cochaperone as a genetic modifier of hyperphenylalaninemia. Human Mutation (2020): 25 April, which has been published in final form at [https://doi.org/10.1002/humu.24026. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsThe variants identified in this study are openly available at http://www.lovd.nl/ with reference numbers 0000644164, 0000645396, 0000644166, and 0000405673Biallelic variants of the gene DNAJC12, which encodes a cochaperone, were recently described in patients with hyperphenylalaninemia (HPA). This paper reports the retrospective genetic analysis of a cohort of unsolved cases of HPA. Biallelic variants of DNAJC12 were identified in 20 patients (generally neurologically asymptomatic) previously diagnosed with phenylalanine hydroxylase (PAH) deficiency (phenylketonuria [PKU]). Further, mutations of DNAJC12 were identified in four carriers of a pathogenic variant of PAH. The genetic spectrum of DNAJC12 in the present patients included four new variants, two intronic changes c.298‐2A>C and c.502+1G>C, presumably affecting the splicing process, and two exonic changes c.309G>T (p.Trp103Cys) and c.524G>A (p.Trp175Ter), classified as variants of unknown clinical significance (VUS). The variant p.Trp175Ter was detected in 83% of the mutant alleles, with 14 cases homozygous, and was present in 0.3% of a Spanish control population. Functional analysis indicated a significant reduction in PAH and its activity, reduced tyrosine hydroxylase stability, but no effect on tryptophan hydroxylase 2 stability, classifying the two VUS as pathogenic variants. Additionally, the effect of the overexpression of DNAJC12 on some destabilizing PAH mutations was examined and a mutation‐specific effect on stabilization was detected suggesting that the proteostasis network could be a genetic modifier of PAH deficiency and a potential target for developing mutation‐specific treatments for PKUThis work was funded by grant PI16/00573, B2017/BMD-3721, the Fundación Isabel Gemio and the Fundación La Caixa (LCF/PR/PR16/11110018), an institutional grant from the Fundación Ramón Areces to the Centro de Biología Molecular Severo Ochoa, and the European Regional Development Fun