English Cross-Cultural Adaptation, Validation and reliability of the COCU-LCRD 23 scale. Research Project

RESUMEN Objetivos: Adaptar y validar el instrumento COCU-LCRD 23 en los cuidadores de habla inglesa de la zona levantina española, consiguiendo que sea equivalente a nivel semántico, conceptual, de contenido, técnico y de criterio de distintas culturas. Determinar la validez y fiabilidad del instrumento COCU-LCRD 23 y averiguar el grado de conocimiento sobre LCRD en la población estudiada. Metodología: En este proyecto se plantean tres fases. En la fase 1, se procederá con la traducción retro traducción y adaptación transcultural del instrumento COCU-LCRD 23 al habla inglesa. En la fase 2 se realizará la validez de contenido. Se usará la técnica DELPHI modificada a dos rondas, que será efectuada por 10 expertos en la materia y con los datos obtenidos se calculará el índice de validez de contenido (IVC). Por último en la fase 3, se ejecutará un estudio observacional transversal para determinar la validez de constructo y la fiabilidad por consistencia interna y análisis RASCH (teoría de respuesta al ítem) del instrumento COCU-LCRD 23 en inglés. n= 115 Para el proceso de validación del cuestionario, se utilizará una técnica de análisis mixta, mediante métodos clásicos de validación de cuestionarios y métodos de análisis de respuesta al ítem, incluyendo análisis RASCH. La suposición de la independencia local entre los ítems se probará utilizando la estadística Q3 de Yen. El análisis de Rasch se llevará a cabo mediante el programa informático Jmetrik. Para la estimación de los parámetros se utilizará el método de estimación conjunta de máxima verosimilitud. El análisis diferencial de funcionamiento de los ítems (DIF) se realizará comparando el grupo focal con el grupo de referencia. Se calculará el tamaño del efecto (OR común) y el intervalo de confianza del 95%. El análisis de la validez de constructo se llevará a cabo mediante dos técnicas: análisis factorial y pruebas de contraste de hipótesis en grupos conocidos. Para comparar las puntuaciones de conocimiento entre los grupos se realizará la prueba t de Student o la prueba U de Mann-Whitney, en función de la distribución de la variable. Para la validez de constructo mediante análisis factorial y fiabilidad por consistencia interna, se utilizará el programa FACTOR. Tras esto se realizará un análisis descriptivo de las variables de interés, para caracterizar la muestra. Posteriormente, se llevará a cabo un análisis bi-variante y multivariante de las puntuaciones del cuestionario. Las variables dicotómicas se estudiarán mediante la prueba t de Student o la U de Mann-Withney en función de su distribución. Para ello, se llevará a cabo la prueba de Kolmogorov-Smirnof. Para las variables de más de dos categorías se utilizará la prueba ANOVA(Análisis de la Varianza de un factor)o la prueba de Kruskall-Wallis. También se establecerán correlaciones con variables cuantitativas mediante la prueba r de Pearson o la S de Spearman si las variables categóricas son ordinales. Para el análisis multivariante se utilizará un modelo lineal o de regresión logística según proceda. Para el análisis de datos se utilizará el programa SPSS versión 26.0.ABSTRACT Objectives: To adapt and validate the COCU-LCRD 23 instrument in the English-speaking caregivers of the Spanish Levantine area, making it equivalent at the semantic, conceptual, content, technical and criteria levels of different cultures. To determine the validity and reliability of the COCU-LCRD 23 instrument and to find out the degree of knowledge about LCRD in the population studied. Methodology: In this project three phases are proposed. In phase 1, we will proceed with the retro-translation and cross-cultural adaptation of the COCU-LCRD 23 instrument into the English language. In phase 2, content validity will be conducted. The modified DELPHI technique will be used in two rounds, which will be carried out by 10 experts in the field and with the data obtained the content validity index (CVI) will be calculated. Finally, in phase 3, a cross-sectional observational study will be carried out to determine construct validity and reliability by internal consistency and RASCH analysis (item response theory) of the COCU-LCRD 23 instrument in English. n= 115 For the process of validating the questionnaire, a mixed analysis technique will be used, using classic questionnaire validation methods and item response analysis methods, including RASCH analysis. The assumption of local independence between items will be tested using Yen's Q3 statistics. Rasch analysis will be performed using the Jmetrik software. The maximum likelihood joint estimation method will be used for parameter estimation. Differential item performance analysis (DIF) will be performed by comparing the focus group with the reference group. The effect size (common OR) and the 95% confidence interval will be calculated. The analysis of construct validity will be carried out by means of two techniques: factorial analysis and hypothesis contrast tests in known groups. To compare the knowledge scores between the groups, the Student t-test or the Mann-Whitney U-test will be performed, depending on the distribution of the variable. For construct validity by factor analysis and reliability by internal consistency, the program FACTOR will be used. After this, a descriptive analysis of the variables of interest will be made to characterize the sample. Subsequently, a bivariate and multivariate analysis of the questionnaire scores will be carried out. The dichotomous variables will be studied by means of the Student t test or the Mann-Withney U test depending on their distribution. The Kolmogorov-Smirnof test will be used for this purpose. For variables of more than two categories, the ANOVA test (Analysis of Variance of a factor) or the Kruskall-Wallis test will be used. Correlations with quantitative variables will also be established using Pearson's r test or Spearman's S test if the categorical variables are ordinal. For multivariate analysis a linear or logistic regression model will be used as appropriate. For data analysis, SPSS version 26.0 will be used.Máster en Gestión Integral e Investigación de las Heridas Crónica

Riesgo cardiovascular determinado mediante el modelo REGICOR y edad del corazón en trabajadores de diferentes sectores productivos

Objetivo: Debido a la escasez de estudios tanto nacionales como internacionales que impliquen a diferentes sectores productivos nos planteamos valorar cuál es el nivel de riesgo cardiovascular de un gran número de trabajadores pertenecientes a diferentes sectores laborales. Métodos: Entre enero de 2011 y diciembre de 2012 en 60.798 trabajadores se determinó el nivel de riesgo cardiovascular mediante el modelo de Framingham calibrado para población española (REGICOR) y mediante la edad del corazón. Se realizan análisis de la chi cuadrado, t de Student y regresión logística binaria. Resultados: El 94,1% de las mujeres y el 81,4% de los hombres del sector sanitario presentan niveles de REGICOR bajo y el 65% de mujeres y 31,1% de hombres, también del sector sanitario, presentan edades del corazón inferiores a su edad biológica. En la regresión logística el factor que más influye en la aparición de valores elevados de REGICOR y edad del corazón es el consumo de tabaco (odss ratio 4,8 y 8,6 respectivamente). Conclusión: Los valores tanto de REGICOR como de edad del corazón son peores en los varones y a medida que va aumentando la edad. Por sectores productivos, el sanitario es el que mejor se comporta en ambos casos en las mujeres mientras que en los hombres no hay un sector claramente dominante aunque globalmente los mejores valores se obtienen en el sector servicios y en sanidadObjective: Due to the lack of studies done in this area, both nationally and internationally, we have decided to assess the different levels of cardiovascular risk in a large group of workers from a variety of industries. Method: The level of cardiovascular risk in 60,798 workers was determined between January 2011 and December 2012 using the Framingham Risk Calculator calibrated for the Spanish population and heart age. Chi-Squared test, Student’s t test and Binary logistic regression analysis were also performed. Results: REGICOR testing showed that 94.1% of the females and 81.4% of the males, in the health care sector, had low level results. We found that the actual heart age in 65% of the females and 31.1 % of the males, was lower than their biological age. The major independent risk factor, that elevated the REGICOR value and heart age using logistic regression, was cigarette smoking (odss ratio is 4.8 and 8.6). Conclusion: We have determined that males have lower values in both, REGICOR and Heart age, and that these values continue to decrease as they get older. As per work sectors, women in the health care sector demonstrated better results. As for the men, there was no specific section with better results. However, as a whole, the sector with the best results was that of service and health care

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer : a nationwide study in Spain

We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. This was a prospective study and it included patients from 22 hospitals located in Spain - 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. This was a prospective study and it included patients from 22 hospitals located in Spain - 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients

Frequency of hereditary transthyretin amyloidosis among elderly patients with transthyretin cardiomyopathy

Transthyretin amyloid cardiomyopathy (ATTR-CM) is increasingly recognized as a cause of heart failure in the elderly. Although wild-type transthyretin amyloidosis is the most frequent form of ATTR-CM found in the elderly, hereditary transthyretin amyloidosis (ATTRv) can also occur. We sought to determine the prevalence of ATTRv among elderly ATTR-CM patients, identify predictors of ATTRv and evaluate the clinical consequences of positive genetic testing in this population. Prevalence of ATTRv in elderly ATTR-CM patients (≥70 years) was assessed in a cohort of 300 consecutive ATTR-CM patients (median age 78 years at diagnosis, 82% ≥70 years, 16% female, 99% Caucasian). ATTRv was diagnosed in 35 (12%; 95% confidence interval [CI] 3.1–8.8) and 13 (5.3%; 95% CI 5.6–26.7) patients in the overall cohort and in those ≥70 years, respectively. Prevalence of ATTRv among elderly female patients with ATTR-CM was 13% (95% CI 2.1–23.5). Univariate analysis identified female sex (odds ratio [OR] 3.66; 95% CI 1.13–11.85; p = 0.03), black ancestry (OR 46.31; 95% CI 3.52–Inf; p = 0.005), eye symptoms (OR 6.64; 95% CI 1.20–36.73; p = 0.03) and polyneuropathy (OR 10.05; 95% CI 3.09–32.64; p<0.001) as the only factors associated with ATTRv in this population. Diagnosis of ATTRv in elderly ATTR-CM patients allowed initiation of transthyretin-specific drug treatment in 5 individuals, genetic screening in 33 relatives from 13 families, and identification of 9 ATTRv asymptomatic carriers. Hereditary transthyretin amyloidosis is present in a substantial number of ATTR-CM patients aged ≥70 years. Identification of ATTRv in elderly patients with ATTR-CM has clinical meaningful therapeutic and diagnostic implications. These results support routine genetic testing in patients with ATTR-CM regardless of ageThis study has been funded by Instituto de Salud Carlos III (ISCIII) through the projects ‘PI18/0765 & PI20/01379’ (co-funded by European Regional Development Fund/European Social Fund ‘A way to make Europe’/‘Investing in your future’). AMB receives grant support by ISCIII (CM20/002209). The CNIC is supported by the ISCIII, MCIN, the Pro-CNIC Foundation, and the Severo Ochoa grant (CEX2020-001041-S

Cyberbullying and Gambling Disorder: Associations with Emotion Regulation and Coping Strategies

The presence of unsuitable coping and emotion regulation strategies in young populations with gambling disorder (GD) and in those who have experienced cyberbullying victimization has been suggested. However, this association has not been explored in depth. In this study, our aim was to analyze individual differences in emotion regulation, coping strategies, and substance abuse in a clinical sample of adolescents and young adult patients with GD (n = 31) and in a community sample (n = 250). Furthermore, we aimed to examine the association between cyberbullying and GD. Participants were evaluated using the Cyberbullying Questionnaire-Victimization, the Canadian Adolescent Gambling Inventory, the Coping Strategies Inventory, the Difficulties in Emotion Regulation Scale, the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Structural Equation Modeling was used to explore associations between these factors in a community sample and in a clinical group. In both groups, exposure to cyberbullying behaviors was positively associated with higher emotion dysregulation and the use of maladaptative coping styles. Our findings uphold that adolescents and young adults who were victims of cyberbullying show difficulties in emotion regulation and maladaptive coping strategies when trying to solve problems. The specific contribution of sex, age, gambling severity, emotion regulation, and coping strategies on cyberbullying severity is also discussed. Populations at vulnerable ages could potentially benefit from public prevention policies that target these risk factors

Proyecto Puentes: conectando la universidad con la salud mental comunitaria

Se presenta la memoria del Proyecto Puentes, cuya finalidad es explorar e implementar vías de participación entre la comunidad universitaria y las personas con problemas de salud mental. Es decir, tender puentes entre lo académico y la realidad de esas personas, con el propósito de conseguir una fuente de aprendizaje significativo para el estudiantado de la UCM, pero también herramientas útiles en los procesos de recuperación e integración de las personas con problemáticas de salud mental.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaFALSEsubmitte

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms