Retinal and Choroidal Effects of Continuous Positive Airway Pressure as Treatment for Sleep Apnea: Results at 12 Months

Background: To determine the impacts of continuous positive airway pressure (CPAP) treatment on retinal and choroidal thickness measurement in individuals with obstructive sleep apnea (OSA). Methods: Participants were 28 patients with OSA treated with CPAP who were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and an indication for CPAP. Participants underwent a full ophthalmologic examination including standard automated perimetry (SAP) and optical coherence tomography (OCT) at the levels peripapillary, macular, and choroidal before CPAP onset, and after three and twelve months of CPAP. The data compared before and after treatment were intraocular pressure, SAP, and the thicknesses peripapillary retinal nerve fiber layer (pRNFL), total retinal (TR), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal. Results: After 3 months of CPAP, we observed thickening of the pRNFL (in 5/6 subfields) (p < 0.004) and TR (in 5/9 subfields) (p < 0.010). At 12 months, thickening persisted in these layers, this time affecting 2/6 and 2/9 subfields, respectively (p < 0.012 and p < 0.001, respectively). Choroidal thinning was observed at the temporal level at both 3 and 12 months compared to measurements before starting CPAP treatment (p = 0.014 and p = 0.038, respectively). SAP remained unchanged. Intraocular pressure was higher at 12 months than at 3 months (p = 0.001). Conclusions: 12 months of CPAP avoids retinal thinning and normalizes choroidal thickness in OSA patients

Analysis of labor flows and consumption in Spain during COVID-19

Este documento analiza el vínculo entre el consumo de las familias y sus determinantes durante la pandemia en España. Para ello, se utiliza información tanto cuantitativa como cualitativa sobre la evolución del consumo contenida en la Encuesta de Expectativas de los Consumidores (CES, por sus siglas en inglés) llevada a cabo por el Banco Central Europeo. En primer lugar, se construye un índice según la información cualitativa. Su heterogeneidad por grupos poblacionales apunta a que la caída del consumo durante la pandemia ha resultado tanto del consumo no satisfecho (debido a las restricciones sobre él derivadas de las medidas adoptadas para contener la pandemia) como del deterioro registrado en el mercado de trabajo. Asimismo, los resultados indican que en 2021 (con datos hasta agosto), y en consonancia con la menor severidad de las medidas vigentes para contener la pandemia, el vínculo negativo entre el nivel de ingresos y la evolución del consumo (relacionado con el ahorro forzoso) se moderó con respecto a 2020. Posteriormente, se estima qué proporción de la recuperación del gasto que tuvo lugar en el tercer trimestre de 2020, tras la intensa caída registrada en el primer semestre, puede explicarse por los cambios observados en la distribución de horas trabajadas. En primer lugar, se combina información sobre el número de horas trabajadas, el sector, el género y la edad de la Encuesta de Población Activa (EPA) y el consumo de la Encuesta Financiera de las Familias (EFF) para estimar el cambio potencial en el gasto asociado a la evolución en el número de horas trabajadas para diversos grupos poblacionales (definidos según la edad, el género y la educación). Las estimaciones proporcionan también información sobre los grupos poblacionales cuyo gasto se ha visto más afectado por la caída del número de horas (los de bajo nivel educativo y con edades menores de 55 años). En un segundo paso, se comparan los cambios potenciales y los observados en el consumo de acuerdo con la CES para obtener la contribución de los cambios en las horas trabajadas a la evolución del gasto frente a la de otros factores (como el gasto pospuesto). Los resultados indican que los cambios en las horas trabajadas pueden explicar casi la mitad de la recuperación del consumo durante el tercer trimestre de 2020. Se analizan también las perspectivas de gasto futuro. El análisis basado en la información cualitativa contenida en la encuesta CES sobre este aspecto indica que en 2020 las perspectivas de gasto de los hogares con distinto nivel de ingresos eran similares, a pesar de que las familias de mayores rentas acumularon un volumen de ahorro forzoso mayor en este período. En 2021, una vez superada la fase de mayor incertidumbre sobre la situación económica y sanitaria, los hogares de mayores rentas presentaban también mejores perspectivas de gasto. Ello sugiere que la bolsa de ahorro acumulada durante la pandemia podría contribuir a imprimir un mayor vigor a la recuperación del consumo cuando la incertidumbre sobre la situación económica y sanitaria se disipe. Asimismo, los individuos que han sufrido ajustes en el número de horas trabajadas (especialmente, aquellos que han pasado a estar desempleados) parecen ser más pesimistas sobre la evolución de sus perspectivas laborales futuras. Ello incide, a su vez, sobre sus perspectivas de gasto, y sugiere que la consolidación de la recuperación en el mercado de trabajo observada recientemente desempeñará un papel determinante a la hora de explicar la senda futura del consumo.This article analyzes the link between household consumption and its determinants during the pandemic in Spain. For this purpose, both quantitative and qualitative data on consumption included in the Consumer Survey Expectations (CES) carried out by the European Central Bank are used. First, we construct a consumption index on the basis of its qualitative data on spending trends during the pandemic, and its heterogeneity across population groups points towards both unsatisfied consumption (due to existing restrictions on consumption) and the deterioration in the labor market being drivers of the decline of consumption during the pandemic. Likewise, the results show that, in line with the less stringent measures in place to control the pandemic, the strong negative link between income levels and consumption developments (linked to forced savings) has moderated in 2021 (with data up to August) with respect to the previous year. Then, we estimate what proportion of the recovery in household expenditure during the third quarter of 2020, after the large decline observed in the first semester, can be explained by the observed changes in the distribution of hours worked. First, we combine information on hours, industry, gender and age in the Spanish Labor Force Survey and consumption in the Spanish Survey on Household Finances (EFF) to estimate the potential change in expenditure associated with the change of hours worked for different population groups (age, gender, and education level). Those estimations also inform about the groups of the population whose expenditure has been most affected by the pandemic (low-schooling and individuals below 55 years of age). In a second step, we then compare potential and actual changes in consumption observed in the ECB's Consumer Expectation Survey to gauge quantitative contribution of changes in hours to the evolution of expenditure vs other factors (such as postponed expenditure)

Psychological distress in health sciences college students and its relationship with academic engagement

Objective: To determine the prevalence of psychological distress and its relationship with academic engagement (absorption, dedication and vigor), sex and degree among students from four public universities. Method: A non-experimental,comparative correlational, quantitative investigation without intervention. Study population: 1840 nursing and physical therapy students. The data collection tool used was a questionnaire. Results: A 32.2% prevalence of psychological distress was found in the subjects; a correlation between vigor and psychological distress was found for all of the subjects and also for women. High absorption and dedication scores and low psychological distress scores predicted higher vigor scores. Conclusion: The risk of psychological distress is high, especially for women. Women seem to have a higher level of psychological distress than men. Vigor, energy and mental resilience positively influence psychological distress and can be a vehicle for better results during the learning and studying process.





Objetivo: Determinar la prevalencia del malestar psicológico y su relación con el engagement académico (absorción, dedicación y vigor) y con variables sexo y titulación, de los estudiantes de cuatro universidades públicas. Método: Estudio comparativo correlacional, investigación cuantitativa sin intervención, no experimental. Población 1840 estudiantes de Enfermería y Fisioterapia. La herramienta de recogida de datos fue el cuestionario. Resultados: Prevalencia de malestar psicológico en el 32.2% de los sujetos; se hallaron correlaciones entre vigor y malestar psicológico para el conjunto de sujetos y para el grupo de las mujeres. Las puntuaciones altas en absorción y dedicación y bajas en malestar psicológico, predicen valoraciones más altas en vigor. Conclusión: El riesgo de malestar psicológico es alto, especialmente para las mujeres. Éstas se perciben con mayor malestar psicológico que los hombres. El vigor, energía y resistencia con los estudios, influye positivamente sobre el malestar psicológico y puede ser un vehículo para unos mejores resultados del aprendizaje.
Objetivo: Determinar a prevalência do mal-estar psicológico e a sua relação com o engagement acadêmico (absorção, dedicação e vigor) e as variáveis ​​sexo e formação profissional em estudantes de quatro universidades públicas. Método: Investigação quantitativa sem intervenção, estudo não experimental e correlacional comparativo. A amostra foi constituída por 1.840 alunos de Enfermagem e Fisioterapia e o instrumento de coleta de dados foi o questionário. Resultados: A prevalência do mal-estar psicológico foi encontrada em 32,2% dos indivíduos; foram encontradas correlações entre vigor e mal-estar psicológico para o conjunto dos sujeitos, principalmente para o grupo das mulheres. A existência de escores elevados para dedicação e absorção, e baixos para mal-estar psicológico é preditora de pontuações mais elevadas em vigor. Conclusão: O risco de mal-estar psicológico é elevado, especialmente nas mulheres. Estas se percebem com maior mal-estar psicológico que os homens. O vigor, a energia e a resistência, aplicados na relação com os estudos influenciam positivamente o mal-estar psicológico e podem ser um veículo para melhores resultados de aprendizagem
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Psychological distress in health sciences college students and its relationship with academic engagement

P. 715-722Objective: To determine the prevalence of psychological distress and its relationship with academic engagement (absorption, dedication and vigor), sex and degree among students from four public universities. Method: A non-experimental, comparative correlational, quantitative investigation without intervention. Study population: 1840 nursing and physical therapy students. The data collection tool used was a questionnaire. Results: A 32.2% prevalence of psychological distress was found in the subjects; a correlation between vigor and psychological distress was found for all of the subjects and also for women. High absorption and dedication scores and low psychological distress scores predicted higher vigor scores. Conclusion: The risk of psychological distress is high, especially for women. Women seem to have a higher level of psychological distress than men. Vigor, energy and mental resilience positively influence psychological distress and can be a vehicle for better results during the learning and studying process.S

Oxidative stress influence on renal dysfunction in patients with obstructive jaundice: A case and control prospective study

Obstructive Jaundice (OJ) is associated with a significant risk of developing acute renal failure (ARF). The involvement of oxidative stress in the development of cholestasis has been demonstrated in different experimental models. However, its role in the morbidity of human cholestasis is far to be elucidated. The aim of the study was the evaluation of oxidative stress markers in blood from patients with OJ and its relation to complications and benign/malignant evolution of cholestasis. Methods: A prospective cross-sectional study of 105 patients with OJ and 34 control subjects were included. Several markers of liver function and oxidative stress, such as lipoperoxides (LPO), as well as reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed. Results: The patients with OJ showed a marked increase in plasma levels of LPO, SOD and GSH, while GSH-Px levels were decreased. The increase in lipid peroxidation products and the depletion of SOD activity in blood were also related to renal dysfunction. The highest level of LPO was associated with malignant etiology of the disease. The logistic regression analysis showed that the age of the patient and the levels of LPO in blood were predictors of renal dysfunction in OJ patients. Conclusions: This study demonstrates a correlation between oxidative stress and renal dysfunction patients with OJ.Instituto de Salud Carlos III PI02/015

Mural Endocarditis: The GAMES Registry Series and Review of the Literature

Introduction: Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis. Methods: Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series. Results: Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p \0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p \ 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p \ 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p \ 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non MIE, p = 0.006). Mortality was similar.MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p \ 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar. Conclusion: MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs

Impaired Antioxidant Defence Status Is Associated With Metabolic-Inflammatory Risk Factors in Preterm Children With Extrauterine Growth Restriction: The BIORICA Cohort Study

Introduction: An impaired antioxidant status has been described during foetal growth restriction (FGR). Similarly, the antioxidant defence system can be compromised in preterm children with extrauterine growth restriction (EUGR). The aim of this prospective study was to evaluate the antioxidant status in prepubertal children with a history of prematurity without FGR, with and without EUGR, compared to a healthy group. Methods: In total, 211 children were recruited and classified into three groups: 38 with a history of prematurity and EUGR; 50 with a history of prematurity and adequate extrauterine growth (AEUG); and 123 control children born at term. Catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) activities were assessed in lysed erythrocytes with spectrophotometric methods. Plasma levels of the antioxidants α-tocopherol, retinol and β-carotene were determined through solvent extraction and ultra-high-pressure liquid chromatography coupled to mass spectrometry. Results: Children with the antecedent of EUGR and prematurity had lower CAT activity than the other two groups and lower GPx activity than the control children. Lower SOD, GPx and GR activities were observed in the AEUG group compared to the controls. However, higher concentrations of α-tocopherol and β-carotene were found in the EUGR group compared to the other groups; retinol levels were also higher in EUGR than in AEUG children. In EUGR and AEUG children, enzymatic antioxidant activities and plasma antioxidants were associated with metabolic syndrome components and pro-inflammatory biomarkers. Conclusions: This study reveals, for the first time, that the EUGR condition and prematurity appear to be linked to an impairment of the antioxidant defence status, which might condition an increased risk of adverse metabolic outcomes later in life.This study was funded by the Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (Iþ DþI), Instituto de Salud Carlos III-Fondo de Investigación Sanitaria Project No. PI13/01245 from the Spanish Ministry of Health and Consumer Affairs and co-financed by the Consejería de Innovación y Ciencia, Junta de Andalucía, PI-0480-2012, Spain. ÁG was funded by the Research Plan of the Vice-Rectorate of Research and Transfer of the University of Granada, Spain. This paper will be included in MO-D's doctorate under the Biomedicine Program at the University of Córdoba, Spain. The funding bodies did not partake in the design, collection, analyses, or interpretation of the data or in writing the manuscript. Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain (Red SAMID RD12/0026/0015).Ye

Evaluating the Potential of Polygenic Risk Score to Improve Colorectal Cancer Screening

Background: Colorectal cancer has high incidence and associ-ated mortality worldwide. Screening programs are recommended for men and women over 50. Intermediate screens such as fecal immunochemical testing (FIT) select patients for colonoscopy with suboptimal sensitivity. Additional biomarkers could improve the current scenario. Methods: We included 2,893 individuals with a positive FIT test. They were classified as cases when a high-risk lesion for colorectal cancer was detected after colonoscopy, whereas the control group comprised individuals with low-risk or no lesions. 65 colorectal cancer risk genetic variants were geno-typed. Polygenic risk score (PRS) and additive models for risk prediction incorporating sex, age, FIT value, and PRS were generated. Results: Risk score was higher in cases compared with controls [per allele OR = 1.04; 95% confidence interval (CI), 1.02-1.06; P = 65), compared with those in the first decile (<= 54; OR = 2.22; 95% CI, 1.59-3.12; P < 0.0001). The model combining sex, age, FIT value, and PRS reached the highest accuracy for identifying patients with a high-risk lesion [cross-validated area under the ROC curve (AUROC): 0.64; 95% CI, 0.62-0.66]. Conclusions: This is the first investigation analyzing PRS in a two-step colorectal cancer screening program. PRS could improve current colorectal cancer screening, most likely for higher at-risk subgroups. However, its capacity is limited to predict colorectal cancer risk status and should be complemented by additional biomarkers.Impact: PRS has capacity for risk stratification of colorectal cancer suggesting its potential for optimizing screening strategies alongside with other biomarkers

Implementation of a mindfulness-based crisis intervention for frontline healthcare workers during the COVID-19 outbreak in a public general hospital in Madrid, Spain

Introduction: The COVID-19 outbreak is having an impact on the well-being of healthcare workers. Mindfulness-based interventions have shown effectiveness in reducing stress and fostering resilience and recovery in healthcare workers. There are no studies examining the feasibility of brief mindfulness-based interventions during the COVID-19 outbreak. Materials and Methods: This is an exploratory study with a post intervention assessment. We describe an on-site brief mindfulness intervention and evaluate its helpfulness, safety, and feasibility. Results: One thousand out of 7,000 (14%) healthcare workers from La Paz University Hospital in Madrid (Spain) participated in at least one session. One hundred and fifty out of 1,000 (15%) participants filled out a self-report questionnaire evaluating the helpfulness of the intervention for on-site stress reduction. Ninety two subjects (61%) participated in more than one session. Most of the participants were women (80%) with a mean age of 38.6 years. Almost half of the sample were nurses (46%). Sessions were perceived as being helpful with a mean rating of 8.4 on a scale from 0 to 10. Only 3 people (2%) reported a minor adverse effect (increased anxiety or dizziness). Discussion: Our data supports the utility, safety and feasibility of an on-site, brief mindfulness-based intervention designed to reduce stress for frontline health workers during a crisis. There is a need to continue testing this type of interventions, and to integrate emotion regulation strategies as an essential part of health workers' general training. Clinical Trial Registration number: NCT04555005

Infective Endocarditis in Diabetic Patients: A Different Profile with Prognostic Consequences

Background. Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyze the prognostic relevance of DM-related organ damage. Methods. Retrospective analysis of the Spanish IE Registry (2008–2020). Results. The cohort comprises 5590 IE patients with a mean age of 65.0 ± 15.5 years; 3764 (67.3%) were male. DM was found in 1625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p = 0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs. 924 [23.3%], p < 0.001) and higher one-year mortality (640 [39.4%] vs. 1131 [28.5%], p < 0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs. 321 [28.9%], p < 0.001) and one-year mortality (247 [48.0%] vs. 393 [35.4%], p < 0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16–1.55, p < 0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21–1.59, p < 0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06–1.76, p = 0.015) and one-year mortality (OR = 1.59, 95% CI = 1.26–2.01, p < 0.001) Conclusions. The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage