El rol de la clase social, la educación y el desempleo parentales en el desarrollo cognitivo infantil

Objective: Assessing the association between socioeconomic gradient and cognitive development among children of a Spanish birth cohort aged 5-6 years from a gender perspective. Method: Cognitive development was assessed on 525 children aged 5-6 years in the INMA-Valencia cohort, with the Global Cognitive Score (GCS) from McCarthy Scales of Children’s Abilities. Information on social class, education level and employment was collected for both parents in addition to other sociodemographic factors, parental, family and child characteristics. The relationship between maternal and paternal socioeconomic gradient and cognitive development was assessed by linear regressions and comparing the variance explained by each indicator measured in the mother and father. Results: Maternal socioeconomic gradient indicators explained more variance on GCS than paternal. Maternal education and paternal social class had an important individual effect that stayed after adjusting by other parental, child and family determinants. In the multivariable analysis, maternal education, age and intelligence, paternal social class and the child’s age and sex were significantly associated with cognitive development. Conclusions: Diverse socioeconomic gradient factors have an important influence on cognitive development, maternal education being the strongest determinant. Policies should be implemented to mitigate the negative effects of this gradient on child development.Objetivo: Evaluar la asociación del gradiente socioeconómico y el desarrollo cognitivo en ni˜nos y ni˜nas de una cohorte espa˜nola a los 5-6 a˜nos de edad desde una perspectiva de género. Método: Se evaluó el desarrollo cognitivo en 525 ni˜nos/as de 5-6 a˜nos de la cohorte INMA-Valencia, mediante la Puntuación Global Cognitiva (PGC) de las Escalas McCarthy para ni˜nos y ni˜nas. Se recogió información de ambos progenitores sobre clase social, nivel de estudios y empleo, además de otros factores sociodemográficos, características parentales, de la familia y del ni˜no o la ni˜na. La relación entre el gradiente socioeconómico materno y paterno y el desarrollo cognitivo se evaluó mediante modelos de regresión lineal y comparando la varianza explicada por cada uno de los indicadores medidos en la madre y en el padre. Resultados: Los indicadores de gradiente socioeconómico de la madre explicaron más varianza del índice de PGC que los del padre. La educación materna y la clase social paterna tuvieron un importante efecto individual, que se mantuvo tras ajustar por otros determinantes de los progenitores, del ni˜no o de la ni˜na, y del entorno familiar. En el análisis multivariante, la educación, la edad y la inteligencia maternas, la clase social paterna, y la edad y el sexo del infante se asociaron significativamente con el desarrollo cognitivo. Conclusiones: Distintos factores del gradiente socioeconómico tienen influencia en el desarrollo cognitivo, siendo la educación materna el determinante más fuerte. Deberían implementarse políticas para paliar los efectos negativos de este gradiente en el desarrollo infantil

Eficacia de un programa de grupo estructurado en estrategias de afrontamiento para DSPT en adultos y adolescentes en situación de desplazamiento

17 páginasIn this paper, an analysis is made on the efficacy of a structured group program in emotional, cognitive and social coping skills for the treatment of a sample of adults and adolescents that developed posttraumatic stress disorder after a forced displacement situation. The participants completed a 10- session intervention including pre and post assessments about the severity level of the symptoms using the PSD scale (Foa, 1995) and an additional measure one month after. The results showed significant improvements in symptoms in both groups and in each one of the possible comparisons. Recovery shows that the decrease in the severity level of symptoms affects the functioning level positivelyEste estudio evalúa la eficacia de un programa de grupo estructurado en el desarrollo de estrategias de afrontamiento emocional, cognoscitivo y social para un grupo de adultos y adolescentes que desarrollaron estrés postraumático con posterioridad a una situación de desplazamiento. Los participantes completaron los diez encuentros de intervención, incluyendo las medidas pre y post en relación al nivel de severidad de los síntomas con la escala PSD (Foa, 1995) y una medida adicional un mes después. El análisis de los datos, muestra que la magnitud del cambio es significativa en ambos grupos y en cada una de las comparaciones posibles. La recuperación muestra que la reducción en el nivel de severidad de los síntomas, impacta positivamente el nivel de funcionamiento

Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): A significant decline and convergence between areas

Background: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002–2013. Methods: The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time. Results: COPD-PPH admissions declined from 24.5 to 15.5 per 10, 000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002–2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013. Conclusions: COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement

Real-World Management and Clinical Outcomes of Stroke Survivors With Atrial Fibrillation: A Population-Based Cohort in Spain

Antiplatelets; Atrial fibrillation; Treatment strategiesAntiplaquetarios; Fibrilación auricular; Estrategias de tratamientoAntiplaquetàries; Fibril·lació auricular; Estratègies de tractamentObjective: Despite the continuous update of clinical guidelines, little is known about the real-world management of patients with atrial fibrillation (AF) who survived a stroke. We aimed to assess patterns of therapeutic management of stroke survivors with AF and clinical outcomes using data from routine practice in a large population-based cohort. Methods: A population-based retrospective cohort study of all patients with AF who survived a stroke, from January 2010 to December 2017 in the Valencia region, Spain (n = 10,986), was carried out. Treatment strategies and mean time to treatment initiation are described. Temporal trends are shown by the management pattern during the study period. Factors associated with each pattern (including no treatment) vs. oral anticoagulant (OAC) treatment were identified using logistic multivariate regression models. Incidence rates of clinical outcomes (mortality, stroke/TIA, GI bleeding, and ACS) were also estimated by the management pattern. Results: Among stroke survivors with AF, 6% were non-treated, 23% were prescribed antiplatelets (APT), 54% were prescribed OAC, and 17% received OAC + APT at discharge. Time to treatment was 8.0 days (CI 7.6–8.4) for APT, 9.86 (CI 9.52–10.19) for OAC, and 16.47 (CI 15.86–17.09) for OAC + APT. Regarding temporal trends, management with OAC increased by 20%, with a decrease of 50% for APT during the study period. No treatment and OAC + APT remained relatively stable. The strongest predictor of no treatment and APT treatment was having the same management strategy pre-stroke. Those treated with APT had the highest rates of GI bleeding and recurrent stroke/TIA, and untreated patients showed the highest rates of mortality. Conclusion: In this large population-based cohort using real-world data, nearly 30% of AF patients who suffered a stroke were untreated or treated with APT, which overall is not recommended. Treatment was started within 2 weeks as recommended, except for OAC + APT, which was started later. The strong association of APT treatment or non-treatment with the same treatment strategy before stroke occurrence suggests a strong therapeutic inertia and opposes recommendations. Patients under these two strategies had the highest rates of adverse outcomes. An inadequate prescription poses a great risk on patients with AF and stroke; thus monitoring their management is necessary and should be setting-specific.CR-B was funded at the start of this work by the Instituto de Salud Carlos III, Spanish Ministry of Health, co-financed by the European Regional Development Fund (grant number RD16/0001/0011) and currently through a competitive grant (Sara Borrell CD19/00137). FS-S was funded by the Instituto de Salud Carlos III, Spanish Ministry of Health through the REDISSEC network (grant number RD16/0001/0011). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health or the study sponsors

Dietary intake in pregnant women in a Spanish Mediterranean area: as good as it is supposed to be?

Objective To assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics. Design Cross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine. Setting Valencia, Spain. Subjects We studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy. Results More than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts. Conclusions Women in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy

Displacement as a crisis generator: A study in adults and adolescents

This paper presents the results of a research project whose aim was to analyze the factors that should be kept considered when trying to understand displacement as a crisis generation factor and the conditions for its treatment. Two groups were chosen, one composed of 50 adults aged 20 to 55 and another one of 50 adolescents aged 12 to 18, both of which had developed posttraumatic stress disorder after displacement from their place of origin. A descriptive methodological approach was used and the measures were taken from an initial semi–structured interview, Foa’s Posttraumatic Stress Disorder Scale (PSD), Fernández Abascal’s Scale of Strategies and Styles of Coping for Adults and Frydenberg and Lewis’s Adolescent Coping Scale (ACS). The results showed that even when the condition of displacement is a contributing factor to the crisis, the events accompanying displacement also trigger the Posttraumatic Stress Disorder. Threats of recruitment and threats against life, as well as homicides and direct or indirect torture are major risk events. Likewise, present severity levels affect the performance levels in the different areas of life; variability is observed in the selection of strategies as a positive coping source.En este artículo se presentan los resultados de una investigación que buscó analizar los factores que se deben tener en cuenta a la hora de comprender el desplazamiento como un evento generador de crisis y las condiciones para su intervención. Se trabajó con un grupo de 50 adultos con edades entre 20 y 55 años y 50 adolescentes entre 12 y 18 años de edad, que habían desarrollado estrés postraumático posterior a haber sido desplazados de su lugar de origen. Se utilizó una metodología descriptiva y las medidas se establecieron a partir de una entrevista semiestructurada inicial, la Escala de Diagnóstico de Estrés Postraumático (PSD) de Foa, La Escala de Estrategias y Estilos de Afrontamiento para adultos de Fernández Abascal y Escala de Afrontamiento para Adolescentes (ACS) de Frydenberg y Lewis. Los resultados mostraron que la condición de desplazamiento, si bien es un factor que contribuye a la crisis, los eventos que lo acompañan, se consideran también detonantes del Desorden de estrés Postraumático. Las amenazas de reclutamiento y contra la vida, así como los homicidios y las torturas directas o indirectas se constituyen en eventos de mayor riesgo. Igualmente, los niveles de severidad presentes, afectan el nivel de funcionamiento en las diferentes áreas de la vida y se observa variabilidad en la selección de estrategias como una fuente positiva de afrontamiento

A Multilevel Analysis of Real-World Variations in Oral Anticoagulation Initiation for Atrial Fibrillation in Valencia, a European Region

Introduction: Beyond clinical trials, clinical practice guidelines, and administrative regulation, treatment decision-making can be influenced by individual and contextual factors. Our goal was to describe variations in the patterns of initiation of anticoagulation therapy in patients with atrial fibrillation by Health Areas (HA) in the region of Valencia in Spain and to quantify the influence of the HAs on variations in treatment choice.Methods: We conducted a population-based retrospective cohort study of all atrial fibrillation patients who started treatment with oral anticoagulants between November 2011 and February 2014 in each of the region's 24 HAs. We described patient and utilization characteristics per HA and initiation patterns over time, and we identified contextual and individual factors associated with differences in initiation patterns.Results: 21,879 patients initiated treatment with an oral anticoagulant in the 24 HAs. Initiation with direct oral anticoagulants (DOAC) in the first year was 14.6%. In November 2013 the ratio was 25.4%, with HA ratios ranging from 3.8 to 57.1%. DOAC-initiating patients had less comorbidity but were more likely to present episodes of previous ischemic stroke, hemorrhagic stroke, or TIA when compared with patients initiating with VKA treatment. Variability among HAs was statistically significant, with the majority of HAs ranking above or below the regional initiation average (ICC ≈ 8%).Conclusion: There was high variability in the percentage of DOAC initiation and in the choice of DOAC among HAs. Interventions aimed to improve DOAC initiation decision-making and to reduce variations should take into account the Health Area component

Estimating Adherence Based on Prescription or Dispensation Information: Impact on Thresholds and Outcomes. A Real-World Study With Atrial Fibrillation Patients Treated With Oral Anticoagulants in Spain

Objective: To estimate drug exposure, Proportion of Days Covered (PDC) and percentage of patients with PDC ≥ 80% from a cohort of atrial fibrillation patients initiating oral anticoagulant (OAC) treatment. We employed three different approaches to estimate PDC, using either data from prescription and dispensing (PD cohort) or two common designs based on dispensing information only, requiring at least one (D1) or at least two (D2) refills for inclusion in the cohorts. Finally, we assessed the impact of adherence on health outcomes according to each method.Methods: Population-based retrospective cohort of all patients with Non Valvular Atrial Fibrillation (NVAF), who were newly prescribed acenocoumarol, apixaban, dabigatran or rivaroxaban from November 2011 to December 2015 in the region of Valencia (Spain). Patients were followed for 12 months to assess adherence using three different approaches (PD, D1 and D2 cohorts). To analyze the relationship between adherence (PDC ≥ 80) defined according to each method of calculation and health outcomes (death for any cause, stroke or bleeding) Cox regression models were used. For the identification of clinical events patients were followed from the end of the adherence assessment period to the end of the available follow-up period.Results: PD cohort included all patients with an OAC prescription (n = 38,802), D1 cohort excluded fully non-adherent patients (n = 265) and D2 cohort also excluded patients without two refills separated by 180 days (n = 2,614). PDC ≥ 80% ranged from 94% in the PD cohort to 75% in the D1 cohort. Drug exposure among adherent (PDC ≥ 80%) and non-adherent (PDC < 80%) patients was different between cohorts. In adjusted analysis, high adherence was associated with a reduced risk of death [Hazard Ratio (HR): from 0.82 to 0.86] and (except in the PD cohort) the risk for ischemic stroke (HR: from 0.61 to 0.64) without increasing the risk of bleeding.Conclusion: Common approaches to assess adherence using measures based on days’ supply exclude groups of non-adherent patients and, also, misattribute periods of doctors’ discontinuation to patient non-adherence, misestimating adherence overall. Physician-initiated discontinuation is a major contributor to reduced OAC exposure. When using the PDC80 threshold, very different groups of patients may be classified as adherent or non-adherent depending on the method used for the calculation of days’ supply measures. High adherence and high exposure to OAC treatment in NVAF patients is associated with better health outcomes

Women in limnology: From a historical perspective to a present-day evaluation

Research in limnology is nurtured by the work of many fascinating and passionate women, who have contributed enormously to our understanding of inland waters. Female limnologists have promoted and established the bases of our knowledge about inland waters and fostered the need of protecting the values of those ecosystems. However, on numerous occasions, their contribution to the advancement of limnology has not been duly recognized. Here, we review the presence of women in limnology through the history of the discipline: from the pioneers who contributed to the origins to present day' developments. We aim at visibilizing those scientists and establish them as role models. We also analyze in a simple and illustrative way the current situation of women in limnology, the scientific barriers they must deal with, and their future prospects. Multiple aspects fostering the visibility of a scientist, such as their presence in conferences, awards, or representation in societal or editorial boards show a significant gap, with none of those aspects showing a similar visibility of women and men in limnology. This article raises awareness of the obstacles that women in limnology faced and still face, and encourages to embrace models of leadership, scientific management, and assessment of research performance far from those commonly established.info:eu-repo/semantics/publishedVersio

The synthetic molecule stauprimide impairs cell growth and migration in triple-negative breast cancer

Stauprimide, a semi-synthetic derivative of staurosporine, is known mainly for its potent differentiation-enhancing properties in embryonic stem cells. Here, we studied the effects of stauprimide in cell growth and migration of triple-negative breast cancer cells in vitro, evaluating its potential antitumoral activity in an orthotopic mouse model of breast cancer in vivo. Our results from survival curves, EdU incorporation, cell cycle analysis and annexin-V detection in MDA-MB-231 cells indicated that stauprimide inhibited cell proliferation, arresting cell cycle in G2/M without induction of apoptosis. A decrease in the migratory capability of MDA-MB-231 was also assessed in response to stauprimide. In this work we pointed to a mechanism of action of stauprimide involving the modulation of ERK1/2, Akt and p38 MAPK signalling pathways, and the downregulation of MYC in MDA-MB-231 cells. In addition, orthotopic MDA-MB-231 xenograft and 4T1 syngeneic models suggested an effect of stauprimide in vivo, increasing the necrotic core of tumors and reducing metastasis in lung and liver of mice. Together, our results point to the promising role of stauprimide as a putative therapeutic agent in triple-negative breast cancer.MRI experiments were performed in the ICTS “NANBIOSIS”, more specifically in the U28 Unit at the Andalusian Centre for Nanomedicine & Biotechnology (BIONAND). Cell cultures were performed in the Cell Culture Service at the Central Support Services of Research (SCAI) of the University of Málaga. // Partial funding for open access charge: Universidad de Málaga / CBUA