A Machine Learning Approach for Studying the Comorbidities of Complex Diagnoses

The study of diagnostic associations entails a large number of methodological problems regarding the application of machine learning algorithms, collinearity and wide variability being some of the most prominent ones. To overcome these, we propose and tested the usage of uniform manifold approximation and projection (UMAP), a very recent, popular dimensionality reduction technique. We showed its effectiveness by using it on a large Spanish clinical database of patients diagnosed with depression, to whom we applied UMAP before grouping them using a hierarchical agglomerative cluster analysis. By extensively studying its behavior and results, validating them with purely unsupervised metrics, we show that they are consistent with well-known relationships, which validates the applicability of UMAP to advance the study of comorbidities

Impact of Employment Training on the Quality of Life of Young People with Intellectual Disabilities

The CAMPVS program from A LA PAR Fundation is an employment-oriented training resource for young people with intellectual disabilities. This paper aims to study the influence of the training project on the quality of life of its students, as well as on each of the dimensions which make up this construct. A pre-post study has been conducted with sixty-one participants. As a main result, it is worth noting that the quality of life of the students is significantly higher after having studied at CAMPVS, both in the total quality of life index and in each of its dimensions. Changes in different variables are discussed.El programa CAMPVS de la Fundación A LA PAR es un recurso formativo orientado al empleo para jóvenes con discapacidad intelectual. En el presente trabajo se analiza la influencia del proyecto formativo en la calidad de vida de su alumnado, así como sobre cada una de las dimensiones que conforman dicho constructo. Se ha realizado un estudio pre-post con sesenta y un participantes. Como resultado principal cabe destacar que la calidad de vida de los estudiantes es significativamente mejor después de haber estudiado en CAMPVS, tanto en el índice total de calidad de vida como en cada una de sus dimensiones. Se discute sobre los cambios en las distintas variables

Association of fluvoxamine with mortality and symptom resolution among inpatients with COVID-19 in Uganda : a prospective interventional open-label cohort study

Funding: We acknowledge the funding support from the Government of the Republic of Uganda through the Makerere University Research and Innovations Fund (Mak-RIF).Prior research suggests that fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) used for the treatment of obsessive-compulsive disorder and major depressive disorder, could be repurposed against COVID-19. We undertook a prospective interventional open-label cohort study to evaluate the efficacy and tolerability of fluvoxamine among inpatients with laboratory-confirmed COVID-19 in Uganda. The main outcome was all-cause mortality. Secondary outcomes were hospital discharge and complete symptom resolution. We included 316 patients, of whom 94 received fluvoxamine in addition to standard care [median age, 60 years (IQR = 37.0); women, 52.2%]. Fluvoxamine use was significantly associated with reduced mortality [AHR = 0.32; 95% CI = 0.19–0.53; p < 0.001, NNT = 4.46] and with increased complete symptom resolution [AOR = 2.56; 95% CI = 1.53–5.51; p < 0.001, NNT = 4.44]. Sensitivity analyses yielded similar results. These effects did not significantly differ by clinical characteristic, including vaccination status. Among the 161 survivors, fluvoxamine was not significantly associated with time to hospital discharge [AHR 0.81, 95% CI (0.54–1.23), p = 0.32]. There was a trend toward greater side effects with fluvoxamine (7.45% versus 3.15%; SMD = 0.21; χ2 = 3.46, p = 0.06), most of which were light or mild in severity and none of which were serious. One hundred mg of fluvoxamine prescribed twice daily for 10 days was well tolerated and significantly associated with reduced mortality and with increased complete symptom resolution, without a significant increase in time to hospital discharge, among inpatients with COVID-19. Large-scale randomized trials are urgently needed to confirm these findings, especially for low- and middle-income countries, where access to vaccines and approved treatments against COVID-19 is limited.Publisher PDFPeer reviewe

Covid-19 in Children and the Influence on the Employment Activity of Their Female Caregivers: A Cross Sectional Gender Perspective Study

INTRODUCTION: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment. OBJECTIVE: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective. METHODS: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. This subsample was drawn from the FARA cohort. A survey was applied to them. We carried out a descriptive and stratified analysis by age group, educational, and socioeconomic level. RESULTS: We included 60 surveys of caregivers and 10 surveys of children. The main caregiver in 94.8% of the cases was a female. At the beginning of the pandemic, 63.3% of the caregivers were employed, and 78.9% of those lost their employment. The vast majority of these caregiver were women (96.6%, CONCLUSION: Caregivers of children with COVID-19 with low educational levels and lower socioeconomic conditions, as well as those with children under 5 years showed greater likelihood of employment loss between the interviewed subsample

Dexamethasone Use and Mortality in Hospitalized Patients with Coronavirus Disease 2019: a Multicenter Retrospective Observational Study

International audienc

How does neighbourhood socio-economic status affect the interrelationships between functioning dimensions in first episode of psychosis? A network analysis approach

The links between psychosis and socio-economic disadvantage have been widely studied. No previous study has analysed the interrelationships and mutual influences between functioning dimensions in first episode of psychosis (FEP) according to their neighbourhood household income, using a multidimensional and transdiagnostic perspective. 170 patients and 129 controls, participants in an observational study (AGES-CM), comprised the study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas participants' postcodes were used to obtain the average household income for each neighbourhood, collected by the Spanish National Statistics Institute (INE). Network analyses were conducted with the aim of defining the interrelationships between the different dimensions of functioning according to the neighbourhood household income. Our results show that lower neighbourhood socioeconomic level is associated with lower functioning in patients with FEP. Moreover, our findings suggest that “household responsibilities” plays a central role in the disability of patients who live in low-income neighbourhoods, whereas “dealing with strangers” is the most important node in the network of patients who live in high-income neighbourhoods. These results could help to personalize treatments, by allowing the identification of potential functioning areas to be prioritized in the treatment of FEP according to the patient's neighbourhood characteristic

Antipsicóticos inyectables de liberación prolongada para el tratamiento de la esquizofrenia en España.

Los antipsicóticos son un componente esencial del tratamiento de la esquizofrenia. Las formulaciones inyectables de liberación prolongada (ILP) surgen para mejorar la adherencia con el potencial asociado de reducir el riesgo de recaídas. El objetivo de este artículo es analizar el uso de antipsicóticos ILP en España –que es similar al de otros países europeos pero con un predominio de la utilización de ILP de segunda generación–, discutir las posibles causas de las diferencias de prescripción respecto a otros países de nuestro entorno (entre otras, aspectos organizativos, actitudes de psiquiatras, pacientes y familiares, guías de práctica clínica), y discutir su utilización en unidades de agudos, primeros episodios, y en niños y adolescentes. A nuestro juicio, aunque es necesario aumentar las pruebas existentes respecto a las ventajas de los antipsicóticos ILP y la diferenciación entre aquellos disponibles actualmente, su utilización seguirá probablemente creciendo impulsada por la experiencia clínica.post-print1,08 M

Marco activo de recursos de innovación docente: Madrid

Una guía de espacios e instituciones para actividades educativas complementarias en enseñanza secundaria y Formación Profesional

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe