Programa de promoción de la salud sobre alimentación complementaria en lactantes

Se propone un plan de promoción de salud acerca de la introducción de la alimentación complementaria (AC) en el lactante. Iniciar la educación en el proceso de introducción de AC es de gran importancia, puesto que ofrece mayor seguridad y conocimientos a las familias ante la correcta practica. Además, los hábitos adquiridos en este periodo se conservarán a lo largo de la edad adulta. Las enfermeras de pediatría son las encargadas de poner en marcha la implantación de esta promoción de la salud; ofreciendo, tanto a las familias como al lactante, conocimientos basados en la evidencia y en la experiencia clínica y holística.<br /

Arterial stiffness is highly correlated with the scores obtained from the Steno Type 1 Risk Engine in subjects with T1DM

Steno Type 1 Risk Engine (ST1RE); Arterial stiffness; Type 1 diabetes (T1DM)Motor de Risc Steno Tipus 1; Rigidesa arterial; Diabetis mellitus tipus 1 (DM1)Motor de Riesgo Steno Tipo 1; Rigidez arterial; Diabetes mellitus tipo 1 (DM1)OBJECTIVES: Currently used risk scores for type 2 diabetes mellitus (T2DM) clearly underestimate cardiovascular risk in type 1 diabetes (T1DM). Hence, there is a need to develop novel and specific risk-estimation tools for this population. We aimed to assess the relationship between the Steno Type 1 Risk Engine (ST1RE) and arterial stiffness (AS), and to identify potential cut-off points of interest in clinical practice. DESIGN AND METHODS: A total of 179 patients with T1DM (50.8% men, mean age 41.2±13.1 years), without established cardiovascular disease, were evaluated for clinical and anthropometric data (including classical cardiovascular risk factors), and AS measured by aortic pulse-wave velocity (aPWV). The ST1RE was used to estimate 10-year cardiovascular risk and patients were classified into 3 groups: low- (<10%; n = 105), moderate- (10-20%; n = 53) and high-risk (≥20%; n = 21). RESULTS: When compared with the low- and moderate-risk groups, patients in the high-risk group were older, had higher prevalence of hypertension, dyslipidemia and insulin-resistance, and had higher body-mass index and HbA1c. aPWV increased in parallel with estimated cardiovascular risk (6.4±1.0, 8.4±1.3 and 10.3±2.6m/s; p<0.001). As an evaluation of model performance, the C-statistic of aPWV was 0.914 (95% confidence interval [CI]:0.873-0.950) for predicting moderate/high-risk and 0.879 (95%CI:0.809-0.948) for high-risk, according to the ST1RE. The best cut-off points of aPWV were 7.3m/s (sensitivity:86%, specificity:83%) and 8.7m/s (sensitivity:76%, specificity:86%) for moderate/high- and high-risk, respectively. CONCLUSIONS: AS is highly correlated with the scores obtained from the ST1RE. We have identified two cut-off points of AS that can clearly discriminate moderate/high- and high-risk T1DM patients, which could be of great value in clinical practice.Financial support was provided through the Fondo de Investigacion Sanitaria (FIS) PI09/01360 (PI: JMCG), PI12/00954 (PI: JMCG) and PI15/00567 (PI: JMCG) as part of the National R+D+I (2008-2011) and was co-financed by the Instituto de Salud Carlos III - General Evaluation Branch (Spanish Ministry of Economy and Competitiveness) and the European Regional Development Fund (ERDF). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript

Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10-1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22-2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97-1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58-0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52-0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes

La incidència de diabetis mellitus de tipus 1 durant la pandèmia de COVID-19 a Catalunya

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diabetis mellitus de tipus 1; Malaltia crònicaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diabetes mellitus de tipo 1; Enfermedad crónicaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Type 1 diabetes mellitus; Chronic diseaseIntroducció: la diabetis de tipus 1 és una malaltia crònica que es caracteritza per la falta de producció d’insulina per part del pàncrees, el que provoca un augment dels nivells de glucosa en sang. En alguns països s’ha reportat un increment en la incidència de diabetis de tipus 1 durant la pandèmia de COVID-19. Objectiu: comprovar si ha augmentat la incidència de diabetis de tipus 1 durant la pandèmia de COVID-19 a Catalunya. Mètodes: estimació de la incidència esperada de diabetis de tipus 1 per als anys 2020-2021 a través d’una regressió Poisson, i comparació amb la incidència observada. La incidència observada es va obtenir a partir del registre poblacional de diabetis de tipus 1 del programa PADRIS d’analítica de dades d’AQuAS. Resultats: de forma agregada, l’any 2020 la incidència no va augmentar significativament respecte a l’any anterior, però per a l’any 2021 va augmentar significativament en un 28 %. Els majors augments, en tots dos anys, es van donar entre les persones menors de 18 anys i les dones. Conclusions i discussió: durant la pandèmia de COVID-19 es va produir un augment notable i estadísticament significatiu de la incidència de casos de DM1 a Catalunya, encara que no és possible establir una relació de causalitat entre la pandèmia i la diabetis. Es requereixen més estudis per investigar els possibles mecanismes biològics o socials que podrien explicar aquest fenomen i les seves implicacions clíniques i sanitàries.Introducción: la diabetes tipo 1 es una enfermedad crónica que se caracteriza por la falta de producción de insulina por parte del páncreas, lo que provoca un aumento de los niveles de glucosa en sangre. En algunos países se ha reportado un incremento en la incidencia de diabetes tipo 1 durante la pandemia de COVID-19. Objetivo: comprobar si ha aumentado la incidencia de diabetes tipo 1 durante la pandemia de COVID-19 en Cataluña. Métodos: estimación de la incidencia esperada de diabetes tipo 1 para los años 2020-2021 a través de una regresión Poisson, y comparación con la incidencia observada. La incidencia observada se obtuvo a partir del registro poblacional de diabetes tipo 1 del programa PADRIS de analítica de datos de AQuAS. Resultados: de forma agregada, en el año 2020 la incidencia no aumentó significativamente respecto al año anterior, pero para el año 2021 aumentó significativamente en un 28%. Los mayores aumentos, en ambos años, se dieron entre las personas menores de 18 años y las mujeres. Conclusiones y discusión: durante la pandemia de COVID-19 se produjo un aumento notable y estadísticamente significativo de la incidencia de casos de DM1 en Cataluña, aunque no es posible establecer una relación de causalidad entre la pandemia y la diabetes. Se requieren más estudios para investigar los posibles mecanismos biológicos o sociales que podrían explicar este fenómeno y sus implicaciones clínicas y sanitarias.Introduction: Type 1 diabetes (T1D) is a chronic disease characterized by insufficient insulin production by the pancreas, leading to high blood glucose levels. Some countries have reported an increase in the incidence of T1D during the COVID-19 pandemic. Objective: To examine whether the incidence of T1D has increased during the COVID-19 pandemic in Catalonia. Methods: We estimated the expected incidence of T1D for 2020-2021 using a Poisson regression model based on historical data from 2010 to 2019. We compared the expected incidence with the observed incidence obtained from the population-based T1D registry of the PADRIS data analysis program of AQuAS. Results: In 2020, there was no significant increase in incidence compared to 2019, but in 2021 there was a significant increase of 28%. The largest increases occurred among people under 18 years old and women. Conclusions and discussion: There was a notable and statistically significant increase in T1D cases in Catalonia during the COVID-19 pandemic, although a causal relationship between the pandemic and diabetes cannot be established. Further studies are needed to explore the possible biological or social mechanisms that could explain this phenomenon and its clinical and health implications

Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study

BackgroundThe use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting.MethodsMulticenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024.DiscussionThe scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript.Trial registrationNCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021

Experiencia sobre el proceso de salud-enfermedad-atención en pacientes con artritis reumatoidea pertenecientes a la comunidad Wichí de Misión Chaqueña “El Algarrobal”, Salta

Introducción: se ha reportado que la prevalencia de artritis reumatoidea (AR) en la comunidad Wichí representa la más alta informada por el Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). El objetivo de este estudio fue describir la experiencia sobre el proceso de salud- enfermedad-atención de pacientes con AR de la comunidad Wichí de Misión Chaqueña “El Algarrobal”, Salta. Materiales y métodos: estudio narrativo. Diseño de corte etnográfico. Se realizaron entrevistas semiestructuradas y observaciones registradas. Se utilizaron guías de entrevistas y observación. Los aspectos incluidos fueron: concepción del proceso salud-enfermedad, percepción de la AR en la vida diaria, el acceso al sistema de salud, utilización de recursos tradicionales y de medicina tradicional.

Spanish home enteral nutrition registry of the year 2014 and 2015 from the NADYA-SENPE Group

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de fi nalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs. 0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodiosObjective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes fi nished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes fi nished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any signifi cant change in the characteristics of the patients other than longer duration of the episode

Relationship between olive oil consumption and ankle-brachial pressure index in a population at high cardiovascular risk

The aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome. Methods: We performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure. Results: Among 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48]). Conclusions: In a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed

Genetic landscape of 6089 inherited retinal dystrophies affected cases in Spain and their therapeutic and extended epidemiological implications

Inherited retinal diseases (IRDs), defined by dysfunction or progressive loss of photoreceptors, are disorders characterized by elevated heterogeneity, both at the clinical and genetic levels. Our main goal was to address the genetic landscape of IRD in the largest cohort of Spanish patients reported to date. A retrospective hospital-based cross-sectional study was carried out on 6089 IRD affected individuals (from 4403 unrelated families), referred for genetic testing from all the Spanish autonomous communities. Clinical, demographic and familiar data were collected from each patient, including family pedigree, age of appearance of visual symptoms, presence of any systemic findings and geographical origin. Genetic studies were performed to the 3951 families with available DNA using different molecular techniques. Overall, 53.2% (2100/3951) of the studied families were genetically characterized, and 1549 different likely causative variants in 142 genes were identified. The most common phenotype encountered is retinitis pigmentosa (RP) (55.6% of families, 2447/4403). The most recurrently mutated genes were PRPH2, ABCA4 and RS1 in autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) NON-RP cases, respectively; RHO, USH2A and RPGR in AD, AR and XL for non-syndromic RP; and USH2A and MYO7A in syndromic IRD. Pathogenic variants c.3386G > T (p.Arg1129Leu) in ABCA4 and c.2276G > T (p.Cys759Phe) in USH2A were the most frequent variants identified. Our study provides the general landscape for IRD in Spain, reporting the largest cohort ever presented. Our results have important implications for genetic diagnosis, counselling and new therapeutic strategies to both the Spanish population and other related populations.This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health (FIS; PI16/00425 and PI19/00321), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER, 06/07/0036), IIS-FJD BioBank (PT13/0010/0012), Comunidad de Madrid (CAM, RAREGenomics Project, B2017/BMD-3721), European Regional Development Fund (FEDER), the Organización Nacional de Ciegos Españoles (ONCE), Fundación Ramón Areces, Fundación Conchita Rábago and the University Chair UAM-IIS-FJD of Genomic Medicine. Irene Perea-Romero is supported by a PhD fellowship from the predoctoral Program from ISCIII (FI17/00192). Ionut F. Iancu is supported by a grant from the Comunidad de Madrid (CAM, PEJ-2017-AI/BMD7256). Marta del Pozo-Valero is supported by a PhD grant from the Fundación Conchita Rábago. Berta Almoguera is supported by a Juan Rodes program from ISCIII (JR17/00020). Pablo Minguez is supported by a Miguel Servet program from ISCIII (CP16/00116). Marta Corton is supported by a Miguel Servet program from ISCIII (CPII17/00006). The funders played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions

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