Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals

This study aimed to analyze the psychological affectation of health professionals (HPs) of Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID19 cases in the regions in which they worked. A cross-sectional descriptive study was designed, including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April 2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (GSES) were the study’s main results. A 2-factor analysis of covariance was used to determine if the CI regions of COVID-19 cases determined the psychological impact on each of the studied variables. A total of 1710 HPs were included. A third presented psychological impairment classified as severe. The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety, depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency medical technicians (EMT), workers who had to modify their working conditions or those who lived with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions. These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy, with similar data in the different geographical areas. Psychological support is essential to mitigate their suffering and teach them to react to adverse events.This research was funded by Fundación ASISA and Sociedad Española de Urgencias y Emergencias (SEMES)

Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000-2015

Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000-2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000-2009 to 0.22 cases per 100,000 admissions in 2010-2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy

Characteristics of patients with type 2 diabetes mellitus newly treated with GLP-1 receptor agonists (CHADIG Study): a cross-sectional multicentre study in Spain

Objective: Several glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1Ra) have been made recently available in Spain for type 2 diabetes mellitus (DM2) treatment. There are no published data on the clinical and sociodemographic profile of patients initiating treatment with GLP-1Ra in Spain. Our objective was to understand these patients' characteristics in a real-world clinical practice setting. Design: Cross-sectional observational study. Setting: Spanish specialist outpatient clinics. Participants: 403 adults with DM2 initiating GLP-1Ra treatment were included. Primary and secondary outcome measures: Sociodemographic and DM2-related clinical data, including treatment at and after GLP-1Ra initiation and comorbidities, were collected. Results: Evaluable patients (n=403; 50.9% female) were included ( July 2013 to March 2014) at 24 centres by 53 specialists (47 endocrinology, 6 internal medicine), with the following profile (value±SD): age (58.3±10.4 years), diabetes duration (9.9±7 years), body mass index (BMI; 36.2±5.5) and glycated haemoglobin (HbA1c; 8.4±1.4%); 14% had HbA1c≤7%. Previous antidiabetic treatment: 53.8% only oral antidiabetic drugs (OADs), 5.2% insulin and 40% insulin and OAD; of those receiving OAD, 35% single drug, 38.2% 2 drugs and 24% 3 drugs. Concomitant to GLP-1Ra, 55.3% were only on OAD, 36.2% on insulin and OAD, and 7.2% only on insulin. Of those receiving OAD, the GLP-1Ra was mainly associated with 1 drug (65%) or 2 drugs (31.8%). GLP-1Ra are frequently added to existing antidiabetic drugs, with dipeptidyl peptidase-4 inhibitors being the OAD most frequently switched (45% receiving 1 before starting GLP-1Ra, only 2.7% receiving it concomitantly). Conclusions: In Spain, GLP-1Ra therapy is usually started in combination with OADs or OADs and insulin. These drugs are used in relatively young patients often not reaching therapeutic goals with other treatment combinations, roughly a decade after diagnosis and with a relatively high BMI. The latter could be explaine

Second GHEP-ISFG exercise for DVI: “DNA-led” victims’ identification in a simulated air crash

The Spanish and Portuguese-Speaking Working Group of the International Society for Forensic Genetics (GHEP-ISFG) has organized a second collaborative exercise on a simulated case of Disaster Victim Identification (DVI), with the participation of eighteen laboratories. The exercise focused on the analysis of a simulated plane crash case of medium-size resulting in 66 victims with varying degrees of fragmentation of the bodies (with commingled remains). As an additional difficulty, this second exercise included 21 related victims belonging to 6 families among the 66 missings to be identified. A total number of 228 post-mortem samples were represented with aSTR and mtDNA profiles, with a proportion of partial aSTR profiles simulating charred remains. To perform the exercise, participants were provided with aSTR and mtDNA data of 51 reference pedigrees —some of which deficient—including 128 donors for identification purposes. The exercise consisted firstly in the comparison of the post-mortem genetic profiles in order to re-associate fragmented remains to the same individual and secondly in the identification of the re-associated remains by comparing aSTR and mtDNA profiles with reference pedigrees using pre-established thresholds to report a positive identification. Regarding the results of the post-mortem samples re-associations, only a small number of discrepancies among participants were detected, all of which were from just a few labs. However, in the identification process by kinship analysis with family references, there were more discrepancies in comparison to the correct results. The identification results of single victims yielded fewer problems than the identification of multiple related victims within the same family groups. Several reasons for the discrepant results were detected: a) the identity/non-identity hypotheses were sometimes wrongly expressed in the likelihood ratio calculations, b) some laboratories failed to use all family references to report the DNA match, c) In families with several related victims, some laboratories firstly identified some victims and then unnecessarily used their genetic information to identify the remaining victims within the family, d) some laboratories did not correctly use “prior odds” values for the Bayesian treatment of the episode for both post-mortem/post-mortem re-associations as well as the ante-mortem/post-mortem comparisons to evaluate the probability of identity. For some of the above reasons, certain laboratories failed to identify some victims. This simulated “DNA-led” identification exercise may help forensic genetic laboratories to gain experience and expertize for DVI or MPI in using genetic data and comparing their own results with the ones in this collaborative exercise.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Peer reviewe

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

Caracterización ecológica del área marina del banco de Galicia

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación del banco de GaliciaEl banco de Galicia es un monte submarino profundo situado a 180 km de la costa gallega, con una cima situada entre los 650 y los 1.500 m de profundidad y rodeado de zonas abisales de más de 4.000 m de profundidad. El relieve de las montañas submarinas interactúa con la circulación oceánica modificando las condiciones de oligotrofismo imperantes en el mar profundo. El cambio de dirección de las corrientes marinas, al chocar con el banco, produce las llamadas columnas de Taylor que tienen como consecuencia giros sobre la cima y finalmente un enriquecimiento de las aguas que bañan el banco, lo que influye, a través de la cadena trófica, en las especies de cetáceos, aves y tortugas. Estas condiciones, junto al aislamiento de estos bancos, convierten a estos bancos en puntos calientes de biodiversidad. Esta teoría se ha visto corroborada por los estudios realizados en el proyecto INDEMARES, basados en dos campañas de investigación, dónde se ha encontrado una elevada biodiversidad y la presencia de hábitats vulnerables. El banco de Galicia está bañado por tres capas diferentes: la masa de agua central del Atlántico nordeste europeo (East North Atlantic Central Water: ENACW), por debajo de las aguas superficiales y hasta los 500-600 m; la masa de agua mediterránea (Mediterranean Outflow Water: MOW) y la masa de agua del Labrador (Labrador Sea Water: LSW), que es la capa más profunda. En cuanto al tipo de fondo, se encuentra roca en el área del flanco oriental y hacia el sureste y en los montes adyacentes como el Rucabado, distinguiendo claramente dos tipos en cuanto a la pendiente, correspondiendo con la roca plana de la cima y la roca en pendiente del borde del banco y paredes. En la cima se encuentran fondos de arenas medias, de reflectividad media y baja según el espesor de sedimento, y arenas finas en los fondos sedimentaruios de los flancos, a profundidades mayores de 1.500. En el banco se han identificado hasta el momento 793 especies, con taxones que superan las 100 especies como son moluscos, peces (con especial énfasis en los elasmobranquios), crustáceos y cnidarios. Este inventario incluye especies nuevas para la ciencia, primeras citas para aguas españolas y europeas y especies de gran interés científico y biogeográfico. Este último punto se explica por la situación del Banco entre regiones biogeográficas conectadas por corrientes y masas de agua. El estudio de las conexiones tróficas entre este elevado número de especies ha mostrado el reforzamiento de las rutas bentopelágicas (gambas y macrozooplancton) frente a las dietas epi- y endobentónicas más habituales en otros fondos equivalentes. Mediante técnicas de muestreo extractivas (arrastres, dragas) y de vídeo, y su proyección sobre la interpretación geomorfológica realizada a partir de la sonda multihaz, se ha obtenido una estimación de la distribución de los hábitats bentónicos del banco. Los hábitats identificados en fondos sedimentarios son 1) arenas medias con ofiuras Ophiacantidae y Flabellum chunii, 2) arenas medias con arrecife de corales profundos de Lophelia pertusa y/o Madrepora oculata, y 3) arenas finas con holoturias elasipódidas (Benthogone rosea). En fondos rocosos se han caracterizado los hábitats de 4) roca batial sin pendiente con gorgonias y corales negros, 5) roca batial de talud con comunidades de corales y esponjas, 6) roca batial de talud con corales blancos, bambú y negros, gorgonias y esponjas, 7) arrecife de corales profundos de Lophelia pertusa y/o Madrepora oculata y 8) roca con nódulos manganésicos. El único tipo de hábitat de la DH descrito en la zona es el 1.170 (arrecifes). Sólo se han incluido en la Directiva Hábitats como 1.170 aquellos que presentaban una densidad y diversidad suficientes para cumplir la definición de “arrecifes”. De los hábitats descritos en el banco (ver características ecológicas y biológicas más arriba) solo se han incluido en el 1.170 los arrecifes de corales blancos situados en las arenas medias de la cima del banco, los arrecifes de corales blancos de aguas frías de las especies Lophelia pertusa y Madrepora oculata sobre la roca de la cima del monte Rucabado, las comunidades de roca batial de talud de la ladera sur del banco constituidas por colonias de corales blancos de aguas frías de las especies Lophelia pertusa y Madrepora oculata, y una fauna acompañante muy diversa de escleractinias solitarias, corales bambú, corales negros, gorgonias y esponjas de gran porte, y el resto de zonas de roca batial de talud con comunidades de corales y esponjas. Muchos de los hábitats pueden ser incluidos en los listados de hábitat vulnerables de OSPAR, en los tipos jardines de coral, agregaciones de esponjas de profundidad, arrecifes de Lophelia y montículos carbonatados. En cuanto a las especies de interés para la protección, de las citadas en el banco, el delfín mular (Tursiops truncatus) y la tortuga boba (Caretta caretta) son las únicas especies que figuran en el Anexo II de la Directiva de Hábitats. Sin embargo, muchas epecies de elasmobranquis y algunos peces óseos son consideradas vulnerables, amenazadas o en declive según los criterios definidos por OSPAR y la lista roja de especies amenazadas de IUCN. Algunas de están protegidas por el reglamento europeo 1262/2012 que regula la pesca de especies profundas. La lejanía del banco respecto a los principales focos de presión y la ausencia casi total de presión pesquera hace que el grado de conservación sea muy alto, pudiéndose hablar de un ecosistema prácticamente prístino. Las recomendaciones para la gestión de esta zona van encaminadas a garantizar esta calidad ambiental actual.Instituto Español de Oceanografía, Comisión Europea Programa LIFE+, Fundación Biodiversida

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

EducaFarma 9.0

Memoria ID-020 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

EDUCACIÓN AMBIENTAL Y SOCIEDAD. SABERES LOCALES PARA EL DESARROLLO Y LA SUSTENTABILIDAD

Este texto contribuye al análisis científico de varias áreas del conocimiento como la filosofía social, la patología, la educación para el cuidado del medio ambiente y la sustentabilidad que inciden en diversas unidades de aprendizaje de la Licenciatura en Educación para la Salud y de la Maestría en Sociología de la SaludLas comunidades indígenas de la sierra norte de Oaxaca México, habitan un territorio extenso de biodiversidad. Sin que sea una área protegida y sustentable, la propia naturaleza de la región ofrece a sus visitantes la riqueza de la vegetación caracterizada por sus especies endémicas que componen un paisaje de suma belleza