Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado

Objective. The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). Methods. We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. Results. We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p= 2 and 0.698 (IC 95% 0.635- 0.761; p= 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). Conclusions. Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke

Objective: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. Design: Retrospective cohort study. Setting: Tertiary care hospital. Patients: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. Interventions: None. Main variables of interests: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. Results: A total of 165 patients were included. The mean age was 66.1 ± 14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65–0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77–8.85) after adjusting for confounders. Conclusion: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients’ risk and to consider timely alternative care and management.Revisión por pare

Forest use and agriculture in Ucayali, Peruvian Amazon: interactions among livelihood strategies, income and environmental outcomes.

Findings from a survey on sources of income and land allocation outcomes of 578 households from 26 communities with diverse ethnic composition at distinct environmental settings in Ucayali (Peruvian Amazon) are used to contrast livelihood strategies featuring high forest and high agriculture dependency, examining whether agricultural intensi&#64257;cation can be linked to lower deforestation. A typology of households based on their land use allocation pro&#64257;le was used to assess current and cumulative cleared land. Recently cleared areas by households oriented to perennials, semi-perennials and pastures were similar to those focusing on annual crops. Multiple class comparisons provided evidence that land use intensi&#64257;cation is not associated to land sparing. Near 40% of the households&#65287; annual income was derived from forests, followed by agriculture (25%), wages (17%) and livestock (11%). Income structure was used to determine high dependency on forests and on agriculture, featured by respectively 24% and 17% of the households, while 10% relied mostly on wages and/or businesses and half of them had a balanced income structure. Results indicate different expressions of the criticality of forest products, highlighting livelihood strategies based on the integration of income sources. Moreover, the study shows that despite the relevance of forest products, mestizo and indigenous livelihoods heavily depend on agriculture. Policy interventions aimed at environmental conservation and economic development will only be successful when strengthening the integration between agriculture and forest use featured by different social groups in the Amazon.201

Co-evolution of the Finnish National and Local Innovation and Science Arenas: Towards a Dynamic Understanding of Multi-level Governance

Sotarauta M. and Kautonen M. (2007) Co-evolution of the Finnish national and local innovation and science arenas: towards a dynamic understanding of multi-level governance, Regional Studies 41, 1085-1098. In Finland, science policy is in the hands of central government and regions/localities do not directly have any say in the formulation of science policies. However, Finnish city-regions have influenced national science policies indirectly and the interaction of national and local policies has unfolded in time in innovation and science arenas. This paper aims to provide answers to the following questions: (1) how has the institutional basis for science and innovation evolved in Finland over the past 50 years, especially in three Finnish city-regions; (2) which have been the main actors in the evolution of institutional capacity and what have their main strategies been; (3) how have national and local policies and developments co-evolved over time? The article focuses particularly on how different policies, local and national, have co-evolved in the context of multi-level governance. Sotarauta M. et Kautonen M. (2007) L'evolution simultanee dans les domaines de l'innovation nationale et locale et de la science finlandaises: vers une comprehension dynamique de la gouvernance a plusieurs niveaux, Regional Studies 41, 1085-1098. En Finlande, la politique scientifique est entre les mains du gouvernement central, et les regions n'ont pas directement leur mot a dire dans la mise au point des politiques scientifiques. Cependant, les cites-regions finlandaises ont indirectement eu une incidence sur les politiques scientifiques nationales, et l'interaction des politiques nationales et locales se sont devoilees sur le temps dans les domaines de l'innovation et de la science. Cet article cherche a fournir une reponse aux questions suivantes: (1) comment la base institutionnelle en faveur de la science et de l'innovation evolue-t-elle en Finlande depuis les 50 dernieres annees, surtout en trois cites-regions finlandaises; (2) qui ont-ete les principaux agents dans l'evolution de la capacite institutionnelle et quelles ont-ete leurs principales strategies; (3) comment les politiques et developpements nationaux et locaux ont-elles evolue simultanement sur le temps? L'article porte notamment sur comment les differentes politiques, a la fois locales et nationales, ont evolue simultanement dans le cadre de la gouvernance a plusieurs niveaux. Politique scientifique Gouvernance Systeme d'innovation Evolution simultanee Amenagement du territoire Politique d'innovation Finlande Sotarauta M. und Kautonen M. (2007) Koevolution der nationalen und lokalen Innovations- und Wissenschaftsarenen in Finnland: Versuch eines dynamischen Verstandnisses der mehrschichtigen Regierungsfuhrung, Regional Studies 41, 1085-1098. In Finnland liegt die Wissenschaftspolitik in den Handen der Zentralregierung; die Regionen und Gemeinden haben keinen direkten Einfluss auf die Ausarbeitung der Wissenschaftspolitiken. Allerdings haben die finnischen Stadtregionen einen indirekten Einfluss auf die nationalen Wissenschaftspolitiken ausgeubt, und die Wechselwirkungen zwischen den nationalen und lokalen Politiken haben sich in den Arenen der Innovation und Wissenschaft entfaltet. In diesem Beitrag werden Antworten zu den folgenden Fragen gesucht: (1) wie hat sich die institutionelle Basis fur Wissenschaft und Innovation in den letzten 50 Jahren in Finnland weiterentwickelt, insbesondere in den drei untersuchten finnischen Stadtregionen, (2) welche Hauptakteure waren an der Evolution der institutionellen Kapazitat beteiligt und welche Hauptstrategien verfolgten sie, und (3) wie haben sich die nationalen und lokalen Politiken und Veranderungen im Laufe der Zeit gemeinsam weiterentwickelt? Ein besonderer Schwerpunkt des Artikels liegt in der Frage, wie sich verschiedene lokale und nationale Politiken im Kontext der mehrschichtigen Regierungsfuhrung gemeinsam weiterentwickelt haben. Wissenschaftspolitik Regierungsfuhrung Innovationssystem Koevolution Regionalentwicklung Innovationspolitik Finnland Sotarauta M. y Kautonen M. (2007) Coevolucion en los campos cientificos y de innovacion nacional y local en Finlandia: Hacia una comprension dinamica de un gobierno multinivel, Regional Studies 41, 1085-1098. En Finlandia la politica cientifica esta en manos del Gobierno central y las regiones o comunidades no tienen ninguna influencia directa en la formulacion de las politicas cientificas. Sin embargo, las ciudades region finlandesas han influido indirectamente en las politicas cientificas nacionales, y con el tiempo la interaccion de las politicas nacionales y locales se ha desarrollado en campos de innovacion y ciencia. La finalidad de este articulo es responder a las siguientes preguntas: (1) como han progresado las bases institucionales para la ciencia y la innovacion en Finlandia en los ultimos 50 anos, especialmente en los ejemplos de las tres ciudades region finlandesas en este estudio; (2) quienes han sido los principales protagonistas en la evolucion de la capacidad institucional y cuales han sido sus estrategias mas importantes; (3) como han progresado las politicas nacionales y locales y los desarrollos con el paso del tiempo? En este articulo prestamos especial atencion a como han avanzado las diferentes politicas locales y nacionales en el contexto de un gobierno multinivel. Politica cientifica Gobernanza Sistema de innovacion Coevolucion Desarrollo regional Politica de innovacion FinlandiaMulti-level governance, Co-evolution, Local innovation policy, National, Innovation system, Finland,

Lupus Impact Tracker Responds to Changes in Low Disease Activity and Remission Outcomes in a Large Spanish Lupus Registry Cohort

International audienc

Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

Background Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Methods This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmb\uf3lica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism\u2013related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. Results Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score\u2013matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P&nbsp;= .15) or pulmonary embolism\u2013related mortality (4.7% vs 7.8%; P&nbsp;= .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P&nbsp;= .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P&nbsp;= 1.00). Conclusions In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulation. Right heart thrombi may not warrant riskier interventions than standard anticoagulation