Análisis espacial de la mortalidad por enfermedades cardiovasculares en la ciudad de Madrid, España

Fundamentos: Las enfermedades cardiovasculares son la principal causa de muerte en el mundo, aunque su distribución espacial no es homogénea. El objetivo del estudio fue analizar el patrón espacial de la mortalidad por enfermedades cardiovasculares en el área urbana poblada (AUP) del municipio de Madrid así como identificar agregaciones espaciales. Métodos: Se realizó un estudio ecológico, por sección censal, para hombres y mujeres durante 2010. Se calculó la Razón de Mortalidad Estandarizada (RME), Riesgo Relativo Suavizado (RRS) y Probabilidad Posterior (PP) de que el RRS fuera mayor que 1. Para identificar clusters espaciales se utilizó el índice de Moran (I Moran) y el Índice Local de Autocorrelación Espacial (LISA). Los resultados fueron representados cartográficamente. Resultados: En el caso de los hombres se observó una RME mayor de 1,1 especialmente en áreas centrales y en en el grupo de las mujeres ocurrió en la periferia. LA PP de que el RRS fuera mayor que 1 superó el 0,8 en el centro para los hombres y en la periferia en mujeres. El I Moran fue de 0,04 para hombres y de 0,03 para mujeres (p <0,05 en ambos casos). Conclusiones: En el patrón espacial de la mortalidad por enfermedades cardiovasculares en Madrid, se observaron diferencias por sexo. Los mapas de RME, RRS y PP mostraron un patrón más heterogéneo en los hombres mientras que en las mujeres se detectó uno más definido, con un riesgo relativamente mayor en zonas periféricas del AUP. El método LISA mostró agrupaciones espaciales similares a los patrones anteriormente observadosBackground: Cardiovascular disease is the leading cause of death worldwide, but its spatial distribution is not homogeneous. The objective of this study is to analyze the spatial pattern of mortality from these diseases for men and women, in the populated urban area (AUP) of the municipality of Madrid, and to identify spatial aggregations. Methods: An ecological study was carried out by census tract, for men and women in 2010. Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRS) and Posterior Probability (PP) were calculated to consider the spatial pattern of the disease. To identify spatial clusters the Moran index (Moran I) and the Local Index of Spatial Autocorrelation (LISA) were used. The results were mapped. Results: SMR higher than 1.1 was observed mainly in central areas among men and in peripheral areas among women. The PP that RRS was higher than 1 surpassed 0.8 in the center and in the periphery, in both men and women. Moran’s I was 0.04 for men and 0.03 for women (p <0.05 in both cases). Conclusions: Sex differences were observed in the spatial distribution of mortality cases. RME RRS and PP maps showed a heterogeneous pattern in men, whereas in women a clearer pattern was detected, with a relatively higher risk in peripheral areas of the AUP. The LISA method showed similar patterns to those previously observe

Translated and adaptation into Persian of the podiatric health questionnaire (PHQ)

The Podiatric Health Questionnaire (PHQ) is a foot health psicometric tool consisting of six items for measuring foot health status. Currently, PHQ has been adapted into Spanish. Thus, this research focused on develop the Persian translation and adaptation of the PHQ. The translation into Persian and test-retest reliability methods were applied from english version questionnarie. As regards to the total mark for each sub-scale, internal consistency and reliability were determined by the Cronbach α and intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%. High internal consistency was shown for the six sub-scales: a) walk with a Cronbach α of 0.775; b) hygiene and c) nail care with 0.789 and 0.796 respectively; d) foot on pain with 0.779; e) concern domain with 0.788; and f) quality of life with 0.798; and g) visual analogic scale with 0.803. Excellent test-retest reliability (ICC = 0.912 [95% CI = 0.845-0.950]) was shown for the total score. Conclusions: The persian version of the PHQ was shown to be a valid and reliable tool for an acceptable use in the Iran population

Pediatric Chagas disease in the non-endemic area of Madrid: A fifteen-year review (2004-2018)

Background: Chagas disease (CD) has become an emerging global health problem in association with the immigration of individuals from endemic areas (in LatinAmerica) to other countries.Spain is the country in Europe with the highest number of CD cases. Concerning pediatric CD, treatment is not only better tolerated by younger children but also has greater cure possibilities. The aim of this study was to describe clinical and epidemiological aspects of CD in a pediatric population diagnosed of 10 hospitals in the Community of Madrid during the 2004-2018 period, as well as the safety and efficacy of CD treatment on this population. Methodology/principal findings: A multicenter, retrospective, descriptive study was conducted. The studied population included all identified children under the age of 18 with a diagnosis of CD. Diagnosis was performed with a positive parasitological test (with subsequent confirmation) or confirmed persistence of positive serology beyond 9 months, for children younger than one year-old, and with two different positive serological tests, for children older than one. Fifty-one children were included (59% male; 50.9% born in Spain). All mothers were from Latin America. The median age at diagnosis was 0.7 months for those under one year of age, and 11.08 years for those older than one year-old. Only one case presented a symptomatic course (hydrops faetalis, haemodynamic instability at birth, ascites, anaemia). For 94% treatment was completed. Considering patients who received benznidazole (47), AE were recorded in 48,9%. Among the 32 patients older than one year-old treated with benznidazole, 18 (56.25%) had adverse events whereas in the 15 under one year, 5(33,3%) did. Eigtheen (78.2%) of the patients with benznidazole AE were older than one year-old(median age 11.4 years). Of the patients treated with nifurtimox (9), AE were reported in 3 cases (33,3%). Cure was confirmed in 80% of the children under one year-old vs 4.3% in those older (p<0.001). Loss to follow- up occurred in 35.3% of patients. Conclusions/significances: Screening programs of CD since birth allow early diagnosis and treatment, with a significantly higher cure rate in children treated before one year of age, with lower incidence of adverse events. The high proportion of patients lost to follow-up in this vulnerable population is of concern.S

Pedagogía para la práctica educativa del siglo XXI

La obra es coordinada por el doctor René Pedroza Flores, investigador del Instituto de Estudios Sobre la Universidad (iesu), de la uaem; miembro del Sistema Nacional de Investigadores (sni), nivel 2, e integrante regular en la Academia Mexicana de las Ciencias. En este libro participan profesoresinvestigadores miembros expertos en la temática y pertenecientes a nuestra universidad, así como investigadores de importante prestigio internacional en diversas disciplinas. En este sentido, destacan las investigaciones de los españoles Clara Ventura Obrador, Gloria Alguacil Buchna y el colombiano Carlos Alberto Jiménez Vélez; además de la colaboración de la antropóloga francesa Noemí Paymal. Asimismo, son relevantes las contribuciones de los investigadores mexicanos Salvador Soriano y Mónica E. Soriano. Las propuestas incluidas en Pedagogía para la práctica educativa del siglo xxi están encaminadas a conformar mejores sociedades en nuestra era, considerando que la comprensión de estas posturas y su aplicación en diversos contextos específicos representará una posibilidad para edificar sociedades mucho más justas, equitativas y humanas; sobre todo en ámbitos profesionales y universitarios urgentes de subsanar problemáticas en los procesos mundiales educativos de hoy.Pedagogía para la práctica educativa del siglo xxi es una obra que muestra cómo la dinámica de la sociedad actual lleva a concebir la educación de una forma diferente de la visión prevaleciente en la actualidad, la cual reconoce en las competencias y las habilidades el único medio para lograr en los individuos su desarrollo e inserción social. El presente libro otorga al lector un panorama epistemológico, metodológico y teórico del nacimiento de un nuevo paradigma pedagógico, al considerar que una pedagogía humana implica la enseñanza integral y holística posible, mediante el uso de diversos recursos de enseñanza-aprendizaje acordes con la formación de las sociedades de nuestro siglo.UAE

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019

Altres ajuts: Departament de Salut. Generalitat de Catalunya ("Pla estratègic de recerca i innovació en salut (PERIS) 2019-2021"); Ministerio de Asuntos Económicos y Transformación Digital; Red Española de Investigación en Patología Infecciosa (REIPI).Background: Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim: To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods: A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000patientdays. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000patientdays and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results: During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate:0.20episodes/1,000patientdays). Patients' median age was 64.1years; 36.6% (3,403/9,290) were female. In total, 73.7% (n=6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n=5,822) were related to central venous catheter (CVC), 24.1% (n=2,236) to peripheral venous catheters (PVC) and 13.3% (n=1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR:0.94;95%CI:0.93-0.96), especially in the ICU (IRR:0.88;95%CI:0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR:0.88;95%CI:0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC:1.08;95%CI:1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions: Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

A reference time scale for Site U1385 (Shackleton Site) on the SW Iberian Margin

We produced a composite depth scale and chronology for Site U1385 on the SW Iberian Margin. Using log(Ca/Ti) measured by core scanning XRF at 1-cm resolution in all holes, a composite section was constructed to 166.5 meters composite depth (mcd) that corrects for stretching and squeezing in each core. Oxygen isotopes of benthic foraminifera were correlated to a stacked δ^18O reference signal (LR04) to produce an oxygen isotope stratigraphy and age model. Variations in sediment color contain very strong precession signals at Site U1385, and the amplitude modulation of these cycles provides a powerful tool for developing an orbitally-tuned age model. We tuned the U1385 record by correlating peaks in L* to the local summer insolation maxima at 37^oN. The benthic δ^18O record of Site U1385, when placed on the tuned age model, generally agrees with other time scales within their respective chronologic uncertainties. The age model is transferred to down-core data to produce a continuous time series of log(Ca/Ti) that reflect relative changes of biogenic carbonate and detrital sediment. Biogenic carbonate increases during interglacial and interstadial climate states and decreases during glacial and stadial periods. Much of the variance in the log(Ca/Ti) is explained by a linear combination of orbital frequencies (precession, tilt and eccentricity), whereas the residual signal reflects suborbital climate variability. The strong correlation between suborbital log(Ca/Ti) variability and Greenland temperature over the last glacial cycle at Site U1385 suggests that this signal can be used as a proxy for millennial-scale climate variability over the past 1.5 Ma. Millennial climate variability, as expressed by log(Ca/Ti) at Site U1385, was a persistent feature of glacial climates over the past 1.5 Ma, including glacial periods of the early Pleistocene (‘41-kyr world’) when boundary conditions differed significantly from those of the late Pleistocene (‘100-kyr world’). Suborbital variability was suppressed during interglacial stages and enhanced during glacial periods, especially when benthic δ^18O surpassed ~ 3.3-3.5‰. Each glacial inception was marked by appearance of strong millennial variability and each deglaciation was preceded by a terminal stadial event. Suborbital variability may be a symptomatic feature of glacial climate or, alternatively, may play a more active role in the inception and/or termination of glacial cycles.This research was supported by the Natural Environmental Research Council Grant NE/K005804/1 to DH and LS and NE/J017922/1 to DH.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.gloplacha.2015.07.00

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

A reference time scale for Site U1385 (Shackleton Site) on the SW Iberian Margin

Variations in sediment color contain very strong precession signals at Site U1385, and the amplitude modulation of these cycles provides a powerful tool for developing an orbitally-tuned age model. We tuned the U1385 record by correlating peaks in L* to the local summer insolation maxima at 37°N. The benthic δ18O record of Site U1385, when placed on the tuned age model, generally agrees with other time scales within their respective chronologic uncertainties. The age model is transferred to down-core data to produce a continuous time series of log(Ca/Ti) that reflect relative changes of biogenic carbonate and detrital sediment. Biogenic carbonate increases during interglacial and interstadial climate states and decreases during glacial and stadial periods. Much of the variance in the log(Ca/Ti) is explained by a linear combination of orbital frequencies (precession, tilt and eccentricity), whereas the residual signal reflects suborbital climate variability. The strong correlation between suborbital log(Ca/Ti) variability and Greenland temperature over the last glacial cycle at Site U1385 suggests that this signal can be used as a proxy for millennial-scale climate variability over the past 1.5 Ma. Millennial climate variability, as expressed by log(Ca/Ti) at Site U1385, was a persistent feature of glacial climates over the past 1.5 Ma, including glacial periods of the early Pleistocene (‘41-kyr world’) when boundary conditions differed significantly from those of the late Pleistocene (‘100-kyr world’). Suborbital variability was suppressed during interglacial stages and enhanced during glacial periods, especially when benthic δ18O surpassed ~ 3.3–3.5‰. Each glacial inception was marked by appearance of strong millennial variability and each deglaciation was preceded by a terminal stadial event. Suborbital variability may be a symptomatic feature of glacial climate or, alternatively, may play a more active role in the inception and/or termination of glacial cycles

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio