Fish- and Shellmiddens from Galicia (Northwest Spain): Reflections upon a Neglected Coastal Cultural Heritage from the Iberian Peninsula

[EN] The physiographical features of the Galician sea, in particular its temperature, marine currents and plankton richness, have turned its waters into one of the most biologically diversified marine regions of the planet. The 1500 km of shorelines from this Northwest Iberian region are dotted with rías (Galician fjords) where settlements devoted to fishing and trade have existed since prehistoric times. These activities left abundant testimonies in terms of archaeological deposits. In recent decades, urban/industrial development, as well as a number of natural agents (e.g., storms, sea level rise, climate change), is rapidly erasing the evidences of this rich cultural heritage. Loss of fish and shellmiddens in particular will hamper our ability to infer traditional lifeways, doing away with evidence that is crucial to monitoring past climatic changes and to inferring those biological conditions under which marine species and coastal populations thrived in the past. This paper surveys some issues dealing with the coastal bio-archaeological heritage of Galicia, and the risks these deposits face. It concludes with a proposal to save this increasingly threatened marine heritage.S

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Nivel de autocuidado de las personas con diagnostico clínico de insuficiencia cardiaca

Objective. To know the level of self-care for people diagnosed with heart failure in Barañain, (Navarra). Material and methods. A literature review by searching between January and March 2014 in the databases Medline, ProQuest Health & Medical Complete, PsycINFO, PudMed and Cuiden. Time limit of 15 years. Results. Transversal descriptive observatio-nal study that measured the level of self-care in 131 people diagnosed with heart failure, using the European Self-Care Scale (European Heart Failure Self-Care Behavior Scale). We analyzed the relationship between self-care and clinical and demographic characteristics self-care is connected to an improvement in the results in both mortality rates, and the quality of life of patients suffering from chronic cardiac insufficiency or heart failure. Conclusions. The average level of self-care is poor. We found a right following the instructions received, but a low level of recognition of symptoms of clinical decompensation or managing themObjetivo. Conocer el nivel de autocuidado de las personas diagnosticadas de insuficiencia cardiaca en Barañain (Nava-rra). Material y métodos. Estudio observacional descriptivo transversal que midió el nivel de autocuidado en 131 perso-nas diagnosticadas de insuficiencia cardiaca, utilizando la Escala Europea de Autocuidado, (European Heart Failure Self-Care Behavior Escale). Analizamos la relación entre autocuidado y características clínicas y demográficas. Resultados.La puntuación media de autocuidado fue 29,41 (DE 8,4). Con puntuaciones que indicaban autocuidado correcto para la adherencia al tratamiento farmacológico (media 1,13) y vacunación antigripal (1,86); mejorable para dieta sin sal (2,15), y autocuidado deficiente para monitorización de peso (3,56), consulta por aumento de disnea (2,43) o aumen-to de peso (3,35) y realización regular de ejercicio físico (2,85). Encontramos relación estadísticamente significativa entre la edad avanzada y mejor nivel de autocuidado. Los hombres obtuvieron mejores puntuaciones que las mujeres y las personas dependientes mejores que las independientes, sin significación estadística. No hallamos relación entre el autocuidado y el resto de variables estudiadas. Conclusiones. El nivel medio de autocuidado es deficiente. Encontramos un seguimiento correcto de las indicaciones recibidas, pero un bajo nivel de reconocimiento de síntomas de descompen-sación clínica o manejo de los mismos

Down syndrome as risk factor for respiratory syncytial virus hospitalization : A prospective multicenter epidemiological study

Respiratory syncytial virus (RSV) infection in childhood, particularly in premature infants, is associated with significant morbidity and mortality. To compare the hospitalization rates due to RSV infection and severity of disease between infants with and without Down syndrome (DS) born at term and without other associated risk factors for severe RSV infection. In a prospective multicentre epidemiological study, 93 infants were included in the DS cohort and 68 matched by sex and data of birth (±1 week) and were followed up to 1 year of age and during a complete RSV season. The hospitalization rate for all acute respiratory infection was significantly higher in the DS cohort than in the non-DS cohort (44.1% vs 7.7%, P<.0001). Hospitalizations due to RSV were significantly more frequent in the DH cohort than in the non-DS cohort (9.7% vs 1.5%, P=.03). RSV prophylaxis was recorded in 33 (35.5%) infants with DS. The rate of hospitalization according to presence or absence of RSV immunoprophylaxis was 3.0% vs 15%, respectively. Infants with DS showed a higher rate of hospitalization due to acute lower respiratory tract infection and RSV infection compared to non-DS infants. Including DS infants in recommendations for immunoprophylaxis of RSV disease should be considered

Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure.

Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p  Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect

A cluster-randomised clinical trial comparing two cardiovascular health education strategies in a child population: the Savinghearts project

<p>Abstract</p> <p>Background</p> <p>This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7–8 years.</p> <p>Methods/design</p> <p>This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7–8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions<it>.</it> The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a β of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis.</p> <p>Discussion</p> <p>The intervention providing the best results could be recommended as part of health education for young schoolchildren.</p> <p>Trial registration</p> <p>Clinicaltrials.gov: NCT01418872</p

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients