Stress, Coping, and Resilience Before and After COVID-19: A Predictive Model Based on Artificial Intelligence in the University Environment

The COVID-19 global health emergency has greatly impacted the educational field. Faced with unprecedented stress situations, professors, students, and families have employed various coping and resilience strategies throughout the confinement period. High and persistent stress levels are associated with other pathologies; hence, their detection and prevention are needed. Consequently, this study aimed to design a predictive model of stress in the educational field based on artificial intelligence that included certain sociodemographic variables, coping strategies, and resilience capacity, and to study the relationship between them. The non-probabilistic snowball sampling method was used, involving 337 people (73% women) from the university education community in south-eastern Spain. The Perceived Stress Scale, Stress Management Questionnaire, and Brief Resilience Scale were administered. The Statistical Package for the Social Sciences (version 24) was used to design the architecture of artificial neural networks. The results found that stress levels could be predicted by the synaptic weights of coping strategies and timing of the epidemic (before and after the implementation of isolation measures), with a predictive capacity of over 80% found in the neural network model. Additionally, direct and significant associations were identified between the use of certain coping strategies, stress levels, and resilience. The conclusions of this research are essential for effective stress detection, and therefore, early intervention in the field of educational psychology, by discussing the influence of resilience or lack thereof on the prediction of stress levels. Identifying the variables that maintain a greater predictive power in stress levels is an effective strategy to design more adjusted prevention programs and to anticipate the needs of the community

A case-control study of the effects of chronic low back pain in spatiotemporal gait parameters

Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. Method: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. Results: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). Conclusions: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary

Predicción de la resiliencia docente mediante redes neuronales arti-ficiales: influencia del burnout y del estrés por COVID-19

Antecedentes: La resiliencia en el profesorado permite afrontar situaciones difíciles y reponerse a la adversidad existiendo diferencias de género al respecto. Asimismo, la inteligencia artificial y las técnicas asociadas a ella han resultado ser de gran utilidad para predecir variables educativas y estudiar la interconexión entre ellas tras la COVID-19. Dicho esto, el objetivo general de esta investigación fue predecir los niveles de resiliencia en las profesoras y profesores de Secundaria a través del diseño de una red neuronal artificial (RNA). Método: Se administró la Escala Breve de Afrontamiento Resiliente, el Inventario de Burnout de Maslach y el Cuestionario de Estrés frente a la COVID-19 a 401 docentes de secundaria (70.6% mujeres) de centros educativos del sureste español, con una edad media de 44.36 años (DT= 9.38). Resultados: Se hallaron diferencias en la configuración de los modelos predictivos de la resiliencia entre profesoras y profesores contribuyendo las variables independientes en diferente grado en función del género. Conclusiones: Se pone de manifiesto la utilidad de las RNA en el ámbito educativo y la necesidad de diseñar programas más ajustados.Background: Resilience in teachers allows them to face difficult situations to recover from adversity and there are gender differences. Likewise, artificial intelligence and the techniques associated with it have proven to be very useful in predicting educational variables and studying the interconnection between them after COVID-19. That said, the general objective of this research was to predict the levels of resilience in secondary school teachers through the design of an artificial neural network (ANN). Method: The Brief Resilient Coping Scale, the Maslach Burnout Inventory and the COVID-19 Stress Questionnaire were administered to 401 secondary school teachers (70.6% female) from schools in southeastern Spain, with a mean age of 44.36 years (SD = 9.38). Results: Differences were found in the configuration of the predictive models of resilience between male and female teachers, with the independent variables contributing to different degrees depending on gender. Conclusions: It is highlighted the usefulness of ANNs in the educational setting and the need to design more adjusted programs

Associations of accumulated persistent organic pollutants in breast adipose tissue with the evolution of breast cancer after surgery

Dr. JP Arrebola is under contract within the Ramón y Cajal Program (RYC-2016-20155, Ministerio de Economía, Industria y Competitividad, Spain). This study was supported by research grants from Instituto de Salud Carlos III, Junta de Andalucía and European Regional Development Fund – FEDER (PI-0513/2012, PI16/01858, PI18/01573, PI20/01568).Chronic exposure to persistent organic pollutants (POPs) is suspected to contribute to the onset of breast cancer, but the impact on the evolution of patients after diagnosis is unclear. We aimed to analyze the contribution of long-term exposure to five POPs to overall mortality, cancer recurrence, metastasis, and development of second primary tumors over a global follow-up of 10 years after surgery in breast cancer patients in a cohort study. Between 2012 and 2014, a total of 112 newly diagnosed breast cancer patients were recruited from a public hospital in Granada, Southern Spain. Historical exposure to POPs was estimated by analyzing their concentrations in breast adipose tissue samples. Sociodemographic data were collected through face-to-face interviews, while data on evolution tumor were retrieved from clinical records. Statistical analyses were performed using Cox regression (overall survival, breast cancer recurrence or metastasis) and binary logistic regression models (joint outcome variable). We also tested for statistical interactions of POPs with age, residence, and prognostic markers. The third vs first tertile of hexachlorobenzene concentrations was associated with a lower risk of all-cause mortality (Hazard Ratio, HR = 0.26; 95 % Confidence Interval, CI = 0.07-0.92) and of the appearance of any of the four events (Odds Ratio = 0.37; 95 % CI = 0.14-1.03). Polychlorinated biphenyl 138 concentrations were significantly and inversely associated with risk of metastasis (HR = 0.65; 95 % CI = 0.44-0.97) and tumor recurrence (HR = 0.69; 95 % CI = 0.49-0.98). Additionally, p,p & PRIME;dichlorodiphenyldichloroethylene showed inverse associations with risk of metastasis in women with ER-positive tumors (HR = 0.49; 95 % CI = 0.25-0.93) and in those with a tumor size <2.0 cm (HR = 0.39; 95 % CI = 0.18-0.87).Ministerio de Economía, Industria y Competitividad, Spain RYC-2016-20155Instituto de Salud Carlos IIIJunta de AndalucíaEuropean Regional Development Fund – FEDER (PI-0513/2012, PI16/01858, PI18/01573, PI20/01568)University of Granada / CBU

Psychological Impact of COVID-19 in the Setting of Dentistry: A Review Article

The worldwide pandemic has exposed healthcare professionals to a high risk of infection, exacerbating the situation of uncertainty caused by COVID-19. The objective of this review was to evaluate the psychological impact of the COVID-19 pandemic on dental professionals and their patients. A literature review was conducted using Medline-Pubmed, Web of Science, and Scopus databases, excluding systematic reviews, narratives, meta-analyses, case reports, book chapters, short communications, and congress papers. A modified version of the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected studies. The search retrieved 3879 articles, and 123 of these were selected for the review (7 longitudinal and 116 cross-sectional studies). Elevated anxiety levels were observed in dental professionals, especially in younger and female professionals. Except for orthodontic treatments, patients reported a high level of fear that reduced their demand for dentist treatment to emergency cases alone. The results suggest that the COVID-19 pandemic has had psychological and emotional consequences for dental professionals and their patients. Further research is necessary to evaluate the persistence of this problem over time.Universidad de Granada, Plan Propio de Investigacion PPJIA2021-3

Aquaporin-11 Contributes to TGF-β1-Induced Endoplasmic Reticulum Stress in Human Visceral Adipocytes: Role in Obesity-Associated Inflammation

Aquaporin-11 (AQP11) is expressed in human adipocytes, but its functional role remains unknown. Since AQP11 is an endoplasmic reticulum (ER)-resident protein that transports water, glycerol, and hydrogen peroxide (H2O2), we hypothesized that this superaquaporin is involved in ER stress induced by lipotoxicity and inflammation in human obesity. AQP11 expression was assessed in 67 paired visceral and subcutaneous adipose tissue samples obtained from patients with morbid obesity and normal-weight individuals. We found that obesity and obesity-associated type 2 diabetes increased (p < 0.05) AQP11 mRNA and protein in visceral adipose tissue, but not subcutaneous fat. Accordingly, AQP11 mRNA was upregulated (p < 0.05) during adipocyte differentiation and lipolysis, two biological processes altered in the obese state. Subcellular fractionation and confocal microscopy studies confirmed its presence in the ER plasma membrane of visceral adipocytes. Proinflammatory factors TNF-α, and particularly TGF-β1, downregulated (p < 0.05) AQP11 mRNA and protein expression and reinforced its subcellular distribution surrounding lipid droplets. Importantly, the AQP11 gene knockdown increased (p < 0.05) basal and TGF-β1-induced expression of the ER markers ATF4 and CHOP. Together, the downregulation of AQP11 aggravates TGF-β1-induced ER stress in visceral adipocytes. Owing to its “peroxiporin” properties, AQP11 overexpression in visceral fat might constitute a compensatory mechanism to alleviate ER stress in obesity

Factors associated with the development of second primary tumours in head and neck cancer patients

ACKNOWLEDGEMENTS Funding for open access charge: Universidad de Granada/CBUA. Study concepts: RBR. Study design: RBR, ISB, PR. Acquisition of data: RM, COR, ROR, MLL. Data analysis and interpretation: RBR, ISB, PR y JPA. Manuscript preparation: ISB, PR, RBR. Manuscript review: ISB, PR, RM, COR, ROR, MLL, JPA, RBR. Manuscript final approval: ISB, PR, RM, COR, ROR, MLL, JPA, RBR. Being accountable for all aspects of the work: ISB, PR, RM, COR, ROR, MLL, JPA, RBR.Introduction: The development of second primary tumours (SPTs) is one of the main causes of low survival in patients with head and neck cancer (HNC). The aim of this study was to review the evidence about factors associated with developing SPTs in patients with HNC. Methods: An updated systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and the search was performed in Pubmed and Scopus. Only original articles with a cohort or case-control design were included. Article quality was assessed with the Newcastle-Ottawa scale. Results: Thirty-six and two case-control studies were included, with quality medium (n = 5) to high (n = 33). Tobacco showed a significant association with SPT development, with risks ranging from 1.41 (95%CI: 1.04-1.91) to 5.52 (95%CI: 2.91-10.49). Regarding alcohol, risks ranged from 1.46 (95%CI: 1.12-1.91) to 21.3 (95%CI: 2.9-156). Location of the index tumour in the hypopharynx/oropharynx, absence of human papillomavirus and presence of a premalignant lesion also increased the risk of SPTs. More controversy was found for sex, age and other clinical factors of the tumour. Conclusion: Toxic lifestyle habits and clinical factors were associated with the risk of SPTs in HNC patients. These findings may improve individualised prevention strategies in its follow-up.Spanish Ministry of Science, Innovation and Universities through the grant ‘Ramon y Cajal’Universidad de Granada/CBUA (Funding for open access charge

Associations of circulating levels of phthalate metabolites with cytokines and acute phase reactants in a Spanish human cohort

Supplementary data to this article can be found online at https://doi.org/10.1016/j.envres.2022.114470The associations between human phthalate exposure and the onset of chronic diseases with an immunological component (e.g., metabolic syndrome, cancer) remain unclear, partly due to the uncertainties in the underlying mechanisms. This study investigates cross-sectional associations of the concentrations of 10 phthalate metabolites with 19 cytokines and acute phase proteins in 213 serum samples of Spanish adults. The associations were explored by Spearman's correlation, multivariable linear regression, and weighted quantile sum regression analyses. In the multivariable analyses, levels of plasminogen activator inhibitor (PAI)-1 were positively associated with mono-n-butyl phthalate (fold-change per one IQR increase in phthalate levels, 95% Confidence Interval: 1.65, 1.45–1.88) and mono-iso-butyl phthalate (3.07, 2.39–3.95), mono-ethyl phthalate (2.05, 1.62–2.61), as well as categorized mono-iso-decyl and mono-benzyl phthalates. The same phthalates also were significantly associated with leptin, interleukin (IL)-18 and monocyte chemoattractant protein-1. Moreover, the proinflammatory markers IL-1β, IL-17, IL-8, IL-6, IL-12, tumor necrosis factor, and lipopolysaccharide-binding protein showed positive and negative associations with, respectively, mono-(2-ethyl-hexyl) and mono-methyl phthalates. Finally, phthalate mixtures were positively associated with PAI-1, leptin, IL-18, IL-12, IL-8 and IL-1β. Despite the cross-sectional design limitation, these associations point to relevant subclinical immuno-inflammatory actions of these pollutants, warranting confirmation in future studies.Instituto de Salud Carlos III, Spain (grant numbers PI16/01858, PI18/01573, PI20/01568)European Union (ERDF), “A way to make EuropeRamón y Cajal Program (RYC- 2016-20155, Ministerio de Economía, Industria y Competitividad, Spain),PFIS (FI17/ 00310, Pre-doctoral Health Research Training Contracts, Instituto de Salud Carlos III, Spain)PFIS (FI21/00269, Pre-doctoral Health Research Training Contracts, Instituto de Salud Carlos III, Spain

Actividad docente de gamificación para estudio epidemiológico de un brote de COVID-19

La aplicación práctica de la epidemiología en el estudio de brotes epidémicos puede resultar ardua para el estudiantado. El uso de metodologías innovadoras podría facilitar la comprensión de la materia y ayudar a visualizar su utilidad e importancia. Por ese motivo, se ha diseñado una actividad docente en modo de juego que simula un brote de COVID-19, y que pretende ayudar a los alumnos en su aprendizaje de conceptos relacionados con la epidemiología de enfermedades transmisibles.Plan FIDO - Universidad de Granada. Proyecto de innovación docente 20-13

Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

We thank Pablo Lardelli Claret for his helpful advice in statistical methods. We also acknowledge the staff of Hospital Universitario Virgen de las Nieves who took (and are taking) care of the COVID-19 patients.Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23–5.64), age (HR 1.05; 95% CI 1.02–1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00–1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p 0.013), troponin I (p 0.013), C-reactive protein (p 0.013), neutrophils (p 0.024), and fewer platelets (p 0.013) and lymphocytes (p 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters