Characterization of sex, age, and breed for a population of canine leishmaniosis diseased dogs.

Our study of a large canine population investigated whether the development of symptomatic canine leishmaniosis revealed any predilection for sex, age, or breed. Included in the study were 390 leishmaniosis-affected dogs that had been treated at the Hospital Clínic Veterinari attached to the Universitat Autònoma de Barcelona. Of the diseased dogs, 238 were male (61%) and 152 were females (39%), whereas percentages for males and females in the overall reference population of dogs treated at this unit were 53% and 47%, respectively, (P<0.05). Age distribution was bimodal, with the highest prevalence of the disease occurring at 2-4 years of age and a secondary peak occurring at seven years or over. The over represented breeds were the German shepherd (13.6% versus 6.35%, P<0.001), the Rottweiler (13.1% versus 3.0%, P<0.001), and the Boxer (7.9% versus 4.7%, P=0.002), whereas the underrepresented breeds were the Yorkshire terrier (0.5% versus 6.5%, P<0.001), and the Poodle (0.3% versus 3.0%, P<0.001)

Clinical Validation of the Vitro HPV Screening Assay for Its Use in Primary Cervical Cancer Screening

The advances in cervical cancer screening have mostly focused on high-risk human papillomavirus (HR HPV) detection as the primary screening tool in women over 30 years old. Although many new HPV assays have been commercialized during the last few years, only a few of them are validated according to international guidelines. Recently, new approaches for genotype-based risk-stratification and triage of HPV positive women have been developed. In this study, the Vitro HPV Screening assay targeting 14 oncogenic genotypes (HPV16, HPV18, and another 12 HR HPV genotypes) has demonstrated an appropriate clinical performance to be used as primary screening test. Additionally, the 12 HR HPV genotypes have been individually genotyped with a complementary assay performed by reverse dot blot hybridization of the PCR product from the HPV Screening assay. In conclusion, this n ew assay represents a unique integrated solution for cervical cancer screening with the extended HPV genotyping as a clinical tool for risk determination. Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) HPV genotypes, identifying individual HPV16 and HPV18 genotypes, and the HPV-positive samples for the other 12 HR HPV types are subsequently genotyped with the HPV Direct Flow Chip test. Following international guidelines, the aim of this study was to validate the clinical accuracy of the Vitro HPV Screening test on ThinPrep-collected samples for its use as primary cervical cancer screening, using as comparator the validated cobas (R) 4800 HPV test. The non-inferiority analysis showed that the clinical sensitivity and specificity of the Vitro HPV Screening assay for a diagnosis of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were not inferior to those of cobas (R) 4800 HPV (p = 0.0049 and p < 0.001 respectively). The assay has demonstrated a high intra- and inter-laboratory reproducibility, also among the individual genotypes. The Vitro HPV Screening assay is valid for cervical cancer screening and it provides genotyping information on HPV-positive samples without further sample processing in a fully automated workflow

Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands

Objective: National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18-65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors. Methods: Based on the Primary Health Care database, a sample of adult women (aged 18-65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection. Results: 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%-14.5%) and 11.1% (CI 10.3%-11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18-29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts. Conclusions: It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

Introduction Power relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience ‘power’, and how it is discussed and addressed within the context of research partnerships. Methods Five online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the ‘Social Ecology of Power’ framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level. Results A total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and ‘traditional’ research legacies were acknowledged to have generated and maintained power inequities within research partnerships. Conclusions The ‘Social Ecology of Power’ framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes

Prevalencia de genotipos del virus del papiloma humano de alto riesgo no vacunables dentro del programa de Detección Precoz de Cáncer de Cérvix en Cantabria

Estimar la prevalencia de infección por genotipos del virus del papiloma humano(VPH) de alto riesgo no vacunables.Dise˜no: Estudio descriptivo transversal.Emplazamiento: Siete centros de salud de Cantabria seleccionados aleatoriamente.Participantes: Se incluyó a todas las mujeres con una citología vaginal valorable (n = 3.359)entre 2010-2011.Mediciones principales: Se recogieron diagnóstico citológico, resultado de PCR y método anti-conceptivo. Los resultados de las citologías se clasificaron con el sistema Bethesda. Para latipificación de VPH según el riesgo oncogénico se utilizó la clasificación de Mu˜noz et al. Seestimaron proporciones y odds ratio (OR) con sus correspondientes intervalos de confianza al95% (IC95%).Resultados: La prevalencia de infección por VPH fue del 2,71% (IC95%: 2,15-3,27). La prevalen-cia de genotipos de VPH de alto riesgo oncogénico fue del 2,26%; (IC95%: 1,75-2,78). El genotipomás frecuente fue el 16 (28,89%). Más de la mitad de las mujeres fueron positivas para algúngenotipo de alto riesgo no vacunable: 51 (18,89%) o 58 (13,33%) o 68 (12,22%) o 31 (11,11%). Enel 23,33% de las mujeres coexistieron al menos 2 genotipos de alto riesgo no vacunables. Lasmujeres más jóvenes (≤ 30 a˜nos) tuvieron 2 veces más riesgo de infección por cualquier VPH:OR 2,01; (IC95%: 1,02-3,96); y 2 veces más probabilidad de usar anticonceptivos hormonalesfrente al preservativo: OR 2,09; (IC95%: 1,64-2,67).Conclusiones: Atendiendo al alto porcentaje de VPH de alto riesgo oncogénico no vacunable,habría que replantear la estrategia de prevención en la población, que podría tener una falsasensación de protección

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

Efectos de la osteopatía en pacientes con dolor lumbar inespecífico. Estabilometría: Ensayo piloto

El equilibrio postural está sometido a innumerables factores que lo pueden alterar. Estas alteraciones son la causa, en muchas ocasiones, de la aparición de dolor musculo-esquelético e incluso ser el desencadenante de patología cuando los mecanismos compensatorios de este desequilibrio se agotan. Diversos estudios han valorado el desequilibrio postural como una de las causas de dolor lumbar (DL). En concreto, el dolor lumbar inespecífico (DLI). Para ello hemos realizado un ensayo clínico aleatorizado (estudio piloto) donde se han incluido pacientes con y sin DLI. Se han reclutado 42 pacientes, hombres y mujeres con una media de edad de 42 años (±10,11SD). Al grupo experimental se les trató con el abordaje osteopático del Body Adjustment (BA) y al grupo control con un tratamiento de Reeducación Postural Global (RPG) Los resultados muestran una mejora del dolor en ambos grupos, siendo ésta más evidente en el grupo intervención incluso al cabo de un mes post-tratamiento, no obstante la muestra es demasiado pequeña para valorar cambios significativos. La talla muestra diferencias significativas ). La distribución de cargas en el sentido antero-posterior no mostró ninguna diferencia significativa, no obstante sí se detectaron diferencias significativas en el grupo experimental en la distribución de cargas medio-lateral en el análisis inter-sujetos. En cuanto a la asociación de variables no se detectaron diferencias significativas. Podemos concluir que el tratamiento osteopático con BA puede modificar la postura y el dolor en los pacientes con DLI y mantener los resultados a medio plazo

Pragmatic attitude in manual therapy randomized clinical trials. A descriptive study

To investigate the characteristics of the design and report of termed (so-called) pragmatic manual therapy randomized clinical trials