RESUMEN

Australian isolates of Haloquadratum walsbyi, a square-shaped haloarchaeon, often harbor small cryptic plasmids of the pL6-family, approximately 6 kb in size, and five examples have been previously described. These plasmids exhibit a highly conserved gene arrangement and encode replicases similar to those of betapleolipoviruses. To assess their global distribution and recover more examples for analysis, fifteen additional plasmids were reconstructed from the metagenomes of seven hypersaline sites across four countries: Argentina, Australia, Puerto Rico, and Spain. Including the five previously described plasmids, the average plasmid size is 6002 bp, with an average G+C content of 52.5%. The tetramers GGCC and CTAG are either absent or significantly under-represented, except in the two plasmids with the highest %G+C. All plasmids share a similar arrangement of genes organized as outwardly facing replication and ATPase modules, but variations were observed in some core genes, such as F2, and some plasmids had acquired accessory genes. Two plasmids, pCOLO-c1 and pISLA-c6, shared 92.7% nt identity despite originating from Argentina and Spain, respectively. Numerous metagenomic CRISPR spacers matched sequences in the fifteen reconstructed plasmids, indicating frequent invasion of haloarchaea. Spacers could be assigned to haloarchaeal genera by mapping their associated direct repeats (DR), with half of these matching Haloquadratum. Finally, strand-specific metatranscriptome (RNA-seq) data could be used to demonstrate the active transcription of two pL6-family plasmids, including antisense transcripts.

Asunto(s)

Plásmidos , Plásmidos/genética , Filogenia , Halobacteriaceae/genética , Australia , Metagenoma , Argentina , España , Composición de Base/genética , Puerto Rico , Variación Genética

RESUMEN

We demonstrate a transnationally situated dialogue as a method to bring ethnographic and historical research in Brazil, East Africa (Kenya, Tanzania and Uganda), India, Russia and Spain into conversation to show three cancer epistemics sites (research, detection, and care access) where the politics of cancer epistemics are at play. First, in the field of research, we show how certain ways of knowing, and certain questions about and interests in cancer, are privileged over others. Using examples from Spain and East Africa, we highlight how a shift towards microbiological and high-technology research has outpriced many more locally grounded research agendas, ignoring questions of industrial and capital accountability in cancer aetiology. Second, we look at ways of making cancer visible, how knowledge is mobilised in cancer detection and screening, where and for whom. We discuss the increased individualisation of risk which is reframing cancer surveillance and therapeutic agendas. Using examples from India, Spain and Brazil, we demonstrate how the epistemics of cancer detection generate discourses of blame and responsibility at the individual level and accentuate existing inequities whilst simultaneously absorbing patients and their families into complex networks of surveillance. Lastly, we examine how the epistemics of cancer implicate the very possibilities of accessing cancer care, shaping care pathways and possibilities for patients. With ethnographic examples from India, Russia and Brazil, we demonstrate how an orientation towards the individual shifts attention away from the commercialisation of healthcare and dominance of logics of profit in therapeutics. Throughout the paper, we point towards what is holding these cancer discourses together and grapple with how the politics of cancer epistemics are at play across the globe, even if they appear to be taking many different forms. Our approach highlights how practices are mirrored in the framing, implementation, detection and care of cancer with far-reaching effects.

Asunto(s)

Neoplasias , Política , Humanos , España , Federación de Rusia , Brasil , India , África Oriental , Accesibilidad a los Servicios de Salud , Conocimiento

Asunto(s)

Academias e Institutos , Neurología , Pediatría , Neurología/tendencias , Pediatría/tendencias , Humanos , Sociedades Médicas , España , Niño , Estados Unidos

RESUMEN

OBJECTIVE: To investigate factors associated with the prevalence and incidence of gallstone disease (GSD) in women and men of the MAUCO population-based prospective cohort. DESIGN: 8948 MAUCO participants (aged 38-74 years) underwent abdominal ultrasound at baseline (2015-2019); 4385 received follow-up ultrasound at years 2 or 4. Factors associated with prevalent GSD were assessed using Poisson multiple regression and with incident GSD using Cox regression models. RESULTS: GSD prevalence was 40.4% in women (13.1% gallstones, 27.3% cholecystectomies) and 17.1% in men (8.9% gallstones, 8.2% cholecystectomies). In men, GSD prevalence rate ratio (PRR) by age in >64 years was 3.85 (95% CI 3.00 to 4.94), doubling that of women's PRR 1.78 (95% CI 1.57 to 2.01). In women, waist circumference and diabetes were stronger GSD factors; a higher number of children and worse metabolic and socioeconomic conditions were also highlighted. GSD men had higher cardiovascular disease and a family history of GSD and gallbladder cancer. 198 GSD cases developed during follow-up, with incidence increasing by 2% (95% CI 1.005% to 1.03%) per each centimetre above the ideal waist circumference, statistically significant only in women. In men, age was the strongest factor for incidence, followed by a family history of GSD and low high-density lipoprotein increased incidence risk. CONCLUSIONS: GSD burden was high in this population; a third of women had their gallbladder removed, which may pose them at risk of other health problems. Abdominal obesity was the only preventable GSD risk factor, highlighting the need for effective public health policies promoting obesity reduction.

Asunto(s)

Cálculos Biliares , Humanos , Femenino , Persona de Mediana Edad , Masculino , Cálculos Biliares/epidemiología , Estudios Prospectivos , Adulto , Anciano , Incidencia , Prevalencia , Factores de Riesgo , Factores Sexuales , España/epidemiología , Colecistectomía/estadística & datos numéricos , Ultrasonografía

RESUMEN

Ischemic stroke is a major cause of mortality worldwide; however, few studies have been conducted to measure the impact of the distribution of healthcare services on ischemic stroke fatality. This study aimed to explore the relationship between three ischemic stroke outcomes (incidence, mortality, and fatality) and accessibility to hospitals in Spain, considering its economic development. A cross-sectional ecological study was performed using data on hospital admissions and mortality due to ischemic stroke during 2016-2018. Gross geographic product (GGP) per capita was estimated and a healthcare accessibility index was created. A Besag-York-Mollié autoregressive spatial model was used to estimate the magnitude of association between ischemic stroke outcomes and economic development and healthcare accessibility. GGP per capita showed a geographical gradient from southwest to northeast in Spain. Mortality and case-fatality rates due to ischemic stroke were higher in the south of the country in both women and men aged 60+ years. In women and men aged 20-59 years a EUR 1,000 increase in GGP per capita was associated with decreases in mortality of 5% and 4%, respectively. Fatality decreased 3-4% with each EUR 1,000 increase of GGP per capita in both sexes and in the 20-59 and 60+ age groups. Decreased healthcare accessibility was associated with higher fatality in the population aged 60+. Economic development in southwest Spain would not only improve employment opportunities but also reduce ischemic stroke mortality. New health related strategies to improve hospital accessibility should be considered in more sparsely populated regions or those with worse transport and/or healthcare infrastructure.

Asunto(s)

Desarrollo Económico , Accesibilidad a los Servicios de Salud , Accidente Cerebrovascular Isquémico , Análisis Espacial , Humanos , España/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estudios Transversales , Accidente Cerebrovascular Isquémico/mortalidad , Accidente Cerebrovascular Isquémico/epidemiología , Adulto , Adulto Joven , Anciano , Incidencia , Factores Socioeconómicos , Hospitalización/estadística & datos numéricos

RESUMEN

LED spectrophotometry is a robust technique for the indirect characterization of wastewater pollutant load through correlation modeling. To tackle this issue, a dataset with 1300 samples was collected, from both raw and treated wastewater from 45 wastewater treatment plants in Spain and Chile collected over 4 years. The type of regressor, scaling, and dimensionality reduction technique and nature of the data play crucial roles in the performance of the processing pipeline. Eighty-four pipelines were tested through exhaustive experimentation resulting from the combination of 7 regression techniques, 3 scaling methods, and 4 possible dimensional reductions. Those combinations were tested on the prediction of chemical oxygen demand (COD) and total suspended solids (TSS). Each pipeline underwent a tenfold cross-validation on 15 sub-datasets derived from the original dataset, accounting for variations in plants and wastewater types. The results point to the normalization of the data followed by a conversion through the PCA to finally apply a Random Forest Regressor as the combination which stood out These results highlight the importance of modeling strategies in wastewater management using techniques such as LED spectrophotometry.

Asunto(s)

Espectrofotometría , Aguas Residuales , Aguas Residuales/química , España , Eliminación de Residuos Líquidos/métodos , Análisis de la Demanda Biológica de Oxígeno , Chile , Contaminantes Químicos del Agua/análisis

RESUMEN

OBJECTIVES: Bacille Calmette-Guérin (BCG) vaccine has immunomodulatory effects that may provide protection against unrelated infectious diseases. We aimed to determine whether BCG vaccination protects adults against COVID-19. DESIGN: Phase III double-blind randomised controlled trial. SETTING: Healthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom during the COVID-19 pandemic. PARTICIPANTS: 3988 healthcare workers with no prior COVID-19 and no contraindication to BCG. INTERVENTION: Randomised 1:1 using a web-based procedure to receive a single 0.1 mL intradermal dose of BCG-Denmark (BCG group, n = 1999) or saline (placebo group, n = 1989). MAIN OUTCOME MEASURES: Difference in incidence of (i) symptomatic and (ii) severe COVID-19 during the 12 months following randomisation in the modified intention to treat (mITT) population (confirmed SARS-CoV-2 naïve at inclusion). RESULTS: Of the 3988 participants randomised, 3386 had a negative baseline SARS-CoV-2 test and were included in the mITT population. The 12-month adjusted estimated risk of symptomatic COVID-19 was higher in the BCG group (22.6%; 95% confidence interval [CI] 20.6 to 24.5%) compared with the placebo group (19.6%; 95% CI 17.6 to 21.5%); adjusted difference +3.0% points (95% CI 0.2 to 5.8%; p = 0.04). The 12-month adjusted estimated risk of severe COVID-19 (mainly comprising those reporting being unable to work for ≥3 consecutive days) was 11.0% in the BCG group (95% CI 9.5 to 12.4%) compared with 9.6% in the placebo group (95% CI 8.3 to 11.1%); adjusted difference +1.3% points (95% CI -0.7 to 3.3%, p = 0.2). Breakthrough COVID-19 (post COVID-19 vaccination) and asymptomatic SARS-CoV-2 infections were similar in the two groups. There were 18 hospitalisations due to COVID-19 (11 in BCG group, 7 in placebo group; adjusted hazard ratio 1.56, 95% CI 0.60 to 4.02, p = 0.4) and two deaths due to COVID-19, both in the placebo group. CONCLUSIONS: Compared to placebo, vaccination with BCG-Denmark increased the risk of symptomatic COVID-19 over 12 months among healthcare workers and did not decrease the risk of severe COVID-19 or post-vaccination breakthrough COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov NCT04327206.

Asunto(s)

Vacuna BCG , COVID-19 , Personal de Salud , SARS-CoV-2 , Humanos , Vacuna BCG/administración & dosificación , Vacuna BCG/inmunología , COVID-19/prevención & control , COVID-19/epidemiología , Masculino , Femenino , Adulto , Método Doble Ciego , Persona de Mediana Edad , SARS-CoV-2/inmunología , Vacunación , Australia/epidemiología , Brasil/epidemiología , Reino Unido/epidemiología , España/epidemiología

RESUMEN

INTRODUCTION: Parkinson's disease (PD) can affect the intelligibility of speech. Although studies of vowel production are useful for measuring this impairment, they do not exist in Spanish speakers with the disease who have been treated with subthalamic nucleus deep brain stimulation (STN-DBS). STN-DBS is an effective treatment for the classic signs of PD, but with varied effects on speech. PATIENTS AND METHODS: Data from two individuals with PD treated with STN-DBS were studied: one (P1) had impairment and the other (P2) had stable speech intelligibility after STN-DBS implantation. The triangular vowel space area (tVSA) and the vowel articulation index (VAI) were measured and compared before the implantation surgery, and at three, six and nine months after surgery. These measurements were compared with measurements of speech intelligibility (percentage of words correctly identified and degree of intelligibility). RESULTS: Both participants presented variations in measurements of vowel articulation after surgery. In P1, the reduction in the tVSA, but not the post-surgical change in the VAI, was consistent with reduced speech intelligibility. However, in P2, both measurements (tVSA and VAI) reflected stable speech intelligibility after surgery. CONCLUSIONS: Reduced speech intelligibility in Spanish speakers with PD after STN-DBS implantation may be reflected in a reduced tVSA.

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TITLE: Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.Introducción. La enfermedad de Parkinson (EP) puede alterar la inteligibilidad del habla. Aunque los estudios de la producción de las vocales son útiles para medir esta afectación, no existen en hispanohablantes con la enfermedad que hayan sido tratados con estimulación cerebral profunda del núcleo subtalámico (STN-DBS). La STN-DBS es un tratamiento efectivo para los signos clásicos de la EP, pero con variados efectos en el habla. Pacientes y métodos. Se estudiaron los datos de dos personas con EP tratadas con STN-DBS: uno (P1) con deterioro y el otro (P2) con estabilidad de la inteligibilidad del habla después de la implantación de la STN-DBS. Se calcularon y compararon medidas de espacio vocálico acústico triangular (tVSA) e índice de articulación de las vocales (VAI) antes de la cirugía de implantación y a los tres, seis y nueve meses de la intervención. Estas medidas se contrastaron con medidas de inteligibilidad del habla (porcentaje de palabras correctamente identificadas y grado de inteligibilidad). Resultados. Ambos participantes mostraron variación de las medidas de articulación de las vocales después de la cirugía. En P1, la reducción del tVSA, pero no el cambio posquirúrgico del VAI, correspondió con disminución de la inteligibilidad del habla. Por el contrario, en P2, el comportamiento de ambas medidas (tVSA y VAI) reflejó la estabilidad de la inteligibilidad del habla después de la cirugía. Conclusiones. La reducción de la inteligibilidad del habla en hispanohablantes con EP después de la implantación de la STN-DBS puede reflejarse en la reducción del tVSA.

Asunto(s)

Estimulación Encefálica Profunda , Enfermedad de Parkinson , Inteligibilidad del Habla , Núcleo Subtalámico , Humanos , Lenguaje , Enfermedad de Parkinson/terapia , Enfermedad de Parkinson/complicaciones , España

RESUMEN

PURPOSE: This study aimed to investigate the association between social jetlag (SJL) and obesity-related outcomes among adolescents from Valle de Ricote (Region of Murcia, Spain). We explored the relationship between SJL and body mass index (BMI) z-score, waist circumference, and body fat percentage, as well as the odds of having excess weight, obesity, and abdominal obesity in a sample of Spanish adolescents. METHODS: A cross-sectional study was conducted using data from the Eating Healthy and Daily Life Activities (EHDLA) project, which included 847 Spanish adolescents aged 12-17 years. SJL was assessed based on the differences in sleep patterns between weekdays and weekends. Obesity-related indicators such as BMI z-score, waist circumference, body fat percentage, excess weight, obesity, and abdominal obesity were measured. Generalized linear models with a Gaussian or binomial distribution were used to analyze the associations between SJL and obesity-related outcomes, adjusting for potential confounders. RESULTS: The analysis revealed significant associations between SJL and BMI z-score (unstandardized beta coefficient [B] = 0.15, 95% CI: 0.05 to 0.25, p = 0.003), waist circumference (B = 1.03, 95% CI: 0.39 to 1.67, p = 0.002), and body fat percentage (B = 0.83, 95% CI: 0.31 to 1.43, p = 0.008). Additionally, the odds ratios (ORs) for excess weight (OR = 1.35, 95% CI: 1.16 to 1.57; p < 0.001), obesity (OR = 1.59, 95% CI: 1.26 to 2.00; p < 0.001), and abdominal obesity (OR = 1.46, 95% CI: 1.23 to 1.72; p < 0.001) increased significantly with each 60 min increment in SJL. CONCLUSIONS: This study pointed out that the misalignment of sleeping times during weekdays and weekends (SJL) is significantly associated with higher BMI z-scores, waist circumference, body fat percentage, and higher odds of excess weight, obesity, and abdominal obesity among adolescents, being more significant in boys than in girls. These findings highlight the importance of addressing circadian misalignment in the prevention and management of obesity and its related metabolic disorders in this population.

Asunto(s)

Índice de Masa Corporal , Obesidad Infantil , Circunferencia de la Cintura , Humanos , Estudios Transversales , España/epidemiología , Femenino , Masculino , Adolescente , Obesidad Infantil/epidemiología , Niño , Obesidad Abdominal/epidemiología , Sueño/fisiología , Síndrome Jet Lag/epidemiología

RESUMEN

BACKGROUND: Evidence assessing the relationship between chronotype and disordered eating in adolescents is scarce. The current study tried to evaluate the association between chronotype and disordered eating in a sample of Spanish adolescents. METHODS: This secondary cross-sectional study analyzed data from the Eating Healthy and Daily Life Activities (EHDLA) study. The sample consisted of 703 adolescents (56.3% girls) aged between 12 and 17 years from the Valle de Ricote (Region of Murcia, Spain). Chronotype was assessed using the Morningness/Eveningness Scale in Children (MESC). Disordered eating was evaluated by two psychologists using the Sick, Control, One, Fat, and Food (SCOFF) questionnaire. RESULTS: Adolescents with an eveningness chronotype showed a higher SCOFF score (estimated marginal mean [M] = 1.1; 95% confidence interval [CI] 0.7 to 1.5) in comparison with adolescents with a morningness chronotype (M = 0.7; 95% CI 0.5 to 0.8) (p = 0.010), as well as with those with an intermediate chronotype (M = 0.6; 95% CI 0.5 to 0.8) (p = 0.032). A higher predictive probability of having disordered eating was identified in adolescents with an eveningness chronotype (39.5%; 95% CI 22.8% to 59.1%), compared to adolescents with an intermediate chronotype (14.9%; 95% CI 10.8% to 20.1%) (p = 0.008) and with their counterparts with a morningness chronotype (16.9%; 95% CI 11.6% to 24.0%) (p = 0.021). CONCLUSIONS: This study reveals that adolescents with an eveningness chronotype are more likely to exhibit disordered eating behaviors compared to those with morningness or intermediate chronotypes. These findings highlight the importance of considering chronotype in adolescent health, particularly in developing targeted interventions to prevent eating disorders.

Asunto(s)

Ritmo Circadiano , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Adolescente , Femenino , Masculino , Estudios Transversales , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , España/epidemiología , Niño , Ritmo Circadiano/fisiología , Encuestas y Cuestionarios , Conducta Alimentaria/psicología , Conducta del Adolescente , Cronotipo

RESUMEN

Projects and construction management in healthcare facilities are usually assigned to architectural firms and engineering companies with previous experience. However, there is no evaluation system to ensure their level of competence in the healthcare sector. In the past, this was also the case for clinicians when they were self-appointed specialists without any supervision. Currently, the Specialised Health Training (SHT) programme in Spain is the only official specialisation pathway and consists of a period that combines training and paid healthcare practice. Similarly, but from Argentina, hospital residencies in architecture have been carried out for specialised postgraduate training. The aim of this article was to show the experience in Argentina and to propose the extension of the SHT in Spain. Our proposal consists of a programme of residencies in architecture and engineering to be developed in healthcare centres. We believe that this initiative has great potential to address health from its multiple disciplines and to reinforce the maturity of a National Health System in constant change.

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Los proyectos y la dirección de obras en los centros sanitarios se suelen asignar a estudios de arquitectura y empresas de ingeniería con experiencia previa. Sin embargo, no hay un sistema de evaluación que asegure su nivel de competencia en el sector sanitario. Antiguamente, esta situación también se daba en los profesionales clínicos, cuando se autotitulaban especialistas sin ningún tipo de supervisión. En la actualidad, el programa de Formación Sanitaria Especializada (FSE) en España es la única vía de especialización oficial y consiste en un periodo que aúna formación y práctica asistencial remunerada. De manera similar, pero desde Argentina, se llevan realizando unas residencias hospitalarias de arquitectura para la formación especializada de posgrado. El objetivo de este artículo fue mostrar la experiencia en Argentina y proponer la ampliación de la FSE en España. Nuestra propuesta consiste en un programa de residencias en arquitectura e ingeniería a desarrollar en centros sanitarios. Consideramos que esta iniciativa tiene un gran potencial para abordar la salud desde sus múltiples disciplinas y reforzar la madurez de un Sistema Nacional de Salud en constante cambio.

Asunto(s)

Ingeniería , España , Ingeniería/educación , Humanos , Argentina , Especialización

RESUMEN

PURPOSE: This paper aims to examine the association between meal duration and obesity indicators among Spanish adolescents. METHODS: We conducted a cross-sectional analysis using data from the Eating Healthy and Daily Life Activities (EHDLA) project involving 755 adolescents aged 12 to 17 years (54.8% girls) from three secondary schools in the Valle de Ricote Region of Murcia, Spain. To evaluate overall meal duration, participants were asked how long (on average) breakfast, morning snacks, lunch, afternoon snacks, and dinner typically last. Subsequently, global meal duration was measured, and the participants were categorized into tertiles. Obesity-related indicators, including body mass index (BMI) z score, waist circumference (WC), and skinfold thickness, were assessed. The analyses were adjusted for potential confounders such as sex, age, socioeconomic status, physical activity, sedentary behavior, diet quality, and energy intake. RESULTS: Concerning meal duration status, adolescents with long meal durations had the lowest estimated marginal means of BMI z score, WC, and body fat percentage (using the sum of triceps and calf skinfolds). However, significant differences between adolescents with a long meal duration and those with a short meal duration were observed only for BMI z score (p = 0.008), and WC (p = 0.020). Furthermore, significant differences in BMI z score (p = 0.017) between adolescents with a long meal duration and those with a moderate meal duration were identified. CONCLUSIONS: These findings underscore the importance of promoting slower eating habits as part of obesity prevention strategies. Future studies should explore the causality of this association and its potential for behavioral interventions.

Asunto(s)

Índice de Masa Corporal , Conducta Alimentaria , Comidas , Circunferencia de la Cintura , Humanos , Adolescente , Femenino , Masculino , Estudios Transversales , España/epidemiología , Niño , Grosor de los Pliegues Cutáneos , Factores de Tiempo , Obesidad Infantil/epidemiología , Ingestión de Energía

RESUMEN

Connectedness with nature is considered a key element for the future of conservation. There are both internal and external factors that determine the levels of connectedness with nature. Among these factors are gender, age, knowledge about the environment and place of residence. In the latter case, there may be differences in how urban and rural dwellers perceive nature, based on their experiences and contact with it. The main objective of this research is to evaluate and establish the factors that influence and determine the levels of connection with nature, examining how these factors relate and interact with each other, taking the urban and rural context as starting point. The ABC-CNS scale, which addresses the affective, behavioural and cognitive aspects of the connection with nature, was applied via online questionnaire to a sample of university students from two countries, Spain (496 students) and Ecuador (872 students), who were also clustered according to career, age, gender, and place of residence. The results obtained through four General Linear Mixed Models (ABC-CNS and its dimensions as response variables) and LSD test, demonstrated that the ABC-CNS scale presented significant differences for all the variables analyzed (place of residence, gender, age, and career), also demonstrating which levels influence and interact in higher ABC-CNS values. Finally, the study concludes that the analyzed factors contribute to the development of the connection with nature. In the case of place of residence, attention should be given to the specific settings of the environments under study.

Asunto(s)

Población Rural , Población Urbana , Humanos , Masculino , Femenino , Adulto , Encuestas y Cuestionarios , Adulto Joven , Ecuador , España , Adolescente , Naturaleza , Estudiantes/psicología , Conservación de los Recursos Naturales

RESUMEN

The NHEPACHA Iberoamerican Network, founded on the initiative of a group of researchers from Latin American countries and Spain, aims to establish a research framework for Chagas disease that encompasses diagnosis and treatment. For this purpose, the network has created a questionnaire to gather relevant data on epidemiological, clinical, diagnostic, and therapeutic aspects of the disease. This questionnaire was developed based on a consensus of expert members of the network, with the intention of collecting high-quality standardized data, which can be used interchangeably by the different research centers that make up the NHEPACHA network. Furthermore, the network intends to offer a clinical protocol that can be embraced by other researchers, facilitating comparability among published studies, as well as the development of therapeutic response and progression markers.

Asunto(s)

Enfermedad de Chagas , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/tratamiento farmacológico , Humanos , América Latina/epidemiología , Encuestas y Cuestionarios , España/epidemiología , Bases de Datos Factuales , Investigación Biomédica/normas

RESUMEN

Cannabis sativa can be classified in two main types, according to psychotropic cannabinoid ∆9-tetrahydrocannabinol (∆9-THC) content: the drug-type and the fiber-type. According to the European Monitoring Center for Drugs and Drug Addiction, most of the European Union countries consider the possession of cannabis, for personal use, a minor offense with possibility of incarceration. Despite of the model of legal supply (i.e., Spanish cannabis clubs, Netherlands coffee shops) or medical use (i.e., Italy), cannabis remains the most used and trafficked illicit plant in the European Union. Differentiating cannabis crops or tracing the biogeographical origin is crucial for law enforcement purposes. Chloroplast DNA (cpDNA) markers may assist to determine biogeographic origin and to differentiate hemp from marijuana. This research aims: to identify and to evaluate nine C. sativa cpDNA polymorphic SNP sites to differentiate crop type and to provide information about its biogeographical origin. Five SNaPshot™ assays for nine chloroplast markers were developed and conducted in marijuana samples seized in Chile, the USA-Mexico border and Spain, and hemp samples grown in Spain and in Italy. The SNapShot™ assays were tested on 122 cannabis samples, which included 16 blind samples, and were able to differentiate marijuana crop type from hemp crop type in all samples. Using phylogenetic analysis, genetic differences were observed between marijuana and hemp samples. Moreover, principal component analysis (PCA) supported the relationship among hemp samples, as well as for USA-Mexico border, Spanish, and Chilean marijuana samples. Genetic differences between groups based on the biogeographical origin and their crop type were observed. Increasing the number of genetic markers, including the most recently studied ones, and expanding the sample database will provide more accurate information about crop differentiation and biogeographical origin.

Asunto(s)

Cannabis , ADN de Cloroplastos , Polimorfismo de Nucleótido Simple , Cannabis/genética , Marcadores Genéticos , ADN de Cloroplastos/genética , México , Reacción en Cadena de la Polimerasa , Europa (Continente) , Italia , Chile , España

Asunto(s)

Fisiología , Humanos , España , Sociedades Científicas/organización & administración , Animales , Europa (Continente)

RESUMEN

Background: The recent inclusion of polypills-fixed-dose combinations of antihypertensive medicines and a statin with or without aspirin-in the World Health Organization's Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for cardiovascular diseases (CVDs). Although there exists extensive evidence on the effectiveness, safety and acceptability of polypills, there has been no research to date assessing the real-world availability and affordability of polypills globally. Methods: We conducted a cross-sectional survey, based on the WHO/Health Action International methodology, in 13 countries around the world. In the surveyed countries, we first ascertained whether any polypill was authorised for marketing and/or included in EMLs and clinical guidelines. In each country, we collected retail and price data for polypills from at least one public-sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable if the lowest-paid worker spent more than a day's wage to purchase a monthly supply. Results: Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. In the four countries, no surveyed public pharmacies stocked polypills. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Private sector availability was 100% in Argentina and Spain. Most combinations (n = 5) identified were in India. Combinations found in India and Spain were affordable in the local context. A lowest-paid government worker would spend between 0.2 (India) and 2.8 (Mauritius) days' wages to pay the price for one month's supply of the polypills. Polypills were likely to be affordable if they were manufactured in the same country. Conclusion: Low availability and affordability of polypills in the public sector suggest that implementation remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Asunto(s)

Enfermedades Cardiovasculares , Humanos , Estudios Transversales , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/economía , Combinación de Medicamentos , India/epidemiología , Antihipertensivos/economía , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , España/epidemiología , Accesibilidad a los Servicios de Salud , Aspirina/administración & dosificación , Aspirina/economía , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/economía , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Salud Global , Argentina/epidemiología

RESUMEN

Objectives: To determine if there is an association between the neutrophil to lymphocyte ratio (NLR) and prognosis in patients with epithelial ovarian cancer (EOC) diagnosed and treated in a Spanish population. Material and methods: Retrospective cohort of patients with epithelial ovarian cancer who had neutrophil and lymphocyte values in complete blood count before the histopathological diagnosis and survival of at least three months, in an intermediate complexity hospital. Convenience sampling. Measured variables included age, menopausal stage, parity, International Federation of Gynecology and Obstetrics (FIGO) stage, treatment type, residual tumor, lymph node involvement, presence of ascites, cytology, histologic type, differentiation grade, and CA-125 values. Additionally, outcomes, overall survival, disease/progression-free survival were also measured. Bivariate inferential and Cox regression analyses were performed. Results: Out of 78 candidates, 60 women with EOC were included. Of them, 24 (40%) had a low NLR (≤ 2,9) while 36 (60%) had a high NLR (> 2,9). An association was found between high NLR levels and suboptimal cytoreductive surgery. High NLR ratios were associated with lower overall survival (Hazard ratio (HR): 4.1; 95% CI: 1.4-11.8) and lower 5-year disease-free survival (HR: 2.6; 95% CI: 1.2-5.7). Conclusions: A plasma neutrophil to lymphocyte ratio of more than 2.9 was associated with poor prognosis in patients with epithelial ovarian cancer in our setting. There is a need to establish the optimal cut-off point and conduct prospective studies with larger patient numbers in order to support this information.

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Objetivos: evaluar si hay asociación entre los valores del cociente plasmático neutrófilos/ linfocitos (NLR) y el pronóstico en pacientes con cáncer epitelial de ovario (CEO) diagnosticadas y tratadas en una población española. Materiales y métodos: cohorte retrospectiva de pacientes con cáncer epitelial de ovario que tuvieran un recuento de neutrófilos y linfocitos en hemograma previo al diagnóstico histopatológico en un hospital de nivel medio de complejidad y posterior sobrevida de, al menos, 3 meses. Muestreo por conveniencia. Se midieron: edad, estado menopáusico, paridad, estadio Federación International de Ginecología y Obstetricia (FIGO), tipo de tratamiento, tumor residual, afectación ganglionar, presencia de ascitis, citología, tipo histológico, grado de diferenciación y cifras de CA-125; como desenlaces, sobrevida global y sobrevida libre de enfermedad o progresión. Análisis inferencial bivariado y por regresión de Cox. Resultados: de 78 candidatas, ingresaron 60 mujeres con CEO. De ellas, 24 (40%) presentaron un NLR bajo (≤ 2,9) y 36 (60 %) elevado (> 2,9). Se encontró asociación entre los niveles altos de NLR y cirugía citoreductora subóptima. Los niveles altos de NLR se asociaron a menor sobrevida global (Hazard ratio (HR): 4,1; IC 95%: 1,4-11,8) y menor sobrevida libre de enfermedad a los 5 años (HR:2,6; IC 95 %: 1,2-5,7). Conclusiones: un cociente plasmático neutrófilos/linfocitos mayor de 2,9 se asoció a un mal pronóstico en pacientes con cáncer epitelial de ovario en nuestro medio. Se necesita determinar el punto de corte óptimo y realizar estudios prospectivos con mayor número de pacientes que avalen esta información.

Asunto(s)

Carcinoma Epitelial de Ovario , Linfocitos , Neutrófilos , Neoplasias Ováricas , Humanos , Femenino , Estudios Retrospectivos , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/sangre , Neoplasias Ováricas/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Carcinoma Epitelial de Ovario/sangre , Carcinoma Epitelial de Ovario/mortalidad , Carcinoma Epitelial de Ovario/patología , Carcinoma Epitelial de Ovario/cirugía , Pronóstico , Persona de Mediana Edad , Linfocitos/patología , Anciano , Adulto , Estudios de Cohortes , Procedimientos Quirúrgicos de Citorreducción , España/epidemiología , Supervivencia sin Enfermedad , Recuento de Linfocitos , Tasa de Supervivencia , Periodo Preoperatorio , Recuento de Leucocitos

RESUMEN

Introduction. The WPAI-UC/CD-Caregiver questionnaires assess the impact of ulcerative colitis (UC) or Crohn's disease (CD) on parents'/caregivers' work life and daily activities. Our objective was to adapt and validate these questionnaires in the Spanish population. Methods. A translation and back-translation were done. The document was assessed by an expert committee and a pilot group of families of patients with pediatric inflammatory bowel disease (p-IBD). For validation, the parents/caregivers of patients with p-IBD (10-18 years old) were recruited. The expert committee and the pilot group conducted a subjective assessment of the format and time necessary to complete the questionnaires. Cronbach's alpha coefficient was estimated and a factor analysis with varimax rotation was done. Kaiser- Meyer-Olkin (KMO) coefficients and Bartlett's sphericity test were estimated to test the adequacy of the factor analysis. Results. A total of 370 patients (median age: 14.1 years) and 263 parents/caregivers of patients with UC or unclassified IBD and 261 parents/caregivers of patients with CD were included. The KMO coefficients (0.6947 and 0.7179) and Bartlett's sphericity test (p < 0.001) confirmed the adequacy of the factor analysis. The 6 items targeted the same domain. The factor model accounted for 99.99% and 94.68% of variance, and Cronbach's alpha coefficients (0.6581 and 0.6968) showed an adequate consistency. The format and the median time of 2 minutes to complete the questionnaires were considered optimal. Conclusions. The versions of the WPAI-Caregiver questionnaires validated in the Spanish population may be used in families whose children have IBD.

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Introducción. Los cuestionarios WPAI-UC/CD-Caregiver evalúan la repercusión laboral y en actividades cotidianas de los padres/cuidadores de pacientes con colitis ulcerosa (CU) o enfermedad de Crohn (EC). El objetivo fue adaptar y validar estos cuestionarios en la población española. Métodos. Se realizó la traducción y la retrotraducción. El documento fue evaluado por un comité de expertos y por un grupo piloto de familias de pacientes con enfermedad inflamatoria intestinal pediátrica (EII-p). Para la validación, se reclutaron padres/cuidadores de pacientes con EII-p (10-18 años). El comité de expertos y el grupo piloto evaluaron subjetivamente el formato y el tiempo necesario para completar los cuestionarios. Se calculó el coeficiente alfa de Cronbach y se realizó el análisis factorial con rotación Varimax. Se calcularon los coeficientes de Kaiser-Meyer-Olkin (KMO) y la prueba de esfericidad de Bartlett para comprobar la adecuación del análisis factorial. Resultados. Se incluyeron 370 pacientes (mediana 14,1 años), y 263 padres/cuidadores de pacientes con colitis ulcerosa o EII no clasificada y 261 padres/cuidadores de pacientes con enfermedad de Crohn. Los coeficientes KMO (0,6947 y 0,7179) y la prueba de esfericidad de Barttlet (p <0,001) confirmaron la adecuación del análisis factorial. Los 6 ítems se dirigieron a la misma dimensión. El modelo factorial explicó el 99,99 % y el 94,68 % de la varianza, y los alfa de Cronbach (0,6581 y 0,6968) indicaron buena consistencia. El formato y la mediana de 2 minutos para completarlos se consideraron óptimos. Conclusiones. Las versiones validadas en la población española de los cuestionarios WPAI-Caregiver pueden considerarse para su uso en familias con hijos con EII.

Asunto(s)

Cuidadores , Colitis Ulcerosa , Humanos , España , Niño , Cuidadores/psicología , Adolescente , Femenino , Masculino , Enfermedad de Crohn , Eficiencia , Traducciones , Encuestas y Cuestionarios , Enfermedades Inflamatorias del Intestino , Características Culturales , Padres/psicología , Actividades Cotidianas

RESUMEN

Gastric cancer (GC) is the fifth most common cancer worldwide with a varied geographic distribution and an aggressive behavior. In Spain, the incidence is lower and GC represents the tenth most frequent tumor and the seventh cause of cancer mortality. Molecular biology knowledge allowed to better profile patients for a personalized therapeutic approach. In the localized setting, the multidisciplinary team discussion is fundamental for planning the therapeutic approach. Endoscopic resection in very early stage, perioperative chemotherapy in locally advanced tumors, and chemoradiation + surgery + adjuvant immunotherapy for the GEJ are current standards. For the metastatic setting, biomarker profiling including Her2, PD-L1, MSS status is needed. Chemotherapy in combination with checkpoint inhibitors had improved the outcomes for patients with PD-L1 expression. Her2 positive patients should receive antiHer2 therapy added to chemotherapy. We describe the different evidences and recommendations based on the literature.

Asunto(s)

Neoplasias Gástricas , Neoplasias Gástricas/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Humanos , España , Biomarcadores de Tumor/análisis , Oncología Médica/métodos , Oncología Médica/normas , Inmunoterapia/métodos , Receptor ErbB-2/metabolismo , Inhibidores de Puntos de Control Inmunológico/uso terapéutico