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The third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target

Background: A clinical trial was conducted to measure the effectiveness of a combined wavelength of 660 nm and 808 nm Low-Level Laser Therapy (LLLT) in reducing postoperative pain in partially and totally edentulous patients who underwent dental implant surgery. Materials and Methods: The study included 20 blinded individuals divided in a randomized split-mouth fashion; the experimental group in one hemiarch and the control group in the other hemiarch. The experimental group received a total of 22.5 Joules (J) of LLLT divided into 5 points per implant immediately after surgery. The control group received a placebo treatment. At 24 h, 72 h, and 7 days, a blinded surveyor administered a pain questionnaire using a Numerical Rating Scale (NRS) combined with a Verbal Rating Scale (VRS) to assess pain onset after surgery, duration of the first pain episode, and pain evolution. Group data were analyzed with an ANOVA test for repeated measures and a paired t-test at defined time intervals. Results: The experimental group showed a significant decrease in postoperative pain at 24 h and at 72 h for fully edentulous patients. There was a non-significant difference in the duration of the first pain episode. The mean pain levels decreased over time for both the experimental and control treatments, but only statistically significantly for the experimental group in the 24–72 h and 24 h to 7 days intervals. The same was true for the control group when comparing 24 and 72 h and between 24 h and 1 week. The time range between 72 h and 1 week showed no statistically significant differences. Conclusion: Within the limitations of this study, a single dose of 22.5 J LLLT per implant helps to decrease postoperative pain in dental implant surgery at 24 h for partially edentulous patients and at 24 and 72 h for fully edentulous patients.

Background Knowledge of local contextual sex differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex differences in the profile of patients with acute stroke and their associations with in‐hospital death in the national hospital database of Chile. Methods and Results We present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis‐Related Groups, which represents 70% of the operational expenditure of the public health system. Random‐effects multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis International Classification of Diseases, Tenth Revision [ICD‐10] codes) and in‐hospital death, and reported with odds ratios (ORs) and 95% CIs. Of 1 048 575 hospital discharges, 15 535 were for patients with acute stroke (7074 [45.5%] in women), and 2438 (15.6%) of them died during hospitalization. Differences by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. After fully adjusted model, women with ischemic stroke had lower in‐hospital death (OR, 0.79 [95% CI, 0.69–0.91]) compared with men; other independent predictors included age per year increase (OR, 1.03 [95% CI, 1.03–1.04]), chronic kidney disease (OR, 1.47 [95% CI, 1.20–1.80]), atrial fibrillation (OR, 1.50 [95% CI, 1.26–1.80]), and other risk factors. Conversely, for intracerebral hemorrhage, women had a higher in‐hospital mortality rate than men (OR, 1.19 [95% CI, 1.02–1.40]); other independent predictors included age per year increase (OR, 1.009 [95% CI, 1.003–1.01]), chronic kidney disease (OR, 1.55 [95% CI, 1.23–1.97]), oral anticoagulant use (OR, 1.88 [95% CI, 1.37–2.58]), and other risk factors. Conclusions Sex differences in characteristics and in‐hospital death of hospitalized patients exist for acute stroke in Chile. In‐hospital death is higher for acute ischemic stroke in men and higher for intracerebral hemorrhage in women. Future research is needed to better identify contributing factors.

Abstract Background The ageing population has increased the prevalence of disabling and high-cost diseases, such as dementia and mild cognitive impairment (MCI). The latter can be considered a prodromal phase of some dementias and a critical stage for interventions to postpone the impairment of functionality. Working memory (WM) is a pivotal cognitive function, representing the fundamental element of executive functions. This project proposes an intervention protocol to enhance WM in these users, combining cognitive training with transcranial electrical stimulation of alternating current (tACS). This technique has been suggested to enhance the neuronal plasticity needed for cognitive processes involving oscillatory patterns. WM stands to benefit significantly from this approach, given its well-defined electrophysiological oscillations. Therefore, tACS could potentially boost WM in patients with neurodegenerative diseases. Methods This study is a phase IIb randomised, double-blind clinical trial with a 3-month follow-up period. The study participants will be 62 participants diagnosed with MCI, aged over 60, from Valparaíso, Chile. Participants will receive an intervention combining twelve cognitive training sessions with tACS. Participants will receive either tACS or placebo stimulation in eight out of twelve training sessions. Sessions will occur twice weekly over 6 weeks. The primary outcomes will be electroencephalographic measurements through the prefrontal theta oscillatory activity, while the secondary effects will be cognitive assessments of WM. The participants will be evaluated before, immediately after, and 3 months after the end of the intervention. Discussion The outcomes of this trial will add empirical evidence about the benefits and feasibility of an intervention that combines cognitive training with non-invasive brain stimulation. The objective is to contribute tools for optimal cognitive treatment in patients with MCI. To enhance WM capacity, postpone the impairment of functionality, and obtain a better quality of life. Trial registration ClinicalTrials.gov NCT05291208. Registered on 28 February 2022. ISRCTN87597719 retrospectively registered on 15 September 2023.

IntroductionThe presence of multiple chronic conditions, also referred to as multimorbidity, is a common finding in adults. Epidemiologic research can help identify groups of individuals with similar clinical profiles who could benefit from similar interventions. Many cross-sectional studies have revealed the existence of different multimorbidity patterns. Most of these studies were focused on the older population. However, multimorbidity patterns begin to form at a young age and can evolve over time following distinct multimorbidity trajectories with different impact on health. In this study, we aimed to identify multimorbidity patterns and trajectories in adults 18–65 years old.MethodsWe conducted a retrospective longitudinal epidemiologic study in the EpiChron Cohort, which includes all inhabitants of Aragón (Spain) registered as users of the Spanish National Health System, linking, at the patient level, information from electronic health records from both primary and specialised care. We included all 293,923 patients 18–65 years old with multimorbidity in 2011. We used cluster analysis at baseline (2011) and in 2015 and 2019 to identify multimorbidity patterns at four and eight years of follow-up, and we then created alluvial plots to visualise multimorbidity trajectories. We performed age- and sex-adjusted logistic regression analysis to study the association of each pattern with four- and eight-year mortality.ResultsWe identified three multimorbidity patterns at baseline, named dyslipidaemia & endocrine-metabolic, hypertension & obesity, and unspecific. The hypertension & obesity pattern, found in one out of every four patients was associated with a higher likelihood of four- and eight-year mortality (age- and sex-adjusted odds ratio 1.11 and 1.16, respectively) compared to the unspecific pattern. Baseline patterns evolved into different patterns during the follow-up.DiscussionWell-known preventable cardiovascular risk factors were key elements in most patterns, highlighting the role of hypertension and obesity as risk factors for higher mortality. Two out of every three patients had a cardiovascular profile with chronic conditions like diabetes and obesity that are linked to low-grade systemic chronic inflammation. More studies are encouraged to better characterise the relatively large portion of the population with an unspecific disease pattern and to help design and implement effective and comprehensive strategies towards healthier ageing.

The COVID-19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the presence of specific mental health conditions and the risk of death and hospitalization. This is a retrospective cohort study including all individuals with confirmed infection by SARS-CoV-2 from the PRECOVID (Prediction in COVID-19) Study (Aragon, Spain). Mental health illness was defined as the presence of schizophrenia and other psychotic disorders, anxiety, cognitive disorders, depression and mood disorders, substance abuse, and personality and eating disorders. Multivariable logistic regression models were used to examine the likelihood of 30-day all-cause mortality and COVID-19 related hospitalization based on baseline demographic and clinical variables, including the presence of specific mental conditions, by gender. We included 144,957 individuals with confirmed COVID-19 from the PRECOVID Study (Aragon, Spain). The most frequent diagnosis in this cohort was anxiety. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID-19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID-19 based on their mental health status will be crucial to improve their access to the healthcare system and the establishment of public health prevention measures for future outbreaks.

Abstract Background The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. Objective To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. Methods/design This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Population Patients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. Sample size n = 1148 patients (574 per study arm). Intervention Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. Outcomes The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. Statistical analysis The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. Discussion It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. Trial registration ClinicalTrials.gov NCT04147130 . Registered on 22 October 2019

Summary: Background: The Omicron variant has challenged the control of the COVID-19 pandemic due to its immuno-evasive properties. The administration of a booster dose of a SARS-CoV-2 vaccine showed positive effects in the immunogenicity against SARS-CoV-2, effect that is even enhanced after the administration of a second booster. Methods: During a phase-3 clinical trial, we evaluated the effect of a second booster of CoronaVac®, an inactivated vaccine administered 6 months after the first booster, in the neutralization of SARS-CoV-2 (n = 87). In parallel, cellular immunity (n = 45) was analyzed in stimulated peripheral mononuclear cells by flow cytometry and ELISPOT. Findings: Although a 2.5-fold increase in neutralization of the ancestral SARS-CoV-2 was observed after the second booster when compared with prior its administration (Geometric mean units p

Este artículo describe el proceso de diseño y las características de un cuestionario y una pauta de observación intradomiciliaria desarrollados para evaluar tanto transversal como longitudinalmente la relación vivienda-barrio-salud en el marco de transformaciones urbanas llevadas a cabo en poblaciones de elevada vulnerabilidad socio-territorial. Los instrumentos se desarrollaron para el estudio longitudinal multimétodos RUCAS (Regeneración Urbana, Calidad de Vida y Salud), un experimento natural cuyo objetivo principal es evaluar el impacto en salud y calidad de vida de un programa de Regeneración de Conjuntos Habitacionales en dos conjuntos de vivienda social en Chile. El diseño de los instrumentos siguió cuatro etapas principales: (1) revisión narrativa de la literatura para definir las dimensiones del estudio, y de instrumentos existentes para identificar ítems apropiados para su medición; (2) validación de contenido con expertos; (3) pre-test; y (4) estudio piloto. El cuestionario resultante, compuesto de 262 ítems, tiene en cuenta las distintas etapas del ciclo vital y cuestiones de género. La pauta de observación intradomiciliaria (77 ítems) es aplicada por el/la encuestadora. Los instrumentos abordan (i) características de la situación residencial actual que sabidamente afectan la salud y serán intervenidas por el programa; (ii) dimensiones de la salud potencialmente afectadas por la situación residencial y/o por la intervención dentro de los plazos del estudio (4 años); (iii) otras condiciones de salud y relacionadas con la salud que sean relevantes, aun cuando no se verán modificadas dentro de los plazos del estudio, y (iv) dimensiones socioeconómicas, ocupacionales y demográficas relevantes. Los instrumentos han mostrado ser una herramienta capaz de abordar la multidimensionalidad de los procesos de transformación urbana en contextos de pobreza urbana en vivienda formal.

Abstract A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients.

Between 2008 and 2009 suicide rates in Chile were higher than those observed before and after, increasing more than in other countries in Latin America. The Great Recession has been suggested as an important factor behind this increase. This study assesses the excess of suicide attributable to the crisis in Chile, a “mature” neoliberal society with a precarious social security system, low salaries, and high levels of indebtedness, and identifies the most relevant economic variables that may contribute to this excess. We pooled data since 2000 on monthly suicide rates, unemployment, economic activity and perception of problematic indebtedness for different sex and age groups. We adopted an interrupted time series design with Poisson regressions models adjusted for monthly variations and non-linear pre-crisis trajectories via restricted cubic splines. We then further controlled for economic variables to evaluate their possible contributions to suicide increase attributable to the economic crisis. Suicide mortality during the crisis period was higher than in the previous period in all sex and age groups. Overall, we estimated that 301 suicides (95% CI: 181 to 422) were attributable to the crisis in Chile. This excess was concentrated among men younger than 65 and women 65 and older. Including unemployment and indebtedness perception in the models reduced the excess of suicides. The increase was concentrated in the first half of the crisis and an early pre-crisis effect could be observed when anticipating the crisis beginning by three months. Results suggest that the Great Recession had an impact on suicide mortality in Chile and that increase in unemployment and indebtedness could be related to this increase. Results by sex and age are consistent with the most vulnerable groups in the context of Chilean neoliberalism. For future crises, improving unemployment insurance, and reinforcing suicide prevention attending to the economic context should be a priority.

Abstract Background The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The “Regeneración Urbana, Calidad de Vida y Salud” (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile. Methods RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population. Discussion RUCAS’ design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors –including COVID-19 pandemic and associated lockdowns– and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS’ outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.

Objective. A narrative overview of regional academic research collaborations to address the increasing burden and gaps in care for patients at risk of, and who suffer from, stroke in Latin America (LA). Materials and methods. A summary of experiences and knowledge of the local situation is presented. No systematic literature review was performed. Results. The rapidly increasing burden of stroke poses immense challenges in LA, where prevention and manage­ment strategies are highly uneven and inadequate. Clinical research is increasing through various academic consortia and networks formed to overcome structural, funding and skill barriers. However, strengthening the ability to generate, analyze and interpret randomized evidence is central to further develop effective therapies and healthcare systems in LA. Conclusions. Regional networks foster the conduct of multicenter studies –particularly randomized controlled trials–, even in resource-poor regions. They also contribute to the external validity of international studies and strengthen systems of care, clinical skills, critical thinking, and international knowledge exchange.

Abstract Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15–44, 45–64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.

Abstract Background With the number of centenarians increasing exponentially in Spain, a deeper knowledge of their socio-demographic, clinical, and healthcare use characteristics is important to better understand the health profile of the very elderly. Methods We conducted a retrospective, cross-sectional observational study in the EpiChron Cohort (Aragón, Spain) aimed at analyzing the socio-demographic, clinical, drug use and healthcare use characteristics of 1680 centenarians during 2011–2015, using data from electronic health records and clinical-administrative databases. Results Spanish centenarians (79.1% women) had 101.6 years on average. Approximately 80% of centenarians suffered from multimorbidity, with an average of 4.0 chronic conditions; 50% were exposed to polypharmacy, with an average of 4.8 medications; only 6% of centenarians were free of chronic diseases and only 7% were not on medication. Centenarians presented a cardio-cerebrovascular pattern in which hypertension, heart failure, cerebrovascular disease and dementia were the most frequent conditions. Primary care was the most frequently visited healthcare level (79% of them), followed by medical specialist consultations (23%), hospitalizations (13%), and emergency service use (9%). Conclusions Multimorbidity is the rule rather than the exception in Spanish centenarians. Addressing medical care in the very elderly from a holistic geriatric view is critical in order to preserve their health, and avoid the negative effects of polypharmacy.

Background Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). Methods Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. Results 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. Conclusions Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.

[This corrects the article DOI: 10.1371/journal.pone.0238401.].

BackgroundClinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR).MethodsRetrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality.Results5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes.ConclusionsAge and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.

IntroductionOur goal was to study whether influenza vaccination induced antibody mediated rejection in a large cohort of solid organ transplant recipients (SOTR).MethodsSerum anti-Human Leukocyte Antigen (HLA) antibodies were determined using class I and class II antibody-coated latex beads (FlowPRATM Screening Test) by flow cytometry. Anti-HLA antibody specificity was determined using the single-antigen bead flow cytometry (SAFC) assay and assignation of donor specific antibodies (DSA) was performed by virtual-crossmatch.ResultsWe studied a cohort of 490 SOTR that received an influenza vaccination from 2009 to 2013: 110 (22.4%) received the pandemic adjuvanted vaccine, 59 (12%) within the first 6 months post-transplantation, 185 (37.7%) more than 6 months after transplantation and 136 (27.7%) received two vaccination doses. Overall, no differences of anti-HLA antibodies were found after immunization in patients that received the adjuvanted vaccine, within the first 6 months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased the percentage of patients positive for anti-HLA class I significantly compared with patients with one dose (14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not increase reactivity after immunization. A group of 75 (14.4%) patients developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them were DSA, and none experienced allograft rejection. Only two (0.4%) patients were diagnosed with graft rejection with favorable outcomes and neither of them developed DSA.ConclusionOur results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.

Resumen: La creciente longevidad de la población, el aumento de la morbilidad y del consumo de medicamentos han provocado que la polimedicación sea un problema de salud prioritario por sus consecuencias en el incremento de efectos adversos, interacciones farmacológicas y favorecer el deterioro funcional del paciente.La situación clínica de los pacientes cambia a lo largo del tiempo y es preciso ajustar la medicación en cada etapa, valorando la fragilidad, el nivel de dependencia y el deterioro funcional.La labor de deprescribir es compleja y requiere una adecuada formación clínica y farmacológica. En atención primaria reside el mayor conocimiento del paciente y su entorno, y de forma compartida con el paciente y cuidadores se debe valorar qué medicamentos mantener y cuáles retirar desde una perspectiva clínica, ética y social.Existen herramientas de ayuda a la deprescripción que pueden resultar útiles para el médico de familia para facilitar este proceso y que se detallan en este artículo. Abstract: The increasing longevity of the population, the increase in morbidity and the consumption of medications have caused that polypharmacy is a priority health problem due to its consequences: increase of adverse effects, pharmacological interactions and favor the functional deterioration of the patient.The clinical situation of the patients changes over time and it is necessary to adjust the medication in each stage, assessing the fragility, the level of dependence and the functional deterioration.Deprescription is complex and requires an adequate clinical and pharmacological formation. In Primary Care lies the greater knowledge of the patient and their environment, and in a shared way with the patient and caregivers, it is necessary to assess which drugs to maintain and which ones to withdraw from a clinical, ethical and social perspective.There are tools to help deprescription that can be useful for Primary Care to facilitate this process and that are detailed in this article. Palabras clave: Polimedicación/polifarmacia, Prescripción inapropiada, Anciano frágil, Deprescripción, Terapia médica, Keywords: Polypharmacy, Inappropriate prescribing, Frail elderly, Deprescription, Drug therapy

Los diseños genéticamente informativos, y en particular los estudios de gemelos, constituyen la metodología más utilizada para analizar la contribución relativa de los factores genéticos y ambientales a la variabilidad interindividual. Básicamente, consisten en comparar el grado de similitud, con respecto a una característica o rasgo determinado, entre gemelos monocigóticos y dicigóticos. Además de la clásica estimación de heredabilidad, este tipo de registros permite una amplia variedad de análisis únicos por las características de la muestra. El Registro de Gemelos de Murcia es un registro de base poblacional centrado en el análisis de conductas relacionadas con la salud. Las prevalencias de problemas de salud observadas son comparables a las de otras muestras de referencia de ámbito regional y estatal, lo que avala su representatividad. En conjunto, sus características facilitan el desarrollo de diversas modalidades de investigación, además de diseños genéticamente informativos y la colaboración con distintas iniciativas y consorcios.

In the Spanish educational system, immigrant students are one of the principal groups with high rates of school failure. In this situation we assume that part of the difficulties of these students can be explained by their ignorance of cultural codes and the communication mediators in which the school is organized which can impede their access to the curricula, their communication, their participation and their social and educative inclusion. Our study aims to identify similarities and differences in the understanding of sociolinguistic and sociocultural components among immigrant students whose mother tongue is Spanish compared to their peers of compulsory secondary education. To test this, a sample of 247 students from Salamanca was selected. Of these 141 students were immigrants. The results show that immigrant students who speak Spanish have more difficulties inferring the meaning of the vocabulary and the expressions that appear in their teaching resources. This leads us to think about the educational practices that we are developing in order to respond the needs of those students.

Purpose: To determine the intra- and interrater agreement of mean flow velocity (MFV) and pulsatility index (PI) measurement in middle cerebral arteries, assessed by transcranial Doppler (TCD) with M-mode. Methods: Masked experienced neurosonologists performed TCD with M-mode using handheld probe in healthy adult volunteers. The Bland–Altman method for concordance and intraclass correlation coefficient were used. Results: Seventy-seven healthy volunteers and seven raters participated (3 on regular TCD shift and 4 off-shift). The intrarater absolute mean difference between measurements was 5.5 cm/s [95% confidence interval (CI), 4.7–6.3] for MVF and 0.073 (95% CI, 0.063–0.083) for PI. The difference between MFV measurements was significantly higher in off-shift raters (p=0.015). The interrater absolute mean difference between measurements was 6.5 cm/s (95% CI, 5.5–7.5) for MVF and 0.065 (95% CI, 0.059–0.071) for PI. No influence was found for the middle cerebral artery side, volunteer's sex, or age, and there was no significant difference between raters. The intraclass correlation coefficient was 82.2% (95% CI 77.8–85.6) and 72.9% (95% CI 67.4–77.6) for MFV and PI, respectively. Conclusions: There exists good intra- and interrater agreement in MFV and PI measurements using M-mode TCD. These results support the use of this noninvasive tool and are important for clinical and investigational purposes.

Abstract Background Multimorbidity is associated with negative effects both on people’s health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care. Methods/Design Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65–74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months). Sample size: n = 400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration Clinicaltrials.gov, NCT02866799

BackgroundSocial epidemiologic research in relation to the health impacts of precarious employment has grown markedly during the past decade. While the multidimensional nature of precarious employment has long been acknowledged theoretically, empirical studies have mostly focused on one-dimensional approach only (based either on employment temporariness or perceived job insecurity). This study compares the use of a multidimensional employment precariousness scale (EPRES) with traditional one-dimensional approaches in relation to distinct health outcomes and across various socio-demographic characteristics.MethodsWe used a subsample of formal salaried workers (n = 3521) from the first Chilean employment and working conditions survey (2009-2010). Multilevel modified Poisson regressions with fixed effects (individuals nested within regions) and survey weights were conducted to estimate the association between general health, mental health and occupational injuries and distinct precarious employment exposures (temporary employment, perceived job insecurity, and the multidimensional EPRES scale). We assessed the presence of effect measure modification according to sex, age, educational level, and occupational class (manual/non-manual).ResultsCompared to one-dimensional approaches to precarious employment, the multidimensional EPRES scale captured a larger picture of potential health effects and differences across subgroups of workers. Patterns of effect measure that modification were consistent with the expectations that groups in greater disadvantage (women, older individuals, less educated and manual workers) were more vulnerable to poor employment conditions.ConclusionsMultidimensional measures of precarious employment better capture its association with a breath of health outcomes, being necessary tools for research in order to strengthen the evidence base for policy making in the protection of workers' health.

Background: The steady increase in type 2 diabetes prevalence and the availability of new antidiabetic drugs (AD) have risen the use of these drugs with a change in the patterns of specific drug utilization. The complexity of this treatment is due to successive treatment initiation, switching and addition in order to maintain glycaemic control. The aim of this study was to describe the utilization patterns of ADs at initiation, treatment addition, and switching profiles and to measure factors influencing persistence to therapy.Methods: Retrospective observational study. Data were retrieved from the Campania Regional Database for Medication Consumption. Population consisted of patients receiving at least one prescription of ADs between January 1 and December 31, 2016. We calculated time to treatment switching or add-on as median number of days and interquartile range (IQR). Persistence rates were estimated using the Kaplan–Meier method. We used Cox regression models to estimate the likelihood of non-persistence over 1 year of follow-up. Hazard ratios and 95% confidence intervals were calculated.Results: Of 14,679 patients, 86.9% started with monotherapy and 13.1% with combination therapy. Most common initial treatment was metformin in both monotherapy and combination therapy. First-line prescription of sulfonylurea was observed in 6.9% of patients aged 60–79 years and in 10.8% of patients aged ≥80 years. Patients starting with metformin showed fewer treatment modifications (10.4%) compared to patients initiating with sulfonylureas (35.2%). Newer ADs were utilized during treatment progression. Patients who initiated with sulfonylurea were approximately 70% more likely to discontinue treatment compared to those initiated on metformin. Oldest age group (≥80 years) was more likely to be non-persistent, and likelihood of non-persistence was highest in polymedicated patients. Patients changing therapy were more likely to be persistent.Conclusions: Our results show that treatment of T2D in Italy is consistent with clinical guidelines. Even if newer ADs were utilized during disease progression, they seem not to be preferred in patients with a higher comorbidity score, although these patients could benefit from this kind of treatment. Our study highlights patients’ characteristics that might help identify those who would benefit from counselling from their health-care practitioner on better AD usage.

Fundamentos: Las reacciones adversas a medicamentos de uso hu - mano (RAM) son una de las diez principales causas de mortalidad a nivel mundial, siendo las que causan ingreso o prolongan la estancia hospitalaria las de mayor impacto sanitario y económico. Los objetivos de este estudio fueron conocer la incidencia y las características de las RAM en pacientes hospitalizados en los servicios de Medicina Interna. Métodos: Estudio observacional y prospectivo de monitorización in - tensiva de RAM de los pacientes ingresados en los servicios de Medicina Interna en un hospital de tercer nivel durante el año 2014. Se protocolizó la recogida de datos relativos al paciente así como las características de las RAM. El análisis estadístico se realizó con el software SPSS v.20.0. Resultados: Se monitorizaron 253 pacientes. Se detectaron RAM en 54 pacientes (21,34%), encontrándose una asociación positiva entre la edad y la presencia de RAM (p=0.012). La incidencia de ingresos causados por una RAM fue de 7,11% y las RAM mortales fueron un 1,97%. Las RAM fueron graves en el 81,2% de los casos. Los órganos más afectados fueron el gas - trointestinal, trastornos del metabolismo y de la nutrición y el vascular. Los grupos terapéuticos causantes de RAM más frecuentes fueron los agentes cardiovasculares, los antinfecciosos y los del sistema nervioso. El 72,2% de los pacientes que sufrieron RAM presentaban polimedicación. Conclusión: La incidencia de RAM en nuestro estudio se sitúa en el 21,34%. La carga de ingresos o de mortalidad derivados de una RAM la sufren, fundamentalmente, pacientes ancianos, pluripatológicos, polimedi- cados y con peores valores de función renal por lo que es en ellos en quien fundamentalmente se debería realizar una prescripción más cuidadosa.

OBJECTIVES:The objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades. METHODS:This observational, cross-sectional study used the demographic and clinical information from electronic medical databases and the pharmacy billing records of all users of the public health system of the Spanish region of Aragon in 2015. An exploratory factor analysis was conducted based on the tetra-choric correlations among the diagnoses of chronic diseases and the dispensed drugs in 887,572 patients aged ≤65 years. The analysis was stratified by age and sex. To name the constituted patterns, assess their clinical nature, and identify potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms. RESULTS:Six multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs differed by sex and age and became more complex as age advanced. CONCLUSIONS:The six clinically sound multimorbidity-polypharmacy patterns described in this non-elderly population confirmed the existence of systematic associations among chronic diseases and medications, and revealed some unexpected associations suggesting the prescribing cascade phenomenon as a potential underlying factor. These findings may help to broaden the focus and orient the early identification of potential interactions when caring for multimorbid patients at high risk of adverse health outcomes due to polypharmacy.

Resumen El aumento de alumnos inmigrantes en los centros escolares pone de manifiesto nuevos desafíos en educación que nos invitan a reflexionar acerca de si las estrategias educativas diseñadas realmente responden a sus necesidades. Es por ello que en este artículo presentamos el diseño preliminar de un recurso didáctico multimedia al que hemos denominado Uniendo Culturas, con el objetivo de ofrecer a profesores, alumnos y familias una herramienta que contribuya a la mejora de la respuesta educativa que se proporciona al alumnado, tomando como referencia la diversidad sociocultural y lingüística presente en las aulas. Nos hemos apoyado en las TICs debido al gran impacto que tienen en el ámbito escolar al aportar nuevos recursos, estrategias y metodologías que permiten una mayor flexibilidad y adaptación a los intereses y características de la comunidad educativa.

Todo sistema educativo debe tener como prioridad la atención y respuesta a las diferentes necesidades de sus alumnos, potenciando sus capacidades y facilitando la adquisición de los aprendizajes establecidos para cada etapa educativa. Numerosos estudios consideran al profesorado una pieza clave en este proceso, lo que nos lleva a reflexionar sobre el grado en que los docentes se encuentran preparados para asumir este reto. Así, el objetivo del presente estudio es analizar las actitudes y las necesidades formativas de los docentes respecto a las culturas, políticas y prácticas inclusivas. Para ello se elaboró un cuestionario ad hoc que fue aplicado a 402 profesionales de la educación de Castilla y León. Los resultados muestran la existencia de necesidades relacionadas en general con la transformación de las escuelas en centros educativos inclusivos, y en particular, con la formación en metodologías de trabajo más inclusivas, y estrategias para abordar todo el proceso.

Objective: This study examines the psychometric properties of the revised Employment Precariousness Scale (EPRES-2010) in a context of economic crisis and growing unemployment. Methods: Data correspond to salaried workers with a contract (n = 4,750) from the second Psychosocial Work Environment Survey (Spain, 2010). Analyses included acceptability, scale score distributions, Cronbach's alpha coefficient and exploratory factor analysis. Results: Response rates were 80% or above, scores were widely distributed with reductions in floor effects for temporariness among permanent workers and for vulnerability. Cronbach's alpha coefficients were 0.70 or above; exploratory factor analysis confirmed the theoretical allocation of 21 out of 22 items. Conclusion: The revised version of the EPRES demonstrated good metric properties and improved sensitivity to worker vulnerability and employment instability among permanent workers. Furthermore, it was sensitive to increased levels of precariousness in some dimensions despite decreases in others, demonstrating responsiveness to the context of the economic crisis affecting the Spanish labour market.

A lo largo de la historia nos encontramos con numerosos colectivos de nuestra sociedad que han sido, y en ocasiones siguen siéndolo, objeto de exclusión tanto educativa como social: mujeres, personas con discapacidad, minorías étnicas y culturales, etc., poniendo de manifiesto la importancia de construir una escuela para todos que les proporcione la respuesta adecuada a sus necesidades. Así, la formación del profesorado para la inclusión se convierte en una herramienta clave que permita lograr dicho objetivo. En este artículo presentamos un estudio sobre las necesidades de formación docente para la inclusión que el profesorado de Castilla y León encuentra a la hora de abordar de manera coherente la atención a la diversidad del alumnado con el que trabajan (género, cultura, etc.).

El objetivo general del presente estudio ha sido evaluar los patrones de uso del teléfono móvil en población adolescente escolarizada en centros de Educación Secundaria. De modo adicional, hemos evaluado correlatos psicológicos (ansiedad, depresión) y conductuales y asociación con rendimiento escolar. Para la realización del estudio se contó con 528 alumnos, con edades entre los 12 y los 19 años, pertenecientes a cinco centros educativos, cuatro públicos y uno concertado. Los instrumentos utilizados fueron el Cuestionario de Evaluación de la Depresión de Beck (BDI), el Cuestionario de Evaluación de la Ansiedad de Beck (BAI), las escalas de baja autoestima y problemas escolares del Cuestionario de Personalidad MMPI-A, y el Cuestionario para evaluar el uso excesivo del Móvil (COS). Los resultados indican que un porcentaje significativo de estudiantes que abusan del teléfono móvil muestran sintomatología depresiva y ansiógena y baja autoestima. Un 14.8% de los participantes obtiene puntuaciones que les sitúa en un rango de problemas escolares elevado o alto, a su vez vinculado con un uso patológico del teléfono móvil. Todos estos resultados ponen de manifiesto la necesidad de plantear intervenciones que reduzcan patrones conductuales desajustados y mejoren la convivencia escolar.

Nuestros centros educativos son contextos en los que la diversidad se manifiesta en diferentes ritmos de aprendizaje, capacidades, intereses, motivaciones, expectativas. Esta situación, que afecta a la convivencia en los mismos, hace necesaria por parte del sistema una atención educativa adecuada. La inclusión educativa constituye el mejor medio para lograrlo, desde la premisa de que la implicación y la participación de todos en la transformación de las escuelas es la única manera de conseguir una adecuada convivencia en cada centro educativo. No obstante, pone de manifiesto la necesidad de formación, tanto del profesorado como de la administración, para hacer frente al reto que supone conseguir el éxito de todos los alumnos. En nuestra investigación elaboramos un cuestionario para evaluar las necesidades de formación docente para la inclusión, que respondieron 400 profesores de centros educativos de Castilla y León. Los resultados han mostrado necesidades formativas en los profesores, relacionadas fundamentalmente con la necesidad de una preparación consecuente de los profesionales de la educación para participar en la transformación de sus escuelas en centros educativos inclusivos, de manera especial en lo que se refiere a metodologías inclusivas de trabajo y a estrategias para la mejora de la convivencia en los centros.

Objetivo: Evaluar la calidad de vida (CDV) de los niños y adolescentes con parálisis cerebral (PC) desde la percepción de sus padres y de ellos mismos; analizar el grado de acuerdo entre ambas percepciones e identificar las variables que influyen en la CDV. Métodos: Fue realizado un estudio transversal que incluyó a 92 niños y adolescentes con PC (edades entre 8-18 años), sin otras comorbilidades asociadas, en seguimiento en los centros ASPACE de la Comunidad Autónoma de Castilla y León. El proceso de recogida de datos se realizó entre octubre de 2008 y septiembre de 2009 y el instrumento utilizado para evaluación fue la versión española del KIDSCREEN. En los análisis estadísticos, fueron utilizados pruebas t, coeficiente de correlación intraclase (CCI) y regresión lineal múltiple. Resultados: Las puntuaciones de CDV fueron bajas en casi todos los dominios del KIDSCREEN. Las variables del niño condicionaron los resultados de CDV en los dominios “recursos económicos” y “bienestar psicológico”. La variable Gross Motor Function Classification System (GMFCS) explicó solamente un 7% de la varianza del dominio “bienestar físico”, mientras que el “grado de discapacidad intelectual” (DI) explicó un 14% del dominio “bienestar psicológico”. Los padres han subestimado la CDV de sus hijos en 9 de los 10 dominios y el coeficiente de correlación intraclase (CCI) fue alto solamente en el dominio “amigos y apoyo social”. Conclusión: Los resultados subrayan la importancia de oír a los niños y adolescentes con PC, ya que su percepción de CDV puede ser distinta de la que tienen sus padres

Objective: To evaluate quality of life (QoL) of children and adolescents with cerebral palsy (CP) according to the perception of the children themselves and their parents, examining the degree of agreement between the two perceptions, and identify the variables that influence QoL. Methods: We conducted a cross-sectional study that included 92 children and adolescents with CP (aged 8-18 years) without other associated comorbidities in ASPACE monitoring centers of the Autonomous Community of Castile and León - Spain. The process of data collection was conducted between October 2008 and September 2009 and the assessment instrument used was the Spanish version of Kidscreen. Statistical analyzes included t tests, intraclass correlation coefficient (ICC) and multiple linear regression. Results: The QoL scores were low in almost all areas of the Kidscreen. The variables of children determined the results of QoL in the “economic resources” and “psychological well-being.” The variable Gross Motor Function Classification System (GMFCS) explained only 7% of the variation of the domain “physical well-being,” while the “degree of intellectual disability” (ID) explained 14% of the variation of the domain “psychological well-being.” Parents underestimate the QoL of their children in 9 of the 10 domains and intraclass correlation coefficient (ICC) was high only in the “friends and social support.” Conclusion: The results draw attention to the importance of listening to children and adolescents with CP, because their perception of QoL may be different from what their parents have.

La diversidad es un hecho patente en nuestra sociedad que exige, por parte de los sistemas educativos, una educación de calidad para todos los alumnos. La inclusión constituye el mejor medio para lograrlo, si bien pone de manifiesto la necesidad de formación del profesorado para hacer frente al reto que supone conseguir el éxito de todos los alumnos. En nuestra investigación evaluamos las necesidades formativas de 110 profesionales de la educación de España, Costa Rica y República Dominicana, a través del cuestionario de evaluación de las necesidades de formación docente para la inclusión (CEFI). Los resultados han mostrado necesidades formativas en los profesores, relacionadas fundamentalmente con la ausencia de una preparación adecuada de los profesionales de la educación para participar en la transformación de sus escuelas en centros educativos inclusivos, de manera especial en lo que se refiere a metodologías inclusivas para trabajar en los centros.

Diversos estudios constatan la presencia de elevados niveles de burnout en profesionales de servicios humanos. Dicho síndrome se asocia con la accidentalidad y absentismo laborales. En este estudio ex post facto se evalúa la presencia del síndrome de burnout y las estrategias de afrontamiento empleadas por 64 profesionales de acogimiento residencial de menores que trabajaban en diversas provincias españolas. Los instrumentos empleados fueron el MBI y el Cuestionario de Afrontamiento COPE. Los resultados confirman la existencia de una elevada tasa del síndrome en la muestra estudiada. Así mismo, los análisis correlacionales ponen de manifiesto la existencia de asociaciones significativas entre el empleo de estrategias de afrontamiento y una elevada realización personal. Los análisis de varianza indican la existencia de diferencias significativas en función de variables sociodemográficas como el género, así como en función de variables organizacionales (existencia de turnos o satisfacción con la remuneración, entre otras). Se obtienen también correlaciones positivas entre variables como la edad, la antigüedad en el puesto y las dimensiones del burnout. Los resultados justifican la necesidad de intervenir con estos profesionales, dotándoles de estrategias que les permitan hacer frente a las demandas de este tipo de trabajos y de realizar mejoras en las propias organizaciones para hacerlas más saludables.

In Pamplona, Norte de Santander, strawberry (Fragaria x ananassa Duch) producers face a dual challenge: ensuring the safety of their products and conserving natural resources. Nine farms belonging to the Association of Rural Women (ASMUR) were assessed, representing approximately 20% of the total affiliated production units within the association. The level of implementation of Good Agricultural Practices (GAP) was analysed in accordance with the 2020 Resolution of the Colombian Agricultural Institute (ICA), alongside sustainable soil management as per the Food and Agriculture Organization (FAO) guidelines on good practices for the management and sustainable use of soils in rural areas. Field tests and laboratory analyses were carried out to evaluate soil quality. The results revealed that none of the farms meet the requirements for GAP certification, with notable limitations in infrastructure, training, personnel protection, and traceability. On the other hand, the soils exhibited high organic matter content, acidic pH, and low biological activity. To overcome these limitations and achieve GAP certification, it is crucial to develop a specific action plan, provide advisory and training in GAP and sustainable soil management, make investments in key infrastructure, implement soil monitoring, adjust pH with amendments, encourage agroecological practices, promote the use of bio-inputs, and establish partnerships with entities for access to resources and technical-financial support.

Título en inglés: Optimization of culture media QBP to the production of biomass of consortium BIOYAF Título corto: Optimización de un medio de cultivo Resumen: La optimización de los medios de cultivo con fines industriales en la mayoría de los casos ha sido efectuada mediante procedimientos empíricos de ensayo y error. Empleando diversos métodos estadísticos es probable que el medio de cultivo original pueda ser optimizado, en muchos casos es posible obtener un medio que no solo sea más productivo, sino de menor o igual costo que el original. Se optimizó el medio de cultivo QBP para el crecimiento de las cepas del consorcio bacteriano BIOYAF capaz de degradar hidrocarburos del petróleo, empleando un Diseño de Factor Categórico Individual para determinar el tiempo de trabajo, un Diseño Factorial (24) para determinar los rangos de trabajo de concentración de los nutrientes y un Diseño de Superficie de Respuesta para optimizar las concentraciones. Las variables de respuesta de evaluación de los experimentos fueron masa húmeda, masa (UDO), conteo de viables, conductividad, pH y tensión superficial. El tiempo óptimo para el crecimiento de las cepas del consorcio BIOYAF es de seis horas. El medio de cultivo QBP con concentraciones óptimas de fosfato de amonio (3,19 g.l-1), sulfato de magnesio (0,04 g.l-1), levadura (3,77 g.l-1) y sacarosa (47,89 g.l-1) permite que la producción de biomasa aumente de 1,540 UDO a 3,082 UDO. Palabras clave: superficie de respuesta, consorcio bacteriano, crecimiento óptimo. Abstract: The optimization of culture media with industrial purposes, in most cases, has been made through empirical trial and error procedures. Using different statistical methods original culture media can be optimized, in many cases, it is possible to obtain a more productive media, at the same cost as the original one. The culture media QBP was optimized for the growth of the bacterial consortium BIOYAF, which can degrade petroleum hydrocarbons, using a Categorical Individual Factor Design to determine the working time, a Factorial Design (24) to determine working range of elements concentration and a Surface Response Design to optimize the concentrations. The response variables of the experiments used in this work were: wet mass, mass (UDO), viable’s count, conductivity, pH and surface tension. The optimal time for growth of the consortium was of six hours. The optimized QBP culture media (ammonium phosphate: 3.19; magnesium sulphate: 0,04; yeast extract : 3,77; sucrose: 47,89) allowed biomass’ production increases of 1,540 UDO to 3,082 UDO. Key words: Surface Response Design, bacterial consortium, optimum growth.

ObjectivesThe aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern.MethodsA cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex.ResultsSeven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI), chronic obstructive pulmonary disease (COPD), rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns). Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents). Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern.ConclusionsThe present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical patient guidelines to patients with multimorbidity who are taking multiple drugs.

ObjectivesThe primary objective of this study was to identify the existence of chronic disease multimorbidity patterns in the primary care population, describing their clinical components and analysing how these patterns change and evolve over time both in women and men. The secondary objective of this study was to generate evidence regarding the pathophysiological processes underlying multimorbidity and to understand the interactions and synergies among the various diseases.MethodsThis observational, retrospective, multicentre study utilised information from the electronic medical records of 19 primary care centres from 2008. To identify multimorbidity patterns, an exploratory factor analysis was carried out based on the tetra-choric correlations between the diagnostic information of 275,682 patients who were over 14 years of age. The analysis was stratified by age group and sex.ResultsMultimorbidity was found in all age groups, and its prevalence ranged from 13% in the 15 to 44 year age group to 67% in those 65 years of age or older. Goodness-of-fit indicators revealed sample values between 0.50 and 0.71. We identified five patterns of multimorbidity: cardio-metabolic, psychiatric-substance abuse, mechanical-obesity-thyroidal, psychogeriatric and depressive. Some of these patterns were found to evolve with age, and there were differences between men and women.ConclusionsNon-random associations between chronic diseases result in clinically consistent multimorbidity patterns affecting a significant proportion of the population. Underlying pathophysiological phenomena were observed upon which action can be taken both from a clinical, individual-level perspective and from a public health or population-level perspective.

Fun da men tos: Para un buen de sa rro llo de los pro gra mas de va cu na ción es pri mor dial co nocer la co ber tu ra de va cu na - ción. En las Islas Ba lea res la co ber tu ra no ti fi ca da era muy in fe - rior a la del res to de Espa ña. El ob jetivo de este tra ba jo es la es - ti ma ción de la co bertura de las va cunas in clui das en el ca len da - rio re co men da do has ta los 18 me ses de edad (4 do sis de po lio oral, té tanos y dif te ria; 3 de tos fe ri na; 1 de sa ram pión, ru beo la y pa rotiditis). Mé to dos: Estu dio des crip ti vo, trans ver sal, de base po bla - cio nal. Se cal cu la ron los es ti ma do res pun tua les de dis tri bu ción de fre cuen cias y los in ter va los de con fian za al 95% (IC95%) co rres pon dien tes, so bre una mues tra de la po bla ción re si den te en Ba lea res de dos años de edad (na ci da en 1995), se lec cio na da por mues treo alea to rio por con glo me ra dos en una sola eta pa a par tir de las sec cio nes cen sa les. Se con sul tan los re gis tros de va cu nas de Sa ni dad y de los cen tros de sa lud del Insa lud, se pide te le fó ni ca men te a las fa mi lias los da tos del do cu men to de va cu na ción y a los pe dia tras pri va dos los de la his to ria clí nica. Re sul ta dos: La mues tra in cluía 606 ni ños. Pudo ob te ner se la in for ma ción com ple ta de 532. Se con si guió la in for ma ción com ple ta de 377 ca sos (62%) a par tir de los re gis tros del sec tor pú bli co. La co bertura más baja fue la de la va cu na an ti dif té ri ca, 518 ni ños com plen ta men te va cu na dos, el 96,8% (IC95% = 94,8 ? 98,1) y la más alta la de la va cu na an ti per tus sis, 537 ni - ños, el 98,9% (IC95% = 97,5 ? 99,5). Conclusiones: En las Islas Ba lea res exis te una bue na co - ber tu ra de la va cu na ción, si mi lar a lo que se vie ne es ti man do en Espa ña en su to ta li dad. Se cum ple el ob je ti vo in clui do en el Plan de Erra di ca ción de la Po lio. La in for ma ción re co gi da des - de el sec tor pú bli co es es casa.

IntroductionKidney transplant recipients showed a weak humoral response to the mRNA COVID-19 vaccine despite receiving three cumulative doses of the vaccine. New approaches are still needed to raise protective immunity conferred by the vaccine administration within this group of high-risk patients. MethodsTo analyze the humoral response and identify any predictive factors within these patients, we designed a prospective monocentric longitudinal study of Kidney transplant recipients (KTR) who received three doses of mRNA-1273 COVID-19 vaccine. Specific antibody levels were measured by chemiluminescence. Parameters related to clinical status such as kidney function, immunosuppressive therapy, inflammatory status and thymic function were analyzed as potential predictors of the humoral response. ResultsSeventy-four KTR and sixteen healthy controls were included. One month after the administration of the third dose of the COVID-19 vaccine, 64.8% of KTR showed a positive humoral response. As predictive factors of seroconversion and specific antibody titer, we found that immunosuppressive therapy, worse kidney function, higher inflammatory status and age were related to a lower response in KTR while immune cell counts, thymosin-a1 plasma concentration and thymic output were related to a higher humoral response. Furthermore, baseline thymosin-a1 concentration was independently associated with the seroconversion after three vaccine doses. DiscussionIn addition to the immunosuppression therapy, condition of kidney function and age before vaccination, specific immune factors could also be relevant in light of optimization of the COVID-19 vaccination protocol in KTR. Therefore, thymosin-a1, an immunomodulatory hormone, deserves further research as a potential adjuvant for the next vaccine boosters.

The isolation of aerobic marine bacteria able to degrade hydrocarbons represents a promising alternative for the decontamination of oceanic and coastal environments. In the present work, twelve water and sediment samples from the Felton coastline in the Province of Holguín were collected and screened with Bushnell-Haas medium supplemented with light crude oil or with seawater supplemented with yeast extract and crude oil as a carbon source, obtaining twenty seven and six bacterial isolates respectively that were able to grow in these media. The obtained isolates were then subjected to selection in Bushnell-Haas medium supplemented with a heavy crude oil, selecting three strains able to degrade this hydrocarbon mixture within a period of seven days. Pure cultures of these strains were further used in crude oil biodegradability assays. Total petroleum hydrocarbon (TPH) degradation was evaluated through SARA analysis, employing gas chromatography with an FID detector and infrared spectroscopy to analyze the aliphatic and aromatic hydrocarbon fractions, respectively. All three stains removed more than 60% of the TPH and one of them showed the best degradation potential with figures above 65% for the entire hydrocarbon fraction, except resins. Two of the strains were also able to decrease C17:Pr and C18:Ph ratios to less than 50% in comparison to the abiotic control. Two of these strains were phenotypically identified as sp., and the remaining one as sp. The degradation potential exhibited by these new isolates warrants further studies on their possible application to decontaminate coastal environments affected by oil spills.