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Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO’s target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

Rapid microbiological reports to clinicians are related to improved clinical outcomes. We conducted a 3-year quasi-experimental design, specifically a pretest–posttest single group design in a university medical center, to evaluate the clinical impact of rapid microbiological identification information using MALDI-TOF MS on optimizing antibiotic prescription. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated comparing a historical control group (CG) (n = 183), in which the microbiological information (bacterial identification and antibiotic susceptibility) was reported jointly to the clinician between 18:00 h and 22:00 h of the same day and a prospective intervention group (IG) (n = 180); the bacterial identification information was informed to the clinician as soon as it was available between 12:00 h and 14:00 h and the antibiotic susceptibility between 18:00 h and 22:00 h). We observed, in favor of IG, a statistically significant decrease in the information time (11.44 h CG vs. 4.48 h IG (p < 0.01)) from the detection of bacterial growth in the culture medium to the communication of identification. Consequently, the therapeutic optimization was improved by introducing new antibiotics in the 10–24 h time window (p = 0.05) and conversion to oral route (p = 0.01). Additionally, we observed a non-statistically significant decrease in inpatient mortality (global, p = 0.15; infection-related, p = 0.21) without impact on hospital length of stay. In conclusion, the rapid communication of microbiological identification to clinicians reduced reporting time and was associated with early optimization of antibiotic prescribing without worsening clinical outcomes.

Background: Stroke is the second largest single cause of death and disability in Latin America and the Caribbean (LAC). There have been large overall declines in stroke mortality rates in most LAC countries in recent decades. Objective: To analyze trends in mortality caused by stroke in LAC countries in the period 1979–2015. Methods: We extracted data for age-standardized stroke mortality rates per 100,000 in LAC for the period 1979–2015 from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the annual percent change (APC) in LAC as a whole and by country. Analyses were conducted by gender, region and World Bank income classification. Results: Mortality from stroke has decreased in LAC over the study period by an average APC of –1.9%. Most countries showed significant downward trends, with the sharpest decreases in Chile, Colombia and Uruguay. We recorded statistically significant decreases of –1.4% and –2.4% in mortality rates in men and women, respectively, in the whole LAC. Southern and high-income countries showed the steepest decreases. Conclusions: Stroke mortality has decreased in LAC, in both sexes, especially in southern and high-income countries. Our results could serve as a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.

Background: The addition of dendritic cell vaccines (DCV) to NAC could induce immune responses in those patients with residual disease (RD) by transforming the tumor microenvironment. Methods: Core diagnostic biopsies and surgical specimens from 80 patients (38 in the vaccinated group plus NAC (VG) and 42 in the control group (CG, treated only with NAC) were selected. We quantify TILs (CD8, CD4 and CD45RO) using immunohistochemistry and the automated cellular imaging system (ACIS III) in paired samples. Results: A CD8 rise in TNBC samples was observed after NAC plus DCV, changing from 4.48% in the biopsy to 6.70% in the surgical specimen, not reaching statistically significant differences (p = 0.11). This enrichment was seen in up to 67% of TNBC patients in the experimental arm as compared with the CG (20%). An association between CD8 TILs before NAC (4% cut-off point) and pathological complete response in the VG was found in the univariate and multivariate analysis (OR = 1.41, IC95% 1.05–1.90; p = 0.02, and OR = 2.0, IC95% 1.05–3.9; p = 0.03, respectively). Conclusion: Our findings suggest that patients with TNBC could benefit from the stimulation of the antitumor immune system by using DCV together with NAC.

Objective: To compare the Spanish version of the modified Telephone Interview of Cognitive Status (STICS-m) with the Mini-Mental State Examination (MMSE) and predict its ability to detect the development of dementia. Method: 106 participants in a dietary intervention trial underwent face-to-face evaluation with the MMSE, and phone interview with the STICS-m. The correlation between STICS-m and MMSE was assessed with the intraclass correlation coefficient (ICC) of consistency. Secondly, 932 participants over 55 years old from the “Seguimiento Universidad de Navarra” cohort were evaluated with the STICS-m and data on dementia diagnosis were gathered (median follow-up time of 6.5 years). A logistic regression model evaluated the association between STICS-m score or 2-year changes in STICS-m score and risk of developing dementia, adjusting for ApoE, age and years of university education. Results: The ICC between the MMSE and the STICS-m was 0.31 (95% confidence interval [95%CI]: 0.13-0.48). The adjusted odds ratio (OR) for the development of dementia for each additional point in the baseline STICS-m score was 0.85 (95%CI: 0.72-1.02; p = 0.084). When considering the 2-year change in the STICS-m score as exposure, the OR for the development of dementia was 0.79 (95%CI: 0.67-0.93; p = 0.006). Conclusions: The weak correlation between the STICS-m and the MMSE reflects moderate-low concurrent validity. Even so, the STICS-m can be regarded as an useful tool in the epidemiological setting since increasing scores appear to be able to predict a lower risk of developing dementia. Resumen: Objetivo: Estudiar la correlación de la Telephone Interview for Cognitive Status modificada en español (STICS-m) con el Mini-Mental State Examination (MMSE) y predecir la capacidad de la primera para detectar el desarrollo de demencia. Método: Ciento seis sujetos de un estudio de intervención dietética fueron evaluados personalmente con el MMSE y por teléfono con la STICS-m. La correlación entre ambos se midió con el coeficiente de correlación intraclase (CCI) de consistencia. Además, 932 participantes mayores de 55 años de la cohorte “Seguimiento Universidad de Navarra” fueron evaluados con la STICS-m. Durante una mediana de seguimiento de 6,5 años, se recogió información sobre el desarrollo de demencia. Mediante regresión logística se estudió la asociación entre la puntuación de la STICS-m o el cambio a 2 años en la puntuación y el riesgo de desarrollar demencia, ajustando por apolipoproteína E, edad y años de educación universitaria. Resultados: El CCI entre el MMSE y la STICS-m fue de 0,31 (intervalo de confianza del 95% [IC95%]: 0,13-0,48). La odds ratio (OR) ajustada para el desarrollo de demencia para cada punto adicional en la puntuación basal de la STICS-m fue de 0,85 (IC95%: 0,72-1,02; p = 0,084). Al considerar el cambio en la puntuación a los 2 años como variable independiente, la OR fue de 0,79 (IC95%: 0,67-0,93; p = 0,006). Conclusiones: La correlación débil entre la STICS-m y el MMSE refleja solo una moderada-baja validez concurrente. Aun así, la STICS-m puede considerarse útil en el contexto epidemiológico, ya que aumentos en la puntuación parecen predecir un menor riesgo de desarrollar demencia. Keywords: Modified Telephone Interview for Cognitive Status, Spanish, Dementia, Palabras clave: Entrevista telefónica para estatus cognitivo, Español, Demencia

Objectives: Immunostimulatory therapies using immune checkpoint blockers show clinical activity in a subset of glioblastoma (GBM) patients. Several inhibitory mechanisms play a relevant role in the immune response to GBM. With the objective of analyzing the tumor immune microenvironment and its clinical significance, we quantified several relevant immune biomarkers. Design: We studied 76 primary (non-recurrent) GBMs with sufficient clinical follow-up, including a subgroup of patients treated with a dendritic cell vaccine. The IDH-mutation, EGFR-amplification, and MGMT methylation statuses were determined. Several relevant immune biomarkers, including CD163, CD8, PD1, and PDL1, were quantified in representative selected areas by digital image analysis and semiquantitative evaluation. The percentage of each immune expression was calculated with respect to the total number of tumor cells. Results: All GBMs were wild-type IDH, with a subgroup of classical GBMs according to the EGFR amplification (44%). Morphologically, CD163 immunostained microglia and intratumor clusters of macrophages were observed. A significant direct correlation was found between the expression of CD8 and the mechanisms of lymphocyte immunosuppression, in such a way that higher values of CD8 were directly associated with higher values of CD163 (p < 0.001), PDL1 (0.026), and PD1 (0.007). In a multivariate analysis, high expressions of CD8+ (HR = 2.05, 95%CI (1.02–4.13), p = 0.034) and CD163+ cells (HR 2.50, 95%CI (1.29–4.85), p = 0.007), were associated with shorter survival durations. The expression of immune biomarkers was higher in the non-classical (non-EGFR amplified tumors) GBMs. Other relevant prognostic factors were age, receipt of the dendritic cell vaccine, and MGMT methylation status. Conclusions: In accordance with the inverse correlation between CD8 and survival and the direct correlation between effector cells and CD163 macrophages and immune-checkpoint expression, we postulate that CD8 infiltration could be placed in a state of anergy or lymphocytic inefficient activity. Furthermore, the significant inverse correlation between CD163 tissue concentration and survival explains the relevance of this type of immune cell when creating a strong immunosuppressive environment. This information may potentially be used to support the selection of patients for immunotherapy.

Objetivo: Determinar la prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la nutrición maternaMateriales y métodos: Este estudio transversal descriptivo de prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la alimentación de la madre recolectó la información a través del cuestionario del International Study of Asthma and Allergies in Childhood, el cual es empleado para describir el comportamiento epidemiológico de las enfermedades como asma, rinitis y eccema en niños y jóvenes; dicho instrumentos este fue resuelto por los padres de los menores previa firma y entrega del consentimiento informado. El cuestionario arrojó una confiabilidad del 0,78 en el α de Cronbach; a las categorías de interés de este estudio se les hizo análisis de proporción, y el contraste de hipótesis se realizó mediante diferencia de proporciones con intervalo de confianza en un nivel del 95 %,Resultados: Teniendo en cuenta los resultados sobre el consumo de alimentos de la madre en etapa de gestación y la presencia de síntomas de alergia en los menores, se concluye que: Valor-P = 0,05 Valor-Zα/2 = -34,6241 No se acepta la H0 para un α/2 = 0,025, se encontró en el estudio que aunque las madres refirieron haber consumido mayormente alimentos saludables, sus hijos presentaron síntomas de enfermedades alérgicas asociadas a asma, rinitis y eccema.Conclusiones: Este estudio, al igual que otros, no presenta un consenso sobre si la dieta materna influye positivamente en la disminución de alergias en los neonatos.

Un entorno adecuado puede favorecer la práctica de la actividad física, siendo una opción fácil para la población. El objetivo fue determinar la influencia de la percepción de los factores urbanísticos am - bientales en el nivel de actividad física de las personas adultas. Métodos: Estudio transversal basado en el International Physical Ac - tivity and the Environment Network . Las personas participantes fueron se - leccionadas de forma aleatoria y estratificada de la población de las zonas básicas de salud del Área Metropolitana de Pamplona entre las que tenían edad de 18 a 65 años. Se utilizó un cuestionario autoadministrado que inclu - yó la versión completa de la escala Neighborhood Environment Walkability Scale para valorar la percepción de los factores urbanísticos ambientales y la versión larga del International Physical Activity Questionnaire para recoger datos de actividad física. Se calculó la chi 2 y se realizó un análisis multiva - riable mediante regresión logística no condicional. Resultados: Participaron 905 sujetos (54,70% mujeres). Tener sendas de paseo próximas al domicilio o lugar de trabajo se relacionó con practicar actividad física moderada OR: 3,86 (IC 95% 1,70-8,74)] y actividad física total (suma de actividad física vigorosa, moderada y caminar) OR: 2,61 (IC 95% 1,24-5,45)]. La presencia en el barrio de lugares a los que podían ir caminando se asoció con dedicar más tiempo a caminar [OR: 1,26 (IC 95% 1,01-1,58)] y disponer cerca del domicilio o lugar de trabajo de espacios deportivos se asoció con practicar más actividad física vigorosa [OR: 1,46 (IC 95% 1,01 - 2,12). Conclusiones: Existe asociación directa entre la práctica de la actividad física y las características urbanísticas ambientales, como la existencia de sendas de paseo o instalaciones deportivas.

Antecedentes: Las enfermedades alérgicas están asociadas con factores de especial interés para la salud pública,como la alimentación con fórmula láctea como remplazo a la leche materna. El correcto consumo de alimentos desde el inicio de la vida contribuye al adecuado desarrollo de los diferentes sistemas en el organismo que actúan como factores protectores en el desencadenamiento de enfermedades futuras; la inclusión de alimentos diferentes a la leche materna antes de los cuatro meses se encuentra asociada con respuestas alérgicas. Este tipo de investigaciones contribuyen a conocer de primera mano el comportamiento de factores que predisponen a las alergias y así contar con evidencia reciente que colabore en la toma de decisiones acertadas. Objetivo: Correlacionar síntomas asociados con asma, rinitis y eccema al consumo de fórmula láctea antes de 4 meses de vida en Barranquilla, Colombia. Métodos: Estudio de corte transversal en 1520 niños menores de seis a siete meses. Se empleó metodología ISAAC; a cada pregunta relacionada con el objetivo se le aplicó la prueba de chi cuadrado y para la realización de las pruebas se utilizó el software SPSS Statistics versión 24. Se hizo el cálculo de la razón de momios (RM) con intervalo de confianza a 95 % (IC 95%) para la determinación de asociación entre las variables. Resultados: Respecto al asma, rinitis y eccema en relación con el consumo de fórmula láctea antes del primer mes de vida se halló una RM = 1.94 para el asma; para la rinitis RM = 1.637 y para el eccema RM = 1.131. Si la fórmula es introducida después del cuarto mes de vida, RM = 0.374 para asma, RM = 0.745 para rinitis y RM = 0.623 para eccema. Conclusiones: Entre más temprano se introduce la fórmula láctea en los recién nacidos se presenta tendencia al asma, rinitis y eccema; riesgo que desaparece al ser introducida después de los cuatro meses. Al encontrar en la literatura resultados dispares al respecto se recomienda lactar de forma exclusiva hasta los seis meses si no existen factores que no lo permitan.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model’s overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. Material and methods: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4’s new image analysis capability. Results: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as “error requiring intervention to sustain life” and “error resulting in death”, had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model’s high success rate is commendable, understanding the error severity is critical, especially when considering AI’s potential role in real-world medical practice and its implications for patient safety.

With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

IntroductionIncreasing knowledge of obstetric danger signs (ODS) and encouraging birth preparedness and complication readiness (BPCR) practices are strategies to increase skilled maternal health service utilization in low-income countries. One of the methods to increase mothers' knowledge about ODS and promote BPCR practice is through health education intervention (HEI). However, the effect of context-specific community-based health education led by women's groups on these outcomes has yet to be comprehensively studied, and the existing evidence is inconclusive. Thus, we aimed to evaluate the effect of a context-specific community-based HEI led by women's groups on mothers' knowledge regarding ODS and BPCR practices in southern Ethiopia.MethodsAn open-label, two-arm parallel group cluster-randomized controlled trial was conducted from January to August 2023 on pregnant women from 24 clusters (kebeles) (12 interventions and 12 controls) in the northern zone of the Sidama region. The Open Data Kit smartphone application was utilized to collect data. The intention-to-treat analysis was used to compare outcomes between groups. We fitted multilevel mixed-effects modified Poisson regression with robust standard error to account for between and within cluster effects.ResultsOne thousand and seventy pregnant women (540 in the intervention and 530 in the control clusters) responded to this study, making the overall response rate 95.02%. Excessive vaginal bleeding (94.3% in the interventional group vs. 88.7% in the control group) was the commonest ODS mentioned during childbirth. Overall, 68.7% of women in the intervention group and 36.2% of mothers in the control group had good knowledge of ODS (P-value < 0.001). Saving money and materials (97.1% in the interventional group vs. 92.7% in the control group) was the most frequently practiced BPCR plan. Overall, 64.3% of women in the intervention group and 38.9% of mothers in the control group practiced BPCR (P-value < 0.001). HEI significantly increased overall knowledge of ODS (adjusted risk ratio [ARR]: 1.71; 99% CI: 1.14-2.57) and improved overall BPCR practice (ARR: 1.55; 99% CI: 1.02-2.39).ConclusionsA community-based HEI led by women's groups improved mothers' knowledge regarding ODS and BPCR practices in a rural setting in southern Ethiopia. Interventions designed to increase women's knowledge of ODS and improve BPCR practice must implement context-specific, community-based HEI that aligns with World Health Organization recommendations.Trial registrationNCT05865873.

Background: Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. Objectives: This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. Design: A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. Methods: Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. Results: Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). Conclusion: Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.

After three years of the COVID-19 pandemic, it is certain that the SARS-CoV-2 virus has been a turning point for humanity in both developed and developing countries [...]

Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.

Background: Hospital health care workers are at high risk of developing COVID-19 and transmitting the disease to their family upon returning home; the aim here is to estimate the secondary attack rate of COVID-19 in household contacts of health care workers and their transmission risk factors. Material and Methods: COVID-19 cases in the health care workers of an academic hospital in Pamplona, Spain, from 2 March to 26 May 2020, were followed up. The secondary attack rate (SAR) was estimated from cases in household contacts of index cases and their risk factors by Poisson regression. Results: 89 index cases were studied from 99 notified cases in health care workers (89.0%), excluding secondary cases or those who lived alone. Forty-six secondary cases confirmed by the laboratory were found among 326 household contacts, a secondary attack rate of 14.11% (95% CI 10.75–18.31), and 33 household contacts with acute infection symptoms without microbiologic confirmation 10.12% (95% CI 7.30–13.87). Considering all the cases, the secondary attack rate was 27.3 (95% CI 22.75–32.38). Risk factors were the gender and profession of the index case, the number of people living in the household, and the number of persons per bedroom. When the index case health worker used a single room, it had a protective effect, with an incidence rate ratio (IRR) of 0.493 (95% CI 0.246–0.985); Conclusions: The secondary attack rate found among household contacts of health care workers is high. The preventive isolation of health care workers in individual rooms in their house may reduce the transmission in their families.

SARS-CoV-2 is responsible for the COVID-19 pandemic, which has caused almost 570 million infections and over six million deaths worldwide. To help curb its spread, solutions using ultraviolet light (UV) for quick virus inactivation inside buildings without human intervention could be very useful to reduce chances of contagion. The UV dose must be sufficient to inactivate the virus considering the different materials in the room, but it should not be too high, not to degrade the environment. In the present study, we have analyzed the ability of a 254 nm wavelength UV-C lamp to inactivate dried samples of SARS-CoV-2 exposed at a distance of two meters, simulating a full-scale scenario. Our results showed that virus inactivation was extremely efficient in most tested materials, which included plastic, metal, wood, and textile, with a UV-C exposure of only 42 s (equivalent to 10 mJ/cm2). However, porous materials like medium density fibreboard, were hard to decontaminate, indicating that they should be avoided in hospital rooms and public places.

Background: Deaths due to vaccine-preventable diseases are one of the leading causes of death among African children. Vaccine coverage is an essential measure to decrease infant mortality. The COVID-19 pandemic has affected the healthcare system and may have disrupted vaccine coverage. Methods: DTP third doses (DTP3) Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) with 95% confidence intervals (95% CI) was calculated for Africa and the regions. We compared DTP3 vaccination coverage in 2019–2021 in each country using the Chi-square test. Result: During the whole period, the vaccine coverage in Africa increased with an Annual Percent change of 1.2% (IC 95% 0.9–1.5): We detected one joinpoint in 2019. In 2019–2021, there was a decrease in DTP3 coverage with an APC of −3.5 (95% −6.0; −0,9). (p < 0.001). Vaccination rates decreased in many regions of Sub-Saharan Africa, especially in Eastern and Southern Africa. There were 26 countries (Angola, Cabo Verde, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Ethiopia, Eswatini, The Gambia, Guinea-Bissau, Liberia, Madagascar, Malawi, Mauritania, Mauritius, Mozambique, Rwanda, Senegal, Seychelles, Sierra Leone, Sudan, Tanzania, Togo, Tunisia, Uganda, and Zimbabwe) where the vaccine coverage during the two years decreased. There were 10 countries (Angola, Cabo Verde, Comoros, Democratic Republic of the Congo, Eswatini, The Gambia, Mozambique, Rwanda, Senegal, and Sudan) where the joinpoint regression detected a change in the trend. Conclusions. COVID-19 has disrupted vaccine coverage, decreasing it all over Africa.

Background: More than 270 million participants and 128,893 professional players play soccer. Although UEFA recommendations for nutrition in elite football exist, implementing these guidelines among professional and semiprofessional soccer players remains suboptimal, emphasizing the need for targeted and individualized nutritional strategies to improve adherence to established recommendations. Methods: We conducted a comprehensive search in PubMed, Scopus, Web of Science, and clinical trial registers. Inclusion criteria focused on professional or semiprofessional soccer players, nutrition or diet interventions, performance improvement outcomes, and randomized clinical trial study types. We assessed quality using the Risk of Bias 2 (RoB 2) tool. We identified 16 eligible articles involving 310 participants. No nutritional interventions during the recovery period effectively improved recovery. However, several performance-based interventions showed positive effects, such as tart cherry supplementation, raw pistachio nut kernels, bicarbonate and mineral ingestion, creatine supplementation, betaine consumption, symbiotic supplements, and a high-carbohydrate diet. These interventions influenced various aspects of soccer performance, including endurance, speed, agility, strength, power, explosiveness, and anaerobic capacity. Conclusions: Specific strategies, such as solutions with bicarbonate and minerals, high carbohydrate diets, and supplements like creatine, betaine, and tart cherry, can enhance the performance of professional soccer players. These targeted nutritional interventions may help optimize performance and provide the competitive edge required in professional soccer. We did not find any dietary interventions that could enhance recovery.

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

Abstract  Few studies have focused on the long-term influence of the climate on the prevalence of asthma. The aim of this study is to establish the influence of geo-climatic conditions on the prevalence of asthma symptoms both in adolescents and schoolchildren, and to discover if this influence is associated with their time trends. Eight centres in Spain performed both ISAAC phases I (1994) and III (2002) in children 13–14 years old. Six of them also surveyed children 6–7 years old. For each age group and phase, about 3,000 children were surveyed per centre. This study examines the prevalence of current wheeze and severe current wheeze in two different geo-climatic zones, coast and plateau, considering their relative humidity and temperature range. In both age groups, the mean asthma prevalence on the coast, for phase I and III, was significantly higher than on the plateau. Living on the plateau was an independent protective factor for current wheeze and severe current wheeze for the two age groups. Within the coastal centres, the increase of the annual relative humidity was a statistical significant risk factor for current wheeze, the same trend existing for current severe wheeze. These effects were independent of the sex and of the phase of the study. The prevalence of asthma and severe asthma symptoms is more frequent on the coast of Spain as compared to the inner plateau. This finding was repeated both in 1994 and in 2002. [ABSTRACT FROM AUTHOR]

Fundamento: Los conocimientos actuales permiten considerar que existe una asociación de tipo causal entre el nivel de actividad física y la aparición de diversas enfermedades. A pesar de ello, la actividad física es una práctica poco arraigada en la población, que cada vez se está haciendo más sedentaria. El objetivo de este estudio es describir la prevalencia de sedentarismo en la población de Pamplona, así como conocer cuáles son los factores que más influyen en él. Métodos: Se llevó a cabo un estudio transversal mediante encuesta postal en una muestra significativa de la población de Pamplona de 18 a 65 años. La encuesta utilizada incluía una evaluación de la actividad física realizada, basada en el cuestionario de actividad física de Paffenbarger. Se realizó un análisis bivariado y multivariado con aplicación de regresión logística. Resultados: Un 76,6% de las mujeres tienen un estilo de vida sedentario, mientras que en los varones este porcentaje se reduce hasta un 56,7%. El sedentarismo se incrementa con la edad, existiendo hasta un 80,3% de varones sedentarios en el grupo de mayor edad, y un 86,3% entre las mujeres, respectivamente. Conclusiones: Los factores sociodemográficos como sexo, edad, estudios, profesión y estado civil parecen ser determinantes del estilo de vida sedentario, mientras el consumo de tabaco y la existencia de sobrepeso y obesidad no lo son. Entre las personas jóvenes, las mujeres sin estudios universitarios y los varones casados y fumadores parecen ser poblaciones diana para la promoción de la actividad física.

Fundamento: La demanda a los servicios de urgencias, tanto hospitalarios como extrahospitalarios, mantiene un ritmo creciente. El objetivo del presente trabajo es doble: cuantificación y estudio de las características personales de los usuarios demandantes de atención urgente y valorar si el fútbol televisado influye en la utilización del servicio de urgencias. Métodos: Estudio descriptivo longitudinal (9.723 usuarios demandantes) y estudio de casos y controles (1.284 usuarios demandantes) según presencia o no de fútbol televisado mediante modelo de regresión logística. Las asociaciones se han cuantificado mediante la odds ratio (OR). Se excluyen del estudio las consultas telefónicas y las de enfermería. Resultados:El 10,6% de la demanda ha correspondido a consultas en domicilio y se han remitido al hospital el 4,8% del total. El 13,3% de la demanda corresponde a personas desplazadas de otras zonas de salud y son 65 los usuarios hiperfrecuentadores con 8 o más consultas. El mes de agosto (32,3%), el domingo (44,56%) y el grupo horario de 12 a 14 horas (8,38%) son los momento de mayor demanda de atención, siendo las diferencias estadísticamente significativas. El fútbol televisado se asoció a un aumento de la demanda del 19,8% (p

En el ámbito de la investigación de la etiogenia de los trastornos de la conducta alimentaria, los modelos explicativos multicausales han propuesto que la Insatisfacción Corporal es uno de los factores predisponentes. En este trabajo se analiza cómo se distribuye esta variable, medida con el Body Shape Questionnaire (BSQ), en un grupo de adolescentes según la edad y el sexo, y si el anonimato de respuesta influye en la tendencia de la misma. El BSQ fue administrado a una muestra de 294 adolescentes de 12 a 19 años de un Instituto de Enseñanza Secundaria, utilizando un diseño de tres variables (edad, sexo y anonimato) con 3, 2 y 2 categorías respectivamente, obteniendo 12 grupos. Se concluyó que el anonimato de respuesta no influye en la medida de la insatisfacción corporal con el BSQ en un grupo de adolescentes. A los 12-13 años se muestran niveles muy bajos de insatisfacción corporal y no hay diferencias entre los chicos y las chicas en sus puntuaciones. Los chicos mantienen su puntuación de insatisfacción corporal en el intervalo de edad 12-13 a 17-19; las chicas la incrementan en el intervalo que va de 12-13 a 15-16, manteniéndolo posteriormente en niveles similares en edades posteriores, lo que apuntaría la idea de que la insatisfacción corporal se instaura en el período que va de los 12 a los 16 años