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OBJECTIVE: To extend knowledge about the long-term use of hormones in hormone therapy or oral contraception as prognostic factors in breast cancer. METHODS: The MCC-Spain project is a cohort of 1,685 women with incident breast cancer recruited in Spain. Recruitment was carried out between 2007 and 2010, and the follow-up finished in December 2017. The impact of hormone therapy or oral contraception on breast cancer prognosis was analyzed considering year of birth and menopausal status (1,095 women [65%] were postmenopausal). Hazard ratios (HRs) were estimated using Cox regression models. Death by any cause was considered as the event, and hormone therapy or oral contraception were analyzed as regressors. RESULTS: Oral contraception use for less than 5 years shows an HR of 1.10 (95% CI, 0.75 to 1.62), whereas use for 5 or more years shows an HR of 1.46 (95% CI, 0.95 to 2.25), with a P trend of 0.01, showing a dose-dependent response. Regarding hormone therapy and restricting the analysis to postmenopausal women born between1940 and 1959, where most hormone therapy (consumption) is concentrated, the results did not show any trend. CONCLUSION: Concerning oral contraception use, our results demonstrate that their use is related to poor prognosis in breast cancer. However, research in this field is limited and controversial, indicating the need for more research in this area. Regarding hormone therapy consumption, our results indicate no association with better prognosis, which contradicts what has previously been published.

Background We compare the risk of coronavirus disease 2019 (COVID-19) outcomes among co-circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants between January 2021 and May 2022 in Navarra, Spain. Methods We compared the frequency of hospitalization and severe disease (intensive care unit admission or death) due to COVID-19 among the co-circulating variants. Variants analyzed were non–variants of concern (non-VOCs), Alpha, Delta, Omicron BA.1, and Omicron BA.2. Logistic regression models were used to estimate adjusted odds ratio (aOR). Results The Alpha variant had a higher risk of hospitalization (aOR, 1.86 [95% confidence interval {CI}, 1.28–2.71]) and severe disease (aOR, 2.40 [95% CI, 1.31–4.40]) than non-VOCs. The Delta variant did not show a significantly different risk of hospitalization (aOR, 0.73 [95% CI, .40–1.30]) and severe disease (aOR, 3.04 [95% CI, .57–16.22]) compared to the Alpha variant. The Omicron BA.1 significantly reduced both risks relative to the Delta variant (aORs, 0.28 [95% CI, .16–.47] and 0.23 [95% CI, .12–.46], respectively). The Omicron BA.2 reduced the risk of hospitalization compared to BA.1 (aOR, 0.52 [95% CI, .29–.95]). Conclusions The Alpha and Delta variants showed an increased risk of hospitalization and severe disease, which decreased considerably with the Omicron BA.1 and BA.2. Surveillance of variants can lead to important differences in severity.

El diseño y validación de instrumentos en el contexto específico de su uso, garantizando la calidad, es un reto para la psicología. A esto se suma la exigencia legal por parte del gobierno colombiano de medir y gestionar los factores de riesgo psicosocial laboral y las variables individuales asociadas. Este estudio presenta los resultados del proceso de validación del instrumento de estilos de afrontamiento IDEA-10, adicionalmente brinda claridades para la comprensión de este fenómeno a partir de las relaciones encontradas con otras variables. La escala evalúa diez estilos de afrontamiento referenciados en la literatura derivados del modelo de Lazarus & Folkman (1984). Se calculó la fiabilidad por medio de Alpha de Cronbach y Omega McDonald obteniendo resultados entre .37 y .80 en el primer caso y .76 y .85 en el segundo. Se verificó la validez concurrente por medio de correlaciones, la predictiva a partir de regresiones múltiples, y de constructo empleando análisis factoriales exploratorios y confirmatorios dando cuenta no solamente a la calidad del instrumento sino también del funcionamiento del constructo en la población trabajadora colombiana. Para los análisis se utilizaron medidas de autoestima, autoeficacia, desarrollo psicológico, felicidad en la vida y en el trabajo, equilibrio emocional, estrés, burnout y engagement. La muestra fue de 38267 trabajadores colombianos. Los resultados evidencian la calidad del instrumento y corroboran la existencia de diez dimensiones evaluadas aportando sustento sobre sus efectos. Reinterpretación positiva, apoyo social y resolución de problemas muestran mejores asociaciones con fenómenos positivos por lo que conviene fomentar su uso. Desconexión, autoinculpación y autodistracción se relacionan con mayores síntomas de estrés y burnout.

Background As COVID-19 vaccine effectiveness against SARS-CoV-2 infection was lower for cases of the Omicron vs the Delta variant, understanding the effect of vaccination in reducing risk of hospitalisation and severe disease among COVID-19 cases is crucial. Aim To evaluate risk reduction of hospitalisation and severe disease in vaccinated COVID-19 cases during the Omicron BA.1-predominant period in Navarre, Spain. Methods A case-to-case comparison included COVID-19 epidemiological surveillance data in adults ≥ 18 years from 3 January–20 March 2022. COVID-19 vaccination status was compared between hospitalised and non-hospitalised cases, and between severe (intensive care unit admission or death) and non-severe cases using logistic regression models. Results Among 58,952 COVID-19 cases, 565 (1.0%) were hospitalised and 156 (0.3%) were severe. The risk of hospitalisation was reduced within the first 6 months after full COVID-19 vaccination (complete primary series) (adjusted odds ratio (aOR): 0.06; 95% CI: 0.04–0.09) and after 6 months (aOR: 0.16; 95% CI: 0.12–0.21; pcomparison Conclusions Full COVID-19 vaccination greatly reduced the risk of hospitalisation and severe outcomes in COVID-19 cases with the Omicron variant, and a booster dose improved this effect in people aged over 65 years.

In this study, we aimed to present mortality indicators from a database of death causes by age and sex in Navarre (Spain) for 2020: life expectancy at birth, excess mortality, and mortality from COVID-19 and other causes.A Poisson regression model, which accounts for temporal trends in the previous years, was used to estimate the expected deaths by sex and age for 2020.Life expectancy at birth in Navarre for 2020 was 80.6 and 85.9 years for men and women, respectively, 1.4 and 1.0 years lower than in 2019. Deaths in people aged55 years were similar to those expected. The highest adjusted excess mortality rate occurred among men and women aged85 years, were 61% of excess deaths was concentrated. The estimated number of excess deaths did not exceed the number of reported deaths from COVID-19. In individuals aged75 years, around 9 out of 10 people died from COVID-19. Coinciding with the COVID-19 pandemic, there was a remarkable decrease in mortality in people affected by diseases where dementia is included.The first and second waves of the COVID-19 pandemic reduced life expectancy at birth to figures observed ten years ago. The increase in deaths in Navarre for 2020 is largely attributable to COVID-19.

Latin America is one of the regions in which the COVID-19 pandemic has a stronger impact, with more than 72 million reported infections and 1.6 million deaths until June 2022. Since this region is ecologically diverse and is affected by enormous social inequalities, efforts to identify genomic patterns of the circulating SARS-CoV-2 genotypes are necessary for the suitable management of the pandemic. To contribute to the genomic surveillance of the SARS-CoV-2 in Latin America, we extended the number of SARS-CoV-2 genomes available from the region by sequencing and analyzing the viral genome from COVID-19 patients from seven countries (Argentina, Brazil, Costa Rica, Colombia, Mexico, Bolivia, and Peru). Subsequently, we analyzed the genomes circulating mainly during 2021 including records from GISAID database from Latin America. A total of 1,534 genome sequences were generated from seven countries, demonstrating the laboratory and bioinformatics capabilities for genomic surveillance of pathogens that have been developed locally. For Latin America, patterns regarding several variants associated with multiple re-introductions, a relatively low percentage of sequenced samples, as well as an increment in the mutation frequency since the beginning of the pandemic, are in line with worldwide data. Besides, some variants of concern (VOC) and variants of interest (VOI) such as Gamma, Mu and Lambda, and at least 83 other lineages have predominated locally with a country-specific enrichments. This work has contributed to the understanding of the dynamics of the pandemic in Latin America as part of the local and international efforts to achieve timely genomic surveillance of SARS-CoV-2. Copyright © 2023 Molina-Mora, Reales-González, Camacho, Duarte-Martínez, Tsukayama, Soto-Garita, Brenes, Cordero-Laurent, Ribeiro dos Santos, Guedes Salgado, Santos Silva, Santana de Souza, Nunes, Negri, Vidal, Oliveira, Oliveira, Muñoz-Medina, Salas-Lais, Mireles-Rivera, Sosa, Turjanski, Monzani, Carobene, Remes Lenicov, Schottlender, Fernández Do Porto, Kreuze, Sacristán, Guevara-Suarez, Cristancho, Campos-Sánchez and Herrera-Estrella.

Instituto de Salud Carlos III; Miguel Servet program (CPII20/00009) from the Institute of Health Carlos III (cofunded by the European Social Fund (ESF) – ESF investing in your future) (...), Llaha, F., Cayssials, V., Farràs, M., Agudo, A., Sandström, M., Eriksen, A.K., Tjønneland, A., Boutron-Ruault, M.-C., Laouali, N., Truong, T., Le Cornet, C., Katzke, V., Schulze, M., Palli, D., Krogh, V., Signoriello, S., Tumino, R., Ricceri, F., Skeie, G., Jensen, T.M.E., Chen, S.L.F., Lasheras, C., Rodriguez-Barranco, M., Amiano, P., Huerta, J.M., Guevara, M., Almquist, M., Nilson, L.M., Hennings, J., Papier, K., Heath, A., Weiderpass, E., Rinaldi, S., Zamora-Ros, R.

Background: Coffee contains many bioactive substances that can play a role on colorectal cancer. Epidemiological evidence of coffee intake and colorectal cancer is, however, inconsistent. Aim: To provide further information on the risk of colorectal cancer in relation to coffee consumption. Methods: Data derive from two companion case-control studies conducted in Italy and Spain within the European Union Project on Health Impacts of long-term exposure to disinfection by-products in Drinking Water and the Spanish Multi-Case Control study on Cancer. These included a total of 2289 incident cases with colorectal cancer and 3995 controls with information on coffee intake. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were derived from unconditional logistic regression models, adjusted for study centre, sex, age, education, smoking, and other covariates. Results: Compared with never coffee drinkers, the OR was 0.99 (95% CI 0.95-1.02) for total coffee consumption. There was no significant trend in risk with dose or duration, the ORs being 0.95 (95% CI 0.72-1.25) for an amount of five or more cups per day of coffee and 0.95 (95% CI 0.75-1.19) for a duration of consumption of 50 years or longer. The OR was 1.04 (95% CI 0.87-1.25) for two or more cups per day of decaffeinated coffee. There were no heterogeneity across strata of various covariates, as well as no apparent differences between various anatomical subsites. Conclusion: This large pooled analysis of two studies shows no association of coffee and decaffeinated coffee with colorectal cancer risk.

Background The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). Methods Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. Results A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. Conclusions The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Some species of fusaria are well-known pathogens of humans, animals and plants. Fusarium oxysporum and Neocosmospora solani (formerly Fusarium solani) cause human infections that range from onychomycosis or keratitis to severe disseminated infections. In general, these infections are difficult to treat due to poor therapeutic responses in immunocompromised patients. Despite that, little is known about the molecular mechanisms and transcriptional changes responsible for the antifungal resistance in fusaria. To shed light on the transcriptional response to antifungals, we carried out the first reported high-throughput RNA-seq analysis for F. oxysporum and N. solani that had been exposed to amphotericin B (AMB) and posaconazole (PSC). We detected significant differences between the transcriptional profiles of the two species and we found that some oxidation-reduction, metabolic, cellular and transport processes were regulated differentially by both fungi. The same was found with several genes from the ergosterol synthesis, efflux pumps, oxidative stress response and membrane biosynthesis pathways. A significant up-regulation of the C-22 sterol desaturase (ERG5), the sterol 24-C-methyltransferase (ERG6) gene, the glutathione S-transferase (GST) gene and of several members of the major facilitator superfamily (MSF) was demonstrated in this study after treating F. oxysporum with AMB. These results offer a good overview of transcriptional changes after exposure to commonly used antifungals, highlights the genes that are related to resistance mechanisms of these fungi, which will be a valuable tool for identifying causes of failure of treatments.

Endocrine therapy (ET) is the mainstream adjuvant treatment for ER-positive breast cancer (BC). We analysed 9293 ER-positive BC patients diagnosed in nine European countries in 2009–2013 to investigate how comorbidities at diagnosis, age, stage and subtype affected ET use over time, and relapse. Adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs) of receiving ET were estimated according to Charlson comorbidity, age, stage and subtype using logistic regression. The 2-year cumulative incidence and adjusted sub-hazard ratios (SHRs) of relapse were estimated using competing risk analysis, with all-cause death as the competing event. The z-test was used to assess differences in the proportion of patients receiving ET in 1996–1998 and 2009–2013. Ninety percent of the patients started adjuvant ET, range 96% (Belgium, Estonia, Slovenia, Spain)—75% (Switzerland). ORs of starting ET were lower for women aged > 75 years, with severe comorbidities, or luminal B HER2-positive cancer. The factors independently increasing the risk of relapse were: not receiving ET (SHR 2.26, 95%CI 1.02–5.03); severe comorbidity (SHR 1.94, 95%CI 1.06–3.55); luminal B, either HER2 negative (SHR 3.06, 95%CI 1.61–5.79) or positive (SHR 3.10, 95%CI 1.36–7.07); stage II (SHR 3.20, 95%CI 1.56–6.57) or stage III (SHR 7.41, 95%CI 3.48–15.73). ET use increased significantly but differently across countries from 51–85% in 1996–1998 to 86–96% in 2009–2013. ER-positive BC patients in Europe are increasingly prescribed ET but between-country disparities persist. Older women and women with severe comorbidity less frequently receive ET. ET omission and severe comorbidity independently predict early disease relapse.

Coprophilous fungi are saprotrophic organisms that show great diversity, mainly on herbivore dung. The physico-chemical characteristics of this peculiar substrate combined with the high level of fungal adaptation to different environmental conditions offer the perfect setting for discovering new taxa. This study focused on the species diversity of penicillium-like fungi isolated mainly from herbivore dung collected at different Spanish locations. From 130 samples, a total of 104 isolates were obtained, and 48 species were identified. Preliminary identifications were based on morphology and partial β-tubulin (tub2) gene sequences. Putative new taxa were characterized by a multi-gene sequencing analysis testing the tub2, the internal transcribed spacer rDNA (ITS), calmodulin (cmdA), and RNA polymerase II second largest subunit (rpb2) genes, and a detailed phenotypic study. Using this polyphasic approach and following the genealogical concordance phylogenetic species recognition (GCPSR) method, we propose the new genera Penicillago (for Penicillium nodositatum) and Pseudopenicillium (for Penicillium megasporum and P. giganteum) in the family Aspergillaceae, and 11 new species, including seven Penicillium, three Talaromyces and one Pseudopenicillium. A lectotype and epitype are designed for Penicillium nodositatum. Our results show that the species diversity of penicillium-like fungi on herbivore dung has not been widely studied and that this substrate seems to be a good reservoir of interesting Eurotialean fungi.

El objetivo fue identificar si el Compromiso Afectivo (CA) media la relación entre las Prácticas de Gestión Humana (PGH) y las Conductas de Ciudadanía Organizacional (CCO) en una muestra de jefes colombianos. Estudios refieren que las PGH tienen impacto en el compromiso, y este, a su vez, en el desempeño, pero hay menor producción científica sobre el papel mediador del compromiso entre las variables. El estudio fue cuantitativo, no experimental y transversal. Se trabajó con 1037 jefes de 13 empresas colombianas de distintos sectores. Los hallazgos confirman que el CA media entre las PGH y las CCO. Cuando los empleados perciben existencia, calidad y cobertura de las PGH, ello impacta positivamente su vinculación afectiva con la organización y, a su vez, desarrollan mayores conductas en beneficio de esta y de sus compañeros de trabajo, sin que dichos comportamientos se encuentren previamente definidos en su cargo.

Continued waves, new variants, and limited vaccine deployment mean that SARS-CoV-2 tests remain vital to constrain the COVID-19 pandemic. Affordable, point-of-care (PoC) tests allow rapid screening in non-medical settings. Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) is an appealing approach. A crucial step is to optimize testing in low/medium resource settings. Here, we optimized RT-LAMP for SARS-CoV-2 and human β-actin, and tested clinical samples in multiple countries. “TTTT” linker primers did not improve performance, and while guanidine hydrochloride, betaine and/or Igepal-CA-630 enhanced detection of synthetic RNA, only the latter two improved direct assays on nasopharygeal samples. With extracted clinical RNA, a 20 min RT-LAMP assay was essentially as sensitive as RT-PCR. With raw Canadian nasopharygeal samples, sensitivity was 100% (95% CI: 67.6% - 100%) for those with RT-qPCR Ct values ≤ 25, and 80% (95% CI: 58.4% - 91.9%) for those with 25 < Ct ≤ 27.2. Highly infectious, high titer cases were also detected in Colombian and Ecuadorian labs. We further demonstrate the utility of replacing thermocyclers with a portable PoC device (FluoroPLUM). These combined PoC molecular and hardware tools may help to limit community transmission of SARS-CoV-2.

Massive molecular testing for COVID-19 has been pointed out as fundamental to moderate the spread of the pandemic. Pooling methods can enhance testing efficiency, but they are viable only at low incidences of the disease. We propose Smart Pooling, a machine learning method that uses clinical and sociodemographic data from patients to increase the efficiency of informed Dorfman testing for COVID-19 by arranging samples into all-negative pools. To do this, we ran an automated method to train numerous machine learning models on a retrospective dataset from more than 8,000 patients tested for SARS-CoV-2 from April to July 2020 in Bogotá, Colombia. We estimated the efficiency gains of using the predictor to support Dorfman testing by simulating the outcome of tests. We also computed the attainable efficiency gains of non-adaptive pooling schemes mathematically. Moreover, we measured the false-negative error rates in detecting the ORF1ab and N genes of the virus in RT-qPCR dilutions. Finally, we presented the efficiency gains of using our proposed pooling scheme on proof-of-concept pooled tests. We believe Smart Pooling will be efficient for optimizing massive testing of SARS-CoV-2.

Evidence of influenza vaccine effectiveness in preventing confirmed influenza among persons diagnosed with chronic obstructive pulmonary disease (COPD) is scarce. We assessed the average effect of influenza vaccination in the current and prior seasons in preventing laboratory-confirmed influenza in COPD patients. We carried out a pooled test-negative case–control design in COPD patients hospitalized or presented to primary healthcare centres with influenza-like illness who were tested for influenza in 2015/2016 to 2019/2020 seasons in Navarre, Spain. Influenza vaccination status in the current and 5 prior seasons was compared between confirmed-influenza cases and test-negative controls. Vaccination effect was compared between target patients for vaccination with and without COPD. Out of 1761 COPD patients tested, 542 (31%) were confirmed for influenza and 1219 were test-negative controls. Average effect for current-season vaccination in preventing influenza was 40% (95% CI 20–54%), and for vaccination in prior seasons only was 24% (95% CI –10 to 47%). Point estimates seemed higher in preventing outpatient cases (60% and 58%, respectively) than inpatient cases (37% and 19%, respectively), but differences were no statistically significant. Influenza vaccination effect was similar in target population with and without COPD (p = 0.339). Influenza vaccination coverage in control patients with COPD was 68.3%. A 13.7% of the influenza cases in patients with COPD could be prevented by extending the influenza vaccine coverage. Average effect of current-season influenza vaccination was moderate to prevent influenza in COPD persons. The increase of influenza vaccination coverage can still prevent COPD exacerbations.

Introducción: La mujer embarazada tiene cambios propios de su estado, que las hacen más susceptible a desencadenar falla respiratoria, convirtiéndola en un reto terapéutico para el profesional de la salud. La presente investigación describe el abordaje fisioterapéutico en la falla respiratoria durante el embarazo, según la literatura disponible entre el periodo 2007-2017. Métodos: Estudio de enfoque cualitativo, de tipo revisión documental con método descriptivo. La búsqueda fue realizada en bases de datos indexadas, evidenciando cambios anatómicos y fisiológicos del embarazo y su factor de riesgo en la falla respiratoria, así como el abordaje fisioterapéutico con el empleo de técnicas invasivas y no invasivas, Resultados: Los cambios anatomofisiológicos que predisponen a la falla respiratoria en la mujer durante el estado de gestación son disminución de la Capacidad Funcional Residual (CFR), alteración de la mecánica respiratoria, edema de la vía aérea superior y aumento del Consumo de Oxigeno (VO2). Se destaca la utilización de técnicas de fisioterapia de tórax como alternativa psicoprofiláctica durante el embarazo. La Ventilación Mecánica No Invasiva (VMNI) es la primera alternativa con el fin de evitar la intubación y daño pulmonar causado por la Ventilación Mecánica Invasiva (VMI). El uso de técnica invasivas como la Oxigenación por Membrana Extracorpórea (ECMO), se emplea como último recurso en el rescate de la falla respiratoria. Conclusión: Durante el embarazo se presentan múltiples modificaciones a nivel de los diferentes sistemas corporales, haciendo que se convierta en una paciente de alta complejidad en su intervención. Una de las causas principales de ingreso a la Unidad de Cuidados Intensivos (UCI) es la falla respiratoria en la gestante, haciendo necesario implementar el uso de técnicas invasivas y no invasivas, brindando seguridad al paciente con profesionales capacitados en el área.

Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = -0.9), but prompt treatment weakly (R = -0.01/-0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.

COVID-19 vaccine effectiveness was evaluated in close contacts of cases diagnosed during January–April 2021. Among 20,961 contacts, 7,240 SARS-CoV-2 infections were confirmed, with 5,467 being symptomatic and 559 leading to hospitalisations. Non-brand-specific one and two dose vaccine effectiveness were respectively, 35% (95% confidence interval (CI): 25 to 44) and 66% (95% CI: 57 to 74) against infections, 42% (95% CI: 31 to 52) and 82% (95% CI: 74 to 88) against symptomatic infection, and 72% (95% CI: 47 to 85) and 95% (95% CI: 62 to 99) against COVID-19 hospitalisation. The second dose significantly increased effectiveness. Findings support continuing complete vaccination.

BackgroundAfter the first pandemic wave, a nationwide seroepidemiological survey assessed the seroprevalence of SARS-CoV-2 antibodies in the population of Spain and found notable differences among provinces whose causes remain unclear. The present study aimed to examine the influence of environmental factors on SARS-CoV-2 infection. MethodsThis ecological study analyzed the association between environmental and demographic factors and SARS-CoV-2 infection by province. Environmental temperature and humidity were obtained from the Spanish Meteorological Agency and province extension, and latitude and altitude above sea level of their capital cities from the Geographical Institute. The seroprevalence SARS-CoV-2 antibodies by province was obtained from a nationwide representative survey performed in June 2020, after the first pandemic wave in Spain. Linear regression was used in the analysis.ResultsThe seroprevalence of SARS-CoV-2 antibodies of the 50 provinces ranged from 0.2% to 13.6%. Altitude explained nearly half of differences in seroprevalence (determination coefficient [R2]=0.46, p2=0.55, p2 of increase in population density, the seroprevalence increased by 0.84 and 0.63 percentage points, respectively.ConclusionsEnvironmental conditions related to higher altitude in winter-spring, as lower temperature and absolute humidity, may be relevant to SARS-CoV-2 transmission. Places with such adverse conditions may require additional efforts for pandemic control.

Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29–69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05–2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66–1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings., Instituto de Salud Carlos III (PIE14/00045), Crohn’s and Colitis UK (M2017-2), e Intra-CIBERESP mobility program (ESPF60/2017), International Agency for Research on Cancer (IARC), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, NIHR Imperial Biomedical Research Centre (BRC), Health Research Fund (FIS)-Instituto de Salud Carlos III (ISCIII), e Regional Governments of Andalusia, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology-ICO (Spain)

Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5–7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8, cases = 1141), PCV10 types caused 5% of cases &lt, 5 years of age and 15% among ≥5 years, the top serotypes were 19A, 6C, and 3, together causing 42% of cases &lt, 5 years and 37% ≥5 years. In PCV13-using sites (N = 32, cases = 4503), PCV13 types caused 14% in &lt, 5 and 26% in ≥5 years, 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.

The St Gallen Conference endorsed in 2013 a series of recommendations on early breast cancer treatment. The main purpose of this article is to ascertain the clinical factors associated with St Gallen-2013 recommendations accomplishment. A cohort of 1152 breast cancer cases diagnosed with pathological stage, Biological samples were stored at the biobanks supported by Instituto de Salud Carlos III-FEDER: Parc de Salut MAR Biobank (MARBiobanc) (RD09/0076/00036), ‘Biobanco La Fe’ (RD 09 0076/00021) and FISABIO Biobank (RD09 0076/00058), as well as at the Public Health Laboratory of Gipuzkoa, the Basque Biobank, the ICOBIOBANC (sponsored by the Catalan Institute of Oncology), the IUOPA Biobank of the University of Oviedo, and the ISCIII Biobank. SNP genotyping services were provided by the Spanish ‘Centro Nacional de Genotipado’ (CEGEN-ISCIII). We thank all the subjects who participated in the study and all MCC-Spain col laborators. This work was supported by the ‘Acción Transversal del Cancer’, approved by the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III, co-founded by FEDER funds-‘a way to build Europe’ (Grants PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/00613, and PI15/00069). Support was also provided by the Fundación Marqués de Valdecilla (Grant API 10/09); the Junta de Castilla y León (Grant LE22A10-2); the Consejería de Salud of the Junta de Andalucía (2009-S0143); the Conselleria de Sanitat of the Generalitat Valenciana (Grant AP 061/10); the Recercaixa (Grant 2010ACUP 00310); the Regional Government of the Basque Country; the Consejería de Sanidad de la Región de Murcia; European Commission grants FOOD-CT-2006-036224-HIWATE; the Spanish Association Against Cancer (AECC) Scientific Foundation; the Catalan Government DURSI (Grant 2014SGR647); the Fundación Caja de Ahorros de Asturias; the University of Oviedo; Societat Catalana de Diges tologia; and COST action BM1206 Eucolongene.

COVID-19 vaccine effectiveness by product (two doses Comirnaty, Spikevax or Vaxzevria and one of Janssen), against infection ranged from 50% (95% CI: 42 to 57) for Janssen to 86% (70 to 93) for Vaxzevria-Comirnaty combination; among ≥ 60 year-olds, from 17% (−26 to 45) for Janssen to 68% (48 to 80) for Spikevax; and against hospitalisation from 74% (43 to 88) for Janssen to > 90% for other products. Two doses of vaccine were highly effective against hospitalisation, but suboptimal for infection control.

After the first pandemic wave, a nationwide survey assessed the seroprevalence of SARS-CoV-2 antibodies in Spain and found notable differences among provinces whose causes remained unclear. This ecological study aimed to analyze the association between environmental and demographic factors and SARS-CoV-2 infection by province. The seroprevalence of SARS-CoV-2 antibodies by province was obtained from a nationwide representative survey performed in June 2020, after the first pandemic wave in Spain. Linear regression was used in the analysis. The seroprevalence of SARS-CoV-2 antibodies of the 50 provinces ranged from 0.2% to 13.6%. The altitude, which ranged from 5 to 1131 m, explained nearly half of differences in seroprevalence (R2 = 0.47, p &lt, 0.001). The seroprevalence in people residing in provinces above the median altitude (215 m) was three-fold higher (6.5% vs. 2.1%, p &lt, 0.001). In the multivariate linear regression, the addition of population density significantly improved the predictive value of the altitude (R2 = 0.55, p &lt, 0.001). Every 100 m of altitude increase and 100 inhabitants/km2 of increase in population density, the seroprevalence rose 0.84 and 0.63 percentage points, respectively. Environmental conditions related to higher altitude in winter–spring, such as lower temperatures and absolute humidity, may be relevant to SARS-CoV-2 transmission. Places with such adverse conditions may require additional efforts for pandemic control.

Experimental evidence indicates that exercise performed at different times of the day may affect circadian rhythms and circadian disruption has been linked to breast and prostate cancer. We examined in a population‐based case‐control study (MCC‐Spain) if the time‐of‐day when physical activity is done affects prostate and breast cancer risk. Lifetime recreational and household physical activity was assessed by in‐person interviews. Information on time‐of‐day of activity (assessed approximately 3 years after the assessment of lifetime physical activity and confounders) was available for 781 breast cancer cases, 865 population female controls, 504 prostate cases and 645 population male controls from 10 Spanish regions, 2008‐2013. We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) for different activity timings compared to inactive subjects using unconditional logistic regression adjusting for confounders. Early morning (8‐10 am) activity was associated with a protective effect compared to no physical activity for both breast (OR = 0.74, 95% CI = 0.48‐1.15) and prostate cancer (OR = 0.73, 95% CI = 0.44‐1.20); meta‐OR for the two cancers combined 0.74 (95%CI = 0.53‐1.02). There was no effect observed for breast or prostate cancer for late morning to afternoon activity while a protective effect was also observed for evening activity only for prostate cancer (OR = 0.75, 95% CI = 0.45‐1.24). Protective effects of early morning activity were more pronounced for intermediate/evening chronotypes for both cancers. This is the first population‐based investigation identifying a differential effect of timing of physical activity on cancer risk with more pronounced effects for morning hour activity. Our results, if confirmed, may improve current physical activity recommendations for cancer prevention., What's new? Exercise protects against a variety of cancers, but does time of day matter? Disrupting the body's circadian rhythm can boost cancer risk. Here, the authors compared breast and prostate cancer risk among people who exercised in the early morning, late morning, afternoon, and evening. They conducted a population‐based case‐control study, in which participants filled out a questionnaire about their patterns of sleeping, eating, and exercising. Exercising in the early morning appeared to be more strongly protective against breast and prostate cancer than exercising later in the day. Evening exercise appeared to have a moderate protective effect on prostate cancer.

This research was supported by the “Acción Transversal del Cancer”, approved by the Spanish Council of Ministers on 11th October 2007, by the Instituto de Salud Carlos III-FEDER [grant number:PI08/1770, PI08/0533, PI08/1359, PS09/00773-Cantabria, PS09/01286-León, PS09/01903-Valencia, PS09/02078-Huelva, PS09/ 01662-Granada, PI11/01403, PI11/01889-FEDER, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/0613, PI15/00069, PI15/00914, PI15/01032, PI11/01810, PI14/01219, PI11/02213, PIE16/00049, PI17/01179, PI17-00092], by the Fundación Marqués de Valdecilla [grant number: API 10/09], by the ICGC International Cancer Genome Consortium CLL (The ICGC CLL-Genome Project is funded by Spanish Ministerio de Economía y Competitividad (MINECO) through the Instituto de Salud Carlos III (ISCIII)), by the Red Temática de Investigación del Cáncer (RTICC) del ISCIII [grant number: RD12/0036/0036], by the Junta de Castilla y León [grant number: LE22A10-2], by the Consejería de Salud of the Junta de Andalucía [grant number: PI-0571-2009, PI-0306-2011, salud201200057018tra], by the Conselleria de Sanitat of the Generalitat Valenciana [grant number: AP_061/10], by the Recercaixa [grant number: 2010ACUP00310], by the Regional Government of the Basque Country, by the Consejería de Sanidad de la Región de Murcia, by the European Commission [grant number: FOOD-CT-2006-036224-HIWATE], by the Spanish Association Against Cancer (AECC) Scientific Foundation [grant number: GCTRA18022MORE], by the Catalan Government-Agency for Management of University and Research Grants (AGAUR) [grant number: 2014SGR647, 2014SGR850 and 2017SGR723], by the Fundación Caja de Ahorros de Asturias and by the University of Oviedo. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript., There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008–2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged, “Acción Transversal del Cancer” by the Spanish Council of Ministers, Instituto de Salud Carlos III-FEDER [grant number:PI08/1770, PI08/0533, PI08/1359, PS09/00773-Cantabria, PS09/01286-León, PS09/01903-Valencia, PS09/02078-Huelva, PS09/ 01662-Granada, PI11/01403, PI11/01889-FEDER, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/0613, PI15/00069, PI15/00914, PI15/01032, PI11/01810, PI14/01219, PI11/02213, PIE16/00049, PI17/01179, PI17-00092, Fundación Marqués de Valdecilla [grant number: API 10/09], ICGC International Cancer Genome Consortium CLL (The ICGC CLL-Genome Project is funded by Spanish Ministerio de Economía y Competitividad (MINECO) through the Instituto de Salud Carlos III (ISCIII)), Red Temática de Investigación del Cáncer (RTICC) del ISCIII [grant number: RD12/0036/0036], Junta de Castilla y León [grant number: LE22A10-2], Consejería de Salud of the Junta de Andalucía [grant number: PI-0571-2009, PI-0306-2011, salud201200057018tra], Conselleria de Sanitat of the Generalitat Valenciana [grant number: AP_061/10], Recercaixa [grant number: 2010ACUP00310], Regional Government of the Basque Country, Consejería de Sanidad de la Región de Murcia, European Commission [grant number: FOOD-CT-2006-036224-HIWATE], Spanish Association Against Cancer (AECC) Scientific Foundation [grant number: GCTRA18022MORE, Catalan Government-Agency for Management of University and Research Grants (AGAUR) [grant number: 2014SGR647, 2014SGR850 and 2017SGR723], Fundación Caja de Ahorros de Asturias, University of Oviedo

Background: Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited. Methods: We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed (P greater than or equal to 25% for at least one year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever vs. never exposed, lifetime cumulative exposure and duration of exposure (years). We estimated odds ratios (ORs) and 95% confidence intervals (CIs), applying a lag-period of 5 years, adjusting for potential confounders. Results: Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI 1.01, 1.46), with significant trends across categories of lifetime cumulative exposure and duration (p-trend = 0.01 and 0.03 respectively). Stronger associations were found for hormone receptor positive disease (OR ever exposure = 1.38; 95% CI 1.12, 1.67). We found no confounding effects from multiple other common occupational exposures, however results attenuated with adjustment for occupational detergent exposure. Conclusions: This study provides some evidence of an association between occupational heat exposure and female breast cancer risk. Impact: Our results contribute substantially to the scientific literature. Further investigations are needed, considering multiple occupational exposures.

OBJECTIVE There is sparse evidence for the association of suitable food substitutions for red and processed meat on the risk of type 2 diabetes. We modeled the association between replacing red and processed meat with other protein sources and the risk of type 2 diabetes and estimated its population impact. RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer (EPIC)-InterAct case cohort included 11,741 individuals with type 2 diabetes and a subcohort of 15,450 participants in eight countries. We modeled the replacement of self-reported red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk, and nuts. Country-specific hazard ratios (HRs) for incident type 2 diabetes were estimated by Prentice-weighted Cox regression and pooled using random-effects meta-analysis. RESULTS There was a lower hazard for type 2 diabetes for the modeled replacement of red and processed meat (50 g/day) with cheese (HR 0.90, 95% CI 0.83–0.97) (30 g/day), yogurt (0.90, 0.86–0.95) (70 g/day), nuts (0.90, 0.84–0.96) (10 g/day), or cereals (0.92, 0.88–0.96) (30 g/day) but not for replacements with poultry, fish, eggs, legumes, or milk. If a causal association is assumed, replacing red and processed meat with cheese, yogurt, or nuts could prevent 8.8%, 8.3%, or 7.5%, respectively, of new cases of type 2 diabetes. CONCLUSIONS Replacement of red and processed meat with cheese, yogurt, nuts, or cereals was associated with a lower rate of type 2 diabetes. Substituting red and processed meat by other protein sources may contribute to the prevention of incident type 2 diabetes in European populations.

Aims: To study whether the consumption of ultra-processed foods and drinks is associated with breast, colorectal, and prostate cancers. Methods: Multicentric population-based case-control study (MCC-Spain) conducted in 12 Spanish provinces. Participants were men and women between 20 and 85 years of age with diagnoses of colorectal (n = 1852), breast (n = 1486), or prostate cancer (n = 953), and population-based controls (n = 3543) frequency-matched by age, sex, and region. Dietary intake was collected using a validated food frequency questionnaire. Foods and drinks were categorized according to their degree of processing based on the NOVA classification. Unconditional multivariable logistic regression was used to evaluate the association between ultra-processed food and drink consumption and colorectal, breast, and prostate cancer. Results: In multiple adjusted models, consumption of ultra-processed foods and drinks was associated with a higher risk of colorectal cancer (OR for a 10% increase in consumption: 1.11; 95% CI 1.04-1.18). The corresponding odds for breast (OR 1.03; 95% CI 0.96-1.11) and prostate cancer (OR 1.02; 95% CI 0.93-1.12) were indicative of no association. Conclusions: Results of this large population-based case-control study suggest an association between the consumption of ultra-processed foods and drinks and colorectal cancer. Food policy and public health should include a focus on food processing when formulating dietary guidelines. ? 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Background: Consumption of ultra-processed products has increased worldwide and some of their components have been suggested to be carcinogenic. We studied whether the consumption of ultra-processed foods and drinks was associated with breast, colorectal and prostate cancers.Methods: Multicentric population-based case-control study (MCC-Spain) conducted in 12 Spanish provinces. Participants were men and women between 20-85 years of age with diagnoses of colorectal (n=1852), breast (n=1486) or prostate cancer (n=953), and population-based controls (n=3543) frequency-matches by age, sex and region. Dietary intake was collected using a validated food frequency questionnaire. Foods and drinks were categorized according to their degree of processing based on the NOVA classification. Unconditional multivariable logistic regression was used to evaluate the association between ultra-processed food and drink consumption and colorectal, breast and prostate cancer.Results: In multiple adjusted models, consumption of ultra-processed foods and drinks was associated with higher risk of colorectal cancer (OR for an increment of 10% in consumption: 1.11; 95% CI 1.04 to 1.18). The corresponding odds for breast (OR 1.03; 95% CI 0.96 to 1.11) or prostate cancer (OR 1.02; 95% CI 0.93 to 1.12) were indicative of no association. Conclusions: Results of this large population-based case-control study suggest an association between the consumption of ultra-processed foods and drinks and colorectal cancer. Food policy and public health should include a focus on food processing when formulating dietary guidelines.

SummaryBackgroundCOVID-19 is an acute respiratory illness caused by the novel coronavirus SARS-CoV-2. The disease has rapidly spread to most countries and territories and has caused 14·2 million confirmed infections and 602,037 deaths as of July 19th 2020. Massive molecular testing for COVID-19 has been pointed as fundamental to moderate the spread of the disease. Pooling methods can enhance testing efficiency, but they are viable only at very low incidences of the disease. We propose Smart Pooling, a machine learning method that uses clinical and sociodemographic data from patients to increase the efficiency of pooled molecular testing for COVID-19 by arranging samples into all-negative pools.MethodsWe developed machine learning methods that estimate the probability that a sample will test positive for SARS-Cov-2 based on complementary information from the sample. We use these predictions to exclude samples predicted as positive from pools. We trained our machine learning methods on samples from more than 8,000 patients tested for SARS-Cov-2 from April to July in Bogotá, Colombia.FindingsOur method, Smart Pooling, shows efficiency of 306% at a disease prevalence of 5% and efficiency of 107% at disease a prevalence of up to 50%, a regime in which two-stage pooling offers marginal efficiency gains compared to individual testing (see Figure 1). Additionally, we calculate the possible efficiency gains of one- and two-dimensional two-stage pooling strategies, and present the optimal strategies for disease prevalences up to 25%. We discuss practical limitations to conduct pooling in the laboratory.InterpretationPooled testing has been a theoretically alluring option to increase the coverage of diagnostics since its proposition by Dorfmann during World War II. Although there are examples of successfully using pooled testing to reduce the cost of diagnostics, its applicability has remained limited because efficiency drops rapidly as prevalence increases. Not only does our method provide a cost-effective solution to increase the coverage of testing amid the COVID-19 pandemic, but it also demonstrates that artificial intelligence can be used complementary with well-established techniques in the medical praxis.FundingFaculty of Engineering, Universidad de los Andes, Colombia.1Research in contextEvidence before this studyThe acute respiratory illness COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) labeled COVID-19 as a pandemic in March 2020. Reports from February 2020 indicated the possibility of asymptomatic transmission of the virus, which has called for molecular testing to identify carriers of the disease and prevent them from spreading it. The dramatic rise in the global need for molecular testing has made reagents scarce. Pooling strategies for massive diagnostics were initially proposed to diagnose syphilis during World War II, but have not yet seen widespread use mainly because their efficiency falls even at modest disease prevalence.We searched PubMed, BioRxiv, and MedRxiv for articles published in English from inception to July 15th 2020 for keywords “pooling”, “testing” AND “COVID-19”, AND “machine learning” OR “artificial intelligence”. Early studies for pooled molecular testing of SARS-CoV-2 revealed the possibility of detecting single positive samples in dilutions of samples from up to 32 individuals. The first reports of pooled testing came in March from Germany and the USA. These works suggested that it was feasible to conduct pooled testing as long as the prevalence of the disease was low. Numerous theoretical works have focused only on finding or adapting the ideal pooling strategy to the prevalence of the disease. Nonetheless, many do not consider other practical limitations of putting these strategies into practice. Reports from May 2020 indicated that it was feasible to predict an individual’s status with machine learning methods based on reported symptoms.Added value of this studyWe show how artificial intelligence methods can be used to enhance, but not replace, existing well-proven methods, such as diagnostics by qPCR. We show that in this fashion, pooled testing can yield efficiency gains even as prevalence increases. Our method does not compromise the sensitivity or specificity of the diagnostics, as these are still given by the molecular test. The artificial intelligence models are simple, and we make them free to use. Remarkably, artificial intelligence methods can continuously learn from every set of samples and thus increase their performance over time.Implications of all the available evidenceUsing artificial intelligence to enhance rather than replace molecular testing can make pooling testing feasible, even as disease incidence rises. This approach could make pooled testing an effective tool to tackle the disease’s progression, particularly in territories with limited resources.

Este estudio presenta los resultados de un proceso de diseño y validación de una escala de creencias negativas sobre niños adoptados. El proceso constó de tres fases. En la primera, se realizaron encuestas abiertas a 107 personas y de allí se extrajeron las categorías iniciales y los ítems. En la segunda fase, el instrumento se sometió a validación por parte de jueces expertos y se realizaron los ajustes correspondientes. En la tercera, se realizó una aplicación a 233 personas y se llevaron a cabo los análisis psicométricos, desde la teoría clásica de los test, a partir de los cuales se reorganizó la configuración factorial y se redujo el número de ítems. Todos los participantes del estudio pertenecían a estrato socioeconómico medio-alto y contaban, al menos, con formación profesional. Los resultados dan cuenta de un instrumento con cuatro dimensiones: “niño vulnerado”, “niño difícil”, “problemas emocionales” y “no vinculación”; este incluye 20 ítems y cuenta con características psicométricas de validez y confiabilidad que respaldan la calidad del mismo.

Background Cardiovascular disease, particularly ischemic heart disease (IHD), is the leading cause of mortality worldwide. Bisphenol A (BPA) is considered an endocrine disruptor and obesogen, present in numerous products of daily use. The aim of this study was to assess the potential association of serum BPA concentrations and the risk of incident IHD in a sub-cohort of the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC). Methods We designed a case-cohort study within the EPIC-Spain cohort. The population consisted of 4636 participants from 4 EPIC-Spain centers (946 IHD cases and 3690 sub-cohort participants). BPA exposure was assessed by means of chemical analyses of serum samples collected at recruitment. Follow-up was performed by linking with national and regional databases and reviewing patients’ clinical records. Cox Proportional Hazards Models were used for the statistical analyses. Results Median follow-up time was 16 years and 70% of the participants showed detectable BPA values (>0.2 ng/ml). Geometric mean (GM) values of cases and sub-cohort were 1.22 ng/ml vs 1.19 ng/ml respectively (p = 0.90). Cox regression models showed no significant association of BPA serum levels and IHD, acute myocardial infarction or angina pectoris risk. Conclusions We evidenced a similar percentage of detection of BPA among cases and sub-cohort participants from our population, and no clear association with IHD risk was observed. However, further investigation is needed to understand the influence of BPA on IHD risk.

Incidence and mortality provide information on the burden of cancer morbidity and the potential years of life lost due to cancer. The Spanish Deprivation Index (SDI) has been developed as a standardized measure to study socioeconomic deprivation in Spain at the census tract level. In addition, SDI information can be combined with ecological variables at the population level and data from the High-Resolution European Studies in Cancer. The aim of this study is to characterize socioeconomic inequalities in incidence, excess mortality, premature mortality and net survival for three of the most incident cancers (lung, colon-rectum and breast) in Spain using the SDI. This national population-based study will assess the impact of socioeconomic inequalities using a multilevel modelling approach. Spatial analysis, multilevel modeling, net survival and economic impact assessment will be used. The results will be useful for supporting decision-making, planning, and management of public health interventions aimed at reducing the impact of socioeconomic inequalities in the diagnosis and prognosis of cancer patients in Spain.

Background. Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). Methods. Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. Results. A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 € , mortality rates were five times higher in the population with incomes below 18,000 € . No statistically significant changes were observed in the trend of mortality rates throughout the period studied. Conclusions. Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes.

Purpose To evaluate the association between dietary fat and fat subtype and breast cancer development. Methods We conducted a case-control study with 1181 cases of incident breast cancer, diagnosed between 2007 and 2012, and 1682 population controls frequency matched (by age, sex, and region) from the Spanish multicenter case-control study MCC-Spain. Results We found a significant protective effect in premenopausal women of total fat intake [OR 0.51 95% CI (0.31-0.86) highest versus lowest tertile], but no effect was observed in menopausal women [OR 1.15 95% CI (0.83-1.60)]. Analyzing by type of fat, this protective effect persisted only for the monounsaturated fatty acids [OR 0.51 95% CI (0.32-0.82)]. In contrast, other fatty acids did not have a significant effect. In addition, a protection against risk of breast cancer was found when polyunsaturated fats were "substituted" by monounsaturated, maintaining the same total fat intake [OR 0.68 95% CI (0.47-0.99)]. Finally, analyzing by breast cancer subtype, we found no effect, except in premenopausal women where intake of moderate [OR 0.52 95% CI (0.33-0.82)] and high monounsaturated fatty acids [OR 0.47 95% CI (0.27-0.82)] maintains a protective effect against ER/PR + tumors. In contrast, in menopausal women, a high intake of monounsaturated fatty acids was associated with higher risk of HER2 + tumors [OR 2.00 95% CI (0.97-4.13)]. Conclusion Our study shows a differential effect of monounsaturated fatty acids according to menopausal status and breast cancer subtype.

RESUMEN Fundamentos: El Observatorio de Salud Comunitaria de Navarra se creo en 2016 para estudiar los determinantes, resultados y desigualdades en salud. El objetivo de este articulo fue describir la metodologia y el proceso seguidos para su puesta en marcha, asi como analizar la variabilidad de los indicadores seleccionados entre Zonas Basicas de Salud. Metodos: Se especifico la configuracion del observatorio y se describieron estadisticamente los indicadores seleccionados y su variabilidad entre zonas. Resultados: Durante el periodo considerado, el observatorio interactuo con diferentes instituciones, unas como proveedoras de informacion y otras como usuarias de la misma. Uno de sus principales productos fueron los Informes de Perfil de Zona Basica de Salud, que incluyeron para cada zona una seleccion de 21 indicadores agrupados en: factores sociodemograficos, estilos de vida, morbilidad, sistema de salud y mortalidad. Los coeficientes de variacion entre zonas de los indicadores se encontraron entre 0,01 y 0,7, siendo los que aluden a factores sociodemograficos los de mayor variabilidad. Conclusiones: Esta experiencia comparte con otras similares el establecimiento de un sistema de comparacion de determinantes y resultados de salud en areas pequenas. Los indicadores seleccionados captan la variabilidad entre zonas, devolviendo una imagen especifica de las mismas. A partir de sus productos se abren posibilidades de intervencion en coordinacion con Atencion Primaria, los agentes sociales y los activos de salud.

Colletotrichum genus comprises a high number of plant pathogens causing anthracnose disease in different tropical and non-tropical crops. We aimed to review northern South American studies in the online SCOPUS database to: create a taxonomically updated list of the species complexes found in the region, describe their most important phytopathological characteristics, revise the methods used in the region to control disease, and discuss the role of fungus as a plant endophyte. A total of 19 Colletotrichum species within five complexes—acutatum, boninense, gigasporum, gloeosporioides, and orbiculare—have been reported in northern South America. Few studies have been conducted, particularly in Peru and Ecuador, despite the diversity of Colletotrichum hosts cultivated in the region. Important information can be extracted from our review: species do not appear to show host specificity, although some isolates show host preferences, certain plant species can host several Colletotrichum species, some studies show the importance of using plant extracts to control the disease, but biological control using microorganisms is certainly an open area of research in the region. In northern South America, only a few hosts have been reported to harbor Colletotrichum as endophyte, and the potential of these endophytes as biological control agents has not yet been explored.

The influence of high performance human management practices on the social dimensions of the organizational climate, Interpersonal Treatment and Boss Support, in Colombian companies in the service sector was explored. The study was quantitative and statistical regressions were used. The sample consisted of 503 cases belonging to five Colombian companies in the services sector. The instruments used were the Scale of Human Management Practices and THE Organizational Climate Survey (OCS) reduced version. Results showed that human resources management such as selective linkage and reduction of the status gap predict better the social variable of Interpersonal Treatment. Participation in decision-making and performance evaluation predict the Boss Support perceptions. It is concluded that human management practices have a significant impact on the organizational climate.

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis, is caused by dematiaceous fungi, the most frequently implicated are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala.We report a woman who was treated before with mycological cure, but she experience a relapse requiring treatment again. Direct microscopic examination and skin biopsy with culture were necessary to identify a Exophiala psychrophila, and for our knowledge this is the first case reported. Keywords: Chromoblastomycosis, Exophiala salmonis-clade, Subcutaneous mycosis