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Prenatal exposure to dichlorodiphenyldichloroethylene (p,p´-DDE) may interfere with fetal development; however, studies evaluating anthropometry and gestational age at birth show inconsistent results. Typically, p,p´-DDE exposure has been measured during the third trimester and missed the key early pregnancy period. We evaluated the association between p,p´-DDE exposure before week 18 of pregnancy and anthropometry at birth, as well as gestational length, in 170 mother–child pairs from a cohort study in a flower-growing mexican region. Maternal serum p,p´-DDE concentrations were determined by gas chromatography. The associations between p,p´-DDE and z-scores of birth weight, birth length, and gestational age were evaluated by linear multiple regression models. Logistic regression models were used for low birth weight and small size for gestational age. Effect modification by child’s sex was explored. The average gestational age at the blood sample extraction was 10.6 weeks. p,p'-DDE was detected in 64.7% of mothers, at a geometric mean of 0.24 ng/mL. Prenatal p,p´-DDE exposure was not associated with the birth outcomes in the whole sample. However, a high p,p´-DDE exposure was marginally associated with greater small for gestational age risk in male newborns (OR≥0.076ng/mL vs <0.076 ng/mL = 3.09, 95% CI: 0.61; 15.58), but not in female (p for interaction = 0.08).
Even though, we found no reductions in anthropometric measurements or gestational length associated with early prenatal p,p´-DDE exposure, the potential effect modification by infant’s sex in terms of small for the gestational age risk deserves future studies.
Deficits in emotional intelligence (EI) were detected in patients with bipolar disorder (BD), but little is known about whether these deficits are already present in patients after presenting a first episode mania (FEM). We sought (i) to compare EI in patients after a FEM, chronic BD and healthy controls (HC); (ii) to examine the effect exerted on EI by socio-demographic, clinical and neurocognitive variables in FEM patients.
The Emotional Intelligence Quotient (EIQ) was calculated with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Performance on MSCEIT was compared among the three groups using generalized linear models. In patients after a FEM, the influence of socio-demographic, clinical and neurocognitive variables on the EIQ was examined using a linear regression model.
In total, 184 subjects were included (FEM n = 48, euthymic chronic BD type I n = 75, HC n = 61). BD patients performed significantly worse than HC on the EIQ [mean difference (MD) = 10.09, standard error (s.e.) = 3.14, p = 0.004] and on the understanding emotions branch (MD = 7.46, s.e. = 2.53, p = 0.010). FEM patients did not differ from HC and BD on other measures of MSCEIT. In patients after a FEM, EIQ was positively associated with female sex (β = −0.293, p = 0.034) and verbal memory performance (β = 0.374, p = 0.008). FEM patients performed worse than HC but better than BD on few neurocognitive domains.
Patients after a FEM showed preserved EI, while patients in later stages of BD presented lower EIQ, suggesting that impairments in EI might result from the burden of disease and neurocognitive decline, associated with the chronicity of the illness.
The use of most recent Transcatheter aortic valve implants (TAVI) in the treatment of symptomatic severe aortic stenosis (SAS) is evolving with expanded indications from inoperable/high-risk to intermediate and low risk patients. Consequently, TAVI outcomes must be monitored to highlight its value under real-world conditions. Our aim was to prospectively evaluate TAVI (SAPIEN 3) outcomes in terms of patient's health-related quality of life (HRQoL), clinical outcomes, and healthcare resource utilization (HRU).
An observational prospective study including all consecutive patients with SAS undergoing a transcatheter valve implantation with Edwards SAPIEN 3 valve (transfemoral access) was conducted in full accordance with clinical guidelines from the European Society of Cardiology. Patients were evaluated before the intervention (baseline), at discharge, and after one, six and twelve months from the implant. A thoughtful and systematic evaluation of patients’ HRQoL (EQ-5D 5L, the Short Form-36 Health Survey -SF-36- and the Kansas City Cardiomyopathy Questionnaire -KCCQ-), clinical endpoints (that is, cardiovascular mortality, and rates of stroke, major bleeding, myocardial infarction, and re-hospitalization), echocardiographic measurements, and HRU (that is, Length of stay-LOS- in ward/intensive care unit -ICU-) was implemented. Multivariate regression models were applied to test outcomes while controlling key risk factors (that is, patient’ severity at baseline).
A total of seventy-six patients (fifty percent female, fifty-five percent of intermediate-high risk) with a mean age of 82.1 ± 4.78 years were included. Implant success was 97.34% and cardiovascular death was 2.6% at one year. Significant reductions in mean and maximum gradients were achieved and maintained during follow-up. Mean LOS in ward (5.2 ± 4.0days) and ICU (0.22 ± 0.64 days) were low. Statistically significant improvements were detected in the KCCQ overall summary scores, EQ-5D, and SF-36 (Physical component summary) - all adjusted - p < 0.05 - after the intervention.
TAVI represents a safe and effective innovation for SAS with clinical benefits translated into significant improvements in terms of HRQoL. Besides, the low HRU provides new insights for health-economic modelling and the optimization of limited resources of special importance under current pandemic situation.
Health systems are in the need for novel approaches to tackle the challenges from the demographic transition to ageing populations. An effective approach to face these challenges is integrated care delivery. Implementing Comprehensive Geriatric Assessments (CGAs) in Health Ageing might be highly relevant to incorporate this approach. However, this implementation should be supported by Digital Health Interventions (DHIs) in order to reach their full capacity.
To identify the DHIs facilitating the administration of CGAs used in long-term care and home care settings and provide an insight on their characteristics and stage of maturity and evaluation.
A search strategy was conducted in PubMed, CINAHL, and Web of Science, targeting studies evaluating the DHIs facilitating the administration of CGAs used in long-term care and home care settings. Studies in English and Spanish and published up to July 26, 2021 were considered.
Preliminary results of the ongoing study:
A total of four papers describing three digital platforms supporting the administration of the CGAs were identified. Information on implementation reported less completion of some sections affecting the CGAs outcomes, assessments mostly being the responsibility of nurses, and missing data related with less quality of care. Limitations and barriers regarding their usability and feasibility were also identified.
The inclusion of safe data storage, automatic notifications for assessment completion, automatic calculation of final outcomes, and facilitation of multidisciplinary assessments, were identified as key features to enhance the implementation of digital platforms facilitating the administration of CGAs. Nonetheless, information regarding technical features and hardware information of the digital platforms was scarce.
This project is part of the Marie Skłodowska Curie Actions Innovative Training Network H2020-MSCA-ITN, under grant agreement number 813196
En la primera parte de este artículo trazaremos la genealogía de la razón comunal indígena, la cual busca rastrear las condiciones de emergencia, existencia y transformaciones discursivas y de poder que hicieron posible plantear teóricamente la comunalidad como forma de vida de los pueblos indios en Oaxaca, México. Posteriormente, haremos dialogar el pensamiento comunal indígena con el giro descolonial latinoamericano, para examinar los aportes que puede generar la comunalidad en el diseño de una salida viable a la crisis civilizatoria del actual sistema-mundo moderno-colonial-capitalista. Finalmente, vamos a analizar los alcances epistémicos y políticos de la opción comunal para contribuir a la descolonización de las ciencias sociales y la construcción inter-civilizatoria del pluriversalismo transmoderno descolonial como nuevo proyecto universal de vida.
Branched-chain amino acids (BCAA) are considered markers of insulin resistance (IR) in subjects with obesity. In this study, we evaluated whether the presence of the SNP of the branched-chain aminotransferase 2 (BCAT2) gene can modify the effect of a dietary intervention (DI) on the plasma concentration of BCAA in subjects with obesity and IR. A prospective cohort study of adult subjects with obesity, BMI ≥ 30 kg/m2, homeostatic model assessment-insulin resistance (HOMA-IR ≥ 2·5) no diagnosed chronic disease, underwent a DI with an energy restriction of 3140 kJ/d and nutritional education for 1 month. Anthropometric measurements, body composition, blood pressure, resting energy expenditure, oral glucose tolerance test results, serum biochemical parameters and the plasma amino acid profile were evaluated before and after the DI. SNP were assessed by the TaqMan SNP genotyping assay. A total of eighty-two subjects were included, and fifteen subjects with a BCAT2 SNP had a greater reduction in leucine, isoleucine, valine and the sum of BCAA. Those subjects also had a greater reduction in skeletal muscle mass, fat-free mass, total body water, blood pressure, muscle strength and biochemical parameters after 1 month of the DI and adjusting for age and sex. This study demonstrated that the presence of the BCAT2 SNP promotes a greater reduction in plasma BCAA concentration after adjusting for age and sex, in subjects with obesity and IR after a 1-month energy-restricted DI.
The probability of a human-caused incident occurring during dynamic positioning (DP) drilling operations is determined in this paper using binary logistic regression models built with data on 42 incidents that took place during the period 2011–2015. For each case, a range of variables characterising the configuration of the DP system, weather conditions and water depth are taken into account. These variables are taken into account to develop a logistic regression model that shows the likelihood of an incident being caused by human error. The results obtained show that human-based incidents are significantly more likely to occur when there is a lower usage of thrusters. These results are useful for focusing our attention on variables that may be associated with incidents attributable to human error, as well as for setting operational limits that could help to prevent these incidents and improve safety during these operations.
In most trials and systematic reviews that evaluate exercise-based interventions in reducing depressive symptoms, it is difficult to separate treatment from prevention.
To evaluate the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression.
We searched PubMed, PsycINFO, Embase, WOS, SPORTDiscus, CENTRAL, OpenGrey and other sources up to 25 May 2020. We selected randomised controlled trials (RCTs) that compared exclusively exercise-based interventions with control groups, enrolling participants without clinical depression, as measured using validated instruments, and whose outcome was reduction of depressive symptoms and/or incidence of new cases of people with depression. Pooled standardised mean differences (SMDs) were calculated using random-effect models (registration at PROSPERO: CRD42017055726).
A total of 14 RCTs (18 comparisons) evaluated 1737 adults without clinical depression from eight countries and four continents. The pooled SMD was −0.34 (95% CI −0.51 to −0.17; P < 0.001) and sensitivity analyses confirmed the robustness of this result. We found no statistical evidence of publication bias and heterogeneity was moderate (I2 = 54%; 95% CI 22–73%). Only two RCTs had an overall low risk of bias and three had long-term follow-up. Multivariate meta-regression found that a larger sample size, country (Asia) and selective prevention (i.e. people exposed to risk factors for depression) were associated with lower effectiveness, although only sample size remained significant when adjustment for multiple tests was considered. According to the Grading of Recommendations Assessment, Development and Evaluation tool, the quality of evidence was low.
Exercise-based interventions have a small effect on the reduction of depressive symptoms in people without clinical depression. It could be an alternative to or complement psychological programmes, although further higher-quality trials with larger samples and long-term follow-up are needed.
The preservation of Military Macaw Ara militaris in Mexico required the implementation of a nationwide assessment evaluating its vulnerability using IUCN criteria. With the combined effort of several institutions, the abundance, location, dispersion, habitat availability, and climatic conditions of areas occupied by the species were determined. Although the species’ extent of occurrence is extensive (263,919 km2) only 29% of this constitutes area of occupancy. Published estimates indicate a series of isolated populations containing from four macaws to 215. Macaws occurred in 35 populations in four regions of 16 states containing an estimated 1,563–3,263 macaws; lower than required for long-term viability. Within regions, neighbouring populations were separated by an average of 68 km. The extent of occurrence is heterogeneous, and macaws inhabit areas that differ in elevation, precipitation, temperature, and forest cover. Higher local abundances occur in landscapes where annual precipitation is ≥1,100 mm, and primary forest availability ≥1,800 km2. Although the existence of undetected macaw groups in Mexico is possible, these are likely to contain only small numbers of individuals, as most detected areas with macaws contain less than 40 individuals, and larger concentrations are more likely to be noticed due to their conspicuous behaviour. The species is threatened primarily by its low overall abundance, fragmented distribution, and forest loss around populations with the highest abundance. With the information generated, it is possible to design and implement specific management and conservation strategies at different geographic scales for the recovery and maintenance of the species in Mexico. It is necessary to strengthen collaborative programmes among conservation organizations, government agencies, and local communities in each region of the country to organize and finance community-based actions such as monitoring, habitat restoration, protection from poaching and the creation of a network of conservation corridors and macaw reserves focused on conservation.
Background: Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. The objective is to gain insight into the evolution of the degree of compliance with recommendations (DCR) on HH and its associated factors in the surgical areas of a tertiary-care hospital. Methods: This observational, cross-sectional study, was repeated over time, with direct observation of the DCR on HH during the daily activity of healthcare workers in surgical areas: general surgery, urology, vascular surgery, traumatology, neurosurgery, thoracic surgery, heart surgery, pediatric surgery, otorhinolaryngology, gynecology and obstetrics, ophthalmology. Over 14 years (from 2005 to 2018), 15,946 HH opportunities were registered, together with different additional variables (age, sex, professional position, surgical area ). The 2 test was used to study the association and the crude, and adjusted odds ratios were used to quantify its magnitude. Results: The DCR on HH in surgical areas was 49.7% (95% CI, 48.9%–50.5%), and in the group of nonsurgical areas it was 53.4% (95% CI, 53.1%–54.1%). The area with the highest degree of compliance was urology (56.7%; 95% CI, 53.9%–59.6%), and the area with the lowest degree of compliance was traumatology (43.3%; 95% CI, 40.4%–46.2%). Some associated factors were the indications after an activity has been performed (58.6%; aOR, 2.7; 95% CI, 2.5–2.9) and the availability of pocket-size alcohol-based disinfectant (63.8%; aOR, 2.4; 95% CI, 2.2–2.5). Conclusions: The DCR on HH in surgical areas is lower than in other hospital areas, and there is still some margin for improvement. We have identified some modifiable factors that have an independent association with HH compliance in surgical areas. Focusing on them will increase compliance with HH with the ultimate goal of reducing healthcare-associated infections.
Background: Annual flu vaccination is the most effective way to prevent the disease and its complications. Vaccine effectiveness (EV) varies from season to season, requiring annual re-evaluation. The objective of this study was to estimate the preliminary effectiveness of the influenza vaccine until epidemiological week 4 of the 2019–2020 season, in patients admitted to a tertiary-level hospital. Method: We conducted a case-control study at University General Hospital, Alicante, Spain, during the 2019–2020 season. We included all patients hospitalized with influenza confirmed by laboratory test (ie, PCR positive for influenza) during the period between epidemiological week 40 of 2019 and epidemiological week 4 of 2020. These were considered cases, and those with clinical suspicion of influenza and negative RT-PCR were considered controls. Vaccination coverage was calculated in cases and in controls, determining the odds ratio. We calculated the vaccine effectiveness (VE) and its 95% confidence interval using the following formula: VE = (1 − odds ratio) ×100. Result: We included 545 patients: 61 cases and 484 controls. The overall EV for influenza cases prevention was 40.7% (95% CI, −17.1 to 70.1), and for those >1 year of age, the overall EV was 56.9% (95% CI, 13.9–78.5). Conclusion: The 2019–2020 Influenza vaccine was effective in preventing influenza cases in patients admitted up to week 4 of the 2019–2020 season. These results are preliminary and may vary; they should be re-evaluated at the end of the season.
Despite SARS-CoV-19 infection has a stereotypical clinical picture, isolated cases with unusual manifestations have been reported, some of them being well-known to be triggered by viral infections. However, the real frequency in COVID-19 is unknown. Analysing data of 63 822 COVID patients attending 50 Spanish emergency department (ED) during the COVID outbreak, before hospitalisation, we report frequencies of (myo)pericarditis (0.71‰), meningoencephalitis (0.25‰), Guillain–Barré syndrome (0.13‰), acute pancreatitis (0.71‰) and spontaneous pneumothorax (0.57‰). Compared with general ED population, COVID patients developed more frequently Guillain–Barré syndrome (odds ratio (OR) 4.55, 95% confidence interval (CI) 2.09–9.90), spontaneous pneumothorax (OR 1.98, 95% CI 1.40–2.79) and (myo)pericarditis (OR 1.45, 95% CI 1.07–1.97), but less frequently pancreatitis (OR 0.44, 95% CI 0.33–0.60).
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
The signature representation shows that the reliability of the system is a mixture of the reliability functions of the k-out-of-n systems. The first representation was obtained for systems with independent and identically distributed (IID) components and after it was extended to exchangeable (EXC) components. The purpose of the present paper is to extend it to the class of systems with identically distributed (ID) components which have a diagonal-dependent copula. We prove that this class is much larger than the class with EXC components. This extension is used to compare systems with non-EXC components.