Cuestionario de autoevaluación CAMBRA como método de cribado poblacional del riesgo de caries sin métodos exploratorios: un estudio piloto observacional transversal / Modified CAMBRA questionnaire as a method for population-based caries risk screening without exploratory methods: a cross-sectional observational pilot study

Fundamentos: Caries Management by Risk Assessment (CAMBRA) es un cuestionario de diagnóstico del riesgo global de caries dental. Este estudio tuvo como objetivo presentar un cuestionario de autoevaluación basado en CAMBRA que, a diferencia del original, es cumplimentado por padres/madres/cuidadores, sin necesidad de una exploración odontológica, permitiendo establecer un diagnóstico de presunción en menores de siete años excluidos del programa de salud oral del Sistema Nacional de Salud, con el fin de instaurar recomendaciones individualizadas al riesgo de caries y su inclusión precoz en programas preventivos del Servicio Madrileño de Salud (Madrid, España). Métodos: Se llevó a cabo un estudio observacional transversal basado en las recomendaciones STROBE, empleando por primera vez un cuestionario de autoevaluación basado en CAMBRA en niños/as de tres a seis años de una escuela infantil de Madrid (España). Los resultados se analizaron mediante una estadística descriptiva y para el estudio de la relación entre variables cualitativas se utilizó el estadístico exacto de Fisher. Resultados: El cuestionario fue respondido por padres de 120 niños, de los cuales, el 40,8% presentó, a priori, un riesgo de caries bajo, el 42,5% un riesgo moderado y el 16,7% un riesgo alto de caries. Conclusiones: El presente estudio permite la identificación de pacientes en riesgo de presentar y/o desarrollar caries. No obstante, futuros estudios han de evaluar su sensibilidad y especificidad mediante su comparativa frente a un diagnóstico de confirmación tras una exploración odontológica. Pese a ello, el cuestionarioCAMBRA modificado podría ser una herramienta útil para el cribado poblacional, facilitandoel acceso de la población en riesgo de caries y en riesgo de exclusión a planes preventivos y comunitarios.(AU)

Background:Caries Management by Risk Assessment (CAMBRA) is a questionnaire used to diagnose the patient’s overall caries risk. This study aimed to present a self-assessment questionnaire based on CAMBRA which, unlike the original, is completed by parents/caregivers, without the need for a dental examination, allowing a presumptive diagnosis to be established in children under seven years of age excluded from the oral health programme of the National Health System to establish individualised recommendations for caries risk and their early inclusion in preventive programmes of the Madrid Health Service (Madrid, Spain). Methods: A cross-sectional observational study was carried out following STROBE guidelines using for the first time a self-assessment questionnaire based on CAMBRA in a population of children aged from three to six years from a nursery school in Madrid (Spain). The results were analysed using descriptive statistics and Fisher’s exact statistic was used to study the relationship between qualitative variables. Results: The questionnaire was answered by the parents of 120 children (response rate=53.1%), of whom 40.8% presented a low a priori caries risk, 42.5% a moderate risk and 16.7% a high caries risk. Conclusion: The present study allow the identification of patients at risk of presenting and/or developing caries. However, future studies should evaluate its sensitivity and specificity by comparing it with a confirmatory diagnosis after a dental examination. Nevertheless, the modified CAMBRA questionnaire could be a useful tool for population screening, facilitating the access of the population at risk of caries and risk of exclusion to preventive and community plans.(AU)

A simple double differential centrifugation-wash procedure to rapidly obtain bacterial identification and direct antimicrobial susceptibility testing from positive blood cultures / Método sencillo basado en una doble centrifugación diferencial para obtener una identificación bacteriana y sensibilidad a antibióticos rápida a partir de hemocultivos positivos

Introduction: This study proposes a simple and rapid method for both bacterial identification and direct antimicrobial susceptibility testing (AST) by using MALDI-TOF and a double differential centrifugation-wash procedure from positive blood cultures. Methods: Fifty-two positive blood cultures (37 gramnegative bacilli and 15 grampositive cocci) were studied by two methods for identification and AST: a reference method, and the rapid MALDI-TOF method obtaining a purified pellet by using a double differential centrifugation procedure. Results : A total of 1101 MIC values (mg/l) were interpreted according to EUCAST clinical breakpoints and compared using the two methods simultaneously. Discrepancies in 81 MIC values (7.35%) were detected. By analyzing standard parameters, we obtained 98.28% essential agreement and 92.65% categorical agreement considering all isolates tested. Conclusion: This method provides rapid bacterial identification and AST, offering definitive results 24–48h earlier than the conventional method (p<0.001) and improving the turnaround time in blood culture diagnostics, especially in laboratories without 24-h on-call.(AU)

Introducción: Este trabajo propone un método sencillo, rápido y barato de identificación bacteriana y sensibilidad antibiótica utilizando MALDI-TOF y una doble centrifugación diferencial a partir de hemocultivo positivo. Métodos: Se estudiaron 52 hemocultivos positivos (37 bacilos gramnegativos y 15 cocos grampositivos). Se compararon 2 métodos: un método convencional de identificación y determinación de sensibilidad a antibióticos automatizada partiendo de colonia crecida, y un método rápido utilizando MALDI-TOF, caracterizado por la obtención de un pellet purificado procedente de un hemocultivo positivo, mediante un procedimiento basado en una doble centrifugación diferencial. Resultados: Se analizaron y compararon 1.101 valores de CMI (mg/l) de acuerdo con los criterios establecidos por EUCAST y obtenidos por ambos métodos. Se detectaron discrepancias en 81 valores de CMI (7,35%). Considerando todos los aislados, la concordancia esencial fue del 98,28% y la concordancia categórica del 92,65%. Conclusión: Este método proporciona resultados de identificación y sensibilidad a antibióticos definitivos 24-48h antes que un método convencional (p<0,001), mejorando el tiempo de respuesta en el diagnóstico microbiológico de bacteriemias, especialmente en laboratorios sin servicio de guardias de 24h.(AU)

Guía práctica de las nuevas alternativas terapéuticas frente a SARS-CoV-2 en pacientes con inmunomoduladores de uso frecuente en dermatología / Practical Guide to New Treatments for SARS-CoV-2 Infection in Dermatology Patients Being Treated With Common Immunomodulators

En dermatología es frecuente el uso de inmunosupresores e inmunomoduladores, algunos de los cuales pueden predisponer al desarrollo de enfermedad grave por SARS-CoV-2. Las nuevas terapias antivirales frente al SARS-CoV-2 han demostrado reducir la progresión a neumonía por COVID-19 grave en pacientes susceptibles. El pasado 23 de mayo, la Agencia Española de Medicamentos y Productos Sanitarios publicó la última actualización sobre los criterios para la priorización en el acceso precoz a estos fármacos debido a su limitada disponibilidad. En esta guía práctica revisamos los pacientes dermatológicos que en caso de contraer COVID-19 leve-moderada pueden beneficiarse de los nuevos antivirales, así como su indicación (AU)

Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology (AU)

[Translated article] Practical Guide to New Treatments for SARS-CoV-2 Infection in Dermatology Patients Being Treated With Common Immunomodulators / Guía práctica de las nuevas alternativas terapéuticas frente a SARS-CoV-2 en pacientes con inmunomoduladores de uso frecuente en Dermatología

Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology (AU)

En dermatología es frecuente el uso de inmunosupresores e inmunomoduladores, algunos de los cuales pueden predisponer al desarrollo de enfermedad grave por SARS-CoV-2. Las nuevas terapias antivirales frente al SARS-CoV-2 han demostrado reducir la progresión a neumonía por COVID-19 grave en pacientes susceptibles. El pasado 23 de mayo, la Agencia Española de Medicamentos y Productos Sanitarios publicó la última actualización sobre los criterios para la priorización en el acceso precoz a estos fármacos debido a su limitada disponibilidad. En esta guía práctica revisamos los pacientes dermatológicos que en caso de contraer COVID-19 leve-moderada pueden beneficiarse de los nuevos antivirales, así como su indicación (AU)

An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health

Background: Worldwide, approximately 24% of all adults smoke, but smoking is up to twice as prevalent in people with mental ill-health. There is growing evidence that smoking may be a causal risk factor in the development of mental illness, and that smoking cessation leads to improved mental health. Methods: In this scholarly review we have: (1) used a modern adaptation of the Bradford-Hill criteria to bolster the argument that smoking could cause mental ill-health and that smoking cessation could reverse these effects, and (2) by considering psychological, biological, and environmental factors, we have structured the evidence to-date into a stress-diathesis model. Results: Our model suggests that smoking is a psychobiological stressor, but that the magnitude of this effect is mediated and modulated by the individual's diathesis to develop mental ill-health and other vulnerability and protective factors. We explore biological mechanisms that underpin the model, such as tobacco induced damage to neurological systems and oxidative stress pathways. Furthermore, we discuss evidence indicating that it is likely that these systems repair after smoking cessation, leading to better mental health. Conclusion: Based on a large body of literature including experimental, observational, and novel causal inference studies, there is consistent evidence showing that smoking can negatively affect the brain and mental health, and that smoking cessation could reverse the mental ill-health caused by smoking. Our model suggests that smoking prevention and treatment strategies have a role in preventing and treating mental illness as well as physical illness. (AU)

lnc-THRIL and miR-125b relate to disease risk, severity, and imbalance of Th1 cells/Th2 cells in allergic rhinitis

Objective: Tumor necrosis factor and HNRNPL-related immunoregulatory long noncod-ing RNA (lnc-THRIL) and its target microRNA (miR)-125b are reported to regulate immune response through several means by participating in allergic rhinitis (AR) pathology. This study aimed to investigate the role of lnc-THRIL and miR-125b in detecting AR risk, and to further explore their correlation with disease severity and cytokines released from T helper type (Th) 1 and Th2 in AR patients.Methods: A total of 160 AR patients and 80 subjects with severe snoring symptoms (as con-trols) were recruited. Nasal mucosa samples were collected to measure the expressions of lnc-THRIL, miR-125b, and Th1 and Th2 cytokines by reverse transcription quantitative polymerase chain reaction.Results: The expression of lnc-THRIL decreased while that of miR-125b increased in AR patients when compared with that of controls, and further receiver operating characteristic curve showed that both could well distinguish AR patients from controls. Furthermore, lnc-THRIL negatively correlated with miR-125b in AR patients. lnc-THRIL was negatively correlated with Individual Nasal Symptom Score (INSS) (including nasal rhinorrhea score, sneezing score, and congestion score) and Total Nasal Symptom Score (TNSS), and miR-125b was positively asso-ciated with INSS (including itching score, sneezing score, and congestion score) and TNSS. Moreover, lnc-THRIL was correlated with increased Th1 cytokines (interferon-gamma (IFN-γ) and interleukin (IL)-2) but with decreased Th2 cytokines (IL-4 and IL-10), while miR-125b exhib-ited opposite trends in AR patients.Conclusion: lnc-THRIL and its target (miR-125b) relate to disease risk, symptom severity, and Th1/Th2 imbalance of AR, suggesting their potential as biomarkers for AR management (AU)

ABO blood group is associated with COVID-19 susceptibility: a systematic review and meta-analysis

Introduction: Conflicting evidences exist that ABO blood groups correlate with the susceptibility to COVID-19 and its clinical outcomes. This study aimed to pool available articles that assessed a possible relationship between COVID-19 and ABO blood groups. Materials and methods: A search was conducted in four databases comprising Pubmed/Medline, Google scholar, Journal storage (JSTOR) and African Journals Online (AJOL) for relevant studies available before 25th August 2020 and contained extractable data on ABO blood type distribution and COVID-19 disease. Search terms included a combination of “ABO blood group, and COVID-19, coronavirus, and SARS-COV-2”. Results: Fourteen articles that met study inclusion criteria were selected from a total of five hundred and eighty-five articles identified through database search. The fourteen articles reviewed comprised of a total of 73934 subjects (13189 SARS-COV-2 positive cases and 60745 controls). Overall, the risk of SARS-COV-2 infection was found to be significantly increased in patients with blood group A with ORs: 1.24 (95%Cl: 1.09-1.41, P = 0.001). Additionally, blood group O subjects were seen to have decreased odds of contracting COVID-19 infection (OR: 0.78, 95%Cl: 0.68 – 0.89, P=0.0003). No significant association was found between ABO blood groups and COVID -19 severity and mortality. Conclusions: Blood group A was associated with a higher risk of SARS-COV-2 infection whereas risk of infection was lower in blood group O subjects. No statistical significant association was found between ABO blood groups and COVID-19 severity and mortality. The precise role of ABO blood group in COVID-19 susceptibility, severity and mortality requires further research for clarification (AU)

Protrombosis en tiempos de la COVID-19 / Prothrombosis in times of COVID-19

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The situation of infection in the elderly in Spain: a multidisciplinary opinion document / Situación de la infección en el anciano: un documento multidisciplinar de opinión

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed

La infección en los ancianos es un tema enorme que suele recibir enfoques muy específicos pero parciales. Además, es una de las áreas en las que la intervención podría tener más éxito para mejorar la calidad de vida de los pacientes mayores. En un intento de dar el mayor enfoque posible a este tema, la Fundación de Ciencias de la Salud ha convocado a expertos de diferentes áreas para elaborar este documento de opinión sobre la situación de la infección en los ancianos, tratando de comparar las opiniones de médicos expertos, enfermeras, farmacéuticos, periodistas, representantes de asociaciones de ancianos y terminando con los aspectos éticos que plantea el problema. El formato es el de la discusión de una serie de preguntas preformuladas que fueron discutidas entre todos los presentes. Empezamos discutiendo el concepto de "anciano", las razones de la predisposición a la infección, las infecciones más frecuentes y sus causas, y la carga laboral y económica que suponen para la sociedad. También preguntamos si teníamos datos para estimar la proporción de estas infecciones que podrían ser reducidas por programas específicos, incluyendo programas de vacunación. En este contexto, se discutió la baja presencia de este problema en los medios de comunicación, la posición de las asociaciones científicas y de pacientes sobre el problema y los aspectos éticos que todo esto plantea

Año 2005: clasificación clínica, serológica y molecular de la enfermedad inflamatoria intestinal / Year 2005: Clinical, serological and molecular classification of inflammatory bowel disease

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Hallazgos cutáneos en la pandemia de COVID-19 en la Región de Murcia / Skin findings in the COVID-19 pandemic in the Region of Murcia

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Presión arterial central en la obesidad mórbida y tras la cirugía bariátrica / Central blood pressure in morbid obesity and after bariatric surgery

La obesidad está asociada con la hipertensión arterial por mecanismos diversos. La presión arterial (PA) central parece estar más correlacionada que la PA periférica con el riesgo cardiovascular futuro. La cirugía bariátrica constituye un método eficaz para disminuir la PA paralelamente a una pérdida de peso significativa en pacientes con obesidad severa. El estudio de la relación entre la modificación de peso tras cirugía bariátrica y la medición ambulatoria de PA, no solo a nivel periférico, sino también a nivel central, podría aportar información respecto a los mecanismos del daño orgánico asociado a la PA elevada en la obesidad. En esta revisión analizamos la evidencia disponible respecto a la asociación entre la PA central con la obesidad y sus modificaciones tras la cirugía bariátrica

Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity. The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity. In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery

Impact of hepatitis virus infection on arterial calcification among incident hemodialysis patients / Impacto de la infección por el virus de la hepatitis en la calcificación arterial en nuevos pacientes en hemodiálisis

BACKGROUND: The impact of hepatitis virus infection on arterial calcification (AC) was not studied. OBJECTIVE: To study the prevalence, severity and distribution of AC in incident hemodialysis patients with hepatitis B and C viral infection. Cases and methods: 172 stage 5 CKD adults (98 male and 74 female) were included; 58 of them were seronegative for both hepatitis B and C (SN group), 48 were positive for hepatitis B virus infection (HBV group) and 66 were hepatitis C virus positive (HCV group). Beside histopathology of the obtained arterial samples, all these cases were examined for body mass index (BMI), serum calcium (Ca), phosphorus (P), alkaline phosphatase (AP), serum albumin, uric acid (UA), alanine transaminase (ALT), parathormone (PTH), fibroblast growth factor 23(FGF23), interleukin 6 (IL6), and 25 hydroxy vitamin D (25 (OH) vit D), hemoglobin concentration, and serum ferritin. RESULTS: 86 (50%) of the cases had AC; 11 of them were in SN group (19%), 9 in HBV group (18.8%) and all the 66 CV group (100%). In SN group, 4 had intimal calcification, 5 had medial calcification, and 2 had both intimal and medial calcification. In HBV group, 9 had intimal calcification, while no cases were encountered with either medial or both site calcifications. In HCV group, 16 had intimal calcification, 31 had medial calcification, and 19 had both intimal and medial calcification. Calcification was in the form of spots in one case in SN group, and 6 cases in HBV group, a single plaque of calcification in 5 cases of SN group, 3 cases of HBV group, and 16 cases of HCV group, multiple plaques were detected in 4 cases in SN group, and 31 cases in HCV group, and diffuse calcification in one case in SN group, and 19 cases in HCV group. In HBV group, calcification was only detected in patients with high viremia, while all patients with low or moderate viremia were devoid of calcification. In HCV group, all patients with low viremia had intimal solitary plaque of calcification, all patients with moderate viremia had multiple plaques of medial calcification, while all patients with high viremia had diffuse intimal and medial calcification. Both groups of viral hepatitis were significantly different in comparison to SN group in either distribution or calcification score (P < 0.001 in all). HBV group had significantly lower serum P, CaxP and PTH in comparison to SN group (4.6±0.66 vs. 5.45±0.77mg/dL, 36.4±7.2 vs. 44.1±8.69, and 348±65.4 vs. 405.9±83.2pg/mL, P<0.001, <0.001, and 0.035 respectively). On the other hand, HCV group did not show any significant difference in any of the studied parameters compared to SN group. CONCLUSION: HCV positive patients are more prone to develop AC that is more extensive. HBV positive patients were less likely to have arterial medial calcification, probably related to lower serum phosphorus, CaxP product and PTH. HCV infection should be added as risk factor for AC among CKD patients. Further studies are needed to confirm these findings

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Fumar en tiempos del COVID-19. Documento de posición. Comunicado a los profesionales de salud / Smoking in times of COVID-19. Position statement. Communication to health care professionals

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Influencia del tabaquismo en la infección por coronavirus. Documento posición Comité Anti-Tabaco / Influence of smoking habit in coronavirus infection. Anti-Tobacco Committee Position Statemen

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Insuficiencia cardiaca y diabetes: la confrontación de dos grandes epidemias del siglo XXI / Heart failure and diabetes: The confrontation of two major epidemics of the 21st century

Existe una asociación bidireccional entre la insuficiencia cardiaca (IC) y la diabetes mellitus tipo 2 (DM2) que hace que la combinación de ambas enfermedades en un mismo paciente haya pasado a tener un incremento exponencial. Dicha combinación, parte de múltiples causas comunes que llevan a vías fisiopatológicas que resultan en un efecto deletéreo de la DM2 sobre la IC. La consecuencia clínica inevitable es que ante dicha situación el paciente presente peor clínica y peor pronóstico que el paciente con IC sin DM2. Por todo ello debemos tener en cuenta cómo tratar la DM2 en pacientes con IC, y cómo tratar la IC en pacientes con DM2. En esta revisión se hace hincapié en los últimos datos publicados al respecto

There is a bidirectional association between heart failure (HF) and type 2 diabetes mellitus (DM2), which has resulted in an exponential increase in the combination of the 2 diseases in a single patient. This combination is one of many common causes that lead to the pathophysiological pathways resulting in the deleterious effect of DM2 on HF. The inevitable clinical consequence is that, when faced with this situation, patients present worse symptoms and a poorer prognosis than patients with HF but without DM2. We should therefore consider how to treat DM2 in patients with HF and how to treat HF in patients with DM2. In this review, we highlight the latest published data on this issue

Brote de Hepatitis A en Galicia durante 2016-2018 / Hepatitis A outbreak in Galicia during 2016-2018

OBJETIVO: En Galicia, la incidencia (I) de hepatitis A (HA) es baja y la susceptibilidad es del 51% en adultos (18-64 años). Entre 2016 y 2018 se incrementaron los casos, fundamentalmente en hombres. El objetivo de este estudio fue describir los casos de HA en Galicia en este periodo de brote (PB), compararlos con el periodo pre-brote (PPB), y describir las intervenciones realizadas. METODOS: Se realizó un estudio descriptivo de los casos de HA declarados entre 2016-2018 (PB), comparados con los del periodo previo (2010-2015, PPB). Se incluyeron los casos del Sistema de Notificación Obligatoria (por atención primaria, hospitalaria y microbiología) de 2010 a 2018. Se calculó el canal epidémico para el PPB, como media de casos/cuatrisemana para comparar casos observados/esperados. La incidencia (I) [casos por cada 100.000 habitantes (c/105h)] por sexo y edad se comparó con el PPB mediante el Riesgo Relativo (RR). Se enviaron mensajes con recomendaciones específicas a través de webs de referencia para hombres que tenían sexo con hombres (HSH). RESULTADOS: El brote duró 20 cuatrisemanas (septiembre de 2016 a marzo de 2018). La incidencia fue de 3 casos por cada 100.000 habitantes en hombres y 0,5 casos por cada 100.000 habitantes en mujeres. Frente al PPB, el RR-PB en hombres fue 4,8 (IC95%=4-7) y 20,4 (IC95%=5-87) entre 40 y 44 años. El 42% de los hombres respondieron tener relaciones con otros hombres (el 57% entre 20 y 30 años). A finales de 2016 se envió a través de Wapo (una de las webs de referencia de HSH) un mensaje con recomendaciones (fundamentalmente sobre vacunación), registrándose 331 entradas. CONCLUSIONES: La incidencia de HA aumenta en Galicia en el período 2016-2018 por un brote en HSH. La susceptibilidad se incrementa entre jóvenes, lo que hace necesario insistir en la vacunación de los grupos de riesgo

OBJECTIVE: In Galicia, the incidence (I) of hepatitis A (HA) is low and the susceptibility is 51% in adults (18-64 years). Between 2016 and 2018 the cases increased, mainly in men. We intend to describe the cases of HA in Galicia during this outbreak period (PB), compare them with the pre-outbreak period (PPB), and the interventions performed. METHODS: Descriptive study of the cases of HA declared between 2016-18 (PB), compared to those from the previous period (2010-2015, PPB). Cases recorded in the mandatory notification system (general practice, hospitalization and microbiology) from 2010 to 2018 were included. For the pre-outbreak period 2010-2015 (PPB) it was calculated the average of cases/four-week period to compare observed/expected cases; the incidence (I) [cases/100,000 inhabitants (c/105h)] by sex and age was compared with the PPB through the Relative Risk (RR). It were sent messages with recommendations through men who have sex with men (MSM) reference websites. RESULTS: The outbreak lasted 80 weeks (september of 2016 to march of 2018). The incidence was 3 cases/105h in men and 0.5 cases/105h in women. Compared to the PPB, the RR-PB in men was 4.8 (95%CI=4-7) and 20.4 (95%CI=5-87) in 40-44 years. 42% of men declared to have relationships with other men (57% in 20-30 years). At the end of 2016, a message with recommendations (specially vaccination) was sent via Wapo (promoted to MSM through one of its reference websites), where 331 entries were registered. CONCLUSIONS: HA's incidence, in Galicia, increased in 2016-2018 by an outbreak in MSM. We found an increased susceptibility among young people which makes necessary to insist on the vaccination of groups at risk

Estimación del riesgo cardiovascular de por vida (IBERLIFERISK): una herramienta nueva en prevención primaria de las enfermedades cardiovasculares / Estimation of lifetime risk of cardiovascular disease (IBERLIFERISK): a new tool for cardiovascular disease prevention in primary care

Introducción y objetivos: Desarrollar una función predictiva del riesgo cardiovascular de por vida de eventos cardiovasculares, mortales y no mortales en población laboral española. Métodos: Estudio de cohortes retrospectivo. Se seleccionó a trabajadores de entre 18 y 65 años sin antecedentes de enfermedad cardiovascular que realizaron un examen de salud entre los años 2004 y 2007. El 70% de la cohorte se utilizó para desarrollar la ecuación de riesgo y el 30%, para validar la ecuación. Se construyeron 4 modelos de riesgos proporcionales de Cox en los que se utilizaron como variables dependientes la aparición de eventos cardiovasculares y la aparición de eventos competitivos; se usaron los mismos modelos en varones y mujeres. Los eventos mortales y no mortales se evaluaron hasta el año 2014. Resultados: Se incluyó a 762.054 sujetos, con una media de edad de 35,48 años (el 71,14% varones). Resultaron factores significativos en el modelo la ocupación manual, el tabaquismo, la diabetes mellitus, el tratamiento antihipertensivo, la presión arterial sistólica, el colesterol total, el colesterol unido a lipoproteínas de alta densidad y el tratamiento hipolipemiante; en varones, el consumo de alcohol, el índice de masa corporal, los antecedentes de enfermedad coronaria precoz en familiares de primer grado, la enfermedad renal y la presión arterial diastólica. El área bajo la curva c fue 0,84 (IC95%, 0,82-0,85) en varones y 0,73 (IC95%, 0,66-0,80) en mujeres. La calibración mostró una subestimación en los deciles de bajo riesgo y sobrestimación en los de alto riesgo. Conclusiones: El modelo de riesgo cardiovascular de por vida tiene una discriminación y una calibración satisfactorias, con mejores resultados para varones que para mujeres

Introduction and objectives: To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain. Methods: Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014. Results: A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles. Conclusions: The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women