Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2.

OBJECTIVE: The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. MATERIAL AND METHODS: A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. RESULTS: A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. CONCLUSIONS: Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age.

[Severity of COVID-19 attributable to obesity according to BMI and CUN-BAE]. / Gravedad de COVID-19 atribuible a obesidad según IMC y CUN-BAE.

INTRODUCTION: Obesity is considered a risk factor in severe cases of COVID-19, which has been analysed using body mass index (BMI), an estimator that does not correlate adequately with body fat (BF) percentage. The aim of this study was to analyse the population attributable fraction to BF in severe forms of COVID-19 based on BMI and CUN-BAE. MATERIAL AND METHODS: Multicentre observational prevalence study. Sociodemographic information, personal history, BMI and CUN-BAE were collected in SARS-CoV-2 positive cases from the provinces of León and La Rioja. Logistic regression models were used to calculate odds ratios with their respective 95% confidence intervals adjusting for age and personal history, as well as the population attributable fraction to BF. RESULTS: Seven hundred eighty-five patients participated, 123 (15.7%) were severe. Age, obesity (both by BMI and CUN-BAE) and personal history were detected as risk factors. 51.6% of severe cases could be attributed to excess BMI and 61.4% to excess BF estimated according to CUN-BAE, with a higher underestimation of risk in women. CONCLUSIONS: Excess BF is a risk factor for severe forms of COVID-19 together with advanced age and the presence of cardiovascular, chronic respiratory or oncohematological diseases. BMI underestimates the risk especially in women, being CUN-BAE the predictor selected for its better estimation of the percentage of BF.

[Internal validity of a rapid test for COVID-19 antigens in a nursing home]. / Validez interna de una prueba rápida de detección de antígenos COVID-19 en una residencia de mayores.

INTRODUCTION: RT-qPCR is the reference test for the detection of SARS-CoV-2 infection, however, rapid antigen detection tests (RADT) are now available. In this work, the internal validity of the RADT was evaluated in the context of an outbreak in a nursing home. METHODS: Nasopharyngeal exudate samples were analyzed by RADT and RT-qPCR from 61 residents of a nursing home. The sensitivity and specificity of RADT with respect to RT-qPCR was calculated. RESULTS: Specificity was 100% (95% CI 54.1-100.0), while sensitivity in asymptomatic people was 70.3% (95% CI 53.0-84.1) and in symptomatic people 83.3% (95% CI 51.6-97.9). CONCLUSIONS: The RADTs are sufficiently sensitive and specific to be used as screening tests in nursing homes, especially in situations of outbreaks or suspected outbreaks due to the presence of symptoms.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

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 <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

Predictive factors of COVID-19 in patients with negative RT-qPCR.

OBJECTIVE: To evaluate the factors associated with false negatives in RT-qPCR in patients with mild-moderate symptoms of COVID-19. MATERIALS AND METHODS: This was a cross-sectional study that used a random sample of non-hospitalized patients from the primary care management division of the Healthcare Area of Leon (58 RT-qPCR-positive cases and 52 RT-qPCR-negative cases). Information regarding symptoms was collected and all patients were simultaneously tested using two rapid diagnostic tests - RDTs (Combined - cRDT and Differentiated - dRDT). The association between symptoms and SARS-CoV-2 infection was evaluated by non-conditional logistic regression, with estimation of Odds Ratio. RESULTS: A total of 110 subjects were studied, 52% of whom were women (mean age: 48.2±11.0 years). There were 42.3% of negative RT-qPCRs that were positive in some RDTs. Fever over 38°C (present in 35.5% of cases) and anosmia (present in 41.8%) were the symptoms most associated with SARS-CoV-2 infection, a relationship that remained statistically significant in patients with negative RT-qPCR and some positive RDT (aOR=6.64; 95%CI=1.33-33.13 and aOR=19.38; 95% CI=3.69-101.89, respectively). CONCLUSIONS: RT-qPCR is the technique of choice in the diagnosis of SARS-CoV-2 infection, but it is not exempt from false negatives. Our results show that patients who present mild or moderate symptoms with negative RT-qPCR, but with fever and/or anosmia, should be considered as suspicious cases and should be evaluated with other diagnostic methods.

Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors.

OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.

[Reproducibility, correlation and concordance of the Abbreviated Dietary Score questionnaire]. / Reproducibilidad, correlación y concordancia de un cuestionario abreviado del Dietary Score.

OBJECTIVE: The objective of this study was to evaluate the reproducibility, correlation and concordance of the abbreviated Dietary Score (aDS) used in the IBERICAN study. MATERIAL AND METHODS: A cross-sectional study was performed in order to assess the reproducibility of the aDS using a test-retest. Its internal consistency was evaluated using Cronbach's alpha, and reliability of the measurements using the intraclass correlation coefficient (ICC). From the food frequency questionnaire (FFQ) of the PREDIMED-Plus study, adherence to a Mediterranean diet pattern was evaluated using DS, and its correlation and agreement with aDS was assessed. In both cases the lineal regression, Bland-Altman, and kappa index techniques were used. RESULTS: A total of 142 subjects participated, mostly men (56.3%), with a mean age of 64.6±4.9 years. In terms of reproducibility, a Pearson correlation coefficient of 0.538 was obtained; a mean of the differences of 2.03 points, and a weighted kappa index of 0.400 (95% CI=0.295-0.577). The instrument had good internal consistency (Cronbach's alpha=0.699), as well as good reliability (CCI=0.931). The aDS had a correlation coefficient with the DS of 0.517, a mean difference of 1.19 points, and a weighted kappa index of 0.450 (95% CI=0.366-0.532). CONCLUSIONS: The aDS has moderate reproducibility and a good correlation and agreement with the DS, so it can be a useful tool in Primary Care to assess adherence to the Mediterranean diet.

Compositional analysis of dietary patterns.

Instead of looking at individual nutrients or foods, dietary pattern analysis has emerged as a promising approach to examine the relationship between diet and health outcomes. Despite dietary patterns being compositional (i.e. usually a higher intake of some foods implies that less of other foods are being consumed), compositional data analysis has not yet been applied in this setting. We describe three compositional data analysis approaches (compositional principal component analysis, balances and principal balances) that enable the extraction of dietary patterns by using control subjects from the Spanish multicase-control (MCC-Spain) study. In particular, principal balances overcome the limitations of purely data-driven or investigator-driven methods and present dietary patterns as trade-offs between eating more of some foods and less of others.

Social exclusion of the adolescent with overweight: study of sociocentric social networks in the classroom.

BACKGROUND: Multiple studies have shown the social consequences of suffering overweight, with social exclusion or isolation as some of the most important. In order to study the social patterns among adolescents, we have set as objectives to analyse the position of the individual within their network from a sociocentric perspective, comparing the relational pattern of the adolescents suffering from overweight with those who are normal weight. METHOD: This was a cross-sectional descriptive study using logistic regression and social network analysis. We analysed the contact patterns of 235 adolescents in 11 social networks, classifying contact into three levels of intensity: minimum, intermediate and maximum (friendship). The WHO reference was used for the variable of overweight. RESULTS: The prevalence of overweight was 30.2% (25.5% overweight and 4.7% obesity). An analysis of the relational patterns of individuals with overweight showed that at the minimum contact level, they established fewer relationships and less closeness (odds ratio [OR]: 2.32; confidence interval [CI] 95%: 1.17-4.66; p-value: 0.016). This effect was more marked in female adolescents. At intermediate contact level, they had few relationships and low prestige (OR: 3.29; CI: 95%; 1.03-10.51; p-value: 0.045, OR: 3.18; CI: 95%; 1.00-10.04; p-value: 0.049, respectively). At maximum contact level (friendship), female adolescents related little with other adolescents (OR: 3.78; CI: 95%; 1.07-13.32; p-value: 0.038). CONCLUSIONS: Adolescents with overweight take up peripheral positions within their social network, choosing by themselves not to establish contact with others. Social network analysis is crucial to detect adolescents with overweight at risk of exclusion and help alleviate psychological and social deficits.

The NRF2 transcription factor plays a dual role in colorectal cancer: A systematic review.

BACKGROUND: Colorectal cancer is one of the most common cancers worldwide, and is influenced by the interplay of various factors, including a very strong genetic component. For instance, incorrect mitochondrial biogenesis is correlated with increased risk of developing colorectal cancer. Thus, it is important to understand the consequences of changes in both the expression and the correct function of the transcription factors that regulate mitochondrial biogenesis, namely NRF2. OBJECTIVES: The main objective of this paper is to characterise the relationship between NRF2 and colorectal cancer by compiling data from an exhaustive literature search. METHODS: Information was obtained by defining specific search terms and searching in several databases. After a strict selection procedure, data were tabulated and the relationships between articles were assessed by measuring heterogeneity and by constructing conceptual maps. RESULTS AND DISCUSSION: We found a general consensus in the literature that the presence of oxidizing agents as well as the inhibition of the NRF2 repressor Keap1 maintain NRF2 expression at basal levels. This predominantly exerts a cytoprotective effect on cells and decreases risk of colorectal cancer. However, if NRF2 is inhibited, protection against external agents disappears and risk of colorectal cancer increases. Interestingly, colorectal cancer risk is also increased when NRF2 becomes overexpressed. In this case, the increased risk arises from NRF2-induced inflammation and resistance to chemotherapy. CONCLUSION: The proper basal function of NRF2 and Keap1 are essential for preventing oncogenic processes in the colon. Consequently, any disruption to the expression of these genes can promote the genesis and progression of colon cancer.

Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010).

OBJECTIVE: Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. MATERIAL AND METHODS: the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. RESULTS: 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. CONCLUSIONS: bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.

Predictive factors of COVID-19 in patients with negative RT-qPCR / Factores predictivos del COVID-19 en pacientes con RT-qPCR negativa

OBJECTIVE: To evaluate the factors associated with false negatives in RT-qPCR in patients with mild-moderate symptoms of COVID-19. MATERIALS AND METHODS: This was a cross-sectional study that used a random sample of non-hospitalized patients from the primary care management division of the Healthcare Area of Leon (58 RT-qPCR-positive cases and 52 RT-qPCR-negative cases). Information regarding symptoms was collected and all patients were simultaneously tested using two rapid diagnostic tests - RDTs (Combined - cRDT and Differentiated - dRDT). The association between symptoms and SARS-CoV-2 infection was evaluated by non-conditional logistic regression, with estimation of Odds Ratio. RESULTS: A total of 110 subjects were studied, 52% of whom were women (mean age: 48.2±11.0 years). There were 42.3% of negative RT-qPCRs that were positive in some RDTs. Fever over 38°C (present in 35.5% of cases) and anosmia (present in 41.8%) were the symptoms most associated with SARS-CoV-2 infection, a relationship that remained statistically significant in patients with negative RT-qPCR and some positive RDT (aOR=6.64; 95%CI=1.33-33.13 and aOR=19.38; 95% CI=3.69-101.89, respectively). CONCLUSIONS: RT-qPCR is the technique of choice in the diagnosis of SARS-CoV-2 infection, but it is not exempt from false negatives. Our results show that patients who present mild or moderate symptoms with negative RT-qPCR, but with fever and/or anosmia, should be considered as suspicious cases and should be evaluated with other diagnostic methods

OBJETIVO: Evaluar los factores asociados con falsos negativos a RT-qPCR negativa y sintomatología leve o moderada de COVID-19. MATERIALES Y MÉTODOS: Estudio transversal. Se utilizó una muestra aleatoria de pacientes no hospitalizados de la Gerencia de Atención Primaria del Área de Salud de León (58 con RT-qPCR positiva y 52 con RT-qPCR negativa). Se recogió información sobre síntomas, y a todos se les realizaron simultáneamente dos pruebas de diagnóstico rápido (PDR): combinada (PRD-C) y diferenciada (PRD-D). La asociación de los síntomas con la infección por SARS-CoV-2 se evaluó mediante regresión logística no condicional, con el cálculo de odds ratio (OR). RESULTADOS: Se estudiaron un total de 110 personas, y el 52% de ellas fueron mujeres (edad media: 48,2±11,0años). El 42,3% de las RT-qPCR negativas dieron positivo en algún PDR. La fiebre de más de 38°C (presente en el 35,5% de los casos) y la anosmia (presente en el 41,2%) fueron los síntomas más asociados a la infección por SARS-CoV-2, relación que se mantuvo estadísticamente significativa en pacientes con RT-qPCR negativa y algún PDR positivo (ORa: 6,64; IC95%: 1,33-33,13, y ORa: 19,38; IC95%: 3,69-101,89, respectivamente). CONCLUSIONES: La RT-qPCR es la técnica de elección en el diagnóstico de la infección por SARS-CoV-2, pero no está exenta de falsos negativos. Nuestros resultados ponen de manifiesto que los pacientes que presentan síntomas leves o moderados con RT-qPCR negativa pero con fiebre y/o anosmia deben ser considerados casos sospechosos y deben ser valorados con otros métodos diagnósticos

Retroperitoneal fibrosis: typical and atypical manifestations.

Retroperitoneal fibrosis (RPF) is a well described clinical entity that is being diagnosed with increasing frequency. RPF is characterized by replacement of the normal tissue of the retroperitoneum with fibrosis and/or chronic inflammation. However, aetiology, clinical presentation and radiological appearance in many cases are protean. Up to 15% of patients have additional fibrotic processes outside the retroperitoneum. In the abdomen, RPF may spread contiguously to involve multiple structures in both the retroperitoneum and the peritoneal cavity or multiple non-contiguous sites may be involved. We retrospectively reviewed 30 patients (19 male, 11 female; age range 28-79 years) with biopsy proven RPF. Although we found RPF most commonly as an isolated fibrotic plaque in the lower lumbar region (18 patients), 12 patients (40%) presented with RPF in atypical locations (4 peripancreatic, 1 periduodenal, 7 pelvic). The RPF was non-malignant in 24 patients (21 idiopathic, 2 perianeurysmal, 1 ergot-derivative treatment) and malignant in six cases. We present a pictorial review of the varied appearances of RPF, concentrating on atypical sites. The radiological differential diagnosis and its appearance with various imaging modalities are discussed. Current concepts with respect to management, prognosis and treatment are summarized.

Reproducibilidad, correlación y concordancia de un cuestionario abreviado del Dietary Score / Reproducibility, correlation and concordance of the Abbreviated Dietary Score questionnaire

OBJETIVO: El objetivo de este estudio es evaluar la reproducibilidad, la correlación y la concordancia del Dietary Score abreviado (DSa) utilizado en el estudio IBERICAN. MATERIAL Y MÉTODOS: Estudio transversal. Se evaluó la reproducibilidad del DSa mediante una prueba test-retest, evaluando su consistencia interna mediante alfa de Cronbach y la fiabilidad de las mediciones mediante el coeficiente de correlación intraclase (CCI). A partir del cuestionario de frecuencia alimentaria (CFA) del estudio PREDIMED-Plus se evaluó la adherencia a un patrón de dieta mediterránea mediante el DS, valorándose su correlación y concordancia con el DSa. En ambos casos se utilizaron técnicas de regresión lineal, de Bland-Altman e índice de kappa. RESULTADOS: Participaron 142 sujetos, mayoritariamente hombres (56,3%), con una media de edad de 64,6+/-4,9 años. En términos de reproducibilidad, se obtuvo un coeficiente de correlación de Pearson de 0,538; una media de las diferencias de 2,03 puntos y un índice kappa ponderado de 0,400 (IC del 95%=0,295-0,577). El instrumento tuvo buena consistencia interna (alfa de Cronbach=0,699), así como buena fiabilidad (CCI=0,931). El DSa presentó un coeficiente de correlación con el DS de 0,517; una media de las diferencias de 1,19 puntos y un índice kappa ponderado de 0,450 (IC del 95%=0,366-0,532). CONCLUSIONES: El DSa presenta una moderada reproductibilidad y una buena correlación y concordancia con el DS, por lo que puede ser una herramienta útil en Atención Primaria para valorar la adherencia a la dieta mediterránea

OBJECTIVE: The objective of this study was to evaluate the reproducibility, correlation and concordance of the abbreviated Dietary Score (aDS) used in the IBERICAN study. MATERIAL AND METHODS: A cross-sectional study was performed in order to assess the reproducibility of the aDS using a test-retest. Its internal consistency was evaluated using Cronbach's alpha, and reliability of the measurements using the intraclass correlation coefficient (ICC). From the food frequency questionnaire (FFQ) of the PREDIMED-Plus study, adherence to a Mediterranean diet pattern was evaluated using DS, and its correlation and agreement with aDS was assessed. In both cases the lineal regression, Bland-Altman, and kappa index techniques were used. RESULTS: A total of 142 subjects participated, mostly men (56.3%), with a mean age of 64.6+/-4.9 years. In terms of reproducibility, a Pearson correlation coefficient of 0.538 was obtained; a mean of the differences of 2.03 points, and a weighted kappa index of 0.400 (95% CI=0.295-0.577). The instrument had good internal consistency (Cronbach's alpha=0.699), as well as good reliability (CCI=0.931). The aDS had a correlation coefficient with the DS of 0.517, a mean difference of 1.19 points, and a weighted kappa index of 0.450 (95% CI=0.366-0.532). CONCLUSIONS: The aDS has moderate reproducibility and a good correlation and agreement with the DS, so it can be a useful tool in Primary Care to assess adherence to the Mediterranean diet

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2 / Inmunogenicidad de la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y personas mayores institucionalizadas sin infección previa por SARS-CoV-2

Objective The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. Material and methods A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. Results A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. Conclusions Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age (AU)

Objetivo El objetivo de nuestra investigación fue comparar la evolución de la respuesta inmunitaria humoral inducida por la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y en personas mayores institucionalizadas (>65años) sin infección previa por SARS-CoV-2. Material y métodos Se realizó un estudio observacional prospectivo en una muestra de conveniencia conformada por sanitarios y mayores institucionalizados, determinando anticuerpos contra las proteínas S y N del SARS-CoV-2 a los 2 y 6 meses de recibir la segunda dosis de la vacuna, así como a los 2 meses después de recibir la tercera dosis. Resultados Se observó una reducción significativa de la respuesta inmune humoral anti-S 6 meses después de la segunda dosis de vacuna, tanto en sanitarios como en residentes. La administración de una tercera dosis de vacuna indujo un aumento significativo de esta respuesta de anticuerpos en ambos grupos, alcanzándose una proporción similar de individuos respondedores a los 2 meses de esta tercera dosis. Conclusiones La inmunidad humoral inducida por 2 dosis de la vacuna BNT162b2 en personas sin infección previa por SARS-CoV-2 disminuye con el tiempo. La administración de una tercera dosis aumenta significativamente los anticuerpos anti-S siendo muy recomendable, especialmente en personas mayores de 65 años (AU)

Lesiones en la lucha tradicional: el caso de la lucha leonesa (2005-2015) / Injuries in traditional wrestling: the leonese wrestling case study (2005-2015)

El objetivo de este estudio fue describir la localización anatómica, el tipo y la gravedad de las lesiones ocurridas en las competiciones oficiales de las ligas de verano masculinas (2005-2015) de Lucha Leonesa. Al objeto de realizar un análisis más profundo, se tuvo en cuenta, el perfil del luchador. Se produjeron un total de 401 lesiones, siendo los luchadores de mayor nivel los que menos número de lesiones sufrieron. Las contusiones fueron las lesiones más frecuentes (41,4%) pero entre las graves fueron los esguinces (42,3%). Los miembros inferiores fueron la localización más frecuente en el total de lesiones (38,2%) y entre las graves (45,4%). La rodilla, el tórax y el hombro acumulaban casi la mitad de las lesiones y el 68% de las lesiones graves. Los resultados obtenidos sugieren que las características de las lesiones que se pueden observar en la lucha leonesa son similares a las de otros deportes de combate

This study aimed at describing the anatomical location, type and severity of the sport injuries observed during the Leonese Wrestling "masculine summer leagues" official tournaments (2005-2015). The wrestler’s profile was taken into account as a way to achieve a deep analysis. A total of 401 injuries were registered. The best wrestlers were the ones that suffered the least number of injuries. Contusions were the type of injuries more frequently registered (41.4%), while sprains were the most common cause of severe injury (42.3%). The most frequent anatomical location affected and the one in which a great number of severe injuries occurred were the lower limbs (38.2% and 45.4%). The knee, thorax, and shoulder accounted for almost half of the total injuries and represented 68% of the severe injuries. The obtained results suggest that Leonese Wrestling show a similar injury pattern to the one observed in other combat sports

Gravedad de COVID-19 atribuible a obesidad según IMC y CUN-BAE / Severity of COVID-19 attributable to obesity according to BMI and CUN-BAE

Introducción La obesidad es considerada un factor de riesgo en casos graves de la COVID-19, habiendo sido analizada mediante el índice de masa corporal (IMC), estimador que no correlaciona adecuadamente con el porcentaje de grasa corporal (GC). El objetivo de este estudio ha sido analizar la fracción atribuible poblacional a la GC en formas graves de COVID-19 atendiendo al IMC y al CUN-BAE. Material y métodos Estudio multicéntrico observacional de prevalencia. Se recogió información sociodemográfica, antecedentes personales, IMC y CUN-BAE, de casos positivos SARS-CoV-2, de las provincias de León y La Rioja. Mediante modelos de regresión logística se calcularon odds ratio con sus respectivos intervalos de confianza del 95% ajustando por edad y antecedentes personales, así como la fracción atribuible poblacional a la GC. Resultados Participaron 785 pacientes, 123 (15,7%) fueron graves. Se detectaron como factores de riesgo la edad, la obesidad (tanto por IMC como por CUN-BAE) y los antecedentes personales. Un 51,6% de casos graves podrían ser atribuidos a un exceso de IMC y un 61,4% a exceso de GC estimada según CUN-BAE, observándose una mayor infraestimación del riesgo en mujeres. Conclusiones El exceso de GC es un factor de riesgo para formas graves de la COVID-19 junto con la edad avanzada y la presencia de enfermedades cardiovasculares, respiratorias crónicas u oncohematológicas. El IMC infraestima el riesgo, especialmente en mujeres, siendo el CUN-BAE el predictor seleccionado por su mejor estimación del porcentaje de GC (AU)

Introduction Obesity is considered a risk factor in severe cases of COVID-19, which has been analysed using body mass index (BMI), an estimator that does not correlate adequately with body fat (BF) percentage. The aim of this study was to analyse the population attributable fraction to BF in severe forms of COVID-19 based on BMI and CUN-BAE. Material and methods Multicentre observational prevalence study. Sociodemographic information, personal history, BMI and CUN-BAE were collected in SARS-CoV-2 positive cases from the provinces of León and La Rioja. Logistic regression models were used to calculate odds ratios with their respective 95% confidence intervals adjusting for age and personal history, as well as the population attributable fraction to BF. Results Seven hundred eighty-five patients participated, 123 (15.7%) were severe. Age, obesity (both by BMI and CUN-BAE) and personal history were detected as risk factors. 51.6% of severe cases could be attributed to excess BMI and 61.4% to excess BF estimated according to CUN-BAE, with a higher underestimation of risk in women. Conclusions Excess BF is a risk factor for severe forms of COVID-19 together with advanced age and the presence of cardiovascular, chronic respiratory or oncohematological diseases. BMI underestimates the risk especially in women, being CUN-BAE the predictor selected for its better estimation of the percentage of BF (AU)

Health-related quality of life in individuals with metabolic syndrome: a cross-sectional study / Calidad de vida relacionada con la salud en individuos con síndrome metabólico: un estudio descriptivo

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected

INTRODUCCIÓN Y OBJETIVOS: El síndrome metabólico (SM) es la combinación de diversos factores de riesgo cardiovascular que pueden derivar en un mayor impacto en la morbimortalidad prematura. Sin embargo, el impacto del SM en la calidad de vida relacionada con la salud (CVRS) es desconocido. El objetivo de este estudio es evaluar la CVRS en la población adulta española de 55 años o más con SM. MÉTODOS: Se realizó un análisis transversal con los datos del ensayo PREDIMED-Plus. Seis mil cuatrocientos treinta varones y mujeres entre 55-75 años con sobrepeso/obesidad y SM. El instrumento de medida de la CVRS fue el cuestionario SF-36. Cada escala del SF-36 fue descrita y estratificada por sexo. RESULTADOS: Los participantes mostraron valores más altos en las escalas función social (media: 85,9; IC 95%: 85,4-86,4) y rol emocional (media: 86,8; IC 95%: 86,0-87,5). En los varones, la peor puntuación fue en la dimensión salud general (media: 65,6; IC 95%: 65,0-66,2) y en las mujeres el dolor corporal (media: 54,3; IC 95%: 53,4-55,2). Además, los varones obtuvieron puntuaciones más altas en todas las escalas. En la escala función física en varones se encontró una disminución significativa de la CVRS en los participantes entre 70 y 75 años en comparación con los más jóvenes. Las peores puntuaciones se obtuvieron en las dimensiones físicas agregadas. CONCLUSIONES: El SM afecta de manera negativa a la CVRS en las dimensiones agregadas físicas, haciendo especial hincapié en la esfera dolor corporal en mujeres y salud general en varones. Sin embargo, las esferas psicológicas se encuentran menos afectadas por el SM