Achalasia: diagnostic delay and manometric characteristics with high-resolution solid-state and perfusion equipment.

INTRODUCTION: The early diagnosis of achalasia requires a high degree of clinical suspicion, and delays in diagnosis are frequent. High-resolution oesophageal manometry (HRM) is the gold standard for its diagnostic confirmation. There are two HRM systems, perfusion and solid-state, which allow its classification into three subtypes: I, or classical; II, or with pan-oesophageal pressurization; and III, or spastic. OBJECTIVE: To determine the clinical and manometric characteristics of the three subtypes with high-resolution perfusion and solid-state equipment and the time of evolution until diagnosis. METHODS: This was a multicentre, observational, retrospective study of patients from the INTEGRA database of the Spanish Association of Neurogastroenterology and Motility who were diagnosed with primary achalasia confirmed by HRM, who fell under the Chicago Classification v3.0, and who had not been treated. RESULTS: The study included 110 patients (subtype I, N = 14; subtype II, N = 73; subtype III, N = 23). The HRM equipment was perfusion for 49 and solid-state for 61. The mean age was 61.8 ± 14 years (age range 44-81), the age was lower in subtype II, and the sex distribution was similar. The time of clinical evolution until diagnosis was > 12 months (51.6%), subtype II being the one that was diagnosed earlier and the most often (66.3%). Dysphagia was the most frequent symptom (90.5%). According to the comparative analysis by high-resolution perfusion and solid-state oesophageal manometry equipment, the baseline pressure of the lower oesophageal sphincter was higher in the solid-state oesophagus, but the difference was not statistically significant. The median integrated relaxation pressure at 4 seconds (IRP4) was similar (21 mmHg) between the perfusion and solid-state measurements. We describe the ranges of IRP4 in achalasia patients with both systems and confirm the possibility of achalasia even when IRP4 is within the normal range. CONCLUSIONS: Achalasia in our environment has a significant diagnostic delay. No significant differences were observed in the oesophagogastric junction between the two groups diagnosed with perfusion and solid-state equipment.

Perfiles de Personalidad en adolescentes con Trastornos por Ansiedad en Población General y Clínica / Personality Profiles in Adolescents with Anxiety Disorders in General and Clinical population

La personalidad es el trasfondo que determina la forma de pensar, sentir y comportarse e influye en la psicopatología. En este contexto, resulta relevante el estudio de la relación entre personalidad y ansiedad en la adolescencia. El principal objetivo de nuestro estudio es analizar las diferencias entre casos con Trastornos por Ansiedad (TA) y una muestra de población general (PG) en los diferentes perfiles / prototipos de personalidad (PRP) derivados del el Inventario clínico para adolescentes de Millon (MACI). Un segundo objetivo fue estudiar el modelo más parsimonioso de PRP capaz de predecir TA. Para responder a estos objetivos se utilizó un diseño observacional analítico y se realizó un muestreo aleatorio de adolescentes en PG (n = 461) y consecutivo de pacientes con TA, valorados según criterios DSM-5 (n = 77). Los instrumentos de medida utilizados fueron el MACI y Adolescent Symptom Inventory. Los PRP Introvertidos, Inhibidos, Pesimistas, Sumisos, Oposicionistas, Autopunitivos y Límites presentan una media significativamente mayor en TA y los PRP Histriónico y Egocéntrico en PG. El modelo más parsimonioso de PRP que mejor predice TA está conformado por tener mayor edad y los PRP más límite y menos rebelde. El estudio ofrece una imagen novedosa de los PRP en casos de TA que invitan a su estudio clínico, favoreciendo nuevos caminos de investigación que incluyan la personalidad en la heterogeneidad del trastorno. (AU)

Personality is the background that determines the way we think, feel and behave and influences psychopathology. In this context, the study of the relationship between personality and anxiety in adolescence is important. The main objective of our study is to analyse the differences between cases with Anxiety Disorders (AD) and a sample of general population (GP) in the different personality profiles / prototypes (PRP) derived from the Millon Adolescent Clinical Inventory (MACI). Secondary objective: to study the most parsimonious predictive model of PRP to predict AD. To respond to these objectives, an observational analytical design was used and a random sampling of adolescents in GP (n = 461) and consecutive sampling of patients with AD, assessed according to DSM-5 criteria (n = 77) was performed. The measurement instruments used were the MACI and the Adolescent Symptom Inventory. Introverted, Inhibited, Doleful, Submissive, Oppositional, Self-demeaning and Borderline PRPs present a significantly higher mean in AD and the Dramatizing and Egotistic PRPs in GP. The most parsimonious PRP model that best predicts AD is shaped by having older age and the most Borderline and least Unruly PRPs. The study offers a novel picture of PRPs in AD cases that invite their clinical study, favoring new paths of research that include personality in the heterogeneity of the disorder. (AU)

Improving COVID-19 vaccine uptake: a message co-design process for a national mHealth intervention in Colombia.

BACKGROUND: COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose. OBJECTIVE: This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia. METHODS: Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings. RESULTS: Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention. CONCLUSIONS: Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes.

Incidence of Anal Cancer and Related Risk Factors in HIV-Infected Patients Enrolled in the National Prospective Spanish Cohort CoRIS.

BACKGROUND: People living with HIV have an increased risk of anal cancer. OBJECTIVE: To estimate anal cancer incidence and related risk factors in a national cohort of HIV-infected patients. DESIGN: Prospective multicenter cohort study. SETTINGS: Multicenter study including patients from the Spanish HIV Research Network. PATIENTS: We collected data from 16,274 HIV-infected treatment-naive adults recruited from January 2004 to November 2020. MAIN OUTCOMES MEASURES: The primary outcome measures of this study were the incidence and prevalence of anal carcinoma. The secondary outcome measures included the associations between baseline and time-dependent covariables and the primary end point. RESULTS: Twenty-six cases of anal cancer were diagnosed, 22 of which were incident cases resulting in a cumulative incidence of 22.29 of 100,000 person-years, which was stable during the study period. At the end of the study, 20 of the 43 centers had screening programs for high-grade anal dysplasia. Patients with anal cancer were males (26/26; 100% vs 13,833/16,248; 85.1%), were mostly men who have sex with men (23/26; 88.5% vs 10,017/16,248; 61.6%), had a median age of 43 years (interquartile range, 35-51), were more frequently previously diagnosed with an AIDS-defining illness (9/26; 34.6% vs 2429/16,248; 15%), and had lower nadir CD4 cell counts (115 vs 303 µL). About a third (34.6%, 9/26) were younger than 35 years. In multivariable analysis, men who have sex with men and patients with previous AIDS-defining illness had an 8.3-fold (95% CI, 1.9-36.3) and 2.7-fold (95% CI, 1.1-6.6) increased HR for developing anal cancer, respectively. Patients with higher CD4 cell counts during the follow-up showed a 28% lower risk per each additional 100 CD4 cell/µL (95% CI, 41%-22%). LIMITATIONS: Lack of information on some potential risk factors, screening, and treatment of high-grade anal dysplasia were not uniformly initiated across centers during the study period. CONCLUSIONS: Although the overall incidence in our study was low, there was a significant number of patients younger than 35 years with anal cancer. In addition to age, other factors, such as men who have sex with men and patients with severe immunosuppression (current or past), should be prioritized for anal cancer screening. INCIDENCIA DEL CNCER DE ANO Y LOS FACTORES DE RIESGO RELACIONADOS CON PACIENTES INFECTADOS POR VIH INCLUIDOS EN LA COHORTE PROSPECTIVA NACIONAL ESPAOLA CORIS: ANTECEDENTES:Las personas portadoras del virus de la inmunodeficiencia humana tienen un mayor riesgo de cáncer anal.OBJETIVO:Nosotros queremos estimar la incidencia de cáncer anal y los factores de riesgo relacionados en una cohorte nacional española de pacientes infectados por VIH.DISEÑO:Estudio de cohortes de tipo multicéntrico y prospectivo.ÁMBITO:Se incluyeron pacientes de la Red Española de Investigación en VIH.PACIENTES:Recolectamos los datos de 16,274 adultos infectados por el VIH que nunca habían recibido tratamiento, reclutados desde enero de 2004 hasta noviembre de 2020.MEDIDAS DE RESULTADO PRINCIPALES:Las medidas de resultado primarias de este estudio fueron la incidencia y la prevalencia del carcinoma anal. Las medidas de resultado secundarias incluyeron las asociaciones entre las covariables basales y dependientes del tiempo y el criterio principal de valoración.RESULTADOS:Se diagnosticaron 26 casos de cáncer anal, de los cuales 22 fueron casos incidentales resultando con una incidencia acumulada de 22,29/100.000 personas-año que se mantuvo estable durante el período de estudio.Al final de nuestro estudio, 20 de los 43 centros referentes tenían programas de detección de displasia anal de alto grado. Los pacientes con cáncer anal eran hombres (26/26; 100% vs 13 833/16 248; 85,1%), en su mayoría hombres que mantenían sexo con otros hombres (23/26; 88,5% vs 10 017/16 248; 61,6%), la mediana de edad fue de 43 años (IQR: 3 -51), 34,6% (9/26) < 35 años, previa y frecuentemente diagnosticados con una enfermedad definitoria de SIDA (9/26; 34,6% vs 2429/16248; 15%) y que tenían un punto opuesto mucho más bajo en el recuentos de células CD4 (115 µL frente a 303 µL).En el análisis multivariable, los hombres que tenían relaciones sexuales con otros hombres y los pacientes con enfermedades definitorias de sida anteriores, tenían un aumento de 8,3 veces (IC del 95%: 1,9 a 36,3) y de 2,7 veces (IC del 95%: 1,1 a 6,6) en el cociente de riesgos instantáneos para desarrollar cáncer anal, respectivamente. Los pacientes con recuentos de células CD4 más altos durante el seguimiento mostraron un riesgo 28 % menor por cada 100 células CD4/µl adicionales (95% IC: 41%- 22%).LIMITACIONES:La falta de información sobre algunos factores potenciales de riesgo, la detección y el tratamiento de la displasia anal de alto grado no se iniciaron uniformemente en todos los centros durante el período de estudio.CONCLUSIONES:Si bien la incidencia general en nuestro estudio fue baja, hubo un número significativo de pacientes de <35 años con cáncer anal. Además de la edad, otros factores como los hombres que tienen sexo con hombres y los pacientes con inmunosupresión severa (actual o pasada) deben priorizarse para la detección del cáncer anal. ( Traducción-Dr. Xavier Delgadillo ).

Late poor outcomes of Clostridioides difficile infections in oncological patients: A multicentre cohort study.

Background: Cancer has been associated with an increased risk of in-hospital mortality in CDI patients. However, data on delayed mortality in cancer patients with CDI are scarce. Aim/Objective: The aim of the present study was to compare outcomes between oncological patients and the general population with Clostridioides difficile infection (CDI) after 90 days of follow-up. Methods: A multicenter prospective cohort study was conducted in 28 hospitals participating in the VINCat program. Cases were all consecutive adult patients who met the case definition of CDI. Sociodemographic, clinical, and epidemiological variables and evolution at discharge and after 90 days were recorded for each case. Findings/results: The mortality rate was higher in oncological patients (OR = 1.70, 95% CI: 1.08-2.67). In addition, oncological patients receiving chemotherapy (CT) presented higher recurrence rates (18.5% vs 9.8%, p = 0.049). Among oncological patients treated with metronidazole, those with active CT showed a higher rate of recurrence (35.3% vs 8.0% p = 0.04). Discussion: Oncological patients presented a higher risk of poor outcomes after CDI. Their early and late mortality rates were higher than in the general population, and in parallel, those undergoing chemotherapy (especially those receiving metronidazole) had higher rates of recurrence.

Rasgos de personalidad en adolescentes con trastorno por déficit de atención con hiperactividad / Personality traits in adolescents with Attention Deficit Hyperactivity Disorder

Antecedentes: Existen pocos estudios que relacionen personalidad y trastorno por déficit de atención con hiperactividad (TDAH) en adolescentes. Objetivo: estudiar diferencias entre casos con TDAH y población general en prototipos de personalidad (PRP) derivados del Inventario clínico para adolescentes de Millon (MACI). Material y Método: Diseño observacional analítico. Muestreo aleatorio en población general (n = 461) y consecutivo de pacientes con TDAH valorados según criterios DSM-5 (n = 85), en adolescentes entre 13 y 17 años. Instrumentos de medida: MACI y Adolescent Symptom Inventory. Resultados: los PRP Pesimista, Rudo, Rebelde, Oposicionista, Autopunitivo y Límite presentan una media significativamente mayor en TDAH y los PRP Sumiso y Conformista, en población general. El modelo de PRP que mejor prediceTDAH está conformado por tener sexo masculino y los PRP Rudo, Límite, Sumiso y Autopunitivo, clasificando el 82.4% de los casos. Conclusión: Los casos de TDAH tienen PRP diferenciales con la población general que invitan a su estudio clínico e intervención terapéutica. El estudio ofrece una imagen novedosa de los PRP en casos de TDAH y abre nuevos caminos de investigación que incluyan la personalidad al explicar la heterogeneidad del trastorno. (AU)

Background: There are few studies linking personality and Attention Deficit Hyperactivity Disorder (ADHD) in adolescents. Research objective: to study differences between cases with ADHD and the general population in personality prototypes (PRP) derived from the Millon Clinical Inventory for Adolescents (MACI). Material and Method: Analytical observational design. Random sampling in the general population (n = 461) and consecutive of patients with ADHD evaluated according to DSM-5 criteria (n = 85), in adolescents between 13 and 17 years old. Measurement instruments: MACI and Adolescent Symptom Inventory. Results: ADHD presents a significantly higher mean in Doleful, Forceful, Unruly, Oppositional, Self-demeaning and Borderline PRP and the general population in Submissive and Conforming PRP. The PRP model that best predicts ADHD includes male sex and the Forceful, Borderline, Submissive and Self-demeaning PRP. The model classifies 82.4% of the cases. Conclusion. ADHD cases have differential PRP in comparison with the general population, which invites their clinical study and therapeutic intervention. The study offers a novel image of PRP in ADHD and opens new lines of research that include personality when explaining the heterogeneity of the disorder. (AU)

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study.

Introduction: Bloodstream infections (BSI) are a major cause of mortality all over the world. Inappropriate empirical antimicrobial treatment (i-EAT) impact on mortality has been largely reported. However, information on related factors for the election of i-EAT in the treatment of BSI in adults is lacking. The aim of the study was the identification of risk-factors associated with the use of i-EAT in BSI. Methods: A retrospective, observational cohort study, from a prospective database was conducted in a 400-bed acute-care teaching hospital including all BSI episodes in adult patients between January and December 2018. The main outcome variable was EAT appropriation. Multivariate analysis using logistic regression was performed. Results: 599 BSI episodes were included, 146 (24%) received i-EAT. Male gender, nosocomial and healthcare-associated acquisition of infection, a high Charlson Comorbidity Index (CCI) score and the isolation of multidrug resistant (MDR) microorganisms were more frequent in the i-EAT group. Adequation to local guidelines' recommendations on EAT resulted in 91% of appropriate empirical antimicrobial treatment (a-EAT). Patients receiving i-EAT presented higher mortality rates at day 14 and 30 when compared to patients with a-EAT (14% vs. 6%, p = 0.002 and 22% vs. 9%, p < 0.001 respectively). In the multivariate analysis, a CCI score ≥3 (OR 1.90 (95% CI 1.16-3.12) p = 0.01) and the isolation of a multidrug resistant (MDR) microorganism (OR 3.79 (95% CI 2.28-6.30), p < 0.001) were found as independent risk factors for i-EAT. In contrast, female gender (OR 0.59 (95% CI 0.35-0.98), p = 0.04), a correct identification of clinical syndrome prior to antibiotics administration (OR 0.26 (95% CI 0.16-0.44), p < 0.001) and adherence to local guidelines (OR 0.22 (95% CI 0.13-0.38), p < 0.001) were identified as protective factors against i-EAT. Conclusion: One quarter of BSI episodes received i-EAT. Some of the i-EAT related factors were unmodifiable (male gender, CCI score ≥3 and isolation of a MDR microorganism) but others (incorrect identification of clinical syndrome before starting EAT or the use of local guidelines for EAT) could be addressed to optimize the use of antimicrobials.

Personalidad en adolescentes en muestra general y clínica / Personality in adolescents in a general and clinical sample

El objetivo principal del estudio fue analizar las diferencias entre muestra general y clínica en los prototipos de personalidad (PRP) del “Inventario clínico para adolescentes de Millón” (MACI). La metodología incluyó un diseño observacional y analítico, utilizando un muestreo de participantes (13-17 años) aleatorio polietápico, estratificado y proporcional por conglomerados en muestra general (n= 461) y un muestreo consecutivo en muestra clínica (n= 219). Encontramos que los PRP introvertido, inhibido, pesimista, rudo, oposicionista, autopunitivo y límite presentan una media significativamente mayor en muestra clínica y los PRP histriónico y conformista en muestra general. Se observa ausencia de diferencias significativas en los PRP egocéntrico, sumiso y rebelde. En la variable sexo observamos más diferencias significativas de PRP en muestra clínica que en la general y en la variable edad encontramos una tendencia lineal significativa descendente en los PRP sumiso o conformista y ascendente en los PRP rebelde y rudo en muestra general. El clínico debe estar alerta ante la interpretación de los PRP del MACI que no diferencian entre muestra general y clínica. (AU)

The main objective of the study was to analyze the differences between samples from general and clinical sample in personality prototypes (PRP), derived from the Millon Adolescent Clinical Inventory (MACI). The methodology included an analytical and observational design with a random, multi-stage, stratified and proportional cluster sampling in general sample (n= 461) and consecutive sampling of clinical sample (n= 219), in adolescents between 13 and 17 years of age. We found introvert, inhibited, doleful, forceful, oppositional, self-demeaning and borderline PRP in the clinical sample and dramatizing and conforming PRP in the general sample present a significantly higher mean. There is a relevant absence of significant differences in egotistic, submissive and unruly PRP. By sex, more significant differences in PRP are observed in the clinical sample. By age, a significant downward linear trend in the submissive and conforming PRP is observed, as well as an upward trend in the unruly and forceful PRP in the general sample. The clinician must be alert in the interpretation of the MACI PRP that do not differentiate between general and clinical samples. (AU)

Clostridioides difficile infection recurrence in the VINCat hospitals: a prospective observational cohort study.

Background: The 2016 cumulative incidence of Clostridioides difficile infection (CDI) in Spain was reported by the European Center for Disease Control to be above the mean of other European countries. The aim of this multicenter prospective observational cohort study was to examine the risk factors that determine 90-day CDI recurrence in Catalonia, Spain. Methods: The study included 558 consecutive adults admitted to hospital who had a symptomatic, first positive CDI diagnosis. Sociodemographic, clinical and epidemiological variables were recorded. The primary outcome was 90-day CDI recurrence. Results: In this Catalan population, having received more than one course of antibiotics in the 30 days prior to CDI diagnosis (odds ratio: 2.459; 95% CI: 1.195-5.060; p = 0.015) and active chemotherapy (odds ratio: 4.859; 95% CI: 1.495-15.792; p = 0.009) are significant predictors of 90-day CDI recurrence. Conclusion: The identification of independent risk factors of 90-day CDI recurrence will enable the optimization of preventive measures in at-risk populations.

Trastorno por Déficit de Atención con Hiperactividad: Ritmo Circanual en el Mes de Nacimiento / Attention Deficit Hyperactivity Disorder: Circannual Rhythm in the Month of Birth

Estudiamos la existencia de ritmo circanual en el mes de nacimiento en participantes con trastorno de déficit de atención e hiperactividad (TDAH)y analizamos la asociación entre meses de nacimiento y TDAH. La muestra incluye 10978 participantes (1778 TDAH / 9200 no TDAH), entre 3 y18 años, reclutados mediante muestreo consecutivo de primeras consultas atendidas en salud mental entre 1992 y 2021. Los participantes conTDAH presentan un ritmo circanual significativo en los meses de nacimiento, con una acrofase en octubre. Nacer en el último cuatrimestre del añoincrementa significativamente la probabilidad de ser diagnosticado TDAH, controlando el efecto de sexo y edad. Con el transcurso de los meses delaño, existe una tendencia lineal creciente significativa de ser diagnosticado de TDAH, no observada en población general, ni en casos sin TDAH.Es necesario tener precaución en el diagnóstico y tratamiento de los niños nacidos en los últimos meses del año, que, por su mayor inmadurez encomparación con los demás niños de la clase, pudieran ser diagnosticados y tratados erróneamente como TDAH. (AU)

We studied the existence of circanual rhythm in the month of birthin participants with attention deficit hyperactivity disorder (ADHD) and analyzed the association between months of birth and ADHD. We analyzed10,978 participants (1,778 ADHD/9,200 non-ADHD), aged 3 to 18 years. A consecutive sample of first visits to mental health between 1992 and2021 is used. Participants with ADHD exhibit a significant circannual rhythm in the months of birth, with an acrophase in October. Being born in thelast quarter of the year significantly increases the probability of being diagnosed with ADHD, controlling for the effect of sex and age. As the monthsof the year go by, there is a significant increasing linear trend of being diagnosed with ADHD, which is not observed neither in general populationnor in cases without ADHD. Caution is necessary in diagnosis and treatment of children born in the last months of year, who, due to their greaterimmaturity compared to the other children in class, could be misdiagnosed and treated as ADHD. (AU)

Transcriptomic and proteomic retinal pigment epithelium signatures of age-related macular degeneration.

There are currently no treatments for geographic atrophy, the advanced form of age-related macular degeneration. Hence, innovative studies are needed to model this condition and prevent or delay its progression. Induced pluripotent stem cells generated from patients with geographic atrophy and healthy individuals were differentiated to retinal pigment epithelium. Integrating transcriptional profiles of 127,659 retinal pigment epithelium cells generated from 43 individuals with geographic atrophy and 36 controls with genotype data, we identify 445 expression quantitative trait loci in cis that are asssociated with disease status and specific to retinal pigment epithelium subpopulations. Transcriptomics and proteomics approaches identify molecular pathways significantly upregulated in geographic atrophy, including in mitochondrial functions, metabolic pathways and extracellular cellular matrix reorganization. Five significant protein quantitative trait loci that regulate protein expression in the retinal pigment epithelium and in geographic atrophy are identified - two of which share variants with cis- expression quantitative trait loci, including proteins involved in mitochondrial biology and neurodegeneration. Investigation of mitochondrial metabolism confirms mitochondrial dysfunction as a core constitutive difference of the retinal pigment epithelium from patients with geographic atrophy. This study uncovers important differences in retinal pigment epithelium homeostasis associated with geographic atrophy.

Correlación entre las pruebas de antígeno prostático específico rápida y sérica / Correlation between rapid and serum prostate-specific antigen tests

Introducción: Al día de hoy no se ha alcanzado un consenso sobre el mejor enfoque para realizar el tamizaje y la detección precoz del Cáncer de Próstata (CaP), en la población. No obstante, hay programas que recomiendan la utilización de la prueba de antígeno prostático específico rápida para la detección de CaP sin un análisis de correlación frente a la prueba sérica. Objetivo: Identificar la correlación entre las pruebas de antígeno prostático específico rápida y sérica, en la población mexicana. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo, bajo un muestreo no probabilístico por conveniencia. En el período comprendido entre el 25 de mayo al 13 de julio de 2017. Se calcularon los coeficientes de correlación punto biserial (r pb ) y phi (r phi ). Resultados: Se incluyeron 1 635 registros, principalmente de la Ciudad de México y del Estado de México (n= 1 398; 85,5 por ciento, IC95 por ciento 81-89,9). La edad promedio fue de 51 años (DE= 7,68). El valor promedio de antígeno prostático sérico fue de 1,49 ng/mL (DE= 1,91). La proporción de hombres con una prueba rápida positiva (n=60; 3,7 por ciento; IC95 por ciento 2,9-4,6) fue menor (p= 0,0415) en comparación con la proporción de pacientes con una prueba sérica ≥ 4 ng/mL (n=85; 5,2 por ciento; IC95 por ciento 4,1-6,3). El número de casos dobles negativos fue de 1 530 (93,6 por ciento; IC95 por ciento 92,3-94,6) y de dobles positivos fue de 40 (2,4 por ciento; IC95 por ciento1,7-3,2). Los coeficientes de correlación punto biserial y phi mostraron una correlación baja entre la prueba rápida y la prueba sérica de antígeno prostático (rpb= 0,469; p < 0,001; r2= 0,2199 y r ph i= 0,540; p < 0,001; r2= 0,2916). Conclusiones: La prueba de antígeno prostático específico rápida es una herramienta conveniente para los programas de detección de alteración prostática en unidades médicas del primer nivel de atención, donde la prueba sérica no se puede realizar, al ser una prueba con una baja sensibilidad y con un bajo coeficiente de correlación respecto de la prueba de antígeno prostático específico sérica, esto es un punto importante que debe considerarse al diseñar programas de detección oportuna de cáncer de próstata(AU)

Introduction: To date, no consensus has been reached on the best approach for screening and early detection of Prostate Cancer (PCa) in the population. However, there are programs recommending the use of the rapid prostate-specific antigen test for the detection of PCa without a correlation analysis versus the serum test. Objective: To identify the correlation between rapid and serum prostate specific antigen tests in the Mexican population. Methods: A descriptive, cross-sectional and retrospective study was carried out, under a non-probabilistic convenience sampling from May 25 to July 13, 2017. The correlation coefficients of point biserial (rpb) and phi (rphi) were calculated. Results: One thousand six hundred thirty five (1,635) records were included, mainly from Mexico City and the State of Mexico (n= 1,398; 85.5 percent, 95 percent CI 81-89.9). The average age was 51 years (SD= 7.68). The mean value of serum prostate antigen was 1.49 ng/ml (SD= 1.91). The proportion of men with positive rapid test (n=60; 3.7 percent; 95 percent CI 2.9-4.6) was lower (p= 0.0415) compared to the proportion of patients with a serum test ≥ 4 ng/ml (n= 85; 5.2 percent; 95 percent CI 4.1-6.3). The number of double negative cases was 1,530 (93.6 percent; CI95 percent 92.3-94.6) and of double positives was 40 (2.4 percent; CI95 percent 1.7-3.2). The point biserial and phi correlation coefficients showed low correlation between the rapid test and the serum prostate antigen test (rpb= 0.469; p < 0.001; r2= 0.2199 and rphi= 0.540; p < 0.001; r2= 0. 2916). Conclusions: The rapid prostate-specific antigen test is a convenient tool for prostatic alteration detection programs in primary care medical units, where the serum test cannot be performed, however, as it is a test with low sensitivity and with low correlation coefficient with respect to serum prostate-specific antigen testing, this is an important point to consider when designing prostate cancer early detection programs(AU)

Human Mitoribosome Biogenesis and Its Emerging Links to Disease.

Mammalian mitochondrial ribosomes (mitoribosomes) synthesize a small subset of proteins, which are essential components of the oxidative phosphorylation machinery. Therefore, their function is of fundamental importance to cellular metabolism. The assembly of mitoribosomes is a complex process that progresses through numerous maturation and protein-binding events coordinated by the actions of several assembly factors. Dysregulation of mitoribosome production is increasingly recognized as a contributor to metabolic and neurodegenerative diseases. In recent years, mutations in multiple components of the mitoribosome assembly machinery have been associated with a range of human pathologies, highlighting their importance to cell function and health. Here, we provide a review of our current understanding of mitoribosome biogenesis, highlighting the key factors involved in this process and the growing number of mutations in genes encoding mitoribosomal RNAs, proteins, and assembly factors that lead to human disease.

Enfermera comunitaria y participación comunitaria. ¿Mito o realidad? / Community nurse and community participation. Myth or reality?

Este artículo tiene como objetivo presentar elementos de reflexión y análisis de la realidad desde el inicio de la Atención Primaria de salud en 1978, centrándose en la Comunitat Valenciana. Se destaca la influencia de las políticas sanitarias en todos los aspectos referenciados, que afecta directamente al pleno desarrollo de la Atención Primaria (AP) desde la integración de la asistencia, la implicación de las direcciones sanitarias, el desarrollo de la formación universitaria de Enfermería y la Especialidad de Enfermería Familiar y Comunitaria (EEFyC), la cobertura de plazas en AP, el aumento de técnicas derivadas del hospital a la AP, hasta las dificultades para implicar a la enfermería de AP en actividades comunitarias. A su vez, presentamos proyectos que se están llevando a cabo con la ciudadanía con un liderazgo de enfermeras comunitarias (EC) y con el apoyo institucional. La enfermería comunitaria actualmente es una parte minúscula de nuestra realidad; sigue siendo un mito

This article aims to present elements of reflection and analysis of the reality since the beginning of primary health care in 1978. This essay will focus on the Valencia Community. The influence of the health policies in all the referenced aspects is highlighted, as it which directly affects the full development of Primary Care (PC), from the integration of care, the involvement of the health directorates, the development of nursing university training and the Specialty of Family and Community Nursing (SFCN), the coverage of places in primary care, the increase in techniques derived from the hospital to the PC, to the difficulties in implicating the PC nursing in community activities. We also present projects that are being conducted in the citizenship by a clear leadership of nurses and with institutional support. Community nursing is currently a tiny part of our reality; it is still a myth

Calidad de vida relacionada con la salud en casos de trastorno por déficit de atención con hiperactividad con/sin tratamiento farmacológico / Health-related quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment

Introducción: La calidad de vida relacionada con la salud (CVRS) es un marcador relevante para valorar los efectos de una intervención terapéutica. El objetivo del estudio es analizar la CVRS comparando casos con trastorno por déficit de atención con hiperactividad (TDAH) tratados farmacológicamente con metilfenidato (TDAH-T), casos no tratados (TDAH-N) y controles. Material y métodos: Muestra de 228 participantes entre 8 y 14 años (114 controles, 57 TDAH-T y 57 TDAH-N). Muestreo consecutivo de TDAH según DSM-IV (ADHD Rating Scales IV) y muestreo aleatorio de controles emparejados por sexo y edad. Evaluación de CVRS mediante KIDSCREEN-52 versión padres. Resultados: La intensidad de síntomas de TDAH es significativamente menor en TDAH-T que en TDAH-N y se observa correlación significativa moderada entre mayor intensidad de síntomas de TDAH y peor CVRS. Los casos de TDAH tienen significativamente peor CVRS que los controles en bienestar psíquico, estado de ánimo, relación con padres, relación con amigos, entorno escolar y aceptación social. Los casos de TDAH-T presentan significativamente mejor CVRS que TDAH-N en la dimensión escolar, pero no se diferencian significativamente en otras dimensiones del KIDSCREEN-52. Conclusiones: Sería recomendable que el tratamiento del TDAH integrase modelos terapéuticos multidimensionales que mejoren los síntomas básicos del trastorno y la CVRS

Introduction: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. Material and methods: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. Results: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. Conclusions: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL

[Health-related quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment]. / Calidad de vida relacionada con la salud en casos de trastorno por déficit de atención con hiperactividad con/sin tratamiento farmacológico.

INTRODUCTION: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. MATERIAL AND METHODS: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. RESULTS: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. CONCLUSIONS: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL.

[Participatory tools and methods for community action. SESPAS Report 2018]. / Herramientas y métodos participativos para la acción comunitaria. Informe SESPAS 2018.

Participation is a process that requires the involvement of the policy makers, managers, technicians and staff of the institutions, and of citizens, as well as intersectoral and interdisciplinary action. To generate transformative changes, an infrastructure that encourages participation and planned action is required, and that recognises all the actors in the process. It takes time and commitment to ensure continuity through the joint production of actions, hence the importance of consolidating participatory projects that continue beyond political changes making public services sustainable. Training, the appropriate use of participation tools and a horizontal policy of delegated power are essential to ensure participation. Surveys, sociograms, flowcharts, health assets mapping, participatory budgets and participatory evaluation matrices are some of the tools that can be chosen, depending on the type of subjects addressed, the time and resources available, the characteristics of the participating population and territory, as well as determining the use that will be made of the information generated for the next phase. Participation tools are useful for citizens and professionals to analyze, understand, debate and decide collectively how to improve living conditions and environments. Over the past decade, social networks in the virtual environment have generated new trends in mass participation, which are self-managed by citizens.

Herramientas y métodos participativos para la acción comunitaria. Informe SESPAS 2018 / Participatory tools and methods for community action. SESPAS Report 2018

La participación es un proceso que requiere la implicación de responsables de la política, del personal directivo y técnico de las instituciones, y de la ciudadanía, así como de la acción intersectorial e interdisciplinaria. Para generar cambios transformadores es necesaria una infraestructura que favorezca la participación y la acción planificada, reconociendo a todos los actores del proceso. Se precisan tiempo y compromiso para su continuidad a través de la producción conjunta de acciones, y de ahí la importancia de consolidar proyectos participativos que continúen más allá de los cambios políticos para que los servicios públicos sean sostenibles. La formación, el uso adecuado de las herramientas de participación y una política horizontal de poder delegado son imprescindibles para el desarrollo de la participación. Herramientas como sondeos, sociogramas, flujogramas, mapeos de activos para la salud, presupuestos participativos o matrices de evaluación participativa son algunas de las que pueden elegirse, en función del tipo de materias abordadas, el tiempo y los recursos disponibles, las características de la población participante y del territorio, así como del uso que se va a hacer de la información generada para la siguiente fase. Las herramientas de participación son útiles para que la ciudadanía profesionales analicen, comprendan, debatan y decidan colectivamente con el fin de mejorar las condiciones de vida y los entornos. En la última década, las redes sociales en el entorno virtual han generado nuevas tendencias de participación masiva y autogestionada por la ciudadanía

Participation is a process that requires the involvement of the policy makers, managers, technicians and staff of the institutions, and of citizens, as well as intersectoral and interdisciplinary action. To generate transformative changes, an infrastructure that encourages participation and planned action is required, and that recognises all the actors in the process. It takes time and commitment to ensure continuity through the joint production of actions, hence the importance of consolidating participatory projects that continue beyond political changes making public services sustainable. Training, the appropriate use of participation tools and a horizontal policy of delegated power are essential to ensure participation. Surveys, sociograms, flowcharts, health assets mapping, participatory budgets and participatory evaluation matrices are some of the tools that can be chosen, depending on the type of subjects addressed, the time and resources available, the characteristics of the participating population and territory, as well as determining the use that will be made of the information generated for the next phase. Participation tools are useful for citizens and professionals to analyze, understand, debate and decide collectively how to improve living conditions and environments. Over the past decade, social networks in the virtual environment have generated new trends in mass participation, which are self-managed by citizens

Predicción de deterioro cognitivo en esquizofrenia: retrospectiva de 31 años / Prediction of cognitive damage in patient with schizophrenia: A thirty-one year retrospective

Este trabajo pretende averiguar qué subpruebas de la "Escala de inteligencia de Wechsler para adultos" (WAIS) forman el modelo cognitivo más parsimonioso capaz de predecir el importante deterioro cognitivo presentado por pacientes con esquizofrenia en edades avanzadas. Evaluamos con el "Mini-examen cognoscitivo" (MEC-35) a un grupo de 30 mujeres institucionalizadas diagnosticadas de esquizofrenia que 31 años antes habían sido valoradas con el WAIS. Encontramos que el 53,3% de las pacientes muestran deterioro significativo y 31 años antes puntuaciones más bajas en todas las pruebas del WAIS. Estas diferencias eran significativas (p< 0,05) en todas las medidas de cociente intelectual. A través del análisis de regresión logística encontramos que el modelo cognitivo que mejor predicción hizo lo forman las subpruebas de Semejanzas, Rompecabezas y Aritmética del WAIS, clasificando el 96,7% de los casos y presentando excelente validez de criterio con una sensibilidad del 93,8% y especificidad del 100%. Concluimos que el aumento de deterioro cognitivo en pacientes ancianas con esquizofrenia parece asociarse con una baja inteligencia fluida previa

The purpose of this study is to find out which tests from the Wechsler Intelligence Scale define the most detailed cognitive model that is able to predict the relevant cognitive impairment in elderly people with schizophrenia. A group of 30 institutionalised women who were diagnosed with schizophrenia were assessed with MEC-35; they had been previously assessed 31 years before using the WAIS. It was found that 53.3% of the patients showed significant cognitive impairment and 31 years ago their scores were lower in all the subtests from the WAIS. Those differences are significant (p< .05) in all of the IQ measurements. Throughout the logistical regression analysis we found that the cognitive model that made the best prediction was produced from the following subtests: Similarities, Puzzles and Arithmetic, classifying 96.7% of the cases and showing an excellent criterion validity, a sensitivity of 93.8% and a 100% of specificity. We conclude that the increase of the cognitive impairment in elderly patients with schizophrenia seems to be associated with previous low fluid intelligence