ABSTRACT
Introduction: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. Methods: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. Results: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. Conclusion: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
Introducción: El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas. Métodos: Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA. Resultados: El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%. Conclusión: La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.
ABSTRACT
INTRODUCTION: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. METHODS: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. RESULTS: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. CONCLUSION: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , SARS-CoV-2 , Spain/epidemiologyABSTRACT
INTRODUCTION: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. METHODS: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. RESULTS: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. CONCLUSION: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
ABSTRACT
AIMS: To test the feasibility of a school-based intervention, which combines an incentive-driven physical activity program with lifestyle lectures, and its potential beneficial outcome on children's metabolic parameters. METHODS: We conducted a 6-month pilot intervention in two high schools in Mallorca, Spain, consisting of a program which involved free supervised exercise sessions and nutritional lectures, where children received credit points as a reward for the hours spent exercising and attendance to the lectures. The credit-earned points obtained were exchanged for gifts. We developed personalized cards and a web application for the participants to check the gifts they were eligible for (www.actyboss.com). Percentage body fat, percentage of fat-free mass and BMI were measured. Secondary measures included fitness parameters, blood pressure and blood lipids levels. 90 children signed up the consent form and 56 completed the program until the endpoint. RESULTS: We found a beneficial effect on body composition, fitness parameters, and systolic blood pressure in children who participated in ACTYBOSS compared to children who did not start the intervention. CONCLUSIONS: We describe the incentive-driven, after-school intervention pilot program to promote physical activity and a healthy lifestyle. The program had a positive effect on anthropometric measurements. A larger incentive-driven healthy lifestyle program is now ongoing.
Subject(s)
Behavior Therapy , Exercise , Health Behavior , Health Education/methods , Obesity/prevention & control , Reward , Adolescent , Blood Pressure , Body Composition , Body Mass Index , Child , Diet , Female , Humans , Male , Motivation , Obesity/psychology , Physical Education and Training , Physical Fitness , Pilot Projects , Program Evaluation , School Health Services , SpainABSTRACT
Comunicamos la puesta en marcha de un programa intensivo y multidisciplinar de pérdida de peso en pacientes con obesidad mórbida (OM). Este ensayo clínico se basa en la educación para la salud, el apoyo en el proceso de cambio, los medicamentos y las sesiones de terapia de grupo. Nuestra intención es demostrar que los resultados obtenidos con este programa de pérdida de peso a 2 años son, cuando menos, comparables a los resultados que se obtienen con la cirugía bariátrica en estos pacientes con OM. Es nuestra intención igualmente (..) (AU)
Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system (AU)
Subject(s)
Humans , Randomized Controlled Trials as Topic/methods , Obesity, Morbid/therapyABSTRACT
Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system.
Subject(s)
Obesity, Morbid/therapy , Randomized Controlled Trials as Topic/methods , Adolescent , Adult , Aged , Bariatric Surgery/economics , Behavior Therapy/economics , Combined Modality Therapy/economics , Comorbidity , Diet, Reducing/economics , Exercise Therapy/economics , Female , Health Care Costs , Humans , Male , Medicine , Middle Aged , Nutritional Support/economics , Obesity, Morbid/blood , Obesity, Morbid/economics , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Patient Care Team , Patient Selection , Research Design , Spain/epidemiology , Treatment Outcome , Young AdultABSTRACT
Malignant gliomas are characterized by their invasiveness and angiogenesis. Matrix metalloproteinases (MMPs) degrade extracellular matrix and create a more permissive environment for cell invasion. We aimed to investigate for the presence of inter- and intratumoral heterogeneity in MMP-2 messenger RNA (mRNA) expression by means of quantitative analysis and to evaluate its prognostic impact in glioma patients. Representative sections from the center and periphery of tumors resected en bloc were taken fresh for study, stained with hematoxylin/eosin for histological evaluation, and immunohistochemically analyzed for Ki-67. MMP-2 mRNA expression was evaluated by real-time reverse transcriptase polymerase chain reaction (RT-PCR). There was MMP-2 expression in all analyzed tumors. By topographical dissection of surgical specimens, we found no differences in cell proliferation or density but significant differences with regard to MMP-2 mRNA expression between central and peripheral regions, being highest at the center of malignant gliomas. MMP-2 mRNA expression showed no prognostic influence on overall or disease-free survival. Our results demonstrate that MMP-2 is differentially expressed in central and peripheral regions of gliomas. Further studies are necessary to clarify the significance of these findings and their possible relevance in clinical practice.
Subject(s)
Biomarkers, Tumor/analysis , Brain Neoplasms/enzymology , Glioma , Matrix Metalloproteinase 2 , Adolescent , Adult , Aged , Aged, 80 and over , Brain Neoplasms/diagnosis , Brain Neoplasms/genetics , Disease-Free Survival , Extracellular Matrix/metabolism , Glioma/diagnosis , Glioma/enzymology , Glioma/genetics , Humans , Immunohistochemistry , Ki-67 Antigen/analysis , Male , Matrix Metalloproteinase 2/analysis , Matrix Metalloproteinase 2/genetics , Matrix Metalloproteinase 2/metabolism , Middle Aged , Neoplasm Invasiveness , Prognosis , RNA, Messenger/analysis , RNA, Messenger/genetics , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction/methodsABSTRACT
Genomic imprinting requires the differential marking by DNA methylation of genes in male and female gametes. In the female germline, acquisition of methylation imprint marks depends upon the de novo methyltransferase Dnmt3a and its cofactor Dnmt3L, but the reasons why specific sequences are targets for Dnmt3a and Dnmt3L are still poorly understood. Here, we investigate the role of transcription in establishing maternal germline methylation marks. We show that at the Gnas locus, truncating transcripts from the furthest upstream Nesp promoter disrupts oocyte-derived methylation of the differentially methylated regions (DMRs). Transcription through DMRs in oocytes is not restricted to this locus but occurs across the prospective DMRs at many other maternally marked imprinted domains, suggesting a common requirement for transcription events. The transcripts implicated here in gametic methylation are protein-coding, in contrast to the noncoding antisense transcripts involved in the monoallelic silencing of imprinted genes in somatic tissues, although they often initiate from alternative promoters in oocytes. We propose that transcription is a third essential component of the de novo methylation system, which includes optimal CpG spacing and histone modifications, and may be required to create or maintain open chromatin domains to allow the methylation complex access to its preferred targets.
Subject(s)
DNA Methylation/physiology , Genomic Imprinting/genetics , Oocytes/metabolism , Transcription, Genetic/genetics , Alleles , Animals , Chromogranins , Female , GTP-Binding Protein alpha Subunits, Gs/metabolism , Mice , Mice, Inbred C57BL , Molecular Sequence DataABSTRACT
Recent investigations suggest that sex hormones play an important role in the brown adipose tissue (BAT) thermogenic program by acting on several steps of the lipolytic signal cascade and on the UCP1 transcription control. However, the number of studies focusing on steroid receptor status in brown adipose tissue is negligible. In the present study, we analyze steroid receptor mRNA levels in brown adipose tissue in male and female rats and in pregnant and lactating females, all of them models with a different hormonal background. The direct effect of sex hormones on the expression of their receptors was studied in vitro in primary culture of brown adipocytes. Oestrogen receptor (ERalpha) and androgen receptor (AR) densities were higher in male than in female BAT. PR A+B mRNA expression was downregulated in lactation, suggesting a role of progesterone signalling in thermogenesis impairment at this stage. In vitro studies showed that progesterone decreased PR A+B mRNA and that testosterone downregulated ERalpha mRNA. The results highlighted in this study demonstrate the presence of steroid receptor mRNA in BAT and in brown cell cultured adipocytes, supporting the idea that changes in steroid receptor expression would be important for the understanding of sex hormone effects on BAT physiology.
Subject(s)
Adipose Tissue, Brown/metabolism , Gene Expression Profiling , Gonadal Steroid Hormones/metabolism , Receptors, Steroid/genetics , Animals , Cells, Cultured , Female , Gene Expression Regulation , Lactation , Male , Mice , Pregnancy , Progesterone/blood , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats , Rats, Wistar , Receptors, Androgen/genetics , Receptors, Androgen/metabolism , Receptors, Estrogen/genetics , Receptors, Estrogen/metabolism , Receptors, Progesterone/genetics , Receptors, Progesterone/metabolism , Receptors, Steroid/metabolism , Sex CharacteristicsABSTRACT
The complex imprinted Gnas locus encodes several gene products including G(s)alpha, the ubiquitously expressed G protein alpha-subunit required for receptor-stimulated cAMP generation, and the neuroendocrine-specific G(s)alpha isoform XLalphas. XLalphas is only expressed from the paternal allele, whereas G(s)alpha is biallelically expressed in most tissues. XLalphas knock-out mice (Gnasxl(m+/p-)) have poor suckling and perinatal lethality, implicating XLalphas as critical for postnatal feeding. We have now examined the metabolic phenotype of adult Gnasxl(m+/p-) mice. Gnasxl(m+/p-) mice had reduced fat mass and lipid accumulation in adipose tissue, with increased food intake and metabolic rates. Gene expression profiling was consistent with increased lipid metabolism in adipose tissue. These changes likely result from increased sympathetic nervous system activity rather than adipose cell-autonomous effects, as we found that XLalphas is not normally expressed in adult adipose tissue, and Gnasxl(m+/p-) mice had increased urinary norepinephrine levels but not increased metabolic responsiveness to a beta3-adrenergic agonist. Gnasxl(m+/p-) mice were hypolipidemic and had increased glucose tolerance and insulin sensitivity. The similar metabolic profile observed in some prior paternal Gnas knock-out models results from XLalphas deficiency (or deficiency of the related alternative truncated protein XLN1). XLalphas (or XLN1) is a negative regulator of sympathetic nervous system activity in mice.
