[Health and well-being of healthcare workers: employment and working conditions beyond the pandemic]. / Salud y bienestar del personal sanitario: condiciones de empleo y de trabajo más allá de la pandemia. Informe SESPAS 2024.

Healthcare workers are people who work in health activities, whether or not they have direct contact with citizens. Currently, around 1.3 million people (70% women) work in healthcare activities in Spain. This represents around 10% of the active population, having increased by 33% since 2008, especially the number of women, which has doubled. Healthcare organizations, especially hospitals, are extremely complex workplaces, with precarious working and employment conditions, especially in more hierarchical occupations, exposing healthcare workers to numerous occupational hazards, mainly from ergonomic and psychosocial conditions. These causes frequent musculoskeletal and mental disorders, highlighting burnout, which is estimated at 40% in some services such as intensive care units. This high morbidity is reflected in a high frequency of absences due to illness, around 9% after the pandemic. The pandemic, and its consequences in the last three years, has put extreme pressure on the health system and has clearly shown its deficiencies in relation to working and employment conditions. The hundreds of occupational health professionals, technicians and healthcare workers, who are part of the structures of health organizations, constitute very valuable resources to increase the resilience of the NHS. We recommend the strengthening in resources and institutionally of the occupational health services of health centers and the creation of an Observatory of working, employment and health conditions in the National Health Service, as an instrument for monitoring changes and proposing solutions.

The Temporary Incapacity (TI) register as a complementary system to traditional epidemiological surveillance during the COVID-19 pandemic in Spain.

INTRODUCTION: During the COVID-19 pandemic, a set of social measures were adopted for the preservation of business activity and the protection of workers. One of these measures was issuing the Temporary Disability (TD) for COVID-19 cases, close contacts, and especially vulnerable workers. OBJETIVE: This study analyzes whether the TD registry could be used as a complementary source to traditional epidemiological surveillance. METHODS: A longitudinal study of time series was carried out with a cross-correlation analysis of TD and COVID-19 cases reported to the National Epidemiological Surveillance Network (RENAVE). The analysis included six pandemic waves between 10/03/2020 and 31/12/2021 in Spain. Cross-correlation coefficients (r) were calculated using a time lag of -14 days. RESULTS: During the study period, 2,253,573 TD processes were recorded in Spain and 4,894,802 COVID-19 cases were reported to RENAVE. Significant positive correlations were observed at time lags of -7, -10, and -14, indicating that TD notification preceded RENAVE notification. In the first and sixth pandemic waves, TD notification preceded RENAVE by 12 and 7 days, respectively. Negative correlations between the two series were observed in the second and fourth waves, coinciding with a lower number of reported cases. In the third and fifth waves, TD notification also preceded RENAVE (lags -1, -5 and -14, -7, respectively). CONCLUSIONS: The results confirm the usefulness of TD registry as a complementary system to traditional epidemiological surveillance in Spain, by detecting COVID-19 cases in the 7, 10, and 14 days prior. A better positive correlation is observed in waves where more cases were reported.

Antiproliferative in Vitro Evaluation of Terpenic Amines Synthesized via a Rhodium-catalyzed Hydroaminomethylation.

Terpene-derived alkaloids show a variety of biological activities, including antioxidant, anti-inflammatory, antimicrobial and cytotoxicity effects. In this work, homologated monoterpene amines have been prepared via a rhodium-catalyzed hydroaminomethylation of biomass-based alkenes, such as (R)-limonene, linalool, myrcene and camphene, in combination with secondary amines of aliphatic and aromatic nature, namely morpholine and N-methylaniline, leading to highly chemo- and regioselective processes. The as-prepared amines were obtained in 50-99 % overall yields, and in vitro tested on a human colon cancer cell line (HCT-116) to evaluate their cytotoxic potential. The lead compound of the series (3 a) showed cytotoxicity in the micromolar range (IC50 52.46 µM) via the induction of cell death by apoptosis, paving the way towards further structure-activity relationship studies.

Análisis de los procesos asistenciales hospitalarios por silicosis en España, 1997-2020 / Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-202

Fundamentos: la remergencia de la silicosis en españa desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio fue analizar los procesos asistenciales por silicosis atendidos por el sistema nacional De salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. Métodos: se empleó el rae-cmbd, aplicando los códigos cie-9-cm 500 y 502 (1997-2016) y cie-10-cm j60, j62.0 y j62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. Resultados: se obtuvieron 111.325 registros (veinte-cien años), el 4,3% por silicosis como diagnóstico principal (dp) y el 95,7% Como diagnóstico secundario (ds). El 98% eran hombres y el 2% mujeres. La edad media de los procesos por ds fue de 75,1, y de68,7 para los procesos por dp. La mediana de edad aumentó ocho años para los ds y disminuyó tres para los dp. Aunque la carga Asistencial global disminuyó, los procesos en menores de cincuenta años por dp entre 2006 y 2009 registraron una tendencia Ascendente (apc=27,01%). Los procesos por ds mostraron una tendencia ascendente no significativa (apc=1,92%) entre 2005 y 2020.Conclusiones: la tendencia al crecimiento de los procesos asistenciales por silicosis en menores de cincuenta años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en españa. La carga asistencial asociada constituye un problema de salud pública presente y futuro dada la reducción de edad de los afectados.(AU)

Background: the re-emergence of silicosis in spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the national health system between 1997 and 2020 to better understand the epidemiological dimension of the problem. Methods: processes were obtained from the Registro de actividad sanitaria especializada (rae-cmbd), with icd-9-cm codes 500 and 502 (1997-2016) and icd-10-cm j60, j62.0 and j62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. Results: a total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (pd) And 95.7% as a secondary diagnosis (sd). Men accounted for 98% and women for 2%. The mean age for sd processes was 75.1, and 68.7 for pd processes. The median age increased by eight years for sd and decreased by three years for pd. Although the overall Burden of care decreased, under-fifty pd procedures between 2006 and 2009 showed an upward trend (apc=27.01%). Sd processes Showed a non-significant upward trend (apc=1.92%) between 2005 and 2020. Conclusions: the upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare Impact of the re-emergence of silicosis in spain. The associated burden of care constitutes a present and future public health problem Given the decreasing age of those affected.(AU)

[Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-2020]. / Análisis de los procesos asistenciales hospitalarios por silicosis en España, 1997-2020.

OBJECTIVE: The re-emergence of silicosis in Spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the National Health System between 1997 and 2020 to better understand the epidemiological dimension of the problem. METHODS: Processes were obtained from the Registro de Actividad Sanitaria Especializada (RAE-CMBD), with ICD-9-CM codes 500 and 502 (1997-2016) and ICD-10-CM J60, J62.0 and J62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. RESULTS: A total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (PD) and 95.7% as a secondary diagnosis (SD). Men accounted for 98% and women for 2%. The mean age for SD processes was 75.1, and 68.7 for PD processes. The median age increased by eight years for SD and decreased by three years for PD. Although the overall burden of care decreased, under-fifty PD procedures between 2006 and 2009 showed an upward trend (APC=27.01%). SD processes showed a non-significant upward trend (APC=1.92%) between 2005 and 2020. CONCLUSIONS: The upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare impact of the re-emergence of silicosis in Spain. The associated burden of care constitutes a present and future public health problem given the decreasing age of those affected.

OBJECTIVE: La remergencia de la silicosis en España desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio fue analizar los procesos asistenciales por silicosis atendidos por el Sistema Nacional de Salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. METHODS: Se empleó el RAE-CMBD, aplicando los códigos CIE-9-CM 500 y 502 (1997-2016) y CIE-10-CM J60, J62.0 y J62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. RESULTS: Se obtuvieron 111.325 registros (veinte-cien años), el 4,3% por silicosis como diagnóstico principal (DP) y el 95,7% como diagnóstico secundario (DS). El 98% eran hombres y el 2% mujeres. La edad media de los procesos por DS fue de 75,1, y de 68,7 para los procesos por DP. La mediana de edad aumentó ocho años para los DS y disminuyó tres para los DP. Aunque la carga asistencial global disminuyó, los procesos en menores de cincuenta años por DP entre 2006 y 2009 registraron una tendencia ascendente (APC=27,01%). Los procesos por DS mostraron una tendencia ascendente no significativa (APC=1,92%) entre 2005 y 2020. CONCLUSIONS: La tendencia al crecimiento de los procesos asistenciales por silicosis en menores de cincuenta años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en España. La carga asistencial asociada constituye un problema de Salud Pública presente y futuro dada la reducción de edad de los afectados.

[Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018.] / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018.

OBJECTIVE: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and is legally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this work was to describe and analyse this issue, and to identify the major obstacles to its recognition. METHODS: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics, of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to 2018, using frequencies, proportions, and incidence rates. RESULTS: There were large differences between the two sets of data collected in the different registries, especially regarding the number of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public health system. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctors to report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officially recognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with this occupational disease by was 2,2270,520 euros. CONCLUSIONS: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has important health care and economic repercussions for the individuals involved as well as for the public health system.

OBJETIVO: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tiene la consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar este problema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. METODOS: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pacientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana, desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. RESULTADOS: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados, los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracción atribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechas de enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. El coste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. CONCLUSIONES: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hecho conlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.

Neurogenic diabetes insipidus in a critical patient with COVID-19 pneumonia in treatment with extracorporeal membrane oxygenation: a case report.

The following case report analyses a patient with extracorporeal membrane oxygenation (ECMO), who suffered from a severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 pneumonia. ARDS is defined as a diffuse and inflammatory injury of the lungs; classifying this as severe when the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO2/FiO2) is equal to or lower than 100 mmHg. To decide if the patient was suitable for the use of ECMO therapy, the ELSO criteria were used; and in this case, the patient matched with the criteria of hypoxemic respiratory failure (with a PaO2/FiO2 < 80 mmHg) after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. During hospitalization, the patient presented a Central Diabetes Insipidus (CDI), probably explained by the damage hypoxia generated on the central nervous system. There are few reports of this complication produced by COVID-19. The case is about a 39-year-old woman, who started with ECMO 6 days after the beginning of Invasive Mechanical Ventilation (IMV), because of a severe ARDS. On the fifth day of ECMO, the patient started with a polyuria of 7 L in 24 h. A series of paraclinical studies were made, but no evidence of central nervous system lesions was found. After treatment with desmopressin was initiated and the ARDS was solved, polyuria stopped; with this, CDI was diagnosed. There are many complications secondary to the evolution of COVID-19 infection, and some of them are not yet well explained.

Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018 / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018

Fundamentos: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tienela consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar esteproblema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. Métodos: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pa-cientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana,desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. Resultados: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados,los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracciónatribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechasde enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. Elcoste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. Conclusiones: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hechoconlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.(AU)

Background: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and islegally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this workwas to describe and analyse this issue, and to identify the major obstacles to its recognition. Methods: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics,of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to2018, using frequencies, proportions, and incidence rates.Results: There were large differences between the two sets of data collected in the different registries, especially regarding thenumber of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public healthsystem. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctorsto report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officiallyrecognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with thisoccupational disease by was 2,2270,520 euros. Conclusions: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has importanthealth care and economic repercussions for the individuals involved as well as for the public health system.(AU)

Novel Catalyst Composites of Ni- and Co-Based Nanoparticles Supported on Inorganic Oxides for Fatty Acid Hydrogenations.

In the quest to develop nanometrically defined catalytic systems for applications in the catalytic valorization of agri-food wastes, small Ni-based nanoparticles supported on inorganic solid supports have been prepared by decomposition of organometallic precursors in refluxing ethanol under H2 atmosphere, in the presence of supports exhibiting insulating or semi-conductor properties, such as MgAl2O4 and TiO2, respectively. The efficiency of the as-prepared Ni-based nanocomposites has been evaluated towards the hydrogenation of unsaturated fatty acids under solvent-free conditions, with high selectivity regarding the hydrogenation of C=C bonds. The influence of the support on the catalytic performance of the prepared Ni-based nanocomposites is particularly highlighted.

High sugar but not high fat diet consumption induces hepatic metabolic disruption and up-regulation of mitochondrial fission-associated protein Drp1 in a model of moderate obesity.

Identification of new modifications and the association with diet patterns are essential for the prevention of non-alcoholic fatty liver disease (NAFLD). To address this problem, we feed rats with high caloric diets based on high sucrose (HSD) and high fat (HFD) and analysed metabolic and mitochondrial alterations. Both diets induce moderated obesity and fat accumulation in the liver after 8, 10 and 12 months of diet. The HSD induces both hyperleptinemia and hyperinsulinemia, as well as up-regulation of transcription factors SRBEP1 and PPARγ along slight increase nitrosylation of proteins and increased mitochondrial fission. In contrast, HFD induced hyperleptinemia without changes in neither insulin levels nor oxidative stress, SREBP1, PPARγ, or mitochondrial dynamics. In conclusion, chronic consumption of high sucrose content diets induces more pathological and metabolic alteration in liver in comparison with consumption of high-fat content diets, although both induces obesity and liver steatosis in these animal models.

[The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. Usefulness of sick leave for the surveillance of the pandemic evolution.] / El impacto de la Covid-19 en la incapacidad temporal de las personas que trabajan en centros socio-sanitarios en España. Utilidad de la incapacidad temporal para el seguimiento de la evolución de la pandemia.

OBJECTIVE: The nursing homes represented high-risk settings for SARS-CoV-2 infection, both for residents and for the employees. The COVID-19 impact on long-term care facilities (LTCFs) is evaluated, measured through the employees sick leave (SL). The pandemic evolution in the general population aged between 16 and 65 years was analyzed together with the sick leave to assess the latter as a complementary indicator of the SARS-CoV-2 surveillance. METHODS: A descriptive study of all sick leave processes due to COVID-19 recorded between February 15th 2020 and May 1st 2021 in nursing homes was carried out. The close contact sick leave/infection sick leave ratios, the 100,000 affiliated/occupied sick leave rates were computed and compared with the COVID-19 cases cumulative incidence notified to the National Network of epidemiological Surveillance (RENAVE). RESULTS: 261.892 SL processes were recorded. The close contact sick leave/infection sick leave median ratio in nursing homes was 1.8 (Interquartile range, ICR: 1.1-3.3), with values lower than 1 at certain periods. The infection sick leaves were higher in number and ratio and prior to the cases recorded in RENAVE. The sick leave ratio ranged between 81.679/100.000 occupied in nursing homes with medical care and 4.895/100.000 in other residential facilities. CONCLUSIONS: The results confirmed the dramatic impact of COVID-19 in nursing homes and the inequalities characterizing this impact. They also confirmed the potential use of sick leave as an alternative source for epidemiological and public health surveillance, especially now, when the transition of the COVID-19 surveillance to a system not including universal individual surveillance is being discussed.

OBJETIVO: Los centros sociosanitarios representaron entornos de alto riesgo de contagio por SARS-CoV-2, tanto para los residentes como para las personas trabajadoras. Se evaluó el impacto en términos de incapacidad temporal (IT) por COVID-19 en las personas que trabajan en centros sociosanitarios y se comparó con la evolución de la pandemia en la población general de 16 a 65 años, para valorar la utilidad de la IT como indicador complementario de la epidemia por SARS-CoV-2. METODOS: Se realizó un estudio descriptivo de todos los procesos de incapacidad temporal por COVID-19 registrados entre el 15 de febrero de 2020 y el 1 de mayo de 2021 en establecimientos residenciales. Se obtuvieron las ratios de incapacidad temporal por contacto estrecho /incapacidad temporal por infección, las tasas de incapacidad temporal por 100.000 afiliados/ocupados y se compararon con la incidencia acumulada de casos COVID-19 notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE). RESULTADOS: Se registraron 261.892 procesos de incapacidad temporal. La mediana de la ratio de incapacidad temporal por contacto estrecho /incapacidad temporal por infección en residencias fue de 1,8 (Rango intercuartílico, RIC: 1,1-3,3), con valores menores a 1 en periodos. Las IT por infección fueron superiores en número, tasa y anteriores en el tiempo a los casos registrados en RENAVE. Por tipo de residencia, la tasa de incapacidad temporal osciló entre 81.679/100.000 ocupados en asistencia en establecimientos residenciales con cuidados sanitaros y 4.895/100.000 en otros establecimientos residenciales. CONCLUSIONES: Los resultados confirmaron el enorme impacto que tuvo la COVID-19 en los centros sociosanitarios y la desigualdad que ha caracterizado este impacto. Apoyan también la posible utilización de la incapacidad temporal como fuente de información alternativa para la vigilancia epidemiológica y de salud pública, lo cual resulta de especial interés en este momento en el que se está planteando una transición en la vigilancia del COVID-19 hacia un sistema que ya no incluya una vigilancia individualizada universal.

El impacto de la COVID-19 en la incapacidad temporal de las personas que trabajan en centro / The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. Usefulness of sick leave for the surveillance of the pandemic evolution

Fundamentos: Los centros sociosanitarios representaron entornos de alto riesgo de contagio por SARS-CoV-2, tanto para los residentes como para las personas trabajadoras. Se evaluó el impacto en términos de incapacidad temporal (IT) por COVID-19 en las personas que trabajan en centros sociosanitarios y se comparó con la evolución de la pandemia en la población general de 16 a 65 años, para valorar la utilidad de la IT como indicador complementario de la epidemia por SARS-CoV-2. Métodos: Se realizó un estudio descriptivo de todos los procesos de incapacidad temporal por COVID-19 registrados entre el 15 de febrero de 2020 y el 1 de mayo de 2021 en establecimientos residenciales. Se obtuvieron las ratios de incapacidad temporal por contacto estrecho /incapacidad temporal por infección, las tasas de incapacidad temporal por 100.000 afiliados/ocupados y se compararon con la incidencia acumulada de casos COVID-19 notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE). Resultados: Se registraron 261.892 procesos de incapacidad temporal. La mediana de la ratio de incapacidad temporal por contacto estrecho /incapacidad temporal por infección en residencias fue de 1,8 (Rango intercuartílico, RIC: 1,13,3), con valores menores a 1 en periodos. Las IT por infección fueron superiores en número, tasa y anteriores en el tiempo a los casos registrados en RENAVE. Por tipo de residencia, la tasa de incapacidad temporal osciló entre 81.679/100.000 ocupados en asistencia en establecimientos residenciales con cuidados sanitaros y 4.895/100.000 en otros establecimientos residenciales. Conclusiones: Los resultados confirmaron el enorme impacto que tuvo la COVID-19 en los centros sociosanitarios y la desigualdad que ha caracterizado este impacto.(AU)

Background: The nursing homes represented highrisk settings for SARS-CoV-2 infection, both for residents and for the employees. The COVID-19 impact on longterm care facilities (LTCFs) is evaluated, measured through the emplo yees sick leave (SL). The pandemic evolution in the general population aged between 16 and 65 years was analyzed together with the sick leave to assess the latter as a complementary indicator of the SARS-CoV-2 surveillance. Methods: A descriptive study of all sick leave processes due to COVID-19 recorded between February 15th 2020 and May 1st 2021 in nursing homes was carried out. The close contact sick leave/infection sick leave ratios, the 100,000 affiliated/occupied sick leave rates were computed and compared with the COVID-19 cases cumulative incidence notified to the National Network of epidemiological Surveillance (RENAVE). Results: 261.892 SL processes were recorded. The close contact sick leave/infection sick leave median ratio in nursing homes was 1.8 (Interquartile range, ICR: 1.1-3.3), with values lower than 1 at certain periods. The infection sick leaves were higher in number and ratio and prior to the cases recorded in RENAVE. The sick leave ratio ranged between 81.679/100.000 occupied in nursing homes with medical care and 4.895/100.000 in other residential facilities. Conclusions: The results confirmed the dramatic impact of COVID-19 in nursing homes and the inequalities characterizing this impact. They also confirmed the potential useof sick leave as an alternative source for epidemiological and public health surveillance, especially now, when the transition of the COVID-19 surveillance to a system not including universal individual surveillance is being discussed.(AU)

Urgent need for a rapid microbiological diagnosis in critically ill pneumonia

Severe lower respiratory tract infection is a common issue in Intensive Care Units that causes significant morbidityand mortality. The traditional diagnostic-therapeutic approachhas been grounded on taking respiratory samples and/or bloodcultures as soon as possible and starting empirical antibiotictherapy addressed to cover most likely pathogens based onthe presence of the patient’s risk factors for certain microorganisms, while waiting for the culture results in the following 48-72 hours to adequate the antibiotic treatment to thesensitivity profile of the isolated pathogen. Unfortunately, thisstrategy leads to use broad-spectrum antibiotics more timesthan necessary and does not prevent possible therapeuticfailures. The recent development of rapid molecular diagnostic techniques, based on real time polymerase chain reaction(RT-PCR), makes it possible to determine the causative agentand its main resistance pattern between 1 and 5 hours aftersampling (depending on each technique), with high precision,some of them reaching a negative predictive value greaterthan 98%, facilitating the very early withdrawal of unnecessary broad-spectrum antibiotics. Its high sensitivity can alsodetect unsuspected pathogens based on risk factors, allowingadequate treatment in the first hours of stay. This short review discusses the potential usefulness of these techniques incritically ill patients with lower respiratory tract infection andadvocates their immediate implementation in clinical practice. (AU)

Moderate Intensity Functional Training as Adjuvant Treatment in Patients With Peripheral Arterial Disease: A Case Report.

BACKGROUND: Traditional aerobic training and muscle resistance ("strength") training have been shown to be effective for improving functional and health-related quality of life (HRQoL) outcomes in peripheral arterial disease (PAD). However, the transfer of the current resistance exercise modes proposed to other activities of daily living (ADLs) is questionable. Moderate intensity functional training (MIFT) has emerged with the aim of achieving cardiovascular and neuromuscular adaptations simultaneously with functional exercises typical of ADLs. The effect of MIFT in patients with PAD is not yet known. Our purpose is to verify the influence of the combination of intermittent treadmill walking exercise with MIFT on functional capacity and HRQoL in patients with PAD. METHODS: Three patients with PAD participated in a novel supervised exercise therapy program of 6 weeks duration based on intermittent treadmill walking exercise and MIFT. RESULTS: After the training period, the 3 patients showed high adherence to the program (95%) and they improved total distance (TD) (25%, 9%, and 21%), claudication onset distance (COD) (56%, 19%, and 151%), total number of repetitions (33%, 24%, and 33%) and total work capacity (80%, 79%, and 72%). Also, physical component in Short Form-36 Health Survey (SF-36) and Vascular Quality of Life Questionnaire-6 (VascuQol-6) showed increases in the patients. CONCLUSIONS: The 6-week intervention in patients with PAD, based on intermittent treadmill walking exercise and MIFT, seems to improve their functional status and total work capacity in functional exercises as well as their HRQoL.

Understanding Cu(II)-based systems for C(sp3)-H bond functionalization: insights into the synthesis of aza-heterocycles.

Herein we report the synthesis of imidazo[1,5-a]pyridine heterocycles via a Cu(II)-mediated functionalization of α'-C(sp3)-H bonds of pyridinylaldimines and subsequent cyclization. This strategy exploits the inherent directing ability of heteroleptic aldimine and pyridine groups in the substrate yielding the C-H functionalization of α'-methylene groups in a regioselective fashion over distant methyl or methylene groups in ß or γ positions. The observed correlation between the nature of the anionic ligands (halide vs. carboxylate) bonded to copper and the chemoselectivity of the C(sp3)-H activation process points to a concerted metalation-deprotonation pathway prior to cyclization to furnish the corresponding imidazo[1,5-a]pyridine derivative. This copper-mediated C(sp3)-H bond functionalization reaction works for a variety of substrates incorporating linear alkyl chains (from 3 to 12 carbon atoms), and good functional group tolerance (aryl, ether and ester groups). Cu-Catalyzed C(sp2)-H cyanation on the imidazole ring can then take place selectively under oxidative conditions.

Copper nanocatalysts applied in coupling reactions: a mechanistic insight.

Copper-based nanocatalysts have seen great interest for use in synthetic applications since the early 20th century, as evidenced by the exponential number of contributions reported (since 2000, more than 48 000 works published out of about 81 300 since 1900; results from SciFinder using "copper nanocatalysts in organic synthesis" as keywords). These huge efforts are mainly based on two key aspects: (i) copper is an Earth-abundant metal with low toxicity, leading to inexpensive and eco-friendly catalytic materials; and (ii) copper can stabilize different oxidation states (0 to +3) for molecular and nanoparticle-based systems, which promotes different types of metal-reagent interactions. This chemical versatility allows different pathways, involving radical or ionic copper-based intermediates. Thus, copper-based nanoparticles have become convenient catalysts, in particular for couplings (both homo- and hetero-couplings), transformations that are involved in a remarkable number of processes affording organic compounds, which find interest in different fields (medicinal chemistry, natural products, drugs, materials, etc.). Clearly, this richness in reactivity makes understanding the mechanisms more complex. The present review focuses on the analysis of reported contributions using monometallic copper-based nanoparticles as catalytic precursors applied in coupling reactions, paying attention to those shedding light on the reaction mechanism.

Scabies in Spain? A comprehensive epidemiological picture.

INTRODUCTION: Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997-2019 as well as to describe the main environments of transmission using different data sources. METHODS: We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. RESULTS: The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. DISCUSSION: An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.