Factors influencing the health-related quality of life of older men and women living with HIV in Spain.

The number of older people living with HIV (OPLHIV) is increasing worldwide. However, little is known about the factors that better predict their health-related quality of life (HRQoL). We administered the validated WHOQoL-HIV BREF questionnaire to 247 Spanish OPLHIV (192 men and 55 women). In addition to the six domains of the questionnaire, we constructed a seventh domain as theaverage of punctuations of all domains. Multivariable Poisson regression models with robust estimates by sex were constructed for the seven domains (14 in total). The best-subset selection method together with Mallow's Cp metric was used to select the model factors. The percentage of variability explained by Poisson models ranged from15-38% for men and 29-70% for women. The analysis showed that women were most affected by ageing (four domains), mobility impairments (five domains), and mental disorders (five domains). The factors with the greatest negative influence on men were heterosexuality (six domains), mental disorders (six domains), being single (five domains), and poverty risk (three domains). Physical activity was found to improve HRQoL in both men (six domains) and women (four domains). Future OPLHIV programmes would benefit from considering sex specific HRQoL factors. This could also improve the cost-effectiveness of interventions.

Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study.

BACKGROUND: Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain. METHODS: We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates. RESULTS: The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (ß: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (ß: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (ß: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (ß: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (ß: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009). CONCLUSION: The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.

Effectiveness of antibiotic-coated intramedullary nails for open tibia fracture infection prevention. A systematic review and meta-analysis.

INTRODUCTION: Open Tibia fractures are associated with high rates of Fracture Related Infection (FRI). Given the negative outcomes and increased costs related to the latter, several prophylactic local antibiotic delivery methods have been proposed, aiming to decrease the FRI rate. Our objective with this study was to determine the effectiveness of antibiotic-coated intramedullary nails for open tibia FRI prevention. PATIENTS AND METHODS: We conducted a PRISMA compliant systematic review and meta-analysis. Queries were performed on Embase, PubMed, Lilacs and Cochrane data libraries. Seventeen studies were included for qualitative analysis and 2 studies were amenable for meta-analysis. RESULTS: Global infection, deep infection and non-union rates were 8.4%, 5.4% and 3.7% in the antibiotic-coated nail group and 22%, 14% and 14% in the non-antibiotic-coated nail group respectively. The meta-analysis showed a protective trend that favored the antibiotic-coated nail group although it didn't achieve statistical significance: deep infection Relative Risk (RR) (RR = 0.17 CI95% [0.02 - 1.31]); global infection RR = 0.36 CI95% [0.10 - 1.35]) and non-union (RR = 0.14 CI95% [0.02 - 1.22]), CONCLUSIONS: Our findings suggest a favorable trend towards antibiotic-coated nail, with decreased risk of global infection, deep infection and non-union as compared to non-antibiotic-coated nail in patients with open tibia fractures. Nonetheless, higher level evidence studies are required to confirm our findings.

Risk factors for reamputation in patients with diabetic foot: A case-control study.

BACKGROUND: Reamputation as a complication of diabetic foot ulcers presents a high economic burden and represents a therapeutic failure. It is paramount to identify as early as possible patients in whom a minor amputation may not be the best option. The purpose of this investigation was to do a case-controlled study to determine risk factors associated with re-amputation in patients with DFU (diabetic foot ulcers) at two University Hospitals. METHODS: Multicentric, observational, retrospective, case-control study from clinical records of 2 university hospitals. Our study included 420 patients, with 171 cases (re-amputations), and 249 controls. We performed a multivariate logistic regression analysis and time-to-event survival analysis to identify re-amputation risk factors. RESULTS: Statistically significant risk factors were artery history of tobacco use (p = 0.001); male sex (p = 0.048); arterial occlusion in Doppler ultrasound (p = 0.001); percentage of stenosis in arterial ultrasound >50 % (p = 0.053); requirement of vascular intervention (p = 0.01); and microvascular involvement in photoplethysmography (p = 0.033). The most parsimonious regression model suggests that history of tobacco use, male sex, arterial occlusion in ultrasound, and percentage of stenosis in arterial ultrasound >50 % remained statistically significant. The survival analysis identified earlier amputations in patients with larger occlusion in arterial ultrasound, high leukocyte count, and elevated ESR. CONCLUSION: Direct and surrogate outcomes in patients with diabetic foot ulcers identify vascular involvement as an important risk factor for reamputation. LEVEL OF EVIDENCE: III.

Characterization of Fe3O4 Nanoparticles for Applications in Catalytic Activity in the Adsorption/Degradation of Methylene Blue and Esterification.

The aim of this study is to evaluate the applicability of the catalytic activity (CA) of the Fe3O4 magnetic system in the adsorption/degradation of methylene blue and esterification. The thermal decomposition method allowed the preparation of Fe3O4 nanoparticles. The crystallites of the Fe3O4 structural phase present an acicular form confirmed by X-ray diffraction. Transmission electron microscopy results identified the acicular shape and agglomeration of the nanoparticles. Mössbauer spectroscopy showed that the spectrum is composed of five components at room temperature, a hyperfine magnetic field distribution (HMFD), two sextets, a doublet, and a singlet. The presence of the HMFD means that a particle size distribution is present. Fluorescence spectroscopy studied the CA of the nanoparticles with methylene blue and found adsorption/degradation properties of the dye. The catalytic activity of the nanoparticles was evaluated in the esterification reaction by comparing the results in the presence and absence of catalyst for the reaction with isobutanol and octanol, where it is observed that the selectivity for the products MIBP and MNOP is favored in the first three hours of reaction.

Production and Characterization of Nanostructured Powders of Nd2Fe14B and Fe90Al10 by Mechanical Alloying.

The objective of this work is to evaluate the applicability of exchange coupling between nanoparticles of Nd2Fe14B (hard magnetic material) and Fe90Al10 (soft magnetic material), as permanent magnets produced by surfactant-assisted mechanical alloying. The obtained powders were then mixed with 85% of the Nd2Fe14B system and 15% of the Fe90Al10 system and subsequently sintered at 300 °C, 400 °C and 500 °C for one hour. The results obtained by Mössbauer spectrometry (MS) show a ferromagnetic behavior with six magnetic sites represented by sextets (16k1, 16k2, 8j1, 8j2, 4c and 4e), characteristic of the Nd2Fe14B system. X-ray diffraction (XRD) results show a tetragonal and BCC structure for the Nd2Fe14B and FeAl systems, respectively. The results obtained by vibrating sample magnetometry (VSM), for mixtures of the Nd2Fe14B and Fe90Al10 sy stems sintered at 300 °C, 400 °C and 500 °C, allow for the conclusion that the coercive field (Hc) decreases drastically with temperature and the percentage of soft phase at values of Hc = 132 Oe compared to the coercive field values reported for Nd2Fe14B Hc = 6883 Oe, respectively. Images obtained by transmission electron microscopy (TEM), for the Fe90Al10 system, show a tendency for the nanoparticles to agglomerate.

Mechanochemical Synthesis and Nitrogenation of the Nd1.1Fe10CoTi Alloy for Permanent Magnet.

In this work, the mechanochemical synthesis method was used for the first time to produce powders of the nanocrystalline Nd1.1Fe10CoTi compound from Nd2O3, Fe2O3, Co and TiO2. High-energy-milled powders were heat treated at 1000 °C for 10 min to obtain the ThMn12-type structure. Volume fraction of the 1:12 phase was found to be as high as 95.7% with 4.3% of a bcc phase also present. The nitrogenation process of the sample was carried out at 350 °C during 3, 6, 9 and 12 h using a static pressure of 80 kPa of N2. The magnetic properties Mr, µ0Hc, and (BH)max were enhanced after nitrogenation, despite finding some residual nitrogen-free 1:12 phase. The magnetic values of a nitrogenated sample after 3 h were Mr = 75 Am2 kg-1, µ0Hc = 0.500 T and (BH)max = 58 kJ·m-3. Samples were aligned under an applied field of 2 T after washing and were measured in a direction parallel to the applied field. The best value of (BH)max ~ 114 kJ·m-3 was obtained for 3 h and the highest µ0Hc = 0.518 T for 6 h nitrogenation. SEM characterization revealed that the particles have a mean particle size around 360 nm and a rounded shape.

Data driven methodology for model selection in flow pattern prediction.

The determination of multiphase flow parameters such as flow pattern, pressure drop and liquid holdup, is a very challenging and valuable problem in chemical, oil and gas industries, especially during transportation. There are two main approaches to solve this problem in literature: data based algorithms and mechanistic models. Although data based methods may achieve better prediction accuracy, they fail to explain the two-phase characteristics (i.e. pressure gradient, holdup, gas and liquid local velocities, etc.). Recently, many approaches have been made for establishing a unified mechanistic model for steady-state two-phase flow to predict accurately the mentioned properties. This paper proposes a novel data-driven methodology for selecting closure relationships from the models included in the unified model. A decision tree based model is built based on a data driven methodology developed from a 27670 points data set and later tested for flow pattern prediction in a set made of 9224 observations. The closure relationship selection model achieved high accuracy in classifying flow regimes for a wide range of two-phase flow conditions. Intermittent flow registering the highest accuracy (86.32%) and annular flow the lowest (49.11%). The results show that less than 10% of global accuracy is lost compared to direct data based algorithms, which is explained by the worse performance presented for atypical values and zones close to boundaries between flow patterns.

[HIV in Spain 2017: policies for a new management of chronicity beyond virological control]. / VIH en España 2017: políticas para una nueva gestión de la cronicidad más allá del control virológico.

The analysis of the available databases related to HIV/AIDS confirms a paradigm shift in the patient's life expectancy: now HIV has become a chronic disease, so patients are aging. However, this advance is accompanied by a negative counterpart: due to the increase in the number of years of life gained, there is a prevalence of comorbidities greater than the general population and at an earlier age. Reducing the risk associated with all the comorbidities that the ageing patient with HIV/AIDS may develop, must now be a health objective; it must be added to the traditional objectives that until now were part of the strategy to reduce the impact of the HIV infection. In the specific case of women, it is also necessary to train peri and postmenopausal women to increase their skills and motivation to care for their health; It is also very important to examine the role that hormone replacement therapy can play in reducing their symptoms.

El análisis de las bases de datos disponibles relacionadas con VIH/SIDA confirma un cambio de paradigma en la esperanza de vida del paciente: ahora el VIH se ha convertido en una enfermedad crónica, con la que los pacientes están envejeciendo. No obstante, este avance se acompaña de una contraparte negativa: debido al incremento en el número de años de vida ganados, se da una prevalencia de comorbilidades mayor a la de la población general y a una edad más temprana. Reducir el riesgo asociado a todas las comorbilidades que puede desarrollar el paciente con VIH/SIDA mientras envejece debe ser hoy en día un objetivo de salud, que se suma a los objetivos tradicionales que hasta ahora formaban parte de la estrategia para reducir el impacto de la infección por el VIH. En el caso específico de la mujer, además es necesario formar a las mujeres peri y postmenopáusicas para incrementar sus habilidades y su motivación para el cuidado de su salud; también es muy importante que se examine el rol que puede tener la terapia de reemplazo hormonal en la reducción de sus síntomas.

VIH en España 2017: políticas para una nueva gestión de la cronicidad más allá del control virológico / HIV in Spain 2017: policies for a new management of chronicity beyond virological control

El análisis de las bases de datos disponibles relacionadas con VIH/SIDA confirma un cambio de paradigma en la esperanza de vida del paciente: ahora el VIH se ha convertido en una enfermedad crónica, con la que los pacientes están envejeciendo. No obstante, este avance se acompaña de una contraparte negativa: debido al incremento en el número de años de vida ganados, se da una prevalencia de comorbilidades mayor a la de la población general y a una edad más temprana. Reducir el riesgo asociado a todas las comorbilidades que puede desarrollar el paciente con VIH/SIDA mientras envejece debe ser hoy en día un objetivo de salud, que se suma a los objetivos tradicionales que hasta ahora formaban parte de la estrategia para reducir el impacto de la infección por el VIH. En el caso específico de la mujer, además es necesario formar a las mujeres peri y postmenopáusicas para incrementar sus habilidades y su motivación para el cuidado de su salud; también es muy importante que se examine el rol que puede tener la terapia de reemplazo hormonal en la reducción de sus síntomas

The analysis of the available databases related to HIV/AIDS confirms a paradigm shift in the patient's life expectancy: now HIV has become a chronic disease, so patients are aging. However, this advance is accompanied by a negative counterpart: due to the increase in the number of years of life gained, there is a prevalence of comorbidities greater than the general population and at an earlier age. Reducing the risk associated with all the comorbidities that the ageing patient with HIV/AIDS may develop, must now be a health objective; it must be added to the traditional objectives that until now were part of the strategy to reduce the impact of the HIV infection. In the specific case of women, it is also necessary to train peri and postmenopausal women to increase their skills and motivation to care for their health; It is also very important to examine the role that hormone replacement therapy can play in reducing their symptoms