Redes comunitarias: evaluación de la respuesta a la emergencia social durante la primera ola de la pandemia por COVID-19 en Cataluña / Community networks: evaluation of the response to the social emergency during the first wave of the COVID19 pandemic in Catalonia

Introducción: La pandemia ha provocado una crisis sanitaria, económica y social. En Cataluña, en la primera ola, la comunidad se organizó de forma ágil para dar respuesta a las necesidades emergentes. El objetivo del estudio fue identificar y caracterizar redes comunitarias existentes o emergentes en Cataluña con el fin de visibilizarlas y establecer sinergias.Métodos: Estudio transversal. Fase 1: identificación de iniciativas a través de cuestionario ad hoc enviado a población en general mediante internet y redes sociales. Fase 2: encuesta semiestructurada a redes identificadas para caracterizarlas y evaluar su grado de coordinación local. Análisis descriptivo.Resultados: Fase 1: 303 respuestas que identifican 100 iniciativas de 96 municipios catalanes. Un 74% fueron creadas en pandemia y atendían a múltiples problemáticas: soledad, salud mental, alimentación, preparación/reparto de elementos de protección de la salud. Dirigidas principalmente a personas mayores y con diversidad funcional. Un 43% eran iniciativas ciudadanas. Fase 2: participan 32 redes (tasa de respuesta: 32%), un 60% se coordinaban con servicios sociales y consejos municipales. Dificultaba la coordinación: falta de recursos y elevada burocracia; la facilitaban: existencia de estructuras de coordinación previas a la pandemia. El 70% tenía voluntad de continuar ofreciendo servicios tras la pandemia.Discusión: Se recomienda el trabajo en red a nivel local de Atención Primaria y entidades municipales con las redes comunitarias, vinculando sus accionesa las existentes, con el fin de facilitar la implementación, continuidad y fortalecimiento de la salud comunitaria. (AU)

Background. The pandemic has caused a health, economic and social crisis. In Catalonia, during the first wave, the community organised itself to respond to emerging needs. The aim of the study was to identify and characterise existing or emerging community networks in Catalonia in order to make them visible and establish synergies.Methods. Cross-sectional study. Phase 1: Identification of initiatives through an ad hoc questionnaire sent to the general population via internet and social networks. Phase 2: Semi-structured survey of identified networks to characterise them and evaluate the degree of local coordination.Descriptive analyses were made.Results. Phase 1: 303 responses identifying 100 initiatives from 96 Catalan municipalities. 74% were created during the pandemic andaddressed multiple problems: loneliness, mental health, nutrition, creation/distribution of personal protective equipment. They were mainly aimed at the elderly and people with functional diversity. 43% were citizen initiatives. Phase 2: 32 networks participated (response rate: 32%), 60% were coordinated with social services and municipal councils. Coordination was hindered by lack of resources and high bureaucracy which was facilitated by the existence of coordination structures prior to the pandemic. 70% were willing to continue offering post-pandemic services. Discussion. It is important that Primary Care and municipal entities work together at local level with community networks, linking their actions to existing ones. This is in order to facilitate the implementation, continuity and strengthening of community health

Estimación del coste social del consumo de drogas ilegales en Catalunya / An estimation of the social cost of illicit drug consumption in Catalonia

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.(AU)

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.(AU)

An estimation of the social cost of illicit drug consumption in Catalonia. / Estimación del coste social del consumo de drogas ilegales en Catalunya.

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.

The hepatitis C care cascade among people who inject drugs accessing harm reduction services in Catalonia: Major gaps for migrants.

BACKGROUND: This study aimed to describe the HCV cascade of care among people who inject drugs (PWID) in Catalonia, as well as to compare the observed gaps in care between Spanish-born and migrant PWID. METHODS: A cross-sectional study of PWID (N = 410) attending four harm reduction services (HRS) was performed in 2016-17 (HepCdetect II Study). Participants were tested for both HCV antibodies (rapid testing) and RNA (from dried blood spot samples). The HCV care cascade was estimated from HCV testing results combined with self-reported data on previous testing, diagnosis and treatment collected through a questionnaire. Logistic regressions were used to test for an association between migration status and the proportions observed in each step of the HCV care cascade adjusting for age, sex, years of injection, homelessness, and treatment for drug dependence. RESULTS: Overall, 85.4% were men and 28.0% were migrants. Among Spanish-born (n = 295) and migrant (n = 115) PWID participants in the study, 96.6% vs. 88.6% had previously been HCV screened (AOR=3.11; 95% CI: 1.11-8.65), 79.3% vs. 80.9% were antibody positive, and 70.7% vs. 67.6% were HCV-RNA positive or cured with treatment; among the latter, 36.6% vs. 18.2% had started treatment (AOR=2.41; 95% CI: 1.09-5.34), and 20.6% vs. 9.1% had been cured by treatment, respectively. Unawareness of having hepatitis C was more common among migrants than Spanish-born PWID (46.0% and 31.5%, respectively; p<0.05). CONCLUSION: This study estimates the HCV care cascade among Spanish-born and migrant PWID in Catalonia for the very first time, and highlights a higher attrition of migrant PWID in all HCV care cascade stages. The observed limited linkage to care and treatment by PWID that attend the HRS network warrants future implementation of decentralized diagnosis and antiviral treatment. Strategies focusing on migrants by increasing HCV screening coverage and treatment access will be especially relevant in our setting.

Utility of a one-step screening and diagnosis strategy for viremic HCV infection among people who inject drugs in Catalonia.

BACKGROUND: In Catalonia (Spain), people who inject drugs (PWID) face numerous barriers to access to mainstream healthcare services for hepatitis C confirmatory diagnosis and treatment, so simplified testing strategies for viremic infection are urgently needed. Among PWID attending harm-reduction services in Catalonia, we aimed (i) to assess the utility of an in-house HCV-RNA detection assay on dried blood spots (DBS) as a one-step screening and confirmatory diagnosis strategy for hepatitis C, (ii) to estimate the prevalence of viremic HCV infection, and (iii) to identify factors associated with unawareness of viremic infection. METHODS: A cross-sectional study of current PWID (N â€¯= 410) was performed in four harm-reduction services. All participants underwent HCV antibody point-of-care testing and parallel DBS collection for centralized RNA testing. An epidemiological questionnaire was administered. Paired EDTA-plasma samples were additionally collected for HCV viral load testing in 300 participants. RESULTS: HCV-RNA testing from DBS was feasible and showed 97.2% sensitivity and 100% specificity for viral loads >3000 IU/mL in real-life conditions. No significant differences in the performance when detecting viremic infections were observed between this one-step testing strategy vs. the conventional two-step algorithm involving venepuncture. Overall HCV seroprevalence was 79.8%, and prevalence of viremic infection was 58.5%. Importantly, 35.8% of viremic HCV participants were unaware of their status, and no specific socio-demographic or bio-behavioral factors independently associated with unawareness of viremic infection were identified. Among participants reporting a past or current HCV infection, 29.0% stated having received HCV antiviral treatment. CONCLUSION: The high viremic HCV infection burden among PWID attending HRS, estimated for the first time in Catalonia, together with the low levels of awareness of viremic status and access to treatment, suggest that scaling up this one-step screening and diagnosis strategy to the network of harm-reduction services would help to achieve HCV elimination targets set by the World Health Organization.

Reliable determination of new lipid peroxidation compounds as potential early Alzheimer Disease biomarkers.

Lipid peroxidation plays an important role in Alzheimer Disease, so corresponding metabolites found in urine samples could be potential biomarkers. The aim of this work is to develop a reliable ultra-performance liquid chromatography-tandem mass spectrometry analytical method to determine a new set of lipid peroxidation compounds in urine samples. Excellent sensitivity was achieved with limits of detection between 0.08 and 17 nmol L-1, which renders this method suitable to monitor analytes concentrations in real samples. The method's precision was satisfactory with coefficients of variation around 5-17% (intra-day) and 8-19% (inter-day). The accuracy of the method was assessed by analysis of spiked urine samples obtaining recoveries between 70% and 120% for most of the analytes. The utility of the described method was tested by analyzing urine samples from patients early diagnosed with mild cognitive impairment or mild dementia Alzheimer Disease following the clinical standard criteria. As preliminary results, some analytes (17(RS)-10-epi-SC-Δ15-11-dihomo-IsoF, PGE2) and total parameters (Neuroprostanes, Isoprostanes, Isofurans) show differences between the control and the clinical groups. So, these analytes could be potential early Alzheimer Disease biomarkers assessing the patients' pro-oxidant condition.

An aggressive primary orbital natural killer/T-cell lymphoma case: poor response to chemotherapy.

Natural killer/T-cell lymphoma (NKTCL) and its presentation with extranodal orbital involvement as a single lesion are extremely rare. The aim of this article was to describe the presentation, diagnosis, and systemic treatment of a primary orbital NKTCL. A 67-year-old Caucasian woman presented with left exophthalmos, pain, periorbital swelling, and limited extrinsic ocular motility. Orbital cellulitis was suspected, but finally orbital biopsy was performed due to no response to initial antibiotic and anti-inflammatory standard treatment. The pathologic diagnosis was NKTCL. Systemic evaluations were negative. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy was initiated, but after 2 cycles of treatment, tumoral progression was observed. SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) rescue chemotherapy was then administered. Lymphoma progression was inevitable. She died 10 months later. Although more nasal NKTCL cases have been described, the nonnasal primary orbital NKTCL is an uncommon neoplasm with high mortality rate, despite the recent use of more potent chemotherapy regimens.

Relative survival of patients with uveal melanoma managed in a single center.

To assess the 5-year relative survival of patients diagnosed with uveal melanoma (UM) in a single center. UM patients were recruited from 1995 to 2004 (N = 155) and were followed until December 2008. Relative survival (RS) methods were used to assess excess mortality. An RS regression model was fitted by sex, age, tumor origin, treatment, and tumor size to estimate the excess hazard rate (EHR) of death from UM. The overall 5-year RS was 90%, lower in women (84.6%) than in men (100%), lower in patients older than 60 years (88.8%) compared with those younger than or of 60 years of age (94.8%). Large tumors (80.8%) showed lower RS than medium (95.1%) and small ones (98.3%). Enucleated patients (80.5%) had lower RS compared with those who received brachytherapy (93.6%) and other treatments (94.7%). A significant EHR was found for women (EHR: 3.65), patients older than 60 years (EHR: 2.25), large-sized melanoma (EHR: 2.45), and during the third (EHR: 5.37) and fourth year (EHR: 3.01) of follow-up. This is the first Spanish study in a single center reporting RS among UM patients, taking into account clinical characteristics. Prognostic factors that explained RS among UM patients were sex, age, tumor size, and the year of follow-up. We also found a peak of excess mortality from the third until the fourth year after diagnosis, which warrants strict follow-up of these patients during this time interval.

[Chlorhexidine: the ideal antiseptic]. / Clorhexidina: un antiséptico ideal.

This article is a extensive bibliographical review about the characteristics of chlorhexidine as a cutaneous antiseptic. This antiseptic belongs to the biguanides (metformin) group and is very active against a large number of micro-organisms. Its systemic absorption is practically null, thus, it lacks any systemic toxicity. As a cutaneous antiseptic it has a rapid, long-lasting effect and is not inactive in the presence of organic matter and, due to its transparency it does not hide the evolution of wounds. Due to these properties, its recommendations for use have grown and consolidated over time until it has converted into one of the most effective, active and safe antiseptics for daily clinical practice.

Clorhexidina: un antiséptico ideal / Chlorhexidine: the ideal antiseptic

Revisión bibliográfica extensa sobre las características de la clorhexidina como antiséptico cutáneo perteneciente al grupo de las biguanidas y muy activo frente a un alto número de microorganismos. Su absorción sistémica es prácticamente nula, por lo que carece de toxicidad sistémica. Como antiséptico cutáneo produce un efecto rápido y duradero, no se inactiva en presencia de materia orgánica y, por ser transparente, no enmascara la evolución de las heridas. Gracias a estas propiedades, sus recomendaciones de uso se han ido consolidando y ampliando con el paso del tiempo, hasta convertirse en uno de los antisépticos más eficaces, activos y seguros para la práctica clínica diaria

This article is a extensive bibliographical review about the characteristics of chlorhexidine as a cutaneous antiseptic. This antiseptic belongs to the biguanides (met-formin) group and is very active against a large number of micro-organisms. Its systemic absorption is practically null, thus, it lacks any systemic toxicity. As a cutaneous antiseptic it has a rapid, long-lasting effect and is not inactive in the presence of organic matter and, due to its transparency, it does not hide the evolution of wounds. Due to these properties, its recommendations for use have grown and consolidated over time until it has converted into one of the most effective, active and safe antiseptics for daily clinical practice