Fostamatinib effectiveness and safety for immune thrombocytopenia in clinical practice.

Fostamatinib, a recently approved syk inhibitor used in adult primary immune thrombocytopenia (ITP), has been shown to be safe and effective in this disorder. However, clinical trial results may not be similarly reproduced in clinical practice. Here 138 ITP patients (both primary and secondary) from 42 Spanish centers who had been treated with fostamatinib were evaluated prospectively and retrospectively. The median age of our cohort (55.8% women) was 66 years (interquartile range, IQR, 56-80 years). The median time since ITP diagnosis at fostamatinib initiation was 51 months (IQR, 10-166 months). The median number of therapies prior to fostamatinib initiation was 4 (IQR, 2-5), including eltrombopag (76.1%), romiplostim (57.2%) and intravenous immunoglobulins (IVIG) (44.2%). Fifty-eight patients (42.0%) had signs/symptoms of bleeding in the month prior to treatment initiation. 79.0% of patients responded to fostamatinib with 53.6% complete responses (platelet count > 100 x 109 /L). Eighty-three patients (60.1%) received fostamatinib monotherapy achieving a high response rate (85.4%). The proportion of time in response during the 27-month period examined was 83.3%. The median time to platelet response was 11 days (IQR, 7-21 days). Sixty-seven patients (48.5%) experienced adverse events, mainly grade 1-2, the commonest of which were diarrhea (n = 28) and hypertension (n = 21). One patient had deep venous thrombosis and one patient developed acute myocardial infarction. Fostamatinib was shown to be effective with good safety profile in patients with primary and secondary ITP across a wide age spectrum in this real-world study.

Comparison Between Standard and High Dose of G-CSF for Mobilization of Hematopoietic Progenitors Cells in Patients and Healthy Donors.

A standard dose of 10 µg/kg/day granulocyte colony stimulating factors (G-CSF) is currently recommended for hematopoietic progenitor cells (HPCs) mobilization. Our aim was to analyze whether certain patients or healthy donors could benefit from high dose of G-CSF.We performed a retrospective multicenter analysis of HPCs mobilization procedures (2015-2020) in patients and healthy donors. Those who received standard dose of G-CSF (10 µg/Kg/day for 4 days to patients and healthy donors) and those that received higher dose (24 µg/Kg/day for 4 days to patients and 16 µg/Kg/day for 4 days to healthy donors) were compared.496 individuals were included (201 standard dose and 295 higher dose). Between standard or higher dose, we did not find significant differences in median number of mobilized CD34+ cells/mL, neither among healthy donors (77 100 vs 75 500 respectively, P = .895), nor in patients (34 270 vs 33 704 respectively, P = .584). Additionally, among those with the same underlaying pathology the comparison between standard and higher dose did not showed differences. High G-CSF dose was not associated with a less frequent incidence of poor mobilizers (<20 000 CD34+ cells/mL) neither in healthy donors (1 [1.3%] vs 0; P = .218) nor patients (30 [24.4%] vs 32 [18.1%]; P = .165). Multivariate analysis showed that age, gender, and G-CSF dose did not influence median number of mobilized CD34+ cells/mL in healthy donors or patients. However, the underlying pathology among patients significantly influenced the CD34+ cells mobilization. In healthy donors, cellular blood count showed significantly higher leukocytes and platelets count with G-CSF high-dose, while in patients just a higher platelets count was found. To conclude, high dose of G-CSF compared to standard dose did not show significant benefit in terms of mobilization of CD34+ cells in healthy donors or in patients, also without a decrease in the incidence of poor mobilizers.

Strong Cellular Immune Response, but Not Humoral, against SARS-CoV-2 in Oncohematological Patients with Autologous Stem Cell Transplantation after Natural Infection.

Oncohematological patients show a low immune response against SARS-CoV-2, both to natural infection and after vaccination. Most studies are focused on the analysis of the humoral response; therefore, the information available about the cellular immune response is limited. In this study, we analyzed the humoral and cellular immune responses in nine individuals who received chemotherapy for their oncohematological diseases, as well as consolidation with autologous stem cell transplantation (ASCT), after being naturally infected with SARS-CoV-2. All individuals had asymptomatic or mild COVID-19 and were not vaccinated against SARS-CoV-2. These results were compared with matched healthy individuals who also had mild COVID-19. The humoral response against SARS-CoV-2 was not detected in 6 of 9 oncohematological individuals prior to ASCT. The levels of antibodies and their neutralization capacity decreased after ASCT. Conversely, an enhanced cytotoxic activity against SARS-CoV-2-infected cells was observed after chemotherapy plus ASCT, mostly based on high levels of NK, NKT, and CD8+TCRγδ+ cell populations that were able to produce IFNγ and TNFα. These results highlight the importance of performing analyses not only to evaluate the levels of IgGs against SARS-CoV-2, but also to determine the quality of the cellular immune response developed during the immune reconstitution after ASCT.

Mortality in acquired thrombotic thrombocytopenic purpura in the pre-caplacizumab era.

Despite the effectiveness of plasma exchange (PEX) and immunosuppressants in the treatment of acquired thrombotic thrombocytopenic purpura (aTTP), a number of patients still die as a result of the disease. Whether caplacizumab could rescue these patients remains still unsettled. The objective of this study was to characterise mortality patterns and prognostic factors in the first episode of aTTP.We queried the Spanish TTP Registry for patients with a diagnosis of aTTP in their presenting episode who fulfilled complete clinical and follow-up data (n = 102). The patients were diagnosed between 2004 and 2018, and all were treated with daily PEX and corticosteroids. Clinical and laboratory data were analysed at diagnosis and during the treatment course.Eight patients (7.7%) died between 12 h and 36 days after presentation, and could be classified into three patterns: death before treatment, early death driven by acute cardiac or neurologic events, and late death due to unremitted aTTP. Stupor or coma at diagnosis and platelet count < 20 × 109 /L by the 6th treatment day were independently associated with increased risk of death.Stupor or coma at diagnosis and lack of response to PEX by the 6th day in patients experiencing the first episode of aTTP are strong predictors of mortality. These patients could be rescued by novel agents aimed at halting the microvascular thrombosis until adequate immunosuppression is achieved.

Marine amphipods (Parhyale hawaiensis) as an alternative feed for the lined seahorse (Hippocampus erectus, Perri 1810): nutritional value and feeding trial.

Finding new alternatives to traditional live preys such as Artemia and rotifers, which do not always promote optimal fish growth and survival, is required for the successful aquaculture of highly specialized predatory species, including seahorses. The present study assessed the nutritional value of an interesting marine amphipod (Parhyale hawaiensis), and evaluates through a feeding trial its potential use as a natural prey for 10-months lined seahorse, Hippocampus erectus. P. hawaiensis showed high levels of valuable lipids (20.4-26.7% on dry matter basis) and polyunsaturated fatty acids (PUFAs) ( 26.4-41% of total FAs), including the long-chain PUFAs (LC-PUFAs) arachidonic acid (ARA) (2.9-7.7%), eicosapentaenoic acid (EPA) (4.3-6.5%) and docosahexaenoic acid (DHA) (2.1-6.2%). A comparison between wild-captured and cultured amphipods revealed a significant improvement of the amphipod FA profile in terms of DHA%, total omega-3 (n3) FAs and n3/n6 ratio when employing both a conventional amphipod culture based on a commercial shrimp diet, and, to a lesser extent, a large (3,500 L) biofloc system. Seahorses fed with frozen/wild amphipods, either singly or in combination with Artemia enriched with Super Selco® (INVE Aquaculture, Belgium) for 57 days, substantially improved seahorse growth and FA profiles in terms of ARA, EPA and DHA%, including indices associated to marine sources, such as Σn3 and n3/n6, compared to a diet based solely on enriched Artemia. These results support the use of marine amphipods as an alternative food organism for juvenile H. erectus and suggest a potential use for general marine aquaculture.

Marine amphipods as a new live prey for ornamental aquaculture: exploring the potential of Parhyale hawaiensis and Elasmopus pectenicrus.

Marine amphipods are gaining attention in aquaculture as a natural live food alternative to traditional preys such as brine shrimps (Artemia spp.). The use of Artemia is convenient for the culture of many marine species, but often problematic for some others, such as seahorses and other marine ornamental species. Unlike Artemia, marine amphipods are consumed by fish in their natural environment and show biochemical profiles that better match the nutritional requirements of marine fish, particularly of polyunsaturated fatty acids (PUFA), including eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. Despite their potentially easy culture, there are no established culture techniques and a deeper knowledge on the reproductive biology, nutritional profiles and culture methodologies is still needed to potentiate the optimization of mass production. The present study assessed, for the first time, the aquaculture potential of Parhyale hawaiensis and Elasmopus pectenicrus, two cosmopolitan marine gammarids (as per traditional schemes of classification) that naturally proliferate in the wild and in aquaculture facilities. For that purpose, aspects of the population and reproductive biology of the species were characterized and then a series of laboratory-scale experiments were conducted to determine amphipod productivity, the time needed to reach sexual maturity by hatchlings (generation time), cannibalism degree, the effects of sex ratio on fecundity and the effects of diet (shrimp diet, plant-based diet and commercial fish diet) on fecundity and juvenile growth. P. hawaiensis, unlike E. pectenicrus, was easily maintained and propagated in laboratory conditions. P. hawaiensis showed a higher total length (9.3 ± 1.3 mm), wet weight (14.4 ± 6.2 mg), dry weight (10.5 ± 4.4 mg), females/males sex ratio (2.24), fecundity (12.8 ± 5.7 embryos per female), and gross energy content (16.71 ± 0.67 kJ g-1) compared to E. pectenicrus (7.9 ± 1.2 mm total length; 8.4 ± 4.3 mg wet weight; 5.7 ± 3.2 mg dry weight; 1.34 females/males sex ratio; 6.5 ± 3.9 embryos per female; 12.86 ± 0.82 kJ g-1 gross energy content). P. hawaiensis juvenile growth showed a small, but significant, reduction by the use of a plant-based diet compared to a commercial shrimp and fish diet; however, fecundity was not affected, supporting the possible use of inexpensive diets to mass produce amphipods as live or frozen food. Possible limitations of P. hawaiensis could be their quite long generation times (50.9 ± 5.8 days) and relatively low fecundity levels (12.8 ± 5.7 embryos per female). With an observed productivity rate of 0.36 ± 0.08 juveniles per amphipod couple per day, P. hawaiensis could become a specialty feed for species that cannot easily transition to a formulated diet such as seahorses and other highly priced marine ornamental species.

Iron Deficiency in Menstruating Adult Women: Much More than Anemia.

Background: Iron deficiency anemia (IDA) is highly prevalent in women of child-bearing age. However, their nonhematological symptoms have been overlooked. This study aims to analyze the nonhematological features and symptoms of IDA in a group of women of reproductive age and the changes occurred during iron therapy. Materials and Methods: IDA women underwent dietary, physical activity, menstrual blood loss, and cognitive function assessment at baseline. Hematological and biochemical parameters were analyzed. Executive attention was tested by the flanker task and working memory by the 2-back task. Oral iron therapy (ferrous sulfate) was given to 35 women for 8 weeks and the changes in iron status, biochemical markers, cognitive function, and nonhematological symptoms were evaluated. Results: Patients presented nonhematological symptoms: pica, 32.4%; cheilitis, 20.6%; restless legs syndrome (RLS), 20.6%; diffuse hair loss, 55.9%; and ungual alterations, 38.2%. Two or more symptoms were present in 58.8% of women. Serum iron and working memory were correlated at baseline. Multivariate analyses show associations (odds ratio [OR], 95% confidence interval [CI]) between pica and reaction time in the working memory test (OR 2.14, 95% CI 1.19-3.87, p = 0.012); RLS with total serum protein (OR 0.08, 95% CI 0.06-0.92, p = 0.043); and cheilitis with mean corpuscular hemoglobin (OR 0.388, 95% CI 0.189-0.799, p = 0.01). Pica, cheilitis, and RLS completely resolved with iron therapy, and ungual alterations and hair loss improved in 92.3% and 84.2% of women, respectively. Better performance in executive attention and working memory was observed after iron therapy. Conclusions: More attention should be given to the nonhematological manifestations of IDA to improve the quality of life of menstruating women.

Laboratory parameters provided by Advia 2120 analyser identify structural haemoglobinopathy carriers and discriminate between Hb S trait and Hb C trait.

BACKGROUND: Haemoglobinopathies have spread owing to human migration, and the number of people needing diagnosis and management of these conditions is increasing. Clinicians need to accurately identify carriers and provide adequate genetic counselling in order to prevent the occurrence of homozygous or compound heterozygous offspring. OBJECTIVES: To identify red blood cell (RBC) laboratory parameters that discriminate between structural haemoglobinopathy carriers and healthy subjects, and to compare RBC laboratory indices between HbAS and HbAC individuals. METHODS: Samples of 500 variant Hb carriers (355 HbAS, 104 HbAC, 19 HbAD, 7 HbAE, 7 HbAO-Arab, 4 α-chain variants and 4 Hb Lepore) and 251 normal controls were run on an Advia 2120 analyser (Siemens). Classic haematological parameters and RBC populations were assessed in all subjects. A multivariable binary logistic regression model was created to predict the probability of a subject carrying any structural haemoglobinopathy. HbAS (n=355, 71%) and HbAC (n=104, 20.8%) subjects were compared. RESULTS: A clinical prediction rule was developed by assigning one point to each of the most efficient variables: mean corpuscular volume (MCV) <88.4 fL, RBC distribution width >13.4%, percentage of microcytic RBCs (%MICRO) >0.7% and the ratio of microcytic RBCs to hypochromic RBCs >0.8. A score of 0, 1, 2, 3 or 4, resulted in a probability of 9.6%, 36.3%, 66.7%, 85.2% or 98.3%, respectively. Among the most frequent variant Hb, HbAC subjects had lower values of parameters related to cell size (MCV, %MICRO) and higher values of parameters related to haemoglobin concentration (MCHC, %HYPER) than HbAS subjects. Coexistence of α-thalassaemia in both HbAS and HbAC individuals resulted in decreased Hb, MCV, MCH and MCHC. CONCLUSIONS: Structural haemoglobinopathy should be investigated in subjects belonging to ethnic groups with high prevalence of variant Hb and with a score of 3 or 4. Erythrocytes of HbAC subjects are smaller and denser than those of HbAS subjects.

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results.

HYPOTHESIS: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. OBJECTIVES: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. PATIENTS AND METHODS: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. RESULTS: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. CONCLUSION: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.

STUDY OBJECTIVE: To assess and compare efficacy, pain, and the learning curve associated with diagnostic therapeutic hysteroscopy using mechanical tissue removal versus bipolar electrical resection in the management of endometrial polyps in an ambulatory care setting. DESIGN: A randomized controlled clinical trial (Canadian Task Force classification I). SETTING: Hospital de Igulada, Barcelona, Spain. PATIENTS: A total of 133 patients diagnosed with endometrial polyp(s) were included and randomly assigned to 1 of the 2 hysteroscopic methods. Criteria assessed were total hysteroscopy time, full polypectomy procedure time, pain experienced by patients, and learning curve of staff in training. MEASUREMENTS AND MAIN RESULTS: The average time to perform total hysteroscopy using the mechanical tissue removal system (TRUCLEAR 5.0 System; Smith & Nephew Inc., Andover, MD) was 6 minutes 49 seconds versus 11 minutes 37 seconds required for the bipolar electrosurgery system (GYNECARE VERSAPOINT; Ethicon Inc, Somerville, NJ) (p < .01). Results for complete polypectomy time favored the TRUCLEAR System at 3 minutes 7 seconds over the VERSAPOINT System at 8 minutes 25 seconds (p < .01). If a successful procedure is predicated on access to cavity, visualization, and complete resection and excision of endometrial polyp, the mechanical TRUCLEAR Tissue Removal System shows a higher success rate than the VERSAPOINT Bipolar Electrosurgery System at 92% and 77%, respectively. Analysis of pain using the visual analog scale revealed no significant differences between the 2 techniques (p > .05). A study of the residents' learning curve showed a higher level of autonomy with hysteroscopy using the TRUCLEAR Tissue Removal System with which residents showed a higher level of confidence compared with hysteroscopy with the VERSAPOINT Bipolar Electrosurgery System. CONCLUSION: In hysteroscopic polypectomy, the mechanical tissue removal system was significantly faster, achieved a greater success rate for complete polypectomy, and required a shorter learning curve from staff being trained in the management of endometrial polyps when compared with bipolar electrical resection.

Use of mobile phones as a tool for weight loss: a systematic review.

We conducted a systematic review of the literature on the use of mobile phones for weight loss. A total of 43 studies were identified on obese or overweight adults, aged 18 years or over. After review, ten articles met the inclusion criteria. There were 19-534 participants per study. Participants were from European, Asian and North American regions. The mean body mass index (BMI) of the subjects varied from 22 to 36 kg/m(2). Two studies used text messaging or multimedia messaging. All the other studies used mobile-phone apps or web-based programmes that could be accessed from mobile phones as a part of a weight-loss intervention or for evaluating their potential for use and their acceptance. Most studies lasted 2-4 months and the maximum duration was 1 year. All but two studies showed reductions in the participants' bodyweight, BMI, waist circumference and body fat in the various interventions. There appeared to be a proportional relationship between weight loss and programme use. The programmes most benefited those who took a pro-active approach to everyday problems. Frequent self-recording of weight seemed to be important, as was the personalisation of the intervention (counselling and individualized feedback). Finally, a social support system acted as a motivational tool.

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation (AU)

Estudio descriptivo del nuevo sistema morcelador de histeroscopia diagnóstica-terapéutica / Descriptive study of a new diagnostic-therapeutic hysteroscopic morcellation system

Hipótesis. El nuevo sistema de morcelación es una técnica histeroscópica diagnóstica-terapéutica eficaz y segura para el tratamiento ambulatorio de pólipos endometriales. Objetivo. Describir nuestra experiencia inicial con el nuevo sistema de morcelación histeroscópica Truclear System (Smith & Nephew) en término de polipectomías realizadas a nivel ambulatorio sin necesidad de derivación quirúrgica de la paciente. Pacientes y métodos. Estudio observacional prospectivo no aleatorizado que incluye las 100 primeras pacientes en las que se les realizó una histeroscopia con el nuevo sistema morcelador entre junio del 2011 a enero del 2012 en el Hospital de Igualada. Se diferencian 2 grupos de pacientes. Grupo 1: 55 primeras pacientes que cumplen alguno de los criterios de inclusión establecidos para la realización de una histeroscopia; Grupo 2: 45 pacientes con sospecha diagnóstica-ecográfica de pólipo endometrial. Resultados. Se realizó un total de 41 y 40 histeroscopias en el grupo 1 y 2 respectivamente, obteniendo una sospecha histeroscópica de pólipo endometrial en el 56 y 82,5% respectivamente. La tasa de éxito en la polipetomía fue del 100%, sin necesidad de derivación quirúrgica posterior en ningún caso y con una tolerancia buena o regular en el 91,3% de las pacientes. Conclusión. El nuevo sistema morcelador permite la realización de la polipectomía a nivel ambulatorio sin necesidad de derivación quirúrgica en aquellas pacientes con diagnóstico ecográfico de pólipo (AU)

Hypothesis: The new morcellation system is a safe and effective diagnostic-therapeutic technique for the outpatient management of endometrial polyps. Objective: To describe our inicial experience with the new mechanical Truclear System (Smith&Nephew) hysteroscope in a number of polypectomies performed in the outpatient setting without the need for surgical referral. Patients and methods: An observational prospective non-randomized study was performed in 100 patients who underwent hysteroscopy between June 2011 and January 2012 at the Igualada Hospital. There were two patient groups: group 1 included the first 55 patients who met the inclusion criteria for hysteroscopy and group 2 included 45 patients with endometrial polyps suspected on ultrasound. Results: We performed 41 and 40 uneventful hysteroscopies in groups 1 and 2, respectively, 56 and 82.5% were suspected endometrial polyps, respectively. Polypectomy was 100% successful in all patients. None of the patients were referred for surgery. Tolerance was moderate to good in 91.3% of the patients. Conclusion: The new morcellator system allows polypectomies to be conducted in outpatients with an ultrasound diagnosis of polyps, without the need to refer the patient for surgery (AU)

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women.

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation.

[Diagnosis of depression in Sub-Saharan immigrants]. / Diagnóstico de depresión en inmigrantes subsaharianos.

OBJECTIVE: The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors. DESIGN: Cross-sectional, descriptive survey. SETTING: Community of Madrid, Spain. PARTICIPANTS: Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004. MEASUREMENTS: Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression. RESULTS: Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27 +/- 6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment. CONCLUSIONS: The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression.

Diagnóstico de depresión en inmigrantes subsaharianos / Diagnosis of depression in sub-saharan immigrants

Objetivo. El proceso migratorio, las características sociodemográficas y la falta de integración en las redes sociales y sanitarias de la población procedente de África subsahariana podrían favorecer un aumento de las enfermedades relacionadas con la salud mental. El objetivo es conocer la prevalencia de depresión en esta población y sus factores de riesgo. Diseño. Estudio descriptivo, transversal. Emplazamiento. Comunidad de Madrid. Participantes. Inmigrantes subsaharianos mayores de 18 años que han acudido a 2 «Programas de Atención Sociosanitaria a Inmigrantes de la Comunidad de Madrid» durante el período comprendido entre agosto de 2003 y febrero de 2004. Mediciones. Para el diagnóstico de depresión se realizaron entevistas semiestructuradas (criterios DSM-IV) por personas entrenadas y el Inventario de Depresión de Beck. Resultados. En total participaron 606 inmigrantes subsaharianos (el 55,4%, varones). Edad media de 27 ± 6,61 años. Diagnóstico de depresión en un 5,4% (intervalo de confianza [IC] del 95%, 3,78-7,56). Se presenta más riesgo de depresión en personas que llevan más de 2 años viviendo en España (13,1%), entre los que tienen hijos (10,7%) y entre los que tienen ciertos problemas de salud, como osteomusculares (18,9%), gastrointestinales (18,8%), neurológicos (17,4%), dermatológicos (20,5%) y astenia (70,6%). Un 6% de los diagnosticados de depresión sigue tratamiento farmacológico. Conclusiones. La prevalencia de depresión entre esta población no es superior a la de la población de origen. Se observa un aumento de la incidencia con el paso del tiempo, probablemente debido a la situación socioeconómica en la que se encuentran, que al prolongarse en el tiempo puede actuar como factor estresante crónico. Otro dato importante es la falta de tratamiento en los diagnosticados de depresión

Objective. The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors. Design. Cross-sectional, descriptive survey. Setting. Community of Madrid, Spain. Participants. Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004. Measurements. Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression. Results. Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27±6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment. Conclusions. The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression

Motivos para emigrar y principales preocupaciones de los inmigrantes subsaharianos residentes en Madrid / Reasons to immigrate and main concerns of subsaharan immigrants residing in Madrid

Objetivo: conocer los motivos que llevaron a los inmigrantessubsaharianos a realizar la migración, así como sus principalesen los primeros años tras su llegada a España.Metodología: estudio descriptivo transversal, llevado a caboen inmigrantes subsaharianos mayores de 18 años residentesen Madrid y que entre agosto de 2003 y febrero de 2004participaron en dos programas de atención a inmigrantes, dela asociación KARIBU y de la ONG de “Médicos del Mundo”.Para la recogida de los datos se utilizó un cuestionarioestructurado que contenía sociodemográficas (sexo, edad,tiempo de estancia, situación laboral y situación administrativa),motivo para iniciar la migración y principales preocupacionesen el momento de la entrevista.Resultados: fueron estudiados 606 inmigrantes subsaharianos.Las motivaciones principales eran de tipo económico(31,02%) y las referidas a mejoría de la calidad de vida ybúsqueda de nuevas oportunidades (26,90%). El motivo ganardinero/mejorar ingresos, lo alegaron un 52,97% de loshombres frente un 3,7% de las mujeres. La principal preocupaciónse refería al trabajo (72,44%), seguido del dinero(58,09%) y la familia (43,64%).Conclusiones: en la población inmigrante que procede deÁfrica subsahariana la principal motivación para emigrar esla económica. Las principales preocupaciones son el trabajo,el dinero y la familia, habiendo diferencias de género

Objective: to ascertain the reasons that led sub-saharanimmigrants to immigrate as well as to identify their mainconcerns during the first few years after their arrival in Madrid.Methodology: a descriptive, cross-sectional study carried outin sub-saharan immigrants over 18 residing in Madrid, whomparticipated in two “immigrant care” programmes, organisedby the KARIBU association and Physicians of the World NGObetween august 2003 and february 2005. A structured questionnairewas used for data collection which contained sociodemographicdata (sex, age, time of residence, work statusand legal status), reason for immigration and their mainworries and concerns at the time of the interview.Results: 606 Sub-Saharan immigrants were surveyed. Themain reasons to immigrate were economic reasons (31,02%)and those referring to an improved quality of life and thesearch for new opportunities (26,90%). The reason to makemoney/improve income was referred by 52,97% of men vs3,7% of women. The main concern was work (72,44%),followed by money (58,09%), and family (43,64%).Conclusions: economic reasons are the main motivationfor African sub-saharan immigrants to come to Spain. Theirmain concerns have to do with work, money and family,with differences between the sexes

Conocimientos sobre anticoncepción y transmisión del VIH y la hepatitis B en la población inmigrante subsahariana / Knowledge of contraception and transmission of HIV and hepatitis B in the Sub-Saharan immigrant population

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Acercamiento a las características sociosanitarias de las mujeres subsaharianas de 2 programas de atención a inmigrantes de Madrid / Approach to the socio-sanitary characteristics of sub-Saharan immigrant women in 2 immigrants programs in Madrid

Objetivo. Conocer algunas características sociosanitarias de las mujeres subsaharianas que acuden a 2 programas de atención a inmigrantes: principales problemas de salud, utilización de servicios sanitarios generales y ginecológicos. Método. Estudio observacional, descriptivo y transversal realizado a mujeres inmigrantes subsaharianas mayores de 18 años, en 2 programas de atención a inmigrantes que residían en Madrid, durante el período comprendido entre agosto de 2003 y febrero de 2004. Resultados. Contestaron 270 mujeres inmigrantes subsaharianas. Un 88% estaba en situación administrativa irregular. Un 91% trabajaba sin contrato. Los principales problemas de salud fueron problemas respiratorios (23%; intervalo de confianza [IC] del 95%, 18-28) y problemas ginecológicos (17%; IC del 95%, 13-22). Respecto a la utilización de servicios sanitarios, el 32% (IC del 95%, 27-38) acudió a organizaciones no gubernamentales (ONG) y un 19% (IC del 95%, 15-24) a centros de urgencias. Un 16% (IC del 95%, 12-21) se realizó revisión ginecológica desde que residía en España. Conclusiones. Se trata de una población joven, una gran mayoría trabaja sin contrato y se encuentra en situación de irregularidad administrativa. Hay una mala utilización de los servicios sanitarios, con poca utilización de servicios ginecológicos. Todos estos datos nos indican la necesidad de programas de salud para mejorar la información y conocimientos acerca de la salud y la utilización de servicios sanitarios

Objective. To determine the following health and social characteristics of sub-Saharan immigrant women attending 2 immigrant programs: main health problems and utilization of general and gynecological health services. Method. A cross-sectional descriptive study was carried out in sub-Saharan immigrant women over 18 years of age living in Madrid and attending two health and social centers for immigrants in Madrid between August 2003 and February 2004. Results. A total of 270 sub-Saharan immigrant women participated in the survey. Eighty-eight percent had irregular administrative status. Ninety-one percent were working without a work contract. The main health problems were breathing difficulties (23%; 95% CI: 18-28) and gynecologic problems (17%; 95% CI: 13-22). Thirty-two percent (95% CI: 27-38) had used NGO health services and 19% (CI 95%, 15-24) had used emergency services. Sixteen percent (95% CI: 12-21) had used a gynecologic service for check-ups since living in Spain. Conclusions. The immigrant women studied were young. Most were working without contracts and had irregular administrative status. Health services utilization was low, especially that of gynecologic services. These findings reveal the need for health programs to improve information and knowledge about health and health services utilization