Remdesivir use in severe and critical COVID-19 patients might be associated with lower incidence of arterial thrombotic events.

INTRODUCTION: Venous thromboembolism (VTE) and arterial thrombotic (AT) events are a striking feature of severe COVID-19, however, relationship of remdesivir use and the risk of thrombotic events is unknown and has not been investigated before. METHODS: We retrospectively analyzed a cohort of 876 consecutive hospitalized severe and critical COVID-19 patients who were treated with remdesivir and compared them to 876 case-matched control patients. All patients were treated in our tertiary-level institution in period from 10/2020 to 6/2021. VTE and AT were diagnosed by objective imaging and laboratory methods. RESULTS: After exclusion of 71 VTE and 37 AT events present at the time of hospital admission, there were a total of 70 VTE (35 in the remdesivir and 35 in the control group) and 38 AT events occurring during hospitalization (13 in the remdesivir and 25 in the control group). There was a similar cumulative post-admission VTE incidence among both remdesivir and matched control patients (P = 0.287). Significantly lower cumulative post-admission AT incidence was observed among patients treated with remdesivir than among matched control patients (1.7% vs 3.3%, HR = 0.51, P = 0.035). Tendency for lower AT rates was evident in subgroups of patients stratified according to the type of AT, as well as according to the intensity of required oxygen supplementation at the time of remdesivir use. CONCLUSION: Remdesivir use in severe and critical COVID-19 patients might be associated with lower occurrence of AT during hospitalization, whereas similar rates of VTE events were observed among both patients treated with remdesivir and control patients.

The performance of the WHO COVID-19 severity classification, COVID-GRAM, VACO Index, 4C Mortality, and CURB-65 prognostic scores in hospitalized COVID-19 patients: data on 4014 patients from a tertiary center registry.

AIM: To evaluate the predictive properties of several common prognostic scores regarding survival outcomes in hospitalized COVID-19 patients. METHODS: We retrospectively reviewed the medical records of 4014 consecutive COVID-19 patients hospitalized in our tertiary level institution from March 2020 to March 2021. Prognostic properties of the WHO COVID-19 severity classification, COVID-GRAM, Veterans Health Administration COVID-19 (VACO) Index, 4C Mortality Score, and CURB-65 score regarding 30-day mortality, in-hospital mortality, presence of severe or critical disease on admission, need for an intensive care unit treatment, and mechanical ventilation during hospitalization were evaluated. RESULTS: All of the investigated prognostic scores significantly distinguished between groups of patients with different 30-day mortality. The CURB-65 and 4C Mortality Score had the best prognostic properties for prediction of 30-day mortality (area under the curve [AUC] 0.761 for both) and in-hospital mortality (AUC 0.757 and 0.762, respectively). The 4C Mortality Score and COVID-GRAM best predicted the presence of severe or critical disease (AUC 0.785 and 0.717, respectively). In the multivariate analysis evaluating 30-day mortality, all scores mutually independently provided additional prognostic information, except the VACO Index, whose prognostic properties were redundant. CONCLUSION: Complex prognostic scores based on many parameters and comorbid conditions did not have better prognostic properties regarding survival outcomes than a simple CURB-65 prognostic score. CURB-65 also provides the largest number of prognostic categories (five), allowing more precise risk stratification than other prognostic scores.

The politics of LGBT+ suicide and suicide prevention in the UK: risk, responsibility and rhetoric.

Suicide is a major public health concern, patterned by systematic inequalities, with lesbian, gay, bisexual and trans (LGBT+) people being one example of a minoritised group that is more likely to think about and attempt suicide worldwide. To address this, UK national suicide prevention policies have suggested that LGBT+ people should be prioritised in prevention activities. However, there is little research seeking to understand how LGBT+ suicide is re/presented in political and policy spheres. In this article, we critically analyse all mentions of LGBT+ suicide in UK parliamentary debates between 2009 and 2019 and in the eight suicide prevention policies in use during this period. We argue that LGBT+ suicide is understood in two contrasting ways: firstly, as a pathological 'problem', positioning LGBT+ people either as risks or as at risk and in need of mental health support. Alternatively, suicide can be seen as externally attributable to perpetrators of homophobic, biphobic and transphobic hate, requiring anti-hate activities as part of suicide prevention. In response, we argue that although these explanations may appear oppositional; they both draw on reductive explanations of LGBT+ suicide, failing to consider the complexity of suicidal distress, thus constraining understandings of suicide and suicide prevention.

Efecto de una intervención educativa repetida frente a una intervención inicial sobre el control de la presión arterial en pacientes hipertensos / Effect of a repeated educational intervention versus an initial intervention on blood pressure control in hypertensive patients

Introducción y objetivos:La hipertensión es uno de los principales factores de riesgo cardiovascular. Una intervención educativa, destinada a aumentar o reforzar los conocimientos del paciente, puede contribuir a un mejor control de su presión arterial. Nuestro objetivo fue evaluar la eficacia de una educación terapéutica continuada frente a una intervención inicial en hipertensos.Métodos:Estudio experimental, de intervención comunitaria multicéntrica, mediante la aplicación de un programa de educación terapéutica en hipertensión arterial (HTA).Resultados:Se incluyeron 980 pacientes en tratamiento antihipertensivo, 490 en cada grupo, con edad media de 65 años, y un 50% mujeres siendo la presión arterial sistólica (PAS) media inicial en ambos grupos de 136 mmHg. Respecto a los conocimientos sobre la hipertensión, aunque se observó una mejoría inicial similar en ambos grupos, al finalizar el estudio, en el grupo de intervención continuado (GIC) se observó una media de 23,06 respuestas acertadas, mientras que en el grupo de intervención inicial (GII) la media fue de 20,91, siendo la diferencia estadísticamente significativa (p < 0,001). Al finalizar el estudio la cifra media de PAS fue de 127,5 mmHg en el GIC y de136.57 mmHg en el grupo GII. Asimismo, se observó un menor porcentaje de pacientes con IMC ≥ 25 en el GIC (78,2%) que en le GII 82,6%, siendo esta diferencia estadísticamente significativa (p < 0,001). Este mismo efecto se observó sobre el perímetro abdominal, observándose en el GIC un perímetro abdominal aumentado en un 46,3% frente a un 68,8% en el GII (p < 0,001).Conclusión:Una intervención educativa continuada aumenta el grado de conocimiento sobre la hipertensión respecto a una intervención inicial. Asimismo, esta intervención se asocia a una mejoría en las cifras de presión arterial, peso, índice de masa corporal y perímetro abdominal. (AU)

Introduction and objectives:Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients.Methods:Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension.Results:980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001).Conclusión:A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures. (AU)

Red cell distribution width is a potent prognostic parameter for in-hospital and post-discharge mortality in hospitalized coronavirus disease 2019 patients: a registry-based cohort study on 3941 patients.

AIM: To investigate clinical and prognostic associations of red cell distribution width (RDW) in hospitalized coronavirus disease 2019 (COVID-19) patients. METHODS: We retrospectively analyzed the records of 3941 consecutive COVID-19 patients admitted to a tertiary-level institution from March 2020 to March 2021 who had available RDW on admission. RESULTS: The median age was 74 years. The median Charlson comorbidity index (CCI) was 4. The majority of patients (84.1%) on admission presented with severe or critical COVID-19. Patients with higher RDW were significantly more likely to be older and female, to present earlier during infection, and to have higher comorbidity burden, worse functional status, and critical presentation of COVID-19 on admission. RDW was not significantly associated with C-reactive protein, occurrence of pneumonia, or need for oxygen supplementation on admission. During hospital stay, patients with higher RDW were significantly more likely to require high-flow oxygen therapy, mechanical ventilation, intensive care unit, and to experience prolonged immobilization, venous thromboembolism, bleeding, and bacterial sepsis. Thirty-day and post-hospital discharge mortality gradually increased with each rising RDW percent-point. In a series of multivariate Cox-regression models, RDW demonstrated robust prognostic properties at >14% cut-off level. This cut-off was associated with inferior 30-day and post-discharge survival independently of COVID-19 severity, age, and CCI; and with 30-day survival independently of COVID severity and established prognostic scores (CURB-65, 4C-mortality, COVID-gram and VACO-index). CONCLUSION: RDW has a complex relationship with COVID-19-associated inflammatory state and is affected by prior comorbidities. RDW can improve the prognostication in hospitalized COVID-19 patients.

[Effect of a repeated educational intervention versus an initial intervention on blood pressure control in hypertensive patients]. / Efecto de una intervención educativa repetida frente a una intervención inicial sobre el control de la presión arterial en pacientes hipertensos.

INTRODUCTION AND OBJECTIVES: Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients. METHODS: Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension. RESULTS: 980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

A Balancing Act: Agency and Constraints in University Students' Understanding of and Responses to Sexual Violence in the Night-Time Economy.

This article extends our understanding of how university students make sense of, and respond to, sexual violence in the night-time economy (NTE). Based on semi-structured interviews with 26 students in a city in England, we examine students' constructions of their experiences of sexual violence within the NTE, exploring their negotiations with, and resistance to, this violence. Building upon theories of postfeminism, we interrogate the possibilities for resistance within the gendered spaces of the NTE and propose a disaggregated conceptualization of agency to understand responses to sexual violence, thereby offering useful insights for challenging sexual violence in the NTE and in universities.

Grado de conocimiento de la hipertensión en pacientes hipertensos / Grade of knowledge of hypertension in hypertensive patients

Objetivo: Evaluar el grado de conocimientos de la hipertensión en pacientes hipertensos. Método: Estudio multicéntrico descriptivo transversal, realizado en centros de atención primaria y especializada de España. Participaron 980 pacientes hipertensos, mayores de 18 años, con tratamiento farmacológico. Variables principales: años de diagnóstico, factores de riesgo, presión arterial, perímetro abdominal, índice de masa corporal, adherencia a la medicación (test de Morisky-Green), y los ítems de un cuestionario validado sobre conocimientos. Resultados: El 50% mujeres, edad media 65 años. El 46% con más de 10 años del diagnóstico de hipertensión. En relación a la adherencia a la medicación, el 56,6% no lo era, siendo el olvido la primera causa. Al analizar los conocimientos sobre la hipertensión el 41,7% refería que nadie les había informado, el 35,8% no consideraba que la hipertensión fuera para toda la vida y solo el 42,3% conocía los objetivos de presión arterial. El mayor desconocimiento sobre los riesgos que provoca la hipertensión en el organismo fue el relacionado con el riñón, donde solo el 48,6% afirmaba conocer ese dato. En relación a la medicación, solo el 41,4% conocía que era para toda la vida. También se observó que hay diferencias estadísticamente significativas entre nivel de conocimientos y nivel de estudios (p < 0,001). Conclusión: Los conocimientos básicos sobre la hipertensión siguen siendo bajos en estos pacientes. Estos resultados permiten orientar futuras intervenciones. orientando la educación terapéutica al paciente y mejorar su participación en la enfermedad para controlar mejor su hipertensión

Aims: To evaluate the grade of knowledge of hypertension in hypertensive patients. Method: Cross-sectional descriptive multicentre study. Primary and specialized care centres in Spain. Participants: 980 hypertensive patients, older than 18 years, with pharmacological treatment. Main variables: Years of diagnosis, risk factors, blood pressure, abdominal circumference, body mass index, adherence to medication (Morisky-Green test) and the items of a validated questionnaire on knowledge. Results: 50% were women, mean age 65 years. Seventy-eight percent lived with family, 46% over 10 years old diagnosed with hypertension. In relation to adherence to medication, 56.6% were not compliant, forgetting being the first cause. Knowledge about hypertension 41.7% said that no one had explained it, 35.8% did not consider hypertension a lifelong process, and only 42.3% knew the objectives of blood pressure. The area of major lack of knowledge of the risk of hypertension was the problems caused by hypertension in the kidney, only 48.6% answered affirmatively. In relation to medication, only 41.4% knew it is for life. Statistically significant differences were also observed between the level of knowledge and the level of studies (p < .001). Conclusions: Basic knowledge about hypertension remains low in these patients. These results enable future interventions to be oriented by promoting therapeutic education to the patient and improving their involvement in the disease in order to better control their hypertension

Grade of knowledge of hypertension in hypertensive patients. / Grado de conocimiento de la hipertensión en pacientes hipertensos.

AIMS: To evaluate the grade of knowledge of hypertension in hypertensive patients. METHOD: Cross-sectional descriptive multicentre study. Primary and specialized care centres in Spain. PARTICIPANTS: 980 hypertensive patients, older than 18 years, with pharmacological treatment. MAIN VARIABLES: Years of diagnosis, risk factors, blood pressure, abdominal circumference, body mass index, adherence to medication (Morisky-Green test) and the items of a validated questionnaire on knowledge. RESULTS: 50% were women, mean age 65 years. Seventy-eight percent lived with family, 46% over 10 years old diagnosed with hypertension. In relation to adherence to medication, 56.6% were not compliant, forgetting being the first cause. Knowledge about hypertension 41.7% said that no one had explained it, 35.8% did not consider hypertension a lifelong process, and only 42.3% knew the objectives of blood pressure. The area of major lack of knowledge of the risk of hypertension was the problems caused by hypertension in the kidney, only 48.6% answered affirmatively. In relation to medication, only 41.4% knew it is for life. Statistically significant differences were also observed between the level of knowledge and the level of studies (p<.001). CONCLUSIONS: Basic knowledge about hypertension remains low in these patients. These results enable future interventions to be oriented by promoting therapeutic education to the patient and improving their involvement in the disease in order to better control their hypertension.

La profesión periodística en el Caribe Colombiano: Entre percepción y significados

El objetivo de esta investigación fue conocer cómo perciben su oficio los periodistas en las principales ciudades de la región Caribe colombiana; para alcanzarlo se utilizó un método de investigación mixto, aplicando una fase cualitativa y otra cuantitativa, que posteriormente fue interrelacionada mediante una triangulación de datos. Entre los hallazgos se logró establecer que para los periodistas de la región Caribe colombiana el ejercicio de su oficio brinda gran satisfacción profesional (entendida como el gusto que se experimenta al ejercer el periodismo) pero poca satisfacción laboral (que refiere a las condiciones de contratación y remuneración). Se encontró que existe la intención de los periodistas por cualificarse, sin embargo, el poco tiempo libre con el que cuentan y la baja remuneración salarial les dificulta este propósito. También se evidenciaron desencuentros en el interior de los medios entre los periodistas empíricos y los periodistas con una formación profesional: falta de pasión por el oficio y ausencia de métodos para la investigación periodística, son ejemplos de ello.

The objective of this research was to understand how journalists perceive their trade in major cities of the Colombian Caribbean region; to achieve a mixed research method was used, applying a qualitative and a quantitative phase, which was subsequently interconnected by a triangulation of data. Among the findings it was established that journalists in the Colombian Caribbean region exercising their profession gives great job satisfaction (defined as the pleasure experienced when practicing journalism) but little job satisfaction (which refers to conditions recruitment and remuneration). It was found that there is an intention of journalists qualify, however, with little free time they have low wages and remuneration, difficult for them to this end. Lack of passion for the job and lack of methods for investigative journalism, are examples of this: disagreements within the empirical media between journalists and journalists with professional training in the field wreaked.

Cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy.

We conducted a cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease (COPD) compared with usual care. A randomized controlled trial was carried out over four months with 45 patients treated with long-term oxygen therapy, 24 in the telehealth group (TG) and 21 in the control group (CG). The analysis took into account whether the severity of comorbidity (defined as the presence of additional chronic diseases co-occurring with COPD) was associated with differences in costs and/or quality-adjusted life years (QALYs). Results of cost-utility analysis were expressed in terms of the incremental cost-effectiveness ratio (ICER). The average total cost was €2300 for the TG and €1103 for the CG, and the average QALY gain was 0.0059 for the TG and 0.0006 for the CG (resulting an ICER of 223,726 €/QALY). For patients without comorbidity, the average total cost was €855 for the TG and €1354 for the CG, and the average QALY gain was 0.0288 for the TG and 0.0082 for the CG (resulting in the telehealth programme being the dominant strategy). For patients with comorbidity, the average total cost was €2782 for the TG and €949 for the CG, and the average QALY gain was -0.0017 for the TG and -0.0041 for the CG (resulting an ICER of 754,592 €/QALY). The telehealth programme may not have been cost-effective compared to usual care, although it could be considered cost-effective for patients without comorbidity.

Implementation of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy.

We conducted a pilot study of the effectiveness of home telehealth for patients with advanced chronic obstructive pulmonary disease treated with long-term oxygen therapy. Patients were randomized into a telehealth group (n = 24) and a control group (n = 21) who received usual care. Patients in the telehealth group measured their vital signs on weekdays and performed spirometry on two days per week. The data were transmitted automatically to a clinical call centre. After four months of monitoring the mean number of accident and emergency department visits in the telehealth group was slightly lower than in the control group (0.29 versus 0.43, P = 0.25). The mean number of hospital admissions was 0.38 in the telehealth group and 0.14 in the control group (P = 0.47). During the study a total of 40 alerts were detected. The clinical triage process detected eight clinical exacerbations which were escalated by the case manager for a specialist consultation. There were clinically important differences in health-related quality of life in both groups. The mean score on the SGRQ was 10.9 versus 4.5 in the control group (P = 0.53). The EuroQol-5D score improved by 0.036 in the telehealth group and by 0.003 in the control group (P = 0.68). Both patients and healthcare professionals showed a high level of satisfaction with the telehealth programme.