COVID-19 Associated Pulmonary Aspergillosis (CAPA): Hospital or Home Environment as a Source of Life-Threatening Aspergillus fumigatus Infection?

Most cases of invasive aspergillosis are caused by Aspergillus fumigatus, whose conidia are ubiquitous in the environment. Additionally, in indoor environments, such as houses or hospitals, conidia are frequently detected too. Hospital-acquired aspergillosis is usually associated with airborne fungal contamination of the hospital air, especially after building construction events. A. fumigatus strain typing can fulfill many needs both in clinical settings and otherwise. The high incidence of aspergillosis in COVID patients from our hospital, made us wonder if they were hospital-acquired aspergillosis. The purpose of this study was to evaluate whether the hospital environment was the source of aspergillosis infection in CAPA patients, admitted to the Hospital Universitario Central de Asturias, during the first and second wave of the COVID-19 pandemic, or whether it was community-acquired aspergillosis before admission. During 2020, sixty-nine A. fumigatus strains were collected for this study: 59 were clinical isolates from 28 COVID-19 patients, and 10 strains were environmentally isolated from seven hospital rooms and intensive care units. A diagnosis of pulmonary aspergillosis was based on the ECCM/ISHAM criteria. Strains were genotyped by PCR amplification and sequencing of a panel of four hypervariable tandem repeats within exons of surface protein coding genes (TRESPERG). A total of seven genotypes among the 10 environmental strains and 28 genotypes among the 59 clinical strains were identified. Genotyping revealed that only one environmental A. fumigatus from UCI 5 (box 54) isolated in October (30 October 2020) and one A. fumigatus isolated from a COVID-19 patient admitted in Pneumology (Room 532-B) in November (24 November 2020) had the same genotype, but there was a significant difference in time and location. There was also no relationship in time and location between similar A. fumigatus genotypes of patients. The global A. fumigatus, environmental and clinical isolates, showed a wide diversity of genotypes. To our knowledge, this is the first study monitoring and genotyping A. fumigatus isolates obtained from hospital air and COVID-19 patients, admitted with aspergillosis, during one year. Our work shows that patients do not acquire A. fumigatus in the hospital. This proves that COVID-associated aspergillosis in our hospital is not a nosocomial infection, but supports the hypothesis of "community aspergillosis" acquisition outside the hospital, having the home environment (pandemic period at home) as the main suspected focus of infection.

Mortalidad atribuible al consumo de tabaco en España 2016 / Smoking-Attributable Mortality in Spain in 2016

INTRODUCCIÓN: La mortalidad atribuible (MA) al consumo de tabaco es un indicador valioso que permite caracterizar la evolución y el impacto en la salud poblacional de la epidemia tabáquica. El objetivo de este trabajo es estimar la MA al consumo de tabaco en España en 2016 en población ≥ 35 años utilizando la mejor evidencia disponible. MÉTODOS: Se aplicó un método dependiente de las prevalencias de consumo de tabaco basado en el cálculo de fracciones atribuidas poblacionales. Las prevalencias de consumo (fumadores-exfumadores-nunca fumadores) proceden de la estimación combinada de la Encuesta Nacional de Salud-2016 y la Europea-2014; el exceso de riesgo de morir en fumadores y exfumadores del seguimiento de diferentes cohortes; y la mortalidad observada del Instituto Nacional de Estadística. Se presenta la estimación global de MA y en función del sexo, grupos de edad y grandes grupos de enfermedades (cáncer, cardiometabólicas y respiratorias), acompañadas de las fracciones atribuidas poblacionales. RESULTADOS: En 2016 se atribuyeron 56.124 muertes al consumo de tabaco, el 84% sucedieron en hombres (47.000) y el 50% en mayores de 74 años (27.795). El 50% de la MA fue por tumores (28.281), de los cuales el 65% fueron de pulmón. Una de cada cuatro muertes (13.849) ocurrió antes de los 65 años. CONCLUSIONES: Una de cada siete muertes que ocurrieron en España en 2016 se atribuyen al consumo de tabaco. Esta estimación permite objetivar el gran impacto que el consumo de tabaco tiene en la mortalidad, especialmente por cáncer de pulmón y enfermedad pulmonar obstructiva crónica

INTRODUCTION: Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. METHODS: A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, or current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiovascular diseases and respiratory diseases. RESULTS: In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. CONCLUSIONS: One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease

Economía informal, un problema de salud laboral / The informal economy: an occupational health issue

La economía informal se debe diferenciar de conceptos tales como empleo informal y sector informal, cada uno con sus propias características. Existen varios tipos de trabajadores informales que se agrupan en varias categorías según su labor. Los familiares de estos trabajadores se agrupan dentro del empleo vulnerable, que no se benefician tampoco de coberturas sanitarias. El empleo informal condiciona una gran morbimortalidad que se traduce en pérdidas económicas y gran número de años de vida perdidos por discapacidad, especialmente entre poblaciones jóvenes y mujeres. Son necesarias políticas sanitarias encaminadas a disminuir las desigualdades socioeconómicas, mejorando la capacitación de profesionales sanitarios y la accesibilidad a los servicios sanitarios de estos trabajadores

Informal economy must be differentiated from concepts such as informal employment and the informal sector, each with its own characteristics. There are several types of informal workers that are grouped into several categories according to their work. The families of these workers are grouped into vulnerable job, which is also not beneficial for health coverage. Informal working conditions mean great morbidity resulting in economic losses and a large number of quality-adjusted life year, especially among young populations and women. Health policies are needed to reduce socio-economic inequalities, improve the training of health professionals and the accessibility of health services to these workers

Rotación en la OMS, el sueño cumplido de un especialista / WHO internship: a specialist's dream come true

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[The informal economy: an occupational health issue]. / Economía informal, un problema de salud laboral.

Informal economy must be differentiated from concepts such as informal employment and the informal sector, each with its own characteristics. There are several types of informal workers that are grouped into several categories according to their work. The families of these workers are grouped into vulnerable job, which is also not beneficial for health coverage. Informal working conditions mean great morbidity resulting in economic losses and a large number of quality-adjusted life year, especially among young populations and women. Health policies are needed to reduce socio-economic inequalities, improve the training of health professionals and the accessibility of health services to these workers.

La economía informal se debe diferenciar de conceptos tales como empleo informal y sector informal, cada uno con sus propias características. Existen varios tipos de trabajadores informales que se agrupan en varias categorías según su labor. Los familiares de estos trabajadores se agrupan dentro del empleo vulnerable, que no se benefician tampoco de coberturas sanitarias. El empleo informal condiciona una gran morbimortalidad que se traduce en pérdidas económicas y gran número de años de vida perdidos por discapacidad, especialmente entre poblaciones jóvenes y mujeres. Son necesarias políticas sanitarias encaminadas a disminuir las desigualdades socioeconómicas, mejorando la capacitación de profesionales sanitarios y la accesibilidad a los servicios sanitarios de estos trabajadores.

Medicina alternativa frente a medicina científica en un área básica de salud. ¿Un fenómeno emergente? / Alternative medicine vs cientific medicine in a basic health area. An emergent phenomenon?

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