Prevalencia de anticuerpos neutralizantes frente al SARS-CoV-2 inducidos tras 2 dosis de vacuna BNT162b2 (Pfizer–BioNTech) en trabajadores sanitarios / Prevalence of neutralizing antibodies against SARS-CoV-2 using a rapid serological test in health workers of a Spanish Department of Health in Alicante (Spain) before the booster dose of the vaccine

Fundamento: Estudiar la prevalencia de anticuerpos neutralizantes en el personal sanitario y de apoyo tras la administración de la segunda dosis de vacuna BNT162b2 (Pfizer–BioNTech). Material y métodos: En diciembre 2021 llevamos a cabo un estudio en el Departamento de Salud de Orihuela, Alicante (España), formado por 1.500 trabajadores. En los participantes del estudio, recogimos variables demográficas y realizamos un test «point-of-care» (POC) de inmunocromatografía para medir la presencia de anticuerpos neutralizantes (OJABIO® SARS-CoV-2 Neutralizing Antibody Detection Kit, fabricado por Wenzhou OJA Biotechnology Co., Ltd.- Wenzhou, Zhejiang, China) antes de la administración de la tercera dosis de vacuna. Resultados: Obtuvimos información completa de 964 (64%) trabajadores, siendo 290 varones y 674 mujeres. La edad media fue de 45,8 años (mín: 18, máx: 68) y el tiempo desde la última dosis (TUD) de vacuna fue 40,5 semanas (mín: 1,71; máx: 47,71). Un total de 131 (13,5%) habían padecido infección por SARS-CoV-2 confirmada mediante RT-PCR. La proporción de sujetos con presencia de anticuerpos neutralizantes fue de 38,5%. En el análisis multivariable el TUD de vacuna (razón de probabilidades ajustada [ORa] semana: 1,07; IC 95%: 1,04; 1,09) y la infección previa por SARS-CoV-2 (ORa: 3,7; IC 95%: 2,39; 5,63) mostraron asociación estadísticamente significativa con la presencia de anticuerpos neutralizantes. Conclusiones: El TUD de vacuna y la infección previa por SARS-CoV-2 determinaron la presencia de anticuerpos neutralizantes en 38,5% del personal sanitario y personal de apoyo.(AU)

Aim: To study the prevalence of neutralizing antibodies in healthcare workers and healthcare support personnel after the administration of the second dose of the BNT162b2 vaccine (Pfizer-BioNTech). Materials and methods: In December 2021, we undertook a study in the Health Department in Orihuela, Alicante (Spain), which consists of 1500 workers. We collected demographic variables about the study participants, and we performed a «point-of-care» immunochromatography test to measure the presence of neutralizing antibodies (OJABIO® SARS-CoV-2 Neutralizing Antibody Detection Kit, manufactured by Wenzhou OJA Biotechnology Co., Ltd. Wenzhou, Zhejiang, China) before the administration of the third dose of the vaccine. Results: We obtained complete information about 964 (64%) workers, which consisted of 290 men and 674 women. The average age was 45,8 years (min. 18, max. 68) and the average time since the last dose of the vaccine was 40,5 weeks (min. 1,71, max. 47,71). A total of 131 participants (13,5%) had suffered infection by SARS-CoV-2 confirmed using RT-PCR. The proportion of participants who showed presence of neutralizing antibodies was 38,5%. In the multivariable analysis, the time since the last dose of the vaccine (aOR week: 1,07; 95%CI: 1,04; 1,09) and previous infection by SARS-CoV-2 (aOR: 3,7; 95CI: 2,39; 5,63) showed a statistically significant association with the presence of neutralizing antibodies. Conclusions: The time since the administration of the last dose of the vaccine and the previous infection by SARS-CoV-2 determined the presence of neutralizing antibodies in 38,5% of the healthcare workers and support workers.(AU)

Prevalence of neutralizing antibodies against SARS-CoV-2 using a rapid serological test in health workers of a Spanish Department of Health in Alicante (Spain) before the booster dose of the vaccine.

AIM: To study the prevalence of neutralizing antibodies in healthcare workers and healthcare support personnel after the administration of the second dose of the BNT162b2 vaccine (Pfizer-BioNTech). MATERIALS AND METHODS: In December 2021, we undertook a study in the Health Department in Orihuela, Alicante (Spain), which consists of 1500 workers. We collected demographic variables about the study participants, and we performed a "point-of-care" immunochromatography test to measure the presence of neutralizing antibodies (OJABIO® SARS-CoV-2 Neutralizing Antibody Detection Kit, manufactured by Wenzhou OJA Biotechnology Co., Ltd. Wenzhou, Zhejiang, China) before the administration of the third dose of the vaccine. RESULTS: We obtained complete information about 964 (64%) workers, which consisted of 290 men and 674 women. The average age was 45,8 years (min. 18, max. 68) and the average time since the last dose of the vaccine was 40,5 weeks (min. 1,71, max. 47,71). A total of 131 participants (13,5%) had suffered infection by SARS-CoV-2 confirmed using RT-PCR. The proportion of participants who showed presence of neutralizing antibodies was 38,5%. In the multivariable analysis, the time since the last dose of the vaccine (aOR week: 1,07; 95%CI: 1,04; 1,09) and previous infection by SARS-CoV-2 (aOR: 3,7; 95CI: 2,39; 5,63) showed a statistically significant association with the presence of neutralizing antibodies. CONCLUSIONS: The time since the administration of the last dose of the vaccine and the previous infection by SARS-CoV-2 determined the presence of neutralizing antibodies in 38,5% of the healthcare workers and support workers.

Non-invasive assessment of hormonal fluctuations during pregnancy in guanacos (Lama guanicoe) and its application in a wild population.

Obtaining endocrinological profiles using non-invasive methodologies by the measurement of hormone fecal metabolites is a widely used method to monitor ovarian activity and pregnancy in wild species. These tools allow the obtention of physiological information without causing capture-related stress on the individuals. In this research, we aimed to 1) biologically validate a non-invasive method to assess fecal progestagens and estrogens fluctuations during gestation in guanacos (Lama guanicoe) and 2) apply this technique to assess pregnancy in a wild free-ranging population. Fecal samples were collected through the gestation period (~12 months) of female guanacos in a 6.5-ha paddock. An increase in fecal metabolites of both hormones was detected. Progestagens increased gradually, in contrast to estrogens, which remained at basal values for most of the gestation period and peaked only a few days before calving. To assess pregnancy in wild free-ranging animals, fecal samples were collected from a population of La Payunia provincial reserve (Mendoza, Argentina) during the beginning of gestation and at the end of gestation. Through the first months of possible gestation, pregnant females represented between 40 and 80% of the population; at the end of gestation, only 20-40% of the females had confirmed pregnancies. Our results demonstrated that the polyclonal antisera and sexual hormone metabolite assays used here detect variations in the metabolites excreted through feces in guanacos and provide the possibility of non-invasive hormone monitoring of female reproductive status. Also, the findings in wild conditions suggest that natural abortions could have occurred during the first months of gestation. Although some abortions may be natural, the harsh environmental conditions that challenge the support of such a long gestational process may be another relevant factor to consider. The results obtained here enhance our understanding of the reproductive physiology of one of the most emblematic ungulates in South America.

Quality-Adjusted Life Year Proxies for Caries in Primary Dentition: A Discrete Choice Experiment.

INTRODUCTION: Cost-utility analysis (CUA)-a method to evaluate intervention cost-effectiveness-transforms benefits of alternatives into a measure of quantity and quality of life, such as quality-adjusted life year (QALY), to enable comparison across heterogeneous programs. Measurement challenges prevent directly estimating utilities and calculating QALYs for caries in primary dentition. Proxy disease QALYs are often used as a substitute; however, there lacks quantitative evidence that these proxy diseases are comparable to caries. OBJECTIVE: To employ a discrete choice experiment (DCE) to quantitatively determine the most comparable proxy disease for different levels of caries in primary dentition. METHODS: A cross-sectional DCE survey was administered to respondents (N = 461) who resided in California, were aged ≥18 y, and were primary caretakers for ≥1 child aged 3 to 12 y. Four attributes were included: pain level, disease duration, treatment cost, and family life impacts. Mixed effects logistic regression and conditional logistic regression were used to analyze the survey data. RESULTS: Respondents from the overall sample preferred no pain over mild (odds ratio [OR] = 0.50, P < 0.05), moderate (OR = 0.57, P < 0.05), and severe pain (OR = 0.48, P < 0.05). Acute gastritis (OR = 0.44, P < 0.05), chronic gastritis (OR = 0.31, P < 0.01), and cold sore (OR = 0.38, P < 0.05) were less preferred than stage 1 caries. Acute tonsilitis (OR = 0.43, P < 0.05), acute gastritis (OR = 0.38, P < 0.05), chronic gastritis (OR = 0.26, P < 0.01), and cold sore (OR = 0.33, P < 0.01) were less preferred than stage 2 caries. Chronic gastritis (OR = 0.42,P < 0.05) was less preferred than stage 4 caries. CONCLUSIONS: Parents viewed the characteristics of many diseases with similar QALYs differently. Findings suggest that otitis media and its QALY-as commonly used in CUAs-may be a suitable proxy disease and substitute. However, other disease states with slightly different QALYs may be suitable. As such, the recommendation is to consider a range of proxy diseases and their QALYs when conducting a CUA for child caries interventions. KNOWLEDGE TRANSFER STATEMENT: This study reviews and systematically compares pediatric diseases that are comparable to caries in primary dentition. The findings may inform future research using cost-utility analysis to examine the incremental cost-effectiveness ratio of interventions to prevent and treat caries as compared with an alternative.

A deep learning approach to the automatic detection of alignment errors in cryo-electron tomographic reconstructions.

Electron tomography is an imaging technique that allows for the elucidation of three-dimensional structural information of biological specimens in a very general context, including cellular in situ observations. The approach starts by collecting a set of images at different projection directions by tilting the specimen stage inside the microscope. Therefore, a crucial preliminary step is to precisely define the acquisition geometry by aligning all the tilt images to a common reference. Errors introduced in this step will lead to the appearance of artifacts in the tomographic reconstruction, rendering them unsuitable for the sample study. Focusing on fiducial-based acquisition strategies, this work proposes a deep-learning algorithm to detect misalignment artifacts in tomographic reconstructions by analyzing the characteristics of these fiducial markers in the tomogram. In addition, we propose an algorithm designed to detect fiducial markers in the tomogram with which to feed the classification algorithm in case the alignment algorithm does not provide the location of the markers. This open-source software is available as part of the Xmipp software package inside of the Scipion framework, and also through the command-line in the standalone version of Xmipp.

Spatial aggregation patterns in four mistletoe species: ecological and environmental determinants.

Plant spatial distribution is an important topic in ecology as it determines species coexistence and biodiversity dynamics. Usually, plants show clustered distributions in nature. Mistletoes are a good example of aggregated distributions, as they form dense aggregations due to several factors (availability of competent hosts, seed dispersal vectors, microclimate conditions). We analysed four native mistletoe species with divergent life histories and host ranges: Desmaria mutabilis and Tristerix corymbosus from the temperate rainforests of southern Chile; and Tristerix aphyllus and Tristerix verticillatus from the northern semi-desert zone. While T. corymbosus and T. verticillatus have a wide host range, T. aphyllus and D. mutabilis are specialists that can parasitize only a few plant species. We hypothesized that specialized species would be more aggregated due to ecological and environmental restrictions. We used heterogeneous Poisson models to quantify spatial aggregation. Three of the four mistletoe species were spatially clustered at both environments, with aggregation being stronger in the temperate rainforest of southern Chile and particularly in the host-specialist species. Our results suggest that environmental constraints are more important than ecological constraints (host range) in shaping mistletoe spatial structure. Mistletoe aggregated spatial distribution depends primarily on the environment that they inhabit, which conditions host spatial availability, and arrangement.

Thermal Performance of Multifunctional Facade Solution Containing Phase Change Materials: Experimental and Numerical Analysis.

This work focuses on the development and analysis of a new multifunctional facade panel incorporating PCM in foam layers. The thermal performance was analysed recurring to a hotbox heat flux meter method to determine the thermal transmittance (U-value) and the main findings are presented. The experimental setup was based on the steady-state approach, using climatic chambers, assuring a stable thermal environment. Even small fractions of PCM achieved a small reduction in thermal amplitude. Numerical simulations using Ansys Fluent were developed to evaluate the performance of PCM use over a wide range of temperature boundary conditions and operating modes. These numerical models were calibrated and validated using the results of experimental tests, achieving a correlation factor of 0.9674, and, thus, accurately representing a real-world scenario. The decrement factor (f) was used to analyse the data. It was identified that the efficiency of the panel and size of the optimum region increased with the PCM fraction growth. The results showed the significant potential of the multi-layered panel, with the thermal regulator effect of the PCM incorporated, on indoor space temperature so as to reach good thermal comfort levels. The efficiency of the panel can be improved by nearly 50% depending on the input boundary conditions. The efficiency of the panel and the size of the optimum region increase with growth in the PCM fraction. The simulated behaviour was at an optimum when the input mean temperature was 20 °C for a room temperature of between 18-20 °C.

Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables.

OBJECTIVE: To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS: This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS: A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION: Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.

Retirada difícil de filtro de vena cava inferior (FVCI). Consideraciones técnicas y variables asociadas / Difficult withdrawal of an inferior vena cava filter: technical considerations and associated variables

Objetivo: Analizar la eficacia del procedimiento de retirada de los filtros de la vena cava inferior (FVCI), así como los factores clínico-radiológicos asociados a una retirada difícil. Material y método: Estudio retrospectivo, observacional y unicéntrico de pacientes tratados mediante retirada de FVCI entre mayo del 2015 y mayo del 2021. Se recogieron variables clínico-demográficas, del procedimiento y radiológicas: tipo de FVCI, angulación respecto a la vena cava inferior (VCI) >15°, gancho contra la pared y patas del dispositivo incrustadas en la pared de VCI> 3mm. Las variables de eficacia fueron: tiempo de fluoroscopia, éxito en la retirada del FVCI y número de intentos hasta la retirada. Como variables de seguridad: presencia de complicaciones, retirada quirúrgica y mortalidad. La variable principal fue la retirada difícil, definida como más de 5min de fluoroscopia o más de un intento de retirada. Resultados: Se incluyó a 109 pacientes, 54 (49,5%) fueron considerados retirada difícil. Las variables radiológicas gancho contra la pared (33,3% vs. 9,1%; p=0,027), patas incrustadas (20,4% vs. 3,6%; p=0,008) y> 45 días desde la colocación (51,9% vs. 25,5%; p=0,006) fueron significativamente más frecuentes en el grupo de retirada difícil. Estas variables mantienen la asociación al analizar los FVCI Optease®. En los FVCI Celect® solo se asoció con retirada difícil la inclinación del FVCI> 15° (25% vs. 0%; p=0,029).Conclusión: Se ha encontrado asociación entre una retirada difícil y las siguientes variables: tiempo desde colocación del FVCI, patas incrustadas y contacto del gancho con la pared de VCI. Al analizar según el tipo de FVCI, estas variables se mantienen en el tipo Optease®, en cambio, la inclinación de más de 15° dificulta la retirada de los dispositivos de morfología cónica (Celect®).(AU)

Objective: To analyze the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. Material and methods: This retrospective observational study included patients who underwent IVC filter withdrawal at a single center between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC> 15°, hook against the wall, and legs embedded in the IVC wall> 3mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5minutes fluoroscopy or more than 1 attempt at withdrawal. Results: A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p=0.027), embedded legs (20.4% vs. 3.6%; p=0.008), and>45 days since IVC filter placement (51.9% vs. 25.5%; p=0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter>15° was significantly associated with difficult withdrawal (25% vs 0%; p=0.029). Conclusion: Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter>15° was significantly associated with difficult withdrawal.(AU)

Differential effects of high dose omega-3 fatty acids on metabolism and inflammation in patients with obesity: eicosapentaenoic and docosahexaenoic acid supplementation.

Background: Obesity is complicated by low-grade chronic inflammation characterised by increases in inflammatory proteins and cells in peripheral blood. It has been known that omega-3 fatty acids (FA) like eicosapentaenoic (EPA) and docosahexaenoic (DHA) could modulate the inflammatory process and improve metabolic markers. Objective: This study aimed to determine the effect of high-dose omega-3 FA on metabolic and inflammatory markers among patients with obesity and healthy volunteers. Methods: This prospective study included 12 women with obesity (body mass index [BMI] ≥ 35.0 kg/m2) and 12 healthy women (BMI < 24.0 kg/m2) who were supplemented with a dose of 4.8 g/day (3.2 g EPA plus 1.6 g DHA) for 3 months followed by no treatment for 1 month. Plasma metabolic and inflammatory markers and levels of mRNA transcripts of CD4+ T lymphocyte subsets were determined monthly. Results: None of the participants exhibited changes in weight or body composition after study completion. EPA and DHA supplementation improved metabolic (insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], triglyceride [TG]/ high-density lipoprotein [HDL] ratio, TG, and arachidonic acid [AA]/EPA ratio) and tumor necrosis factor-alpha (TNF-α). Moreover, the levels of mRNA transcripts of T CD4+ lymphocyte subsets (TBX21, IFNG, GATA-3, interleukin [IL]-4, FOXP3, IL-10 IL-6, and TNF-α), were down-regulated during the intervention phase. After 1 month without supplementation, only insulin, HOMA-IR and the mRNA transcripts remained low, whereas all other markers returned to their levels before supplementation. Conclusion: Supplementation with high-dose omega-3 FAs could modulate metabolism and inflammation in patients with obesity without weight loss or changes in body composition. However, these modulatory effects were ephemeral and with clear differential effects: short-duration on metabolism and long-lasting on inflammation.

Effect of COVID-19 pandemic on utilisation of community-based mental health care in North-East of Italy: A psychiatric case register study.

AIMS: WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services' utilisation, by considering psychiatric diagnoses and type of mental health contacts. METHODS: The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A 'difference in differences' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated. RESULTS: In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions. CONCLUSIONS: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

Técnicas de radiología intervencionista para el manejo del sangrado uterino anormal (SUA) / Interventional radiology techniques for the management of abnormal uterine bleeding (AUB)

El sangrado uterino anormal (SUA) es una de las patologías ginecológicas más comunes en mujeres en edad reproductiva. El sistema de clasificación de la Federación Internacional de Ginecología y Obstetricia (PALM-COEIN) armoniza las definiciones de los síntomas de hemorragia normal y anormal y clasifica las posibles causas subyacentes en causas estructurales y no estructurales. El objetivo de este manuscrito es revisar el diagnóstico radiológico de cada una de las causas estructurales de sangrado uterino anormal, examinar las indicaciones de las técnicas de radiología vascular intervencionista en el manejo del SUA y conocer el procedimiento de embolización de arterias uterinas, así como sus posibles complicaciones y contraindicaciones.(AU)

Abnormal uterine bleeding is one of the most common gynaecological pathologies in women of reproductive age. The classification system of the International Federation of Gynaecology and Obstetrics (PALM-COEIN) harmonizes the definitions of normal and abnormal bleeding symptoms and classifies possible underlying causes as structural and non-structural. The aim of this manuscript is to review the radiological diagnosis of each of the structural causes of abnormal uterine bleeding, to examine the indications for interventional vascular radiology techniques in the treatment of abnormal uterine bleeding, and to learn about the uterine artery embolization procedure, as well as its possible complications and contraindications.(AU)

Difficulty with Oral Health Complications in Adolescents with Developmental Disability and Obesity.

INTRODUCTION: Developmental disabilities (DDs), obesity, and dental caries are highly prevalent health conditions among adolescents. Evidence indicates that a significant proportion of adolescents with DDs are obese, and those with obesity and dental caries share common risk factors. OBJECTIVE: In this first-ever US-based cross-sectional national study, we assessed the likelihood of adolescents with DDs and obesity experiencing chronic difficulty with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition among adolescents with DDs and obesity compared to adolescents with no DDs or obesity. METHODS: For this secondary data analysis study, we used data of 68,942 adolescents aged 10 to 17 y from the 2016 through 2019 National Survey of Children's Health. Weighted descriptive and bivariate analyses were conducted. Four multiple logistic regression models predicting chronic difficulty in the past 12 mo with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition were conducted, controlling for other variables. RESULTS: The adjusted odds ratio (aOR) of experiencing chronic difficulty in the past 12 mo for adolescents with no DDs or obesity was significantly lower for decayed teeth (aOR, 0.64; 95% confidence interval [CI], 0.51-0.80; P < 0.0001), toothaches (aOR, 0.43; 95% CI, 0.30-0.60; P < 0.0001), bleeding gums (aOR, 0.48; 95% CI, 0.33-0.70; P < 0.0001), and eating or swallowing due to a health condition (aOR, 0.34; 95% CI, 0.20-0.57; P < 0.0001) compared to adolescents with both DDs and obesity. CONCLUSIONS: Results from this study indicate that DD adolescents with obesity have more/greater impending oral health needs than adolescents with no DDs or obesity. KNOWLEDGE TRANSFER STATEMENT: Results of this study highlight the high oral health needs and the chronic difficulty adolescents with developmental disabilities and obesity experience compared to adolescents without developmental disabilities and obesity. Targeted oral health policies and interventions that will promote oral health among this high-risk group are recommended.

Oral Diseases and Oral Health-Related Quality of Life among Kenyan Children and Adolescents with HIV.

INTRODUCTION: Children and adolescents living with HIV (CALHIV) have a higher risk of hard and soft oral tissue diseases as compared with their healthy peers. It is important to increase awareness regarding the need to integrate oral health within medical care among pediatric HIV populations. Studies on associations of oral diseases with oral health-related quality of life (OHRQoL) in CALHIV are lacking. This study examined the association between oral diseases and OHRQoL in Kenyan CALHIV. METHODS: This cross-sectional analysis was nested in a longitudinal cohort study of CALHIV in Nairobi. CALHIV received oral examinations, and the World Health Organization's Oral Health Surveys and Record Form was administered. OHRQoL was measured with the Parental-Caregiver Perceptions Questionnaire, with the subdomains of global, oral symptoms, function limitations, and emotional and social well-being, with higher scores indicating poorer OHRQoL. Linear regression was used to model associations between OHRQoL and oral diseases, adjusting for age at the time of oral examination, CD4 counts, and caregiver's education. RESULTS: Among 71 CALHIV, the mean age was 12.6 y (SD, 2.9; range, 10 to <21), and the mean composite OHRQoL score was 12.6 (SD, 11.2). Ulcers (not herpes simplex virus or aphthous) were associated with the worst overall OHRQoL (mean, 21.8; SD, 11.1; P = 0.055) and oral symptoms subdomain (mean, 7.0, SD, 2.5; P = 0.003). Children with dry mouth and untreated caries had significantly higher mean global OHRQoL scores than those without disease (P < 0.0001). In the multivariate analysis, the OHRQoL composite score was 6.3 units (95% CI, -0.3 to 12.9) higher for those who had dry mouth and untreated dental caries; dry mouth accounted for the highest percentage of variability of OHRQoL (9.6%) and the global subdomain (31.9%). Ulcers accounted for the highest percentage of variability of the oral symptoms domain (15.4%). CONCLUSIONS: Oral ulcers, dry mouth, and untreated caries were associated with poorer OHRQoL in CALHIV. Integrating oral health into the primary care of CALHIV may improve their OHRQoL. KNOWLEDGE TRANSFER STATEMENT: This study aimed to determine the association of oral diseases with the oral health-related quality of life of children and adolescents living with HIV (CALHIV). The findings will form part of the evidence to incorporate oral health protocols into care programs for CALHIV. Oral health monitoring has the potential to increase the surveillance of HIV clinical status, monitor the effectiveness of antiretroviral therapy, and improve the oral health-related quality of life of CALHIV.

[Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]. / Factores asociados a la insatisfacción con el tratamiento farmacológico en pacientes con diabetes mellitus tipo 2: estudio transversal.

BACKGROUND AND OBJECTIVES: Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables. MATERIALS AND METHODS: This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted. RESULTS: Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]). CONCLUSIONS: Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.

Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique.

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA "C", tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

[Analysis of accidental falls and the integration in the chronicity programs of patients with amyotrophic lateral sclerosis]. / Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease. There is no curative treatment available, and these patients require multidisciplinary support to promote their comfort and quality of life. PATIENTS AND METHODS: Longitudinal descriptive study in patients registered in primary care (PC), Costa de Ponent-Barcelona Institut Catala de la Salut to analyse emergency hospital visits, use of support devices and their integration into the primary care chronicity program. Variables were sex, age and evolution time, emergency visits, patients with percutaneous gastrostomy (PEG), non-invasive or invasive ventilation (NIV/VI), integration in the primary care chronicity program. RESULTS: 81 patients, 49.4% male, mean age 65.6 years (±11.7), evolution time less than 2 years or equal to or greater than 2 years (42 and 58%, respectively). Of them, 47 (58.5%) made 107 consultations. The most frequent reasons for consultation were falls (26.8%), respiratory difficulties (23.3%), comorbidity (16.7%), eating problems (11%) and pain (10.2%) without differences by age or sex. Greater frequency (p < 0.001) was observed in patients with less than two years of evolution and significant increases in the use of NIV and PEG up to 51.9 and 35.8% respectively, as well as integration in primary care chronicity program of 61.7%. CONCLUSIONS: Accidental falls were the most frequent and potentially avoidable reason for hospital emergency visits in patients with ALS, especially in the first two years of the disease. Significant increases are detected in the use of support devices and in primary care chronicity program integration. It is necessary to increase home resources, especially in physiotherapy and occupational therapy.

TITLE: Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.Introducción. La esclerosis lateral amiotrófica (ELA) es la enfermedad degenerativa de las motoneuronas más frecuente. No dispone de tratamiento curativo y estos pacientes requieren un soporte multidisciplinar para favorecer su confort y calidad de vida. Pacientes y métodos. Estudio descriptivo longitudinal en pacientes registrados en atención primaria, Costa de Ponent-Barcelona, Institut Català de la Salut, para analizar las visitas urgentes hospitalarias, la utilización de dispositivos de soporte y su integración en el programa de atención a la cronicidad. Las variables fueron sexo, edad y tiempo de evolución, visitas urgentes, portadores de gastrostomía percutánea (PEG), ventilación no invasiva o invasiva (VNI/VI) e integración en el programa de atención a la cronicidad. Resultados. Se incluyó a 81 pacientes, un 49,4% varones, con una edad media de 65,6 años (±11,7), y un tiempo de evolución menor de 2 años o igual o mayor de 2 años (42 y 58%, respectivamente). De ellos, 47 (58,5%) realizaron 107 consultas. Los motivos de consulta más frecuentes fueron: caídas (26,8%), dificultades respiratorias (23,3%), comorbilidad (16,7%), problemas en la alimentación (11%) y dolor (10,2%), sin diferencias por edad o sexo. Se observó una mayor frecuentación (p menor de 0,001) en pacientes con menos de dos años de evolución e incrementos significativos en la utilización de la VNI y la PEG hasta el 51,9 y el 35,8%, respectivamente, así como integración en el programa de atención a la cronicidad del 61,7%. Conclusiones. El motivo más frecuente de consulta a urgencias hospitalarias de pacientes con ELA y potencialmente evitable fueron las caídas accidentales, especialmente en los primeros dos años de enfermedad. Se detectan incrementos significativos en la utilización de dispositivos de soporte y en la integración en el programa de atención a la cronicidad. Es necesario incrementar los recursos domiciliarios, especialmente en fisioterapia y terapia ocupacional.

Plastic energy allocation toward life-history functions in a consumer-resource interaction : Analyzing the temporal patterns of the consumer-resource dynamics.

Various environmental alterations resulting from the current global change compromise the persistence of species in their habitual environment. To cope with the obvious risk of extinction, plastic responses provide organisms with rapid acclimatization to new environments. The premise of plastic rescue has been theoretically studied from mathematical models in both deterministic and stochastic environments, focusing on analyzing the persistence and stability of the populations. Here, we evaluate this premise in the framework of a consumer-resource interaction considering the energy investment towards reproduction vs. maintenance as a plastic trait according to positive/negative variation of the available resource. A basic consumer-resource mathematical model is formulated based on the principle of biomass conversion that incorporates the energy allocation toward vital functions of the life-cycle of consumer individuals. Our mathematical approach is based on the impulsive differential equations at fixed moments considering two impulsive effects associated with the instants at which consumers obtain environmental information and when energy allocation strategy change occurs. From a preliminary analysis of the non-plastic temporal dynamics, namely when the energy allocation is constant over time and without experiencing changes concerning the variation of resources, both the persistence and stability of the consumer-resource dynamic are dependent on the energy allocation strategies belonging to a set termed stability range. We found that the plastic energy allocation can promote a stable dynamical pattern in the consumer-resource interaction depending on both the magnitude of the energy allocation change and the time lag between environmental sensibility instants and when the expression of the plastic trait occurs.

Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica / Analysis of accidental falls and the integration in the chronicity programs of patients with amyotrophic lateral sclerosis

Introducción: La esclerosis lateral amiotrófica (ELA) es la enfermedad degenerativa de las motoneuronas más frecuente. No dispone de tratamiento curativo y estos pacientes requieren un soporte multidisciplinar para favorecer su confort y calidad de vida. Pacientes y métodos: Estudio descriptivo longitudinal en pacientes registrados en atención primaria, Costa de Ponent-Barcelona, Institut Català de la Salut, para analizar las visitas urgentes hospitalarias, la utilización de dispositivos de soporte y su integración en el programa de atención a la cronicidad. Las variables fueron sexo, edad y tiempo de evolución, visitas urgentes, portadores de gastrostomía percutánea (PEG), ventilación no invasiva o invasiva (VNI/VI) e integración en el programa de atención a la cronicidad. Resultados: Se incluyó a 81 pacientes, un 49,4% varones, con una edad media de 65,6 años (±11,7), y un tiempo de evolución menor de 2 años o igual o mayor de 2 años (42 y 58%, respectivamente). De ellos, 47 (58,5%) realizaron 107 consultas. Los motivos de consulta más frecuentes fueron: caídas (26,8%), dificultades respiratorias (23,3%), comorbilidad (16,7%), problemas en la alimentación (11%) y dolor (10,2%), sin diferencias por edad o sexo. Se observó una mayor frecuentación (p < 0,001) en pacientes con menos de dos años de evolución e incrementos significativos en la utilización de la VNI y la PEG hasta el 51,9 y el 35,8%, respectivamente, así como integración en el programa de atención a la cronicidad del 61,7%. Conclusiones: El motivo más frecuente de consulta a urgencias hospitalarias de pacientes con ELA y potencialmente evitable fueron las caídas accidentales, especialmente en los primeros dos años de enfermedad. Se detectan incrementos significativos en la utilización de dispositivos de soporte y en la integración en el programa de atención a la cronicidad. Es necesario incrementar los recursos domiciliarios, especialmente en fisioterapia y terapia ocupacional.(AU)

Introduction: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease. There is no curative treatment available, and these patients require multidisciplinary support to promote their comfort and quality of life. Patients and methods: Longitudinal descriptive study in patients registered in primary care (PC), Costa de Ponent-Barcelona Institut Català de la Salut to analyse emergency hospital visits, use of support devices and their integration into the primary care chronicity program. Variables were sex, age and evolution time, emergency visits, patients with percutaneous gastrostomy (PEG), non-invasive or invasive ventilation (NIV/VI), integration in the primary care chronicity program. Results: 81 patients, 49.4% male, mean age 65.6 years (±11.7), evolution time less than 2 years or equal to or greater than 2 years (42 and 58%, respectively). Of them, 47 (58.5%) made 107 consultations. The most frequent reasons for consultation were falls (26.8%), respiratory difficulties (23.3%), comorbidity (16.7%), eating problems (11%) and pain (10.2%) without differences by age or sex. Greater frequency (p < 0.001) was observed in patients with less than two years of evolution and significant increases in the use of NIV and PEG up to 51.9 and 35.8% respectively, as well as integration in primary care chronicity program of 61.7%. Conclusions: Accidental falls were the most frequent and potentially avoidable reason for hospital emergency visits in patients with ALS, especially in the first two years of the disease. Significant increases are detected in the use of support devices and in primary care chronicity program integration. It is necessary to increase home resources, especially in physiotherapy and occupational therapy.(AU)

Evaluación de un cuestionario de conocimientos en insuficiencia cardíaca y su utilidad para guiar la intervención educativa / Evaluation of a heart failure knowledge questionnaire and its use in guiding the educational intervention

ntroducción y objetivo: La educación por enfermería es una pieza clave en todo programa de insuficiencia cardíaca (IC), pero existen modelos muy heterogéneos y faltan instrumentos de medida. Nuestro objetivo ha sido evaluar un cuestionario propio y su utilidad como guía de la educación.Métodos: Estudio de cohortes prospectivo de pacientes tras el diagnóstico de IC seguidos en una unidad especializada. El grupo expuesto recibió sesiones educativas guiadas por evaluación del conocimiento mediante el cuestionario, y se comparó con un grupo con educación estándar. Se evaluó la validez y la fiabilidad del cuestionario. La utilidad del modelo educativo se determinó por la variable combinada principal de muerte y/o ingreso hospitalario o atención en urgencias por IC.Resultados: Se incluyeron 152 pacientes, 88 con educación guiada y 64 estándar, con un seguimiento medio de 16±4 meses. En el grupo guiado, la puntuación del cuestionario de evaluación (pc) subió del 59 al 78,5% (p=0,018) y se asoció con un mayor autocuidado (28,5-0,6*pc; p=0,04) y una tendencia a mejor calidad de vida (51,1-1,1*pc; p=0,09) y adherencia (5,02+0,04*pc; p=0,06), con una fiabilidad aceptable (Alfa de Cronbach: 0,75). La variable combinada principal ocurrió en 12 pacientes (13,6%) con educación guiada frente a 19 (29,7%) con la estándar (hazard ratio: 0,46; intervalo de confianza del 95%: 0,24-0,88; p=0,019), aunque en el análisis multivariante, solo fueron predictores: el nivel educativo, la edad, NT-proBNP y la fibrilación auricular.Conclusión: El cuestionario de conocimientos en IC propuesto es una herramienta válida y fiable, y permite cuantificar el aprendizaje. Su utilidad para guiar la educación precisa de cierta habilidad del paciente que determina un grupo con mejor pronóstico. (AU)

Introduction and objective: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention.Methods: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF.Results: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (P=0.018), which was associated with greater self-care (28.5-0.6*qs, P=0.04), a tendency toward better quality of life (51.1-1.1*qs, P=0.09), and adherence (5.02+0.04*qs, P=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; P=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis.Conclusion: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis. (AU)