[Recommendations for Primary Health Care for transgender people]. / Recomendaciones para la atención de la salud en Atención Primaria de las personas transgénero.

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

Psychometric properties of the Eating Attitudes Test-26 in Spanish schoolchildren.

INTRODUCTION: Disordered Eating Attitudes and Behaviours (DEABs) can impact both the mental and physical health of children. Early detection is crucial to prevent complications and improve outcomes. The Eating Attitudes Test-26 (EAT-26) is a widely used, cost-effective tool for assessing DEABs. OBJECTIVE: To evaluate the psychometric properties of the EAT-26 by analysing its factor structure, internal consistency, convergent validity, and measurement invariance across sexes in Spanish schoolchildren. METHOD: Validation study in a sample of 718 schoolchildren. The sample was randomly divided into 2 groups, each with 359 participants, and we carried out an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) of the instrument. Subsequently, we assessed the internal consistency by means of the ordinal alpha, the convergent validity with the SCOFF questionnaire and the measurement invariance across the sexes. RESULTS: The results of the EFA and CFA supported a multidimensional structure of the EAT comprising 6 factors and 21 items. These factors underlie a second-order model of DEABs. The internal consistency was adequate for most factors. The SCOFF questionnaire showed a moderate convergent validity for most of the EAT-21 factors. We found measurement invariance across the sexes. CONCLUSIONS: The abbreviated EAT-21 scale exhibited modest and promising psychometric properties, making it a suitable instrument for assessing DEABs in both sexes in educational settings.

[Management of chronic non-oncologic pain by multicomponent programs using non-pharmacologic therapies: A systematic review of the literature]. / Manejo del dolor crónico no oncológico con programas multicomponentes de terapias no farmacológicas: revisión sistemática de la literatura.

Chronic pain is a public health problem suffered by 20% of the world's population. Pharmacological approaches are insufficient, so a multi-therapeutic approach that also includes non-pharmacological therapies (psychological therapies, meditation, physical exercise, healthy habits, etc.) is proposed. The aim of this review was to review the existing scientific evidence on the effect of multicomponent programs with non-pharmacological therapies in people with chronic non-oncologic pain. To this end, a search for scientific articles was carried out in three databases (PubMed, Web of Science and PsycINFO) and 17 articles were selected, following the PRISMA recommendations. The patients who participated in these programs were mostly women, aged 18 to 80years, working or on sick leave due to pain, with secondary education or less and married. The most frequent pain was musculoskeletal, mainly low back pain. All the articles studied the effectiveness of two or more therapies, highlighting psychological therapies, physical exercise and education. Positive results were obtained in the reduction of different variables such as pain, pain catastrophizing, anxiety and depression, in addition to improving functionality and quality of life. It has also been shown that patients' prior expectations regarding the intervention influence its effectiveness. Although throughout the review there was great heterogeneity in the interventions, in the evaluation methods and in the results themselves, it can be concluded that multicomponent programs show positive results in the management of chronic pain, and should therefore be incorporated as a routine therapeutic treatment.

Teoría de la mente en trastornos del neurodesarrollo: más allá del trastorno del espectro autista / Theory of mind in neurodevelopmental disorders: Beyond autistic spectrum disorder

Introducción La teoría de la mente (ToM) es la capacidad humana de percibir, interpretar y atribuir los estados mentales de las otras personas y la alteración de esta función cognitiva es un síntoma nuclear del trastorno del espectro autista (TEA). Hay otros trastornos del neurodesarrollo como el trastorno obsesivo-compulsivo de inicio en la infancia (TOC) y el síndrome de Tourette (ST), que pueden presentarse con disfunciones cognitivas, y en los que la ToM ha sido menos estudiada, especialmente en población juvenil. El objetivo de este estudio fue comparar la ToM avanzada entre grupos de jóvenes con diagnóstico de TOC, ST o TEA y un grupo de controles sanos. Métodos Se entrevistaron clínicamente a varones de entre 11 y 17 años con diagnóstico principal de TOC (n = 19), ST (n = 14), TEA (n = 18), y un grupo control de sujetos sanos (n = 20). Se les administró instrumentos de estimación de cociente intelectual, severidad de los síntomas psiquiátricos y las pruebas para evaluar la ToM: la tarea Historias de la vida cotidiana y el Test de la mirada. Resultados Los jóvenes con ST presentan dificultades similares para resolver tareas de ToM avanzada al nivel de los pacientes con TEA, a diferencia de los pacientes con TOC de inicio en la infancia que presentan resultados similares a los controles sanos. Conclusiones La ToM está alterada en otros trastornos del neurodesarrollo más allá del TEA, como en el ST. (AU)

Introduction Theory of mind (ToM) is the human ability to perceive, interpret, and attribute the mental states of other people, and the alteration of this cognitive function is a core symptom of autistic spectrum disorder (ASD). In such other neurodevelopmental disorders as childhood-onset obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) that can present with cognitive dysfunctions, ToM has been less extensively studied, especially in the young population. The aim of the study was to compare advanced ToM between groups of young people diagnosed with OCD, TS, or ASD and a control group. Methods Clinical interviews were conducted with male patients aged between 11 and 17 years with a main diagnosis of OCD (n = 19), TS (n = 14), or ASD (n = 18), and a control group (n = 20). We administered instruments for estimating intelligence quotient and severity of psychiatric symptoms, and tasks to evaluate ToM (the “Stories from everyday life” task and the “Reading the mind in the eyes” test). Results Young people with TS and with ASD present similar difficulties in solving advanced ToM tasks, whereas patients with childhood-onset OCD present similar results to controls. Conclusions ToM is altered in other neurodevelopmental disorders beyond ASD, such as TS. (AU)

Riding the waves from epidemic to endemic: Viral mutations, immunological change and policy responses.

Nonpharmaceutical interventions (NPI) are an important tool for countering pandemics such as COVID-19. Some are cheap; others disrupt economic, educational, and social activity. The latter force governments to balance the health benefits of reduced infection and death against broader lockdown-induced societal costs. A literature has developed modeling how to optimally adjust lockdown intensity as an epidemic evolves. This paper extends that literature by augmenting the classic SIR model with additional states and flows capturing decay over time in vaccine-conferred immunity, the possibility that mutations create variants that erode immunity, and that protection against infection erodes faster than protecting against severe illness. As in past models, we find that small changes in parameter values can tip the optimal response between very different solutions, but the extensions considered here create new types of solutions. In some instances, it can be optimal to incur perpetual epidemic waves even if the uncontrolled infection prevalence would settle down to a stable intermediate level.

Demonstrating the reliability of in vivo metabolomics based chemical grouping: towards best practice.

While grouping/read-across is widely used to fill data gaps, chemical registration dossiers are often rejected due to weak category justifications based on structural similarity only. Metabolomics provides a route to robust chemical categories via evidence of shared molecular effects across source and target substances. To gain international acceptance, this approach must demonstrate high reliability, and best-practice guidance is required. The MetAbolomics ring Trial for CHemical groupING (MATCHING), comprising six industrial, government and academic ring-trial partners, evaluated inter-laboratory reproducibility and worked towards best-practice. An independent team selected eight substances (WY-14643, 4-chloro-3-nitroaniline, 17α-methyl-testosterone, trenbolone, aniline, dichlorprop-p, 2-chloroaniline, fenofibrate); ring-trial partners were blinded to their identities and modes-of-action. Plasma samples were derived from 28-day rat tests (two doses per substance), aliquoted, and distributed to partners. Each partner applied their preferred liquid chromatography-mass spectrometry (LC-MS) metabolomics workflows to acquire, process, quality assess, statistically analyze and report their grouping results to the European Chemicals Agency, to ensure the blinding conditions of the ring trial. Five of six partners, whose metabolomics datasets passed quality control, correctly identified the grouping of eight test substances into three categories, for both male and female rats. Strikingly, this was achieved even though a range of metabolomics approaches were used. Through assessing intrastudy quality-control samples, the sixth partner observed high technical variation and was unable to group the substances. By comparing workflows, we conclude that some heterogeneity in metabolomics methods is not detrimental to consistent grouping, and that assessing data quality prior to grouping is essential. We recommend development of international guidance for quality-control acceptance criteria. This study demonstrates the reliability of metabolomics for chemical grouping and works towards best-practice.

Theory of mind in neurodevelopmental disorders: beyond autistic spectrum disorder.

INTRODUCTION: Theory of mind (ToM) is the human ability to perceive, interpret, and attribute the mental states of other people, and the alteration of this cognitive function is a core symptom of autistic spectrum disorder (ASD). In such other neurodevelopmental disorders as childhood-onset obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) that can present with cognitive dysfunctions, ToM has been less extensively studied, especially in the young population. The aim of the study was to compare advanced ToM between groups of young people diagnosed with OCD, TS, or ASD and a control group. METHODS: Clinical interviews were conducted with male patients aged between 11 and 17 years with a main diagnosis of OCD (n = 19), TS (n = 14), or ASD (n = 18), and a control group (n = 20). We administered instruments for estimating intelligence quotient and severity of psychiatric symptoms, and tasks to evaluate ToM (the "Stories from everyday life" task and the "Reading the mind in the eyes" test). RESULTS: Young people with TS and with ASD present similar difficulties in solving advanced ToM tasks, whereas patients with childhood-onset OCD present similar results to controls. CONCLUSIONS: ToM is altered in other neurodevelopmental disorders beyond ASD, such as TS.

Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up.

INTRODUCTION: The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM: The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS: Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS: The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS: There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Cost-effective fibrinolytic enzyme production by microalga Dunaliella tertiolecta using medium supplemented with corn steep liquor.

A fibrinolytic enzyme from the microalga Dunaliella tertiolecta was produced under mixotrophic conditions using different corn steep liquor (CSL) concentrations ( 0 ≤ CLS ≤ 0.75%), purified using a combination of salting out and ion-exchange chromatography, and then biochemical characterized. Cultivation of this microalga using 0.5% CSL led to the highest maximum cell concentration (1.960±0.010 mg L-1) and cell productivity (0.140g L-1 day-1), besides a high fibrinolytic activity of the extract obtained by the homogenization method (102 ±1 U mL-1). The enzyme extracted from the microalgal biomass was 5-fold purified with a 20% yield and was found to have a specific activity of 670 U mg-1. The enzyme, whose molecular weight determined by fibrin zymography was 10 kDa, was shown to be stable at pH 3.0-9.0 and up to 70°C with optimal pH and temperature values of 8.0 and 50°C, respectively. When compared to other fibrinolytic enzymes, this protease stood out for its high fibrinolytic activity, which was enhanced by Fe2+, inhibited by Zn2+, Cu2+, Mg2+, and Ca2+, and strongly inhibited by phenylmethylsulfonyl fluoride, suggesting that it belongs to the serine metalloprotease family. Moreover, thanks to its thermal stability, the enzyme may be easily preserved and activated under high-temperature conditions.

Assessing the potential impact of applying a higher sensitivity test to selected cattle populations for the control of bovine tuberculosis in England.

Bovine tuberculosis (bTB) continues to be the costliest, most complex animal health problem in England. The effectiveness of the test-and-slaughter policy is hampered by the imperfect sensitivity of the surveillance tests. Up to half of recurrent incidents within 24 months of a previous one could have been due to undetected infected cattle not being removed. Improving diagnostic testing with more sensitive tests, like the interferon (IFN)-gamma test, is one of the government's top priorities. However, blanket deployment of such tests could result in more false positive results (due to imperfect specificity), together with logistical and cost-efficiency challenges. A targeted application of such tests in higher prevalence scenarios, such as a subpopulation of high-risk herds, could mitigate against these challenges. We developed classification machine learning algorithms (using 80% of 2012-2019 bTB surveillance data as the training set) to evaluate the deployment of IFN-gamma testing in high-risk herds (i.e. those at risk of an incident in England) in two testing data sets: i) the remaining 20% of 2012-19 data, and ii) 2020 bTB surveillance data. The resulting model, classification tree analysis, with an area under a receiver operating characteristic (ROC) curve (AUC) > 95, showed a 73% sensitivity and a 97% specificity in the 2012-2019 test dataset. Used on 2020 data, it predicted eight percent (3 510 of 41 493) of eligible active herds as at-risk of a bTB incident, the majority of them (66% or 2 328 herds) experiencing at least one. Whilst all predicted at-risk herds could have preventive measures applied, the additional application of IFN-gamma test in parallel interpretation to the statutory skin test, if the risk materialises, would have resulted in 8 585 additional IFN-gamma reactors detected (a 217% increase over the 2 710 IFN-gamma reactors already detected by tests carried out). Only 18% (330 of 1 819) of incidents in predicted high-risk herds had the IFN-gamma test applied in 2020. We therefore conclude that this methodology provides a better way of directing the application of the IFN-gamma test towards the high-risk subgroup of herds. Classification tree analysis ensured the systematic identification of high-risk herds to consistently apply additional measures in a targeted way. This could increase the detection of infected cattle more efficiently, preventing recurrence and accelerating efforts to achieve eradication by 2038. This methodology has wider application, like targeting improved biosecurity measures in avian influenza at-risk farms to limit damage to the industry in future outbreaks.

In vivo sensitization to gliadin by oral administration.

Celiac disease is a highly prevalent immune-mediated enteropathy that develops in genetically susceptible individuals expressing HLA-DQ2 or HLA-DQ8 after ingestion of gluten and results in decreased quality of life and increased morbidity. This pathology is triggered by immunogenic peptides generated from gliadins present in gluten, which act on the intestinal mucosa in a context of high intestinal permeability, activating the innate and adaptive response of the immune system. Several in vivo rodent models attempt to reproduce some phases of the intestinal inflammatory process that occurs in celiac disease. Allergic sensitization to gluten simulates, or enhances in some animal models, the loss of tolerance to gliadin peptides and the initial events that lead to celiac disease in a specific genetic or environmental context. Here we describe a simple method for performing gliadin sensitization in an in vivo animal model.

Cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Revisión sistemática de la literatura científica / Cytoreductive surgery in patients with oligometastatic prostate cancer. systematic review of the scientific literature

Introducción La aparición de pruebas de imagen más específicas y sensibles, junto con el empleo cada vez más extendido de técnicas mínimamente invasivas, ha centrado el interés urológico sobre el cáncer de próstata oligometastásico. A pesar de esto, aún queda por determinar el manejo óptimo de esta patología. Objetivo Evaluar la eficacia y seguridad de la cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Adquisición de la evidencia Revisión sistemática de la literatura científica (01/01/2010-31/12/2021) en las bases de datos Medline, Embase, Cochrane Library, CINAHL, Scopus, Agencias de Evaluación de Tecnologías Sanitarias y ClinicalTrials.gov. Los descriptores utilizados han sido prostatectomy, prostatic neoplasm, radical prostatectomy, y los términos de búsqueda libre prostatectomy y oligomestastasicprostate. Los criterios de inclusión fueron estudios con pacientes con cáncer de próstata oligometastásico e intervenidos mediante prostatectomía radical citorreductora (CRP). Síntesis de la evidencia La revisión sistemática incluyó cuatro estudios observacionales, dos ensayos clínicos y dos series de casos, de calidad moderada. Los resultados observados sugieren un beneficio en cuanto a eficacia en aquellos pacientes oligometastásico sometidos a una cirugía de próstata citorreductora. Por otro lado, la mayoría de estos estudios revelan una reducción en el número de las complicaciones locales cuando se compara con los mejores tratamientos sistémicos. Conclusiones La cirugía citorreductora en este grupo de pacientes, es un procedimiento seguro que reduce las complicaciones locales, que ofrece resultados prometedores en cuanto a supervivencia. Hasta la fecha, la falta de ensayos prospectivos limita el papel de esta opción terapéutica a entornos experimentales (AU)

Introduction Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. Objective Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. Evidence gathering Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastaticprostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. Evidence synthesis The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. Conclusions Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments (AU)

Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators.

AIMS: For better understanding of the impact of COVID-19 pandemic on mortality in different countries, we studied the excess mortality from any cause during 2020 and 2021 in 22 European countries, and its relationship with three socioeconomic variables: life expectancy at birth in 2019, per capita income, and low education level. METHODS: Using an ecological design, we analyzed excess mortality data between January 2020 and December 2021 in 22 European countries, obtained from the EuroMOMO surveillance system. Using weekly Z-score data for each country, we estimated the annual average deviation in mortality during 2020 and 2021 for each country. We analyzed possible relationships between the excess mortality and three independent variables: gross domestic product per capita (GDPpc) in 2020, life expectancy at birth in 2019, and proportion of the population over age 18 years with a lower than secondary education level in 2018. RESULTS: In the 22 European countries analyzed, the total number of excess deaths in 2020 and 2021 was 800,011 (11%) more than expected, with deaths among those aged 65 years and over accounting for 87.66% of these. Excess mortality was higher in 2020, especially in Spain, UK, Italy, and France. In 2021, excess mortality was highest in Hungary, the Netherlands, France, and Germany. Excess mortality during 2021 was inversely correlated with life expectancy (r =-.489, p = .021) and income level (r =-.550, p = .008). CONCLUSION: Reducing socioeconomic inequalities among countries not only improves conditions of most disadvantages but also will help to reduce excess of mortality from future pandemics.

Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos / Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists

Introducción y objetivos Los programas de telemedicina entre clínico y paciente se han desarrollado con fuerza durante la pandemia de enfermedad por COVID-19, pero no hay datos de experiencias entre clínicos. Nuestro objetivo es analizar el impacto de la pandemia por COVID-19 en la actividad y resultados en salud de un programa de consulta electrónica universal (e-consulta) para todas las derivaciones de pacientes entre médicos de atención primaria y el Servicio de Cardiología de nuestra área. Métodos Analizamos mediante regresión logística a 25.121 pacientes con al menos una e-consulta entre 2018 y 2021 realizada con el Servicio de Cardiología de nuestra área sanitaria. También se realizó el análisis de regresión logística del impacto de la pandemia por COVID-19 sobre la resolución de la e-consulta y tiempo de espera de la atención, hospitalizaciones y mortalidad, tomando como referencia las consultas realizadas durante 2018. Resultados Observamos que una menor demora en la atención y resolución de la e-consulta (sin necesidad de atención presencial) se asociaba a un mejor pronóstico. Los períodos de pandemia COVID-19 presentaron similares resultados a los del 2018. Conclusiones Los resultados de nuestro estudio muestran una significativa reducción de las derivaciones a través de e-consulta durante el primer año de la pandemia por COVID-19 con recuperación posterior de la demanda asistencial sin que los períodos de pandemia se asociasen con peores resultados en salud. La reducción del tiempo de demora de resolución de la e-consulta y el grupo sin necesidad de consulta presencial se asociaron a un mejor pronóstico (AU)

Blackground and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes (AU)

[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]. / Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos.

Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

The hammer and the jab: Are COVID-19 lockdowns and vaccinations complements or substitutes?

The COVID-19 pandemic has devastated lives and economies around the world. Initially a primary response was locking down parts of the economy to reduce social interactions and, hence, the virus' spread. After vaccines have been developed and produced in sufficient quantity, they can largely replace broad lock downs. This paper explores how lockdown policies should be varied during the year or so gap between when a vaccine is approved and when all who wish have been vaccinated. Are vaccines and lockdowns substitutes during that crucial time, in the sense that lockdowns should be reduced as vaccination rates rise? Or might they be complementary with the prospect of imminent vaccination increasing the value of stricter lockdowns, since hospitalization and death averted then may be permanently prevented, not just delayed? We investigate this question with a simple dynamic optimization model that captures both epidemiological and economic considerations. In this model, increasing the rate of vaccine deployment may increase or reduce the optimal total lockdown intensity and duration, depending on the values of other model parameters. That vaccines and lockdowns can act as either substitutes or complements even in a relatively simple model casts doubt on whether in more complicated models or the real world one should expect them to always be just one or the other. Within our model, for parameter values reflecting conditions in developed countries, the typical finding is to ease lockdown intensity gradually after substantial shares of the population have been vaccinated, but other strategies can be optimal for other parameter values. Reserving vaccines for those who have not yet been infected barely outperforms simpler strategies that ignore prior infection status. For certain parameter combinations, there are instances in which two quite different policies can perform equally well, and sometimes very small increases in vaccine capacity can tip the optimal solution to one that involves much longer and more intense lockdowns.

Epidemiología de la faringitis estreptocócica. Período enero de 2018 - diciembre de 2021 / Epidemiology of streptococcal pharyngitis. January 2018 - December 21

La faringoamigdalitis es uno de los motivos más frecuentes de consulta en pediatría. Aproximadamente un 70-80% de las faringoamigdalitis son de etiología viral. El 20-30% restante son de origen bacteriano. El agente causal más frecuente es Streptococcus pyogenes (estreptococo ß-hemolítico del grupo A). El rol de Streptococcus dysgalactiae subsp. equisimilis, (estreptococos ß-hemolíticos grupos C y G) fue claramente establecido como agente etiológico en la faringitis bacteriana, tanto en niños como en adultos. Se realizó un análisis descriptivo y retrospectivo entre enero 2018 y diciembre de 2021. Se evaluó la prevalencia de faringitis estreptocócica, la edad, el período estacional, los agentes etiológicos y la resistencia a macrólidos durante los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021). Se analizaron 11 396 muestras de exudados de fauces de pacientes con sospecha de faringitis bacteriana; las mismas se procesaron mediante el uso de técnicas microbiológicas convencionales. En el período estudiado el porcentaje de positividad de los cultivos de exudados de fauces se mantuvo constante. Al comparar los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021) se observó una disminución en el número de aislados de S. pyogenes con un aumento de S. dysgalactiae subsp. equisimilis, mientras que la resistencia a macrólidos encontrada fue superior en S. pyogenes y para S. dysgalactiae subsp. equisimilis se mantuvo constante. Es importante realizar el cultivo para la identificación del agente etiológico y determinar la sensibilidad antibióticapara continuar con la vigilancia epidemiológica de la resistencia a los macrólidos, porque representan una opción en pacientes alérgicos a ß-lactámicos (AU)

Pharyngotonsillitis is one of the most frequent reasons for consultation in children. Approximately 70-80% of pharyngotonsillitis are of viral etiology. The remaining 20-30% are bacterial in origin. The most frequent causative agent is Streptococcus pyogenes (group A ß-hemolytic streptococcus). Streptococcus dysgalactiae subsp. equisimilis (ß-hemolytic streptococcus groups C and G) was clearly established as an etiologic agent in bacterial pharyngitis in both children and adults. A descriptive and retrospective analysis was conducted between January 2018 and December 2021. The prevalence of streptococcal pharyngitis, age, seasonal period, etiologic agents, and macrolide resistance during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods were evaluated. We analyzed 11 396 specimens of swabs from patients with suspected bacterial pharyngitis. Conventional microbiological techniques were used. In the study period, the percentage of positivity of swab cultures remained constant. When comparing the preCOVID-19 (2018-2019) and COVID-19 (2020-2021) periods, a decrease in the number of S. pyogenes isolates was observed with an increase in S. dysgalactiae subsp. equisimilis, while the resistance to macrolides found was higher for S. pyogenes and remained constant for S. dysgalactiae subsp. equisimilis. The identification of the etiologic agent and determination of antibiotic sensitivity are important for epidemiological surveillance of macrolide resistance, as they are a treatment option in patients who are allergic to ß-lactams (AU)