Human intestinal enteroids and predictive models validate the operational limits of sanitizers used for viral disinfection of vegetable process wash water.

Vegetables are globally associated with a considerable number of foodborne outbreaks caused by viral infections, specifically human norovirus. In fresh produce industry, washing represents a critical step for food safety as process wash water (PWW) needs to be maintained at appropriate microbial quality to prevent water-mediated cross-contamination. This study aimed to explore the disinfection efficacy of chlorine (free chlorine, FC), chlorine dioxide (ClO2) and peracetic acid (PAA) in PWW against infectious human norovirus and Tulane virus (TV). First, we tested the extent of TV inactivation in baby leaf, bell pepper, and vegetables mix PWW and monitored the viral decay by cell culture. Then, inactivation kinetics were defined for infectious human norovirus exposed to FC, ClO2 and PAA in baby leaves PWW using the human intestinal enteroids (HIE) system. Finally, kinetic inactivation models were fitted to TV reduction and decay of sanitizers to aid the implementation of disinfection strategies. Results showed that >8 log10 human norovirus and 3.9 log10 TV were inactivated by 20 ppm FC within 1 min; and by 3 ppm ClO2 in 1 min (TV) or 5 min (norovirus). PAA treatment at 80 ppm reduced ca. 2 log10 TV but not completely inactivated the virus even after 20 min exposure, while 5 min treatment prevented norovirus replication in HIE. TV inactivation in PWWs was described using an exponential decay model. Taking these data together, we demonstrated the value of applying the HIE model to validate current operational limits for the most commonly used sanitizers. The inactivation kinetics for human norovirus and TV, along with the predictive model described in this study expand the current knowledge to implement post-harvest produce safety procedures in industry settings.

Parental Stress in Families with Children with Early Intervention Needs linked to Socio-Environmental Vulnerability / Estrés Parental en Familias con Niños/as de Necesidades de Atención Temprana ligadas a Vulnerabilidad Socioambiental

Background and objective: Environmental risk factors are associated with a lower capacity to cope with parenting, generating greater stress in the education of children. When faced with social risk factors, mothers of children with special educational needs tend to be more vulnerable to stress. The main aim of this study was to analyse variables associated to the stress perceived by parents of children with early care needs (socio-environmental vulnerability and child’s diagnosis). Method. Four hundred and six parents (233 mothers and 173 fathers) of 239 children with early care (EC) and education needs collaborated in this research. Results. Situations of environmental vulnerability caused high levels of stress in the parents. The experience of stressful events during pregnancy conditioned the later maternal anxiety. A significant positive linear correlation was found between the results achieved in the Overprotective educational style and parental stress. Conclusions. Most interventions in Early Childhood Care and Development Centres focus on the needs of children, leaving parents out of the clinical intervention. This approach should be shifting towards a family-centred model, which will work more effectively and improve the quality of life of the family.(AU)

Antecedentes y objetivos: Factores de riesgo ambiental son asociados a una menor capacidad para afrontar la crianza, generando en la educación de los hijos/as un mayor estrés. Sumidos en factores de riesgo social, las madres de niños/as con necesidades educativas especiales tienden a mostrarse más vulnerables ante el estrés. El objetivo principal de este estudio fue analizar las variables asociadas al estrés percibido por los progenitores de niños/as con necesidades de atención temprana (vulnerabilidad socio-ambiental y diagnóstico del niño). Método. Cuatrocientos seis progenitores (233 madres y 173 padres) de 239 de niños/as con necesidades de Atención Temprana (AT) colaboraron en esta investigación. Resultados. Situaciones de vulnerabilidad ambiental provocaron en las progenitoras elevados niveles de estrés. La vivencia de acontecimientos estresantes durante el embarazo, condicionó la ansiedad materna posterior. Se halló una correlación lineal positiva significativa entre los resultados alcanzados en el estilo educativo Sobreprotector y el Estrés parental. Conclusiones. La mayoría de las intervenciones en los Centros de Atención Temprana y Desarrollo Infantil se centran en las necesidades de los niños, dejando a los padres fuera de la intervención clínica. Este enfoque debería cambiar hacia un modelo centrado en la familia, que funcionará más eficazmente y mejorará la calidad de vida de la familia.(AU)

Effect of the Use of Gnrh Analogs in Low-Grade Cerebral Glioma.

Low-grade gliomas are the most common brain tumors in children. This tumor type presents a wide range of clinical, histological, and biological behaviors. In recent years, an association between estrogens and progesterone and the development of tumors has been suggested. A case of a 2-year-old girl is described with a low-grade brain tumor treated with chemotherapy and disease stabilization. The treatment with Decapeptyl® was initiated due to precocious puberty, and the tumor showed a decrease in its solid component-more than 50% of the initial size-three years after starting treatment. Several studies have described the influence of estrogen and progesterone on the development of gliomas, decreasing or increasing their expression in those tumors with greater aggressiveness, respectively. Despite the fact that the tumor-hormonal expression relationship in other tumor types has been evaluated, its role in the treatment of brain tumors remains unknown.

Assessment and Prediction of Fish Freshness Using Mathematical Modelling: A Review.

Fish freshness can be considered as the combination of different nutritional and organoleptic attributes that rapidly deteriorate after fish capture, i.e., during processing (cutting, gutting, packaging), storage, transport, distribution, and retail. The rate at which this degradation occurs is affected by several stress variables such as temperature, water activity, or pH, among others. The food industry is aware that fish freshness is a key feature influencing consumers' willingness to pay for the product. Therefore, tools that allow rapid and reliable assessment and prediction of the attributes related to freshness are gaining relevance. The main objective of this work is to provide a comprehensive review of the mathematical models used to describe and predict the changes in the key quality indicators in fresh fish and shellfish during storage. The work also briefly describes such indicators, discusses the most relevant stress factors affecting the quality of fresh fish, and presents a bibliometric analysis of the results obtained from a systematic literature search on the subject.

A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients.

Background: The aim of this study was to evaluate the usefulness of C-Reactive Protein (CRP), Procalcitonin (PCT), and Interleukine 6 (IL6) biomarkers in predicting the existence of high-risk episodes (HRE) during the first 24 h of fever in pediatric cancer patients. HRE were defined as the presence of Gram-negative bloodstream infections or Systemic Inflammatory Response Syndrome. Methods: The study included 103 consecutive fever episodes in 44 hemato-oncological pediatric patients, from whom samples for biomarkers were taken upon initial evaluation (CRP-1, PCT-1 and IL6-1) and then between 12 and 24 h afterward (CRP-2, PCT-2 and IL6-2). Results: An IL6-1 value higher than 164 pg/mL showed an area under the curve (AUC) of 0.890 (0.791−0.989) and OR of 48.68 (7.92−951.42, p < 0.001) to detect HRE in multivariate analysis. A PCT-1 higher than 0.32 ng/mL showed an AUC of 0.805 (0.700−0.910) and OR of 4.55 (0.90−27.84, p = 0.076). A PCT-2 higher than 0.94 ng/mL showed an AUC of 0.836 (0.725−0.947) and OR of 13.01 (1.82−149.13, p = 0.018), and an increase in CRP between the first and second sample (CRP-2vs1) higher than 291% also showed an AUC of 0.785 (0.655−0.915) and OR of 31.09 (4.87−355.33, p = 0.001). Conclusions: IL6-1, PCT-2, and CRP-2vs1 showed a strong and independent correlation with HREs in pediatric cancer patients. CRP variations over the first 24 h provide an improvement in predictive models that are especially useful if IL-6 and PCT are not available.

[Experience with Denosumab in central giant-cell granuloma]. / Experiencia con Denosumab en granuloma central de células gigantes.

INTRODUCTION: Central Giant Cell Granuloma is an infrequent bone lesion located mainly in the maxillary bone. The main treatment is surgery with wide margins, so it sometimes causes great morbidity and esthetic al terations. Denosumab, a RANK-ligand inhibitor monoclonal antibody, has been presented as a valid therapeutic alternative in the treatment of these lesions. OBJECTIVE: to describe the clinical and radio logical response after treatment with Denosumab in a patient with unresected giant cell granuloma. CLINICAL CASE: 12-year-old boy who consulted due to a 24-hour maxillary swelling, without other associated symptoms. Examination revealed a tumor in the upper left maxilla with bulging of the ip- silateral gingiva. A CT scan was performed which showed a large expansive intraosseous lesion in the maxillary alveolar ridge. The biopsy of the lesion was compatible with Central Giant Cell Granuloma. Due to the size and location of the lesion, initial treatment with Denosumab, a human monoclonal antibody with action on RANK-ligand, was indicated. After 10 months of treatment, the patient showed a favorable clinical and radiological response, with a size decrease of the lesion and metabolic activity. As an adverse effect, the boy presented mild hypocalcemia, resolved after supplementation with calcium. CONCLUSION: the use of Denosumab as the first line of treatment in Giant Cell Granu loma may be an adequate therapeutic option in adolescents with lesions that are difficult to resect.

Biomarkers and Fever in Children with Cancer: Kinetics and Levels According to Final Diagnosis.

We investigated the kinetics of CRP, PCT, IL-6 and MR-proADM in a cohort of consecutive febrile patients with cancer in order to test the hypothesis that higher plasma concentrations and the absence of a rapid decrease in peak values would be associated with disease severity. (1) Method: A prospective descriptive and analytical study of patients with cancer and fever (≤18 years of age) at a University Hospital was carried out between January 2018 and December 2019. Information collected: sex, age, diagnosis, date and symptoms at diagnosis and medical history. The episodes were classified into three groups: bacterial infection, non-bacterial infection and systemic inflammatory response syndrome (SIRS). (2) Results: One hundred and thirty-four episodes were included. Bacterial infection criteria were met in 38 episodes. Biomarkers were measured at four different points: baseline, at 12-24 h, at 25-48 h and at 49-72 h. All the biomarkers evaluated decreased after the peak level was reached. IL-6 and MR-proADM showed a trend towards higher levels in the SIRS group although this rise was statistically significant only for IL-6 (p < 0.005). Bacterial infections more frequently presented values of PCT above the cut-off point (>0.5 ng/mL) at 12-24 h. (3) Conclusion: In our experience, IL-6 kinetics is faster than PCT kinetics and both are faster than CRP in patients with fever and cancer who present a good outcome. Patients with a good evolution show a rapid increase and decrease of PCT and particularly of IL-6 levels.

Ototoxicidad en pacientes oncológicos: experiencia y propuesta de un protocolo de vigilancia / Ototoxicity in cancer survivors: experience and proposal of a surveillance protocol

Introducción: La ototoxicidad se presenta en diversos porcentajes según estudios tras el tratamiento con quimioterapia basada en platino y/o radioterapia craneal. El objetivo es mostrar nuestra experiencia en la monitorización de la ototoxicidad. Material y métodos: Se realizó una revisión del 1999 al 2019 en el registro de pacientes oncológicos pediátricos de nuestro hospital y remitidos a la Unidad de Hipoacusia Infantil. Resultados: 46 pacientes fueron remitidos a nuestra unidad. 41 pacientes recibieron platinos como parte de su tratamiento, 17 pacientes fueron sometidos a una intervención neuroquirúrgica y 18 pacientes recibieron radioterapia craneal. A todos se les realizó una anamnesis y otoscopia, y la monitorización se llevó a cabo con una audiometría tono-verbal y/o productos de distorsión. Se objetivó una hipoacusia como secuela del tratamiento en ocho pacientes (21,05% de los pacientes remitidos para seguimiento audiológico). Fue imposible determinar la situación audiológica al finalizar el tratamiento en ocho pacientes. La adaptación audioprotésica fue necesaria en dos pacientes. En la coordinación con Oncología Pediátrica, se consideró oportuno el cambio de cisplatino por carboplatino por ototoxicidad importante durante el tratamiento en un único paciente. Conclusión: Es imprescindible una adecuada coordinación con Oncología Pediátrica para realizar una vigilancia activa de la ototoxicidad y modificar, si es posible, la dosificación o el tipo de quimioterápico en caso de verse afectada la audición. En nuestra experiencia, y siguiendo las recomendaciones actuales, realizamos una valoración pretratamiento, una monitorización durante el tratamiento, al finalizarlo y después de forma anual por el riesgo de desarrollo diferido de una hipoacusia. (AU)

Introduction: Ototoxicity occurs in different percentages in patients after treatment with platinum-based chemotherapy or cranial radiation therapy. The aim of this study was to present experience in ototoxicity monitoring. Material and methods: A review was made of the registry of paediatric cancer patients referred to the Children's Hearing Loss Unit from 1999 to 2019. Results: Of the 46 patients referred to this unit, 41 had received platinum as part of their treatment, 17 patients underwent neurosurgery, and 18 patients received cranial radiation therapy. An anamnesis and otoscopy were performed on all of them, and the monitoring was carried out with tone-verbal audiometry and/or distortion products. Hearing loss was observed in eight patients (21.05% of patients referred for audiological follow-up) as a consequence of the treatment. It was impossible to determine the audiological situation in eight patients at the end of treatment. Hearing aid adaption was necessary in two patients. In coordination with Paediatric Oncology, a change from cisplatin to carboplatin due to bilateral grade two ototoxicity was considered appropriate during treatment in one patient. Conclusion: Adequate coordination with Paediatric Oncology is essential to carry out active surveillance for ototoxicity and to modify, if possible, the dosage or type of chemotherapy in case hearing is affected. In our experience, and following current recommendations, a pre-treatment assessment is usually performed, as well as monitoring during treatment, at the end of treatment, and annually thereafter due to the risk of a later development of hearing loss. (AU)

[Ototoxicity in cancer survivors: experience and proposal of a surveillance protocol]. / Ototoxicidad en pacientes oncológicos: experiencia y propuesta de un protocolo de vigilancia.

INTRODUCTION: Ototoxicity occurs in different percentages in patients after treatment with platinum-based chemotherapy or cranial radiation therapy. The aim of this study was to present experience in ototoxicity monitoring. MATERIAL AND METHODS: A review was made of the registry of paediatric cancer patients referred to the Children's Hearing Loss Unit from 1999 to 2019. RESULTS: Of the 46 patients referred to this unit, 41 had received platinum as part of their treatment, 17 patients underwent neurosurgery, and 18 patients received cranial radiation therapy. An anamnesis and otoscopy were performed on all of them, and the monitoring was carried out with tone-verbal audiometry and/or distortion products. Hearing loss was observed in eight patients (21.05% of patients referred for audiological follow-up) as a consequence of the treatment. It was impossible to determine the audiological situation in eight patients at the end of treatment. Hearing aid adaption was necessary in two patients. In coordination with Paediatric Oncology, a change from cisplatin to carboplatin due to bilateral grade two ototoxicity was considered appropriate during treatment in one patient. CONCLUSION: Adequate coordination with Paediatric Oncology is essential to carry out active surveillance for ototoxicity and to modify, if possible, the dosage or type of chemotherapy in case hearing is affected. In our experience, and following current recommendations, a pre-treatment assessment is usually performed, as well as monitoring during treatment, at the end of treatment, and annually thereafter due to the risk of a later development of hearing loss.

Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer.

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008-2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1-2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan-Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7-65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05-1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02-2.0); active smoking, 1.59 (1.02-2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15-2.11); chronic kidney disease, 1.86 (1.37-2.53); and ulcer severity (SINBAD system) 1.12 (1.02-1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

Análisis de las reulceraciones en una unidad multidisciplinar de pie diabético tras la implementación de un programa de cuidado integrado del pie / Analysis of recurrent ulcerations at a multidisciplinary diabetic Foot unit after implementation of a comprehensive Foot care program

Antecedentes y objetivo: El objetivo de este estudio fue evaluar qué factores de riesgo se asociaban con la reulceración en el pie diabético después de la implementación de un nuevo programa preventivo de cuidado integrado del pie (CIP), desarrollado por un podólogo y un endocrinólogo en una unidad multidisciplinar de pie diabético y su impacto potencial en reducir la tasa de reulceración. Material y métodos: Estudio de cohortes y retrospectivo que incluyó de manera consecutiva a pacientes que consultaron por primera vez por una úlcera de pie diabético durante el período 2008-2014, y que se resolvió mediante cicatrización. Los sujetos fueron seguidos hasta la reulceración o en su defecto hasta el 30 de junio de 2016, con un máximo de 8,1 años. Se analizó la incidencia acumulada de reulceraciones durante el período 2008-2010 (antes del CIP) y 2011-2014 (tras la implementación del CIP). Resultados: Se incluyeron 280 sujetos, mediana de edad 69,5 años (P25: 60,2-P75:78); 64,6% varones y 92,1% tenían diabetes tipo 2. Ciento veintiséis (45%) se reulceraron. La mediana hasta la reulceración fue de 0,97 (P25:0,44-P75:1,74) años. El análisis multivariante demostró que la neuropatía sensitiva (HR [IC 95%] 1,58 [0,99-2,54] p=0,050); amputación menor (HR [IC 95%] 1,66 [0,12-2,46] p=0,011); y período 2011-2014 versus 2008-2010 (HR [IC 95%] 0,60 [0,42-0,87] p=0,007) se asociaron independientemente a la reulceración. Conclusiones: Los factores predictivos para reulceración fueron neuropatía sensitiva, amputación menor y la implementación del programa de CIP. La implementación del CIP se asoció con una reducción del 40% en la reulceración. La prevención de la reulceración es factible y debiera ser prioritaria en una unidad multidisciplinar de pie diabético

Background and objective: The aim of this study was to assess the risk factors associated to recurrent diabetic foot ulcers after implementing a new preventive comprehensive foot care (CFC) program carried out by a podiatrist and an endocrinologist at a multidisciplinary diabetic foot unit (MDFU) and its potential impact in decreasing recurrent ulcers. Material and methods: A retrospective cohort study including consecutive patients who attended the MDFU for the first time from 2008 to 2014 complaining of a diabetic foot ulcer that finally healed. Patients were monitored until ulcer recurred or up to June 30, 2016. Maximum follow-up time was 8.1 years. Cumulative incidence of recurrent ulcers was analyzed during two periods: 2008-2010 (before CFC was implemented) and 2011-2014 (after implementation of CFC). Results: A total of 280 subjects with a median age of 69.5 years (Q25:60,2-Q75:78) were included. Of these, 64.6% were males and 92.1% had type 2 diabetes mellitus. One hundred and twenty-six (45%) suffered recurrent ulcers. Median time to recurrent ulceration was 0.97 (Q25:0.44-Q75:1.74) years. Multivariate analysis showed sensory neuropathy (HR [95% CI] 1.58 [0.99-2.54], P=.050); minor amputation (HR [95% CI] 1.66 [0.12-2, 46], P=.011); and 2011-2014 period versus 2008-10 period (HR [95% CI] 0.60 [0.42-0.87], P=.007) to be factors independently associated to recurrent ulcers. Conclusions: Sensory neuropathy, minor amputation, and implementation of the CFC program were predictors of reulceration. Implementation of the CFC program was associated to a 40% reduction in reulceration. Prevention of recurrent ulcers is feasible and should be a priority in a MDFU

Analysis of recurrent ulcerations at a multidisciplinary diabetic Foot unit after implementation of a comprehensive Foot care program. / Análisis de las reulceraciones en una unidad multidisciplinar de pie diabético tras la implementación de un programa de cuidado integrado del pie.

BACKGROUND AND OBJECTIVE: The aim of this study was to assess the risk factors associated to recurrent diabetic foot ulcers after implementing a new preventive comprehensive foot care (CFC) program carried out by a podiatrist and an endocrinologist at a multidisciplinary diabetic foot unit (MDFU) and its potential impact in decreasing recurrent ulcers. MATERIAL AND METHODS: A retrospective cohort study including consecutive patients who attended the MDFU for the first time from 2008 to 2014 complaining of a diabetic foot ulcer that finally healed. Patients were monitored until ulcer recurred or up to June 30, 2016. Maximum follow-up time was 8.1 years. Cumulative incidence of recurrent ulcers was analyzed during two periods: 2008-2010 (before CFC was implemented) and 2011-2014 (after implementation of CFC). RESULTS: A total of 280 subjects with a median age of 69.5 years (Q25:60,2-Q75:78) were included. Of these, 64.6% were males and 92.1% had type 2 diabetes mellitus. One hundred and twenty-six (45%) suffered recurrent ulcers. Median time to recurrent ulceration was 0.97 (Q25:0.44-Q75:1.74) years. Multivariate analysis showed sensory neuropathy (HR [95% CI] 1.58 [0.99-2.54], P=.050); minor amputation (HR [95% CI] 1.66 [0.12-2, 46], P=.011); and 2011-2014 period versus 2008-10 period (HR [95% CI] 0.60 [0.42-0.87], P=.007) to be factors independently associated to recurrent ulcers. CONCLUSIONS: Sensory neuropathy, minor amputation, and implementation of the CFC program were predictors of reulceration. Implementation of the CFC program was associated to a 40% reduction in reulceration. Prevention of recurrent ulcers is feasible and should be a priority in a MDFU.

Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid / Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid

Antecedentes y objetivo: Las consecuencias negativas de la hipoglucemia en las personas con diabetes mellitus tipo 1 (DM1) pueden resultar en el desarrollo de miedo a la hipoglucemia. Este estudio traduce al español, adapta y valida, el cuestionario original Hypoglycemia Fear Survey (HFS) y analiza qué variables se asocian con el miedo a la hipoglucemia en DM1. Material y métodos: El HFS fue traducido y adaptado mediante el proceso de traducción-retrotraducción y el nuevo cuestionario obtenido, EsHFS, fue administrado a una población con DM1. Se analizó: factibilidad, confiabilidad (alpha de Cronbach), validez de contenido (mediante correlación del EsHFS y el cuestionario de calidad de vida, EsDQOL) y estabilidad (correlación test-retest) del cuestionario. Resultados: El EsHFS consta de 24 ítems, identificándose 3 subescalas: subescala 1, de preocupación; subescala 2, de comportamiento asociado a evitación y la subescala 3, de comportamiento que produce hiperglucemia. Población incluida: 163 sujetos, M (DE) 36(10,5) años, 24% tratados mediante infusión subcutánea continua de insulina. El 99,8% autocumplimentó el EsHFS en<10min. El alpha de Cronbach para el EsHFS global fue de 0,92. El EsHFs y las subescalas se correlacionaron con el EsDQOL. La correlación test-retest (Pearson) obtuvo una r=0,92. Edad, sexo femenino, menor nivel formativo/estudios, convivencia sin pareja, frecuencia de autoanálisis y de hipoglucemia no grave, antecedentes de hipoglucemia grave y/o asintomática, se asociaron independientemente al resultado del EsHFS. Conclusiones: La versión española, EsHFS, posee unas buenas propiedades psicométricas y podría ser útil para evaluar el miedo a la hipoglucemia en población con DM1 que hable español en nuestro entorno

Background and objective: The negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. Material and methods: The HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). Results: The EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. Study population: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. Conclusions: The Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM

Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid. / Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: The negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. MATERIAL AND METHODS: The HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). RESULTS: The EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. STUDY POPULATION: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. CONCLUSIONS: The Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM.

The HIDEA School-Based Screening Scale for Teachers to Detect ADHD Markers in Elementary Students / Escala HIDEA de cribado escolar orientada al profesorado para detectar marcadores TDAH en Primaria

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with academic difficulties both short- and long-term. The aim of the study was to provide a new brief ADHD screening scale that could be easily used by teachers and educational professionals in elementary schools. Method: Participants were teachers of 158 children with a prior diagnosis of ADHD and 169 children without a diagnosis of ADHD. An initial pool of 38 items was generated from ADHD symptoms of both DSM-5 and CIE-10 criteria, as well from Conners 3, EDAH, SDQ and ADHD-RS-IV scales. Results: A 5-item model showed the best fit (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). The HIDEA total score was highly correlated with both ADHD-IN (r = .93; p<.001) and ADHD-HY (r = .87; p<.001). The ROC curve for the HIDEA total score gave an AUC value of .998 (95%, CI = [.994, 1.000]). HIDEA scale showed a good sensitivity (97%) and very good specificity (3%). Conclusion: The HIDEA scale has shown adequate psychometric properties. It is potentially useful for screening ADHD in elementary grade as part of a preventive strategies in school settings (AU)

Introducción: el trastorno por déficit de atención e hiperactividad (TDAH) está asociado a dificultades académicas tanto a corto como a largo plazo. El objetivo de este estudio fue desarrollar una escala breve de cribado del TDAH de sencillo manejo para profesorado y profesionales de Educación Primaria. Método: los participantes fueron educadores/as de 158 niños/as con un diagnóstico previo de TDAH, y 169 sin diagnóstico TDAH. Se generó un pool inicial de 38 ítems a partir del DSM-5 y CIE-10, así como de las escalas Conners 3, EDAH, SDQ y ADHD-RS-IV. Resultados: el modelo de 5-ítems mostró el mejor ajuste (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). La puntuación en la escala HIDEA correlacionaba de manera elevada tanto con la «inatención» (r = .93; p<.001) como con la «hiperactividad/impulsividad» (r = .87; p<.001). La curva ROC obtuvo un AUC de .998 (95%, CI = [.994, 1.000]). HIDEA mostró buena sensibilidad (97%) y buena especificidad (3%). Conclusión: la escala HIDEA ha mostrado unas propiedades psicométricas adecuadas, mostrando ser una herramienta de cribado clínico para el TDAH en Primaria, potencialmente útil en estrategias preventivas aplicables en la escuela (AU)

The HIDEA School-Based Screening Scale for Teachers to Detect ADHD Markers in Elementary Students.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with academic difficulties both short- and long-term. The aim of the study was to provide a new brief ADHD screening scale that could be easily used by teachers and educational professionals in elementary schools. METHOD: Participants were teachers of 158 children with a prior diagnosis of ADHD and 169 children without a diagnosis of ADHD. An initial pool of 38 items was generated from ADHD symptoms of both DSM-5 and CIE-10 criteria, as well from Conners 3, EDAH, SDQ and ADHD-RS-IV scales. RESULTS: A 5-item model showed the best fit (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). The HIDEA total score was highly correlated with both ADHD-IN (r = .93; p<.001) and ADHD-HY (r = .87; p<.001). The ROC curve for the HIDEA total score gave an AUC value of .998 (95%, CI = [.994, 1.000]). HIDEA scale showed a good sensitivity (97%) and very good specificity (3%). CONCLUSION: The HIDEA scale has shown adequate psychometric properties. It is potentially useful for screening ADHD in elementary grade as part of a preventive strategies in school settings.

Clinical characteristics and mortality in patients treated in a Multidisciplinary Diabetic Foot Unit. / Características clínicas y mortalidad de los pacientes atendidos en una Unidad Multidisciplinar de Pie Diabético.

BACKGROUND AND OBJECTIVE: This study reviews the clinical characteristics of patients with diabetic foot ulcer treated in a Multidisciplinary Diabetic Foot Unit (MDFU) and analyzes the mortality and factors associated with its survival. MATERIAL AND METHODS: Data from all patients who attended the MDFU for the first time for a diabetic foot ulcer during the 2008-2014 period were analized. The patients were followed until their death or until June 30, 2016, for up to 8 years. RESULTS: A total of 345 patients were included, with a median age (P25-P75) of 71 (61.5-80) years, and 321 (93%) had type 2 diabetes. They were characterized as patients with inadequate glycemic control, 48% had HbA1c ≥ 8% and high prevalence of chronic complications: 60.2% retinopathy, 43.8% nephropathy and 47.2% ischemic heart disease and/or cerebrovascular disease. A total of 126 (36.5%) patients died and 69 (54.8%) were due to cardiovascular disease. Survival measured by Kaplan-Meier declined over time to 69, 60 and 45% at 3, 5 and 7 years respectively. Cox's multivariate regression analysis showed the following variables associated with mortality, HR (95% CI): age 1.08 (1.05-1.11); previous amputation 2.24 (1.34-3.73); active smoking 2.10 (1.12-3.97); cerebrovascular disease 1.75 (1.05-2.92); renal dysfunction 1.65 (1.04-2.61) and ischemic heart disease 1.60 (1.01-2.51). CONCLUSIONS: Patients with diabetic foot ulcer are characterized by high morbidity and mortality, with cardiovascular disease being the most frequent cause of death. It is necessary to pay more attention to this risk group, tailoring objectives and treatments to their situation and life expectancy.