Publications by authors named "Irma Casas"

39 Publications

The COVID-19 vaccination.

Med Clin (Engl Ed) 2021 Apr 29. Epub 2021 Apr 29.

Servicio de Medicina Preventiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.medcle.2021.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082374PMC
April 2021

Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B).

PLoS One 2021 26;16(4):e0249942. Epub 2021 Apr 26.

Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach's alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249942PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075224PMC
April 2021

The COVID-19 vaccination.

Med Clin (Barc) 2021 Mar 26. Epub 2021 Mar 26.

Servicio de Medicina Preventiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autonòma de Barcelona, Bellaterra, Barcelona, España.

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http://dx.doi.org/10.1016/j.medcli.2021.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997597PMC
March 2021

Reliability and validity study of the Spanish adaptation of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-A).

PLoS One 2021 19;16(3):e0248595. Epub 2021 Mar 19.

Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A) is an instrument that evaluates fear of childbirth through the expectations of women in relation to childbirth and their experience during the birth. The objective of this study was to translate the W-DEQ-A into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) adapting the questionnaire to Spanish and (2) a transversal study in a sample of 273 pregnant women in the Sexual and Reproductive Health centres in the Metropolitan Northern Barcelona in Catalonia (Spain). The psychometric properties were analysed in terms of reliability and construct validity. The confirmatory factorial analysis did not confirm the unidimensionality of the original structure of the WDEQ-A, as happened with the other studies in which it has previously been validated. The result of the exploratory factorial analysis suggests four factors, or dimensions, very similar but not identical to those obtained in other analysis studies of the W-DEQ-A. The Cronbach alpha and the omega scale were also adequate for all the scales and for each of the dimensions. The results of this study confirm the findings of other studies that suggest that the W-DEQ-A is multi-dimensional. In the Spanish version of the W-DEQ-A four dimensions have been identified to explore fear of childbirth in pregnant women. The Spanish version of the WDEQ-A (WDEQ-A-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248595PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978360PMC
March 2021

Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER).

Rheumatology (Oxford) 2021 Apr;60(4):1793-1803

Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.

Objective: The aim of the present study was to describe the demographic, clinical and immunological characteristics of patients with late-onset (≥50 years) SLE vs patients with early-onset SLE (<50 years).

Methods: We performed a cross-sectional retrospective study of 3619 patients from the RELESSER database (National Register of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology).

Results: A total of 565 patients (15.6%) were classified as late-onset SLE and 3054 (84.4%) as early-onset SLE. The male-to-female ratio was 5:1. Mean (s.d.) age at diagnosis in the late-onset group was 57.4 (10.4) years. At diagnosis, patients with late-onset SLE had more comorbid conditions than patients with early-onset SLE; the most frequent was cardiovascular disease (P <0.005). Furthermore, diagnostic delay was longer in patients with late-onset SLE [45.3 (3.1) vs 28.1 (1.0); P <0.001]. Almost all patients with late-onset SLE (98.7%) were Caucasian. Compared with early-onset SLE and after adjustment for time since diagnosis, patients with late-onset SLE more frequently had serositis, major depression, thrombotic events, cardiac involvement and positive lupus anticoagulant values. They were also less frequently prescribed immunosuppressive agents. Mortality was greater in late-onset SLE (14.3% vs 4.7%; P <0.001).

Conclusion: Late-onset SLE is insidious, with unusual clinical manifestations that can lead to diagnostic errors. Clinical course is generally indolent. Compared with early-onset disease, activity is generally reduced and immunosuppressants are less commonly used. Long-term prospective studies are necessary to determine whether the causes of death are associated with clinical course or with age-associated comorbidities in this population.
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http://dx.doi.org/10.1093/rheumatology/keaa477DOI Listing
April 2021

Reliability and validity study of the Spanish adaptation of the "Educational Practices Questionnaire" (EPQ).

PLoS One 2020 17;15(9):e0239014. Epub 2020 Sep 17.

Universitat Autònoma de Barcelona, Barcelona, Spain.

The Educational Practices Questionnaire is an instrument for assessing students perceptions of best educational practices in simulation. As for other countries, in Spain, it is necessary to have validated rubrics to measure the effects of simulation. The objective of this study was to carry out a translation and cultural adaptation of the Educational Practices Questionnaire into Spanish and analyze its reliability and validity. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 626 nursing students. Psychometric properties were analyzed in terms of reliability and construct validity by confirmatory and exploratory factor analysis. The exploratory and confirmatory factor analyses showed that the one-dimensional model is acceptable for both scales (presence and importance). The results show that the participants' scores can be calculated and interpreted for the general factor and also for the four subscales. Cronbach's alpha and the Omega Index were also suitable for all the scales and for each of the dimensions. The Educational Practices Questionnaire is a simple and easy-to-administer tool to measure how nursing degree students perceive the presence and importance of best educational practices.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239014PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497994PMC
October 2020

Effect of an awareness campaign on the diagnosis and clinical impact of primary immunodeficiency.

Med Clin (Barc) 2021 03 28;156(6):270-276. Epub 2020 Aug 28.

Servicio de Enfermedades Infecciosas, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autònoma Barcelona, Departamento de Medicina, Barcelona, España; CIBER enfermedades respiratorias, Madrid, España; Institut de Recerca Germans Trias i Pujol, Barcelona, España. Electronic address:

Background And Objectives: Predominantly antibody deficiencies are the most prevalent primary immunodeficiency (PID) in adults. These are rare diseases difficult to diagnose. Therefore, they are diagnosed late. This study aims to evaluate whether an awareness campaign of PIDs among physicians is associated with an increase in number of diagnoses, a reduction in diagnostic delay and diagnosis at earlier stages.

Patients And Methods: A single centre, interventional, quasi-experimental study was designed that included 2 periods, period 1 pre-intervention (1986-2008) and period 2 post-intervention (2009-2018). A descriptive comparative study of variables was carried out in both periods.

Results: 116 patients were included [27 (23.3%) in period 1 and 89 (76.7%) in period 2]. The incidence rate increased significantly (0.204 and 1.236/100,000habs./year; P < 0.05), the diagnosis delay tended to be lower (4 vs. 3.73 years). The reasons for diagnostic suspicion were diverse and the burden disease at diagnosis (expressed by bronchiectasis, altered spirometry, ability to generate antibodies by thymus-independent mechanism and need for substitute treatment) tended to decrease in period 2.

Conclusions: Given the potentially serious complications of patients with late diagnosis of PIDs, it is necessary to create specialized multidisciplinary units, to unify assistance protocols and to design interventions to increase the knowledge of these entities.
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http://dx.doi.org/10.1016/j.medcli.2020.04.066DOI Listing
March 2021

Serial testing of health care workers for tuberculosis infection: A prospective cohort study.

PLoS One 2020 17;15(7):e0235986. Epub 2020 Jul 17.

Universitat Autònoma de Barcelona, Barcelona, Spain.

Health Care Workers (HCW) may have an occupational risk of latent tuberculosis infection (LTBI) and TB disease. The objective of this study was to evaluate the performance of the 2-step strategy: tuberculin skin test (TST) followed by confirmation with Interferon (IFN)-γ- release assays (IGRAs) in HCW. A secondary objective was to determine the factors related to conversions and reversions. HCW at risk of occupational exposure who attended the Occupational Department of the Hospital Germans Trias i Pujol were included during the study period (2013-2016). All professionals testing negative for LTBI were included in a cohort study. These workers were followed up with the administration of a TST and an IGRA quantification at least one year after inclusion in the study. Workers with positive TST, regardless of the results of the IGRA tests, were followed-up with an IGRA. 255 workers were enrolled in the study and 108 workers from the same cohort were followed up. During the follow-up period, seven workers presented TST test conversion. One of these conversions was also confirmed by an IGRA test. There were 2 conversions of cases only testing positive with the IGRA. There have been only 2 reversions of cases testing negative with the IGRA. In this study, not all TST conversions were confirmed when using the IGRA test, which highlights the importance of the 2-step strategy. We have detected a low number of conversions and reversions. Our conclusions should be confirmed in studies with a longer follow-up time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235986PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367452PMC
September 2020

[HOSPITALS AS PROMOTERS OF SMOKELESS SPACES: STRATEGIES AIMED AT SMOKING CONTROL]

Rev Esp Salud Publica 2020 07 6;94. Epub 2020 Jul 6.

Comité Hospital Sin Humo. Hospital Universitari Germans Trias i Pujol. Badalona. España.

The objective of this study was to describe the measures introduced at the Hospital Germans Trias i Pujol, Barcelona, aimed at achieving a smoke-free environment, and encouraging research, training, and clinical approaches with respect to smoking. The experience gained as a center attached to the Catalan Network of Smokeless Hospitals since 2002 shows that preventing and controlling smoking requires a specific agenda developed by a competent committee comprising workers from all hospital areas. Likewise, coordination with other centers in the network is essential as it permits the sharing of experiences. The involvement of hospital management is critical for the effective introduction of health protection and promotion strategies, both in workers and in users. The raising of awareness and the ongoing training of all health workers and coordination with other health care providers in the Health network are the main aspects that require strengthening in the future.
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July 2020

Effect of vaccination on the prevention of influenza-related severe illness in adults attended in a third level hospital during the 2017-2018 epidemic season.

Med Clin (Barc) 2020 08 15;155(3):112-118. Epub 2020 May 15.

Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER Enfermedades respiratorias; Dirección Médica, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

Objectives: The objective of this research was to evaluate the effect of influenza vaccination on the prevention of influenza-related severe cases in adults treated in a third-level hospital during the 2017-2018 epidemic season.

Methodology: A descriptive analysis was performed on the entire population of subjects with a laboratory-confirmed influenza test during the 2017-2018 season. A severe case was defined as a patient treated in one of the Intensive Care Units (ICUs) and/or death. The effect of the vaccine on the adult population was determined by multivariate logistic regression analysis.

Results: Between epidemiological weeks 44/2017 and 19/2018, the hospital's laboratory detected 706 positive samples for influenza virus. Of the 551 confirmed patients aged 18 years or older, forty-three were admitted to one of the ICUs, and 26 died during admission. The explanatory multivariate model has shown that flu vaccination prior to or during the epidemic season was a protective factor for the development of severity [OR:0.27 (0.11-0.65, p=0.004)], adjusted by age [OR: 1.03 (1.01-1.06), p=.04], sex, type of virus (H1N1-pdm09, H3N2 or B virus), Chronic Complex Patient index or Advanced Chronic Disease index.

Conclussions: Influenza vaccination is a protective factor against the development of severity associated with influenza infection in a season when vaccination did not contain the virus with higher epidemic circulation among the population. Flu vaccination should be recommended annually following the guidelines established by the health authorities.
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http://dx.doi.org/10.1016/j.medcli.2020.01.030DOI Listing
August 2020

[Influenza vaccination coverage in healthcare personnel: a call for optimization in data recording and analysis.]

Rev Esp Salud Publica 2020 03 25;94:e1-e4. Epub 2020 Mar 25.

Servicio de Medicina Preventiva. Hospital Universitari Germans Trias i Pujol. Badalona. España.

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March 2020

Intervention to reduce the incidence of surgical site infection in spine surgery.

Am J Infect Control 2020 05 7;48(5):550-554. Epub 2019 Nov 7.

Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain; Preventive Medicine Department, Germans Trias i Pujol University Hospital, Badalona, Spain.

Background: This study examines the incidence, characteristics, and risk factors of surgical site infections (SSIs) after spine surgery and evaluates the efficacy of a preventive intervention.

Methods: This was a quasi-experimental pretest/posttest study in patients undergoing spinal surgery in an orthopedic surgery department from December 2014 to November 2016. Based on the results of the study, we revised the preventive protocol with modification of wound dressing, staff training, and feedback. SSI rates were compared between the pre-intervention (December 2014 to November 2015) and post-intervention (December 2015 to November 2016) periods. The risk factors were analyzed using univariate and multivariate analyses.

Results: Of the 139 patients included, 14 cases of SSI were diagnosed, with a significant decrease in the incidence of SSIs from the pre-intervention period to the post-intervention period (19.4% vs 2.6%; P = .001). The etiology was known in 13 cases, with enteric flora being predominant in the pre-intervention group. Univariate analysis showed that age, body mass index, days until sitting and ambulation, and incontinence were statistically significant risk factors. After multivariate analysis, only body mass index and days until ambulation remained significant. When the effect of intervention was adjusted with other risk factors, this variable remained statistically significant.

Conclusions: An intervention that includes modification of wound dressing and early mobilization, as well as staff awareness training, monitoring, and feedback, allowed a significant reduction in the incidence of SSI following spinal surgery, particularly infections caused by enteric flora.
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http://dx.doi.org/10.1016/j.ajic.2019.09.007DOI Listing
May 2020

Reliability and validity study of the Spanish adaptation of the "Creighton Simulation Evaluation Instrument (C-SEI)".

Nurse Educ Pract 2019 Feb 7;35:14-20. Epub 2019 Jan 7.

Department of Preventive Medicine, Hospital Germans Trias i Pujol, Carretera del Canyet sn, 08916, Badalona, Barcelona, Spain. Electronic address:

There are multiple advantages to using human patient simulation (HPS) as a teaching method for clinical nursing education. Valid, reliable tools that can be used when applying this teaching method are needed to evaluate nursing student skill acquisition. The aim of this study was to translate the Creighton Simulation Evaluation Instrument (C-SEI) into Spanish and to analyse the reliability and validity of the Spanish C-SEI version with nursing students. The study was conducted in two phases: (1) Adaptation of the instrument into Spanish. (2) Cross-sectional study in a sample of 249 nursing students who were evaluated by two observers. The psychometric properties were analysed in terms of reliability (internal consistency and inter-observer consistency) and construct validity using an exploratory factor analysis. Questionnaire internal consistency was 0.839 for the tool as a whole. Inter-observer concordance for the tool as a whole was 0.936 and greater than 0.80 for the majority of the items. The exploratory factor analysis showed a four-factor structure that explains 49.5% of the total variance. The results of this study show that the C-SEI-sp tool is a valid and reliable tool that is easy to apply in the monitoring of student performance in clinical simulation scenarios.
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http://dx.doi.org/10.1016/j.nepr.2018.12.007DOI Listing
February 2019

Immune-mediated inflammatory diseases differently affect IGRAs' accuracy for latent tuberculosis infection diagnosis in clinical practice.

PLoS One 2017 7;12(12):e0189202. Epub 2017 Dec 7.

Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Badalona, Spain.

Background: Clinical accuracy of IGRAs remains unclear on patients with immune-mediated inflammatory diseases (IMIDs). Here, we assess the impact of immunosuppressants and IMIDs on QuantiFERON-TB Gold In-Tube (QFN-G-IT) and T-SPOT.TB accuracy.

Methods: Patients with IMIDs who required latent tuberculosis infection (LTBI) screening were enrolled and classified into: (i) 50 patients with inflammatory rheumatic diseases, (ii) 50 patients with psoriasis and (iii) 30 patients with Crohn's disease. A total of 44 healthy individuals without immunosuppression were also included as controls. Tuberculin skin test (TST), T-SPOT.TB and QFN-G-IT assays were performed. IGRAs were performed following manufacturer's instructions.

Results: Immunosuppressant's intake was more frequent on patients with Crohn's disease and psoriasis. Positive IGRAs and TST results were reduced in Crohn's disease patients, whereas rate of indeterminate T-SPOT.TB results was increased in this group with respect to the other IMIDs analysed and controls. When IFN-γ response was studied, the levels of this cytokine after mitogen stimulation were significantly lower in Crohn's and inflammatory rheumatic diseases than in psoriasis. Interestingly, psoriatic patients were the only ones not receiving corticosteroids. Furthermore, a negative correlation was observed between the IFN-γ secreted after mitogen stimulation and corticosteroids dose.

Conclusions: IMIDs seem to negatively affect the clinical accuracy of IGRAs, being Crohn's disease patients the most affected individuals due to their concomitant drug-profile and impaired immune response.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189202PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720599PMC
December 2017

HEPACONTROL. A program that reduces early readmissions, mortality at 60 days, and healthcare costs in decompensated cirrhosis.

Dig Liver Dis 2018 Jan 13;50(1):76-83. Epub 2017 Aug 13.

University Hospital Germans Trias i Pujol, Liver Unit, Gastroenterology, Barcelona, Spain.

Background & Aims: Decompensated cirrhosis patients have an elevated incidence of early readmission, mortality and economic burden. The aims of HEPACONTROL were to reduce early readmission and to evaluate its impact on mortality and emergency department visits.

Patients And Methods: Quasi-experimental study with control group which compared two cohorts of patients discharged after being admitted for cirrhosis-related complications. A prospective cohort (n=80), who followed the HEPACONTROL program, which began with a follow-up examination seven days after discharge at the Hepatology Unit Day Hospital and a retrospective cohort of patients (n=112), who had been given a standard follow-up. Outcome variables that were compared between both groups were early readmission rates, the number of emergency department visits post-discharge, financial costs and mortality.

Results: The rate of early readmission was lower in the group with HEPACONTROL (11.3% vs 29.5%; P=.003). Also, the mean number of visits to the emergency department post-discharge (1.10±1.64 vs 1.71±2.36; P=.035), mortality at 60days (3.8% vs 14.3%; P=.016), and the cost of early readmission were all lower compared with the group with standard follow-up (P=.029).

Conclusions: HEPACONTROL decreases the incidence of early readmission the rate of emergency department visits and mortality at 60days in patients with decompensated cirrhosis, and it is cost-effective.
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http://dx.doi.org/10.1016/j.dld.2017.08.024DOI Listing
January 2018

Positive Mental Health and Prevalence of Psychological Ill-Being in University Nursing Professors in Catalonia, Spain.

J Psychosoc Nurs Ment Health Serv 2017 Jul;55(7):38-48

The aim of the current study was to examine the prevalence of psychological ill-being among university nursing professors in Spain and determine their grade of positive mental health. A cross-sectional study was conducted from June 2013 to December 2013 with a sample of 263 university nursing professors. Sociodemographic and occupational variables, as well as variables related to daily habits and lifestyle, were collected. Psychological ill-being was measured using the General Health Questionnaire (GHQ-12) and positive mental health was evaluated with the Positive Mental Health Questionnaire (PMHQ). Prevalence of psychological ill-being (GHQ-12 score >2) among the sample was 27% (range = 21.8% to 32.6%), with a higher prevalence in teachers from first and second cycles (Bachelor's degree and Master's degree, respectively) and a lower prevalence in those having very satisfactory social relationships. Significant differences were found in relation to consumption of tranquilizer drugs and Bach flower remedies. PMHQ scores were lower among teachers with a GHQ-12 score >2. Participants presented a good level of positive mental health. Preventive policies should be applied with the aim of reducing psychological ill-being among professors and potentiating positive mental health. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 38-48.].
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http://dx.doi.org/10.3928/02793695-20170619-06DOI Listing
July 2017

Early hospital readmission in decompensated cirrhosis: Incidence, impact on mortality, and predictive factors.

Dig Liver Dis 2017 Aug 18;49(8):903-909. Epub 2017 Mar 18.

Hospital Universitari Germans Trias i Pujol, Liver Unit, Gastroenterology, Departament of Medicine, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.

Background & Aims: The early hospital readmission of patients with decompensated cirrhosis is a current problem. A study is presented on the incidence, the impact on mortality, and the predictive factors of early hospital readmission.

Patients And Methods: On the study included 112 cirrhotic patients, discharged after some decompensation between January 2013 and May 2014. Multivariate analyses were performed to identify predictors of early readmission and mortality.

Results: The early readmission rate was 29.5%. The predictive factors were male gender (OR: 2.81; 95% CI: 1.07-7.35), Model for End-Stage Liver Disease-sodium score ≥15 (OR: 3.79; 95% CI 1.48-9.64), and Charlson index ≥7 (OR: 4.34, 95% CI 1.65-11.4). This model enabled patients to be classified into low or high risk of early readmissions (13.6% vs. 52.2%). The mortality rate was significantly higher among patients with early readmission (73% vs. 35%) (p<.0001). After adjusting for the Model for End-Stage Liver Disease-sodium score, Charlson index, dependence in activities of daily living, educational status, and number of medications on discharge, the early readmission was independently associated with mortality.

Conclusions: Early hospital readmission is common, and is independently associated with mortality. Male gender, MELD-Na ≥15, and Charlson index ≥7 are predictors of early readmission. These results could be used to develop future strategies to reduce early readmission.
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http://dx.doi.org/10.1016/j.dld.2017.03.005DOI Listing
August 2017

Psychometric evaluation of a new instrument in Spanish to measure the wellness of university nursing faculty.

Arch Environ Occup Health 2018 Jan 20;73(1):29-37. Epub 2016 Oct 20.

a Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona , Barcelona , Spain.

The aim of this study was to design and validate an instrument to measure the wellness among university nursing faculty. The study was performed in two phases. Phase I consisted of the development of the instrument with discussion groups and participant consensus. We designed an instrument including the 21 items or psychosocial risk factors identified and estimated an index by evaluating the frequency and intensity of each item. The items were grouped into 3 dimensions: teaching work demands, curricular demands, and organizational difficulties. Phase II, we evaluated the psychometric properties of the tool in a sample of 263 participants. Exploratory factor analysis showed a 3-factor structure that explained 53% of the total variance. The internal consistency of the instrument was 0.91 for the whole instrument. The results indicate that the tool developed is valid and reliable and may be a good instrument to monitor the wellness of university nursing faculty.
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http://dx.doi.org/10.1080/19338244.2016.1246411DOI Listing
January 2018

Executive Summary of the Guidelines for the Use of interferon-gamma Release Assays in the Diagnosis of Tuberculosis Infection.

Arch Bronconeumol 2016 Sep 15;52(9):477-81. Epub 2016 Jul 15.

Servicio de Microbiología, Institut d'Investigació Germans Trias i Pujol; Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Badalona, Barcelona, España; CIBER Enfermedades Respiratorias, Badalona, Barcelona, España. Electronic address:

Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guide-line for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the Grading of Recommendations of Assessment Development and Evaluations methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health.
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http://dx.doi.org/10.1016/j.arbres.2016.02.020DOI Listing
September 2016

Executive summary of the guidelines for the use of interferon-γ release assays in the diagnosis of tuberculosis infection.

Enferm Infecc Microbiol Clin 2016 May 28;34(5):304-8. Epub 2016 Feb 28.

Service of Microbiology, Institut d'Investigació Germans Trias i Pujol; Hospital Universitari Germans Trias i Pujol; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona; CIBER Enfermedades Respiratorias, Carretera del Canyet s/n, 08916 Badalona, Barcelona, Spain. Electronic address:

Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guideline for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at the risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health.
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http://dx.doi.org/10.1016/j.eimc.2015.11.021DOI Listing
May 2016

[Guidelines for the prevention and control of tuberculosis in health care workers].

Med Clin (Barc) 2015 Dec 11;145(12):534.e1-13. Epub 2015 Nov 11.

Unitat de Prevenció i Control de la Tuberculosi de Barcelona , Barcelona, España.

Tuberculosis remains one of the communicable diseases that cause increased morbidity and mortality worldwide. With an incidence rate of 13,04 per 100,000 population, Spain ranks third among the most affected European countries. These data show a tendency to decrease meaning that it may go unnoticed with the potential to miss the appropriate preventive measures in a suspected case. In centers where patients are treated with tuberculosis, health care worker presents risk of transmission. This risk is higher in some areas or work units. The Occupational health physicians' services, which monitorize the health of health care workers, use different strategies in order to prevent and detect tuberculosis infection. The national guidelines include the tuberculin skin test as a screening test for tuberculosis infection with mention of new diagnostic tests based on the in vitro detection of gamma interferon (IGRA) for certain cases. The purpose of this guide is to establish common criteria for IGRA tests, as a supplementary aid to the tuberculin skin test in health care workers, from the evidence available today. Recommendations for its use have been adapted to the different situations faced by the professionals involved in monitoring the health of health workers.
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http://dx.doi.org/10.1016/j.medcli.2015.06.018DOI Listing
December 2015

A novel whole-blood miRNA signature for a rapid diagnosis of pulmonary tuberculosis.

Eur Respir J 2015 Apr 5;45(4):1173-6. Epub 2015 Feb 5.

Infection Biology Laboratory, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain

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http://dx.doi.org/10.1183/09031936.00221514DOI Listing
April 2015

Immunogenicity of 60 novel latency-related antigens of Mycobacterium tuberculosis.

Front Microbiol 2014 8;5:517. Epub 2014 Oct 8.

Department of Microbiology, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol Badalona, Spain ; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona Bellaterra, Spain ; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III Badalona, Spain.

The aim of our work here was to evaluate the immunogenicity of 60 mycobacterial antigens, some of which have not been previously assessed, notably a novel series of in vivo-expressed Mycobacterium tuberculosis (IVE-TB) antigens. We enrolled 505 subjects and separated them in individuals with and without latent tuberculosis infection (LTBI) vs. patients with active tuberculosis (TB). Following an overnight and 7 days stimulation of whole blood with purified recombinant M. tuberculosis antigens, interferon-γ (IFN-γ) levels were determined by ELISA. Several antigens could statistically significantly differentiate the groups of individuals. We obtained promising antigens from all studied antigen groups [dormancy survival regulon (DosR regulon) encoded antigens; resuscitation-promoting factors (Rpf) antigens; IVE-TB antigens; reactivation associated antigens]. Rv1733, which is a probable conserved transmembrane protein encoded in DosR regulon, turned out to be very immunogenic and able to discriminate between the three defined TB status, thus considered a candidate biomarker. Rv2389 and Rv2435n, belonging to Rpf family and IVE-TB group of antigens, respectively, also stood out as LTBI biomarkers. Although more studies are needed to support our findings, the combined use of these antigens would be an interesting approach to TB immunodiagnosis candidates.
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http://dx.doi.org/10.3389/fmicb.2014.00517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189613PMC
October 2015

Impact of the 2009 influenza A H1N1 pandemic on invasive pneumococcal disease in adults.

Scand J Infect Dis 2014 Mar 24;46(3):185-92. Epub 2014 Jan 24.

From the Infectious Diseases Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES , Spain.

Background: The incidence of invasive pneumococcal disease (IPD) appears to be associated with influenza. The objectives of this study were to evaluate the changes in IPD incidence and clinical data as well as the trends in Streptococcus pneumoniae serotype distribution in adults during the peak period of the 2009 influenza A H1N1 pandemic (IAP).

Methods: We performed a prospective multicentre study on IPD from week 42 to 48, 2009 in an area of Barcelona (Catalonia, Spain) covering 1,483,781 adult inhabitants. Serotyping was done by Quellung reaction. The data from 2009 were compared to those from the same periods in 2008 and 2010.

Results: Two hundred and three cases of IPD were detected during 2009, compared with 182 in 2008 and 139 in 2010. The incidence of IPD during the 7-week study period in 2009 (2.89) was statistically higher than that observed in 2008 (1.96) and 2010 (1.46). IAP was confirmed in 3/30 patients during the 2009 study period. Patients with IPD in 2009 were significantly healthier and younger than those in the other years, although the mortality was higher than in 2008 (p = 0.05) and 2010 (p > 0.05). Eleven (10 non-PCV-7) serotypes not present in 2008 appeared in 2009.

Conclusions: During weeks 42 to 48, in which the 2009 IAP peaked in Catalonia, the incidence of IPD was statistically higher than that observed in the same time period in 2008 and 2010, with some differences in the epidemiological data, showing a close relationship between S. pneumoniae and influenza.
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http://dx.doi.org/10.3109/00365548.2013.867072DOI Listing
March 2014

Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study.

Am J Infect Control 2014 Jan 5;42(1):38-42. Epub 2013 Nov 5.

Infectious Diseases Unit, Internal Medicine Department, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain.

Background: Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections and is associated with high morbidity and mortality. Numerous studies on HAP have been performed in intensive care units (ICUs), whereas very few have focused on patients in general wards. This study examined the incidence of, risk factors for, and outcomes of HAP outside the ICU.

Methods: An incident case-control study was conducted in a 600-bed hospital between January 2006 and April 2008. Each case of HAP was randomly matched with 2 paired controls. Data on risk factors, patient characteristics, and outcomes were collected.

Results: The study group comprised 119 patients with HAP and 238 controls. The incidence of HAP outside the ICU was 2.45 cases per 1,000 discharges. Multivariate analysis identified malnutrition, chronic renal failure, anemia, depression of consciousness, Charlson comorbidity index ≥3, previous hospitalization, and thoracic surgery as significant risk factors for HAP. Complications occurred in 57.1% patients. The mortality attributed to HAP was 27.7%.

Conclusions: HAP outside the ICU prevailed in patients with malnutrition, chronic renal failure, anemia, depression of consciousness, comorbidity, recent hospitalization, and thoracic surgery. HAP in general wards carries an elevated morbidity and mortality and is associated with increased length of hospital stay and increased rate of discharge to a skilled nursing facility.
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http://dx.doi.org/10.1016/j.ajic.2013.06.021DOI Listing
January 2014

Hepatitis C virus transmission during colonoscopy evidenced by phylogenetic analysis.

J Clin Virol 2013 Jul 6;57(3):263-6. Epub 2013 Apr 6.

Microbiology Service, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.

Background: Nosocomial transmission events still play an important role in hepatitis C virus (HCV) spreading. Among most reported medical procedures involved in nosocomial transmission, endoscopy procedures remain controversial and might be underestimated.

Objective: The aim of the study was to investigate a case of nosocomial person-to-person transmission of HCV in an endoscopy unit.

Study Design: An acute HCV infection was detected in a person that had undergone a colonoscopy after an HCV-infected patient. Serum samples from both persons were subjected to a molecular epidemiology study. The HCV NS5B genetic region was amplified and directly sequenced and the E1-E2 region was amplified, cloned and sequenced (20 clones per specimen). All sequences were subjected to phylogenetic analyses. A conventional epidemiological investigation was performed to determine the most likely cause of HCV transmission.

Results: NS5B sequence analysis revealed that both persons were infected with closely related HCV-1b strains. Furthermore, phylogenetic analysis of E1-E2 sequences evidenced a direct transmission between patients. The epidemiological investigation pointed out to anesthetic procedures as the most likely source of HCV transmission. The index case, not having spontaneously cleared the infection 10 months after infection, required antiviral treatment, which resulted in a sustained virological response.

Conclusions: The molecular epidemiology study performed provided evidence of a person-to-person transmission of HCV during a colonoscopy procedure, and the anesthetic procedure was the most likely source of HCV transmission. This study highlights the importance of strictly following standard precautions by healthcare workers in order to prevent nosocomial HCV transmission.
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http://dx.doi.org/10.1016/j.jcv.2013.03.007DOI Listing
July 2013

Incidence of tuberculosis infection among healthcare workers: risk factors and 20-year evolution.

Respir Med 2013 Apr 10;107(4):601-7. Epub 2013 Jan 10.

Preventive Medicine Service, Hospital Germans Trias i Pujol, Badalona, Spain.

Objective: To determine the incidence of latent tuberculosis infection (LTBI), and risk factors for tuberculosis skin test (TST) conversion among Healthcare workers (HCWs) during a 20-year follow-up period.

Design: Prospective cohort analysis. Surveillance was conducted from January 1, 1988, to December 31, 2007.

Setting: 600-bed tertiary referral hospital in Barcelona, Spain.

Participants: HCWs in risk for occupational tuberculosis (TB) exposure, with negative baseline TST, direct contact with patients and/or biological samples and at least one follow-up visit with TST.

Methods: TST is performed in HCWs with no previous history of TB or no previous positive TST. When TST is negative this test is performed once a year in high-risk workers, or at least every 2 years according to the hospital's guidelines. In all cases an interview questionnaire to gather information on possible risk factors was performed.

Results: The study included 614 HCWs, 27% worked in areas of risk for TB exposure. Annual incidence rate had decreased from 46.8 per 100 person-years in 1990 to 1.08 per 100 person-years in 2007. Cumulative incidence was higher in HCWs who work in high-risk areas (p = 0.004) and in time periods from 1990 to 1995, and from 1996 to 2001 (p < 0.0001). Cox regression model showed a hazard ratio of 1.55 (CI 95%; 1.05-2.27) in high-risk workers, adjusted by gender, age and professional status.

Conclusions: Incidence of LTBI among HCWs is high, although it decreased throughout the follow-up period. It is crucial to maintain surveillance programs in HCWs.
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http://dx.doi.org/10.1016/j.rmed.2012.12.008DOI Listing
April 2013

[A study of tuberculosis infection in workers at a university general hospital: associated factors and evolution in 20 years].

Arch Bronconeumol 2011 Nov 23;47(11):541-6. Epub 2011 Sep 23.

Servicio de Medicina Preventiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.

Objective: To estimate the prevalence of tuberculous infection (TI) in the health-care workers of a hospital over the course of a 20-year period and analyze the associated risk factors.

Subjects And Methods: A cross-sectional, descriptive study of the workers of a general hospital from 1988 until 2007, using a tuberculin test (TT) and questionnaire.

Results: 2,179 workers were studied (mean age 32.4 years (SD 8.4). 24.5% worked in areas at risk for tuberculosis (TB). 8.1% (174) were vaccinated with BCG. The prevalence of positive baseline TT was 25.7% (95% confidence interval: 23.8-27.4%). There was a greater percentage of positive TT in the 1988-1992 period (44.2%) and a smaller percentage (15.8%) in the 2003-2007 period (P<.0001). The prevalence of TI was 1.53 times greater in males and 1.89 in those vaccinated with BCG. When compared with resident physicians, the prevalence of TI was greater in the rest of the professional categories, while increasing 1.03 times per year that age increases and 1.05 times per year of professional activity.

Conclusions: The data provide relevant information about the evolution of TI in hospital professionals over the course of a 20-year period. The prevalence decreased during the study period, probably due to a decrease in the incidence of TB in the reference community and to improved prevention measures and nosocomial control.
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http://dx.doi.org/10.1016/j.arbres.2011.07.003DOI Listing
November 2011

Evaluation of interferon-gamma release assays in the diagnosis of recent tuberculosis infection in health care workers.

PLoS One 2009 Aug 24;4(8):e6686. Epub 2009 Aug 24.

Servei de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.

Background: Health care workers (HCWs) are a group at risk of latent tuberculosis infection (LTBI). The aims of this study were to determine IFN-gamma response by QuantiFERON-TB GOLD In Tube (QFN-G-IT) and T-SPOT.TB in HCWs, comparing the results with tuberculin skin test (TST); and to analyze the capacity of IFN-gamma tests to detect recent versus remote LTBI with a prolonged stimulation test (PST).

Methodology/principal Findings: A total of 147 HCWs were enrolled; 23 of whom were BCG vaccinated. 95 HCWs (64.6%) had a previous positive TST and were not retested; and 52 HCWs had a previous negative TST or were tested for the first time. When we analysed individuals without previous positive TST, the number of positive results for T-SPOT.TB was 12/52 (23.1%); and for QFN-G-IT, 9/52 (17.3%). The global concordance (kappa) between T-SPOT.TB and QFN-G-IT with TST was 0.754 and 0.929 respectively. Of individuals with previous positive TST, T-SPOT.TB and QFN-G-IT were negative in 51.6% (49/95) and 62.1% (59/95) respectively, decreasing the concordance to 0.321 and 0.288, respectively. In non-BCG vaccinated HCWs with previous positive TST a positive IFN-gamma test was associated with degree of exposure and diameter of TST. PST was performed in 24 HCW with previous positive TST and negative IFN-gamma tests. PST was developed in 3 cell cultures stimulated with medium alone, ESAT-6 and CFP-10, respectively. In the third and sixth day of incubation period, part of the supernatants were replaced with complete medium supplemented with (rIL)-2. On day 9, ELISPOT assay was performed. In 14 samples PST was not valid due to not having enough cells. In 8 cases, the response was negative, and in 2 cases positive, suggesting that these patients were infected with Mycobacterium tuberculosis in some point in the past.

Conclusions: Both IFN-gamma tests showed a similar number of positive results, and concordance between the tests was excellent. None of the tests was affected by prior BCG vaccination. IFN-gamma tests are a useful tool for detecting recent infection in HCW population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0006686PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726945PMC
August 2009

[Cancer diagnosis in hospital workers].

Med Clin (Barc) 2009 Jun 20;133(2):53-6. Epub 2009 May 20.

Unidad de Medicina Preventiva, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, España.

Background And Objective: We aimed to identify cases of cancer diagnosis in hospital workers and to establish if an excess of cases exist.

Material And Method: For cases occurring during 1990-2005 the following data about workers were checked: birth date, sex, location of the neoplasm, date of diagnosis of the neoplasm, working category, hospital service/unit and work duration at the hospital. The standard incidence ratio (SIR) was calculated for each type of cancer.

Results: Fifty one neoplasms were registered (21 male and 30 women) Most frequent types of cancer were breast (19 cases), leukemia-lymphoma (7 cases), lung (4 cases) and prostate (4 cases). At the time of diagnosis the average age was 47,3 years (DE 9,2). 22 cases were detected in doctors, 18 in nurses and assistant nurses and 4 in assistants. An excess of cases was not found. Comparing data with cancer cases in the whole population, the prevalence of colon cancer was lower than the average (SIR: 0,25; CI 95%: 0,03-0,89) as well as the prevalence of gastric cancer (SIR: 0,19; CI 95%: 0,02-0,69).

Conclusions: An excess of cancer risk was not found in the studied group. Difficulties in obtaining information about people at risk and cancer incidence reveal the need to improve the sources of information for this kind of studies in Spain.
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http://dx.doi.org/10.1016/j.medcli.2008.10.058DOI Listing
June 2009