Publications by authors named "J L Quesada"

354 Publications

Trends in mortality due to pressure ulcers in Spain, over the period 1999-2016.

J Tissue Viability 2021 Apr 3. Epub 2021 Apr 3.

Clinical Medicine Department, Miguel Hernández University, Carretera Nacional, N-332 S/n, 03550, Sant Joan, Alicante, Spain. Electronic address:

Aim: to analyse trends in mortality by Pressure Ulcers (PU) in Spain, between 1999 and 2016.

Methods: Mortality due to PU in residents in Spain over 65, where a PU was underlying/basic cause of death, was analysed. Data for populations and deaths were gathered from the Spanish National Statistics Institute. Variables were age, sex, year of death and underlying/basic cause of death. Age-adjusted mortality rates were calculated (direct method), with 2013 European standard population. To analyse temporal trends and to detect significant changes, joinpoint regression models were adjusted to estimate average annual percentage change of Age-Adjusted mortality Rates for each segment detected. An analysis was performed for those over 65, and by the age groups 65-84, and over 84 years.

Results: A total of 11,238 deaths due to PU in people over 65, between 1999 and 2016, were analysed. There was a general decrease for both, women and men, over the period. From the Joinpoint analysis, for men, two changes were detected in those over 65, with a significant decrease observed until 2008. For those over 84, was a significant decrease of 4.4% on average per year. For women, a significant decrease is observed in all age groups, with a change of trend in 2007.

Conclusion: This study provides a general overview of the epidemiology of PU mortality in Spain. It may serve as a confirmation of the good health policies carried out in the past on PU, given that we observe a generalised decrease in mortality from PUs over the period. Mortality was higher in women at the beginning of the period but without differences at the end, compared with men. Changes occurred over time could be explained by implementation of patient safety policies.
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http://dx.doi.org/10.1016/j.jtv.2021.03.007DOI Listing
April 2021

Structural vulnerability: migration and health in social context.

BMJ Glob Health 2021 Apr;6(Suppl 1)

Department of Anthropology, University of California San Francisco, San Francisco, California, USA.

Based on the authors' work in Latin America and Africa, this article describes and applies the concept 'structural vulnerability' to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA-Mexico border and another in Djibouti. Migrants' and providers' various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.
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http://dx.doi.org/10.1136/bmjgh-2021-005109DOI Listing
April 2021

A modified Delphi consensus study to identify improvement proposals for COPD management amongst clinicians and administrators in Spain.

Int J Clin Pract 2021 Mar 6:e13934. Epub 2021 Mar 6.

Clinical Medicine Department, Miguel Hernandez University of Elche, San Juan de Alicante, Spain.

Aims: To identify the obstacles hindering the appropriate management of chronic obstructive pulmonary disease (COPD) in Spain based on consensus amongst clinicians and administrators.

Methods: A two-round modified Delphi questionnaire was sent to clinicians (pulmonologists and GPs) and administrators, all experts in COPD. The scientific committee developed the statements and selected the participating experts. Four areas were explored: diagnosis, training, treatment, and clinical management. Panellists' agreement was assessed using a 9-point Likert scale, with scores of 1 to 3 indicating disagreement and 7 to 9, agreement. Consensus was considered to exist when 70% of the participants agreed or disagreed with the statement.

Results: Respective response rates for the first and second round were 68% and 91% for clinicians, and 60% and 100% for administrators. The statements attracting the highest degree of consensus were: "Not enough nursing resources (time, staff, duties) are allocated for performing spirometry" (85.3% clinicians; 75% administrators); "Nurses need specific training in COPD" (84.8% clinicians; 100% administrators); "Rehabilitation programs are necessary for treating patients with COPD" (94.1% clinicians; 91.7% administrators); and "Integrated care processes facilitate the deployment of educational programs on COPD" (79.4% clinicians; 83.3% administrators).

Conclusions: This document can inform the development and implementation of specific initiatives addressing the existing obstacles in COPD management.

What's Known: COPD is a prevalent and underdiagnosed disease that causes substantial morbidity and mortality. The National COPD Strategy established objectives and work programmes to apply in Spain. There are barriers impeding the application of interventions contemplated in the COPD strategy.

What's New: Different agents involved in COPD management agree that the main challenges to improve COPD management are resource shortages in primary care nursing and lack of training in the use of COPD clinical guidelines. Clinicians and administrators involved in COPD management support the implementation of urgent measures to tackle the underdiagnosis of COPD, especially in primary care, along with the routine inclusion of respiratory rehabilitation programmes for COPD.
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http://dx.doi.org/10.1111/ijcp.13934DOI Listing
March 2021

Effluent decontamination by the ibuprofen-mineralizing strain, Sphingopyxis granuli RW412: Metabolic processes.

Environ Pollut 2021 Apr 24;274:116536. Epub 2021 Jan 24.

Dept. of Environmental Protection, Estación Experimental Del Zaidín - CSIC, Calle Professor Albareda 1, 18008, Granada, Spain. Electronic address:

The high global consumption of ibuprofen and its limited elimination by wastewater treatment plants (WWTPs), has led to the contamination of aquatic systems by this common analgesic and its metabolites. The potentially negative environmental and public health effects of this emerging contaminant have raised concerns, driving the demand for treatment technologies. The implementation of bacteria which mineralize organic contaminants in biopurification systems used to decontaminate water or directly in processes in WWTPs, is a cheap and sustainable means for complete elimination before release into the environment. In this work, an ibuprofen-mineralizing bacterial strain isolated from sediments of the River Elbe was characterized and assayed to remediate different ibuprofen-polluted media. Strain RW412, which was identified as Sphingopyxis granuli, has a 4.48 Mb genome which includes plasmid sequences which harbor the ipf genes that encode the first steps of ibuprofen mineralization. Here, we confirm that these genes encode enzymes which initiate CoA ligation to ibuprofen, followed by aromatic ring activation by a dioxygenase and retroaldol cleavage to unequivocally produce 4-isobutylcatechol and propionyl-CoA which then undergo further degradation. In liquid mineral salts medium, the strain eliminated more than 2 mM ibuprofen within 74 h with a generation time of 16 h. Upon inoculation into biopurification systems, it eliminated repeated doses of ibuprofen within a few days. Furthermore, in these systems the presence of RW412 avoided the accumulation of ibuprofen metabolites. In ibuprofen-spiked effluent from a municipal WWTP, ibuprofen removal by this strain was 7 times faster than by the indigenous microbiota. These results suggest that this strain can persist and remain active under environmentally relevant conditions, and may be a useful innovation to eliminate this emerging contaminant from urban wastewater treatment systems.
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http://dx.doi.org/10.1016/j.envpol.2021.116536DOI Listing
April 2021

Long-term outcomes of transvaginal ultrasound-guided aspiration versus traditional conservative surgery as treatment for endometriomas: A retrospective study of cohorts.

J Obstet Gynaecol Res 2021 Apr 31;47(4):1462-1471. Epub 2021 Jan 31.

Department/Division of Gynaecology, Miguel Hernández University, Alicante, Spain.

Aim: To evaluate if the long-term results (on fertility, need of hysterectomy and persistence of endometriosis) after a minimally invasive intervention (transvaginal ultrasound-guided puncture-aspiration [TUGPA]) for endometriomas are significantly different from performing the traditional conservative surgery (CS) by laparoscopy or laparotomy.

Methods: We performed a retrospective study of cohorts on patients undergoing surgery for ovarian endometriomas between January 1998 and April 2015. Cohort 1 consisted of 75 women whose first intervention for endometriomas had been TUGPA. For the cohort 2, we selected a randomized paired case in which the first operation for endometriomas had been CS by laparoscopic or laparotomy (another set of 75 patients).

Results: There were significantly more recurrences and the time to recurrence and repetition of operations were also significantly shorter in patients with TUGPA. However, there were no significant differences in overall pregnancy/delivery outcomes, in hysterectomy performances, or in endometriosis persistence at the last follow-up visit. There were no significant differences related to the symptoms or to analytical presurgical values but the application of multivariate analysis with binary logistic regression to each dependent variable adjusted for age, symptoms, and presurgical analyses showed a significant risk of recurrence and reoperation of TUGPA versus CS.

Conclusions: Those patients with endometriomas who underwent TUGPA (with or without associated medications) had a significant increase in recurrence and the need for reoperation. However, in the long-term there were no significant differences in the results of pregnancy/childbirth, need for hysterectomy, or in the clinical or doubtful persistence of endometriosis.
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http://dx.doi.org/10.1111/jog.14679DOI Listing
April 2021

Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain.

Aten Primaria 2021 02 25;53(2):101942. Epub 2021 Jan 25.

Family Medicine Chair, Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.

Aims: To validate a translated and culturally adapted version of the Morisky Medication Adherence Scale for use in Spanish population, and to examine the psychometric properties of this scale in patients with type 2 diabetes mellitus in Spain.

Design: This cross-sectional study was conducted in a single university hospital in Spain. Patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, being treated with anti-diabetic medication were included.

Intervention: We used the Spanish version of the scale to measure treatment adherence.

Principal Measurements: three level categorical scale is broken down into low adherence (score of <6), medium adherence (score of 6 to <8) and high adherence (score of 8). To validate the questionnaire, we measured internal consistency through Cronbach's α, confirmed construct validity through an exploratory principal component analysis and assessed test-retest reliability.

Results: 232 patients met the inclusion criteria. The Cronbach's α coefficient was 0.40 (95% CI 0.28-0.52). The exploratory principal component analysis showed three components. The intraclass correlation coefficient was 0.718 (95% CI 0.564-0.823).

Conclusions: the Spanish version of the Morisky Medication Adherence scale showed low internal consistency, the exploratory factor analysis identified three dimensions, and the test-retest reliability was acceptable, therefore, psychometric properties of MMAS-8 are not suitable for measuring medication adherence in type 2 diabetes mellitus patients from Spain.
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http://dx.doi.org/10.1016/j.aprim.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844132PMC
February 2021

Trends in premature mortality due to ischemic heart disease in Spain from 1998 to 2018.

Rev Esp Cardiol (Engl Ed) 2021 Jan 2. Epub 2021 Jan 2.

Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain.

Introduction And Objectives: Ischemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region.

Methods: Observational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models.

Results: During the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of -3.92% and -5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain.

Conclusions: Premature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.
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http://dx.doi.org/10.1016/j.rec.2020.09.034DOI Listing
January 2021

A randomized controlled double-blind study of rotigotine on neuropsychiatric symptoms in de novo PD.

NPJ Parkinsons Dis 2020 Dec 15;6(1):41. Epub 2020 Dec 15.

Department of Neurology, Inselspital, University Hospital Bern, CH-3010, Bern, Switzerland.

Management of apathy, depression and anxiety in Parkinson's disease (PD) represents a challenge. Dopamine agonists have been suggested to be effective. This multicenter, randomized (1:1), double-blind study assessed the 6-month effect of rotigotine versus placebo on apathy, depression and anxiety in de novo PD. The primary outcome was the change of apathy, measured with the LARS. The secondary outcomes were the change in depression and anxiety, measured with BDI-2 and STAI-trait and state. Forty-eight drug-naive PD patients were included. The primary outcome was not reached, with a surprisingly high placebo effect on apathy (60%). There was no significant difference in the change of depression at 6 months between rotigotine and placebo. Trait-anxiety was significantly improved by rotigotine compared to placebo (p = 0.04). Compared to placebo, low dose rotigotine significantly improved trait anxiety, but not apathy and depression. The major placebo effect on apathy points towards the importance of a multidisciplinary and tight follow-up in the management of neuropsychiatric symptoms.
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http://dx.doi.org/10.1038/s41531-020-00142-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738499PMC
December 2020

Impact of patients' perception of COPD and treatment on adherence and health-related quality of life in real-world: Study in 53 community pharmacies.

Respir Med 2021 Jan 3;176:106280. Epub 2020 Dec 3.

Department of Public Health, History of Science and Gynecology, Miguel Hernández University and CIBER en Epidemiología y Salud Pública, Crtra Alicante-Valencia km 81, Sant Joan d'Alacant, 03550, Alicante, Spain. Electronic address:

Background: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings.

Methods: We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test.

Results: Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001).

Conclusions: The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.
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http://dx.doi.org/10.1016/j.rmed.2020.106280DOI Listing
January 2021

Hospital admissions trends for severe hypoglycemia in diabetes patients in Spain, 2005 to 2015.

Diabetes Res Clin Pract 2021 Jan 23;171:108565. Epub 2020 Nov 23.

Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.

Aims: To analyze hospital admissions trends, inpatient mortality, and mean length of hospital stay due to hypoglycemia in patients with diabetes in Spain from 2005 to 2015.

Methods: National Institute of Statistics provided information on hospital discharge and mortality. Hospital admissions due to severe hypoglycemia were identified using ICD-9 codes. Age-adjusted admission and mortality rates were stratified by sex and year. Joinpoint regression models were used to estimate trends.

Results: Admissions rates per 100,000 population were higher for men than women in 2005 (30.2, 95%CI:29.3, 31.0 versus 21.5, 95%CI:20.9, 22.1) and 2015 (23.7, 95%CI:23.0, 24.4 versus 13.2, 95%CI:12.7, 13.6). Mortality per 100,000 population was also higher for men in both years (2005: 9.4, 95%CI:7.8, 11.0 versus 8.6, 95%CI:7.4, 9.8; 2015: 6.4, 95%CI:5.3, 7.6 versus 4.1, 95%CI:3.3, 4.8). Mortality dropped 5.2 percentage points annually (95%CI:-8.4, -1.9) in men and 7.0 percentage points annually (95%CI:-8.7, -5.2) in women from 2005 to 2015. Mean length of hospital stay changed only for women: 7.8 days (95%CI:7.5, 8.0) to 6.7 days (95%CI:6.4, 6.9).

Conclusions: Hospital admissions and inpatient mortality due to hypoglycemia in diabetes patients decreased from 2005 to 2015. This trend was more pronounced in women. Mean length of hospital stay decreased in women.
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http://dx.doi.org/10.1016/j.diabres.2020.108565DOI Listing
January 2021

Health literacy of pregnant women and duration of breastfeeding maintenance: A feasibility study.

J Adv Nurs 2021 Feb 18;77(2):703-714. Epub 2020 Nov 18.

National Institute for Health Research Health Protection Research Unit (NIHR HPRU), Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK.

Aims: Research the association between health literacy (HL) and exclusive breastfeeding at 4-months postpartum.

Background: Despite the benefits of breastfeeding (BF), its rates are low worldwide. Among the reasons for abandonment is the level of maternal education. Maternal education has been associated with HL, but evidence between HL and BF maintenance is limited.

Design: A cross-sectional study.

Methods: The sample compromised 229 nursing mothers recruited from January 2018 to the end of December 2018 at Spain by systematic sampling method. Women were interviewed postpartum on parameters associated with the start and continuation of BF up to 4 months postpartum. Multivariate logistic regression models to explain exposure variables and exclusive BF cessation at 4 months.

Results: Approximately 10% of the participants had inadequate HL. Factors associated with early cessation of exclusive BF at 4 months in the multivariate model adjusted using a stepwise variable selection process based on a likelihood ratio test were civil status, risk of pregnancy, type of delivery, limited or inadequate level of HL, and LATCH score at discharge, with an 85.6% area under the ROC curve.

Conclusions: Our study offers preliminary evidence regarding the hitherto inconsistent relation between HL and early cessation exclusive BF at 4 months, supporting the conduct of further studies with larger sample sizes and greater statistical power. Such studies are warranted before endorsing HL-based interventions aiming to mitigate early cessation exclusive BF.

Impact: Low or inadequate HL is linked to multiple poor health and clinical outcomes. We investigated the prevalence of exclusive BF at 4 months postpartum, and the impact of HL in maintaining optimal exclusive BF practices. Limited or inadequate HL was one of the factors associated with early cessation of exclusive BF in the multivariate regression model, although further research is needed.
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http://dx.doi.org/10.1111/jan.14625DOI Listing
February 2021

Neutron Capture on the s-Process Branching Point ^{171}Tm via Time-of-Flight and Activation.

Authors:
C Guerrero J Lerendegui-Marco M Paul M Tessler S Heinitz C Domingo-Pardo S Cristallo R Dressler S Halfon N Kivel U Köster E A Maugeri T Palchan-Hazan J M Quesada D Rochman D Schumann L Weissman O Aberle S Amaducci J Andrzejewski L Audouin V Bécares M Bacak J Balibrea A Barak M Barbagallo S Barros F Bečvář C Beinrucker D Berkovits E Berthoumieux J Billowes D Bosnar M Brugger Y Buzaglo M Caamaño F Calviño M Calviani D Cano-Ott R Cardella A Casanovas D M Castelluccio F Cerutti Y H Chen E Chiaveri N Colonna G Cortés M A Cortés-Giraldo L Cosentino H Dafna A Damone M Diakaki M Dietz E Dupont I Durán Y Eisen B Fernández-Domínguez A Ferrari P Ferreira P Finocchiaro V Furman K Göbel A R García A Gawlik T Glodariu I F Gonçalves E González-Romero A Goverdovski E Griesmayer F Gunsing H Harada T Heftrich J Heyse T Hirsh D G Jenkins E Jericha F Käppeler Y Kadi B Kaizer T Katabuchi P Kavrigin V Ketlerov V Khryachkov D Kijel A Kimura M Kokkoris A Kriesel M Krtička E Leal-Cidoncha C Lederer-Woods H Leeb S Lo Meo S J Lonsdale R Losito D Macina A Manna J Marganiec T Martínez C Massimi P Mastinu M Mastromarco F Matteucci E Mendoza A Mengoni P M Milazzo M A Millán-Callado F Mingrone M Mirea S Montesano A Musumarra R Nolte A Oprea N Patronis A Pavlik J Perkowski L Piersanti I Porras J Praena K Rajeev T Rauscher R Reifarth T Rodríguez-González P C Rout C Rubbia J A Ryan M Sabaté-Gilarte A Saxena P Schillebeeckx S Schmidt A Shor P Sedyshev A G Smith A Stamatopoulos G Tagliente J L Tain A Tarifeño-Saldivia L Tassan-Got A Tsinganis S Valenta G Vannini V Variale P Vaz A Ventura V Vlachoudis R Vlastou A Wallner S Warren M Weigand C Weiss C Wolf P J Woods T Wright P Žugec

Phys Rev Lett 2020 Oct;125(14):142701

European Organization for Nuclear Research (CERN), Geneva, Switzerland.

The neutron capture cross sections of several unstable nuclides acting as branching points in the s process are crucial for stellar nucleosynthesis studies. The unstable ^{171}Tm (t_{1/2}=1.92  yr) is part of the branching around mass A∼170 but its neutron capture cross section as a function of the neutron energy is not known to date. In this work, following the production for the first time of more than 5 mg of ^{171}Tm at the high-flux reactor Institut Laue-Langevin in France, a sample was produced at the Paul Scherrer Institute in Switzerland. Two complementary experiments were carried out at the neutron time-of-flight facility (n_TOF) at CERN in Switzerland and at the SARAF liquid lithium target facility at Soreq Nuclear Research Center in Israel by time of flight and activation, respectively. The result of the time-of-flight experiment consists of the first ever set of resonance parameters and the corresponding average resonance parameters, allowing us to make an estimation of the Maxwellian-averaged cross sections (MACS) by extrapolation. The activation measurement provides a direct and more precise measurement of the MACS at 30 keV: 384(40) mb, with which the estimation from the n_TOF data agree at the limit of 1 standard deviation. This value is 2.6 times lower than the JEFF-3.3 and ENDF/B-VIII evaluations, 25% lower than that of the Bao et al. compilation, and 1.6 times larger than the value recommended in the KADoNiS (v1) database, based on the only previous experiment. Our result affects the nucleosynthesis at the A∼170 branching, namely, the ^{171}Yb abundance increases in the material lost by asymptotic giant branch stars, providing a better match to the available pre-solar SiC grain measurements compared to the calculations based on the current JEFF-3.3 model-based evaluation.
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http://dx.doi.org/10.1103/PhysRevLett.125.142701DOI Listing
October 2020

[Incubation period of COVID-19: A systematic review and meta-analysis].

Rev Clin Esp 2021 Feb 1;221(2):109-117. Epub 2020 Oct 1.

Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España.

Background And Objective: The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves. Several emerging studies have produced varying results; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19.

Methods: For this systematic review, a literature search was conducted using Pubmed, Scopus/EMBASE, and the Cochrane Library databases, covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020.We estimated the mean and 95th percentile of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables.

Results: We included seven studies (n = 792) in the meta-analysis. The heterogeneity (I 83.0%, < 0.001) was significantly decreased when we included the study quality and the statistical model used as moderator variables (I 15%). The mean incubation period ranged from 5.6 (95% CI: 5.2 to 6.0) to 6.7 days (95% CI: 6.0 to 7.4) according to the statistical model. The 95 percentile was 12.5 days when the mean age of patients was 60 years, increasing 1 day for every 10 years.

Conclusion: Based on the published data reporting the incubation period of COVID-19, the mean time between exposure and onset of clinical symptoms depended on the statistical model used, and the 95th percentile depended on the mean age of the patients. It is advisable to record sex and age when collecting data in order to analyze possible differential patterns.
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http://dx.doi.org/10.1016/j.rce.2020.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528969PMC
February 2021

Expert consensus for primary management of reproductive health: a Delphi study.

Ir J Med Sci 2020 Sep 28. Epub 2020 Sep 28.

Chair of Reproductive and Community Medicine, Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550, Alicante, San Juan de Alicante, Spain.

Background: The main barrier for an appropriate primary management of the reproductive health was lack of knowledge about the risk factors and prevention measures for infertility and the main recommendations was to involve primary care physicians in reproductive health.

Aims: To reach a consensus around barriers and enablers for appropriate primary management of the reproductive health.

Methods: An observational study was performed using the modified Delphi technique, from October 2017 to April 2018 in private and public assisted reproduction clinics in Spain. A questionnaire consisted of 58 items, divided into four blocks to explore consensus among a group of experts by synthesizing opinions.

Results: In the first Delphi round, the response rate was 50% and panelists reached a 72.4% of consensus. In second round, the response rate was 55% and panelists reached a 25% of consensus. To minimize limitations related to the use of a structured questionnaire, a space for free text responses was provided. The following items yielded unanimous agreement: "It is necessary to promote reproductive planning-not just contraception-from secondary school," "The media should not trivialize pregnancies in women aged over 50," "Postponing family formation is the main cause of the increase in assisted reproduction treatments in Spain," and "Postponing motherhood implies an inherently decreased probability of having children."

Conclusions: These recommendations could set the basis for a public health action plan for primary management of reproductive health. The findings may be applicable to any country whose health services system provides primary healthcare.
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http://dx.doi.org/10.1007/s11845-020-02380-7DOI Listing
September 2020

Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study.

Int J Clin Pract 2021 Jan 8;75(1):e13610. Epub 2020 Nov 8.

Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain.

Background And Aim: Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics.

Methods: Cross-sectional study in occupational risks prevention centre in Castellón (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analysed (Liposcale test), along with the concentration, size and number of the main types of lipoprotein particles, determined by 2D diffusion-ordered NMR spectroscopy. Using contingency tables, we analysed the characteristics of people with normal LDL and HDL cholesterol but abnormal levels of LDL and HDL particles. The magnitude of association between explanatory variables and abnormal levels of each kind of lipoprotein was assessed with multivariable logistic regression models.

Results: Of the 400 total participants (31.3% women; age 46.4 ± 4.3 years), 169 had normal LDL and HDL cholesterol. Abnormal lipoprotein particle values depended on the subtype: prevalence of abnormal LDL levels ranged from 8.3% to 36.7%; and of HDL, from 28.4% to 42.6%. High systolic blood pressure and total cholesterol were significantly associated with abnormal LDL levels. Male sex and high systolic blood pressure were associated with abnormalities in HDL.

Conclusions: An extended lipids profile, obtained by NMR, enables the identification of people with normal HDL-C and LDL-C levels who present abnormal levels of LDL-P and/or HDL-P. Higher total cholesterol, systolic blood pressure, BMI and male sex were significantly associated with these abnormal values.
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http://dx.doi.org/10.1111/ijcp.13610DOI Listing
January 2021

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort.

Prim Care Diabetes 2021 Feb 6;15(1):88-94. Epub 2020 Jul 6.

Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain. Electronic address:

Aims: To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.

Methods: A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008-2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.

Results: Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m or less was 11.4% (95% CI 4.8-18.3) for all-cause mortality, 9.2% (95% CI 5.3-13.4) for coronary heart disease, and 2.6% (95% CI -1.8 to 7.4) for stroke.

Conclusions: Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.
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http://dx.doi.org/10.1016/j.pcd.2020.06.004DOI Listing
February 2021

The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study.

Prim Care Diabetes 2020 12 27;14(6):678-684. Epub 2020 Jun 27.

Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain. Electronic address:

Aim: Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years.

Methods: Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008-2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted.

Results: 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables.

Conclusion: These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.
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http://dx.doi.org/10.1016/j.pcd.2020.06.003DOI Listing
December 2020

Reply to Dutheil et al.

J Appl Physiol (1985) 2020 07;129(1)

Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.

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http://dx.doi.org/10.1152/japplphysiol.00437.2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322503PMC
July 2020

Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group.

Med Phys 2021 Jan 12;48(1):19-56. Epub 2020 Dec 12.

SLAC National Accelerator Laboratory, Stanford, CA, USA.

Background: Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing.

Aims: To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics.

Materials And Methods: G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes.

Results: This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data.

Discussion: Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics.

Conclusion: The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application.
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http://dx.doi.org/10.1002/mp.14226DOI Listing
January 2021

The economic benefits of increasing breastfeeding rates in Spain.

Int Breastfeed J 2020 05 4;15(1):34. Epub 2020 May 4.

Department of Anesthesia and Pain Management, Morales Meseguer General University Hospital, Murcia Health Service, Murcia, Región de Murcia, Spain.

Background: Interventions aimed at promoting breastfeeding rates are among the most effective possible health policies available, with an estimated return of US$35 per dollar invested. Indeed, some authors found that a 10% increase in exclusive breastfeeding rates in the first two years of life led to a reduction in treatment costs of US$312 million in the US, US$7.8 million in the UK, US$30 million in China, and US$1.8 million in Brazil. Among high-income countries, Spain stands out for its low breastfeeding rate.

Methods: We calculated the savings that the Spanish National Health System would have benefited from had breastfeeding rates been higher in Spain, both from the time of hospital discharge and at 6 months postpartum. We followed the methods used in similar studies carried out in the US, Italy, Australia, the Netherlands, and the UK, to conservatively estimate these potential savings by considering only the lower thresholds in all our estimates. Here we approximated the benefits of having increased exclusive breastfeeding rates based on the lower incidence of infantile pathologies among exclusively breastfed infants. Robust evidence indicates that among breastfed infants there is a lower prevalence of otitis media, gastroenteritis, respiratory infections, and necrotising enterocolitis. We obtained the estimated monetary cost of these diseases by combining their prevalences with data about their economic costs for diagnosis-related groups.

Results: The estimated effects we calculated imply that the Spanish National Health System could have saved more than €5.6 million for every percentage point increase in exclusive breastfeeding rates in Spain during 2014.

Conclusions: Breastfeeding is essential both for the health of mothers and the health and development of newborns but is rarely considered as an economic issue and remains economically invisible. In addition to the improved wellbeing of mothers and their infants, breastfeeding can positively impact society as a whole and should therefore be better defined in public policies. Thus, strategies aimed at increasing exclusive breastfeeding rates would likely contribute to lowering the fiscal burden of the Spanish National Health System. Moreover, the magnitude of these potential benefits suggests that such policies would likely be socially cost-effective.
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http://dx.doi.org/10.1186/s13006-020-00277-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197147PMC
May 2020

Influence of Puerperal Health Literacy on Tobacco Use during Pregnancy among Spanish Women: A Transversal Study.

Int J Environ Res Public Health 2020 04 23;17(8). Epub 2020 Apr 23.

Department of Clinical Medicine, Miguel Hernández University, Av de la Universitat d'Elx s/n, 03202 Elche, Spain.

: Despite the fact that tobacco use during pregnancy produces adverse perinatal effects, some women continue to smoke. Health literacy (HL) is essential for health outcomes in adults. However, little is known about HL in pregnant women or postpartum women. The study aimed to analyse the relationship between the degree of HL of women during the early puerperium and tobacco use during pregnancy.

Methods: A multicentre, descriptive, cross-sectional study was carried out with women in the early puerperium in a region of eastern Spain, between November 2017 and May 2018. Their HL level was obtained using the Newest Vital Sign (NVS) tool. Multivariate logistic models were adjusted to estimate the magnitude of association with tobacco use in pregnancy. Odds ratios (OR) were estimated with a 95% confidence interval.

Results: 193 were included in the total. 29.5% (57) of pregnant women smoked tobacco during pregnancy, with a smoking cessation rate of 70.1% (40) while pregnant. 42.0% (81) of pregnant women had inadequate or limited HL. A low level of HL was strongly associated with tobacco use, adjusted by catchment area and age of first pregnancy (LRT < 0.001; ROC curve = 0.71, 95% CI: 0.64-0.79).

Conclusion: A low HL is associated with tobacco consumption during pregnancy. Whether low HL reflects the wide constellation of already-known socioeconomic, political and commercial determinants of tobacco use, or whether incorporating HL support interventions strengthens tobacco cessation activities in pregnancy, warrants further research. Still, it should be considered as essential to understanding the health disparities related to its consumption.
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http://dx.doi.org/10.3390/ijerph17082910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216153PMC
April 2020

An innovative plasmacytoid dendritic cell line-based cancer vaccine primes and expands antitumor T-cells in melanoma patients in a first-in-human trial.

Oncoimmunology 2020 12;9(1):1738812. Epub 2020 Apr 12.

Immunobiology and Immunotherapy of Chronic Diseases, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.

The efficacy of immune checkpoint inhibitors has been shown to depend on preexisting antitumor immunity; thus, their combination with cancer vaccines is an attractive therapeutic approach. Plasmacytoid dendritic cells (PDC) are strong inducers of antitumor responses and represent promising vaccine candidates. We developed a cancer vaccine approach based on an allogeneic PDC line that functioned as a very potent antigen-presenting cell in pre-clinical studies. In this phase Ib clinical trial, nine patients with metastatic stage IV melanoma received up to 60 million irradiated PDC line cells loaded with 4 melanoma antigens, injected subcutaneously at weekly intervals. The primary endpoints were safety and tolerability. The vaccine was well tolerated and no serious vaccine-induced side effects were recorded. Strikingly, there was no allogeneic response toward the vaccine, but a significant increase in the frequency of circulating anti-tumor specific T lymphocytes was observed in two patients, accompanied by a switch from a naïve to memory phenotype, thus demonstrating priming of antigen-specific T-cells. Signs of clinical activity were observed, including four stable diseases according to IrRC and vitiligoïd lesions. Four patients were still alive at week 48. We also demonstrate the in vitro enhancement of specific T cell expansion induced by the synergistic combination of peptide-loaded PDC line with anti-PD-1, as compared to peptide-loaded PDC line alone. Taken together, these clinical observations demonstrate the ability of the PDC line based-vaccine to prime and expand antitumor CD8+ responses in cancer patients. Further trials should test the combination of this vaccine with immune checkpoint inhibitors.
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http://dx.doi.org/10.1080/2162402X.2020.1738812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153838PMC
April 2020

A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project.

Sci Rep 2020 03 16;10(1):4796. Epub 2020 Mar 16.

Chair of Family Medicine, Clinical Medicine Department, Miguel Hernandez University of Elche, San Juan de Alicante, Spain.

This study aimed to assess atrial fibrillation (AF) incidence and predictive factors in hypertensive patients and to formulate an AF risk assessment score that can be used to identify the patients most likely to develop AF. This was a cohort study of patients recruited in primary healthcare centers. Patients aged 40 years or older with hypertension, free of AF and with no previous cardiovascular events were included. Patients attended annual visits according to clinical practice until the end of study or onset of AF. The association between AF incidence and explanatory variables (age, sex, body mass index, medical history and other) was analyzed. Finally, 12,206 patients were included (52.6% men, and mean age was 64.9 years); the mean follow-up was 36.7 months, and 394 (3.2%) patients were diagnosed with AF. The incidence of AF was 10.5/1000 person-years. Age (hazard ratio [HR] 1.06 per year; 95% confidence interval [CI] 1.05-1.08), male sex (HR 1.88; 95% CI 1.53-2.31), obesity (HR 2.57; 95% CI 1.70-3.90), and heart failure (HR 2.44; 95% CI 1.45-4.11) were independent predictors (p < 0.001). We propose a risk score based on significant predictors, which enables the identification of people with hypertension who are at the greatest risk of AF.
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http://dx.doi.org/10.1038/s41598-020-61437-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075918PMC
March 2020

The extracytoplasmic function sigma factor σ is active during infection and contributes to phosphate starvation-induced virulence of Pseudomonas aeruginosa.

Sci Rep 2020 02 21;10(1):3139. Epub 2020 Feb 21.

Department of Environmental Protection, Estación Experimental del Zaidín-Consejo Superior de Investigaciones Científicas, Granada, Spain.

The extracytoplasmic function sigma factor σ of the human pathogen Pseudomonas aeruginosa promotes transcription of potential virulence determinants, including secretion systems and secreted proteins. Its activity is modulated by the VreR anti-σ factor that inhibits the binding of σ to the RNA polymerase in the absence of a (still unknown) inducing signal. The vreI-vreR genes are expressed under inorganic phosphate (Pi) starvation, a physiological condition often encountered in the host that increases P. aeruginosa pathogenicity. However, whether or not σ is active in vivo during infection and contributes to the Pi starvation-induced virulence of this pathogen has not been analyzed yet. Using zebrafish embryos and a human alveolar basal epithelial cell line as P. aeruginosa hosts, we demonstrate in this work that σ is active during infection and that lack of σ considerably reduces the Pi starvation-induced virulence of this pathogen. Surprisingly, lack of the σ inhibitor, the VreR anti-σ factor, also diminishes the virulence of P. aeruginosa. By transcriptomic analyses we show that VreR modulates gene expression not only in a σ-dependent but also in a σ-independent manner. This includes potential virulence determinants and transcriptional regulators that could be responsible for the reduced virulence of the ΔvreR mutant.
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http://dx.doi.org/10.1038/s41598-020-60197-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035377PMC
February 2020

Menstrual cycle phase does not affect whole body peak fat oxidation rate during a graded exercise test.

J Appl Physiol (1985) 2020 03 20;128(3):681-687. Epub 2020 Feb 20.

Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Female sex hormones fluctuate in a predictable manner throughout the menstrual cycle in eumenorrheic women. In studies conducted in both animal and humans, estrogen and progesterone have been found to exert individual metabolic effects during both rest and exercise, suggesting that estrogen may cause an increase in fat oxidation during exercise. However, not all studies find these metabolic changes with the natural physiological variation in the sex hormones. To date, no studies have investigated whether whole body peak fat oxidation rate (PFO) and maximal fat oxidation intensity (FAT) are affected at different time points [mid-follicular (MF), late-follicular (LF), and mid-luteal (ML)] in the menstrual cycle, where plasma estrogen and progesterone are either at their minimum or maximum. We hypothesized that an increased plasma estrogen concentration together with low progesterone concentration in LF would result in a modest but significant increase in PFO. We found no differences in body weight, body composition, or peak oxygen uptake (V̇o) between any of the menstrual phases in the 19 healthy, young eumenorrheic women included in this study. PFO [MF: 0.379 (0.324-0.433) g/min; LF: 0.375 (0.329-0.421) g/min; ML: 0.382 (0.337-0.442) g/min; mean ± (95% CI)] and resting plasma free fatty acid concentrations [MF: 392 (293-492) µmol/l; LF: 477 (324-631) µmol/l; ML: 396 (285-508) µmol/L] were also similar across the menstrual cycle phases. Contrary to our hypothesis, we conclude that the naturally occurring fluctuations in the sex hormones estrogen and progesterone do not affect the whole body PFO and FAT in young eumenorrheic women measured during a graded exercise test. Menstrual cycle phase does not affect the peak fat oxidation rate during a graded exercise test. Natural physiological fluctuations in estrogen do not increase peak fat oxidation rate. FAT is not influenced by menstrual cycle phase in healthy, young eumenorrheic women.
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http://dx.doi.org/10.1152/japplphysiol.00774.2019DOI Listing
March 2020

Structural vulnerability and new perspectives in social medicine on the health of immigrants: Interview with James Quesada and Seth M. Holmes.

Salud Colect 2019 12 9;15:e2146. Epub 2019 Dec 9.

Médico, Doctor en Antropología Médica. Profesor Asociado UC Berkeley's Division of Society and Environment, UCSF-Berkeley's Joint Program in Medical Anthropology, University of California, California, EEUU.

A decade ago, a number of English-speaking authors focused mainly on the analysis and intervention of processes of social determination of health of migrants developed the concept of structural vulnerability as a way to combat individualism, biologism, the invisibilization of processes of structural determination and the blaming of victims. As part of the historical contributions of social medicine, the current developments of the structural vulnerability approach have been disconnected from the discussions of the collective health movement and Latin American social medicine in general, among other reasons due to linguistic barriers associated with the scarcity of publications in Spanish. The present interview, conducted with two of the primary representatives of the structural vulnerability approach, investigates its historical origins and seeks to explore the specific contributions that are being made today, as a way to bring them closer to Spanish-speaking readers and so enable dialogue with the proposals of Latin American social medicine.
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http://dx.doi.org/10.18294/sc.2019.2146DOI Listing
December 2019

Ocular chemical burns in the workplace: Epidemiological characteristics.

Burns 2020 08 30;46(5):1212-1218. Epub 2019 Nov 30.

Universidad Francisco de Vitoria, Faculty of Medicine, Pozuelo de Alarcón, Madrid, Spain. Electronic address:

Background: Epidemiological studies focusing on occupational pathologies can be an important medium through which to bring about change with respect to workplace accidents, both in terms of prevention planning and management as well as the appropriate care following an accident. Ocular chemical burns benefit from urgent attention as, if not treated early and appropriately, the tissue of the eye and its functionality can be seriously compromised. The objective of this study was to collate epidemiological data on workplace ocular chemical burns which could in turn serve to identify key action points in terms of occupational health.

Methods: Cohort study with 604 cases of chemical burns to the eye occurring in the workplace between 2014 and 2015. Criteria inclusion were diagnosis of chemical burn, patient seen at the medical centre of the mutual society, workplace acquired ophthalmic pathology leading to the issuing of a sickness certificate. No exclusion criteria were defined.

Results: Ocular chemical burns were the second most common workplace eye injury (12.68%) behind foreign bodies in the eye (43.42%). Men accounted for 68.54% of cases of ocular chemical burns. In around 75% of cases, sickness certification was for less than 7 days, although 6 patients suffered permanent disability. The occupational sector which was most affected particularly the industry service industry. The economic costs with these workplace injuries were extracted.

Conclusions: Appropriate early medical assistance is essential. The production and distribution of clinical guides for health care workers could optimise first line assistance and mitigate possible training deficiencies.
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http://dx.doi.org/10.1016/j.burns.2019.11.007DOI Listing
August 2020

Characterization of the bacteriocins and the PrtR regulator in a plant-associated Pseudomonas strain.

J Biotechnol 2020 Jan 4;307:182-192. Epub 2019 Nov 4.

Departamento de Ciencias Naturales, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto-INIAB CONICET, Agencia Postal No. 3, X580BYA, Río Cuarto, Córdoba, Argentina. Electronic address:

The emergence of antibiotic resistant bacterial strains demands the development of new antimicrobial agents. In the last decades, bacteriocins have gained significant interest due to their potential application as biopreservatives in the food industry and as therapeutic agents in medicine. Recent studies project the use of these antimicrobials in agriculture as biocontrol agents. The characterization of bacteriocins and their genetic regulation, however, have been scarcely studied in plant-associated bacteria. In this report, an in-silico and proteomic analysis was performed to identify the bacteriocins produced by Pseudomonas fluorescens SF4c. More than one functional bacteriocin was detected in this strain (S-type bacteriocins and phage-tail-like bacteriocins [tailocins]). It is known that the regulator PrtR represses bacteriocin production in P. aeruginosa under normal condition. However, the mechanism for tailocin regulation remains unknown in plant-associated pseudomonads. In this work, an orthologue of the prtR of P. aeruginosa was identified in the SF4c-tailocin cluster and a prtR null mutant constructed. The expression and production of tailocins was abolished in this mutant; thus evidencing that, unlike P. aeruginosa, PrtR is a positive regulator of tailocins expression in P. fluorescens.
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http://dx.doi.org/10.1016/j.jbiotec.2019.11.003DOI Listing
January 2020

Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia.

Atherosclerosis 2019 11 23;290:80-86. Epub 2019 Sep 23.

Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, Spain.

Background And Aims: Cholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment.

Methods: Patients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts.

Results: In the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction.

Conclusions: The predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.
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http://dx.doi.org/10.1016/j.atherosclerosis.2019.09.007DOI Listing
November 2019

Effect of the vaginal microbiome on the pregnancy rate in women receiving assisted reproductive treatment.

J Assist Reprod Genet 2019 Oct 24;36(10):2111-2119. Epub 2019 Aug 24.

Reproductive Unit, Instituto Bernabeu, 03016, Alicante, Spain.

Purpose: To investigate if the vaginal microbiome influences the IVF outcome.

Methods: Thirty-one patients undergoing assisted reproductive treatment (ART) with own or donated gametes and with cryotransfer of a single euploid blastocyst were recruited for this cohort study. Two vaginal samples were taken during the embryo transfer procedure, just before transferring the embryo. The V3 V4 region of 16S rRNA was used to analyze the vaginal microbiome, and the bioinformatic analysis was performed using QIIME2, Bioconductor Phyloseq, and MicrobiomeAnalyst packages. Alpha diversity was compared between groups according to the result of the pregnancy test.

Results: Fourteen (45.2%) patients did not and seventeen (54.8 %) did achieve pregnancy under ART. A greater index of alpha diversity was found in patients who did not achieve pregnancy comparing to those who did, although this difference was not significant (p = 0.088). In the analysis of beta diversity, no statistically significant differences were observed between groups established as per the pregnancy status. Samples from women who achieved pregnancy showed a greater presence of Lactobacillus spp. The cluster analysis identified two main clusters: the first encompassed the genera Lactobacillus, Gardnerella, Clostridium, Staphylococcus, and Dialister, and the second included all other genera. Women who achieved pregnancy were mainly detected microorganisms from the first cluster.

Conclusions: The vaginal microbiome can influence the results of ART. The profiles dominated by Lactobacillus were associated with the achievement of pregnancy, and there was a relationship between the stability of the vaginal microbiome and the achievement of pregnancy.
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http://dx.doi.org/10.1007/s10815-019-01564-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823330PMC
October 2019