Health surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to ...measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing.
Cross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data.
We analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR.
Prevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Accessible Summary
What is known on the subject?
Attention‐deficit/hyperactivity disorder (ADHD) is characterized by problems of inattention and impulsive hyperactivity in children. Equine‐assisted ...activities and therapies (EAATs) have been used as alternative non‐pharmacological intervention option in patients with ADHD.
What does this paper adds to existing knowledge?
Nowadays, more studies of high methodological quality are needed to determine whether EAAT is an effective intervention for the treatment in children with ADHD.
What are the implications for practice?
Between 15 and 40 min of rising horses, 8–32 total sessions, for 4–32 weeks, seem to be beneficial to reduce the symptoms of ADHD.
Introduction
Attention‐deficit/hyperactivity disorder (ADHD) is a disorder characterized by problems of inattention and impulsive hyperactivity. Equine‐assisted activities and therapies (EAATs) have become an emerging non‐pharmacological intervention option in patients with ADHD.
Aim
To perform a systematic review of updated literature about EAAT in children with ADHD.
Method
A systematic review was performed until 28 November 2019, in four electronic databases: PubMed, Web of Science, Embase and Google Scholar. The inclusion criteria were as follows: (a) intervention programme, with pre‐ and post‐data, based on EAAT, (b) children with ADHD and (c) articles written in English.
Results
A total of 9 articles were found that meet the inclusion criteria. The evidence level was C for 7 studies and B for 2 studies. The level of conclusion was 3.
Discussion
There are few studies with high methodological quality, and there is a high heterogeneity in the variables included, what make that the level of evidence and conclusion are low.
Conclusion
There is no account with enough studies of high methodological quality to determine whether EAAT is an effective intervention for the treatment in children with ADHD.
The aim of this analysis was to ascertain the type of relationship between fish and seafood consumption, omega-3 polyunsaturated fatty acids (ω-3 PUFA) intake, and depression prevalence.
...Cross-sectional analyses of the PREDIMED-Plus trial. Fish and seafood consumption and ω-3 PUFA intake were assessed through a validated food-frequency questionnaire. Self-reported life-time medical diagnosis of depression or use of antidepressants was considered as outcome. Depressive symptoms were collected by the Beck Depression Inventory-II. Logistic regression models were used to estimate the association between seafood products and ω-3 PUFA consumption and depression. Multiple linear regression models were fitted to assess the association between fish and long-chain (LC) ω-3 PUFA intake and depressive symptoms.
Out of 6587 participants, there were 1367 cases of depression. Total seafood consumption was not associated with depression. The odds ratios (ORs) (95% confidence intervals (CIs)) for the 2nd, 3rd, and 4th quintiles of consumption of fatty fish were 0.77 (0.63⁻0.94), 0.71 (0.58⁻0.87), and 0.78 (0.64⁻0.96), respectively, and
for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5⁻1 g/day) was significantly associated with a lower prevalence of depression.
In our study, moderate fish and LC ω-3 PUFA intake, but not high intake, was associated with lower odds of depression suggesting a U-shaped relationship.
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical ...course of mpox, in a large population of patients from Spain. Nationwide case‐series study. Patients from 18 Spanish hospitals, with PCR‐confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty‐three individuals were included. Seven hundred eighty‐six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3. HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV‐RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV‐RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV‐RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox adjusted OR = 4.06 (95% confidence interval 1.57−10.51), p = 0.004. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
Resistance to Immune Checkpoint Blockade (ICB) constitutes the current limiting factor for the optimal implementation of this novel therapy, which otherwise demonstrates durable responses with ...acceptable toxicity scores. This limitation is exacerbated by a lack of robust biomarkers. In this study, we have dissected the basal TME composition at the gene expression and cellular levels that predict response to Nivolumab and prognosis. BCR, TCR and HLA profiling were employed for further characterization of the molecular variables associated with response. The findings were validated using a single-cell RNA-seq data of metastatic melanoma patients treated with ICB, and by multispectral immunofluorescence. Finally, machine learning was employed to construct a prediction algorithm that was validated across eight metastatic melanoma cohorts treated with ICB. Using this strategy, we have unmasked a major role played by basal intratumoral Plasma cells expressing high levels of IGKC in efficacy. IGKC, differentially expressed in good responders, was also identified within the Top response-related BCR clonotypes, together with IGK variants. These results were validated at gene, cellular and protein levels; CD138+ Plasma-like and Plasma cells were more abundant in good responders and correlated with the same RNA-seq-defined fraction. Finally, we generated a 15-gene prediction model that outperformed the current reference score in eight ICB-treated metastatic melanoma cohorts. The evidenced major contribution of basal intratumoral IGKC and Plasma cells in good response and outcome in ICB in metastatic melanoma is a groundbreaking finding in the field beyond the role of T lymphocytes.
Background
Fluconazole‐resistant Candida parapsilosis is a matter of concern.
Objectives
To describe fluconazole‐resistant C. parapsilosis genotypes circulating across hospitals in Spain and Rome and ...to study their azole‐resistance profile associated with ERG11p substitutions.
Patients/Methods
We selected fluconazole‐resistant C. parapsilosis isolates (n = 528 from 2019 to 2023; MIC ≥8 mg/L according to EUCAST) from patients admitted to 13 hospitals located in five Spanish cities and Rome. Additionally, we tested voriconazole, posaconazole, isavuconazole, amphotericin B, micafungin, anidulafungin and ibrexafungerp susceptibility.
Results
Of the 53 genotypes found, 49 harboured the Y132F substitution, five of which were dominating city‐specific genotypes involving almost half the isolates. Another genotype involved isolates harbouring the G458S substitution. Finally, we found two genotypes with the wild‐type ERG11 gene sequence and one with the R398I substitution. All isolates were fully susceptible/wild‐type to amphotericin B, anidulafungin, micafungin and ibrexafungerp. The azole‐resistance patterns found were: voriconazole‐resistant (74.1%) or voriconazole‐intermediate (25.2%), posaconazole‐resistant (10%) and isavuconazole non‐wild‐type (47.5%). Fluconazole‐resistant and voriconazole non‐wild‐type isolates were likely to harbour substitution Y132F if posaconazole was wild type; however, if posaconazole was non‐wild type, substitution G458S was indicated if isavuconazole MIC was >0.125 mg/L or substitution Y132F if isavuconazole MIC was ≤0.125 mg/L.
Conclusions
We detected a recent clonal spread of fluconazole‐resistant C. parapsilosis across some cities in Spain, mostly driven by dominating city‐specific genotypes, which involved a large number of isolates harbouring the Y132F ERG11p substitution. Isolates harbouring substitution Y132F can be suspected because they are non‐susceptible to voriconazole and rarely posaconazole‐resistant.
Background
Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. ...T‐Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterization by a multifactorial approach. The general purpose of this study is to determine the effectiveness, comfort, and experience of the patient catheterized with T‐Control® compared with patients with a conventional Foley catheter.
Study Design
This trial is a mixed‐method study comprising a two‐arm, pilot comparative study with random allocation to T‐Control catheter or traditional Foley catheter in patients with long‐term catheterization and a study with qualitative methodology, through discussion groups.
Endpoints
The comfort and acceptability of the T‐Control® device (qualitative) and the quality of life related to self‐perceived health (quantitative) will be analysed as primary endpoints. As secondary endpoints, the following will be analysed: magnitude and rate of infections (symptomatic and asymptomatic); days free of infection; indication of associated antibiotic treatments; determination of biofilm; number of catheter‐related adverse events; use of each type of catheterization's healthcare resources; and level of satisfaction and workload of health professionals.
Patients and Methods
Eligible patients are male and female adults aged ≥18 years, who require a change of long‐term bladder catheter. The estimated sample size is 50 patients. Patient follow‐up includes both the time of catheter insertion and its removal or change 4 weeks later, plus the time until the discussion groups take place.
Childhood obesity is one of the main public health issues facing advanced societies. The Spanish population presents 28.6% overweight or obese adolescents, and Extremadura, 22.3%. Physical fitness is ...considered one of the most important health markers and a common predictor of morbidity and mortality caused by cardiovascular diseases. Thus, fitness tests are needed for health monitoring, especially in overweight and obese adolescents. Therefore, this study aimed to explore the relationship between body composition and physical fitness in adolescents and to analyse if there are differences in physical condition and body composition between the sexes, as well as to compare the different body mass index (BMI) categories to each other. This project also tried to find regression equations to predict the physical fitness test results.
A total of 225 adolescents were recruited. Weight status was classified according to WHO 2007 standards. Body composition variables (i.e., BMI, fat mass (FM), FM percentage (FM%), and fat-free mass (FFM)) and physical fitness (standing long jump (SLJ), speed-agility (SA), cardiorespiratory fitness (CF), and handgrip strength (HS)) were assessed.
Significant differences were found between the sexes in body composition (FM%, FM, and FFM) and physical fitness (SLJ, SA, CF, and HS) (
< 0.001) in favour of males. Significant differences were also found in speed (
= 0.002), CF (
< 0.001), and SLJ (
= 0.004) in favour of normal-weight adolescents compared to overweight and obese adolescents. Contrarily, the outcomes revealed a significantly greater HS (
= 0.014) in favour of overweight and obese participants compared to normal-weight adolescents. Moreover, the results showed that CF and SLJ correlated inversely with BMI, FM%, and total FM. There was also a direct relationship between SA and FM percentage, as well as between HS and FFM. Finally, four fitness test predictive models are proposed based on body composition, age, sex, and BMI.
Overweight and obese adolescents have lower levels of physical fitness than their normal-weight peers, regardless of their sex. Normal-ranged body composition values are related to a greater physical fitness in adolescents. Furthermore, this study presents several equations that can help to predict the performance of different fitness tests in adolescents.
The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in ...the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 ± 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers.
Background
Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. ...T‐Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterisation by a multifactorial approach. The general purpose of this study is to evaluate the effectiveness and cost‐effectiveness of the T‐Control catheter versus the Foley‐type catheter in patients with Acute Urine Retention (AUR).
Study design
This is a pragmatic, open, multicentre, controlled clinical trial with random allocation to the T‐Control catheter or a conventional Foley‐type catheter in patients with AUR.
Endpoints
The magnitude of infections will be analysed as a primary endpoint. While as secondary endpoint, the following will be analysed: rate of symptomatic and asymptomatic infections; days free of infection; quality of life‐related to self‐perceived health; indication of associated antibiotic treatments; determination of biofilm; number of catheter‐related adverse events; use of each type of catheterisation's healthcare resources; level of satisfaction and workload of health professionals and acceptability of the T‐Control device as well as the patient experience.
Patients and methods
Eligible patients are male adults aged ≥50 years, with AUR and with an indication of bladder catheterisation for at least 2 weeks. The estimated sample size is 50 patients. Patient follow‐up includes both the time of catheter insertion and its removal or change 2 weeks later, plus 2 weeks after this time when the patient will be called for an in‐depth interview.
PDF
