Factors driving microbial community composition and diversity are well established but the relationship with microbial functioning is poorly understood, especially at large scales. We analysed ...microbial biodiversity metrics and distribution of potential functional groups along a gradient of increasing land-use perturbation, detecting over 79,000 bacterial and 25,000 fungal OTUs in 715 sites across 24 European countries. We found the lowest bacterial and fungal diversity in less-disturbed environments (woodlands) compared to grasslands and highly-disturbed environments (croplands). Highly-disturbed environments contain significantly more bacterial chemoheterotrophs, harbour a higher proportion of fungal plant pathogens and saprotrophs, and have less beneficial fungal plant symbionts compared to woodlands and extensively-managed grasslands. Spatial patterns of microbial communities and predicted functions are best explained when interactions among the major determinants (vegetation cover, climate, soil properties) are considered. We propose guidelines for environmental policy actions and argue that taxonomical and functional diversity should be considered simultaneously for monitoring purposes.
The use of some anti‐hypertensive drugs in the current COVID‐19 pandemic has become controversial. This study investigated possible relationships between anti‐hypertensive medications use and ...COVID‐19 infection risk in the ambulatory hypertensive population. This is a population‐based retrospective cohort study involving 34 936 hypertensive adults >50 years in Tarragona (Southern Catalonia, Spain) who were retrospectively followed through pandemic period (from 01/03/2020 to 30/04/2020). Two data sets including demographic/clinical characteristics (comorbidities and cardiovascular medications use) and laboratory PCR codes for COVID‐19 were linked to construct an anonymized research database. Cox regression was used to calculate multivariable hazard ratios (HRs) and estimate the risk of suffering COVID‐19 infection. Across study period, 205 PCR‐confirmed COVID‐19 cases were observed, which means an overall incidence of 586.8 cases per 100 000 persons‐period. In multivariable analyses, only age (HR: 1.03; 95% CI: 1.02‐1.05; P < .001) and nursing home residence (HR: 19.60; 95% CI: 13.80‐27.84; P < .001) appeared significantly associated with increased risk of COVID‐19. Considering anti‐hypertensive drugs, receiving diuretics (HR: 1.22; 95% CI: 0.90‐1.67; P = .205), calcium channel blockers (HR: 1.29; 95%CI: 0.91‐1.82; P = .148), beta‐blockers (HR: 0.97; 95% CI: 0.68‐1.37; P = .844), and angiotensin‐converting enzyme inhibitors (HR: 0.83; 95% CI: 0.61‐1.13; P = .238) did not significantly alter the risk of PCR‐confirmed COVID‐19, whereas receiving angiotensin II receptor blockers was associated with an almost statistically significant reduction risk (HR: 0.67; 95% CI: 0.44‐1.01; P = .054). In conclusion, our data support that receiving renin‐angiotensin‐aldosterone system inhibitors does not predispose for suffering COVID‐19 infection in ambulatory hypertensive people. Conversely, receiving angiotensin II receptor blockers could be related with a reduced risk.
The recent COVID-19 pandemic has compromised socio-health care, with consequences for the diagnosis and follow-up of other pathologies. The aim of this study was to evaluate the impact of COVID-19 on ...cancer diagnosis in Girona, Spain.
Observational study of samples received in two pathology laboratories during 2019-2020 (tertiary hospital in Girona and county hospital in Figueres). Date, sample type, and location and morphology were available. Samples were recoded to determine malignancy and grouped by location. Comparisons were made by calendar year and period of exposure to COVID-19.
102,360 samples were included: 80,517 from Girona and 21,843 from Figueres. The reduction in activity in the pathology laboratories in 2020 compared to the previous year was 25.4% in Girona and 27.5% in Figueres. The reduction in cancer diagnoses in 2020 compared to 2019 was 6.8% in Girona and 21% in Figueres. In both laboratories, a decrease was observed in the diagnoses of neoplasms of the lip, oral cavity and pharynx, larynx, colon, rectum and anus, kidney and urinary system, melanoma, and central nervous system. A statistically significant higher probability of a sample received in the pathology laboratory displaying malignancy during COVID-19 was found (Girona: OR = 1.28, 95% CI: 1.23-1.34; Figueres: OR = 1.10, 95% CI: 1.01-1.20) with respect to the COVID-19-free period.
The COVID-19 pandemic has resulted in a reduction in cancer diagnoses by pathology departments that varies according to tumor location and type of hospital. Despite this, the optimization of care resources and the recovery effort have partially reduced the impact of the pandemic in certain neoplasms.
Background
The prevalence of
BRAF
mutation has been reported in between 38% and 48% of melanoma patients, based on mainly Stage III or metastatic melanoma, however, information based on ...population-based studies is scarce
Objectives
We performed a population-based retrospective cohort study to determine the prevalence of the
BRAF
mutation in patients diagnosed with
in situ
and infiltrating cutaneous malignant melanoma in the province of Girona between 2009 and 2011.
Materials & Methods
Using the database of the Girona Cancer Registry, we performed
BRAF
mutation analysis based on paraffin-embedded tissue. This data was then correlated with other known clinical and histological prognostic factors for survival.
Results
We found 286 incident cases of cutaneous melanoma in the Girona Cancer Registry database. Excluding missing cases,
BRAF
-mutated patients constituted 38.9% of “
in situ
” melanoma cases and 53.8% of invasive melanoma cases. Five-year relative survival was not statistically different between
BRAF
-mutated patients (93.6%; 95% CI: 87.1–100.5) and non-mutated patients (84.3%, 95% CI: 75.3–94.8). Only stage was significant as a prognostic factor for survival based on multivariate analysis.
Conclusion
From our population-based study, we conclude that
BRAF
mutation is not an independent prognostic factor for melanoma survival.
ATDOM is the Catalan home healthcare program at primary care level. Patients in the home care program are usually frail, elderly people with multiple comorbidities. They are often polymedicated, ...leading to a high risk of drug-related problems (DRPs). Our hypothesis is that the pharmacist-led individualized review of the pharmacotherapeutic plans of ATDOM patients will be effective in improving the quality of treatments by reducing DRPs in terms of indication, adequacy, effectiveness, and safety.
Aim: To compare the effectiveness of a standardized pharmaceutical intervention for the review and optimization of pharmacological treatments in ATDOM patients with usual management practice.
Pragmatic randomized clinical trial with a comparable control group, with prospective follow-up regarding the intervention on the adequacy of the pharmacological treatment of patients in the ATDOM program.
Primary care teams in the Camp de Tarragona Primary Care Area, Tarragona, Spain.
Four hundred and thirty-two ATDOM patients will be recruited, those who are over 65 years old and who are currently undergoing pharmacological treatment.
Effectiveness of a six-month long intervention in reducing DRPs per patient and polypharmacy. Additionally, in the intervention group we will evaluate the implementation of the proposals for change or improvement made by the responsible physician.
The outcomes will be analyzed on an intent-to-treat basis and the analysis units will be the individual patients. Logistic regression and linear regression models will be used to evaluate the effects of the intervention on dichotomous and continuous variables versus the control arm.
The protocol was approved by the Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAPJGol), Barcelona, (19/141-P).
If the results of the pharmaceutical intervention are favorable, widespread implementation of the program could be possible. It could be extended to all ATDOM patients or outpatients in general. Interdisciplinary teamwork could be strengthened as a result, which would improve the healthcare continuum.
Retrospectively registered.
gov Identifier NCT05820945; Registered 21 March, 2023.
Evaluar el impacto de una intervención farmacéutica en la optimización del tratamiento de los pacientes con diabetes mellitus tipo 2.
Estudio de intervención antes/después.
Centros de Salud de la ...Dirección de Atención Primaria Camp de Tarragona.
Pacientes con edad ≥18 años, diagnosticados de diabetes mellitus tipo 2 y en tratamiento con fármacos antidiabéticos.
Revisión del tratamiento farmacológico para la diabetes mellitus tipo 2 y emisión de propuestas para su adecuación.
Se recogieron variables demográficas y clínicas para valorar la adecuación del tratamiento antidiabético. Se concertó una reunión de consenso con el médico de atención primaria de los pacientes para valorar las propuestas de mejora. Se valoró la implementación de las propuestas y la variación en el control glicémico postintervención.
Se incluyeron 907 pacientes (59% varones). Se hicieron 782 propuestas de intervención en el 65,8% de los pacientes revisados. El 43,5% de las propuestas correspondieron a suspensión de fármaco, el 16% a intensificación posológica y el 12,6% a cambio por un equivalente terapéutico. Se implementaron el 54,7% de las propuestas consensuadas. La HbA1c se redujo un 0,2% después de la intervención (7,4 vs. 7,2%).
La revisión del tratamiento farmacológico de los pacientes con diabetes mellitus tipo 2 por parte de un farmacéutico o un farmacólogo facilita su optimización.
To evaluate the impact of a pharmaceutical intervention on treatment optimization in patients with type 2 diabetes mellitus.
Before-after intervention study.
Health centers of the Primary Care Department of Camp de Tarragona.
Patients aged ≥ 18 years, diagnosed with type 2 diabetes mellitus and under treatment with antidiabetic drugs.
Review of pharmacological treatment for type 2 diabetes mellitus and issuance of proposals for its adequacy.
Demographic and clinical variables were collected to assess the adequacy of antidiabetic treatment. A consensus meeting was arranged with the patients’ primary care physician to evaluate the proposals for improvement. The implementation of the proposals and the variation in postintervention glycemic control were assessed.
A total of 907 patients (59% men) were included. A total of 782 proposals for intervention were made in 65.8% of the patients reviewed. Of the proposals, 43.5% corresponded to drug discontinuation, 16% to intensification of dosing and 12.6% to exchange for a therapeutic equivalent. Of the consensual proposals, 54.7% were implemented. HbA1c was reduced by 0.2% after the intervention (7.4 vs 7.2%).
Review of the pharmacological treatment of patients with type 2 diabetes mellitus by a pharmacist or pharmacologist facilitates its optimization.
ObjectiveTo investigate possible relationships between pre-existing medical conditions (including common comorbidities and chronic medications) and risk for suffering COVID-19 disease in middle-aged ...and older adults.DesignPopulation-based retrospective cohort study.SettingTwelve primary care centres (PCCs) in Tarragona (Spain).Participants79 083 people (77 676 community-dwelling and 1407 nursing-home residents), who were all individuals aged >50 years affiliated to the 12 participating PCCs.OutcomesBaseline cohort characteristics (age, sex, vaccinations, comorbidities and chronic medications) were established at study start (1st. March 2020) and primary outcome was time to COVID-19 confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to 23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating multivariable HRs adjusted for age, sex, comorbidities and medications use.ResultsDuring the study period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, which means an incidence of 480.5 PCR-confirmed COVID-19 cases per 100 000 persons-period. Assessing the total study cohort, only age (HR 1.02; 95% CI 1.01 to 1.03; p=0.002), nursing-home residence (HR 21.83; 95% CI 16.66 to 28.61; p<0.001) and receiving diuretics (HR 1.35; 95% CI 1.04 to 1.76; p=0.026) appeared independently associated with increased risk. Smoking (HR 0.62; 95% CI 0.41 to 0.93; p=0.022), ACE inhibitors (HR 0.68; 95% CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95% CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among community-dwelling individuals, cancer (HR 1.52; 95% CI 1.03 to 2.24; p=0.035), chronic respiratory disease (HR 1.82; 95% CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95% CI 1.06 to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE inhibitors (HR 0.66; 95% CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; 95% CI 0.44 to 0.91; p=0.012) was associated with decreased risk.ConclusionAge, nursing-home residence and multiple comorbidities appear predisposing for COVID-19. Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be protective, which should be closely investigated in further studies specifically focused on these concerns.
Analizar y comparar la epidemiologia de los incidentes de seguridad del paciente notificados en centros de atención primaria, antes y después del inicio de la pandemia COVID-19.
Estudio descriptivo ...analítico comparando los incidentes notificados del 01-marzo-2019 al 28-febrero-2020, y del 01-marzo-2020 al 28-febrero-2021, realizados a través de la plataforma TPSC Cloud™ accesible desde la Intranet corporativa en 25 centros de atención primaria del distrito de Tarragona, Cataluña, España.
Registros obtenidos a partir de notificaciones voluntarias mediante formulario electrónico, estandarizado y anonimizado. Variables: centro sanitario, profesional, tipo de incidente, matriz de riesgo, factores causales, contribuyentes y evitabilidad. Análisis estadístico: Se realizó análisis descriptivo del total de notificaciones y otro específico de los eventos adversos, comparando ambos períodos.
Se notificaron un total de 2.231 incidentes. Comparando ambos períodos, en el de pandemia se observó una reducción del número de incidentes notificados (solo representaron un 20% del total), pero en proporción se incrementó el porcentaje de notificaciones por parte de profesionales sanitarios y el de eventos adversos que requirieron observación. También aumentaron los factores causales relacionados con los cuidados y el diagnóstico, y disminuyeron los de medicación. Además, se observó un incremento de los factores contribuyentes relacionados con el profesional. La evitabilidad fue elevada (>95%) en ambos períodos.
Durante la pandemia, se han notificado un menor número de incidentes de seguridad del paciente, pero en proporción, más eventos adversos, siendo en su mayoría evitables. El propio profesional se convierte en el principal factor contribuyente.
To analyse and compare the epidemiology of patient safety incidents reported in Primary Health Care, before and after the start of the COVID-19 pandemic.
Analytical descriptive study comparing reported incidents from March 1st 2019 to February 28th 2020, and from March 1st 2020 to February 28th 2021, notified through the TPSC Cloud™ platform accessible from the Intranet corporative in 25 Primary Health Care centres from Tarragona district, in Catalonia (Spain).
Data obtained from voluntary notifications, through electronic, standardized and anonymized forms. Variables: Centre, professional, incident type, risk matrix, causal factors and contributing factors, and avoidability. Statistical analysis: Every notification was included in descriptive analysis, and another one specifically for adverse events, comparing both periods.
2231 incidents were reported. Comparing both periods, during the pandemic a reduction in the number of reported incidents was observed (only represented 20% of the total). However, the percentage of reported notifications from health care professionals and adverse events that required observation were increased. Causal factors related to attendance and diagnosis were incremented whereas the causal factors related to medication were decreased. In addition, an increase in contributing factors related to the professional was observed. Avoidability was high (>95%) in both periods.
During the pandemic, fewer patient safety incidents have been reported, but proportionally more adverse events, most of which are preventable. The professional himself becomes the main contributing factor.
PDF
