Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically ...close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.
This work aims to investigate the presence of Streptococcus suis in wild rabbits. A total of 65 S. suis isolates were recovered from 33.3% of the wild rabbits examined. Most isolates (86.2%) belong ...to genotype cps9. These isolates were further characterized by pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and virulence genotyping. Overall, S. suis exhibited a low genetic diversity. Only 5 genetic profiles were obtained by PFGE and most isolates (71.4%) were included in two pulsotypes that were also widely distributed among the wild rabbit population. MLST analysis assigned all cps9 isolates into three new singlestones (ST216, ST217 and ST284), which were not genetically related to the European ST87 and Spanish ST61 widespread swine clones, indicating a different genetic background for the S. suis isolates from wild rabbits and pigs. Wild rabbit isolates exhibited the genotype mrp−/epf−/sly−, different from those showed by most of the swine S. suis isolates of the ST87 and ST61 clones. None of the S. suis isolated from wild rabbits exhibited the genotype cps2/mrp+/epf+/sly+ associated with human infections. These results indicate that S. suis isolates from wild rabbits are not genetically related with prevalent clones usually associated with infections in pigs or humans in Europe and do not exhibit either their virulence genotypes. Therefore, although wild rabbits could represent an unknown reservoir of this pathogen, they could not represent a potential risk for pigs or humans.
Estudio de la calidad de vida relacionada con la salud (CVRS) en lactantes nacidos prematuros de 32–35 semanas de gestación según su ingreso por infección respiratoria del tracto inferior.
Estudio ...transversal anidado en el estudio FLIP-2 sobre 216 progenitores/prematuros de 32–35 semanas, seleccionados concurrentemente en la entrevista final del estudio FLIP-2. Se midió la CVRS del prematuro con la escala QUALIN modificada, la del progenitor se midió con el cuestionario SF-12 y con escalas visuales. Se valoró la sobrecarga del cuidador con escalas directas (Zarit modificada) y medidas indirectas. Se hizo un estudio descriptivo y de asociación multivariante.
El 33% (71 niños) ingresó por causa respiratoria. Ingresaron significativamente más los nacidos en partos triples y los residentes en hogares con más de 5 habitantes. El 47% de los progenitores de los pacientes ingresados causó baja laboral para atender al niño, frente al 18% del otro grupo. Los padres de los pacientes ingresados tienen mayor sobrecarga y menor puntuación en el componente físico del cuestionario SF-12. El modelo multivariante asocia a la CVRS del prematuro con mayor edad gestacional, tener hermanos de 0–3 años, recibir profilaxis del virus respiratorio sincitial (VRS) cuando está recomendada por tener factores de riesgo, menor sobrecarga del cuidador, mayor CVRS del cuidador en la escala mental del cuestionario SF-12 y no haber perdido jornadas laborales.
Haber ingresado por infección respiratoria no se asocia a diferente CVRS en los prematuros, aunque sí a diferente CVRS y sobrecarga en los cuidadores. La CVRS en los lactantes está asociada a la de sus cuidadores y a su sobrecarga, y a recibir profilaxis del VRS cuando la presencia de factores de riesgo la haría recomendable.
Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32–35 weeks of gestational age.
Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements).
From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0–3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care.
Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it.
Se pretende evaluar los valores predictivos de ingreso por el virus respiratorio sincitial (VRS) de diferentes asociaciones de factores de riesgo en prematuros españoles de 32 a 35 semanas de ...gestación atendidos en 2 estaciones de VRS consecutivas.
Se utilizó la base de datos del estudio FLIP-2. Se excluyó a los niños que recibieron palivizumab profiláctico. Se estudiaron 193 ingresos de VRS positivo y 4.568 niños no ingresados. Los factores de riesgo analizados fueron la edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10 primeras semanas de la estación, hermano mayor que fuera a la escuela o asistiera a la guardería, madre fumadora durante la gestación, sexo varón, lactancia materna ausente durante 2 meses o menos, 4 o más adultos en casa, sibilancias en padres o hermanos, ser pequeño para la edad gestacional y 2 o más fumadores en casa.
El modelo de regresión logística incluyó los 4 primeros factores citados como variables independientemente significativas, con un coeficiente de determinación de 0,062 y un área bajo la curva de 0,687 (p<0,001). Los valores predictivos de ingreso de VRS positivo para un niño con los 4 factores de riesgo fueron los siguientes: el 6,2% de sensibilidad, el 98,6% de especificidad, el 16,2% de valor predictivo positivo, el 96,1% de valor predictivo negativo, el 94,9% de exactitud, un cociente de probabilidad positivo (CP+) de 4,581 y un cociente de probabilidad negativo de 0,951. El CP+ para un niño con los 2 factores mayores de riesgo es de 2,657.
La utilidad predictiva de ingreso de VRS positivo según la presencia de diferentes factores de riesgo en prematuros españoles de 32 a 35 semanas de gestación es escasa, aunque similar a otros modelos existentes.
The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain.
A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home.
Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R
2 of 0.062 and area under curve of 0.687 (
P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657.
Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models.
Chronic diseases strongly affect individuals' health status. In aggregate terms, this impact is reflected by the stock of health, which measures the amount of health of a population in a given period ...of time.
The objectives of this study were to measure the relative burden of chronic illnesses by assessing health‐related quality of life using the EQ‐5D‐5L instrument, to rank diseases according to their associations with the stock of health, and to calculate the stock of health of the Spanish population and the amount of health loss attributable to each chronic disease from a social perspective.
Data were gathered from the Spanish Health Survey (ENSE 2011–2012, N = 20,587). A population weighted least squares model was used.
Chronic diseases represent 19.19% of the stock of health losses in Spain compared with a country free from those diseases. In Spain, the stock of health in 2011 was 31.86 million units on the visual analog scale.
The diseases with the strongest impact in terms of loss of stock of health at the individual level were mental illness and embolism, stroke, or cerebral hemorrhage. Collectively, the diseases with the largest impact included osteoarthritis, arthritis, or rheumatism; chronic back pain; and high blood pressure.
The aim of this study was to evaluate the long-term cost-effectiveness of sacral neuromodulation in the treatment of severe faecal incontinence as compared with symptomatic management.
In the public ...health field, a micro-costing evaluation method was conducted from the perspectives of the health system and the society. The incremental cost-effectiveness ratio was used as a decision index, and we considered various scenarios to evaluate the impact of the cost of symptomatic management and percutaneous nerve evaluation success rate in its calculation. Clinical data were retrieved from a consecutive cohort of 93 patients with severe faecal incontinence undergoing sacral neuromodulation after a failure of conservative (pharmacological and biofeedback) and/or surgical (sphincteroplasty) first-line treatments were considered.
The long-term incremental cost-effectiveness ratio comparing sacral neuromodulation versus symptomatic management was 14347€/QALY and 28523€/QALY from the societal and health service provider's perspectives, respectively. If the definitive pulse generator implant success rate was 100%, incremental cost-effectiveness would correspond to 6831€/QALY and 16761€/QALY, respectively.
Sacral neuromodulation may be considered a cost-effective technique in the long-term treatment of severe faecal incontinence from the societal and health care sector perspectives. Improving patient selection and determining the predictive outcome factors for successful sacral neuromodulation in the treatment of faecal incontinence would improve cost-effectiveness.
Antes de hablar de innovación educativa, necesitamos determinar qué entendemos por perfeccionar tanto el acto educativo como el proceso de crecimiento de las personas involucradas en él. Inspirados ...por la forma de entender el desarrollo personal de Leonardo Polo y Erik Erikson, entre otros autores, analizamos los requisitos antropológicos y psicológicos necesarios para que emerja la novedad tanto en cada acto educativo como en los actores que participan en él. Encontramos que la novedad emerge en el interior de cada acto educativo cuando la competencia se pone al servicio de la transformación del mundo en aras del encuentro interpersonal.
Lantus, the reference insulin glargine used for the treatment of diabetes, lost its patent protection in 2014, opening the market to biosimilar competitors.
First, to analyze the adoption rates of ...insulin glargine biosimilars in primary care in England and estimate the savings realized and missed, since an insulin glargine biosimilar was first used, and second, to assess potential variations in adoption rates across Clinical Commissioning Groups (CCGs).
Data sets capturing information on all insulin glargine items prescribed by all general practitioners up to December 2018 were used. Total costs of insulin glargine and uptake rates of biosimilars were calculated. The real-world budget impact was estimated assuming the cost of reference insulin glargine for all items and comparing the total costs in this scenario with the total costs in the real world. The missed savings were estimated assuming the cost of biosimilars for all insulin glargine items. Choropleth maps were generated to assess potential variations in uptake across CCGs.
Insulin glargine biosimilars generated savings of £900,000 between October 2015 (time of first prescription) and December 2018. The missed savings amounted to £25.6 million in this period, indicating that only 3.42% of the potential savings were achieved. The analyses demonstrated a large level of variation in the uptake of insulin glargine biosimilars across CCGs, with market shares ranging from 0 to 53.3% (December 2018).
These results may encourage decision makers in England to promote the use of best-value treatments in primary care and to reevaluate variation across CCGs.
Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive ...cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction.
A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial's eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial's primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider's and society perspective using direct and indirect medical costs.
This is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA.
ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.
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