Objetivos: La autopercepción en salud es definida como la apreciación del propio estado de salud. Este es un fenómeno multidimensional en el que actúan variables como la salud psicológica, el capital ...social y algunos factores sociodemográficos. Su estimación ha tomado relevancia en salud pública, ya que predice indicadores como morbilidad, mortalidad y uso de servicios sanitarios. El objetivo fue realizar una medición de la salud psicológica, el capital social y diversos factores sociodemográficos y establecer su probable asociación con la autopercepción en salud. Métodos: Se realizó un estudio transversal entre septiembre y octubre de 2021. Se aplicó un instrumento con 52 preguntas sobre autopercepción en salud, capital social, salud psicológica y algunos factores sociodemográficos, y se realizó un análisis bivariado y multivariado en el programa CIETmap para identificar las variables que tuvieron mayor influencia en la autopercepción en salud. Resultados: En la muestra, el 80 % de las personas consideró su estado de salud como bueno o muy bueno, mientras que 17 % afirmó que su estado de salud es regular; el 17 % del total de la muestra tiene un alto riesgo de sufrir trastornos emocionales, y 58 % de los encuestados cuenta con buenas redes de apoyo. Por último, se estimó que la medida de asociación que mayor riesgo presentó en la autopercepción en salud fue vivir sin pareja (OR=5.90). Conclusiones: En la población estudiada, los factores asociados al capital social y al bienestar psicológico están relacionados con la autopercepción en salud, y vivir sin pareja fue un factor relevante.
The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a ...hyperinflammatory state according to clinical and laboratory parameters.
A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).
In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001).
Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.
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Abdominal Hypopressive Training (AHT) provides postural improvement, and enhances deep trunk muscle activation. However, until recently, there was a lack of scientific literature supporting these ...statements. The major purpose of this study was to investigate the effect of AHT on posture control and deep trunk muscle function.
125 female participants aged 18-60 were randomly allocated to the Experimental Group (EG), consisting of two sessions of 30 min per week for 8 weeks of AHT, or the Control Group (CG), who did not receive any treatment. Postural control was measured with a stabilometric platform to assess the static balance and the activation of deep trunk muscles (specifically the Transverse Abdominal muscle (TrA)), which was measured by real-time ultrasound imaging.
The groups were homogeneous at baseline. Statistical differences were identified between both groups after intervention in the Surface of the Center of Pressure (CoP) Open-Eyes (S-OE) (
= 0.001, Cohen's d = 0.60) and the Velocity of CoP under both conditions; Open-Eyes (V-OE) (
= 0.001, Cohen´s d = 0.63) and Close-Eyes (V-CE) (
= 0.016, Cohen´s d = 0.016), with the EG achieving substantial improvements. Likewise, there were statistically significant differences between measurements over time for the EG on S-OE (
< 0.001, Cohen´s d = 0.99); V-OE (
= 0.038, Cohen´s d = 0.27); V-CE (
= 0.006, Cohen´s d = 0.39), anteroposterior movements of CoP with Open-Eyes (RMSY-OE) (
= 0.038, Cohen´s d = 0.60) and activity of TrA under contraction conditions (
< 0.001, Cohen´s d = 0.53).
The application of eight weeks of AHT leads to positive outcomes in posture control, as well as an improvement in the deep trunk muscle contraction in the female population.
Etiological diagnosis of fever in children with sickle cell disease (SCD) is often challenging. The aim of this study was to analyze the pattern of inflammatory biomarkers in SCD febrile children and ...controls, in order to determine predictors of severe bacterial infection (SBI).
A prospective, case-control study was carried out during 3 years, including patients younger than 18 years with SCD and fever (cases) and asymptomatic steady-state SCD children (controls). Clinical characteristics and laboratory parameters, including 10 serum proinflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17a, IFN-γ and TNF-α) and comparisons among study subgroups were analyzed.
A total of 137 patients (79 cases and 58 controls) were included in the study; 78.5% males, median age 4.1 (1.7-7.5) years. Four cases were diagnosed with SBI, 41 viral infection (VI), 33 no proven infection (NPI) and 1 bacterial-viral coinfection (the latter excluded from the subanalyses). IL-6 was significantly higher in patients with SBI than in patients with VI or NPI (163 vs 0.7 vs 0.7 pg/ml, p < 0.001), and undetectable in all controls. The rest of the cytokines analyzed did not show any significant difference. The optimal cut-off value of IL-6 for the diagnosis of SBI was 125 pg/mL, with high PPV and NPV (PPV of 100% for a prevalence rate of 5, 10 and 15% and NPV of 98.7%, 97.3% and 95.8% for those prevalences rates, respectively).
We found that IL-6 (with a cut-off value of 125 pg/ml) was an optimal marker for SBI in this cohort of febrile SCD children, with high PPV and NPV. Therefore, given its rapid elevation, IL-6 may be useful to early discriminate SCD children at risk of SBI, in order to guide their management.
The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for ...depression and the values and criteria upon which these opinions are based.
A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities.
The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a "patient-centred" approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed.
Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.
Not enough is known about universal prevention of depression in adults.
To evaluate the effectiveness of an intervention to prevent major depression.
Multicenter, cluster randomized trial with sites ...randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982).
10 primary care centers in each of 7 cities in Spain.
Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate.
For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression.
New cases of major depression, assessed every 6 months for 18 months.
At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points CI, -4.18 to 0.16 percentage points; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities.
Potential self-selection bias due to nonconsenting patients.
Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted.
Institute of Health Carlos III.
BackgroundFew data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of ...attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care.MethodsA systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12 months of follow-up. Data were analysed using multilevel logistic regression.Results7777 primary care attendees aged 18–75 years were selected, of whom 1251 (16.1%) were excluded. Of the remaining 6526, 1084 (16.6%) refused to participate. Thus, 5442 patients (attending 231 family physicians in 41 health centres) were interviewed at baseline, of whom 3804 (70%) and 3567 (66%) remained at 6 and 12 months of follow-up, respectively. The province and sociodemographic factors were stronger predictors of attrition than psychosocial factors. Depression and anxiety had no effect but other psychosocial factors affected attrition. There were different profiles for the patients lost at 12 months when predictors measured at baseline versus 6 months were included.ConclusionsThese findings suggest that several psychosocial factors might be considered factors of attrition in primary care cohorts and confirm that baseline characteristics are insufficient for analysing non-response in longitudinal studies, indicating that different retention strategies should be applied for patients interviewed at 6 and 12 months.
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► Different types of substrates induce suicide inactivation of tyrosinase. ► The rate of this process is: o-diphenols>o-aminophenols>aromatic o-diamines. ► The catalytic and ...inactivation constants fit to Hammett's equation. ► The catalysis and suicide inactivation mechanisms are similar in all substrates.
A study of the diphenolase, o-aminophenol oxidase, and the aromatic o-diamine oxidase activities of tyrosinase carried out by measuring the catalysis and suicide inactivation kinetics provides the following information: catalytic constant, kcatS, Michaelis constant, KMS, the maximum apparent inactivation constant, λmaxS, and the partition ratio “r” between the suicide inactivation pathway and catalytic pathway or the number of turnovers made by one mol of enzyme before its inactivation. Analysis of these data, taking into account chemical shifts of the carbon atom supporting the hydroxyl or amino group, (δ) and σp+, enables a mechanism to be proposed for the transformation of o-diphenols, o-aminophenols and o-phenylendiamines into their products (o-quinones, o-quinoneimine and o-diimine), and, at the same time, for the suicide inactivation.
The reaction constants in the representations of log kcatX/kcatH vs.σp+ according to Hammett's equation for the three types of substrate (o-diphenols, o-aminophenols and o-phenylendiamines) confirm that the catalysis mechanism is similar (simultaneous oxidation/reduction process on the two copper atoms). The dependence of log λmaxX/λmaxH vs.σp+ for the three substrate types reflects a lower reaction constant (in absolute value), which might indicate a similar reaction mechanism for the different molecules, but different from the previous mechanism, in that the oxidation/reduction only involves one copper atom.
We also discuss the proposed mechanism and compare it with those described by other authors. Knowledge and quantification of the catalysis/inactivation process of tyrosinase might be of interest for optimizing applications such as wastewater treatment.
The aim of the study was to describe the epidemiologic and clinical characteristics and identify the risk factors of short-term and 1-year mortality in a recent cohort of patients with infective ...endocarditis (IE).From January 2008, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in 25 Spanish hospitals.Overall, 1804 patients were diagnosed. The median age was 69 years (interquartile range, 55-77), 68.0% were men, and 37.1% of the cases were nosocomial or health care-related IE. Gram-positive microorganisms accounted for 79.3% of the episodes, followed by Gram-negative (5.2%), fungi (2.4%), anaerobes (0.9%), polymicrobial infections (1.9%), and unknown etiology (9.1%). Heart surgery was performed in 44.2%, and in-hospital mortality was 28.8%. Risk factors for in-hospital mortality were age, previous heart surgery, cerebrovascular disease, atrial fibrillation, Staphylococcus or Candida etiology, intracardiac complications, heart failure, and septic shock. The 1-year independent risk factors for mortality were age (odds ratio OR, 1.02), neoplasia (OR, 2.46), renal insufficiency (OR, 1.59), and heart failure (OR, 4.42). Surgery was an independent protective factor for 1-year mortality (OR, 0.44).IE remains a severe disease with a high rate of in-hospital (28.9%) and 1-year mortality (11.2%). Surgery was the only intervention that significantly reduced 1-year mortality.
Around 2·5 million deaths and more than 110 million COVID-19 cases have been reported globally. Although it initially appeared that HIV infection was not a risk factor for COVID-19 or more severe ...disease, more recent large studies suggest that people living with HIV (particularly with low CD4 cell counts or untreated HIV infection) might have a more severe clinical course than those who are HIV-negative. Moreover, the COVID-19 pandemic has disrupted HIV prevention and treatment services worldwide, creating huge challenges to the continuity of essential activities. We have reviewed the most relevant features of COVID-19 in people living with HIV and highlighted topics where further research is required.
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