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  • Publication
    [Genetic protocol in primary care for rare diseases: Wolfram syndrome as a prototype].
    (2022-03-16) Esteban-Bueno, Gema; Díaz-Anadón, Lucas Ramón; Rodríguez González, Antonio; Navarro Cabrero, Miguel; Berenguel Hernández, Aída María
    Rare diseases, despite their individual low frequency, affect 7% of the population all combined. Consequently, every primary care practitioner (PCP) will have several of these patients under his care. 80% of rare diseases are genetically determined, which makes genetic counseling fundamental in these cases. The follow-up of patients with Wolfram syndrome (WS) can be used to design a protocol to support these patients, with the participation of researchers and healthcare professionals specialized in WS, the patients themselves and their familial environment. This protocol can be suitable for the diagnosis and management of other diseases as well. The main steps of every genetic clinical procedure are developed in this article, emphasizing the role of PCP in supporting patients and their families and in transmitting genetic information in a comprehensible manner.
  • Publication
    Neuroprotective Effect of 3',4'-Dihydroxyphenylglycol in Type-1-like Diabetic Rats-Influence of the Hydroxytyrosol/3',4'-dihydroxyphenylglycol Ratio.
    (2022-03-08) Rodríguez-Pérez, María Dolores; Pérez de Algaba, Inmaculada; Martín-Aurioles, Esther; Arrebola, María Monsalud; Ortega-Hombrados, Laura; Verdugo, Cristina; Fernández-Prior, María África; Bermúdez-Oria, Alejandra; De La Cruz, José Pedro; González-Correa, José Antonio
    The aim of this study was to assess the possible neuroprotective effect of 3',4'-dihydroxyphenylglycol (DHPG), a polyphenol from extra virgin olive oil (EVOO), in an experimental model of diabetes and whether this effect is modified by the presence of another EVOO polyphenol, hydroxytyrosol (HT). The neuroprotective effect was assessed in a hypoxia-reoxygenation model in brain slices and by quantifying retinal nerve cells. The animals were distributed as follows: (1) normoglycemic rats (NDR), (2) diabetic rats (DR), (3) DR treated with HT (5 mg/kg/day p.o.), (4) DR treated with DHPG (0.5 mg/kg/day), or (5) with 1 mg/kg/day, (6) DR treated with HT plus DHPG 0.5 mg/kg/day, or (7) HT plus 1 mg/kg/day p.o. DHPG. Diabetic animals presented higher levels of oxidative stress variables and lower numbers of neuronal cells in retinal tissue. The administration of DHPG or HT reduced most of the oxidative stress variables and brain lactate dehydrogenase efflux (LDH) as an indirect index of cellular death and also reduced the loss of retinal cells. The association of DHPG+HT in the same proportions, as found in EVOO, improved the neuroprotective and antioxidant effects of both polyphenols.
  • Publication
    Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.
    (2022-04-08) Orozco-Beltrán, Domingo; Merino-Torres, Juan Francisco; Pérez, Antonio; Cebrián-Cuenca, Ana M; Párraga-Martínez, Ignacio; Ávila-Lachica, Luis; Rojo-Martínez, Gemma; Pomares-Gómez, Francisco J; Álvarez-Guisasola, Fernando; Sánchez-Molla, Manuel; Gutiérrez, Felix; Ortega, Francisco J; Mata-Cases, Manel; Carretero-Anibarro, Enrique; Vilaseca, Josep Maria; Quesada, Jose A
    The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.
  • Publication
    The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial.
    (2022-03-17) Cantero-Téllez, Raquel; Pérez-Cruzado, David; Villafañe, Jorge Hugo; García-Orza, Santiago; Naughton, Nancy; Valdes, Kristin
    A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) post-intervention and at the 3-month follow-up (p
  • Publication
    Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study.
    (2021-12-30) Sánchez-Guarnido, Antonio José; Huertas, Paloma; Garcia-Solier, Rosario; Solano, Miguel; Díez, Beatriz; León, Marta; Herruzo-Cabrera, Javier
    Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients' illnesses. To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.
  • Publication
    Teletherapy and hospitalizations in patients with serious mental illness during the COVID-19 pandemic: A retrospective multicenter study.
    (2022-04-18) Sánchez-Guarnido, Antonio José; Urquiza, Beatriz Machado; Sánchez, Maria Del Mar Soler; Masferrer, Carmen; Perles, Francisca; Petkari, Eleni
    Interventions with patients with Serious Mental Illness (SMI) had to adapt rapidly to the COVID-19 safety restrictive measures, leading to the widespread use of teletherapy as an alternative. The aims of this study were to compare the use of different intervention modalities with patients with SMI during the first wave of the pandemic and examine their association with emergency hospital visits and hospitalization rates six months later. Records of 270 service users of fifteen outpatient mental health services across Spain, were retrospectively assessed. We retrieved clinical data and data on the modality of intervention received (in-person, over the phone, videoconferencing) in three time points (before, during and after the first COVID-19 wave). Also, data were retrieved regarding the frequency of their emergency hospital visits and hospitalization rates, two, four and six months later. During the first wave of the pandemic, teletherapy (over the phone and videoconferencing) was the modality most widely used, whilst in-person therapy sessions were significantly reduced, though they seemed to return to pre-COVID levels after the first wave had passed. Importantly, patients receiving teletherapy during the first wave seemed to have significantly fewer emergency visits and hospitalization rates four and six months later (χ2 = 13.064; p Under challenging circumstances as those created by the COVID pandemic, teletherapy is a useful tool for protection against hospitalizations and can be used as an alternative to in-person therapy, to ensure continuity of care for patients with SMI.
  • Publication
    Sun exposure and protection habits in transplant athletes: An international survey.
    (2021-12-08) Navarrete-De Gálvez, M; Ruiz Sánchez, J M; Navarrete-De Gálvez, E; Aguilera, J; Rivas-Ruiz, F; de Troya-Martín, M; Herrera-Ceballos, E; de Gálvez, M V
    Transplant recipients are particularly prone to the development of skin cancer, and overexposure to UV radiation during outdoor activities increases the risk of carcinogenesis. The aim of this study was to analyze sun-related behaviors and knowledge in transplant athletes, examine the frequency of sunburns, and explore associations with a history of skin cancer. Cross-sectional descriptive study. Participants (n = 170) in the XXI World Transplant Games from >50 countries completed a questionnaire on sun protection habits and knowledge, type of transplant, immunosuppressive therapy, and personal history of skin cancer. The most common transplanted organs were the kidney (n = 79), the liver (n = 33), and the heart (n = 31). Overall, 61.3% of athletes had been doing sport for >15 years and 79.5% spent >1-2 h a day outdoors. Fifteen % of athletes had a history of skin cancer. The prevalence of sunburn in the previous year was 28.9%, higher in athletes aged 15 years and 79.5% spent >1-2 h a day outdoors. Fifteen % of athletes had a history of skin cancer. The prevalence of sunburn in the previous year was 28.9%, higher in athletes aged 1-2 h a day outdoors. Fifteen % of athletes had a history of skin cancer. The prevalence of sunburn in the previous year was 28.9%, higher in athletes aged Despite high awareness that sun exposure increases the risk of skin cancer, sunburn was common in transplant athletes. Efforts should be made to strengthen multidisciplinary sun protection education strategies and ensure periodic dermatologic follow-up to prevent sun-induced skin cancer in this population.
  • Publication
    Reply to: Comment on: Clinical benefits of empagliflozin in very old patients with type 2 diabetes hospitalized for acute heart failure.
    (2022-02-17) Pérez-Belmonte, Luis M; Miramontes-González, José P; Osuna-Sánchez, Julio; Lara, José P; Gómez-Huelgas, Ricardo
  • Publication
    Heterogeneity in the association between prediabetes categories and reduction on glomerular filtration rate in a 5-year follow-up.
    (2022-05-05) Manouchehri, Marjan; Cea-Soriano, Lucía; Franch-Nadal, Josep; Ruiz, Antonio; Goday, Albert; Villanueva, Rosa; Diez-Espino, Javier; Mata-Cases, Manel; Giraldez-García, Carolina; Regidor, Enrique; PREDAPS Study Group
    Prediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate 
  • Publication
    Training in digital competencies for health professionals: systematic mapping (2015-2019)
    (ediciones profesionales informacion sl-epi, 2021-03-01) Fernandez-Luque, Antonia-Maria; Ramirez-Montoya, Maria-Soledad; Cordon-Garcia, Jose-Antonio; [Fernandez-Luque, Antonia-Maria] Univ Salamanca, Grp E Lectra, Salamanca, Spain; [Fernandez-Luque, Antonia-Maria] Lib Area Gest Sanitaria Este Malaga Axarquia, Malaga, Spain; [Ramirez-Montoya, Maria-Soledad] Tecnol Monterrey, Escuela Humanidades & Educ, Avda Garza Sada 20501 Sur, Monterrey 64849, Nuevo Leon, Mexico; [Cordon-Garcia, Jose-Antonio] Univ Salamanca, Grp E Lectra, Fac Traducc & Documentac, Francisco de Vitoria 6-16, Salamanca 37008, Spain; Andalusian public foundation Progreso y Salud; Fundacion Fimabis, Consejeria de Salud de la Junta de Andalucia
    Digital competencies are one of the main transversal competencies of the XXI century. By means of systematic mapping, international published papers and research on digital skills training were critically evaluated, generating a process that helps us to recognize information about health professionals and the type of educational technology used in training. With this in mind, we employed the systematic mapping method using the WoS and Scopus databases between 2015 and 2019 in English and Spanish, specifically focused on research articles. The five competencies of the European Framework of Digital Competence were used to analyze the articles, and the works were classified according to the educational technology used. Inclusion, exclusion, and quality criteria were applied. Two hundred and forty-eight articles were selected for the study. Most focused on the information literacy dimension (168) and used digital educational technology. In total, 27 papers were concerned with competence in communication, 19 with safety, and 12 with problem-solving. Only 8% of the papers were conducted in the context of health institutions, and 68% were based in an academic context. Articles related to the social field were found that dealt with aspects directly linked to health and safety. The publications on digital competencies used in the field of health mostly addressed the dimension of information competence, with a focus on the design and implementation of training activities in the management of information sources, instructional standards, curriculum design, and the competencies of the health librarian as an instructor.
  • Publication
    Impact of Climate Change on Eye Diseases and Associated Economical Costs.
    (2021-07-05) Echevarría-Lucas, Lucía; Senciales-González, José Mᵃ; Medialdea-Hurtado, María Eloísa; Rodrigo-Comino, Jesús
    Climate change generates negative impacts on human health. However, little is known about specific impacts on eye diseases, especially in arid and semi-arid areas where increases in air temperatures are expected. Therefore, the main goals of this research are: (i) to highlight the association between common eye diseases and environmental factors; and (ii) to analyze, through the available literature, the health expenditure involved in combating these diseases and the savings from mitigating the environmental factors that aggravate them. Mixed methods were used to assess the cross-variables (environmental factors, eye diseases, health costs). Considering Southern Spain as an example, our results showed that areas with similar climatic conditions could increase eye diseases due to a sustained increase in temperatures and torrential rains, among other factors. We highlight that an increase in eye diseases in Southern Spain is conditioned by the effects of climate change by up to 36.5%; the economic burden of the main eye diseases, extrapolated to the rest of the country, would represent an annual burden of 0.7% of Spain's Gross Domestic Product. In conclusion, the increase in eye diseases has a strong economic and social impact that could be reduced with proper management of the effects of climate change. We propose a new concept: disease sink, defined as any climate change mitigation action which reduces the incidence or morbidity of disease.
  • Publication
    Occupational Therapy in Mental Health via Telehealth during the COVID-19 Pandemic.
    (2021-07-03) Sánchez-Guarnido, Antonio José; Domínguez-Macías, Esther; Garrido-Cervera, José Antonio; González-Casares, Roberto; Marí-Boned, Silvia; Represa-Martínez, Águeda; Herruzo, Carlos
    The COVID-19 pandemic has brought about changes in mental health occupational therapy. Research into these changes and the associated risks of relapse is insufficient. To explore the changes that have taken place in forms of occupational intervention (face-to-face and online) during the pandemic, and to analyze their association with subsequent relapses, a multicenter retrospective cohort study was carried out of 270 patients with mental disorder diagnoses under follow-up in day hospitals during 2020. Our results show that the frequency of face-to-face occupational therapy interventions decreased during lockdown and subsequently recovered. Interventions via telehealth increased during lockdown and have since been continued to a greater extent than before lockdown. Patients who received occupational intervention via telehealth relapsed less in the following six months (10.7% vs. 26.3%; χ2 = 10.372; p = 0.001), especially those who received intervention via videoconferencing (4.2% vs. 22%; χ2 = 5.718; p = 0.017). In conclusion, lockdown subsequent to the COVID-19 outbreak led to a reduction in face-to-face occupational therapy interventions, putting people with prior mental disorders at risk, while the implementation of telehealth tools helped reduce relapses.
  • Publication
    Preconception Care for Men and Women during the Pandemic, an Intervention Proposal.
    (2021-06-28) Rovira-Vizcaíno, Nieves Estrella; Sáez-Padilla, Jesús; Romero-Márquez, José Manuel; Merino-Godoy, María de Los Ángeles
    The COVID-19 pandemic and its measures resulted in limited outdoor activities, reduced group meetings, etc., leading to unhealthy habits. Several studies showed how certain unhealthy habits can lead to serious consequences for both men and women, as well as affect future offspring. (1) Background: Therefore, we present a community intervention at the preconception stage to avoid future risks. The purpose of this intervention is to change lifestyles and beliefs about the health of men and women in the preconception period; (2) Methods: For the design of the intervention, a bibliographic search was performed both in English and Spanish in the main databases of health sciences and nursing (Cochrane, PubMed, Web of Science, CINAHL, LILACS, Dialnet), using descriptors in MeSH health for sciences; (3) Results: We proposed that a variety of lifestyles be analyzed, including aspects such as physical activity, nutrition, etc. In addition, stress management should be emphasized through a relaxation workshop, where three different techniques be proposed to reduce anxiety levels in stressful situations; (4) Conclusions: Due to the limited scientific results of interventions carried out in the preconception period simultaneously with men and women, more community interventions that address this topic are needed to assess the impact of these actions on the health of the population.
  • Publication
    Skin lesions in children during the first wave of the SARS-CoV-2 pandemic.
    (2021-05-04) Carazo Gallego, Begoña; Martín Pedraz, Laura; Galindo Zavala, Rocío; Rivera Cuello, Mercedes; Mediavilla Gradolph, Concepción; Núñez Cuadros, Esmeralda
    Cutaneous manifestations have been included in COVID-19 patients' clinical spectrum. Our objective was to determine the association between skin lesions in children and SARS-CoV-2 infection, analyzing others possible infectious/autoimmune etiologies. Observational, multicenter, cross-sectional study, about children with skin manifestations from April to May 2020. The diagnosis of SARS-CoV-2 was performed by PCR in nasopharyngeal exudate and/or presence of antibodies by serology. Sixty-two children were included, 9 (14.5%) presented positive antibodies to SARS-CoV-2, with no positive PCR to SARS-Cov-2 in those patients in whom it was made. Patients with positive serology to SARS-CoV-2 presented chilblains and/or vesicular-bullous skin lesions more frequently (66.7% vs. 24.5%, p=0.019). Generalized, urticarial and maculopapular rash was more common in patients with negative antibodies (37.7 vs. 0%, p=0.047), others pathogens were isolated in 41.5% of these patients. There were no significant differences in the positivity for autoantibodies between both groups. In our study, the presence of chilblains-like and/or vesicular lesions were significantly related to SARS-CoV-2 previous contact.
  • Publication
    [Paratyphoid fever two months after a trip to India].
    (2021-03-04) Ortega Recio, M D; Ojeda Burgos, G G; Palacios Muñoz, R; Gómez Ayerbe, C
  • Publication
    Skin manifestations during the COVID-19 pandemic in the pediatric emergency department.
    (2021-07-16) Oliva Rodríguez-Pastor, Silvia; Martín Pedraz, Laura; Carazo Gallego, Begoña; Galindo Zavala, Rocío; Lozano Sánchez, Gema; de Toro Peinado, Inmaculada; Rodriguez Benjumea, Margarita; Mejias, Asuncion; Núñez Cuadros, Esmeralda
    The role of SARS-CoV-2 as the cause of chilblains in children remains a matter of debate but it is important to elucidate it for patient isolation and contact tracing. We sought to define the etiology, clinical presentation, time course, and outcomes of children presenting to the emergency department (ED) with cutaneous manifestations shortly after the first pandemic peak of COVID-19 in Spain. A prospective, observational study in children From April 14 through May 8, 2020, we enrolled 62 children. Of those, 34 had acro-ischemic skin lesions and 28 had a variety of skin rashes. Overall, 40% of children had mild systemic symptoms. Children with chilblains were older, had pain more frequently and a more prolonged duration of skin lesions, while those with non-specific rashes had fever more frequently. Lesions were resolved in 75% of children at follow up. Five patients demonstrated SARS-CoV-2 antibodies, and none tested positive with PCR. Three additional patients tested positive with PCR for rhinovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae. The number of ED visits for chilblains, which are rare in pediatrics, was high soon after the first peak of COVID-19 in Spain. The disease course was self-limited, outcomes were favorable, and the possibility of viral transmission was negligible as all patients tested negative for SARS-CoV-2 by PCR.
  • Publication
    Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain.
    (2021) Ramos-Rincon, Jose-Manuel; Buonaiuto, Verónica; Ricci, Michele; Martín-Carmona, Jesica; Paredes-Ruíz, Diana; Calderón-Moreno, María; Rubio-Rivas, Manel; Beato-Pérez, José-Luis; Arnalich-Fernández, Francisco; Monge-Monge, Daniel; Vargas-Núñez, Juan-Antonio; Acebes-Repiso, Gonzalo; Mendez-Bailon, Manuel; Perales-Fraile, Isabel; García-García, Gema-María; Guisado-Vasco, Pablo; Abdelhady-Kishta, Alaaeldeen; Pascual-Pérez, Maria-de-Los-Reyes; Rodríguez-Fernández-Viagas, Cristina; Montaño-Martínez, Adrián; López-Ruiz, Antonio; Gonzalez-Juarez, Maria-Jesus; Pérez-García, Cristina; Casas-Rojo, José-Manuel; Gómez-Huelgas, Ricardo; SEMI-COVID-19 Network
    Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1-May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status-not comorbidities-are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.
  • Publication
    Electricity demand during pandemic times: The case of the COVID-19 in Spain.
    (2020-10-13) Santiago, I; Moreno-Munoz, A; Quintero-Jiménez, P; Garcia-Torres, F; Gonzalez-Redondo, M J
    Electricity demand and its typical load pattern are usually affected by many endogenous and exogenous factors to which the generation system must accordingly respond through utility operators. Lockdown measures to prevent the spread of COVID-19 imposed by many countries have led to sudden changes in socioeconomic habits which have had direct effects on the electricity systems. Therefore, a detailed analysis of how confinement measures have modified the electricity consumption in Spain, one of the countries most affected by this pandemic, has been performed in this work. Its electricity consumption has decreased by 13.49% from March 14 to April 30, compared to the average value of five previous years. Daily power demand profiles, especially morning and evening peaks, have been modified at homes, hospitals, and in the total power demand. These changes generate a greater uncertainty for the System Operator when making demand forecasts, but production deviations have increased by only 0.1%, thanks to the presence of a diversified generation mix, which has been modified during this period, increasing the proportion of renewable sources and decreasing CO2 emissions.
  • Publication
    Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.
    (2020) Casas, María de la Paz; García, Fernando; Freyre-Carrillo, Carolina; Montiel, Natalia; de la Iglesia, Alberto; Viciana, Isabel; Domínguez, Ana; Guillot, Vicente; Muñoz, Aurora; Cantudo, Purificación; Franco-Álvarez, Francisco; Reguera, Juan Antonio; Romera, María Angustias; Cabezas, Teresa; Vargas, Julio; Ramírez-Arcos, Mercedes; Guerrero, Inmaculada; García-Navarrete, África; Pérez-Santos, María Jesús; Clavijo, Encarnación; Roldán, Carolina; Guzmán, Antonio; Palanca, Matilde; Torres, Eva; Serrano, María Del Carmen; Lozano, María Del Carmen; Becerril, Berta; Luzón, Pilar; Galán, María Ángeles; Alados, Juan Carlos; García, Federico
    undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.
  • Publication
    CB1 and LPA1 Receptors Relationship in the Mouse Central Nervous System.
    (2019-09-19) González de San Román, Estíbaliz; Manuel, Iván; Ledent, Catherine; Chun, Jerold; Rodríguez de Fonseca, Fernando; Estivill-Torrús, Guillermo; Santín, Luis Javier; Rodríguez Puertas, Rafael
    Neurolipids are a class of bioactive lipids that are produced locally through specific biosynthetic pathways in response to extracellular stimuli. Neurolipids are important endogenous regulators of neural cell proliferation, differentiation, oxidative stress, inflammation and apoptosis. Endocannabinoids (eCBs) and lysophosphatidic acid (LPA) are examples of this type of molecule and are involved in neuroprotection. The present study analyzes a possible relationship of the main receptor subtypes for both neurolipid systems that are present in the central nervous system, the CB1 and LPA1 receptors, by using brain slices from CB1 KO mice and LPA1-null mice. Receptor-mediated G protein activation and glycerophospholipid regulation of potential precursors of their endogenous neurotransmitters were measured by two different in vitro imaging techniques, functional autoradiography and imaging mass spectrometry (IMS), respectively. Possible crosstalk between CB1 and LPA1 receptors was identified in specific areas of the brain, such as the amygdala, where LPA1 receptor activity is upregulated in CB1 KO mice. More evidence of an interaction between both systems was that the CB1-mediated activity was clearly increased in the prefrontal cortex and cerebellum of LPA1-null mice. The eCB system was specifically over-activated in regions where LPA1 has an important signaling role during embryonic development. The modifications on phospholipids (PLs) observed in these genetically modified mice by using the IMS technique indicated the regulation of some of the PL precursors of both LPA and eCBs in specific brain areas. For example, phosphatidylcholine (PC) (36:1) was detected as a potential LPA precursor, and phosphatidylethanolamine (PE) (40:6) and PE (p18:0/22:6) as potential eCB precursors. The absence of the main cerebral receptors for LPA or eCB systems is able to induce modulation on the other at the levels of both signaling and synthesis of endogenous neurotransmitters, indicating adaptive responses between both systems during prenatal and/or postnatal development.