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  • Publication
    Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.
    (2022-04-29) Alonso, J; Vilagut, G; Alayo, I; Ferrer, M; Amigo, F; Aragón-Peña, A; Aragonès, E; Campos, M; Del Cura-González, I; Urreta, I; Espuga, M; González Pinto, A; Haro, J M; López Fresneña, N; Martínez de Salázar, A; Molina, J D; Ortí Lucas, R M; Parellada, M; Pelayo-Terán, J M; Pérez Zapata, A; Pijoan, J I; Plana, N; Puig, M T; Rius, C; Rodriguez-Blazquez, C; Sanz, F; Serra, C; Kessler, R C; Bruffaerts, R; Vieta, E; Pérez-Solá, V; Mortier, P; MINDCOVID Working group
    Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.
  • Publication
    Genetic landscape of Segawa disease in Spain. Long-term treatment outcomes.
    (2021-11-25) Fernández-Ramos, Joaquín A; De la Torre-Aguilar, María José; Quintáns, Beatriz; Pérez-Navero, Juan Luis; Beyer, Katrin; López-Laso, Eduardo; Spanish Segawa Disease Research group
    In 2009, we described a possible founder effect of autosomal dominant Segawa disease in Córdoba (Spain) due to mutation c.265C>T (p. Q89*) in the GCH1 gene. We present a retrospective multicentre study aimed at improving our knowledge of Segawa disease in Spain and providing a detailed phenotypic-genotypic description of patients. Clinical-genetic information were obtained from standardized questionnaires that were completed by the neurologists attending children and/or adults from 16 Spanish hospitals. Eighty subjects belonging to 24 pedigrees had heterozygous mutations in GCH1. Seven genetic variants have been described only in our cohort of patients, 5 of which are novel mutations. Five families not previously described with p. Q89* were detected in Andalusia due to a possible founder effect. The median latency to diagnosis was 5 years (IQR 0-16). The most frequent signs and/or symptoms were lower limb dystonia (38/56, 67.8%, p = 0.008) and diurnal fluctuations (38/56, 67.8%, p = 0.008). Diurnal fluctuations were not present in the phenotypes other than dystonia. Fifty-three of 56 symptomatic patients were treated with a levodopa/decarboxylase inhibitor for (mean ± SD) 12.4 ± 8.12 years, with 81% at doses lower than 350 mg/day (≤5 mg/kg/d in children). Eleven of 53 (20%) patients had nonresponsive symptoms that affected daily life activities. Dyskinesias (4 subjects) were the most prominent adverse effects. This study identifies 5 novel mutations and supports the hypothesis of a founder effect of p. Q89* in Andalusia. New insights are provided for the phenotypes and long-term treatment responses, which may improve early recognition and therapeutic management.
  • Publication
    Dyslipidemias and stroke prevention: recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology.
    (2020-11-04) Palacio-Portilla, E J; Roquer, J; Amaro, S; Arenillas, J F; Ayo-Martín, O; Castellanos, M; Freijo, M M; Fuentes, B; García-Pastor, A; Gomis, M; Gómez-Choco, M; López-Cancio, E; Martínez-Sánchez, P; Morales, A; Rodríguez-Yáñez, M; Segura, T; Serena, J; Vivancos-Mora, J; de Leciñana, M A; Comité ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología
    We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value
  • Publication
    Home haemodialysis, the perfect opportunity to stay at home.
    (2021-04-16) Pérez Fernández, Álvaro; Gordillo García, Llenalia; Poveda García, Inmaculada
  • Publication
    Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.
    (2022) Estella, Á; Garcia Garmendia, J L; de la Fuente, C; Machado Casas, J F; Yuste, M E; Amaya Villar, R; Estecha, M A; Yaguez Mateos, L; Cantón Bulnes, M L; Loza, A; Mora, J; Fernández Ruiz, L; Díez Del Corral Fernández, B; Rojas Amezcua, M; Rodriguez Higueras, M I; Díaz Torres, I; Recuerda Núñez, M; Zaheri Beryanaki, M; Rivera Espinar, F; Matallana Zapata, D F; Moreno Cano, S G; Gimenez Beltrán, B; Muñoz, N; Sainz de Baranda Piñero, A; Bustelo Bueno, P; Moreno Barriga, E; Rios Toro, J J; Pérez Ruiz, M; Gómez González, C; Breval Flores, A; de San José Bermejo Gómez, A; Ruiz Cabello Jimenez, M A; Guerrero Marín, M; Ortega Ordiales, A; Tejero-Aranguren, J; Rodriguez Mejías, C; Gomez de Oña, J; de la Hoz, C; Ocaña Fernández, D; Ibañez Cuadros, S; Garnacho Montero, J; Work Group of Infectious Disease (GTEI) de la Sociedad Andaluza de Medicina Intensiva y Unidades coronarias SAMIUC
    The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Prospective descriptive multicenter cohort study. 26 Intensive care units (ICU) from Andalusian region in Spain. Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. None. Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.
  • Publication
    Effects of probiotics on cognitive and emotional functions in healthy older adults: Protocol for a double-blind randomized placebo-controlled crossover trial.
    (2022-01-25) Ruiz-Gonzalez, Cristofer; Cardona, Diana; Rodriguez-Arrastia, Miguel; Ropero-Padilla, Carmen; Rueda-Ruzafa, Lola; Carvajal, Francisca; Sanchez-Labraca, Nuria; Aparicio Mota, Adrian; Roman, Pablo
    Aging is a process that includes changes in cognitive and emotional functions, as well as changes in the diversity and integrity of gut microbiota. Probiotic treatments have recently been studied as a potential new therapeutic approach to alleviate a wide range of problems in other populations; however, clinical studies in older adults remain insufficient and limited. Thus, the aim of this project is to evaluate the efficacy of a multispecies probiotic formulation as a therapeutic strategy for attenuating the emotional and cognitive decline associated with aging in adults over the age of 55. This is a double-blind randomized placebo-controlled crossover trial involving at least 32 older adults and comparing two conditions: (a) probiotic, providing a multispecies probiotic for 10 weeks (Lactobacillus rhamnosus and Bifidobacterium lactis); and (b) placebo, receiving a harmless substance (potato starch). Despite the increasing use of probiotics for the treatment of cognitive and emotional problems, no study has yet focused on this group, to the best of our knowledge. Therapeutic strategies of the kind outlined in this protocol will help to shed light on the current state of knowledge about this topic, as well as promote health programs tailored to this population, which would encourage active aging and healthy lifestyles. Not only do we expect improvements in the emotional dimension in terms of anxiety, stress, depression, and sleep quality, we also expect improvements in the cognitive dimension in terms of attention, memory, and decreased impulsivity.
  • Publication
    Cutaneous vasculitis due to COVID-19 vaccination.
    (2021-11-13) Gázquez Aguilera, Elena María; Rodríguez García, Manuel; Cantón Yebra, María Teresa
  • Publication
    Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.
    (2022-02-17) Mortier, P; Vilagut, G; Alayo, I; Ferrer, M; Amigo, F; Aragonès, E; Aragón-Peña, A; Asúnsolo Del Barco, A; Campos, M; Espuga, M; González-Pinto, A; Haro, J M; López Fresneña, N; Martínez de Salázar, A; Molina, J D; Ortí-Lucas, R M; Parellada, M; Pelayo-Terán, J M; Pérez-Gómez, B; Pérez-Zapata, A; Pijoan, J I; Plana, N; Polentinos-Castro, E; Portillo-Van Diest, A; Puig, M T; Rius, C; Sanz, F; Serra, C; Urreta-Barallobre, I; Kessler, R C; Bruffaerts, R; Vieta, E; Pérez-Solá, V; Alonso, J; MINDCOVID Working group
    Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.
  • Publication
    Impact of operators experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry(2)
    (Elsevier ireland ltd, 2021-12-29) Cruz-Gonzalez, Ignacio; Torres Saura, Francisco; Trejo-Velasco, Blanca; Fernandez Diaz, Jose Antonio; Fajardo Molina, Ricardo; Del Valle-Fernandez, Raquel; Moreno Terribas, Gerardo; Marti Sanchez, David; Lopez-Minguez, Jose-Ramon; Gomez-Blazquez, Ivan; Sanmartin Pena, Juan-Carlos; Botas, Javier; Martin Lorenzo, Pedro; Palazuelos, Jorge; Albarran Rincon, Ramon; Mohandes, Mohsen; Rodriguez Entem, Felipe-Jose; Marti, Gerard; Valero, Ernesto; Gutierrez, Hipolito; Amat-Santos, Ignacio J.; Nombela-Franco, Luis; Salinas, Pablo; Teruel, Luis; Gomez-Hospital, Joan-Antoni; Arzamendi, Dabit; Torres Sanabria, Mario; Calle Perez, German; Canadas Pruano, Dolores; Perez de Prado, Armando; Benito Gonzalez, Tomas; Arroyo-Ucar, Eduardo; Estevez-Loureiro, Rodrigo; Caneiro-Queija, Berenice; Ibanez Criado, Jose L.; Ruiz-Nodar, Juan M.; [Cruz-Gonzalez, Ignacio] Univ Hosp Salamanca, Inst Biomed Res Salamanca, Cardiol Dept, Salamanca, Spain; [Trejo-Velasco, Blanca] Univ Hosp Salamanca, Inst Biomed Res Salamanca, Cardiol Dept, Salamanca, Spain; [Cruz-Gonzalez, Ignacio] Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain; [Gutierrez, Hipolito] Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain; [Amat-Santos, Ignacio J.] Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain; [Torres Saura, Francisco] Univ Hosp Vinalopo, Intervent Cardiol Unit, Elche, Spain; [Arroyo-Ucar, Eduardo] Univ Hosp Vinalopo, Intervent Cardiol Unit, Elche, Spain; [Fernandez Diaz, Jose Antonio] Univ Hosp Puerta Hierro, Intervent Cardiol Unit, Madrid, Spain; [Fajardo Molina, Ricardo] Univ Hosp Torrecardenas, Cardiol Dept, Almeria, Spain; [Del Valle-Fernandez, Raquel] Univ Hosp Cent Asturias, Cardiol Dept, Oviedo, Spain; [Moreno Terribas, Gerardo] Univ Hosp Clin San Cecilio Granada, Cardiol Dept, Intervent Cardiol Unit, Granada, Spain; [Moreno Terribas, Gerardo] Univ Granada, Med Sch, Granada, Spain; [Marti Sanchez, David] Hosp Cent Def, Cardiol Dept, Madrid, Spain; [Marti Sanchez, David] Univ Alcala, Med Sch, Madrid, Spain; [Lopez-Minguez, Jose-Ramon] Infanta Cristina Univ Hosp Badajoz, Cardiol Dept, Badajoz, Spain; [Lopez-Minguez, Jose-Ramon] Univ Extremadura, Med Sch, Badajoz, Spain; [Gomez-Blazquez, Ivan] Univ Hosp 12 Octubre, Cardiol Dept, Madrid, Spain; [Sanmartin Pena, Juan-Carlos] Clin Univ Hosp Santiago, Cardiol Dept, Santiago De Compostela, Spain; [Botas, Javier] Univ Hosp Fdn Alcorcon, Cardiol Dept, Madrid, Spain; [Botas, Javier] Rey Juan Carlos Univ, Sch Med, Madrid, Spain; [Martin Lorenzo, Pedro] Univ Hosp Gran Canaria Dr Negrin, Cardiol Dept, Intervent Cardiol Unit, Las Palmas Gran Canaria, Spain; [Palazuelos, Jorge] Hosp La Luz, Cardiol Dept, Madrid, Spain; [Albarran Rincon, Ramon] Univ Clin Navarra, Cardiol & Cardiac Surg Dept, Pamplona, Spain; [Mohandes, Mohsen] Joan XXIII Univ Hosp, Intervent Cardiol Unit, Tarragona, Spain; [Rodriguez Entem, Felipe-Jose] Univ Hosp Marques de Valdecilla, Cardiol Dept, Santander, Spain; [Marti, Gerard] Univ Hosp Vall dHebron, Cardiol Dept, Barcelona, Spain; [Valero, Ernesto] Clin Univ Hosp Valencia, Cardiol Dept, Valencia, Spain; [Gutierrez, Hipolito] Clin Univ Hosp Valladolid, Cardiol Dept, Valladolid, Spain; [Amat-Santos, Ignacio J.] Clin Univ Hosp Valladolid, Cardiol Dept, Valladolid, Spain; [Nombela-Franco, Luis] Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain; [Salinas, Pablo] Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain; [Teruel, Luis] Bellvitge Univ Hosp IDIBELL, Cardiol Dept, Barcelona, Spain; [Gomez-Hospital, Joan-Antoni] Bellvitge Univ Hosp IDIBELL, Cardiol Dept, Barcelona, Spain; [Arzamendi, Dabit] Univ Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain; [Torres Sanabria, Mario] Univ Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain; [Calle Perez, German] Univ Hosp Puerta del Mar, Cardiol Dept, Cadiz, Spain; [Canadas Pruano, Dolores] Univ Hosp Puerta del Mar, Cardiol Dept, Cadiz, Spain; [Perez de Prado, Armando] Univ Hosp Leon, Cardiol Dept, Leon, Spain; [Benito Gonzalez, Tomas] Univ Hosp Leon, Cardiol Dept, Leon, Spain; [Estevez-Loureiro, Rodrigo] Univ Hosp Alvaro Cunqueiro, Intervent Cardiol Unit, Vigo, Spain; [Caneiro-Queija, Berenice] Univ Hosp Alvaro Cunqueiro, Intervent Cardiol Unit, Vigo, Spain; [Ibanez Criado, Jose L.] Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante, Cardiol Dept, Alicante, Spain; [Ruiz-Nodar, Juan M.] Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante, Cardiol Dept, Alicante, Spain; [Ruiz-Nodar, Juan M.] Univ Miguel Hernandez, Fac Med, Alicante, Spain; ISCIII; ERDF, "A way to make Europe"; Gerencia Regional Salud de CyL; Boston Scientific [Marlborough, Massachusetts, US]
    Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX.Methods: Prospective, multicenter, "real-world" registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared.Results: 359 patients [mean age 75.5 (SD8.1), CHA(2)DS(2)-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the center's previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed.Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operator's experience with its previous device iteration or the number of Watchman FLX devices implanted.
  • Publication
    Tuberculosis mimicking Crohn's disease and respiratory infection by COVID-19.
    (2021-01-29) Estébanez Ferrero, Beatriz; Ruiz Pardo, José; Velasco Albendea, Francisco Javier; Vidaña Márquez, Elisabet; Moreno Moraleda, Isabel
  • Publication
    Recreational physical activity reduces breast cancer recurrence in female survivors of breast cancer: A meta-analysis.
    (2022-06-11) Zagalaz-Anula, Noelia; Mora-Rubio, María José; Obrero-Gaitán, Esteban; Del-Pino-Casado, Rafael
    The aim of this review was to systematically collect the published evidence to assess the effect of recreational physical activity (PA) in reducing breast cancer (BC) recurrence in female survivors. A bibliographic search was carried out in PubMed Medline, CINAHL Complete, Scopus and Lilacs until June 2021. We selected observational studies or clinical trials comprising women diagnosed with BC, in which the risk of recurrence of BC was measured before or after performing recreational PA. As a secondary outcome, we analyzed disease free survival for recurrence/disease-specific mortality. The methodological quality of observational studies was assessed with the Newcastle-Ottawa Scale and clinical trials with the PEDro scale. A random effects model was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) to infer the results for any female survivor of BC. We performed separate meta-analyses for prediagnosis and postdiagnosis recreational PA. Eleven studies were included, providing data from 29,677 surviving women with BC with an age range of 18-79 years old. Postdiagnosis recreational PA reduced the risk of BC recurrence by 16% (RR, 0.84; 95% CI: 0.78 to 0.91) and the risk of recurrence/disease-specific mortality by 23% (RR, 0.77; 95% CI: 0.66 to 0.93). Prediagnosis PA reduced the risk of BC by 18% (RR, 0.82; 95% CI: 0.74 to 0.91). This systematic review with meta-analysis shows that recreational PA can be an interesting therapeutic tool to protect against recurrence of BC in female survivors.
  • Publication
    Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in hospital paediatrics
    (Ediciones doyma s a, 2022-11-01) Alfredo Goycochea-Valdivia, Walter; Melendo Perez, Susana; Aguilera-Alonso, David; Escosa-Garcia, Luis; Martinez Campos, Leticia; Baquero-Artigao, Fernando; Soc Espanola Infectologia Pediat; [Alfredo Goycochea-Valdivia, Walter] Hosp Univ Virgen Rocio, Serv Infectol Reumatol & Inmunol Pedidat, Seville, Spain; [Melendo Perez, Susana] Hosp Univ Vall dHebron, Serv Pediat, Unidad Patol Infecciosa & Inmunodeficiencias Pedi, Barcelona, Spain; [Aguilera-Alonso, David] Hosp Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiSGM, Serv Pediat, Secc Enfermedades Infecciosas, Madrid, Spain; [Escosa-Garcia, Luis] Inst Invest Hosp Univ La Paz IdiPAZ, Serv Pediat Hosp Enfermedades Infecciosas & Trop, Madrid, Spain; [Baquero-Artigao, Fernando] Inst Invest Hosp Univ La Paz IdiPAZ, Serv Pediat Hosp Enfermedades Infecciosas & Trop, Madrid, Spain; [Martinez Campos, Leticia] Hosp Univ Torrecardenas, Unidad Infectol Pediat, Almeria, Spain; [Aguilera-Alonso, David] Inst Salud Carlos III, CIBER Enfermedades Infecciosas CIBERINFEC, Madrid, Spain; [Escosa-Garcia, Luis] Inst Salud Carlos III, CIBER Enfermedades Infecciosas CIBERINFEC, Madrid, Spain; [Baquero-Artigao, Fernando] Inst Salud Carlos III, CIBER Enfermedades Infecciosas CIBERINFEC, Madrid, Spain
    In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicro-bials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in cur-bing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicro-bial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Espanola de Infectologia Pediatrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country. (c) 2022 Asociacion Espanola de Pediatr & iacute;a. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).
  • Publication
    Adaptacion transcultural al espanol y validez de contenido de 3 escalas de riesgo nutricional
    (Ediciones doyma s a, 2022-07-05) Balaguer Lopez, Evelin; Garcia-Molina, Pablo; Nunez, Francisco; Crehua-Gaudiza, Elena; Montal Navarro, Maria Angeles; Pedron Giner, Consuelo; Vitoria Minana, Isidro; Jovani Casano, Carmen; Galera Martinez, Rafael; Gomez-Lopez, Lilian; Rodriguez Martinez, Gerardo; Martinez-Costa, Cecilia; [Balaguer Lopez, Evelin] Univ Valencia, Dept Enfermeria, Valencia, Spain; [Garcia-Molina, Pablo] Univ Valencia, Dept Enfermeria, Valencia, Spain; [Montal Navarro, Maria Angeles] Univ Valencia, Dept Enfermeria, Valencia, Spain; [Balaguer Lopez, Evelin] Inst Invest INCLIVA, Grp Asociado Cuidados, Valencia, Spain; [Garcia-Molina, Pablo] Inst Invest INCLIVA, Grp Asociado Cuidados, Valencia, Spain; [Montal Navarro, Maria Angeles] Inst Invest INCLIVA, Grp Asociado Cuidados, Valencia, Spain; [Balaguer Lopez, Evelin] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Garcia-Molina, Pablo] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Nunez, Francisco] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Crehua-Gaudiza, Elena] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Montal Navarro, Maria Angeles] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Martinez-Costa, Cecilia] Inst Invest INCLIVA, Grp Invest Nutr Pediat, Valencia, Spain; [Nunez, Francisco] Univ Valencia, Dept Pediat Obstet & Ginecol, Valencia, Spain; [Crehua-Gaudiza, Elena] Univ Valencia, Dept Pediat Obstet & Ginecol, Valencia, Spain; [Martinez-Costa, Cecilia] Univ Valencia, Dept Pediat Obstet & Ginecol, Valencia, Spain; [Crehua-Gaudiza, Elena] Hosp Clin Univ Valencia, Serv Pediat, Secc Gastroenterol & Nutr Pedidat, Valencia, Spain; [Montal Navarro, Maria Angeles] Hosp Clin Univ Valencia, Serv Pediat, Secc Gastroenterol & Nutr Pedidat, Valencia, Spain; [Martinez-Costa, Cecilia] Hosp Clin Univ Valencia, Serv Pediat, Secc Gastroenterol & Nutr Pedidat, Valencia, Spain; [Pedron Giner, Consuelo] Hosp Infantil Univ Nino Jesus, Serv Pediat, Secc Gastroenterol & Nutr, Madrid, Spain; [Vitoria Minana, Isidro] Hosp Univ & Politecn La Fe, Serv Pediat, Unidad Nutr & Metabolopatias, Valencia, Spain; [Jovani Casano, Carmen] Hosp Gen Castellon, Serv Pediat, Secc Gastroenterol & Nutr Pediat, Castellon De La Plana, Spain; [Galera Martinez, Rafael] Complejo Hosp Torrecardenas, Hosp Maternoinfantil, Serv Pediat, Unidad Gastroenterol & Nutr Pediat, Almeria, Spain; [Gomez-Lopez, Lilian] Leeds Teaching Hosp NHS Trust, Gastroenterol & Nutr Dept, Leeds, W Yorkshire, England; [Rodriguez Martinez, Gerardo] Univ Zaragoza, Hosp Clin Univ Lozano Blesa, Inst Invest Sanitaria Aragon, Serv Pediat, Zarargoza, Spain
    Introduction: There are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country. Objectives: Cross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content. Material and methods: Cross-cultural adaptation using the translation-back-translation met-hod in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales. Results: Starting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item "weight and height". Conclusion: This study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item "weight and height" to consider its use in a Spanish child population adequate. (c) 2021 Asociacion Espanola de Pediatr?? acute accent a. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).
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    [New antibiotic susceptibility testing definitions: «I» no longer means intermediate susceptibility].
    (2021-05-29) Aguilera-Alonso, David; Martínez Campos, Leticia; Fernández Llamazares, Cecilia M; Calvo, Cristina; Baquero-Artigao, Fernando; en representación del Grupo de Trabajo PROA-SEIP
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    Unhealthy food advertising. A position paper by the AEP Committee on Nutrition and Breastfeeding.
    (2022-08-08) Delgado, Juan Rodríguez; Campoy, Cristina; Martínez, Rafael Galera; Mayo, Encina Gallego; Gil-Campos, Mercedes; Jiménez, David González; Ferreiro, Susana Redecillas; de Pipaón, Miguel Sáenz; Leis, Rosaura
    Some important factors influencing and maintaining unhealthy habits are food advertising and products accessibility. In order to develop and support recommendations, an analysis of the available evidence on the impact of food advertising on the health of children and adolescents has been carried out. Literature review of systematic reviews and meta-analyses published up to January 2022 for the term "food advertising" that analyzed the impact of food advertising on weight, body mass index (BMI), adiposity, dietary intake, behavior toward the advertised product, its purchase or consumption in children and adolescents. Twenty-one systematic reviews fulfilled the inclusion criteria, including a total of 490 primary studies, 5 of which also contained a meta-analysis. The vast majority of the primary studies evaluate intermediate effects, related to the behavior of children and adolescents in relation to advertised products and their consumption. There is great variety in terms of the type of advertising and effects studied. Most of the studies agree that there is an association between food advertising and effect analyzed, being more evident in children under 12 years of age and in obese children. Most recent systematic reviews are focused on online advertising, noticing the negative effects especially in adolescents. Children and adolescents are a particularly vulnerable population to food advertising strategies. Despite the difficulty to demonstrate an independent effect, there is evidence of an association between food advertising and childhood and adolescents' behavior respect to the announced products, and the increase of consumption at short-term. In Spain unhealthy product advertising are still very common in the media and in the children and adolescent's online environment. The Nutrition and Breastfeeding Committee of the Spanish Association of Pediatrics supports the need for regulation and limitation of unhealthy food advertising, covering all media and marketing strategies.
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    (2022-07-07) Fernández-Galilea, A; Estella, A; García-Garmendia, J L; Loza, A; Palacios-García, I; Sierra-Camerino, R; Seller, G; Rodríguez-Delgado, M; Rodriguez-Higueras, I; Garnacho-Montero, J
    Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality. Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses. Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095). In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders.
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    tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
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    (2022) Ruiz Pardo, José; Gras Gómez, Cristina; Estébanez Ferrero, Beatriz; Sánchez Fuentes, Pedro Antonio; Gorostiaga Altuna, Íñigo; Vidaña Márquez, Elisabet; Moya, Pedro; Reina Duarte, Ángel
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    Giant cystic hepatocarcinoma in the absence of cirrhosis.
    (2022) Estébanez Ferrero, Beatriz; Rodríguez Perdomo, Martín de Jesús; Velasco Albendea, Francisco Javier; López Ordoño, Gabriel
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