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[Resumen] Objetivos Determinar el pronóstico de pacientes ingresados por una hemorragia subaracnoidea espontánea (HSA) y factores asociados. Desarrollar modelos predictivos al ingreso de mortalidad intrahospitalaria y supervivencia a largo plazo en estos pacientes. .dio de seguimiento retrospectivo de los pacientes ingresados en 2003-2013 la Unidad de Cuidados Intensivos del Complexo Hospitalario Universitario HSA. Se analizaron características demográficas, comorbilidad, clínica de debut, escalas pronósticas al ingreso, manejo complicaciones, mortalidad intrahospitalaria y supervivencia a los 10 años tras el diagnóstico. incluyeron 536 pacientes (Edad: 56,9±14,1 años, 59,3% mujeres, índice de Charlson 0,7±1,1), siendo las manifestaciones más frecuentes cefalea (76,5%), mareo (54, 1 %) y coma (34,0%). En el 78, 1 % de casos se constató presencia de eurisma (HSA-A), en un 17,9% no se encontró causa (HSA-1), el 3,2% ,resentó sangrado perimesencefálico (HSA-PM). Un 53,7% presentaron complicaciones neurológicas durante su ingreso y un .,48,9% complicaciones sistémicas, más frecuentes en HSA-A. La mortalidad ;mtrahospitalaria fue del 27,8%, y la probabilidad global de supervivencia desde el ingreso fue del 62,8% a los 5 años y del 59, 1 % a los 10 años. Las variables predictoras de mortalidad intrahospitalaria fueron el coma de debut (OR=l,87), una puntuación 3-4 en la escala de Fisher (OR=2,26), la escala APACHE II en las primeras 24 horas (OR= l,05) y el SOFA total día O (OR=l,19), asociándose las mismas variables, junto con la edad, a la supervivencia a largo plazo. Se construyeron dos modelos predictivos de mortalidad intrahospitalaria y supervivencia, con adecuada calibración y capacidad discriminativa. Conclusiones Los pacientes con HSA son jóvenes, con escasa comorbilidad e importante impacto pronóstico dependiente de la clínica de debut, gravedad al ingreso y complicaciones durante la estancia. En función del subtipo presentan características y pronóstico diferen, [Resumo] Obxectivos • Determinar o prognóstico de doentes ingresados por unha hemorraxia subaracnoidea espontánea (HSA) e factores asociados. • Desenrolar modelos preditivos ao ingreso de mortalidade intrahospitalaria e supervivencia a longo prazo nestes doentes. Material e métodos Estudo de seguimento retrospectivo dos doentes ingresados en 2003-2013 na Unidade de Coidados Intensivos do Complexo Hospitalario Universitario da Coruña con HSA. Analizáronse características demográficas, comorbilidade, clínica de debut, escalas pronósticas ao ingreso, manexo diagnósticoterapéutico, complicacións, mortalidade intrahospitalaria e supervivencia aos 10 anos tras o diagnóstico. Resultados Incluíronse 536 doentes (Idade: 56,9±14,1 anos, 59,3% mulleres, índice de Charlson 0,7±1,1), senda as manifestacións máis frecuentes cefalea (76,5%), mareo (54,1%) e coma (34,0%). No 78,1% de casos constatouse presenza de aneurisma (HSA-A), nun 17,9% non se atopou causa (HSA-I), o 3,2% presentou sangrado perimesencefálico (HSA-PM). Un 53,7% presentaron complicacións neurolóxicas durante o seu ingreso e un 48,9% algunha complicación sistémica, máis frecuentes na HSA-A. A mortalidade intrahospitalaria foi do 27,8%, e a probabilidade global de supervivencia desde o ingreso foi do 62,8% aos 5 anos o do 59, 1 % aos 10 anos. As variables predictoras de mortalidade intrahospitalaria foron o coma de debut (OR=l,87), unha puntuación 3-4 na escala de Fisher (OR=2,26), a escala APACHE II nas primeiras 24 horas (OR=l,05) e o SOFA total día O (OR=l,19), asociándose as mesmas variables, xunto coa idade, á supervivencia a longo prazo. Construíronse dous modelos predictivos de mortalidade intrahospitalaria e supervivencia, con axeitada calibración e capacidade discriminativa. Conclusións Os doentes con HSA son novas, con escasa comorbilidade e importante impacto pronóstico dependente da clínica de debut, gravidade ao ingreso e complicaciones durante a estancia. En función do subtipo os doentes presentan ca, [Abstract] Objectives • To determine the prognosis of patients admitted by spontaneous subarachnoid haemorrhage (SAH) and associated factors. • To develop predictive models at admission of in-hospital mortality and at long-term survival in these patients. Material and methods Retrospective follow-up study of patients admitted in 2003-2013 to the Intensive Care Unit of the Complexo Hospitalario Universitario de A Coruña with SAH. We analyzed on demographic characteristics, comorbidity, clinical debut, prognostic seores at admission, diagnostic-therapeutic management, complications, inhospital mortality and survival at 10 years after diagnosis. Results We included 536 patients (Age: 56.9±14.1 years, 59.3% women, Charlson index 0.7±1.1), the most frequent manifestations being headache (76.5%), dizziness (54.1 %) and coma (34.0%). The presence of aneurysms (SAH-A) was found in 78.1 % of cases, idiopathic etiologic (SAH-I) was found in 17.9%, and 3.2% presented perimesencephalic bleeding (SAH-PM). Neurological complications occurred in 53.7% of cases during admission and 48.9% of cases presented systemic complication, which were more frequent in SAHA. In-hospital mortality was 27.8% and probability of survival since admission was 62.8% at 5 years and 59,1 % at 10 years. The predictive variables ofin-hospital mortalitywere debut coma (OR=l.87), a score of 3-4 on the Fisher scale (OR=2.26), the APACHE II scale in the first 24 hours (OR=l.05) and total SOFA day O (OR=l.19), the same variables together with age, being associated with long-term survival. Two predictive models of in-hospital mortality and survival were constructed, with adequate calibration and discriminating capacity. 37 Resumen del estudio Conclusions Patients with SAH are young, with low comorbidity and significant prognostic impact depending on the clinic of debut, severity on admission and complications during the stay. Depending on the subtype, patients have different characteristics and prognosis. The p

[Abstract] Objective: To evaluate trends in respiratory care practices and bronchopulmonary dysplasia (BPD) among very preterm infants born in Spain between 2010 and 2019. Study design: This was a retrospective cohort study of data obtained from a national population-based database (SEN1500 network). Changes in respiratory care and BPD-free survival of infants with gestational age (GA) of 230-316 weeks and <1500 g were assessed over two 5-year periods. Temporal trends were examined by joinpoint and Poisson regression models and expressed as the annual per cent change and adjusted relative risk (RR) for the change per year. Results: A total of 17 952 infants were included. In the second period, infants were less frequently intubated in the delivery room and during neonatal intensive care unit stay. This corresponded with an increase in use of non-invasive ventilation techniques. There were no significant differences between the periods in BPD-free survival or survival without moderate-to-severe BPD. After adjusting for covariates, the RR for the change per year was significant for the following variables: never intubated (RR 1.03, 95% CI 1.02 to 1.04); intubation in the delivery room (RR 0.98, 95% CI 0.97 to 0.99); use of nasal intermittent positive pressure ventilation (RR 1.08, 95% CI 1.05 to 1.11); and BPD-free survival (only in the group with the lowest GA; RR 0.98, 95% CI 0.97 to 0.99). Conclusion: Our findings reveal significant changes in respiratory care practices between 2009 and 2019. Despite an increase in use of non-invasive respiratory strategies, BPD-free survival did not improve and even worsened in the group with the lowest GA (230-256).

[Abstract] Introduction: While non-invasive positive-pressure ventilation (NIPPV) is increasingly used as a mode of respiratory support for preterm infants, it remains unclear whether this technique translates into improved respiratory outcomes. We assessed the association between NIPPV use and bronchopulmonary dysplasia (BPD)-free survival in never intubated very preterm infants. Methods: This multicenter cohort study analyzed data from the Spanish Neonatal Network SEN1500 corresponding to preterm infants born at <32 weeks gestational age and <1,500 g and not intubated during first admission. The exposure of interest was use of NIPPV at any time and the main study outcome was survival without moderate-to-severe BPD. Analyses were performed both by patients and by units. Primary and secondary outcomes were compared using multilevel logistic-regression models. The standardized observed-to-expected (O/E) ratio was calculated to classify units by NIPPV utilization and outcome rates were compared among groups. Results: Of the 6,735 infants included, 1,776 (26.4%) received NIPPV during admission and 6,441 (95.6%) survived without moderate-to-severe BPD. After adjusting for confounding variables, NIPPV was not associated with survival without moderate-to-severe BPD (OR 0.84; 95%CI 0.62–1.14). A higher incidence of moderate-to-severe BPD-free survival was observed in high- vs. very low-utilization units, but no consistent association was observed between O/E ratio and either primary or secondary outcomes. Conclusion: NIPPV use did not appear to decisively influence the incidence of survival without moderate-to-severe BPD in patients managed exclusively with non-invasive ventilation.

[Abstract] Objective: The objective of this study was to identify factors associated with the intensive care unit (ICU) length of stay (LOS) of patients with an acute traumatic spinal cord injury above T6. Methods: We performed a retrospective, observational study of patients admitted to an ICU between 1998 and 2017 (n = 241). The LOS was calculated using a cumulative incidence function, with events of death being considered a competing event. Factors associated with the LOS were analyzed using both a cause-specific Cox proportional hazards regression model and a competing risk model. A multistate approach was also used to analyze the impact of nosocomial infections on the LOS. Results: A total of 211 patients (87.5%) were discharged alive from the ICU (median LOS = 23 days), and 30 (12.4%) died (median LOS = 11 days). In the multivariate analysis after adjusting for variables collected 4 days after the ICU admission, a higher American Spinal Injury Association motor score (subdistribution hazards ratio [sHR] = 1.01), neurological level C5-C8 (HR = 0,64), and lower Sequential Organ Failure Assessment score (sHR = 0.82) and fluid balance (sHR = 0.95) on day 4 were linked to a lower LOS in this unit. In the multivariate analysis, the onset of an infection was significantly associated with a longer LOS when adjusting for variables collected both at ICU admission (adjusted sHR = 0.62; 95% confidence interval = 0.50-0.77) and on day 4 (adjusted hazards ratio = 0.65; 95% confidence interval = 0.52-0.80). Conclusions: After adjusting the data for conventional variables, we identified a lower American Spinal Injury Association motor score, injury level C5-C8, a higher Sequential Organ Failure Assessment score on day 4, a more positive fluid balance on day 4, and the onset of an infection as factors independently associated with a longer ICU LOS.

[Abstract] Objectives: To analyze the relationship between neurological progression following traumatic spinal cord injury and Spinal Cord Compression (SCC) and Spinal Ligamentous Injury (LI) by magnetic resonance imaging. Design: Retrospective observational study. Setting: Spinal Cord Injury Unit (A Coruña, Spain). Participants: Patients were admitted for traumatic spinal cord injury between January 2010 and December 2018 with a magnetic resonance imaging examination performed during the acute phase. Intervention: Evaluation of SCC and LI by magnetic resonance imaging. Outcome measures: Comparisons between neurological examination at admission and discharge were made, assessing ASIA Impairment Scale (AIS) grade and motor score. Results: Data from 296 patients were collected. A relationship between SCC and LI and complete injuries were found (P < 0.001). Improvement of the AIS grade was observed in 31.6% of patients with SCC and 31.3% with LI versus 42.7% and 37.8% of subjects without these complications, respectively. Regarding motor score, patients with SCC had lower mean values at the beginning (46.9 ± 26.8 versus 61.1 ± 29.9 in the control group, P < 0.001), as well as less improvement when assessed by the percentage of change (35.1 ± 37.5% versus 49.4 ± 38.1% in the control group, P = 0.010). Similar results were obtained in cases with LI: mean motor score at admission was 45.9 ± 26.7 versus 54.9 ± 29.4 in the control group (P = 0.014) and the percentage of change was 28.5 ± 37.1% in comparison to 46.0 ± 37.5% (P = 0.001) in the controls. Conclusions: There is a relationship between SCC and LI and complete spinal cord injury. This patient population has lower possibilities of improving their AIS grade and motor score.

[Abstract] Background: Controversy exists regarding the relationship of the outcome of patients with colorectal cancer (CRC) with the time from symptom onset to diagnosis. The aim of this study is to investigate this association, with the assumption that this relationship was nonlinear and with adjustment for multiple confounders, such as tumor grade, symptoms, or admission to an emergency department. Methods: This multicenter study with prospective follow-up was performed in five regions of Spain from 2010 to 2012. Symptomatic cases of incident CRC from a previous study were examined. At the time of diagnosis, each patient was interviewed, and the associated hospital and clinical records were reviewed. During follow-up, the clinical records were reviewed again to assess survival. Cox survival analysis with a restricted cubic spline was used to model overall and CRC-specific survival, with adjustment for variables related to the patient, health service, and tumor. Results: A total of 795 patients had symptomatic CRC and 769 of them had complete data on diagnostic delay and survival. Univariate analysis indicated a lower HR for death in patients who had diagnostic intervals less than 4.2 months. However, after adjustment for variables related to the patient, tumor, and utilized health service, there was no relationship of the diagnostic delay with survival of patients with colon and rectal cancer, colon cancer alone, or rectal cancer alone. Cubic spline analysis indicated an inverse association of the diagnostic delay with 5-year survival. However, this association was not statistically significant. Conclusions: Our results indicated that the duration of diagnostic delay had no significant effect on the outcome of patients with CRC. We suggest that the most important determinant of the duration of diagnostic delay is the biological profile of the tumor. However, it remains the responsibility of community health centers and authorities to minimize diagnostic delays in

[Resumen] Objetivo. Valorar en individuos con lesión medular traumática (LMT) la relación entre la mortalidad y la necesidad de UCI y las alteraciones objetivadas mediante resonancia magnética (RM) precoz, analizando alteraciones parenquimatosas, disrupción de ligamentos vertebrales (DLV) y compresión del cordón medular (CCM). Diseño. Estudio retrospectivo. Ámbito. Hospital de tercer nivel, unidad de lesionados medulares y UCI. Pacientes. Individuos con LMT aguda entre los años 2010 y 2019. Intervenciones. Análisis de RM realizada en las primeras 72 horas. Variables de interés. Ingreso en UCI y mortalidad. Resultados. Recogidos 269 casos. El patrón que se asoció a una mayor mortalidad fue la hemorragia (16,7%) por 12,5% de los edemas a un nivel y 6,5% de los edemas a múltiples niveles (p = 0,125). Lo mismo aconteció con los ingresos en UCI: 69,0% en hemorragia por 60,2% en edema múltiple y 46,3% en edemas cortos (p = 0,018). Con respecto a la CCM, la mortalidad fue del 13,4% con 59,2% de ingresos en UCI por 2,2% y 42,2% de quienes no presentaban compresión (p = 0,020 y p = 0,003). Las cifras de éxitus e ingreso en UCI en los individuos con DLV fueron del 15,0% y el 67,3%, respectivamente, por un 6,2% y 44,4% de los individuos sin DLV (p < 0,001 y p = 0,013). Conclusiones. La presencia de hemorragia medular, CCM y DLV se asoció a una mayor necesidad de UCI. Existe un significativo aumento de la mortalidad en los casos con CCM y DLV., [Abstract] Objective. To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). Design. Retrospective study. Setting. Third-level hospital, Spinal Cord Injury Unit and ICU. Patients. Individuals with acute TSCI between 2010 and 2019. Intervention. Analysis of MRI performed in the first 72 h. Variables of interest. Admission to ICU and mortality. Results. 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). Conclusions. The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.

[Abstract] Introduction: Studies updating the evidence in advanced maternal age as an independent factor of obstetric risk are needed. The aim of this study was to determine the prevalence of ≥ 35-years-old pregnant women who give birth in a Spanish hospital in Northwestern Spain, and to describe the incidence of maternal and perinatal morbidity and mortality. Material and methods: Retrospective follow-up observational study including women ≥ 20 years-old who gave birth over one year (n = 1378). Data were collected from medical records, including socio-demographic characteristics, comorbidities, gestational conditions, variables related with the delivery and perinatal outcomes. Multivariable logistic regression analysis was performed to determine the association of advanced maternal age with obstetric and perinatal outcomes. Results: Forty-two percent of pregnant women were ≥ 35 years old. In the multivariable analysis, advanced maternal age was associated with the likelihood of gestational diabetes (OR = 1.84; 95% CI = 1.10 - 3.07), hypothyroidism (OR = 2.11; 95% CI = 1.17 - 3.80), lower probability of an eutocic delivery (OR = 0.74; 95% CI = 0.56 - 0.98), and a hospital admission > four days (OR = 2.91; 95% CI = 1.95 - 4.35). An association with the rate of C-sections was not found (OR = 1.24; 95% CI = 0.89 - 1.72). Conclusion: A high prevalence of pregnant women of advanced maternal age was confirmed. There was a higher rate of comorbidities and longer hospital admissions in older women but not a higher rate of higher C-sections and other complications.

[Resumen] Introducción: La enfermedad de Crohn se define como una enfermedad inflamatoria intestinal crónica, que puede afectar a cualquier tramo del tracto digestivo. Los pacientes que han fracasado al tratamiento inicial optan a recibir tratamiento con terapia biológica con fármacos anti-TNF, ustekinumab o vedolizumab. Con todo, un importante número de pacientes sufre fracaso terapéutico incluso con terapia biológica, lo que puede llegar a agotar las alternativas terapéuticas. Es por eso que en la práctica clínica se emplean diferentes estrategias de optimización de los fármacos biológicos, como pueden ser aumento de dosis, acortamiento de intervalo de administración o asociación con fármacos inmunosupresores. Objetivo: Evaluar la efectividad y seguridad de la intensificación de la pauta de ustekinumab mediante acortamiento de intervalo posológico a 4 semanas en pacientes con enfermedad de Crohn con pérdida de respuesta al fármaco para recuperación de respuesta clínica y mejoría de parámetros clínicos Metodología: Estudio analítico observacional, ambispectivo y unicéntrico. Se incluirán 50 pacientes, aproximadamente todos los pacientes esperados con intensificación del tratamiento con ustekinumab en el periodo establecido, (tasa remisión=30%, seguridad=95%, presión absoluta=13%). Para evaluación de la respuesta se medirán los valores de PCR y calprotectina y el Índice de Harvey-Bradshaw en el momento de la intensificación, a los 6 y a los 12 meses. Se realizará un análisis descriptivo e inferencial., [Resumo] Introdución. A enfermidade de Crohn defínese como unha enfermidade inflamatoria intestinal crónica que pode afectar a calquera sección do tracto dixestivo. Os pacientes que fracasaron no tratamento inicial optan por recibir tratamento con terapia biolóxica con fármacos anti-TNF, ustekinumab ou vedolizumab. Non obstante, un número importante de pacientes sofren un fracaso terapéutico mesmo coa terapia biolóxica, que pode esgotar as alternativas terapéuticas. É por iso que na práctica clínica utilízanse diferentes estratexias para optimizar fármacos biolóxicos, como aumentar a dose, acurtar o intervalo de administración ou combinalo con fármacos inmunosupresores. Obxetivo. Avaliar a eficacia e seguridade da intensificación do réxime de ustekinumab acurtando o intervalo de dosificación a 4 semanas en pacientes con enfermidade de Crohn con perda de resposta ao fármaco para a recuperación da resposta clínica e a mellora dos parámetros clínicos. Metodoloxía. Estudo analítico observacional, ambispectivo e unicéntrico. Incluiranse 50 pacientes, aproximadamente todos os pacientes esperados con intensificación do tratamento con ustekinumab no período establecido, (taxa de remisión=30%, seguridade=95%, presión absoluta=13%). Para avaliar a resposta, mediranse os valores de PCR e calprotectina e o índice de Harvey-Bradshaw no momento da intensificación, aos 6 e aos 12 meses. Realizarase unha análise descritiva e inferencial., [Abstract] Introduction. Crohn's disease is defined as a chronic inflammatory bowel disease that can affect any section of the digestive tract. Patients who have failed initial treatment choose to receive treatment with biological therapy with anti-TNF drugs, ustekinumab or vedolizumab. However, a significant number of patients suffer therapeutic failure even with biological therapy, which can exhaust therapeutic alternatives. That is why in clinical practice different strategies are used to optimize biological drugs, such as increasing the dose, shortening the administration interval or association with immunosuppressive drugs. Objetive. To evaluate the effectiveness and safety of intensifying the ustekinumab regimen by shortening the dosing interval to 4 weeks in patients with Crohn's disease with loss of response to the drug for recovery of clinical response and improvement of clinical parameters. Methods. Observational, ambispective and unicentric analytical study. Fifty patients will be included, approximately all the expected patients with intensification of treatment with ustekinumab in the established period, (remission rate=30%, safety=95%, absolute pressure=13%). To evaluate the response, CRP and calprotectin values and the Harvey-Bradshaw Index will be measured at the time of intensification, at 6 and 12 months. A descriptive and inferential analysis will be carried out.

[Resumen] INTRODUCCIÓN. El dolor lumbar crónico (DLC) causa discapacidad, impacto social y económico. El ejercicio terapéutico (ET) de alta intensidad muestra resultados positivos en otras condiciones de salud, pero no existen artículos de revisión sobre su eficacia en DLC. REVISIÓN SISTEMÁTICA. Objetivo: Determinar la eficacia del ET de alta intensidad en la calidad de vida relacionada con la salud (CVRS), la discapacidad y la intensidad del dolor, así como la adherencia al plan de tratamiento en personas con DLC. Metodología: Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus en marzo de 2022. Se incluyen ensayos clínicos aleatorizados (ECAs), guías de práctica clínica y revisiones sistemáticas, publicadas en español, inglés o portugués (2012-2022). Además, se realiza una búsqueda en bola de nieve. Resultados: Se incluyen 8 ECAs (n=379), en los que se analizan diferentes modalidades de ET de alta intensidad, que muestran ser eficaces y entre las cuales no existen diferencias significativas. Conclusiones: El ET de alta intensidad es eficaz para reducir la intensidad del dolor y la discapacidad, así como para mejorar la CVRS y la adherencia en personas con DLC. Aun así, es necesario aumentar la investigación. PROYECTO DE INVESTIGACIÓN. Objetivos: Determinar la eficacia del ET de alta intensidad comparado con el ET de intensidad moderada para mejorar la CVRS en personas con DLC (objetivo principal), así como la discapacidad, la intensidad del dolor, los síntomas de depresión y ansiedad y la adherencia al plan de tratamiento (objetivos secundarios). Metodología: Se realizará un ECA abierto de grupos paralelos (ET de alta intensidad vs ET de intensidad moderada), en sujetos adultos con DLC del distrito sanitario de A Coruña. Se necesitarán 130 participantes, los cuales serán reclutados por los médicos de Atención Primaria colaboradores en el estudio en sus respectivos Centros de Salud. El procedimiento consistirá en una valoración inicial, seguida de un pr, [Resumo] INTRODUCIÓN. A dor lumbar crónica (DLC) causa discapacidade, impacto social e económico. O exercicio terapéutico (ET) de alta intensidade mostra resultados positivos noutras condicións de saúde, pero non existen artigos de revisión sobre a súa eficacia en DLC. REVISIÓN SISTEMÁTICA. Obxectivo: Determinar a eficacia do ET de alta intensidade na calidade de vida relacionada coa saúde (CVRS), a discapacidade e a intensidade da dor, así como a adherencia ao plan de tratamento en persoas con DLC. Metodoloxía: Realízase unha revisión bibliográfica en Pubmed, Pedro e Scopus en marzo de 2022. Inclúense ensaios clínicos aleatorizados (ECAs), guías de práctica clínica e revisións sistemáticas, publicadas en español, inglés ou portugués (2012-2022). Ademais, realízase unha procura en bóla de neve. Resultados: Inclúense 8 ECAs (n=379), nos que se analizan diferentes modalidades de ET de alta intensidade, que mostran ser eficaces e entre as cales non existen diferenzas significativas. Conclusións: O ET de alta intensidade é eficaz para reducir a intensidade da dor e a discapacidade, así como para mellorar a CVRS e a adherencia en persoas con DLC. Aínda así, é necesario aumentar a investigación. PROXECTO DE INVESTIGACIÓN. Obxectivos: Determinar a eficacia do ET de alta intensidade comparado co ET de intensidade moderada para mellorar a CVRS en persoas con DLC (obxectivo principal), así como a discapacidade, a intensidade da dor, os síntomas de depresión e ansiedade e a adherencia ao plan de tratamento (obxectivos secundarios). Metodoloxía: Realizarase un ECA aberto de grupos paralelos (ET de alta intensidade vs ET de intensidade moderada), en suxeitos adultos con DLC do distrito sanitario de A Coruña. Necesitaranse 130 participantes, os cales serán recrutados polos médicos de Atención Primaria colaboradores no estudo nos seus respectivos Centros de Saúde. O procedemento consistirá nunha valoración inicial, seguida dun programa de ET (de alta ou moderada intensidade, segun, [Abstract] INTRODUCTION. Chronic low back pain (CLBP) causes disability, social and economic impact. High-intensity training (HIT) shows positive results in other health conditions, but there are no review articles on its efficacy in CLBP. SYSTEMATIC REVIEW. Objective: To determine the efficacy of HIT on health-related quality of life (HRQoL), disability, and pain intensity, as well as adherence to the treatment plan in people with CLBP. Methods: A review is conducted in Pubmed, PEDro and Scopus in March 2022. Randomised clinical trials (RCTs), clinical practice guidelines and systematic reviews, published in Spanish, English or Portuguese (2012-2022) are included. In addition, a snowball search is performed. Results: 8 RCTs (n=379) are included, in which different modalities of HIT are analysed, which are shown to be effective and between which there are no significant differences. Conclusions: HIT is effective in reducing pain intensity and disability, as well as improving HRQoL and adherence in people with CLBP. However, more research is needed. RESEARCH PROJECT. Objectives: To determine the efficacy of HIT compared to moderate-intensity training (MIT) in improving HRQoL in people with CLBP (primary objective), as well as disability, pain intensity, symptoms of depression and anxiety, and adherence to the treatment plan (secondary objectives). Methods: An open parallel-group RCT (HIT vs MIT) will be conducted in adult subjects with CLBP in the A Coruña health district. It will require 130 participants, who will be recruited by the Primary Care physicians collaborating in the study in their respective Health Centres. The procedure will consist of an initial assessment, followed by an exercise programme (high or moderate intensity, depending on the assigned group) lasting 8 weeks. This will be followed by a post-intervention assessment, a 6-month follow-up (where participants will be advised to continue with the prescribed exercises at home) and a final assessment.

[Abstract] This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity—lower hip abductor muscle endurance and poorer physical health, and with feet symptoms—greater body mass index and less core stability.

[Abstract] Objective: To characterize patients with acute traumatic spinal cord injury (ATSCI) above T6 who were admitted to the intensive care unit (ICU) for ≥30 days and their 1-year mortality compared with patients admitted for <30 days. Methods: A retrospective observational study was performed on 211 patients with an acute traumatic spinal cord injury above T6 who were admitted to an ICU between 1998 and 2017. Multivariate logistic regression analysis was performed to determine the relationship between an ICU stay ≥30 days and mortality after ICU discharge. Results: Of patients, 29.4% were admitted to the ICU for ≥30 days, accounting for 53.4% of total days of ICU stays generated by all patients. An ICU stay ≥30 days was not identified as an independent risk factor for mortality (1-year survival: 88.5% vs. 88.1%; adjusted hazard ratio [HR] 0.80, P = 0.699). Variables identified as predictors of 1-year post-ICU discharge mortality were severity at admission according to the Acute Physiology and Chronic Health Evaluation II score (HR 1.18) and the American Spinal Injury Association Impairment Scale motor score (HR 0.97). Among patients who required invasive mechanical ventilation, a longer duration of the respiratory support was associated with increased mortality (HR 1.01). Conclusions: Three out of 10 patients with acute traumatic spinal cord injury above T6 require prolonged stays in the ICU. Variables found to be associated with 1-year post-ICU discharge mortality in these patients were American Spinal Injury Association Impairment Scale motor score, severity, and greater duration of invasive mechanical ventilation, but not an ICU stay ≥30 days.

[Abstract] Introduction and objective: The use of well characterized osteoarthritis (OA) cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). Methods: The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: I) Patients older than 55 years who underwent an abdominal x-ray to study both hips II) Patients diagnosed with radiographic hand OA according to ACR criteria III) Patients diagnosed with radiographic knee or hip OA according to ACR criteria. Follow-up was performed every two years collecting clinical, analytical, genetic and radiographic information. Results: The cohort consists of 937 patients, 873 have radiographic knee OA, 783 hip OA and 679 hand OA. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Twenty-one point four percent and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7% respectively. Of the population, 44.1% has only 1 joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; p<.001), BMI (OR=1.11; p=.002) and total WOMAC (OR=1.03; p=.005) are the only risk factors if we compare the involvement of a single location versus three. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL≤2 grade, and therefore a significantly higher percentage of patients with knee OA experienced pain (66.1%) compared to patients with OA hip (21.1%) (p<., [Resumen] Introducción y objetivo. El uso de cohortes de Osteoartritis (OA) bien caracterizadas es obligatorio para estudiar y profundizar en el conocimiento en esta enfermedad. En España no existe actualmente ninguna cohorte prospectiva en esta patología; así el objetivo de este trabajo es describir la primera cohorte de Osteoartritis en España, la PROCOAC (PROspective COhort of A Coruña). Material y métodos. El Servicio de Reumatología del Hospital Universitario de A Coruña inició un estudio de seguimiento prospectivo en el año 2006. Los criterios de inclusión fueron: I) Pacientes mayores de 55 años a los que se les realizó una radiografía abdominal que permitiese estudiar ambas caderas II) Pacientes diagnosticados de OA radiográfica de mano según los criterios ACR III) Pacientes diagnosticados de OA radiográfica de rodilla y/o cadera según los criterios ACR. Se realizó seguimiento cada dos años recogiendo información clínica, analítica, genética y radiográfica. Resultados. La cohorte consta de 937 individuos, 873 tienen OA radiográfica de rodilla, 783 de cadera y 679 de mano. La edad media de la población es 63,9 ± 8,9 años y el IMC promedio de 29,6 ± 5,1. Más de la mitad de la población tiene hipertensión arterial y el 17% diabetes. La osteoartritis predominate en la mano es la nodular (78,1%), seguida de la rizartrosis (55,3%) y la erosiva (18,4%). El 21,4% y el 43,1% son sanos a nivel de rodilla y cadera respectivamente; observando un grado 1 en el 26% y 37%; un grado 2 en el 26,7% y 11,5%; un grado 3 en el 14,9% y 4%; y un grado 4 en el 9,4% y 3,7% respectivamente. El 44,1% de la población tiene 1 articulación afectada, el 39,9% tiene 2 y el 13,4% tiene 3 articulaciones afectadas. La edad (OR = 1,11; p < 0,001), el IMC (OR = 1,11; p = 0,002) y el WOMAC total (OR = 1,03; p = 0,005) son los únicos factores de riesgo si comparamos la afectación de una sola ubicación frente a tres. También se detectó una discrepancia entre el dolor y el daño radiográfico a nivel

[Abstract] Objective: To analyze the changes in demographic and lesion characteristics of persons with acute traumatic spinal cord injury (ATSCI) above T6 over a period of 20 years, and to evaluate their impact on ICU resources use, length of stay and mortality.Design: Retrospective observational study.Setting: Intensive Care Unit (ICU) of the University Hospital Complex of A Coruña, Spain.Participants: The study included 241 persons between 1998 and 2017 with an ATSCI above T6. For the purposes of the analysis, the overall study period was divided into three subperiods.Results: Both the mean age of the people with ATSCI (49 vs. 51 vs. 57 years; P = 0.046) and the Charlson Comorbidity Index were higher during the last subperiod (mean: 1.9 ± 2.2; P < 0.01). The most frequent cause of the injury was falls, whose percentage increased over the years. The most common classification in the American Spinal Injury Association Impairment scale was grade A. An increase in the score of the Acute Physiology and Chronic Health Evaluation (APACHE II) score was observed (median: 9 vs. 10 vs. 15; P < 0.01). The length of stay in the ICU has decreased significantly over the years (30 ± 19 vs. 22 ± 14 vs. 19 ± 13 days). No significant differences were found between the rates of ICU or in-hospital mortality recorded over the three subperiods.Conclusions: Despite the progressive increase in the age, comorbidity, and APACHE II, the length of ICU stay decreased significantly, with no associated changes in the mortality rates.

[Abstract] Managing patients with multimorbidity and frequent hospital readmissions is a challenge. Integrated care programs that consider their needs and allow for personalized care are necessary for their early identification and management. This work aims to describe these patients' clinical characteristics and evaluate a program designed to reducing readmissions. This prospective study analyzed all patients with ≥ 3 admissions to a medical department in the previous year who were included in the Internal Medicine Department chronic care program at the Lucus Augusti University Hospital (Lugo, Spain) between April 1, 2019 and April 30, 2021. A multidimensional assessment, personalized care plan, and proactive follow-up with a case manager nurse were provided via an advanced hospital system. Clinical and demographic variables and data on healthcare system use were analyzed at 6 and 12 months before and after inclusion. Descriptive and survival analyses were performed. One hundred sixty-one patients were included. Program participants were elderly (mean 81.4 (SD 11) years), had multimorbidity (10.2 (3) chronic diseases) and polypharmacy (10.6 (3.5) drugs), frequently used the healthcare system, and were highly complex. Most were included for heart failure. The program led to significant reductions in admissions and emergency department visits (p = .0001). A total of 44.7% patients died within 1 year. The PROFUND Index showed good predictive ability (p = .013), with high values associated with mortality (RR 1.15, p = .001). Patients with frequent hospital readmissions are highly complex and need special care. A personalized integrated care program reduced admissions and allowed for individualized decision-making.

[Abstract] Objective: To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). Methods: Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient's death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. Results: A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. Conclusions: This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised., [Resumen] Objetivo. Describir los costes evitados y analizar la efectividad del tratamiento con antibióticos por vía intravenosa en perfusión continua en pacientes en unidades de Hospitalización a Domicilio (HD) administrados con bombas de infusión elastoméricas (BIE) preparadas en un Servicio de Farmacia Hospitalaria (SFH). Método. Estudio observacional retrospectivo del número y tipo de BIE preparados en el SFH y pacientes tratados entre enero 2017 y diciembre 2018. Los datos analizados fueron: datos demográficos de pacientes, localización de la infección, microorganismo, medicación y tipo de BIE, dosis y duración del tratamiento y efectividad en términos de curación o no curación o muerte. Valoración económica: coste de BIE, tiempo de enfermería necesario para la preparación y coste de la atención en HD. Resultados. Se analizaron 1.688 BIE preparados para tratar 102 pacientes que resultaron en 106 episodios de tratamiento ambulatorio durante 1.409 días, evitando así 1.409 días de ingreso hospitalario. El 59,8% de los pacientes eran hombres y la edad media 70,5±17 años. El 31,1% de los tratamientos fueron empíricos versus 68,9% dirigidos por patógeno. Los antimicrobianos más empleados fueron piperacilina-tazobactam (42,7%), ceftazidima (24,5%), meropenem (19,8%), ceftolozano-tazobactam (2,8%) y cloxacilina (1,9%). La duración media del tratamiento fue de 13,29 ± 8,60 días. Localización de la infección: respiratorias (42,5%), urinarias (17,9%), piel y partes blandas (12,3%), bacteriemias (11,3%), osteomielitis (7,5%), abdominales (3,8%) y un 4,7% en otras localizaciones. La tasa de curación del 84%. El coste total evitado fue de 580.788,28€ durante los 24 meses de estudio. Conclusiones. Este programa representa un ahorro económico muy importante para el sistema de salud, y la efectividad del tratamiento con antibióticos no se ha visto comprometida.

[Abstract] Objective: We aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group. Methods: We used two data sets from the CMBD (Conjunto mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis. Results: We identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70-80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60-80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases). Conclusions: We identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time.

[Resumo] Introdución: A sepse neonatal defínese como unha infección sistémica que ten lugar naqueles lactantes con idade menor ou igual a 28 días de vida, considerándose de inicio precoz aquela que aparece nos 7 primeiros días de vida. É responsable dunha importante morbilidade e mortalidade. Con todo, o seu diagnóstico é complexo. O hemocultivo está considerado como a proba “gold standard” pero menos do 1% dos neonatos teñen cultivos positivos. A sepse de inicio precoz ten habitualmente unha presentación inespecífica e con síntomas solapados. Nun marco de falta de consenso nos criterios para o diagnóstico de sepse neonatal, na práctica diaria é habitual a combinación de datos analíticos e clínicos para a identificación de pacientes con risco de desenvolvela. Estas probas teñen unha baixa especificidade e supoñen a realización de procedementos invasivos de maneira seriada. Nos últimos anos, xurdiu unha ferramenta non invasiva que permite obxetivar de forma continua a perfusión periférica, o Índice de Perfusión (PI). O PI é a razón entre o pulso sanguíneo pulsátil e o non pulsátil no tecido periférico. Diversos estudos demostraron a súa utilidade en poboación neonatal. Obxectivo: O presente estudo pretende determinar o valor diagnóstico do índice de perfusión na detección de sepse de inicio precoz en neonatos a termo con risco de infección. Metodoloxía: Estudo observacional lonxitudinal de carácter prospectivo, de avaliación de probas diagnósticas. Incluiranse neonatos a termo con risco de infección, aos que se lles medirá de forma continua o PI. Crearase unha curva ROC para o devandito índice e calcularase a sensibilidade, especificidade, valor predictivo positivo e valor predictivo negativo para o diagnóstico de sepse precoz usando o punto de corte resultante da análise desta curva., [Resumen] Introducción: La sepsis neonatal se define como una infección sistémica que tiene lugar en aquellos lactantes con edad menor o igual a 28 días de vida, considerándose de inicio precoz aquella que aparece en los 7 primeros días de vida. Es responsable de una importante morbilidad y mortalidad. Sin embargo, su diagnóstico es complejo. El hemocultivo está considerado como la prueba “gold standard” pero menos del 1% de los neonatos tienen cultivos positivos. La sepsis de inicio precoz tiene habitualmente una presentación inespecífica y con síntomas solapados. En un marco de falta de consenso en los criterios para el diagnóstico de sepsis neonatal, en la práctica diaria es habitual la combinación de datos analíticos y clínicos para la identificación de pacientes con riesgo de desarrollarla. Estas pruebas tienen una baja especificidad y suponen la realización de procedimientos invasivos de manera seriada. En los últimos años, ha surgido una herramienta no invasiva que permite objetivar de forma continua la perfusión periférica, el Índice de Perfusión (PI). El PI es la razón entre el pulso sanguíneo pulsátil y el no pulsátil en el tejido periférico. Diversos estudios han demostrado su utilidad en población neonatal. Objetivo: El presente estudio pretende determinar el valor diagnóstico del índice de perfusión en la detección de sepsis de inicio precoz en neonatos a término con riesgo de infección. Metodología: Estudio observacional longitudinal de carácter prospectivo, de evaluación de pruebas diagnósticas. Se incluirán neonatos a término con riesgo de infección, a los que se les medirá de forma continua el PI. Se creará una curva ROC para dicho índice y se calculará la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo para el diagnóstico de sepsis precoz usando el punto de corte resultante del análisis de esta curva., [Abstract] Introduction: Neonatal sepsis is defined as a systemic infection that occurs in infants aged less than or equal to 28 days of life, considering early onset that appears in the first 7 days of life. It is responsible for significant morbidity and mortality. However, its diagnosis is complex. Blood culture is considered the “gold standard” test, but less than 1% of neonates have positive cultures. Early-onset sepsis usually has a nonspecific presentation with overlapping symptoms. In a framework of lack of consensus in the criteria for the diagnosis of neonatal sepsis, in daily practice it is common to combine analytical and clinical data to identify patients at risk of developing it. These tests have low specificity and involve serial invasive procedures. In recent years, a non-invasive tool has emerged that makes it possible to continuously target peripheral perfusion, the Perfusion Index (PI). PI is the ratio of pulsatile to non-pulsatile blood pulses in peripheral tissue. Several studies have shown its usefulness in the neonatal population. Objective: The present study aims to determine the diagnostic value of the perfusion index in the detection of early-onset sepsis in term neonates at risk of infection. Methodology: Prospective longitudinal observational study, evaluating diagnostic tests. Term neonates at risk of infection will be included and their PI will be measured continuously. A ROC curve will be created for this index and the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of early sepsis will be calculated using the cut-off point resulting from the analysis of this curve.

[Abstract] Developmental Coordination Disorder (DCD) is one of the most frequent neurodevelopmental disorders in school-aged children worldwide, but it is a highly under-diagnosed condition in Spain. Moreover, little is known about the interrelation of sociodemographic factors, sensory processing and daily activities in DCD and functional performance in school-aged children with and without DCD. Thus, the aims of this thesis were: (1) to examine the prevalence and associated sociodemographic factors of DCD in Spanish school-aged children; (2) to identify how sensory processing patterns present in children with DCD in comparison to typically developing children and children with ADHD; and (3) to explore the role of individual, environmental and activity factors on performance and participation in motor-based daily activities in children with and without motor coordination difficulties. Two samples including more than 800 Spanish school-aged children were analyzed. Findings show that prevalence of p-DCD in this population ranges from 8% to 13%. In addition, we found a complex influence between individual (i.e., age, sex, sensory processing), environmental (i.e., family-related factors [educational background, area of residence and siblings] and country) and activity-related factors over daily functioning, where motor performance mediates the relationship between individual and environmental constraints, learning of activities and daily participation., [Resumen] El Trastorno del Desarrollo de la Coordinación (TDC) es una condición del neurodesarrollo frecuente en población escolar en otros ámbitos geográficos, pero ampliamente desconocida en el contexto español. Además, existe poca información sobre la interrelación de factores sociodemográficos, del procesamiento sensorial y de las actividades diarias en el TDC y en el desempeño funcional en población escolar con y sin TDC. Los objetivos de esta tesis fueron: (1) examinar la prevalencia de TDC y los factores sociodemográficos asociados en escolares españoles; (2) identificar los patrones de procesamiento sensorial presentes en el TDC; y (3) estudiar el papel de los factores individuales, del entorno y de la actividad en el desempeño y participación en actividades motoras de la vida diaria. Para ello se analizaron dos muestras de más de 800 escolares españoles. Los hallazgos muestran que la prevalencia de probable TDC en España alcanza el 8%-13%. Se encontró una compleja influencia entre los factores individuales (edad, sexo, procesamiento sensorial), del entorno (factores familiares y geográficos) y relacionados con la actividad sobre el TDC y sobre el funcionamiento diario, donde el desempeño motor media la relación entre las constricciones personales y del entorno, el aprendizaje de actividades diarias y la participación., [Resumo] O Trastorno do Desenvolvemento da Coordinación (TDC) é unha condición do neurodesarrollo frecuente en poboación escolar noutros ámbitos xeográficos pero moi descoñecida no contexto español. Ademais, existe pouca información sobre a interrelación de factores sociodemográficos, do procesamento sensorial e das actividades diarias no TDC e no desempeño funcional en poboación escolar con e sen TDC. Os obxectivos desta tese foron: (1) examinar a prevalencia de TDC e os factores sociodemográficos asociados en escolares españois; (2) identificar os patróns de procesamento sensorial presentes no TDC; e (3) estudar o papel dos factores individuais, da contorna e da actividade no desempeño e participación en actividades motoras da vida diaria. Para iso analizáronse dúas mostras de máis de 800 escolares españois. Os achados mostran que a prevalencia de probable TDC en España alcanza o 8%-13%. Atopouse unha complexa influencia entre os factores individuais (idade, sexo, procesamento sensorial), da contorna (factores familiares e xeográficos) e relacionados coa actividade sobre o funcionamento diario, onde o desempeño motor media a relación entre os constrinximentos persoais e da contorna, a aprendizaxe de actividades diarias e a participación.

[Abstract] Aim: To determine the incidence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in children and young people who play federated football. Methods: Prospective study, from October 2020 to January 2021, in players aged 4 to 19 years from federated football clubs in Galicia, Spain (N = 23,845). Outbreaks and cases of SARS-CoV-2 infection were recorded. The cumulative incidence was compared with the incidence registered in Galicia in the same age range. Results: The cumulative incidence was 29.8 cases per 10,000 licenses in 4 months, lower than the incidence registered in the general population for all ages and both sexes (283.7 per 10,000 inhabitants; rate ratio = 9.5). It was higher in January (40.7 per 10,000), coinciding with the population peak. More cases were registered in futsal (42.9 vs 27.5 per 10,000) and competitions with periodic screenings (127.4 vs 9.1 per 10,000). There were 2 outbreaks in 2389 teams (0.08%). Conclusion: The results support the safety of football practice in children and young people with prevention protocols.

[Abstract] The most frequent endocrine disease in obese patients is hypothyroidism. To date, there are no clear data regarding what happens to the dose of levothyroxine (LT4) after bariatric surgery (BS). The objective of the present study was to evaluate thyroid hormone replacement dose in morbidly obese hypothyroid patients after BS-induced weight loss. We explore the best type of measured or estimated body weight for LT4 dosing. We performed an observational study evaluating patients with morbid obesity and hypothyroidism who underwent BS. We included 48 patients (three men). In morbidly obese hypothyroid patients 12 months after BS-induced weight loss, the total LT4 dose or the LT4 dose/kg ideal body weight did not change, while there was a significant increase in LT4 dose/body surface area, LT4 dose/kg weight, LT4 dose/kg adjusted body weight, LT4 dose/kg body fat, and LT4 dose/kg lean body weight. There were no differences in LT4 dose and its variation between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The present study strongly suggests that LT4 dosing in obese hypothyroid patients can be individually adapted more precisely if it is based on ideal body weight.

[Abstract] Aim. To test the mediating role of motor performance in the relationship between individual and environmental constraints, delayed learning of activities of daily living (ADL), and daily participation in typically developing children and children with probable developmental coordination disorder (DCD). Method. Parents of 370 randomly selected children aged 5 to 10 years (194 females; mean age [SD] 7y 5mo [1y 10mo]) were included in the study (321 typically developing, 49 probable DCD). Motor performance, ADL learning, and participation were assessed using the DCDDaily-Questionnaire. Individual variables included child’s age and sex, and environmental variables included mother and family educational level, presence of siblings, and area of residence. Direct, indirect, and mediating effects were tested using a partial least squares-based structural equation modelling approach. Results. The model explained 44.5% of the variance of daily participation. Motor performance significantly mediated the effect of individual and environmental constraints, and ADL learning on daily participation. Interpretation. Results suggest that the effect of individual and environmental constraints and delayed learning of ADL on daily participation is mediated by motor performance in typically developing children and children with probable DCD. These findings provide further evidence that interventions to promote participation in children with probable DCD should adopt ecological, task-oriented approaches. Further studies should evaluate model generalizability with clinical samples.

[Abstract] Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). Conclusion: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being., [Resumen] Objetivo: Determinar el grado de satisfacción en el parto y puerperio. Método: Estudio observacional longitudinal. Se recogieron variables clínicas de las pacientes y del parto, realizándose un análisis descriptivo e inferencial. Se utilizaron los cuestionarios validados de ansiedad estado y rasgo (STAI) y la encuesta de satisfacción Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) en Español. Resultados: Se incluyeron en el estudio 381 mujeres que se agruparon en satisfechas vs. no-satisfechas (94,54% vs. 5,46%). Las mujeres con un parto eutócico refieren estar más satisfechas (p=0,005), así como aquellas que realizaron piel con piel con su recién nacido (p=0,012). Las madres que se separaron de sus bebés refieren estar menos satisfechas (p=0,004), al igual que las que no cumplieron las expectativas reflejadas en el plan de nacimiento (p=0,013). El 100% de las mujeres con ansiedad mínima están satisfechas (p=0,004), de igual manera sucede con el grado de ansiedad estado postparto (p<0,001). Conclusión: El porcentaje de mujeres satisfechas es elevado, es necesario cuidar la atención al parto y puerperio, fomentando las buenas prácticas de atención al parto, así como el bienestar emocional de las mujeres., [Resumo] Objetivo: Determinar o grau de satisfação no parto e puerpério. Método: Estudo observacional longitudinal. Foram coletadas variáveis clínicas das pacientes e do parto, realizando-se análise descritiva e inferencial. Foram utilizados os questionários validados de ansiedade como traço e estado (STAI) e a pesquisa de satisfação da Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) em espanhol. Resultados: 381 mulheres foram incluídas no estudo, agrupadas em satisfeitas vs. não satisfeitas (94,54% vs. 5,46%). Mulheres com parto eutócico relataram estar mais satisfeitas (p = 0,005), assim como aquelas que realizaram contato pele-a-pele com o recém-nascido (p = 0,012). As mães que se separaram de seus bebês relataram estar menos satisfeitas (p = 0,004), assim como aquelas que não tiveram atendidas as expectativas refletidas no plano de parto (p = 0,013). 100% das mulheres com ansiedade mínima estão satisfeitas (p = 0,004), o mesmo ocorre com o grau de ansiedade pós-parto (p <0,001). Conclusão: O percentual de mulheres satisfeitas é alto, é necessário cuidar da assistência ao parto e puerpério, promovendo boas práticas na assistência ao parto, bem como o bem-estar emocional da mulher.