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Cristina Bermejo Boixareu,1,* Cristina Ojeda-Thies,2,* Ainhoa Guijarro Valtueña,3 Bernardo Abel Cedeño Veloz,4 María Gonzalo Lázaro,4 Laura Navarro Castellanos,5 Rocío Queipo Matas,5,6 Paloma Gómez Campelo,5 Ana Royuela Vicente,7 Juan Ignacio González-Montalvo,5,8 Pilar Sáez-López5,9,10 1Geriatrics Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain; 2Orthopaedic Surgery and Traumatology Department, 12 de Octubre University Hospital, Madrid, Spain; 3Orthopaedic Surgery and Traumatology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain; 4Geriatrics Department, University Hospital of Navarra, Pamplona, Spain; 5La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain; 6European University of Madrid, Madrid, Spain; 7Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, IDIPHISA, CIBERESP, Madrid, Spain; 8Geriatrics Department, La Paz University Hospital, Madrid, Spain; 9Geriatrics Department, Fundación Alcorcón University Hospital, Madrid, Spain; 10Spanish National Hip Fracture Registry, Madrid, Spain*These authors contributed equally to this workCorrespondence: Cristina Bermejo Boixareu, Head of Geriatrics Department, University Hospital Puerta de Hierro Majadahonda, Madrid, 28224, Spain, Email Cristina_bermejo@hotmail.com

Abstract Background Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge. Methods An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge. Results 308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge. Conclusions Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

The usefulness of bronchoalveolar lavage fluid (BALF) to support the diagnosis of acute cellular (ACR) rejection in lung transplant (LTX) recipients remains controversial. ACR has been associated with blood eosinophil counts (EOS) in other solid organ recipients, but there are few studies in relation to lung transplants. Our aim was to assess the usefulness of the combined analysis of BALF cellularity and EOS for the diagnosis of ACR in lung transplant recipients. This is a retrospective study of findings observed simultaneously in 887 transbronchial biopsies (TBB), BALF, and blood samples obtained from 363 LTx patients transplanted between 2014 and 2020. The variables collected were: demographics, ACR degree, BALF cellularity, and simultaneous blood EOS counts. The lymphocyte count in BALF was significantly higher in patients with ACR than in those without (11.35% vs. 6.11%; p < 0.001). In parallel, EOS counts were also significantly higher in patients with ACR than in the non-ACR group (EOS 213 ± 206/mm3 vs. 83 ± 129/mm3; p < 0.001). Increases in both parameters were associated with an increased risk of ACR (lymphocytes OR 1.100; 95% CI 1.080–1.131; EOS OR 1.460; 95% CI 1.350–1.580). The diagnostic specificity of ACR for a lymphocyte count > 12% was 71.1%, which increased to 95.8% when taking into account a simultaneous blood EOS count > 200/mm3. Simultaneous assessment of BALF lymphocyte counts and blood eosinophil counts may be useful for diagnosing ACR in patients with risk factors for TBB or in the presence of inconclusive histological samples.

Cristina Bermejo Boixareu,1,&ast; Cristina Ojeda-Thies,2,&ast; Ainhoa Guijarro Valtueña,3 Bernardo Abel Cedeño Veloz,4 María Gonzalo Lázaro,4 Laura Navarro Castellanos,5 Rocío Queipo Matas,5,6 Paloma Gómez Campelo,5 Ana Royuela Vicente,7 Juan Ignacio González-Montalvo,5,8 Pilar Sáez-López5,9,10 1Geriatrics Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain; 2Orthopaedic Surgery and Traumatology Department, 12 de Octubre University Hospital, Madrid, Spain; 3Orthopaedic Surgery and Traumatology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain; 4Geriatrics Department, University Hospital of Navarra, Pamplona, Spain; 5La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain; 6European University of Madrid, Madrid, Spain; 7Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, IDIPHISA, CIBERESP, Madrid, Spain; 8Geriatrics Department, La Paz University Hospital, Madrid, Spain; 9Geriatrics Department, Fundación Alcorcón University Hospital, Madrid, Spain; 10Spanish National Hip Fracture Registry, Madrid, Spain&ast;These authors contributed equally to this workCorrespondence: Cristina Bermejo Boixareu, Geriatrics Department, Puerta de Hierro University Hospital, Madrid, Spain, Email cristina_bermejo@hotmail.comObjective: The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality.Materials and Methods: This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥ 75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality.Results: We included 25,938 patients (2888 were 75– 79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery > 48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35– 5.64; p< 0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09– 0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19– 0.96; p=0.039]).Conclusion: Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.Keywords: centenarians, fracture, registry, mortality, ASA grade

Resumen: Introducción: Es importante conocer si en la reanimación neonatal el uso de diversas herramientas de calidad tiene impacto en la preparación del puesto de estabilización, correcto desarrollo del procedimiento y evolución clínica de aquellos neonatos más vulnerables. Material y métodos: Estudio de intervención cuasiexperimental, prospectivo y multicéntrico en 5 unidades neonatales iii-A. En las fases pre y postintervención, ambas de un año de duración, se realizaron auditorías aleatorias semanales de los puestos de estabilización en el paritorio para comprobar su preparación. En la fase postintervención se usaron checklists, briefings y debriefings en las reanimaciones de los neonatos menores de 32 semanas. Se compararon el desarrollo del procedimiento y la evolución inicial posreanimación entre ambos periodos. Resultados: Se realizaron 852 auditorías en el periodo preintervención y 877 en el postintervención. El porcentaje de auditorías sin defecto fue superior en la segunda fase (63% vs. 81% p

Concerns over widespread technological unemployment are often dismissed with the argument that human labour is not destroyed by automation but rather reallocated to other tasks, occupations or sectors. When focusing on pure employment levels, the idea that workers are not permanently excluded but 'just' reallocated might be reassuring. However, while attention has been devoted to the impact of automation on employment levels, little has been said about the quality of new job matches for displaced workers. Using an administrative longitudinal panel covering a large sample of Spanish workers from 2001 to 2017, we investigate the short‐ and medium‐term re‐employment prospects of workers displaced from sectors with an increasing density of industrial robots. Furthermore, we examine the role of reallocation to other sectors or local labour markets as adjustment mechanisms. Our analysis suggests that exposed middle‐ and low‐skilled workers are more likely than non‐exposed workers to remain unemployed 6 months after displacement. Among those who find a new occupation, an additional robot per 1000 workers increases the probability of being re‐employed in a lower paying job by about 1.9 percentage points for middle‐ and low‐skilled workers, with significantly higher penalties for those who relocate to a different sector. Moreover, these workers tend to face a qualification downgrading in the new job and are more likely to be re‐employed through temporary employment agencies. High‐skilled workers are less negatively affected by exposure, although they can also incur a penalty when changing sectors. [ABSTRACT FROM AUTHOR]

Objective It is important to determine whether the use of different quality improvement tools in neonatal resuscitation is well-received by health care teams and improves coordination and perceived quality of the stabilization of the newborn at birth. This study aimed to explore the satisfaction of personnel involved in resuscitation for infants under 32 weeks of gestational age (<32 wGA) at birth with the use of an assistance toolkit: Random Real-time Safety Audits (RRSA) of neonatal stabilization stations, the use of pre-resuscitation checklists, and the implementation of briefings and debriefings. Study Design A quasi-experimental, prospective, multicenter intervention study was conducted in five level III-A neonatal intensive care units in Madrid (Spain). The intervention involved conducting weekly RRSA of neonatal resuscitation stations and the systematic use of checklists, briefings, and debriefings during stabilization at birth for infants <32 wGA. The satisfaction with their use was analyzed through surveys conducted with the personnel responsible for resuscitating these newborns. These surveys were conducted both before and after the intervention phase (each lasting 1 year) and used a Likert scale response model to assess various aspects of the utility of the introduced assistance tools, team coordination, and perceived quality of the resuscitation. Results Comparison of data from 200 preintervention surveys and 155 postintervention surveys revealed statistically significant differences (p < 0.001) between the two phases. The postintervention phase scored higher in all aspects related to the effective utilization of these tools. Improvements were observed in team coordination and the perceived quality of neonatal resuscitation. These improved scores were consistent across personnel roles and years of experience. Conclusion Personnel attending to infants <32 wGA in the delivery room are satisfied with the application of RRSA, checklists, briefings, and debriefings in the neonatal resuscitation and perceive a higher level of quality in the stabilization of these newborns following the introduction of these tools. Key Points RRSA, checklists, briefings, and debriefings improve the quality of neonatal resuscitation at birth. These tools, when used together, are well-received and enhance perceived resuscitation quality. Perception of utility and quality improvement is consistent across roles and experience. [ABSTRACT FROM AUTHOR]