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Antimicrobial resistance; Shigella sonnei; Sexually transmitted infection Resistencia antimicrobiana; Shigella sonnei; Infección de transmisión sexual Resistència antimicrobiana; Shigella sonnei; Infecció de transmissió sexual Background Several countries have recently reported the detection of ESBL-producing Shigella sonnei associated with transmission among MSM. In a previous study by our group, 2.8% of Shigella spp. obtained from MSM in Barcelona between 2015 and 2019 were ESBL producers. Objectives To describe and characterize the emerging ESBL-producing Shigella spp. associated with sexual transmission among MSM detected from 2020 to 2021 in Barcelona, elucidating their connectivity with contemporaneous ESBL-producing Shigella spp. from other countries. Results From 2020 to 2021, we identified that among MSM, 68% of S. sonnei were XDR harbouring blaCTX-M-27 and 14% of Shigella flexneri were MDR harbouring blaCTX-M-27. WGS analysis showed that the ESBL-producing S. sonnei were part of a monophyletic cluster, which included isolates responsible for the prolonged outbreak occurring in the UK. Our data also reveal the first emergence and clonal dissemination of ESBL-producing and fluoroquinolone-resistant S. flexneri 2a among MSM. Conclusions We report an increasing trend of antimicrobial resistance in Shigella spp. among MSM in Barcelona since 2021, mainly as a consequence of the dissemination of XDR ESBL-producing S. sonnei, previously reported in the UK. These results highlight the importance of international collaborative surveillance of MDR/XDR S. sonnei and S. flexneri for rapid identification of their emergence and the prevention of the transmission of these pathogens. This work was partially supported by the ‘Ministerio de Economía y Competitividad’, ‘Instituto de Salud Carlos III’, and co-financed by the European Regional Development Fund (ERDF) ‘A Way to Achieve Europe’ (Spanish Network for Research in Infectious Diseases, grant number RD16/0016/0003) and by the Centro de Investigación Biomédica en Red (CIBER de Enfermedades Infecciosas, grant no. CB21/13/00054). A.M.M. is supported by a grant from the ‘Fondo de Investigación Sanitaria’ (Contratos Predoctorales de Formación en Investigación, grant number FI19/00315).

BackgroundNeisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy.ObjectivesThis study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018.MethodsWGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records.ResultsTwelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour.ConclusionsOur findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.

The Toxicology Working Group of the Catalan Society of Emergency Medicine (SoCMUETox) began the Intox-28 study in 2013. The aim was to identify differences in poisoning cases between 3 age groups.Descriptive observational study of poisoning cases managed in 8 hospital emergency departments on the 28th day of each month from 2013 to 2019. We gathered information on patient particulars, type of poison, clinical data, and discharge destination. The patient sample was distributed into 3 groups for comparison: minors under the age of 17 years, adults aged 17 to 65 years, and adults over the age of 65 years.The hospitals registered 1088 cases: 132, 859, and 97 in each age group. In comparisons between the minors and the adults aged 65 years or younger, the minors had more females (58.3% vs 46.1%), fewer recreational poisonings (22% vs 46.1%) more poisonings inside the home (67.4% vs 51.1%), more medication poisonings (49.2% vs 31.1%), and less often received treatment (43.2% vs 73%) (P .001, all comparisons). The proportion of older adults receiving treatment (73.2%) was similar to that of the younger adults.The characteristics of poisonings vary according to age. Differences lie in gender, intentionality, and type of poison.El Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d’Urgències i Emergències (SoCMUETox) inició en 2013 el estudio Intox-28. El objetivo de este trabajo es evaluar las diferencias existentes en las características de las intoxicaciones según la edad de los pacientes.Estudio descriptivo observacional de las intoxicaciones atendidas en 8 servicios de urgencias hospitalarios (SUH) el día 28 de cada mes durante el periodo 2013-19. Se recogieron datos demográficos, tipo de tóxico, datos clínicos y destino al alta. Los pacientes se dividieron en 3 grupos: menores de 17 años, adultos (entre 17 y 65 años) y mayores de 65 años.Se registraron 1.088 intoxicaciones: 132 (12,1%), 859 (78,9%) y 97 (8,9%) en cada grupo de edad respectivamente. En comparación a los pacientes adultos, en los menores de 17 años hubo más mujeres (58,3% vs 46,1%; p 0,001), menos intoxicaciones de tipo recreativo (22% vs 46,1%; p 0,001) y acontecieron más frecuentemente en el domicilio (67,4% vs 51,1%; p 0,001). El tipo de tóxico más implicado fueron los fármacos (49,2% vs 31,1%; p 0,001) y precisaron tratamiento con menor frecuencia (43,2% vs 73%; p 0,001). Los mayores de 65 años precisaron tratamiento en porcentaje similar a los pacientes de 17 a 65 años (73,2%).Existen diferencias entre los grupos de edad, entre las que destacan el sexo predominante, la intencionalidad de la intoxicación y el tipo de tóxico implicado.

This doctoral thesis empirically evaluates the effects of monetary policy on income and wealth inequality in two of the main monetary areas of the world: the Eurozone and the United States. Moreover, in the case of the Eurozone, the interaction between the dynamics of income inequality and banking activity is evaluated, distinguishing between banking structures. Specifically, I empirically assess whether cooperative banks have a differential impact on the evolution of inequality with respect to other banking structures such as commercial banks or savings banks. Different macroeconometric (SVAR, Proxy SVAR) and microeconometric (simulations and estimations with panel data) methodologies have been used to conduct the empirical part of this study. All these econometric techniques are well documented and extensively explained in the corresponding articles. This doctoral thesis is a set of publications. Specifically, the dissertation is composed by the following four articles that have already been published or accepted for publication at the date of submission of the dissertation: I. Albert, J. F., Gómez-Fernández, N., & Ochando, C. (2019). Effects of unconventional monetary policy on income and wealth distribution: Evidence from United States and Eurozone. Panoeconomicus, 66(5), 535-558. Published in Panoeconomicus (Journal indexed in Economics (JCR, Q4 and SJR, Q2). II. Albert, J. F., Peñalver, A., & Perez-Bernabeu, A. (2020). The effects of monetary policy on income and wealth inequality in the US Exploring different channels. Structural Change and Economic Dynamics, 55, 88-106. Published in Structural Change and Economic Dynamics (Journal indexed in Economics (JCR, Q1 and SJR, Q2). III. Albert, J. F. & Gómez-Fernández, N. (online-first). Monetary Policy and the redistribution of net worth in the U.S. Journal of Economic Policy Reform. DOI: 10.1080/17487870.2021.1895778. Accepted for publication in March 2021 (Journal indexed in Economics (JCR, Q2 and SJR, Q1). IV. Albert, J. F. & Chaves, R. Estructura bancaria y desigualdad de renta. La banca cooperativa marca la diferencia. CIRIEC-España, revista de economía pública, social y cooperativa. Accepted for publication in February 2021 (Journal indexed in Economics (SJR, Q2) and Sociology and Political Science (SJR, Q1).

In this study, the plasmid content of clinical and commensal strains was analyzed and compared. The replicon profile was similar in both populations, except for L, M, A/C, and N (detected only in clinical strains) and HI1 (only in commensal strains). Although I1 and F were the most frequent replicons, only IncI1, sequence type 12 (ST12) was associated with bla CMY-2 in both populations. In contrast, the widespread resistant IncF plasmids were not linked to a single epidemic plasmid.

En los últimos años están cobrando un gran protagonismo, tanto en la literatura económica como en la praxis política, las conexiones entre la política monetaria y los retos de la desigualdad y la crisis climática. Este artículo sintetiza y examina los principales debates actuales acerca de los efectos potenciales de la política monetaria sobre la desigualdad de la renta y de la riqueza a través de diferentes canales, al tiempo que valora cómo dichas desigualdades pueden incidir en la aplicación de la política monetaria. Asimismo, en relación con la crisis climática, se abordan las implicaciones que pueden derivarse de la degradación ambiental y el cambio climático sobre la política monetaria, así como las posibilidades de esta para favorecer la sostenibilidad ambiental. Finalmente, teniendo en cuenta las nuevas sensibilidades de los bancos centrales para hacer frente a tales retos, se proponen distintas actuaciones de política monetaria que podrían contribuir a un crecimiento inclusivo sostenible en el marco de la Agenda 2030.

Background In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries. Methods Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks. Results In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried blaCTX-M-27. Single-nucleotide-polymorphism-based analysis revealed that the isolates were organized into different lineages, most of which were closely related to dominant MSM-associated lineages described previously in the UK and Australia. Conclusions This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.

Sexually transmitted infections (STIs) by Mycoplasma genitalium are a major problem worldwide, especially given their marked and rapid propensity for developing antimicrobial resistance. Since very few treatment options exist, clinicians face an important challenge in the management of the infection. In this scenario, little is known regarding the transmission dynamics of M. genitalium and the epidemiology of antimicrobial resistance. This mgpB-based molecular typing study, conducted among 54 asymptomatically infected individuals prospectively recruited from an STI screening service, reveals two distinct epidemiological clusters that significantly correlate with sexual conduct in heterosexuals and men who have sex with men (MSM), respectively. This well-defined structuration suggests the presence of two independent sexual networks with little connectivity between them. On the other hand, the study demonstrates the multiclonal feature of the emergence of antibiotic resistance in M. genitalium to both macrolides and fluoroquinolones. The high prevalence of macrolide resistance in M. genitalium among MSM, influenced by dense network connectivity and strong antibiotic selective pressure, may correspond to allodemics affecting other STIs such as gonorrhea, syphilis and enteric pathogens. Collaterally, the structural and functional impact of mutations in the mgpB gene, encoding the major adhesin P140 (MgpB), may require further investigation.

En este trabajo se estudia la relación existente entre tres diferentes estructuras bancarias (bancos cooperativos, bancos comerciales y cajas de ahorro) y la desigualdad de renta. El estudio basado en datos panel utiliza modelos estáticos y dinámicos y analiza el conjunto de la Eurozona con un total de 19 países y 2.253 bancos para un periodo temporal comprendido entre 2010 y 2019. Los resultados muestran que solo los bancos cooperativos reducen la desigualdad en contraposición a los bancos comerciales y las cajas de ahorro. Además, estos son robustos entre diferentes metodologías empeladas y utilizando distintos indicadores de desigualdad. Asimismo, los resultados apuntan a que la relación negativa entre la presencia de los bancos cooperativos y la desigualdad es más intensa y significativa para los países del norte de Europa con mayor desarrollo económico que para los países del sur. A su vez, se han examinado los posibles canales de transmisión a través de los cuáles la banca cooperativa podría reducir la desigualdad. Los resultadossugieren que es la promoción de la inclusión financiera por parte de los bancos cooperativos lo que podría jugar un papel determinante en la reducción de la desigualdad de renta. Los resultados hallados en esta investigación revelan la importancia de distinguir entre estructuras bancarias a la hora de analizar el papel del sistema financiero en el desarrollo económico y en el bienestar de la población.

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The objective was to evaluate the effectiveness of an occupational injury prevention program, known as the Preferential Action Plan (PAP), focused on companies with high incidence rates of occupational injuries. We studied 1189 companies in the industrial, construction and services sectors between 1999 and 2007 in the Valencia region (Spain). Our sample included 507,262 workers, among whom 44,250 non-fatal occupational injuries with at least a workday lost were registered. Companies included in a PAP program were divided into three intervention groups, according to the year that each company entered into a PAP (2000, 2001, and 2002). We calculated annual percentage change in incidence rates of occupational injuries for companies with a PAP and for those without a PAP (comparison group), and trends in the incidence rates of occupational injuries were compared between each intervention group and the comparison group. The results showed that the trend in the occupational injury rate declined 12%, 14% and 11% annually for the 2000, 2001, and 2002 intervention groups respectively, and around 5% for the comparison group. The differences in intervention and comparison group trends were found to be statistically significant. This pattern is observed by company size and activity sector, length of sick leave, and type of injury. According to these results, the use of PAPs in companies with high incidence rates of occupational injuries seems to be effective in the prevention of occupational injuries.