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Este artículo presenta el análisis urbano de los espacios públicos y áreas verdes actuales, en la ciudad de Córdoba Veracruz México, con el objetivo de identificar los indicadores presentes de un espacio saludable. Se analizaron los parques, áreas verdes, campos y canchas deportivas en relación con el número de sus habitantes y entorno urbano en donde se localizan. El espacio abierto público es indispensable para el desarrollo de las actividades físicas, medioambientales y psicológicas de los habitantes, la pertinencia de realizar una investigación en donde se analice el total de áreas verdes y espacios públicos con las que cuenta en la actualidad la ciudad permitirá determinar el estado en el que se encuentran, para su posterior intervención, considerando los parámetros establecidos por organizaciones internacionales como la OMS (Organización Mundial de la Salud) y los objetivos de la Agenda 2030 de la ONU (Organización de las Naciones Unidas)[1]. Como resultado de esta investigación se determinó el estado en el que se encuentran los espacios abiertos públicos que existen en la ciudad mediante una visita de campo y fotografías de sitio actuales. Recopilando datos e indicadores sobre: el deterioro, uso y actividades, ubicación, estado del mobiliario, estados de las instalaciones, nivel de usuarios, áreas con las que cuenta, jardines, tipo de flora, fauna, áreas recreativas y deportivas, áreas infantiles, entre otras. [1] https://www.un.org/sustainabledevelopment/es/objetivos-de-desarrollo-sostenible/

Natural evolution has provided multicellular organisms with sophisticated functionalities and repair mechanisms for surviving and preserve their functions after an injury and/or infection. In this context, biological systems have inspired material scientists over decades to design and fabricate both self-healing polymeric materials and soft actuators with remarkable performance. The latter are capable of modifying their shape in response to environmental changes, such as temperature, pH, light, electrical/magnetic field, chemical additives, etc. In this review, we focus on the fusion of both types of materials, affording new systems with the potential to revolutionize almost every aspect of our modern life, from healthcare to environmental remediation and energy. The integration of stimuli-triggered self-healing properties into polymeric soft actuators endow environmental friendliness, cost-saving, enhanced safety, and lifespan of functional materials. We discuss the details of the most remarkable examples of self-healing soft actuators that display a macroscopic movement under specific stimuli. The discussion includes key experimental data, potential limitations, and mechanistic insights. Finally, we include a general table providing at first glance information about the nature of the external stimuli, conditions for self-healing and actuation, key information about the driving forces behind both phenomena, and the most important features of the achieved movement.

Carbon–carbon (C–C) bond formation is the key reaction in organic synthesis to construct the carbon framework of organic molecules. The continuous shift of science and technology toward eco-friendly and sustainable resources and processes has stimulated the development of catalytic processes for C–C bond formation based on the use of renewable resources. In this context, and among other biopolymer-based materials, lignin has attracted scientific attention in the field of catalysis during the last decade, either through its acid form or as a support for metal ions and metal nanoparticles that drive the catalytic activity. Its heterogeneous nature, as well as its facile preparation and low cost, provide competitive advantages over other homogeneous catalysts. In this review, we have summarized a variety of C–C formation reactions, such as condensations, Michael additions of indoles, and Pd-mediated cross-coupling reactions that were successfully carried out in the presence of lignin-based catalysts. These examples also involve the successful recovery and reuse of the catalyst after the reaction.

Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Influenza vaccination coverages among health care students are low. The aim of this study was to find out which measures, according to medical and nursing students, could contribute to improve these vaccination rates.A cross-sectional study that included medical and nursing students of the University of Zaragoza who were doing internships in health centers during the 2020-2021 school year. The information was obtained in December 2020 by a self-administered online questionnaire, in which they were asked to describe the measures that, in their opinion, are necessary to increase their influenza vaccination coverage. A qualitative analysis of the content of the answers was carried out, extracting themes, sub-themes and selecting the most representative verbatims.The questionnaire was answered by 83 students (response rate: 5.9%); 64 (77.1%) were women, and 74.7% of them were studying medicine. The main measures proposed were improving the accessibility of the vaccine, improving the training on influenza vaccine, promoting vaccination by the teaching staff, and increasing the diffusion of information about the vaccination campaign.This study has found measures to be applied specifically to medical and nursing students to potentially improve their influenza vaccination coverage. For its implementation, collaboration between universities and health services is necessary.Las coberturas de vacunación antigripal en estudiantes sanitarios son bajas. El objetivo de este estudio fue conocer las medidas que, según los estudiantes de medicina y enfermería, podrían contribuir a mejorar dichas tasas de vacunación.Estudio transversal que incluyó a los alumnos de medicina y enfermería de la Universidad de Zaragoza que realizaban prácticas en centros sanitarios durante el curso académico 2020-2021. La información se obtuvo en diciembre 2020 utilizando un cuestionario on line auto-cumplimentado, en el que se solicitaba que describieran las medidas que, en su opinión, son necesarias para incrementar sus coberturas de vacunación antigripal. Se realizó un análisis cualitativo del contenido de las respuestas, extrayendo temas, subtemas y seleccionando los verbatims más representativos.83 estudiantes respondieron el cuestionario (tasa de respuesta: 5,9%); 64 (77,1%) eran mujeres, cursando medicina el 74,7%. Las principales medidas propuestas estaban relacionadas con mejorar la accesibilidad de la vacuna, mejorar la formación sobre la vacuna antigripal, promover la vacunación por parte del personal docente y aumentar la difusión de la información sobre la campaña de vacunación.Este estudio ha identificado medidas a aplicar específicamente en los estudiantes de medicina y enfermería con las que potencialmente mejorar sus coberturas de vacunación antigripal. Para su implementación, es necesaria la colaboración entre las universidades y los servicios de salud.

[EN] Background The peroxisome proliferator-activated receptor (PPAR)-γ plays a key role in adipose tissue differentiation and fat metabolism. However, it is unclear which factors may regulate its expression and whether obese patients have changes in adipose tissue expression of PPAR-γor potential regulators such as miR-27. Thus, our aims were to analyze PPAR-γ and miR-27 expression in adipose tissue of obese patients, and to correlate their levels with clinical variables. Subjects and Methods. We included 43 morbidly obese subjects who underwent sleeve gastrectomy (31 of them completed 1-year follow-up) and 19 non-obese subjects. mRNA expression of PPAR-γ1 and PPAR-γ2, miR-27a, and miR-27b was measured by qPCR in visceral and subcutaneous adipose tissue. Clinical variables and serum adipokine and hormone levels were correlated with PPAR-γ and miR-27 expression. In addition, a systematic review of the literature regarding PPAR-γ expression in adipose tissue of obese patients was performed. Results We found no differences in the expression of PPAR-γ and miR-27 in adipose tissue of obese patients vs. controls. The literature review revealed discrepant results regarding PPAR-γ expression in adipose tissue of obese patients. Of note, we described a significant negative correlation between pre-operative PPAR-γ1 expression in adipose tissue of obese patients and post-operative weight loss, potentially linked with insulin resistance markers. Conclusion PPAR-γ1 expression in adipose tissue is associated with weight loss after sleeve gastrectomy and may be used as a biomarker for response to surgery., Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was funded by the following grants to M.M.: ISCIII and FEDER, PI10/01692, PI16/01548, RD16/0017/0023, and I3SNS-INT12/049, L.H.C.: Junta de Castilla y León GRS 681/A/11, J.-L. T.: GRS 1587/A/17 and GRS1356/A/16, G.S.: ERC 260464, EFSD 2030, MICINNSAF2013-43506-R, and Comunidad de Madrid S2010/BMD-2326. G.S. is an investigator of the Ramón y Cajal Program., Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCLE

Our objective was to analyze the information in Spanish on YouTube about the influenza vaccine. In August 2020, a search was conducted on YouTube using the terms &ldquo, Vacuna gripe&rdquo, &ldquo, Vacuna influenza&rdquo, and &ldquo, Vacuna gripa&rdquo, Associations between the type of authorship, country of publication, and other variables (such as tone, hoaxes, and vaccination recommendations) were studied via univariate analysis. A total of 100 videos were evaluated, 57.0% were created in Mexico (24.0%), Argentina (17.0%), and Spain (16.0%), and 74.0% were produced by mass media or health professionals. Positive messages were detected in 65.0%. The main topics were the benefits of the vaccine (59.0%) and adverse effects (39.0%). Hoaxes were detected in 19 videos. User-generated content, compared to that of health professionals, showed a higher probability of hoaxes (odds ratio (OR) = 15.56), a lower positive tone (OR = 0.04), and less evidence of recommendations to vaccinate pregnant individuals (OR = 0.09) and people aged 60/65 or older. Videos published in Spain, in comparison with those from Hispanic America, presented significant differences in the positive tone of their messages (OR = 0.19) and in the evidence of the benefits of vaccination (OR = 0.32). A higher probability of hoaxes was detected in videos from Spain and the USA. Information in Spanish about the influenza vaccine on YouTube is usually not very complete. Spanish health professionals are urged to produce pro-vaccination videos that counteract hoaxes, and users in Hispanic America should be advised to consult videos produced in Hispanic American countries by health professionals to obtain reliable information.

Autistic spectrum disorder (ASD) is a complex neurodevelopmental disability with a genetic basis, and several studies have suggested a potential role of the reelin gene (RELN) in ASD susceptibility. Accordingly, genetic association studies have explored this potential association, but the results have been controversial thus far. For this reason, we assessed the association of four genetic variants of RELN (the 5′UTR CGG triplet repeat and polymorphisms rs736707, rs362691, and rs2229864) with ASD by means of a systematic review and meta-analysis. We retrieved studies comparing the distribution of the above-mentioned genetic variants between ASD patients and healthy controls. A meta-analysis was conducted using a random effects model, and calculations of the odds ratios (ORs) and confidence intervals (CIs) were performed. A sensitivity analysis and tests to determine the heterogeneity of the results were also performed. Eleven previous studies fulfilled the inclusion criteria and analyzed the association of the above-mentioned genetic variants and ASD. We did not find any significant association between the allele or genotype frequencies of the analyzed polymorphisms and ASD, and large heterogeneity was found for the rs736707 polymorphism. Moreover, no significant differences were found between the 5′UTR triplet repeat and this disorder. In light of current evidence, no single genetic variant within this gene is clearly associated with the development of ASD, and ethnic differences may explain part of the observed heterogeneity. Larger studies among different ethnic groups are needed to establish the role of specific genetic variants within RELN in the etiology of this disorder.

Objective: To analyze the characteristics of YouTube videos in Spanish on the basic measures to prevent coronavirus disease 2019 (COVID-19). Methods: On 18 March 2020, a search was conducted on YouTube using the terms “Prevencion Coronavirus” and “Prevencion COVID-19”. We studied the associations between the type of authorship and the country of publication with other variables (such as the number of likes and basic measures to prevent COVID-19 according to the World Health Organization, among others) with univariate analysis and a multiple logistic regression model. Results: A total of 129 videos were evaluated; 37.2% were produced in Mexico (25.6%) and Spain (11.6%), and 56.6% were produced by mass media, including television and newspapers. The most frequently reported basic preventive measure was hand washing (71.3%), and the least frequent was not touching the eyes, nose, and mouth (24.0%). Hoaxes (such as eating garlic or citrus to prevent COVID-19) were detected in 15 videos (10.9%). In terms of authorship, papers produced by health professionals had a higher probability of reporting hand hygiene (OR (95% CI) = 4.20 (1.17–15.09)) and respiratory hygiene (OR (95% CI) = 3.05 (1.22–7.62)) as preventive measures. Conclusion: Information from YouTube in Spanish on basic measures to prevent COVID-19 is usually not very complete and differs according to the type of authorship. Our findings make it possible to guide Spanish-speaking users on the characteristics of the videos to be viewed in order to obtain reliable information.

Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88-60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64-42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.

Objective: To find out what measures medical students believe could help improve their influenza vaccination coverage. Method: On 5 November, 2019, the Dean of the Zaragoza Medical School sent an e-mail to the students asking them to fill out a questionnaire through Google Forms, in which they were asked to describe, in an open field, the measures that they believed could contribute to improving their flu vaccination coverage. The content of the responses was analyzed in a classic way, extracting descriptors and selecting the most representative verbatim accounts. Results: The main measures proposed were to improve the training on influenza and its vaccine, to improve the accessibility of the vaccine in time and space, to provide incentives to get vaccinated, to create visible and positive attitudes towards the vaccine, and to increase the diffusion of information about the vaccination campaign. Conclusion: This qualitative study has found potential measures to be applied specifically to medical students to improve their vaccination coverage in our country.

Background The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

BACKGROUND The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. OBJECTIVE The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. METHODS On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). RESULTS In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). CONCLUSIONS It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

People affected by the human immunodeficiency virus (HIV) have a higher risk of invasive pneumococcal disease. Therefore, vaccination against streptococcus pneumoniae is recommended for that group. The objective of this study was to analyze the impact of implementing a hospital appointment to assess vaccination status as part of the vaccination schedule of HIV patients.We carried out a quasi-experimental uncontrolled before and after study with a sampling of consecutive cases of HIV patients referred to our department from November 1, 2014 to June 30, 2018. The study compared the vaccination coverage on the date of the appointment for an assessment of their vaccination status in our department and after the appointment. The analysis used the chi-squared test and the values on the date of the first appointment were taken as a reference.209 patients were analyzed, and a statistically significant improvement was observed regarding their vaccination coverage: 2.9% of the patients had been vaccinated on the date in which they made an appointment for assessment by our department, and 88.0% were vaccinated after they left (OR [95%CI]: 30.7 [13.92-67.58]) with the 13-valent pneumococcal conjugate vaccine; and 16.3% had been vaccinated on the date they made the first appointment vs. 83.7% after they came to the appointment (OR [95%CI]: 5.2 [3.76-7.04]) with the 23-valent polysaccharide pneumococcal vaccine.Implementing a hospital appointment for vaccination is an effective intervention to improve vaccination coverage against streptococcus pneumoniae in HIV patients.Las personas infectadas por el virus de la inmunodeficiencia humana (VIH) presentan riesgo elevado de sufrir la enfermedad neumocócica invasiva, motivo por el que se recomienda su vacunación frente al neumococo. El objetivo de este trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en las coberturas de vacunación de estos pacientes.Se elaboró un estudio cuasiexperimental sin grupo control, de tipo antes/después, en el que se realizó un muestreo de casos consecutivos de pacientes con VIH remitidos a nuestra consulta entre el 1 noviembre de 2014 y el 30 junio de 2018. Las coberturas en el momento de la fecha de la cita para la valoración de su estado vacunal (en nuestra consulta) y después de ser atendido se compararon usando la prueba chi-cuadrado. Como referencia se utilizaron las del momento de la fecha de la primera cita.Se analizaron 209 pacientes, en los que se obtuvieron mejoras estadísticamente significativas en sus coberturas vacunales: 2,9% en el momento de la fecha de la cita para la valoración en nuestra consulta y 88% después de ser atendidos en nuestra consulta (RR [IC95%]= 30,7 [13,92-67,58]) para la vacuna antineumocócica conjugada 13-valente, y 16,3% en el momento de la primera cita y 83,7% después de ser atendidos en nuestra consulta (RR [IC95%]=5,2 [3,76-7,04]) para la vacuna antineumocócica polisacárida 23-valente.Implementar una consulta hospitalaria de vacunas representa una intervención efectiva para mejorar las coberturas de vacunación frente al neumococo en pacientes con VIH.

Influenza vaccination coverage in risk groups has been put forward as a healthcare quality indicator. Our objective was to determine the vaccination rate in splenectomized patients.We carried out a cross-sectional study that included splenectomized patients in the Zaragoza III Sector from January 2012 to December 2016. The patients were identified through the database of the Clinical Documentation and File Management Services of the Sector Hospital under code 41.5 of the ICD-9. The variables (sociodemographic and surgical variables, and having received information and advice regarding vaccination when they were admitted to the Immunization Unit) were obtained after a review of the patients' records in the Specialized and Primary Care Services. The association with being vaccinated during the campaign corresponding to the surgery date was studied with bivariate analysis and multiple logistic regression model.81 patients were analyzed; 60.5% were men, with an average age of 56.3 years. Neoplasms and hematological diseases were the most common motives for surgery (64.2%). The vaccination rate was 58%. Having been advised to vaccinate (OR=6.53; 95%CI=1.88-22.69) and having been vaccinated in the previous season (OR=4.79; 95%CI= 1.48-15.57) were associated with vaccination.The coverage rate ranks in an intermediate position when compared with other countries. It is necessary to improve the referral system of these patients to the Immunization Unit because the information obtained by this service leads to better results.La cobertura vacunal antigripal en grupos de riesgo ha sido postulada como un indicador de la calidad asistencial. El objetivo de este estudio fue conocer dicha tasa de vacunación en esplenectomizados.Se realizó un estudio transversal que incluyó a los esplenectomizados del sector Zaragoza III entre enero de 2012 y diciembre de 2016. La identificación de los pacientes se realizó a través de la base de datos del Servicio de Archivos y Documentación Clínica del hospital del sector, utilizando el código 41.5 de la Clasificación Internacional de Enfermedades (9ª edición). Las variables (sociodemográficas, quirúrgicas y el haber recibido información y consejo para vacunarse al ser atendido en la consulta hospitalaria de vacunas) fueron obtenidas revisando las historias de atención especializada y primaria. Se analizó la asociación con la vacunación en la campaña correspondiente a la fecha de la cirugía mediante un análisis bivariado y un modelo de regresión logística múltiple.Fueron estudiados 81 pacientes. El 60,5% eran hombres, con una edad media de 56,3 años. Las neoplasias y las enfermedades hematológicas fueron los motivos más frecuentes de cirugía (64,2%). La tasa de vacunación fue del 58%. Recibir la recomendación de vacunación (OR=6,53; IC95%=1,88-22,69) y haber sido vacunado en la temporada anterior (OR=4,79; IC95%=1,48-15,57) se asociaron con la acción de vacunarse.La cobertura se encuentra en una posición intermedia comparada con otros países. Se ha de mejorar la sistemática de derivación de estos pacientes a la consulta hospitalaria de vacunas, dado que la información facilitada en ella contribuye a obtener mejores resultados.

Splenectomized patients have an increased risk of sepsis caused by encapsulated bacteria. Pneumococcal, meningococcal and Haemophilus influenzae B vaccination is recommended in this group. The aim of our study was to assess the impact of the introduction of an immunization hospital clinic on their immunization coverages.Quasi-experimental study. The control group included patients splenectomized between January 2012-April 2014, and the intervention group included patients splenectomized between May 2014-December 2016. The global and specific immunization coverages were compared between both groups using a Chi-square test.80 patients were analyzed. The most commonly administered vaccine was the 23-valent pneumococcal polysaccharide vaccine (65.0%). A significant improvement was observed both in the global immunization rate (17.1% in the pre-intervention study vs. 57.8% in the post-intervention study) (RR: 3.37; 95% CI: 1.56-7.27) and in the specific immunization rate for the Haemophilus influenzae B, meningococcal C and 13-valent pneumococcal conjugate vaccines.Introducing an immunization hospital clinic is an effective measure to improve the immunization coverage of splenectomy patients.Los pacientes esplenectomizados presentan riesgo elevado de sepsis por bacterias encapsuladas, motivo por el que se recomienda vacunarles frente a neumococo, meningococo y Haemophilus infl uenzae B. El objetivo de nuestro trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en sus coberturas de vacunación.Estudio cuasiexperimental. Constituyeron el grupo control los esplenectomizados entre enero 2012-abril 2014, y el grupo intervención los operados entre mayo 2014-diciembre 2016. Se compararon las coberturas vacunales global y específica para cada vacuna según grupo utilizando la prueba chi-cuadrado.Se analizaron 80 pacientes. La vacuna más administrada fue la antineumocócica polisacárida 23-valente (65,0%). Hubo una mejora significativa en la tasa de vacunación global (17,1% en el periodo preintervención versus 57,8% en el postintervención) (RR=3,37; IC95%:1,56-7,27) así como específicamente para las vacunas frente a Haemophilus influenzae de tipo B, antimeningocócica C y antineumocócica conjugada 13-valente.Implementar una consulta hospitalaria de vacunas representa una medida efectiva para mejorar las coberturas vacunales de estos pacientes.

Background Studies in different autoimmune pathologies report a lower response rate (immunogenicity) to vaccinations than in the general population. Our objective is to analyze the immunogenicity of the vaccine against hepatitis B virus (HBV) in patients with multiple sclerosis (MS). Methods In a single prospective cohort of MS patients with negative HBV serology, hepatitis B (rDNA) B vaccine was administered at 0, 1 and 6 months. Immunogenicity was analyzed by the determination of antibodies to surface antigens of HBV. We considered a patient as a responder if antibodies level was higher than 10 IU/L. Posterior analysis of immunogenicity was conducted by demographic variables (e.g. MS phenotype, EDSS) and use of disease-modifying drugs (DMTs). Results Vaccination study of 251 patients: 160 of them were sero-negative (63.7%). Patients vaccinated: 99. Overall response: 74.1%. No significant relationship by sex (female 77.6% responders, male 68.8%) and MS phenotype (relapsing forms 74.3% responders, secondary progressive 50%). Variables associated with significantly lower immunogenicity were: age (>55 years), EDSS score (median: non-responders=3.0, responders=1.0), number of relapses and treatment with fingolimod (28.6% responders, n=7). Anti-CD20 therapies showed lower vaccine response (50%), but were not very represented in our sample (n=2). Immunogenicity with other DMTs: interferon/glatiramer 69.6% (n=23), teriflunomide 71.4% (n=14), dimethylfumarate 92.3% (n=13), natalizumab 100% (n=7). Conclusion The overall immunogenicity of our sample is lower than that reported in the general population (74 vs >86%), as in other autoimmune diseases. Preliminary data show a lower immunogenicity with older age, higher EDSS score, number of relapses and fingolimod use.

The quality of health information online is a concern to governments and users. Our objective was to determine the extent to which the information available online regarding meningococcal B vaccine recommendations adhere to the guidelines of the Spanish Ministry of Health.Cross-sectional study carried out in April 2017. The study assessed adherence of information regarding vaccine recommendations to official guidelines. The information was collected via Google with 20 keywords. The Chi-squared test was used to analyze the association between the adhered information and its origin.In total, 186 web links were analyzed. Adhered recommendations were found in a range of links, from 52.2% (97/186) with an indication for people with properdin deficiency/terminal component pathway deficiency, to 79.6% for outbreak situations. Vaccinating children from two months of age was a recommendation not issued by the Ministry that was found in 72.6% of the links. For each of the Ministry recommendations, official public health institutions always provide information adhering to them. Digital media provided information about vaccination adhering to official guidelines with a significantly higher frequency than scientific societies in cases of people with properdin deficiency/terminal component pathway deficiency (OR: 2.72; 95%CI: 1.18-6.28) and asplenia (OR: 3.83; 95%CI: 1.66-8.86).We have observed a difficulty to obtain adhered information. Users must be encouraged to access websites of official public health institutions when looking for information about this vaccine.La calidad de la información sanitaria en internet preocupa a gobiernos y usuarios. Nuestro objetivo fue determinar en qué medida la información disponible en la red sobre las recomendaciones de vacunación frente al meningococo B se adhiere a lo indicado por el Ministerio de Sanidad español.Estudio transversal realizado en abril de 2017. Se evaluó la adhesión de la información sobre recomendaciones de recibir la vacuna. La información se obtuvo a través de Google utilizando veinte palabras clave. Se utilizó la prueba chi-cuadrado para estudiar la asociación entre obtener información adherida y el tipo de origen de la misma.Se analizaron 186 enlaces web. Se detectaron recomendaciones adheridas entre el 52,2% (97/186) de los enlaces para la indicación en personas con deficiencia de properdina/factores terminales del complemento, y el 79,6% para las situaciones de brotes. Vacunar a niños a partir de los dos meses de edad fue una recomendación no elaborada por el Ministerio que se detectó en el 72,6% de los enlaces. Para cada una de las recomendaciones del Ministerio, los organismos oficiales de salud pública siempre proporcionaron información adherida. Medios de comunicación digitales aportaron con una frecuencia significativamente mayor, que las Sociedades Científicas, información adherida sobre vacunar a personas con deficiencia de properdina/factores terminales del complemento (OR: 2,72; IC95%: 1,18-6,28) y asplenia (OR: 3,83; IC95%: 1,66-8,86).Se evidencia una dificultad para obtener información adherida a lo indicado por la ponencia de vacunación del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se debe promocionar en los usuarios la consulta de páginas web de organismos oficiales de salud pública cuando busquen información sobre esta vacuna.

Thrombosis is frequent in patients with Behçet's disease (BD), although the exact cause remains uncertain. Some single nucleotide polymorphism (SNP) (G1691A in factor V gene, also called factor V Leiden [FVL], G20210A in prothrombin gene and C677T in methyltetrahydrofolate reductase [MTHFR] gene) have been associated with thrombosis and ocular involvement in BD with controversial results.To assess the effects of FVL, prothrombin and MTHFR SNP variants in patients with BD and thrombosis and ocular involvement by means of a systematic review and meta-analysis.We retrieved studies analyzing the genotype of the above-mentioned polymorphism among patients with BD. A meta-analysis was conducted in a random effects model and calculations of odds ratio (OR) and confidence intervals (CI) were done. Sensitivity analysis and tests for heterogeneity of the results were performed.27 previous studies analyzed the association of BD and thrombosis with the FVL, prothrombin and MTHFR polymorphisms. A significant association was found between the possession of the AA or GA genotypes of FVL polymorphism among patients with BD and the presence of any thrombosis (OR=2.51; 95% CI: 1.68, 3.74; P0.00001). In addition, a significant association was found between the possession of the GA or AA genotypes and the presence of BD (OR=2.67; 95% CI: 1.93. 3.72; P0.00001) when cases with BD and healthy controls were compared. This association was not found when studies from Turkey were excluded. No association was found between prothrombin and MTHFR SNPs and thrombosis in BD, and no association between any SNP and ocular involvement was shown either.Factor V Leiden could be responsible for some thrombotic events in at least Turkish patients. However, this relationship has to be demonstrated from a pathogenic point of view.

To assess patient safety culture in directors/managers.Cross-sectional descriptive study carried out from February to June 2011 among the executive/managing staff of the Aragón Health Service through semi-structured interviews.A total of 12 interviews were carried out. All the respondents admitted that there were many patient safety problems and agreed that patient safety was a priority from a theoretical rather than practical perspective. The excessive changes in executive positions was considered to be an important barrier which made it difficult to establish long-term strategies and achieve medium-term continuity.This study recorded perceptions on patient safety culture in directors, an essential factor to improve patient safety culture in this group and in the organisations they run.

A voluntary ban on male pig castration is expected for most E.U. countries in 2018. However, standard immunocastration (IC) protocols still need to be modified for Iberian (IB) pig males due to their long life cycle.

A key element to promote the compliance of hand hygiene (HH) among health care workers (HCWs) is to analyze their perceptions of it. Our objective was to evaluate the beliefs and perceptions that nursing students have on HH.A cross-sectional study was performed during the 2011-2012 school year. It included all enrolled nursing students from a Spanish University. The information was obtained by a self-administered questionnaire, which assessed the importance of HH to control nosocomial infections (NI), beliefs (by Hand Hygiene Beliefs Scale-HHBS) and perceptions of the importance given to HH in the curriculum (by Hand Hygiene Importance Scale-HHIS). Associations were analyzed using logistic regression.146 students of the 270 (54.1%) completed the questionnaire. Assessing the importance of HH as NI control measure ranged from 4 to 10 points (median = 9). The more agreement HHIS item was to consider HH as an important part of the curriculum (76.1%), while HHBS item was to believe that hands washing after going to the toilet reduces the transmission of infectious diseases (100%). Importance of HH to control NI valued with9 points was associated with the agreement to consider it as an relevant part of the curriculum (OR:2.5), and to believe that HCWs play an important role in preventing NI (OR: 4.3).HH was rated as an important NI control measure. Educational programs should be carried out at universities to students do HH, whether they observe poor compliance among HCWs in their practices.

Resumen Introduccion Entre los argumentos del trabajador sanitario para no vacunarse de gripe esta el temor a reacciones adversas (RA). El objetivo fue estudiar la frecuencia y las caracteristicas de tales reacciones. Metodos Estudio de cohortes que incluyo a los 2.587 trabajadores vacunados en las temporadas 2006–2007, 2007–2008 y 2008–2009. Para detectar RA se contacto con el trabajador una semana despues de la vacunacion. Resultados Se evaluaron 1.893 trabajadores (73,2%). El 30,3% sufrio alguna RA. Ninguna reaccion fue grave. Conclusiones El temor a la gravedad de las RA no parece justificable como motivo de rechazo a la vacuna antigripal.

Introduction and objectives Epistaxis has been known since antiquity. However, we have limited epidemiological data at our disposal. The aim of this study was to know the main epidemiological characteristics of the cases of epistaxis admitted and to determine the factors associated with the recurrence of bleeding. Methods A retrospective study was conducted including admissions for epistaxis in the ENT department of our hospital during the period between January 2003 and December 2008. We analysed the distribution by gender, age, location and time of year. The aetiological causes identified included systemic and local factors. We analyzed the variables related to bleeding recurrence. Results We evaluated 178 cases of epistaxis: 68% of patients were male (121/178), compared to 32% of women (57/178). The median age (p25–p75) was 65 (53–75) years. Epistaxis was most noticeable during the months of January and April. Among the systemic causes, hypertension (56%), anti-platelet treatment (23%), and anti-coagulant therapies (18.5%) predominated. Local factors were much less numerous than general ones (11% vs 68%). Recurrent bleeding was present in 14% of cases (25/178) and only the posterior location was shown to influence this variable (P Conclusions The typical pattern of the patients admitted to our department for epistaxis is a middle-aged or elderly male with underlying co-morbidity and posterior epistaxis.

A disgruntled former subway motorman, a mercenary soldier, an ex-mafia thug, and a fourth criminal decide to hijack a New York subway train and threaten to kill a passenger per minute if they are not given a ransom of a million dollars. Garber, head of the New York City Transit Police, is given the case; he will find out how a simple cold will play a key role in the film’s denouement.

Objetivos Conocer la frecuencia de efectos adversos (EA) en una unidad de cuidados intensivos (UCI), localizar donde se originan, en que medida la asistencia es responsable de su aparicion, valorar sus consecuencias y determinar tanto su evitabilidad como los factores intrinsecos propios del paciente que predisponen a sufrir un EA. Material y metodo Estudio de cohortes prospectivo realizado desde octubre de 2005 a mayo de 2006 en la UCI de adultos del Hospital Universitario de Salamanca. La informacion con la que se rellenaba un cuestionario de informacion general, un cuestionario de cribado y un cuestionario de confirmacion del EA se obtuvo revisando diariamente las historias clinicas de todos los pacientes ingresados en dicha unidad. Se considero EA al dano no intencionado o complicacion, recogida en la historia clinica, que conllevaba incapacidad en el momento del alta, muerte o prolongacion de la duracion del ingreso y que habia sido causado por la asistencia sanitaria. Resultados De los 160 ingresos estudiados 33 fueron causados por 37 EA (el 20,63% de los ingresos); durante el ingreso en UCI se detectaron 72 EA (45 EA por cada 100 ingresos). La infeccion nosocomial fue el EA mas frecuente (el 64,9 y el 47,2%, respectivamente). El 13,5% de los EA causantes de un ingreso en UCI y el 9,7% de los EA detectados durante el ingreso en UCI se consideraron altamente evitables y aumentaron la duracion del ingreso. El origen mas frecuente de ellos estuvo en el quirofano. Los principales factores asociados con la aparicion de EA fueron la obesidad (riesgo relativo [RR] = 6,82; intervalo de confianza [IC] del 95%, 1,3-34,2) y la diabetes mellitus (RR = 5,94; IC del 95%, 2,2- 15,9). Conclusiones La frecuencia de EA detectados en nuestra UCI esta dentro de la observada en otros estudios. El porcentaje de EA evitables es pequeno y refleja oportunidades donde mejorar la asistencia. La UCI puede utilizarse como unidad observatorio de EA porque, ademas de originarlos, recibe los EA causados por otros servicios del hospital.

Trainee students in healthcare settings of Castilla-León have been included as target group for influenza vaccination since 2012-2013 season. Our aim was to determine vaccination coverage against seasonal influenza virus among nursing students and to identify its determining factors after the implementation of such indication.An analytical cross-sectional study was performed during the 2014-2015 school year. It included all enrolled nursing students from a university of Castilla-León. The information (2014-2015 influenza vaccination status, reasons and 10 questions about knowledge of vaccines) was obtained by a self-administered questionnaire. Absolute and relative frequencies were calculated and the associations were evaluated using a Chi-square test and logistic regression.227 students of the 340 (66.8%) completed the questionnaire. 5.3% of them reported having been vaccinated. The main reasons to be vaccinated were: self-protection (75%), protection of family/friends (58.3%) and protection of patients (50%). The main reasons to be unvaccinated were: nobody has offered to vaccinate me (59.2%) and not having risk of influenza or its complications (40.8%). At least 8 knowledge questions were answered correctly by 22.0% of students. Being aware that vaccines components are not dangerous was associated with vaccination (p=0.023).The coverage was low regarding rates in health-care workers. Therefore, it is necessary to develop strategies to promote and raise awareness regarding vaccination in this group. The level of knowledge was improvable. Since the knowledge that the doses of chemical substances in vaccines are not dangerous was associated with vaccination, specific educational programs should be carried out at universities to improve/reinforce the students' knowledge regarding vaccines.

Objective To perform a systematic review to analyze the association between occupational exposure to wood dust and cancer. Methods A systematic literature search of entries made in the MEDLINE-PubMed database between 1957 and 2013 was conducted to identify studies that had assessed the relationship between occupational exposure to wood dust and different types of cancer. A meta-analysis of selected case-control and cohort studies was subsequently performed. Results A total of 114 studies were identified and 70 were selected for review. Of these, 42 studies focused on the relationship between wood dust and nasal cancer (n = 22), lung cancer (n = 11), and other types of cancer (n = 9). Low-to-moderate quality evidence that wood dust acts as a carcinogen was obtained, and a stronger association between wood dust and nasal adenocarcinoma was observed. A lesser association between wood dust exposure and lung cancer was also observed. Several studies suggested that there is a relationship between wood dust and the onset of other cancers, although there was no evidence to establish an association. A meta-analysis that included four case-controls studies showed that workers exposed to wood dust exhibited higher rates of nasal adenocarcinoma than other workers (odds ratio = 10.28; 95% confidence interval: 5.92 and 17.85; P

Vaccination coverage against seasonal influenza virus among healthcare personnel is low. The aim of this study was to know the reasons for which the medical students have intention to be vaccinated against influenza when they become healthcare workers (HCWs), and to identify its determining factors.A cross-sectional study was performed during the 2011-2012 school year. It included all enrolled medical students from a Spanish University. The information (intention to be vaccinated, reasons and 8 questions about knowledge of influenza vaccine) was obtained by a self-administered questionnaire. Absolute and relative frequencies were calculated and the associations were then evaluated using a Chi-square test and logistic regression.654 students of the 1130 (57.9%) completed the questionnaire. 63.0% had intention to be vaccinated. The main reasons to have intention to be vaccinated were: belief that vaccination is convenient (68.2%), to avoid transmitting influenza to patients (65.5%), and to avoid getting influenza from patients (64.8%). The main reasons for not having intention to be vaccinated were: low risk of influenza (41.7%) and to avoid shots/medication (27.7%). Knowledge that the vaccine is recommended for HCWs was associated with the intention (p= 0.000).Intention to get vaccinated was high regarding current coverage; thus, it is needed to investigate why the coverages against influenza among Spanish physicians are usually low. The level of knowledge has left room for improvement and knowing that the vaccine is recommended for HCWs was associated with the intention.

Purpose The objective of this study is to determinate the relationship between the accurate information related to the diagnosis and the information that the patients know about it

Infectious diseases are a major cause of morbidity and mortality in the workplace. Worker vaccination against a number of infectious diseases is considered the most effective strategy of primary prevention to control them.A literature review was performed in Medline and websites of Spanish scientific societies were consulted to detect workers vaccination recommendations. The inclusion criteria was that the recommendation had been made from January 2007 to October 2012.Seventeen papers were selected and websites of the Ministry of Health, Spanish Society of Chemotherapy, Spanish Society of Preventive Medicine, Public Health and Hygiene, and Vaccinology Spanish Association provided relevant information to our review. Groups of workers at increased risk of acquiring infectious diseases during their professional activity were determined, and vaccination recommendations were established (vaccination against tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, pneumococcus, meningococcus, measles, rubella, mumps, chickenpox, influenza, Haemophilus influenzae b, typhoid, polio, tuberculosis and rabies).Epidemiological changes in recent years, with the re-emergence of some diseases such as whooping cough, measles or mumps, force the exposed workers (especially the health care workers) to check their immune status.

To assess the frequency of adverse events (AE) in an intensive care unit (ICU), to detect where they occur, to grade the confidence that an AE is due to medical management and if it is avoidable, to assess their consequences and to determine which patient factors are associated with AE.We performed a prospective cohort study from October 2005 to May 2006 in the adult ICU at Hospital Universitario, Salamanca. Each day a physician reviewed all patients' medical records. The patient general information, AE screening and AE analysis forms were filled out. An AE was defined as an unintentional injury or complication that results in disability at the time of discharge, death or prolonged ICU stay, that is caused by health care management and that is written in the medical record.Of the 160 admissions studied, 33 (20.63%) were identified as having 37 AE as the primary reason for admission to the unit. 72 AE were identified during ICU stay (45 AE each 100 admissions). Nosocomial infection was the main AE (64.9% and 47.2% respectively); 13.5% AE as the primary reason for admission to the unit and 9.7% AE identified during ICU stay were evaluated as strongly avoidable. These AE lead to an increase in ICU stay and were caused mainly in operating theatre. The major patient factors associated with AE were overweight (relative risk [RR]=6.82; 95% confidence interval [CI], 1.3-34.2) and diabetes mellitus (RR=5.94; 95% CI, 2.2-15.9).The frequency of AE in our ICU is within the range reported in the literature. Few AE were evaluated as strongly avoidable; these events indicate opportunities for improvement. ICU can be used as AE observation unit, since as well as causing them, it receives AE caused by other units.