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Objective: Latin America had only one Spanish-speaking postgraduate academic programme on managing wounds and ostomies until 2021. Since then, two more programmes have been developed; one in Colombia and another in Mexico. Therefore, studying alumni outcomes becomes highly relevant. We aimed to describe the alumni's professional development and academic satisfaction from a Wound, Ostomy and Burn Therapy postgraduate programme in Mexico City, Mexico., Method: An electronic survey was sent to all alumni from January-July 2019 from the School of Nursing of Universidad Panamericana. Employability, academic development and satisfaction following completion of the academic programme were evaluated., Results: From 88 respondents, 77 of whom were nurses, 86 (97.7%) answered that they were working, and 86.4% were working in an area related to the studied programme. Regarding general satisfaction, 88% were totally satisfied/satisfied with the programme and 93.2% would recommend it., Conclusion: Alumni from the Wound, Ostomy and Burn Therapy postgraduate programme are satisfied with the academic curriculum and have good professional development, demonstrated by a high employment rate.

On October 3rd 2018, dengue virus (DENV) infection was confirmed in three family members (symptoms onset between August 18th and 27th) without travel history outside of Spain. They had been together in the Autonomous Communities (AC) of Murcia and Andalusia. By the end of October, a second cluster of two dengue cases (symptoms onset on September 27th and 30th) was confirmed in the AC of Murcia. DENV type 1 sequence was identical to the first cluster, and the epidemiological link was a visit from a case of the first cluster to a fruit-farm neighboring the small village of residence of the second cluster. The entomological investigation found Aedes albopictus activity in this area although all mosquitoes were PCR-negative for DENV. This is the first autochthonous dengue outbreak identified in Spain. This outbreak highlights challenges to timely detect and respond to DENV transmission and opens questions on dengue dynamics in a non-endemic context., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To describe and analyse from a clinical and epidemiological point of view, a food borne outbreak in a psychiatric institution in Granada, in 2015, and to examine whether treatment with psychoactive drugs constitutes a risk factor for the development of a food borne disease, analysing the degree of susceptibility according to the therapeutic group consumed., Method: Ambispective cohort study. Residents were the unit of analysis. Our group carried out an active case search and a food survey. A search for other risks was developed as well as a food inspection. Location, time and individual variables were studied. A descriptive analysis was conducted (absolute and relative frequencies). Calculation of attack rates by building and by menu was made. Bi-variant analysis (Chi-square test, t-Student test) and relative risk were used as a measure of strength of association. For risk analysis of medication, a multivariate analysis using logistic regression was carried out., Results: 18 cases with diarrhoea without fever were found (incubation period from 6 to 16hours). Cases were mild and self-limiting. The clinical manifestations, the temporal grouping of cases and the characteristics of the ingested foods, focussed suspicion on a bacterial toxin. Being equal in the rest of variables, the N03AF, and N03AG therapeutic groups confer greater risk of disease (odds ratio [OR]: 8.626; 95% confidence interval [95%CI]: 2.050-36.308; p=0.003; and OR: 14.516; 95%CI: 3.155-66.784; p=0.001, respectively)., Conclusion: Decreased intestinal transit, caused by the administration of anticonvulsants, may increase exposure time of the intestinal mucosa to the toxin, increasing the risk of disease and suffering from complications. An additional hygienic effort should be made in this type of institution to prevent these pathologies., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Research Question: The purpose of the present study was to investigate whether ten unrelated SRY-negative individuals with this sex differentiation disorder presented a double dose of SOX9 as the cause of their disease., Design: Ten unrelated SRY-negative 46,XX ovotesticular disorder of sexual development (DSD) subjects were molecularly studied. Multiplex-ligation dependent probe amplification (MLPA) and quantitative real-time PCR analysis (qRT-PCR) for SOX9 were performed., Results: The MLPA analysis demonstrated that one patient presented a heterozygous duplication of the entire SOX9 coding region (above 1.3 value of peak ratio), as well as at least a ~ 483 kb upstream duplication. Moreover, no duplication of other SOX9 probes was observed corresponding to the region between -1007 and -1500 kb upstream. A qRT-PCR analysis showed a duplication of at least -581 kb upstream and ~1.63 kb of the coding region that encompasses exon 3. The limits of the duplication were mapped approximately from ~71539762 to 72122741 of Chr17. No molecular abnormalities were found in the remaining nine patients., Conclusion: This study is thought to be the first report regarding a duplication of SOX9 that is associated with the presence of 46,XX ovotesticular DSD, encompassing at least -581 kb upstream, and the almost entire coding region of the gene., (Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: Sexual transmission of hepatitis A (HAV) is documented, mainly by risk behaviors in men who have sex with men (MSM). There have been HAV outbreaks in MSM in countries of the European Union in the last years. The aim of this work was to study HAV epidemiology in Andalusia in the last 10 years (2007-2017) and the outbreaks among MSM in this period., Methods: Retrospective descriptive study of HAV cases reported in the Andalusia Epidemiological Surveillance System between January 2007 and May 2017. We calculated the annual incidence rate per 100000 habitants. We studied case distribution for gender and age. We used the male-female ratio as an indirect marker for MSM., Results: The mean annual incidence rate in the study period was 4.09 cases per 100000 habitants, with a difference by sex: 4.7 per 100000 men and 2.53 per 100000 women. Two large outbreaks were detected in this period: one in 2008-2009 and another in 2016-2017. The epidemiological characteristics of these outbreaks differ from the classical pattern of the disease, affecting young MSM with associated sexual risk behaviors., Conclusions: MSM play a fundamental role in recent outbreaks of HAV. For disease control we must carry out a different strategy, assessing the introduction of systematic vaccination.

Background: In 2009 a system was introduced for the automatic import (AI) of cases with suspected notifiable diseases (ND) from electronic medical record (EMR) to RedAlerta, an application for surveillance in Andalusia. At present, the contribution of this system to classical active statement has not been determined enough. The main objective of this study is to evaluate the usefulness of IA in the province of Granada, between 2009 and 2014., Methods: During the study period (2009-2014), an epidemiologist assessed whether AI met declaration criteria or not. We calculate the contribution of AI to RedAlerta and the percentage of validation of AI, estimating 95% CI., Results: The contribution of AI was 17.3% (95% CI 16.1 to 18.5); and type of statement, 5.2% (95% CI 4.1 to 6.5) for urgent and 24.4% (95% CI 22.7 to 26.2) for ordinary. The contribution was higher (more than 45%) in Lyme disease, congenital hypothyroidism, genital herpes, hepatitis C and other viral hepatitis. 30% (95% CI 28.1 to 32) of AI were validated; 39.9% (95% CI 33 to 47.2) urgent and 29.1% (95% CI 27.2 to 31.2%) ordinary. The percentage of validation was higher than 45% (between 47.5 and 100%) in vaccine-preventable diseases, sexually transmitted infections and low incidence., Conclusions: Although not replace manual reporting and requires verification, the AI system is useful and increases the completeness of the epidemiological surveillance system.

Background and Purpose: Hypoxia inducible factor-1 (HIF-1) promotes transitory neuronal survival suggesting that additional mechanisms such as the endoplasmic reticulum (ER) stress might be involved in determining neuronal survival or death. Here, we examined the involvement of ER stress in hypoxia-induced neuronal death and analysed the relationship between ER stress and the HIF-1 pathways., Experimental Approach: Cultures of rat cortical neurons were exposed to chemical hypoxia induced by 200 μM CoCl2 , and its effect on neuronal viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and counting apoptotic nuclei. Protein levels were determined by Western blot analysis. RT-PCR was performed to analyse the content and the t1/2 of HIF-1α mRNA., Key Results: Chemical hypoxia induced neuronal apoptosis in a time-dependent manner and activated the ER stress PRK-like endoplasmic reticulum kinase (PERK)-dependent pathway. At later stages, chemical hypoxia increased the expression of the C/EBP homologous protein (CHOP) and caspase 12 activity. CoCl2 reduced HIF-1α mRNA t1/2 leading to a decrease in HIF-1α mRNA and protein content, simultaneously activating the ER stress PERK-dependent pathway. Salubrinal, a selective inhibitor of phospho-eIF2α phosphatase, protected neurons from chemical hypoxia by reducing CHOP levels and caspase 12 activity, and increasing the t1/2 of HIF-1α mRNA and the levels of HIF-1α protein. Knocking down HIF-1α blocked the neuroprotective effects of salubrinal., Conclusions and Implications: Neuronal apoptosis induced by chemical hypoxia is a process regulated by HIF-1α stabilization early on and by ER stress activation at later stages. Our data also suggested that HIF-1α levels were regulated by ER stress., (© 2015 The British Pharmacological Society.)

Background: It has been identified differences of medical care practice in primary care related to physician's sex. Simultaneously, there are gender inequalities in the assignment of health resources. Both aspects give rise to an increasing growing interest in the management and provision of health services., Objectives: To examine the differences in the referral practice made by female and male primary care physicians working in health centers in Andalusia, to consider whether there are disparities in referrals received by men and women, and to examine the interaction between patient's sex and physician's sex., Methods: Observational, cross-sectional, and multicenter study., Population: 4 health districts in Andalucía and their physicians., Sample: 382 physicians., Measurements: referral rate per visit (RV), referral rate per patient quota (RQ), patient's sex, physician: sex, age, postgraduate family medicine specialty, size of the patient quota by sex, mean number of patients/day by sex, mean age of the patient quota by sex, and proportion of men in the quota. Health center: urban / rural, size of the team, enrolled population, and postgraduate family medicine specialty's accreditation., Sources: databases of health districts., Period of Study: 2010., Analysis: Bivariate and multivariate multilevel analysis of the referral rate per visit with mixed Poisson model., Results: In 2010 382 physicians made 129,161 referrals to specialized care. The RQ was 23.47 and the RV was 4.92. The RQ in women and men was 27.23 and 19.78 for women physicians, being 27.37 and 19.51 for male physicians. The RV in women and men was 4.92 and 5.48 for women physicians, being 4.54 and 4.93 for male physicians., Conclusion: There are no differences in referral according to physician's sex. However, there are signs that might indicate the existence of gender inequality, and women patient received less referrals. There are no physician-patient's sex interaction.

Many studies have focused on expanding our knowledge of the structure and diversity of peripheral and central nicotinic receptors. Nicotinic acetylcholine receptors (nAChRs) are members of the Cys-loop superfamily of pentameric ligand-gated ion channels, which include GABA (A and C), serotonin, and glycine receptors. Currently, 9 alpha (α2-α10) and 3 beta (β2-β4) subunits have been identified in the central nervous system (CNS), and these subunits assemble to form a variety of functional nAChRs. The pentameric combination of several alpha and beta subunits leads to a great number of nicotinic receptors that vary in their properties, including their sensitivity to nicotine, permeability to calcium and propensity to desensitize. In the CNS, nAChRs play crucial roles in modulating presynaptic, postsynaptic, and extrasynaptic signaling, and have been found to be involved in a complex range of CNS disorders including Alzheimer's disease (AD), Parkinson's disease (PD), schizophrenia, Tourette´s syndrome, anxiety, depression and epilepsy. Therefore, there is growing interest in the development of drugs that modulate nAChR functions with optimal benefits and minimal adverse effects. The present review describes the main characteristics of nAChRs in the CNS and focuses on the various compounds that have been tested and are currently in phase I and phase II trials for the treatment of neurodegenerative diseases including PD, AD and age-associated memory and mild cognitive impairment.

Hypoxia-inducible factor 1α (HIF-1α) is a transcription factor that plays a key role in regulating the adaptive response to hypoxia. HIF-1α is stabilised during hypoxia and, after dimerisation with hypoxia-inducible factor 1β (HIF-1β), triggers the expression of various genes involved in cell cycle control and energy metabolism associated with cell survival. However, HIF-1α also regulates the expression of proapoptotic genes. The aim of this study was to ascertain the influence of HIF-1α on neurotoxicity evoked by hypoxia in rat cortical neurons. We found that mild hypoxia induces time-dependent neuronal death involving free radical production, mitochondrial depolarisation, cytochrome c release and caspase-3 activation. Lentivirus-mediated HIF-1α knockdown markedly strengthened all of these effects during the initial 24h of hypoxia, which suggests that HIF-1α plays a neuroprotective role in hypoxia-mediated neuronal death. After this initial period, the protective actions of HIF-1α disappeared over the course of the hypoxia-mediated HIF-1α stabilisation. Moreover, lentiviral-mediated overexpression of HIF-1α increased lactate dehydrogenase (LDH) A, one of the target genes for HIF-1α, but did not show protective actions on hypoxia-mediated neuronal death, indicating that the level of endogenous HIF-1α stabilisation achieved during hypoxia was already the maximum required for HIF-1α transcription activities. These results indicate that HIF-1α is neuroprotective in the early phases of hypoxia., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In September and October 2010, 13 primary measles cases were identified among unvaccinated persons aged between 9 and 32 years (median: 16.5) in 11 districts in Germany. All cases had attended meetings in Taizé, France. This outbreak illustrates the risk of long distance spread of infectious diseases associated with international mass gatherings, and underlines the importance of closing immunisation gaps against measles by vaccinating non-immune adolescents and young adults.

Purpose: To study the effect of a non-viral vector (carbosilane dendrimer) to efficiently deliver small interfering RNA to postmitotic neurons to study the function of hypoxia-inducible factor-1alpha (HIF1-alpha) during chemical hypoxia-mediated neurotoxicity., Methods: Chemical hypoxia was induced in primary rat cortical neurons by exposure to CoCl(2). HIF1-alpha levels were determined by Western Blot and toxicity was evaluated by both MTT and LDH assays. Neurons were incubated with dendriplexes containing anti-HIF1-alpha siRNA and both uptake and HIF1-alpha knockdown efficiency were evaluated., Results: We report that a non-viral vector (carbosilane dendrimer) can deliver specific siRNA to neurons and selectively block HIF1-alpha synthesis with similar efficiency to that achieved by viral vectors. Using this method, we have found that this transcription factor plays a neuroprotective role during the early phase of chemical hypoxia-mediated neurotoxicity., Conclusion: This work represents a proof-of-concept for the use of carbosilane dendrimers to deliver specific siRNA to postmitotic neurons to block selected protein synthesis. This indicates that this type of vector is a good alternative to viral vectors to achieve very high transfection levels in neurons. This also suggests that carbosilane dendrimers might be very useful for gene therapy.

Background: Psittacosis can be transmitted to humans from infected birds, being the cause of atypical pneumonia. This work is aimed at determining the source of a psittacosis outbreak, the characteristics of the subjects exposed and describing the measures to control the outbreak., Methods: Descriptive study. Notification to the Epidemiological Monitoring System and Autonomic Agriculture authorities, taking the pertinent measures (inspection, sampling, disinfecting and precautionary quarantine of birds), closing the establishment. Case definition and epidemiological survey. Frequency analysis., Results: Seventeen (17) individuals (one of whom died) came into contact with suspicious animals (53% males/47% females), nine of whom (mean age: 30) showed symptoms (100% fever, flu-like symptoms 44.4%). A serology was performed for C. psitacci on 11 of the 17 subjects exposed (68.75%), two of whom (18.18%) tested positive. The presence of C. psittaci DNA was detected in the pulmonary tissue study conducted on the deceased individual. A total of 33% (3/9) of those showing symptoms were confirmed by diagnosis. The Autonomic Agriculture authorities placed 22 animal compounds under quarantine. A total of seven (10%) of the 70 samples taken (60: animal cloacas and 10 birds) revealed a positive antigen, the PCR nucleic acid test being positive in one there-of., Conclusions: The exposure to diseased animals at the establishments involved caused the outbreak, the common source of contagion being of an occupational nature. The appropriate coordination/collaboration between the local Health and Agriculture authorities made it possible to prevent any further cases from arising.

Background and Objectives: The management of biosanitary (hospital) waste, while being a key issue in the prevention of public health risks, involves professional risks as well. The objective of this study was to analyze the risks of infection and their relation with the various works within a cluster of brucellosis detected in an infectious waste plant., Subjects and Method: Cross-descriptive study of the total of 24 employees at the waste plant. A survey was carried out taking into account personal as well as professional items and serological tests. Both bivariant (contingency charts and mean comparison) and multivariant (logistic regression) analyses were carried out., Results: The seroprevalence of brucella infection was 45.93% (CI95%, 26.17-66.76). The estimated risk (OR) for processing workers was 33.72 (CI95%, 2.73-415.96). The permanence within the posts was not different among groups., Conclusions: Infection seroprevalence was higher than that found in endemic populations. The post of processing was found to hold a relation with the contact with Brucella sp.

Background: The magnitude of the epidemic depends upon the scope of the contaminated product distributed. In the spring of 2000, an episode caused by the sale of sausage products which had not undergone health inspection. The purpose of this study is to provide an epidemiological description of the outbreak caused by Trichinella britovi., Methods: Descriptive study of the control measures and those affected. The food products contaminated with this parasite was investigated by means of an epidemiological survey., Results: Thirty-eight (38) cases were reported throughout weeks 18-22 of the epidemic. The symptoms most often reported were fever, myalgia and palpebral edema. Eighty-seven percent (87%) of those affected tested positive for eosinophilia. Forty percent (40%) required hospitalization. Late diagnosis was curtailed once the alert had been broadcast. T. Britovi was found in the sausage product., Conclusions: Trichinellosis epidemics can occur despite the current inspection and control systems, placing food safety at risk. Broadcasting a health alert curtails late diagnosis. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs in industries and establishments. A well-tuned, fast-reacting epidemiological monitoring system must be kept in place.

Objective: Description of an outbreak of mumps in an urban area. Study of the effectiveness of the mumps component of the triple virus (TV) vaccination., Design: Cross sectional descriptive study of the outbreak. The cases were obtained from the Andalusian Register of Infectious Diseases (SVEA in Spanish). The effectiveness of the vaccine was studied through a retrospective cohort design, with the cohorts defined according to their vaccination history., Setting: Urban area of low social class and income and young population pyramid. The outbreak occurred between March and November 1997. The effectiveness of vaccination at one school was studied. PATIENTS AND OTHER PARTICIPANTS, RESIDENTS IN THE AREA: The source of the population was the 1996 municipal census., Interventions: The declared cases of mumps were taken from the SVEA. The state of vaccination was documented through a review of the school registration records, vaccination cards and the health centre register of names., Measurements and Main Results: A total of 283 cases of mumps were declared. There were more cases in the 0-10 age group than at older ages. 79% of cases were vaccinated (95% CI, 74.3-73.7). Effectiveness of a dose of the mumps component of the vaccine was low (46%; CI, 0-84), though the effectiveness of a second dose was higher (87%; CI, 27-99)., Conclusions: The low effectiveness of the mumps component of the TV vaccination was confirmed. It is proposed that the age for the second dose should be brought forward to school-starting age (primary, first year). Ensuring school vaccination is recommended.

Background: Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis., Methods: One hundred fourteen patients on chronic hemodialysis were investigated for the presence of several cutaneous aging markers in a cross-sectional study, using multivariate analysis to minimize the confounding effect of age., Results: Skin cancer was diagnosed in 3 patients (2.6%), actinic keratoses in 12 (10.5%), senile lentigo in 22 (20%), senile purpura in 15 (13%), and Favre-Racouchot disease in 6 (5%). There was no association with skin types or facial wrinkles with any other of the skin-aging features studied. Multivariate analysis, controlling for age as a confounding variable, indicated that the degree of facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis (P = 0.012 and P = 0.012, respectively). Favre-Racouchot disease (Odds Ratio [OR] = 1.23, P = 0.055, 95% confidence interval [CI] 0.99-1.52) and actinic keratoses (OR = 1.15, P = 0.076, CI 0.98-1.34) became increasingly frequent with the duration of chronic hemodialysis., Conclusions: These data show a high prevalence of cutaneous aging lesions in patients on chronic hemodialysis. Acceleration of cutaneous aging is associated with time on hemodialysis.

Facial wrinkling is a marker of skin ageing. The association between smoking and facial wrinkling has been previously studied. Nevertheless, there are no reports assessing the role of sun exposure and smoking in an area with a great proportion of sunny days. Smoking habits were investigated in 282 healthy individuals. Facial wrinkles were measured according to the Daniell scale at the external canthus. A logistic regression model was developed controlling for age, sex, sun exposure, smoking habit and searching for the interaction between sun exposure and smoking. A statistically significant risk was found for smoking habit (OR = 3.1; 95% CL 1.28-7.76; p = 0.008), sun exposure (OR = 1.50; 95% Cl 1.25-1.80; p = 0.05), and age (OR = 1.18; 95% Cl 1.13-1.23; p = 0.024) for facial wrinkling. These results show the evidence of an accelerated skin ageing in smokers. A clear explanation given to smokers could be a useful strategy to persuade them to leave smoking.

Objective: To evaluate the effectiveness of anti-flu vaccination on elderly people not in institutions, by measuring its effect on the reduction of deaths and hospital admissions due to Cardio-respiratory failure., Design: A retrospective cohort., Setting: La Chana Health Centre, Granada., Patients and Other Participants: 1,965 elderly people who were seen at the Health Centre over the previous three years., Measurements and Main Results: 779 elderly people (39.6%) were vaccinated. 35 were admitted to hospital with Cardio-respiratory failure and 59 died. Of these two groups, 13 and 23 respectively had been given the anti-flu vaccination that year. After checking for variables which could lead to confusion, the vaccine was shown to be effective both in reducing admissions (advantage ratio 1,330) and deaths (advantage ratio 1,221)., Conclusions: Given the effectiveness of anti-flu vaccinations, active efforts to encourage non-institutionalised elderly people to be vaccinated should be increased.

Objective: We aimed to discover how thyroid function tests (TFTs) were used in general practice (GP) consultations. We would evaluate how many TFTs were requested, their efficiency, cost and their impact on referrals to endocrinology., Design: This was a longitudinal, retrospective and observational study. SITE. At the Primary Care level, in the La Chana Health Centre, Granada., Patients: 69 patients with possible Thyroid Disease, and who had a TFT performed by their GP, were surveyed. The test comprised parallel TSH, free T4 and free T3., Main Measurements and Results: 2.46 TFTs per GP per year were requested. 14 showed positive (20.28%) and a definite diagnosis of Thyroid Function Disease (TFD) was made in 11 cases (15.94%). The cost per test was 1,718 pesetas; and per diagnosis, 8,467 pesetas. 78.26% of the cases were resolved by the GP without need of referral., Conclusions: The GPs carried out few FTFs; but those they did were very efficient. Cost was low and patients benefited from the fact that their GPs were able to use this technique. Endocrinology referrals were reasonable. All general practitioners should have use of TFTs.