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This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018–2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20–0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018–2020 was 28% (P = 0.0001 for comparison with 2006–2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018–2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.
Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in pediatric intensive care units (PICUs), but its definite diagnosis remains controversial. The CDC Ventilator-Associated Event (VAE) module (validated in adults) constitutes a new approach for VAP surveillance.
Design:
We described epidemiological characteristics of PICU VAE cases, investigated possible risk factors, and evaluated 3 different sets of diagnostic VAE criteria.
Setting:
This study was conducted in a PICU in a tertiary-care general hospital in northern Greece during 2017–2019.
Patients:
The study included patients aged 35 days–16 years who received mechanical ventilation.
Methods:
From medical records, we retrieved epidemiological data, clinical data, and laboratory characteristics as well as ventilator settings for our analysis. We assessed “oxygen deterioration” for the tier 1 CDC VAE module using 3 sets of diagnostic criteria: (1) CDC adult VAE criteria [increase of daily minimum fraction of inspired oxygen (FiO2) ≥ 0.2 or positive end expiratory pressure (PEEP) ≥ 3 cmH2O for 2 days], (2) the US pediatric VAE criteria [increase of FiO2 ≥ 0.25 or mean airway pressure (MAP) ≥ 4 cmH2O for 2 days], and (3) the European pediatric VAE criteria (increase of FiO2 ≥ 0.2 or PEEP ≥ 2 cmH2O for 1 day or increase of FiO2 ≥ 0.15 and PEEP ≥ 1 cm H2O for 1 day).
Results:
Among 326 children admitted to the PICU, 301 received mechanical ventilation. The incidence rate according to the CDC adult VAE criteria was 4.7 per 1,000 ventilator days. For the US pediatric VAE criteria the incidence rate was 6 per 1,000 ventilator days. For the European pediatric VAE criteria the incidence rate was 9.7 per 1,000 ventilator days. These results revealed statistically significant correlation of all 3 algorithms with adverse outcomes, including mortality.
Conclusions:
All VAE algorithms were associated with higher mortality rates. Our findings highlight the need for a unified pediatric VAE definition to improve preventive strategies.
In 2017, a Patient Involvement Interest Group (PIIG) was created in the Spanish Network for Health Technology Assessment of the National Health System (RedETS) to facilitate and promote Patient Involvement (PI) in Health Technology Assessment (HTA). The PIIG proposed a decisional flowchart to guide researchers’ in decisions regarding PI methods in HTA. The flowchart proposed a combination of direct involvement and incorporation of patient-based evidence depending on the scope and the aims of the assessment.
This work aims to present the flowchart and the results of the evaluation of the latest experiences in PI in HTA in RedETS (2018–2020), including direct-involvement and patient-based evidence.
Methods
A survey was sent to the HTA researchers who implemented PI initiatives in RedETS assessments. The survey asked to describe their experiences, lessons learned, challenges and added value regarding the use of direct-involvement, systematic reviews (SR) and primary studies. A descriptive analysis was performed and the results were discussed in an online PIIG workshop.
Results
Thirty-two assessments included direct PI, twenty-one SR synthesized qualitative and quantitative studies about patient experiences, values and preferences and eight included primary studies, mainly of qualitative design. Recruitment and the lack of methodological resources were the main barriers both for direct PI and primary studies. Relevance of the included studies was the main barrier for SR. Added value was found in all PI methods. Direct-involvement had an impact on the project plan and PICO definition, outcomes relevance, information about the health condition and treatments. SR contributed with relevant patient-based evidence, deeper assessment of patient experiences, values and preferences and implementation factors. Primary studies developed new or contextualized knowledge directly applicable to decision-making.
Conclusions
The PI flowchart has served to facilitate the incorporation of patient input in HTA reports. The different approaches implemented have allowed to provide relevant and well-grounded data in each report to inform decision-making in patient-centered healthcare provision, but it is necessary that specific training and resources are provided to enable adequate and timely implementation.
Biofuel crops such as napiergrass possess traits characteristic of invasive plant species, raising concern that biofuels might escape cultivation and invade surrounding agricultural and natural areas. Napiergrass biofuel types are being developed to have reduced invasion risk, but these might be cultivated in areas where naturalized populations of this species are already present. The successful management of napiergrass biofuel plantations will therefore require techniques to monitor for escaped biofuels as distinguished from existing naturalized populations. Here we used 20 microsatellite DNA markers developed for pearl millet to genotype 16 entries of napiergrass, including naturalized populations and accessions selected for biofuel traits. Use of the markers showed a clear genetic separation between the biofuel types and naturalized entries and revealed naturalized populations undergoing genetic isolation by distance. These findings demonstrated the utility of microsatellite marker transfer in the development of an important tool for managing the invasion risk of a potential biofuel crop.
There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities.
Methods:
We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007–2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared.
Results:
The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia.
Conclusions:
The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.
The purpose of this paper is to examine firms’ adoption of corporate social responsibility activities and the efficacy of such activities in specific contexts and industries. This paper analyses the specific context of the Spanish construction and real-estate industry. By using a longitudinal multi-case approach, the study suggests links between market orientation and corporate social responsibility. The research also identifies two profiles of firms. The first group, which is proactive (e.g., market oriented), demonstrate altruistic concerns about consumers and corporate social responsibility; for the second, which is more reactive, their concerns about corporate social responsibility are more opportunistic and aimed at attracting additional customers or responding to competitive pressures.
The Theory of Planned Behavior (TPB) is one of the main theoretical models in the study of the different variables, which influence in the practise of physical activity. The aim in this study was to develop a questionnaire based on TPB in physical activity context providing evidence for the validity of the obtained measures. The instrumental project included three independent studies. The first study entailed the construction and qualitative assessment of the items. In the second study, the analysis of factorial structure was performed by means of exploratory measures, and it showed that the reliability of measures was adequate. The third study provided evidence on the dimensionality of the scale. The confirmatory factorial analysis guaranteed the stability of factorial structure proposed by the TPB and provided evidence for the internal validity of the inventory. Moreover, this study provided evidence of its external validity.
This study first reports concentrations of arsenic (As) and selenium (Se) in fish tissue of Clarias gariepinus from Sagua la Grande River in the Villa Clara Province, Cuba. We also confirm the mercury (Hg) levels in these fish obtained previously. Individuals were captured in three areas near Sagua la Grande City, where this fish is a common source of food for the city inhabitants. Concentrations range of As, Hg and Se (in wet weight) were 0.01–0.11 μg.g−1; 0.03–0.24 μg.g−1 and 0.75–3.87 μg.g−1, respectively. As and Se levels were positively correlated (n=19, ρ=0.673, P<0.05). High levels of Se were found in fish tissue and in 31.6% (n=6) of individuals captured exceeded the threshold value for Se toxicity, which means that Se is likely to produce adverse consequences on the fish themselves or on the wildlife organisms that eat them. As and Se concentrations were positively correlated with fish weight and length (P<0.05). Fish from irrigation canal have higher Se concentrations than fish captured in the other two stations. However, no significant differences were found between Hg and As concentrations in fish at the three sampling stations. Finally, as the Se concentrations in C. gariepinus were abnormally high, we suggest the need for studies about Se sources in the zone, the effect of Se in fish and the intake associated with fish consumption.
Human intervention is the main cause of the decline of the Critically Endangered European mink Mustela lutreola. In this study we analysed the main causes of direct human-caused mortality of the species in Spain. A total of 47 mortality records were obtained for the period 1950–1989, and 145 for 1990–2008. There was temporal variation in the cause of death, with trapping and shooting being the most common causes of mortality in 1950–1989 and road-kills in 1990–2008. In the case of road-kills there was variation related to road type. Males were more affected by road-kills than females, especially during the mating season when they range more widely. Our results indicate that there has been a change in human social behaviour and in people's awareness of the species, with a reduction in European mink captured and shot but an increase in mortality on roads.
To estimate the association strength of dietary behaviour and sedentary habits in relation to childhood obesity in Spain.
Design
A matched case–control study was carried out using data collected by sentinel network paediatricians in general practices.
Setting
Five Spanish autonomous communities.
Subjects
Cases were 437 children (2–14 years old) with BMI >95th percentile according to Spanish reference tables. Controls were 751 children (2–14 years old; two paired per case) with BMI <84th percentile. Data were collected in two phases: individual (questionnaires filled in by sentinel paediatricians) and family (self-administered questionnaires filled in a family environment). Crude OR and adjusted OR (ORc and adj OR) for the given variables were calculated using a simple and multiple conditional logistic regression analysis.
Results
The factors with the greatest effect on obesity were family history of obesity: both parents (adj OR = 11·2), mother but not father (adj OR = 9·1), father but not mother (adj OR = 6·1), siblings (adj OR = 2·7); and eating between meals (adj OR = 2·5) and consumption of sweets and soft drinks >2 times/week (adj OR = 2·0). The highest protection effect was found for five meals per day (adj OR = 0·5), the regular consumption of breakfast (adj OR = 0·5) and for eating fruit for dessert (adj OR = 0·6). Factors related to sedentary habits did not appear as noteworthy.
Conclusions
We have determined the association between certain dietary behaviour and family history with childhood obesity in several Spanish regions.
High postprandial levels of TAG may further induce endothelial dysfunction and inflammation in subjects with high fasting levels of TAG, an effect that seems to be related to oxidative stress. The present study investigated whether minor compounds of olive oil with antioxidant activity decrease postprandial levels of soluble isoforms of intercellular adhesion molecule 1 (sICAM-1) and vascular cell adhesion molecule 1 (sVCAM-1), as surrogate markers of vascular inflammation, after a high-fat meal. A randomized crossover and blind trial on fourteen healthy and fourteen hypertriacylglycerolaemic subjects was performed. The study involved a 1-week adaptation lead-in period on a National Cholesterol Education Program Step I diet supplemented with extra-virgin olive oil (EVOO) containing 1125 mg polyphenols/kg and 350 mg tocopherols/kg, or refined olive oil (ROO) with no polyphenols or tocopherols. After a 12 h fast, the participants ate a high-fat meal enriched in EVOO or ROO (50 g/m2 body surface area), which on average provided 3700 kJ energy with a macronutrient profile of 72 % fat, 22 % carbohydrate and 6 % protein. Blood samples drawn hourly over the following 8 h demonstrated a similar postprandial TAG response for both EVOO and ROO meals. However, in both healthy and hypertriacylglycerolaemic subjects the net incremental area under the curve for sICAM-1 and sVCAM-1 were significantly lower after the EVOO meal. In conclusion, the consumption of EVOO with a high content of minor antioxidant compounds may have postprandial anti-inflammatory protective effects.
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