[Overcoming the barriers in the approach of the chronic patient]. / Superando las barreras en el abordaje del paciente crónico.

At least one in three adults has multiple chronic conditions. The assistance of patients with chronic conditions is mandatory. This is one of the main tasks of the primary care physicians. The approach in these patients is challenging, as there are many barriers at different levels (sanitary system, healthcare professionals and patients). In addition, COVID-19 pandemic has worsened this situation even more. Therefore, it is necessary to take actions that try to improve this state. For this purpose, with the aim to find solutions/recommendations that may be helpful to attain a better diagnosis, treatment and follow-up of patients with chronic diseases, a group of experts of SEMERGEN have tried to identify the problems in the attention to these patients, searching for potential solutions and areas of improvement. The present document has specifically focused on four prevalent chronic conditions in primary care: dyslipidemia, arterial hypertension, chronic venous disease and depression.

Miedos e inquietudes ante la pandemia en España: un análisis exploratorio de las desigualdades sociales Fears and uncertainty about the pandemic in Spain: an exploratory analysis of social inequalities

The Covid-19 crisis impacted Spanish society, modifying its habits and customs. Society shows concerns that evolve into fear and uncertainty of what will happen in the future in different aspects. The main objective of this study is to delve into those fears and evaluate the social inequalities revealed by how those fears are perceived. We analysed the "Efectos y consecuencias del coronavirus” survey from CIS at three different moments: October 2020, September 2021, and December 2021. The results show a higher prevalence of social fears compared to economic ones. However, the perceived economic concerns reveal the main differences in educational level, age, and place of birth. In addition, women express concern the most. It is necessary to wait to see how the crisis unfolds to assess how these fears evolve. © 2023 Federacion Espanola de Sociologia. All rights reserved.

Risk Perception Management Related to COVID-19: A Study of Scenario Planning in Cuba

The COVID-19 pandemic is the most disastrous health event of the twenty-first century with significant impacts on the economy, institutions, organizations and people's well-being and lifestyle. Risk perception is a knowledge process that manifests itself in risk behavior and reflects people's experiences, beliefs and social influences. The management of risk perception is essential in contributing to people's protective behaviors in the presence of health risks. In Cuba, one of its significant effects is reflected in the psychology of individuals, despite policies to mitigate its consequences. Minimizing COVID-19 transmission requires the application of effective policies that contribute with adequate perceptions, depending on the risk factors. The goal of this research is to develop a system of actions that can contribute to the transition of a favorable scenario for the management of risk perception regarding COVID-19 in Cuba according to the new normality and through the use of a scenario planning methodology. The findings allow characterizing the current scenario and proposing actions and indicators in order to achieve the most favorable scenario for risk perception management related to COVID-19 from a geographic perspective. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Sars-CoV-2 in critical immunocompromised patients. Evolution and prognosis

Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.

Challenges and Results of Haploidentical Stem Cell Transplantation for Adult Patients in Cuba

The Hermanos Ameijeiras Hospital (HAH) in Havana is the only center performing allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients in Cuba. Because transplants from unrelated donors are not possible due to political restrictions and economic embargo, in 2016 HAH and University of Illinois at Chicago (UIC) started a collaboration to support the training of a physician, annual educational programs and exchange of guidelines and protocols to perform haploidentical transplants. The first haploidentical transplant was performed at HAH in 2016. Because of limited resources, disease risk stratification is based on morphologic assessment, as cytogenetic is tested on an irregular basis. Peripheral blood stem cells (PBSC) were infused based on total nucleated cell count (TNC) due to lack of reagents for flow cytometry. Posttransplant chimerism and CMV monitoring cannot be performed. Transplant activity was stopped in 2020 due to high expenses allocated for COVID19 pandemic in Cuba. From 2016 to 2020, 16 haploidentical HSCT in 15 patients (9 males/ 6 females) were completed at HAH. The median age of patients was 34 years (range:21-54). Diagnoses included: acute leukemia, n=12, myelodysplastic syndrome, n=1, Hodgkin disease, n=1, and severe aplastic anemia, n=1. At the time of transplant, 11 patients were in morphologic remission and 5 had active disease. Conditioning regimens utilized were myeloablative (Flu/Bu) in 10 cases and at reduced intensity (Flu/Cy/ TBI200 +/- ATG) in 6 cases, and GVHD prophylaxis was standard PTCy on D3 and 4, CsA and mycophenolate. The donors were mother (n=10), father (n=1), child (1), or sibling (n=3) and the median age was 48 years (range: 26-68). All patients received fresh stem cells from PBSC(n=13) or bone marrow (n=3). Median cell dose infused was 5.5x108 TNC/kg (range: 2.2-8). All patients but 1 engrafted and median time to neutrophil and platelet engraftment was 17 days (range:12-28) and 16 days (range:11-30), respectively. Acute graft-versus-host disease (GVHD) grade 2-3 occurred in 50% of patients and chronic GVHD in 2 out of 8 that were evaluable. Day 100 and 2-year overall survival rates were 73% and 40%, respectively. With a medium follow-up of 18.8 months (range: 0.3-64), 5 of 15 patients (30%) are alive and complete remission. Causes of death in the remaining 10 patients included relapse of original disease, n= 4;bacterial infection, n=2;brain hemorrhage, n=1;VOD, n=1;graft failure, n=1;and multi-organ failure, n=1. Despite significant difficulties, HAH implemented a haploidentical transplant program for adult patients in Cuba. Among future steps, improving access to molecular testing and using younger donors will be pursued to improve on the results. The partnership between HAH and UIC has been instrumental in building clinical and research capacity and continues to support HAH in its mission to provide care to patients in Cuba.(Figure Presented)Copyright © 2023 American Society for Transplantation and Cellular Therapy

Tourist activity importance in Mexico: an assesment of the economic eecovery prospective effects during the post-pandemic

The purpose of this paper is to build a multisectoral impacts framework derived from de economic contraction faced by tourism in the Covid-19 pandemic context. For this, is used an Input-Output Model updated with the 2019 economic census values complemented with the Mexico ' s National Accounts data. The objective is reaching a characterization before and after the closure of tourist activities. The results obtained through hypothetical extraction techniques, in impact simulation, show the gross value product contraction magnitude by subsector, also they allow to get a measure in order to reach a faster economic recovery along all the activities linked to tourism.

Digital natives and immigrants in the context of COVID-19: the contradictions of a diversity of myths

In the context of COVID-19 different changes and tensions have occurred in the Education System as a result of several factors. The rapid and strong transition towards a distance learning system mainly based on technology has brought to the surface weaknesses in the Education System derived from teacher training, the lack of technology, the lack of educational resources to be used in virtual distance learning and the lack of credibility regarding the effectiveness of this training modality. This article highlights the lack of differences in technological proficiency between so-called digital”natives” and”immigrants”, between students and teachers. In general, it is problematic to assume that students are digitally competent, while teachers have not developed such proficiency. This has led to negative consequences that, in turn, caused educational institutions to neglect the training of students in digital competencies. Mere exposure to technology should not be confused with having a high capacity to use it. It concludes by defending the term digital learners, rather than digital natives. Thus, it is argued that digital literacy is not only about handling technological tools, but also thinking and problem-solving in a digital society. © 2023 Universidade Federal de Minas Gerais. All rights reserved.

Bibliometric analysis of the 100 most cited articles published in Spanish in Latin America and the Caribbean on COVID-19

The aim of the study was to identify the 100 most cited articles on COVID-19 from Latin America and the Caribbean, published in Spanish. The records were obtained from the Web of Science. The following were examined: number of citations, authorship, geographic coverage, collaboration, journal and thematic categories. The 100 articles were published in 41 journals. The most cited journal was Salud Pública de México (10 articles;75 citations). Mexico was the top performer (28 articles;201 citations). The most cited authors were: C. Alpuche-Aranda and E. Lazcano-Ponce, affiliated with the most cited institution, the National Institute of Public Health of Mexico (n = 7). The main Web of Science category was Medicine, General & Internal (36 articles;173 citations). Epidemiology was the most worked topic. There was no correlation between international collaboration and the highest number of citations (r = 0.15, p = 0.1). The study may help to recognize the visibility of the most cited research. © 2023, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Depression, Anxiety, and Stress Scale: Factor validation during the first COVID-19 lockdown in Mexico

Introduction: Globally, mental health problems have affected nearly 1 billion people and approximately 1 in 10 Mexicans. The detection and surveillance of depression, anxiety, and stress in Mexico requires more reliable and valid instruments. Objective: To determine the factor validity and internal consistency of the Depression, Anxiety, and Stress Scale-21 items (DASS-21) in a non-probabilistic national sample of Mexican adults. Method: Cross-sectional study by means of an online survey of 1 613 Mexican adults aged 18 years and older. The Spanish version of the DASS-21 was used, which evaluates the presence of depressive symptoms, anxiety, and stress. Factor validity was determined by comparing different confirmatory factor analysis models: one-dimensional, three factors (correlated and non-correlated), second or-der, and bifactor. Results: The application of the bifactor model to the DASS 21, supports its validity for identifying the presence of symptoms of depression, anxiety, and stress, as well as an altered general emotional state in a sample of Mexican adults. Conclusions: The DASS-21 is a theoretically robust instrument useful for research and clinical practice. © 2023 Fundación Universitaria Konrad Lorenz.

Association between HLA and SARSCOV- 2 infection in Mexican Mestizos

The Acute Respiratory Syndrome caused by the new coronavirus described in Wuhan, China in 2019 is a viral, respiratory multifactorial infectious disease, which presents different stages depending on genetic and environmental factors that influence severity. As December 19, 2022, 653,192,573 COVID-19 cases worldwide and over six million deaths;330,795 occurred in Mexico, were reported. Our aim was to analyze the contribution of HLA in Mexican patients infected with COVID-19, categorized in different clinical subgroups. A total of 114 COVID-19 patients and 164 healthy controls, all of them Mexican Mestizos from the highlands, were included in the study;RNA columns were used for extraction, and real-time PCR method was performed for the virus identification. DNA was isolated with the Maxwell16 system and 11 HLA loci were typed using NGS (CareDx, Immucor, and One Lambda). The subjects included: 22 asymptomatic, 86 symptomatic and 109 who were previously vaccinated. We compared controls versus positive patients;versus symptomatic;vaccinated negative versus vaccinated positive;controls versus asymptomatic;asymptomatic versus symptomatic individuals. The significant high risk alleles were A*29:02 (OR = 3.95), B*45:01 (OR = 6.92), C*03:04 (OR = 2.24). DPB1*03:01(OR = 3.17) is a susceptibility marker in vaccinated and unvaccinated patients. The latter is prevalent in Hispanics, Russia, Finland, Spain and the United Kingdom. DQA1*02:01 (p = 0.009, OR = 1.96;DQB1*02:02 (p = 0.009, OR = 2.13) was a susceptibility marker in infected patients who were vaccinated. This is prevalent in Argentina, Brazil, Algeria, Australia, Canada, and China, while high-risk B*45:01 and C*03:04 are prevalent in India, Israel, Eastern Europe, and Mediterranean countries. Protective alleles where DRB1*04:01, A*02:01, DQB1*03:01 and DPB1*02:01. These data are relevant to prioritize vaccination, according to the HLA profile in Mexicans, therefore these data are relevant for the epidemiology of COVID-19.

Mobile banking service quality and consumer loyalty

The Covid-19 pandemic forced people and entities to adopt measures to protect themselves from contagion by resorting to the use of digital media, as was the case in banking. The purpose of this research was to determine the relationship between the quality of mobile banking service and consumer loyalty in Peru. The methodology was mixed approach. In the quantitative aspect, with a sample of 383 users of banking entities in Comas, Lima, a survey was applied, with a reliability of the instrument of 0.912. In the qualitative aspect, seven experts were interviewed whose opinions were contrasted with the theoretical information developed. The results of the survey indicated that there is a correlation with a preferred position with a tendency to be strong among the study variables (Spearman's Rho of 0.796). Likewise, the experts indicated that mobile banking has managed to retain the majority of users due to the speed and security of the service. In conclusion, it was evidenced that there is a preferential relationship with a tendency to be strong between the variables under study, based on a relative trust and security of the user, making it necessary to offer quality services using various communication mechanisms. © 2023, Universidad del Zulia. All rights reserved.

Drug-drug interactions with nirmatrelvir/ritonavir for COVID-19 and the role of hospital pharmacists

4CPS-043 Table 1DDI category, n(%) C: monitor therapy D: consider therapy modification X: avoid concomitant use 24(46.2) 16(30.8) 12(23.1) ATC of DDI, n (%) N-nervous system C-cardiovascular system B-blood and blood forming organs G-genito urinary system H-systemic hormonal preparations L-antineoplastic and immunomodulating agents A-alimentary tract and metabolism M-musculo-skeletal system R-respiratory system 21(40.4) 13(25) 5(9.6) 4(7.7) 3(5.8) 2(3.8) 2(3.8) 1(1.9) 1(1.9) Medical department with DDI, n(%) Haematology Oncology Nephrology Pneumology Emergency room 6(23.1) 4(15.4) 3(11.5) 3(11.5) 3(11.5) Pharmacy intervention on concomitant drugs, n(%) Discontinuation Adverse events monitoring Dose reduction Substitution Efficacy monitoring 23(44.2) 15(28.8) 7(13.5) 5(9.6) 2(3.8) Statistical significant differences were found with ATC and DDI category (p<0.001): cardiovascular system drugs had more X-category DDI (41.7%) and nervous system drugs had more C-category DDI (60.8%).Haematology department had more patients presenting any DDI (23.1%, p=0.047).No DDI provoked any adverse event during treatment with nirmatrelvir/ritonavir.Conclusion and RelevanceA high risk for DDI with nirmatrelvir/ritonavir was found, although most of them were mild and none provoked any adverse event. Cardiovascular system drugs showed the most severe DDI.Haematology patients and those receiving nervous system drugs had higher prevalence for DDI.Almost half of pharmacy recommendations were to discontinue the drug presenting the DDI. None of the pharmaceutical interventions induced any adverse event derived from the modification of concomitant treatment during nirmatrelvir/ritonavir administration.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Impact of combined non-invasive support strategies use during acute respiratory failure due to COVID-19

Objectives: To evaluate the impact of combined non-invasive support strategies in critically ill COVID-19 patients [high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or both]. Method(s): Prospective observational multicenter study in 73 Spanish ICU with data obtained from the SEMICYUC registry. All confirmed COVID-19 patients admitted due to respiratory failure were included. They were classified according to the ventilatory strategy used on admission and subsequently according to success, failure, or strategy change. Demographic data, comorbidities, severity at admission, respiratory, biomarkers, failure, length of stay and mortality were evaluated. Result(s): We analyzed 3,889 patients, 33% receiving HFNC, and 11% NIV at ICU admission. NIV group compared to HFNC were more severely ill with more shock on admission. When NIV was received as a first-choice higher failure rates and mortality were shown vs HFNC (68% vs 61%, p=0.016 and 27% vs 20%, p=0.003). Among patients who initially received HFNC, 57% failed and 7.4% switched to NIV, with no change in mortality. Among patients who were switched to NIV, 66% failed presenting a higher mortality trend than the intubated patients after the HFNC starting (40% vs 30%, p=0.098). Among patients who initially received NIV, 60% failed and 20% switched to HFNC. Patients in whom NIV was switched to HFNC, had lower mortality than patients who initially failed (18% vs 40%, p<0.001). Among patients who were switched to HFNC, 43% failed, presenting the same mortality as the intubated patients after the NIV starting (38% vs 38%, p=0.934). Conclusion(s): Patients receiving NIV at admission have worse outcomes than those receiving HFNC. Changing the strategy in patients who received HFNC as a first choice without success can worsen the prognosis.

Autoimmune manifestations associated with coronavirus disease 2019.

Introduction: Coronavirus disease 2019 (COVID-19), caused by a new coronavirus. Severe acute respiratory syndrome coronavirus 2 is having a devastating impact throughout the world. Its pathophysiology is the result of direct cytopathic effects of SARS-CoV-2 on respiratory epithelium, endothelium, other organ-specific cell types and the subsequent induction of a pro-inflammatory cytokine storm and dysregulated adaptive immunity, causing severe tissue damage. Objective(s): To describe autoimmune characteristics present during SARS-Cov-2 infection. Method(s): A literature review on COVID-19 and autoimmune manifestations was carried out. The articles were selected from a search of the following websites: Pubmed, Medline, SciELO. An analysis and summary of the reviewed information was made. Analysis and synthesis of information: Viruses have been considered the main infectious agents that trigger autoimmune phenomena in genetically susceptible individuals. SARS-CoV-2 has already been linked to a long list of autoinflammatory and autoimmune conditions that can be induced by various mechanisms proposed to explain virus-induced autoimmunity. In this pathology, the most described, is molecular mimicry. COVID-19 shares similarities with autoimmune diseases in its clinical manifestations, pathophysiological mechanisms and therapeutic response, such powerful immune reactions participate in the pathogenesis of both entities. Conclusion(s): SARS-CoV-2 infection may represent the complex and interrelated link between infections and autoimmunity.Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

What to do in front of the risk of a "lost generation”? Youth and employment in an era of uncertainty

The difficult socioeconomic scenario that is predicted in the wake of the health crisis is already a reality for young people. In this context, the aim of the study is to analyse the dimensions that determine the youth employability in order to identify the pillars of action that, with a political, socio-labour and educational character, should contribute to improve their professional and personal development. For that purpose, qualitative methodology has been followed, focusing on the review of reports, strategies and scientific research on youth employment from the Great Recession to the COVID-19 crisis (2008-2022). Three axes of intervention have been differentiated: (1) protection and promotion of employment, (2) improvement of employability and (3) transversal measures. The results point the need to make progress from public policies in the second and areas, since they make possible the promotion of effective labour transitions. © 2023 Servicio de Publicaciones de la Universidad de Navarra. All rights reserved.

The economic performance of the EU fishing fleet during the COVID-19 pandemic

The COVID-19 outbreak and subsequent public health interventions have depressed demand and disrupted supply chains for many fishing businesses. This paper provides an analysis of the COVID-19 impacts on the profitability of the EU fishing fleets. Nowcasting techniques were used to estimate the impact of the COVID-19 pandemic on the economic performance for the EU fishing fleet in 2020 and 2021. Our results show that the economic impact of COVID-19 on this sector was smaller than initially expected and overall profits remained positive. This was in part due to low fuel prices that reduced operating costs of fishing, and the early response from governments to support the sector. The results vary by fishing fleet, revealing that small-scale fleets and the fleets in the Mediterranean and Black seas have been more impacted than large-scale fleets and the fleets in the Northeast Atlantic. © G. Carpenter et al., Published by EDP Sciences 2023.

Technologies and their resources in higher cello education The digital benefits in face-to-face higher cello teaching

As a result of the COVID-19 pandemic, music teaching in higher music conservatories is in a state of obligatory openness to the use of technologies and audiovisual media in its methodology. The aim of this research is to study in depth the theoretical and practical use of technologies and audiovisual media in the instrumental teaching of the cello. The aim is to prove that the use of technologies and all that they encompass can significantly improve the teaching of the instrument. © GKA Ediciones, authors.