The effect of virtual reality versus standard-of-care treatment on pain perception during paediatric vaccination: A randomised controlled trial.

AIMS AND OBJECTIVES: To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure. BACKGROUND: Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs. DESIGN: A randomised controlled clinical trial. METHODS: One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong-Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann-Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables. RESULTS: Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described. CONCLUSIONS: Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did. RELEVANCE TO CLINICAL PRACTICE: Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity. REPORTING METHOD: The CONSORT Statement for non-pharmacological randomised clinical trials were followed.

Risk of SARS-CoV-2 Reinfections in a Prospective Inception Cohort Study: Impact of COVID-19 Vaccination.

The risk of reinfection could be related to the initial SARS-CoV-2 clinical presentation, but there are no data about the risk change after SARS-CoV-2 vaccination. We evaluated the rate of reinfection in an inception cohort study of 4943 health care workers (HCWs) according to symptoms and serologic results during March−May 2020. Incidence rates (IR) and IR ratios (IRR) before and after SARS-CoV-2 vaccination were determined by adjusting Poisson models. Overall, 1005 HCWs (20.3%) referred COVID-19 suggestive symptoms during the first surge of disease, and 33.5% and 55% presented a positive PCR or serology result, respectively. Meanwhile, 13% of asymptomatic HCWs had specific antibodies. During a follow up of 3422.2 person-years before vaccination, the rate of reinfection among seropositive individuals was 81% lower for those who were symptomatic compared with those who were asymptomatic (IRR of 0.19; 95% CI, 0.05−0.67; p = 0.003). During the 3100 person-years period after vaccination, an overall 74% decrease in the rate of infection was observed (IRR of 0.26; 95% CI, 0.21−0.32; p < 0.001), with a significant 83% and 70% decrease in seropositive and seronegative HCWs, respectively. In conclusion, the risk of SARS-CoV-2 reinfections is closely related to the clinical and serological presentation of COVID-19. COVID-19 vaccination further decreases the risk of reinfection more markedly among seropositive.

[Systematic review of the role of digital health in managing sickness absence and return to work]. / Revisión Sistemática sobre salud digital en la gestión del absentismo y el retorno al trabajo.

OBJECTIVE: Digital technologies have become a strategy to improve the effectiveness of health services. The objective of this study was to analyse the impact of the use of digital health tools on the management of sickness absence and return to work. METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. The following databases were searched for the period April 2021 to June 2021: Pubmed, Cochrane, Web of Science, CINAHL and ScienceDirect. Methodological quality was assessed by using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: A total of 24 studies were eligible for inclusion; there was great heterogeneity of results, due to a wide range of measurement methods. The majority of outcomes supported the use of digital tools as making an important contribution to  in managing the number of sickness absence and return to work cases. In some studies, there were no significant changes as compared to traditional case management; nevertheless, none of the 24 studies found detrimental effects due to the use of digital health tools. Additionally, 10 of the studies provided data on presenteeism and other determinants of\ sickness absence and return to work, including resilience, work engagement and psychological detachment from work. CONCLUSIONS: The use of digital health tools contributes positively to the recovery of workers who are in a situation of temporary disability, facilitating the management of return to work and favoring a decrease in workplace sickness absence.

Objetivo: El uso de tecnologías digitales se ha convertido en una estrategia para incrementar la efectividad de los servicios de salud. El objetivo de este estudio es analizar el impacto del uso de las herramientas de salud digital sobre la gestión del absentismo laboral y el retorno al trabajo. Métodos: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Cochrane, Web of Science, CINAHL y ScienceDirect. La calidad metodológica fue analizada a partir de las herramientas de evaluación crítica del Joanna Briggs Institute (JBI). Resultados: Un total de 24 estudios fueron incluidos en esta revisión, de los cuales se extrajeron resultados muy heterogéneos debido a la variabilidad de métodos de medición. El uso de herramientas digitales contribuía, mayoritariamente, en la mejora de las cifras de absentismo y de retorno a la actividad laboral, no evidenciándose en ninguno que ocasionara un perjuicio. Adicionalmente, en 10 de los estudios se obtuvieron datos sobre presentismo y otros factores influyentes en el absentismo y el retorno a la actividad laboral, como fueron la resiliencia, el compromiso laboral y el desapego psicológico al trabajo. Conclusiones: El uso de herramientas de salud digital contribuye positivamente en la recuperación de los trabajadores que se encuentran en situación de incapacidad temporal, facilitando la gestión del retorno al trabajo y, por consiguiente, favoreciendo la reducción del absentismo laboral.

Revisión Sistemática sobre salud digital en la gestión del absentismo y el retorno al trabajo / Systematic review of the role of digital health in managing sickness absence and return to work

Objetivo: El uso de tecnologías digitales se ha convertido en una estrategia para incrementar la efectividad de los servicios de salud. El objetivo de este estudio es analizar el impacto del uso de las herramientas de salud digital sobre la gestión del absentismo laboral y el retorno al trabajo. Métodos: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Cochrane, Web of Science, CINAHL y ScienceDirect. La calidad metodológica fue analizada a partir de las herramientas de evaluación crítica del Joanna Briggs Institute (JBI).(AU)

Objective: Digital technologies have become a strategy to improve the effectiveness of health services. The objective of this study was to analyse the impact of the use of digital health tools on the management of sickness absence and return to work. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. The following databases were searched for the period April 2021 to June 2021: Pubmed, Cochrane, Web of Science, CINAHL and ScienceDirect. Methodological quality was assessed by using the Joanna Briggs Institute (JBI) critical appraisal tools.(AU)

Interferon-γ production by CMV-specific CD8+ T lymphocytes provides protection against cytomegalovirus reactivation in critically ill patients.

PURPOSE: To evaluate the usefulness of the secretion of interferon-γ (IFNγ) by cytomegalovirus (CMV)-specific CD8+ T cells to determine the risk of CMV reactivation in critically ill non-immunosuppressed patients. METHODS: Two-center prospective cohort study including critically ill non-immunosuppressed CMV-seropositive patients admitted between December 2012 and March 2013. The incidence of CMV reactivation by polymerase chain reaction (real-time PCR) in plasma was investigated. IFNγ secretion by CMV-specific CD8+ T lymphocytes was determined at the time of admission to the intensive care unit (ICU) by means of the QuantiFERON(®)-CMV (QF-CMV) test. Cox regression analyses were performed to investigate CMV reactivation risk factors. RESULTS: Fifty-three patients were included, of whom 13 (24.5%) presented CMV reactivation. Twenty-six patients (49.1%) were QF-CMV "reactive" (QF-CMV(R)). Of the 26 QF-CMV(R) patients, 11.5% (3/26) had CMV reactivation, whereas 37% (10/27) of QF-CMV "non reactive" patients (QF-CMV(NR)) presented reactivation (p = 0.03). By Cox regression, the presence of QF-CMV(R) at ICU admission (HR 0.09, 95% CI 0.02-0.44; p = 0.003) was associated with a decreased risk of CMV reactivation. The sensitivity, specificity, positive predictive value, and negative predictive value of QF-CMV were 77, 57, 37, and 88%, respectively. Eleven of the 53 patients (20.7%) died during the follow-up period. Mortality was more frequent in patients with CMV reactivation (6/13, 46.1 vs. 5/40, 12.5%; p = 0.015). CONCLUSIONS: In critically ill non-immunosuppressed patients, the presence of functional CMV-specific CD8+ T lymphocyte response at intensive care unit admission provides protection against CMV reactivation.

[Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012]. / Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012 (*).

BACKGROUND: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. METHODS: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. RESULTS: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92-0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to university OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. CONCLUSION: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the pregnant smoker was being young, poorly educated, exposed to tobacco smoke at home and with a previous history of heavy smoking.

Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012 / Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012

Fundamentos: El tabaquismo durante la gestación constituye el principal problema prevenible de salud perinatal. El objetivo es establecer la prevalencia de tabaquismo de las mujeres gestantes en distintos momentos del embarazo así como explorar factores asociados al mismo. Métodos: estudio transversal. La población diana fueron las mujeres cuyo control de embarazo se realizaba en centros de salud públicos. Muestra aleatoria representativa de 40 centros estratificados según número de embarazos. Participaron 1.813 mujeres seleccionadas en 3 muestras independientes (inicio y final del embarazo y posparto). La exposición se midió mediante cotinina en orina, autodeclaración y monóxido de carbono. Se registraron variables ociodemográficas, de tabaquismo y clínico-obstétricas. Se realizó una regresión logística para identificar los factores asociados al tabaquismo. Resultados: La prevalencia media fue 21,6%, menor al final del embarazo (15,6%) y en el puerperio (16,7%) y mayor en el principio del embarazo (30,3%). Las mujeres fumadoras diarias pasaron del 56,3% antes del embarazo al 14% al final (autodeclaración). El 21,8% de los abandonos se produjo antes del embarazo y el 23,6% cuando las mujeres supieron que estaban embarazadas. La ocultación del consumo fue 19,6% . Fueron factores asociados ser joven (OR: 0,956; IC: 0,92-0,99), estar ex- puesta al tabaco en el hogar (OR: 3,48; IC: 2,6-4,7), consumo pregestacional alto (6-10 OR: 13,1 IC: 3-56,9; >10 OR: 25,1 IC: 5,8-109,6), mayor edad gestacional en la medición (al final OR: 0,5 IC: 0,4-0,8; posparto inmediato OR: 0,4 IC: 0,3-0,6) y menor nivel de estudios (sin estudios y primer grado comparadas con universitarias OR: 1,98; IC: 1,22-3,22) . Conclusiones: El perfil de la mujer gestante fumadora es el de una mujer joven con bajo nivel educativo, expuesta al humo de tabaco en el hogar y con alto consumo pregestacional (AU)

Background: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. Methods: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. Results: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92- 0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to univer- sity OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. Conclusion: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the educated, exposed to tobacco smoke at home and with a previous history of heavy smoking (AU)

Xp38gamma/SAPK3 promotes meiotic G(2)/M transition in Xenopus oocytes and activates Cdc25C.

We have studied the role of p38 mitogen-activated protein kinases (MAPKs) in the meiotic maturation of Xenopus oocytes. Overexpression of a constitutively active mutant of the p38 activator MKK6 accelerates progesterone-induced maturation. Immunoprecipit ation experiments indicate that p38gamma/SAPK3 is the major p38 activated by MKK6 in the oocytes. We have cloned Xenopus p38gamma (Xp38gamma) and show that co-expression of active MKK6 with Xp38gamma induces oocyte maturation in the absence of progesterone. The maturation induced by Xp38gamma requires neither protein synthesis nor activation of the p42 MAPK-p90Rsk pathway, but it is blocked by cAMP-dependent protein kinase. A role for the endogenous Xp38gamma in progesterone-induced maturation is supported by the inhibitory effect of kinase-dead mutants of MKK6 and Xp38gamma. Furthermore, MKK6 can rescue the inhibition of oocyte maturation by anthrax lethal factor, a protease that inactivates MAPK kinases. We also show that Xp38gamma can activate the phosphatase XCdc25C, and we identified Ser205 of XCdc25C as a major phosphorylation site for Xp38gamma. Our results indicate that phosphorylation of XCdc25C by Xp38gamma/SAPK3 is important for the meiotic G(2)/M progression of Xenopus oocytes.