Interpersonal forgiveness: validation of the Enright Forgiveness Inventory (EFI-30) in aSpanish sample / Perdón interpersonal: validación del Enright Forgiveness Inventory (EFI-30) en una muestra española

Antecedentes: Diversos estudios demuestran la relevancia del per-dón interpersonal tras una ofensa para mejorar la salud y el bienestar. A pe-sar de su importancia, es evidente la falta de instrumentos de evaluación del perdón adaptados al contexto español. El Enright Forgiveness Inventory (EFI-30) es el instrumento que operacionaliza uno de los modelos teóricos más asentados y reconocidos en el área del perdón a nivel mundial. El obje-tivo del presente estudio es adaptar el EFI-30 a la población española y re-visar suspropiedades psicométricas. Método: 426 estudiantes de grado y más-ter (98 hombres y 328 mujeres) con edades entre 18 y 30 años (M= 21.24; DE= 2.91), completaron el EFI-30 tras su adaptación, así como Trans-gression Related Interpersonal Motivations Inventory (TRIM-18), Reme-dial Strategies Scale (RSS) y Depression Anxiety and Stress Scale (DASS-21). Resultados: El Análisis Factorial Confirmatorio indicó buen ajuste a la estructura original de seis factores (CFI=.91, TLI=.90, IFI=.91, RMSEA= .067). La fiabilidad de las subescalas y del instrumento general fue buena, similar a la versión original. Los resultados mostraron adecuada validez convergente y de criterio. Conclusiones:EFI-30 muestra adecuadas propiedades psicométricas en un contexto español, siendo una medida apropiada para evaluar el perdón interpersonal de una ofensa especifica en al ámbito de la investigación e intervención clínica.(AU)

Background: Numerous studies have demonstrated the im-portance of interpersonal forgiveness after a specific offense for improving the health and well-being of individuals. Despite its importance, there is an evident lack of forgiveness evaluation instruments adapted to the Spanish context. The Enright Forgiveness Inventory (EFI-30) is the questionnaire that implements one of themost establishedand recognized theoretical models in thearea offorgiveness. The aim of the present study is to adapt the EFI-30 for the Spanish population and evaluate its psychometric prop-erties. Method: A sample of 426 undergraduate and graduate students (98 men, 328 women) aged from 18 to 30 years (M= 21.24; SD=2.91), com-pleted the EFI-30 after its adaptation to the Spanishcontext, as well as the Transgression Related Interpersonal Motivations Inventory (TRIM-18), the Remedial Strategies Scale (RSS) and the Depression Anxiety and Stress Scale (DASS-21). Results: The Confirmatory Factor Analysis showed a good fit tothe original six-factor structure (CFI=.91, TLI=.90, IFI=.91, RMSEA= .067). The reliability of these subscales and the instrument was similar to the original version. The results showed adequate criteria and convergent validity. Conclusions:The EFI-30 shows adequatepsycho-metric properties within the Spanish context and is an appropriate instru-ment for evaluating interpersonal forgiveness of a specific offense in re-search and clinical intervention.(AU)

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers.

OBJECTIVE: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) Bionanocomposites with Crystalline Nanocellulose and Graphene Oxide: Experimental Results and Support Vector Machine Modeling.

Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) is a biodegradable and biocompatible bacterial copolymer used in the biomedical and food industries. However, it displays low stiffness and strength for certain applications. This issue can be solved via reinforcement with nanofillers. In this work, PHBHHx-based bionanocomposites reinforced with different loadings of crystalline nanocellulose (CNC) and graphene oxide (GO) were developed by a green and straightforward solution casting technique. Their crystalline nature and surface topography were explored via X-ray diffraction (XRD) and field-emission scanning electron microscopy (FE-SEM), respectively, their composition was corroborated via Fourier-transformed infrared spectroscopy (FTIR), and their crystallization and melting behavior were determined via differential scanning calorimetry (DSC). The nanofillers had a nucleating role, raising the crystallization temperature of the polymer, whilst hardly any changes were found in the melting temperature. Further, significant enhancements in the stiffness, strength, and thermal stability of the PHBHHx matrix were observed with the incorporation of both nanofillers, which was attributed to a synergic effect. The mechanical properties for various concentrations of CNC and GO were accurately predicted using a machine learning (ML) model in the form of a support vector machine (SVM). The model performance was evaluated in terms of the mean absolute error (MAE), the mean square error (MSE), and the correlation coefficient (R2). These bio-based nanocomposites are a valuable alternative to conventional petroleum-based synthetic polymeric materials used nowadays for biomedicine and food packaging applications.

Synthesis and Characterization of Polyhydroxyalkanoate/Graphene Oxide/Nanoclay Bionanocomposites: Experimental Results and Theoretical Predictions via Machine Learning Models.

Predicting the mechanical properties of multiscale nanocomposites requires simulations that are costly from a practical viewpoint and time consuming. The use of algorithms for property prediction can reduce the extensive experimental work, saving time and costs. To assess this, ternary poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV)-based bionanocomposites reinforced with graphene oxide (GO) and montmorillonite nanoclay were prepared herein via an environmentally friendly electrochemical process followed by solution casting. The aim was to evaluate the effectiveness of different Machine Learning (ML) models, namely Artificial Neural Network (ANN), Decision Tree (DT), and Support Vector Machine (SVM), in predicting their mechanical properties. The algorithms' input data were the Young's modulus, tensile strength, and elongation at break for various concentrations of the nanofillers (GO and nanoclay). The correlation coefficient (R2), mean absolute error (MAE), and mean square error (MSE) were used as statistical indicators to assess the performance of the models. The results demonstrated that ANN and SVM are useful for estimating the Young's modulus and elongation at break, with MSE values in the range of 0.64-1.0% and 0.14-0.28%, respectively. On the other hand, DT was more suitable for predicting the tensile strength, with the indicated error in the range of 0.02-9.11%. This study paves the way for the application of ML models as confident tools for predicting the mechanical properties of polymeric nanocomposites reinforced with different types of nanofiller, with a view to using them in practical applications such as biomedicine.

Workplace aggression against healthcare workers in a Spanish healthcare institution between 2019 and 2021: The impact of the COVID-19 pandemic.

Objectives: Describe the incidence of first aggressions among healthcare workers (HCWs) before and during the COVID-19 pandemic in a Spanish healthcare institution, according to workers' socio-occupational characteristics and analyze the impact of the pandemic on it. Methods: A cohort involving HCWs who worked in the institution for at least 1 week each year from 1 January 2019 to 31 December 2021. Adjusted relative risks (aRR) were estimated using generalized estimating equations and negative binomial models to calculate the differences in WPA between the different time periods. All analyses were stratified by gender. Results: Among women, the incidence was 6.8% (6.0; 7.8) during the pre-COVID-19 period, 6.0% (5.2; 7.0) during the COVID-19 baseline and 5.1% (4.3; 5.9) during the COVID-19 endline; and 4.6% (3.4; 6.1), 5.3% (4.1; 6.8) and 4.4% (3.5; 5.8), respectively, among men. Among men, the incidence of WPA was 4.6 (3.4; 6.1), 5.3 (4.1; 6.8), and 4.4% (3.5; 5.8), respectively. These incidences were significantly higher among male nurses and aides [11.1 (8.0; 15.4), 12.3 (8.9; 16.6), and 9.3% (6.5; 13.3) during each period] and psychiatric center workers [women: 14.7 (11.2; 19.0), 15.4 (11.8; 19.8), and 12.4% (9.2; 16.6); men: 12.3 (7.2; 20.0), 17.8 (11.6; 26.2), and 14.3% (8.8; 22.4)]. Among women, the risk of WPA was 23% lower in the post-COVID-19 period compared to before the pandemic [aRR = 0.77 (0.64; 0.93)], while the risk during the COVID-19 baseline was not significantly different [aRR = 0.89 (0.74; 1.06)]. Conclusions: The COVID-19 pandemic led to an unexpected decrease in first-time WPA against HCWs. However, ~5% of HCWs experienced at least one incidence of aggression in the last follow-up year. Healthcare managers should continue to increase the prevention of aggression against HCWs, especially among vulnerable groups with a higher level of incidence.

[Economic cost estimation of a sample of occupational disease cases accepted by the National Institute of Social Security and evaluated at Parc de Salut Mar, 2014-2021]. / Estimación económica de una muestra de casos de enfermedad profesional confirmados por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar, 2014-2021.

Underreporting of occupational diseases (OD) is a social and economic problem, because it has negative consequences for both the welfare of the affected workers and its impact on budgetary planning for the management of health services. We evaluated the healthcare costs of a sample of 13 cases of OD treated at a public hospital in Barcelona between 2014 and 2021, and officially accepted by the National Institute of Social Security (INSS). The total cost of care was €474,859, with an average cost of €36,528 per patient. By diagnostic group, the highest costs were associated with cancer cases, accounting for 79% of the total (€375,068). The findings of this study reflect the economic impact of health care provided by a public hospital to patients with an OD recognized by the INSS.

La infranotificación de enfermedades profesionales (EEPP) es un problema social y económico, pues repercute en el bienestar del trabajador afectado, y en las estimaciones presupuestarias que se planifican anualmente para la gestión de los servicios sanitarios. Los costes asistenciales fueron evaluados en una muestra de 13 casos de EEPP con resolución positiva por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar (Barcelona) entre 2014 y 2021. El coste de la asistencia generada del total de casos fue de 474.859 €, con un coste medio de 36.528 € por paciente. Por grupo diagnóstico, el coste más alto lo originaron los casos de cánceres que supusieron el 79% del gasto total (375.068 €). Los hallazgos del estudio reflejan el impacto económico que supone la asistencia sanitaria prestada por un hospital público a pacientes con una EEPP reconocida en el INSS.

Estimación económica de una muestra de casos de enfermedad profesional confirmados por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar, 2014-2021 / Economic cost estimation of a sample of occupational disease cases accepted by the National Institute of Social Security and evaluated at Parc de Salut Mar, 2014-2021

La infranotificación de enfermedades profesionales (EEPP) es un problema social y económico, pues repercute en el bienestar del trabajador afectado, y en las estimaciones presupuestarias que se planifican anualmente para la gestión de los servicios sanitarios. Los costes asistenciales fueron evaluados en una muestra de 13 casos de EEPP con resolución positiva por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar (Barcelona) entre 2014 y 2021. El coste de la asistencia generada del total de casos fue de 474.859 €, con un coste medio de 36.528 € por paciente. Por grupo diagnóstico, el coste más alto lo originaron los casos de cánceres que supusieron el 79% del gasto total (375.068 €). Los hallazgos del estudio reflejan el impacto económico que supone la asistencia sanitaria prestada por un hospital público a pacientes con una EEPP reconocida en el INSS (AU)

Underreporting of occupational diseases (OD) is a social and economic problem, because it has negative consequences for both the welfare of the affected workers and its impact on budgetary planning for the management of health services. We evaluated the healthcare costs of a sample of 13 cases of OD treated at a public hospital in Barcelona between 2014 and 2021, and officially accepted by the National Institute of Social Security (INSS). The total cost of care was €474,859, with an average cost of €36,528 per patient. By diagnostic group, the highest costs were associated with cancer cases, accounting for 79% of the total (€375,068). The findings of this study reflect the economic impact of health care provided by a public hospital to patients with an OD recognized by the INSS (AU)

[Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study]. / Pacientes críticos COVID-19. ¿Han variado el manejo y los resultados en la UCI tras un año de pandemia? Estudio multicéntrico, prospectivo, observacional.

Objective: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic. Methodology: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). Results: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%). Conclusions: After one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study.

OBJECTIVE: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS: After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers / Afrontar lo desconocido: percepciones, temores y preocupaciones del personal hospitalario ante la infección por SARS-CoV-2

Objective: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. Method: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. Results: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. Conclusions: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers’ fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.(AU)

Objetivo: Este estudio explora los temores y las preocupaciones respecto al riesgo de infección y transmisión del SARS-CoV-2 a familiares, compañeros de trabajo y pacientes en relación con las intervenciones preventivas no farmacológicas entre el personal hospitalario (incluido personal de medicina, personal de enfermería y auxiliares, y personal de limpieza, mantenimiento y seguridad) de una institución sanitaria de Barcelona (España), durante la primera y segunda oleadas de la pandemia por SARS-CoV-2. Método: La investigación utilizó un enfoque cualitativo exploratorio. Se realizaron seis grupos focales y diez entrevistas individuales en línea, que se grabaron en audio, se transcribieron literalmente y se analizaron mediante análisis temático y codificación mixta. Resultados: Participaron en el estudio 40 profesionales. En todos los grupos surgieron cuatro temas comunes: retos relacionados con la falta de preparación ante una pandemia, preocupaciones sobre el equipo de protección personal, directrices poco claras para el rastreo de casos y contactos, y dificultades relacionadas con la comunicación. Conclusiones: Este estudio hace hincapié en las recomendaciones clave para mejorar las intervenciones preventivas no farmacológicas con el fin de reducir los temores y las preocupaciones de los trabajadores sobre el riesgo de infección y de contagio a otras personas, incluidas las familias. Por encima de todo, estas deben incluir garantizar la disponibilidad y el uso correcto de equipos de protección individual adecuados, mejorar las directrices sobre el rastreo de casos y contactos, y establecer canales de comunicación eficaces para todos los trabajadores de la organización. Estas recomendaciones deben reforzarse en el personal de mantenimiento y seguridad, así como en el personal de enfermería y auxiliares del turno de noche, para reducir también las desigualdades sanitarias.(AU)

Analysis of the costs associated with the follow-up of HIV patients discontinuing antiretroviral treatment due to lack of effectiveness or unacceptable toxicity in Spain.

OBJECTIVE: To assess the use of resources and the costs associated with  following up patients infected with the human immunodeficiency virus after  discontinuation of an antiretroviral treatment and initiation of a new one due to  a lack of effectiveness or unacceptable toxicity, as compared to the costs  involved in the routine follow-up of patients on antiretroviral treatment, from  the Spanish National Health System perspective. Method: The use of resources (clinical tests, medical visits, and hospital pharmacy visits) associated with following three profiles of patients  infected with the human immunodeficiency virus (stable ones, those  discontinuing an existing antiretroviral treatment and being switched to a new  one due to a lack of effectiveness, and those discontinuing an existing antiretroviral treatment and being switched to a new one due to  unacceptable toxicity) was identified, based on clinical practice guidelines and  the findings of a multidisciplinary expert panel (n = 5). The experts agreed on  the main adverse events leading to discontinuation, classifying them into  gastrointestinal, renal, osseous, musculoskeletal, dermatological, hepatic, lipid  profile-related, neuropsychiatric and sexual alterations. Unit costs were  identified from official healthcare costs databases. The cost  (€, 2020) of  following up each patient profile was estimated, excluding the cost of the  antiretroviral treatment itself, with a time horizon of two years. RESULTS: The per-patient cost of following up stable patients over two years  was estimated at €4,148 (tests: €2,293; visits: €1,855). Patient follow-up after  discontinuation of an existing antiretroviral treatment and initiation of a  different one due to a lack of effectiveness was estimated at €5,434 (tests:  €2,777; visits: €2,657). The cost of follow-up after discontinuation of an  existing regimen and initiation of a new one due to unacceptable toxicity varied  according to the adverse event prompting the switch, ranging from  €4,690 for lipid profile dysregulation, to €5,304, for musculoskeletal  alterations. In this patient profile, the cost of tests ranged from €2,403 to  €3,017, and that of visits from €2,287 to €2,842. CONCLUSIONS: The cost associated with following up of patients infected with  the human immunodeficiency virus after discontinuation of an existing  antiretroviral regimen and initiation of a new one is higher than that of routine  follow-up, without taking the cost of drugs into account. The treatment  discontinuation rate is a relevant factor when selecting the most appropriate  therapy for each patient.

OBJETIVO: Estimar el uso de recursos y costes asociados al seguimiento de  pacientes con infección por el virus de la inmunodeficiencia humana tras  discontinuación del tratamiento antirretroviral actual debido a falta de  efectividad o toxicidad inaceptable y cambio a un nuevo tratamiento antirretroviral, comparado con el seguimiento habitual de los  pacientes con tratamiento antirretroviral, desde la perspectiva del Sistema  Nacional de Salud español.Método: Se identificó el uso de recursos (pruebas clínicas, visitas médicas,  visitas a la farmacia hospitalaria) asociado al seguimiento de pacientes con  infección por el virus de la inmunodeficiencia humana en tres perfiles de  pacientes (estable, discontinuación y cambio por falta de efectividad,  discontinuación y cambio por toxicidad inaceptable), a partir de las guías de  práctica clínica y un panel de expertos multidisciplinar (n = 5). Los expertos  consensuaron los principales eventos adversos que conducían a la  discontinuación, agrupándolos en: alteraciones gastrointestinales, renales,  óseas, musculoesqueléticas, dermatológicas, hepáticas y del perfil lipídico,  trastornos neuropsiquiátricos y sexuales. Los costes unitarios se identificaron a  partir de bases de datos oficiales  assode costes sanitarios y de la literatura.  Se estimó el coste (€, 2020) del seguimiento en cada perfil de paciente, sin  incluir el coste derivado del tratamiento antirretroviral, en un horizonte  temporal de dos años. RESULTADOS: El coste por paciente a dos años se estimó en 4.148 € (pruebas:  2.293 €; visitas: 1.855 €) para el seguimiento del paciente estable. El  seguimiento del paciente tras discontinuación por falta de efectividad y cambio  de tratamiento antirretroviral se estimó en 5.434 € (pruebas: 2.777 €; visitas:  2.657 €). El coste del seguimiento tras la discontinuación por toxicidad  inaceptable y cambio de tratamiento antirretroviral varió en función del evento  adverso que motivó el cambio, oscilando entre 4.690 € para las alteraciones  del perfil lipídico, y 5.304 € para las alteraciones musculoesqueléticas. En este  perfil de pacientes, las pruebas variaron entre 2.403 € y 3.017 € y las visitas  entre 2.287 € y 2.842 €. CONCLUSIONES: El coste asociado al seguimiento del paciente con infección por  el virus de la inmunodeficiencia humana tras discontinuación y cambio a un  nuevo tratamiento antirretroviral es mayor comparado con el seguimiento  habitual, sin tener en cuenta el coste farmacológico. La tasa de discontinuación  del tratamiento antirretroviral es un factor relevante a la hora  de seleccionar la terapia más adecuada para cada paciente.

Análisis de los costes asociados al seguimiento de pacientes con VIH que discontinúan el tratamiento antirretroviral por falta de eficacia o toxicidad inaceptable en España / Analysis of the costs associated with the follow-up of HIV patients discontinuing antiretroviral treatment due to lack of effectiveness or unacceptable toxicity in Spain

Objetivo: Estimar el uso de recursos y costes asociados al seguimientode pacientes con infección por el virus de la inmunodeficiencia humanatras discontinuación del tratamiento antirretroviral actual debido a faltade efectividad o toxicidad inaceptable y cambio a un nuevo tratamientoantirretroviral, comparado con el seguimiento habitual de los pacientescon tratamiento antirretroviral, desde la perspectiva del Sistema Nacionalde Salud español.Método: Se identificó el uso de recursos (pruebas clínicas, visitasmédicas, visitas a la farmacia hospitalaria) asociado al seguimiento depacientes con infección por el virus de la inmunodeficiencia humana entres perfiles de pacientes (estable, discontinuación y cambio por faltade efectividad, discontinuación y cambio por toxicidad inaceptable), apartir de las guías de práctica clínica y un panel de expertos multidisciplinar (n = 5). Los expertos consensuaron los principales eventos adversos que conducían a la discontinuación, agrupándolos en: alteracionesgastrointestinales, renales, óseas, musculoesqueléticas, dermatológicas,hepáticas y del perfil lipídico, trastornos neuropsiquiátricos y sexuales.Los costes unitarios se identificaron a partir de bases de datos oficiales de costes sanitarios y de la literatura. Se estimó el coste (€, 2020) delseguimiento en cada perfil de paciente, sin incluir el coste derivado deltratamiento antirretroviral, en un horizonte temporal de dos años.Resultados: El coste por paciente a dos años se estimó en 4.148 €(pruebas: 2.293 €; visitas: 1.855 €) para el seguimiento del pacienteestable. (AU)

Objective: To assess the use of resources and the costs associatedwith following up patients infected with the human immunodeficiency virusafter discontinuation of an antiretroviral treatment and initiation of a newone due to a lack of effectiveness or unacceptable toxicity, as comparedto the costs involved in the routine follow-up of patients on antiretroviraltreatment, from the Spanish National Health System perspective.Method: The use of resources (clinical tests, medical visits, and hospitalpharmacy visits) associated with following three profiles of patients infected with the human immunodeficiency virus (stable ones, those discontinuing an existing antiretroviral treatment and being switched to a newone due to a lack of effectiveness, and those discontinuing an existingantiretroviral treatment and being switched to a new one due to unacceptable toxicity) was identified, based on clinical practice guidelinesand the findings of a multidisciplinary expert panel (n = 5). The expertsagreed on the main adverse events leading to discontinuation, classifyingthem into gastrointestinal, renal, osseous, musculoskeletal, dermatological,hepatic, lipid profile-related, neuropsychiatric and sexual alterations. Unitcosts were identified from official healthcare costs databases. The cost (€, 2020) of following up each patient profile was estimated, excludingthe cost of the antiretroviral treatment itself, with a time horizon of twoyears.Results: The per-patient cost of following up stable patients over twoyears was estimated at €4,148 (tests: €2,293; visits: €1,855). Patientfollow-up after discontinuation of an existing antiretroviral treatment andinitiation of a different one due to a lack of effectiveness was estimatedat €5,434 (tests: €2,777; visits: €2,657). (AU)

Efficacy of Emotionally Focused Therapy among Spanish-speaking couples: study protocol of a randomized clinical trial in Argentina, Costa Rica, Guatemala, Mexico, and Spain.

BACKGROUND: Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. METHODS: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. DISCUSSION: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04277325. Registered on February 20, 2020.

Active ageing policy in challenging production environments: a case study involving social partners in Spain.

In recent years, due to population ageing, the European Union has promoted active ageing policies as a means to encourage workers to delay labour market exit. Our paper explores what active ageing means to social partners (employers, managers and workers) in Spain and also the viability of implementing an active ageing culture in organizations. We used a qualitative case study methodology to identify perceptions regarding obstacles and facilitators in the adoption of an active ageing culture in different production sectors, as well as responses to active ageing policies. Data-generating workshops were held with employees and managers of four types of companies located in the south of the country. Perceived obstacles to active ageing were more organizational than individual in nature. Some of these obstacles gave rise to a kind of forced active ageing in a context in which the previous predominant message had been to retire as early as possible. Job adaptation was perceived as both an obstacle and a facilitator. Increasing recognition of older workers and raising their motivation to extend their working lives were found to be important pending tasks. In contexts of high unemployment, active ageing often remains largely unknown within productive organizations, and the idea of retiring as soon as possible continues to guide many workers. In these circumstances, the implementation of top-down, uniform active ageing policies has proven to be of limited efficacy. Awareness campaigns and initiatives aimed at improving older workers' health and abilities should be launched as complementary active ageing strategies. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00650-6.

Machine Learning for Property Prediction and Optimization of Polymeric Nanocomposites: A State-of-the-Art.

Recently, the field of polymer nanocomposites has been an area of high scientific and industrial attention due to noteworthy improvements attained in these materials, arising from the synergetic combination of properties of a polymeric matrix and an organic or inorganic nanomaterial. The enhanced performance of those materials typically involves superior mechanical strength, toughness and stiffness, electrical and thermal conductivity, better flame retardancy and a higher barrier to moisture and gases. Nanocomposites can also display unique design possibilities, which provide exceptional advantages in developing multifunctional materials with desired properties for specific applications. On the other hand, machine learning (ML) has been recognized as a powerful predictive tool for data-driven multi-physical modelling, leading to unprecedented insights and an exploration of the system's properties beyond the capability of traditional computational and experimental analyses. This article aims to provide a brief overview of the most important findings related to the application of ML for the rational design of polymeric nanocomposites. Prediction, optimization, feature identification and uncertainty quantification are presented along with different ML algorithms used in the field of polymeric nanocomposites for property prediction, and selected examples are discussed. Finally, conclusions and future perspectives are highlighted.

Identification of LOC101927355 as a Novel Biomarker for Preeclampsia.

Preeclampsia, a disorder with a heterogeneous physiopathology, can be attributed to maternal, fetal, and/or placental factors. Long non-coding RNAs (lncRNAs) refer to a class of non-coding RNAs, the essential regulators of biological processes; their differential expression has been associated with the pathogenesis of multiple diseases. The study aimed to identify lncRNAs, expressed in the placentas and plasma of patients who presented with preeclampsia, as potential putative biomarkers of the disease. In silico analysis was performed to determine lncRNAs differentially expressed in the placentas of patients with preeclampsia, using a previously published RNA-Seq dataset. Seven placentas and maternal plasma samples collected at delivery from preterm preeclamptic patients (≤37 gestational weeks of gestation), and controls were used to validate the expression of lncRNAs by qRT-PCR. Six lncRNAs were validated and differentially expressed (p < 0.05) in the preeclampsia and control placentas: UCA1 and HCG4 were found upregulated, and LOC101927355, LINC00551, PART1, and NRAD1 downregulated. Two of these lncRNAs, HCG4 and LOC101927355, were also detected in maternal plasma, the latter showing a significant decrease (p = 0.03) in preeclamptic patients compared to the control group. In silico analyses showed the cytoplasmic location of LOC101927355, which suggests a role in post-transcriptional gene regulation. The detection of LOC101927355 in the placenta and plasma opens new possibilities for understanding the pathogenesis of preeclampsia and for its potential use as a biomarker.

Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study.

Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73-0.91) to 0.39 (0.35-0.44). The adjusted RR was 0.54 (0.48-0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.

Función de la senescencia endotelial en la fisiopatología del síndrome metabólico y el envejecimiento / Role of endothelial senescence in the physiotherapy of metabolic syndrome and ageing

Estimado director: Hemos leído con interés el artículo Prevalencia del síndrome metabólico en la población dos consultorios del Policlínico Primero de Enero, de los autores Rivero Sabournin y otros.1 Dicho trabajo demuestra el potencial investigativo en la Atención Primaria de Salud, así como la pertinencia de este escenario en los estudios epidemiológicos. Para el desarrollo de la investigación sus autores se basan en los criterios de síndrome metabólico (SM) del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III),1 aunque resulta imprescindible evaluar los criterios de la Clasificación Consensuada o Armonizada de Alberti y otros del año 2009,2 los cuales constituyen la guía más importante para la evaluación por parte del médico de cabecera de los pacientes que pudieran padecer de SM. Otro elemento importante en esta investigación es que se resalta la relación SM y envejecimiento, aunque no se argumenta cuáles pudieran ser los nexos entre ellos. Actualmente se considera que sea el endotelio (END) y la disfunción endotelial (DISF) la vía común de cada una de estas alteraciones como lo han propuesto varios autores: niveles elevados de ácidos grasos,3 envejecimiento,4 oxidación de LDL,5 hiperglucemia,6 niveles séricos de adipoquinas7,8 y las especies reactivas del oxígeno.9 Para un abordaje de esta relación SM-E-END sería necesario analizar que la base fisiopatológica del SM es la insulinorresistencia (IR) y que, precisamente, el endotelio tiene una función importante, donde la insulina (INS) logra desempeñar su función.8 En el endotelio se produce el factor de crecimiento similar a la INS (IGF, según sus siglas en inglés)9 y es donde se encuentran proteínas de membrana que sirven de transportadores a la INS. Una vez que se instaura el daño endotelial o la disfunción endotelial (DE), la pérdida...(AU)

High frequency of social polygyny reveals little costs for females in a songbird.

Mating system theory predicts that social polygyny-when one male forms pair bonds with two females-may evolve by female choice in species with biparental care. Females will accept a polygynous male if the benefit of mating with a male providing high-quality genes or rearing resources outweighs the cost of sharing mate assistance in parental care. Based on this rationale, we hypothesise that the population frequency of social polygyny (FSP) varies due to changes in mate sharing costs caused by changing environmental conditions. We predicted that: (1) polygamous females (i.e. mated with a polygynous male) pay a survival cost compared to monogamous females; (2) FSP would be higher in years with better rearing conditions and (3) the difference in survival rates between monogamous and polygamous females would be small following years with higher FSP. We tested these predictions using regression and multistate analyses of capture-recapture data of pied flycatchers, Ficedula hypoleuca, in central Spain collected over 26 years (1990-2016). Monogamous females had a higher mean survival rate than polygamous females (prediction 1), but there was no difference in survival between polygynous and monogamous males. In addition, FSP was positively associated with annual reproductive success (a proxy of the quality of rearing conditions-prediction 2). Finally, following years with high FSP, the survival of polygamous females was similar to that of monogamous females (prediction 3), while the chance of breeding in a polygamous state for 2 years in a row increased for both males and females. Our findings suggest that fluctuating environmental conditions may be a necessary but neglected aspect of understanding social polygyny mechanisms.

The mRNA-1273 Vaccine Induces Cross-Variant Antibody Responses to SARS-CoV-2 With Distinct Profiles in Individuals With or Without Pre-Existing Immunity.

mRNA-based vaccines effectively induce protective neutralizing antibodies against SARS-CoV-2, the etiological agent of COVID-19. Yet, the kinetics and compositional patterns of vaccine-induced antibody responses to the original strain and emerging variants of concern remain largely unknown. Here we characterized serum antibody classes and subclasses targeting the spike receptor-binding domain of SARS-CoV-2 wild type and α, ß, γ and δ variants in a longitudinal cohort of SARS-CoV-2 naïve and COVID-19 recovered individuals receiving the mRNA-1273 vaccine. We found that mRNA-1273 vaccine recipients developed a SARS-CoV-2-specific antibody response with a subclass profile comparable to that induced by natural infection. Importantly, these antibody responses targeted both wild type SARS-CoV-2 as well as its α, ß, γ and δ variants. Following primary vaccination, individuals with pre-existing immunity showed higher induction of all antibodies but IgG3 compared to SARS-CoV-2-naïve subjects. Unlike naïve individuals, COVID-19 recovered subjects did not mount a recall antibody response upon the second vaccine dose. In these individuals, secondary immunization resulted in a slight reduction of IgG1 against the receptor-binding domain of ß and γ variants. Despite the lack of recall humoral response, vaccinees with pre-existing immunity still showed higher titers of IgG1 and IgA to all variants analyzed compared to fully vaccinated naïve individuals. Our findings indicate that mRNA-1273 vaccine triggered cross-variant antibody responses with distinct profiles in vaccinees with or without pre-existing immunity and suggest that individuals with prior history of SARS-CoV-2 infection may not benefit from the second mRNA vaccine dose with the current standard regimen.