Child-to-parent Violence Offenders (Specialists vs. Generalists): The Role of Direct Victimization at Home / Menores con medidas judiciales por violencia filio-parental (especialistas vs. generalistas): el papel de la victimización directa en el hogar

Background/Objectives: Current research has identified direct victimization at home as one of the main predictors of child-to-parent violence (CPV). However, the mechanisms involved in this relationship have not been studied. Thus, we first analyze the differences between CPV offenders and offenders who have committed other types of offenses, as well as the differences between two types of CPV offenders: specialists (those who have only committed CPV) and generalists (those who have committed CPV in addition to other offenses), in multiple risk factors. Next, we specifically examine direct victimization at home and its relationship with social-cognitive processing in CPV. Method: The sample consisted of 208 Spanish young offenders recruited from the Juvenile Justice Service (163 males) aged 14-20 years. Concretely, 83 were CPV offenders, 126 other offenders and concerning the CPV group, 57 were specialists and 26 generalists. A wide range of individual, family, and social variables were evaluated. Results: Compared to other offenders, CPV offenders show more socio-cognitive difficulties, less parental warmth and more parental criticism/rejection, more direct victimization at home and more vicarious victimization at school and in the street. Specialist and generalist CPV offenders differ significantly in their characteristics, with the generalists showing a more negative profile than the specialists. (AU)

Antecedentes/Objetivos: La investigación actual ha identificado a la victimización directa en el hogar como uno de los principales predictores de la violencia filio-parental (VFP). Sin embargo, los mecanismos implicados en esta relación no han sido estudiados. Así, en el presente estudio analizamos, en primer lugar, las diferencias entre jóvenes infractores con delitos relacionados con la VFP y jóvenes infractores con otro tipo de delitos, así como las diferencias entre dos tipos de infractores: especialistas (los que han cometido sólo delitos relacionados con la VFP) y generalistas (los que han cometido delitos relacionados con la VFP y además otros delitos), en múltiples factores de riesgo. A continuación, examinamos específicamente la victimización directa en el hogar y su relación con el procesamiento socio-cognitivo en la VFP. Método: La muestra estuvo compuesta por 208 jóvenes infractores españoles reclutados en el Servicio de Justicia Juvenil (163 chicos) con edades comprendidas entre los 14 y los 20 años. Concretamente, 83 con delitos relacionados con la VFP (57 especialistas y 26 generalistas) y 126 con otros delitos. Se evaluó una amplia gama de variables individuales, familiares y sociales. Resultados: En comparación con otros infractores, los jóvenes con delitos relacionados con la VFP muestran más dificultades socio-cognitivas, menos calidez parental y más crítica/rechazo parental, más victimización directa en el hogar y más victimización vicaria en la escuela y en la calle. Los especialistas y generalistas difieren significativamente en sus características, mostrando los generalistas un perfil más negativo que los especialistas. (AU)

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study.

BACKGROUND: Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. METHODS: This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. RESULTS: A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex-specific elevated troponin levels were significantly associated with 30-day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I. CONCLUSION: In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19.

Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain

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Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.

Association between a Suppressive Combined Antiretroviral Therapy Containing Maraviroc and the Hepatitis B Virus Vaccine Response.

The response to the HBV vaccine in HIV-infected patients is deficient. Our aim was to analyze whether a suppressive combined antiretroviral treatment (cART) containing maraviroc (MVC-cART) was associated with a better response to HBV vaccine. Fifty-seven patients on suppressor cART were administered the HBV vaccine. The final response, the early response, and the maintenance of the response were assessed. An anti-HBs titer of >10 mIU/ml was considered a positive response. A subgroup of subjects was simultaneously vaccinated against hepatitis A virus (HAV). Lineal regression analyses were performed to determine demographic, clinical, and immunological factors associated with the anti-HBs titer. Vaccine response was achieved in 90% of the subjects. After 1 year, 81% maintained protective titers. Only simultaneous HAV vaccination was independently associated with the magnitude of the response in anti-HBs titers, with a P value of 0.045 and a regression coefficient (B) [95% confident interval (CI)] of 236 [5 to 468]. In subjects ≤50 years old (n = 42), MVC-cART was independently associated with the magnitude of the response (P = 0.009; B [95% CI], 297 [79 to 516]) together with previous vaccination and simultaneous HAV vaccination. High rates of HBV vaccine response can be achieved by revaccination, simultaneous HAV vaccination, and administration of cARTs including MVC. MVC may be considered for future vaccination protocols in patients on suppressive cART.

Recomendación del uso de ecuaciones de corrección de valores de potasio en presencia de interferencia por hemólisis / Recommendation on the use of correction equations for potassium levels in haemolysed samples

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Candida orthopsilosis fungemias in a Spanish tertiary care hospital: Incidence, epidemiology and antifungal susceptibility / Fungemias por Candida orthopsilosis en un hospital terciario español: incidencia, epidemiología y sensibilidad a antifúngicos

Background. Few studies exist on prevalence of fungemia by Candida orthopsilosis, with variable results. Aims. To study the incidence, epidemiology and antifungal susceptibility of C. orthopsilosis strains isolated from fungemias over two years at a tertiary hospital. Methods. Candidemia episodes between June 2007 and June 2009 in a university hospital (Puerta del Mar, Cádiz, Spain) were studied. The strains initially identified as Candida parapsilosis were genotypically screened for C. parapsilosis sensu stricto, C. orthopsilosis and Candida metapsilosis, and their antifungal susceptibility was evaluated. Results. In this period 52 cases of candidemia were documented. Of the 19 strains originally identified as C. parapsilosis, 13 were confirmed as C. parapsilosis sensu stricto and 6 as C. orthopsilosis. Of the 52 isolates, the most frequent species were Candida albicans (30.8%), C. parapsilosis sensu stricto (25%), C. orthopsilosis, Candida tropicalis and Candida glabrata in equal numbers (11.5%). C. orthopsilosis isolates were susceptible to amphotericin B, caspofungin, voriconazole and fluconazole, with no significant differences in MIC values with C. parapsilosis sensu stricto. The source of isolates of C. orthopsilosis were neonates (50%) and surgery (50%), and 100% were receiving parenteral nutrition; however C. parapsilosis sensu stricto was recovered primarily from patients over 50 years (69.2%) and 46.1% were receiving parenteral nutrition. Conclusions. These findings show that C. orthopsilosis should be considered as human pathogenic yeast and therefore its accurate identification is important. Despite our small sample size our study suggests that a displacement of some epidemiological characteristics previously attributed to C. parapsilosis to C. orthopsilosis may be possible (AU)

Antecedentes. Apenas se han publicado estudios sobre la prevalencia de los episodios de fungemia por Candida orthopsilosis, y sus resultados han sido variables. Objetivos. Examinar la incidencia, epidemiología y sensibilidad a antifúngicos de las cepas de C. orthopsilosis aisladas de fungemias en un periodo de 2 años en un hospital de asistencia terciaria. Métodos. Entre junio de 2007 y junio de 2009, en el Hospital Universitario Puerta del Mar (Cádiz, España) se estudiaron todos los episodios de fungemia. Las cepas identificadas inicialmente como Candida parapsilosis se genotipificaron para su clasificación como C. parapsilosis sensu stricto, C. orthopsilosis y Candida metapsilosis, y se testó su sensibilidad a los antifúngicos. Resultados. Durante este periodo, se documentaron 52 episodios de fungemia. De las 19 cepas identificadas originalmente como C. parapsilosis, 13 fueron C. parapsilosis sensu stricto, y 6 C. orthopsilosis. De los 52 aislamientos, las especies más frecuentes fueron Candida albicans (30,8%), C. parapsilosis sensu stricto (25%) y C. orthopsilosis (11,5%), y Candida tropicalis y Candida glabrata fueron aisladas en igual número. Todos los aislamientos de C. orthopsilosis fueron sensibles a anfotericina B, caspofungina, voriconazol y fluconazol, sin diferencias significativas en las concentraciones inhibitorias mínimas obtenidas con C. parapsilosis sensu stricto. Los aislamientos de C. orthopsilosis procedían de recién nacidos (50%) y de pacientes sometidos a cirugía (50%). El 100% de los pacientes recibía nutrición parenteral; sin embargo, el foco de C. parapsilosis sensu stricto procedía, ante todo, de pacientes de más de 50 años de edad (69,2%), y el 46,1% recibía nutrición parenteral. Conclusiones. Los resultados del presente estudio revelan que C. orthopsilosis debe considerarse una levadura patogénica para el ser humano y, por esta razón, es importante su identificación. A pesar del pequeño tamaño de la muestra, el presente estudio evidencia el desplazamiento a C. orthopsilosis de algunas características epidemiológicas atribuidas previamente a C. parapsilosis (AU)

Candida orthopsilosis fungemias in a Spanish tertiary care hospital: incidence, epidemiology and antifungal susceptibility.

BACKGROUND: Few studies exist on prevalence of fungemia by Candida orthopsilosis, with variable results. AIMS: To study the incidence, epidemiology and antifungal susceptibility of C. orthopsilosis strains isolated from fungemias over two years at a tertiary hospital. METHODS: Candidemia episodes between June 2007 and June 2009 in a university hospital (Puerta del Mar, Cádiz, Spain) were studied. The strains initially identified as Candida parapsilosis were genotypically screened for C. parapsilosis sensu stricto, C. orthopsilosis and Candida metapsilosis, and their antifungal susceptibility was evaluated. RESULTS: In this period 52 cases of candidemia were documented. Of the 19 strains originally identified as C. parapsilosis, 13 were confirmed as C. parapsilosis sensu stricto and 6 as C. orthopsilosis. Of the 52 isolates, the most frequent species were Candida albicans (30.8%), C. parapsilosis sensu stricto (25%), C. orthopsilosis, Candida tropicalis and Candida glabrata in equal numbers (11.5%). C. orthopsilosis isolates were susceptible to amphotericin B, caspofungin, voriconazole and fluconazole, with no significant differences in MIC values with C. parapsilosis sensu stricto. The source of isolates of C. orthopsilosis were neonates (50%) and surgery (50%), and 100% were receiving parenteral nutrition; however C. parapsilosis sensu stricto was recovered primarily from patients over 50 years (69.2%) and 46.1% were receiving parenteral nutrition. CONCLUSIONS: These findings show that C. orthopsilosis should be considered as human pathogenic yeast and therefore its accurate identification is important. Despite our small sample size our study suggests that a displacement of some epidemiological characteristics previously attributed to C. parapsilosis to C. orthopsilosis may be possible.