Gender Inequalities of Health and Quality of Life in Informal Caregivers in Spain: Protocol for the Longitudinal and Multicenter CUIDAR-SE Study.

BACKGROUND: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in this scenario. This protocol outlines the CUIDAR-SE study, focusing on the gender-specific impact of informal caregiving on health and quality of life among caregivers in Andalusia and the Basque Country from 2013 to 2024. OBJECTIVE: This study aims to analyze the gender differences in health and quality of life indicators of informal caregivers residing in 2 Spanish autonomous communities (Granada, Andalusia, and Gipuzkoa; Basque Country) and their evolution over time, in relation to the characteristics of caregivers, the caregiving situation, and support received. METHODS: The CUIDAR-SE study uses a longitudinal, multicenter design across 3 phases, tracking health and quality of life indicators among informal caregivers. Using a questionnaire adapted to the Spanish context that uses validated scales and multilevel analysis, the research captures changes in caregivers' experiences amid societal crises, notably the 2008 economic crisis and the COVID-19 pandemic. A multistage randomized cluster sampling technique is used to minimize study design effects. RESULTS: Funding for the CUIDAR-SE study was in 3 phases starting in January 2013, 2017, and 2021, spanning a 10-year period. Data collection commenced in 2013 and continued annually, except for 2016 and 2020 due to financial and pandemic-related challenges. As of March 2024, a total of 1294 participants have been enrolled, with data collection ongoing for 2023. Initial data analysis focused on gender disparities in caregiver health, quality of life, burden, perceived needs, and received support, with results from phase I published. Currently, analysis is ongoing for phases II and III, as well as longitudinal analysis across all phases. CONCLUSIONS: This protocol aims to provide comprehensive insights into caregiving dynamics and caregivers' experiences over time, as well as understand the role of caregiving on gender inequality in health, considering regional variations. Despite limitations in participant recruitment, focusing on registered caregivers, the study offers a detailed exploration of the health impacts of caregiving in Spain. The incorporation of a gender perspective and the examination of diverse contextual factors enrich the study's depth, contributing significantly to the discourse on caregiving health complexities in Spain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58440.

Correction: Mahmood et al. Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program. Int. J. Environ. Res. Public Health 2022, 19, 14857.

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Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor / Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program.

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Occurrence of pathogenic microorganisms in small drinking-water systems in Costa Rica.

This study describes the quality of drinking water sampled over 2 years (2018 and 2019) from 20 ASADAS (Spanish acronym for Administrative Associations for Water and Sewer Systems) in Costa Rica. The analysis included Rotavirus (RV), somatic coliphages, fecal coliforms, and Escherichia coli. The ASADAS were categorized into three regions as temperate rainy (region 1), tropical rainy (region 2), and tropical rainy and dry (region 3) according to biogeographic classification. The concentrations of fecal coliforms and E. coli were higher in samples from surface water sources from the ASADAS in region 3 compared to regions 1 and 2. RV-positive samples (24/296) were detected in drinking-water samples from regions 2 and 3 during dry and transition seasons, with higher concentrations more frequently in the dry season. In addition, somatic coliphages were detected in samples from the three regions, with higher concentrations in region 2. Furthermore, a statistically significant relationship was found between somatic coliphages and diarrheal cases, classified as outbreaks or alerts in the region. Thus, the results confirmed that somatic coliphages are a good indicator of the presence of diarrhea cases in a specific region.

Correlation between the cervical sagittal alignment and spine - pelvic sagittal alignment in asymptomatic adults.

Background: Although there are studies that adequately document the linear correlation between pelvic incidence (PI), sacral slope, lumbar lordosis, and thoracic kyphosis, few have analyzed the pelvic-spine correlation including the cervical spine. Methods: This is a cross-sectional study, wherein the cervical spine was evaluated using radiography and computed tomography (CT) scans, the lumbosacral spine and the pelvis was evaluated using radiography, in adult patients without spinal pathology. Using the Surgimap tool, cervical and spinopelvic parameters were calculated by several investigators. To evaluate the correlation between cervical and spinopelvic parameters, Spearman's coefficient was calculated. To evaluate the concordance correlation of the measured parameters of cervical sagittal alignment on tomography and conventional radiography, Lin's coefficient was calculated and Bland-Altman plots were performed. Results: A total of 51 healthy adults were included in a follow-up from January 2019 to December 2020. Cervical sagittal alignment and sagittal spinopelvic alignment were assessed using radiography, and a correlation was observed between T1 slope (T1S) and lumbar mismatch (coefficient of 0.28, P = 0.047). Then, cervical sagittal alignment was evaluated using CT and sagittal spinopelvic alignment using radiography, and no correlation was observed between PI and thoracic inlet angle or cervical mismatch with lumbar mismatch. Conclusion: In asymptomatic patients, in whom cervical sagittal alignment and spinal-pelvic alignment were evaluated, only a positive correlation was found between lumbar mismatch and T1S, which lacks clinical significance. No concordance was identified between lumbar mismatch and cervical mismatch. Therefore, it is inferred that there is an independence between the sagittal spine-pelvic alignment with respect to the sagittal cervical alignment.

Factores asociados al reingreso hospitalario en pacientes con trastorno bipolar en Valle del Cauca, Colombia / Factors related with hospital readmission in patients with bipolar disorder in Valle del Cauca, Colombia

RESUMEN Objetivo Identificar factores asociados con el reingreso hospitalario en pacientes con trastorno bipolar (TB) en un hospital psiquiátrico y desarrollar un modelo explicativo del riesgo de reingreso. Método Estudio observacional longitudinal retrospectivo a partir de base de datos secundaria aportada por el Hospital Psiquiátrico Departamental Universitario del Valle. Estadística: análisis de supervivencia utilizando un modelo de regresión Cox. Se definió como variable dependiente el riesgo de reingreso y como variables independientes algunas sociodemográficas y clínicas. Resultados Se obtuvo una asociación estadísticamente significativa entre el riesgo de reingreso y las variables: falta de red de apoyo al no tener acudiente HR=1,33 [IC 95% 1,02-1,72; (p=0,034)] y falta de adherencia al tratamiento HR=2,33 [IC 95% 1,87-2,90; (p=0,000)]. Conclusión Para disminuir el reingreso hospitalario por TB, se deben priorizar las intervenciones en los casos de pacientes que no tengan acudiente y haya inadecuada adherencia al tratamiento; esta última, a partir de la percepción por parte del médico especialista. Enfocarse sobre estos dos factores puede incidir sobre los reingresos.

ABSTRACT Objective To identify the factors associated with hospital readmission in patients with bipolar disorder between 2011 and 2017 in a psychiatric hospital in order to develop an explanatory model of the risk of rehospitalization. Method Retrospective longitudinal observational study based on a secondary database provided by the Hospital Psiquiátrico Departamental Universitario del Valle. Statistics: Survival analysis using a Cox regression model. The risk of readmission was defined as a dependent variable and some sociodemographic and clinical variables were defined as independent variables. Results From the multivariate model of Cox Regression, a statistically significant association was obtained between the risk of readmission and the variables: lack of support network due to lack of retentive HR=1.33 [95% CI 1.02-1.72; (p=0.034)] and not having adherence to the treatment HR=2.33 [95% CI 1.87-2.90; (p=0.000)]. Conclusion In order to reduce hospital readmission due to bipolar disorder, interven-tions should be prioritized in cases where patients do not have a guardian and there is inadequate adherence to the treatment; the latter perceived by the specialist doctor. Focusing on these two factors can influence readmissions.

Supratentorial Embryonal Tumor in Adult Patient: Case Report and Literature Review.

Embryonal tumors are the new nomenclature of the primitive neuroectodermal tumors or PNET. Their supratentorial location and their manifestation in adult population are not very frequent. Embryonal tumors are conformed from undifferentiated neuroepithelial cells that have the ability to show differentiation to several cell lines. Next is presented a case from an adult male patient with a clinical headache pictures and convulsions. With imaging study that shows a meningeal enhancement with frontal lobe infiltration with histopathological study of embryonic tumor with areas of glial differentiation.

Optimización de las condiciones de inoculación por biobalística de un Begomovirus en tomate y tabaco / Optimizing conditions for biolistic inoculation of Begomovirus in tomato and tobacco

La transmisión experimental de Begomovirus es problemática. La mayoría de estos virus se pueden transmitir de planta a planta por su vector biológico, Bemisia tabaci. Las inoculaciones experimentales con mosca blanca son problemáticas debido a sus hábitos de alimentación, requerimiento de una planta viva infectada e instalaciones de contención para el vector. Por su parte la inoculación mecánica de Begomovirus es posible, pero generalmente a tasas bajas y no en todos los casos. Por esta razón el bombardeo de partículas (biobalística) de DNA viral como una estrategia de inoculación fue desarrollada. La posibilidad de utilizar el dispositivo de mano Helios Gen Gun System (Biorad®), un equipo de biobalística, para la transmisión de un Begomovirus bipartita a plantas de tomate y tabaco fue ensayado y optimizado. Los parámetros evaluados fueron: número de disparos (1-2), presión de helio (220 y 320 psi) y diámetro de las partículas de oro (0.6 y 1.6µm). Los síntomas característicos de la enfermedad viral (clorosis, mosaico y deformación de la hoja) aparecieron 3 semanas después del bombardeo en las hojas jóvenes no inoculadas. La replicación del DNA viral en las plantas se confirmó por Reacción en cadena de la polimerasa. Plantas infectadas en un 100 se obtuvieron cuando en el bombardeo se emplearon partículas de oro de 1.6 µm recubiertas con DNA viral a una presión de 320psi. A nuestro entender este es el primer reporte en Colombia de la inoculación directa de plantas de tomate y tabaco con un Begomovirus bipartita usando un dispositivo portátil de biobalística.

Experimental transmission of Begomovirus is problematic. Most Begomoviruses can be transmitted readily from plant to plant by the whitefly vector, but this also requires a live infected plant and extensive facilities to maintain the insect. Whitefly inoculations can also be problematic because of their preferential feeding habits on certain plants. Mechanical inoculation of Begomovirus is possible but generally at low rates and for others not at all. For this reason particle bombardment (biolistic) of DNA viral as an inoculum was developed. The possibility of using the Helios Gen Gun System (Biorad®), a biolistic hand-held device, for transmitting Begomovirus bipartite to tomato and tobacco plants was assayed and optimized. Biolistic inoculation was carried out with the hand held device at 220 or 320 psi, applying 1 or 2 shots /plant and using gold particles of 0.6 or 1.6µm in size. Characteristic symptoms of viral disease (chlorosis, mosaic and leaf deformation) appeared 3 weeks post-inoculation in the newly developing leaves. Replication of the viral DNA in plants was confirmed by Polymerase Chain Reaction. All bombarded plants became infected when biolistic inoculation was carried out with the hand held device at 320psi and using 1.6 µm gold particles in size. To our knowledge this is the first report in Colombia of successful direct inoculation of tomato and tobacco plants with Begomovirus bipartite geminivirus using a biolistic hand-held device.

Evidence for selective sweeps by Wolbachia infections: phylogeny of Altica leaf beetles and their reproductive parasites.

Infections with maternally inherited Wolbachia bacteria may have dramatic influences on reproductive traits and speciation patterns of their hosts. We here show that in the beetle genus Altica, infection has influenced phylogenetic patterns of the host's mtDNA and different strains led to repeated selective sweeps. By comparing a COI/II-based phylogeny of the hosts with a phylogeny of the bacteria based on ftsZ, we show that cospeciation is rare and restricted to few recently diverged species. While in general each species apparently harbours a single Wolbachia strain, Altica lythri presents a strikingly different pattern: in the polyphyletic species, three highly divergent mtDNA haplotypes (2.1-4.6% p-distance) are coupled with three different Wolbachia strains (wLytA1, wLytA2 and wLytB). These haplotypes and Wolbachia strains are widely distributed and mostly found in sympatry. A phylogeny based on microsatellite data supports the monophyly of A. lythri. The discrepancy between mtDNA and nuclear phylogeny may best be explained by interspecific hybridization that led to introgression of mtDNA coupled with a different Wolbachia strain. Selective sweeps apparently drove the introgressed haplotypes to widespread distribution. As for effects of Wolbachia on reproduction, infection with wLytA1 appears to be correlated with a substantial sex ratio distortion, which was most prominent in A. lythri.

Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes.

Posterior reversible encephalopathy syndrome (PRES) can present with focal neurologic deficits, mimicking a stroke and can often represent a diagnostic challenge when presenting atypically. A high degree of suspicion is required in the clinical setting in order to yield the diagnosis. Cerebral CT perfusion (CTP) is utilized in many institutions as the first line in acute stroke imaging. CTP has proved to be a very sensitive measure of cerebral blood flow dynamics, most commonly employed to delineate the infarcted tissue from penumbra (at-risk tissue) in ischemic strokes. But abnormal CTP is also seen in stroke mimics such as seizures, hypoglycemia, tumors, migraines and PRES. In this article we describe a case of PRES in an elderly bone marrow transplant recipient who presented with focal neurological deficits concerning for a cerebrovascular accident. CTP played a pivotal role in the diagnosis and initiation of appropriate management. We also briefly discuss the pathophysiology of PRES.

Determinación de parámetros fisicoquímicos y microbiológicos de la chicha en Bogotá / Determination of physico-chemical and microbiological parameters of the "Chicha" drink in Bogota

Introducción y objetivo: En el laboratorio de salud pública de la Secretaría Distrital de salud se realizó el estudio de caracterización de la bebida fermentada denominada Chicha durante el l Festival de la Chicha, el Maíz y la Dicha, con objeto de evaluar sus parámetros fisicoquímicos y microbiológicos y determinar su inocuidad para la salud del consumidor. Método: Se colectaron 49 muestras, a las que se hicieron análisis microbiológicos y fisicoquímicos. Resultados: El análisis microbiológico arrojó un 3,9% de muestras negativas para coliformes fecales; un 93,9% negativas para Bacillus cereus; un 100% negativas para salmonella, y de un 42,9% para mohos. El pH obtuvo un valor medio de 3,44 y el grado alcohólico promedio fue de 3,35%, con valor máximo de 5,2%. En ninguna de las muestras analizadas se detectaron trazas de metanol. Discusión: El punto óptimo de fermentación de la bebida se obtiene entre 15 y 20 días de desarrollo, con contenidos de etanol alrededor de 4%. Por lo tanto, la bebida no debe expenderse para consumo antes de 15 días de proceso de fermentación. Así, la bebida es inocua para el consumidor; siempre y cuando sea elaborada, almacenada y comercializada siguiendo los procedimientos adecuados para la manipulación de alimentos, utilizando materias primas de buena calidad y educación a los productores y distribuidores. Palabras clave: bebida fermentada, grado alcohólico, pH, metanol, coliformes fecales, recuento de mohos, Bacillus cereus, detección de salmonella.

Background and objective: Bogota’s Public Health Laboratory (District Secretariat of Health) carried out a study to characterize the fermented drink called “chicha” during the Festival of Chicha, Corn and Happiness with the aim of evaluating its physicochemical and microbio- logical parameters and determining its innocuousness for consumers’ health. Materials and Methods: Physicochemical and microbiological analysis were made to 49 samples collected. Results:The Microbiological results were as follows: 93.9% of the samples were negative for fecal coliforms, 93.9% were negative for Bacillus cereus, 100% were negative for salmonella, and for molds 42.9% of the samples had higher counts of the punctual estimator as a result of highly humid storage locations and the acidity of the drink. The mean pH value was 3.44. The average alcohol content was 3.35% and the top value was 5.2%. No traces of Methanol were detected in the analyzed samples. Discussion. The optimal fermentation of the beverage is reached after 15 and 20 days, with an ethanol content of about 4.0%. Therefore, the drink should not be sold for consumption before 15 days of fermentation. The conclusion is that the drink is safe for the consumer as long as it is processed, stored, and marketed according to suitable food handling procedures, good quality raw materials and trained producers and distributors. Recommendations: This study is a technical review to be used for future regulations or rules of the drink called “Chicha”. It is also a tool to apply surveillance and control actions aimed at improving the production and marketing of that drink. Keywords: Fermented beverage, alcohol proof, pH, methanol, fecal Coliforms, fungi recount,Bacillus cereus, detection of Salmonella sp.

Características dentales individualizantes relevantes en el estudio de lesión patrón de huella de mordedura por género y edad / Significant individual dental features in the study of the bite print lesion regarding fender and age

El aumento de lesiones personales que involucran huellas de mordedura en Colombia, hace necesario analizar tal evidencia, sin embargo, su análisis es controversial, debido al hecho de que las huellas de mordeduras son tan sutiles, que pueden ser ignoradas; existe diversidad de opiniones y poca evidencia sobre las características dentales de la población colombiana mestiza actual.

Comportamiento clínico del ionómero de vidrio multipropósito vitremer en hipoplasias de primeros molares permanentes (Estudio Piloto) / Clinical behavior of the multiporpose galss ionomer VITREMER in first permanent molar hipoplasia

Se realizó un estudio piloto descriptivo para observar el comportamiento clínico del ionómero de vidrio VITREMER 3M en primeros molares permanetes hipoplásticos. Se escogieron 21 molares con este defecto clasificándose de acuerdo a su nomenclatura, diagnóstico de hipoplasia, agresividad y tejidos dentales involucrados. Posteriormente fueron restaurados con el material en estudio y se controlaron en períodos de tiempo de 2,5 y 8 meses, observando las siguientes variables: permanencia en boca, presencia de caries recurrente, erosiones y adaptación clínica del material.