Assessing the social impacts of the COVID-19 crisis using phone helplines. The case of the Balearic Islands, Spain.

Background: Crises and health policies to tackle them can increase health inequalities. We explored the scope and usefulness of helplines set up during the COVID-19 crisis and characterised the vulnerability of their users. This study explored the geographic and socioeconomic effects of the telephone helplines set up by the Balearic Islands Government and aimed to characterise the vulnerability of their users. Methods: Telephonic survey combined with a geographical analysis of a sample of calls made between 15th of March and 30th of June of 2020 to five helplines: COVID-19 general information; psychological, social (minimum vital income), labour (temporary employment regulation), and housing (rental assistance) helps. The questionnaire included sociodemographic and housing characteristics, type of problem, and if it was solved or not. We used multinomial regression to explore factors associated with having solved the problem. We calculated the standardised rate of calls by municipality using Chi-squared and z-test to test differences. Results: 1,321 interviews from 2,678 selected (231 excluded, 608 untraceable, and 518 refusals). 63.8% of women, 48.7% were born in another country. They had no internet at home in 3.1%, only on the phone in 17.3%. The 23.5% had no income at home. The Problem was solved in 25.4%, and partly in 30.9%. Factors associated with not solving the problem were not having income at home (p = 0.021), labour (p = 0.008), economic (p = 0.000) or housing (p = 0.000) problems. People from 55 of 67 municipalities did at least one call. The highest rates of calls were from coastal tourist municipalities. Conclusion: Helplines reached most of the territory of the Balearic Islands and were used mainly in tourist municipalities. It probably has not been helpful for families with more significant deprivation. Digital inequalities have emerged.

Vulnerabilidad sobrevenida. El impacto social de la Covid-19 / Successful vulnerability. The social impact of Covid-19

Las crisis sanitarias, así como las medidas adoptadas para hacerles frente, pueden aumentar las desigualdades. Este estudio quiere ahondar sobre el impacto social que ha tenido la crisis sanitaria de la COVID-19. Objetivos: 1. Identificar aquellas personas, grupos o familias más vulnerables y aquellas a las que les ha afectado especialmente la crisis del COVID-19; 2. Describir en profundidad la situación que han vivido y cómo la han afrontado; 3. Conocer qué dificultades han encontrado para solicitar las ayudas del Gobierno. Métodos: Estudio cualitativo que forma parte de un estudio más amplio cuantitativo, que combinó una encuesta telefónica con un estudio geográfico. Se entrevistaron 1.321 personas mediante un cuestionario semiestructurado con algunas preguntas abiertas, de las cuales se seleccionaron 243 para su análisis cualitativo. Se realizaron 8 entrevistas en profundidad. Resultados: El impacto de la pandemia se ha reflejado en forma de malestar psicológico. Algunas familias han tenido que cambiar de vivienda, comunidad autónoma e incluso volver a la vivienda de sus padres. Se han observado grandes dificultades para las familias con personas dependientes (mayores, con discapacidad, hijos e hijas); monoparentales; para familias cuyo sustento básico son pensiones no contributivas y para las personas solas. Los Servicios Sociales han sido un gran apoyo, aunque se ha percibido falta de coordinación entre estos y las diferentes instituciones. Conclusiones: Dadas las características de esta pandemia, algunos grupos no vulnerables se han encontrado con dificultades, no han podido hacer frente a la situación, y los que ya eran vulnerables han aumentado su vulnerabilidad. (AU)

Objectives: 1) To rank more vulnerable people, groups, or households in relation to how the COVID-19 crisis has affected them; 2) To describe the circumstances experienced during the COVID-19 crisis, the way to dealt with, and the success in handling them; 3) To identify the difficulties when applying for government aid. Methods: It was a qualitative study that was part of a broader quantitative study, combining a telephone survey with a geographical study. We phone surveyed 1321 persons using a semi-structured questionnaire with some open questions. From them, 243 we selected for qualitative analysis. Afterwards, we conducted eight in-depth interviews. Results: The COVID-19 crisis caused psychological discomfort. The drawback most frequently reported has been the need to move into worse homing conditions, which include moving to other neighbourhoods or regions, or sharing with relatives (typically, moving into parent’s home). The households more frequently reporting difficulties have been those with dependent persons (young children, elderly or disabled people), single-parents households, households receiving basic subsidy only, and singles living alone. In most cases, Social Services have helped to dealt with the effects of COVID -19 crisis. However, coordination between different institutions should be improved. Conclusions: Given the characteristics of this pandemic and the impossibility of anticipating it, people already socially vulnerable have encountered special difficulties in dealing with the COVID-19 crisis, have been unable to cope with them, and have worsened their degree of vulnerability. (AU)

Dry needling for treating spasticity in multiple sclerosis.

[Purpose] The aim of the study is to evaluate the efficacy of dry needling (DN) in the treatment of spasticity in patients with multiple sclerosis (MS). [Participants and Methods] Twelve participants (3 males and 9 females) with MS, with no evidence of a relapse in the last four weeks and with an EDSS (Expanded Disability Status Scale) greater than 2.5 points (related with pyramidal score) were recruited. DN was performed in lower limbs for 12 consecutive sessions and evaluated with: PSFS (Penn Spasm Frequency Scale), VAS (visual analogical scale) of spasticity, EDSS (Pyramidal item), Time up and go (TUG), 25 foot, 9hold peg test (9HPT) and the improvement or not in the quality of life (MSQol54) was verified before and after treatment. A follow up visit was carried out to assess improvement. [Results] All patients improved in: VAS scale, EDSS score, quality of life, 9HPT, 25 foot test and TUG and 90% of them showed a decrease in the number of spasms/hour (PSFS). [Conclusion] Dry needling produces positive changes in spasticity in patients with MS and their quality of life, as well as walking capacity and manual dexterity. Therefore, DN should be considered in the treatment of spasticity in patients with MS.

Cobertura de pacientes pediátricos con necesidades paliativas en la Comunidad de Madrid / Coverage of pediatric patients with palliative needs in the Region of Madrid

No disponible

Crystal-Plasticity-Finite-Element Modeling of the Quasi-Static and Dynamic Response of a Directionally Solidified Nickel-Base Superalloy.

The flow stress behaviour of a directionally solidified nickel-base superalloy, MAR-M247, is presented through the combination of experiments and crystal-plasticity simulations. The experimental campaign encompassed quasi-static and dynamic testing in the parallel and perpendicular orientation with respect to the columnar grains. The material showed low strain-rate sensitivity in all cases. Virtual samples were generated with DREAM3d and each grain orientation was established according to the DS nature of the alloy. The elasto-visco-plastic response of each crystal is given by phenomenological-base equations, considering the dislocation-dislocation interactions among different slip systems. The hardening-function constants and the strain-rate sensitivity parameter were fitted with the information from tests parallel to the grain-growth direction and the model was able to predict with accuracy the experimental response in the perpendicular direction, confirming the suitability of the model to be used as a tool for virtual testing. Simulations also revealed that in oligocrystalline structures of this type, the yield-strength value is controlled by the grains with higher Schmid factor, while this influence decreases when plastic strain increases. Moreover, the analysis of the micro-fields confirmed that grains perpendicular to the loading axis are prone to nucleate cavities since the stresses in these regions can be twice the external applied stress.

Can fibrinolytic system components explain cognitive impairment in multiple sclerosis?

BACKGROUND: The fibrinolytic system is capable of modulating inflammatory and degenerative events within the central nervous system. Specifically, the plasminogen activator inhibitor-1 (PAI-1) has been associated with different pathological conditions in multiple sclerosis (MS) and its role in cognitive functioning is also known. OBJECTIVES AND METHODS: To study the association between plasma levels and the polymorphic variants of the PAI-1 gene and cognitive performance in MS. 176 patients were studied. Neuropsychological evaluation was performed with the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). A Polymerase Chain Reaction (PCR) was used to determine PAI-1 4G/5G polymorphisms and quantification was performed using an Enzyme-Linked ImmunoSorbent Assay (ELISA). RESULTS: Participants were categorized as not cognitively impaired (NCI; n=114) and cognitively impaired (CI; n=62). The NCI group had a higher percentage of heterozygous subjects but no statistical differences were found between the CI and NCI group. Neuropsychological functioning did not correlate with plasma levels of PAI-1 or its genetic polymorphism. It is noteworthy that PAI-1 plasma levels were related to neurological impairment. DISCUSSION: Cognitive impairment in MS is due to strategic focal lesions affecting regions and tracts involved in cognitive processes and to diffuse damage in the white and gray matter. This complex etiology could explain the absence of a relationship between the cognitive functioning and PAI-1 in patients with MS that has been found in vascular dementia or Alzheimer's disease. Plasma curves of PAI-1 and its measures in cerebrospinal fluid could help elucidate the role of PAI-1 in MS.

Efficacy of a short cognitive training program in patients with multiple sclerosis.

BACKGROUND: Cognitive impairment is a common feature in multiple sclerosis (MS) and may have a substantial impact on quality of life. Evidence about the effectiveness of neuropsychological rehabilitation is still limited, but current data suggest that computer-assisted cognitive training improves cognitive performance. OBJECTIVE: The objective of this study was to evaluate the efficacy of combined computer-assisted training supported by home-based neuropsychological training to improve attention, processing speed, memory and executive functions during 3 consecutive months. METHODS: In this randomized controlled study blinded for the evaluators, 62 MS patients with clinically stable disease and mild-to-moderate levels of cognitive impairment were randomized to receive a computer-assisted neuropsychological training program (n=30) or no intervention (control group [CG]; n=32). The cognitive assessment included the Brief Repeatable Battery of Neuropsychological Test. Other secondary measures included subjective cognitive impairment, anxiety and depression, fatigue and quality of life measures. RESULTS: The treatment group (TG) showed significant improvements in measures of verbal memory, working memory and phonetic fluency after intervention, and repeated measures analysis of covariance revealed a positive effect in most of the functions. The control group (CG) did not show changes. The TG showed a significant reduction in anxiety symptoms and significant improvement in quality of life. There were no improvements in fatigue levels and depressive symptoms. CONCLUSION: Cognitive intervention with a computer-assisted training supported by home training between face-to-face sessions is a useful tool to treat patients with MS and improve functions such as verbal memory, working memory and phonetic fluency.

Cognitive status in patients with multiple sclerosis in Lanzarote.

OBJECTIVES: Cognitive impairment is a common feature in multiple sclerosis affecting ~43%-72% of patients, which involves cognitive functions such as memory, processing speed, attention, and executive function. The aim of this study was to describe the extent and pattern of the involvement of cognitive impairment and psychological status in all patients with multiple sclerosis on a small Spanish island. PATIENTS AND METHODS: In all, 70 patients and 56 healthy controls were included in the study between February 2013 and May 2013. All participants were assessed using the Brief Repeatable Battery of Neuropsychological Test. The patients also completed instruments to evaluate the presence of fatigue, perceived cognitive dysfunction, and symptoms of anxiety and depression. All procedures were performed in a single session. RESULTS: Cognitive impairment, defined as a score <1.5 standard deviation on two subtests of the battery, was present in 35% of the participants. The most frequently affected domain was working memory, followed by verbal memory and processing speed. Disease duration showed a moderate correlation with visuospatial memory and processing speed. The Expanded Disability Status Scale score correlated with verbal and processing speed. Verbal memory was correlated with depression symptoms and fatigue. CONCLUSION: Cognitive impairment was present in 35% of the study population. The most affected domains were working memory and verbal memory. Working memory and verbal fluency deficit are independent factors of disease evolution. Cognitive decline is related to clinical variables and psychological measures such as fatigue or depression but not to anxiety.

Low Prevalence of Sleep Disorders in Demyelinating Disease in a Northern Tenerife Population.

STUDY OBJECTIVES: Sleep disorders are seen in patients with demyelinating disease (DD) more often than in the general population. Combination of physical and psychological factors such as pain, spasms, nocturia, depression, anxiety, or medication effects could contribute to sleep disruption. Frequently, these disturbances have a major impact on health and quality of life of patients. The aim of this study was to estimate the prevalence of sleep disorders in patients seen in the DD consultation. METHODS: 240 patients; mean age 43 years, 187 women; 163 patients with multiple sclerosis (MS): 144 relapsing-remitting, 19 progressive forms, 36 clinically isolated syndrome, 26 radiological isolated syndrome, and 15 patients with others DD. All participants completed questionnaires: Pittsburgh, Epworth, and Stanford scales, indirect symptoms of RLS and Obstructive Sleep Apnea, Fatigue Severity Scale, and Multiple Sclerosis Quality of Life-54. RESULTS: Moderate/severe insomnia 12.5%, OSA 5.8%, RLS 9.6% (confirmed 3 cases), narcolepsy 0, fatigue (> 4) 24.6%. Physical QoL 66.6 ± 19.6, Mental QoL 66.1 ± 21.9. Patients with an established diagnosis showed higher scores on insomnia compared to the group of CIS and RIS (F = 3.85; p = 0.023), no differences were in the other parameters. Fatigue showed high correlation with insomnia (r = 0.443; p < 0.001), RLS (r = 0.513; p < 0.001), and sleepiness (r = 0.211; p = 0.001). None of the variables included in the regression model were shown to be predictors of Physical and Mental QoL. CONCLUSIONS: A high percentage of our sample sleeps well. Emphasize the low prevalence of sleep disorders (insomnia, fatigue, RLS, etc). We detected an overestimation in the RLS questionnaire and the low QoL recorded.

Dermatosis ampollar por inmunoglobulina A lineal: Reporte de dos casos / Linear immunoglobulin A bullous dermatosis: Two cases report

La dermatosis ampollar por inmunoglobulina A lineal es una rara enfermedad, generalmente autolimitada, que afecta a niños de 4,5 años (edad media), con una incidencia de 0,52,3 casos/millón de habitantes/año. Es, tras la dermatitis herpetiforme, la enfermedad ampollar pediátrica más frecuente. Ocurre en brotes con lesión patognomónica en collar de perlas y afecta preferentemente la zona genital y peribucal. Su diagnóstico se basa en una alta sospecha clínica y en la biopsia de piel con observación de ampollas subepidérmicas y depósito lineal de inmunoglobulina A en inmunofluorescencia directa. Frecuentemente, el diagnóstico es tardío debido al desconocimiento de esta enfermedad.

Linear immunoglobulin A bullous dermatosis is a rare entity with frequent spontaneous resolution. It usually presents in children with average age of 4.5 years. Its incidence is about 0.5-2.3 cases/million individuals/year. It is, after dermatitis herpetiformis, the most frequent paediatric blister disorder. It usually appears in bouts with acute development of vesicles in strings of pearls; affecting the perioral area and genitalia. Diagnosis is based on the clinical signs and symptoms and biopsy of the skin with subepidermal blister and a linear band of immunoglobulin A in the direct immunofluorescence. Often, diagnosis is made late because of the unawareness of this disease.

Dermatosis ampollar por inmunoglobulina A lineal: Reporte de dos casos / Linear immunoglobulin A bullous dermatosis: Two cases report

La dermatosis ampollar por inmunoglobulina A lineal es una rara enfermedad, generalmente autolimitada, que afecta a niños de 4,5 años (edad media), con una incidencia de 0,52,3 casos/millón de habitantes/año. Es, tras la dermatitis herpetiforme, la enfermedad ampollar pediátrica más frecuente. Ocurre en brotes con lesión patognomónica en collar de perlas y afecta preferentemente la zona genital y peribucal. Su diagnóstico se basa en una alta sospecha clínica y en la biopsia de piel con observación de ampollas subepidérmicas y depósito lineal de inmunoglobulina A en inmunofluorescencia directa. Frecuentemente, el diagnóstico es tardío debido al desconocimiento de esta enfermedad.(AU)

Linear immunoglobulin A bullous dermatosis is a rare entity with frequent spontaneous resolution. It usually presents in children with average age of 4.5 years. Its incidence is about 0.5-2.3 cases/million individuals/year. It is, after dermatitis herpetiformis, the most frequent paediatric blister disorder. It usually appears in bouts with acute development of vesicles in strings of pearls; affecting the perioral area and genitalia. Diagnosis is based on the clinical signs and symptoms and biopsy of the skin with subepidermal blister and a linear band of immunoglobulin A in the direct immunofluorescence. Often, diagnosis is made late because of the unawareness of this disease.(AU)

[Linear immunoglobulin A bullous dermatosis: Two cases report]. / Dermatosis ampollar por inmunoglobulina A lineal: Reporte de dos casos.

Linear immunoglobulin A bullous dermatosis is a rare entity with frequent spontaneous resolution. It usually presents in children with average age of 4.5 years. Its incidence is about 0.5-2.3 cases/million individuals/year. It is, after dermatitis herpetiformis, the most frequent paediatric blister disorder. It usually appears in bouts with acute development of vesicles in strings of pearls; affecting the perioral area and genitalia. Diagnosis is based on the clinical signs and symptoms and biopsy of the skin with subepidermal blister and a linear band of immunoglobulin A in the direct immunofluorescence. Often, diagnosis is made late because of the unawareness of this disease.

Frequency of BCL2 and BCL6 translocations in follicular lymphoma: relation with histological and clinical features.

Follicular lymphomas (FLs) usually carry BCL2 translocations although BCL6 translocations are also present. We explored relationships between translocations status and clinical or histological parameters at diagnosis in 182 patients stratified in four groups: BCL2-/BCL6-, BCL2+/BCL6-, BCL2-/BCL6+ and BCL2+/BCL6+. BCL2-/BCL6- and BCL2+/BCL6-. Double negative cases were ascribed to lower histological grades. In contrast, BCL2-/BCL6+ cases corresponded to higher grades. However, a majority of BCL2+/BCL6+ tumours were classified as lower grades. These results were reinforced by the finding that double positive patients had lower LDH levels and PS than those with solitary BCL6 rearrangements. Bone marrow involvement was more frequent in BCL2+/BCL6+ compared with BCL2-/BCL6+ tumours. Our data confirm the presence of a relationship between histological grade and translocation status, suggesting that FLs carrying BCL6 translocations probably constitute a special biological subtype. Clinical and histological differences between BCL2-/BCL6+ and BCL2+/BCL6+ tumours could reflect an interplay between both translocations.

Lacrimal caruncle primary basal cell carcinoma: case report and review.

BACKGROUND: Basal cell carcinoma (BCC) is a common malignant skin neoplasm. The surface of the caruncle contains sebaceous glands, hair follicles, and lacrimal and sweat gland elements. Consequently, the caruncle may spawn any neoplasm that occurs in the conjunctiva, skin, or lacrimal gland. We report a patient with a primary BCC located on the lacrimal caruncle. METHODS: An 80-year-old man with a 5-month history of a gradually enlarging left caruncular neoplasm was seen. The lesion was nodular and irregularly brown-black colored, with no involvement of adjacent conjunctiva or skin. He had a history of sun exposure, but no personal or family history of other malignant neoplasms. RESULTS: The mass was excised completely. Histopathologic examination revealed a BCC originating in the basal layer of the conjunctival epithelium. No tumor recurrence has been noted after 7 years of follow-up. Primary BCC of the caruncle is unusual, and only four cases have been described in the PubMed. BCC should be considered in the differential diagnosis of caruncle and adjacent skin lesions.

El impacto de los cambios sociales en el ejercicio pediátrico / Social changes impact in pediatric practice

El estudio, realizado con una metodología cualitativa, intenta desentrañar el impacto que tuvieron los cambios sociales acaecidos en los últimos años sobre el ejercicio de la pediatría. Las preguntas que guiaron el trabajo y que respondieron, en calidad de informantes clave, catorse reconocidos pediatras fueron: ¿Qué problemas debe tratar la pediatría?, ¿Hubo cambios en el universo asistencial?, ¿A quién debe atenderse? ¿Qué influencia tuvieron en la práctica las modificaciones en el sistema de salud (aparición de las obras sociales, de los seguros prepagos, de los servicios de emergencias médicas)? ¿Qué impacto tuvieron los avances en los métodos diagnósticos y terapéuticos, y la segmentación de la pediatría en subespecializaciones? ¿Qué cambios experimentaron las características sociales y personales de los pacientes y la relación médico-paciente? ¿Cuál es la posición actual del pediatra en la sociedad? ¿La percepción de los cambios y de su influencia en la práctica de la pediatría es diferente en grupos con diferente antigüedad en la profesión? Aparecieron diferencias generacionales, pero también puntos de vista compartidos como el amor por la profesión, la necesidad de una atención integral (médico-psicológico-social), la repercusión económica de los cambios sociales, la percepción de que la globalización y la economía de mercado afectan a la relación médico-paciente y la continuación de la lucha por la infancia y los adolescentes

El impacto de los cambios sociales en el ejercicio pediátrico / Social changes impact in pediatric practice

El estudio, realizado con una metodología cualitativa, intenta desentrañar el impacto que tuvieron los cambios sociales acaecidos en los últimos años sobre el ejercicio de la pediatría. Las preguntas que guiaron el trabajo y que respondieron, en calidad de informantes clave, catorse reconocidos pediatras fueron: ¿Qué problemas debe tratar la pediatría?, ¿Hubo cambios en el universo asistencial?, ¿A quién debe atenderse? ¿Qué influencia tuvieron en la práctica las modificaciones en el sistema de salud (aparición de las obras sociales, de los seguros prepagos, de los servicios de emergencias médicas)? ¿Qué impacto tuvieron los avances en los métodos diagnósticos y terapéuticos, y la segmentación de la pediatría en subespecializaciones? ¿Qué cambios experimentaron las características sociales y personales de los pacientes y la relación médico-paciente? ¿Cuál es la posición actual del pediatra en la sociedad? ¿La percepción de los cambios y de su influencia en la práctica de la pediatría es diferente en grupos con diferente antig³edad en la profesión? Aparecieron diferencias generacionales, pero también puntos de vista compartidos como el amor por la profesión, la necesidad de una atención integral (médico-psicológico-social), la repercusión económica de los cambios sociales, la percepción de que la globalización y la economía de mercado afectan a la relación médico-paciente y la continuación de la lucha por la infancia y los adolescentes (AU)