European University of the Canary Islands
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Decoding the meaning of medical guidelines and their medicolegal implications
No full textMedical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make informed decisions, ensure quality of care, allocate healthcare resources effectively and reduce legal liability. MPGs have medicolegal implications, as they influence clinical decision-making and patient outcomes, which can impact liability and malpractice cases. They define the standard of care within the healthcare industry and provide best practice recommendations. MPGs are a cornerstone of the informed consent process, as they facilitate a shared decision support system and they provide valuable evidence-based recommendations on various treatments or medical options. Finally, MPGs are also relevant in medical claims; thus, adherence to MPGs is highly encouraged in order to assure the best medical care. Nonetheless, MPGs have limitations and we advocate for wise usage of MPGs combined with the expertise of trained physicians that allows for individualisation and evidence-based recommendations. In this review, we describe the potential legal implications that MPGs may represent for healthcare providers and the role that MPGs have in daily practice at different stages in the doctor–patient relationship.Sin financiación3.6 Q2 JCR 20220.987 Q1 2023No data IDR 2022UE
Restrictive vs Liberal Blood Transfusions for Patients with Acute Myocardial Infarction and Anaemia by Heart Failure Status: An RCT Subgroup Analysis
No full textBackground: Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI).
Methods: We used data from the randomized REALITY trial (https://www.clinicaltrials.gov/study/NCT02648113), comparing restrictive versus liberal transfusion strategies in patients with AMI and anaemia. HF was defined as history of HF or Killip class > 1 at randomization. Primary outcome was major adverse cardiovascular events (MACE: composite of all-cause death, non-recurrent AMI, stroke, or emergency revascularization prompted by ischaemia) at 30 days.
Results: Among 658 randomized patients, 311 (47.3%) had HF. HF patients had higher rates of MACE at 30 days and 1 year, and higher rates of non-fatal new-onset HF. There was no interaction between HF and effect of randomized assignment on the primary outcome or non-fatal new-onset HF. A liberal transfusion strategy was associated with increased all-cause death at 30 days and at 1 year in HF patients (Pinteraction = 0.009 and P = 0.049, respectively). The main numerical difference in cause of death between restrictive and liberal strategies was death by HF at 30 days (4 vs 11).
Conclusions: HF is frequent in AMI patients with anaemia and is associated with higher risk of MACE (including all-cause death) and non-fatal new-onset HF. While there was no interaction of HF with effect of transfusion strategy on MACE, a liberal transfusion strategy was associated with higher all-cause death that appears driven by a higher risk of early death due to HF.Instituto de Salud Carlos III (Spanish Ministry of Economy and Competitiveness) (PI15/01543)7.2 Q1 JCR 20221.666 Q1 SJR 2023No data IDR 2022UE
Adverse childhood experiences and cognition: A cross-sectional study in Xhosa people living with schizophrenia and matched medical controls
No full textBackground: Adverse childhood experiences (ACEs) are associated with impaired cognitive function in adult life in the general population as well as in people living with schizophrenia (PLS). Research on cognitive function in PLS in low- and middle-income countries (LMIC) is, however, limited. The objectives of this study were to investigate the association between ACE types and various cognitive domains in a sample of PLS and matched medical controls, and to determine the moderating effect of group membership (PLS vs. medical controls) on these associations, in the South African setting. Methods: Participants (n PLS = 520; n medical controls = 832) completed the Childhood Trauma QuestionnaireShort Form, the Structured Clinical Interview for DSM-IV (SCID-I), and the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB). An efficiency or speed score was used to assess performance across 9 cognitive domains. The association between exposure to different ACE types and 9 cognitive domains was examined using partial correlations and multiple linear regression models, adjusting for sex, age and education years. Finally, potential moderating effects of group membership (PLS vs. medical controls) on the association between ACEs and cognitive domains were tested. Results: In the entire sample, emotional and physical abuse predicted worse performance on sensorimotor and emotion identification domains. Also, emotional abuse was negatively associated with motor function, physical abuse was negatively associated with spatial processing, and physical neglect was negatively associated with face memory and emotion identification. In contrast, emotional neglect was related to better performance on abstraction and mental flexibility. No moderating effect of group membership was found on any of these associations. Conclusion: Exposure to ACEs was associated with social and non -social cognition in adulthood, although the magnitude of these relationships was small and similar between PLS and matched medical controls. The nature of these associations differed across ACE subtype, suggesting the need for a nuanced approach to studying a range of mechanisms that may underlie different associations. However, a number of ACE subtypes were associated with worse performance on emotional identification, indicating that some underlying mechanisms may have more transversal impact. These findings contribute to the sparse body of literature on ACEs and cognition in PLS in LMIC.National Institute of Mental Health (NIMH: Grant number U01MH125053; SAX study, grant number: 5UO1MH096754)Instituto de Salud Carlos III (PI19/00941 SURVIVE)Co-funded by the European Union (COV20/00988, PI17/00768)Fundación Española de Psiquiatría y Salud MentalThis work was also support by Erasmus, 4Alianza Universidades and the European UnionInstituto de Salud Carlos III and co-funded by the European Regional Development Fund (CD22/00061).7.3 Q1 JCR 20221.831 Q1 SJR 2023No data IDR 2022UE
Más allá del número de seguidores. Medición de la resonancia en redes sociales basada en interacciones directas
No full textIn the context of the digital attention economy, the following analysis
presents SlimScore, a method for assessing the resonance of content in
social networks, focusing on direct interactions. To test the effectiveness of
the tool, a study is carried out focusing on the social network X, based on
a sample of 345,000 messages from more than 17,000 nodes (profiles).
Through a comparative analysis with the Ayzenberg Social Index metric,
it is shown how this approach provides more accurate results in measuring
the virality of messages in social networks.En el contexto de la economía de la atención digital, se introduce en el siguiente análisis SlimScore, un método para evaluar la resonancia del contenido en redes sociales, centrándose en interacciones directas. Para comprobar la eficacia de la herramienta, se elabora un estudio centrado en la red social X, a partir una muestra de 345.000 mensajes, procedentes de más de 17.000 nodos (perfiles). Mediante un análisis comparativo con la métrica Ayzenberg Social Index, se demuestra cómo este enfoque ofrece resultados más precisos en la medición de la distribución de mensajes en redes sociales.Sin financiaciónNo data JCR 20220.128 Q2 SJR 2023No data IDR 2022UE
High diversity, novel genotypes, and vertical transmission of hemotropic Mycoplasma in micromammals
No full textHemotropic mycoplasmas (hemoplasmas) are emerging zoonotic pathogens. Micromammals have received little attention as hosts for hemoplasmas despite their ubiquitous presence, high population abundances, and close association with humans. A PCR protocol targeting a fragment of the 16 S rRNA gene and direct sequencing in blood samples of 189 adult specimens and 35 fetuses belonging to three species of Eulipotyphla (shrews) and seven species of Rodentia, captured in three ecologically diverse habitats in North-Eastern Spain (Steppe, High Mountain, Mediterranean) yielded and occurrence of 26%, including 36% of 39 shrews and 23% of 150 rodents. Sequencing revealed the presence of 14 nucleotide sequence types (ntST) among the 56 readable sequences. In general, each ntST was associated with a given host species, although in some cases, the same ntST was sequenced in different species (chiefly rodents). Most ntST were closely related to rodent and/or bat hemoplasmas, but one was identical with Mycoplasma haemocanis/haemofelis, and others can be considered novel genotypes. High sequence diversity was detected in rodents, whereas in the white-toothed shrew (Crocidura russula), 9/11 sequences from two distant areas were identical. Phylogenetic and network analyses classified our sequences in different clades including hemoplasmas of rodents, carnivores, bats, and humans. Twelve of the fetuses (34.2%) of 9/12 litters (75.0%) of shrews and rodents were hemoplasma-positive, indicating frequent vertical transmission. Our study contributes to expanding our knowledge about the distribution, diversity, and transmission of hemoplasmas.Gobierno de España (CGL2010-17931) and Gobierno de Aragón (A16_23R)2.0 Q4 JCR 20220.543 Q1 2023No data IDR 2023UE
A multidisciplinary approach to analyze the antimicrobial resistance in natural ecosystems
No full textAntimicrobial Resistance (AMR) poses a global threat to both human health and environmental well-being. Our study delved into Costa Rican wildlife reserves, uncovering a substantial human impact on these ecosystems and underscoring the imperative to pinpoint AMR hotspots. Embracing a One Health perspective, we advocated for a comprehensive landscape analysis that intricately intertwined geographic, climatic, forest, and human factors. This study illuminated the link between laboratory results and observed patterns of antimicrobial use, thereby paving the way for sustainable solutions. Our innovative methodology involved deploying open-ended questions to explore antimicrobial usage across livestock activities, contributing to establishing a comprehensive methodology. Non-invasive sampling in wildlife emerged as a critical aspect, shedding light on areas contaminated by AMR. Feline species, positioned at the apex of the food chain, acted as sentinels for environmental health due to heightened exposure to improperly disposed waste. Regarding laboratory findings, each sample revealed the presence of at least one antimicrobial resistance gene (ARG). Notably, genes encoding resistance to tetracyclines dominated (94.9%), followed by beta-lactams (75.6%), sulfonamides (53.8%), aminoglycosides (51.3%), quinolones (44.9%), phenicols (25.6%), and macrolides (20.5%). Genes encoding polymyxins were not detected. Moreover, 66% of samples carried a multi-resistant microbiome, with 15% exhibiting resistance to three antimicrobial families and 51% to four. The absence of a correlation between forest coverage and ARG presence underscored the profound human impact on wildlife reserves, surpassing previous estimations. This environmental pressure could potentially modify microbiomes and resistomes in unknown ways. As not all antimicrobial families encoding ARGs were utilized by farmers, our next step involved evaluating other human activities to identify the primary sources of contamination. This comprehensive study contributed crucial insights into the intricate dynamics of AMR in natural ecosystems, paving the way for targeted interventions and sustainable coexistence.Fondo de Educación Superior Estatal del Consejo Nacional de Rectores de Costa Rica (CONARE)8.3 Q1 JCR 20221.679 Q1 SJR 2023No data IDR 2023UE