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Invasive Treatment Strategy in Adults With Frailty and Non-ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial
No full textImportance: The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year.
Objective: To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up.
Design, setting, and participants: The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle.
Interventions: Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy.
Main outcomes and measures: The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions.
Results: Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points.
Conclusions and relevance: In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior.Centro de Investigacion Biomedica en Red Enfermedades Cardiovaculares (FIS 17/01736)13.8 Q1 JCR 20223.478 Q1 SJR 2023No data IDR 2022UE
Editorial: Break the mental health stigma: mental health in the workplace
No full textThe workplace today is an environment where mental health issues are increasingly becoming a focus of interest and concern. However, in some organizations, there is still a stigma attached to this issue. This can lead to discriminatory actions and attitudes towards employees who live with mental disorders, both at the personal and public levels. In particular, the stigmatization of people living with mental disorders in the workplace has a number of detrimental effects such as emotional distress (feeling uncomfortable and embarrassed), lower self-esteem, difficulties in social relationships, and a lower likelihood of initiating or maintaining a psychological treatment. It can also lead to difficulties in workplace relationships and in getting support or other job benefits (1). This Research Topic aims to integrate twelve studies in order to pave the way towards breaking down the barriers of mental health stigma in the workplace. This Editorial encompasses pioneering research endeavors, from observational studies, validation studies of new assessment tools until intervention studies, and integrates the complexities of mental health in professional settings, offering insights, and solutions to foster supportive environments where individuals can thrive.Fundação para a Ciência e a Tecnologia, I.P. (UIDB/05704/2020)Fundação para a Ciência e a Tecnologia, I.P. (UIDP/05704/2020)Scientific Employment Stimulus. Institutional Call. (https://doi.org/10.54499/CEECINST/00051/2018/CP1566/ CT0012)4.7 Q2 JCR 20221.155 Q1 SJR 2023No data IDR 2022UE
Conflictos familiares y gastos extraordinarios en la pensión de alimentos: Algunas cuestiones prácticas
No full textLa presente investigación reflexiona sobre las situaciones conflictivas familiares, en especial de aquellas familias con hijos, bien sean parejas divorciadas o parejas que nunca han tenido vinculación jurídica entre ellas, y la gran relevancia de la utilización de mecanismos de resolución alternativa de conflictos con el fin de gestionar de forma asertiva y ágil las cuestiones relativas a sus problemáticas, en especial aquellas de alta litigiosidad como es la definición y determinación de la responsabilidad sobre aquellos gastos de naturaleza extraordinaria complementarios a los gastos que se incluyen en la fijación de la pensión de alimentos, debido a que estos según jurisprudencia pacífica en España son gastos imprevisibles y no periódicos lo cual impide su cuantificación anticipada o periódica.This research reflects on family conflict situations, especially those families with children, whether they are divorced couples or couples who have never had a legal relationship between them, and the great relevance of the use of alternative conflict resolution mechanisms in order to manage in an assertive and agile manner the issues related to their problems, especially those of high litigation such as the definition and determination of responsibility for those expenses of an extraordinary nature complementary to the expenses that are included in the establishment of alimony because these, according to calm jurisprudence in Spain, are unpredictable and non-periodic expenses, which prevents their early or periodic quantification. With this purpose in mind, this research provides brief insights into the legal obligation of support between relatives, including its main characteristics, to later delve into the need or recommendation of including clauses in regulatory agreements regarding extraordinary expenses, concluding with a brief study jurisprudence on extraordinary expenses when children are minors or adults, emphasizing those related to pharmaceutical expenses and those related to the issuance of the child’s national identity document and passport.Sin financiación0.1 Q4 JCR 2022No data SJR 2023No data IDR 2022UE
Melatonin as an anti-stress signal: effects on an acute stress model and direct actions on interrenal tissue in goldfish
No full textBackground: Melatonin is a key hormone in regulation of circadian rhythms, and involved in many rhythmic functions, such as feeding and locomotor activity. Melatonin reportedly counteracts stress responses in many vertebrates, including fish. However, targets for this action of melatonin and underlying mechanisms remain unknown.
Results: This study reports potential anti-stress properties of melatonin in goldfish (Carassius auratus), with a focus on its effect on plasma cortisol, food intake, and locomotor activity, all of them involved in the responses to stress exposure. Indeed, acute injection of melatonin counteracted stress-induced hypercortisolinemia and reduced food intake. The reduced locomotor activity following melatonin treatment suggests a possible sedative role in fish. To assess whether this anti-stress effects of melatonin involve direct actions on interrenal tissue, in vitro cultures of head kidney (containing the interrenal cortisol-producing tissue) were carried out in presence of ACTH, melatonin, and luzindole, an antagonist of melatonin receptors. Melatonin in vitro reduced ACTH-stimulated cortisol release, an effect attenuated by luzindole; this suggests the presence of specific melatonin receptors in interrenal tissue.
Conclusions: Our data support a role for melatonin as an anti-stress signal in goldfish, and suggest that the interrenal tissue of teleosts may be a plausible target for melatonin action decreasing cortisol production.Ministerio de Ciencia e Innovación (PID2019-103969RB-C32; PID2022-136288OB-C32)5.2 Q1 JCR 20221.24 Q1 SJR 2023No data IDR 2022UE
Estudio de la relación de la actividad física con aspectos generales de la vida en población adulta mayor en la Comunidad Valenciana
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Biomedicina y Ciencias de la SaludEl envejecimiento de la población a nivel mundial es una realidad creciente que sin duda nos
obliga como sociedad a estudiar los diferentes factores que influyen en la vida de las personas
mayores. El envejecimiento saludable es, entre otros, uno de los objetivos o medios propuestos
por la Organización Mundial de la Salud para garantizar la máxima capacidad intrínseca de las
personas mayores y se encuentra estrechamente ligado al concepto de envejecimiento activo.
Es por ello por lo que, la promoción de la actividad física en la población mayor de 65 años se ha
convertido en un aspecto crucial para mejorar la calidad de vida relacionada con la salud, así
como por su influencia en la prevención de enfermedades crónicas.
Sin embargo, en la Comunidad Valenciana, detectamos una falta de estudios que analizaran la
relación del tiempo que las personas mayores se mantenían físicamente activas con la calidad
de vida, las enfermedades no transmisibles, el riesgo de sufrir enfermedades mentales y las
limitaciones para realizar actividades de la vida diaria. Por lo tanto, esta tesis doctoral pretende
dar respuesta a esta brecha en la investigación y examinar cómo la actividad física y otros
factores sociodemográficos influyen en la vida de las personas mayores de 65 años en la
Comunidad Valenciana.
El objetivo principal de la presente tesis doctoral consistió en analizar el tiempo que las personas
mayores se mantenían físicamente activas, y relacionarlo con aspectos claves de la salud. Lo cual
se concretó a través de objetivos específicos en los que se fue relacionando el nivel de actividad
física (insuficiente, recomendado o adicional), junto con otras variables demográficas de interés,
como la edad, el sexo o el nivel de estudios con diferentes apartados de la Encuesta de Salud de
Comunidad Valenciana.
Para lograr este objetivo, se llevó a cabo un estudio transversal a partir de la solicitud a la
Dirección General de Salud Pública de la Conselleria de Sanidad de la Comunidad Valenciana del
acceso a los resultados de la Encuesta de Salud de la Comunidad Valenciana correspondiente al
año 2016, donde recogían datos de los veinticuatro departamentos de salud y de la cual
obtuvimos una muestra de 3.199 individuos con una edad igual o superior a los 65 años.
El diseño del estudio incluyó los apartados recogidos en la Encuesta de Salud de la Comunidad
Valenciana relativos a datos sociodemográficos, calidad de vida relacionada con la salud,
morbilidad, salud mental, actividad física y limitaciones para realizar actividades de la vida diaria,
donde se utilizaban cuestionarios estandarizados para recopilar la información. Para contrastar
la existencia de relación significativa entre las variables se utilizaron diferentes pruebas
estadísticas que culminaron en la realización de modelos de regresión logística multivariante Los resultados obtenidos indican una asociación significativa entre la actividad física y la calidad
de vida relacionada con la salud en adultos mayores. Aquellos que mantenían un nivel
recomendable o adicional de actividad física según las recomendaciones de la OMS mostraron
una mejor percepción de su bienestar general y una menor incidencia de enfermedades
crónicas. Se observó una reducción en el riesgo de desarrollar problemas de salud mental y
menos limitaciones para realizar actividades cotidianas en aquellos que se mantenían
físicamente activos. Además, se encontró que la actividad física regular estaba asociada con una
mejor salud cardiovascular y un menor riesgo de desarrollar diabetes, EPOC y cáncer en esta
población.
En conclusión, los hallazgos de esta investigación respaldan la importancia de implementar
políticas y programas de promoción de la actividad física dirigidos específicamente a la población
mayor de 65 años en la Comunidad Valenciana. Mantenerse físicamente activo según las
directrices de la OMS no solo está asociado con una mejor calidad de vida, sino que también
puede ayudar a prevenir enfermedades crónicas, reducir el riesgo de problemas de salud mental
y mejorar la capacidad funcional en la vida diaria.The aging of the population worldwide is an increasing reality that undoubtedly compels us as a
society to study the different factors that influence the lives of older adults. Healthy aging is,
among others, one of the objectives or means proposed by the World Health Organization to
ensure the maximum intrinsic capacity of older people and is closely linked to the concept of
active aging. Therefore, promoting physical activity in the population over 65 has become a
crucial aspect for improving health-related quality of life, as well as for its influence on the
prevention of chronic diseases.
However, in the Valencian Community, we detect a lack of studies analyzing the relationship
between the time older adults spend physically active and quality of life, non-communicable
diseases, the risk of mental illnesses, and limitations in performing daily activities. Therefore,
this doctoral thesis aims to address this research gap and examine how physical activity and
other sociodemographic factors influence the lives of people over 65 in the Valencian
Community.
The main objective of this doctoral thesis was to analyze the time older adults spent physically
active and relate it to key health aspects. This was achieved through specific objectives in which
the level of physical activity (insufficient, recommended, or additional) was related to other
demographic variables of interest, such as age, sex, or level of education, along with different
sections of the Valencian Community Health Survey.
To achieve this objective, a cross-sectional study was conducted based on a request to the
General Directorate of Public Health of the Valencia Department of Health for access to the
results of the Valencian Community Health Survey for the year 2016, which collected data from
the twenty-four health departments and from which we obtained a sample of 3.199 individuals
aged 65 years or older.
The study design included sections collected in the Valencian Community Health Survey
regarding sociodemographic data, health-related quality of life, morbidity, mental health,
physical activity, and limitations in performing daily activities, where standardized
questionnaires were used to collect information. To test the existence of a significant
relationship between the variables, different statistical tests were used, culminating in the
creation of multivariate logistic regression models.
he results indicate a significant association between physical activity and health-related quality
of life in older adults. Those who maintained a recommended or additional level of physical activity according to WHO recommendations showed a better perception of their overall well being and a lower incidence of chronic diseases. A reduction in the risk of developing mental
health problems and fewer limitations in performing daily activities were observed in those who
remained physically active. Additionally, regular physical activity was associated with better
cardiovascular health and a lower risk of developing diabetes, COPD, and cancer in this
population.
In conclusion, the findings of this research support the importance of implementing policies and
programs to promote physical activity specifically targeted at the population over 65 in the
Valencian Community. Remaining physically active according to WHO guidelines is not only
associated with better quality of life but can also help prevent chronic diseases, reduce the risk
of mental health problems, and improve functional capacity in daily life.No data 2022UE
Monitorización en pacientes críticos ingresados en UCI
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Biomedicina y Ciencias de la SaludLa supervisión continua de parámetros fisiológicos en la Unidad de Cuidados
Intensivos (UCI) es crucial en la detección temprana de cambios en el estado del
paciente y en la toma de decisiones clínicas precisas. La integración de sistemas
de ayuda a la toma de decisiones clínicas eficaces, en inglés Clinical Decision
Support Systems (SSDC), en los Servicios de Medicina Intensiva (SMI) se
presenta como una necesidad imperativa, dada la rápida evolución tecnológica
y la demanda de información en tiempo real por parte de los clínicos
intensivistas.
Se pone énfasis en explorar la importancia y los beneficios de la monitorización
automática de parámetros en la UCI mediante dispositivos IoMT (Internet of
Medical Things). Este enfoque busca avanzar hacia una UCI modernizada, donde
la sensorización y la monitorización sean automatizadas, no invasivas y en
tiempo real, con la posibilidad de desarrollar modelos predictivos para asistir al
clínico intensivista dotándole de un sistema de ayuda a la toma de decisiones
clínicas más completa.
Se propone la automatización de la recolección de datos de diversos parámetros
de forma automática e inteligente, utilizando la conectividad proporcionada por
la IoMT, con el fin de centralizar la información y alimentar los sistemas de
información clínica (SIC) de la UCI, sin perder de vista el sentido clínico. Además,
se aborda el estudio y desarrollo de dispositivos que cubran necesidades no
satisfechas total o parcialmente según los clínicos.
Se examinan las capacidades de estos dispositivos para recopilar datos en
tiempo real, transmitirlos de manera segura a los sistemas de información
clínica y proporcionar alertas tempranas ante cambios significativos en el estado
del paciente. Así mismo, se evalúa el impacto de esta tecnología en la mejora de
los resultados clínicos, la eficiencia del personal sanitario y la reducción de
costos asociados con la atención en la UCI. Esta investigación, parte de una línea de investigación en curso, presentando los
avances realizados hasta la fecha, así como describe el trabajo actual y
delineando futuras líneas de investigación.
Los hallazgos de esta investigación proporcionarán una comprensión más
profunda de cómo la monitorización automática de parámetros fisiológicos
utilizando dispositivos IoMT puede transformar la atención en la UCI,
optimizando la detección de cambios críticos en el estado del paciente y
facilitando la toma de decisiones clínicas más informadas y oportunas. Esto
implica una mejora significativa en la carga de trabajo de los intensivistas, al
disponer de herramientas de apoyo que hacen más eficiente su labor.Continuous monitoring of physiological parameters in the Intensive Care Unit
(ICU) plays a crucial role in early detection of changes in patient status and
precise clinical decision-making. The integration of effective Clinical Decision
Support Systems (CDSS) in Intensive Care Medicine Services (ICMS) is presented
as an imperative necessity, given the rapid technological evolution and demand
for real-time information by intensivist clinicians.
Emphasis is placed on exploring the importance and benefits of automatic
parameter monitoring in the ICU through Internet of Medical Things (IoMT)
devices. This approach aims to advance towards a modernized ICU, where
sensorization and monitoring are automated, non-invasive, and real-time, with
the potential to develop predictive models to assist the intensivist clinician with
a more comprehensive clinical decision support system.
Automating the collection of data from various parameters in an intelligent
manner, using IoMT-provided connectivity, is proposed to centralize information, and feed the ICU's Clinical Information Systems (CIS), without
losing sight of clinical relevance. Additionally, the study and development of
devices that address partially or entirely unmet clinical needs are addressed.
The capabilities of these devices to collect real-time data, transmit it securely to
clinical information systems, and provide early alerts to significant changes in
patient status are examined. Furthermore, the impact of this technology on
improving clinical outcomes, healthcare staff efficiency, and reducing costs
associated with ICU care is evaluated.
This research, part of an ongoing research line, presents the advances made to
date, describes current work, and outlines future research directions.
The findings of this research will provide a deeper understanding of how
automatic monitoring of physiological parameters using IoMT devices can
transform ICU care, optimizing the detection of critical changes in patient status
and facilitating more informed and timely clinical decision-making. This implies
a significant improvement in the workload of f intensivists, by providing support
tools that make their work more efficient.No data 2022UE
Gaia Focused Product Release: A catalogue of sources around quasars to search for strongly lensed quasars
No full textContext. Strongly lensed quasars are fundamental sources for cosmology. The Gaia space mission covers the entire sky with the
unprecedented resolution of 0.18′′ in the optical, making it an ideal instrument to search for gravitational lenses down to the limiting
magnitude of 21. Nevertheless, the previous Gaia Data Releases are known to be incomplete for small angular separations such as
those expected for most lenses.
Aims. We present the Data Processing and Analysis Consortium GravLens pipeline, which was built to analyse all Gaia detections
around quasars and to cluster them into sources, thus producing a catalogue of secondary sources around each quasar. We analysed the
resulting catalogue to produce scores that indicate source configurations that are compatible with strongly lensed quasars.
Methods. GravLens uses the DBSCAN unsupervised clustering algorithm to detect sources around quasars. The resulting catalogue
of multiplets is then analysed with several methods to identify potential gravitational lenses. We developed and applied an outlier
scoring method, a comparison between the average BP and RP spectra of the components, and we also used an extremely randomised
tree algorithm. These methods produce scores to identify the most probable configurations and to establish a list of lens candidates.
Results. We analysed the environment of 3 760 032 quasars. A total of 4 760 920 sources, including the quasars, were found within 6′′
of the quasar positions. This list is given in the Gaia archive. In 87% of cases, the quasar remains a single source, and in 501 385 cases
neighbouring sources were detected. We propose a list of 381 lensed candidates, of which we identified 49 as the most promising ones.
Beyond these candidates, the associate tables in this Focused Product Release allow the entire community to explore the unique Gaia
data for strong lensing studies further.Marie Curie Research Training Network (MRTNCT-2006-033481),Marie Curie project PIOFGA-2009-255267 (Space AsteroSeismology & RR Lyrae stars, SAS-RRL)(MTKD-CT-2004-014188)FP7-606740 (FP7-SPACE-2013-1)5.4 Q1 JCR 20231.896 Q1 SJR 2023No data IDR 2023UE
Design of a mortar including waste materials for intervention in public spaces in exomarine areas in coastal tourist territories
No full textAnnually, the oceans become the depositories of millions of tonnes of plastic waste, a
global environmental crisis that has intensified over recent decades. This accumulation
of marine plastics not only poses a significant threat to aquatic ecosystems but also
emerges as a burgeoning challenge for waste management worldwide. In this context,
the construction sector, as the principal consumer of resources and waste generator
within the European Union, plays a pivotal role. This is particularly pertinent in the
Canary Islands archipelago, due to its isolated condition, necessitating the incorporation
of circular economy processes to mitigate material dependence from external sources
for construction products, as no raw materials are manufactured or processed in the
regionSin FinanciaciónNo data SPI 2022UE
Diccionario radical: Apostillas a La Arquitectura Radical
No full textSin FinanciaciónNo data JCR 2023; No data SJR 2023; 0,02 C4 IDR 202