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Background: Health inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. Methods: We analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016–December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. Results: The mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00–1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37–2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12–1.59) and mental (PR = 1.49; 95 %CI = 1.33–1.66) health days. Conclusion: HCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.

Background: Career motivation toward gerontological nursing (CMGN) has been studied by various authors. It is essential to identify the influencing factors and guarantee that undergraduate nursing degrees provide adequate social and healthcare responses to the current demand for gerontological care. Objective: In the absence of a validated instrument to measure students' career motivation in geriatric nursing in our sociocultural context, this study aimed to adapt and validate the original questionnaire Chinese CMGN. Methods: Cross-sectional data from 316 nursing students were collected in May 2021. The cultural and linguistic adaptation process was conducted in accordance with the recommendations of Ramada-Rodilla and Beaton. A committee of experts was established to assess content validity. The CMGN questionnaire consists of 20 items divided into 2 subscales: “Expectancy” (6 items) and “Values” (14 items). To determine the psychometric properties, the following analyses were carried out: content validity (Aiken's V coefficient and Pearson's coefficient of variation), internal consistency (Cronbach's α) and construct validity (confirmatory factor analysis and convergent and divergent validity). To verify the model once the parameters were estimated, we calculated the goodness-of-fit between the model and the data. Data analyses were performed using SPSS for Windows (IBM SPSS Statistics 25.0) and Analysis of Moment Structures (AMOS 27.0). Results: A total of 316 nursing students were surveyed, of which 91.1% were women and the mean age was 21.61 ± 5.45 years (range: 18–56). The results indicate that the psychometric properties of the questionnaire were adequate in terms of content and construct validity. The internal consistency using Cronbach's alpha for both subscales was greater than 0.8. The AMOS results revealed that the final model fit statistics of CMIN/df (2.204), GFI (0.922), CFI (0.948) and RMSEA (0.062) indicated a satisfactory model fit. Finally, an original second-order model was obtained, resulting in the Spanish version of the CMGN (SV-CMGN) instrument. Conclusions: We developed a valid SV-CMGN questionnaire that is socially and culturally adapted to the Spanish context and is capable of measuring the motivation of nursing students toward a career in gerontological nursing, from the newest to the most experienced. This new version opens up the possibility of studying the phenomenon of motivation in other Spanish-speaking countries. Keywords: Gerontological nursing; Motivation; Students, nursing; Validation study; Surveys and questionnaires.

Objectives: This study aimed to investigate the impact of a multicomponent exercise programme on perceived health-related quality of life (HRQoL) and depressive symptomatology in older people living in a long-term nursing home (LTNH). Methods: A quasi-experimental study was conducted. Forty-one older people were conveniently selected from the largest LTNH in the Basque Country. The participants were assigned to either an intervention group (n = 21) or a control group (n = 20). The intervention group participated in 50-min moderate intensity multicomponent physical exercise sessions (strength and balance, three sessions a week for 3 months). The control group participants continued their usual activities in the LTNH. Assessments were completed at baseline and reassessed after the 12-week intervention by the same nurse researchers who filled out the questionnaires: the 36-item Short Form Survey (SF-36) and the Geriatric Depression Scale (GDS). Results: Thirty-eight participants completed the study (19 participants in each group). In the SF-36 parameters, physical functioning increase in the intervention group tends with a mean increase of 11.06 units (a 17.2% increase over the pre). In the role-emotional, the increase in the intervention group is with a mean increase of 5.27 units (a 29.1% increase over the pre) (P

Summary: Background: Policymakers urgently need evidence to adequately balance the costs and benefits of mass vaccination against COVID-19 across all age groups, including children and adolescents. In this study, we aim to assess the effectiveness of CoronaVac's primary series among children and adolescents in Chile. Methods: We used a large prospective national cohort of about two million children and adolescents 6–16 years to estimate the effectiveness of an inactivated SARS-CoV-2 vaccine (CoronaVac) in preventing laboratory-confirmed symptomatic SARS-CoV-2 infection (COVID-19), hospitalisation, and admission to an intensive care unit (ICU) associated with COVID-19. We compared the risk of individuals treated with a complete primary immunization schedule (two doses, 28 days apart) with the risk of unvaccinated individuals during the follow-up period. The study was conducted in Chile from June 27, 2021, to January 12, 2022, when the SARS-CoV-2 Delta variant was predominant but other variants of concern were co-circulating, including Omicron. We used inverse probability-weighted survival regression models to estimate hazard ratios of complete immunization over the unvaccinated status, accounting for time-varying vaccination exposure and adjusting for relevant demographic, socioeconomic, and clinical confounders. Findings: The estimated adjusted vaccine effectiveness for the inactivated SARS-CoV-2 vaccine in children aged 6–16 years was 74.5% (95% CI, 73.8–75.2), 91.0% (95% CI, 87.8–93.4), 93.8% (95% CI, 87.8–93.4) for the prevention of COVID-19, hospitalisation, and ICU admission, respectively. For the subgroup of children 6–11 years, the vaccine effectiveness was 75.8% (95% CI, 74.7–76.8) for the prevention of COVID-19 and 77.9% (95% CI, 61.5–87.3) for the prevention of hospitalisation. Interpretation: Our results suggest that a complete primary immunization schedule with the inactivated SARS-CoV-2 vaccine provides effective protection against severe COVID-19 disease for children 6–16 years. Funding: Agencia Nacional de Investigación y Desarrollo (ANID) Millennium Science Initiative Program and Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (FONDAP).

Background: Synovial sarcoma (SS) is characterized by local invasiveness and a propensity to develop distant metastases. Current treatment for pediatric patients is based on the strategy used by the two main international groups, the Children's Oncology Group (COG) and the European group (EpSSG).Overall survival (OS) and event free survival (EFS) vary according to different publications; however, they tend to be dismal in initially metastatic patients, as well as relapsed patients. Objective: To describe the clinical, histopathological, molecular findings and outcome in a series of 22 pediatric patients treated at our institution over 15 years. Materials and methods: A retrospective, descriptive study in patients with a histopathological or molecular diagnosis of SS between December 2005 and August 2019, treated according to the EpSSGNRSTS 2005 protocol. Results: Median age at diagnosis was 138.1 months, 32.1% presented with a primary axial site, and 68% with a tumor larger than 5 cm. Initial metastatic disease was seen in 22.7%. Of initially localized patients, 70.6% were classified as high-risk. Chemotherapy was administered to 91% of our patients and 77.2% received radiotherapy.The 3-5- and 10-year OS and EFS was 66%, 58.7% and 48.9%, and 57%, 33%, 22.2% respectively. Localized patients had a 5- and 10-year OS of 73.3% and 61.1%, versus 40% and 0% in metastatic disease, respectively.The only statistically significant factors were presence of metastasis, tumor size and IRS group.Tumor relapse was seen in 31.8% of patients. Only patients with local recurrence that achieved a complete surgery are alive without disease. Treatment schemes after recurrence or progression included a combination of gemcitabine-docetaxel, vincristine-irinotecan-temozolomide, kinase tyrosine inhibitors, and metronomic therapy with cyclophosphamide or etoposide. A long progression free survival of 14 months was observed with etoposide. Conclusions: Although the sample size was not large enough to draw robust conclusions, in our series, OS and EFS rates were found to be lower than those reported in other studies, probably related to unfavorable prognostic factors, including a high incidence of metastasis and tumors larger than 5 cm. New therapeutic strategies are needed to improve outcome, especially in metastatic and relapsed disease. In addition, assessing the role of maintenance therapy in larger numbers of patients and broadening the use of metronomic chemotherapy would be necessary.

Resumen: Introducción: El derrame pleural (DP) maligno se asocia a un mal pronóstico, pero la mortalidad de los pacientes con derrames no malignos no ha sido suficientemente estudiada. Nuestro objetivo fue describir la evolución clínica y explorar los factores asociados con la mortalidad por todas las causas a 1, 5 y 10 años de los pacientes que desarrollan un DP. Métodos: Estudio observacional retrospectivo de los pacientes intervenidos mediante toracocentesis diagnóstica durante el decenio 2008-2017 en un servicio de neumología. Se evaluaron variables demográficas, bioquímicas, anatomopatológicas y evolutivas. La etiología de los derrames se determinó mediante criterios estandarizados. Resultados: Se estudió a 358 pacientes con líquido pleural analizado; el 69,2% de los cuales eran varones con una edad media de 68,9 años (DE 15,1). Predominaron los derrames malignos (29,4%), paraneumónicos (19,8%) y secundarios a insuficiencia cardiaca (18,9%). Los pacientes con derrame maligno y por insuficiencia cardiaca tuvieron tasas de mortalidad a un año del 60,0% y 30,8%, respectivamente y del 85% y 64,7% a 5 años. El sexo masculino (hazard ratio [HR] 1,46; IC 95%: 1,03-2,07), la citología positiva para malignidad (HR 1,66; IC 95%: 1,03-2,68) y la recidiva del derrame (HR 1,61; IC 95%: 1,17-2,21) se asociaron a un peor pronóstico y a mortalidad a 5 años. Conclusiones: Los pacientes intervenidos mediante toracentesis por derrame tienen una alta mortalidad a corto y largo plazo. En nuestros pacientes hospitalizados con DP, los factores asociados con mayor mortalidad a 1 y 5 años fueron la edad, el sexo masculino, la recidiva del DP y la coexistencia de neoplasia maligna. Abstract: Introduction: Occurrence of malignant pleural effusion (PE) is known to be associated with a poor prognosis, but the mortality of patients with non-malignant effusions has not been sufficiently studied. Our objective was to describe the clinical course and explore risk factors associated with all-cause mortality at 1, 5 and 10 years in patients who develop a PE. Methods: Retrospective observational study of patients undergoing diagnostic thoracentesis during the decade 2008-2017 in a pulmonology service. Demographic, biochemical, pathological and evolutionary variables were evaluated. The etiology of the effusions was determined using standardized criteria. Results: Pleural fluid samples from 358 patients with a mean age of 68.9 years (SD 15.1 years), 69.2% males, were analyzed. Malignant (29.4%), parapneumonic (19.8%) and secondary to heart failure (18.9%) effusions predominated. Patients with malignant and heart failure related PE had 1-year mortality rates of 60.0% and 30.8%, respectively, and 85% and 64.7% at 5 years. Male gender (hazard ratio [HR] 1.46; 95% CI: 1.03-2.07), positive cytology for malignancy (HR 1.66; 95% CI: 1.03-2.68) and effusion recurrence (HR 1.61; 95% CI: 1.17-2.21) were associated with a worse prognosis and 5-year mortality. Conclusions: Patients undergoing thoracentesis for effusion have a high short and long-term mortality. In our series of hospitalized patients with PE, the factors associated with higher mortality at 1 and 5 years were age, male sex, recurrence of PE, and coexistence of malignancy.

Resumen: Antecedentes: Las sepsis son las infecciones nosocomiales más frecuentes en las Unidades de Cuidados Intensivos Neonatales (UCIN), afectando especialmente a los recién nacidos de muy bajo peso al nacer (RNMBP, ≤ 1.500 g). Un sistema de vigilancia epidemiológica puede contribuir a su prevención mediante una evaluación continua de su frecuencia y factores de riesgo asociados. El objetivo de este artículo es describir la implementación del sistema de vigilancia de las sepsis nosocomiales en RNMBP (NeoKissEs) en un grupo de UCIN españolas. Métodos: Estudio de cohorte de RNMBP con < 28 días de edad ingresados en las UCIN participantes. Dos UCIN tradujeron y adaptaron materiales a partir del sistema original alemán NEO-KISS. Durante la implementación, se desarrollaron 8 talleres formativos, con participación de 210 profesionales. Se creó un sistema web para la introducción de datos de pacientes y episodios de sepsis, su monitorización, análisis comparativo y retroalimentación a las unidades. En cada UCIN, un neonatólogo fue responsable de la implementación, recogiendo información sobre las dificultades percibidas durante el proceso. Resultados: De 50 unidades que aceptaron participar, 45 utilizaron NeoKissEs durante la fase de implementación, registrando 1.108 episodios de sepsis asociados a catéter vascular en 3.638 neonatos, con una tasa de 18,4 episodios por 1.000 pacientes-día con catéter (IC del 95%: 17,8-19,1). Conclusiones: El sistema de vigilancia epidemiológica NeoKissEs representa una fuente útil de información para la comparación estandarizada de la incidencia de sepsis de las UCIN, evaluar factores de riesgo y facilitar la evaluación del efecto de futuras intervenciones preventivas. Abstract: Background: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500 g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. Methods: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2 NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. Results: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. Conclusions: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.

Background: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500 g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. Methods: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2 NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. Results: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. Conclusions: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs. Resumen: Antecedentes: Las sepsis son las infecciones nosocomiales más frecuentes en las Unidades de Cuidados Intensivos Neonatales (UCIN), afectando especialmente a los recién nacidos de muy bajo peso al nacer (RNMBP, ≤ 1.500 g). Un sistema de vigilancia epidemiológica puede contribuir a su prevención mediante una evaluación continua de su frecuencia y factores de riesgo asociados. El objetivo de este artículo es describir la implementación del sistema de vigilancia de las sepsis nosocomiales en RNMBP (NeoKissEs) en un grupo de UCIN españolas. Métodos: Estudio de cohorte de RNMBP con < 28 días de edad ingresados en las UCIN participantes. Dos UCIN tradujeron y adaptaron materiales a partir del sistema original alemán NEO-KISS. Durante la implementación, se desarrollaron 8 talleres formativos, con participación de 210 profesionales. Se creó un sistema web para la introducción de datos de pacientes y episodios de sepsis, su monitorización, análisis comparativo y retroalimentación a las unidades. En cada UCIN, un neonatólogo fue responsable de la implementación, recogiendo información sobre las dificultades percibidas durante el proceso. Resultados: De 50 unidades que aceptaron participar, 45 utilizaron NeoKissEs durante la fase de implementación, registrando 1.108 episodios de sepsis asociados a catéter vascular en 3.638 neonatos, con una tasa de 18,4 episodios por 1.000 pacientes-día con catéter (IC del 95%: 17,8-19,1). Conclusiones: El sistema de vigilancia epidemiológica NeoKissEs representa una fuente útil de información para la comparación estandarizada de la incidencia de sepsis de las UCIN, evaluar factores de riesgo y facilitar la evaluación del efecto de futuras intervenciones preventivas.

Background: Intravenous acetaminophen (IV APAP) is an option in multimodal postoperative analgesia. Prior trials focus on hip and knee arthroplasties, whereas large-scale data on utilization and effectiveness in shoulder arthroplasties are lacking. Methods: Data on 67,494 (452 hospitals) partial/total shoulder arthroplasties were extracted from the Premier claims database (2011–2016). Patients were categorized by receipt and dosage of IV APAP. Multilevel models measured associations between IV APAP and opioid utilization (in oral morphine equivalents), length/cost of stay and opioid-related complications. Effect estimates (adjusted % change) with 95% confidence intervals (CIs) are reported. Results: IV APAP was used in 17.7% (n = 11,949) of patients with an increasing utilization trend. Most patients received only one dose on the day of surgery (69.5%; n = 8308). When adjusting for relevant covariates, IV APAP was not associated with meaningful effects on outcomes. Specifically, its use (versus no use) was not associated with decreased (but rather somewhat increased) opioid utilization: + 5.4% (CI 3.6–7.1%; P

Objectives: To describe this uncommon but outstanding vascular post-treatment complication attributable to detached polymer coatings from intravascular medical devices employed in diagnostic or therapeutic procedures. Methods: In this retrospective study we report the cases of two patients who after endovascular procedures for brain aneurysms developed neurological onsets which required further radiological analysis. Results: In the Magnetic Resonance studies performed after the neurological attacks the patients developed multiple millimetric enhancing lesions in the vascular area of the procedure: Both patients underwent biopsy. The imaging findings and clinical course suggested foreign body reactions in both cases, this being histologically confirmed in one case by the presence of thread-like material compatible with a polymer coating. Conclusions: Fragments from polymer-coated devices used in intravascular procedures, including brain aneurysm treatment, may be released into the blood stream or treated aneurysm, occasionally causing foreign body granulomas, a complication we must be aware of to obtain an accurate diagnosis and indicate appropriate treatment.

Purpose: Predicting the risk of early distant brain failure (DBF) is in demand for management decisions in patients who are candidates for local treatment of brain metastases. This study aimed to analyze the association between circulating tumor cells (CTCs) and brain disease control after stereotactic radiation therapy/radiosurgery (SRT) for breast cancer brain metastasis (BCBM). Methods and Materials: We prospectively assessed CTCs before (CTC1) and 4 to 5 weeks after (CTC2) SRT and their relationship with the number of new lesions (NL) suggestive of BCBM before SRT. CTC were quantified and analyzed by immunocytochemistry to evaluate the expression of the proteins COX2, EGFR, ST6GALNAC5, NOTCH1, and HER2. Distant brain failure-free survival (DBFFS), the primary endpoint, diffuse DBFFS (D-DBFFS), and overall survival were estimated. Analysis for DBF within 6 months, with death as competing risk, was performed. Results: Patients were included between 2016 and 2018. CTCs were detected in all 39 patients before and in 34 of 35 patients after SRT. After median follow-up of 16.6 months, median DBFFS, D-DBFFS, and overall survival were 15.3, 14.1, and 19.5 months, respectively. DBF at 6 months was 40% with CTC1 ≤0.5 and 8.82% with CTC1 >0.5 CTC/mL (P = .007), and D-DBF at 6 months was 40% with CTC1 ≤0.5 and 0 with CTC1 >0.5 CTC/mL (P = .005) and 25% with NL/CTC1 >6.8 and 2.65% with NL/CTC1 ≤6.8 (P = .063). On multivariate analysis, DBFFS was inferior with CTC1 ≤0.5 (hazard ratio, 8.27; 95% confidence interval, 2.12-32.3; P = .002), and D-DBFFS was inferior with CTC1 ≤0.5 (hazard ratio, 10.22; 95% confidence interval, 1.99-52.41; P = .005). Protein expression was not associated with outcomes. Conclusions: These data suggest that CTC1 and NL/CTC1 may have a role as a biomarker of early diffuse DBF and as a subsequent guide between focal or whole-brain radiation therapy in patients with BCBM.

Multiorgan failure (MOF) is a life-threating condition that affects two or more systems of organs not involved in the disorder that motivates admission to an Intensive Care Unit (ICU). Patients who survive MOF frequently present long-term functional, neurological, cognitive, and psychiatric sequelae. However, the changes to the brain that explain such symptoms remain unclear. Objective: To determine brain connectivity and cognitive functioning differences between a group of MOF patients six months after ICU discharge and healthy controls (HC). Methods: 22 MOF patients and 22 HC matched by age, sex, and years of education were recruited. Both groups were administered a 3T magnetic resonance imaging (MRI), including structural T1 and functional BOLD, as well as a comprehensive neuropsychological evaluation that included tests of learning and memory, speed of information processing and attention, executive function, visual constructional abilities, and language. Voxel-based morphometry was used to analyses T1 images. For the functional data at rest, functional connectivity (FC) analyses were performed. Results: There were no significant differences in structural imaging and neuropsychological performance between groups, even though patients with MOF performed worse in all the cognitive tests. Functional neuroimaging in the default mode network (DMN) showed hyper-connectivity towards sensory-motor, cerebellum, and visual networks. DMN connectivity had a significant association with the severity of MOF during ICU stay and with the neuropsychological scores in tests of attention and visual constructional abilities. Conclusions: In MOF patients without structural brain injury, DMN connectivity six months after ICU discharge is associated with MOF severity and neuropsychological impairment, which supports the use of resting-state functional MRI as a potential tool to predict the onset of long-term cognitive deficits in these patients. Similar to what occurs at the onset of other pathologies, the observed hyper-connectivity might suggest network re-adaptation following MOF. Keywords: Multiorgan failure, Multiple organ dysfunction syndrome, Functional connectivity, Resting state, Hyper-connectivity, Default Mode Network, Neuropsychological Evaluation

Objective: The objective was to investigate how state level strategies in South Carolina could maximize HPV vaccine uptake. Design: An environmental scan identified barriers, facilitators, and strategies for improving HPV vaccination in South Carolina. Interviews were conducted with state leaders from relevant organizations such as public health agencies, medical associations, K-12 schools, universities, insurers, and cancer advocacy organizations. A thematic content analysis design was used. Digital interview files were transcribed, a data dictionary was created and data were coded using the data dictionary. Results: Thirty four interviews were conducted with state leaders. Barriers to HPV vaccination included lack of HPV awareness, lack of provider recommendation, HPV vaccine concerns, lack of access and practice-level barriers. Facilitators included momentum for improving HPV vaccination, school-entry Tdap requirement, pharmacy-based HPV vaccination, state immunization registry, HEDIS measures and HPV vaccine funding. Strategies for improving HPV vaccination fell into three categories: 1) addressing lack of awareness about the importance of HPV vaccination among the public and providers; 2) advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination; and 3) coordination of efforts. Discussion: A statewide environmental scan generated a blueprint for action to be used to improve HPV vaccination in the state. Keywords: HPV, HPV vaccines, Cervical cancer, Prevention, Health systems, Barriers, Facilitators, Strategies, South Carolina

The objective was to assess dynamic functional connectivity (FC) and local/global connectivity in Parkinson's disease (PD) patients with mild cognitive impairment (PD-MCI) and with normal cognition (PD-NC).The sample included 35 PD patients and 26 healthy controls (HC). Cognitive assessment followed an extensive neuropsychological battery. For resting-state functional MRI (rs-fMRI) analysis, independent component analysis (ICA) was performed and components were located in 7 networks: Subcortical (SC), Auditory (AUD), Somatomotor (SM), visual (VI), cognitive-control (CC), default-mode (DMN), and cerebellar (CB). Dynamic FC analysis was performed using the GIFT toolbox. FC differences between groups in each FC state were analysed with the network-based statistic (NBS) approach. Finally, a graph-theoretical analysis for local/global parameters was performed.The whole sample showed 2 dynamic FC states during the rs-fMRI. PD-MCI patients showed decreased mean dwell time in the hypo-connectivity state (p=0.030) and showed increased number of state transitions (p=0.007) compared with the HC. In addition, in the hypo-connectivity state, PD-MCI patients showed reduced inter-network FC between the SM-CC, SM-VI, SM-AUD, CC-VI and SC-DMN compared with the HC (p

Patients with multiple sclerosis (MS) display reduced structural connectivity among brain regions, but the pathogenic mechanisms underlying network disruption are still unknown. We aimed to investigate the association between the loss of diffusion-based structural connectivity, measured with graph theory metrics, and magnetic resonance (MR) markers of microstructural damage. Moreover, we evaluated the cognitive consequences of connectivity changes. We analysed the frontoparietal network in 102 MS participants and 25 healthy volunteers (HV). MR measures included radial diffusivity (RD), as marker of demyelination, and ratios of myo-inositol, N-acetylaspartate and glutamate+glutamine with creatine in white (WM) and grey matter as markers of astrogliosis, neuroaxonal integrity and glutamatergic neurotoxicity. Patients showed decreased global and local efficiency, and increased assortativity (p

Objetivo: La finalización del despliegue de los programas de detección precoz de cáncer de mama en todas las comunidades autónomas de España ha facilitado el inicio de una investigación conjunta, con información procedente de varios programas, orientada a mejorar su efectividad. Métodos: Se ha construido una cohorte de más de 1 millón de mujeres cribadas para evaluar el riesgo y los determinantes de los resultados falsos positivos. Se ha evaluado el impacto del cambio de técnica de mamografía analógica a digital y se está estudiando el cáncer de intervalo y los resultados falsos negativos. Resultados: Los resultados ofrecen información muy útil, desde el punto de vista de salud pública, para identificar e informar mejor a las mujeres con mayor riesgo de presentar efectos adversos, a la vez que ayudará a identificar características ligadas a los programas y a las mujeres que permitan establecer mejores estrategias de prevención. Conclusiones: Estos resultados se incorporarán a los modelos matemáticos sobre evaluación de la eficiencia de los programas que se están desarrollando actualmente. Modelos que pueden ser de gran utilidad como herramienta dirigida a informar y guiar las decisiones clínicas y de planificación sanitaria sobre el control del cáncer.Objective: The consolidation of breast cancer screening programs, with full coverage of the target population in all Spanish regions, has encouraged the beginning of a joint research strategy. This strategy aims to improve the effectiveness of breast cancer screening by gathering information from distinct screening programs. Methods: A retrospective cohort with information on over 1.5 million screened women was constructed to evaluate risk factors for a false-positive result. The impact of the change from digital mammography to screen-film mammography was evaluated, while results for interval cancers and false negatives are currently being studied. Results: The results are highly useful from the perspective of public health, as they can be used to identify and improve the information provided to women with a higher risk of experiencing an adverse effect. These results will also be helpful to identify screening program-related characteristics and women's personal characteristics, which will allow better prevention strategies to be developed. Conclusions: The results obtained will be included in mathematical models currently under development to evaluate the efficiency of breast cancer screening. These models could be highly useful to provide information and guide clinical and health policy decisions on cancer prevention and control.

El objetivo de este estudio ex post facto fue determinar las variables predictoras del rechazo, abandono y fracaso terapéutico en hombres maltratadores tratados psicológicamente de forma voluntaria en un marco comunitario. La muestra constó de 451 sujetos que habían acudido en busca de tratamiento psicológico en los últimos diez años (1997-2007). La terapia ofrecida fue un programa estructurado cognitivo-conductual de veinte sesiones en un formato individual. Según el análisis de regresión logística, la probabilidad de rechazo de la terapia (n = 255; 56,1%) era mayor cuando los agresores eran inmigrantes y cuando no se trataba también a la víctima dentro de un abordaje integral. Los sujetos abandonaban más el tratamiento (n = 88; 45%) cuando estaban en paro y cuando no se trataba a la víctima. Y, a su vez, los fracasos terapéuticos (n = 13; 13,7%) fueron más probables cuando los agresores eran menos empáticos y estaban más inadaptados a la vida cotidiana. Por último, no hubo variables predictoras claras de la pérdida de sujetos en el seguimiento de los 12 meses (n = 44; 46,3%). Se comentan las implicaciones de este estudio para investigaciones futuras.

El objetivo de este estudio fue evaluar un programa individual de tipo cognitivo-conductual, de 20 sesiones, en el tratamiento de hombres violentos contra la pareja, llevado a cabo durante 10 años en un marco comunitario. La muestra constó de 196 sujetos que participaron voluntariamente en el estudio. Se utilizó un diseño experimental de medidas repetidas (en el pretratamiento, en el postratamiento y en los seguimientos de 1, 3, 6 y 12 meses). La tasa de éxitos fue del 88% en los pacientes que completaron el tratamiento. A pesar de la pérdida de pacientes en el seguimiento (un total de un 46% al cabo de un año), los resultados se mantuvieron en los pacientes evaluados en los cuatro periodos establecidos (un 53% al cabo de 12 meses), con una alta reducción de las recaídas. Sin embargo, hubo un nivel más bien alto de rechazos y de abandonos del tratamiento. Una conclusión es que hay que desarrollar estrategias motivacionales para atraer y mantener a los sujetos en el tratamiento. Se comentan las implicaciones de este estudio para la práctica clínica, para la toma de decisiones sociales y para las investigaciones futuras.

Objetivo: Estimar la prevalencia del sobrepeso y la obesidad en Cantabria. Métodos: En el marco del estudio CANHTABRIA, se realizaron, entre los años 2002 y 2004, mediciones de peso y talla a una muestra de1.197 sujetos ≥ 18 años de edad representativa de la población general. Resultados: La prevalencia de sobrepeso fue del 37,6% (intervalo de confianza del 95% [IC95%]: 34,2-41), en hombres un 43,8% (IC95%: 37,2-50,5) y en mujeres un 32,4% (IC95%: 28,6-36,1; p < 0,01). La prevalencia de obesidad fue del 22,3% (IC95%: 19,1-25,5), un 23,2% (IC95%: 16,9-29,5) en hombres y un 21,5% (IC95%: 18,3-24,8) en mujeres. El sobrepeso y la obesidad fueron 2 veces más frecuentes en las personas con menor nivel de estudios respecto a las de mayor nivel. Conclusiones: El aumento de peso constituye un importante problema de salud pública en Cantabria, ya que afecta a 6 de cada 10 adultos de su población general, especialmente hombres y personas con menor nivel educativo.Objetive: To estimate the prevalence of overweight and obesity in Cantabria (Spain). Methods: In the framework of the CANHTABRIA study, carried out in 2002-2004, measurements of height and weight were performed on a representative sample of 1197 subjects aged 18 years or over. Results: The overall prevalence of overweight was 37.6% (95%CI: 34.2-41); 43.8% (95%CI: 37.2-50.5) in males, and 32.4% (95%CI: 28.6-36.1) in females (p < 0.01). Prevalence of obesity was 22.3% (95%CI: 19.1-25.5); 23.2% (95%CI: 16.9-29.5) in males, and 21.5% (95%CI: 18.3-24.8) in females. Compared to persons with higher education, individuals with lowest level of education had two-fold higher prevalence of overweigth and obesity. Conclusions: The Increase in weight is a public health problem in Cantabria as it affects 6 out of 10 adults of the general population, mainly males and individuals with low educational level.

En este trabajo se han estudiado las repercusiones psicopatológicas de la violencia doméstica en la mujer en función de las circunstancias del maltrato en una muestra de 212 víctimas en un Servicio de Violencia Familiar. Los resultados pusieron de manifiesto que la gravedad psicopatológica (estrés postraumático y malestar emocional) estaba relacionada con diferentes circunstancias de maltrato: la situación de la mujer en relación con la convivencia con el maltratador, la cercanía de la violencia en el tiempo, los años de sufrimiento del maltrato y la presencia de relaciones sexuales forzadas, así como los episodios de maltrato en la infancia. Por otro lado, se halló que el apoyo social y el apoyo familiar eran variables relacionadas con un menor nivel de gravedad psicopatológica. Se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras.