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En el Perú, la pandemia de la COVID-19 ha evidenciado la utilidad de tener un sistema de vigilancia laboratorial estructurado y en funcionamiento desde hace 22 años, basado en la vigilancia de influenza; inicialmente en modalidad de unidades centinela, y después fortaleciéndose e innovándose, con recur-sos propios y con apoyo externo, para generar información de calidad. Se han implementado avances biotecnológicos para la confirmación diagnóstica e incrementado las capacidades de la red nacional de laboratorios, manteniendo la eficiencia, considerando las diversas y complejas realidades de los niveles regionales, y superando dificultades de comunicación y articulación entre instituciones. Resulta necesa-rio consolidar este sistema, con trabajo colaborativo y coordinado entre sus componentes, impulsando su eficacia y oportunidad y promoviendo la vigilancia genómica de nuevos virus y variantes, como ac-tualmente ocurre con el SARS-CoV-2.

The aim of this study was to use latent profile analysis to identify specific profiles of burnout syndrome in combination with work engagement and to identify whether job satisfaction, psychological well-being, and other sociodemographic and work variables affect the probability of presenting a profile of burnout syndrome and low work enthusiasm. A total of 355 healthcare professionals completed the Spanish Burnout Inventory, the Utrecht Work Engagement Scale, the Job Satisfaction Scale, and the Psychological Well-Being Scale for Adults. Latent profile analysis identified four profiles: (1) burnout with high indolence (BwHIn); (2) burnout with low indolence (BwLIn); (3) high engagement, low burnout (HeLb); and (4) in the process of burning out (IPB). Multivariate logistic regression showed that a second job in a government healthcare institution; a shift other than the morning shift; being divorced, separated or widowed; and workload are predictors of burnout profiles with respect to the HeLb profile. These data are useful for designing intervention strategies according to the needs and characteristics of each type of burnout profile.

The Positive Mental Health Questionnaire (PMHQ) has been validated across various populations but has displayed diverse psychometric structures depending on the procedures used. The original version of the PMHQ includes 39 items organized into 6 factors, although there are reports that indicate a reduced structure of between 1 and 4 factors. The aim of this study was to assess the psychometric properties of the PMHQ with 1, 4 and 6 factors. A total of 360 healthcare workers aged 23 to 77 (M = 37.06; SD = 10.79) participated. Construct validity was assessed through confirmatory factor analysis using weighted root mean square residual. The original 6-factor (χ2/df: 3.40; RMSEA: 0.085; CFI: 0.913; TLI: 0.906) and a reduced 4-factor (χ2/df: 2.90; RMSEA: 0.072; CFI: 0.931; TLI: 0.926) structure showed acceptable fit. The fit of the 1-factor model was unacceptable. The internal consistency was evaluated through McDonald’s ω, and it was acceptable for 4 of 6 factors of the original structure and for 3 of 4 factors of the reduced structure. In conclusion, these findings suggest that the 6-factor and 4-factor models are valid for measuring positive mental health. However, issues with internal consistency must be investigated.

Genetic defects in the nuclear encoded subunits and assembly factors of cytochrome c oxidase (mitochondrial complex IV) are very rare and are associated with a wide variety of phenotypes. Biallelic pathogenic variants in the COX11 protein were previously identified in two unrelated children with infantile-onset mitochondrial encephalopathies. Through comprehensive clinical, genetic and functional analyses, here we report on a new patient harboring novel heterozygous variants in COX11, presenting with Leigh-like features, and provide additional experimental evidence for a direct correlation between COX11 protein expression and sensitivity to oxidative stress. To sort out the contribution of the single mutations to the phenotype, we employed a multi-faceted approach using Saccharomyces cerevisiae as a genetically manipulable system, and in silico structure-based analysis of human COX11. Our results reveal differential effects of the two novel COX11 mutations on yeast growth, respiration, and cellular redox status, as well as their potential impact on human protein stability and function. Strikingly, the functional deficits observed in patient fibroblasts are recapitulated in yeast models, validating the conservation of COX11’s role in mitochondrial integrity across evolutionarily distant organisms. This study not only expands the mutational landscape of COX11-associated mitochondrial disorders but also underscores the continued translational relevance of yeast models in dissecting complex molecular pathways.

The objective of this study is the characterization of the phenolic profile and antioxidant activity of elderberries (Sambucus nigra L.) from a collection of 79 wild specimens in northern Spain to assess variations in the species at the local level and evaluate its interest as a source of biocompounds. Also, a first study was carried out on the microflora present in this fruit, providing information relevant to its commercial exploitation. Moreover, the phenolic composition, antioxidant capacity and microbial composition in overripe fruits were determined, seeking a better use for this currently wasted resource. A wide variability in levels of phenolics was detected. Elderberries showed high antioxidant activity related to a high cyanidin derivative content, making them of interest to industry. Microflorae were present in very variable concentration ranges, so their levels should be monitored in those applications that require strict control. Overripe fruits are of interest as a source of anthocyanidins, since their concentration and antioxidant capacity remain after the optimal ripening period, promoting sustainability and a better use of natural resources. The database generated is of particular interest for further breeding trials based on the phenolic profile and antioxidant activity of the samples.

‘Violetto di Ramacca’ is a local variety of artichoke grown in Sicily (Southern Italy), known for its purple color with green streaks. In this study, the effects of two different preparation and drying methods (method A, fresh sample oven-dried at 40 °C for 48 h then mixed and ground into flour; and B, minced and frozen sample oven-dried at 40 °C for 24 h then blended and ground into flour) for flours from different parts of the artichoke (bracts, stems, and mix), used at different percentages of integration (5, 7.5, and 10%), in combination with re-milled semolina, have been evaluated. The polyphenol contents of the flours produced with the two methods were measured. The results showed significant differences between the methods and samples, with a range from 9.09 mg GAE/g d.m. (bracts 100%, method A) to 2.62 mg/g (mix 100%, method B). The values were then lowered in the flour products with supplements ranging from 0.96 mg GAE/g (bract flour 10%, method A) to 0.11 mg GAE/g (mixed flour 7.5%, method B). As the amounts of polyphenols increased, the antioxidant activity increased, with a range that varied in the pure flour from 8.59 mg trolox eq/g d.m. (bract flour, method A) to 3.83 mg trolox eq/g d.m. (mixed flour, method B). These flours were also analyzed for color, highlighting a clear difference between methods A (greener) and B (browner). The flours thus obtained were used to produce breads, which were evaluated for their physicochemical characteristics during 4 days of storage. The results showed a reduction in volumes and heights, an increase in the percentage of integration of the artichoke flours, a greater quantity of moisture in the integrated breads, and a lower reduction in the structural characteristics during storage compared to the control breads. The TPA was conducted on the breads from T0 to T4, highlighting that, although initially more compact, the integrated breads offered less alteration of the values during storage. The aw ranged from 0.63 (mix flour 5%, method B) to 0.90 (bract flour 5%, method B). The amounts of polyphenols (from 0.57 mg GAE/g in bread with bracts at 10% (method A) to 0.13 mg GAE/g in bread with mix 5% (method B)) and the antioxidant activity (from 0.55 mg trolox eq/g d.m. in bread with bract flour 10% (method A) to 0.14% mg trolox eq/g d.m. in bread with mix flour) were also evaluated, showing a trend similar to the values obtained in the flours. Colorimetric tests highlighted a color more similar to wholemeal bread in the loaves produced with method B. Statistical factor analysis and cluster analysis were conducted for all trials.

The paper aims to analyze the regulations and the program of studies envisaged by the Scuola tecnica bibliografica – a two-year technical course established in 1886 to be given at the central national libraries of Rome and Florence – in order to outline the strategies that the Ministry of Public Education intended to implement in the field for the professional training of librarians. The unpublished correspondence accompanying these official documents between the Minister of Public Education Michele Coppino, Desiderio Chilovi and Domenico Gnoli is examined, in order to shed light on the complex events that led to perennial postponements of the inauguration of the new course up to to arrive at an inevitable and sad ending: its ‘failure’ to start.

Abstract Background Recent evidence from cross‐sectional and longitudinal studies supports the hypothesis that sarcopenia is associated with worsening cognitive function. However, primary evidence largely comes from high‐income countries, whereas in low‐ and middle‐income countries, this association has been underexplored. This study aimed to estimate the longitudinal association between sarcopenia and mild cognitive impairment in a sample of older Mexican adults. Methods Data come from the three waves of the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) in Mexico (2009, 2014, 2017). Four hundred ninety‐six older adults, aged ≥50, were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Mild cognitive impairment was determined based on the recommendations of the National Institute on Aging‐Alzheimer's Association. Cognitive function was evaluated by a composite cognitive score of five different cognitive tests: immediate and delayed recall, forward and backward digit span and semantic verbal fluency. Three‐level mixed‐effects models (logistic and linear) were used to estimate the longitudinal associations between sarcopenia, mild cognitive impairment and cognitive function. Results The prevalence of mild cognitive impairment (8.9%, 12.9%, 16.0%) and sarcopenia (10.5%, 20.7%, 23.3%) showed a significant temporal increase for Waves 1, 2 and 3 (P‐value

Seaports (hereafter “ports”) within the European Union are facing increasingly restrictive regulation in the near future from various sources driven by climate change prevention and public opinion supporting “green” values. Ports are complex hubs for maritime transportation systems and global supply chains, as well as an integral part of critical national infrastructures. However, they are also significant individual sources of harmful emissions, and their involvement is crucial to reducing transportation-related environmental impacts. To meet future regulatory requirements, stakeholders will need to find ways to align their policies accordingly and create long-term pathways toward these ambitious targets. The empirical case study presented in this paper among European Port Cluster (EPC) stakeholders distinctly reflects the mounting importance of environmental policies and the need for further preparative measures for meeting future demands. This paper emphasizes the intensified impact of forthcoming regulation on existing business models in the EPC and contributes a foresight-based framework to approaching this issue systematically. The adoption of future-oriented regulation is a non-linear, potentially disruptive, and complex foresight process that requires each stakeholder to formulate their own strategic pathway toward a target-seeking scenario. Changing direction from the status quo toward sustainability also requires a strong commitment beyond mere regulatory compliance.

El turismo es uno de los sectores que más ingresos ha generado en las últimas décadas, convirtiéndolo para muchas localidades en motor de desarrollo, por su contribución a la economía, así como por la facilidad que ofrece de adaptarse a las condiciones de cada territorio. En este contexto cobra gran relevancia la planificación turística como herramienta fundamental para alcanzar el éxito en el desarrollo, gestión y manejo de la actividad. El municipio Jiguaní, ubicado en la provincia de Granma es un pueblo rico en recursos naturales e histórico - culturales, los cuales no son aprovechados en la actividad turística. Por ello el objetivo de esta investigación fue evaluar los recursos que tiene este municipio para la implementación del turismo como una apuesta del futuro. Para ello se seleccionó la metodología de Leyva, 2016 cuya aplicación en dicho territorio resultó en la creación de una base teórica para impulsar futuros proyectos de desarrollo local asociados a esta zona. Se utilizaron métodos empíricos como: la observación y la revisión documental; y como teóricos: el histórico-lógico y el inductivo-deductivo. Como principal conclusión, se determinó que aunque esta localidad no cuenta con la infraestructura necesaria para el turismo, sí posee potencialidades para su desarrollo.

The present work validated and evaluated a duplex real-time RT-PCR using specific primers and probes for genes RdRp from SARS-CoV-2 and GAPDH from humans; the latter was used as an endogenous control in all reactions. We evaluated the specificity, the sensitivity, the robustness, the reproducibility, the repeatability, the comparability, and the limit of detection. The predictive positive and negative values (PPV and PNV, respectively) and all the parameters evaluated using our duplex real-time RT-PCR was 100%. The detection limit was 100 copies/μL according to the acceptance criteria established for the validation of this protocol. Our duplex real-time RT-PCR demonstrated to be a good alternative for the diagnosis of COVID-19; in addition, this PCR was used adequately in suspicion of COVID-19, allowing it to control the number of false-negatives.

En una carta al editor reciente el Comité de Ética propone indagar en los ingresantes a residencias su objeción de conciencia (OC). El Instituto Universitario desarrolla hace años líneas de acción para evitar cualquier discriminación en el proceso de ingreso, indagar sobre OC podría impactar sobre quien entrevista, resultando inapropiada.

Se presenta el caso de una paciente de sexo femenino y edad de 10 años, la que requirió ingreso dos años antes con diagnóstico presuntivo de neumonía. El examen imagenológico de entonces mostró una imagen compatible con atelectasia y masa a nivel de lóbulo superior de pulmón izquierdo, requiriendo valoración en el servicio de cirugía, donde se decidió tratamiento de exéresis de masa luego de superar el cuadro infeccioso. La situación pandémica por COVID-19 provocó que la paciente dejara de seguir asistiendo y al ingresar nuevamente tenía un cuadro clínico agravado, precediendo con el tratamiento quirúrgico. Los hallazgos histopatológicos confirman la presencia de mucormicosis pulmonar. Después de 14 días con tratamiento de anfotericina B en forma liposómica, la paciente es dada de alta por la favorable evolución.

The genus Rhytidhysteron is characterised by forming navicular to apothecial hysterothecia, exposing the green, yellow, orange, red, vinaceous or black colours of the hymenium which generally releases pigments in the presence of KOH. The exciple is smooth or striated, the asci bitunicate and ascospores have 1–5 transverse septa. To date, twenty-six Rhytidhysteron species have been described from the Tropics. The present study aims to describe three new species in the Neotropics of Mexico based on molecular methods and morphological features. Illustrations and a taxonomic key are provided for all known species of this genus. Rhytidhysteron cozumelense from the Isla Cozumel Biosphere Reserve, R. esperanzae from the Sierra Juárez, Oaxaca and R. mesophilum from the Sierra Madre Oriental, Hidalgo are described as new species. With the present study, the number of species of Rhytidhysteron known from Mexico is now increased to eight.

Antonio Niño y José Antonio Montero (eds.) Madrid, Biblioteca Nueva, 2012 430 páginas

BackgroundCervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level.MethodsThe study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy.ResultsAs for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7–89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates.ConclusionsThe assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices.

El propósito de este artículo es interpretar antropológicamente los mensajes y las imágenes de los volantes que reparten en las calles para publicitar el consumo de la magia amorosa. En ese sentido, se describe y sistematiza su contenido, se interpreta el papel que desempeñan quienes realizan los rituales y los ideales amorosos que difunden los individuos que comercializan con estos productos culturales. La metodología se centra en el contraste de cien volantes recolectados en algunas ciudades colombianas durante los últimos ocho años. Así, se encontró que la publicidad callejera de la magia amorosa está centrada en el ritual de la liga o el amarre, que no solo es apetecido por sectores populares o por mujeres, sino que este recurso de asistencia amorosa es frecuentado por diversos sectores socioeconómicos, donde cada uno encuentra administradores de lo mágico según sus respectivos capitales culturales. El amor es uno de los ámbitos que merece mayor atención en la vida cotidiana, pues, en términos generales, sostener los vínculos amorosos y sexuales con una pareja en particular es un sofisma de felicidad y de seguridad para muchas personas. El ritual del amarre representa violencias simbólicas relacionadas con la humillación y la dominación. Cabe añadir que este tema es relevante, puesto que innova en el estudio de la magia y de los sincretismos religiosos, pues analiza lo que dicen los volantes que brindan la posibilidad de solucionar el abandono y la infidelidad a través del recurso del amarre en secreto y a distancia.

Il progetto Post-I_IT (Post Incunaboli ITaliani) – frutto di una collaborazione tra la Fondazione Scuola per i Beni e le Attività Culturali e l’ICCU – ha portato a un aggiornamento di dati presenti in due fondamentali banche dati dedicate al libro antico: il Censimento nazionale delle edizioni italiane del XVI secolo (EDIT16) e l’Incunabula Short-Title Catalogue (ISTC). In particolare, il progetto si è concentrato sull’individuazione di post-incunaboli italiani ‘erroneamente’ censiti in uno dei più importanti repertori bibliografici dedicati al libro del Quattrocento al fine di integrare informazioni relative a specifiche edizioni ed esemplari conservati nelle biblioteche di tutto il mondo. Oltre a porre l’accento su questioni terminologiche, il contributo intende analizzare alcune sostanziali differenze relative alla metodologia descrittiva delle due banche dati soprattutto alla luce del recente restyling che ha riguardato e potenziato EDIT16. Tra le informazioni che è stato possibile integrare grazie al progetto vi sono: le opere di dubbia paternità, le controverse attribuzioni tipografico-editoriali, le date e i luoghi di pubblicazione incerti, la localizzazione di esemplari non ancora censiti e il reperimento di esemplari digitalizzati a cui si rimanda tramite collegamento hyperlink. Come per altri progetti, è stato possibile dimostrare come l’interazione tra banche dati possa stimolare ulteriori riflessioni e considerazioni in merito al nodale servizio informativo dei repertori bibliografici favorendo indagini ricognitive che vanno oltre i confini nazionali.

Recently, microalgae are arousing considerable interest as a source of countless molecules with potential impacts in the nutraceutical and pharmaceutical fields. Haematococcus pluvialis, also named Haematococcus lacustris, is the largest producer of astaxanthin, a carotenoid exhibiting powerful health effects, including anti-lipogenic and anti-diabetic activities. This study was carried out to investigate the properties of two selected strains of H. pluvialis (FBR1 and FBR2) on lipid metabolism, lipolysis and adipogenesis using an in vitro obesity model. FBR1 and FBR2 showed no antiproliferative effect at the lowest concentration in 3T3-L1 adipocytes. Treatment with FBR2 extract reduced lipid deposition, detected via Oil Red O staining and the immunocontent of the adipogenic proteins PPARγ, ACLY and AMPK was revealed using Western blot analysis. Extracts from both strains induced lipolysis in vitro and reduced the secretion of interleukin-6 and tumor necrosis factor-α. Moreover, the FBR1 and FBR2 extracts improved mitochondrial function, reducing the levels of mitochondrial superoxide anion radical and increasing mitochondrial mass compared to untreated adipocytes. These findings suggest that FBR2 extract, more so than FBR1, may represent a promising strategy in overweight and obesity prevention and treatment.

Abstract Background SLC39A8, a gene located on chromosome 4q24, encodes for the manganese (Mn) transporter ZIP8 and its detrimental variants cause a type 2 congenital disorder of glycosylation (CDG). The common SLC39A8 missense variant A391T is associated with increased risk for multiple neurological and systemic disorders and with decreased serum Mn. Patients with SLC39A8-CDG present with different clinical and neuroradiological features linked to variable transferrin glycosylation profile. Galactose and Mn supplementation therapy results in the biochemical and clinical amelioration of treated patients. Results Here, we report clinical manifestations, neuroradiological features and glycophenotypes associated with novel SLC39A8 variants (c.1048G > A; p.Gly350Arg and c.131C > G; p.Ser44Trp) in two siblings of the same Italian family. Furthermore, we describe a third patient with overlapping clinical features harbouring the homozygous missense variant A391T. The clinical phenotype of the three patients was characterized by severe developmental disability, dystonic postural pattern and dyskinesia with a more severe progression of the disease in the two affected siblings. Neuroimaging showed a Leigh syndrome-like pattern involving the basal ganglia, thalami and white matter. In the two siblings, atrophic cerebral and cerebellum changes consistent with SLC39A8-CDG were detected as well. Serum transferrin isoelectric focusing (IEF) yielded variable results with slight increase of trisialotransferrin isoforms or even normal pattern. MALDI-MS showed the presence of hypogalactosylated transferrin N-glycans, spontaneously decreasing during the disease course, only in one affected sibling. Total serum N-glycome depicted a distinct pattern for the three patients, with increased levels of undergalactosylated and undersialylated precursors of fully sialylated biantennary glycans, including the monosialo-monogalacto-biantennary species A2G1S1. Conclusions Clinical, MRI and glycosylation features of patients are consistent with SLC39A8-CDG. We document two novel variants associated with Leigh syndrome-like disease presentation of SLC39A8-CDG. We show, for the first time, a severe neurological phenotype overlapping with that described for SLC39A8-CDG in association with the homozygous A391T missense variant. We observed a spontaneous amelioration of transferrin N-glycome, highlighting the efficacy of MS-based serum glycomics as auxiliary tool for the diagnosis and clinical management of therapy response in patients with SLC39A8-CDG. Further studies are needed to analyse more in depth the influence of SLC39A8 variants, including the common missense variant, on the expression and function of ZIP8 protein, and their impact on clinical, biochemical and neuroradiological features.

Esta investigación buscaba conocer el estado actual del proceso artesanal de producción de hilo de fibra de alpaca, de la región de Puno en el Perú. Por tal motivo, se realizó un estudio con una perspectiva de alcance descriptivo y exploratorio, teniendo como unidad de análisis a los alpaqueros, artesanos, productores medianos y algunos directivos del sector textil. Se diseñó una investigación documental para obtener datos cualitativos y cuantitativos sobre la producción del hilado de alpaca. En el 2019 se hizo la investigación de campo para recolectar los datos directamente de las comunidades alpaqueras, obteniendo información sobre los métodos del proceso de producción de hilos de fibra de alpaca. Se concluyó que la fabricación artesanal de hilo de alpaca mantiene, principalmente, un proceso manual, sin embargo, se han incorporado pequeñas máquinas como la abridora y la de hilatura, compuestas de dispositivos mecánicos simples, con la finalidad de reducir el tiempo de producción de la fibra y mejorar la calidad del hilo obtenido.

Objective To assess the diagnostic Read code usage for 18 conditions by examining their frequency and diversity in UK primary care between 2000 and 2013.Design Population-based cohort studySetting 684 UK general practices contributing data to the Clinical Practice Research Datalink (CPRD) GOLD.Participants Patients with clinical codes for at least one of asthma, chronic obstructive pulmonary disease, diabetes, hypertension (HT), coronary heart disease, atrial fibrillation (AF), heart failure, stroke, hypothyroidism, chronic kidney disease, learning disability (LD), depression, dementia, epilepsy, severe mental illness (SMI), osteoarthritis, osteoporosis and cancer.Primary and secondary outcome measures For the frequency ranking of clinical codes, canonical correlation analysis was applied to correlations of clinical code usage of 1, 3 and 5 years. Three measures of diversity (Shannon entropy index of diversity, richness and evenness) were used to quantify changes in incident and total clinical codes.Results Overall, all examined conditions, except LD, showed positive monotonic correlation. HT, hypothyroidism, osteoarthritis and SMI codes’ usage had high 5-year correlation. The codes’ usage diversity remained stable overall throughout the study period. Cancer, diabetes and SMI had the highest richness (code lists need time to define) unlike AF, hypothyroidism and LD. SMI (high richness) and hypothyroidism (low richness) can last for 5 years, whereas cancer and diabetes (high richness) and LD (low richness) only last for 2 years.Conclusions This is an under-reported research area and the findings suggest the codes’ usage diversity for most conditions remained overall stable throughout the study period. Generated mental health code lists can last for a long time unlike cardiometabolic conditions and cancer. Adopting more consistent and less diverse coding would help improve data quality in primary care. Future research is needed following the transfer to the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) coding.

Background Atrial fibrillation (AF) is an important risk factor for ischaemic stroke, and AF incidence is expected to increase. Guidelines recommend using oral anticoagulants (OACs) to prevent the development of stroke. However, studies have reported the frequent underuse of OACs in AF patients. The objective of this study is to describe nonvalvular atrial fibrillation (NVAF) incidence in England and assess the clinical and socioeconomic factors associated with the underprescribing of OACs. Methods and findings We conducted a population-based retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD) database to identify patients with NVAF aged ≥18 years and registered in English general practices between 2009 and 2019. Annual incidence rate of NVAF by age, deprivation quintile, and region was estimated. OAC prescribing status was explored for patients at risk for stroke and classified into the following: OAC, aspirin only, or no treatment. We used a multivariable multinomial logistic regression model to estimate relative risk ratios (RRRs) and 95% confidence intervals (CIs) of the factors associated with OAC or aspirin-only prescribing compared to no treatment in patients with NVAF who are recommended to take OAC. The multivariable regression was adjusted for age, sex, comorbidities, socioeconomic status, baseline treatment, frailty, bleeding risk factors, and takes into account clustering by general practice. Between 2009 and 2019, 12,517,191 patients met the criteria for being at risk of developing NVAF. After a median follow-up of 4.6 years, 192,265 patients had an incident NVAF contributing a total of 647,876 person-years (PYR) of follow-up. The overall age-adjusted incidence of NVAF per 10,000 PYR increased from 20.8 (95% CI: 20.4; 21.1) in 2009 to 25.5 (25.1; 25.9) in 2019. Higher incidence rates were observed for older ages and males. Among NVAF patients eligible for anticoagulation, OAC prescribing rose from 59.8% (95% CI: 59.0; 60.6) in 2009 to 83.2% (95% CI: 83.0; 83.4) in 2019. Several conditions were associated with lower risk of OAC prescribing: dementia [RRR 0.52 (0.47; 0.59)], liver disease 0.58 (0.50; 0.67), malignancy 0.74 (0.72; 0.77), and history of falls 0.82 (0.78; 0.85). Compared to white ethnicity, patients from black and other ethnic minorities were less likely to receive OAC; 0.78 (0.65; 0.94) and 0.76 (0.64; 0.91), respectively. Patients living in the most deprived areas were less likely to receive OAC 0.85 (0.79; 0.91) than patients living in the least deprived areas. Practices located in the East of England were associated with higher risk of prescribing aspirin only over no treatment than practices in London (RRR 1.22; 95% CI 1.02 to 1.45). The main limitation of this study is that these findings depends on accurate recording of conditions by health professionals and the inevitable residual confounding due to lack of data on certain factors that could be associated with under-prescribing of OACs. Conclusions The incidence of NVAF increased between 2009 and 2015, before plateauing. Underprescribing of OACs in NVAF is associated with a range of comorbidities, ethnicity, and socioeconomic factors, demonstrating the need for initiatives to reduce inequalities in the care for AF patients. Alyaa Ajabnoor and co-workers study incidence of non-valvular atrial fibrillation in England and apparent inequalities in care. Author summary Why was this study done? Previous research has shown that the incidence of atrial fibrillation (AF) is expected to increase, although limited data exists in the UK. AF is one of the most important risk factors for future stroke risk, and the treatment of choice is anticoagulation. Many patients with nonvalvular atrial fibrillation (NVAF) are not receiving anticoagulant therapy for stroke prevention, although it remains uncertain whether there is an association with patient ethnicity and socioeconomic status. What did the researchers do and find? We used electronic health records from GP practices in England to estimate the incidence of NVAF between the 2009 and 2019. We have also explored the clinical and socioeconomic factors associated with prescribing oral anticoagulants (OACs). We have found that the incidence of NVAF in England has increased during the past decade and plateaued from 2015 onwards. There are racial and socioeconomic inequalities in the prescribing of OACs in England, with low socioeconomic status and black or other non-white ethnicities associated with the prescription of aspirin only or no treatment compared to white patients or those with higher socioeconomic status. What do these findings mean? There are many patients at risk for stroke who are not receiving anticoagulants, and clinical and sociodemographic factors play a role in the underprescribing of OACs Our findings suggest that, in order to improve AF outcomes, these inequalities need to be addressed through equitable interventions to improve OAC prescribing to prevent stroke events and reduce mortality.

Objetivo. Determinar la relación entre los índices aterogénicos y la presencia de obesidad abdominal en pobladores del distrito de Trujillo, Perú. Los índices aterogénicos relacionados con la obesidad pueden brindar una información adicional al riesgo establecido por la obesidad. Métodos. El estudio fue de diseño no experimental, descriptivo correlacional y de corte transversal. La muestra estuvo conformada por 319 personas adultas cuyas edades oscilan entre 25 y 65 años que acudieron a cuatro centros de salud de la ciudad entre julio y diciembre de 2019. Para evaluar los índices aterogénicos se midieron las fracciones lipídicas de colesterol, triglicéridos, cHDL y cLDL mediante el uso de Colesterometro Mission®. Con respecto a la presencia de obesidad abdominal se utilizaron los indicadores de la circunferencia de la cintura establecidos por la Asociación Latinoamericana de Diabetes. Resultados. El análisis estadístico empleado para relacionar ambas variables fue la prueba de chi cuadrado en el programa SPSS versión 25. Se determinó que el 61,1 % de la población presenta obesidad abdominal. En cuanto a los índices aterogénicos, estos alcanzaron un diagnóstico de riesgo en el 75,5 % para el índice TG/cHDL; 67,4 % en el índice de Castelli y 56,4 % para el índice cLDL/cHDL. Solamente se encontró relación entre el índice TG/cHDL y la obesidad abdominal (p = 0,004). Conclusiones. El índice TG/cHDL se asocia mejor con la obesidad abdominal y debe ser considerado adicionalmente en el diagnóstico probable o seguimiento de enfermedad coronaria o insulinorresistencia en el obeso.

Introduction: Several studies in the adult population have shown that obesity is an independent risk factor for elevated intraocular pressure (IOP), whereas data in the paediatric population are sparse and controversial. The purpose of the present study is to investigate the relationship between body mass index (BMI), blood pressure (BP), and IOP in healthy school children. Methods: The survey was conducted among a random sample of 8-year-old Italian students. Data were collected on their health status and behaviours related to obesity (physical activity, food and drinking habits, etc.). Physical examinations, conducted at school, included measurements of height, weight, BP, and IOP. Results: Five hundred and seventy-six subjects were recruited (92.8% response rate); 42.4% were overweight or obese, 58.9% consumed inadequate daily servings of fruit and vegetables, and 87.5% were involved in sedentary activities. Elevated BP/hypertension (HTN) affected 3.6% and high IOP was revealed in 12.5% of the children. In the multivariate analysis, elevated BP/HTN was the only significant determinant of ocular HTN (OR 5.36, 95% CI 1.95–14.73, p = 0.001). Conclusions: Our results show that high IOP affects 12.5% of 8-year-old school children and appears to be associated with high BP related to a high BMI.

ABSTRACT In recent years the immunomodulatory actions of vitamin D, a steroid hormone, have been extensively studied. In 2020, due to the COVID-19 pandemic, the question arose as to 25(OH)D status would be related to susceptibility to SARS-CoV-2 infection, since several studies pointed out a higher prevalence and severity of the disease in populations with low levels of 25(OH)D. Thus, we investigated the 25(OH)D levels in adults “Detected” positive for SARS CoV-2 by RT-PCR (reverse transcriptase polymerase chain reaction) test, and in negative controls, “not Detected”, using the Fleury Group's examination database, in Sao Paulo, Brazil. Of a total of 14.692 people with recent assessments of 25(OH)D and RT-PCR tests for COVID-19, 2.345 were positive and 11.585 were negative for the infection. The groups did not differ in the percentage of men and women, or in the age distribution. There were no differences in the distribution of 25(OH)D between the two groups (p = 0.08); mean 25(OH)D of 28.8 ± 21.4 ng/mL and 29.6 ± 18.1 ng/mL, respectively. In the specific population studied, clinical, environmental, socioeconomic and cultural factors should have greater relevance than 25(OH)D in determining the susceptibility to COVID-19.

Several studies have demonstrated the effectiveness of plant extracts against various diseases, especially skin disorders; namely, they exhibit overall protective effects. The Pistachio (Pistacia vera L.) is known for having bioactive compounds that can effectively contribute to a person’s healthy status. However, these benefits may be limited by the toxicity and low bioavailability often inherent in bioactive compounds. To overcome these problems, delivery systems, such as phospholipid vesicles, can be employed. In this study, an essential oil and a hydrolate were produced from P. vera stalks, which are usually discarded as waste. The extracts were characterized by liquid and gas chromatography coupled with mass spectrometry and formulated in phospholipid vesicles intended for skin application. Liposomes and transfersomes showed small size (80%. The immune-modulating activity of the extracts was assayed in macrophage cell cultures. Most interestingly, the formulation in transfersomes abolished the cytotoxicity of the essential oil while increasing its ability to inhibit inflammatory mediators via the immunometabolic citrate pathway.

Similar to its bacterial homolog GroEL, Hsp60 in oligomeric conformation is known to work as a folding machine, with the assistance of co-chaperonin Hsp10 and ATP. However, recent results have evidenced that Hsp60 can stabilize aggregation-prone molecules in the absence of Hsp10 and ATP by a different, “holding-like” mechanism. Here, we investigated the relationship between the oligomeric conformation of Hsp60 and its ability to inhibit fibrillization of the Ab40 peptide. The monomeric or tetradecameric form of the protein was isolated, and its effect on beta-amyloid aggregation was separately tested. The structural stability of the two forms of Hsp60 was also investigated using differential scanning calorimetry (DSC), light scattering, and circular dichroism. The results showed that the protein in monomeric form is less stable, but more effective against amyloid fibrillization. This greater functionality is attributed to the disordered nature of the domains involved in subunit contacts.

Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI). This study aimed to investigate if cDPP3 levels are associated with CS severity and the need for ventilation in patients suffering from CS. Fifteen patients with CS were included in this study. Six patients were invasively ventilated. The values of cDPP3 were higher in ventilated patients than in non-ventilated patients at admission, 3 h, and 24 h after admission in the intensive care unit. Patients with pulmonary hypertension at admission also showed high cDPP3 values at all time points. Furthermore, high cDPP3 levels were associated with reduced stroke volume. Our results suggest that cDPP3 could predict CS progression and guide therapy escalation.

This prospective single-center study was designed to assess the clinical utility of the FilmArray® blood culture identification (BCID) panel for improving the diagnostic accuracy in neonatal sepsis. Results obtained using the FilmArray® BCID panel were correlated with results of blood culture in all consecutive neonates with suspicion of early-onset (EOS) and late-onset sepsis (LOS) attended in our service over a two-year period. A total of 102 blood cultures from 92 neonates were included, 69 (67.5%) in cases of EOS and 33 (32.3%) in LOS. The FilmArray® BCID panel was performed in negative culture bottles at a median of 10 h of blood culture incubation (IQR 8–20), without differences by the type of sepsis. The FilmArray® BCID panel showed a 66.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.7% negative predictive value. There were four false-negative cases, three of which were Streptococcus epidermidis in neonates with LOS, and there was one case of Granulicatella adiacens in one neonate with EOS. We conclude that the use of the FilmArray® BCID panel in negative blood cultures from neonates with clinical suspicion of sepsis is useful in decision-making of starting or early withdrawal of empirical antimicrobials because of the high specificity and negative predictive values of this assay.

Abstract Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient’s residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54 % were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17 % and 24 % (p = 0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95 % confidence interval [CI] 1.7–7.1; p = 0.001), with little change from north to south provinces (OR 1.5;95 % CI 1.0-2.2; p = 0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95 % CI 1.2–3.5; p = 0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95 % CI 1.5–6.2; p = 0.02), but not among provinces (HR 1.3;95 % CI 1.0–2.0; p = 0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95 % CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Conclusions The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

ABSTRACT Objective: Choosing Wisely (CW) is an initiative that aims to advance the dialogue between physicians and patients about low-value health interventions. Given that thyroid conditions are frequent in clinical practice, we aimed to develop an evidence-based list of thyroid CW recommendations. Materials and methods: The Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) named a Task Force to conduct the initiative. The Task Force work was based on an electronic Delphi approach. The 10 recommendations that received the highest scores by the Task Force were submitted for voting by all SBEM associates. The 5 recommendations that received the highest scores by SBEM associates are presented herein. Results: The Task Force was composed of 14 thyroidologists from 10 tertiary-care, teaching-based Brazilian institutions. The brainstorming/ideation phase resulted in 69 recommendations. After the removal of duplicates and recommendations that did not adhere to the initiative's scope, 35 remained. Then the Task Force voted to attribute a grade (0 [lowest agreement] to 10 [highest agreement]) for each recommendation. The 10 recommendations that received the highest scores by the Task Force were submitted to all SBEM associates. A total of 683 associates voted electronically, attributing a grade (0 to 10) for each recommendation. The 5 recommendations that received the highest scores by the SBEM associates compose our final list. Conclusion: A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions are offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making.

Abstract Aim and purposes This study conducts an across-the-board comparative analysis of the impact of the main measures used by the 10 leading maritime nations of the EU on the relative competitiveness of the fleets that they control, covering the period from 1996 to 2011. We propose two models to compare the relative effectiveness of the maritime policy measures implemented: one for the full set of countries and measures and the other specifically for each maritime nation. Findings The estimation results make us conclude that generally the measures adopted in national-level maritime policies (tonnage tax, second register and other measures) seem to have been effective in that they have had a positive effect on the competitiveness of controlled fleets, but with uneven impact on the fleets of each country.

Background and study aims Adenoma detection rate (ADR) is a well-accepted quality indicator of screening colonoscopy. In recent years, the added value of artificial intelligence (AI) has been demonstrated in terms of ADR and adenoma miss rate (AMR). To date, there are no studies evaluating the impact of AI on the performance of trainee endoscopists (TEs). This study aimed to assess whether AI might eliminate any difference in ADR or AMR between TEs and experienced endoscopists (EEs). Patients and methods We performed a prospective observational study in 45 subjects referred for screening colonoscopy. A same-day tandem examination was carried out for each patient by a TE with the AI assistance and subsequently by an EE unaware of the lesions detected by the TE. Besides ADR and AMR, we also calculated for each subgroup of endoscopists the adenoma per colonoscopy (APC), polyp detection rate (PDR), polyp per colonoscopy (PPC) and polyp miss rate (PMR). Subgroup analyses according to size, morphology, and site were also performed. Results ADR, APC, PDR, and PPC of AI-supported TEs were 38 %, 0.93, 62 %, 1.93, respectively. The corresponding parameters for EEs were 40 %, 1.07, 58 %, 2.22. No significant difference was found for each analysis between the two groups (P > 0.05). AMR and PMR for AI-assisted TEs were 12.5 % and 13 %, respectively. Sub-analyses did not show any significant difference (P > 0.05) between the two categories of operators. Conclusions In this single-center prospective study, the possible impact of AI on endoscopist quality training was demonstrated. In the future, this could result in better efficacy of screening colonoscopy by reducing the incidence of interval or missed cancers.

This paper focuses on an investigation into the complex phenomenology of bullying and cyberbullying behaviour, focusing actions of contrast and treatment within a preventive perspective of inclusive education capable of designing multi-level strategies. The paper presents the results of a collaborative research-training project with a network of Apulian secondary schools and the consequent design of the educational device for the prevention and treatment of the phenomenon (the SEP device: sensitise, educate, protect) useful for dealing with the phenomena from a pedagogical point of view. The device allows to develop an observational and receptive posture concerning the behavioural prodromes and to accept the complexity of the phenomena adopting multiple-levels educational choices. Prevenire e contrastare bullismo e cyberbullismo attraverso il dispositivo SEP: sensibilizzare, educare, proteggere. Risultanze di un’indagine. Il presente contributo mette a tema un’indagine sulla complessa fenomenologia dei comportamenti di bullismo e cyberbullismo, focalizzando le azioni di contrasto e di cura entro una prospettiva preventiva di didattica dell’inclusione in grado di progettare strategie a più livelli. Nel contributo si presentano le risultanze di una ricerca-formazione collaborativa avviata con una rete di scuole secondarie di I e II grado pugliesi e la conseguente progettazione del dispositivo di educazione alla prevenzione e cura del fenomeno (il dispositivo SEP: sensibilizzare, educare, proteggere) utile a fronteggiare i fenomeni in chiave pedagogica. Il dispositivo consente di assumere una postura osservativa e ricettiva dei prodromi comportamentali e di accogliere la complessità dei fenomeni adottando scelte educative a più livelli articolate in un approccio adattivo inclusivo costruito sul contesto e rivolto all’intero gruppo e non solo alla diade bullo-vittima. These are articulated in an inclusive adaptive approach built on the context and aimed at the entire group and not just on the bully-victim dyad. The concept of inclusion, indeed, is closely linked to education to “active citizenship”, understood as responsible participation in building a civil society and requires action that involves the entire school community and families.