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Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units. (C) 2017 SEEN. Published by Elsevier Espana, S.L.U. All rights reserved.

Purpose: Chagas disease (CD) has become a global health issue mainly due to migration. Germany lacks surveillance data and is home to a large Latin American immigrant population. Recognising that Bolivia is the country with the highest CD prevalence in Latin America, this cross-sectional, descriptive pilot study investigated CD and associated factors among citizens of Bolivian origin living in Munich, Germany. Methods: Participants completed a questionnaire in order to collect socioeconomic and health-related data. In addition, serology was performed. In case of positive serological tests, PCR diagnostic and clinical staging together with disease management was initiated. Qualitative research was conducted to identify personal and community barriers as well as strategies to increase CD awareness among the population at risk. Results: Between June 2013 and June 2014, 43 people from Bolivia (or descendants) were enrolled. A total of 9.3% (4/43), of whom two women were of childbearing age, tested seropositive (ELISA and IFAT), and one also by PCR. For 2/4 positive participants, clinical evaluation was performed and the indeterminate form of CD was diagnosed. Knowledge about CD symptoms and ways of transmission were completely absent among 55.8% (24/43, 2/4 with CD) and 30.2% (13/43, 1/4 with CD) of participants, respectively. A total of 27.9% (12/43, 0/4 with CD) of participants had donated blood prior to the study, whereas 62.8% (27/43, 3/4 with CD) were motivated to donate blood in the future. The qualitative research identified lack of knowledge as well as stigma and fears related to CD. Conclusions: Despite the small number of participants, the prevalence of CD as well as the potential risk of non-vectorial transmission was alarming. Campaigns adapted for Latin American migrants as well as control strategies should be developed and put in place in order to prevent non-vectorial transmission and actively detect cases of CD in Germany.

This paper analyzes the effects of the 2014-15 Chilean tax reform on firms' incentives to retain earnings and finance their operations with equity versus debt. The analysis comprises a comparison with the situation of the pre-reform period, and draws some conclusions about firms' valuation. The approach consists of analyzing the effects of the tax reform on total taxes paid and cash flows received by investors. Although the final effects are specific to the firm and investor, as they depend on the firm's dividend payout ratio and each investor's personal income tax rate, the results show that in general the reform reduced the value of firms and lessened the incentives to retain earnings. The simulations show that the majority of firms would choose the accrual or "attributed" tax–based system. However, if the latter is not permitted, firms will choose debt over equity. The cash-based or semi-integrated system becomes the preferred option only when elusion (or tax avoidance) is possible.

Total Skin Electron Irradiation (TSEI) is a radiotherapy treatment which involves irradiating the entire body surface as homogeneously as possible. It is composed of an extensive multi-step technique in which quality management requires high consumption of resources. The TG-100 proposes a new perspective of quality management in radiotherapy, presenting a systematic method of risk analysis throughout the global flow of the stages through the patient. With the intention of applying this method, a multidisciplinary team of people was involved in the procedure that produced the process map (PM). This PM can be useful for those centers that intend to implement the TSEI technique. This is the first stage of a full risk analysis performed in a reference center in this treatment technique.

Background: In Europe, Spain has the highest number of people with Chagas disease (CD). Bolivian migrants account for 81% of the reported cases. One of the priorities in controlling the disease is prevention of mother-to- child transmission. Despite under-diagnosis in Spain being estimated at 90%, there are currently few studies that explore the social and cultural dimensions of this disease. Objective: The aim of this study was to explore the knowledge and experiences of Bolivian women with CD, in order to generate a useful understanding for the design and implementation of public health initiatives. Design: Qualitative study based on semi-structured interviews, triangular groups, and field notes. Participants: Fourteen Bolivian women with CD living in Madrid. Results: The participants were aware that the disease was transmitted through the vector, that it could be asymptomatic, and that it could also be associated with sudden death by heart failure. They opined that the treatment as such could not cure the disease but only slow it down. There was a sense of indifference along with a lack of understanding of the risk of contracting the disease. Participants who presented with symptoms, or those with relatives suffering from the disease, were concerned about fatalities, cardiac problems, and possible vertical transmission. There was also a fear of being rejected by others. The disease was described as something that affected a large number of people but only showed up in a few cases and that too after many years. There was a widespread assumption that it was better not to know because doing so, allows the disease to take hold. Conclusions: Disease risk perception was very low in Bolivian women living in Madrid. This factor, together with the fear of being screened, may be contributing to the current rate of under-diagnosis.

Background and Aim: Reduction in FDG-PET uptake as response predictor after induction chemotherapy for breast cancer has been described. Our aim was to determine whether a SUV reduction ≥45% in the breast lesion could accurately predict pathological Complete Response (pCR). Material and Method: Stage II-IIIa breast cancer patients (p) with primary tumor ≥3cm or positive axilla were included provided they were amenable to neoadjuvant chemotherapy with Docetaxel-Doxorubicin-Cyclophosphamide (TAC). A FDG-PET scan was performed on day −1 of the first course and was repeated on day+8 of the same course. SUV-uptake differences (day 8 minus day −1) were correlated to the eventual pathological response according to Miller-Payne criteria. Results: 42p were included. Median age was 45 years (30-66). 11p (26.2%) were triple-negative tumors. 2p (4.8%) were Her-2 +. By stage, 13p (30.9%) were IIA, 17p (40.4%) IIB and 12p (28.2%) IIIA. 23p (54.7%) were N+ (FNAB positive). Median breast-SUV on first PET scan was 5.51 (1.3−18.50). 40p (95.2 %) completed the scheduled 6 courses. 41p (97.6%) were submitted to surgery. 11p (26.2%) achieved a pCR. 40p (95.2%) were evaluable for the primary objective. 1p (0.02%) died of disease progression before surgery and 1p (0.02%) with pCR could not be assessed by PET. 7 out of 14 p (50%) with uptake reduction ≥45% with respect to the basal value, and 3/26p (11.5%) whose reduction was 45% accurately predicted 7/10 pCR (70%) that could be assessed. Conclusions: Our study confirmed the value of PET-SUV reduction on day 8th as an early predictor of pCR with neoadjuvant TAC chemotherapy. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-16.

Background FDG-PET has proven to be useful during the initial staging of several tumor types. The aim of the present study was to assess the accuracy of this test in the assessment of initial axillary status in patients referred to treatment with induction chemotherapy. Material and Methods: Women with stage II-IIIA (tumors measuring ≥3cm or positive-staged axillary involvement) to be treated with neoadjuvant Docetaxel-Doxorubicin-Cyclophosphamide (TAC scheme) were included. In every patient a physical exam, MRI, ultrasound-guided FNAB and FDG-PET were performed prior starting chemotherapy. The criteria to consider the axilla to be initially positive were positive surgical staging or type-D pathological response (Miller-Payne) in the axilla. The ability of FDG-PET to predict pathological response in patients with breast cancer was assessed and compared with other routine procedures. Results: 42 patients (p) were included. Median age was 45 years (30-66). 11p (26.2%) were triple-negative. 2p (4.8%) were Her-2 +. By clinical stage, 13p (30.9%) were IIA, 17p (40.4%) IIB and 12p (28.2%) IIIA. 41p (97.6%) underwent surgery after induction chemotherapy. According to surgical staging 31p (75.6%) were deemed to be N+ from the diagnosis (19p with pathologic N1-3a and 12p with type-D nodal response). PET scan positively detected deposits in the axilla in 26p (83.9%) of those patients compared to 22p (70.9%) with ultrasound-FNAB, 19p (61.3%) physical exam and 14p (45.2%) MRI. Conclusions: In this study FDG-PET could predict axillary involvement more precisely than other routine staging procedures in these patients submitted to be treated with induction chemotherapy. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-08.

Introduction: RECIPE study was designed to assess the impact of dietary supplementation with fermented milk enriched with plant sterols (FMPS) on the nutritional behavior, lifestyle and the joint therapeutic responsibility of hypercholesterolemic patients. Methods: Observational, prospective, multicenter, international study, was conducted to assess dietary habits and other lifestyle components in hypercholesterolemic patients in whom the general practitioner indicated FMPS supplementation. Nutritional, lifestyle and clinical data were collected at the initial visit and after a 4 months follow-up. The biochemical and anthropometric data were retrieved from medical records obtained at baseline and 4 months. Results: We report the results of Spain. Two hundred and one physicians who provided valid data of 1044 patients participated. The addition of FMPS was associated with improved overall nutritional index, being adequate initially in 28.2% of patients, and increasing up to 75.2% at the end of the study (P< 001). This nutritional change was associated with an improvement in the lipid profile and anthropometric data. Patients more adherent to therapy generally achieved a better result in all parameters compared to non-compliant ones. Conclusions: The addition of FMPS to a diet designed to reduce the LDL enhances the patient's attitude regarding changes in lifestyle, leading to better overall control of dyslipidemia and anthropometric improvement. © 2012 Elsevier España, S.L. and SEA.