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Summary: Background: Prognostic factors for ambulatory oncology patients have been described, including Eastern Cooperative Oncology Group (ECOG), tumor stage and malnutrition. However, there is no firm evidence on which variables best predict mortality in hospitalized patients receiving active systemic treatment. Our main goal was to develop a predictive model for 90-day mortality upon admission. Methods: Between 2020 and 2022, we prospectively collected data from three sites for cancer patients with hospitalizations. Those with metastatic disease receiving systemic therapy in the 6 months before unplanned admission were eligible to this study. The least absolute shrinkage and selection operator (LASSO) method was used to select the most relevant factors to predict 90-day mortality at admission. A multivariable logistic regression was fitted to create the PROgnostic Score for Hospitalized Cancer Patients (PROMISE) score. The score was developed in a single-center training cohort and externally validated. Findings: Of 1658 hospitalized patients, 1009 met eligibility criteria. Baseline demographics, patient and disease characteristics were similar across cohorts. Lung cancer was the most common tumor type in both cohorts. Factors associated with higher 90-day mortality included worse ECOG, stable/progressive disease, low levels of albumin, increased absolute neutrophil count, and high lactate dehydrogenase. The c-index after bootstrap correction was 0.79 (95% CI, 0.75–0.82) and 0.74 (95% CI, 0.68–0.80) in the training and validation cohorts, respectively. A web tool (https://promise.vhio.net/) was developed to facilitate the clinical deployment of the model. Interpretation: The PROMISE tool demonstrated high performance for identifying metastatic cancer patients who are alive 90 days after an unplanned hospitalization. This will facilitate healthcare providers with rational clinical decisions and care planning after discharge. Funding: Merck S.L.U., Spain.

Summary: Studies on sensory information processing typically focus on whisker-related tactile information, overlooking the question of how sensory inputs from other body areas are processed at cortical levels. Here, we present a protocol for stimulating specific rodent limb receptive fields while recording in vivo somatosensory-evoked activity. We describe steps for localizing cortical-hindlimb coordinates using acute peripheral stimulation, electrode placement, and the application of electrical stimulation. This protocol overcomes the challenge of inducing a reproducible and consistent stimulation of specific limbs.For complete details on the use and execution of this protocol, please refer to Miguel-Quesada et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Objectives: To date, studies have not provided definitive answers regarding whether previous immune checkpoint inhibitor (ICI) treatment alters outcomes for cancer patients with COVID-19. Methods: The OnCovid registry (NCT04393974) was searched from February 27, 2020, to January 31, 2022, for patients who received systemic anti-cancer therapy in the 4 weeks before laboratory-confirmed COVID-19 diagnosis. Propensity-score matching using country, vaccination status, primary tumor type, sex, age, comorbidity burden, tumor stage, and remission status investigated differences in predefined clinical outcomes comparing those who had or had not received ICIs. Results: Of 3523 patients screened, 137 ICI-only and 1378 non-ICI met inclusion criteria. Before matching, ICI patients were older, male, enrolled at centers in Italy, and had histories of smoking, thoracic cancers, advanced cancer stages, and active malignancies (P ≤0.02). After matching, there were 120 ICI and 322 non-ICI patients. ICI patients had no differences (odds ratio: 95% CI) in presenting COVID-19 symptoms (0.69: 0.37-1.28), receipt of COVID-specific therapy (0.88: 0.54-1.41), 14-day (0.95: 0.56-1.61), or 28-day (0.79: 0.48-1.29) mortalities. However, ICI patients required less COVID-19-related hospitalization (0.37: 0.21-0.67) and oxygen therapy (0.51: 0.31-0.83) and developed fewer complications (0.57: 0.36-0.92). Conclusion: In this propensity-score matched analysis, previous ICI therapy did not worsen and potentially improved COVID-19 outcomes in patients with cancer.

Background: To date, limited evidence exists on the impact of COVID-19 in patients with soft tissue sarcoma (STS), nor about the impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in this specific population. Methods: We described COVID-19 morbidity and mortality among patients with STS across ‘Omicron’ (15 December 2021–31 January 2022), ‘Pre-vaccination’ (27 February 2020–30 November 2020), and ‘Alpha-Delta’ phase (01 December 2020–14 December 2021) using OnCovid registry participants (NCT04393974). Case fatality rate at 28 days (CFR 28 ) and COVID-19 severity were also described according to the SARS-CoV-2 vaccination status, while the impact of the receipt of cytotoxic chemotherapy within 4 weeks prior to COVID-19 on clinical outcomes was assessed with Inverse Probability of Treatment Weighting (IPTW) models adjusted for possible confounders. Results: Out of 3820 patients, 97 patients with STS were included. The median age at COVID-19 diagnosis was 56 years (range: 18–92), with 65 patients (67%) aged < 65 years and most patients had a low comorbidity burden (65, 67.0%). The most frequent primary tumor sites were the abdomen (56.7%) and the gynecological tract (12.4%). In total, 36 (37.1%) patients were on cytotoxic chemotherapy within 4 weeks prior to COVID-19. The overall CFR 28 was 25.8%, with 38% oxygen therapy requirement, 34% rate of complications, and 32.3% of hospitalizations due to COVID-19. CFR 28 (29.5%, 21.4%, and 12.5%) and all indicators of COVID-19 severity demonstrated a trend toward a numerical improvement across the pandemic phases. Similarly, vaccinated patients demonstrated numerically improved CFR 28 (16.7% versus 27.7%) and COVID-19 morbidity compared with unvaccinated patients. Patients who were on chemotherapy experienced comparable CFR 28 (19.4% versus 26.0%, p = 0.4803), hospitalizations (50.0% versus 44.4%, p = 0.6883), complication rates (30.6% versus 34.0%, p = 0.7381), and oxygen therapy requirement (28.1% versus 40.0%, p = 0.2755) compared to those who were not on anticancer therapy at COVID-19, findings further confirmed by the IPTW-fitted multivariable analysis. Conclusion: In this study, we demonstrate an improvement in COVID-19 outcomes in patients with STS over time. Recent exposure to chemotherapy does not impact COVID-19 morbidity and mortality and SARS-CoV-2 vaccination confers protection against adverse outcomes from COVID-19 in this patient population.

La romana Margherita Sarrocchi se propuso escribir, como muchos de sus contemporáneos, una obra comparable a los grandes poemas épicos de la Antigüedad. A diferencia de ellos, la autora quiso dotar a sus personajes femeninos de una autoridad y prevalencia como no se había visto hasta entonces. Las guerreras Rosmonda y Silveria encarnaron el deseo de Sarrocchi de crear personajes femeninos con voz propia, portavoces de injusticias y capaces de rebelarse contra el destino que normalmente les aguardaba, bien rechazándolo, bien aceptándolo en sus propios términos.

Abstract Ecuador has both high richness and high endemism, which are increasingly threatened by anthropic pressures, including roads. Research evaluating the effects of roads remains scarce, making it difficult to develop mitigation plans. Here, we present the first national assessment of wildlife mortality on roads that allow us to (1) estimate roadkill rates per species, (2) identify affected species and areas, and (3) reveal knowledge gaps. We bring together data from systematic surveys and citizen science efforts to present a dataset with 5010 wildlife roadkill records from 392 species, and we also provide 333 standardized corrected roadkill rates calculated on 242 species. Systematic surveys were reported by ten studies from five Ecuadorian provinces, revealing 242 species with corrected roadkill rates ranging from 0.03 to 171.72 ind./km/year. The highest rates were for the yellow warbler Setophaga petechia in Galapagos (171.72 ind./km/year), the cane toad Rhinella marina in Manabi (110.70 ind./km/year), and the Galapagos lava lizard Microlophus albemarlensis (47.17 ind./km/year). Citizen science and other nonsystematic monitoring provided 1705 roadkill records representing all 24 provinces in Ecuador and 262 identified species. The common opossum Didelphis marsupialis, the Andean white‐eared opossum Didelphis pernigra, and the yellow warbler Setophaga petechia were more commonly reported (250, 104, and 81 individuals, respectively). Across all sources, we found 15 species listed as “Threatened” and six as “Data Deficient” by the IUCN. We recommend stronger research efforts in areas where the mortality of endemic or threatened species could be critical for populations, such as in Galapagos. This first country‐wide assessment of wildlife mortality on Ecuadorian roads represents contributions from academia, members of the public, and government, underlining the value of wider engagement and collaboration. We hope these findings and the compiled dataset will guide sensible driving and sustainable planning of infrastructure in Ecuador and, ultimately, contribute to reduce wildlife mortality on roads.

Background: The purpose of this study was to validate glenoid cartilage lesions as a negative prognostic factor and to define a new image-based preoperative evaluation method to identify surgical candidates for arthroscopic labral refixation with suture anchors in posterior shoulder instability. Methods: Twenty-six patients who underwent arthroscopic posterior labral repair for shoulder instability were evaluated. Only patients with structural dynamic posterior instability were included. We evaluated on preoperative magnetic resonance arthrogram: glenoid version, humeral head subluxation, type of capsular insertion, and the cartilage lesions using the new Cartilage Wear Index (CWI). Two subgroups were analyzed with regard to the preoperative CWI and shoulder outcome scores: Single Assessment Numerical Evaluation (SANE) and Western Ontario Shoulder Instability Index (WOSI). Results: The median age at operation was 28 (interquartile range = 21-33) years. Median overall postoperative outcome assessment demonstrated a SANE of 90 and a WOSI of 385. The median CWI was 1.02. Subgroup analysis revealed worse median WOSI and SANE scores in patients with a CWI >1.02 and a strong correlation between a high preoperative CWI and a higher postoperative WOSI score (R = 0.58; P = .038). Conclusion: The CWI can be useful to identify patients who might obtain better outcomes when treated with arthroscopic labral repair in posterior shoulder instability.

The emergence of distributed energy resources in the electricity system involves new scenarios in which domestic consumers can be aggregated in virtual power plants to participate in energy markets. In this paper, a reconfigurable hierarchical multi-time scale framework is developed by combining the concepts of dynamic storage virtualization and intent profiling with model predictive control. The combined implementation of these concepts allows the simultaneous weighted participation in different energy markets, not only according to some aggregators’ criteria, but also to several risk factors. In a first stage, the framework optimizes the strategy for bidding in day-ahead market whereas the second one consists of a control stage to mitigate deviations and potential penalties. The smart management of individual storage virtualization enables the participation in the demand-response program, which improves the forecasted economical profit related to the day-ahead participation. The changes in the schedule are performed considering new potential penalties. The framework is reconfigurable at every sample time at control stage. This enables to make dynamic participations depending on node availability or system peaks. The proposed case studies cover day-ahead and demand-response participations, but the framework is open to other multi-service configurations. The results have been assessed with satisfactory conclusions.

Background As management and prevention strategies against COVID-19 evolve, it is still uncertain whether prior exposure to immune checkpoint inhibitors (ICIs) affects COVID-19 severity in patients with cancer.Methods In a joint analysis of ICI recipients from OnCovid (NCT04393974) and European Society for Medical Oncology (ESMO) CoCARE registries, we assessed severity and mortality from SARS-CoV-2 in vaccinated and unvaccinated patients with cancer and explored whether prior immune-related adverse events (irAEs) influenced outcome from COVID-19.Findings The study population consisted of 240 patients diagnosed with COVID-19 between January 2020 and February 2022 exposed to ICI within 3 months prior to COVID-19 diagnosis, with a 30-day case fatality rate (CFR30) of 23.6% (95% CI 17.8 to 30.7%). Overall, 42 (17.5%) were fully vaccinated prior to COVID-19 and experienced decreased CFR30 (4.8% vs 28.1%, p=0.0009), hospitalization rate (27.5% vs 63.2%, p

Objective While greater body mass index (BMI) is associated with increased risk of developing atrial fibrillation (AF), the impact of BMI on outcomes in newly diagnosed AF is unclear. We examine the influence of BMI on outcomes and whether this is modified by sex and evaluate the effect of non-vitamin K oral anticoagulants (NOACs) in patients with high BMI.Methods GARFIELD-AF is a prospective registry of 52 057 newly diagnosed AF patients. The study population comprised 40 482 participants: 703 underweight (BMI

We reviewed the available information on the use of immune checkpoint inhibitors (ICIs) in populations with special conditions, namely, patients with HIV, tuberculosis, or underlying autoimmune disease. Available data show that treatment with ICIs is safe in patients with HIV; it is advisable, however, that these patients receive adequate antiretroviral therapy and have an undetectable viral load before ICIs are initiated. Tuberculosis reactivation has been reported with the use of ICIs, possibly due to immune dysregulation. Tuberculosis has also been associated with the use of immunosuppressors to treat immune-related adverse events (irAEs). Active tuberculosis must be ruled out in patients with symptoms or signs, and selected patients may benefit from screening for latent tuberculosis infection, although more data are required. Limited data exist regarding the safety of ICIs in patients with cancer and autoimmune disease. Data from observational studies suggest that up to 29% of patients with a preexisting autoimmune disease treated with an ICI present with an autoimmune disease flare, and 30% present with a de novo irAE of any type. The frequency of flares appears to differ according to the type of ICI received, with higher rates associated with PD-1/PD-L1 inhibitors. The most common autoimmune diseases for which patients reported flares with ICI therapy are rheumatoid arthritis, other inflammatory arthritis, and psoriasis. Most studies have reported flares or de novo irAEs associated with ICIs that were mild to moderate, with low rates of discontinuation and no deaths due to flares. Therefore, the use of ICIs in these patients is possible, but careful monitoring is required.

ABSTRACT We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T.

Astrocytes respond to neurotransmitters with calcium transients stimulating the release of gliotransmitters that regulate synaptic and neuronal functions. Here, the authors show that cortical astrocytes also respond to sensory inputs and regulate sensory-evoked neuronal network activity.

La Academia de la Arcadia supuso, desde su creación, un excelente auspicio para las mujeres que deseaban ejercer la escritura. Las escritoras de la Arcadia formaron un nutrido grupo que, si bien dentro del canon impuesto, destacó por la calidad de algunas de sus componentes hasta el punto de llegar a formar parte de las antologías masculinas de la época y siglos posteriores. No obstante, no todo fue positivo, pues quedaron fuera de la institución poetas de talento cuyo estilo de vida no congeniaba con el estilo que sus fundadores quisieron imprimir a la Arcadia. Al menos, Cristina Dudley y Teresa Zani, entre otras, vieron su labor poética reconocida en diversas antologías.

Las ilustraciones creadas para la campaña publicitaria de la marca Maskom para Teatro Soho Caixabank, es el objetivo de este ejercicio de ensayo visual, Una colección de retóricas visuales, compuestas a través de la combinación de elementos comestibles transformados, escalados y reinterpretados basados en la historia del teatro, a través de la selección de un conjunto de obras representativas. Maskom Supermercados es una franquicia histórica de Málaga que, en su condición de patrocinador, se publicita en las redes sociales del teatro a través de estas imágenes que hacen convivir dos marcas de ámbitos bien distintos –el sector agroalimentario y el cultural– sin dejar de ofrecer un contenido exigente, en su desarrollo gráfico y enfoque conceptual, y entretenido. Esta propuesta gráfica desrarollada por Narita Estudio reúne, bajo el título “Historia del Teatro” mas de 20 ilustraciones –de las que se muestran en este ensayo doce– como un conjunto de metáforas, elipsis y juegos de retórica visual.

Background: Cancer patients are at higher risk of COVID-19 complications and mortality than the rest of the population. Breast cancer patients seem to have better prognosis when infected by SARS-CoV-2 than other cancer patients. Methods: We report a subanalysis of the OnCovid study providing more detailed information in the breast cancer population. Results: We included 495 breast cancer patients with a SARS-CoV-2 infection. Mean age was 62.6 years; 31.5% presented more than one comorbidity. The most frequent breast cancer subtype was luminal-like ( n = 245, 49.5%) and 177 (35.8%) had metastatic disease. A total of 332 (67.1%) patients were receiving active treatment, with radical intent in 232 (47.6%) of them. Hospitalization rate was 58.2% and all-cause mortality rate was 20.3%. One hundred twenty-nine (26.1%) patients developed one COVID-19 complication, being acute respiratory failure the most common ( n = 74, 15.0%). In the multivariable analysis, age older than 70 years, presence of COVID-19 complications, and metastatic disease were factors correlated with worse outcomes, while ongoing anticancer therapy at time of COVID-19 diagnosis appeared to be a protective factor. No particular oncological treatment was related to higher risk of complications. In the context of SARS-CoV-2 infection, 73 (18.3%) patients had some kind of modification on their oncologic treatment. At the first oncological reassessment (median time: 46.9 days ± 36.7), 255 (51.6%) patients reported to be fully recovered from the infection. There were 39 patients (7.9%) with long-term SARS-CoV-2-related complications. Conclusion: In the context of COVID-19, our data confirm that breast cancer patients appear to have lower complications and mortality rate than expected in other cancer populations. Most breast cancer patients can be safely treated for their neoplasm during SARS-CoV-2 pandemic. Oncological treatment has no impact on the risk of SARS-CoV-2 complications, and, especially in the curative setting, the treatment should be modified as little as possible.

Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository ( N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT− not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more ‘Do not attempt cardio-pulmonary resuscitation’ orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p

La presente investigación cualitativa pretende comprender cómo el liderazgo compartido de la dirección de un centro escolar influye en los procesos de cambio y mejora en el aprendizaje. A través de un estudio de caso, se persigue identificar y comprender los procesos de transformación escolar necesarios para que se genere el cambio y la innovación educativa, explorando las estrategias que impulsan los procesos de enseñanza-aprendizaje, el trabajo del profesorado, la organización y las metodologías implementadas en las aulas. Los principales resultados ponen de manifiesto cómo la dirección del centro escolar lidera y dinamiza el trabajo en equipo del profesorado, posibilitando que se produzca un cambio educativo sistémico con la participación e implicación de toda la comunidad educativa; por lo que la visión educativa del equipo directivo, el compromiso de los docentes, el protagonismo del alumnado y la colaboración de las familias son claves en la transformación iniciada en el centro.

Myelin, critical for the correct function of the nervous system, is organized in different patterns that can include long non-myelinated axonal segments. How myelin patterning is regulated remains unexplained. The carbohydrate-binding protein galectin-4 (Gal-4) influences oligodendrocyte differentiation in vitro and is associated with non-myelinable axon segments (NMS) in cultured neurons. In consequence, Gal-4 has been proposed as a myelin patterning regulator, although no in vivo studies have corroborated this hypothesis. We used Gal-4-deficient mice (Lgals4-KO) to study the role of Gal-4 in cortical myelination in vivo. We show that cultured neurons of Lgals4-KO mice form NMS that are regulated as in control neurons. In addition, oligodendrocyte/myelin markers expression measured by biochemical and immunochemical means, and cortical myelin microstructure studied by in-depth image analysis appear unaltered in these animals. Consistently, myelin displays an essentially normal function assessed by in vivo electrophysiology and locomotion analyses. In conclusion, cortical myelin of Lgals4-KO mice does not show any significant defect in composition, organization or function, pointing to a negligible role of Gal-4 in myelination in vivo or, as discussed, to unknown mechanisms that compensate its absence.

Show caves have different grades of colonization by phototrophic biofilms. They may receive a varied number of visits, from a few thousand to hundreds of thousands of visitors annually. Among them, Tesoro Cave, Rincon de la Victoria, Spain, showed severe anthropic alterations, including artificial lighting. The most noticeable effect of the lighting was the growth of a dense phototrophic community of cyanobacteria, algae and bryophytes on the speleothems, walls and ground. The biofilms were dominated by the cyanobacterium Phormidium sp., the chlorophyte Myrmecia israelensis, and the rhodophyte Cyanidium sp. In many cases, the biofilms also showed an abundance of the bryophyte Eucladium verticillatum. Other cyanobacteria observed in different biofilms along the cave were: Chroococcidiopsis sp., Synechocystis sp. and Nostoc cf. edaphicum, the green microalgae Pseudococcomyxa simplex, Chlorella sp. and the diatom Diadesmis contenta. Preliminary cleaning tests on selected areas showed the effectiveness of hydrogen peroxide and sodium hypochlorite. A physicochemical treatment involving the mechanical removal of the thickest layers of biofilms was followed by chemical treatments. In total, 94% of the surface was cleaned with hydrogen peroxide, with a subsequent treatment with sodium hypochlorite in only 1% of cases. The remaining 5% was cleaned with sodium hypochlorite in areas where the biofilms were entrapped into a calcite layer and in sandy surfaces with little physical compaction. The green biofilms from the entire cave were successfully cleaned.

El objetivo fue identificar los factores de riesgo psicosocial en agencias distribuidoras de automóviles de la Ciudad de Chihuahua que inciden en la calidad de vida del trabajador y por tanto en su productividad. Se usaron los instrumentos indicados en el Diario Oficial de la Federación para la NOM 03, dichos instrumentos tienen por escala de medición la ordinal con opciones tipo Likert y con alfa de Cronbach superior a 0.7. Como resultado el “Nivel de Presión” en la relación obrero-patronal es bastante fuerte dentro de los miembros de la cadena de suministro que se ha reflejado en un clima laboral desfavorable, aunado a estilo de liderazgo no positivo. Abstract The objective of this research is to identify the psychosocial risk factors in Chihuahua City’s automotive distribution agencies that adversely affect the quality of life of workers and therefore, having a negative or unfavorable impact on their productivity. Instruments indicated in the Official Gazette of the Federation NOM-035 were used, which have an ordinal scale of measurement with Likert-type options and with a Cronbach alpha higher than 0.7. As a result, the “Level of Pressure” in reference to the employer-employee relationship is extremely intense among members of the supply chain, which is reflected in an unfavorable ‘work environment, combined with non-positive leadership styles. To gather the necessary information, Google Forms and questionnaire instruments estabashed in NOM with an ordinal scale, based on reference Guides II and III were used. The information was then processed with the use of Excel and SPSS (Statistical Package for Social Sciences) version 23. Deterministic and simple random sampling was used. This is a mix of desk and field research.

Background Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.Methods In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.Results We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.

Call For Papers Umática [nº4]

El número especial I+Diseño X ANIVERSARIO –publicado en edición impresa en febrero de esta año y presentado en Transferencias.design– daba cuenta de una década cumplida en la trayectoria de este proyecto. Surgido en la necesidad y compromiso de disponer de una herramienta de investigación y difusión del diseño, desde una perspectiva dimensional, de alcance social y económico. La componente más innovadora del diseño –como indicábamos en la editorial en primer número– ha ido consolidando nuevos perfiles profesionales, integrando cada vez más el diseño como una función clave en instituciones y empresas. No obstante, su generalización aún queda lejos. La divulgación de las investigaciones los proyectos desarrollados en el ámbito del diseño pueden ayudar a reconocer la importancia de los mismos en nuestro entorno y hacer diario, en cualesquiera de los sectores de actividad social y económica. No puede encontar hoy mejor enclave este proyecto editorial de la Universidad de Málaga, en una ciudad que ha vivido un proceso de transformación en los últimos años reseñable. Proyecto que cuenta, desde este año, con otra institución de referencia como es la Universidad de Deusto en Bilbao, otra ciudad de referencia en investigación y desarrollo industrial. Los procesos de diseño son también procesos de cambio, sus metodologías –resistentes al caos– enfrentan, con rigor científico y procesos disruptivos, los desafíos a los que, sin duda alguna, hemos de enfrentarnos en los próximos años. Cambios de paradigma que pueden encontrar, en el pensamiento de diseño, su visión anticipatoria, recursos y estrategias que faciliten los procesos de transformación en los que nos encontramos inmersos, considerando la responsabilidad social, la sostenibilida e inclusión como factores clave. A lo largo de todos estos años, el equipo editorial de I+Diseño –en la dirección del profesor Sebatián García-Garrido, docentes y profesionales implicados– ha ayudado a poner en valor la investigación académica y científica desarrollada por universidades, centros de diseño y profesionales tanto nacionales como internacionales. Una importante labor que esta nueva dirección reconoce y espera seguir desarrollando e implementando, para que el conocimiento, la investigación y experimentación en diseño sea patrimonio de todos.

Stiffness is a well-known complication after reverse shoulder arthroplasty. Although multiple factors may be involved, the main cause for stiffness is rarely identified. Imaging studies frequently are inconclusive in ruling out mechanical or biological causes. Periprosthetic infection should be always suspected, but the absence of major clinical signs and accurate diagnostic tests is frequent. A lack of objective criteria establishing a diagnosis and when to proceed with revision surgery is often present in such cases. Moreover, additional surgical procedures should be carefully evaluated, as they can represent a point of no return. Shoulder arthroscopy plays an increasingly important role in these cases, either as a diagnostic or therapeutic tool. There are no reports about arthroscopy on stiffness after reverse shoulder arthroplasty. In this Technical Note, we describe an arthroscopic technique aimed to identify potential causes of reverse shoulder arthroplasty stiffness. Subsequent circumferential release is described and discussed.

Static magnetic fields have been shown to induce effects on the human brain. Different experiments seem to support the idea that moderate static magnetic field can exert some influence on the gating processes of the membrane channels. In this article we visit the order of magnitude of the energy magnetic terms associated with moderate applied field (between 10 and 200 milliteslas). It is shown that gradients of the Zeeman energy associated with the inhomogeneous applied fields can induce pressures of the order of 10–2Pa. The surface tension generated by the magnetic pressure, on the surface delimiting the brain region subject to relevant field and gradients, is found to range between 10–1 and 1 mN⋅m–1. These pressures seem to be strong enough to interfere with the elastic and electrostatic energies involved in the channel activation-inactivation-deactivation mechanisms of biological membranes. It has been described that small mechanical force can activate voltage gated potassium channels. Moreover, stretch-activated ion channels are widely described in different biological tissues. Virtually, all these channels can modify their activity if stressed by a sufficient pressure delivered for enough time. We propose mechanical stimulation – possibly not exclusively – as a candidate mechanism how static magnetic field can produce effects in biological systems. It must be emphasized, that such field gradients were not previously proposed as a possible source of neural activity modification.

Entrevista a Felipe Formariz Pombo: Subdirector General de Coordinación y Relaciones Institucionales del Ministerio de Ciencia, Innovación y Universidades. Administrador Civil del Estado. Ha sido Subdirector General de Marketing Exterior del Turismo (Turespaña), Director de la Oficina Española de Turismo en Bruselas, y Vocal Asesor de la D.G. de Comunicación e Información Diplomática el Ministerio de Asuntos Exteriores y Cooperación, entre otros puestos de relevancia. Entrevista Soledat Berbegal Soledat Berbegal es Consejera y Directora de Reputación de Marca en Actiu, empresa familiar y Premio Nacional de Diseño 2017, especializada en el diseño y fabricación de muebles para espacios de trabajo y contract presente en más de 90 países. Su trabajo está ligado a la proyección internacional de la marca Actiu a través de proyectos comprometidos con la investigación, sostenibilidad, diseño o tecnología, centrando su esfuerzo en fomentar relaciones corporativas estratégicas y consolidar la percepción del mobiliario como una herramienta para mejorar el bienestar y la productividad en espacios de trabajo.

Background: Food allergy is an adverse reaction secondary to a specific immune response after exposure to a food. Knowing the natural course of food allergies is essential for opportune diagnosis and treatment. Objective: To know the clinical profile of children diagnosed with food allergy attended to at the pediatric allergology department of a secondary care hospital. Method: Cross-sectional study of medical records of children with a confirmed diagnosis of food allergy. The type of food allergy, initial clinical presentation, history of familial atopy, time of breastfeeding, ablactation age and positive food allergens per patient, among others, were assessed. Descriptive analysis was performed and association was searched with the chi-square test. Results: Females were predominant among 95 patients. Milk, soy, wheat and egg were the foods with more allergic responses. Predominant clinical manifestations were gastrointestinal. The time from symptoms’ onset to definitive diagnosis was 3.2 years. Food allergy was associated with an ablactation age ≥ 6 months, milk and soy with respiratory and gastrointestinal symptoms, egg with respiratory and dermatological symptoms, and wheat with gastrointestinal symptoms. Conclusions: Food allergies in our population appeared mainly as gastrointestinal symptoms and there was an association between clinical presentation and allergenic foods.

Abstract Transcranial direct current stimulation modifies cortical excitability and in consequence some cerebral functions. In the present study we aimed to elucidate whether tDCS could affect temperature and pain perceptions in healthy subjects testing different stimulation parameters. A total of 20 healthy subjects were studied by means of quantitative sensory testing. Two different experiments were performed. First, we studied the effects of 15 minutes 2 mA anodal transcranial direct current stimulation applied over left M1 and parietal cortex in two separated sessions. Then, we tested the effects of 5 minutes tDCS over M1 by means of a sham controlled design to optimize the possibility to study minimal effects of tDCS using different polarities (cathodal and anodal) and intensities (1 and 2 mA). 2 mA anodal tDCS, when applied for both 15 and 5 minutes over the motor cortex, increased cold perception threshold. Conversely, motor cortex cathodal tDCS modulated cold perception threshold only when 1 mA intensity was used. M1-tDCS can modify the temperature perception; these effects are polarity and intensity dependent. As stimulation intensity seems critical to determine the effects, we suggest that for clinical application strong anodal tDCS (>1 mA) or weak cathodal tDCS (

Drug–drug interactions are of significant concern in clinical practice in oncology, particularly in patients receiving Cyclin-dependent kinase (CDK) 4/6 inhibitors, which are typically exposed to long-term regimens. This article presents the highlights from the ‘First Workshop on Pharmacology and Management of CDK4/6 Inhibitors: Consensus about Concomitant Medications’. The article is structured into two modules. The educational module includes background information regarding drug metabolism, corrected QT (QTc) interval abnormalities, management of psychotropic drugs and a comprehensive review of selected adverse effects of palbociclib and ribociclib. The collaborative module presents the conclusions of the five working groups, each of which comprised five experts from different fields. From these conclusions positive lists of drugs for treating common comorbid conditions that can be safely administered concomitantly with palbociclib and/or ribociclib were developed.

Background: Multiple sclerosis (MS) is an autoimmune disorder of the CNS in which inflammation, demyelination, and axonal damage of the central nervous system coexist. Fatigue is one of the most disabling symptoms in MS and little is known about the neurophysiological mechanisms involved.Methods: To give more mechanistic insight of fatigue in MS, we studied a cohort of 17 MS patients and a group of 16 age-matched healthy controls. Baseline Fatigue Severity Scales and Fatigue Rating were obtained from both groups to check the level of fatigue and to perform statistical correlations with fatigue-induced neurophysiologic changes. To induce fatigue we used a handgrip task. During the fatiguing task, we evaluated fatigue state (using a dynamometer) and after the task we evaluated the Borg Rating of Perceived Exertion Scale. Transcranial magnetic stimulation and peripheral electric stimulation were used to assess corticospinal tract and peripheral system functions before and after the task.Results: Clinically significant fatigue and central motor conduction time were greater in patients than in controls, while motor cortex excitability was decreased and maximal handgrip strength reduced in patients. Interestingly, fatigue state was positively correlated to perceived fatigue in controls but not in patients. Furthermore, in the presence of similar fatigue state over time, controls showed a significant fatigue-related reduction in motor evoked potential (a putative marker of central fatigue) whereas this effect was not seen in patients.Conclusions: in MS patients the pathogenesis of fatigue seems not driven by the mechanisms directly related to corticospinal function (that characterize fatigue in controls) but seems probably due to other “central abnormalities” upstream to primary motor cortex.

Spinal plasticity is thought to contribute to sensorimotor recovery of limb function in several neurological disorders and can be experimentally induced in animals and humans using different stimulation protocols. In healthy individuals, electrical continuous Theta Burst Stimulation (TBS) of the median nerve has been shown to change spinal motoneuron excitability in the cervical spinal cord as indexed by a change in mean H-reflex amplitude in the flexor carpi radialis muscle. It is unknown whether continuous TBS of a peripheral nerve can also shift motoneuron excitability in the lower limb. In 26 healthy subjects, we examined the effects of electrical TBS given to the tibial nerve in the popliteal fossa on the excitability of lumbar spinal motoneurons as measured by H-reflex amplitude of the soleus muscle evoked by tibial nerve stimulation. Continuous TBS was given at 110% of H-reflex threshold intensity and compared to non-patterned regular electrical stimulation at 15 Hz. To disclose any pain-induced effects, we also tested the effects of TBS at individual sensory threshold. Moreover, in a subgroup of subjects we evaluated paired-pulse inhibition of H-reflex. Continuous TBS at 110% of H-reflex threshold intensity induced a short-term reduction of H-reflex amplitude. The other stimulation conditions produced no after effects. Paired-pulse H-reflex inhibition was not modulated by continuous TBS or non-patterned repetitive stimulation at 15 Hz. An effect of pain on the results obtained was discarded, since non-patterned 15 Hz stimulation at 110% HT led to pain scores similar to those induced by EcTBS at 110% HT, but was not able to induce any modulation of the H reflex amplitude. Together, the results provide first time evidence that peripheral continuous TBS induces a short-lasting change in the excitability of spinal motoneurons in lower limb circuitries. Future studies need to investigate how the TBS protocol can be optimized to produce a larger and longer effect on spinal cord physiology and whether this might be a useful intervention in patients with excessive excitability of the spinal motorneurons.

Se realizó un estudio que tuvo como objetivos caracterizar la morbilidad de los educandos de primaria del Consejo Popular "Cayo Hueso", del Municipio Centro Habana, en el curso escolar 2008-2009, e identificar la relación entre la morbilidad encontrada y los resultados académicos de los educandos. El estudio fue complejo combinado de tipo transversal descriptivo y analítico (caso y control). Se estudiaron los educandos de primer a sexto grados de las seis instituciones educacionales de la enseñanza primaria del mencionado Consejo Popular. Para cumplir los objetivos propuestos se les realizó a todas las madres un cuestionario con preguntas que exploraron los antecedentes patológicos personales de los educandos. Se identificaron alteraciones del estado de salud que pudieron estar relacionadas con las condiciones ambientales de los hogares o las instituciones educacionales y constituir factores de riesgo para el aprendizaje. El retardo del desarrollo psicomotor y la inatención e hiperactividad fueron las alteraciones de salud que más se asociaron con estos resultados académicos. Se hacen recomendaciones.A study aiming to characterize the morbidity of primary students was conducted in Cayo Hueso Community Council, Havana, in the 2008-2009 school year. Also, the relationship between the found morbidity and students´ academic results was to be identified. This was a complex cross-sectional combination of descriptive and analytical (case and control) study. The students from the first to sixth years were sample to study from six different primary education institutions from this community council. In order to meet our objectives, a questionnaire exploring the personal medical history of these students was applied to all mothers. Health disorders were identified. They could be related to the environmental conditions of their homes or their educational institutions and be risk factors for learning. Psychomotor developmental delay, inattention and hyperactivity were the health disorders most associated with these academic results. Recommendations are made.

La colección de portadas de Novelas y Cuentos —de la editorial Dédalo— realizadas por Manolo Prieto (Puerto de Santa María, Cádiz 1912-Madrid 1991) es una extensa producción gráfica. Más de 600 portadas diseñadas a lo largo de 17 años. Un prontuario de recursos gráficos llevado a cabo entre la década de los años 40 a los 60, un periodo clave en el desarrollo del diseño gráfico en España. Este artículo incorpora un nuevo documento en la investigación y catalogación de esta producción que modificó sustancialmente el método de trabajo de Manolo Prieto.

El Ministerio de Educación realiza acciones para lograr cumplir los objetivos de la Tercera Revolución Educacional; una es el proyecto multicéntrico, liderado por el Instituto Central de Ciencia Pedagógicas, "Aprendizaje para Todos", en el marco del cual se solicitó al Instituto Nacional de Higiene, Epidemiología y Microbiología realizar un estudio en el que se caracterizaran los hábitos de vida y los aspectos psicosociales de los educandos de primaria, según resultados de su aprendizaje, y se relacionaran los hábitos y las características psicosociales con sus resultados académicos. El estudio fue complejo combinado, de tipo transversal, descriptivo y analítico (caso y control), en los educandos de primer a sexto grados de las seis instituciones educacionales de la enseñanza primaria del Consejo Popular "Cayo Hueso", durante el curso escolar 2006-2007. Para cumplir los objetivos a todas las madres se les aplicó un cuestionario con preguntas acerca de la historia educacional de los hijos, sus hábitos y comportamientos. Se identificaron hábitos de vida y comportamientos inadecuados que predominaron en los educandos con problemas de aprendizaje, tales como: jugar en exceso, dormir tiempo insuficiente o con dificultades, las malas relaciones con la madre o el padre y convivientes, el comportamiento violento, intranquilo e impulsivo, estar triste sin razón, poco satisfecho con estudios y no soportar las frustraciones. Se asociaron como factor de riesgo a los problemas de aprendizaje: el juego en exceso, ser intranquilo e impulsivo, poco satisfecho con el estudio, dormir tiempo insuficiente, o con dificultades, no soportar frustraciones y el comportamiento violento y triste sin razón. Como factor protector se encontró leer en tiempo libre.Ministry of Education take actions to fulfil the objectives of the Third Educational Revolution; one is the multicenter project leaded by the Central Institute of Educational Science, "Learning for Everybody" where authors requested to National Institute of Hygiene, Epidemiology and Microbiology the carrying out of an study to characterize the life habits and the psychosocial features of primary school students, according to the results of their learning and that are related to habits and the psychosocial features with the academic results. The study was complex, combined, cross sectional, descriptive and analytical (case-control) conducted in the first to sixth grades students from the six educational institutions of primary teaching of the above mentioned council during the school course 200-2007. To fulfill the objectives the mother filled a questionnaire with questions on the educational history of children, habits and behaviors. There were identified inappropriate life habits and behaviors with predominance in students with learning problems including: to play in excess, an insufficient sleep hours or with difficulties for it, bad relationships with parents and other family members, the violent behavior, restless and impulsive, to be sad without any reason, no satisfied with the studies and to hate the frustrations. The risk factors included the above mentioned situations. As a protector factor was to read in the spare time.

Se realizó un estudio de casos y controles en 3 311 niños y adolescentes (2 755 niños de primaria y 556 adolescentes de secundaria) de todas las instituciones educacionales de estos niveles de enseñanza de los consejos populares "Cayo Hueso" y "Colón", del municipio de Centro Habana, durante el período de enero a junio de 2006. El presente trabajo tuvo como objetivo determinar la relación entre el uso de video juegos y los efectos sobre el comportamiento en niños y adolescentes de las instituciones educacionales de estos niveles de enseñanza de los consejos populares mencionados. Se les aplicó una encuesta a todas las madres, la cual contenía preguntas sobre el uso de video juegos o ataris, tiempo que juegan, elementos del comportamiento de los niños tales como la violencia, las relaciones interpersonales, la intranquilidad y/o la impulsividad de ellos. La selección de los casos y de los controles se realizó a partir de la respuestas dadas por las madres de los alumnos relativas a si usaban o no los video juegos o ataris fuera de la escuela en su tiempo libre, contenidas en el cuestionario. Como principales resultados se obtuvo asociación entre el uso de juegos de video con el comportamiento violento y la dificultad de las relaciones interpersonales en los alumnos de primaria, así como el comportamiento intranquilo y/o impulsivo, el cual predominó en los adolescentes de secundaria básica. Se recomienda a los padres limitar el tiempo de juegos de video a no más de una hora y supervisar el contenido de los estos, así como propiciar en los niños y en los adolescentes la realización de actividades que permitan el adecuado desarrollo físico, mental, social y familiar.A case-control study was conducted in 3 311 children and adolescents (2 755 students of primary school and 556 of secondary school) from all the educational institutions of these teaching levels of the "Cayo Hueso" and "Colon" popular councils of the Centro Habana municipality from January to June, 2006. The objective of present paper was to determine the relationship between the use of video games and the effects on the behavior of children and adolescents from the educational institutions of the above mentioned teaching levels and popular councils. A survey was applied in all the mothers, which contained questions on the use of video games or "ataris", the times playing, elements of behavior of children such as violence, interpersonal relationships, anxiety and/or its impulsiveness. Selection of cases and control was from the responses given by student's mothers related to if they used or not the video games or "ataris" outside school in the spare time registered in the questionnaire. The main results included the association between the use of video games and a violent behavior and the difficulty of interpersonal relationships in primary school students, as well as the anxious and/or impulsive behavior which predominate in basic secondary students. Authors made recommendations in this respect.

Introducción: el deterioro de las condiciones ambientales contribuye de forma importante a los procesos de la enfermedad, porque expone a la población urbana a enfermedades y riesgos muy bien identificados y conocidos. Objetivos: identificar las condiciones ambientales riesgosas en los hogares, las escuelas y sus entornos para la prevalencia de las infecciones respiratorias en educandos, en el curso escolar 2006-2007. Métodos: se realizó un estudio descriptivo transversal en los educandos de 1ro. a 6to. grado del universo de las escuelas primarias del consejo popular Cayo Hueso, del municipio Centro Habana. Se aplicó a las madres un cuestionario con preguntas al respecto, y se realizó la evaluación de las condiciones ambientales de las escuelas y sus entornos, según las orientaciones de guías preelaboradas. Resultados: la prevalencia de infecciones respiratorias agudas fueron obtenidas de los educandos que asisten a las escuelas "Pedro Carbó Serviá", "Salvador Cisneros Betancourt", "Fernández Roig" y "República de Bolivia", y coincidió con que son las que tienen más factores de riesgo del ambiente y/o las que tienen mayores frecuencias de educandos con condiciones ambientales riesgosas de sus hogares, escuelas o entorno.Introduction: deterioration of environmental conditions contributes in a very important way to disease processes because of to expose to urban population to diseases and risks very well identified and well known. Objective: to identify the risky environmental conditions at homes, schools and its surroundings for prevalence of respiratory infections in the students during 2006-1007 courses. Methods: a cross-sectional and descriptive study was conducted in students from 1st to sixth degrees from the universe of primary schools of "Cayo Hueso" popular council of the Centro Habana municipality. In mothers a questionnaire was distributed with related questions and the environmental conditions of schools and its surroundings were assessed according to the guidances of previously drew up guides. Results: prevalence of acute respiratory infections was achieved from the students of the "Pedro Carbó Serviá", "Salvador Cisneros Betancourt", "Fernández Roig" and "República de Bolivia" schools which have more environmental risk factors and/or those with great frequencies of students with risky environmental conditions at home, school and surroundings.

Se realizó un estudio que tuvo como objetivos caracterizar las condiciones ambientales de los hogares de los educandos de primaria del Consejo Popular "Cayo Hueso", del Municipio de Centro Habana, en el curso escolar 2006-2007, e identificar la relación entre las condiciones ambientales existentes y los resultados académicos obtenidos en ese período. El estudio fue complejo, combinado, de tipo transversal, descriptivo y analítico (caso y control). Se estudiaron los educandos de primer a sexto grados de las seis instituciones educacionales de la enseñanza primaria del Consejo Popular "Cayo Hueso", del municipio de Centro Habana, durante el curso escolar antes mencionado. Para cumplir los objetivos propuestos, a todas las madres se les aplicó un cuestionario con preguntas que exploraron la historia educacional de los hijos, sus hábitos y comportamientos. Los resultados se expresaron en porcentajes por instituciones educacionales. Se identificaron condiciones de vida inadecuadas en las viviendas de los educandos que pueden actuar como factores de riesgo a su salud o al aprendizaje. La ingestión de alcohol y el hábito de fumar dentro de las viviendas, así como el riesgo social en su entorno, fueron los hábitos inadecuados que más se relacionaron con los problemas de aprendizaje.The objective of present study was to characterize the identified environmental conditions and the academic results of students. Study was complex and combined and cross-sectional, descriptive and analytical (case-control). The students from first to sixth degrees from the six educational institutions of primary education from the above mentioned council. To fulfill the proposed objectives, in all mothers we applied a questionnaire with questions to explore the educational history of theirs children, habits and behaviors. Results were expressed in percentages by educational institutions. The conditions of a inappropriate life at homes of students were identified that may be like risk factors for health of for learning. Alcohol ingestion and smoking at home, as well as the social risk of its environment, were the inappropriate habits more related to learning problems.

En el medio ambiente de las instituciones educacionales se presentan frecuentemente factores de riesgo para la salud de educandos y educadores, que favorecen la aparición de enfermedades transmisibles. En ocasiones estos factores de riesgo se relacionan en lo fundamental con el incumplimiento de procedimientos establecidos precisamente para su prevención. El objetivo de este trabajo fue identificar factores de riesgo de enfermedades transmisibles en una escuela primaria del Complejo Escolar Ciudad Libertad, en el municipio de Marianao, y orientar las medidas pertinentes para su eliminación en el proceso de implementación de un sistema de vigilancia. Como parte fundamental de la metodología de este sistema estuvo la capacitación del personal de salud en los aspectos higiénicos y epidemiológicos relacionados con las enfermedades transmisibles y sus factores de riesgo ambientales y personales. Se planteó además en el diseño aplicar el sistema de análisis de riesgo y puntos críticos de control utilizado en la higiene de los alimentos. Entre los principales resultados se identificaron múltiples factores de riesgo para las enfermedades transmisibles por diferentes vías en el ambiente de la institución educacional estudiada y de los hábitos y comportamientos de los educandos, así como sus causas. Se concluye que la identificación de los factores de riesgo de enfermedades transmisibles en las instituciones educacionales es realizable y pueden ser prevenidos o eliminados con medidas sencillas y aplicables en el mismo centro escolar.In the environment of educational institutions frequently there are risk factors for health of students and professors, favoring the appearance of communicable diseases. Some- times these risk factors are mainly related with the failure to fulfil of the established procedures precisely for its prevention. The aim of present paper is to identify the risk factors of communicable diseases in a primary school of «Ciudad Libertad» school complex in the Marianao municipality and to direct the pertinent measures for its elimination in the implementation of a surveillance system. As a fundamental part of the methodology of this system is the training of health staff in the hygienic and epidemiologic features related to the communicable diseases and its environmental and personal risk factors. Also, as regards the design authors propose to apply the risk analysis system and the critical control points used in the foods hygiene. Among the major results there were multiple risk factors for the communicable diseases by different routes in the environment of study educational institution and students habits and behaviors, as well as its causes. We conclude that identification of risk factors of communicable diseases in educational institutions is feasible and may to be prevented or eliminated using simple and applicable measures in the same school center.

Introducción: las tentativas de suicidio se han incrementado considerablemente antes de los 20 años en las últimas décadas. Objetivos: identificar los factores de riesgo asociados con los intentos suicidas en adolescentes de 10 a 19 años. Métodos: se realizó un estudio analítico (casos controles pareados) de los adolescentes que tuvieron intento de suicidio en la provincia de Cienfuegos durante el segundo semestre de 2007. Se calcularon porcentajes y medias aritméticas, para identificar asociación se utilizó la prueba chi cuadrado de Mantel y Haenszel y cálculo de odds ratio, sus intervalos de confianza y significación para a= 0,05. Resultados: se identificó asociación con el intento de suicidio de las variables siguientes: deseos de hacerse daño, elaboración de planes anteriores para cometer dicho acto, presencia de desesperanza, maltrato físico, disputa, desconfianza y malas relaciones con los padres, antecedentes familiares de suicidio y enfermedad psiquiátrica, sentirse atormentado, y problemas con la pareja, entre otros. Se encontró que un 9,0 % de los adolescentes estudiados manifestaron no arrepentimiento o sin crítica de lo ocurrido. Conclusiones: existieron factores personales y familiares asociados con los intentos de suicidio, así como un alto porcentaje de adolescentes que intentaron suicidarse con crítica o arrepentimiento de lo ocurrido.Introduction: suicide attempts have increased before the twenties in past decades. Objectives: to identify the risk factors associated with the suicide attempts in adolescents aged 10-19. Methods: an analytical study (matched case-controls) was conducted in adolescents with a suicide attempt in the Cienfuegos province during the second semester of 2007. The percentages and arithmetic means were estimated to identify the association we used the Mantel-Haenszel Chi2 test and the odds-ratio calculus, its confidence and signification interval (IC) for a= 0,05. Results: the association with suicide attempt of following variables was identified: desires to self-damage, the working out of prior plans to commit such act, presence of hopelessness, physical maltreatment, disputes, distrust and poor relationships with parents, family backgrounds of suicide and psychiatric disease, to torment and partner problems, among others. The 9,0 % of study adolescents declared any regret or without critic on the situation. Conclusions: there were personal and family factors associated with suicide attempts, as well as a high percentage of adolescents attempting to commit suicide with critics or regret of situation.

Se presenta un estudio transversal para la identificación de los problemas visuales en estudiantes de una secundaria básica urbana del municipio Habana Vieja, durante el curso 2002-2003. A todos los alumnos estudiados (1 129, que corresponden al 98 % del total de estudiantes), se les realizó la medición de la agudeza visual utilizando la cartilla de Snellen calibrada de diferentes letras y análisis de su nivel de aprendizaje. En la exploración realizada en la escuela, el 37,0 % de los alumnos presentó alteraciones visuales, y fueron remitidos a los especialistas de oftalmología por tener déficit visual. A estos se les diagnosticaron afecciones específicas, entre las más frecuentes la combinación de hipermetropía y astigmatismo en el 12,8 %, seguido de la miopía y astigmatismo en el 5,3 % y en tercer lugar se encontró la hipermetropía con 4,6 %. De los 376 adolescentes con problemas de aprendizaje, el 45 % tenía trastornos oftalmológicos. Los resultados se presentan en forma de tabla estadística y gráfico. El alto porcentaje de educandos con déficit de la agudeza visual y la asociación entre los problemas visuales y el bajo rendimiento escolar, indican que es importante realizar sistemáticamente estudios oftalmológicos a los estudiantes de los diferentes niveles del sistema educacional, para detectar y solucionar a tiempo los problemas que puedan interferir en su aprendizaje posterior.Present paper is a cross-sectional study conducted to identify the visual problems in the students of an urban basic secondary school from the Habana Vieja municipality during the 2002-2003 courses. All study students (1 129 corresponding to the total of students) underwent the visual acuity measurement using the Snellen's chart graduated of different letters and analysis of learning level. In screening performed in this school, the 37.0% of students showed visual alterations being referred to Ophthalmology specialists due to visual deficits. They were diagnosed with specific affections among the more frequent is the combination of hypermetropia and astigmatism in the 12.8%, followed by myopia and astigmatism in the 5.3% and in third place there was present the hypermetropia with a 4.6%. From the 376 adolescents presenting with learning problems, the 45% has ophthalmological disorders. Results are showed in statistic tables and graphs. The high percentage of students with visual acuity deficit and the association among the visual problems and the low educational performance, suggest that it is essential to perform systematically ophthalmologic studies in students of different levels of the educational system to detect and to solve in time the problems that could interfere in its subsequent learning.

Determinados hábitos y comportamientos son más frecuentes en educandos con malos resultados académicos, por ser sus causas o consecuencias. El objetivo del actual trabajo fue identificar la relación entre los hábitos o comportamientos de vida inadecuados, con los malos resultados académicos de los alumnos de una secundaria básica del municipio Habana Vieja. Se realizó un estudio de tipo transversal, en los 1 129 alumnos de una Escuela Secundaria Básica del Municipio Habana Vieja en Ciudad de La Habana, en el curso 2003-2004. Se identificaron los hábitos y comportamientos inadecuados mediante una encuesta a los educandos y el resultado académico se evaluó por las notas obtenidas en las asignaturas del año en curso, los cuales se clasificaron en 2 categorías, denominados con "malos resultados académicos" (una o más asignaturas con menos de 60 puntos) y "con buenos resultados académicos" (cuando no tuvieron asignaturas con menos de 60 puntos). Se encontró que los siguientes hábitos y comportamientos inadecuados predominaron en los educandos con malos resultados académicos: no jugar al aire libre, jugar videojuegos, no leer en el tiempo libre, no merendar en las mañanas, ir a discotecas, no ingerir vegetales, malas relaciones interpersonales con coetáneos, profesores, madres y padres, tener relaciones sexuales antes de los 14 años, cambios frecuentes de parejas sexuales, no uso del condón, violencia hacia otros, pensar que el suicidio resuelve los problemas. En ambos grupos, los porcentajes fueron similares en aspectos como: ver televisión en exceso, dormir tiempo insuficiente, tener accidentes, cometer infracciones del tránsito.Specific habits and behaviors are more frequent among students with poor academic results as causes or consequences. The objective of present paper was to identify the relation among the poor habits or behaviors of life to the poor academic results of the students from a Basic Secondary School of the Habana Vieja municipality. A cross-sectional study was conducted in the 1 129 students from above mentioned educational level in 2003-2004 courses. The inappropriate habits and behaviors were identified by means of a survey applied to students and the academic result was assessed according to the marks obtained in the subjects of present year which were classified in two categories: "poor academic results (one or more subjects with less than of 60 points) and "good academic results" (when there were not subjects with less than 60 points). There was predominance of inappropriate habits and behaviors in students with poor academic results: not to play in the open air, to play video games, not to read in the spare time, not to have snack in the morning, to go to discotheques, not to consume vegetables before 14 years old, poor interpersonal relationships with contemporaries, professors, and parents, frequent changes of sexual partner, not to use condom, to do violence to others persons, to think that suicide solve the problems. En both groups, the percentages were similar in features like: to see television in excess, not to sleep enough, to have accidents and to commit traffic infringements.

OBJETIVO: Identificar la relación que guardan las consultas de urgencias por enfermedades respiratorias agudas, crisis agudas de asma bronquial e infecciones respiratorias agudas, con los cambios diarios en los niveles de contaminación atmosférica, en menores de 14 años de edad que fueron atendidos en dos centros hospitalarios de la ciudad de La Habana. MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de series de tiempo durante el periodo comprendido entre el 1 de octubre de 1996 y el 11 marzo de 1998. Se estudió la asociación entre la presencia de crisis agudas de asma bronquial, infecciones respiratorias agudas y enfermedades respiratorias agudas por un lado, y la exposición a niveles de partículas menores de 10 µg/m³ (PM10), humo y dióxido de azufre (SO2), por otro; asimismo, se construyeron modelos con la técnica de regresión binomial negativa, para estudiar periodos de latencia de 1 a 5 días y el efecto acumulado de siete días, previos a las consultas de urgencia. RESULTADOS: Los niveles de contaminación atmosférica, por lo general, resultaron bajos, ya que el promedio de 24 horas para PM10, humo y SO2 fue de 59.2 µg/m³ (DE=29.2), 27.7 µg/m³ (DE=21.2) y 21.1 µg/m³ (DE=20.1), respectivamente. Un incremento de 20 µg/m³ en el promedio diario de humo se relacionó con un incremento de 2.2% (IC 95% 0.9-3.6) en el número de consultas de urgencias por crisis agudas de asma bronquial. Un incremento de 20 µg/m³ en el promedio diario de humo y de SO2 se relacionó con un incremento en las infecciones respiratorias agudas de 2.4% (95% CI 1.2-3.6) y 5% (95% CI 1.3-5.3), respectivamente, con un retraso de cinco días. Además, se presentó un efecto acumulado en todos los contaminantes estudiados. CONCLUSIONES: Los resultados sugieren que los niveles de contaminantes atmosféricos en la ciudad de La Habana afectan la salud respiratoria de los niños, por lo que se requiere de la aplicación de medidas de control, en particular para disminuir las emisiones vehicularesOBJECTIVE: To identify the relationship between emergency visits for acute respiratory illnesses, acute bronchial asthma crisis (ABAC) and acute respiratory infections (ARI), in children less than 14 years of age, and the daily changes of air pollutant levels, in two central hospitals of Havana City, between October 1st 1996 and March 16 1998. MATERIAL AND METHODS: An ecological time series study was conducted. We assessed the relationship between the presence of acute respiratory illnesses, ABAC, and IRA, and exposure to levels of particles less than 10 µg/m³ (PM10), smoke, and sulfur dioxide (SO2); negative binomial regression models were used to assess latency periods of one to five days as well as the cumulative effect of seven days before the emergency visit. RESULTS: The levels of atmospheric pollutants were low, in general. The 24-hour mean values for PM10 levels, smoke, and SO2, were 59.2 µg/m³ (SD=29.2), 27.7 µg/m³ (SD=21.2), and 21.1 µg/m³ (SD=20.1), respectively. An increase of 20 µg/m³ in the daily average of black smoke was associated with a 2.2% increase (95% CI 0.9-3.6) in the number of emergency visits for ABAC. A 20µg/m³ increase in the daily average of black smoke and SO2 was associated with an increase in ARI of 2.4% (95% CI 1.2-3.6), and 5% (95% CI 1.3-5.3), respectively, with a 5-day lag. We also ob served a cumulative effect for all the contaminants studied. CONCLUSIONS: These results suggest that air pollution levels in Havana City affect children's respiratory health; therefore implementation of control measures is necessary, especially those aimed at decreasing motor vehicle exhaust fumes

Con el objetivo de identificar los factores de riesgo asociados con el bajo peso al nacer (BPN) en el municipio Boyeros en los años 1994-1995, se realizó un estudio analítico (cohorte retrospectiva). Fueron estudiadas 4 461 embarazadas, de ellas 426 tuvieron hijos con BPN. Se utilizó el riesgo relativo y la prueba de chi cuadrado para conocer respectivamente magnitud y significación estadística de la asociación entre las variables independientes y la dependiente. Se determinó también el porcentaje de riesgo atribuible al factor de riesgo. Las alteraciones cervicales uterinas, la anemia del tercer trimestre y la sepsis vaginal, fueron los factores de riesgo más asociados con el BPN y los que producirían mayor impacto en la disminución del problema de salud. Ser fumadora o adolescente también constituyó factor de riesgo, no así la cantidad de partos o legrados previos y el bajo nivel de escolaridad de la madre.A cohort analytic retrospective study was conducted so as to identify those risk factors associated with low birth weight (LBW) in the municipality of Boyeros from 1994 to 1995. 4 461 pregnant women were studied. 426 of them had children with LBW. The relative risk and the chi square test were used to know the magnitude and statistical significance of the association between the independent variables and the dependent variable. The percentage of risk attributable to the risk factor was also determined. Cervical uterine alterations, anemia in the third trimester and vaginal sepsis were the risk factors most associated with LBW and the ones that produced a greater impact on the reduction of the health problem. Being a smoker or an adolescent was also a risk factor; however, the number of deliveries or previous induced abortions and the low educational level of the mothers were not considered as risk factors.