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This study investigates the reasons behind the decision to send children aged under three to ECEC (Early Childhood Education and Care) and the causes that may explain why some families send their child to ECEC once they reach the age of two while others decide to do so at an earlier age. To answer the first question posed a probit model is used, while to answer the second query a Heckprobit model is estimated to take into account possible selection bias. The data for this study was taken from an unpublished database compiled by the Spanish National Institute for Educational Evaluation, which gathers information from 1,166 children schooled in the Infant Education stage. The results of our estimations show that the decision to enroll children under three in ECEC services depends fundamentally on the sociodemographic characteristics of the mother (educational level, employment situation and age), on household size (if it is a large family) and on the availability of ECEC services in the area in which the child lives. Our study has also shown that the only variable regarding factors that explain the differences in the age of access to ECEC services, two or under two, is the importance that parents place on their children developing empathy towards others. On the basis of our results, the study offers recommendations aimed at the progressive universalization of this initial educational stage.

Leisure participation enhances the learning of adaptive skills and the quality of life in youth with developmental disabilities. The goal of this study was to evaluate the effects of a leisure education program in individuals with developmental disabilities in terms of adaptive behavior and quality of life. Nine participants divided into two small groups and their families were included. A quasi-experimental design was employed to determine whether there was a program effect. The Adaptive Behavior Assessment System, the KIDSCREEN-27, and the Family Quality of Life Scale were administered before and after the intervention. There was a significant increase in social, home, and school skills as well as a better perception of quality of life in relationships with parents, social support, and school. In addition, the program affected the family's perception of practical and emotional support. Findings provide support for the application of this leisure program to enhance quality of life outcomes.

Previous research has shown the consolidation of the digital divide as an object of study over the last two decades. The pandemic caused by COVID-19 has multiplied the consequences of digital exclusion, as well as the number of studies examining its effects in the educational field. Based on this current educational reality, we approach a proposal that examines in depth the existing literature on the digital divide in the educational context by using the systematic review as a research methodology. We present an analysis of relevant studies published in the last three years with the aim of answering the following questions: How did the digital divide affected e-learning and ICT implementation during the pandemic?; what methods were used to assess it?; and what are the proposals to counteract its presence?. The results obtained in our study confirm the use of systematic reviewing which synthesize and accumulate the results of different primary studies. These results also serve to identify research gaps that point, in our case, towards future lines of work on the causes, persistence and interventions to mitigate the expansion of the digital divide in today's educational landscape.

The intestinal microbiota and the human body are in a permanent interaction. There is a symbiotic relationship in which the microbiota plays a vitally important role in the performance of numerous functions, including digestion, metabolism, the development of lymphoid tissue, defensive functions, and other processes. It is a true metabolic organ essential for life and has potential involvement in various pathological states, including cancer and pathologies other than those of a digestive nature. A growing topic of great interest for its implications is the relationship between the microbiota and cancer. Dysbiosis plays a role in oncogenesis, tumor progression, and even the response to cancer treatment. The effect of the microbiota on tumor development goes beyond a local effect having a systemic effect. Another aspect of great interest regarding the intestinal microbiota is its relationship with drugs, modifying their activity. There is increasing evidence that the microbiota influences the therapeutic activity and side effects of antineoplastic drugs and also modulates the response of several tumors to antineoplastic therapy through immunological circuits. These data suggest the manipulation of the microbiota as a possible adjuvant to improve oncological treatment. Is it possible to manipulate the microbiota for therapeutic purposes?

Introduction: Due to the pandemic, academic challenges arose, and virtual simulation was used to replace the clinical experiences, offering innovative learning strategies and standardized teaching. Objective: To compare the perception and the level of satisfaction in the acquisition of knowledge, abilities and skills through face-to-face and virtual simulation among medical students. Methods: Analytical cross-sectional study including medical students who received virtual and face-to-face simulation practices. A survey was con-ducted to investigate the sociodemographic and academic characteristics, institutional physical conditions, self-assessment regarding the acquisition of technical and soft skills, and quality and satisfaction with clinical simulation. Results: 105 students with a median age of 22 years were included, who reported greater acquisition of technical skills through face-to-face simulation compared to the virtual modality. In-person simulation resulted in an 85% mastery of some topics compared to virtual simulation (65.7%, p < 0.001). However, for medication presentation and dosage scenarios, 80% reported mastery of the topic through virtual practice compared to 53.3% in the face-to-face modality (p < 0.001). The development of soft skills was similar in both scenarios, such as problem solving (83.8%), effective communication (78.1%), among others. Conclusions: Clinical simulation is crucial to medical training, its face-to- face application is perceived as the most suitable way to use it in the educational environment.

The trophic ecology of fishes in the genus Rhamdia remains poorly reported. Here, we aim to describe the diet composition and infer the trophic levels, niche breadth, and niche overlap between Rhamdia guatemalensis and Rhamdia laticauda in northeast Oaxaca, Mexico. Fishes were sampled using an electrofishing device between 2016 and 2017. We calculated the Quotient index and the diet composition was analyzed using the percentage of the Index of Relative Importance (%IRI) to analyze possible ontogenetic and sexual differences on feeding ecology. We then calculated the trophic niche breadth using the Levins´ standardized index (BA). Trophic levels (TLk) of each species were calculated using the trophic index and trophic niche overlap using Pianka´s index (Ojk). The results indicate that both species are carnivorous and tend to prey on aquatic insects, with R. guatemalensis feeding on nine different orders of animals and R. laticauda displaying a broader diet spectrum, encompassing 19 orders. Our data showed ontogeny and sex differences in the trophic ecology of R. guatemalensis. They were secondary consumers (TLk > 3) and showed a specialized diet (BA < 0.4). We found evidence of trophic niche partitioning between adults (Ojk = 0.40) and females (Ojk = 0.42). Our results highlight the fundamental role of this species in the area as a carnivorous/insectivorous, predatory fishes, secondary consumers, and biological control for Diptera, Ephemeroptera, and Megaloptera. Both species minimize the trophic overlap through food resource partitioning mediated by fish body size. Additionally, adults and females consume different prey, which allows the coexistence of closely related species. Our findings regarding trophic ecology could be crucial for devising conservation and management plans for these particular Rhamdia species.

Abstract Less than 15–20% of patients who meet the criteria for hereditary breast and ovarian cancer (HBOC) carry pathogenic coding genetic mutations, implying that other molecular mechanisms may contribute to the increased risk of this condition. DNA methylation in peripheral blood has been suggested as a potential epigenetic marker for the risk of breast cancer (BC). We aimed to discover methylation marks in peripheral blood associated with BC in 231 pre-treatment BC patients meeting HBOC criteria, testing negative for coding pathogenic variants, and 156 healthy controls, through methylation analysis by targeted bisulfite sequencing on 18 tumor suppressor gene promoters (330 CpG sites). We found i) hypermethylation in EPCAM (17 CpG sites; p = 0.017) and RAD51C (27 CpG sites; p = 0.048); ii) hypermethylation in 36 CpG-specific sites (FDR q

Abstract Background Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. Methods The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. Results Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. Conclusions The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.

Objective: The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods. Methods: In total, 3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006– 2008, 2012–2014, 2017–2019). The distribution of diagnostic cytology, risk of malignancy, diagnostic performance indices of fine needle aspiration (FNA), and cytologic–histologic correlation in indeterminate cytology were analyzed. Results: Only 2.2% of cytology tests were insufficient for a diagnosis. About 86.9% cytology was benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006–2008), 10.1% (2012–2014), and 10% (2017–2019). Surgery was performed in 13% of benign cytology, resulting in malignant histology in 2.7%. All malignant and suspicious cytology underwent surgery, with malignancy confirmed in 98% and 77% of cases, respectively. All ‘indeterminate with atypia’ cytology (2006–2008) and Bethesda IV (2012–2014; 2017–2019) underwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the ‘indeterminate without atypia’ category (2006–2008) and Bethesda III (2012–2014; 2017–2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6%, with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods. Conclusion: The Bethesda system reduces indeterminate cytology and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.

Background: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a relatively common complication. Multiple studies described this relationship in critical patients, however its incidence and outcome in other risk groups such as immunosuppressed patients remains unknown. In this sense, we aimed to evaluate the rates and outcomes of CAPA in hematological patients and according to the different hematological malignances, comparing to invasive pulmonary aspergillosis (IPA) in non-COVID-19 ones. Methods: Nationwide, population-based and retrospective observational cohort study including all adult patients with hematological malignancies admitted in Spain since March 1, 2020 to December 31, 2021. The main outcome variable was the diagnosis of IPA during hospitalization in hematological patients with or without COVID-19 at admission. The rate of CAPA compared to IPA in non-COVID-19 patients in each hematological malignancy was also performed, as well as survival curve analysis. Findings: COVID-19 was diagnosed in 3.85 % (4367 out of 113,525) of the hematological adult inpatients. COVID-19 group developed more fungal infections (5.1 % vs. 3 %; p

La soberanía y seguridad alimentaria son aspectos determinantes del desarrollo socioeconómico. Entre las amenazas para el logro de la soberanía alimentaria es importante considerar la insularidad. Cuba, al ser un estado insular, es más vulnerable a los impactos del cambio climático. El trabajo tiene como objetivo elaborar un modelo para la gestión de vulnerabilidades enfocado en la soberanía y seguridad alimentaria de la provincia Guantánamo. La investigación, de carácter cuali-cuantitativa, se desarrolló con una muestra constituida por tres municipios de la provincia Guantánamo, siendo los criterios de selección, la existencia de diferentes índices de vulnerabilidad alimentaria (considerando el índice propuesto por el PMA en Cuba), que sean municipios priorizados por el gobierno en el Estrategia de Desarrollo Provincial, municipios incluidos en polos productivos, multi-amenazados con implicaciones para la producción de alimentos y con bajos valores de índice de desarrollo humano. Se presenta un modelo para la gestión de vulnerabilidades en función del logro de la seguridad alimentaria, que incluye un diagnóstico inicial, a partir de indicadores, en el que se evalúan las amenazas, las vulnerabilidades y los factores condicionantes, para el logro de la soberanía alimentaria. Los resultados mostraron que las principales amenazas que afectan los municipios estudiados son las inundaciones por intensas lluvias, la intensa sequía, el cambio climático y los fenómenos hidrometeorológicos extremos; sin embargo, su impacto en cada contexto es diferente. Por ello, resulta necesario que los análisis de vulnerabilidades sean integrados, con enfoque interdisciplinar y de manera comparativa en América Latina y el Caribe.

Background To reduce health inequities in paediatric patients with complex diseases, our hospital developed a food security programme in 2022. The programme aims to mitigate food insecurity (FI) in paediatric patients with oncological, transplantation and congenital cardiovascular diagnoses, by providing a monthly nutritious food supply that covers up to 50% of the patient’s family food intake, accompanied by social and nutritional follow-up. In this study, we aimed to assess the effect of the programme on FI and nutritional status and describe its implementation.Method We conducted a before-and-after study of patients who entered the programme in a 14-month period. We used the Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) scale score, FI level and nutritional status measures to assess the effect of the programme. We used the Wilcoxon and McNemar tests to assess changes in scores and proportions of patients with moderate and severe FI, respectively, 31.5%–14.4% (p=0.0008) and of moderate FI from 68.5% to 36.9%.Results 111 patients were included. They had a baseline median (IQR) ELCSA score=8 (7–11) that changed to 6 (4–9) (p

Objetivo: describir la prevalencia de patología maligna incidental posterior a una histerectomía por causa benigna. Método: estudio de corte transversal descriptivo, basado en registros hospitalarios. Se incluyeron mujeres a quienes se les realizó una histerectomía por causa benigna en un hospital general de referencia entre 2013 y 2021. Se excluyeron mujeres con histerectomía obstétrica. Variables medidas: edad, vía de la histerectomía, tipo de histerectomía, diagnóstico histopatológico de lesión premaligna o de cáncer invasor, tipo de cáncer. Análisis: descriptivo, se estimó la prevalencia en el periodo global de condiciones preneoplásicas y neoplásicas. Resultado: de 816 registros clínicos se analizaron 674 casos (87 %) que cumplieron los criterios de inclusión. Predominó la población premenopáusica. Se identificaron 26 casos de enfermedad maligna no anticipada para una prevalencia del 3,8 % y 13 casos de patología premaligna (1,9 %). El origen más frecuente fue el cuello uterino (40 %) seguido del ovario (33 %). Conclusiones: se debe considerar informar riesgo de lesión no esperada a las pacientes que serán sometidas a histerectomía por condición benigna. Se enfatiza la importancia de realizar una adecuada aproximación prequirúrgica, en especial para descartar cáncer de ovario y cérvix en nuestro medio. Se requieren estudios de seguimiento de las pacientes con cáncer no anticipado para determinar el tratamiento y su pronóstico en la región.

Background: This paper describes the experience of conducting a co-researched project with people with learning disabilities in Madrid, Spain, during the COVID pandemic and lockdown. I discuss the advantages and limitations of working online and challenges encountered while coordinating and facilitating the research. Methods: Our research project was on the impact of COVID on the lives of people with learning disabilities, which the eight co-researchers chose. As part of my PhD, I offered my services as researcher to work together with persons with learning disabilities. Eight people took up my offer. We worked together from January 2021 to March 2022 virtually and I recorded this experience. I have written the paper, but as part of my co-researcher agreement, I have shared my reflections and work with my co-researchers, and we have co-written a section to share our findings. Findings: In this paper, I discuss the advantages and limitations of working online, challenges I encountered while coordinating and facilitating the research and the work together. Remote work enabled the group to work on a biweekly basis and with members from different parts of Madrid. It saved people time and effort getting around town, yet we had to introduce express times and spaces to socialise and create a working relationship that is less natural than during in-person interactions and breaks. During our fieldwork, we found that the pandemic had spurred the access to digital devices and programmes, but people may still be reliant on their environment, carers or supporters to facilitate it. I included a section written with my co-researchers, in which we reflect together on the experience of working online and how we reached out to their peers during our fieldwork. We identified limitations due to our online research methodology such as lack of owning a digital device, the difficulties having access to a private space from which to connect online and the joy of meeting other people to exchange experiences. Conclusion: Human rights based participatory research can be done online. There are different ways of overcoming barriers to participation. However, there are people with no access to the internet or without digital skills that are being excluded and we must ensure that we reach out to them as well.

Background: Psychological distress is a predictor of future health and disease data, with consequent implications for both the patient and the healthcare system. Taking advantage of the unprecedented situation caused by the COVID-19 pandemic we aimed to assess whether the type of medical care received by patients during the initial months of the pandemic influenced their evolution, particularly at the psychological level. Additionally, we investigated whether allostatic load was associated not only with physical but also psychological alterations. Methods: All the patients diagnosed with COVID-19 infection at HM Madrid Hospital during the month of March 2020 were studied, both those hospitalized (110) and those treated on an outpatient basis (46). They were psychologically evaluated using the Profile of Mood States (POMS) test. We calculated the allostatic load using different laboratory parameters. Results: Outpatient patients had significantly higher scores than hospitalized ones in Tension-Anxiety (52 ± 19.3 vs. 38 ± 4.3; p < 0.001). So, 36.9% of the outpatient patients exhibited anxiety. Allostatic load has not been correlated with patients’ psychological alterations. Conclusions: Psychological distress of outpatient patients should be taken into account in their management to improve mental health planning. This knowledge could provide comprehensive care to patients including their mental health, in the face of subsequent epidemics/pandemics.

Abstract Background While existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes. Methods All PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019. Results Overall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184–580] vs. 97 cells/mm3 [IQR: 34–272], p

Abstract Background Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. Methods We selected three hospitals from each of Mexico’s main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. Results The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions’ largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. Conclusions The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.

La calidad de las aguas alumbradas por pozos horizontales cubiertos (galerías), asociadas o no con presas subálveas, desata un enorme interés por su apropiación en medios áridos y semiáridos donde los recursos hídricos son escasos. El objeto de estudio de este trabajo es conocer las prácticas de alumbrar y explotar las aguas de freáticos próximos a la superficie del territorio, concretamente los recursos de la circulación subsuperficial en las ramblas de Béjar, Nogalte, Vilerda y Goñar en el sector noroccidental de la depresión prelitoral murciana (sureste de España). Se trata de aprovechamientos hídricos históricos organizados como comunidades de propietarios de aguas. Son modelos de sostenibilidad en su explotación para usos del agua en abastecimientos y regadíos, que también incorporan el valor de adaptación a sucesos extremos de sequías e inundaciones. La metodología es la del análisis geográfico regional aplicado al estudio de casos (sistemas socio-hídricos) de forma diacrónica y comparada, con amplio trabajo de campo y consulta de fuentes documentales, con entrevistas a los gestores y usuarios de estos sistemas de captación y distribución del agua. Los casos estudiados ponen de manifiesto que son sistemas sostenibles de aprovechamiento de agua que facilitan el desarrollo local en medios semiáridos como el sureste ibérico.

Background: Despite concerted efforts in South America, these diseases continue to pose a significant burden of morbidity and mortality in endemic regions. This study aimed to analyse hospital data and investigate the hospitalisation rates of dengue fever, leishmaniasis, and malaria in Ecuador between 2015 and 2022. Methods: Open-access databases from the National Institute of Statistics and Censuses of Ecuador between 2015 and 2022 were analysed. Data were filtered using specific terms for each disease (ICD-10), and descriptive statistics of geographical distributions were calculated using Microsoft Excel, Stata 14.2, and Rstudio. Results: Dengue had the highest burden, with 31,616 reported cases, followed by malaria (1,316) and leishmaniasis (283). From 2015 to 2022, the highest hospitalisation rate per 105 inhabitants for dengue was observed in Sucumbios province (697.2), for malaria in Pastaza province (108.4), and for leishmaniasis in Morona Santiago province (18.8). The data’s trend analysis revealed a slight increase in dengue and mild downward trends in hospitalisation for malaria and leishmaniasis. Conclusions: The results suggest that vector-borne disease control has failed in Ecuador. Unfortunately, there was no significant trend towards a decrease in dengue, malaria, and leishmaniasis in Ecuador during the years studied. This study highlights the need to optimise sustainable vector control programs and emphasises continuous monitoring of disease incidence and control measures.

The objective of this review is to summarize the current scientific evidence to formulate clinical recommendations regarding the classification, diagnostic approach, and treatment of rare histological subtypes of cervical cancer; neuroendocrine carcinoma, gastric-type mucinous adenocarcinoma, and glassy cell adenocarcinoma. These histological subtypes are generally characterized by their low frequency, aggressive biological behavior, certain chemoradioresistance, and consequently, high recurrence rates with a deleterious impact on survival. Molecular studies have identified several associated mutations in neuroendocrine carcinoma (PIK3CA, MYC, TP53, PTEN, ARID1A, KRAS, BRCA2) and gastric-type adenocarcinoma (KRAS, ARID1A, PTEN) that may serve as molecular targets. While adenocarcinomas are typically treated and classified based on squamous histology across early, locally advanced, and advanced stages, the treatment strategies for neuroendocrine carcinomas in early stages or locally advanced cases differ, particularly in the sequencing of administering chemotherapy, chemoradiotherapy, or surgery. The chemotherapy regimen is based on etoposide plus cisplatin (EP). Unlike squamous cell carcinomas, immune checkpoint inhibitors are yet to establish a standard role in the treatment of recurrent neuroendocrine carcinomas due to the absence of clinical trials. Regarding glassy cell adenocarcinomas and gastric-type adenocarcinoma, the potential use of immunotherapy in advanced stages/disease requires further evaluation through international collaborations, given the limited number of cases.

# Background Patients with chronic lung disease (CLD), such as asthma or chronic obstructive pulmonary disease, were expected to have an increased risk of clinical manifestations and severity of COVID-19. However, these comorbidities have been reported less frequently than expected. Chronic treatment with inhaled corticosteroids (ICS) may impact the clinical course of COVID-19. The main objective of this study is to know the influence of chronic treatment with ICS on the prognosis of COVID-19 hospitalized patients with CLD. # Methods A multicenter retrospective cohort study was designed, including patients hospitalized with COVID-19. Epidemiological and clinical data were collected at admission and at seven days, and clinical outcomes were collected. Patients with CLD with and without chronic treatment with ICS were compared. # Results Two thousand five hundred ninety-eight patients were included, of which 1,171 patients had a diagnosis of asthma and 1,427 of COPD (53.37% and 41.41% with ICS, respectively). No differences were found in mortality, transfer to ICU, or development of moderate-severe ARDS. Patients with chronic ICS had a longer hospital stay in both asthma and COPD patients (9 vs. 8 days, *p =* 0.031 in asthma patients), (11 vs. 9 days, *p =* 0.018 in COPD patients); although they also had more comorbidity burden. # Conclusions Patients with chronic inhaled corticosteroids had longer hospital stays and more chronic comorbidities, measured by the Charlson comorbidity index, but they did not have more severe disease at admission, evaluated with qSOFA and PSI scores. Chronic treatment with inhaled corticosteroids had no influence on the prognosis of patients with chronic lung disease and COVID-19.

A main goal of the university institution should be to reduce the desertion of its students, in fact, the dropout rate constitutes a basic indicator in the accreditation processes of university centers. Thus, evaluating the cognitive functions and learning skills of students with an increased risk of academic failure can be useful for the adoption of strategies for preventing and reducing school dropout. In this research, cognitive functions and learning skills in 284 university students were evaluated. Academic performance predictors were identified, and conglomerates analysis was carried out to establish groups according to those variables. The stability and validity of the conglomerates were tested with discriminant analyzes and comparison tests. The variables associated significantly to academic performance were: attention, intelligence, motivation, metacognition and affective components. The conglomerate analysis suggested a three-group solution: (1) students with cognitive skills of moderate to high, but deficient learning strategies; (2) students with cognitive and learning capabilities of moderate to high; (3) students with cognitive functions low and moderate learning capacity. Students from groups 1 and 3 showed worse academic performance; 83.3% of students at risk of desertion belonged to such groups. Two groups of students have been identified with the highest risk of academic failure: those with poor cognitive capacity and those with bad learning skills.

Introducción: El uso de mHealth puede mejorar la adherencia a el automonitoreo con glucometría capilar (GC) en la transición del ámbito hospitalario al ambulatorio. Objetivo: evaluar la adherencia al automonitoreo con GC de los pacientes con Diabetes Tipo 2 (DM2) vinculados a un programa de educación usuarios de mHealth (ClouDi) comparado con el programa de educación y seguimiento presencial usual. Materiales y métodos: Estudio longitudinal prospectivo. Se analizaron pacientes con DM2 valorados por consulta de educación de diabetes con indicación de tratamiento con insulina al egreso hospitalario. Se analizaron dos grupos: uno con seguimiento presencial y otro vinculado a un programa educativo y uso de ClouDi. Resultados: De los 86 pacientes (44% de sexo femenino, 41 usuarios ClouDi, edad promedio 58.8 ± 11.2 años, con una media de duración de la diabetes de 7.8 ± 7.4 años), 53.6% se encontraban en estrato 2, el 92.9% pertenecían al régimen contributivo, el 42.9% con educación básica primaria y 51.2% empleados. Fue considerada la adherencia a la GC al realizar y registrar 3 o más mediciones por día en los pacientes de ClouDi fue mayor comparado con los pacientes en cuidado usual (64.4% vs 28.2%, p

La educación emocional (EE) es un elemento fundamental de la educación integral. En este sentido, es necesario poner la mirada sobre las prácticas educativas que realizan los maestros y maestras, particularmente de aquellos que atienden primera infancia, bajo la consideración de que aquellos aprendizajes que se instauran en los primeros años son más duraderos y estables. Teniendo en cuenta lo anterior, la presente investigación se pregunta: ¿Cómo son las competencias de la Educación Emocional (EE) en las prácticas educativas de las maestras que atienden primera infancia en los Centros de Desarrollo de la corporación (PAN)? Con el fin de responder la pregunta se desarrolló una investigación etnográfica entorno a la Educación Emocional (EE), con la cual se pudo describir y posteriormente analizar las prácticas educativas de las maestras participantes. El análisis de la información permitió concluir que las competencias emocionales se encuentran presentes en las prácticas educativas; sin embargo, es necesario poner la mirada sobre el desarrollo de programas y actividades que potencien el desarrollo emocional de los maestros y maestras para que estos, a su vez, empleen estrategias adecuadas de manejo de su propia emocionalidad y puedan realizar un acompañamiento de (EE) más adecuado en la población que acompañan.

Clavulanic acid is a potent β-lactamase inhibitor produced by Streptomyces clavuligerus, widely used in combination with β-lactam antibiotics to combat antimicrobial resistance. This systematic review analyzes the most successful methodologies for clavulanic acid overproduction, focusing on the highest yields reported in bench-scale and bioreactor-scale fermentations. Studies have demonstrated that glycerol is the preferred carbon source for clavulanic acid production over other sources like starch and dextrins. The optimization of feeding strategies, especially in fed-batch operations, has improved glycerol utilization and extended the clavulanic acid production phase. Organic nitrogen sources, particularly soybean protein isolates and amino acid supplements such as L-arginine, L-threonine, and L-glutamate, have been proven effective at increasing CA yields both in batch and fed-batch cultures, especially when balanced with appropriate carbon sources. Strain engineering approaches, including mutagenesis and targeted genetic modifications, have allowed for the obtainment of overproducer S. clavuligerus strains. Specifically, engineering efforts that overexpress key regulatory genes such as ccaR and claR, or that disrupt competing pathways, redirect the metabolic flux towards CA biosynthesis, leading to high clavulanic acid titers. The fed-batch operation at the bioreactor scale emerges as the most feasible alternative for prolonged clavulanic acid production with both wild-type and mutant strains, allowing for the attainment of high titers during cultivations.

Despite the plasma proteome being able to provide a unique insight into the health and disease status of individuals, holding singular promise as a source of protein biomarkers that could be pivotal in the context of personalized medicine, only around 100 proteins covering a few human conditions have been approved as biomarkers by the US Food and Drug Administration (FDA) so far. Mass spectrometry (MS) currently has enormous potential for high-throughput analysis in clinical research; however, plasma proteomics remains challenging mainly due to the wide dynamic range of plasma protein abundances and the time-consuming procedures required. We applied a new MS-based multiplexed proteomics workflow to quantitate proteins, encompassing 67 FDA-approved biomarkers, in >1300 human plasma samples from a clinical cohort. Our results indicate that this workflow is suitable for large-scale clinical studies, showing good accuracy and reproducibility (coefficient of variation (CV) < 20 for 90% of the proteins). Furthermore, we identified plasma signature proteins (stable in time on an individual basis), stable proteins (exhibiting low biological variability and high temporal stability), and highly variable proteins (with low temporal stability) that can be used for personalized health monitoring and medicine.

In the academic year of 2004-2005, the Spanish region of Madrid began to implement a bilingual educational programme (MBP hereinafter) in state schools. One of the objectives of this programme was to make the study of a foreign language (English) accessible to students from economically disadvantaged families who cannot afford private foreign language classes. Our study aims to evaluate whether students from a disadvantaged socio-economic background really do have the same probability of participating in the MBP as their more privileged peers. The analysis use the PISA 2015 database which corresponds to the representative sample of the Community of Madrid in Spain, with added administrative information supplied by the Madrid Regional Ministry of Education concerning the identification of bilingual and non-bilingual schools. Using these data, we estimate a logit model directed at identifying which factors explain the choice by students of whether to attend a bilingual state school. The results obtained reveal that the probability of attending a bilingual school is higher for students belonging to socio-economically and culturally better-off households. This suggests that the MBP could be fostering segregation within the state education sector in Madrid.

BackgroundRheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient’s quality of life. Often, delays in outpatient consultations or the patient’s difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. ObjectiveThe main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. MethodsThis is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. ResultsParticipant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. ConclusionsThis paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial RegistrationClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID)PRR1-10.2196/55829

Forecasting air pollutant levels is essential in regulatory plans focused on controlling and mitigating air pollutants, such as particulate matter. Focusing the forecast on air pollution peaks is challenging and complex since the pollutant time series behavior is not regular and is affected by several environmental and urban factors. In this study, we propose a new hybrid method based on artificial neural networks to forecast daily extreme events of PM2.5 pollution concentration. The hybrid method combines self-organizing maps to identify temporal patterns of excessive daily pollution found at different monitoring stations, with a set of multilayer perceptron to forecast extreme values of PM2.5 for each cluster. The proposed model was applied to analyze five-year pollution data obtained from nine weather stations in the metropolitan area of Santiago, Chile. Simulation results show that the hybrid method improves performance metrics when forecasting daily extreme values of PM2.5.

Abstract Background The mean weight loss (WL) after successful bariatric surgery is approximately one third of the initial body weight, which is mainly achieved between the first 2 years of follow‐up. However, 15%–35% of patients do not achieve a significant percentage of total WL (%TWL). Information on factors associated with a higher or lower WL after bariatric surgery is limited. This study aimed to assess the change in %TWL and describe the factors associated with greater or lesser WL over time. Methods This prospective longitudinal study included patients treated with laparoscopic Roux‐en‐Y gastric bypass or sleeve gastrectomy. Baseline data were recorded before surgery. Follow‐up was performed at 3 (n = 141), 6 (n = 208), 9 (n = 115), 12 (n = 216), 24 (n = 166), and 36 months (n = 99). Generalized estimating equation analysis was performed to assess the changes in %TWL over time and factors associated with different patterns of WL. Results In total, 231 patients were included (women, 82.2%; basal body mass index (BMI) 41.4 ± 5.1 kg/m2). The tendencies to increase %TWL (32 ± 6.5) were evident in the first year and stabilized thereafter. Sustained nutritionist follow‐up (2.3%, p = 0.004), baseline BMI >40 kg/m2 (0.4%, p 30 min/day after surgery reduced their %TWL by 0.6% (p = 0.002). Conclusions Modifiable factors such as nutritional monitoring and WL before surgery are associated with a significant increase in %TWL over time. Basal BMI was associated with a significant decrease in %TWL.

Abstract Background Foreign body reaction in brain tissue is a very rare immune response that has not been well studied. Hemostatic material has been reported as a possible trigger of this response in other organs and could be detected by [18F]fluorodeoxyglucose positron emission tomography/computerized tomography ([18F]FDG PET/CT), but there is no reported experience about the role of [18F]fluorocholine in this finding. [18F]Fluorocholine has the potential to differentiate viable central nervous system tumors from other entities, so it is frequently used in the follow-up of neurosurgery patients. Case presentation A right frontoparietal neoplastic lesion was found in a young-aged patient with analgesic refractory headache. Surgical resection and postsurgical radiotherapy were performed, and the pathologist analysis turned out a cellular ependymoma with signs of anaplasia. In the follow-up, an magnetic resonance imaging (MRI) showed a suspicious lesion, so a [18F]fluorocholine PET/CT was performed. Increased uptake was described in the right parietal region on the margin of the residual cystic lesion. The patient got a complete resection which was confirmed later by MRI. In the pathology analysis, a focally congestive cerebral parenchyma with a central histiocytic reaction to a foreign body area was described. Conclusions Following the experience of the current case report, [18F]fluorocholine PET/CT could also show a false positive related to foreign body reaction. This entity should be considered to avoid unnecessary major surgery on our patients.

Background: Patients with B-lymphocyte malignancies (BCMs) receiving B-lymphocyte-targeted therapies have increased risk of severe COVID-19 outcomes and impaired antibody response to SARS-CoV-2 mRNA vaccination in comparison to non-hematologic oncologic patients or general population. Consequently, it is vital to explore vaccine-induced T-lymphocyte responses in patients referred for the understanding of immune protection against SARS-CoV2 infections. The objective of the present study was to analyze the recall immune responses carried out by T lymphocytes after two COVID-19 mRNA vaccine doses. Methods: We enrolled 40 patients with BCMs and 10 healthy controls (HCs) after 4 weeks from the second mRNA vaccine dose. Spike (S)-specific T-lymphocyte responses were assessed in peripheral blood mononuclear lymphocytes (PBMCs) by intracellular IFN-γ staining combined with flow cytometry. Furthermore, the humoral response was assessed with the measurement of anti-spike antibodies. Results: From March to July 2021, 40 patients (median age 68) received mRNA vaccines. The overall antibody response for BCMs was 52.5% versus 100% for the healthy controls (p = 0.008). The antibody response was different across BCMs: 18.75% for non-Hodgkin lymphoma, 54.5% for chronic lymphocytic leukemia, and 92.3% for multiple myeloma. Responses varied by malignancy type and treatment, with anti-CD20 therapies showing the lowest response (6.7%). T-lymphocyte analysis revealed reduced numbers and altered differentiation stages in patients compared to the controls. However, the vaccine-induced T response was generally robust, with variations in specific T subpopulations. Conclusions: mRNA vaccines induced significant humoral and cellular immune responses in B-cell lymphoid malignancy patients, although responses varied by treatment type and malignancy. Further research is needed to optimize vaccination strategies in this population.

In this eight-year grassland field trial, we compared the fertilization effects of biomass ashes (BMAs) and carbonated lime (CaCO3) in combined application with cattle slurry (CS). Our study focused on plant coverage, forage yield, and quality, as well as soil physicochemical and microbiological properties. The fertilization strategies included CS mixed with BMA or CaCO3 applied three times a year and a separate annual application of ash or CaCO3, independent of CS. Samplings were performed in 2010, 2014, and 2018. Despite an absence of observable effects on soil, microbial properties, and forage quality, CS application, with or without BMA/CaCO3, resulted in higher forage yields compared to the unfertilized control and plots receiving only ash or CaCO3. Forage properties remained consistent across treatments. However, the combined application of CS with both ash and CaCO3 led to a reduction in volatile organic compounds, total carbon, total nitrogen, nitrate, and electrical conductivity in the soil from 2010 to 2018. Additionally, the relative abundance of specific microbial families (Nitrosomonadaceae, Acidothermaceae, Bacillaceae, and Peptostreptococcaceae) varied based on whether soils received a single amendment or a combination thereof. Our findings suggest that BMA is a valuable substitute for traditional liming agents, regardless of the application mode.

Early diagnosis and treatment of chronic kidney disease (CKD) is a worldwide challenge. Subjects with albumin-to-creatinine ratio (ACR) ≥ 30 mg/g and preserved renal function are considered to be at no cardiorenal risk in clinical practice, but prospective clinical studies evidence increased risk, even at the high-normal (HN) ACR range (10–30 mg/g), supporting the need to identify other molecular indicators for early assessment of patients at higher risk. Following our previous studies, here we aim to stratify the normoalbuminuria range according to cardiorenal risk and identify the glycoproteins and N-glycosylation sites associated with kidney damage in subclinical CKD. Glycoproteins were analyzed in urine from hypertensive patients within the HN ACR range compared to control group (C; ACR < 10 mg/g) by mass spectrometry. A different cohort was analyzed for confirmation (ELISA) and sex perspective was evaluated. Patients’ follow-up for 8 years since basal urine collection revealed higher renal function decline and ACR progression for HN patients. Differential N-glycopeptides and their N -glycosylation sites were also identified, together with their pathogenicity. N-glycosylation may condition pathological protein deregulation, and a panel of 62 glycoproteins evidenced alteration in normoalbuminuric subjects within the HN range. Haptoglobin-related protein, haptoglobin, afamin, transferrin, and immunoglobulin heavy constant gamma 1 (IGHG1) and 2 (IGHG2) showed increased levels in HN patients, pointing to disturbed iron metabolism and tubular reabsorption and supporting the tubule as a target of interest in the early progression of CKD. When analyzed separately, haptoglobin, afamin, transferrin, and IGHG2 remained significant in HN, in both women and men. At the peptide level, 172 N-glycopeptides showed differential abundance in HN patients, and 26 showed high pathogenicity, 10 of them belonging to glycoproteins that do not show variation between HN and C groups. This study highlights the value of glycosylation in subjects not meeting KDIGO criteria for CKD. The identified N-glycopeptides and glycosylation sites showed novel targets, for both the early assessment of individual cardiorenal risk and for intervention aimed at anticipating CKD progression.