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Las secundarias básicas en Cuba constituyen un nivel educativo que tiene como fin el logro del desarrollo de la personalidad y la formación integral de cada educando. Se dispone en este nivel la ampliación y sistematización de los contenidos del proceso educativo, en correspondencia con los ideales patrios, cívicos y humanistas de la sociedad cubana. El artículo muestra un análisis de las insuficiencias presentes en directivos de las Secundarias Básicas del municipio Majibacoa, en cuanto a su preparación con respecto al clima organizacional. Se utilizaron en la investigación métodos triangulados como la observación y conversaciones sostenidas con especialistas, trabajadores y funcionarios, y por otra parte la revisión de diagnósticos. En estas instituciones se constató que los directivos muestran carencia de pensamiento estratégico, utilizan métodos autoritarios y normativos, no ejercen la dirección democrática, ni practican la búsqueda de soluciones bajo la tutela de especialistas. A pesar de que estos directivos poseen experiencia en el cargo que ocupan, la falta de preparación incide en la toma de decisiones acertadas, a partir de situaciones concretas y condiciones objetivas en su gestión de dirección educacional. Las características expuestas representan factores que confluyen para configurar el clima organizacional de estas instituciones.

Background: Conventional therapies (CTs), pharmacological (PH) and non–pharmacological (NPH), do not always achieve benefits in the treatment of chronic low back pain (CLBP). We assessed efficacy and safety of acupuncture for CLBP as alternative or addition to CT. Methods: We included randomised controlled trials (RCTs) comparing acupuncture alone or in combination with CT to CT. We searched Medline, Cochrane Library, Embase up to May 2022. We assessed risk of bias with the original Cochrane tool and GRADE certainty of evidence. Results were pooled through meta-analysis. Results: Ten RCTs (2122 participants) were included comparing acupuncture versus CT and 4 RCTs (374 participants) were comparing acupuncture plus CT to CT alone. In terms of comparing acupuncture with NPH or PH, no differences were found for pain and disability. Comparing acupuncture with PH and NPH combined, pain and disability were reduced (SMD=-0.50, 95% CI -0.62 to -0.37; SMD=-0.71, 95% CI -1.17 to -0.24). Comparing acupuncture plus NPH with NPH alone, pain and disability were reduced (SMD=-0.70, 95% CI -0.94 to -0.46; SMD=-0.95, 95% CI -1.36 to -0.54). Comparing acupuncture plus PH with PH alone, pain and disability were reduced (MD=-0.21, 95% CI -433.28 to -10.42; MD=-3.1, 95% CI -4.87 to -1.83). Comparing acupuncture plus combined treatment versus combined treatment alone, no differences were found in pain, while disability was reduced (MD=-3.40 95% CI -5.17 to -1.63). No studies assessed adverse event. Certainty of evidence ranged from moderate to very low. Conclusions: We are uncertain whether acupuncture is more effective and safer than CT. In the comparisons without estimates’ imprecision, acupuncture showed promising results. Acupuncture could be an option based on patients’ preferences.

Background: Despite extensive research on the specific learning disorder (developmental dyslexia) – SLD (DD), many fallacies still cause confusion amongst professionals worldwide. These myths involve the characteristics, diagnoses and treatment of SLD (DD) and should be eradicated. Aim: The authors aimed to determine the knowledge, needs and perspectives of South African professionals working with children with SLD (DD). Setting: A mixed-methods research design was implemented. Methods: A survey study was carried out and a sample of 108 respondents was obtained. The respondents include speech–language therapists (SLTs), occupational therapists (OTs) and psychologists. Results: Speech–language therapists and psychologists displayed better knowledge about the facts of SLD (DD), compared to OTs. Their knowledge levels were, however, not significantly affected by existing misconceptions surrounding the condition. The fallacy that SLD (DD) is caused by a visual impairment is still believed. An investigation into the professionals’ perspectives regarding the identification of SLD (DD) suggested that South African psychologists were the most confident of their ability to identify characteristics. Nonetheless, all professionals reported not being convinced of their ability to provide a differential diagnosis of the disorder. Statements regarding management highlighted the uncertainties about the importance of addressing phonological awareness skills in treatment. Additional training needs were also identified as SLTs, OTs and psychologists generally feel unprepared to assess and treat SLD (DD). Conclusion: The differences identified amongst professional groups were related to the knowledge of the facts and characteristics of SLD (DD) and the ability to identify and manage the condition. Additional training needs should be addressed. Contribution: The authors would like to acknowledge and thank the NRF for partially funding the publication of this article.

IntroductionThis systematic review aimed to answer whether we can predict subsequent social functioning in first episode psychosis (FEP) by means of an initial cognitive examination. In order to do this, we gathered longitudinal studies which evaluated neurocognition and/or social cognition regarding their impact on long-term social functioning of FEP patients.MethodsThe MOOSE method was employed and 28 studies covering data from a total of 2572 patients with longitudinal trajectories from 2 months to 5 years were reviewed.ResultsIn general, cognitive deficits impacted on the social functioning of the FEP patients across the time. The neurocognitive domains which most closely predicted social functioning were processing speed, sustained attention and working memory. An overall cognitive dysfunction, low IQ and the academic trajectory were also found predictive. Regarding social cognition, the findings were not unanimous.DiscussionIn addition of the impact of each variable, several of the articles found a complex relationship between social cognition, neurocognition, social functioning and negative symptoms, pointing social cognition as a modulator of neurocognition but being modulated as well by negative symptoms. The principal clinical implication of this review is that the initial assessment of FEP patients and their rehabilitation must take cognition into account.

Background:. Acellular dermal matrices (ADMs) entered the market in the early 2000s and their use has increased thereafter. Several retrospective cohort studies and single surgeon series reported benefits with the use of ADMs. However, robust evidence supporting these advantages is lacking. There is the need to define the role for ADMs in implant-based breast reconstruction (IBBR) after mastectomy. Methods:. A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints, and establish recommendation for the use of ADMs for subpectoral one-/two-stage IBBR (compared with no ADM use) for adult women undergoing mastectomy for breast cancer treatment or risk reduction using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results:. Based on the voting outcome, the following recommendation emerged as a consensus statement: the panel members suggest subpectoral one- or two-stage IBBR either with ADMs or without ADMs for adult women undergoing mastectomy for breast cancer treatment or risk reduction (with very low certainty of evidence). Conclusions:. The systematic review has revealed a very low certainty of evidence for most of the important outcomes in ADM-assisted IBBR and the absence of standard tools for evaluating clinical outcomes. Forty-five percent of panel members expressed a conditional recommendation either in favor of or against the use of ADMs in subpectoral one- or two-stages IBBR for adult women undergoing mastectomy for breast cancer treatment or risk reduction. Future subgroup analyses could help identify relevant clinical and pathological factors to select patients for whom one technique could be preferable to another.

The slaughter process in livestock is considered a stressor where the transport and handling of animals, as well as the selected stunning and bleeding methods, can cause acute pain, distress, and suffering. In water buffaloes, although stunning is known to be performed before bleeding to induce unconsciousness, no emphasis is made on the nociceptive events during this process. Particularly, current mechanical stunning methods applied to cattle are unsuitable for water buffaloes due to anatomical differences in the skull from other large ruminants. Furthermore, although very high-pressure pneumatic (200–220 psi) may be effective in the frontal position for lighter-weight water buffalos, for heavier animals, it is less likely to be effective. The present review aims: (1) to analyze the anatomical particularities of water buffaloes to discuss the importance of selecting a stunning method suitable for buffaloes, and (2) to revise the potential pain-related consequences, such as hyperalgesia and sensitization, and the signs to assess the stun quality and death to comprehend the relevance of a proper technique according to the species.

As fish welfare becomes a growing concern, it is important to ensure humane treatment during slaughter. This study aimed to assess the onset of unconsciousness in Atlantic halibut immersed in CO2-saturated seawater through electroencephalography (EEG). Of the 29 fish studied, 10 exhibited escape attempts, indicating aversion to CO2-saturated water despite its oxygenation. EEG signals showed four distinct phases: transitional, excitation (high amplitude–high frequency), suppressed, and iso-electric phases. The onset of the suppressed phase, indicative of unconsciousness, occurred on average 258.8 ± 46.2 s after immersion. The spectral analysis of the EEG signals showed a progressive decrease in median frequency, spectral edge frequency, and high frequency contribution, which corresponded to the gradual loss of consciousness. The study concludes that CO2-saturated water is not recommended for pre-slaughter handling of halibut due to the extended time required for the onset of unconsciousness and the observed aversive behaviour. Ensuring humane treatment during slaughter is important for addressing public concern and safeguarding fish welfare in all stages of production.

Reading and writing difficulties (RWD) in learners pose significant challenges not just for children but also for parents. While there is limited support available for children with RWD and their parents in Mauritian schools, research may reveal areas of parental need that speech-language therapists may address. The aim was to determine parents’ perspectives regarding their Grade 4 children with RWD in mainstream government schools in Mauritius. Teachers identified children with RWD with the Screening Tool for Learning Disorder, and parents were requested to participate in the study. Sixty-seven parents completed a questionnaire investigating their perspectives on the symptoms and causes of their child’s RWD and the ways in which they assist their child. The screening tool differentiated between children at risk of specific learning disorder (SLD) and children who indicated clear symptoms of SLD. The results of the tool did not correspond closely with the participants’ satisfaction with their child’s academic performance. The majority of participants could, however, identify RWD in their children when descriptions were given. Parents mostly cited laziness as the main cause of their child’s RWD. The results showed that participants had limited information about the causes and symptoms of RWD and SLD. There is a lack of awareness about the role of speech-language therapists in the intervention of RWD. There are limited resources and support for children with RWD, despite an inclusive education policy in Mauritius. Speech-language therapists and teachers should collaborate to support children with RWD and their parents using inclusive education strategies.

BackgroundOverlapping systematic reviews (SRs) are increasingly frequent in the medical literature. They can easily generate discordant evidence, as estimates of effect sizes and their interpretation might differ from one source to another.ObjectiveTo analyze how methodologists and clinicians make a decision when faced with discordant evidence formalized in structured tables.MethodsWe conducted a 16-item survey exploring how methodologists and clinicians would react when presented with multiple Summary of Findings (SoF) tables (generated using the GRADE tool) derived from 4 overlapping and discordant SRs and meta-analyses on thrombolytic therapy for intermediate-risk pulmonary embolism. SoF tables reported 4 different magnitudes of effects and overall certainty. Participants were asked to provide their recommendations regarding the intervention and the reasons behind their conclusion.ResultsOf the 80 invitees, 41 (51%) participated. The majority described themselves as “somewhat familiar” or experts with SoF tables. The majority recommended the therapy (pharmacological systemic thrombolysis), grading the recommendation as weak positive. Certainty of evidence and benefit-risk balance were the two criteria that prevailed in generating the recommendation. When faced with overlapping meta-analyses, the preferred approach was to use only high-quality SRs and exclude redundant SRs. Several participants suggested integrating the SoF tables with additional information, such as a more comprehensive evaluation of the risk of bias of systematic reviews (71%), heterogeneity/inconsistency (68%) and studies included within each SR (62%).ConclusionWhen faced with multiple controversial SR results, the type and completeness of reported information in SoF tables affect experts' ability to make recommendations. Developers of the SoF table should consider collating key information from overlapping and potentially discordant reviews.

Summary: Background: Influenza is one of the most common respiratory viral infections worldwide. Numerous vaccines are used to prevent influenza. Their selection should be informed by the best available evidence. We aimed to estimate the comparative efficacy and safety of seasonal influenza vaccines in children, adults and the elderly. Methods: We conducted a systematic review and network meta-analysis (NMA). We searched the Cochrane Library Central Register of Controlled Trials, MEDLINE and EMBASE databases, and websites of regulatory agencies, through December 15th, 2020. We included placebo- or no vaccination-controlled, and head-to-head randomized clinical trials (RCTs). Pairs of reviewers independently screened the studies, abstracted the data, and appraised the risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was laboratory-confirmed influenza. We also synthesized data for hospitalization, mortality, influenza-like illness (ILI), pneumonia or lower respiratory-tract disease, systemic and local adverse events (AEs). We estimated summary risk ratios (RR) using pairwise and NMA with random effects. This study is registered with PROSPERO, number CRD42018091895. Findings: We identified 13,439 citations. A total of 231 RCTs were included after screening: 11 studies did not provide useful data for the analysis; 220 RCTs [100,677 children (

Introduction: leptospirosis is one of the endemic zoonoses in Cuba, causing human, animal and economic losses, making it a significant health problem. Rats are a very remarkable vector. Experimental work to study fetal renal alterations in the Wistar rats has not been carried out in Cuba. Objective: to identify the main renal morphometric alterations in fetuses of Wistar rats infected with serovar Leptospira canicola, at the Universidad de Ciencias Médicas de Pinar del Rio in the period between 2017-2019. Method: an experimental study was carried out in pregnant Wistar rats: 2 groups with three animals each: the experimental group with a dose of bacterial concentration of 300 million leptospires per milliliter; 1 ml was inoculated to each one, infecting them with strains of Leptospira canicola. The kidneys of fetuses extracted by cesarean section were studied, and the variables: renal length and kidney weight were analyzed. Results: the results obtained confirmed kidney damage caused by Leptospira canicola both in the major and minor axis of both kidneys, as well as variations in the weight of the infected pups. Conclusions: leptospiral infection in pregnant Wistar rats causes alterations in the kidneys of the fetuses, bringing changes in the morphometry of both the major and minor axes, as well as in the body weight of the fetus, which leads to a decrease in renal weight.

Background: The use of mobile health (mHealth) technology is rapidly expanding in healthcare worldwide. mHealth tools may provide parents with access to resources essential for promoting language development. Aim: The current study aimed to determine how an mHealth parental resource influenced 42 preschool children’s (4.0–5.11 months old) language abilities after a 17-week intervention period. Setting: Participants were identified from six early childhood development (ECD) centres from a low-income community in Tshwane, South Africa. Method: A randomised controlled trial (RCT), pre-test post-test research design was employed to determine whether an mHealth parental resource influenced 42 preschool children’s (4.0–5.11 months old) language abilities after a 17-week intervention period. Data were collected using the language subtests of a South African standardised protocol, the Emergent Literacy and Language Assessment Protocol (ELLA). Results: The parental mHealth application targeting language stimulation did not significantly improve the experimental group’s language outcomes when compared with the control group because most of the parents (n = 27) used the application for less than 20% of the active days. Conclusion: Providing parents with more support with mobile resources may lead to improved usage of the application.

The thalamus is a subcortical structure formed by different nuclei that relay information to the neocortex. Several reports have already described alterations of this structure in patients of schizophrenia that experience auditory hallucinations. However, to date no study has addressed whether the volumes of specific thalamic nuclei are altered in chronic patients experiencing persistent auditory hallucinations. We have processed structural MRI images using Freesurfer, and have segmented them into 25 nuclei using the probabilistic atlas developed by Iglesias and collaborators (Iglesias et al., 2018). To homogenize the sample, we have matched patients of schizophrenia, with and without persistent auditory hallucinations, with control subjects, considering sex, age and their estimated intracranial volume. This rendered a group number of 41 patients experiencing persistent auditory hallucinations, 35 patients without auditory hallucinations, and 55 healthy controls. In addition, we have also correlated the volume of the altered thalamic nuclei with the total score of the PSYRATS, a clinical scale used to evaluate the positive symptoms of this disorder. We have found alterations in the volume of 8 thalamic nuclei in both cohorts of patients with schizophrenia: The medial and lateral geniculate nuclei, the anterior, inferior, and lateral pulvinar nuclei, the lateral complex and the lateral and medial mediodorsal nuclei. We have also found some significant correlations between the volume of these nuclei in patients experiencing auditory hallucinations, and the total score of the PSYRATS scale. Altogether our results indicate that volumetric alterations of thalamic nuclei involved in audition may be related to persistent auditory hallucinations in chronic schizophrenia patients, whereas alterations in nuclei related to association cortices are evident in all patients. Future studies should explore whether the structural alterations are cause or consequence of these positive symptoms and whether they are already present in first episodes of psychosis.

Background: Phonological awareness (PA) skills and working memory (WM) are universally regarded as crucial precursors to skilled reading. The orthography of the language being read influences the ease with which a child learns to read. Research has been undertaken on reading in languages with an opaque orthography. Research on the role of PA and WM in Afrikaans with its transparent orthography is limited. Aim: The study investigated and described the role of WM in the acquisition of PA and ultimately reading in Afrikaans. Setting: The research study was conducted in private schools with Afrikaans as the language of learning and teaching (LoLT) in Grade 2. Method: A descriptive research design with correlational components was applied. Results: Phonetic decoding was employed more than eidetic decoding. Word reading skills developed rapidly and exceeded the expectations in the first two quarters of the year. Participants who read the comprehension test fluently scored higher on the questions than those who did not read fluently. The correlation between WM and reading comprehension was not statistically significant. The statistically significant correlation between WM and word reading seems to be present in both transparent and opaque orthographies. The statistically significant correlation between PA and word reading was not found in other transparent orthographies. The correlation between phonemic awareness (PhA) and word reading is the same in other orthographies. Conclusion: The statistically significant correlation between WM and word reading indicates that WM supports reading development as the ability to hold information in memory supports phoneme-grapheme associations.

It is not just the world but our ways of producing knowledge that are in crisis. The Covid-19 pandemic has exposed our interconnected vulnerabilities in ways never seen before while underscoring the need for emancipation in particular from the hegemonic knowledge politics that underpin “business-as-usual” academic research that have both contributed to and failed to address the systemic challenges laid bare by the pandemic. Political ecologists tasked with knowledge generation on vulnerabilities and their underlying power processes are particularly well placed to envision such emancipatory processes. While pausing physically due to travel restrictions, as researchers in political ecology and rural development at the same university department, we want to make a stop to radically rethink our intellectual engagements. In this article, we aim to uncover “sanitized” aspects of research encounters, and theorize on the basis of anecdotes, feelings and informal discussions—“data” that is often left behind in fieldwork notes and personal diaries of researchers—, the ways in which our own research practices hamper or can be conducive to emancipation in times of multiple interconnected health, political, social, and environmental crises. We do so through affective autoethnography and resonances on our research encounters during the pandemic: with people living in Swedish Sapmi, with African students in our own “Global North” university department and with research partners in Nepal. We use a threefold focus on interconnectedness, uncertainty and challenging hegemonic knowledge politics as our analytical framework. We argue that acknowledging the roles of emotions and affect can 1) help embrace interconnectedness in research encounters; 2) enable us to work with uncertainty rather than “hard facts” in knowledge production processes; and 3) contribute to challenging hegemonic knowledge production. Opening up for emotions in research helps us to embrace the relational character of vulnerability as a pathway to democratizing power relations and to move away from its oppressive and colonial modes still present in universities and research centers. Our aim is to contribute to envisioning post-Covid-19 political ecology and rural development research that is critically reflexive and that contributes to the emergence of a new ethics of producing knowledge.

El siguiente trabajo es la ejecución de una investigación realizada en el ámbito deportivo, en el equipo de hockey sobre césped en la categoría 15-16 de la escuela de deporte (EIDE) de la provincia Las Tunas. En la misma se comprobó que los niveles de resistencia estaban por debajo de los que se debieran tener en esta categoría, en correlación con estudios realizados por diferentes autores y lo que exige el programa de preparación del deportista en esta modalidad. Es por ello que se realiza un análisis de la variable resistencia para la comprensión teórica, como basamento para la utilidad práctica.

La superación y capacitación de los profesionales que conforman el Sistema Deportivo Cubano se establece como una política del Instituto Nacional de Deportes (INDER) y una preocupación del Estado Cubano. La comunicación constituye un aspecto decisivo en la preparación de este profesional, cuya misión es educar a las nuevas generaciones de ahí que se requiere adoptar una construcción epistémica acerca del modo de actuación de los entrenadores deportivos que esté en conformidad con las actuales exigencias. En este sentido se encamina el presente artículo, que tiene como objetivo reflexionar en torno a la necesidad de comunicarse efectivamente, requisito básico para obtener la respuesta deseada y una educación en valores. Muchos de los fracasos profesionales que se vivencian en el contexto del entrenamiento deportivo tienen su origen en una mala transmisión del mensaje que se quiere comunicar, por tanto, mejorar la asertividad en la comunicación es el primer paso hacia la excelencia y la educación.

At a time of growing interest in and awareness about the relationships between humans and animals, it is of relevance to scientifically analyse the intrinsic nature of these interactions. Reactions to emotional tears show our extraordinary capacity for detecting micro-nuances when judging another human's face. Regarding such behaviour, previous studies carried out in our laboratory have pointed to an adaptive function of emotional tears: i.e. their inhibitory influence on perceived aggressiveness. In the present work we aimed to further explore that hypothesis by extending our investigation from humans to animals, using pictures of five different animal faces (cat, dog, horse, chimpanzee, hamster) to which tears were added digitally. To this end, we conducted an online study of 403 participants recruited from different social networks and academic institutions. We questioned the participants about their perceptions of emotional intensity, aggressiveness and friendliness in the animal faces and analysed the comparisons they made between faces with and without tears. In addition, a latent variable referred to as "passion for animals" was measured using different indicators. By adding the results obtained in each species and breaking them down into different basic emotions, we found that the presence of tears was related to a higher absolute frequency of participants who perceived sadness, which endorsed our previous results obtained using images of humans. Regarding aggressiveness, the presence of tears favoured the perception of less aggressiveness. A structural equation model was also conducted to explore the relations among all the measured variables. The model confirmed that the presence of tears in the animal faces had a significant influence on the perception of higher emotional intensity and friendliness, and of lower aggressiveness.

This study investigated the reading demands of restricted-use items administered to South African grade 9 learners as part of the Trends in International Mathematics and Science Study (TIMSS) 2015. The method proposed by Mullis, Martin and Foy (2013) was used to categorise items into low, medium and high readability groups. The ‘knowing’ domain contained mostly low readability items; the ‘applying’ domain was almost equally medium and high readability items; with the ‘reasoning’ domain containing mostly high readability items. Results show significant differences between the percentage of correct answers between the low and high categories and between the medium and high categories. However, the impact of reading demand on performance cannot be fully analysed without cross-reference to English proficiency. Nevertheless, the higher the readability, the greater the chance is for learners to answer incorrectly. A continued expected low performance for most South African learners is implied.

Crying is an ubiquitous human behavior through which an emotion is expressed on the face together with visible tears and constitutes a slippery riddle for researchers. To provide an answer to the question “How our gaze reacts to another person’s tears?,” we made use of eye tracking technology to study a series of visual stimuli. By presenting an illustrative example through an experimental setting specifically designed to study the “tearing effect,” the present work aims to offer methodological insight on how to use eye-tracking technology to study non-verbal cues. A sample of 30 healthy young women with normal visual acuity performed a within-subjects task in which they evaluated images of real faces with and without tears while their eye movements were tracked. Tears were found to be a magnet for visual attention in the task of facial attribution, facilitating a greater perception of emotional intensity. Moreover, the inspection pattern changed qualitatively and quantitatively, with our participants becoming fully focused on the tears when they were visible. The mere presence of a single tear running down a cheek was associated with an increased emotional inference and greater perception of sincerity. Using normalized and validated tools (Reading the Eyes in the Mind Test and the SALAMANCA screening test for personality disorders), we measured the influence of certain characteristics of the participants on their performance of the experimental task. On the one hand, a higher level of cognitive empathy helped to classify tearful faces with higher emotional intensity and tearless faces with less emotional intensity. On the other hand, we observed that less sincerity was attributed to the tearful faces as the SALAMANCA test scores rose in clusters A (strange and extravagant) and B (immature and emotionally unstable) of our sample. The present findings highlight the advantages of using eye tracking technology to study non-verbal cues and draw attention to methodological issues that should be taken into account. Further exploration of the relationship between empathy and tear perception could be a fruitful avenue of future research using eye tracking.

Abstract Background Increased investment in optimal student mental health and well-being has been noted by universities around the world. Studies show the need for contextually relevant, granular understandings of specific aspects of student mental health and well-being. Methods A survey was conducted at two time points – at the beginning and end of the academic year – at a large, urban university in South Africa. The Mental Health Continuum-Short Form, the Flourishing Scale, and the Fragility of Happiness Scale were used in the testing of undergraduate students from a variety of scientific disciplines. Two separate comparisons were made, based on the baseline data (n = 551) and the follow-up data (n = 281). In Comparison 1 (baseline, n = 443; follow-up, n = 173), two independent, biographically (very) similar groups were compared. Comparison 2 (n = 108) compared the results from the baseline and follow-up of the same group of students who completed the instruments at both time points. Results Results indicate a significant decline in mental health and well-being for both groups (independent and dependent) over the course of the academic year. Both follow-up groups were found to have lower psychological, emotional and social well-being, psychological flourishing, and reduced mental health, in comparison with the baseline groups. Conclusions The statistically significant decreases in the mental health and well-being of participants in this study indicate the need for substantive interventions to support student mental health and well-being. Strong foci for well-being interventions should include self-efficacy, sense of direction, meaning and creating a sense of belonging.

Gran parte del desarrollo y la expansión de la industria forestal se debe a la contrarreforma agraria llevada a cabo en el periodo dictatorial, en el que —a través del Decreto de Ley 701— se les devuelven tierras a la oligarquía y se conceden recursos estatales a empresas forestales. De ahí en más, el Estado ha llevado a cabo una serie de acciones para proteger el patrimonio de algunas familias dueñas de predios en Wallmapu. Estas estrategias de protección han estado acompañadas de formas de violencia que se han cometido en estos territorios y que han afectado a la vida cotidiana de sus habitantes. Así pues, el presente texto revisa cómo se materializan estas formas de violencia, poniendo en evidencia su recurrencia y gravedad. Para ello, se distinguen entre tres principales formas de violencia: (1) física, (2) ecológica y (3) simbólica. Este capítulo pretende discutir acerca de cómo se llevan a cabo las estrategias represivas del Estado, y acerca de los actores que se hacen parte de estas lógicas, como las empresas.

This article proposes to approach elements defining the moral economies that build the plurality of homosexual identities today. The analysis of the social relations between Moroccan and French homosexuals makes it possible to understand that the imperative of sincerity carries specific values under the guise of a universal definition of homosexual identities. The ethnographic survey identifies, at the heart of the transformation of social relationships into inter-ethnic relations and racializing processes, the affirmation of love feeling as a value.

This article is an exploratory note on the interweaving between the struggles for homosexual rights and the fight against HIV/AIDS in Morocco. Sandrine Musso and Marien Gouyon are both returning to their fields in order to bring out the stakes of such an interweaving in a context where homosexuality is punished by the law. First, this paper traces the emergence of the fight against AIDS and secondly that of rights for homosexuality in order to think of the repercussions of one against the other. Based on the analysis of the social uses of the category “MSM” in aids prevention, this article underlines the forms of subjectivities and citizenship that emerge from a crisscrossing of underprivileged struggles in public space.

Abstract Background Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. Results We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Conclusions Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.

Abstract Background Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. Methods/Design The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. Discussion The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. Trial registration ClinicalTrials.gov, NCT02645357

Objective: To calculate the positive predictive value (ppv) of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCAs) and anti-proteinase 3 (PR 3) antibodies for Wegener's granulomatosis (WG) and to evaluate their association with other diseases.Methods: The clinical files of all 94 patients who had a positive c- or perinuclear (p)-ANCA test, or both, in the laboratory of the University Hospital, Leuven between April 1995 and March 1996 and who attended the Internal Medicine Department of the hospital were retrospectively studied.Results: Of the 94 patients with ANCAs (fluorescence titre > or = 1/40), 57 were c-ANCA positive and 45 p-ANCA positive (eight were simultaneously c- and p-ANCA positive). Of the 57 c-ANCA positive patients, 23 had WG. The ppv for WG thus was 40%. This value did not increase by defining a higher threshold for a positive ANCA. There was not a good relation between ANCA titres and disease activity in the WG patients, nor was there a relation between anti-PR 3 antibody levels and WG disease activity. The ppv of anti-PR 3 antibodies for WG however was very high (85%). There was a positive correlation between the level of (hyper) gammaglobulinaemia and c-ANCA titres in those patients with final diagnoses not known to be associated with c-ANCA. Forty five patients had positive p-ANCAs. The largest group were those with inflammatory bowel disease (n = 20, of whom the majority had colitis ulcerosa or primary sclerosing cholangitis, or both); the great majority of these patients had no anti-myeloperoxidase antibodies. Vasculitis was present in eight patients, of whom two had WG (both were also c-ANCA positive).Conclusion: There is a low ppv of c-ANCAs for WG, caused by a high percentage of PR 3 negative, positive c-ANCA determinations, possibly related to hypergammaglobulinaemia. Anti-PR 3 antibodies have a high ppv for WG. However, neither c-ANCA titre, nor the level of anti-PR 3 antibodies correlated with the activity of the disease. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the preliminary psychometric performance of a new clinical feeding scale to diagnose oropharyngeal dysphagia (OPD) in neonates. Methods: Twenty neonates with a median gestational age of 35 weeks were evaluated using the Neonatal Feeding Assessment Scale (NFAS) and modified barium swallow studies (MBSS). The results were compared. Results: Nine of the 20 participants presented with OPD on the NFAS. Comparison of the scale’s results with instrumental MBSS indicated that all participants without OPD were correctly excluded (100% sensitivity). The specificity was 78.6%, indicating that three participants were falsely identified with OPD on the scale. Inter-rater reliability was determined on 50% (n = 10) of the sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the scale and on the diagnostic outcome. Conclusion: The preliminary performance of the scale appears to be promising. A further validation study will take place.

Auditory hallucinations (AH) are the most frequent positive symptoms in patients with schizophrenia. Hallucinations have been related to emotional processing disturbances, altered functional connectivity and effective connectivity deficits. Previously, we observed that, compared to healthy controls, the limbic network responses of patients with auditory hallucinations differed when the subjects were listening to emotionally charged words. We aimed to compare the synchrony patterns and effective connectivity of task-related networks between schizophrenia patients with and without AH and healthy controls. Schizophrenia patients with AH (n = 27) and without AH (n = 14) were compared with healthy participants (n = 31). We examined functional connectivity by analyzing correlations and cross-correlations among previously detected independent component analysis time courses. Granger causality was used to infer the information flow direction in the brain regions. The results demonstrate that the patterns of cortico-cortical functional synchrony differentiated the patients with AH from the patients without AH and from the healthy participants. Additionally, Granger-causal relationships between the networks clearly differentiated the groups. In the patients with AH, the principal causal source was an occipital–cerebellar component, versus a temporal component in the patients without AH and the healthy controls. These data indicate that an anomalous process of neural connectivity exists when patients with AH process emotional auditory stimuli. Additionally, a central role is suggested for the cerebellum in processing emotional stimuli in patients with persistent AH.

Según Darwin, el lloro emocional fue considerado un resultado fortuito a la luz de la evolución; sin propósito alguno, y debía ser visto como una consecuencia secundaria a fenómenos más importantes. Aunque es el comportamiento más dramático por el cual las emociones emergen en el rostro, muy poco es lo que se sabe desde la neurociencia. El presente estudio tiene como objetivo demostrar que la idea de Darwin está lejos de ser cierta, y que el lloro emocional parece jugar un papel esencial en el desarrollo de las relaciones sociales, siendo un factor de influencia en la percepción de sinceridad. Estudios previos han encontrado una influencia en la inhibición de la agresión, y que favorece la inferencia emocional y la amigabilidad. Como señal de comunicación, estudiamos su influencia sobre la atribución emocional, su intensidad y sinceridad percibida. Aplicamos la tecnología de rastreo de la mirada y utilizamos imágenes de rostros con y sin lágrimas visibles, al igual que un cuestionario de evaluación. Dieciséis estudiantes de enfermería se reclutaron para llevar a cabo el presente estudio piloto. Los rostros con lágrimas mostraron ser estadísticamente distintos y las consecuencias de los hallazgos presentados para el avance de la neuropsicología clínica son examinadas someramente.

Analizamos el dramático incendio de Horta de Sant Joan de 2009 en Cataluña, bajo el marco de la ecología política. La historia ambiental local, los cambios de usos del paisaje forestal anterior al incendio y el choque entre los diferentes discursos sociales alrededor de éste revelan diferentes formas sociopolíticas de construir la relación entre la naturaleza y la sociedad. Cada actor social explica y evalúa la gestión del territorio y del incendio mediante escalas de tiempo e intereses diferentes. Estos distintos discursos se pueden clasificar según el grado en que favorecen la inclusión o la exclusión del fuego en el sistema socioecológico. Nuestro análisis muestra los diferentes «paisajes deseados» propuestos por los actores sociales, cuya contextualización y análisis permiten realizar una reflexión más profunda sobre los valores dominantes y dominados en relación con los bosques y los incendios. Concluimos que es necesaria una adecuada politización del debate en torno a las causas de los incendios forestales y las formas en las que la sociedad catalana responde a ellos.

Introducción: el envejecimiento, al contrario del crecimiento, no es un fenómeno genéticamente programado, es un proceso deletéreo, progresivo, intrínseco y universal, que con el tiempo ocurre en todo ser vivo a consecuencia de la interacción de la genética del individuo y su medio ambiente Objetivo: describir el comportamiento de la discapacidad física en los adultos mayores. Material y método: se realizó un estudio observacional descriptivo y de corte transversal en la población de adultos mayores residentes en el Consejo Popular "Hermanos Barcón" en el 2010. Se estudió un universo de 2567 ancianos. La muestra seleccionada se obtuvo mediante un muestreo por conglomerados bietápico, donde las unidades de la primera etapa fueron los 15 consultorios del consejo popular, de los cuales se seleccionaron 2 por muestreo simple aleatorio, el consultorio #199 y el #214. Para la recogida de la información se aplicó el índice de Lawton. Resultados: se estimaron las tasas de prevalencia específicas de discapacidad física para cada una de las variables biológicas y sociales estudiadas y calcularon los intervalos de confianza al 95% para las respectivas tasas de prevalencia. Resultó mayor la discapacidad física en el sexo femenino y el grupo de edades de 80 años y más, así como el bajo nivel de escolaridad. Conclusiones: las principales limitaciones en la realización de las actividades instrumentadas de la vida diaria fueron las actividades con desplazamiento fuera del hogar seguidas de las propias del hogar.Introduction: aging, oppose to growing, is not a genetic programmed phenomenon, it is a lethal, progressive, intrinsic and universal process, that occurs in every living being as a consequence of the individual genetic features and environmental interaction. Objective: to describe the behavior of physical disability in the elderly. Material and Method: observational, descriptive and cross-sectional study was conducted comprising the old population at "Hermanos Barcon" Popular Council during 2010 in Pinar del Rio. The target group included 2567 old people, and the sample was chosen through a two-staged conglomeration, where the first-stage included 15 Doctor's Offices from the popular council; out them 2 were selected by a simple, at random sampling (number 199 and 214 Doctor's Offices), following Lawton's index to collect the information. Results: the rates for the specific prevalence of physical disabilities in each of the biological and social variables under study were estimated, as well as the calculation of the intervals of confidence up to 95% to the respective rates of prevalence. Female sex showed the highest occurrence rates of physical disabilities along with the group of 80 years old or more, and low levels of instruction. Conclusions: the main limitations to perform the instrumented daily activities were those that required movements from one place to another out of their houses, followed by those into their houses.

Se presenta el caso de una mujer de 47 años de edad, color de la piel blanca, de procedencia rural y ama de casa, que ingresa en el Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río por presentar fiebre elevada, artralgias y mialgias de miembros inferiores, vómitos, diarreas, astenia, anorexia marcadas y coloración ictérica azafranada de piel y mucosas. Los exámenes serológicos muestran una leptospirosis por L. autumnalis. Se comprueba la naturaleza predominantemente hemolítica del íctero, que ocasiona una anemia intensa, necesitando ser transfundida. Se analizan las posibles causas de la hemólisis. Se concluye como una anemia hemolítica microangiopática, lo que es excepcional en la enfermedad.A 47 year-old, Caucasian housewife-woman who lives in a rural area was admitted at "Abel Santamaria Cuadrado" University Hospital presenting high fever, arthralgia and myalgia of the lower limbs, vomits and marked diarrhea, asthenia, anorexia and saffron-colored (jaundice) skin and mucosa. Serological examinations showed leptospirosis caused by Laelia autumnalis. The prevailing hemolytic nature of jaundice was proved; which provoked an intense anemia, the patient needed a blood transfusion. The possible causes of hemodialysis were analyzed. Microangiopathic hemolytic anemia is a rare complication in leptospirosis.

Actualmente, se consideran tratamientos eficaces para la agorafobia algunos psicofármacos, la terapia cognitiva conductual (TCC) y la combinación de ambos. Entre los tratamientos psicológicos se han desarrollado nuevas alternativas terapéuticas, tales como técnicas de exposición con realidad virtual (TERV). El objetivo de este estudio experimental ha sido evaluar, en una muestra de pacientes con agorafobia (N = 64), la eficacia de la TERV combinada con dos psicofármacos (venlafaxina y paroxetina), utilizando un sistema virtual formado por siete escenarios. Para ello, se compararon cinco tipos de tratamiento: cuatro grupos de tratamientos combinados y un grupo de tratamiento psicofarmacológico. Se tomaron medidas en el pre-tratamiento, post-tratamiento y en el seguimiento a los seis meses, y como variables dependientes se consideraron medidas de agorafobia y ansiedad. Los resultados mostraron que todos los grupos eran estadísticamente significativos, tanto en el postratamiento como en el seguimiento a los seis meses. Atendiendo a la eficacia clínica, los resultados mostraron que los grupos de tratamiento combinado con TERV disminuyeron las puntuaciones de agorafobia y ansiedad, manteniéndolas en el tiempo, más que las técnicas de tratamiento tradicional.

Shared decision-making (SDM) arises in contexts where patients and health professionals must make decisions about screening tests or treatments without a single or “best” option. Decision Aids (DAs) are created to facilitate the SDM process. They are interventions designed to help people participate in decision making between various screening tests and therapeutic options, providing information about options and patient’s health outcome status. Using Das increases patients’ knowledge regarding their health status, decreases decisional conflict, reduces the proportion of people who were passive in decision-making and reduces the proportion of people who remained undecided post-intervention. Nevertheless, despite the apparent positive effects of DAs in many health care specialties, including oncology, a standard use has not been yet reached. Therefore, it is essential to explore desired level involvement of patients and health professionals in SDM process, and identify potential barriers and facilitators influencing implementation of Das in our context.

Se realizó un estudio observacional, descriptivo y transversal, con el objetivo de caracterizar la salud funcional de los ancianos residentes en el área del Consultorio 10 del Policlínico "Pedro Borrás Astorga" de la ciudad de Pinar del Río, así como su relación con las enfermedades generales seleccionadas en los meses de enero a julio de 2008. Se aplicó una encuesta voluntaria y anónima a 180 ancianos, que recogió las variables sexo, enfermedades generales asociadas: hipertensión arterial, diabetes mellitus, cardiopatía isquémica y osteoartritis. Para caracterizar su salud funcional se aplicaron los índices de Katz de independencia en las actividades básicas de la vida diaria y de Lawton-Brody de independencia en las actividades instrumentadas de la vida diaria. Existió un predominio de ancianos del sexo femenino. No hubo asociación entre el sexo y la clasificación en dependencia e independencia. Las enfermedades generales estudiadas en la población general de ancianos mostraron una elevada prevalencia de la hipertensión arterial, sobre todo en los discapacitados. La prevalencia de osteoartritis prácticamente se cuadruplicó en ancianos dependientes. En el análisis de todas las enfermedades en los dos grupos de ancianos teniendo el sexo como variable de confusión, se encontró que sólo en la osteoartritis actuaba como el tipo de variable analizada. Se recomendó incrementar las acciones preventivas, educativas y de control en busca de cambios favorables en hábitos y estilos de vida en los ancianos estudiados, dada la alta frecuencia de hipertensión arterial.An observation, descriptive and cross-sectional research was conducted from January to July 2008 aimed at characterizing functional health and its association with certain general diseases of the aged living in the area of No-10 Medical Office belonging to "Pedro Borras Astorga" teaching outpatient clinic in Pinar del Rio city. A volunteer and anonymous survey was applied to 108 aged, collecting the variable of sex and associated general diseases: hypertension, diabetes mellitus, ischemic heart disease and osteoarthritis. To characterize functional health the rates of Katz and Lawton-Brody concerning the independence of instrumented everyday activities were used. Female sex prevailed. Disabled and able aged that presented Hypertension and osteoarthritis exceeded four times in disabled. Increasing preventive, educative and control measures to achieve favorable lifestyle changes in patients that participated in the study, due to the high frequency of hypertension.