Tests de screening para la detección de la enfermedad de alzheimer: revisión sistemática y meta-análisis

Objetivo: En la actualidad el diagnóstico de demencia es cada vez más frecuente, y el test de screening cognitivo más utilizado para el diagnóstico de enfermedad de Alzheimer (EA) es el Mini-Mental State Examination (MMSE). Pero seguimos sin conocer como varía en función de la prevalencia, y, por ende, la sensibilidad que muestra a la hora de detectar EA. Método: una búsqueda bibliográfica en diferentes bases de datos como Cochrane, PsycInfo, Ovid, Embase, para un posterior meta-análisis de 56 estudios sobre diferentes investigaciones publicadas sobre test de screening en la EA, donde se incluyeron el MMSE, Addenbrooke's Cognitive Examination III (ACER III), el test del reloj (CDT), la Evaluación Cognitiva de Montreal (MoCa), ADAS-Cog Test, entre otros. Resultados: no existen diferencias significativas entre la media de total y el MMSE comparado con el resto de cuestionarios cognitivos. Pero sí una gran variación del valor predictivo positivo para diferentes prevalencias. Conclusiones: este trabajo respalda la necesidad de conocer la sensibilidad y el valor predictivo para diferentes prevalencias de los test de screening cognitivo para la EA, con la finalidad de poder adecuar y baremar la prueba diagnóstica más correcta según otros factores como la edad y el nivel académico.Objective: Currently the diagnosis of dementia is becoming more frequent and the most widely used cognitive screening test for the diagnosis of Alzheimer's disease (AD) is the Mini- Mental State Examination (MMSE). But we still do not know how it varies depending on the prevalence and the sensitivity it shows when detecting AD. Method: a bibliographic search in different databases as Cochrane, PsycInfo, Ovid, Embase, for a subsequent meta-analysis of 56 studies on different published researches on screening tests in AD, where the MMSE was included; Addenbrooke's Cognitive Examination III (ACER III), clock-drawing test (CDT), the montreal cognitive assessment (MoCa), ADAS-Cog Test, among others. Results: there are no significant differences between the total mean and the MMSE compared to the rest of the cognitive questionnaires, but there is a great variation in the positive predictive value for different prevalences. Conclusions: this work supports the need about knowing the sensitivity and the predictive value for different prevalences of the cognitive screening tests for AD, in order to be able to adapt and scale the most correct diagnostic test according to other factors such as age and academic level

Influencia de la formación musical en el rendimiento académico: una revisión bibliográfica

Music education has gained recent interest in the field of education and psychology with an increase of neuroscientific research, which demonstrates its positive effects on cognitive development and academic performance. The objective of this review is to look at the different cognitive processes that explain the relationship between musical training and academic performance. We synthesized a set of studies through a structured procedure in three steps: initial, systematic and manual research. The results show how students with musical training have better verbal memory, executive functions, selective attention and brain plasticity. These data suggest that musical training during the school period may favor academic performance. The degree of these changes seems to be preceded by pre-existing individual differences in students, as well as in training time, among other factors. We conclude that musical training produces direct positive effects on neuroanatomical differentiation, cognitive abilities and, at the same time, an increase in achievement and academic performance. La formación musical ha generado un reciente interés en el campo de la educación y la psicología con el aumento de la investigación desde la neurociencia, la cual demuestra sus efectos positivos en el desarrollo tanto a nivel cognitivo como de rendimiento académico. El objetivo de esta revisión es conocer los procesos cognitivos que explican la relación entre la formación musical y el rendimiento académico. Para ello, sintetizamos un conjunto de estudios mediante un procedimiento estructurado en tres pasos: búsqueda inicial, sistemática y manual. Los resultados muestran cómo los alumnos con formación musical presentan mejor memoria verbal, funciones ejecutivas, atención selectiva y plasticidad cerebral. Estos datos sugieren que el entrenamiento musical durante el período escolar puede favorecer el rendimiento académico. El grado de estos cambios parece ser precedido por las diferencias individuales preexistentes en los alumnos, así como en el tiempo de entrenamiento, entre otros factores. Concluimos que la formación musical produce efectos positivos directos sobre la diferenciación neuroanatómica, habilidades cognitivas y, a su vez, un aumento del logro y rendimiento académico.

The first session is the one that counts: An exploratory study of therapeutic alliance

Background: The controversy about whether psychotherapy outcome is the consequence of the techniques themselves, common factors or both is still current. The importance of common factors has been demonstrated, although it is also known that they alone are insufficient. At the present time, the contextual model grants heavy weight to the therapeutic alliance in the first sessions and seems to predict positive final results. Furthermore, monitoring sessions has demonstrated that this alliance improves. Objectives: To analyze the relationship between the therapeutic alliance and patient’s perceived improvement during the first five sessions of therapy, and find out whether the therapeutic alliance is maintained or unstable within that timeframe. Methods: Thirty-four patients at a university psychological care service who had had at least five therapy sessions participated. Of these, 70.46% were women (Mage = 24.24, SD = 6.73). The patients filled out the Outcome Rating Scale and Session Rating Scale the week before each session. Data were analyzed by the Dual STATIS method. Results: The compromise matrix explained 77.36% of the variability. The position of the vectors and the distribution of the position of the patients on the graph show that as their perception increased, therapeutic alliance remained stable. Moreover, the position of the vectors shows that the therapeutic alliance was forged in the first session and remained stable during the following sessions. Conclusion: This exploratory study demonstrated the importance of the first session in establishing the therapeutic alliance, and for it to remain stable, regardless of whether the rest of the therapeutic process has variations or changes. Novel use of the STATIS method for analyzing measurements in the first five sessions, showed that beginning the therapeutic intervention with a strong alliance, produced the favorable, lasting effects necessary for development of the intervention

Revisão da Taxonomia da Bloom para apoiar a redação dos resultados do aprendizado e o alinhamento construtivo

The purpose of this essay is to explain the importance of Bloom's revised taxonomy in the writing of learning outcomes, for which recommendations for its use are proposed. The document mentions the need to generate educational proposals that are more closely linked to the social context, which is why policies have been issued to promote the design and implementation of student-centered curricula. In this sense, the work developed by authors such as Kennedy (2006) and Biggs and Tang (2011) for the writing of learning outcomes is addressed. Finally, it is developed with an example, the coherence that should exist between learning outcomes, assessment and implementation of teaching-learning strategies, in the formative process of the student population, understood as constructive alignment. It is concluded that although taxonomies are a guide that proposes a hierarchical classification of the levels of development of cognitive and knowledge processes, their use should go from being a mechanical task to a process of reflection on the object of study of an academic discipline. Also, on the importance of carrying out the process of designing the results in work teams, with training on their elaboration and the use of taxonomies, for which the participation and accompaniment of experts in curricular matters becomes an essential requirement.El presente ensayo tiene el objetivo de explicar la importancia de la taxonomía revisada de Bloom, en la redacción de resultados de aprendizaje, para lo cual se plantean recomendaciones de su uso. En el documento se hace mención sobre la necesidad de generar propuestas educativas con mayor vinculación al contexto social, razón por la cual se han emitido políticas que promueven el diseño y la ejecución de planes de estudios centrados en el estudiantado. En este sentido, se aborda el trabajo desarrollado por autores como Kennedy (2006) y Biggs y Tang (2011) para la redacción de los resultados de aprendizaje. Finalmente, se desarrolla con un ejemplo, la coherencia que debe existir entre los resultados de aprendizaje, la evaluación y la implementación de las estrategias de enseñanza-aprendizaje, en el proceso formativo de la población estudiantil, entendido esto como el alineamiento constructivo. Se concluye que si bien las taxonomías son una guía que propone una clasificación jerárquica de los niveles de desarrollo de los procesos cognitivos y de conocimiento, su uso debe pasar de ser una tarea mecánica a un proceso de reflexión sobre el objeto de estudio de una disciplina académica. También, sobre la importancia de llevar a cabo el proceso de diseño de los resultados en equipos de trabajo, con la capacitación sobre su elaboración y el uso de las taxonomías, para lo cual la participación y acompañamiento de expertos en materia curricular se convierte en un requisito imprescindible.O objetivo deste ensaio é explicar a importância da taxonomia revista de Bloom na redação dos resultados do aprendizado, para os quais são apresentadas recomendações para seu uso. O documento menciona a necessidade de gerar propostas educacionais com maiores vínculos com o contexto social, razão pela qual foram emitidas políticas para promover a concepção e implementação de currículos centrados no estudante. A este respeito, é abordado o trabalho desenvolvido por autores como Kennedy (2006) e Biggs e Tang (2011) para a redacção de resultados de aprendizagem. Finalmente, a coerência que deve existir entre os resultados do aprendizado, a avaliação e a implementação de estratégias de ensino-aprendizagem no processo formativo da população estudantil, entendida como alinhamento construtivo, é desenvolvida com um exemplo. Conclui-se que, embora as taxonomias sejam um guia que propõe uma classificação hierárquica dos níveis de desenvolvimento dos processos cognitivos e de conhecimento, sua utilização deve passar de uma tarefa mecânica a um processo de reflexão sobre o objeto de estudo de uma disciplina acadêmica. Também, sobre a importância de realizar o processo de elaboração dos resultados em equipes de trabalho, com treinamento sobre sua elaboração e o uso de taxonomias, para o qual a participação e o acompanhamento de especialistas em assuntos curriculares se tornam um requisito essencial

Revisão da Taxonomia da Bloom para apoiar a redação dos resultados do aprendizado e o alinhamento construtivo

The purpose of this essay is to explain the importance of Bloom's revised taxonomy in the writing of learning outcomes, for which recommendations for its use are proposed. The document mentions the need to generate educational proposals that are more closely linked to the social context, which is why policies have been issued to promote the design and implementation of student-centered curricula. In this sense, the work developed by authors such as Kennedy (2006) and Biggs and Tang (2011) for the writing of learning outcomes is addressed. Finally, it is developed with an example, the coherence that should exist between learning outcomes, assessment and implementation of teaching-learning strategies, in the formative process of the student population, understood as constructive alignment. It is concluded that although taxonomies are a guide that proposes a hierarchical classification of the levels of development of cognitive and knowledge processes, their use should go from being a mechanical task to a process of reflection on the object of study of an academic discipline. Also, on the importance of carrying out the process of designing the results in work teams, with training on their elaboration and the use of taxonomies, for which the participation and accompaniment of experts in curricular matters becomes an essential requirement.El presente ensayo tiene el objetivo de explicar la importancia de la taxonomía revisada de Bloom, en la redacción de resultados de aprendizaje, para lo cual se plantean recomendaciones de su uso. En el documento se hace mención sobre la necesidad de generar propuestas educativas con mayor vinculación al contexto social, razón por la cual se han emitido políticas que promueven el diseño y la ejecución de planes de estudios centrados en el estudiantado. En este sentido, se aborda el trabajo desarrollado por autores como Kennedy (2006) y Biggs y Tang (2011) para la redacción de los resultados de aprendizaje. Finalmente, se desarrolla con un ejemplo, la coherencia que debe existir entre los resultados de aprendizaje, la evaluación y la implementación de las estrategias de enseñanza-aprendizaje, en el proceso formativo de la población estudiantil, entendido esto como el alineamiento constructivo. Se concluye que si bien las taxonomías son una guía que propone una clasificación jerárquica de los niveles de desarrollo de los procesos cognitivos y de conocimiento, su uso debe pasar de ser una tarea mecánica a un proceso de reflexión sobre el objeto de estudio de una disciplina académica. También, sobre la importancia de llevar a cabo el proceso de diseño de los resultados en equipos de trabajo, con la capacitación sobre su elaboración y el uso de las taxonomías, para lo cual la participación y acompañamiento de expertos en materia curricular se convierte en un requisito imprescindible.O objetivo deste ensaio é explicar a importância da taxonomia revista de Bloom na redação dos resultados do aprendizado, para os quais são apresentadas recomendações para seu uso. O documento menciona a necessidade de gerar propostas educacionais com maiores vínculos com o contexto social, razão pela qual foram emitidas políticas para promover a concepção e implementação de currículos centrados no estudante. A este respeito, é abordado o trabalho desenvolvido por autores como Kennedy (2006) e Biggs e Tang (2011) para a redacção de resultados de aprendizagem. Finalmente, a coerência que deve existir entre os resultados do aprendizado, a avaliação e a implementação de estratégias de ensino-aprendizagem no processo formativo da população estudantil, entendida como alinhamento construtivo, é desenvolvida com um exemplo. Conclui-se que, embora as taxonomias sejam um guia que propõe uma classificação hierárquica dos níveis de desenvolvimento dos processos cognitivos e de conhecimento, sua utilização deve passar de uma tarefa mecânica a um processo de reflexão sobre o objeto de estudo de uma disciplina acadêmica. Também, sobre a importância de realizar o processo de elaboração dos resultados em equipes de trabalho, com treinamento sobre sua elaboração e o uso de taxonomias, para o qual a participação e o acompanhamento de especialistas em assuntos curriculares se tornam um requisito essencial

Cardiac dysfunction and remodeling regulated by anti-angiogenic environment in patients with preeclampsia : the ANGIOCOR prospective cohort study protocol

Background: Cardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite of advances for diagnosis and treatment. Changes during pregnancy affect importantly the maternal CV system. Pregnant women that develop preeclampsia (PE) have higher risk (up to 4 times) of clinical CVD in the short- and long-term. Predominance of an anti-angiogenic environment during pregnancy is known as main cause of PE, but its relationship with CV complications is still under research. We hypothesize that angiogenic factors are associated to maternal cardiac dysfunction/remodeling and that these may be detected by new cardiac biomarkers and maternal echocardiography. Methods: Prospective cohort study of pregnant women with high-risk of PE in first trimester screening, established diagnosis of PE during gestation, and healthy pregnant women (total intended sample size n = 440). Placental biochemical and biophysical cardiovascular markers will be assessed in the first and third trimesters of pregnancy, along with maternal echocardiographic parameters. Fetal cardiac function at third trimester of pregnancy will be also evaluated and correlated with maternal variables. Maternal cardiac function assessment will be determined 12 months after delivery, and correlation with CV and PE risk variables obtained during pregnancy will be evaluated. Discussion: The study will contribute to characterize the relationship between anti-angiogenic environment and maternal CV dysfunction/remodeling, during and after pregnancy, as well as its impact on future CVD risk in patients with PE. The ultimate goal is to improve CV health of women with high-risk or previous PE, and thus, reduce the burden of the disease. Trial registration: NCT04162236

Forest biomass density across large climate gradients in northern South America is related to water availability but not with temperature

Understanding and predicting the likely response of ecosystems to climate change are crucial challenges for ecology and for conservation biology. Nowhere is this challenge greater than in the tropics as these forests store more than half the total atmospheric carbon stock in their biomass. Biomass is determined by the balance between biomass inputs (i.e., growth) and outputs (mortality). We can expect therefore that conditions that favor high growth rates, such as abundant water supply, warmth, and nutrient-rich soils will tend to correlate with high biomass stocks. Our main objective is to describe the patterns of above ground biomass (AGB) stocks across major tropical forests across climatic gradients in Northwestern South America. We gathered data from 200 plots across the region, at elevations ranging between 0 to 3400 m. We estimated AGB based on allometric equations and values for stem density, basal area, and wood density weighted by basal area at the plotlevel. We used two groups of climatic variables, namely mean annual temperature and actual evapotranspiration as surrogates of environmental energy, and annual precipitation, precipitation seasonality, and water availability as surrogates of water availability. We found that AGB is more closely related to water availability variables than to energy variables. In northwest South America, water availability influences carbon stocks principally by determining stand structure, i.e. basal area. When water deficits increase in tropical forests we can expect negative impact on biomass and hence carbon storage

COVID-19 : Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study

Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Semiótica, la pasión del conocimiento. Interpretación e interacciones de la cultura.

El documento aquí expuesto está inspirado por diversas voces y construido por varias manos. Así que sus páginas transitan entre la polisemia y la polifonía, que emergen con la lectura de las interpretaciones semióticas que aquí se encuentran. Cada uno de los artículos, seleccionados por un grupo de especialistas que colaboraron de manera generosa con esta actualización, recoge la experiencia y el conocimiento de los autores que trabajan en esta disciplina; a la vez, constituye una aporte sólido y valioso para quienes están interesados en conocer los avances alcanzados por la semiótica en Colombia, un país donde la Asociación de Estudios en Semiótica se esfuerza de manera permanente por la consolidación de estos estudios