Ecto-calreticulin expression in multiple myeloma correlates with a failed anti-tumoral immune response and bad prognosis

Immunogenic cell death (ICD) has been proposed to be a crucial process for antitumor immunosurveillance. ICD is characterized by the exposure and emission of Damage Associated Molecular Patterns (DAMP), including calreticulin (CRT). A positive correlation between CRT exposure or total expression and improved anticancer immunosurveillance has been found in certain cancers, usually accompanied by favorable patient prognosis. In the present study, we sought to evaluate CRT levels in the plasma membrane of CD38+ bone marrow mononuclear cells (BMMCs) isolated from 71 patients with varying degrees of multiple myeloma (MM) disease and examine the possible relationship between basal CRT exposure and the bone marrow immune microenvironment, as well as its connection with different clinical markers. Data show that increased levels of cell surface-CRT were associated with more aggressive clinical features and with worse clinical prognosis in MM. High CRT expression in MM cells was associated with increased infiltration of NK cells, CD8+ T lymphocytes and dendritic cells (DC), indicative of an active anti-tumoral immune response, but also with a significantly higher presence of immunosuppressive Treg cells and increased expression of PD-L1 in myeloma cells

La psicopatologización del trabajo: el estado de malestar del sujeto responsable

La economía globalizada ha dado lugar a un individuo hiperreflexivo –el sujeto responsable o culpable– en un contexto muy individualizado y de alta competitividad. En este marco, la idea que la literatura ha venido manejando es la de la psicologización de los procesos laborales, como crítica a la explicación de procesos colectivos solo en base a términos individuales. A lo largo de este estudio se muestra cómo esta tendencia individualista arropada por un discurso científico propio de ciencias psi- es origen de problemáticas para el individuo. Así, se propone el término de psicopatologización del mundo laboral como última consecuencia de este proceso: sin seguridad y sin procesos colectivos, el trabajo se ordena en relaciones desiguales e incontrolables para los trabajadores. Con estas reglas, el conflicto laboral colectivo se comienza a comprender como una patología individual aislada. El objetivo de este artículo es plantear el camino inverso deconstruyendo las relaciones laborales actuales bajo la mirada de la Psicología Social. Se vuelve a llegar al punto de partida: lograr reconocer lo laboral como un proceso relacional y colectivo, donde el conflicto es una parte sustancial y no patología

Job Insecurity and Mental Health: The Moderating Role of Coping Strategies From a Gender Perspective

Job insecurity is a growing phenomenon, typical of an employment context characterised by high rates of temporary work and unemployment. Previous research has shown a direct relationship between job insecurity and mental health impairment. The present analysis goes into this relationship in depth, studying the moderating role of coping strategies and predicting that men and women implement different types of strategies. A sample of 1.008 workers is analysed, 588 women and 420 men. The Tobin CSI scale was used to analyse the coping strategies, in addition to JIS-8 to assess job insecurity, the MOS Perceived Social Support Survey and the GHQ-28 test to evaluate mental health. Then, a hierarchical linear regression was designed to study the moderating role of 8 coping strategies of job insecurity and 4 mental health subscales in men and women, separately. Results illustrate that coping strategies play a moderating role in the relationship between job insecurity and mental health. However, the aggravating role of disengagement coping strategies is more relevant than the buffering role of engagement strategies. On the other hand, women implement a greater number of coping strategies, with more positive results for mental health. Also, in the relationship between job insecurity and mental health the most important strategies are the ones related to social interaction inside and outside an organisation, and these are the main ones used by women. It therefore follows that strengthening rich social relationships inside and outside the working environment is a guarantee of well-being

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Intervenciones para disminuir las desigualdades en salud Interventions to reduce health inequalities

El objetivo de este artículo es recoger, describir y valorar las intervenciones en desigualdades en salud desarrolladas en España llevadas a cabo por administraciones, fundaciones, ONG u otras entidades. La búsqueda se organizó en tres ámbitos: estrategias de la administración, intervenciones y, entre éstas, las dirigidas a grupos sociales excluidos. Las políticas y acciones de las administraciones autonómicas se exploraron mediante consultas formales a las 17 comunidades y ciudades autónomas. Se interrogó sobre su producción de información según nivel socioeconómico y género, de planes y programas, y ejemplos de intervenciones. Para identificar intervenciones se consultó a informadores clave y se revisaron la bibliografía científica y las bases de datos. Se contactó con 2 ONG de ámbito estatal (Médicos del Mundo y Cáritas). Respondieron 14 administraciones. La información sanitaria incluye análisis por sexo, pocas veces por género y/o nivel socioeconómico, y 6 comunidades autónomas estudian desigualdades en la población general. Casi todas producen información específica según patologías (sida...) o grupos sociales (mujer, inmigrantes...). Remiten ejemplos de intervenciones en territorios y/o grupos vulnerables, evaluadas con indicadores de proceso. Entre 1995 y 2002 se han publicado 722 artículos sobre desigualdades en España, de los que 28 son intervenciones. De ellas, 9 han sido evaluadas, mayoritariamente con diseños quasi experimentales. Las grandes ONG, a veces con subvenciones públicas, trabajan con población excluida (prostitutas, inmigrantes sin papeles...) mediante programas de acercamiento. La mayor parte de la información sanitaria todavía no incluye análisis de las desigualdades en salud, aunque van aumentando progresivamente. Se han multiplicado los estudios sobre las desigualdades, pero se han publicado muy pocas intervenciones y menos todavía estudios evaluativos. Las administraciones y ONG trabajan en intervenciones dirigidas prioritariamente a grupos excluidos.<br>The objective of this study is to compile, describe and assess interventions to reduce health inequalities developed in Spain by administrations, NGO or other entities. The search was organized in three settings: governmental strategies, interventions, and among the latter, those particularly addressing excluded social groups. Administration actions and policies were investigated through formal surveys addressed to regional governments (17 regions and 2 cities). Production of information by gender and socio-economic level (SEL), plans and programs, as well as interventions was explored. Key informants were consulted and scientific literature was reviewed in order to identify interventions. Médicos del Mundo and Cáritas, two of the main national NGO were consulted. Fourteen administrations responded. In general, health information includes sex analysis, few administrations analyse by gender or SEL and six study inequalities in the general population. Most administrations produce specific information by pathologies (HIV/AIDS...) or social groups (women...). They mention intervention experiences applied to territories or vulnerable groups, evaluated through process indicators. In the period 1995-2002, 722 papers on inequalities in Spain have been published. Among them, 28 are interventions and 9 have been evaluated, mainly with quasi-experimental designs. Large NGO, sometimes with public funding, work with excluded populations through outreach programs. Most Spanish health information does not include yet inequalities analysis, although it is growing steadily. Publication of inequalities studies has increased sharply, but intervention publications are rare and evaluated interventions are extremely scarce. Administrations and NGO work in interventions mainly addressed to excluded populations

Análisis retrospectivo de las características en torno a la muerte de pacientes sometidos a trasplante hemopoyético:: Experiencia de un centro

Stem cell transplantation is a therapeutic procedure associated with potentially fatal complications (toxicity, graft versus host disease, infections, relapse/progression, etc). Aim: To explore the conditions in which patients transplanted in our institution die. Methods. Descriptive and retrospective analysis of the clinical chart and MED-A forms from adult patients who were transplanted in our hospital and died between October 2000 and September 2003. Results: 32 patients (60% males) were included. Type of transplant: Auto 13 (40%), allo 19 (60%). Cause of death: 50% progression, 50% transplant related mortality. Median of survival was 5 months (range 0,5-39,5). Regarding place of death, 78% of patients died within the hospital and other 22% died at home. Six (24%) of patients dying within the hospital were admitted for palliative management. Pain, disnea and anxiety were the most frequent symptoms and 23,5% of patients died with an insufficient symptom control. Comments regarding the symptomatology in the last week of life were recorded in 15 of 16 nursing charts and in 6 of 16 physician charts. Conclusions: A high proportion of our patients died within the hospital but none in the Palliative Care Unit. In most of cases, despite an appropriate treatment, symptoms were not completely controlled. Most of comments regarding symptomatology of patients were recorded in Nursing charts.El trasplante de progenitores hemopoyéticos (TPH) es una terapia asociada a complicaciones que generan malestar y que son potencialmente mortales (toxicidad, enfermedad injerto contra huesped, infecciones, recaída de la enfermedad etc). Objetivo: Explorar las condiciones en las que mueren los pacientes trasplantados en nuestra institución. Metodología: Análisis descriptivo y retrospectivo. Sujetos de estudio: Adultos con TPH en el HGU Gregorio Marañón que murieron entre Octubre de 2000 y Septiembre de 2003. Resultados: 32 pacientes (60% hombres) fueron incluidos. Tipo de transplante: Auto en 13 (40%) y alo en 19 (60%). La Causa de muerte fue progresión de la enfermedad en el 50% y mortalidad relacionada con el procedimiento en el otro 50%. La mediana de supervivencia fue de 5 meses (rango 0,5-39,5). El 78% de los pacientes murió hospitalizado y el resto (22%) en casa. Seis (24%) de los pacientes que murieron en el hospital fueron ingresados para un manejo paliativo. Dolor, disnea y ansiedad fueron los síntomas mas frecuentes, y el 23,5% de los pacientes murió sin un control óptimo de la sintomatología. Comentarios sobre la sintomatología durante la última semana de vida aparecieron en 15 de 16 registros de Enfermería y en 6 de 16 registros médicos. Conclusiones: Una elevada proporción de nuestros pacientes murieron en el hospital pero ninguno en la Unidad de Cuidados Paliativos. En la mayoría de los casos, a pesar de que un adecuado tratamiento fue prescrito, los síntomas no fueron completamente controlados. Las referencias a la situación sintomática de los pacientes son recogidas esencialmente en los registros de Enfermería

Análisis retrospectivo de las características en torno a la muerte de pacientes sometidos a trasplante hemopoyético

Stem Cell Transplantation (SCT) is a procedure useful to treat several radio and chemosensitive diseases, being the only curative option in some cases. Nevertheless, this procedure is associated with complications which are uncomfortable and eventually life-threatening (toxicity, GvHD, infections, relapse/progression, etc). In summary death is a frequent event among patients undergoing SCT that has been poorly studied. Objective: To explore the conditions in which patients transplanted in our institution died. Methodology: Descriptive and retrospective analysis. Patients: Adults transplanted in our institution who died between Oct-00 and Sep-03 (32 patients). STRONG>Variables: Age, sex, type of SCT, dates of transplant and death. In patients who died in the hospital: Reason of last admission, change to a palliative approach, control of symptoms and comments from physicians and nurses about the patient conditions during the last week of life. Statistical analysis: Frequencies of categorical variables and median of quantitative variables. Comments regarding patients´ sympthomatology will be categorised before quantification. Subgroups will be analyse separately.El trasplante de progenitores hemopoyéticos (TPH) es un procedimiento terapéutico eficaz en el tratamiento de diversas enfermedades quimio y radiosensibles, siendo en algunos casos la única opción terapéutica. Sin embargo, este ratamiento está asociado a complicaciones que generan disconfort y que son potencialmente mortales (toxicidad, EICH, infecciones, recaída de la enfermedad etc). En definitiva, la muerte es un evento frecuente en pacientes sometidos a TPH que ha sido poco explorado. Objetivo: Explorar las condiciones en las que mueren los pacientes trasplantados en nuestra titución. Metodología: Análisis descriptivo y retrospectivo. Sujetos de estudio: Adultos con TPH en el HGU ""Gregorio Marañón"" que murieron entre Oct00 y Sep03 (32 pacientes).Variables: Edad, sexo, tipo de TPH, fechas de trasplante y fallecimiento. En los pacientes que murieron en el hospital: Motivo del último ingreso, cambio a una actitud paliativa, control de síntomas, comentarios médicos y de enfermería sobre la situación de los pacientes durante la última semana de vida. Análisis estadístico: Recuento de frecuencias absolutas y relativas para las variables categóricas y medidas de tendencia central para las variables cuantitativas. Los comentarios en torno a la sintomatología del paciente en su fase final se analizarán con objeto de identificar categorías cuantificables de forma global y por subgrupos