Riqueza mononuclear fagocítica en médula ósea: nuevo predictor de respuesta a terapia estándar de primera linea en pacientes con linfoma de Hodgkin

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 27-10-2016Esta tesis tiene embargado el acceso al texto completo hasta el 27-04-2018Introducción: Ha sido descrita una relación positiva entre el incremento de macrófagos asociados al tejido tumoral ganglionar (MAT) en el linfoma de Hodgkin (LH) y el fallo en la respuesta inicial al tratamiento. Objetivos: Evaluar el papel de la riqueza mononuclear fagocítica en médula ósea en la respuesta a la terapia estándar de primera línea y en el pronóstico de pacientes con LH. Desarrollar un modelo predictivo de respuesta terapéutica en estos pacientes. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas y los aspirados medulares de 98 pacientes con LH diagnosticados en nuestro Centro entre el 01/01/2002 y el 31/12/2013 cuantificándose la proporción de monocitos, promonocitos y macrófagos en médula ósea tras el diagnóstico de LH y antes del inicio del tratamiento. Resultados: Un total de 98 pacientes (68 varones y 30 mujeres) con una mediana de edad de 34,50 años (rango: 18-85) fueron incluidos en el análisis detectándose una relación inversamente proporcional entre la proporción de macrófagos en médula ósea y la probabilidad de alcanzar una respuesta precoz y final [95% IC (1,205- 1,844)] p< 0,005; [95% IC (1,205- 1,844)] p< 0,005, respectivamente] al tratamiento de primera línea. Conclusiones: La proporción de macrófagos medulares en el momento del diagnóstico de LH es un factor pronóstico independiente que predice la respuesta a la terapia estándar de primera línea.Introduction: It has been described a positive relationship between increased of tumour associated macrophages (TAM) in Hodgkin lymphoma (HL) and failure in the initial response to treatment. Objectives: To evaluate the role of mononuclear phagocyte proportion on bone marrow in the response to standard first-line therapy and prognosis of patients with HL as well as develop a predictive model of therapeutic response in theses patients. Patients & methods: Medical records of 98 patients with HL diagnosed at our Center from 01/01/2002 to 31/12/2013 were retrospectively revised and we count the proportion of monocites, promonocites and macrophages in bone marrow after HL diagnosis and before to start the treatment. Results: A total of 98 patients (68 males and 30 females) with a median of age of 34.50 years (range: 18-85) were included in the analysis and we finding an inversely proportional relationship between the proportion of macrophages in bone marrow and the probability to reach an early and final therapeutic responses [95% IC (1,205- 1,844)] p< 0,005; [95% IC (1,205- 1,844)] p< 0,005, respectively] to the first-line treatment. Conclusions: The proportion of macrophages in bone marrow at diagnosis of HL is an independent prognosis factor that it is predictor of response to standard first-line therapy

Alcohol use and family‑related factors among Spanish university students: the unHicos project

Background: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. Methods: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student’s T-Test, and non-conditional logistic regression models were carried out to examine this association. Results: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2-17.6), and that of BD was 48.8% (95% CI = 47.9-48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. Conclusions: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.This work was supported by the National Drug Plan, Ministry of Health, Social Services and Equality of Spain (Codes: 2010/145, 2013/034 and 2020/030) and project PI16/01947

Metodologías activas: Ambientes de aprendizaje en Educación Infantil y la coeducación en las aulas

Este Trabajo Fin de Grado muestra cómo trabajar la metodología activa de los ambientes de aprendizaje en Educación Infantil en relación con la coeducación en las aulas. Las metodologías activas forman parte de las distintas acciones innovadoras que actualmente se están llevando a cabo en Educación Infantil, y que, en este caso, se sustentan en la Escuela Nueva y en los diferentes autores que marcaron esta corriente pedagógica: Rousseau, Froebel y Montessori. Los ambientes de aprendizaje pertenecen a las metodologías activas, destacando elementos como: la organización de los espacios, el material atractivo, la mezcla de niños y niñas de diferentes edades y sobre todo la transformación de las aulas que se convierten en verdaderos espacios donde se dan aprendizajes significativos. Se destaca también la necesidad de la coeducación en las aulas y en los hogares para desarrollar la formación de la identidad personal en estas edades infantiles. Se completa con la propuesta práctica de cinco ambientes: profesiones, hogar, sentidos, psicomotricidad gruesa y artes plásticas. En ellos se trabaja la coeducación en diferentes grados para favorecer de forma continua el desarrollo integral de los niños y niñas.<br /

Constanza de Acuña y Avellaneda (n. 1570), heredera de un vasto patrimonio. En su epitafio: esposa y madre

Constanza de Acuña es recordada como segunda consorte del i conde de Gondomar; sin embargo, también fue una rica legataria y el último eslabón de un conspicuo linaje pucelano. En las siguientes páginas, reseñamos su perfil más conocido, el de esposa y madre; no obstante, y por vez primera, aspiramos a descubrir a la perspicaz aristócrata que se ocultaba tras ese proverbial semblante: una mujer diestra y ambiciosa, siempre a la sombra de su célebre cónyuge, Diego Sarmiento de Acuña (1567-1626). Para todo ello, contamos con una fuente documental única y muy interesante: el famoso epistolario gondomarienseConstanza de Acuña is remembered as the second wife of the first Count of Gondomar. Nevertheless, she was a rich heiress as well as the last descendant of an important family from Valladolid (Spain). In this paper, we will try to meet not only a wife and mother, but also an intelligent aristocrat: a hidden woman behind her powerful husband, Diego Sarmiento de Acuña (1567-1626). This is, in brief, an innovate work, because doña Constanza has never been the main character of a research about her House. Finally, for all of this, we will draw on the famous letters from Count of Gondomar’s Archiv

Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study.

Objective: To assess the impact of a training program targeted to Primary Care (PC) professionals on the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. Methods: A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p<0.05). Results: PC providers’ communication skills and attitudes showed significant improvements in the variables studied (p<0.001), as well as in the clinical interview evaluation parameters. Conclusion: The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. Practice implications: Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.pre-print200 K

Factores de riesgo asociados a la depresión durante el confinamiento domiciliario por COVID-19 en el personal universitario

Introducción/Objetivos La pandemia causada por SARS-CoV-2 obligó a la población mundial a un confinamiento obligatorio para frenar el ascenso de contagios. El aislamiento aumentó las tasas de depresión y otras patologías mentales en la población general, sin embargo, el efecto del confinamiento por COVID-19 no ha sido convenientemente estudiado en personal universitario. El objetivo fue estudiar la depresión en el personal universitario confinado por la pandemia por SARS-CoV-2 y los potenciales factores de riesgo frente a aquellos que no estuvieron confinados durante los meses de mayo y junio de 2020. Material y Métodos El estudio se dirigió al personal administrativo, docente e investigador afiliado a la Universidad de Granada. Fueron evaluados mediante una encuesta online a través de la plataforma LimeSurvey distribuida por el correo interno de la Universidad abierta entre mayo y junio de 2020. Se analizaron distintas variables y factores de riesgo estandarizados. Se empleó IBM SPSS 24.0 mediante descriptivos de frecuencias y medias y test bivariantes de chi-cuadrado. Valores p menores a 0,05 se consideraron significativos. Resultados 96 personas respondieron el cuestionario. La prevalencia de depresión fue del 8,3%. En el cuestionario se estudiaron los posibles factores de riesgo asociados a la depresión. Se encontraron evidencias significativas de asociación entre depresión y los síntomas por COVID-19 (p=0,012), antecedentes personales (p=0,005), problemas laborales (p=0,008), eventos vitales que han afectado notablemente en bienestar psíquico en los últimos 6 meses (p=0,005) y el nivel de ejercicio durante la pandemia (p=0,034). Conclusiones Se hallaron evidencias de asociación entre la prevalencia de depresión y una serie de factores de riesgo (síntomas por COVID-19, antecedentes personales, problemas laborales, eventos vitales y nivel de ejercicio) a los que se vio expuesto el personal universitario durante el confinamiento por COVID-19

Prevalence of hazardous alcohol use among Spanish primary care providers

Background: Alcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use. Methods: A descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion. Results: One thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5–29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4–37.6] and professionals aged 56 years or over (34.2%) [95% CI: 28.2–40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR = 1.52; 95% CI: 1.22–1.90), PC physicians (OR = 1.42; 95% CI: 1.01–2.02) and professionals with more time worked (OR = 1.03; 95% CI: 1.01–1.05). Conclusion: Our study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical settingThe study has been financed by the Spanish Society of Family and Community Medicine (semFYC, Sociedad Española de Medicina Familiar y Comunitaria) through the Francesc Borrell Scholarship in the year 2018 and has been awarded with the 1st Prize for the best Research Project in Primary Care by the Spanish Society of Primary Care Physicians (SEMERGEN, Sociedad Española de Médicos de Atención Primaria) in the year 2018. Also, this publication has been financed by one of the PhD scholarships, SEMERGEN, 2018

Comportamiento de la enfermedad renal crónica en pacientes con enfermedad cerebrovascular

A descriptive study with retrospective analytical components was conducted with cerebrovascular disease patients hospitalized in the Arnaldo Milian Castro Provincial University Hospital between January and December 2009 in order to determine the behavior of chronic kidney disease. The universe was formed by 416 patients admitted during the specified period in the Service of Neurology for non-traumatic cerebrovascular disease. The sample was formed by 256 patients who met the study inclusion criteria. In addressing the status of renal function, no significant differences in age, sex and skin color was found. The highest number corresponded to the age group between 60 to 79 years of age, and stage III of the disease among those with deterioration of renal function. Occult renal disease was present in a high percentage, the majority belonged to the age group 80 years and over and to the stage III. The most common cerebrovascular accident was the atherothrombotic one in stage II and III of the renal disease. Hypertension was prominent among the comorbidities, isolated and linked to diabetes mellitus. The intraparenchymal hemorrhage had the highest percentage of unsatisfactory evolution and those of ischemic type reached appreciable values, which could be related to advanced stages of kidney disease and the presence of associated diseases. Further studies on vascular diseases, where chronic kidney disease can affect the outcome and prognosis, are recommended.Se realizó un estudio descriptivo con componentes analíticos retrospectivo con pacientes hospitalizados por enfermedad cerebrovascular en el Hospital Provincial Universitario "Arnaldo Milián Castro" entre enero y diciembre de 2009, con el propósito de determinar el comportamiento de la enfermedad renal crónica. El universo de estudio estuvo constituido por 416 pacientes ingresados durante el período señalado en el Servicio de Neurología por enfermedad cerebrovascular no traumática y la muestra por 256 pacientes que cumplieron los criterios de inclusión del estudio. Al atender al estado de la función renal no se encontraron diferencias significativas respecto a la edad, el sexo y el color de la piel; el mayor número correspondió al grupo de edades de 60 - 79 años y al estadio III de la enfermedad entre aquellos con deterioro de la función renal. La enfermedad renal oculta estuvo presente en un elevado porcentaje, la mayoría pertenecía al grupo de 80 y más años y al estadio III; el accidente cerebrovascular más frecuente fue el aterotrombótico en los estadios II y III de la enfermedad renal y entre las enfermedades concomitantes se destacó la hipertensión, aislada y unida a diabetes mellitus; la hemorragia intraparenquimatosa presentó el mayor porcentaje de evolución no satisfactoria y los de tipo isquémico alcanzaron valores apreciables, lo que pudiera estar en relación con estadios avanzados de la enfermedad renal y la presencia de enfermedades asociadas. Se recomienda continuar estudios en enfermedades vasculares donde la enfermedad renal crónica pueda condicionar su evolución y pronóstico

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: a multicenter correlation study

Background: In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. Objective: To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. Methods The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P <.05. Results: The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p=.007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p=.187), with statistically significant differences only observed in the intellectual and cognitive indicator (P =.022). Conclusions: CT levels are high in teaching healthcare professionals in the clinical environment

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

Background: Health professionals’ training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider’s knowledge and skills addressing alcoholrelated problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. Methods: An observational, descriptive, cross-sectional, multicenter study was performed. Location: PC centres of the Spanish National Health System (SNHS). Participants: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS’s PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. Results: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5–71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4–31.7) reported having received basic training, and 3% (95% CI: 2.3–4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). Conclusion: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.post-print565 K