Saber compartir y protegerse: claves para la educación cibercrítica digital de los menores

Children live together consuming, producing, and sharing digital content. These are hypermediated communication actions typical of cyberculture, and require training in critical thinking that, even when minors receive it, is not always perceived as necessary, which can put the privacy of children at risk. This study focuses on analyzing the cyber skills of primary and high school students to act critically, and examines the level of conceptual, attitudinal, and procedural competence that children perceive they have acquired to access, consume, create, and share digital content on social media. The specific objective is to understand some of the components that may be related to young people’s perception of the training they have received, as well as whether there are differences in terms of their willingness to acquire training to protect themselves when creating and consuming digital content. To this end, a 25-item questionnaire on the knowledge, attitudes, and actions of young people was designed, validated, and administered to a sample of 417 Spanish students completing primary and high school education. The results obtained indicate that, at the conceptual level, there are no differences between the educational stages, while differences were found at the attitudinal and procedural levels. The two factors identified show that, although high school students have acquired certain critical and protective attitudes, they behave more riskily in their self-presentation and posts than primary school students when accessing, creating, and sharing digital content on social media, and that the training received and the willingness to learn about how to create and share were the differentiating variables for increased protection. We conclude that there is a need for introducing education specific to the critical analysis and self-protection of Internet use at the primary education level, as well as additional training that would help to avoid risky behavior during high schoolLos menores conviven consumiendo, produciendo y compartiendo contenidos digitales. Se trata de acciones de comunicación hipermediada propias de la cibercultura, que requerirían de una educación crítica, no siempre percibida como necesaria, aunque los menores hayan recibido formación para ello, situándoles ante ciertos riesgos para su privacidad. El presente estudio se centra en analizar la educación cibercrítica en el alumnado de educación Primaria y de educación Secundaria obligatoria, atendiendo al nivel de competencia digital conceptual, actitudinal y procedimental que perciben que han adquirido para acceder, consumir, crear y compartir contenidos digitales en las redes. Como objetivo específico interesa comprender algunos de los efectos que pueden estar relacionados con la percepción que tienen los jóvenes respecto a la formación recibida, así como si existen diferencias en función de las predisposiciones a adquirir formación protectora para crear y consumir contenidos digitales. Se diseñó y validó un cuestionario de 25 ítems sobre conocimientos, actitudes y acciones administrada a una muestra de 417 estudiantes españoles que finalizaban las etapas de educación Primaria y de educación Secundaria obligatoria (ESO). Los resultados obtenidos indican que, a nivel conceptual no hay diferencias entre las etapas, mientras que sí existen a nivel actitudinal y procedimental. Los dos factores hallados evidencian que el alumnado de educación Secundaria, si bien tiene adquiridas ciertas actitudes críticas y protectoras, asume más comportamientos de riesgo de autorrepresentación y difusión que el colectivo de educación Primaria cuando accede, crea y comparte contenidos digitales en las redes, siendo la formación recibida y la predisposición a aprender sobre cómo crear y compartir variables diferenciadoras para aumentar la protección. Se concluye con la necesidad de introducir la educación cibercrítica con actitudes protectoras en la etapa de educación Primaria y reforzar la formación que evite comportamientos de desprotección en la etapa de educación SecundariaS

Differences in the clinical management of women and men after detection of a solitary pulmonary nodule in clinical practice

Objectives To explore differences in the clinical management of men and women in the 5 years after detecting a solitary pulmonary nodule (SPN) by chest radiograph or CT in routine clinical practice. Methods We followed up 545 men and 347 women with an SPN detected by chest radiograph or CT in a retrospective cohort of 25,422 individuals undergoing routine thoracic imaging in 2010–2011.We compared the frequency of each management strategy (no further test, immediate intervention or follow up) according to sex by means of chi-squared.We estimated the relative risk of women versus men of having been followed up instead of an immediate intervention using multivariate logistic regression. We compared by sex the time between detection of the nodule and lung cancer diagnosis, the time between diagnosis and death by means of Mann-Whitney U test and the cumulative effective dose of radiation in each management strategy by means of t test. Results Women were more likely than men to have follow-up rather than immediate intervention (aRR = 1.8, CI 1.3–2.7, p = 0.002), particularly in those who underwent CT (aRR = 4.2, CI 1.9–9.3, p < 0.001). The median time between SPN detection and lung cancer diagnosis was higher in women (4.2 months, interquartile range (IQR) 5.1) than in men (1.5 months, IQR 16.2). The mean cumulative effective dose was 21.3 mSv, 19.4 mSv in men and 23.9mv in women (p = 0.023). Conclusions Our results could reflect decisions based on a greater suspicion of lung cancer in men. The incidental detection of SPNs is increasing, and it is necessary to establish clear strategies aimed to reduce variability in their management according to patient’s sex

La vesícula extracelular TGF-β basal es un biomarcador predictivo de la respuesta a los inhibidores del punto de control inmunitario y de la supervivencia en el cáncer de pulmón no microcítico

Antecedentes: Los inhibidores de los puntos de control inmunitarios (ICI) son una estrategia terapéutica eficaz que mejora la supervivencia de los pacientes con cáncer de pulmón en comparación con los tratamientos convencionales. terapéutica eficaz que mejora la supervivencia de los pacientes con cáncer de pulmón en comparación con los tratamientos convencionales. Sin embargo, se necesitan biomarcadores predictivos novedosos para estratificar qué pacientes obtienen un beneficio clínico, ya que el histológico PD-L1, actualmente utilizado y altamente heterogéneo, ha mostrado una baja precisión. La biopsia líquida es el análisis de biomarcadores en fluidos corporales y representa una herramienta mínimamente invasiva que puede utilizarse para monitorizar la evolución del tumor y los efectos del tratamiento, reduciendo potencialmente los sesgos asociados a la heterogeneidad tumoral asociada a las biopsias de tejidos. En este contexto citoquinas, como el factor de crecimiento transformante-β (TGF-β), pueden encontrarse libres en circulación en la sangre y empaquetadas en vesículas extracelulares (VE), que tienen un tropismo de administración específico y pueden afectar a la interacción entre el tumor y el sistema inmunitario. El TGF-β es una citocina inmunosupresora que desempeña un papel crucial en el escape inmunitario de los tumores, la resistencia al tratamiento y la metástasis. Así pues, nuestro objetivo era evaluar el valor predictivo predictivo del TGF-β circulante y EV en pacientes con cáncer de pulmón no microcítico que reciben ICI.Background: Immune‐checkpoint inhibitors (ICIs) are an effective therapeutic strategy, improving the survival of patients with lung cancer compared with conventional treatments. However, novel predictive biomarkers are needed to stratify which patients derive clinical benefit because the currently used and highly heterogenic histological PD‐L1 has shown low accuracy. Liquid biopsy is the analysis of biomarkers in body fluids and represents a minimally invasive tool that can be used to monitor tumor evolution and treatment effects, potentially reducing biases associated with tumor heterogeneity associated with tissue biopsies. In this context, cytokines, such as transforming growth factor‐β (TGF‐β), can be found free in circulation in the blood and packaged into extracellular vesicles (EVs), which have a specific delivery tropism and can affect in tumor/immune system interaction. TGF‐β is an immunosuppressive cytokine that plays a crucial role in tumor immune escape, treatment resistance, and metastasis. Thus, we aimed to evaluate the predictive value of circulating and EV TGF‐β in patients with non–small‐cell lung cancer receiving ICIs

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered

Psicología: aspectos fundamentales de la formación y la profesión

El aspecto de la práctica clínica ha sido abordado primeramente por la doctora Córdoba Basulto, desde la experiencia, y de manera muy breve profundiza en el ámbito de la Psicología de la salud, rescata y enfatiza el aspecto de la atención e intervención al paciente de urología, colocándolo en la parte de sujeto y no de enfermedad. Nuevamente señalando el trabajo multidisciplinario donde cada agente contribuye con la atención. Desde una perspectiva meramente clínica y específicamente con la experiencia del psicoanálisis, Márquez, Guadarrama, López y Huitrón nos permiten observar la postura de la adolescencia en el proceso terapéutico, indicando que la mejor forma de tratar a un adolescente no es lo individual, ni lo familiar, sino lo grupal.Este libro es una compilación de aportaciones que permiten observar el estado actual de la psicología en México, permitiendo vislumbrar los retos reales que no solamente tienen los alumnos que asumir en su formación profesional, sino todos aquellos que se encuentran laborando en esta basta disciplina. En este sentido, el mundo globalizado y el empleo exagerado de la tecnología se convierten en nuevas exigencias que propician a su vez nuevas formas, no sólo de atención, sino de estudio e investigación que le permitan la comprensión del comportamiento humano. La Psicología mexicana en los últimos años ha dejado de ser dogmática para convertirse en una ciencia amplia y de visión, lo que le ha permitido incursionar en nuevos campos de conocimiento como el de la psicología de la salud o de la psicología criminal. Es decir ha dejado de ser una psicología de diagnóstico y clínica para convertirse en una ciencia que asume al individuo como un ser social, complejo o bien como algunos ya lo han señalado como un ente psicosociobiológico

Chemotherapy or allogeneic transplantation in high-risk Philadelphia chromosome–negative adult lymphoblastic leukemia

The need for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adults with Philadelphia chromosome–negative (Ph−) acute lymphoblastic leukemia (ALL) with high-risk (HR) features and adequate measurable residual disease (MRD) clearance remains unclear. The aim of the ALL-HR-11 trial was to evaluate the outcomes of HR Ph− adult ALL patients following chemotherapy or allo-HSCT administered based on end-induction and consolidation MRD levels. Patients aged 15 to 60 years with HR-ALL in complete response (CR) and MRD levels (centrally assessed by 8-color flow cytometry) <0.1% after induction and <0.01% after early consolidation were assigned to receive delayed consolidation and maintenance therapy up to 2 years in CR. The remaining patients were allocated to allo-HSCT. CR was attained in 315/348 patients (91%), with MRD <0.1% after induction in 220/289 patients (76%). By intention-to-treat, 218 patients were assigned to chemotherapy and 106 to allo-HSCT. The 5-year (±95% confidence interval) cumulative incidence of relapse (CIR), overall survival (OS), and event-free survival probabilities for the whole series were 43% ± 7%, 49% ± 7%, and 40% ± 6%, respectively, with CIR and OS rates of 45% ± 8% and 59% ± 9% for patients assigned to chemotherapy and of 40% ± 12% and 38% ± 11% for those assigned to allo-HSCT, respectively. Our results show that avoiding allo-HSCT does not hamper the outcomes of HR Ph− adult ALL patients up to 60 years with adequate MRD response after induction and consolidation. Better postremission alternative therapies are especially needed for patients with poor MRD clearance

HIV in Spain 2017: policies for a new management of chronicity beyond virological control

The analysis of the available databases related to HIV/AIDS confirms a paradigm shift in the patient's life expectancy: now HIV has become a chronic disease, so patients are aging. However, this advance is accompanied by a negative counterpart: due to the increase in the number of years of life gained, there is a prevalence of comorbidities greater than the general population and at an earlier age. Reducing the risk associated with all the comorbidities that the ageing patient with HIV/AIDS may develop, must now be a health objective; it must be added to the traditional objectives that until now were part of the strategy to reduce the impact of the HIV infection. In the specific case of women, it is also necessary to train peri and postmenopausal women to increase their skills and motivation to care for their health; It is also very important to examine the role that hormone replacement therapy can play in reducing their symptoms.El análisis de las bases de datos disponibles relacionadas con VIH/SIDA confirma un cambio de paradigma en la esperanza de vida del pa-ciente: ahora el VIH se ha convertido en una enfermedad crónica, con la que los pacientes están envejeciendo. No obstante, este avance se acompaña de una contraparte negativa: debido al incremento en el número de años de vida ganados, se da una prevalencia de comorbilidades mayor a la de la población general y a una edad más temprana. Reducir el riesgo asociado a todas las comorbilidades que puede desarrollar el paciente con VIH/SIDA mientras envejece debe ser hoy en día un objetivo de salud, que se suma a los objetivos tradicionales que hasta ahora formaban parte de la estrategia para reducir el impacto de la infección por el VIH. En el caso específico de la mujer, además es necesario formar a las mujeres peri y postmenopáusi-cas para incrementar sus habilidades y su motivación para el cuidado de su salud; también es muy importante que se examine el rol que puede tener la terapia de reemplazo hormonal en la reducción de sus síntomas. Palabras clave: VIH, SIDA, Comorbilidad, Cronicidad, Envejeci-miento, Política sanitaria, Gestión clínicaEl presente trabajo ha sido editado por la Fundación Gaspar Casal, con ayuda del patrocinio de Gilead Sciences.S

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region.

In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research