El sistema alimentario global : ponderación cuantitativa de las variables del modelo en el entorno de Cataluña

El presente trabajo constituye la tercera parte de El Sistema Alimentario Global . El objetivo principal es proponer la encuesta como herramienta para optimizar el modelo matemático que se llevó a cabo en las dos fases anteriores y que se basaba en una red que configuraba el espacio alimentario a través de 4 ejes diferentes: Disponibilidad alimentaria, Economía, Políticas y Cultura, los cuales se les daba una ponderación igual a cada uno. Con el perímetro definido a Cataluña se pretende, a partir de la encuesta, saber qué importancia le dan los catalanes a estos ejes y así poder aplicar una ponderación más afinada y representativa de la realidad. Para ello se lleva a cabo el diseño del cuestionario, la recopilación de los datos, la aplicación de técnicas estadísticas de muestreo: estratificación por cuotas y ponderación de los estratos, técnicas de depuración de encuestas, así como técnicas de profiling para diferenciar grupos entre las variables del sistema alimentario y las características sociodemográficas que los determinan

Set in Stone? Mobile Practices Evolution in Later Life

In what ways do mobile communication practices change through later life? To what extent do sociodemographic characteristics, country of residence, and well-being relate to these changing practices? To answer these questions, we used an online, longitudinal study targeting internet users aged 60 and over in six countries (Austria, Canada, Israel, the Netherlands, Spain, and Romania). The focus is on the 3,125 respondents who declared using a mobile phone in every wave (2016, 2018, and 2020). Results show an increasing usage diversification already before the Covid-19 pandemic. A latent class analysis identified three different styles of mobile practices. The most sophisticated relies on almost all the analyzed functions, while the most unsophisticated is limited to voice calls, texting (mainly SMS), and photographs to a lesser extent. Finally, a multinomial analysis provided a picture of the individual characteristics related to the usage styles in the period. The most relevant dimensions were country of residence and age, followed by internet use intensity. The country of residence is relevant to explaining usage because the telecommunications price structure determines the priority given to the mobile phone in (senior) individuals’ everyday lives. The article contributes nuanced evidence of the trajectories of digital practices in later life. At the same time, the findings support and better inform country-based policies, services, and products for more effective inclusion of the older population in today’s hyper-digitized societies

La reforma a primària

Abstract not availabl

Bioarchaeological study of rescue contexts from Río Negro province : a contribution for the revalorization of human remains

El objetivo de este trabajo es presentar las medidas de conservación preventiva aplicadas sobre un conjunto de restos humanos de la Colección Acta Nº 102, proveniente de rescates en el noreste de la provincia de Río Negro, así como los resultados de los análisis bioarqueológicos. Los procedimientos implementados permitieron ordenar y remontar fragmentos óseos para lograr una mayor completitud anatómica. Los resultados de los estudios tafonómicos indican que diferentes historias post-depositacionales afectaron la preservación de los huesos. Se cuantificó un número mínimo de 22 individuos pertenecientes a ambos sexos y diversas categorías de edad (desde las últimas semanas de gestación hasta la adultez). Este trabajo permitió obtener información de contextos arqueológicos perturbados por actividades antrópicas actuales que contribuye a la revalorización de los conjuntos osteológicos deteriorados. Se promueve la devolución de los restos humanos a los pueblos originarios y fomenta la interacción entre diferentes actores sociales e instituciones.The objective of this work is to present the measures of preventive conservation applied in a set of human remains of the Collection Acta Nº 102, coming from several rescues from northeastern of the Río Negro province, as well as the results of the bioarchaeological analyses. The implemented procedures allowed to order and generate a greater completeness of the anatomical units. Taphonomic studies indicate different post-depositional histories, which generated different states of bone preservation. The presence of a minimum number of 22 individuals, belonging to both sexes and different age-at-death (last weeks of gestation to adult) was observed. This work allowed obtaining information in archaeological contexts disturbed by current anthropogenic activities that is indispensable for the revaluation of deteriorated osteological sets. The return of human remains to indigenous societies is promoted and interaction between different social actors and institutions is encouraged.Fil: La Valle, Esteban. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Berón, Francisca. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Morey, Yanina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Flensborg, Gustavo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano. Universidad Nacional del Centro de la Provincia de Buenos Aires. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano; Argentin

Bioarchaeological analysis at Loteo Silva site: New contributions for the lower valley of the Negro river (Viedma, Rio Negro province)

Se presenta el análisis bioarqueológico de los restos humanos rescatados en el sitio Loteo Silva (Viedma, provincia de Río Negro) con el objetivo de caracterizar y evaluar las prácticas funerarias, la funcionalidad del sitio, la paleodieta, y discutir la cronología de las ocupaciones humanas de cazadoresrecolectores en el curso inferior del río Negro. Asimismo, se discute e inserta este contexto en la arqueología del área de estudio y de microregiones aledañas (e.g., transición pampeano-patagónica oriental, costa norte del Golfo San Matías). Los resultados indican la presencia de tres individuosadultos de ambos sexos, inhumados tanto en modalidades primarias como secundarias simples. Los estudios tafonómicos dan cuenta de la estabilidad en la historia post-depositacional y la exposición de los restos en momentos cercanos a su recuperación. Análisis de isótopos estables muestran una dieta basada en recursos preferentemente terrestres. Dos fechados radiocarbónicos arrojaron una edad correspondiente al lapso ca. 3.600-3.200 años AP, indicando la ocupación más temprana conocida hasta el momento para el curso inferior del río Negro y la evidencia de manipulación antrópica de cadáveres más temprana del noreste de Patagonia. Los entierros recuperados en el sitio Loteo Silva presentan tendencias y características similares a otros contextos mortuorios del área de estudio y de regiones vecinas.The bioarchaeological analysis of the human remains rescued at Loteo Silva site (Viedma, Río Negro province) is presented, with the objective of characterizing and evaluating funerary practices, site functionality, paleodiet, and discussing the chronology of hunter-gatherer occupations from the lower course of the Negro River. In addition, this context is discussed and inserted in the archaeology of the study area and surrounding microregions (e.g., eastern Pampa-Patagonia transition, northern coast of San Matías Gulf). The results indicate the presence of three adult individuals of both sexes, buried in both simple primary and secondary modalities. The taphonomic studies show the stability in the post-depositional history and the exposure of the skeletons at moments close to their actual recovery. Stable isotope analysis indicates that mainly terrestrial resources were consumed by these individuals. Two radiocarbon dates showed a chronology of ca. 3.600-3.200 years BP, indicating the earliest occupation for the lower course of the Negro River and the earliest evidence of burial manipulation from the Northeastern Patagonia. The burials recovered at Loteo Silva site presents trends and characteristics similar to other mortuary contexts of the study area and neighboring regions.Fil: Flensborg, Gustavo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano. Universidad Nacional del Centro de la Provincia de Buenos Aires. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano; ArgentinaFil: la Valle, Esteban Martín. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Berón, Francisca. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Morey, Yanina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Arqueología; ArgentinaFil: Scartascini, Federico Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio. Universidad Nacional de Río Negro. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio; ArgentinaFil: Alberti, Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Multidisciplinario de Historia y Ciencias Humanas; Argentin

Concordance of p16INK4a and E6*I mRNA among HPV-DNA-Positive Oropharyngeal, Laryngeal, and Oral Cavity Carcinomas from the ICO International Study

Simple Summary The utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC), and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16(INK4a) immunohistochemistry, taking E6*I mRNA detection as the reference standard, was assessed in HPV-DNA-positive formalin-fixed paraffin-embedded samples from 29 countries. The concordance of p16(INK4a) and E6*I mRNA among 78, 257, and 51 HPV-DNA-positive OCC, OPC, and LC, respectively, was moderate to substantial in OCC and OPC but only fair in LC. A different p16(INK4a) expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. We concluded that the diagnostic algorithm of HPV-DNA testing followed by p16(INK4a) immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. Our study provides new insights into the use HPV-DNA, p16(INK4a), and HPV-E6*I mRNA for diagnosing an HPV-driven head and neck carcinoma. Background: Tests or test algorithms for diagnosing HPV-driven oral cavity and laryngeal head and neck carcinomas (HNC) have not been yet validated, and the differences among oral cavity and laryngeal sites have not been comprehensively evaluated. We aimed to assess the utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC) and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16(INK4a) immunohistochemistry, taking E6*I mRNA detection as the reference standard. Methods: Formalin-fixed paraffin-embedded OCC, OPC, and LC carcinomas were collected from pathology archives in 29 countries. All samples were subjected to histopathological evaluation, DNA quality control, and HPV-DNA detection. All HPV-DNA-positive samples (including 78 OCC, 257 OPC, and 51 LC out of 3680 HNC with valid HPV-DNA results) were also tested for p16(INK4a) immunohistochemistry and E6*I mRNA. Three different cutoffs of nuclear and cytoplasmic staining were evaluated for p16(INK4a): (a) >25%, (b) >50%, and (c) >= 70%. The concordance of p16(INK4a) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was assessed. Results: A total of 78 OCC, 257 OPC, and 51 LC were HPV-DNA-positive and further tested for p16(INK4a) and E6*I mRNA. The percentage of concordance between p16(INK4a) (cutoff >= 70%) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was 79.5% (95% CI 69.9-89.1%), 82.1% (95% CI 77.2-87.0%), and 56.9% (95% CI 42.3-71.4%), respectively. A p16(INK4a) cutoff of >50% improved the concordance although the improvement was not statistically significant. For most anatomical locations and p16(INK4a) cutoffs, the percentage of discordant cases was higher for HPV16- than HPV-non16-positive cases. Conclusions: The diagnostic algorithm of HPV-DNA testing followed by p16(INK4a) immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. A different p16(INK4a) expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. Our study provides new insights into the use HPV-DNA, p16(INK4a), and HPV-E6*I mRNA for diagnosing an HPV-driven HNC, including the optimal HPV test or p16(INK4a) cutoffs to be used. More studies are warranted to clarify the role of p16(INK4a) and HPV status in both OPC and non-OPC HNC

Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis

Background p16(INK4a) (p16) immunohistochemistry is the most widely used biomarker assay for inferring HPV causation in oropharyngeal cancer in clinical and trial settings. However, discordance exists between p16 and HPV DNA or RNA status in some patients with oropharyngeal cancer. We aimed to clearly quantify the extent of discordance, and its prognostic implications. Methods In this multicentre, multinational individual patient data analysis, we did a literature search in PubMed and Cochrane database for systematic reviews and original studies published in English between Jan 1, 1970, and Sept 30, 2022. We included retrospective series and prospective cohorts of consecutively recruited patients previously analysed in individual studies with minimum cohort size of 100 patients with primary squamous cell carcinoma of the oropharynx. Patient inclusion criteria were diagnosis with a primary squamous cell carcinoma of oropharyngeal cancer; data on p16 immunohistochemistry and on HPV testing; information on age, sex, tobacco, and alcohol use; staging by TNM 7th edition; information on treatments received; and data on clinical outcomes and follow-up (date of last follow-up if alive, date of recurrence or metastasis, and date and cause of death). There were no limits on age or performance status. The primary outcomes were the proportion of patients of the overall cohort who showed the different p16 and HPV result combinations, as well as 5-year overall survival and 5-year disease-free survival. Patients with recurrent or metastatic disease or who were treated palliatively were excluded from overall survival and disease-free survival analyses. Multivariable analysis models were used to calculate adjusted hazard ratios (aHR) for different p16 and HPV testing methods for overall survival, adjusted for prespecified confounding factors. Findings Our search returned 13 eligible studies that provided individual data for 13 cohorts of patients with oropharyngeal cancer from the UK, Canada, Denmark, Sweden, France, Germany, the Netherlands, Switzerland, and Spain. 7895 patients with oropharyngeal cancer were assessed for eligibility. 241 were excluded before analysis, and 7654 were eligible for p16 and HPV analysis. 5714 (74middot7%) of 7654 patients were male and 1940 (25middot3%) were female. Ethnicity data were not reported. 3805 patients were p16-positive, 415 (10middot9%) of whom were HPV-negative. This proportion differed significantly by geographical region and was highest in the areas with lowest HPV-attributable fractions (r=-0middot744, p=0middot0035). The proportion of patients with p16+/HPV- oropharyngeal cancer was highest in subsites outside the tonsil and base of tongue (29middot7% vs 9middot0%, p<0middot0001). 5-year overall survival was 81middot1% (95% CI 79middot5-82middot7) for p16+/HPV+, 40middot4% (38middot6-42middot4) for p16-/HPV-, 53middot2% (46middot6-60middot8) for p16-/HPV+, and 54middot7% (49middot2-60middot9) for p16+/HPV-. 5-year disease-free survival was 84middot3% (95% CI 82middot9-85middot7) for p16+/HPV+, 60middot8% (58middot8-62middot9) for p16-/HPV-; 71middot1% (64middot7-78middot2) for p16-/HPV+, and 67middot9% (62middot5-73middot7) for p16+/HPV-. Results were similar across all European sub-regions, but there were insufficient numbers of discordant patients from North America to draw conclusions in this cohort. Interpretation Patients with discordant oropharyngeal cancer (p16-/HPV+ or p16+/HPV-) had a significantly worse prognosis than patients with p16+/HPV+ oropharyngeal cancer, and a significantly better prognosis than patients with p16-/HPV- oropharyngeal cancer. Along with routine p16 immunohistochemistry, HPV testing should be mandated for clinical trials for all patients (or at least following a positive p16 test), and is recommended where HPV status might influence patient care, especially in areas with low HPV-attributable fractions. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd

Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis

Background: p16INK4a (p16) immunohistochemistry is the most widely used biomarker assay for inferring HPV causation in oropharyngeal cancer in clinical and trial settings. However, discordance exists between p16 and HPV DNA or RNA status in some patients with oropharyngeal cancer. We aimed to clearly quantify the extent of discordance, and its prognostic implications. Methods: In this multicentre, multinational individual patient data analysis, we did a literature search in PubMed and Cochrane database for systematic reviews and original studies published in English between Jan 1, 1970, and Sept 30, 2022. We included retrospective series and prospective cohorts of consecutively recruited patients previously analysed in individual studies with minimum cohort size of 100 patients with primary squamous cell carcinoma of the oropharynx. Patient inclusion criteria were diagnosis with a primary squamous cell carcinoma of oropharyngeal cancer; data on p16 immunohistochemistry and on HPV testing; information on age, sex, tobacco, and alcohol use; staging by TNM 7th edition; information on treatments received; and data on clinical outcomes and follow-up (date of last follow-up if alive, date of recurrence or metastasis, and date and cause of death). There were no limits on age or performance status. The primary outcomes were the proportion of patients of the overall cohort who showed the different p16 and HPV result combinations, as well as 5-year overall survival and 5-year disease-free survival. Patients with recurrent or metastatic disease or who were treated palliatively were excluded from overall survival and disease-free survival analyses. Multivariable analysis models were used to calculate adjusted hazard ratios (aHR) for different p16 and HPV testing methods for overall survival, adjusted for prespecified confounding factors. Findings: Our search returned 13 eligible studies that provided individual data for 13 cohorts of patients with oropharyngeal cancer from the UK, Canada, Denmark, Sweden, France, Germany, the Netherlands, Switzerland, and Spain. 7895 patients with oropharyngeal cancer were assessed for eligibility. 241 were excluded before analysis, and 7654 were eligible for p16 and HPV analysis. 5714 (74·7%) of 7654 patients were male and 1940 (25·3%) were female. Ethnicity data were not reported. 3805 patients were p16-positive, 415 (10·9%) of whom were HPV-negative. This proportion differed significantly by geographical region and was highest in the areas with lowest HPV-attributable fractions (r=–0·744, p=0·0035). The proportion of patients with p16+/HPV– oropharyngeal cancer was highest in subsites outside the tonsil and base of tongue (29·7% vs 9·0%, p<0·0001). 5-year overall survival was 81·1% (95% CI 79·5–82·7) for p16+/HPV+, 40·4% (38·6–42·4) for p16–/HPV–, 53·2% (46·6–60·8) for p16–/HPV+, and 54·7% (49·2–60·9) for p16+/HPV–. 5-year disease-free survival was 84·3% (95% CI 82·9–85·7) for p16+/HPV+, 60·8% (58·8–62·9) for p16–/HPV–; 71·1% (64·7–78·2) for p16–/HPV+, and 67·9% (62·5–73·7) for p16+/HPV–. Results were similar across all European sub-regions, but there were insufficient numbers of discordant patients from North America to draw conclusions in this cohort. Interpretation: Patients with discordant oropharyngeal cancer (p16–/HPV+ or p16+/HPV–) had a significantly worse prognosis than patients with p16+/HPV+ oropharyngeal cancer, and a significantly better prognosis than patients with p16–/HPV– oropharyngeal cancer. Along with routine p16 immunohistochemistry, HPV testing should be mandated for clinical trials for all patients (or at least following a positive p16 test), and is recommended where HPV status might influence patient care, especially in areas with low HPV-attributable fractions

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

El sistema alimentario global : ponderación cuantitativa de las variables del modelo en el entorno de Cataluña

El presente trabajo constituye la tercera parte de El Sistema Alimentario Global . El objetivo principal es proponer la encuesta como herramienta para optimizar el modelo matemático que se llevó a cabo en las dos fases anteriores y que se basaba en una red que configuraba el espacio alimentario a través de 4 ejes diferentes: Disponibilidad alimentaria, Economía, Políticas y Cultura, los cuales se les daba una ponderación igual a cada uno. Con el perímetro definido a Cataluña se pretende, a partir de la encuesta, saber qué importancia le dan los catalanes a estos ejes y así poder aplicar una ponderación más afinada y representativa de la realidad. Para ello se lleva a cabo el diseño del cuestionario, la recopilación de los datos, la aplicación de técnicas estadísticas de muestreo: estratificación por cuotas y ponderación de los estratos, técnicas de depuración de encuestas, así como técnicas de profiling para diferenciar grupos entre las variables del sistema alimentario y las características sociodemográficas que los determinan