Vacunas antipoliomieliticas, erradicación y posterradicación

Vaccination against polio generates herd immunity (both with the attenuated (OPV) and inactivated (IPV) vaccines) and this will allow the eradication of the disease. The OPV vaccine produces 2-4 polio cases per cohort of one million children and therefore IPV is used in countries that can afford its cost (about 15 times more expensive than OPV). In 1988 the World Health Assembly established the polio eradication goal as "interruption of wild poliovirus transmission". If the elimination of wild poliovirus were achieved, the use of OPV will produce annually between 250 and 500 cases of polio in the world. From 1999, it was clear that eradication would require ending of immunization with OPV. On the 25th of January, 2013 it is approved the plan for the eradication and containment of all polioviruses, wild or not, so that no child suffers paralytic poliomyelitis. The most important landmarks include the lack of wild polio cases after 2014, the introduction of at least one dose of IPV in all immunization programs and to cease the type 2 OPV vaccination by the end of 2016 and to stop the use of the oral bivalent vaccine in 2019. To achieve all this, a complex scientific work and economic solidarity will be required.La vacunación antipoliomielítica genera inmunidad de grupo (con vacunas atenuadas (VPO) e inactivadas (VPI) y ello permitirá la erradicación de la enfermedad. La VPO produce de 2-4 casos de poliomielitis por cohorte de un millón de niños y por ello los países que pueden hacer frente al coste de la VPI (unas 15 veces más cara) la utilizan. En 1988 la Asamblea de la Organización Mundial de la Salud aprobó el objetivo de la erradicación como "la interrupción de la transmisión de poliovirus salvajes". Si se conseguía su eliminación, el mantenimiento de la VPO produciría al año entre 250 y 500 casos de poliomielitis en el mundo. Desde 1999 era evidente que la erradicación requeriría la cesación de la vacunación con VPO. El 25 de enero del 2013 se aprobó el plan para la erradicación y la contención de todos los virus de la polio, salvajes o no, para que ningún niño sufra una poliomielitis paralítica. Los hitos más importantes incluyen, la no aparición de casos de polio salvaje tras el año 2014, la introducción de al menos una dosis de VPI en todos los programas de vacunación y que se suspenda la vacunación con VPO tipo 2 al final del 2016 y que en 2019 se pueda cesar de utilizar la vacuna bivalente oral. Para todo ello será preciso un trabajo científico complejo y solidaridad financiera

El copyright en cuestión. Diálogos sobre propiedad intelectual

Análisis desde un enfoque editorial y legal del debate sobre la propiedad intelectual y sus formas en el contexto digital. Un debate que interesa a profesores, estudiantes, editores, divulgadores, bibliotecarios y autores. En el libro se estudia los derechos de autor y las cuestiones relacionadas con la propiedad intelectual provocadas por el impacto de la tecnología en la edición, creación, docencia e investigación al tiempo que se ofrece propuestas de futuro para conciliar los puestos de vista de autores, universidades, lectores, editoriales y bibliotecas.In the book analysis and debate, from an editorial and legal approach, intellectual property and its forms in the digital environment is made. A debate that concerns teachers, students, publishers, disseminators, librarians and authors. In the book copyright issues and intellectual property caused by the impact of technology in the editing, creating, teaching and research is studied. Finally, proposals for the future are offered to reconcile the positions of view of authors, universities, readers, publishers and libraries

Publicación de una revista electrónica

Este proyecto de innovación educativa se presentó en el Congreso Internacional de Innovación en la Educación celebrado en Valladolid los dias 26, 27 y 28 de abril de 2005Centro de reciente creación como centro independiente. La motivación principal para abordar este proyecto ha sido buscar otra vía más para dar a conocer en la comarca las actividades realizadas en el centro y buscar otros cauces para que los miembros de la comunidad educativa participen en la dinámica del instituto. Una de las formas tradicionales de fomentar las relaciones entre un instituto y su entorno es la elaboración de una revista escolar, pero pareció más apropiado, dado el auge de las tecnologías de la información y de la comunicación en las aulas, que esta revista tuviera un soporte electrónico y publicarla en Internet y no en la forma tradicional. El principal objetivo ha sido fomentar el uso de las tecnologías de la información y la comunicación no sólo entre los alumnos (que, en su mayoría, tienen un nivel de usuario poco experto), sino también entre el profesorado. Al margen de este objetivo de carácter global (tanto para alumnos como para profesores) tambien se pesigue el siguiente doble objetivo más engarzado con los contenidos curriculares: a) aumentar el interés por la lectura y la escritura entre el alumnado del centro y b) incidir en el conocimiento, análisis y valoración de los acontecimientos acaecidos en su entorno. Participan dieciocho profesores de los veintidós integrantes del claustro. De todos modos, aunque participaron profesores de todas las materias, se hace hincapié en cuatro en particular: Lengua castellana y Literatura, que como área instrumental aporta las herramientas expresivas y comprensivas necesarias para elaborar una publicación; Informática, para impartir conocimientos sobre el soporte material de la publicación; Ciencias Sociales, para situar los acontecimientos en la correcta perspectiva social y devenir histórico, y Educación Plástica y Visual para entender el tratamiento de la imagen en los medios informativos de prensa escrita, ya sea en soporte de papel o electrónico, así como la importancia de la disposición tipográfica a la hora de transmitir contenidos. El desarrollo de la experiencia se temporaliza del siguiente modo: - En octubre, se recogieron propuestas de título para la revista, que acabó llamándose 'Actualidad Digital', y el equipo de profesores dedicado al proyecto se reunió para realizar una tabla en Front Page, que sirvió para dar forma a la publicación, y se decidió el espacio dedicado a las distintas secciones. Cada departamento se hizo cargo de una sección. Cada enlace de la plantilla (sumario - en portada - novedades entre otros) llevaba a una página en Front Page de dimensión variable y a cargo de un departamento diferente, de esta forma se podía variar cada una por separado en el servidor tantas veces como se juzgara necesario. También se evitaba trabajar con marcos o macros, algo difíciles para principiantes. En noviembre, los alumnos elaboraron el contenido de las diferentes secciones para el primer número y presentaron cada sección como una única página de Microsoft Front Page dividida en columnas o/y filas por una tabla. En Educación Plástica e Iniciación a la Imagen, los alumnos crearon las imágenes (fotográficas, en principio, después gifs animados). Fue imposible cargar vídeos o sonido en el sitio web, dada la escasez de megas concedida por el Centro Nacional de Información y Comunicación Educativa (CNICE), aunque se trabajó con archivos de este tipo en el aula. A principios de diciembre, un pequeño equipo ensambló las páginas situándolas en los enlaces correspondientes y subió la revista al sitio web. Este proceso se repitió cada trimestre. El resultado ha sido los tres números que lleva por el momento la publicación, aunque el segundo número se renovó varias veces por partes, pues el segundo trimestre fue más largo y aportó más noticias. El formato de la revista cambió dos veces para dar cabida a distintas propuestas de diseño, pero no la estructura interna formada por catorce páginas enlazadas (o hipervinculadas) entre sí. Paralelamente a las tres revistas digitales, se elaboraron materiales para aprender a realizar una página web en Front Page y colgarla en Internet. Una de las tareas fundamentales era que todo el profesorado tuviera unos conocimientos básicos de los programas necesarios para elaborar una página web. Para ello se elaboraron unidades didácticas muy sencillas sobre hipervínculos, uso de un programa FTP y conocimientos básicos de Front Page 2003. Posteriormente, se llevaron al aula para trabajar con los alumnos. Con estos conocimientos mínimos ya se elaboró la primera revista. Además, se crearon actividades que trataban contenidos curriculares de distintas materias y cuyos resultados podían utilizarse para elaborar nuestra revista electrónica:ú Para introducir nociones de lenguaje de programación se insertaron contadores de visitas y otros objetos en lenguaje html en la actividad 'Contadores'.ú En Geografía e Historia, se realizó una encuesta utilizando los programas Excel y Word y sus resultados se colgaron en la revista.ú En Plástica y tratamiento de la imagen, se elaboraron titulares en Word Art y se modificaron en programas de tratamiento de la imagen, en concreto, NeoPaint y Photoshop. ú En Lengua castellana, se estudió el lenguaje periodístico, se comparó una misma noticia en diferentes medios y las conclusiones se presentaron en 'Cuadros de texto'.ú En diferentes asignaturas se elaboraron gifs animados para realizar presentaciones animadas y motivadoras de los contenidos que debían estudiar los alumnos.Las fuentes consultadas para la elaboración de estos materiales fueron fundamentalmente la página web del CNICE (www.cnice.mecd.es) y sus cursos en CD-ROM sobre 'Procesador de textos', 'Aplicaciones de Neobook' e 'Internet'.Junta de Castilla y LeónCastilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante, s. n.; 47071 Valladolid; +34983411881; +34983411939ES

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. Findings Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a –0·30 (95% CI –0·42 to –0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (–0·42% [–0·63 to –0·20]) and via SMS (–0·37% [–0·57 to –0·17]), but not when delivered via websites (–0·09% [–0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. Interpretation Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; Consejería de Salud de Andalucía.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure.

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of "extra-target" RAS suggests the need for RAS screening in all three DAA target regions