Homogeneización del proceso de tutorización del trabajo final de grado en estudiantes de Fisioterapia

La asignatura de trabajo final de grado (TFG) es una incorporación del espacio europeo con la que el alumno integra los contenidos adquiridos durante su formación. A pesar de intentar homogeneizar la formación, la inexistencia de instrucciones específicas produce diferencias en el desarrollo de los trabajos, incluso en una misma facultad debido a las diferencias metodológicas de los docentes, frustrando al alumnado. Este trabajo evaluó la influencia del uso de rúbricas y tutoriales como herramientas para homogeneizar el proceso de tutorización del TFG en el grado de satisfacción del alumnado con la asignatura. Durante dos años académicos, 9 profesores recibieron rúbricas y tutoriales para guiar la tutorización. El resto de profesores no recibieron ningún material adicional. Después de la presentación del trabajo, el alumnado contestó un cuestionario para evaluar el grado de satisfacción con el TFG. Los resultados mostraron que el uso de rúbricas no mejora la percepción de la organización de la asignatura ni del aprendizaje adquirido, así como tampoco aumenta el grado de satisfacción con el tutor y la asignatura. Sin embargo, esta metodología puede ser útil para minimizar la creencia de la exigencia de las tareas vinculadas al tutor, y con ello, la posible frustración del alumnado

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

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Chronic Pain and Work Conditions of Hotel Housekeepers: A Descriptive Study

[eng] Objectives: To estimate the prevalence of musculoskeletal pain of hotel housekeepers (HHs) and to describe the work conditions and perception of health in this occupational group in the Balearic Islands, Spain. Methods: Cross-sectional descriptive study with HHs of the Balearic Islands, performed in primary care. Random sample of HHs who worked during the 2018 season. We collected information on sociodemographic variables, job characteristics, workload, pain, perceived health, and physical activity. After participants signed the informed consent form, we conducted a face-to-face interview in the primary care centre and accessed the participants' electronic health records. Results: 1043 HHs aged 43.3 ± 10 years and with 10.7 ± 9.1 years worked as HHs were included. 51% (95% CI: 48-54%) reported chronic pain, mainly in the lower back 28.7% (95% CI: 25.9-31.5%), hands/wrists 23.7% (95% CI: 21.1-26.4%), neck 21.6% (95% CI: 19.1-24.3%), shoulders 19.9% (95% CI: 17.4-22.4%), and back 17.8% (95% CI: 15.4-20.2%). Pain was associated with older age, more years worked, more beds made/day and difficulty in pushing the housekeeping cart. More than half HHs reported that they did not incorporate occupational risk prevention measures (ORPMs) into their routine; 17.3% (95% CI: 15.1-19.7%) HHs considered their health as poor or very poor. Perception of health was worse in HHs with chronic pain. Conclusions: A high percentage of HHs of the Balearic Islands reported chronic pain, a low compliance with ORPMs and compared to women of the same sociodemographic profile they perceive a worse health status

An Educational and Exercise Mobile Phone-Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial

[eng] Background: Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. Objective: The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. Methods: A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). Results: After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02)

Elimination of Onchocerciasis from Mexico.

BACKGROUND:Mexico is one of the six countries formerly endemic for onchocerciasis in Latin America. Transmission has been interrupted in the three endemic foci of that country and mass drug distribution has ceased. Three years after mass drug distribution ended, post-treatment surveillance (PTS) surveys were undertaken which employed entomological indicators to check for transmission recrudescence. METHODOLOGY/PRINCIPAL FINDINGS:In-depth entomologic assessments were performed in 18 communities in the three endemic foci of Mexico. None of the 108,212 Simulium ochraceum s.l. collected from the three foci were found to contain parasite DNA when tested by polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA), resulting in a maximum upper bound of the 95% confidence interval (95%-ULCI) of the infective rate in the vectors of 0.035/2,000 flies examined. This is an order of magnitude below the threshold of a 95%-ULCI of less than one infective fly per 2,000 flies tested, the current entomological criterion for interruption of transmission developed by the international community. The point estimate of seasonal transmission potential (STP) was zero, and the upper bound of the 95% confidence interval for the STP ranged from 1.2 to 1.7 L3/person/season in the different foci. This value is below all previous estimates for the minimum transmission potential required to maintain the parasite population. CONCLUSIONS/SIGNIFICANCE:The results from the in-depth entomological post treatment surveillance surveys strongly suggest that transmission has not resumed in the three foci of Mexico during the three years since the last distribution of ivermectin occurred; it was concluded that transmission remains undetectable without intervention, and Onchocerca volvulus has been eliminated from Mexico

Mass drug administration (MDA) with ivermectin in two endemic foci: Coverage rate, expressed in percent, of the eligible population.

<p>The eligible population excluded pregnant and lactating women and children under 5 years of age. These groups represented 9.5% of the total population during the last year of MDA in the Southern Chiapas focus in 2011. Panel A: Semi-annual treatment regimen was employed in Northern Chiapas from 2000 through 2007 when MDA ceased. Panels B-C. Semi-annual regimen was employed in Southern Chiapas from 1995 through 2011 (Panel B; Figure taken from Rodriguez-Perez et al., 2013 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003922#pntd.0003922.ref018" target="_blank">18</a>]); in addition, quarterly treatment was employed in 50 communities from 2003 through 2008 and in 163 communities from 2009 through 2011 when MDA ceased (Panel C). The semi-annual treatment regimen was employed in Oaxaca from 1996 through 2008 when MDA ceased (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003922#pntd.0003922.g002" target="_blank">Fig 2</a> in Rodriguez-Perez et al., 2010 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003922#pntd.0003922.ref020" target="_blank">20</a>]). The line at 85% indicates the coverage needed to be maintained in order to interrupt transmission.</p

The epidemiological situation in the three onchocerciasis endemic foci in Mexico.

<p>Geographical extension (2000): 1) 1,172.10 km²; 2) 13,901.3 km²; 3) 4,250,0 km².</p><p>* “New” clinical onchocerciasis cases were defined as those individuals diagnosed positive by Mazzotti reaction, nodules, or skin biopsies (‘snips’) for the first time.</p><p>^¶ The upper value represents point estimate and the lower value in parentheses represents the 95%-confidence interval. When the point estimate was 0 only the upper limit of confidence interval is presented.</p><p>^& Las Golondrinas [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003922#pntd.0003922.ref029" target="_blank">29</a>].</p><p>^# The present study.</p><p>^& Population no longer at risk of infection.</p><p>The epidemiological situation in the three onchocerciasis endemic foci in Mexico.</p

Entomological parameters in the three foci of onchocerciasis in Mexico.

<p>* Northern Chiapas: El Ambar, Alta Gracia, Chimix, and Nueva Esperanza; Oaxaca: Santiago Teotlaxco, Tiltepec, San Miguel Reagui, Santiago Lalopa, La Chichina, and La Esperanza Comaltepec; Southern Chiapas: Brasil, Mexiquito, Jose Maria Morelos, Estrella Roja, Ampliación Malvinas, Las Golondrinas, Las Nubes II, and Nueva América.</p><p>^§ Each pool contained a maximum of 50 flies.</p><p>^& Each pool contained a maximum of 200 flies.</p><p>^¶ The upper value represents point estimate and the lower value in parentheses represents the 95%-confidence interval.</p><p>Entomological parameters in the three foci of onchocerciasis in Mexico.</p