Appropriateness of radiological diagnostic tests in otolaryngology

Objective: To evaluate the appropriateness of imaging tests associated with radiation in the field of otolaryngology according to the available recommendations, and to estimate the effective radiation dose associated. Method: Cross-sectional epidemiological study of the totality of the imaging test requests carried out by two Spanish hospitals (n = 1931). We collected the following information: patient demographic data, type of imaging test, imaging tests referred in the previous 12 months, referrer department and diagnostic suspicion. In accordance with the available guidelines, we considered the requests: (a) Appropriate; (b) Inappropriate; (c) Not adequately justified; (d) Not included in the guidelines. We calculated the prevalence of each category and their variation according to the different variables. Collective and per capita effective dose were calculated for each category. Results: Of the 538 requests, 42% were considered appropriate, 34.4% inappropriate, 11.9% not adequately justified and 11.7% not included in the guidelines. Imaging tests requested by general partitioners (aOR: 0.18; 95% CI: 0.06–0.50) and clinical departments (aOR: 0.27; 95% CI: 0.11–0.60) were less likely to be considered appropriate than those requested by the Otolaryngology department. Patients with a diagnosis suspicion of tumour pathology were more likely to have a requested imaging test classified as appropriate (aOR: 7.12; 95% CI: 3.25–15.61). The cumulative effective dose was 877.8 mSv, of which 40% corresponded to tests classified as inappropriate. Conclusions: A high percentage of imaging tests are considered as inappropriate in the field of otolaryngology, with a relevant frequency of associated effective radiation dose. Type of department, the diagnostic suspicion and the type of imaging tests were variables associated to the inappropriateness of the test

Sponyloarthritis features forecasting the presence of HLA-B27 or sacroiliitis on magnetic resonance imaging in patients with suspected axial spondyloarthritis: Results from a cross-sectional study in the ESPeranza Cohort

Introduction: Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA. Methods: Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR−) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features. Results: Pretest probabilityies of a positive result was 41 % for MRI-SI and 40 % for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the ‘ASAS criteria’ (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41 % to 79–80 %. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73 % and 81 %, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively). Conclusions: If patients with suspected axial SpA have either 1) IBP according to Calin/ASAS definition plus alternating buttock pain, or 2) IBP according to Calin definition plus awakening at night, or 3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantlyVNC received one of the ASAS research grants on call 2013 to perform this study. The Spanish Foundation of Rheumatology received funding from Pfizer to develop the Esperanza Programme. Nowadays, the programme is supported by a restricted grant of the Institute Carlos III (FIS PI13/02034)

Heritagisation processes in Modern Movement public housing in Seville: Expert opinions and community experiences in El Carmen,Triana

Los resultados etnográficos del estudio antropológico abarcan procesos de construcción de conocimiento(s) y de activación(es) social(es) en el El Carmen de Triana. Presentamos aquí un esbozo de los principales hitos desarrollados por el estudio antropológico, cuyo análisis se ha centrado en la identificación de procesos de patrimonialización vecinales. La Asociación de Vecinos Nuestra Señora del Carmen de Triana es el agente vecinal principal involucrado en los procesos contemporáneos que atraviesan la construcción histórica de las identidades vecinales. Entre los grupos sociales que conforman la asociación vecinal, destaca el denominado en la etnografía como «vecindario base». Este constituye el grupo motor, entre otras razones, porque en la reproducción de su identidad colectiva produce un discurso(s)/praxi(s) que genera la suficiente cohesión social como para permitir su reproducción social. En esta lógica encontramos los elementos socioculturales a los que el vecindario otorga reconocimiento social: un tipo específico de relaciones sociales. Se trata del tipo específico de organización vecinal basada en el parentesco ficticio con miembros del vecindario, cuya principal consecuencia es la ampliación de la red de solidaridad y apoyo mutuo –en sentido kropotkiano– hacia elementos externos a la familia por parentesco consanguíneo. Por lo anterior, entendemos la existencia de un proceso de patrimonialización vecinal latente sobre la base del parentesco ficticio y el despliegue del universo de relaciones sociales vinculadas a esta forma de organización sociocultural del vecindario. Así, proponemos ubicar este proceso de patrimonialización latente dentro de nuevas categorías patrimoniales urbanas, como es el denominado patrimonio difuso: «Es un área no definida realmente por límites geográficos, sino más bien por cualidades de homogeneidad cultural, así como por aspectos antropológicos, costumbres y maneras de vivir y de interrelacionarse entre sus habitantes» (BORIANI, 2014:102) En cuanto a la activación social, cabe mencionar el proceso de empoderamiento de los agentes vecinales en relación a las luchas y resistencias sociopolíticas a las que se enfrentan como vecindario. El encuentro entre los agentes expertos y los agentes sociales en el marco del trabajo de campo etnográfico posibilitó que un proyecto de investigación (experto) pudiese ser apropiado por parte de los agentes sociales (vecindario) y transformado en una herramienta de lucha colectiva más, incorporándola a su narrativa y acción colectiva.The ethnographic results of the anthropological study encompass knowledge-building and social activation processes in El Carmen, Triana. We present here a summary of the principal goals of the anthropological study, where analysis focused on identifying community heritagisation processes. The Asociación de Vecinos Nuestra Señora del Carmen de Triana is the primary community actor involved in the contemporary processes that permeate the historical construction of neighbourhood identities. Among the various social groups that comprise this residents’ association, the most salient is the ethnographic “base community”. This group is the principal driving force in the neighbourhood, in part because the reproduction of its collective identity produces discourse/s or praxis/es that create sufficient social cohesion to allow their social reproduction. Within this logic, we find sociocultural elements that are socially acknowledged by neighbourhood residents: specific types of social relations. This is a particular form of neighbourhood organisation based on a fictitious sense of kinship with other community members, the main consequence of which is the expansion of the network of mutual aid and goodwill–in the Kropotkinian sense–to elements outside the circle of blood relatives. In light of the foregoing, we observed the existence of a latent community heritagisation process based on fictitious kinship and the deployment of the universe of social relations derived from this form of sociocultural organisation among neighbourhood residents. We therefore posit that this latent heritagisation process pertains to new urban heritage categories such as diffuse heritage: “An area defined not by geographical boundaries, but rather by markers of cultural homogeneity, as well as by anthropological aspects, customs and ways of living and interacting among its inhabitants” (BORIANI, 2014:102). With regard to social activation, we must mention the process of empowerment of community agents in relation to the sociopolitical struggles and challenges they face as a neighbourhood. The encounter between expert agents and social agents in the context of ethnographic fieldwork made it possible for an (expert) research project to be approved by (neighbourhood) social agents and become another tool of community initiative, incorporating it into their collective narrative and action

Dual targeted therapy in patients with psoriatic arthritis and spondyloarthritis: a real-world multicenter experience from Spain

Dual targeted therapy (DTT) has emerged as a promising approach in patients with refractory spondyloarthritis (SpA) or psoriatic arthritis (PsA) and extra-musculoskeletal manifestations of both diseases, but its effectiveness/safety ratio still remains unclear. This is a retrospective, real-world multicenter study in refractory SpA and PsA patients with simultaneous use of two biological or synthetic targeted agents. Effectiveness was assessed using Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Disease Activity in Psoriatic Arthritis (DAPSA) Score. We identified 39 different DTT combinations in 36 patients (22 SpA; 14 PsA), 25 of them with concomitant inflammatory bowel disease. The most commonly used combinations were TNF inhibitor plus antagonist of the IL12/23 pathway, followed by TNF inhibitor plus IL-17 antagonist. During a median exposure of 14.86 months (IQR 8-20.2), DTT retention rate was 69.4% (n=25/36; 19 SpA, 6 PsA). Major clinical improvement (change in ASDAS-CRP > 2 or improvement > 85% in DAPSA) was achieved in 69.4% of patients (n=25/36 therapeutical combinations; 17/21 SpA, 8/15 PsA), with a 58.3% (n=21/36 combinations; 15/20 SpA, 6/13 PsA) low-activity/remission rate. Of the patients who were receiving glucocorticoids, 55% managed to withdraw them during follow-up. Interestingly, only four serious adverse events in three patients were observed, leading to DTT discontinuation

Geoquímica de metales traza en piritas de depósitos VMS de la Faja Pirítica Ibérica

Depto. de Mineralogía y PetrologíaFac. de Ciencias GeológicasTRUEpu

Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO

Background To evaluate the influence of the disease activity on radiographic progression in axial spondyloarthritis (axSpA) patients treated with TNF inhibitors (TNFi). Methods The study included 101 axSpA patients from the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO), which had clinical data and radiographic assessment available. Patients were classified into 2 groups based on the duration of TNFi treatment at baseline: (i) long-term treatment (>= 4 years) and (ii) no long-term treatment (= 2 mSASSS units. At inclusion, approximately half of the patients (45.5%) were receiving long-term treatment with TNFi (>= 4 years). In this group of subjects, a significant difference in averaged Ankylosing Spondylitis disease Activity Score (ASDAS) across follow-up was found between progressors and non-progressors (2.33 vs 1.76, p=0.027, respectively). In patients not under long-term TNFi treatment (54.5%) though, no significant ASDAS differences were observed between progressors and non-progressors until the third year of follow-up. Furthermore, no significant differences were found in progression status, when disease activity was measured by Bath Ankylosing spondylitis Disease Activity Index (BASDAI) and C reactive protein (CRP). Conclusions Patients on long-term TNFi treatment with a mean sustained low disease activity measures by ASDAS presented lower radiographic progression than those with active disease

re-habitar El Carmen : Un proyecto sobre patrimonio contemporáneo

El proyecto _re-HABITAR suponía para el propio proceder de la institución un avance más allá del reconocimiento, registro, inventario o protección patrimonial de la arquitectura del siglo XX y del Movimiento Moderno para posicionarse en la acción preventiva y conservativa de ese legado contemporáneo. Para ello, la praxis patrimonial se aferraba a un modelo: el de la vivienda social en España en la segunda mitad del siglo XX; a un caso concreto: el de la barriada de Nuestra Señora del Carmen (Recasens Méndez-Queipo de Llano, 1958); y a un requisito fundamental: analizar un objeto vivo y en uso, aún con la presencia de quienes lo vivieron y usaron desde su origen

An anthropological approach to Modern Movement public housing in El Carmen, Triana

Exponer el proceso de investigación desarrollado por el estudio antropológico supone realizar una descripción de dos dimensiones claves: los puntos teóricos y metodológicos de partida. El abordaje del patrimonio arquitectónico contemporáneo (en adelante, PAC) de la vivienda social del Movimiento Moderno (en adelante, VSMM) se ha realizado desde su dimensión social analizando las percepciones sociales en relación al concepto de Patrimonio Cultural y los procesos de patrimonialización. El patrimonio cultural, en tanto que construcción social, permite poner de manifiesto quién(es) activa(n) qué elemento(s) de la cultura en una realidad concreta y la instrumentalización que realizan de este(s). Así, cualquier elemento sociocultural con reconocimiento social por parte de un colectivo puede ser objeto de procesos de patrimonialización. En este sentido, proponemos estudiar los elementos socioculturales a los que el vecindario de El Carmen de Triana otorga reconocimiento social, diferenciado entre procesos de patrimonialización manifiestos y latentes. En los primeros existe un colectivo que persigue el reconocimiento institucional de los elementos propios con reconocimiento social. Los segundos se generan cuando existe reconocimiento social, pero el colectivo no ha creado una organización para logar el reconocimiento experto. En estas páginas proponemos analizar la(s) experiencia(s) histórica(s) del vecindario a través de una mirada crítica sobre el contexto multidimensional en el que se producen/ reproducen estas expresiones colectivas. Así, el trabajo de campo se orientó hacia la cotidianeidad del vecindario, en los espacios domésticos, de sociabilidad y rituales, principalmente, desde una perspectiva teórico-metodológica del «ser/estar/sentir El Carmen de Triana». Esta nueva forma de entender la producción de expresiones socioculturales colectivas está basada en la propuesta «epistemología del sentir situada» desarrollada por Iván Periáñez Bolaño (2016). Finalmente, entendemos la VSMM como un producto de la política de vivienda de la dictadura (1939-1975). Por ello, proponemos la reflexión antropológica a partir de este marco explicativo. Esto nos permite entender y analizar los contextos socioculturales como espacios de coexistencia de múltiples memorias locales, transformadas y resignificadas, vinculadas a la dictadura en la ciudad.The anthropological research process can be summed up in a description of two key aspects: theoretical and methodological foundations. The contemporary architectural heritage (hereafter CAH) of Modern Movement public housing (hereafter MMPH) was examined from a social perspective, analysing social perceptions related to the concept of cultural heritage and heritagisation processes. Cultural heritage, as a social construct, makes it possible to identify who activates which elements of culture in a specific context, and what use they make of them. Thus, any sociocultural element acknowledged by a social group can become an object of heritagisation processes. In this respect, we proposed to study the sociocultural elements that are socially acknowledged by the community of El Carmen, Triana, distinguishing between patent and latent heritagisation processes. The first one occurs when a collective actively seeks official recognition of unique, socially acknowledged identifiers, and the latter when social acknowledgment exists. The second one occurs when an organisation is created to seek expert recognition. We propose to analyse the past experience(s) of the neighbourhood residents by critically examining the multi-dimensional context in which these collective expressions are produced/reproduced. Our fieldwork therefore focused on the everyday reality of the neighbourhood in domestic, social and ritual settings, guided by the theoretical/ methodological perspective of “being/living/feeling El Carmen”. This new way of understanding the production of collective sociocultural expressions is based on the “epistemology of situated feeling”, an approach developed by Iván Periáñez Bolaño (2016). Finally, we see the MMPH as a product of the housing policy of the Franco regime (1939–1975). We therefore propose an anthropological reflection based on this explanatory framework, which allows us to understand and analyse sociocultural contexts as a spaces of coexistence with multiple local memories–transformed and resignified–associated with the dictatorship in the city

Mujeres en la historia; historias de mujeres

El trabajo obtuvo un Premio Tomás Garcia Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2020/2021. Modalidad ASe presenta un proyecto llevado a cabo en el CEIP San Martín de Garganta la Olla (Cáceres) centrado en el fomento de la literatura y la escritura en edad infantil. Partiendo del álbum ilustrado, el cómic y la novela, se trabaja a partir de autoras y personajes femeninos relevantes desde un punto de vista coeducativo e igualitario, indagando en el papel que ha tenido la mujer a lo largo de la historia en todos los ámbitos del STEAM: ciencia, tecnología, ingeniería, artes y matemáticas. Otros objetivos del proyecto fueron: favorecer el trabajo colaborativo; iniciar a los alumnos en el uso de las tecnologías de la información y comunicación desarrollando un espíritu crítico ante los mensajes que reciben; fomentar el uso del lenguaje computacional; propiciar ambientes educativos en los que primen valores como la responsabilidad, el esfuerzo, la igualdad de género, etc.ExtremaduraES