Metodología de diseño urbano participativo: mejora participativa integral del asentamiento informal Blikkiesdorp, en Grootfontein, Namibia

Metodología de diseño urbano participativo: mejora participativa integral del asentamiento informal Blikkiesdorp, en Grootfontein, Namibi

Estigma asociado a la enfermedad mental: Todavía queda mucho por hacer

Han pasado 30 años desde que tuvieran lugar en nuestro país los inicios de la llamada reforma psiquiátrica. Pese a la intencionalidad de cambio en el modelo asistencial y en el imaginario colectivo en lo que a la enfermedad mental respecta, seguimos encontrándonos ante un campo plagado de retos que abarcar. Se ha realizado una revisión bibliográfica en torno a diversos aspectos de la enfermedad mental, comenzando por una contextualización del asunto que nos ocupa y del proceso de reforma citado. En este trabajo hacemos especial incidencia en el estigma social al que está sometido este colectivo, además de recoger algunas aportaciones sobre la situación actual, una serie de recomendaciones para los profesionales que intervienen con personas con enfermedad mental, y algunas cuestiones en torno a la participación y la labor del incipiente movimiento asociativo en la lucha contra el estigma. Incluimos un estudio sobre las actitudes hacia la enfermedad mental en los alumnos del segundo ciclo de E.S.O. de la Comarca de la Ribagorza (Huesca)

Un Viaje que comenzó mucho antes de hacer las maletas : el sufrimiento y las diferencias culturales en el proceso terapéutico

A lo largo del trabajo se intenta contextualizar la situación actual de gran urgencia que vive nuestro planeta como es la gran oleada de refugiados e inmigrantes desplazados de sus países, y cómo trabajar con ellos desde las diferentes culturas de las que proceden frente a la cultura occidental del terapeuta, además de las circunstancias vividas en sus propios países, en los viajes a nuevos mundos y en las condiciones en las que viven en los países de acogida, intentando ofrecer herramientas para identificar problemas y generar soluciones. En este trabajo también se pretende demostrar la utilidad de la DMT en el trabajo con esta población, ya que la utilización de las diferentes herramientas de las que dispone esta profesión ayuda en el desarrollo de los traumas y situaciones complejas vividas y un mayor acercamiento a culturas desconocidas por el terapeuta. A través de esta revisión bibliográfica del trabajo de DMT con refugiados, inmigrantes y sobrevivientes de violencia en general, se pretende resaltar la importancia de del movimiento como terapia con esta población y mostrar la urgencia de buscar soluciones a la integración de esta población en las sociedades de acogid

DDR1 and Its Ligand, Collagen IV, Are Involved in In Vitro Oligodendrocyte Maturation

Discoidin domain receptor 1 (DDR1) is a tyrosine kinase receptor expressed in epithelial cells from different tissues in which collagen binding activates pleiotropic functions. In the brain, DDR1 is mainly expressed in oligodendrocytes (OLs), the function of which is unclear. Whether collagen can activate DDR1 in OLs has not been studied. Here, we assessed the expression of DDR1 during in vitro OL differentiation, including collagen IV incubation, and the capability of collagen IV to induce DDR1 phosphorylation. Experiments were performed using two in vitro models of OL differentiation: OLs derived from adult rat neural stem cells (NSCs) and the HOG16 human oligodendroglial cell line. Immunocytofluorescence, western blotting, and ELISA were performed to analyze these questions. The differentiation of OLs from NSCs was addressed using oligodendrocyte transcription factor 2 (Olig2) and myelin basic protein (MBP). In HOG16 OLs, collagen IV induced DDR1 phosphorylation through slow and sustained kinetics. In NSC-derived OLs, DDR1 was found in a high proportion of differentiating cells (MBP+/Olig2+), but its protein expression was decreased in later stages. The addition of collagen IV did not change the number of DDR1+/MBP+ cells but did accelerate OL branching. Here, we provide the first demonstration that collagen IV mediates the phosphorylation of DDR1 in HOG16 cells and that the in vitro co-expression of DDR1 and MBP is associated with accelerated branching during the differentiation of primary OLs

DDR1 and Its Ligand, Collagen IV, Are Involved in In Vitro Oligodendrocyte Maturation

Discoidin domain receptor 1 (DDR1) is a tyrosine kinase receptor expressed in epithelial cells from different tissues in which collagen binding activates pleiotropic functions. In the brain, DDR1 is mainly expressed in oligodendrocytes (OLs), the function of which is unclear. Whether collagen can activate DDR1 in OLs has not been studied. Here, we assessed the expression of DDR1 during in vitro OL differentiation, including collagen IV incubation, and the capability of collagen IV to induce DDR1 phosphorylation. Experiments were performed using two in vitro models of OL differentiation: OLs derived from adult rat neural stem cells (NSCs) and the HOG16 human oligodendroglial cell line. Immunocytofluorescence, western blotting, and ELISA were performed to analyze these questions. The differentiation of OLs from NSCs was addressed using oligodendrocyte transcription factor 2 (Olig2) and myelin basic protein (MBP). In HOG16 OLs, collagen IV induced DDR1 phosphorylation through slow and sustained kinetics. In NSC-derived OLs, DDR1 was found in a high proportion of differentiating cells (MBP+/Olig2+), but its protein expression was decreased in later stages. The addition of collagen IV did not change the number of DDR1+/MBP+ cells but did accelerate OL branching. Here, we provide the first demonstration that collagen IV mediates the phosphorylation of DDR1 in HOG16 cells and that the in vitro co-expression of DDR1 and MBP is associated with accelerated branching during the differentiation of primary OLs

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

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

Un Viaje que comenzó mucho antes de hacer las maletas : el sufrimiento y las diferencias culturales en el proceso terapéutico

A lo largo del trabajo se intenta contextualizar la situación actual de gran urgencia que vive nuestro planeta como es la gran oleada de refugiados e inmigrantes desplazados de sus países, y cómo trabajar con ellos desde las diferentes culturas de las que proceden frente a la cultura occidental del terapeuta, además de las circunstancias vividas en sus propios países, en los viajes a nuevos mundos y en las condiciones en las que viven en los países de acogida, intentando ofrecer herramientas para identificar problemas y generar soluciones. En este trabajo también se pretende demostrar la utilidad de la DMT en el trabajo con esta población, ya que la utilización de las diferentes herramientas de las que dispone esta profesión ayuda en el desarrollo de los traumas y situaciones complejas vividas y un mayor acercamiento a culturas desconocidas por el terapeuta. A través de esta revisión bibliográfica del trabajo de DMT con refugiados, inmigrantes y sobrevivientes de violencia en general, se pretende resaltar la importancia de del movimiento como terapia con esta población y mostrar la urgencia de buscar soluciones a la integración de esta población en las sociedades de acogid

Un Viaje que comenzó mucho antes de hacer las maletas : el sufrimiento y las diferencias culturales en el proceso terapéutico

A lo largo del trabajo se intenta contextualizar la situación actual de gran urgencia que vive nuestro planeta como es la gran oleada de refugiados e inmigrantes desplazados de sus países, y cómo trabajar con ellos desde las diferentes culturas de las que proceden frente a la cultura occidental del terapeuta, además de las circunstancias vividas en sus propios países, en los viajes a nuevos mundos y en las condiciones en las que viven en los países de acogida, intentando ofrecer herramientas para identificar problemas y generar soluciones. En este trabajo también se pretende demostrar la utilidad de la DMT en el trabajo con esta población, ya que la utilización de las diferentes herramientas de las que dispone esta profesión ayuda en el desarrollo de los traumas y situaciones complejas vividas y un mayor acercamiento a culturas desconocidas por el terapeuta. A través de esta revisión bibliográfica del trabajo de DMT con refugiados, inmigrantes y sobrevivientes de violencia en general, se pretende resaltar la importancia de del movimiento como terapia con esta población y mostrar la urgencia de buscar soluciones a la integración de esta población en las sociedades de acogid