Off-label use of rituximab in patients with systemic lupus erythematosus with extrarenal disease activity: a retrospective study and literature review.

Introduction: Off-label rituximab is commonly used for patients with systemic lupus erythematosus (SLE) with extrarenal disease activity. Methods: The outcomes and tolerability of rituximab in adult patients with non-renal SLE treated at our hospital from 2013 to 2020 were described. Patients were followed-up until December 2021. Data were retrieved from electronic medical records. Response was classified into complete, partial or no response according to the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2 K)-based definitions. Results: A total of 44 cycles were administered to 33 patients. Median age was 45 years and 97% were female. Median follow-up was 5.9 years (IQR 3.7-7.2). The most frequent symptoms that motivated rituximab use were thrombocytopenia (30.3%), arthritis (30.3%), neurological manifestations (24.2%) and cutaneous lupus (15.2%). After most treatment cycles a partial remission was achieved. The median SLEDAI-2 K score declined from 9 (IQR 5-13) to 1.5 (IQR 0-4) (p < 0.00001). The median number of flares significantly declined after receiving rituximab. Platelet counts significantly improved in patients with thrombocytopenia and patients with skin disorders or neurological manifestations also had a partial or complete response. Only 50% of patients with a predominant joint involvement had either a complete or a partial response. The median time to relapse after the first cycle was 1.6 years (95% CI, 0.6-3.1). Anti-dsDNA levels decreased significantly after rituximab from a median of 64.3 (IQR 12-373.9) to 32.7 (IQR 10-173), p = 0.00338. The most frequent adverse events were infusion-related reactions (18.2%) and infections (57.6%). All patients needed further treatment to maintain remission or to treat new flares. Conclusion: A partial or complete response was documented after most rituximab cycles in patients with non-renal SLE. Patients with thrombocytopenia, neurolupus, and cutaneous lupus had better response than those with a predominant joint involvement.

Collision Detection and Avoidance for Underwater Vehicles Using Omnidirectional Vision.

Exploration of marine habitats is one of the key pillars of underwater science, which often involves collecting images at close range. As acquiring imagery close to the seabed involves multiple hazards, the safety of underwater vehicles, such as remotely operated vehicles (ROVs) and autonomous underwater vehicles (AUVs), is often compromised. Common applications for obstacle avoidance in underwater environments are often conducted with acoustic sensors, which cannot be used reliably at very short distances, thus requiring a high level of attention from the operator to avoid damaging the robot. Therefore, developing capabilities such as advanced assisted mapping, spatial awareness and safety, and user immersion in confined environments is an important research area for human-operated underwater robotics. In this paper, we present a novel approach that provides an ROV with capabilities for navigation in complex environments. By leveraging the ability of omnidirectional multi-camera systems to provide a comprehensive view of the environment, we create a 360° real-time point cloud of nearby objects or structures within a visual SLAM framework. We also develop a strategy to assess the risk of obstacles in the vicinity. We show that the system can use the risk information to generate warnings that the robot can use to perform evasive maneuvers when approaching dangerous obstacles in real-world scenarios. This system is a first step towards a comprehensive pilot assistance system that will enable inexperienced pilots to operate vehicles in complex and cluttered environments.

Early Access to Medicines: Use of Multicriteria Decision Analysis (MCDA) as a Decision Tool in Catalonia (Spain).

Early access to medicines allows the prescription of a medicine before it is available in the public formulary to patients with severe or rare diseases with high unmet needs who have no authorised therapeutic alternatives available. In this context, consistent decision making is difficult, and a systematic assessment procedure could be useful to tackle complex situations and guarantee the equity of medicines' access. A multidisciplinary panel (MP) conducted four workshops to develop an early access framework based on a reflective multiple criteria decision analysis (MCDA). A set of 12 criteria was agreed: eight quantitative (severity of disease, urgency, efficacy, safety, internal and external validity, therapeutic benefit and plausibility) and four qualitative (therapeutic alternative, existence of precedents, management impact and costs). Quantitative criteria were weighted using a five-point scale. The relative importance of quantitative criteria had mean weights from 4.7 to 3.6, showing its relevance in the decisions. The framework was tested using two case studies, and reliability was assessed by re-test. The re-test revealed no statistical differences, indicating the consistency and replicability of the framework developed. MCDA may help to structure discussions for heterogeneous treatment requests, providing predictability and robustness in decision making involving sensitive and complex situations.

Labour accidents and financial performance: empirical analysis of the type of relationship in the Spanish context.

This article performs empirical research and finds a negative relationship between accidents in the workplace and financial performance. The relationship is stronger and more persistent for performance 1 year ahead than for the current year. We find no significant evidence of curvilinear U-shaped or inverted U-shaped relationships. Results are strong across different industries and samples, variable definitions and model specifications. The study contributes to the scarce extant research with reliable data and samples of a wide span of industries. The study also contributes methodologically with refined analyses of the curvilinear relationship and providing robust widespread inference for a large number of industries.

Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study.

Off-label use of rituximab is commonly requested for patients with resistant nephropathies. The outcomes and tolerability of rituximab in adult patients with nephropathy treated at our hospital (from 2013 to 2018) were described. Data were retrieved from electronic medical records. Response was classified as complete remission (CR), partial remission (PR), or no response (NR) according to the KDIGO criteria. A total of 89 requests were received for 61 patients. Median age was 58 years (45.9% female). Idiopathic membranous nephropathy (MN) (n = 30) was the most frequent indication, followed by minimal change disease (MCD) (n = 15) and secondary membranoproliferative glomerulonephritis (MPGN) (n = 12). Three patients with focal segmental glomerulosclerosis (FSGS) were included. After most treatment cycles in MN, a CR or PR was observed; median proteinuria levels significantly decreased for these patients (6000 mg/24h (IQR 3584-10,300) vs. 1468.8 (IQR 500-4604.25), p < 0.01). In MPGN, no response was documented after 46.7% of rituximab cycles. A CR or PR was described with the majority of rituximab cycles in MCD, with a significant decrease in proteinuria (6000 mg/24 h (IQR 4007-11,426) vs. 196.8 (IQR 100-1300), p = 0.013). No cycles produced a response in FSGS. Mean CD19+ B-cell decreased in all types of nephropathy (10.44% vs. 0.29%, p < 0.0001). Eleven patients presented infusion-related reactions, and 17 presented infectious complications. The majority of patients with MN and MCD had complete or partial responses; however, neither MPGN nor FSGS had encouraging results.

The status of imported Barremian-Bedoulian flint in north-eastern Iberia during the Middle Neolithic. Insights from the variscite mines of Gavà (Barcelona).

Barremian-Bedoulian flint from the Vaucluse region (western Provence, SE France), is traditionally considered one of the most significant chrono-cultural markers of the Chasséen culture during the Middle Neolithic (end of the 5th and beginning of the 4th millennium BC). Diffusion of Provençal flints became massive during the first half of the 4th millennium BC, penetrating in several neighbouring cultural spheres such as the Sepulcros de Fosa culture in north-eastern Iberia. The integrated study of the lithic assemblages from the variscite mines of Gavà (Barcelona) and its contextualization within the Sepulcros de Fosa culture in north-eastern Iberia have revealed unexpected complexity in the modes of consumption, use and status of imported Barremian-Bedoulian industries in north-eastern Iberia during the 5th to 4th millennia cal. BC transition. Local communities within this region, already controlling extraction and regional diffusion of variscite ornaments, exerted control over the fluxes of Vauclusian flint south of the Pyrenees, where it had a triple status (functional, symbolic and both). In addition, the results provide complementary data to better understand relevant aspects of the nature and organisation of Barremian-Bedoulian flint exploitation and early supply systems at the Provençal producing sites during the later phase of the Chasséen culture.

Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides: Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity.

The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome.A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 ±â€Š17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 ±â€Š2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.

Surgical treatment for an uncommon headache: A gap of 4800 years.

Background Surgical management of headache due to anomalies in the cervical spine is uncommon, as most cases improve with drugs and/or physical therapy. Case We report two instances of a very uncommon congenital upper cervical spine anomaly due to the presence of a pseudoarthrosis between a unilateral paracondylar process in the base of the skull and an epitransverse process arising from the transverse apophysis (PCP/ETA). The first one corresponds to a male on whom an endoscopic guided puncture was performed, and the second to an adult male from the Neolithic period who showed two cranial trepanations together with the presence of morphine metabolites in both bones and dental calculus. Discussion We draw a parallel between the treatment of two individuals separated by a gap of more than 4800 years: contemporary direct vision of the false joint through a small endoscope, which provides an accurate puncture, and ancient double trepanation with clear signs of bone eburnation.

Close-Range Tracking of Underwater Vehicles Using Light Beacons.

This paper presents a new tracking system for autonomous underwater vehicles (AUVs) navigating in a close formation, based on computer vision and the use of active light markers. While acoustic localization can be very effective from medium to long distances, it is not so advantageous in short distances when the safety of the vehicles requires higher accuracy and update rates. The proposed system allows the estimation of the pose of a target vehicle at short ranges, with high accuracy and execution speed. To extend the field of view, an omnidirectional camera is used. This camera provides a full coverage of the lower hemisphere and enables the concurrent tracking of multiple vehicles in different positions. The system was evaluated in real sea conditions by tracking vehicles in mapping missions, where it demonstrated robust operation during extended periods of time.

Ús i abús de les noves tecnologies de la comunicació per part dels adolescents / Adolescentes y nuevas tecnologías de la comunicación / Teenagers and new communication technologies

Objectiu: conèixer la utilització i l'actitud dels adolescents enfront les noves tecnologies de la comunicació. Mètode: estudi observacional, transversal a 539 adoles-cents que estudiaven 2n d'ESO (educació secundària obli-gatòria) en cinc instituts de Reus i dos pobles veïns. Els adolescents van respondre, el febrer del 2013, un qüestionari autoadministrat de 47 preguntes. Resultats: Televisió: el 39,1% la miren sols. La miren durant el dinar el 75,0% i durant el sopar el 80,6%. Els repetidors de curs la tenen més sovint a la seva habitació i la miren més de 3 h/dia. Telèfon mòbil: el 83,1% en tenen, el 53,1% l'utilitzen més d'1 h/dia, sobretot per a missatgeria, Internet i WhatsApp. Videojocs: el 84,2% en tenen. El 46,8% hi juguen 1-2 h/dia. Els jocs a què juguen més són de guerra i futbol. Ordinador: el 69,7% en tenen a l'habitació. Sols el 15,9% dels pares tenen control sobre el seu ús. L'utilitzen sobretot per a Facebook, navegar o xatejar. Els repetidors de curs estan una mitjana de 3 hores o més al dia connectats. El 27,8% dels enquestats han rebut propostes per quedar i el 18,8%, propostes de tipus sexual. El 49,2% diuen que la identificació del xat és fiable. Conclusions: els adolescents del nostre entorn dediquen moltes hores a les noves tecnologies de la comunicació. La majoria no tenen control parental i troben fiables les identificacions per Internet. Un nombre considerable reben proposicions per quedar, i també de tipus sexual. Els repetidors de curs són els que més tenen la televisió a l'habitació i els que dediquen més hores a veure-la i a estar connectats a Internet

Objetivo. Conocer la utilización y la actitud de los adolescentes frente a las nuevas tecnologías de la comunicación. Método. Estudio observacional, transversal a 539 adolescentes que estudiaban 2.º de ESO (educación secundaria obligatoria) en cinco institutos de Reus y dos poblaciones vecinas. Los adolescentes respondieron, en febrero de 2013, un cuestionario autoadministrado de 47 preguntas con respuestas. Resultados. Televisión: Televisión: el 39,1% la miran solos. La miran durante la comida el 75,0% y durante la cena el 80,6%. Los repetidores de curso la tienen con más frecuencia en su habitación i la miran más de 3 h/día. Teléfono móvil: Teléfono móvil: el 83,1% lo tienen. El 53,1% lo utilizan más de 1 h/día, sobre todo para mensajes, Internet y WhatsApp. Videoconsola: Videoconsola: el 84,2% la tienen. El 46,8% juegan 1-2 h/día. Los juegos con los que más juegan son de guerra y útbol. Ordenador: Ordenador: el 69,7% lo tienen en la habitación. Solo el 15,9% de los padres tienen control sobre su uso. Lo utilizan sobre todo para Facebook, navegar o chatear. Los repetidores de curso están una media de 3 horas o más al día conectados. El 27,8% de los encuestados han recibido propuestas para citas, y el 18,8% propuestas de tipo sexual. El 49,2% dicen que la identificación en los chats es fiable. Conclusiones. Los adolescentes de nuestro entorno dedican muchas horas a las tecnologías de la comunicación. La mayoría no tienen control parental y hallan fiable las identificaciones por Internet. Un número considerable reciben proposiciones para citas, y también de tipo sexual. Los repetidores de curso son los que más tienen televisión en la habitación y los que dedican más horas a verla y a estar conectados a Internet (AU)

Objective. To know the use and attitude of adolescents towards new communication technologies. Method. Observational cross-sectional study with 539 adolescents studying second year of secondary education, in 5 institutes in Reus and two neighboring towns. Adolescents responded in February 2013 a self-administered questionnaire of 47 questions. Results. Television: Television: 39.1% watch it alone. 75% of the students look at it during lunch and 80.6% while having dinner. Repeating students have it more often in their room and watch it more than 3 hours/day. Mobile phone: Mobile phone: 83.1% have one and 53.1% use it more than 1 hour/day, especially for messaging, internet and whatsapp. Game console: Game console: 84.2% have one and 46.8% play 1-2hours/day. The games they play are more frequently about war or football. Computer: Computer: 69.7% have one in the room. Only 15.9% of parents have control over their use. They use it especially for Facebook, browsing or chats. Repeating students are an average of 3 or more hours a day connected. 27.8% of respondents have received proposals for dates, and 18.8% of them sexual. 49.2% say that identification is reliable in chats. Conclusions. Teenagers around us spend many hours using communication technologies. Most have no parental control and think that internet has reliable identifications. A considerable number of adolescents receive proposals for dates and a few of a sexual nature. Repeating students are those who have more TV in their room and they spend more hours to watch it and to be connected to the Internet (AU)

Omnidirectional underwater camera design and calibration.

This paper presents the development of an underwater omnidirectional multi-camera system (OMS) based on a commercially available six-camera system, originally designed for land applications. A full calibration method is presented for the estimation of both the intrinsic and extrinsic parameters, which is able to cope with wide-angle lenses and non-overlapping cameras simultaneously. This method is valid for any OMS in both land or water applications. For underwater use, a customized housing is required, which often leads to strong image distortion due to refraction among the different media. This phenomena makes the basic pinhole camera model invalid for underwater cameras, especially when using wide-angle lenses, and requires the explicit modeling of the individual optical rays. To address this problem, a ray tracing approach has been adopted to create a field-of-view (FOV) simulator for underwater cameras. The simulator allows for the testing of different housing geometries and optics for the cameras to ensure a complete hemisphere coverage in underwater operation. This paper describes the design and testing of a compact custom housing for a commercial off-the-shelf OMS camera (Ladybug 3) and presents the first results of its use. A proposed three-stage calibration process allows for the estimation of all of the relevant camera parameters. Experimental results are presented, which illustrate the performance of the calibration method and validate the approach.

Estimació dels casos de mort tributàries de cures pal·liatives pediàtriques / Estimación de los casos de muerte tributarias de cuidados paliativos pediátricos / Estimation of the number of child deaths that are susceptible of benefitting from palliative care

Fonament: la mort ha estat, és i seguirà sent una realitat, per sort poc freqüent, en pediatria. La causa inicial o fonamental que pot causar la mort a un nen o una nena pot ser una malaltia aguda o crònica, que equival a una potencial mort imprevisible o previsible, respectivament. En els casos en què es pot preveure una mort abans d'arribar a l'edat adulta, independentment de les opcions curatives, estan indicades les cures pal·liatives pediàtriques (CPP). Objectiu: conèixer la situació i les causes de mortalitat de pacients entre 0 i 19 anys a Catalunya entre el període 2007-2011 i classificar les causes inicials o fonamentals en tributàries o no de CPP. Mètode.: revisió de l'estadística de mortalitat i de la causalitat d'aquesta segons fonts del Ministeri de Sanitat, Serveis Socials i Igualtat. Classificació de la causa inicial de mort entre tributàries o no de CPP, segons la classificació de Cochrane H et al. Resultats.: els primers anys de vida, la principal causa de mortalitat són les afeccions originades en el període perinatal i les malformacions congènites, en edats posteriors, els tumors i les causes externes. Més del 60% de morts en l'edat pediàtrica podrien ser tributàries de CPP a causa del caràcter amenaçant o limitant de la malaltia de base. Conclusions: l'etiologia de la mort varia en funció de l'edat. Conèixer les causes de mortalitat i les malalties tributàries de CPP permet estimar les necessitats de CPP (AU)

Fundamento. La muerte ha sido, es y seguirá siendo una realidad, por suerte poco frecuente, en pediatría. La causa inicial o fundamental que puede causar la muerte a un niño o una niña puede ser una enfermedad aguda o crónica, que equivale a una probable muerte imprevisible o previsible, respectivamente. En aquellos casos en los que se puede prever una muerte antes de llegar a la edad adulta, independientemente de las opciones curativas, están indicados los cuidados paliativos pediátricos (CPP). Objetivo. Conocer la situación y las causas de mortalidad de pacientes entre 0 y 19 años en Cataluña entre el periodo 2007-2011 y clasificar las causas iniciales o fundamentales en tributarias o no de CPP. Método. Revisión de la estadística de mortalidad y de la causalidad de ésta según fuentes del Ministerio de Sanidad, Servicios Sociales e Igualdad. Clasificación de la causa inicial de muerte entre tributarias o no de CPP, según la clasificación de Cochrane H et al. Resultados. En los primeros años de vida, la principal causa de mortalidad son las afecciones originadas en el período perinatal y las malformaciones congénitas, en edades posteriores, los tumores y las causas externas. Más del 60% de muertes en la edad 0-19 años podrían ser tributarias de CPP debido al carácter amenazante o limitante de la enfermedad de base. Conclusiones. La etiología de la muerte varía en función de la edad. Conocer las causas de mortalidad y las enfermedades tributarias de CPP permite estimar las necesidades de CPP (AU)

Background. Death has been, is, and will continue to be a reality, fortunately rare, in pediatrics. The main causes of death in children are acute or chronic diseases, which result in unexpected or foreseeable death, respectively. In those cases where death before adulthood can be foreseen there is an indication for paediatric palliative care (PPC), regardless of the curative options. Objective. To determine the status and cause of death in patients younger than 19 years in Catalonia between 2007 and 2011, and to classify the causes of death in terms of their potential for PPC services. Method. We reviewed the mortality statistics of the Spanish Ministry of Health, Social Services, and Equality, and we identified the main cause of death. We then categorized the causes of death between those who could have benefitted from PPC and those who could not, according to the Cochrane classification. Results. The main causes of death were congenital malformations or perinatal diseases in the younger age groups, and cancer and external causes in older children and adolescents. More than 60% of children who die are candidates for PPC, due to the life-threatening or life-limiting characteristics of the underlying disease. Conclusions. The cause of death varies with age. In those cases where death before adulthood could be foreseen, a comprehensive and multidisciplinary care involving the child and the family is necessary (AU)

Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry).

OBJECTIVE: To evaluate systemic involvement in primary SS in a large cohort of Spanish patients using the EULAR-SS disease activity index (ESSDAI) definitions. METHODS: Systemic involvement was characterized using ESSDAI definitions for the 10 clinical domains (constitutional, lymphadenopathy, glandular, articular, cutaneous, pulmonary, renal, peripheral nervous system, central nervous system and muscular). ESSDAI scores at diagnosis, during follow-up and cumulated at the last visit were calculated. RESULTS: The cohort consisted of 921 patients. After a mean follow-up of 75 months, 77 (8%) patients still had an ESSDAI score of zero at the last visit. Organ by organ, the percentage of patients who developed activity during the follow-up (ESSDAI score ≥ 1 at any time) ranged between 1.4% and 56%, with articular, pulmonary and peripheral neurological involvement being the most common. Logistic multivariate regression analysis showed the following features at diagnosis and had the closest association with systemic activity (statistically significant independent variables in at least two domains): cryoglobulinaemia in five domains; anaemia, lymphopenia and low C3 levels in three domains each and age <35 years in two domains. Sicca features, ANA and RF at diagnosis were not associated with a higher cumulated activity score in any clinical domain. CONCLUSION: Primary SS is undeniably a systemic disease, with the joints, lungs, skin and peripheral nerves being the most frequently involved organs. Cytopenias, hypocomplementaemia and cryoglobulinaemia at diagnosis strongly correlated with higher cumulated ESSDAI scores in the clinical domains. Clinically the ESSDAI provides a reliable picture of systemic involvement in primary SS.

Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol.

BACKGROUND: Lifestyle is one of the main determinants of people's health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors' communication skills, and more specifically the Motivational Interviewing. METHODS/DESIGN: The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. - SCOPE: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product-moment correlation coefficient). DISCUSSION: The verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes. TRIALS REGISTRATION Dislip-EM study: NCT01282190 (ClinicalTrials.gov).

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol.

BACKGROUND: The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. METHODS/DESIGN: An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. DISCUSSION: Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity. TRIALS REGISTRATION: ClinicalTrials.gov (NCT01282190).

ZmXTH1, a new xyloglucan endotransglucosylase/hydrolase in maize, affects cell wall structure and composition in Arabidopsis thaliana.

Xyloglucan endotransglucosylase/hydrolases (XTHs; EC 2.4.1.207 and/or EC 3.2.1.151) are enzymes involved in the modification of cell wall structure by cleaving and, often, also re-joining xyloglucan molecules in primary plant cell walls. Using a pool of antibodies raised against an enriched cell wall protein fraction, a new XTH cDNA in maize, ZmXTH1, has been isolated from a cDNA expression library obtained from the elongation zone of the maize root. The predicted protein has a putative N-terminal signal peptide and possesses the typical domains of this enzyme family, such as a catalytic domain that is homologous to that of Bacillus macerans beta-glucanase, a putative N-glycosylation motif, and four cysteine residues in the central and C terminal regions of the ZmXTH1 protein. Phylogenetic analysis of ZmXTH1 reveals that it belongs to subgroup 4, so far only reported from Poaceae monocot species. ZmXTH1 has been expressed in Pichia pastoris (a methylotrophic yeast) and the recombinant enzyme showed xyloglucan endotransglucosylase but not xyloglucan endohydrolase activity, representing the first enzyme belonging to subgroup 4 characterized in maize so far. Expression data indicate that ZmXTH1 is expressed in elongating tissues, modulated by culture conditions, and induced by gibberellins. Transient expression assays in onion cells reveal that ZmXTH1 is directed to the cell wall, although weakly bound. Finally, Arabidopsis thaliana plants expressing ZmXTH1 show slightly increased xyloglucan endohydrolase activity and alterations in the cell wall structure and composition.

El Pla Estratègic d'Ordenació de l'Atenció de Pediatria a l'Atenció Primària / No disponible

Recentment s'ha fet públic el Pla Estratègic d'Ordenacióde l'Atenció de Pediatria a l'Atenció Primària elaboratper la Direcció General de Planificació i Avaluació del Departament de Salut. Aquesta aportació no pretén una discussió minuciosa del text del Pla Estratègic, sinó considerar alguns dels conceptes en què es basa per fer les seves propostes i també les raons amb les quals hi dóna suport. L'autor creu que no es pot assegurar que la seva aplicació garanteixi una atenció pediàtrica primària de qualitat

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[Assessment of self-perceived body image in female adolescents aged 12-21 years in the city of Reus (Spain)]. / Valoración de la propia imagen corporal en adolescentes femeninas de 12 a 21 años de la ciudad de Reus.

OBJECTIVE: To assess the degree of body image distortion in female adolescents and evaluate its association with the social esthetic model and the adoption of dietary measures. METHOD: We performed a cross sectional, observational study in a random sample of female adolescents aged 12 to 21 years old. Information was gathered via two different sources. A structured questionnaire including sociodemographic and anthropometric items was administered to determine adolescents' desire to resemble advertising models, their satisfaction with trouser size, and whether they would follow an unsupervised diet, etc. A game consisting of 9 images of female shapes of increasing size was used to evaluate self-perceived body image. The subjects chose the shape they believed most closely resembled their own. RESULTS: A sample of 401 subjects with a mean age of 17.6 (standard deviation = 2.6) years was evaluated. Seventy-five percent had normal weight, 11% were overweight, 13% were obese, and 0.8% were underweight. A total of 76.8% of the subjects had distorted body image and wished to look like advertising models (p < 0.001), 47.7% were dissatisfied with their trouser size (p < 0.001), and 15.3% were following special diets without supervision (p < 0.001). CONCLUSIONS: The majority of adolescents aged between 13 and 21 years old were dissatisfied with their body image. A distorted body image translates into wanting to resemble advertising models and dissatisfaction with trouser size, which in turn leads to following unsupervised diets.

Valoración de la propia imagen corporal en adolescentes femeninas de 12 a 21 años de la ciudad de Reus / Assessment of self-perceived body image in female adolescents aged 12-21 years in the city of Reus (Spain)

Objetivo. Determinar el grado de distorsión de la autoimagen corporal en adolescentes femeninas, y evaluar su asociación con el modelo estético-social y la adopción de medidas dietéticas. Método. Estudio observacional y transversal. Muestra aleatoria poblacional de adolescentes femeninas de entre 12 y 21 años de edad. La información fue recogida a través de 2 fuentes: mediante un cuestionario estructurado sobre datos sociodemográficos y antropométricos (deseo de parecerse a las modelos publicitarias, satisfacción con la talla de pantalón que usaban, si realizaban dietas sin supervisión, etc.) y valoración de la autopercepción de la propia imagen corporal mediante un juego de 9 imágenes de siluetas femeninas de anchura creciente. Resultados. Se analizaron 401 adolescentes con una media de edad de 17,6 años (desviación estándar = 2,6). En cuanto al peso, el 75,3% tenía normopeso, el 11% sobrepeso, el 13% obesidad y el 0,8% bajopeso. Respecto a la percepción de la imagen, el 76,8% presentaba distorsión de la autoimagen corporal y le gustaba parecerse a las modelos publicitarias (p < 0,001). El 47,7% no estaba de acuerdo con la talla de pantalón que usaba (p < 0,001). El 15,3% realizaba dieta sin supervisión (p < 0,001). Conclusiones. La mayoría de adolescentes en edades comprendidas entre 13 y 21 años no está conforme con su imagen corporal. La distorsión de la autoimagen corporal se traduce en querer parecerse más a las modelos publicitarias y a no estar satisfechas con sus tallas de pantalón. Esto las lleva a la realización de dietas sin supervisión

Objective. To assess the degree of body image distortion in female adolescents and evaluate its association with the social esthetic model and the adoption of dietary measures. Method. We performed a cross sectional, observational study in a random sample of female adolescents aged 12 to 21 years old. Information was gathered via two different sources. A structured questionnaire including sociodemographic and anthropometric items was administered to determine adolescents' desire to resemble advertising models, their satisfaction with trouser size, and whether they would follow an unsupervised diet, etc. A game consisting of 9 images of female shapes of increasing size was used to evaluate self-perceived body image. The subjects chose the shape they believed most closely resembled their own. Results. A sample of 401 subjects with a mean age of 17.6 (standard deviation 5 2.6) years was evaluated. Seventy-five percent had normal weight, 11% were overweight, 13% were obese, and 0.8% were underweight. A total of 76.8% of the subjects had distorted body image and wished to look like advertising models (p < 0.001), 47.7% were dissatisfied with their trouser size (p < 0.001), and 15.3% were following special diets without supervision (p < 0.001). Conclusions. The majority of adolescents aged between 13 and 21 years old were dissatisfied with their body image. A distorted body image translates into wanting to resemble advertising models and dissatisfaction with trouser size, which in turn leads to following unsupervised diets

La millora de l’atenció primària: reflexions després d’escoltar la ràdio / No disponible

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