Pesticides in water and sediments from natural protected areas of Spain and their associated ecological risk.

In the last years, issues related to intensive agriculture have been found in protected areas potentially harming wildlife. This study aimed to analyze a wide range of pesticides in water and sediments of two protected areas namely Doñana Natural Park (DNP) and Tablas de Daimiel National Park (TDNP) performing an environmental risk assessment in order to highlight potential risks to living organisms derived from pesticide burden. Higher pesticide load was found in DNP than TDNP with similar distribution profiles, with pyrethroid insecticides (PYRs) the main detected class. Particularly problematic are two PYRs, cyhalothrin and fenvalerate, which were detected at high concentrations that can pose a high risk to aquatic organisms. In addition, despite being detected at lower concentrations, the presence of chlorpyrifos, cypermethrin, and permethrin in water, and of chlorpyrifos, dicofol, and diflufenican in sediments, must be taken into account due to their potential risks for aquatic organisms. Moreover, some banned pesticides such as dimethoate, terbutryn, diazinon, and tricyclazol were detected in water at levels which deserve further investigation to assess their potential sources, including potential illegal practices.

Nanoparticle-mediated thermal Cancer therapies: Strategies to improve clinical translatability.

Despite significant advances, cancer remains a leading global cause of death. Current therapies often fail due to incomplete tumor removal and nonspecific targeting, spurring interest in alternative treatments. Hyperthermia, which uses elevated temperatures to kill cancer cells or boost their sensitivity to radio/chemotherapy, has emerged as a promising alternative. Recent advancements employ nanoparticles (NPs) as heat mediators for selective cancer cell destruction, minimizing damage to healthy tissues. This approach, known as NP hyperthermia, falls into two categories: photothermal therapies (PTT) and magnetothermal therapies (MTT). PTT utilizes NPs that convert light to heat, while MTT uses magnetic NPs activated by alternating magnetic fields (AMF), both achieving localized tumor damage. These methods offer advantages like precise targeting, minimal invasiveness, and reduced systemic toxicity. However, the efficacy of NP hyperthermia depends on many factors, in particular, the NP properties, the tumor microenvironment (TME), and TME-NP interactions. Optimizing this treatment requires accurate heat monitoring strategies, such as nanothermometry and biologically relevant screening models that can better mimic the physiological features of the tumor in the human body. This review explores the state-of-the-art in NP-mediated cancer hyperthermia, discussing available nanomaterials, their strengths and weaknesses, characterization methods, and future directions. Our particular focus lies in preclinical NP screening techniques, providing an updated perspective on their efficacy and relevance in the journey towards clinical trials.

Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge.

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

Severe pulmonary hypertension and circulatory failure associated with Congenital syphilis. Case report.

BACKGROUND: Congenital syphilis is a vertical infection caused by Treponema pallidum. Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS: This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS: A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment.

High linoleic acid levels in red blood cells predict a poor response to neoadjuvant chemotherapy in human epidermal growth factor receptor type 2-positive breast cancer patients.

OBJECTIVE: Polyunsaturated fatty acids are categorized as ω-3 or ⍵-6. Previous studies demonstrate that breast cancers display a high expression of fatty acid synthase and high fatty acid levels. Our study sought to determine if changes in plasma or red blood cell membrane fatty acid levels were associated with the response to preoperative (neoadjuvant) chemotherapy in non-metastatic breast cancer patients. METHODS: Our prospective study assessed fatty acid levels in plasma and red blood cell membrane. Response to neoadjuvant chemotherapy was evaluated by the presence or absence of pathologic complete response and/or residual cancer burden. RESULTS: A total of 28 patients were included. First, patients who achieved pathologic complete response had significantly higher neutrophil-to-lymphocyte ratio versus no pathologic complete response (P = 0.003). Second, total red blood cell membrane polyunsaturated fatty acids were higher in the absence of pathologic complete response (P = 0.0028). Third, total red blood cell membrane ⍵-6 polyunsaturated fatty acids were also higher in no pathologic complete response (P < 0.01). Among ⍵-6 polyunsaturated fatty acids, red blood cell membrane linoleic acid was higher in the absence of pathologic complete response (P < 0.01). Notably, plasma polyunsaturated fatty acid, ⍵-6, and linoleic acid levels did not have significant differences. A multivariate analysis confirmed red blood cell membrane linoleic acid was associated with no pathologic complete response; this was further confirmed by receiver operating characteristic analysis (specificity = 92.3%, sensitivity = 76.9%, and area under the curve = 0.855). CONCLUSIONS: Pending further validation, red blood cell membrane linoleic acid might serve as a predictor biomarker of poorer response to neoadjuvant chemotherapy in non-metastatic human epidermal growth factor receptor type 2-positive breast cancer. Measuring fatty acids in red blood cell membrane could offer a convenient, minimally invasive strategy to identifying patients more likely to respond or those with chemoresistance.

Hidrocistomas ecrinos múltiples

RESUMEN Los hidrocistomas ecrinos son tumores benignos, únicos o múltiples. Se presentan con mayor frecuencia en la mediana edad y predominan en el sexo femenino. Se presenta un paciente con hidrocistomas ecrinos múltiples, masculino de 74 años.

ABSTRACT Eccrine hydrocystomas are benign tumors, which can be single or multiple. They occur most oftenly in middle aged patients or in the elderly, predominantly female. We present a case of multiple eccrine hydrocystomas, in a 74-year-old male patient.

Evaluación de la simulación de alta fidelidad con actores en cuidados paliativos y estudiantes de Enfermería: un estudio de método mixto / Assessment of high fidelity simulation with actors in palliative care in nursing students: A mixed methods study

Objetivo: Los métodos formativos más efectivos son los experienciales, y entre ellos, los que están centrados en las vivencias y emociones. La simulación clínica, especialmente la de alta fidelidad, es una de las metodologías más efectivas para la adquisición de competencias en cuidados. La simulación con actores puede preparar a los futuros sanitarios en técnicas y competencias intelectuales e interpersonales. El objetivo fue valorar la simulación de alta fidelidad con actores como herramienta en la formación de cuidados paliativos en estudiantes de enfermería. Método: Durante tres años se realizó el estudio en la Facultad de Enfermería de la Universidad de Murcia con estudiantes de enfermería. Se realizó un estudio de método mixto con un diseño secuencial explicativo en tres momentos: 1)Estudio cuasi-experimental con grupo único (n=12) antes y después de cursar la asignatura de cuidados paliativos donde se realizó simulación clínica y se evaluaron competencias de comunicación mediante la escala CICAA. 2)Estudio cualitativo fenomenológico tras la simulación (174 narrativas reflexivas de estudiantes). 3)Estudio transversal observacional, un año después, para valorar la transferencia a la clínica de conocimientos y habilidades (contestaron 71 estudiantes). Resultados: La simulación de alta fidelidad con actores mejora las habilidades comunicativas y la capacidad para establecer una relación de ayuda eficaz tanto con pacientes en la fase final de la vida como con sus familiares. Es una metodología de aprendizaje innovadora, útil y que fomenta la reflexión y el traslado del aprendizaje a la clínica. Conclusiones: Se recomienda la estandarización de metodologías activas de aprendizaje para mejorar la adquisición de habilidades transversales como las de comunicación en cuidados paliativos.(AU)

Objective: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. Method: Over three years, the study was conducted in the Faculty of Nursing of Murcia with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: 1)Quasi-experimental study in a single group (n=12) before and after attending the palliative care course with clinical simulation with actors to assess the communication skills (CICAA scale). 2)Qualitative study with phenomenological perspective after clinical simulation (174 reflective students’ narratives). 3)Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). Results: Students who interacted with actors in clinical simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the clinical simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. Conclusions: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.(AU)

Patritumab deruxtecan in untreated hormone receptor-positive/HER2-negative early breast cancer: final results from part A of the window-of-opportunity SOLTI TOT-HER3 pre-operative study.

BACKGROUND: Patritumab deruxtecan (HER3-DXd) is a human epidermal growth factor receptor 3 (HER3)-directed antibody-drug conjugate composed of a fully human anti-HER3 monoclonal antibody (patritumab) covalently linked to a topoisomerase I inhibitor payload via a stable, tumor-selective, tetrapeptide-based cleavable linker. TOT-HER3 is a window-of-opportunity study designed to assess the biological activity, measured by CelTIL score [= -0.8 × tumor cellularity (in %)  + 1.3  × tumor-infiltrating lymphocytes (TILs) (in %)], and clinical activity of HER3-DXd during short-term (21 days) pre-operative treatment in patients with primary operable HER2-negative early breast cancer. PATIENTS AND METHODS: Patients with previously untreated hormone receptor-positive/HER2-negative tumors were allocated to one of four cohorts according to baseline ERBB3 messenger RNA expression. All patients received one dose of HER3-DXd 6.4 mg/kg. The primary objective was to evaluate change from baseline in CelTIL score. RESULTS: Seventy-seven patients were evaluated for efficacy. A significant change in CelTIL score was observed, with a median increase from baseline of 3.5 (interquartile range, -3.8 to 12.7; P = 0.003). Among patients assessable for clinical response (n = 62), an overall response rate of 45% was observed (tumor measurement by caliper), with a trend toward an increase in CelTIL score among responders compared with non-responders (mean difference, +11.9 versus +1.9). Change in CelTIL score was independent of baseline ERBB3 messenger RNA and HER3 protein levels. Genomic changes occurred, including switching toward a less proliferative tumor phenotype based on PAM50 subtypes, suppression of cell proliferation genes, and induction of genes associated with immunity. Treatment-emergent adverse events were observed in 96% of patients (14% grade ≥3); most common were nausea, fatigue, alopecia, diarrhea, vomiting, abdominal pain, and neutrophil count decrease. CONCLUSIONS: A single dose of HER3-DXd was associated with clinical response, increased immune infiltration, suppression of proliferation in hormone receptor-positive/HER2-negative early breast cancer, and a tolerable safety profile consistent with previously reported results. These findings support further study of HER3-DXd in early breast cancer.

Access disparities and underutilization of germline genetic testing in Chilean breast cancer patients.

PURPOSE: Latin American reports on genetic cancer risk assessments are scarce. In Chile, current breast cancer (BC) guidelines do not define strategies for germline genetic testing. Our study sought to quantify the disparities in access to genetic testing in Chilean BC patients, according to international standards and their clinical characteristics to explore improvement strategies. METHODS: Retrospective analysis of invasive BC databases including patients treated in a Public Hospital (PH) and in an Academic Private Center (AC) in Santiago, Chile between 2012 and 2021. RESULTS: Of 5438 BC patients, 3955 had enough data for National Comprehensive Cancer Network (NCCN) categorization. From these, 1911 (48.3%) fulfilled NCCN criteria for germline testing, of whom, 300 were tested for germline mutations and 268 with multigene panels. A total of 65 pathogenic variants were found in this subset. As expected, BRCA1/2 mutations were the most frequent (17.7%). Access to genetic testing was higher in AC versus PH (19.6% vs. 10.3%, p = 0.0001). Other variables associated with germline genetic testing were BC diagnosis after 2018, being 45 years old or younger at diagnosis, BC family history (FH), FH of ovarian cancer, non-metastatic disease, and triple-negative subtype. CONCLUSION: In our cohort, 15% of BC patients who met NCCN criteria for germline testing were effectively tested. This percentage was even lower at the PH. Current recommendations encourage universal genetic testing for BC patients; however, our findings suggest that Chile is far from reaching such a goal and national guidelines in this regard are urgently needed. To our knowledge, this is the first study of its kind in Chile and Latin America.

Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery.

BACKGROUND: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. MATERIAL AND METHODS: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. RESULTS: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. CONCLUSIONS: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions.

Positive body image: a qualitative study on the successful experiences of adolescents, teachers and parents.

Purpose Body image encompasses body-related self-perceptions and personal attitudes. Dissatisfaction with body image during the early stages of adolescence is negatively related to self-esteem and other health problems. A few publications focused on positive body image and directly related to the experiences and interactions of adolescents themselves. To explore positive body image in adolescents and describe the familial and educational factors that contribute to its development.Methods A qualitative study was conducted. Purposive sampling was used, and 9 adolescents, 6 families, and 8 teachers participated in semi-structured interviews, which were then theme analyzed. Results Self-care, body acceptance, confronting messages that attack body image, and the influence of social media have been identified as emerging themes in adolescents' positive body image experiences. Therefore, the pubertal period, family values, fostering, and educational actions as well as media literacy were identified as factors promoting self-esteem and positive body image in the family and educational environment. Conclusions Their parents also expressed aspects such as those that contribute to the development of healthy self-esteem, confidence, and positive body image. Alternatively, the teachers indicated educational activities to work on self-image and self-esteem when faced with situations of concern in the classroom.

Factores asociados al desarrollo de estrés, ansiedad y depresión en trabajadores sanitarios en el contexto de la pandemia por COVID-19 en Perú / Factors associated with the development of stress, anxiety and depression in the context of COVID-19 pandemic in Peruvian healthcare facilities

Objetivo: Describir las características sociodemográficas y determinar los factores asocia-dos a manifestaciones psicológicas de depresión, ansiedad y estrés en trabajadores sanita-rios en el contexto de la pandemia por COVID-19 en los establecimientos de salud del Perú durante mayo de 2020.Métodos: Se realizó un estudio transversal en trabajadores sanitarios de establecimientos hospitalarios del Perú. Se elaboró un cuestionario estructurado que incluía las características sociodemográficas, la profesión, área y lugar de trabajo, y cuestionarios validados para tras-torno de ansiedad generalizada (GAD-7), Salud del paciente (PHQ-9) y la Escala de impacto del estresor revisada (IES-R). Para el análisis se utilizó modelos lineales generalizados de Poisson, función de enlace logarítmico y varianzas robustas. Se calculó el rango intercuartílico (RIC) y la razón de prevalencia ajustada (RPa) y su intervalo de confianza del 95% (IC95%).Resultados: De un total de 258 encuestados, 254 (98%) completaron al cuestionario, sien-do el 61,8% mujeres y el área de trabajo más común emergencia u hospitalización (62,2%). La puntuación mediana del PHQ-9 fue 4 (RIC:2-7), del GAD-7 fue 6 (RIC:4-8) y para el IES-R fue 16 (RIC:8-24). El análisis multivariado mostró que ser médico se asocia con una menor prevalencia de ansiedad (RPa: 0,77; IC 95%: 0,62-0,94), mientras que vivir solo se asoció con una mayor prevalencia de depresión (RPa: 1,46; IC 95%: 1,11-1,92).Conclusión: El personal sanitario manifestó alteraciones psicológicas, asociado principal-mente al personal no médico y vivir solo (AU)

Objective: To describe the sociodemographic characteristics and determine the factors as-sociated with psychological manifestations of depression, anxiety, and stress in healthcare workers in the context of COVID-19 pandemic in health facilities in Peru during the month of May 2020.Methods: An analytical cross-sectional study was conducted out in healthcare workers of hospital establishments in Peru. To evaluate the outcome of interest, we administered a structured questionnaire that asked about type of healthcare personnel; sociodemographic characteristics; Generalized Anxiety Disorder scale (GAD-7); Patient Health Questionnaire scale (PHQ-9); and the Revised Stressor Impact scale (IES-R). We used generalized linear Poisson models, with a logarithmic link function and robust variance.Results: Out of 258 respondents, 254 completed the survey; 61.8% were women; the most common work area was emergency department or hospitalization (inpatient) services (62.2%). The median PHQ-9 score was 4 points (IQR: 2-7); for the GAD-7, it was 6 points (IQR: 4-8), and for the IES-R, 16 points (IQR: 8-24). The multivariate analysis showed that being a physician was associated with less anxiety (PR: 0.77; 95% CI: 0.62-0.94), whereas living alone was associated with a greater risk of depression (PR: 1.46; 95% CI: 1.11-1.92).Conclusions: Healthcare personnel are at risk of manifesting psychological alterations, mainly associated with the female gender, non-medical personnel and living alone (AU)

Human papillomavirus infection and lung adenocarcinoma: special benefit is observed in patients treated with immune checkpoint inhibitors.

BACKGROUND: Human papilloma virus (HPV) has been associated with the development and modulation of response in a series of neoplasms. In the case of lung adenocarcinoma, its role in etiology and pathogenesis is still controversial. Considering that this infection brings foreign epitopes, it could be of prognostic significance in patients with lung adenocarcinoma treated with immunotherapy. METHODS: In a retrospective cohort study we evaluated the presence of HPV genomic material in lung adenocarcinoma primary lesions with the INNO-LiPA platform. Viral replication was also evaluated by detecting the presence of oncoprotein E6/E7 messenger RNA (mRNA) by quantitative RT-PCR. To confirm possible hypotheses regarding viral oncogenesis, vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 (HIF1) were evaluated with stromal fibrosis and immunoscore. RESULTS: A total of 133 patients were included in the analysis, of whom 34 tested positive for HPV, reaching an estimated prevalence of 25.6% [95% confidence interval (CI) 18.2% to 32.9%]. E6/7 mRNA was identified in 28 out of the 34 previously positive cases (82.3%). In immune checkpoint inhibitor (ICI)-treated patients, the median overall survival reached 22.3 months [95% CI 19.4 months- not reached (NR)] for HPV-negative and was not reached in HPV-positive (HPV+) ones (95% CI 27.7-NR; P = 0.008). With regard to progression-free survival, HPV- patients reached a median of 9.2 months (95% CI 7.9-11.2 months) compared to 14.3 months (95% CI 13.8-16.4 months) when HPV was positive (P = 0.001). The overall response rate for HPV+ patients yielded 82.4% compared to 47.1% in negative ones. No differences regarding programmed death-ligand 1, VEGF, HIF1, stromal fibrosis, or immunoscore were identified. CONCLUSIONS: In patients with HPV+ lung adenocarcinoma, a significant benefit in overall response and survival outcomes is observed.

Binding of synthetic carbohydrate receptors to enveloped virus glycans: Insights from molecular dynamics simulations.

Can envelope glycans be targeted to stop viral pandemics? Here we address this question by using molecular dynamics simulations to study the binding between 10 synthetic carbohydrate receptors (SCRs) and the 33 N-glycans most commonly found on the surfaces of enveloped viruses, including Zika virus and SARS-CoV-2. Based on association quotients derived from these simulations, we classified the SCRs as weak binders, promiscuous binders, or selective binders. The SCRs almost exclusively associate at the Man3GlcNAc2 core, which is common to all N-glycans, but the binding affinity between the SCR⋅glycan pair depends on the noncovalent interactions between the heterocycle rings and the glycan antennae. Systematic variations in the glycan and SCR structures reveal relationships that could guide the design of SCRs to attain affinity and selectivity towards a chosen envelope glycan target. With these results, envelope glycans, which are currently considered "undruggable", could become viable targets for new therapeutic strategies.

Riesgo de caídas en personas mayores: comparación de resultados pre y postaplicación de un programa de ejercicios multicomponentes basado en subsistemas de la estabilidad postural / Comparison of the risk of falls in older people before and after to application of a multicomponent exercise program based on subsystems of postural stability

Antecedentes y objetivo: Los programas de ejercicios de componentes múltiples han demostrado una adecuada efectividad en personas mayores. Sin embargo, no siempre muestran beneficios directos sobre la estabilidad y el riesgo de caídas. Esto implica la necesidad de aplicar estos programas de ejercicios con un fuerte componente de entrenamiento de la estabilidad postural. El objetivo fue comparar el riesgo de caídas antes y después de la aplicación de un programa de ejercicios de componentes múltiples basado en componentes específicos de estabilidad postural. Materiales y métodos: Mediante un estudio cuasi experimental, participaron 72 personas mayores de 60 años y más, las que fueron evaluadas basalmente con las siguientes pruebas clínicas: Five Times Sit to Stand(FTST); Estación unipodal (EUP); Timed Up and Go (TUG); Self-Selected Walking Speed (SSWS) y Falls Efficacy Scale (FES). Posteriormente se realizó una intervención de 12 sesiones de 45min/3 veces por semana, que consistió en un programa de ejercicios de componentes múltiples con 6 estaciones de ejercicios de acondicionamiento físico y estabilidad. Un mes después los voluntarios fueron evaluados nuevamente. Resultados: Se observaron mejoras significativas en las pruebas FTST (p<0,0001); EUP derecha (p=0,006), EUP izquierda (p=0,010) y TUG (p<0,0001). No hubo cambios significativos en las pruebas SSWS (p=0,938) y FES (0,767). Conclusiones: El entrenamiento de componentes múltiples basados en subsistemas de la estabilidad, postural podría estar asociado a una mejora significativa en el rendimiento de las pruebas de EUP, TUG y FTST, y con ello a una posible reducción del riesgo de caídas.

Background and objective: Multicomponent Exercise Programs have shown adequate effectiveness in older people. However, they do not always show direct benefits on balance and risk of falls. This implies the need to apply these exercise programs with a strong a strong postural stability training component. The objective was to compare the risk of falls before and after the application of an Multicomponent Exercise Program based on specific components of postural stability. Material and methods: Through a quasi-experimental research, 72 people aged 60 years and over participated, who were evaluated based on the following clinical tests: Five Times Sit to Stand (FTST); Unipedal Stance Test (UST); Timed Up and Go (TUG); Self-Selected Walking Speed (SSWS) and Falls Efficacy Scale (FES). Subsequently, an intervention of 12 45-minute sessions was carried out three times per week, which consisted of a Multicomponent Exercise Program with 6 specific stations of physical conditioning and stability exercises. A month later the volunteers were evaluated again. Results: Significant improvements were observed in the FTST tests (P<.0001); Right EUP (P=.006), Left EUP (P=.010) and TUG (P<.0001). There were no significant changes in the SSWS tests (P=.938), and FES (.767). Conclusions: The multicomponent training plan based on postural stability subsystems could be associated with the best significant performance in the EUP, TUG and FTST tests, and with it to a possible reduction of the risk of falls.

Fighting for inclusion across borders: Latin American Trans women's health in Canada.

Background: Worldwide, Trans women from Latin America experience some of the highest rates of violence, which has led many to emigrate. There is limited research exploring the experiences of Trans migrants, and most LGBTQI2S + migrant research focuses on immigrant gay men. This study uses the frameworks of Intersectionality and the Social Determinants of Health (SDoH) to examine the impact of migration on the health and wellbeing of Latin American Trans women living in Toronto, Canada. Methodology: This qualitative arts-based study included nine participants and used hand mapping, a sociodemographic questionnaire, and focus groups to generate data. Data analysis encompassed inductive and deductive approaches and rigor was maintained through reflexivity and several verification strategies. Results: While migration was used as a safety strategy, participants' multiple identities as immigrants, Trans women, and Latinas, produced compounded experiences of oppression post-migration. Facing transphobia and xenophobia simultaneously, participants were forced to navigate precarious housing and employment, minimal social capital, and low social position. This limited their ability to exercise power and ultimately caused poor health and wellbeing post-migration; however, participants used sophisticated strategies to resist asymmetrical power relations, actively searching for safety and community participation, and caring for themselves and each other. Conclusion: The participants fought for inclusion across borders of economic exclusion and gender identity, borders of power and social position, as well as geopolitical borders. Their intersectional experiences across these "borders" should be understood in the context of migration without liberation, consumption without income, compounding oppressions, as well as positive intersectionality. While the women's resistance and strength are positive by-products of fighting oppression, they cannot be the solution. Access to health and wellbeing should not be a privilege for some; it must be a right for all.

[Knowledge on stroke in Spanish population. A systematic review]. / Conocimiento sobre el ictus en la población española. Una revisión sistemática.

OBJECTIVES: To analyze by means of a systematic review the general knowledge about strokes of the Spanish population. MATERIALS AND METHODS: A systematic review is performed following PRISMA guidelines and with data from PubMed, Scopus and EMBASE. All studies carried out in Spain, centred around the knowledge of strokes are compiled (terminology, pathophysiology, signs and symptoms, risk factors, treatment, and willingness to make use of the Emergency Services). From the 4,627 articles collected, 21 were ultimately included in this review. RESULTS: In Spain, the term stroke is less known than others such as embolism or cerebrovascular accident. Loss of strength is the most widely recognized symptom, whereas arterial hypertension is the most widely identified risk factor. The least known symptom and risk factor are visual impairment and diabetes mellitus, respectively. When faced with a suspected stroke, the attitude of most respondents is adequate as they decide to go to the hospital or call the Emergency Services. However, in rural areas or in cases in which the symptoms suddenly stop, a greater number of participants choose to go to their family physician. The main sources of information of the participants are their family members and their doctors. CONCLUSIONS: General knowledge about strokes is scarce among the general population. Nonetheless, the attitude of most of the participants is adequate as they choose to contact specialized Emergency Services.

TITLE: Conocimiento sobre el ictus en la población española. Una revisión sistemática.Objetivos. Analizar mediante una revisión sistemática el estado de conocimiento sobre el ictus en la población española. Materiales y métodos. Se ha llevado a cabo una revisión sistemática siguiendo las directrices PRISMA en las bases de datos PubMed, Scopus y EMBASE. Se incorporaron todos los estudios realizados en España que versaran sobre el conocimiento del ictus (terminología, fisiopatología, síntomas y signos, factores de riesgo, tratamiento e intención de acudir a servicios de emergencias). Se identificaron 4.627 artículos, de los cuales 21 se incluyeron finalmente en la revisión. Resultados. El término ictus es menos reconocido que otros, como embolia o infarto cerebral. La pérdida de fuerza es el síntoma más reconocido y la hipertensión arterial es el factor de riesgo más identificado. El síntoma y el factor de riesgo menos reconocidos son los déficits visuales y la diabetes mellitus, respectivamente. Ante la sospecha de ictus, la actitud de la mayoría de los encuestados es adecuada, ya que eligen acudir al hospital o llamar a los servicios de emergencias. Sin embargo, en el medio rural, y ante síntomas que ceden espontáneamente, un mayor número de participantes elige acudir a su médico de familia. Las principales fuentes de información de los participantes son sus familiares y médicos. Conclusiones. El conocimiento global sobre el ictus es escaso entre la población española. Sin embargo, la actitud de la mayoría de los participantes es adecuada, ya que elige mayoritariamente contactar con servicios de emergencias especializados.