Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study.

BACKGROUND: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. OBJECTIVE: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. METHODS: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. RESULTS: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. CONCLUSIONS: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55829.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombian pediatric patients: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en pacientes pediátricos colombianos: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for moderate-severe ulcerative colitis (UC) in pediatric patients in Latin America. The aim of this study was to describe the efficacy and safety, in real world, treated with tofacitinib in our setting. MATERIALS AND METHODS: Case series of pediatric patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then maintenance therapy between November 2021 and February 2023. RESULTS: Four female patients, median age 14.5 (SD 2.1; RIQ 12.5-16.5) years, all with prior biologic exposure, all 4 with prior use of anti-TNF, and 2/4 with prior use of anti-integrin. Clinical, biochemical and endoscopic remission was obtained in 3/4 at induction. Information was obtained from 3 patients in 6-month maintenance, 2/3 remained in clinical, biochemical and endoscopic remission and 1/3 has not achieved biochemical or endoscopic remission. Information was obtained from 1 patient in 12-month maintenance, achieving clinical and biochemical remission, however, endoscopic remission has not been achieved. One patient was initiated for severe acute UC with risk of colectomy, with significant improvement after 7 days, reaching therapeutic objectives at induction. No serious adverse events were reported in any of the cases. CONCLUSIONS: Efficacy and safety are demonstrated with tofacitinib in pediatric patients. With high percentage of response in induction treatment, sustained over time, and safe. In the context of severe acute hospitalized UC, it has a role as a potential rescue therapy due to its rapid action.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

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Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

Endoscopic Retrograde Cholangiopancreatography in Children: Nine Years' Experience at Santa Fe Foundation in Bogota, Colombia.

INTRODUCTION: Experience in the use of diagnostic and/or therapy of endoscopic retrograde cholangiopancreatography (ERCP) in children is limited. This is due to the underdiagnosis of pancreaticobiliary disease in the pediatric population and specialist personnel in this procedure. OBJECTIVE: To determine the safety and success rate of ERCP in children at Hospital Fundación Santa Fe de Bogotá between January 2007 and June 2015. METHODOLOGY: This was an observational, descriptive, retrospective case series study of patients under 18 years, who underwent ERCP between January 2007 and June 2015. The following variables were analyzed: indication, duration, type of procedure, rate of success, and complications. RESULTS: A total of 30 patients were included, in whom 65 ERCP procedures were performed. Successful cannulation was achieved in 52 of the 65 procedures (80%). Among the complications that occurred, there were four cases of pancreatitis (6.2%), two cases of bleeding (3.1%), and one case of bacteremia (1.5%), and in most cases (58 in total, 89.2%), there were no complications. DISCUSSION: The pediatric gastroenterology group of the Fundación Santa Fe de Bogotá has obtained good results in performing ERCP in the pediatric population with a success rate of 80% associated with a null mortality rate. There is enough literature available to conclude that performing ERCP in the pediatric population maintains an adequate success rate and a low complication rate. In all the studies evaluated, a null mortality rate was found, so it is considered that this procedure is safe in patients under 18 years of age.

M-Health in lung cancer: A literature review.

The internet and digital technology have become an important resource for patients with cancer. Mobile health strategies permit patients and clinicians to interact via different tools to enrich the supplements to routine hospital visits or out-patient attendance. In this work, we have reviewed different mobile health platforms to support lung cancer patients in different areas: pre-surgery; post-surgery and on systemic treatment. We have also reviewed different digital tools used by long-term lung cancer survivors as well as the impact of these tools on the quality of life, and we tried to analyse according to literature the potential efficiency of these platforms in health system administration.

Pilot Study on Satisfaction in Children and Adolescents after a Comprehensive Educational Program on Healthy Habits.

Prospective research in the area of Education Sciences and Physical-Sports Education agree on the need to design and implement educational programs that promote emotional competencies (ECs), interpersonal competencies (ICs), an adequate level of healthy physical activity (NAFS) and a good adherence to the Mediterranean diet (ADM). The main objective of the study is to design an intervention program in intra- and interpersonal competencies together with nutritional education and corporality called "MotivACTION". The sample consisted of 80 primary schoolchildren aged 8 to 14 years (M = 12.70; SD = 2.76) (37 girls and 43 boys) from two schools in the Community of Madrid. An ad-hoc questionnaire was created to assess the participant's perception of the usefulness of the "MotivACTION" educational experience. The program "MotivACTION: Feed your SuperACTION" is designed and implemented based on the development of a workshop organized through the Universidad Europea de Madrid. As the main preliminary results of the pilot study, the schoolchildren who experienced the "MotivACTION" workshop showed high satisfaction with the educational program. They were able to create a healthy menu with the frog chef. They also felt better and happier at the end of it, and they enjoyed practicing physical activity moving to the rhythm of the music while doing mathematical calculations.

A Holistic Vision of the Academic and Sports Development of Elite Spanish Track and Field Athletes.

BACKGROUND: Combining sports and studies could be stressful, but beneficial for the athletes' career development. This study explores resources and barriers in the combination of the sports and academic life spheres during the lifespan of elite Spanish track-and-field athletes. METHODS: Seven elite Spanish track-and-field athletes participated in a semistructured interview about their experiences to establish a dual career combining sports and studies/work. Interpretive phenomenological analysis (IPA) followed to analyze data. RESULTS: Findings show that elite Spanish track-and-field athletes face educational and institutional barriers to developing a dual career. Time management, social support, and additional resources could play a key role in the success or failure to develop a dual career. CONCLUSIONS: This study shows that, to overcome dual-career barriers, athletes are resourceful if social support is provided at both the micro (coaches, families, etc.) and macro (political and educational institutions) levels. It also shows that pursuing an academic career can help in alleviating inherent tensions to athletic life and in finding personal balance.

Measuring optimal psychological states: Proposal of two brief versions to measure flow and clutch in athletes.

Background: The study of sports experiences with high levels of performance has led to the observation of two psychological states categorized as optimal, denominated flow and clutch. The objective of this study is to design and validate two brief scales version to measure flow and clutch. Methods: Following the MIMO (Maximum Information, Minimum Discomfort) protocol, three studies are carried out: In Study 1, we developed the short versions of the questionnaires based on theory-driven and data-driven criteria; in Study 2, we used quantitative criteria to validate the short versions; and in Study 3, we checked the final version of each scale to observe their statistical validity and their relation to other variables. Results: The new short flow scale is made up of seven items, while the clutch scale is made up of five items. Throughout the three studies, evidence is provided of the internal consistency, invariance of the measurement models and content validity, validity related to the responding process and validity in relation to other variables. Conclusion: This study provides two short versions to evaluate flow and clutch, which will help to continue advancing in the study of optimal psychological states in sport.

Crops with potential for diclosulam remediation and concomitant bioenergy production.

The objective of this work was to evaluate crops for their ability to phytoremediate diclosulam residues in the soil and produce lignocellulosic ethanol. Physiological characteristics, biomass production, soil cover rate, fermentable sugar production and lignocellulosic ethanol production potential of the crops were evaluated in soil with diclosulam residues. The experimental design was a randomized block with four replications. The treatments were arranged in a 4 × 2 factorial scheme with the following crops as the first factor: Avena sativa, Canavalia ensiformis, Mucuna aterrima, and Pennisetum glaucum. The second factor was the presence or absence of the herbicide diclosulam in the soil (30 g ha-1). The physiological variables of the plant species were not affected by the presence of diclosulam; the soil cover of P. glaucum was lower in the area with diclosulam, with a value of 26%. The levels of glucose were not affected by the presence of diclosulam in A. sativa, C. ensiformis, and M. aterrima, indicate not change the estimated yield of ethanol for this species. Avena sativa and Pennisetum glaucum have the potential to phytoremediate soils containing diclosulam residues, with concomitant lignocellulosic ethanol production ability.

Phytoremediation of soils with herbicide residues is a viable tool and has been increasingly widespread throughout the world. The use of plant species capable of making the soil feasible for successive plantings sensitive to previously applied residual herbicides is a way to optimize agricultural production. However, there are few studies in which vegetable biomass used in the phytoremediation process is used. Thus, our study is innovative because it seeks to combine phytoremediation with the production of bioethanol, ensuring even more sustainable agriculture.

Study of an Anti-Doping Education Program in Spanish Sports Sciences Students.

Doping continues to be one of the biggest risks to the credibility of elite sports, and its practice remains widespread among athletes despite improved controls. Athletes' support personnel could be key to preventing doping behavior. In this sense, anti-doping education for this population appears as a possible strategy to reduce doping behaviors in elite sport, but these programs must be evaluated and designed based on scientific evidence. The aim of this research is to explore the impact of an anti-doping education program about substances perceived efficacy, ill-health short- and long-term effects, and the morality of doping substance use in Spanish sports sciences students. METHOD: A total of 145 students of Physical Activity and Sport Sciences (PASS) from different Spanish universities who took an online anti-doping educational course of the Spanish Anti-Doping Commission (CELAD) answered a questionnaire on their perceptions about doping before, after, and four months later. RESULTS: The results show that the course reduced students' ignorance about the effects of substances on performance and health and increased their moral judgment and feelings against doping. DISCUSSION: The results are in line with previous research that showed that the moral stance against doping can be improved through educational programs. CONCLUSION: Online educational interventions can be effective in reducing doping behavior, so their future implementation among ASP can be an effective strategy to reduce doping behavior.

Familial Adenomatous Polyposis: Case Report and Literature Review.

Familial adenomatous polyposis (FAP) is an autosomal inheritance disease characterized by 100 or more adenomatous polyps in the colon and rectum with a high risk of developing colorectal carcinoma (CRC). The management of this disease is based on early screening and timely follow up, with subsequent planning of risk-reducing or therapeutic surgeries. We present a case of a patient with a strong family history of FAP with a "de novo" diagnosis of CRC. Furthermore, a literature discussion of current and future perspectives of treatment is performed.

Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Employee-Athletes: Exploring the Elite Spanish Athletes' Perceptions of Combining Sport and Work.

Researchers have studied the athletes' dual careers with the aim of helping them to combine the sport and the academic-vocational sphere. Most of this research has addressed the study-sport combination, but there is a lack of studies on the work-sport combination. The main objective of this research was to explore the subjective perceptions of Spanish elite athletes when attempting to combine their careers as professional athletes with a second profession or trade. Further, this study aims to identify the access to facilitating resources and the perception of obstacles and barriers to the development of a dual career. A qualitative approach was chosen to address these research questions. Interpretative phenomenological analysis was carried out on a sample of 18 elite athletes, and the data were collected using semi-structured interviews based on a set of superordinate and subordinate categories. The results showed that the athletes interviewed possessed valuable resources such as the transference of sports values to the work sphere. However, important barriers were highlighted such as the perception of sport institutions as absent entities in the work-sport combination. Thus, the study of this type of dual career seems to be one of the challenges facing the interested scientific community for the coming years.

Fuelling the passion: Psychological needs and behavioural regulations as antecedents of passion for football.

The purpose of the present study was to examine the motivational antecedents of passion for sport by testing a model where players' satisfaction of the three basic psychological needs was expected to predict their harmonious and obsessive passions through the mediation of autonomous and controlled motivations. Four-hundred eighty-seven elite U18 male football players (Mage = 17.43, SD = 0.71) completed measures of psychological need satisfaction, behavioural regulations and passion for sport. Measurement models were defined using exploratory structural equation models. The results support the model where autonomous and controlled regulations partially mediate the relationship between psychological needs and passion. In this model, the need for relatedness positively and directly predicts harmonious passion and indirectly predicts obsessive passion, which supports its key role in discriminating between the two types of passion. Moreover, autonomy and competence satisfaction present direct and indirect effects on both types of passions. Finally, autonomous regulations positively predict obsessive and harmonious passion, although the strength of the relationship was stronger for the latter. In sum, our results highlight that (a) satisfaction of each need is crucial to promote harmonious passion and (b) both autonomous and controlled regulations contribute to the understanding of how passion is developed in football.

Analysis of the Athletic Career and Retirement Depending on the Type of Sport: A Comparison between Individual and Team Sports.

The type of sport practiced may shape the athletic career, considered as the period in which an athlete is dedicated to obtaining their maximum performance in one or more sports. The aim of this study was to compare athletic careers and retirement in individual and team sports. Four hundred and ten former elite athletes (38.5 ± 7.6 years) answered an ad hoc questionnaire; 61.5% were men and 38.5% women; 45.1% were from individual sports, while 54.9% were from team sports. It emerged that the age of maximum sports performance and the retirement age occurred significantly later in team sports than in individual sports (U = 15,042 and U = 12,624.5, respectively p < 0.001). Team sports athletes combined their athletic career with work to a greater extent than those from individual sports (χ2 (3, N = 408) = 14.2; p = 0.003; Cv = 0.187). Individual sports athletes trained more hours per week (30.0 ± 11.7 h) than those involved in team sports (19.2 ± 10.7 h; U = 9682; p < 0.001). These athletes (team sports) were in a better economic and working situation at retirement transition (χ2 (3, N = 406) = 23.9; p < 0.001; Cv = 0.242). Individual sports athletes perform physical activity more frequently than team sports athletes (U = 16,267.5; p = 0.045), while team sports athletes participate more actively in veteran competitions (χ2 (1, N = 390) = 3.9; p = 0.047; Cv = 0.104) and more frequently attend events as spectators (χ2 (1, N = 390) = 8.4; p = 0.004; Cv = 0.151). dual career support providers should be aware that team sports athletes enjoy a longer athletic career, and they are in a better position to face the retirement transition than individual sports athletes.

The Influence of Basic Psychological Needs and Passion in Promoting Elite Young Football Players' Development.

Motivational variables and cognitive skills have been identified as important in an athlete's development. The aim of this study is to explore the influence of each basic psychological needs satisfaction on player's development regarding reflection and concentration disruption with the mediation of types of passion in Spanish young elite football players. A total of 487 elite U18 male football players (Mage = 17.43, SD = 0.71) completed measures of basic psychological needs satisfaction, passion for football, reflective thinking, and concentration disruption. Measurement models were defined using exploratory structural equation models. The results provide support for the model, where each psychological needs satisfaction prompted reflection and had a negative influence on concentration disruption with the mediation of harmonious passion. In addition, obsessive passion mediated the positive relationship between competence satisfaction and concentration disruption. Finally, competence and relatedness satisfaction influenced the development of reflection directly and positively and, exclusively, relatedness satisfaction had a negative influence in a direct way on concentration disruption. In sum, our results highlight that (a) the environment of young footballers through psychological needs satisfaction has a positive (i.e., reflection) or negative (i.e., concentration disruption) influence on the field, but only with the mediation of harmonious passion, (b) in a competitive environment, the perception of competence can have a positive influence on concentration disruption, but only with the development of obsessive passion as a mediator, and (c) relatedness satisfaction plays a key role in distinguishing between reflection and concentration disruption.

Validación de la versión española de la Escala de Reflexión en futbolistas de élite jóvenes / Validation of the Spanish Version of the Reflection Scale for Young Elite Football Players / Validação da versão espanhola da Escada de Reflexão em futebolistas de elite jovens

Resumen Objetivo. Validar la versión española de la Escala de Reflexión del instrumento Reflective Learnning Continuum en futbolistas jóvenes de élite. Método. Estudio de validación. La versión original fue traducida y adaptada siguiendo el protocolo de la American Psychological Association. Una vez traducida, se administró a 478 jugadores jóvenes de élite junto con el Behavioural Regulation in Sport Questionnaire, con el objetivo de evaluar sus propiedades psicométricas; además, se llevaron a cabo el análisis de consistencia interna, el análisis factorial confirmatorio y el análisis de correlaciones bivariadas con variables teóricamente relacionadas. Resultados. En el análisis de contenido, la versión española de la Escala de Reflexión aplicada mostró evidencias en los aspectos cultural y lingüístico con la versión original. Además, el análisis factorial confirmatorio mostró un ajuste aceptable a los datos: χ²(df) = 28.61 (88), p < 0.001, RMSEA (90% CI) = 0.07 (0.06-0.08), CFI = 0.99, TLI = 0.99. Los análisis de consistencia interna, así como la relación con la motivación, apoyaron la versión validada. Conclusión. Los resultados proporcionan evidencia en favor de las propiedades psicométricas de la validación al español de la Escala de Reflexión.

Abstract Objective. To validate the Spanish version of the Reflection Scale from the instrument Reflective Learning Continuum for young elite football players. Method. Validation study. The original version was translated and adapted following the protocol of the American Psychological Association. Once translated, the version was administered to 478 young elite players together with the Behavioral Regulation in Sport Questionnaire, aiming to evaluate the psychometric properties. In addition, internal consistency analysis, confirmatory factor analysis and bivariate correlations analysis with theoretically related variables were carried out. Results. The Spanish version of the Reflection Scale shows cultural and linguistic evidence with its original version. Moreover, confirmatory factor analysis showed an acceptable fit to the data χ²(df)= 28.61 (88), p < 0.001, RMSEA (90% CI) = 0.07 (0.06-0.08), CFI = 0.99, TLI = 0.99. Also, the internal consistency analyses, as well as the relationship with motivation, support the validated version. Conclusion. The results provide evidence in favour of the psychometric properties of the Spanish validation of the Reflection Scale.

Resumo Escopo. Validar a versão espanhola da Escada de Reflexão do instrumento Reflective Learnning Continuum em futebolistas jovens de elite. Metodologia. Estudo de validação. A versão original foi traduzida e adaptada seguindo o protocolo da American Psycological Association. Uma vez traduzida, foi administrada a 478 jogadores jovens de elite junto com o Behavioural Regulation in Sport Qustionnaire, com o escopo de avaliar suas propriedades psicométricas; Além, foram realizadas analises de correlações bivariadas com variáveis teoricamente relacionadas. Resultados. Na análise de conteúdo, a versão espanhola da Escada de Reflexão aplicada mostrou evidencias nos aspectos cultural e linguístico com a versão original. Além, a análise fatorial confirmatória mostrou um ajuste aceitável para os dados: As análises de consistência interna, assim como a relação com a motivação, apoiaram a versão validada. Conclusão. Os resultados proporcionaram evidencia em favor das propriedades psicométricas da validação ao espanhol da Escada de Reflexão.

Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría / Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics

Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el "grado de acuerdo" entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.

Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.

The Employability Process of Spanish Retired Elite Athletes: Gender and Sport Success Comparison.

The aims of the study were: (i) to describe the work integration after retirement in elite athletes, (ii) to compare the working integration of women and men, and Olympic and non-Olympic athletes, and (iii) to specify the factors that affect their employment status and current monthly income. A total of 476 former elite athletes were surveyed. Non-parametric statistics were applied to compare the differences between groups and a classification tree analysis was performed for the dependent variables. The former elite athlete's unemployment rate was better than the general population. At the gender comparison, a wage gap appeared between women and men. At the comparison between Olympic and non-Olympic athletes, the link to first employment differed in both groups. In the prediction models, finishing higher education arose as a key factor of the working status and the monthly salary. Among those without higher education studies, planning arose as a factor determining their salary, while among those with high qualifications, gender was the key factor. This study supports the importance of a holistic view of athletic career development and it offers practical insights into the process of reaching first employment after retirement.