Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center.

In order to reset the immune system to baseline function, autologous hematopoietic stem cell transplantation (HSCT) has been performed in patients with multiple sclerosis (MS). After June 2015, 617 new consecutive patients with MS were autografted in our center with non-frozen peripheral blood stem cells. The autografts were performed on an out-patient basis, after conditioning with cyclophosphamide and rituximab. The aim of the study was the assessment of both safety and efficacy of the method. The study's primary co-end-points were recovery of granulocyte and platelet counts and transplant-related mortality. Secondary end-points were overall survival and clinical response (improvement or stabilization of the self-reported expanded disability status scale score). The protocol was registered in ClinicalTrials.gov identifier NCT02674217.0. We included 401 females and 216 males, with a median age of 46 years. A total of 259 patients had relapsing-remitting MS (RRMS), 228 had secondary progressive (SPMS) and 130 had primary progressive (PPMS) multiple sclerosis. All procedures were initially performed on an out-patient basis and only 32 individuals (5%) required hospitalization. One to three aphereses (median 1) were required to harvest at least 1 × 106 /kg viable CD34+ cells. The total number of viable CD34+ infused cells ranged between 1 and 37·83 × 106 /kg (median 5·68). Patients recovered more than 0·5 × 109 /l absolute granulocytes by day 8 (median, range = 2-14), and platelet values were above 20 × 109 /l by day 4 (median, range = 0-11). Eleven individuals required red blood cells and six needed platelet transfusions. To date, there have been no deaths attributable to the transplant, yielding a 30-month overall survival of 100%. Patients have been followed for 3-42 months (median = 12). The overall response rate (decrease or stabilization of the self-reported EDSS score) at 12 months was 78% for all patients (83% in RRMS, 78% in PPMS and 73% in SPMS), while the disability progression-free survival was 82% for all patients (86% in RRMS, 78·5% in SPMS and 78% in SPMS). Changes in the self-reported EDSS score in parallel with neurological improvement were observed in people with all types of MS after HSCT, employing the 'Mexican method'.

Modifi cación de la actitud y conducta ante el tabaco de los profesores participantes en un programa de prevención de tabaquismo entre sus alumnos / Changes in the attitude and behaviour with regard to tobacco in teachers that take part in a smoking prevention program among students

Objetivo: Evaluar la evolución de actitudes y conducta delos profesores al impartir un programa de prevención detabaquismo.Sujetos y métodos: Ensayo comunitario prospectivo congrupo control, realizado durante tres cursos. Los profesoresde educación secundaria de Fuentesaúco (Zamora)desarrollaron el programa (GI) siendo los de Babilafuente(Salamanca) el grupo control (GC). Se utilizó el cuestionariodel proyecto ESFA, comparando los resultados enambos grupos mediante T de Student y prueba de Mann-Whitney.Resultados: Participaron 53 profesores (28:GI, 25:GC) conedades entre 28 y 61 años (media 43,12; 41,15-45,09). Antesde la intervención fumaba el 25,0% en el GI y el 20,0% enel GC(p=0,750). Los profesores del GI pensaban que no sedebe fumar en la escuela (media: 4,17;DS:0,88; escala:1-5),que la prevención se debe impartir en la escuela (media:4,26;DS:0,78) y aceptaban realizar el programa (media: 4,17;DS: 0,66), dudando sobre su capacidad para desarrollarlo(media: 3,84; DS: 1,00). No existían diferencias signifi cativasGI-GC excepto en la mejor actitud frente al consumo detabaco de los profesores del GI (p=0.001).Después de desarrollar el programa fuma el 21,7% en elGI y el 11,1% en el GC(p=0,444). Los profesores del GImantienen su actitud contra el consumo en el centro (media:4,55; DS:0,62), siguen pensando que la prevención se debeimpartir en la escuela (media: 4,26; DS:0.59) y que se debenrealizar estos programas (media:3,80; DS:1,07), manteniendolas dudas sobre su idoneidad para realizarlo (media:3,77; DS:1,00), no observándose diferencias signifi cativasGI-GC.Conclusiones: A pesar de haber realizado el programa losprofesores del GI mantienen dudas acerca de su capacidadpara abordar el problema. Es preciso incentivar y formar alos profesores para mejorar los resultados de estos programas (AU)

Objectives: To assess the evolution of the attitude and thebehaviour of teachers included in a smoking prevention program. Subjects and methods: A community-based prospectivestudy with a control group, carried out along three years.The teachers in Fuentesaúco (Zamora) developed the program(IG), and the teachers in Babilafuente (Salamanca)were the control group (CG). We used the ESFA questionnaire,comparing the results of both groups with theStudent’s T-test and the Mann-Whitney Test.Results: A total of 53 teachers participated in the program(28:IG; 25:CG), with ages between 28 and 61 years (average43.12; 41.15-45.09). Before the intervention, 25.0%of IG and 20.0% of CG smoked (p=0.750). Teachers inIG thought that smoking should not be allowed in theschool (average: 4.17; SD:0.88; range 1-5), and that preventionshould be taught in school (average 4.26; SD:0.78).They agreed to participate in the program (average: 4.17;SD:0.66), although they doubted their own ability to putit into practice (average: 3.84; SD:1.00). No signi cantdifferences were found between the IG and the CG, exceptfor a more positive attitude to teachers smoking inIG (p=0.001). After the execution of the program, 21.7of IG and 11.1% of CG smokes (p=0.444). Teachers inthe IG maintain their attitude to smoking in the school(average: 4.55; SD:0.62), they still think that preventionhas to be taught in the school (average: 4.26; SD:0.59), andthat these programs have to be carried out (average: 3.80;SD:1.07), although they still doubt their ability to put itinto practice (average: 3.77; SD:1.00). No signi cant differenceswere found between IG and CG.Conclusions: Although they have participated in this program,teachers in the IG still have doubts with regard totheir ability to deal with this problem. Teachers have to bemotivated and educated in order to improve the results ofthese programs (AU)

El consumo de tabaco en adolescentes / Consumption of tobacco in adolescents

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[Predictive factors of smoking behaviour in secondary school children]. / Factores predictores de la conducta fumadora en alumnos de enseñanza secundaria.

INTRODUCTION: Many factors have been reported as being responsible for starting smoking during school age, but it is still not well known which cognitive determinants may be used as predictive factors of tobacco use. SUBJECTS AND METHODS: A prospective, longitudinal, study, including 417 pupils from 12 to 17 years, was carried out over three years in two rural Secondary Education Institutes in Castilla y León. The ESFA questionnaire was used, which included scales on attitudes and beliefs, social influences, self-efficacy, intention to smoke in the future and smoker behaviour. RESULTS: Of the 417 pupils studied, 36.7 % were smokers (38.6 % females and 34.4 % males). The mean of starting smoking was 12 years (11.83-12.15). In the initial analysis there was a clear relationship between cognitive determinants and smoker behaviour. The advertising and peer pressure lost predictive value after 3 years. The multivariate analysis showed that the determining factors of tobacco use are, besides age (OR = 3.85; 95 % CI, 1.27-11.64), to have a favourable attitude to smoking, (OR = 4.47; 95 % CI, 2.15-9.32), and the conduct perceived among peers (OR = 5.05; 95 % CI, 2.50-10.19). CONCLUSIONS: The determining factors that demonstrates a clear relationship with smoker behaviour are, age, favourable attitude of pupils towards smoking, and the perceived behaviour by smoker friends. Smoking prevention programs should take these factors into accounts when designing their activities.

Factores predictores de la conducta fumadora en alumnos de enseñanza secundaria / Predictive factors of smoking behaviour in secondary school children

Introducción: Se han descrito múltiples factores como responsables de la iniciación al consumo de tabaco durante la edad escolar, pero aún no se conoce bien qué determinantes cognitivos se comportan como factores predictores del consumo de tabaco. Sujetos y métodos: Se ha realizado un estudio prospectivo, longitudinal, de 3 años de duración, en dos institutos de educación secundaria rurales de Castilla y León. Han participado 417 alumnos de 12 a 17 años. Se ha utilizado el cuestionario ESFA, que incluye escalas sobre actitudes y creencias, influencias sociales, autoeficacia, intención de fumar en el futuro y conducta fumadora. Resultados: Son fumadores el 36,7 % de los alumnos (el 38,6 % de las alumnas y el 34,4 % de los alumnos). La edad media de inicio al consumo es de 12 años (11,83-12,15). En el análisis inicial existe una clara relación entre determinantes cognitivos y conducta fumadora. A los 3 años pierden valor predictivo la presión de la publicidad y de los allegados. El análisis multivariante muestra que los determinantes del consumo de tabaco son además de la edad (odds ratio [OR] 5 3,85; intervalo de confianza del 95 % [IC 95 %]: 1,27-11,64), tener una actitud favorable a fumar (OR 5 4,47; IC 95 %: 2,15-9,32) y la conducta percibida entre iguales (OR 5 5,05; IC 95 %: 2,50-10,19). Conclusiones: Los determinantes que demuestran una clara relación con la conducta fumadora son la edad, la actitud de los alumnos favorable a fumar y la conducta percibida de los amigos fumadores. Los programas de prevención de tabaquismo deberán tener en cuenta estos factores al diseñar sus actividades (AU)

Introduction: Many factors have been reported as being responsible for starting smoking during school age, but it is still not well known which cognitive determinants may be used as predictive factors of tobacco use. Subjects and methods: A prospective, longitudinal, study, including 417 pupils from 12 to 17 years, was carried out over three years in two rural Secondary Education Institutes in Castilla y León. The ESFA questionnaire was used, which included scales on attitudes and beliefs, social influences, self-efficacy, intention to smoke in the future and smoker behaviour. Results: Of the 417 pupils studied, 36.7 % were smokers (38.6 % females and 34.4 % males). The mean of starting smoking was 12 years (11.83-12.15). In the initial analysis there was a clear relationship between cognitive determinants and smoker behaviour. The advertising and peer pressure lost predictive value after 3 years. The multivariate analysis showed that the determining factors of tobacco use are, besides age (OR 5 3.85; 95 % CI, 1.27-11.64), to have a favourable attitude to smoking, (OR 5 4.47; 95 % CI, 2.15-9.32), and the conduct perceived among peers (OR 5 5.05; 95 % CI, 2.50-10.19). Conclusions: The determining factors that demonstrates a clear relationship with smoker behaviour are, age, favourable attitude of pupils towards smoking, and the perceived behaviour by smoker friends. Smoking prevention programs should take these factors into accounts when designing their activities (AU)