Pubertal Suppression in Early Puberty Followed by Testosterone Mildly Increases Final Height in Transmasculine Youth.

Context: Treatment for transmasculine youth (TMY) can involve testosterone treatment and is sometimes preceded by gonadotropin-releasing hormone agonist (GnRHa) treatment for puberty blockade. GnRHas can increase final height in birth-assigned females with central precocious puberty. Maximizing final adult height (FAH) is an important outcome for many TMY. Objective: Our objective was to determine how GnRHa treatment before testosterone impacts FAH. Methods: Retrospective cohort study at 5 US transgender health clinics. Participants were 32 TMY treated with GnRHas in early to midpuberty before testosterone (GnRHa + T group) and 62 late/postpubertal TMY treated with testosterone only (T-only group). Results: The difference between FAH minus midparental target height (MPTH) was +2.3 ± 5.7 cm and -2.2 ± 5.6 cm in the GnRHa + T and T-only groups, respectively (P < .01). In the GnRHa + T group, FAH was 1.8 ± 3.4 cm greater than predicted adult height (PAH) (P < .05) and FAH vs initial height (IH) z-score was 0.5 ± 1.2 vs 0.16 ± 1.0 (P < .05). After adjusting for patient characteristics, each additional month of GnRHa monotherapy increased FAH by 0.59 cm (95% CI 0.31, 0.9 cm), stage 3 breast development at start of GnRHa was associated with 6.5 cm lower FAH compared with stage 2 (95% CI -10.43, -2.55), and FAH was 7.95 cm greater in the GnRHa + T group than in T-only group (95% CI -10.85, -5.06). Conclusion: Treatment with GnRHa in TMY in early puberty before testosterone increases FAH compared with MPTH, PAH, IH, and TMY who only received testosterone in late/postpuberty. TMY considering GnRHas should be counseled that GnRHas may mildly increase their FAH if started early.

Evaluation of European LeukemiaNet 2022 risk classification in patients undergoing allogeneic haematopoietic stem cell transplantation for acute myeloid leukaemia: Identification of a very poor prognosis genetic group.

European LeukemiaNet refined their risk classification of acute myeloid leukaemia (AML) in 2022 (ELN 2022) according to the two new myeloid classifications published the same year. We have retrospectively assessed the prognostic value of the ELN 2022 in 120 AML patients undergoing allogeneic haematopoietic cell transplantation (allo-HCT), including 99 in first complete response (CR1) from 2011 to 2021 in our centre. Adverse risk patients (Adv) presented inferior outcome in terms of overall survival (OS) and leukaemia-free survival (LFS) (OS [p = 0.003], LFS [p = 0.02]), confirmed in multivariate analysis (hazard ratio [HR] for OS = 2.00, p = 0.037). These results were also seen in patients allografted in CR1. Further analysis identified a subgroup named adverse-plus (AdvP), including complex karyotype, MECOM(EVI1) rearrangements and TP53 mutations, with worse outcomes than the rest of groups of patients, including the Adv (HR for OS: 3.14, p < 0.001, HR for LFS: 3.36, p < 0.001), with higher 2-year cumulative incidence of relapse (p < 0.001). Notably, within this analysis, the outcome of Adv and intermediate patients were similar. These findings highlight the prognostic value of ELN 2022 in patients undergoing allo-HCT, which can be improved by the recognition of a poor genetic subset (AdvP) within the Adv risk group.

Infrequent Presentations of Chronic NPM1-Mutated Myeloid Neoplasms: Clinicopathological Features of Eight Cases from a Single Institution and Review of the Literature.

Non-acute myeloid neoplasms (MNs) with NPM1 mutations (NPM1mut-MNs) pose a diagnostic and therapeutic dilemma, primarily manifesting as chronic myelomonocytic leukemia (CMML) and myelodysplastic syndromes (MDS). The classification and treatment approach for these conditions as acute myeloid leukemia (AML) are debated. We describe eight cases of atypical NPM1mut-MNs from our institution and review the literature. We include a rare case of concurrent prostate carcinoma and MN consistent with chronic eosinophilic leukemia, progressing to myeloid sarcoma of the skin. Of the remaining seven cases, five were CMML and two were MDS. NPM1 mutations occur in 3-5% of CMML and 1-6% of MDS, with an increased likelihood of rapid evolution to AML. Their influence on disease progression varies, and their prognostic significance in non-acute MNs is less established than in AML. Non-acute MNs with NPM1 mutations may display an aggressive clinical course, emphasizing the need for a comprehensive diagnosis integrating clinical and biological data. Tailoring patient management on an individualized basis, favoring intensive treatment aligned with AML protocols, is crucial, regardless of blast percentage. Research on the impact of NPM1 mutations in non-acute myeloid neoplasms is ongoing, requiring challenging prospective studies with substantial patient cohorts and extended follow-up periods for validation.

Characteristics and long-term outcome in a large series of chronic myelomonocytic leukaemia patients including 104 formerly referred to as oligomonocytic.

Recently modified diagnostic criteria for chronic myelomonocytic leukaemia (CMML) have lowered the cut-off for absolute monocytosis. In the largest series to date, we have analysed 313 CMML patients, including 104 with oligomonocytic (OM)-CMML. Five-year survival was longer for OM-CMML than for other patients (p < 0.001). Multivariate analysis identified OM-CMML as a favourable prognostic factor (HR 0.58; p = 0.002). The 5-year cumulative incidence of progression to classical CMML was 47%. Older age and transfusion dependence were adverse prognostic factors for OM-CMML. Our results support the inclusion of OM-CMML in the CMML category as a subtype with superior outcomes.

Low molecular weight poly((D,L)-lactide-co-caprolactone) liquid inks for diluent-free DLP printing of cell culture platforms.

Digital light processing (DLP) printing offers the possibility of fabricating complex objects in a fast and reproducible manner. A main requirement for DLP printing is the use of inks with low viscosities that can flow under the printing platform in a short period of time. Its exploitation in tissue engineering applications has been centered on the use of hydrogel forming materials diluted in aqueous solutions or the use of polyesters in combination with diluents and heating platforms that aid in the reduction of their viscosity. The use of diluents, however, modifies the mechanical properties and reduces the shape fidelity of the printed objects and, the use of heating platforms results in vats with heterogeneous temperatures and ink viscosities. Here, we report on the synthesis of a library of methacrylated low molecular weight (<3000 g mol-1) homopolymers ((P(D,L)LA and PCL) and copolymers (P((D,L)LA-co-CL)) of 2- and 3-arms based on (D,L)-lactide and ε-caprolactone. The resulting inks possessed low viscosity that made them printable in the absence of diluents and heating elements. DLP printing of cubical and cylindrical patterns resulted in objects with a higher shape fidelity than their counterparts fabricated using diluents and with printed features on the order of 300 µm. The printed materials were biocompatible and supported the growth of human mesenchymal stem cells (hMSCs). Moreover, the variations in the composition resulted in polymers that enabled the attachment of hMSCs to different extents, leading to the formation of well-adhered cell monolayers or loosely adhered cell aggregates.

Germ line variants in patients with acute myeloid leukemia without a suspicion of hereditary hematologic malignancy syndrome.

Germ line predisposition in acute myeloid leukemia (AML) has gained attention in recent years because of a nonnegligible frequency and an impact on management of patients and their relatives. Risk alleles for AML development may be present in patients without a clinical suspicion of hereditary hematologic malignancy syndrome. In this study we investigated the presence of germ line variants (GVs) in 288 genes related to cancer predisposition in 47 patients with available paired, tumor-normal material, namely bone marrow stroma cells (n = 29), postremission bone marrow (n = 17), and saliva (n = 1). These patients correspond to 2 broad AML categories with heterogeneous genetic background (AML myelodysplasia related and AML defined by differentiation) and none of them had phenotypic abnormalities, previous history of cytopenia, or strong cancer aggregation. We found 11 pathogenic or likely pathogenic variants, 6 affecting genes related to autosomal dominant cancer predisposition syndromes (ATM, DDX41, and CHEK2) and 5 related to autosomal recessive bone marrow failure syndromes (FANCA, FANCM, SBDS, DNAJC21, and CSF3R). We did not find differences in clinical characteristics nor outcome between carriers of GVs vs noncarriers. Further studies in unselected AML cohorts are needed to determine GV incidence and penetrance and, in particular, to clarify the role of ATM nonsense mutations in AML predisposition.

Real-World Data on Chronic Myelomonocytic Leukemia: Clinical and Molecular Characteristics, Treatment, Emerging Drugs, and Patient Outcomes.

Despite emerging molecular information on chronic myelomonocytic leukemia (CMML), patient outcome remains unsatisfactory and little is known about the transformation to acute myeloid leukemia (AML). In a single-center cohort of 219 CMML patients, we explored the potential correlation between clinical features, gene mutations, and treatment regimens with overall survival (OS) and clonal evolution into AML. The most commonly detected mutations were TET2, SRSF2, ASXL1, and RUNX1. Median OS was 34 months and varied according to age, cytogenetic risk, FAB, CPSS and CPSS-Mol categories, and number of gene mutations. Hypomethylating agents were administered to 37 patients, 18 of whom responded. Allogeneic stem cell transplantation (alloSCT) was performed in 22 patients. Two-year OS after alloSCT was 60.6%. Six patients received targeted therapy with IDH or FLT3 inhibitors, three of whom attained a long-lasting response. AML transformation occurred in 53 patients and the analysis of paired samples showed changes in gene mutation status. Our real-world data emphasize that the outcome of CMML patients is still unsatisfactory and alloSCT remains the only potentially curative treatment. However, targeted therapies show promise in patients with specific gene mutations. Complete molecular characterization can help to improve risk stratification, understand transformation, and personalize therapy.

Long-term outcomes in patients with relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies after undergoing sequential conditioning regimen based on IDA-FLAG and high-dose melphalan.

Allogeneic hematopoietic cell transplantation (alloHCT) remains the only curative option for relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies. To improve alloHCT results in this setting, sequential regimens were designed as a strategy to lower tumor burden and quickly induce the graft-versus-leukemia effect. We analyzed long-term outcomes of a sequential regimen based on IDA-FLAG and high-dose melphalan, as set forth by the CETLAM cooperative group. This protocol yielded a high complete response rate (89%) and a lower cumulative relapse incidence (30% at five years) compared to other regimens. Five-year non-relapse mortality, however, reached 45%, with grade 3-4 acute graft-versus-host disease being the most frequent adverse event (a 100-day incidence of 29%). Altogether, 5-year overall survival was 25% in this group of patients with otherwise dismal prognosis. Long-term survivors enjoyed a good quality of life after a median follow-up of 68 months.

Elastin-like Polymers as Nanovaccines: Protein Engineering of Self-Assembled, Epitope-Exposing Nanoparticles.

In this chapter we describe two unconventional strategies for the formulation of new nanovaccines. Both strategies are based on obtaining chimeric genes that code for proteins in which the major antigens of the pathogens are fused to an elastin-like recombinamer (ELR) as carrier. ELRs are a family of synthetic protein biopolymers obtained using DNA recombinant techniques. The ELRs employed in the present chapter are block copolymers that are able to assemble, under controlled conditions, into nanoparticles similar to virus-like particles and to provoke an immune response. We describe the biosynthesis of ELRs genetically fused to an antigenic sequence from Mycobacterium tuberculosis and a simple procedure for obtaining stable nanoparticles displaying the antigen in the first strategy. The second approach describes the production of a DNA vaccine library consisting of plasmids codifying for major antigens from Rift Valley fever virus fused to different ELR-based block copolymer architectures.The procedures described can be adapted for the production of other chimeric DNA-protein vaccines based on protein polymer carriers.

European LeukemiaNet 2017 risk stratification for acute myeloid leukemia: validation in a risk-adapted protocol.

The 2017 European LeukemiaNet (ELN 2017) guidelines for the diagnosis and management of acute myeloid leukemia (AML) have become fundamental guidelines to assess the prognosis and postremission therapy of patients. However, they have been retrospectively validated in few studies with patients included in different treatment protocols. We analyzed 861 patients included in the Cooperativo Para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias-12 risk-adapted protocol, which indicates cytarabine-based consolidation for patients allocated to the ELN 2017 favorable-risk group, whereas it recommends allogeneic stem cell transplantation (alloSCT) as a postremission strategy for the ELN 2017 intermediate- and adverse-risk groups. We retrospectively classified patients according to the ELN 2017, with 327 (48%), 109 (16%), and 245 (36%) patients allocated to the favorable-, intermediate-, and adverse-risk group, respectively. The 2- and 5-year overall survival (OS) rates were 77% and 70% for favorable-risk patients, 52% and 46% for intermediate-risk patients, and 33% and 23% for adverse-risk patients, respectively. Furthermore, we identified a subgroup of patients within the adverse group (inv(3)/t(3;3), complex karyotype, and/or TP53 mutation/17p abnormality) with a particularly poor outcome, with a 2-year OS of 15%. Our study validates the ELN 2017 risk stratification in a large cohort of patients treated with an ELN-2017 risk-adapted protocol based on alloSCT after remission for nonfavorable ELN subgroups and identifies a genetic subset with a very poor outcome that warrants investigation of novel strategies.

Entirely environment-friendly polylactide composites with outstanding heat resistance and superior mechanical performance fabricated by spunbond technology: Exploring the role of nanofibrillated stereocomplex polylactide crystals.

This study aims at investigating the manufacturing and characterization of all-polylactide composites prepared by melt spunbond spinning technology. To do so, a series of asymmetric stereocomplex polylactide (SC-PLA) blends (PLLA 95 wt%/PDLA 5 wt%) was melt spun. To examine the impact of molecular structure of PDLA, the blends of linear PLLA, and low and high molecular weight as well as branched PDLAs, were subjected to a single step spunbond process. DSC thermograms of the samples showed two melting temperatures at around 170 °C and 210 °C, which were attributed to the melting of homo and stereocomplex crystals, respectively. The samples were spun at 190 °C, between the homo and stereocomplex crystals' melting temperatures, and at 230 °C, above the stereocomplex crystals' melting temperature. Morphology images showed the formation of fibers in the range of 40-50 µm. Shear rheological measurements revealed that the spun SC-PLA samples had a substantially higher viscosity and storage modulus in the low frequency region, and higher shear thinning behavior, compared to the non-spun samples. Extensional rheology measurements also showed that the spun samples demonstrated strain hardening behavior. Substantial enhancement of rheological properties was noted for the samples containing the branched and high molecular weight PDLA spun at 230 °C. After etching, the spun samples at 190 °C exhibited small spherical crystals with diameters in the range of 80-90 nm, whereas comparatively thin fibers in the size range of 60-70 nm were observed for the samples spun at 230 °C. Remarkable enhancements up to 100% and 60% was noted for the tensile modulus and strength, respectively, of the spun SC-PLA samples. The spun fibers also demonstrated a considerable reduction in boiling water and hot air shrinkage. The distinctive role of nanofibrillated stereocomplex crystals as a rheology modifier and a crystallization nucleating agent makes PLA more sustainable and paves the way for the fabricated all-PLA composites in applications requiring high heat resistance and superior mechanical performance. The present study unequivocally indicates a huge potential for the sustainable entirely all-PLA products manufactured by fiber in fiber and, indeed, unfolds unknown opportunities for PLA-based merchandises in future.

El sexo en la vejez visto desde el resto de la sociedad / Society's views on sexuality of the elderly

Introducción: De acuerdo con la definición de sexualidad según la Organización Mundial de la Salud, el sexo atañe al ser humano durante toda su vida; sin embargo, parece que la sociedad fracciona a la persona en edades y priva de una realidad justa en el disfrute de la sexualidad en la senectud. El aumento de este sector poblacional, su esperanza de vida y mejora del estado de salud está abriendo un hueco en el interés por este tema, del que antes carecía. La mayoría de los estudios de investigación acerca de la sexualidad en la senectud cuentan como sujetos de estudio a los propios mayores; pero ¿y si estudiásemos la visión del resto de la sociedad Objetivos: Conocer qué piensa la sociedad del sexo en la tercera edad. Metodología: Se realizó un estudio observacional descriptivo transversal de un total de 685 personas. Para la recogida de información, se realizó un cuestionario de diseño propio, anónimo y específico que se difundió a través de internet. Resultados Se obtuvieron resultados que esclarecían la opinión de la sociedad mediante un análisis estadístico descriptivo. Conclusiones: La sexualidad de las personas mayores es un tema aún con prejuicios negativos por parte de la sociedad; sin embargo, cuando a esta se le pide empatía, la respuesta es muy positiva (AU)

Introduction: According to the World Health Organization, sexuality concerns human beings throughout their entire lifetime. However, it seems that society categorizes people into their age groups and that the elderly are deprived of a fair reality relating to the enjoyment of sexuality in old age. The increase of this population sector, life expectancy and improvement of the state of health, is increasing interest on this subject, which was previously lacking. The majority of research studies about sexuality in old age are carried out with within the elderly sector, but what if there was a research study based on the rest of society´s views on this subject? Objectives: To know what society think in relation to sex within the elderly sector. Methodology: A descriptive cross-sectional observational study of a total of 685 people was carried out. For the collection of information, an own, anonymous, and specific design questionnaire was made and disseminated through the internet. Results: Results were obtained that clarified the opinion of society through a multivariate statistical analysis with IBM SPSS Statistics 19. Conclusions: Society´s views on the sexuality of the elderly is a subject with negative prejudices. However, when empathy is asked, the response is very positive (AU)

Risk Factors for Mortality in Hematopoietic Stem Cell Transplantation Recipients with Bloodstream Infection: Points To Be Addressed by Future Guidelines.

In recent years, important epidemiologic changes have been described in hematopoietic stem cell transplantation (HSCT) recipients with bloodstream infection (BSI), with increases in gram-negative bacilli and multidrug resistant (MDR) gram-negative bacilli. These changes have been linked to a worrisome increase in mortality. We aimed to define the risk factors for mortality of HSCT patients experiencing BSI. All episodes of BSI in patients with HSCT between 2008 and 2017 were prospectively collected. Multivariate analyses were performed. A total of 402 BSI episodes were documented in 293 patients who had undergone HSCT (75.4% allogenic, 32.3% autologous, 19.3% second HSCT). The median time from HSCT to BSI was 62 days (interquartile range, 9 to 182 days). Gram-positive cocci accounted for 56.7% of the episodes; gram-negative bacilli, for 42%. The most common microorganisms were coagulase-negative staphylococci (30.6%) and Pseudomonas aeruginosa (15.9%). MDR gram-negative bacilli caused 11.9% of all episodes. Clinical characteristics, source of BSI, etiology, and outcomes changed depending on time since HSCT. Globally, 26.6% of episodes were treated with inappropriate empiric antibiotic therapy, more frequently in BSI episodes caused by P. aeruginosa, MDR P. aeruginosa, and MDR gram-negative bacilli. The 30-day mortality was 19.2%. Independent risk factors for mortality were BSI occurring ≥30 days after HSCT (odds ratio [OR], 11.21; 95% confidence interval [CI], 4.63 to 27.19), shock (OR, 7.10; 95% CI, 2.98 to 16.94), BSI caused by MDR P. aeruginosa (OR, 4.45; 95% CI, 1.12 to 17.72), and inappropriate empiric antibiotic therapy for gram-negative bacilli or Candida spp. (OR, 3.73; 95% CI, 1.27 to 10.89). HSCT recipients experiencing BSI have high mortality related to host and procedure factors, causative microorganism, and empiric antibiotic therapy. Strategies to identify HSCT recipients at risk of MDR P. aeruginosa and reducing inappropriate empiric antibiotic therapy are paramount to reduce mortality.

Análisis de la situación de los profesionales del servicio de pool en un hospital universitario / Analysis of the situation of professionals from the pool service at a University Hospital

Objetivo: identificar la situación laboral de los profesionales del servicio de pool en el Hospital Universitario de Burgos (HUBU).Método: se llevó a cabo un estudio transversal en 2019. Sediseñó un cuestionario ad hoc, con 19 ítems, dirigido a enfermeras/os y técnicos en cuidados auxiliares de Enfermería (TCAE) con experiencia previa en algún servicio de pool. La población potencial fueron todos los contactos que tenía registrados el colectivo Unión de Profesionales por la Mejora Sanitaria (UPROMES) de Burgos, quien realizó la difusión de la encuesta vía correo electrónico y Whatsapp. Se llevó a cabo un análisis descriptivo.Resultados: participaron 137 profesionales, 86,86% (n= 119) enfermeras y 13,13% (n= 18) TCAE. La edad media (DE) de enfermeras fue 33,14 (6,37) años y de 46,92 (6,87) para TCAE. El 65,69% (n=90) de los sujetos de estudio reconoció haber trabajado alguna vez en el pool de dirección del HUBU, el 21,16% (n= 29) en el pool de planta del HUBU y el 13,13% (n=18) en el pool de otro hospital. Con 15 días de antelación rara vez habían recibido el turno el 50% (n= 45) del pool de dirección y el 41,37% (n= 12) del pool de planta. El método de comunicación de los turnos para el pool de dirección más frecuente fue el teléfono privado, y para el pool de planta la cartelera.Conclusiones: se informa del turno de trabajo con poca antelación. Para la asignación de unidad no se tiene en cuenta la experiencia profesional, formación o habilidades del profesional en dicha unidad.(AU)

Objective: to understand the occupational situation of the professionals from the pool service at the Hospital Universitario de Burgos (HUBU).Methods: across-sectional study was conducted in 2019. An ad hoc questionnaire was designed, with 19 items, targeted to nurses and Assistant Nursing Care Technicians (TCAE) with previous experience in some pool service. The potential population included all contacts registered by the Union of Professionals for Sanitary Improvement (UPROMES), which distributed the survey by email and Whatsapp. Descriptive analysis was conducted.Results: the study included 137 professionals: 86.86% (n= 119) were nurses and 13.13% (n= 18) were TCAEs. The mean age (SD) of nurses was 33.14 (6.37) years, and 46.92 (6.87) years for TCAEs; 65.69% (n= 90) of the study subjects admitted that they have worked at some point at the management pool of HUBU, 21.16% (n= 29) in the ward pool of the HUBU, and 13.13% (n=18) in the pool of other hospital. Their shift had been rarely received with 15 days in advance by 50% (n= 45) of the management pool, and 41.37% (n= 12) of the ward pool. The most frequent method of communication of shifts for the management pool was by private phone, and the billboard for the ward pool.Conclusions: information about the working shift is provided with little time in advance. Professional experience, training, or personal skills in the unit are not taken into account for unit assignation.(AU)

The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever.

BACKGROUND: Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. METHODS: Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. RESULTS: The incidence of NF among the groups was reduced (64%, 44%, and 24%; P<0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age ≥60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05). CONCLUSIONS: G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.

Declaración de voluntades anticipadas. Un testamento vital para asegurar la autonomía / Declaration of living wills, a vital testament for ensuring personal self-reliance

Introducción: Visto el escaso número de declaraciones de voluntades anticipadas presentadas, las diferencias entre modelos de documentos en las distintas comunidades autónomas, la falta de difusión, la importancia y beneficios que aportaría que el número de declarantes aumentará... nos preguntamos: ¿por qué la declaración de voluntades anticipadas es una gran desconocida? Objetivos: Conocer si la población sabe de la existencia de la declaración de voluntades anticipadas. Saber si tiene intención de realizarla. Metodología: Tras una búsqueda bibliográfica previa se realizó un estudio observacional descriptivo transversal de un total de 1.652 personas de entre 18 y 79 años de todo el territorio nacional. Para la recogida de información, se elaboró un cuestionario de diseño propio, anónimo y específico que se difundió a través de internet mediante correo electrónico, mensajería instantánea y redes sociales. Se utilizó el análisis estadístico multivariante IBM SPSS Statistics 19. Resultados: Casi un 90% de los encuestados ha pensado alguna vez en su propia muerte. Un poco más del 50% conocía qué eran las voluntades anticipadas. El 90% afirmaba que el documento tenía gran utilidad. Solo un 3% había registrado el documento. Conclusiones: La realización de las voluntades anticipadas es sin duda de vital importancia para la población anciana, aunque no por eso deja de serlo para la sociedad en su conjunto, ya que realmente ni la enfermedad ni la muerte entienden de edad. Con este documento se asegurará el respeto en cualquier situación, y a lo largo de toda la vida, de la autonomía y la libertad para decidir de cada individuo

Introduction: Considering the small number of Living Will declarations made; the differences between the documents of each Autonomous Community, the lack of publicity about its existence; and the importance and the benefits that could bring an increase in the number of deponents... we wonder: ¿Why are the Living Will Declarations still unknown? Aim: To know if the public is aware of the existence of the Living Will Declarations. To know if there are persons with the intention to make use of it. Methodology: After a previous bibliographical research, a transversal descriptive observational study of a total of 1652 people between 18 and 79 years of the whole national territory was carried out. For the collection of information, a selfdesigned, anonymous and specific questionnaire was developed and disseminated through the web via email, instant messaging and social networks. A multivariate statistical analysis IBM SPSS Statistics 19. Results: Almost 90% of respondents have thought about their own death. A little over 50% knew what the anticipated Wills were. 90% said that the document was very useful. Only 3% had registered the document. Conclusion: The use of anticipated wills is undoubtedly of vital importance for the elderly population, and also for the society as a whole, since neither illness nor death take age into account. If this document is taken into account, it will ensure respect in any situation and for each individual to decide over its freedom and autonomy