Synchronic distribution of the dinoflagellate Protoceratium reticulatum and yessotoxins in a high stratified fjord system: Tidal or light modulation?

Protoceratium reticulatum is the main yessotoxin-producer along the Chilean coast. Thus far, the yessotoxin levels recorded in this region have not posed a serious threat to human health. However, a bloom of P. reticulatum during the austral summer of 2022 caused the first ban of shellfish collection, due to the high toxin levels. A bloom of P. reticulatum during the austral summer of 2020 allowed an evaluation of the fine-scale distribution of the dinoflagellate during a tidal cycle. High-resolution measurements of biophysical properties were carried out in mid-summer (February 18-19) at a fixed sampling station in Puyuhuapi Fjord, Chilean Patagonia, as part of an intensive 24-h biophysical experiment to monitor the circadian distributions of P. reticulatum vegetative cells and yessotoxins. High P. reticulatum cell densities (>20 × 103 cells L-1) were found in association with a warmer (14.5-15 °C) and estuarine (23.5-24.5 g kg-1) sub-surface water layer (6-8 m). P. reticulatum cell numbers and yessotoxins followed a synchronic distribution pattern consistent with the excursions of the pycnocline. Nevertheless, the surface aggregation of the cells was modulated by the light cycle, suggesting daily vertical migration. The yessotoxin content per P. reticulatum cell ranged from 9.4 to 52.2 pg. This study demonstrates both the value of fine-scale resolution measurements of biophysical properties in a highly stratified system and the potential ecosystem impact of P. reticulatum strains producing high levels of yessotoxins.

Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital. / Hipotermia terapéutica: estudio descriptivo de una cohorte de 10 años en un hospital público de alta complejidad.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

Introducción. La hipotermia terapéutica (HT) reduce el riesgo de muerte o discapacidad en niños con encefalopatía hipóxico-isquémica (EHI) moderada-grave. Objetivo. Describir una población de pacientes con EHI que requirió HT y su evolución hasta el alta hospitalaria. Población y métodos. Estudio descriptivo de cohorte retrospectivo. Se analizaron todos los pacientes que ingresaron a HT entre 2013 y 2022. Se evaluaron datos epidemiológicos, clínicos, de monitoreo, tratamiento, estudios complementarios y condición al alta. Se compararon los factores de riesgo entre pacientes fallecidos y sobrevivientes, y de estos, los que requirieron necesidades especiales al alta (NEAS). Resultados. Se incluyeron 247 pacientes. Mortalidad: 11 %. Evento centinela más frecuente: período expulsivo prolongado (39 %). Inicio del tratamiento: mediana 5 horas de vida. Convulsiones: 57 %. Eritropoyetina intravenosa: 66,7 %. Patrón anormal de monitoreo de función cerebral: 52 %. Normalización del monitoreo: mediana 24 horas. Resonancia magnética patológica: 42 %. Variables predictoras de mortalidad: Sarnat y Sarnat grave, y ecografía patológica al ingreso. Conclusión. La mortalidad global fue del 11 %. Las derivaciones aumentaron en forma más evidente a partir del año 2018. El horario de inicio de HT fue más tardío que en reportes anteriores. Los signos neurológicos de gravedad según la escala de Sarnat y Sarnat y la ecografía cerebral basal patológica fueron predictores independientes de mortalidad al alta. Los pacientes con NEAS presentaron normalización del trazado del electroencefalograma de amplitud integrada más tardío. El hallazgo más frecuente en la resonancia fue la afectación de los ganglios basales. No se encontraron diferencias clínicas ni de complicaciones estadísticamente significativas entre los pacientes que recibieron eritropoyetina.

The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis.

OBJECTIVE: Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children? SOURCES: This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034. SUMMARY OF THE FINDINGS: Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %). CONCLUSIONS: These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress.

Effects of the toxic dinoflagellate Protoceratium reticulatum and its yessotoxins on the survival and feed ingestion of Argopecten purpuratus veliger larvae.

The effects of yessotoxins (YTXs) produced by the dinoflagellate Protoceratium reticulatum in the early stages of bivalves have not been studied in detail. The present study evaluates the effects of P. reticulatum and YTXs on the survival and feed ingestion of veliger larvae of Argopecten purpuratus. Larvae were 96 h-exposed to 500, 1000 and 2000 P. reticulatum cells mL-1, and their equivalent YTX extract was prepared in methanol. Results show a survival mean of 82 % at the highest density of dinoflagellate, and 38 % for larvae with the highest amount of YTX extract. Feed ingestion is reduced in the dinoflagellate exposure treatments as a function of cell density. Therefore, the effect of YTXs on A. purpuratus represents a new and important area of study for investigations into the deleterious effects of these toxins in the early stages of the life cycle of this and, potentially, other bivalves.

The Impact of the COVID-19 Pandemic on Influenza Vaccination Attitudes and Actions in Spain's Adult Population.

Seasonal influenza is an acute respiratory infection caused by the influenza virus which constitutes a significant public health issue associated with high morbidity and mortality. The aim of this study was to investigate changes in attitudes, perceptions, and practices regarding influenza vaccination in the Spanish adult population during the COVID-19 pandemic, as well as their vaccination intentions, with special attention paid to those over 65 years old and in high-risk groups. To this end, a cross-sectional study was conducted through 2219 telephone interviews, and the results were compared with results obtained a year earlier. Regarding the reasons for deciding to get vaccinated in the 2022/23 season, a significant increase was observed in vaccine confidence (36.7% vs. 42.8%), social responsibility (32.5% vs. 43.8%), and in awareness of the importance of vaccination due to COVID-19 (21.7% vs. 25.4%). Advanced age (OR 2.8, 95% CI 2.0-3.9), belonging to high-risk groups (OR 2.7, 95% CI 2.0-3.7), and prior vaccination (OR 25.3, 95% CI 19.5-32.7) emerged as significant predictors for the intent to receive the influenza vaccine in the 2022/23 season. Continuously observing shifts in perceptions and behaviors related to influenza immunization is crucial to pinpoint factors that may influence the willingness to receive the vaccine and, in this way, design public health strategies that achieve a greater acceptance of it.

The mRNA and protein levels of the glycolytic enzymes lactate dehydrogenase A (LDHA) and phosphofructokinase platelet (PFKP) are good predictors of survival time, recurrence, and risk of death in cervical cancer patients.

INTRODUCTION: Patients with cervical cancer (CC) may experience local recurrence very often after treatment; when only clinical parameters are used, most cases are diagnosed in late stages, which decreases the chance of recovery. Molecular markers can improve the prediction of clinical outcome. Glycolysis is altered in 70% of CCs, so molecular markers of this pathway associated with the aggressiveness of CC can be identified. METHODS: The expression of 14 glycolytic genes was analyzed in 97 CC and 29 healthy cervical tissue (HCT) with microarray; only LDHA and PFKP were validated at the mRNA and protein levels in 36 of those CC samples and in 109 new CC samples, and 31 HCT samples by qRT-PCR, Western blotting, or immunohistochemistry. A replica analysis was performed on 295 CC from The Cancer Genome Atlas (TCGA) database. RESULTS: The protein expression of LDHA and PFKP was associated with poor overall survival [OS: LDHA HR = 4.0 (95% CI = 1.4-11.1); p = 8.0 × 10-3 ; PFKP HR = 3.3 (95% CI = 1.1-10.5); p = 4.0 × 10-2 ] and disease-free survival [DFS: LDHA HR = 4.5 (95% CI = 1.9-10.8); p = 1.0 × 10-3 ; PFKP HR = 3.2 (95% CI = 1.2-8.2); p = 1.8 × 10-2 ] independent of FIGO clinical stage, and the results for mRNA expression were similar. The risk of death was greater in patients with overexpression of both biomarkers than in patients with advanced FIGO stage [HR = 8.1 (95% CI = 2.6-26.1; p = 4.3 × 10-4 ) versus HR = 7 (95% CI 1.6-31.1, p = 1.0 × 10-2 )] and increased exponentially as the expression of LDHA and PFKP increased. CONCLUSIONS: LDHA and PFKP overexpression at the mRNA and protein levels was associated with poor OS and DFS and increased risk of death in CC patients regardless of FIGO stage. The measurement of these two markers could be very useful for evaluating clinical evolution and the risk of death from CC and could facilitate better treatment decision making.

Dinophysis acuminata or Dinophysis acuta: What Makes the Difference in Highly Stratified Fjords?

Dinophysis acuminata and D. acuta, which follows it seasonally, are the main producers of lipophilic toxins in temperate coastal waters, including Southern Chile. Strains of the two species differ in their toxin profiles and impacts on shellfish resources. D. acuta is considered the major cause of diarrhetic shellfish poisoning (DSP) outbreaks in Southern Chile, but there is uncertainty about the toxicity of D. acuminata, and little information on microscale oceanographic conditions promoting their blooms. During the austral summer of 2020, intensive sampling was carried out in two northern Patagonian fjords, Puyuhuapi (PUY) and Pitipalena (PIT), sharing D. acuminata dominance and D. acuta near detection levels. Dinophysistoxin 1 (DTX 1) and pectenotoxin 2 (PTX 2) were present in all net tow samples but OA was not detected. Although differing in hydrodynamics and sampling dates, D. acuminata shared behavioural traits in the two fjords: cell maxima (>103 cells L-1) in the interface (S ~ 21) between the estuarine freshwater (EFW)) and saline water (ESW) layers; and phased-cell division (µ = 0.3-0.4 d-1) peaking after dawn, and abundance of ciliate prey. Niche analysis (Outlying Mean Index, OMI) of D. acuta with a high marginality and much lower tolerance than D. acuminata indicated an unfavourable physical environment for D. acuta (bloom failure). Comparison of toxin profiles and Dinophysis niches in three contrasting years in PUY-2020 (D. acuminata bloom), 2018 (exceptional bloom of D. acuta), and 2019 (bloom co-occurrence of the two species)-shed light on the vertical gradients which promote each species. The presence of FW (S < 11) and thermal inversion may be used to provide short-term forecasts of no risk of D. acuta blooms and OA occurrence, but D. acuminata associated with DTX 1 pose a risk of DSP events in North Patagonian fjords.

Necesidades psicosociales en cuidados paliativos de las personas con esclerosis lateral amiotrófica, familiares y cuidadores/as. Una revisión de revisiones / Psychosocial needs in palliative care of amyotrophic lateral sclerosis patients, family members and caregivers. A review of reviews

Introducción: La esclerosis lateral amiotrófica (ELA) se define por la degeneración progresiva de las motoneuronas superiores e inferiores, lo que provoca una debilidad muscular progresiva que amenaza gravemente la autonomía motora, la comunicación oral, la deglución y la respiración. Estas características hacen que la ELA sea una de las enfermedades más duras emocionalmente para los y las pacientes y sus familiares y personas cuidadoras. La persona con ELA y la familia se pueden beneficiar de los cuidados paliativos en las etapas tempranas de la enfermedad, no solo para planificar una buena muerte cuando corresponda, sino para beneficiarse de tratamientos especializados a cualquier edad y en cualquier estadio de la enfermedad.Objetivo: El objetivo de esta revisión es actualizar y organizar el conocimiento sobre las necesidades paliativas psicosociales de las personas con ELA y cuidadoras, con el fi n de mejorar protocolos de tratamiento y la implementación de planes integrales de cuidados paliativos. Material y métodos: Para ello se realizó una búsqueda en PubMed y Cochrane y en la revista Medicina Paliativa de artículos de revisión sobre ELA y cuidados paliativos. Resultados: Se identificaron 5 estudios que cumplían criterios de inclusión con abundante información sobre necesidades psicosociales de las personas con ELA y cuidadoras, que recorren todo el proceso de la enfermedad, desde el diagnóstico hasta el duelo. Los resultados se clasifican en base a un triple eje: I. Naturaleza de la necesidad; II. Etapa de la enfermedad y III. Persona cuidadora o enferma. Conclusiones: Los beneficios de los cuidados paliativos en la ELA requieren una consideración complementaria a los de la neurología desde el diagnóstico hasta el duelo. (AU)

Introduction: Amyotrophic lateral sclerosis (ALS) is defined by a progressive degeneration of the upper and lower motor neurons resulting in progressive muscle weakness, which severely compromises motor autonomy, oral communication, swallowing, and breathing. These characteristics make ALS one of the most emotionally difficult diseases for patients and their families, as well as their caregivers. The patient and his/her family can benefit from palliative care in the early stages of the disease, not only to plan for a good death when appropriate but also to benefit from specialized treatments at any age and any stage of the disease.Objective: The aim of this review was to update and organize the extant knowledge about the psychosocial palliative needs of patients and caregivers in order to improve treatment protocols and the implementation of comprehensive palliative care plans. Material and methods: To this end, we searched PubMed and Cochrane and the journal Palliative Medicine for review articles on ALS and palliative care. Results: Five studies that met inclusion criteria were identified with a wealth of information on the psychosocial needs of patients and caregivers, covering the entire disease process from diagnosis to bereavement. The results are classified on the basis of a threefold axis: I. Nature of the need; II. Stage of the illness; and III. Caregiver or sick person. Conclusion: The conclusion is that the benefits of palliative care in ALS require complementary consideration to those of neurology from diagnosis to bereavement. (AU)

Objective Analysis Of Voice Quality In Patients With Thyroid Pathology.

OBJECTIVE: The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI). DESIGN: Observational case-control study. SETTING: Hospital Universitario Nuestra Señora de Candelaria. PARTICIPANTS: Fifty-eight subjects, 29 controls and 29 thyroidectomy candidates. MAIN OUTCOME MEASURES: All participants with thyroid pathology completed the Spanish version of Voice Handicap Index-10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale. RESULTS: Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student's test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56]  = -3.85, p < .001) and ABI (t[54.39]  = -4.82, p < .001) in thyroidectomy candidates. CONCLUSION: A mild decrease in vocal quality is part of the symptomatology presented by thyroidectomy candidates.

MR-proADM as marker of endotheliitis predicts COVID-19 severity.

BACKGROUND: Early identification of patients at high risk of progression to severe COVID-19 constituted an unsolved challenge. Although growing evidence demonstrates a direct association between endotheliitis and severe COVID-19, the role of endothelial damage biomarkers has been scarcely studied. We investigated the relationship between circulating mid-regional proadrenomedullin (MR-proADM) levels, a biomarker of endothelial dysfunction, and prognosis of SARS-CoV-2-infected patients. METHODS: Prospective observational study enrolling adult patients with confirmed COVID-19. On admission to emergency department, a blood sample was drawn for laboratory test analysis. Primary and secondary endpoints were 28-day all-cause mortality and severe COVID-19 progression. Area under the curve (AUC) and multivariate regression analysis were employed to assess the association of the biomarker with the established endpoints. RESULTS: A total of 99 patients were enrolled. During hospitalization, 25 (25.3%) cases progressed to severe disease and the 28-day mortality rate was of 14.1%. MR-proADM showed the highest AUC to predict 28-day mortality (0.905; [CI] 95%: 0.829-0.955; P < .001) and progression to severe disease (0.829; [CI] 95%: 0.740-0.897; P < .001), respectively. MR-proADM plasma levels above optimal cut-off (1.01 nmol/L) showed the strongest independent association with 28-day mortality risk (hazard ratio [HR]: 10.470, 95% CI: 2.066-53.049; P < .005) and with progression to severe disease (HR: 6.803, 95% CI: 1.458-31.750; P = .015). CONCLUSION: Mid-regional proadrenomedullin was the biomarker with highest performance for prognosis of death and progression to severe disease in COVID-19 patients and represents a promising predictor for both outcomes, which might constitute a potential tool in the assessment of prognosis in early stages of this disease.

Diseño del sitio web de la Universidad Virtual de Salud de Pinar del Río / The design of a Website at Pinar del Río Virtual HealthUniversity

RESUMEN Introducción: con el desarrollo de las tecnologías de la información y las comunicaciones, las páginas web constituyen un medio facilitador del conocimiento. Objetivo: elaborar la planificación para el diseño del sitio web de la Universidad Virtual de Salud de Pinar del Río. Desarrollo: para el desarrollo del sitio se llevarán a cabo cinco procesos fundamentales: planificación inicial del sitio, definición, diseño y estándares, puesta en marcha y plan de mantenimiento. Para la confección de la página se empleará el gestor de contenido WordPress, donde PHP será el lenguaje de programación, MySQL como motor de bases de datos, Apache como servidor Web, y Windows como sistema operativo. Conclusiones: la página web constituye un medio de apoyo a los procesos desarrollados en la Universidad de Ciencias Médicas de Pinar del Río, pues facilita el proceso de gestión de la información de la Universidad Virtual de Salud de dicha institución. Además, como herramienta de enseñanza despierta el interés por la investigación y contribuye a la alfabetización informacional tanto de estudiantes, como de profesores y del personal de salud que ingrese en la página.

ABSTRACT Introduction: with the development of communication and information technologies, the websites constitute a means of knowledge facilitator. Objective: to plan the design of a website at Pinar del Río Virtual Health University. Development: to the creation of the website, five main processes have to be considered: initial planning of website, its definition, design and standards, starting up and maintenance plan. To the creation of the website Word Press content manager was applied, using PHP as a programming language, MySQL as a motor of databases, Apache as a web server and Windows as an operative system. These tools allow the creation of a digital product that is able to solve the needs of information flow, interchange and update of constant communication, that are required by professionals and graduates in training. Conclusions: the website constitutes a means of support to the processes Pinar del Rio University of Medical Sciences develops, facilitating the process of information management of the Virtual Health University in this higher education institution. It encourages students to make use of it, contributing to the improvement of information literacy for students, professors and health care personnel who browse through the website.

Bases para la implementación de la ciencia abierta / Basis for the implementation of open science

RESUMEN Introducción: La comunicación científica exige nuevos estándares que permitan una difusión rápida de los resultados científicos; lo cual adquiere gran connotación en las Ciencias de la Salud. Objetivo: Describir las bases para la implementación de la ciencia abierta. Método: Se desarrolló una revisión bibliográfica en las bases de datos Scopus, SciELO, Pubmed y RedALyC, citándose 27 artículos. Se emplearon fórmulas de búsqueda obtenidas por la combinación de descriptores y los operadores OR y AND. Resultados: La ciencia abierta permite mejor velocidad de difusión y posicionamiento de la producción científica, evaluar la fiabilidad de los estudios y detectar conflictos de intereses. Es necesario el trabajo en materia de infraestructura para la publicación y manipulación de los datos de investigación, así como en políticas que delimiten su uso. La ciencia abierta no cambia la motivación y objetivos de la investigación, sino el cómo hacer ciencia y difundirla. Conclusiones: La ciencia abierta se sustenta el acceso libre y sin restricciones a la información, permitiendo el acceso abierto a los códigos, a los datos, a las publicaciones, así como procesos de evaluación abierta.

ABSTRACT Introduction: Scientific communication requires new standards that allows a quick diffusion of scientific results, acquiring an eminent important in the Health Sciences. Objective: Describe the basis for the implementation of open Science. Method: A bibliographic review was developed in Scopus, SciELO, Pubmed and RedALyC databases, citing 27 articles. Search formulas obtained by the combination of descriptors and the OR and AND operators were used. Results: Open science allows a quick diffusion and good positioning of scientific production, evaluation of the reliability of studies and to detect conflicts of interest. A good infrastructure is needed for the scientific publications and to manipulate all research data, as well as policies to limit their use. Open science does not change the motivation and objectives of research, but rather how science is done and how disseminated. Conclusions: Open science is based on free and unrestricted access to information, allowing open access to codes, data, publications, as well as open evaluation processes.

Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study. / Factores que condicionan la pérdida de control al reducir escalones terapéuticos en el tratamiento del asma moderada-grave en la práctica clínica habitual: estudio español multicéntrico.

BACKGROUND: Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure. OBJECTIVE: To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists. METHODS: A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016. RESULTS: The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P<.001), greater age at diagnosis (>40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P<.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEV1 (P=.001) and a poorer Asthma Control Test score or Asthma Control Questionnaire score before the step-down (P<.001). The logistic regression analysis showed a higher probability of step-down failure in the more elderly patients (OR, 0.983; 95% CI 0.969-0.997) and those with severe asthma compared to those with moderate asthma (OR, 0.537; 95% CI 0.292-0.985), as well as an increased probability of success if the patients had the disease controlled for more than 6 months (OR, 2.253; 95% CI 1.235-4.112). CONCLUSION: In standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.

ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study.

INTRODUCTION: Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. METHODS: A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). RESULTS: None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). CONCLUSION: Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes.

Ejes de evaluación diagnóstica de niños con déficit de atención e hiperactividad / Diagnosis and evaluation of children with hyperactivity and deficit attention disorder

RESUMEN Para lograr un análisis integral de los pacientes con trastorno por déficit de atención e hiperactividad, a partir de las insuficiencias en su diagnóstico, se asume como objetivo el proponer ejes de peritaje de los niños con esta dolencia, que aporten una compresión integral. Se concluye que un proceso de evaluación diagnóstica debe ser: exhaustivo, con enfoque a la potencialidad, personalizado, contextualizado, sistémico, con visión evolutiva y que considere la respuesta al tratamiento, lo cual se refleja en los ejes, en correspondencia con los síntomas nucleares predominantes, los trastornos mentales comórbidos, las alteraciones somáticas asociadas, los factores etiológicos identificados, el rendimiento escolar: las potencialidades socio-compensatorias, la respuesta al tratamiento, las características de los entornos de interacción, de acuerdo con la evolución, y el pronóstico del trastorno.

ABSTRACT To determine insufficiencies in the diagnostic evaluation of patients with attention deficit hyperactivity disorder, for a complete assessment. We propose axes for diagnostic evaluation of children with attention deficit hyperactivity disorder, for its better comprehension. We conclude that a diagnostic evaluation process of attention deficit hyperactivity disorder should be: comprehensive, focused on potential, personalized, contextualized, systemic, with an evolutionary vision including treatment response. In relation to predominant nuclear symptoms, axes reflect comorbid mental disorders, associated somatic alterations, etiological factors identified, school performance: socio-compensatory potential, response to treatment, characteristics of the interaction environments, evolution and prognosis of the disorder.

Psychomotor Limitations of Overweight and Obese Five-Year-Old Children: Influence of Body Mass Indices on Motor, Perceptual, and Social-Emotional Skills.

The present research aimed to study the psycho-motor performance of five-year-old children with different body mass indices (BMI). A total of 694 pre-school children in the province of Albacete-Spain participated. Their performance in motor, perceptual, and social-emotional skills was analyzed using a standardized observation sheet (Checklist of Psychomotor Activities-CPA) and then compared according to their BMI using non-parametric statistical methods (Mann-Whitney test). Separate comparisons were made for girls and boys. Results indicated significant differences in performance amongst the groups of girls in all the motor and perceptual activities, and in the social relationships component of the social-emotional factor. These differences seemed to penalize motor activities, perceptual skills, and social relationships in overweight and obese girls compared to normal weight girls. In the case of boys, there were significant differences in laterality and visual-motor coordination (favoring overweight boys). Differences in respiratory control were also found, but in this case, penalizing obese boys compared to normal weight boys. Knowledge of possible psychomotor limitations in obese children could allow psychologists and healthcare professionals to design more focused interventions.

Percepción de autoecacia hacia la inclusión en futuros maestros de educación física / Perception of self-eficacy towards inclusion in pre-service teachers of physical education / Percepção de autoeficácia para inclusão em futuros professores de educação física

Los maestros son un eje fundamental en el proceso de construcción de una escuela inclusiva. Es por ello que parece relevante estudiar cómo perciben su eficacia en el trato con alumnos y alumnas con discapacidad, hecho de especial importancia en la formación inicial de futuros maestros y maestras de Educación Física (EF). El objetivo de la presente investigación fue analizar la autoeficacia percibida por parte de futuros docentes de EF en formación para la adaptación de tareas en EF, convirtiéndolas en inclusivas. Un total de 228 estudiantes (Medad=21.85 años) de los grados de maestro en educación primaria y maestro en educación infantil participaron en este estudio, en ambos casos con la mención en EF. Todos cumplimentaron una adaptación al contexto español de la Self-Eficacy Scale for Physical Education Teacher Education Majors towards Children with Disabilities (SE-PETE-D) (Block, Hutzler, Barak y Klavina, 2013). Los resultados indicaron que los participantes con formación específica en EF inclusiva y con participación previa en deporte inclusivo se percibían como más competentes a la hora de adaptar las tareas de clase para conseguir una EF inclusiva respecto a sus compañeros sin formación específica o contacto previo. Estos resultados sugirieron incluir programas de formación en EF inclusiva con el objetivo de mejorar la formación inicial de los maestros de educación primaria e infantil con mención de EF

Teachers are a fundamental axis in the process of building an inclusive school. It seems relevant to study how they perceive their effectiveness in dealing with students with disabilities, a fact of special importance in the initial training of future teachers of physical education (PE). The objective of the present research was to explore the differences in perceived self-efficacy to adapt tasks in PE and make them inclusive by PE teachers in training. A total of 228 students (Mage=21.85 years) from the bachelor’s degrees in Primary Education and Bachelor’s in Early Childhood Education, both with a specialitation in PE, took part of this study. All of them completed the Spanish version of the Self-Efficacy Scale for Physical Education Teacher Education Majors towards Children with Disabilities (SE-PETE-D) (Block, Hutzler, Barak and Klavina, 2013). The results indicated that the participants with specific training in inclusive PE and with participation in inclusive sport were perceived as more competent when adapting tasks to achieve an inclusive PE. "ese results suggested to include training programs in inclusive PE with the aim of improving the initial training of PE teachers

Os professores são um eixo fundamental no processo de construção de uma escola inclusiva. Por isso, parece relevante estudar como eles percebem sua efetividade em lidar com alunos com deficiência, fato de especial importância na formação inicial de futuros professores de Educação Física (EF). O objetivo desta pesquisa foi analisar a autoeficácia percebida por parte de futuros professores de EF em treinamento para a adaptação de tarefas de EF, tornando-os inclusivos. Um total de 228 alunos (Midade=21,85 anos) das séries de professoras no ensino fundamental e professor na educação infantil participaram deste estudo, em ambos os casos com a menção na EF. Todos preencheram uma adaptação ao contexto espanhol da Escala de auto-efficácia para Educação Física Professor Majors educação às crianças com Defficiência (SE-PETE-D) (Block, Hutzler, Barak and Klavina, 2013). Os resultados indicaram que os participantes com formação específfca na participação inclusiva e anterior inclusive EF esporte percebidos como mais competente na adaptação atribuições de sala de aula para alcançar uma EF inclusive em comparação com seus pares sem formação especí€ca ou contato anterior. Estes resultados sugeridos incluem programas de formação em EF inclusiva com o objetivo de melhorar a formação inicial de profesores de educação primária e infantil com menção de EF

El paradigma de la sepsis: en busca del biomarcador perfecto / Sepsis paradigm: looking for the perfect biomarker

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Diagnostic capacity of SD-OCT segmented ganglion cell complex versus retinal nerve fiber layer analysis for congenital glaucoma.

PURPOSE: To compare the diagnostic performance of circumpapillary retinal nerve fiber layer (cpRNFL) analysis versus segmented ganglion cell complex analysis both by spectral-domain optical coherence tomography (SD-OCT) in children with primary congenital glaucoma (PCG). METHODS: Participants were 40 children diagnosed with PCG and 60 healthy children. Ophthalmological data collected (for one eye per child) were cup-disc ratio (C/D) and axial length (AL). SD-OCT with automated segmentation was used to measure the thicknesses and volumes of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). For the cpRNFL measurements conventional S-D OCT software was used and the capacity of each method to discriminate between normal and glaucomatous eyes was compared. RESULTS: Mean age was 11.20 ± 3.94 years for the glaucoma patients and 10.90 ± 2.46 years for controls (p = 0.64). All measurements were reduced (thinner) in the glaucoma group, significantly so for: cpRNFL, GCL, IPL and outer-superior and outer-inferior quadrant mRNFL. According to their areas under the receiver operating characteristics curve (AUC), temporal superior cpRNFL (0.869) and outer superior GCL (0.840), IPL (0.799), and mRNFL (0.767) showed the better diagnostic capacity. No differences were observed in AUCs for the most discriminatory cpRNFL and macular measurements. CONCLUSION: Segmented macular layer analysis shows a good capacity to discriminate between normal and glaucomatous eyes; which is comparable to that of cpRNFL analysis in children with PCG.