Prevalence of dry eye disease in the low vision population at the University of Colorado

Purpose: To evaluate the prevalence of diagnosed dry eye syndrome, meibomian gland dysfunction, and blepharitis amongst the low vision population. Methods: A retrospective analysis was conducted on patients seen in the University of Colorado Low Vision Rehabilitation Service between the dates of 12/1/2017 and 12/1/2022. 74 ICD-10 codes were used to identify patients as having dry eye syndrome or not having dry eye syndrome. Data was further analyzed to determine the prevalence of blepharitis and meibomian gland dysfunction using 29 blepharitis and 9 meibomian gland dysfunction ICD-10 codes. Data were also analyzed to determine the age and sex of the patients with diagnosed dry eye syndrome. Results: The percentage of patients with a diagnosis of dry eye syndrome by an eyecare provider was 38.02 %. The prevalence of dry eye syndrome by age group was 3.57 % for 0–19 years, 14.35 % for 20–39 years, 29.07 % for 40–59 years, 43.79 % for 60–79 years, and 46.21 % for 80 and above. The prevalence of meibomian gland dysfunction and blepharitis was 11.90 % and 9.1 % respectively. Dry eye syndrome prevalence amongst males was 31.59 % and 42.47 % for females. Conclusion: This study demonstrates that dry eye syndrome in the low vision population is a significant co-morbidity occurring in over a third of patients in the University of Colorado Low Vision Rehabilitation Service. These findings are meaningful as ocular comfort should not be overlooked while managing complex visual needs. (AU)

Impact of obesity on in-hospital mortality and morbidity among patients admitted for antineoplastic chemotherapy: a nationwide analysis / Impacto de la obesidad en la mortalidad y morbilidad hospitalaria entre pacientes ingresados para quimioterapia antineoplásica: un análisis a nivel nacional

Background: Obesity is a complex and multifactorial medical condition that can have far reaching consequences on cancer patients, particularly those undergoing treatment such as chemotherapy. Our study focuses to comprehensively explore the various adverse outcomes in obese patients receiving chemotherapy during hospitalization. Methods: The National Inpatient Sample 2020 was used using the ICD-10 codes to identify patients hospitalized with a primary discharge diagnosis of neoplastic chemotherapy with or without a secondary diagnosis of obesity. Statistical analysis using Stata software was done, and primary and secondary outcomes were obtained after adjusting for confounders using multivariate regression analysis. Results: Mortality was similar in both obese and non-obese patients. Length of stay and total hospitalization charges were increased in obese patients. Obese patients had higher odds of developing acute respiratory failure and were more likely to require non-invasive and invasive mechanical ventilation. Conclusion: Our study concluded that obesity could be considered an independent predictor of worse outcomes in patients admitted for neoplastic chemotherapy. Notably, addressing obesity could help to improve the efficacy of treatment for cancer patients while simultaneously reducing any negative consequences associated with being obese.(AU)

Has the 8th American joint committee on cancer TNM staging improved prognostic performance in oral cancer? A systematic review / ¿Ha mejorado la estadificación TNM del octavo comité conjunto estadounidense sobre cáncer? ¿Rendimiento pronóstico en el cáncer oral? Una revisión sistemática

Background: The 8th edition of the American Joint Committee on Cancer (AJCC) classification has introduced two new parameters: depth of invasion (DOI) and extranodal extension (ENE). The aim of this systematic review was to determine whether this 8th edition referred to oral squamous cell carcinoma (OSCC) offers performance superior to that of the 7th edition in relation to overall survival (OS) and disease-specific survival (DSS). Material and Methods: The review was carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed (MEDLINE), Scopus and Cochrane Library databases were searched covering the period up until April 7th, 2022.Results: Thirteen retrospective cohort studies were finally included. The introduction of DOI and ENE in the 8th edition of the AJCC classification resulted in improved prognostic performance of the classification. Conclusions: Patients with OSCC can be better classified in relation to OS and DSS, while maintaining the simplicity and ease of use of the classification. This allows more appropriate treatment protocols to be applied and affords a better estimation of the prognosis of each patient.(AU)

Therapeutic response of oral chronic graft-versus-host disease to topical corticosteroids according to the 2014 National Institutes of Health (USA) consensus criteria / Respuesta terapéutica de la enfermedad de injerto contra huésped crónica oral a los corticosteroides tópicos según los criterios de consenso de los Institutos Nacionales de Salud (EE. UU.) de 2014

Background: Chronic graft-versus-host-disease (cGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. The oral cavity is one of the most frequently affected anatomic sites and is affected in 70% of all patients who develop cGVHD. The objective of this study was to determine the therapeutic response to topical corticosteroids and clinical outcome of patients with oral cGVHD using the 2014 NIH consensus criteria. Material and Methods: The oral manifestations of cGVHD were collected at the first and the follow-up (FU) visits after the therapeutic treatment of oral GVHD. The FU intervals were: FU0, first visit; FU1, 0-1 month; FU2, 1-3 months; FU3, 3-6 months; FU4, 6-9 months; and FU5, 9-12 months. The oral cGVHD activity was assessed using the NIH modification of the Schubert Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The functional impact was assessed by the organ-specific severity score. Results: Fourteen patients (93.3%) at FU0 were being treated with at least one form of systemic immunosuppressive therapy, i.e., prednisolone, cyclosporin, and tacrolimus. The OMRS was reduced between FU0 and FU3 (p < 0.001), FU0 and FU4 (p < 0.001), and FU0 and FU5 (p = 0.004). The organ-specific severity scores were also reduced between FU0 and FU4 (p = 0.016), and FU0 and FU5 (p = 0.001). There was no significant difference in the highest Thongprasom sign score between all follow-up intervals (FU0-FU5) (p = 0.201). One patient (6.7%) at FU4 and three patients (20.0%) at FU5 did not receive topical corticosteroid therapy for oral cGVHD....(AU)

Efecto de la ganancia ponderal gestacional en una cohorte de gestantes con obesidad operadas y no operadas de cirugía bariátrica / Effect of gest ational weight gain in a cohort of pregnancy women with obesity operated and not operated for bariatric surgery

Objetivo: determinar el efecto de la ganancia de peso gestacional y los resultados perinatales en mujeres con obesidad operadas y no operadas de cirugía bariátrica. Material y métodos: se realizó un estudio retrospectivo observacional de cohortes. La ganancia ponderal gestacional fue clasificada como insuficiente, adecuada o excesiva según las guías del Instituto de Medicina de Estados Unidos: 4,99-9,07 kg para índice de masa corporal (IMC) > 30 kg/m2. La ganancia ponderal se calculó con la diferencia entre el peso de la primera visita del primer trimestre y el peso en la visita del tercer trimestre. Los resultados examinados incluyeron variables anteparto (diabetes gestacional, hipertensión gestacional, preeclampsia, ruptura prematura de membranas, placenta previa, desprendimiento prematuro de placenta, retraso de crecimiento intrauterino, corioamnionitis, aborto espontáneo), intraparto (parto inducido, parto vaginal, ventosa, fórceps, cesárea, distocia de hombros), posparto (hemorragia posparto, necesidad de trasfusión posparto, anemia posparto, necesidad de asistencia a Urgencias, muerte materna, desgarro posparto, trombosis posparto) y neonatales (parto pretérmino, percentil peso > 90, percentil peso < 10, puntuación Apgar < 7, malformaciones). Mediante el paquete estadístico SPSS 22.0 se realizó un análisis estadístico de los datos. Resultados: se reclutaron 256 mujeres; 38 (14,58 %) eran gestantes poscirugía bariátrica y las 218 (85,15 %) restantes eran gestantes con obesidad no operadas. De las gestantes con obesidad no operadas, 119 (46,68 %) tenían obesidad grado 1 (IMC 30-34,9) y 99 (38,67 %) tenían obesidad grados 2 y 3 (IMC > 35). Se realizó un análisis global y por subgrupos. En el análisis global tuvieron ganancia insuficiente 78 (30,46 %), ganancia adecuada 117 (45,70 %) y excesiva 61 (23,82 %). En conjunto, la ganancia ponderal insuficiente se asoció con menor probabilidad de hipertensión arterial (HTA)...(AU)

Objective: to determine the effect of gestational weight gain and perinatal outcomes in obese women who underwent and did not undergo bariatric surgery. Material and methods: a retrospective observational cohort study was conducted. The gestational weight gain was classified as insufficient, adequate or excessive according to the guidelines of the United States Institute of Medicine: 4.99-9.07 kg for body mass index (BMI) > 30 kg/ m2. Weight gain was calculated as the difference between the weight at the first visit of the 1st trimester and the weight at the visit of the 3rd trimester. Outcomes examined included antepartum variables (gestational diabetes, gestational hypertension, preeclampsia, premature rupture of membranes, placenta previa, placental abruption, intrauterine growth retardation, chorioammionitis, spontaneous abortion), intrapartum variables (induced delivery, vaginal delivery, vacuum, forceps delivery, cesarean section, shoulder dystocia), postpartum variables (postpartum hemorrhage, need for postpartum transfusion, postpartum anemia, need for emergency care, maternal death, postpartum tear, postpartum thrombosis) and neonatal variables (preterm delivery, weight percentile > 90, weight percentile < 10, Apgar score < 7, malformations). Using the statistical package SPSS 22.0, a statistical analysis of the data was performed. Results: two hundred and fifty-six women were recruited; 38 (14.58 %) were pregnant after bariatric surgery and 218 (85.15 %) were pregnant women with obesity who had not been operated on. Of the pregnant women with obesity who had not been operated on, 119 (46.68 %) had grade1 obesity (BMI 30-34.9), and 99 (38.67 %) had grade 2 and 3 obesity (BMI > 35). A global and subgroup analysis was performed. In the overall analysis, 78 (30.46 %) had insufficient gain, 117 (45.70 %) had adequate gain, and 61 (23.82 %) excessive gain. Overall, insufficient weight gain was associated with a lower probability of...(AU)

Dispositivo de presión negativa empleado en pacientes pediátricos con abdomen hostil: serie de casos / Negative pressure device used in pediatric patients with hostile abdomen. Case series

Introducción: El abdomen hostil es una patología quirúrgica caracterizada por una pérdida de espacio entre los órganos y estructuras del abdomen. La terapia de presión negativa se ha descrito de manera extensa en adultos, pero no así en pacientes pediátricos. El objetivo de este estudio es presentar los resultados a corto plazo de la terapia de presión negativa en pacientes pediátricos con abdomen hostil debido a distintas etiologías. Material y métodos: Identificación y análisis retrospectivo de los pacientes pediátricos con abdomen hostil (< 18 años) tratados con terapia de presión negativa ABTHERA. Resultados: Se incluyó a 7 pacientes. La mediana de edad fue de 16 años (rango: 9-17). 5 (71,4%) eran niños y 2 (28,6%) niñas. 3 (43%) presentaban antecedentes médico-quirúrgicos de interés (lupus eritematoso sistémico, apendicectomía complicada y derivación ventriculoperitoneal). El dispositivo se empleó a presión constante, entre–50 y –125 mmHg. Los hallazgos preoperatorios y postoperatoriosse notificaron mediante la clasificación de Bjork. Los dispositivos sesustituyeron cada 4-7 días (mediana de 5 días). La cantidad total dereemplazos fue de 1-4 (mediana de 3). 5 (71,4%) pacientes precisaronventilación mecánica invasiva durante la terapia de presión negativadebido al estado clínico. 4 (57%) pacientes recibieron nutrición enteral.1 (14%) paciente requirió reintervención posterior al cierre definitivopor el desarrollo de un absceso retroperitoneal. El resultado, evaluadoen base a la tolerancia oral, el movimiento intestinal y la ausencia dedolor, fue favorable en todos los pacientes.Conclusión: Los dispositivos de terapia de presión negativa aportanresultados favorables en los pacientes pediátricos con abdomen hostil,aunque se necesita más información para evaluar los ajustes de presióny la frecuencia de reemplazo del dispositivo.(AU)

Introduction: Hostile abdomen is a surgical condition characterized by loss of space between organs and structures in the abdomen. Negative pressure therapy use has been widely described in adults; the case is not the same for pediatric patients. The goal of this study is to present short-term results of negative pressure therapy use in pediatric patients with hostile abdomen due to different etiologies. Materials and methods: Pediatric hostile abdomen patients (< 18 years) who were treated Negative pressure therapy using ABTHERA were identified and retrospectively reviewed. Results: 7 patients were included in this study. Median age was 16 (range: 9-17 yo). 5 (71.4%) were male and 2 (28.6%) females. 3 (43%) had significant past medical/surgical history (Systemic Lupus Erythematosus, complicated appendectomy and ventriculoperitonealshunt). The device was set at a continuous pressure ranging from –50 to –125 mmHg. Pre and post-surgical findings were reported using Bjork’s classification. Devices were replaced every 4-7 days (median 5 days). Total amount of replacements was 1-4 (median 3). 5 (71.4%) patients required invasive mechanical ventilation during use of Negative pressure therapy based on clinical status. 4 (57%) patients received enteral nutrition. 1 (14%) patient required re-intervention posterior to definitive closure due to retroperitoneal abscess development. Outcome, evaluated by (oral tolerance, bowel movement and absence of pain), was favorable in all patients. Conclusion: Negative pressure therapy devices generate favorable results in hostile abdomen in pediatric population but further information is needed to assess pressure settings and device replacement frequency.(AU)

Use of Dicranum polysetum extract against Paenibacillus larvae causing American Foulbrood under in vivo and in vitro conditions / Uso del extracto de Dicranum polysetum contra larvas de Paenibacillus causantes de la loque americana en condiciones in vivo e in vitro

Recent research shows that Dicranum species can be used to ameliorate the negative effects of honeybee bacterial diseases and that novel compounds isolated from these species may have the potential to treat bacterial diseases. This study aimed to investigate the efficacy of Dicranum polysetum Sw. against American Foulbrood using toxicity and larval model. The effectiveness of D. polysetum Sw. ethanol extract in combating AFB was investigated in vitro and in vivo. This study is important in finding an alternative treatment or prophylactic method to prevent American Foulbrood disease in honey bee colonies. Spore and vegetative forms of Paenibacillus larvae PB31B with ethanol extract of D. polysetum were tested on 2040 honey bee larvae under controlled conditions. Total phenolic and flavonoid contents of D. polysetum ethanol extracts were determined as 80.72 mg/GAE(Gallic acid equivalent) and 303.20 µg/mL, respectively. DPPH(2,2-diphenyl-1-picrylhydrazyl) radical scavenging percent inhibition value was calculated as 4.32%. In Spodoptera frugiperda (Sf9) and Lymantria dispar (LD652) cell lines, the cytotoxic activities of D. polysetum extract were below 20% at 50 µg/mL. The extract was shown to considerably decrease infection in the larvae, and the infection was clinically halted when the extract was administered during the first 24 h after spore contamination. The fact that the extract contains potent antimicrobial/antioxidant activity does not reduce larval viability and live weight, and does not interact with royal jelly is a promising development, particularly regarding its use to treat early-stage AFB infection.(AU)

Physical Activity, Learning Experience, and Their Influence on Athletic and Sports Performance in the United States: The Mediating Role of Quality of Life / Actividad física, experiencia de aprendizaje y su influencia en el rendimiento atlético y deportivo en los Estados Unidos: el papel mediador de la calidad de vida

The purpose of this study is to examine the associations between physical activity (PA), sportsman learning experiences (SLE), and sports performance in a sample of football players from the United States. The study specifically aims to explore the potential moderating effect of physical health impairments (PHYI) and the mediating role of quality of life (QOL) in these relationships. A quantitative cross-sectional methodology was employed to gather data from 300 football players. The data collection process involved the use of self-administered questionnaires, and a convenient sampling technique was utilised. The data that was gathered was subjected to analysis using both demographic and inferential statistics with the assistance of SPSS. The regression analysis demonstrates a statistically significant and positive relationship between physical activity (PA) and both quality of life (QOL) and subjective life expectancy (SLE). Furthermore, the findings suggest that QOL partially mediates the association between PA and SLE. It is worth mentioning that the inclusion of PHYI significantly amplifies the beneficial impact of physical activity on systemic lupus erythematosus (SLE). The aforementioned findings underscore the necessity of implementing all-encompassing athlete development initiatives that prioritise both the physical and mental well-being of individuals, particularly those athletes who are confronted with health-related obstacles. The present study makes a valuable contribution to the ongoing exploration of athlete development and provides practical implications for the design of comprehensive athlete support systems with the goal of improving athletic performance and overall life satisfaction.(AU)

El concepto del estrés de aculturación desde la mirada del inmigrante hispano en los Estados Unidos / The concept of acculturation stress from the perspective of the Hispanic immigrant in the United States

Objetivo principal: Clarificar el significado de estrés de aculturación del inmigrante hispano, además de conocer cada una de las dimensiones y características propias del concepto, con la finalidad de comprender mejor las necesidades de la persona inmigrante que vive en los Estados Unidos. Metodología: El análisis de concepto se hizo a través de los ocho pasos propuestos por Walker y Avant. Resultados principales: Se identificaron tres dimensiones del concepto estrés de aculturación: (1) estresores personales, (2) estresores del entorno y (3) estresores sociales. Como antecedentes del concepto se identificó el arrepentimiento, la culpa y negación. En general, las consecuencias se reflejan en la salud mental del inmigrante hispano. Además, se reconoció los instrumentos de medición que evalúan el estrés de aculturación. Conclusión principal: Se obtuvo una definición clara del concepto estrés de aculturación desde la perspectiva del inmigrante hispano, que ayudará a estimar la validez de constructo de las mediciones de este concepto. Las dimensiones reportadas con mayor frecuencia son consideradas en el inventario de estrés en hispanos, sin embargo, se recomienda analizar la validez de constructo del concepto. Sería importante considerar las consecuencias derivadas del estrés de aculturación en la prevención y tratamiento de la salud mental. (AU)

Objective: Clarify the meaning of acculturation stress for the Hispanic immigrant, in addition to knowing each of the dimensions and characteristics of the concept, in order to better understand the needs of the immigrant living in the United States. Methods: The concept analysis was done through the eight steps proposed by Walker and Avant. Results: Three dimensions of the acculturation stress concept were identified: (1) personal stressors, (2) environmental stressors and (3) social stressors. Repentance, guilt, and denial were identified as antecedents in the concept. In general, the consequences are reflected in the mental health of the Hispanic immigrant. In addition, the measurement instruments that assess acculturation stress were recognized. Conclusions: A clear definition of the acculturation stress concept was obtained, which will help to estimate the construct validity of the measurements of this concept. The most frequently reported dimensions are considered in the stress inventory in Hispanics; however, it is recommended to analyze the construct validity of the concept. It would be important to consider the consequences derived from acculturation stress in the prevention and treatment of mental health. (AU)

Género y "domesticidad". Claves históricas de la relación terapéutica en el origen de la enfermería profesional norteamericana (1800-1860) / Gender and "domesticity" Historical keys to understand the therapeutic relationship in the origin of american professional nursing (1800-1860)

En la primera mitad del siglo XIX, los cuidados de salud que se administraban en el ámbito doméstico en los Estados Unidos de América eran transmitidos de madres a hijas como parte del aprendizaje cotidiano femenino. En el contexto de las relaciones terapéuticas que se establecían a pie de cama de quienes enfermaban, el ejercicio de los cuidados se entendía como una manifestación moral de la mujer hacia los suyos y un ejemplo de benevolencia femenina. Se produjo un cambio paulatino en el que influyeron los movimientos sociales en favor de las mujeres y el acceso a la educación. La investigación muestra un recorrido que permite comprender el contexto cotidiano como un elemento catalizador para la visibilidad, reconocimiento y legitimidad social de los cuidados realizados por las mujeres, y su papel en la profesionalización de la enfermería y en las relaciones que se establecían entre médicos, enfermeras y aquellos que enfermaban. El artículo propone una transición progresiva desde las prácticas de los cuidados en el ámbito doméstico al de la profesionalización de las mujeres como enfermeras.(AU)

In the first half of the 19th century, the health care administered in the domestic sphere in the United States of America was transmitted from mothers to daughters as part of women’s daily learning. In the context of the therapeutic relationships established at the bedside of those who were ill, the exercise of care was understood as a moral manifestation of women towards their loved ones, and an example of feminine benevolence. We observe that there was a gradual change that was influenced by social movements in favour of women and the access to education. The research shows a path that allows us to understand the domestic context as a catalyst for the visibility, recognition and social legitimacy of the care provided by women, and its role in the professionalization of nursing, and in the relationships established between doctors, nurses and those who fell ill. The article proposes a progressive transition from care practices in the domestic sphere to the professionalization of women as nurses.(AU)

La revisión emocional del encuentro médico-terapéutico en M. Balint, P. Freeling y K. Browne (1957-1967) / The emotional perspective of the encounter between doctor and patient in m. Balint, P. Freeling and K. Browne (1957-1967)

Se analiza la perspectiva emocional de la relación médico-paciente y la confianza propia de esta interrelación, a través de publicaciones y relatos médicos de Michael Balint, Kevin Browne y Paul Freeling, aparecidos en la década de 1960. Balint promovió en la clínica Tavistock (Londres) los llamados ‘Grupos Balint’ en los que participaron Browne y Freeling. Sus publicaciones se enmarcan en la aproximación psicoanalítica y psicosomática, enfoque que actualizó la consideración de la persona como un todo y mostró el significado de las emociones en la enfermedad. Balint, Browne y Freeling destacaron el carácter terapéutico de la relación médico-paciente y subrayaron la subjetividad y la participación tanto del profesional como del paciente, en el encuentro médico-paciente. El movimiento Balint y en ese marco, la obra de Browne y Freeling, se sumó a otras que llevaron a promover la integración de lo psicológico y el entorno social en la definición de la enfermedad y en la práctica de la medicina de ese tiempo. El artículo pone de manifiesto los contrastes entre las propuestas de Michael Balint y las planteadas por la Escuela Psicosomática norteamericana y otros movimientos de origen psicoanalítico, respecto a la psicogenia y a la relación médico-paciente.(AU)

The emotional perspective of the doctor-patient relationship and the trust inherent in this interrelation are analysed through medical narratives published in the 1960s by Michael Balint, Kevin Browne and Paul Freeling. Balint promoted the so-called ‘Balint Groups’ in the Tavistock clinic (London), in which Browne and Freeling participated. Their publications are part of the psychoanalytic and psychosomatic approach, that updated the consideration of the person as a whole and showed the meaning of emotions in illness. Balint, Browne and Freeling highlighted the therapeutic nature of the doctor-patient relationship and underlined the subjectivity and participation of both the professional and the patient in the doctor-patient encounter. The Balint movement and within this framework, the work of Browne and Freeling, joined others that led to promoting the integration of the psychological and the social environment in the definition of the disease and in the practice of medicine at that time. The article also focusses the contrasts between the proposals of Michael Balint and those raised by the American Psychosomatic Society, and other psychoanalytic movements, regarding the doctor-patient relationship.(AU)

Enfermeros por el mundo. Estados Unidos / Nurses around the world. USA

Elena Castiñeira se enamoró de la Enfermería en cuanto empezó a estudiarla. Pronto su ilusión, las ganas por comenzar a poner en práctica sus conocimientos y descubrir cómo era la profesión fuera de España se hicieron presentes. Acabó probando suerte en varios países: en Inglaterra, Alemania e incluso en EE.UU., donde está en la actualidad. Hacerse un hueco no fue fácil, tuvo que pasar por pruebas que se iban alargando en el tiempo, pero las condiciones laborables y el trato con los profesionales sanitarios hicieron que mereciera la pena, algo que ha hecho que desee quedarse al otro lado del charco una larga temporada. ¿Cómo comenzó todo? ¡Nos cuenta!.(AU)

Bienestar psicológico, salud mental y pautas percibidasde apego: estudio comparativo entre mexicanos y estadounidenses durante la pandemia COVID 19 / Psychological well-being, Mental health and patterns of perceived attachment: a comparative study between Mexicans and Americans during the COVID 19 Pandemic

Psychological Well-Being, Mental Health and Patterns of Perceived Attachment: A Comparative Study between Mexicans and Americans during the COVID 19 Pandemic. A correlational and comparative study was carried out on Psychological Well-Being, elements of mental health, and Patterns of Perceived Attachment in Childhood as a possible protection variable in the COVID-19 pandemic. The total N was 316, of which 161 were Mexican students and 155 Americans. The instruments used were the Psychological Well-being Scale, the Depression Anxiety Stress Inventory, and the Inventory of Perceived Attachment Patterns During Childhood. The results show higher indicators of mental health impairment in young Mexicans compared to Americans: depression 76% vs 20.24%. anxiety 93% vs 38% and stress 68% vs 12.5%. In addition, average positive correlations were identified between Psychological Well-Being and secure attachment and negative correlations with the other forms of attachment. In the Americans, a low positive association was found between secure attachment and self-acceptance, positive relationships (the highest correlated), and the scale’s total. Similarly, disorganized, anxious, and avoidant attachment patterns are negatively correlated with self-acceptance, positive relationships, mastery of the environment, life purposes, and the total. Therefore, we consider that Patterns of Perceived Attachment in Childhood are associated with the elements of mental health such as: anxiety, depression, and stress, and with the levels of psychological well-being experienced during the pandemic. Finally, suggestions of other mediating and protective variables for future research are offered (AU)

Clinical characteristics of oral chronic graft-versus-host disease according to the 2014 National Institutes of Health (USA) consensus criteria

Background: Chronic graft-versus-host disease (cGVHD) is a serious and common complication of allogeneic hematopoietic cell transplantation (alloHCT). The oral cavity is the second most common site affected by cGVHD. In 2014, the 2005 National Institutes of Health (NIH) consensus criteria were revised to address areas of controversy. The aim of this study was to evaluate the clinical characteristics of oral cGVHD using the 2014 NIH consensus criteria. Material and methods: The baseline data of oral manifestation of patients, who were diagnosed with oral cGVHD, in the first dental visit were analyzed (n=22). The oral mucosal disease was evaluated by NIH modified Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The salivary gland disease and sclerotic disease were determined by the presence of signs and symptoms. The functional impact was assessed by the organ-specific severity score. Results: The median time from transplant to oral cGVHD diagnosis was 11.9 months. White striae with an erosive area was found in 72.7% of the patients. The mean ± SD of NIH modified OMRS was 6.1 ± 3.0. The most common and severely affected site of lichen planus-like features was buccal mucosa. Xerostomia, superficial mucocele and limited mouth opening were found in 18.2%, 9.1%, and 9.1%, respectively, of the patients. Almost all patients (90.9%) had partial limitation of oral intake. There were no significant differences in NIH modified OMRS or organ-specific severity score among the patient characteristic groups. Moreover, there was no association between the oral manifestations of cGVHD and the patient characteristics. Conclusions: The most common oral manifestation of cGVHD was white striae with an erosive area of oral mucosal disease, followed by xerostomia, superficial mucocele, and limited mouth opening. The 2014 NIH consensus criteria for diagnostic and severity assessment are informative and feasible in real-world practice. (AU)

El fentanilo como punto de partida en la crisis de opioides. Situación actual y visión retrospectiva en Europa y EEUU / Fentanyl as a starting point in the opioid crisis. Current situation and retrospective view in Europe and the USA

El fentanilo, un fármaco opioide sintetizado en 1960 de elevada potencia analgésica y amplia utilidad terapéutica, se ha convertido en la principal causa de muerte por sobredosis de drogas en los EEUU. Los datos provisionales de fallecidos por sobredosis de drogas en 2021 ofrecen la escalofriante cifra de 108.000 muertos, en una tendencia fuertemente ascendente desde hace una década. En Europa los fallecidos por sobredosis de drogas en 2020 (6.400) también aumentaron ligeramente respecto a 2019, aunque no específicamente relacionadas con el fentanilo. Tanto en Europa como en EEUU, aproximadamente el 75% de las sobredosis de drogas con resultado mortal están relacionadas con los opioides. En EEUU particularmente con el fentanilo y los análogos del fentanilo fabricados ilícitamente, y en Europa con la heroína. Aunque con diferentes matices epidemiológicos, la crisis de opioides es un fenómeno global que se ha superpuesto con carácter de pandemia a la reciente crisis sanitaria mundial por COVID-19. La tasa de mortalidad relacionada con los opioides sintéticos (particularmente con el fentanilo) crece exponencialmente de forma imparable. Esto ocurre de una manera muy pronunciada en EEUU desde el año 2013, pero también en Europa desde el año 2017, aunque con menor impacto. De alguna forma podríamos entender al fentanilo como un punto de partida en la crisis de opioides, puesto que el fenómeno es dinámico y cambiante. Para comprender mejor la epidemia de opioides resulta necesario saber que a medida que son fiscalizadas las sustancias relacionadas con el fentanilo, nuevos opioides sintéticos (NSO) sin uso médico aprobado (como por ejemplo los llamados ‘nitacenos’) son detectados cada vez con mayor frecuencia en las incautaciones de drogas e informes forenses y toxicológicos en todo el mundo

Fentanyl, an opioid drug synthesized in 1960 with high analgesic potency and broad therapeutic utility, has become the leading cause of drug overdose death in the United States. Provisional data on drug overdose deaths in 2021 offer the chilling figure of 108.000 deaths, in a strongly upward trend for a decade. In Europe, drug overdose deaths in 2020 (6.400) also increased slightly compared to 2019, although not specifically related to fentanyl. In both Europe and the US, approximately 75% of fatal drug overdoses are related to opioids. In the US particularly with illicitly manufactured fentanyl and fentanyl analogues, and in Europe with heroin. Although with different epidemiological nuances, the opioid crisis is a global phenomenon that has been superimposed as a pandemic on the recent global health crisis due to COVID-19. The mortality rate related to synthetic opioids (particularly fentanyl) is growing exponentially and unstoppably. This has occurred in a very pronounced way in the US since 2013, but also in Europe since 2017, although with less impact. In some way we could understand fentanyl as a starting point in the opioid crisis, since the phenomenon is dynamic and changing. To better understand the opioid epidemic, it is necessary to know that as substances related to fentanyl are controlled, new synthetic opioids (NSO) without approved medical use (such as the so-called ‘nitazenes’) are detected with increasing frequency. in drug seizures and forensic and toxicology reports worldwide. (AU)

Procedimiento de autorización de las vacunas contra la COVID-19: Estados Unidos de América, Unión Europea y América Latina / Authorization procedure for COVID-19 vaccines: United States of America, European Union and Latin America

Introducción: El reconocimiento de la enfermedad COVID-19 como pandemia, planteó un reto a las Autoridades Reguladoras Nacionales del Medicamento (ARNs). Éstas tuvieron que desarrollar pautas, procedimientos, crear grupos de trabajo y alianzas para maximizar la eficiencia de la evaluación, revisión y autorización de las vacunas. El objetivo del presente trabajo es la exposición de los procedimientos empleados en Estados Unidos, Unión Europea y América Latina para autorizar el uso de las vacunas frente a la COVID-19; y ello con el fin de determinar si la multiplicidad de procedimientos ha dado origen al registro de un elevado número de vacunas. Método: Se realizó una revisión de la legislación farmacéutica usada para la emisión de autorizaciones de las vacunas para la COVID-19, durante la emergencia sanitaria. La información fue recopilada hasta el 15/10/2022. Las fuentes consultadas fueron sitios web gubernamentales de las ARNs: Estados Unidos, Unión Europea y América Latina. Resultados: Los Estados Unidos y la Unión Europea usaron actividades consignadas en sus flujos estándares, tales como el pre-Investigational New Drug, y el asesoramiento científico y rolling review, respectivamente. Por su parte, América Latina, hizo uso extensivo del reliance y la autorización de uso de emergencia, con el fin de acceder al mayor número posible de vacunas. Conclusiones: Los procedimientos usados son diversos, pero todos ellos están orientados a proporcionar de manera rápida un producto de contención a la pandemia. Está diversidad da como resultado la presencia de distintas vacunas en Estados Unidos, Unión Europea y América Latina. (AU)

Introduction: The recognition of the COVID-19 disease as a pandemic posed a challenge to the National Drug Reg-ulatory Authorities (NRAs). They had to develop guidelines, procedures, create working groups and partnerships to maximize the efficiency of vaccine evaluation, review and licensure.The aim of this article is to present the procedures used in the United States, European Union and Latin America to license the use of vaccines against COVID-19; in order to determine whether the multiplicity of procedures has led to the registration of a large number of vaccines. Method: A review of the pharmaceutical legislation used for the issuance of COVID-19 vaccines licenses during the health emergency was carried out. The information was collected up to October 15, 2022. The sources consulted were government websites of the NRAs: United States, European Union, and Latin America. Results: The United States and the European Union used activities included in their standard flows, such as pre-In-vestigational New Drug, scientific advice and rolling review, respectively. Latin America, on the other hand, made extensive use of reliance and emergency use authorization in order to access as many vaccines as possible. Conclusions: The procedures used are diverse, but all of them are oriented to provide a rapid pandemic contain-ment product. This diversity results in the presence of different vaccines in the United States, European Union and Latin America. (AU)

El viaje del uranio español en los años sesenta: significados y materialidades de un objeto híbrido / The journey of Spanish uranium in the sixties meanings and materialities of a hybrid object

En 1966, 137 toneladas de mineral de uranio español llegaron al puerto de Nueva Orleans procedentes del puerto de Cádiz. En este artículo quiero utilizar este viaje que conectó agentes políticos, industriales y empresariales con capacidades y experiencias técnicas, para explorar el uranio como un objeto híbrido —físico, técnico y diplomático—. El uranio conectó los intereses de las autoridades franquistas con los de los científicos y empresarios de la industria eléctrica. Sirvió al régimen de Franco para formar investigadores en nuevos métodos y prácticas experimentales y también para popularizar las políticas e ideologías atómicas de Estados Unidos. Al tiempo que alimentó los reactores nucleares, el uranio generó nuevos espacios disciplinares, modificó paisajes y diseñó nuevas cartografías industriales y administrativas. Además de ser una pieza clave en la política exterior del régimen franquista —le sirvió al régimen español para alinearse con el pensamiento occidental imperante sobre los usos civiles de la energía nuclear—, internamente sirvió para abandonar los discursos autárquicos y reforzar el poder de los tecnócratas, que utilizaron la energía atómica para transformar la producción eléctrica española. Este viaje cambió la materialidad del mineral de uranio, su física y su química, y también sus significados. (AU)

In 1966, 137 tons of Spanish uranium ore arrived at the port of New Orleans from the port of Cádiz. In this paper, I want to use this trip, which involved political, industrial, and business agents as well as technical capabilities, to explore the uranium as a hybrid object - physical, technical and diplomatic. This material connected the interests of the Franco authorities, scientists, and businessmen from the electrical industry. It served the Franco regime in training researchers, in buying and importing technologies, methods and experimental practices, and in introducing ways to popularize atomic policies and ideologies from the United States. Uranium was a fuel that not only powered nuclear reactor but also fed new disciplinary spaces, modified landscapes, and sketched new industrial and administrative cartographies. Besides being a key piece of the Franco regime’s foreign policy —it was useful to the Spanish regime to align itself with prevailing Western thought on the civil uses of nuclear energy— it served internally to effectively abandon autarchic discourses and strengthen the power of the technocrats, who used atomic energy to transform Spanish electrical production. The materiality of uranium ore changed with travel and also its meanings. (AU)

El constructo binomial «cuidados en salud-educación» en la épica norteamericana del Western, como realidad geopolítica / The binomial construct “health care-education” in the North American epic of the Western as a geopolitical reality

El Western, como reflejo de la sociedad norteamericana, narra en forma de épica la historia de la conquista del Oeste, articulando un discurso en torno a la cultura de la población aborigen y del héroe de frontera, como los más significativos elementos de la realidad geopolítica. En esta investigación, a través del discurso fílmico del Western, hemos establecido como Objetivo principal, el análisis del constructo binomial: «cuidados en salud-educación», examinándolo a través del método panofskyano y gadameriano, con una muestra que atiende al paradigmático clasicismo de John Ford en el film Centauros del desierto y ocupándonos, a su vez, de la propuesta educativa y sanitaria que ofrece. Hemos concluido que el constructo binomial «cuidados en salud-educación» es un elemento universal en el discurso del Western, actuando como agente civilizador y como vector esencial para el asentamiento de nuevos grupos sociales en los territorios de frontera, durante la conquista del Oeste (AU)

The Western, as a reflection of American society, depicts the story of the conquest of the West epically, framing a narrative around the culture of the indigenous population and the frontier hero as the most significant elements of the geopolitical reality. In this investigation, through the filmic discourse of Westerns, our main Objective is the analysis of the binomial construct: “health care-education", looking at it through the Panofsky and Gadamerian method, following the paradigmatic classicism of John Ford in the film The Searchers and, at the same time, addressing the educational and health approach it offers. We have concluded that the binomial construct "health care-education" is a universal element in the filmic discourse of the Western, acting as a civilizing agent and as an essential means for the settlement of new social groups in the frontier territories during the conquest of the West (AU)