Increased specificity of Fasciola hepatica excretory-secretory antigens combining negative selection on hydroxyapatite and salt precipitation.

A single and rapid method to obtain an antigenic fraction of excretory-secretory antigens (ESAs) from Fasciola hepatica suitable for serodiagnosis of fascioliasis is reported. The procedure consists in the negative selection of F. hepatica ESAs by hydroxyapatite (HA) chromatography (HAC; fraction HAC-NR) followed by antigen precipitation with 50% ammonium sulphate (AS) and subsequent recovery by means of a Millex-GV or equivalent filter (Fi-SOLE fraction). Tested in indirect ELISA, the Fi-SOLE antigens detected natural infections by F. hepatica with 100% sensitivity and 98.9% specificity in sheep, and 97.7% sensitivity and 97.7% specificity in cattle, as determined by ROC analysis. The SDS-PAGE and proteomic nano-UHPLC-Tims-QTOF MS/MS analysis of fractions showed that the relative abundance of L-cathepsins and fragments thereof was 57% in fraction HAC-NR and 93.8% in fraction Fi-SOLE. The second most abundant proteins in fraction HAC-NR were fatty-acid binding proteins (11.9%). In contrast, free heme, and heme:MF6p/FhHDM-1 complexes remained strongly bond to the HA particles during HAC. Interestingly, phosphorylcholine (PC)-bearing antigens, which are a frequent source of cross-reactivity, were detected with an anti-PC mAb (BH8) in ESAs and fraction HAC-NR but were almost absent in fraction Fi-SOLE.

Bayesian hierarchical modelling of the geospatial distribution of fasciolosis in dairy cattle and the impact on production: Application to the main milk-producing region (Galicia) in Spain.

Fasciolosis caused by Fasciola hepatica is a common parasitic infection among cattle in many countries. Although infected adult cows rarely show overt clinical signs, milk production may be impaired. Thus, significant production losses may occur in dairy herds with a high prevalence of fasciolosis. In this study, Bayesian hierarchical modelling was used to estimate the geospatial distribution of dairy cattle fasciolosis and its impact on milk production. The study was conducted in Galicia, the main milk producing region in Spain and a geographically heterogeneous area. The aims were: 1) to model the geospatial distribution of fasciolosis in dairy herds in the study area, 2) to identify clusters of herds with a high prevalence of fasciolosis, and 3) to assess the effect of fasciolosis on milk yield and quality. A large number of dairy cattle farms (n = 4907), of which 1660 provided production records, were surveyed. Fasciola infection status was determined by applying the MM3-SERO ELISA test to bulk tank milk samples. A high probability of infection was predicted in several zones, particularly in the centre, northeast and southeast of Galicia. Conversely, the predicted probability was very low in some parts of the northwest of the region. Infections with high within-herd prevalence (> 25% lactating cows infected) predominated. High within-herd prevalence was associated with loss of milk production (-1.387 kg/cow/ day, on average). No association between Fasciola infection and either milk fat or protein content was observed. This study has generated the first maps of the spatial distribution of the probability of Fasciola infection in dairy cattle herds in Galicia. The maps presented here can be used for reference purposes, enabling the design of better targeted fasciolosis control programmes in the region. Use of Bayesian hierarchical statistical analysis enabled us to ascertain the uncertainty of the predictions and to account for the spatial autocorrelation in the data. It also enabled us to generate maps showing the residual spatial variation in milk production, a topic that may deserve more detailed study.

Association between e-cigarette and conventional cigarette use among Spanish adolescents. / Asociación entre el uso de cigarrillos electrónicos y cigarrillos convencionales en adolescentes españoles.

In recent years, studies have highlighted the upward trend in electronic cigarette use among adolescents, as well as the potential of e-cigarette use to lead to subsequent conventional cigarette use. The study's aims were two-fold: 1) to examine the progression from e-cigarette use to conventional cigarette use; and 2) to analyze the differences in the severity of smoking pattern among dual users (i.e., e-cigarette and conventional cigarette use), cigarette-only smokers, and e-cigarette-only users in a Spanish adolescent population. Data were obtained from the ESTUDES, a representative survey of addictive behaviors of Spanish adolescents aged 14-18, which was comprised of 38,010 adolescents (Mage = 15.69; SD = 1.19; 51.35% females). Results indicate that lifetime e-cigarette use increased the prevalence of subsequent conventional cigarette use by 1.86 times (95% CI 1.74, 1.99), and the prevalence of conventional cigarette use in the last month by 2.38 times (95% CI 2.19, 2.58), independently of whether the e-cigarette contains nicotine or not. Dual users showed a higher percentage of daily smokers, and a greater number of cigarettes per day, a higher use of e-cigarettes with nicotine, and an earlier age of smoking onset. Regarding risk perception, e-cigarette-only users perceived both conventional tobacco and e-cigarettes as less harmful (all p-values < .001). These findings document the strength of association between e-cigarette and conventional cigarettes, and underscore the importance of developing legal restrictions and prevention strategies aimed at reducing e-cigarette use, which in turn would reduce tobacco use.

En los últimos años, algunos estudios han destacado la tendencia ascendente en el uso del cigarrillo electrónico entre adolescentes, así como el potencial para el posterior consumo de cigarrillos convencionales. Este estudio tuvo dos objetivos: 1) examinar la progresión del cigarrillo electrónico al cigarrillo convencional; y 2) analizar las diferencias en el patrón de gravedad del tabaquismo entre consumidores duales (i.e., cigarrillos electrónicos y convencionales), fumadores de cigarrillos y consumidores de cigarrillos electrónicos. Los datos se obtuvieron de la encuesta ESTUDES, una encuesta nacional que recoge información de conductas adictivas en adolescentes entre 14 y 18 años, la cual consta de 38 010 personas (Medad = 15,69; DT = 1,19; 51,35% mujeres). Los resultados indicaron que haber usado alguna vez un cigarrillo electrónico incrementó la probabilidad de un consumo posterior de cigarrillos 1,86 veces (IC 95% 1,74-1,99), y la probabilidad de consumir tabaco en el último mes 2,38 veces (IC 95% 2,19-2,58), independientemente de si los cigarrillos electrónicos contienen o no nicotina. Los consumidores duales mostraron un mayor porcentaje de fumadores diarios, un mayor número de cigarrillos al día, un mayor uso de cigarrillos electrónicos con nicotina y una edad de inicio más temprana. Con respecto a la percepción de riesgo, los adolescentes que han usado solo cigarrillos electrónicos percibían tanto el tabaco como los cigarrillos electrónicos como menos dañinos (todos los valores p < ,001). Estos hallazgos indican la fuerte asociación entre los cigarrillos electrónicos y los convencionales, y subrayan la importancia de desarrollar restricciones legales y estrategias preventivas dirigidas al cigarrillo electrónico, lo que reduciría a su vez el consumo de tabaco.

Protocol for a Trial Assessing the Efficacy of a Universal School-Based Prevention Program for Addictive Behaviors.

BACKGROUND: "Juego de Llaves" [ Set of Keys ] is a universal school-based prevention program for adolescents aged 12-15. It is aimed at reducing drug use and other addictive behaviors. This paper describes the full protocol for the evaluation design, instruments, randomization procedure, follow-ups, and primary outcomes. METHOD: Non-Randomized Control Cluster Trial in a set of Spanish secondary schools, with follow-ups at 12-, 24- and 36-months. Participants will be allocated to an experimental or control group. Using a digital application designed for the study, a battery of instruments will be used to assess addictive behaviors, sociodemographic variables, school climate and other transdiagnostic psychological variables. RESULTS: A pilot test will be carried out to test the implementation protocol and to calculate the sample size needed for outcome evaluation. After implementing the program, longitudinal statistical approaches will be used to report intervention efficacy and potential moderators and mediators. CONCLUSIONS: There is a lack of assessments on the effectiveness of school prevention programs, and this paper is expected to improve monitoring and ongoing evaluation in prevention.

Field evaluation of the enhanced MM3-COPRO ELISA test for the diagnosis of Fasciola hepatica infection in sheep.

Fasciolosis is a severe zoonosis responsible for major economic losses in livestock. The enhanced MM3-COPRO test (eMM3-COPRO) and the commercial version BIO K 201 (Bio-X Diagnostics, Rochefort, Belgium) are widely used as immunodiagnostic tools for the specific detection of coproantigens released by Fasciola during the late prepatent and patent stages of infection. However, performance of the eMM3-COPRO has never been evaluated under field conditions. To address this gap, a large number of ovine faecal samples, collected in a region where fasciolosis is endemic (Galicia, NW Spain), were analyzed. Two groups of sheep flocks were selected according to the Fasciola infection status: 'Fasciola-free' and 'Fasciola-infected' flocks. 'Fasciola-free' flocks were seronegative flocks with no history of fasciolosis detected by either coproscopy or necropsy in the last 5 years. Faecal samples from these sheep were used to calculate a cut-off value for infection (OD = 0.021). The cut-off was calculated using a bootstrap resampling method that enables estimation of the sampling distribution of the statistical parameters without making assumptions about the underlying data distribution. 'Fasciola-infected' flocks were characterized by high seroprevalence, a history of fasciolosis and periodical treatment with flukicides. Samples from these flocks were used to estimate the diagnostic accuracy of the eMM3-COPRO relative to coproscopy, which although limited by poor sensitivity is the only reference test available for diagnosing fasciolosis in vivo. To overcome this limitation, all animals classified positive by eMM3-COPRO were treated with triclabendazole and then retested. The eMM3-COPRO displayed higher sensitivity than coproscopy, as it detected coproantigens in all samples with positive coproscopy and in 12% of samples with negative coproscopy. The test also proved highly specific as coproantigens disappeared after the treatment. The eMM3-COPRO was less time consuming than coproscopy, particularly when the procedure involved numerous samples, and showed promise as a tool for monitoring flukicide efficacy.

CM-352 Efficacy in a Mouse Model of Anticoagulant-Associated Intracranial Hemorrhage.

BACKGROUND: Intracranial hemorrhage (ICH) is one of the major devastating complications of anticoagulation. Matrix metalloproteinase (MMP) inhibition has been proposed as a novel pharmacological approach for ICH treatment. OBJECTIVES: We evaluated the effects of CM-352 (MMP-fibrinolysis inhibitor) in an experimental ICH model associated with oral anticoagulants as compared with clinically used prothrombin complex concentrate (PCC). METHODS: ICH was induced by collagenase injection into the striatum of wild type (C57BL/6J) anticoagulated mice (warfarin or rivaroxaban) and Mmp10 -/- mice. Hematoma volume and neurological deficits were measured 24 hours later by diaminobenzidine staining and different behavioral tests. Circulating plasminogen activator inhibitor-1 (PAI-1) activity and interleukin-6 (IL-6) were measured in plasma samples and local inflammation was assessed by neutrophil infiltration. Finally, fibrinolytic effects of MMP-10 and rivaroxaban were evaluated by thromboelastometry and thrombin-activatable fibrinolysis inhibitor (TAFI) activation assays. RESULTS: Only PCC reduced hemorrhage volume and improved functional outcome in warfarin-ICH, but both PCC and CM-352 treatments diminished hemorrhage volume (46%, p < 0.01 and 64%, p < 0.001, respectively) and ameliorated functional outcome in rivaroxaban-ICH. We further demonstrated that CM-352, but not PCC, decreased neutrophil infiltration in the hemorrhage area at 24 hours. The effect of CM-352 could be related to MMP-10 inhibition since Mmp10 -/- mice showed lower hemorrhage volume, better neurological score, reduced IL-6 levels and neutrophil infiltration, and increased PAI-1 after experimental ICH. Finally, we found that CM-352 reduced MMP-10 and rivaroxaban-related fibrinolytic effects in thromboelastometry and TAFI activation. CONCLUSION: CM-352 treatment, by diminishing MMPs and rivaroxaban-associated fibrinolytic effects, might be a novel antihemorrhagic strategy for rivaroxaban-associated ICH.

No evidence of the clinical utility of single-item breakpoint to inform on tobacco demand in persons with substance use disorders.

RATIONALE: Behavioral economics has shown that single-item demand indicators are promising for capturing crucial aspects of nicotine reinforcement. It is suggested that brief breakpoint measures perform comparably to full-length demand indices in characterizing nicotine dependence; however, there have been no thorough assessments of their validity in clinical settings. OBJECTIVES: This study aimed to assess the validity and accuracy of a single-item breakpoint in informing on tobacco demand. METHODS: The sample consisted of 88 treatment-seeking smokers (% males = 70.5%) enrolled in substance use treatment. Participants provided data on smoking characteristics and completed the Fagerström Test for Nicotine Dependence, a single-item breakpoint measure and a 14-item cigarette purchase task (CPT). Hierarchical regressions were performed to compare the predictive capability of a single-item breakpoint and full-length tobacco demand indicators in determining nicotine addiction severity. RESULTS: The single-item breakpoint was significantly correlated with all indices stemmed from the CPT and both latent factors (all r values = .250-.368). Neither the brief breakpoint nor the full-length breakpoint significantly predicted nicotine dependence. After controlling for sex and smoking variables, factor 2 [ß = .565, p < .001] and its observed variables Omax [ß = .279, p = .006], 1/elasticity [ß = .340, p = .001], and intensity [ß = .551, p < .001], robustly predicted nicotine dependence severity. CONCLUSIONS: Our findings do not support the validity of single-item breakpoint measures for characterizing nicotine dependence in substance users. In a bid to foster translational research, brief demand measures capturing Omax, intensity, and elasticity should be developed.

The silent epidemic of lymphogranuloma venereum inside the COVID-19 pandemic in Madrid, Spain, March 2020 to February 2021.

Despite social distancing measures implemented in Madrid to prevent the propagation of SARS-CoV-2, a significant increase (57.1%; 28.5 to 38.5 cases/month) in cases of lymphogranuloma venereum was detected during the COVID-19 pandemic. This unusual scenario might have accelerated a shift in Chlamydia trachomatis (CT) epidemiology towards a higher proportion of L genotypes compared with non-L genotypes in CT-positive samples. Our data underscore the importance of surveillance of sexually transmitted infections during the pandemic, in particular among vulnerable populations.

Current Challenges for Fasciolicide Treatment in Ruminant Livestock.

Pharmacological treatment remains essential to control fasciolosis in areas where infection is endemic. However, there are major constraints to treating food-producing animals. Of particular concern is the lack of flukicides for treating early Fasciola infections in ruminant livestock in some countries. In addition, the information provided in package leaflets, particularly regarding withdrawal periods, is often incomplete, confusing, and/or contradictory. International regulatory bodies should harmonize the use of flukicides in livestock in favor of fairer, safer international trade. In addition, monitoring the efficacy of fasciolicides on farms is also essential to minimize the spread of drug-resistant populations of Fasciola. The current situation regarding flukicide formulations in the European Union and other, non-European countries is analyzed in this review paper.

Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis.

BACKGROUND AND AIMS: An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects. METHODS: A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg-Mazumdar, Egger's and Duval & Tweedie's trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), Omax (i.e. maximum expenditure), Pmax (i.e. price associated to Omax ) and breakpoint (i.e. price at which consumption ceases). RESULTS: All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132-0.494), except Pmax , which was significantly associated with alcohol-related problems only (r = 0.064). The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between Omax and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited. CONCLUSIONS: The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and Omax are the most relevant indices to account for alcohol involvement.

Fingolimod in multiple sclerosis: profile of use in habitual practice.

OBJECTIVES: Fingolimod is the first oral drug indicated in monotherapy as a modifier of the course of very active relapsing-remitting multiple sclerosis (RRMS). The safety profile of fingolimod is well established in clinical trials and post-marketing studies. Our objective was to study the profile of fingolimod use in our health area. METHODS: A retrospective, observational, descriptive study was performed on the use of fingolimod in adult patients diagnosed with RRMS between January 2015 and February 2017 or until suspension of treatment in a reference hospital in north-western Spain. RESULTS: A total of 55 patients were included with a mean±SD time of treatment with fingolimod of 26±14.6 months (range 2-53). Thirteen patients permanently discontinued the treatment (10 due to outbreaks/disease progression and 3 due to adverse effects). No statistically significant differences were found between the percentage of patients who discontinued fingolimod and who had received only one previous treatment and those who had received two or more treatments. No cases of symptomatic bradycardia were reported. CONCLUSIONS: Fingolimod is a safe treatment for patients with multiple sclerosis.

[The COVID-19 psychological helpline of the Spanish Ministry of Health and Spanish Psychological Association: characteristics and demand.] / El teléfono de asistencia psicológica por la COVID-19 del Ministerio de Sanidad y del Consejo General de la Psicología de España: Características y demanda.

Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.

Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud.

Risk Factors for Mortality in Nursing Home Residents: An Observational Study.

Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.

Maternal immune response in the placenta of sheep during recrudescence of natural congenital infection of Neospora caninum.

In order to gain further insight into the pathogenesis and transmission of ovine neosporosis, the serological response of 13 naturally infected pregnant sheep was monitored. All sheep were euthanized upon the detection of a sharp increase in the level of specific antibodies against N. caninum in order to study the maternal immune response after the recrudescence of a chronic infection. Ten sheep were euthanized between 84 and 118 days of gestation, whereas the three remaining and three control not infected, pregnant sheep were euthanized at 135 days of gestation after no sharp increase in antibodies was detected. Vertical transmission was confirmed in 11 sheep by detection of N. caninum-DNA in at least one fetus, confirming recrudescence. Not all of fetuses showed pathologic microscopic lesions, however, multifocal non-purulent encephalitis was the main finding. Furthermore, nine out of the 11 vertical transmission positive sheep had lesions in placentomes (mainly multifocal necrotic foci), and the parasite was detected in eight out of 11 placentas by PCR and/or immunohistochemestry. The placentomes from sheep that suffered recrudescence showed an increased number of T lymphocytes CD3+ (CD4/CD8 < 1) and macrophages (MHC-II+), assessed by immunohistochemestry, together with an up-regulation of IFN-γ, IL-10, IL-4, TNFα, IL-2 and IL-18. IL-17 was only upregulated in the three infected sheep that did not have a sharp increase in antibody levels. In the sheep that showed fetal death at the time of euthanasia (n = 3) the placental microscopic lesions were more severe, the inflammatory infiltrate was higher, and the upregulation of cytokines was greater than in those sheep carrying viable fetuses. This study suggests that, similarly to bovine neosporosis, the time of gestation when recrudescence occurs determines the viability of the fetuses and, thus, seems to be related to the severity of lesions and immune response in the placenta. These results suggest that there might be a correlation, either as cause or as a consequence, between protection against vertical transmission of the parasite and a milder maternal serological response together with a high level of transcription of IL-17 in the placenta.

Risk, Diagnostic and Predictor Factors for Classical Hodgkin Lymphoma in HIV-1-Infected Individuals: Role of Plasma Exosome-Derived miR-20a and miR-21.

The incidence of classical Hodgkin lymphoma (cHL) in the HIV-1 setting has increased 5-25-fold compared to that observed in the general population. This study aimed to determine whether selected micro RNAs (miRs) and other soluble biomarkers and cellular subsets are dysregulated in cHL and could be used as biomarkers. This was a retrospective and longitudinal matched case-control study of 111 Caucasian, HIV-1-infected adult individuals, including 37 individuals with cHL and 74 with no type of cancer. Immunovirological data, plasma exosome-derived miR-16, miR-20a, miR-21, miR-221, miR-223, miR-106a, miR-185, miR-23, miR-30d, miR-222, miR-146a and miR-324, plasma IL-6, sCD14, sCD27, sCD30, sIL-2R, TNFR1, and cell phenotyping of T and B lymphocytes and natural killer (NK) cells were analyzed. Before cHL diagnosis, miR-20a, miR-21, and sCD30 were higher in cHL (p = 0.008, p = 0.009 and p = 0.042, respectively), while miR-16 was down-regulated (p = 0.040). miR-20a and miR-21 were independently associated with cHL (p = 0.049 and p = 0.035, respectively). The combination of miR-20a and miR-21 showed a good AUC value of 0.832 with a moderate likelihood ratio positive (LR+) value of 5.6 and a slight likelihood ratio negative (LR-) value of 0.23. At cHL diagnosis, miR-20a, miR-21 and miR-324 were overexpressed in cHL (p = 0.005, p = 0.024, and p = 0.001, respectively), while miR-223, miR-16, miR-185 and miR-106a were down regulated (p = 0.042, p = 0.007, p = 0.006, and p = 0.002, respectively). In addition, sCD14, sCD27, sCD30 and IL2R levels were higher in these individuals (p = 0.038, p = 0.010, p = 0.030, p = 0.006, respectively). miR-20a was independently associated with cHL (p = 0.011). The diagnostic value of miR-20a showed good AUC value of 0.754 (p = 0.074) with a slight LR+ value of 2 and a slight LR- of 0.25. After chemotherapy, miR-20a was higher in those individuals who had an adverse outcome (p < 0.001), while sCD14 and sCD30 were higher (p < 0.001). A specific signature of miRs and cytokines associated with a subsequent cHL diagnosis was found in this study, especially miR-20a and miR-21. Also, another biomarker signature was found at cHL diagnosis, with a relevant discriminant disease value for miR-20a. Of note, miR-20a expression was higher in those individuals who had an adverse clinical outcome after chemotherapy.

Systematic Review of Preventive Programs for Reducing Problem Gambling Behaviors Among Young Adults.

Young adulthood is a developmental period from late adolescence to one's late twenties or early thirties. Prevalence studies internationally have reported that individuals in this age group tend to have the highest rates of problem gambling. However, much of the prevention work designed to minimize the risk of problem and disordered gambling has been primarily focused on school settings and aimed at high school students. The objective of this study was to summarize the existing literature on the effectiveness of prevention programs aimed at reducing the prevalence of gambling problems in young adults. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic academic databases were consulted in order to examine the studies conducted during the last 20 years. After removing duplicates and adhering to the inclusion and exclusion criteria, nine studies were included in this review. All studies targeted college or university students and followed a selective or indicated prevention strategy. A Personalized Normative Feedback approach was incorporated in most of the studies, which had generally good results in reducing and/or minimizing at-risk or problem gambling. The limited number of studies included in this review highlights the need to address scientific quality standards before proceeding with the design, implementation and widespread dissemination of these preventive programs as well as the need to ensure the program's efficacy prior to implementation.

Substance Use and Gambling Patterns Among Adolescents: Differences According to Gender and Impulsivity.

Although alcohol, tobacco and cannabis are the most prevalent drugs used by adolescents, gambling is a growing concern due to its increasing popularity. To date there have been few studies exploring the existing patterns of concurrent use of drugs and gambling in adolescents. This study aims to identify subpopulations of adolescents using different substances and gambling activities, to explore gender differences and to examine impulsivity as a predictor of class membership. A cross-sectional survey was carried out in 22 high-schools, and 1644 adolescents were assessed (54.1% males; mean age = 15.21 years, SD = .75). Participants reported their last-year frequency of using alcohol, tobacco and cannabis, as well as bingo, poker, other casino games, sports betting, lottery, scratch tickets and electronic gaming machines. Problem drinking was evaluated with the Rutgers Alcohol Problems Index, and gambling severity with the South Oaks Gambling Scale for Adolescents. Impulsivity was assessed using a Delay Discounting task, the Barratt Impulsiveness Scale and the Impulsive Sensation-Seeking Scale. Based on a latent class model of drugs and gambling activities, four subpopulations of males and five of females were found. General impulsivity and sensation seeking were the most consistent predictors of class membership. These novel findings support the need to consider specific groups of adolescents engaging in different patterns of addictive behaviors when implementing selective prevention strategies.

Gambling Motives Questionnaire validation in adolescents: Differences based on gambling severity and activities. / Validación del Cuestionario de Motivos de Juego en adolescentes: Diferencias según la gravedad y las actividades de juego.

Self-reported reasons for gambling have been highlighted as crucial to understanding why adults develop problems with gambling. However, research on motives among adolescents remains scarce. The aim of this study is to explore the factorial structure of the Gambling Motives Questionnaire (GMQ) and to analyze differences in motives among adolescents, depending on the gambling activity and level of gambling severity. A total of 698 adolescent gamblers (M = 15.24, SD = .76) were assessed. As well as the GMQ, the South Oaks Gambling Screen (SOGS-RA) questionnaire was used. Gamblers were classified into three categories (strategic, non-strategic, and mixed) according to the activities engaged in during the last year. An Exploratory Factor Analysis was conducted followed by a Confirmatory Factor Analysis in order to explore the internal structure of the GMQ. Three two-way between-groups Analyses of Variance (ANOVA) were conducted to explore differences in motives according to the type of activity and the gambling severity levels. According to the factorial structure of the GMQ, three main groups of motivations were found: enhancement, coping and social. Compared to non-problem gamblers, problem gamblers scored higher on all motives. Moreover, gamblers seeking enhancement prefer strategic games, those gambling to cope with stress use non-strategic games more frequently, while social gamblers do not show a preference for either strategic or non-strategic games. In conclusion, gambling motives are related to gambling severity and structural characteristics of gambling. These findings may be useful from a prevention standpoint.

Los motivos de juego han sido considerados como variables clave para comprender el desarrollo de problemas asociados al mismo en adultos. Sin embargo, la literatura sobre las motivaciones de los adolescentes para jugar es escasa. El presente estudio tiene como objetivo explorar la estructura factorial del Cuestionario de Motivos de Juego (GMQ) y analizar las diferencias de los motivos de los adolescentes según la actividad de juego y la gravedad de los problemas asociados. Se evaluó una muestra de 698 jugadores adolescentes (M = 15,24, DT = ,76) a los que se les aplicó, además del GMQ, el cuestionario South Oaks Gambling Screen (SOGS-RA). Los jugadores fueron clasificados en tres categorías (estratégicos, no estratégicos, mixtos) según el tipo de juegos utilizados durante el último año. Para el estudio de la estructura interna del GMQ se realizó un primer Análisis Factorial Exploratorio y un segundo Análisis Factorial Confirmatorio. Se emplearon tres Análisis de Varianza (ANOVA) de dos vías para evaluar las diferencias en motivos entre los niveles de gravedad y tipo de actividad. De acuerdo con la estructura factorial del GMQ, existen tres principales grupos de motivaciones para jugar: búsqueda de emociones positivas, afrontamiento del estrés y causas sociales. En comparación con los jugadores sin problema, los jugadores problemáticos puntuaron más alto en todos los motivos. Además, los jugadores que buscan emociones positivas se decantan más por los juegos estratégicos, los que utilizan el juego para afrontar el estrés utilizan más los no estratégicos, mientras que los jugadores sociales no presentan preferencia por ninguno de los dos. En conclusión, la motivación para jugar se encuentra en relación con la gravedad y las características del juego. Estos resultados son de utilidad desde el punto de vista de la prevención.