How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study.

AIM: To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals. METHODS: Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up. RESULTS: We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life. CONCLUSION: A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.

Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP).

CONTEXT: Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. OBJECTIVES: To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). METHODS: A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. RESULTS: The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). CONCLUSION: MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.

Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review.

OBJECTIVE: Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited. DESIGN: This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States. METHODS: Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles. RESULTS: Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers. CONCLUSIONS: Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.

Screening of Phosphate Solubilization Identifies Six Pseudomonas Species with Contrasting Phytostimulation Properties in Arabidopsis Seedlings.

The interaction of plants with bacteria and the long-term success of their adaptation to challenging environments depend upon critical traits that include nutrient solubilization, remodeling of root architecture, and modulation of host hormonal status. To examine whether bacterial promotion of phosphate solubilization, root branching and the host auxin response may account for plant growth, we isolated and characterized ten bacterial strains based on their high capability to solubilize calcium phosphate. All strains could be grouped into six Pseudomonas species, namely P. brassicae, P. baetica, P. laurylsulfatiphila, P. chlororaphis, P. lurida, and P. extremorientalis via 16S rRNA molecular analyses. A Solibacillus isronensis strain was also identified, which remained neutral when interacting with Arabidopsis roots, and thus could be used as inoculation control. The interaction of Arabidopsis seedlings with bacterial streaks from pure cultures in vitro indicated that their phytostimulation properties largely differ, since P. brassicae and P. laurylsulfatiphila strongly increased shoot and root biomass, whereas the other species did not. Most bacterial isolates, except P. chlororaphis promoted lateral root formation, and P. lurida and P. chlororaphis strongly enhanced expression of the auxin-inducible gene construct DR5:GUS in roots, but the most bioactive probiotic bacterium P. brassicae could not enhance the auxin response. Inoculation with P. brassicae and P. lurida improved shoot and root growth in medium supplemented with calcium phosphate as the sole Pi source. Collectively, our data indicate the differential responses of Arabidopsis seedlings to inoculation with several Pseudomonas species and highlight the potential of P. brassicae to manage phosphate nutrition and plant growth in a more eco-friendly manner.

Insights into the Use of Peripherally Acting µ-Opioid Receptor Antagonists (PAMORAs) in Oncologic Patients: from Scientific Evidence to Real Clinical Practice.

OPINION STATEMENT: Management of chronic pain is crucial to improve the quality of life of cancer and palliative care patients. Opioid-based treatments used to control pain can be prolonged over time. Unfortunately, constipation is one of the most disturbing adverse effects of long-term use of opioids. Opioid-induced constipation (OIC) occurs when opioids bind to the specific receptors present in the gastrointestinal (GI) tract, and can affect any patients receiving chronic opioid therapy, including cancer patients. The limited efficacy of laxatives to treat OIC symptoms prompted the search for new therapeutic strategies. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have recently emerged as new effective drugs for OIC management due to their specific binding to enteric µ-receptors. Little information is available on the use of PAMORAs in real-life practice for OIC treatment in cancer patients. In this paper, a panel of experts specializing in cancer and palliative care pools their clinical experience with PAMORAs in cancer patients presenting OIC and highlights the importance of timing and choice of therapy in achieving prompt OIC management and benefitting patients.

Characterization of plant growth-promoting bacteria associated with avocado trees (Persea americana Miller) and their potential use in the biocontrol of Scirtothrips perseae (avocado thrips).

Plants interact with a great variety of microorganisms that inhabit the rhizosphere or the epiphytic and endophytic phyllosphere and that play critical roles in plant growth as well as the biocontrol of phytopathogens and insect pests. Avocado fruit damage caused by the thrips species Scirtothrips perseae leads to economic losses of 12-51% in many countries. In this study, a screening of bacteria associated with the rhizosphere or endophytic phyllosphere of avocado roots was performed to identify bacterial isolates with plant growth-promoting activity in vitro assays with Arabidopsis seedlings and to assess the biocontrol activity of the isolates against Scirtothrips perseae. The isolates with beneficial, pathogenic and/or neutral effects on Arabidopsis seedlings were identified. The plant growth-promoting bacteria were clustered in two different groups (G1 and G3B) based on their effects on root architecture and auxin responses, particularly bacteria of the Pseudomonas genus (MRf4-2, MRf4-4 and TRf2-7) and one Serratia sp. (TS3-6). Twenty strains were selected based on their plant growth promotion characteristics to evaluate their potential as thrips biocontrol agents. Analyzing the biocontrol activity of S. perseae, it was identified that Chryseobacterium sp. shows an entomopathogenic effect on avocado thrips survival. Through the metabolic profiling of compounds produced by bacteria with plant growth promotion activity, bioactive cyclodipeptides (CDPs) that could be responsible for the plant growth-promoting activity in Arabidopsis were identified in Pseudomonas, Serratia and Stenotrophomonas. This study unravels the diversity of bacteria from the avocado rhizosphere and highlights the potential of a unique isolate to achieve the biocontrol of S. perseae.

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol.

INTRODUCTION: The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS: To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.

Las Curvas Para Medir Circunferencia Cefálica Y Las Potenciales Diferencias Antropométricas En Latinoamérica Y El Mundo / Cephalic Circumference Curves And Potential Anthropometric Differences In Latin America And The World

Resumen La circunferencia cefálica (CC) es una medición que detecta alteraciones del crecimiento adecuado del cerebro. Las curvas de CC más utilizadas mundialmente son las propuestas por los CDC, NCHS y OMS. A pesar de las críticas sobre la metodología para crearlas, se han hecho actualizaciones para corregir inconsistencias. Esto ha servido para detectar y tratar oportunamente problemas de tamaño craneal tanto en los extremos pequeños (microcefalia) o grandes (macrocefalia). Algunos autores opinan que existe la necesidad de contar con curvas regionales para mejorar el valor diagnóstico de éstas en cada población. Otros, como Kenton Holden y colaboradores, han propuesto nuevas curvas que consolidan diferentes bases de datos con el objetivo de reducir el riesgo de errores en el diagnóstico de microcefalia o macrocefalia leve. Es necesario estudiar cuál es el patrón de crecimiento craneal normal de niños/as latinoamericanos por cada región o país, así como conocer las diferencias interétnicas.

Abstract The cephalic circumference (CC) is a measurement that detects alterations in the proper growth of the brain. CC curves most used worldwide are those proposed by the CDC, NCHS and WHO. Despite criticism of the methodology used to create them, updates have been made to correct inconsistencies, and that has helped to detect and treat on time problems of cranial size at both the small (microcephaly) and large (macrocephaly) ends. Several authors have suggested that regional reference curves should be made, and others, like Kenton Holden and colleagues, have proposed new curves that consolidate different databases, aiming to reduce the risk of errors in the diagnosis of microcephaly or mild macrocephaly. It is necessary to study what the normal cranial growth pattern of Latin American children is for each region or country, as well as to determine the interethnic differences.

The shift in GH3 cell shape and cell motility is dependent on MLCK and ROCK.

Cytoskeletal organization, actin-myosin contractility and the cell membrane together regulate cell morphology in response to the cell environment, wherein the extracellular matrix (ECM) is an indispensable component. Plasticity in cell shape enables cells to adapt their migration mode to their surroundings. GH3 endocrine cells respond to different ECM proteins, acquiring different morphologies: a rounded on collagen I-III (C I-III) and an elongated on collagen IV (C IV). However, the identities of the molecules that participate in these responses remain unknown. Considering that actin-myosin contractility is crucial to maintaining cell shape, we analyzed the participation of MLCK and ROCK in the acquisition of cell shape, the generation of cellular tension and the cell motility mode. We found that a rounded shape with high cortical tension depends on MLCK and ROCK, whereas in cells with an elongated shape, MLCK is the primary protein responsible for cell spreading. Further, in cells with a slow and directionally persistent motility, MLCK predominates, while rapid and erratic movement is ROCK-dependent. This behavior also correlates with GTPase activation. Cells on C I-III exhibited higher Rho-GTPase activity than cells on C IV and vice versa with Rac-GTPase activity, showing a plastic response of GH3 cells to their environment, leading to the generation of different cytoskeleton and membrane organizations and resulting in two movement strategies, rounded and fibroblastoid-like.

Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells.

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from brown sea algae. Briefly, the tumor tissue is cut into small pieces and submitted to an enzymatic digestion with collagenase and trypsin. Next, a cell suspension is obtained. The tumor cell suspension is mixed with 1.2% sodium alginate and dropped into a CaCl2 solution, and the alginate/cell suspension is gelled on contact with the CaCl2 to form spherical beads. The cells embedded in the alginate beads are supplied with nutrients provided by the culture media enriched with 20% FBS. Three-dimensional culture in alginate beads maintains the viability of adenoma cells for long periods of time, up to four months. Moreover, the cells can be liberated from the alginate by washing the beads with sodium citrate and seeded on glass coverslips for further immunocytochemical analyses. The use of a cell culture model allows for the fixation and visualization of the actin cytoskeleton with minimal disorganization. In summary, alginate beads provide a reliable culture system for the maintenance of pituitary adenoma cells.

Have We Improved Pain Control in Cancer Patients? A Multicenter Study of Ambulatory and Hospitalized Cancer Patients.

BACKGROUND: Pain in cancer patients is recognized as a major health problem, yet few studies of both inpatient and outpatient populations have been carried out. OBJECTIVE: The study objective was to assess the frequency, type, and characteristics of pain in adult cancer patients, including both inpatients and outpatients. METHODS: This cross-sectional study involved 1064 adult cancer patients (437 outpatients and 627 inpatients) from 44 hospitals and/or long-term-care centers in Catalonia, Spain. Cancer patients suffering from pain of any etiology for ≥2 weeks and/or under analgesic treatment ≥2 weeks were enrolled. Demographic and pain data were collected. The Spanish version of the Brief Pain Inventory was used to assess pain. RESULTS: Pain frequency was 55.3%. Pain was less frequent in outpatients than inpatients (41.6% versus 64.7%; p<0.001), although median pain duration was longer in outpatients (20 versus 6 weeks; p<0.001). Pain was assessable in 333 patients, and intensity was similar in both out- and inpatients; however, outpatients reported less improvement, less pain interference with daily life, and less pain related to the cancer per se. In both groups, patients with multiple myeloma (73%), breast (65%), and lung cancer (61%) were most likely to report pain. CONCLUSIONS: Pain in cancer patients, both ambulatory and hospitalized, remains a challenge for health care professionals, health administrators, and stakeholders. Our study reveals the high level of pain and distress that cancer patients continue to suffer, a problem that is particularly notable in outpatients due to the intensity and duration of the pain.

Impacto de los nomencladores nacionales geográficos en el Sistema Nacional de Salud / Impact of the national geographical codifiers in the National System of Health

Como parte del proceso de informatización del Sistema Nacional de Salud (SNS) en Cuba surge la necesidad de contar con una solución informática al menor costo posible para la gestión de la información de salud, de cara a todos los profesionales, técnicos y dirigentes que toman decisiones asistenciales, clínicas o de gestión en salud. La solución tiene que ser eficiente al permitir a los usuarios autorizados combinar la información de los diferentes módulos que componen el Sistema de Información para la Salud (SISalud) y desplegarse centralizadamente para acceder desde cualquier nivel del SNS. Para compartir la información con otros sistemas, el Registro Informatizado de Salud (RIS) sigue una arquitectura orientada a servicios y basada en componentes, formando parte de la estructura de SISalud. Como componentes del RIS se dispone en la actualidad de nomencladores nacionales geográficos, que gestionan de manera homogénea la información del Registro de Ubicación Geográfica, el Registro de Localidades del país y el Registro de las Áreas de Salud, incorporando así la fortaleza de los procesos definidos en el SNS y respetando los procedimientos oficiales que garanticen la confidencialidad de la información de salud. Se expone el impacto para el proceso de informatización del sector a partir de la etapa de piloto o censo. El Proyecto RIS contribuye a un objetivo nacional y sus resultados se generalizan a lo largo del país, produciendo cambios en la gestión de las unidades de salud, pues los recursos humanos deben capacitarse y elevar su cultura informacional(AU)

As part of the process of computerization of the National Health System (NHS) in Cuba there is the need for an IT solution at the lowest cost for the management of health information. The solution must be efficient to allow authorized users to combine information from different modules in the system for Health Information (SISalud) and must be deployed centrally for access from any level of the NHS. To share information with other systems, the Computerized Health Record (RIS) follows a service-oriented architecture and component-based, being part of SISalud structure. Currently available as components of the RIS are geographic nomenclatures, uniformly managing information on the Register of Geographical Location, the Locations Registry and the Registry of the Health Areas, incorporating the strength of the processes defined in the NHS and respecting formal procedures to ensure the confidentiality of health information. We discuss the impact on the sector computerization process from the pilot stage. The RIS project contributes to a national objective and results are generalized throughout the country, producing changes in the management of health units(AU).

Catalonia WHO palliative care demonstration project at 15 Years (2005).

Since 1990, a wide range of palliative care services has been implemented throughout the Catalan Health Care System. In 2005, 21,400 patients received palliative care; 59% had cancer (79.4% of all cancer patients) and 41% had other noncancer diagnoses (25.0%-56.5% of all noncancer patients). Today, more than 95% of Catalonia is covered by palliative care services. Fourteen districts have comprehensive palliative care networks. A total of 140 full-time physicians work in 183 specialty programs, including 63 palliative care units (with a total of 552 beds), 34 hospital consult teams, 70 home care teams, 16 outpatient clinics, and specialized pediatric and HIV/AIDS consult teams. Opioid consumption increased from 3.5mg per capita in 1989 to 21 mg per capita population in 2004. The cost of the specialist palliative care network is more than 40 million Euros annually. However, the cost efficiency is striking. Due to the radical change in the use of acute and emergency beds, the project saves the Catalan Health Care System an estimated 48 million Euros annually, a net savings of 8 million Euros annually. Additional preliminary data suggest that symptom control and patient/family satisfaction are both improved by these services.

La sexualidad de los adolescentes de 14 a 19 años en una población dada / Sexuality in 14-19 years old adolescents of a give population

Se realiza un estudio por encuestas sobre sexualidad en al adolescencia a 218 jóvenes en edades entre 14 y 19 años, para conocer fundamentalmente el nivel en que se encuentra la práctica de relaciones sexuales, el grado de información y el uso de métodos anticonceptivos y antecedentes de embarazo por edad y sexo. En el análisis realizado se encontró que el 51 por ciento de la muestra tiene relaciones sexuales desde edades tempranas. La mayoría tiene información sobre los métodos anticonceptivos. Sólo el 66 por ciento de los jóvenes que practican relaciones sexuales está protegido por sí mismo o por su pareja; hay 38 que no tienen ninguna protección. Los métodos anticonceptivos más idóneos para esas edades no lo conocen o simplemente no lo usan, como son el diafragma o el condón. El 61 por ciento de los jóvenes que practica relaciones sexuales tiene antecedentes de embarazo, la mayoría culminó en partos en primer lugar, seguido de legrados y como consecuencia el abandono de los estudios y pocas comenzaron a trabajar. El médico y la enfermera de familia son los más indicados para llevar a la familia la educación sexual que requieren, por la vinculación que tienen con su población

La sexualidad de los adolescentes de 14 a 19 años en una población dada / Sexuality in 14-19 years old adolescents of a give population

Se realiza un estudio por encuestas sobre sexualidad en al adolescencia a 218 jóvenes en edades entre 14 y 19 años, para conocer fundamentalmente el nivel en que se encuentra la práctica de relaciones sexuales, el grado de información y el uso de métodos anticonceptivos y antecedentes de embarazo por edad y sexo. En el análisis realizado se encontró que el 51 por ciento de la muestra tiene relaciones sexuales desde edades tempranas. La mayoría tiene información sobre los métodos anticonceptivos. Sólo el 66 por ciento de los jóvenes que practican relaciones sexuales está protegido por sí mismo o por su pareja; hay 38 que no tienen ninguna protección. Los métodos anticonceptivos más idóneos para esas edades no lo conocen o simplemente no lo usan, como son el diafragma o el condón. El 61 por ciento de los jóvenes que practica relaciones sexuales tiene antecedentes de embarazo, la mayoría culminó en partos en primer lugar, seguido de legrados y como consecuencia el abandono de los estudios y pocas comenzaron a trabajar. El médico y la enfermera de familia son los más indicados para llevar a la familia la educación sexual que requieren, por la vinculación que tienen con su población