Estudio sobre la aproximación al VIH: gestión sanitaria y el proceso asistencial en España / Study on the approach to HIV: health management and the process healthcare in Spain

Introducción: El VIH sigue representando un problema de gran relevancia para la salud pública en España. El objetivo de este estudio es realizar un análisis que permita conocer en profundidad los recursos, cuidados clínicos y la gestión durante las fases de diagnóstico, seguimiento y tratamiento de la infección por el VIH en España. Métodos: En la primera fase un comité científico multidisciplinar diseñó una herramienta de recogida de información, en forma de encuesta. En la segunda fase, realizada en las comunidades autónomas de Andalucía, Cataluña y La Rioja, un grupo multidisciplinar de 42 expertos, representantes de la administración pública, perfiles clínicos y representantes de las ONG en el ámbito del VIH contestaron a la encuesta. Resultados: La valoración de los recursos destinados al VIH es en general positiva. En el diagnóstico los expertos consideraron que existía una buena coordinación entre atención primaria y hospitalaria. Con respecto al tratamiento las valoraciones han reflejado una buena opinión sobre la conciliación terapéutica y adherencia, y una valoración negativa sobre la evaluación de las interacciones entre medicamentos con el tratamiento antirretroviral. Sobre el seguimiento, la percepción expresada fue dispar con respecto a la coordinación entre atención hospitalaria y primaria y sobre la adaptación de los cuidados a la cronicidad, envejecimiento, fragilidad, salud mental y los procesos oncológicos. Conclusión: Existen determinados procesos que pueden ser mejorados en relación con el manejo de la infección de las personas con VIH en España, incluyendo protocolos de seguimiento y coordinación entre atención primaria y hospitalaria en el tratamiento y seguimiento de la enfermedad.(AU)

Introduction: HIV continues to represent a problem of great relevance for public health in Spain. This study aims to carry out an analysis that will provide in-depth knowledge of the resources, clinical care, and management during the diagnosis, follow-up, and treatment phases of HIV infection in Spain. Methods: In the first phase, a multidisciplinary Scientific Committee designed an information collection tool in the form of a survey. In the second phase, carried out in the autonomous communities of Andalusia, Catalonia, and La Rioja, a multidisciplinary group of 42 experts, representatives of the public administration, clinical profiles, and representatives of NGOs in the field of HIV answered the survey. Results: The assessment of HIV resources is generally positive. As regards diagnosis, the experts considered that there was good coordination between primary and hospital care. Regarding treatment, the evaluations reflected good opinions on therapeutic conciliation and adherence, with a negative opinion in the evaluation of drug interactions with antiretroviral treatment. Regarding follow-up, the perception expressed was disparate concerning the coordination between hospital and primary care as well as the adaptation of care to chronicity, aging, fragility, mental health, and oncological processes. Conclusion: There are certain processes that can be improved in the management of HIV infection in people with HIV in Spain, including protocols for follow-up and coordination between primary and hospital care in the treatment and follow-up of the disease.(AU)

Toxicity of a Modified PEG-Asparaginase-Based SMILE Regimen Is Comparable to L-Asparaginase-Based SMILE in a Non-Asian Population.

INTRODUCTION: L-asparaginase-based chemotherapy regimens are effective for treating chemotherapy-resistant natural killer- (NK-) cell neoplasms. To treat these lymphoma subtypes in Asia, where NK/T-cell lymphomas are more prevalent, the NK-Cell Tumor Study Group developed the SMILE regimen, which includes a steroid, methotrexate, ifosfamide, L-asparaginase, and etoposide. In the US however, the only commercially available form of asparaginase is the pegylated form (PEG-asparaginase) which has been incorporated into a modified SMILE (mSMILE). We sought to study the toxicity associated with replacing L-asparaginase with PEG-asparaginase in mSMILE. PATIENTS AND METHODS: We retrospectively identified all adult patients treated with the mSMILE chemotherapy regimen in our database at Moffitt Cancer Center (MCC) between December 1, 2009, and July 30, 2021. Patients were included if they were treated with mSMILE irrespective of their underlying diagnosis. Toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5. The rate of toxicity in our mSMILE treatment group was numerically compared to data published in a metanalysis of the SMILE regimen's toxicity (Pokrovsky et al., 2019). RESULTS: A total of 21 patients were treated with mSMILE at MCC during the 12-year analysis window. Compared to patients receiving the L-asparaginase-based SMILE, patients receiving mSMILE experienced grade 3 or 4 leukopenia less often, with a toxicity rate of 62% (median with SMILE, 85% [95% CI, 74%-95%]); thrombocytopenia, however, was more common, with a toxicity rate of 57% (median with SMILE, 48% [95% CI, 40%-55%]). Other hematological, hepatic and coagulation related toxicities were also reported. CONCLUSION: In a non-Asian population, the mSMILE regimen with PEG-asparaginase is a safe alternative to the L-asparaginase-based SMILE regimen. There is a comparable risk of hematological toxicity, and no treatment-related mortality was seen in our population.

Study on the approach to HIV: health management and the healthcare process in Spain.

INTRODUCTION: HIV continues to represent a problem of great relevance for public health in Spain. This study aims to carry out an analysis that will provide in-depth knowledge of the resources, clinical care, and management during the diagnosis, follow-up, and treatment phases of HIV infection in Spain. METHODS: In the first phase, a multidisciplinary Scientific Committee designed an information collection tool in the form of a survey. In the second phase, carried out in the autonomous communities of Andalusia, Catalonia, and La Rioja, a multidisciplinary group of 42 experts, representatives of the public administration, clinical profiles, and representatives of NGOs in the field of HIV answered the survey. RESULTS: The assessment of HIV resources is generally positive. As regards diagnosis, the experts considered that there was good coordination between Primary and Hospital care. Regarding treatment, the evaluations reflected good opinions on therapeutic conciliation and adherence, with a negative opinion in the evaluation of drug interactions with antiretroviral treatment. Regarding follow-up, the perception expressed was disparate concerning the coordination between Hospital and Primary Care as well as the adaptation of care to chronicity, aging, fragility, mental health, and oncological processes. CONCLUSION: There are certain processes that can be improved in the management of HIV infection in people with HIV in Spain, including protocols for follow-up and coordination between primary and hospital care in the treatment and follow-up of the disease.

History of keratinocyte carcinoma and survival after a second primary malignancy: the Moffitt Cancer Center patient experience.

PURPOSE: History of keratinocyte carcinoma (KC) has been associated with survival following the diagnosis of a second primary malignancy (SPM), with the direction of the association varying by cancer type. Research is needed to elucidate the role of other key factors in this association. METHODS: A retrospective cohort study was conducted among patients newly diagnosed and/or treated at Moffitt Cancer Center in December 2008-April 2020 with breast cancer, lung cancer, melanoma, colon cancer, prostate cancer, and non-Hodgkin lymphoma/chronic lymphocytic leukemia (NHL/CLL) (n = 29,156). History of KC was obtained from new patient intake questionnaires. Age- and stage-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated to estimate the association between history of KC and survival following each cancer, stratified by demographic/clinical characteristics. RESULTS: KC history was most prevalent in patients with melanoma (28.7%), CLL (19.8%) and lung cancer (16.1%). KC history was associated with better overall survival following prostate cancer (HR = 0.74, 95% CI = 0.55-0.99) and poorer overall survival following CLL (HR = 1.73, 95% CI = 1.10-2.71). Patients with a history of KC experienced better survival within the first four years of a melanoma diagnosis (HR = 0.79, 95% CI = 0.67-0.92); whereas poorer survival was observed for patients who survived 7 + years after a melanoma diagnosis (HR = 2.18, 95% CI = 1.17-4.05). Stratification by treatment and stage revealed directional differences in the associations between KC history and survival among patients with breast cancer and melanoma. CONCLUSIONS: KC history may be a predictor of survival following an SPM, possibly serving as a marker of immune function and/or DNA damage repair capacity.

Spatially explicit assessment of genetic variation to inform conservation effort for an endangered Mediterranean conifer, Cedrus atlantica.

Preserving the genetic diversity of forest species is critical for maintaining their adaptive potential and allowing for generation turnover in forest ecosystems. Considering an uncertain future, it is necessary to establish reliable genetic conservation strategies to optimize the genetic variation preserved within populations in a spatially explicit context to assist decision-makers. Hence, we aimed to incorporate genetic information into spatially designed conservation actions. Cedrus atlantica is a large, long-lived conifer native to the mountains of North Africa, threatened by extinction. The relevant genetic units for conservation were selected using Bayesian analysis. The relative contribution of the populations to the genetic pool that maximized the species' genetic diversity was calculated to design an optimal seed bank. Finally, the relationship between the genetic composition and bioclimatic variables was estimated and projected throughout the study area under current and future climatic conditions. Three relevant genetic units were found for C. atlantica conservation that maximizes genetic diversity in a spatial context. Bioclimatic variables with the highest influence on genetic composition were closely related to climate warming and decreased soil water availability. We identified the role of genetic markers in designing a reliable conservation strategy for forest trees considering climate change, increased deforestation, and aridity. Projections of genetic composition due to the climate in the study region of North Africa provide spatially explicit guidance for optimizing the selection and preservation of seed banks.

Fatigue Perpetuating Factors as Mediators of Change in a Cognitive Behavioral Intervention for Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia: A Pilot Study.

BACKGROUND: Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) has demonstrated preliminary efficacy in reducing fatigue in patients treated with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML). PURPOSE: The aim of the current analyses was to explore whether fatigue perpetuating factors (disturbed sleep/wake cycle, dysregulated activity patterns, maladaptive cognitions about fatigue and cancer, insufficient processing of cancer and treatment, inadequate social support and interactions, heightened fear of cancer progression) changed over time in patients receiving CBT-TTF, and whether the effect of CBT-TTF on fatigue was mediated by these factors. METHODS: Secondary data analyses were conducted from a pilot randomized controlled trial. Patients with CML treated with a TKI who reported moderate to severe fatigue were randomized 2:1 to CBT-TTF delivered via FaceTime for iPad or a waitlist control condition (WLC). Self-report measures of fatigue and fatigue perpetuating factors were obtained before randomization and post-intervention (i.e., approximately 18 weeks later). Mixed model and mediation analyses using bootstrap methods were used. RESULTS: A total of 36 participants (CBT-TTF n = 22, WLC n = 14) who had baseline and 18-week follow-up data and attended >5 sessions for CBT-TTF were included. Participants randomized to CBT-TTF reported improvements in activity (mental, physical, social, p's ≤ .023) and cognitions (helplessness, catastrophizing, focusing on symptoms, self-efficacy, p's ≤ .003) compared to WLC. Mental activity, social activity, self-efficacy, helplessness, and focusing on symptoms, as well as sleep and insufficient processing (avoidance) mediated the relationship between treatment group and fatigue. CONCLUSIONS: CBT-TTF appears to improve TKI-related fatigue in CML patients through changes in behavior (sleep, activity patterns) and cognitions about fatigue and cancer. A larger randomized controlled trial is warranted to confirm these findings.

Genetic similarities versus morphological resemblance: Unraveling a polyploid complex in a Mediterranean biodiversity hotspot.

The Balkan Peninsula is recognized as one of the hotspots of biodiversity in Europe. This area has shown since the Last Glacial Maximum appropriate conditions for species diversification and hybridization, which has led to the existence of numerous taxonomically unresolved entities. Here, we focus on the Western Balkans and explore the genetic structure and relationships among species belonging to the V. austriaca - V. orbiculata diploid-polyploid complex, including populations showing intermediate morphologies. A combination of nuclear markers (microsatellites), plastid DNA regions (trnH-psbA, ycf6-psbM) and ploidy level estimations using flow cytometry are employed to assess the genetic structure and evolutionary dynamics of this polyploid complex. To reconstruct the evolutionary history, an approximate Bayesian computation approach is combined with projections of the species distribution models onto the climatic scenarios of the Mid-Holocene (6 ka BP) and Last Glacial Maximum (22 ka BP). Four main groups were found: one well-established entity within the diploid level, V. dalmatica, a second diploid-tetraploid group which corresponds to V. orbiculata, a hexaploid cluster harboring V. austriaca subsp. jacquinii individuals, and an enigmatic tetraploid group. According to the molecular data obtained, this latter cluster represents an allopolyploid cryptic lineage −with V. orbiculata and V. dalmatica as putative parents− morphologically similar to V. orbiculata, but genetically more related to V. austriaca subsp. jacquinii. Veronica dalmatica and this "uncertain tetraploid" group are involved in the formation of the hexaploid taxon V. austriaca subsp. jacquinii, with the possibility of recent gene flow among different cytotypes. The present study supports a scenario of diversification from a diploid common ancestor leading to two different but interrelated lineages. The first one would correspond with the diploid V. orbiculata plus tetraploid individuals of this species arising through allo- and autopolyploidization, and the second one would involve all ploidy levels with allopolyploidization being prevalent.

Tumor Microenvironment Composition and Severe Cytokine Release Syndrome (CRS) Influence Toxicity in Patients with Large B-Cell Lymphoma Treated with Axicabtagene Ciloleucel.

PURPOSE: One of the challenges of adoptive T-cell therapy is the development of immune-mediated toxicities including cytokine release syndrome (CRS) and neurotoxicity (NT). We aimed to identify factors that place patients at high risk of severe toxicity or treatment-related death in a cohort of 75 patients with large B-cell lymphoma treated with a standard of care CD19 targeted CAR T-cell product (axicabtagene ciloleucel). EXPERIMENTAL DESIGN: Serum cytokine and catecholamine levels were measured prior to lymphodepleting chemotherapy, on the day of CAR T infusion and daily thereafter while patients remained hospitalized. Tumor biopsies were taken within 1 month prior to CAR T infusion for evaluation of gene expression. RESULTS: We identified an association between pretreatment levels of IL6 and life-threatening CRS and NT. Because the risk of toxicity was related to pretreatment factors, we hypothesized that the tumor microenvironment (TME) may influence CAR T-cell toxicity. In pretreatment patient tumor biopsies, gene expression of myeloid markers was associated with higher toxicity. CONCLUSIONS: These results suggest that a proinflammatory state and an unfavorable TME preemptively put patients at risk for toxicity after CAR T-cell therapy. Tailoring toxicity management strategies to patient risk may reduce morbidity and mortality.

Phylogeography of an endangered disjunct herb: long-distance dispersal, refugia and colonization routes.

Quaternary glacial cycles appear to have had a consistent role in shaping the genetic diversity and structure of plant species. Despite the unusual combination of the characteristics of the western Mediterranean-Macaronesian area, there are no studies that have specifically examined the effects of palaeoclimatic and palaeogeographic factors on the genetic composition and structure of annual herbs. Astragalus edulis is a disjunct endemic found in the easternmost Canary Islands and the semi-arid areas of north-eastern Africa and south-eastern Iberian Peninsula. This endangered species shows no evident adaptations to long-distance dispersal. Amplified fragment length polymorphism (AFLP) data and plastid DNA sequences were analysed from a total of 360 individuals distributed throughout the range of this species. The modelled potential distribution of A. edulis under current conditions was projected over the climatic conditions of the Last Interglacial (130 ka BP) and Last Glacial Maximum (21 ka BP) to analyse changes in habitat suitability and to look for associations between the modelling and genetic results. Amplified fragment length polymorphism analysis showed clear phylogeographic structure with four distinct genetic clusters. Approximate Bayesian computation (ABC) models based on plastid DNA sequences indicated a Middle Pleistocene long-distance dispersal event as the origin of the populations of the Canary Islands. The models also suggested south-western Morocco as the ancestral area for the species, as well as subsequent colonization of north-eastern Morocco and the Iberian Peninsula. The data compiled indicated the possibility of the presence of refuge areas at favourable locations around the High Atlas and Anti-Atlas mountain ranges. Moreover, palaeodistribution models strongly support the events inferred by ABC modelling and show the potential distribution of the species in the past, suggesting a putative colonization route.

Phylogeography of Arenaria balearica L. (Caryophyllaceae): evolutionary history of a disjunct endemic from the Western Mediterranean continental islands.

Although it has been traditionally accepted that Arenaria balearica (Caryophyllaceae) could be a relict Tertiary plant species, this has never been experimentally tested. Nor have the palaeohistorical reasons underlying the highly fragmented distribution of the species in the Western Mediterranean region been investigated. We have analysed AFLP data (213) and plastid DNA sequences (226) from a total of 250 plants from 29 populations sampled throughout the entire distribution range of the species in Majorca, Corsica, Sardinia, and the Tuscan Archipelago. The AFLP data analyses indicate very low geographic structure and population differentiation. Based on plastid DNA data, six alternative phylogeographic hypotheses were tested using Approximate Bayesian Computation (ABC). These analyses revealed ancient area fragmentation as the most probable scenario, which is in accordance with the star-like topology of the parsimony network that suggests a pattern of long term survival and subsequent in situ differentiation. Overall low levels of genetic diversity and plastid DNA variation were found, reflecting evolutionary stasis of a species preserved in locally long-term stable habitats.

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean]. / Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe.

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Designing conservation strategies to preserve the genetic diversity of Astragalus edulis Bunge, an endangered species from western Mediterranean region.

Astragalus edulis (Fabaceae) is an endangered annual species from the western Mediterranean region that colonized the SE Iberian Peninsula, NE and SW Morocco, and the easternmost Macaronesian islands (Lanzarote and Fuerteventura). Although in Spain some conservation measures have been adopted, it is still necessary to develop an appropriate management plan to preserve genetic diversity across the entire distribution area of the species. Our main objective was to use population genetics as well as ecological and phylogeographic data to select Relevant Genetic Units for Conservation (RGUCs) as the first step in designing conservation plans for A. edulis. We identified six RGUCs for in situ conservation, based on estimations of population genetic structure and probabilities of loss of rare alleles. Additionally, further population parameters, i.e. occupation area, population size, vulnerability, legal status of the population areas, and the historical haplotype distribution, were considered in order to establish which populations deserve conservation priority. Three populations from the Iberian Peninsula, two from Morocco, and one from the Canary Islands represent the total genetic diversity of the species and the rarest allelic variation. Ex situ conservation is recommended to complement the preservation of A. edulis, given that effective in situ population protection is not feasible in all cases. The consideration of complementary phylogeographic and ecological data is useful for management efforts to preserve the evolutionary potential of the species.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe / Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean / Questionário básico e critérios metodológicos para as Pesquisas sobre Condições de Trabalho, Emprego e Saúde na América Latina e Caribe

Resumen: El objetivo de este trabajo es presentar un cuestionario básico y criterios metodológicos mínimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en América Latina y el Caribe. Para ello, se llevó a cabo un proceso de consenso, tanto virtual como presencial, con la participación de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la región hasta 2013. El cuestionario final incluyó 77 preguntas agrupadas en seis dimensiones: características sociodemográficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y características familiares. Entre los criterios metodológicos mínimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en América Latina y el Caribe, lo que contribuiría a mejorar la información en salud laboral en la región.

Abstract: This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Resumo: O objetivo deste trabalho é apresentar um questionário básico e critérios metodológicos mínimos, para serem considerados em futuras pesquisas sobre Condições de Trabalho, Emprego e Saúde (ECTES) na América Latina e Caribe. Para tal, foi realizado um processo de consenso, tanto virtual como presencial, com a participação de um grupo internacional de expertos que, para definir a proposta, partiram das pesquisas disponíveis na região até 2013. O questionário final incluiu 77 perguntas agrupadas em seis dimensões: características sociodemográficas do trabalhador e a empresa; condições de emprego; condições de trabalho; estado de saúde; recursos e atividades preventivas; assim como características familiares. Entre os critérios metodológicos mínimos destacam-se o domicílio da pessoa entrevistada como lugar da entrevista e os relacionados com a qualidade do trabalho de campo. Estes resultados podem ajudar a melhorar a comparabilidade das futuras ECTES na América Latina e Caribe, o que contribuiria para melhorar a informação sobre saúde do trabalhador na região.

Liver fibrosis progression despite HCV cure with antiviral therapy in HIV-HCV-coinfected patients.

BACKGROUND: Accelerated liver fibrosis and more frequent hepatic decompensation events and liver-related deaths are characteristically seen in chronic hepatitis C patients coinfected with HIV compared with HCV-monoinfected individuals. Quantitative estimates of long-term clinical benefits derived from curing HCV with antiviral therapy in coinfected patients are scarce, despite being needed for accurate cost-effectiveness decisions using expensive direct-acting antivirals in this population. METHODS: We retrospectively examined all HIV-HCV-coinfected patients followed at one reference clinic in Madrid since 2004. Liver fibrosis was measured longitudinally using elastometry; changes above 30% in kilopascal units were considered as significant. RESULTS: A total of 568 HIV-HCV-coinfected patients were examined. Pegylated interferon/ribavirin therapy had been given to 396 (69.7%) of whom 138 (34.8%) had achieved sustained virological response (SVR). Mean follow-up was of 6.8 (±1.5) years for hepatic events and 4.4 (±0.8) years for liver fibrosis. Hepatic decompensation events, liver-related deaths and significant liver fibrosis progression occurred less frequently in SVR than in non-treated/treatment failures. Although regression of liver fibrosis occurred in most SVR patients, fibrosis significantly progressed in 7.2% of them, in association with higher plasma HIV RNA (P=0.005) and longer exposure to HIV protease inhibitors (P=0.009). CONCLUSIONS: Achievement of SVR dramatically reduces the risk of hepatic decompensation events and liver-related deaths in HIV-HCV-coinfected patients. Although liver fibrosis generally improves following HCV cure, worsening may occur in association with uncontrolled HIV replication and prolonged exposure to protease inhibitors. Thus, periodic assessment of liver fibrosis is warranted after SVR and screening for liver cancer should continue in coinfected patients with advanced liver fibrosis.

Performance variability in basketball players with intellectual impairment: Ankara World Championships 2013 analysis / Análisis de la variabilidad del rendimeinto en jugadores de baloncesto con discapacidad intelectual. Campeonato del mundo Ankara 2013

The aim of the present study was to identify performance variability in basketball for players with intellectual impairment (II) and to compare it with able-bodied (AB) players. Official game statistics from the 13 games played in the Ankara World II-Basketball Championships (2013) were gathered and descriptive data, variability coefficient (VC), maximum scores and its Z-score were calculated from those players who participated at least 10 minutes per game (N = 46; guards = 10, forwards = 21, centers = 15). Results indicated higher performance variability and lower efficiency in shooting percentages and turnovers in II-players comparing with studies in ABplayers. Differences found between game positions indicated similar roles of guards, forwards and centers in II and AB-players. These findings are relevant to understand how II impact on basketball performance, which is a necessary step to develop specific eligibility systems in II-basketball according to the guidelines of the International Paralympic Committee

El objetivo del presente estudio fue identificar la variabilidad en el rendimiento en baloncesto para personas con discapacidad intelectual (DI) y compararlo con jugadores sin DI. Las estadísticas oficiales de juego de los 13 partidos disputados en los Campeonatos del Mundo de Baloncesto para personas con DI de Ankara (2013) fueron recogidas y se analizaron las variables descriptivas, los coeficientes de variabilidad (CV), indicadores máximos y su correspondiente valor-Z en aquellos jugadores que participaron al menos 10 minutos por partido (N= 46; bases = 10, aleros = 21 y pívots = 15). Los resultados indicaron una mayor variabilidad en el rendimiento y una menor eficacia en el porcentaje de tiro y en las pérdidas de balón en jugadores con DI comparado con estudios en jugadores sin DI. Las diferencias encontradas entre las posiciones de juego indicaron roles similares de los bases, aleros y pívots en jugadores con y sin DI. Estos descubrimientos son relevantes para entender el impacto de la DI sobre el rendimiento en baloncesto, lo cual es un paso necesario para el desarrollo de sistemas específicos de elegibilidad en baloncesto para personas con DI de acuerdo a las directrices del Comité Paralímpico Internacional

Working conditions and health in Central America: a survey of 12,024 workers in six countries.

OBJECTIVE: To describe the survey methodology and initial general findings of the first Central American Survey of Working Conditions and Health. METHODS: A representative sample of 12,024 workers was interviewed at home in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. Questionnaire items addressed worker demographics, employment conditions, occupational risk factors and self-perceived health. RESULTS: Overall, self-employment (37%) is the most frequent type of employment, 8% of employees lack a work contract and 74% of the workforce is not covered by social security. These percentages are higher in Guatemala, Honduras and El Salvador, and lower in Costa Rica, Panama and Nicaragua. A third of the workforce works more than 48 h per week, regardless of gender; this is similar across countries. Women and men report frequent or usual exposures to high ambient temperature (16% and 25%, respectively), dangerous tools and machinery (10%, 24%), work on slippery surfaces (10%, 23%), breathing chemicals (12.1%, 18%), handling toxic substances (5%, 12.1%), heavy loads (6%, 20%) and repetitive movements (43%, 49%). Two-thirds of the workforce perceive their health as being good or very good, and slightly more than half reports having good mental health. CONCLUSIONS: The survey offers, for the first time, comparable data on the work and health status of workers in the formal and informal economy in the six Spanish-speaking Central American countries, based on representative national samples. This provides a benchmark for future monitoring of employment and working conditions across countries.

Optimizing premedications in the prevention of bendamustine infusion-related reactions.

BACKGROUND: Bendamustine is indicated for the treatment of chronic lymphocytic leukemia (CLL) and rituximab refractory indolent non-Hodgkin lymphoma. Clinical trials have reported a 25% incidence of infusion-related reactions (IRRs) in patients receiving bendamustine. While these reactions are well documented, there is no consensus on the optimal premedication regimen for the prevention of these adverse effects. At our center, we utilize a regimen of ondansetron 16 mg orally and dexamethasone 10 mg IV push prior to each infusion of bendamustine. This report describes our experience with our current premedication regimen with regard to IRRs and the incidence of febrile neutropenia (FN). METHODS: We retrospectively analyzed 73 consecutive patients receiving bendamustine infusions at our institute from June 2008 to June 2010 to determine the incidence of IRRs and FN. The primary objective was to determine the incidence of IRRs. Secondary objectives included incidence of FN and hospital admission rate. RESULTS: A total of 478 infusions of bendamustine were administered to 73 consecutive patients. The median patient age was 69 years. IRRs affected 19% of our population, and 10.9% experienced FN. Notably, all IRRs were attributed to rituximab infusions and no patients experienced an IRR when receiving bendamustine alone. This compares favorably to the initial reported IRRs of 25% with bendamustine alone. CONCLUSIONS: Based on our experience with bendamustine, ondansetron and dexamethasone provide a safe and effective prevention of IRRs associated with bendamustine. By avoiding the use of other premedications, the likelihood of additional complications or adverse affects can be minimized.

Impact of IL28B polymorphisms on response to peginterferon and ribavirin in HIV­hepatitis C virus-coinfected patients with prior nonresponse or relapse.

IL28B polymorphisms predict treatment response in chronic hepatitis C. However, no information exists in prior treatment failures. A total of 62 HIV/hepatitis C virus (HCV) patients who completed retreatment with peginterferon-α/ribavirin were examined, of whom 25 (40%) had been cured. Predictors of response [odds ratio, OR (95% confidence interval, CI)] were HCV genotypes 2/3 [16.1 (2.7-90.9)], prior relapse [9.6 (1.5-62.4)] and ribavirin plasma trough concentrations at week 4 [4.9 (1.3-18.4)]. IL28B-CC only predicted response in prior nonresponders carrying HCV genotypes 1/4 [25.1 (1.9-337)].