The Medical Science Liaison Role in Spain: Opinion of the Commercial Department Personnel.

INTRODUCTION: The Medical Science Liaison (MSL) works in a cross-functional way, especially with the commercial department. The aim of the present study was to evaluate the knowledge of these positions about the MSL role in their companies and describe the grade of internal interaction between them in daily practice. METHODS: An online survey was completed by 151 employees from commercial departments between January and April 2020. It consisted of 29 or 31 items, depending on answers. RESULTS: Of participants, 22.5% and 77.5% occupied management or non-management positions, respectively. Most respondents stated that the MSL role belongs primarily to the medical department (94.6%), considered important that promotional materials are elaborated or supported by the medical department (95.4%), highlighted the importance of sharing their daily activity with MSLs (77.8%) and vice versa (89.3%). The most valuable activity of MSLs was clinical sessions (55.3%), followed by speaker briefings (16.0%), and data discussions (14.7%). Most useful activities of MSLs for participant's day to day were external training (sessions to healthcare providers, HCPs, 34.9%), support of key opinion leaders' (KOLs) unmet needs (22.1%), and feedback from fieldwork aimed at redefining new strategies of the company (15.4%). The mean overall assessment (0-10) of the MSL was 8.1. CONCLUSION: The MSL represents a key role inside pharmaceutical and biotechnological companies, providing scientific value. The members of the commercial departments interact with the MSL on a daily basis and consider that it is a strategic position with a great future that adds value within the company.

The Medical Science Liaison Role in Spain: A Survey Capturing the Opinion of Medical Department Professionals.

BACKGROUND: Literature that addresses the role of Medical Science Liaison (MSL) is currently limited. To the best of our knowledge, this is the first survey in Spain that gathers opinions from professionals whose work is either in or related to the medical departments from pharmaceutical companies. METHODS: A survey delivered by the SurveyMonkey online platform was completed by 101 pharmaceutical industry professionals (medical advisor/manager, 31.7%; medical director, 26.7%; medical information, 12.9%; and MSL manager, 11.9%). RESULTS: The median score for the global impression of the MSL was 8.7. The collaboration goes beyond formation since 85.1% of the respondents believed that MSLs should actively collaborate in both clinical trials and investigator-initiated studies, they should have more involvement with market access (51.5%), and they play an important role in compliance (94.0%). There was a tendency toward granting MSLs more responsibilities in terms of budget (73.3%) and their participation in the elaboration of the Medical Plan (91.1%). This position was considered as a strategic partner both internally and externally (76.2%). CONCLUSION: MSL is a well-known field-based profile with increasing importance and responsibilities. MSLs represent a strategic position as internal collaborators in the company, whose success relies on cross-functional work. The MSL's profile is in constant development, currently facing challenges such as adapting to remote interactions, or providing a clear definition with the best metrics to measure their performance as a non-promotional position.

Environmentally friendly, but behaviorally complex? A systematic review of e-scooter riders' psychosocial risk features.

INTRODUCTION: E-scooters have made a place for themselves on urban roads as an affordable, easy-to-use and environmentally friendly method of transportation. However, and partly because of their road behaviors and safety outcomes, e-scooter users have started to represent a focus of attention for transport planners and policymakers. AIM: The present systematic review aims to target and analyze the existing studies investigating the psychosocial characteristics of e-scooter riders, focusing on their behavioral and risk-related features. METHODS: For this systematic review, the PRISMA methodology was used, which allows for the selection of suitable papers based on the study topic, in accordance with a set of pre-defined criteria and a search algorithm. A total of 417 indexed articles were filtered, resulting in only 32 eligible original articles directly addressing the issue. WOS, Scopus, NCBI, Google Scholar, and APA databases were used to create and test search techniques. RESULTS: At the literature level, most of the existing studies are distributed in a few regions of the globe. At the user's level, results show how e-scooters are most commonly used by young, highly educated, urban-dwelling males, usually for short trips. In regard to road behavior, individuals with the lowest degrees of risk perception remain more prone to engaging in risky road behaviors likely to increase their crash involvement. This might be worsened by the lack of normative e-scooter regulations (and their enforcement) in many countries, plus the marked absence of road training processes. As common limitations, it can be mentioned that 87.5% of these studies used self-report methods, while 59.4% had local coverage. CONCLUSIONS: The findings of this systematic review endorse the growing need to develop and enforce traffic laws and training processes for e-scooter users. In addition, road safety education and training programs are highlighted by existing studies as potentially pertinent alternatives to increase risk perception, and reduce risky behaviors, road conflicts and crash likelihood among e-scooter riders.

Essential but also vulnerable? Work intensification, effort/reward imbalance, fatigue and psychological health of Spanish cargo drivers during the COVID-19 pandemic.

Objective: This study investigates the combined effect of the Effort/Reward Imbalance (ERI) model of stress and work intensification within the context of the COVID-19 pandemic on the psychological health (general and work-related fatigue, and psychological strain) of cargo drivers, one of the most demanded workforces during the first year of this pandemic. Methods: For this cross-sectional research, the data provided by n = 1,013 professional drivers from the different 17 autonomous communities (regions) of Spain were analyzed. Participants answered a questionnaire composed of the short version of the Effort Reward Imbalance (ERI) questionnaire, a Work Intensification Scale (WIS) designed for this study, the fatigue subscale of the Checklist Individual Strength (CIS), the Need for Recovery after Work Scale (NFR), and the General Health Questionnaire (GHQ). Results: Hierarchical regression analyses show that both (ERI and work intensification) models significantly predict driver's fatigue and psychological strain. The effect of work intensification exists above and beyond the effect of effort/reward imbalance, which has been previously related to the safety performance of cargo drivers. Conclusions: These findings suggest that the ERI and work intensification models can be complementarily used, especially in scenarios introducing substantial changes in the work environment, such as the COVID-19 crisis. Also, the results of this study support the need to intervene in the working conditions of professional drivers in order to improve their psychological health and well-being during both pandemic and post-pandemic times, as crisis-related management interventions are necessary to promote health and safety in professional drivers in potentially similar contexts in the future.

The medical science liaison role in Spain: A nationwide survey.

CONTEXT AND AIMS: The Medical Science Liaison's (MSL's) value to the company has evolved into a more strategic role with a wide variety of responsibilities. We conducted an online survey of current MSLs nationwide to assess their profile, activity development, performance evaluation, and career development. SUBJECTS AND METHODS: A 37-item survey was hosted on SurveyMonkey© and accessible from December 2018 to February 2019. The survey was open to current MSLs from different pharmaceutical companies in Spain and included questions about the participant profile, activity development, performance evaluation, and career development. STATISTICAL ANALYSIS USED: The results were expressed as valid percentages; to establish relationships between the answers to different questions, exclusion and comparison filters were used on the web platform. RESULTS: A total of 179 MSLs responded to the anonymous survey. Off-label information management (79%), relationships with key opinion leaders (76%), continuous medical training for HCPs (70%), involvement in clinical trials/investigator-initiated trials (68%), and elaboration of the National Strategy (67%) were mentioned as the top new competencies. Fifty-eight percent spend an average of 61%-80% of their time out in the field and 68% use remote interactions. Fifty-six percent did not agree that their current performance metrics are a reflection of their true value. Forty-five percent of the participants disagreed when asked if their activity is easily balanced with their personal lives. CONCLUSIONS: Based on our findings, we believe that there is a need to consider the MSL's strategic priorities, to define metrics that accurately assess MSL performance, and to find ways to fully maximize their limited time.

To what extent do our walking and cycling behaviours relate to each other, and do we cycle as well as we think we do? Piloting the walking and cycling behaviour questionnaires in the UK.

Greater uptake of active transport has been argued as necessary for the transport system to achieve relevant sustainability and public health goals; however, the research tools used to investigate behaviour when using these modes are far less well-developed than those used to investigate driving behaviour. This study takes two self-report behavioural measures, the Walking Behaviour Questionnaire (WBQ) and the Cycling Behaviour Questionnaire (WBQ), and pilots them in the UK. Exploratory and confirmatory factor analyses with data from 428 respondents revealed factor structures different to those described in the limited number of previous studies that used the CBQ and WBQ. Across both questionnaires, scales measuring intentional behaviour differed from original descriptions to a greater extent than did the scale concerning unintentional attention or memory errors. In addition to a validation exercise, this research explored the relationships between variables, finding a correlation between the reported performance of unintentional errors when walking and cycling. Looking in more detail at cycling behaviours, we found that those who rated themselves as more proficient cyclists also reported performing fewer unintentional cycling errors. Results also showed self-reported helmet use to bear little to no relationship with other self-reported cycling behaviours or self-rated cycling proficiency. Finally, using structural equation modelling, we demonstrated that responses to the CBQ add very little (over and above age, gender, and exposure to the road environment) to the explanation of self-reported past collision involvement. In total, only 7% of the variation in past collision involvement was explained by the included variables. We urge caution when using self-report behavioural measures that have not been validated in the context of intended use, and the importance of using such measures in combination with other approaches rather than in isolation when trying to develop an understanding of overall system performance.

The Medical Science Liaison Role in Spain: A Survey About the Opinion of HealthCare Professionals.

PURPOSE/AIM: There are limited studies addressing the knowledge of healthcare professionals (HCPs) on the Medical Science Liaison (MSL) role. The objective of this study was to determine the percentage of HCPs that know the role, and to describe their opinion about the utility of the MSL activities on their clinical practice. METHODS: An online survey was completed by 107 HCPs between June 2019 and January 2020 through three Scientific Societies. It consisted of 17 or 25 questions, depending on the answers. RESULTS: Most HCPs (73.8%) knew the MSL role inside the pharmaceutical industry and were able to differentiate the MSL role from others in marketing/sales departments (77.6%). Support for research projects (70.8%) and training courses (68.1%) were the most valuable activities. Participants scored the credibility of data provided by the MSL with a mean of 7.5 (out of 10), and the added value that the MSL provides to their clinical practice with a mean of 6.9. Among HCPs unfamiliar with the role (26.2%), 60% of them are interested in meeting with the local MSL. CONCLUSION: Our study demonstrates that the MSL role is well-known by HCPs, mostly Key Opinion Leaders, and they agree on the importance of working together in scientific projects on, e.g., disease awareness, medical training, or clinical trials. Given the advance of targeted therapies and the move toward personalized medicine, the MSL role will be in more demand and necessary for HCPs in the years to come.

[Parental perceptions of increased child-to-parent violence of Spanish adolescents during covid-19 lockdown.] / Percepciones parentales de incremento de violencia filioparental de los adolescentes españoles durante el confinamiento por COVID-19.

OBJECTIVE: Internationally, there was a warning of the risk of increased domestic violence during lockdown due to the COVID-19 pandemic, including child-to-parent violence. The objective of our study was to assess the prevalence of different violent behaviors from children to parents during pre-lockdown, lockdown and immediately after, between March 14 and June 20, 2020, and to assess differences in behaviors between pre-lockdown and lockdown and between pre-lockdown and post-lockdown. METHODS: The researchers developed a survey with closed questions about different violent behaviors of the children (poor responses, insults and physical aggression). This was distributed with the CAWI methodology during the months of August and September 2020 to a sample of Spanish parents stratified by autonomous communities. 1,500 families with 1,927 adolescents aged 12 to 18 years participated. The frequency of responses obtained between the pre-lockdown and lockdown and between pre-lockdown and post-lockdown was compared through the Mac Nemar test for comparison of related samples. RESULTS: The prevalences of poor responses, insults and aggressions in a pre-lockdown setting were 30.1%, 3.8% and 0.6%, respectively. Poor responses and insults increased significantly between pre-lockdown and lockdown (p<0.001) and between pre-lockdown and post-lockdown (p<0.001) in all autonomous communities, age groups, genders, occupation type of the adolescent and type of household. No statistically significant differences were found in physical aggression for the periods evaluated. Single-parent families, adolescents residing in subsidized housing and those without an occupation or education ("NEET") exhibited more violent behavior in the three periods. CONCLUSIONS: Lockdown led to an increase in nonphysical violent behaviors, which were maintained to the end, warning of the potentially persistent risks of lockdown in this age group, especially in vulnerable families.

OBJETIVO: A nivel internacional se alertó de riesgo de aumento de violencia doméstica, durante el confinamiento debido a la pandemia por COVID-19, incluyendo violencia filioparental. El objetivo de nuestro estudio fue valorar la prevalencia de diferentes conductas violentas de hijos adolescentes a padres en los periodos pre-confinamiento, confinamiento e inmediatamente después del confinamiento producido entre el 14 de marzo y el 20 de junio de 2020, y valorar diferencias en las conductas entre pre y confinamiento, y entre pre y post-confinamiento. METODOS: Los investigadores elaboraron una encuesta con preguntas cerradas acerca de diferentes conductas violentas (malas respuestas, insultos y agresión física) de los hijos. Esta fue distribuida con metodología CAWI durante los meses de agosto y septiembre de 2020 a una muestra de padres españoles estratificada por comunidades autónomas. Participaron 1.500 familias con 1.927 hijos entre 14 y 18 años. Se comparó la frecuencia de respuestas obtenidas entre el momento pre-confinamiento y durante el confinamiento, y entre pre y post confinamiento, a través de la prueba de Mc Nemar para comparación de muestras relacionadas. RESULTADOS: Las prevalencias encontradas de malas respuestas, insultos y agresiones en situación previa al confinamiento fueron del 30,1%, 3,8% y 0,6% respectivamente. Las malas respuestas e insultos aumentaron de forma altamente significativa entre el pre y el confinamiento (p<0,001), y entre el pre y post-confinamiento (p<0,001), en todas las comunidades autónomas, franjas de edad, sexo, tipo de ocupación del adolescente y tipo de vivienda. No se hallaron diferencias estadísticamente significativas en las agresiones físicas en los periodos evaluados. Las familias monoparentales, los adolescentes residentes en viviendas cedidas y aquellos sin ocupación ni estudios ("ninis") presentaban valores porcentualmente más elevados de conductas violentas en los tres periodos. CONCLUSIONES: El confinamiento supuso un incremento de conductas violentas no físicas, que se mantuvieron al cesar el mismo, alertando de los riesgos del confinamiento en esta franja de edad, potencialmente persistente, en especial en familias vulnerables.

A Novel Circulating MicroRNA for the Detection of Acute Myocarditis.

BACKGROUND: The diagnosis of acute myocarditis typically requires either endomyocardial biopsy (which is invasive) or cardiovascular magnetic resonance imaging (which is not universally available). Additional approaches to diagnosis are desirable. We sought to identify a novel microRNA for the diagnosis of acute myocarditis. METHODS: To identify a microRNA specific for myocarditis, we performed microRNA microarray analyses and quantitative polymerase-chain-reaction (qPCR) assays in sorted CD4+ T cells and type 17 helper T (Th17) cells after inducing experimental autoimmune myocarditis or myocardial infarction in mice. We also performed qPCR in samples from coxsackievirus-induced myocarditis in mice. We then identified the human homologue for this microRNA and compared its expression in plasma obtained from patients with acute myocarditis with the expression in various controls. RESULTS: We confirmed that Th17 cells, which are characterized by the production of interleukin-17, are a characteristic feature of myocardial injury in the acute phase of myocarditis. The microRNA mmu-miR-721 was synthesized by Th17 cells and was present in the plasma of mice with acute autoimmune or viral myocarditis but not in those with acute myocardial infarction. The human homologue, designated hsa-miR-Chr8:96, was identified in four independent cohorts of patients with myocarditis. The area under the receiver-operating-characteristic curve for this novel microRNA for distinguishing patients with acute myocarditis from those with myocardial infarction was 0.927 (95% confidence interval, 0.879 to 0.975). The microRNA retained its diagnostic value in models after adjustment for age, sex, ejection fraction, and serum troponin level. CONCLUSIONS: After identifying a novel microRNA in mice and humans with myocarditis, we found that the human homologue (hsa-miR-Chr8:96) could be used to distinguish patients with myocarditis from those with myocardial infarction. (Funded by the Spanish Ministry of Science and Innovation and others.).

COVID GEAS: COVID-19 National Survey in Patients With Systemic Autoimmune Diseases.

OBJECTIVES: COVID-19 outcomes in population with systemic autoimmune diseases (SAD) remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 infection in people with rheumatic disease. METHODS: Two phases cross-sectional survey of individuals with rheumatic disease in April 2020 and October 2020. COVID infection, severity of disease, age, sex, smoking status, underlying rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analyzed. RESULTS: A total of 1,529 individuals with autoimmunity disease diagnosis were included. Out of 50 positive patients, 21 required telephone medical assistance, 16 received assessment by primary care physician, 9 were evaluated in Emergency Department and 4 patient required hospitalization. Multivariate analysis was performed without obtaining differences in any of the systemic autoimmune diseases. Regarding the treatments, significant differences were found (p 0.011) in the treatment with anti-TNF-alpha agents with OR 3.422 (1.322-8.858) and a trend to significance (p 0.094) was observed in patients receiving mycophenolate treatment [OR 2.016 (0.996-4-081)]. CONCLUSIONS: Anti-TNF-alpha treatment was associated with more than 3-fold risk of suffering from SARS-CoV-2 infection, although in all cases infection was mild. Cumulative incidence in patients with SAD was up to 5 times higher than general population but with great differences between autoimmune diseases.

Lifetime Victimization in Children and Adolescents With ADHD.

The objective of this study is to describe the frequency and type of victimization in a Spanish child and adolescent clinical ADHD sample and to analyze the association between the types of victimization and the severity of the symptoms. The sample is composed of 106 outpatients in treatment for ADHD, according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Symptom severity was measured by the Conners-3 scales. ADHD and comorbid diagnostics were evaluated with the Mini-Kid interview. The victimization experiences were studied using the Juvenile Victimization Questionnaire (JVQ). Children with child maltreatment history showed a greater intensity of hyperactivity/impulsivity, aggression and behavioral disorders as well as depression and anxiety disorders. The presence of peer victimization was associated with inattention, learning disorders, executive functioning, and relationship problems. Episodes of victimization should be considered in the treatment of the ADHD. Child maltreatment history is more associated with hyperactivity-impulsivity symptoms, while peer victimization is more associated with attentional symptoms.

Emotional regulation for adolescents: a group-based treatment pilot study through the STEPPS programme.

BACKGROUND: Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits. AIMS: To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13-17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain. METHOD: We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale. RESULTS: There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients. CONCLUSION: Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.

Behavioral Health at School: Do Three Competences in Road Safety Education Impact the Protective Road Behaviors of Spanish Children?

Background: Education in road safety (also known as Road Safety Education-RSE) constitutes, nowadays, an emergent approach for improving present and future road behaviors, aiming at taking action against the current, and concerning, state-of-affairs of traffic crashes, through a behavioral perspective. In the case of children, and despite their overrepresentation in traffic injury figures, RSE-based strategies for behavioral health in transportation remain a "new" approach, whose impact still needs to be empirically tested. Objective: The aim of this study is to assess the impact of three key road safety skills of the Positive Attitudes, Risk perception and Knowledge of norms (PARK) model, addressed in RSE-based interventions, on the safe road behavior of Spanish children. Methods: For this cross-sectional study, a representative sample of 1930 (50.4% males and 49.6% females) Spanish children attending primary school, with a mean age of 10.1 (SD = 1.6) years, was gathered from 70 educational centers across all Spanish regions, through a national study on RSE and road safety. Results: Road safety skills show a positive relationship with children's self-reported safe behaviors on the road. However, the knowledge of traffic norms alone does not predict safe behaviors: it needs to be combined with risk perception and positive attitudes towards road safety. Furthermore, the degree of exposure to previous RSE interventions was shown to have an effect on the score obtained by children in each road safety skill; on the other hand, road misbehaviors observed in parents and peers had a negative impact on them. Conclusion: The outcomes of this study suggest that education in road safety is still a key process for the acquisition of safe habits, patterns and behaviors among young road users.

Job stress and emotional exhaustion at work in Spanish workers: Does unhealthy work affect the decision to drive?

OBJECTIVES: The purpose of this study was to assess the relationships among the following elements: unhealthy work indicators (job stress and emotional exhaustion at work), the decision to drive (or not), and driving crashes suffered by Spanish workers. METHODS: For this cross-sectional study, a full sample of 1,200 Spanish drivers (44% women and 56% men) was used, their mean age being 42.8 years. They answered a questionnaire divided into three sections: demographic and driving-related data; burnout, job stress, and life stress; and self-reported road behaviors and driving safety indicators. RESULTS: Overall, 41.6% of drivers reported emotional exhaustion at work. Furthermore, 80.2% of the participants showing substantial signs of job stress or exhaustion had experienced one or more important stressful life events during the previous year. Job stress was associated with the number of driving crashes suffered along the last 3 years. Also, and especially in situations where drivers admit not feeling well enough to drive, job stress and emotional exhaustion seem to be independent from the decision to drive, and from perceiving these variables as potential impairers of driving performance. CONCLUSIONS: First of all, this study showed a high prevalence of job stress and emotional exhaustion symptoms experienced at work by Spanish workers. Moreover, significant relationships were found among self-rated driving performance, workplace stress and burnout indicators, which suggests that job stress and emotional exhaustion levels may, indeed, impair driving performance, but they do not influence the decision to drive or not. In other words, even when they are significantly affected by job stress or emotional exhaustion at work, most Spanish drivers still drive.

Immune-Regulatory Molecule CD69 Controls Peritoneal Fibrosis.

Patients with ESRD undergoing peritoneal dialysis develop progressive peritoneal fibrosis, which may lead to technique failure. Recent data point to Th17-mediated inflammation as a key contributor in peritoneal damage. The leukocyte antigen CD69 modulates the setting and progression of autoimmune and inflammatory diseases by controlling the balance between Th17 and regulatory T cells (Tregs). However, the relevance of CD69 in tissue fibrosis remains largely unknown. Thus, we explored the role of CD69 in fibroproliferative responses using a mouse model of peritoneal fibrosis induced by dialysis fluid exposure under either normal or uremic status. We found that cd69-/- mice compared with wild-type (WT) mice showed enhanced fibrosis, mesothelial to mesenchymal transition, IL-17 production, and Th17 cell infiltration in response to dialysis fluid treatment. Uremia contributed partially to peritoneal inflammatory and fibrotic responses. Additionally, antibody-mediated CD69 blockade in WT mice mimicked the fibrotic response of cd69-/- mice. Finally, IL-17 blockade in cd69-/- mice decreased peritoneal fibrosis to the WT levels, and mixed bone marrow from cd69-/- and Rag2-/-γc-/- mice transplanted into WT mice reproduced the severity of the response to dialysis fluid observed in cd69-/- mice, showing that CD69 exerts its regulatory function within the lymphocyte compartment. Overall, our results indicate that CD69 controls tissue fibrosis by regulating Th17-mediated inflammation.

Immunosuppression-Independent Role of Regulatory T Cells against Hypertension-Driven Renal Dysfunctions.

Hypertension-associated cardiorenal diseases represent one of the heaviest burdens for current health systems. In addition to hemodynamic damage, recent results have revealed that hematopoietic cells contribute to the development of these diseases by generating proinflammatory and profibrotic environments in the heart and kidney. However, the cell subtypes involved remain poorly characterized. Here we report that CD39(+) regulatory T (TREG) cells utilize an immunosuppression-independent mechanism to counteract renal and possibly cardiac damage during angiotensin II (AngII)-dependent hypertension. This mechanism relies on the direct apoptosis of tissue-resident neutrophils by the ecto-ATP diphosphohydrolase activity of CD39. In agreement with this, experimental and genetic alterations in TREG/TH cell ratios have a direct impact on tissue-resident neutrophil numbers, cardiomyocyte hypertrophy, cardiorenal fibrosis, and, to a lesser extent, arterial pressure elevation during AngII-driven hypertension. These results indicate that TREG cells constitute a first protective barrier against hypertension-driven tissue fibrosis and, in addition, suggest new therapeutic avenues to prevent hypertension-linked cardiorenal diseases.

Importancia de la detección del trastorno por déficit de atención/hiperactividad en el adulto / Importance of screening attention deficit hyperactivity disorder in adults

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Maintenance of immune tolerance by Foxp3+ regulatory T cells requires CD69 expression.

Although FoxP3(+) regulatory T cells are key players in the maintenance of immune tolerance and autoimmunity, the lack of specific markers constitute an obstacle to their use for immunotherapy protocols. In this study, we have investigated the role of the C-type lectin receptor CD69 in the suppressor function of Tregs and maintenance of immune tolerance towards harmless inhaled antigens. We identified a novel FoxP3(+)CD69(+) Treg subset capable to maintain immune tolerance and protect to developing inflammation. Although CD69(+) and CD69(-)FoxP3(+) Tregs exist in homeostasis, only CD69-expressing Tregs express high levels of CTLA-4, ICOS, CD38 and GITR suppression-associated markers, secrete high amounts of TGFß and have potent suppressor activity. This activity is regulated by STAT5 and ERK signaling pathways and is impaired by antibody-mediated down-regulation of CD69 expression. Moreover, immunotherapy with FoxP3(+)CD69(+) Tregs restores the homeostasis in Cd69(-/-) mice, that fail to induce tolerance, and is also highly proficient in the prevention of inflammation. The identification of the FoxP3(+)CD69(+) Treg subset paves the way toward the development of new therapeutic strategies to control immune homeostasis and autoimmunity.

Do firstborn children have an increased risk of ADHD?

OBJECTIVE: Although previous reports have found no birth-order influence on ADHD risk, the authors hypothesize that being the firstborn is a risk factor for developing ADHD. METHOD: They selected all of the currently treated ADHD outpatients (n = 748) from our database. Families with adopted sons, nonnuclear families, and families with only one child and with sons (affected or unaffected) younger than 6 or older than 18 years were excluded. A total of 181 families with 213 ADHD sons met the inclusion criteria. We used all siblings without a clinical diagnosis of ADHD and who had no contact with our service as our unaffected controls (n = 173). RESULTS: The bivariate analysis showed that ADHD was associated with birth order and that firstborn children had nearly twice the ADHD risk of children with other birth orders. CONCLUSION: birth order can be an ADHD risk factor in clinical samples.