Erradicación de la poliomielitis en España: ¿qué ha pasado en la última década? / Eradication of poliomyelitis in Spain: What has happened in the last decade?

Al cumplirse sesenta años desde el inicio de la campaña de vacunación frente a la poliomielitis en España, se destaca el importante hito en el control de la enfermedad que ha supuesto el cambio desde una incidencia de más de 2.000 casos anuales en la década de los 60 a una ausencia mantenida de poliovirus (PV) salvaje desde 1988. A pesar del impacto negativo observado en las coberturas de vacunación de poliomielitis al inicio de la pandemia de COVID-19, estas se fueron recuperando, alcanzando un 98,2% en la primovacunación en 2022. En la última década, se han identificado dos elementos esenciales para mantener el objetivo de eliminación de la poliomielitis y que, además, refuerzan la importancia de mantener altas coberturas de vacunación: los sistemas de vigilancia epidemiológica robustos y la respuesta rápida a las alertas para proteger a la población vulnerable y evitar la circulación del virus. Es crucial interrumpir la transmisión a nivel internacional para lograr la erradicación, manteniendo una vigilancia continua de alta calidad y una coordinación efectiva entre los diferentes niveles frente a cualquier detección de PV, ya sea salvaje o derivado de la vacuna.(AU)

On the 60th anniversary of the initiation of the polio vaccination campaign in Spain, the significant milestone in achieving disease control is highlighted. There has been a shift from an incidence of over 2,000 yearly cases in the 1960s to a sustained absence of wild poliovirus (WPV) since 1988. Despite the observed negative impact on polio vaccination coverage at the onset of the COVID-19 pan-demic, these rates gradually recovered, reaching 98.2% in primary vaccination in 2022. Over the past decade, two essential elements have been identified to maintain the goal of polio elimination and that reinforces the importance of sustaining high vaccination co-verage: robust epidemiological surveillance systems and a swift response to alerts to protect the vulnerable population and prevent virus reintroduction. In order to achieve eradication, it is crucial to interrupt international transmission and maintain continuous high-quality surveillance and effective coordination across different levels in response to any detection of PV, wild or vaccine derived.This article aimed to provide a comprehensive view of the polio eradication situation in Spain, focusing on the key events that occu-rred in the last decade and the present and future challenges.(AU)

[Eradication of poliomyelitis in Spain: What has happened in the last decade?] / Erradicación de la poliomielitis en España: ¿qué ha pasado en la última década?

On the 60th anniversary of the initiation of the polio vaccination campaign in Spain, the significant milestone in achieving disease control is highlighted. There has been a shift from an incidence of over 2,000 yearly cases in the 1960s to a sustained absence of wild poliovirus (WPV) since 1988. Despite the observed negative impact on polio vaccination coverage at the onset of the COVID-19 pandemic, these rates gradually recovered, reaching 98.2% in primary vaccination in 2022. Over the past decade, two essential elements have been identified to maintain the goal of polio elimination and that reinforces the importance of sustaining high vaccination coverage: robust epidemiological surveillance systems and a swift response to alerts to protect the vulnerable population and prevent virus reintroduction. In order to achieve eradication, it is crucial to interrupt international transmission and maintain continuous high-quality surveillance and effective coordination across different levels in response to any detection of PV, wild or vaccine derived. This article aimed to provide a comprehensive view of the polio eradication situation in Spain, focusing on the key events that occurred in the last decade and the present and future challenges.

hito en el control de la enfermedad que ha supuesto el cambio desde una incidencia de más de 2.000 casos anuales en la década de los 60 a una ausencia mantenida de poliovirus (PV) salvaje desde 1988. A pesar del impacto negativo observado en las coberturas de vacunación de poliomielitis al inicio de la pandemia de la COVID-19, estas se fueron recuperando, alcanzando un 98,2% en la primovacunación en 2022. En la última década se han identificado dos elementos esenciales para mantener el objetivo de eliminación de la poliomielitis y que, además, refuerzan la importancia de mantener altas coberturas de vacunación: los sistemas de vigilancia epidemiológica robustos y la respuesta rápida a las alertas para proteger a la población vulnerable y evitar la circulación del virus. Es crucial interrumpir la transmisión a nivel internacional para lograr la erradicación, manteniendo una vigilancia continua de alta calidad y una coordinación efectiva entre los diferentes niveles frente a cualquier detección de PV, ya sea salvaje o derivado de la vacuna. Este artículo tuvo como objetivo proporcionar una visión integral sobre la situación de erradicación de la poliomielitis en España, centrándose en los eventos clave ocurridos en la última década y en los retos presentes y futuros.

Case report: Self-administration of alpha-1 antitrypsin therapy: a report of two cases.

Intravenous augmentation therapy with human alpha-1 proteinase inhibitor for the management of respiratory disease is recommended for people with alpha-1 antitrypsin deficiency (AATD) who are nonsmokers or former smokers. Augmentation therapy usually requires weekly administration at the hospital or clinic and poses an additional burden for patients due to interference with daily life, including work and social activities. Self-administration is a useful alternative to overcome this limitation, but there is a lack of published information on clinical outcomes. We report two cases of individuals with AATD at different stages of the disease who were successfully managed with self-administered augmentation therapy, with increased satisfaction because of the independence gained, lack of interference with clinical stability, and no relevant safety issues.

Beyond the Task List: A Proposed Integration of Naturalistic Developmental Behavioral Interventions to BCBA Training.

Naturalistic developmental behavioral intervention (NDBI) is firmly rooted in both the science of ABA as well as developmental science. Research indicates that many practicing board certified behavior analysts (BCBAs) are unfamiliar with NDBI models and do not implement these approaches when working with young autistic children (Hampton and Sandbank Autism, 26(4), 875-888, 2022). In this article we align NDBI to the seven dimensions of ABA, describe their compatibility with the ABA service system, and urge community agencies and insurance funders to support NDBI use. Finally, we provide a roadmap for BCBAs who provide behavior analytic intervention to young autistic children and for Verified Course Sequence faculty to effectively align the 6th edition BCBA Test Content Outline with the principles and application of NDBI.

Actualización del coste de vacunar a lo largo de toda la vida en España para el año 2023 / Updated cost of vaccinating throughout life in Spain in 2023

Fundamentos: en el calendario de vacunación a lo largo de toda la vida del consejo interterritorial del sistema nacional de Salud (cisns) se introdujeron cuatro modificaciones importantes en 2023. El objetivo de este estudio fue estimar el coste de la vacuNación a lo largo de toda la vida a una persona sana y a ciertos grupos de riesgo tomando como referencia el calendario de 2023 yCompararlo con una estimación previa de 2019. Métodos: se realizo un estudio descriptivo del coste de administrar las vacunas incluidas en el calendario de vacunación a lo Largo de toda la vida para el año 2023 y en el calendario para grupos de riesgo.Resultados: el coste estimado de vacunar a una persona sana a lo largo de toda la vida en 2023 es de 1.541,56 euros en mujeres Y 1.498,18 euros en hombres, lo que supondría un incremento del 125% con respecto al coste en 2019. Las condiciones de riesgo con El coste más alto son asplenia además de déficit del complemento e inmunodeficiencias primarias, suponiendo 3.159.82 euros y 2.566Euros, respectivamente, de media. Vacunar a toda la población sana en españa en un año costaría unos 565 millones de euros y Vacunar a la cohorte de recién nacidos de 2023 a lo largo de toda la vida unos 500 millones de euros.Conclusiones: a pesar del incremento en el coste en 2023, considerando el impacto económico de las enfermedades prevenibles por vacunación en la sociedad, la vacunación sigue siendo una intervención barata que aporta múltiples beneficios.(AU)

Background: four modifications were introduced in the lifetime vaccination schedule of the interterritorial council of the National health system (cisns) in 2023. the aim of this study was to estimate the cost of vaccinating a healthy person and people with Certain risk conditions throughout life in spain and to compare with a previous estimation from 2019.Methods: a descriptive study of the cost of administering the vaccines included in the lifetime vaccination schedule for the year 2023 and in the schedule for risk groups was carried out. Results: the estimated cost to immunize a healthy person throughout life in 2023 is 1,541.56€ for a woman and 1,498.18€ for a Men, which corresponds to an increase of 125% compared to the cost in 2019. The risk conditions with the highest cost are asplenia And complement deficiency and primary immunodeficiencies, with a cost of 3,159.82 euros and 2,566 euros respectively on average. The cost of vaccinating the whole healthy population in spain in a year is around 565m€. Moreover, the cost of vaccinating the New-borns cohort of 2023 was estimated at 500m€. Conclusions: despite the cost increase in 2023, immunization is still a very cheap intervention, considering the economic Impact of immunopreventable diseases in the society. The relative low cost of immunization throughout life makes this health inter-vention useful and worthwhile.(AU)

Two murine models of sepsis: immunopathological differences between the sexes-possible role of TGFß1 in female resistance to endotoxemia.

Endotoxic shock (ExSh) and cecal ligature and puncture (CLP) are models that induce sepsis. In this work, we investigated early immunologic and histopathologic changes induced by ExSh or CLP models in female and male mice. Remarkable results showed that females supported twice the LD100 of LPS for males, CLP survival and CFU counts were similar between genders, high circulating LPS levels in ExSh mice and low levels of IgM anti-LPS in males. In the serum of ExSh males, TNF and IL-6 increased in the first 6 h, in CLP males at 12 h. In the liver of ExSh mice, TNF increased at 1.5 and 12 h, IL-1 at 6 h. TGFß1 increased in females throughout the study and at 12 h in males. In CLP mice, IL-6 decreased at 12 h, TGFß1 increased at 6-12 h in males and at 12 h in females. In the lungs of ExSh males, IL-1ß increased at 1.5-6 h and TGFß1 at 12 h; in females, TNF decrease at 6 h and TGFß1 increased from 6 h; in CLP females, TNF and IL-1ß decreased at 12 h and 1.5 h, respectively, and TGFß1 increased from 6 h; in males, TGFß1 increased at 12 h. In the livers of ExSh mice, signs of inflammation were more common in males; in the CLP groups, inflammation was similar but less pronounced. ExSh females had leucocytes with TGFß1. The lungs of ExSh males showed patches of hyaline membranes and some areas of inflammatory cells, similar but fewer and smaller lesions were seen in male mice with CLP. In ExSh females, injuries were less extent than in males, similar pulmonary lesions were seen in female mice with CLP. ExSh males had lower levels of TGFß1 than females, and even lower levels were seen in CLP males. We conclude that the ExSh was the most lethal model in males, associated with high levels of free LPS, low IgM anti-LPS, exacerbated inflammation and target organ injury, while females showed early TGFß1 production in the lungs and less tissue damage. We didn't see any differences between CLP mice.

Bacterial incidence and drug resistance from pathogens recovered from blood, cerebrospinal and pleural fluids in 2019-2020. Results of the Invifar network.

Background: Antimicrobial resistance is a global concern. Analysis of sterile fluids is essential because microorganisms are defined as significant in most cases. Blood, cerebrospinal, and pleural fluids are frequently received in the microbiology lab because they are associated with considerable rates of morbi-mortality. Knowledge of epidemiology in these samples is needed to choose proper empirical treatments due to the importance of reducing selection pressure. Methods: We used retrospective laboratory data of blood, CSF, and pleural fluid collected from patients in Mexico between 2019 and 2020. Each laboratory identified the strains and tested susceptibility using its routine methods. For Streptococcus pneumoniae, a comparative analysis was performed with data from the broth microdilution method. Results: Forty-five centers participated in the study, with 30,746 clinical isolates from blood, 2,429 from pleural fluid, and 2,275 from CSF. For blood and CSF, Staphylococcus epidermidis was the most frequent. For blood, among gram negatives, the most frequent was Escherichia coli. Among Enterobacterales, 9.8% of K. pneumoniae were carbapenem-resistant. For S. pneumoniae, similar resistance percentages were observed for levofloxacin, cefotaxime, and vancomycin. For CSF, the most frequent gram-negative was E. coli. In Acinetobacter baumannii, carbapenem resistance was 71.4%. The most frequent species detected for pleural fluid was E. coli; in A. baumannii, carbapenem resistance was 96.3%. Conclusion: Gram-negative bacteria, with E. coli most prevalent, are frequently recovered from CSF, blood, and pleural fluid. In S. pneumoniae, the routine, conventional methods showed good agreement in detecting resistance percentages for erythromycin, levofloxacin, and vancomycin.

Toward deeper understanding and wide-scale implementation of naturalistic developmental behavioral interventions.

LAY ABSTRACT: Naturalistic Developmental Behavioral Interventions (NDBIs) are a group of early interventions that use a variety of strategies from applied behavioral and developmental sciences. Although Naturalistic Developmental Behavioral Interventions have been demonstrated effective, Naturalistic Developmental Behavioral Interventions are not implemented on a wide scale within early intervention programs for children on the autism spectrum. Potential reasons likely stem from differing theoretical orientations of developmental and behavioral sciences and practitioners' lack training, knowledge, and support for implementing Naturalistic Developmental Behavioral Interventions. In support of efforts to promote wide-scale implementation of Naturalistic Developmental Behavioral Interventions, we (1) clarify their common features, (2) discuss possible misconceptions, and (3) offer reasons why Naturalistic Developmental Behavioral Interventions should be widely implemented. We also provide recommendations to the autism service community, intervention developers, and researchers.

[Updated cost of vaccinating throughout life in Spain in 2023]. / Actualización del coste de vacunar a lo largo de toda la vida en España para el año 2023.

OBJECTIVE: Four modifications were introduced in the Lifetime Vaccination Schedule of the Interterritorial Council of the National Health System (CISNS) in 2023.The aim of this study was to estimate the cost of vaccinating a healthy person and people with certain risk conditions throughout life in Spain and to compare with a previous estimation from 2019. METHODS: A descriptive study of the cost of administering the vaccines included in the Lifetime Vaccination Schedule for the year 2023 and in the schedule for risk groups was carried out. RESULTS: The estimated cost to immunize a healthy person throughout life in 2023 is 1,541.56€ for a woman and 1,498.18€ for a men, which corresponds to an increase of 125% compared to the cost in 2019. The risk conditions with the highest cost are asplenia and complement deficiency and primary immunodeficiencies, with a cost of 3,159.82 euros and 2,566 euros respectively on average. The cost of vaccinating the whole healthy population in Spain in a year is around 565M€. Moreover, the cost of vaccinating the new-borns cohort of 2023 was estimated at 500M€. CONCLUSIONS: Despite the cost increase in 2023, immunization is still a very cheap intervention, considering the economic impact of immunopreventable diseases in the society. The relative low cost of immunization throughout life makes this health intervention useful and worthwhile.

OBJECTIVE: En el calendario de vacunación a lo largo de toda la vida del Consejo Interterritorial del Sistema Nacional de Salud (CISNS) se introdujeron cuatro modificaciones importantes en 2023. El objetivo de este estudio fue estimar el coste de la vacunación a lo largo de toda la vida a una persona sana y a ciertos grupos de riesgo tomando como referencia el calendario de 2023 y compararlo con una estimación previa de 2019. METHODS: Se realizo un estudio descriptivo del coste de administrar las vacunas incluidas en el calendario de vacunación a lo largo de toda la vida para el año 2023 y en el calendario para grupos de riesgo. RESULTS: El coste estimado de vacunar a una persona sana a lo largo de toda la vida en 2023 es de 1.541,56 euros en mujeres y 1.498,18 euros en hombres, lo que supondría un incremento del 125% con respecto al coste en 2019. Las condiciones de riesgo con el coste más alto son asplenia además de déficit del complemento e inmunodeficiencias primarias, suponiendo 3.159.82 euros y 2.566 euros, respectivamente, de media. Vacunar a toda la población sana en España en un año costaría unos 565 millones de euros y vacunar a la cohorte de recién nacidos de 2023 a lo largo de toda la vida unos 500 millones de euros. CONCLUSIONS: A pesar del incremento en el coste en 2023, considerando el impacto económico de las enfermedades prevenibles por vacunación en la sociedad, la vacunación sigue siendo una intervención barata que aporta múltiples beneficios.

Prevalence of High Blood Pressure in Pediatric Patients with Sleep-Disordered Breathing, Reversibility after Treatment: The KIDS TRIAL Study Protocol.

Current data support an increase in the prevalence of high blood pressure (HBP) in pediatric patients with sleep-disordered breathing (SDB). Adeno-tonsillectomy has been shown to be an effective treatment for most patients. Our objective was to determine the prevalence of HBP in pediatric patients with SDB and the impact of adeno-tonsillectomy with a multicenter, longitudinal, and prospective study that included 286 children referred for suspected SDB. The diagnosis of SDB was established by polysomnography (PSG) and the diagnosis of HBP by 24-h ambulatory blood pressure monitoring (ABPM). In patients without SDB and SDB without treatment indication, these tests were repeated six months after the baseline visit. For patients with medical treatment for SDB, the tests were repeated six months after the treatment initiation. Finally, in patients with surgery indication, ABPM was performed just before surgical treatment and ABPM and PSG six months after the intervention. The study contributes to elucidating the association between SDB and HBP in pediatric patients. Moreover, it contributes to determining if intervention with adeno-tonsillectomy is associated with BP reduction. The results have direct implications for the management of SDB, providing essential information on treatment indications for existing clinical guidelines. NCT03696654.

[Non-inferiority studies efficacy and safety: review of methodological and statistical aspects in clinical trials and non-interventional studies with medicinal products.] / Estudios de no inferioridad de eficacia y seguridad: revisión e interpretación de aspectos metodológicos y estadísticos en ensayos clínicos y estudios observacionales con medicamentos.

Non-inferiority studies are increasingly more common for introducing new medicines in the market. Despite being situations where the use of this study design is justified, there is not a common analytical approach on how to conduct them. Pursuing a rigorous methodology, both in the study conduction and in its disseminations, is critical to ensure robust results to enable regulatory agencies and clinicians to reach valid conclusions and decisions which ultimately will benefit clinical practice. Most of the published reviews focus on the efficacy outcomes of non-inferiority clinical trials. We are unaware of other reviews that goes beyond and includes specific aspects for non-interventional designs and for studies focused on safety. Moreover, this review provides a simple and practical perspective with a minimum mathematical content on this complex type of studies.

Los estudios de no inferioridad son cada vez más frecuentes para introducir nuevos medicamentos en el mercado. Aunque existen situaciones en las que su uso está justificado, no existe un enfoque analítico único y conservador. Para arrojar resultados fiables y de calidad, deben seguir una estricta metodología, tanto en la ejecución como en la difusión de los resultados, la cual permita, tanto a las agencias reguladoras como a los clínicos, establecer conclusiones válidas y decisiones que repercutan en beneficio de la práctica clínica. La mayor parte de las revisiones publicadas se centran en los ensayos clínicos de no inferioridad de eficacia. En esta revisión se contemplan, además, los diseños observacionales y los aspectos específicos de los estudios de seguridad. Todo ello desde un punto de vista práctico y sencillo, con un contenido matemático mínimo.

Estudios de no inferioridadde eficacia y seguridad: revisión e interpretación de aspectosmetodológicos y estadísticosen ensayos clínicos y estudiosobservacionales con medicamentos / Non-inferiority studies efficacy and safety: review of methodological and statistical aspects in clinical trials and non-interventional studies with medicinal products

Los estudios de no inferioridad son cada vez más frecuentes para introducir nuevos medicamentos en el mercado. Aunque existensituaciones en las que su uso está justificado, no existe un enfoque analítico único y conservador. Para arrojar resultados fiables y decalidad, deben seguir una estricta metodología, tanto en la ejecución como en la difusión de los resultados, la cual permita, tanto alas agencias reguladoras como a los clínicos, establecer conclusiones válidas y decisiones que repercutan en beneficio de la prácticaclínica. La mayor parte de las revisiones publicadas se centran en los ensayos clínicos de no inferioridad de eficacia. En esta revisiónse contemplan, además, los diseños observacionales y los aspectos específicos de los estudios de seguridad. Todo ello desde unpunto de vista práctico y sencillo, con un contenido matemático mínimo.(AU)

Non-inferiority studies are increasingly more common for introducing new medicines in the market. Despite being situations wherethe use of this study design is justified, there is not a common analytical approach on how to conduct them. Pursuing a rigorousmethodology, both in the study conduction and in its disseminations, is critical to ensure robust results to enable regulatory agenciesand clinicians to reach valid conclusions and decisions which ultimately will benefit clinical practice. Most of the published reviewsfocus on the efficacy outcomes of non-inferiority clinical trials. We are unaware of other reviews that goes beyond and includes spe-cific aspects for non-interventional designs and for studies focused on safety. Moreover, this review provides a simple and practicalperspective with a minimum mathematical content on this complex type of studies.(AU)

Adapting parent-focused interventions for diverse caregivers of children with intellectual and developmental disabilities: Lessons learned during global crises.

Parent-focused interventions have been designed to provide training and support to caregivers who are essential in achieving positive outcomes for children with intellectual and developmental disabilities (IDD). In 2020, significant crises, including the COVID-19 pandemic and continued racial tensions, profoundly impacted the livelihood of children with IDD and their families. Many ongoing efforts to address disparities among this population were halted temporarily and required further adaptations. Researchers adapted interventions and support to address the disparities impacting children with IDD and their families with limited guidance. We provide a descriptive case analysis of four parent-focused interventions that responded to the global crises to continue serving children with IDD and their families. The four distinct programs were based on applied behavior analysis and naturalistic, developmental-behavioral paradigms that were culturally adapted for families of young children with IDD from diverse cultural and socioeconomic backgrounds. We present the qualitative reports on the challenges and benefits that arose with adapting the four parent-focused interventions for telehealth implementation. We focused specifically on adaptations made in recruitment and retention, instrumentation and measurement, research staff training, and intervention delivery. We synthesize our experience with challenges and solutions in adapting parent-focused interventions for racially/ethnically and socioeconomically diverse children with IDD and their families. We conclude with recommendations for researchers and practitioners on methods for adapting parent-focused interventions to address the significant health disparities that impact racially, ethnically, and socioeconomically diverse children with IDD and their families.

An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021.

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.

Las relaciones interdisciplinarias: un reto para los docentes en la carrera de Medicina / Interdisciplinary relationships: a challenge for professors in the medical field

RESUMEN Introducción: la interacción entre las disciplinas que conforman el currículo de las carreras, constituye en la actualidad una necesidad del proceso enseñanza aprendizaje, de ahí el nivel de actualidad de las relaciones interdisciplinarias como soporte metodológico en la solución de problemas profesionales. Objetivo: caracterizar el estado del proceso de relaciones interdisciplinarias entre Historia de Cuba y el resto de las disciplinas en el segundo año de la carrera de Medicina. Métodos: teóricos (modelación, análisis-síntesis y análisis documental), métodos empíricos (revisión documental, entrevistas y encuestas) y la estadística descriptiva para el procesamiento de los datos que se obtuvieron, todos desde el enfoque dialéctico materialista. Se seleccionó un universo de 465 estudiantes y una muestra de 237 a través de un muestreo aleatorio simple. Resultados: se apreciaron dificultades en el trabajo metodológico dentro del colectivo de año, las cuales se manifiestan en las insuficiencias que muestra el proceso de relaciones interdisciplinarias en segundo año de la carrera de Medicina. Conclusiones: la falta de una estrategia para el proceso en estudio limita su proyección en el trabajo metodológico que realizan los colectivos pedagógicos de la carrera, el estudio es novedoso al confirmar empíricamente que el elemento articulador de esas relaciones interdisciplinarias son el desarrollo de habilidades, el trabajo metodológico de los colectivos pedagógicos y el papel de la disciplina principal integradora.

ABSTRACT Introduction: the interaction between the disciplines that make up the curriculum of the medical studies constitutes a need at present for the teaching-learning process, hence the current level of interdisciplinary relations as a methodological support in the solution of professional problems. Objective: to characterize the state of the process of interdisciplinary relations between Cuban History and the rest of the disciplines in the second academic year of the medical studies. Methods: theoretical (modeling, analysis-synthesis and documentary analysis), empirical methods (documentary review, interviews and surveys) and descriptive statistics for the processing of the data collected, all from the dialectical materialist approach. A target group of 465 students and a sample of 237 students were chosen through simple random sampling. Results: difficulties were verified in the methodological work within the academic year group, which are manifested in the inadequacies shown by the process of interdisciplinary relations in the second academic year of Medicine major. Conclusions: the lack of a strategy for the process under study limits its projection in the methodological work carried out by the pedagogical collectives of the medical studies, the study is novel by empirically confirming that the articulating element of these interdisciplinary relations are the development of skills, the methodological work of the pedagogical collectives and the role of the main integrating discipline.

Tact instruction for children with autism spectrum disorder: A review.

Tacts facilitate social interaction, and a strong tact repertoire can lead to the development of other verbal operants. For children with autism spectrum disorder (ASD), the development of a tact repertoire can reduce stereotypical and repetitive language and increase social communication, as functional language may reduce the amount of stereotypical vocal behavior that children engage in. However, teaching tact repertoires to children with ASD that maintain and generalize is difficult. The current study reviewed tact interventions for children with ASD from 2000 to 2019 to provide an overview of current tact interventions, their effectiveness, and the inclusion of intervention components that may promote maintenance and generalization of learned tacts in children with ASD. Fifty-one studies were included in the review. Of the studies that met criteria for effect size calculations 87.18% of the interventions showed excellent or high effect. Although many of the studies focused more on stimulus control to answer specific research questions, some studies implemented intervention components and procedures that could promote acquisition and generalization of learned tacts in children with ASD. We discuss implications and the need to increase research regarding tact intervention components that can increase generalization in children with ASD.

Drug utilization study on immediate release Fentanyl in Spain. Prevalence, incidence, and indication.

PURPOSE: We aimed to characterize the trends of immediate release fentanyl (IRF) use in Spain between 2012 and 2017 and indication for its use. IRF drugs are rapid-acting opioids approved to treat breakthrough cancer pain (BTCP) in patients already receiving maintenance opioid therapy for chronic cancer pain. A substantial increase in consumption of IRF has been observed with emerging cases of abuse and dependence, most of them in noncancer patients. METHODS: An ecological descriptive consumption study with aggregated data from drug dispensed by community pharmacies and reimbursed by the National Health System in which Defined Daily Doses per 10 000 inhabitants (DID) were calculated and a retrospective cohort study using data from the Spanish Database for Pharmacoepidemiological Research in Primary Care in which participants entered the cohort study after 1 year with the Primary Care Practitioners were performed. Annual prevalence and incidence rate of IRF use were estimated by sex and calendar year. Potential indication was also assessed. RESULTS: IRF use in Spain increased from 2.1 DID in 2012 to 3.8 DID in 2017. The incidence rate and prevalence increased in 53% and 74%, respectively. Patients without previous cancer or BCTP diagnosis represented 27% of incident users, predominantly women. Half of patients with noncancer-related diagnosis had a musculoskeletal disorder linked to the first IRF prescription. CONCLUSIONS: National consumption and new IRF users in Spain increased over the study period and one quarter of patients did not have a BTCP or cancer diagnosis registered in their clinical record.

An Evaluation of Two Tact-Training Procedures on Acquired Tacts and Tacting During Play.

A common practice in tact training is to include a supplemental verbal stimulus (e.g., "What is it?") in addition to the presentation of a nonverbal discriminative stimulus. Previous literature has suggested that this supplemental verbal stimulus can impede acquisition and generalization relative to the presentation of the object alone, as it may establish faulty stimulus control or decrease spontaneous tacting. Research has yet to compare these 2 training methods on the generalization of learned tacts to more naturalistic, play-based environments. The present study evaluated the use of "What is it?" compared to the presentation of only the nonverbal discriminative stimulus on tact acquisition among 3 children with autism spectrum disorder and the extent to which these training procedures led to tacting in a play-based setting following discrete-trial training. Overall, participants learned to tact stimuli under both conditions, and all participants demonstrated generalization of tacts in a play-based setting. Recommendations for the development and evaluation of naturalistic posttraining assessment are discussed.

Implementing early intensive behavioral intervention in community settings.

LAY ABSTRACT: Although research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.