Real-world experience with pertuzumab and trastuzumab combined with chemotherapy in neoadjuvant treatment for patients with early-stage HER2-positive breast cancer: the NEOPERSUR study.

PURPOSE: HER2-targeted therapies have dramatically improved outcomes of patients with HER2-positive breast cancer (BC), as demonstrated in neoadjuvant trials. This study aims to provide real-world evidence on the use and effectiveness of combined pertuzumab, trastuzumab and chemotherapy (CT) in early-stage HER2-positive BC. METHODS: A retrospective, multicentre study was conducted on patients diagnosed with HER2-positive early BC treated with neoadjuvant pertuzumab and trastuzumab plus CT at 13 Spanish sites. The primary endpoint was pathological complete response (pCR). RESULTS: A total of 310 patients were included. Pertuzumab and trastuzumab were combined with anthracyclines and taxanes, carboplatin and docetaxel, and taxane-based CT in 77.1%, 16.5%, and 6.5% of patients, respectively. Overall, the pCR rate was 62.2%. The pCR was higher amongst patients with hormone receptor-negative tumours and with tumours expressing higher levels of Ki-67 (> 20%). After postoperative adjuvant treatment, 13.9% of patients relapsed. Those patients who did not achieve pCR, with tumours at advanced stages (III), and with node-positive disease were more likely to experience distant relapse. Median overall survival (OS) and distant disease-free survival (D-DFS) were not reached at the study end. The estimated mean OS and D-DFS times were 7.5 (95% CI 7.3-7.7) and 7.3 (95% CI 7.1-7.5) years, respectively (both were significantly longer amongst patients who achieved pCR). Grade 3-4 anti-HER2 related toxicities were reported in six (1.9%) patients. CONCLUSION: Neoadjuvant pertuzumab and trastuzumab plus CT achieve high pCR rates in real-life patients with HER2-positive early BC, showing an acceptable safety profile. Innovative adjuvant strategies are essential in patients at high risk of distant disease recurrence.

Clinicopathological and Genomic Identification of Breast Cancers with No Impact on Mortality.

BACKGROUND: Implementing mammogram screening means that clinicians are seeing many breast cancers that will never develop metastases. The purpose of this study was to identify subgroups of breast cancer patients who did not present events related to long-term breast cancer mortality, taking into account diagnosis at breast screening, absence of palpability and axillary involvement, and genomic analysis with PAM50. PATIENTS AND METHODS: To identify them, a retrospective observational study was carried out selecting patients without any palpable tumor and without axillary involvement, and a genomic analysis was performed with PAM50. RESULTS: The probability of distant metastasis-free interval (DMFI) of 337 patients was 0.92 (95% CI, 0.90-0.93) at 20 years and 0.96 (95% CI, 0.92-1.00) in 95 patients (28%) with available PAM50 tests. In 22 (23.15%) luminal A tumors and in 9 (9.47%) luminal B tumors smaller than 1 cm, and in HER2 and basal type tumors, there were no metastatic events (20-year DMFI of 1.00). CONCLUSION: Patients with nonpalpable breast cancer found at screening with negative nodes are at very low risk. It is possible to identify subgroups without metastatic events by determining the intrinsic subtype and tumor size less than 1 cm. Therefore, de-escalation of treatment should be considered.

Asociación entre la historia reproductiva, el subtipo de cáncer de mama y la supervivencia de mujeres premenopáusicas / Association between reproductive history, breast cancer subtype, and survival in premenopausal women

Antecedentes y objetivo: La historia reproductiva influye en el riesgo de cáncer de mama. Hemos analizado su asociación con el subtipo tumoral y la supervivencia en mujeres premenopáusicas. Pacientes y métodos: Estudio observacional, retrospectivo, de mujeres premenopáusicas con carcinoma de mama, estadios I-III, en los últimos 20 años. Revisión de la historia reproductiva, de los datos clínicos y de los tratamientos en las historias de salud. Resultados: En 661 mujeres premenopáusicas (32,40% de 1.377 totales), la mediana de edad fue de 47 años (19-53), de la menarquia 12 (7-17), del primer parto 28 (16-41) y de número de partos 2 (0-9). Fueron nulíparas 111 (18,20%). Emplearon lactancia natural 359 (58,80%) con mediana de duración de 6 meses. Consumieron anovulatorios 271 (44,40%), con mediana de 36 meses. Se halló asociación entre menarquia <10 años y menos riesgo de subtipo luminal (OR: 0,52; IC 95%: 0,28-0,94; p=0,03), entre menarquia >11 años y menos riesgo de subtipo HER2 (OR: 0,50; IC 95%: 0,26-0,97; p=0,04) y entre primer parto >30 años y menos riesgo de subtipo triple negativo (OR: 0,40; IC 95%: 0,17-0,93; p=0,03). La probabilidad de supervivencia global y libre de enfermedad a 20 años fue de 0,80 (IC 95%: 0,71-0,90) y 0,72 (IC 95%: 0,64-0,79), respectivamente. Las pacientes con uno o más de un parto presentaron mejor supervivencia global que las nulíparas (HR: 0,51; IC 95%: 0,27-0,96, p=0,04). Conclusiones: Los hallazgos sugieren que existe asociación entre edad de la menarquia y del primer parto y subtipo de cáncer de mama. La nuliparidad está asociada con peor supervivencia.(AU)

Background and objective: Reproductive history influences breast cancer risk. We analysed its association with tumour subtype and survival in premenopausal women. Patients and methods: Retrospective, observational study of premenopausal women with stage I-III breast carcinoma in the last 20 years. Review of reproductive history, clinical data, and treatments in health records.Results: In 661 premenopausal women (32.40% of 1377 total cases), median age was 47 years (19-53), menarche 12 (7-17), first delivery 28 (16-41) and number of deliveries 2 (0-9). One hundred and eleven (18.20%) were nulliparous. Three hundred and fifty-nine (58.80%) used natural lactation, with a median duration of 6 months. Anovulatory drugs were used by 271 (44.40%), with a median duration of 36 months. Associations were found between menarche <10 years and lower risk of luminal subtype (OR: 0.52, 95% CI: 0.28-0.94; P=.03), between menarche >11 years and lower risk of HER2 subtype (OR: 0.50, 95% CI: 0.26-0.97; P=.04) and between first birth >30 years and lower risk of triple negative subtype (OR: 0.40, 95% CI: 0.17-0.93; P=.03). The 20-year overall and disease-free survival probabilities were 0.80 (95% CI: 0.71–0.90) and 0.72 (95% CI: 0.64-0.79) respectively. Patients with ≥1 delivery had better overall survival than nulliparous patients (HR: 0.51, 95% CI: 0.27-0.96, P=.04). Conclusions: The findings suggest an association between age at menarche and age at first delivery and breast cancer subtype. Nulliparity is associated with worse survival.(AU)

Association between reproductive history, breast cancer subtype, and survival in premenopausal women. / Asociación entre la historia reproductiva, el subtipo de cáncer de mama y la supervivencia de mujeres premenopáusicas.

BACKGROUND AND OBJECTIVE: Reproductive history influences breast cancer risk. We analysed its association with tumour subtype and survival in premenopausal women. PATIENTS AND METHODS: Retrospective, observational study of premenopausal women with stage I-III breast carcinoma in the last 20 years. Review of reproductive history, clinical data, and treatments in health records. RESULTS: In 661 premenopausal women (32.40% of 1377 total cases), median age was 47 years (19-53), menarche 12 (7-17), first delivery 28 (16-41) and number of deliveries 2 (0-9). One hundred and eleven (18.20%) were nulliparous. Three hundred and fifty-nine (58.80%) used natural lactation, with a median duration of 6 months. Anovulatory drugs were used by 271 (44.40%), with a median duration of 36 months. Associations were found between menarche <10 years and lower risk of luminal subtype (OR: 0.52, 95% CI: 0.28-0.94; P=.03), between menarche >11 years and lower risk of HER2 subtype (OR: 0.50, 95% CI: 0.26-0.97; P=.04) and between first birth >30 years and lower risk of triple negative subtype (OR: 0.40, 95% CI: 0.17-0.93; P=.03). The 20-year overall and disease-free survival probabilities were 0.80 (95% CI: 0.71-0.90) and 0.72 (95% CI: 0.64-0.79) respectively. Patients with ≥1 delivery had better overall survival than nulliparous patients (HR: 0.51, 95% CI: 0.27-0.96, P=.04). CONCLUSIONS: The findings suggest an association between age at menarche and age at first delivery and breast cancer subtype. Nulliparity is associated with worse survival.

Seis acciones metodológicas sencillas para el uso de la plataforma Moodle / Six simple methodological actions for the use of the Moodle platform

Para desarrollar un curso o asignatura a través de la educación a distancia utilizando la plataforma Moodle, es preciso dominar los recursos que esta ofrece; aunque sin el conocimiento del contenido, de pedagogía y una experiencia práctica de impartición tradicional de la materia, no es posible lograrlo con posibilidades de éxito. Es propósito de los autores socializar algunas acciones metodológicas sencillas, conformadas por ellos y aplicadas ya en su práctica docente, las que pueden ser útiles a los que se inician en la virtualización del proceso enseñanza aprendizaje.

To develop a course or subject through distance learning using the Moodle platform, it is necessary to master the resources that it offers; although without knowledge of the content, pedagogy and a practical experience of traditional teaching of the subject, it is not possible to achieve it with any chance of success. It is the purpose of the authors to socialize some simple methodological actions, formed by them and already applied in their teaching practice, which can be useful to those who are starting out in the virtualization of the teaching-learning process.

La pedagogía de la inclusión aplicada a la clase de Educación Física / The pedagogy of inclusion applied to the Physical Education class

La pedagogía de la inclusión persigue formar personas desde la perspectiva de su individualidad, teniendo en cuenta su interacción social. Para la escuela cubana es un reto porque requiere cambios en la forma de interactuar, investigar y ofrece oportunidades de aprendizaje considerando la diversidad de necesidades y las diferencias de contextos, como alternativa más viable para proporcionar una respuesta educativa individualizada, comprensiva y diversificada. La Educación Física es una de las materias del currículo que tiene una alta responsabilidad de educar desde la diversidad, pero para ello los docentes deben capacitarse en las exigencias educativas a satisfacer. Los autores proponen algunas acciones metodológicas ya aplicadas a fin de que constituyan experiencias compartidas entre los docentes de la especialidad en sus clases.

The pedagogy of inclusion seeks to train people from the perspective of their individuality, taking into account their social interaction. For the Cuban school it is a challenge because it requires changes in the way of interacting, investigating and offering learning opportunities considering the diversity of needs and the differences in contexts, as a more viable alternative to provide an individualized, comprehensive and diversified educational response. Physical Education is one of the subjects in the curriculum that has a high responsibility to educate from diversity, but for this, teachers must be trained in the educational demands to be met. The authors propose some methodological actions already applied so that they constitute shared experiences among the teachers of the specialty in their classes.

Características clínico-patológicas y supervivencia de pacientes con cáncer de mama de riesgo muy bajo / Clinicopathological characteristics and survival results of patients with ultralow risk breast cancer

Antecedentes y objetivo: La universalización del cribado mamográfico ha incrementado el diagnóstico de cánceres de mama con pronóstico excelente. La ausencia de tumor palpable les confiere un riesgo muy bajo de mortalidad por cáncer de mama. El objetivo del estudio fue identificar subgrupos con muy buena evolución a largo plazo.Pacientes y métodosIdentificamos pacientes con muy buena evolución mediante estudio descriptivo, observacional y retrospectivo. Los criterios de riesgo muy bajo fueron la procedencia del cribado mamográfico, sin tumor palpable, el fenotipo tumoral y la afectación ganglionar.ResultadosDe 746 pacientes con carcinoma de mama, con ganglios negativos, entre 2001 y 2015, 110 (14,75%) procedían del cribado con tumores no palpables. Ochenta y ocho (80%) eran hormonosensibles, 10 (9,10%) triples negativos y 11 (10%) HER2. La mediana de seguimiento fue 10 años (3,5-17). Solo tres pacientes desarrollaron metástasis, no hubo recidivas loco-regionales, siete presentaron segundos tumores primarios y hubo cuatro muertes, dos por cáncer de mama y dos por otras causas. El intervalo libre de metástasis a distancia (ILMD) fue 95,60% (intervalo de confianza (IC) 95% 90,70-100,50); 96,30% (IC 95% 91,21-99,39) en 88 tumores hormonosensibles, 100% en 34 hormonosensibles de grado histológico 1 (aproximación a luminales A) y 94,40% (IC 95% 86,76-102,04) en 54 de grado 2-3 (luminales B). En los triples negativos y HER2 fue 100%. En tumores menores y mayores de 1 cm fue 100% y 95,50% (IC 95% 89, 42-101,58).ConclusionesLas pacientes con tumores no palpables, detectados en el cribado mamográfico tienen un riesgo de recurrencia muy bajo. La buena evolución en los subgrupos luminal A, triple negativo, HER2 y menores de 1 cm puede explicar la eficacia del tratamiento, pero también los hace candidatos a desescalar su tratamiento. (AU)

Background and objective: To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement.Patients and methodsWe identified patients with good progress by means of a descriptive, observational and retrospective study.ResultsOf 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76–102.04) in 54 grade 2–3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours <1 cm it was 100%, and >1 cm it was 95.50% (95% CI 79.42–100.98).ConclusionsPatients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment. (AU)

Clinicopathological characteristics and survival results of patients with ultralow risk breast cancer. / Características clínico-patológicas y supervivencia de pacientes con cáncer de mama de riesgo muy bajo.

BACKGROUND AND OBJECTIVE: To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement. PATIENTS AND METHODS: We identified patients with good progress by means of a descriptive, observational and retrospective study. RESULTS: Of 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76-102.04) in 54 grade 2-3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours <1 cm it was 100%, and >1 cm it was 95.50% (95% CI 79.42-100.98). CONCLUSIONS: Patients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment.

La herramienta Actividad Tarea de la plataforma Moodle aplicada a trabajos de terminación de curso / The Activity Task tool of the Moodle platform applied to course completion projects

RESUMEN Fundamento: las plataformas interactivas favorecen el proceso enseñanza aprendizaje en el modelo a distancia, semipresencial y presencial al ofrecer herramientas para el diseño y creación, mantenimiento y desarrollo de aulas virtuales. Objetivo: describir las experiencias del uso de la herramienta Actividad Tarea de la plataforma interactiva Moodle en el desarrollo del trabajo de terminación de curso por los estudiantes universitarios. Métodos: el estudio se realizó en la Facultad de Cultura Física de la Universidad Central "Marta Abreu" de Las Villas, Villa Clara, durante el curso 2021-2022. Se emplearon métodos teóricos: análisis-síntesis e inducción-deducción; y empíricos: análisis documental, análisis del contenido del trabajo de terminación de curso utilizando la Actividad Tarea de la plataforma Moodle, a partir de elementos solicitados en una guía; y la entrevista a estudiantes. Resultados: se evidenció que el uso de la herramienta Actividad Tarea facilitó la ejecución del trabajo de terminación de curso, así como su revisión por los profesores. El cumplimiento del cronograma donde se programaron los diferentes aspectos de interacción estudiante-profesor favoreció la obtención de resultados positivos en ascenso gradual hasta alcanzar evaluaciones sobresalientes; los estudiantes se sintieron motivados y emitieron criterios de satisfacción sobre la metodología empleada. Conclusiones: la aplicación de la herramienta Actividad Tarea de la plataforma interactiva Moodle en el desarrollo del trabajo de terminación de curso resultó una experiencia positiva y aplicable en los centros de educación superior, porque contribuyó a lograr un aprendizaje significativo en la ejecución de esta forma evaluativa.

ABSTRACT Background: interactive platforms favor the teaching-learning process in the distance, blended and face-to-face learning model by offering tools for the design and creation, maintenance and development of virtual classrooms. Objective: to describe the experiences of the use of the Task Activity tool of the Moodle interactive platform in the development of course completion work by university students. Methods: the study was carried out at the Faculty of Physical Culture of the "Marta Abreu" Central University of Las Villas, Villa Clara, during the 2021-2022 academic year. Theoretical methods were used: analysis-synthesis and induction-deduction; and empirical: documentary analysis, analysis of the content of the course completion work using the Task Activity of the Moodle platform, based on elements requested in a guide; and student interview. Results: it was evidenced that the use of the Task Activity tool facilitated the execution of the course completion work, as well as its review by the teachers. Compliance with the schedule where different aspects of student-teacher interaction were scheduled favored the achievement of positive results in gradual ascent until reaching outstanding evaluations; the students felt motivated and expressed satisfaction criteria about the methodology used. Conclusions: the application of the Activity Task tool of the Moodle interactive platform in the development of course completion work was a positive and applicable experience in higher education centers, because it contributed to achieving significant learning in the execution of this evaluative form.

Estudio de casos aplicado a una experiencia de estimulación del talento en la formación universitaria / Case study applied to a talent stimulation experience in university education

RESUMEN Fundamento: se muestran los antecedentes teóricos e investigativos que actúan como marco referencial de este estudio, son analizados el talento y su estimulación, así como su materialización en la formación del profesional de la Cultura Física. Objetivo: valorar la efectividad del método estudio de casos para el diagnóstico y la estimulación del talento en jóvenes universitarios. Métodos: se realizó un estudio descriptivo en la Facultad de Cultura Física en la Universidad Central "Marta Abreu" de las Villas durante el periodo 2018-2019. Se utilizaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; empíricos: entrevista semiestructurada a los estudiantes y observación de actividades pedagógicas en la aplicación del método de estudio de casos múltiples. La información fue triangulada para llegar a las regularidades. Resultados: los métodos empleados permitieron conformar el diagnóstico utilizando las siguientes variables: motivación en la esfera profesional, orientación hacia la creación en áreas de la esfera profesional, aprendizaje estratégico y creador en áreas de la esfera profesional y contexto educativo desarrollador del talento, las que permitieron ubicar a los estudiantes en las categorías de talentoso, y potencionalmente talentoso a partir del análisis de las dimensiones que los caracterizan. Conclusiones: se valoró la efectividad del método estudio de casos para la investigación del talento en la formación del profesional en la Cultura Física, lo que permitió estructurar un proceso de estimulación para estos estudiantes sobre bases científicas.

ABSTRACT Background: the theoretical and researching antecedents that act as a reference framework for this study are shown, the talent and its stimulation are analyzed, as well as its materialization in the training of the Physical Culture professional. Objective: to assess the effectiveness of the case study method for the diagnosis and stimulation of talent in young university students. Methods: a descriptive study was carried out at the Faculty of Physical Culture at "Marta Abreu" Central University de las Villas from 2018 to 2019. Theoretical methods were used: historical-logical, analysis-synthesis and induction-deduction; empirical ones: semi-structured interview with students and observation of pedagogical activities in the application of the multiple case study method. The information was contrasted to arrive at the regularities. Results: the methods used made possible to form the diagnosis using the following variables: motivation in the professional sphere, orientation towards creation in areas of the professional sphere, strategic and creative learning in areas of the professional sphere and educational context developing talent, which allowed to place students in the categories of talented, and potentially talented from the analysis of the dimensions that characterize them. Conclusions: the effectiveness of the case study method for the investigation of talent in the training Background: the theoretical and investigative antecedents that act as a reference framework for this study are shown, the talent and its stimulation are analyzed, as well as its materialization in the training of the Physical Culture professional.

Modelo de formación pedagógica continua para el desarrollo de competencias pedagógicas en profesores universitarios / Continuous pedagogical training pattern for the development of pedagogical skills in university teachers

RESUMEN Fundamento: la educación superior precisa transformar la realidad en las competencias pedagógicas de los docentes universitarios a través de una concepción diferente de la formación pedagógica continua. Objetivo: diseñar un modelo de formación pedagógica continua para el desarrollo de competencias pedagógicas en los profesores universitarios. Métodos: se realizó una investigación de desarrollo, con enfoque cualitativo en la Facultad de Cultura Física de la Universidad Central "Marta Abreu" de Las Villas durante el año 2018, cuyo objeto de estudio fue el desarrollo de competencias de profesionales universitarios. Para ello se emplearon métodos teóricos: analítico-sintético, inducción-deducción y sistémico-estructural; y empíricos: la revisión documental de diversas bibliografías que permitieron la concepción pedagógica en el diseño del modelo. Resultados: se fundamenta el proceso de diseño de un modelo de formación pedagógica continua para formar competencias en los profesores universitarios. Contiene la determinación de necesidades, características, un sistema de acciones, un sitio web con información necesaria para la preparación pedagógica, ofrece recomendaciones metodológicas para la formación de competencias, un curso a distancia y finalmente se centra en la evaluación de los resultados una vez ejecutado. Conclusiones: el modelo está basado en la formación pedagógica continua para el desarrollo de competencias en los profesores universitarios, constituye un sistema con acciones concatenadas y sus componentes están estructurados y jerarquizados. Fue valorado por criterios de expertos como muy adecuado por su pertinencia, factibilidad de aplicación y contribución al objetivo para el cual fue diseñado.

ABSTRACT Background: in higher education, the effectiveness in terms of pedagogical skills in university teachers needs to be transformed through a different conception of continuous pedagogical training. Objective: to design a pattern for continuous pedagogical training for university teachers on the development of pedagogical skills. Methods: during 2018, a development research with a qualitative approach, was carried out in the Faculty of Physical Culture at the "Marta Abreu" Central University of Las Villas, for the development of professional competences in university teachers. For this purpose, theoretical methods were used: analytical-synthetic method, induction-deduction method and systemic-structural method; and empirical methods: documentary review of different bibliographies that enabled the pedagogical conception in the pattern. Results: the basis for the process of designing a pattern of continuous pedagogical training to develop skills in university teachers, is explained. It involves the identification of needs, characteristics, a system of actions, a web site with the required information for pedagogical training, it also provides methodological recommendations for skill building, a distance learning course and finally it focuses on the evaluation of results once it has been implemented. Conclusions: the pattern is based on continuous pedagogical training for the development of skills in university teachers, it comprises a system with concatenated actions and its components are structured and hierarchical. This pattern was evaluated by experts as very appropriate for its relevance, feasibility of application and contribution to the designed objective.

Experiences with Prescribing Large Quantities of Systemic Anticancer Therapy Near Death.

Background: The most important decision after diagnosing terminal cancer is whether to provide active therapy or withhold treatment. Objective: To analyze the aggressiveness of care by evaluating systemic anticancer therapy (SACT) given near to death, describing this care and identifying factors that determine its use. Design: This involves retrospective observational cohorts study. Setting/Subjects: This involves patients with metastatic tumors who died at a University Hospital in Spain between 2015 and 2016. Measurements: Data obtained from prescribing oncologists and patients' clinical records, type of cancer, and information on treatment. The dependent variable used was the interval between the date of the last dose and date of death. Results: Ninety-four (32.60%) of 288 patients received SACT in the last month of life. This cohort had a higher frequency of lung cancer (OR: 1.58; CI 95%: 1.14-2.18), received more care from oncologist 2 (OR: 1.50; CI 95%: 1.08-2.08), had fewer last-line treatment cycles (OR: 1.28; CI 95%: 1.13-1.45), a lower subjective response (OR: 3.13; CI 95%: 1.34-7.29), less clinical benefit (OR: 2.38; CI 95%: 1.04-5.55), more visits to the Emergency Department (OR: 1.59; CI 95%: 1.06-2.38), and less care from the Palliative Care Unit (OR: 4.55; CI 95%: 2.69-7.70). In multivariate analysis, the predictors of having received SACT close to death remained: receiving fewer cycles of treatment (OR: 1.28; CI 95%: 1.12-1.47) and less palliative care (OR: 4.54; CI 95%: 2.56-7.69). Conclusions: A third of cancer patients received SACT in the last month of life with less efficacy and poorer quality of care than patients not receiving it.

El tratamiento grupal multicomponente: un método efectivo contra el tabaquismo / Group multicomponent treatment: an effective method against nicotinism

RESUMEN Introducción: El tabaquismo es una enfermedad crónica perteneciente al grupo de las adicciones. En Cuba existen pocas referencias de publicaciones que midan el resultado de estrategias psicoterapéuticas. Objetivo: Evaluar los resultados alcanzados en pacientes que durante un año recibieron tratamiento grupal multicomponente para la cesación tabáquica. Métodos: Investigación descriptiva longitudinal de corte evaluativo. Se evaluaron los resultados en 83 fumadores que recibieron un año de tratamiento multicomponente para la cesación tabáquica en el Departamento de Salud Mental de Plaza de la Revolución. Se aplicó encuesta y se determinó niveles de monóxido de carbono y carboxihemoglobina. Resultados: Al año de tratamiento, 42,1 % se mantenía sin fumar, 21,7 % disminuyó el consumo. Aunque acudieron más féminas a recibir ayuda, un mayor número de hombres logró la abstinencia. De los abstinentes, solo 10 señalaron convivir con fumadores, ninguno tenía antecedentes personales de alcoholismo y 11,4 % estaba en fase precontemplativa o contemplativa. 91,4 % de los exfumadores no tenían intoxicación por monóxido de carbono. En contraposición, 91,7 % de los que seguían fumado tenían niveles moderados de carboxihemoglobina. Los principales beneficios fueron mejoría de salud y de economía, de forma grupal se produjo un ahorro de 191 625 pesos. La totalidad de los pacientes refirió satisfacción con el tratamiento recibido brindando sugerencias para su perfeccionamiento. Conclusiones: La aplicación del tratamiento multicomponente para la cesación tabáquica es satisfactorio, a pesar de ser el tabaquismo una adicción difícil de controlar Se aporta información útil, sobre la deshabituación tabáquica en contextos clínicos, que permite perfeccionar las acciones de cesación.

ABSTRACT Introduction: Smoking habit is a chronic disease belonging to the group of addictions. In Cuba there are few references of publications that measure the result of psychotherapeutic strategies against this habit. Objective: To evaluate the results achieved in patients that during one year received a group multicomponent treatment for smoking cessation. Method: Descriptive longitudinal research of evaluative type. The results were evaluated in 83 smokers a year after receiving multicomponent treatment for smoking cessation in the Department of Mental Health of Plaza de la Revolución municipality. A survey was applied and levels of carbon monoxide and carboxyhemoglobin were determined. Results: 42,1 % of the patients keep without smoking a year after treatment, 21,7 % decreased consumption. Although more women went to receive help, a greater number of men achieved abstinence. Of the abstinents only 10 reported living with smokers, none had personal history of alcoholism and the 11,4 % was in pre-completion or completion phase. 91,4 % of former smokers had no carbon monoxide poisoning. In contrast, 91,7 % of those who continued to smoke had moderate levels of carboxyhemoglobin. The main benefits were improvement of health and economy, and as a group there was a pocket saving of 191 625 pesos. All patients expressed satisfaction with the treatment received and offered suggestions for its improvement. Conclusions: The results of the use of the multicomponent treatment for smoking cessasion are satisfactory, instead of being nicotinism an addiction which is hard to control. It was provided information on smoking cessation in clinical contexts that allows improving cessation actions.

Estimular el desarrollo de alumnos talentos en las condiciones actuales de la educación superior / Encourage the development of talented students in the current conditions of higher education

RESUMEN El artículo aborda una problemática que hoy enfrenta la educación superior ante la masividad en este nivel de enseñanza: la estimulación de los indicadores del talento en la formación del profesional. Se realizó una revisión bibliográfica donde predominaron los métodos de análisis y juicios críticos con el objetivo de constituir una sistematización teórica que permitió determinar las dimensiones del talento, sus indicadores y marco conceptual; como resultado se elaboró una alternativa metodológica acerca de cómo trabajar curricularmente la orientación hacia la creación en áreas de la esfera profesional, el aprendizaje estratégico y creador, y los contextos educativos desarrolladores del talento; también se incluyen en este texto procederes metodológicos para estimular el talento desde los componentes académico, laboral e investigativo en las condiciones actuales de las universidades cubanas.

ABSTRACT The article addresses a problem that today faces higher education that of massive registration at this level of education: the stimulation of talent indicators in professional training. A literature review was carried out where the methods of analysis and critical judgments predominated with the aim of constituting a theoretical systematization that allowed to determine the dimensions of talent, its indicators and conceptual framework; as a result, a methodological alternative was elaborated about how to work through the curriculum the orientation towards creation in areas of the professional sphere, the strategic and creative learning, and the educational contexts that develop the talent in the professional formation; also included in this text are methodological procedures to stimulate talent from the academic, labor and research components in the current conditions of Cuban universities.

Evaluación del riesgo clínico, no genómico y resultados de supervivencia en el carcinoma de mama hormonosensible, HER-2 negativo, con ganglios negativos / Evaluation of non-genomic, clinical risk and survival results in endocrine-sensitive, HER-2 negative, lymph node negative breast cancer

Antecedentes y objetivos: En el cáncer de mama hormonosensible, HER-2 negativo, con ganglios negativos, la presencia de un riesgo genómico bajo permite tratar solo con hormonoterapia adyuvante, obteniendo unas excelentes tasas de supervivencia. La justificación de este estudio es demostrar que también se obtienen unas excelentes tasas de supervivencia tratando solo con hormonoterapia adyuvante mediante la evaluación del riesgo clínico. Pacientes y métodos: Estudio descriptivo, observacional y retrospectivo entre 2006 y 2016 de la cohorte de cáncer de mama hormonosensible, HER-2 negativo, con ganglios negativos, tamaño del tumor mayor de 1cm o entre 0,6 y 1cm con características desfavorables. Revisión retrospectiva de los registros de salud. Datos de mortalidad del Registro Nacional de Defunciones. Resultados: Un total de 203 pacientes fueron evaluables para la supervivencia. Ciento veintitrés (60,50%) fueron tratadas solo con hormonoterapia adyuvante, 77 (37,90%) con quimioterapia-hormonoterapia, una (0.50%) solo con quimioterapia y 2 (1%) no recibieron ningún tratamiento. La tasa de supervivencia global a los 5 años fue del 97% (intervalo de confianza [IC] del 95% 94-100). La tasa de intervalo libre de metástasis a distancia fue del 94% (IC 95% 90-98). En el subgrupo de pacientes tratadas solo con hormonoterapia la tasa de supervivencia global y del intervalo libre de metástasis a distancia a los 5 años fue del 98% (IC 95% 95-100) y 97% (IC 95% 93-100), respectivamente. Conclusiones: Las pacientes con cáncer de mama hormonosensible, HER-2-negativo, con ganglios negativos, tratadas solo con hormonoterapia según su riesgo clínico, obtienen resultados de supervivencia similares a los descritos cuando son tratadas solo con hormonoterapia según su riesgo genómico

Background and objectives: In endocrine-sensitive, HER-2 negative, node negative breast cancer, the presence of a low genomic risk allows treatment with adjuvant endocrine therapy alone, obtaining excellent survival rates. The justification for this study is to show that excellent survival rates are also obtained by treating with adjuvant hormone therapy alone, based on clinical risk assessment. Patients and methods: A descriptive, observational and retrospective study was performed between 2006 and 2016 with endocrine-sensitive, HER-2 negative, node negative breast cancer, greater than 1cm or between 0.6 and 1cm with unfavourable features. Retrospective review of health records. Mortality data of the National Registry of Deaths. Results: A total of 203 patients were evaluable for survival. One hundred and twenty-three (60.50%) were treated with adjuvant endocrine therapy alone, 77 (37.90%) with chemotherapy and endocrine therapy, one (0.50%) with chemotherapy alone and 2 (1%) were not treated. The overall survival rate at 5 years was 97% (95% confidence interval [CI] 94-100). Distant recurrence-free interval was 94% (95% CI 90-98). In the subgroup of patients treated with endocrine therapy alone, overall survival and distant recurrence-free interval rates at 5 years were 98% (95% CI 95-100) and 97% (95% CI 93-100), respectively. Conclusions: Patients with endocrine-sensitive, HER-2-negative, node negative breast cancer treated with endocrine therapy alone according to their clinical risk have similar survival outcomes as those treated with endocrine therapy according to their genomic risk

La formación de competencias pedagógicas en los profesores universitarios / The training of pedagogical competences in university professors

Numerosos estudios han definido el término competencia y cómo desarrollarla y evaluarla en disímiles contextos. A partir de una revisión crítica de la literatura sobre el tema en el ámbito nacional e internacional, esta investigación resuelve el problema científico ¿cómo contribuir a la formación de competencias de los profesores universitarios? Se definieron los conceptos de competencias pedagógico-didácticas, interactivas, investigativas, productivas, especificadoras e institucionales, con sus acciones y recomendaciones metodológicas como propuesta válida en aras de un adecuado desempeño docente.

Numerous studies have defined the term competence and how to develop and evaluate it in different contexts. Based on a critical review of the literature on the subject at national and international level, this research work solves the scientific problem how to contribute to the training of competences in university professors? The concepts of pedagogical-didactic, interactive, researching, productive, specification and institutional competences were defined, with their actions and methodological recommendations as a valid proposal for their training in university professors for the sake of an adequate teaching performance.

Evaluation of non-genomic, clinical risk and survival results in endocrine-sensitive, HER-2 negative, lymph node negative breast cancer. / Evaluación del riesgo clínico, no genómico y resultados de supervivencia en el carcinoma de mama hormonosensible, HER-2 negativo, con ganglios negativos.

BACKGROUND AND OBJECTIVES: In endocrine-sensitive, HER-2 negative, node negative breast cancer, the presence of a low genomic risk allows treatment with adjuvant endocrine therapy alone, obtaining excellent survival rates. The justification for this study is to show that excellent survival rates are also obtained by treating with adjuvant hormone therapy alone, based on clinical risk assessment. PATIENTS AND METHODS: A descriptive, observational and retrospective study was performed between 2006 and 2016 with endocrine-sensitive, HER-2 negative, node negative breast cancer, greater than 1cm or between 0.6 and 1cm with unfavourable features. Retrospective review of health records. Mortality data of the National Registry of Deaths. RESULTS: A total of 203 patients were evaluable for survival. One hundred and twenty-three (60.50%) were treated with adjuvant endocrine therapy alone, 77 (37.90%) with chemotherapy and endocrine therapy, one (0.50%) with chemotherapy alone and 2 (1%) were not treated. The overall survival rate at 5 years was 97% (95% confidence interval [CI] 94-100). Distant recurrence-free interval was 94% (95% CI 90-98). In the subgroup of patients treated with endocrine therapy alone, overall survival and distant recurrence-free interval rates at 5 years were 98% (95% CI 95-100) and 97% (95% CI 93-100), respectively. CONCLUSIONS: Patients with endocrine-sensitive, HER-2-negative, node negative breast cancer treated with endocrine therapy alone according to their clinical risk have similar survival outcomes as those treated with endocrine therapy according to their genomic risk.

Consumo de drogas: reporte por tarjeta de enfermedad de declaración obligatoria. Municipio Plaza de la Revolución / Drugs consumption: Report on compulsory disease declaration card

Introducción:El consumo de sustancias psicoactivas es considerado un serio problema por su impacto negativo sobre la salud, la economía, la convivencia familiar y social. Objetivo: Identificar las características comportamentales relacionadas con el consumo de sustancias psicoactivas en pacientes del municipio Plaza de la Revolución. Material y Métodos: Investigación descriptiva de corte transversal en los 71 pacientes residentes en el municipio, reportados por tarjeta EDO durante el período 2013- 2015 por trastornos relacionados con el consumo de sustancias psicoactivas. Se aplicó una encuesta y una entrevista semiestructurada, previo consentimiento informado de los pacientes. Resultados: El 87.4 por ciento de los encuestados pertenecía al sexo masculino donde primaron personas en edades entre 20 y 29 años. La mayoría de las féminas eran adolescentes contando con una menor de solo 13 años. Primó el diagnóstico de abuso a múltiples sustancias siendo la marihuana, el alcohol y los fármacos los más usados. Los cuadros de intoxicación aguda fueron en su mayoría provocados por psicofármacos. Los monoconsumidores menores de 21 años prefirieron los cannabinoides sintéticos, los de mayor edad el crack. Elevada prevalencia de tabaquismo en los pacientes con incremento del consumo de cigarrillos cuando ingerían bebidas alcohólicas. Los encuestados tenían escasa percepción de riesgo del uso de la marihuana. El mayor número de reportes fue realizado por el Departamento de salud mental del municipio. Conclusiones: Teniendo en cuenta el consumo de múltiples sustancias encabezadas por la marihuana así como el uso de nuevas drogas de síntesis fundamentalmente en adolescentes y adultos jóvenes se trazaron estrategias por el equipo de salud mental(AU)

Introduction: The consumption of psychoactive substances is considered a serious problem because of its negative impact on health, economy, and family and social coexistence. Objective: To identify the behavioral characteristics related to the consumption of psychoactive substances in patients of Plaza de la Revolución Municipality. Material and methods: A descriptive cross-sectional investigation was conducted in 71 patients who live in the municipality, and were reported by compulsory disease declaration cards presenting disorders related to the consumption of psychoactive substances during the 2013-2015 period. A survey and a semi-structured interview were both applied, with a previous informed consent given by the patients. Results: the 87 percent of the inquired people were male, most of them aged 20 - 29 years. Most women were adolescents, including an underage who was only 13 years old. The aspect of great importance was the diagnosis of multiple substance abuse, being Marijuana, alcohol, and medications the most used ones. The cases of acute intoxication were mainly caused by psychopharmaceutical drugs. Monoconsumers younger than 21 years of age preferred the synthetic cannabinoids, and the older ones preferred the crack. There was a high prevalence of smoking in patients with increased cigarette consumption when they were drinking alcohol. The inquired people had a little risk perception of using Marijuana. The greatest number of reports was carried out by the Department of Mental Health of the municipality. Conclusions: Some strategies were developed by the mental health team, considering the consumption of multiple substances headed by Marijuana, as well as the use of new synthetic drugs which were mainly consumed by adolescents and young adults(AU)

Off-label antineoplastic drugs. An effectiveness and safety study / Efectividad y seguridad de los medicamentos antineoplásicos en situaciones especiales de uso

Objective: The use of antineoplastic medicines in special situations is common in clinical practice; it is strongly regulated and there is little information on its outcomes. We have analysed such use and health outcomes. Methods: All off-label cases between 2005 and 2015, with any type of cancer and in any stage were included. Health histories of a single health centre were reviewed to gather information on treatment features, response, survival, and toxicity. Results: 85 men and 83 women, aged 56, had largely metastatic tumours treated with a median of 4 cycles (0-118) of chemotherapy, hormone therapy, or biotherapy, for palliative purposes between 1st and 4th lines (80% of cases). The subjective response rate was 32.5%, complete objective 1.9%, partial 8.8%, stabilisation 15.6%, progression 38.8%, and not assessable 35.1%. The median duration of response was 2.5 months (1-17), progression-free survival (PFS) 5 months (4 - 21.3), and overall survival (OS) 11 months (9.2-20.6). In the univariate analysis, performance status, treatment line, number of cycles, and type of response influenced on OS. In the multivariate model, the functional status (HR 0.36; CI 95% 0.17-0.77. P= 0.009) and number of cycles (HR 3.66; CI 95% 2.08-6.44. P= 0.0001) influenced independently on overall survival. The most frequent grade 3 and 4 toxicity were asthenia (19%), neutropenia (10.7%), and nausea and vomiting (8.9%). Conclusions: Off-label antineoplastic drugs were mostly used in metastatic tumours, with little effectiveness. The functional status must be considered to select the patients to be treated (AU)

Objetivos: El uso de medicamentos antineoplásicos en situaciones especiales es común en la práctica clínica, está fuertemente regulado y hay poca información sobre sus resultados. Hemos analizado su empleo y los resultados en salud. Método: Se analiza una cohorte de todos los casos off label entre 2005 y 2015, en cualquier cáncer y estadio. Se revisaron historias de salud de un centro para extraer información sobre tratamiento, respuesta, supervivencia y toxicidad. Resultados: 85 hombres y 83 mujeres, de 56 años de mediana de edad, tenían mayoritariamente tumores metastásicos tratados con una mediana de 4 ciclos (0-118) de quimioterapia, hormonoterapia o bioterapia, con finalidad paliativa entre 1.ª y 4.ª línea (80% de casos). La tasa de respuesta subjetiva fue 32,5%, objetiva completa 1,9%, parcial 8,8%, estabilización 15,6%, progresión 38,8% y no valorable 35,1%. La mediana de duración de la respuesta fue 2,5 meses (1-17), de supervivencia libre de progresión (SLE) 5 meses (4 - 21,3) y global (SG) 11 meses (9,2-20,6). En el análisis univariante, el estado funcional, la línea de tratamiento, el número de ciclos y el tipo de respuesta influyeron en la SG. En el modelo multivariante, el estado funcional (HR 0,36; IC 95% 0,17-0,77. P= 0,009) y el número de ciclos (HR 3,66; IC 95% 2,08-6,44. P= 0,0001) influían de forma independiente en la SG. La toxicidad grado 3 y 4 más frecuente fue la astenia (19%), la neutropenia (10,7%) y la emesis (8,9%). Conclusiones: Los medicamentes antineoplásicos en situaciones especiales de uso se emplearon mayoritariamente en tumores metastásicos, con poca efectividad. El estado funcional debe ser tenido en cuenta para seleccionar los pacientes a tratar (AU)

Off-label antineoplastic drugs. An effectiveness and safety study.

OBJECTIVE: The use of antineoplastic medicines in special situations is common in clinical practice; it is strongly regulated and there is little information on its outcomes. We have analysed such use and health outcomes. METHODS: All off-label cases between 2005 and 2015, with any type of cancer and in any stage were included. Health histories of a single health centre were reviewed to gather information on treatment features, response, survival, andtoxicity. RESULTS: 85 men and 83 women, aged 56, had largely metastatic tumours treated with a median of 4 cycles (0-118) of chemotherapy, hormone therapy, or biotherapy, for palliative purposes between 1st and 4th lines (80% of cases). The subjective response rate was 32.5%, complete objective 1.9%, partial 8.8%, stabilisation 15.6%, progression 38.8%, and not assessable 35.1%. The median duration of response was 2.5 months (1-17), progression-free survival (PFS) 5 months (4 - 21.3), and overall survival (OS) 11 months (9.2-20.6). In the univariate analysis, performance status, treatment line, number of cycles, and type of response influenced on OS. In the multivariate model, the functional status (HR 0.36; CI 95% 0.17-0.77. P= 0.009) and number of cycles (HR 3.66; CI 95% 2.08-6.44. P= 0.0001) influenced independently on overall survival. The most frequent grade 3 and 4 toxicity were asthenia (19%), neutropenia (10.7%), and nausea and vomiting (8.9%). CONCLUSIONS: Off-label antineoplastic drugs were mostly used in metastatic tumours, with little effectiveness. The functional status must be considered to select the patients to be treated.

Objetivos: El uso de medicamentos antineoplásicos en situaciones especiales es común en la práctica clínica, está fuertemente regulado y hay poca información sobre sus resultados. Hemos analizado su empleo y los resultados en salud.Método: Se analiza una cohorte de todos los casos off label entre 2005 y 2015, en cualquier cáncer y estadio. Se revisaron historias de salud de un centro para extraer información sobre tratamiento, respuesta, supervivencia y toxicidad.Resultados: 85 hombres y 83 mujeres, de 56 años de mediana de edad, tenían mayoritariamente tumores metastásicos tratados con una mediana de 4 ciclos (0-118) de quimioterapia, hormonoterapia o bioterapia, con finalidad paliativa entre 1.ª y 4.ª línea (80% de casos). La tasa de respuesta subjetiva fue 32,5%, objetiva completa 1,9%, parcial 8,8%, estabilización 15,6%, progresión 38,8% y no valorable 35,1%. La mediana de duración de la respuesta fue 2,5 meses (1-17), de supervivencia libre de progresión (SLE) 5 meses (4 ­ 21,3) y global (SG) 11 meses (9,2-20,6). En el análisis univariante, el estado funcional, la línea de tratamiento, el número de ciclos y el tipo de respuesta influyeron en la SG. En el modelo multivariante, el estado funcional (HR 0,36; IC 95% 0,17- 0,77. P= 0,009) y el número de ciclos (HR 3,66; IC 95% 2,08-6,44. P= 0,0001) influían de forma independiente en la SG. La toxicidad grado 3 y 4 más frecuente fue la astenia (19%), la neutropenia (10,7%) y la emesis (8,9%).Conclusiones: Los medicamentes antineoplásicos en situaciones especiales de uso se emplearon mayoritariamente en tumores metastásicos, con poca efectividad. El estado funcional debe ser tenido en cuenta para seleccionar los pacientes a tratar.