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The properties of grazed grassland soils are frequently degraded in tropical areas. The objective of this work was to review the literature on the theory and results of sampling and analysis of the spatial variability of grassland soil properties worldwide and in Ecuador. The methodology, results, and discussion of 15 articles were reviewed, available in the databases: Scopus, SciELO, ScienceDirect, Scimago Journal & Country Rank, Dialnet, and SpringerLink, and the respective theory of 5 books. It was found that worldwide there are soil sampling works that evaluate the spatial variability of their properties, while at the national level, the samples do not consider such variability. Therefore, it is crucial to conduct research in Ecuador on the spatial variability of soil properties with grasslands, allowing reliable decisions to be made for their management and conservation.

Background: Studies suggest divergent temporal trends in stroke incidence in high income countries, with increasing rates in younger people, particularly women. No age- and sex-specific stroke incidence data are available for Latin American and Caribbean (LAC) regions, despite large populations undergoing rapid structural changes. Aim: To determine temporal trends in age and sex stroke incidence in LAC populations. Methods: A systematic review in accordance with MOOSE and PRISMA guidelines was undertaken with a modified Cochrane Stroke Group search strategy of MEDLINE, WOS, and LILACS databases, to identify relevant references for prospective observational studies with sex-disaggregated data on stroke incidence in LAC populations from January 1997 to December 2021. Two independent reviewers screened titles/abstracts, and reviewed selected full text articles. Random-effects meta-analysis was conducted to estimate the pooled overall crude stroke incidence and relative temporal rate ratio (RTTR) by age-groups in all and sex-disaggregated data. The Joanna Briggs Institute’s risk of bias assessment was applied. Results: Of 9242 identified records, 6 LAC studies (9 periods) were selected. Overall crude stroke incidence was higher in men than women (incidence [men:women] rate ratio [IRR] = 1.12, 95% confidence interval [CI] 1.04-1.21 [I 2 =38.3%]). When analyzed for temporal trend, relative ratio of stroke incidence was greater in younger than older age-groups ( Conclusions: Divergent temporal trends in stroke incidence are apparent in LAC, with less favorable trends in younger age-groups and especially in young women. Further studies are needed to understand these findings and establish strategies targeting prevention in younger populations.

Background and Aims: OPTIMISTmain is an international, multicenter, stepped-wedge cluster randomized trial to determine effectiveness and safety of less-intensive versus standard monitoring in thrombolysis-treated patients with mild-moderate acute ischemic stroke. A process evaluation was undertaken to determine feasibility, acceptability, and impact of the intervention on care processes, experience and staffing. Methods: A sample of stroke care nursing managers and unit staff from 7 US sites were invited to participate in semi-structured interviews at an early stage of the study. Implementer clinician surveys were undertaken pre- and post-intervention to define integration of the intervention. Qualitative data were independently analyzed by 2 coders; survey data reported from descriptive analysis. Results: 19 nurses were interviewed from the units with 1:2 to 1:6 nurse-to-patient ratios. Less-intensive monitoring was well accepted: less time constraints and improved workload, and perceived to be cost efficient from improved use of neuro-intensive care beds. Some nurses had initial safety concerns over missing deteriorating patients. Less-intensive monitoring led to patients being less irritable and more cooperative from having more rest. There was greater flexibility in the allocation of nursing staff from workforce shortages arising due to the COVID pandemic. Similar results were evident in the survey (13 hospitals, 34 respondents): 80% of respondents agreed that less-intensive monitoring benefited work; 74% believed it should be widely adopted at a national level. Nurses reported time being freed up to provide more patient education (56%), continence/daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (24%, e.g. communication, family support). Conclusions: Less-intensive monitoring after thrombolysis for acute ischemic stroke patients appears feasible and acceptable among US healthcare professionals.

Objective Behcet's disease is a complex systemic inflammatory vasculitis of incompletely understood etiology. This study was undertaken to investigate genetic associations with Behcet's disease in a diverse multiethnic population. Methods A total of 9,444 patients and controls from 7 different populations were included in this study. Genotyping was performed using an Infinium ImmunoArray-24 v.1.0 or v.2.0 BeadChip. Analysis of expression data from stimulated monocytes, and epigenetic and chromatin interaction analyses were performed. Results We identified 2 novel genetic susceptibility loci for Behcet's disease, including a risk locus in IFNGR1 (rs4896243) (odds ratio [OR] 1.25; P = 2.42 x 10(-9)) and within the intergenic region LNCAROD/DKK1 (rs1660760) (OR 0.78; P = 2.75 x 10(-8)). The risk variants in IFNGR1 significantly increased IFNGR1 messenger RNA expression in lipopolysaccharide-stimulated monocytes. In addition, our results replicated the association (P < 5 x 10(-8)) of 6 previously identified susceptibility loci in Behcet's disease: IL10, IL23R, IL12A-AS1, CCR3, ADO, and LACC1, reinforcing the notion that these loci are strong genetic factors in Behcet's disease shared across ancestries. We also identified >30 genetic susceptibility loci with a suggestive level of association (P < 5 x 10(-5)), which will require replication. Finally, functional annotation of genetic susceptibility loci in Behcet's disease revealed their possible regulatory roles and suggested potential causal genes and molecular mechanisms that could be further investigated. Conclusion We performed the largest genetic association study in Behcet's disease to date. Our findings reveal novel putative functional variants associated with the disease and replicate and extend the genetic associations in other loci across multiple ancestries., National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) [R01AR070148]; NIH [U54GM104938, U19AI082714, UM1AI144292, P30AR053483, P30AR073750], Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) grant number R01AR070148 to Dr. Sawalha. Recruitment and genotyping of the EuropeanAmerican controls was supported by NIH grants number U54GM104938, U19AI082714, UM1AI144292, P30AR053483, and P30AR073750 to Drs. Guthridge and James. This work was supported by the use of study data downloaded from the dbGaP web site, under dbGaP accession phs000272. v1.p1.

Background: A key problem in multimorbidity (MM) is polypharmacy (PP), which is associated with increased risks for partly preventable adverse outcomes. The Ariadne principles support primary care consultations that aim to prioritize and share appropriate treatment goals in MM. The aim of this study is to evaluate the effectiveness of the complex MULTIPAP intervention, which implements the Ariadne principles in a primary care population of young-elderly patients with MM&PP, at improving the appropriateness of prescription. Methods: We conducted a pragmatic cluster randomized clinical trial in 38 family practices in Spain. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles. The latter consisted of two key components: FP training (eMULTIPAP) and FP–patient interviews. Patients aged 65-74 years with MM&PP were recruited. The primary outcome was the baseline-adjusted Medication Appropriateness Index (MAI) score at 6 months. Participants were not blinded to group assignment, but the analysis of outcomes was blinded. Secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year). We analysed the primary outcome in the intention-to-treat population, the missing data being multiply imputed. We analysed outcomes using multi-level regression models, with FP as a random effect. Findings: Between 8 Nov 2016 and 31 Dec 2017, we recruited 117 FPs and 593 of their patients. Mean patient age was 69.7 (2.7) years, 55.8% were women, 60.5% belonged to social classes V-VI, and 28.7% had low self-reported income. In the intention-to-treat analysis, the between-group difference in mean MAI score after 6 months’ follow-up was -2.42 (95% CI -4.27 to -0.59) and between baseline and 12 months’ follow-up was -3.40 (95% CI -5.45 to -1.34). There were no significant differences in another secondary outcomes. Interpretation: The MULTIPAP intervention improved medication appropriateness stably over time. Differences in secondary outcomes were not significant. Clinical Trial Registration: (Clinicaltrials.gov NCT02866799) Funding Statement: This work was supported by the Health Research Fund Coordinated project (grant references PI15/00276, PI15/00572, PI15/00996) from the Institute of Health Carlos III, Spain, and by the Chronic Disease Health Services Research Network (REDISSEC) (grant references RD16/0001/0006, RD16/0001/0005 and RD16/0001/0004) co-funded by the European Regional Development Fund (ERDF) "A way to make Europe". Ethics Statement: The study was approved by the Ethics Committee for Clinical Research of Aragon 199 (CEICA, PI15/0217), was favourably evaluated by the Research Ethics Committee of the Province of Malaga 200 on 25 September 2015 and by the Central Committee of Primary Care Research of the Community of 201 Madrid Declaration of Interests: We declare no competing interest

Background: Stroke is a major global cause of death and disability. Most strokes occur in populations of low-middle-income country (LMIC); therefore, the subsequent disease burden is greater than in populations of high-income countries. Few epidemiological data exist for stroke in Latin America, composed primarily of LMIC. Aims: To determine epidemiological measures of incidence, prevalence, and 1-month case-fatality for stroke in Latin America/Caribbean (LAC) during 1997–2021. Summary of review: A structured search was conducted to identify relevant references from MEDLINE, WOS, and LILACS databases for prospective observational and cross-sectional studies in LAC populations from January 1997 to December 2021. A total of 9242 records were screened and 12 selected for analysis, seven incidence studies and five prevalence studies. Case-fatality was reported in six articles. Sub-group analysis by age, sex, and income countries was performed. A narrative synthesis of the findings was performed. Meta-analysis was performed using random-effect model to obtain pooled estimates with 95% confidence intervals (CIs). Studies quality was assessed according to the risk of bias criteria described in the Joanna Briggs Institute’s guide. The overall crude annual incidence rate of first-ever stroke in LAC was 119.0 (95% CI = 95.9–142.1)/100,000 people (with high heterogeneity between studies ( I2 = 98.1%)). The overall crude prevalence was 3060 (95% CI: 95.9–142.1)/100,000 people (with high heterogeneity between studies ( I2 = 98.8%)). The overall case-fatality at 1 month after the first stroke was 21.1% (95% CI = 18.6–23.7) ( I2 = 49.40%). Conclusion: This review contributes to our understanding regarding the burden caused by stroke in LAC. More studies with comparable designs are needed to generate reliable data and should include both standardized criteria, such as the World Health Organization clinical criteria and updated standard methods of case assurance, data collection, and reporting.

Resumen Antecedentes y objetivo Varios estudios han puesto de manifiesto un cumplimiento terapeutico suboptimo en la poblacion general, sobre todo en ancianos y en enfermos cronicos. El objetivo de este estudio es describir la adherencia al tratamiento de diabetes mellitus, dislipidemia e hipertension arterial, e identificar los factores que la influencian. Material y metodos Estudio observacional transversal retrospectivo sobre 16.208 pacientes mayores de 65 anos de la Cohorte EpiChron, que iniciaron tratamiento en monoterapia de un antidiabetico, un hipolipidemiante o un antihipertensivo en 2010. La adherencia se midio mediante el calculo de la relacion de posesion de medicacion durante un ano de seguimiento, considerandose adherentes los casos con posesion de medicacion ≥80%. Se realizo un estudio descriptivo y un modelo de regresion logistica para identificar los factores predictores de baja adherencia. Resultados La adherencia a los antidiabeticos, antihipertensivos e hipolipidemiantes fue del 72,4; 50,7 y 44,3%, respectivamente. Se observo un aumento en la adherencia del 3-8% por cada enfermedad cronica adicional del paciente. La presencia de enfermedad mental no afecto a la adherencia, y el sexo, edad y numero de farmacos prescritos no presentaron efectos consistentes. Conclusiones Los resultados obtenidos ponen de manifiesto una adherencia al tratamiento suboptima en las enfermedades cronicas estudiadas. La adherencia aumento con el numero de enfermedades cronicas, mientras que sexo, edad y numero de farmacos no presentaron un efecto consistente. Es necesario investigar si existen otros factores que puedan influir en la adherencia terapeutica, ya que su mejora puede tener mayor impacto en la salud que cualquier avance en las terapias.

espanolEste trabajo explica la practica del Skateboarding, entre los grupos de jovenes en la ciudad de Xalapa. A traves de entrevistas a ejecutantes skaters se recupera informacion de este movimiento.Se expone la disertacion para concebirlo entre deporte extremo y movimiento urbano juvenil, esto a partir de la participacion de los promotores y de las caracteristicas particulares de los jovenes skaters; su organizacion, los espacios de practica, sus habilidades sobre la patineta, sus practicas culturales e identidad en relacion al skateboarding, asi como la difusion de sus actividades y los patrocinios. En Xalapa la practica del skaters data de la decada de los ochenta del siglo XX, sin embargo se visibilizo en la primera decada del siglo XXI cuando fue recurrente apreciar a adolescentes de entre 12 y 20 anos ejecutar trucos sobre la patineta en las calles de la ciudad, en parques y demas lugares publicos. Por lo ello en este articulo se precisa, un tipo de jovenes, las relaciones que establecen entre si y con los promotores asi como el futuro del skateboarding en esta ciudad. EnglishIn the city of Xalapa, young people have been skateboarding since the 1980s, although the activity did not become visible until the first decade of 21th century when young people between the ages of 12 and 20 were frequently seen performing tricks on their skateboards in the streets, parks, and other public places. Through the analysis of interviews with skaters, this article gathers information about the skateboarding movement. Based on the way they organize in their practice spaces, their skateboarding skills, their cultural production and identity in relation to skateboarding, the article exposes a conception of skateboarding as an extreme sport or as an urban youth movement. It also examines the relationship between skateboarding and sponsors and promotors of skateboarding activities, and considers its future in the city. catalaA la ciutat de Xalapa la practica del skate data dels anys vuitanta del segle XX, pero, es va visibilitzar en la primera decada del segle XXI quan va ser recurrent veure joves d’entre 12 i 20 anys executar trucs sobre la taula als carrers de la ciutat, en parcs i altres llocs publics. A traves d’entrevistes a executants skaters es recupera informacio d’aquest moviment. S’exposa la dissertacio per concebre-ho com esport extrem o moviment urba juvenil, aixo a partir de l’organitzacio dels joves en els espais de practica, de les seves habilitats sobre el skate, la seua produccio cultural i identitat en relacio amb el skateboarding. A mes es revisa la relacio que guarden amb els patrocinadors i els promotors per a la difusio de les seues activitats, sense perdre de vista el futur del skateboarding en aquesta ciutat.

This study aims to assess the accuracy of temporary employment as indicator or proxy measure of precarious employment. Using sensitivity and specificity analysis, we compared type of contract (temporary versus permanent) with the Chilean version of the multidimensional Employment Precariousness Scale. Temporary employment exhibited very low sensitivity (90%), resulting in roughly 38% of false negative results. Different EPRES-Ch cut-off scores produced similar results. The main implication of these findings is that the public health relevance of precarious employment is being underestimated both in terms of prevalence and of its association with health, making it critical that valid multidimensional measures of precarious employment be implemented.

Este artículo analiza el mecanismo de Debida Diligencia conforme al Pilar II de los Principios Rectores de Naciones Unidas para Empresas y Derechos Humanos, para ello referimos el campo de Empresas y Derechos Humanos, sus principales antecedentes en los Sistemas Internacional e Interamericano de protección de Derechos Humanos y el vínculo con la Agenda 2030. Luego, referimos al concepto de debida diligencia en Derecho Internacional de los Derechos Humanos, identificando las precisiones, diferencias y convergencias cuando se utiliza respecto de las obligaciones de los Estados, y cuando se utiliza en el Pilar II. A continuación, referimos elementos teóricos para comprender el mecanismo de gestión de impactos negativos en los derechos humanos, elementos prácticos y dificultades para aplicarlo en terreno. En las conclusiones exponemos aquellos elementos críticos que obstaculizan la aplicación efectiva conforme al Pilar II que deben hacer las empresas de este mecanismo.

Made available in DSpace on 2019-10-04T12:41:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-07-02 National Health and Medical Research Council of Australia Background-The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence-based processes of care for acute ischemic stroke (AIS) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results-Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0-2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or defect-free care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18-1.65) and better survival (odds ratio, 2.23; 95% CI, 1.62-3.09). Defect-free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0-1) (odds ratio, 1.22; 95% CI, 1.04-1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions-Use of evidence-based care is associated with improved clinical outcome in AIS. Strategies are required to address regional variation in the use of proven AIS treatments. Univ New South Wales, Fac Med, George Inst Global Hlth, Sydney, NSW, Australia Ctr Estudios Clin, Inst Ciencias & Innovac Med, Santiago, Chile Clin Alemana Univ Desarrollo, Fac Med, Serv Neurol, Dept Neurol & Psiquiatria, Santiago, Chile Peking Univ, Hlth Sci Ctr, George Inst Global Hlth, Beijing, Peoples R China Australian Catholic Univ, Nursing Res Inst, St Vincents Hlth Australia Sydney, Sydney, NSW, Australia Univ Cent Lancashire, Fac Hlth & Wellbeing, Preston, Lancs, England Univ Chile, Fac Med, Dept Ciencias Neurol, Santiago, Chile Univ Sao Paulo, Ribeirao Preto Med Sch, Stroke Serv Neurol Div, Ribeirao Preto, Brazil Fukuoka Univ, Fac Med, Dept Prevent Med & Publ Hlth, Fukuoka, Fukuoka, Japan Univ Leicester, Dept Cardiovasc Sci, Leicester Biomed Res Ctr, Leicester, Leics, England Univ Leicester, Natl Inst Hlth Res, Leicester Biomed Res Ctr, Leicester, Leics, England Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland George Inst Global Hlth, Sydney, NSW, Australia Univ Desarrollo, Serv Neurol, Dept Neurol & Psiquiatria Clin Alemana Santiago, Santiago, Chile St Vincents Hlth Australia Sydney, Sydney, NSW, Australia Australian Catholic Univ, Sydney, NSW, Australia Univ Cent Lancashire, Stroke Practice Res Unit, Sch Hlth, Lancashire Clin Trials Unit, Preston, Lancs, England Univ Leicester, Dept Cardiovasc Sci, Cardiovasc Res Ctr, British Heart Fdn, Leicester, Leics, England Univ Kelaniya, Dept Pharmacol, Fac Med, Colombo, Sri Lanka Christian Med Coll & Hosp, Dept Neurol, Ludhiana, India Kaohsiung Med Univ & Hosp, Dept Neurol, Kaohsiung, Taiwan Linkou Chang Gung Mem Hosp, Dept Neurol, Taipei, Taiwan Peking Union Med Coll Hosp, Beijing, Peoples R China Univ Sao Paulo, Ribeirao Preto Sch Med, Ribeirao Preto, Brazil Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia Univ Cent Lancashire, Sch Hlth Sci, Coll Hlth & Wellbeing, Preston, Lancs, England Univ Desarrollo, Santiago, Chile Univ New South Wales, Neurosci Res Australia, Sydney, NSW, Australia Natl Univ Singapore, Dept Pharmacol, Singapore, Singapore Bradford Royal Infirm, Bradford Inst Hlth Res, Leeds, W Yorkshire, England Christian Med College, Ludhiana, Punjab, India RemediumOne Pvt Ltd, Kandy, Sri Lanka Kaohsiung Med Univ, Chung Ho Mem Hosp, Kaohsiung, Taiwan Calvary Publ Hosp Bruce, Bruce, Australia Royal North Shore Hosp, St Leonards, NSW, Australia Royal Prince Alfred Hosp, Camperdown, NSW, Australia Concord Repatriat Gen Hosp, Camperdown, NSW, Australia Fiona Stanley Hosp, Camperdown, NSW, Australia Macquarie Base Hosp, Melbourne, Vic, Australia Univ Sao Paulo, Fac Med Ribeirao Preto, Hosp Clin, Sao Paulo, Brazil Hosp Governador Celso Ramos, Florianopolis, SC, Brazil Sao Paulo State Univ, Hosp Fac Med Botucatu, UNESP, Sao Paulo, Brazil Yangquan Coalmine Grp Gen Hosp, Yangquan, Peoples R China Nanjing Med Univ, Nanjing Hosp 1, Nanjing, Jiangsu, Peoples R China 85 Hosp Peoples Liberat Army, Beijing, Peoples R China Chifeng Univ, Affiliated Hosp, Chifeng, Peoples R China Beijing Pinggu Hosp, Beijing, Peoples R China Wenzhou Med Univ, Affiliated Hosp 1, Wenzhou, Peoples R China Soochow Univ, Affiliated Hosp 2, Suzhou, Peoples R China Hebei Med Univ, Hosp 3, Shijiazhuang, Hebei, Peoples R China Capital Med Univ, Xuanwu Hosp, Beijing, Peoples R China Jining Med Univ, Affiliated Hosp, Jining, Peoples R China Third Peoples Hosp Huizhou, Huizhou, Peoples R China Second Cangzhou Cent Hosp, Cangzhou, Peoples R China Shanghai Jiao Tong Univ, Hosp Affiliated, Sch Med, Shanghai, Peoples R China Baogang Hosp, Baotou, Peoples R China Harbin Med Univ, Affiliated Hosp 1, Harbin, Heilongjiang, Peoples R China Shanghai Jiao Tong Univ Sch, Tong Ren Hosp, Peoples Hosp Hejian City, Shanghai, Peoples R China Peking Univ, Shougang Hosp, Beijing, Peoples R China Guangzhou Med Univ, Affiliated Hosp 3, Guangzhou, Guangdong, Peoples R China Second Hosp Nanchang, Nanchang, Jiangxi, Peoples R China Bethune Int Peace Hosp, Beijing, Peoples R China Hua Henan Prov Peoples Hosp, Beijing, Peoples R China Hua Henan Prov Peoples Hosp, Zhengzhou, Henan, Peoples R China Shanghai Jiao Tong Univ, Sch Med, Shanghai Ninth Peoples Hosp, Shanghai, Peoples R China Shijiazhuang Cent Hosp, Shijiazhuang, Hebei, Peoples R China Hosp Base San Jos de Osorno, Osorno, Chile Christian Med Coll & Hosp, Ludhiana, Punjab, India Unit Narayana Hrudayalaya Ltd, Mazumdar Shaw Med Ctr, Bangalore, Karnataka, India Dr Ramesh Cardiac & Multispecial Hosp Pvt Ltd, Guntur, India Post Grad Inst Med Educ & Res, Chandigarh, India Baby Mem Hosp Ltd, Calicut, Kerala, India Sree Chitra Tirunal Inst Med Sci & Technol, Thiruvananthapuram, Kerala, India Sri Jayawardenepura Gen Hosp, Sri Jayawardenepura Kott, Sri Lanka Colombo North Teaching Hosp, Colombo, Sri Lanka Colombo South Coching Hosp, Colombo, Sri Lanka Linkou Chang Gung Mem Hosp, Taoyuan, Taiwan Taipei Med Univ, Shuang Ho Hosp, Taipei, Taiwan En Chu Kong Hosp, New Taipei, Taiwan Natl Cheng Kung Univ Hosp, Tainan, Taiwan Queen Alexandra Hosp, Portsmouth, Hants, England Portsmouth Hosp NHS Natl Hlth Serv iTrust, Portsmouth, Hants, England Univ Coll London Hosp NHS Fdn Trust, London, England Univ Hosp Birmingham NHS Fdn Trust, Queen Elizabeth Hosp Birmingham, Birmingham, W Midlands, England Southend Univ Hosp NHS Fdn Trust, Southend On Sea, England Kings Coll Hosp London, London, England York Teaching Hosp NHS Fdn Trust, York, N Yorkshire, England Nottingham Univ Hosp NHS Trust, Nottingham, England Blackpool Teaching Hosp NHS Fdn Trust, Blackpool, England Gloucestershire Hosp NHS Fdn Trust, Gloucestershire Royal Hosp, Gloucester, England Teaching Hospi NHS Fdn Trust, London, England Royal Cornwall Hosp NHS Trust, Truro, England Royal London Hosp, Barts Hlth NHS Trust, London, England Sheffield Teaching Hosp NHS Fdn Trust, Sheffield, S Yorkshire, England Cambridge Univ Hosp NHS Fdn Trust, Addenbrookes Hosp, Cambridge, England Royal Victoria Hosp, Belfast Hlth & Social Care Trust, London, England Pinderfields Gen Hosp, Mid Yorkshire Hosp NHS Trust, Wakefield, England Royal Devon & Exeter NHS Fdn Trust, London, England Bradford Teaching Hosp NHS Fdn Trust, Bradford, W Yorkshire, England Great Western Hosp NHS Fdn Trust, Swindon, Wilts, England Watford Dist Gen Hosp, Watford, England Imperial Coll Healthcare NHS Trust, London, England Medway NHS Fdn Trust, Gillingham, England Royal Liverpool & Broadgreen Univ NHS Trust, Liverpool, Merseyside, England Calderdale & Huddersfield NHS Fdn Trust, Huddersfield, W Yorkshire, England Hywel Dda Univ Hlth Board, Haverfordwest, Wales Chesterfield Royal Hosp NHS Fdn Trust, Calow, England Luton & Dunstable Univ Hosp NHS Fdn Trust, Luton, Beds, England Countess Chester Hosp NHS Fdn Trust, Chester, Cheshire, England Peterborough City Hosp, Peterborough, Cambs, England Univ Hosp Leicester NHS Trust, Leicester Royal Infirm, Leicester, Leics, England Dist Hosp NHS Fdn Trust, London, England Barnsley Hosp NHS Fdn Trust, Barnsley, England Dorset Cty Hosp NHS Fdn Trust, Dorchester, England Royal Bournemouth & Christchurch Hosp NHS Fdn Tru, Royal Bournemouth Hosp, Bournemouth, Dorset, England Southern Hlth & Social Care Trust, Craigavon Area Hosp, Portadown, England United Lincolnshire Hosp NHS Trust, Pilgrim Hosp, Lincoln, England Bedford Hosp NHS Trust, Bedford, England Sao Paulo State Univ, Hosp Fac Med Botucatu, UNESP, Sao Paulo, Brazil National Health and Medical Research Council of Australia: 1066966

The adenoma detection rate (ADR) is the main quality indicator of colonoscopy. The ADR recommended in fecal immunochemical testing (FIT)-based colorectal cancer screening programs is unknown.Using the COLONPREV (NCT00906997) study dataset, we performed a post-hoc analysis to determine if there was a correlation between the ADR in primary and work-up colonoscopy, and the equivalent figure to the minimal 20% ADR recommended. Colonoscopy was performed in 5722 individuals: 5059 as primary strategy and 663 after a positive FIT result (OC-Sensor™; cut-off level 15 µg/g of feces). We developed a predictive model based on a multivariable lineal regression analysis including confounding variables.The median ADR was 31% (range, 14%-51%) in the colonoscopy group and 55% (range, 21%-83%) in the FIT group. There was a positive correlation in the ADR between primary and work-up colonoscopy (Pearson's coefficient 0.716;ADR in primary and work-up colonoscopy of a FIT-positive result are positively and significantly correlated.

Purpose To describe the characteristics of new users of cilostazol in Europe with the aim to support the evaluation of its benefit/risk as used in regular clinical practice before the implementation of labeling changes recommended by the European Medicines Agency. Methods New users of cilostazol were identified in populations enrolled in five European health automated databases in the UK (The Health Improvement Network [THIN]), Spain (EpiChron cohort and Information System for the Improvement of Research in Primary Care [SIDIAP]), Sweden (National Registers), and Germany (German Pharmacoepidemiological Research Database [GePaRD]) between 2002 and 2012. New users were characterized according to the prevalence of cardiovascular disease and other comorbidities, concurrent use of interacting medications, new contraindications, duration of use, and potential off‐label prescribing. Results We identified 22 593 new users of cilostazol. The median age was between 68.0 (THIN) and 73.7 (Sweden) years. More than 78% of users had concomitant cardiovascular disease, and between 78.8% (GePaRD) and 91.6% (THIN) were treated with interacting medications. Prevalence of new cardiovascular contraindications ranged from 1.5% (THIN) to 11.6% (GePaRD), and concurrent use of two or more antiplatelet drugs ranged from 6.3% (SIDIAP) to 13.5% (EpiChron cohort). Between 39.4% (Sweden) and 52.9% (THIN) of users discontinued cilostazol in the first 3 months. Between 41.0% (SIDIAP) and 93.4% (THIN) were considered to have received cilostazol according to the European Medicines Agency labeling. Conclusions In this collaborative European study, most cilostazol users were elderly patients with a high prevalence of cardiovascular diseases and other comorbidity and concurrent use of interacting drugs, indicating that this is a vulnerable population at high risk of complications, especially cardiovascular events. © 2017 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

Background: There is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT). Objectives: To evaluate the performance of this test at distinct positivity cut-offs in a population -based colorectal cancer (CRC) screening program. Methods: CRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40 tig Hb/g) respect to a reference value (15 tig Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013). Results: At the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women 60 years increasing cut-off at 25-30 tig Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40 tig Hb/g (CRC miss rate 25%). Conclusions: To improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1(∗)04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10(-43)) and HLA-DQα1 47 (p = 4.02 × 10(-46)), 56, and 76 (both p = 1.84 × 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 × 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function.

We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 x 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DR beta 1 and HLA-DQ alpha 1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1*04. An omnibus test on polymorphic amino acid positions highlighted DR beta 1 13 (p = 4.08 x 10(-43)) and HLA-DQ alpha 1 47 (p = 4.02 x 10(-46)), 56, and 76 (both p = 1.84 x 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 x 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 x 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 x 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function.

ntroducción . Los estudiantes universitarios tienen relaciones sexuales coitales a temprana edad con múltiples parejas sexuales, practicando diversas modalidades como: sexo casual, transaccional y grupal, que los hace vulnerables a embarazarse y adquirir infecciones de transmisión sexual. Método . Se llevó a cabo un estudio transversal a 1854 estudiantes universitarios del área de la salud, (medicina, enfermería, odonto logía y psicología) de dos universidades públicas del Estado de México, entre 18 y 24 años, estableciendo asociación por medio de X 2 con el inicio temprano de relaciones sexuales coitales, el número de parejas sexuales, llevar a cabo sexo grupal, transacc ional y casual. Resultados . Los hombres iniciaron relaciones sexuales coitales a menor edad que las mujeres. En los hombres se observa asociación ( p =.001) entre el inicio temprano de relaciones sexuales coitales con llevar a cabo sexo casual, transaccional y grupal. En las mujeres se asocia el inicio temprano de relaciones sexuales con sexo casual y con mayor número de parejas sexuales con diferencias estadísticamente significativas. Conclusión . Los estudiantes que tienen relaciones sexuales coitales a temp rana edad, tienen más parejas sexuales y llevan a cabo sexo casual, transaccional y grupal que los hace vulnerables a adquirir infecciones de transmisión sexual así como embarazos no planeados.

The purpose of this study was to assess the self-determination of Spanish high school students with Intellectual Disability and other Special Educational Needs (SEN). A total of 371 students between 11 and 17 years of age participated in the study. Of these, 46.4% (n=171) presented SEN, specifically learning disabilities (n=97; 26.2%), borderline and intellectual disability with higher IQ scores (n=43; 11.6%) and mild intellectual disability (n=32; 8.6%). The remaining students without SEN made up the control group. The assessment was carried out using a translated and validated Spanish version of The Arc’s Self-Determination Scale (Wehmeyer, 1995). This measure had appropriate psychometric properties. Students with SEN obtained significantly lower scores than their peers without SEN. However, no differences were found in relation to the type of SEN or, more specifically, in relation to the presence of intellectual disability. The educational implications of the results are discussed.

Objective: To examine immunogenetic and clinical features in a series of patients with the idiopathic tubulointerstitial nephritis and uveitis (TINU) syndrome diagnosed at the single referral hospital for a defined population in Southern Spain. Patients and Methods: Retrospective study of the case records of all patients diagnosed with the TINU syndrome in the Departments of Ophthalmology and Medicine of the Valme University Hospital (Seville, Spain) from January 1996 through October 2000. Patients were included in this study if they had a renal biopsy showing interstitial edema and infiltration by lymphocytes, plasma cells, macrophages, eosinophils, and neutrophils. In these cases fibrosis was occasionally seen, but no glomerular changes were found. In addition, a diagnosis of uveitis by expert ophthalmologists was always required. Underlying diseases, which might be responsible for the renal or ocular manifestations, were excluded. Patients were HLA-DRB1 genotyped from DNA by using molecular-based methods. Results: Six patients (4 females) fulfilled the definitions described above. Four were younger than 18 years. In addition to tubulointerstitial nephritis, non-granulomatous uveitis (anterior or panuveitis) associated with low visual acuity was present at the time of diagnosis. Leukocytosis and increase of acute phase reactants were also commonly observed at the time of diagnosis. Topical and oral corticosteroids were prescribed to all the patients. Cyclosporine A therapy was required in 2 cases. After a 2.5-year median follow-up, visual acuity had improved in all cases. Of note, 4 of 6 patients carried the HLA-DRB1*01 allele. Conclusion: The TINU syndrome should be considered in the differential diagnosis of patients presenting with visual and renal manifestations. The presence of renal dysfunction in patients with uveitis may be of some help, as a warning sign, for the recognition of patients who require a rapid diagnosis and therapy. In Southern Spain, the TINU syndrome appears to be associated with HLA-DRB1*01 allele. Semin Arthritis Rheum 32:125-129. Copyright 2002, Elsevier Science (USA). All rights reserved.

In a Liminal Space: The Novellas of Emilia Pardo Bazan. By Julia Biggane. U of Durham: Durham Modern Languages Series, 2000. 164 pages. Julia Biggane's concise, well organized and highly readable In a Liminal Space: The Novellas of Emilia Pardo Bazan is a welcome addition to Pardo Bazan studies. Biggane's monograph analyzes the twenty-one novelas breves that were produced by dona Emilia largely in the last two decades of her career, works that have been subject to "continued critical neglect," due, in part, the author suggests, to "anxiety about the indeterminacy and marginality of the early novella in Spain" (8). Biggane tackles much in a disciplined way. Her analysis of each of the novellas focuses on thematic, structural and, in particular, narratological issues; her point of departure for the latter is the work of Gerard Genette and Mieke Bal, which she summarizes clearly, and applies effectively throughout the book in language refreshingly free of jargon. In a Liminal Space is also valuable for its brief overview of evocative critical studies on the novella genre. For the author, the most satisfying approach to the elusive novella is Jean-Marie Schaeffer's foregoing of generic systematization for the concept of process: "Concentrating on genre as a process," writes Biggane, "allows for difference, change, and semantic flexibility, whilst acknowledging that novellas need also to be read in relation to (sometimes normative) `generic intertexts'" (10). Biggane concludes that the novellas written in Spain between 1860 and 1910 are examples of a "processive identity of genre" (10), whereas the novela breve published in the magazines El Cuento Semanal, Los Contemporaneos, El libro popular, and La Novela Corta, hugely popular from 1907 to the mid-1920's in Spain, exhibits a "more stable identity" (11) since it conforms to a much more rigid mold imposed by the exigencies of the publishing world and the reading public. The great majority of Pardo Bazan's novellas (fifteen out of the twenty-one) appeared in these publications. Although an overview of Pardo Bazan's novella production is problematic, the aims of In a Liminal Space are to stimulate research in this area. Study of Pardo Bazan's short novel corpus is particularly relevant considering her clear inclination towards shorter fiction. One need only recall dona Emilia's sense of narrative economy expressed in an unpublished letter to Perez Galdos studied by this reader: she gently criticized the chapter on the growth of Madrid commerce at the beginning of Fortunata and Jacinta as unnecessary to the plot. Equally valuable and fascinating for any specialist of fin-de-siecle Spanish literature, is Biggane's study in the third chapter of the social and cultural phenomenon that the rise of mass-market publications devoted to short fiction represented in early twentieth-century Spain. These magazines flourished for various reasons, among them the rapid change in technological, and educational development, and the growing shift of the population to urban centers. The consistent editorial emphasis on quality flattered the readership, "a new reading class with limited income and leisure time" (80), thereby promoting a new genre--different from the novel, which was still relatively expensive, and still associated, as Biggane notes, with the leisured upper-middle classes. An additional feature of this chapter is the author's overview of Perez de Ayala's contributions (about a dozen novelas breves) to the mass-market magazines as a point of comparison with Pardo Bazin's novellas. The fact that Perez de Ayala made substantial changes to some of his novelas breves when they were later published in book form, seems to indicate that he was writing for two different readerships, a view that applies to dona Emilia as well. …

Behcet's disease (BD) is an immuno-mediated vasculitis in which knowledge of its etiology and genetic basis is limited. To improve the current knowledge, a genetic analysis performed with the Immunochip platform was carried out in a population from Spain. A discovery cohort comprising 278 BD cases and 1,517 unaffected controls were genotyped using the Immunochip platform. The validation step was performed on an independent replication cohort composed of 130 BD cases and 600 additional controls. The strongest association signals were observed in the HLA class I region, being HLA-B*51 the highest peak (overall P = 6.82E-32, OR = 3.82). A step-wise conditional logistic regression with classical alleles identified HLA-B*57 and HLA-A*03 as additional independent markers. The amino acid model that best explained the association, includes the position 97 of the HLA-B molecule and the position 66 of the HLA-A. Among the non-HLA loci, the most significant in the discovery analysis were: IL23R (rs10889664: P = 3.81E-12, OR = 2.00), the JRKL/CNTN5 region (rs2848479: P = 5.00E-08, OR = 1.68) and IL12A (rs1874886: P = 6.67E-08, OR = 1.72), which were confirmed in the validation phase (JRKL/CNTN5 rs2848479: P = 3.29E-10, OR = 1.66; IL12A rs1874886: P = 1.62E-08, OR = 1.61). Our results confirm HLA-B*51 as a primary-association marker in predisposition to BD and suggest additional independent signals within the class I region, specifically in the genes HLA-A and HLA-B. Regarding the non-HLA genes, in addition to IL-23R, previously reported in our population; IL12A, described in other populations, was found to be a BD susceptibility factor also in Spaniards; finally, a new associated locus was found in the JRKL/CNTN5 region., This work was supported by Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III (ISCIII, 13/01118), Fondos FEDER and Plan Andaluz de Investigación (CTS-0197). LOF is the recipient of a fellowship (ISCIII, FI11/00547) and FDC was funded by the RETICS Program (RIER, ISCIII, RD12/0009/0013). Instituto de Salud Carlos III Junta de Andalucía Red de Investigación en Inflamación y Enfermedades Reumáticas (España) RIER