Resumen Introducción La salud y la inequidad menstrual no han sido bien atendidas en las esferas social, económica, sanitaria y política. Aunque la evidencia disponible es escasa, ya sugiere un ...vínculo entre experiencias de inequidad menstrual (relativa a las dificultades sistemáticas para el acceso a la salud y educación menstrual, productos menstruales y espacios de manejo menstrual, entre otros aspectos) y la salud menstrual. El objetivo de este estudio fue explorar las experiencias de salud e inequidad menstrual en mujeres y personas que menstrúan (18–55 años) en Barcelona y alrededores (España). Métodos Estudio cualitativo desde una perspectiva feminista crítica. El muestreo fue intencionado y selectivo. El reclutamiento se realizó en centros de salud sexual y reproductiva, redes sociales y a través de técnicas de bola de nieve. Se realizaron 34 entrevistas semi-estructuradas utilizando foto-elicitación, entre diciembre de 2020 y febrero de 2021. Las entrevistas se llevaron a cabo en centros de salud sexual y reproductiva, espacios públicos y por teléfono. Los datos se analizaron mediante Análisis Temático Reflexivo. Resultados Se identificaron tres categorías: “Descuido sistemático de la menstruation y el cycle menstrual”, “Candy “lo privacy” se vuelve public: manejo menstrual” y “Navegando la salad menstrual: entree la medicalización y la agencia”. Las participantes compartieron diversas experiencias de inequidad menstrual. Diversas participantes compartieron experiencias de pobreza menstrual, al no poder acceder o escoger productos menstruales debido a su precio y disponibilidad. Según las participantes, los aprendizajes menstruales son escasos. Estos suelen darse a través de la experiencia propia y el autoaprendizaje, o de familiares y amigas. La menstruación y el ciclo menstrual parecen tener un impacto significativo en el día a día, incluyendo el impacto de tener que ocultar la menstruación y las barreras para manejar la menstruación en los espacios públicos. Se identificaron barreras para acceder y utilizar el sistema sanitario. Las participantes también reportaron la prescripción sistemática de anticonceptivos hormonales como panacea para abordar la salud menstrual. Conclusiones Es necesario desarrollar e implementar políticas estructurales y multidimensionales para promover la agencia de las mujeres y personas que menstrúan, así como de las comunidades, para generar oportunidades para aprender sobre la menstruación, acceder a productos menstruales y servicios de atención sanitaria, así como a espacios adecuados para el manejo menstrual. Fomentar la formación de profesionales de la salud es también crucial para mejorar el acceso y la calidad de la servicios para la salud menstrual. Estas políticas deben incluir a las personas trans y no binarias, así como a poblaciones más vulnerables.
With the advent of parallel processors for embedded systems, it is very important to design new runtime and system features so that embedded software developers can take advantage of the increased ...throughput and responsiveness without the hindrances of low-level synchronization and data sharing. In this paper, we design and implement a fully-prioritized, work-conserving, and event-driven parallel computing runtime on Responsive MultiThreaded Processor (RMTP), a simultaneous multi-threading (SMT) processing platform with priority for real-time systems, which implements hardware-based resource allocation and context switching. The proposed runtime achieves low-cost forks and fine-grained prioritized scheduling by using special-purpose hardware functionalities on the RMTP, and also reduces resource over-subscription penalties while allowing for dynamic parallelism by employing a continuation-stealing execution strategy. We evaluate the performance of the proposed system with a set of benchmarks derived from the MiBench suite, and show that meaningful speedup can be achieved even when the degree of parallelism at each level is dynamically varied.
In November 2018, the FDA approved the use of venetoclax combined with hypomethylating agents (HMA) or low-dose cytarabine (LDAC) in patients with newly diagnosed acute myeloid leukemia (AML) of age ...≥ 75 years, or with comorbidities that preclude the use of intensive chemotherapy. However, the evidence in relapse/ refractory (R/R-AML) patients is scarce.
To analyze the efficacy and safety of the off-label use of venetoclax in patients with R/R-AML.
Retrospective, multicenter, observational study in 5 hospitals from Castilla y León region, Spain.
All data were collected from patients' medical records and included: concomitant diseases, main baseline characteristics, prior treatment and the response obtained, startend date of venetoclax, dose and combination.
rates of CR/CRi (complete remission/complete remission with incomplete hematologic response, overall survival (OS), hematological toxicity, mortality.
We included 10 patients (8 men/ 2 women), median age 73.5 (41-78) years, and ECOG <2 at diagnosis. 55.5% belonged to the high-risk prognostic group according to European LeukemiaNet 2017. 55.5% received intensive first-line chemotherapy and 60% received ≥2 (1-3) previous lines. 2 patients received a previous transplant, and 6 received previous treatment with HMA. Prior to venetoclax, 50% of patients had ECOG ≥2. Median venetoclax treatment duration was 27 (0 – 62) days. Venetoclax was administered with azacitidine (75 mg/m2 – 7d) in 60% of patients, with decitabine (20 mg/m2 - 5d) in 30% and with LDAC (20 mg/m2- 10d) in 10%. Only 10% of patients achieved CR/CRi. Of the remaining, only 20% received subsequent salvage therapy. Within a median follow-up time of 39 (2-147) days, 70% of the patients died. Median OS from diagnosis was 15 months (95% CI 9.7 – 20.3) and from the start of venetoclax was 49 days (95% CI: 31.8 – 66.2). One patient discontinued treatment due to hematological toxicity.
In the R/R-AML setting, the rate of CR/CRi and OS of venetoclax combination treatment is low. However, the patients included had very poor prognosis. These results show a real-world evolution of patients without being included in clinical trials under strict inclusion criteria that diminish the selection of patients. Further research is warranted.
Background Menstrual products are necessary goods for women and people who menstruate to manage menstruation. Understanding the use and perceptions of menstrual products is key to promote menstrual ...equity and menstrual health. This study aimed at assessing the use and perceptions on menstrual products among women and people who menstruate aged 18–55 in Spain. Methods A mixed-methods study was conducted, including a cross-sectional study (N = 22,823), and a qualitative study (N = 34). Results Participants used a combination of products. Non-reusable products were the most used, while over half used reusable products. Usage changed when data were stratified by age, gender identification, completed education, country of birth and experiencing financial issues. It also varied between trans and cis participants. Menstrual products’ use also shifted based on experiences of menstrual poverty and access to information and products. Overall, reusable products were perceived to be more acceptable than non-reusable. Barriers to use the menstrual cup were also identified, including experiences of menstrual inequity (e.g., menstrual poverty, lack of access to information or menstrual management facilities). Conclusion Perceptions and choices of menstrual products need to be acknowledged, especially when designing and implementing menstrual policies to address menstrual inequity and menstrual health.
Sobre «Homofobia y/o ser enfermero Rodríguez López, Tomás
Revista de Ciencias Médicas de Pinar del Río,
02/2012, Letnik:
16, Številka:
1
Journal Article
Community-based tourism in Cape Verde - a case study López-Guzmán, Tomás; Borges, Osvaldo; Castillo-Canalejo, Ana María
Tourism and hospitality management,
06/2011, Letnik:
17, Številka:
1
Journal Article, Paper
Recenzirano
Odprti dostop
Community-based tourism is taking its place in the world as an alternative to traditional tourist destinations, especially in developing countries. This form of tourism allows for greater contact ...with the local community and for the tourist to experience new sensations while enabling the economic and social development of the geographic area. In this paper, the results of fieldwork carried out in the island of Fogo (Cape Verde) are presented, assessing the opinion and perception tourists visiting this island have of both the quality of the services offered by community-based tourism enterprises, as well as the potential of the tourism resources in the area. The main results of the investigation endorse the quality of services offered to tourists by local businesses and highlight the hospitality of the local community, a key element for the development of this kind of tourism, particularly in different african countries. Similarly, it highlights the passenger satisfaction with services received and the need to strengthen the training to tourism staff through aid, for example, international cooperation, NGOs and universities. The originality of this research comes from analysis of the demand made on a concrete island of Cape Verde, a country which is producing a huge economic development through the tourism sector.
Introducción y Objetivos. De un heterogéneo conjunto compuesto por 30 prototipos nasales seleccionamos deliberadamente 10 que presentaban perfil con óptima definición del dorso y piel de grosor ...intermedio con el fin de investigar sistemáticamente, en estos últimos, al segmento inicial del borde superior de la rama alar externa y al tramo distal del borde anterior del cartílago triangular. Material y Método. Mediante disecciones rutinarias, realizamos el análisis con material de individuos adultos, de ambos sexos y raza blanca, previamente formolizado. Resultados. Identificamos sus características regulares y según diferencias encontradas en el resto del material disponible, 20 prototipos, intentamos posteriormente una clasificación pertinente. Conclusiones. Esta secuencia analítica nos orientó hacia el principal objetivo de nuestro trabajo, o sea, demostrar con propiedad que el singular comportamiento entre ambos elementos cartilaginosos configura, invariablemente, un profundo ángulo promotor de suficiente proyección en el perfil cutáneo del tercio inferior nasal.
Introduction:
Given that there is no large case-series, effect of pregnancy on the course of pre-existing primary immune thrombocytopenia (ITP) patients is unclear1,2. Furthermore, outcome predictors ...evidence of neonates born to mothers with ITP is very scarce1. Due to obvious ethical reasons, no clinical trial regarding ITP and pregnancy has been reported until recent days3. Nevertheless, the relationship between ITP and pregnancy is considered a “trending topic” nowadays. As it is the, until now, unknown safety and efficacy of new drugs as TPO mimetics in this setting3-6.
Aims:
To evaluate outcome and global management of pregnancy and delivery on ITP women an on their offspring.
Methods:
Primary ITP was defined as a platelet count < 100 x 109/L in the absence of other causes or disorders that may be associated with thrombocytopenia.
All women diagnosed of primary ITP from 2011 to 2016 in 24 Spanish Hematology Departments who had at least one pregnancy after ITP onset were included in this registry.
Results:
We included 297 primary ITP pregnancies from 204 women. At pregnancy diagnosis, we observed a majority of chronic ITP cases (71.9 %). At ITP diagnosis, median age of our case-series was 23 years (IQR, 18-31) and median platelet count was 18 x 109/l (IQR, 6-36). Median time from ITP diagnosis to pregnancy was 162 months (IQR, 0-364). Median number of pregnancies prior to ITP diagnosis was 1 (IQR, 0-2) with 1 pregnancy (IQR, 1-2) after ITP diagnosis as a median.
51.6% of women received corticosteroids, immunoglobulins (IVIG) (16.6%), rituximab (7.1%) and/or splenectomy (8.7%) as ITP treatments between or before new pregnancies. On the other hand, 26.5% of women needed treatment for ITP during pregnancy, mainly steroids (13.9%) and IVIG (10.2%).
The median platelet-count nadir during pregnancy was 73 x 109/l (IQR, 31-174). 135 (45.4%) pregnancies had less than 50 x 109 platelets/l with 77 (25.9%) with less than 30 x 109 platelets/l. 57 women (19.2%) exhibited hemorrhagic symptoms, being 30 (10.1%) of them severe bleedings.
Regarding type of delivery, this was vaginal in 187 (62.9%) of pregnancies. Median platelet count at delivery was 111 x 109/l (IQR, 70-187). 47 patients (15.8 %) experienced 60 bleeding episodes. We only observed 52 cases (19.5%) of neonatal thrombocytopenia among 266 living newborns.
Conclusions:
Our results are comparable to previously reported1,2. No severe bleeding complications during pregnancy and/or delivery were observed in our study. Rate of neonatal thrombocytopenia, and therefore, newborn bleeding is low.
No relevant conflicts of interest to declare.
Introduction:Renal impairment (RI) is a common complication of multiple myeloma (MM). Almost 20% of patients (pts) present with RI at diagnosis, while approximately 40%-50% of pts will develop RI ...during the course of their disease. However, there is little information on the renal response of pts with relapsed refractory MM (RRMM) receiving treatment with new drugs in clinical practice.
Aims: This is an observational, prospective, multicenter study conducted in pts with RRMM and RI (defined as an estimated glomerular filtration rate eGFR < 50 mL/min) to evaluate renal response to the administered therapy in pts with moderate (creatinine clearance CrCl 30-50 mL/min) or severe (CrCl < 30 mL/min) RI. Secondary objectives include MM response rate, overall survival, safety, and health resource utilization. We present results from an interim analysis 4 mos after completion of the inclusion period (cutoff: June 13, 2016).
Methods:Renal and MM responses were evaluated according to International Myeloma Working Group criteria. Both eGFR by the Cockroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas were compared to analyze renal response.
Results:Overall, 312 pts (mean ± SD age 75 ± 9 yrs, 50% male, 57% in first relapse) were included in the study; 217 (70%) had moderate and 95 (30%) had severe RI, respectively. Anti-myeloma therapies administered were lenalidomide (LEN; 35% of pts), bortezomib (BORT; 21%), different chemotherapy regimens (CT; 22%), and other non-CT treatments (22%). Median follow-up was 7 mos (range, 0-39 mos). To date, 123 pts (39%) have discontinued treatment, 12% due to adverse events (AEs), and 37% have died. The main causes of death were disease progression (8.3%) and infections (6.4%). The mean baseline eGFR according to CG and MDRD formulas was 38.7/41.7 (± 8.5/11.8) mL/min in the moderate RI subgroup and 20.3/20.1 (± 8.0/10.1) mL/min in the severe RI group, with a strong correlation (coefficient 0.91) between the CG and MDRD eGFR. Overall, 13.5% (95% CI, 9.7%-17.2%) of patients had a renal response (5.8% renal complete response renalCR, 0.3% renal partial response renalPR, and 7.4% renal minor response renalMR) according to the CG formula while responses measured by the MDRD formula, were 17.3% (9.9% renalCR, 0.3% renalPR, and 7.1% renalMR). Median time to best renal response was 1.8 mos (range, 0.5-8.9 mos). After adjusting for demographic and clinical characteristics, there were no significant differences in GFR improvement between pts receiving LEN- and BORT-based treatments (P = 0.706). Arterial hypertension and female sex were statistically significantly associated with poor renal response. The overall MM efficacy response rate (≥ PR) was 33.4%, achieved after a median of 3.4 mos (range, 0.07-37.8 mos). For pts receiving BORT and LEN, respectively, the overall response rates were 43.5% and 44.8%, whereas only 23% of pts receiving CT achieved at least PR. Progression-free survival was 13.3 mos with LEN-based, 6.8 mos with BORT-based, and 7.5 mos with CT-based therapies (P = 0.006).
Conclusions: Preliminary results of this study in pts with RRMM and RI show that LEN- and BORT-based therapies are the regimens most commonly used in clinical practice in these pts. Overall, these therapies can improve RI in approximately 13% of cases, with no differences seen in renal function improvement between LEN- and BORT-based treatments.
De La Rubia:Amgen, Bristol Myers, Celgene, Janssen: Consultancy. Morales:Celgene: Consultancy. García-Muñoz:Celgene, Roche: Consultancy. Duran:Celgene: Employment.
This paper presents a fieldwork-based analysis on the sociodemographic characteristics, travel arrangements, motivations and travel experience evaluation of tourists visiting Quito, Ecuador. The ...results of this research show differences in the profile of tourists in terms of travel arrangements, their motivation and their evaluation of the destination, based on tourists’ geographical origin. The main practical implication of this research is to better understand the characteristics of tourists who visit Quito, with the purpose of designing cultural and touristic products that meet the needs of different groups of travelers.
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