Objective
We assessed the prevalence of bullying and cyberbullying in 12–16‐year‐olds and the association with student self‐reports after a police informative talk.
Design
We used a survey to assess ...the impact of the intervention: 1458 high school students received a police informative talk during the 2018–2019 school year and completed the self‐administered EBIP‐Q and ECI‐Q questionnaires. Perceptions of conduct and bystanders' attitudes were assessed. Correspondence indexes were calculated using Cohen's kappa and gender differences studied using logistic regression.
Results
81.34% (95% CI: 79.33–83.34) of students were involved in bullying and 54.75% (95% CI: 52.19–56.76) in cyberbullying. Almost 90% of participants did not perceive their real bullying correctly. Girls were more frequently victims of bullying and cyberbullying (OR = 1.67 and OR = 1.22, p = .004), but more frequently self‐reported being bullies or victim/bully (OR = 0.57 and 0.39, p < .05). Male bystanders reported 7.33% (p < .001) more feelings of inadequacy than girls when witnessing bullying.
Conclusion
Poor self‐reporting reflects poor understanding of bullying and cyber‐bullying. Police information sessions might produce the opposite reactions in adolescents, as they reduce bullying to visible, harmful violence. Educators should focus on adolescent relationships rather than violence prevention. A friendly, male‐targeted approach is needed.
Background: Predictive biomarkers of response to chemotherapy plus antiangiogenic for metastatic colorectal cancer (mCRC) are lacking. The objective of this study was to test the prognostic role of ...splenomegaly on baseline CT scan. Methods: This study is a sub-study of PRODIGE-9 study, which included 488 mCRC patients treated by 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) and bevacizumab in first line. The association between splenic volume, and PFS and OS was evaluated by univariate and multivariable Cox analyses. The relation between circulating monocytic Myeloid derived suppressor cells (mMDSC) and splenomegaly was also determined. Results: Baseline splenic volume > 180 mL was associated with poor PFS (median PFS = 9.2 versus 11.1 months; log-rank p = 0.0125), but was not statistically associated with OS (median OS = 22.6 versus 28.5 months; log-rank p = 0.1643). The increase in splenic volume at 3 months had no impact on PFS (HR 0.928; log-rank p = 0.56) or on OS (HR 0.843; log-rank p = 0.21). Baseline splenic volume was positively correlated with the level of baseline circulating mMDSC (r = 0.48, p-value = 0.031). Conclusion: Baseline splenomegaly is a prognostic biomarker in patients with mCRC treated with FOLFIRI and bevacizumab, and a surrogate marker of MDSC accumulation.
Background: The clinical epidemiology of immune thrombocytopenia (ITP) is not well known. Some issues (bleeding events at diagnosis, association to other autoimmune diseases, rate of infection prior ...to ITP onset) are not well described in adults. Little is known as regards first-line treatment choice in the real-life practice.
Aim: The aims of this study were to assess i) the clinical epidemiology of incident ITP adults; ii) the use of first-line treatments in this population; and iii) the factors associated with the initial use of intravenous (IV) corticosteroids (CS) and of intravenous immunoglobulin (IVIg) in a real-life setting. This study was carried out on behalf of the French national center for autoimmune cytopenia and the French national center for rare diseases in immunohematology.
Methods: Study population was the patients included between June 2013 and December 2014 in the CARMEN (Cytopénies Auto-immunes : Registre Midi-PyréneEN) multicenter registry. This multicenter registry is carried out on behalf of the French national center for autoimmune cytopenia and the French national center for rare diseases in immunohematology. The originalities of this registry are: the prospective follow-up of newly diagnosed ITPs, aimed at completeness of recording in the French Midi-Pyrénées region, South of France (3 million inhabitants), and the detailed recording of ITP treatment exposures. All the physicians in charge of ITP patients in the region, belonging to the netwotk of the regional center for autoimmune cytopenia, prospectively follow every patient newly diagnosed for ITP during routine visit or hospital stay. ITP is defined in accordance with French guidelines: platelet count <150 x 109/L and exclusion of other causes of thrombocytopenia. In this study, we assessed the clinical epidemiology at ITP onset, as well as ITP treatment use during the week following the diagnosis. Logistic regression models were performed to assess the factors associated with the use of IV CS and of IVIg. The following covariates were included: age, gender, Charlson's comorbidity score, secondary vs. primary ITP, bleeding score and platelet count.
Results: Out of 121 newly diagnosed ITP, 113 patients were followed in the region and gave informed consent. Median age was 65 years (range: 18-95). Half of the patients were female, 24 (21.3%) had a secondary ITP, 57 (50.4%) had a Charlson's score ≥1, median platelet count was 17 x109/L (range: 1-126); 57 (50.9%) had bleeding symptoms, including 2 severe gastro-intestinal tract and 1 intracranial bleeding. Median Khellaf's bleeding score was 5 (range: 0-35). Twenty-five (21.4%) patients had another autoimmune disease (mostly: Hashimoto's thyroiditis, n=6, Sjögren syndrome, n=5, Evans syndrome, n=3) and 23 (20.3%) experienced an infection within the six weeks before ITP onset (including 8 influenza-like and 3 gastro-enteritis like syndromes, the others being various bacterial infections). Sixty-eight (60.2%) patients were treated during the week following the diagnosis. Among them, 66 (98.5%) received CS (median dose: 0.99 mg/kg/d), including 21 (31.3%) IV CS, 29 (43.3%) IVIg, 8 (11,9%) platelet transfusion, 2 romiplostim and 1 rituximab. The factors associated with the use of IV CS were secondary ITP (OR: 5.91; 95% CI: 1.78-19.71) and Khellaf's bleeding score >8 (OR: 4.09; 95% CI 0.96-17.35). Those associated with the use of IVIg were Khellaf's bleeding score >8 (OR: 7.30; 95% CI 1.36-32.27) and platelet count <10 x 109/L (OR: 3.95; 95% CI 1.77-13.29).
Conclusions: This prospective cohort of newly diagnosed ITP adults confirms that severe bleeding is rare at ITP onset. Associated autoimmune diseases and recent infections are frequent. IVIg and IV CS were frequently used, particularly in case of severe bleeding.
Godeau:Roche: Research Funding; Amgen: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Adoue:LFB: Other: Symposium presentations ; OCTAPHARMA: Other: Symposium presentations ; ACTELION: Other: Symposium presentations ; PFIZER: Other: Symposium presentations ; AMGEN: Other: Symposium presentations ; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; GSK: Other: Symposium presentations.
Resumen La formación de futuros profesionales enfermeros debe reforzar el dominio de competencias en promoción de la salud comunitaria. En la fase final del plan de estudios, el estudiantado ...universitario elabora el Trabajo Final de Grado orientado a evaluar las competencias de la titulación. El Aprendizaje-Servicio se incorpora como una modalidad, en la que se ha de realizar un diario reflexivo, siendo la reflexión una parte esencial en el desarrollo académico y profesional. El estudiantado participante de proyectos de Aprendizaje-Servicio, realiza un aprendizaje competencial, que supone un compromiso con la comunidad repercutiendo en un desarrollo personal y profesional, que implica un sentido ético y de responsabilidad social en contacto directo con la comunidad.
A Geografia tornou-se numa disciplina relevante para o desenvolvimento de competências cruciais numa sociedade que se vê cada vez mais assolada pelas consequências das ações humanos contrárias à ...sobrevivência do planeta. É com esta particular responsabilidade que, na Escola do século XXI, conhecimento, capacidades e atitudes devem ser estimulados pelos docentes. É preciso construir um Olhar Geográfico, que identifique os Riscos e contribua para a correta mitigação das suas consequências, bem como, prepare os jovens para o seu futuro. Foi nesta perspetiva que o Relatório foi redigido, descrevendo e discutindo uma sequência didática sobre os Riscos Mistos, implementada no âmbito do Mestrado em Ensino de Geografia da Universidade de Lisboa, na Escola Secundária Manuel de Arriaga, numa turma do 9º ano de escolaridade. Debate-se brevemente a relevância da Geografia dos Riscos nos Açores, apresenta-se a planificação da sequência de trabalho, os recursos construídos e os resultados da sua implementação – no contexto atribulado da pandemia do COVID-19, que “explodiu” em março de 2020. Com a interrupção do ensino presencial, a sequência didática foi adaptada, de forma a promover à distância as mesmas competências e objetivos previstos. A experiência que se pretendeu implementar tentou privilegiar uma aprendizagem diversificada e rica, com utilização de diferentes estratégias. As atividades mais práticas e participadas pelos alunos foram aquelas que mais os envolveram e as que tiveram um melhor feedback, em atividades síncronas e assíncronas. Contudo, apenas parte da turma evidenciou um assinalável interesse em relação às tarefas propostas. Com diferenciação em dois grupos de alunos, mais e menos empenhados, num balanço global, o ensino/aprendizagem imersivo e centrado na resolução de problemas acaba por ser mais mobilizador.
A adequada gestão de uma empresa é fundamental para a concretização dos objetivos definidos e, consequentemente, o seu crescimento e sustentabilidade. Neste âmbito, a gestão administrativa desempenha ...um papel muito importante na estrutura empresarial, uma vez que é a área onde são realizadas todas as atividades de apoio ao bom funcionamento da entidade.O presente relatório pretende descrever as atividades necessárias para garantir uma adequada gestão corrente de uma sociedade de revisores oficiais de contas, focando, principalmente, nas responsabilidades específicas deste tipo de sociedade.Com o intuito de contextualizar o objeto de estudo deste relatório, são apresentados os conceitos de gestão e de auditoria, essenciais para a compreensão dos serviços prestados pela entidade acolhedora do estágio, bem como os deveres de comunicação e obrigações legais impostos pelas entidades que supervisionam a atividade de auditoria.Posteriormente, é realizada uma apresentação da sociedade e são descritas as atividades desenvolvidas no estágio, que incidiram, principalmente, nas áreas de gestão administrativa, de consultoria e de auditoria.
Summary
Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged ≥80 years) are lacking. The aim of the present study was to ...describe ITP in this subgroup. The data source was the prospective CARMEN‐France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65–79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85·7 years in the VEP group. Comorbidities were more frequent in the VEP group (67·4% vs. 47·9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10·3% vs. 4·1%, P = 0·1) as well as mortality. Exposure to ITP drugs, response to first‐line treatment, need of second‐line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex odds ratio (OR) 4·75, 95% confidence interval (CI) 1·31–17·32 and platelet count of <20 × 109/l (OR 10·05, 95% CI 4·83–67·39). Exposure to anticoagulants was strongly associated with severe bleeding (OR 7·61, 95% CI 1·77–32·83).
Introduction:There are discrepancies across recommendations about the indication of bone marrow smear in adults diagnosed for immune thrombocytopenia (ITP). The 2011 American Society of Hematology ...guidelines do not recommend bone marrow smear in case of typical ITP. In contrast, the 2010 international consensus and the 2017 French guidelines recommend systematic bone marrow smear in adults aged >60 years even in case of typical ITP to detect a blood cancer, particularly myelodysplastic syndrome. This recommendation is driven from expert consensus. Data are lacking about the positivity rate of this examination in older patients with typical ITP. The aim of this study was to assess the positivity rate of bone marrow smear at ITP diagnosis in >60-year-old patients with no other clinical or biological sign of hematological malignancy.
Methods:Data source was theCARMEN (Cytopénies Auto-immunes : Registre Midi-PyréneEN) registry. All adult patients with an incident diagnosis of ITP in the French Midi-Pyrénées region (South of France, 3 million inhabitants) are prospectively enrolled since June 2013 in the multicenter CARMEN registry. ITP is defined by international guidelines (platelet count <100 x 109/L and exclusion of other causes of thrombocytopenia). Investigations performed at ITP diagnosis in a real-life basis, including bone marrow smear, are recorded with their results. Study population was selected among the patients included in the CARMEN registry from June 2013 to December 2018. Inclusion criteria were: age>60 years; absence of clinical signs of hematological malignancy (lymphadenopathy, hepatomegaly, splenomegaly); isolated thrombocytopenia on blood count; bone marrow smear performed at ITP diagnosis. We described patients with abnormal bone marrow smear and implications for ITP management.
Results:We identified 114patients (66 men and 48 women) satisfying all inclusion criteria. Mean age at ITP diagnosis was 76 years (standard deviation - SD: 9 years). Platelet count at diagnosis was 32.7 x 109/L (SD: 27.7 x 109/L) and 58 patients presented with bleeding: skin bleeding only (n=33), oral bleeding (n=17), epistaxis (n=10) and hematuria (n=3). Only one patient had an abnormal bone marrow smear corresponding to a characterized hematological disease: a myelodysplastic syndrome. It was a 62-year-old man without medical history who presented in 2014 with extensive skin bleeding, and isolated thrombocytopenia (6 x 109/L). Other blood count parameters were: hemoglobin: 15.2 g/dL; MCV: 83 fL; leukocytes: 5.3 x 109/L; polynuclear neutrophils: 3.5 x 109/L; lymphocytes: 1.0 x 109/L; monocytes: 0,3 x 109/L . Bone marrow smear revealed normal cellularity. The megakaryocytic lineage was normally represented with significant number of megakaryocytes with multiple separated nuclei. Significant dysgranulopoiesis was also observed with pseudo-Pelger-Huët anomaly and cytoplasmic hypogranulation. Some erythroblasts with defective haemoglobination or cytoplasmic vacuolation were present. This aspect was compatible with the diagnosis of myelodysplastic syndrome with multilineage dysplasia (MDS-MLD). Karyotype was normal. The patient was initially treated for ITP with steroids and intravenous immunoglobulins (with partial response), then with danazol (complete response), eltrombopag (after loss of response to danazol and ocular bleeding, resulting in complete response) and more recently romiplostim (after loss of response to eltrombopag, resulting in complete response). He was treated in 2019 by rituximab to spare exposure to thrombopoietin receptor agonists, without efficacy. Before Rituximab, another bone marrow smear was performed (4 years after the first one) with the same cytologic and cytogenetic features (MLD-MDS with normal caryotype).
Conclusions:Diagnosis of hematological malignancy is very uncommon in >60 year-old patients who present with typical ITP. Myelodysplastic syndrome was found in 1 (0.8%) patient in this series, and did not impact the management or the evolution of the patient with a five-year follow-up. Overall, this study sustains guidelines that does not recommend systematic testing for bone marrow examination in >60 year-old patients with typical ITP.
Comont:BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees. Recher:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sunesis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Honoraria; Macrogenics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Beyne-Rauzy:Novartis: Research Funding; Cellgene: Research Funding. Moulis:CSL Behring: Research Funding; Amgen pharma: Research Funding, Speakers Bureau; Novartis pharma: Research Funding, Speakers Bureau.
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