RESUMEN Introducción: La hipopotasemia es un trastorno hidroelectrolítico frecuente, asociado a enfermedades sistémicas y multifactoriales, cuya forma aguda puede complicarse y causar la muerte, pero en su presentación crónica puede ser un marcador de nefropatía. Objetivo: Caracterizar el perfil del paciente con hipopotasemia no medicamentosa atendidos de emergencia. Métodos: Se revisaron los registros de pacientes mayores de 18 años con diagnóstico de hipopotasemia, ingresados en el hospital en el período de junio 2018 a diciembre de 2019. Se colectaron datos demográficos, antecedentes médicos y evolución postratamiento. Se comparó con 108 pacientes sin hipopotasemia atendidos en el período de estudio. Resultados: Se encontraron 87 casos con edad media de 38,5 años. El 90,8 % eran hombres menores de 50 años, de oficio agricultor (29,9 %), con historia de exposición a plaguicidas y a altas temperaturas ambientales. La mayoría de ellos no tenía historia de enfermedad cardiometabólicas o renal previa. El 48,3 % de todos los pacientes con hipopotasemia (n = 42) tenía creatinina mayor a 1,2 mg/dL y 63 % tenía hiponatremia. La hipopotasemia fue moderada en 39 % y severa en 12 %, los hombres 4,7 veces más afectados que las mujeres. Respecto al grupo sin hipopotasemia y creatinina anormal, tenían mayor frecuencia de enfermedad crónica (92,5 % versus 8 %). Conclusiones: Se encontró hipopotasemia no medicamentosa en varones agricultores, sin enfermedad crónica, pero con datos de nefropatía temprana e hiponatremia, se sugirió la posibilidad de nefropatía mesoamericana. Debe establecerse una alerta epidemiológica regional y un programa de prevención y control.

ABSTRACT Introduction: Hypokalemia is a frequent hydroelectrolytic disorder, associated with systemic and multifactorial diseases, whose acute form can be complicated and cause death, but in its chronic presentation it can be a marker of nephropathy. Objective: To characterize the profile of the patient with non-drug hypokalemia seen in an emergency. Methods: The records of patients older than 18 years diagnosed with hypokalemia, admitted to the hospital from June 2018 to December 2019, were reviewed. Demographic data, medical history, and post-treatment evolution were collected. It was compared with 108 patients without hypokalemia seen in the same period. Results: 87 cases with mean age of 38.5 years were studied. 90.8% were men under 50 years of age, who worked as farmers (29.9%), with history of exposure to pesticides and high ambient temperatures. Most of them had no history of previous cardiometabolic or renal disease. 48.3% of all patients with hypokalemia (n = 42) had creatinine higher than 1.2 mg/dL and 63% had hyponatremia. Hypokalemia was moderate in 39% and severe in 12%, and it was found that men were affected 4.7 times more than women. Regarding the group without hypokalemia and abnormal creatinine, they had higher frequency of chronic disease (92.5% versus 8%). Conclusions: Non-drug hypokalemia was found in male farmers, without chronic disease, but with evidence of early nephropathy and hyponatremia. The possibility of Mesoamerican nephropathy was suggested. A regional epidemiological alert and a prevention and control program should be established.

Resumo Instituições de Ensino contribuem para o bem-estar, saúde e desempenho dos estudantes. O presente estudo tem como objetivo o estudo de validação de um instrumento de avaliação dos ambientes de aprendizagem. O estudo do instrumento Ecossistemas dos Ambientes de Aprendizagem Saudáveis (EA2S) envolveu 521 estudantes, 359 (69,4%) do sexo feminino. Relativamente à idade dos estudantes, 26,2% possui até 19 anos (n=127), 64,3% entre 20 e 30 anos (n=311), 4,1% entre 31 e 40 anos (n=20) e 5,4% 41 ou mais anos (n=26). O Instrumento EA2S é constituído por um total de 62 itens organizados em 9 dimensões. O estudo psicométrico revelou resultados coerentes em termos conceptuais e de robustez ao nível da consistência interna e modelos adequados resultante da análise fatorial confirmatória das escalas, foram identificadas diferenças de sexo e idade na avaliação dos ambientes de aprendizagem. Considera-se o instrumento EA2S e as respetivas escalas um instrumento que vem responder a uma necessidade das instituições de ensino para avaliar o ambiente de aprendizagem saudável numa perspetiva ecológica e permite a monitorização de medidas de promoção da saúde e prevenção dos riscos com o objetivo central de melhorar o bem-estar e saúde dos estudantes.

Abstract Educational institutions contribute to students' well-being, health and performance. The present study aims to validate an instrument for the assessment of learning environments. The study of the Ecosystems of Healthy Learning Environments (EA2S) instrument involved 521 students, 359 (69.4%) females. Regarding the age of the students, 26.2% were up to 19 years old (n=127), 64.3% between 20 and 30 years old (n=311), 4.1% between 31 and 40 years old (n=20) and 5.4% 41 or older (n=26). The EA2S instrument consists of a total of 62 items organized into 9 dimensions. The psychometric study revealed coherent results in conceptual terms and robustness at the level of internal consistency and adequate models resulting from the confirmatory factor analysis of the scales, gender and age differences were identified in the evaluation of learning environments. The EA2S instrument and the respective scales are considered an instrument that responds to a need of educational institutions to evaluate the healthy learning environment from an ecological perspective and allows the monitoring of health promotion and risk prevention measures with the central objective of improving the well-being and health of students.

ABSTRACT Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.

Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

RESUMEN. Objetivos: El presente estudio describe las enfermedades musculoesqueléticas (EME) de una cohorte de trabajadores de tipo manual, así como el uso de los fármacos indicados para el control del dolor. Estudio observacional retrospectivo llevado a cabo en el ámbito del Aragon Workers' Health Study (AWHS). Se ha analizado la prevalencia de las diferentes EME, la tasa de utilización de fármacos empleados en el tratamiento del dolor y el número de dosis diarias definidas (DDD) consumidas. El 15,4% de los trabajadores estudiados fueron diagnosticados de, al menos, una EME. De ellos, el 54,1% tenía sobrepeso y el 74,0% eran mayores de 55 años. La tasa de utilización de los antiinflamatorios no esteroideos (AINE) fue del 69,5%, y de los analgésicos no opiáceos, del 29,9%. Los datos presentados ponen de manifiesto la utilización elevada y, en algunos casos, continuada que existe de tratamientos analgésicos y antiinflamatorios.

ABSTRACT Objectives: The present study describes the musculoskeletal diseases (MSD) of a cohort of manual workers, as well as the use of drugs indicated for pain control. Retrospective observational study carried out within the framework of the Aragon Workers' Health Study (AWHS). The prevalence of the different EMEs, the rate of use of drugs used in the treatment of pain and the number of defined daily doses (DDD) consumed have been analysed. 15.4% of the workers studied were diagnosed with at least one EME. Of them, 54.1% were overweight and 74.0% were older than 55 years. The utilization rate of non-steroidal anti-inflammatory drugs (NSAIDs) was 69.5%, and of non-opioid analgesics, 29.9%. The data presented show the high use and, in some cases, the continuous use of analgesic and anti-inflammatory treatments.

ABSTRACT Objectives: The present study describes the musculoskeletal diseases (MSD) of a cohort of manual workers, as well as the use of drugs indicated for pain control. Retrospective observational study carried out within the framework of the Aragon Workers' Health Study (AWHS). The prevalence of the different EMEs, the rate of use of drugs used in the treatment of pain and the number of defined daily doses (DDD) consumed have been analysed. 15.4% of the workers studied were diagnosed with at least one EME. Of them, 54.1% were overweight and 74.0% were older than 55 years. The utilization rate of non-steroidal anti-inflammatory drugs (NSAIDs) was 69.5%, and of non-opioid analgesics, 29.9%. The data presented show the high use and, in some cases, the continuous use of analgesic and anti-inflammatory treatments.

RESUMEN. Objetivos: El presente estudio describe las enfermedades musculoesqueléticas (EME) de una cohorte de trabajadores de tipo manual, así como el uso de los fármacos indicados para el control del dolor. Estudio observacional retrospectivo llevado a cabo en el ámbito del Aragon Workers' Health Study (AWHS). Se ha analizado la prevalencia de las diferentes EME, la tasa de utilización de fármacos empleados en el tratamiento del dolor y el número de dosis diarias definidas (DDD) consumidas. El 15,4% de los trabajadores estudiados fueron diagnosticados de, al menos, una EME. De ellos, el 54,1% tenía sobrepeso y el 74,0% eran mayores de 55 años. La tasa de utilización de los antiinflamatorios no esteroideos (AINE) fue del 69,5%, y de los analgésicos no opiáceos, del 29,9%. Los datos presentados ponen de manifiesto la utilización elevada y, en algunos casos, continuada que existe de tratamientos analgésicos y antiinflamatorios.

Resumen En México, Theobroma cacao es afectado por la mancha negra (MN) causada por Phytophthora capsici. Actualmente se carece de un estudio epidemiológico de esta enfermedad. El objetivo fue conocer la influencia del clima, fructificación y la incidencia de la moniliasis (Moniliophthora roreri) en la intensidad epidémica de MN en cinco localidades del sureste de México. Se analizó la estructura temporal epidémica de MN y se estudió la correlación de cambios absolutos de incidencia MN con temperatura, humedad relativa (HR), precipitación, y flujos de fructificación. La posible competencia entre P. capcisi y M. roreri también se analizó correlativamente. Las epidemias tuvieron una duración de 15 a 25 semanas restringidas a septiembre - febrero con incidencias finales (Y f ) del 6 al 24%. Las curvas se ajustaron al modelo Gompertz (r = 0.059 - 0.123, R2 0.97 - 0.99) con fase exponencial en octubre correspondiendo con la mayor precipitación pluvial. La MN se asoció positivamente con HR mayor al 90%, precipitación, periodos de temperaturas menores de 19.9 y de 20 - 26.9 °C, y con intensidad de fructificación. P. capcisi tuvo menor aptitud parasítica que M. roreri, el cual indujo epidemias más tempranas, con mayor duración e intensidad. La caracterización de MN como epidemia policíclica justifica estrategias de manejo dirigidas a la reducción del inóculo secundario.

Abstract In Mexico, Theobroma cacao is affected by the black pod rot (BPR) caused by Phytophthora capsici. Currently, an epidemiological study of this disease is lacking. The objective was to determine the influence of climate, fruit set and the incidence of cacao frosty pod rot (Moniliophthora roreri) on the epidemic intensity of BPR in five locations in southeastern Mexico. The temporal structure of BPR epidemics was analyzed and the correlation of absolute change of BPR incidence with temperature, relative humidity (RH), precipitation, and fruiting flows was studied. The possible competition between P. capcisi and M. roreri was also analyzed correlatively. The epidemics had a duration of 15 to 25 weeks restricted to September - February with 6 to 24% final incidence (Y f ). The curves were best fitted to the Gompertz model (r = 0.059 - 0.123, R2 0.97 - 0.99) with an exponential phase in October corresponding with the highest rainfall. BPR was positively associated with RH greater than 90%, precipitation, temperature periods lower than 19.9, and 20 - 26.9 °C, and with fruiting intensity. P. capcisi had less parasitic fitness than M. roreri, which induced earlier epidemics, with greater duration and intensity. The characterization of BPR as a polycyclic epidemic justifies management strategies aimed at reducing the secondary inoculum.

ABSTRACT Reference evapotranspiration (ET0) and rainfall are basic variables for estimating the net irrigation depth (NID). The objective of this study was to estimate the NID for designing irrigation systems in Piracicaba, SP, Brazil, using ET0 and rainfall probability distributions. A 30-year ET0 and rainfall dataset (1990-2019) was obtained from the ESALQ/USP weather station. The water balance between ET0 and rainfall indicated July, August, and September as months of higher water deficit. Based on the first-order Markov chain, August presented the highest water deficit. Rainfall and ET0 were estimated on 19 probability levels, and four probability distributions such as normal, log-normal, beta, and mixed gamma were evaluated. The analysis of historical August series using accumulated values in periods of five, ten, or 15 days is recommended for sizing irrigation designs in Piracicaba, SP, Brazil. The log-normal and mixed gamma probability distributions presented the best fit for ET0 and rainfall data, respectively. To reach a crop coefficient Kc = 1 in Piracicaba, SP, Brazil in August, the irrigation system should be designed for an NID of 4.1 mm day-1. The use of mean monthly rainfall and ET0 values for designing irrigation systems underestimates the NID by a mean of 26.6% compared to estimates made at a probability of 75% at five-, ten-, and 15-day intervals because the mean rainfall values occurred with exceedance probabilities of < 36%, and mean ET0 values occurred with non-exceedance probabilities of < 56%.

BACKGROUND Few studies have focused on microbial diversity in indoor environments of ships, as well as the role of the microbiome and its ecological interconnections. In this study, we investigated the microbiome and virome present on the internal surfaces of a polar ship in different stages (beginning, during, and at the end) of the Brazilian Antarctic expedition in order to evaluate abundance of microorganisms in different periods. OBJECTIVES AND METHODS We used shotgun metagenomic analysis on pooled samples from sampling surfaces in the ship’s interior to track the microbial diversity. FINDINGS Considering the total fraction of the microbiome, the relative abundance of bacteria, eukaryotes, viruses, and archaea was 83.7%, 16.2%, 0.04%, and 0.002%, respectively. Proteobacteria was the most abundant bacterial phyla, followed by Firmicutes, Actinobacteria, and Bacteroidetes. Concerning the virome, the greatest richness of viral species was identified during the middle of the trip, including ten viral families after de novo assembly: Autographiviridae, Chrysoviridae, Genomoviridae, Herelleviridae, Myoviridae, Partitiviridae, Podoviridae, Potyviridae, Siphoviridae, and Virgaviridae. MAIN CONCLUSIONS This study contributed to the knowledge of microbial diversity in naval transportation facilities, and variations in the abundance of microorganisms probably occurred due to factors such as the number of passengers and activities on the ship.

ABSTRACT Purpose: To investigate the effects of chronic stress in the prostate of prepubertal and adult rats. Methods: Thirty-two male rats were assigned into four groups depending on the type of treatment (control or stressed) and the age at which stress was initiated (prepubertal or adult). Restraint stress stimuli were applied for six weeks. Stressed prepubertal and adult rats evaluated immediately after the last stress stimuli were named SP and SA groups, respectively. Age-matched rats were used as control groups (CP and CA). At the end of the experiment, the rats were euthanized, and prostate morphological parameters were evaluated and statistically compared. Results: Application of stress stimuli to the SP group resulted in reduced body weight, but no prostate morphological modification was noted. The SA group showed reduced testosterone level and prostatic epithelium surface density, in comparison to CA group. Further, the prostatic lumen surface density was increased in adult stressed animals, in comparison to adult controls. Conclusions: The stress stimuli promoted changes in hormonal and morphological parameters in the prostate of adult stressed rats. Prepubertal stressed animals did not presented modifications of prostate morphology.

Abstract Healthy workplaces contribute to the well-being, health and performance of workers and organizations. This study aims at building and validating an ecological instrument for the assessment of healthy workplaces based on the Healthy Workplaces conceptual model proposed by the World Health Organization (Burton, 2010). After a complex and robust construction process of the Ecosystems of Healthy Workplaces (EATS) instrument that involved researchers, experts and several organizations, it was tested on 460 participants working in various functions in different sectors of activity, 231 (50.3%) of whom were female. The age of the workers varies between 18 and 67 years, with a mean of 44 years and standard deviation of 11.36. The EATS instrument is composed of a total of 62 items organized into 9 dimensions. The psychometric study revealed conceptually coherent and robust results in terms of internal consistency and adequate models resulting from the confirmatory factor analysis of the scales. The EATS and its scales are considered an instrument that meets the need of organizations to assess the healthy working environment from an ecological perspective and allows for the monitoring of health promotion and risk prevention measures in organizations with the main purpose of improving the well-being and health of workers, organizations and society as a whole.

Resumo Organizações e ambientes de trabalho saudáveis contribuem para o bem-estar, saúde e desempenho de trabalhadores e das organizações. O presente estudo tem como objetivo a construção e estudo de validação de um instrumento ecológico de avaliação dos ambientes de trabalho saudáveis tendo por base o modelo conceptual Healthy Workplaces proposto pela Organização Mundial de Saúde (Burton, 2010). Após complexo e robusto processo de construção do instrumento Ecossistemas dos Ambientes de Trabalho Saudáveis (EATS) que envolveu investigadores, peritos e diversas organizações foi testado em 460 participantes em exercício de diversas funções em vários sectores de atividade, 231 (50,3%) do sexo feminino. A idade dos trabalhadores varia entre os 18 e os 67 anos, com média de 44 anos e desvio padrão de 11,36. O Instrumento EATS é constituído por um total de 62 itens organizados em 9 dimensões. O estudo psicométrico revelou resultados coerentes em termos conceptuais e de robustez ao nível da consistência interna e modelos adequados resultante da análise fatorial confirmatória das escalas, foram identificadas diferenças de sexo, idade e escolaridade na avaliação dos ambientes de trabalho. Considera-se o instrumento EATS e as respetivas escalas um instrumento que vem responder a uma necessidade das organizações para avaliar o ambiente de trabalho saudável numa perspetiva ecológica e permite a monitorização de medidas de promoção da saúde e prevenção dos riscos nas organizações com o objetivo central de melhorar o bem-estar e saúde dos trabalhadores, organizações e a sociedade como um todo.

The process of manual correction of essays causes some difficulties, among which we point out the time spent for correction and feedback to the student. For institutions such as elementary schools, universities and the National High School Exam in Brazil (ENEM), such activity demands time and cost for the evaluation of the texts produced. Going off-topic is one of the items evaluated in the ENEM essay that can nullify the whole essay produced by the candidate. In this context, the automatic analysis of essays with the application of techniques and methods of Natural Language Processing, Text Mining and other Artificial Intelligence (AI) techniques has shown to be promising in the process of automated evaluation of written language. The goal of this research is to compare different AI techniques for the classification of going off-topic in texts and identify the one with the best result to enable a smart correction system for essays. Therefore, computer experiments were carried out to classify these texts in order to normalize, identify patterns and classify the essays in 1,320 Brazilian Portuguese essays in 119 different topics. The results indicate that the CNN classifier (convolutional neural network) obtained greater gain in relation to the other classifiers analyzed, both in accuracy and in relation to the results of false positives, precision of metrics, recall and F1-Score. In conclusion, the solution validated in this research contributes to positively impacting the work of teachers and educational institutions, by reducing the time and costs associated with the essay evaluation process.

O processo de correção manual de redações acarreta algumas dificuldades, dentre as quais apontam-se o tempo dispendido para a correção e devolutiva de resposta ao aluno. Para instituições como escolas de ensino básico e fundamental, universidades e o Exame Nacional do Ensino Médio (ENEM), tal atividade demanda tempo e custo para a avaliação dos textos produzidos. A fuga ao tema é um dos itens avaliados na redação do ENEM que pode anular a redação produzida pelo candidato. Neste contexto, a análise automática de redações com a aplicação de técnicas e métodos de Processamento de Linguagem Natural, Mineração de Textos e outras técnicas de Inteligência Artificial (IA) tem se revelado promissora no processo de avaliação automatizada da linguagem escrita. O objetivo desta pesquisa é comparar diferentes técnicas de IA para classificação de fuga ao tema em textos e identificar aquela com melhor resultado para viabilizar um sistema de correção inteligente de redações. Para tanto, foram executados experimentos computacionais visando a classificação desses textos para normalizar, identificar padrões e classificar as redações em 1.320 redações de língua portuguesa em 119 temas diferentes. Os resultados indicam que o classificador RNC (rede neural convolucional) obteve maior ganho em relação aos demais classificadores analisados, tanto em acurácia, quanto em relação aos resultados de falsos positivos, métricas de precisão, recall e F1-Score. Como conclusão, a solução validada nesta pesquisa contribui para impactar positivamente o trabalho de professores e instituições de ensino, por meio da redução de tempo e custos associados ao processo de avaliação de redações.

Abstract In the seismic refraction method, refracted waves provide the velocity and irregularity of the substratum. In this study, we took advantage of this method to construct 3D images of the refractor subsurface for two rectangular arrays of sources and receivers. The procedure consists of fitting a straight line to the refracted arrival times that pass through each of the cells that discretize the study surface. The slope inverse is the P-wave velocity, and the intercept time allows us to estimate the substratum depth. We applied this method to two archaeological zones where it was necessary to know the structure of the subsoil velocity and the possible presence of anomalies associated with buried constructions. The results show velocity anomalies related to buried structures and lateral discontinuities due to changes in the refractor layer composition. At the site of Plazuelas, Guanajuato, the slope irregularity of this refractor indicates the unevenness of the ground that had to be filled for the Pyramid's construction. At the Xalasco site, Tlaxcala, impedance contrast is low, but lateral velocity variations show anthropogenic anomalies related to the distribution of remains of ceremonial archaeological foundations.

Resumen En el método de refracción sísmica las ondas refractadas proveen la velocidad e irregularidad del subestrato. En este estudio aprovechamos el principio de este método para construir imágenes 3D de la superficie refractora para dos arreglos rectangulares de fuentes y receptores. El procedimiento consiste en ajustar los tiempos de arribo de las ondas refractadas que cruzan cada una de las celdas que discretizan la superficie de estudio. El inverso de la pendiente es la velocidad de onda compresional y el intercepto permite calcular la profundidad del subestrato. Aplicamos este método a dos zonas arqueológicas donde se requería conocer la estructura de velocidad del subsuelo y la posible presencia de anomalías asociadas a construcciones enterradas. Los resultados muestran la presencia de anomalías de velocidad que se pueden relacionar con estructuras enterradas y discontinuidades laterales por cambios en la composición de los materiales del subestrato refractor. En el sitio de Plazuelas, Guanajuato, la irregularidad en la pendiente de este refractor indica el desnivel del terreno que tuvo que ser rellenado para la construcción de la Pirámide. En el sitio de Xalasco, Tlaxcala, el contraste de impedancia es bajo, pero las variaciones laterales de velocidad muestran anomalías de origen antropogénico que se pueden relacionar con estructuras arqueológicas de interés.

ABSTRACT The COVID-19 pandemic has particularly affected the mental health of children and adolescents. In Spain, numerous studies have been carried out about the emotional impact on this population. The objective of this paper is to examine, through a systematic review, the most immediate psychological effects of the pandemic on Spanish children and adolescents and the related variables. A search was conducted, obtaining 356 articles of which 27 met the inclusion criteria. The studies reviewed address emotional problems, emotion-regulation problems, anxiety, depression, and stress in Spanish children and adolescents. An increase in emotional problems during confinement was observed. Differences were found in emotional problems, being generally more common in girls and older children and adolescents. Related variables of a family nature and referred to the pandemic, coping styles, and other psychological problems were examined. These results are relevant to design interventions that can prevent the impact of other similar situations.

RESUMEN La pandemia del COVID-19 ha afectado de forma particular a la salud mental infanto-juvenil. En España se han llevado a cabo numerosos estudios acerca de las repercusiones emocionales en esta población. El objetivo de este trabajo es examinar, mediante una revisión sistemática, los efectos psicológicos más inmediatos de la pandemia en niños y adolescentes españoles y las variables relacionadas. Se realizó una búsqueda, obteniéndose 356 artículos de los que 27 cumplieron los criterios de inclusión. Los estudios revisados abordan problemas emocionales, de regulación emocional, ansiedad, depresión y estrés en niños y adolescentes españoles. Se encontraron diferencias en estos problemas emocionales, siendo generalmente más comunes en chicas y en niños mayores y adolescentes. Se revisaron variables relacionadas de carácter familiar, relativas a la pandemia, estilos de afrontamiento y otros problemas psicológicos. Estos resultados son relevantes para el diseño de intervenciones que puedan prevenir la repercusión de otras situaciones similares.

ABSTRACT Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.

Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

ABSTRACT Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.