Adverse childhood experiences in early life increase the odds of depression among adults with multiple sclerosis.

Background: Adverse childhood experiences are demonstrated risk factors for depression, a common co-morbidity of multiple sclerosis, but are understudied among people with multiple sclerosis. Objective: Estimate the association between adverse childhood experiences and depression among 1,990 adults with multiple sclerosis. Methods: Participants were members of Kaiser Permanente Northern California from two studies between 2006 and 2021 and were diagnosed with multiple sclerosis by a neurologist. Adverse childhood experiences were assessed using two instruments, including the Behavioral Risk Factor Surveillance System. Participants self-reported ever experiencing a major depressive episode. Meta-analysis random effects models and logistic regression were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between adverse childhood experiences and a history of depression across study samples. Adverse childhood experiences were expressed as any/none, individual events, and counts. Models adjusted for sex, birth year, race, and ethnicity. Results: Exposure to any adverse childhood experiences increased the odds of depression in people with multiple sclerosis (OR: 1.71, 95% CI: 1.21-2.42). Several individual adverse childhood experiences were also strongly associated with depression, including "significant abuse or neglect" (OR: 2.79, 95% CI: 2.11-3.68). Conclusion: Findings suggest that adverse childhood experiences are associated with depression among people with multiple sclerosis. Screening for depression should be done regularly, especially among people with multiple sclerosis with a history of adverse childhood experiences.

Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals.

BACKGROUND: Paediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals. METHODS: Participants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility. RESULTS: The CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8-4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents' perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p<0.001). Focus group participants noted the CSAT report helped assess their centre's clinical capacity to sustain PEWS and provided constructive feedback for improvement. CONCLUSIONS: We present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.

Perfil clínico, epidemiológico y de laboratorio de los pacientes catalogados como sospechosos de leptospirosis en el Hospital Nacional de Niños Benjamín Bloom, desde enero 2015 a diciembre 2016 / Clinical, epidemiological and laboratory profile of patients classified as suspected of leptospirosis at the Benjamin Bloom National Children's Hospital, from January 2015 to December 2016

La presente investigación estuvo orientada a describir las manifestaciones clínicas, la caracterización epidemiológica y los hallazgos de laboratorio de los pacientes catalogados como sospechosos de Leptospirosis en la población pediátrica de El Salvador. Se trató de un estudio descriptivo y retrospectivo que incluyó al total de pacientes del Hospital Nacional de Niños Benjamín Bloom, catalogados como sospechosos de leptospirosis entre el 1 de enero de 2015 y el 31 de diciembre de 2016. La leptospirosis es una enfermedad infecciosa causada por bacterias patógenas llamadas leptospiras que son transmitidas, directa o indirectamente, desde los animales a los seres humanos siendo, por tanto, una zoonosis. Un caso confirmado es aquel que se demuestra serológicamente mediante MAT incrementado o títulos elevados o identificación de ADN de la bacteria en suero u orina. Un caso sospechoso es toda persona con fiebre de 7 días o más de duración y al menos dos de los siguientes síntomas: mialgias en miembros inferiores, cefalea, signos de irritación meníngea, inyección conjuntival, alteración del estado de conciencia, manifestaciones hemorrágicas, rash, falla cardíaca, náuseas, vómitos, dolor abdominal u oliguria, anuria o proteinuria. Cumpliendo esta definición de caso se investigaron los expedientes catalogados como sospechosos de leptospirosis. Esta información, se obtuvo a partir de revisión de expedientes, recolectando los datos específicos y determinando así un perfil integral de los pacientes afectados por esta infección de alta relevancia nacional y mundial. Los datos fueron introducidos en Google forms, una herramienta en línea de administración de encuestas que se incluye en el conjunto de aplicaciones de Google Drive. Para el análisis se utilizó estadística descriptiva, con elaboración de tablas de frecuencias para generar diferentes gráficos y uso de medidas de tendencia central como moda y media aritmética. Los principales resultados fueron que el 97.4% de los pacientes presentan fiebre, siendo los síntomas principales los vómitos, diarrea, dolor abdominal e ictericia, así como cefalea y mialgias. Los hallazgos más frecuentes al examen físico corresponden a hepato y/o esplenomegalia, ictericia y palidez. Predomina el sexo masculino y niños menores de 2 años. La mayoría de pacientes habitan en área urbana y cuenta con servicios básicos no encontrando mayor contacto con animales, sólo 1 paciente afirma contacto con ratas. Las principales alteraciones de laboratorio son anemia y trombocitopenia. En el hospital Bloom no hay casos confirmados de leptospirosis en el período descrito