An integer programming model to assign patients based on mental health impact for tele-psychotherapy intervention during the Covid-19 emergency.

The Covid-19 pandemic challenges healthcare systems worldwide while severely impacting mental health. As a result, the rising demand for psychological assistance during crisis times requires early and effective intervention. This contributes to the well-being of the public and front-line workers and prevents mental health disorders. Many countries are offering diverse and accessible services of tele-psychological intervention; Ecuador is not the exception. The present study combines statistical analyses and discrete optimization techniques to solve the problem of assigning patients to therapists for crisis intervention with a single tele-psychotherapy session. The statistical analyses showed that professionals and healthcare workers in contact with Covid-19 patients or with a confirmed diagnosis had a significant relationship with suicide risk, sadness, experiential avoidance, and perception of severity. Moreover, some Covid-19-related variables were found to be predictors of sadness and suicide risk as unveiled via path analysis. This allowed categorizing patients according to their screening and grouping therapists according to their qualifications. With this stratification, a multi-periodic optimization model and a heuristic are proposed to find an adequate assignment of patients to therapists over time. The integer programming model was validated with real-world data, and its results were applied in a volunteer program in Ecuador.

Psychometric Properties of the Brief Religious Coping Scale (Brief-RCOPE) in Chilean Adults Exposed to Stressful Events.

Among the different ways of coping with stress, religious coping has shown particularly the promising results; nonetheless, there are few validated instruments to assess it in non-English language. This article presents the psychometric properties of the Brief Religious Coping Scale (Brief-RCOPE) in Chilean adults exposed to stressful events. The scale shows a reliability, test-retest stability, and confirmatory factor analysis support structural validity. The scale also shows concurrent validity with another measure of religious coping. Finally, confirming predictive criterion validity, negative religious coping predicts posttraumatic stress symptoms 6 months after, but not posttraumatic growth. Positive religious coping was associated with posttraumatic growth enhancement. This study shows Brief-RCOPE as a valid and reliable instrument for measuring religious coping in this population.

Postoperative junctional ectopic tachycardia: risk factors for occurrence in the modern surgical era.

BACKGROUND: Postoperative (PO) junctional ectopic tachycardia (JET) can be a life-threatening arrhythmia that follows surgical repair of congenital heart disease (CHD) and results in PO morbidity. METHODS: We reviewed 750 open heart surgeries (OHS) for CHD performed between January 2005 and February 2009. Kaplan-Meier and Cox proportional hazards model analyses were used to estimate the frequency and evaluate risk factors that might predict JET occurrence. RESULTS: The patients ranged in age from 1 day to 36.6 years; half were less than 4.8 months at the time of OHS. JET occurred in 115 of 750 (15.3%) OHS. JET was bimodally distributed by age with a peak incidence between 1-2 weeks and 1-3 years. JET occurred more commonly: (1) in specific types of OHS (single ventricle [19.5%] and cono-truncal defects [19.3%]) (P = 0.03); (2) with increased total surgical time (P = 0.001), aortic cross-clamp time (P < 0.001), cardiopulmonary bypass time (P < 0.001); and (3) followed use of inotropic agents (dopamine or milrinone, P < 0.001). JET lengthened intensive care stay by 3 days (P = 0.0001) and increased mortality (+JET [9.6%] vs -JET [4.6%], P = 0.03). In a multiple variable Cox regression model, total surgical time and PO use of milrinone were the best predictors for JET risk. PO administration of nitroprusside decreased risk of JET. CONCLUSIONS: JET occurred more commonly following OHS associated with prolonged surgical times and PO use of inotropic medications. In contrast to previous reports, our results suggest that mechanical injury to the atrioventricular node area is not strongly associated with JET.

Hypnotic intervention in people with fibromyalgia: A randomized controlled trial.

Fibromyalgia affects the quality of life of the patients, as well as their family. It also affects their social, labor, physical, and psychological dynamics. We aimed to evaluate the effectiveness of audio-recorded hypnosis in ameliorating fibromyalgia symptoms. We enrolled 97 individuals with fibromyalgia (mean age: 45 years) and randomly distributed them to two groups (48 in the experimental group and 47 in the control group). Individuals in both groups maintained their standard pharmacological treatment and continued their usual physical or psychological activities. The experimental group received an audio-recorded hypnosis intervention in the first session; subsequently, they received another audio hypnosis session to use for daily practice for a month. We evaluated the pre- and post-intervention pain intensity, pain interference, fatigue intensity, fatigue interference, depressive symptomatology, and satisfaction with life. We found that the self-administered audio-recorded hypnotic intervention significantly decreased the intensity and interference of pain and fatigue, as well as the depressive symptomatology. Audio-recorded clinical hypnosis techniques could provide an effective, practical, and economical alternative for reducing fibromyalgia-related symptoms.

Procalcitonin as a Predictive Marker for Bacteremia in Children With a Central Line and Fever.

OBJECTIVES: Unnecessary use of antibiotics is an increasing problem. In this study, we sought to determine the diagnostic accuracy of procalcitonin in predicting bacteremia in children with a central line and fever, and we sought to determine optimal cutoff values to maximize sensitivity and specificity. This is the largest study to date in which procalcitonin is examined as a predictive marker of bacteremia in pediatric patients with a central line and fever. METHODS: We conducted a retrospective cohort study of children aged 0 to 23 years with a central line and fever of 38°C who had procalcitonin and blood cultures drawn before initiation of antibiotics and had no other identified bacterial infection. Patients were also prospectively monitored via a custom-built electronic medical record dashboard for eligibility. RESULTS: There were 523 patients and >2500 procalcitonin values reviewed for eligibility. Of these, 169 (47%) patients and 335 blood cultures with procalcitonin were included. There were 94 (28%) positive bacterial blood cultures and 241 (72%) negative bacterial blood cultures. In bacteremic cultures, the mean procalcitonin level was 9.96 ± 15.96 ng/mL, and the median procalcitonin level was 4.85 ng/mL (interquartile range 18.5). In nonbacteremic cultures, the mean procalcitonin level was 1.23 ± 10.37 ng/mL, and the median procalcitonin level was 0.3 ng/mL (interquartile range 0.7). A receiver operating characteristic analysis indicated a procalcitonin level of ≥0.6 ng/mL as the best cutoff point that produced a sensitivity of 85.6% and a specificity of 65.7% (area under the curve 0.85). CONCLUSIONS: Procalcitonin is a sensitive biomarker in predicting bacteremia in children with a central line and fever.

Propiedades psicométricas del Cuestionario de Aceptación y Acción-II en adultos ecuatorianos / Psychometric properties of the acceptance and action questionnaire-II in ecuadorian adults

Resumen Objetivo. Analizar las propiedades psicométricas del AAQ-II en población adulta ecuatoriana con tomas presenciales, aumentando la fiabilidad de la muestra. Método. En este estudio se evaluaron las propiedades psicométricas de la Acceptance and Action Questionnaire-II (AAQ-II) en población ecuatoriana. Participaron 450 personas entre 18 y 53 años, de las cuales un 46.7% fueron mujeres y un 53.3% hombres. Resultados. En el análisis factorial confirmatorio se encontró una estructura de tres dimensiones: evitación de recuerdos, evitación emocional y falta de autodominio. Un análisis de invarianza reveló que la escala es invariante entre hombres y mujeres. Se encontró que la escala presenta buena consistencia interna (α = .90). Se discute la validez de la AAQ-II como una herramienta para evaluar la evitación experiencial en población adulta ecuatoriana.

Abstract Objective. To analyze AAQ-II psychometric properties on the Ecuadorian people. Method. In this study, the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) were evaluated in an Ecuadorian population. A total of 450 people between 18 and 53 years of age, 46.7% of whom were women, participated. Results. The confirmatory factor analysis found a three-dimensional structure: memory avoidance, emotional avoidance, and lack of self-control. An analysis of invariance between men and women revealed that the scale is invariant by sex. The scale was found to have good internal consistency (α = .90). The validity of the AAQ-II as a tool to assess experiential avoidance in an Ecuadorian adult population is discussed.

Activity of bone cement loaded with daptomycin alone or in combination with gentamicin or PEG600 against Staphylococcus epidermidis biofilms.

Daptomycin is a promising candidate for local treatment of bone infection due to its activity against multi-resistant staphylococci. We investigated the activity of antibiotic-loaded PMMA against Staphylococcus epidermidis biofilms using an ultra-sensitive method bacterial heat detection method (microcalorimetry). PMMA cylinders loaded with daptomycin alone or in combination with gentamicin or PEG600, vancomycin and gentamicin were incubated with S. epidermidis-RP62A in tryptic soy broth (TSB) for 72 h. Cylinders were thereafter washed and transferred in microcalorimetry ampoules pre-filled with TSB. Bacterial heat production, proportional to the quantity of biofilm on the PMMA, was measured by isothermal microcalorimetry at 37 °C. Heat detection time was considered time to reach 20 µW. Experiments were performed in duplicate. The heat detection time was 5.7-7.0 h for PMMA without antibiotics. When loaded with 5% of daptomycin, vancomycin or gentamicin, detection times were 5.6-16.4 h, 16.8-35.7 h and 4.7-6.2 h, respectively. No heat was detected when 5% gentamicin or 0.5% PEG600 was added to the daptomycin-loaded PMMA. The study showed that vancomycin was superior to daptomycin and gentamicin in inhbiting staphylococcal adherence in vitro. However, PMMA loaded with daptomycin combined with gentamicin or PEG600 completely inhibited S. epidermidis-biofilm formation. PMMA loaded with these combinations may represent effective strategies for local treatment in the presence of multi-resistant staphylococci.

Propiedades psicométricas de la Escala de Satisfacción con la Vida en población ecuatoriana adulta / Psychometric Properties of the Satisfaction with Life Scale in the Adult Ecuadorian Population / Propriedades psicométricas da Escada de Satisfação com a Vida em população equatoriana adulta

Resumen Objetivo. Analizar las propiedades psicométricas de la Escala de Satisfacción con la Vida (SWLS, por sus siglas en inglés) en población ecuatoriana adulta. Método. Se realizó un análisis factorial confirmatorio en el que participaron 756 ecuatorianos adultos. Resultados. Al igual que en la escala original, el análisis de esta investigación mostró un alto ajuste en el modelo con un solo factor. Si bien los hombres presentaron mayores niveles de satisfacción con la vida que las mujeres, el análisis de invarianza evidenció que la estructura factorial de la escala es equivalente en ambos sexos, lo que permite su comparación. En el análisis de confiabilidad, la SWLS presentó adecuada consistencia interna (α = 0.81). Conclusión. La SWLS es una herramienta útil para el estudio de la satisfacción con la vida en población adulta ecuatoriana.

Abstract Objective. To analyze the psychometric properties of the Satisfaction with Life Scale (SWLS) in the adult Eduadorian population. Method. A confirmatory factorial analysis was carried out in which 756 adult Ecuadorians participated. Results. The confirmatory factor analysis showed a very good fit in the model with a single factor, just like the original scale. Although men presented higher levels of satisfaction with life than women, the invariance analysis showed that the factorial structure of the scale is equivalent in both genders, which allows comparison. In the reliability analysis, the SWLS showed adequate internal consistency (α = 0.81). Conclusion. The SWLS is a useful tool for the study of satisfaction with life in the Ecuadorian adult population.

Resumo Escopo. Analisar as propriedades psicométrica da Escada de Satisfação com a Vida (SWLS) em população equatoriana adulta. Metodologia. Foi feita uma análise fatorial confirmatória na que participaram 756 equatorianos adultos. Resultados. Igual que na escada original, a análise de esta pesquisa mostrou um alto ajuste no modelo com um fator só. Embora os homens apresentaram maiores níveis de satisfação com a vida que as mulheres, a análise de invariância evidenciou que a estrutura fatorial da escada é equivalente em ambos sexos, o que permite sua comparação. Na análise de confiabilidade, a SWLS apresentou adequada consistência interna (α = 0.81). Conclusão. A SWLS é uma ferramenta útil para o estudo da satisfação com a em população adulta equatoriana.

Cavernomas de tronco encefálico: presentación de 8 casos operados, análisis y revisión del estado del arte / Brainstem cavernous malformations: a series of 8 surgicalcases, analysis and state of the art review

Introducción: Las lesiones del tronco cerebral son uno de los mayores desafíos neuroquirúrgicos. Los angiomas cavernosos de esta localización son lesiones de comportamiento agresivo, con alta morbi-mortalidad asociada, donde el neurocirujano tiene la posibilidad de curar al paciente pero con un nivel de riesgo que hacen que la oportunidad de la cirugía se mantenga en debate. Material y Método: Análisis retrospectivo de 8 casos de cavernomas de tronco operados entre los años 2009-2013 con sus características clínicas, quirúrgicas y de seguimiento. Se realiza además una revisión reflexiva sobre la evolución del manejo de estas lesiones y del estado del arte a nivel en el concierto internacional. Resultados: Los 8 casos presentaron evoluciones inmediatas y mediatas favorables tras la cirugía. No hubo mortalidad ni empeoramiento del status neurológico en relación al estado preoperatorio en ninguno de los 8 casos. Tres de los pacientes de la serie fueron operados tras caer en una condición clínica crítica y son los que registran los mayores déficits durante el seguimiento. El análisis de la evolución del manejo de este tipo de lesiones a nivel mundial revela una tendencia hacia el manejo quirúrgico precoz en lesiones sintomáticas. Conclusiones: Los resultados de esta serie así como la evolución del estado del arte permiten concluir que en pacientes sintomáticos una cirugía precoz ofrece en general mejores expectativas que intervenciones tardías para lesiones relativamente superficiales.

Introduction: Brainstem lesions are a major neurosurgical challenge. Cavernous angiomas of this location are lesions of aggressive behavior, with high morbidity and mortality associated, where the neurosurgeon has the possibility to cure the patient but with a level of risk that makes that the surgery timing remains under debate. Material and Methods: A retrospective analysis of 8 brainstem cavernomas cases operated in the period 2009-2013 is presented whit its clinical, surgical and follow-up characteristics. A thoughtful review of the evolution of the management of these lesions and the state of art in the international level is also carried out. Results: All 8 patients presented immediate and mediate favorable changes after surgery. There was no mortality or worsening of the neurological condition in relation to the preoperative status in any of the 8 cases. 3 patients in this series underwent surgery after falling in a critical condition and are those who have the highest deficit in the follow-up. The analysis of the evolution of the worldwide management of these injuries reveals a trend towards early surgical management in symptomatic lesions. Conclusions: The results of this series as well as the evolution of the state of the art let us conclude that in symptomatic patients an early surgery offers overall better expectations than later interventions in relatively superficial lesions.