Hepatic osteodystrophy in cirrhosis due to alcohol-related liver disease.

INTRODUCTION: hepatic osteodystrophy, including osteoporosis, is an abnormal bone metabolism related with chronic liver diseases. Osteoporosis is associated with an increased risk of bone fractures, with a significant impact on morbidity, mortality and healthcare costs. Nevertheless, bone disorders tend to be undervalued in cirrhosis due to alcohol-related liver disease (ALD cirrhosis). This study aimed to assess the prevalence of hepatic osteodystrophy and osteoporosis in ALD cirrhosis. METHODS: a prospective observational study was performed that included patients with ALD cirrhosis, between September 2017 and December 2018. Bone mineral density was determined by dual energy X-ray absorptiometry at the lumbar spine and the femoral neck. Hepatic osteodystrophy was defined as a T-score below -1 SD and osteoporosis as a T-score below -2.5 SD. RESULTS: ninety-four patients were included; 24.5 % (n = 23) had prior fragility fractures and ten patients suffered new osteoporotic fractures during the study period. Hepatic osteodystrophy was diagnosed in 79.8 % (n = 75) and osteoporosis in 21.3 % (n = 20) of cases. Patients with hepatic osteodystrophy presented significantly worse Child-Turcotte-Pugh (p < 0.05) and Model for End-Stage Liver Disease (MELD-sodium) scores (p = 0.01). According to the multivariate analysis, lower body mass index (BMI) (OR = 0.787, 95 % CI: 0.688-0.901, p = 0.001) and vitamin D deficiency (OR = 6.798, 95 % CI: 1.775-26.038, p = 0.005) were significantly and independently associated with hepatic osteodystrophy. Patients with osteoporosis also had a lower BMI (p = 0.01). Female patients and those with prior fragility fractures were more likely to suffer from osteoporosis (p < 0.05). CONCLUSION: our study revealed a high prevalence of hepatic osteodystrophy and osteoporosis in patients with ALD cirrhosis (particularly in those with a lower BMI) and a concerning high rate of fragility fractures. Bone mineral density should be assessed in order to allow for an early diagnosis and the implementation of preventive measures.

A rare case of diarrhea and ascites.

BACKGROUND: Eosinophilic enterocolitis is a rare condition included in the spectrum of the eosinophilic gastrointestinal disorders. Diagnosis is based on clinical presentation combined with an increase infiltration of eosinophils in the gastrointestinal tract, in the absence of other secondary causes of eosinophilic infiltration. CASE PRESENTATION: We report a case of a 22-year-old male with eosinophilic enterocolitis presenting with malabsorption syndrome (diarrhea, vomiting, weight loss), bowel wall thickening, and ascites. Secondary causes of intestinal eosinophilia were excluded, and diagnosis was established in a timely manner. Treatment plan included a 6-food elimination diet and corticosteroid therapy, with clinical remission after 2 weeks of therapy. The patient remains asymptomatic after 12 months of follow-up, with no relapse.

Misplacement of a nasogastric feeding tube: a case report.

Nasogastric tube (NGT) insertion is widely used for enteral feeding. After blind insertion of a NGT, confirmation of correct placement prior to feeding using reliable methods is mandatory. NGT misplacement in the respiratory tract can lead to serious complications. We report a case of a patient with dysphagia and malnutrition that needed enteral feeding as nutritional support. A NGT was blindly inserted, and its gastric position was confirmed through air insufflation and epigastric auscultation. Enteral feeding was initiated. Few hours later, the patient presented with respiratory distress. An urgent thoracic computed tomography was requested due to suspiction of pulmonary embolism, which revealed the NGT in the respiratory tree and a pneumonia in the lower lobe of the right lung. The NGT was removed, a new insertion was attempted and its gastric position was confirmed by radiography. Enteral feeding was initiated uneventfully. This case highlights the need for use of reliable methods of confirming tube location in order to avoid complications of misplacement.

Autonomy support, basic psychological needs and well-being in Mexican athletes.

Based on Basic Needs Theory, one of the mini-theories of Self-determination Theory (Ryan & Deci, 2002), the present study had two objectives: (a) to test a model in the Mexican sport context based on the following sequence: perceived coach autonomy support, basic psychological needs satisfaction, and psychological well-being, and b) to analyze the mediational effect of the satisfaction of perceived coach autonomy support on indicators of psychological well-being (satisfaction with life and subjective vitality). Six hundred and sixty-nine young Mexican athletes (Boys = 339; Girls = 330; M(age) = 13.95) filled out a questionnaire assessing the study variables. Structural equations analyses revealed that perceived coach autonomy support predicted satisfaction of the basic psychological needs for autonomy, competence, and relatedness. Furthermore, basic need satisfaction predicted subjective vitality and satisfaction with life. Autonomy, competence and relatedness partially mediated the path from perceived coach autonomy support to psychological well-being in young Mexican athletes.

Empowering and Disempowering Motivational Climates, Mediating Psychological Processes, and Future Intentions of Sport Participation.

Based on the conceptual model of multidimensional and hierarchical motivational climate the objective of this study was to test two models. One model (M1) of total mediation, testing the mediating mechanisms that explain why the motivational climate affects intention of continuity or dropout. Specifically, we test the mediating role of satisfaction/frustration of basic psychological needs and self-determined motivation, in the relationship between the players' perception of the empowering and disempowering climate created by the coach, and the intention of young soccer players to continue/dropout the sport practice. The second model (M2) of partial mediation, contributes to knowing the mechanisms that link the antecedent variables included in the model (perceived empowering and disempowering motivational climate) and the outcomes (intention of continuity or dropout in sport). A total of 381 young male soccer players between 12 and 14 years of age (M = 12.41, SD = 0.89), completed a questionnaire package tapping into the variables of interest: players' perception of the motivational climate created by the coach (empowering and disempowering), satisfaction/thwarting of basic psychological needs, self-determined motivation and the intention to continue/dropout sports participation. The hypothesized model was tested using a structural equation model technique with latent variables. The results of the partial mediation model were satisfactory (χ2= 120.92; df = 68; RMSEA = 0.045; CFI = 0.968; TLI = 0.957) and showed that need satisfaction and self-determined motivation partially mediated the relationship between the perception of the empowering climate and the intention to continue. Moreover, need satisfaction showed a positive and significant relationship with the intention to continue sports participation. Additionally, need thwarting and self-determined motivation totally mediated the relationship between the perception of the disempowering climate and the intention to dropout. Furthermore, needs thwarting was positively and significantly related to the intention to dropout of sports participation. Findings point to the importance of fostering empowering climates and preventing the creation of disempowering climates in the grassroots football.

[Subtotal sternal agenesis with ectopia cordis: surgical management and long-term outcome (a case in Benin)]. / Agénésie sternale subtotale avec ectopia cordis: gestion chirurgicale et résultat à long terme (à propos d´un cas au Bénin).

Sternal agenesis as well as ectopia cordis are extremely rare congenital malformations. We here report a single case treated in the Department of Paediatric Surgery in Benin. The study involved a 3-year-old girl with congenital sternal agenesis associated with ectopia cordis; firstly, she underwent controlled healing. Then thoracoplasty was performed with favourable outcome. Long-term results are good. Now, she is 13 years old, is attending school and has a satisfactory clinical condition. This is one of the few cases reported in the literature. Optimal therapeutic management has been keeping the patient alive in West Africa.

Corrigendum: Quality of the Physical Education Teacher's Instruction in the Perspective of Self-Determination.

[This corrects the article DOI: 10.3389/fpsyg.2021.708441.].

Quality of the Physical Education Teacher's Instruction in the Perspective of Self-Determination.

The teacher's instructions in physical education class have important implications for the psychological well-being of their students. The aim of this study was to analyze, under the postulates of the Self-Determination Theory (SDT), a model with the following sequence: the perception of the quality of the instructions (task presentation, amount of corrective feedback, and its legitimate perception) generated by the physical education teacher, the satisfaction of the three basic psychological needs and the subjective vitality in young students. The participants were 890 students (462 males and 428 females) of primary level from the metropolitan area of Monterrey, Mexico, between ages 11 and 13 (M = 11.36; SD = 0.49). The structural equation modeling showed positive and significant associations in all model interrelations, that is, task presentation and the amount of corrective feedback (B = 0.88, p < 0.001), and this in turn with legitimate perception (B = 0.81, p < 0.001); the legitimate perception of feedback and the satisfaction of the need for autonomy, competence, and relatedness (B = 0.63, p < 0.001; B = 0.90, p < 0.001; B = 1.01, p < 0.001, respectively); finally, the satisfaction of the three psychological needs and the subjective vitality (B = 0.12, p < 0.01; B = 0.43, p < 0.001; B = 0.24, p < 0.001, respectively). Therefore, the importance of a quality task presentation, as well as providing corrective feedback based on support for autonomy, is evident, so that students perceive it legitimately and thus facilitate the satisfaction of their basic psychological needs and in consequence, indicators of psychological well-being such as subjective vitality.

Coaches' Corrective Feedback, Psychological Needs, and Subjective Vitality in Mexican Soccer Players.

In the sport context, an essential aspect of an athlete's development and performance happens during the interaction with the coach while receiving information on the aspects of performance that need to be modified (corrective feedback). Grounded in the Self-Determination Theory and particularly on the basic psychological needs theory, a structural equation model (SEM) was tested with the following sequence: perception of the amount of corrective feedback generated by the coach, perceived legitimacy of corrective feedback, satisfaction of basic psychological needs, and vitality in soccer players. Additionally, simple mediation and serial (double) mediation models were also tested. Participants were 377 Mexican soccer players (Maged = 16.46, SD = 1.08), who completed the instruments that evaluated the study variables. SEM results reported positive and significant variables' interrelations in the sequence. The analysis of serial mediation model showed that the perceived legitimacy of feedback and the satisfaction of basic psychological needs fully mediated the relationship between the perception of the amount of corrective feedback generated by the coach and the perception of the subjective vitality of Mexican soccer players. Results suggest that coaches have to ensure that athletes accept the corrective feedback provided and meet their basic psychological needs. Based on SDT tenets, this research highlights the importance for coaches to be aware of the athlete's perceptions when they are providing corrective feedback and their implications for athlete's technical development and well-being. It is suggested to incorporate those aspects to training programs for coaches.

Students' Perceptions of Teachers' Corrective Feedback, Basic Psychological Needs and Subjective Vitality: A Multilevel Approach.

The way students perceive corrective feedback has repercussions on what they learn and think. Based on the self-determination theory, the aim of this study is to test a model of multilevel mediation that examines the relationships between the perception of corrective feedback with its degree of acceptance (perceived legitimacy) at the team level and the subjective vitality of students at the individual level, mediated by the satisfaction of the three psychological needs, in the context of physical education. The participants were 742 students aged between 10 and 13 years old (52.6% men, 47.4% women) in 29 physical education groups. The results of the multilevel structural equation modeling analysis found at the group (between) level a positive and significant relationship between corrective feedback and perceived legitimacy (B between = 0.49, p < 0.01), as well as a positive and significant relationship between perceived legitimacy and the needs of competence (B between = 0.66, p < 0.05) and relatedness (B between = 0.95, p < 0.01). In addition, there was a positive and significant association between competence and subjective vitality (B between = 2.06, p < 0.01), and a negative and significant association between relatedness and subjective vitality (B between = -0.85, p < 0.01). Also, on an individual (within) level, the needs of autonomy (B within = 0.09, p < 0.05), competence (B within = 0.27, p < 0.01), and relatedness (B within = 0.17, p < 0.01) were positively and significantly associated with subjective vitality. Finally, corrective feedback showed a positive indirect effect on subjective vitality through perceived legitimacy and competence, while the indirect effect was negative through perceived legitimacy and relatedness. In conclusion, on an individual level, students who perceive their basic psychological needs to be met in turn, increase their subjective vitality. At the group level, the results are discussed. These findings suggest that teachers might be best advised to ensure that their students accept corrective feedback, by having it couched in a manner that suggests that learning and improvement can follow, and communicated in an autonomy-supporting way.

Assessing the Relationship between Autonomy Support and Student Group Cohesion across Ibero-American Countries.

Teacher-endorsed supporting behaviors present themselves as key influencers of student adaptive academic and social functions. The objective of this paper was twofold. First, this study sought to test a model in which student-perceived autonomy support was associated with group cohesion, considering the mediating role of basic psychological needs satisfaction and intrinsic motivation. Second, the current study examined the dimensionality of the model across five Western countries, namely Spain, Portugal, Brazil, Chile, and Mexico. A convenience sample of 3033 college students (Mage = 21.51 ± SD = 3.71) were recruited for the analysis. The results revealed that perceived autonomy support was positively associated with needs satisfaction, being consequently associated with intrinsic motivation and, ultimately, with group cohesion. Additionally, a multigroup analysis revealed that the model was invariant across college students from the different countries. The current results are discussed around the promotion of teacher uses of autonomy-supportive behaviors fostering adaptive outcomes in students regarding positive social relations and that the cultures of Ibero-American countries are equivalent in this process.

Autonomous Motivation as a Mediator Between an Empowering Climate and Enjoyment in Male Volleyball Players.

The objective of this work was to analyze a mediation model concerning the perception of an empowering climate generated by a coach and enjoyment through the autonomous motivation of athletes. The sample consisted of 71 elite male volleyball players from six countries. The age range was 14 to 18 years (M = 16.5, SD = 0.96). The relationships between the perception of an empowering climate, autonomous motivation, and enjoyment were positive and significant. The mediation model showed that autonomous motivation acts as a mediator in the relationship between the perception of an empowering climate generated by the coach and the enjoyment reported by the athletes.

Validación del Cuestionario de Climas Motivacionales empowering y disempowering en jóvenes deportistas mexicanos / Validation of the Empowering and Disempowering Motivational Climates Questionnaire with young Mexican athletes

Resumen Introducción: El objetivo del estudio fue validar el Cuestionario de Climas Motivacionales Empowering y Disempowering (Empowering and Disempowering Motivational Climate Questionnaire-Coach, EDMCQ-C) en jóvenes deportistas mexicanos a través del análisis de sus propiedades psicométricas, fiabilidad, validez convergente-discriminante, concurrente y factorial (de primero y segundo orden). Método: Participaron un total de 1243 jóvenes deportistas mexicanos de 12 a 17 años. Resultados: Los análisis mostraron adecuadas propiedades psicométricas, tanto de fiabilidad por dimensiones y factores, como de validez, convergente-discriminante, concurrente, factorial, de dos dimensiones (AFC de primer orden) y de cinco factores con sus respectivas dos dimensiones (AFC de segundo orden). Conclusión: Estos datos sugieren que la versión adaptada al contexto mexicano es un instrumento válido y fiable para evaluar la percepción de los climas motivacionales que generan los entrenadores en jóvenes deportistas mexicanos.

Abstract Abstract Introduction: The aim of the study was to validate the Empowering and Disempowering Motivational Climate Questionnaire-Coach (EDMCQ-C) in young Mexican athletes through the analysis of its psychometric properties, reliability, convergent-discriminant, concurrent and factorial (first and second order) validity. Method: A total of 1243 young Mexican athletes aged 12 to 17 years participated. Results: Analysis showed adequate psychometric properties, both reliability by dimensions and factors, as well as convergent-discriminant, concurrent, factorial, two-dimensional (first-order CFA) and five-factor validity with their respective two dimensions (second-order CFA). Conclusion: These data suggest that the version adapted to the Mexican context is a valid and reliable instrument to assess the perception of motivational climates generated by coaches in young Mexican athletes.

El papel del profesor en la motivación y la salud mental de los estudiantes de educación física / The teacher's role on the motivation and mental health in physical education students

RESUMEN Introducción: La teoría de la autodeterminación sugiere que los sujetos con regulaciones autónomas mostrarán mayores niveles de funcionamiento óptimo que aquellos con regulaciones controladoras. Asimismo, la teoría ha defendido la importancia que tienen los factores sociales en los procesos motivacionales. En el contexto educativo, uno de los factores sociales que tiene un papel importante en la motivación de los estudiantes es el estilo interpersonal que utiliza el profesor cuando brinda instrucciones; por tanto, aquellos ambientes que fomenten la motivación autónoma serán importantes para el desarrollo óptimo y la salud mental de los estudiantes. Objetivo: Examinar si el grado en que los estudiantes perciben que el profesor de educación física apoya sus necesidades de autonomía, competencia y relaciones ayudará a fomentar su bienestar y reducir su malestar, a través de la motivación como mecanismo mediador. Método: Participaron 734 estudiantes de secundaria entre 11 y 17 años usando un diseño de estudio transversal. Se utilizó la técnica estadística de ecuaciones estructurales. Resultados: Los alumnos que perciben que su profesor apoya su autonomía, su competencia y sus relaciones presentan mayor motivación autónoma y menor no motivación; lo que les genera mayor bienestar y menor malestar. Discusión y conclusión: Se destaca la importancia de la motivación autónoma como el mecanismo mediador más potente para generar bienestar y evitar malestar en las clases de actividad física. Este estudio extiende y generaliza los hallazgos de la teoría de la autodeterminación a la población mexicana.

ABSTRACT Introduction: Self-Determination Theory (SDT) suggests that individuals with autonomous regulations hold greater levels of optimal functioning than those with controlling regulations. In addition, SDT underlines the importance of social aspects within motivational processes. In the educational setting, teachers' interpersonal style while giving instructions represents one of the most prominent social factors for triggering students' motivation. Therefore, contexts that foster autonomous motivation are considered the most suitable for promoting pupils' optimal growth and mental health. Objective: To examine if students' perception of Physical Education Teachers' support of their needs of autonomy, competence and relatedness could help encouraging their well-being and reducing their ill-being, through the mediating role of motivation. Method: Participants were 734 secondary school students between 11-17 years old. We used a cross-sectional design. Statistical analyses were carried out using structural equation modeling. Results: The degree to which the students perceived that the teacher-created context supported their autonomy, competence and relatedness predicted positively their autonomous motivation and negatively their no motivation, which in turn predicted positively well-being and negatively ill-being. Discussion and conclusion: Our results highlight the importance of autonomous motivation as the most powerful mediation mechanism for improving well-being and avoiding ill-being in physical activity classes. This research confirms and extends the finding of the self-determination theory within the Mexican population.

Alternativas de intervencionismo en las dilataciones esofágicas en el niño / Intervention alternatives in the esophageal dilations of the child

Introducción: el notable desarrollo de la imagenología, la introducción de bujías dilatadoras y de los stents, han permitido importantes avances en el tratamiento de la estenosis esofágica en el niño. Objetivo: evaluar las diferentes modalidades de intervencionismo en las dilataciones esofágicas, teniendo en cuenta la etiología, el tipo de lesión y los recursos disponibles. Métodos: se realizó un estudio descriptivo de corte transversal y prospectivo, en el que se expone nuestra experiencia en el tratamiento de 106 pacientes, con estenosis esofágica, ingresados en el servicio de cirugía del Hospital Pediátrico Docente Universitario de Centro Habana, a los cuales se les aplicaron diferentes modalidades de tratamiento dilatador, en el período comprendido de Enero de 1995 a Enero de 2011. Resultados: la ingesta de sustancias cáusticas constituyó la principal causa de estenosis esofágica en el 91,4 por ciento, por lo que requirió este grupo un mayor número de sesiones y de dilataciones (promedio 21,6 sesiones por paciente/rango 16 a 34; dilataciones 54 por pacientes), para las posquirúrgicas (promedio de 7 sesiones/rango de 2 a 5; y 16 dilataciones por paciente). La modalidad más utilizada fue la endoscópica videoasistida con arco en C, y la eficacia del tratamiento fue de un 90,5 por ciento. Requirieron de sustitución esofágica el 9,5 por ciento de los pacientes. Conclusiones: las dilataciones esofágicas en las estenosis de diferentes etiologías deben de iniciarse de forma precoz, y ser la primera línea de tratamiento antes de considerar otras variantes como las que implican una cirugía de sustitución del órgano

Introduction: the great development of imaging, and the introduction of dilating bougies and stents have allowed important advances in the treatment of esophageal stenosis in the child. Objective: to evaluate the different modalities of interventionism in esophageal dilations, taking the etiology, the type of lesion and the available resources into account. Methods: a prospective, cross-sectional and descriptive study was carried out to present our experience in treating 106 patients who suffered esophageal stenosis, were admitted to the surgical service of university teaching pediatric hospital of Centro Habana and were performed different dilating treatment modalities in the period of January 1995 to January 2011. Results: the intake of caustic substances represented the main cause of esophageal stenosis in 91.4 percent of cases, so this group required a higher number of sessions and of dilations (average of 21.6 sessions per patient/range of 16 to 34; dilations, 54 per patient) for post-surgical periods (average of 7 sessions/range of 2 to 5 and 16 dilations per patient). The most used modality was video-assisted endoscopy with C-arch and the efficacy of treatment was 90.5 percent. Of these patients, 9.5 percent required esophageal replacement. Conclusions: esophageal dilations in stenoses of different etiologies should early start and be the first line of treatment before considering other variants such as the organ replacement surgery