Using high-resolution imaging to study the impact of the Kalogon wheelchair cushion on blood flow in the gluteal area.

AIM OF THE STUDY: This study investigated how the air-bladder offloading mode of the Orbiter by Kalogon wheelchair cushion (Orbiter) affected blood flow in the gluteal region of non-disabled subjects. The hypothesis was that the cushion's offloading mode would improve blood flow, resulting in reduced reactive hyperemia when compared to the static setting, or Loaded Control (LC). Furthermore, the study proposed a technique using a high-resolution image laser speckle contrast system to measure blood flow in the gluteal area. METHODS: Two procedures were carried out, one with the participant sitting on a cushion in LC, and the second, the cushion was set to offloading mode. Blood flow was measured through data imaging after each procedure. Three trials were performed, starting and ending in different cushion bladders. Customized algorithms were used to select regions of interest on the images for calculations. The Wilcoxon Signed-Rank Test was conducted to compare the offloads and loaded control values of each region of interest. Results were considered significant at α = 0.05. RESULTS: Ten healthy, non-disabled adults participated in the study, seven females and three males. There were no significant differences among the participants. However, results showed that seven subjects tended to decrease reactive hyperemia in the offload sequence of trial when the last two bladders offloaded were the sacrum followed by the right ischial tuberosity. CONCLUSIONS: The high-resolution imager showed that the Orbiter Offloads helped reduce reactive hyperemia in seven subjects, potentially improving blood flow. More research is necessary to comprehend the mechanisms of these effects fully.

Impacts of exile on mental health: Considerations with a differential approach. State of the art 2000-2019 / Impactos del exilio sobre la salud mental: Consideraciones con enfoque diferencial. Estado del arte 2000-2019.

Introducción: : Resultados: Conclusiones: Introduction: Exile generates the fracture of the vital project and a high load of stress, which can induce the appearance of mental health disorders and health in general. The impact is subject to various demographic variables. Objective: The objective of this article is to present the product of a review of the impacts od exile on mental health based on age, gender and the most important risk and protection factors. Finally, reference is made to the most relevant approaches from the perspective of mental health Methodology: A search was carried out in various databases of academic literature between the period 2000-2019 using terms in Spanish, English and Portuguese in relation to the impacts of exile on the mental health of women, minor and older adults. The saturation criterion was used. Results: Although exile itself does not necessarily result in mental illness, the greatest risk is associated with armed conflicts; in women, the absence of an affective partner and the confluence of care roles; in older adults, loneliness, illness and poverty and in all ages and genders, being a victim of hostility or discrimination in the host society. As protective factors, younger age; family and social network; favorable economic conditions, higher level of educations, integration into social groups with cultural and linguistic affinity in the country of arrival. Conclusions: There is no single therapeutic approach. It´s important to highlight relevance of a comprehensive and cross-cultural perspective and the need for specific public policies.

Introducción: El exilio genera la fractura del proyecto vital y una alta carga de estrés, lo cual puede inducir la aparición de trastornos sobre la salud mental y sobre la salud en general. El impacto está sujeto a diversas variables demográficas y contextuales. Objetivo: El objetivo de este artículo es presentar el producto de una revisión de los impactos del exilio sobre la salud mental en función de la edad, el género y a los más importantes factores de riesgo y protección. Por último, se hace referencia a los abordajes más relevantes desde la perspectiva de la salud mental. Metodología: Fue realizada búsqueda en diversas bases de datos de literatura científica entre los años 2000 y 2019 utilizando términos en español, inglés y portugués con relación a los impactos del exilio en la salud mental de mujeres, menores y adultos mayores. Fue utilizado criterio de saturación. Resultados: Aunque el exilio en sí no necesariamente resulta en enfermedad, el riesgo mayor se asocia a conflictos bélicos; en la mujer, a la ausencia de compañero afectivo y a la confluencia de roles de cuidado; en adultos mayores, la soledad, enfermedad y pobreza y en todas las edades y géneros, ser víctima de hostilidad o discriminación en la sociedad de acogida, representan factores de vulnerabilidad. Como factores de protección, menor edad; red de soporte familiar y social, condiciones económicas favorables, mayor nivel de escolaridad, inserción en grupos sociales con afinidad cultural y lingüística en el país de llegada. Conclusiones: No hay un abordaje terapéutico único. Se destaca la relevancia de una mirada integral y transcultural y la necesidad de políticas públicas específicas.

Effects on tissue oxygenation in the gluteal region with a smart pressure redistribution wheelchair cushion compared to a pressure relief manoeuvre.

OBJECTIVE: The study examines the effects of the air-bladder offloading mode of a smart pressure redistribution wheelchair cushion on tissue oxygenation in the gluteal tissue of non-disabled participants. The hypothesis is that the cushion's offloading mode, which involves sequentially deflating its five air-bladders one at a time for a specific duration, would improve tissue oxygenation during sitting. METHODS: Two procedures were conducted. The first compared the cushion's offloads to a loaded control (LC) with the cushion on static mode, and the second compared the cushion's offloading mode to a standard manual offload performed by the participant. Three trials of each procedure were performed in randomized order. Tissue oxygenation was continuously monitored with three oxygenation parameters analysed: oxygen saturation (SO2), oxygenated haemoglobin (OxyHb), and deoxygenated haemoglobin (DeoxyHb). Data recordings were segmented in each step of the offloading sequence for analysis. A paired t-test was performed for comparisons with significance considered at α = 0.05. Ten healthy adults participated in the study. IMPACT: Results showed that as the air bladders deflated over time, the three evaluated parameters changed, affecting oxygenation even when other tissue areas were offloaded. The results indicated that the cushion's sacral offload had the greatest impact on improving tissue oxygenation among the five air-bladders in all ten subjects (p < 0.05). Furthermore, SO2 during the cushion's offload in the sacral region was similar to a manual offload. The study results suggest that the cushion could benefit tissue oxygenation, especially for individuals unable to change positions independently. Further research is needed to determine its effectiveness for wheelchair users.

The cushion's offloads, which involved deflating its five air-cell bladders one at a time for a specific duration, improved tissue oxygenation in the gluteal region of non-disabled individuals while seated.The cushion's offload in the sacral region had the greatest impact on improving tissue oxygenation among the five air-bladders in all ten subjects.This cushion could be an alternative for users who have limitations in performing pressure relief manoeuvres for the prevention of pressure injuries.A cushion that enhances tissue oxygenation while the user remains seated allows longer sitting periods, improving their quality of life, regardless of their ability to perform pressure relief manoeuvres.

Estrategias de afrontamiento en familiares de pacientes críticos / Coping strategies for relatives of critically ill patients

Introducción: la estadía en la unidad de cuidados intensivos genera cambios en la dinámica familiar causados por las alteraciones en las actividades diarias que obligan a utilizar estrategias que los mitiguen. Objetivo: describir las estrategias de afrontamiento de los familiares de pacientes críticos. Materiales y métodos: revisión integradora de literatura en las bases de datos y metabuscadores PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY, obteniendo 13 artículos: 7 estudios cuantitativos observacionales, 4 cualitativos fenomenológicos y 2 revisiones sistemáticas. Resultados: se determinó que las estrategias más utilizadas por los familiares de pacientes críticos son respuesta emocional, apoyo social, valores y creencias y crisis familiar. La más recurrente en los estudios revisados es la respuesta emocional debido a la implicación afectiva que tiene en los familiares la hospitalización de su ser querido. Conclusión: la respuesta emocional usada por los familiares como estrategia evidencia la necesidad de que los enfermeros garanticen espacios de acercamiento y expresión de sentimientos. Los servicios de salud deben priorizar el trato humanizado y una comunicación acorde con las necesidades de los familiares.

Introduction: the stay in the intensive care unit generates changes in the family dynamics caused by alterations in its daily activities that force the use of strategies that mitigate them. Objective: to describe the coping strategies for the relatives of critically ill patients. Materials and methods: integrative review of the literature in the PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY databases, obtaining 13 articles: 7 quantitative observational studies, 4 qualitative phenomenological studies and 2 systematic reviews. Results: it was determined that the most used strategies by relatives of critically ill patients are emotional response, social support, values and beliefs and family crisis. The most recurrent in the studies reviewed is the emotional response due to the emotional involvement of the family members in the hospitalization of their loved ones. Conclusion: the emotional response used by relatives as a strategy shows the need for nurses to guarantee spaces for approaching and expressing feelings. Health services should prioritize humanized treatment and communication according to the need of family members.

Comparación de biomarcadores inflamatorios en pacientes con trastorno afectivo bipolar tipo I y sujetos controles / Comparison of Inflammatory Biomarkers Between Bipolar Disorder I Patients and Control Subjects

Introducción: En el trastorno afectivo bipolar tipo I (TABI) se han descrito cambios inflamatorios en los diferentes episodios afectivos y en la etapa de eutimia, propuestos como posibles marcadores periféricos del trastorno, razón por la cual son necesarios estudios con adecuados criterios de inclusión para explorar esta hipótesis. Objetivo: Cuantificar y comparar las concentraciones séricas de interleucinas (IL) y factor de necrosis tumoral (TNF) en pacientes con TABI y en sujetos controles, incluyendo un análisis de comparación según el estado afectivo. Métodos: Estudio transversal sobre 41 pacientes con TABI y 11 controles, en los que se determinaron concentraciones de IL-1B, IL-RA, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 y TNF durante las fases de eutimia, depresión y manía, y se compararon con los de los sujetos controles. Resultados y conclusiones: El subgrupo de pacientes en manía tenía menor escolaridad y mayor número de hospitalizaciones, y el subgrupo de pacientes en depresión mostró mayor número de episodios depresivos a lo largo de la vida. No se encontraron diferencias estadísticamente significativas entre las concentraciones de IL y TNF de sujetos con TABI y sujetos controles ni entre los diferentes subgrupos de TABI (eutimia, depresión y manía). Es necesario aumentar la muestra en estudios posteriores con el fin de mejorar el poder estadístico y explorar la hipótesis infamatoria del trastorno bipolar.

Introduction: Inflammatory changes have been described in different affective episodes, as well as in the euthymic phase of Bipolar I Disease. These changes have been proposed as possible peripheral markers of the disease. For this reason well-designed studies are needed to explore this hypothesis. Objective: Quantify and compare the serum levels of interleukins (IL) and tumour necrosis factor (TNF) in bipolar I patients and healthy subjects, including the comparison between the affective episodes of the disease. Methods: Cross-sectional study including 41 bipolar I patients and 11 healthy control subjects. Serum levels of IL-1B, IL-RA, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12, and TNF were measured during the euthymic, depressive, and manic phases and were compared with the serum levels of the healthy subjects. Conclusions: Manic phase patients had low education and high number of hospitalisations. Depressive phase patients showed high number of depressive episodes throughout life. No statistically significant differences were found in IL and TNF levels between bipolar I patients and healthy controls, or between the bipolar I subgroups (euthymic, manic and depressive states). An increase in the size of the sample is necessary in future studies, in order to enhance the statistical value of the results, and explore the inflammatory hypothesis of the bipolar disease.

Diferencias en las circunstancias de riesgo al volante en universitarios guatemaltecos y españoles / Differences in mobility, traffic accidents and associated circumstances in guatemalan and spanish university students

Comparar las diferencias en las circunstancias de riesgo al volante en universitarios de Guatemala y España. Materiales y métodos. Estudio transversal realizado durante el 2007 a 2011 en una muestra de 2130 conductores (1016 en Guatemala y 1114 en España), quienes respondieron un cuestionario autoadministrado que valoraba: patrones de movilidad, uso de dispositivos de seguridad, estilos de conducción e implicación en accidentes de tránsito. Resultados. Los estudiantes de Guatemala se implicaron con mayor frecuencia en circunstancias de riesgo como hablar por el teléfono móvil (74,4% vs 24,3%), distraerse (47,1% vs 18,8%) o no usar el cinturón de seguridad (23,9% vs 5,9%) con respecto a los españoles; en el análisis ajustado el reporte de haber tenido algún accidente fue 4,8 veces mayor (IC 95% 3,1-7,4) en universitarios de Guatemala. Conclusiones. Existen factores dependientes del vehículo, entorno físico y de índole social, que podrían tener un rol importante en las diferencias detectadas en ambas poblaciones...

The purpose of this study was to compare the frequency of involvement in risky driving circumstances between Guatemalan and Spanish university students and identify in both populations the differences between the involvement in such circumstances and road crashes. Materials and methods. A cross sectional study was conducted during the academic courses 2007 to 2011 on a sample of 2 130 drivers (1 016 in Guatemala and 1 114 in Spain), who completed a self-administered questionnaire that assessed: mobility patterns, use of safety devices, driving styles and involvement in road traffic crashes. Results: Furthermore, they were involved more frequently in almost all the risky-driving circumstances compared with Spanish students, principally in: mobile use (74.4 % versus 24.3 %), distraction (47.1 % versus 18.8 %) or not using seatbelt (23.9% vs 5.9). Finally, the adjusted analysis yields an accident rate 4.8 times higher among Guatemalans (CI 95% 3.1-7.4). Conclusions: Considering the factors more frequently associated with suffer road traffic crashes dependent on human factor, it is noted physical and social factors as well as that the car-dependent issues, must play an important role in the marked differences detected in both populations...

Movilidad, accidentalidad por tránsito y sus factores asociados en estudiantes universitarios de Guatemala / Mobility, traffic accidents, and associated factors among Guatemalan university students / Mobilidade, acidentes de trânsito e fatores associados entre estudantes universitários da Guatemala

El objetivo fue identificar y cuantificar la asociación entre la intensidad de exposición (km/año recorridos), la accidentalidad y sus factores asociados en universitarios de Guatemala. Se realizó un estudio trasversal durante el curso 2010-2011, sobre una muestra de 1.016 conductores, quienes cumplimentaron un cuestionario autoadministrado que valoraba: patrones de movilidad, uso de dispositivos de seguridad, estilos de conducción y accidentalidad. Se obtuvieron asociaciones positivas entre la intensidad de exposición y la mayor implicación en circunstancias de riesgo al volante (coeficiente de regresión ajustado de 3,25, IC95%: 2,23-4,27, para las mayores exposiciones). Tanto una mayor implicación en tales circunstancias, como una mayor edad, fueron las variables más fuertemente asociadas con la mayor accidentalidad. Pese a que la intensidad de exposición se asocia positivamente con una mayor accidentalidad, se constató que la mayor parte de dicha asociación está mediada por una mayor implicación en circunstancias de riesgo al volante.

The aim of this study was to identify and quantify the association between the amount of driving (km/year), traffic accidents, and other factors among university students in Guatemala. A cross-sectional study was performed during the 2010-2011 school year in a sample of 1,016 drivers who completed a self-administered questionnaire that assessed mobility patterns, use of safety accessories, driving style, and automobile crashes. The results showed a positive association between amount of driving and greater involvement in risky driving (adjusted regression coefficient 3.25, 95%CI: 2.23-4.27, for the highest level of exposure). More frequent involvement in risky driving and older age showed the strongest associations with traffic accidents. Although the amount of driving was positively associated with a higher accident rate, most of this association was found to be mediated by involvement in risky driving practices.

O objetivo foi identificar e quantificar a associação entre a intensidade de exposição (km/anos percorridos), a acidentalidade e os seus fatores em universitários da Guatemala. Realizou-se um estudo transversal durante o curso 2010-2011 sobre uma amostra de 1.016 condutores de veículos, que responderam a um questionário autoadministrado que valorizava: padrões de mobilidade, uso de dispositivos de segurança, maneira de condução e acidentalidade. Obtiveram-se associações positivas entre intensidade de exposição e maior implicância em circunstâncias de risco ao conduzir (coeficiente de regressão ajustado a 3,25; IC95%: 2,23-4,27, para as maiores exposições). Tanto a maior implicância em ditas circunstâncias como uma maioridade foram as variáveis mais fortemente associadas com a maior acidentalidade. Apesar de a intensidade de exposição ser associada positivamente com uma maior acidentalidade, estabelecemos que a maior parte da dita associação está mediada pela maior implicância em circunstâncias de risco ao conduzir.