Telemedicine Beyond Borders: A Mixed-Methods Approach to Understanding Cross-National Usage Intention.

Introduction: Drawing on the Unified Theory of Acceptance and Use of Technology 2 and the Diffusion of Innovation Theory, this article investigates the adoption of telemedicine services from a patient perspective in Germany, Spain, and the United States using a mixed-methods approach. Digital health technologies have the potential to improve access to care and to alleviate the burden on traditional health care systems and are becoming more integrated into everyday medicine. Therefore, understanding the factors that impact patients' intentions to use telemedicine is crucial to ensure successful development. Methods: Based on 1,200 surveys collected in Germany, Spain, and the United States, structural equation modeling (IBM SPSS Amos 24) is employed to test the hypotheses. The article also explores how age and gender moderate the proposed relationships. Results: Seven out of the 10 hypotheses (performance expectancy, hedonic motivation, habit, relative advantage, and perceived security) are found to be positive, direct, and statistically significant. Furthermore, findings suggest stronger effects for telemedicine usage intention for younger female users than their male counterparts. Discussion: With digital health technologies becoming more prevalent, the outcomes of this study can endorse the development of effective strategies to promote the adoption of telemedicine, ultimately improving access to care and contributing to the advancement of and modern health care.

Prevention of type 2 diabetes in prediabetic patients by using functional olive oil enriched in oleanolic acid: The PREDIABOLE study, a randomized controlled trial.

AIM: To assess whether the regular intake of an oleanolic acid (OA)-enriched olive oil is effective in the prevention of diabetes. METHODS: In the PREDIABOLE study, prediabetic individuals (impaired fasting glucose and impaired glucose tolerance) of both sexes (176 patients, aged 30-80 years) were randomized to receive 55 mL/day of OA-enriched olive oil (equivalent dose 30 mg OA/day) [intervention group (IG)] or the same oil not enriched [control group (CG)]. The main outcome was the incidence of new-onset type 2 diabetes in both groups. RESULTS: Forty-eight new diabetes cases occurred, 31 in the CG and 17 in the IG. The multivariate-adjusted hazard ratio was 0.45 (95% CI, 0.24-0.83) for the IG compared with the CG. Intervention-related adverse effects were not reported. CONCLUSIONS: The intake of OA-enriched olive oil reduces the risk of developing diabetes in prediabetic patients. The results of the PREDIABOLE study promote the use of OA in new functional foods and drugs for the prevention of diabetes in individuals at risk of developing it.

Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study).

BACKGROUND: Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). METHODS: In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). RESULTS: After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. CONCLUSIONS: In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.

Evans Syndrome as First Manifestation of Primary Immunodeficiency in Clinical Practice.

BACKGROUND: Evans syndrome (ES) is a rare immune disorder in children, manifested by simultaneous or sequential autoimmune cytopenias (ACs) of unknown cause and having a chronic course with periods of exacerbation and remission. Some primary immunodeficiencies (PIDs) may present with autoimmune manifestations without infections, masking suspicion of them. The PIDs that can typically manifest as ES are autoimmune lymphoproliferative syndrome and common variable immunodeficiency (CVID). MATERIALS AND METHODS: Review of clinical charts and laboratory results of pediatric patients followed-up in the outpatient clinic of PID with a diagnosis of ES and humoral immunodeficiency. RESULTS: Three pediatric patients, a boy and 2 girls, presented with corticosteroid-dependent ES. In the diagnostic approach, autoimmune lymphoproliferative syndrome was ruled out, and during follow-up, patients showed laboratory signs of humoral immune deficiency and were diagnosed with CVID. After initiating the recommended treatment for CVID with AC, patients improved without new exacerbations. CONCLUSIONS: These cases highlight the importance of detection of possible PID in the context of ES and the establishment of CVID treatment to control AC.

Prevalence of Oppositional Defiant Disorder in a sample of Spanish children between six and sixteen years: teacher’s report.

INTRODUCTION: Our main objective is to study the prevalence of Oppositional Defiant Disorder (ODD) in school children aged 6-16 years of an autonomous region of Spain (Castile and Leon), according to reports from the teachers and to analyze the impact of the disorder on academic performance and school behavior. METHODS: Population study with stratified multistage, proportional and cluster design sample. Sample analyzed: 1,049. Cases were defined according to DSM-IV-TR criteria. RESULTS: An overall prevalence rate of 4.2% was found, this being significantly higher in males (5.7%) compared to females (2.6%) and in rural (6.8%) than in urban areas (3%). No significant differences by grade or type of school were found. ODD prevalence without considering functional impairment would increase to 5.1%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, math and writing) and entail worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks and disruption of the class). CONCLUSIONS: Based on the prevalence, early onset, persistence of symptoms and social and academic dysfunction of ODD, early diagnosis and preventive intervention are necessary.

Normative Beliefs about Adolescent-to-Parent Violence: The Spanish Adaptations of the Beliefs about Child-to-Parent Abuse Questionnaire and the Abusive Behavior by Children-Indices.

Ascertaining the true prevalence of adolescent-to-parent violence (APV) is challenging because the measurement of APV in research is complex. There is no consensus on which behaviors constitute APV or how frequently they need to occur to be considered abusive. This study aimed to explore the normative beliefs about APV related to the perpetrator's gender in a sample of Spanish parents, by developing Spanish adaptations of the BACPAQ and the ABC-I. The participants were 329 Spanish parents aged 19 to 81, and 77% were mothers. They answered the Spanish adaptation of the BACPAQ online after being contacted by university students using the snowball sampling technique. Results show that sons were judged more harshly than daughters; although, differences were statistically significant only for a few psychologically abusive behaviors. There was agreement with the original study on the abusive nature of most behaviors, especially regarding physical violence. Cultural differences were reflected in verbal, psychological, and economic violence, and Spanish parents used more stringent thresholds than Australians. Future research should tackle the difficulty of carrying out studies on APV using a single tool able to reflect normative beliefs about this type of domestic violence in different cultures.

Bystanders' reactions to animal abuse in relation to psychopathy, empathy with people and empathy with nature.

Social and academic interest in animal abuse has recently increased thanks to greater awareness of the importance of biodiversity in promoting sustainability. The redefinition of human-animal relationships, in the context of the fight against speciesism and the defense of veganism, has also contributed to this greater attention. Moreover, public awareness of animal rights has strengthened social reactions to violence against animals, though there are still some social sectors that are indifferent to these changes. Thus, better knowledge of the psychological mechanisms underlying reactions to animal abuse could contribute to better informal, social control of such abuse. The main aim of this study is to analyze the relationships between psychopathy, empathy with people, and empathy with nature arising from people's reactions to protected and domestic animal abuse and illegal dumping. Also, as previous studies have shown differences between men and women, both in animal abuse and in personality traits, thus gender is taken into account when analyzing these relationships. A total of 409 people, resident in a highly environmentally protected territory, participated in this study. They were aged between 18 and 82 years old and 49.9% women. Participants were asked about assigned punishments, as well as the probability of intervening personally and/or calling the police, in relation to ten scenarios, based on press releases, describing one of three types of transgression of environmental laws: abuse of protected animals, abuse of domestic animals or illegal dumping. They also responded to Spanish adaptations of the Inventory of Callous Unemotional Traits, the Basic Empathy Scale, the Dispositional Empathy with Nature Scale, and the Social Desirability Scale. Each participant was randomly given ten scenarios corresponding to just one transgression type but all the personality scales. Results show that people's reactions were greater for abuse of domestic than protected animals or for illegal dumping, irrespective of gender. Empathy with nature was related to the reaction against animal abuse more than empathy with people and psychopathy. Results are discussed highlighting the need for future research into similarities and differences between animal abuse and other types of environmental offences, which have many victims but no single being suffering.

Psychosocial Profile of Juvenile and Adult Offenders Who Acknowledge Having Committed Child-to-Parent Violence.

The main objective of this study was to establish the psychosocial profile of adolescents and adults who have admitted to committing child-to-parent violence (CPV) and were serving a judicial sanction or prison sentence, respectively. Two groups of participants took part in this study. The first group was made up of 89 male youths who were serving judicial sanctions, and the second group was made up of 70 men serving a prison sentence. A cross-sectional retrospective design with concurrent measurements was used in this study. Group differences in the exposure-to-violence variables were conducted. Automatic regression models were used to estimate a self-reported CPV. In relation to the variables of indirect exposure to violence, statistically significant differences between those who admitted having committed CPV and those who did not, irrespective of being adults or adolescents, were found for seeing violence in class and at home but not for seeing violence on the street or on television. Regarding the variables related to experiencing violence, the results showed statistically significant differences in experiencing violence at home but not in class or on the street. The best predictive model of CPV includes some of the dimensions of self-concept, specifically academic and family self-concept, as well as the avoidant and rational problem-solving styles and the negative orientation toward problems. The results have shown the existence of a CPV offender profile that is common to minors and adults.

Sarcoptic mange outbreak decimates South American wild camelid populations in San Guillermo National Park, Argentina.

Sarcoptic mange epidemics can devastate wildlife populations. In 2014, mange was first detected in vicuñas (Vicugna vicugna) and guanacos (Lama guanicoe) in San Guillermo National Park (SGNP), Argentina. This study describes the temporal dynamics of the outbreak, its effects on the park's wild camelid populations between 2017-2019, and investigates the potential source of the epidemic. From May 2017 to June 2018, transect surveys indicated a sharp decrease in the density of living vicuñas and guanacos by 68% and 77%, respectively. By April 2019 no vicuñas or guanacos were recorded on transect surveys, suggesting their near-extinction in the park. Clinical signs consistent with mange (e.g., intense scratching, hyperkeratosis, alopecia) were observed in 24% of living vicuñas (n = 478) and 33% of living guanacos (n = 12) during surveys, as well as in 94% of vicuña carcasses (n = 124) and 85% of guanaco carcasses (n = 20) examined. Sarcoptes scabiei was identified as the causal agent by skin scrapings, and the cutaneous lesions were characterized by histopathology (n = 15). Genetic characterization revealed that mites recovered from seven vicuñas (n = 13) and three guanacos (n = 11) shared the same genotype, which is consistent with a single source and recent origin of the epidemic. Tracing the potential source, we identified a governmental livestock incentive program which introduced llamas (Lama glama) in areas adjacent to SGNP in 2009, some of which had alopecic scaling consistent with sarcoptic mange. Though at the time of our study no llamas with mange were available for confirmatory sampling, we hypothesize that the introduction of mange-infected llamas may have triggered the outbreak in wild camelids. This unprecedented event in SGNP had devastating effects on dominating herbivores with potentially profound cascading effects at the community and ecosystem levels.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption.

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients' usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24). Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

Validation of the Explanations of Adolescent-to-Parent Violence Scale.

BACKGROUND: Adolescent-to-parent violence (APV) is a social problem that is seldom addressed from a psychosocial level of analysis. This work aims to fill this gap by developing the Escala de Explicaciones de la Violencia Filioparental (EEVFP), an instrument to measure APV explanations given spontaneously by ordinary people. METHOD: The sample was composed of 763 men and women aged 15 to 79, with and without offspring. RESULTS: Using a cross-validation procedure based on factorial analysis, the scale's underlying structure that best fit the data included six factors: Poor Parenting, Inadequate Environment, Emotional Reaction, Adolescence, and Evil/Madness. Evidence on the relationship between EEVFP and the Revised Scale of Causal Dimensions was also provided, as well as on differences in explanations due to gender and having children. CONCLUSIONS: The results provide sufficient evidence of reliability and validity to consider EEVFP a useful tool in APV research exploring the relationship between APV explanations and subsequent behavior. This research may be helpful in training practitioners and in designing intervention strategies that avoid blaming parents and increase support from their surroundings.

(Pro)renin Receptor Is a Novel Independent Prognostic Marker in Invasive Urothelial Carcinoma of the Bladder.

(Pro)renin receptor (PRR) is being investigated in several malignancies as it activates pathogenic pathways that contribute to cell proliferation, immunosuppressive microenvironments, and acquisition of aggressive neoplastic phenotypes. Its implication in urothelial cancer (UC) has not been evaluated so far. We retrospectively evaluate the prognostic role of PRR expression in a series of patients with invasive UC treated with radical cystectomy and other clinical and histopathological parameters including p53, markers of immune-checkpoint inhibition, and basal and luminal phenotypes evaluated by tissue microarray. Cox regression analyses using stepwise selection evaluated candidate prognostic factors and disease-specific survival. PRR was expressed in 77.3% of the primary tumors and in 70% of positive lymph nodes. PRR expression correlated with age (p = 0.006) and was associated with lower preoperatively hemoglobin levels. No other statistical association was evidenced with clinical and pathological variables (gender, ASA score, Charlson comorbidity index, grade, pT, pN) or immunohistochemical expressions evaluated (CK20, GA-TA3, CK5/6, CD44, PD-L1, PD-1, B7-H3, VISTA, and p53). PRR expression in primary tumors was associated with worse survival (log-rank, p = 0.008). Cox regression revealed that PRR expression (HR 1.85, 95% CI 1.22-2.8), pT (HR 7.02, 95% CI 2.68-18.39), pN (HR 2.3, 95% CI 1.27-4.19), and p53 expression (HR 1.95, 95% CI 1.1-3.45) were independent prognostic factors in this series. In conclusion, we describe PRR protein and its prognostic role in invasive UC for the first time. Likely mechanisms involved are MAPK/ERK activation, Wnt/ß-catenin signaling, and v-ATPAse function.

Encephalomyocarditis virus infection in an Italian zoo.

A fatal Encephalomyocarditis virus (EMCV) infection epidemic involving fifteen primates occurred between October 2006 and February 2007 at the Natura Viva Zoo. This large open-field zoo park located near Lake Garda in Northern Italy hosts one thousand animals belonging to one hundred and fifty different species, including various lemur species. This lemur collection is the most relevant and rich in Italy. A second outbreak between September and November 2008 involved three lemurs. In all cases, the clinical signs were sudden deaths generally without any evident symptoms or only with mild unspecific clinical signs. Gross pathologic changes were characterized by myocarditis (diffuse or focal pallor of the myocardium), pulmonary congestion, emphysema, oedema and thoracic fluid. The EMCV was isolated and recognized as the causative agent of both outbreaks. The first outbreak in particular was associated with a rodent plague, confirming that rats are an important risk factor for the occurrence of the EMCV infection.

What Goes on in This House Do Not Stay in This House: Family Variables Related to Adolescent-to-Parent Offenses.

Research on adolescent-to-parent violence (APV) associates specific psychosocial characteristics with adolescents who assault their parents, whether they are within or outside the juvenile justice system, or whether these characteristics are shared by other adolescents convicted of other crimes. The aim of this paper is to compare three groups of adolescents. Those who have been sentenced for APV are compared with adolescents who have committed other crimes, and with a group who have not been involved in the justice system. The sample used consists of 148 male participants between the ages of 14 and 21. A comparison is made regarding type of self-reported behavior, frequency of drug use, academic performance, exposure to violence, self-concept, and parents' conflict resolution tactics. The results obtained indicate that adolescents with judicial measures, regardless of the crime committed, differ from those who have not been in trouble with the justice system in terms of them having suffered violence in the street, the frequency with which they use drugs and in their academic achievement. Likewise, adolescents convicted of APV differ from the other two groups in the frequency with which they are victims of violence at home, in that their mothers use the tactic of asking somebody else for help as a way of solving marital conflicts, and in having a more negative family self-concept. The results are discussed highlighting the importance of taking into account whether a sample is judicial, clinical, or community, and the specific APV behaviors which are measured.

Are Health e-Mavens the New Patient Influencers?

Even though the healthcare industry is usually considered a rather traditional and slowly evolving sector, change is happening. Digitalization is transforming the way of obtaining medical advice and treatment and the Internet has become a key source for the seeking of healthcare information. It has allowed people to turn into more active collaborators in matters of their own health by enabling them to easily search and share information with other patients. Although research points out the growing importance of user-generated content in many sectors and its positive impact on information credibility, trust, engagement, and, ultimately, customer behavior (Malthouse et al., 2016), there is a lack of attention to this topic in healthcare. In this brief review, we address this gap by analyzing the role of health e-mavens, which are a particular type of influencers that possesses both expertise and online social influence. We lastly illustrate possible benefits of their impact on other to the different parties involved and affected by this phenomenon.

A Trypanosoma cruzi Genome Tandem Repetitive Satellite DNA Sequence as a Molecular Marker for a LAMP Assay for Diagnosing Chagas' Disease.

Chagas' disease is a neglected tropical disease caused by Trypanosoma cruzi which is endemic throughout Latin America and is spread by worldwide migration. Diagnosis is currently limited to serological and molecular techniques having variations regarding their sensitivity and specificity. This work was aimed at developing a new sensitive, applicable, and cost-effective molecular diagnosis technique for loop-mediated isothermal amplification-based detection of T. cruzi (Tc-LAMP). The results led to determining a highly homologous satellite repeat region (231 bp) among parasite strains as a molecular marker for diagnosing the disease. Tc-LAMP was performed correctly for detecting parasite DNA (5 fg for the CL Brener strain and 50 fg for the DM28, TcVI, and TcI strains). Assay results proved negative for DNA from 16 helminth species and 7 protozoa, including Leishmania spp. Tc-LAMP based on the highly repeated T. cruzi satellite region is thus proposed as an important alternative for diagnosing T. cruzi infection, overcoming other methods' limitations such as their analytic capability, speed, and requiring specialized equipment or highly trained personnel. Tc-LAMP could be easily adapted for point-of-care testing in areas having limited resources.

The coexpression of fibroblast activation protein (FAP) and basal-type markers (CK 5/6 and CD44) predicts prognosis in high-grade invasive urothelial carcinoma of the bladder.

High-grade urothelial carcinoma (UC) of the bladder is a heterogeneous disease with dismal prognosis. Bladder tumors with basal phenotype are intrinsically aggressive, and morphological parameters that define disease staging remain main prognosticators. We intend to evaluate the role of cancer-associated fibroblasts (CAFs) in the prognosis of bladder cancer and its association with basal and luminal phenotypes. Clinical and pathological parameters, including the immunohistochemical expression of fibroblast activation protein (FAP) and markers of basal (CK5/6, CD44) and luminal (CK20, GATA3) phenotypes, have been investigated in a series of 121 patients with UC of the bladder treated by radical cystectomy with lymph node dissection, and their implication in long-term cancer-specific survival has been evaluated. A cytoplasmic immunostaining of FAP in CAFs implies worse disease-specific survival (hazard ratio [HR] = 1.68; P = .048). FAP expression is associated with tumor staging (P < .0001), with best discrimination at T2a/T2b level, and with negative expression of markers of luminal phenotype, such as CK20 (P < .0001) and GATA3 (P = .005). In the multivariate analysis, simultaneous expression of FAP, CK5/6, and CD44 is a strong prognosticator of disease-specific survival (HR = 2.3; P = .001), together with nodal invasion (HR = 3.47; P < .0001) and bladder infiltration up to deep muscle or beyond (HR = 2.47; P = .02). There is no association between positive FAP expression in primary tumor and nodal disease (P = .22). FAP expression in CAFs favors tumor invasion in high-grade invasive UC of the bladder with basal phenotype. This new immunohistochemical marker could be added to the routine immunohistochemical protocol to predict clinical behavior in these patients.

Unilateral mydriasis during temporal lobe seizures.

Autonomic signs and symptoms are a common feature of epileptic seizures. Although sympathetic activation responses are predominant, we can also find sympathetic inhibition and even an activation of the parasympathetic division of the autonomic nervous system, especially in partial seizures. These autonomic symptoms during seizures are thought to be the result of neuronal discharges arising from or spreading to cortical areas of the central autonomic network. Mydriasis, most commonly bilateral, is one of the most frequent findings. The patient described, a middle-aged man with a focal lesion in the right temporal lobe extended to the adjacent hypothalamus, presented with episodes of autonomic symptoms including prominent unilateral mydriasis, finally evolving into a state of decreased alertness. An ictal electroencephalogram and a simultaneous video recording supported the clinical impression of an epileptic aetiology. Unilateral mydriasis is a rare condition during epileptic seizures and very few cases have been reported in the past.

[Social valuation and punishment assignment in transgressions of environment protection laws]. / Valoración social y asignación de castigo en transgresiones a las leyes de protección del medio ambiente.

The <> of breaches of environmental law is not always evident. This characteristic contributes to making the study of people's evaluation of anti-ecological behaviour of special interest for the understanding of environmental law compliance. In this study, 573 participants evaluated seven transgressions of environmental law, on seven scales. The results show that participants differentially evaluate the transgressions; that Indignation and the Severity of the consequences are the scales that best predict the punishment that participants think should be assigned to these transgressions; that women are stricter in evaluating; and that there are marginal differences related to area of residence and age.

The sequential analysis of transgressors' accounts of breaking environmental laws.

Three-hundred and twenty written accounts of environmental transgressors were assessed by sequential analysis to reveal their argument streams. The accounts were obtained from the written statements that transgressors are allowed to give during the Spanish administrative process and which were included in files handled by four environmental law enforcement agencies. These agencies are distributed across national, regional, island and municipality jurisdictions. The setting for the study is a highly protected environment in which environmental laws have high salience. Results reveal that transgressors use simple argument streams, consistently more defensive than conciliatory, and questioning the perceived legitimacy of environmental law. It was seen also that the empirical functioning of the explanations related to pursuing emotional/prosocial objectives differs from what was expected from the traditional conceptual definition. Results are discussed in terms of how the assessment of the internal dynamic of the accounts would provide valuable information on transgressors' reasoning in relation to environmental laws.