RESUMO
BACKGROUND: Mental health literacy (MHL) is especially important for young people, but comprehensive studies on MHL in adolescents are limited, with no nationwide studies in Spain. This research aims to study MHL among Spanish adolescents and its relationship with sociodemographic factors. METHODS: An exploratory study is carried out using stratified random sampling in Spanish adolescents (N = 1000), aged 12-16 years and balanced in terms of gender, age and territorial distribution. Data collection took place in October and November 2023 through online surveys using the CAWI methodology. Sociodemographic variables, contact with mental health and the Spanish version of the Mental Health Literacy Questionnaire (MHLq-E), a self-administered instrument of 32 Likert-type items (1-5) that assesses the dimensions of help-seeking skills, knowledge about causes and symptoms, and stigma, were evaluated. Descriptive and multivariate analyses of variance (MANOVA) were conducted. RESULTS: In general, adequate levels of literacy were observed, although some aspects related to help-seeking towards teachers, stigmatising attitudes towards people of low economic status and knowledge of severe mental health problems could be improved. The results show contact with previous mental health problems as a key variable for stigma and knowledge about symptomatology together with age. Likewise, gender and family educational level were found to be related to the ability to seek professional help. CONCLUSION: This study provides information on levels of MHL among Spanish adolescents and highlights significant socio-demographic variables. These findings pave the way for interventions aimed at improving adolescents' understanding, attitudes and skills to manage mental health problems, making possible to adapt content and focus on specific groups, thus increasing its effectiveness.
Assuntos
Letramento em Saúde , Saúde Mental , Humanos , Adolescente , Letramento em Saúde/estatística & dados numéricos , Masculino , Feminino , Espanha , Estudos Transversais , Criança , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde , Estigma Social , Transtornos MentaisRESUMO
METHODS AND RESULTS: We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p=0.05) and PPMI rate (17.8% vs. 6.4%; p=0.004) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). CONCLUSION: Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.
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Estenose da Valva Aórtica , Valva Aórtica , Bloqueio de Ramo , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/terapia , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Desenho de Equipamento , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodosRESUMO
AIMS: Limited data exist on radial access in carotid artery stenting (CAS). This single-center study was performed to compare the outcome and complication rates of transradial (TR) and transfemoral (TF) CAS. METHODS AND RESULTS: The clinical and angiographic data of 775 consecutive patients with high risk for carotid endarterectomy, treated between 1999 and 2016 by CAS with cerebral protection, were evaluated. Patients were divided into 2 groups according to vascular access: TR (n = 101; 13%) and TF (n = 674). Primary combined end-point: in-hospital major adverse cardiac and cerebral events. Secondary end-points: angiographic outcome of the procedure and crossover rate to another puncture site. Angiographic success was achieved in all 775 patients, the crossover rate was 4.9% in the TR and 0% in the TF group (P < 0.05). TR was performed at the right side in 97% of cases. The incidence of in-hospital major adverse cardiac and cerebral events was 2% in the TR and 3.6% in the TF group (P = ns). CONCLUSIONS: The TR approach for CAS is safe and efficacious, with acceptable cross-over rate. In both groups, vascular complications rarely occurred.
Assuntos
Implante de Prótese Vascular , Artérias Carótidas , Estenose das Carótidas , Cateterismo Periférico , Artéria Femoral/cirurgia , Complicações Pós-Operatórias , Artéria Radial/cirurgia , Idoso , Angiografia/métodos , Argentina/epidemiologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Doenças Cardiovasculares , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/cirurgia , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Risco Ajustado , Fatores de Risco , Stents , Resultado do TratamentoRESUMO
OBJECTIVES: Critical limb ischemia complicates peripheral artery disease leading to tissue damage and amputation. We hypothesized that modifying adipose stromal cells (ASCs) to overexpress human vascular endothelial growth factor 165 (VEGF) would limit ischemic muscle damage to a larger extent than nonmodified ASCs. APPROACH AND RESULTS: Rabbits with critical hindlimb ischemia were injected with allogeneic abdominal fat-derived ASCs transfected with plasmid-VEGF165 (ASCs-VEGF; n=10). Additional rabbits received nontransfected ASCs (ASCs; n=10) or vehicle (placebo; n=10). One month later, ASCs-VEGF rabbits exhibited significantly higher density of angiographically visible collaterals and capillaries versus placebo (both P<0.05) but not versus ASCs (both P=NS). Arteriolar density, however, was increased in both ASCs and ASCs-VEGF groups (both P<0.05 versus placebo). ASCs-VEGF and ASCs showed comparable post-treatment improvements in Doppler-assessed peak systolic velocity, blood pressure ratio, and resistance index. Ischemic lesions were found in 40% of the muscle samples in the placebo group, 19% in the ASCs-VEGF group, and 17% in the ASCs groups (both P<0.05 versus placebo, Fisher test). CONCLUSIONS: In a rabbit model of critical limb ischemia, intramuscular injection of ASCs genetically modified to overexpress VEGF increase angiographically visible collaterals and capillary density. However, both modified and nonmodified ASCs increase arteriolar density to a similar extent and afford equal protection against ischemia-induced muscle lesions. These results indicate that modifying ASCs to overexpress VEGF does not enhance the protective effect of ASCs, and that arteriolar proliferation plays a pivotal role in limiting the irreversible tissue damage of critical limb ischemia.
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Tecido Adiposo/transplante , Terapia Genética/métodos , Isquemia/terapia , Músculo Esquelético/irrigação sanguínea , Neovascularização Fisiológica , Células Estromais/transplante , Fator A de Crescimento do Endotélio Vascular/biossíntese , Tecido Adiposo/citologia , Tecido Adiposo/metabolismo , Animais , Arteríolas/metabolismo , Arteríolas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Capilares/metabolismo , Capilares/fisiopatologia , Células Cultivadas , Circulação Colateral , Modelos Animais de Doenças , Feminino , Membro Posterior , Humanos , Isquemia/genética , Isquemia/metabolismo , Isquemia/patologia , Isquemia/fisiopatologia , Masculino , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Necrose , Coelhos , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Células Estromais/metabolismo , Fatores de Tempo , Transfecção , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
OBJECTIVES: To report the incidence and predictors of moderate/severe radial artery spasm (RAS) in patients undergoing cardiovascular percutaneous procedures through a transradial approach (TRA) in centers with TRA expertise. BACKGROUND: Data regarding the actual rate of clinically meaningful RAS are limited due to difference in study designs and operator expertise. METHODS: The RAS registry, an international (14 centers from Argentina, Chile, India, Indonesia, Macedonia, The Netherlands and United States of America) registry that included 1,868 patients undergoing TRA cardiovascular procedures (63.5% diagnostic and 56.5% therapeutic).All selected centers used TRA as default strategy in the cardiac catheterization laboratory. Throughout 2012, each center included all consecutive TRA cases (during a 2-month period) into a dedicated database covering clinical characteristics as well as procedural topics related to TRA patterns and RAS occurrence. RESULTS: The incidence of moderate/severe RAS was 2.7%. Only 0.7% of patients required crossover (8 to transfemoral and 5 to contralateral TRA). Patients with moderately/severe spasm were more frequently females, had a history of dyslipidemia, received more often a 7F sheath and more puncture attempts than patients without spasm. By multivariate analysis, the need for more than one attempt and the use of a 7 F sheath were independent predictors of the development of moderate/severe RAS. CONCLUSIONS: The incidence of moderate/severe RAS is low in centers with a default TRA. Its development appears to be strongly related to the numbers of puncture attempts and the use of large sheaths.
Assuntos
Arteriopatias Oclusivas/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Artéria Radial/fisiopatologia , Vasoconstrição , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Ásia/epidemiologia , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Cateterismo Periférico/instrumentação , Desenho de Equipamento , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Punções , Sistema de Registros , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Thromboembolic pulmonary disease is challenging for physicians when diagnosed in acute, sub-acute and chronic clinical patients, not only due to its morbi-mortality, but also because of its complex therapeutic management. Severity of the acute condition and potential commitment of right ventricular systolic function require therapeutic strategies, sometimes combined, in order to change the disease's course, optimizing patient survival. Pharmacological and mechanical thrombolysis are useful therapeutic tools for patients suffering from severe acute pulmonary embolism. This study refers to a young woman who developed a sub-massive pulmonary embolism, of sub-acute onset. She underwent the combined sequential therapeutic strategy of pharmacological and mechanical thrombolysis with successful outcome.
Assuntos
Trombólise Mecânica , Embolia Pulmonar/terapia , Terapia Trombolítica , Adulto , Terapia Combinada/métodos , Feminino , Humanos , Resultado do TratamentoRESUMO
AIM: To assess the results of transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve prosthesis (Medtronic, Minneapolis, MN), without balloon predilation, in high-risk patients with degenerated severe aortic stenosis. METHODS AND RESULTS: Fifty-one consecutive patients who underwent direct TAVI, 98% through a transfemoral approach. Patients were 79 ± 8 years of age, 74% in New York Heart Association classes III or IV and at high risk for surgical valve replacement (mean logistic EuroScore 20 ± 15). Mean aortic valve area was 0.7 ± 0.2 cm(2). Procedural success rate was 94.2%. In-hospital, there were 2 deaths, 1 minor stroke with minimal sequelae, and 14 (28%) pacemaker implantation. At 30 days, there was one additional stroke and no new deaths. The mean postprocedural transprosthetic gradient was 15 ± 5 mm Hg; periprosthetic severe regurgitation was absent and moderate in one case. After a median follow-up of 7 months, there were five additional deaths (two cardiac), while 84% of survivors were in New York Heart Association classes I or II. CONCLUSIONS: These results suggest that direct CoreValve implantation in patients with severe aortic stenosis is feasible and may lead to hemodynamic and clinical improvement in patients who are poor candidates for aortic valve surgery, pending confirmation in larger series with longer follow-up.
Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica/patologia , Calcinose/terapia , Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Argentina , Calcinose/diagnóstico , Calcinose/mortalidade , Calcinose/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Ecocardiografia Transesofagiana , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES: We aimed to assess safety and, secondarily, the efficacy of intramyocardial high-dose plasmid-vascular endothelial growth factor (VEGF) 165 (pVEGF165) gene transfer in no-option patients with coronary artery disease (CAD). BACKGROUND: Controlled trials of pVEGF165 in CAD have shown little benefit. One possible reason is shortness of dosage. We have shown in large mammalian models of chronic myocardial ischemia and acute myocardial infarction that intramyocardial pVEGF165 at doses significantly higher than those used in recent phase II trials is safe and efficacious on myocardial perfusion, left ventricular function, and infarct size limitation. METHODS: Using an injection catheter, 10 patients with severe CAD not amenable for revascularization received 10 intramyocardial injections of 0.38 mg (total dose, 3.8 mg) pVEGF165 in zones exhibiting myocardial ischemia, as assessed by combined stress 99mTc-sestamibi single-photon emission computed tomography and stress echocardiography. RESULTS: No serious adverse events related to either VEGF or the injection procedure occurred over the 2-year follow-up. One patient suffered femoral artery thrombosis after a follow-up coronary angiography, successfully resolved with medical treatment. Six patients suffered uncomplicated coronary ischemic events during the second year follow-up. Angina functional class decreased from 2.6 ± 0.2 to 1.2 ± 0.3 (mean ± SEM, P < 0.05), quality of life increased from 56.9 ± 3.2 to 82.6 ± 2.4 (P < 0.05), the summed difference score of myocardial perfusion decreased from 13.4 ± 2 to 7.7 ± 1.8 (P < 0.04), and stress ejection fraction did not change (44.2 ± 3.6% to 47.8 ± 3.1%, P = NS). CONCLUSIONS: High-dose intramyocardial pVEGF165 is safe at 2 years follow-up in patients with severe CAD. The efficacy results observed must be taken cautiously given the uncontrolled, open-label study design.
Assuntos
Doença da Artéria Coronariana/terapia , Técnicas de Transferência de Genes , Terapia Genética/métodos , Neovascularização Fisiológica , Plasmídeos , Fator A de Crescimento do Endotélio Vascular/biossíntese , Idoso , Argentina , Circulação Colateral , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Ecocardiografia sob Estresse , Feminino , Terapia Genética/efeitos adversos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Compostos Radiofarmacêuticos , Índice de Gravidade de Doença , Volume Sistólico , Tecnécio Tc 99m Sestamibi , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
Introduction: Those who are professionally dedicated to teaching can be exposed with their work to situations that influence their perception of psychological well-being. This study aims to evaluate how the factors of personality, emotional intelligence, burnout and the psychosocial climate derived from the work environment of teachers influence their levels of psychological well-being, to verify whether these variables allow us to establish a predictive model of psychological well-being by means of multiple regression analysis. Methods: Participants were a group of 386 teachers in early childhood, Primary and Secondary education, both in training and in active service (71.5% women; 28.5% men). A correlation and multiple regression analysis were performed to establish a predictive model of psychological well-being. We used 5 instruments: Psychosocial Climate at Work Scales (ECPT); verall Personality Assessment Scale (OPERAS); Questionnaire for Evaluation of Burnout Syndrome at Work (CESQT); Spanish adaptation of the Riff Psychological Well-being Scales (EBP) and Spanish validation of the Trait Meta-Mood Scale (TMMS-24). Results: Most of the relationships were significant, and the multiple regression analysis explains 58.5% of the global variance of psychological well-being in teachers, being emotional stability the most relevant and main predictor of psychological well-being, explaining its 38.1%. Discussion: Personality shows a great influence in psychological well-being of teachers, particularly emotional stability. The ability to establish predictive models to explain psychological well-being in educational environments is confirmed.
RESUMO
The main activating variables of psychological well-being and Emotional Intelligence that influence teachers include the process of evaluating well-being, their motivation, and their ability to perceive and regulate sources of stress and burnout. The relationship and influence of psychological well-being and emotional intelligence was analyzed with the adequate regulation of burnout. Those who participated included 386 active teachers (55%), and teachers in training (45%), studying for degrees in Pre-School and Primary Education, and Master's degrees in Secondary Education Teacher Training of which 71.5% were women. The following were used: Psychological Well-Being Scales, Trait Meta-Mood Scale and the Spanish Burnout Inventory. Pearson's correlation analysis and multiple regression analysis were performed. The results showed that enthusiasm for the teaching job is related to psychological well-being, especially domain of the environment and personal growth. Multiple regression analysis made it possible to establish a predictive model of well-being, showing that psychological well-being is the main adjustment predictor and/or the mismatch in the work of the teaching staff in both samples, through an adequate regulation of positive relationships, mastery of their environment and having a purpose in life.
Assuntos
Esgotamento Profissional , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Esgotamento Psicológico , Pré-Escolar , Inteligência Emocional , Feminino , Humanos , Masculino , Motivação , Professores Escolares/psicologia , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
Chest pain is a frequent symptom in patients with pulmonary hypertension of any etiology. Its pathophysiology has not been clearly established, the proposed causes are ischemia due to increased right ventricle wall stress, transient increased pulmonary hypertension resulting in acute pulmonary artery dilatation and external compression of the left main coronary artery (LMCA) by a dilated pulmonary artery. We report and discuss here three cases where the association between chest pain and compression of the LMCA by a dilated pulmonary artery could be shown, and they were treated with coronary stenting.
Assuntos
Angina Pectoris/etiologia , Dor no Peito/etiologia , Complexo de Eisenmenger/complicações , Hipertensão Pulmonar/complicações , Stents , Adulto , Angina Pectoris/diagnóstico por imagem , Cineangiografia , Complexo de Eisenmenger/diagnóstico por imagem , Complexo de Eisenmenger/terapia , Feminino , Humanos , Hipertensão Pulmonar/terapia , Artéria Pulmonar/diagnóstico por imagemRESUMO
BACKGROUND: Type III Intestinal Failure (IF) is a devastating clinical condition.characterized by the inability of the gut to absorb necessary macronutrients, and/or water and electrolytes, requiring Parenteral Nutrition (PN) as chronic therapy. Long-term PN may lead to life-threatening complications; the loss of central venous access (LCVA) is the most frequent and challenging. To date, few studies in the literature have reported the relevance of Non-conventional Vascular Accesses (NCVA) in the management IF as part of the comprehensive multidisciplinary care. METHODS: A retrospective analysis of a database collected from January 2006 to December 2019 was performed using SPSS v25.0 for statistical analysis, followed by a systematic review, using the PRISMA.methodology RESULTS: From January 2006 to December 2019, 184 NCVA were placed in 71 patients with LCVA as IF-related complication; 173 were placed in 61 patients by interventional radiology (IR) and 11 NCVA were placed in 10 patients by the surgical team during the intestinal transplant (ITx) operation. From the 173 IR procedures 166 (95.9%) were successful with 3 ± 2.7 procedures/patient; average catheter permanence rate was 738.68 ± 997 days; complications related to the procedures occurred in 18/173 (10.4%), including two deaths. On the other hand, among the 11 NCVA implanted by the surgical team, 7 (64%) were successful and were safely withdrawn 30 days after ITx when were no longer needed; 2 (18%) catheters malfunctioned during the first week and could not be further used, and 1 was accidently removed; average catheter permanence rate was 26 ± 4 days. There was one complication (9%) requiring laparotomy; there was no mortality associated the procedure in this group. A systematic review was conducted to evaluate the success and safety of NCVA as part of the treatment of HPN-related complications; from 337,542 papers, 14 studies were included. A total of 28 HPN-patients with LCVA received NCVA; 34 procedures were successfully performed, while procedure-related complications were reported in 11.7%, as well as one death. CONCLUSIONS: The data analyzed show that NCVAs may be successfully placed by expert teams, allowing to sustain long-term PN, as well as increasing the Intestinal Transplantation applicability for candidates in the extreme need of vascular access.
Assuntos
Síndrome da Veia Cava Superior , Humanos , Nutrição Parenteral Total , Estudos RetrospectivosRESUMO
A 62-year-old diabetic female was referred to our institution with a 6-month history of pulmonary hypertension and worsening right-sided heart failure. Computed tomography of the chest and pulmonary angiogram revealed a pulmonary artery mass. Due to patient's frail state, palliative kissing stenting to both pulmonary arteries was performed with optimal angiographic results and overt clinical improvement. At 5 month follow-up, both stents were patent and adequate lung perfusion was observed bilaterally.
Assuntos
Arteriopatias Oclusivas/terapia , Procedimentos Endovasculares/instrumentação , Hemangiossarcoma/complicações , Artéria Pulmonar , Stents , Neoplasias Vasculares/complicações , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/fisiopatologia , Biópsia , Constrição Patológica , Feminino , Insuficiência Cardíaca/etiologia , Hemangiossarcoma/patologia , Humanos , Hipertensão Pulmonar/etiologia , Pessoa de Meia-Idade , Cuidados Paliativos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Vasculares/patologiaRESUMO
BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner.
Assuntos
Logro , Pré-Escolar/educação , Motivação , Psicologia da Criança , Percepção Social , Criança , HumanosRESUMO
Transcatheter aortic valve replacement (TAVR) represents a viable therapeutic option in patients with severe symptomatic aortic valve stenosis. The development of a left ventricular pseudoaneurysm (LVP) represents an infrequent but potentially catastrophic complication after transapical TAVR. In this case report, we present a patient undergoing TAVR through subclavian access which had an LVP and underwent successful percutaneous closure.
Assuntos
Falso Aneurisma/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Estenose da Valva Aórtica/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Ventrículos do Coração/cirurgia , Humanos , Masculino , Substituição da Valva Aórtica Transcateter/métodos , Resultado do TratamentoRESUMO
RESUMEN Objetivo: Analizar si el implante más alto en el implante percutáneo de válvula aórtica (TAVI) con válvulas auto-expandibles utilizando la superposición de las cúspides derecha e izquierda disminuye la necesidad de marcapasos definitivo. Material y Métodos: Se analizaron 164 pacientes consecutivos que recibieron TAVI con válvulas auto- expandibles; en 101(61,6%) de ellos se implantaron utilizando la vista coplanar de las tres cúspides, a la cual llamamos técnica convencional (CON) y en 63 (38,4%) utilizamos la técnica COVL, con superposición de las cúspides derecha e izquierda . El punto final primario (PFP) fue la necesidad de marcapasos definitivo (MCPD) a 30 días. Resultado: No hubo diferencias entre los grupos en la edad media, prevalencia de sexo masculino, hipertensión, cirugía de revascularización previa, antecedente de accidente cerebrovascular (ACV), función renal, o hemodiálisis. Los pacientes en el grupo COVL tuvieron más diabetes, angioplastia coronaria (ATC) e infarto previos. La ATC pre-TAVI fue similar, con mayor score STS (6,3 ± 2,1 vs. 5,8 ± 2,4; p = 0,05). La presencia de fibrilación auricular fue mayor en el grupo COVL sin diferencia en bloqueo auriculoventricular, de rama derecha o izquierda. No hubo diferencia en el área valvular aórtica, gradiente medio y fracción de eyección ventricular izquierda. A 30 días se observó una reducción significativa del PFP en la estrategia COVL, (6,3% vs 17,8%, p = 0,03). No hubo diferencia en mortalidad, ACV, sangrado mayor, infarto agudo de miocardio o regurgitación aórtica. Hubo tendencia a menor presencia de nuevo bloqueo competo de rama izquierda en el grupo COVL (4,8% vs. 12,9%, p = 0,08). Conclusiones: El uso de la técnica de COVL, que permite un implante más alto en el TAVI con válvulas autoexpandibles, demostró en esta serie ser factible y seguro, con disminución de la necesidad de MCPD sin aumento de las complicaciones.
ABSTRACT Objective: The aim of this study was to analyze whether higher transcatheter aortic valve implantation with self-expandable valves using the right and left cusp overlap strategy decreases the need for permanent pacemaker. Methods: A total of 164 consecutive patients undergoing TAVI with self-expandable valves were analyzed: 101 (61.6%) implanted with the conventional technique (CON) using the three-cusp coplanar view, and 63 (38.4%) using the right and left cusp overlap (COVL) technique. The primary endpoint (PEP) was the need for permanent pacemaker (PPM) at 30 days. Results: Mean age, prevalence of male gender, hypertension, prior coronary artery bypass graft surgery (CABG), and history of stroke, kidney function or hemodialysis was not different between groups. Patients in the COVL group had more diabetes, coronary percutaneous transluminal coronary angioplasty (PTCA) and prior infarct, and pre-TAVI PTCA was similar, with higher STS score (6.3±2.2 vs. 5.8±2.4; p=0.05). The presence of atrial fibrillation was greater in the COVL group, without differences in right or left bundle branch or atrioventricular block. There was no difference in aortic valve area, mean gradient and left ventricular ejection fraction. At 30 days, the need of PPM was significantly reduced with the COVL technique (6.3%% vs. 17.8%; p=0.03). No difference was observed in mortality, stroke, major bleeding, acute myocardial infarction or aortic regurgitation, and the presence of new-onset complete left bundle branch block was lower in the COVL group (4.8% vs. 12.9%; p=0.08). Conclusions: Use of the COVL technique, which allows higher self-expandable valve implantation during TAVI, was feasible and safe, decreasing the need for PPM without increasing complications.
RESUMO
RESUMEN Introducción: La endocarditis infecciosa (EI) post implante percutáneo de válvula aórtica (TAVI) es poco frecuente, con una alta tasa de morbimortalidad. Métodos: Se analizaron 630 pacientes consecutivos con TAVI, de los cuales 6 (0,95%) presentaron EI. Resultados: Cuatro eran hombres, edad 81,3 ± 2,2 años, y todos sintomáticos. La fracción de eyección ventricular izquierda (FEVI) fue 56,8 ± 5,3%. Todos recibieron un implante exitoso y uno presentó regurgitación moderada. Dos requirieron marcapaso definitivo, a uno de ellos se le debió recolocar el cable a las 24 hs. La EI se presentó a los 63,5 ± 73,3 días (mediana de 35 días). El germen aislado fue un coco (+) en cuatro casos. En uno se observó una vegetación en el ecocardiograma transesofágico. Un paciente falleció dentro de los 30 días. El seguimiento fue a 23 ± 22 meses, ningún paciente presentó nuevos eventos o internaciones. En el eco Doppler la FEVI fue de 55,9 ± 4,6%, el gradiente medio 8,2 ± 1,8 mmHg y la velocidad pico de 1,8 ± 0,2 m/seg. Un paciente terminó una regurgitación moderada. Conclusiones: En esta serie de pacientes, la EI post TAVI fue poco frecuente y presentó una evolución favorable con el tratamiento antibiótico.
ABSTRACT Background: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare complication with high morbidity and mortality. Methods: Of 630 consecutive patients undergoing TAVI, 6 (0.95%) presented IE. Results: Four patients were men, mean age was 81.3 ± 2.2 years and all the patients were symptomatic. Left ventricular ejection fraction (LVEF) was 56.8 ± 5.3%. The procedure was successful in all the patients and one presented moderate regurgitation. Two patients required definitive pacemaker and the lead had to be reimplanted 24 hours later in 1 patient. Time to IE was 63.5 ± 73.3 days (median 35 days). A Gram-positive coccus was isolated in four cases. One patient presented a vegetation on transesophagic echocardiography. One patient died within 30 days. During follow-up of 23 ± 22 months none of the patients presented new events or hospitalizations. On Doppler echocardiography, LVEF was 55.9 ± 4.6%, mean trans-aortic gradient was 8.2 ± 1.8 mm Hg and peak systolic velocity was 1.8 ± 0.2 m/s. One patient had moderate regurgitation. Conclusions: In this series of patients, IE after TAVI was uncommon and had a favorable course with antibiotic treatment.
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Antecedentes/Objetivo: El estudio establece las propiedades psicométricas de la adaptación española de la versión abreviada del Inventario de Estrategias de Afrontamiento (CSI-SF) publicado por Addison et al. (2007). La prueba utiliza un modelo de dos ejes para clasificar las estrategias de afrontamiento (de compromiso y de evitación) y las categorías objetivas del afrontamiento (centrada en el problema y centrada en la emoción). Método: Participaron 940 personas (62.87% mujeres; 37.12% hombres) divididas en dos submuestras. Se realizó un análisis factorial exploratorio (AFE) y un análisis factorial confirmatorio (AFC), así mismo la correlación de Pearson y el Alfa de Cronbach para examinar la fiabilidad y validez de la adaptación al español del CSI-SF. Resultados: El análisis de consistencia interna reveló una alta fiabilidad para todas las escalas (EFE = .890, PFE = .836. PFD = .767, EFD = .934), y todos los índices de ajuste utilizados para examinar el CSI-SF versión española proporcionaron soporte para su uso como una medida adecuada de las estrategias de afrontamiento del estrés. Discusión/Conclusión: La escala CSI-SF versión española es una prueba que proporciona un diagnóstico rápido y eficiente cuyos factores explican el 62.79% de la varianza común total de las estrategias de afrontamiento que se emplean frente a la situación de estrés en distintos ámbitos.(AU)
Background / Objective: The study establishes the psychometric properties of the Spanish adaptation of the abbreviated version of the Coping Strategies Inventory (CSI-SF) published by Addison et al. (2007). The test uses a two-axis model to classify coping strategies (commitment and avoidance) and objective categories of coping (problem-focused and emotion-focused). Method: 940 people participated (62.87% women; 37.12% men) aged between 18 and 66 years (x̄= 33.2; dt = 12.01). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were carried out, as well as Pearson's correlation and Cronbach's Alpha to examine the reliability and validity of the Spanish adaptation of the CSI-SF. Results: Internal consistency analysis revealed high reliability for all scales, and all adjustment indexes used to examine the CSI-SF Spanish version provided support for its use as an adequate measure of stress coping strategies. Discussion/Conclusions: The CSI-SF scale Spanish version is a test that provides a quick and efficient diagnosis of the coping strategies used in the face of stress in different settings.
Assuntos
Humanos , Masculino , Feminino , Adulto , Ciências da Saúde , Adaptação Psicológica , Psicometria/métodos , Espanha , Estresse Psicológico , Inquéritos e Questionários , Estudos de Casos e ControlesRESUMO
BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner
ANTECEDENTES: las atribuciones causales de la motivación influyen desde Educación Infantil en la explicación del rendimiento escolar. Se realizó una revisión sistemática de los conocimientos disponibles (1970-2019) de la Teoría Atribucional de la Motivación de Logro de Weiner (1986) para conocer los trabajos relacionados con las atribuciones causales del éxito y fracaso escolar. Se hallaron numerosos estudios empíricos relacionados con la teoría de Bernard Weiner. Sin embargo, son escasas las investigaciones con estudiantes de Educación Infantil. Por ello, el objetivo de este estudio fue identificar las causas a las que atribuyen sus éxitos y fracasos escolares en Educación Infantil. MÉTODO: se seleccionó una muestra de 200 estudiantes con edades comprendidas entre los 3 y 6 años. Para recopilar los datos se utilizó una entrevista clínica piagetiana implementada individualmente. RESULTADOS: se recopiló un gran volumen de información cualitativa para clasificar que desbordaba las atribuciones causales tradicionales de Weiner. Crear una categoría para agrupar todas las nuevas atribuciones implicaba perder demasiada información bajo una etiqueta inespecífica. CONCLUSIÓN: se diseñó una nueva categorización de las atribuciones causales formada por 10 categorías -adaptada al rango de edad 3-6 años- que revisa y amplía la creada por Weiner
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Ensino Fundamental e Médio , Desempenho Acadêmico , Fracasso Acadêmico , Pais , Entrevistas como AssuntoRESUMO
BACKGROUND: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery. METHODS: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery. RESULTS: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1-144 months), there were no new neurological deficits, while one additional death occurred. CONCLUSIONS: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.