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Objetivo: analisar a relação entre apoio social e qualidade do sono de pessoas idosas que cuidam de outros idosos em ambiente de vulnerabilidade social. Método: estudo transversal realizado com 65 cuidadores entrevistados por meio de instrumento de caracterização, Índice de Katz, Escala de Lawton e Brody, Índice de Qualidade do Sono de Pittsburgh e Escala de Apoio Social do Medical Outcomes Study, com dados analisados com testes de comparação e de correlação. Resultados: a maioria eram mulheres, cônjuges do idoso cuidado e possuíam sono de má qualidade. Observou-se correlação fraca e inversa entre má qualidade do sono e a dimensão interação social positiva (Rho=-0,27; p=0,028). Identificou-se relação significativa entre: apoio material e disfunção diurna (p=0,034); apoio afetivo e eficiência do sono (p=0,026); interação social positiva e qualidade subjetiva do sono (p=0,001) e disfunção diurna (p=0,008). Conclusão: Quanto maior a interação social positiva, melhor é a qualidade do sono.
Objective: to analyze the relationship between social support and sleep quality of elderly individuals who care for other elderly individuals in a socially vulnerable environment. Method: a cross-sectional study conducted with 65 caregivers interviewed using a characterization instrument, Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, and Medical Outcomes Study Social Support Scale, with data analyzed using comparison and correlation tests. Results: the majority were women, spouses of the elderly being cared for, and had poor sleep quality. A weak and inverse correlation was observed between poor sleep quality and the positive social interaction dimension (Rho=-0.27; p=0.028). Significant relationships were identified between: material support and daytime dysfunction (p=0.034); emotional support and sleep efficiency (p=0.026); positive social interaction and subjective sleep quality (p=0.001), as well as daytime dysfunction (p=0.008). Conclusion: The higher the positive social interaction, the better the sleep quality.
Objetivo: analizar la relación entre el apoyo social y la calidad del sueño de personas mayores que cuidan de otras personas mayores en entornos socialmente vulnerables. Método: estudio transversal realizado con 65 cuidadores entrevistados mediante un instrumento de caracterización, Índice de Katz, Escala de Lawton y Brody, Índice de Calidad del Sueño de Pittsburgh y Escala de Apoyo Social del Medical Outcomes Study, los datos fueron analizados mediante pruebas de comparación y correlación. Resultados: la mayoría eran mujeres, cónyuges del adulto mayor que recibe el cuidado y tenían mala calidad del sueño. Se observó una correlación débil e inversa entre la mala calidad del sueño y la dimensión de interacción social positiva (Rho=-0,27; p=0,028). Se identificó que había relación significativa entre: apoyo material y disfunción diurna (p=0,034); apoyo afectivo y eficiencia del sueño (p=0,026); interacción social positiva y calidad subjetiva del sueño (p=0,001) y disfunción diurna (p=0,008). Conclusión: Cuanto mayor sea la interacción social positiva, mejor será la calidad del sueño.
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Introducción. La formación integral de los residentes excede el conocimiento teórico y la técnica operatoria. Frente a la complejidad de la cirugía moderna, su incertidumbre y dinamismo, es necesario redefinir la comprensión de la educación quirúrgica y promover capacidades adaptativas en los futuros cirujanos para manejar efectivamente el entorno. Estos aspectos se refieren a la experticia adaptativa. Métodos. La presente revisión narrativa propone una definición de la educación quirúrgica con énfasis en la experticia adaptativa, y un enfoque para su adopción en la práctica. Resultados. Con base en la literatura disponible, la educación quirúrgica representa un proceso dinámico que se sitúa en la intersección de la complejidad de la cultura quirúrgica, del aprendizaje en el sitio de trabajo y de la calidad en el cuidado de la salud, dirigido a la formación de capacidades cognitivas, manuales y adaptativas en el futuro cirujano, que le permitan proveer cuidado de alto valor en un sistema de trabajo colectivo, mientras se fortalece su identidad profesional. La experticia adaptativa del residente es una capacidad fundamental para maximizar su desempeño frente a estas características de la educación quirúrgica. En la literatura disponible se encuentran seis estrategias para fortalecer esta capacidad. Conclusión. La experticia adaptativa es una capacidad esperada y necesaria en el médico residente de cirugía, para hacer frente a la complejidad de la educación quirúrgica. Existen estrategias prácticas que pueden ayudar a fortalecerla, las cuales deben ser evaluadas en nuevos estudios.
Introduction. The comprehensive training of residents exceeds theoretical knowledge and operative technique. Faced with the complexity of modern surgery, its uncertainty and dynamism, it is necessary to redefine the understanding of surgical education and promote adaptive capabilities in future surgeons for the effective management of the environment. These aspects refer to adaptive expertise. Methods. The present narrative review proposes a definition of surgical education with an emphasis on adaptive expertise, and an approach for its adoption in practice. Results. Based on the available literature, surgical education represents a dynamic process that is situated at the intersection of the complexity of surgical culture, learning in the workplace, and quality in health care, aimed at training of cognitive, manual, and adaptive capacities in the future surgeon, which allow them to provide high-value care in a collective work system, while strengthening their professional identity. Resident's adaptive expertise is a fundamental capacity to maximize his or her performance in the face of these characteristics of surgical education. In the available literature there are six strategies to strengthen this capacity. Conclusion. Adaptive expertise is an expected and necessary capacity in the surgical resident to deal with the complexity of surgical education. There are practical strategies that can help strengthen it, which must be evaluated in new studies.
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Humans , Education, Medical, Graduate , Deep Learning , Professional Competence , General Surgery , Vocational Education , MetacognitionABSTRACT
INTRODUCTION AND OBJECTIVES: Autoimmune liver diseases (AILDs) are rare and require precise evaluation, which is often challenging for medical providers. Chatbots are innovative solutions to assist healthcare professionals in clinical management. In our study, ten liver specialists systematically evaluated four chatbots to determine their utility as clinical decision support tools in the field of AILDs. MATERIALS AND METHODS: We constructed a 56-question questionnaire focusing on AILD evaluation, diagnosis, and management of Autoimmune Hepatitis (AIH), Primary Biliary Cholangitis (PBC), and Primary Sclerosing Cholangitis (PSC). Four chatbots -ChatGPT 3.5, Claude, Microsoft Copilot, and Google Bard- were presented with the questions in their free tiers in December 2023. Responses underwent critical evaluation by ten liver specialists using a standardized 1 to 10 Likert scale. The analysis included mean scores, the number of highest-rated replies, and the identification of common shortcomings in chatbots performance. RESULTS: Among the assessed chatbots, specialists rated Claude highest with a mean score of 7.37 (SD = 1.91), followed by ChatGPT (7.17, SD = 1.89), Microsoft Copilot (6.63, SD = 2.10), and Google Bard (6.52, SD = 2.27). Claude also excelled with 27 best-rated replies, outperforming ChatGPT (20), while Microsoft Copilot and Google Bard lagged with only 6 and 9, respectively. Common deficiencies included listing details over specific advice, limited dosing options, inaccuracies for pregnant patients, insufficient recent data, over-reliance on CT and MRI imaging, and inadequate discussion regarding off-label use and fibrates in PBC treatment. Notably, internet access for Microsoft Copilot and Google Bard did not enhance precision compared to pre-trained models. CONCLUSIONS: Chatbots hold promise in AILD support, but our study underscores key areas for improvement. Refinement is needed in providing specific advice, accuracy, and focused up-to-date information. Addressing these shortcomings is essential for enhancing the utility of chatbots in AILD management, guiding future development, and ensuring their effectiveness as clinical decision-support tools.
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Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition.
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INTRODUCTION: Incarcerated individuals exhibit higher suicide rates compared to the general population. Investigating risk factors aids in developing effective public policies and interventions. The goal of this study was to assess and analyze factors predicting both suicidal thoughts and suicide attempts in a population of male incarcerated individuals who engage in the use of multiple psychoactive substances. METHODS: A cross-sectional observational study was conducted. A total of 174 male individuals deprived of liberty participated in the study, all of whom were serving a closed regime sentence during the data collection steps. Participants were assessed with the following instruments: the "Addiction Severity Index" (ASI-6) and the "Barratt Impulsiveness Scale" (BIS-11). RESULTS: Amongst our sample, prevalences of 36.7% in suicidal ideation and of 16.0% in suicide attempts were found. Impulsivity (OR = 1.098, 95% CI: 1.008 - 1.197), social support (OR = 0.281, 95% CI: 0.085 - 0.925), witnessing someone being killed or beaten (OR = 5.173, 95% CI: 2.143 - 12.486), cigarette use (OR = 3.309, 95% CI: 1.063 - 10.293), and cocaine use (OR = 2.678, 95% CI: 1.040 - 6.897) were also found to be associated with suicidal ideation. No significant associations were found between drug use and suicide attempts. CONCLUSION: A high prevalence of suicidal behaviors was observed in the study's sample, with findings demonstrating that impulsivity moderately differentiates the groups 'with' and 'without' suicidal ideation. Traumatic life events and substance use were also associated with suicide ideation, while social support was established as a protective factor for it.
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BACKGROUND AND AIMS: Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified. METHODS: Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment. RESULTS: 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients. CONCLUSIONS: Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply.
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Critical Illness , Malnutrition , Nutritional Status , Parenteral Nutrition , Prealbumin , Humans , Male , Prealbumin/metabolism , Prealbumin/analysis , Middle Aged , Female , Critical Illness/therapy , Prospective Studies , Adult , Malnutrition/diagnosis , Biomarkers/blood , Aged , Intensive Care Units , Nutrition Assessment , C-Reactive Protein/analysis , C-Reactive Protein/metabolismABSTRACT
The purpose of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-support treadmill training (BWSTT) for improving walking function of individuals with chronic incomplete spinal cord injury (iSCI). A 4-week, double-blinded, randomized, sham-controlled pilot study involved 12 sessions of real (10 Hz, 1800 pulses) or sham rTMS combined with BWSTT (15-20 min, moderate intensity). Walking independence was assessed using the Walking Index for Spinal Cord Injury II (WISCI-II). Lower extremity motor function (lower extremity motor score [LEMS]) and spasticity, sensory function, functional independence (Spinal Cord Injury Measure III [SCIM-III]), and quality of life were also assessed. Walking independence (WISCI-II) after the 6th session was higher in the BWSTT/rTMS real (n = 7) (median change (IQR): 3 (1.5 to 3.5)) than in the sham group (n = 8) (median change (IQR): 0 (0 to 0.25), but there was no difference between groups after 12th session (BWSTT/rTMS real median change (IQR): 4 (2 to 5); BWSSTT/rTMS sham median change (IQR): 0 (0 to 3.25). Compared to baseline, LEMS and SCIM-III mobility scores were increased after 12 sessions in the BWSTT/rTMS real but not in the sham group. Within- and between-group sensory function, functional independence, and quality of life remained similar. This preliminary result suggests that combining BWSTT with rTMS could lead to earlier gait improvement in patients with chronic iSCI.
Subject(s)
Exercise Therapy , Spinal Cord Injuries , Transcranial Magnetic Stimulation , Walking , Humans , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/rehabilitation , Spinal Cord Injuries/therapy , Pilot Projects , Male , Female , Transcranial Magnetic Stimulation/methods , Walking/physiology , Middle Aged , Adult , Double-Blind Method , Exercise Therapy/methods , Body Weight/physiology , Treatment Outcome , Quality of Life , Chronic DiseaseABSTRACT
Resumo A presente revisão integrativa tem por objetivo identificar os arranjos de cuidado em saúde mental que foram implementados no enfrentamento à pandemia de COVID-19. Realizou-se busca em três bases de dados (SciELO, PubMed e LILACS), em português, inglês e espanhol, com os descritores "SAÚDE MENTAL" or "SALUD MENTAL" or "MENTAL HEALTH" AND "COVID-19", no período de 2020 a 2021. Foram encontrados 3.451 artigos, sendo 43 selecionados para análise. Em relação ao cuidado em saúde mental, os principais arranjos identificados foram os digitais, de natureza pública, desenvolvidos na esfera municipal e com integração com a rede de saúde. Os modelos de cuidado em saúde mental para o enfrentamento da pandemia são discutidos a partir dos tipos de arranjo produzidos nesse contexto sanitário emergencial e crítico. Apresenta-se, ainda, um recorte da realidade encontrada no Sistema Único de Saúde (SUS), reiterando sua resiliência. Concluiu-se que os arranjos digitais foram os mais usados e que há necessidade de investigar a acessibilidade deste modelo para populações com maior vulnerabilidade social. Reafirma-se a importância do SUS para o enfrentamento da COVID-19 e no acesso a informações de saúde.
Abstract This integrative review aims to identify the mental health care measures that were produced during the COVID-19 pandemic. This research was conducted on three databases (SciELO, PubMed, and LILACS) with the following descriptors in Portuguese, English, and Spanish: "SAÚDE MENTAL" or "SALUD MENTAL" or "MENTAL HEALTH" AND "COVID-19" from 2020 to 2021. In total, 3,451 articles were found, 43 of which were analyzed. Most measures were digital, stemmed from public institutions, focused on the local perspective, and were integrated with the public health care system. This study discusses the models of care in mental health based on measures to cope with the COVID-19 pandemic. It also discusses the Brazilian health care system, reiterating its resilience. In conclusion, digital measures occurred most often. This study suggest the evaluation of the accessibility of this mental health care model for most vulnerable groups. Finally, this research reinforces the importance of the Brazilian health care system for public health and access to information to cope with the COVID-19 pandemic.
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Introducción: El estigma relacionado con la identidad sexual, especialmente entre HSH, sigue siendo un desafío importante en muchas culturas, este estigma puede aparecer de varias maneras, desde una discriminación explícita hasta estereotipos más discretos, y puede afectar negativamente la salud mental y emocional de quienes lo sufren. Objetivo: Analizar el estigma de identidad sexual y apoyo social entre los hombres que tienen sexo con otros hombres en Central y Asunción, Paraguay durante el 2024. Metodología: Estudio cualitativo, fenomenológico de tipo descriptivo y explicativo. Las categorías de análisis consideradas en este estudio fueron: a) Estigma y apoyo social en la comunidad en general, b) Divulgación de identidad sexual a la comunidad en general, c) Divulgación de identidad sexual a familiares y amigos y d) Estigma y apoyo social en la comunidad de LGBT. Resultados: Participaron del estudio, nueve HSH, donde los testimonios revelan el profundo anhelo de vivir con autenticidad y libertad. Los HSH en Paraguay desean poder ser ellos mismos sin temor a ser juzgados o rechazados, anhelan relaciones abiertas y honestas, y aspiran a una comunidad donde puedan compartir experiencias y apoyarse mutuamente Conclusión: Los HSH enfrentan obstáculos en su crecimiento y unión como comunidad. La ausencia de una comunidad fuerte y unida dificulta el apoyo mutuo y el desarrollo personal, además de la competencia y la falta de colaboración entre organizaciones e individuos crean un ambiente dividido, donde cada uno busca sus propios beneficios en lugar de trabajar juntos por el bien de todos.
Introduction: Stigma related to sexual identity, especially among MSM, remains a major challenge in many cultures, this stigma can appear in various ways, from explicit discrimination to more discreet stereotypes, and can negatively affect the mental and emotional health of those who suffer from it. Objective: Analyze the stigma of sexual identity and social support among men who have sex with other men in Central and Asunción, Paraguay during 2024. Methodology: Qualitative, Phenomenological Study of a descriptive and explanatory type. The analysis categories considered in this study were: a) Stigma and social support in the community in general, b) Disclosure of sexual identity to the community in general, c) Disclosure of sexual identity to family and friends and d) Stigma and social support in the LGBT community. Results: Nine MSM participated in the study, where the testimonies reveal the deep desire to live with authenticity and freedom. MSM in Paraguay want to be able to be themselves without fear of being judged or rejected, they long for open and honest relationships, and they aspire to a community where they can share experiences and support each other. Conclusion: MSM face obstacles in their growth and unity as a community. The absence of a strong and united community makes mutual support and personal development difficult, in addition to competition and lack of collaboration between organizations and individuals creating a divided environment, where everyone seeks their own benefits instead of working together for the good. of everyone.
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This study aimed to determine the feasibility of applying machine-learning methods to assess the progression of chronic kidney disease (CKD) in patients with coronavirus disease (COVID-19) and acute renal injury (AKI). The study was conducted on patients aged 18 years or older who were diagnosed with COVID-19 and AKI between April 2020 and March 2021, and admitted to a second-level hospital in Mérida, Yucatán, México. Of the admitted patients, 47.92% died and 52.06% were discharged. Among the discharged patients, 176 developed AKI during hospitalization, and 131 agreed to participate in the study. The study's results indicated that the area under the receiver operating characteristic curve (AUC-ROC) for the four models was 0.826 for the support vector machine (SVM), 0.828 for the random forest, 0.840 for the logistic regression, and 0.841 for the boosting model. Variable selection methods were utilized to enhance the performance of the classifier, with the SVM model demonstrating the best overall performance, achieving a classification rate of 99.8% ± 0.1 in the training set and 98.43% ± 1.79 in the validation set in AUC-ROC values. These findings have the potential to aid in the early detection and management of CKD, a complication of AKI resulting from COVID-19. Further research is required to confirm these results.
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Background: Mental health of university students has been impacted during the pandemic, highlighting the importance of understanding its psychosocial determinants. Nevertheless, there has been limited exploration into whether the digital inclusion conditions for remote education could mediate the effects that variables such as resilience, social support, and academic self-efficacy may have on mental health. Considering the above, there is evidence that shows a consistent relationship between resilience, social support and academic self-efficacy on mental health, to the extent that these are psychological variables. On the other hand, digital inclusion, which comprehends a contextual variable, not a psychological one, related to ICT access opportunities and mainly focused on the quality of Internet access, should be analyzed in a differential manner. Objectives: This study seeks to analyze the effect of resilience, social support and academic self-efficacy, on the mental health of a group of Peruvian university students; in addition, it seeks to analyze the mediating role of digital inclusion. Materials and methods: A cross-sectional study was conducted with 3,147 undergraduate students from a private university in Lima, Perú. From August to October 2020, data were collected online through questionnaire, this include The Depression, Anxiety and Stress Scale 21 (DASS-21), The 10-item version of the Connor-Davidson Resilience Scale (CD-RISC10), The Multidimensional Scale of Perceived Social Support (EMASP), The Perceived Self-Efficacy Specific for Academic Situations Scale (EAPESA) and to measure digital inclusion, the Perceived Quality of Internet Access reported by the students. The levels of participants' anxiety, depression and stress were described using frequency and percentage. Pearson Correlation test was used to measure the correlation between the variables and a Path analysis was conducted. Finally, The PROCESS macro for SPSS (Model 4) was applied to examine the mediating effect of the model controlling gender variable. Results: The results revealed significant levels of extremely severe symptoms of anxiety (36.8%), depression (33.4%) and stress (18.1%) among the participants. A path analysis, which indicated that resilience (ß = -0.346), social support (ß = -0.189), academic self-efficacy (ß = -0.060) and digital inclusion (ß = -0.089) had significant impact on students' General Distress. In addition, digital inclusion plays a partial mediation role with low but significant effect size in the relationship between resilience, social support and self-efficacy with mental health. Conclusion: Mental health of university students during the pandemic shows alarming levels of general or emotional distress. The findings indicate that resilience, social support and self-efficacy protect college students' mental health by reducing general distress. However, the study shows that when there is a digital divide around internet quality the impact of these factors is affected.
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Objective: To develop a natural language processing application capable of automatically identifying benign gallbladder diseases that require surgery, from radiology reports. Materials and Methods: We developed a text classifier to classify reports as describing benign diseases of the gallbladder that do or do not require surgery. We randomly selected 1,200 reports describing the gallbladder from our database, including different modalities. Four radiologists classified the reports as describing benign disease that should or should not be treated surgically. Two deep learning architectures were trained for classification: a convolutional neural network (CNN) and a bidirectional long short-term memory (BiLSTM) network. In order to represent words in vector form, the models included a Word2Vec representation, with dimensions of 300 or 1,000. The models were trained and evaluated by dividing the dataset into training, validation, and subsets (80/10/10). Results: The CNN and BiLSTM performed well in both dimensional spaces. For the 300- and 1,000-dimensional spaces, respectively, the F1-scores were 0.95945 and 0.95302 for the CNN model, compared with 0.96732 and 0.96732 for the BiLSTM model. Conclusion: Our models achieved high performance, regardless of the architecture and dimensional space employed.
Objetivo: Desenvolver uma aplicação de processamento de linguagem natural capaz de identificar automaticamente doenças cirúrgicas benignas da vesícula biliar a partir de laudos radiológicos. Materiais e Métodos: Desenvolvemos um classificador de texto para classificar laudos como contendo ou não doenças cirúrgicas benignas da vesícula biliar. Selecionamos aleatoriamente 1.200 laudos com descrição da vesícula biliar de nosso banco de dados, incluindo diferentes modalidades. Quatro radiologistas classificaram os laudos como doença benigna cirúrgica ou não. Duas arquiteturas de aprendizagem profunda foram treinadas para a classificação: a rede neural convolucional (convolutional neural network - CNN) e a memória longa de curto prazo bidirecional (bidirectional long short-term memory - BiLSTM). Para representar palavras de forma vetorial, os modelos incluíram uma representação Word2Vec, com dimensões variando de 300 a 1000. Os modelos foram treinados e avaliados por meio da divisão do conjunto de dados entre treinamento, validação e teste (80/10/10). Resultados: CNN e BiLSTM tiveram bom desempenho em ambos os espaços dimensionais. Relatamos para 300 e 1000 dimensões, respectivamente, as pontuações F1 de 0,95945 e 0,95302 para o modelo CNN e de 0,96732 e 0,96732 para a BiLSTM. Conclusão: Nossos modelos alcançaram alto desempenho, independentemente de diferentes arquiteturas e espaços dimensionais.
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Background: social support is important for adaptation in chronic diseases, such as diabetes and depression, because it favors recovery and adherence to treatment. Introducing its evaluation in the follow-up of diabetic patients can reduce complications derived from secondary non-adherence. Aims: to establish social support in diabetic patients and its correlation with depressive symptoms. Methods: a cross-sectional analytical study nested in a cohort of 173 recently diagnosed diabetic patients (<6 months) in Colombia over 18 years of age, treated in a cardiovascular risk program in 2022. The Chronic Illness Social Support Inventory was used. Results: Most of the participants were women (77.5%); single(83.8%), age (mean = 62.6 years (SD 12.3)); glycemia (mean = 146.4 (SD 65.5)), glycosylated hemoglobin (mean = 7.6 (SD 1.7)). Cronbach's α coefficient for the general scale of the social support instrument was 0.9859. The mean social support was 168.5 (SD 37.4), range 38-228. The total social support score was normally distributed (Shapiro Wilk p > 0.05). The correlation between domains was statistically significant. The PHQ9 total score was significantly associated with the domains of Personal Interaction and Guide but did not significantly correlate with the overall social support score. The respondents who were at risk of developing depression were referred for treatment. Conclusions: findings suggest that perceived social support may play a significant role in the prevention and treatment of depression in diabetic patients. It is desirable that health professionals consider evaluating and enhancing social support to improve their mental health. More research is needed to gain a comprehensive understanding of this relationship.
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A 48-year-old woman presented to the emergency department with a one-week history of progressive dyspnea. During her hospitalization, the diagnosis of diffuse alveolar hemorrhage was made. She subsequently developed respiratory failure and acute right ventricular failure. Despite medical treatment, she continued to experience distributive shock due to a generalized inflammatory response. Circulatory support with ECMO was needed. We opted for triple cannulation to manage the multiorgan failure as a bridge to recovery. We describe our experience with an uncommon cannulation technique: veno-pulmonary-arterial cannulation, which enabled us to address cardiogenic shock, refractory hypoxemia, and distributive shock, leading to the successful recovery of the patient.
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PURPOSE: To verify clinical validity evidence for the ineffective social support network nursing diagnosis. METHOD: A quantitative, descriptive, cross-sectional study was performed with 98 violence-victimized women treated in two reference centers for violence in the city of Recife, Pernambuco, Brazil. The women were interviewed from August 2021 to June 2022. FINDINGS: The clinical indicators that best predicted the nursing diagnosis were as follows: Frustration with unmet support expectations, negative social interaction, perceived neglect of support demands, feeling of abandonment, low reciprocity, and encouragement of negative behaviors. Etiological factors that showed greater association were excessive demand for support, limited social network, social isolation, the fragility of institutional service networked organizations, and inadequate appreciation of available social support. CONCLUSIONS: The clinical validity evidence for the ineffective social support network nursing diagnosis has been verified. Thus, the validated clinical indicators and etiological factors can accurately diagnose and predict the emergence of this phenomenon in violence-victimized women. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge in nursing teaching, research, and practice and support the nursing process in violence-victimized women.
OBJETIVO: Verificar evidências de validade clínica para o diagnóstico de enfermagem Rede de Apoio Social Ineficaz. MÉTODO: Estudo quantitativo, descritivo e transversal realizado com 98 mulheres vítimas de violência atendidas em dois centros de referência em violência na cidade do Recife, Pernambuco, Brasil. As mulheres foram entrevistadas no período de agosto de 2021 a junho de 2022. RESULTADOS: Os indicadores clínicos que melhor predisseram o diagnóstico de enfermagem foram: Frustração com Expectativas de Apoio Não Atendidas, Interação Social Negativa, Negligência Percebida nas Demandas de Apoio, Sentimento de Abandono, Baixa Reciprocidade e Incentivo a Comportamentos Negativos. Os fatores etiológicos que apresentaram maior associação foram Demanda Excessiva de Apoio, Rede Social Limitada, Isolamento Social, Fragilidade das Organizações em Rede de Serviços Institucionais e Valorização Inadequada do Apoio Social Disponível. CONCLUSÕES: Foram verificadas evidências de validade clínica para o diagnóstico de enfermagem Rede de Apoio Social Ineficaz. Assim, os indicadores clínicos e fatores etiológicos validados têm a capacidade de diagnosticar e prever com precisão o surgimento deste fenômeno em mulheres vítimas de violência. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A validação clínica do diagnóstico fundamenta as intervenções de enfermagem direcionadas às mulheres vítimas de violência e à sua rede de apoio social. PALAVRASCHAVE: Apoio social; Educação saudável; diagnóstico de enfermagem; rede social; violência contra as mulheres.
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BACKGROUND: There is a lack of studies analyzing the association between oral mucositis (OM) and nutritional imbalance in children during hematopoietic stem cell transplantation (HSCT). The aim of this study was to compare the risk factors for OM and nutritional imbalance during HSCT in pediatric patients with nonmalignant diseases (NMD) and malignant diseases (MD). METHODS: Data on age, sex, primary disease, transplantation type, conditioning regimen, GVHD prophylaxis, gastrointestinal toxicity, OM, percent body weight loss or gain, nutritional repositioning, and overall survival (OS) were retrospectively collected from the 132 medical records. The data were then compared between patients with NMD (n = 70) and MD (n = 62). RESULTS: OM had a similar severity between the groups. The primary risk factor for OM in the NMD group was the conditioning regimen with busulfan, while in the MD group it was GVHD prophylaxis with cyclosporin and methotrexate. OM did not have an impact on body weight loss or gain in any of the groups. In the NMD, body weight gain due to fluid overload was more pronounced and associated with a lower age range. OS was similar between the groups and was not affected by OM. CONCLUSIONS: OM pattern was similar in pediatric patients with or without MD, but the factors that determined these oral lesions were different. There were disparities in body weight changes between the two groups, and these changes were not associated to OM.
Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Nutritional Status , Stomatitis , Transplantation Conditioning , Humans , Hematopoietic Stem Cell Transplantation/adverse effects , Female , Male , Child , Child, Preschool , Stomatitis/etiology , Retrospective Studies , Adolescent , Infant , Transplantation Conditioning/methods , Transplantation Conditioning/adverse effects , Risk Factors , Graft vs Host Disease/etiology , Graft vs Host Disease/prevention & control , Neoplasms/complicationsABSTRACT
Introduction: This study in Argentina evaluated the impact of the growzen™ buddy smartphone app on adherence to recombinant human growth hormone (r-hGH) treatment. Methods: The adherence data, invitation dates with a link to the app, app activation dates, and height measurements entered were extracted from the growzen™ digital health ecosystem. Patients with 12 months of adherence data, aged ≥2 years at treatment start, and aged <19 years were selected both before and after app implementation. Mean adherence was classified as optimal (≥85%) versus suboptimal (<85%). Adherence before and after implementation and the pre-post effect on adherence were assessed. Results: Data for 830 patients were available. Prior to app implementation, the proportion of patients with optimal adherence was 68% (n = 348/515). Following the app implementation, out of 315 patients, 302 (96%) received an invitation with a link to the app, 225 (71%) activated their account, and 127 (40%) entered height data in the first year. There was a significant early increase in the proportion of patients with optimal adherence following implementation: 82% (n = 258/315), p < 0.001. After implementation, the proportion of patients with optimal adherence included 80% (n = 78/98) of those with an active account who did not enter height measurements and 89% (n = 113/127) of those who did. There was a significant and positive pre-post app effect on adherence (p < 0.01) in patients with an active account. Discussion: Our results show that using the growzen™ buddy app has a rapid and positive impact on adherence to r-hGH treatment, and patients who were more engaged with the app demonstrated better adherence.
Subject(s)
Human Growth Hormone , Medication Adherence , Mobile Applications , Recombinant Proteins , Smartphone , Humans , Argentina , Male , Female , Retrospective Studies , Human Growth Hormone/therapeutic use , Human Growth Hormone/administration & dosage , Medication Adherence/statistics & numerical data , Adolescent , Child , Recombinant Proteins/therapeutic use , Child, Preschool , Young Adult , AdultABSTRACT
BACKGROUND: The COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people's lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project. METHODS: To gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data. RESULTS: The survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals' resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems. CONCLUSIONS: Proposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.
Subject(s)
COVID-19 , Mental Health , Humans , Portugal/epidemiology , Cross-Sectional Studies , Male , Female , COVID-19/epidemiology , COVID-19/psychology , Adult , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Middle Aged , Focus Groups , Emigrants and Immigrants/psychology , Emigrants and Immigrants/statistics & numerical data , Brazil/epidemiology , Cabo Verde , Qualitative Research , Young AdultABSTRACT
Prior literature has demonstrated a negative association between social support and elder mistreatment. Furthermore, social support may moderate the negative relationship between health-related indicators and elder mistreatment. This study is the first to investigate these assertions in Brazil using nationally representative data. We employ the 2019 National Health Survey and a series of binary logistic regressions. Overall, increased social support from stronger ties, like family and close friends, reduces the likelihood of elder mistreatment. However, increased participation in broader and more distant social networks and circles of sociability may increase the risk of mistreatment. Moreover, the negative relationship between health-related indicators and elder mistreatment is partially moderated by increased social support. While findings on other support dimensions vary, family support appears crucial in mitigating elder mistreatment. This study contributes by underscoring the intricate interplay of social support, health, and mistreatment, advocating for family-centered interventions to improve elder well-being in Brazil.
ABSTRACT
Familism is a multidimensional construct that includes familial support. However, limited research examines whether the sub-components of familism equally contribute to mental health and whether familism protects against depression beyond social support. To address these gaps, we test associations between the multidimensional components of familism (familial support, familial obligations, family as referents) and social support with depressive symptoms among immigrant Dominican women in New York City. We tested associations between the multidimensional components of familism, specifically, familial support, familial obligations, and family as referents (Sabogal et al., 1987), as well as social support, with depressive symptoms among 419 women. Multiple regression analysis indicated that whereas familial support predicted decreases in depressive symptoms (ß = - 0.15), family obligations, and family as referents did not. However, only social support predicted decreased depressive symptoms (ß= - 0.18) when accounting for covariates and familism subscales. Controlling for covariates, age predicted decreased depressive symptoms (ß = - 0.19), whereas self-rated poor health exhibited the inverse effect (ß = 0.17). These findings highlight the need for a nuanced understanding of familism, social support, and the association of cultural and demographic values on Latina mental health. These results illustrate the need for further analysis of social support and the multiple components of the familism construct.