The biobehavioural pain and movement questionnaire (BioPMovQ): development and psychometric validation of a new questionnaire.

Objective: The purpose of this research was to design and psychometrically validate a new instrument (the Biobehavioural Pain and Movement Questionnaire/BioPMovQ), which assesses the relationship between pain and various factors related to motor behaviour from a biobehavioural perspective. Methods: A mixed-method design combining a qualitative study with an observational and cross-sectional study was employed to develop (content validity) and psychometrically validate (construct validity, reliability and concurrent/discriminant validity) a new instrument. A total of 200 patients with chronic musculoskeletal pain were recruited. Results: According to the exploratory factor analysis, the final version of the BioPMovQ consists of 16 items distributed across 4 subscales (1, disability, 2, self-efficacy for physical activity; 3, movement avoidance behaviours; and 4, self-perceived functional ability), all with an eigen value greater than 1, explaining 55.79% of the variance. The BioPMovQ showed high internal consistency (Cronbach's α = 0.82; McDonald's ω = 0.83). The intraclass correlation coefficient was 0.86 (95% confidence interval 0.76 to 0.91), which was considered to demonstrate excellent test-retest reliability. The standard error of measurement and minimal detectable change were 3.43 and 8.04 points, respectively. No floor or ceiling effects were identified. There was a positive, significant and moderate magnitude correlation with the Graded Chronic Pain Scale (r = 0.54), kinesiophobia (r = 0.60), pain catastrophising (r = 0.44) and chronic pain self-efficacy (r = -0.31). Conclusion: The BioPMovQ showed good psychometric properties. Based on the findings of this study, the BioPMovQ can be used in research and clinical practice to assess patients with chronic musculoskeletal pain.

Plasma proteome association with coronary heart disease and carotid intima media thickness: results from the KORA F4 study.

BACKGROUND AND AIMS: Atherosclerosis is the main cause of stroke and coronary heart disease (CHD), both leading mortality causes worldwide. Proteomics, as a high-throughput method, could provide helpful insights into the pathological mechanisms underlying atherosclerosis. In this study, we characterized the associations of plasma protein levels with CHD and with carotid intima-media thickness (CIMT), as a surrogate measure of atherosclerosis. METHODS: The discovery phase included 1000 participants from the KORA F4 study, whose plasma protein levels were quantified using the aptamer-based SOMAscan proteomics platform. We evaluated the associations of plasma protein levels with CHD using logistic regression, and with CIMT using linear regression. For both outcomes we applied two models: an age-sex adjusted model, and a model additionally adjusted for body mass index, smoking status, physical activity, diabetes status, hypertension status, low density lipoprotein, high density lipoprotein, and triglyceride levels (fully-adjusted model). The replication phase included a matched case-control sample from the independent KORA F3 study, using ELISA-based measurements of galectin-4. Pathway analysis was performed with nominally associated proteins (p-value < 0.05) from the fully-adjusted model. RESULTS: In the KORA F4 sample, after Bonferroni correction, we found CHD to be associated with five proteins using the age-sex adjusted model: galectin-4 (LGALS4), renin (REN), cathepsin H (CTSH), and coagulation factors X and Xa (F10). The fully-adjusted model yielded only the positive association of galectin-4 (OR = 1.58, 95% CI = 1.30-1.93), which was successfully replicated in the KORA F3 sample (OR = 1.40, 95% CI = 1.09-1.88). For CIMT, we found four proteins to be associated using the age-sex adjusted model namely: cytoplasmic protein NCK1 (NCK1), insulin-like growth factor-binding protein 2 (IGFBP2), growth hormone receptor (GHR), and GDNF family receptor alpha-1 (GFRA1). After assessing the fully-adjusted model, only NCK1 remained significant (ß = 0.017, p-value = 1.39e-06). Upstream regulators of galectin-4 and NCK1 identified from pathway analysis were predicted to be involved in inflammation pathways. CONCLUSIONS: Our proteome-wide association study identified galectin-4 to be associated with CHD and NCK1 to be associated with CIMT. Inflammatory pathways underlying the identified associations highlight the importance of inflammation in the development and progression of CHD.

Volatiles of symbiotic bacterial origin explain ectoparasitism and fledging success of hoopoes.

BACKGROUND: Some parasites use olfactory cues to detect their hosts and, since bacterial symbionts are partially responsible for animal odours, they could influence host parasitism. By autoclaving nest materials of hoopoe (Upupa epops) nests before reproduction started, we explored the hypothetical links between host-associated bacteria, volatiles and parasitism. During the nestling stage, we (i) estimated the level of ectoparasitism by chewing lice (Suborder Mallophaga) in adult hoopoe females and by Carnus haemapterus flies in nestlings, and (ii) characterized microbial communities and volatile profiles of nest environments (nest material and nest cavity, respectively) and uropygial secretions. RESULTS: Experimental nests had less diverse bacterial communities and more diverse volatile profiles than control nests, while occupants experienced lower intensity of parasitism in experimental than in control nests. The experiment also affected beta diversity of the microbial communities of nest material and of the volatiles of the nestling uropygial secretions. Moreover, microbial communities of uropygial secretions and of nest materials covaried with their volatile profiles, while the volatile profile of the bird secretions explained nest volatile profile. Finally, a subset of the volatiles and bacteria detected in the nest material and uropygial secretions were associated with the ectoparasitism intensity of both adult females and nestlings, and with fledging success. CONCLUSIONS: These results show that a component of animal odours is linked with the microbial communities of the host and its reproductive environment, and emphasize that the associations between bacteria, ectoparasitism and reproductive success are partially mediated by volatiles of bacterial origin. Future work should focus on mechanisms underlying the detected patterns.

GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: Construct validity and reliability.

INTRODUCTION: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown. METHODS: E-health study, in which cross-sectional data were collected online (n = 1030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role. RESULTS: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p < 0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71). CONCLUSIONS: The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Human occupations of upland and cold environments in inland Spain during the Last Glacial Maximum and Heinrich Stadial 1: The new Magdalenian sequence of Charco Verde II.

The settlement of cold and arid environments by Pleistocene hunter-gatherers has been a heated topic in Paleolithic Archaeology and the Quaternary Sciences for years. In the Iberian Peninsula, a key area for studying human adaptations to such environments is composed by the large interior and upland regions of the northern and southern plateaus (Mesetas) and bordering areas. As, traditionally, these regions have been relatively under-investigated compared to the ecologically more favored coastal areas of the peninsula, our knowledge of the human settlement of the whole Iberian hinterland remains scarce for the Last Glacial. In this paper we present the discovery and first geoarcheological, paleoenvironmental and chronometric evidence obtained at Charco Verde II, a new site close to the southwestern foothills of the Iberian system range (Guadalajara province, Spain), bearing a sequence of Magdalenian human occupations starting at least at 20.8-21.4 ka cal BP during the Last Glacial Maximum, and covering Greenland Stadial 2 until ∼15.1-16.6 ka cal BP, including Heinrich stadial 1. As this site is located in an upland region which today faces one of the harshest climates in Iberia, such occupation sequence, occurred during some of the coldest and most arid phases of the Last Glacial, has relevant implications for our understanding of human-environment-climate interactions and population dynamics in Iberia and Western Europe. These findings support the hypothesis that the Iberian hinterland was not avoided by Upper Paleolithic hunter-gatherers due to ecological constraints, but it hosted a complex and relatively dense settlement at least in some areas, even during cold periods. This suggest, one more time, that the historical scarcity of Upper Paleolithic sites in inland Iberia is, to a significant extent, an artifact of research bias.

Escala de ansiedad generalizada GAD-7 en profesionales médicos colombianos durante pandemia de COVID-19: validez de constructo y confiabilidad

Introducción: La detección de síntomas de ansiedad entre el personal sanitario que atiende a pacientes contagiados de COVID-19 es una prioridad actual. Se requieren instrumentos rápidos y válidos para esta población. El objetivo es establecer la validez de constructo y la confiabilidad de la Escala de Ansiedad Generalizada (GAD-7) en médicos colombianos durante la cuarentena por la COVID-19. Métodos: Estudio eSalud, en el que se recopilaron datos transversales en línea (n = 1.030) de 610 médicos de COVID y 420 no de COVID durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Se contactó con cada sujeto, que confirmó participación, identidad y función profesional. Resultados: Se encontró una estructura factorial de 1 solo factor, conformado por los 7 ítems del instrumento, que logró explicar el 70% de la varianza. Los índices de bondad de ajuste (RMSEA = 0,080; CFI = 0,995; SRMR = 0,053; p 0,07. Por último, la consistencia interna del instrumento fue buena, con alfa de Cronbach = 0,920 (IC95%,8,80-9,71). Conclusiones: El GAD-7 es un instrumento que presenta indicadores adecuados de validez y confiabilidad. Es un excelente instrumento, confiable, fácil y rápido de usar para la detección de los síntomas de ansiedad generalizada en personal médico, atienda o no a pacientes contagiados de COVID-19.

Introduction: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalized Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown. Methods: E-health study, in which cross-sectional data were collected online (n = 1,030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role. Results: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p 0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71). Conclusions:The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

GEnZ explorer: a tool for visualizing agroclimate to inform research and regulatory risk assessment.

Confined field trials (CFT) of genetically engineered (GE) crops are used to generate data to inform environmental risk assessments (ERA). ERAs are required by regulatory authorities before novel GE crops can be released for cultivation. The transportability of CFT data to inform risk assessment in countries other than those where the CFT was conducted has been discussed previously in an analysis showing that the primary difference between CFT locations potentially impacting trial outcomes is the physical environment, particularly the agroclimate. This means that data from trials carried out in similar agroclimates could be considered relevant and sufficient to satisfy regulatory requirements for CFT data, irrespective of the country where the CFTs are conducted. This paper describes the development of an open-source tool to assist in determining the transportability of CFT data. This tool provides agroclimate together with overall crop production information to assist regulators and applicants in making informed choices on whether data from previous CFTs can inform an environmental risk assessment in a new country, as well as help developers determine optimal locations for planning future CFTs. The GEnZ Explorer is a freely available, thoroughly documented, and open-source tool that allows users to identify the agroclimate zones that are relevant for the production of 21 major crops and crop categories or to determine the agroclimatic zone at a specific location. This tool will help provide additional scientific justification for CFT data transportability, along with spatial visualization, to help ensure regulatory transparency.

Comparative analysis of the burnout syndrome index between contract and freelance physiotherapists: An observational study.

BACKGROUND: Burnout syndrome has been extensively studied in different health science professions. It has been less studied in physiotherapy than in professions such as medicine. Moreover, it is not known how the working condition influences this syndrome. OBJECTIVE: The main objective of this study was to compare the burnout index between contract and freelance physiotherapists in the private sector in the Community of Madrid, Spain. METHODS: A cross-sectional study was performed with 174 participants divided into 2 groups; one group was composed of contract physiotherapists (n = 87) and the other group was composed of freelance physiotherapists (n = 87). A Mann-Whitney U test was performed for comparison between the groups. Spearman's correlation coefficient was used to analyze the correlations between the burnout syndrome index and the secondary variables. RESULTS: There were statistically significant differences when comparing the groups, with a large effect size for the burnout index with a higher rate among contract physiotherapists (78 [71-84.75]) than in freelance physiotherapists (61.5 [55-72.75]).There were also significant differences in the type of patients treated, number of patients treated per day, time spent per patient, and the annual salary range between the contract and freelance physiotherapists. CONCLUSION: Contract physiotherapists who participated in this study had a significantly higher burnout syndrome index than freelance physiotherapists. Other socio-occupational variables were also found to be related to the burnout syndrome index in freelance physiotherapists and contract physiotherapists. The results of this study could be of interest for new occupational health strategies to reduce the burnout index in contract physiotherapists.

Sensorimotor, cognitive and affective behavior according to perceived level of disability in patients with chronic low back pain: an observational cross-sectional study.

OBJECTIVES: The aim was to evaluate the influence of the level of disability on sensorimotor and psychological variables in nonspecific chronic low back pain (NCLBP). METHODS: A cross-sectional observational study was performed with 90 participants, divided into one group with NCLBP (60 participants) and one asymptomatic group (30 participants). Symptomatic participants were divided into a "major" or "minor" disability group using the Roland Morris Disability Questionnaire score, resulting in two groups of 30 participants. All participants completed a series of self-administered questionnaires and performed sensorimotor tests. RESULTS: There were no statistically significant differences in the sensorimotor variables except in pain intensity, which was greater in the NCLBP group with high lumbar disability. There were statistically significant differences between the symptomatic groups in the degree of self-efficacy, pain catastrophism and kinesiophobia. CONCLUSIONS: Patients with NCLBP and high levels of disability present greater pain intensity and significantly poorer results in psychological variables compared with those with NCLBP and low levels of disability. In contrast, there were no differences for sensorimotor variables between the patients with NCLBP and high levels of disability and those with low levels of disability.

Effects of Physiotherapy on Pain and Mouth Opening in Temporomandibular Disorders: An Umbrella and Mapping Systematic Review with Meta-Meta-Analysis.

The aim of this meta-meta-analysis was to assess the current evidence regarding the effect of physical therapy (PT) interventions on pain and functional variables in temporomandibular disorders (TMD). We conducted an umbrella systematic review (SR) and four meta-meta-analyses (MMA) and created an evidence map to determine the effectiveness of PT on pain intensity and maximum mouth opening in patients with TMD. The quality of the included SR was assessed with the AMSTAR 2, and the risk of bias with ROBIS. Of the 31 SR included in the umbrella SR, only 10 were included in the MMA. The MMA showed moderate effects for manual therapy and therapeutic exercise, and large effects for low-level laser therapy on improving pain intensity and maximum mouth opening in patients with TMD, with a limited to moderate quality of evidence. The overlapping analyses showed only a slight overlap for all the MMA according to the corrected covered area (range from 0.07 to 0.2), 23.1% to 41.6%. This umbrella SR showed that manual therapy and exercise interventions, as well as low-level laser therapy interventions, are effective in the reduction in pain intensity and improvement of maximum mouth opening in TMD. This article presents a synthesis of the available evidence related to the various physical therapy interventions used in patients presenting with temporomandibular disorders. These results could help clinicians to select the optimal intervention for their patients and to reject those that are less useful.

Alternaria spore exposure in Bavaria, Germany, measured using artificial intelligence algorithms in a network of BAA500 automatic pollen monitors.

Although Alternaria spores are well-known allergenic fungal spores, automatic bioaerosol recognition systems have not been trained to recognize these particles until now. Here we report the development of a new algorithm able to classify Alternaria spores with BAA500 automatic bioaerosol monitors. The best validation score was obtained when the model was trained on both data from the original dataset and artificially generated images, with a validation unweighted mean Intersection over Union (IoU), also called Jaccard Index, of 0.95. Data augmentation techniques were applied to the training set. While some particles were not recognized (false negatives), false positives were few. The results correlated well with manual counts (mean of four Hirst-type traps), with R2 = 0.78. Counts from BAA500 were 1.92 times lower than with Hirst-type traps. The algorithm was then used to re-analyze the historical automatic pollen monitoring network (ePIN) dataset (2018-2022), which lacked Alternaria spore counts. Re-analysis of past data showed that Alternaria spore exposure in Bavaria was very variable, with the highest counts in the North (Marktheidenfeld, 154 m a.s.l.), and the lowest values close to the mountains in the South (Garmisch-Partenkirchen, 735 m a.s.l.). This approach shows that in our network future algorithms can be run on past datasets. Over time, the use of different algorithms could lead to misinterpretations as stemming from climate change or other phenological causes. Our approach enables consistent, homogeneous treatment of long-term series, thus preventing variability in particle counts owing to changes in the algorithms.

Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial.

BACKGROUND AND AIMS: Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS: We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS: There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS: UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).

Towards European automatic bioaerosol monitoring: Comparison of 9 automatic pollen observational instruments with classic Hirst-type traps.

To benefit allergy patients and the medical practitioners, pollen information should be available in both a reliable and timely manner; the latter is only recently possible due to automatic monitoring. To evaluate the performance of all currently available automatic instruments, an international intercomparison campaign was jointly organised by the EUMETNET AutoPollen Programme and the ADOPT COST Action in Munich, Germany (March-July 2021). The automatic systems (hardware plus identification algorithms) were compared with manual Hirst-type traps. Measurements were aggregated into 3-hourly or daily values to allow comparison across all devices. We report results for total pollen as well as for Betula, Fraxinus, Poaceae, and Quercus, for all instruments that provided these data. The results for daily averages compared better with Hirst observations than the 3-hourly values. For total pollen, there was a considerable spread among systems, with some reaching R2 > 0.6 (3 h) and R2 > 0.75 (daily) compared with Hirst-type traps, whilst other systems were not suitable to sample total pollen efficiently (R2 < 0.3). For individual pollen types, results similar to the Hirst were frequently shown by a small group of systems. For Betula, almost all systems performed well (R2 > 0.75 for 9 systems for 3-hourly data). Results for Fraxinus and Quercus were not as good for most systems, while for Poaceae (with some exceptions), the performance was weakest. For all pollen types and for most measurement systems, false positive classifications were observed outside of the main pollen season. Different algorithms applied to the same device also showed different results, highlighting the importance of this aspect of the measurement system. Overall, given the 30 % error on daily concentrations that is currently accepted for Hirst-type traps, several automatic systems are currently capable of being used operationally to provide real-time observations at high temporal resolutions. They provide distinct advantages compared to the manual Hirst-type measurements.

Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study.

OBJECTIVES: The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP). METHODS: A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy. RESULTS: The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance. CONCLUSIONS: Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement.

Microbial infection risk predicts antimicrobial potential of avian symbionts.

Symbiotic bacteria on animal hosts can prevent pathogenic bacterial infections by several mechanisms. Among them, symbiotic bacteria can indirectly enhance host's immune responses or, directly, produce antimicrobial substances against pathogens. Due to differences in life-style, different host species are under different risks of microbial infections. Consequently, if symbiotic bacteria are somewhat selected by genetically determined host characteristics, we would expect the antimicrobial properties of bacterial symbionts to vary among host species and to be distributed according to risk of infection. Here we have tested this hypothesis by measuring the antimicrobial ability of the bacterial strains isolated from the uropygial-gland skin of 19 bird species differing in nesting habits, and, therefore, in risk of microbial infection. In accordance with our predictions, intensity and range of antimicrobial effects against the indicator strains assayed varied among bird species, with hole-and open-nesters showing the highest and the lowest values, respectively. Since it is broadly accepted that hole-nesters have higher risks of microbial infection than open nesters, our results suggest that the risk of infection is a strong driver of natural selection to enhance immunocompetence of animals through selecting for antibiotic-producing symbionts. Future research should focus on characterizing symbiotic bacterial communities and detecting coevolutionary processes with particular antibiotic-producing bacteria within-host species.

Persistent trigeminal artery associated with an occipital arteriovenous malformation: a case report and literature review.

BACKGROUND: Persistent trigeminal artery or persistent primitive trigeminal artery (PTA) is the most common carotid-basilar anastomosis in both cadaveric and live patient studies, followed by persistent hypoglossal and persistent otic arteries. Approximately 0.2% of all angiographies reported this finding. CASE REPORT: We present the case of a 21-year-old male who arrived at the emergency department with tonic‒clonic seizures. After performing diagnostic contrast magnetic resonance imaging and digital subtraction angiography, the patient was diagnosed with a right occipital arteriovenous malformations (AVM) fed by the right calcarine artery associated with an ipsilateral PTA. After considering surgical and endovascular treatment options, the patient was selected for watchful waiting. We included a literature review of the PTA, the results of a PubMed search regarding the combined presence of these findings, and a brief discussion providing insight into the implications for treatment. CONCLUSIONS: Although several studies have linked PTA to different vascular pathologies, such as cerebral aneurysms, the association between PTA and AVMs remains scarce. This case, along with the literature review, shows that further research is needed to characterize the relationship between these findings.

Cross-Sectional Comparative Study on Central Sensitization-Psychosocial Associated Comorbidities and Psychological Characteristics in Breast Cancer Survivors with Nociceptive Pain and Pain with Neuropathic Features and without Pain.

The frequency of a high Central Sensitization Inventory (CSI) total score and the prevalence of pain have already been established among breast cancer survivors (BCS). However, the psychological factors' influence based on the clinical features of pain is still unknown, as well as BCS characteristics with no pain. Thus, our main aim was to evaluate the presence of a high CSI total score in BCS with pain and compare it with BCS without pain and to evaluate the influence of psychosocial factors. A cross-sectional comparative study was designed to compare BCS with nociceptive pain (n = 19), pain with neuropathic features (n = 19) or no pain (n = 19), classified by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). CSI, pain catastrophizing, fear of movement, anxiety and depression symptoms were analyzed and compared among the three groups. The CSI total score was higher in both BCS pain groups compared to BCS without pain, but there were no statistical differences between the pain groups. The same observation was made when comparing pain catastrophizing. The neuropathic feature group showed greater levels of fear of movement, anxiety and depression compared to the no pain group. Thus, CS-psychosocial associated comorbidities and pain-catastrophizing thoughts were more prevalent among BCS with pain, regardless of the clinical features of pain. BCS with neuropathic pain features showed greater psychological disturbances.

[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]. / Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19.

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

Sustaining communicable disease elimination efforts in the Americas in the wake of COVID-19.

The COVID-19 pandemic has disrupted implementation of health interventions and set back priority programs aiming to control and eliminate communicable diseases. At the same time, the pandemic has opened up opportunities to expedite innovations in health service delivery to increase effectiveness and position health on the development and political agendas of leaders and policy makers. In this context, we present an integrated, sustainable approach to accelerate elimination of more than 35 communicable diseases and related conditions in the region of the Americas. The Elimination Initiative promotes a life-course, person-centred approach based on four dimensions - preventing new infections, ending mortality and morbidity, and preventing disability - and four critical lines of action including strengthening health systems integration and service delivery, strengthening health surveillance and information systems, addressing environmental and social determinants of health, and furthering governance, stewardship, and finance. We present key actions and operational considerations according to each line of action that countries can take advantage of to further advance disease elimination in the region.

Assessment of country implementation of the WHO global health sector strategy on sexually transmitted infections (2016-2021).

BACKGROUND: In 2016, WHO launched the Global Health Sector Strategy on STIs, 2016-2021 (GHSS) to provide guidance and benchmarks for country achievement by 2020 and four global targets for achievement by 2030. METHODS: A country survey jointly developed by experienced technical personnel at WHO Headquarters (HQ) and WHO regional offices was reviewed and distributed by WHO regional advisors to 194 WHO Member States in September-March 2020. The survey sought to assess implementation and prioritization of STI policy, surveillance, service delivery, commodity availability, and surveillance based on targets of the GHSS. RESULTS: A majority (58%, 112/194) of countries returned a completed survey reflecting current (2019) STI activities. The regions with the highest survey completion rates were South-East Asia Region (91%, 10/11), Region of the Americas (71%, 25/35) and Western Pacific Region (67%, 18/27). Having a national STI strategy was reported by 64% (72/112) and performing STI surveillance activities by 88% (97/110) of reporting countries. Availability of STI services within primary health clinics was reported by 88% of countries (99/112); within HIV clinics by 92% (103/112), and within reproductive health services by 85% (95/112). Existence of a national strategy to eliminate mother-to-child transmission of HIV and syphilis (EMTCT) was reported by 70% of countries (78/112). Antimicrobial resistance (AMR) monitoring for gonococcal infection (gonorrhoea) was reported by 64% (57/89) of reporting countries with this laboratory capacity. Inclusion of HPV vaccine for young women in the national immunization schedule was reported by 59% (65/110) and availability of cervical cancer screening was reported by 91% (95/104). Stockouts of STI medicines, primarily benzathine penicillin, within the prior four years were reported by 34% (37/110) of countries. CONCLUSIONS: Mechanisms to support improvements to STI service delivery through national-level policy, commitment, programming and surveillance are needed to operationalize, accelerate and monitor progress towards achievement of the 2030 global STI strategy targets.