Exploring active ageing in a community-based living environment: an ethnographic study in the Western Norway context.

Background: Age-friendly environments intend to promote active ageing by facilitating social, mental, and physical participation. This could potentially delay the onset of chronic complex conditions, enabling people to live longer independently at home, and prevent loneliness. This study investigates a community-based living environment in Norway called Helgetun and aims to explore how it can facilitate active ageing. Method: We chose an ethnographic approach consisting of observation, informal conversations, and in-depth semi-structured interviews with 15 residents (11 female, 4 male, ages 62-84). We analysed the data using reflexive thematic analysis. Result: We developed three themes on facilitating active ageing in this living environment: maintaining self-identity, experiencing growth and development, and feeling a sense of belonging. These themes were related to physical activity levels, social engagement, and overall satisfaction with the living environment. Maintaining self-identity concerned getting a new role in life as well as access to meaningful activities. Experiencing growth and development involved being exposed to new activities, learning new skills, and experiencing mastery. Lastly, feeling a sense of belonging meant feeling safe and part of a group, as well as receiving social support and help. This feeling of social connectedness and safety was reflected in their experience with the COVID-19 pandemic, in which most felt relatively unaffected, suggesting that this way of living could increase reliance among this age group. Conclusion: Having a flexible structure, adapting to the core needs and individual resources of the residents, can facilitate active ageing in community-based living environments. Our findings contribute to the growing evidence that these environments increase social and physical engagement, whilst reducing social isolation and loneliness. These findings may be particularly relevant in a Norwegian context-where older adults are less dependent on family for care-and are meant as grounding points for policymakers to reflect upon designing future senior living.

The acceptability, adoption, and feasibility of a music application developed using participatory design for home-dwelling persons with dementia and their caregivers. The "Alight" app in the LIVE@Home.Path trial.

Background: Music interventions for persons with dementia can improve health and interaction with caregivers, yet the reach is often restricted to institutions. We describe the participatory design process of a prototype music application for patients affiliated with a gerontopsychiatric hospital and evaluate the acceptability, adoption, and feasibility of use for dyads of home-dwelling persons with dementia and their informal caregivers. Methods: The application "Alight" was developed following an iterative, expert-driven participatory design approach, which includes a requirement elicitation phase and two rounds of prototyping and testing in real-world settings. End users and stakeholders were involved in all steps, that is, workshops, interviews, field observation, ethnographic inquiries, and beta testing sessions with music therapists, patients, and caregivers in collaboration with a commercial music and technology company. The last prototyping and testing took place in the LIVE@Home.Path trial, a stepped-wedge multicomponent randomized controlled trial to improve resource utilization and caregiver burden in municipal dementia care during 2019-2021. Results: Mean age of the person with dementia in the LIVE@Home.Path trial was 82 years, 62% were female, and the majority had Alzheimer's dementia (44%) of mild severity (71%). Sixty-three dyads were offered Alight in the multicomponent intervention, of which 13% (n = 8) accepted use. The dyads accepting Alight did not differ in demographic and clinical characteristics compared to those not interested. The feasibility was high among those accepting Alight, 75% (n = 6) reported a positive impact on mood, 50% (n = 4) experienced a positive impact on activity, and 50% (n = 4) gooduser-friendliness. The adoption was high with daily use or use several times a week reported by 63% (n = 5). Obstacles emerged when updating the application in homes without wireless Wi-Fi, and some participants were unfamiliar with using touchscreens. Conclusion: The feasibility and adoption of the application were high and accepting dyads did not differ on demographic and clinical variables from those not reached. This suggests a high potential for utilization in dementia care. This study contributes methodologically to the field of participatory design and mHealth interventions by demonstrating a specific design approach that throughout the process successfully involved researchers, industry partners, health care practitioners, and end users. Clinical trial registration: ClinicalTrials.gov, NCT04043364.

Motivating Physical Activity for Individuals with Intellectual Disability through Indoor Bike Cycling and Exergaming.

People with intellectual disabilities have more sedentary lifestyles than the general population. Regular physical activity is of both medical and social importance, reducing the risk of cardiovascular disease and promoting functioning in everyday life. Exergames have been envisioned for promoting physical activity; however, most of them are not user-friendly for individuals with intellectual disabilities. In this paper, we report the design, development, and user acceptance of a mobile health solution connected to sensors to motivate physical activity. The system is mounted on an indoor stationary bicycle and an ergometer bike tailored for people with intellectual disabilities. The development process involved the application of user-centered design principles to customize the system for this group. The system was pilot-tested in an institutional house involving six end-users (intervention group) and demonstrated/self-tested to relatives of persons with ID and staff (supervision group). A System Usability Scale and open-ended interview in the supervision group were used to assess the user acceptance and perceived usefulness. Results indicate that the users with an intellectual disability enjoyed using the system, and that respondents believed it was a useful tool to promote physical activity for the users at the institution. The results of this study provide valuable information on beneficial technological interventions to promote regular physical activity for individuals with intellectual disabilities.

The Sonozotz project: Assembling an echolocation call library for bats in a megadiverse country.

Bat acoustic libraries are important tools that assemble echolocation calls to allow the comparison and discrimination to confirm species identifications. The Sonozotz project represents the first nation-wide library of bat echolocation calls for a megadiverse country. It was assembled following a standardized recording protocol that aimed to cover different recording habitats, recording techniques, and call variation inherent to individuals. The Sonozotz project included 69 species of echolocating bats, a high species richness that represents 50% of bat species found in the country. We include recommendations on how the database can be used and how the sampling methods can be potentially replicated in countries with similar environmental and geographic conditions. To our knowledge, this represents the most exhaustive effort to date to document and compile the diversity of bat echolocation calls for a megadiverse country. This database will be useful to address a range of ecological questions including the effects of anthropogenic activities on bat communities through the analysis of bat sound.

Trofoblasto, impronta y conflicto genómico en gineco-obstetricia / Trophoblast, imprinting and genomic conflict in gynecology-obstetrics

La teoría del Conflicto Genómico es parte de la biología evolutiva y actúa en los mamíferos a través del mecanismo de impronta genética, estos genes cumplen un rol central en el desarrollo fetal y del trofoblasto contribuyendo a un balance entre los requerimientos nutricionales fetales (genes con impronta paterna) y el aporte materno (genes con impronta materna). El desbalance de estos genes tiene implicancias en la etiopatogenia de diversas patologías en Gineco-Obstetricia: en Medicina Fetal (preeclampsia, diabetes gestacional, síndrome de Beckwith-Wiedemann), oncología (mola completa, mola incompleta, teratomas) y fertilidad. Se presenta un caso de displasia mesenquimática placentaria asociado a Beckwith-Wiedemann.

The theory of Genomic Conflict is part of evolutionary biology and acts in mammals through the mechanism of genetic imprinting, these genes play a central role in fetal and trophoblastic development producing a balance between fetal nutritional requirements (genes with paternal imprinting) and maternal supply (genes with maternal imprinting). The imbalance of these genes has implications in the pathogenesis of various diseases in Obstetrics and Gynecology: in Fetal Medicine (preeclampsia, gestational diabetes, Beckwith-Wiedemann syndrome), oncology (complete and partial hydatiform mole, teratomas) and fertility. A case of placental mesenchymal dysplasia associated with Beckwith-Wiedemann is presented.

Hemorrhagic activity of Bothrops venoms determined by two different methods and relationship with proteolytic activity on gelatin and lethality.

The changes in hemorrhagic activity, proteolytic activity on gelatin and the lethal potency of four Bothrops venoms treated at different pH values or with EDTA were studied. Venoms from B. alternatus, B. jararaca, B. moojeni and B. neuwiedii of Argentina were preincubated at pH 5.8, 5.1 or 3.8 or with EDTA and the hemorrhagic activity expressed as size of the hemorrhagic lesion or as the amount of hemoglobin extracted, the proteolytic activity on gelatin and the lethal potency were determined. Although the MHDs recorded in rats were 19-56 fold higher than those recorded in mice, the A(550) extracted per gram of hemorrhagic haloes was very similar in rats or mice independent of the venom dose. Inhibition of proteolytic activity after preincubation at pH 5.1 or 3.8, agrees with the decreased amount of hemoglobin extracted from the hemorrhagic haloes, and with the increase in mean survival time after the i.p. injection to mice. Preincubation with EDTA resulted in 80% inhibition of hemorrhagic activity of B. jararaca venom and complete inhibition with the other Bothrops venoms tested. Measurement of the amount of hemoglobin extracted gives significant information in comparative studies, not available by measurement of the size of hemorrhagic haloes.

Ultrasonografía en las complicaciones postoperatorias en ginecología y obstetricia / Ultrasonography in the postoperative complications in gynecology and obstetrics

Se analizan la utilidad y técnicas del ultrasonido en el estudio de los hematomas postquirúrgicos en pacientes gíneco-obstétricas tanto de cirugía abdominal y vaginal. La vía de abordaje puede incluir el ultrasonido de pared abdominal, trans-abdominal, transvaginal o transperineal. Se pueden distinguir colecciones subcutáneas, subaponeuróticas, prevesicales, de cúpula vaginal y perineales; el ultrasonido tiene un alto rendimiento en el diagnóstico, localización y necesidades de drenaje de estas colecciones. Debido a su alta sensibilidad el ultrasonido se debe utilizar para la evaluación de la paciente que presenta complicaciones en el postoperatorio, especialmente en la fiebre de origen no precisado.

A reduced immunization scheme to obtain an experimental anti-Loxosceles laeta ("violinist spider") venom.

Bites by Loxosceles (L.) laeta spiders can produce severe envenomation in humans. The only specific treatment is the early administration of antivenom. The production of anti-Loxosceles antivenom is hampered by the extremely low venom yield by these spiders and by the difficulties in maintaining a large breeder of Loxosceles. We developed an experimental equinum L. laeta antivenom, using as immunogen venom glands homogenates from spiders captured in Argentina. Horses immunized with venom gland homogenate (1.0 mg total protein per horse) by the subcutaneous route were bled after completion of the immunization scheme. Plasma was fractionated by ammonium sulfate precipitation and treated with pepsin to obtain F(ab')2 fragments. The protein composition of the experimental antivenom was assessed by SDS-PAGE, and its immunochemical reactivity was compared with those of other anti-Loxosceles antivenoms available for therapeutic use in Argentina by ELISA and Western blot. The experimental, homologous anti-L. laeta antivenom appeared to be more efficient in neutralizing the lethal potency in mice and the necrotizing activity in rabbits than of the heterologous antivenom.

Phase I and pharmacokinetics study of crotoxin (cytotoxic PLA(2), NSC-624244) in patients with advanced cancer.

A Phase I clinical trial was performed on patients with solid tumors refractory to conventional therapy. Crotoxin was administered i.m. for 30 consecutive days at doses ranging from 0.03 to 0.22 mg/m(2). Patients entered the study after providing a written informed consent. Although 26 patients were entered only 23 were evaluated. Reversible, nonlimiting neuromuscular toxicity evidenced as diplopia because of pareses of the external ocular muscles was present in 13 patients. It started at doses of 0.18 mg/m(2) and lasted from 2 to 6 h. These episodes did not require dose adjustment and disappeared in 1-3 weeks of treatment. Three patients experienced palpebral ptosis, nystagmus (grade 2), and anxiety (grade 2-3) at the dose-limiting toxicity of 0.22 mg/m(2). Also at dose-limiting toxicity, 1 patient showed nystagmus (grade 2) and anxiety (grade 3) without evidence of palpebral ptosis. Transient increases (grades 1-3) in the levels of creatinine kinase, aspartate aminotransferase, and alanine transaminase attributed to crotoxin myotoxicity were observed but returned to normal by the last week of treatment. At 0.21 mg/m(2) there was a case of grade-3 anaphylactic reaction on day 31, which required treatment. Hypersensitivity was regarded as an adverse drug-related reaction, and the patient was removed from the protocol. Two patients at different doses (0.12 mg/m(2) and 0.22 mg/m(2)) had sialorrhea. Four patients had asymptomatic transient increase in blood pressure (up to 20 mm Hg) 12 h after the first injection, which lasted 24 h. No treatment was required and toxicity did not reappear. Six patients experienced slight eosinophilia during the first 2 weeks. The maximum tolerated dose was set at 0.21 mg/m(2). Objective measurable partial responses (>50% reduction of tumor mass) were noted in 2 patients treated at 0.21 mg/m(2) and 1 at 0.12 mg/m(2). One patient (at 0.21 mg/m(2)) presented a complete response on day 110. Crotoxin pharmacokinetics showed rapid absorption from the injection site to blood (t(1/2 A) = 5.2 +/- 0.6 min). Plasma concentration reached a peak (C(max) = 0.79 +/- 0.1 ng/ml) at tau(max) = 19 +/- 3 min. The half-life of the distribution (alpha) phase is 22 +/- 2 min. Starting at 1.5 h after injection, the decrease in plasma concentration becomes slower, reaching 14 +/- 3 pg/ml 24 h after injection. The profile is dominated by the elimination (beta) phase with a half-life of 5.2 +/- 0.6 h. Consequently, 24 h after the injection ( approximately 5 half-life) 97% of the product was eliminated. The area under plasma concentration versus time curve was 0.19 +/- 0.05 microg/min/ml. Assuming availability (F) approximately 1, the clearance is C(L) = 26.3 +/- 7 ml/min, and the apparent volume of distribution is V(d) = 12 +/- 3 liter/kg. The recommended dose for a Phase II study is 0.18 mg/m(2).

Experiencia preliminar en el uso del doppler de arteria cerebral media fetal en madres RH negativas sensibilizadas / Preliminar experience in the use of doppler of fetal medial cerebral artery in alloinmumized mothers to negative rhesus factor

Se presentan 4 pacientes aloinmunizadas al factor Rh, en las cuales se efectuó seguimiento con ultrasonido Doppler color midiendo el flujo máximo de la arteria cerebral media con el propósito de evaluar anemia fetal, técnica de menor riesgo que la amniocentesis. Los 4 casos presentaron valores normales, lo que correlacionó con un buen resultado perinatal. Es necesario aumentar la casuística para poder validar el método

Torsión anexial: aproximación diagnóstica por imágenes / Adnexal torsion: imaging diagnostic approximation

La torsión de los anexos uterinos es una condición quirúrgica poco frecuente causada por la rotación parcial o completa del pedículo ovárico sobre su eje, produciendo congestion y necrosis del ovario. El cuadro clínico es a menudo confuso, lo que retrasa el diagnóstico y tratamiento oportuno. Exámenes de imágenes son un importante elemento de apoyo, principalmente la ultrasonografía convencional y Doppler color dadas sus ventajas de rapidez, disponibilidad, bajo costo y no invasividad. El signo sonográfico característico de esta entidad es la presencia de múltiples folículos ubicados en la periferia de un ovario agrandado en forma unilateral. La ultrasonografía Doppler color es específico pero poco sensible donde la ausencia de flujo indica oclusión venosa y arterial completa, pero su presencia no excluye el diagnóstico. La tomografía axial computada y la resonancia nuclear magnética usualmente no son requeridas, pero se han descrito algunos hallazgos que pueden ayudar a un correcto diagnóstico

Síndrome de Einsenmger y embarazo / Einsenmger's syndrome and pregnancy

Se presenta un caso clínico de una paciente de 21 años, M1, portadora de un Síndrome de Einsenmenger diagnosticado posterior a su primer parto, que ingresa a la Unidad de Alto Riesgo Obstétrico del Hospital San Juan de Dios cursando un Embarazo de 14 sem, en capacidad funcional III, oxígeno -dependiente, la paciente se maneja con tratamiento médico hasta lograr viabilidad fetal, a las 28 sem se decide interrupción del embarazo dado el compromiso materno progresivo, con riesgo vital y deterioro fetal. Se realiza cesárea electiva por un equipo multidisciplinario y multicéntrico, obteniéndose un RN vivo en buenas condiciones, sin incidentes anestésicos ni quirúrgicos durante el procedimiento. La paciente evoluciona en el puerperio inmediato con inestabilidad hemodinámica y shock cardiogénico, falleciendo a las 39 horas de puerperio. Se analiza el tema del Síndrome de Einsenmenger, su manejo actual, mal pronóstico, y la contraindicación de embarazo dado su alta mortalidad materna y compromiso fetal

Diagnóstico prenatal de situs inversus totalis / Prenatal diagnose of situs inversus totalis

Se presenta un caso clínico de diagnóstico prenatal por ultrasonografía de Situs Inversus completop en la Unidad de ultrasonografía del Hospital San Juan de Dios con su confirmación post natal por radiología y ultrasonografía. Es de notar la baja incidencia de esta patología y la importancia del diagnóstico prenatal por las posibles múltiples malformaciones asociadas

Diagnóstico prenatal y manejo perinatal de defectos nefrourológicos / Prenatal diagnosis and perinatal management of nephrourologic abnormalities

Los defectos nefrourológicos tienen una alta frecuencia en el examen ultrasonográfico prenatal. Los defectos mayores de riñones o vejiga son vistos en aproximadamente 2 a 3 por 1000 embarazos, sobre 2 por ciento de los fetos tiene un diagnóstico menos grave. Los defectos nefrourológicos pueden ser únicos o formar parte de un síndrome genético. El objetivo de este trabajo es presentar la experiencia recopilada durante cinco años en diagnóstico prenatal y manejo perinatal de defectos nefrourológicos. Nuestro servicio cuenta con un equipo de ultrasonografistas que realizan exámenes a pacientes del área del Servicio de Salud Metropolitano Occidente; se cuenta además con la participación de un grupo multidisciplinario de médicos compuesto por neonatólogos, genetistas y cirujanos infantiles con los cuales se revisan los casos y se discute él diagnóstico, pronóstico y tratamiento perinatal de nuestras pacientes

Tumor ovárico fetal: diagnóstico ultrasonográfico y manejo perinatal / Fetal ovarian cyst: ultrasound diagnosis and perinatal management

Las lesiones ováricas fetales son de baja incidencia, siendo su diagnóstico prenatal de importancia, ya que permite orientar al clínico respecto a la probable etiología y decidir su manejo perinatal. En la siguiente publicación se revisan cuatro casos de lesiones ováricas con diagnóstico prenatal y el resultado del seguimiento postnatal de cada una de ellas

Diagnóstico ultrasonográfico antenatal de quiste del colédoco y su manejo perinatal / Prenatal ultrasonographic diagnosis of choledochal cyst and perinatal management

Se presentan dos casos de dilatación quística de la vía biliar fetal diagnosticados antenatalmente mediante ultrasonografía, además de su correlación posnatal y manejo quirúrgico, en el Servicio de Obstetricia Ginecología del Hospital San Juan de Dios. Es de notar que estas malformaciones son de muy escasas incidencia. Además, el diagnóstico prenatal muchas veces es difícil y se engloba bajo el diagnóstico de quiste abdominal fetal

Diagnóstico y manejo perinatal de trisomia 18 / Diagnosis and perinatal management of trisomy 18

El síndrome de Edwards es un cuadro de baja frecuencia y muy mal pronóstico, por lo cual el diagnóstico prenatal es indispensable para tomar una conducta adecuada. Presentamos 9 casos en los cuales se sospechó este diagnóstico por ultrasonido con confirmación pre o postnatal. Destacan por su frecuencia la presencia de retardo de crecimiento intrauterino, polihidramnios y el signo de mano traslapada. La trisomía 18 tiene una mortalidad perinatal de 89 por ciento con un 78 por ciento de partos vaginales

Imagenología del absceso tuboovárico: ultrasonografía transvaginal / Tube-ovarian abscess imagenology: transvaginal ultrasound

El absceso tuboovárico es el resultado del compromiso séptico que involucra al ovario y trompa uterina. Un correcto diagnóstico de esta patología determina que el tratamiento sea conservador o intervencionista. El diagnóstico se basa en la anamnesis y examen físico, complementados con laboratorio e imagenología. La ultrasonografía ha sido un aporte importante para el diagnóstico, ya que no requiere preparación, es económica, rápida y no invasiva. Las imágenes ecográficas características son: líquido en el Douglas, ovario multiquístico, trompa dilatada y masa compleja uni o bilateral, hipoecoica con ecos internos, contornos irregulares y nivel líquido; el Doppler demuestra disminución de la resistencia vascular. Actualmente están en estudio los aportes de la tomografía axial computada y de la resonancia magnética, pero su valor está limitado por su alto costo

Infección por virus hepatitis A y embarazo: hallazgos sonográficos / Hepatitis A virus infection and pregnancy: ultrasonographic findings

Presentamos un caso de infección materna por virus hepatitis A en una mujer de 20 años que cursaba un embarazo de 17 semanas. El seguimiento sonográfico mostró compromiso fetal caracterizado por ascitis, heteregeneidad hepática, intestino hiperecogénico y oligohidroamnios. Similares hallazgos han sido publicados en 2 casos reportados de infección intrauterina por este virus

Diagnóstico prenatal de placenta acreta por ultrasonido Doppler / Prenatal diagnosis of placenta accreta using Doppler ultrasound

Se presentan 5 casos de pacientes con placenta previa y signos ultrasonográficos clásicos de acretismos como ausencia o adelgazamiento de zona hipoecogénica retroplacentaria, abombamiento placentario hacia la vejiga, vascularización aumentada con vasos que invaden miometrio y ocasionalmente vejiga. En cuatro de los casos se confirmo el diagnóstico de acretismo placentario por ultrasonido Doppler color. Se analizan las características clínicas, el manejo perinatal y los hallazgos intraoperatorios. En todos los casos la anatomía patológica certificó el diagnostico