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1.
An. psicol ; 37(2): 265-275, mayo-sept. 2021. graf
Artículo en Inglés | IBECS | ID: ibc-202550

RESUMEN

The main aim of this study was to find out more about the role of great-grandparenthood. A group of participants with greatgrandchildren (n = 78) was interviewed using a questionnaire containing questions that had been put through a previous pilot study, covering participants' sociodemographics, the activities that participants shared with their great-grandchildren, and their view of the role of great-grandparent and their related degree of satisfaction. The data were recorded and analyzed both with frequency tables and descriptive statistics and with the Kruskal-Wallis non-parametric test. The results showed several significant relationships between the shared activities and the sociodemographic variables, such as great-grandparents' age (p ≤ .05), education (p ≤ .01), health status (p ≤ .05), the distance at which they live from their great-grandchildren (p ≤ .05). Also, it was found that participants generally con-sider the role of great-grandparent to be a continuation of their prior role as grandparent, albeit from the perspective of a formal intergenerational typology, distinct from the informal typology and, above all, opposed to the role of substitute/surrogate. Greater perceived satisfaction was associated with this typical interaction of the formal role (p ≤ .01). Great-grandparents may already be fulfilling a notable function in today's four-generation families


El objetivo general de este trabajo es conocer mejor el rol de bisabuelidad. Se entrevistó a un grupo de voluntarios con bisnietos (n = 78) mediante un cuestionario, cuyo contenido fue pilotado previamente, con preguntas sobre sus características sociodemográficas, las actividades que solían compartir con sus bisnietos y su opinión del rol de bisabuelidad, con la satisfacción asociada. Los datos fueron registrados y analizados tanto con tablas de frecuencia y estadísticos descriptivos, como con la prueba no-paramétrica de Kruskal-Wallis. Los resultados obtenidos mostraron numerosas relaciones significativas entre las actividades compartidas y aspectos socio-demográficos de los bisabuelos como la edad (p ≤ .05), el nivel educativo (p ≤ .01), la salud (p ≤ .05), la distancia a la que viven de sus bisnietos (p ≤ .05). Además, de mostrar que perciben su rol de bisabuelidad en general como una continuidad del rol anterior de abuelidad, aunque desde una tipología intergeneracional formal, distinta a la tipología informal y, sobre todo, opuesta a la del rol sustituto/subrogado. La mayor satisfacción percibida estaba asociada a esa interacción típica del rol formal (p ≤ .01). Los bisabuelos podrían estar cumpliendo ya alguna función destacable en las familias actuales de cuatro generaciones


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Anciano , Anciano de 80 o más Años , Abuelos/psicología , Relaciones Intergeneracionales , Actividades Cotidianas/psicología , Proyectos Piloto , Factores Socioeconómicos , Encuestas y Cuestionarios , Satisfacción Personal
2.
BMC Health Serv Res ; 21(1): 629, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34193128

RESUMEN

BACKGROUND: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late. The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients' quality of life. METHODS: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues. 3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis. RESULTS: Eight PCPs were trained. Patient recruitment was a challenge for PCPs who feared to impose additional loads on their patients. PCPs became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient's cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life. CONCLUSIONS: While the intervention was acceptable to PCPs, recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life. TRIAL REGISTRATION: The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki.


Asunto(s)
Cuidados Paliativos , Calidad de Vida , Muerte , Humanos , Proyectos Piloto , Atención Primaria de Salud , Suiza
3.
BMC Res Notes ; 14(1): 245, 2021 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-34193271

RESUMEN

OBJECTIVE: Sepsis is a major cause of mortality for critically ill patients. This study aimed to determine whether presepsin values can predict mortality in patients with sepsis. RESULTS: Receiver operating characteristic (ROC) curve analysis, Log-rank test, and multivariate analysis identified presepsin values and Prognostic Nutritional Index as predictors of mortality in sepsis patients. Presepsin value on Day 1 was a predictor of early mortality, i.e., death within 7 days of ICU admission; ROC curve analysis revealed an AUC of 0.84, sensitivity of 89%, and specificity of 77%; and multivariate analysis showed an OR of 1.0007, with a 95%CI of 1.0001-1.0013 (p = 0.0320).


Asunto(s)
Evaluación Nutricional , Sepsis , Biomarcadores , Humanos , Unidades de Cuidados Intensivos , Receptores de Lipopolisacáridos , Fragmentos de Péptidos , Proyectos Piloto , Pronóstico , Curva ROC , Sepsis/diagnóstico
4.
Int J Comput Assist Radiol Surg ; 16(8): 1393-1401, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34224068

RESUMEN

PURPOSE: We present the validation of PROST, a robotic device for prostate biopsy. PROST is designed to minimize human error by introducing some autonomy in the execution of the key steps of the procedure, i.e., target selection, image fusion and needle positioning. The robot allows executing a targeted biopsy through ultrasound (US) guidance and fusion with magnetic resonance (MR) images, where the target was defined. METHODS: PROST is a parallel robot with 4 degrees of freedom (DOF) to orient the needle and 1 DOF to rotate the US probe. We reached a calibration error of less than 2 mm, computed as the difference between the needle positioning in robot coordinates and in the US image. The autonomy of the robot is given by the image analysis software, which employs deep learning techniques, the integrated image fusion algorithms and automatic computation of the needle trajectory. For safety reasons, the insertion of the needle is assigned to the doctor. RESULTS: System performance was evaluated in terms of positioning accuracy. Tests were performed on a 3D printed object with nine 2-mm spherical targets and on an anatomical commercial phantom that simulates human prostate with three lesions and the surrounding structures. The average accuracy reached in the laboratory experiments was [Formula: see text] in the first test and [Formula: see text] in the second test. CONCLUSIONS: We introduced a first prototype of a prostate biopsy robot that has the potential to increase the detection of clinically significant prostate cancer and, by including some level of autonomy, to simplify the procedure, to reduce human errors and shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Biopsia Guiada por Imagen/métodos , Neoplasias de la Próstata/diagnóstico , Robótica/métodos , Programas Informáticos , Biopsia con Aguja/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Fantasmas de Imagen , Proyectos Piloto , Ultrasonografía
5.
BMC Neurol ; 21(1): 272, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34243742

RESUMEN

BACKGROUND: Human hairy (not glabrous skin) is equipped with a subgroup of C-fibers, the C-tactile (CT) fibers. Those do not mediate pain but affective aspects of touch. CT-fiber-activation reduces experimental pain if they are intact. In this pilot study we investigated pain modulating capacities of CT-afferents in CRPS. METHODS: 10 CRPS-patients (mean age 33 years, SEM 3.3) and 11 healthy controls (mean age 43.2 years, SEM 3.9) participated. CT-targeted-touch (brush stroking, velocity: 3 cm/s) was applied on hairy and glabrous skin on the affected and contralateral limb. Patients rated pleasantness of CT-targeted-touch (anchors: 1 "not pleasant"-4 "very pleasant") twice daily on 10 days. Pain intensity (NRS: 0 "no pain" - 10 "worst pain imaginable") was assessed before, 0, 30, 60 and 120 min after each CT-stimulation. To assess sensory changes, quantitative-sensory-testing was performed at the beginning and the end of the trial period. RESULTS: CT-targeted-touch was felt more pleasant on the healthy compared to the affected limb on hairy (p < 0.001) and glabrous skin (p 0.002), independent of allodynia. In contrast to healthy controls patients felt no difference between stimulating glabrous and hairy skin on the affected limb. Thermal pain thresholds increased after CT-stimulation on the affected limb (cold-pain-threshold: p 0.016; heat-pain-threshold: p 0.033). CONCLUSIONS: CT-stimulation normalizes thermal pain thresholds but has no effect on the overall pain in CRPS. Therefore, pain modulating properties of CT-fibers might be too weak to alter chronic pain in CRPS. Moreover, CT-fibers appear to lose their ability to mediate pleasant aspects of touch in CRPS.


Asunto(s)
Síndromes de Dolor Regional Complejo/fisiopatología , Fibras Nerviosas Amielínicas/fisiología , Dolor/fisiopatología , Adulto , Humanos , Umbral del Dolor/fisiología , Proyectos Piloto , Percepción del Tacto/fisiología
6.
Artículo en Inglés | MEDLINE | ID: mdl-34198658

RESUMEN

BACKGROUND: The importance of promoting exercise adherence among individuals with acute coronary syndrome (ACS) is imperative. However, challenges in maintaining behavior among ACS patients are also well-documented. Emerging findings in the general population have supported the use of habit-formation techniques, which include incorporating routine consistency and cues, to be effective for facilitating exercise behavior. The effectiveness of habit formation approaches, however, has not been tested on participants with ACS. The purpose of this study was to test the effectiveness of facilitating physical activity habits among patients with ACS in a two-arm, parallel design, randomized controlled pilot trial. METHODS: Participants (n = 13) were older adult patients (M age = 64.20, SD = 5.35) with ACS who were referred to a cardiac rehabilitation center. The experimental group attended monthly group meetings from months 1-3 and received phone call follow-ups from months 4-6. CONCLUSIONS: The experimental group showed an increase in weekly moderate-to-vigorous level physical activity, M = 228.20 mins (SD = 112.45), compared with the control group, M = 151.17 (SD = 112.22), d = 0.61. The experimental condition also showed greater use of routine consistency (experimental: M = 4.60 (SD = 0.548); control: M = 3.76 (SD = 1.62)) and cue usage (experimental: M = 3.60 (SD = 0.471); control: M= 2.60 (SD = 0.398)) over the control condition at the six-month mark. The study supports the effectiveness of habit-building techniques among patients with ACS, with effect sizes ranging from a medium to large magnitude. Findings from this pilot study support a full clinical trial with larger sample size.


Asunto(s)
Síndrome Coronario Agudo , Rehabilitación Cardiaca , Anciano , Ejercicio Físico , Hábitos , Humanos , Persona de Mediana Edad , Proyectos Piloto
7.
Artículo en Inglés | MEDLINE | ID: mdl-34200618

RESUMEN

Fibromyalgia (FM) is a chronic pain condition associated with impaired muscle strength and exercise-induced pain. Physical exercise has been highlighted, by international clinical guidelines and stakeholders, as an essential component of rehabilitation in FM. Exposure to pain during exercise is generally correlated with elevated lactate levels and, additionally, is one known reason for persons with FM to avoid physical exercise and activity. A crossover design was used to test and evaluate an approach consisting of resistance exercise with heavy loads and a low number of repetitions among ten women with FM. The participants were consecutively recruited to test and perform exercise with two different resistance levels (A = light/moderate load, and B = heavy load) in a randomized crossover trial using an AB/BA setting. Results showed that the heavy load exercise session was experienced as more positive than the light/moderate load exercise session and that lower lactate levels followed exercise with heavier weight loads. This is promising and indicates that the approach of heavy weight loads and accustomed repetitions is accepted in FM and has the potential to attenuate hesitation to exercise due to exercise-induced pain. However, these effects need to be further investigated in more extensive studies.


Asunto(s)
Fibromialgia , Entrenamiento de Fuerza , Estudios Cruzados , Ejercicio Físico , Terapia por Ejercicio , Femenino , Humanos , Proyectos Piloto
8.
Artículo en Inglés | MEDLINE | ID: mdl-34201275

RESUMEN

Bike patrollers must have a good level of fitness to perform their patrolling duties adequately and effectively by bike and accomplish specific work tasks, which may require the use of various physical capacities. However, there is little information on the real workload associated with bike patrol and its impact on health. The purpose of this study was to assess the general physical fitness of police officers before and after a season of bike patrolling and then quantify its effects on each patroller's health. All six male police officers (29.5 ± 4.3 years old) performed two complete physical fitness evaluations (PRE- and POST-season), which included anthropometric measurements (weight, waist circumference, and body mass index), a push-up test, a sit-up test, a grip strength test, a vertical jump test, a sit-and-reach test, and an aerobic capacity test on a bicycle ergometer. Paired t-tests were used to evaluate the differences in test performance between the PRE- and POST-season. Grip strength, estimated VO2max, and power deployed on the bike all showed significant improvement after the season (p-value 0.0133; 0.007; and 0.003, respectively). No significant differences were found among the evaluation's other components (p > 0.05). Results show the workload associated with a bike patrol season caused a considerable improvement in grip strength, VO2max, and power deployed on the bike, and might be beneficial for their overall health as a work-integrated avenue to keep the officers fit for duty. Further research on the subject is suggested.


Asunto(s)
Ciclismo , Policia , Adulto , Prueba de Esfuerzo , Humanos , Masculino , Aptitud Física , Proyectos Piloto , Estaciones del Año
9.
Front Immunol ; 12: 625732, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34194422

RESUMEN

The etiological agent of COVID-19 SARS-CoV-2, is primarily a pulmonary-tropic coronavirus. Infection of alveolar pneumocytes by SARS-CoV-2 requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase. ACE2, present on the surface of many cell types, is known to be a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (Ang II) into Angiotensin-(1-7) [Ang-(1-7)]. We therefore hypothesized that SARS-CoV-2 could trigger variations of ACE2 expression and Ang II plasma concentration in SARS-CoV-2-infected patients. We report here, that circulating blood cells from COVID-19 patients express less ACE2 mRNA than cells from healthy volunteers. At the level of circulating cells, this ACE2 gene dysregulation mainly affects the monocytes, which also show a lower expression of membrane ACE2 protein. Moreover, soluble ACE2 (sACE2) plasma concentrations are lower in prolonged viral shedders than in healthy controls, while the concentration of sACE2 returns to normal levels in short viral shedders. In the plasma of prolonged viral shedders, we also found higher concentrations of Ang II and angiotensin I (Ang I). On the other hand, the plasma levels of Ang-(1-7) remains almost stable in prolonged viral shedders but seems insufficient to prevent the adverse effects of Ang II accumulation. Altogether, these data evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.


Asunto(s)
Angiotensina II/sangre , Angiotensina I/sangre , Enzima Convertidora de Angiotensina 2/sangre , COVID-19/sangre , Fragmentos de Péptidos/sangre , Adulto , Enzima Convertidora de Angiotensina 2/genética , COVID-19/virología , Femenino , Perfilación de la Expresión Génica , Antígenos HLA-DR , Humanos , Receptores de Lipopolisacáridos , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Monocitos/metabolismo , Proyectos Piloto , Estudios Prospectivos , ARN Mensajero , Esparcimiento de Virus
10.
Sensors (Basel) ; 21(13)2021 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-34202786

RESUMEN

The high prevalence of falls and the enormous impact they have on the elderly population is a cause for concern. We aimed to develop a walking-monitor gait pattern (G-STRIDE) for older adults based on a 6-axis inertial measurement (IMU) with the application of pedestrian dead reckoning algorithms and tested its structural and clinical validity. A cross-sectional case-control study was conducted with 21 participants (11 fallers and 10 non-fallers). We measured gait using an IMU attached to the foot while participants walked around different grounds (indoor flooring, outdoor floor, asphalt, etc.). The G-STRIDE consisted of a portable inertial device that monitored the gait pattern and a mobile app for telematic clinical analysis. G-STRIDE made it possible to measure gait parameters under normal living conditions when walking without assessing the patient in the outpatient clinic. Moreover, we verified concurrent validity with convectional outcome measures using intraclass correlation coefficients (ICCs) and analyzed the differences between participants. G-STRIDE showed high estimation accuracy for the walking speed of the elderly and good concurrent validity compared to conventional measures (ICC = 0.69; p < 0.000). In conclusion, the developed inertial-based G-STRIDE can accurately classify older people with risk to fall with a significance as high as using traditional but more subjective clinical methods (gait speed, Timed Up and Go Test).


Asunto(s)
Accidentes por Caídas , Dispositivos Electrónicos Vestibles , Anciano , Estudios de Casos y Controles , Estudios Transversales , Marcha , Humanos , Proyectos Piloto , Equilibrio Postural , Estudios de Tiempo y Movimiento , Caminata
11.
Adv Mind Body Med ; 35(3): 20-30, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34237026

RESUMEN

Context: Opioid use disorder (OUD) involves excessive use of opioids-such as heroin, morphine, fentanyl, codeine, oxycodone, and hydrocodone-leading to major health, social, and economic consequences. Yoga lifestyle interventions have been found to be useful as adjunct therapies in management of substance use disorders and chronic pain conditions. Objective: The research team intended to develop, validate, and test for feasibility a yoga program for OUD patients that could reduce opiate withdrawal symptoms-such as pain, fatigue, low mood, anxiety and sleep disturbances-and cravings associated with drugs. Design: The research team first performed a literature review of traditional and contemporary yoga texts, such as Hatha Yoga Pradipika and Light on Yoga, as well as modern scientific literature in the following search engines-Google Scholar, PubMed, and PsychInfo, using the keywords yoga, pranayama, hatha yoga, relaxation. meditation, substance use, addiction, impulsivity, craving, sleep quality, and fatigue. Using the information obtained, the team developed a yoga program and designed a pilot study that used the program. Setting: The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Participants: Participants in the pilot study were 8 inpatients, 6 males and 2 females, who were on opioid agonist treatment (buprenorphine) for OUD. Intervention: The intervention was the yoga program previously validated by the research team. In the pilot study, participants were taught a one-hour, yoga-based intervention, with sessions occurring once per day, for 10 sessions. Outcome Measures: For validation, 13 experts scored the yoga program that the research team had developed and gave suggestions for each yogic practice for use during the acute phase of withdrawal and the maintenance phase respectively. A content validity ratio (CVR) was calculated from their scoring, and the research team made changes to the program base on the scoring and suggestions. For the pilot study, assessments occurred at baseline and postintervention. The participants' yoga performance was rated by the yoga trainer on a yoga performance assessment scale (YPA). Other measurements included: (1) the Clinical Opiate Withdrawal Scale (COWS), (2) the Hamilton's anxiety rating scale (HAM-A), (3) the Hamilton's depression rating scale (HAM-D), (4) buprenorphine dosage, (5) the Clinical Global Impression Severity (CGI-S) scale, (6) a visual analog scale (VAS) for pain, (7) sleep quality (latency and duration), and (8) the module's safety. Results: Four practices were removed from the program due to CVR scores below the cutoff, and one practice was found not to be feasible (Kapalabhati). Two categories of yoga modules emerged: (1) for the acute symptomatic phase (40 minutes) and (2) for the maintenance phase (one hour). Practices were added or excluded based on the phase. Conclusions: The yoga module that was developed for reducing withdrawal symptoms and cravings in OUD patients was found to be safe, feasible, and potentially useful as an adjunct therapy to conventional treatment.


Asunto(s)
Meditación , Trastornos Relacionados con Opioides , Yoga , Estudios de Factibilidad , Femenino , Humanos , India , Masculino , Trastornos Relacionados con Opioides/terapia , Proyectos Piloto
12.
Artículo en Inglés | MEDLINE | ID: mdl-34199448

RESUMEN

BACKGROUND: Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities. METHODS: Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1. MAIN OUTCOME: perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure. SECONDARY OUTCOMES: retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements. CONCLUSION: MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.


Asunto(s)
Neoplasias de la Mama , Calidad de Vida , Actividades Cotidianas , Neoplasias de la Mama/terapia , Canadá , Femenino , Humanos , Ocupaciones , Proyectos Piloto
13.
BMJ ; 374: n1637, 2021 07 06.
Artículo en Inglés | MEDLINE | ID: mdl-34230058

RESUMEN

OBJECTIVE: To assess the performance of the SARS-CoV-2 antigen rapid lateral flow test (LFT) versus polymerase chain reaction testing in the asymptomatic general population attending testing centres. DESIGN: Observational cohort study. SETTING: Community LFT pilot at covid-19 testing sites in Liverpool, UK. PARTICIPANTS: 5869 asymptomatic adults (≥18 years) voluntarily attending one of 48 testing sites during 6-29 November 2020. INTERVENTIONS: Participants were tested using both an Innova LFT and a quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) test based on supervised self-administered swabbing at testing sites. MAIN OUTCOME MEASURES: Sensitivity, specificity, and predictive values of LFT compared with RT-qPCR in an epidemic steady state of covid-19 among adults with no classic symptoms of the disease. RESULTS: Of 5869 test results, 22 (0.4%) LFT results and 343 (5.8%) RT-qPCR results were void (that is, when the control line fails to appear within 30 minutes). Excluding the void results, the LFT versus RT-qPCR showed a sensitivity of 40.0% (95% confidence interval 28.5% to 52.4%; 28/70), specificity of 99.9% (99.8% to 99.99%; 5431/5434), positive predictive value of 90.3% (74.2% to 98.0%; 28/31), and negative predictive value of 99.2% (99.0% to 99.4%; 5431/5473). When the void samples were assumed to be negative, a sensitivity was observed for LFT of 37.8% (26.8% to 49.9%; 28/74), specificity of 99.6% (99.4% to 99.8%; 5431/5452), positive predictive value of 84.8% (68.1% to 94.9%; 28/33), and negative predictive value of 93.4% (92.7% to 94.0%; 5431/5814). The sensitivity in participants with an RT-qPCR cycle threshold (Ct) of <18.3 (approximate viral loads >106 RNA copies/mL) was 90.9% (58.7% to 99.8%; 10/11), a Ct of <24.4 (>104 RNA copies/mL) was 69.4% (51.9% to 83.7%; 25/36), and a Ct of >24.4 (<104 RNA copies/mL) was 9.7% (1.9% to 23.7%; 3/34). LFT is likely to detect at least three fifths and at most 998 in every 1000 people with a positive RT-qPCR test result with high viral load. CONCLUSIONS: The Innova LFT can be useful for identifying infections among adults who report no symptoms of covid-19, particularly those with high viral load who are more likely to infect others. The number of asymptomatic adults with lower Ct (indicating higher viral load) missed by LFT, although small, should be considered when using single LFT in high consequence settings. Clear and accurate communication with the public about how to interpret test results is important, given the chance of missing some cases, even at high viral loads. Further research is needed to understand how infectiousness is reflected in the viral antigen shedding detected by LFT versus the viral loads approximated by RT-qPCR.


Asunto(s)
Prueba de Ácido Nucleico para COVID-19 , Prueba Serológica para COVID-19 , COVID-19/diagnóstico , Portador Sano/diagnóstico , Portador Sano/virología , Adulto , COVID-19/complicaciones , Estudios de Cohortes , Femenino , Humanos , Masculino , Proyectos Piloto , Valor Predictivo de las Pruebas , Curva ROC , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Reino Unido
14.
BMC Med Educ ; 21(1): 378, 2021 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-34246265

RESUMEN

BACKGROUND: Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students. METHODS: A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention. RESULTS: Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P = .02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P = .16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P = .31) were observed between the two groups. CONCLUSIONS: The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016.


Asunto(s)
Calidad de Vida , Estudiantes de Medicina , China , Empatía , Humanos , Salud Mental , Proyectos Piloto
15.
Front Public Health ; 9: 649524, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34249831

RESUMEN

Background: COVID-19 outbursts have been registered worldwide within care homes with asymptomatic transmission combined with shortage/inaccuracy of diagnostic tests undermining the efforts at containment of the disease. Nursing facilities in Lombardy (Italy) were left with no, or limited, access to testing for 8 weeks after the outbreak of COVID-19. Methods: This study includes 246 residents and 286 workers of three different nursing homes in Brescia-Lombardy. Clinical questionnaires and rapid serology tests were devised to integrate the data of the first available RT-PCR screening. Follow-up serology after 60-days was performed on 67 of 86 workers with positive serology or clinically suspicious. Findings: Thirty-seven residents and 18 workers had previous positive RT-PCR. Thorough screening disclosed two additional RT-PCR-positive workers. Serology screening revealed antibodies in 59 residents and 48 workers, including 32/37 residents and all workers previously positive at RT-PCR. Follow up serology disclosed antibodies in two additional workers with recent symptoms at the time of screening. The professionals in close contact with residents had more infections (47/226-20.79% vs. 1/60-1.66%; p = 0.00013 Fisher exact-test). A suspicious clinical score was present in 44/64 residents and in 41/50 workers who tested positive with either method with totally asymptomatic disease more frequent among residents 28.1 vs. 10.0% (p = 0.019 Fisher exact-test). Interpretation: Based on the available RT-PCR ± results at the time of symptoms/contacts, our integrated clinical and serological screening demonstrated sensitivity 89% and specificity 87%. This multimodal assessment proved extremely useful in understanding the viral spread in nursing homes, in defining its stage and in implementing protective measures. Rapid serology tests demonstrated efficient and particularly suited for older people less able to move/cooperate.


Asunto(s)
COVID-19 , Sistemas de Atención de Punto , Anciano , Humanos , Italia/epidemiología , Casas de Salud , Proyectos Piloto , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2
16.
Artículo en Inglés | MEDLINE | ID: mdl-34200176

RESUMEN

Prenatal exposure to bisphenol A (BPA) may increase the risk of abnormal birth outcomes, and DNA methylation might mediate these adverse effects. This study aimed to investigate the effects of maternal BPA exposure on maternal and fetal DNA methylation levels and explore whether epigenetic changes are related to the associations between BPA and low birth weight. We collected urine and blood samples originating from 162 mother-infant pairs in a Taiwanese cohort study. We measured DNA methylation using the Illumina Infinium HumanMethylation 450 BeadChip in 34 maternal blood samples with high and low BPA levels based on the 75th percentile level (9.5 µg/g creatinine). Eighty-seven CpGs with the most differentially methylated probes possibly interacting with BPA exposure or birth weight were selected using two multiple regression models. Ingenuity pathway analysis (IPA) was utilized to narrow down 18 candidate CpGs related to disease categories, including developmental disorders, skeletal and muscular disorders, skeletal and muscular system development, metabolic diseases, and lipid metabolism. We then validated these genes by pyrosequencing, and 8 CpGs met the primer design score requirements in 82 cord blood samples. The associations among low birth weight, BPA exposure, and DNA methylation were analyzed. Exposure to BPA was associated with low birth weight. Analysis of the epigenome-wide findings did not show significant associations between BPA and DNA methylation in cord blood of the 8 CpGs. However, the adjusted odds ratio for the dehydrogenase/reductase member 9 (DHRS9) gene, at the 2nd CG site, in the hypermethylated group was significantly associated with low birth weight. These results support a role of BPA, and possibly DHRS9 methylation, in fetal growth. However, additional studies with larger sample sizes are warranted.


Asunto(s)
Metilación de ADN , Efectos Tardíos de la Exposición Prenatal , Compuestos de Bencidrilo/toxicidad , Peso al Nacer , Estudios de Cohortes , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Exposición Materna/efectos adversos , Fenoles , Proyectos Piloto , Embarazo , Efectos Tardíos de la Exposición Prenatal/genética , Taiwán/epidemiología
17.
Medicina (Kaunas) ; 57(6)2021 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-34204366

RESUMEN

Background and Objectives: The aim of this study was to assess the effects of physiotherapy with aerobic exercise together with temporomandibular joint range of motion exercises (supervised) and physiotherapy with aerobic exercise only (unsupervised), also to review the correlations between neck movements, pain, temporomandibular joint range of motion movements and quality of life in individuals with migraine. Methods: The flexion, extension and lateral flexion of the cervical spine were measured in degrees with a mechanical goniometer and pressure pain thresholds with algometer. Quality of life was assessed with the SF-36 questionnaire and temporomandibular joint range of motion with a centimeter. Results: The study showed statistically significant cervical flexion results in both groups (p < 0.05), masticatory muscle results and temporomandibular joint range of motion between the groups (p < 0.05). A correlation between left upper trapezius muscle pain and cervical lateral flexion was observed in the intervention group. Physical activity correlated with cervical extension, activity limitation due to physical ailments and general health. A correlation between temporomandibular joint and right-side masticatory muscles pain was found. A correlation between upper trapezius muscle pain and left- as well as right-side temporalis muscles were found in the control group. Strong correlations were found between pain and activity limitation due to physical ailments and emotional state. The temporomandibular joint range of motion strongly correlated with activity limitation due to physical ailments. Conclusions: Physiotherapy based on aerobic exercises together with temporomandibular joint exercises was more effective than physiotherapy based on aerobic exercise for decreasing pain, increasing pressure pain thresholds and cervical range of motion.


Asunto(s)
Trastornos Migrañosos , Calidad de Vida , Humanos , Trastornos Migrañosos/terapia , Dolor de Cuello/terapia , Modalidades de Fisioterapia , Proyectos Piloto , Rango del Movimiento Articular , Articulación Temporomandibular
18.
Molecules ; 26(12)2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34207244

RESUMEN

Fast diagnostic results using breath analysis are an anticipated possibility for disease diagnosis or general health screenings. Tests that do not require sending specimens to medical laboratories possess capabilities to speed patient diagnosis and protect both patient and healthcare staff from unnecessary prolonged exposure. The objective of this work was to develop testing procedures on an initial healthy subject cohort in Hawaii to act as a range-finding pilot study for characterizing the baseline of exhaled breath prior to further research. Using comprehensive two-dimensional gas chromatography (GC×GC), this study analyzed exhaled breath from a healthy adult population in Hawaii to profile the range of different volatile organic compounds (VOCs) and survey Hawaii-specific differences. The most consistently reported compounds in the breath profile of individuals were acetic acid, dimethoxymethane, benzoic acid methyl ester, and n-hexane. In comparison to other breathprinting studies, the list of compounds discovered was representative of control cohorts. This must be considered when implementing proposed breath diagnostics in new locations with increased interpersonal variation due to diversity. Further studies on larger numbers of subjects over longer periods of time will provide additional foundational data on baseline breath VOC profiles of control populations for comparison to disease-positive cohorts.


Asunto(s)
Espiración/fisiología , Compuestos Orgánicos Volátiles/química , Adolescente , Adulto , Pruebas Respiratorias/métodos , Femenino , Cromatografía de Gases y Espectrometría de Masas/métodos , Hawaii , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Adulto Joven
19.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-34208325

RESUMEN

Background and Objectives: Chronic rhinosinusitis (CRS) is a condition that affects as much as 10.9% of the population and, along with presence of nasal polyps, is associated with significant morbidity and decreased quality of life. Studies on molecular pathways that have been activated in nasal polyp tissue are mainly based on cytokine concentration detection. Therefore, our aim is to investigate the complex appearance, relative distribution and interlinks of IL-1, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 and Ki 67 in chronic rhinosinusitis with nasal polyps (CRSwNP) affected human nasal mucosa. Materials and Methods: Samples of nasal polyps were obtained from 12 patients with previously diagnosed CRSwNP and no prior surgery. Control group consisted of samples from 17 otherwise healthy individuals with isolated nasal septum deviation. Tissues were stained for IL-1, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 and Ki67 immunohistochemically. Non-parametric statistic, Mann-Whitney U test and Spearman's rank correlation coefficient were used. Results: All factors, except connective tissue cytokine IL-10 and proliferation marker Ki-67, had increased presence in connective tissue and decreased presence in epithelium of nasal polyps when compared to controls. Very strong and strong positive correlations between factors were observed. Conclusions: Decreased appearance of IL-1α, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 positive structures in the nasal epithelium with selective increase of IL-1α and IL-12 in nasal subepithelial connective tissue characterize the cytokine endotype with dysfunctional epithelial barrier and local stimulation of immune response in the connective tissue in case of chronic rhinosinusitis with polyps. Decrease of IL-6 in both-epithelium and connective tissue with strong correlation between it and IL-7 and IL-10 in connective tissue suggests significant stimulation of this regulatory cytokine and, possibly, the important role in pathogenesis of the development in nasal polyps. Correlations between Ki67 and cytokines indicate possible involvement of IL-4, IL-7 and IL-12 in regulation of cellular proliferation.


Asunto(s)
Pólipos Nasales , Rinitis , Proliferación Celular , Enfermedad Crónica , Citocinas , Humanos , Antígeno Ki-67 , Pólipos Nasales/complicaciones , Proyectos Piloto , Calidad de Vida , Rinitis/complicaciones
20.
Medicina (Kaunas) ; 57(6)2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34208475

RESUMEN

Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.


Asunto(s)
Tumores del Estroma Gastrointestinal , Neoplasias Gástricas , Tumores del Estroma Gastrointestinal/cirugía , Gastroscopía , Humanos , Recurrencia Local de Neoplasia , Proyectos Piloto , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Resultado del Tratamiento
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