"Development and characterization of edible films based on starch isolated from different Colombian potato varieties".

This work reports on the extraction and characterization of the behavior of starch from residues of several potato varieties (Criolla, Sabanera and Pastusa) of Colombian origin from the Andean region using different techniques and the evaluation of the effect of citric acid (CA) on the grain morphology. Additionally, films were produced with each one of the extracted starches and glycerol. Pastusa variety starch shows a higher granule size than the other varieties and Pastusa starch shows lower amylose content compared to Sabanera and Criolla. Criolla and Pastusa starches exhibit more thermal stability than Sabanera starch. Starch-glycerol films were also produced using the cast solving method. The films were mechanically analyzed by tensile test and the barrier properties were assessed by water vapor permeability (WVP). The tensile strength of the films varied in the 2.0-2.4 MPa range, while the elongation at break was comprised between 25 and 32 %. With regard to water vapor permeability, the obtained values fall within the 4-7 × 10-10 g m-1 s-1 Pa-1 range. It was observed that the thickness of the films and the protein content affected water vapor permeability, increasing this value at higher levels of thickness.

Buccopharyngeal route administered high polyphenolic olive oil and COVID-19: A pilot clinical trial.

INTRODUCTION: Waning immunity after vaccination justifies the need for additional effective COVID-19 treatments. Immunomodulation of local immune response at the oropharyngeal mucosa could hypothetically activate mucosal immunity, which can prevent SARS-CoV-2 main immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections using an enteral route, which point to potential effects on time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. SUMMARY: This pilot clinical trial investigated the effect of buccopharyngeal administered high polyphenolic olive oil on COVID-19 incidence, duration, and severity. IMPORTANCE: Waning immunity after vaccination justifies the need of further research for additional effective treatments for COVID-19. OBJECTIVE: Immunomodulation of local immune response at the buccopharyngeal mucosa could hypothetically activate mucosal immunity, which would in turn difficult SARS-CoV-2 immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections, using an enteral route, which suggest potential shortening of time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Double blind, randomized pilot clinical trial conducted at a single site, Talavera de la Reina, Spain. Potential study participants were identified by simple random sampling from the epidemiological database of contact patients recently diagnosed of COVID-19 during the study period. A total of 88 adult participants were enrolled and 84 completed the 3-month study, conducted between July 1, 2021 and August 31, 2022. INTERVENTION: Participants were randomized to receive oromucosal administered high polyphenolic olive oil, 2 mL twice a day for 3 months or no treatment. MAIN OUTCOME AND MEASURES: Primary outcomes were incidence, duration, and severity of COVID-19 after intervention. RESULTS: There were no differences in incidence between both groups but there were significant differences in duration, the median time to resolution of symptoms was 3 days in the high polyphenolic olive oil group compared with 7 days in the no-treatment group. Although time to resolution is directly related to severity, this study did not find any differences in severity. CONCLUSION AND RELEVANCE: Among full-vaccinated adults recent infected with COVID-19, a daily intake of tiny quantities of oromucosal administered high polyphenolic olive oil before infection significantly improved the time to symptom resolution. This finding strongly support the appropriateness of further deep research on the use of oromucosal administered high polyphenolic olive oil as an effective immune strategy against COVID-19.

Propuesta de intervención enfermera multicomponente para la prevención de caídas en personas mayores / Proposal for a multicomponent nursing intervention for preventing falls in elderly persons

Objetivo: desarrollar y evaluar una propuesta de intervención enfermera multicomponente en Atención Primaria para la prevención de caídas en personas de 65 años o más.Metodología: estudio cuasi-experimental antes-después de grupo único. Se reclutaron 30 pacientes con alto riesgo de caídas por conveniencia. La intervención consistió en una revisión individualizada del tratamiento farmacológico y en dos sesiones grupales: una sobre identificación de riesgos y prevención de caídas, y otra sobre ejercicio físico y fortalecimiento muscular. Para la evaluación se administró un cuestionario ad hoc antes de la intervención, inmediatamente después y transcurridos cuatro meses post-intervención. Para el análisis estadístico se emplearon pruebas de contraste de hipótesis no paramétricas para muestras apareadas con un nivel de significación p< 0,05.Resultados: participaron 27 personas (90%). La mayoría era mujer (77,8%), viudo/a (51,9%), sin estudios (48,1%) y vivía en pareja (40,7%). Un 74% era polimedicado y solo en 2/4 casos se pudieron retirar benzodiacepinas. Se observó una mejora significativa en los conocimientos sobre prevención de caídas y, aunque a los cuatro meses eran inferiores que en el análisis postintervención, fueron mayores que los preintervención. También se halló un aumento significativo en el número de horas practicando ejercicio físico (p= 0,008) y una disminución destacada en el número de caídas, de 15 en el año preintervención a seis en el año post-intervención (p= 0,004).Conclusiones: esta intervención enfermera multicomponente puede contribuir a disminuir el riesgo de caídas en personas mayores a corto y medio plazo y/o complementar otras intervenciones encaminadas para dicho fin.(AU)

Objective: to develop and evaluate a proposal for a multicomponent nursing intervention in Primary Care for the prevention of falls in persons who are over 65 years old.Methodology: a quasi-experimental before-and-after single-arm study, where 30 patients with high risk of falls were recruited by convenience. The intervention consisted in an individualized review of their pharmacological treatment, and of two group sessions: one on risk detection and prevention of falls, and another one on physical exercise and muscular strengthening. An ad-hoc questionnaire was administered before the intervention, immediately after, and four months after the intervention. Non-parametric hypothesis contrast tests were used for paired samples with a p< 0.05 level of significance.Results: twenty-seven (27) persons (90%) were included; the majority were female (77.8%), widowed (51.9%), without formal education (48.1%) and living with a partner (40.7%). Of these, 74% were on multiple medication, and benzodiazepines could only be discontinued in 2/4 cases. A significant improvement was observed regarding knowledge for preventing falls, and even though this was lower at four months than in the post-intervention analysis, it was higher than pre-intervention. There was also a significant increase in the number of hours doing physical exercise (p= 0.008) and a significant reduction in the number of falls, from 15 in the pre-intervention year to six in the post-intervention year (p= 0.004).Conclusions: this multicomponent nursing intervention can contribute to reduce the risk of falls in elderly persons at short and medium term and/or complement other interventions targeted to the same aim.(AU)

[Relationship between low back pain and screen time among schoolchildren.] / Relación entre el dolor lumbar y el tiempo de pantallas entre los escolares.

OBJECTIVE: Low back pain in childhood and adolescence is considered a predictor of low back pain in adulthood. Sedentary lifestyle is associated with low back pain. This study evaluated the relationship between low back pain and screen time in adolescents 10 to 15 years. METHODS: Cross-sectional study involving schoolchildren 10 and 15 years from school centers of the urban area in Talavera de la Reina. Chi-square test was used to analyze the relationship between low back pain and time spent watching. A logistic regression adjusted for confounding variables was performed and represented by the Odds Ratio. Statistical significance was considered for p<0.05. RESULTS: A total of 1,278 surveys were completed. 31% of schoolchildren reported low back pain in the last 3 months. Statistically significant differences were observed between low back pain with respect to sex and sleep time. Moreover, differences were noticed in the proportion of school-children who report low back pain during the week and use screens more than 2 hours compared to those who report using screens less than 2 hours. These differences were not observed on weekends. CONCLUSIONS: Although adolescents spend more time in front of screens on weekends, the proportion of adolescents who report low back pain is higher during the week.

OBJETIVO: La presencia de dolor lumbar en la niñez y en la adolescencia se considera un predictor de padecer lumbalgia en la edad adulta. Existe evidencia que relaciona el sedentarismo de manera independiente con el dolor lumbar. El objetivo de este estudio fue evaluar la relación existente entre el dolor lumbar y el tiempo de uso de pantallas en adolescentes de 10 a 15 años. METODOS: Estudio transversal donde participaron escolares de entre 10 y 15 años de los centros educativos de la zona urbana de Talavera de la Reina. Para analizar la relación entre el dolor lumbar y el tiempo dedicado a la pantalla se utilizó la prueba de Chi-cuadrado. Se realizó una regresión logística ajustada por las posibles variables de confusión y representada por la Odds Ratio. Se consideró significación estadística si p<0,05. RESULTADOS: Un total de 1.278 encuestas fueron completadas. El 31% de los escolares referían dolor lumbar en los últimos 3 meses. Existen diferencias estadísticamente significativas entre el dolor lumbar con respecto al sexo y al número de horas de sueño. Existen diferencias en la proporción de escolares que refieren dolor lumbar entre semana y utilizan pantallas más de 2 horas en comparación a los que refieren el uso de pantallas menos de 2 horas. Estas diferencias no se observaron los fines de semana. CONCLUSIONES: Aunque los adolescentes pasan más tiempo delante de las pantallas los fines de semana, la proporción de adolescentes que refieren dolor lumbar es superior entre semana.

Hunting territories and land use overlap in sedentarised Baka Pygmy communities in southeastern Cameroon.

A significant number of Baka Pygmies in Cameroon have been sedentarised in roadside villages, in contrast to their nomadic hunter-gatherer existence of the past. Although this change in lifestyle has had important consequences on health, most Baka villages still supplement their diets from forest products, especially wild meat. We used a combination of participatory methods and monitoring of individual hunters to map hunting territories in 10 Baka villages in southeastern Cameroon. From these, we determined whether wild meat extraction levels per village were related to the size of hunting territories, measured habitat use by hunters and finally defined the overlap between hunting territories and extractive industries in the region. Mapped village hunting areas averaged 205.2 ± 108.7 km2 (range 76.8-352.0 km2); all villages used a total of 2052 km2. From 295 tracks of 51 hunters, we showed that hunters travelled an average of 16.5 ± 13.5 km (range 0.9-89.8 km) from each village. Home ranges, derived from kernel utilization distributions, were correlated with village offtake levels, but hunter offtake and distance travelled were not significantly related, suggesting that enough prey was available even close to the villages. Hunters in all village areas exhibited a clear bias towards certain habitats, as indicated by positive Ivlev's index of selectivity values. We also showed that all village hunting territories and hunter home ranges fall within mining and logging concessions. Our results are important for local understanding of forest land uses and to reconcile these with the other land uses in the region to better inform decisions concerning land use policy and planning.

Correlation between three assessment pain tools in subacromial pain syndrome.

OBJECTIVE: To compare the correlation of Visual Analog Scale with pain subsections of Shoulder Pain and Disability Index and Constant-Murley Score in subacromial pain syndrome patients. DESIGN: Single cross-sectional analysis. SETTING: Hospital Rehabilitation Department. METHODS: The assessment tools were applied at baseline. Correlations between Visual Analog Scale, Shoulder Pain and Disability Index and Constant-Murley Score pain subsections were assessed by Pearson correlation coefficient. Linear regression models were calculated between scales. Statistical significance was set at two-sided p < 0.05. RESULTS: Forty-three patients were included. Pearson's correlation between assessments was for Visual Analog Scale-Shoulder Pain Disability Index-pain (r = 0.61, p < 0.001) and for Visual Analog Scale-Constant Murley Score-pain were (r = -0.74, p < 0.001). Visual Analog Scale-Shoulder Pain and Disability Index-pain determination coefficient was r2 = 0.37 and r2 = 0.54 for Visual Analog Scale-Constant-Murley Score-pain. CONCLUSIONS: Visual Analog Scale showed better correlation with Constant Murley Score-pain than with Shoulder Pain and Disability Index-pain in subacromial pain syndrome patients.

Ethnobotanical survey of wild edible plants used by Baka people in southeastern Cameroon.

BACKGROUND: Forest inhabitants worldwide, and indigenous people especially, have depended for generations on plants and animals harvested in these ecosystems. A number of Baka hunter-gatherer populations in south-eastern Cameroon became sedentarised in the 1950s, but still rely on hunting and gathering to meet their basic needs. The use of wild edible plants (WEP) by these communities remains largely undocumented. In this study, we record the diversity of WEP used by Baka people in dense rainforests in the Mintom region. The area still contains relatively undisturbed forest expanses, just south of the Dja Biosphere Reserve, one of the most important protected areas in the Congo Basin. METHODS: We conducted two ethnobotanical surveys in 2019 in four villages on the Mintom road. In the first survey, we interviewed a total of 73 individuals to determine WEP usage. In our second survey, we specifically quantified WEP harvested and consumed daily in a number of households over a 2-week period during the major rainy season, when use of forest products is highest. Specimens of all recorded plants were collected and identified at the National Herbarium of Cameroon. RESULTS: We documented 88 plant species and 119 unique species/plant organ/recipes in 1519 different citations. A total of 61 genera and 43 families were noted. Excluding 14 unidentified wild yam species, 17 WEP species had not been reported in previous ethnobotanical surveys of the Baka. Our results showed that cultivated starchy plant foods make up a significant proportion of our study population's daily nutritional intake. CONCLUSIONS: A high diversity of WEP is consumed by the studied Baka communities. The study area is likely to be significant in terms of WEP diversity since 18 out of the 30 "key" non-timber forest products, NTFP, in Cameroon were mentioned. Documentation of the use of WEP by indigenous communities is vital to ensure the continuity of traditional knowledge and future food security.

Wild meat hunting and use by sedentarised Baka Pygmies in southeastern Cameroon.

As a result of sedentarisation many Baka Pygmies have changed their mobility patterns away from nomadic lifestyles to living in roadside villages. These settled groups are increasingly dependent on cultivated foods but still rely on forest resources. The level of dependence on hunting of wild animals for food and cash, as well as the hunting profiles of sedentarised Pygmy groups is little known. In this study we describe the use of wild meat in 10 Baka villages along the Djoum-Mintom road in southeastern Cameroon. From data collected from 1,946 hunting trips by 121 hunters, we show that most trips are of around 13 hours and a median of eight hours. A mean ± SD of 1.15 ± 1.11 animal carcasses are taken in a single trip; there was a positive correlation between duration of trips and carcasses. A total of 2,245 carcasses of 49 species of 24 animal families were taken in the study; species diversity was similar in all villages except one. Most hunted animals were mammals, with ungulates contributing the highest proportion. By species, just over half of the animal biomass extracted by all hunters in the studied villages was provided by four mammal species. Most animals were trapped (65.77% ± 16.63), followed by shot with guns (22.56% ± 17.72), other methods (8.69% ± 6.96) and with dogs (2.96% ± 4.49). A mean of 7,569.7 ± 6,103.4 kg yr-1 (2,080.8-19,351.4) were extracted per village, giving 75,697 kg yr-1 in total, which is equivalent to 123 UK dairy cattle. In all villages, 48.07% ± 17.58 of animals hunted were consumed by the hunter and his family, around 32.73% ± 12.55, were sold, followed by a lower percentage of carcasses partially sold and consumed (19.21% ± 17.02). Between 60% and 80% of carcasses belonged to the "least concern" category, followed by "near threatened", "vulnerable" and, rarely "endangered". The only endangered species hunted was the chimpanzee (Pan troglodytes). We suggest that hunting is a critical activity that provides a vital source of food for our study communities. Measured wild meat extraction levels are likely to be sustainable if hunter densities do not increase.

La perspectiva de la formación universitaria sobre la Enfermería de urgencias y emergencias: la opinión del alumnado / The perspective of university education on Emergency Care Nursing: the opinion by students

OBJETIVO: conocer la percepción de los egresados sobre su formación en servicios de urgencias y emergencias y las competencias adquiridas con ella; valorar su satisfacción con la formación recibida y estimar la intención de cursar una hipotética especialidad en Enfermería de Urgencias y Emergencias (EUE) en caso de que estuviese reglada. MÉTODO: estudio descriptivo transversal realizado entre 2017 y 2019 cuya población diana fueron los estudiantes de último curso de Enfermería de las universidades españolas. Se diseñó un cuestionario ad hoc autoadministrado que incluyó variables sociodemográficas, relacionadas con la formación teórica y práctica y con la intención de cursar la Especialidad de Urgencias y Emergencias si existiese. Se realizaron análisis uni y bivariantes. RESULTADOS: participaron 1.529 estudiantes. El 65,9% cursó alguna asignatura relacionada con urgencias y emergencias. La valoración global de la duración de las estancias clínicas, entre quienes las efectuaron, fue de 3,9 sobre 7 en el caso de la rotación hospitalaria y de 3,6 en la rotación extrahospitalaria. Un 28% de los estudiantes refirió no haber adquirido competencias suficientes para trabajar en el primer caso y un 35,9% en el segundo. Cuanto mayor es la duración de la estancia clínica, mayor es la valoración de los alumnos en cuanto a la adquisición de las competencias. Un 53% elegiría la "hipotética" especialidad de EUE vía Enfermera Interna Residente como primera opción sobre resto de opciones actuales. CONCLUSIONES: es necesario un análisis profundo de la aplicación de los planes de estudios del Grado en Enfermería. Los recién egresados tendrían entre sus expectativas la realización de una especialidad en EUE

OBJECTIVE: to understand the perception of graduated students about their education on Emergency Care and the skills acquired through it; to assess their satisfaction with the training received, and estimate their willingness to follow a hypothetical specialty on Emergency Care Nursing (ECN), in case this was regulated. METHOD: a cross-sectional descriptive study conducted between 2017 and 2019; its target population was the last-year students of the Nursing Degree in Spanish universities. A self-administered ad hoc questionnaire was designed, which included sociodemographical variables, as well as variables regarding theoretical and practical training, and about the willingness to follow the Emergency Care specialty if available. Univariate and bivariate analyses were conducted. RESULTS: the study included 1,529 patients; 65.9% of them studied some subject associated with Emergency Care. The overall assessment of the duration of clinical stays, between those involved, was 3.9 out of 7 in the case of hospital rotation, and 3.6 in case of extra-hospital rotation. In total, 28% of students reported that they had not acquired enough skills to work in the first case, and 35.9% in the second case. The longer the duration of the clinical stay, the higher the score assigned by students to the skills acquired. Of these students, 53% would choose the "hypothetical" ECN through Internal Nursing Resident as their first option over the rest of current options. CONCLUSIONS: deep analysis is required regarding the implementation of the education plans for the Nursing Degree. Recent graduates would have an ECN specialty among their education expectations

Estilos de aprendizaje de preferencia entre estudiantes de Medicina en La Gambia / Learning styles proffered by medical students in The Gambia

Introducción: En las últimas tres décadas, la proposición de que los estudiantes aprenden siguiendo diferentes estilos se ha convertido en un prominente tema en pedagogía a nivel mundial. En La Gambia no se conoce cuáles son los estilos de aprendizaje en estudiantes de Medicina. Objetivo: Caracterizar los estilos de aprendizaje de preferencia en estudiantes de la Escuela de Medicina y Ciencias Afines de la Salud en La Gambia. Métodos: Se aplicó un diseño transversal mediante el cuestionario estandarizado VARK para la recolección de datos, cuyo análisis se realizó con el uso del software SPSS. Resultados: La mayoría de los estudiantes prefirieron variantes multimodales de aprendizaje; la variante bimodal se escogió con más frecuencia. No se obtuvieron asociaciones significativas entre las puntuaciones VARK y el sexo o la edad de los estudiantes (p > 0,05). Se alcanzaron diferencias significativas para las puntuaciones kinestésicas entre estudiantes de preclínica y clínica (p = 0,031). Además, se logró una asociación significativa con relación a las variantes unimodales preferidas entre los estudiantes de preclínica y clínica. No fueron encontradas diferencias significativas en cuanto al rendimiento académico entre estudiantes con preferencias unimodales o multimodales (p > 0,05). Conclusiones: La aplicación del cuestionario VARK permitió la identificación de los estilos preferidos de aprendizaje para modos particulares de presentación de la información en estudiantes de Medicina en La Gambia. Los estilos de aprendizaje difirieron entre los estudiantes, la mayoría de los cuales tuvieron preferencia por los estilos multimodales, que incluían la variante kinestésica. Estos hallazgos pudieran emplearse para mejorar la calidad de la enseñanza(AU)

Introduction: In the last three decades, the proposition that students learn by following different styles has become a prominent topic in pedagogy worldwide. In The Gambia, learning styles in medical students are not known. Objective: To characterize the learning styles preferred by the students of the School of Medicine and Allied Health Sciences of The Gambia. Methods: A cross-sectional design was applied using the standardized VARK questionnaire for data collection, the analysis of which was performed using the SPSS software. Results: Most students preferred multimodal variants of learning; the bimodal variant was chosen more frequently. No significant associations were obtained between VARK scores and the sex or age of the students (p>0.05). Significant differences were reached for kinesthetic scores between preclinical and clinical students (p=0.031). In addition, a significant association was achieved in relation to the preferred unimodal variants among preclinical and clinical students. No significant differences were found regarding academic performance among students with unimodal or multimodal preferences (p>0.05). Conclusions: The application of the VARK questionnaire allowed the identification of preferred learning styles for particular ways of presenting information among medical students in The Gambia. Learning styles differed among students, most of whom had a preference for multimodal styles, which included the kinesthetic variant. These findings could be used to improve the quality of teaching(AU)

Variabilidad de la práctica clínica en la extracción de hemocultivos en España / Variability in clinical practice for blood culture extraction in Spain

Objetivo: conocer la variabilidad de la técnica de extracción de hemocultivos en la práctica clínica de los enfermeros, así como valorar las diferencias en función de la existencia o no de un protocolo. Método: estudio descriptivo transversal realizado en 2018 mediante encuesta online de participación voluntaria y anónima, difundida a través del Consejo General de Enfermería, 200 direcciones-gerencia de centros hospitalarios nacionales, perfiles privados, institucionales y páginas de grupos. Se diseñó un cuestionario ad hoc de 23 preguntas para explorar variables sociodemográficas, laborales y relacionadas con la extracción de hemocultivos: existencia de protocolo en el servicio, indicaciones de solicitud correctas y cuestiones técnicas. Se realizó un análisis descriptivo de la muestra, así como un análisis bivariante mediante la prueba x2 de Pearson. Resultados: participaron 1.516 profesionales (84,4% mujeres, 64,4% con experiencia mayor a 10 años). El 53,2% refirió la existencia de un protocolo específico en su servicio. Quienes disponían de protocolo empleaban con mayor frecuencia el equipo estéril, clorhexidina alcohólica al 2% para la desinfección de la piel y algún tipo de antiséptico para la desinfección de los tapones (p< 0,001); en caso de muestras del catéter venoso central, fue más habitual que extrajeran otra muestra de un acceso periférico (p< 0,001), cambiaran la aguja para inocular la sangre en los frascos (p< 0,05) sin desechar ninguna cantidad (p< 0,001) y recogieran unos 10 cc de frente a otros volúmenes (p< 0,01). Conclusiones: hay una alta variabilidad en la realización de la técnica y diferencias en función de la existencia o no de un protocolo. La unificación de procedimientos consensuados se torna necesaria para optimizar y rentabilizar la extracción de hemocultivos

Objective: to understand the variability in the technique for blood culture extraction in the clinical practice of nurses, as well as to assess any differences based on whether there is a protocol or not. Method: a descriptive cross-sectional study conducted in 2018 through an on-line survey with voluntary and anonymous participation; it was distributed through the General Council of Nurses, 200 managements of national hospitals, private and institutional profiles, and group webpages. A 23-question ad-hoc questionnaire was designed, in order to explore sociodemographical, and occupational variables, as well as those associated with blood culture extraction: the existence of a protocol in the unit, correct indications of application, and technical matters. A descriptive analysis of the sample was conducted, as well as bivariate analysis through Pearson's x2 test. Results: the study included 1,516 professionals (84.4% were women, 64.4 % with >10-year experience); 53.2% of them reported there was a specific protocol in their unit. Those who had a protocol used more frequently the sterile equipment, chlorhexidine 2% for skin disinfection, and some type of antiseptic for disinfecting the stoppers (p< 0.001). In the case of central venous catheter samples, it was more frequent that they extracted another sample from a peripheral (p< 0.001), changed the needle in order to inject the blood into the vials (p< 0.05) without discarding any (p< 0.001), and collected 10cc vs. other volumes (p< 0.01). Conclusions: there is high variability in terms of conducting the technique, as well as differences based on whether there is a protocol or not. The standardization of procedures by consensus becomes necessary in order to optimize and make the most of blood culture extraction

Spanish Version of the Whiplash Disability Questionnaire in Adults With Acute Whiplash-Associated Disorders.

OBJECTIVE: The purpose of this study was to develop and validate a Spanish version of the Whiplash Disability Questionnaire (WDQ) for the Spanish population with acute whiplash-associated disorder (WAD). METHODS: This was a cross-sectional questionnaire validation study. Adults with acute WAD (grade I to III) were enrolled within 3 weeks of their injury. A blinded forward and back translation of the WDQ was made from English to Spanish, and the resulting back-translation version was compared with the original. Patients with WAD completed the Spanish version of the 13-item WDQ. The developed questionnaire was assessed using psychometric statistical analysis including correlation with the numerical rating score for pain, Northwick Park Neck Pain Questionnaire, Neck Disability Index, and 36-item Short Form Health Survey. RESULTS: Fifty-six patients completed the questionnaire, the mean age was 33.9 years (standard deviation [SD] = 10.5), and 76.8% were women. Participants were enrolled 13.9 days (SD 4.9) after the injury, with 14.3% presenting with WAD grade I and 85.7% with WAD grade II. The mean WDQ score was 62 (SD = 31). Two factors were detected, and the factor structure remained stable after translation. Positive correlations were identified between the total WDQ score and the numerical rating score, Neck Pain Questionnaire, and Neck Disability Index results, with a strong negative correlation with the 36-item Short Form Health Survey. CONCLUSION: The Spanish version of WDQ is psychometrically reliable and a valid instrument to measure the disability status in patients with acute WAD within the clinic.

Deficient Inhibitory Endogenous Pain Modulation Correlates With Periaqueductal Gray Matter Metabolites During Chronic Whiplash Injury.

OBJECTIVES: This study examined predictive correlations between periaqueductal gray (PAG) and anterior cingulate cortex (ACC) metabolite levels with deficient inhibitory endogenous pain modulation (EPM), including sensory and affective measures of pain during chronic whiplash injury (WHI). MATERIALS AND METHODS: Healthy patients, and participants with chronic WHI, without (WHI-noP) or with pain (WHI-P), were screened with the Douleur Neuropathique 4 tool (DN4). EPM was assessed with C6 tonic heat pain stimuli with a Conditioned Pain Modulation (CPM) protocol. Magnetic resonance spectroscopy quantified ACC and PAG metabolite levels. RESULTS: WHI-P participants were characterized with high pain intensity and interference, and lower quality of life scores, compared with WHI-noP. Inhibitory CPM at 30 seconds was identified in the healthy noninjured (-45±16%; P<0.001) and WHI-noP groups (-36±8%; P<0.001). However, inhibitory EPM was not detected in the WHI-P group (-25±15%; P=0.06). Best fit and stepwise multiple regression revealed that the PAG glutamate/myoinositol metabolite ratio (P=0.01) and total creatine levels (P=0.02) predicted loss of EPM in the WHI-P group (r=0.71, α=0.97). Although myoinositol predicted loss of EPM in the ACC (P=0.04), this was below statistical power (r=0.31; α=0.56). The ACC N-acetyl-aspartate/myoinositol ratio (P=0.006) predicted chronic pain (DN4, r=0.53; α=0.87). DISCUSSION: The results of this study demonstrate deficient EPM at 30 seconds during tonic heat pain stimulation in WHI-P participants, compared with noninjured healthy volunteers or individuals with WHI-noP. In addition, quantification of PAG and ACC metabolites related to glutamate and glia predicted central chronic pain mechanisms related to loss of inhibitory EPM, while ACC metabolites characterized chronic pain described by descriptors and sensory changes.

Soleus H-reflex modulation following transcutaneous high- and low-frequency spinal stimulation in healthy volunteers.

The main aim of this work was to investigate the difference in the excitability of the soleus H-reflex in healthy volunteers following spinal transcutaneous electrical nerve stimulation (TENS) and high-frequency alternating current (HFAC) at a frequency of 10 kHz applied at the lower thoracic spinal level (T10-T12). A double-blind, randomized, crossover, controlled clinical trial was designed. Participants received three randomized interventions (TENS, 10 kHz, and sham stimulation) during 40 min. The amplitude and latency of the soleus H-reflex were registered prior to, during, and 10 min following stimulation. Twenty-four participants completed the study. A significant inhibition of H-reflex amplitude was observed following transcutaneous spinal TENS (12.7%; 95% CI 1.5-22.2%) when compared with sham stimulation (5.5%; 95% CI 3.6-14.5%; p = 0.03). An increase in H-reflex latency was also observed following transcutaneous spinal stimulation at 10 kHz (2%; 95% CI 1.4-2.5%) as compared with sham stimulation (0.7%; 95% CI 0.07-1.3%; p < 0.01). No differences were found between TENS and 10 kHz for H-reflex modulation. Transcutaneous spinal TENS and HFAC at a frequency of 10 kHz had a modulatory effect on the soleus H-reflex when compared to sham stimulation; however, no differences were found between these two interventions.

Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial.

OBJECTIVES: To evaluate the effectiveness of high-intensity laser therapy on shoulder pain and function in subacromial impingement syndrome. DESIGN: Clinical controlled trial with alternate allocation. SETTING: Hospital Department of Rehabilitation. SUBJECTS: A total of 46 participants with subacromial impingement syndrome. INTERVENTION: Participants were sequence allocated to an intervention group (high-intensity laser therapy + exercise therapy) and control group (sham-laser + exercise therapy) and received 15 sessions (five days a week during three weeks). MAIN MEASURES: Patiens were evaluated at baseline, after 15 sessions, and at one month and at three months after completing the intervention. The main outcome variables were pain and functionality as measured by visual analogue scale; pressure pain threshold; Shoulder Pain and Disability Index; Constant-Murley Score; and QuickDASH. Secondary outcomes were number of sessions at discharge and drug use. RESULTS: A total of 21 patients in high-intensity laser therapy group (56.7 ± 8.9 years) and 22 patients in sham-laser group (61.3 ± 8.9 years) concluded the study. Visual analogue scale (cm) at baseline, one-month, and three-months were 6.2 ± 0.5, 3 ± 2.6, and 2.6 ± 2.4 for the control group and 5.4 ± 1.5, 3.6 ± 1.3, and 1.8 ± 1.7 for experimental group, respectively. Shoulder Pain and Disability Index (points) at baseline, one-month, and three-monts were 51.8 ± 16.1, 16.3 ± 16.1, and 13.6 ± 17.1 in the control group and 41.8 ± 20.6, 20.5 ± 19.7, 11 ± 14.5 in experimental group, respectively. No differences were found between groups ( P > 0.05). CONCLUSION: The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.

Afferent stimulation inhibits abnormal cutaneous reflex activity in patients with spinal cord injury spasticity syndrome.

BACKGROUND: Tibialis Anterior (TA) cutaneous reflex (CR) activity evoked following cutaneous stimulation of the plantar (Pl) surface (Pl-TA CR) has demonstrated hyperreflexia and damage of inhibitory mechanisms in subjects with spinal cord injury (SCI) and spasticity. OBJECTIVES: To modulate Pl-TA CR and Soleus H-reflex activity with transcutaneous electrical nerve stimulation (TENS) and vibratory stimulation of the plantar pad during rest and controlled isometric plantarflexion. METHODS: Non-injured subjects (n = 11) and individuals with incomplete SCI with (n = 14) and without spasticity (n = 14) were recruited. The effect of TENS and vibratory stimuli on Pl-TA CR and soleus H-reflex activity were assessed during rest and controlled ramp-and-hold plantarflexion. RESULTS: Vibration failed to inhibit H-reflex activity during rest or plantarflexoin following SCI compared to healthy subjects. In contrast, vibration-induced inhibition of Pl-TA CR was specifically detected in SCI spastic subjects during both rest and the hold phase of plantarflexion. TENS inhibited Pl-TA CR activity in the SCI spasticity group only during hold plantarflexion. CONCLUSIONS: Plantar vibratory stimuli inhibited the pl-TA CR, but not the H reflex, during rest and controlled movement in SCI spastic subjects. Assessment of Pl-TA CR modulation should contribute to the development of modality-specific sensory stimuli programmes for the neurorehabilitation of SCI spasticity.

Assessing sensorimotor excitability after spinal cord injury: a reflex testing method based on cycling with afferent stimulation.

Several studies have examined spinal reflex modulation during leg cycling in healthy and spinal cord injury (SCI) subjects. However, the effect of cutaneous plantar afferent input on spinal excitability during leg cycling after SCI has not been characterised. The aim of the study was to test the feasibility of using controlled leg cycling in combination with plantar cutaneous electrical stimulation (ES) cycling to assess lower limb spinal sensorimotor excitability in subjects with motor complete or incomplete SCI. Spinal sensorimotor excitability was estimated by measuring cutaneomuscular-conditioned soleus H-reflex activity. Reflex excitability was tested before and after a 10-min ES cycling session in 13 non-injured subjects, 6 subjects with motor incomplete SCI (iSCI) who had moderately impaired gait function, 4 subjects with motor iSCI who had severely impaired gait function, and 5 subjects with motor complete SCI (cSCI). No modulation of soleus H-reflex with plantar cutaneous stimuli was observed after either iSCI or cSCI when compared to non-injured subjects. However, after ES cycling, reflex excitability significantly increased in subjects with iSCI and moderately impaired gait function. ES cycling facilitated spinal sensorimotor excitability only in subjects with motor iSCI with residual gait function. Increased spinal excitability induced with a combination of exercise and afferent stimulation could be adopted with diagnostic and prognostic purposes to reveal the activity-based neurorehabilitation profile of individual subjects with motor iSCI. TRIAL REGISTRATION: ISRCTN 26172500 ; retrospectively registered on 15 July 2016 Graphical abstract ᅟ.

Treatment with albumin-hydroxyoleic acid complex restores sensorimotor function in rats with spinal cord injury: Efficacy and gene expression regulation.

Sensorimotor dysfunction following incomplete spinal cord injury (SCI) is often characterized by paralysis, spasticity and pain. Previously, we showed that intrathecal (i.t.) administration of the albumin-oleic acid (A-OA) complex in rats with SCI produced partial improvement of these symptoms and that oral 2-hydroxyoleic acid (HOA, a non-hydrolyzable OA analogue), was efficacious in the modulation and treatment of nociception and pain-related anxiety, respectively. Here we observed that intrathecal treatment with the complex albumin-HOA (A-HOA) every 3 days following T9 spinal contusion injury improved locomotor function assessed with the Rotarod and inhibited TA noxious reflex activity in Wistar rats. To investigate the mechanism of action of A-HOA, microarray analysis was carried out in the spinal cord lesion area. Representative genes involved in pain and neuroregeneration were selected to validate the changes observed in the microarray analysis by quantitative real-time RT-PCR. Comparison of the expression between healthy rats, SCI rats, and SCI treated with A-HOA rats revealed relevant changes in the expression of genes associated with neuronal morphogenesis and growth, neuronal survival, pain and inflammation. Thus, treatment with A-HOA not only induced a significant overexpression of growth and differentiation factor 10 (GDF10), tenascin C (TNC), aspirin (ASPN) and sushi-repeat-containing X-linked 2 (SRPX2), but also a significant reduction in the expression of prostaglandin E synthase (PTGES) and phospholipases A1 and A2 (PLA1/2). Currently, SCI has very important unmet clinical needs. A-HOA downregulated genes involved with inflammation and upregulated genes involved in neuronal growth, and may serve to promote recovery of function after experimental SCI.

Evolución del proceso de afrontamiento y adaptación en adultos hospitalizados que experimentaron un trauma músculo esquelético por accidentes de tránsito / The evolution of coping and adaptation in hospitalised adults who have suffered traffic accident-related musculoskeletal trauma

Objetivo: Explorar la evolución del proceso de afrontamiento y adaptación de 11 casos de adultos que experimentaron un trauma músculo esquelético, por accidentes de tránsito, durante la estancia hospitalaria en la Clínica Universidad de la Sabana en 2015. Método: Estudio de casos que permitió describir y comparar el proceso de afrontamiento y adaptación en 11 personas. Se aplicó la Escala de medición del proceso de afrontamiento y adaptación versión abreviada en español, al ingreso y al egreso hospitalario. En esta investigación se tuvo en cuenta los principios éticos correspondientes, se obtuvo el consentimiento informado de los participantes y las autorizaciones de la Subcomisión de Investigación de la Facultad de Enfermería y Rehabilitación de la Universidad de la Sabana y de la Clínica donde se llevó a cabo el estudio. Resultado: Los hallazgos de este estudio muestran para ocho de los once casos una tendencia a mantenerse en nivel alto de afrontamiento o a pasar de nivel medio a alto desde el ingreso hasta el egreso hospitalario. Conclusión: La mayoría de los casos tuvo un proceso de afrontamiento y adaptación dirigido al problema, donde se encontró interés por resolver dudas relacionadas con la situación antes de actuar, utilización de experiencias pasadas consideradas como útiles, adopción de nuevas habilidades para afrontar las situaciones difíciles y el uso de soluciones alternativas y recursos (AU)

Objective: Exploring the evolution of coping and adaptation strategies by 11 cases of adults who had suffered traffic accident-related musculoskeletal trauma during their stay in hospital at Clínica Universidad de la Sabana during 2015. Methods: Studying the aforementioned cases enabled describing and comparing the 11 patients' coping and adaptation strategies. The abridged Spanish version of Roy's Coping Adaptation Processing Scale (CAPS) was used for measuring such strategies; it was used on patient admission to and discharge from hospital. This research took the relevant ethical principles into account; the patients gave their written informed consent and the Universidad de la Sabana and its hospital where the study was carried out authorised the study (i.e. the Faculty of Nursing and Rehabilitation's Research Subcommittee). Results: This study's findings showed that eight of the eleven cases maintained a high coping ability, or improved from moderate (on admission to hospital) to high level ability (on discharge). Conclusion: Problem-centred coping and adaptation strategies were involved in most cases. Patients approached this through resolving situation-related questions before acting, using past experiences considered useful, adopting new skills to cope with difficult situations and using alternative solutions and resources (AU)