A Retrospective Study on tDCS Treatment in Patients with Drug-Resistant Chronic Pain.

Background. Transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) has an analgesic effect superior to a placebo in chronic pain. Some years ago, tDCS was implemented at the Hospital Nacional of Paraplegics (Toledo, Spain) to treat patients with pharmacological resistance to chronic pain. Objective. The main objectives of this study with tDCS were (1) to confirm the safety of one-year treatment; (2) to estimate the number of patients after one year in treatment; (3) to describe the effects of tDCS on the pain intensity during one-year treatment; and (4) to identify factors related to treatment success. Methods. This was a retrospective study conducted at the National Hospital for Paraplegics with 155 patients with pharmacologically resistant chronic pain. Anodal tDCS was applied over the M1 for 20 min at 1.5 mA for 10 treatment sessions from Monday to Friday (Induction phase), followed by 2-3 sessions per month (Maintenance phase). Pain intensity was assessed using a Visual Analogue Scale (VAS). Results. Anodal tDCS on M1 confirmed the reduction in the pain intensity. Moreover, 58% of outpatients completed one year of treatment. Only the VAS values obtained during the baseline influenced the response to treatment. Patients with a very high VAS at the baseline were more likely to not respond adequately to tDCS treatment. Conclusions. Anodal tDCS over M1 is an adequate therapy (safe and efficient) to treat drug-resistant chronic pain. Moreover, pain intensity at the start of treatment could be a predictor of patients' continuity with tDCS for at least one year.

Effects of transcranial static magnetic field stimulation over the left dorsolateral prefrontal cortex on random number generation.

OBJECTIVE: Focal application of transcranial static magnetic field stimulation (tSMS) is a neuromodulation technique, with predominantly inhibitory effects when applied to the motor, somatosensory or visual cortex. Whether this approach can also transiently interact with dorsolateral prefrontal cortex (DLPFC) function remains unclear. The suppression of habitual or competitive responses is one of the core executive functions linked to DLPFC function. This study aimed to assess the impact of tSMS on the prefrontal contributions to inhibitory control and response selection by means of a RNG task. METHODS: We applied 20 min of tSMS over the left DLPFC of healthy subjects, using a real/sham cross-over design, during performance of a RNG task. We used an index of randomness calculated with the measures of entropy and correlation to assess the impact of stimulation on DLPFC function. RESULTS: The randomness index of the sequences generated during the tSMS intervention was significantly higher compared to those produced in the sham condition. CONCLUSIONS: Our results indicate that application of tSMS transiently modulates specific functional brain networks in DLPFC, which indicate a potential use of tSMS for treatment of neuropsychiatric disorders. SIGNIFICANCE: This study provides evidence for the capacity of tSMS for modulating DLPFC function.

Hand Motor Fatigability Induced by a Simple Isometric Task in Spinal Cord Injury.

This study aimed: (1) to evaluate the hand motor fatigability in people with spinal cord injury (SCI) and compare it with measurements obtained form an able-bodied population; (2) to compare the hand motor fatigability in people with tetraplegia and in people with paraplegia; and (3) to analyse if motor fatigability is different in people with SCI with and without clinical significant perceived fatigability. MATERIALS AND METHODS: 96 participants with SCI (40 cervical and 56 thoracolumbar) and 63 able-bodied controls performed a simple hand isometric task to assess motor fatigability. The Fatigue Severity Scale was used for perceived fatigability evaluation. RESULTS: The main results of this study can be summarized as follows: (1) the waning in muscle force (motor fatigability) during a fatiguing task is similar in controls and participants with SCI; (2) the motor fatigability is influenced by the maximal muscle force (measured at the beginning of the task); and (3) the perceived fatigability and the motor fatigability are largely independent in the individuals with SCI. CONCLUSION: Our findings suggest that the capability to maintain a prolonged effort is preserved in SCI, and this capacity depends on the residual maximal muscle force in people with SCI.

Social support and job satisfaction in nursing staff: Understanding the link through role ambiguity.

AIM: This study aimed to analyse the mediator effect of role ambiguity between social support from supervisor and colleagues and job satisfaction in Portuguese nursing staff. BACKGROUND: Few studies have analysed the processes through which social support increases job satisfaction in the nursing context. DESIGN: A cross-sectional design using questionnaires. METHOD: A total of 124 registered nurses and 130 certified nursing assistants participated in the study. Mediation analysis was performed by calculating percentile confidence intervals (10,000 resamples). RESULTS: Mediation analysis revealed a partial mediation between social support and job satisfaction through role ambiguity. The direct effect was greater in the case of supervisor support. CONCLUSIONS: Social support is a crucial resource in the nursing work context with a beneficial effect on well-being (e.g. reducing role stress) and job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Managers of hospitals and health units can establish the organizational bases to facilitate this process, considering the importance of the role of the supervisors and colleagues in the provision of high levels of instrumental and socio-emotional support.

Linking Self-efficacy to Quality of Working Life: The Role of Work Engagement.

The aim of this study was to explore the effect of work engagement, as an intermediary variable, on the relationship between self-efficacy, and job satisfaction and affective organizational commitment as individual indicators of quality of working life (QWL). A cross-sectional correlational design was utilized assessing a convenience sample of 321 nursing staff. All participants were employed in public hospitals and had more than five months of professional experience in the same hospital. Mediation analysis was performed using path analysis and bootstrapping confidence intervals (percentile-corrected). Work engagement partially mediated the relation between self-efficacy and job satisfaction, and fully mediated the relation between self-efficacy and affective organizational commitment. Self-efficacy seems to be an important predictor of QWL in nursing staff, although its effect is partially mediated (e.g., job satisfaction) or fully mediated (e.g., affective commitment) by work engagement.

Predictors of primary non-adherence to concomitant chronic treatment in HIV-infected patients with antiretroviral therapy.

OBJECTIVES: To identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases. METHODS: We conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication. RESULTS: Out of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001). CONCLUSION: One-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.

Effects of transcranial direct current stimulation on temperature and pain perception.

Transcranial direct current stimulation modifies cortical excitability and in consequence some cerebral functions. In the present study we aimed to elucidate whether tDCS could affect temperature and pain perceptions in healthy subjects testing different stimulation parameters. A total of 20 healthy subjects were studied by means of quantitative sensory testing. Two different experiments were performed. First, we studied the effects of 15 minutes 2 mA anodal transcranial direct current stimulation applied over left M1 and parietal cortex in two separated sessions. Then, we tested the effects of 5 minutes tDCS over M1 by means of a sham controlled design to optimize the possibility to study minimal effects of tDCS using different polarities (cathodal and anodal) and intensities (1 and 2 mA). 2 mA anodal tDCS, when applied for both 15 and 5 minutes over the motor cortex, increased cold perception threshold. Conversely, motor cortex cathodal tDCS modulated cold perception threshold only when 1 mA intensity was used. M1-tDCS can modify the temperature perception; these effects are polarity and intensity dependent. As stimulation intensity seems critical to determine the effects, we suggest that for clinical application strong anodal tDCS (>1 mA) or weak cathodal tDCS (<2 mA) should be used for pain control.

New Insights from Clinical Assessment of Upper Extremities in Cervical Traumatic Spinal Cord Injury.

Upper extremity function has a strong impact on the quality of life in cervical spinal cord-injured patients. Upper extremity function depends on many factors, such as muscle strength, level of lesion, and extension of the cord damage in its axial axis produced by the injury. These variables can be obtained by the International Standards for Neurological Classification of Spinal Cord Injury, which is the standard for the functional evaluation of traumatic spinal cord injury (SCI) patients. The aim of this study was to describe the relationship between upper limb muscle strength, level of injury, and axial damage with the functionality of upper limb measured using the Jebsen-Taylor Hand Function Test (JTHFT) and the 9 Hole Peg Test (9HPT) in cervical SCI. Twenty-nine patients were included in this study. Our results suggest that both the JTHFT and 9HPT can be similarly used to quantify functional impairment after cervical SCI. Moreover, our data suggest that the upper extremity motor score, JTHFT, and 9HPT strongly correlate with the American Spinal Injury Association (ASIA) impairment scale (graded from A to E), but not with the lesion level. Our findings can be of great importance for the clinician or researchers whose therapeutic interventions have as a main objective to improve upper limb functionality in patients with cervical SCI. We suggest that ASIA impairment scale, ASIA motor score, and functional tests (including JTHFT and/or 9HPT) could be used as outcome measures in cervical SCI clinical trials.

Inicio del empleo de los abonos bacterianos en nuestra agricultura Nitragina de Kudzu

Han sido aisladas seis cepas de bacterias nodulares específicas del Kudzú tropical. Entre las cepas aisladas 5 pertenecen al grupo de las bacterias nodulares de crecimiento rápido y 1 cepa al grupo de las de lento crecimiento. Por medio de experiencias vegetativas se han determinado las propiedades de virulencia y actividad fijadora de nitrógeno atmosférico de las cepas en cuestión. La cepa más activa se ha utilizado en la elaboración del abono bacteriano Nitragina de Kudzú. La producción de nitragina líquida se ha llevado a cabo por el método de fermentación en condiciones de laboratorio. El producto terminado alcanzaba una titulación de diez mil millones de células por mililitro. La producción total de nitragina de Kudzú entre los meses de abril y junio de 1967 alcanzó la cifra de 1, 700 litros(AU)