Pressure Injury Link to Entropy of Abdominal Temperature.

This study examined the association between pressure injuries and complexity of abdominal temperature measured in residents of a nursing facility. The temperature served as a proxy measure for skin thermoregulation. Refined multiscale sample entropy and bubble entropy were used to measure the irregularity of the temperature time series measured over two days at 1-min intervals. Robust summary measures were derived for the multiscale entropies and used in predictive models for pressure injuries that were built with adaptive lasso regression and neural networks. Both types of entropies were lower in the group of participants with pressure injuries (n=11) relative to the group of non-injured participants (n=15). This was generally true at the longer temporal scales, with the effect peaking at scale τ=22 min for sample entropy and τ=23 min for bubble entropy. Predictive models for pressure injury on the basis of refined multiscale sample entropy and bubble entropy yielded 96% accuracy, outperforming predictions based on any single measure of entropy. Combining entropy measures with a widely used risk assessment score led to the best prediction accuracy. Complexity of the abdominal temperature series could therefore serve as an indicator of risk of pressure injury.

Program Evaluation of Environmental and Policy Approaches to Physical Activity Promotion in a Lower Income Latinx School District in Southeast Los Angeles.

There is alarming population wide prevalence of low adolescent physical activity as this represents a risk factor for later chronic disease development. There is evidence to suggest that schools with strong wellness policies have students that are more frequently active. We designed an intervention to enhance students' physical activity levels in five majority Latinx, underserved school districts. Evaluation consisted of assessment of written quality of school-district wellness policies; observation of student's physical activity during leisure times; and after-school program practices and policies. We examined one of these district's results more closely, the only participating district with a community coalition, and extracted lessons learned. On the physical activity section of the wellness policy, this district covered a moderate extent of recommended content areas using weak language. Compared to previous reports, we identified low vigorous activity levels for girls and boys at baseline (respectively, 12% and 18%). Finally, we identified that of four after school program sites assessed at baseline, no program reported the recommended 50% or more of program time dedicated to physical activity. Based on these evaluation findings, additional strategies are urgently needed to encourage all students and particularly more girls to be physically active throughout the school day.

Iatrogenic Propylene Glycol Intoxication Due to High-Dose Pentobarbital for Refractory Intracranial Hypertension: A Case Report.

Propylene glycol is a rarely reported toxicity from high-dose administration of certain intravenous drugs, including lorazepam and pentobarbital. We present a case of iatrogenic propylene glycol toxicity secondary to a high-dose pentobarbital infusion for the treatment of refractory intracranial hypertension due to cerebral venous sinus thrombosis. The patient developed metabolic acidosis and acute kidney failure secondary to propylene glycol toxicity. After initiation of continuous renal replacement therapy, the patient's acute renal failure and lactic acidosis resolved. Using the Naranjo scale, this case received a score of 5, defining it as a "probable" adverse drug event. In patients who develop lactic acidosis and acute renal failure after initiation of high-dose pentobarbital, propylene glycol toxicity should be higher up in the differential diagnosis. Monitoring the serum osmolality while on pentobarbital could help provide valuable information to prevent iatrogenic propylene glycol toxicity.

Knowledge and beliefs, behaviors, and adherence among Latino parents or legal guardians related to antibiotic use for upper respiratory tract infections in children under 6 years of age.

OBJECTIVE: Evaluate parents or legal guardians' knowledge and beliefs, behaviors, and adherence regarding antibiotic use for upper respiratory tract infection (URTI) in their children who are younger than 6 years. DESIGN: A cross-sectional study from September 2016 to February 2017. SETTING: Emergency department with a pediatric unit. PARTICIPANTS: One hundred and one parents or legal guardians who visited one of the selected emergency departments during the study period. INTERVENTION: Administration of a validated questionnaire to assess knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. MAIN OUTCOME MEASURES: Knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. RESULTS: Items with the least desired scores were seen in the "knowledge and beliefs" domain. Higher number of antibiotics used for URTI during the last year (P < 0.01) and lower education level (P = 0.03) were associated with least desired knowledge and beliefs scores. The "behaviors" domain contained the items with the best scores: higher education level (P = 0.05), fewer antibiotics used for URTI during the last year (P = 0.05), and older age (P = 0.02) were the only variables associated with better behaviors. For the "adherence" domain, lower education level (P < 0.01) was associated with poor indicators of adherence. The Cronbach alpha for the "knowledge and beliefs" items was 0.875, the "behaviors" items 0.569, and the "adherence" items 0.798. CONCLUSION: Findings of our study support the need for proper antibiotic education among parents, especially in those with an increased risk of antibiotic misuse and overuse. Pharmacists and physicians need to establish a dialogue with parents or legal guardians to discuss how antibiotics work, what types of infection they treat, and how to prevent antibiotic resistance. Sociodemographic variables can be used to identify at-risk groups and to develop successful interventions.

Prevalence of Concurrent Prescribing of ACE-Is and ARBs among Beneficiaries of Puerto Rico's Government-Sponsored Health Care Plan During 2012 and 2013.

OBJECTIVE: Cardiovascular conditions are the second cause of death in Puerto Rico. The individual use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) is considered the first-line therapy for the treatment of several cardiovascular-related medical conditions. However, the concurrent use of these 2 therapeutic classes of drugs is not supported by treatment guidelines. Studies have shown that their concurrent use represents a potential health risk. The research described in this paper aimed to determine the prevalence of the concurrent prescription of ACE-Is and ARBs, either separately or as a combination product, in a group of beneficiaries of the Puerto Rico Health Services Administration (ASES, by its initials in Spanish). METHODS: A 2-year cross sectional study was conducted. All pharmacy claims from the years 2012 and 2013 were provided by ASES and subsequently evaluated by the investigators to identify those involving the prescription of an ACE-I, an ARB, or a combination of drugs belonging to both therapeutic classes. Each pharmacy claim was complemented with sociodemographic and clinical data. The final dataset was analyzed at the person-month level using frequency, cumulative frequency, percentage, and cumulative percentage. RESULTS: The final sample consisted of 361,841 beneficiaries. A total of 23,598 beneficiaries were excluded because of incomplete diagnostic information. Of the beneficiaries with complete information, 36,202 out of 338,243 (10.7%) had concurrent prescriptions for ACE-Is and ARBs during the study period. We excluded 1,124 beneficiaries who had a primary diagnosis of HF, resulting in a final pool of 35,078 beneficiaries (10.4%) who had prescriptions for combination products. CONCLUSION: An unacceptable pattern of ACE-I and ARB co-prescribing during the years 2012 and 2013 was observed in patients with diagnoses for which the combination is not clinically indicated.

The Effect of Morbid Obesity on Subarachnoid Hemorrhage Prognosis in the United States.

OBJECTIVE: The association between obesity and nontraumatic subarachnoid hemorrhage (SAH) patient outcome is unclear. The aim of this study was to determine the impact of morbid obesity (body mass index ≥40 kg/m2) on nontraumatic SAH outcomes. METHODS: Using the Nationwide Inpatient Sample, we identified hospitalized, nontraumatic SAH patients who received their diagnoses from 2008 to 2013 and tested the effect of obesity on their mortality and clinical outcomes. Odds ratios were estimated with a mixed effects linear logistic model with adjustment for hospital clustering. All statistical testing was 2-sided, with a significance level of 5%. RESULTS: Out of 224,561 discharged patients with a diagnosis of nontraumatic SAH, 4714 (2.10%) were defined as morbidly obese. Patients with morbid obesity were younger (54.3 ± 0.44 vs. 59.5 ± 0.08 years; P < 0.001) and had longer length of stay (LOS) (13 ± 0.46 vs. 11.5 ± 0.06 days; P = 0.002). Morbid obesity was associated with significantly higher hospital costs (P < 0.001) and charges (P < 0.001). The risk of acute respiratory failure was higher in morbidly obese patients (odds ratio [OR] 1.49, 95% confidence interval [CI]: 1.3-1.71, P < 0.001). In a multivariate analysis of hospital mortality, obesity had a negative impact on mortality (OR 0.83, 95% CI: 0.74-0.92, P < 0.001). Overall, in-hospital mortality was associated with age, morbid obesity, LOS, clipping and coiling, and acute respiratory failure but not the symptomatic vasospasm. CONCLUSIONS: Morbid obesity is associated with increased LOS, hospital costs and charges and with acute respiratory failure. However, it is also associated with a decrease in hospital mortality.

Frecuencia de Mordida Abierta Anterior en Escolares del Primero al Noveno Grado y sus factores asociados / Frequency of anterior open bite First to Ninth Grade Schoolchildren and Associated Factors

Introducción: La mordida abierta anterior se ha descrito clásicamente como una deformidad de etiología multifactorial. La mordida abierta dental en el sector anterior, y cruzada posterior son dos tipos de mordidas más frecuentes que pueden encontrarse principalmente en niños. Objetivo: Conocer la frecuencia de mordida abierta en alumnos de la escuela Gregoria. M. de Saldívar y sus factores asociados. Material y Método: Estudio observacional descriptivo cuyos datos fueron recolectados a través de un cuestionario precodificado, participaron del estudio 52 alumnos del primero al noveno grado de la Escuela Gregoria M. de Saldívar. Las variables del estudio consideradas fueron: la presencia o no de mordida abierta, su frecuencia según los hábitos y su asociación con hábitos. Resultados: Del total de 52 alumnos, 28 son del sexo masculino y 24 del sexo femenino, el 15,4% de la muestra presenta mordida abierta anterior. De los 15,4% de la muestra que presentó mordida abierta anterior el 87,5 % de ellos correspondió al sexo femenino. Teniendo en cuenta la presencia o ausencia de hábitos de acuerdo al sexo, se encontró que un 62,5% del sexo femenino con mordida abierta anterior presentó el hábito de succión del dedo pulgar o uso prolongado del chupete. Conclusión: La etiología de esta maloclusión es debida principalmente al uso prolongado del chupete y el hábito de succión del dedo pulgar. Según los resultados de este estudio, la cifra obtenida guarda relación con la práctica de estos hábitos, pero no hubo predominancia en alguno de ellos .

Introduction: Anterior open bite has classically been described as a deformity of multifactorial etiology. Open bite in the anterior sector and posterior crossbite are two of the most commonly found bite disorders, especially in boys. Objective: To determine the prevalence of open bite and associated factors in students of the Gregoria. M. de Saldívar school. Material and Methods: We conducted a descriptive observational study including 52 students of the Gregoria M. de Saldívar school using a pre-coded questionnaire. Study variables included were the presence or absence of open bite, and the prevalence and association found with certain personal habits. Results: Of the 52 students, 28 were male and 24 female, with 15.4% presenting anterior open bite Of the 15.4 % of the sample with anterior open bite, 87.5% were girls; and in relation to the habits named, we found that 62.5% of the girls with anterior open bite had either the habit of thumb sucking or prolonged pacifier use.. Conclusion: The etiology of this type of malocclusion is primarily due to habits of prolonged use of pacifiers or thumbsucking. According to the results of our study, the data obtained is related to these habits, with neither habit predominating compared to the other in those with anterior open bite

Relación entre la edad de maduración o edad ósea de la 2da, 3ra, y 4ta vertebras cervicales, y la maduración radicular del canino y primer premolar inferior izquierdo, pacientes niños y jóvenes de un consultorio ortodóncico privado de Asunción / Relationship between age at maturity or bone age of the 2nd, 3rd, and 4th cervical vertebrae, and maturation of the canine root and lower left first premolar, patients, children and young people from a private orthodontic clinic of Asuncion

La edad cronológica, el desarrollo dentario y esquelético, la altura, el peso y las manifestaciones de las características sexuales secundarias constituyen algunos parámetros muy utilizados para identificar los estadíos de crecimiento del individuo. Este estudio analítico de corte transverso y temporalmente retrospectivo, realizado en una n=67 pacientes, que acudieron a una clínica de ortodoncia privada de Asunción en el periodo 1998-2004, tiene el objetivo de establecer una correlación entre la maduración de las vértebras cervicales y la de los gérmenes del canino y del primer premolar inferior izquierdo. Se observaron radiografías panorámicas y laterales, así como fichas clínicas, para la recolección de datos, los cuales fueron procesados en planilla Excel y en el programa SPSS. Se encontró mediante la Prueba de Sperman, que existe una correlación (r) estadísticamente significativa (p<0.000001) entre los estadíos de maduración de los gérmenes dentarios mencionados, lo que permite sugerir que dicho hallazgo es una opción como método de diagnóstico oportuno, sencillo y económico para el tratamiento precoz de anomalías dentofaciales, dentro del campo de la ortodoncia .

Intervenção fisioterapêutica na mielomeningocele / Physical therapy intervention in myelomeningocele

A mielomeningocele (MMC) é um defeito de fechamento do tubo neural, caracterizado pela falha na fusão dos arcos vertebrais, displasia medular e distensão cística das meninges, que contêm tecido nervoso em seu interior. O defeito acontece entre a terceira e quinta semana de vida intra-uterina e nem sempre é diagnosticada durante a gravidez, sendo responsável por 85 por cento dos casos de defeito do tubo neural (DFTN). A manifestação clínica mais óbvia da mielomeningocele (MMC) é a perda das funções sensoriais e motoras nos membros inferiores. O presente estudo demonstrou os resultados da fisioterapia em uma criança com MMC através da funcionalidade e da independência nas atividades de vida diária (AVDs), por meio de aquisições da capacidade de engatinhar e deambular com auxílio.

The myelomeningocele (MMC) is a failure on the neural tube closing, characterized by the flaw in the fusion of vertebral arches, medullary dysplasia and cystic distention of the meninges which contain nervous tissue in their interior. The defect occurs between the third and fifth week of intra-uterine life and not always is diagnosed during pregnancy. It is responsible for 85 percent of neural tube defect cases. The most obvious myelomeningocele clinical manifestations are: loss of sensory and motor functions of the lower limbs. The present study showed the results of physical therapy in a child with MMC through functionality and independence on daily life activities through acquisitions of the capacity of crawling and walking with assistance.

Abordagem fisioterapêutica em prematuro de alto risco na UTI neonatal / Physical therapy in high risk premature newborn in neonatal ICU

Recém-nascidos (RN) prematuros têm sobrevivido cada vez mais devido aos avanços da tecnologia e novos conhecimentos científicos sobre técnicas e estratégias terapêuticas dentro das Unidades de Terapia Intensiva Neonatal. A prematuridade traz consigo o risco de inúmeros distúrbios durante o período neonatal, responsável pela maturidade e também por seqüelas que poderão comprometer o desenvolvimento destas crianças. A importância da atuação do fisioterapeuta na UTI neonatal será de prevenir ou atenuar alterações causadas por patologias respiratórias e pela hospitalização, pela manutenção ou ainda normalização e estabilização dos padrões motores, bem como do tônus e trofismo muscular, além de estimular e acompanhar o desenvolvimento neuro-psico- motor. O objetivo do presente estudo de caso foi relatar o destaque que a Fisioterapia tem hoje dentro da UTI neonatal, desde a avaliação até o tratamento de crianças com desconforto respiratório. A indicação precisa e o tratamento precoce influi diretamente na prevenção da perda funcional (quadro motor), minimização das deformidades e atitudes posturais inadequadas que se acentuam com o crescimento e uma assistência efetiva e global da criança para atingir o seu potencial máximo.

Premature newborn babies have been surviving more and more due to technology progress and new scientific knowledge on therapeutic technical strategies at units of intensive neonatal therapy. Prematurity brings with itself the risk of countless disturbances during the neonatal period, responsible for the maturity and also for sequelae that can commit the children development. The importance of the physical therapist performance in the Neonatal Intensive Care Unit will be to prevent or to lessen alterations caused by breathing pathologies and for the hospitalization, for the maintenance or still normalization and stabilization of the motor patterns, as well as of the tonus and muscular trophism, besides stimulating and following the neuro psychomotor development. The objective of the present case study is to acquaint with the importance that the physical therapy has today in the Neonatal Intensive Care Unit, from the evaluation to the children treatment with breathing discomfort. The determined indication and precocious treatment influence directly on the functional loss prevention (motor picture), minimization of the deformities and inadequate postural attitudes that accentuate with the growth and an effective and global attendance of the children to reach their maximum potential.