Multi-part quality evaluation of a customized mobile application for monitoring elderly patients with functional loss and helping caregivers.

BACKGROUND: The challenges faced by caregivers of the elderly with chronic diseases are always complex. In this context, mobile technologies have been used with promising results, but often have restricted functionality, or are either difficult to use or do not provide the necessary support to the caregiver - which leads to declining usage over time. Therefore, we developed the Mobile System for Elderly Monitoring, SMAI. The purpose of SMAI is to monitor patients with functional loss and to improve the support to caregivers' communication with the health team professionals, informing them the data related to the patients' daily lives, while providing the health team better tools. METHOD: SMAI is composed of mobile applications developed for the caregivers and health team, and a web portal that supports management activities. Caregivers use an Android application to send information and receive care advice and feedback from the health team. The system was constructed using a refinement stage approach. Each stage involved caregivers and the health team in prototype release-test-assessment-refinement cycles. SMAI was evaluated during 18 months. We studied which features were being used the most, and their use pattern throughout the week. We also studied the users' qualitative perceptions. Finally, the caregiver application was also evaluated for usability. RESULTS: SMAI functionalities showed to be very useful or useful to caregivers and health professionals. The Focus Group interviews reveled that among caregivers the use of the application gave them the sensation of being connected to the health team. The usability evaluation identified that the interface design and associated tasks were easy to use and the System Usability Scale, SUS, presented very good results. CONCLUSIONS: In general, the use of SMAI represented a positive change for the family caregivers and for the NAI health team. The overall qualitative results indicate that the approach used to construct the system was appropriate to achieve the objectives.

The impact of stressful life events, symptom status, and adherence concerns on quality of life in people living with HIV.

Studies concerning persons living with HIV (PLWH) report that stressful life events (SLEs) contribute to an exacerbation of symptoms and reduced antiretroviral (ARV) adherence and quality of life (QOL). Little is known about whether these findings are site-specific. Our study's aims were to characterize the type and frequency of SLEs for PLWH in Puerto Rico, South Africa, and the United States, and to assess the impact of SLEs by national site, symptoms, and ARV adherence concerns on QOL. The sample consisted of 704 participants. The total number of SLEs correlated significantly with the total number of symptoms, adherence concerns, and QOL (p ≤ .001). Overall, 27.2% of the variance in QOL was explained by the aforementioned variables. Although SLEs were of concern to PLWH, worries about ARV adherence were of even greater concern. Routine assessment of ARV concerns and SLEs can promote ongoing ARV adherence and improved QOL.

The endogenous cytokine profile and nerve fibre density in mouse ear Leishmania major-induced lesions related to nociceptive thresholds.

Several reports have shown that cutaneous leishmaniasis lesions are painless, suggesting that Leishmania infection interferes with pain perception. Comparisons of inflammation-induced hyperalgesia between BALB/c and C57BL/6 mice have been little explored in the literature, and comparative data regarding nociception in leishmaniasis are non-existent. In susceptible BALB/c mice and resistant C57BL/6 mice that were intradermally inoculated with a low dose of Leishmania major in the ear, we investigated the variation in nociception over a 12-wk period post-infection and this variation's association with the structure of nerve fibres and the presence of endogenous cytokines that are classically considered hyper- or hypo-nociceptive. Infected BALB/c mice presented susceptibility and severe lesions. Infected C57BL/6 mice exhibited resistance and healing lesions. The immune response involved pro- and anti-inflammatory cytokine secretion, respectively. The infection-induced hypoalgesia in BALB/c mice after wks 9 was accompanied by decreased levels of IL-6 and IL-10 in ear tissue with intact nerves. C57BL/6 mice showed short-lived hyperalgesia in wks 2, which was related to increased local levels of IL-6, KC/CXCL-1, TNF-α and IL-10 and a decrease in nerve density. The increase in pro-inflammatory cytokine IL-6, KC/CXCL-1 and TNF-α levels during hyperalgesia suggested a role for these mediators in afferent nerve sensitisation, which was secondary to the inflammatory damage of nerve fibres stained by PGP 9.5. In contrast, the mechanisms of hypoalgesia may include the downregulation of cytokines, the preservation of the structure of nerve endings, and as yet uninvestigated unidentified differences in neurotransmitter release or a direct role of the parasites in the context of the progressive and permissive inflammatory response of BALB/c mice.

Atraso na erupção dental em adolescente com hipotireoidismo / Delayed tooth eruption in an adolescent with hypothyroidism / Retardo en la erupción dental en adolescentes con hipotiroidismo

OBJETIVO: Relatar o caso de adolescente que procurou serviço odontológico de um ambulatório de medicina do adolescente por apresentar atraso de erupção dentária. A atuação multiprofissional permitiu chegar ao diagnóstico de hipotireoidismo. DESCRIÇÃO DO CASO: Paciente de 16 anos e 4 meses cuja queixa inicial foi atraso na erupção dentária. Na avaliação odontológica, chamava atenção o importante atraso na erupção dentária, o que poderia estar relacionado a alguma moléstia orgânica. Desta forma, solicitou-se a intervenção da equipe médica, que, no acompanhamento, constatou se tratar de hipotireoidismo. COMENTÁRIOS: Chama-se a atenção o fato de que adolescentes prezam a aceitação pelos seus pares e as questões estéticas e, muitas vezes, a procura por um serviço de saúde envolve queixas que podem parecer triviais. Porém, o olhar atento não deixará que problemas orgânicos mais graves passem despercebidos. Salienta-se ainda a importância da atuação da equipe multiprofissional.

OBJECTIVE: To report the case of an adolescent with undiagnosed hypothyroidism who sought dental clinic care due to delayed tooth eruption. Multiprofessionalwork enabled the diagnosis. CASE DESCRIPTION: This is a 16 years and 4 month-old patient whose initial complaint was delayed tooth eruption. Dental evaluation drew attention to the significant delay in tooth eruption as it could be related to organic diseases. This has prompted the intervention of medical professionals who diagnosed hypothyroidism in the follow-up. COMMENTS: Teenagers typically value acceptance by their peers and may have aesthetic concerns that lead them to seek health services for seemingly trivial complaints. A high degree of surveillance in these cases can detect more serious underlying organic problems. We highlight the importance of the multidisciplinary team in this approach.

OBJETIVO: Relatar caso de adolescente que buscó servicio odontológico de un ambulatorio de medicina del adolescente, por presentar retardo en la erupción dental y cuya actuación multiprofesional permitió llegar al diagnóstico de hipotiroidismo. DESCRIPCIÓN DEL CASO: Se describe la historia de una paciente de 16 años y 4 meses de edad cuya queja fue retardo en la erupción dental. En la evaluación odontológica, llamaba la atención el importante retardo en la erupción dental, lo que podría estar relacionado a alguna enfermedad orgánica. De este modo, se solicitó la intervención del equipo médico que, en el seguimiento, constató tratarse de hipotiroidismo. COMENTARIOS: Se llama la atención para el hecho de que adolescentes estiman mucho la aceptación por sus pares y las cuestiones estéticas y, muchas veces, la búsqueda por un servicio de salud implica quejas que pueden parecer comunes, pero una mirada atenta no dejará que problemas orgánicos más graves pasen desapercibidos. Se subraya además la importancia de la actuación del equipo multiprofesional.

Variation in neuronal differentiation of a newly isolated mouse embryonic stem cell line: a detailed immunocytochemistry study.

Neural precursor differentiation from mouse ES (embryonic stem) cells have been demonstrated using EB (embryoid body), co-culture on stromal feeder layers, and in the absence of external inducing signals. Most of available mouse ES cell original research articles have worked with only six different cell lines. Our goals were to isolate one new mouse ES lineage, and perform a detailed immunocytochemistry study during neural differentiation, making use of an EB strategy protocol following the generation of neural progenitors, glial cells and postmitotic neurons. The dynamics of differentiation of ES cell derived neuronal precursors into differentiated glia cells and neurons were followed in vitro and correlated to exposure to specific elements of feeder medium. Morphological aspects of generated cellular types, including its immunocytochemical expression of differentiation markers were studied. Immuno-positivity against ß-III tubulin, PGP and TH (tyrosine hydroxylase) was observed from stage I. Approximately 80% of cells were positive for TH at stage I. The first glial cell type appears in stage III. TH, PGP or ß-III tubulin-positive cells with neuronal typical morphology only being seen in stage III when TH-positive cells corresponded to approximately 12% of total cells. Variations among other literature findings can be explained by the choice we made to use a newly isolated ES cell line. As colonies may behave differently during neuronal differentiation, it reinforces the necessity of studying original ES cell lines.

Prevalence, self-care behaviors, and self-care activities for peripheral neuropathy symptoms of HIV/AIDS.

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual (n = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study's results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.

Exploring HIV stigma and quality of life for persons living with HIV infection.

The purpose of this study was to explore the potential contribution of perceived HIV stigma to quality of life for people living with HIV infection. A cross-sectional design explored the contribution of demographic variables, symptoms, and stigma to quality of life in an international sample of 726 people living with HIV infection. Stigma independently contributed a significant 5.3% of the explained variance in quality of life, after removing contributions of HIV-related symptoms and severity of illness. This study empirically documents that perceived HIV stigma had a significantly negative impact upon quality of life for a broad sample of people living with HIV infection.

Does "asymptomatic" mean without symptoms for those living with HIV infection?

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.

A randomized controlled trial testing the efficacy of an HIV/AIDS symptom management manual.

This study investigates whether using an HIV/AIDS symptom management manual with self-care strategies for 21 common symptoms, compared to a basic nutrition manual, had an effect on reducing symptom frequency and intensity. A 775-person, repeated measures, randomized controlled trial was conducted over three months in 12 sites from the United States, Puerto Rico, and Africa to assess the relationship between symptom intensity with predictors for differences in initial symptom status and change over time. A mixed model growth analysis showed a significantly greater decline in symptom frequency and intensity for the group using the symptom management manual (intervention) compared to those using the nutrition manual (control) (t=2.36, P=0.018). The models identified three significant predictors for increased initial symptom intensities and in intensity change over time: (1) protease inhibitor-based therapy (increased mean intensity by 28%); (2) having comorbid illness (nearly twice the mean intensity); and (3) being Hispanic receiving care in the United States (increased the mean intensity by 2.5 times). In addition, the symptom manual showed a significantly higher helpfulness rating and was used more often compared to the nutrition manual. The reduction in symptom intensity scores provides evidence of the need for palliation of symptoms in individuals with HIV/AIDS, as well as symptoms and treatment side effects associated with other illnesses. The information from this study may help health care providers become more aware of self-management strategies that are useful to persons with HIV/AIDS and help them to assist patients in making informed choices.

The UFRJ-UERJ group: interdisciplinary virtual reality experiments in neuropsychiatry.

This paper describes the research lines of an interdisciplinary group composed by two government universities in Rio de Janeiro. The first research line, a Virtual Environment for testing the acceptance of Virtual Reality equipment by schizophrenia patients, has stimulated a growing interest in this area in the country and abroad. The second research line, in progress now, develops a virtual environment to improve the learning abilities of children with Attention-Deficit and Hyperactivity Disorder (ADHD). Another study is related to the use of Virtual Reality in the cognitive treatment of common city phobias, beginning with the reproduction of some tunnels of our city to treatment of claustrophobic patients. The last of the research lines in progress in this group develops a virtual square for stimulating autistic patients.