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1.
Protein Sci ; 33(5): e4986, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38607226

RESUMO

Despite the generally accepted role of the hydrophobic effect as the driving force for folding, many intrinsically disordered proteins (IDPs), including those with hydrophobic content typical of foldable proteins, behave nearly as self-avoiding random walks (SARWs) under physiological conditions. Here, we tested how temperature and ionic conditions influence the dimensions of the N-terminal domain of pertactin (PNt), an IDP with an amino acid composition typical of folded proteins. While PNt contracts somewhat with temperature, it nevertheless remains expanded over 10-58°C, with a Flory exponent, ν, >0.50. Both low and high ionic strength also produce contraction in PNt, but this contraction is mitigated by reducing charge segregation. With 46% glycine and low hydrophobicity, the reduced form of snow flea anti-freeze protein (red-sfAFP) is unaffected by temperature and ionic strength and persists as a near-SARW, ν ~ 0.54, arguing that the thermal contraction of PNt is due to stronger interactions between hydrophobic side chains. Additionally, red-sfAFP is a proxy for the polypeptide backbone, which has been thought to collapse in water. Increasing the glycine segregation in red-sfAFP had minimal effect on ν. Water remained a good solvent even with 21 consecutive glycine residues (ν > 0.5), and red-sfAFP variants lacked stable backbone hydrogen bonds according to hydrogen exchange. Similarly, changing glycine segregation has little impact on ν in other glycine-rich proteins. These findings underscore the generality that many disordered states can be expanded and unstructured, and that the hydrophobic effect alone is insufficient to drive significant chain collapse for typical protein sequences.


Assuntos
Proteínas Intrinsicamente Desordenadas , Dobramento de Proteína , Água/química , Cloreto de Sódio , Glicina/química , Interações Hidrofóbicas e Hidrofílicas
2.
J Proteome Res ; 23(4): 1263-1271, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38478054

RESUMO

Amino acid substitutions (AASs) alter proteins from their genome-expected sequences. Accumulation of substitutions in proteins underlies numerous diseases and antibiotic mechanisms. Accurate global detection of AASs and their frequencies is crucial for understanding these mechanisms. Shotgun proteomics provides an untargeted method for measuring AASs but introduces biases when extrapolating from the genome to identify AASs. To characterize these biases, we created a "ground-truth" approach using the similarities betweenEscherichia coli and Salmonella typhimurium to model the complexity of AAS detection. Shotgun proteomics on mixed lysates generated libraries representing ∼100,000 peptide-spectra and 4161 peptide sequences with a single AAS and defined stoichiometry. Identifying S. typhimurium peptide-spectra with only the E. coli genome resulted in 64.1% correctly identified library peptides. Specific AASs exhibit variable identification efficiencies. There was no inherent bias from the stoichiometry of the substitutions. Short peptides and AASs localized near peptide termini had poor identification efficiency. We identify a new class of "scissor substitutions" that gain or lose protease cleavage sites. Scissor substitutions also had poor identification efficiency. This ground-truth AAS library reveals various sources of bias, which will guide the application of shotgun proteomics to validate AAS hypotheses.


Assuntos
Escherichia coli , Proteômica , Proteômica/métodos , Substituição de Aminoácidos , Escherichia coli/genética , Peptídeos/genética , Peptídeos/química , Proteínas
3.
Osteoporos Int ; 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38459139

RESUMO

This study, characterizing the incidence of hip fractures in Mexico, showed not only that the crude number of fractures has increased, but also there has been a decrease in fracture rates. Nonetheless, as the population ages in the coming decades, the current declines rate of could be expected to reverse. PURPOSE: This study is to examine the incidence, rates, and time trends of hip fractures from 2006 to 2019 in Mexico. Additionally, an analysis of the follow-up of the birth cohorts was carried out. METHODS: Hip fractures registered during the period of the study were obtained through the Mexican Social Security Institute (IMSS) national discharge records. The incidence per 100,000 individuals was calculated from the IMSS population at risk. A time trend analysis was conducted using linear regression, and the identification of breakpoints in linear trends. RESULTS: There was an increase of hip fractures for both sexes ≥ 60 years (43% for women and 41%, for men). However, the rates diminished from 167.8/100,000 in 2006 to 138.5 /100,000 in the population 60 and over (1.9% and 0.9% per year in women and men respectively). When the information was analyzed by age groups, hip fracture rates were similar in both sexes but higher in women. The most significant contribution to the total number of fractures is due to the groups ≥ 70 years; people born before 1937 are accounting for the burden of fractures over the total data. In contrast, the younger generations appear to have lower rates. CONCLUSION: Rates of hip fracture have steadily declined in Mexico since 2006; however, with the population aging in the coming decades, current rates declines could be expected to reverse.

4.
J Psychosoc Oncol ; 42(1): 148-158, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37114974

RESUMO

This study examines feedback from two interventions, hypnosis and progressive muscle relaxation (PMR), to improve body image in a randomized phase II trial. Eighty-seven women were randomized either to hypnosis or PMR. Sixty-three women (72%) were motivated to write comments about their study experience. These comments were explored in an unplanned qualitative analysis. Thematic analysis generated five themes, suggesting both hypnosis and PMR may improve body image through the ability to relax and manage stress, sleep better, improve mood and create a mind-body connection. Sexual health emerged as a theme for participants in only the hypnosis group which suggests hypnotic suggestions for body image may improve overall sexual health. Additional research is needed to assess this further.


Assuntos
Treinamento Autógeno , Hipnose , Feminino , Humanos , Imagem Corporal , Hipnose/métodos
5.
Osteoporos Int ; 35(3): 451-468, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37955683

RESUMO

The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk. PURPOSE: The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication. METHODS: To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture. RESULTS: A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk. CONCLUSIONS: There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.


Assuntos
Osteoporose , Fraturas por Osteoporose , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Preferência do Paciente , Projetos Piloto , Medição de Risco , Canadá/epidemiologia , Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Comunicação , Fatores de Risco
6.
Annu Rev Biophys ; 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38134335

RESUMO

The rate of protein synthesis is slower than many folding reactions and varies depending on the synonymous codons encoding the protein sequence. Synonymous codon substitutions thus have the potential to regulate cotranslational protein folding mechanisms, and a growing number of proteins have been identified with folding mechanisms sensitive to codon usage. Typically, these proteins have complex folding pathways and kinetically stable native structures. Kinetically stable proteins may fold only once over their lifetime, and thus, codon-mediated regulation of the pioneer round of protein folding can have a lasting impact. Supporting an important role for codon usage in folding, conserved patterns of codon usage appear in homologous gene families, hinting at selection. Despite these exciting developments, there remains few experimental methods capable of quantifying translation elongation rates and cotranslational folding mechanisms in the cell, which challenges the development of a predictive understanding of how biology uses codons to regulate protein folding. Expected final online publication date for the Annual Review of Biophysics, Volume 53 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

7.
Pilot Feasibility Stud ; 9(1): 192, 2023 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-38001523

RESUMO

BACKGROUND: Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this study is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. METHODS: This two-phased design will determine the feasibility of CARE-CITE-Gait, a novel intervention that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-h home visits for dyad collaborative goal setting. In phase I, content validity, usability, and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In phase II, feasibility (based on measures of recruitment, retention, intervention adherence, and safety) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, quasi-experimental design with repeated measures (two baseline visits 1 week apart, posttest, and 1-month follow-up) with 15 carepartner and stroke survivor dyads. Outcome data collectors will be blinded. Outcomes include psychosocial variables (family conflict surrounding stroke recovery, strain, autonomy support, and quality of life) collected from carepartners and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. DISCUSSION: The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05257928. Registered 25 February 2022. TRIAL STATUS: This trial was registered on ClinicalTrials.gov (NCT05257928) on March 25, 2022. Recruitment of participants was initiated on May 18, 2022.

8.
BMC Health Serv Res ; 23(1): 1320, 2023 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-38031120

RESUMO

BACKGROUND: Rheumatoid arthritis is a highly prevalent disease. Patients undergo various medical and pharmacological treatments, which have an economic impact on hospitals. The aim of this study was to estimate the direct economic costs of Mexican Social Security Institute (IMSS) resources used to provide healthcare to adult patients with rheumatoid arthritis in 2016-2017. METHODS: Data of patients aged > 18 years with Rheumatoid Arthritis (RA) were obtained from databases and public information sources to estimate the use of IMSS resources for the target population. Total costs were estimated by means of the macro-costing method, employing the diagnosis-related group (DRG). Each DRG of the IMSS was constructed with one of the diagnoses and the respective combination of clinical characteristics included in the ICD-9. This study was conducted from the national perspective of IMSS, the largest healthcare service administrator in the country. As such, it can be considered representative of the broader healthcare landscape in Mexico. RESULTS: The total cost per year of furnishing inpatient care to RA patients was found to be $170,099,794 MXN ($9,096,245.67 USD) for 2016 and $167,039,481 MXN ($8,932,592.57 USD) for 2017, implying an enormous economic impact on the government budget for Mexican public health services. CONCLUSIONS: Our results demonstrate that the direct costs of musculoskeletal and cardiovascular surgery represented the highest costs of RA in-hospital care at IMSS (the largest health institution in Mexico) in 2016 and 2017. Further studies are needed that include the cost of drugs and other indirect costs in addition to our results to get the most accurate approximation of the cost of living with RA.


Assuntos
Artrite Reumatoide , Custos de Cuidados de Saúde , Adulto , Humanos , México/epidemiologia , Alta do Paciente , Atenção à Saúde , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/terapia
10.
J Pediatr Health Care ; 37(6): 684-687, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37702647

RESUMO

Health care clinicians, educators, and students who plan and implement quality improvement (QI) projects must know reporting guidelines for successful project planning and publication. We aimed to identify QI guidelines, which authors can locate, and highlight how best to use them for manuscript preparation. We also address guidelines for educational QI projects. Because of the increasing number of Doctor of Nursing Practice projects generated, these students and their mentors must be familiar with commonly used guidelines for reporting QI projects to facilitate peer review, demonstrate quality and rigor of work, reduce revisions, and potentially accelerate a paper's acceptance for publication.


Assuntos
Mentores , Melhoria de Qualidade , Humanos , Estudantes , Atenção à Saúde , Editoração
11.
Appl Nurs Res ; 73: 151718, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37722786

RESUMO

PURPOSE: The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS: Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS: Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS: The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.


Assuntos
Ensaios Clínicos como Assunto , Características da Vizinhança , Seleção de Pacientes , Disparidades Socioeconômicas em Saúde , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Asiático , Hospitalização , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/terapia , Cuidadores , População Urbana , Projetos Piloto , Brancos , Negro ou Afro-Americano , Ensaios Clínicos como Assunto/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/economia , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos
12.
J Nurs Educ ; 62(8): 479-482, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37561904

RESUMO

BACKGROUND: Virtual mock interviews were offered to students to improve job interviewing skills. This educational quality improvement project aimed to use virtual mock interviews to increase student preparedness and confidence, and reduce anxiety related to professional interviews. METHOD: Health professions students (n = 19) participated in the mock interviews conducted and recorded through a web-based meeting. Students received the recorded interview to watch before follow-up. Students completed pre- and postquestionnaires that addressed students' preparedness, confidence, and anxiety related to interviewing. RESULTS: Participants' confidence and preparedness improved significantly in their virtual interviews (p < .001), and their anxiety decreased significantly after the virtual interviews (p < .001). After watching the interviews, students' reported eye contact needed improvement and answers included too many "uhms." CONCLUSION: Students benefited from the virtual mock interviews. Mock virtual job interviews may have a positive effect on successful job acquisition in health professions. [J Nurs Educ. 2023;62(8):479-482.].


Assuntos
Estudantes de Ciências da Saúde , Humanos , Ocupações em Saúde
13.
J Craniofac Surg ; 34(6): 1776-1779, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37276332

RESUMO

Orofacial clefts are one of the most common birth defects and the most common craniofacial malformation worldwide. The most common orofacial clefts (OFCs) are congenital cleft lip with or without cleft palate (CL ± P) and isolated cleft palate (CP). The incidence of OFCs varies depending on region and ethnicity; however, it affects approximately 1 in 600 newborns worldwide. In most cases, CL ± P and CP are multifactorial congenital malformations, where both exogenous and genetic factors play an important role. The objective of this study was to describe the frequency of potential risk factors associated with the development of CL ± P and CP in Mexican population. Patients were referred for multisystemic treatment, from private and public institutions in different regions of the country (center, north, and south). Sociodemographic information, prenatal and parental history were obtained through direct interviews with the patients or the patients' mothers in the case of underaged patients. Referred patients were invited to participate in the study. No interventions were applied for this study. The relationship between these factors and the prevalence of CL ± P and CP was studied. A total of 554 patients were included, the majority with CLP (30% to 7%), statistically significant differences were found for folic acid ( P = 0.02) consumption. Familial aggregation did not reach statistical significance for first-degree family members ( P = 0.34) but was significant for second-degree family members ( P = 0.007). More risk factors associated with CL ± P and CP may still be unknown, prompting more epidemiological research and research in other little-studied areas, such as; specific genetic factors in Mexican population.


Assuntos
Fenda Labial , Fissura Palatina , Gravidez , Feminino , Humanos , Recém-Nascido , Fenda Labial/epidemiologia , Fenda Labial/genética , Fissura Palatina/epidemiologia , Fissura Palatina/genética , Mães , Ácido Fólico
14.
J Dev Phys Disabil ; : 1-23, 2023 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-37361457

RESUMO

Mothers of school-aged children ages 3 to 17 years with developmental disabilities (DDs) commonly report sleep problems in their children associated with impaired maternal sleep. However, existing research relies heavily on mothers' self-reported sleep. This study aimed to determine the feasibility of objectively measuring child and mother sleep-wake patterns using actigraphy and videosomnography. This was an observational pilot study. Mothers wore actigraphy watches and video-recorded their child's sleep for 7 nights. Mothers also completed a 7-day sleep diary and questionnaires on sleep quality, depressive symptoms, stress, and child sleep problems. Ten mothers (32-49 years) and ten children with DDs (8-12 years) completed this study. Half of the children were boys with autism spectrum disorders. We successfully recruited 77% of eligible mothers for the study during the pandemic. Eight mothers successfully wore the actigraphy, and nine successfully video-recorded their child's sleep. Mothers rated their participation positively and considered the data collection protocol acceptable. While mothers' sleep patterns from actigraphy were mostly within recommendations, self-reported sleep quality was poor. Child's sleep estimates from videosomnography showed children slept substantially less than recommended sleep hours. Mothers also reported a high frequency of child sleep problems. Consistent with this pattern, mothers also endorsed elevated stress and depression. The use of actigraphy and videosomnography is feasible. Objective sleep measurement for mothers' and children's sleep is needed with self-report to measure multidimensional aspects of sleep and discrepancies between objective and self-report sleep measures. Future studies can use multi-methods sleep measures and work toward interventions that can improve family sleep and reduce mothers' stress and depression.

15.
J Pediatr Health Care ; 37(5): 570-574, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37354156

RESUMO

Authors submitting a paper often receive an opportunity to revise and resubmit the paper. Authors may find addressing reviewers' comments challenging. We posit authors should welcome expert suggestions for revisions that strengthen the paper and develop a persuasive response if they disagree with the reviewer. A thoughtful, detailed response allows authors to dialogue with reviewers. Our paper uses exemplars of responses to reviewers to illustrate the effectiveness of clear and compelling author responses. Addressing reviewers' comments ultimately results in a better paper-more likely to be accepted. Developing skills in resubmitting research and clinical scholarship reports is essential to the dissemination process.


Assuntos
Editoração , Redação , Humanos , Revisão da Pesquisa por Pares
16.
Home Healthc Now ; 41(3): 149-157, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37144930

RESUMO

Conducting research in the home environment presents challenges related to setting, study participants, methods, and researchers. Researchers should be aware of potential challenges to ensure rigor and improve planning for future studies. This paper describes difficulties experienced and lessons learned when conducting a two-group, randomized pilot study (n = 32) of a web-based intervention (Carepartner and Constraint-Induced Therapy [CARE-CITE]) designed to foster positive carepartner engagement in home-based activities to improve upper extremity function in persons with stroke. Challenges and issues included: 1) recruitment and referral, 2) data collection in the home setting, 3) participants' understanding of the rationale for adhering to constraint-induced movement therapy principles (wearing mitt on the less-affected limb), 4) tracking adherence of upper extremity practice time, 5) participant-driven goal setting, 6) potentially unsafe participant practice activities, 7) home visit safety, 8) encouraging versus controlling-using autonomy support, 9) participant needs beyond study scope, and 10) ethical safeguards for addressing depressive symptoms. Researchers can incorporate suggested strategies to support methodological rigor and facilitate interventions engaging carepartners in the rehabilitation process when planning for research in the home environment.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Cuidadores , Projetos Piloto , Extremidade Superior
17.
Aging Clin Exp Res ; 35(7): 1405-1416, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37222927

RESUMO

Normal bone remodeling depends of a balance between bone forming cells, osteoblasts and bone resorbing cells, the osteoclasts. In chronic arthritides and some inflammatory and autoimmune diseases such as rheumatoid arthritis, there is a great constellation of cytokines produced by pannus that impair bone formation and stimulate bone resorption by inducing osteoclast differentiation and inhibiting osteoblast maturation. Patients with chronic inflammation have multiple causes that lead to low bone mineral density, osteoporosis and a high risk of fracture including circulating cytokines, impaired mobility, chronic administration of glucocorticoids, low vitamin D levels and post-menopausal status in women, among others. Biologic agents and other therapeutic measures to reach prompt remission might ameliorate these deleterious effects. In many cases, bone acting agents need to be added to conventional treatment to reduce the risk of fractures and to preserve articular integrity and independency for daily living activities. A limited number of studies related to fractures in chronic arthritides were published, and future investigation is needed to determine the risk of fractures and the protective effects of different treatments to reduce this risk.


Assuntos
Artrite Reumatoide , Reabsorção Óssea , Fraturas Ósseas , Humanos , Feminino , Osteoclastos , Osso e Ossos , Osteoblastos , Citocinas
18.
Res Sq ; 2023 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-37090566

RESUMO

Background: Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this preliminary clinical trial is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. Methods: This two-phased study will determine the feasibility of CARE-CITE-Gait, a novel intervention developed by our team that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-hour (home-based) visits for dyad collaborative goal setting. In Phase I, the usability and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In Phase II, feasibility (based on measures of recruitment, retention, and intervention adherence) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, evaluator blinded, quasi-experimental design with repeated measures (two baseline visits one week apart, post-test, and one-month follow-up) with 15 carepartner and stroke survivor dyads. Outcomes include psychosocial variables (strain, family conflict surrounding stroke recovery, autonomy support and life changes) collected from carepartners, and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. Discussion: The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. Trial Registration: ClinicalTrials.gov, NCT05257928. Registered 25 February 2022, https://clinicaltrials.gov/ct2/show/NCT05257928.

20.
Nutr. hosp ; 40(2): 354-361, mar.-abr. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-219333

RESUMO

Antecedentes: la desnutrición pediátrica es una de las principales causas de complicaciones en niños hospitalizados, por ello, el tamizaje nutricional al ingreso es indispensable. La Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) es una herramienta sencilla, reproducible y fácil de interpretar, sin embargo, en México no se encuentra validada. El objetivo del estudio fue validar y adaptar a la población mexicana la herramienta de tamizaje nutricional STAMP. Metodología: la validación se realizó en dos fases: en primer lugar, se realizó la traducción y adaptación cultural; y en segundo lugar, se llevó a cabo un estudio transversal comparando la herramienta STAMP con una evaluación nutricional completa (ENC). Un médico pediatra especialista en nutrición realizó la ENC con la evaluación de parámetros antropométricos, clínicos y dietéticos y, posteriormente, dos nutriólogas realizaron la misma evaluación con la herramienta STAMP. Finalmente, se tamizaron todos los pacientes en leve y moderado o grave riesgo de desnutrición. Resultados: de los 300 pacientes incluidos en el estudio, 160 fueron niños (53,3 %) y 140, niñas (46,7 %), con una media de edad de 9,44 ± 5,73 años. Las valoraciones realizadas con la herramienta STAMP tuvieron una concordancia del 100 %. Comparado con la ENC, se obtuvo un índice kappa de 0,480 (p < 0,01). La prueba STAMP mostró una sensibilidad del 92 %, una especificidad del 75 %, valor predictivo positivo (VPP) del 45 %, valor predictivo negativo (VPN) del 97 %, LR- de 3,68 y LR- de 0,10. Conclusiones: la herramienta de tamizaje STAMP cuenta con los elementos necesarios para evaluar de forma objetiva el riesgo de desnutrición en niños mexicanos y es una prueba altamente sensible y específica. (AU)


Background: pediatric malnutrition is one of the main causes of complications in hospitalized children. Nutritional screening at admission is essential. The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) is a simple, reproducible and easy-to-interpret tool, but it is not validated in Mexico. The objective of the study was to validate and adapt the STAMP nutritional screening tool to the Mexican population. Methods: the validation was carried out in two phases: firstly, the translation and cultural adaptation was carried out; and secondly, a cross-sectional study was performed comparing the STAMP tool with a complete nutritional assessment (CNA). A pediatrician specialized in nutrition performed the CNA with the evaluation of anthropometric, clinical and dietary parameters; later, two nutritionists carried out the same evaluationwith the STAMP tool. Finally, the patients were graded as low risk and moderate or severe malnutrition risk. Results: of the 300 patients included in the study, 160 were boys (53.3 %) and 140 were girls (46.7 %), with a mean age of 9.44 ± 5.73 years. The assessments made by with the STAMP tool had a 100 % concordance. Compared with CNA, a kappa index of 0.480 (p < 0.01) was obtained. The STAMP test showed a sensitivity of 92 %, a specificity of 75 %, positive predictive value (PPV) of 45 %, negative predictive value (NPV) of 97 %, RVN of 3,68, and RVN of 0,10. Conclusions: the STAMP screening tool has the necessary elements to objectively assess the risk of malnutrition in Mexican children and is a highly sensitive and specific test. (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Avaliação Nutricional , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Estado Nutricional , México/epidemiologia , Estudos Transversais , Inquéritos e Questionários
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