Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression.

To evaluate the age-related efficacy and safety of atropine 0.01% eye drops over 2 years for myopia control in a multicentric pediatric Spanish cohort. A non-controlled, interventional, prospective multicenter study was conducted as an extension of the Spanish Group of Atropine Treatment for Myopia Control Study (GTAM 1). Children aged 6-14 years with myopia from - 2.00 to - 6.00 D, astigmatism < 1.50 D and documented annual myopic progression of at least - 0.50 D under cycloplegic examination were recruited. From the original cohort of 105 participants, 92 children who had been receiving atropine 0.01% eye drops once nightly in each eye for 1 year continued their participation in this extended study (GTAM 2). All the patients underwent a standardized quarterly follow-up protocol, which included measurements of best-corrected visual acuity (BCVA), cycloplegic autorefraction, axial length (AL), anterior chamber depth (ACD), and pupil diameter. The study sample was divided into three age groups: 6-8, 9-11, and 12-14 years old. The mean change in cycloplegic spherical equivalent (SE) and axial length (AL) during the 24 months of follow-up was analyzed. Correlations between SE and AL, as well as the distribution of annual progression, were evaluated. Adverse effects were recorded using a specific questionnaire. Finally, 81 children completed the follow-up and were included in the analysis. Over the 2-year period, the mean changes in SE and AL were - 0.88 ± 0.60 D and 0.49 ± 0.25 mm, respectively. Additionally, 51 patients (63%) experienced SE annual progression lower than - 0.50 D. The correlation between the progression of SE and AL during the total period of treatment was mild (r = - 0.36; p < 0.001). There were no differences between the first and the second year of treatment in the progression of SE (- 0.42 ± 0.41 D versus - 0.45 ± 0.39 D; p = 0.69) or AL (0.25 ± 0.16 mm versus 0.23 ± 0.14 mm; p = 0.43). Older patients (12-14 years old) showed less AL progression than younger children (6-8 years old): 0.36 ± 0.18 mm versus 0.59 ± 0.30 mm; p = 0.01. Adverse effects were mild, infrequent, and decreased over time. On average, the myopia progression in control groups from other published biannual studies exceeded that observed in our study. Over 2 years, atropine 0.01% demonstrated a safe treatment for controlling myopia progression in a multicentric cohort of Spanish children. The effect remained stable during this period. Older patients exhibited a more favorable response in terms of AL enlargement. However, further studies are needed to investigate the age-related effect of low-dose atropine in the Caucasian population.

Validez de constructo y propiedades psicométricas del cuestionario “Respuestas al afecto positivo” (RAP) / Construct validity and psychometric properties of the questionnaire "Responses to Positive Affect" (RAP)

Los estudios constatan el papel de la rumia depresiva como un amplificador del estado de ánimo negativo, sin embargo, se conoce menos sobre la rumia relacionada con el afecto positivo. Presentamos la validez de constructo y propiedades psicométricas del cuestionario “Respuestas al afecto positivo” (RAP) en una muestra de 302 personas de la población general (55,2% mujeres), con edades entre los 18 y 68 años (M= 28,6; DT= 12,0). Los análisis factorial exploratorio y confirmatorio indican una estructura de dos factores: rumia positiva centrada en la emoción y en la persona (α= 0,88) y amortiguación (α= 0,83), ambos con una adecuada invarianza configural, métrica y escalar por sexo. Los dos factores presentan una adecuada validez convergente, discriminante e incremental con constructos relacionados con el afecto negativo y positivo. Los resultados se discuten atendiendo a los estudios revisados y se propone el RAP como instrumento de evaluación en procedimientos terapéuticos que tratan de potenciar el afecto positivo y el bienestar psicológico. (AU)

Previous studies confirm the role of depressive rumination in the exacerbation of negative mood. However, less is known about rumination in relation to positive affect. We present the construct validity and psychometric properties of the Responses to Positive Affect (RAP) questionnaire in a sample of 302 people from the general population (55.2% female), aged 18-68 years (M= 28.6, SD= 12.0). Exploratory and confirmatory factor analyses indicate a two-factor structure: emotion- and person-centered positive rumination (α= .88) and buffering (α= .83), both with adequate configural, metric and scalar invariance by sex. The two factors present adequate convergent, discriminant and incremental validity with constructs related to negative and positive affect. The results are discussed according to the studies reviewed and the RAP is proposed as an assessment instrument in therapeutic procedures that seek to enhance positive affect and psychological wellbeing. (AU)

Adesão às precauções básicas do controlo da infeção: Uma scoping review / Adherence tostandard precautions: A scoping review

Introdução : As infeções associadas aos cuidados de saúde são uma causa significativa de mortalidade e morbilidade, bem como, de encargos financeiros a vultad os para o sistema de saúde. As p recauções básicas do controlo da infeção são um conjunto de medidas fundamentais a aplicar, com o objetivo de prevenir a transmissão cruzada de agentes microbianos e diminuir a ocorrência de infeções. Os enfermeiros tê m um papel fundamental na prevenção das infeções associadas aos cuidados de saúde, nomeadamente através da implementação das precauções básicas do controlo da infeção. Estudos têm demonstrado a necessidade de educação contínua e de momentos regulares de tr eino de competências, enquanto estratégias de aquisição de conhecimentos e melhoria das práticas dos enfermeiros. As precauções básicas são uma componente essencial na segurança dos cuidados e na proteção dos profissionais de saúde, no entanto, a adesão a estas medidas é inferior ao desejado. O estudo está integrado no projeto Controlo das Infeções Associadas aos Cuidados de Saúde " do grupo NursID do Centro de Investigação em Tecnologias e Serviços de Saúde. Objetivos : A nalisar e mapear o conhecimento disp onível sobre as intervenções educacionais ou formativas promotoras da adesão dos enfermeiros às p recauções b ásicas do c ontrolo d a i nfeção Método : Foi criado um protocolo de Scoping Review sustentado na metodologia de Joanna Briggs Institute , o qual obedec e aos critérios de elegibilidade com base na População, Conceito e Contexto, e construída a frase booleana de acordo com a base de pesquisa e os descritores indexados. A pesquisa foi realizada em diversas bases de dados, nomeadamente, EBSCO, SCOPUS , e Web of Science. Resultados : Foram incluídos seis estudos, os quais relatam a aplicação de múltiplos programas de intervenção, com diferentes metodologias e contextos de implementação. Dos resultados dos estudos salientaram se estratégias que promoveram a adesã o dos enfermeiros às precauções básicas do controlo da infeção, como por exemplo, sessões de treino, palestras, discussões de opinião entre a equipa, utilização de pósteres e vídeos. Conclusões O s estudos analisados demonstram que a implementação de estr atégias e programas educacionais, com o a realização de palestras e sessões de treino seguidas de reuniões de feedback aumentam a adesão às precauções básicas do controlo da infeção e têm efeitos benéficos na reduç ã o das infeções associadas aos cuidados de saúde, no entanto, é imperiosa a realização de mais investigação no âmbito da adesão dos profissionais de saúde às precauções básicas do controlo da infeção.

Introduction : Healthcare a ssociated i nfections are an explicit cause of mortality and morbidity, as well as heavy financial burdens on the healthcare system. The Standard Precautions are a set of fundamental measures to prevent the cro ss transmission of microbial agents and reduce the occurrence of i nfections. Nurses have a key role in preventing healthcare associated infections , namely through the implementation of s tandard p recautions. Studies have shown the need for continuous educat ion and regular moments of skills training, as goals of acquiring knowledge and improving the practices of nurses. The s tandard p recautions are an essential component in the safety of care and the protection of health professionals however, adherence to t hese measures is less than desired. The study is part of the Control of Healthcare A ssociated I nfections research project of the NursID group of the Center for Health Technology and Services Research Objectives : T o analyse and map the available knowledg e about educational or training interventions that promote nurses' adherence to the s tandard p recautions Method : A Scoping Review protocol was created based on the Joanna Briggs Institute methodology, which complies with the eligibility criteria based on Population, Concept and Context, and the Boolean phrase was constructed according to the search base and indexed descriptors. The search was carried o ut in several databases: EBSCO, SCOPUS, e Web of Science. Results : Six studies were included, which report the application of multiple intervention programs, with different methodologies and implementation contexts. From the results of the studies, strategies that promoted nurses' adherence to basic infection control precautions were highlighted, such as train ing sessions, lectures, opinion discussions among the team, use of posters and videos. Conclusions : T he studies analyzed demonstrate that the implementation of educational strategies and programs, such as holding lectures and training sessions followed by feedback meetings, increases the rate of adherence to standard precautions and has beneficial effects in reducing h ealthcare a ssociated infections; h owever, it is imperative to carry out more research in the context of health professionals' adherence to s t andard precautions

A multicenter Spanish study of atropine 0.01% in childhood myopia progression.

To evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between - 2.00 D to - 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than - 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were - 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (- 0.44 ± 0.41 D versus - 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: - 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than - 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.

Radiotherapy CT-based contouring atlas for non-malignant skeletal and soft tissue disorders: a practical proposal from Spanish experience.

OBJECTIVE: Interest in low-dose radiotherapy (LD-RT) for the symptomatic treatment of nonmalignant conditions, including inflammatory and degenerative disorders of the joints and para-articular soft tissues, has increased substantially in recent years. In the present document, we provide a CT-based contouring atlas to help identify and delineate the most common osteoarticular regions susceptible to LD-RT. METHODS: The clinical efficacy of LD-RT is supported by a large body of evidence. However, there is no consensus on the parameters for contouring the planning target volume (PTV). Moreover, 3D simulation and planning should be the standard of care even for nonmalignant disorders. For this reason, the present guidelines were prepared to help guide PTV contouring based on CT images, with the same quality criteria for patient immobilization, treatment simulation, planning and delivery as those routinely applied for cancer radiotherapy. RESULTS: PTV for radiotherapy requires precise identification of the target areas based on CT and other imaging techniques. Using a series of cases treated at our institution, we have defined the PTVs for each location on the simulation CT to establish the relationship between the image and the anatomical structures to be treated. We also specify the immobilization systems used to ensure treatment accuracy and reproducibility. CONCLUSIONS: This comprehensive atlas based on CT images may be of value to radiation oncologists who wish to use LD-RT for the symptomatic treatment of degenerative or inflammatory osteoarticular diseases. ADVANCES IN KNOWLEDGE: The recommendations and contouring atlas described in this article provide an eminently practical tool for LD-RT in non-malignant conditions, based on the same quality criteria recommended for all modern radiotherapy treatments in Spain.

Validity, reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-BESTest and brief-BESTest in patients with end-stage renal disease.

PURPOSE: This study determined the validity, test-retest reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) in patients with end-stage renal disease. METHODS: A cross-sectional study with 74 patients with end-stage renal disease (male 66.2%; 63.9 ± 15.1 years old) was conducted. Participants were asked to report the number of falls during the previous 12 months and to complete the activity-specific balance confidence (ABC) scale. The BESTest was administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC scale. Test-retest relative reliability and agreement were explored with the intraclass correlation coefficient (ICC) equation (2,1) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level were established. RESULTS: Balance test scores were significantly correlated with each other (spearman's correlation = 0.89-0.92) and with the ABC scale (spearman's correlation = 0.49-0.59). Balance tests presented high test-retest reliability (ICC = 0.84-0.94), with no evidence of bias. Minimal detectable change values were 10.8 (expressed as a percentage 13.5%), 5.3 (23.7%) and 5.6 (34%) points for the BESTest, Mini-BESTest and Brief-BESTest, respectively. CONCLUSIONS: All tests are valid and reliable to assess balance in patients with end-stage renal disease. Nevertheless, based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended tests for this specific population. Implications for Rehabilitation Balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) are reliable and valid in patients with end stage renal disease (ESRD). The minimal detectable changes of 10.8 for the BESTest, 5.3 for the Mini-BESTest and 5.6 for the Brief-BESTest can be used by clinicians to identify a true change in balance over time or in response to interventions. Based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended; and the selection of one of them may be based on time and equipment availability.

Antielevation syndrome with onset of diplopia 10 years after inferior oblique anterior transposition.

Antielevation syndrome as a complication of inferior oblique anterior transposition usually appears in the early postoperative period. A 29-year-old woman who had been operated on for right superior oblique palsy developed diplopia 10 years after surgery: motility examination was consistent with an antielevation syndrome. A right inferior oblique recession of 14 mm was performed on the previously transposed muscle; motility improved, and the patient has remained asymptomatic.

B-scan ultrasonography to screen for retinal tears in acute symptomatic age-related posterior vitreous detachment.

OBJECTIVE: To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). DESIGN: Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. PARTICIPANTS: Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. TESTING: Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. MAIN OUTCOME MEASURES: Index test performance for the detection of retinal tears secondary to age-related PVD. RESULTS: Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. CONCLUSIONS: Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Hábito de ingesta alcohólica en la población escolar de Andacollo / Alcoholic drinking habit in the school population of Andacollo

Se expone y analiza el hábito de ingestión de bebidas alcohólicas en 895 escolares de los dos últimos cursos de enseñanza básica y de todos los de enseñanza media de la comuna de Andacollo en mayo de 1985. Mediante el uso de un cuestionario anónimo se pudo constatar que el inicio de la ingestión de alcohol ocurre fundamentalmente en la enseñanza básica, siendo éste más precoz en los varones. El consumo habitual de alcohol se constató en el 25,3% de los varones y en el 4% de las mujeres. La vivencia de embriaguez había sido experimentada por el 70,9% de los varones y por el 18,9% de las mujeres. El 20,1% de los varones encuestados y el 2,6% de las mujeres se pueden catalogar como bebedores excesivos. El 37% de los estudiantes reconocieron haber sido inducidos a ingerir alcohol por sus padres. El castigo físico por parte del padre en estado de ebriedad fue denunciado por el 3,7% de los escolares. Sólo el 21,8% de los padres, en contraste con el 71,6% de las madres, son reconocidos como no bebedores por los escolares