Teenager Perspectives on COVID Alert, a Digital Exposure Notification App in Canada.

PURPOSE: COVID Alert is an exposure notification app deployed in Canada to help limit the spread of COVID-19. METHODS: This was a cross-sectional survey conducted in Québec, Canada. The questionnaire was codesigned with patients and members of the public. It assessed the perspectives of teenagers aged 15-17 years old. RESULTS: Among 237 respondents, 27% had downloaded the COVID Alert app. Friends and relatives constituted the largest influence for app download. The most frequently reported concerns included threats to privacy, confidentiality, cybersecurity, and geolocalization. Among nonusers, having more social contacts and evidence demonstrating effectiveness would have motivated app download. Individual factors associated with download included high concern about the pandemic and high self-perceived app knowledge. DISCUSSION: Future digital health interventions should engage teenagers in developing tools that promote social acceptance and responsible use in this group.

CD300f immune receptor contributes to healthy aging by regulating inflammaging, metabolism, and cognitive decline.

Emerging evidence suggests that immune receptors may participate in many aging-related processes such as energy metabolism, inflammation, and cognitive decline. CD300f, a TREM2-like lipid-sensing immune receptor, is an exceptional receptor as it integrates activating and inhibitory cell-signaling pathways that modulate inflammation, efferocytosis, and microglial metabolic fitness. We hypothesize that CD300f can regulate systemic aging-related processes and ultimately healthy lifespan. We closely followed several cohorts of two strains of CD300f-/- and WT mice of both sexes for 30 months and observed an important reduction in lifespan and healthspan in knockout mice. This was associated with systemic inflammaging, increased cognitive decline, reduced brain glucose uptake observed by 18FDG PET scans, enrichment in microglial aging/neurodegeneration phenotypes, proteostasis alterations, senescence, increased frailty, and sex-dependent systemic metabolic changes. Moreover, the absence of CD300f altered macrophage immunometabolic phenotype. Taken together, we provide strong evidence suggesting that myeloid cell CD300f immune receptor contributes to healthy aging.

A nitroalkene derivative of salicylate alleviates diet-induced obesity by activating creatine metabolism and non-shivering thermogenesis.

Obesity-related type II diabetes (diabesity) has increased global morbidity and mortality dramatically. Previously, the ancient drug salicylate demonstrated promise for the treatment of type II diabetes, but its clinical use was precluded due to high dose requirements. In this study, we present a nitroalkene derivative of salicylate, 5-(2-nitroethenyl)salicylic acid (SANA), a molecule with unprecedented beneficial effects in diet-induced obesity (DIO). SANA reduces DIO, liver steatosis and insulin resistance at doses up to 40 times lower than salicylate. Mechanistically, SANA stimulated mitochondrial respiration and increased creatine-dependent energy expenditure in adipose tissue. Indeed, depletion of creatine resulted in the loss of SANA action. Moreover, we found that SANA binds to creatine kinases CKMT1/2, and downregulation CKMT1 interferes with the effect of SANA in vivo. Together, these data demonstrate that SANA is a first-in-class activator of creatine-dependent energy expenditure and thermogenesis in adipose tissue and emerges as a candidate for the treatment of diabesity.

Flow Cytometry Analysis of SIRT6 Expression in Peritoneal Macrophages.

The sirtuin 6 has emerged as a regulator of acute and chronic immune responses. Recent findings show that SIRT6 is necessary for mounting an active inflammatory response in macrophages. In vitro studies revealed that SIRT6 is stabilized in the cytoplasm to promote tumor necrosis factor (TNFα) secretion. Notably, SIRT6 also promotes TNFα secretion by resident peritoneal macrophages upon lipopolysaccharide (LPS) stimulation in vivo. Although many studies have investigated SIRT6 function in the immune response through different genetic and pharmacological approaches, direct measurements of in vivo SIRT6 expression in immune cells by flow cytometry have not yet been performed. Here, we describe a step-by-step protocol for peritoneal fluid extraction, isolation, and preparation of peritoneal cavity cells, intracellular SIRT6 staining, and flow cytometry analysis to measure SIRT6 levels in mice peritoneal macrophages. By providing a robust method to quantify SIRT6 levels in different populations of macrophages, this method will contribute to deepening our understanding of the role of SIRT6 in immunity, as well as in other cellular processes regulated by SIRT6. Graphical abstract.

Public Perspectives on Exposure Notification Apps: A Patient and Citizen Co-Designed Study.

Canada deployed a digital exposure notification app (COVID Alert) as a strategy to support manual contact tracing. Our aims are to (1) assess the use, knowledge, and concerns of the COVID Alert app, (2) identify predictors of app downloads, and (3) develop strategies to promote social acceptability. A 36-item questionnaire was co-designed by 12 citizens and patients partnered with 16 academic researchers and was distributed in the province of Québec, Canada, from May 27 to 28 June 2021. Of 959 respondents, 43% had downloaded the app. Messaging from government sources constituted the largest influence on app download. Infrequent social contacts and perceived app inefficacy were the main reasons not to download the app. Cybersecurity, data confidentiality, loss of privacy, and geolocation were the most frequent concerns. Nearly half of the respondents inaccurately believed that the app used geolocation. Most respondents supported citizen involvement in app development. The identified predictors for app uptake included nine characteristics. In conclusion, this project highlights four key themes on how to promote the social acceptability of such tools: (1) improved communication and explanation of key app characteristics, (2) design features that incentivize adoption, (3) inclusive socio-technical features, and (4) upstream public partnership in development and deployment.

SIRT6 stabilization and cytoplasmic localization in macrophages regulates acute and chronic inflammation in mice.

Acute and chronic inflammations are key homeostatic events in health and disease. Sirtuins (SIRTs), a family of NAD-dependent protein deacylases, play a pivotal role in the regulation of these inflammatory responses. Indeed, SIRTs have anti-inflammatory effects through a myriad of signaling cascades, including histone deacetylation and gene silencing, p65/RelA deacetylation and inactivation, and nucleotide­binding oligomerization domain, leucine rich repeat, and pyrin domain­containing protein 3 inflammasome inhibition. Nevertheless, recent findings show that SIRTs, specifically SIRT6, are also necessary for mounting an active inflammatory response in macrophages. SIRT6 has been shown to positively regulate tumor necrosis factor alpha (TNFα) secretion by demyristoylating pro-TNFα in the cytoplasm. However, how SIRT6, a nuclear chromatin-binding protein, fulfills this function in the cytoplasm is currently unknown. Herein, we show by Western blot and immunofluorescence that in macrophages and fibroblasts there is a subpopulation of SIRT6 that is highly unstable and quickly degraded via the proteasome. Upon lipopolysaccharide stimulation in Raw 264.7, bone marrow, and peritoneal macrophages, this population of SIRT6 is rapidly stabilized and localizes in the cytoplasm, specifically in the vicinity of the endoplasmic reticulum, promoting TNFα secretion. Furthermore, we also found that acute SIRT6 inhibition dampens TNFα secretion both in vitro and in vivo, decreasing lipopolysaccharide-induced septic shock. Finally, we tested SIRT6 relevance in systemic inflammation using an obesity-induced chronic inflammatory in vivo model, where TNFα plays a key role, and we show that short-term genetic deletion of SIRT6 in macrophages of obese mice ameliorated systemic inflammation and hyperglycemia, suggesting that SIRT6 plays an active role in inflammation-mediated glucose intolerance during obesity.

Experimental Validation of a Microwave System for Brain Stroke 3-D Imaging.

This paper experimentally validates the capability of a microwave prototype device to localize hemorrhages and ischemias within the brain as well as proposes an innovative calibration technique based on the measured data. In the reported experiments, a 3-D human-like head phantom is considered, where the brain is represented either with a homogeneous liquid mimicking brain dielectric properties or with ex vivo calf brains. The microwave imaging (MWI) system works at 1 GHz, and it is realized with a low-complexity architecture formed by an array of twenty-four printed monopole antennas. Each antenna is embedded into the "brick" of a semi-flexible dielectric matching medium, and it is positioned conformal to the head upper part. The imaging algorithm exploits a differential approach and provides 3-D images of the brain region. It employs the singular value decomposition of the discretized scattering operator obtained via accurate numerical models. The MWI system analysis shows promising reconstruction results and extends the device validation.

A Nitroalkene Benzoic Acid Derivative Targets Reactive Microglia and Prolongs Survival in an Inherited Model of ALS via NF-κB Inhibition.

Motor neuron degeneration and neuroinflammation are the most striking pathological features of amyotrophic lateral sclerosis (ALS). ALS currently has no cure and approved drugs have only a modest clinically therapeutic effect in patients. Drugs targeting different deleterious inflammatory pathways in ALS appear as promising therapeutic alternatives. Here, we have assessed the potential therapeutic effect of an electrophilic nitroalkene benzoic acid derivative, (E)-4-(2-nitrovinyl) benzoic acid (BANA), to slow down paralysis progression when administered after overt disease onset in SOD1G93A rats. BANA exerted a significant inhibition of NF-κB activation in NF-κB reporter transgenic mice and microglial cell cultures. Systemic daily oral administration of BANA to SOD1G93A rats after paralysis onset significantly decreased microgliosis and astrocytosis, and significantly reduced the number of NF-κB-p65-positive microglial nuclei surrounding spinal motor neurons. Numerous microglia bearing nuclear NF-κB-p65 were observed in the surrounding of motor neurons in autopsy spinal cords from ALS patients but not in controls, suggesting ALS-associated microglia could be targeted by BANA. In addition, BANA-treated SOD1G93A rats after paralysis onset showed significantly ameliorated spinal motor neuron pathology as well as conserved neuromuscular junction innervation in the skeletal muscle, as compared to controls. Notably, BANA prolonged post-paralysis survival by ~30%, compared to vehicle-treated littermates. These data provide a rationale to therapeutically slow paralysis progression in ALS using small electrophilic compounds such as BANA, through a mechanism involving microglial NF-κB inhibition.

A novel nitroalkene vitamin E analogue inhibits the NLRP3 inflammasome and protects against inflammation and glucose intolerance triggered by obesity.

Chronic metabolic diseases, like obesity, type II diabetes and atherosclerosis often involve a low-grade and sterile systemic inflammatory state, in which activation of the pro-inflammatory transcription factor NF-kB and the NLRP3 inflammasome play a major role. It is well established that genetic inhibition of the NLRP3 inflammasome ameliorates acute and chronic inflammation. Indeed, accumulating experimental evidences in murine models and also in humans suggest that inhibition of the NLRP3 inflammasome might be a suitable approach to tackle the deleterious effects of chronic metabolic diseases. In this work, we explored our previously synthesized nitroalkene-Trolox™ derivative named NATx0, as a non-conventional anti-inflammatory strategy to treat chronic inflammatory diseases, such as obesity-induced glucose intolerance. We found that NATx0 inhibited NF-kB nuclear translocation and pro-inflammatory gene expression in macrophages in vitro. In addition, treatment with NATx0 prevented NLRP3 inflammasome activation after LPS/ATP stimulation in macrophages in vitro. When tested acutely in vivo, NATx0 inhibited neutrophil recruitment in zebrafish larvae, and also diminished IL-1ß production after LPS challenge in mice. Finally, when NATx0 was administered chronically to diet-induced obese mice, it decreased muscle tissue inflammation and glucose intolerance, leading to improved glucose homeostasis. In conclusion, we propose that this novel nitroalkene-Trolox derivative is a suitable tool to tackle acute and chronic inflammation in vitro and in vivo mainly due to inhibition of NF-kB/NLRP3 activation.

Neurorehabilitation in the times of Covid-19: insights from the Spanish Neurorehabilitation Society (SENR).

The entire world is experiencing an unprecedented global health crisis and Spain has been one of the most heavily affected countries within Europe. Unexpected rapid changes and reorganization of medical services that occurred during the pandemic lead to an impact in the practice of neurorehabilitation. The idiosyncrasies typical of neurorehabilitation management, specially in acute facilities, that makes it susceptible as a vector of dissemination of Covid but also because of the need of finding new wards and intensive care units for Covid patients, the interventions in neurorehabilitation has suffered enormous changes. There is a need for rethinking the future to treat a new wave of patients with neurorehabilitation necessities such as those recovering from Covid 19 with neurological sequelae but also of those neurorehab patients who were unable to access the health system during the locke down period. This article is intended to invite to reflect on and discuss the redesign of our current neurorehabilitation plans after the experience on the Covid 19 pandemic.

A Prototype Microwave System for 3D Brain Stroke Imaging.

This work focuses on brain stroke imaging via microwave technology. In particular, the open issue of monitoring patients after stroke onset is addressed here in order to provide clinicians with a tool to control the effectiveness of administered therapies during the follow-up period. In this paper, a novel prototype is presented and characterized. The device is based on a low-complexity architecture which makes use of a minimum number of properly positioned and designed antennas placed on a helmet. It exploits a differential imaging approach and provides 3D images of the stroke. Preliminary experiments involving a 3D phantom filled with brain tissue-mimicking liquid confirm the potential of the technology in imaging a spherical target mimicking a stroke of a radius equal to 1.25 cm.

Del cuidado intensivo al cuidado crítico, un cambio de nombre que refleja evolución / From intensive care to critical care, a name change that reflects evolution

Introducción: el cuidado intensivo implica la atención brindada en unidades de alta complejidad, se caracteriza por estar dirigida al paciente con patologías graves, inestabilidad fisiológica y alto riesgo de complicación. Sin embargo, frente al incremento de una población con mayor complejidad asociada al envejecimiento, enfermedades crónicas y sus complicaciones, surge el término cuidado crítico que refleja tanto las nuevas características del paciente como la respuesta del cuidado avanzado centrado en las necesidades personales. Objetivo: describir la transformación del cuidado intensivo hacia el cuidado crítico y sus implicaciones para la enfermería con base en la revisión de bibliografía disponible en acceso abierto. Metodología: revisión narrativa de la literatura del periodo 2010-2019 incluyendo artículos en español de Scielo y PubMed, utilizando los descriptores cuidado crítico or terapia intensiva or cuidado intensivo and enfermería. Resultados: por consenso de autores se eligieron 26 artículos en los que se identificaron las siguientes temáticas: a) las unidades de cuidado; b) el paciente crítico; c) los criterios de ingreso; d) el personal y sus funciones, y e) nuevos retos. Conclusión: el término cuidado crítico refleja la respuesta a la demanda de cuidado profesional de mayor complejidad y con ello la expansión del campo de acción de la enfermería profesional.

Introduction: Intensive care involves care provided in highly complex units and ¡fs characterized by being directed to the patient with serious pathologies, physiological instability and high risk of complications. However, faced with the increase in a population that presents greater complexity associated with aging, chronic diseases and their complications, the term critical care has emerged, reflecting both the new characteristics of the patient and the response of advanced care focused on the needs of the person. Objective: To describe the transformaron of intensive care towards critical care and its implications for nursing based on a review of the literature available in open access. Methods: A narrative review of the literature of the period 2010-2019 including articles in Spanish of the bases Scielo and Pubmed using the descriptors critical care or intensive therapy or intensive care and nursing. Results: According to the authors' consensus criteria, 26 articles were chosen in which the following topics were identified: a) the care units; b) the critical patient; c) entry criteria; d) the staff and their functions and e) new challenges. Conclusión: The term critical care reflects the response to the demand for professional care of greater complexity and with it the expansión of the field of action of professional nursing.

A novel nitroalkene-α-tocopherol analogue inhibits inflammation and ameliorates atherosclerosis in Apo E knockout mice.

BACKGROUND AND PURPOSE: Atherosclerosis is characterized by chronic low-grade inflammation with concomitant lipid accumulation in the arterial wall. Anti-inflammatory and anti-atherogenic properties have been described for a novel class of endogenous nitroalkenes (nitrated-unsaturated fatty acids), formed during inflammation and digestion/absorption processes. The lipid-associated antioxidant α-tocopherol is transported systemically by LDL particles including to the atheroma lesions. To capitalize on the overlapping and complementary salutary properties of endogenous nitroalkenes and α-tocopherol, we designed and synthesized a novel nitroalkene-α-tocopherol analogue (NATOH) to address chronic inflammation and atherosclerosis, particularly at the lesion sites. EXPERIMENTAL APPROACH: We synthesized NATOH, determined its electrophilicity and antioxidant capacity and studied its effects over pro-inflammatory and cytoprotective pathways in macrophages in vitro. Moreover, we demonstrated its incorporation into lipoproteins and tissue both in vitro and in vivo, and determined its effect on atherosclerosis and inflammatory responses in vivo using the Apo E knockout mice model. KEY RESULTS: NATOH exhibited similar antioxidant capacity to α-tocopherol and, due to the presence of the nitroalkenyl group, like endogenous nitroalkenes, it exerted electrophilic reactivity. NATOH was incorporated in vivo into the VLDL/LDL lipoproteins particles to reach the atheroma lesions. Furthermore, oral administration of NATOH down-regulated NF-κB-dependent expression of pro-inflammatory markers (including IL-1ß and adhesion molecules) and ameliorated atherosclerosis in Apo E knockout mice. CONCLUSIONS AND IMPLICATIONS: In toto, the data demonstrate a novel pharmacological strategy for the prevention of atherosclerosis based on a creative, natural and safe drug delivery system of a non-conventional anti-inflammatory compound (NATOH) with significant potential for clinical application.

Electrophilic nitroalkene-tocopherol derivatives: synthesis, physicochemical characterization and evaluation of anti-inflammatory signaling responses.

Inflammation plays a major role in the onset and development of chronic non-communicable diseases like obesity, cardiovascular diseases and cancer. Combined, these diseases represent the most common causes of death worldwide, thus development of novel pharmacological approaches is crucial. Electrophilic nitroalkenes derived from fatty acids are formed endogenously and exert anti-inflammatory actions by the modification of proteins involved in inflammation signaling cascades. We have developed novel nitroalkenes derived from α-tocopherol aiming to increase its salutary actions by adding anti-inflammatory properties to a well-known nutraceutical. We synthesized and characterized an α-tocopherol-nitroalkene (NATOH) and two hydrosoluble analogues derived from Trolox (NATxME and NATx0). We analyzed the kinetics of the Michael addition reaction of these compounds with thiols in micellar systems aiming to understand the effect of hydrophobic partition on the reactivity of nitroalkenes. We studied NATxME in vitro showing it exerts non-conventional anti-inflammatory responses by inducing Nrf2-Keap1-dependent gene expression and inhibiting the secretion of NF-κB dependent pro-inflammatory cytokines. NATxME was also effective in vivo, inhibiting neutrophil recruitment in a zebrafish model of inflammation. This work lays the foundation for the rational design of a new therapeutic strategy for the prevention and treatment of metabolic and inflammation-related diseases.

Alternativas quirúrgicas conservadoras del útero ante la hemorragia postparto / Conservative surgical alternatives of the uterus on postpartum hemorrhage

La hemorragia posparto es una de las complicaciones obstétricas más temidas y una de las tres primeras causas de mortalidad materna en el mundo, que afecta aproximadamente el 2 % de todas las mujeres parturientas. En su manejo es crucial una actuación inmediata y secuencial, que inicia con el tratamiento farmacológico tradicional y que en muchas ocasiones no logra ser efectivo para detener el sangrado, por lo que se hace necesaria la intervención quirúrgica. El tratamiento conservador del útero ha demostrado ser una alternativa terapéutica útil para disminuir la hemorragia y conservar la fertilidad en aquellas pacientes con paridad no satisfecha. La presente revisión tiene como objetivo recopilar las principales alternativas quirúrgicas conservadoras del útero ante la hemorragia posparto. Ello permitirá a los profesionales vinculados a la atención de la paciente obstétrica grave, profundizar en el conocimiento sobre las técnicas más utilizadas en la actualidad.

Postpartum haemorrhage is one of the most feared obstetric complications and one of the top three causes of world maternal mortality, affecting approximately 2% of all women in labor. In its management, an immediate and sequential approach is crucial, which starts with traditional pharmacological treatment and which in many cases fails to be effective in stopping bleeding, makes surgical intervention necessary. Conservative treatment of the uterus has been shown to be a useful therapeutic alternative for reducing bleeding and preserving fertility in those patients with unsatisfied parity. The present review aims at compiling the main conservative surgical alternatives of the uterus on postpartum haemorrhage. This will allow professionals related to the attention of the severely ill obstetric patient, to deepen on the most currently used techniques.

The EAL-domain protein FcsR regulates flagella, chemotaxis and type III secretion system in Pseudomonas aeruginosa by a phosphodiesterase independent mechanism.

The second messenger c-di-GMP regulates the switch between motile and sessile bacterial lifestyles. A general feature of c-di-GMP metabolism is the presence of a surprisingly large number of genes coding for diguanylate cyclases and phosphodiesterases, the enzymes responsible for its synthesis and degradation respectively. However, the physiological relevance of this apparent redundancy is not clear, emphasizing the need for investigating the functions of each of these enzymes. Here we focused on the phosphodiesterase PA2133 from Pseudomonas aeruginosa, an important opportunistic pathogen. We phenotypically characterized P. aeruginosa strain K overexpressing PA2133 or its inactive mutant. We showed that biofilm formation and motility are severely impaired by overexpression of PA2133. Our quantitative proteomic approach applied to the membrane and exoprotein fractions revealed that proteins involved in three processes were mostly affected: flagellar motility, type III secretion system and chemotaxis. While inhibition of biofilm formation can be ascribed to the phosphodiesterase activity of PA2133, down-regulation of flagellar, chemotaxis, and type III secretion system proteins is independent of this enzymatic activity. Based on these unexpected effects of PA2133, we propose to rename this gene product FcsR, for Flagellar, chemotaxis and type III secretion system Regulator.

Low-dose, non-supervised, health insurance initiated exercise for the treatment and prevention of chronic low back pain in employees. Results from a randomized controlled trial.

OBJECTIVE: Back pain is a major problem requiring pragmatic interventions, low in costs for health care providers and feasible for individuals to perform. Our objective was to test the effectiveness of a low-dose 5-month exercise intervention with small personnel investment on low back strength and self-perceived pain. METHODS: Two hundred twenty-six employees (age: 42.7±10.2 years) from three mid-size companies were randomized to 5-month non-supervised training at home (3 times/week for 20 minutes) or wait-list-control. Health insurance professionals instructed the participants on trunk exercises at the start and then supervised participants once a month. RESULTS: Muscle strength for back extension increased after the 5-month intervention with a significant between-group difference (mean 27.4 Newton [95%CI 2.2; 60.3]) favoring the exercise group (p = 0.035). Low back pain was reduced more in subjects after exercise than control (mean difference -0.74 cm [95%CI -1.17; -0.27], p = 0.002). No between-group differences were observed for back pain related disability and work ability. After stratified analysis only subjects with preexisting chronic low back pain showed a between-group difference (exercise versus controls) after the intervention in their strength for back extension (mean 55.7 Newton [95%CI 2.8; 108.5], p = 0.039), self-perceived pain (mean -1.42 cm [95%CI -2.32; -0.51], p = 0.003) and work ability (mean 2.1 points [95%CI 0.2; 4.0], p = 0.032). Significant between-group differences were not observed in subjects without low back pain: strength for back extension (mean 23.4 Newton [95%CI -11.2; 58.1], p = 0.184), self-perceived pain (mean -0.48 cm [95%CI -0.99; 0.04], p = 0.067) and work ability (mean -0.1 points [95%CI -0.9; 0.9], p = 0.999). An interaction between low back pain subgroups and the study intervention (exercise versus control) was exclusively observed for the work ability index (p = 0.016). CONCLUSION: In middle-aged employees a low-dose, non-supervised exercise program implemented over 20 weeks improved trunk muscle strength and low back pain, and in those with preexisting chronic low back pain improved work ability.

Grupo psicoeducativo en cuidados paliativos para el paciente cardiópata y su familia / Psychoeducational group in palliative care for cardiac patient and his family

El presente artículo tiene la finalidad de compartir la experiencia que ha tenido la Unidad de Cuidados Integrales Avanzados (UCIA) con la conformación de grupos a los que se les brinda atención psicoeducativa, como parte de los cuidados paliativos ofrecidos por el Instituto Nacional de Cardiología Ignacio Chávez. En la atención directa con los pacientes en situación de terminalidad y su familia se identificaron situaciones que afectan directamente su calidad de vida, razón por la cual se diseñó un programa para realizar intervención psicoeducativa con enfoque biopsicosocial a través de un equipo de salud transdisciplinar con el objetivo principal de ampliar el repertorio de afrontamiento del paciente y del cuidador principal a través de la orientación respecto a la enfermedad, síntomas y cuidados paliativos específicos que puede realizar en el hogar. Dicho programa cuenta con las políticas, normas y lineamientos de operación que considera el contexto actual de los pacientes en situación de terminalidad y de su familia. Se destacan aspectos importantes observados posterior a la psicoeducación tales como: identificación de conductas adaptativas, ampliación del repertorio de afrontamiento, disminución de las consultas en los servicios de urgencias y del número de hospitalizaciones.

This article aims to share the experience of the Comprehensive Care Unit (CCU) with the formation of groups that are given psychoeducational care, as part of the palliative care offered by the National Institute of Cardiology Ignacio Chavez. In direct care with terminally ill patients and their families, situations that directly affect their quality of life were identified, that is why a program was designed to carry out a psychoeducational intervention with a bio-psycho-social approach through a team of transdisciplinary health, with the main objective of expanding the repertoire for coping with the patient and the main caregiver through orientation regarding the illness, symptoms and specific palliative care that can be done at home. This program has the policies, rules and guidelines of operation that considers the current context of terminally ill patients and their family. Important aspects observed after psychoeducation are highlighted such as identification of adaptive behaviors, expansion of coping repertoire, reduction of visits to the emergency services and number of hospitalizations.

Riesgo de no adherirse al tratamiento en pacientes cardiópatas con anticoagulación oral y análisis de los factores influyentes / Risk of not adhering to treatment in cardiac patients with oral anticoagulation and analysis of the influential factors", "_i": "

Introducción: La falta de adherencia al tratamiento del paciente con anticoagulación oral es causa de complicaciones tromboembólicas o hemorrágicas, relacionada con múltiples factores. Objetivo: Determinar el riesgo que existe en los pacientes cardiópatas para no adherirse al tratamiento de anticoagulación oral y analizar los factores que influyen. Material y métodos: Estudio analítico, prospectivo y transversal de agosto a noviembre de 2012. Muestra no aleatorizada n = 297; incluyó pacientes adultos bajo tratamiento de anticoagulación oral que asisten a la Clínica de Anticoagulantes. Datos recolectados con instrumento validado con cuatro dimensiones: factor socioeconómico, terapia, proveedor y sistema de salud y paciente; 42 ítems con respuesta tipo Likert con valor de 0 a 2; de 0-60% = riesgo alto de no adherencia, 61-80% = riesgo moderado y ≥ 81% = sin riesgo. Análisis estadístico con frecuencias, porcentajes, medias y desviación estándar; pruebas de Pearson (adherencia y factores), t de Student (adherencia, sexo y procedencia), ANOVA (adherencia y tiempo con el tratamiento) y Kruskall Wallis (nivel académico y adherencia); significancia p ‹ 0.05. Resultados: 60% de nivel de factor socioeconómico bajo; 76% se encuentran sin riesgo de no adherirse y 23% con riesgo moderado; sólo el factor socioeconómico tiene riesgo moderado (88.41 ± 13.9). La adherencia se asocia más con los factores de proveedor y sistema de salud de proveedor y sistema de salud y paciente (r = 0.774, p = 0.000) y factor socioeconómico (r = 0.771, p = 0.000). Los pacientes de provincia se adhieren menos que los del D.F. (t = 2.61, gl = 295, p = 0.009); aquéllos con educación superior se adhieren más que quienes tienen educación básica (x2 = 10.34, gl = 2, p = 0.016). Conclusión: La mayoría de pacientes anticoagulados no tienen riesgo de dejar su tratamiento; sin embargo, el factor que dificulta la adherencia es el socioeconómico.)

Introduction: Lack of adherence to treatment of patients with oral anticoagulation is a cause of thromboembolic or hemorrhagic complications related to multiple factors. Objective: To determine the risk involved in cardiac patients for not adhering to the treatment of oral anticoagulation and analyze influencing factors. Material and methods: Analytical, prospective transversal study from August to November 2012. Nonrandomized sample n = 297; included adult patients under oral anticoagulation treatment attending the Anticoagulant Clinic. Data collected with a validated instrument with four dimensions: socioeconomic factor; therapy; provider and health system; and patient; 42 items with Likert value of 0-2; 0-60% = high risk of non-adherence, 61-80% = moderate risk, and ≥ 81% = no risk. Statistical analysis with frequencies, percentages, means and standard deviation; Pearson tests (adhesion and factors), Student’s t (adherence, sex and origin), ANOVA (adherence, and treatment time) and Kruskal Wallis (academic and adherence); significance p ‹ 0.05. Results: 60% of low socioeconomic level, 76% are without risk of not adhering and 23% moderate risk; only SE has moderate risk factor (88.41 ± 13.9). Adherence factors associated more with PSS (r = 0.774, p = 0.000) and SE (r = 0.771, p = 0.000). Patients in province adhere less than patients in Mexico City (t = 2.61, gl = 295, p = 0.009), those with higher education adhere more than those with only basic education (x2 = 10.34, gl = 2, p = 0.016). Conclusion: The majority of anticoagulated patients are not at risk of leaving treatment, however, the complicating factor for adherence is SE.