Primary Disease Prevention for Southwest American Indian Families During the COVID-19 Pandemic: Camp in a Box.

The goal of the American Indian Youth Wellness Camp in a Box was to engage, educate and empower families to improve their health and overall well-being during the COVID-19 pandemic. Camp in a Box was a 9-week program, inclusive of a 1-week intensive camp component followed by an 8-week booster component with content focused on nutrition, mental health and physical activity education. The Camp in a Box is a Tribal/Urban Indian-University partnership, and materials were developed to replace an existing weeklong residential camp and to comply with social distancing guidelines. Fourteen American Indian families from Tribal/Urban Indian communities in the southwestern United States participated (36 children aged 2-18 years; 32 adults). The intensive camp week included daily materials for families to complete together, Monday through Friday. Materials were provided for approximately 4 h of activities per day. The booster sessions began after camp week and included approximately 4 h of supplementary activities designed to be completed at any time most convenient for the family over the course of the week. Activities were designed to encourage interaction among family members with materials and supplies for parents and youth to participate. Self-reported outcomes suggested that families changed their eating habits to include more vegetables, less sweets and junk food. Parents reported an increase in family physical activity and that the activities brought the family closer together. Our Camp in a Box program was feasible and well-received until school began. During camp week, 100% of recruited families participated; at Booster Week 8, ten families (71%) remained enrolled and active. Camp in a Box is a feasible alternative to residential camps for promotion of health behaviors associated with metabolic disease prevention among American Indian families. In contrast to residential camps for youth, Camp in a Box offers an opportunity to engage the entire family in health promotion activities.

[User satisfaction with telephonic consultations carried out during the COVID-19 pandemic.] / Evaluación de la satisfacción del paciente en la teleconsulta durante la pandemia por COVID-19.

OBJECTIVE: To face the COVID-19 pandemic, our intensive care and hospitalization units were expanded, surgical activity was limited to urgent and non-delayed procedures and teleconsultations were increased in order to minimize face-to-face consultations. The objective of this work was to learn users' satisfaction with teleconsultations performed during the pandemic as well as its benefits, applications and areas for improvement. METHODS: Cross-sectional study through a questionnaire with 26 closed questions and 5 open ones, grouped in 9 dimensions: patient characteristics; the query; treatment; utility; resolution; security; satisfaction; face-to-face modality and opportunities for improvement. Necessary sample size: 307 (confidence: 95%; error: 3%; expected satisfaction: 92%). Definitive sample: 352. Stratified random sampling by specialty. Period: March 16th-May 25th 2020. The statistical analysis was done with the statistical program SPSS vs.27.0. 95% confidence intervals were calculated.Statistical significance was established at p<0.05. RESULTS: Patient profile: age 54 (SD: 18.6) years; 213 (60.5%) women. Calls made by doctors (298; 84.7%) and nurses (15; 4.3%); 342 (97.2%) attended at home. Reasons: follow-up (223; 63.4%); first consultation (45; 12.8%); result's report (23; 6.5%) and manage an appointment (50; 14.2%). 29 (8.62%) were directed to another center. 335 (95.44%; 95% CI: 93.26%-97.62%) patients were satisfied and 309 (91.96%; 95% CI: 89.06%-94.87%) would recommend them. 351 (99.72%; 95% CI: 99.16%-99.99%) felt they were treated with kindness; 336 (95.96%; 95% CI: 93.81%-98.11%) considered sufficient care; 309 (95.96%; 95% CI: 93.81%-98.11%) were able to solve doubts; 311 (96.58%; 95% CI: 94.60%-98.57%) calmed down; for 245 (69.6%; 95% CI: 65.98%-74.67%) it was as useful as the face-to-face session; equally safe (240; 69.57%; 95% CI: 64.71%-74.42%) and beneficial (338; 96.02%; 95% CI: 94.25%-98.26%). CONCLUSIONS: The high satisfaction expressed by users, the benefits verified and the high resolution of the teleconsultations, makes us consider expanding these services after the pandemic.

OBJETIVO: Para afrontar la pandemia por COVID-19, ampliamos la unidad de cuidados intensivos y hospitalización, limitando la actividad quirúrgica a las urgentes y no-demorables, minimizando las consultas presenciales y aumentando las teleconsultas. El objetivo de este trabajo fue conocer la satisfacción de nuestros usuarios con las teleconsultas realizadas durante la pandemia, beneficios, aplicaciones y áreas de mejora. METODOS: Estudio transversal con un cuestionario con 26 preguntas cerradas y 5 abiertas, agrupadas en 9 dimensiones: características del paciente, la consulta, trato, utilidad, resolución, seguridad, satisfacción, modalidad presencial y oportunidades de mejora. Tamaño muestral necesario: 307 (confianza: 95%; error: 3%; satisfacción esperada: 92%). Muestra definitiva: 352. Muestreo aleatorio estratificado por especialidad, entre el 16 marzo a 25 mayo. El análisis estadístico se hizo con el programa estadístico SPSS vs. 27.0. Se calcularon los intervalos de confianza al 95%. La significación estadística se estableció en p<0,05. RESULTADOS: Perfil del paciente: edad 54,0 (SD: 18,6) años; 213 (60,5%) mujeres. Llamadas realizadas por médicos (298; 84,7%) y enfermeros (15; 4,3%); 342 (97,2%) atendidas en el hogar. Motivos: seguimiento (223; 63,4%); primera consulta (45; 12,8%); informar resultado (23; 6,5%) y gestionar cita (50; 14,2%). Fueron direccionados a otro centro 29 (8,62%). Estaban satisfechos 335 (95,44%; IC95%: 93,26%-97,62%) pacientes y 309 (91,96%; IC95%: 89,06%-94,87%) las recomendarían. Se sintieron tratados con amabilidad 351 (99,72%; IC95%: 99,16%-99,99%); 336 (95,96%; IC95%: 93,81%-98,11%) consideraron la atención suficiente; 309 (95,96%; IC95%: 93,81%-98,11%) pudieron resolver dudas; 311 (96,58%; IC95%: 94,60%-98,57%) se tranquilizaron; para 245 (69,6%; IC 95%: 65,98%-74,67%) fue tan útil como la presencial; igual de segura (240; 69,57%; IC95%: 64,71%-74,42%) y beneficiosa (338; 96,02%; IC 95%: 94,25%-98,26%). CONCLUSIONES: La alta satisfacción manifestada por los usuarios, los beneficios constatados y la gran resolución de las teleconsultas, nos hace plantearnos ampliar estos servicios tras la pandemia.

[Home and Ambulatory Artificial Nutrition (NADYA) Group Report. Home parenteral nutrition in Spain, 2018]. / Nutrición parenteral domiciliaria en España 2018. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

INTRODUCTION: Aim: to communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2018 Material and methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: there were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was "palliative cancer" (22.0%), followed by "others". In children it was Hirschsprung's disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: the number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN.

INTRODUCCIÓN: Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2018. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE del 1 de enero al 31 de diciembre de 2018. Resultados: se registraron 278 pacientes (54,7% mujeres), 23 niños y 255 adultos, procedentes de 45 hospitales españoles, lo que representa una tasa de prevalencia de 5,95 pacientes/millón de habitantes/año 2018. El diagnóstico más frecuente en adultos fue "oncológico paliativo" (22,0%), seguido de "otros". En niños fue la enfermedad de Hirschsprung junto con la enterocolitis necrotizante, con cuatro casos (17,4%). El primer motivo de indicación fue síndrome de intestino corto tanto en niños (60,9%) como en adultos (35,7%). El tipo de catéter más utilizado fue el tunelizado tanto en niños (81,0%) como en adultos (41,1%). Finalizaron 75 episodios, la causa más frecuente fue el fallecimiento (52,0%) y el paso a vía oral (33,3%). Conclusiones: el número de centros y profesionales colaboradores en el registro de pacientes que reciben NPD se mantiene estable, así como las principales indicaciones y los motivos de finalización de la NPD.

[Caring with meaning: the spiritual care in healthcare from the professional´s perspective]. / Cuidando con sentido: la atención de lo espiritual en la práctica clínica desde la perspectiva del profesional.

OBJECTIVE: To treat whole patient, spiritual and religious dimension included, allows improve the quality humanization healthcare. The aim of this study was to know the point of professional view regarding to assess this dimensions in patients attended in regional hospital. METHODS: Cross-sectional descriptive study, through an ad-hoc survey with 30 issues (Likert 0: strongly disagree with 4: strongly agree), to health professionals, conducted in April 2017. Necessary sample size: 238. The SPSS (v19.0) statistical analysis was used. We calculated the absolute frequency and percentage of answers with each question and we used Chi-Square to assess the association of the answers with sex and professional category and ANOVA for age. RESULTS: We recruited 302 participants. 95.5% of women stand out the importance of creating an environment to express their spiritual and/or religious dimension the patient, compared to 87.6% of men (p = 0.017). At an older age, professionals differentiated the concepts of spirituality and religiosity better and agreed that both dimensions affected the patient (differences between 5-8 years of average age). The doctors were more in agreement with the importance of spirituality, followed by nurses and less auxiliaries, with significant differences in 17 issues. CONCLUSIONS: The professionals recognized the importance of taking care of the spiritual and/or religious dimension, with some differences between professional categories, sex and age. Training in these subjects would favor a more comprehensive and quality assistance.

OBJETIVO: La calidad en la humanización de la asistencia sanitaria implica el cuidado integral de los pacientes, considerando todas las facetas de la persona, incluida también su dimensión espiritual y religiosa. El objetivo de este estudio fue conocer la visión de los profesionales respecto al cuidado de esta dimensión en los pacientes atendidos en un hospital comarcal. METODOS: Se realizó un estudio descriptivo transversal, mediante una encuesta ad-hoc a profesionales sanitarios con 30 cuestiones (según escala de Likert, de 0=totalmente en desacuerdo a 4=totalmente de acuerdo), realizada en abril de 2017. El tamaño muestral necesario fue de 238. Se analizó con SPSS v19.0, se describieron la frecuencia absoluta y el porcentaje de acuerdos con cada cuestión, y se usó Chi-Cuadrado para valorar la asociación de las respuestas con el sexo y la categoría profesional, y ANOVA para la edad. RESULTADOS: Se reclutaron 302 participantes. El 95,5% de mujeres destacó la importancia de crear un ambiente para que el paciente exprese su dimensión espiritual y/o religiosa, frente al 87,6% de hombres. A mayor edad, los profesionales diferenciaron mejor los conceptos de espiritualidad y religiosidad, y coincidieron en que ambas dimensiones afectaban al enfermo (diferencias entre 5-8 años de edad media). Los médicos estuvieron más de acuerdo con la importancia de la espiritualidad, seguidos de los enfermeros y los auxiliares, con diferencias significativas en 17 cuestiones. CONCLUSIONES: Los profesionales reconocen la importancia de cuidar la dimensión espiritual y/o religiosa, con algunas diferencias entre categorías profesionales, sexo y edad. La formación en estos temas favorecería una atención más integral y de calidad en la asistencia.

Cuidando con sentido: la atención de lo espiritual en la práctica clínica desde la perspectiva del profesional / Caring with meaning: the spiritual care in healthcare from the professional's perspective

OBJETIVO: La calidad en la humanización de la asistencia sanitaria implica el cuidado integral de los pacientes, considerando todas las facetas de la persona, incluida también su dimensión espiritual y religiosa. El objetivo de este estudio fue conocer la visión de los profesionales respecto al cuidado de esta dimensión en los pacientes atendidos en un hospital comarcal. METODOS: Se realizó un estudio descriptivo transversal, mediante una encuesta ad-hoc a profesionales sanitarios con 30 cuestiones (según escala de Likert, de 0=totalmente en desacuerdo a 4=totalmente de acuerdo), realizada en abril de 2017. El tamaño muestral necesario fue de 238. Se analizó con SPSS v19.0, se describieron la frecuencia absoluta y el porcentaje de acuerdos con cada cuestión, y se usó Chi-Cuadrado para valorar la asociación de las respuestas con el sexo y la categoría profesional, y ANOVA para la edad. RESULTADOS: Se reclutaron 302 participantes. El 95,5% de mujeres destacó la importancia de crear un ambiente para que el paciente exprese su dimensión espiritual y/o religiosa, frente al 87,6% de hombres. A mayor edad, los profesionales diferenciaron mejor los conceptos de espiritualidad y religiosidad, y coincidieron en que ambas dimensiones afectaban al enfermo (diferencias entre 5-8 años de edad media). Los médicos estuvieron más de acuerdo con la importancia de la espiritualidad, seguidos de los enfermeros y los auxiliares, con diferencias significativas en 17 cuestiones. CONCLUSIONES: Los profesionales reconocen la importancia de cuidar la dimensión espiritual y/o religiosa, con algunas diferencias entre categorías profesionales, sexo y edad. La formación en estos temas favorecería una atención más integral y de calidad en la asistencia

OBJECTIVE: To treat whole patient, spiritual and religious dimension included, allows improve the quality humanization healthcare. The aim of this study was to know the point of professional view regarding to assess this dimensions in patients attended in regional hospital. METHODS: Cross-sectional descriptive study, through an ad-hoc survey with 30 issues (Likert 0: strongly disagree with 4: strongly agree), to health professionals, conducted in April 2017. Necessary sample size: 238. The SPSS (v19.0) statistical analysis was used. We calculated the absolute frequency and percentage of answers with each question and we used Chi-Square to assess the association of the answers with sex and professional category and ANOVA for age. RESULTS: We recruited 302 participants. 95.5% of women stand out the importance of creating an environment to express their spiritual and/or religious dimension the patient, compared to 87.6% of men (p = 0.017). At an older age, professionals differentiated the concepts of spirituality and religiosity better and agreed that both dimensions affected the patient (differences between 5-8 years of average age). The doctors were more in agreement with the importance of spirituality, followed by nurses and less auxiliaries, with significant differences in 17 issues. CONCLUSIONS: The professionals recognized the importance of taking care of the spiritual and/or religious dimension, with some differences between professional categories, sex and age. Training in these subjects would favor a more comprehensive and quality assistance

[Spanish home enteral nutrition registry of the year 2016 and 2017 from the NADYA-SENPE Group]. / Registro del grupo nadya-senpe de nutrición enteral domiciliaria en españa; años 2016 y 2017.

INTRODUCTION: Objective: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2016 and 2017. Material and methods: from January 1st 2016 to December 31st 2017, the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: in 2016, 4,578 active patients were recorded and prevalence was 98.33 patients per one million inhabitants; in 2017, 4,777 patients were recorded, with a prevalence of 102.57 per one million inhabitants; 50.8% were males in 2016 and 50.5% in 2017. During the period 2016-17, median age was 71.5 years (IIQ 57-83), 1,558 HEN episodes were finished and the main cause was death (793 patients, 50.89%). Adult males were younger than females (65.3 vs. 73.3 years, p-value < 0.001). The most frequent diagnosis was the neurological disorder that presents with aphagia or severe dysphagia (59%). Nasogastric tube was the most frequent administration route (48.3%) and it is the most widely used in elderly patients (p < 0.001). One hundred and twenty-six pediatric patients were registered (57.1% females). Median age at the beginning of HEN in children was four months. "Other disorders" was the most recorded diagnostic group (41.3%), followed by the group of neurological disorder that presents with aphagia or severe dysphagia. Regarding children, 57.6% were fed through gastrostomy and the younger ones were fed through nasogastric tube (p-value 0.001). Conclusions: the number of patients in the registry, as well as the number of participating centers, is progressively increasing. The main characteristics of the patients have not changed. Despite the increase in diagnostic possibilities in the pediatric population, the classification within the group of "Other pathologies" is quite significant.

INTRODUCCIÓN: Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías.

Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España; años 2016 y 2017 / Spanish home enteral nutrition registry of the year 2016 and 2017 from the NADYA-SENPE Group

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías

Objective: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2016 and 2017. Material and methods: from January 1st 2016 to December 31st 2017, the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: in 2016, 4,578 active patients were recorded and prevalence was 98.33 patients per one million inhabitants; in 2017, 4,777 patients were recorded, with a prevalence of 102.57 per one million inhabitants; 50.8% were males in 2016 and 50.5% in 2017. During the period 2016-17, median age was 71.5 years (IIQ 57-83), 1,558 HEN episodes were finished and the main cause was death (793 patients, 50.89%). Adult males were younger than females (65.3 vs. 73.3 years, p-value < 0.001). The most frequent diagnosis was the neurological disorder that presents with aphagia or severe dysphagia (59%). Nasogastric tube was the most frequent administration route (48.3%) and it is the most widely used in elderly patients (p < 0.001). One hundred and twenty-six pediatric patients were registered (57.1% females). Median age at the beginning of HEN in children was four months. "Other disorders" was the most recorded diagnostic group (41.3%), followed by the group of neurological disorder that presents with aphagia or severe dysphagia. Regarding children, 57.6% were fed through gastrostomy and the younger ones were fed through nasogastric tube (p-value 0.001). Conclusions: the number of patients in the registry, as well as the number of participating centers, is progressively increasing. The main characteristics of the patients have not changed. Despite the increase in diagnostic possibilities in the pediatric population, the classification within the group of "Other pathologies" is quite significant

Reduced interference in working memory following mindfulness training is associated with increases in hippocampal volume.

Proactive interference occurs when previously relevant information interferes with retaining newer material. Overcoming proactive interference has been linked to the hippocampus and deemed critical for cognitive functioning. However, little is known about whether and how this ability can be improved or about the neural correlates of such improvement. Mindfulness training emphasizes focusing on the present moment and minimizing distraction from competing thoughts and memories. It improves working memory and increases hippocampal density. The current study examined whether mindfulness training reduces proactive interference in working memory and whether such improvements are associated with changes in hippocampal volume. 79 participants were randomized to a 4-week web-based mindfulness training program or a similarly structured creative writing active control program. The mindfulness group exhibited lower proactive interference error rates compared to the active control group following training. No group differences were found in hippocampal volume, yet proactive interference improvements following mindfulness training were significantly associated with volume increases in the left hippocampus. These results provide the first evidence to suggest that (1) mindfulness training can protect against proactive interference, and (2) that these benefits are related to hippocampal volumetric increases. Clinical implications regarding the application of mindfulness training in conditions characterized by impairments to working memory and reduced hippocampal volume such as aging, depression, PTSD, and childhood adversity are discussed.

Correction to: Reduced interference in working memory following mindfulness training is associated with increases in hippocampal volume.

The article Reduced interference in working memory following mindfulness training is associated with increases in hippocampal volume, written by Jonathan Greenberg, Victoria L. Romero, Seth Elkin-Frankston, Matthew A. Bezdek, Eric H. Schumacher, and Sara W. Lazar.

Mindfulness-based training with transcranial direct current stimulation modulates neuronal resource allocation in working memory: A randomized pilot study with a nonequivalent control group.

Mindfulness-based training (MBT) and transcranial electrical stimulation (TES) methods such as direct current stimulation (tDCS) have demonstrated promise for the augmentation of cognitive abilities. The current study investigated the potential compatibility of concurrent "electrical" MBT and tDCS (or eMBT) by testing its combined effects on behavioral and neurophysiological indices of working memory (WM) and attentional resource allocation. Thirty-four healthy participants were randomly assigned to either a MBT task with tDCS group (eMBT) or an active control training task with sham tDCS (Control) group. Training lasted 4-weeks, with up to twenty MBT sessions and with up to eight of those sessions that were eMBT sessions. Electroencephalography was acquired during varying WM load conditions using the n-back task (1-, 2-, 3-back), along with performance on complex WM span tasks (operation and symmetry span) and fluid intelligence measures (Ravens and Shipley) before and after training. Improved performance was observed only on the 3-back and spatial span tasks for eMBT but not the Control group. During 3-back performance in the eMBT group, an increase in P3 amplitude and theta power at electrode site Pz was also observed, along with a simultaneous decrease in frontal midline P3 amplitude and theta power compared to the Control group. These results are consistent with the neural efficiency hypothesis, where higher cognitive capacity was associated with more distributed brain activity (i.e., increase in parietal and decrease in frontal amplitudes). Future longitudinal studies are called upon to further examine the direct contributions of tDCS on MBT by assessing the differential effects of electrode montage, polarity, current strength and a direct contrast between the eMBT and MBT conditions on performance and neuroimaging outcome data. While preliminary, the current results provided evidence for the potential compatibility of using eMBT to modulate WM capacity through the allocation of attention and its neurophysiological correlates.

OPTIMIZACIÓN DE PARÁMETROS PARA LA CONSTRUCCIÓN DE LA CURVA DE RUPTURA EN LA ADSORCIÓN DE Cr(VI) SOBRE CÁSCARA DE CACAO / PARAMETER OPTIMIZATION FOR Cr(VI) ADSORPTION BREAKDOWN CURVES ONTO COCOA SHELL

RESUMEN El objetivo de la presente investigación fue evaluar la cáscara de la mazorca cacao (Theobroma cacao L.) para su uso en la adsorción de cromo hexavalente en solución acuosa, usando columna de lecho empacado, aplicando el método de superficie de respuesta (MSR), con el fin de determinar los valores óptimos de las variables incidentes en el proceso y, posteriormente, con estos valores, realizar los ensayos de adsorción. Se utilizó un diseño de experimentos compuesto central con puntos estrellas. La biomasa, se lavó, se secó, se disminuyó tamaño y se tamizó; los experimentos, se llevaron a cabo a 25°C, a diferentes tamaños de partícula, de caudal y de cantidad de biomasa, en columnas en sistema en continuo, obteniéndose un porcentaje de remoción de 39,16%, de Cr(VI). Al realizar los experimentos en sistema por lotes, se obtuvo que a tamaño de partícula 0,355mm, se favorece la adsorción. De los ensayos de adsorción en columna, utilizando los parámetros óptimos arrojados obtenidos por el MSR, se obtuvo un porcentaje de remoción de 62,65%, encontrando que los modelos de Yoon-Nelson y Thomas fueron los que ajustaron los datos experimentales de la curva de ruptura, con R2= 0,98. Se concluye que la cáscara de cacao es un buen precursor de bioadsorbentes y que las variables más influyentes en la adsorción de Cr(VI) en sistema por lotes y continuo son el tamaño de partícula y la altura del lecho.

SUMMARY The aim of the present investigation was to evaluate the cocoa shell (Theobroma cacao L.) for its use in the adsorption of hexavalent chromium in aqueous solution using packed bed column, applying the surface response method (SRM) in order to determine the optimum values of the variables involved in the process. The adsorption tests were carried out with these values. Was used a central composite experiment design with star points. The biomass was washed, dried, decreased size and sieved; the experiments were carried out at 25°C, at different particle sizes, flow rate and amount of biomass, in columns in continuous system; obtaining a percentage of removal of 39.16% of C (VI). Was obtained when performing the experiments in batch system that at a size of 0.355mm particle favors the adsorption. From the adsorption tests in the column using the optimum parameters obtained by the MSR, was obtained a removal percentage of 62.65%; finding that the models of Yoon-Nelson and Thomas were those that adjusted the experimental data of the rupture curve, with R2 =0.98. It's concluded that the cocoa shell is a good precursor of bioadsorbents and that the most influential variables in Cr (VI) adsorption in batch and continuous systems are particle size and bed height.

Functional connectivity within and between intrinsic brain networks correlates with trait mind wandering.

Individual differences across a variety of cognitive processes are functionally associated with individual differences in intrinsic networks such as the default mode network (DMN). The extent to which these networks correlate or anticorrelate has been associated with performance in a variety of circumstances. Despite the established role of the DMN in mind wandering processes, little research has investigated how large-scale brain networks at rest relate to mind wandering tendencies outside the laboratory. Here we examine the extent to which the DMN, along with the dorsal attention network (DAN) and frontoparietal control network (FPCN) correlate with the tendency to mind wander in daily life. Participants completed the Mind Wandering Questionnaire and a 5-min resting state fMRI scan. In addition, participants completed measures of executive function, fluid intelligence, and creativity. We observed significant positive correlations between trait mind wandering and 1) increased DMN connectivity at rest and 2) increased connectivity between the DMN and FPCN at rest. Lastly, we found significant positive correlations between trait mind wandering and fluid intelligence (Ravens) and creativity (Remote Associates Task). We interpret these findings within the context of current theories of mind wandering and executive function and discuss the possibility that certain instances of mind wandering may not be inherently harmful. Due to the controversial nature of global signal regression (GSReg) in functional connectivity analyses, we performed our analyses with and without GSReg and contrast the results from each set of analyses.

[Avoidable Hospital Admissions for Heart Failure, Spain]. / Hospitalizaciones evitables por insuficiencia cardíaca.Variables implicadas.

OBJECTIVE: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure. METHODS: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; Chi-square test and Fisher exact test for qualitative variables. RESULTS: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had New York Health Association (NYHA) class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; re-vascularization; inclusion in the COMPARTE Program; treatment change decompensation. CONCLUSIONS: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process.

OBJETIVO: Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca. METODOS: Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la poblacion de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y Chi2 y Fisher para cualitativas. RESULTADOS: Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con New Yorl Health Asosiation (NYHA) grado III y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes mellitus(57,3%), enfermedad renal crónica (56,4%),anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes. CONCLUSIONES: Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betablo¬queantes y la no inclusión del paciente en el proceso asistencial.

Accuracy of a Genetic Test for the Diagnosis of Hypolactasia in Chilean Children: Comparison With the Breath Test.

BACKGROUND: Lactase nonpersistence (LNP) in humans is a genetically determined trait. This age-dependent decrease of lactase expression is most frequently caused by single nucleotide polymorphisms in the regulatory region of the lactase (LCT) gene. The homozygous LCT-13,910C/C genotype (rs 4988235) predominates in Caucasian adults with LNP, and is useful for its diagnosis in this population. The accuracy of this genetic test (GT) has not been completely established in children or in a Latin-American population. OBJECTIVES: The aim of the study was to determine diagnostic accuracy of GT for LNP in Chilean children using the lactose breath test (BT) as a reference, and to compare diagnostic yield in preschool- (<6 years) and in school-age (≥6 years) children. METHODS: Children referred for BT for diagnosis of lactose malabsorption to the Gastroenterology Laboratory at Clínica Alemana, Santiago, from October 2011 to March 2012 were invited to participate. After informed consent, symptom questionnaires, both historic and post lactose ingestion were completed. H2 and CH4 in expired air and -13,910 C>T single nucleotide polymorphism by polymerase chain reaction, restriction enzyme analysis, and/or Sanger sequencing were determined. GT accuracy was calculated compared to BT as reference method. Diagnostic yield of GT in preschool- and school-age children was compared. RESULTS: Lactose malabsorption was detected by BT in 42 of 60 children (70%). Genotype -13,910C/C was identified in 41 of 60 patients (68%). GT showed 80% sensitivity, 63% specificity, and 74% accuracy for LNP in the preschool population. In school-age children values were higher, 85%, 80%, and 84%, respectively. CONCLUSIONS: GT results were significantly concordant with BT results for hypolactasia detection in Chilean children, particularly in those of age 6 years and older.

Hospitalizaciones evitables por insuficiencia cardíaca. Variables relacionadas / Avoidable hospital admissions for heart failure, Spain

Fundamentos: Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca. Métodos: Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la poblacion de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y λ2 y Fisher para cualitativas. Resultados: Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con grado III de la NYHA y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes (57,3%), enfermedad renal crónica (56,4%), anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes. Conclusiones: Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betabloqueantes y la no inclusión del paciente en el proceso asistencial (AU)

Background: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure to prevent further unplanned admissions. Methods: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; λ2 test and Fisher exact test for qualitative variables. Results: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had NYHA class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; revascularization; inclusion in the COMPARTE Program; treatment change decompensation. Conclusiones: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process (AU)

Análisis de la influencia de la información sobre la ansiedad y el dolor en la mamografía / Analysis of influence of information on anxiety and pain in mammography

Objetivo: Analizar el efecto de una intervención (información ampliada) frente a la práctica habitual (información básica) en mujeres que se van a realizar una mamografía sobre la percepción del dolor y ansiedad (pre y posmamografía). Pacientes y métodos: Se realizó un ensayo clínico controlado y con asignación aleatoria a un grupo de intervención (información ampliada) y a uno de control (información básica) de mujeres derivadas para la realización de una mamografía a la Unidad Funcional de Radiodiagnóstico. Las 2 variables principales del estudio fueron el dolor tras la mamografía (escala visual analógica de 0 a 10) y la ansiedad pre y posmamografía (subescala estado del cuestionario de ansiedad estado-rasgo de Spielberger). Otras variables que se tuvieron en cuenta fueron: servicio remitente, existencia de antecedentes familiares de cáncer de mama, densidad de la mama, nivel de estudios alcanzado y si era la primera vez que se realizaba una mamografía. Resultados: No se observaron diferencias significativas entre grupos en cuanto a las variables de resultado: dolor y ansiedad pre y posmamografía. Sin embargo, en el grupo experimental se observó un descenso significativo con respecto a sus puntuaciones pre-mamografía de ansiedad (p < 0,05). En cuanto al dolor, encontramos diferencias significativas en las mujeres que acudían por primera vez a una mamografía en el grupo de intervención (5 vs. 2,9; p < 0,05). Conclusiones: Tras nuestra intervención, comprobamos que los niveles de ansiedad tras la mamografía disminuyen, así como los niveles de dolor en aquellas mujeres que no se habían realizado mamografías previamente (AU)

Objectives: To analyze the effect of an information intervention (extended information), instead of common practice (basic information) on women undergoing a mammogram, on pain and anxiety (before and after mammogram). Patients and methods: A controlled clinical trial was performed, with random assignment to a control group (basic information) and an intervention group (extended information) of women undergoing a mammogram in Radiology Unit. The two main variables studied were pain after mammogram (Analog Visual Scale from 1 to 10) and level of anxiety before and after the mammogram (the Spielberger State Trait Anxiety Inventory). Other variables were analyzed, such as the service requesting, family background of breast cancer, education, breast density, and whether the women were undergoing mammography for the first time. Results: No significant differences between women receiving more detailed information and those receiving general information were found in anxiety of pain levels. However, pre-mammogram anxiety levels were significantly decreased after the mammogram in the intervention group (p<.05). Significant differences in pain levels were found in women undergoing a first mammogram in the intervention group (5 vs 2.9, p<0.05). Conclusions: In the intervention group, post-mammogram anxiety levels were lower than pre-mammogram levels, while pain levels were lower in women undergoing a first mammogram (AU)

Resultados de un programa de telemedicina para pacientes con diabetes tipo 2 en atención primaria / Results of a telemedicine program for primary care patients with type 2 diabetes

Objetivo: Evaluar la repercusión de un programa de telemedicina en el estado de salud percibido de pacientes con diabetes tipo 2 en atención primaria, así como la aceptación y el grado de satisfacción de los pacientes. Método: Mediante un diseño no experimental (reflexivo) antes-después se realizó, a través de telemedicina, un seguimiento de 18 meses en 52 pacientes con diabetes. Además de la transmisión electrónica semanal de la glucemia basal, periódicamente se proporcionó a los pacientes recomendaciones sobre hábitos saludables. Resultados: Al comparar los valores medios de glucemia a lo largo del seguimiento no se observaron diferencias estadísticamente significativas. Sin embargo, al finalizar la participación, la puntuación en el estado de salud autopercibido aumentó significativamente respecto a la valoración inicial (70,5 ± 12,8 frente a 62,8 ± 15,0; p = 0,02). Tras 18 meses de participación en el programa de telemedicina se manifestaron satisfechos el 57,7% y muy satisfechos el 38,5%. Conclusiones: Aunque no se ha observado una mejoría en el control glucémico a lo largo del seguimiento, la transmisión electrónica de la información ha resultado viable y satisfactoria para los pacientes, en quienes se ha comprobado un mayor nivel de salud percibida (AU)

Objective: To evaluate the impact of a telemedicine program on self-perceived health in patients with type 2 diabetes in primary care, as well as patient acceptance of and satisfaction with this program. Method: We conducted an 18-month follow-up through telemedicine in 52 diabetic patients. The study design was non-experimental (before and after). In addition to weekly electronic transmission of fasting glucose levels, we regularly provided advice to patients about healthy habits. Results: No statistically significant differences were observed when mean blood glucose values were compared during follow-up. However, at the end of participation, the mean score in self-perceived health was significantly higher than at the initial assessment (70.5 ± 12.8 vs. 62.8 ± 15.0, p = 0.02). After 18 months of participation in the telemedicine program, 57.7% of patients were satisfied and 38.5% were very satisfied. Conclusions: Although glycemic control did not improve during the follow-up, electronic transmission of information was found to be feasible and satisfactory for patients. The patients reported a higher level of self-perceived health (AU)

[Results of a telemedicine program for primary care patients with type 2 diabetes]. / Resultados de un programa de telemedicina para pacientes con diabetes tipo 2 en atención primaria.

OBJECTIVE: To evaluate the impact of a telemedicine program on self-perceived health in patients with type 2 diabetes in primary care, as well as patient acceptance of and satisfaction with this program. METHOD: We conducted an 18-month follow-up through telemedicine in 52 diabetic patients. The study design was non-experimental (before and after). In addition to weekly electronic transmission of fasting glucose levels, we regularly provided advice to patients about healthy habits. RESULTS: No statistically significant differences were observed when mean blood glucose values were compared during follow-up. However, at the end of participation, the mean score in self-perceived health was significantly higher than at the initial assessment (70.5±12.8 vs. 62.8±15.0, p=0.02). After 18 months of participation in the telemedicine program, 57.7% of patients were satisfied and 38.5% were very satisfied. CONCLUSIONS: Although glycemic control did not improve during the follow-up, electronic transmission of information was found to be feasible and satisfactory for patients. The patients reported a higher level of self-perceived health.

Exploración de expectativas en la población de referencia de un hospital de tercer nivel / Survey of user expectations in the reference population of an acute care hospital

Objetivo: Conocer las expectativas de la población a la que da cobertura el Hospital San Juan de Dios del Aljarafe con respecto a la cartera de servicios y atención prestada, conocer qué aspectos de laasistencia valoran más y cuáles menos y acercar a la población general la cartera de servicios que se presta.Material y método: Estudio transversal en el que participan 66 ciudadanos del Distrito Sanitario Aljarafe, distribuidos en 9 grupos focales según la edad.Resultados: Se recogen 148 expectativas que se agrupan en 8 temas y 20 categorías. Las expectativas más citadas son: información médica según pacientes y familiares demanden, conocer todos los servicios del hospital y trato amable y humano a pacientes y familiares.Sobre accesibilidad: listas de espera mínimas, mayor servicio de autobuses, mejor gestión de las citas y que se ofrezcan todas las especialidades. Otros aspectos citados: buena limpieza en las instalaciones,habitaciones individuales y confortables, coordinación yseguimiento entre atención primaria y especializada.Conclusiones: Entre las expectativas manifestadas, se identifican aspectos que causan gran satisfacción (habitaciones individuales,trato amable), otros bien valorados, aunque el deseo es mejorarlos (listas de espera, realización de pruebas diagnósticas, gestión de citas), y aspectos claramente mejorables (transporte, más información, dar a conocer la cartera de servicios y ofrecer más especialidades)

Objective: To study user expectations on the portfolio of services and the care provided in the hospital San Juan de Dios del Aljarafe; to find out which aspects of the care provided are the most and least valued by the users; to provide more knowledge on the portfolioof services to the general public.Materials and method: We carried out a cross-sectional study in which 66 users of the Aljarafe healthcare district took part. They were divided into 9 focus groups according to age.Results: We collected 148 responses on expectations that were classified into 8 subjects and 20 categories. The most common responses were: to have medical information on demand for patients and relatives, to get to know all the services provided by the hospital and to receive a friendly and humane treatment from the professionals.In terms of accessibility, the most common responses were: to have minimum waiting lists, to have a better bus service, to improve the management of appointments and that all medical specialties are offered.Other aspects mentioned were: appropriate cleanliness of the premises, single and comfortable rooms and patient follow-up and coordination between primary care and specialised care.Conclusions: Among the types of expectations expressed by users, we identified aspects that produce great satisfaction (such as single roomsand friendly treatment), aspects that are well valued but need to be improved (such as those concerning waiting lists, performance of diagnostic tests and management of appointments) and aspects thatare clearly improvable (such as transport, information, knowledge about the portfolio of services and the offer of medical specialties)

[Not Available]. / Exploración de expectativas en la población de referencia de un hospital de tercer nivel.

OBJECTIVE: To study user expectations on the portfolio of services and the care provided in the hospital San Juan de Dios del Aljarafe; to find out which aspects of the care provided are the most and least valued by the users; to provide more knowledge on the portfolio of services to the general public. MATERIALS AND METHOD: We carried out a cross-sectional study in which 66 users of the Aljarafe healthcare district took part. They were divided into 9 focus groups according to age. RESULTS: We collected 148 responses on expectations that were classified into 8 subjects and 20 categories. The most common responses were: to have medical information on demand for patients and relatives, to get to know all the services provided by the hospital and to receive a friendly and humane treatment from the professionals. In terms of accessibility, the most common responses were: to have minimum waiting lists, to have a better bus service, to improve the management of appointments and that all medical specialties are offered. Other aspects mentioned were: appropriate cleanliness of the premises, single and comfortable rooms and patient follow-up and coordination between primary care and specialised care. CONCLUSIONS: Among the types of expectations expressed by users, we identified aspects that produce great satisfaction (such as single rooms and friendly treatment), aspects that are well valued but need to be improved (such as those concerning waiting lists, performance of diagnostic tests and management of appointments) and aspects that are clearly improvable (such as transport, information, knowledge about the portfolio of services and the offer of medical specialties).