RESUMO
Pancreatic ß-cells respond to metabolic stress by upregulating insulin secretion, however the underlying mechanisms remain unclear. Here we show, in ß-cells from overweight humans without diabetes and mice fed a high-fat diet for 2 days, insulin exocytosis and secretion are enhanced without increased Ca2+ influx. RNA-seq of sorted ß-cells suggests altered metabolic pathways early following high fat diet, where we find increased basal oxygen consumption and proton leak, but a more reduced cytosolic redox state. Increased ß-cell exocytosis after 2-day high fat diet is dependent on this reduced intracellular redox state and requires the sentrin-specific SUMO-protease-1. Mice with either pancreas- or ß-cell-specific deletion of this fail to up-regulate exocytosis and become rapidly glucose intolerant after 2-day high fat diet. Mechanistically, redox-sensing by the SUMO-protease requires a thiol group at C535 which together with Zn+-binding suppresses basal protease activity and unrestrained ß-cell exocytosis, and increases enzyme sensitivity to regulation by redox signals.
Assuntos
Dieta Hiperlipídica , Exocitose , Animais , Humanos , Camundongos , Cisteína Endopeptidases/genética , Citosol , Dieta Hiperlipídica/efeitos adversos , Glucose , Peptídeo HidrolasesRESUMO
Due to a worldwide response to the COVID-19 pandemic, many changes were imposed on individuals' daily lives, including those related to the physical activity of children and adolescents. The present study aims to comprehend the impact of early COVID-19 pandemic restrictions on Portuguese adolescents' physical fitness parameters during two school years. A total of 640 students from the 5th to the 12th grades participated in the longitudinal study. Data on body composition, aerobic fitness, speed, agility, lower and upper body strength, and flexibility were collected at three moments: 1. before the COVID-19 pandemic (December 2019); 2. after the COVID-19 lockdown when the schools reopened delivering in-person classes (October 2020), and 3. two months after the in-person classes started (December 2020). To analyze the overall changes between the three moments and between two age groups, we conducted repeated measure ANOVAs. The main findings indicate that participants' body composition (i.e., waist circumference) and aerobic fitness (i.e., maximal oxygen uptake) deteriorated after the first lockdown but improved two months after the in-person classes started. However, the same did not happen to neuromuscular fitness (i.e., horizontal Jumps and Sit and Reach). These findings suggest that the COVID-19 lockdown may have negatively impacted adolescents' physical fitness, particularly older adolescents. Altogether, data reinforce the importance of in-person classes and school context in promoting adolescents' physical health.
Assuntos
COVID-19 , Criança , Humanos , Adolescente , Estudos Longitudinais , Pandemias , Portugal , Controle de Doenças Transmissíveis , Aptidão Física/fisiologiaRESUMO
OBJECTIVE: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well as their related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively in health in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep of a subpopulation of young students. METHODS: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High school of Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, the survey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test or Mann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done. RESULTS: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of them owned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8) than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors, such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night (OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined as protector factor (OR=0.43; CI95% [0.26-0.72]). CONCLUSIONS: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showing differences between genders.
OBJETIVO: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación (TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidad del sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociación de los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes. METODOS: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria de Alcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentes variables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t de student o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística. RESULTADOS: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%. El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de 6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornos de sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de la noche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector (OR=0,43 IC95% [0,26-0,72]). CONCLUSIONES: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inadecuado de las TIC, existiendo diferencias claras entre hombres y mujeres.
Assuntos
Transtornos do Sono-Vigília , Sono , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Estudos Transversais , Espanha/epidemiologia , EstudantesRESUMO
The identification of vertebral fracture is a key point in an FLS. We have analyzed the characteristics of 570 patients according to the route of identification (referral by other doctors, emergency registry or through VFA), concluding that promoting referral by other doctors with a training campaign is effective. PURPOSE: Vertebral fractures (VF) are associated with increased risk of further VFs. Our objective was to analyze the characteristics of patients with VF seen in a Fracture Liaison Service (FLS). METHODS: An observational study was carried out on patients with VF referred to the outpatient metabolic clinic (OMC) after a training campaign, identified in the emergency registry, and captured by VF assessment with bone densitometry (DXA-VFA) in patients with non-VFs. Patients with traumatic VF or VF > 1 year, infiltrative or neoplastic disease were excluded. The number and severity of VFs (Genant) were analyzed. Treatment initiation in the first 6 months after baseline visit was reviewed. RESULTS: Overall, 570 patients were included, mean age 73. The most common route for identifying VF was through referral to OMC (303 cases), followed by the emergency registry (198) and DXA-VFA (69). Osteoporosis by DXA was found in 312 (58%) patients and 259 (45%) had ≥ 2 VFs. The rate of grade 3 VFs was highest among patients on the emergency registry. Those identified through OMC had a higher number of VFs, a higher rate of osteoporosis, more risk factors and greater treatment initiation. Patients with VFs detected by DXA-VFA were mostly women with a single VF and had a lower rate of osteoporosis by DXA. CONCLUSIONS: We present the distribution of VFs by the route of identification in an FLS. Promoting referral by other doctors with a training campaign may help in the quality improvement of the FLS-based model of care.
Assuntos
Fraturas Ósseas , Osteoporose , Médicos , Fraturas da Coluna Vertebral , Humanos , Feminino , Idoso , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Instituições de Assistência AmbulatorialRESUMO
OBJECTIVE: In non-alcoholic fatty liver disease (NAFLD), fibrosis determines the risk of liver complications. Non-invasive tests (NITs) such as FIB-4, NAFLD Fibrosis Score (NFS) and Hepamet, have been proposed as a tool to triage NAFLD patients in primary care (PC). These NITs include AST±ALT in their calculations. Many patients with NAFLD take statins, which can affect AST/ALT, but it is unknown if statin affects NITs fibrosis prediction. METHODS: We included 856 patients referred through a standardised pathway from PC with a final diagnosis of NAFLD. 832 had reliable vibration controlled transient elastography (VCTE) measurements. We assessed the effects of statins on the association between NITs and VCTE at different fibrosis thresholds. RESULTS: 129 out of 832 patients were taking a statin and 138 additional patients had indication for a statin. For any given FIB-4 value, patients on a statin had higher probabilities of high VCTE than patients not on a statin. Adjusting for body mass index, diabetes and age almost completely abrogated these differences, suggesting that these were related to patient's profile rather to a specific effect of statins. Negative predictive values (NPVs) of FIB-4 <1.3 for VCTE >8, 10, 12 and 16 were, respectively, 89, 94, 96% and 100% in patients on a statin and 92, 95, 98% and 99% in patients not on a statin. Statins had similar impact on Hepamet predictions but did not modify NFS predictions. CONCLUSION: In patients with NAFLD referred from PC, those on statins had higher chances of a high VCTE for a given FIB-4 value, but this had a negligible impact on the NPV of the commonly used FIB-4 threshold (<1.3).
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hepatopatia Gordurosa não Alcoólica , Fibrose , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Encaminhamento e ConsultaRESUMO
We analyzed the practical consequences of applying an adjusted FRAX® for recent fractures in a FLS. After analyzing 2777 patients, we concluded that the adjusted FRAX® is irrelevant when calculating FRAX® with DXA and is only useful for fractures of the humerus when DXA is not available. PURPOSE: A FRAX® adjusted to fractures less than 2 years old has been proposed. The objective of this work was to analyze the clinical implications of applying the adjusted FRAX® instead of the classic FRAX® in a fracture liaison service (FLS) unit. METHODS: Adults aged 50 years or older with fragility fractures (hip, spine, humerus, and forearm) that occurred in the 12 months prior to the baseline visit were included. We recorded demographic data, type of fracture, DXA, classic FRAX®, and FRAX® adjusted for recent fractures and indications for anti-osteoporotic medication (AOM) following the guidelines of the Spanish Society of Rheumatology. RESULTS: A total of 2777 patients were included, mean age 73 years, 84% women. The type of fracture was as follows: forearm (n = 958; 34.5%), hip (n = 781; 28.1%), humerus (n = 642; 23.1%), and spine (n = 397, 14.3%). DXA was performed in 2134 cases (76.8%). A total of 2522 patients (90.8%) were candidates for AOM (100% involving the hip and spine, 83% forearm, and 85% humerus). FRAX®-hip ≥ 3% increased from 1601 to 1775 cases (57.6 to 64%). The average FRAX®-hip (SD) increased from 5.7 (6) to 7.5 (9) (4.6 to 8.8 in males and 5.9 to 7.3 in females). The percentage of forearm fracture candidates for AOM, with or without DXA, did not change after FRAX®-hip adjustment, while the number of patients with humerus fractures increased from 59 to 80% in those who did not have DXA. In the entire sample, FRAX®-adjusted led to an indication of AOM for 15 additional patients (0.5% of major fractures): 14 with a humerus fracture and 1 with a forearm fracture. CONCLUSIONS: The adjusted FRAX® for recent fractures in an FLS unit in an adjusted FRAX® is irrelevant when calculating FRAX® with DXA; in fact, it is only useful for fractures of the humerus when DXA is not available.
Assuntos
Densidade Óssea , Fraturas do Quadril , Adulto , Idoso , Pré-Escolar , Feminino , Antebraço , Humanos , MasculinoRESUMO
The COVID-19 pandemic has placed today's society in an unprecedented scenario. During Portugal's first home confinement period (March-July 2020), the online-based "COVID-19 in Trials and Tribulations" project was implemented to support families with school-aged children. The project was grounded on the self-regulation framework and delivered through Facebook® and Instagram® pages. Being responsive to ongoing developments of the pandemic, activities were conveyed in two phases. Phase 1 occurred during lockdown (school was suspended). Phase 2 occurred while students were enrolled in at-distance (online) school. The present study aimed to examine the reach of the project, while examining the content and format of delivery that generated the most engagement among the users (4500 Facebook® effective followers; 1200 Instagram® effective followers) during the confinement period. Results showed that, at the individual page level, Facebook® had higher reach indicators compared to Instagram®, except for video. At the Facebook® post level, followers and users showed more engagement with the page prior to the at-distance schooling phase; however, videos still generated engagement (p = 0.002). Both the post type (p < 0.01) and frequency (p < 0.001) of publication were suggested to be good predictors of engagement. The information gathered will help design and inform future interventions that may be implemented as new lockdowns are set in place.
Assuntos
COVID-19 , Autocontrole , Mídias Sociais , Criança , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Rede SocialRESUMO
Sleep Procrastination literature has focused on the behaviors individuals engage in before going to bed (Bedtime Procrastination) but not on the behaviors individuals engage in after going to bed (While-in-Bed Procrastination). The main goal of this study is to explore whether this While-in-Bed procrastination is a novel phenomenon that adds to the Sleep Procrastination literature. The study was conducted online with 400 high school students (Mage = 16.56; 139 males) recruited through personal contacts and social media. The Bedtime procrastination scale was adapted and validated for this sample, whereas the While-in-Bed Procrastination scale was developed for this study. Data show a low correlation (r = 0.158 **) between Bedtime and While-in-Bed Procrastination scales, suggesting that Sleep Procrastination may be composed of the two facets. Additionally, results showed that more Bedtime Procrastination was related to later waking time and later dinnertime hours, whereas more While-in-Bed Procrastination was linked to being male, later desired time to sleep, and earlier dinnertime hour. Findings indicate that solely assessing Bedtime Procrastination as representing the procrastination of Sleep is limited and overlooks a significant part of this behavior. This exploratory study adds a new perspective to the literature by stressing the role of While-in-Bed Procrastination, thus opening new research pathways.
Assuntos
Procrastinação , Sono , Mídias Sociais , Adolescente , Feminino , Humanos , Masculino , Motivação , EstudantesRESUMO
The current study aimed to analyze the relationships between students' background variables (students' academic preparation and sociocultural status), students' cognitive and behavioral engagement, and an outcome variable (academic achievement). One sample of 380 first-year students who were studying in different scientific areas participated in the study. Students answered a questionnaire at the beginning and at the end of their first semester in college. To increase ecological validity, students' cognitive and behavioral engagement and academic achievement were assessed using a specific curricular subject of the course as a reference. Students' grades were collected through academic services. Data from both time points were analyzed with a structural equation model (SEM), and data showed a goodness of fit of SEM in both time points. Findings indicate that cognitive and behavioral engagement mediated the relationship between students' background variables and their academic achievement. The analysis of both SEM allows us to understand that academic achievement at the end of the semester is closely related to what happens at the beginning of the semester (e.g., approach to learning, study time). Thus, promoting students' engagement at the beginning of the semester should be considered a priority, as the first part of the first semester represents a critical period for students and for their integration in college. Thus, universities should consider improving their mechanisms of collecting information to allow for early identification, support, and monitoring of students at risk of dropping out, showing high level of disengagement and low academic achievement.
RESUMO
Students' writing constitutes a topic of major concern due to its importance in school and in daily life. To mitigate students' writing problems, school-based interventions have been implemented in the past, but there is still a need to examine the effectiveness of different types of writing interventions that use robust design methodologies. Hence, the present study followed a longitudinal cluster-randomized controlled design using a multilevel modeling analysis with 370 fourth-grade students (nested in 20 classes). The classes were randomly assigned to four conditions: one comparison group and three writing types of writing interventions (i.e., week-journals, Self-Regulation Strategy Development (SRSD) instruction and SRSD plus Self-Regulated Learning (SRL) program using a story-tool), with five classes participating in each condition. Data supports our hypothesis by showing differences between the treatment groups in students' writing quality over time. Globally, the improvement of students' writing quality throughout time is related to the level of specialization of the writing interventions implemented. This is an important finding with strong implications for educational practice. Week-journals and writing activities can be easily implemented in classrooms and provides an opportunity to promote students' writing quality. Still, students who participated in the instructional programs (i.e., SRSD and SRSD plus story-tool) exhibited higher writing quality than the students who wrote week-journals. Current data did not find statistical significant differences between results from the two instructional writing tools.
Assuntos
Aprendizagem , Instituições Acadêmicas , Estudantes , Redação , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Fundamentos: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación(TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidaddel sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociaciónde los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes.Métodos: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria deAlcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentesvariables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t destudent o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística.Resultados: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%.El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornosde sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de lanoche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector(OR=0,43 IC95% [0,26-0,72]).Conclusiones: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inade-cuado de las TIC, existiendo diferencias claras entre hombres y mujeres.(AU)
Background: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well astheir related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively inhealth in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep ofa subpopulation of young students.Methods: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High schoolof Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, thesurvey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test orMann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done.Results: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of themowned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8)than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors,such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night(OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined asprotector factor (OR=0.43; CI95% [0.26-0.72]).Conclusions: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showingdifferences between genders.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Estudantes , Sono , Transtornos do Sono-Vigília , Distúrbios do Início e da Manutenção do Sono , Tecnologia da Informação , Estudos Transversais , EspanhaRESUMO
Stomata are pores on the plant surface that enable gas exchange with the atmosphere. In Arabidopsis thaliana, brassinosteroids, which function upstream of the TTG/bHLHs/MYBs/GL2 transcriptional network, positively regulate stomatal formation in the hypocotyl. Gibberellins also promote stomatal development in the embryonic stem. Here, we investigated the hypothetical interactions between the gibberellin and brassinosteroid signaling pathways during stomatal formation. By combining genetics and gene expression studies, we found that gibberellins promote stomatal development, functioning upstream of both brassinosteroids and the TTG/bHLHs/MYBs/GL2 network. Gibberellins also regulate an earlier step in stomatal development than that regulated by the receptor-like membrane protein TOO MANY MOUTHS.
Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/crescimento & desenvolvimento , Brassinosteroides/metabolismo , Regulação da Expressão Gênica de Plantas , Giberelinas/metabolismo , Hipocótilo/crescimento & desenvolvimento , Estômatos de Plantas/crescimento & desenvolvimento , Arabidopsis/genética , Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Hipocótilo/genética , Hipocótilo/metabolismo , Estômatos de Plantas/genética , Estômatos de Plantas/metabolismo , Plântula/genética , Plântula/crescimento & desenvolvimento , Plântula/metabolismo , Transdução de SinaisRESUMO
Engaged students tend to show school-committed behaviors (e.g., attend classes, get involved with the learning process), high achievement, and sense of belonging. However, students with disabilities are prone to show a lack of engagement with school due to the specific difficulties they have to handle. In fact, children with disabilities are likely to show poor participation in school when compared with children without disabilities. This poor involvement is related to their low autonomy to participate in the school activities, which, in turn, results in low school engagement. Parents play a crucial role in their children's education. Parental involvement in school activities promotes autonomous behaviors and, consequently, school engagement. In fact, extant literature has shown close relationships between parental involvement, school engagement, and academic performance. Yet, parental involvement in school activities of children with Cerebral Palsy (CP) has received little direct attention from researchers. These children tend to display lower participation due to the motor, or cognitive, impairments that compromise their autonomy, and have a high likelihood to develop learning disabilities, with special incidences in reading and arithmetic. Therefore, our aim is twofold, to understand the parental styles; and how the perceived parental involvement in school activities is related to their children school engagement. Hence, 19 interviews were conducted with one of the parents of 19 children with CP. These interviews explored the school routines of children and the perceived involvement of parents in those routines. Additionally, children filled out a questionnaire on school engagement. Results show that the majority of the parents were clustered in the Autonomy Allowance and Acceptance and Support parental style, and the majority of their children were perceived as autonomous. Moreover, about a half of the children reported a high level of school engagement. Finally, neither children's autonomous behaviors reported by parents, nor parental style, seem to be related with the children's level of school engagement. Rehabilitation centers and schools could consider training parents/caregivers focusing on their educational needs, promotion of reflections on the usefulness of applying autonomy promotion strategies with their child, and foster their involvement.
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An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database includes cleaned data extracted from the EMRs of primary-care practitioners. The purpose of the study was to develop and validate a case definition of asthma in children 1-17 who consult family physicians, in order to provide primary-care estimates of childhood asthma in Alberta as accurately as possible. The validation involved the comparison of the application of a theoretical algorithm (to identify patients with asthma) to a physician review of records included in the CPCSSN database (to confirm an accurate diagnosis). The comparison yielded 87.4% sensitivity, 98.6% specificity and a positive and negative predictive value of 91.2% and 97.9%, respectively, in the age group 1-17 years. The algorithm was also run for ages 3-17 and 6-17 years, and was found to have comparable statistical values. Overall, the case definition and algorithm yielded strong sensitivity and specificity metrics and was found valid for use in research in CPCSSN primary-care practices. The use of the validated asthma algorithm may improve insight into the prevalence, diagnosis, and management of paediatric asthma in Alberta and Canada.
Assuntos
Algoritmos , Asma/epidemiologia , Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Adolescente , Alberta/epidemiologia , Asma/diagnóstico , Canadá , Criança , Pré-Escolar , Coleta de Dados , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Prevalência , Reprodutibilidade dos Testes , Vigilância de Evento SentinelaRESUMO
OBJECTIVE: To assess the major clinical factors affecting the quality of anticoagulation and evaluate the predictive value of the SAMe-TT2R2 score to identify patients who will achieve a high average time in therapeutic range (T.T.R.) with vitamin K antagonist (V.K.A.) treatment. RESEARCH DESIGN AND METHODS: This observational, cross-sectional, retrospective and nationwide multicenter study included 1524 patients from the primary care setting with non-valvular atrial fibrillation receiving V.K.A. (≥12 months). We performed a bivariate analysis to identify factors individually associated with the T.T.R. and a multiple regression analysis to identify the independent predictive factors. For the validation of the SAMe-TT2R2 score, the receiver operating characteristic (R.O.C.) curve was calculated and the Hosmer-Lemeshow test was used to test calibration. RESULTS: A total of 94.8% of patients received acenocumarol (4.8% warfarin). A progressive decrease in mean T.T.R. was found when the SAMe-TT2R2 score increased from 0 points (72.1 ± 17.1%) to 4 points (64.1 ± 23.2%), p < 0.001. Other risk scores (CHADS2 and CHA2DS2-VASc, HAS-BLED) were also associated with the mean T.T.R. We found a significant association between low T.T.R. and the following clinical factors: female sex, three or more comorbidities, amiodarone treatment, dietary habits, bleeding history and the intake of ≥7 tablets per day besides V.K.A. (p < 0.01). Regarding SAMe-TT2R2 score validation, the R.O.C. curve showed significant capability, although not high, of discriminating good anticoagulation control (T.T.R. ≥65%) with an area under the curve of 0.562 (95% C.I. 0.533-0.592, p < 0.001) which increased, remaining modest, to 0.594 (95% C.I. 0.564-0.624, p < 0.001) when the factors not included in SAMe-TT2R2 score were added. CONCLUSION: In this cohort, the SAMe-TT2R2 score had a significant, although modest, ability to assess the likelihood of good international normalized ration (I.N.R.) control, and its predictive value might slightly improve by adding other simple clinical factors. Further research is needed to refine the predictive scales.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Espanha/epidemiologia , Varfarina/uso terapêuticoRESUMO
OBJECTIVE: Determining the prevalence of post-traumatic stress disorder (PTSD) related to the type of war exposure and associated factors in school-aged children from three Colombian towns. METHODS: Cross-sectional epidemiological study. Representative randomised sample of 493 children aged 5-14. The children were evaluated during 2002 using semi-structured psychiatric interviews and the clinician administered PTSD scale. 167 children were evaluated in La Palma who had been chronically exposed to war, 164 in Arbeláez who had had recent war-exposure and 162 in Sopó who had not been exposed to war. War-related PTSD prevalence was calculated in each municipality. Odds ratio (OR) and chi-square were used for evaluating the association between exposure to war and PTSD and the related risk. Multivariate analysis used the logistic regression model. The affected children required specialised mental health counselling. RESULTS: The prevalence of PTSD resulting from war was 16,8 % in La Palma, 23,2 % in Arbeláez and 1.2% in Sopó. A 19.9 OR (CI 4.7, 119.2), 30,5 Chi-square and p = 0.000 revealed war-related PTSD association and risk for children when comparing the exposed towns to Sopó. The logistic regression showed that geographical closeness to war zone and intense emotional reaction to war increased the probability of war-related PTSD. Vulnerability factors were predominant in war-exposed towns. Poverty, parents' low educational level and child abuse predominated in La Palma. Attention-deficit and psychosomatic disorders were more prevalent in Arbeláez. CONCLUSIONS: War affects children's mental health; the children from the exposed towns had 19 times greater probability of war-related PTSD than those from a non-exposed town. Early therapeutic intervention is a public health priority. The results are useful for countries suffering from war, internal conflict and/or terrorism.
Assuntos
Transtornos de Estresse Pós-Traumáticos/epidemiologia , Guerra , Adolescente , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , PrevalênciaRESUMO
BACKGROUND: Homework is a universal practice used in schools, and is commonly related to academic achievement. According to literature, parental homework involvement has positive and negative aspects, depending on parents’ behaviors. METHOD: Assuming a phenomenographic perspective, this study examined 4th graders’ parents’ conceptions of their involvement in homework. With the purpose of mapping the parents’ various conceptions of homework involvement, 32 semi-structured interviews were conducted and analyzed. RESULTS: The results show that parents’ conceptions of homework involvement have a positive meaning, and focus primarily on the role played in the promotion of academic learning by (a) fostering their children’s autonomy, (b) exerting control over their learning, and (c) providing them with emotional encouragement (when children struggle with difficulties). CONCLUSIONS: Given that parents perceive their involvement in their children’s homework as important, it is necessary to promote parent-teacher collaboration and parent-training workshops to improve the quality of parental homework involvement.
Assuntos
Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , Adulto , Chile , Emoções , Feminino , Comportamento de Ajuda , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Motivação , Autonomia Pessoal , Instituições Acadêmicas , AutoimagemRESUMO
This study analyzed the effects of five types of homework follow-up practices (i.e., checking homework completion; answering questions about homework; checking homework orally; checking homework on the board; and collecting and grading homework) used in class by 26 teachers of English as a Foreign Language (EFL) using a randomized-group design. Once a week, for 6 weeks, the EFL teachers used a particular type of homework follow-up practice they had previously been assigned to. At the end of the 6 weeks students completed an EFL exam as an outcome measure. The results showed that three types of homework follow-up practices (i.e., checking homework orally; checking homework on the board; and collecting and grading homework) had a positive impact on students' performance, thus highlighting the role of EFL teachers in the homework process. The effect of EFL teachers' homework follow-up practices on students' performance was affected by students' prior knowledge, but not by the number of homework follow-up sessions.
RESUMO
OBJECTIVE: The aim was to analyze the psychometric properties of two screening instruments, Wender-Utah Rating Scale (WURS) that evaluates childhood ADHD and Adult ADHD Self-Report Scales (ASRS) that assesses symptoms in adulthood, in alcohol-dependent patients. METHOD: A total of 355 outpatients were included. Conners' adult ADHD diagnostic interview results were used as a gold standard in childhood and adulthood ADHD. RESULTS: The WURS with a 41 cutoff had a sensitivity of 79.6% and a specificity of 60.3%. The ASRS with a 14 cutoff had a sensitivity of 86.7% and specificity of 66.1%. Analyzing both rating scales in combination, it was observed that patients with positive ASRS and WURS presented a sensitivity of 92.3%. Patients with positive ASRS, but negative WURS, presented a specificity of 73.6%. CONCLUSION: WURS and ASRS are useful tools in the diagnosis of adult ADHD in alcohol-dependent patients; with the use of both instruments, the psychometric properties are substantially improved.
Assuntos
Alcoolismo/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Programas de Rastreamento/instrumentação , Psicometria/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Alcoolismo/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Autorrelato , Sensibilidade e Especificidade , UtahRESUMO
BACKGROUND: Although academic achievement is believed to be an important factor in students' decision to continue studying at university, research on this topic is limited. METHOD: The current study analyzed the relationship between academic achievement and the intention of 327 non-traditional students to continue studying at university, using a path model. RESULTS: The central hypothesis of the study was confirmed, as the intention to continue studying was determined by previous academic results, although the amount of variance explained was relatively low (13%). CONCLUSIONS: The results from this study indicate that the intention to continue studying at university depends less than expected on the performance achieved. So, universities should consider other variables such as the quality of the academic support offered to these students continue their studies.