Educational, Exercise, and Occupational Therapy-Based Telerehabilitation Program Versus "Wait-and-See" for Improving Self-perceived Exertion in Patients With Post-COVID Fatigue and Dyspnea: A Randomized Clinical Trial.

OBJECTIVE: The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN: Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods. RESULTS: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001). CONCLUSIONS: Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.

Frequency of Use, Perceptions and Barriers of Information and Communication Technologies Among Latin American Physicians: An Ecuadorian Cross-Sectional Study.

OBJECTIVE: In recent years, the use of information and communication technologies (ICTs) has increased in various sectors, among which the healthcare service is no exception. However, studies have mostly focused on the use of ICTs among patients with chronic diseases, with few reports on the advantages and barriers of these technologies among physicians, particularly in Latin America. We designed this study to fill in the gap, as an objective assessment of the frequency of use, perceptions, and barriers of ICTs among physicians remains crucial for a successful implementation of these technologies into the mainstream medical practice. METHODS: We conducted an anonymous cross-sectional survey-based study in 640 Ecuadorian physicians. The survey used consisted of 13 items and evaluated the frequency of use, perceptions, and barriers of ICTs among physicians. Chi-square tests for goodness of fit and independence were performed, whilst Phi coefficient was interpreted to assess the strength of associations. Fisher exact test was performed when required. RESULTS: Over 90% of physicians reported the use of ICTs to message other colleagues and patients (p=0.000). While 89.5% of physicians used social media to interact with other colleagues, only 58.1% used them to interact with patients (p=0.000). Most participants reported the use of ICTs to search for academic information (p=0.000). Moreover, more than 80.0% agree that ICTs may be used to promote health and medical services, search new job opportunities, get involved in research projects and promote teamwork with colleagues. However, 83.6% of physicians expressed concerns about privacy and patient confidentiality, while 53.8% stated that they lacked the time to use ICTs. CONCLUSION: High usage of ICTs was found among Ecuadorian physicians. Younger physicians, with less postgraduate years, and non-specialists were more likely to have a positive perception toward ICTs. Privacy and patient confidentiality, followed by time management, were the most reported barriers in our study.

Minimal Clinically Important Difference in Quality of Life for Patients With Low Back Pain.

STUDY DESIGN: Multicenter, prospective, cohort study. OBJECTIVE: To estimate the Minimal Clinically Important Difference (MCID) for the physical (PCS) and mental (MCS) component summaries of Short Form SF-12 (SF-12), in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: Quality of life is one of the core domains recommended to be assessed in patients with LBP. SF-12 is the most widely used instrument for this purpose, but its MCID was unknown. METHODS: A total of 458 patients with subacute and chronic LBP were consecutively recruited across 21 practices. LBP, referred pain, disability, PCS, and MCS were assessed upon recruitment and 12 months later. Self-reported health status change between baseline and 12 month-assessment, was used as the external criterion. The MCID for SF-12 was estimated following four anchor-based methods; minimal detectable change (MDC); average change (AC); change difference (CD); and receiver operating characteristic curve (ROC), for which the area under the curve (AUC) was calculated. The effect on MCID values of pain duration and baseline scores was assessed. RESULTS: Values for PCS were: MDC: 0.56, AC: 2.71, CD: 3.29, and ROC: 1.14. Values for MCS were: MDC: 3.77, AC: 3.54, CD: 1.13, and ROC: 4.23. AUC values were <0.7; MCID values were smaller among chronic patients and those with better baseline quality of life. CONCLUSION: Different methods for MCID calculation lead to different results. In patients with subacute and chronic LBP, improvements >3.77 in MCS and >3.29 in PCS, can be considered clinically relevant. MCID is smaller in patients with longer pain duration and better baseline quality of life. LEVEL OF EVIDENCE: 2.

Effectiveness of the Godelieve Denys-Struyf (GDS) method in people with low back pain: cluster randomized controlled trial.

BACKGROUND: The Godelieve Denys-Struyf method (GDS) is a motor learning intervention that may be applied in group or individualized sessions. OBJECTIVE: The study objective was to compare the effectiveness of routine physical therapy, group GDS (GDS-G) sessions, and group and individualized GDS (GDS-I) sessions. DESIGN: This was a cluster randomized controlled trial. SETTING: The study took place in 21 primary care physical therapy units ("clusters") of the Spanish National Health Service (SNHS). PARTICIPANTS: The participants were 461 people with subacute and chronic low back pain (LBP). INTERVENTION: Clusters were randomized into 3 groups. All participants received medical treatment and a 15-minute group education session on active management. Additional interventions were as follows: control (fifteen 40-minute sessions of transcutaneous electrical nerve stimulation, microwave treatment, and standardized exercises), GDS-G (eleven 50-minute group GDS sessions), and GDS-I (the same 11 sessions plus four 50-minute individualized GDS sessions). MEASUREMENTS: Primary outcomes at baseline and 2, 6, and 12 months later were LBP and pain referred down the leg (separate pain intensity numeric rating scales) and disability (Roland-Morris Questionnaire [RMQ]). Secondary outcomes were use of medication and self-reported health (mental and physical component summaries of the 12-Item Short-Form Health Survey [SF-12]). Separate linear mixed models for LBP, pain referred down the leg, and disability were developed to adjust for potential confounders. Randomization, outcome assessment, and data analyses were masked. RESULTS: At 12 months, disability improved 0.7 (95% confidence interval [CI]=-0.4, 1.8) RMQ point in the control group, 1.5 (95% CI=0.4, 2.7) RMQ points in the GDS-I group, and 2.2 (95% CI=1.2, 3.2) RMQ points in the GDS-G group. There were no differences in pain. LIMITATIONS: The amount of exercise was smaller in the control group, and GDS-I sessions were provided by junior physical therapists. CONCLUSIONS: The improvement in disability was slightly higher with group GDS sessions than with the program routinely used in clusters within the SNHS. Adding individualized GDS sessions eliminated this advantage. Further studies should compare the GDS with other types of exercise.

Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial.

STUDY DESIGN: A simple blind, random controlled clinical trial. OBJECTIVE: To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING: 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS: 137 patients diagnosed with nonspecific LBP. METHODS: The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS: Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION: Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.

Desarrollo social y psicología social / Social development and social psychology

En la actualidad existen corrientes que promulgan el precipitado fin de la historia humana por la manera como hoy se vive el capitalismo. Con tantas situaciones desfavorables para los países pobres a nivel mundial, podría concluirse la anterior premisa. Sin embargo, siguiendo otras vertientes, este escrito le apuesta a las posibilidades de inversión en lo humano y lo social.

At present there are currents that enact the precipitate end of human history by the way capitalism is lived today. With so many unfavorable situations for poor countries worldwide, the previous premise could be concluded. However, following other aspects, this writing bets on the possibilities of investment in the human and social.

Conductas autodestructivas, ideación y gestos suicidas en adolescentes del nivel medio/polimodal en escuelas públicas de San Salvador de Jujuy / Self-destructive behavior, suicidal ideation and gestures among adolescents of intermediate-polymodal level at public schools in San Salvador de Jujuy

INTRODUCCION: En la provincia de Jujuy, entre 1998 y 2007 se realizaron dos investigaciones relacionadas con la temática del suicidio. Se relevancia reflejó la importancia de seguir indagando en torno a conductas autodestructivas, ideación y gestos suicidas, y dio sustento a la presente investigación.OBJETIVO: Analizar si los adolescentes del nivel medio o polimodal de escuelas públicas presentan conductas autodestructivas, ideación o gestos suicidas.METODOS: En la primera etapa de la investigación se trabajó con un diseño de tipo cuantitativo. Se utilizó una técnica de exploración personal, la Escala ISO-30, para conocer el riesgo suicida en relación con conductas autodestructivas, ideación y gestos suicidas. Tras obtener los porcentajes de riesgo suicida de la muestra de adolescentes, se trabajó con un diseño cualitativo. Se realizaron entrevistas semi-dirigidas, que permitieron categorizar los datos obtenidos mediante su triangulación.RESULTADOS: De los 164 adolescentes que integraron el total de la muestra, 29 (17%) presentaron "alto riesgo" suicida. Se corroboró en ellos la incidencia directa del medio socio-familiar. Se verificó que las particularidades que predisponen a los jóvenes a conductas autodestructivas, ideación y gestos suicidas tienen relación con: a) dificultad para establecer lazos con sus semejantes; b) trastornos de ansiedad-angustia; c) falta de referentes significativos.CONCLUSIONES: Es fundamental implementar políticas públicas de salud que contemplen servicios especializados para la atención de casos de urgencia, afianzando redes institucionales, promoviendo la participación de organizaciones no gubernamentales y realizando protocolos de intervención y acciones de promoción desde los distintos estamentos.

INTRODUCTION: In the province of Jujuy, two investigations related to suicide were carried out from 1998 to 2007. They showed the importance of continuing the research on self-destructive behavior and suicidal ideation and gestures, and gave support to this study.OBJECTIVE: To analyze whether the adolescents from intermediate or polymodal level at public schools have self-destructive behavior and suicidal ideation and gestures.METHODS: The first stage of the research used a quantitative design with a personal exploration technique, ISO-30 scale, to know suicide risk in relation to self-destructive behavior and suicidal ideation and gestures. After obtaining the rates of suicide risk from the sample of adolescents, a qualitative design was used. Semi-direct interviews were performed, allowing data classification by triangulation.RESULTS: From the total sample of 164 adolescents, 29 (17%) had suicidal "high risk". They showed a direct influence of socio-family factors. According to the study, the conditions that lead young people to have self-destructive behavior and suicidal ideation and gestures are related to: a) difficulty in establishing relationships with peers; b) anxiety-anguish disorders; c) lack of significant referents.CONCLUSIONS: It is fundamental to implement public health policies which consider special services for emergency care, strengthening institutional networks, encouraging the participation of non-government organizations and performing intervention protocols and promotion activities from different levels.

Conductas autodestructivas, ideación y gestos suicidas en adolescentes del nivel medio/polimodal en escuelas públicas de San Salvador de Jujuy / Self-destructive behavior, suicidal ideation and gestures among adolescents of intermediate-polymodal level at public schools in San Salvador de Jujuy

INTRODUCCION: En la provincia de Jujuy, entre 1998 y 2007 se realizaron dos investigaciones relacionadas con la temática del suicidio. Se relevancia reflejó la importancia de seguir indagando en torno a conductas autodestructivas, ideación y gestos suicidas, y dio sustento a la presente investigación.OBJETIVO: Analizar si los adolescentes del nivel medio o polimodal de escuelas públicas presentan conductas autodestructivas, ideación o gestos suicidas.METODOS: En la primera etapa de la investigación se trabajó con un diseño de tipo cuantitativo. Se utilizó una técnica de exploración personal, la Escala ISO-30, para conocer el riesgo suicida en relación con conductas autodestructivas, ideación y gestos suicidas. Tras obtener los porcentajes de riesgo suicida de la muestra de adolescentes, se trabajó con un diseño cualitativo. Se realizaron entrevistas semi-dirigidas, que permitieron categorizar los datos obtenidos mediante su triangulación.RESULTADOS: De los 164 adolescentes que integraron el total de la muestra, 29 (17%) presentaron "alto riesgo" suicida. Se corroboró en ellos la incidencia directa del medio socio-familiar. Se verificó que las particularidades que predisponen a los jóvenes a conductas autodestructivas, ideación y gestos suicidas tienen relación con: a) dificultad para establecer lazos con sus semejantes; b) trastornos de ansiedad-angustia; c) falta de referentes significativos.CONCLUSIONES: Es fundamental implementar políticas públicas de salud que contemplen servicios especializados para la atención de casos de urgencia, afianzando redes institucionales, promoviendo la participación de organizaciones no gubernamentales y realizando protocolos de intervención y acciones de promoción desde los distintos estamentos.

INTRODUCTION: In the province of Jujuy, two investigations related to suicide were carried out from 1998 to 2007. They showed the importance of continuing the research on self-destructive behavior and suicidal ideation and gestures, and gave support to this study.OBJECTIVE: To analyze whether the adolescents from intermediate or polymodal level at public schools have self-destructive behavior and suicidal ideation and gestures.METHODS: The first stage of the research used a quantitative design with a personal exploration technique, ISO-30 scale, to know suicide risk in relation to self-destructive behavior and suicidal ideation and gestures. After obtaining the rates of suicide risk from the sample of adolescents, a qualitative design was used. Semi-direct interviews were performed, allowing data classification by triangulation.RESULTS: From the total sample of 164 adolescents, 29 (17%) had suicidal "high risk". They showed a direct influence of socio-family factors. According to the study, the conditions that lead young people to have self-destructive behavior and suicidal ideation and gestures are related to: a) difficulty in establishing relationships with peers; b) anxiety-anguish disorders; c) lack of significant referents.CONCLUSIONS: It is fundamental to implement public health policies which consider special services for emergency care, strengthening institutional networks, encouraging the participation of non-government organizations and performing intervention protocols and promotion activities from different levels.