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Background: 'Learning by doing' is a learning model based on performing actions and gaining experience. The 'nursing process' is a systematic, rational method for providing nursing care. During their university education, nursing students need to acquire the ability to promote healthy lifestyles. Objective: To determine the effectiveness of a learning strategy based on learning by doing and grounded in the use of the nursing process, on the lifestyle of nursing students. Methods: This quasi-experimental intervention (before-after), performed over 2011–2022, involved 2300 nursing students at a university nursing school in Spain. The risk factors for chronic diseases—being a smoker, being overweight, or having high blood pressure—to which each student was exposed were recorded. Those positive for at least one risk factor selected companion students as 'support nursing students' who became responsible for designing an individualised care plan to reduce the risk(s) faced. To ensure the correct use of the nursing process, teachers approved and monitored the implementation of the care plans. Whether risk-reduction objectives were met was determined three months later. Results: The students with risk factors largely improved their lifestyles (targets for reducing smoking/body weight were met) with the help of their supporting peers. Conclusions: The learning by doing method demonstrated its effectiveness, improving the lifestyle of at-risk students via the use of the nursing process. [ABSTRACT FROM AUTHOR]

Purpose: To describe the process of delivery of pediatric palliative care from the perspective of a pediatric interdisciplinary team and the children's parents. Methods: A qualitative descriptive case study was conducted. Purposeful sampling took place within a specialized pediatric palliative care Unit in Madrid (Spain), located at the Niño Jesus Hospital. The study participants included a specialized pediatric palliative care team from Madrid's pediatric palliative care program, other professional teams involved in interdisciplinary care and parents of children under pediatric palliative care. Data were collected via semi-structured interviews, focus groups and researchers' field notes. A thematic analysis was performed. Results: This study included 28 participants (20 women, 8 men), of whom 18 were professionals who belonged to the pediatric palliative care interdisciplinary team, 4 professionals were from other units that collaborated with the pediatric palliative care, and 6 were parents (5 women, 1 man). The mean age of the pediatric palliative care members was 38.2 years (SD ± 7.9), that of the collaborating professionals was 40.5 (SD ± 6.8), and that of the parents was 44.2 (SD ± 5.4). Two main themes emerged: a) Pediatric palliative care has a distinct identity, associated with life. It represents the provision of special care in highly complex children, in the context of the home, far from the hospital environment; b) The team is key: its interdisciplinary organization provides a more comprehensive view of the child and their family, fosters communication among professionals, and improves coordination with other services involved in the care of children. The mindset shift experienced by ID-PPC professionals towards a palliative approach makes them more sensitive to the needs of their patients and leads them to develop specific skills in areas such as communication, decision-making, and adaptability that were identified as differentiating aspects of pediatric palliative care. Conclusions: Describing pediatric palliative care from the professional and parental perspective helps to establish realistic and comprehensive goals for the care of children and their parents. The findings of this study may help with the establishment of a pediatric palliative care team, as a necessary organizational change in a health care system that cares for children with complex and life-threatening conditions. Promoting training in pediatric palliative care, prioritizing more horizontal organizations, providing tools and spaces for coordination and communication between professionals from different services, together with the creation of a position of case coordinator in the care process of children could enhance the understanding of pediatric palliative care services. [ABSTRACT FROM AUTHOR]

Communicative health plays an important role in the well-being of a person with or without a disability. The aim of the article is to describe the communicative interaction that occurs between a group of caregivers and the people which they take care to identify their perceptions focus on their communicative health. This is descriptive research. 12 informal caregivers participated and they completed a survey based on the communication strategies used in interactions with the people who they take care. The results show that the interaction between the caregiver and the person who they take care. This is characterized by the presence of different communicative intentions, the use of verbal and non-verbal code, the passive role of the person with disabilities, and the active role of the caregiver. In the discussion the authors introduce the criteria to take into account when someone is talking about communicative health in people with disabilities. The study shows the signs that account for communicative health evidenced in the caregiver-person dyad who is cared for. [ABSTRACT FROM AUTHOR]

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants—adults and young people over the age of 11—and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition—global, local and non-ethno-national—of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted. [ABSTRACT FROM AUTHOR]

The use of marker-less methods to automatically obtain kinematics of movement is expanding but validity to high-velocity tasks such as cycling with the presence of the bicycle on the field of view is needed when standard video footage is obtained. The purpose of this study was to assess if pre-trained neural networks are valid for calculations of lower limb joint kinematics during cycling. Motion of twenty-six cyclists pedalling on a cycle trainer was captured by a video camera capturing frames from the sagittal plane whilst reflective markers were attached to their lower limb. The marker-tracking method was compared to two established deep learning-based approaches (Microsoft Research Asia-MSRA and OpenPose) to estimate hip, knee and ankle joint angles. Poor to moderate agreement was found for both methods, with OpenPose differing from the criterion by 4–8° for the hip and knee joints. Larger errors were observed for the ankle joint (15–22°) but no significant differences between methods throughout the crank cycle when assessed using Statistical Parametric Mapping were observed for any of the joints. OpenPose presented stronger agreement with marker-tracking (criterion) than the MSRA for the hip and knee joints but resulted in poor agreement for the ankle joint. [ABSTRACT FROM AUTHOR]

Inactive carrier phases in chronic hepatitis B virus (HBV) infection present minimal liver disease and HBV replication activity suggesting partial immune reconstitution, although the mechanisms responsible remain elusive. Moreover, hepatitis B surface antigen (HBsAg) production-hypothesized to modulate the immune response-is unaltered. In the current study, we assessed the intrahepatic transcriptome in inactive carriers of HBV versus healthy liver donors, including in the context of diverse HBsAg levels (serum and liver), to better understand the phenomenon of immune control. We found a deregulated liver transcriptome in inactive carriers compared with healthy controls, despite normal liver function. Moreover, diverse HBsAg levels have minimal impact on the liver transcriptome in inactive carriers, although gene correlation analysis revealed that leukocyte activation, recruitment, and innate responses genes were correlated with liver HBsAg levels. These findings provide more insight into the mechanisms underlying anti-HBV strategies currently under development, aimed at interfering with HBsAg production or inducing a state of immune control. [ABSTRACT FROM AUTHOR]

Objective: To know the nurses' perception of the factors that influence the safe administration of medications in the work context of the General University Hospital of Elda (Alicante), Spain. Method: This is a qualitative phenomenological study through interviews semi-structured in which 15 nurses chosen by deliberate sampling participated. Results: The participants expressed concern about the performance of the medication administration procedures, which made it possible to perceive safety as the greatest concern in the study unit. A main category called "knowing" was established, which encompasses all the reflections about the nurse's performance during the medication administration process. The following subcategories are developed from this main category: work overload, insufficient training, distractions, and communication and information failures. Conclusion: Knowing the nurses' perception of the factors that influence the safe administration of medications could facilitate the use of instruments to standardize and reduce variability in the safe administration of medications. As well as improving conditions in work environments and not favoring social, personal and professional stigmatization due to care error. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to evaluate the effect of an antimicrobial stewardship bundle on the management of asymptomatic bacteriuria (ASB). Methods In this quasi-experimental study, patients were selected by retrospective, consecutive sampling of patients with a positive urine culture report in 3 separate groups: preintervention, postdiagnostic intervention, and posteducation. Patients met the prespecified criteria for non–catheter-associated ASB. The diagnostic intervention involved a new urinalysis/urine culture ordering process in place of urinalysis with reflex to urine culture. Additionally, an educational intervention involved pharmacist-led sessions to educate providers with patient cases and guideline-based recommendations. The primary outcome of this study was the difference in the rate of inappropriate management of ASB, defined as the use of antimicrobial agents intended to treat ASB. Secondary outcomes included length of antimicrobial therapy, length of stay, and change in urine culture orders per 1,000 patient-days. Results A total of 120 patients were included. There was a significant reduction in the inappropriate management of ASB between the preintervention and postdiagnostic intervention groups (P = 0.0349). This was not seen when comparing the postdiagnostic intervention and posteducation groups (P = 0.93). Additionally, there was a significant difference in urinalysis/urine culture ordering between the preintervention and postdiagnostic intervention groups (370 vs 224 urinalysis orders per 1,000 days present, P < 0.0001; 131 vs 54 urine culture orders per 1,000 days present, P < 0.0001). Conclusion An antimicrobial stewardship bundle involving a diagnostic stewardship intervention and pharmacist-led education reduced treatment of ASB in patients without urinary catheters. [ABSTRACT FROM AUTHOR]

Objective: To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.Design: Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.Setting: Spain.Participants: Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.Results: 74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.Conclusions: Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF. [ABSTRACT FROM AUTHOR]

Objective: To compare response to rituximab (RTX) between adult patients positive for myelin oligodendrocyte glycoprotein (MOG) and aquaporin-4 (AQP4) antibodies.Methods: We prospectively studied adult patients with MOG or AQP4 antibodies who received RTX under an individualized dosing schedule adapted to the biological effect of RTX monitored by memory B-cell measurement. Memory B cells were counted monthly and when relapse occurred. The biological effect of RTX was considered significant with <0.05% memory B cells in peripheral blood lymphocytes.Results: In 16 patients with MOG antibodies and 29 with AQP4 antibodies, mean follow-up was 19 (range = 9-38) and 38 (13-79) months. Under RTX, 10 relapses occurred in 6 of 16 (37.5%) patients with MOG antibodies, and 13 occurred in 7 of 29 (24%) with AQP4 antibodies. The median time of relapse after the most recent infusion was 2.6 (0.6-5.8) and 7 (0.8-13) months, respectively (p < 0.001). Memory B cells had reemerged in 2 of 10 (20%) relapses in patients with MOG antibodies and 12 of 13 (92.5%) with AQP4 antibodies (p < 0.001).Interpretation: In AQP4 antibody-associated disorder, relapse mostly occurs when the biological effect of RTX decreases, which argues for treatment efficacy. In MOG antibody-associated disorder, the efficacy of RTX is not constant, because one-third of patients showed relapse despite an effective biological effect of RTX. In this subpopulation, memory B-cell depletion was unable to prevent relapse, which was probably caused by different immunological mechanisms. These findings should be used to improve treatment strategies for MOG antibody-associated disorder. ANN NEUROL 2020;87:256-266. [ABSTRACT FROM AUTHOR]

The greater use of applications, including educational environments, requires a critical and evaluative look that allows establishing criteria for the design of specific applications for educational purposes and specifically the educational use in the discipline of artistic education. That is the reason to develop this research whose objective is to design a tool for the evaluation of Educational Applications for Arts Education. To reach this aim, a theoretical investigation is carried out and previous works that allow to establish the criteria for the realization of the evaluation are consulted. After this, the research methodology (based on the OEPE method), the instrument design and its validation are shown. Then it is given an explanation of the implementation of the design and its piloting. The results obtained lead us towards the viewpoint that there is a low development of creativity by the evaluated applications. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the current study is to assess, using new technologies, the interaction of four monthly silicone hydrogel contact lenses on the ocular surface and the comfort over 15 days of use.Methods: Prospective cross-over, randomized and double-masked study including four materials (lotrafilcon-B, samfilcon-A , comfilcon-A and filcom-V3). Clinical examination was performed in the following order: tear meniscus height, first break-up of the tear film, the average time of all tear film breakup incidents, bulbar redness, limbal redness (Keratograph 5M ,Oculus, Germany); central corneal thickness (Pentacam, Oculus, Germany), thermography values (FLIR A325; FLIR Systems Inc., USA), and slit-lamp evaluations, including ocular surface staining. Finally, subjective comfort was obtained from Contact Lens Dry Eye Questionnaire-8.Results: The impact of contact lens wear on the ocular surface didn't show statistically significant changes over time except for corneal and conjunctival staining grades on day 15 compared to day 1 for the comfilcon A group (P = .003 and P = .01, respectively). Contact lens stability and impact on the ocular surface during contact lens wear didn't show statistically significant changes over time except in the case of the comfilcon A material with respect to the irritation item (P = .01).Conclusions: These results suggest that the impact of monthly silicone hydrogel contact lens materials on the ocular surface after and during contact lens wear, contact lens stability over time, and subjective comfort did not reveal any significant changes over 15 days of use for any of the materials. [ABSTRACT FROM AUTHOR]

The objective of this study is to describe the sexual compulsivity of Indonesian college students. We used a cross-sectional design and recruited 301 college students in Universitas Indonesia. Data were collected using the modified Sexual Compulsivity Scale (SCS) instrument. These findings show that Indonesian students have lower sexual compulsivity scale (mean: 11.39 ± 4.21). Male students have significantly higher SCS score than female students (p = 0.000). Working students were also found to have a higher SCS score than those who did not work (p = 0.039). Further studies on sexual compulsivity among young adults in Indonesia are deemed necessary to give more understanding about sexual compulsivity. These findings provide basic information to design a sexual counseling method for improving the sexual health of young adults. [ABSTRACT FROM AUTHOR]

Background: Increased plasma free fatty acids (FFAs) impair insulin sensitivity in dairy cows via unknown mechanisms. In nonruminants, saturated FFAs upregulate the hepatic synthesis and secretion of ceramide, which inhibits insulin action.Objective: We aimed to determine whether an increase in plasma FFAs promotes hepatic and plasma ceramide accumulation in dairy cows.Methods: Six nonpregnant, nonlactating Holstein cows were used in a study with a crossover design and treatments consisting of intravenous infusion of either saline (control) or triacylglycerol emulsion (TG; 20 g/h) for 16 h. The feeding level was set at 120% of energy requirements. Blood was collected at regular intervals and liver was biopsied at 16 h. Ceramides, monohexosylceramides (Glc/Gal-Cer), lactosylceramides (LacCer), and sphingomyelins (SMs) in plasma and liver were profiled. Hepatic expression of ceramide synthases was determined. Data were analyzed with the use of mixed models, regressions, and Spearman rank correlations.Results: After 16 h of infusion, plasma FFA concentrations were >5-fold and liver triacylglycerol concentrations were 4-fold greater in TG cows, relative to control. Plasma total and very long-chain ceramide (e.g., C24:0-ceramide) concentrations increased ∼4-fold in TG over control by hour 16 of infusion, while C16:0-ceramide were not modified by TG. Infusion of TG increased plasma Glc/Gal-Cer (e.g., C16:0-Glc/Gal-Cer, 4-fold by hour 16) relative to control, but did not alter LacCer or SM concentrations. Hepatic ceramide concentrations increased with TG relative to control (e.g., C24:0-ceramide by 1.7-fold). Hepatic expression of ceramide synthase 2 was 60% greater after TG infusion compared with the control. Circulating ceramides were related to circulating FFA and hepatic triacylglycerol concentrations (e.g., C24:0-ceramide, ρ = 0.73 and 0.80, respectively; P < 0.001).Conclusion: Hepatic ceramide synthesis is associated with elevations in circulating FFAs and hepatic triacylglycerol during the induction of hyperlipidemia in dairy cows. This work supports the emerging evidence for the role of ceramide during hepatic steatosis and insulin antagonism in cows. [ABSTRACT FROM AUTHOR]

Background: Lightly touching the tip of the index finger on an external surface reduces the postural sway during upright standing due to the additional somatosensory information provided by the touch to the postural control system. But when the individuals apply more force, it provides more mechanical support. However, because most of the studies investigated only two levels of force, whether the control mechanisms of postural sway are affected by the different force levels was unknown.Research Question: To examine the influence of the magnitude of force (up to 1, 2, 4, 6 or 8 N) applied to the touch bar on the mechanisms used to control the postural sway during quiet standing with eyes open or closed.Methods: Ten young right-handed adults stood for 35 s on a force platform, with feet apart, while touched a rigid bar with different force levels with eyes open or closed. The amplitude and velocity of the center of pressure and its components, Rambling and Trembling trajectories, respectively, related to more supraspinal and spinal control mechanisms, were assessed.Results: The touch reduced all trajectories, mainly of the Rambling component and with closed eyes. There was a floor effect of the touch force as amplitudes and velocities were minimal at 4 N of force.Significance: The component of postural sway under the supraspinal neural control is more affected by different force magnitudes applied to the touch bar. [ABSTRACT FROM AUTHOR]

Objectives: This study is focused on how architectural design of adolescent psychiatric hospitals could positively affect not only patients but also staff members working at the hospitals. Background: Adolescents between the ages of 12 and 18 are among the young population with the highest percentage of mental illness. However, there are limited number of intentionally designed psychiatric hospitals for adolescents. Staff who work in adolescent psychiatric hospitals may face workplace violence. Studies on environmental impacts suggest that the built environment affects patients' well-being and safety as well as staff's satisfaction, working condition, safety, and health. However, there are very few studies that focus on adolescent psychiatric hospitals and the impact of the built environment on both staff and patients. Methods: Data were collected through literature analysis and semi-structured interviews with staff of three psychiatric state hospitals with adolescent patient units. The triangulation of multiple data sources informed a set of environmental design conditions that captures the complexity and connectedness of architectural design and the occupants of an adolescent psychiatric hospital. Results: The results present architectural composition, atmosphere, lighting, natural environment, safety, and security as indispensable design conditions to create an enclosed and city-like campus that provides a serene, secure, and structured environment that benefit staff and adolescent patients. Conclusion: The specific design strategies that need to be incorporated in the architectural design of a safe and secure adolescent psychiatric hospital include an open floor plan that respects patients' autonomy and offers privacy while always providing staff with full visibility of patients. [ABSTRACT FROM AUTHOR]

Introduction. Renal biopsy is the principal instrument to evaluate the diagnosis and prognosis of children with kidney disease. There are relatively few studies establishing epidemiology of its findings in the pediatric population. Methods. A descriptive study was conducted to describe characteristics of pediatric patients who had undergone a renal biopsy over the last 10 years in a national reference center, trying to accomplish an etiopathogenic approach of biopsy findings. Results. 241 patients were included. Most frequent indications were nephrotic syndrome (34.1%) and systemic disease with renal involvement (30.2%). The most prevalent biopsy diagnosis was glomerulonephritis (44%) and among these patients, glomerulonephritis mediated by immune complexes was the most frequent pathogenic type (90.5%). When the biopsy was indicated for proteinuria plus hematuria and systemic disease with renal involvement, the most frequent biopsy diagnosis was glomerulonephritis (60 and 85%, respectively). For isolated hematuria, the predominant biopsy diagnosis was inherited diseases of the glomerular basement membrane (70%) and for nephrotic syndrome, podocytopathy (82%). Glomerulonephritis was more frequent in patients older than 10 yrs (65%) and the rate of postbiopsy major complications was low (1.2%). Conclusion. Immune complex glomerulonephritis was the most frequent histological finding, differing from previous reports. To our knowledge this is the first description that classifies biopsy findings according to the probable pathogenic mechanism. [ABSTRACT FROM AUTHOR]

According to the Ministry of National Education of Colombia, Programs at the level of university education have a low graduation rate and dropout numbers are alarming. However, results vary in different regions of the country. Objective: To determine the factors related to student retention in face-to-face undergraduate programs offered by the Francisco de Paula Santander University, a public institution located in Cúcuta, a town bordering Venezuela. Method: Descriptive cross Quantitative approach with a sample of two hundred and sixteen (216) students from last semester. The instrument is a survey called "factors related to student retention in face-to-face undergraduate programs", designed and validated by the authors. Results: It was found that from the analyzed factors (personal, socio-economic, institutional and academic), the most influential is the one related to the personal. Conclusions: influential aspects are evident in achieving retention, which should be taken into account by the educational institutions in order to promote retention and reduce the backlog and desertion of their students; among them they are: motivation and how passionate the students are about the selected career; the definition of a method of study; the economic contribution of parents, although working while studying when you have a clear purpose is also relevant; the quality of the academic program; teaching methodology; as well as bibliographic and computer resources that are accessed. [ABSTRACT FROM AUTHOR]

Purpose. To compare the ocular surface symptoms and signs in an adult population of silicone-hydrogel (Si-Hy) contact lens (CL) wearers with another modality of CL wear, overnight orthokeratology (OK). Materials and Methods. This was a prospective and comparative study in which 31 myopic subjects were fitted with the same Si-Hy CL and 23 underwent OK treatment for 3 months. Dry eye questionnaire (DEQ) was filled in at the beginning of the study and then after 15 days, 1 month, and 3 months using each CL modality. The tear quality was evaluated with noninvasive tear break-up time. Tear production was measured with Schirmer test. Tear samples were collected with Schirmer strips being frozen to analyze the dinucleotide diadenosine tetraphosphate (Ap4A) concentration with High-Performance Liquid Chromatography (HPLC). Results. After refitting with ortho-k, a reduction in discomfort and dryness symptoms at the end of the day (p<0.05, χ2) was observed. No significant changes were observed in Ap4A concentration in any group. Bulbar redness, limbal redness, and conjunctival staining increased significantly in the Si-Hy group (p<0.05, Kruskal–Wallis test). Conclusion. Discomfort and dryness symptoms at the end of the day are lower in the OK CL group than in the Si-Hy CL group. [ABSTRACT FROM AUTHOR]

Background: Residual depressive symptoms are associated with a poor prognosis for relapse or recurrence and are recognized as impeding factors of functionality. Recovery to the pre-depression level of functioning should be the goal of treatment.Aim: To evaluate outcomes in depressed outpatients treated with escitalopram regarding response, recovery, residual symptoms, functionality and ability to work over 48 weeks.Method: 3278 outpatients were evaluated at weeks 8, 24 and 48. A simple questionnaire was used to rate severity of illness, impairment of functionality, treatment response, tolerability, presence and severity of residual symptoms, whether remission with residual symptoms or recovery was achieved, and to what degree the patient was able to work.Results: Data over the full 48-week period were available for 75.8% of patients, for whom treatment response was rated as "very good" or "good" in 81%. However, only 42% of the completing patients achieved recovery without residual symptoms, while 41% were rated as remitters with residual symptoms. Lack of energy/motivation was the most common reported residual symptom and was present in 23.5% of patients at study end. Concentration difficulties were present in 15.8% and impaired sleep in 13.9% of patients. Complete inability to work decreased from 36% at baseline to 9% at week 48, while full-time working capacity increased from 37% to 62%.Limitations: Non-controlled observational real life study using simple ratings rather than established rating scales.Conclusion: <50% of patients completing a one-year antidepressant treatment regimen were rated as being symptomatically fully recovered, and ≈50% still reported functional deficits. [ABSTRACT FROM AUTHOR]

This study aimed to identify the GPS-based external training load variables that influence the internal training loads (RPE-derived parameters: RPE and session RPE – sRPE), and generate a model to predict GPS-based external load variables from RPE and perceived wellness values. Training load data for 21 elite young players were collected over 72 training sessions and 23 matches from the same competitive season, and 564 observations (training sessions, 462; matches, 102) were analysed. Considering all observations (training sessions and matches), significant moderate and large correlations (p < 0.01) were detected between RPE values and EL measures. The correlation between the GPS outcomes with both the RPE and sRPE values was higher during training sessions than during matches. Moreover, increased RPE and perceived wellness measures had a significant positive effect on external load variables (p < 0.001). The present work provides preliminary evidence of the utility of the RPE and sRPE method to quantify the training loads in young soccer players since most of the GPS-based EL indicators were moderate to highly correlated with the RPE-derived parameters. Additionally, EL variables may be estimated when combining perceived IL and subjective wellness indicators in young soccer players. [ABSTRACT FROM AUTHOR]

Introduction: Given the health problem that has become teenage pregnancy and the lack of knowledge of the same during the postpartum period, the program was designed "home care to the mothers of newborns and infants to adolescents" with to identify care practices engaged with themselves and with their newborn, prevent avoidable disorders by assessing and monitoring, promote healthy practices and include the family in the care of the mother and child. Materials and Methods: This program targeted users between 10 and 19 years, graduates of Gynecology and Obstetrics Service of the State Social Enterprise Meoz Erasmus University Hospital in Cucuta and your newborn. During the study, a structured program that corresponds to the quantitative paradigm, prospective descriptive cross. The sample consisted of 251 postpartum adolescents and their newborns living in the city of Cucuta. For data collection we used a domain valuation format for the woman and her newborn and the questionnaire "care practices with themselves engaged in postpartum women" 2010 version. Results and Discussion: Among the sociodemographic factors evidenced schooling and low socioeconomic status, cohabiting relationships, single mothers and extended family such as variables prevalent. Practices are inadequate food and health care in particular. Conclusions: It was found that adolescents apply postpartum care consistent with their culture and the indications given by the health care team during pregnancy, however when humanized nursing care exercises and respectful, positive changes are evident in the health of the mother and his family and the adoption of healthy practices. [ABSTRACT FROM AUTHOR]

Research that undertakes longitudinal analysis of presidential discourse inevitably wrestles with a difficult issue: which presidential speeches should be analyzed? Surprisingly, there has been essentially no interrogation of this issue. Studies vary in the speeches they analyze: some focus on inaugural addresses, others on State of the Union addresses, yet others focus on some broader body of speeches, often with limited discussion of the criteria used for selection. The result is that when scholars set out to study broad trends in the rhetoric of America's most important political figure, they have little guidance in determining what speeches they should analyze. This article offers a detailed conception of major presidential addresses, argues that such addresses provide an ideal corpus of texts for longitudinal content analysis of modern presidential speeches, and briefly describes the contours of a data set consisting of 406 such speeches. This data set serves as a resource for scholars to rely upon when studying presidential discourse, one that might standardize future analyses so that more meaningful generalizations can be made and more precise replications can be undertaken. [ABSTRACT FROM AUTHOR]

Payments for Environmental Services (PES) have been claimed as a more efficient way of accomplishing conservation and development goals than other indirect strategies, reaching their optimum when the buyer pays the opportunity costs of the foregone benefits. Different inefficient situations have been described, like lack of additionality, where payments are given for practices that would have been adopted anyway. Trade-offs between efficiency and equity of PES have usually emerged as well. In this paper we assess the equity, additionality and stakeholders'' perceptions of a PES scheme in a Mexican community inside a Biosphere Reserve. We applied structured interviews to all adults, a total of 66 people from 31 households. Our results show a dual response in equity and additionality, depending on land tenure. PES have an egalitarian effect within landowners and landless groups, but it broadens the gap between them. Additionality is low for landowners and high for the landless people in the community, even though the former are the ones with full decision over the land. Although the scheme does not seem efficient under the classical PES paradigm, it is perceived as a reward, reinforcing conservation attitudes even though most of the interviewees claim it to be insufficient. [Copyright &y& Elsevier]

Objective: This study aimed to examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults.Methods: Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow-up. Adjusted generalized estimating equations models were performed.Results: Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = -0.14 to B = -3.16; P < .05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = -0.06 to B = -0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression.Conclusions: Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review and meta‐analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID‐19 (LC). The impact of PR on LC and a comparison of face‐to‐face and telerehabilitation approaches was explored. Methods: This systematic review and meta‐analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non‐randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta‐analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. Results/Findings: This systematic review and meta‐analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi‐experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face‐to‐face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face‐to‐face group. Implications on Physiotherapy Practice: PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face‐to‐face and telerehabilitation have similar effects, except for physical quality of life. [ABSTRACT FROM AUTHOR]

Background: The simultaneous effect of physical activity (PA) and smoking on pulmonary function in young people remains unclear. Propose: The aim of this study was to determine the influence of smoking and PA on pulmonary function in young university students in Cáceres, Spain. Methods: A sample of 120 young nursing students was studied (60 smokers and 60 nonsmokers). All subjects underwent spirometry with a COPD-6 portable device, and their level of PA was quantified using the International Physical Activity Questionnaire. The influence of PA and smoking on pulmonary function was determined by comparing hypotheses. Results: Significant differences were observed between smokers and nonsmokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and the difference between lung age and chronological age (LA–CA) in those who practiced mild PA. In the subjects who performed moderate and vigorous PA, these differences were not noted. In the intragroup analysis, significant differences were observed in smokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and LA–CA; however, in the control group, differences were only observed in terms of lung age and LA–CA. These findings were confirmed in the multivariate analysis. Conclusions/Implications for Practice: Our findings confirmed a deterioration in pulmonary function in smokers who did not perform moderate or vigorous PA. The level of PA performed was positively related to pulmonary function in smokers, whereas in nonsmokers, improvements were only significant in LA–CA. [ABSTRACT FROM AUTHOR]

Validity and reliability have become crucial factors in tracking player load and positioning. One of the most important parameters to guarantee accurate measurements with radiofrequency systems is the number of reference nodes used to calculate player position. However, the accuracy of ultra-wideband (UWB) technology has only been analysed with 6 antennae. So, the purpose of the present study was to analyse the accuracy and inter-unit reliability of an UWB system with eight antennae. Three well-trained males covered 18 trajectories for the analysis of x- and y- coordinate accuracy assessment related to the positional variation among eight antennae UWB data and lines on a basketball court. This was achieved using geographical information system mapping software that calculated, for each interval and participant, the distance from the main axis of locomotion and the opposite side of the field every 0.5 s. The results showed that this is a valid system (Mean = 0.03 m; magnitude differences = 0.21% with real measures as reference; %CV <1% in all cases) for measuring locomotion and positioning. Besides, the inter-unit, test-retest and inter-subject analysis did not influence the reliability results. So, an eight antennae UWB system can be considered suitable for locomotion and positioning in an indoor environment. [ABSTRACT FROM AUTHOR]

Background: Preclinical results showing therapeutic effect and low toxicity of metronomic chemotherapy with cyclophosphamide (Cy) + celecoxib (Cel) for mammary tumors encouraged its translation to the clinic for treating advanced breast cancer patients (ABCP).Patients and Methods: A single-arm, mono-institutional, non-randomized, phase II, two-step clinical trial (approved by Bioethics Committee and Argentine Regulatory Authority) was designed. Patients received Cy (50 mg po.d) + Cel (200 mg p.o.bid). Patient eligibility criteria included: ABCP who progressed to anthracyclines, taxanes and capecitabine, ≤4 chemotherapy schemes, with good performance status. Several pro- and anti-angiogenic molecules and cells were determined as biomarkers. Informed consent was signed by all patients. Primary endpoint was clinical benefit (CB).Results: Twenty patients were enrolled. Main clinical outcomes were prolonged disease stabilization and partial remission in 10/20 and 1/20 patients, respectively. CB was 55 %, and time to progression (TTP) was 21.1 weeks. Median TTP in patients who achieved CB was 35.6 weeks, and mean overall survival was 44.20 weeks. There were no grade 3/4 toxicities associated with treatment. Circulating endothelial cells (CECs) increased at the time of progression in patients who showed CB (P = 0.014). Baseline CECs and circulating endothelial progenitor cells showed marginal associations with TTP. Serum VEGF decreased (P = 0.050), sVEGFR-2 increased (P = 0.005) and VEGF/sVEGFR-2 ratio decreased during treatment (P = 0.041); baseline VEGF and VEGF/sVEGFR-2 were associated with TTP (P = 0.035 and P = 0.030, respectively), while sVEGFR-2 did not.Conclusions: Treatment was effective, showing low toxicity profile and excellent tolerability. The combination had anti-angiogenic effect. Increased levels of CEC could be useful for detecting progression. Baseline VEGF and VEGF/sVEGFR-2 values could be useful as early predictors of response.Trial Registration: ANMAT#4596/09. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate-severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation. [ABSTRACT FROM AUTHOR]

The application of participatory methods for codesigning sustainable land uses in research and development (R&D) projects for the agroecological transition are receiving increasing attention. However, there has been limited research critically assessing participatory methods employed in a codesign process. We therefore analyze the participatory methods applied for codesigning alternative land uses in the Sustainable Amazonian Landscape (SAL) project in the Caquetá department, Colombia. We conducted our analysis by situating the codesign process in a participation continuum and a codesign typology. We found that a gradient of participation level in the R&D project is beneficial for managing a codesign process. Thus, codesigning can be shaped during the project to respond to specific needs, and farmer participation levels change during the project. We found that codesigning is a process that only partially relies on participatory methods epistemologies. Instead, it reflects a tension between the continuity of a codesign project in a given territory, the sustained involvement of local partners, and external conditions such as socioeconomic and institutional stability. These are essential points to consider for co-designing the agroecological transition, as we suggest that these project-based research conditions might hinder critical principles of the codesign process. [ABSTRACT FROM AUTHOR]

Aims: To test the screening performance of urinary ethyl glucuronide (EtG) under routine clinical conditions in a sample of alcohol-dependent outpatients, comparing it against urinary ethanol, self reports and clinical judgment.Methods: A cross-sectional study under routine conditions was conducted in February 2015, where 613 consecutive urinary samples, provided by 188 outpatients with alcohol use disorders, were analyzed for ethanol and EtG (cut-off level = 500 ng/ml). Clinical variables such as the presence of aversive medication, comorbidities and clinician judgment were also collected. The discrepancy between the number of alcohol and EtG positives was recorded. A logistic regression analysis including clinical variables was conducted to assess for predictors of EtG positivity.Results: Urinary alcohol yielded 9 positives (1.5% of all urine samples) belonging to 8 patients. EtG yielded 136 positives (22% of all urine samples) belonging to 74 patients. Of these, 93.4% (127 of 136) were negative for alcohol. All urinary alcohol positives resulted in EtG positives. The clinician judged 48 samples from 26 patients as belonging to not abstinent patients and 550 samples from 178 patients as belonging to abstinent patients. She was unsure in 15 samples from 15 patients. When comparing it against EtG as the gold standard, the area under the curve was 0.592. Self reports were extremely unreliable in this study, with only 5 patients reporting drinking in a total of 6 urine samples. In the logistic regression model, only aversive medications (OR 2.1, 95% CI 1.3-3.3) and clinician judgment (OR 2, 95% CI 1.4-2.9) resulted in significant effects.Conclusions: EtG performed largely better than ethanol for urine screening in alcohol outpatients, detecting an extra 20.4% (125 out of 613) of positives. It means that for each alcohol-positive sample, there were 15 EtG-positive samples. Although better than ethanol, clinician judgment was also not performed efficiently. If routinely implemented in the screening of alcohol outpatients, EtG might bring relevant changes that merit further research. [ABSTRACT FROM AUTHOR]

Introduction: Research on the emotional impact of tobacco-warning images (TWIs) has not evaluated the role of context (ie, cigarette packs) as a modulator of the emotional response to TWIs. The objective of the present study was to identify the influence of the cigarette package brand on the emotional impact of TWIs that cover 30% of cigarette packs in smokers and nonsmokers using a specific methodology for the study of emotion.Methods: The participants included 95 smokers and 111 nonsmokers who observed three TWIs under two conditions: TWIs that covered 30% of cigarette packs and TWIs alone, without brands. Additionally, 18 pictures from the International Affective Picture System were presented as comparison stimuli and to reduce the effect of habituation. The Self-Assessment Manikin was used to assess valence, arousal, and dominance dimensions.Results: TWIs that covered 30% of cigarette packs were evaluated as least aversive, with lower ratings of arousal and higher ratings of dominance in both groups. Differences in the valence, arousal, and dominance dimensions were found between groups. Smokers rated TWIs that covered 30% of cigarette packs as less aversive and more arousing and gave them lower dominance scores compared with nonsmokers.Conclusion: The results suggest that cigarette packages modulate the emotional impact of TWIs, especially in smokers, and the minimum size of TWIs (ie, 30% of the front and back of the package) is not sufficiently large to generate an emotional impact associated with avoidance behavior.Implications: Cigarette packages modulate the emotional impact of TWIs, especially in smokers. The cigarette package itself is an appetitive context that captures the attention of the observer and decreases the aversive emotional response to the TWIs. The minimum size of TWIs (ie, 30% of the front and back of the package) is not sufficiently large to generate an emotional impact associated with avoidance behavior. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare the effect of conventional bread and a whole grain bread on appetite and energy intake, satiety and satiety gut-hormones. A randomized controlled crossover pilot study was carried out in 11 university students (age: 18.7 ± 0.9 years; body mass index: 22.7 ± 2.7 kg/m(2)). Participants consumed two different mid-morning cereal-based snacks, including a conventional or whole grain bread. Two testing days were completed, including satiety questionnaires, blood sampling and consumption of standardized breakfast, mid-morning test-snacks and ad libitum lunch. Several gut-hormones were analysed and satiation was assessed using Visual Analogue Scale scores. The consumption of whole grain bread increased satiety perception, decreased the remained energy intake during the testing day, and decreased the postprandial response of peptide YY, compared with conventional bread (p < 0.005). These data suggest that the consumption of whole grain bread might be a useful strategy to improve satiety. [ABSTRACT FROM AUTHOR]

Background Accelerate Pheno blood culture detection system (AXDX) provides rapid identification and antimicrobial susceptibility testing results. Limited data exist regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia. Methods A single-center, quasi-experimental study of bacteremic inpatients before and after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX + RTN). Results Of 830 bacteremic episodes, 188 of 245 (77%) historical and 308 (155 AXDX, 153 AXDX + RTN) of 585 (65%) intervention episodes were included. Median LOS was shorter with AXDX (6.3 days) and AXDX + RTN (6.7 days) compared to historical (8.1 days) (P =.001). In the AXDX and AXDX + RTN cohorts, achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%, respectively) and median time to optimal therapy (TTOT) was faster (1.3 days and 1.4 days, respectively) compared to historical (84.6%, P ≤.001 and 2.4 days, P ≤.001, respectively). Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6 days each vs 7 days; P =.011). Median LOS benefit during intervention was most pronounced in coagulase-negative Staphylococcus bacteremia (P =.003). Conclusions LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest that AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction.Study Design: This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents' contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models.Results: A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users' demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38-2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04-10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70-18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality.Conclusions: While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls.Implications: Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers. [ABSTRACT FROM AUTHOR]

Background: Severe combined immunodeficiency due to adenosine deaminase (ADA) deficiency (ADA-SCID) is a rare and life-threatening primary immunodeficiency.Methods: We treated 50 patients with ADA-SCID (30 in the United States and 20 in the United Kingdom) with an investigational gene therapy composed of autologous CD34+ hematopoietic stem and progenitor cells (HSPCs) transduced ex vivo with a self-inactivating lentiviral vector encoding human ADA. Data from the two U.S. studies (in which fresh and cryopreserved formulations were used) at 24 months of follow-up were analyzed alongside data from the U.K. study (in which a fresh formulation was used) at 36 months of follow-up.Results: Overall survival was 100% in all studies up to 24 and 36 months. Event-free survival (in the absence of reinitiation of enzyme-replacement therapy or rescue allogeneic hematopoietic stem-cell transplantation) was 97% (U.S. studies) and 100% (U.K. study) at 12 months; 97% and 95%, respectively, at 24 months; and 95% (U.K. study) at 36 months. Engraftment of genetically modified HSPCs persisted in 29 of 30 patients in the U.S. studies and in 19 of 20 patients in the U.K. study. Patients had sustained metabolic detoxification and normalization of ADA activity levels. Immune reconstitution was robust, with 90% of the patients in the U.S. studies and 100% of those in the U.K. study discontinuing immunoglobulin-replacement therapy by 24 months and 36 months, respectively. No evidence of monoclonal expansion, leukoproliferative complications, or emergence of replication-competent lentivirus was noted, and no events of autoimmunity or graft-versus-host disease occurred. Most adverse events were of low grade.Conclusions: Treatment of ADA-SCID with ex vivo lentiviral HSPC gene therapy resulted in high overall and event-free survival with sustained ADA expression, metabolic correction, and functional immune reconstitution. (Funded by the National Institutes of Health and others; ClinicalTrials.gov numbers, NCT01852071, NCT02999984, and NCT01380990.). [ABSTRACT FROM AUTHOR]

Background: Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established.Objective: To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF.Methods: We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF.Results: Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5-64), amphotericin B 2 mg/L (range 0.25-64), posaconazole 16 mg/L (range 0.5-64), itraconazole 32 mg/L (range 4-64), and isavuconazole 32 mg/L (range 8-64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality.Conclusions: Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF. [ABSTRACT FROM AUTHOR]

Background: Neurocognitive impairment is recognised as a risk factor for suicidal behaviour in adults. The current study aims to determine whether neurocognitive deficits also predict ongoing or emergent suicidal behaviour in young people with affective disorders.Methods: Participants were aged 12-30 years and presented to early intervention youth mental health clinics between 2008 and 2018. In addition to clinical assessment a standardised neurocognitive assessment was conducted at baseline. Clinical data was extracted from subsequent visits using a standardised proforma.Results: Of the 635 participants who met inclusion criteria (mean age 19.6 years, 59% female, average follow up 476 days) 104 (16%) reported suicidal behaviour during care. In 5 of the 10 neurocognitive domains tested (cognitive flexibility, processing speed, working memory, verbal memory and visuospatial memory) those with suicidal behaviour during care were superior to clinical controls. Better general neurocognitive function remained a significant predictor (OR=1.94, 95% CI 1.29- 2.94) of suicidal behaviour in care after controlling for other risk factors.Limitations: The neurocognitive battery used was designed for use with affective and psychotic disorders and may not have detected some deficits more specific to suicidal behaviour.Conclusion: Contrary to expectations, better neurocognitive functioning predicts suicidal behaviour during care in young people with affective disorders. While other populations with suicidal behaviour, such as adults with affective disorders or young people with psychotic disorders, tend to experience neurocognitive deficits which may limit their capacity to engage in some interventions, this does not appear to be the case for young people with affective disorders. [ABSTRACT FROM AUTHOR]

Background: The semantic variant of primary progressive aphasia (svPPA) is characterized by a progressive loss of semantic knowledge impairing the ability to name and to recognize the meaning of words.Objective: We aimed to evaluate the immediate and short-term effect of errorless learning speech therapy on the naming and recognition of commonly used words in patients with svPPA.Methods: Eight participants diagnosed with svPPA received 16 sessions of intensive errorless learning speech therapy. Naming and word comprehension tasks were evaluated at baseline, immediately postintervention, and at follow-up after 1, 3, and 6 months. These evaluations were performed using two item sets (a trained list and an untrained list).Results: In the naming tasks, patients showed a significant improvement in trained items immediately after the intervention, but that improvement decayed progressively when therapy ended. No improvements were found either in trained comprehension or in untrained tasks.Conclusion: Errorless learning therapy could improve naming ability in patients with svPPA. This effect may be due to the relative preservation of episodic memory, but the benefit is not maintained over time, presumably because there is no consolidation. [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors.Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week.Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7-10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0-3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority. [ABSTRACT FROM AUTHOR]

Beer is a beverage that has been consumed worldwide for thousands of years due to social, religious, and cultural reasons; it contains polyphenolic compounds as well as phenolic acids with a potential positive effect on human health. This study aimed to explore the impact of moderate beer consumption on human health and gut microbiota diversity. Three hundred fifty-five mL of non-alcoholic beer (NAB) or alcoholic beer (AB) were consumed daily by the participants for 30 days in each study. Anthropometric measures, blood samples for biochemistry, and fecal samples for microbiota analysis were collected on Day 1 and Day 30. Microbial diversity was characterized by high-throughput sequencing of 16S rDNA libraries, and data were analyzed using the QIIME pipeline. We found that NAB and AB have effects on the composition of the gut microbiota, favoring the proliferation of Bacteroidetes with respect to Firmicutes. No increase in weight, waist, and hip parameters was observed, and the liver and lipid profile values were not modified for NAB. In addition, the consumption of NAB induced a decrease in fasting blood serum glucose and an increase in functional β cells, while, on the other hand, there was an increase in blood serum glucose and a decrease in functional β cells with the consumption of AB. In general, beer consumption neither changed anthropometric values, nor affected liver function. Although the glucose values decreased with NAB or increased with AB, they remained within the normal range. Our conclusion is that moderate consumption of NAB has a positive effect on human health via supplementation of biological active polyphenol and phenolic acids, and by enrichment of the gut microbiota diversity with beneficial bacteria, while the presence of alcohol in AB interferes with this effect. More work should be done on this topic before general conclusions are drawn. [ABSTRACT FROM AUTHOR]

Background: Limb-girdle muscular dystrophy recessive 1 calpain3-related (LGMDR1), previously known as LGMD2A, is a disease caused by mutations in the CAPN3 gene. It is characterized by progressive weakness and muscle degeneration. Frizzled related protein (FRZB), upregulated in LGMDR1, was identified as a key regulator of the crosstalk between Wnt and integrin signalling pathways. FRZB gene silencing showed a recovery in the expression of some of the costamere protein levels in myotubes.Results: Here, we performed a comprehensive characterization of Frzb-/- mice muscles to study the absence of Frzb in skeletal muscle and eventual links with the molecular characteristics of LGMDR1 patient muscles. Frzb-/- mice showed reduced muscle size and strength. Gait analysis showed that Frzb-/- mice moved more slowly but no impaired regeneration capacity was observed after muscle injury. Additionally, Frzb-/- mice muscle showed an increased number of mesoangioblasts. Lack of Frzb gene in Frzb-/- mice and its increased expression in LGMDR1 patients, showed contrary regulation of Rora, Slc16a1, Tfrc and Capn3 genes. The reciprocal regulation of Frzb and Capn3 genes further supports this axis as a potential target for LGMDR1 patients.Conclusions: Our data confirm a role for Frzb in the regulation of Rora, Slc16a1, Tfrc, and Capn3 genes in muscle cells. In vivo, reduced muscle strength and gait in the Frzb-/- mice are intriguing features. The reciprocal relationship between FRZB and CAPN3 further supports a key role for this axis in patients with LGMDR1. [ABSTRACT FROM AUTHOR]

PURPOSE: To establish technical values for nursing diagnoses in primary healthcare with which to weight the delivery of care based on criteria of complexity and relevance. METHODS: A three‐phase cross‐sectional descriptive study: (1) establishing and weighting of the assessment criteria of technical values, (2) scoring of the assessment criteria per diagnosis, and (3) assigning technical values. FINDINGS: Diagnoses were ordered on the scoring scale obtained and a technical value of 1 to 4 was assigned according to their quartile. CONCLUSIONS: Having a technical value for each nursing diagnosis helps to measure the diversity and complexity of care. IMPLICATIONS FOR NURSING PRACTICE: Technical values may contribute to improving nursing management indicators, as they incorporate a quantitative view into the assessment process. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self‐efficacy in this relationship. Design: A multi‐centre randomized controlled clinical trial. Methods: Data were collected from February 2018 ‐ March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow‐up of 6 months. In addition, the roles of breastfeeding and general self‐efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis. Results: Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non‐exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22–0.60] p <.001) and 61% (aHR: 0.39 [0.20–0.78] p =.008), respectively. We found that self‐efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self‐efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self‐efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02–0.19). Greater positive variations in the breastfeeding self‐efficacy scores during follow‐up predicted exclusive and non‐exclusive breastfeeding duration. Conclusion: A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self‐efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed. Impact: Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum. Trial registration: Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549. [ABSTRACT FROM AUTHOR]

Background: Older adults are more susceptible to manifest the effects of their social, economic, cultural, or political environment on their health. Objective: To describe the health needs of older women in a day care center. Methodology: Mixed study, with a population of 490 women and a sample of 177. The 60-item Gordon's 11 Functional Health Patterns Assessment questionnaire was applied, obtaining a 0.735 reliability, as well as an in-depth interview in 10 key topics. The data were analyzed with central tendency and content analysis measurements. Results: The needs of older women were submitted to a full analysis (physical, social, emotional, and spiritual). The majority has type-2 diabetes mellitus or high blood pressure. Almost half of them has overweight, constipation, and abdominal distention problems. There is no follow-up of preventive health actions, only curative ones. Conclusion: The needs detected are nutritional guidance, preventing and recovering from physical ailments, keeping moving, reducing stress and anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Flow cytometry (FC) is a helpful tool for the diagnosis of myelodysplastic syndrome (MDS). Different FC score systems have been developed. The "Ogata score" is a simple diagnostic score that has been validated having a sensitivity of 69% and a specificity of 92% in low‐risk MDS. We aimed to study the feasibility and the utility of the "Ogata score" for the diagnosis of MDS among Latin America (LA) Laboratories. Methods: This is a case and control study conducted in LA institutions members of Grupo Latinoamericano de Mielodisplasia (GLAM). A total of 146 MDS patients and 57 control patients were included. "Ogata score" was calculated. Results: The sensitivity of "Ogata score" was 75.6% (95% CI, 66.8‐81.3), specificity was 91.2% (95% CI, 79.7‐96.7), PPV was 95.6% (95% CI, 88.5‐98.3), and NPV was 65.4% (95% CI, 49.1‐71.9). In low/intermediate‐1 IPSS patients group, the sensitivity was 70.1% (95% CI, 60.2‐78.2), specificity was 91.2% (CI‐95%, 79.7‐96.7), PPV was 94.2% (95% CI, 86.4‐97.8), and NPV was 62.1% (95% CI, 53.0‐78.7). In the group of patients "without MDS specific markers" (patients without ring sideroblasts, blast excess, or chromosomal abnormalities), the sensitivity was 66.7% (CI‐95%, 55.8‐76.0), specificity was 91.2% (95% CI, 79.7‐96.7), PPV was 92.3% (95% CI, 82.2‐97.1), and NPV was 63.5% (95% CI, 51.9‐73.5). Conclusions: The diagnostic power found in this study was similar to the reported by Della‐Porta et al. Also in LA, the analysis was made in modern equipment with acquisition of at least 100 000 events which permits a good reproducibility of the results. [ABSTRACT FROM AUTHOR]

There has been polarizing debate on addictive-like eating in recent years. To move toward valid definition and measurement of this construct, qualitative research describing individuals' experiences is needed. The present study explored how Brazilian men and women define and experience addictive-like eating. Interviews were conducted with 7 men and 8 women (Mage = 46.6 years, MBMI = 35.43 kg/m2) seeking treatment for addictive-like eating. Thematic analysis of interviews identified three saturated, overarching themes describing participants' conceptualizations of the (1) characteristics, (2) causal factors, and (3) consequences of addictive-like eating. Lack of control was a key characteristic of addictive-like eating described by all participants. A causal factor which most participants described was emotional eating. Consequences included emotional, interpersonal, occupational, and health-related impairments which appeared primarily related to weight gain, rather than to the pattern of addictive-like eating itself. These results are largely consistent with those of previous qualitative studies. Importantly, the symptoms described by our participants and in previous qualitative studies may be inadequately captured by existing self-report questionnaires designed to assess addictive-like eating. To address this potential limitation, we provide recommendations for assessing the full range of possible addictive-like eating symptoms. [ABSTRACT FROM AUTHOR]

Aim: To determine the effectiveness of a case management model for approaching multi‐pathological people in a health promoting entity of the contributory healthcare scheme in Bogotá, Colombia between 2018 ‐. Design: Mixed methods research. Method: The study contemplates two components: a quantitative component using a quasi‐experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model. The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777—November 2017, under the financing agreement No. 848—December 2017. Discussion: Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system. Impact: In Colombia, considering complications and management of chronic non‐communicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia. Trial registration number: RPCEC00000293 [ABSTRACT FROM AUTHOR]

Background: Drug resistance is a challenge for the global control of tuberculosis. We examined mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and in a reference laboratory.Methods: This multicentre cohort study was done in Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand. We collected Mycobacterium tuberculosis isolates and clinical data from adult patients aged 16 years or older. Patients were stratified by HIV status and tuberculosis drug resistance. Molecular or phenotypic drug susceptibility testing was done locally and at the Swiss National Center for Mycobacteria, Zurich, Switzerland. We examined mortality during treatment according to drug susceptibility test results and treatment adequacy in multivariable logistic regression models adjusting for sex, age, sputum microscopy, and HIV status.Findings: We obtained M tuberculosis isolates from 871 patients diagnosed between 2013 and 2016. After exclusion of 237 patients, 634 patients with tuberculosis were included in this analysis; the median age was 33·2 years (IQR 26·9-42·5), 239 (38%) were women, 272 (43%) were HIV-positive, and 69 (11%) patients died. Based on the reference laboratory drug susceptibility test, 394 (62%) strains were pan-susceptible, 45 (7%) monoresistant, 163 (26%) multidrug-resistant (MDR), and 30 (5%) had pre-extensively or extensively drug resistant (pre-XDR or XDR) tuberculosis. Results of reference and local laboratories were concordant for 513 (81%) of 634 patients and discordant for 121 (19%) of 634. Overall, sensitivity to detect any resistance was 90·8% (95% CI 86·5-94·2) and specificity 84·3% (80·3-87·7). Mortality ranged from 6% (20 of 336) in patients with pan-susceptible tuberculosis treated according to WHO guidelines to 57% (eight of 14) in patients with resistant strains who were under-treated. In logistic regression models, compared with concordant drug susceptibility test results, the adjusted odds ratio of death was 7·33 (95% CI 2·70-19·95) for patients with discordant results potentially leading to under-treatment.Interpretation: Inaccurate drug susceptibility testing by comparison with a reference standard leads to under-treatment of drug-resistant tuberculosis and increased mortality. Rapid molecular drug susceptibility test of first-line and second-line drugs at diagnosis is required to improve outcomes in patients with MDR tuberculosis and pre-XDR or XDR tuberculosis.Funding: National Institutes of Allergy and Infectious Diseases, Swiss National Science Foundation, Swiss National Center for Mycobacteria. [ABSTRACT FROM AUTHOR]