ARTÍCULO ORIGINAL: VALORACIÓN RÁPIDA DEL RIESGO TROMBÓTICO EN PACIENTES HOSPITALIZADOS CON ENFERMEDADES NO QUIRÚRGICAS

Justificación y Objetivos: Los eventos tromboembólicos en pacientes hospitalizados son contribuyentes de morbi-mortalidad. La minoría de los episodios se presentan durante el internamiento, siendo más frecuentes en los primeros tres meses posteriores al egreso. Se han desarrollado guías internacionales de diagnóstico y tratamiento de los eventos tromboembólicos, sin embargo, los lineamientos respecto a la prevención en los pacientes hospitalizados es escasa. En nuestro país no existen guías para estratificar por riesgo de sangrado y/o trombosis a los pacientes durante su estancia hospitalaria, por lo que se propone una guía de valoración rápida. Métodos: Entre enero y octubre del 2012 se realizó una búsqueda en las bases de datos EBSCO, PUBMED y MDCONSULT. Se seleccionaron y organizaron las referencias según el año de publicación, la escala de evidencia del Centro de Medicina Basada en Evidencia de Oxford del año 2009 y según la relevancia de los resultados, es decir la importancia que tiene el resultado en nuestro objetivo: la prevención de la enfermedad tromboembólica en el paciente hospitalizado. Resultados y Conclusiones: Se propone una guía local con la cual se valore rápidamente el riesgo de trombosis y sangrado individualmente de forma tal que la tromboprofilaxis administrada sea correcta y basada en evidencia. Esta guía es sencilla de implementar y no pretende reemplazar el criterio médico, sino sugerir lineamientos generales

Baseline Religion Involvement Predicts Subsequent Salivary Cortisol Levels Among Male But not Female Black Youth

Background: Compared to Whites, Blacks are exposed to higher levels of chronic stress in the United States. As a result, major Black-White differences exist in the baseline and response of cortisol. Yet, the potential association between baseline religiosity and subsequent cortisol levels of Blacks are not known. Objectives: In the current study we aimed to determine the association between baseline religious behaviors and daytime salivary cortisol level among male and female Black youth. Materials and Methods: With a longitudinal design, data came from wave 1 (1994) and wave 6 (2000) of a cohort from an urban area in the Midwest of the United States. The study followed 227 Black adolescents (109 males and 118 females) for six years. Socio-demographics and religious behaviors (frequency of participation in religious activities) were measured at baseline. Base morning cortisol level at wave 6 was the outcome. We fitted a linear regression model to test the association between baseline religiosity at wave 1 and cortisol level at wave 6, while baseline age, socio-economics, and psychological symptoms were controlled. Results: In the pooled sample, frequency of participation in religious activities at baseline was negatively associated with mean cortisol level at follow up (r = -0.29, P > 0.01) among all, males (r = -0.38, P > 0.01), but not females (r = -.20, P > 0.05). Frequency of participation in religious activities remained a significant predictor of subsequent cortisol level (b = -0.283, 95% CI = -.107 - -0.022) while the effect of age, socioeconomics, and psychological symptoms were controlled. We could only find such an association among male Black youth (b = -0.368, 95% CI = -0.148 - -0.024) but not female Black youth (b = -0.229, 95% CI = -.113 - 0.011). Conclusions: Religiosity has been used as a coping mechanism among Blacks. Religiosity may also be related to stress regulation among Black youth. Future studies need to test complex associations between race, sex, religiosity, chronic stress, coping, and function of hypothalamo-pituitary-adrenal (HPA). It is not known whether male Black youth who are and those who are not religious differently cope with stress associated with daily discrimination and living in disadvantaged neighborhoods

Stroke risk perception among participants of a stroke awareness campaign

BACKGROUND: Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. METHODS: Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. RESULTS: Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. CONCLUSION: Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health

Neck muscle afferents influence oromotor and cardiorespiratory brainstem neural circuits

Sensory information arising from the upper neck is important in the reflex control of posture and eye position. It has also been linked to the autonomic control of the cardiovascular and respiratory systems. Whiplash associated disorders (WAD) and cervical dystonia, which involve disturbance to the neck region, can often present with abnormalities to the oromotor, respiratory and cardiovascular systems. We investigated the potential neural pathways underlying such symptoms. Simulating neck afferent activity by electrical stimulation of the second cervical nerve in a working heart brainstem preparation (WHBP) altered the pattern of central respiratory drive and increased perfusion pressure. Tracing central targets of these sensory afferents revealed projections to the intermedius nucleus of the medulla (InM). These anterogradely labelled afferents co-localised with parvalbumin and vesicular glutamate transporter 1 indicating that they are proprioceptive. Anterograde tracing from the InM identified projections to brain regions involved in respiratory, cardiovascular, postural and oro-facial behaviours-the neighbouring hypoglossal nucleus, facial and motor trigeminal nuclei, parabrachial nuclei, rostral and caudal ventrolateral medulla and nucleus ambiguus. In brain slices, electrical stimulation of afferent fibre tracts lateral to the cuneate nucleus monosynaptically excited InM neurones. Direct stimulation of the InM in the WHBP mimicked the response of second cervical nerve stimulation. These results provide evidence of pathways linking upper cervical sensory afferents with CNS areas involved in autonomic and oromotor control, via the InM. Disruption of these neuronal pathways could, therefore, explain the dysphagic and cardiorespiratory abnormalities which may accompany cervical dystonia and WAD

Measuring achievement goal motivation, mindsets and cognitive load: validation of three instruments’ scores

© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education Objective: Measurement of motivation and cognitive load has potential value in health professions education. Our objective was to evaluate the validity of scores from Dweck\u27s Implicit Theories of Intelligence Scale (ITIS), Elliot\u27s Achievement Goal Questionnaire-Revised (AGQ-R) and Leppink\u27s cognitive load index (CLI). Methods: This was a validity study evaluating internal structure using reliability and factor analysis, and relationships with other variables using the multitrait-multimethod matrix. Two hundred and thirty-two secondary school students participated in a medical simulation-based training activity at an academic medical center. Pre-activity ITIS (implicit theory [mindset] domains: incremental, entity) and AGQ-R (achievement goal domains: mastery-approach, mastery-avoidance, performance-approach, performance-avoidance), post-activity CLI (cognitive load domains: intrinsic, extrinsic, germane) and task persistence (self-directed repetitions on a laparoscopic surgery task) were measured. Results: Internal consistency reliability (Cronbach\u27s alpha) was \u3e 0.70 for all domain scores except AGQ-R performance-avoidance (alpha 0.68) and CLI extrinsic load (alpha 0.64). Confirmatory factor analysis of ITIS and CLI scores demonstrated acceptable model fit. Confirmatory factor analysis of AGQ-R scores demonstrated borderline fit, and exploratory factor analysis suggested a three-domain model for achievement goals (mastery-approach, performance and avoidance). Correlations among scores from conceptually-related domains generally aligned with expectations, as follows: ITIS incremental and entity, r = −0.52; AGQ-R mastery-avoidance and performance-avoidance, r = 0.71; mastery-approach and performance-approach, r = 0.55; performance-approach and performance-avoidance, r = 0.43; mastery-approach and mastery-avoidance, r = 0.36; CLI germane and extrinsic, r = −0.35; ITIS incremental and AGQ-R mastery-approach, r = 0.34; ITIS incremental and CLI germane, r = 0.44; AGQ-R mastery-approach and CLI germane, r = 0.48 (all p \u3c 0.001). We found no correlation between the number of task repetitions (i.e. persistence) and mastery-approach scores, r = −0.01. Conclusions: ITIS and CLI scores had appropriate internal structures and relationships with other variables. AGQ-R scores fit a three-factor (not four-factor) model that collapsed avoidance into one domain, although relationships of other variables with the original four domain scores generally aligned with expectations. Mastery goals are positively correlated with germane cognitive load

Limits to Growth

Urban, industrial and agricultural wastewaters contain up to three magnitudes higher concentrations of total nitrogen and phosphorous, compared with natural water bodies. Normal primary and secondary treatment of these wastewaters eliminates the easily settled materials and oxidizes the organic material present, but does not remove the nutrients which will cause eutrophication of the rivers or lakes into which these wastewaters may be discharged. Tertiary treatment of the effluent is therefore required, and both chemical and physical methods which are used are very expensive. Oswald estimates that the relative cost of tertiary treatment to remove PO 4 3− , NH 4 + and NO 3 − is about 4 times the cost of primary treatment. Higher orders of treatment, such as quaternary treatment required to remove refractory organics and organic and inorganic toxicants and quinary treatment to remove inorganic salts and heavy metals, are 8 to 16 times as expensive as primary treatment. Algae can be used as a biological alternative tertiary treatment and also for the removal of heavy metals and possibly other toxic substances. The possibility exists that the algae produced in these systems can be used as animal feed supplements, or be composted. The use of waste-grown algae may ultimately also have application in closed cycle life-support systems, or may be used in conjunction with power stations, not only to treat wastewaters, but also to act as a CO2 sink for the amelioration of the impact of greenhouse gases