33 research outputs found
Escala Hospitalaria de Ansiedad y Depresión (HADS) en cuidadores primarios informales de pacientes con cáncer: propiedades psicométricas.
Introduction: Symptoms of anxiety and depression are some of the major mental health problems in caregivers affecting quality of life. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS) has made possible the detection of possible cases of depression and anxiety. However, the psychometric properties of this instrument have not been documented in caregivers in the Mexican population. Objetives: Determine the psychometric properties of the HADS in a sample of caregivers in the Mexican population. Materials and Methods: 200 caregivers from the National Cancer Institute participated, of which 65.5% were women and 34.5% men, with a mean age of 47.4 ± 14.1 years. Participants completed concurrently the HADS and Zarit Burden Interview. Results: A factor analysis to two factors explained 42.05% of the variance with 14 items on two factors. The internal consistency of the overall scale was satisfactory (α=0.83). Cronbach’s alphas for each subscale were .78 and .82. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=0.41-0.64, p<0.05). Conclusions: The HADS has adequate construct validity, internal consistency and concurrent validity for use in caregivers of cancer patients from the Mexican population. The relevance of the results is that this is a population that can require mental health care in stages of care for patients with cancer.Introducción: la sintomatología ansiosa y depresiva son parte de los principales problemas de salud mental en cuidadores primarios informales afectando su calidad de vida. A través de instrumentos de tamizaje válidos y confiables como la Escala Hospitalaria de Ansiedad y Depresión (HADS) ha sido posible detectar posibles casos. Sin embargo, hasta ahora no se habían caracterizado las propiedades psicométricas en cuidadores primarios informales de pacientes con cáncer en población mexicana. Objetivo: determinar las propiedades psicométricas de la HADS en una muestra de cuidadores primarios informales. Material y Método: Participaron 200 pacientes del Instituto Nacional de Cancerología, de los cuales 65,5% eran mujeres y 34,5% hombres; la edad promedio fue de 47,4 ± 14,1 años. Los participantes contestaron además del HADS la escala de carga de Zarit. Resultados: El análisis factorial presentó dos factores con los 14 reactivos originales. La consistencia interna de la escala global mostró un índice satisfactorio (α=0,83). Los alfas de Cronbach de cada subescala tuvieron un valor de 0,82 y 0,78 que explican el 42,58% de la varianza. La validez por medio de correlación con las medidas concurrentes mostraron resultados significativos (r de Pearson de 0,41-0,64, p<0,05). Conclusiones: La HADS en cuidadores primarios de pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a requerir atención oportuna en salud mental en diferentes etapas del cuidado de pacientes con cáncer
DIAGNÓSTICO DE LA SITUACIÓN DEL AGAVE-MEZCAL Y OPCIONES DE DESARROLLO LOCAL EN COMUNIDADES INDÍGENAS DE OAXACA
La situación de crisis económica y ambiental que impera en todo el mundo se ha reflejado en la sobreexplotación de los recursos naturales, ocasionando con ello la pérdida de biodiversidad, contaminación y agotamiento de los mismos; además de, un mayor empobrecimiento de comunidades, debilitamiento cultural y ahondamiento de las brechas regionales. Por ello cobra gran importancia la búsqueda de alternativas que permitan la conservación in-situ de cultivos de especies nativas que ayuden a mitigar la pérdida de la diversidad genética, como es el Agave spp. utilizado para la producción de mezcal artesanal en el estado de Oaxaca.
Las condiciones de desigualdad y pobreza que imperan en el estado de Oaxaca son muy notables y de manera particular en la región mixteca donde las condiciones geográficas y de los suelos, que no son aptos para la agricultura, ocasionan los bajos niveles de productividad de la actividad agrícola, en la cual se ocupa gran parte de la población económicamente activa. Aunado a esto se presentan altos índices de marginación, migración y pobreza, donde los programas de apoyo social para la comunidad han sido deficientes, razón por la cual es necesaria la búsqueda de alternativas que les permita contar con una mejor productividad y desarrollo económico y laboral
Effects of weight loss after bariatric surgery on pulmonary function tests and aobtructive sleep apnea in morbidly obese women
Introducción: la obesidad afecta a la función respiratoria
e incrementa el riesgo de síndrome de apneas-hipopneas
del sueño (SAHS).
Objetivo: evaluar el efecto de la cirugía bariátrica, en
mujeres con obesidad mórbida, sobre la función respiratoria
y sobre el índice de apneas-hipopneas (IAH) tras
dos años de seguimiento.
Métodos: se incluyeron 15 mujeres (índice de masa
corporal [IMC] medio 50,52 ± 12,71 kg.m-2, edad media
40,13 ± 10,06 años). Los enfermos fueron analizados en
dos fases: previo a la cirugía bariátrica y tras dos años
de la misma. En cada visita se valoraron las medidas
antropométricas y se realizaron pruebas de función respiratoria
consistentes en espirometría, pletismografía,
medida de la presión inspiratoria máxima y del índice
de tensión-tiempo de los músculos inspiratorios, así como
análisis de gases arteriales. Por último, también se efectuó
una poligrafía cardiorrespiratoria durante el sueño.
Resultados: tras la cirugía bariátrica el IMC disminuyó
en 44,07 kg.m-2 (IC 95% 38,32 – 49,81). De igual
forma, se observaron incrementos significativos en el
volumen espiratorio forzado al primer segundo (FEV1)
(p < 0,01), la capacidad vital forzada (FVC) (p < 0,01), el
volumen de reserva espiratorio (ERV) (p = 0,040), la capacidad
funcional residual (FRC) (p = 0,009) y la resistencia
de las vías aéreas (Raw) (p = 0,018). Por otra parte,
el IAH (p = 0,001) y el índice de desaturación de oxígeno
(p = 0,001) disminuyeron tras la cirugía. Se observó una
correlación significativa entre el grado de pérdida de
peso y el incremento del ERV (0,774, p = 0,024).
Conclusiones: tras dos años desde la cirugía bariátrica
se siguen observando mejorías significativas en la función
respiratoria y en la gravedad del SAHS. La mejoría
del ERV estaría en relación directa con los niveles de peso
perdidoIntroduction: obesity impacts on respiratory function
and also it acts as a risk factor for obstructive sleep apnea
(OSA).
Aims: to study the effects of bariatric surgery on pulmonary
function tests and on OSA in morbidly obese women
over 4 years.
Methods: fifteen morbidly obese women (mean
body mass index [BMI] 50.52 ± 12.71 kg.m-2, mean age
40.13 ± 10.06 years) underwent pulmonary function tests
(PFT) in two opportunities (before and after weight loss
surgery). PFT included spirometry, body plethysmography
and measure of maximal inspiratory mouth pressure
(PImax) and of tension-time index for inspiratory muscles.
Also, in both opportunities, resting arterial blood gas tensions
were evaluated and a full night sleep register was
performed.
Results: BMI significantly decreased after bariatric
surgery (-44.07 kg.m-2 [CI 95% -38.32 – -49.81]). Also,
there was a significantly increase in forced expiratory
volume in 1 second (FEV1) (p < 0.01), forced vital capacity
(FVC) (p < 0.01), expiratory reserve volume (ERV)
(p = 0.040), functional residual capacity (FRC) (p = 0.009)
and a decline in airways resistance (Raw) (p = 0.018).
Concerning sleep registers, apnea hypopnea index
(p = 0.001) and desaturation index (p = 0.001) were also
reduced after weight loss. Improve in ERV had a significant
correlation with weight loss (r = 0.774, p = 0.024).
Conclussions: pulmonary function tests and apnea
hypopnea index improve after bariatric surgery in mor-
bidly obese women. Improvement of ERV is well correlated
with weight los
DQB1*0602 allele shows a strong association with multiple sclerosis in patients in Malaga, Spain.
This is the peer reviewed version of the following article: [Fernández O, Fernández V, Alonso A, Caballero A, Luque G, Bravo M, León A, Mayorga C, Leyva L, de Ramón E. DQB1*0602 allele shows a strong association with multiple sclerosis in patients in Malaga, Spain. J Neurol. 2004 Apr;251(4):440-4], which has been published in final form at [doi: 10.1007/s00415-004-0350-2].Política de acceso abierto tomada de: https://www.sherpa.ac.uk/id/publication/8072Background The human leukocyte antigen (HLA) class II DR2 haplotype (DRB1*1501, DQA1*0102, DQB1*0602) has been associated with multiple sclerosis (MS) in all ethnic groups and very strongly in Caucasians.
Aim To investigate the possible HLA class II (DRB1,DQA1 and DQB1) associations with MS in Malaga, southern Spain.
Methods We analysed the HLA class II sub-regions DRB1, DQA1 and DQB1 by polymerase chain reaction (PCR) and sequence-specific oligonucleotide probe hybridization (PCR/SSO) for DRB1 and DQB1 and with sequence-specific primers (PCR/SSP) for DRB1 subtypes and DQA1. Possible HLA class II associations with clinical MS characteristics were investigated in 149 subjects with and 160 without MS. Results Associations were detected between MS and the HLA class II alleles DRB1*1501 (45.6 % vs. 21.3%, p=0.001),DQA1*0102 (44% vs. 29.4%, p=0.001) and DQB1*0602 (45% vs. 20.6%, p=0.001). The DR2 haplotype (DRB1*1501, DQA1*0102, DQB1*0602) was associated with MS (43.6 % vs. 20%, p=0.002). DQB1*0602 was the only allele that maintained an association with MS in a logistic regression model. No HLA class II alleles or genotypes were significantly associated with any clinical characteristics of MS.
Conclusions Our results confirm the positive association of the DR2 haplotype with MS, particularly the allele DQB1*0602, in the population studied. DR4 was not associated with the disease in Malaga. HLA class II alleles or haplotype were not associated with clinical or demographic characteristics, or clinical form or severity of MS
Hospital anxiety and depression scale (HADS) in informal primary caregivers of cancer patients: psychometric properties
Introduction: Symptoms of anxiety and depression are some of the major mental health problems in caregivers affecting quality of life. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS) has made possible the detection of possible cases of depression and anxiety. However, the psychometric properties of this instrument have not been documented in caregivers in the Mexican population. Objetives: Determine the psychometric properties of the HADS in a sample of caregivers in the Mexican population. Materials and Methods: 200 caregivers from the National Cancer Institute participated, of which 65.5% were women and 34.5% men, with a mean age of 47.4 ± 14.1 years. Participants completed concurrently the HADS and Zarit Burden Interview. Results: A factor analysis to two factors explained 42.05% of the variance with 14 items on two factors. The internal consistency of the overall scale was satisfactory (α=0.83). Cronbach’s alphas for each subscale were .78 and .82. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=0.41-0.64, p<0.05). Conclusions: The HADS has adequate construct validity, internal consistency and concurrent validity for use in caregivers of cancer patients from the Mexican population. The relevance of the results is that this is a population that can require mental health care in stages of care for patients with cancer.</p
Treatment of early borderline lesions in low immunological risk kidney transplant patients : a Spanish multicenter, randomized, controlled parallel-group study protocol: the TRAINING study
Subclinical inflammation, including borderline lesions (BL), is very common (30-40%) after kidney transplantation (KT), even in low immunological risk patients, and can lead to interstitial fibrosis/tubular atrophy (IFTA) and worsening of renal function with graft loss. Few controlled studies have analyzed the therapeutic benefit of treating these BL on renal function and graft histology. Furthermore, these studies have only used bolus steroids, which may be insufficient to slow the progression of these lesions. Klotho, a transmembrane protein produced mainly in the kidney with antifibrotic properties, plays a crucial role in the senescence-inflammation binomial of kidney tissue. Systemic and local inflammation decrease renal tissue expression and soluble levels of α-klotho. It is therefore important to determine whether treatment of BL prevents a decrease in α-klotho levels, progression of IFTA, and loss of kidney function. The TRAINING study will randomize 80 patients with low immunological risk who will receive their first KT. The aim of the study is to determine whether the treatment of early BL (3rd month post-KT) with polyclonal rabbit antithymocyte globulin (Grafalon®) (6 mg/kg/day) prevents or decreases the progression of IFTA and the worsening of graft function compared to conventional therapy after two years post-KT, as well as to analyze whether treatment of BL with Grafalon® can modify the expression and levels of klotho, as well as the pro-inflammatory cytokines that regulate its expression. This phase IV investigator-driven, randomized, placebo-controlled clinical trial will examine the efficacy and safety of Grafalon® treatment in low-immunological-risk KT patients with early BL. : NCT04936282. Registered June 23, 2021, . Protocol Version 2 of 21 January 2022. Sponsor: Canary Isles Institute for Health Research Foundation, Canary Isles (FIISC). [email protected]
Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients
The impact of human leukocyte antigen (HLA)-mismatching on the early appearance of subclinical inflammation (SCI) in low-immunological-risk kidney transplant (KT) recipients is undetermined. We aimed to assess whether HLA-mismatching (A-B-C-DR-DQ) is a risk factor for early SCI. As part of a clinical trial (Clinicaltrials.gov, number NCT02284464), a total of 105 low-immunological-risk KT patients underwent a protocol biopsy on the third month post-KT. As a result, 54 presented SCI, showing a greater number of total HLA-mismatches (p = 0.008) and worse allograft function compared with the no inflammation group (48.5 ± 13.6 vs. 60 ± 23.4 mL/min; p = 0.003). Multiple logistic regression showed that the only risk factor associated with SCI was the total HLA-mismatch score (OR 1.32, 95%CI 1.06-1.64, p = 0.013) or class II HLA mismatching (OR 1.51; 95%CI 1.04-2.19, p = 0.032) after adjusting for confounder variables (recipient age, delayed graft function, transfusion prior KT, and tacrolimus levels). The ROC curve illustrated that the HLA mismatching of six antigens was the optimal value in terms of sensitivity and specificity for predicting the SCI. Finally, a significantly higher proportion of SCI was seen in patients with >6 vs. ≤6 HLA-mismatches (62.3 vs. 37.7%; p = 0.008). HLA compatibility is an independent risk factor associated with early SCI. Thus, transplant physicians should perhaps be more aware of HLA mismatching to reduce these early harmful lesions
Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients
The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 +/- 1.2 vs. 5.7 +/- 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 +/- 14.9 vs. 125.7 +/- 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients