Reliability and parameterization of Romberg Test in people who have suffered a stroke

AIM: To analyze the reliability and describe the parameterization with inertial sensors, of Romberg test in people who have had a stroke. METHODS: Romberg's Test was performed during 20 seconds in four different setting, depending from supporting leg and position of the eyes (opened eyes / dominant leg; closed eyes / dominant leg; opened eyes / non-dominant leg; closed eyes / non-dominant leg) in people who have suffered a stroke over a year ago. Two inertial sensors (sampling frequency 180Hz) were placed in lumbar (L5-S1) and in the trunk (T7). The test was performed three times for the four different settings. The outcome variables were extracted in each of the axes (X, Y, Z) (figure 1). We considered as the maximum, minimum and mean velocity and the magnitude of the angular displacement for each of the sensors (Figure 2 shows an example of direct extraction of variables). Statistical Analysis: descriptive analysis of all outcome variables for each axis and sensor. Further analysis of the internal consistency of the measure was performed by analysis interclass correlation (ICC) with a confidence interval of 95%. RESULTS: Values obtained after statistical analysis show levels of reliability ranging from 0.61 (Z axis speed - eyes closed / nondominant leg) and 0.92 (Y axis offset - opened eyes / dominant leg). The descriptive results of all outcome variables are shown in Table 1. CONCLUSION: Making inertial sensors in trunk and / or lumbar, inertial sensors are reliable tools for parameterizing Romberg test in different settings in people who have suffered stroke over a year ago.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Improving adherence physical activity, quality of life and social support for activities in people with intellectual disabilities, through multimodal intervention (education + activity)

Background People with intellectual disabilities (ID) have a poor level of physical activity as they experience many barriers towards doing it (Bodde & Seo, 2009). Physical activity provides many benefits so there are studies to improve adherence to physical activity (Stanish & Frey, 2008). In our study we carried out a multimodal intervention (educational advice + physical activity) to improve adherence to physical activity in people with ID. Method. The sample consisted of 40 people with ID. They all received a multimodal intervention in ASPROMANIS INDUSTRIAL (Malaga, Spain), 2 hours per week for 8 weeks. The outcome measures were: IPAQ (International Physical Activity Questionnaire, WhoQoL Scale to find out about quality of life and SE/SS-AID to know self-efficacy and social support for activity. We measured fitness condition (strength, flexibility, balance and aerobic condition) through a physical fitness test (Functional reach test, single-leg stance with eyes open, single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, time-stands test, partial sit-up test, handgrip test, two-minute step test). Results and discussion The results show that with the multimodal intervention, we did not find significant changes in physical activity by measuring with IPAQ (Mets/total) in people with ID. However, we detected an increasing trend [F=0.04(0,84). On the other hand we found significant changes in quality of life [F=4.18(0,04)], professional support[F=40,31(0)] and support for friends [10,09(0)]. Finally, in those with the fitness condition, we found an increasing trend towards flexibility, strength, balance and aerobic condition, and a significant increase in abdominal muscle strength [4.22(0,04)]. Conclussion The conclusion of our study is that a multimodal intervention over 8 weeks in people with ID can improve their quality of life and provide social support for activity, but without significant improvement in physical condition and physical activity. Randomized clinical trials and a higher sample will be needed to confirm this tendency towards improvement.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Correlation between self-efficacy and social support for activity scale and fitness condition

Background: Several factors influence the levels of fitness in people with intellectual disabilities (King et al., 2003) including self-efficacy and social support (Jamieson, Parker, Roberts-Thomson, Lawrence, & Broughton, 2014). The objective of our study is to examine the relationship between fitness and self-efficacy and social support for activity in people with intellectual disabilities. Our hypothesis is that self-efficacy and social support will have a mild relationship to fitness. Methods: An observational cross-sectional study was conducted. We used the self efficacy and social support for activity scale for people with intellectual disabilities (SE/SS-AID). To measure the correlations we used physical fitness tests (Functional reach test, Single-leg stance with eyes open-, Single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, Time-stands test, Partial sit-up test, Handgrip test, two-minute step test). The physical fitness tests was separated into four categories to provide greater specificity (strength, balance, flexibility and aerobic condition). Data from the SE/SS-AID and physical fitness tests were measured in 131 adults with ID. Results and discussion. We found important correlations between the physical fitness tests and the SE/SS-AID (Calf Muscle Flexibility = 0.26 Anterior Hip Flexibility = 0.23 Abdominal Strength= 0, 21). To our knowledge, this is the first study to examine the correlations between fitness, self-efficacy and social support for activities. Other studies have measured fitness condition and social support and self efficacy for activity with regard to the SE/SS-AID scale for people with intellectual disabilities (Skowronski, Horvat, Nocera, Roswal, & Croce, 2009) but we can not know the correlations between these Conclusion: The main conclusion of our studywas that we found a low correlation between some physical fitness tests and the Self Efficacy and Social Support scales for activities. References Jamieson, L. M., Parker, E. J., Roberts-Thomson, K. F., Lawrence, H. P., & Broughton, J. (2014). Self-efficacy and self-rated oral health among pregnant aboriginal Australian women. BMC Oral Health, 14(1), 29. doi:10.1186/1472-6831-14-29 King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K., & Young, N. L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical & Occupational Therapy in Pediatrics, 23(1), 63-90. Skowronski, W., Horvat, M., Nocera, J., Roswal, G., & Croce, R. (2009). Eurofit special: European fitness battery score variation among individuals with intellectual disabilities. Adapted Physical Activity Quarterly: APAQ, 26(1), 54-67.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Effect of obesity in Independence and balance in people with intelectual disability

Background People with obesity often have problems with postural control. Some studies show that people with intellectual disabilities (ID) have a higher likelihood of having falls than the general population, with a prevalence in adults of between 29% and 70% (Cox et al., 2010). Currently, there are no studies that show the effects of obesity on independence and balance in people with ID. The objective of our study is analyse, in people with ID, the degree of influence that obesity has on independence with regard to activities of daily living, static and semi-static balance. Therefore, we can compare two groups: obese people and non-obese people. Our hypothesis is that obesity will exercise a negative influence on static and semi-static balance as well as on independence and the development of the activities of daily living. Method In a cross-sectional study, we compared static and semi-static balance in two groups of people with ID: the obese and the non-obese. All those in the sample had a low ID (IQ: 70-50) to mild ID (IQ 50-35). To measure balance we used a single leg balance test (SLBT) with opened eyes and closed eyes, and a functional reach test (FRT). In order to measure levels of dependence we used a Barthel index. The outcome variables were: time in balance in SLBT open eyes/closed eyes), maximum range of FRT and Barthel index. Results and Discussion We found significant differences in all outcome variables between two groups. To our knowledge, this is the first study to analyze how obesity affects independence, static balance and semi-static balance in people with ID. However, other studies have analyzed the effects of obesity on the general population (Singh et al., 2009). In both studies (General population: Singh et al. 2009 and people with ID in this study) we observed that obesity can be a determinant of negatively static balance and semi-static balance. Conclussion The main conclusion of this study is that obesity has a negative effect on independence, static balance and semi-static balance in people with ID. These results would have been carried out when we carry out an intervention on people with ID to prevent falls. References - Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C. Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res. 2010 Dec;54(12):1045-57. doi: 10.1111/j.1365-2788.2010.01333.x. - Enkelaar L, Smulders E, van Schrojenstein Lantman-de Valk H, Weerdesteyn V, Geurts AC. Clinical measures are feasible and sensitive to assess balance and gait capacities in older persons with mild to moderate Intellectual Disabilities. Res Dev Disabil. 2013 Jan;34(1):276-85. doi: 10.1016/j.ridd.2012.08.014. - Singh D, Park W, Levy MS, Jung ES. The effects of obesity and standing time on postural sway during prolonged quiet standing. Ergonomics. 2009 Aug;52(8):977-86.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Usability of an application for smart phones to improve physical activity in people with intellectual disabilities.

Background People with intellectual disabilities (ID) generally have a poor level of physical activity and poor adherence to this (Hughes et al., 2011). There have been some studies that use ICTs (Information Technology and Communication) to improve physical activity in other disabilities, but not in ID (Quilici et al., 2013). Usability involves ease in using a tool, so it is important to understand the usability of an application. In this study we will examine the usability of an application which is intended to improve physical activity in people with ID. Method. This is a prospective study. We installed an application onto the smart phones of people with ID, which was a reminder with some advice about physical activities that people with ID can use if they follow this advice. Usability was measured by SUS (System Usability Scale). This scale was based on a 10 item questionnaire with 5 possible answers. The total punctuation was between 0 and 100. We used this scale because it has been used in other studies and it has a high reliability (0.85). Results and discussion. We found there to be only limited usability for this application in people with ID, with a punctuation of 48,13 (±7,15). There are studies that measure the usability of mobile phones in people with ID (Stock, Davies, Wehmeyer and Palmer, 2008). However, to our knowledge, this is the first study to examine the usability of an application to improve physical activity in people with ID. Conclussion. The application to improve physical activity in people with ID had mild usability. This may reflect the difficulty that these people often have in using mobile phones and applications. References Hughes, S. L., Leith, K. H., Marquez, D. X., Moni, G., Nguyen, H. Q., Desai, P., & Jones, D. L. (2011). Physical activity and older adults: expert consensus for a new research agenda. The Gerontologist, 51(6), 822-832. doi:10.1093/geront/gnr106 Quilici, J., Fugon, L., Beguin, S., Morange, P. E., Bonnet, J.-L., Alessi, M.-C., … Cuisset, T. (2013). Effect of motivational mobile phone short message service on aspirin adherence after coronary stenting for acute coronary syndrome. International Journal of Cardiology. doi:10.1016/j.ijcard.2013.01.252 Stock, S. E., Davies, D. K., Wehmeyer, M. L., & Palmer, S. B. (2008). Evaluation of cognitively accessible software to increase independent access to cellphone technology for people with intellectual disability. Journal of Intellectual Disability Research: JIDR, 52(12), 1155-1164. doi:10.1111/j.1365-2788.2008.01099.xUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Atypical Hemolytic Uremic Syndrome

SummaryHemolytic uremic syndrome (HUS) is a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. The atypical form of HUS is a disease characterized by complement overactivation. Inherited defects in complement genes and acquired autoantibodies against complement regulatory proteins have been described. Incomplete penetrance of mutations in all predisposing genes is reported, suggesting that a precipitating event or trigger is required to unmask the complement regulatory deficiency. The underlying genetic defect predicts the prognosis both in native kidneys and after renal transplantation. The successful trials of the complement inhibitor eculizumab in the treatment of atypical HUS will revolutionize disease management

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030