Análisis motivacional en adolescentes. El SMAT (Test de motivaciones en adolescentes)

Terceres Jornades de Foment de la Investigació de la FCHS (Any 1997-1998)El origen de la presente comunicación se sitúa en la realización de las prácticas correspondientes al Curso de Adaptación Pedagógica (C.A.P.) realizado en esta Universidad durante el curso 1997-98. En ellas realizamos una medición de los intereses motivacionales de los alumnos de dos cursos de 3º de B.U.P. a partir de la aplicación del Test de Motivaciones en Adolescentes (SMAT). Nuestro objetivo fundamental era valorar aspectos de la validez criterial del instrumento, en relación a su capacidad predictiva sobre el rendimiento escolar de los alumnos. Para ello, comparamos los resultados obtenidos en la prueba con los resultados académicos de los alumnos en la evaluación que en ese momento estaban realizando

Validez del Illness Behavior Questionnaire (IBQ): Estudio factorial y criterial

Segones Jornades de Foment de la Investigació de la FCHS (Any 1996-1997)El propósito del presente trabajo es doble: por una parte se pretende estudiar las propiedades psicométricas del cuestionario de Conducta de Enfermedad (IBQ) de Pilowky. Para ello, se analiza la fiabilidad, midiendo la consistencia interna del instrumento, y la validez de constructo, tanto a nivel factorial como de criterio. Por otra parte, se pretende aportar evidencia al modelo de pánico de Clark (1985) en lo que se refiere a la focalización atencional en las señales corporales. Los resultados han de ser tomados con cierta cautela, ya que la muestra no es lo suficientemente amplia como para obtener conclusiones lo suficientemente sólidas. Sin embargo, nuestros datos sugieren, de acuerdo con la literatura, que la estructura de siete factores obtenida por Pilowsky es difícilmente replicable. Parece ser que el cuestionario estaría midiendo un claro factor de Hipocondría General, mientras que los otros factores habrían de estar mejor representados en el cuestionario. En función de los análisis hemos realizado algunas modificaciones, sobre todo en la asignación de ítems a factores y en la elaboración de las escalas. Nuestra adaptación tiene en cuenta 41 ítems, repartidos en seis factores denominados Hipocondría, Alteración emocional, Preocupación por la enfermedad, Inhibición afectiva, Negación y Convicción de enfermedad. Nuestra adaptación, al menos la escala de Hipocondría, es lo bastante precisa como para discriminar a nivel clínico entre fóbicos y ansiosos generales, y éstos del grupo control. Por tanto, consideramos que se trata de una adaptación fiable y válida del instrumento. Finalmente, hemos encontrado diferencias significativas en el nivel de Hipocondría, es decir, en el nivel de preocupación y autoobservación de los estímulos corporales entre los pánico y los demás grupos. Esto supone un claro apoyo al modelo de pánico de Clark

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Regardant à travers les flammes : Processus de formation des amas coquilliers fuegiens et comportements humains sur la côte maritime de la Terre de Feu

International audienceThis work presents a synthetic approach to the analysis of combustion structures and their archaeological remains, seeking to understand site-formation processes and spatial organization of maritime Hunter-Gatherers on the northern coast of the Beagle Channel in Tierra del Fuego, as well as past human behavior concerning direct and indirect production and exploitation of thermal energy.Therefore, the communication will address and integrate different methodological aspects developed for the study of combustion structures in these particular environmental and anthropic contexts: First, the analysis of ethno-archaeological data concerning the use of fire. Second, the study of the functionality and duration of combustion structures by means of an experimental analytical approach. Third, the study of soil transformation processes by thermal action, including experimentation, modelling, soil analysis (soil composition at multiple scales) and micromorphology. Fourth, the analysis of the organic and inorganic content of such soils through the study of biomarkers and inorganic elements, which have allowed to identify what food was consumed and discriminate functionality between several episodes of use. Fifth, the anthracological analysis of wood remains to approach fuel selection strategies. And finally, the stratigraphic and spatial analysis of combustion structures in the framework of shell-midden depositional sequences. All these approaches will be integrated with the objective of reconstructing the microhistories that lead to the formation of three Fuegian shell-middens (Túnel 1, Túnel VII, Lanashuaia), and gaining insights into the nature of maritime Hunter-Gatherer behavior and coastal occupations.Dans ce travail de synthèse, nous présenterons différents aspects sur la manière dont l'analyse des structures de combustion et les traces de leur utilisation contribuent à la compréhension des processus de formation et d'organisation des sites de chasseurs-cueilleurs adaptés au littoral maritime sur la côte nord du canal de Beagle en Terre de Feu, ainsi que sur les comportement de ces populations dans le passé liés à la production et à l'exploitation de l'énergie thermique de façon directe ou indirecte.Nous présenterons l'interaction des différents aspects méthodologiques qui ont été développés pour l'étude des structures de combustion et leur interprétation dans ces contextes anthropiques tels que : l'analyse des données ethno-archéologiques liées au feu ; l'étude du mode de fonctionnement, durée d’utilisation et fonction des structures de combustion à travers une approche analytique expérimentale des processus de transformation sédimentaires liés à l'action de la chaleur et aux activités liées à son utilisation (expérimentation, modélisation et analyse sédimentaires (composition sédimentaire à différentes échelle et analyses micro morphologiques) ; l'analyse du contenu organique et inorganique de ces sédiments à travers l'étude des éléments inorganiques et des biomarqueurs moléculaires afin de comprendre la fonctionnalité des différents épisodes d'utilisation, la nature des aliments consommés et l'analyse à travers des études anthracologiques des ressources utilisées pour la combustion. Pour conclure nous aborderons l'analyse de la relation de ces informations avec les séquences de dépôt de ces amas coquillers afin d'intégrer ces différentes approches et ainsi comprendre la nature de ces occupations et comportements humains ainsi que les micro-histoires respectives qui ont donné lieu à la formation de ces gisements (Tunel 1, Tunel VII, Lanashuaia, etc.

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings