39 research outputs found
Caregiver Burden Domains and Their Relationship with Anxiety and Depression in the First Six Months of Cancer Diagnosis
Cancer caregiving is associated with burden and a poor psychological state. However, there is no previous information about the predictive utility of specific burden domains on anxiety and depression in the first six months after a partner’s cancer diagnosis. In a longitudinal study, 67 caregivers completed the Zarit Burden Interview (ZBI) and Hospital Anxiety and Depression Scale (HADS) at T1 (45–60 days after diagnosis) and T2 (180–200 days after diagnosis). Most of the caregivers were female (65.7%, mean age = 51.63, SD = 13.25), while patients were mostly male (56.7%). The TRIPOD checklist was applied. ZBI scores were moderate and HADS anxiety reached significant values. There were no differences in ZBI and HADS between T1 and T2. The relationship between burden, anxiety, and depression were more consistent at T2, while emotional burden at T1 were related and predicted anxiety and depression at T2. Some burden domains were related and predicted anxiety in caregivers in the first six months after partner cancer diagnosis. This information could be useful to prevent the onset of these symptoms in the first six months after diagnosis
Aortic dissection. The diagnostic challenge in out-of-hospital health care
Se presenta un caso de dolor torácico asociado a debilidad de ambos miembros inferiores secundaria a una disección aórtica, una patología poco frecuente, que puede debutar de múltiples formas clínicas, caracterizada por una elevada morbimortalidad. En este caso clínico se revisa la clínica más frecuentemente asociada a esta patología, el diagnóstico y las complicaciones derivadas de su tratamiento, destacando la necesidad de un diagnóstico precoz.
El médico de urgencias debe estar familiarizado con esta enfermedad, considerándola en el diagnóstico diferencial de todo aquel paciente que consulte por dolor torácico.We present a case of chest pain associated with lower limbs weakness secondary to acute aortic dissection, an uncommon illness, that can debut in various ways presenting a high morbimortality.
In this case we review the most common symptoms associated to this clinical entity, its diagnosis and complications related to its treatment, underlining the importance of an early diagnosis.
The emergency physician must be familiarized with this pathology, in order to, consider it in the differential diagnosis of every patient that consult for chest pain
Proteomic analysis of granulomas from cattle and pigs naturally infected with Mycobacterium tuberculosis complex by MALDI imaging
Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) has recently gained prominence for its ability to provide molecular and spatial information in tissue sections. This technology has the potential to uncover novel insights into proteins and other molecules in biological and immunological pathways activated along diseases with a complex host–pathogen interaction, such as animal tuberculosis. Thus, the present study conducted a data analysis of protein signature in granulomas of cattle and pigs naturally infected with the Mycobacterium tuberculosis complex (MTC), identifying biological and immunological signaling pathways activated throughout the disease. Lymph nodes from four pigs and four cattle, positive for the MTC by bacteriological culture and/or real-time PCR, were processed for histopathological examination and MALDI-MSI. Protein identities were assigned using the MaTisse database, and protein–protein interaction networks were visualized using the STRING database. Gene Ontology (GO) analysis was carried out to determine biological and immunological signaling pathways in which these proteins could participate together with Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Distinct proteomic profiles between cattle and pig granulomas were displayed. Noteworthy, the GO analysis revealed also common pathways among both species, such as “Complement activation, alternative pathway” and “Tricarboxylic acid cycle”, which highlight pathways that are conserved among different species infected by the MTC. In addition, species-specific terms were identified in the current study, such as “Natural killer cell degranulation” in cattle or those related to platelet and neutrophil recruitment and activation in pigs. Overall, this study provides insights into the immunopathogenesis of tuberculosis in cattle and pigs, opening new areas of research and highlighting the importance, among others, of the complement activation pathway and the regulation of natural killer cell- and neutrophil-mediated immunity in this disease
Cost‐effectiveness and cost‐utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP‐Costs): a multicentre randomized controlled trial protocol
Background: Emotional disorders are common, and they have become more prevalent since the COVID‐19 pan‐ demic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetu‐ ate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive‐behavioural therapy (tCBT) as a cost‐effective alternative. However, it is not suitable for everyone; in some cases, one‐on‐one sessions may be more effective. The objective of the present study is to compare, in cost‐benefit terms, group and individual tCBT with the treatment usu‐ ally administered in Spanish primary care (TAU). Methods: A randomized, controlled, multicentre, and single‐blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calcu‐ late incremental cost‐effectiveness and cost‐utility ratios. Discussion: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped‐care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. Trial registration: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)
This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe
Role of age and comorbidities in mortality of patients with infective endocarditis
[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.
[Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.
[Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.
[Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group
una mirada desde las Ciencias de la Conducta
Este libro es el resultado de los trabajos presentados en el 1er Congreso Internacional "Convivencia y bienestar con sentido humanista para una cultura de paz"
POR UNA CULTURA DE PAZ: UNA MIRADA DESDE LAS CIENCIAS DE LA CONDUCTA
En
virtud
de
lo
anterior,
los
estudiosos
de
las
ciencias
de
la
conducta
de
la
Universidad
Autónoma
del
Estado
de
México,
ante
la
persistencia
y
proliferación
de
estos
hechos
en
diversas
partes
del
Mundo
y
de
nuestro
país
en
particular, se
convocó
a
los
estudiosos
interesados
y
a
la
sociedad
en
general
a
presentar
trabajos
para
analizar,
debatir
y
proponer
estrategias
de
acción
y
dirección,
que
fortalezcan
una
convivencia y bienestar con sentido humanista para una cultura de paz.
El
presente
texto
es
producto
de
esta convocatoria
que
recoge
los
trabajos
de
los
interesados
en
la
temática,
de
diferentes
países
(España,
Argentina,
Cuba,
Brasil,
Costa
Rica
y
México)
retomando
con
ello
sus
experiencias
relativas
al
estudio,
análisis,
comprensión
e
instrumentación
de
la
cultura
de
paz
en
los
distintos
ámbitos
institucionales
en
los
que
participan:
educativo,
salud,
penitenciario,
social,
laboral,
familia,
alimentario,
psicológico,
por
mencionar
algunos.
El
presente
libro,
propicia
un
espacio
de
reflexión,
diálogo
y
posicionamiento
de
las
ciencias
de
la
conducta
para
la
apropiación,
análisis,
debate
y
propuestas
que
fortalezcan
una
cultura
de
paz
a
través
de
la
convivencia
y
el
bienestar
social
con
sentido
humanista.
El
sistema
económico
neoliberal
y
el
proceso
de
globalización
han
contribuido
al
logro
de
avances
significativos
en
la
ciencia
y
la
tecnología,
pero
también
han
propiciado
la
polarización
de
las
sociedades
lo
que
ha
impactado
de
manera
negativa
a
la
sociedad
en
su
conjunto,
pero
en
mayor
medida
a
los grupos
vulnerables. Dicha
polarización
ha
traído
consigo
un
desarrollo
desigual
del
mundo
que
se
expresa
de
diferentes
maneras
tanto
en
países
desarrollados
como
en
los
llamados
del
tercer
mundo,
en
donde
no
están
satisfechas
las
necesidades
humanas
elementales
de
todos
los
sectores
de
la
población,
siempre
falta
algo.
Si
a
esto
le
sumamos
los
conflictos
internacionales por
diferentes
motivos
que
enfrentan
algunas
naciones,
una
insuficiente
cobertura
educativa
y
de
salud,
desempleo
y
pobreza
extrema,
entre
otras
cosas;
estamos
frente
a
retos
de
gran
envergadura
para
los
gobiernos,
para
los
estudiosos
y
para
la
sociedad
civil
en
general. Uno
de
los
intentos
para
frenar
y prevenir
la
agudización
de
estas
problemáticas
es
la
cultura
de
paz,
cuyo
estudio
y propuestas
han
ido
avanzando
en
diferentes
sentidos
y
de
manera
favorable,
el
tema
está
presente
en
diferentes
Organismos
Internacionales
como
la
ONU,
la
UNESCO,
la
OCDE,
El
Banco
Mundial,
entre
otros.
Pero
falta
mucho
por
hacer.Universidad Autónoma del Estado de Méxic