Prognostic value of geriatric conditions for death and bleeding in older patients with atrial fibrillation

Background: Geriatric conditions, such as frailty and cognitive impairment, are prevalent in older patients with atrial fibrillation (AF). We examined the prognostic value of geriatric conditions for predicting 1-year mortality and bleeding events in these patients. Methods: SAGE (Systematic Assessment of Geriatric Elements)-AF study is a multicenter cohort study which enrolled individuals (mean age 75 years, 48% women, 86% taking oral anticoagulation) 65 years and older with AF and CHA2DS2 -VASc score of 2 or higher from clinics in Massachusetts and Georgia, USA between 2016 and 2018. A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing was performed at baseline. Study endpoints included all-cause mortality and clinically relevant bleeding. Results: At 1 year, 1,097 (96.5%) individuals attended the follow up visit, 44 (3.9%) had died, and 56 (5.1%) had clinically relevant bleeding. After adjustment for demographic and clinical factors, social isolation (odds ratio [OR] 1.69, 95% confidence interval [CI]: 1.01-2.84), depression (OR 1.94, 95% CI: 1.28-2.95) and frailty (OR 2.55, 95% CI: 1.55-4.19) were significantly associated with the composite endpoint of death or clinically relevant bleeding. After multivariable adjustment, depression (OR 1.79, 95% CI 1.09-2.93) and frailty (OR 2.83, 95% CI 1.55-5.17) were significantly associated with clinically relevant bleeding. Conclusions: Social isolation, depression, and frailty were prognostic of dying or experiencing clinically relevant bleeding during the coming year in older men and women with AF. Assessing geriatric impairments merits consideration in the care of these patients

Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study

Background: Atrial fibrillation (AF) and heart failure (HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods: The SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF (mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results: Patients with prevalent HF (n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2DS2VASC and HAS-BLED scores than patients without HF (all P\u27s \u3c 0.01). In multivariable adjusted regression models, HF (present vs. absent) was associated with both prevalent frailty (adjusted odds ratio [aOR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year (aOR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment (aOR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year (aOR 1.04, 95%CI: 0.64-1.70). Conclusions: Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration

Los comportamientos de control en la pareja en la era digital: la aceptación de la violencia de género, el sexismo y los mitos del amor

Young people have incorporated information and communication technology (ICT) and its influence on socialization as a new instrument to exercise controlling behaviors in their relationships. The present research aims to analyse the influence of some variables that affect social perception of those controlling behaviors, such as the adopted role on the scene (i.e., protagonist vs. observer) and means of control that is used (i.e., face-to-face vs. WhatsApp) while considering the effect of attitudinal variables: acceptability of intimate partner violence against women (IPVAW), ambivalent sexism, and myths about romantic love. Two studies were implemented: Study 1 included women (n = 224) and Study 2 included men (n = 120), all of them college students. The main results revealed that both women and men perceive controlling behaviors amongst other peer couples; however, few of them recognize suffering or the exercise of these behaviors within their relationships. In addition, data pointed out the adopted role on the scene and the ideological variables (ambivalent sexism, acceptability of IPVAW, and myths about romantic love) that influenced social perception of dating violence; however, there was no influence of means of control. This research contributes to the previous literature, evidencing that controlling behaviors through technological means are accepted and normalized among young people. Additionally, it shows novel data about young people’s social perception of controlling behaviors in their relationships, depending on whether they adopt the role of observer or the role of protagonist in a violent situation.Con las tecnologías de la información y la comunicación (TIC) y su influencia en la socialización, los jóvenes han incorporado un instrumento más para ejercer comportamientos controladores en sus relaciones de pareja. Esta investigación pretende analizar la influencia de algunas variables que afectan a la percepción social de estos comportamientos controladores, como el rol del participante en el escenario (protagonista vs. observador u observadora) y el medio de control utilizado (cara a cara vs. WhatsApp), considerando el efecto de las variables ideológicas: aceptabilidad de la violencia, sexismo y mitos del amor romántico. Se llevaron a cabo dos estudios: un primer estudio con mujeres (n = 224) y uno segundo con hombres (n = 120), todos ellos estudiantes universitarios. Los principales resultados indicaron que tanto mujeres como hombres observan comportamientos controladores en otras parejas de su edad, aunque pocos reconocen sufrir o ejercer estos comportamientos en sus relaciones. Asimismo, se encuentra que el rol que se ocupa en el escenario y las variables ideológicas (sexismo ambivalente, aceptabilidad de la violencia y mitos sobre el amor romántico) influyen en la percepción social de la violencia en la pareja, si bien no se encontró influencia del medio de control. Estos hallazgos constituyen una aportación a la literatura existente, poniendo en evidencia que los comportamientos controladores ejercidos a través de los medios tecnológicos son aceptados y normalizados entre los jóvenes y las jóvenes. Asimismo, proporciona datos novedosos sobre la percepción social que esta población tiene de los comportamientos controladores en las relaciones en función de si se adopta el rol de observador o de protagonista de la situación violenta

Analisis Kemampuan Berpikir Kritis dan Sikap Peduli Lingkungan Peserta Didik SMP Kelas VII pada Materi Pemanasan Global di SMP Negeri 29 Medan

This study aims to determine the critical thinking skills of seventh grade junior high school students on global warming material at SMP Negeri 29 Medan in the 2021/2022 Academic Year, and the attitude of caring for the environment towards global warming material. This type of research is descriptive with mixed research methods. The population in the study consisted of 8 classes and the sample consisted of 2 classes, namely class VII-7 and VII-8 with 62 students. The sampling technique used is random sampling. The research data collection used a HOTS-based essay test instrument totaling 12 items, an interview instrument totaling 7 questions, an environmental care attitude questionnaire totaling 15 statements, and also observation sheets of learning tools. The results showed that students' critical thinking skills could be categorized as low with an average percentage score of 47.50. Factors that influence students' critical thinking skills are situational factors and dispositional factors. The most influential situational factor is the accountable factor, while the most influential dispositional factor is habituation and practice. The caring attitude of students in class VII at SMP Negeri 29 Medan for the 2021/2022 school year can be categorized as not caring with an average percentage score of 49.78.Penelitian ini bertujuan untuk mengetahui kemampuan berpikir kritis siswa kelas VII SMP pada materi pemanasan global di SMP Negeri 29 Medan Tahun Pelajaran 2021/2022, dan sikap peduli lingkungan terhadap materi pemanasan global. Jenis penelitian ini adalah deskriptif dengan metode penelitian campuran. Populasi dalam penelitian terdiri dari 8 kelas dan sampel terdiri dari 2 kelas yaitu kelas VII-7 dan VII-8 dengan jumlah siswa 62 orang. Teknik pengambilan sampel yang digunakan adalah random sampling. Pengumpulan data penelitian menggunakan instrumen tes uraian berbasis HOTS sebanyak 12 butir, instrumen wawancara sebanyak 7 soal, angket sikap peduli lingkungan sebanyak 15 pernyataan, serta lembar observasi perangkat pembelajaran. Hasil penelitian menunjukkan bahwa kemampuan berpikir kritis siswa dapat dikategorikan rendah dengan rata-rata persentase skor 47,50. Faktor yang mempengaruhi kemampuan berpikir kritis siswa adalah faktor situasional dan faktor disposisi. Faktor situasional yang paling berpengaruh adalah faktor akuntabel, sedangkan faktor disposisional yang paling berpengaruh adalah pembiasaan dan praktik. Sikap peduli siswa kelas VII SMP Negeri 29 Medan tahun pelajaran 2021/2022 dapat dikategorikan tidak peduli dengan rata-rata persentase skor 49,78

Definição de atributos ambientais essenciais para a humanização em quartos de internação

Em arquitetura, humanizar significa oferecer espaços mais qualificados aos usuários, com estímulos ambientais que propiciem bem-estar. Estabelecimentos de saúde públicos raramente oferecem espaços para que os pacientes circulem, além do quarto de internação. Esta pesquisa busca investigar quais são os elementos ambientais essenciais para a humanização desses espaços através de revisão de literatura e um estudo de caso em hospital público. Assim, realizou-se uma revisão de literatura para elencar possíveis elementos capazes de gerar maior conforto e bem-estar físico e psicológico aos usuários, e aspectos relacionados à psicologia ambiental foram abordados para melhor compreensão do comportamento dos usuários. A pesquisa, de caráter investigativo, foi realizada por meio de um estudo de caso, com o apoio de diversos métodos quali/quantitativos, como: visita exploratória, inquirição, observação do comportamento e análise dos traços físicos – imprescindíveis para auxiliar na definição dos atributos prioritários. Os métodos foram aplicados com a finalidade de avaliar o ambiente, identificar os usuários e suas atividades. Pode-se concluir que os elementos ambientais considerados como essenciais são em sua maioria aqueles inerentes à própria arquitetura. Ao projetar ambientes de saúde, que possuem usuários fragilizados, devem-se levar em conta seus anseios e suas necessidades para garantir uma permanência satisfatória

Definição de atributos ambientais essenciais para a humanização em quartos de internação

Em arquitetura, humanizar significa oferecer espaços mais qualificados aos usuários, com estímulos ambientais que propiciem bem-estar. Estabelecimentos de saúde públicos raramente oferecem espaços para que os pacientes circulem, além do quarto de internação. Esta pesquisa busca investigar quais são os elementos ambientais essenciais para a humanização desses espaços através de revisão de literatura e um estudo de caso em hospital público. Assim, realizou-se uma revisão de literatura para elencar possíveis elementos capazes de gerar maior conforto e bem-estar físico e psicológico aos usuários, e aspectos relacionados à psicologia ambiental foram abordados para melhor compreensão do comportamento dos usuários. A pesquisa, de caráter investigativo, foi realizada por meio de um estudo de caso, com o apoio de diversos métodos quali/quantitativos, como: visita exploratória, inquirição, observação do comportamento e análise dos traços físicos – imprescindíveis para auxiliar na definição dos atributos prioritários. Os métodos foram aplicados com a finalidade de avaliar o ambiente, identificar os usuários e suas atividades. Pode-se concluir que os elementos ambientais considerados como essenciais são em sua maioria aqueles inerentes à própria arquitetura. Ao projetar ambientes de saúde, que possuem usuários fragilizados, devem-se levar em conta seus anseios e suas necessidades para garantir uma permanência satisfatória

Understanding Lesion Creation Biophysics and Improved Lesion Assessment during Radiofrequency Catheter Ablation. The Perfect Combination to Achieve Durable Lesions in Atrial Fibrillation Ablation

Atrial fibrillation (AF) is a prevalent arrhythmia, while pulmonary vein isolation (PVI) has become a cornerstone in its treatment. The creation of durable lesions is crucial for successful and long-lasting PVI, as inconsistent lesions lead to reconnections and recurrence after ablation. Various approaches have been developed to assess lesion quality and transmurality in vivo, acting as surrogates for improved lesion creation and long-term outcomes utilizing radiofrequency (RF) energy. This review manuscript examines the biophysics of lesion creation and different lesion assessment techniques that can be used daily in the electrophysiology laboratory when utilizing RF energy. These methods provide valuable insights into lesion effectiveness, facilitating optimized ablation procedures and reducing atrial arrhythmia recurrences. However, each approach has its limitations, and a combination of techniques is recommended for comprehensive lesion assessment during AF catheter ablation. Future advancements in imaging techniques, such as magnetic Resonance Imaging (MRI), optical coherence tomography, and photoacoustic imaging, hold promise in further enhancing lesion evaluation and guiding treatment strategies