Upper body motor function and swallowing impairments and its association in survivors of head and neck cancer: A cross-sectional study

Background Upper body motor function and swallowing may be affected after curative treatment for head and neck cancer. The aims of this study are to compare maximum mouth opening (MMO), temporomandibular dysfunction (TMD), cervical and shoulder active range of motion (AROM) and strength, and swallowing difficulty between survivors of head and neck cancer (sHNC) and healthy matched controls (HMC) and to examine the correlations between these outcomes in sHNC. Methods Thirty-two sHNC and 32 HMC participated on the study. MMO, TMD, cervical and shoulder AROM, cervical and shoulder strength, the SPADI shoulder pain and disability indices, the Eating Assessment Tool (EAT-10) score, swallowing difficulty as determined using a visual analogue scale (VAS), and the location of disturbances in swallowing, were recorded. Results MMO and cervical and shoulder AROM and strength were significantly lower in sHNC, whereas FAI, SPADI score, EAT-10 and VAS were higher. The MMO, TMD, cervical and shoulder AROM, and cervical shoulder strength values showed significant correlations (some direct, others inverse) with one another. Swallowing difficulty was inversely associated with the MMO, cervical AROM and shoulder strength. Conclusion Compared with controls, sHNC present smaller MMO, lower cervical and shoulder AROM, lower cervical and shoulder strength and higher perception of TMD, shoulder pain and disability and swallowing difficulty. sHNC suffer impaired swallowing related to lower MMO, presence of TMD, cervical AROM and shoulder strength values. Improving these variables via physiotherapy may reduce the difficulty in swallowing experienced by some sHNC.Fondos Estructurales de la Union Europea (FEDER)Unit of Excellence on Exercise and Health (UCEES), University of Granad

Ehlers–Danlos Syndrome Type Arthrochalasia: A Systematic Review

Ehlers–Danlos syndrome type arthrochalasia (aEDS) is a rare genetic disease characterized by severe generalized joint hypermobility, bilateral congenital hip dislocation, skin hyperextensibility, muscle hypotonia, and mild dysmorphic features. It is an autosomal dominant connective tissue disease causing defects in collagen, associated with two genes, COL1A1 or COL1A2. Only about 42 cases have been published worldwide. Treatment is currently symptomatic and focuses on increasing the quality of life of these patients, as there is no curative treatment. The main objective of the review was to update information on Ehlers–Danlos syndrome type arthrochalasia from scientific publications. The review report was carried out in accordance with the criteria of the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) review protocol, by searching Orphanet, OMIM, PubMed, and Scopus, as well as free sources. A total of 20 articles were analyzed, which, after analysis, provide an updated report that aims to establish a solid starting point for future lines of research

Estrutura interna de uma escada de desesperança para adultos maiores do México

Objective. To obtain and analyze the structure and internal coherence of an initial proposal of the despair scale for older adults in northeast Coahuila, Mexico. Method. The study sample consisted of 106 adults over 60 years old; 57.5% were women and 42.5% were men. The sampling strategy was incidental. Hopelessness was measured through an instrument of 20 reagents expressly for the elderly population. Results. With the exploratory and confirmatory factor analysis, a two-component solution was obtained: motivation and sense of life and catastrophizing of the present and the future, explained 48.8% of the variance. Further, this new instrument showed an appropriate convergence validity as it showed a positive correlation, that goes from medium to high, with the Beck Hopelessness Scale (EDB), and the CESD-20 Depression Scale. The reliability was 0.91. Conclusion. The reliability of the scale proposed in this first version presented adequate values that reflect internal consistency and a coherent structure, similar what was reported in other studies with other tools.Objetivo. Obtener y analizar la estructura interna de una propuesta de la Escala de Desesperanza para Adultos Mayores del noreste de Coahuila, México. Método. La muestra del estudio estuvo conformada por 106 adultos mayores de 60 años, 57.5% mujeres y el 42.5% hombres. La estrategia de muestreo fue no probabilístico, incidental. La desesperanza se midió con un instrumento de 20 reactivos para población de adultos mayores, de respuesta con escala Likert, agrupados en tres dimensiones. Resultados. Con el análisis factorial exploratorio y confirmatorio se obtuvo una solución de dos componentes: motivación y sentido de vida y catastrofización del presente y del futuro, los cuales explican el 48.8% de la varianza. Además, presentaron una validez convergente apropiada, al mostrar una correlación positiva, que va de media a alta con la Escala de Desesperanza de Beck (EDE) y con la Escala de Depresión CESD-20. La fiabilidad fue de 0.91. Conclusión. La confiabilidad de la escala propuesta presentó valores adecuados que reflejan consistencia interna y una estructura coherente, similar a lo reportado en otros estudios con otras herramientas.Escopo. Obter e analisar a estrutura interna de uma proposta inicial da Escada de Desesperança, para adultos maiores do nordeste de Coahuila, México. Metodologia. A amostra do estudo esteve conformada por 106 adultos maiores de 60 anos, 57,5% foram mulheres e 47% homens. A estratégia da amostragem foi não probabilística, incidental. A desesperança foi medida com um instrumento de 20 reativos para população de adultos maiores, de resposta com escada Likert, agrupados em três dimensões. Resultados. Com a análise fatorial exploratório e confirmatório foi obtida uma solução de dois componentes: motivação e sentido de vida e catastrofização do presente e do futuro, os quais explicam o 48.8% da variedade. Além, apresentaram uma validade convergente apropriada, ao mostrar uma correlação positiva, que vai de média alta com a Escada de desesperança de Beck (EDE) e com a escada de depressão CESD-20. A fiabilidade foi de 0.91. Conclusão. A confiabilidade da escada proposta em esta primeira versão apresentou valores adequados que refletem consistência interna e uma estrutura coerente, similar ao reportado em outros estudos com outras ferramentas

Nursing Staff Knowledge on the Use of Intraosseous Vascular Access in Out-Of-Hospital Emergencies

In healthcare practice, there may be critically injured patients in whom catheterisation of a peripheral venous access is not possible. In these cases, intraosseous access may be the preferred technique, using an intraosseous vascular access device (IOVA). Such devices can be used for infusion or administration of drugs in the same way as other catheterisations, which improves emergency care times, as it is a procedure that can be performed in seconds to a minute. The aim of this study was to analyse the level of knowledge of nursing staff working in emergency departments regarding the management of the intraosseous vascular access devices. To this end, a cross-sectional online study was carried out using an anonymous questionnaire administered to all professionals working in emergency and critical care units (ECCUs) in Granada district (Spain). The results show that 60% of the participants believe that with the knowledge they have, they would not be able to perform intraosseous vascular access, and 74% of the participants believe that the low use of this device is due to insufficient training. The obtained results suggest that the intraosseous access route, although it is a safe and quick way of achieving venous access in critical situations, is considered a secondary form of access because the knowledge of emergency and critical care professionals is insufficient, given the totality of the participants demanding more training in the management of intraosseous access devices. Therefore, the implementation of theoretical/practical training programmes related to intraosseous access (IO) could promote the continuous training of nurses working in ECCUs, in addition to improving the quality of care in emergency and critical care situations

Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study

Background: In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level. Methods: Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of < 10%, 10-25%, and 25% and a prescribed radiation dose of < 35 Gy, 50 Gy, and 66-70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field. Results: A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%. Conclusion: This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.This work was supported, in part, by Grants-in-Aid for Scientific Research from the Health Andalusian Authority PI-SAS-209/04

Evaluation of Lactobacillus Coryniformis K8 Consumption by Health Care Workers Exposed to COVID-19 (LactoCor2 Project): Protocol for a Randomized Controlled Trial

Acknowledgments We thank all participants for their valuable contributions. We would especially like to thank the managing directors of the San Cecilio and Virgen de las Nieves University Hospitals.Background: Lactobacillus coryniformis K8 CECT5711 has immune-modulating properties, enhances the immune response to viral antigens leading to the production of specific antibodies, and has anti-inflammatory activity, which may help to prevent uncontrolled inflammatory processes leading to respiratory and other organ failures. Objective: The purpose of this study is to evaluate the effect of the consumption of a probiotic strain on the incidence and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS-CoV-2. Methods: This is a double-blind randomized clinical trial in which the experimental group will receive a capsule of L coryniformis K8 per day (3×109 colony former units/day), and the control group will receive a daily placebo capsule consisting of maltodextrin. A sample size of 314 volunteers was calculated. Volunteers must meet the following inclusion criteria: older than 20 years and active health personnel caring for patients with COVID-19, including all professionals such as medical doctors, nurses, and caretakers at the 2 referral hospitals that treat patients with COVID-19. The main outcome of the clinical trial will be the incidence of symptomatic infection by SARS-CoV-2 in personnel who care for patients with suspected or confirmed COVID-19. Results: The study had to be extended to the 2 referral hospitals that treat patients with COVID-19 in the province of Granada (Andalusia, Spain); Hospital San Cecilio and Hospital Virgen de las Nieves. A total of 255 individuals met the inclusion criteria and were randomly assigned to one of the 2 groups. Conclusions: The results of this randomized controlled trial will provide valuable information regarding the administration of L coryniformis K8 against COVID-19, including whether there are fewer infectious processes due to this virus or, in case of occurrence, whether the disease is milder in participants taking the probiotic strain

COVID-19 in Pregnant Women, Maternal—Fetal Involvement, and Vertical Mother-to-Child Transmission: A Systematic Review

Pregnant women are included in the COVID-19 risk groups even if they do not have any pathology. This requires an analysis of research focused on pregnant women to understand the impact of SARS-CoV-2 on their condition. There is also a need to know whether there is vertical mother-to-child transmission, as well as other consequences in case the pregnant woman is infected and COVID-19 positive. A systematic review was carried out to analyze the existing information on the complications of a pregnant woman infected with the SARS-CoV-2 coronavirus and the possibility of vertical transmission from mother to child, registered in the PROSPERO website and searched in the PubMed, Scopus, CINAHL, and Cochrane Library databases. Finally, 22 articles were included in the review. The review suggests that vertical transmission from mother to child could be exceptionally possible at the time of delivery or breastfeeding, but not through the placenta. It is interesting to point out the good acceptance of vaccination by pregnant women, which may be the reason for the low infectivity. Further research on pregnant women should be carried out to provide evidence on vertical mother-to-child transmission and the role of breast milk in relation to SARS-CoV-2

Evolution of the COVID-19 Pandemic after the Introduction of School Referral Nurses in the Province of Granada—A Descriptive Study

The aim of this research is to describe the evolution of the pandemic in a school context, following the introduction of school nurses into the educational setting. Background: The first wave of COVID-19 in Spain prevented social interaction by imposing lockdowns on the population. All non-essential activities, including face-to-face education, were interrupted, affecting the school-aged population during the second and third trimester of the 2019/2020 school year. Schools are places where prevention, identification and case management measures should be rapidly implemented. Methods: This is a prospective and descriptive study using a quantitative method to study the school population of Granada and its province during the school year 2020/2021, from September 2020 to May 2021. The study participants were all schools under the jurisdiction of the Territorial Delegation of Education of Granada, whether public, private, state-subsidised or charter schools, including all educational stages. Results: The confirmation rate in Granada city (11.2%), in contrast to the Andalusian average (6.9%), places Granada as the province with the highest incidence rate. The infection rates among teachers show the same confirmation rate as the general population of Granada (9%); however, among students this rate is lower (7%). There is a higher incidence of outbreaks taking place outside school and a lower incidence of outbreaks occurring within the school environment. Both partial and total outbreaks are more frequent in early childhood education. Conclusion: The early identification and management of reported suspected cases of COVID-19 in schools is proving effective in preventing infection in the school population, achieving good pandemic control in schools, and reducing the number of outbreaks and people affected. Schools have been confirmed to be safe. Establishing screening for asymptomatic schoolchildren could be a tool to improve control in schools.Colegio Oficial de Enfermeria de Granada (CODEGRA

Persistent pain management in an oncology population through pain neuroscience education, a multimodal program: PaiNEd randomized clinical trial protocol

Pain is one of the most persistent symptoms after cancer treatment. The central nervous system can erroneously stay in its alarm phase, altering the pain experience of patients who have cancer. Pain neuroscience education (PNE) with multimodal approaches may benefit these patients.“Subvenciones para la Financiación de la Investigación, Desarrollo e Innovación (I+D+I) Biomédica y en Ciencias de la Salud, Consejería de Salud y Familias”, of the Andalusian Regional Government (PI-0171-2020