Clinical study of untreated hip in spastic tetraparesis

Objective: To evaluate CP patients considering the hip joint and analyzing the relation between severity, age and scoliosis. Methods: A transversal descriptive study was performed in 40 patients (1 to 17 y.o.), 21 (52,5%) female and 19 (47,5%) male from Cruz Verde Association; 19 (47,5%) had history of prematurity; 26 (65,0%) with anoxia; meningitis in 4 (10%), hydrocephalus in 10(25,0%); microcephalus in 15 (37,5%). From the total 38 (95,0%) presented spasticity, 1 (2,5%) athetoid and 1 (2,5%) mixed. According to topographic classification 28 (70,0%) presented tetraparesis and 12 (30,0%) double hemiparesis. All of them are non-ambulators and 38 (95,0%) were classified as GFMCS V and 2 (5,0%) were level IV. The patients were divided in two groups (with or without indications for hip surgical treatment). The hips were analysed by Thomas, abduction, and Nelaton-Galeazzi tests. The scoliosis was clinically analysed considering trunk symmetry and dorsal hump. Results: We observed positive correlation between the patients scoliosis and hip flexion contracture. There was no difference between the patients age and and hip flexion contracture. There was no difference between topographic types and hip contractures. Conclusions: We did not find positive correlation between patients age and hip contractures; patients with scoliosis present worse hip abduction compromise.Objetivo: Avaliar quadris de pacientes com tetraparesia espástica considerando a gravidade das deformidades articulares, a idade e a escoliose. Métodos: Realizamos um estudo descritivo transversal de 40 pacientes (um a 17 anos); 21 (52,5%) do sexo feminino e 19 (47,5%) do masculino em pacientes da Associação Cruz Verde; 19 (47,5%) apresentaram prematuridade, 26 (65,0%) anóxia, quatro (10,0%) meningite, 10 (25,0%) hidrocefalia e 15 (37,5%) microcefalia; 38 (95,0%) apresentavam espasticidade, um (2,5%) atetose e um (2,5%) o padrão misto; 28 (70,0%) apresentavam tetraparesia e 12 (30,0%) dupla hemiparesia. Nenhum paciente deambulava, 38 (95,0%) foram classificados como GFMCS V e dois (5,0%) como IV. Consideramos dois grupos, conforme a necessidade ou não do tratamento cirúrgico dos quadris pelo risco de luxação e dor. Utilizamos os testes de Thomas, abdução brusca e Nelaton-Galeazzi. A escoliose foi avaliada pela simetria do tronco e gibosidade. Resultados: Observamos correlação entre a escoliose e a positividade do teste da abdução brusca. Não houve correlação entre a idade e a contratura dos quadris. Não houve diferença entre os tipos topográficos e a contratura do quadril. Conclusões: Não encontramos correlação entre a idade e o grau de contratura articular; pacientes com escoliose apresentaram maior comprometimento da abdução do quadril.Universidade Federal de São Paulo (UNIFESP) EPMUniversidade Federal de São Paulo (UNIFESP) EPM Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Does app-based unguided self-management improve mental health literacy, patient empowerment and access to care for people with mental health impairments? Study protocol for a randomised controlled trial

Introduction Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is—to a large extent—caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services. Methods and analysis Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis. Ethics and dissemination Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences. Trial registeration The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results

Decomposição funcional de circuitos lógicos combinatórios

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Decomposição funcional de circuitos lógicos combinatórios

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Decomposição funcional de circuitos lógicos combinatórios

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International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1

INTRODUCTION: The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism. OBJECTIVE: The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets. METHODS: We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated. RESULTS: Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types. CONCLUSIONS: The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).status: publishe