Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review

Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient’s adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.This study will be supported by University of Malaga (Spain). Partial funding for open access charge: Universidad de Málag

¿Qué es la Calidad de Vida para los Estudiantes?

El termino calidad de vida es usualmente empleado de manera vaga y sin ninguna definición clara. En México la calidad de vida se a estudiado en pacientes enfermos, por eso nuestra inquietud de investigar sobre esta en estudiantes que no presentan ninguna enfermedad , limitación física, económica, social o mental Se encuestaron a 500 estudiantes universitarios de  la Universidad Autónoma de Puebla, Universidad de las Américas, Instituto Culinario de Puebla y U. De Guadalajara, a los cuales se les aplico uno de los diferentes 9 cuestionariosautoaplicables basados en estructura de escala global y a los parámetros clinimétricos de pregunta directa. El objetivo fue determinar lo que los estudiantes incluyen en calidad de vida  dependiendo en la calificación que otorguen a esta. Nos damos cuenta que para los estudiantes que considera que su calidad de vida muy agradable, se basan en que estén bien socioeconomicamente y estabilidad familiar; los que calificaron de totalmente agradable o agradable refieren tener todo sin especificar, buena los que ya mencionan aspectos negativos de su vida ,mientras para los que la calificaron como muy desagradable fue por falta de  éxito y superación personal, Sin mencionar el ambiente familiar, nadie califico su calidad de vida como totalmente desagradable. Para la mayoría de los profesionales  en la salud la calidad de vida se basa en el estado de salud del paciente (físico o mental) sin tomar en cuenta aspectos tan importantes como son estabilidad familiar, económica, social y cultural En base a los resultados obtenidos se observo que para la mayoría de los estudiantes su calidad de vida no se basa en el estado de salud, sino en sus relaciones familiares, nivel socioeconómico y realización personal. Por lo que es necesario que en México se investigue mas sobre lo parámetros que se toman en cuanta para calificar la calidad de vida del paciente

Cysteamine (Cystagon®) adherence in patients with cystinosis in Spain: successful in children and a challenge in adolescents and adults.

Journal Article; Research Support, Non-U.S. Gov't;BACKGROUND Cysteamine has improved survival and prognosis in cystinosis. Increasing numbers of patients reach adulthood and face new challenges such as compliance that wanes over time. The aim of this study was to evaluate adherence to cysteamine treatment in a group of cystinotic patients in Spain in an attempt to identify potential therapy pitfalls and improve the overall care of affected individuals. Despite the impact of cysteamine on prognosis, there is a paucity of data regarding adherence. METHOD Thirty-four cystinotic patients (21 male) 38% ≥18 years were enrolled in a voluntary, anonymous survey. Replies were obtained from patients (15/34), mothers (11/34), fathers (4/34) and both parents (4/34). RESULTS Patient age (median and interquartile range) at diagnosis was 1 year (0.57-1), and patient age at Cystagon® initiation was also 1 year (0.8-1.8). Sixteen (47%) were kidney transplant (KTx) recipients; six were retransplanted. Age at first KTx 10 years (8.7-13.7). Patient understanding of multiorgan involvement in cystinosis: 4.1 organs reported; eye 97% and kidney 91%. Cysteamine was given by mother (100%) and father (83%) in <11 year olds, or self-administered (94%) in ≥11 year olds. Four daily doses in 89% versus 56% in <11 year olds or ≥11 year olds, with fixed schedule in 94% versus 50% in <11 or ≥11 year olds and progressive loss of reminders over time. Furthermore, 44% complained of unpleasant smell. Motivation for treatment compliance was 100% versus 40% in <11 versus ≥11 year olds, respectively. Disease impact in patients <18 years is as follows: school (29%), social (14%), 'feeling different' (10%); in patients ≥18 years: 'feeling different' (62%), professional (39%) and job absenteeism (31%). Referring physician: paediatric nephrologist (94%) and nephrologist (63%) in <11 versus ≥11 year olds. Ophthalmological follow-up: 83% versus 38% in <11 versus ≥11 year olds. Patient opinion of physician expertise: paediatric nephrologist (94%) and nephrologist (44%). New treatment options (65%) and better information (42%) were demanded to improve adherence. CONCLUSION Treatment with Cystagon is effective in young patients. However, adherence diminishes over time in adolescents and adults despite disease impact. Strategies such as better information on the disease, patient self-care promotion and facilitated transition to adult healthcare services are required to improve compliance and the clinical management of cystinosis.This study has been supported by A.C. Nielsen Company S.L.and Orphan Europe S.L.UYe

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

¿Qué es la Calidad de Vida para los Estudiantes?

El termino calidad de vida es usualmente empleado de manera vaga y sin ninguna definición clara. En México la calidad de vida se a estudiado en pacientes enfermos, por eso nuestra inquietud de investigar sobre esta en estudiantes que no presentan ninguna enfermedad , limitación física, económica, social o mental Se encuestaron a 500 estudiantes universitarios de  la Universidad Autónoma de Puebla, Universidad de las Américas, Instituto Culinario de Puebla y U. De Guadalajara, a los cuales se les aplico uno de los diferentes 9 cuestionariosautoaplicables basados en estructura de escala global y a los parámetros clinimétricos de pregunta directa. El objetivo fue determinar lo que los estudiantes incluyen en calidad de vida  dependiendo en la calificación que otorguen a esta. Nos damos cuenta que para los estudiantes que considera que su calidad de vida muy agradable, se basan en que estén bien socioeconomicamente y estabilidad familiar; los que calificaron de totalmente agradable o agradable refieren tener todo sin especificar, buena los que ya mencionan aspectos negativos de su vida ,mientras para los que la calificaron como muy desagradable fue por falta de  éxito y superación personal, Sin mencionar el ambiente familiar, nadie califico su calidad de vida como totalmente desagradable. Para la mayoría de los profesionales  en la salud la calidad de vida se basa en el estado de salud del paciente (físico o mental) sin tomar en cuenta aspectos tan importantes como son estabilidad familiar, económica, social y cultural En base a los resultados obtenidos se observo que para la mayoría de los estudiantes su calidad de vida no se basa en el estado de salud, sino en sus relaciones familiares, nivel socioeconómico y realización personal. Por lo que es necesario que en México se investigue mas sobre lo parámetros que se toman en cuanta para calificar la calidad de vida del paciente

Estilo de vida de los estudiantes de informática

This article presents the preliminary results of a descriptive exploratory study on life style of university students of the area of the Computation who will serve for the design of strategies of prevention of not transmissible illnesses. We used a questionnaire of our own design that probes three dimensions: General Data, Health and Perception that allow us to have a global vision of the lifestyle of the respondents. The questionnaire was applied in the summer of 2014 to 1060 students of Computer and Information Technology careers. The results indicate that we are facing a population whose daily habits tend to risky behaviors for their health and already present risk factors of noncommunicable diseases such as: 28.8% overweight / obesity (n = 277), 67.1% smoking (n = 646), 31.5% lack of physical activity (n = 303), 71% sedentary lifestyle (n = 684) as well as waist circumference greater than 83 cm, 24.5% (n = 236).Este artículo presenta los resultados preliminares de un estudio descriptivo exploratorio sobre estilo de vida de estudiantes universitarios del área de la Computación que servirán para el diseño de estrategias de prevención de enfermedades no trasmisibles. Se utilizó un cuestionario de diseño propio que sondea tres dimensiones: Datos Generales, Salud y Percepción que permiten tener una visión global del estilo de vida de los encuestados. El cuestionario se aplicó en el verano de 2014 a 1060 estudiantes de las carreras de Computación y Tecnologías de la Información. Los resultados indican que nos encontramos frente a una población cuyos hábitos cotidianos tienden a comportamientos riesgosos para su salud y ya presentan factores de riesgo de enfermedades no transmisibles como lo son: 28.8% sobrepeso/obesidad (n=277), 67.1% tabaquismo (n=646), 31.5% falta de actividad física (n=303), 71% sedentarismo (n=684) así como perímetro de cintura superior a 83 cm un 24.5% (n=236)