Effectiveness of procedural sedation and analgesia in pediatric emergencies. A cross-sectional study

Introduction. Pain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among healthcare professionals and relatives, and agreement between the satisfaction of healthcare professionals and relatives. Method. A cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Arms, Cry, Consolability scale (FLACC) and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. STATA 16 was used for data analysis. Results. A total of 94 procedures were registered. Our results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between healthcare professionals (i.e., pediatric nurses and pediatricians) was considered substantial. However, the agreement between healthcare professionals and relatives was moderate. Conclusions. Our results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, although the availability of international guides. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques, and the causes of the differences between the perspectives of healthcare professionals and relatives. These research lines may be useful to improve our quality of care and pediatric patient comfort

Factores que favorecen el estrés parental durante el ingreso hospitalario del niño con patologia aguda

Revisar la evidencia empírica primaria acumulada en relación a los factores que influyen en el estrés parental durante la hospitalización del niño por patología aguda Revisión sistemática en inglés y español, sin restricción de tiempo, incluyendo artículos, libros, capítulos de libro, informes y tesis en Cinalh, Cochrane Plus, Dialnet,Google&Google Scholar, Lilacs, Proquest Health&Medical Complete, Proquest Medline,Proquest Theses&Dissertations, PsycInfo, Psicodoc, Pubmed, ScienceDirect, Scopus, TDX,Web of Science. Se obtuvieron 20443 referencias. Se eliminaron las referencias duplicadas, no relacionadas con el tema y de acceso restringido. Se revisaron 22 estudios en texto completo, clasificados en diseños transversales (11), de cohortes (5) y de caso (6). Todos presentaron elevada calidad metodológica. Resultados: Factores asistenciales como la información, la comunicación, los procedimientos terapéuticos y la actitud profesional se relacionan significativamente con la ansiedad y el estrés parental. Tras el alta, además, los padres pueden presentar sintomatología de estrés post-traumático, falta de cohesión familiar y salud general más empobrecida. Conclusiones: El impacto emocional del ingreso por patología aguda implica graves secuelas en la salud familiar. Promover el apoyo psicoemocional a los padres, mejorar la calidad asistencial y extender la investigación en este campo serían estrategias necesarias para prevenir complicaciones y reducir costes sanitarios.To review primary studies related to the factors influencing parental stress during the child's hospitalization for acute pathology. Methodology: A systematic review was performed in English and Spanish including articles, books, book chapters, reports and theses, published up to now, in Cinalh, Cochrane, Dialnet, Google&Google Scholar, Lilacs, Proquest Health&Medical Complete, ProQuest Medline, Proquest Theses&Dissertations, PsycInfo,Psicodoc, PubMed, ScienceDirect, Scopus, TDX, Web of Science. Total of 20443 references were obtained. Duplicate references, those not related to the topic and the restricted access references were removed. Full text of 22 studies were reviewed and analysed, classified as cross sectional (11), cohort (5) and case designs (6). All reported good methodological quality. Results: Health care factors such as information, communication, therapeutic procedures and professional attitude are significantly associated to parental anxiety and stress. After discharge, in addition, parents may have symptoms of post-traumatic stress, lack of family cohesion and poorer overall health. Conclusions: The emotional impact of hospitalization for acute pathology involves serious consequences on family health. Promoting psychological and emotional support to parents, improving the health care quality and extending the research in this field might be necessary strategies to prevent complications and to reduce the health care costs

Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study)

BDNF; Cytokines; FibromyalgiaBDNF; Citocinas; FibromialgiaBDNF; Citocines; FibromiàlgiaIntroduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre-post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes. Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d'Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed

Methods for Heart Rate Variability Biofeedback (HRVB) : A Systematic Review and Guidelines

Altres ajuts: acords transformatius de la UABHeart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported

Mejora del comportamiento en la extrusión de pastas cerámicas de baja plasticidad.

Shaping by extrusion may be used for the manufacture of tiles, bricks, and also refractory products. The three fundamental aspects that must be considered to achieve ideal extrusion conditions are the nature of the material, particle size and Plastic behaviour. Of these, obtaining a mass of adequate plasticity is essential during the processing in order to prevent defects such as cracks, laminations or migrations of the liquid phase [1]. Plastic behaviour depends on numerous factors [2]: size and shape of the particle, mineralogical composition, presence of electrolytes, organic matter, etc. With regard to traditional ceramics, as is the case of the manufacture of ceramic tiles, clay materials are those with the necessary plasticity to carry out the extrusion process. However, in the absence of clays with sufficient plasticity or when the composition incorporates a high proportion of other non-plastic ingredients, the extrusion operation may be seriously compromised, particularly for the manufacture of large or complex tiles. In these cases it is necessary to add plasticizers or binders to the pastes to achieve rheological behaviour and plasticity enabling correct processing of the composition [3]. In this report the influence of different additives in different proportions on the plasticity index of a ceramic composition was evaluated and the variation of the plasticity index was related to the behaviour of the paste during extrusion.El conformado por extrusión se puede utilizar para la fabricación de baldosas, ladrillos, tejas o también productos refractarios. Los tres aspectos fundamentales que se deben considerar para lograr unas condiciones de extrusión idóneas son la naturaleza del material, el tamaño de partícula y el comportamiento plástico. De éstas, obtener una masa de plasticidad adecuada es fundamental durante el procesado, para evitar la aparición de defectos tales como grietas, laminaciones o migraciones de la fase líquida [1]. El comportamiento plástico depende de numerosos factores [2]: tamaño y forma de la partícula, composición mineralógica, presencia de electrolitos, materia orgánica, etc. En lo que concierne a las cerámicas tradicionales, como es el caso de la fabricación de baldosas cerámicas, los materiales arcillosos son los que confieren la plasticidad necesaria para llevar a cabo el proceso de extrusión. Sin embargo, cuando no se dispone de arcillas con la plasticidad suficiente o cuando la composición incorpora otros ingredientes no plásticos en elevada proporción, la operación de extrusión se puede ver seriamente comprometida, sobre todo en la fabricación de baldosas de gran formato o de geometría compleja. En estos casos es necesario añadir a las pastas aditivos plastificantes o ligantes para conseguir un comportamiento reológico y plasticidad que permitan un correcto procesado de la composición [3]. En este trabajo se evaluó la influencia de la incorporación de diferentes aditivos en distintas proporciones sobre el índice de plasticidad de una composición cerámica y se relacionó la variación del índice de plasticidad con el comportamiento de la pasta durante la extrusión

Women's experiences during childbirth: a systematic review protocol

Review question / Objective: General aim of this systematic review is to synthesize available evidence on women's experiences during childbirth in health institutions and formal care settings. Specific objectives are to: 1. Describe women's experiences during childbirth in institutional health centers. 2. Classify women's experiences according to the Mother and Baby Friendly Birth Facility (MBFBF) criteria. 3. Describe prevalence of these experiences across different countries and cultures. 4. Determine the impact of childbirth experiences on self-perceived women's health on aspects related to physical, psychological and social domains. Condition being studied: This review will be framed within the context of the Mother and Baby Friendly Birth Facility (MBFBF). Women's experiences during childbirth will be classified according to the categories defined by the MBFBF. Other actions or experiences, as interventionism or different procedures applied during childbirth, will also be analyzed (Mena-Tudela et al., 2020)

Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia : Study protocol of a randomized, controlled trial (On&Out study)

Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre-post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes. Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d'Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed. Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d'Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 ()

Filaggrin and cytokines in respiratory samples of preterm infants at risk for respiratory viral infection

Respiratory viral infections (RVIs) are frequent in preterm infants possibly inducing long-term impact on respiratory morbidity. Immune response and respiratory barriers are key defense elements against viral insults in premature infants admitted to Neonatal Intensive Care Units (NICUs). Our main goals were to describe the local immune response in respiratory secretions of preterm infants with RVIs during NICU admission and to evaluate the expression and synthesis of lung barrier regulators, both in respiratory samples and in vitro models. Samples from preterm infants that went on to develop RVIs had lower filaggrin gene and protein levels at a cellular level were compared to never-infected neonates (controls). Filaggrin, MIP-1α/CCL3 and MCP-1 levels were higher in pre-infection supernatants compared to controls. Filaggrin, HIF-1α, VEGF, RANTES/CCL5, IL-17A, IL-1β, MIP-1α and MIP-1β/CCL5 levels were higher during and after infection. ROC curve and logistic regression analysis shows that these molecules could be used as infection risk biomarkers. Small airway epithelial cells stimulated by poly:IC presented reduced filaggrin gene expression and increased levels in supernatant. We conclude that filaggrin gene and protein dysregulation is a risk factor of RVI in newborns admitted at the NICU.This study has been partially supported by ISCIII – Instituto de Salud Carlos III, FIS (Fondo de Investigación Sanitaria—Spanish Health Research Fund) grants FI19/00067, PI18/00167, PI21/00896, PI18CIII/00009 and FEDER funds (Fondo Europeo de Desarrollo Regional); Sociedad Española de Alergología e Inmunología Clínica (SEAIC)Beca19A04_Valverde; Alfonso X El Sabio University Grant: VIII Convocatoria Santander-UAX; CIBER de Enfermedades Respiratorias (CIBERES), a Carlos III Institute of Health Initiative.S

Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation

Cancer is the leading cause of death after liver transplantation (LT). This multicenter case–control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who received tacrolimus-based immunosuppression. After 13 922 person/years follow-up, 425 patients (19.7%) developed malignancy (cases) and were matched with 425 controls by propensity score based on age, gender, smoking habit, etiology of liver disease, and hepatocellular carcinoma (HCC) before LT. The independent predictors of post-LT malignancy were older age (HR = 1.06 [95% CI 1.05–1.07]; p < .001), male sex (HR = 1.50 [95% CI 1.14–1.99]), smoking habit (HR = 1.96 [95% CI 1.42–2.66]), and alcoholic liver disease (HR = 1.53 [95% CI 1.19–1.97]). In selected cases and controls (n = 850), the immunosuppression protocol was similar (p = .51). An increased cumulative exposure to tacrolimus (CET), calculated by the area under curve of trough concentrations, was the only immunosuppression-related predictor of post-LT malignancy after controlling for clinical features and baseline HCC (CET at 3 months p = .001 and CET at 12 months p = .004). This effect was consistent for de novo malignancy (after excluding HCC recurrence) and for internal neoplasms (after excluding non-melanoma skin cancer). Therefore, tacrolimus minimization, as monitored by CET, is the key to modulate immunosuppression in order to prevent cancer after LT