CHRONOFALLS: A multicentre nurse-led intervention in the chronoprevention of in-hospital falls in adults

Background: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. Methods: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. Results: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. Conclusions: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies

In utero exposure to butyl benzyl phthalate induces modifications in the morphology and the gene expression profile of the mammary gland: an experimental study in rats

<p>Abstract</p> <p>Background</p> <p>Environmental estrogens are exogenous estrogen-mimicking compounds that can interfere with endogenous endocrine systems. Several of these endocrine disruptors have been shown to alter normal development and influence tumorigenesis in experimental models. N-butyl benzyl phthalate (BBP), a widely used plasticizer, is a well-known endocrine disruptor. The aim of this study was to elucidate the effect of prenatal exposure to BBP on the morphology, proliferative index, and genomic signature of the rat mammary gland at different ages.</p> <p>Methods</p> <p><it>In utero </it>exposure was performed by gavage of pregnant Sprague Dawley CD rats with 120mg or 500mg BBP/kg/day from day 10 post-conception to delivery. Female litters were euthanized at 21, 35, 50 and 100 days. The morphology and proliferative index of the mammary gland were studied from whole mount preparations and BrdU incorporation, respectively. Gene expression profile was assessed by microarrays. Several genes found differentially expressed and related to different functional categories were further validated by real time RT-PCR.</p> <p>Results</p> <p>Prenatal exposure of BBP induced delayed vaginal opening and changes in the post-natal mammary gland long after the end of the treatment, mainly by 35 days of age. Exposure to the high dose resulted in modifications in architecture and proliferative index of the mammary gland, mostly affecting the undifferentiated terminal end buds. Moreover, the expression profiles of this gland in the exposed rats were modified in a dose-dependent fashion. Analysis of functional categories showed that modified genes were related to immune function, cell signaling, proliferation and differentiation, or metabolism.</p> <p>Conclusions</p> <p>Our data suggest that <it>in utero </it>exposure to BBP induced a delayed pubertal onset and modified morphology of the mammary gland. These alterations were accompanied by modifications in gene expression previously associated with an increased susceptibility to carcinogenesis.</p

Minimising Mortality in Endangered Raptors Due to Power Lines: The Importance of Spatial Aggregation to Optimize the Application of Mitigation Measures

Electrocution by power lines is one of the main causes of non-natural mortality in birds of prey. In an area in central Spain, we surveyed 6304 pylons from 333 power lines to determine electrocution rates, environmental and design factors that may influence electrocution and the efficacy of mitigation measures used to minimise electrocution cases. A total of 952 electrocuted raptors, representing 14 different species, were observed. Electrocuted raptors were concentrated in certain areas and the environmental factors associated with increased electrocution events were: greater numbers of prey animals; greater vegetation cover; and shorter distance to roads. The structural elements associated with electrocutions were shorter strings of insulators, one or more phases over the crossarm, cross-shaped design and pylon function. Of the 952 carcasses found, 148 were eagles, including golden eagle (Aquila chrysaetos), Spanish imperial eagle (Aquila adalberti) and Bonelli's eagle (Aquila fasciata). Electrocuted eagles were clustered in smaller areas than other electrocuted raptors. The factors associated with increased eagle electrocution events were: pylons function, shorter strings of insulators, higher slopes surrounding the pylon, and more numerous potential prey animals. Pylons with increased string of insulators had lower raptor electrocution rates than unimproved pylons, although this technique was unsuccessful for eagles. Pylons with cable insulation showed higher electrocution rates than unimproved pylons, both for raptors and eagles, despite this is the most widely used and recommended mitigation measure in several countries. To optimize the application of mitigation measures, our results recommend the substitution of pin-type insulators to suspended ones and elongating the strings of insulators

Essential versus accessory aspects of cell death: recommendations of the NCCD 2015

Cells exposed to extreme physicochemical or mechanical stimuli die in an uncontrollable manner, as a result of their immediate structural breakdown. Such an unavoidable variant of cellular demise is generally referred to as ‘accidental cell death’ (ACD). In most settings, however, cell death is initiated by a genetically encoded apparatus, correlating with the fact that its course can be altered by pharmacologic or genetic interventions. ‘Regulated cell death’ (RCD) can occur as part of physiologic programs or can be activated once adaptive responses to perturbations of the extracellular or intracellular microenvironment fail. The biochemical phenomena that accompany RCD may be harnessed to classify it into a few subtypes, which often (but not always) exhibit stereotyped morphologic features. Nonetheless, efficiently inhibiting the processes that are commonly thought to cause RCD, such as the activation of executioner caspases in the course of apoptosis, does not exert true cytoprotective effects in the mammalian system, but simply alters the kinetics of cellular demise as it shifts its morphologic and biochemical correlates. Conversely, bona fide cytoprotection can be achieved by inhibiting the transduction of lethal signals in the early phases of the process, when adaptive responses are still operational. Thus, the mechanisms that truly execute RCD may be less understood, less inhibitable and perhaps more homogeneous than previously thought. Here, the Nomenclature Committee on Cell Death formulates a set of recommendations to help scientists and researchers to discriminate between essential and accessory aspects of cell death

Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

<p>Abstract</p> <p>Background</p> <p>Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.</p> <p>Methods</p> <p>Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.</p> <p>Results</p> <p>There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.</p> <p>Conclusion</p> <p>A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.</p

Application of bioassays with Enchytraeus crupticus and Folsomia candida to evaluate the toxicity of a metal-contaminated soil, before and after remediation.

Purpose: A contaminated soil was amended to reduce bioavailability of metals (As, Cd, Cu, Pb, and Zn) and to modify its potential environmental impacts. Reproduction toxicity tests using two different soil invertebrates, Enchytraeus crypticus and Folsomia candida, were used to evaluate efficiency of soil amendments to reduce metal availability. Materials and methods: This study has been carried out on a very contaminated soil from El Arteal mining district (SE Spain). The amendments used were marble sludge from the cutting and polishing of marble, compost from greenhouse wastes, and synthetic iron oxides. Soils were analyzed for cation exchange capacity, organic carbon and calcium carbonate content, particle size distribution, pH, electrical conductivity, and total metal content. Porewater and 0.01 M CaC

Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter, Randomized Controlled Trial with 18-Month Follow-Up.

BACKGROUND: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important. OBJECTIVE: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery. METHODS: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses. RESULTS: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04). CONCLUSION: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523

Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial

<p>Abstract</p> <p>Background</p> <p>Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.</p> <p>The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS.</p> <p>Method/design</p> <p>A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment.</p> <p>Discussion</p> <p>This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons.</p> <p>Trail Registration</p> <p>ISRCTN Number: 30907460</p

Baixa percepção de risco entre adolescentes espanhóis em relação ao consumo de álcool

Según los estudios recientes, los adolescentes españoles muestran una baja percepción del riesgo asociado al consumo de alcohol. El objetivo de la presente investigación es analizar los factores que favorecen esta baja percepción a partir de la opinión de un grupo de 32 profesionales/expertos en adolescencia, familia, escuela, medios de comunicación y políticas locales. Se utilizó una metodología cualitativa, fundamentada en Grounded Theory, a partir de la información obtenida mediante 5 grupos de discusión guiados por entrevistas semiestructuradas. Se identificaron 12 factores o subcategorías agrupados en 4 categorías generales: riesgo a corto plazo, inmediatez y percepción de invulnerabilidad (categoría ¿pensamiento adolescente¿); concepción benévola del alcohol, normalización del consumo y binomio alcohol-diversión (categoría ¿normas sociales¿); consumo habitual en los padres, inconsistencia verbal-no verbal en el modelado parental, consumo sin riesgo en los medios, consumo con resultados positivos en los medios (categoría ¿modelos sociales¿); excesivo contenido sanitario, riesgo a largo plazo (categoría ¿discurso preventivo¿). Tras discutir los resultados en el contexto de la literatura científica actual, se realizan varias propuestas con el objetivo de aumentar la percepción del riesgo en los adolescentes: incidir con mayor fuerza en contenidos sobre los riesgos a corto plazo del alcohol; orientar las estrategias educativas dirigidas al adolescente, también hacia los agentes de socialización, especialmente los padres; incidir en políticas centradas en la sustancia y en reducir la oferta.According to recent studies, Spanish adolescents show low perception of risk in alcohol consumption. The current study aims to analyze the factors that favor this low perception based on the opinion of a group of 32 professional experts on adolescence, family, school, mass media, and local policies. A qualitative methodology was used, based on Grounded Theory, using information from 5 focus groups guided by semi-structured interviews. Twelve factors or subcategories were identified, grouped in 4 general categories: short-term risk, immediacy, and perception of invulnerability (¿adolescent thinking¿ category); benevolent view of alcohol, normalization of consumption, and alcohol-entertainment binomial (¿social norms¿ category); parents¿ habitual consumption, verbal/non-verbal inconsistency in parental model, risk-free consumption depicted in the mass media, consumption with positive results in the media (¿social models¿ category); and excessive health content, long-term risk (¿preventive discourse¿ category). After discussing the results in the context of the current scientific literature, the article offers various proposals for increasing risk perception in adolescents: stronger impact of contents on short-term risks of alcohol; educational strategies targeted to adolescents to include agents of socialization, especially parents; and policies centered on the substance and reduction of supply.De acordo com estudos recentes, os adolescentes espanhóis mostram baixa percepção de risco em relação ao consumo de álcool. O estudo tem como objetivo analisar os fatores associados com a baixa percepção de risco, com base nas opiniões de um grupo de 32 especialistas em adolescência, família, escola, mídia e políticas locais. Foi utilizada uma metodologia qualitativa, baseada na Teoria Fundamentada, usando informações de cinco grupos focais orientados por entrevistas semi-estruturadas. Foram identificados 12 fatores ou subcategorias, agrupados em quatro categorias gerais: risco no curto prazo, imediatismo e percepção de invulnerabilidade (categoria de ¿pensamento adolescente¿); visão benevolente em relação ao álcool, normalização do consumo e binômio álcool-entretenimento (categoria de ¿normas sociais¿); consumo habitual pelos pais, inconsistência na comunicação verbal versus não verbal no modelo representado pelos pais, consumo isento de risco retratado pela mídia, consumo com resultados positivos na mídia (categoria de ¿modelos sociais¿) e excesso de conteúdo relacionado à saúde, risco no longo prazo (categoria de ¿discurso preventivo¿). Depois de discutir os resultados no contexto da literatura científica atual, o artigo oferece várias propostas para aumentar a percepção de risco entre os adolescentes: impacto mais forte de conteúdos sobre os riscos do álcool no curto prazo; estratégias educativas orientadas aos adolescentes para incluir os agentes da socialização, especialmente os pais, além de políticas centradas na substância e na redução da oferta.Departamento de Educación y Psicología SocialVersión del edito