What the System Hides: A Case of Sexual Abuse

En este artículo se estudia, desde una perspectiva sistémica, un caso clínico real. María, una adolescente diagnosticada de bulimia nerviosa, que en un principio acude a la consulta para tratar este trastorno de su conducta alimentaria, acabará revelando haber sido víctima de un abuso intrafamiliar, cuando el profesional le pregunta por las relaciones entre los miembros de la familia. El caso servirá para examinar varias cuestiones: 1º La importancia del marco de referencia: la situación del paciente puede resultar incomprensible si el médico centra su atención exclusivamente en el cuadro clínico, sin tener en cuenta la ecología de su medio habitual. 2º La visión de la enfermedad de la paciente como síntoma de un sufrimiento interior cuyo origen se encuentra en una dificultad familiar. 3º La mejoría del paciente comienza por la revelación de un secreto traumático, pero no a nivel individual, como ocurre en el modelo psicodinámico clásico, sino a nivel familiar. 4º La superación del trauma, que ha comenzado por esa revelación, no se completa hasta que no se produce el reajuste del sistema familiar.In this paper, a real clinical case is evaluated from a systemic point of view. María is an adolescent diagnosed with bulimia nervosa, who, initially, comes to the medical office to treat her eating disorder, but then she reveals that she has been a victim of intra-familial sexual abuse when the professional asks her about relationships between family members. This case will enable an examination of several matters: 1st. The importance of the frame of reference: the reality of the patient can be incomprehensible if the doctor only pays attention to the clinical situation, disregarding the ecology of her home environment. 2nd. The view of the disease as a symptom of inner suffering which has its origin in family difficulties. 3rd. The patient’s improvement begins with the disclosure of a traumatic secret, but not on the individual level, as in the classic psychodynamic model, but on a family level. 4th. The overcoming of the trauma, which was started with the revelation, is not completed until the readjustment of the family system

Analysis of Role Changes for Women with Breast Cancer Related Lymphedema to Return to Work

Breast Cancer survivors diagnosed with secondary lymphedema have decreased quality of life and experience greater challenges when attempting to return to work compared to survivors who do not have secondary lymphedema. Limited research is available in understanding the impact breast cancer-related lymphedema has on survivors transitioning from traditional medical care to return to work. Occupational therapists specializing in Lymphedema therapy have the unique training skills and knowledge to address the challenges this population faces, as well as the tools needed to educate patients and their family members on how to manage returning to work, and make any adaptations to their work environment in order to achieve overall satisfaction and quality of life. A quantitative study was done to identify the impact BCRL has had on the role changes survivors with secondary lymphedema experience, as well as satisfaction with work. Results collected from the study were indicative of decreased overall satisfaction with return to work secondary to diagnosis, significant role changes with decreased independence and difficulties from employers, as well as little to no therapeutic services addressing return to work during this survivorship phase. Future recommendations include developing a program addressing return to work and successful techniques manage lymphedema symptoms of the affected limb within the work environment.https://soar.usa.edu/otdcapstones-spring2022/1042/thumbnail.jp

PROPUESTA DE DISEÑO ESCENOGRÁFICO: EL SUEÑO DE UNA NOCHE DE VERANO

[ES] Una propuesta de análisis de texto y diseño escenográfico para la obra “El sueño de una noche de verano” de W. Shakespeare, donde se piensa el espacio teatral como el condicionante esencial, en relación al análisis dramatúrgico del texto, como el punto de partida más conveniente a la hora de diseñar una propuesta de escenografía. Es de ese espacio para la representación de donde obtenemos el más importante conjunto de datos que nos ayudará a proyectar no sólo la estética general de la propuesta, sino de la funcionalidad dramática y optimizada de las estructuras, ambientes, espacios y objetos, que han de ser proyectados, según las pautas marcadas por la idea general de puesta en escena, y en ese sentido, de la propuesta de diseño escenográfico: en este caso, a partir de la relación estética propia de las ilustraciones inspiradas en el arte turco, persa y árabe, y de los elementos propios del imaginario e historia de los objetos escenográficos.Del Rey Martinez, S. (2015). PROPUESTA DE DISEÑO ESCENOGRÁFICO: EL SUEÑO DE UNA NOCHE DE VERANO. http://hdl.handle.net/10251/60662.TFG

Psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) for caregivers of children with gastrostomy tube nutritional support

BACKGROUND: To analyse the psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) in parents/caregivers of children with home enteral nutrition (HEN) by gastrostomy tube (GT). METHODS: Eighty-six caregivers (mothers) of paediatric patients with HEN by GT were recruited. Patients suffered from neurological disease (61.6%) and other chronic diseases. The SAGA-8 scale, a structured questionnaire to explore satisfaction with HEN by GT, and the Caregiver Burden Inventory (Zarit) were completed. The discriminating power of each of the SAGA-8 items, internal consistency and external validity were evaluated. An exploratory factor analysis and Kaiser-Meyer-Olkin (KMO) was performed as well. RESULTS: Eighty-four percent of the families expressed high satisfaction with GT feeding. All eight items of SAGA-8 gave additional information. The exploratory factor analysis revealed that a significant part of the items' variability could be explained by two independent factors: Factor 1 (direct benefit), which compiled the variables related to the perception of children's overall improvement by GT feeding; Factor 2 (indirect benefit), which grouped the variables related to a decrease in respiratory infections, feeding time and institutional support. Results from KMO (0.628) indicated the high adequacy of the items assessed in the factorial analysis. Moreover, the questionnaire presented high internal consistency (0.76), and the external validation analysis confirmed the correlation between SAGA-8 and Zarit, thereby emphasising the approptiate use of the SAGA-8 to detect carers' satisfaction. CONCLUSIONS: The SAGA-8 questionnaire has a high discriminatory power to assess the degree of satisfaction experienced by parents/caregivers of children with HEN by GT and, subsequently, the patients' wellbeing

Satisfaction with gastrostomy feeding in caregivers of children with home enteral nutrition: application of the SAGA-8 questionnaire and analysis of involved factors.

Aims: To assess the degree of satisfaction of caregivers of children with gastrostomy tube (GT) feeding through the structured questionnaire SAGA-8. Secondly, to evaluate if the parental satisfaction degree was related to several independent variables. Methods: A cross-sectional observational study was performed in 92 caregivers of children with GT feeding and chronic diseases. The following data was obtained: caregiver satisfaction with GT feeding (SAGA-8), age at GT placement, anthropometric data, length and mode of nutritional support, family demographic characteristics and caregiver psychological status. Results: All primary caregivers were mothers. High satisfaction with GT feeding was expressed by 82.6% of families. The simplicity of the system was emphasized by 87%, and 85.9% were very satisfied with the support received from the hospital staff. 73.9% of mothers acknowledged their child"s nutritional status had improved and 89.1% rated the enhancement family"s overall situation. Moreover, 75% of mothers reduced feeding-time, and 68.5% reported less respiratory infections. Finally, 71.7% of mothers recognized that they would have implemented this technique earlier. Caregiver satisfaction was positively correlated with age at GT placement and length of treatment, and both variables explained the 19.4% of the satisfaction variance. No correlation with anthropometric data, nutrition support mode, family demographic characteristics or caregiver psychological status was observed. Conclusions: The SAGA-8 questionnaire is a simple,specific, straight-forward tool to evaluate parental/caregiver degree of satisfaction with GT feeding and facilitates effective monitoring of the intervention. Lengths of HEN and precocious age at GT placement are responsible for most of parental satisfaction

Factors predicting distress among parents/caregivers of children with neurological disease and home enteral nutrition

Abstract Background & aims Caregivers of children with chronic diseases included in a home enteral nutrition (HEN) programme are at risk of experiencing a feeling of burden, high level of anxiety and psychological distress. The aims of this study were: first, to examine the prevalence of symptoms of anxiety-depression in caregivers of children with neurological diseases requiring HEN by gastrostomy tube (GT); second, to compare the characteristics of caregivers with high or low risk of exhibiting symptoms of anxiety-depression; and third, to investigate possible associations to child disease severity and nutrition support mode. Methods A cross-sectional observational study was performed in 58 caregivers of children (31 boys, aged 0.3-18 years) with neurological diseases and GT feeding. The characteristics of caregivers with high or low risk of presenting symptoms of anxiety-depression were compared regarding the following variables: socio-demographic characteristics, the primary caregiver's intrapsychic factors, anthropometric parameters of the child, length of HEN, type of nutrients delivered by GT and infusion regime. Results All primary caregivers were mothers. Fifty-three per cent of them showed high risk of exhibiting symptoms of anxiety-depression. Mothers with high or low risk of presenting symptoms of anxiety-depression were comparable in age and family socio-economic status. They were also similar in terms of age, anthropometric conditions and length of HEN in their children. No differences were found between the two groups of mothers according to the level of the child's motor function impairment, type of nutrients delivered by GT and infusion regime. Higher levels of psychological distress and perception of burden overload were found in mothers with high risk of exhibiting symptoms of anxiety-depression. Conclusions This study found a high prevalence of symptoms of anxiety-depression, perception of burden overload and psychological distress in caregivers of children with HEN. Thus, greater practical and emotional support is required for these families

Mitochondrial Transplantation Enhances Phagocytic Function and Decreases Lipid Accumulation in Foam Cell Macrophages

Macrophages have mechanisms for eliminating cholesterol from cells. If excess cholesterol is not eliminated from the macrophages, then transformation into a foam cell may occur. Foam cells are a hallmark of the atherosclerotic lesions that contribute to the development and rupture of atherosclerotic plaques. Several in vitro and in vivo studies have shown changes in the macrophage phenotype and improved phagocytosis after the acquisition of functional mitochondria. However, the effect of mitochondrial transplantation on promoting phagocytosis and phenotypic changes in lipid-loaded macrophages leading to foam cells has not been studied. We aimed to prove that the transplantation of healthy mitochondria to highly cholesterol-loaded macrophages induces macrophage phagocytosis and reduces the macrophage shift towards foam cells. For this purpose, using a murine macrophage cell line, RAW264.7, we determined if mitochondria transplantation to 7-ketocholesterol (7-KC)-loaded macrophages reduced lipid accumulation and modified their phagocytic function. We evidenced that mitochondrial transplantation to 7-KC-loaded macrophages reestablished phagocytosis and reduced lipid content. In addition, CPT1a expression and anti-inflammatory cytokines were restored after mitochondrial transplantation. We have developed a potential therapeutic approach to restore foam cell functionality

Advantages of 18F-FDG PET/CT imaging over modified Duke criteria and clinical presumption in patients with challenging suspicion of infective endocarditis

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as possible or rejected IE despite a persisting high level of clinical suspicion. Herein, we evaluate th

Transcriptional Auto-Regulation of RUNX1 P1 Promoter

RUNX1 a member of the family of runt related transcription factors (RUNX), is essential for hematopoiesis. The expression of RUNX1 gene is controlled by two promoters; the distal P1 promoter and the proximal P2 promoter. Several isoforms of RUNX1 mRNA are generated through the use of both promoters and alternative splicing. These isoforms not only differs in their temporal expression pattern but also exhibit differences in tissue specificity. The RUNX1 isoforms derived from P2 are expressed in a variety of tissues, but expression of P1-derived isoform is restricted to cells of hematopoietic lineage. However, the control of hematopoietic-cell specific expression is poorly understood. Here we report regulation of P1-derived RUNX1 mRNA by RUNX1 protein. In silico analysis of P1 promoter revealed presence of two evolutionary conserved RUNX motifs, 0.6kb upstream of the transcription start site, and three RUNX motifs within 170bp of the 5\u27UTR. Transcriptional contribution of these RUNX motifs was studied in myeloid and T-cells. RUNX1 genomic fragment containing all sites show very low basal activity in both cell types. Mutation or deletion of RUNX motifs in the UTR enhances basal activity of the RUNX1 promoter. Chromatin immunoprecipitation revealed that RUNX1 protein is recruited to these sites. Overexpression of RUNX1 in non-hematopoietic cells results in a dose dependent activation of the RUNX1 P1 promoter. We also demonstrate that RUNX1 protein regulates transcription of endogenous RUNX1 mRNA in T-cell. Finally we show that SCL transcription factor is recruited to regions containing RUNX motifs in the promoter and the UTR and regulates activity of the RUNX1 P1 promoter in vitro. Thus, multiple lines of evidence show that RUNX1 protein regulates its own gene transcription