Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Longitudinally in Latin America

Objective: Studies have shown that functional and psychosocial sequelae of traumatic brain injury (TBI) predict emotional well-being of caregivers (Harris, 2000). Previous research examining the mental health of caregivers and the health-related quality of life (HRQoL) of people with TBI have primarily been in the US (Sander, 2012). Very little research has been conducted to uncover the unique relationships between HRQoL of people with TBI and caregiver mental health longitudinally, or in low-middle income Latin American countries. The aim of this study was to evaluate how HRQoL after TBI predict caregiver depression longitudinally in two countries and three data collection sites in Latin America. Design: Multi-site, multinational longitudinal study. Setting: Three hospitals in Neiva and Cali, Colombia, and Mexico City, Mexico (before hospital discharge), as well as in the homes of individuals with TBI and caregivers in these regions (before discharge, at 2 and 4 months after discharge). Participants: A sample of 109 TBI caregiver-patient dyads (n = 218) was included in the study. Main Outcome Measure(s): Caregiver depression (Patient Health Questionnaire-9) and HRQoL in the person with TBI (Short Form-36). Results: Three multiple regressions were conducted to examine which aspects of patient HRQoL at baseline predicted caregiver depression at baseline, 2 months, and 4 months post-discharge. Eight aspects of patient HRQoL were simultaneously entered into each model as predictors: physical functioning, role limitations (physical and emotional), vitality, mental health, social functioning, pain, and general health. At baseline, the overall model significantly predicted caregiver depression, F(8, 105) = 2.62, p = .012, R 2 = .18. Patient mental health was the only significant unique predictor of caregiver depression at baseline, p = .021, β = -.34. The overall model predicting 2-month caregiver depression was significant, F(8, 101) = 3.21, p = .003, R 2 = .22. Only mental health, p = .016, β = -.36, was a significant unique predictor. The overall model predicting 4-month caregiver depression was significant, F(8, 98) = 2.70, p = .010, R 2 = .19, and no factors uniquely predicted caregiver depression, all ps\u3e.05. Conclusions: Results suggest that TBI patient HRQoL can predict caregiver depression among Latin American caregivers before and during the first 4 months after hospital discharge. Across all three time points (baseline, 2 months, and 4 months), caregiver depression was significantly predicted by patient HRQoL. At baseline, patient mental health was the only domain that uniquely predicted caregiver depression. At 2 months, only physical role limitations uniquely predicted caregiver depression, and no unique predictors were detected at 4 months. These findings suggest that within the cultural framework in Latin America, there is a strong relationship between functional and psychological impairments after TBI and depression outcomes in Latin American caregivers. The results highlight the importance of uncovering these relational distinctions and may infer early detection of mental health needs and psychological intervention considerations for Latin American caregivers.https://scholarscompass.vcu.edu/gradposters/1052/thumbnail.jp

Relación entre la ejecución en pruebas neuropsicológicas y una escala de actividades de la vida diaria en pacientes con lesión frontal.

Objetivo. Comparar la ejecución en las pruebas neuropsicológicas para lesión frontal y el desempeño de los pacientes según una Escala de Actividades de la V ida Diaria (A VD). Material y método. La muestra estuvo conformada por 14 pacientes con lesión frontal y 10 sujetos a controles de edad y escolaridad similar . La batería neuropsicológica inclu- yó: W isconsin Card Sorting T est, la T orre de Londres, la prueba de S troop, el T est de clasificación de Piaget, todas las ejecuciones de las pruebas neuropsicológicas se com- pararon con los resultados de la escala A VD. Resultados. Los hallazgos muestran que la ejecución neuropsicológica en pacientes con lesión frontal se asocia con una pobre es- trategia de planeación, or ganización, síntesis de la información, mostrando puntajes ba- jos en la pruebas de T orre de Londres, el S troop y de Piaget. Cuando se compararon los resultados con la escala de A VD no se encontró correlación con los resultados en las ejecuciones de las pruebas neuropsicológicas. Conclusiones. Los resultados sugieren que las actividades mentales superiores son más complejas y que las pruebas neuropsi- cológicas sólo se centran en un aspecto de funciones que son multimodales. El análisis de la función, a través de la escala A VD, se propone como parte de la evaluación que se requiere para detectar el daño frontal

Predicting Caregiver Burden Over the First 4 Months After TBI in Latin America: A Multi-site, Multi-Country Study

Disparities in TBI exist between developed and developing regions, and this neurological condition typically requires caregivers to provide aid and functional support for those with TBI (Hyder, Wunderlich, Puvanachandra, Gururaj, & Kobusingye, 2007). Latin America, among these global regions, has elevated risks of both sustaining TBI and poorer post-TBI functioning (Bonow et al., 2018). Previous literature has shown the poor cognitive, mental health, and social functional outcomes following the injury (Deloche, Dellatolas, & Christensen, 2000), but research has minimally explored both longitudinal trends of these outcomes, and if functional outcomes of the injury differentially predict caregiver burden. The aim of the current study was to examine if deficits in cognitive/executive functioning, depression, and social disadaptation among individuals with TBI in Latin America predict longitudinal trajectories of caregiver burden. A sample of 109 Latin American caregivers of individuals with a newly sustained TBI, from three hospitals were included in the study. In order to evaluate this series of relationships, Hierarchal Linear Modeling (HLM) assessed whether key features of TBI (e.g, depression, cognitive dysfunction, and social disadaptation), at baseline, predicted longitudinal outcomes of caregiver burden. Study findings showed that social disadaptation significantly predicted caregiver burden trajectory. Further, results showed that caregiver burden trajectories generally decreased over time, and men reported greater caregiver burden compared to women. These findings highlight unique trends among post-TBI caregivers in Latin America and suggest that future research should assess mechanisms that influence these trends.https://scholarscompass.vcu.edu/gradposters/1090/thumbnail.jp

Allelic variation in HMW glutenin in Spanish wheat landraces and their relationship with bread quality

The allelic variation of high molecular weight glutenins as principal determinants of bread quality has been analyzed in 165 Spanish wheat ( Triticum aestivum ssp. vulgare L.) landraces provided by the Plant Genetic Resources Centre. The identification by standard electrophoresis techniques has been supported by a new PCR screening method, allowing the identification of the 2•• glutenin subunit from the Glu-A1 locus in some landraces. The relation of high molecular weight glutenins and bread quality has been evaluated by SDS-sedimentation tests and mixographs. A positive influence on quality has been found for the 2•• glutenin subunit from the Glu-A1 locus, pairs 7 + 8 and 13 + 16 from the Glu-B1 locus, and pair 5 + 10 from the Glu-D1 locus. The presence of a wide range of values for quality traits in landraces with the same high molecular weight glutenin composition points to the possible influence of other prolamins such as the low molecular weight glutenins. Their influence on bread quality will be assessed in future studies. A complete description of the high molecular weight glutenin composition and quality values of all the landraces analyzed in this study is provided for use in wheat breeding program

O jogo como veículo para melhorar habilidades de leiturade crianças com dificuldade leitora

Objective. Colombian scientific literature on reading acquisition and rehabilitation of reading difficulties is limited. For this reason, this study aims to prove the impact of an intervention program for reading, based on play and implicit learning, in children with non-specific reading disabilities, after finishing the program and 6 months later. Method. Using a cross - sectional and comparative design, 20 children, between 7 to 9 years old, with typical psychological development with regular attendance at a school in Cali (Colombia), participated voluntary in this study. Pre and post - assessment included the evaluation of phonological awareness, reading skills and general cognitive functioning, that were used to establish if there were differences between the three times of assessment. Results. Children showed significant improvement in their reading skills after their participation in the intervention program, maintaining the effect in the long term. Conclusion. Non - specific reading difficulties can be improved with an intervention program of reading, based on play and implicit learning .Objetivo. A partir de las escasas propuestas de intervención de la lectura en población infantil colombiana, el presente estudio tiene por objetivo evaluar el impacto de un programa de intervención de la lectura, centrado en juego y aprendizaje implícito, sobre el desempeño lector en niños con dificultades lectoras, inmediatamente después y seis meses posteriores a la aplicación del programa. Método. Por medio de un diseño cuasi - experimental, transversal y comparativo, se evaluaron 20 niños, entre los 7 y 9 años de edad, con un desarrollo psicológico típico, quienes asistían regularmente a un colegio público de la ciudad de Cali (Colombia). Las evaluaciones pre y post incluyeron la aplicación de pruebas que exploran conciencia fonológica, capacidad lectora y rendimiento cognitivo general. Estos datos se emplearon para calcular diferencias entre los desempeños de los niños, obtenidos en la preintervención, posintervención inmediata y a largo plazo. Resultados. Los datos recogidos demostraron que los niños mejoran significativamente su rendimiento lector inmediatamente después de la aplicación del programa, con un efecto que se mantiene a largo plazo. Conclusión. Las dificultades lectoras que presentan los niños participantes pueden mejorarse con la aplicación de un programa de intervención de la lectura, centrado en el juego y aprendizaje implícito.Escopo. A partir das escassas propostas de intervenção da leitura em população infantil colombiana, o presente estudo tem por escopo avaliar o impacto de um programa de intervenção da leitura, centrado no jogo e aprendizagem implícita, sobre o desenvolvimento leitor de crianças com dificuldades leitoras, imediatamente depois e seis meses após à aplicação do programa. Metodologia. Usando uma pesquisa comparativa quasi - experimental, transversal, foram avaliadas 20 crianças, entre os 7 e 9 anos de idades, com um desenvolvimento psicológico típico, que assistem regularmente a uma escola pública da cidade de Cali (Colômbia). As avaliações pre e post incluíram a aplicação de provas que exploram consciência fonológica, capacidade leitora e rendimento cognitivo geral. Esses dados foram utilizados para calcular as diferenças entre o desempenho das crianças obtido na pré - intervenção, imediatamente após a intervenção, e longo prazo. Resultados . Esta análise demostrou que as crianças melhoraram significativamente seu rendimento leitor imediatamente depois da aplicação do programa, com um efeito que se mantem ao longo prazo. Conclusão . As dificuldades leitoras que apresentam as crianças podem ser melhoradas com a aplicação de um programa de intervenção da leitura centrado no jogo e aprendizagem implícito

A compreensão verbal e a leitura em crianças com e sem retraso leitor

Objective. This study aims to describe differences between performance in reading tasks and the level of verbal comprehension in subjects, with and without reading delay, as the relationship between both measures. Method. For this purpose, the reading subtests of the Evaluación Neuropsicológica Infantil (ENI) and the verbal comprehension index of the Wechsler Intelligence Scale for Children (WISC-IV) were used. The sample consisted of 40 children, aged from 7 to 9 years old, in 2nd to 4th grade, from a low socioeconomic strata school in Cali, and with an intelligence quotient (IQ) which averaged 86 Participants were divided into two groups; 20 with reading disabilities and 20 who were normal readers, according to the scores obtained in the ENI reading tasks. Results. The results showed differences between the perfomances of both groups of children, as well as a significant positive correlation between ICV and reading comprehension of the ENI. Conclusion. These results are in accordance with the hypothesis that states that oral language development is one of the most important facilitators of learning in reading acquisition, because while children understand what they say and what they are told, they will be able to make sense of what they read.Objetivo. Describir diferencias entre el desempeño en tareas de lectura y de comprensión verbal en niños con y sin retraso lector, así como la relación entre ambos tipos de desempeños. Método. Se utilizaron tareas de lectura de la Evaluación neuropsicológica infantil (ENI) y el Índice de Comprensión Verbal (ICV) de la escala de inteligencia Wechsler (WISC-IV) para niños. Los participantes fueron 40 niños de ambos sexos, entre 7 y 9 años de edad, quienes cursaban entre 2° y 4° grado de primaria en un colegio de estrato socioeconómico bajo de la ciudad de Cali, con un coeficiente intelectual (CI) promedio de 86. Los participantes fueron divididos en dos grupos, 20 niños que presentaban retraso lector y 20 niños con un desarrollo lector típico, según los puntajes obtenidos en las tareas de lectura de la ENI. Resultados. Se encontraron diferencias en el rendimiento de ambos grupos de niños evaluados, así como una correlación significativa entre el ICV y el subdominio de comprensión de la ENI. Conclusión. Estos resultados son acordes con la hipótesis de que el desarrollo del lenguaje oral es uno de los principales facilitadores en la adquisición del aprendizaje de la lectura, puesto que en la medida en que el niño comprende la semántica oral, estará con mejor preparación para dotar de significado lo leído.Escopo. Descrever as diferenças entre o desempenho em tarefas de leitura e compreensão verbal em crianças com e sem atraso, ea relação entre os dois tipos de performances. Metodologia. Foram utilizadas tarefas de leitura da Avaliação Neuropsicológica Infantil (ENI por suas siglas em espanhol) e o índice de Compreensão Verbal (ICV) da escada de inteligência Wechsler (WISC-IV) para crianças. Os participantes foram 40 crianças de ambos sexos, entre 7 e 9 anos de idade, que cursavam entre 2 e 4 grado de primária em um colégio de baixa extração socioeconômica na cidade de Cali, com um coeficiente intelectual (CI) com 86 como média. Os participantes foram divididos em dois grupos, 20 crianças que presentavam retraso leitor e 20 crianças com um desenvolvimento leitor típico, segundo as pontuações obtidas nas tarefas de leitura da ENI . Resultados. em grupos Mabos, ICV e compreensão do IPD foram encontrados. correlações foram achadas diferenças significativas entre o desempenho de ambos grupos das crianças avaliadas, e uma correlação significativa entre o ICV e subdomínio de compreensão de leitura da ENI. Conclusão. Estes resultados estão acordes com a hipótese de que o desenvolvimento da linguagem oral é um dos principais facilitadores a aquisição da aprendizagem da leitura, posto que na medida em que a criança compreende a semântica oral estará melhor preparada para dotar de sentido o que lê

Riesgos del Emprendedor

ColcienciasUniversidad EAFIT - Departamento de Contaduría Pública. Semillero de Investigación en Control, Auditoría y Riesgos (SICAR)p. 9

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Cuáles son las dificultades de la lectura y escritura en niños asociadas a antecedentes neurológicos (Parte 1)

Video explicativo sobre las dificultades de la lectura y escritura en niños asociadas a antecedentes neurológicos1BajaReproductor de videoExpositivo: Aprendizaje pasivo que se logra por recursos que en su contenido inducen al usuario final a asimilar conceptos que le son expuestos. Un recurso expositivo muestra información al usuario final sin solicitar de éste ningún tipo de acción por su parte semánticamente significativa.Educación Superio