Preocupações sobre a recorrência do câncer em mulheres mexicanas sobreviventes do câncer de mama. Propriedades psicométricas da escala CARS

Fear of recurrence is one of the main affectations of cancer survivors. In Latin-American exist a lack of evidence on the subject and of valid instruments to measure it. The objective of this study was to determine the psychometric properties of the Concerns About Recurrence Scale in Mexican breast cancer survivors. An instrumental study was carried out with 200 women breast cancer survivors with a mean age of 53 years old and a mean survival of 52.5 months. A confirmatory factor analysis of the original version of the scale identified four factors that explained 77 % of the variance and satisfactory goodness of fit indicators: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071 as well as high internal consistency α = .945. Significant associations were also identified between general fear subscale, anxiety subscale of the HADS and total HADS score (r = .638 and r = .607; p = .01). The CARS presented adequate validity, reliability and factorial structure. It is recommended for usage in clinical care and research with Mexican breast cancer survivors.El miedo a la recurrencia es una de las principales afectaciones de los supervivientes de cáncer. En América Latina existe una falta de evidencia en el tema y de instrumentos válidos para medirlo. El objetivo del presente estudio fue determinar las propiedades psicométricas de la Escala de Preocupaciones Acerca del Cáncer (CARS, por su sigla en inglés) en supervivientes de cáncer de mama mexicanas. Se llevó a cabo un estudio instrumental con 200 mujeres supervivientes de cáncer mamario con una edad promedio de 53 años y una sobrevida promedio de 52.5 meses. Un análisis factorial confirmatorio de la versión original del instrumento identificó cuatro factores que explicaron el 77 % de la varianza de la escala e indicadores de bondad de ajuste satisfactorios: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071, así como una elevada consistencia interna α = .945. Asimismo, se identificaron asociaciones significativas entre las subescalas de miedo general, ansiedad de la HADS y puntaje total de la HADS (r = .638 y r = .607; p = .01). La escala CARS presentó adecuada validez, confiabilidad y estructura factorial. Es recomendable su uso en escenarios clínicos y de investigación con supervivientes de cáncer de mama mexicanas.O medo da recorrência é uma das principais sequelas dos sobreviventes do câncer. Na América Latina há uma falta de evidências sobre o assunto e uma falta de instrumentos válidos para medi-lo. O objetivo do presente estudo foi determinar as propriedades psicométricas da Escala Preocupações sobre o Câncer (CARS) em sobreviventes do câncer de mama mexicanas. Foi realizado um estudo instrumental com 200 mulheres sobreviventes de câncer de mama com uma média de idade de 53 anos e uma sobrevivência média de 52,5 meses. Uma análise fatorial confirmatória da versão original do instrumento identificou quatro fatores que explicaram 77 % da variação da escala e indicadores satisfatórios de bondade de ajuste: CFI = 0,967, TLI = 0,957, SRMR = 0,035, RMSEA = 0,071, assim como alta consistência interna α = 0,945. Associações significativas também foram identificadas entre as subescalas de medo geral, ansiedade HADS e pontuação total HADS (r = 0,638 e r = 0,607; p = 0,01). A escala CARS mostrou adequada validade, confiabilidade e estrutura de fatores. É recomendado seu uso em ambientes clínicos e de pesquisa com sobreviventes do câncer de mama mexicanas

Recycled Precast Concrete Kerbs and Paving Blocks, a Technically Viable Option for Footways

[EN] The linear economy paradigm in place to date has to be seriously challenged to give way to a new school of thought known as the circular economy. In this research work, precast kerbs and paving blocks made with recycled concrete (RACC-mixture) bearing 50 wt% mixed recycled aggregate (masonry content of 33%) and an eco-efficient cementitious material as 25 wt% conventional binder replacement were evaluated to assess their intrinsic potential to replace traditional raw materials, in keeping with circular economy criteria. Therefore, precast products were subjected to mechanical strength, durability and microstructure tests and were compared to conventional concrete units (CC-mixture and commercially available precast elements). Although a class demotion was observed for water absorption and some decreases in flexural strength (26%), splitting tensile strength (12.8%) and electrical resistivity (45%) and a lower class water absorption were registered, and the recycled mixture also exhibited a greater performance in terms of compressive strength (6%), a better abrasion resistance classification and a comparable porosity and microstructure, which ensures a good concrete durability. In any case, the results showed that precast pieces were European standard-compliant, thus supporting the viability of the mixed recycled aggregates and eco-efficient cementitious replacement in footways

Estudio exploratorio de relación entre la percepción de apoyo social instrumental y la modificación de roles familiares en mujeres con cáncer de mama

Objetivo: Explorar la relación entre las fuentes y el tipo de apoyo instrumental brindado a las mujeres con Cáncer de Mama (CM) con la modificación de roles y actividades cotidianas en las pacientes y sus allegados. Método: Se realizó un estudio cualitativo centrado en la etnografía de 9 pacientes con CM. A través del software MAXQDA v10, se hizo un análisis temático del discurso para posteriormente elaborar tablas cruzadas para el análisis de las variables en estudio. Resultados: Para estas mujeres, la familia nuclear constituye la principal fuente de apoyo instrumental, al mismo tiempo que son quienes suelen modificar más sus actividades cotidianas y roles sociales. Las mujeres con CM expresan dificultad para delegar principalmente actividades del hogar debido a 3 razones: la responsabilidad de madre, la sensación de utilidad y una ideología tradicional de género. Conclusiones: El impacto del cáncer en la mujer tiene consecuencias únicas, debido al papel central que ellas asumen en la vida familiar. Los movimientos funcionales, afectivos y relacionales que ocurren en la familia ante un diagnóstico de CM parece ser un hecho frecuente y de gran trascendencia, que ha sido poco estudiado en nuestra población. Estos aspectos deben ser considerados como un elemento importante en la comprensión y el soporte que se debe otorgar a las mujeres con CM y a sus familias

Fertilización foliar con nanopartículas de ZnO y su efecto en la producción, calidad biofísica y nutraceútica en frutos de nogal pecanero (Carya illinoinensis)

El nogal pecanero (Carya illinoinensis) es uno de los cultivos más importantes de la Comarca Lagunera. La deficiencia de zinc (Zn) es uno de los principales problemas que limitan su productividad. La nanotecnología incluye materiales nutrimentales con los que se pueden sustituir fertilizantes convencionales con variado efecto en rendimiento, calidad biofísica y nutracéutica en el fruto. Los efectos de la aplicación foliar de nanopartículas de ZnO en nogal pecanero variedad Western fueron evaluados mediante dosis de Zn con los siguientes tratamientos: control, 4000 (ZnSO4), 2000 (nps ZnO), y 4000 (nps ZnO) mg L-1. El diseño experimental fue en bloques al azar con cuatro repeticiones. Las variables evaluadas en fruto y árbol fueron: rendimiento, número de nueces kg-1, largo y ancho de nuez, concentración de Zn en foliolos, ácidos grasos, proteína cruda, porcentaje de grasa y humedad. Se observó diferencia significativa en rendimiento y nivel de Zn en los foliolos, donde el mejor tratamiento fue 4000 mg L-1 de nanopartículas de ZnO, mientras que para la variable largo de nuez se observó diferencia significativa, siendo inferior el tratamiento de 4000 mg L-1 de ZnSO4. En las variables nutracéuticas, el contenido de ácidos grasos evaluado mediante el contenido de grasas saturadas (C16:0 y C18:0) mostró cambios altamente significativos, siendo el tratamiento con la dosis de 4000 mg L-1 de nanopartículas el que tuvo mayor porcentaje. Los ácidos grasos insaturados (C18:1 y C18:3) mostraron diferencias significativas, siendo los tratamientos evaluados con nanopartículas los que tuvieron un porcentaje inferior. El contenido de proteína también mostró diferencias altamente significativas, siendo el tratamiento control y el químico a base de ZnSO4 los tratamientos superiores. Las nanopartículas pueden ser usadas para mejorar el rendimiento y abastecer el contenido de Zn al cultivo, pero la calidad de fruto se ve afectada desde el punto de vista nutricional

Mental health professionals' use of the ICD-11 classification of impulse control disorders and behavioral addictions: An international field study

Background and aims The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico

BackgroundPsychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support.ObjectiveThe aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not.MethodsThis was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey.Results73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support.ConclusionPsychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health

Autosomal dominant polycystic kidney disease in young adults

Background The clinical manifestations of autosomal dominant polycystic kidney disease (ADPKD) usually appear in adulthood, however pediatric series report a high morbidity. The objective of the study was to analyze the clinical characteristics of ADPKD in young adults. Methods Family history, hypertension, albuminuria, estimated glomerular filtration rate (eGFR) and imaging tests were examined in 346 young adults (18-30 years old) out of 2521 patients in the Spanish ADPKD registry (REPQRAD). A literature review searched for reports on hypertension in series with more than 50 young (age <30 years) ADPKD patients. Results The mean age of this young adult cohort was 25.24 (SD 3.72) years. The mean age at diagnosis of hypertension was 21.15 (SD 4.62) years, while in the overall REPQRAD population was aged 37.6 years. The prevalence of hypertension was 28.03% and increased with age (18-24 years, 16.8%; 25-30 years, 36.8%). Although prevalence was lower in women than in men, the age at onset of hypertension (21 years) was similar in both sexes. Mean eGFR was 108 (SD 21) mL/min/1.73 m(2), 38.0% had liver cysts and 3.45% of those studied had intracranial aneurysms. In multivariate analyses, hematuria episodes and kidney length were independent predictors of hypertension (area under the curve 0.75). The prevalence of hypertension in 22 pediatric cohorts was 20%-40%, but no literature reports on hypertension in young ADPKD adults were found. Conclusions Young adults present non-negligible ADPKD-related morbidity. This supports the need for a thorough assessment of young adults at risk of ADPKD that allows early diagnosis and treatment of hypertension. Lay Summary Impairment of renal function usually develops from the fourth decade of life in autosomal dominant polycystic kidney disease (ADPKD). However, hypertension precedes the onset of renal insufficiency. In published pediatric series, the prevalence of hypertension is 20%-40%. However, clinical information on young adults with ADPKD is scarce. We present the largest cohort of young adults (age 18-30 years) with ADPKD published to date. Prevalence of hypertension is 28% and increases with age, reaching 36.8% in the subgroup aged 25-30 years, despite normal glomerular filtration rate and albuminuria. The prevalence of hypertension is higher in males, but the mean age at diagnosis (21 years) was similar in both sexes. Young adults present non-negligible ADPKD-related morbidity. This supports the need for a thorough assessment that allows early diagnosis and treatment of hypertension, before decline of estimated glomerular filtration rate. Ambulatory blood pressure monitoring may be especially useful in this regard.11 página

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation