Determinantes de la calidad de vida relacionada con la salud de pacientes en diálisis de Uruguay

Ana I. Galain: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. -- Inés Olaizola: Servicio de Asistencia Renal Integral, SARI. Centro de Diálisis Ibirapitá, Montevideo, Uruguay.-- Laura Schwartzmann: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.-- Carlos Zúñiga: Facultad de Medicina, Universidad Católica de Concepción, Concepción, Chile.-- Juan J. Dapueto: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Contacto: Juan J. Dapueto. Dirección: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Av. Italia 2870 piso 15, Montevideo11600, Uruguay. E-mail: [email protected] are limited studies reporting on the Health Related Quality of Life (HRQL) of patients with end stage renal disease living in non-industrialized countries. This study describes the underlying relationships among determinants of HRQL in patients under renal replacement treatment. A cross-sectional design was used with a sample of 243 patients attending five hemodialysis and peritoneal dialysis centers of Montevideo (mean age 56.6 years, SD 16.2; 58% males). A univariate linear regression analysis was performed for each independent variable. A total of 61 independent variables were included: biological/clinical, sociodemographic, and psychosocial. HRQL outcomes were evaluated using the SF-36 Health Survey eight subscales, Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Variables shown to have significant association in the univariate analysis (p<0.10) were included in a multivariate regression analysis. Ten regression models were studied, for the 8 SF-36 subscales, PCS and MCS scores. Fifteen variables were significant in the multivariable models; time in renal replacement treatment, urea, creatinine, haemoglobin, iron, hospitalizations, acute illness, blindness, age, gender, living with someone, working status, administration of antidepressants or antipsychotic medications, and maintenance of sex life, explaining 43% of the variance of PCS and 35% of MCS. The type and relevance of the explanatory variables differed along the various dimensions of HRQL. As a conclusion we underline the entwining of biological, sociodemographic and psychosocial factors as determinants of health related quality of life patients with end stage renal disease, thus supporting the multidimensional definition and modelling of the construct.Existen pocos estudios sobre la percepción subjetiva de la calidad de vida relacionada con la salud (HRQL por sus siglas en inglés) en pacientes renales cursando su etapa terminal, que vivan en países no industrializados. El propósito de este estudio fue comprender las relaciones subyacentes entre los diferentes determinantes de la calidad de vida relacionada con la salud, en los pacientes en tratamiento sustitutivo renal en Uruguay. Se realizó un estudio transversal en una muestra de 243 pacientes de cinco centros de hemodiálisis y diálisis peritoneal de la ciudad de Montevideo (edad media de 56,6 años, SD 16,2; 58% hombres). Se realizó un análisis de regresión lineal univariado para cada variable independiente. Se incluyó un total de 61 variables independientes biológicas/clínicas, sociodemográficas y psicosociales. La HRQL fue evaluada utilizando el cuestionario SF-36, que consta de ocho subescalas, más el Componente de Resumen Físico (PCS) y el Componente de Resumen Mental (MCS). Aquellas variables que mostraron una asociación significativa en el análisis univariado (p< 0.10) fueron incluidas en un análisis de regresión multivariado. Fueron estudiados diez modelos de regresión, para las 8 subescalas del SF-36, el PCS y MCS. Quince variables fueron significativas en los modelos multivariados: tiempo en tratamiento sustitutivo renal, urea, creatinina, hemoglobina, hierro, hospitalizaciones, enfermedades agudas, ceguera, edad, género, vivir con alguien, situación laboral, administración de antidepresivos o de antipsicóticos y mantenimiento de la vida sexual; explicando el 43% de la varianza de PCS y el 35% de MCS. El tipo y relevancia de las variables explicativas difieren a lo largo de las diversas dimensiones de la HRQL. Destacamos como conclusión el entrelazamiento de factores biológicos, sociodemográficos y psicosociales como determinantes de la calidad de vida relacionada con la salud en los pacientes renales cursando su etapa terminal, lo que apoya la definición y modelado multidimensional del constructo

Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish Version 4 in South America: Classic Psychometric and Item Response Theory Analyses

BACKGROUND: The FACT-G has gone through many validation studies. However, little research has been conducted in South American Spanish speaking patients. The present study aimed to evaluate the FACT-G Spanish Version 4 in Uruguayan cancer patients. METHODS: The data analyzed were collected from 309 patients, with various tumor sites, at different stages of disease and receiving different treatments. RESULTS: Reliability was evaluated using Cronbach's coefficient alpha and showed high internal consistency for each of the subscales and its total scale (range = .78 – .91) of the FACT-G. The FACT-G total score also showed significant mean differences among known groups (performance status, in vs. outpatients) when tested by ANOVA and t-test. When the tumor stage (Local and Regional vs. Metastatic disease) was used as a clinical anchor, the FACT-G total score, the Physical Well-being (PWB), and Functional Well-being (FWB) subscale scores showed mean differences, ranging from 5 to 10 points in a scale from 0–108 (effect sizes = 0.30–0.60). Item response theory (IRT)-based evaluation using mean square fit statistics (.60–1.4) criteria showed that only two items misfit: "Estoy satisfecho(a) con mi vida sexual" (I am satisfied with my sex life) and "Estoy satisfecho(a) de cómo estoy enfrentando mi enfermedad" (I am satisfied with how I am coping with my illness). CONCLUSION: The results indicated that, using both traditional and IRT approaches, the Spanish FACT-G has good reliability and validity to be used as a QOL instrument among Uruguayan cancer patients

Validation of a core patient-reported outcome measure for fatigue in patients receiving hemodialysis: The SONG-HD fatigue instrument

Background and objectives Fatigue is a very common and debilitating symptom and identified by patients as a critically important core outcome to be included in all trials involving patients receiving hemodialysis. A valid, standardized measure for fatigue is needed to yield meaningful and relevant evidence about this outcome. This study validated a core patient-reported outcome measure for fatigue in hemodialysis. Design, setting, participants, &amp; measurements A longitudinal cohort study was conducted to assess the validity and reliability of a new fatigue measure (Standardized Outcomes in Nephrology-Hemodialysis Fatigue [SONGHD Fatigue]). Eligible and consenting patients completed the measure at three time points: baseline, a week later, and 12 days following the second time point. Cronbach α and intraclass correlation coefficient were calculated to assess internal consistency, and Spearman rho was used to assess convergent validity. Confirmatory factor analysis was also conducted. Hemodialysis units in the United Kingdom, Australia, and Romania participated in this study. Adult patients aged 18 years and over who were English speaking and receiving maintenance hemodialysis were eligible to participate. Standardized Outcomes in Nephrology-Hemodialysis, the Visual Analog Scale for fatigue, the 12-Item Short Form Survey, and Functional Assessment of Chronic Illness Therapy–Fatigue were used. Results In total, 485 participants completed the study across the United Kingdom, Australia, and Romania. Psychometric assessment demonstrated that Standardized Outcomes in Nephrology-Hemodialysis is internally consistent (Cronbach α =0.81–0.86) and stable over a 1-week period (intraclass correlation coefficient =0.68–0.74). The measure demonstrated convergence with Functional Assessment of Chronic Illness Therapy–Fatigue and had moderate correlations with other measures that assessed related but not the same concept (the 12-Item Short Form Survey and the Visual Analog Scale). Confirmatory factor analysis supported the one-factor model. Conclusions SONG-HD Fatigue seems to be a reliable and valid measure to be used in trials involving patients receiving hemodialysis

A Rasch and factor analysis of the Functional Assessment of Cancer Therapy-General (FACT-G)

BACKGROUND: Although the Functional Assessment of Cancer Therapy – General questionnaire (FACT-G) has been validated few studies have explored the factor structure of the instrument, in particular using non-sample dependent measurement techniques, such as Rasch Models. Furthermore, few studies have explored the relationship between item fit to the Rasch Model and clinical utility. The aim of this study was to investigate the dimensionality and measurement properties of the FACT-G with Rasch Models and Factor analysis. METHODS: A factor analysis and Rasch analysis (Partial Credit Model) was carried out on the FACT-G completed by a heterogeneous sample of cancer patients (n = 465). For the Rasch analysis item fit (infit mean squares ≥ 1.30), dimensionality and item invariance were assessed. The impact of removing misfitting items on the clinical utility of the subscales and FACT-G total scale was also assessed. RESULTS: The factor analysis demonstrated a four factor structure of the FACT-G which broadly corresponded to the four subscales of the instrument. Internal consistency for these four scales was very good (Cronbach's alpha 0.72 – 0.85). The Rasch analysis demonstrated that each of the subscales and the FACT-G total scale had misfitting items (infit means square ≥ 1.30). All these scales with the exception of the Social & Family Well-being Scale (SFWB) were unidimensional. When misfitting items were removed, the effect sizes and the clinical utility of the instrument were maintained for the subscales and the total FACT-G scores. CONCLUSION: The results of the traditional factor analysis and Rasch analysis of the FACT-G broadly agreed. Caution should be exercised when utilising the Social & Family Well-being scale and further work is required to determine whether this scale is best represented by two factors. Additionally, removing misfitting items from scales should be performed alongside an assessment of the impact on clinical utility

the italian didactic tradition

Starting with a historic overview highlighting the increasing interest and involvement of the community of mathematicians in educational issues, the chapter outlines some of the crucial features that shaped Italian didactics and, more specifically, the emergence of research studies on mathematics education. Some of these features are related to local conditions, for instance, the high degree of freedom left to the teacher in the design and realization of didactic interventions. The specificity of the Italian case can also be highlighted through a comparison with the reality of other countries. The fruitfulness of this comparison is presented by reporting on collective and personal collaboration experiences between the French and Italian research communities. A final contribution, coming from East Asia, puts the Italian tradition under the lens of a completely new eye, and invites reflection upon historical and institutional aspects of the Italian tradition

Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop

There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes

Knowledge distillation for efficient standard scanplane detection of fetal ultrasound

Abstract: In clinical practice, ultrasound standard planes (SPs) selection is experience-dependent and it suffers from inter-observer and intra-observer variability. Automatic recognition of SPs can help improve the quality of examinations and make the evaluations more objective. In this paper, we propose a method for the automatic identification of SPs, to be installed onboard a portable ultrasound system with limited computational power. The deep Learning methodology we design is based on the concept of Knowledge Distillation, transferring knowledge from a large and well-performing teacher to a smaller student architecture. To this purpose, we evaluate a set of different potential teachers and students, as well as alternative knowledge distillation techniques, to balance a trade-off between performances and architectural complexity. We report a thorough analysis of fetal ultrasound data, focusing on a benchmark dataset, to the best of our knowledge the only one available to date. Graphical abstract: [Figure not available: see fulltext.]

Report of the procedure of voluntary interruption of pregnancy at a university hospital in Uruguay

ABSTRACT OBJECTIVE To describe the constitution and operation of a voluntary interruption of pregnancy team of a university hospital, from the outlook of the mental health team. METHODS In this case study, the following aspects were analyzed: 1) historical background; 2) implementation of Law 18,897 of October 22, 2012; and 3) functioning of the program at the Hospital de Clínicas of the Facultad de Medicina (Universidad de la República, Uruguay), taking into account three dimensions: structure, process, and results. RESULTS Between December 2012 and November 2013, a total of 6,676 voluntary interruptions of pregnancy were reported in Uruguay; out of these, 80 were conducted at the Hospital de Clínicas. The patients&#8217; demographic data agreed with those reported at the national level: Of the total patients, 81.0% were aged over 19 years; 6.2% decided to continue with the pregnancy; and only 70.0% attended the subsequent control and received advice on contraception. CONCLUSIONS In its implementation year in Uruguay, we can assess the experience as positive from the point of view of women&#8217;s health. Our experience as a mental health team at the Hospital de Clínicas, inserted into the multidisciplinary voluntary interruption of pregnancy team, is in the process of assessment and reformulation of practices