Abstract Objective To evaluate the utility of first-trimester placental volume and vascular flow indices to predict intrauterine growth retardation (IUGR). Study Design In 1004 singleton pregnancies ...attending routine care we recorded maternal characteristics, biophysical and biochemical factors included in the first trimester screening for aneuploidy (FTSA) and uterine artery pulsatility index (PI). Placental volume, Vascularization Index, Flow Index and Vascularization Flow Index were obtained. Customized curves were used to define IUGR. We compared pregnancies with and without IUGR. The performance of different predictive models was described by the areas under the receiver operator characteristic (AUROC) curve. Predictive models of IUGR were compared using a two by two approach and subset analysis was performed. Results Placental volume and all vascular indices were significantly lower (p < 0.001, p ≤ 0.01), and uterine artery PI higher (p < 0.001), in pregnancies with IUGR, with and without associated pre-eclampsia. Results obtained in the analysis of homogeneous subsets showed that the effectiveness of combined predictive models for IUGR improved significantly after adding vascular indices or placental volume to maternal characteristics, FTSA variables and uterine artery PI (AUROC curve value 0.703 (95% CI 0.663–0.744) versus 0.720 (95% CI 0.681–0.759) and 0.735 (95% CI 0.696–0.733), respectively). The most effective model at first trimester was that which included only maternal characteristics, uterine a-PI and placental volume, similar to that of the most complex model built with all the factors analyzed in this study (AUROC curve value 0.735 (95% CI 0.696–0.773). Conclusions Placental volume and vascular indices were predictors factors of IUGR at first trimester. The effectiveness of combined predictive models for IUGR increased significantly after adding these factors, but the sensitivity of these models was too low for them to be considered useful in clinical practice.
Antecedentes: la evidencia empírica acumulada en los últimos años sobre la eficacia, efectividad y eficiencia de los tratamientos psicológicos en la infancia y adolescencia reclama una actualización. ...El principal objetivo de este artículo es el de llevar a cabo una revisión de los tratamientos psicológicos empíricamente apoyados para una diversidad de problemas psicológicos habituales en la infancia y la adolescencia. Método: se revisan los tratamientos psicológicos para diferentes trastornos psicológicos y problemas en el ajuste socioemocional o conductual en población infanto-juvenil en función de los niveles de evidencia y grados de recomendación del Sistema Nacional de Salud de España (Guías de Práctica Clínica). Resultados: los hallazgos sugieren que los tratamientos psicológicos específicamente dirigidos a niños, niñas y adolescentes disponen de apoyo empírico para el abordaje de un amplio elenco de problemas psicológicos. Este grado de apoyo empírico oscila de bajo a alto en función del problema analizado. La revisión muestra un avance desigual en los diferentes campos de intervención. Conclusiones: a partir de esta actualización, los profesionales de la psicología podrán tomar decisiones informadas a la hora de implementar aquellas intervenciones psicológicas con apoyo empírico para el abordaje de los problemas en la infancia y la adolescencia.
The effects of iron deficiency (ID) have been widely studied in heart failure (HF) with reduced ejection fraction. On the other hand, studies in HF with preserved ejection fraction (HFpEF) are few ...and have included small numbers of participants. The aim of this study was to assess the role that ID plays in functional capacity and quality of life (QoL) in HFpEF while comparing several iron-related biomarkers to be used as potential predictors. ID was defined as ferritin <100 ng/mL or transferrin saturation <20%. Submaximal exercise capacity, measured by the 6-min walking test (6MWT), and QoL, assessed by the Minnesotta Living with Heart Failure Questionnaire (MLHFQ), were compared between iron deficient patients and patients with normal iron status. A total of 447 HFpEF patients were included in the present cross-sectional study, and ID prevalence was 73%. Patients with ID performed worse in the 6MWT compared to patients with normal iron status (ID 271 ± 94 m vs. non-ID 310 ± 108 m,
< 0.01). They also scored higher in the MLHFQ, denoting worse QoL (ID 49 ± 22 vs. non-ID 43 ± 23,
= 0.01). Regarding iron metabolism biomarkers, serum soluble transferrin receptor (sTfR) was the strongest independent predictor of functional capacity (β = -63,
< 0.0001, R
0.39) and QoL (β = 7.95,
< 0.0001, R
0.14) in multivariate models. This study postulates that ID is associated with worse functional capacity and QoL in HFpEF as well, and that sTfR is the best iron-related biomarker to predict both. Our study also suggests that the effects of ID could differ among HFpEF patients by left ventricular ejection fraction.
In the current crisis caused by SARS-CoV-2, there is a global need to know and combat the virus. One of the strategies is to track and diagnose cases in order to isolate and interrupt the ...epidemiological chain. Therefore, the aim of this article is to describe the different most used diagnostic tests and analyze their validity and indications for use according to scientific evidence and the main recommendations of scientific societies and reference organizations at national and international level. Since the beginning of the pandemic, the availability of tests has been subject to the conditions of the manufacturing market itself and to the guidelines set in each country. Among the most used types of tests, it is worth highlighting PCR, antibody detection tests (IgG and IGM) and total antibodies (Ab), also known as rapid tests, and tests for the detection of antigens in nasopharyngeal exudate or other upper/lower respiratory samples. For each of these tests, it is necessary to know their recommendations for use and the procedure for taking samples, which is essential to minimize alterations in the results due to poor handling. Likewise, it is necessary to determine the most appropriate moment for taking samples and their adequate interpretation of the results obtained, which must always be considered together with the patient's symptoms for clinical decision-making.
Background: chronic kidney disease in children has become a serious public health problem, it implies a high risk of mortality that increases over the years, its early recognition allows to act on ...risk factors and prevent their progression to terminal stages.
Objective: to describe the clinical-epidemiological characteristics of chronic kidney disease in children treated at the Paquito González Cueto Cienfuegos Pediatric University Hospital in the period 2018-2020.
Methods: a retrospective descriptive study was carried out, a series of cases in patients diagnosed with chronic kidney disease in the last 3 years, with a universe of 260 patients. Clinical and epidemiological variables were analyzed. For the analysis of the results, the SPSS 15.0 program was used, which allowed the processing, statistical analysis and preparation of the output tables.
Results: 260 patients with chronic kidney disease were treated. The male sex was the most affected (59.2 %); the age group that predominated was that of 5 to 14 years (43.9 %); 92.3 % of the patients were found in stage I of the disease; the most associated risk factor and the most frequent causes were congenital malformations (75 %), being vesico-ureteral reflux the one that affected a greater number of patients (53.3 %); 61.8 % of the patients with glomerulopathies had minimal damage disease 42,6 % were asymptomatic.
Conclusions: chronic kidney disease is one of the main causes of morbidity and mortality that has been increasing in recent years in pediatric age, with congenital malformations of the genitourinary system being its main cause; early detection of risk prevents its progression.
ObjectiveThis study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients’ (T2DM) reported outcomes ...measures (PROMs) in the long-term. Design: open, community-based pragmatic, multicentre, controlled trial with random allocation by clusters to usual care (UC) or to one of the three interventions.ParticipantsA total of 2334 patients with uncomplicated T2DM and 211 healthcare professionals were included of 32 primary care centres.SettingPrimary Care Centers in Canary Islands (Spain).InterventionThe intervention for patients (PTI) included an educational group programme, logs and a web-based platform for monitoring and automated short message service (SMS). The intervention for professionals (PFI) included an educational programme, a decision support tool embedded into the electronic clinical record and periodic feedback about patients’ results. A third group received both PTI and PFI (combined intervention, CBI).Outcome measureCognitive-attitudinal, behavioural, affective and health-related quality of life (HQoL) variables.ResultsCompared with UC at 24 months, the PTI group significantly improved knowledge (p=0.005), self-empowerment (p=0.002), adherence to dietary recommendations (p<0.001) and distress (p=0.01). The PFI group improved at 24 months in distress (p=0.03) and at 12 months there were improvements in depression (p=0.003), anxiety (p=0.05), HQoL (p=0.005) and self-empowerment (p<0.001). The CBI group improved at 24 months in self-empowerment (p=0.008) and adherence to dietary recommendations (p=0.004) and at 12 months in knowledge (p=0.008), depression (p=0.006), anxiety (p=0.003), distress (p=0.01), HQoL (p<0.001) and neuropathic symptoms (p=0.02). Statistically significant improvements were also observed at 24 months in the proportion of patients who quit smoking for PTI and CBI (41.5% in PTI and 42.3% in CBI vs 21.2% in the UC group).ConclusionsAssessed interventions to improve PROMs in T2DM attain effectiveness for knowledge, self-empowerment, distress, diet adherence and tobacco cessation. PTI produced the most lasting benefits.Trial registration numberClinicalTrials.gov NCT01657227 (6 August 2012) https://clinicaltrials.gov/ct2/show/NCT01657227.
Background: chronic kidney disease in children has become a serious public health problem, it implies a high risk of mortality that increases over the years, its early recognition allows to act on ...risk factors and prevent their progression to terminal stages.
Objective: to describe the clinical-epidemiological characteristics of chronic kidney disease in children treated at the Paquito González Cueto Cienfuegos Pediatric University Hospital in the period 2018-2020.
Methods: a retrospective descriptive study was carried out, a series of cases in patients diagnosed with chronic kidney disease in the last 3 years, with a universe of 260 patients. Clinical and epidemiological variables were analyzed. For the analysis of the results, the SPSS 15.0 program was used, which allowed the processing, statistical analysis and preparation of the output tables.
Results: 260 patients with chronic kidney disease were treated. The male sex was the most affected (59.2 %); the age group that predominated was that of 5 to 14 years (43.9 %); 92.3 % of the patients were found in stage I of the disease; the most associated risk factor and the most frequent causes were congenital malformations (75 %), being vesico-ureteral reflux the one that affected a greater number of patients (53.3 %); 61.8 % of the patients with glomerulopathies had minimal damage disease 42,6 % were asymptomatic.
Conclusions: chronic kidney disease is one of the main causes of morbidity and mortality that has been increasing in recent years in pediatric age, with congenital malformations of the genitourinary system being its main cause; early detection of risk prevents its progression.
•Information about sympathetic activation (SA) in HFpEF and HFmrEF and its clinical implications is scarce.•HFpEF and HFmrEF are associated with lower SA compared to HFrEF in adjusted analyses.•SA ...estimated with NE levels is associated with all-cause and CV mortality across the entire LVEF spectrum.•The strongest association between NE and CV mortality is HFmrEF patients, and the weakest in HFpEF.•This fact could help to explain why the response to the neurohormonal treatment of patients with HFmrEF is similar to HFrEF, instead of to HFpEF.
Sympathetic activity (SA) is increased in patients with heart failure and reduced ejection fraction (HFrEF) and is associated with poor outcomes. However, its clinical implications are less understood in HF with mid-range (HFmrEF) and preserved ejection fraction (HFpEF). We aimed to study SA across left ventricle ejection fraction (LVEF) groups and its association with clinical outcomes.
SA estimated by norepinephrine (NE) levels was determined in 742 consecutive outpatients with chronic HF: 348 (47%) with HFrEF, 116 (16%) HFmrEF, and 278 (37%) HFpEF. After a mean follow-up of 15 months, 17% died. Adjusted analyses showed that patients with HFpEF and HFmrEF had lower estimated marginal means of NE levels compared to HFrEF (278 and 116 pg/mL, respectively, vs. 348 pg/mL; p-value=0.005). Adjusted Cox regression analyses showed that high norepinephrine levels independently predicted all-cause mortality (ACM) in all 3 groups. The strongest associations between high NE levels and cardiovascular mortality (CVM) were observed in HFmrEF (HR: 4.7 1.33–16.68), while the weakest association was in HFpEF (HR: 2.62 1.08–6.35).
Adjusted analyses showed that HFpEF and HFmrEF were associated with lower SA compared to HFrEF. Nevertheless, increasing NE levels were independently associated with ACM and CVM in all three LVEF groups. The strongest association between high NE levels and CVM was present in HFmrEF patients, while the weakest was seen in HFpEF. These findings could explain why the response to neurohormonal therapies in patients with HFmrEF is similar to that of patients with HFrEF rather than with HFpEF.
Las condiciones y el medioambiente de trabajo, el propio proceso laboral y la problemática que implica disponer de una población laboral que envejece y decrece, son elementos determinantes en la ...dinámica ecosistémica del proceso salud-enfermedad e implican un desafío para la salud ocupacional cubana. Este artículo tiene como objetivo esbozar los criterios a seguir en la realización de las evaluaciones médico ocupacionales preventivas como procedimiento metodológico para la valoración de la aptitud laboral. La información que se presenta se sustenta en un análisis documental, y se organiza bajo criterios clínicos, ocupacionales y legales imprescindibles a considerar por el médico especialista en Medicina General Integral de la atención primaria de salud cubana. Se concluye que las evaluaciones médico ocupacionales preventivas se orientan a las condiciones de trabajo más adecuadas para el sujeto en consideración a su capacidad psicológica, física y fisiológica, así como a su seguridad personal y la de otros. De igual modo, proporcionan al trabajador un certificado de aptitud laboral que resulta ser un requisito para su inserción en el mercado de trabajo y, al mismo tiempo, es un documento con valor legal, educacional, informativo, científico, ético y económico.
To study to what extent a brief intervention increases the rate of participation in the programme of early diagnosis of breast cancer (EDBC).
Before-and-after intervention study without a control ...group on women who had not had a mammography.
Primary care: 3 rural lists and 2 urban ones.
All women between 52 and 67 who attended the clinic during a 6-month period.
If they had had no mammography in the previous 2 years, the reasons were explored and a brief structured intervention, depending on the reason, was conducted. After this, the woman was invited to make an appointment with the EDBC Unit.
Effective intervention: checking that the mammography had been done at the EDBC Unit. It was checked whether women who had not attended for consultation attended the unit with their mammography done.
Out of a target population of 565 women, 403 (71%) attended for consultation. Of these, 315 (78%) were in the programme, 51 (13%) had had a mammography outside the programme, and 37 (9%) had not had a mammography. After the intervention, 21 women had a mammography (56.7% 95% CI, 41-73 success of intervention). Seventy of the 162 women who did not attend for consultation had a mammography in the programme. The rate of participation in the EDBC rose from 68% (385/565) to 72% (406/565).
The brief intervention was effective in over half the women. This small increase contributed to reaching the minimum levels of coverage recommended in a programme of this kind.
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