Background
The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD‐11). A version of the ICD‐11 for Mental, Behavioural and ...Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDDR includes behavioural indicators (BIs) for assessing the severity of disorders of intellectual development (DID) as part of the section on neurodevelopmental disorders. Reliable and valid diagnostic assessment measures are needed to improve identification and treatment of individuals with DID. Although appropriately normed, standardised intellectual and adaptive behaviour assessments are considered the optimal assessment approach in this area, they are unavailable in many parts of the world. This field study tested the BIs internationally to assess the inter‐rater reliability, concurrent validity, and clinical utility of the BIs for the assessment of DID.
Methods
This international study recruited a total of 206 children and adolescents (5–18 years old) with a suspected or established diagnosis of DID from four sites across three countries Sri‐Lanka (n = 57), Italy (n = 60) and two sites in India (n = 89). Two clinicians assessed each participant using the BIs with one conducting the clinical interview and the other observing. Diagnostic formulations using the BIs and clinical utility ratings were collected and entered independently after each assessment. At a follow‐up appointment, standardised measures (Leiter‐3, Vineland Adaptive Behaviour Scales‐II) were used to assess intellectual and adaptive abilities.
Results
The BIs had excellent inter‐rater reliability (intra‐class correlations ranging from 0.91 to 0.97) and good to excellent concurrent validity (intra‐class correlations ranging from 0.66 to 0.82) across sites. Compared to standardised measures, the BIs had more diagnostic overlap between intellectual and adaptive functioning. The BIs were rated as quick and easy to use and applicable across severities; clear and understandable with adequate to too much level of detail and specificity to describe DID; and useful for treatment selection, prognosis assessments, communication with other health care professionals, and education efforts.
Conclusion
The inclusion of newly developed BIs within the CDDR for ICD‐11 Neurodevelopmental Disorders must be supported by information on their reliability, validity, and clinical utility prior to their widespread adoption for international use. BIs were found to have excellent inter‐rater reliability, good to excellent concurrent validity, and good clinical utility. This supports use of the BIs within the ICD‐11 CDDR to assist with the accurate identification of individuals with DID, particularly in settings where specialised services are unavailable.
The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental.
...To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp.
Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos.
The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion.
The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.
•The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.•The attitude toward organ donation for transplantation is similar among students from the autonomous communities with > 50 donors per million population (pmp) and with < 40 donors pmp.•In both groups, the attitude toward own organ donation at death is related to all psychosocial variables analyzed.•Only a few years ago pmp donation ceilings were proposed, and now they are currently exceeded.•Obtaining high donation rates does not guarantee its persistence over time, so the process must be permanently promoted.
The involvement of health professionals from their training period is important for the promotion of living liver donation. There are data that indicate that the awareness of living donation is lower ...in areas with high rates of deceased donation.
To analyze the attitude toward living liver donation among Spanish medical students, according to donation rates of their regions.
Population under study: Medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: group 1 (n = 1136): students in universities of regions with >50 donors per million population (pmp); group 2 (n = 2018): students in region universities with <40 donors pmp. Assessment instrument: the attitude questionnaire for living liver donation Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático-Ríos (PCID-DVH Ríos).
The attitude toward related liver donation is more favorable among the students of regions with <40 donors pmp than among those of >50 donors pmp. Thus, in group 1, a total of 88% (n = 1002) of students are in favor compared with 91% (n = 1831) of group 2 (P=.02). The psychosocial profile of each study group about their attitude toward living related liver donation is analyzed. There is a similar profile between the 2 groups, although there are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor.
The awareness of living related donation among Spanish medical students is greater among the regions with lower organ donation rates.
•The awareness of related living donation among Spanish medical students is greater among the regions with lower organ donation rates.•The psychosocial profile of each study group about their attitude toward living related liver donation is similar.•There are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor.•No differences in attitude are observed depending on donation rates of their geographic area.
Objective:
To analyze the level of understanding of the brain death concept among medical students in universities in Spain.
Methods:
This cross-sectional sociological, interdisciplinary, and ...multicenter study was performed on 9598 medical students in Spain. The sample was stratified by geographical area and academic year. A previously validated self-reported measure of brain death knowledge (questionnaire Proyecto Colaborativo Internacional Donante sobre la Donación y Transplante de Organos) was completed anonymously by students.
Results:
Respondents completed 9275 surveys for a completion rate of 95.7%. Of those, 67% (n = 6190) of the respondents understood the brain death concept. Of the rest, 28% (n = 2652) did not know what it meant, and the remaining 5% (n = 433) believed that it did not mean that the patient was dead. The variables related to a correct understanding of the concept were: (1) being older (P < .001), (2) studying at a public university (P < .001), (3) year of medical school (P < .001), (4) studying at one of the universities in the south of Spain (P = .003), (5) having discussed donation and transplantation with the family (P < .001), (6) having spoken to friends about the matter (P < .001), (7) a partner’s favorable attitude toward donation and transplantation (P < .001), and (8) religious beliefs (P < .001).
Conclusions:
Sixty-seven percent of medical students know the concept of brain death, and knowledge improved as they advanced in their degree.
Introduction
The attitude of medical students towards living kidney donation (LKD) is of great interest given that they will become promoters of this technique in the near future.
Objective
To ...analyse the attitude of Spanish medical students towards related and unrelated LKD and to determine the factors affecting this attitude.
Materials and methods
Type of study:
A sociological, interdisciplinary, multicentre, and observational study.
Study population:
Medical students enrolled in Spain (
n
= 34.000).
Sample size:
A sample of 9598 students (99 % confidence and precision of ±1 %), stratified by geographical area and academic year.
Measurement instrument:
A validated questionnaire (PCID-DVR RIOS) was administered and completed anonymously.
Results
There was a completion rate of 95.7 % (
n
= 9275); 93 % (
n
= 8630) were in favour of related LKD, and 30 % (
n
= 2784) were in favour of unrelated LKD. The following factors were associated with this attitude: (1) age (
p
= 0.008); (2) sex (
p
< 0.001); (3) year of university degree (
p
< 0.001); (4) a belief that a transplant might be necessary in the future (
p
< 0.001); (5) attitude towards deceased organ donation (
p
< 0.001); (6) a willingness to accept a kidney from a living donor (
p
< 0.001); (7) attitude towards living liver donation (
p
< 0.001); (8) a partner’s attitude towards donation (
p
< 0.001); (9) having spoken about the subject with one’s family (
p
< 0.001), or friends (
p
< 0.001); (10) pro-social behaviour (
p
< 0.001); (11) the respondent’s religious attitude (
p
< 0.001); and (12) fear of possible mutilation of the body after donation (
p
< 0.001).
Conclusions
The attitude of medical students towards LKD is very favourable when it is the related kind of donation, and it is associated with factors of general knowledge about organ donation and transplantation and social interaction and religion.
Abstract Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the latest class of drugs approved to treat type 2 DM (T2DM). Although adverse effects are often caused by a metabolite rather than the ...drug itself, only the safety assessment of disproportionate drug metabolites is usually performed, which is of particular concern for drugs of chronic use, such as SGLT2i. Bearing this in mind, in silico tools are efficient strategies to reveal the risk assessment of metabolites, being endorsed by many regulatory agencies. Thereby, the goal of this study was to apply in silico methods to provide the metabolites toxicity assessment of the SGLT2i. Toxicological assessment from SGLT2i metabolites retrieved from the literature was estimated using the structure and/or statistical-based alert implemented in DataWarrior and ADMET predictorTM softwares. The drugs and their metabolites displayed no mutagenic, tumorigenic or cardiotoxic risks. Still, M1-2 and M3-1 were recognized as potential hepatotoxic compounds and M1-2, M1-3, M3-1, M3-2, M3-3 and M4-3, were estimated to have very toxic LD50 values in rats. All SGLT2i and the metabolites M3-4, M4-1 and M4-2, were predicted to have reproductive toxicity. These results support the awareness that metabolites may be potential mediators of drug-induced toxicities of the therapeutic agents.
We investigated the association between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity. Dynapenia is the age-related decline in muscle ...strength and results in negative outcomes to older adults. Accordingly, obesity is more prevalent throughout aging and is associated with comorbidities, such as type 2 diabetes, dyslipidemia and cardiovascular diseases. Both dynapenia and obesity are strongly linked to chronic inflammation, sharing common signaling pathways.
We recruited 247 older adults aged 60 or older and collected sociodemographic, anthropometric and metabolic data. Dynapenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Circulating inflammatory cytokines were measured in plasma using a multiplex panel kit. Anthropometric, sociodemographic, lipid profile, and fasting blood glucose were also assessed.
Dynapenic participants were predominantly males (74.4%), had insufficiently active lifestyle and higher IL-10 plasma levels (0.95 pg/mL; 0.40–2.12). The prevalence of obesity was higher among non-dynapenic participants (45.3%; 95% CI, 37.7–53). In dynapenic older adults, obesity was predominant in males (53.6%) and subjects with normal muscle strength had higher serum levels of TNF-β (0.63 pg/mL; 0.30–1.30) and lower hand-grip strength (24 kg; 20.00–28.00). Using a multivariate quantile regression analysis, we found a strong and negative association between IL-10 and muscle strength.
This study can help to understand the association of inflammation, obesity and muscle strength to promote interventions in order to avoid or delay the negative outcomes associated with dynapenia and sarcopenia in older adults.
•We investigated the association between inflammation and muscle strength in obese and non-obese older adults.•Dynapenic participants were mostly males, had insufficiently active lifestyle and higher IL-10 plasma levels.•We found a strong and negative association between IL-10 and muscle strength.
Awake brain surgery, combined with neurophysiological evaluation and intraoperative mapping, is one of the preferential lines of treatment when approaching low-grade gliomas. Speech and language ...assessment is used while applying Direct Electrical Stimulation (DES) and during the resection of a lesion/tumour, as it allows to establish related eloquent areas and optimise the extent of the resection and avoid impairments. Patients need to be assessed pre, intra and post-surgery, but in under resourced countries such as Portugal, there are still no standardised and validated tools to conduct this type of evaluation. To address this need, the tasks of the Dutch Linguistic Intraoperative Protocol (DuLIP) were adapted to European Portuguese, and the resulting materials were standardised for a group of 144 Portuguese participants. For each task, the impact of age, gender and schooling were measured. The resulting Portuguese version of the DuLIP (DuLIP-EP) consists of 17 tasks, including phonological, syntactic, semantic, naming and articulatory tests. No significant differences were found between male and female participants. However, schooling influenced phonological and syntactic fluency, object naming and verb generation. Schooling and age had a significant impact on semantic fluency and reading with semantic odd word out tasks. This is the first contribution to the standardisation of a tool that can be used during an awake brain surgery in Portugal, which includes a new phonological odd word out task that is not currently available in the Dutch version.
The recent developments with mass dimension one fermionic fields in a cosmological context are briefly presented. The main results for inflation, dark matter, dark energy, cosmological perturbations, ...particle creation and interacting models are discussed. The Friedmann–Robertson–Walker equations for both torsion and torsion free cases are compared and discussed in different scenarios. We review and call attention for some important assumptions made on derivation of the motion equations. Other approaches and generalizations are suggested and some limitations are presented.
There is insufficient evidence to implant a combined cardiac resynchronization therapy (CRT) device with defibrillation capabilities (CRT-D) in all CRT candidates. The aim of the study was to assess ...myocardial scar size and its heterogeneity as predictors of sudden cardiac death (SCD) in CRT candidates.
A cohort of 78 consecutive patients with dilated cardiomyopathy and class I indication for CRT-D were prospectively enrolled. Before CRT-D implantation, a contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed. The core and border zone (BZ) of the myocardial scar were characterized and quantified with a customized post-processing software. The first appropriate implantable cardioverter defibrillator (ICD) therapy was considered as a surrogate of SCD. During a mean follow-up of 25 months (25-75th percentiles, 15-34), appropriate ICD therapy occurred in 11.5% of patients. In a multivariate Cox proportional hazards regression model for clinical and ce-CMR variables, the scar mass percentage hazards ratio (HR) per 1% increase 1.1 (1.06-1.15), P < 0.01, the BZ mass HR per 1 g increase 1.06 (1.04-1.09), P < 0.01, and the BZ percentage of the scar HR per 1% increase 1.06 (1.02-1.11), P < 0.01, were the only independent predictors of appropriate ICD therapy. Receiver-operating characteristic curve analysis showed that a scar mass <16% and a BZ < 9.5 g had a negative predictive value of 100%.
The presence, size, and heterogeneity of myocardial scar independently predict appropriate ICD therapies in CRT candidates. The ce-CMR-based scar analysis might help identify a subgroup of patients at relatively low risk of SCD.
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