bluuebunny/crossref_metadata_2025 huggingface dataset:
Síntomas depresivos en adultos mayores institucionalizados y factores asociados
Authors: Estrada Restrepo Alejandro , Cardona Arango Doris , Segura Cardona Ángela María , Ordoñez Molina Jaime , Osorio Gómez Jorge Julián , Chavarriaga Maya Lina Marcela
Published: April 2019

Este estudio tuvo como objetivo explorar los factores asociados con síntomas depresivos en adultos mayores institucionalizados. Se realizó un estudio transversal en 276 adultos mayores de Centros de Bienestar del Anciano de Medellín. Se valoraron características demográficas, funcionales, ansiedad, salud percibida, redes de apoyo, estado nutricional y calidad de vida. Prevalencias de sintomatología depresiva fueron similares por sexo y edad (p > 0.05). Adultos dependientes para la realización de actividades cotidianas, tuvieron mayores porcentajes de síntomas de depresión (p < 0.001). Altos niveles de ansiedad (OR = 2.74), deterioro funcional (OR = 2.82), ningún grado de formación académica (OR = 3.70) y mujeres parcialmente dependientes (OR = 21.89) se asociaron con mayor probabilidad de presentar síntomas de depresión (p < 0.05). En general, perdida de roles, estado de dependencia y calidad de vida disminuida aumentan la sintomatología depresiva.
Viviendo con una enfermedad crónica fatal: significados en una muestra brasileña
Authors: Simões Kelly , Souza Filho Edson
Published: April 2019

La enfermedad crónica fatal impacta la vida con transformaciones en términos conductuales y afectivos. Los objetivos de este trabajo fueron: identificar el significado de la vivencia de la enfermedad crónica fatal y percibir el significado del concepto de salud y enfermedad, en una muestra brasileña de portadores de enfermedad crónica fatal. Para esto, se adoptó una posición teórica psicosocial de análisis subjetivo, según el abordaje de las representaciones sociales. En cuanto al método, la investigación fue cualitativa y utilizó estudios de caso en pacientes internados portadores de enfermedades crónicas fatales. Se concluyó que es la enfermedad en sí misma lo que parece ocupar un lugar central y dar sentido a los comportamientos y movilizaciones, y que el concepto de salud queda supeditado al estado de enfermedad.
Internacionalidad de las revistas de psicología multidisciplinar editadas en iberoamérica e incluidas en la Web of Science
Authors: Zych Izabela , Buela-Casal Gualberto
Published: April 2019

Las revistas internacionales se consideran más prestigiosas y de mayor calidad que las nacionales, aunque su significado no se había establecido hasta hace poco. Es más, el criterio de internacionalidad se utiliza para tomar importantes decisiones como por ejemplo en la evaluación del personal docente, universidades, programas de doctorado etc., aún sin conocer su significado exacto. Por tanto, el presente estudio utiliza los criterios de internacionalidad establecidos en una encuesta a más de 16.000 científicos de todo el mundo, para la elaboración de un Índice de Internacionalidad de las revistas de psicología multidisciplinar incluidas en la Web of Science. Los resultados demuestran que la revista con mayor nivel de internacionalidad es la Revista Latinoamericana de Psicología, seguida por The Spanish Journal of Psychology, Psicothema y Universitas Psychologica. Todas las revistas cumplen con los criterios de internacionalidad y el estudio proporciona resultados de gran relevancia para potenciarla.
Memoria y metamemoria: relaciones funcionales y estabilidad de las mismas
Authors: Sierra Fitzgerald Oscar
Published: April 2019

La habilidad general de reflexionar sobre los propios procesos cognitivos se denomina metacognición y sobre las habilidades mnésicas, en particular, metamemoria. Empleando la Prueba de Aprendizaje Auditivo Verbal de Rey estandarizada en Colombia (PAAVR; Sierra, 2001), se exploró la metamemoria predictiva y su estabilidad. Antes de cada ensayo de aprendizaje de la PAAVR, 428 sujetos sanos estimaron cuántas palabras creían poder recordar. Las correlaciones entre los puntajes de aprendizaje y las correspondientes estimaciones fueron altas (0.35-0.73). La correlación entre aprendizaje total y la estimación total del mismo - derivada de sumar las estimaciones individuales- fue 0.77. La estabilidad de las estimaciones, un año más tarde, fue significativa. Interferencia y olvido, normalmente observados en procesos de codificación y recuperación de memoria, ocurrieron, de manera estrechamente paralela, en la metamemoria.
Psicología cultural: contribuciones teóricas y fundamentos epistemológicos – de las aportaciones de Vygotsky hacia la discusión lingüística de Bakhtin.
Authors: Pizzinato Adolfo
Published: April 2019

Este artículo pretende presentar conceptos clave en el marco de lo que se define por psicología cultural. Además de presentar una psicología que trata de la cultura, como el aspecto central de su propuesta de entendimiento de los fenómenos humanos, se presentan sus orígenes, sus autores y sus temas de mayor interés, sobretodo en lo que concierne a la narratividad y la incorporación de aspectos de la lingüística a la investigación y a la discusión conceptual en la psicología contemporánea.
Actitud hacia la masturbación en adolescentes: propiedades psicométricas de la versión española del attitudes toward masturbation inventory
Authors: Sierra Juan Carlos , Perla Felipe , Gutiérrez-Quintanilla Ricardo
Published: April 2019

La masturbación es una conducta sexual frecuentemente asociada a la culpabilidad sexual. Ante la ausencia de instrumentos para evaluar las actitudes hacia esta conducta, este estudio pretende examinar algunas propiedades psicométricas de la versión española del Inventario de Actitudes Negativas hacia la Masturbación de Abramson y Mosher (IANM), el cual fue aplicado junto con la Encuesta de Opinión Sexual a una muestra de 610 adolescentes salvadoreños (308 varones y 302 mujeres). El análisis factorial exploratorio aisló tres factores: Afectos negativos en experiencias personales con la masturbación (α = 0,85), Actitudes negativas hacia aspectos positivos de la masturbación (α = 0,76) y Falsas creencias acerca de la naturaleza nociva de la masturbación (α = 0,61). No se encontraron diferencias por sexo en la puntuación total de la escala ni en dos de las tres subescalas, pero sí en algunos de los ítems en los que las mujeres presentaban una actitud más negativa hacia la masturbación. La erotofilia se asoció inversamente a las actitudes negativas hacia la masturbación.
Autoeficacia y percepción de control en la prevención de la enfermedad cardiovascular
Authors: Carpi Ballester Amparo , Zurriaga Llorens Rosario , González Navarro Pilar , Marzo Campos Juan Carlos , Buunk Abraham P.
Published: April 2019

Desde la Teoría de Acción Planeada (TAP), el objetivo de este trabajo es analizar si la autoeficacia y la percepción de control presentan diferencias predictivas sobre la intención y las conductas preventivas de la enfermedad cardiovascular. La muestra estuvo compuesta por 359 sujetos. Los datos han sido analizados empleando el paquete estadístico EQS 6.1. Los resultados muestran que la autoeficacia influye positiva y significativamente sobre la intención y sobre la conducta, mientras que la percepción de control influye negativa y significativamente sobre la intención de conducta, pero no sobre la conducta preventiva. Este trabajo ha mostrado la conveniencia de distinguir entre autoeficacia y percepción de control en la TAP en la prevención de conductas de salud cardiovascular.
Comorbilidad de trastornos de personalidad: estudio en personas sin hogar
Authors: Salavera Bordás Carlos , Puyuelo Miguel , Tricás José M , Lucha Orosia
Published: April 2019

En este estudio se lleva a cabo una investigación sobre comorbilidad en los trastornos de personalidad en personas sin hogar. El objetivo del estudio era analizar si existe comorbilidad entre trastornos. Para ello, se lleva a cabo un estudio ex post facto, de carácter transversal, con una muestra de 91 pacientes, que cumplimentaron una entrevista semiestructurada y el MCMI II, en el transcurso de su tratamiento. Los resultados muestran como en un 40,66% de la muestra, coexisten 2 o más trastornos de personalidad a un tiempo, con una media de 2,06 TP por persona. Además, los trastornos de personalidad del grupo B: antisocial, límite, histriónico y narcisista, son los que un mayor índice de comorbilidad presentan. Por el contrario, trastornos de personalidad del grupo C: obsesivo-compulsivo, por evitación o por dependencia, a pesar de tener mayor presencia, apenas presentan comorbilidad con otros. Por último, se comentan la implicación que tiene este estudio en la práctica clínica y líneas futuras de investigación.
Estudio y análisis de conductas violentas en educación secundaria en España
Authors: Gázquez Linares José Jesús , Pérez-Fuentes María Del Carmen
Published: April 2019

El objetivo de este estudio, es comparar la prevalencia de determinadas conductas violentas en los mismos niveles educativos durante dos estudios transversales: el primero, realizado en el curso académico 2004-2005, y el segundo, tres años más tarde, durante el periodo 2007-2008. Para ello, se ha analizado una muestra total de 1.475 sujetos de edades comprendidas entre los 14 y 16 años. Los resultados muestran, que se produce un descenso significativo en la prevalencia de prácticamente todas las conductas violentas analizadas, tales como: insultos, peleas, etc., durante los años académicos mencionados anteriormente. Por otra parte, las mujeres son las que más sufren la agresión verbal indirecta y, por el contrario, los hombres son los que más ejercen este tipo de conducta.
El efecto diferencial de escribir sobre un mismo trauma o sobre diferentes traumas en el bienestar psicológico y el estado de salud autoinformado
Authors: Peñate Wenceslao , Bethencourt Juan Manuel
Published: April 2019

El presente trabajo se inscribe dentro de los estudios sobre la eficacia de la reexperimentación emocional de traumas y sucesos altamente estresantes. Específicamente se estudia el papel de escribir sobre un mismo trauma o sobre traumas diferentes sobre la salud mental y física. 37 mujeres estudiantes de psicología fueron asignadas a tres condiciones experimentales: escribir tres días sobre un mismo trauma, escribir sobre un trauma diferente cada día y escribir sobre cuestiones triviales. Como variables dependientes se tomaron la afectividad positiva y negativa, el nivel de síntomas de estrés postraumático, el nivel de depresión y el nivel de salud (autoinformado). Se llevaron a cabo mediciones sesión a sesión y a los dos meses. Los resultados indicaron que la afectividad negativa disminuyó y aumentó la afectividad positiva, sesión a sesión. A los dos meses se observó una disminución significativa de la sintomatología de estrés postraumático y de la salud física para el grupo que escribió sobre el mismo trauma, en comparación con los otros dos grupos. El nivel de depresión también disminuyó, tanto para el grupo que escribió sobre el mismo trauma como para el que escribió sobre traumas distintos. A pesar de que el modelo de la exposición cognitiva es el que consigue un mayor apoyo, los resultados se discuten de acuerdo a nuevos modelos explicativos más comprehensivos.
Propiedades psicométricas de la versión en español de la escala revisada de restricción alimentaria en una muestra de adolescentes
Authors: Silva Jaime R , Urzúa M Alfonso
Published: April 2019

La escala de restricción revisada (ER) es un instrumento psicométrico para medir restricción alimentaria crónica. Objetivo: Obtener la fiabilidad y estructura factorial de la versión en español de la ER en una muestra de adolescentes. Materiales y método: 838 adolescentes (15,5 años) completaron el instrumento. Se realizó un análisis factorial exploratorio y confirmatorio sobre los puntajes. Resultados: Ambas sub-escalas de la ER muestran una fiabilidad apropiada, aunque el item 9 mostró una homogeneidad corregida pobre (r<.3). Dos factores correlacionados emergieron del análisis factorial, explicando el 55,76% de la varianza. El análisis confirmatorio develó un ajuste moderado de la estructura bifactorial hipotética. Conclusiones: El instrumento muestra una estructura bifactorial y niveles adecuados de fiabilidad en una muestra de adolescentes.
Representaciones sociales del habitante de la calle
Authors: Navarro Carrascal Oscar , Gaviria Londoño Marta
Published: April 2019

En el presente artículo nos interesamos en el análisis de las representaciones sociales de objetos socialmente importantes, como es el caso de la vulnerabilidad social. A través de este enfoque buscamos entender como las personas conciben y explican los diferentes aspectos del vivir en la calle. Para ello se entrevistaron 100 personas y su producción semántica fue analizada a través de un análisis estructural de representación social. Se encontró que existen por lo menos dos tipos de representación social del habitar en la calle: una representación “compasiva” y otra “temerosa”.
Sentido común y conflicto: impacto de las teorías legas sobre relaciones intergrupales
Authors: Ramírez Luisa Fernanda , Levy Sheri
Published: April 2019

Teorías legas, son teorías del sentido común que las personas legas utilizan para explicar y predecir fenómenos del su entorno. Evidencia empírica sugiere que las teorías legas impactan las relaciones intergrupales, entre otras razones, por su capacidad para promover tolerancia o rechazo hacia las minorías sociales. Este artículo revisa algunos hallazgos sobre la relación entre tres teorías legas (la Ética Protestante del Trabajo, la Creencia en un Mundo Justo y el Esencialismo Psicológico) y actitudes hacia miembros de grupos minoritarios en diversos contextos sociales y culturales, señalando el papel de algunas variables que inciden en su interpretación (características del perceptor y del contexto social y cultural), y sus implicaciones teóricas. Al hacerlo, establece la relevancia del estudio de varias teorías legas en el contexto latinoamericano destacando los escasos, pero sustanciales hallazgos en algunos países latinoamericanos, y llama la atención sobre la necesidad de emprender más estudios en esta dirección
Prueba computarizada Memonum: efecto de intervalos y distractores sobre la memoria de trabajo en mujeres mayores de 50 años
Authors: Prada Sarmiento Edward Leonel , Pineda Garzón Gina Elizabeth , Mejía Orduz Manuel Alejandro , Conde Cotes Carlos Arturo
Published: April 2019

Mediante la prueba computarizada Memonum se evaluaron los efectos de dos intervalos de exposición de dígitos (1 y 8 segundos), y la presentación de un distractor sobre el desempeño de la memoria de trabajo en 80 mujeres mayores de 50 años. Se evidenció un efecto significativo del intervalo sobre las variables: número de aciertos, aciertos acumulados, y empleo de estrategias adicionales, demostrando un mejor desempeño mnemónico en participantes que presentaron la prueba en el intervalo de 8 segundos y sugiriendo que un tiempo amplio de exposición potencia la capacidad de almacenamiento de la memoria en adultos mayores. La presencia del distractor tuvo un efecto significativo sobre el número de aciertos acumulados, considerándose como un estimulo interferente capaz de afectar la memoria de trabajo en adultos mayores.
Reflexiones en torno a la comprensión del maltrato infantil
Authors: Carreño Manosalva Clara Ines , Rey de Alonso Alicia
Published: April 2019

La presente investigación es un aporte a la comprensión de la infancia y del maltrato infantil. Se llevó a cabo un estado del arte del conocimiento producido en las experiencias de investigación / intervención realizadas en el marco del Programa de Especialización del Maltrato Infantil de la Universidad Javeriana entre los años 2002 al 2006. El artículo recrea la actualidad de esta preocupación en Colombia, ofrece reinterpretaciones al discurso construido y plantea un marco para el análisis complejo del maltrato dentro de las relaciones entre adulto y niño.
Dynamic Force Identification in Peripheral Milling Based on CGLS Using Filtered Acceleration Signals and Averaged Transfer Functions
Authors: Wang Chenxi , Zhang Xingwu , Qiao Baijie , Cao Hongrui , Chen Xuefeng
Published: April 2019

Dynamic milling forces have been widely used to monitor the condition of the milling process. However, it is very difficult to measure milling forces directly in operation, particularly in the industrial scene. In this paper, a dynamic force identification method in time domain, conjugate gradient least square (CGLS), is employed for reconstructing the time history of milling forces using acceleration signals in the peripheral milling process. CGLS is adopted for force identification because of its high accuracy and efficiency, which handles the ill-conditioned matrix well. In the milling process, the tool with high-speed rotation has different transfer functions between tool nose and accelerometers at different angular positions. Based on this fact, the averaged transfer functions are employed to reduce the error amplification of regularization processing for milling force identification. Moreover, in order to eliminate the effect of idling and high-frequency components on identification accuracy, the Butterworth band-pass filter is adopted for acceleration signals preprocessing. Finally, the proposed method is validated by milling tests under different cutting parameters. Experimental results demonstrate that the identified and measured milling forces are in good agreement on the whole time domain, which verifies the effectiveness and generalization of the indirect method for milling force measuring. In addition, the Tikhonov regularization method is also implemented for comparison, which shows that CGLS has higher accuracy and efficiency.
High-Quality Machining of Edges of Thin-Walled Plates by Tilt Side Milling Based on an Analytical Force-Based Model
Authors: Liu Gongyu , Dang Jiaqiang , Ming Weiwei , An Qinglong , Chen Ming , Li Haonan
Published: April 2019

The milling of thin-walled workpieces is a common process in many industries. However, the machining defects are easy to occur due to the vibration and/or deformation induced by the poor stiffness of the thin structures, particularly when side milling the edges of plates. To this problem, an attempt by inclining the tool to a proper tilt angle in milling the edges of plates was proposed in this paper, in order to decrease the cutting force component along the direction of the lowest stiffness of the plates, and therefore to mitigate the machining vibration and improve the machined surface quality effectively. First, the milling force model in consideration of the undeformed chip thickness and the tool-workpiece engagement (TWE) was introduced in detail. Then, a new analytical assessment model based on the precisely established cutting force model was developed so as to obtain the optimum tool tilt angle for the minimum force-induced defects after the operation. Finally, the reliability and correctness of the theoretical force model and the proposed assessment model were validated by experiments. The methodology in this paper could provide practical guidance for achieving high-quality machined surface in the milling operation of thin-walled workpieces.
Proteomics profiling of arginine methylation defines PRMT5 substrate specificity
Authors: Musiani Daniele , Bok Jabez , Massignani Enrico , Wu Liling , Tabaglio Tommaso , Ippolito Marica Rosaria , Cuomo Alessandro , Ozbek Umut , Zorgati Habiba , Ghoshdastider Umesh , Robinson Robert C. , Guccione Ernesto , Bonaldi Tiziana
Published: April 2019

Proteomics identifies target sites and substrates of the arginine methyltransferase PRMT5.
Oligoribonuclease Contributes to Tolerance to Aminoglycoside and β-Lactam Antibiotics by Regulating KatA in Pseudomonas aeruginosa
Authors: Xia Bin , Li Mei , Tian Zhenyang , Chen Gukui , Liu Chang , Xia Yushan , Jin Yongxin , Bai Fang , Cheng Zhihui , Jin Shouguang , Wu Weihui
Published: April 2019

Pseudomonas aeruginosa
is an opportunistic bacterial pathogen and is intrinsically resistant to a variety of antibiotics. Oligoribonuclease (Orn) is a 3′-to-5′ exonuclease that degrades nanoRNAs.
The NOD-

scid IL2rγ
null

Mouse Model Is Suitable for the Study of Osteoarticular Brucellosis and Vaccine Safety
Authors: Khalaf Omar H. , Chaki Sankar P. , Garcia-Gonzalez Daniel G. , Ficht Thomas A. , Arenas-Gamboa Angela M.
Published: April 2019

Osteoarticular brucellosis is the most common complication in
Brucella
-infected humans regardless of age, sex, or immune status. The mechanism of bone destruction caused by
Brucella
species remained partially unknown due to the lack of a suitable animal model.
Crystal Structure of VapBC-1 from Nontypeable Haemophilus influenzae and the Effect of PIN Domain Mutations on Survival during Infection
Authors: Molinaro Ashley L. , Kashipathy Maithri M. , Lovell Scott , Battaile Kevin P. , Coussens Nathan P. , Shen Min , Daines Dayle A.
Published: April 2019

Herein the crystal structure of the VapBC-1 complex from nontypeable
Haemophilus influenzae
(NTHi) is described. Our results show that some of the mutations in the PIN domain of the VapC-1 toxin were associated with decreased toxicity in
E. coli
, but the mutants retained the ability to homodimerize and to heterodimerize with the wild-type cognate antitoxin, VapB-1. A new system was designed and constructed to quantify the effects of these mutations on NTHi survival during infections of primary human tissues
ex vivo
. Any mutation to a conserved amino acid in the PIN domain significantly decreased the number of survivors compared to that of the in
cis
wild-type toxin under the same conditions.
Autopsy of a reservoir: Facies architecture in a multidam system, Elwha River, Washington, USA
Authors: Stratton Laurel E. , Grant Gordon E.
Published: April 2019

The 2011–2014 removal of two large dams on the Elwha River, Washington State, the largest dam removal yet completed globally, created extensive cutbank exposures of reservoir sediments, allowing the first characterization of the facies architecture of sediments through direct observation in reservoirs worldwide and providing an unparalleled opportunity to assess the relationship between environmental influences, such as changes in sediment supply, and their expression in the stratigraphic record. Using a combination of facies description from observation of 49 measured sections and >100 exposures and analysis of digital elevation models and historic aerial photographs, we delineated the characteristic depositional zones of each reservoir and mapped the evolution of the subaerial delta over the life span of the reservoir. Former Lake Mills, the younger, upstream reservoir, was characterized by a tripartite, subaerial Gilbert-style delta that prograded >1 km into the main reservoir from 1927 to 2011. Sediments were composed of coarse-grained topset beds, steeply dipping foreset beds, and a fine-grained, gently dipping prodelta. While individual event horizons were discernible in fine-grained sediments of former Lake Mills, their number and spacing did not correspond to known drawdown or flood events. Former Lake Aldwell, impounded from 1913 to 2011, was initially defined by the rapid progradation of a Gilbert-style, subaerial delta prior to the upstream completion of Glines Canyon Dam. However, the 1927 closure of Glines Canyon Dam upstream caused the delta to evolve to a fine-grained, mouth-bar–type delta indicative of low, finer-grained sediment. This evolution, combined with a previously unrecognized landslide deposit into the upper delta plain, suggests that understanding the exogenic influences on reservoir sedimentation is critical to interpretation and prediction of the sedimentation within individual systems.
Middle-aged man who could not afford an angioplasty
Authors: Podder Vivek , Price Amy , Sivapuram Madhava Sai , Biswas Rakesh
Published: April 2019

Coronary artery disease managed by percutaneous coronary intervention (PCI) has been noted for profit-driven overuse medicine. Concerns mount over inappropriate use of PCI for patients in India. We describe the case of a 55-year-old Indian man who presented for a second opinion following an urgent recommendation for PCI by two cardiologists following a recent acute myocardial infarction even though the patient was symptom-free and out of the window period for primary PCI. The proposed intervention placed the patient at financial risk for insolvency. This case report highlights the challenges and consequences of inappropriate overuse of PCI. Also, we outline the current lack of shared decision-making among patients and physicians for the PCI procedure. The challenges, inherent in the assumptions that overuse of PCI is evidence-based, are discussed including recommendations for the practice of evidence based medicine for this intervention.
A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report
Authors: Muralidhar Venkiteswaran , Raghav Pankaja , Das Prianka , Goel Akhil
Published: April 2019

India is the largest consumer of asbestos in the world. There is no report from India of mesothelioma related to asbestos. The case is a 42-year-old man who died of pleural mesothelioma. He was exposed to asbestos domestically and from the environment since birth. Two of his close family members worked in a factory that used asbestos. The living quarter of the family was within the premises of the factory. Asbestos waste was strewn on the grounds surrounding the quarters. After decades of legal battles by workers and families exposed to asbestos, Indian courts have ordered remedial measures and compensation to people, who are exposed to asbestos at work and the environment. Mesothelioma, currently in epidemic proportions in the west where asbestos production was banned in the 1990s, could rise to alarming levels in the next decades in India if the legal remedial measures are not implemented soon.
Tc-99m HYNIC-TOC scintigraphy in dedifferentiated thyroid cancer
Authors: Agrawal Kanhaiyalal , Patro P Sai Sradha , Preetam C
Published: April 2019

There is literature evidence showing utility of somatostatin receptor (SSTR) positron emission tomography-CT (PET-CT) imaging in differentiated thyroid cancer with Thyroglobulin Elevated and Negative Iodine Scan (TENIS). These patients are less benefited with I-131 therapy and surgery remains only curable option if disease could be localised. If surgery is not feasible, other therapeutic options are not promising. However, if these patients show strongly positive SSTR imaging, then possibility of peptide receptor radionuclide therapy may be explored. As SSTR PET-CT imaging is expensive and not widely available, Technetium-99m (Tc-99m) hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC), which is a Single photon emission computed tomography (SPECT) tracer, can be used. We are documenting a case of raised serum thyroglobulin antibody and negative I-131 whole body scan with disease recurrence localised on Tc-99m HYNIC-TOC scan.
Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence
Authors: Ivanovski Trajche , Espino Ibañez Ana María , Barcelo Martin Bernardino , Gomila Muñiz Isabel
Published: April 2019

Heroin-related myelopathy is an uncommon but often devastating complication of heroin intake. It is usually reported in individuals exposed to intravenous heroin after a variable drug-free period, leading to acute and complete spinal cord injury with poor long-term outcome. We describe an original case of acute longitudinally extensive transverse myelopathy following single heroin and cocaine intravenous exposure after a long period of abstinence confirmed by toxicological hair and retrospective urine drug analysis. This case could provide new insights in the understanding of this rare neurological complication.
Septic pulmonary embolism caused byPseudomonas aeruginosaafter a CO2laser surgery for rhinitis
Authors: Nishizawa Toshinori , Kanemura Hiroaki , Jinta Torahiko , Tamura Tomohide
Published: April 2019

A 26-year-old healthy patient had a fever and chest pain three days after nasal carbon dioxide (CO2) laser surgery for chronic and allergic rhinitis. In the emergency room, he was diagnosed as a right pneumothorax and managed as outpatients with oral antibiotic therapy and close follow-up. Six days later, in follow-up clinic, his presenting signs and symptoms included right chest pain, tachypnoea and elevated levels of white blood cell count and C reactive protein. He was diagnosed as septic pulmonary embolism (SPE) by the detection of multiple nodules with cavitation on chest CT. Culture of pleural fluids showedPseudomonas aeruginosa. Intravenous antibiotic treatment and drainage of the pleural effusion improved his condition. Since SPE occurred after nasal CO2laser surgery in this case, careful attention should be paid to infectious complications of nasal CO2laser surgery.
Late-onset presentation of POLG1-associated mitochondrial disease
Authors: Meira Bruna , Roque Rafael , Pinto Miguel , Caetano André
Published: April 2019

Mutations in the nuclear POLG1 gene compromise the integrity of mitochondrial DNA and show great allelic and clinical heterogeneity. Among adult POLG1-associated mitochondrial disease, the main clinical feature is chronic progressive external ophthalmoplegia. Other related clinical manifestations are sensory or cerebellar ataxia, peripheral neuropathy, myopathy or extrapyramidal symptoms. We report the case of a 72-year-old man who presented with a late onset sensory neuronopathy, chronic progressive external ophthalmoplegia, gait ataxia and parkinsonism. Genetic studies showed a compound heterozygosity of known pathogenic mutations in the POLG1 gene (variant T252I/P587 L in cis configuration in allele 1 and variant R807C in allele 2). Late life presentation highlights that mitochondrial disorders should be considered regardless of age of onset of symptoms.
Topographic correlation between macular superficial microvessel density and ganglion cell-inner plexiform layer thickness in glaucoma-suspect and early normal-tension glaucoma
Authors: Kim Jin-Soo , Kim Young Kook , Baek Sung Uk , Ha Ahnul , Kim Yong Woo , Jeoung Jin Wook , Park Ki Ho
Published: April 2019

Background/Aims

To investigate the topographic relationship between macular superficial microvessel density (SMD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in eyes with glaucoma-suspect (GS) and early normal-tension glaucoma (NTG).

Methods

A total of 86 eyes of 86 patients with early NTG (standard automated perimetry mean deviation >−5.5 decibels) and a total of 25 eyes of 25 patients with GS were retrospectively reviewed. All of the subjects underwent optical coherence tomography (OCT) and OCT angiography (OCTA) scan. On the OCTA scan images, macular SMD was analysed by customised software.

Results

In GS and patients with early NTG, macular GCIPL thickness showed significant correlations with macular SMD in the superotemporal (ST), inferotemporal (IT) and inferoinferior (II) sectors (r=0.191, 0.373 and 0.346 for ST, IT and II sector, respectively). Additionally, circumpapillary retinal nerve fibre layer (RNFL) thickness and macular SMD showed significant correlations between the ST sector of the macula and the 1, 9 clock-hour peripapillary regions and between the IT and II sectors of the macula and the 6, 7, 8 clock-hour peripapillary regions. The IT sector macular SMD showed fair diagnostic power (area under the receiver operating characteristic curve [AUROC] = 0.758) and showed high diagnostic power when combined with IT sector macular GCIPL thickness (AUROC=0.954).

Conclusions

Sectoral macular SMD showed topographic correlations with macular GCIPL thickness and circumpapillary RNFL thickness in patients with GS and early-stage NTG. Macular SMD analysis is potentially useful in the clinical evaluation of early glaucoma.
Self-administration of injectable contraception: a systematic review and meta-analysis
Authors: Kennedy Caitlin E , Yeh Ping Teresa , Gaffield Mary Lyn , Brady Martha , Narasimhan Manjulaa
Published: April 2019

Introduction

Depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) may facilitate self-administration and expand contraceptive access. To inform WHO guidelines on self-care interventions, we conducted a systematic review and meta-analysis comparing self-administration versus provider administration of injectable contraception on outcomes of pregnancy, side effects/adverse events, contraceptive uptake, contraceptive continuation, self-efficacy/empowerment and social harms.

Methods

We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, LILACS and EMBASE in September 2018 for peer-reviewed studies comparing women who received injectable contraception with the option of self-administration with women who received provider-administered injectable contraception on at least one outcome of interest. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).

Results

Six studies with 3851 total participants met the inclusion criteria: three RCTs and three controlled cohort studies. All studies examined self-injection of DMPA-SC; comparison groups were either provider-administered DMPA-SC or provider-administered intramuscular DMPA. All studies followed women through 12 months of contraceptive coverage and measured (dis)continuation of injectable contraception. Meta-analysis found higher rates of continuation with self-administration compared with provider administration in three RCTs (RR: 1.27, 95% CI 1.16 to 1.39) and three controlled cohort studies (RR: 1.18, 95% CI 1.10 to 1.26). Four studies reported pregnancies; all showed no difference across study arms. Four studies reported side effects/adverse events; while two controlled cohort studies showed increased injection site reactions with self-administration, no other side effects increased with self-administration. One study found no difference in social harms. No studies reported measuring uptake or self-efficacy/empowerment.

Conclusion

A growing evidence base suggests that self-administration of DMPA-SC can equal or improve contraceptive continuation rates compared with provider administration. This benefit comes without notable increases in pregnancy or safety concerns. Self-injection of DMPA-SC is a promising approach to increasing contraceptive use.
Clinical characteristics and lipid lowering treatment of patients initiated on proprotein convertase subtilisin-kexin type 9 inhibitors: a nationwide cohort study
Authors: Jensen Jakob Solgaard , Weeke Peter Ejvin , Bang Lia Evi , Høfsten Dan Eik , Ripa Maria Sejersten , Schjerning Anne-Marie , Theilade Juliane Elizabeth , Køber Lars Valeur , Gislason Gunnar Hilmar , Pallisgaard Jannik
Published: April 2019

Objectives

Given the novelty of proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), little is known regarding overall implementation or clinical characteristics among patients who initiate treatment. We aimed to assess the total number of patients initiated on PCSK9i along with a description of the clinical characteristics and lipid lowering treatment (LLT) of such patients.

Setting

A register-based descriptive cohort study of patients receiving a PCSK9i in the time period from 01 January 2016 to 31 March 2017 using a cross linkage between three nationwide Danish registers. Information regarding PCSK9i prescriptions, patient demographics, concurrent pharmacotherapy, comorbidities and previous coronary procedures was identified.

Results

Overall, 137 patients initiated treatment with PCSK9i in the study period from 11 in the first quarter of 2016 to 40 in the first quarter of 2017. The majority had a history of ischaemic heart disease (IHD) (67.9%) with ischaemic stroke and diabetes mellitus being present in 7.3% and 16.8% of patients, respectively. All patients initiated on PCSK9i had been previously prescribed statin treatment with atorvastatin and simvastatin being most frequently prescribed in 53% and 36% of patients, respectively. The majority of patients had received both statins and ezetimibe (94.9%) and approximately half of these patients had also received bile acid sequestrant (45.3%). Clinical characteristics mainly differed in patients receiving triple LLT compared with patients not receiving triple LLT in the regards of heart failure.

Conclusion

Patients treated with PCSK9i were rare, characterised by having IHD and had received various and intensive conventional LLT prior to PCSK9i initiation in agreement with current international guidelines.
Female genital cutting in Malaysia: a mixed-methods study
Authors: Rashid Abdul , Iguchi Yufu
Published: April 2019

Objective

This study aimed to understand the reasons for the practice by the Muslim community, traditional practitioners and the views of religious scholars as well as the medicalisation trend of the practice of female genital cutting (FGC).

Design

This is a mixed-method (qualitative and quantitative) study. A questionnaire was created and used by three trained research assistants for the quantitative component of the study. The qualitative component of the study included in-depth interviews and focus group interviews.

Setting

This study was conducted in rural areas of two states in the Northern Peninsular Malaysia.

Participants

Due to the sensitive nature of the study, the study sample was chosen using a snowball sampling method. Two of the three Northern states Mufti’s approached consented to participate in the study.

Results

Quantitative: There were 605 participants, most had undergone FGC (99.3%), were in the opinion FGC is compulsory in Islam (87.6%) and wanted FGC to continue (99.3%). Older respondents had FGC conducted by traditional midwives (X2=59.13, p<0.001) and younger age groups preferred medical doctors (X2=32.96, p<0.001) and would permit doctors (X2=29.17, p<0.001) to conduct FGC on their children. These findings suggest a medicalisation trend. Regression analysis showed the odds of FGC conducted by traditional midwives and nurses and trained midwives compared with medical doctors was 1.07 (1.05; 1.09) and 1.04 (1.01; 1.06), respectively. For every 1-year decrease in age, the odds of participants deciding medical doctors should perform FGC as compared with traditional midwives increase by 1.61.

Qualitative: Focus group discussions showed most believed that FGC is compulsory in Islam but most traditional practitioners and the Mufti’s stated that FGC is not compulsory in Islam.

Conclusion

Almost everyone in the community believed FGC is compulsory in Islam and wanted the practice to continue, whereas the traditional practitioners and more importantly the Mufti’s, who are responsible in issuing religious edicts, say it is not a religious requirement.
Management of multiple sclerosis symptoms through reductions in sedentary behaviour: protocol for a feasibility study
Authors: Aminian Saeideh , Motl Robert W , Rowley Jacqueline , Manns Patricia, J
Published: April 2019

Introduction

People with multiple sclerosis (MS) are less physically active, and more sedentary than their peers despite evidence that activity helps to manage MS-related symptoms. Traditional approaches to increasing physical activity, such as exercise programmes, can be challenging for people with MS, especially those with walking disability. Focusing on decreasing prolonged sitting, and increasing light-intensity activities may be more feasible and result in more sustainable behaviour change in persons with MS. This paper describes the rationale and development of a sedentary behaviour intervention targeting persons with MS.

Methods and analysis

The feasibility and preliminary efficacy of a sedentary behaviour intervention will be tested using a prepost intervention design in 40 adults with MS. The 22-week programme includes a 15-week intervention and a 7-week follow-up. The intervention itself is divided into two stages: Sit-Less and Move-More. The Sit-Less stage is designed to encourage participants to break up prolonged sitting bouts, while the Move-More stage promotes increasing steps per day, in addition to interrupting sitting. The intervention is delivered through individual coaching sessions between an interventionist and a participant, and an accompanying newsletter based on social cognitive theory. A Fitbit is used to monitor activity throughout the programme. Process, resource and management metrics will be recorded (eg, retention, time required for communication during the trial). Sedentary and physical activities and MS-related symptoms are measured before and after the intervention and again during follow-up. Experiences with the programme are explored through an online survey and one-on-one interviews.

Ethics and dissemination

The Health Research Ethics Board at the University of Alberta granted permission to conduct this study. Results will be disseminated in scientific journals and conferences, and the MS Society of Alberta. Physical therapists and kinesiologists are important stakeholders and will be targeted during dissemination.

Trial registration number

NCT03136744.
Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis
Authors: McDermott Imelda , Checkland Kath , Moran Valerie , Warwick-Giles Lynsey
Published: April 2019

Objectives

Since April 2015, Clinical Commissioning Groups (CCGs) have taken on the responsibility to commission primary care services. The aim of this paper is to analyse how CCGs have responded to this new responsibility and to identify challenges and factors that facilitated or inhibited achievement of integrated care systems.

Design

We undertook an exploratory approach, combining data from interviews and national telephone surveys, with analysis of policy documents and case studies in four CCGs. Data were analysed using thematic content analysis.

Setting/participants

We reviewed 147 CCG application documents and conducted two national telephone surveys with CCGs (n=49 and n=21). We interviewed 6 senior policymakers and 42 CCG staff who were involved in primary care co-commissioning (general practitioners and managers). We observed 74 primary care commissioning committee meetings and their subgroups (approx. 111 hours).

Results

CCGs in our case studies focused their primary care commissioning activities on developing strategic plans, ‘new’ primary care initiatives, and dealing with legacy work. Many plans focused on incentivising and supporting practices to work together and provide a broad range of services. There was a clear focus on ensuring the sustainability of general practice. Our respondents expressed mixed views as to what new collaborative service models, such as the new models of care and sustainability and transformation partnerships (STPs), would mean for the future of primary care and the impact they could have on CCGs and their members.

Conclusions

There is a disconnect between locally based primary care and the wider system. One of the major challenges we identified is the lack of knowledge and expertise in the field of primary care at STP level. While primary care commissioning by CCGs seems to be supporting local collaborations between practices, there is some way to go before this is translated into broader integration initiatives across wider footprints.
Comparison of the Kane formula with existing formulas for intraocular lens power selection
Authors: Connell Benjamin J , Kane Jack X
Published: April 2019

Objective

To compare the accuracy of a new intraocular lens (IOL) power formula (Kane formula) with existing formulas using IOLMaster, predominantly model 3, biometry (measures variables axial length, keratometry and anterior chamber depth) and optimised lens constants. To compare the accuracy of three new or updated IOL power formulas (Kane, Hill-RBF V.2.0 and Holladay 2 with new axial length adjustment) compared with existing formulas (Olsen, Barrett Universal 2, Haigis, Holladay 1, Hoffer Q, SRK/T).

Methods and analysis

A single surgeon retrospective case review was performed from patients having uneventful cataract surgery with Acrysof IQ SN60WF IOL implantation over 11 years in a Melbourne private practice. Using optimised lens constants, the predicted refractive outcome for each formula was calculated for each patient. This was compared with the actual refractive outcome to give the prediction error. Eyes were separated into subgroups based on axial length as follows: short (≤22.0 mm), medium (>22.0 to <26.0 mm) and long (≥26.0 mm).

Results

The study included 846 patients. Over the entire axial length range, the Kane formula had the lowest mean absolute prediction error (p<0.001, all formulas). The mean postoperative difference from intended outcome for the Kane formula was −0.14+0.27×1 (95% LCL −1.52+0.93×43; 95% UCL +0.54+1.03×149). The formula demonstrated the lowest absolute error in the medium axial length range (p<0.001). In the short and long axial length groups, no formula demonstrated a significantly lower absolute mean prediction error.

Conclusion

Using three variables (AL, K, ACD), the Kane formula was a more accurate predictor of actual postoperative refraction than the other formulae under investigation. There were not enough eyes of short or long axial length to adequately power statistical comparisons within axial length subgroups.
Ageing population has changed the nature of major thoracic injury
Authors: Ferrah Noha , Cameron Peter , Gabbe Belinda , Fitzgerald Mark , Judson Rodney , Marasco Silvana , Kowalski Tanya , Beck Ben
Published: April 2019

Introduction

An increasing proportion of the major trauma population are older persons. The pattern of injury is different in this age group and serious chest injuries represent a significant subgroup, with implications for trauma system design. The aim of this study was to examine trends in thoracic injuries among major trauma patients in an inclusive trauma system.

Methods

This was a retrospective review of all adult cases of major trauma with thoracic injuries of Abbreviated Injury Scale score of 3 or more, using data from the Victorian State Trauma Registry from 2007 to 2016. Prevalence and pattern of thoracic injury was compared between patients with multitrauma and patients with isolated thoracic injury. Poisson regression was used to determine whether population-based incidence had changed over the study period.

Results

There were 8805 cases of hospitalised major trauma with serious thoracic injuries. Over a 10-year period, the population-adjusted incidence of thoracic injury increased by 8% per year (incidence rate ratio [IRR] 1.08, 95% CI 1.07 to 1.09). This trend was observed across all age groups and mechanisms of injury. The greatest increase in incidence of thoracic injuries, 14% per year, was observed in people aged 85 years and older (IRR 1.14, 95% CI 1.09 to 1.18).

Conclusions

Admissions for thoracic injuries in the major trauma population are increasing. Older patients are contributing to an increase in major thoracic trauma. This is likely to have important implications for trauma system design, as well as morbidity, mortality and use of healthcare resources.
Directed unions of local monoidal transforms and GCD domains
Authors: Guerrieri Lorenzo
Published: April 2019

Let [Formula: see text] be a regular local ring of dimension [Formula: see text]. A local monoidal transform of [Formula: see text] is a ring of the form [Formula: see text], where [Formula: see text] is a regular parameter, [Formula: see text] is a regular prime ideal of [Formula: see text] and [Formula: see text] is a maximal ideal of [Formula: see text] lying over [Formula: see text] In this paper, we study some features of the rings [Formula: see text] obtained as infinite directed union of iterated local monoidal transforms of [Formula: see text]. In order to study when these rings are GCD domains, we also provide results in the more general setting of directed unions of GCD domains.