Search

Nowadays, most of the health expenditure is due to chronic patients who are readmitted several times for their pathologies. Personalized prevention strategies could be developed to improve the management of these patients. The aim of the present work was to develop local predictive models using interpretable machine learning techniques to early identify individual unscheduled hospital readmissions. To do this, a retrospective, case-control study, based on information regarding patient readmission in 2018–2019, was conducted. After curation of the initial dataset (n = 76,210), the final number of participants was n = 29,026. A machine learning analysis was performed following several algorithms using unscheduled hospital readmissions as dependent variable. Local model-agnostic interpretability methods were also performed. We observed a 13% rate of unscheduled hospital readmissions cases. There were statistically significant differences regarding age and days of stay (p < 0.001 in both cases). A logistic regression model revealed chronic therapy (odds ratio: 3.75), diabetes mellitus history (odds ratio: 1.14), and days of stay (odds ratio: 1.02) as relevant factors. Machine learning algorithms yielded better results regarding sensitivity and other metrics. Following, this procedure, days of stay and age were the most important factors to predict unscheduled hospital readmissions. Interestingly, other variables like allergies and adverse drug reaction antecedents were relevant. Individualized prediction models also revealed a high sensitivity. In conclusion, our study identified significant factors influencing unscheduled hospital readmissions, emphasizing the impact of age and length of stay. We introduced a personalized risk model for predicting hospital readmissions with notable accuracy. Future research should include more clinical variables to refine this model further.

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P

External validation is crucial in developing reliable machine learning models. This study aimed to validate three novel indices—Thermographic Joint Inflammation Score (ThermoJIS), Thermographic Disease Activity Index (ThermoDAI), and Thermographic Disease Activity Index-C-reactive protein (ThermoDAI-CRP)—based on hand thermography and machine learning to assess joint inflammation and disease activity in rheumatoid arthritis (RA) patients. A 12-week prospective observational study was conducted with 77 RA patients recruited from rheumatology departments of three hospitals. During routine care visits, indices were obtained at baseline and week 12 visits using a pre-trained machine learning model. The performance of these indices was assessed cross-sectionally and longitudinally using correlation coefficients, the area under the receiver operating curve (AUROC), sensitivity, specificity, and positive and negative predictive values. ThermoDAI and ThermoDAI-CRP correlated with CDAI, SDAI, and DAS28-CRP cross-sectionally (ρ = 0.81; ρ = 0.83; ρ = 0.78) and longitudinally (ρ = 0.55; ρ = 0.61; ρ = 0.60), all p < 0.001. ThermoDAI and ThermoDAI-CRP also outperformed Patient Global Assessment (PGA) and PGA + C-reactive protein (CRP) in detecting changes in 28-swollen joint counts (SJC28). ThermoJIS had an AUROC of 0.67 (95% CI, 0.58 to 0.76) for detecting patients with swollen joints and effectively identified patients transitioning from SJC28 > 1 at baseline visit to SJC28 ≤ 1 at week 12 visit. These results support the effectiveness of ThermoJIS in assessing joint inflammation, as well as ThermoDAI and ThermoDAI-CRP in evaluating disease activity in RA patients.

El hábito es una de las encrucijadas filosóficas en las que el dilema entre naturaleza y libertad se pone de manifiesto. El artículo expone la descripción que Paul Ricoeur ofrece sobre esta noción en Lo voluntario y lo involuntario (1950) y defiende que el hábito constituye una genuina y paradójica forma de libertad, pues ésta se realiza gracias y a través de la necesidad. Se tiene en consideración el difícil punto de partida de Ricoeur, quien, por una parte, rechaza lo que él denomina la explicación cosmológica de Tomás de Aquino y, por otra, acoge la novedad del cogito cartesiano, siendo a la vez consciente de las limitaciones dualistas que el planteamiento conlleva. Inspirándose en Ravaisson, Ricoeur rechaza una interpretación maquinal del hábito y se acerca a la idea clásica de segunda naturaleza. En el artículo se muestran los problemas de Ricoeur en el empleo de este término y se señalan los límites de la propuesta del autor, para quien, al final, no hay sistema entre lo natural y lo libre.

Abstract Background Evidence regarding the rate of relapse in people with bipolar disorder (BD), particularly from the UK, is lacking. This study aimed to evaluate the rate and associations of clinician-defined relapse over 5 years in a large sample of BD patients receiving routine care from a UK mental health service. Method We utilised de-identified electronic health records to sample people with BD at baseline. Relapse was defined as either hospitalisation, or a referral to acute mental health crisis services, between June 2014 and June 2019. We calculated the 5-year rate of relapse and examined the sociodemographic and clinical factors that were independently associated with relapse status and the number of relapses, over the 5-year period. Results Of 2649 patients diagnosed with BD and receiving care from secondary mental health services, 25.5% (n = 676) experienced at least one relapse over 5 years. Of the 676 people who relapsed, 60.9% experienced one relapse, with the remainder experiencing multiple relapses. 7.2% of the baseline sample had died during the 5-year follow-up. Significant factors associated with experiencing any relapse, after adjustment for relevant covariates, were history of self-harm/suicidality (OR 2.17, CI 1.15–4.10, p = 0.02), comorbidity (OR 2.59, CI 1.35–4.97, p = 0.004) and psychotic symptoms (OR 3.66, CI 1.89–7.08, p < 0.001). Factors associated with the number of relapses over 5 years, after adjustment for covariates, were self-harm/suicidality (β = 0.69, CI 0.21–1.17, p = 0.005), history of trauma (β = 0.51, CI = 0.07–0.95, p = 0.03), psychotic symptoms (β = 1.05, CI 0.55–1.56, p

Previous research has shown that language is an essential part of the development of mathematical skills and, specifically, in solving verbal problems. We know that using a different language from one’s mother tongue is highly beneficial for students, and that language plurality and bilingualism is more and more habitual and present in current educational environments. However, what is still not clear is how it influences certain tasks, especially the most naturalistic ones, such as the formation of the concept of numbers and in tasks with a greater verbal component, such as solving problems in the early ages. The present research examined the problem-solving performance of first- and second-grade elementary education students in bilingual environments, comparing the problem solving of students whose language of instruction (LI) is the same as their mother tongue (MT) and those whose MT differs from the LI. Through an analysis of variance, the results showed that there exist differences in change and combination problems. Discrepancies in performance were also found, depending on the evolutionary moment. These results suggest that it is necessary to study how the LI can shape mathematical skills in the early years.

Abstract Background Presently, physical inactivity is the main public health problem in many countries worldwide. Physical activity promotes the maintenance or improvement of one’s physical condition. Physical fitness has been established as the main biological marker of the state of health of an individual, and therefore, there is a clear need to measure health-related physical fitness through the use of a reliable and valid instrument. This study is a continuation of the transcultural adaptation process and a new proposal of the nursing outcome Physical Fitness (2004), found in the 5th Edition of the Nursing Outcomes Classification. The objective of this study was to examine the validity and reliability of the nursing outcome Health-Related Physical Fitness survey, proposed and transculturally adapted to the Spanish context. Methods An instrumental study to validate the nursing outcome Physical Fitness (2004), from the 5th Edition of the Nursing Outcome Classification was carried out. It took place between the months of May, 2016 to May, 2017. On the first stage, the instrument proposed Health-Related Physical Fitness survey was administered to 160 adults who used the Health Services of Murcia, Spain by three independent evaluators. After 4 weeks, it was administered again to 33 participants to calculate the intra-rater reliability. Lastly, the SF-12v2 Health Survey was administered to obtain external evidence of validity. Results The inter-rater reliability of the nursing outcome proposed obtained high values (between 0.91–0.99) in the evaluations performed by the three evaluators. As for the intra-rater reliability, high values were obtained (0.94–1), except for the item “balance”, which was moderate (0.56). Lastly, a positive and statistically significant correlation (p

Summary: Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials. Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74–15.53;

Objectives Remote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts.Methods ThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman’s correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP.Results Correlations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria.Conclusions ThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.

Abstract Background Patterns of development and underlying factors explaining anxiety disorders in children and adolescents are under‐researched, despite their high prevalence, impact and associations with other mental disorders. We aimed to a] understand the pattern and persistence of specific anxiety disorders; b] examine differing trajectories of symptoms of specific anxiety disorders and; c] examine socio‐demographic and health‐related predictors of persistent anxiety disorder‐specific symptoms, across middle childhood to early adolescence. Methods The current study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children birth cohort. The Development and Wellbeing Assessment questionnaire was administered to parents to capture child and adolescent anxiety total scores and DAWBA‐derived diagnoses. Separation anxiety, specific phobia, social anxiety, acute stress reaction, and generalized anxiety at 8, 10 and 13 years were selected. Further, we included the following socio‐demographic and health‐related predictors: sex, birth weight, sleep difficulties at 3.5 years, ethnicity, family adversity, maternal age at birth, maternal postnatal anxiety, maternal postnatal depression, maternal bonding, maternal socio‐economic status and maternal education. Results Different anxiety disorders presented different prevalence and patterns of development over time. Further, latent class growth analyses yielded a trajectory characterized by individuals with persistent high levels of anxiety across childhood and adolescence; for specific phobia (high = 5.8%; moderate = 20.5%; low = 73.6%), social anxiety (high = 3.4%; moderate = 12.1%; low = 84.5%), acute stress reaction (high = 1.9%; low = 98.1%) and generalized anxiety (high = 5.4%; moderate = 21.7%; low = 72.9%). Finally, the risk factors associated with each of the persistent high levels of anxiety disorders were child sleeping difficulties and postnatal maternal depression and anxiety. Conclusions Our findings show that a small group of children and young adolescents continue to suffer from frequent and severe anxiety. When considering treatment strategies for anxiety disorders in this group, children's sleep difficulties and postnatal maternal depression and anxiety need to be assessed as these may predict a more prolonged and severe course of illness.

Abstract Background Sleep difficulties are associated with impaired executive functions (EFs) in school-aged children. However, much less is known about how sleep during infancy relates to EF in infants and toddlers. The aim of this study was to investigate whether parent-reported sleep patterns at 6 and 12 months were associated with their inhibitory control (IC) and working memory (WM) performances at 30 months. Methods This study included children whose parents filled in a sleep questionnaire at 6 or 12 months and who participated in the development assessment at 30 months (initial available sample at 30 months; N = 472). The final sample comprised (a) 359 infants with IC task and sleep questionnaire at 6 months and 322 toddlers at 12 months and (b) 364 infants with WM task and sleep questionnaire at 6 months and 327 toddlers at 12 months. Nighttime, daytime and total sleep duration, frequency of night awakenings, time awake at night, and proportion of daytime sleep were assessed at 6 and 12 months using the Brief Infant Sleep Questionnaire. IC at 30 months was measured using a modified version of the Snack Delay task, and WM was measured at 30 months using the Spin the Pots task. Further, children were divided into three groups (i.e., “poor sleepers”, “intermediate sleepers”, and “good sleepers”) based on percentile cut-offs (i.e., 90th percentiles) to obtain a comprehensive understanding of the direction and nature of the associations between sleep and EF in early childhood. Results Our results showed an inverted U-shaped association between proportion of daytime sleep at 12 months and IC at 30 months, indicating that average proportions of daytime sleep were longitudinally associated with better IC performance. Furthermore, a linear relation between time awake at night at 12 months and WM at 30 months was found, with more time awake at night associating with worse WM. Conclusions Our findings support the hypothesis that sleep disruption in early childhood is associated with the development of later EF and suggest that various sleep difficulties at 12 months distinctively affect WM and IC in toddlers, possibly in a nonlinear manner.

Objectives Sensitive detection of joint inflammation in rheumatoid arthritis (RA) is crucial to the success of the treat-to-target strategy. In this study, we characterise a novel machine learning-based computational method to automatically assess joint inflammation in RA using thermography of the hands, a fast and non-invasive imaging technique.Methods We recruited 595 patients with arthritis and osteoarthritis, as well as healthy subjects at two hospitals over 4 years. Machine learning was used to assess joint inflammation from the thermal images of the hands using ultrasound as the reference standard, obtaining a Thermographic Joint Inflammation Score (ThermoJIS). The machine learning model was trained and tuned using data from 449 participants with different types of arthritis, osteoarthritis or without rheumatic disease (development set). The performance of the method was evaluated based on 146 patients with RA (validation set) using Spearman’s rank correlation coefficient, area under the receiver-operating curve (AUROC), average precision, sensitivity, specificity, positive and negative predictive value and F1-score.Results ThermoJIS correlated moderately with ultrasound scores (grey-scale synovial hypertrophy=0.49, p

Adolescent dating violence has become a public health problem because of the associated high morbidity and mortality rates. Despite social awareness about dating violence, the high justification of violence among adolescents is one of the main risk factors for both perpetration and victimisation. Therefore, the objective of the present work was to evaluate the effectiveness of an educational intervention in reducing the justification of violence in adolescent dating. A quasi-experimental, longitudinal, prospective study with a control group was conducted. The study was carried out in six different schools in the Region of Murcia (Spain), and the participants were 854 students aged 14–18 years. The educational intervention was focused on reducing the justification of adolescent dating violence and consisted of 9 weekly 1 h group sessions. The Justification of Verbal/Coercive Tactics Scale (JVCT) and the Attitudes About Aggression in Dating Situations (AADS) survey were administered at baseline and at the end of the intervention in order to determine the justification of psychological and physical violence, respectively. At baseline, the justification of physical violence was at a medium-to-high level in boys (76.8%) and girls (56.7%), whereas psychological violence was much less justified. Concretely, female psychological violence was justified by 19.5% boys and 16.7% girls, while male violence was justified by 19.0% boys and 17.8% girls. After the educational intervention, a significant decrease in physical violence justification, especially in the AADS dimension of female aggression, was observed. The effect of the intervention was especially evident in psychological violence justification: a statistically significant difference was observed in the JVCT scores of boys (−6.4 and 1.3 points in the intervention and control groups, respectively; p = 0.031), but not of girls (p = 0.594). In conclusion, the educational intervention was adequate to reduce the justification of dating violence among the participants. It may provide adolescents with the skills and resources necessary to confront and resolve conflicts in relationships in a non-violent manner.

Electrical Impedance Tomography design can be simplified to obtain a low cost 16 electrodes edema monitoring clinical instrument by using voltage measurement multiplexing. Multiplexers introduce errors, which we have estimated by consecutive phantom measurements both using voltage multiplexers and by selecting the electrodes by hand, all other things being the same. Noise is taken care of by averaging. The EIDORS reconstruction of the phantom with multiplexed measurements is compared to the hand-selected electrode measurements reconstruction. The difference image obtained is considered an estimation of the multiplexer induced error. This measurement error is subtracted from the multiplexed object measurement matrix, giving a modified reconstruction which is closer to the hand-selected electrodes measurement based reconstruction than the multiplexed reconstruction. The quality factor of the uncorrected multiplexer obtained image of 57% is increased to 83% which is the best increase of three methods described. This suggests the benefit of a “calibration” phase for all 16 electrodes, prior to EIT reconstruction, using a set-up-specific “error matrix” to correct the data matrix before submission to the reconstruction method.

As in adults, childhood obesity is associated with several metabolic disorders; however, there is little information regarding complex obesity-derived complications such as hepatic steatosis or endothelial dysfunction at early ages. Therefore, the objective of the present study was to analyze the effect of a nutritional and physical exercise program on obesity comorbidities in the form of subclinical atherosclerosis and non-alcoholic fatty liver in young children. A total of 148 children completed the study. For nine months (one academic year), children carried out a nutritional and physical activity program of 3 h/week. Anthropometric, clinical, liver ultrasound and carotid intima-media thickness (cIMT) parameters were evaluated. Our results showed that the program significantly improved anthropometrical parameters, especially regarding BMI and body fat (p < 0.001 and p = 0.004, respectively). The effect on metabolic parameters was limited, although a significant reduction on triglycerides was observed (p = 0.009). The education program had a great influence on the echogenic parameters, since the percentage of children with light steatosis decreased from 35% to 4% at the end of the study. In addition, cIMT also decreased significantly in both groups, although there was no statistically significant differences between groups. In conclusion, detection of early complications of obesity through sonographic parameters may allow early intervention, as in the present study, to prevent obesity co-morbidities in children.

The present research study focuses on how the language of instruction has an impact on the mathematical thinking development as a consequence of using a language of instruction different from the students’ mother tongue. In CLIL (Content and Language Integrated Learning) academic content and a foreign language are leant at the same time, a methodology that is widely used in the schools in the present times. It is, therefore, our main aim to study if the language of instruction in second language immersion programs influences the development of the first formal mathematical concepts. More specifically, if the learning of mathematical concepts in the early ages develops in a similar way if it is taught in the students’ mother tongue and is not influenced by the language used for teaching. Or else, if it can influence the development of the first skills only in the students’ general performance or in certain areas. The results of both the analysis of variance and multiple regression confirm how influencing the language of instruction is when mathematical thinking is developed teaching formal contents in a non-coincidence language. The second language is affecting the resolution of daily life problems, being more competent those students in 1st grades whose language of instruction matched with their mother tongue.

Teaching mathematics and improving mathematics competence are pending subjects within our educational system. The PEIM (Programa Evolutivo Instruccional para Matemáticas), a constructivist intervention program for the improvement of mathematical performance, affects the different agents involved in math learning, guaranteeing a significant improvement in students’ performance. The program is based on the following pillars: (a) students become the main agents of their learning by constructing their own knowledge; (b) the teacher must be the guide to facilitate and guarantee such a construction by being a great connoisseur of the fundamental aspects of the development of the child’s mathematical thinking; (c) the mathematical contents must be sequenced in terms of the complexity and significance for the student as well as contextualized at all times; and (d) the classroom must have a constructivist climate highlighting cooperative work among students. The implementation of PEIM along with the empirical evaluation conducted in several centers in Madrid and Zaragoza (Spain) confirm how students improve their mathematical competence. Both first- and second-grade students in elementary education were far more effective in solving problems, highlighting the use of more advanced strategies in their resolution and a lower incidence of conceptual errors. Moreover, it was possible to verify how the students proving greater difficulty, experienced an evolution in learning similarly to those who did not present it. The program provides customized education to allow the teacher to know at all times how he should be more influential on the students’ learning through mathematical profiles. Both teaching practice and teachers were observed, being that of the experimental group more prone to analyzing processes and allowing the construction of knowledge by students, due to their psycho-developmental training. As a result, we found several improvements through the implementation of the program that may serve, for upcoming years, as a basis for the necessary changes in the teaching of mathematics.

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878–0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

Background The concurrence of sleep and socio-emotional development in children is well accepted. However, the predictive role of sleep problems in infancy and the development of emotional and behavioural problems later in childhood remain still unclear. Therefore, in this study we examined the associations between sleep problems in early childhood and internalising, externalising and dysregulation symptoms in toddlers.Methods 1679 families entered the study during pregnancy and 936 children participated at 24 months. Parent-reported sleep duration, sleep-onset latency, night wakings, proportion of daytime sleep and bedtime at 3, 8, 18 and 24 months were assessed with two sleep questionnaires. Externalising, internalising and dysregulation problems at 24 months were examined with the Brief Infant-Toddler Social and Emotional Assessment.Results Short sleep duration at 3 and 8 months, more night wakings at 3, 8, 18 and 24 months and greater proportion of daytime sleep at 24 months were associated with internalising symptoms. Shorter sleep duration at 8, 18 and 24 months and longer sleep-onset latency and more night wakings at all time points, in addition to earlier bedtime at 8 months and greater proportion of daytime sleep at 24 months, were related to dysregulation. Finally, more night wakings at 3 and 24 months, and longer sleep-onset latency at 24 months were associated with externalising problems.Conclusion Shorter sleep and poorer sleep quality in infancy were prospectively related to emotional and behavioural symptoms in toddlers, and these associations were strongest for internalising and dysregulation symptoms. This study contributes to the recent research on the role of early sleep problems in socio-emotional development, suggesting that shorter sleep duration, longer sleep-onset latency and higher waking frequency are related to internalising, externalising and dysregulation symptoms in toddlers, and thus it might be beneficial to provide early interventions for those infants reporting these sleep problems.

Abstract Background Escherichia coli sequence type 131 (ST131) is a successful clonal group that has dramatically spread during the last decades and is considered an important driver for the rapid increase of quinolone resistance in E. coli. Methods Risk factors for rectal colonization by ST131 Escherichia coli (irrespective of ESBL production) were investigated in 64 household members (18 were colonized) and 54 hospital contacts (HC; 10 colonized) of 34 and 30 index patients with community and nosocomial infection due to these organisms, respectively, using multilevel analysis with a p limit of

The quantitative dynamic monitoring of the performance of hamstring muscles during rehabilitation and training cannot currently be undertaken using elastic resistance bands. Hip extension with a fully extended knee involves hamstring agonists, while knee flexion involves only the hamstring. The purpose of this study is to provide normative values of torque, velocity and power involving hamstring muscles opposing elastic bands. Twenty amateur athletes aged 25.7 ± 4.9, were studied during two motor tasks—hip extension and knee flexion, both isometric & dynamic—with an elastic resistance band and DINABANG portable instrument. We compared the peak isometric torque in hip extension with agonists (2.93 Nm/kg) and without them (1.21 Nm/kg): the difference is significant. The peak angular limb velocity—starting at 50% of the maximum torque—is smaller in hip extension with agonists (215.96°/s) than in a knee flexion without them (452.56°/s). The combination of peak torque and peak velocity estimates power and there is no difference (p = 0.051) with and without agonists: 452.56°Nm/s.kg without agonists and 542.13°Nm/s.kg with them. This study opens the possibility of monitoring torque–velocity–power profiles for hamstring exercise in open chain.

Abstract Fluctuations with power-law scaling and long-range temporal correlations (LRTCs) are characteristic to human psychophysical performance. Systems operating in a critical state exhibit such LRTCs, but phenomenologically similar fluctuations and LRTCs may also be caused by slow decay of the system’s memory without the system being critical. Theoretically, criticality endows the system with the greatest representational capacity and flexibility in state transitions. Without criticality, however, slowly decaying system memory would predict inflexibility. We addressed these contrasting predictions of the ‘criticality’ and ‘long-memory’ candidate mechanisms of human behavioral LRTCs by using a Go/NoGo task wherein the commission errors constitute a measure of cognitive flexibility. Response time (RT) fluctuations in this task exhibited power-law frequency scaling, autocorrelations, and LRTCs. We show here that the LRTC scaling exponents, quantifying the strength of long-range correlations, were negatively correlated with the commission error rates. Strong LRTCs hence parallel optimal cognitive flexibility and, in line with the criticality hypothesis, indicate a functionally advantageous state. This conclusion was corroborated by a positive correlation between the LRTC scaling exponents and executive functions measured with the Rey-Osterrieth Complex Figure test. Our results hence support the notion that LRTCs arise from critical dynamics that is functionally significant for human cognitive performance.

This article analyzes the rhetorical strategies involved in the spread of texts created in a digital context. The Internet has initiated a new communicative environment which seeks to shape the contents and circumstances of dissemination of online news and electronic literature. The digital medium affects journalism and literature with a series of rhetorical strategies aimed at persuading the audience to double click (automated interactions, clickbait, trending). These rhetorical strategies are not accepted as valid in conventional media and publishing, however they promote rapid dissemination of digital news, as well as reconfi gure the existing relationships between authors and readers in literary works. Our aim is to explain how the dissemination of these texts can be understood from a rhetorical viewpoint, no matter how much the spread of fake news or the radical change in the electronic literary works can be criticized. We point to the consequences of a communicative context that prioritizes immediacy, anonymity and content democratization. Analyzing selected examples from the Spanish (social) media context will demonstrate how double-click rhetoric relates to fictionalization and backgrounding of ethos.

The main aim of the present study is to analyze the differences that may exist when students address the resolution of verbal problems in their mother tongue and in the language of instruction when these are different. We understand that knowing the type of verbal problems and their semantic structure can be helpful for students’ contextual and mathematical understanding and will allow teachers to improve instruction during the first years of elementary education in bilingual schools specialized in the area of second language acquisition as well as in CLIL (Content and Language Integrated Learning). This study shows how children, as they are acquiring a greater command of the second language, show similar effectiveness to those students who work on mathematics in their mother tongue. This transversal study was conducted on 169 bilinguals studying in international schools. The sample was made up of 80 1st grade students (39 girls, mean age of 7.1 years and 41 boys, mean age of 7.3 years); and 89 2nd grade students (38 girls, mean age 8.2 years, and 51 boys, mean age 8.2 years). The exploratory analyses let us show how 1st grade students demonstrate lower effectiveness in solving problems when they do it in a second language, compared to 2nd grade students whose effectiveness is higher in carrying them out. It is also relevant that in first graders, the largest number of errors are found in the simplest tasks as students’ effectiveness is less when they are taught in a second language, since it takes them longer to create effective resolution models. This fact will allow us to reconsider appropriate strategies and interventions when teaching mathematics in bilingual contexts.

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.

In rivers and other freshwater bodies, the presence of mercury can be due to direct contamination by anthropic activities such as gold mining. However, it can also be attributed to atmospheric deposition and erosion, runoff, or lixiviation from surrounding soils. In the case of the Amazon rainforest, high mercury contents have been reported for litter and topsoil, which could affect the mercury concentrations in water bodies. Samples of suspended particulate matter were obtained from a transect of the Itenez River, associated lakes, and some of its tributaries. The aim was to obtain information on particulate mercury’s origin in the study area and determine the relationship between particulate mercury and particulate organic carbon. The concentration of mercury, organic matter, and the C:N ratio of the suspended matter was determined. The concentration of particulate mercury by water volume depended on changes in suspended matter loads, which in turn were mostly affected by the nature of the watershed or sediment resuspension. The observed values for the percentage of organic matter and the C:N ratio suggest that most of the mercury content in rivers and lakes originated from soils. A positive correlation was found between mercury concentration by weight of particulate matter and organic carbon content in particles. This correlation might be due to the direct binding of mercury to organic matter through functional groups like thiols or to an indirect effect of oxyhydroxides that can adsorb mercury and are associated with organic matter.

Objectives: to determine how the immigration phenomenon influences the response to informal care in the domestic level through the caregiver activity, and to analyze the cultural dialogue established in the residential area of Murcia (Spain).Method: This is an ethnographic study, conducted in 26 informal immigrant caregivers. As data collection instruments, semi-structured interviews and participant observation were employed. MAXQDA-2 assisted content analysis was also applied.Results: the immigrant caregiver is the main consumer of traditional medicines, extending these health practices to her home group. A cultural dialogue is established on informal care, characterized by interculturalism and mutual adaptation.Conclusions: cultural hybridization was identified for informal caregivers, immigrants and cultural integration: new health care practices and cultural behaviors in informal systems. There is a transformation in the roles of family members attended in domestic environments, increasing quality of life and self care. They represent an alternative to medicalization, promoting self-management of health.

Doi: 10.5902/2179769210713 Aims: evaluate the perception of help from students of the 2nd year of Nursing at Catholic University of Murcia concerning “Nanda.es Tool” for carrying out care plans. Methods: Descriptive, transverse study involving 109 nursing students in the second year, the data were analyzed with SPSS software, version 19.Results: 73.4 % of students believe the tool helps a lot or very much, 87.5% and 90.3 % responded that the web tool supports them for better methodological understanding of nursing; 33% believe that the difficulty in making a care plan is not difficult or a little difficult; 88.9% would recommend it to nurses, and 91.7 % would recommend it to nursing students. Conclusions: This web tool is a good ally for nursing diagnoses and care plans, with good accuracy and time improvement.

Today oil and gas exploration has integrated to the geology and geophysics studies, new technologiesas data from remote sensing that helps to detect interesting aspects for research. Cuban southernpetroleum province has a low exploration level. The study area includes Ana María Gulf and the deepwaters sector between Bahia de Cochinos and Cabo Cruz (batimetry over 200m). In 2010, usingGoogle Earth non professional system was taken and image of the study area and were detectedtwelve (12) anomalies associated to seabed, they look like depressions, their shape is almost circularand they have a big size (higher than 2000 m), these anomalies could be similar to pockmarks,that are depressions in seabed mainly circulars with a range of diameters from units of meters to10 – 12 km, and they have been found in shallow and deep waters in any latitude. The majority ofpockmarks are associated to the presence of oil, gas and hydrates of gas. The seabed study withdifferent nontraditional methods can be useful for hydrocarbon exploration in offshore Southern Cuba.

Objetivo: Evaluar el efecto de una intervención educativa específica sobre el control del asma y la calidad de vida. Diseño: Ensayo clínico con asignación aleatoria de pacientes asmáticos, a un grupo de intervención educativa (GI) y otro de control (GC). Se midió el nivel de control del asma y de calidad de vida, al inicio y trimestralmente durante un año. El cegamiento solo fue posible en la recogida y análisis de datos. Emplazamiento: Dos centros de atención primaria urbanos. Participantes: Se incluyeron 163 asmáticos, de 18 a 55 años, asignados aleatoriamente 84 al GI y 79 al GC. Finalizaron el seguimiento 104 (GI: 55; GC: 49). Intervención: GI: Tres sesiones educativas, grupales, impartidas por médicos de familia. pimera al inicio de la primavera, segunda a los 15 días, y tercera, de refuerzo, a los 6 meses. GC: asistencia habitual. Mediciones principales: Nivel de control del asma y de calidad de vida mediante el Asthma Control Test (ACT) y el Asthma Quality of life Questionnaire (AQLQ). Resultados: Al tercer mes, hubo diferencia significativa en el porcentaje de pacientes con buen control (p = 0,002), 75% en el GI y 48,5% en el GC, RR = 1,6 [1,2 a 2,1], NNT = 3,8 [2,4 a 9,4] y una mejoría con respecto al inicio en los niveles de calidad de vida (p = 0,005); RR = 2,3 [1,3 a 4,1], NNT = 4,3 [2,6 a 12,4]. Sin diferencias en los trimestres restantes. Conclusiones: Estos talleres son efectivos para mejorar el control y la calidad de vida a corto plazo, lo que nos puede orientar en la elección del momento más adecuado para realizarlos.

Osteoarthritis (OA) affects 240 million people globally. Few studies have examined the links between osteoarthritis and the Mediterranean diet (MD). The aim of this paper was to systematically review and analyze the epidemiological evidence in humans on the MD and its association with OA. A systematic search of EMBASE identified three studies that explored the association between MD and OA. Two of them were cross-sectional and the third one was a 16-week randomized clinical trial. Prisma declaration was followed to carry out this review. These studies described a positive association between a higher adherence to a MD and the quality of life of participants suffering OA. The prevalence of OA was lower in participants with a higher adherence to a Mediterranean diet. Biomarkers of inflammation and cartilage degradation related to OA were also analyzed and significant differences were detected only for IL1-α, which decreased in the MD group. Exploring the relationship between MD and OA is complex, moreover, the limited evidence and methodological differences in such studies makes it difficult to compare results. In conclusion, the three studies included in this systematic review demonstrated some relation between osteoarthritis and a Mediterranean diet. However, prospective and longer interventions are required to evaluate the long-term efficacy of the Mediterranean diet to improve symptomatology and preventing osteoarthritis.

La elevada frecuencia de ansiedad y depresión en estudiantes universitarios está relacionada con factores sociales, familiares y por el estrés académico. El objetivo es analizar la prevalencia de trastornos de ansiedad y depresión y factores académicos y sociofamiliares asociados. El estudio se realizó en una muestra de 700 alumnos, aplicando la Escala de Ansiedad y Depresión de Goldberg (EADG). Como factores de estudio se utilizaron variables que medían diversas situaciones estresantes relacionadas con factores sociofamiliares y académicos. El 47,1% de los estudiantes sufrían trastornos de ansiedad y el 55,6% depresión. En el análisis multivariante, el sexo femenino son quienes presentan mayor riesgo de ansiedad (OR: 2,30 IC 955 1,65-3,19) y de depresión (OR.: 1,98 IC 95% 1,43 -2,76), son estudiantes que realizan largos desplazamientos diarios y tienen otras obligaciones extra académicas, suponiendo mayor riesgo en estudiantes de ciencias jurídicas y de la empresa.

Fundamento: La elevada frecuencia de ansiedad y depresión en estudiantes universitarios está relacionada con factores sociales, familiares y con el estrés académico. El objetivo de este estudio ha sido determinar la consistencia interna y la validez de un cuestionario de situaciones socio familiares y académicas que pueden estar relacionadas con situaciones psicopatológicas en estudiantes universitarios Método: El estudio se realizó en la Universidad Católica San Antonio de Murcia, en una muestra de 700 alumnos a los que se les administró un cuestionario de elaboración propia, que contenía ítems que valoraban aspectos académicos y socio familiares. Como factores de estudio independientes se utilizaron variables que medían diversas situaciones estresantes de los estudiantes y la escala de ansiedad y depresión de Goldberg, todo con el fin de medir la validez del cuestionario. Resultados: La fiabilidad del cuestionario quedó demostrada al obtener en el test-retest un coeficiente de correlación intraclase de 0,819. El cuestionario original de 19 ítems quedó reducido a 15 tras el análisis de homogeneidad, obteniendo un alfa de Cronbach de 0,758. La validez de constructo se evaluó con el análisis factorial del cuestionario, resultando dos factores que representaban a aspectos académicos y aspectos sociofamiliares. Los estudiantes con el test de ansiedad y depresión positivo eran los que más puntuación obtuvieron en el cuestionario global y en los dos factores, quedando demostrada la validez de criterio Conclusiones: El cuestionario del estudio es una herramienta de valoración, de fácil uso y de ágil aplicación para la detección precoz de ansiedad y depresión en estudiantes universitarios

Con el objetivo de evaluar la calidad del diagnóstico coproparasitológico de los geohelmintos intestinales, se realizó un control de la calidad externo activo en la provincia de Las Tunas, de abril a junio de 2012. Se evaluaron las habilidades de 22 profesionales de la Atención Primaria de Salud, para realizar el procedimiento de Kato Katz, la identificación parasitaria e informe de resultados y se les midió el nivel de conocimientos sobre aspectos de interés del diagnóstico de estos gusanos. Se realizaron evaluaciones cualitativas de cada parámetro y se estableció un esquema general de calificación. Las principales deficiencias se presentaron en el informe de resultados, específicamente en la identificación de las especies antropozoonóticas (72,7% evaluados de regular), mientras que la mayoría tuvo resultados favorables en la realización de Kato Katz (54,5% excelente y 27,2% bien) y en el nivel de conocimientos (13,6% excelente y 54,5% bien).

N/A