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Mutations in the lipoyltransferase 1 (LIPT1) gene are rare inborn errors of metabolism leading to a fatal condition characterized by lipoylation defects of the 2-ketoacid dehydrogenase complexes causing early-onset seizures, psychomotor retardation, abnormal muscle tone, severe lactic acidosis, and increased urine lactate, ketoglutarate, and 2-oxoacid levels. In this article, we characterized the disease pathophysiology using fibroblasts and induced neurons derived from a patient bearing a compound heterozygous mutation in LIPT1. A Western blot analysis revealed a reduced expression of LIPT1 and absent expression of lipoylated pyruvate dehydrogenase E2 (PDH E2) and alpha-ketoglutarate dehydrogenase E2 (α-KGDH E2) subunits. Accordingly, activities of PDH and α-KGDH were markedly reduced, associated with cell bioenergetics failure, iron accumulation, and lipid peroxidation. In addition, using a pharmacological screening, we identified a cocktail of antioxidants and mitochondrial boosting agents consisting of pantothenate, nicotinamide, vitamin E, thiamine, biotin, and α-lipoic acid, which is capable of rescuing LIPT1 pathophysiology, increasing the LIPT1 expression and lipoylation of mitochondrial proteins, improving cell bioenergetics, and eliminating iron overload and lipid peroxidation. Furthermore, our data suggest that the beneficial effect of the treatment is mainly mediated by SIRT3 activation. In conclusion, we have identified a promising therapeutic approach for correcting LIPT1 mutations.
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Primary mitochondrial diseases result from mutations in nuclear DNA (nDNA) or mitochondrial DNA (mtDNA) genes, encoding proteins crucial for mitochondrial structure or function. Given that few disease-specific therapies are available for mitochondrial diseases, novel treatments to reverse mitochondrial dysfunction are necessary. In this work, we explored new therapeutic options in mitochondrial diseases using fibroblasts and induced neurons derived from patients with mutations in the GFM1 gene. This gene encodes the essential mitochondrial translation elongation factor G1 involved in mitochondrial protein synthesis. Due to the severe mitochondrial defect, mutant GFM1 fibroblasts cannot survive in galactose medium, making them an ideal screening model to test the effectiveness of pharmacological compounds. We found that the combination of polydatin and nicotinamide enabled the survival of mutant GFM1 fibroblasts in stress medium. We also demonstrated that polydatin and nicotinamide upregulated the mitochondrial Unfolded Protein Response (mtUPR), especially the SIRT3 pathway. Activation of mtUPR partially restored mitochondrial protein synthesis and expression, as well as improved cellular bioenergetics. Furthermore, we confirmed the positive effect of the treatment in GFM1 mutant induced neurons obtained by direct reprogramming from patient fibroblasts. Overall, we provide compelling evidence that mtUPR activation is a promising therapeutic strategy for GFM1 mutations.
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Fibroblastos , Glucósidos , Mitocondrias , Enfermedades Mitocondriales , Niacinamida , Estilbenos , Respuesta de Proteína Desplegada , Humanos , Fibroblastos/metabolismo , Fibroblastos/efectos de los fármacos , Glucósidos/farmacología , Mitocondrias/metabolismo , Mitocondrias/efectos de los fármacos , Enfermedades Mitocondriales/metabolismo , Enfermedades Mitocondriales/tratamiento farmacológico , Enfermedades Mitocondriales/genética , Proteínas Mitocondriales/metabolismo , Proteínas Mitocondriales/genética , Mutación , Neuronas/metabolismo , Neuronas/efectos de los fármacos , Niacinamida/farmacología , Fenotipo , Estilbenos/farmacología , Respuesta de Proteína Desplegada/efectos de los fármacos , Factor G de Elongación Peptídica/efectos de los fármacos , Factor G de Elongación Peptídica/genética , Factor G de Elongación Peptídica/metabolismoRESUMEN
Molecular diagnostic methods to detect and quantify viral RNA in clinical samples rely on the purification of the genetic material prior to reverse transcription polymerase chain reaction (qRT-PCR). Due to the large number of samples processed in clinical laboratories, automation has become a necessity in order to increase method processivity and maximize throughput per unit of time. An attractive option for isolating viral RNA is based on the magnetic solid phase separation procedure (MSPS) using magnetic microparticles. This method offers the advantage over other alternative methods of making it possible to automate the process. In this study, we report the results of the MSPS method based on magnetic microparticles obtained by a simple synthesis process, to purify RNA from oro- and nasopharyngeal swab samples of patients suspected of COVID-19 provided by three diagnostic laboratories located in the Buenos Aires Province, Argentina. Magnetite nanoparticles of Fe3O4 (MNPs) were synthesized by the coprecipitation method and then coated with silica (SiO2) produced by hydrolysis of tetraethyl orthosilicate (TEOS). After preliminary tests on samples from the A549 human lung cell line and swabs, an extraction protocol was developed. The quantity and purity of the RNA obtained were determined by gel electrophoresis, spectrophotometry, and qRT-PCR. Tests on samples from naso- and oropharyngeal swabs were performed in order to validate the method for RNA purification in high-throughput SARS-CoV-2 diagnosis by qRT-PCR. The method was compared to the spin columns method and the automated method using commercial magnetic particles. The results show that the method developed is efficient for RNA extraction from nasal and oropharyngeal swab samples, and also comparable to other extraction methods in terms of sensitivity for SARS-CoV-2 detection. Of note, this procedure and reagents developed locally were intended to overcome the shortage of imported diagnostic supplies as the sudden spread of COVID-19 required unexpected quantities of nucleic acid isolation and diagnostic kits worldwide.
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Background: During the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. Methods: Analytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results: 563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. Conclusion: The association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.
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Nemaline myopathy (NM) is one of the most common forms of congenital myopathy and it is identified by the presence of "nemaline bodies" (rods) in muscle fibers by histopathological examination. The most common forms of NM are caused by mutations in the Actin Alpha 1 (ACTA1) and Nebulin (NEB) genes. Clinical features include hypotonia and muscle weakness. Unfortunately, there is no curative treatment and the pathogenetic mechanisms remain unclear. In this manuscript, we examined the pathophysiological alterations in NM using dermal fibroblasts derived from patients with mutations in ACTA1 and NEB genes. Patients' fibroblasts were stained with rhodamine-phalloidin to analyze the polymerization of actin filaments by fluorescence microscopy. We found that patients' fibroblasts showed incorrect actin filament polymerization compared to control fibroblasts. Actin filament polymerization defects were associated with mitochondrial dysfunction. Furthermore, we identified two mitochondrial-boosting compounds, linoleic acid (LA) and L-carnitine (LCAR), that improved the formation of actin filaments in mutant fibroblasts and corrected mitochondrial bioenergetics. Our results indicate that cellular models can be useful to study the pathophysiological mechanisms involved in NM and to find new potential therapies. Furthermore, targeting mitochondrial dysfunction with LA and LCAR can revert the pathological alterations in NM cellular models.
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Mitochondria play a key role in cellular functions, including energy production and oxidative stress regulation. For this reason, maintaining mitochondrial homeostasis and proteostasis (homeostasis of the proteome) is essential for cellular health. Therefore, there are different mitochondrial quality control mechanisms, such as mitochondrial biogenesis, mitochondrial dynamics, mitochondrial-derived vesicles (MDVs), mitophagy, or mitochondrial unfolded protein response (mtUPR). The last item is a stress response that occurs when stress is present within mitochondria and, especially, when the accumulation of unfolded and misfolded proteins in the mitochondrial matrix surpasses the folding capacity of the mitochondrion. In response to this, molecular chaperones and proteases as well as the mitochondrial antioxidant system are activated to restore mitochondrial proteostasis and cellular function. In disease contexts, mtUPR modulation holds therapeutic potential by mitigating mitochondrial dysfunction. In particular, in the case of neurodegenerative diseases, such as primary mitochondrial diseases, Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), Amyotrophic Lateral Sclerosis (ALS), or Friedreich's Ataxia (FA), there is a wealth of evidence demonstrating that the modulation of mtUPR helps to reduce neurodegeneration and its associated symptoms in various cellular and animal models. These findings underscore mtUPR's role as a promising therapeutic target in combating these devastating disorders.
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Enfermedades Mitocondriales , Enfermedades Neurodegenerativas , Animales , Enfermedades Neurodegenerativas/metabolismo , Mitocondrias/metabolismo , Envejecimiento , Respuesta de Proteína DesplegadaRESUMEN
The term neurodegeneration with brain iron accumulation (NBIA) brings together a broad set of progressive and disabling neurological genetic disorders in which iron is deposited preferentially in certain areas of the brain. Among NBIA disorders, the most frequent subtype is pantothenate kinase-associated neurodegeneration (PKAN) caused by pathologic variants in the PANK2 gene codifying the enzyme pantothenate kinase 2 (PANK2). To date, there are no effective treatments to stop the progression of these diseases. This review discusses the utility of patient-derived cell models as a valuable tool for the identification of pharmacological or natural compounds for implementing polytarget precision medicine in PKAN. Recently, several studies have described that PKAN patient-derived fibroblasts present the main pathological features associated with the disease including intracellular iron overload. Interestingly, treatment of mutant cell cultures with various supplements such as pantothenate, pantethine, vitamin E, omega 3, α-lipoic acid L-carnitine or thiamine, improved all pathophysiological alterations in PKAN fibroblasts with residual expression of the PANK2 enzyme. The information provided by pharmacological screenings in patient-derived cellular models can help optimize therapeutic strategies in individual PKAN patients.
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BACKGROUND: Mental health data from Latin America and the Caribbean countries (LACC) national and international surveys are essential for public health surveillance. This review aimed to identify and describe available mental health survey data in LACC, providing access details for researchers. METHODS: Our study was a scoping review. The search for available mental health survey data was conducted in PubMed and through grey literature searches, and the search dates were between 26 August 2021 and 15 October 2021. Included survey data were/had (1) nationally representative, (2) the latest version available from 2012 onward, (3) collected in at least one LACC and (4) at least one mental health variable or related factor. We accepted all written languages, including Spanish and English. RESULTS: A total of 56 national and 13 international surveys were included, with data available on 95 mental health variables classified into 10 categories. Most national surveys were performed in upper-middle-income countries. Variables categorised as 'Substance use' and 'Violence' were the most frequent. Mexico and Colombia had the highest production in both the national and international surveys. The main target population was the adult population. However, there are several mental health topics and LACC yet unsurveyed. CONCLUSION: We identified a total of 69 representative surveys from LACCs since 2012. We categorised the available data on mental health variables into 10 categories, and provided technical details to facilitate the future selection and use of these surveys.
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Salud Mental , Adulto , Humanos , América Latina/epidemiología , México/epidemiología , Colombia/epidemiología , Región del Caribe/epidemiologíaRESUMEN
Given the role of E-cadherin (E-cad) in holding epithelial cells together, an inverse relationship between E-cad levels and cell invasion during the epithelial-mesenchymal transition and cancer metastasis has been well recognized. Here we report that E-cad is necessary for the invasiveness of RasV12-transformed intestinal epithelial cells in Drosophila. E-cad/ß-catenin disassembles at adherens junctions and assembles at invasive protrusions--the actin- and cortactin-rich invadopodium-like protrusions associated with the breach of the extracellular matrix (ECM)--during dissemination of RasV12-transformed intestinal epithelial cells. Loss of E-cad impairs the elongation of invasive protrusions and attenuates the ability of RasV12-transformed cells to compromise the ECM. Notably, E-cad and cortactin affect each other's localization to invasive protrusions. Given the essential roles of cortactin in cell invasion, our observations indicate that E-cad plays a role in the invasiveness of RasV12-transformed intestinal epithelial cells by controlling cortactin localization to invasive protrusions. Thus our study demonstrates that E-cad is a component of invasive protrusions and provides molecular insights into the unconventional role of E-cad in cell dissemination in vivo.
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Cadherinas , Cortactina , Animales , Cortactina/metabolismo , Cadherinas/metabolismo , Células Epiteliales/metabolismo , Actinas/metabolismo , Uniones Adherentes/metabolismo , Drosophila/metabolismoRESUMEN
In recent years, cities are experiencing changes in the ways of moving around, increasing the use of micromobility vehicles. Bicycles are the most widespread transport mode and, therefore, cyclists' behaviour, safety, and comfort have been widely studied. However, the use of other personal mobility vehicles is increasing, especially e-scooters, and related studies are scarce. This paper proposes a low-cost open-source data acquisition system to be installed on an e-scooter. This system is based on Raspberry Pi and allows collecting speed, acceleration, and position of the e-scooter, the lateral clearance during meeting and overtaking manoeuvres, and the vibrations experienced by the micromobility users when riding on a bike lane. The system has been evaluated and tested on a bike lane segment to ensure the accuracy and reliability of the collected data. As a result, the use of the proposed system allows highway engineers and urban mobility planners to analyse the behaviour, safety, and comfort of the users of e-scooters. Additionally, the system can be easily adapted to another micromobility vehicle and used to assess pavement condition and micromobility users' riding comfort on a cycling network when the budget is limited.
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Aceleración , Ciclismo , Reproducibilidad de los Resultados , Recolección de Datos , Accidentes de Tránsito/prevención & controlRESUMEN
BACKGROUND: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/f1000research.27150.2.
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BACKGROUND: The gut visceral musculature plays essential roles in not only moving substances through the lumen but also maintaining the function and physiology of the gut. Although the development of the visceral musculature has been studied in multiple model organisms, how it degenerates is poorly understood. RESULTS: Here, we employ the Drosophila midgut as a model to demonstrate that the visceral musculature is disrupted by intrinsic and extrinsic factors, such as aging, feeding, chemical-induced tissue damage, and oncogenic transformation in the epithelium. Notably, we define four prominent visceral musculature disruption phenotypes, which we refer as "sprout," "discontinuity," "furcation," and "crossover" of the longitudinal muscle. Given that the occurrence of these phenotypes is increased during aging and under various stresses, we propose that these phenotypes can be used as quantitative readouts of deterioration of the visceral musculature. Intriguingly, administration of a tissue-damaging chemical dextran sulfate sodium (DSS) induced similar visceral musculature disruption phenotypes in zebrafish larvae, indicating that ingestion of a tissue-damaging chemical can disrupt the visceral musculature in a vertebrate as well. CONCLUSIONS: Our study provides insights into the deterioration of the gut visceral musculature and lays a groundwork for investigating the underlying mechanisms in Drosophila as well as other animals.
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Proteínas de Drosophila , Pez Cebra , Animales , Drosophila/genética , Proteínas de Drosophila/genética , Endodermo , MúsculosRESUMEN
Mobility patterns and lifestyles have changed in recent years in cities worldwide, thanks to the strong rise in modes of travel commonly referred to as micromobility. In this context, e-scooters have experienced a great rise globally which has led to an increase of crashes involving this type of micromobility vehicle in urban areas. Thus, there is a need to study e-scooter users' behaviour and their interaction with cyclists. This research aimed at characterizing the meeting manoeuvre between micromobility users along diverse typologies of two-way bicycle track by using an instrumented e-scooter. As a result, bicycle tracks having concrete or vegetated curb presented lower clearance distance (≈0.8 m) than those without edge elements (>1 m), with no statistically significant differences found between the interaction with bicycles and e-scooters. Additionally, an online questionnaire was proposed to assess users' perceived risk during the meeting manoeuvre, concluding that micromobility users feel safer and more comfortable riding on pavements away from parked or moving motorized traffic, and on protected bicycle tracks.
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Accidentes de Tránsito , Viaje , Ciclismo , Ciudades , Estilo de Vida , Encuestas y CuestionariosRESUMEN
Diadromous fishes can exhibit interesting evolutionary and population-level patterns given their use of freshwater and marine environments as part of their life histories. The River goby genus Awaous are prominent members of riverine ichthyofaunas and occur throughout Atlantic and Pacific slopes of the Americas from the southern United States to Ecuador and Brazil. Here we study the widespread and polymorphic Awaous banana complex to assess phylogeographic patterns and test previous hypotheses that all populations of this species in the Americas belong to the same species. Analysis of sequence data based on the mitochondrial cytochrome oxidase I gene shows multiple clades within the Atlantic and Pacific basins, which correspond to previously described species. Additionally, haplotype analysis demonstrates unique and unconnected networks between these species. Within these clades we document biogeographic patterns that are congruent with results of other co-occurring diadromous species, as well as a novel biogeographic pattern for the region. Our results support the recognition of distinct species of Awaous in the Atlantic (A. banana and A. tajasica) and Pacific (A. transandeanus) basins. These results are concordant with previously established morphological characters permitting the separation of these species.
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Peces , Animales , ADN Mitocondrial/genética , Peces/genética , Variación Genética , Filogenia , Filogeografía , RíosRESUMEN
Dissemination of transformed cells is a key process in metastasis. Despite its importance, how transformed cells disseminate from an intact tissue and enter the circulation is poorly understood. Here, we use a fully developed tissue, Drosophila midgut, and describe the morphologically distinct steps and the cellular events occurring over the course of RasV12-transformed cell dissemination. Notably, RasV12-transformed cells formed the Actin- and Cortactin-rich invasive protrusions that were important for breaching the extracellular matrix (ECM) and visceral muscle. Furthermore, we uncovered the essential roles of the mechanosensory channel Piezo in orchestrating dissemination of RasV12-transformed cells. Collectively, our study establishes an in vivo model for studying how transformed cells migrate out from a complex tissue and provides unique insights into the roles of Piezo in invasive cell behavior.
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Proteínas de Drosophila/metabolismo , Canales Iónicos/metabolismo , Mecanotransducción Celular , Invasividad Neoplásica/patología , Proteínas ras/metabolismo , Animales , Membrana Basal/metabolismo , Membrana Basal/patología , Transformación Celular Neoplásica , Modelos Animales de Enfermedad , Drosophila , Proteínas de Drosophila/genética , Vesículas Extracelulares/metabolismo , Tracto Gastrointestinal/patología , Genes ras , Canales Iónicos/genética , Metástasis de la Neoplasia/patología , Podosomas/metabolismo , Proteínas ras/genéticaRESUMEN
Background: During the COVID-19 pandemic, it has been necessary to incorporate technologies in the care of mental health problems. But there have been difficulties in the application of technology-based interventions in mental health. Some quantitative systematic reviews don't allow us to fully identify and properly describe this subject. In order to answer the question "how do electronic interventions apply in mental health and what makes the application of any of these interventions work", this study will carry out an overview of systematic reviews, which will make it possible to develop a theoretical framework on the implementation of electronic care in mental health problems. Methods: We will search MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020, with no language restriction. We will follow a qualitative method approach and include systematic reviews that assess primary studies relating to adults with common mental health problems using any type of mobile mental health intervention that includes a synchronic component and communication with a mental health professional. For the analysis, we will make a meta-synthesis of the systematic reviews, using an emergent grounded theory approach to synthesize the information, prioritizing the systematic reviews with the lowest risk of bias in the AMSTAR-2 tool. The meta-synthesis will be based on interpreting, integrating, and inferring the evaluation elements to understand better the e-health implementation process for patients with mental health problems. Finally, we will present the overall assessment in a Summary of Qualitative Findings table. Conclusion: Our results will allow a better understanding of the facilitator and limitations in implementing e-health interventions for mental health problems.
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COVID-19 , Salud Mental , Adulto , Humanos , Metaanálisis como Asunto , Pandemias , SARS-CoV-2 , Revisiones Sistemáticas como AsuntoRESUMEN
BACKGROUND: Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program's effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks. METHODS: PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage. RESULTS: Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10). CONCLUSIONS: PASMO's strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.
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Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Prevención Primaria/organización & administración , Sexo Seguro/estadística & datos numéricos , Adolescente , Adulto , América Central/epidemiología , Condones/estadística & datos numéricos , Costa Rica/epidemiología , El Salvador/epidemiología , Guatemala/epidemiología , Infecciones por VIH/epidemiología , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Nicaragua/epidemiología , Evaluación de Programas y Proyectos de Salud , Conducta de Reducción del Riesgo , Parejas Sexuales/clasificación , Encuestas y CuestionariosRESUMEN
Es un anteproyecto de investigacion cuya finalidad e s valorar la eficacia de la implementacion de un protocolo para la prevencion de caidas de pacientes en un servicio de UTI, el mismo intentará a traves de un estudio pre-experimental, comprobar la eficacia del protocolo, mediante datos sobre caidas que estan registradas en el periodo mayo-octubre 2007, documentados en la institución,luego se aplicará el protocolo de prevención de caidas y finalmente se realizara una comparacion con los registros de caidas en el periodo mayo a octubre 2008 posteriores a la implementacion del protocolo.
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Humanos , Accidentes por Caídas/prevención & control , Prescripciones de MedicamentosRESUMEN
Es un anteproyecto de investigacion cuya finalidad e s valorar la eficacia de la implementacion de un protocolo para la prevencion de caidas de pacientes en un servicio de UTI, el mismo intentará a traves de un estudio pre-experimental, comprobar la eficacia del protocolo, mediante datos sobre caidas que estan registradas en el periodo mayo-octubre 2007, documentados en la institución,luego se aplicará el protocolo de prevención de caidas y finalmente se realizara una comparacion con los registros de caidas en el periodo mayo a octubre 2008 posteriores a la implementacion del protocolo.(AU)
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Humanos , Accidentes por Caídas/prevención & control , Prescripciones de MedicamentosRESUMEN
resumen está disponible en el texto completo
Abstract: Background Depression is a frequent condition in pregnancy, at least as frequent as it is among non-pregnant women. Studies on its prevalence show rates from 2% to 21% of major depression and 8% to 31% of depressive symptomatology. In Mexico, a prevalence of 22% has been estimated on the basis of a self-report scale. Risk factors for depression in pregnancy include previous history of depression, parental separation during childhood, single mother-hood, not wishing to be pregnant, lack of social support and low educational attainment. Objective Due to the consequences of depression on pregnancy and to the scarce studies available in Mexico, the aim of this study was to examine the presence of depression in pregnant women as well as the risk factors associated with the latter. Material and methods Three hundred pregnant women receiving ante-natal care were interviewed in the waiting rooms of three institutions (one third level hospital, a health center and a clinic specializing in women). The instrument included a scale of depression (CES-D) and the following risk factors: previous depression symptoms, parental separation before the age of 11, possible depression and problem-atic alcohol consumption in expectant motliers parents, unplanned pregnancy and lack of social support. Results A total of 30.7% of the interviewees showed significant depressive symptomatology (CES-D > 16). Fifty-nine percent mentioned having suffered from depressive symptomatology in the past. Some degree of disability in the past month was reported by 19% of those that mentioned depression symptoms. The mean number of days they stopped performing their everyday activities was 11.21 (SD = 10.68) with a range of 1 to 30 days. Seven women (21.2%) stated that they could not engage in their activities because of their depression every single day of the past month. As for suicidal ideation at any time in their lives, the following symptoms were displayed: half said that they had thought a great deal about death, a quarter said that they had wanted to die, nearly a fifth had intended to take their own life and 7.7% had injured themselves in order to take their own lives. During the previous month, the frequency of these behaviors had considerably declined, almost to zero, and only "thinking frequently about death" was common (18%). The variables associated with depression symptoms (CES-D) were: previous symptoms of depression (t = -4-40, p > 0.000), separation from the father before the age of 11 (t = -2.68; p > 0.008), possible depression in mother (t = -3.24, p > 0.001), possible depression in father (t = -2.41, p > 0.016), problematic alcohol consumption in father (t= -2.23, p > 0.040), unplanned pregnancy (t=-2.43, p>0-015), lack of emotional social support (t = 2.87, p > 0.005) and lack of practical social support (t = 2.94, p > 0.005). The evaluation of a risk model of these factors on depressive symptomatology through logistic regression (with the step-by-step method) showed that the following variables were significant: possible depression in the mother (of the expec-tant mother) which increases the risk of displaying depression in pregnancy 0.8 times, previous depressive symptomatology, which increases it 1.08 times, lack of practical social support, which increases it 1.71 times and not having a partner, which increases it 1.51 times. Discussion and conclusions The results, as regards mental health, showed that depressive symptoms occured in nearly a third of pregnant women; this percentage is higher than the 22% found in Mexico in previous studies. Although this symptomatology does not necessarily meet the criteria for major depression, it has been considered to be of sufficient clinical importance, as it has been associated with disability, psychiatric and physical co-morbidity; demand for treat-ment for and risk of future depression and in this case, with post-partum depression. A fifth of the subjects displayed more serious symptomatology in terms of disability, as the women mentioned not being able to engage in their everyday activities, working or studying. The mean number of days in which they were unable to carry out their activities was eleven during the previous month. This data suggests that this population with greater pathology should be detected and referred for specialized mental care by antenatal care services. Suicidal ideation during the previous month decreased considerably, in comparison with that reported at any time in theit lives, which agrees with reports that state that self-damaging behaviors and suicide attempts tend to be very low during pregnancy. As for pathological antecedents, 59% considered that they had suffered from depressive symptomatology in the past, in addition to having experienced suicidal ideation to varying degrees. It is significant that nearly 8% had previously attempted suicide. Both, previous depressive symptomatology and suicidal ideation in the past, were associated with current depression symptoms in the expectant mother, as has been reported in other countries. Unplanned pregnancy was also related to depression (CES-D). As literature suggests, not wishing to be pregnant is related to this disorder and although not planning a pregnancy is not synonymous with not wishing for it, according to these data, lack of planning also increases depressive symptoms. Among childhood situations, parental separation or loss of the father before the age of 11 was a significant variable as regards symptomatology in pregnancy; this was similar to what other authors have reported. Separation from the mother was not related to these symptoms, contrary to what other studies have reported in both pregnant and non-pregnant women. Adversity in childhood in the form of parents' mental pathology or substance use has been associated with depression among the general population. The results obtained here show a significant relationship between problematic alcohol consumption in the father and possible depression in the mother or father -as perceived by the interviewee herself- and depression symptoms in the expectant mother. During pregnancy and above all, post-partum, women have a real need to receive both emotional and practical support. This study, like others showed that the lack of this support increased the risk of depression. The construction of a model with some of these variables showed that being a single or divorced mother, having had a mother who may have been depressed, having displayed depressive symptoms in the past and the lack of practical support increased the risk of depressive symptomatology. By way of a conclusion, one can say that although there are similarities between depression in pregnancy and at other moments in women's lives, its presence during this period is particu-larly important due to the new demands the woman has to cope with and the adverse effects it has on the development of pregnancy, and the high risk of experiencing depression during the post-partum. Designing intervention programs for expectant mothers could have an enormous effect on improving the mental health of mothers and their babies, a reason why it is important to take into account the risk factors described in this study.