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INTRODUCTION: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting ß2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.
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Asma , Cumplimiento de la Medicación , Humanos , Asma/tratamiento farmacológico , Estudios Transversales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cumplimiento de la Medicación/estadística & datos numéricos , Filipinas , Médicos/psicología , Costo de Enfermedad , China , Australia , Canadá , México , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Brasil , Argentina , Factores de Edad , Antiasmáticos/uso terapéutico , Pautas de la Práctica en Medicina , Francia , Encuestas y Cuestionarios , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , ItaliaRESUMEN
BACKGROUND: Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS: In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS: We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION: An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER: Open Science Framework ( https://osf.io/tqmz2/ ).
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Investigación Biomédica , Dolor Musculoesquelético , Telemedicina , Humanos , Masculino , Femenino , Consenso , Técnica Delphi , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/terapiaRESUMEN
Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America. Clinical trial registration: https://clinicaltrials.gov/, NCT05453370.
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Purpose: To understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and methods: A retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15-20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal results: There was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n = 149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major conclusions: Conducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.
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Contact zones provide important insights into the evolutionary processes that underlie lineage divergence and speciation. Here, we use a contact zone to ascertain speciation potential in the red-eyed treefrog (Agalychnis callidryas), a brightly coloured and polymorphic frog that exhibits unusually high levels of intraspecific variation. Populations of A. callidryas differ in a number of traits, several of which are known sexual signals that mediate premating reproductive isolation in allopatric populations. Along the Caribbean coast of Costa Rica, a ~100 km contact zone, situated between two phenotypically and genetically divergent parent populations, contains multiple colour pattern phenotypes and late-generation hybrids. This contact zone provides the opportunity to examine processes that are important in the earliest stages of lineage divergence. We performed analyses of colour pattern variation in five contact zone sites and six parental sites and found complex, continuous colour variation along the contact zone. We found discordance between the geographic distribution of colour pattern and previously described genomic population structure. We then used a parental site and contact zone site to measure assortative mating and directional selection from naturally-occurring amplectant mating pairs. We found assortative mating in a parental population, but no assortative mating in the contact zone. Furthermore, we uncovered evidence of directional preference towards the adjacent parental phenotype in the contact zone population, but no directional preference in the parent population. Combined, these data provide insights into potential dynamics at the contact zone borders and indicate that incipient speciation between parent populations will be slowed.
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Preferencia en el Apareamiento Animal , Anuros , Animales , Costa Rica , Región del Caribe , Aislamiento ReproductivoRESUMEN
Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.
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Desnutrición , Niño , Humanos , Lactante , Preescolar , Recién Nacido , Estudios de Factibilidad , Guatemala , Proyectos Piloto , Desnutrición/diagnóstico , DietaRESUMEN
Families and youth from the Northern Triangle of Central America seeking asylum in the U.S. report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ + refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.
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Refugiados , Trastornos por Estrés Postraumático , Adolescente , Humanos , Refugiados/psicología , Salud Mental , México , Trastornos por Estrés Postraumático/terapia , Trastornos por Estrés Postraumático/psicología , Hispánicos o LatinosRESUMEN
The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.
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COVID-19 , Telerrehabilitación , Brasil , Brotes de Enfermedades , Humanos , Modalidades de FisioterapiaRESUMEN
OBJECTIVE: This scoping review aims to identify and understand the different tools and methods used in studies in the field of human eating behavior to assess, measure, or classify participants' ambivalence toward food and diet, as well as to identify which tools and methods are most frequently employed. INTRODUCTION: People's attitudes toward food and eating behaviors are often ambivalent (simultaneously positive and negative), making it harder to change eating behaviors in favor of a healthier diet. This highlights the importance of resolving diet-related ambivalence. Identifying and understanding the different methods used in the literature to assess attitudinal ambivalence toward food and diet will provide researchers with a range of options to choose from for future studies. INCLUSION CRITERIA: We will include peer-reviewed studies as well as preprints that assess the ambivalence of human participants toward food and diet, regardless of sex, age, or other sociodemographic factors. We will exclude studies in which the methods used to assess ambivalence are not detailed or cannot be reproduced, as well as studies that assess the ambivalence of participants toward farming and agricultural methods or toward methods of food production and preparation. METHODS: This review will follow the JBI methodology for scoping reviews. Peer-reviewed studies will be retrieved from MEDLINE, PsycINFO, Web of Science, Food Science Source, FSTA, and CINAHL, while preprints will be retrieved from PsyArXiv and MedArXiv. Two independent reviewers will screen the articles. All relevant extracted information will be presented as tables and a descriptive summary of the findings.
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Dieta Saludable , Dieta , Afecto , Conducta Alimentaria , Alimentos , Humanos , Literatura de Revisión como AsuntoRESUMEN
OBJECTIVE: We sought to examine a community engagement (CE) strategy, defined as a monetary contribution, on water filter usage DESIGN: A natural, quasi-experimental study was conducted in Guatemala following the distribution of water filters. Households in the 2014-2015 group (free water filter) were compared with households in the 2018-2019 group (CE strategy: US$5.50 for water filter) SAMPLE: One-year post-distribution, the comparison group (n = 56) and intervention group (n = 38) completed a survey on family health and water filter use RESULTS: Households in the CE group had almost five times higher odds (OR = 4.7, p = .022) of having a working water filter 1 year later. Using a multivariable logistic regression model, the single best predictor to explain working water filters was the CE strategy CONCLUSIONS: CE strategies that support ownership and dignity might sustain public health initiatives, in conjunction with collaborative international partnerships. Future research could include linking villages with local and international organizations that support safe drinking water initiatives.
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Agua Potable , Composición Familiar , Filtración , Guatemala , HumanosRESUMEN
Background: COVID-19 has caused a global public health emergency. Government mitigation strategies included a series of behavior-based prevention policies that had a likely impact on the spread of other contagious respiratory illnesses, such as seasonal influenza. Our aim was to explore how 2019-2020 influenza tracked onto COVID-19 pandemic and its mitigation methods. Materials and Methods: We linked the WHO FluNet database and COVID-19 confirmed cases (Johns Hopkins University) for four countries across the northern (Canada, the United States) and southern hemispheres (Australia, Brazil) for the period 2016-2020. Graphical presentations of longitudinal data were provided. Results: There was a notable reduction in influenza cases for the 2019-2020 season. Northern hemisphere countries experienced a quicker ending to the 2019-2020 seasonal influenza cases (shortened by 4-7 weeks) and virtually no 2020 fall influenza season. Countries from the southern hemisphere experienced drastically low levels of seasonal influenza, with consistent trends that were approaching zero cases after the introduction of COVID-19 measures. Conclusions: It is likely that the COVID-19 mitigation measures played a notable role in the marked decrease in influenza, with little to no influenza activity in both the northern and southern hemispheres. In spite of this reduction in influenza cases, there was still community spread of COVID-19, highlighting the contagiousness of SARS-CoV-2 compared to influenza. These results, together with the higher mortality rate from SARS-CoV-2 compared to influenza, highlight that COVID-19 is a far greater health threat than influenza.
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COVID-19/epidemiología , COVID-19/fisiopatología , Gripe Humana/epidemiología , Gripe Humana/fisiopatología , Internacionalidad , Pandemias/estadística & datos numéricos , Evaluación de Síntomas/estadística & datos numéricos , Australia/epidemiología , Brasil/epidemiología , Canadá/epidemiología , Femenino , Humanos , Masculino , Salud Pública/estadística & datos numéricos , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Postoperative delirium is associated with opioid use in the elderly and is a common complication of geriatric hip fractures, with reported incidences from 16% to 70%. Intravenous (IV) acetaminophen is a safe and efficacious medication in elderly patients and has been shown to reduce use of opioids after hip fracture. At our institution, IV acetaminophen was implemented for the first 24 hours postoperatively as part of a multimodal pain control regimen for geriatric hip fracture patients. METHODS: A retrospective review of 123 hip fragility fracture patients older than 60 years from January 2016 to December 2016 was performed. Delirium was identified using a validated chart-based review tool. The rate of delirium, as well as length of stay, pain scores, opioid administration, need for one-to-one supervision, and readmissions were analyzed. RESULTS: Sixty-five patients (52.8%) received IV acetaminophen during this period. No notable differences were found in baseline characteristics between groups. Ten of 65 patients receiving IV acetaminophen postoperatively experienced delirium compared with 19 of 58 who did not receive the medication (15.4% versus 32.8%, P = 0.024). The IV acetaminophen group also required fewer doses of IV opioids on postoperative day 1 (0.37 versus 1.19 doses, P = 0.008), were less likely to require one-to-one supervision (9.2% versus 24.1%, P = 0.025), and had shorter lengths of hospital stay (6.37 versus 8.47 days, P = 0.037). Readmission rates and discharge dispositions did not vary with significance between the two groups. CONCLUSION: The inclusion of IV acetaminophen as part of a multimodal pain regimen led to fewer episodes of delirium in this study. The reduced use of opioids immediately after surgery may have been a large factor in this outcome. Lower delirium rates may reduce the utilization of inpatient resources for direct patient supervision and provide for shorter hospital stays.
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Acetaminofén/administración & dosificación , Delirio/prevención & control , Fracturas de Cadera/complicaciones , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Delirio/inducido químicamente , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Dolor/etiología , Complicaciones Posoperatorias/inducido químicamente , Estudios RetrospectivosRESUMEN
INTRODUCTION: Guatemala is the only country in Central America with a majority indigenous population. Most indigenous Mayans prefer to seek health advice from family members. It is important to understand the beliefs of Mayan caregivers. The purpose of this study was to examine indigenous ways of explaining health and illness in the context of one Mayan village. METHOD: We applied a qualitative descriptive design in summer 2017. Interviews were conducted in Spanish with 10 Mayan caregivers, who were primarily female, between ages 19 and 50 years, in Guatemala. The sample was drawn from families who received a water filter the previous year. RESULTS: Health was explained by access to food, including local herbs, and clean water. Illness was explained by bodily symptoms and behavioral changes. DISCUSSION: Findings align with several United Nations 2030 Sustainable Development Goals and suggest a need to strategize with global partners.
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Servicios de Salud del Niño/normas , Salud Infantil/normas , Grupos de Población/psicología , Adulto , Niño , Salud Infantil/etnología , Salud Infantil/estadística & datos numéricos , Servicios de Salud del Niño/estadística & datos numéricos , Femenino , Guatemala/etnología , Humanos , Masculino , Persona de Mediana Edad , Grupos de Población/etnología , Grupos de Población/estadística & datos numéricos , Investigación CualitativaRESUMEN
PURPOSE: We sought to understand decision making, family involvement, and cultural factors that influence palliative care for Guatemalans. DESIGN: A qualitative descriptive study was conducted in Guatemala to explore palliative care experiences among seven participants. FINDINGS: The overarching theme was Relief from Suffering, reinforced by three support systems: the family, community rezadora, and priest. The family made decisions and provided physical care. The rezadora sang prayers and prepared the home altar. The priest provided traditional sacraments. DISCUSSION: The role of the rezadora should be considered in providing palliative care to Guatemalans. Some Guatemalans are unfamiliar with or have difficulty understanding the role of the nurse in palliative and end-of-life care. IMPLICATIONS: We suggest training opportunities using international resources to enhance the role for Guatemalan nurses in end-of-life care. Palliative care nurses in the United States may benefit from incorporating the rezadora into strategies that extend these services to Guatemalans.
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Toma de Decisiones , Relaciones Familiares/psicología , Cuidados Paliativos/normas , Cultura , Guatemala , Humanos , Cuidados Paliativos/métodos , Investigación Cualitativa , Población Rural , Espiritualidad , Estrés Psicológico/psicología , Estrés Psicológico/terapiaRESUMEN
BACKGROUND: No effective cure exists for knee osteoarthritis (OA). Low-burden self-management strategies that can slow disease progression are needed. Bone marrow lesions (BMLs) are a source of knee pain and accelerate cartilage loss. Importantly, they may be responsive to biomechanical off-loading treatments. OBJECTIVE: The study objective is to investigate whether, in people with medial tibiofemoral OA, daily cane use for 12 weeks reduces the volume of medial tibiofemoral BMLs and improves pain, physical function, and health-related quality of life. DESIGN: This study will be an assessor-masked, 2-arm, parallel-group, multisite randomized controlled trial. SETTING: The community will serve as the setting for this study. PARTICIPANTS: The study participants will be people who are 50 years old or older and have medial tibiofemoral OA and at least 1 medial tibiofemoral BML. INTERVENTION: The participants will be allocated to either the cane group (using a cane daily whenever walking for 12 weeks) or the control group (not using any gait aid for 12 weeks). MEASUREMENTS: Outcomes will be measured at baseline and 13 weeks. The primary outcome will be total medial tibiofemoral BML volume measured from magnetic resonance imaging. Secondary outcomes will include BML volume of the medial tibia and/or femur, knee pain overall and on walking, physical function, participant-perceived global change, and health-related quality of life. Additional measures will include physical activity, cointerventions, adverse events, participation, participant demographics, cane training process measures and feasibility, barriers to and facilitators of cane use, and loss to follow-up. LIMITATIONS: People who are morbidly obese will not be included because of difficulties with magnetic resonance imaging. CONCLUSIONS: The findings of this study will help to determine whether cane use can alter disease progression in people with medial tibiofemoral OA and/or influence clinical symptoms. This study may directly influence clinical guidelines for the management of knee OA.
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Médula Ósea/patología , Bastones , Osteoartritis de la Rodilla/fisiopatología , Actividades Cotidianas , Anciano , Fenómenos Biomecánicos , Médula Ósea/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Manejo del Dolor , Dimensión del Dolor , Calidad de Vida , Resultado del Tratamiento , Soporte de PesoRESUMEN
Depression (DEP) is one of the main disabling diseases and is considered a contributor factor for erectile dysfunction (ED). Both of these conditions may be associated with hormonal changes and sleep disturbances. We aimed to evaluate the interaction between ED complaints and depression symptoms on sleep parameters, hormone levels and quality of life in men. This was a cross-sectional study of 468 men aged 20-80 years. The participants were classified according to the presence of ED and/or DEP in groups of healthy individuals, ED, DEP and DEP with ED (DEP-ED). All participants completed questionnaires about sleep, clinical history and quality of life, and underwent polysomnography with blood collection the following morning. ED participants showed higher frequency of insomnia symptoms (65.5%), whereas DEP group had more complaints of difficulty in falling asleep and early morning awakening. In the polysomnography, all groups showed similar parameters. No differences were found in cortisol and total testosterone levels; however, free testosterone levels and the physiological domain of quality of life were lower in DEP-ED group. ED and DEP, as independent factors, negatively affected subjective sleep parameters. The interaction between these factors led to a low quality of life and was related to a decrease in free testosterone levels.
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Depresión/epidemiología , Disfunción Eréctil/epidemiología , Disfunción Eréctil/psicología , Calidad de Vida/psicología , Apnea Obstructiva del Sueño/epidemiología , Adulto , Anciano , Brasil , Estudios de Casos y Controles , Comorbilidad , Estudios Transversales , Depresión/diagnóstico , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Polisomnografía , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Apnea Obstructiva del Sueño/diagnóstico , Encuestas y Cuestionarios , Testosterona/sangreRESUMEN
PURPOSE: Infants and children in developing countries bear the burden of diarrheal disease. Diarrheal disease is linked to unsafe drinking water and can result in serious long-term consequences, such as impaired immune function and brain growth. There is evidence that point-of-use water filtration systems reduce the prevalence of diarrhea in developing countries. In the summer of 2014, following community forums and interactive workshops, water filters were distributed to 71 households in a rural Maya community in Guatemala. The purpose of this study was to evaluate the uptake of tabletop water filtration systems to reduce diarrheal diseases. DESIGN: A descriptive correlational study was used that employed community partnership and empowerment strategies. One year postintervention, in the summer of 2015, a bilingual, interdisciplinary research team conducted a house-to-house survey with families who received water filters. METHODS: Survey data were gathered from the head of household on family demographics, current family health, water filter usage, and type of flooring in the home. Interviews were conducted in Spanish and in partnership with a village leader. Each family received a food package of household staples for their participation. Descriptive statistics were calculated for all responses. Fisher's exact test and odds ratios were used to determine relationships between variables. FINDINGS: Seventy-nine percent (n = 56) of the 71 households that received a water filter in 2014 participated in the study. The majority of families (71.4%; n = 40) were using the water filters and 16 families (28.6%) had broken water filters. Of the families with working water filters, 15% reported diarrhea, while 31% of families with a broken water filter reported diarrhea. Only 55.4% of the homes had concrete flooring. More households with dirt flooring and broken water filters reported a current case of diarrhea. A record review of attendees at an outreach clinic in this village noted a decrease in intestinal infections from 2014 (53%) to 2015 (32%). CONCLUSIONS: A trend suggests that water filter usage was both practically and clinically significant in reducing the incidence of diarrheal disease in this sample. Some homes did not have flat surfaces for water filter storage. Housing conditions should be taken into consideration for future diarrheal disease prevention initiatives. CLINICAL RELEVANCE: Point-of-use water filters using a community-university partnership can reduce diarrheal disease in rural regions of Guatemala.
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Diarrea/prevención & control , Filtración/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Purificación del Agua/métodos , Adulto , Niño , Preescolar , Diarrea/epidemiología , Guatemala/epidemiología , Encuestas Epidemiológicas , Humanos , LactanteRESUMEN
Most anurans possess a tympanic middle ear (TME) that transmits sound waves to the inner ear; however, numerous species lack some or all TME components. To understand the evolution of these structures, we undertook a comprehensive assessment of their occurrence across anurans and performed ancestral character state reconstructions. Our analysis indicates that the TME was completely lost at least 38 independent times in Anura. The inferred evolutionary history of the TME is exceptionally complex in true toads (Bufonidae), where it was lost in the most recent common ancestor, preceding a radiation of >150 earless species. Following that initial loss, independent regains of some or all TME structures were inferred within two minor clades and in a radiation of >400 species. The reappearance of the TME in the latter clade was followed by at least 10 losses of the entire TME. The many losses and gains of the TME in anurans is unparalleled among tetrapods. Our results show that anurans, and especially bufonid toads, are an excellent model to study the behavioural correlates of earlessness, extratympanic sound pathways, and the genetic and developmental mechanisms that underlie the morphogenesis of TME structures.
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Regions of the US with growing Latino populations are in need of culturally sensitive sexual risk reduction programs. A Latino community, a public school district, and a university in eastern North Carolina collaborated to test the feasibility of ¡Cuídate!, a culturally tailored, evidence-based sexual risk reduction program, with Mexican and Central American youth. Ten male and 10 female adolescents, ages 13-17 years, participated in the ¡Cuídate! program and post-program focus groups. Early adolescent boys and girls (ages 13-15) gained the most from this program. A safe environment facilitated healthy sexual communication, and condom skills-building provided a context for shared partner responsibility. Grade-level and gender differences were significant. Analysis of the focus group data identified three important messages: Everybody needs sex education, We like this program better because it is hands-on, and I'm going to make better decisions about sex. The findings of this study support the need for community-based interventions that ensure cultural respect, trust, and a safe environment in which to discuss sexual issues.