Utilidad de los anticuerpos anti-células parietales gástricas y anti-factor intrínseco en el estudio de la deficiencia de vitamina B12 asociada a gastritis autoinmune y anemia perniciosa / Usefulness of anti-gastric parietal cell and anti-intrinsic factor antibodies in the study of vitamin B12 deficiency associated with autoimmune gastritis and pernicious anemia / Utilidade de anticorpos anti-células parietais gástricas e anti-fator intrínseco no estudo da deficiência de vitamina B12 associada à gastrite autoimune e à anemia perniciosa

Resumen La gastritis autoinmune (GAI) es una afección inflamatoria progresiva de la mucosa oxíntica caracterizada por la destrucción de células parietales, pérdida de factor intrínseco, malabsorción de vitamina B12 (cobalamina), hierro y otros micronutrientes y puede progresar hacia un estado avanzado de anemia megaloblástica conocida como anemia perniciosa (AP). El objetivo de este estudio fue determinar la deficiencia de vitamina B12 debida a malabsorción utilizando la detección de anticuerpos anti-células parietales gástricas (ACPG) y anti-factor intrínseco (AFI). Se analizaron 2050 sueros de pacientes con un inmunoanálisis quimioluminiscente para vitamina B12 total y 2,8% de éstos con las pruebas de inmunofluorescencia indirecta para ACPG y enzimoinmunoanálisis para AFI. La deficiencia de vitamina B12 (<200 ng/mL) fue del 13,1%. En la detección de anticuerpos se encontró: 2 doble positivos ACPG/AFI, 17 simple positivos ACPG y 4 simple positivos AFI. Todas las muestras ACPG y/o AFI positivas tuvieron valores de vitamina B12 total <200 ng/mL. En 5 pacientes con ACPG positivos se diagnosticó gastritis crónica confirmada por biopsia. En los 6 pacientes AFI positivos se realizó el diagnóstico de AP y en 2 de ellos se confirmó por histopatología. La positividad de ACPG y/o AFI permitió la clasificación de pacientes con sospecha de GAI en candidatos para la examinación histológica y la aplicación de esquemas terapéuticos adecuados. Se destaca la importancia de las pruebas de laboratorio como parte de una estrategia de diagnóstico temprano y vigilancia endoscópica, para evitar las manifestaciones relacionadas con la deficiencia de hierro y vitamina B12 y las complicaciones de la enfermedad avanzada.

Abstract Autoimmune gastritis (AIG) is a progressive inflammatory condition of the oxyntic mucosa, characterised by gastric parietal cell destruction, loss of intrinsic factor, and malabsorption of vitamin B12 (cobalamin), iron and other micronutrients; conditioning progress to a state of megaloblastic anemia known as pernicious anemia (PA). The aim of this study was to determine vitamin B12 deficiency due to malabsorption utilizing anti-parietal cell (APCA) and anti-intrinsic factor (IFA) antibodies detection. 2050 patient serum samples were analised by chemiluminescent immunoassay for vitamin B12. A total of 2.8% of them were tested for APCA by indirect immunofluorescence and for IFA by enzyme immunoessay. Vitamin B12 deficiency (<200 ng/mL) was 13.1%. Regarding antibody detection: 2 APCA/IFA double positives, 17 APCA simple positives and 4 IFA simple positives were found. APCA and/or IFA positive samples had total vitamin B12 values <200 ng/mL. Chronic gastritis confirmed by biopsy was diagnosed in 5 patients with positive ACPG antibodies. All 6 IFA positive patients were diagnosed with PA, while 2 of them also received histopatologic confirmation. APCA and/or IFA confirmation allowed for the classification of patients with suspicion of AIG as possible candidates for histologic examination and application of appropriate therapeutic schemes. Importance of laboratory testing is to be noted; as part of a strategy that enables early diagnosis and adequate endoscopic surveillance, to avoid manifestations related to iron and vitamin B12 deficiency and the complications of advanced disease.

Resumo A gastrite autoimune (GAI) é uma doença inflamatória progressiva da mucosa oxíntica, caracterizada pela destruição das células parietais gástricas, perda do fator intrínseco, má absorção de vitamina B12 (cobalamina), ferro e outros micronutrientes pode progredir para um estado avançado de anemia megaloblástica conhecida como anemia perniciosa (AP). O objetivo deste estudo foi determinar a deficiência de vitamina B12 por má absorção usando a detecção de anticorpos anti-células parietais gástricas (ACPG) e anti-fator intrínseco (AFI). Foram analisados 2050 soros de pacientes com um imunoensaio quimioluminiscente para vitamina B12 total, 2,8% deles com testes de imunofluorescência indireta para ACPG e enzimaimunoensaio para AFI. A deficiência de vitamina B12 (<200 ng/mL) foi de 13,1%. Na detecção de anticorpos foram encontrados: 2 duplo positivos ACPG/AFI, 17 simples positivos ACPG e 4 simples positivos AFI. Todas as amostras ACPG e/ou AFI positivas apresentaram valores de vitamina B12 total <200 ng/mL. Gastrite crônica confirmada por biópsia foi diagnosticada em 5 pacientes positivos para ACPG. Nos 6 pacientes AFI positivos o diagnóstico de AP foi feito e em 2 deles foi confirmado por histopatologia. A positividade para ACPG e/ou AFI permitiu a classificação de pacientes com suspeita de GAI em candidatos para exame histológico e a aplicação de esquemas terapêuticos adequados. Destaca-se a importancia dos testes laboratoriais, como parte de uma estratégia de diagnóstico precoce e vigilância endoscópica, para evitar manifestações relacionadas à deficiência de ferro e vitamina B12 e complicações da doença avançada.

Association between intrinsic capacity and falls among older adults / 预防医学

Objective @#To examine the association between intrinsic capacity and falls in older adults, so as to provide insights into the risk assessment of falls. @*Methods@#Older adults aged 60 years and above were selected from two districts and one county in Bengbu City, Anhui Province from September 2022 to June 2023 using convenience sampling method. Demographic information, health-related behaviors and incidence of falls among participants were collected through questionnaire surveys. The intrinsic capacity included five dimensions: sensory, motor, vitality, cognition and psychology, which were investigated by the sensory dimension screening scale recommended by the World Health Organization, the Simple Physical Functioning Battery (SPPB), the Micro Nutritional Assessment Scale (MNAS-SF), the Brief Intelligent Mental State Examination Scale (MMSE), and the Center for Evaluation of Streamlined Depression Levels 10-entry scale (CESD-10), respectively. A total score of 1 or more indicated a decrease in intrinsic capacity. The association between intrinsic capacity and falls in older adults was analyzed by a multivariable logistic regression model.@*Results@#A total of 1 950 questionnaires were allocated, and 1 917 were valid, with an effective rate of 98.30%. There were 934 men (48.72%) and 983 women (51.28%), with a mean age of (68.15±3.42) years. There were 1 352 rural residents (70.53%) and 1 431 illiterate and primary school-educated residents (74.65%). In the past year, 347 residents fell, accounting for 18.10%. The median comprehensive score for intrinsic capacity was 1.00 (interquartile range, 2.00) points, and 1 320 had a decrease in intrinsic capacity, accounting for 68.86%. Multivariable logistic regression analysis showed that decline in intrinsic ability was associated with the risk of falls after adjustment for age, gender, educational level, marital status, alcohol consumption and self-rated health status (OR=1.531, 95%CI: 1.408-1.721).@*Conclusion@#Decreased intrinsic capacity in older adults may contribute to an increased risk of falls.

MOTIVOS INTRÍNSECOS, EXTRÍNSECOS Y EXPECTATIVAS PARA ELECCIÓN DE LA CARRERA, COMO PREDICTORES DE RENDIMIENTO ACADÉMICO EN ESTUDIANTES DE ENFERMERÍA / INTRINSIC AND EXTRINSIC MOTIVATIONS AND EXPECTATIONS FOR CAREER CHOICE, AS PREDICTORS OF ACADEMIC PERFORMANCE IN NURSING STUDENTS

[{"text": "INTRODUCCIÓN. El decantarse por una carrera universitaria, es una decisión que marca el futuro profesional de los jóvenes; en ella están envueltas motivaciones intrínsecas, extrínsecas y expectativas que pueden predecir el desempeño académico. OBJETIVO. Predecir el rendimiento académico de los estudiantes de una facultad de enfermería, a través de los motivos intrínsecos, extrínsecos y expectativas para la elección de la carrera. METODOLOGÍA. Estudio correlacional, longitudinal, analítico. La muestra estuvo constituida por 400 estudiantes de primer semestre. Se aplicó una cédula socio demográfica; Escala de Motivación en Educación (EME); Escala de Expectativas Para la Elección de la Carrera e Interés Hacia los Estudios (EEPECIHE); Escala de Seguimiento Cambios en las Expectativas, Grado de Interés y Satisfacción de los Estudiantes (ESCEGIS). Los datos se analizaron con el software SPSS versión 25 para iOS; el estudio contó con la aprobación del comité de bioética en investigación de la Facultad de Enfermería Culiacán. RESULTADOS. Existen diferencias significativas de las motivaciones, expectativas y rendimiento académico (p <.05) al inicio del semestre y al finalizar el semestre; las motivaciones y expectativas predicen el rendimiento académico, en 74.6%, (R2=0,747, Ajuste R2 = 0,746,

Prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores. Barranquilla (Atlántico), Colombia

Introducción: El riesgo de caídas es de carácter multifactorial, ya sea debido a factores extrínsecos o intrínsecos. Las caídas se consideran el principal mecanismo de lesión no intencional en los mayores. Objetivo: Determinar la prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores de la ciudad de Barranquilla (Colombia). Materiales y métodos: Estudio descriptivo correlacional, realizado en 98 adultos mayores, tanto institucionalizados como en comunidad, residentes en Barranquilla (Atlántico), Colombia. Se aplicó una encuesta sobre factores de riesgo intrínsecos; el riesgo de caída se midió con la escala de Berg y se establecieron niveles de Vitamina D en sangre. Resultados: El promedio de edad fue de 75 años, con edades más avanzadas en población institucionalizada. La prevalencia general de caídas fue de 49 % en el último año. El 68,8 % de la población que presentó caídas fueron mujeres, con mayor proporción de caídas en los residentes en hogares geriátricos (52,1 %). Las mujeres provenientes de la comunidad se cayeron más que los hombres (91,3 %) lo cual muestra significancia estadística frente a las caídas (p = 0,002). El consumo de antihipertensivos fue el de mayor proporción (92 %), lo cual demuestra que es estadísticamente significativa para la población institucionalizada (p = 0,0224). El riesgo de caída alto y moderado fue mayor en la población institucionalizada (32 %). El 79,2 % de los individuos que presentaron caídas presentó niveles de vitamina D insuficientes. Conclusión: La población adulta mayor presenta una alta prevalencia de caídas, especialmente las mujeres y la población institucionalizada en centros geriátricos. Los hechos que presentaron significancia estadística fueron ser mujer y provenir de la comunidad, junto con el consumo de antihipertensivos en población institucionalizada.

Introduction: Fall risk can be related to multiple factors, whether they are of extrinsic or intrinsic nature. Falls are considered the main mechanism of accidental injury in the elderly. Objective: To determine the prevalence of falls and intrinsic risk factors in older adults in the city of Barranquilla (Colombia). Materials and methods: A descriptive correlation study was carried out on 98 institutionalized and community elderly adults from Barranquilla (Atlántico), Colombia. A survey on intrinsic risk factors was applied; the risk of falling was measured with the Berg scale and levels of Vitamin D in the blood were established. Results: The participant's average age was 75 years old, considering that the oldest ages were in the institutionalized population. The general prevalence of falls was 49% in the last year, 68.8% of the population that presented falls were women, and the highest proportion of falls occurred with residents of geriatric homes (52,1%). Women coming from the community fell more than men (91,3%) showing statistical significance compared to falls (p-value of 0,002). The consumption of antihypertensive drugs was the one with the highest proportion (92%), which showed statistical significance for the institutionalized population (p-value of 0,0224). The high and moderate risk of falls was higher in the institutionalized population (32%). Insufficient vitamin D levels (79,2% of those that fell) had a higher prevalence in women, without statistical significance. Conclusion: The elderly population has a high prevalence of falls, especially in women and in the population institutionalized in geriatric centers. The facts that presented statistical significance were being a woman and coming from the community, along with the consumption of antihypertensives in the institutionalized population.

Cross-cultural adaptation of the Science Motivation Questionnaire II (SMQ-II) for Portuguese-speaking Brazilian secondary school students

Introduction: Science motivation is important for students' scientific literacy. Yet, there is a lack of valid and reliable measurement tools for the Brazilian context. This study presents the Brazilian Portuguese version of the Science Motivation Questionnaire (SMQ-II) and motivational baseline data. Method: The instrument was translated into Brazilian Portuguese using cross-cultural validation procedures. For structural validity evidence, the responses of 646 secondary school students were subjected to exploratory and confirmatory factor analysis, as well as measurement invariance. For reliability evidence, Cronbach's alpha (a) and McDonald's omega (w) were calculated. Students' motivation was analysed using 2 (gender) x 4 (grade levels) x 3 (study modality) MANOVA. Results: 24 items measuring intrinsic motivation, career motivation, grade motivation, and self-efficacy supported a four-factor structure with adequate reliability against the original five-factor structure (self-determination was not salient). Measurement invariance was established across the gender and study modalities, but not for grade levels. Higher-grade level Brazilian students were less motivated, and girls reported higher intrinsic and career motivation, but lower self-efficacy than boys. Conclusion: These findings lay the foundation for the assessment of Brazilian students' science motivation, although they also reveal problems in the latent structure of the SMQ-II and call for the development of instruments rooted in contemporary motivational theories.

Introdução: A motivação científica é importante para a alfabetização científica dos estudantes. No entanto, há uma falta de ferramentas de medição válidas e confiáveis para o contexto brasileiro. Este estudo apresenta a versão em português brasileiro do Questionário de Motivação Científica (SMQ-II) e dados de base motivacionais. Método: O instrumento foi traduzido para o português brasileiro utilizando procedimentos de validação transcultural. Para construir provas de validade, as respostas de 646 alunos do ensino médio foram submetidas à análise exploratória e confirmatória de fatores, bem como invariância de medidas. Para a evidência de confiabilidade, foram calculados o alfa de Cronbach (a) e o ômega de McDonald's (w). A motivação dos estudantes foi analisada usando 2 (gênero) x 4 (notas) x 3 (modalidade de estudo) MANOVA. Resultados: 24 itens medindo a motivação intrínseca, motivação de carreira, motivação de grau e auto-eficácia suportaram uma estrutura de quatro fatores com confiabilidade adequada contra a estrutura original de cinco fatores (a autodeterminação não foi saliente). A invariância da medição foi estabelecida através de gênero e modalidade de estudo, mas não para o nível de nota. Os estudantes brasileiros de grau superior estavam menos motivados, e as meninas relataram maior motivação intrínseca e de carreira, mas menor auto-eficácia do que os meninos. Conclusão: Estas descobertas abrem o caminho para a avaliação da motivação científica dos estudantes brasileiros, mas também revelam problemas na estrutura latente do SMQ-II e exigem o desenvolvimento de instrumentos enraizados em teorias motivacionais contemporâneas.

Motivación Intrínseca y Perspectiva Temporal de Universitarios del Noroeste de México / Intrinsic Motivation and Temporal Perspective of University Students in Northwestern Mexico

Resumen Se buscó identificar el perfil de motivación intrínseca (MI) y su relación con la perspectiva temporal en estudiantes universitarios del noroeste de México. En una muestra no probabilística por conveniencia de 553 estudiantes, se puso a prueba un modelo de motivación intrínseca, autoeficacia, orientación al logro, percepción escolar, morosidad y orientaciones temporales (pasado, presente y futuro). Se conformó un modelo estructural de MI que posee bondad de ajuste práctica adecuada. El modelo explica 48% de la variabilidad de la motivación intrínseca; destaca el efecto positivo de la orientación al logro (peso estructural=.65*) y el efecto negativo e indirecto (a través de la autoeficacia) de la morosidad (peso estructural=-.53*) sobre la MI. Y un efecto positivo de las orientaciones temporales (pasado negativo, presente hedonista y presente fatalista) sobre la morosidad (peso estructural=.54*). El estudio ofrece información sobre los aspectos que deben ser desarrollados en los estudiantes universitarios en relación con la motivación intrínseca.

Abstract The purpose of this study was to identify the intrinsic motivation (IM) profile and its relationship with time perspective in a non-probabilistic convenience sample of 553 students university students from a northwestern region in Mexico. Structural equation models were fitted for intrinsic motivation, with self-efficacy, achievement orientation, school perception, procrastination and temporal orientations (past, present and future) as direct and indirect predictors. A structural model of IM was formed that has adequate practical goodness-of-fit. The overall model explained 48% of the variance for intrinsic motivation. Achievement orientation was positively associated (structural weight =.65*) with intrinsic motivation while procrastination was negatively and indirectly (through self-efficacy) related (structural weight =.53*) to IM. Temporal orientations (negative past, hedonistic present and fatalistic present) were positively related to procrastination (structural weight =.54*). This study provides information regarding important predictors of intrinsic motivation that can be targeted among university students.

Impacto econômico da implementação de políticas públicas para distúrbios de sono no Brasil: uma revisão integrativa / Economic impact of the implementation of public policies for sleep disorders in Brazil: an integrative review

Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.

Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.

Capital psicológico que influye a la motivación intrínseca de universitarios del noroeste de México / Psychological capital influences the intrinsic motivation for university students from northwestern Mexico

Resumen El capital psicológico y la motivación, bajo la perspectiva teórica de la psicología positiva y la autodeterminación respectivamente, conducen al ser humano a la obtención de resultados y al éxito del desarrollo profesional y personal. Asimismo, ante situaciones problemáticas, representan recursos para generar estrategias de resolución. Se planteó como hipótesis que el capital psicológico ejerce influencia sobre la motivación intrínseca de estudiantes universitarios. El objetivo fue identificar un modelo empírico compuesto por dos factores en interacción de un grupo de 253 estudiantes universitarios de primer ingreso en la carrera de psicología, con un promedio de edad de 19.64 años (DT = 3.34). Se integró una muestra por conveniencia a la que se aplicó un cuestionario con reactivos de tipo escala valorativa: 29 reactivos midieron motivación con cinco opciones de respuesta y 24 reactivos capital psicológico con seis opciones de respuesta. La recolección de datos se realizó en diversas sesiones que duraron aproximadamente 20 minutos; el cuestionario fue contestado voluntariamente, y los datos recabados fueron analizados con ecuaciones estructurales. Se obtuvo un modelo con bondad de ajuste que identificó la influencia del capital psicológico sobre la motivación intrínseca, lo que representa que los estudiantes poseen fuertes motivadores internos para realizar sus estudios y auguran el desempeño exitoso, según advierten algunos estudios preliminares. De acuerdo con la teoría de la autodeterminación, prevalecen los factores internos para generar acciones que repercuten con diversos comportamientos organizacionales.

Abstract Psychological capital and motivation under the perspective of positive psychology and self-determination lead the human being to obtain results and success of professional and personal development; when faced with problematic situations, they also represent resources to generate resolution strategies. In work environments, psychological capital is considered an important resource as the human capital is in any organization. Currently, the study of the psychological capital is focused on university students, which means that educational institutions have to plan the graduate profile that will characterize future professionals. Psychological capital is a construct composed of personal resources defined as: optimism, hope, resilience, and self-efficacy. The data collected in the work environment indicated that these variables could favorably affect organizational effectiveness and job performance. Also, in the educational field, it has been observed that university students who scored high in psychological capital showed greater academic performance and success in completing their studies than those who obtained low scores. Specifically, some studies have shown a predominance of high hope and resilience scores of students. Psychological capital is an antecedent, mediating, or consequent variable that interacts with motivation, with various organizational behaviors, with academic performance, and success in completing professional studies. Therefore, this article set out to identify the influence that psychological capital exerted on the intrinsic motivation of the group of students included in the sample. The aim of this study was to identify an empirical model capable of showing if psychological capital is linked to intrinsic motivation in a group of 253 university newly admitted students the career of Psychology, with an average age of 19.64 years (DT = 3.34); 199 were female and 54 were male. A convenience sample was integrated, by choosing the participation of a cohort of students who were in groups conformed by the preferences of the students' schedules and the availability of space in each classroom. A questionnaire with rating scale items was applied: 29 items belonged to the Educational Motivation Scale, with five response options; and 24 items belonged to the Psychological Capital Scale, with six response options. The items on both scales demonstrated internal consistency in previous research. A psychologist carried out the data collection in several sessions that lasted approximately 20 minutes. The sample voluntarily answered the questionnaire. Structural equations were used to analyze the data. The confirmatory factor analysis technique was performed, since it allowed testing the hypothesis. The empirical model obtained had practical goodness of fit, since it presented a C2 = 26.51 (13 gl, p = .01). The practical goodness of fit was manifested in the fit values of .97 for BBN, .97 for BBNN and .98 for CFI. The RMSEA was equal to .06. The measurement model obtained was made up of four latent first-order variables (self-efficacy, hope, optimism, and resilience); these variables formed a latent second-order variable called psychological capital that influenced the second-order variable called intrinsic motivation. Intrinsic motivation was integrated by three first-order latent variables (intrinsic motivation to know, intrinsic motivation to accomplish, and intrinsic motivation to experience stimulation). A good-fit model identified the influence of psychological capital on intrinsic motivation, which meant that students had strong internal motivators to carry out their studies and predict successful performance according to some preliminary studies. The empirical model registered also had high factorial weights for hope and resilience. In this study, psychological capital (self-efficacy, hope, optimism, and resilience) was associated with intrinsic motivation (intrinsic motivation to know, intrinsic motivation to accomplish, and intrinsic motivation to experience stimulation). In previous research, the relationship with motivation was more generic. According to the theory of self-determination, internal factors prevail to generate actions that affect several organizational behaviors.

Degeneración combinada subaguda / Subacute combined degeneration

Introducción: La degeneración combinada subaguda (DCS) es un trastorno caracterizado por la degeneración difusa de la sustancia blanca a nivel del SNC, que afecta específicamente los cordones posteriores y laterales de la médula espinal, con pérdida de la mielinización periférica y central. De manera frecuente, las manifestaciones clínicas son parestesias y debilidad generalizada causada por deficiencia de vitamina B12. Presentación del caso: Paciente masculino de 79 años, con cuadro clínico de 3 meses de evolución de limitación funcional para la marcha acompañado de desorientación. Al examen físico evidenció desorientación, cuadriparesia e hiporreflexia, con niveles séricos bajos de vitamina B12, RM cervical con focos hiperintensos en el segmento C3/C6 y endoscopia de vías digestivas altas con atrofia de la mucosa gástrica. Presentamos un caso clínico de DCS. Discusión: Este es un caso de DCS que se manifiesta por medio de una alteración neuropsiquiátrica, con una presentación inicial inespecífica que comprende deterioro de la marcha, movimientos anormales con afectación cognitiva y psiquiátrica dada por alucinaciones visuales y desorientación. Su sospecha es importante en pacientes con factores de riesgo por medio del conocimiento de la patología, para una adecuada sospecha diagnóstica y una instauración oportuna de reposición vitamínica, la cual presenta una excelente respuesta. Conclusión: La DCS es un trastorno en el que se evidencia anemia con deficiencia de vitamina B12, des-mielinización del tejido nervioso y en muchos casos signos sugestivos de atrofia gástrica, y para ello es crucial la detección temprana de esta enfermedad por medio de la determinación de niveles séricos de vitamina B12, asociado a síntomas neurológicos, para así lograr su adecuado diagnóstico y tratamiento.

Introduction: Subacute combined degeneration (DCS) is a disorder characterized by diffuse degeneration of white matter at the CNS level, specifically affecting the posterior and lateral cords of the spinal cord, also with loss of peripheral and central myelination, frequently the clinical manifestations are paresthesias and generalized weakness caused by vitamin B12 deficiency. Case presentation: A 79-year-old male patient with a 3-month history of functional limitation for walking accompanied by disorientation. On physical examination, he revealed disorientation, quadriparesis, and hyporeflexia, with low serum levels of vitamin B12, cervical MRI with hyperintense foci in segment C3/C6, and upper digestive tract endoscopy with atrophy of the gastric mucosa. We present a clinical case of DCS. Discussion: This is a case of DCS that manifests itself through neuropsychiatric alteration with a nonspecific initial presentation with gait impairment, abnormal movements with cognitive and psychiatric affectation given by visual hallucinations and disorientation. Its suspicion is important in patients with risk factors. risk through knowledge of the pathology for an adequate diagnostic suspicion and a timely establishment of vitamin replacement for which it presents an excellent response. Conclusion: DCS is a disorder where anemia with vitamin B12 deficiency, demyelination of the nervous tissue and in many cases signs suggestive of gastric atrophy are evident, for which early detection of this disease is crucial through the determination of serum levels of vitamin B12 associated with neurological symptoms, in order to achieve its proper diagnosis and treatment.

Motives for physical activity participation among lebanese adults aged 18 to 50 years: a cross-sectional study / Motivos para participação de atividade física em libanes adultos de 18 a 50 anos: um estudo transversal

ABSTRACT Background: Sports participation motivations can be intrinsic, extrinsic, or even amotivational. Few studies on adult participation in PA have been found in the Lebanese context. This study aims to: a) investigate significant differences in sports participation motivation across gender, age, occupation, and time of practice, and b) investigate sports participation motives that discriminated the best between those variables. Material and methods: The Arabic version of the Sport Motivation Scale was collected electronically from 531 volunteers practicing regular PA for the last six months. Gender, occupation, marital status, and time of practice were all analyzed using Mann-Whitney U test and the Kruskal Wallis Test with 0.05 as level of significance. Results: Internal motivation subscales (particularly the intention to accomplish) were the most influential motives for both genders. A significant difference across gender was reported in the extrinsic motivation and amotivation subscales. Furthermore, age, occupation, marital status, and time of practice show significant differences in motivation factors either dependent or regardless of gender distribution (p<0.05). Conclusion: no significant differences in the intrinsic motivation for sports participation between genders. Other factors, on the other hand, had a substantial impact. Research contribution: these findings are intended to contribute to a better understanding of differences in motivation for participating in PA and to aid in its promotion among Lebanese adults

RESUMO Contexto: As motivações para a participação desportiva podem ser intrínsecas, extrínsecas ou mesmo amotivacionais. Poucos estudos sobre a participação de adultos em AF foram encontrados no contexto libanês. Este estudo tem como objetivos: a) investigar diferenças significativas na motivação para a prática desportiva em função do género, idade, profissão e tempo de prática, e b) investigar os motivos da prática desportiva que melhor discriminaram entre essas variáveis. Material e métodos: A versão árabe da Sport Motivation Scale foi coletada eletronicamente de 531 voluntários praticantes regulares de AF nos últimos seis meses. Gênero, ocupação, estado civil e tempo de atuação foram analisados por meio do teste U de Mann-Whitney e do teste de Kruskal Wallis com nível de significância de 0,05. Resultados: As subescalas de motivação interna (particularmente a intenção de realizar) foram os motivos mais influentes para ambos os sexos. Uma diferença significativa entre os gêneros foi relatada nas subescalas de motivação extrínseca e amotivação. Além disso, idade, ocupação, estado civil e tempo de prática mostram diferenças significativas nos fatores de motivação dependentes ou independentes da distribuição por gênero (p<0,05). Conclusão: não houve diferenças significativas na motivação intrínseca para a prática desportiva entre os sexos. Outros fatores, por outro lado, tiveram um impacto substancial. Contribuição da pesquisa: esses achados pretendem contribuir para uma melhor compreensão das diferenças na motivação para participar da AF e auxiliar na sua promoção entre adultos libaneses.

Factors that cause women with osteoporosis to fall

ABSTRACT Objectives: To analyze and compare intrinsic and extrinsic factors that cause falls among women receiving treatment for osteoporosis. Subjects and methods: A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale-International (FES-I) and investigated the extrinsic factors for falls. Results: We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n = 71, 49.5%), a faller group (FG; 1 fall, n = 42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n = 31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P < .005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P = .015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P = .028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P < .001). Conclusion: Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.

Effect of three intrinsic foot muscle exercises on cross-sectional area of abductor hallucis muscle and foot morphology in subjects with flatfoot / 中国康复理论与实践

ObjectiveTo compare the effect of three kinds of intrinsic foot muscle exercise on flatfoot. MethodsFrom September to November, 2022, 45 subjects with flatfoot from Capital University of Physical Education and Sports were randomly divided into short foot exercise (SFE) group (n = 15), toe-spread-out exercise (TSOE) group (n = 15) and short foot & toe-spread-out exercise (SF+TSOE) group (n = 15), who received SFE, TSOE and SF+TSOE, respectively, for eight weeks. The cross-sectional area of abductor hallucis muscle, navicular drop test (NDT) and Chippaux-Smirak index (CSI) were measured before treatment, four weeks after treatment and eight weeks after treatment. ResultsThree subjects dropped out in each group. The main effect of time was significant for left and right cross-sectional area of abductor hallucis muscle, NDT and CSI (F > 13.906, P < 0.001). The main effect of group was not significant for left and right cross-sectional area of abductor hallucis muscle, NDT and CSI (F < 1.934, P > 0.05). The interaction effect of group and time was significant for left and right NDT (F > 3.044，P < 0.05), and it was better in SF+TSOE group than in SFE group and TSOE group (P < 0.05). ConclusionSF and TSOE can improve the cross-sectional area of abductor hallucis muscle and foot morphology in subjects with flatfoot, and the combination of them may be more effective.

Correlation between intrinsic capacity and activities of daily living for old adults in China: based on China Health and Retirement Longitudinal Study / 中国康复理论与实践

ObjectiveTo explore the weights and comprehensive indices of each field of intrinsic capacity of old adults, and the correlation between intrinsic capacity and activities of daily living (ADL). MethodsThe data of 5 506 cases aged more than 60 years in the 2015 China Health and Retirement Longitudinal Study (CHARLS) were used to collect the assessment of intrinsic capacity and the measurement of ADL. The assessment of intrinsic capacity included cognition, motor, vitality, sensory and psychology; while the ADL scale included six indicators, namely dressing, bathing, eating, getting in or out of bed, going to the toilet, and controlling urine and feces. ResultsA total of 1 343 cases were limited in ADL (24.4%). Women, lower education level, older age, the widowed, greater number of chronic diseases, and poorer self-rated health were the factors more likely to be limited in ADL. Principal component analysis showed that the largest weight value was in psychological domain, followed by the cognitive domain, and the lowest weight value was in the motor domain. After controlling for the effects of age, gender, living environment, economic income, education level, marriage, smoking and drinking, number of chronic diseases, and self-rated health, the Logistic regression analysis showed that low exercise capacity (OR = 0.581, 95%CI 0.501 to 0.674), depression (OR = 0.426, 95%CI 0.368 to 0.493), audile and visual impairment (OR = 0.813, 95%CI 0.699 to 0.947; OR = 0.684, 95%CI 0.578 to 0.809), overweight (OR = 1.203, 95%CI 1.014 to 1.428) and obesity (OR = 1.584, 95%CI 1.312 to 1.912) were independent risk factors for ADL limitation in older adults. ConclusionDecrease of intrinsic capacity is a predictor for ADL limitation in older adults.

Research progress of physical resilience in the elderly / 中华全科医师杂志

With the increase of the elderly population, health problems of the elderly are more prominent and the health needs of the elderly are more complex and diverse, therefore, how to maintain their physical functional status has become the focus of research. Physical resilience and successful aging are closely related. This article reviews the concept of physical resilience, the relationship between physical resilience and frailty and intrinsic capacity, and its impact on the health status of the elderly. The aim of the article is to provide a reference for the assessment of physiological resilience and the related interventions to promote healthy aging.

Impact of intrinsic capacity on predicting future falls and readmission in older patients / 中华老年医学杂志

Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.

Research progress on intrinsic capacity in older adults / 中华老年医学杂志

In order to cope with increasingly severe global population aging, WHO defines "healthy ageing" as the process of developing and maintaining the functional ability required for healthy living of the elderly.Functional ability is related to the interaction between intrinsic capacity(IC)and the environment.IC refers to the sum of all the physical and mental abilities of the individual.Unlike frailty and disability, IC focuses on the functional aspects of the elderly, longitudinally tracking a person's life, rather than on health conditions of the individual at a certain time.Evaluation of IC, including cognitive function, psychological status, sensory function, vitality and locomotor function, is expected to become crucial to predict outcomes and risks of care dependence in the elderly.Starting from screening for IC declines of the elderly in the community, integrated care is formulated taking older people and their caregivers into consideration to improve the quality of life of the elderly to the greatest extent and reduce the social burden.

Age-related change in mitochondrial DNA copy number and its correlation with intrinsic capacity and body composition / 中华老年医学杂志

Objective:To investigate the correlation of peripheral blood relative mitochondrial DNA copy number(mtDNAcn)with intrinsic capacity and body composition, and to identify potential biomarkers for healthy aging.Methods:Clinical data of 416 patients admitted to our hospital from September 2019 to June 2021 were consecutively collected.MtDNA was extracted from peripheral blood of these subjects, and mtDNAcn was determined by a real-time fluoresence quantitative reverse transcription-polymerase chain reaction(qRT-PCR). Intrinsic capacity assessment included 5 aspects that were exercise[Morse Fall Scale(MFS), Physiological Frailty Phenotype(PFP), Sarcopenia Questionnaire(SARC-CALF), Short Physical Performance Battery(SPPB), Time Up and Go Test(TUG)]; vitality[Mini Nutritional Assessment(MNA), Multidimensional Prognostic Index(MPI)]; cognition[Mini-Mental State Examination(MMSE)scale]; psychology[Geriatric Depression Scale(GDS), Self-rating Anxiety Scale(SAS)]; sensory capacities[Cumulative Illness Rating Scale-the Comorbidity Index(CIRS-CI)]. To assess body composition, dual-energy X-ray absorptiometry was used to measure body fat, including trunk fat, total body fat, fat in the abdominal region, fat in the buttock region, and then to calculate fat index(FMI)and limb skeletal muscle mass index(ASMI).Results:Spearman correlation analysis showed that mtDNAcn had a negatively correlation with age( r=-0.176, P<0.05). After adjustment for gender and body mass index, partial correlation analysis showed mtDNAcn were still negatively correlated with age( r=-0.144, P<0.05). Furthermore, mtDNAcn was significantly correlated with 4 m gait speed, the scores of SARC-CalF, MFS, MNA, MMSE, MPI and its sub-scale's Activities of Daily Living(ADL)and Short Portable Mental Status Questionnaire(SPMSQ)( r=0.171, -0.207, -0.163, 0.221, 0.184, -0.210, 0.241, -0.269, all P<0.05). After adjustment for age, gender and body mass index, partial correlation analysis showed mtDNAcn still had a significant correlation with gait speed, the scores of MFS, MNA, MPI and SPMSQ( r=0.170, -0.170, 0.148, -0.242, -0.188, all P<0.05). In addition, the Spearman correlation analysis showed that mtDNAcn was positively correlated with FMI, trunk fat, total body fat, abdominal fat and fat in the buttock region( r=0.168, 0.143, 0.175, 0.116, 0.199, all P<0.05). However, after adjustment for age and gender, mtDNAcn was only correlated with FMI, total body fat, fat in the buttock region( r=0.126, 0.131, 0.127, all P<0.05). On the other hand, multiple linear regression analysis showed that mtDNAcn was significantly correlated with age, gait speed, FMI, total body fat, fat in the buttock region, the scores of MFS, PFP, MNA and MPI( β=-0.191, 0.156, 0.126, 0.131, 0.125, -0.119, -0.145, 0.151, -0.171, all P<0.05). Conclusions:MtDNAcn is correlated with physical function, frailty, nutrition, falling, cognition and body composition, and may be considered as a biomarker for the evaluation of the locomotion and vitality of human intrinsic capacity.

Correlation between social and physical anhedonia and intrinsic motivation in patients with schizophrenia / 中华行为医学与脑科学杂志

Objective:To explore the social and physical anhedonia and its relationship to intrinsic motivation in patients with schizophrenia.Methods:One hundred and twenty-five stable schizophrenic patients from three psychiatric hospitals in Hefei, Wuhu and Beihai, and 101 healthy controls from same communities were recruited.All subjects completed Chinese version of revised social anhedonia scale(RSAS-C), Chinese version of revised physical anhedonia scale(RPAS-C) and intrinsic motivation inventory for schizophrenia research(IMI-SR), while positive and negative syndrome scale(PANSS) and Calgary depression scale for schizophrenia(CDSS) were used to assess the clinical symptoms of schizophrenic patients.All analyses were conducted by SPSS 26.0 software.The Mann-Whitney U test and covariance analysis were used for comparison between the groups, and Spearman correlation and multiple logistic regression analysis were used to explore the association between the anhedonia and intrinsic motivation in schizophrenics. Results:Compared with controls, the RSAS-C (10.00(6.00, 14.00) vs 11.00(8.00, 15.00), Z=-2.187, P<0.05) and RPAS-C (12.00(7.50, 20.00) vs 16.00(10.00, 23.00), Z=-3.026, P<0.01) scores in patients were higher, but the differerce between the groups disappeared after controlling age, sex and years of education.The IMI-SR perceived choice subscore (31.00(28.00, 39.00 vs 36.00(31.00, 42.00), Z=-3.172, P<0.01) were lower, while value/usefulness subscores (41.00(35.00, 45.00) vs 36.00(32.00, 42.00), Z=-3.387, P<0.01) were higher in patients than those in controls, and there was no significant difference between the total score and interest/enjoyment subscore(both P<0.05). In patents, Spearman correlation analysis showed that the RSAS-C and RPAS-C scores were significant negatively correlated with the IMI-SR total scores and interest/enjoyment subscore, perceived choice and value/usefulness( r=-0.193--0.364, all P<0.05), which still existed after controlling age, sex, years of education, course of disease, antipsychotic dose, and scores of PANSS and CDSS.Logistic regression analysis showed that the score of RSAS-C( B=-0.096, 95% CI=0.836-0.998, P=0.025) and perceived choice subscore( B=-0.110, 95% CI=0.823-0.974, P=0.010) had negative effects on the IMI-SR total score. Conclusion:There is a correlation between anhedonia and intrinsic motivation in patients with schizophrenia, the higher the social anhedonia, the lower the intrinsic motivation to participate in cognitive activities, suggesting that intervention for social anhedonia may have significance in improving the intrinsic motivation of patients with cognitive rehabilitation therapy.

The mediating role of intrinsic motivation between challenge-hindrance stressors and thriving at work among clinical nurses / 中国实用护理杂志

Objective:To explore the relationship between challenge-hindrance stressors and thriving at work in clinical nurses, and to analyze the mediating role of intrinsic motivation.Methods:This was a cross-sectional survey. A total of 319 nurses from the Provincial Hospital Affiliated to Shandong First Medical University, Qilu Hospital of Shandong University, Shandong Provincial Qianfoshan Hospital from May to June 2022 were investigated by general data questionnaire, Challenge-Hindrance Stressors Scale, Intrinsic Motivation Scale and Thriving At Work Scale. Pearson was used to analyze the correlation between various variables, and Amos 23.0 was used to construct a structural equation model to analyze the mediating role of intrinsic motivation between challenging stressors, hindrance stressors, and thriving at work.Results:The score for challenging stressors was (21.22 ± 4.42) points, the score for hindrance stressors was (13.51 ± 3.59) points, the score for intrinsic motivation was (78.96 ± 11.52) points, and the score for thriving at work was (51.27 ± 8.03) points. Challenging stressors was positively associated with intrinsic motivation and thriving at work ( r=0.222, 0.221, both P<0.01), hindrance stressors was negatively associated with intrinsic motivation and thriving at work ( r=-0.152, -0.337, both P<0.01), intrinsic motivation was positively correlated with thriving at work ( r=0.564, P<0.01). Intrinsic motivation was partially mediated between challenging stressors, hindrance stressors and thriving at work, respectively accounting for 16.02% and 13.79%. Conclusions:Challenging stressors and hindrance stressors can indirectly influence their thriving at work through intrinsic motivation. Nursing managers should help nurses treat different stressors correctly to enhance their intrinsic motivation and promote their thriving at work.

Clinical effect of intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy in the treatment of perimenopause with insomnia / 国际中医中药杂志

Objective:To explore the clinical effect and safety of intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy in the treatment of perimenopause with insomnia.Methods:Prospective cohort study. A total of 60 perimenopause with insomnia visiting the Hebei Medical Qigong Hospital were enrolled as the research objects between June 2019 and June 2021. According to random number table method, they were divided into the control group and the observation group, 30 in each group. The control group was treated with oral estazolam tablets, while the observation group was treated with intrinsic-nourishing exercise combined with oral Chinese medicine on basis of the control group. All the patients were treated for 4 weeks as a course, and totally 2 courses. The levels of serum estradiol (E 2), FSH, and LH were detected by automatic chemiluminescence immunoassay analyzer. Pittsburgh sleep quality Index (PSQI) was used to evaluate sleep quality, and the quality of life was evaluated by the MOS 36-item Short Form Health Survey (SF-36). And the responsive rates, sleep quality, scores of TCM symptoms, and adverse reactions were compared before and after treatment. Results:The total response rate of observation group was significantly higher than that of the control group (90.0% vs. 66.7%; χ2=4.81, P<0.05). After treatment, PSQI scores of sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep disturbance, use of hypnotics, and daytime function in the observation group were significantly lower than those in the control group ( t=14.11, 12.49, 9.88, 13.54, 9.47, 14.11, 17.91, P<0.01). After treatment, the TCM symptom scores of insomnia with more dreams, waist and knee soreness, five upsets, fatigue and forgetfulness in the observation group were significantly lower than those in the control group ( t=9.51, 13.08, 16.17, 12.81, P<0.01). After treatment, the E 2 [(35.16±3.61) mmol/L vs. (31.06±3.12) mmol/L, t=4.71] in the observation group was significantly higher than that of the control group ( P<0.01), while the FSH [(69.61±6.04) U/L vs. (73.26±7.41) U/L, t=2.09], and LH [(32.21±3.35) U/L vs. (36.04±3.49) U/L, t=4.34] in the observation group were significantly lower than those in the control group ( P<0.05 or P<0.01). At 4 and 8 week after treatment, the SF-36 scores in the observation group were significantly higher than those in the control group ( t=6.30, 4.36, P<0.01). During treatment, 16.7% (5/30) adverse reaction happened in the observation group, while 10.0% (3/30) in the control group, but there was no statistical significant difference between two groups ( χ2=0.56， P=0.448). Conclusion:The intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy can significantly improve clinical curative effect, improve sleep quality and TCM symptoms, regulate hormones and quality of life in perimenopause with insomnia.