Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies.

Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG.    Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.

Pericarditis aguda secundaria a COVID-19 / Acute pericarditis secondary to COVID-19

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Is Viewing Sexually Explicit Material Cheating on Your Partner? A Comparison Between the United States and Spain.

This cross-sectional study examined whether university students from the U.S. (n = 392) and Spain (n = 200) considered the viewing of sexually explicit material (SEM) to be tantamount to committing infidelity. Participants' ages ranged from 18 to 36 (U.S. sample) and 18 to 35 (Spain sample), respectively. At both universities, the study was made available to students via a computer program that allows recruitment and completion of the questionnaires online. It was found that the majority of U.S. and Spanish participants (73 and 77%, respectively) indicated that they did not consider viewing SEM as an act of infidelity. Also, overall, U.S. participants, those who were not currently in a relationship, and those who do not view SEM, were significantly more likely to believe that viewing SEM constituted infidelity compared to Spanish participants, those currently in a relationship, and those who view SEM. Finally, it was found that among U.S. and Spanish participants, intolerance of infidelity in general, negative attitudes toward SEM, and the proclivity for jealousy significantly correlated with believing that viewing SEM was tantamount to infidelity. For U.S. participants only, religiosity and (low) self-esteem also correlated with the belief that viewing SEM was infidelity. Implications of the findings are discussed.

Evaluación del bienestar espiritual en pacientes en cuidados paliativos / Assessment of spiritual well-being in palliative care patients

OBJETIVO: La evaluación del bienestar espiritual del paciente es un aspecto crítico y fundamental en la atención holística y multidisciplinar. Disponer de un instrumento válido de evaluación de la espiritualidad con finalidad tanto investigadora como clínica es muy conveniente. En este estudio se examina la presencia de bienestar espiritual, o sentido de la vida, en pacientes en cuidados paliativos a través de un cuestionario con garantías psicométricas de calidad. PACIENTES Y MÉTODOS: Han participado en este estudio con diseño transversal un total de 60 pacientes en cuidados paliativos. El instrumento básico empleado ha sido la versión española del Cuestionario del Sentido de la Vida (Meaning in Life Scale), de 21 ítems y 4 escalas: Propósito, Falta de significado, Paz, y Beneficios de la espiritualidad. Se proporciona, también, una puntuación global de espiritualidad. Se registraron, además, variables de tipo clínico y sociodemográfico, así como estimaciones del estado de salud, calidad de vida (general y actual), felicidad personal, el grado de religiosidad y la creencia en la existencia de vida ultraterrena. RESULTADOS: Los resultados muestran que la versión española de este instrumento (Cuestionario del Sentido de la Vida [Meaning in Life Scale]) es una medida de bienestar espiritual con garantías psicométricas de calidad (buena fiabilidad y validez), adecuada para evaluar la complejas exigencias generadas por la enfermedad crónica del paciente en cuidados paliativos. El bienestar espiritual se relaciona significativamente con diversas variables de calidad de vida, percepción de salud, felicidad personal o religiosidad. No existe una relación significativa entre las puntuaciones de espiritualidad y variables sociodemográficas como la edad o el sexo. La presencia de bienestar espiritual en estos pacientes es más baja de la esperada. CONCLUSIÓN: Este cuestionario de espiritualidad resulta un instrumento válido para valorar las 4 dimensiones básicas del bienestar espiritual. Los resultados sugieren que considerar y evaluar el bienestar espiritual de los pacientes en cuidados paliativos puede ser de ayuda para la práctica clínica. La presencia de espiritualidad parece desempeñar un papel importante en el bienestar psicológico, el estado de salud y la calidad de vida percibidos por el paciente en cuidados paliativos. El grado de bienestar espiritual de estos pacientes es relativamente bajo

OBJECTIVE: Assessing spiritual well-being is an essential and critical aspect of holistic and multidisciplinary patient care practice. A valid assessment of spirituality is necessary for clinical and research purposes. This study examined the presence of spiritual well-being, or meaning in life, in palliative care patients using a psychometrically-sound questionnaire of spirituality. PATIENTS AND METHODS: A cross-sectional study was carried out with 60 palliative care patients. The main instrument, a Spanish-language version of the 21-item Meaning in Life Scale, comprises 4 scales: PURPOSE, Lessened Meaning, Peace, and Benefits of Spirituality. A total score for Spiritual well-being is also achieved. The following variables were also used: clinical, sociodemographic and assessments on self-rated health, quality of life (general and recently), personal happiness, religiosity, and belief in an afterlife. Results: Results of this study demonstrated that the Meaning in Life Scale is a psychometrically-sound measure of spiritual well-being for the palliative care patient (good reliability and validity), as they manage the complex demands of a chronic illness. Spiritual well-being was significantly associated with various quality of life variables, health status, personal happiness, or religiosity in patients on palliative care. No association was found between spirituality scores and sex or age. The presence of spiritual well-being in palliative care patients was lower than expected. CONCLUSION: This spirituality questionnaire is a valid instrument to assess 4 core dimensions of spiritual well-being. The results suggest that to address and assess spiritual well-being with palliative care patients may be helpful for clinical praxis. Spirituality may play an important role in the psychological well-being, quality of life, and self-rated health for palliative care patients. Spiritual well-being in these patients was relatively low

A relaxation technique enhances psychological well-being and immune parameters in elderly people from a nursing home: a randomized controlled study.

BACKGROUND: The aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease. In residential programs for the aged, it is vital to diminish their risk of disease, promote their independence, and augment their psychological well-being and quality of life. METHODS: We performed a randomized controlled study, evaluating the ability of a relaxation technique based on Benson's relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group. The study included a 2-week intervention period and a 3-month follow-up period. The main outcome variables were psychological well-being and quality of life, biomedical variables, immune changes from the pre-treatment to post-treatment and follow-up periods. RESULTS: Our findings reveal significant differences between the experimental and control groups in CD19, CD71, CD97, CD134, and CD137 lymphocyte subpopulations at the end of treatment. Furthermore, there was a decrease in negative affect, psychological discomfort, and symptom perception in the treatment group, which increased participants' quality of life scores at the three-month follow-up. CONCLUSIONS: This study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly. The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people. This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs, but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN85410212.