Response to physical activity of females with multiple sclerosis throughout the menstrual cycle: a protocol for a randomised crossover trial (EMMA Project).

The relationship between multiple sclerosis (MS) and females is a crucial aspect in the development of the disease, with the ovarian hormonal cycle being a sensitive stage, especially in females with relapsing-remitting multiple sclerosis. The objectives of the study are to identify moderating variables that modify satisfaction with physical activity practice throughout the menstrual cycle (MC) in females in or out of their MC, during high-intensity interval training (HIIT) and strength training sessions and to compare the acute effects of different types of physical activity sessions in females with and without MS. This protocol is the methodology used in the EMMA Study, a randomised, single-blind crossover trial study conducted in females with MS who were matched 1:1, based on age, lifestyle factors and country of residence, with females without MS, to analyse the effect of physical activity practice on satisfaction, functionality, fatigue and inflammatory profile through their MC. Participants will visit the facilities approximately 10 times (4 preliminary familiarisation visits and 6 visits to carry out a physical activity session in each phase of the MC) for 3-4 months. A total sample of 30 females (15 females without MS and 15 with MS) is necessary for the study. The evaluation will comprise clinical, nutritional and psychological interviews, including different variables. It is hypothesised during the luteal phase, females with MS are expected to exhibit different acute responses to HIIT and strength training sessions as compared with females without the disease. Before starting the study, all participants will read and sign an informed consent form. Trial registration number: This research protocol is registered with ClinicalTrials.gov to ensure transparency and accessibility of study information (NCT06105463). The university's ethics committee number for this study is UALBIO2022/048.

Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that, due to dyspnea, decreases patients' physical function and quality of life. The aim of the research was to evaluate the effectiveness of water-based exercise (WE) in improving functional capacity and respiratory muscle strength in patients with COPD. It consisted of a systematic review and meta-analysis of eight randomized clinical trials (RCTs) from the last 10 years, found in PubMed, PEDro, Scopus and Web of Science databases. Methodological quality was analyzed using the PEDro scale and the Cochrane Collaboration Risk of Bias Tool. Regarding the evaluation of functional capacity, mainly assessed were lung function, respiratory muscle strength, and maximal or aerobic exercise. The results showed that WE improves functional capacity compared to a non-exercising control group (SMD: 73.42; IC 95%: 40.40 to 106.45; I2: 0%). There are no statistically significant differences between a WE treatment and a land exercise (LE) treatment (p = 0.24) in functional capacity, nor with respect to respiratory muscle strength (p = 0.97). These data should be interpreted with caution, as more RCTs with aquatic intervention in COPD patients are needed to elucidate whether there are differences between WE or LE according to patient characteristics and comorbidities.

Academic Stress in University Students: The Role of Physical Exercise and Nutrition.

The university experience can cause academic stress that, in turn, can lead to comorbidities. Students increasingly face demands and challenges that require a large amount of physical and psychological resources. These circumstances can make them experience physical and mental fatigue, lower their interest in studying, and even lead them to lose control over their academic performance and health. The objective of this work is to determine the relationship between the practice of physical exercise, eating patterns, and academic stress among university students. A questionnaire was administered to 742 students using non-probabilistic sampling. The mean age was 21.24 (DT = 3.8), and 20.1% were men and 79.4% were women. To identify academic stress, the Stress Manifestation Scale of the Students Stress Inventory (SSI) subscale was used; the Mediterranean Diet Score was applied for eating patterns, and the practice of exercise was measured by weekly hours of exercise. The results show that there is a relationship between academic stress and physical exercise, but not with adherence to the Mediterranean Diet. However, there is a relationship between the consumption of "unhealthy" foods exceeding the recommendations for the Spanish population and academic stress. In short, physical activity and diet are variables that are related to psychological well-being. Therefore, they should constitute the backbone of actions designed by university managers to eliminate or reduce stress suffered by students. Finally, the work demonstrates the need to create new scales that consider not only the foods that help alleviate stress but also their portions.

Effectiveness of Physiotherapy in Managing Symptomatology in Gambling Disorder Patients: A Systematic Review.

Although the prevalence of gambling disorder (GD) and problem gambling has remained stable in recent years, the expansion of legalized gambling is considered a public health problem leading to significant personal, familial, and social impacts. This study aims to assess the effectiveness of various physiotherapy interventions on the symptoms of patients with GD. A systematic review following PRISMA guidelines was conducted in December 2022, using descriptors related to physiotherapy and GD in ten databases. Inclusion criteria were designed to identify clinical trials published in the last decade. Eight studies were identified, with a total of 357 patients, and the main variables measured were anxiety and depression symptoms, gambling craving, and gambling desire. The interventions included aerobic exercise, relaxation techniques, and non-invasive brain stimulation. Results suggest that physiotherapy may help with GD symptoms, although more research is needed to strengthen these findings. These findings highlight the potential of physiotherapy in treating GD and provide a basis for future research to better understand the effectiveness of these interventions.

Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis.

Parkinson's disease (PD) is a neurodegenerative pathology classified as a movement disorder. Physical exercise within a physiotherapy program is an important element to improve postural stability, balance and mobility in order to reduce falls in people with PD. The aim of this work was to determine the efficacy of specific balance and trunk mobility exercises, as well as their benefits for and effects on patients with idiopathic PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The search was performed in five databases: Cochrane Library, SciELO, PEDro, Scopus and PubMed, in February 2022 with the following descriptors: Parkinson's disease, trunk, exercise, therapy and physical therapy. The inclusion criteria were randomized controlled trials (RCTs) over the last ten years. A meta-analysis on static and dynamic balance was conducted with the software Review Manager. Nine articles met the objectives and inclusion criteria, with a total of 240 participants. The trials had moderate methodological quality according to the PEDro scale. The studies included differed with regard to intervention protocol and outcome measures. Finally, eight studies were included in a quantitative analysis in which it was shown that trunk-specific exercises interventions did not significantly improve static balance (SMD = -0.10, 95% CI = -0.29, 0.08; p = 0.28) or dynamic balance (SMD = 0.64 95% CI = -0.24, 1.52; p = 0.15). However, significant differences were found in static balance measured subjectively using the Berg Balance Scale (SMD = -0.52, 95% CI = -1.01, -0.02; p = 0.04). Although some differences were not significant, the studies included in this systematic review consider that specific trunk exercises or balance training combined with muscle strengthening in patients with idiopathic PD should be a complement to pharmacological treatment for improving balance dysfunction and postural instability, preventing falls and promoting wellness.

Telerehabilitation, A Viable Option in Patients with Persistent Post-COVID Syndrome: A Systematic Review.

The number of patients with post-COVID-19 syndrome continues to increase considerably, having serious healthcare, social and economic repercussions. The objective of this study is to describe the effectiveness of telerehabilitation to alleviate the symptoms of post-COVID-19 syndrome. A systematic review was conducted using the information available on four databases (PubMed, Medline, Scielo and PEDRo) on these patients until November 2022. The MeSH search terms were: Post-COVID syndrome, Post-COVID-19, Long COVID, Telerehabilitation, Physiotherapy, Rehabilitation, Virtual, Home care. Six articles were included which provided information on 140 patients, detailing their symptomatology, assessment, treatment and monitoring. The variables measured were dyspnea, fatigue, physical performance and quality of life. All studies included aerobic and anaerobic exercises. Most notable among the techniques used were rib cage expansion exercises, respiratory control and thoracic cage stretching, patient education, Mindfulness and virtual reality games to address physical, mental and relaxation aspects. The use of telerehabilitation could be an effective tool for the treatment of persistent symptoms after suffering from COVID-19. It has been shown in these studies that patients improve both their physical performance and their quality of life.

Comparative Analysis of Quality of Life of Patients with Dermatological Problems: Teledermatology Versus Face-to-Face Dermatology.

The health-related quality of life (HRQoL) of the patients cared for with teledermatology (TD) services was analyzed as compared with face-to-face dermatology (F-F/D) at the hospital. This study was a controlled, non-blinded, intra-level, and multicenter randomized clinical trial, with a 6-month follow-up. A total of 450 patients were randomly assigned to two different groups. The Spanish version of the generic EuroQol-5-dimensions-5-Levels (EQ-5D-5L) questionnaire and the specific Skindex-29 questionnaire were used at 0 and 6 months. The number of primary care visits (2.24 TD; 1.68 F-F/D) and number of hospital visits (0.01 TD; 1.48 F-F/D) were statistically significant. It was observed that from month 0 onwards, the users included in the F-F/D group self-perceived a lower HRQoL than the users included in the TD group (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). At the end of the study, the patients included in the F-F/D group still obtained lower scores in their perception of HRQoL, as compared to those included in the other type of follow-up (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). TD was an effective diagnosis and follow-up tool. At the end of the study period, the HRQoL of the patients in both groups was significantly higher as compared to their baseline levels. Additionally, both the general and specific HRQoL perceived by the TD patients was higher than the F-F/D group from the start of the study.

Patients' Experiences and Communication with Teledermatology versus Face-to-Face Dermatology.

(1) Background: Teledermatology (TD) has exponentially grown since the onset of COVID-19, as the Face-to-Face Dermatology (F-F/D) modality changed within Public Health Systems. Although studies have been conducted on health results, we did not find any that analyzed the experiences of individuals who received care through TD. Therefore, the main objective of the study was to analyze the experiences of dermatology patients and the communication with health personnel. (2) Methods: A multicenter, controlled, randomized, non-blinded clinical trial was designed. Data were collected during the six months of follow-up. Four-hundred and fifty patients participated in the present study, who were assigned to two different groups: TD and F-F/D. The sociodemographic and clinical characteristics of the participants were collected. The 'Generic Short Patient Experiences Questionnaire' (GS-PEQ) was used to assess patients' experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. (3) Results: After six months of follow-up, 450 patients completed the study (TD = 225; F-F/D = 225) of which 53.3% were women, with an average age of 52.16 (SD = 19.97). The main reasons for the consultations were skin lesions (51.56%) located on the head and neck (46.8%), followed by the legs (20.7%). According to the GS-PEQ, TD users indicated having a greater confidence in the professional skills of the doctors (p < 0.01). However, the F-F/D group indicated having received more adequate information about their diagnosis/afflictions (p < 0.01), were more involved in the decisions related to their treatment (p < 0.01), and more satisfied with the help and treatment received (p < 0.01). Regarding the HCCQ, the TD group obtained better assessments with respect to if the patients had been treated in a rude and hasty manner, if the health professionals had addressed them with a smile, and if these could adequately manage the reason for the consultation (p < 0.01). (4) Conclusions: The results of the study generally showed positive experiences and communication. The TD group indicated having received less information about the diagnosis, were less involved in the decisions, and were less satisfied with the help and treatment received. However, they indicated having more confidence on the professional skills of the doctors, and that the work at the institution was better organized. In addition, they perceived better communication skills of the health professionals, although less respect for their privacy.

Effectiveness of positive expiratory pressure on patients over 16 years of age with cystic fibrosis: systematic review and meta-analysis.

INTRODUCTION: Cystic fibrosis (CF) is an autosomal recessive disease that involves the cells that produce mucus and sweat, affecting many organs, especially the lungs. Positive expiratory pressure (PEP) devices generate a pressure opposite to that exerted by the airways during expiration, thus improving mucociliary clearance. OBJECTIVES: To evaluate the efficacy of PEP devices as a resource to facilitate the mucus removal and other outcomes in people with CF, as well as the possible adverse effects derived from their use. MATERIAL AND METHOD: A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were 'cystic fibrosis', 'PEP', and 'physiotherapy and/or physical therapy'. The search was performed in four databases: PubMed, PEDro, and Web of Science and Scopus, in July 2021. The inclusion criteria were randomized controlled trials (RCTs) over the last 10 years. The methodological quality of the studies was analyzed and meta-analysis was performed with Review Manager software. RESULTS: Ten RCTs met the objectives and criteria, with a total of 274 participants. The trials score a moderate methodological quality on the PEDro scale. No clear results were obtained on whether PEP provides better lung function than other breathing techniques (such as airway clearance); but it does achieve a higher rate of lung clearance than physical exercise. CONCLUSIONS: PEP is more effective than usual care or no intervention, although there is not enough evidence to confirm that PEP achieves improvements in forced expiratory volume in the first second (FEV1) compared with other techniques. It is a safe technique, without adverse effects.

Effectiveness of Video Games as Physical Treatment in Patients with Cystic Fibrosis: Systematic Review.

Physical training at home by making individuals play active video games is a new therapeutic strategy to improve the condition of patients with cystic fibrosis (CF). We reviewed studies on the use of video games and their benefits in the treatment of CF. We conducted a systematic review with data from six databases (PubMed, Medline, Scopus, Web of Science, PEDro, and Cochrane library plus) since 2010, according to PRISMA standards. The descriptors were: "Cystic Fibrosis", "Video Game", "Gaming Console", "Pulmonary Rehabilitation", "Physiotherapy", and "Physical Therapy". Nine articles with 320 participants met the inclusion criteria and the study objective. Patients who played active video games showed a high intensity of exercise and higher ventilatory and aerobic capacity compared to the values of these parameters in tests such as the cardiopulmonary stress test or the six-minute walk test. Adequate values of metabolic demand in these patients were recorded after playing certain video games. A high level of treatment adherence and satisfaction was observed in both children and adults. Although the quality of the included studies was moderate, the evidence to confirm these results was insufficient. More robust studies are needed, including those on evaluation and health economics, to determine the effectiveness of the treatment.

Teledermatology versus Face-to-Face Dermatology: An Analysis of Cost-Effectiveness from Eight Studies from Europe and the United States.

(1) Background: The aim of this systematic review was to compare the cost-effectiveness of two follow-up methods (face-to-face and telemedicine) used in dermatology in the last ten years. (2) Methods: A search for articles that included economic analyses was conducted in August 2021 in the databases PubMed, Medline, Scielo and Scopus using the following keywords: "Cost-Benefit Analysis", "Dermatology", "Telemedicine", "Primary Health Care", as well as other search terms and following the PICOS eligibility criteria. (3) Results: Three clinical trials and five observational studies were analyzed, providing information for approximately 16,539 patients (including four cost-minimization or saving analyses, three cost-effectiveness analyses, and one cost-utility analysis) in Europe and the United States. They describe the follow-up procedures in each of the cases and measure and analyze the direct and indirect costs and effectiveness. All the articles indicate that teledermatology lowers costs and proves satisfactory to both patients and professionals. (4) Conclusions: Although it has been found that follow-up via teledermatology can be more efficient than traditional hospital follow-up, more work is needed to establish evaluation protocols and procedures that measure key variables more equally and demonstrate the quality of the evidence of said studies.

Correction: A non-randomized clinical trial to examine patients' experiences and communication during telemonitoring of pacemakers after five years follow-up.

[This corrects the article DOI: 10.1371/journal.pone.0261158.].

Self-Stigma, Mental Health and Healthy Habits in Parent of Children with Severe Mental Disorder.

BACKGROUND: Family members who have children with Severe Mental Disorder under their care have a hard impact on them as they are faced with the task of attending to their demands and care. This is a change in their lives as it significantly interferes with their physical and social well-being. The aim of this study was to explore the relationships between self-stigma, depression, stress and anxiety and their relationship with healthy habits, such as sport and a healthy diet. METHODS: The sample consisted of 538 parents aged between 38 and 52 years (M = 43.42; SD = 13.11). The parents have children with a diagnosis of mental disorder under their care. Participants completed the Spanish adaptation of the Self-Stigma in Relatives of people with Mental Illness (SSRMI), the Depression, Anxiety and Stress Scale (DASS-21), the Kidmed Scale and the WHO scale, whose responses were analysed using structural equation modelling. RESULTS: The results showed that self-stigma was positively related to anxiety, stress and depression and, in turn, these three variables were negatively related to sporting activity and healthy eating. CONCLUSION: This study, therefore, is further evidence of the impact of self-stigma at the physical and mental level on family members, which highlights the need to provide them with support tools and resources, and to work on raising social awareness of mental disorders.

A non-randomized clinical trial to examine patients' experiences and communication during telemonitoring of pacemakers after five years follow-up.

Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The 'Generic Short Patient Experiences Questionnaire' (GS-PEQ) was used to assess patients' experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the 'Telehealth Patient Satisfaction Survey' and a 'costs survey' was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants' mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians. Trial registration: ClinicalTrials.gov NCT02234245.

Análisis de los factores relacionados con el tiempo prehospitalario en la atención al ictus / Factors related to prehospital time in caring for patients with stroke

Objetivo: Identificar factores que influyen en el tiempo prehospitalario (TPH) en pacientes que presentan un ictus. Método: Se realizó una revisión sistemática de la literatura en 6 bases de datos. Se seleccionaron estudios descriptivos, publicados entre 1995 y 2019, en inglés, portugués o castellano, que identificasen factores que influyen en el TPH en pacientes que han padecido un ictus. Resultados: Se analizaron 101 artículos. Se identificaron factores relacionados con el marco temporal en la atención prehospitalaria del ictus, que se clasificaron en sociodemográficos, clínicos, contextuales, cognitivos y conductuales. El aviso inmediato al sistema de emergencias médicas (SEM) fue el principal factor que redujo el TPH; ser derivado desde otro centro sanitario se relacionó con un mayor TPH. Conclusión: El TPH depende de factores inherentes al paciente y a su entorno. Es necesario el desarrollo de estrategias educativas que incidan sobre dichos factores, especialmente sobre la importancia de reconocer los síntomas iniciales del ictus y del aviso inmediato al SEM. (AU)

Objectives: To identify factors that affect prehospital time (PHT) for patients with stroke. Material and methods: Systematic review. We searched 6 databases to select descriptive studies of factors influencing PHT in stroke. The studies selected were published in English, Portuguese, or Spanish between 1995 and 2019. Results: One hundred one articles were analyzed. Sociodemographic, clinical, contextual, cognitive, and behavioral data related to PHT in patients with stroke were identified. Calling the emergency medical services (EMS) immediately after onset of stroke symptoms was the main factor associated with a shorter PHT. Referral from another hospital was associated with a longer PHT. Conclusion: PHT is affected by factors inherent to patients and the setting for the event. Educational strategies should be developed to address relevant factors, especially regarding the importance of recognizing the onset of a stroke and calling the EMS immediately. (AU)

Factors related to prehospital time in caring for patients with stroke. / Análisis de los factores relacionados con el tiempo prehospitalario en la atención al ictus.

OBJECTIVES: To identify factors that affect prehospital time (PHT) for patients with stroke. MATERIAL AND METHODS: Systematic review. We searched 6 databases to select descriptive studies of factors influencing PHT in stroke. The studies selected were published in English, Portuguese, or Spanish between 1995 and 2019. RESULTS: One hundred one articles were analyzed. Sociodemographic, clinical, contextual, cognitive, and behavioral data related to PHT in patients with stroke were identified. Calling the emergency medical services (EMS) immediately after onset of stroke symptoms was the main factor associated with a shorter PHT. Referral from another hospital was associated with a longer PHT. CONCLUSION: PHT is affected by factors inherent to patients and the setting for the event. Educational strategies should be developed to address relevant factors, especially regarding the importance of recognizing the onset of a stroke and calling the EMS immediately.

OBJETIVO: Identificar factores que influyen en el tiempo prehospitalario (TPH) en pacientes que presentan un ictus. METODO: Se realizó una revisión sistemática de la literatura en 6 bases de datos. Se seleccionaron estudios descriptivos, publicados entre 1995 y 2019, en inglés, portugués o castellano, que identificasen factores que influyen en el TPH en pacientes que han padecido un ictus. RESULTADOS: Se analizaron 101 artículos. Se identificaron factores relacionados con el marco temporal en la atención prehospitalaria del ictus, que se clasificaron en sociodemográficos, clínicos, contextuales, cognitivos y conductuales. El aviso inmediato al sistema de emergencias médicas (SEM) fue el principal factor que redujo el TPH; ser derivado desde otro centro sanitario se relacionó con un mayor TPH. CONCLUSIONES: El TPH depende de factores inherentes al paciente y a su entorno. Es necesario el desarrollo de estrategias educativas que incidan sobre dichos factores, especialmente sobre la importancia de reconocer los síntomas iniciales del ictus y del aviso inmediato al SEM.

Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis.

Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were "dysmenorrhea", "physical the-rapy", "physiotherapy", and "manual therapy". The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: -1.13, 95% CI: -1.61 to -0.64, I2: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities.

Explanatory Factors for Periprosthetic Infection in Total Knee Arthroplasty.

There are many studies whose results reveal possible risk factors for developing an infection after a total knee arthroplasty (TKA). The objective of this study is to analyse the risk factors that depend on the hospital and, especially, if the patellar replacement influences the appearance of periprosthetic infection. A retrospective study was performed, where data from the electronic registry of patients of people over 18 and who had undergone TKA, between the years 2015 and 2018, were reviewed. Dependent variables on the patients and the health care system were collected. The possible associations between the factors and the appearance of infection after TKA were studied using univariate and multivariate regression analyses. A total of 907 primary knee arthroplasties were included in the study. Those patients who had their patella replaced had a significantly higher risk of developing an infection (OR 2.07; 95% confidence interval 1.01-6.31). Likewise, patients who underwent surgery by surgeons with more than 10 years of experience were more than twice as likely to become infected than those operated on by younger surgeons (OR 2.64; 95%CI 1.01-6.97). Male patients were also found to be three times more likely to be infected than women (OR 2.99; 95%CI 1.32-5.74). Those interventions that were longer had a higher risk of infection. The same happened with patients who stayed in the hospital for a longer period of time. The rest of the variables did not show statistically significant results. In this study, it was found that the replacement of the patella may be a factor of infection, but it should be corroborated with randomized clinical trials. Furthermore, patients who underwent longer surgeries or those with prolonged hospital stays should be closely monitored to detect infection as soon as possible and establish the most appropriate treatment.

Inattention, Impulsivity, and Hyperactivity in Deaf Children Are Not Due to Deficits in Inhibitory Control, but May Reflect an Adaptive Strategy.

The present study had two main aims: (1) to determine whether deaf children show higher rates of key behaviors of ADHD (inattentive, hyperactive, and impulsive behaviors) and of Conduct Disorder-CD-(disruptive, aggressive, or antisocial behaviors) than hearing children, also examining whether the frequency of these behaviors in deaf children varied based on cochlear implant (CI) use, type of school (regular vs. specific for deaf) and level of receptive vocabulary; and (2) to determine whether any behavioral differences between deaf and hearing children could be explained by deficits in inhibitory control. We measured behaviors associated with ADHD and CD in 34 deaf and hearing children aged 9-10 years old, using the revised Spanish version of the Conners scale. We then assessed inhibitory control ability using a computerized Stroop task and a short version of the Attention Network Test for children. To obtain a measure of the level of receptive vocabulary of the deaf children we used a Spanish version of the Carolina Picture Vocabulary Test for Deaf and hearing-impaired children. Deaf children showed significantly higher rates of behaviors associated with ADHD and CD, and over 85% of cases detected with high risk of ADHD-inattentive type in the entire present sample were deaf children. Further, in the group of deaf children a negative correlation was found between receptive vocabulary and frequency of disruptive, aggressive, or antisocial behaviors associated with CD. However, inhibitory control scores did not differ between deaf and hearing children. Our results suggested that the ADHD-related behaviors seen in deaf children were not associated with a deficit in inhibitory control, at least in the interference suppression subcomponent. An alternative explanation could be that these behaviors are reflecting an adaptive strategy that permits deaf children to access information from their environment which is not available to them via audition.

The Influence of Teachers on Motivation and Academic Stress and Their Effect on the Learning Strategies of University Students.

Students often experience the university period as a very stressful time. The teacher is a key figure who can cushion this stressful experience for the student. This study therefore aims to analyse the influence of teachers from the Self-Determination Theory perspective on academic stress, motivation, critical thinking, metacognitive strategies and academic performance in university students. The study involved 2456 university students with an average age of 22.51 years. A structural equation model was created to analyse the causal relationships between the variables. The results showed that the psychological controlling of the teacher positively predicted academic stress while autonomy support negatively predicted academic stress. Academic stress negatively predicted motivation, metacognitive strategies, critical thinking and academic performance. Academic motivation positively predicted metacognitive strategies and critical thinking. Finally, metacognitive strategies and critical thinking positively predicted academic performance. These results highlight the importance of the role that the teacher adopts during classes and the protective factor of academic motivation in the presence of stress.