Conceptual framework of mental health literacy: Results from a scoping review and a Delphi survey.

Mental health literacy (MHL) has been identified as a factor influencing early help-seeking for mental health problems (MHPs) and stigmatizing attitudes. However, the lack of consensus on its definition has led to considerable heterogeneity in measurement and, consequently, methodological challenges in comparing data. In this way, the present study was conducted with the following objectives: in Phase I, mapping the existing literature through a scoping review; in Phase 2, 28 experts in the field of mental health participated to develop a consensus statement on the relevance and importance of the findings from Phase 1. A total of 37 articles were included for review. Notable nuances were identified in the conceptualization of MHL, particularly with regard to the fact that it should not be limited to mental disorders but should also encompass mental health. Furthermore, the sociocultural influence was highlighted as shaping MHL, recognizing it as a modifiable competence that adapts to different contexts and life stages, involving both individual and collective levels. The experts deemed the findings pertinent and relevant with a high degree of consensus, except for factors related to MHL. This framework provides a refined definition of MHL and related factors that should be taken into account to guide nursing and other disciplines' studies and interventions on MHL. The evolution of this concept includes dimensions to be considered in future research, especially when developing new measurement instruments or implementing educational programmes. This knowledge and skills cannot be determined globally without considering the context and development of the individual.

New correlations between ocular parameters and disease severity in Spanish patients with Gaucher's disease Type I.

BACKGROUND: Gaucher's disease is associated with a high variety of structural and functional abnormalities in the eye, which do not always affect visual acuity. The purpose of this study was to analyse ocular features in Spanish patients with Gaucher's disease type I, and to investigate their possible correlation with phenotypic and burden parameters of this entity. METHODS: This cross-sectional observational study compared parameters belonging to 18 eyes from 9 Spanish patients with Gaucher's disease Type I with 80 eyes from 40 healthy controls. Complete ophthalmological examination included choroidal and retinal thickness maps with swept source optical coherence tomography. Systemic analysis included genotype, plasmatic biomarkers, [ferritin, chemokine ligand 18 (CCL18) and chitotriosidase (ChT)] and severity scoring systems results ["Gaucher Disease Severity Score Index Type I" (GauSSI-I) and "Gaucher disease severity scoring system" (GD-DS3)]. RESULTS: Nine subjects (18 eyes) were cases (female: 55.5%, mean age 45 years; male: 44.5%, mean age 36 years) and 40 subjects (80 eyes) were controls (female: 49%, mean age 50 years; male: 51%, mean age 55 years). There were no statistically significant differences when comparing ocular parameters (visual acuity; axial length, refractive errors, corneal parameters, lens, retinal and choroidal thickness) between case and control subjects (p>0.05). A statistically significant moderate correlation was observed between lower retinal thickness and choroidal quadrants thickness and greater disease severity scores. A lower central retinal thickness also correlates with higher biological plasmatic levels, and has a statistically significant association with the most affected patient with genotype N370S/Del 55pb. Conversely, higher pachymetry involves a more severe plasmatic concentration of biomarkers. CONCLUSIONS: Our results suggest that pachymetry, and retinal and choroidal thickness, are associated with burden biomarkers and disease severity index scores in Spanish patients with Gaucher's disease Type I.

HIF-1α and HIF-2α redundantly promote retinal neovascularization in patients with ischemic retinal disease.

Therapies targeting VEGF have proven only modestly effective for the treatment of proliferative sickle cell retinopathy (PSR), the leading cause of blindness in patients with sickle cell disease. Here, we shift our attention upstream from the genes that promote retinal neovascularization (NV) to the transcription factors that regulate their expression. We demonstrated increased expression of HIF-1α and HIF-2α in the ischemic inner retina of PSR eyes. Although both HIFs participated in promoting VEGF expression by hypoxic retinal Müller cells, HIF-1 alone was sufficient to promote retinal NV in mice, suggesting that therapies targeting only HIF-2 would not be adequate to prevent PSR. Nonetheless, administration of a HIF-2-specific inhibitor currently in clinical trials (PT2385) inhibited NV in the oxygen-induced retinopathy (OIR) mouse model. To unravel these discordant observations, we examined the expression of HIFs in OIR mice and demonstrated rapid but transient accumulation of HIF-1α but delayed and sustained accumulation of HIF-2α; simultaneous expression of HIF-1α and HIF-2α was not observed. Staggered HIF expression was corroborated in hypoxic adult mouse retinal explants but not in human retinal organoids, suggesting that this phenomenon may be unique to mice. Using pharmacological inhibition or an in vivo nanoparticle-mediated RNAi approach, we demonstrated that inhibiting either HIF was effective for preventing NV in OIR mice. Collectively, these results explain why inhibition of either HIF-1α or HIF-2α is equally effective for preventing retinal NV in mice but suggest that therapies targeting both HIFs will be necessary to prevent NV in patients with PSR.

Microscopic Study of Injectable Steroids: Effects of Postmixing Time on Particle Aggregation.

BACKGROUND: Epidural steroid injection (ESI) is a common practice for pain treatment since 1953. In 2014, the FDA issued a warning about ESI. Studies have focused on the effect of the particle size and their ability to generate harmful aggregates. Although steroid aggregates provide longer times for reabsorption, therefore a longer anti-inflammatory effect, they are potentially harmful to the central nervous system via embolic mechanisms.Previous studies have established that steroidal aggregates with asizes over 100 mu m are potentially able to occlude blood vessels. Studies by Tiso et al and Benzon et al addressed the role of steroids on CNS adverse events, with similar outcomes. The main difference was on the role of aggregates with a size over 100 mu m, which Benzon et al. attributed to the ability of certain steroid preparations to rapidly precipitate and form large aggregates. OBJECTIVES: Studying the effect of the time elapsed between mixing the steroid preparation and injection on the number and size of aggregates with sizes above 100 mu m. STUDY DESIGN: Original study in basic science. SETTING: Basic scienceMETHODS: Steroids evaluated are commonly used in Spain for ESI: betamethasone, triamcinolone, and dexamethasone. The size and number of the aggregates was determined for undiluted commercial steroid preparations in the usual amount for a single and double dosage used for ESI.Samples were examined with a Leica TCS-SP2 microscope at the first, the fifth and the 30th minute after shaking the preparations. Aggregates observed in the different preparations were manually counted and grouped in the following size range: 0-20, 20-50, 50-100, 100-300, 300-500 and > 500 mu m.Statistical analysis was carried out using the R software. Nonparametric techniques were used in the comparison of aggregate size. Global comparison of the groups using the Kruskal-Wallis test and post-hoc comparisons using the Wilcoxon test, adjusting P-values by the Holm method for multiple comparisonsRESULTS: Aggregates present in triamcinolone and betamethasone samples were statistically larger than in dexamethasone samples. Triamcinolone suspensions produced significantly larger aggregates than betamethasone five minutes after mixing. Triamcinolone preparations produced greater particle aggregates (> 500 mu m), which were not present in dexamethasone and betamethasone preparations. LIMITATIONS: Study how the human internal factors like blood elements and spinal fluid could interact with steroids and influence the size of the aggregates formed. CONCLUSIONS: This study demonstrates that the size of the particles injected depends on the type of steroid and the time allowed between mixing and injecting. The results demonstrate that waiting longer than 5 minutes between mixing and injecting can predispose the formation of potentially harmful aggregates in triamcinolone and betamethasone samples. The presence of greater particle aggregates (> 500 mu m) may occlude some important vessels and arteries with serious adverse results. Vigorous shaking of the injectable could prevent such events. KEY WORDS: Epidural steroid injection, triamcinolone, betamethasone, dexamethasone, steroid aggregates.

Cervical plexus as anatomical target for the treatment of postoperative cervical neuropathic pain.

Objective: The incidence of chronic neuropathic pain following neck dissections is approximately 40%. Standard drug therapy in these patients include pharmacologic treatments due to the neuropathic pain (gabapentinoids, tricyclic antidepressants…). In this case, standard options were limited. The addition of ultrasound guidance to invasive pain management techniques has enabled us to successfully treat pathologies in which previous treatments options had been limited. Pulsed radiofrequency (PRF) ablation permits treatment over nerve structures that, due to either their morphological or functional characteristics, could not be approached using the conventional variant. Case report: A 45-year-old man with severe postoperative pain after undergoing partial glossectomy and functional neck dissection for squamous cell carcinoma of the tongue. The patient had been treated pharmacologically for several years with minimal results, baseline VAS of 90. After a successful superficial cervical plexus block under ultrasound guidance, he underwent PRF for a possible long-lasting effect. VAS post PRF improved in subsequent visits: VAS at 1 month was 0; at 3 months was 10 and at 6 months was 60. Conclusion: Postoperative changes to include alterations in nerve structures are a frequent source of chronic pain. The incidence of this type of pain in the cervical region is quite variable. Noninvasive treatment options are limited and oftentimes ineffective. Due to its location, superficial cervical plexus is an anatomical site with the potential risk of undergoing structural alterations (fibrosis, radiotherapy-associated retraction phenomena or neuroma formation). Interventional treatments performed under ultrasound guidance allow the dynamic application of therapies such as radiofrequency ablation. PRF could potentially cause an additive effect between neuromodulation and the hydrodissection caused by the infiltration of substances within a fibrotic area.

The Contribution of Optical Coherence Tomography in Neuromyelitis Optica Spectrum Disorders.

Neuromyelitis optica spectrum disorders (NMOSD) comprises a group of central nervous system disorders of inflammatory autoimmune origin that mainly affect the optic nerves and the spinal cord and can cause severe visual and general disability. The clinical signs are similar to those of multiple sclerosis (MS), with the result that it is often difficult to differentiate between the two, thus leading to misdiagnosis. As the treatment and prognosis of NMOSD and MS are different, it is important to make an accurate and early diagnosis of NMOSD. Optical coherence tomography (OCT) is a non-invasive technique that enables a quantitative study of the changes that the optic nerve and the macula undergo in several neurodegenerative diseases. Many studies have shown that some of these changes, such as retinal nerve fiber layer thinning or microcystic macular edema, can be related to alterations in the brain due to neurodegenerative disorders. The purpose of this mini-review is to show how OCT can be useful for the diagnosis of NMOSD and follow-up of affected patients, as well as for the differential diagnosis with MS.

Optical Coherence Tomography in Patients with Chronic Migraine: Literature Review and Update.

Migraine is a chronic disease characterized by unilateral, pulsating, and often moderate-to-severe recurrent episodes of headache with nausea and vomiting. It affects approximately 15% of the general population, yet the underlying pathophysiological mechanisms are not fully understood. Optical coherence tomography (OCT) is a safe and reproducible diagnostic technique that utilizes infrared wavelengths and has a sensitivity of 8-10 µm. It can be used to measure thinning of the retinal nerve fiber layer (RNFL) in some neurological disorders. Although ophthalmologists are often the first specialists to examine patients with migraine, few studies have addressed the involvement of the optic nerve and retino-choroidal structures in this group. We reviewed the literature on the etiological and pathological mechanisms of migraine and the relationship between recurrent constriction of cerebral and retrobulbar vessels and ischemic damage to the optic nerve, retina, and choroid. We also assessed the role of OCT for measuring peripapillary RNFL thickness and macular and choroidal changes in migraine patients. There is considerable evidence of cerebral and retrobulbar vascular involvement in the etiology of migraine. Transitory and recurrent constriction of the retinal and ciliary arteries may cause ischemic damage to the optic nerve, retina, and choroid in patients with migraine. OCT to assess the thickness of the peripapillary RNFL, macula, and choroid might increase our understanding of the pathophysiology of migraine and facilitate diagnosis of retino-choroidal compromise and follow-up of therapy in migraine patients. Future studies should determine the usefulness of OCT findings as a biomarker of migraine.

Efecto de los factores socioculturales en la capacidad de autocuidado del paciente hospitalizado con diabetes tipo 2 / The Effect of Socio-cultural Factors on the Self-care Capacity of Hospitalized Patients with Type 2 Diabetes / Efeito dos fatores socioculturais na capacidade de autocuidado do paciente hospitalizado com diabete tipo 2

Introducción: la diabetes tipo 2 es considerada como un problema de salud pública por su creciente prevalencia e incidencia. Objetivo: describir el efecto de los factores socioculturales en la capacidad de autocuidado del paciente hospitalizado con diabetes tipo 2 en el Hospital General de Tecomán, Colima, México. Método: estudio transversal, observacional. Se trabajó con 68 pacientes hospitalizados con diabetes tipo 2; se utilizó un instrumento que midió el efecto de los factores socioculturales en la capacidad de autocuidado. El análisis de datos se realizó con Razón de Momios, intervalos de confianza al 95% y fracción atribuible en expuestos. Resultados: los factores socioculturales tuvieron un leve efecto positivo en la capacidad de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) en pacientes hospitalizados con diabetes tipo 2. Conclusiones: los factores socioculturales: experiencias vitales, experiencias laborales, religión, costumbres y tradiciones, prácticas curativas y ritos, señalados en la Teoría General del Déficit de Autocuidado, muestran un efecto positivo sobre la capacidad de autocuidado de las personas con diabetes tipo 2.

Introduction: Type 2 diabetes is considered a public health problem because of its increasing prevalence and incidence. Objective: The purpose of this research is to describe the effect of socio-cultural factors on the self-care capacity of patients with type 2 diabetes who are hospitalized at the Tecomán General Hospital in Colima, Mexico. Method: This is a cross-sectional, observational study of 68 hospitalized patients with type 2 diabetes. An instrument to measure the effect of socio-cultural factors on the capacity for self-care was used. Data analysis was conducted with the odds ratio method, confidence intervals at 95% and attributable fraction in exposures. Results: Socio-cultural factors had a slight positive effect on the capacity for self-care among hospitalized patients with type 2 diabetes (RM = 1.10, 95% CI, 0.26 to 4.74). Conclusions: The socio-cultural factors outlined in the General Self-care Deficit Theory; namely, life experiences, work experiences, religion, customs and traditions, healing practices and rituals, were shown to have a positive effect on the self-care capacity of people with type 2 diabetes.

Introdução: a diabete tipo 2 é considerada um problema de saúde pública por sua crescente prevalência e incidência. Objetivo: descrever o efeito dos fatores socioculturais na capacidade de autocuidado do paciente hospitalizado com diabete tipo 2 no Hospital General de Tecomán, Colima, México. Método: estudo transversal, observacional. Trabalhou-se com 68 pacientes hospitalizados com diabete tipo 2; utilizou-se um instrumento que mediu o efeito dos fatores socioculturais na capacidade de autocuidado. A análise de dados foi realizada com Razão de Chances, intervalos de confiança de 95% e fração atribuível em expostos. Resultados: os fatores socioculturais tiveram um leve efeito positivo na capacidade de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) em pacientes hospitalizados com diabete tipo 2. Conclusões: os fatores socioculturais, como experiências vitais, experiências laborais, religião, costumes e tradições, práticas curativas e rituais, indicados na Teoria Geral do Déficit de Autocuidado, mostram um efeito positivo sobre a capacidade de autocuidado das pessoas com diabete tipo 2.

Vibrational and electronic spectra of 9,10-dihydrobenzo(a)pyren-7(8H)-one and 7,8,9,10-tetrahydrobenzo(a)pyrene: an experimental and computational study.

The molecular geometries, vibrational and UV-vis spectra of 9,10-dihydrobenzo(a)pyrene-7(8H)-one (9,10-H(2)BaP) and 7,8,9,10-tetrahydrobenzo(a)pyrene (7,8,9,10-H(4)BaP) were investigated using density functional theory (DFT-B3LYP), with the triple-ζ 6-311+G(d,p) and Dunning's cc-pVTZ basis sets. From the comparison of infrared experimental and calculated infrared, and Raman data comprehensive assignments are made. The calculated infrared frequencies below 1800 cm(-1) are in good agreement with experimental data, with an average deviation of <4 cm(-1). Using the B3LYP/6-311+G(d,p)//TD-B3LYP/6-311G(d,p) level of theory, transition energies, and oscillator strengths of the 30 lowest electronic absorption bands are assigned to π-π* transitions, with good qualitative agreement between experimental and simulated absorption data. In addition, the HOMO-LUMO gaps and their chemical hardness were analyzed.

Prednisona en el tratamiento de la artritis reumatoide / Prednisone in the treatment of rheumatoid arthritis

La artritis reumatoide (AR) de larga evolución por sí misma conlleva el riesgo de desarrollar osteoporosis, la que se atribuye a la disminución de la actividad física y uso de corticosteroides durante el tratamiento de la misma. De ahí la duda para iniciar tratamiento con esteroides durante el curso de la enfermedad. En la actualidad se ha demostrado que el uso de corticosteroides, a dosis bajas, es realmente efectivo para disminución de sintomatología dolorosa y el retardo en la destrucción articular. En la presente revisión, se analizan las indicaciones, dosis recomendadas y reacciones adversas más frecuentes durante su uso; y se valora el riesgo-beneficio de la utilización durante el tratamiento de ésta patología

Tratamiento modificador en la artritis reumatoide. ¿Algo real? / Combination treatment of rheumatoid arthrisis: something real?

La artritis reumatoide (AR) es una enfermedad autoinmune presente en el 1 por ciento de la población adulta que ocasiona múltiples gastos familiares y hospitalarios. Dados los síntomas incapacitantes y deformidades articulares a las que lleve la enfermedad el objetivo actual del tratamiento es prevenir el daño estructural. Se han introducido una gran cantidad de fármacos intentando cambiar el curso de la enfermedad (remisión), llamados de la enfermedad reumática (DMARD). Los fármacos más utilizados son la hidroxicloroquina (HCQ), sulfasalazina (SSz), azatioprina (AZA), D-penicilamina (DP), sales de oro, metrotexate (MTX), entre otros. La presente revisión intenta establecer las características, efectividad y seguridad de cada fármaco para la remisión de la artritis reumatoide (AR)

Crisis ecológica. Salud y Bioética / Ecological crisis. Health and Bioetic

Se realizó una revisión bibliográfica sobre las consecuencias que ha traído para la salud de la humanidad la crisis ecológica generada en nuestros días. La relación hombre naturaleza es multicausal, pero es la conducta humana la que se debe cambiaro transformar, surge así la bioética con el propósito de lograr la unidad d ela ciencia y la ética en la explicación y solución de este problema, pues ella explica con argumento científico y éticos en qué consiste la crisis ecológica, así en la medida en que ella afecta la salud del hombre y cual debe ser la conducta de este ante la solución del problema(AU)