Dimensionality of the system usability scale among professionals using internet-based interventions for depression: a confirmatory factor analysis.

BACKGROUND: The System Usability Scale (SUS) is used to measure usability of internet-based Cognitive Behavioural Therapy (iCBT). However, whether the SUS is a valid instrument to measure usability in this context is unclear. The aim of this study is to assess the factor structure of the SUS, measuring usability of iCBT for depression in a sample of professionals. In addition, the psychometric properties (reliability, convergent validity) of the SUS were tested. METHODS: A sample of 242 professionals using iCBT for depression from 6 European countries completed the SUS. Confirmatory Factor Analysis (CFA) was conducted to test whether a one-factor, two-factor, tone-model or bi-direct model would fit the data best. Reliability was assessed using complementary statistical indices (e.g. omega). To assess convergent validity, the SUS total score was correlated with an adapted Client Satisfaction Questionnaire (CSQ-3). RESULTS: CFA supported the one-factor, two-factor and tone-model, but the bi-factor model fitted the data best (Comparative Fit Index = 0.992, Tucker Lewis Index = 0.985, Root Mean Square Error of Approximation = 0.055, Standardized Root Mean Square Residual = 0.042 (respectively χ2diff (9) = 69.82, p < 0.001; χ2diff (8) = 33.04, p < 0.001). Reliability of the SUS was good (ω = 0.91). The total SUS score correlated moderately with the CSQ-3 (CSQ1 rs = .49, p < 0.001; CSQ2 rs = .46, p < 0.001; CSQ3 rs = .38, p < 0.001), indicating convergent validity. CONCLUSIONS: Although the SUS seems to have a multidimensional structure, the best model showed that the total sumscore of the SUS appears to be a valid and interpretable measure to assess the usability of internet-based interventions when used by professionals in mental healthcare.

Características de los cuidadores principales de niños y adolescentes con fibrosis quística / Characteristics of main caregivers of children and adolescents with cystic fibrosis

Introducción: Las investigaciones sobre los cuidadores han tomado importancia por los efectos negativos que provoca en las esferas físicas, psicológicas y sociales de estas personas, debido a su dedicación prolongada a la atención de enfermos cuyas dolencias les impiden totalmente su autocuidado. Objetivos: Referir las características de los cuidadores principales de pacientes pediátricos con fibrosis quística. Métodos: Estudio descriptivo de corte transversal realizado en el segundo semestre del 2016, con 54 cuidadoras principales de pacientes menores de 19 años, atendidos en los hospitales Pediátrico de Centro Habana, Juan Manuel Márquez, de Marianao, y el William Soler, de Boyeros. Resultados: Las cuidadoras son mujeres, madres en su mayoría, sin vínculo laboral, con nivel educativo medio superior, dedicadas al cuidado de los enfermos a tiempo completo, lo que interfiere su vida personal y social. Ante estas situaciones responden con mediana capacidad de afrontamiento y adaptación ante las situaciones que les generan estrés. Conclusiones: Las estrategias de afrontamiento utilizadas por las cuidadoras están afectadas pues no generan respuestas efectivas que les permita adaptarse y responder a las situaciones de forma óptima, por lo que se requiere reforzar los recursos que están utilizando. La meta de enfermería como ciencia y como disciplina es un factor muy importante para obtener esos recursos necesarios para mejorar la calidad de vida de los niños, adolescentes y sus cuidadores(AU)

Introduction: Research on caregivers has become important because of the negative effects this activity causes in the physical, psychological and social aspects of these people due to their prolonged dedication to the care of patients, whose illnesses prevent them from fully looking for themselves. Objective: To describe the characteristics of the main caregivers of pediatric patients with cystic fibrosis. Methods: A cross-sectional descriptive study conducted in the second semester of 2016, with 54 main caregivers of patients under 19 years old that were attended in Centro Habana Pediatric Hospital, Juan Manuel Márquez (Marianao´s municipality Pediatric Hospital), and William Soler (Boyeros municipality´s Pediatric Hospital). Results: Caregivers are women, mostly mothers, with no employment, with a medium superior level of education, who are devoted to caring for the sick patients full-time, and this interferes with their personal and social life. Given these situations, they respond with a medium capacity for coping and adapting to situations that generate stress. Conclusions: Coping strategies used by caregivers are affected because they do not generate effective responses that allow them to adapt and respond to situations in an optimal way, so it is necessary to reinforce the resources they are using. The goal of nursing as a science and as a discipline is a very important factor in obtaining those necessary resources to improve the quality of life of children, adolescents and their caregivers(AU)

Características de los cuidadores principales de niños y adolescentes con fibrosis quística / Characteristics of main caregivers of children and adolescents with cystic fibrosis

Introducción: Las investigaciones sobre los cuidadores han tomado importancia por los efectos negativos que provoca en las esferas físicas, psicológicas y sociales de estas personas, debido a su dedicación prolongada a la atención de enfermos cuyas dolencias les impiden totalmente su autocuidado. Objetivos: Referir las características de los cuidadores principales de pacientes pediátricos con fibrosis quística. Métodos: Estudio descriptivo de corte transversal realizado en el segundo semestre del 2016, con 54 cuidadoras principales de pacientes menores de 19 años, atendidos en los hospitales Pediátrico de Centro Habana, Juan Manuel Márquez, de Marianao, y el William Soler, de Boyeros. Resultados: Las cuidadoras son mujeres, madres en su mayoría, sin vínculo laboral, con nivel educativo medio superior, dedicadas al cuidado de los enfermos a tiempo completo, lo que interfiere su vida personal y social. Ante estas situaciones responden con mediana capacidad de afrontamiento y adaptación ante las situaciones que les generan estrés. Conclusiones: Las estrategias de afrontamiento utilizadas por las cuidadoras están afectadas pues no generan respuestas efectivas que les permita adaptarse y responder a las situaciones de forma óptima, por lo que se requiere reforzar los recursos que están utilizando. La meta de enfermería como ciencia y como disciplina es un factor muy importante para obtener esos recursos necesarios para mejorar la calidad de vida de los niños, adolescentes y sus cuidadores(AU)

Introduction: Research on caregivers has become important because of the negative effects this activity causes in the physical, psychological and social aspects of these people due to their prolonged dedication to the care of patients, whose illnesses prevent them from fully looking for themselves. Objective: To describe the characteristics of the main caregivers of pediatric patients with cystic fibrosis. Methods: A cross-sectional descriptive study conducted in the second semester of 2016, with 54 main caregivers of patients under 19 years old that were attended in Centro Habana Pediatric Hospital, Juan Manuel Márquez (Marianao´s municipality Pediatric Hospital), and William Soler (Boyeros municipality´s Pediatric Hospital). Results: Caregivers are women, mostly mothers, with no employment, with a medium superior level of education, who are devoted to caring for the sick patients full-time, and this interferes with their personal and social life. Given these situations, they respond with a medium capacity for coping and adapting to situations that generate stress. Conclusions: Coping strategies used by caregivers are affected because they do not generate effective responses that allow them to adapt and respond to situations in an optimal way, so it is necessary to reinforce the resources they are using. The goal of nursing as a science and as a discipline is a very important factor in obtaining those necessary resources to improve the quality of life of children, adolescents and their caregivers(AU)

Proposal for a new trajectory for subaxial cervical lateral mass screws.

PURPOSE: Lateral mass screws combined with rods are the standard method for posterior cervical spine subaxial fixation. Several techniques have been described, among which the most used are Roy Camille, Magerl, Anderson and An. All of them are based on tridimensional angles. Reliability of freehand angle estimation remains poorly investigated. We propose a new technique based on on-site spatial references and compare it with previously described ones assessing screw length and neurovascular potential complications. METHODS: Four different lateral mass screw insertion techniques (Magerl, Anderson, An and the new described technique) were performed bilaterally, from C3 to C6, in ten human spine specimens. A drill tip guide wire was inserted as originally described for each trajectory, and screw length was measured. Exit point was examined, and potential vertebral artery or nerve root injury was assessed. RESULTS: Mean screw length was 14.05 mm using Magerl's technique, 13.47 mm using Anderson's, 12.8 mm using An's and 17.03 mm using the new technique. Data analysis showed significantly longer lateral mass screw length using the new technique (p value < 0.00001). Nerve potential injury occurred 37 times using Magerl's technique, 28 using Anderson's, 13 using An's and twice using the new technique. Vertebral artery potential injury occurred once using Magerl's technique, 8 times using Anderson's and none using either An's or the new proposed technique. The risk of neurovascular complication was significantly lower using the new technique (p value < 0.01). CONCLUSION: The new proposed technique allows for longer screws, maximizing purchase and stability, while lowering the complication rate.

Manifestaciones somáticas en un grupo de adolescentes con ansiedad / Somatic manifestations in a group of adolescents with anxiety disorders

Introducción: la ansiedad es el síntoma psiquiátrico más prevalente en la sociedad moderna, también en la infancia y adolescencia.Objetivo: caracterizar un grupo de adolescentes ansiosos, la intensidad de la ansiedad, las manifestaciones clínicas y las áreas de conflictos.Métodos: se realizó un estudio descriptivo con técnicas cuanti-cualitativas en 30 adolescentes entre 11 y 16 años de edad, con ansiedad de más de 6 meses de evolución, seleccionado aleatoriamente, que dieron el consentimiento para ser incluidos en el estudio. Fueron atendidos por Psiquiatría Infantil del Hospital Pediátrico Universitario Centro Habana, entre enero y junio del año 2014. Las variables estudiadas fueron: edad, sexo, intensidad de la ansiedad, manifestaciones clínicas y áreas de conflictos. Se realizó historia social psiquiátrica, examen psiquiátrico, entrevista psicológica, test IDAREN y de Frases Incompletas de Rotter.Resultados: 77 por ciento tienen entre 11 y 14 años, 73 por ciento es del sexo femenino, con nivel medio y alto para la ansiedad-estado (97 por ciento) y ansiedad-rasgo del 83 por ciento; predominaron las manifestaciones somáticas, como trastornos del sueño (83 por ciento), hiperactividad-excitación (80 por ciento), síntomas cardíacos (77 por ciento), salto epigástrico (70 por ciento), dolor abdominal (63 por ciento) y sudoración (53 por ciento); y las psicológicas, como inseguridad (70 por ciento), sensación de amenaza (67 por ciento), dificultad en la concentración y la memoria (63 por ciento), sentimientos negativos (60 por ciento) e irritabilidad (53 por ciento). El 83 por ciento tenía conflictos en área familiar, 70 por ciento en las relaciones sociales, y 50 por ciento en área escolar.Conclusiones: predominan el sexo femenino, las edades entre 11 y 14 años, con niveles medio y alto para ansiedad-estado y ansiedad-rasgo, así como los síntomas somáticos de ansiedad y conflictos en el área familiar(AU)

Introduction: anxiety is the most prevailing psychiatric symptom in the modern society and also in childhood and adolescence.Objective: to characterize a group of anxious adolescence, the intensity of anxiety, the clinical manifestations and the areas of conflict.Methods: a descriptive study based on quantitative and qualitative techniques was performed in 30 adolescents aged 11 to 16 years, who presented anxiety disorders for over 6 months and randomly selected after giving their consent to be included in the study. These patients had been seen at the infantile psychiatry service of the university pediatric hospital Centro Habana from January to June 2014. The studied variables were: age, sex, intensity of anxiety, clinical manifestations and areas of conflicts. A psychiatric social history, psychiatric exam, psychological interview, IDAREN test and Rotter's incomplete phrase test were all applied.Results: in the study group, 77 percent were 11 to 14 years, 73 percent were females, with middle and high level for anxiety-state (97 percent) and anxiety-trait (83 percent); somatic manifestations such as sleep disorders (83 percent), hyperactivity-excitement (80 percent), heart symptoms (77 percent), epigastric_beat (70 percent), stomachache (63 percent), sweating (53 percent), and psychological manifestations as insecurity (70 percent), feeling of being threatened (67 percent), difficult concentration and memorization (63 percent), negative feelings (60 percent) and irritability (53 percent) predominated. Eighty three percent of them faced conflicts in their family setting, 70 percent with their social relationships and 50 percent at the school area.Conclusions: females, 11-14 years of age, middle and high levels for anxiety-state and anxiety-trait, somatic symptoms of anxiety and conflicts in the family setting are predominant(AU)

Manifestaciones somáticas en un grupo de adolescentes con ansiedad / Somatic manifestations in a group of adolescents with anxiety disorders

INTRODUCCIÓN: la ansiedad es el síntoma psiquiátrico más prevalente en la sociedad moderna, también en la infancia y adolescencia. OBJETIVO: caracterizar un grupo de adolescentes ansiosos, la intensidad de la ansiedad, las manifestaciones clínicas y las áreas de conflictos. MÉTODOS: se realizó un estudio descriptivo con técnicas cuanti-cualitativas en 30 adolescentes entre 11 y 16 años de edad, con ansiedad de más de 6 meses de evolución, seleccionado aleatoriamente, que dieron el consentimiento para ser incluidos en el estudio. Fueron atendidos por Psiquiatría Infantil del Hospital Pediátrico Universitario Centro Habana, entre enero y junio del año 2014. Las variables estudiadas fueron: edad, sexo, intensidad de la ansiedad, manifestaciones clínicas y áreas de conflictos. Se realizó historia social psiquiátrica, examen psiquiátrico, entrevista psicológica, test IDAREN y de Frases Incompletas de Rotter. RESULTADOS: 77 % tienen entre 11 y 14 años, 73 % es del sexo femenino, con nivel medio y alto para la ansiedad-estado (97 %) y ansiedad-rasgo del 83 %; predominaron las manifestaciones somáticas, como trastornos del sueño (83 %), hiperactividad-excitación (80 %), síntomas cardíacos (77 %), salto epigástrico (70 %), dolor abdominal (63 %) y sudoración (53 %); y las psicológicas, como inseguridad (70 %), sensación de amenaza (67 %), dificultad en la concentración y la memoria (63 %), sentimientos negativos (60 %) e irritabilidad (53 %). El 83 % tenía conflictos en área familiar, 70 % en las relaciones sociales, y 50 % en área escolar. CONCLUSIONES: predominan el sexo femenino, las edades entre 11 y 14 años, con niveles medio y alto para ansiedad-estado y ansiedad-rasgo, así como los síntomas somáticos de ansiedad y conflictos en el área familiar.

INTRODUCTION: anxiety is the most prevailing psychiatric symptom in the modern society and also in childhood and adolescence. Objective: to characterize a group of anxious adolescence, the intensity of anxiety, the clinical manifestations and the areas of conflict. METHODS: a descriptive study based on quantitative and qualitative techniques was performed in 30 adolescents aged 11 to 16 years, who presented anxiety disorders for over 6 months and randomly selected after giving their consent to be included in the study. These patients had been seen at the infantile psychiatry service of the university pediatric hospital Centro Habana from January to June 2014. The studied variables were: age, sex, intensity of anxiety, clinical manifestations and areas of conflicts. A psychiatric social history, psychiatric exam, psychological interview, IDAREN test and Rotter's incomplete phrase test were all applied. RESULTS: in the study group, 77 % were 11 to 14 years, 73 % were females, with middle and high level for anxiety-state (97 %) and anxiety-trait (83 %); somatic manifestations such as sleep disorders (83 %), hyperactivity-excitement (80 %), heart symptoms (77 %), epigastric_beat (70 %), stomachache (63 %), sweating (53 %), and psychological manifestations as insecurity (70 %), feeling of being threatened (67 %), difficult concentration and memorization (63 %), negative feelings (60 %) and irritability (53 %) predominated. Eighty three percent of them faced conflicts in their family setting, 70 % with their social relationships and 50 % at the school area. CONCLUSIONS: females, 11-14 years of age, middle and high levels for anxiety-state and anxiety-trait, somatic symptoms of anxiety and conflicts in the family setting are predominant.

Exposure to non-ionizing radiation provokes changes in rat thyroid morphology and expression of HSP-90.

Non-ionizing radiation at 2.45 GHz may modify the morphology and expression of genes that codify heat shock proteins (HSP) in the thyroid gland. Diathermy is the therapeutic application of non-ionizing radiation to humans for its beneficial effects in rheumatological and musculo-skeletal pain processes. We used a diathermy model on laboratory rats subjected to maximum exposure in the left front leg, in order to study the effects of radiation on the nearby thyroid tissue. Fifty-six rats were individually exposed once or repeatedly (10 times in two weeks) for 30 min to 2.45 GHz radiation in a commercial chamber at different non-thermal specific absorption rates (SARs), which were calculated using the finite difference time domain technique. We used immunohistochemistry methods to study the expression of HSP-90 and morphological changes in thyroid gland tissues. Ninety minutes after radiation with the highest SAR, the central and peripheral follicles presented increased size and the thickness of the peripheral septa had decreased. Twenty-four hours after radiation, only peripheral follicles radiated at 12 W were found to be smaller. Peripheral follicles increased in size with repeated exposure at 3 W power. Morphological changes in the thyroid tissue may indicate a glandular response to acute or repeated stress from radiation in the hypothalamic-pituitary-thyroid axis. Further research is needed to determine if the effect of this physical agent over time may cause disease in the human thyroid gland.

Procalcitonin, C-reactive protein, and cell counts in the diagnosis of parapneumonic pleural effusions.

BACKGROUND AND OBJECTIVE: Pleural effusion is relatively common in pneumonia. Because traditional methods for its diagnosis are not always effective, there is a need for new biomarkers to make its differential diagnosis easier. METHODS: A total of 233 patients with pleural effusion were admitted to our hospital between 2005 and 2008. Total and differential leukocyte counts, along with blood and pleural fluid procalcitonin and C-reactive protein (CRP) were performed on all of them. The patients were classified into 5 groups depending on the cause of their effusion: (1) parapneumonic, n = 28; (2) tuberculous, n = 49; (3) neoplastic, n = 57; (4) miscellaneous, n = 46; and (5) transudates, n = 53. RESULTS: Procalcitonin levels were higher in the pleural fluid of the parapneumonic group (PAR, 0.15 ng/mL) compared with those of the rest of the groups, but statistically significant differences were only observed with the miscellaneous and tuberculous groups (P < 0.001). Levels of CRP were also higher in the PAR (0.67 mg/L) compared with those of the rest of the groups, with statistically significant differences observed (P < 0.001-0.004) in all of them. The parameter with the largest area under the receiver operator characteristics curve was the product of the total neutrophil count and the CRP in the pleural fluid, in which an area of 0.836 had a sensitivity of 64.3% and a specificity of 93.4%. CONCLUSIONS: Determination of procalcitonin and CRP, in the pleural fluid and blood, does not seem to provide great value to the diagnosis of PAR. However, calculating the product of the total neutrophil count and the CRP may be useful in the diagnosis of these effusions because increased values have a high specificity and predictive values.

Accuracy of plasma levels of polymorphonuclear elastase as early prognostic marker of acute pancreatitis in routine clinical conditions.

OBJECTIVES: The early prognostic evaluation of acute pancreatitis (AP) is a key step in the appropriate management of the disease. Plasma levels of polymorphonuclear elastase have proved to be an accurate early prognostic marker of AP in research conditions. Whether the test remains sufficiently accurate in routine clinical conditions has been questioned. The aim of our study was to evaluate the accuracy of plasma polymorphonuclear-elastase levels for the early prognostic evaluation of AP in the clinical setting. METHODS: A total of 224 consecutive patients with AP admitted to our Gastroenterology Department were included. A blood sample for polymorphonuclear-elastase quantification was obtained from all of them in the first morning of hospital stay, together with samples for routine haematological and biochemical analysis. Blood samples for polymorphonuclear-elastase evaluation were sent to the laboratory and managed there according to routine protocols. AP was classified as mild or severe according to the Atlanta classification, whereas polymorphonuclear-elastase results were kept blind. Results were shown as mean+/-SD and compared using Student's t-test for unrelated samples. The accuracy of the test for the prognostic evaluation of AP was calculated after drawing the corresponding receiver operator curve. RESULTS: Fifty patients (23%) suffered from severe AP. The plasma levels of polymorphonuclear elastase were 217.8+/-93.5 microg/l in patients with severe AP and 68.1+/-32.7 microg/l in those with mild disease (P<0.001). The sensitivity and specificity of the test for the detection of severe AP were 92 and 91%, respectively, for an optimal cut-off value of 110 microg/l. The positive and negative predictive values for a prevalence of severe disease of 20% were 78 and 96%, respectively. The area under the receiver operator curve was 0.956. CONCLUSION: Quantification of plasma polymorphonuclear-elastase levels is a very accurate method for the early prognostic evaluation of AP, and is easily applicable in the clinical setting.

Bulimia / Bulimia

La bulimia significa "hambre de buey" y es un trastorno alimenticio que se caracteriza por la ingestión episódica de grandes cantidades de alimentos de manera compulsiva, con un consecuente sentimiento de culpa y depresión por no poder controlar la conducta. Debido a ello el paciente trata de recuperar el control, al principio mediante la inducción al vómito y posteriormente con el uso de laxantes, diuréticos, ayunos y hasta ejercicios compulsivos. Si un paciente bulímico acude a nuestra consulta, el examen clínico generalmente puede arrojar erosiones, abrasiones, opacidades a nivel del esmalte dental en determinadas zonas que solían ser observadas en pacientes con trastornos alimenticios que presentan regurgitación gástrica, tales como: esofagitis, gastritis, úlcera péptica, úlcera duodenal, etc. La manifestación más resaltante es la amilolisis (desmineralización) que es la pérdida de esmalte y dentina en la superficie de los dientes, resultante de la acción química y mecánica. Esta manifestación se observa mayormente en casos muy severos y de mucha data, de allí la importancia de nuestro papel para su diagnóstico, debido a que lesiones de este tipo son irreversibles

Registro nacional del cáncer: estado actual y perspectivas / National registry of cancer: actual status and perspectives

Describe el Registro Nacional del Cáncer RNC que creó la SSA en 1982. En 1983 y 1984 reunió 32612 casos nuevos de cáncer en 34 hospitales de la ciudad de México. De éstos 14 atienden a derechohabientes, 11 a población abierta y 9 son privados. Hubo 20089 casos en mujeres, 10827 en hombres y 1696 en menores de 15 años. Su único formato es la Tarjeta de Registro en que recolecta y anota datos del: paciente, hospital, tumor, tratamiento inicial y seguimiento anual. Se procesa en computadora y por lector óptico. Las localizaciones predominantes fueron cérvix 6966 casos y mama 3712, que sumados representaron el 32% de la casuística general y el 53% de las neoplasias malignas en la mujer. Toma como ejemplo los casos de cáncer de cérvix y mama atendidos en el Instituto Nacional de Cancerología en 1983 para detallar su distribución por: edad, entidad federativa de residencia, estadio clínico, tipo histológico, tratamiento inicial y seguimiento en 1984 y 1985. Comenta la excelente aceptación y aprovechamiento del RNC en las Instituciones de Salud y la extensión progresiva del sistema al resto del país