Implementation frameworks guiding digital self-management intervention in chronic pain: A scoping review.

BACKGROUND AND OBJECTIVE: The development, evaluation and implementation of digital self-management interventions for chronic pain have increased exponentially. While intervention outcomes appear promising to improve well-being and functioning in target populations, it is unclear how the development and evaluation processes were structured and how implementation was planned and executed. The aim of this systematic review is to provide a comprehensive overview of implementation frameworks used to guide and evaluate scientific innovation in chronic pain. DATABASES AND DATA TREATMENT: Four bibliography databases (Medline, Web of Science, PsycInfo, CINAHL) and two registries (PubMed Central, MedaRxiv) were systematically searched. Hits (n = 6830) and full texts (n = 351) were screened and read by two independent reviewers. Peer-reviewed articles that met the inclusion criteria were included in the narrative synthesis. RESULTS: In total, 10 studies were identified that report on seven distinct interventions. Five implementation frameworks were utilized across these studies: Behavioural Interventions using Technology (BIT); Consolidated Framework for Implementation Research (CFIR); mHealth Agile and User-Centered Research and Development Lifecycle; Medical Research Council (MRC); Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM). Frameworks were operationalized using qualitative and quantitative methods, evaluating the innovation on various levels (e.g., individual vs. organizational) and applying a variety of study designs (e.g., single-arm or large trials). CONCLUSIONS: By utilizing implementation frameworks, access to evidence-based chronic pain care may be increased. Although the evidence on the utility of implementation frameworks to guide and evaluate digital self-management interventions is still limited, the body of literature is increasing. Future studies are urged to operationalize, communicate and discuss the innovation process, to promote transparency and replicability. SIGNIFICANCE: The use of implementation frameworks to guide and evaluate digital self-management interventions for chronic pain is a recent development in the field. Several promising examples exist and are presented in this review. Currently, the evidence is still limited, and prospective studies need to transparently operationalize, communicate and discuss their efforts. By utilizing an implementation framework, promising interventions can be made available to end-users, closing the research-to-clinical practice gap and increasing access to evidence-based care to people with chronic pain.

Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain.

BACKGROUND: The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal. METHODS: The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal. RESULTS: The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster. CONCLUSIONS: These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles. SIGNIFICANCE: The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.

Enthesis: not the same in each localisation - a molecular, histological and biomechanical study.

The interphase between tendon and bone consists of a highly specialised tissue called enthesis. Typically, the enthesis is described as a succession of four different zones: tendon, non-mineralised fibrocartilage, mineralised fibrocartilage and bone. However, the microstructure of the entheses, cellular composition and mechanical properties vary depending on their anatomical location. The present study aimed to characterise three of the most relevant sites of enthesis injury in a rat model: the patellar tendon, the Achilles tendon and the supraspinatus enthesis, in terms of biomechanics, histology and genetic expression. The patellar enthesis presented the highest ultimate load and lowest stiffness of the three, while the supraspinatus was the weakest and stiffest. The histological characterisation revealed key differences at the insertion site for each enthesis. The patellar enthesis showed a large cartilaginous area at the tendon-to-bone interphase whilst this interphase was smaller in the supraspinatus entheses samples. Furthermore, the Achilles tendon enthesis displayed a more abrupt transition from tendon to bone. Additionally, each enthesis exhibited a particular and distinct pattern of expression of tenogenic, chondrogenic and osteogenic markers. This study provided valuable insights for a better understanding of the three entheses at relevant anatomical sites. Moreover, the larger cross-sectional area of the patellar enthesis, the strong mechanical properties and the easier surgical access to this location led to the conclusion that the patellar tendon enthesis site could be most suitable for the development of a preclinical model for general enthesis regeneration studies in rats.

Protonation of Planar and Nonplanar Porphyrins: A Calorimetric and Computational Study.

Herein, we report the first calorimetric study of the protonation of planar and nonplanar free-base porphyrins: H2OETPP (strongly saddled by its substituents), H2T(tBu)P (strongly ruffled by its substituents), and the nominally planar porphyrins (npPs) H2OEP, H2TPP, H2T(nPe)P, and H2T(iPr)P. The observed enthalpies of protonation in solution (ΔHprotsoln) for formation of the dications in 1,1,2,2-tetrachloroethane with 2% trifluoroacetic acid are -45 ± 1 kcal mol-1 for the npPs, -52.0 kcal mol-1 for H2T(tBu)P, and -70.9 kcal mol-1 for H2OETPP. The corresponding enthalpies of protonation (ΔHDFT) obtained from DFT calculations (-27 ± 5, -42, and -63 kcal mol-1, respectively) reproduce this trend. The much more negative enthalpy of protonation seen for H2OETPP is consistent with this molecule being pre-deformed into the saddle structure favored by porphyrin dications. Except for OETPP, the calculated enthalpies of the first protonations (ΔH1) are significantly more positive than the enthalpies of the second protonations (ΔH2). In addition, the structural strain energies for the first protonations (ΔEst(1)) are also significantly more positive than ΔEst(2). According to the calculations, the monocations thus have higher proton affinities than the corresponding free-base porphyrins due to a structural strain effect, which is consistent with the generally elusive nature of the porphyrin monocation. The recent observations of monocations for free-base porphyrins with a high degree of saddling can be rationalized in terms of ΔH1 and ΔH2 being similar; so, the monocation is no longer an unstable intermediate.

Effects of FK506 on the healing of diaphyseal, critical size defects in the rat femur.

There is much interest in understanding the influence of the immune system on bone healing, including a number of reports suggesting a beneficial effect of FK506 (tacrolimus) in this regard. The influence of FK506 in a rat, femoral, critical size defect was examined using locally implanted, recombinant, human (rh) BMP-2 and adenovirally-transduced, autologous, adipose-derived mesenchymal stromal cells (AD-MSCs) expressing BMP-2. FK506 was delivered systemically using an implanted osmotic pump. Empty defects and those implanted with unmodified AD-MSCs did not heal in the presence or absence of FK506. Defects treated with rhBMP-2 healed with a large callus containing thin cortices and wispy trabeculae; this, too, was unaffected by FK506. A third of defects implanted with adenovirally-transduced AD-MSCs healed, but this improved to 100 % in the presence of FK506. New bone formed in response to BMP-2 synthesised endogenously by the genetically modified cells had a slimmer callus than those healed by rhBMP-2, with improved cortication and advanced reconstitution of marrow. These results suggest that FK506 may have had little effect on the intrinsic biology of bone healing, but improved healing in response to adenovirally-transduced cells by inhibiting immune responses to the first-generation adenovirus used here. Because the genetically modified cells produced bone of higher quality at far lower doses of BMP-2, this approach should be explored in subsequent research.

Effects of freeze-thaw on the biomechanical and structural properties of the rat Achilles tendon.

Rodent models are commonly used to investigate tendon healing, with the biomechanical and structural properties of the healed tendons being important outcome measures. Tendon storage for later testing becomes necessary when performing large experiments with multiple time-points. However, it is unclear whether freezing rodent tendons affects their material properties. Thus the aim of this study was to determine whether freezing rat Achilles tendons affects their biomechanical or structural properties. Tendons were frozen at either -20 °C or -80 °C directly after harvesting, or tested when freshly harvested. Groups of tendons were subjected to several freeze-thaw cycles (1, 2, and 5) within 3 months, or frozen for 9 months, after which the tendons were subjected to biomechanical testing. Additionally, fresh and thawed tendons were compared morphologically, histologically and by transmission electron microscopy. No major differences in biomechanical properties were found between fresh tendons and those frozen once or twice at -20 °C or -80 °C. However, deterioration of tendon properties was found for 5-cycle groups and both long-term freezing groups; after 9 months of freezing at -80 °C the tear resistance of the tendon was reduced from 125.4 ±â€¯16.4N to 74.3 ±â€¯18.4N (p = 0.0132). Moreover, tendons stored under these conditions showed major disruption of collagen fibrils when examined by transmission electron microscopy. When examined histologically, fresh samples exhibited the best cellularity and proteoglycan content of the enthesis. These properties were preserved better after freezing at -80 °C than after freezing at -20 °C, which resulted in markedly smaller chondrocytes and less proteoglycan content. Overall, the best preservation of histological integrity was seen with tendons frozen once at -80 °C. In conclusion, rat Achilles tendons can be frozen once or twice for short periods of time (up to 3 months) at -20 °C or -80 °C for later testing. However, freezing for 9 months at either -20 °C or -80 °C leads to deterioration of certain parameters.

Needs of adolescents and young adults after cancer treatment: a systematic review.

The aim of this study was to conduct a systematic review of the literature on the needs of adolescents and young adults (AYAs) who have survived cancer. PRISMA recommendations for systematic reviews were followed, and the quality of the studies reviewed was also assessed with a specific checklist. The following databases were searched from their inception to May 2016: ERIC, EMBASE, MEDLINE, PILOTS, ProQuest, PsycARTICLES, PsycBOOKS, psycCRITIQUES, PsycINFO, Social Services Abstracts and Sociological Abstracts. Fourteen studies were identified and analysed. The results show that the most common needs for AYA cancer survivors are as follows: "individualised information and advice," "counselling and psychological support" and "social support, and social relationships." These results are different from those reported in studies on adults, which shows the importance of specifically addressing the needs of this population. In order to advance in this emerging area of study and facilitate the work of health professionals, it is crucial to reach a consensus on two central issues: how the needs of AYA survivors should be conceptualised and what the most valid and reliable procedure for assessing patient's needs is.

Sustained intra-cartilage delivery of low dose dexamethasone using a cationic carrier for treatment of post traumatic osteoarthritis.

Disease-modifying osteoarthritis drugs (DMOADs) should reach their intra-tissue target sites at optimal doses for clinical efficacy. The dense, negatively charged matrix of cartilage poses a major hindrance to the transport of potential therapeutics. In this work, electrostatic interactions were utilised to overcome this challenge and enable higher uptake, full-thickness penetration and enhanced retention of dexamethasone (Dex) inside rabbit cartilage. This was accomplished by using the positively charged glycoprotein avidin as nanocarrier, conjugated to Dex by releasable linkers. Therapeutic effects of a single intra-articular injection of low dose avidin-Dex (0.5 mg Dex) were evaluated in rabbits 3 weeks after anterior cruciate ligament transection (ACLT). Immunostaining confirmed that avidin penetrated the full cartilage thickness and was retained for at least 3 weeks. Avidin-Dex suppressed injury-induced joint swelling and catabolic gene expression to a greater extent than free Dex. It also significantly improved the histological score of cell infiltration and morphogenesis within the periarticular synovium. Micro-computed tomography confirmed the reduced incidence and volume of osteophytes following avidin-Dex treatment. However, neither treatment restored the loss of cartilage stiffness following ACLT, suggesting the need for a combinational therapy with a pro-anabolic factor for enhancing matrix biosynthesis. The avidin dose used caused significant glycosaminoglycan (GAG) loss, suggesting the use of higher Dex : avidin ratios in future formulations, such that the delivered avidin dose could be much less than that shown to affect GAGs. This charge-based delivery system converted cartilage into a drug depot that could also be employed for delivery to nearby synovium, menisci and ligaments, enabling clinical translation of a variety of DMOADs.

What are the needs of adolescents and young adults after a cancer treatment? A Delphi study.

Advances in the early detection of cancer and the development of more effective treatments have resulted in a larger number of adolescents and young adults (AYAs), becoming cancer survivors. However, knowledge regarding their needs and if those needs are adequately addressed remains limited. The aims of this study were to: (1) better understand the needs of AYAs after cancer treatment; (2) analyse the importance of those needs; (3) determine which needs are not adequately addressed; and (4) test the hypothesis that AYA cancer survivors have different needs than adult survivors. Twenty-nine health oncology professionals, 17 AYA survivors and 12 relatives of AYA survivors participated in the Delphi study. The needs identified could be classified into six categories, and all were rated as highly important by all participants. The category perceived as least adequately addressed across the three groups was 'Counselling and psychological support.' The findings provide important new information regarding the needs of AYA cancer survivors that can inform the development of interventions to improve the quality of life of these individuals.

Validity of three rating scales for measuring pain intensity in youths with physical disabilities.

BACKGROUND: There is growing evidence confirming that youths with physical disabilities are at risk for chronic pain. Although many scales for assessing pain intensity exist, it is unclear whether they are all equally suitable for youths. The aim of this study was to address this knowledge gap by comparing the validity of the Numerical Rating Scale (NRS-11), the Wong Baker FACES Pain Rating Scale (FACES), and a 6-point categorical Verbal Rating Scale (VRS-6) for assessing pain intensity among youths (aged 8-20) with physical disabilities. METHODS: One hundred and thirteen youths (mean age = 14.19 years; SD = 2.9) were interviewed and asked to rate their current pain intensity and recalled (in the past week) worst, least, and average pain with the NRS-11 and the FACES. Participants were also asked to rate their average pain intensity during the past 4 weeks using a VRS-6, and were administered measures assessing pain interference, disability and psychological functioning. RESULTS: Analyses showed that all of the pain intensity measures were associated positively with each other. Nevertheless, the NRS-11 appeared to out-perform both the VRS-6 and in particular the FACES scale with respect to: (1) the associations with the validity criterion (i.e. pain interference, disability and psychological functioning) and (2) a lack of any moderating effect of age on the association between the measure and the criterion variables. CONCLUSIONS: The findings support the validity of the NRS-11 for assessing pain intensity in youths with physical disabilities between the ages of 8 and 20 years.

Does an internal focus really affect running performance? An experimental approach to the effect of attentional focus / ¿Afecta la focalización interna realmente en el rendimiento de carrera? Aproximación experimental hacia el efecto de la focalización atencional / Isso afeta o foco interno realmente no desempenho de corrida? A abordagem experimental para o efeito de foco de atenção

Up to now, the effects of attentional focus on performance in long distance running have showed controversial results, especially derived from methodological issues. It has been considered that an internal attentional focus on breathing increase the runner’s oxygen consumption, decreasing running economy. Nevertheless, none of these conclusion have controlled in real time if participants maintained the instructed attentional focus. We hypothesized that the controlled use of and internal vs. external attentional focus will not have an effect on running economy (oxygen consumption at a set speed) at a moderate intensity. A total of 30 (eight females) long distance runners, aged range from 18 to 50 years (M = 32,87, SD = 8,15) volunteered for the study. The experimental protocol consisted on three sessions (scheduled in three different days): (1) maximal incremental treadmill test, (2) internal attentional focus, and (3) external attentional focus. During sessions 2 and 3, participants performed a 55 min treadmill run at moderate intensity (70% VO2 max. Though a mobile application and a wireless controller it was possible to control for the first time if participants effectively maintained the requested attentional focus during the sessions. Results showed that there was not effect of attentional focus (internal vs. external) on running economy. We conclude that when the workload is controlled at a moderate intensity, runners are free to choose were to focus their attention without affecting their running economy (AU)

Hasta ahora, los estudios sobre los efectos del foco atencional sobre el rendimiento en carreras de fondo han mostrado resultados controvertidos, especialmente derivados de las metodológicas de estudio. Se ha sugerido que un foco atencional interno, centrado en la respiración, aumenta el consumo de oxígeno del corredor, disminuyendo así la economía de carrera. Sin embargo, en los estudios realizados hasta la fecha no se ha controlado en tiempo real a nivel experimental el uso de un foco atencional concreto. Nuestra hipótesis establece que el uso controlado de un foco atencional interno o externo no tiene un efecto sobre la economía de carrera (consumo de oxígeno a una velocidad establecida) si se corre a una intensidad moderada. Un total de 30 corredores de larga distancia (ocho mujeres), con edades de 18 a 50 años (M = 32,87, DT = 8,15) participaron como voluntarios. El protocolo experimental consistió un diseño intrasujeto realizado en tres sesiones: (1) prueba de esfuerzo para detectar el umbral aeróbico, (2) uso de un foco atencional interno, y (3) uso de un foco atencional externo. Durante las sesiones 2 y 3, los participantes realizaron 55 min carrera a intensidad moderada. Mediante el uso de una aplicación móvil y un mando inalámbrico patentados fue posible controlar, a nivel experimental, si los participantes mantenían eficazmente el foco atencional solicitado durante las sesiones. Los resultados muestran que no hubo efecto del uso del foco atencional interno o externo en la economía de carrera. Se concluye que, a una intensidad moderada, los corredores son libres de elegir se estrategia atencional sin que se afecte su rendimiento (AU)

Até agora, os efeitos de foco de atenção sobre o desempenho na corrida de longa distância têm mostrado resultados controversos, especialmente derivados de questões metodológicas. Considerou-se que um foco de atenção interna na respiração aumentar o consumo de oxigênio do corredor, diminuindo economia de corrida. No entanto, nenhum destes conclusão têm controlado em tempo real, se os participantes mantiveram o foco de atenção as instruções. Nossa hipótese é que o uso controlado do e interna vs. foco atencional externo não vai ter um efeito sobre a economia de corrida (consumo de oxigênio a uma velocidade set) em uma intensidade moderada. Um total de 30 (oito mulheres) corredores de longa distância, faixa de idade entre 18 a 50 anos (M = 32,87; DP = 8,15) se voluntariou para o estudo. O protocolo experimental consistiu em três sessões: (1) teste máximo incremental em esteira, (2) foco de atenção interna, e (3) foco atencional externo. Durante as sessões de 2 e 3, os participantes realizaram uma corrida (55 min) em intensidade moderada. Os resultados mostraram que não houve efeito do foco atencional (interno vs. externo) sobre a economia de corrida. Conclui-se que, quando a carga de trabalho é controlado em uma intensidade moderada, os corredores são livres para escolher se a centrar a sua atenção, sem afetar a economia de corrida (AU)

Percepción de las competencias profesionales del docente de educación física en primaria y secundaria / Primary and secundary school physical education teachers’ beliefs

El estudio ha tenido el propósito de analizar el conocimiento de la percepción de las competencias profesionales que tiene el profesor de educación física en primaria y secundaria, como uno de los aspectos que determinan la identidad de la educación física como materia escolar, para dar respuesta al análisis del estado de la educación física desde esta perspectiva. Participaron 119 docentes de Castilla-La Mancha de primaria y secundaria, a los que se les aplicó parte de la "Escala de Percepción de la eficacia de los docentes"; concretamente las preguntas referidas a la percepción sobre las competencias docentes que tienen los profesores; diseñado y validado por el grupo de investigación (GIEEAFyD-UAM), liderado por Hernández et al., (2010). Los resultados muestran que los profesores de primaria se perciben más competentes que los profesores de secundaria en la gestión/organización de la clase y en el conocimiento didáctico de la enseñanza; las diferencias son significativas en la percepción del dominio del contenido de enseñanza y no se hallan diferencias en la capacidad de liderazgo y de relación con otros agentes (AU)

The study has analyzed physical education teachers’ self-perception of their professional competences in primary and secondary school, as one of the aspects that determines physical education identity as a school subject. The main purpose of the analysis is to review the status of physical education from this perspective. 119 primary and secondary school teachers from Castilla-La Mancha took part in the study, which applied part of the Scale of Perception of Teachers´ Efficiency, designed and validated by the research group GIEEAFyD-UAM (Hernández et al. 2010), and, more specifically, those questions referred to teachers’ perception of their own educational competences; The results revealed that primary school teachers regard themselves as more competent than secondary school teachers in classroom management/organization and in teaching methodology. Differences are significant in participants’ perception of their command of the content and there are no differences in leadership qualities and neither in the relation to other education agents (AU)

Utilidad de la serie blanca en el diagnóstico diferencial de la mononucleosis infecciosa / Utility of the white series in the differential diagnosis of infectious mononucleosis

Introducción: la mononucleosis infecciosa (MI) es una enfermedad frecuente en la infancia. Nos planteamos comparar la serie blanca de niños con sospecha de MI, en función de la serología positiva/negativa para virus Epstein-Barr (VEB), citomegalovirus (CMV) y Paul-Bunnell. Material y métodos: estudio descriptivo transversal. Se revisaron niños atendidos en Urgencias en 2010-2011, con diagnóstico de síndrome mononucleósico y serología positiva para VEB o CMV e igual número de niños con serologías negativas como grupo de control. Se compararon variables epidemiológicas, clínicas y serológicas. Resultados: se obtuvieron 50 niños con serologías positivas y 50 niños con serologías negativas (edad media de 5,81 años). Tuvieron serología positiva para VEB 44 niños, 2 para CMV y 4 para ambos. De los 48 niños con serología positiva para VEB, 26 eran Paul-Bunnell negativos y 22 positivos, siendo estos 22 niños el total de Paul-Bunnell positivos. La media de linfocitos, monocitos y basófilos fue mayor en niños con serología positiva para VEB y los neutrófilos fueron más bajos. En los dos casos con CMV positivo encontramos cifras de neutrófilos totales mayores. Ninguna edad se asoció con mayor probabilidad de VEB y Paul-Bunnell positivos. Conclusiones: existe predominio de linfocitos, monocitos y basófilos en niños con MI por VEB. El descenso de neutrófilos es la única variación analítica en los niños con MI por CMV. Estos valores analíticos pueden orientarnos en el diagnóstico de MI. Todos los niños con Paul-Bunnell positivo tenían positividad para el VEB sin relación con la edad (AU)

Introduction: the infectious mononucleosis (IM) is a common disease in childhood. We propose to compare the white series of children with suspected IM, based on serology positive/negative for Epstein -Barr Virus (EBV), Cytomegalovirus (CMV) and Paul- Bunnell. Material and methods: descriptive study. Children were reviewed, taken to hospital in 2010-2011, diagnosed with mononucleosis syndrome and positive serology for EBV or CMV, and equal number of children who were seronegative control group. Epidemiology, clinical and serological variables were compared. Results: there were 50 children with positive serology and 50 negative children (mean age 5.81 years ). EBV serology were 44 children, 2 and 4 both CMV. Of the 48 children with positive serology for EBV, 26 were negative Paul- Bunnell and 22 positive, and these 22 children total positive Paul-Bunnell. The average number of lymphocytes, monocytes and basophils was higher in children with positive serology for EBV and neutrophils were lower. Children were CMV negative but elevated neutrophils. No age was associated with increased likelihood of EBV and Paul- Bunnell positive. Conclusions: there is a predominance of lymphocytes, monocytes and basophils in children with EBV IM. The increase in neutrophils is the only analytical variation in children with CMV IM. These analytical values can guide the diagnosis of IM. All children with positive Paul- Bunnell positive for EBV had no relation with age (AU)

Variabilidad interindividual y reproducibilidad de tres métodos de medida del espesor de la capa de fibras nerviosas / Variability and reproducibility of 3 methods for measuring the thickness of the nerve fiber layer

Objetivos: Calcular la variabilidad interindividual y reproducibilidad de la tomografía confocal (HRT), polarimetría láser (GDx) y tomografía de coherencia óptica (OCT Cirrus) para determinar el espesor de la capa de fibras ganglionares. Método: Se examinaron 2 veces 75 ojos normales. La variabilidad interindividual se analizó previa normalización de los resultados. Para medir la variabilidad entre exámenes se utilizó el coeficiente de variación y para analizar la correlación entre variables, el coeficiente de Pearson. Resultados: La variabilidad interindividual fue similar en GDx (8,9%) y en OCT (11,1%) pero muy elevada en HRT (30,0%). Ningún instrumento detectó cambios significativos con la edad. El coeficiente de variación del espesor total, entre 2 exámenes del mismo sujeto, fue significativamente inferior (p < 0,05) en GDx (1,4) que en OCT (2,0) y muy elevado en HRT (6,4). Lo mismo ocurrió al analizar las fibras superiores (GDx = 1,8; OCT = 2,9; HT = 6,6), pero no las inferiores, donde solo se observaron diferencias significativas con HRT (GDx = 2,2, OCT = 2,7, HRT = 7,0).Entre los resultados de OCT y GDx existió una correlación significativa al comparar los primeros (r = 0,46; p < 0,0001) y los segundos exámenes (r = 0,52; p < 0,0001). Sin embargo, no se observó ninguna correlación significativa entre los datos aportados por HRT respecto a los 2 instrumentos restantes (p > 0,05). Conclusiones: HRT presenta un exceso de dispersión interindividual y de variabilidad intertest en la estimación del espesor del haz de fibras nerviosas. GDx presenta, en este aspecto, ligeras ventajas respecto a OCT (AU)

Objective: To estimate the variability and reproducibility of confocal tomography (HRT), scanning laser polarimetry (GDx) and optical coherence tomography (OCT-Cirrus) to determine the thickness of the layer of ganglion fibers. Method: A total of 75 normal eyes were examined twice. Inter-individual variability was analyzed after standardizing the results. The coefficient of variation was used to measure the variability between tests, and the Pearson coefficient was used to analyze the correlation between variables. Results: The inter-individual variability was similar in GDx (8.9%) and OCT (11.1%), but very high in HRT (30.0%). No instrument detected significant changes with age. The coefficient of variation of the total thickness between the examinations of the same subject was significantly lower (P < 0.05) in GDx (1.4) than in OCT (2.0), but very high in HRT (6.4). The same was true when analyzing the upper fibers (GDx = 1.8, OCT = 2.9, HRT = 6.6), but not with the lower ones, where the only significant differences were observed with HRT (GDx = 2.2, OCT = 2.7, HRT = 7.0). Among the results of OCT and GDx, there was a significant correlation when comparing the first (r = 0.46, P < 0.0001) and second examinations (r = 0.52, P < 0.0001). However there was no significant relationship between the data provided by HRT for the two remaining instruments (P > 0.05). Conclusions: There is a wide variation in the inter-individual and inter-test measurement of the thickness of the of nerve fibers layers using HRT. GDx has, in this respect, slight advantages over OCT (AU)

[Variability and reproducibility of 3 methods for measuring the thickness of the nerve fiber layer]. / Variabilidad interindividual y reproducibilidad de tres métodos de medida del espesor de la capa de fibras nerviosas.

OBJECTIVE: To estimate the variability and reproducibility of confocal tomography (HRT), scanning laser polarimetry (GDx) and optical coherence tomography (OCT-Cirrus) to determine the thickness of the layer of ganglion fibers. METHOD: A total of 75 normal eyes were examined twice. Inter-individual variability was analyzed after standardizing the results. The coefficient of variation was used to measure the variability between tests, and the Pearson coefficient was used to analyze the correlation between variables. RESULTS: The inter-individual variability was similar in GDx (8.9%) and OCT (11.1%), but very high in HRT (30.0%). No instrument detected significant changes with age. The coefficient of variation of the total thickness between the examinations of the same subject was significantly lower (P<.05) in GDx (1.4) than in OCT (2.0), but very high in HRT (6.4). The same was true when analyzing the upper fibers (GDx=1.8, OCT=2.9, HRT = 6.6), but not with the lower ones, where the only significant differences were observed with HRT (GDx = 2.2, OCT = 2.7, HRT = 7.0). Among the results of OCT and GDx, there was a significant correlation when comparing the first (r=0.46, P<.0001) and second examinations (r=0.52, P<.0001). However there was no significant relationship between the data provided by HRT for the two remaining instruments (P>.05). CONCLUSIONS: There is a wide variation in the inter-individual and inter-test measurement of the thickness of the of nerve fibers layers using HRT. GDx has, in this respect, slight advantages over OCT.

Comparación bibliométrica en neuropediatría entre Revista de Neurología y Anales de Pediatría a través de una década / Comparison of bibliometric indicators for neuropaediatrics in Revista de Neurología and Anales de Pediatría over one decade

Objetivo. Análisis bibliométrico de los artículos neuropediátricos publicados en Revista de Neurología y Anales de Pediatría entre 2000 y 2009. Materiales y métodos. Se seleccionaron los artículos neuropediátricos publicados en las dos revistas durante la última década (n = 1.085). Se investigó autoría, tema y bibliografía, índice de aislamiento, índice de Price, colaboración, productividad, transitoriedad y autocitas. Se analizaron las citaciones recibidas a través de Web of Knowledge (WOK): artículos citados, veces citados e índice-h. Resultados. De los 1.085 artículos, 255 correspondían a Anales de Pediatría (el 9,4% del total en ese período) y 830 a Revista de Neurología (el 21,7% del total). El índice de colaboración fue de 4,3. El 89,7% de los autores eran sanitarios (el 96%, hospitalarios; el 0,8%, de atención primaria; y el 2,9%, ambos). El 11,9% eran colaborativos entre autonomías y el 26% procedían de centros extranjeros. El 29,8% fueron originales (el 80,8%, observacionales descriptivos; el 18,3%, analíticos; y el 0,8%, ensayos clínicos). Los temas más frecuentes fueron trastornos paroxísticos (15,9%), y trastornos del desarrollo, conducta y aprendizaje (15%). La media de citas bibliográficas por artículo fue de 27,6; el índice de aislamiento, del 13,4%; y el de Price, del 41,7%. El perfil de los artículos publicados en ambas revistas es diferente, y se encuentran diferencias estadísticamente significativas en casi todos los parámetros analizados. Según la WOK, los 255 artículos de Anales de Pediatría han recibido 40 citas e índice-h de 3; los 830 de Revista de Neurología, 2.234 citas e índice-h de 13. Conclusiones. Existen diferencias en las publicaciones de neuropediatría entre las dos revistas, con una mayor proyección internacional de Revista de Neurología (AU)

Aim. Bibliometric analysis of neuropaediatrics articles published in Revista de Neurología and Anales de Pediatría between 2000 and 2009. Materials and methods. We selected neuropaediatrics articles published in two journal during the last decade (n = 1,085). We investigated authorship, topic and bibliography, to calculate indices of isolation, Price, collaboration, productivity, transience and self-citations. Analyze citations received by Web of Knowledge (WOK): articles cited, sometimes cited and h-index. Results. 1,085 articles were analyzed, 255 published in Anales de Pediatría (9.4% of the total in that period) and 830 in Revista de Neurología (21.7% total). The collaboration index was 4.3. The 89.7% of the authors were medical care (96% hospital staff, 0,8% of primary care staff and 2.9% of both). The 11.9% of the articles were collaborative between regions and the 26% came from foreign centers. The originals were 29.8% (80.8% descriptive observational studies, analytical 18.3% and 0.8% clinical trials). The most frequent topics were paroxysmal disorders (15.9%) and developmental, learning and behavioral disorders (15%). The average number of citations per article was 27.6, with an isolation rate of 13.4% and a Price index of 41.7%. The profile of the articles published in both journals is different, finding significant differences in almost all parameters analyzed. According WOK, the 255 items of Anales de Pediatría have received 40 citations and h-index of 3 and the 830 Revista de Neurología 2,234 citations with h-index of 13. Conclusions. There are differences in the pediatric neurology publications between the two magazines with more international projection of Revista de Neurología (AU)

Gestación sin controlar y su impacto socio-sanitario en una población pediátrica / Pregnancy without control and its social-health care impact in a pediatric population

Introducción. El seguimiento prenatal ha logrado un aumento importante de la supervivencia neonatal. El mal control del embarazo está en relación con el nivel socioeconómico y otros factores sociales complejos. Pacientes y métodos. Estudio observacional, retrospectivo y descriptivo de los recién nacidos de gestaciones no controladas en el Hospital de Cabueñes (Gijón, Asturias) entre 2006 y 2010, seguido de un análisis comparativo con una población control. Resultados. Se registraron 92 gestaciones no controladas (8,31 casos/1000 recién nacidos). El 45,7% de las madres eran españolas y un 14,1% declararon consumir sustancias de abuso. La edad gestacional media fue de 37,7 semanas. Un 20,7% de los niños fueron cedidos para adopción y se procedió a la retirada definitiva de la custodia en el 10,9% de los casos. Se detectaron dos serologías postnatales positivas para el Virus de la Inmunodeficiencia Humana y tres para la Hepatitis C. Respecto al grupo control, las madres que no controlaron el embarazo fueron significativamente más jóvenes (26,9 vs 32,1 años) y tenían más hijos previos (1,73 vs 0,5) e interrupciones voluntarias del embarazo (0,34 vs 0,02). Sus (..) (AU)

Background. Routine antenatal care has increased neonatal surviving rates. Non-attending for antenatal care visits is related to several complex social and economical factors. Patients and methods. An observational, retrospective, descriptive review of all the infants born in Hospital de Cabueñes (Gijón, Asturias) following pregnancies with inadequate antenatal care between 2006 and 2010 and comparison with a control group. Results. Ninety-two pregnancies (8.31 cases/1000 liveborn infants) did not attend any antenatal care visits. Fortyfive percent of the mothers were Spanish and 14.1% reported drug abuse during pregnancy. Average gestational age was 37.7 weeks. Twenty-one percent of the newborns were given up for adoption, and the child’s custody was removed from the parents in 10.9% of cases. Two cases of Human Immunodeficiency Virus infection and three cases of hepatitis C (..) (AU)

[Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery]. / Tratamiento farmacológico preoperatorio de dos pacientes trombopénicos para intervención neuroquirúrgica.

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50,000 and 75,000/microL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia.

Tratamiento farmacol¨®gico preoperatorio de dos pacientes trombop¨¦nicos para intervenci¨®n neuroquir¨²rgica / Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery

El tratamiento y la profilaxis de la hemorragia del paciente con trombopenia o con alteraciones de la funci¨®n plaquetaria son controvertidos. El recuento plaquetario se correlaciona parcialmente con el riesgo hemorr¨¢gico. Existen factores de riesgo hemorr¨¢gico que deben ser evaluados y tratados antes de decidir el tratamiento perioperatorio. El 13% de los pacientes cirr¨®ticos tienen un recuento de plaquertas entre 50.000-75.000/¦ÌL, siendo la trombopenia de origen multifactorial. La p¨²rpura trombop¨¦nica idiop¨¢tica, PTI, es una enfermedad adquirida bien de forma primaria o secundaria a otras enfermedades, siendo la evoluci¨®n y el tratamiento de ambas formas bastante diferente. No hay m¨¦todos cl¨ªnicos que predigan el riesgo de hemorragia perioperatoria en pacientes con trombopenia. Se presentan dos casos de pacientes con trombopenia programados para cirug¨ªa intracraneal, tratados con factores de crecimiento de la trombopoyesis. En ambos casos se consigui¨® un recuento plaquetar acorde al tipo de intervenci¨®n. Se necesitan ensayos cl¨ªnicos controlados que determinen la seguridad, la utilidad profil¨¢ctica de la transfusi¨®n de plaquetas y de los an¨¢logos de la trombopoyetina en algunas situaciones refractarias de trombopenia(AU)

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50 000 and 75 000/¦ÌL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia(AU)