Play for health (P4H): una nueva herramienta en telerehabilitación / Play for health (P4H): a new tool for telerehabilitation

Introducción. Play for Health (P4H) es un sistema de telerehabilitación abierto y de bajo coste basado en el uso de videojuegos y métodos de interacción para mejorar déficits físicos y cognitivos. El propósito principal de este trabajo es presentar P4H, valorar su aceptación y describir la repercusión organizativa que ha supuesto su introducción en el Servicio de Rehabilitación. Material y métodos. Se ha utilizado la estructura básica de P4H junto con 3 videojuegos y 6 métodos de interacción. Se ha aplicado a modo de prueba sobre 40 pacientes con diferentes déficits en un entorno controlado y sin exclusión de otros tipos de terapia. Resultados. Tras 9 meses de utilización preliminar se constata la buena aceptación y valoración por parte de pacientes y personal sanitario, la ausencia de problemas en su utilización y su facilidad de aprendizaje. La implantación de P4H ha supuesto un cambio en el método de trabajo de los terapeutas, dedicando más tiempo a tareas de planificación y control, y la creación de sinergias con el equipo de técnicos. Conclusión. P4H es una herramienta de fácil uso y con gran potencial de expansión que posibilita un enfoque integral del tratamiento cognitivo, físico y social. La incorporación del aspecto lúdico a la terapia, a través de los videojuegos, ha facilitado la aceptación, adherencia e implicación del paciente (AU)

Introduction. Play for Health (P4H) is an open and low cost system of telerehabilitation based on the use of video games and interaction methods to improve physical and cognitive deficits.The main purpose of this paper is to present P4H, assess its acceptance and describe the organizational impact resulting from its introduction in the clinical Rehabilitation Service.Methods and material: We have used the basic structure of P4H platform along with 3 video games and 6 methods of interaction. On a trial basis, it was applied on 40 patients with different deficits in a controlled environment and without exclusion of other types of therapy. Results. After 9 months of preliminary use, its good acceptance and evaluation by the patients and health care personnel, absence of problems and the ease of learning in its use has been seen. The implementation of P4H has meant a change in the method of work of the therapists, who now may be spending more time on planning and control tasks, and the creation of synergies with the technical team. Conclusion. P4H is an easy-to-use tool with great potential for expansion that enables a comprehensive approach to cognitive, physical and social treatment. The addition of the playful aspect to the therapy, through video games, has facilitated acceptance, adherence and involvement of the patient (AU)

Bacterial meningitis in HIV-1-infected patients in the era of highly active antiretroviral therapy.

BACKGROUND: The burden that spontaneous bacterial meningitis (SBM) currently represents among HIV-1-infected patients is poorly known. METHODS: We prospectively evaluated 32 episodes of SBM in HIV-1-infected patients from the VACH (VIH-Aplicación de Control Hospitalario) Cohort and compared findings with those of 267 episodes in uninfected persons, matched by age and year of infection. A group of 13,187 HIV-1-infected patients from the VACH Cohort were used to identify predictors for acquiring SBM. RESULTS: Between 1997 and 2006, we found 32 episodes of SBM among HIV-1-infected patients for an annual incidence rate of 62.0 cases per 100,000 population compared with 3.2 (3.0 to 3.4) per 100,000 population for uninfected patients (P < 0.001). The last CD4 >or=200/mm count was the only predictor for developing SBM. Compared with uninfected, HIV-1-infected patients with SBM had a greater prevalence of primary extrameningeal infection, especially pneumonia (P = 0.02), bacteremia (P = 0.02), focal neurologic signs (P = 0.005), seizures (P = 0.06), a lower cerebrospinal fluid to blood glucose ratio (P = 0.02), and a lower prevalence of nuchal rigidity (P = 0.005). Streptococcus pneumoniae was the most frequent etiologic agent among HIV-1-infected patients. HIV-1-infected patients had neurologic complications more frequently (P = 0.02), a higher overall case fatality rate (P = 0.004), and greater incidence of neurologic sequelae (P = 0.001). CONCLUSIONS: Even in the highly active antiretroviral therapy era, the risk of developing SBM is 19 times higher among HIV-1-infected patients than among uninfected ones. It tends to present in severely immunosuppressed patients not previously vaccinated and off antiretroviral therapy, with a concomitant extrameningeal infection, bacteremia, and focal neurologic signs, and is caused by S. pneumoniae. SBM in HIV-1-infected patients carries a worse prognosis than in uninfected ones both in terms of lethality and sequelae.

First-line antiretroviral therapy with efavirenz or lopinavir/ritonavir plus two nucleoside analogues: the SUSKA study, a non-randomized comparison from the VACH cohort.

BACKGROUND: Efavirenz and lopinavir/ritonavir are both recommended antiretroviral agents for combination first-line therapy, although information on direct comparisons between them is scarce. A retrospective longitudinal study from the VACH cohort comparing both regimens was performed. METHODS: Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity. Survival analysis was conducted using the Kaplan-Meier method, and standard and weighted Cox regression models. RESULTS: A total of 1550 antiretroviral-naive patients starting a two-nucleoside reverse transcriptase inhibitor regimen plus either efavirenz (n = 1159) or lopinavir/ritonavir (n = 391) were included in the study. At baseline, patients starting lopinavir/ritonavir had higher HIV-1 RNA and lower CD4+ cell counts. There was no difference in the adjusted hazards of virological failure [efavirenz versus lopinavir/ritonavir hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.77-1.12, P = 0.43], CD4 recovery (HR = 1.11, 95% CI: 0.95-1.30, P = 0.19) and clinical progression (HR = 0.71, 95% CI: 0.39-1.31, P = 0.27). There was an increased risk of discontinuation for any reason or for toxicity for lopinavir/ritonavir (HR = 2.10, 95% CI: 1.40-3.15, P = 0.0003). CD4 recovery with both drugs was also similar in the lowest CD4 strata. A higher risk of early hypertriglyceridaemia was associated with lopinavir/ritonavir-based regimens. CONCLUSIONS: Our study suggests similar virological efficacy for efavirenz- or lopinavir/ritonavir-based first-line antiretroviral regimens, but an increased risk of discontinuation because of toxicity in case of lopinavir/ritonavir-based therapy. Immunological outcome appeared similar with both regimens.