Autoestima global y calidad de vida relacionada con salud percibida por adultos mayores / Global self-esteem and health related quality life perceived by older adults

Objetivo: determinar el nivel de autoestima y calidad de vida relacionada con la salud (CVRS) en personas matriculadas en el Programa Institucional para la Persona Adulta y Adulta Mayor de la Universidad de Costa Rica (PIAM-UCR). Métodos: estudio descriptivo-correlacional, transversal de abordaje cuantitativo en una población de 256 personas del PIAM-UCR. Se utilizó un cuestionario biosociodemográfico, Escala de Autoestima Global de Rosenberg (EAGR) y SF-12 de CVRS. Durante toda la investigación se respetaron principios bioéticos internacionales. Resultados: los participantes reportaron una alta percepción de autoestima y CVRS, y ambas variables presentaron relaciones estadísticamente significativas (p≤0,05). Conclusiones: existe relación entre la autoestima y la CVRS dado los factores protectores que posee esta población adulta mayor en específico. Además, que una alta autoestima propicia un aumento en la CVRS, las cuales se convierten en variables claves para alcanzar un envejecimiento positivo. (AU)

Objective: determine the level of self-esteem and health-related quality of life (HRQoL) in people enrolled in the Institutional Program for the Adult and Older Adults at the University of Costa Rica (PIAM-UCR). Methods: Descriptive-correlational, cross-sectional study of a quantitative approach in a population of 256 people from PIAM-UCR. An sociodemographic questionnaire, Rosenberg Global Self-Esteem Scale (RGSS) and HRQoL SF-12 were used. Throughout the research, international bioethical principles were respected. Results: the participants reported a high perception of self-esteem and HRQoL, and both variables presented statistically significant relationships (p≤0.05). Conclusions: there is a relationship between self-esteem and HRQoL given the protective factors that this specific older adult population possesses. In addition, that high self-esteem an increase the HRQL, which become key variables to achieve positive aging. (AU)

El índice de síntomas binomial para la evaluación de la asociación temporal entre síntomas cardiorespiratorios y reflujo gastroesofágico en neonatos / The binomial symptom index for the evaluation of temporal association between cardiorespiratory symptoms and gastroesophageal reflux in neonates

INTRODUCCIÓN: La evaluación de la asociación de síntomas entre el reflujo gastroesofágico y los eventos cardiorrespiratorios no está aún resuelta. Este artículo describe una aproximación conservadora para la decisión del tratamiento quirúrgico anti-reflujo mediante el análisis de la asociación de síntomas. MÉTODOS: Cuarenta y tres neonatos con síntomas cardiorrespiratorios potencialmente asociados al reflujo se sometieron a una monitorización cardiorrespiratoria y de pH-impedancia esofágica. Se consideraron tres índices, el índice de síntomas (IS), el índice de sensibilidad de síntomas (ISS) y la probabilidad de asociación de síntomas (PAS). Asimismo, se adoptó una estrategia conservadora para la aplicación de cirugía anti-reflujo, de manera que solo se consideró el tratamiento quirúrgico en aquellos pacientes con valor significativo en los tres índices. Se contrastaron retrospectivamente estos índices y el índice de síntomas binomial (ISB) frente a la decisión de cirugía anti-reflujo utilizando diferentes ventanas de asociación. RESULTADOS: Trece pacientes mostraron algún índice con valor significativo pero solo dos se sometieron al tratamiento quirúrgico. Tanto el IS como el ISS mostraron una tendencia creciente al aumentar el ancho de la ventana de asociación. El PAS sufrió fuertes variaciones aleatorias frente a pequeños cambios del enventanado. El ISB presentó el mejor resultado con la ventana de dos minutos (κ=0.78). CONCLUSIONES: La patología bajo estudio mejora con la madurez del individuo. Sin embargo, la severidad de los síntomas cardiorrespiratorios puede amenazar la vida del neonato y por lo tanto, en algunas ocasiones se deben considerar tratamientos invasivos para proteger la vida. El ISB proporciona una buena predicción de la combinación de valores positivos del IS, ISS y PAS, lo que puede ayudar a mejorar las decisiones clínicas. Sin embargo, son necesarios futuros estudios que prueben al ISB como un predictor óptimo de los eventos clínicos

INTRODUCTION: The evaluation of symptom association between gastroesophageal reflux and cardiorespiratory events in preterm infants remains unclear. This paper describes a conservative approach to decision-making of anti-reflux surgery through symptom association analysis. METHODS: Forty-three neonates with potentially reflux-related cardiorespiratory symptoms underwent synchronized esophageal impedance-pH and cardiorespiratory monitoring. Three indices were considered to evaluate symptom association, the symptom index (SI), the symptom sensitivity index (SSI) and the symptom association probability (SAP). A conservative strategy was adopted regarding the decision of anti-reflux surgery, and therefore, patients were scheduled for laparoscopic Nissen fundoplication if the three indices showed a positive assessment of symptom association. Retrospectively, these indices and the binomial symptom index (BSI) were contrasted against the decision of anti-reflux surgery using different windows of association. RESULTS: Thirteen patients showed positive symptom association but only two underwent anti-reflux surgery. The SI and the SSI showed an increasing trend with the width of the window of association. The SAP was affected randomly by slightly altering the windowing parameters. The BSI showed the best performance with the two-minute window (κ=0.78). CONCLUSIONS: The pathology under study is known to improve with maturity. However, the severity of cardiorespiratory symptoms may threaten the neonate's life and therefore, on some occasions, invasive treatments must be considered to protect life. The BSI provides a good prediction of a combination of positive SI, SSI and SAP, which may improve clinical decisions. However, further clinical studies are required to prove the BSI as an optimal predictor of clinical outcomes

[The binomial symptom index for the evaluation of temporal association between cardiorespiratory symptoms and gastroesophageal reflux in neonates]. / El índice de síntomas binomial para la evaluación de la asociación temporal entre síntomas cardiorrespiratorios y reflujo gastroesofágico en neonatos.

INTRODUCTION: The evaluation of symptom association between gastroesophageal reflux and cardiorespiratory events in preterm infants remains unclear. This paper describes a conservative approach to decision-making of anti-reflux surgery through symptom association analysis. METHODS: Forty-three neonates with potentially reflux-related cardiorespiratory symptoms underwent synchronized esophageal impedance-pH and cardiorespiratory monitoring. Three indices were considered to evaluate symptom association, the symptom index (SI), the symptom sensitivity index (SSI) and the symptom association probability (SAP). A conservative strategy was adopted regarding the decision of anti-reflux surgery, and therefore, patients were scheduled for laparoscopic Nissen fundoplication if the three indices showed a positive assessment of symptom association. Retrospectively, these indices and the binomial symptom index (BSI) were contrasted against the decision of anti-reflux surgery using different windows of association. RESULTS: Thirteen patients showed positive symptom association but only two underwent anti-reflux surgery. The SI and the SSI showed an increasing trend with the width of the window of association. The SAP was affected randomly by slightly altering the windowing parameters. The BSI showed the best performance with the two-minute window (κ =0.78) CONCLUSIONS: The pathology under study is known to improve with maturity. However, the severity of cardiorespiratory symptoms may threaten the neonate's life and therefore, in some occasions, invasive treatments must be considered to protect life. The BSI provides a good prediction of a combination of positive SI, SSI and SAP, which may improve clinical decisions. However, further clinical studies are required to prove the BSI as an optimal predictor of clinical outcomes.

Resultados del descenso endorrectal transanal en la enfermedad de Hirschsprun / Results of transanal endorrectal descent in Hirschprung’s disease

OBJETIVO: Presentar nuestra experiencia en el tratamiento de pacientes con enfermedad de Hirschsprung (EH) intervenidos mediante descenso endorrectal transanal (DET). MÉTODOS: Estudio retrospectivo de los DET realizados. Correlacionamos, fundamentalmente, longitud del segmento agangliónico, con complicaciones, necesidad de colostomía y vía de abordaje. RESULTADOS: Entre 2003 y 2012 hemos realizado 73 DET (57 varones), 78,6% diagnosticados en el periodo neonatal. La longitud agangliónica objetivada en el enema se correspondió con los hallazgos quirúrgicos en un 68,9% de los casos; esta correspondencia fue mayor en las formas cortas que en las largas o pancolónicas (80,9 vs. 44%; p < 0,001). Cuatro pacientes precisaron colostomía preoperatoria. La edad media al descenso fue de 6,3 meses (rango 4,5-33,7). El 64,4% eran formas cortas. El abordaje abdominal fue necesario en 10 pacientes (13,6%), 9 de ellos aganglionismos largos o pancolónicos. El 10,9% (8 pacientes) ha presentado enterocolitis postoperatoria, sin relación con la longitud agangliónica ni con la existencia de displasia residual. La suboclusión por bridas se presentó en el 19,2% de las formas largas o pancolónicas. Actualmente, de los pacientes valorables, 5 tienen hábito estreñido y 12 presentan escapes ocasionales. CONCLUSIONES: El DET es la cirugía de elección para pacientes con EH. La mayoría pueden manejarse con «nursing» preoperatorio, sin colostomía. Las pruebas diagnósticas de elección son la manometría y la biopsia rectal por succión. No hemos encontrado correlación entre la existencia de enterocolitis y la longitud del segmento agangliónico, aunque hemos observado una reducción drástica de las enterocolitis postoperatorias, desde la introducción de modificaciones técnicas, como la sonda rectal posquirúrgica y la sección posterior del manguito muscular

OBJECTIVE: To present our experience of patients with Hirschsprung disease (HD) operated by transanal endorrectal descent (TED). METHODS: A retrospective study performed of TEDs. We correlate fundamentally the aganglionic segment length with: Complications, need for colostomy and surgical approach. RESULTS: Between 2003 and 2012 we performed 73 TED (57 men), 78.6% diagnosed in the neonatal period. The aganglionic segment length evidenced in the enema was correlated with surgical findings in 68.9% of cases, being higher in the short forms than in the long segments (80.9 vs. 44%, P<.001). Four patients required preoperative colostomy. The mean age of surgery was 6.3 months (4.5 to 33.7). Short forms represented 64.4% of cases. The abdominal approach was necessary in 10 patients, 9 of these were long/total colonic aganglionic segment. Postoperative enterocolitis presented in 10,9% (9 patients), with no relation with the length of aganglionic or the existence of residual dysplasia. Obstructions occurred in 19.2% of the long form or pancolonic forms. Currently, of the evaluable patients, 5 present constipationand 12 present occasional leakage. CONCLUSIONS: TED is the surgery of choice for patients with HD. The majority can be handled by preoperative «nursing» without colostomy. The diagnostic tests of choice are manometry with suction biopsy. No significant correlation was found between enterocolitis and length of aganglionic segment, although we observed a drastic reduction of postoperative enterocolitis, since the introduction of technical changes, such as the use of postoperative rectal tubes and the posterior section of the cuff muscles

Results of transanal endorrectal descent in Hirschprung's disease.

OBJECTIVE: To present our experience of patients with Hirschsprung disease (HD) operated by transanal endorrectal descent (TED). METHODS: A retrospective study performed of TEDs. We correlate fundamentally the aganglionic segment length with: Complications, need for colostomy and surgical approach. RESULTS: Between 2003 and 2012 we performed 73 TED (57 men), 78.6% diagnosed in the neonatal period. The aganglionic segment length evidenced in the enema was correlated with surgical findings in 68.9% of cases, being higher in the short forms than in the long segments (80.9 vs. 44%, P<.001). Four patients required preoperative colostomy. The mean age of surgery was 6.3 months (4.5 to 33.7). Short forms represented 64.4% of cases. The abdominal approach was necessary in 10 patients, 9 of these were long/total colonic aganglionic segment. Postoperative enterocolitis presented in 10,9% (9 patients), with no relation with the length of aganglionic or the existence of residual dysplasia. Obstructions occurred in 19.2% of the long form or pancolonic forms. Currently, of the evaluable patients, 5 present constipationand 12 present occasional leakage. CONCLUSIONS: TED is the surgery of choice for patients with HD. The majority can be handled by preoperative «nursing¼ without colostomy. The diagnostic tests of choice are manometry with suction biopsy. No significant correlation was found between enterocolitis and length of aganglionic segment, although we observed a drastic reduction of postoperative enterocolitis, since the introduction of technical changes, such as the use of postoperative rectal tubes and the posterior section of the cuff muscles.

Software for symptom association analysis in pediatric gastroesophageal reflux disease.

Gastroesophageal reflux (GER) disease is a serious complication of the upper gastrointestinal tract. Cardiorespiratory symptoms such as apnea, oxygen desaturation and bradycardia may be related to GER. Thus, the recommended diagnostic methodology in pediatric patients requires 24-h synchronized esophageal and cardiorespiratory monitoring. However, there is no computer tool available for this purpose and therefore, researchers and physicians are forced to seek for customized solutions. This paper presents an open source computer program for the analysis of symptom association. It allows a convenient visualization of the biological signals and implements the three main metrics for symptom association, that is, the symptom index, the symptom sensitivity index and the symptom association probability. This software represents a flexible solution and will facilitate caregivers an easy assessment of the existence of temporal association between GER and cardiorespiratory episodes. This would ideally reduce inappropriate medical and surgical treatments and would provide an early diagnosis of the medical condition.

Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux.

OBJECTIVE: Gastroesophageal reflux is a physiologic process and is considered pathologic (gastroesophageal reflux disease) when it causes symptoms or results in complications. It is common in preterm infants and occurs in healthy neonates. Twenty-four-hour pH monitoring commonly is used in children for diagnosis of gastroesophageal reflux disease, and abnormal reflux is considered with detection of increased esophageal acid exposure. However, in neonates, relatively few gastroesophageal reflux episodes cause esophageal acidification to pH < 4. Premature infants receive frequent feeds, which can induce a weaker acid secretory response than that observed in older infants and adults. As a consequence, gastric pH may be > 4 for prolonged periods, and reflux of gastric contents might be less acidic or even alkaline. Esophageal impedance monitoring can detect weakly acidic and even alkaline gastroesophageal reflux. The role of weakly acidic reflux in the pathophysiology of gastroesophageal reflux disease in preterm infants is not clear. To date, studies that have used impedance-pH in neonates assessed the association between nonacid reflux and cardiorespiratory symptoms, but no impedance data from healthy preterm neonates have been available to determine whether those symptomatic neonates had an increased number of weakly acidic reflux episodes or increased reactivity to a physiologic number of reflux events. Our aim with this study was to provide impedance-pH values for acid, weakly acidic, and weakly alkaline reflux from healthy preterm neonates. METHODS: Esophageal impedance was recorded for 24 hours in 21 asymptomatic preterm neonates by replacing the conventional feeding tube with a specially designed feeding tube that included 9 impedance electrodes (8 French). All neonates were asymptomatic, with spontaneous breathing. Reflux monitoring was performed after comprehensive explanation and on receipt of written parental consent. Esophageal and gastric pH were monitored using a separate parallel pediatric catheter (6 French). According to the corresponding pH change, impedance-detected reflux was classified as acid, weakly acidic, and weakly alkaline. For each infant, the total number of reflux events, the acid exposure and bolus exposure times at 2 cm above the respiratory inversion point, and average proximal extent of reflux were calculated. RESULTS: Twenty-six preterm neonates were recruited into this study. A preliminary analysis was performed, and tracings were classified according to their quality and the presence of technical artifacts (spontaneous pH and impedance drifts, esophageal probe migration, and dysfunction of 1 or more impedance channels). Five studies were excluded because of 1 or more technical artifacts; a total of 21 neonates represent the final cohort included. At birth, the infants had a median postmenstrual age of 32 weeks, and the measurements were performed at a median age of 12 days. The total recording time was 23.7 +/- 2 hours. Gastric pH was higher than 4 during 69.3 +/- 20.4% of the recording time. The median number of reflux events in 24 hours was 71, 25.4% (range: 0%-53.1%) of which were acid, 72.9% (range: 45.3%-98.0%) were weakly acidic, and 0% (range: 0%-8.1%) were weakly alkaline. Compared with fasting periods, feeding periods tended to be associated with a higher number of total reflux events per hour. The acidity of reflux, however, was significantly different: during fasting, the number of acid reflux episodes per hour was higher, whereas during feeding, the number of weakly acidic reflux episodes was increased. Most reflux events were only liquid, whereas gas was present either mixed with liquid or pure only in 7.7% of all reflux episodes detected. The proximal esophageal segments were reached in 90% of reflux episodes. Reflux-related acid exposure (pH drops associated with impedance-detected reflux) was 1.66% (range: 0%-6.43%), whereas total acid exposure (associated and not associated with reflux detected by impedance) was 5.59% (range: 0.04%-20.69%). There was no relationship between the number or acidity of reflux events and anthropometric parameters such as weight and gestational age. CONCLUSIONS: We present the first study using 24-hour impedance-pH recordings in asymptomatic premature neonates. Previous studies that used pH-metry suggested that neonatal cardiorespiratory symptoms could be related to acid gastroesophageal reflux. However, pH-metry could not detect accurately weakly acidic or nonacid reflux. Our healthy premature neonates had approximately 70 reflux events in 24 hours, 25% of which were acid, 73% were weakly acidic, and 2% were weakly alkaline. The number of reflux events per hour (2-3 per hour) was slightly lower than that described in premature neonates with cardiorespiratory events (4 per hour). We confirmed that weakly acidic reflux is more prevalent than acid reflux, particularly so during the feeding periods. In contrast, similar to healthy adults, weakly alkaline reflux was very rare. We confirmed findings from previous studies in which most reflux events were pure liquid during both fasting and during postprandial periods and gas reflux was very rare. As in neonates with cardiorespiratory symptoms, the majority of reflux events in asymptomatic preterms reached the proximal esophagus or pharynx, and there were no differences between acid and weakly acidic reflux. The lack of differences between asymptomatic and diseased infants contravenes the hypothesis for macro- or microaspiration but does not exclude hypersensitivity to reflux as a cause for respiratory symptoms. The acid exposure that was related to reflux events and detected by impedance was significantly lower than the total acid exposure during 24 hours. Increased acid exposure could be attributable to pH-only reflux events or, less frequently, to slow drifts of pH from baselines at approximately 5 to values < 4. These changes were not accompanied by a typical impedance pattern of reflux but by slow drifts in impedance in 1 or 2 channels. Our findings confirm the need for the use of impedance together with pH-metry for diagnosis of all gastroesophageal reflux events. The relationship between gastroesophageal reflux and cardiorespiratory events in neonates and older infants has been studied extensively. The current evidence for such a relationship is controversial. This study provides values of impedance-pH monitoring for acid, weakly acidic, and weakly alkaline reflux from healthy preterm neonates that can be used for comparison when evaluating gastroesophageal reflux in preterm infants with a cardiorespiratory disease.