Prevalence of pre-eclampsia and adverse pregnancy outcomes in women with pre-existing cardiomyopathy: a multi-centre retrospective cohort study.

Pre-eclampsia is associated with postnatal cardiac dysfunction; however, the nature of this relationship remains uncertain. This multicentre retrospective cohort study aimed to determine the prevalence of pre-eclampsia in women with pre-existing cardiac dysfunction (left ventricular ejection fraction < 55%) and explore the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] vs. population prevalence of 4.6% [95% C.I. 2.7-8.2], p = 0.99); 12/13 women had concurrent obstetric/medical risk factors for pre-eclampsia. The prevalence of preterm pre-eclampsia (< 37 weeks) and fetal growth restriction (FGR) was increased (1.8% vs. 0.7%, p = 0.03; 15.2% vs. 5.5%, p < 0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome. Antenatal ß blockers (n = 116) were associated with lower birthweight Z score (adjusted difference - 0.31 [95% C.I. - 0.61 to - 0.01], p = 0.04). To conclude, this study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with pre-existing cardiac dysfunction. Our results do not necessarily support a causal relationship between cardiac dysfunction and pre-eclampsia, especially given the population's background risk status. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.

The impact of assistive technology on burden and psychological well-being in informal caregivers of people with dementia (ATTILA Study).

INTRODUCTION: Assistive technology and telecare (ATT) may alleviate psychological burden in informal caregivers of people with dementia. This study assessed the impact of ATT on informal caregivers' burden and psychological well-being. METHODS: Individuals with dementia and their informal caregivers were recruited to a randomized-controlled trial assessing effectiveness of ATT. Caregivers were allocated to two groups according to their cared-for person's randomization to a full or basic package of ATT and were assessed on caregiver burden, state anxiety, and depression. Caregivers' data from three assessments over 6 months of the trial were analyzed. RESULTS: No significant between- or within-group differences at any time point on caregivers' burden, anxiety, and depression levels were found. DISCUSSION: Full ATT for people with dementia did not impact caregivers' psychological outcomes compared to basic ATT. The length of follow up was restricted to 6 months.

Assessment of need and practice for assistive technology and telecare for people with dementia-The ATTILA (Assistive Technology and Telecare to maintain Independent Living At home for people with dementia) trial.

INTRODUCTION: The objective of this study was to define current assistive technology and telecare (ATT) practice for people with dementia living at home. METHODS: This is a randomized controlled trial (N = 495) of ATT assessment and ATT installation intervention, compared with control (restricted ATT package). ATT assessment and installation data were collected. Qualitative work identified value networks delivering ATT, established an ATT assessment standard. RESULTS: ATT was delivered by public and not-for-profit telecare networks. ATT assessments showed 52% fidelity to the ATT assessment standard. Areas of assessment most frequently leading to identifying ATT need were daily activities (93%), memory (89%), and problem-solving (83%). ATT needs and recommendations were weakly correlated (τ = 0.242; P < .000), with ATT recommendations and installations moderately correlated (τ = -0.470; P < .000). Half (53%) of recommended technology was not installed. Safety concerns motivated 38% of installations. DISCUSSION: Assessment recommendations were routinely disregarded at the point of installation. ATT was commonly recommended for safety and seldom for supporting leisure.

Principles of recovery from traumatic brain injury: reorganization of functional networks.

Recovery after brain injury is an excellent platform to study the mechanism underlying brain plasticity, the reorganization of networks. Do complex network measures capture the physiological and cognitive alterations that occurred after a traumatic brain injury and its recovery? Patients as well as control subjects underwent resting-state MEG recording following injury and after neurorehabilitation. Next, network measures such as network strength, path length, efficiency, clustering and energetic cost were calculated. We show that these parameters restore, in many cases, to control ones after recovery, specifically in delta and alpha bands, and we design a model that gives some hints about how the functional networks modify their weights in the recovery process. Positive correlations between complex network measures and some of the general index of the WAIS-III test were found: changes in delta-based path-length and those in Performance IQ score, and alpha-based normalized global efficiency and Perceptual Organization Index. These results indicate that: 1) the principle of recovery depends on the spectral band, 2) the structure of the functional networks evolves in parallel to brain recovery with correlations with neuropsychological scales, and 3) energetic cost reveals an optimal principle of recovery.

Reorganization of functional connectivity as a correlate of cognitive recovery in acquired brain injury.

Cognitive processes require a functional interaction between specialized multiple, local and remote brain regions. Although these interactions can be strongly altered by an acquired brain injury, brain plasticity allows network reorganization to be principally responsible for recovery. The present work evaluates the impact of brain injury on functional connectivity patterns. Networks were calculated from resting-state magnetoencephalographic recordings from 15 brain injured patients and 14 healthy controls by means of wavelet coherence in standard frequency bands. We compared the parameters defining the network, such as number and strength of interactions as well as their topology, in controls and patients for two conditions: following a traumatic brain injury and after a rehabilitation treatment. A loss of delta- and theta-based connectivity and conversely an increase in alpha- and beta-band-based connectivity were found. Furthermore, connectivity parameters approached controls in all frequency bands, especially in slow-wave bands. A correlation between network reorganization and cognitive recovery was found: the reduction of delta-band-based connections and the increment of those based on alpha band correlated with Verbal Fluency scores, as well as Perceptual Organization and Working Memory Indexes, respectively. Additionally, changes in connectivity values based on theta and beta bands correlated with the Patient Competency Rating Scale. The current study provides new evidence of the neurophysiological mechanisms underlying neuronal plasticity processes after brain injury, and suggests that these changes are related with observed changes at the behavioural level.

Evaluacion del funcionamiento del laboratorio clinico del Hospital de San Jose con relacion a la prestacion de servicios / Performance evaluation related to Hospital San Jose clinical laboratory service

Esta investigacion procuro obtener una vision global sobre el funcionamiento del Laboratorio Clinico del H.S.J. para conocer la fallas que existen en la prestacion de los servicios e identificar entre ellas las mas importantes, con el fin de recomendar las medidas tendientes a mejorar su atencion. Despues de analizar los datos obtenidos de la encuesta se pudo comprobar evidentemente que existe una desorganizacion y falta de coordinacion que esta afectando en accionar y su buen funcionamiento del laboratorio. Dentro de la desorganizacion se vio que entre los componentes mas importantes se encuentra la confusion, la perdida y la demora en los resultados de los examenes practicados, siendo la perdida con un 41% el factor mas importante de los mencionados. Aparece luego la demora en un 31% y finalmente la confusion en un 28%, criterios igualmente importantes ya que son los indicadores basicos que llevan al Laboratorio a desprestigiar su imagen..