Transcranial direct current stimulation for gait recovery following stroke: A systematic review of current literature and beyond.

Background: Over the last decade, transcranial direct current stimulation (tDCS) has set promise contributing to post-stroke gait rehabilitation. Even so, results are still inconsistent due to low sample size, heterogeneity of samples, and tDCS design differences preventing comparability. Nonetheless, updated knowledge in post-stroke neurophysiology and stimulation technologies opens up opportunities to massively improve treatments. Objective: The current systematic review aims to summarize the current state-of-the-art on the effects of tDCS applied to stroke subjects for gait rehabilitation, discuss tDCS strategies factoring individual subject profiles, and highlight new promising strategies. Methods: MEDLINE, SCOPUS, CENTRAL, and CINAHL were searched for stroke randomized clinical trials using tDCS for the recovery of gait before 7 February 2022. In order to provide statistical support to the current review, we analyzed the achieved effect sizes and performed statistical comparisons. Results: A total of 24 records were finally included in our review, totaling n = 651 subjects. Detailed analyses revealed n = 4 (17%) studies with large effect sizes (≥0.8), n = 6 (25%) studies with medium ones (≥0.5), and n = 6 (25%) studies yielding low effects sizes (≤ 0.2). Statistically significant negative correlations (rho = -0.65, p = 0.04) and differences (p = 0.03) argued in favor of tDCS interventions in the sub-acute phase. Finally, significant differences (p = 0.03) were argued in favor of a bifocal stimulation montage (anodal M1 ipsilesional and cathodal M1 contralesional) with respect to anodal ipsilesional M1. Conclusion: Our systematic review highlights the potential of tDCS to contribute to gait recovery following stroke, although also the urgent need to improve current stimulation strategies and subject-customized interventions considering stroke severity, type or time-course, and the use of network-based multifocal stimulation approaches guided by computational biophysical modeling. Systematic review registration: PROSPERO: CRD42021256347.

Lactancia materna. Factores relacionados con la iniciación, la exclusividad y la duración / Breastfeeding. Factors associated with initiation, exclusivity and duration

OBJETIVO: conocer la prevalencia del inicio de la lactancia materna(LM), exclusividad y duración, los factores que influyeron en su elección, mantenimiento o abandono y los tipos de intervención sanitaria recibida. MÉTODO: estudio descriptivo transversal sobre LM de niños en seguimiento pediátrico en cuatro centros de Atención Primaria de Barcelona. Se estudiaron 495 niños cuando tenían entre 10 y19 meses. RESULTADOS: el 92,3% de las madres tenía intención previa de iniciar LM. El 89,5% dio el pecho y el 46,3% mantuvo la LM más de seis meses. No se pudo detectar el principal motivo de abandono de LM, por ser un motivo no específico, aunque un 12,9% la abandonó al incorporarse la madre al trabajo. Los principales problemas al amamantar fueron hipogalactia con un 15,6%, seguido de grietas con un 13,8%.CONCLUSIONES: casi la totalidad de las mujeres prefirió LM. La exclusividad fue seguida en menor número que en los resultados globales de Cataluña. La intención previa ayudó a más mujeres a amamantar y durante más tiempo. La educación posparto fue efectiva para mantener la lactancia. No se identificó el motivo principal concreto del abandono de la LM

OBJECTIVE: to learn about the prevalence of breastfeeding (BF)initiation, its exclusivity and duration, the factors with an impact on its choice, maintenance or discontinuation, and the types of healthcare intervention received. METHOD: a descriptive transversal study on BF for children under paediatric follow-up in four Primary Care Centers in Barcelona. The study included 495 children when their age was between 10 and 19 months. RESULTS: a 92.3% of mothers had the previous intention to initiate BF. Out of these, 89.5% breastfed their children, and46.3% continued BF beyond six months. The main reason for BF discontinuation could not be identified, because it was unspecific, though in 12.9% of cases it was discontinued when mothers returned to work. The main problems with breastfeeding were: hypogalactia for 15.6%, followed by cracked nipples in13.8% of cases. CONCLUSIONS: almost all women preferred BF. Exclusive breastfeeding was followed by a lower number than in the overall results in Catalonia. Previous intention helped more women to breastfeed and for a longer time. Postpartum education was effective to maintain breastfeeding. The specific main reason for BF discontinuation was not identified

Beta-blocker treatment of stable heart failure in primary care.

INTRODUCTION AND OBJECTIVES: Beta-blocker treatment of stable heart failure in primary care. The objective was to evaluate the feasibility and tolerability of uptitrating beta-blockers in patients with stable systolic heart failure seen in primary care. METHODS: Before and after intervention study. The study was conducted in two primary care centers in Barcelona, Spain. Consecutive samples of patients with systolic heart failure who had not received previous beta-blocker treatment were recruited between April 2004 and April 2006. Treatment was started with the lowest dose of bisoprolol or carvedilol and the dose was doubled every two weeks in the absence of contraindications. Patients were followed up for 6 months. RESULTS: The study included 88 patients (76.1% male, 23,9% female, mean age 64.88 years). Of these, 57.1% were treated with bisoprolol and 42.9% with carvedilol. Overall, 75.0% reached the target dose, 21.7% tolerated a dose lower than the target dose, and 3.3% had the beta-blocker withdrawn (due to bradycardia in 1.1%, syncope in 1.1%, and stroke in 1.1%). Adverse events were experienced by 70.4%, the majority of which (57.95%) were resolved without changing treatment. The most common were nausea (42.04%), asthenia (35.22%), and increased dyspnea (17.04%). There were significant improvements in functional class and ejection fraction. CONCLUSIONS: The majority of adverse events were mild. Treatment was withdrawn in only a few patients and most reached the recommended target dose. Appropriately trained primary care physicians can uptitrate beta-blockers in heart failure patients without undue concern.

Betabloqueantes en el tratamiento de la insuficiencia cardiaca estable en atención primaria / Beta-blocker treatment of stable heart failure in primary care

Introducción y objetivos. El objetivo es valorar la factibilidad y la tolerabilidad de la titulación de betabloqueantes en insuficiencia cardiaca sistólica en atención primaria. Métodos. Estudio de intervención antes/después. El estudio se realizó en dos centros de atención primaria de Barcelona. Se incluyó mediante muestreo sucesivo, desde abril de 2004 hasta abril de 2006, a los pacientes con IC sistólica sin tratamiento betabloqueante previo. Se inició titulación con bisoprolol o carvedilol a dosis mínima, doblándose cada 2 semanas en ausencia de contraindicaciones. Seguimiento durante 6 meses. Resultados. Se incluyó a un total de 88 pacientes (76,1% hombres, 23,9% mujeres. Edad media, 64,88 años). Al 57,1% se pautó bisoprolol y al 42,9%, carvedilol. El 75% alcanzaron la dosis diana, el 21,7% toleraron dosis menores de la diana y en el 3,3% hubo de retirarse el betabloqueante (1,1% bradicardia, 1,1% síncope, 1,1% accidente cerebrovascular). El 70,4% de los pacientes presentaron acontecimientos adversos. La mayoría de éstos (57,95%) se resolvieron sin cambios en el tratamiento. Los más frecuentes fueron: mareo (42,04%), astenia (35,22%) y el aumento de la disnea (17,04%). Hubo una mejora significativa de la clase funcional y de la fracción de eyección. Conclusiones. La mayoría de los acontecimientos adversos son leves. Las retiradas del tratamiento son escasas y la mayoría de los pacientes alcanzaron la dosis diana recomendada. Los médicos de atención primaria convenientemente formados pueden titular con seguridad los BB (AU)

Introduction and objectives. Beta-blocker treatment of stable heart failure in primary care. The objective was to evaluate the feasibility and tolerability of uptitrating beta-blockers in patients with stable systolic heart failure seen in primary care. Methods. Before and after intervention study. The study was conducted in two primary care centers in Barcelona, Spain. Consecutive samples of patients with systolic heart failure who had not received previous beta-blocker treatment were recruited between April 2004 and April 2006. Treatment was started with the lowest dose of bisoprolol or carvedilol and the dose was doubled every two weeks in the absence of contraindications. Patients were followed up for 6 months. Results. The study included 88 patients (76.1% male, 23,9% female, mean age 64.88 years). Of these, 57.1% were treated with bisoprolol and 42.9% with carvedilol. Overall, 75.0% reached the target dose, 21.7% tolerated a dose lower than the target dose, and 3.3% had the beta-blocker withdrawn (due to bradycardia in 1.1%, syncope in 1.1%, and stroke in 1.1%). Adverse events were experienced by 70.4%, the majority of which (57.95%) were resolved without changing treatment. The most common were nausea (42.04%), asthenia (35.22%), and increased dyspnea (17.04%). There were significant improvements in functional class and ejection fraction. Conclusions. The majority of adverse events were mild. Treatment was withdrawn in only a few patients and most reached the recommended target dose. Appropriately trained primary care physicians can uptitrate beta-blockers in heart failure patients without undue concern (AU)

[Pre/post assessment of an HIV infection prevention intervention targeted at teenagers in Southern Tarragona, Spain]. / Evaluación pre-post de una actividad preventiva de la infección por VIH dirigida a los adolescentes de las comarcas del sur de Tarragona.

BACKGROUND: Human immuno-deficiency virus (HIV) infection is one of the leading public health problems in our country. Preventive education has shown itself to be a useful tool for curtailing this disease. The objective of this study is that of assessing the effectiveness of a preventive intervention at the Secondary Schools in the Baix Ebre and Montsià areas of the Tortosa Healthcare District aimed at reducing the risk of HIV transmission and furthering the knowledge of this disease. METHOD: A pre/post intervention study was conducted with no control group. A total of 19 schools, corresponding to the fourth year of Compulsory Secondary Education and first year of "Bachillerato" studies were invited to participate. The activity consisted of a workshop 60-90 minutes in length, in conjunction with educational material. A questionnaire was used as the gauging tool. RESULTS: Twelve schools agreed to participate, a total of 896 answers having been gotten for the pre-test and 805 answers for the post-test. A statistically significant increase was found for 52% (10/19) of the items regarding the correct answers on the post-test. A statistically significant improvements was found in four of the five items (80%) related to attitudes, and in five of the eight (62.5%) items related to overall knowledge of this infection following the intervention. A statistically significant improvement regarding prevention-related knowledge was found solely in one of the six items (16.6%). CONCLUSIONS: Preventive activities in the form of participational workshops are a good way of furthering the knowledge and improving the attitudes regarding HIV/AIDS of the participating teenagers. As no curative treatment exists for this disease, prevention from the educational realm is of importance for curtailing increased HIV transmission.

Evaluación pre-post de una actividad preventiva de la infección por VIH dirigida a los adolescentes de las comarcas del sur de Tarragona / Pre/post assessment of an HIV infection prevention intervention targeted at teenagers in southern Tarragona

Fundamentos: La infección por el virus de la inmunodeficiencia humana (VIH) es uno de los principales problemas de salud pública que tiene nuestro país. La educación preventiva ha demostrado ser un instrumento útil en la disminución de la enfermedad. El objetivo de este trabajo es evaluar la efectividad de una intervención preventiva realizada en los Institutos de Enseñanza Secundaria (IES) de las comarcas del Baix Ebre y el Montsià correspondientes a la Región Sanitaria de Tortosa, orientada a reducir el riesgo de transmisión del VIH y aumentar el conocimiento de dicha enfermedad. Método: Se realizó un estudio de intervención antes-después, sin grupo control. Se invitó a participar a 19 centros docentes, correspondientes a los cursos de 4º de Enseñanza Secundaria Obligatoria y 1º de Bachillerato. La actividad consistía en un taller de 60-90 minutos de duración, adjuntando material didáctico. El instrumento de medida fue un cuestionario. Resultados: Aceptaron participar 12 centros, obteniendo 896 respuestas en el pre-test y 805 respuestas en el post-test. En el 52 por ciento (10/19) de los ítems se observó un incremento, estadísticamente significativo, de las respuestas correctas en el post-test. En 4 de los 5 ítems (80 por ciento) sobre actitudes y en 5 de los 8 (62,5 por ciento) ítems sobre conocimientos generales de la infección se observó, después de la intervención, una mejora estadísticamente significativa. Sólo en 1 de los 6 ítems (16,6 por ciento) sobre los conocimientos en prevención se observó una mejoría estadísticamente significativa. Conclusiones: Las actividades preventivas en forma de talleres participativos son un buen instrumento para aumentar los conocimientos y mejorar las actitudes respecto al VIH/SIDA de los adolescentes que participan. Al no existir tratamiento curativo para esta enfermedad, la prevención desde el ámbito educativo es relevante para frenar el aumento de transmisión del VIH (AU)