Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma

To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

Association of Postoperative Urinary Output in the First 24 Hours with Delayed Graft Function After Living and Deceased Donor Kidney Transplant: A Systematic Review

Context: Delayed graft function (DGF) is an important clinical outcome following renal transplantation; therefore, it is important to be correctly diagnosed. The DGF is thought to correlate with the first 24-hour urine output (UOP1), and this clinical sign is expected to predict DGF. Objectives: This study aimed to discover whether the UOP1 correlates significantly to the DGF incidence and can be a DGF predicting factor. Data Sources: This study compared the incidence of DGF with the UOP1 reported by studies obtained from the electronic databases, namely MEDLINE, Cochrane, and EBSCO. Studies that performed multivariate or bivariate analysis and/or reported sensitivity and specificity were included in this review. Results: A total of 1719 studies were obtained from the database search, and 2 studies were enrolled from other sources. Out of 1721 studies, 9 studies were recruited in this review, 5 of which reported sensitivity and specificity. Overall, nine of these studies had a low to moderate risk of bias. Almost all studies reported a significant relationship between the UOP1 and DGF. All studies agreed that the UOP1 is a sensitive predictive factor in predicting DGF. The specificity reported by the studies examined in this review varied greatly. The use of optimum cut-off in each study is considered to be the cause of this variability. Conclusions: The UOP1 is significantly related to the incidence of DGF and is a proper parameter for the prediction of DGF events.

MATERNAL ATTACHMENT AS A FACTOR OF VICTIMIZATION AND BULLING OF CHILDREN WITH DISABILITIES / MUTTERBINDUNG ALS FAKTOR VON VIKTIMIERUNG UND BULLING OF KINDER MIT BEHINDERUNGEN

<p>School bullying is a major diachronic problem of modern society and in recent years it presents considerable intensification, attracting scientific and research attention. The present research studies the victimization due to school bullying of children with disabilities. The aim of the research is to investigate whether the maternal attachment of people with disabilities such as blindness, deafness and motor disability and also of those without disabilities is linked to their victimization or bullying behavior in school, and to highlight the impact of specific demographic characteristics on the possible underlying relationship between maternal attachment and victimization for them. Further, the objectives of the present research include the appraisal of a comparison between individuals with and without disabilities. The research was conducted through a quantitative survey in Greece, to 170 individuals aged between 10 and 21 years of age, with blindness (N=36), deafness (N=38), physical disability (N=50) and without disability (N=50). The results revealed differences between participants with and without disabilities with regard to the type of attachment they have developed with their mothers and to their experiences as victims or offenders of school bullying. The results also demonstrate that there is a correlation between maternal attachment and school bullying behaviors and for certain disability groups mother care and / or mother protection is a predicting factor of these behaviors.</p><p> </p><p> Mobbing in der Schule ist ein großes diachrones Problem der modernen Gesellschaft und hat in den letzten Jahren eine erhebliche Zunahme erfahren, was die Aufmerksamkeit von Wissenschaft und Forschung auf sich zieht. Die vorliegende Studie untersucht die Viktimisierung von Kindern mit Behinderungen durch Mobbing in der Schule. Ziel der Forschung ist es, zu untersuchen, ob die mütterliche Bindung von Menschen mit Behinderungen wie Blindheit, Taubheit und motorischen Behinderungen sowie von Menschen ohne Behinderungen mit ihrem Viktimisierungs- oder Mobbingverhalten in der Schule zusammenhängt, und den Einfluss spezifischer demografischer Merkmale aufzuzeigen über die mögliche zugrunde liegende Beziehung zwischen mütterlicher Bindung und Viktimisierung für sie. Zu den Zielen der vorliegenden Forschung gehört auch die Bewertung eines Vergleichs zwischen Menschen mit und ohne Behinderungen. Die Studie wurde im Rahmen einer quantitativen Umfrage in Griechenland an 170 Personen im Alter zwischen 10 und 21 Jahren mit Blindheit (N=36), Taubheit (N=38), körperlicher Behinderung (N=50) und ohne Behinderung durchgeführt (N=50). Die Ergebnisse zeigten Unterschiede zwischen Teilnehmenden mit und ohne Behinderung hinsichtlich der Art der Bindung, die sie zu ihren Müttern entwickelt haben, und ihrer Erfahrungen als Opfer oder Täter von Mobbing in der Schule. Die Ergebnisse zeigen auch, dass es einen Zusammenhang zwischen mütterlicher Bindung und Mobbing-Verhalten in der Schule gibt und für bestimmte Behindertengruppen die Mutterfürsorge und/oder der Mutterschutz ein Vorhersagefaktor für dieses Verhalten sind.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0883/a.php" alt="Hit counter" /></p>

Femicide: The Notion, Theories, and Challenges for Research

Since the 1990’s, the notion of femicide has disseminated in civil society, the media, policy making, and scientific literature and has helped movements to draw attention to violence against women. The notion was coined to reveal the sexual politics of the murder of women and call militants to action. Today, it is increasingly used with the meaning of killing a woman because she is a woman, emphasizing gender and misogyny as the main motives. Femicide as well as the consequences of its application in diverse research areas are explored from a historical, legal, international, and activist point of view. The political thrust of the notion has proven to be useful in raising awareness on the emergency of the problem. However, the notion becomes unclear when it is used as a heuristic tool because (a) there is more than one interpretation about which types of homicide should be included and which fall beyond the definition of femicide and (b) the gender identity of the victim is not the only or the central motive of the homicide—both caveats pose problems to quantitative data collection and comparison. Available literature on homicide, family, and intimate partner violence offers a complex picture on why men kill women: explanations include diverse and interrelated factors pertaining to individual characteristics of perpetrators and victim, their relational history, and the influence of sociocultural environment, including a culture of male superiority and control. In addition, scientific literature has suggested that the importance of gender equality variables as a predicting factor for intimate partner violence should not be taken for granted, but it should be tested at the empirical level. Accurate options are suggested that yield robust and comparable empirical data for the advancement of knowledge and prevention.

Kaposi sarcoma in HIV-positive children: what are the symptoms and pathophysiology?

Background Introduction: Kaposi Sarcoma (KS) is a tumour caused by human herpesvirus 8 (HHV-8). It is more prevalent in Oriental Africa when compared to countries in the western world, and it is more aggressive in children, with a death rate close to 60%. Aims: clarify the symptoms and pathophysiology of the paediatric KS associated with human immunodeficiency virus (HIV), given the poor scientific production on the topic, and the fact that the knowledge of this disease on children is only an extrapolation of what is known in the adult. Methods Materials and methods: integrative review based on articles found in PubMed database, using the MeSH-indexed descriptors: ‘Children’ AND ‘Kaposi sarcoma’ AND ‘HIV infections’. Results Results: the seven selected studies show that, in HIV-positive children with KS, the prevalent symptoms are: skin lesions in multiple or unique sites, either isolated or associated with other lesions, such as oral and visceral, with the possibility of gastrointestinal bleeding, which could be deadly; lymphadenopathy in axillary, inguinal and cervical regions; respiratory symptoms; and anasarca. As for the pathophysiology, the most common occurrences are: cytopenia (anaemia and thrombocytopenia), both varying from moderate to severe; increased levels of CD4+ lymphocytes, which could act as predicting factor for lymphadenopathy; immunosuppression, a possible indicator for death; and increase in interleukin- 6 (IL-6) and IL-10 levels. Conclusions Conclusions: KS, caused by HHV-8, most prevalent in Africa, tends to be more aggressive in children, with main symptoms including lymphadenopathy and skin lesions, and main pathophysiological aspects including cytopenia and increase in IL-6 and IL-10.

Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes

<b><i>Introduction:</i></b> Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. <b><i>Methods:</i></b> Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. <b><i>Results:</i></b> Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). <i>Streptococcus</i> spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (<i>n</i> = 5). Mean hospital stay was 9.13 days (±7.2). DM (<i>p</i> = 0.016), age (<i>p</i> = 0.001), BMI classification 3, 4, and 6 (<i>p</i> = 0.041), and intensive care unit (ICU) admission (<i>p</i> = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (<i>p</i> = 0.001) and masticator (<i>p</i> = 0.002) space involvement and DM (<i>p</i> = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (<i>p</i> = 0.001), ICU admission (<i>p</i> &#x3c; 0.0001), <i>Streptococcus</i> spp. (<i>p</i> = 0.019), and low hemoglobin levels (<i>p</i> = 0.004) were associated with mortality. <b><i>Discussion/Conclusion:</i></b> DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.

Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy

Objective: Improvement of renal function in obstructive uropathy is a main goal of urinary diversion. In cases of failed internal diversion, percutaneous nephros-tomy (PCN) is used to divert urine from the obstructed kidney. PCN also affect on quality of life, particularly having both sides. The objective of this study was to identify a predicting factor associated with improvement of renal function after bilateral PCNs and to avoid performing bilateral PCNs. Materials and Methods: Data of all patients with bilateral hydronephrosis asso-ciated with malignancy who were performed bilateral PCNs in Siriraj Hospital between December 2011 and December 2016 were reviewed and collected. Success with PCN was defined as a serum creatinine less than 2 mg/dl or decreased more than 95% of initial serum creatinine. Results: A total of 240 patients met the criteria. Mean age was 64.6 ± 14.9 years old. Most common organ of malignancy was cervix. Mean initial serum creatinine (iCr) and nadir serum creatinine (nCr) were 7.7 and 1.9 mg/dl, respectively. On multivariate analysis, no significant predicting factors were demonstrated but only iCr tended to have a statistically significant (p = 0.058). From receiver operating characteristics analysis, at cut-off value of iCr 5 mg/dl could demonstrate signifi-cant difference between success and failure (p = 0.027). Sensitivity and specificity were 72.4% and 44.0%, respectively. Conclusion: Only the iCr was more likely to be a predicting factor. At cut-off value of iCr 5 mg/dl, if a patient presented with iCr more than 5 mg/dl and unilateral PCN at dominant side did not improve serum creatinine, performing contralateral PCN might not help.