Physical Activity and Quality of Life among People with Intellectual Disabilities: The Role of Gender and the Practice Characteristics

Staying physically active is synonymous with good health and well-being, and its benefits on the health of people with intellectual disabilities (PWIDs) have been studied. However, there is a lack of information on how it can influence their quality of life (QoL). This study aimed to analyze the relationship between QoL and physical activity in PWIDs according to gender and the characteristics of the practiced activity. A questionnaire was administered to 380 PWIDs (mean age of 28.23 ± 12.53), 54.21% of which were men. The QoL dimensions and second-order factors were studied in relation to practicing physical activity, the practice type, the context, and gender. The results indicate that people who practiced any activity showed better QoL values. Those who engaged in a nonregulated physical activity had better values in self-determination, emotional well-being, social inclusion, and personal development, while those who did sports presented higher scores in interpersonal relationships and physical well-being. In addition, it also appears that the association between physical activity and the QoL dimensions is distinct in inclusive and specific contexts. In conclusion, physical activity is related to a better QoL, although the impact of the practice type and context differs for each QoL dimension.

The Influence of Physical Activity during Pregnancy on Miscarriage-Systematic Review and Meta-Analysis

Miscarriage is an inability to complete the normal process of pregnancy and childbirth and represents a major concern for pregnant women that can be an emotionally devastating event. While it has been suggested that engaging in strenuous physical activity might be associated with an elevated risk of miscarriage, there is a recent systematic review that suggested that prenatal exercise is not associated with fetal mortality. The aim of this systematic review and meta-analysis (SR + MA) was to assess the effects of physical activity during pregnancy on the likelihood of experiencing a miscarriage (Registration No.: CRD42022370629). Thirteen randomized clinical trials (3728 pregnant women) were included. Meta-analyses were conducted with the dependent variable being the miscarriage ratio in each study. The total risk ratio (RR) sum was calculated using a random effects model. The I2 statistic was utilized to quantify the heterogeneity observed in the results. No significant association between exercise during pregnancy and the occurrence of miscarriage was found (RR = 0.83 95% CI = 0.83 (0.49-1.41); z = 0.69, p = 0.49; I2 = 0.00%, Heterogeneity p = 0.91). Results of the present SR + MA showed no increase in miscarriage risk in those who engaged in low- to moderate-intensity exercise compared to those who did not.

An Individualized Training Program for PE Teachers Based on Self-Determination Theory as a Way to Improve Students' Psychosocial Health: A Study Protocol

The interactions that take place in physical education (PE) between teachers and students have received large attention from the scientific community. However, despite the existence of different studies aiming to promote motivation among students through school interventions, there seem to be no interventions based on motivational strategies in which interventions are personalized to better fit teachers' own characteristics on the basis of theoretical contents grounded in self-determination theory. This study aims to present a protocol intervention in the PE context based on SDT to improve teaching behaviours through an individualized and lifelong training program. This protocol is a convenience study in which PE teachers will design and implement motivational strategies to increase students' motivation in class. The training program will take place along the intervention to allow teachers to personalize their implementation of motivational strategies according to their specific context. Data collection will be conducted before, during and after the intervention using recorded sessions (observational methodology), interviews (qualitative approach), and questionnaires (quantitative approach). The measures will assess teachers' and students' perceived teaching styles. This intervention program is expected to change and improve the quality of teaching behaviours, which could foster students' psychosocial health.

Is Exercise during Pregnancy a Risk for Gestational Age and Preterm Delivery? Systematic Review and Meta-Analysis

Traditionally, one of the primary concerns regarding exercise during pregnancy has been the potential of reducing gestational age and increasing the likelihood of preterm delivery. The aim of this study was to perform a systematic review about the effects of physical activity (PA) during pregnancy on gestational age and preterm delivery. A systematic review and two meta-analyses were performed (Registration No. CRD42022370770). Data sources from online databases were searched up to November 2022. The review exclusively included studies involving pregnant populations and interventions consisting of PA implemented during pregnancy. The primary outcomes analysed were gestational age, measured in weeks, and the occurrence of preterm deliveries. A total of 57 studies were analysed through two independent meta-analyses for the first one, no association was found between moderate exercise during pregnancy and gestational age (Z = 0.45, p = 0.65, ES = 0.08, 95% CI = -0.06-0.04, I2 = 42%, P heterogeneity = 0.001), showing the exercise group had a higher gestational age. In addition, no differences were found between groups in terms of number of preterm deliveries (RR = 0.96, (95% CI = 0.77-1.21, Z = 0.33, p = 0.74; ES = 0.07; I2 = 31%, P heterogeneity = 0.05)). The findings of this study indicate that there is no association between exercise during pregnancy and reduced gestational age or increased risk of preterm delivery in healthy pregnancies.

The Impact of a Challenge-Based Learning Experience in Physical Education on Students’ Motivation and Engagement

The present study investigated how challenge-based learning (CBL) in physical education (PE) may affect students’ basic psychological needs (BPNs), motivational regulations, engagement, and learning in comparison with a traditional teaching (TT) methodology. A quasiexperimental study with experimental and control groups was carried out. In total, 50 participants (16 boys and 34 girls) between 13 and 15 years old (Mage = 13.35, SD = 0.62) were involved in the experience for 6 weeks (ncontrol = 24; nexperimental = 26). Validated questionnaires were administered both before and after the intervention in both groups. Furthermore, theoretical knowledge and badminton-specific motor skill tests were carried out in both groups after the intervention. An analysis showed that after the intervention, students in the CBL condition improved their autonomy (Mbefore = 3.15 vs. Mafter = 3.39; ES = 0.26 *), competence (Mbefore = 4.01 vs. Mafter = 4.18; ES = 0.33 *), and relatedness satisfaction (Mbefore = 3.86 vs. Mafter = 4.06; ES = 0.32 *). As for behavioural engagement measures, students in the CBL condition exhibited higher scores after than those from before (Mbefore = 4.12 vs. Mafter = 4.36; ES = 0.35 *). No significant changes were observed for motivational regulations or agentic engagement. On learning outcomes, students in the experimental group achieved higher scores in both theoretical knowledge (Mcontol = 6.48 vs. Mexperimental = 6.79) and badminton-specific motor skills (Mcontol = 6.85 vs. Mexperimental = 7.65) than the control group did. The present study findings highlight that CBL might be a valid and effective methodological approach for students in PE to achieve adaptive motivational, behavioural, and learning outcomes.

Understanding physical education teachers' motivational outcomes and feasibility beliefs to implement motivational strategies: The role of perceived pressures from a variable- and person-centered approach

Work-related pressures perceived by PE teachers have been suggested to affect their motivation and behaviour. This study aims to contribute to the existing literature on this topic. Through two different objectives. First, the role of perceived pressures in the prediction of teachers' motivation and, in turn, on their feasibility beliefs to implement motivational strategies is tested through a SEM. Secondly, PE teachers' profiles according to the different types of perceived pressures are established and compared in terms of motivational outcomes and feasibility beliefs. A total of 217 PE teachers completed validated questionnaires. Results showed that, as hypothesized, pressures negatively predicted needs satisfaction, which, in turn, positively predicted feasibility beliefs. Three profiles emerged in the cluster analysis. Regarding to these profiles, teachers who were low on perceived pressures displayed the most adaptive pattern; teachers who reported high time constraints pressures underline the detrimental role that this type of pressure plays on both teacher and teaching outcomes. Implications for educational policy and practice are discussed.

Subjective identification and ablation of drivers in persistent atrial fibrillation (CHAOS-AF study): results of the first 50 patients

Funding Acknowledgements

Type of funding sources: None.

Background

Ablation of drivers in persistent atrial fibrillation (AF) has shown controversial results [1-5].

Purpose

To test the efficacy of a tailored approach for persistent AF ablation which includes pulmonary vein isolation (PVI) plus ‘subjective’ identification and ablation of drivers.

Methods

From May 2017, selected patients with persistent AF and ongoing AF at the beginning of the ablation procedure were included. Conventional high-density mapping catheters were used. Drivers were subjectively identified as: a) fractionated continuous (or quasi-continuous) electrograms on 1-2 adjacent bipoles, without dedicated software (Figure, A, dashed line; PR = PentaRay NAV); and b) sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles (Figure, B, arrows; in panels A and B: paper speed 200 mm/s; ORB = 24-pole ORBITER Woven catheter, blue bipoles around tricuspid annulus and green bipoles into the coronary sinus). Ablation included PVI + focal or linear ablation targeting sites with drivers. Ablation success was defined as conversion to sinus rhythm or atrial flutter during ablation. Follow-up included visits with 24h Holter ECG at 3-6-12 months. The primary endpoint was one-year survival free from atrial arrhythmias lasting >30 seconds. We present the results of the first 50 patients included, comparing them with all consecutive patients with persistent AF treated with a PVI-only strategy.

Results

173 Patients received ablation: 50 with the tailored approach (61,2±9,6 years; 24% females) and 123 with only PVI (62,5±9,6 years; 25% females; 89% cryoablation). Basal characteristics were similar (Table), but more patients with long-standing persistent AF were ablated witth the tailored-approach group. In the tailored-approach group, 21 patients (42%) presented 40 detectable sites with continuous fractionated electrograms, 38 on the left atrium and 2 on the right atrium, which was only mapped if ablation of drivers in the left atrium was not successful; 18 (45%) were located within the pulmonary vein antra. 41 patients (82%) showed 143 sites with spatiotemporal dispersion (4 [3 – 4] per patient). Ablation success was achieved in 21 patients (42%; conversion to sinus rhythm, n=7; conversion to atrial flutter, n=14) in the tailored-approach group and 1 patient (0,8%, sinus rhythm) in the PVI-only group. Excluding a 3-month blanking period, the tailored approach, compared to only PVI, improved one-year freedom from atrial arrhythmias (70% Vs 52%, p=0,032) (Figure, C), at the cost of a longer median procedural time (244 [187–275] Vs 108 [81–143] min, p<0,001) and fluoroscopy time (41 [28–65] Vs 33 [21–45] min, p<0,001).

Conclusion

Subjective identification and ablation of drivers, added to PVI, improved one-year survival free from atrial arrhythmias.

P20 CARDIOMIOPATHY INDUCED BY ATRIAL FIBRILLATION: WHAT’S BEHIND IT?

Sustained chronic tachyarrhythmias often cause a deterioration of cardiac function known as tachycardiomyopathy. We report the case of a 69 years old male patient, who was sent to the Emergency Department by his general practitioner for worsening dyspnoea and the discovery of previously unknown atrial fibrillation. His personal history included only arterial hypertension in treatment with ARBs, with no family or personal history of coronary artery disease. At a previous echocardiogram performed in 2019, systolic and diastolic functions were normal. The ECG confirmed the diagnosis of atrial fibrillation with rapid ventricular response, and blood chemistry showed a suppressed level of TSH (< 0,005 mcUI/ml), high FT3/FT4 (4.47 pg/ml/2.34 pg/ml) without any other alterations. A chest X–Ray was normal. The echocardiography evidenced a mildly dilated and hypertrophic left ventricle with severe, global systolic dysfunction, EF 25%, an enlargement of both atria, a mild mitral and tricuspid regurgitation and pulmonary artery mean systolic pressure of 35 mmHg. He was admitted to our Cardiology Department for further investigations. The patient was asymptomatic for dyspnoea at rest, only symptomatic with exertion and NYHA III, and hemodynamically stable. A coronarography excluded critical coronary stenosis. We made diagnosis of autoimmune Grave’s disease, with multiple not vascularized nodules at echography. In addition to betablockers and diuretics, an appropriate therapy for hyperthyroidism was prescribed, with an improvement of dyspnoea and a reduction of mean cardiac frequency. The patient was discharged with the indication to elective atrial cardioversion, only after thyroid function stabilization. In conclusion, we report a case of a severe systolic dysfunction in an atrial fibrillation induced cardiomyopathy, connected to an unknown thyrotoxicosis in Grave’s disease.

P305 ACUTE MYOPERICARDITIS IN 2021: COVID19 RELATED?

The term myopericarditis is used when there are primarily pericarditis symptoms with myocardium involvement as evidenced by cardiac biomarker elevation or imaging studies revealing normal wall motion. We report a case of a young 23–years old man, who presented to the Emergency Department with fever and diarrhea lasting 5 days followed by acute chest pain, modified by trunk position. The electrocardiogram (ECG) showed diffuse inferior and anterolateral ST–segment elevation. No signs of hemodynamic instability were detected. Laboratory tests showed WBC 8840/mmc, CRP 53,2 mg/L, TnT 986 ng/L, a mildly altered liver function with AST 92 UI/L, ALT 88 UI/L, GGT 82 UI/L and an altered pancreatic function with amylase 190 UI/L, lipase 267 UI/L. Naso–pharyngeal swab was negative. The patient received COVID–19 mRNA vaccination 4 months before symptoms, with high immune response, detected with IgG dosage (465 BAU/ml). Ecocardiography showed a left ventricle with normal size, function, and segmental contractility. Valvular apparatus in normal range. Hyper–refraction of the posterior pericardium with minimal effusion. The diagnosis of acute myopericarditis was glaring and we treated the patient with high dosage of non–steroidal anti–inflammatory drugs, colchicine and ACE Inhibitors, based on the increased troponin levels (nadir 1439 nl/L), in order to prevent the possible cardiovascular remodeling. On laboratory testing, the deepening of the main causes of viral or autoimmune myopericarditis did not clarify the etiopathogenesis. No arrhythmias occurred on ECG monitoring. Cardiac MRI showed multiple areas of altered signal (T2) and altered uptake in lateral and inferior ventricular segments and in adjacent pericardium. The pain was gone in two days and left ventricle function was still preserved upon discharge. In conclusion we report a successful treatment of acute myopericarditis of unknown pathogenesis, in a healthy young man. As there are described cases of myopericarditis and myositis associated with COVID–19 in the absence of respiratory symptoms, and others related to SARSCoV2 mRNA vaccination, we dutifully excluded both.

P385 SYNCOPAL VENTRICULAR TACHYCARDIA IN HEALTHY HEART: AN UNUSUAL ORIGIN!

Torsade de pointes is a particular type of ventricular tachycardia, characterized by QRS complexes that vary progressively in amplitude and morphology, giving the impression of oscillating around the isoelectric line. Causes include long QT syndrome (congenital or drug–induced) or severe hypomagnesemia. We report the case of a 57–year–old woman, a smoker, with a history of weight loss in the last 6 months, hospitalized in Medicine for marked asthenia and an episode of fleeting loss of consciousness, from sitting. She was asymptomatic for chest pain. The physical examination showed a pathological thinness, with BMI 15 kg/m2, rhythmic cardiac activity, no murmurs, no signs of decompensation, flat abdomen, not enlarged liver. Pale, dry skin was observed. On ECG: sinus rhythm, HR 70 bpm, QTc slightly increased 0.47 sec, flat T wave in lateral. Blood exams evidenced: hypokalemia, hypomagnesemia, rise of the amylase. On the MRI abdomen we found large inhomogeneous areas on the head and body of the pancreas, referable to the picture of focal pancreatitis. For syncopal episode during hospitalization in Medicine, she was transferred in Cardiology, where, during electrocardiographic monitoring, paroxysmal ventricular tachycardias torsade de pointes–like, symptomatic, self–resolved was registered. We diagnosed an acute pancreatitis with typical radiological characteristics of an autoimmune form, determining severe electrolyte imbalance and consequent symptomatic paroxysmal ventricular tachycardias. Oral magnesium supplement and corticosteroid therapy allowed the resolution of the arrhythmic problem, monitored over time through the implantation of a loop recorder.

Vocational Value Profiles of Students with Preferential Vocational Interest in Sport and Their Relationship with Personal and Academic Wellbeing

In recent years there has been a significant increase in the number of students who choose to pursue university studies related to the field of sports. However, there are no studies that have investigated the existence of differentiated profiles within students whose preferred vocational area is sport. The main objective of this study was to establish the profiles of students in the second year of Spain Bachillerato whose preferred vocational interest is sport, according to the two representative vocational values: (a) “to have a fun professional activity”; and (b) “to have a professional activity whose schedule makes it possible to reconcile personal and professional life”. In addition, the resulting groups were compared according to their perception of general and academic wellbeing and their identification with the other vocational values. Two hundred and thirty participants (MAge = 17.47; DTAge = 0.669; N = 171; 74.3% male and N = 59; 25.7% female) completed some validated measures. Three clusters emerged which did not differ in terms of general and academic wellbeing. Differences were found though in terms of some vocational values such “to help people”, “to develop one’s entrepreneurial initiative” or “to be self-employed”. The findings invite us to rethink the differences in the specific profiles of vocational values and their impact on employability opportunities, and to consider these approaches in the orientation of students who have among their priority options to study sport sciences.

Subjective identification and ablation of drivers in persistent atrial fibrillation

Background

Ablation of drivers in persistent atrial fibrillation (AF) has shown controversial results.

Purpose

To test the efficacy of a tailored approach for persistent AF ablation which includes pulmonary vein isolation (PVI) plus “subjective” identification and ablation of drivers.

Methods

From May 2017 to December 2019, selected patients with persistent AF and ongoing AF at the beginning of the ablation procedure were included. Conventional high-density mapping catheters (PentaRay NAV, IntellaMap Orion or Advisor HD Grid) were used. Drivers were subjectively identified as: a) fractionated continuous (or quasi-continuous) electrograms on 1–2 adjacent bipoles, without dedicated software (Figure 1A, dashed line; PR = PentaRay NAV); and b) sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles (Figure 1B, arrows; in panels A and B: paper speed 200 mm/s; ORB = 24-pole ORBITER Woven catheter, blue bipoles around tricuspid annulus and green bipoles into the coronary sinus). Ablation included PVI + focal or linear ablation targeting sites with drivers. Ablation success was defined as conversion to sinus rhythm or atrial flutter during ablation. Follow-up included visits with 24h Holter ECG at 3–6–12 months. Survival free from atrial arrhythmias lasting >30 seconds was compared between patients ablated with this tailored approach, and all consecutive patients with persistent AF treated with a PVI-only strategy during the same period.

Results

158 Patients received ablation: 35 with the tailored approach (61,7±10,2 years; 29% females) and 123 with only PVI (62,5±9,6 years; 25% females; 89% cryoablation). Basal characteristics were similar (Table 1). In the tailored-approach group, 14 patients (40%) presented 28 detectable sites with continuous fractionated electrograms, 26 on the left atrium and 2 on the right atrium, which was only mapped if ablation of drivers in the left atrium was not successful; 12 (43%) were located within the pulmonary vein antra. 27 patients (77%) showed 103 sites with spatiotemporal dispersion (4 [3–5] per patient). Ablation success was achieved in 17 patients (48%; conversion to sinus rhythm, n=7; conversion to atrial flutter, n=10) in the tailored-approach group and 1 patient (0,8%, sinus rhythm) in the PVI-only group. Excluding a 3-month blanking period, the tailored approach, compared to only PVI, improved one-year freedom from atrial arrhythmias (71% Vs 51%, p=0,05) and mean survival free from atrial arrhythmias (26±3 months; 95% CI 21–32 months Vs 18±2 months; 95% CI 15–22 months) (Figure 1C), at the cost of a longer median procedural time (246 [212–277] vs 108 [81–143] min, p<0,001) and fluoroscopy time (51 [36–76] vs 33 [21–45] min, p<0,001).

Conclusion

Subjective identification and ablation of drivers, added to PVI, improved freedom from atrial arrhythmias.

Funding Acknowledgement

Type of funding sources: None. Table 1. Basal characteristicsFigure 1

[Quadrivalent conjugate vaccines against ACWY meningococcal disease]

Invasive meningococcal disease (IMD) is caused by 6 serogroups of the bacterium Neisseria meningitidis (A, B, C, W, X and Y). It is among the most serious vaccine preventable infectious diseases, characterized by a high case-fatality rate and risk of permanent sequelae. Worldwide, the incidence of IMD is generally low with differences among regions and age groups. The risk increases in overcrowded conditions or in case of travel to endemic areas. The first vaccines produced using polysaccharide capsular antigens have demonstrated a good protective efficacy, but of short lenght. The conjugation of antigens with proteins allowed to obtain a longlasting antibody response towards 4 serogroups: A, C, W, Y. Currently four ACWY quadrivalent conjugate vaccines are available, three of them approved in Europe, which have shown high immunogenicity and safety. In 2020 the MenACYW-TT vaccine conjugated to tetanus toxoid was approved in the USA and it is presently authorized in Europe for the immunization of individuals from 12 months of age. Clinical studies have demonstrated immunogenicity and safety on population samples belonging to different age groups and non-inferiority in comparing it with other vaccines already in use. The possibility of having an increasing number of safe, immunogenic and effective vaccines against IMD allows us to imagine a future without invasive meningococcal disease. It is therefore important to extend vaccination to an increasing number of subjects of different age groups and risk conditions.

Exercise During Pregnancy and Prenatal Depression: A Systematic Review and Meta-Analysis

Background: Prenatal depression is associated with an increased risk of physical, physiological, cardiovascular, and psychological diseases for mothers and future newborns. Prenatal depression and depressive symptoms could have negative effects on the cognitive, emotional, social, and behavioral development of children. Objective: This study aimed to examine the influence of exercise during pregnancy on the prevalence of prenatal depression and depressive symptoms in the scientific literature. Data Sources: A search was carried out examining different online databases up to November 2020. Methods of Study Selection: A systematic review with random effects meta-analysis was performed. Only randomized controlled trials published in English or Spanish with pregnant populations and interventions with exercise programs carried out during pregnancy were included. The scores obtained by the tools that measured the emotional state and depressive symptoms as well as the number and percentage of depressed women of the study groups were analyzed. Tabulation, Integration, and Results: We analyzed 15 studies and found a negative association between moderate exercise during pregnancy and prenatal depression (ES = -0.36, 95% CI = -0.58, -13, I 2 = 80.2%, Pheterogeneity = 0.001). In addition, the studies also showed that women who were inactive during pregnancy had a 16% higher probability of suffering prenatal depression [RR = 0.84 (95% IC = 0.74, 0.96) I 2 = 61.9%, Pheterogeneity = 0.010]. Conclusion: Supervised exercise during pregnancy may be useful for the prevention and reduction of prenatal depression and depressive symptoms. Systematic Review Registration: Registered in PROSPERO (Registration No. CRD42020164819).

Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study)

Funding Acknowledgements

Type of funding sources: None.

Background. Unstable reentrant atrial tachycardias (ATs) (i.e. those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. 

Purpose. We have tested a strategy to convert unstable reentrant ATs into mappable stable ATs based on the detection and ablation of rotors.

Methods. From May 2017 to December 2019, we included all consecutive patients scheduled for ablation of reentrant AT, excluding CTI-dependent atrial flutter, in which the tachycardia circuit was unstable. Operators subjectively identified rotors as sites with fractionated continuous (or quasi-continuous) electrical signals on 1-2 adjacent bipoles of conventional high-density mapping catheters, without dedicated software (Figure, A). Focal ablation of these sites was performed in order to stabilize the AT or convert it into sinus rhythm. In patients without rotors or failed rotor ablation, sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted (Figure, B). Procedural success was defined as the successful ablation of all inducible ATs, without need of cardioversion, final sinus rhythm and non-inducibility. Follow-up included visits with ECG and 24h Holter-ECG at 3, 6 and 12 months.

Results. From May 2017 to December 2019, 97 patients were scheduled for reentrant AT ablation, excluding CTI-dependent atrial flutter. Of these, 18 patients (18.6%; 72.1 ± 8.9 years of age, 9 females) presented unstable circuits and were included. 9 patients (50%) had structural cardiomyopathy, 11 patients (61%) prior atrial arrhythmias ablations, and 4 patients (22%) previous cardiac surgery. 13 patients (72%) had detectable rotors (26 rotors; median 2 [1–3] rotors per patient); focal ablation achieved conversion into stable AT or sinus rhythm in 12 (92%). In the other patient, and the 5 patients without detectable rotors, 17 sites with spatiotemporal dispersion were detected and focally ablated, with success to achieve arrhythmia stabilization in 5 patients (83%). Globally, and excluding one patient with spontaneous AT stabilization, ablation success to stabilize the AT was achieved in 16/17 patients (94.1%). Procedural success was achieved in 16/18 patients (88.9%). Rate of one-year freedom from atrial arrhythmias was 66.7%. In the 9 patients with stable ATs ablated during the same period, procedural success (92.4%) and one-year freedom from atrial arrhythmias (65.8%) were similar (Figure, C).

Conclusion. Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm. Abstract FIGURE

Impacts of social distancing during the covid19 pandemic on the development of children with autism in Brazil

Introduction

COVID-19 is a respiratory disease and its main symptoms are fever, dry cough and difficulty breathing. It spread to several countries, which led the World Health Organization to decree, on March 11, 2020, a pandemic state that deeply affected Brazil. Due to the impossibility of leaving the house, the routine of children with autism was changed. Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. Clinical and daily observations reinforce several scientific studies that defend the importance of maintaining a routine as stable as possible for people with ASD, without this stability they may become emotionally disorganized, feel discomfort or even irritability.

Objectives

Investigate the impact caused by social distancing on the development of children and adolescents with autism.

Methods

An online questionnaire based on the DIR/Floortime basic map of emotional functional capacity development was distributed in Brazil from April to May, 2020. The results were analyzed using SPSS software.

Results

Results obtained from 122 questionnaires showed that after 30 days of quarantine 20% of children no longer had the characteristic of being able to remain calm and organized for at least 2 minutes; 11% no longer initiates interactions with their parents; 27% demonstrated more protests and anger than before the social distancing; 18% demonstrated more emotions such as anger, fear and intimacy, 28% began to understand their limits and 12% of the children are using greater facial expression during the social distancing.

Conclusions

This study brings results that can help to understand the processes in a child with autism.

Do Observed Teaching Behaviors Relate to Students' Engagement in Physical Education?

Teachers' behaviors can affect students' engagement in the Physical Education (PE) setting. According to self-determination theory, teachers can rely on either a need-supportive or a controlling teaching behavior, and these behaviors will differently affect students' outcomes. The main objective of this research was to analyse how teaching behaviors and some contextual variables influence students' engagement in PE classes. The present study adds to the existing literature through an observation-based design in which real-life examples of need-supportive and thwarting teaching behaviors, as well as students' engagement behaviors, have been identified. Thirty-seven different PE lessons were coded for 5-min intervals to assess the occurrence of 36 teaching behaviors and five students' behaviors. Stepwise regression revealed that both structure during activity and relatedness support could predict student engagement in a positive way. Surprisingly, cold teaching also emerged as a direct predictor in the last step of the analysis. On the other hand, controlling and structure before activity behaviors inversely predicted students' engagement. These four variables explained 39% of the variance in student engagement, whereas autonomy support did not correlate with student engagement. These new findings in the field not only confirm the known relevance of teaching behavior for students' outcomes but also suggest an unexpected lack of influence of autonomy support on students' engagement as well as an association between cold teaching and students' engagement. Results are discussed in the light of new approaches, and some practical implications are provided.

Teachers' Psychological Needs Satisfaction and Thwarting: Can They Explain Students' Behavioural Engagement in Physical Education? A Multi-Level Analysis

Students’ engagement in Physical Education has been linked to several adaptive consequences. Even though the existing literature suggests that perceived autonomy support can predict engagement, research is scarce on how teachers’ antecedents might influence this behavioural outcome. This study sought to compare the influence of teachers’ basic psychological needs’ satisfaction and basic psychological needs’ thwarting on students’ behavioural engagement and on the relationship between perceived autonomy-support and the students’ behavioural engagement. The sample included 29 Physical Education teachers and 644 students who were taught by the participants teachers. Data were collected using both paper and online surveys and they were analysed using multilevel modelling techniques. The results revealed that, while teachers’ autonomy satisfaction might be significant in the explanation of students’ engagement (β = 0.33, p < 0.01), it seems that needs thwarting could be a better predictor of this outcome (β autonomy thwarting = −0.17, p < 0.01; β competence thwarting = −0.06, p < 0.05). These findings suggest the impact of certain external pressures on teachers’ practices which, in turn, might affect students’ behavioural outcomes.

MAPping with fragmentation analysis in patients with atypical atrial FLUtter using the RHYthmia navigation system (MAP-FLURHY study)

Background

Atypical atrial flutter (AAFL) circuits use areas of slow conduction which can be visualized as fragmented electrograms (fEGMs).

Purpose

To test an ablation strategy based on the identification and ablation of spots with fEGMs in AAFL.

Methods

The MAP-FLURHY study prospectively included all AAFL ablations with Rhythmia in our Center from June 2016 to June 2019. Patients with non-mappable AAFL, frequent conversion to atrial fibrillation, or cavotricuspid isthmus-dependent flutters were excluded from analysis. The IntellaMap ORION catheter was used to detect fragmentation areas, arbitrarily defined as fEGMs &gt;70ms. Entrainment was used to check if these areas belonged to the AAFL circuit. Ablation targeted the longest fEGM within the circuit (return cycle &lt;30ms): focal ablation for microreentries, and lines including the fEGMs for macroreentries. Ablation success was defined as conversion to sinus rhythm or another flutter. Procedural success was defined as successful ablation of all inducible flutters. Follow-up included visits with 24h Holter ECG at 3–6-12 months.

Results

50 Patients received ablation (Figure). 27 Patients (70.6±13.1 years; 10 females; LVEF 57%±13%) with 44 mappable AAFLs were included in the analysis (Table). All AAFLs showed areas with fEGMs (106 areas; 2.4 areas per flutter). 42/44 AAFLs had fEGMs within the circuit, which were target of ablation. Ablation success: 34/36 AAFLs (94%); success could not be assessed in 6 circuits, due to mechanical conversion to sinus rhythm onto the target fEGM. Fragmented areas within the AAFL circuits (n=51) were longer (110±30 vs 90±15 ms, p&lt;0.001) but had similar voltage (0.34±0.25 vs 0.36±0.26 mV) than areas outside the circuits (n=45). A fEGM duration &gt;100ms/&gt;40% of the cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity. Procedural success was achieved in 24/27 patients (89%). Excluding a 2-month blanking period, mean survival free from atrial arrhythmias was 19 (95% CI: 12.6–25.5) months. 57% of the patients were free from atrial arrhythmias at 1 year.

Conclusions

Most AAFLs had detectable fEGMs which could be target of ablation with high efficacy.

Figure 1

Funding Acknowledgement

Type of funding source: None

Opinions and attitudes of Italian healthcare workers towards recommended but not compulsory rotavirus vaccination

Rotaviruses (RVs) are a leading cause of viral gastroenteritis among children younger than 5. The incidence of RV disease can be reduced through the widespread use of vaccination, but coverage is low in many countries, including Italy. This fact reflects the poor consideration given to the RV vaccine, both by the population and by healthcare workers. Peoples’ opinions are strictly dependent on the attitude of doctors and nurses. The aim of this work is the evaluation of healthcare workers’ knowledge, attitudes and opinions regarding RV vaccination. The results of two surveys were compared; the first was carried out in 2017, soon after the Italian National Immunization Plan introduced the recommendation for the RV vaccine. The second was performed at the end of 2018, approximately 1 year after the adoption of a Law that introduced new compulsory vaccinations, not including the RV vaccine. In 2017, 182 questionnaires were collected, and 111 in 2018. An increase was observed in the percentage of participants who reported recommending the RV vaccine and a significant increase was found in the coverage the participants claimed to reach. Education of healthcare workers after the introduction of compulsory vaccination may prompt them to actively offer also recommended vaccines.

Managing the risk of bacterial meningitis among healthcare workers

BACKGROUND

Meningococcal disease is generally caused by A, B, C, W and Y subgroups of Neisseria meningitidis. In 2015, the Italian mass media focused on this disease due to the death of two nurses. This generated alarm in the general population, especially in healthcare workers (HCWs). The Occupational Medicine department of the Foundation PTV Polyclinic Tor Vergata (PTV) offered free MenACWY vaccine to HCWs and to students of the University of Rome Tor Vergata.

AIMS

To analyse the prevalence of N. meningitidis in PTV, a large teaching hospital, and to evaluate preventive measures offered to individuals at risk (i.e. HCWs and students).

METHODS

The Hospital Informatic Service provided data about patients admitted to PTV from January 2012 to December 2016. Hospital Discharge Registers were analysed and all cases of meningitis were selected. MenACWY vaccine administered to HCWs and students of PTV in 2017 was analysed.

RESULTS

There was just one case of meningococcal disease in 2016. Of the 117 MenACWY vaccines administered, 42% were given to students, 32% to doctors, 8% to nurses, 2% to clerks and 16% to other healthcare professionals.

CONCLUSIONS

International guidelines recommend MenACWY vaccine for microbiologists exposed to N. meningitidis isolates. The Italian Legislative Decree 81/2008, however, states that occupational physicians can adopt special protective measures such as vaccination programmes for HCWs. The response rate highlights how perceived risk may influence behaviour even in populations with a higher background knowledge than the general population.

Influenza vaccination campaigns targeted at healthcare workers:results of four hospitals in Rome

Background

Seasonal influenza vaccination (SIV) of health care workers (HCWs) is well recognized as a public health measure that can protect both HCWs from infection and patients from the risk of influenza complications. Nevertheless, vaccination coverage rates among this specific population result generally lower than the recommended target. With our study, we aimed to describe the activities and the outcomes of four different SIV campaigns targeted at HCWs and organized during the season 2018/2019 in four hospitals in Rome.

Methods

A cross-sectional study involving four teaching hospitals was performed. The collected data were synthetized into a set of descriptors and indicators, validated through a previous study that had involved the same Centers.

Results

The Medical Directorates, in collaboration with the University Hygiene and Public Health Units of the four hospitals organized different strategies: Hospital 1, 3 and 4 realized educational courses for HCWs and actively promoted the campaigns through e-mail invitations to all HCWs. As for the access to vaccination, all the hospitals provided a dedicated unit for SIV; Hospital 1 and Hospital 4 organized also on-site vaccination sessions in the hospital wards, that required a large number of staff. The vaccination coverage rates resulted: 22.37% in Hospital 1, 18.10% in Hospital 4, 9.28% in Hospital 2 and 8,51% in Hospital 3.

Conclusions

Our results demonstrate that multi-activity campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of SIV. Our findings suggest that on-site vaccination may play a key role in determining a higher vaccination coverage.

Key messages

Multi-activity vaccination campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of seasonal influenza vaccination for HCWs. On-site vaccination may play a key role in determining a higher vaccination coverage.

P2839The golden age of ablation: results for atypical flutter ablation in the very elderly

Introduction

Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks.

Purpose

To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients.

Methods

From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months.

Results

107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence.

Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference.

Survival function

Conclusion

AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.

Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial

BACKGROUND

Excessive gestational weight gain is associated with several adverse events and pathologies during pregnancy.

OBJECTIVE

The purpose of this study was to examine the effects of an exercise program throughout pregnancy on maternal weight gain and prevalence of gestational diabetes.

METHOD

A randomized controlled trial was designed that included an exercise intervention group (EG) and standard care control group (CG). The exercise intervention included moderate aerobic exercise performed three days per week (50-55minutes per session) for 8-10 weeks to 38-39 weeks gestation.

RESULTS

594 pregnant women were assessed for eligibility and 456 were included (EG n=234; CG n=222). The results showed a higher percentage of pregnant women gained excessive weight in the CG than in the EG (30.2% vs 20.5% respectively; odds ratio, 0.597; 95% confidence interval, 0.389-0.916; p=0.018). Similarly, the prevalence of gestational diabetes was significantly higher in the CG than the EG (6.8% vs 2.6% respectively; odds ratio, 0.363; 95% confidence interval, 0.138-0.953; p=0.033).

CONCLUSION

The results of this trial indicate that exercise throughout pregnancy can reduce the risk of excessive maternal weight gain and gestational diabetes.

Structure and expression of a polyubiquitin gene from the crustacean Artemia

We have characterized two polyubiquitin genes from the crustacean Artemia franciscana. One of them, Ubi1, has nine ubiquitin units and an intron of a minimum size of 3.5 kb that ends 7 bp before the initiator ATG. The 5' end of the transcript from this gene has been identified by anchored PCR. The existence of the other gene (Ubi2) was inferred from several cDNA clones that differ from Ubi1 in the C-terminal extension and in the 3' untranslated region as well as in the nucleotide sequence of the coding region. We find two transcripts of ubiquitin genes, of 2.7 and 3.3 kb. Hybridization of RNA blots with an oligonucleotide specific for Ubi2 gene demonstrates that this gene codes for the 3.3 kb transcript. Ubiquitin messenger RNAs are present in the dormant embryos and their steady-state levels are maximum at 8 h after resumption of development, declining thereafter. The Ubi2 gene transcripts are less abundant but its proportion in relation to the other transcript does not vary with development.

Hexavalent vaccines: characteristics of available products and practical considerations from a panel of Italian experts

Combination vaccines represent a valuable technological innovation in the field of infectious disease prevention and public health, because of their great health and economic value from the individual, societal, and healthcare system perspectives. In order to increase parents' and healthcare professionals' confidence in the vaccination programs and maintain their benefits to society, more information about the benefits of innovative vaccination tools such as combination vaccines is needed. Purpose of this work is an examination of available hexavalent vaccines, that protect against Diphtheria, Tetanus, Pertussis, Poliomyelitis, Hepatitis B and Haemophilus influenzae type b infections. From the epidemiological updates of vaccine preventable diseases to the vaccine development cycle, from the immunogenicity of antigenic components to the safety and co-administration with other vaccines, several aspects of available hexavalent vaccines are discussed and deepened. Also a number of practical considerations on schedules, age of employment, strategies for vaccination recovery, vaccination in at-risk births are issued, based on the recommendations of Italian Ministry of Health, Italian Society of Pharmacology (SIF), Italian Society for Pediatrics (SIP), Italian Federation of Family Paediatricians (FIMP) and Italian Society of Hygiene, Preventive Medicine and Public Health (SItI).

The Role of Dispositional Flow’s Dimensions in the Prediction of Intention to be Physically Active in Adolescents

Enmarcado en la teoría del flow, este estudio pretende a) comprobar las diferencias en las dimensiones del flow disposicional yen la intención futura de realizar actividad física (IF) según el nivel de AF y b) estudiar el papel predictivo de dichas dimensiones sobre la IF. La muestra estuvo compuesta por 1076 estudiantes de educación física y se segmentó según el nivel actual de AF. Los sujetos que mostraron mayores niveles de AF presentaron valores más elevados en todas las dimensiones. Los análisis de regresión por pasos indicaron que la experiencia autotélica se asoció con IF en todos los participantes. Además, en el grupo de baja actividad el equilibrio percibido entre el reto y la habilidad emergió como predictor mientras que en el grupo de alta actividad, tanto la sensación de control como la percepción de objetivos claros resultaron significativos en la explicación de la IF. Los resultados sugieren que la implementación en clases de EF de diferentes estrategias para mejorar la disposición a experimentar el flow, puede aumentar la IF.

Voluntary termination of pregnancy: An opportunity for Measles, Mumps and Rubella vaccination in an Italian healthcare local unit

In Italy, the National Plan for the Elimination of Measles and Congenital Rubella 2010-15 suggests offering Measles, Mumps and Rubella (MMR) vaccination to susceptible women who underwent voluntary termination of pregnancy (VTP) In Rome, S. Eugenio Hospital is one of the structures where VTP is practised in an Operative Unit called "Family Planning" The primary goal of this study was to estimate the prevalence of susceptibility to rubella, using IgG and IgM immunoassays, among women accessing VTP and to offering MMR vaccination to susceptible women. Secondarily, this study evaluated acceptance of the vaccination offer From 2013 to 2015, data were collected from 1513 voluntary termination of pregnancy (VTP) cases The results show a significant increase of 5 percent in susceptibility prevalence in the target group from 13.6% in 2013 and 2014 to 18.4% in 2015 The association between rubella susceptibility and age was statistically significant (p<0.01) Throughout the entire period, acceptance of the vaccine proposal was 19% (45/232) among susceptible women; 58% (135/232) refused the vaccine and 23% (52/232) took time to think about it This study shows an increase of 5 percent in the prevalence of rubella susceptibility over two years. This result is worrying, even considering the short span of the data collection The rate of acceptance of vaccination is unsatisfactory considering the possibility of future pregnancies This issue deserves continued action, which, going forward, might transform a "project" into a shared strategy as part of a wider network with the goal of aligning Italy with international recommendations.

Validación de la versión española del cuestionario “Actitudes de los alumnos hacia la integración en educación física (CAIPE-R)”

La Educación Física (EF) se muestra, a priori, como un área idónea para trabajar intervenciones educativas para facilitar la inclusión de alumnos con discapacidad, siendo las actitudes de los compañeros sin discapacidad determinantes en este proceso. Este estudio presenta el análisis de validez y fiabilidad de la versión española del cuestionario Children Attitude Integrated Physical Education- Revised (CAIPE-R; Block, 1995). Para ello se utilizó una muestra de 222 alumnos de EF en Educación Secundaria Obligatoria de centros educativos de Madrid, compuesta por 117 varones y 105 mujeres, con edades comprendidas entre los 12 y los 18 años (M=14.07; SD=1.31). Los resultados muestran la adecuada fiabilidad del cuestionario y la validez del constructo, con un buen ajuste al modelo. La escala adaptada arrojó una reducción a 10 ítems, obteniendo una consistencia interna general por encima de 0.70, salvo en los ítems 2 y 8 de la escala general y el ítem 9 de la escala específica. El estudio concluye que la versión muestra una validez y fiabilidad adecuadas para detectar las actitudes hacia la inclusion de compañeros con discapacidad en EF en el contexto español.

The Effects of a Physical Education Intervention to Support the Satisfaction of Basic Psychological Needs on the Motivation and Intentions to be Physically Active

The aim of the study was to investigate the effects of an intervention to support the basic psychological needs on the satisfaction of these needs, intrinsic motivation, intention to be physically active and some enjoyment-related outcomes in Physical Education. The present study incorporated strategies presented by Standage and Ryan (2012) in a previous study. A quasi-experimental study was conducted with two groups (n_experimental = 30; n_control = 23) of 2nd year Secondary Education students aged between 13 and 15 (M = 13.35, SD = .62) by delivering 24 physical education classes. The teacher in the experimental group underwent prior and continual training. The results revealed that the students from the experimental group showed a significant increase in the perception of autonomy and competence. Furthermore, the experimental group showed a greater perception than the control group in the enjoyment related to learning and contents. These results provide information about the efficacy of an intervention programme based on the strategies presented by Standage and Ryan (2012) to foster satisfaction of basic psychological needs and facilitate support for basic psychological needs to promote the development of positive learning-related outcomes.

Effects of extremely low frequency electromagnetic fields on in-vitro cellular cultures HeLa and CHO

This paper presents the cellular proliferation effects of the exposure to extremely low frequency electromagnetic fields (ELF-EMF) on in-vitro cellular cultures HeLa and CHO. Through the magnetic stimulation system (MSS) the cells were exposed to magnetic fields with sinusoidal waveform at 50 Hz; initially for 40 minutes at intensities of 0.4 mT, 1.4 mT, 2.13 mT, 2.49 mT and 2.53 mT in parallel and perpendicular directions to the culture plates. Subsequently, the repetitive electromagnetic field (rEMF) was applied to 2.49 mT in parallel direction (for 40 minutes every twelve hours during 4 days) with which the highest cellular proliferation rate was obtained at 66.6 %. The results show a greater effect on proliferation in radiated cell lines, particularly in the application of rEMF a greater effect of ELF-EMF was observed in the proliferation rate of HeLa cells than in CHO cells, in contrast to the respective control cells. These results supported by other studies serve as a reference in the search for alternatives for the treatment of cervical cancer and the maintenance and preservation of cell lines.

Frequently asked questions on seven rare adverse events following immunization

Routine mass immunization programs have contributed greatly to the control of infectious diseases and to the improvement of the health of populations. Over the last decades, the rise of antivaccination movements has threatened the advances made in this field to the point that vaccination coverage rates have decreased and outbreaks of vaccine-preventable diseases have resurfaced. One of the critical points of the immunization debate revolves around the level of risk attributable to vaccination, namely the possibility of experiencing serious and possibly irreversible adverse events. Unfortunately, the knowledge about adverse events, especially rare ones, is usually incomplete at best and the attribution of a causal relationship with vaccinations is subject to significant uncertainties. The aim of this paper is to provide a narrative review of seven rare or very rare adverse events: hypotonic hyporesponsive episode, multiple sclerosis, apnea in preterm newborns, Guillain-Barré syndrome, vasculitides, arthritis/ arthralgia, immune thrombocytopenic purpura. We have selected these adverse events based on our experience of questions asked by health care workers involved in vaccination services. Information on the chosen adverse events was retrieved from Medline using appropriate search terms. The review is in the form of questions and answers for each adverse event, with a view to providing useful and actionable concepts while not ignoring the uncertainties that remain. We also highlight in the conclusion possible future improvements to adverse event detection and assessment that could help identify individuals at higher risk against the probable future backdrop of ever-greater abandonment of compulsory vaccination policies.

Incidence and predictors of stroke during the index event in an ethnically diverse Takotsubo cardiomyopathy population

Takotsubo cardiomyopathy (TTS) is a peculiar clinical condition often affecting postmenopausal women after a stressful trigger. The underlying mechanisms have not been completely elucidated but several hypotheses have been advanced, with catecholamine cardiotoxicity, microvascular dysfunction and coronary artery spasm each suggested to play a role. The incidence of stroke after TTS appears to range from 0% to 7.7%, and interestingly TTS has been described as both a cause and a complication of stroke. We sought to assess the incidence and predictors of stroke during the index event (peri-index event stroke) in a heterogeneous TTS population. We conducted a retrospective descriptive study reviewing patients who were discharged with a diagnosis of TTS from the Einstein Medical Center, Philadelphia, PA and Danbury Hospital, Danbury, CT in the period between 2003 and 2014. A total of Incidence and predictors of stroke during the index event in an ethnically diverse Takotsubo cardiomyopathy population 206 patients met the modified Mayo Clinic criteria and were included in the study. The patients' overall mean age was 67.8 years; 87% (n=179) were females and 25% (n=53) were African Americans. The following incidence rates were found: stroke 7%, in-hospital heart failure 26.7%, and in-hospital death 7%. On multivariate analysis independent predictors (expressed as odds ratios with 95% confidence intervals) of periindex event stroke were: i) African American race (OR 3.2, 95% CI 1.2-10.2, p=0.048); ii) hypertension (OR 10.5, 95% CI 1.3-88, p=0.03). ACE inhibitor use was a protective factor for developing peri-index event stroke (OR 0.15, 95% CI 0.04-0.5, p=0.001). There was a trend towards dual antiplatelet therapy (DAPT) being protective for stroke (OR 0.3, 95% CI 0.05-1.1, p=0.08). The incidence of peri-index event stroke was 7%. African American race and hypertension were found to be independent predictors of peri-index event stroke. Prospective clinical trials are needed to confirm these findings and to better determine the impact of hypertension as a risk factor for stroke and to assess the role of DAPT in preventing it.

Disability, support and long-term social care of an elderly Spanish population, 2008-2009: an epidemiologic analysis

BACKGROUND

Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity.

METHODS

We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit.

RESULTS

Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer.

CONCLUSIONS

Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons.

Nosocomial rotavirus infection: An up to date evaluation of European studies

Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.

Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Regular Exercise Throughout Pregnancy is Associated with a Shorter First Stage of Labor

Purpose.

The aim of the present study was to examine the influence of moderate physical exercise throughout pregnancy on the duration of labor stages.

Design.

Study was a randomized controlled trial.

Setting.

The study took place at Hospital Puerta de Hierro and Hospital Severo Ochoa in Madrid, Spain.

Subjects.

We examined 166 pregnant women (31.6 ± 3.8 years), and all had uncomplicated and singleton gestation. Of these 83 were allocated to the exercise group (EG) and 83 to the control group (CG).

Intervention.

Women from the EG participated in a physical conditioning program throughout pregnancy, which included 55- to 60-minute sessions, 3 days per week.

Measures.

Pregnancy outcomes were measured: duration of labor stages, gestational age, weight gain, type of delivery, birth weight, birth size, head circumference, Apgar score, pH of umbilical cord.

Analysis.

Student's unpaired t-tests and χ2 tests were used; p values of < .05 indicated statistical significance. Cohen's d was used to determine the effect size.

Results.

Significant differences were found in the duration of the first stage of labor (EG = 389.6 ± 347.64 minutes vs. CG = 515.72 ± 353.36 minutes; p = .02, effect size Cohen's d = .36). The second and third stages did not differ between the study groups.

Conclusion.

A physical exercise program during pregnancy is associated with a shorter first stage of labor. These results may have important relevance to public health.