Changes in patterns of Early Mother-Child Interaction: A longitudinal study of the first 18 months of life

OBJECTIVE

The main objective of the present longitudinal study is to describe the progression of early adult-child interactions between the first and second years of life. Changes identified in interactions are described, focusing on both the qualitative aspects of maternal responses, as well as maternal response latency to the child's behavior using a microanalytical methodology that collected data on maternal and child behavior in real-time without losing sight of the temporal dimension.

PARTICIPANTS

This study examined 52 mother-child dyads from intact families that presented no psychological, social, or biological risk factors at 6, 12 and 18 months of age.

INSTRUMENT

CITMI-R (early mother-child interaction coding system, revised edition) was used to assess early mother-infant interactions during free play sessions between mother and child the.

RESULTS

The results indicate that some components of maternal sensitivity improve as children progress towards the second year of life, detecting an increase in sensitive maternal behavior and a decrease in intrusive behavior in the evolutive observed period; moreover, regarding latency of maternal response, we observed that mothers of older children give more time for their children to explore, which stimulates autonomy. Finally, the implication of these results for intervention directed to optimizing early adult-child interactions are addressed.

Effects of Chest Physiotherapy in Preterm Infants with Respiratory Distress Syndrome: A Systematic Review

Preterm birth carries a higher risk of respiratory problems. The objectives of the study are to summarize the evidence on the effect of chest physiotherapy in the treatment of respiratory difficulties in preterm infants, and to determine the most appropriate technique and whether they are safe. Searches were made in PubMed, WOS, Scopus, Cochrane Library, SciELO, LILACS, MEDLINE, ProQuest, PsycArticle and VHL until 30 April 2022. Eligibility criteria were study type, full text, language, and treatment type. No publication date restrictions were applied. The MINCIR Therapy and PEDro scales were used to measure the methodological quality, and the Cochrane risk of bias and Newcastle Ottawa quality assessment Scale to measure the risk of bias. We analysed 10 studies with 522 participants. The most common interventions were conventional chest physiotherapy and stimulation of the chest zone according to Vojta. Lung compression and increased expiratory flow were also used. Heterogeneities were observed regarding the duration of the interventions and the number of participants. The methodological quality of some articles was not adequate. All techniques were shown to be safe. Benefits were described after conventional chest physiotherapy, Vojta's reflex rolling, and lung compression interventions. Improvements after Vojta's reflex rolling are highlighted in the comparative studies.

Transition of patients with mucopolysaccharidosis from paediatric to adult care

Mucopolysaccharidoses (MPS) are rare disorders associated with enzyme deficiencies, resulting in glycosaminoglycan (GAG) accumulation in multiple organ systems. As patients increasingly survive to adulthood, the need for a smooth transition into adult care is essential. Using case studies, we outline strategies and highlight the challenges of transition, illustrating practical solutions that may be used to optimise the transition process for patients with MPS disorders.

Seven MPS case studies were provided by four European inherited metabolic disease centres; six of these patients transferred to an adult care setting and the final patient remained under paediatric care. Of the patients who transferred, age at the start of transition ranged between 14 and 18 years (age at transfer ranged from 16 to 19 years).

While there were some shared features of transition strategies, they varied in duration, the healthcare professionals involved and the management of adult patients with MPS. Challenges included complex symptoms, patients' unwillingness to attend appointments with unfamiliar team members and attachment to paediatricians. Challenges were resolved by starting transition at an early age, educating patients and families, and providing regular communication with and reassurance to the patient and family. Sufficient time should be provided to allow patients to understand their responsibilities in the adult care setting while feeling assured of continued support from healthcare professionals. The involvement of a coordinated multidisciplinary team with expertise in MPS is also key. Overall, transition strategies must be comprehensive and individualised to patients' needs.

Efficacy of Idursulfase therapy in patients with Mucopolysaccharidosis type II who initiated enzyme replacement therapy in adult age. A systematic review of the literature

BACKGROUND

Enzyme replacement therapy (ERT) has been shown to decrease urine glycosaminoglycans (uGAGs) and liver and spleen volumes, and to improve clinical symptoms in mucopolysaccharidosis type II (MPS-II) patients.

METHODS

A systematic search of the literature, from inception to August 2017, was conducted to identify randomized trials or observational studies including ≥1 MPS-II patients with ERT initiated in adult age (≥16 years) and evaluating ERT efficacy. Evidence was rated according to GRADE criteria. Common efficacy outcomes of the clinical studies were analyzed. Case reports were separately evaluated.

RESULTS

One randomized clinical trial, 4 observational studies and 5 case reports were selected. ERT decreased uGAG levels and liver and spleen size with moderate evidence level and led to anti-ERT antibody and IRRS development in a significant proportion of patients with moderate evidence level. There were no conclusive results for beneficial effects on 6MWT, respiratory, cardiac and neurological function, joint mobility, sleep disorders of respiratory origin, and quality of life.

LIMITATIONS

Excluding one observational study, all others were not conducted specifically in the target population (ERT ≥16 years). Data were from subgroup analyses of selected studies. There was a great heterogeneity between study designs and clinical outcomes evaluated.

CONCLUSIONS

ERT improves uGAGs and liver/spleen volume with a moderate evidence level in MPS-II patients initiating therapy as adults, although the putative associated clinical benefit is unclear.

Prematuridad y capacidad intelectual: un estudio longitudinal hasta los 11 años en una población española

El presente trabajo forma parte de un estudio longitudinal que pretende comprobar si el nivel de riesgo perinatal de un grupo de niños nacidos pretérmino puede condicionar sus capacidades intelectuales en la etapa escolar. Método: Los participantes fueron distribuidos en función del nivel de riesgo perinatal obtenido con el PERI. La muestra definitiva fue evaluada con la Escala WISC-IV. Resultados: Los resultados indican que existen diferencias en las puntuaciones de los niños de bajo riesgo, siendo más altas en tres de los índices de la Escala WISC-IV, mientras que los niños de alto riesgo obtienen puntuaciones más bajas en todos los índices. Discusión: Estos resultados se discuten a la luz de los trabajos existentes sobre el tema.

The view of experts on initiatives to be undertaken to promote equity in the access to orphan drugs and specialised care for rare diseases in Spain: A Delphi consensus

OBJECTIVES

To reach a consensus amongst experts on the most feasible actions to be undertaken to facilitate patient access to specialised care and orphan drugs (OD) in the public health sector in Spain.

METHODS

Two Delphi rounds were completed. The questionnaire was based on a literature review and 2 focus groups. Agreement was sought on the desire (D) and prognosis (P) for the implementation within the next 5 years, on a 5-point Likert scale. Consensus was reached when ≥75% participants chose agreement (1-2) or disagreement options (4-5).

RESULTS

82 experts on rare disease (RD) participated. Agreement on the D and P was reached in 66.07% statements: OD pricing review [absence of clinical effectiveness (D:85.37%; P:85.90%), target population increase (D:79.27%; P:91.03%)]; reference team definition of referral protocols and clinical practice guidelines (D: 97.56%; P: 89.74%); and a unified, usable, etiology-based registry (D:97.56%; P:84.62%). D and P assessment diverged in 32.14% items: creation of a specific funding system for OD (D: 97.56%; P: 60.25%); and a network of medical teams to coordinate the care of RD patients (D: 99%; P: 62%).

CONCLUSIONS

The results have shown the need to promote dialogue between stakeholders, introduce European recommendation to national and regional Spanish policies and set up priorities and undertake actions to drive relevant changes in current medical practice in managing RD patients.

Clinical characteristics of adult patients with inborn errors of metabolism in Spain: A review of 500 cases from university hospitals

Patients with inborn errors of metabolism (IEMs) have become an emerging and challenging group in the adult healthcare system whose needs should be known in order to implement appropriate policies and to adapt adult clinical departments. We aimed to analyze the clinical characteristics of adult patients with IEMs who attend the most important Spanish hospitals caring for these conditions. A cohort study was conducted in 500 patients, categorized by metabolic subtype according to pathophysiological classification. The most prevalent group of IEMs was amino acid disorders, with 108 (21.6%) patients diagnosed with phenylketonuria. Lysosomal storage disorders were the second group, in which 32 (6.4%) and 25 (5%) patients had Fabry disease and Gaucher disease respectively. The great clinical heterogeneity, the significant delay in diagnosis after symptom onset, the existence of some degree of physical dependence in a great number of patients, the need for a multidisciplinary and coordinated approach, and the lack of specific drug treatment are common features in this group of conditions.

Neutrophils extracellular traps damage Naegleria fowleri trophozoites opsonized with human IgG

Naegleria fowleri infects humans through the nasal mucosa causing a disease in the central nervous system known as primary amoebic meningoencephalitis (PAM). Polymorphonuclear cells (PMNs) play a critical role in the early phase of N. fowleri infection. Recently, a new biological defence mechanism called neutrophil extracellular traps (NETs) has been attracting attention. NETs are composed of nuclear DNA combined with histones and antibacterial proteins, and these structures are released from the cell to direct its antimicrobial attack. In this work, we evaluate the capacity of N. fowleri to induce the liberation of NETs by human PMN cells. Neutrophils were cocultured with unopsonized or IgG-opsonized N. fowleri trophozoites. DNA, histone, myeloperoxidase (MPO) and neutrophil elastase (NE) were stained, and the formation of NETs was evaluated by confocal microscopy and by quantifying the levels of extracellular DNA. Our results showed N. fowleri induce the liberation of NETs including release of MPO and NE by human PMN cells as exposure interaction time is increased, but N. fowleri trophozoites evaded killing. However, when trophozoites were opsonized, they were susceptible to the neutrophils activity. Therefore, our study suggests that antibody-mediated PMNs activation through NET formation may be crucial for antimicrobial responses against N. fowleri.

Validity of the Parenting Stress Index-Short Form in a sample of Spanish fathers

The purpose of this study was to analyze the psychometric properties of the Spanish version of the Parenting Stress Index-Short Form in a sample of 115 fathers of infants aged between ten and thirty-nine months old. The exploratory factor analysis revealed three reasonably distinct factors, as in the original version of the instrument. The three extracted factors: Parental Distress, Parent-Child Dysfunctional Interaction and Difficult Child accounted for 47.48 % of the variance. The internal consistency coefficients were high in each factor or subscale. These results provided empirical evidence in favour of the reliability and validity of the Parenting Stress Index-Short Form in Spanish fathers, and can be useful to elucidate the mechanisms through which stress impacts parenting and permitting to develop more targeted interventions for infants and their families.

Association of ACACB polymorphisms with obesity and diabetes

Acetyl-CoA carboxylase beta, encoded by the ACAB gene, plays an important role in the oxidation of fatty acids. The aim of this study was to check the hypothesis that allelic variants of ACACB influence the risk of obesity and type 2 diabetes mellitus. Twenty five tagging single nucleotide polymorphisms (SNPs) capturing common variants of the ACACB gene were selected and analyzed in two cohorts including 1695 postmenopausal women of the general population and in 161 women with severe obesity (BMI>35). In vitro binding of transcription factors was explored by electrophoretic mobility shift assays (EMSA). T alleles at the rs2268388 locus were overrepresented in women with severe obesity (18% vs. 10% in controls; OR 1.74 [95% confidence interval 1.30-2.47]), which was statistically significant after multiple-test adjustment (p=0.0004). Likewise, T alleles at the rs2268388 locus and C alleles at the rs2239607 locus were associated with diabetes, in the discovery as well as in the replication cohorts, even after women with severe obesity were excluded (OR 3.6 and 2.8, for TT and CC homozygotes, respectively). Allelic differences in the binding affinity for nuclear proteins were revealed in vitro by EMSA and competition experiments were consistent with the binding of glucorticoid receptor and serum response factor. In conclusion, common polymorphisms of ACACB gene are associated with obesity and, independently, with type 2 diabetes in postmenopausal women, suggesting that the activity of acetyl-CoA carboxylase beta plays an important role in these disorders related to energy metabolism.

[Factor structure and internal consistency of the Spanish version of the Parenting Stress Index-Short Form]

The aim of this study was to analyze the psychometric properties of the Spanish version of Parenting Stress Index-Short Form. After translating the instrument from English into Spanish using the forward-backward translation method, it was administered to a sample of 129 mothers of children aged between 10 and 39 months olds. The exploratory factor analysis identified two factors: Childrearing Stress and Personal Distress, which accounted for 48.77% of the variance. The internal consistency of these factors was high (Childrearing Stress: .90 and Personal Distress: .87). Implications of these findings and suggestions for future research are discussed.

Update of the Atlanta Classification of severity of acute pancreatitis: should a moderate category be included?

BACKGROUND

Persistent and multiple organ failure (POF and MOF) are predictive of death in acute pancreatitis (AP). Local complications without organ failure are associated with morbidity but a low risk of mortality.

AIM

To design a three-category classification of AP severity and to compare it with the Atlanta Classification (AC) in terms of morbidity and mortality.

METHOD

Severe AP was defined as death, POF (>48 h) or MOF. Moderate AP was defined as the presence of acute collections and/or pancreatic necrosis. Mild AP was defined by exclusion. We compared this classification with AC in 144 episodes of AP.

RESULTS

In the three-category classification, severe AP was associated with significantly more frequent intensive care unit admission, invasive treatment and mortality than moderate and mild AP (p < 0.01). Severe AP patients required longer hospital stay and more nutritional support than mild AP patients (p < 0.01). Patients with moderate AP had significantly longer hospital stay and more need for nutritional support than patients with mild AP (p < 0.01). Five patients died, all of them with MOF and/or POF.

CONCLUSIONS

A three-category classification distinguishes three homogeneous groups of severity.

Safety and efficacy of home intravenous antimicrobial infusion therapy in older patients: a comparative study with younger patients

BACKGROUND

Home intravenous antimicrobial infusion therapy has proved its safety and efficacy in a great number of infections. Despite this there are few published studies about this way of managing in the elderly patient.

OBJECTIVE

To study the safety and efficacy of home intravenous antimicrobial infusion therapy in elderly patients.

STUDY DESIGN

A prospective and comparative study of an elderly group of patients > or =70 years old vs. a cohort of younger adult patients as a control group. All patients were followed until 3 months after discharge.

SETTING

Hospital at Home Programme (HHP) as part of the Internal Medicine Department at Valle de Hebrón Hospital, Barcelona, Spain.

PATIENTS

All patients admitted to HHP diagnosed of infections requiring intravenous antibiotic therapy between March 2006 and March 2007.

RESULTS

We included 145 patients, 90 of whom were 70 years or older. Diabetes mellitus, heart failure and respiratory tract infection were more frequent in these elderly patients. In this group 14 (12%) developed some type of adverse event during treatment, phlebitis being the most common. The majority of those in the elderly patients group were discharged because of satisfactory clinical evolution and only 7 (7%) were re-admitted to hospital. Another 13 (14%) were re-admitted to hospital 3 months after discharge from HHP, mostly for chronic diseases. There were no significant differences between these results and those obtained from the control group.

CONCLUSION

Home intravenous antimicrobial infusion therapy in elderly patients is safe and effective.