Use of speckle tracking in the evaluation of late subclinical myocardial damage in survivors of childhood acute leukaemia

Heart disease is the leading cause of non-cancer death in childhood cancer survivors. to determine the prevalence of subclinical cardiac dysfunction using speckle tracking and compare its results with those obtained by classical methods of assessing left ventricular function and its relationship with different factors to identify the population at higher risk. Echocardiographic assessment of left ventricular function included ejection fraction, tissue Doppler, longitudinal/circumferential strains and biochemical parameters (troponin-T and Pro-BNP) in a cohort of 57 survivors of childhood acute leukaemia with at least 10 years since diagnosis. Ventricular dysfunction was found in 5.2% of patients in M-mode (ejection fraction—EF?<?53% with a reduction in the EF?≥?10%) and in 7% of patients with Simpson’s method, compared with 21.05 and 8.8% with suboptimal global longitudinal strain (GLS) and global circumferential strain, respectively. The GLS alteration was significantly correlated with lower values of left ventricular systolic function and was associated with high tumour risk (odds ratio [OR] 13.8), cumulative doses of anthracyclines?≥?250 mg/m² (OR 7.6) and radiotherapy (OR 7.19). Biomarkers were not useful for the diagnosis of subclinical cardiomyopathy. Good reproducibility was obtained, with an intraobserver correlation of 93.6% and an interobserver correlation of 89.2% in the GLS. The alteration of the GLS was more prevalent than the alteration in the EF and was associated with the treatment received and high tumour risk. strain imaging seems to be a powerful tool to identify an increased number of survivor with an early myocardial injury.     

Noise-Induced Variability of Immuno-PET with Zirconium-89-Labeled Antibodies: an Analysis Based on Count-Reduced Clinical Images

Purpose

Positron emission tomography (PET) with Zirconium-89 (Zr-89)-labeled antibodies can be used for in vivo quantification of antibody uptake. Knowledge about measurement variability is required to ensure correct interpretation. However, no clinical studies have been reported on measurement variability of Zr-89 immuno-PET. As variability due to low signal-to-noise is part of the total measurement variability, the aim of this study was to assess noise-induced variability of Zr-89 -immuno-PET using count-reduced clinical images.

Procedures

Data were acquired from three previously reported clinical studies with [⁸⁹Zr]antiCD20 (74 MBq, n?=?7), [⁸⁹Zr]antiEGFR (37 MBq, n?=?7), and [⁸⁹Zr]antiCD44 (37 MBq, n?=?13), with imaging obtained 1 to 6 days post injection (D0–D6). Volumes of interest (VOIs) were manually delineated for liver, spleen, kidney, lung, brain, and tumor. For blood pool and bone marrow, fixed-size VOIs were used. Original PET list mode data were split and reconstructed, resulting in two count-reduced images at 50 % of the original injected dose (e.g., 37 MBq_74inj).Repeatability coefficients (RC) were obtained from Bland-Altman analysis on standardized uptake values (SUV) derived from VOIs applied to these images.

Results

The RC for the combined manually delineated organs for [⁸⁹Zr] antiCD20 (37 MBq_74inj) increased from D0 to D6 and was less than 6 % at all time points. Blood pool and bone marrow had higher RC, up to 43 % for 37 MBq_74inj at D6. For tumor, the RC was up to 42 % for [⁸⁹Zr]antiCD20 (37 MBq_74inj). For [⁸⁹Zr]antiCD20, (18 MBq_74inj), [⁸⁹Zr]antiEGFR (18 MBq_37inj), and [⁸⁹Zr]antiCD44 (18 MBq_37inj), measurement variability was independent of the investigated antibody.

Conclusions

Based on this study, noise-induced variability results in a RC for Zr-89-immuno-PET (37 MBq) around 6 % for manually delineated organs combined, increasing up to 43 % at D6 for blood pool and bone marrow, assuming similar biodistribution of antibodies. The signal-to-noise ratio leads to tumor RC up to 42 %.

     

Validation of the self-confidence scale of nursing care in urinary retention

Objective:

to validate an instrument to measure self-confidence of nursing care in urinary retention.

Methods:

methodological research study, carried out after ethical approval. A Likert-like scale of 32 items related to nursing care in urinary retention was applied to students of the graduate nursing course. For instrument validation, analysis of the sample adequacy and main components, Varimax orthogonal rotation and internal consistency analyses were developed.

Results:

in a sample of 305 students, there was high correlation of all items with the total scale and Cronbach''s alpha of 0.949. The scale items were divided into five factors with internal consistency: Factor 1 (0.890), Factor 2 (0.874), Factor 3 (0.868), Factor 4 (0.814) and Factor 5 (0.773), respectively.

Conclusion:

the scale meets the validity requirements, demonstrating potential for use in evaluation and research.     

Changes in Experiences With Discrimination Across Pregnancy and Postpartum: Age Differences and Consequences for Mental Health

Objectives. We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes.Methods. We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City.Results. Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity.Conclusions. Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.A large and ever-growing body of research has shown that experiences with discrimination are associated with a wide range of adverse mental and physical health outcomes and may help explain socioeconomic and racial/ethnic health disparities in the United States.1,2 Although the majority of this research has been cross-sectional, an increasing number of longitudinal studies have shown that discrimination predicts poorer health.3,4 Some studies have gone further to examine within-person changes over time in discrimination and the resulting health implications.5–7Recently, Gee et al.8 proposed a life course perspective, calling for more research on changes in experiences with discrimination during critical periods to fully understand discrimination’s health effects and inform interventions. We examined changes across pregnancy and 1 year postpartum in experiences with everyday discrimination and consequences in terms of subsequent changes in depressive and anxiety symptoms among predominantly Black and Latina, socioeconomically disadvantaged young women residing in New York City. In their recent theoretical article, Gee et al. asserted:

Exposure to racism can change in nature, importance, and intensity. Similarly, health and the factors that produce health can change. A growing body of research shows that health is not merely the result of risks that occur sporadically at one point in time. Failure to attend to these temporal changes not only shortchanges our knowledge base, but also can lead to missed opportunities for intervention.8^(p967)

Cross-sectional (or even longitudinal) studies examining between-subjects associations of discrimination with health outcomes cannot assess changes in discrimination over time. To advance understanding of the health effects of discrimination, taking a life course perspective and examining changes in discrimination over time are crucial. Gee et al.8 highlighted potential age-patterned exposures to discrimination, with certain critical periods during which changes are more drastic. Some research supports this perspective, with evidence that racial discrimination increases across adolescence5 among African American youths and increases over time6 among African American, Latino, and Asian American youths. Although Gee et al. focused on racism, we suggest that their framework applies to all forms of discrimination.Pregnancy and postpartum may be a critical period to study changes in discrimination, given that women’s experiences with discrimination during pregnancy increase their likelihood of adverse maternal and infant health outcomes such as having a low birth weight infant9,10 and contracting a sexually transmitted infection.11 Also, women experience changes in their bodies, social relationships, and emotions12 during pregnancy and postpartum and come into contact with a variety of new social institutions, including those related to obstetrics and child care; thus, as a result of these life changes, women may experience changes in exposure to discrimination during this time period.8Changes in experiences with discrimination may also vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status. Socioeconomically disadvantaged women, women of color, and women born outside of the United States who may have experienced discrimination regularly throughout their lives might feel that they are treated better or face less discrimination during pregnancy and the postpartum period, when people may extend them courtesies (e.g., giving up a seat on a bus) and institutions may offer added support (e.g., ensuring prenatal and infant care).By contrast, some theories suggest that Black and Latina women in the United States may experience heightened discrimination during pregnancy and postpartum because of group stereotypes related to sexuality and motherhood (e.g., sexual promiscuity, single parenthood) and the societal devaluation of motherhood in women of color.13,14 Some of these negative stereotypes specifically target Black and Latina adolescents and young women14 and so may be particularly relevant for younger age groups. Thus, experiences with discrimination can increase or decrease during pregnancy and postpartum, and the pattern of change may vary on the basis of characteristics such as age, race/ethnicity, nativity, and socioeconomic status. It is therefore important to assess these characteristics as potential moderators of changes in discrimination during this period.Discrimination is an important determinant of mental health across different social groups.1,2 The majority of research on discrimination and mental health is cross sectional; as noted, however, an increasing amount of research has explored this association longitudinally. For example, individual differences in Black Americans’ experiences with racial discrimination have been found to predict depressive and anxiety symptoms at a later time point, but differences in depressive and anxiety symptoms have not been found to predict racial discrimination at a later point.4,15Studies have begun to explore whether experiences with discrimination change over time and whether these changes are associated with changes in mental health. Schulz et al.7 found that changes over 2 time points (spaced 5 years apart) in Black American women’s experiences with discrimination were positively associated with simultaneous changes in depressive symptoms and negatively associated with changes in self-rated health.Greene et al.6 found that changes in experiences with discrimination across 5 time points (over 3 years) were negatively associated with simultaneous changes in self-esteem and positively associated with changes in depressive symptoms among Black, Latino, and Asian American high school students. Similarly, Brody et al.5 found that changes in experiences with racial discrimination across 3 time points (over 5 years) were positively associated with simultaneous changes in conduct problems and depressive symptoms among Black adolescents. To the best of our knowledge, despite this existing research on discrimination and depressive symptoms, no work has examined associations between changes in discrimination and changes in anxiety or assessed these associations during pregnancy.Yet, pregnancy and postpartum may be a particularly important period during which to examine associations of discrimination with depressive and anxiety symptoms. During pregnancy, these symptoms have adverse consequences for birth outcomes (e.g., preterm birth and low birth weight) and infant development (e.g., cognitive and motor development).16 In the postpartum period, these symptoms have adverse consequences with respect to parenting behaviors (e.g., playing with and talking to the infant) and the health of both the mother and the child.17 In addition, although past research suggests that discrimination has adverse mental health consequences across diverse groups, much of this research has focused on specific groups (e.g., Black Americans), and thus it is important to examine whether these associations vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status.The first aim of our study was to examine changes in experiences with discrimination across pregnancy and 1 year postpartum and assess whether age, race/ethnicity, nativity, or socioeconomic status moderated the pattern of change. Our second aim was to explore whether changes in experiences with discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points and whether the sociodemographic factors just described moderated these associations.Given the competing theories described earlier, we did not have a specific expected pattern of change; rather, we hypothesized that experiences with discrimination would change across pregnancy and the postpartum period and that age, race/ethnicity, nativity, or socioeconomic status of participant might moderate that pattern. Also, consistent with past work showing associations between discrimination and mental health across diverse groups, we hypothesized that changes in experiences with discrimination across pregnancy and postpartum would significantly positively predict changes in depressive and anxiety symptoms at subsequent time points and that participants’ age, race/ethnicity, nativity, and socioeconomic status would not moderate those associations.     

Validation to Portuguese of the Scale of Student Satisfaction and Self-Confidence in Learning

Objective:

translate and validate to Portuguese the Scale of Student Satisfaction and Self-Confidence in Learning.

Material and Methods:

methodological translation and validation study of a research tool. After following all steps of the translation process, for the validation process, the event III Workshop Brazil - Portugal: Care Delivery to Critical Patients was created, promoted by one Brazilian and another Portuguese teaching institution.

Results:

103 nurses participated. As to the validity and reliability of the scale, the correlation pattern between the variables, the sampling adequacy test (Kaiser-Meyer-Olkin) and the sphericity test (Bartlett) showed good results. In the exploratory factorial analysis (Varimax), item 9 behaved better in factor 1 (Satisfaction) than in factor 2 (Self-confidence in learning). The internal consistency (Cronbach''s alpha) showed coefficients of 0.86 in factor 1 with six items and 0.77 for factor 2 with 07 items.

Conclusion:

in Portuguese this tool was called: Escala de Satisfação de Estudantes e Autoconfiança na Aprendizagem. The results found good psychometric properties and a good potential use. The sampling size and specificity are limitations of this study, but future studies will contribute to consolidate the validity of the scale and strengthen its potential use.