Hasil untuk "Medicine (General)"

P. Brancaccio, N. Maffulli, F. Limongelli

Moritz J.S. Jochum, Frédéric S. Singa-Niatou, Crickette Sanz et al.

Transmission of human respiratory pathogens to wild, human-habituated great apes has been repeatedly documented within research and tourism projects. While the implementation of hygiene measures has significantly reduced the risk of pathogen introduction, vigilant surveillance remains essential to evaluate the effectiveness of the adopted measures and identify additional steps for risk reduction. Here, we combined behavioral observations and pathogen genomic surveillance in non-invasive samples to investigate three outbreaks of respiratory disease in human-habituated western lowland gorillas (Gorilla gorilla gorilla) across four sites within the Sangha Trinational Protected Area Network in the northwestern Congo Basin. Clinical signs of respiratory disease were recorded in three groups of monitored gorillas at two neighboring National Parks in the Central African Republic and Republic of Congo. Human respiratory syncytial viruses were identified as the causative agent for all three documented outbreaks. Genomic analyses revealed two distinct viral types suggesting independent introduction rather than intergroup transmission. All symptomatic individuals recovered. These findings highlight the importance of stringent prevention measures at great ape research sites and the need for addressing the burden of respiratory disease in neighboring human communities. The evolving integrated approach centered on the One Health concept in the Sangha Trinational Protected Area Network is proving beneficial to great ape conservation, the preservation of this high-biodiversity landscape and the public health of local communities.

Anna Wajs-Bonikowska, Ewa Maciejczyk, Łukasz Szoka et al.

This study investigates the essential oil (EO) isolated from the seeds and cones of Canadian hemlock (<i>Tsuga canadensis</i>), highlighting notable differences in their chemical composition and biological activities. The seed EO was uniquely dominated by oxygenated derivatives of monoterpene hydrocarbons, particularly bornyl acetate (40%), whereas the cone EO exhibited higher levels of monoterpene hydrocarbons such as α-pinene (23%), β-pinene (20%), and myrcene (23%). A significant finding was the strong cytotoxic activity of cone EO against melanoma cell lines, with IC₅₀ values as low as 0.104 ± 0.015 μL/mL, compared to the minimal effects of seed EO. Additionally, cone EO demonstrated stronger antimicrobial activity, with lower minimum inhibitory concentrations (MICs) against Gram-positive and Gram-negative bacteria, further highlighting its therapeutic potential. Lipophilic extracts from seeds were characterized by unsaturated fatty acids (linoleic, oleic, and sciadonic acids—specific to conifers) and bioactive molecules with high antioxidant and nutritional potential, such as β-tocopherol, β-sitosterol, and campestrol. These findings underscore the unique chemical composition of <i>T. canadensis</i> seed EO and its lipophilic extract, along with the potent cytotoxic and antimicrobial properties of cone EO, offering insights into their potential applications in natural products for pharmaceutical and therapeutic uses.

Hemalatha Kanakarajan, Wouter De Baene, Patrick Hanssens et al.

Abstract Background and purpose Accurate segmentation of brain metastases on Magnetic Resonance Imaging (MRI) is tedious and time-consuming for radiologists that could be optimized with deep learning (DL). Previous studies assessed several DL algorithms focusing only on training and testing the models on the planning MRI only. The purpose of this study is to evaluate well-known DL approaches (nnU-Net and MedNeXt) for their performance on both planning and follow-up MRI. Materials and methods Pre-treatment brain MRIs were retrospectively collected for 255 patients at Elisabeth-TweeSteden Hospital (ETZ): 201 for training and 54 for testing, including follow-up MRIs for the test set. To increase heterogeneity, we added the publicly available MRI scans from the Mathematical oncology laboratory of 75 patients to the training data. The performance was compared between the two models, with and without the addition of the public data. To statistically compare the Dice Similarity Coefficient (DSC) of the two models trained on different datasets over multiple time points, we used Linear Mixed Models. Results All models obtained a good DSC (DSC > = 0.93) for planning MRI. MedNeXt trained with combined data provided the best DSC for follow-ups at 6, 15, and 21 months (DSC of 0.74, 0.74, and 0.70 respectively) and jointly the best DSC for follow-ups at three months with MedNeXt trained with ETZ data only (DSC of 0.78) and 12 months with nnU-Net trained with combined data (DSC of 0.71). On the other hand, nnU-Net trained with combined data provided the best sensitivity and FNR for most follow-ups. The statistical analysis showed that MedNeXt provides higher DSC for both datasets and the addition of public data to the training dataset results in a statistically significant increase in performance in both models. Conclusion The models achieved a good performance score for planning MRI. Though the models performed less effectively for follow-ups, the addition of public data enhanced their performance, providing a viable solution to improve their efficacy for the follow-ups. These algorithms hold promise as a valuable tool for clinicians for automated segmentation of planning and follow-up MRI scans during stereotactic radiosurgery treatment planning and response evaluations, respectively. Clinical trial number Not applicable.

Suvijak Untaaveesup, MD, Thipsukon Amnartpanich, MD, Noraworn Jirattikanwong, MD et al.

Background: Chronic systemic inflammation in individuals with moderate-to-severe atopic dermatitis (AD) potentially predisposes them to metabolic and cardiovascular diseases. Nevertheless, evidence with regard to such association is limited. Objective: To assess the association between metabolic and cardiovascular outcomes and moderate-to-severe AD. Methods: A systematic search was performed through PubMed, Scopus, EMBASE, and Cochrane for population-based studies that addressed the effects of moderate-to-severe AD on metabolic and cardiovascular outcomes compared with the general population from inception to August 31, 2023. Meta-analysis was performed using the random effects model. The pooled odds ratio (OR) and certainty of evidence for each outcome were reported. Results: We included 11 studies, 4 retrospective cohorts, 1 prospective cohort, 4 cross-sectional, and 2 case-control studies involving 405,170 moderate-to-severe AD patients compared to 4,591,478 unaffected controls. Moderate-to-severe AD was associated with a higher risk of myocardial infarction with an OR (95% CI) of 1.33 (1.07, 1.65), angina 1.33 (1.06, 1.66), heart failure 1.56 (1.28, 1.90), stroke 1.45 (1.21, 1.74), hypertension 1.38 (1.18, 1.63), dyslipidemia 1.27 (1.15, 1.41), and metabolic syndrome 1.24 (1.05, 1.42) with very low certainty of evidence. No significantly increased risk of cardiovascular death with an odds ratio (95% CI) of 1.81 (0.96, 3.44) and diabetes of 1.24 (0.91, 1.68) was observed. High heterogeneity was observed in most studies for all of the outcomes. Conclusion: Our meta-analysis demonstrated a modest but significant association between moderate-to-severe AD and increased susceptibility to metabolic and cardiovascular diseases. Initial assessment of cardiovascular and metabolic risk for patients with moderate-to-severe AD should be considered to enable early management strategies.

Xianying Cheng, Ping Wang, Li Cheng et al.

BackgroundCervical cancer incidence and mortality rates in the United States have substantially declined over recent decades, primarily driven by reductions in squamous cell carcinoma cases. However, the trend in recent years remains unclear. This study aimed to explore the trends in cervical cancer incidence and mortality, stratified by demographic and tumor characteristics from 1975 to 2018.MethodsThe age-adjusted incidence, incidence-based mortality, and relative survival of cervical cancer were calculated using the Surveillance, Epidemiology, and End Results (SEER)-9 database. Trend analyses with annual percent change (APC) and average annual percent change (AAPC) calculations were performed using Joinpoint Regression Software (Version 4.9.1.0, National Cancer Institute).ResultsDuring 1975–2018, 49,658 cervical cancer cases were diagnosed, with 17,099 recorded deaths occurring between 1995 and 2018. Squamous cell carcinoma was the most common histological type, with 34,169 cases and 11,859 deaths. Over the study period, the cervical cancer incidence rate decreased by an average of 1.9% (95% CI: −2.3% to −1.6%) per year, with the APCs decreased in recent years (−0.5% [95% CI: −1.1 to 0.1%] in 2006–2018). Squamous cell carcinoma incidence trends closely paralleled overall cervical cancer patterns, but the incidence of squamous cell carcinoma in the distant stage increased significantly (1.1% [95% CI: 0.4 to 1.8%] in 1990–2018). From 1995 to 2018, the overall cervical cancer mortality rate decreased by 1.0% (95% CI: −1.2% to −0.8%) per year. But for distant-stage squamous cell carcinoma, the mortality rate increased by 1.2% (95% CI: 0.3 to 2.1%) per year.ConclusionFor cervical cancer cases diagnosed in the United States from 1975 to 2018, the overall incidence and mortality rates decreased significantly. However, there was an increase in the incidence and mortality of advanced-stage squamous cell carcinoma. These epidemiological patterns offer critical insights for refining cervical cancer screening protocols and developing targeted interventions for advanced-stage cases.

Ali Mohammad Mossadeghrad, Shervin Mossavarali, Seyed Hamid Hosseini Neishabouri et al.

Objective: Employees’ management is the process of planning, organizing, directing, and controlling human resources within an organization, which is of great importance and it is necessary to pay attention to its various dimensions, including the provision, distribution, and retention of employees. In the present study, the challenges and problems in the field of personnel are examined and then solutions to reduce these challenges are discussed. Information sources and selected methods for study:  A scoping review was conducted in August 2023 to identify the challenges faced by healthcare workers and suggest appropriate solutions. The search was performed across English-language databases, including PubMed, Scopus, Web of Science, as well as Persian-language databases SID and Magiran, and search engines Google Scholar and Google. Title and abstract screening were independently carried out by three authors. After the screening and full-text review, data extraction was performed on 104 relevant studies. Data analysis was conducted using the Ritchie and Spencer framework analysis method. Results: A total of 27 challenges related to the healthcare workforce were identified and categorized into three domains: recruitment, distribution, and retention. The most critical challenges included unequal distribution of physicians, workforce shortages, job burnout, and migration of healthcare workers, all of which significantly impact the quality of healthcare services. Regarding workforce recruitment, key strategies included utilizing trainees, training non-specialist staff, and expanding educational capacities. To address distribution disparities, policies such as strengthening family physician programs, telemedicine, and offering financial incentives were proposed. In terms of workforce retention, effective solutions included welfare support, psychological counseling, stress management programs, and work-life balance initiatives. Conclusion: To improve the condition of health workers, policymakers must adopt an integrated, evidence-based approach addressing the three areas of recruitment, distribution, and retention. Moreover, proposed strategies should be contextualized based on each country's economic, social, and cultural conditions and implemented through intersectoral collaboration and sufficient resource allocation to ensure long-term effectiveness.

Min Zhang, Ye Bai, Yutong Wang et al.

BackgroundGeneral obesity is a well-established risk factor for gallstone disease (GSD), but whether central obesity contributes additional independent risk remains controversial. We aimed to comprehensively clarify the effect of body fat distribution on GSD.MethodsWe first investigated the observational association of central adiposity, characterized by waist-to-hip ratio (WHR), with GSD risk using data from UK Biobank (N=472,050). We then explored the genetic relationship using summary statistics from the largest genome-wide association study of GSD (ncase=43,639, ncontrol=506,798) as well as WHR, with and without adjusting for body mass index (BMI) (WHR: n=697,734; WHRadjBMI: n=694,649).ResultsObservational analysis demonstrated an increased risk of GSD with one unit increase in WHR (HR=1.18, 95%CI=1.14-1.21). A positive WHR-GSD genetic correlation (rg =0.41, P=1.42×10-52) was observed, driven by yet independent of BMI (WHRadjBMI: rg =0.19, P=6.89×10-16). Cross-trait meta-analysis identified four novel pleiotropic loci underlying WHR and GSD with biological mechanisms outside of BMI. Mendelian randomization confirmed a robust WHR-GSD causal relationship (OR=1.50, 95%CI=1.35-1.65) which attenuated yet remained significant after adjusting for BMI (OR=1.17, 95%CI=1.09-1.26). Furthermore, observational analysis confirmed a positive association between general obesity and GSD, corroborated by a shared genetic basis (rg =0.40, P=2.16×10-43), multiple novel pleiotropic loci (N=11) and a causal relationship (OR=1.67, 95%CI=1.56-1.78).ConclusionBoth observational and genetic analyses consistently provide evidence on an association of central obesity with an increased risk of GSD, independent of general obesity. Our work highlights the need of considering both general and central obesity in the clinical management of GSD.

Xiang Tang, Guoqing Liu, Li Lin et al.

Abstract Background Neurodevelopmental disorder with absent language and variable seizures (NEDALVS, # 618707) are characterized by delayed speech and motor development, ocular abnormalities, and seizures. NEDAVLS is an autosomal dominant disorder caused by de novo mutations in the wasp protein family member 1 (WASF1) gene. Case presentation We identified a de novo nonsense variant c.1516 C > T (p.Arg506*) of WASF1 gene (NM_003931.3) in two pediatric female patients with delayed motor and language development. Conclusion This case demonstrates the effective role of WES in the diagnosis of NEDALVS. To the best of our knowledge, this variant has not been reported in the Chinese population. This contributes to our further understanding of the disease and to research related to the genetic and clinical heterogeneity, the treatment and prognosis of the disease.

Haim Shmuely, Yekaterina Shvartsman, Rita Berdinstein et al.

Abstract Purpose During the last few decades, the increased use of various types of antibiotics in the general population caused a significant change in regional Helicobacter pylori (H. pylori) antibiotic resistance. Our aim is to study the changes in H. pylori resistance in patients who had undergone an esophagogastroduodenoscopy (EGD) and susceptibility testing and found positive for H. pylori. The study was conducted in a university affiliated hospital between 2013–2020. Methods A cross-sectional study was performed on all consecutive patients who had undergone an EGD and tested positive for H. pylori at the Kaplan Medical Center, Israel. The study period was divided into two sub-periods: 2013–2016 and 2017–2020. Data on age, sex, comorbidities, previous treatments, and antimicrobial susceptibility testing for six antimicrobial agents were compared. Results The resistance rates of H. pylori to clarithromycin and dual resistance to clarithromycin and metronidazole were found significantly higher during the late period. Multivariable analysis showed that the later period, older age, and diabetes mellitus were independent predictors for antimicrobial resistance. Conclusions Our study has shown that there is an increasing resistance of H. pylori to clarithromycin and metronidazole while its susceptibility is unaffected with time to other antibiotics. More recent cross-sectional studies with larger samples are warranted in order to evaluate the changes in the resistance patterns of H. pylori to various antibiotics with time.

Cécile Evin, Nathalie Lassau, Corinne Balleyguier et al.

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that occurs following a sudden blood pressure increase. We report the case of a 64-year-old patient presenting PRES several hours after the administration of a combination of chemotherapy and a checkpoint inhibitor (carboplatin-etoposide-atezolizumab) for small-cell lung cancer. He presented consciousness disorders associated with partial epileptic seizure secondarily generalized. His arterial blood pressure was elevated and brain imaging showed multiple bilateral subcortical parietal, temporal, occipital and cerebellar T2 high signals, predominantly in the posterior region. There were no abnormal T1 signals nor bleeding but a left apparent diffusion coefficient restriction was noted. On arterial spin labelling perfusion sequences, there was an increased perfusion within the left temporo-parieto-occipital, left thalamic and right cerebellar regions. Finally, the neurological symptoms completely regressed after several days of optimal antihypertensive and antiepileptic treatment. The clinical context and radiological features, as well as the progressive resolution of the neurological symptoms, were all in favor of PRES. PRES can occur after the administration of chemotherapy and/or immunotherapy. Prompt diagnosis is crucial through a spectrum of suspicious clinical and radiological characteristics that must be rapidly recognized to quickly anticipate the optimal therapeutic strategy and avoid unnecessary complications.

Mery Yolanda Cifuentes Cifuentes, Linda Stefany Gómez Aristizábal, Gladys Pinilla Bermúdez et al.

Introduction: Congenital syphilis is a major public health problem, and early diagnosis and treatment are necessary to prevent it. Penicillin G benzathine is the treatment of choice in pregnant women; however, it may fail to prevent fetal infection, as in the present case. Case presentation: Male newborn, son of an HIV negative mother with gestational syphilis (venereal disease research laboratory (VDRL) 1:4 dilution, positive treponemal test) diagnosed at week 21 of gestation and treated with three doses of 2 400 000 IU of penicillin G benzathine. At delivery, the mother presented VDRL 1:1 dilution. The newborn was diagnosed with congenital syphilis due to VDRL 1:4 dilution, positive treponemal test, elevated aspartate aminotransferases, hyposthenuria, proteinuria, hematuria, and leukocyturia that resolved after treatment with crystalline penicillin for 10 days. The molecular testing in blood showed a high treponemal load. The VDRL test at 3 months was non-reactive. Conclusions: Preventing congenital syphilis with the recommended treatment for gestational syphilis may fail. Moreover, diagnosing this condition in an asymptomatic newborn is difficult. Therefore, clinical and serological tests are recommended to confirm whether maternal treatment was effective in the fetus.

Eman A Rashed, Abeer M Mohyi, Mona M A. AbdulLatif et al.

Introduction Type 1 diabetes mellitus (T1DM) is an autoimmune disorder triggered by both environmental and genetic risk factors. Although some studies have reported that single-nucleotide polymorphisms of vitamin D receptor (VDR) gene play a role in T1DM susceptibility, their associations are inconclusive and remain controversial in different ethnic groups. This case–control study aimed to evaluate the association between VDR (BsmI-rs1544410 and FokI-rs2228570) single-nucleotide polymorphisms and T1DM in Egyptian children. A total of 100 participants, 50 children with T1DM (cases) and 50 nondiabetic, age-matched and sex-matched patients (controls), were enrolled in the study in which BsmI-rs1544410 and FokI-rs2228570 variants were genotyped using TaqMan real-time PCR technology. Results VDR gene (BsmI-rs1544410 and FokI-rs2228570) variants are not associated with T1DM in Egyptian children. Conclusions VDR (BsmI-rs1544410 and FokI-rs2228570) variants did not differ significantly between T1DM cases and nondiabetic controls among Egyptian children.

Conference Abstracts

Sanjana Haque, Sunitha Kodidela, Namita Sinha et al.

Smoking, which is highly prevalent in HIV-infected populations, has been shown to exacerbate HIV replication, in part via the cytochrome P450 (CYP)-induced oxidative stress pathway. Recently, we have shown that extracellular vesicles (EVs), derived from tobacco- and/or HIV-exposed macrophages, alter HIV replication in macrophages by cell-cell interactions. We hypothesize that cigarette smoke condensate (CSC) and/or HIV-exposed macrophage-derived EVs carry relatively high levels of pro-oxidant and pro-inflammatory cargos and/or low levels of antioxidant and anti-inflammatory cargos, which are key mediators for HIV pathogenesis. Therefore, in this study, we investigated differential packaging of pro- and anti-inflammatory cytokines/chemokines and pro- and anti-oxidant contents in EVs after CSC exposure to myeloid cells (uninfected U937 and HIV-infected U1 cells). Our results showed that relatively long to short exposures with CSC increased the expression of cytokines in EVs isolated from HIV-infected U1 macrophages. Importantly, pro-inflammatory cytokines, especially IL-6, were highly packaged in EVs isolated from HIV-infected U1 macrophages upon both long and short-term CSC exposures. In general, anti-inflammatory cytokines, particularly IL-10, had a lower packaging in EVs, while packaging of chemokines was mostly increased in EVs upon CSC exposure in both HIV-infected U1 and uninfected U937 macrophages. Moreover, we observed higher expression of CYPs (1A1 and 1B1) and lower expression of antioxidant enzymes (SOD-1 and catalase) in EVs from HIV-infected U1 macrophages than in uninfected U937 macrophages. Together, they are expected to increase oxidative stress factors in EVs derived from HIV-infected U1 cells. Taken together, our results suggest packaging of increased level of oxidative stress and inflammatory elements in the EVs upon exposure to tobacco constituents and/or HIV to myeloid cells, which would ultimately enhance HIV replication in macrophages via cell-cell interactions.

Sandra Schlegl, Nina Dittmer, Svenja Hoffmann et al.

Abstract Background Compulsive exercise (CE) is a frequent symptom in patients with eating disorders (EDs). It includes, in addition to quantitatively excessive exercise behaviour, a driven aspect and specific motives of exercise. CE is generally associated with worse therapy outcomes. The aims of the study were to compare self-reported quantity of exercise, compulsiveness of exercise as well as motives for exercise between patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC). Additionally, we wanted to explore predictors of compulsive exercise (CE) in each group. Methods We investigated 335 female participants (n = 226 inpatients, n = 109 HC) and assessed self-reported quantity of exercise, compulsiveness of exercise (Compulsive Exercise Test), motives for exercise (Exercise Motivations Inventory-2), ED symptoms (Eating Disorder Inventory-2), obsessive-compulsiveness (Obsessive-Compulsive Inventory-Revised), general psychopathology (Brief Symptom Inventory-18) and depression (Beck Depression Inventory-2). Results Both patients with AN and BN exercised significantly more hours per week and showed significantly higher CE than HC; no differences were found between patients with AN and BN. Patients with EDs and HC also partly varied in motives for exercise. Specific motives were enjoyment, challenge, recognition and weight management in patients with EDs in contrast to ill-health avoidance and affiliation in HC. Patients with AN and BN only differed in regard to exercise for appearance reasons in which patients with BN scored higher. The most relevant predictor of CE across groups was exercise for weight and shape reasons. Conclusions Exercise behaviours and motives differ between patients with EDs and HC. CE was pronounced in both patients with AN and BN. Therefore, future research should focus not only on CE in patients with AN, but also on CE in patients with BN. Similarities in CE in patients with AN and BN support a transdiagnostic approach during the development of interventions specifically targeting CE in patients with EDs.

Chao Ren, Peiyuan Yin, Neng Ren et al.

Abstract Recent studies have suggested that the regulation of endogenous neural stem cells (NSCs) or transplanting of exogenous nerve cells are the newest and most promising methods for the treatment of dementia and other neurological diseases. The special location and limited number of endogenous NSCs, however, restrict their clinical application. The success in directional differentiation of exogenous stem cells from other tissue sources into neural cells has provided a novel source for NSCs. Study on the relative mechanisms is still at the preliminary stage. Currently the induction methods include: 1) cell growth factor induction; 2) chemical induction; 3) combined growth factor-chemical induction; or 4) other induction methods such as traumatic brain tissue homogenate, gene transfection, traditional Chinese medicine, and coculture induction. Cerebrospinal fluid (CSF), as a natural medium under physiological conditions, contains a variety of progrowth peptide factors that can promote the proliferation and differentiation of mesenchymal stromal cells (MSCs) into neural cells through the corresponding receptors on the cell surface. This suggests that CSF can not only nourish the nerve cells, but also become an effective and suitable inducer to increase the yield of NSCs. However, some other studies believed that CSF contained certain inhibitory components against the differentiation of primary stem cells into mature neural cells. Based on the above background, here we review the relative literature on the influence of the CSF on stem cells in order to provide a more comprehensive reference for the wide clinical application of NSCs in the future.

Idonys Cácerez Pérez, Lizandro Michel Pérez García, Sahily Omara Pérez García et al.

Fundamento: En la enseñanza de las ciencias de la salud los medios informáticos ocupan un lugar fundamental. Objetivo: Determinar la pertinencia de un hiperentorno en la enseñanza-aprendizaje de la atención de enfermería a pacientes con afecciones del sistema osteomioarticular. Metodología: El universo estuvo formado por cuatro profesores y 76 estudiantes del curso 2014-2015 de la carrera Enfermería de la Universidad de Ciencias Médicas de Sancti Spíritus, se utilizaron métodos del nivel teórico: histórico-lógico, inductivo-deductivo, analítico-sintético y sistémico y del nivel empírico: el criterio de expertos, la encuesta y los talleres de socialización. Resultados: Los criterios que aportaron los expertos permitieron valorar su pertinencia, y después de su aplicación parcial la mayoría de los indicadores estaban siempre o algunas veces presentes según criterios de profesores y estudiantes. En los talleres se observó consenso de su relevancia social. Conclusiones: El hiperentorno resultó pertinente para su utilización en la práctica según los expertos y el reconocimiento de estudiantes y profesores de la presencia mayoritaria de indicadores para los medios informáticos en el proceso de enseñanza-aprendizaje de este tema. DeCS: EDUCACIÓN ENFERMERÍA/métodos; ESTUDIANTES DE ENFERMERÍA; EDUCACIÓN CONTINUA EN ENFERMERÍA/métodos; INFORMÁTICA MÉDICA/educación; PROGRAMAS INFORMÁTICOS/métodos; SISTEMA MUSCULOESQUELÉTICO. Palabras clave: Hiperentorno como medio de enseñanza; Educación en enfermería and métodos; Estudiantes de enfermería; Educación continua en enfermería; Informática médica and educación; Programas informáticos and métodos; Sistema musculoesquelético. ABSTRACT Background: In the teaching of health sciences, informatic aids take a major role. Objective: To determine the efficacy of a hyper environment in the teaching learning process of the nursing assistance programme. Methodology: The universe was constituted by four professors and seventy six nursing students from 2014 to 2015 from Sancti Spiritus Medical University. Some methods were used: historical and logical, inductive deductive, analytical and synthetic and the systemic one, all from the theoretical level, from the empirical level: Experts´ criteria, survey and socialization workshops. Results: Expert´s criteria permitted to value its efficacy and after its partial application the majority of the indicators were always or sometimes present according to students´ or professors ´criteria. Conclusion: The hyper environment was efficient to be used in practice according to experts and according to the recognition of students and professors in terms of major presence of indicators for informatic aids in the teaching learning process of the topic given. MeSH: EDUCATION NURSING/methods; STUDENTS NURSING; EDUCATION NURSING CONTINUING/methods; MEDICAL INFORMATICS/education; SOFTWARE/methods; MUSCULOSKELETAL SYSTEM. Keywords: Hypercontext as a teaching medium; education nursing and methods; students nursing and methods; education nursing continuing and methods; medical informatics and education; software and methods; musculoskeletal system.

Arif Kurniadi, Retno Pratiwi

Complete patient service requires continuous support of clinical history. This can be realized by integrating electronic medical record data. The limitation is the wide variety of software, formats, and data dictionaries used in healthcare facilities. This was a descriptive analysis study with cross sectional approach to find open source electronic medical record integration model for clinical data exchange between health care facilities. Respondents were doctors, nurses, pharmacists, laboratory staffs, and person in charge of hospital information system as informant for content analysis. From the study, we managed a web-based service portal to implement clinical data integration that can be accessed by clinician registered within the Ministry of Health. The patients clinical history is stored in the hospital database and requires unique OpenIDRM code on the Health Service Server to integrate it. OpenIDRM contains all of the patients medical record number, as one patient may have several different medical record numbers in several hospitals. In conclusion, clinician can access the patients clinical history by opening a web portal system through a unique OpenIDRM code.

Ruta Ustinavičienė, Lina Škėmienė, Dalia Lukšienė et al.

Background and objective: Computers and the Internet have become an integral part of today's life. Problematic gaming is related to adolescent's health. The aim of our study was to evaluate the prevalence of Internet addiction among 13–18-year-old schoolchildren and its relation to sex, age, and time spent playing computer games, game type, and subjective health evaluation. Materials and methods: A total of 1806 schoolchildren aged 13–18 years were interviewed. The evaluation of Internet addiction was conducted by the Diagnostic Questionnaire according to Young's methodology. The relation between the choice of computer games type, time spent while playing computer games and respondents’ Internet addiction were assessed by using multivariate logistic regression analysis. Results: One-tenth (10.6%) of the boys and 7.7% of the girls aged 13–18 years were Internet addicted. Internet addiction was associated with the type of computer game (action or combat vs. logic) among boys (OR = 2.42; 95% CI, 1.03–5.67) and with the amount of time spent playing computer games per day during the last month (≥5 vs. <5 h) among girls (OR = 2.10; 95% CI, 1.19–3.70). The boys who were addicted to the Internet were more likely to rate their health poorer in comparison to their peers who were not addicted to the Internet (OR = 2.48; 95% CI, 1.33–4.62). Conclusions: Internet addiction was significantly associated with poorer self-rated health among boys.