Obezita je chronické, relabující a progredující onemocnění s rostoucí prevalencí, které významně ovlivňuje zdraví a kvalitu života i u dětí. Je spojena se zvýšeným rizikem metabolických a kardiovaskulárních onemocnění, jako je inzulinová rezistence, diabetes mellitus 2. typu, hypertenze, dyslipidémie a metabolicky asociovaná steatóza jater. Obezita dále může vést k rozvoji syndromu spánkové apnoe, ortopedickým a psychickým komplikacím. Základem terapie je edukace zdravého životního stylu celé rodiny, která však často naráží na překážky, jako jsou časová náročnost, omezená dostupnost specialistů a nízká dlouhodobá adherence rodin. Telemedicína nabízí inovativní přístup ke zlepšení léčby obezity dětí prostřednictvím digitálních nástrojů, online konzultací, chytrých aplikací a nositelných technologií. Umožňuje efektivnější monitorování stravovacích a pohybových návyků, podporu psychického zdraví i snížení časové a finanční zátěže pro rodiny. Výsledky studií ukazují, že kombinace prezenční a distanční podpory a aktivní zapojení rodinných příslušníků vede k vyšší úspěšnosti v redukci tělesné hmotnosti a udržení zdravého životního stylu. Článek se zaměřuje na využití telemedicíny v léčbě obezity u dětí, přehled metod, které byly v této oblasti aplikovány, a jejich účinnost v kontextu současných vědeckých poznatků.
Obesity is a chronic, relapsing, and progressive disease with increasing prevalence, that significantly impacts health and quality of life, even in children. It is associated with an increased risk of metabolic and cardiovascular diseases such as insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease. Additionally, obesity can lead to the development of sleep apnea syndrome, orthopedic issues, and psychological complications. The cornerstone of the care is educating the whole family about a healthy lifestyle; however, this may often be challenging due to obstacles such as time constraints, limited access to specialists, and low long-term adherence of families. Telemedicine offers an innovative approach to improving obesity treatment in children through digital tools, online consultations, smart applications, and wearable technologies. It enables more effective monitoring of dietary and physical activity habits, supports mental health, and reduces time and financial burdens for families. Studies indicate that combining in-person and remote support, along with active involvement of family members, leads to higher success rates in weight reduction and a healthy lifestyle maintenance. This article focuses on the use of telemedicine in the treatment of obesity in children, providing an overview of the methods applied in this field and their effectiveness in the context of current scientific knowledge.
- MeSH
- Child MeSH
- Humans MeSH
- Pediatric Obesity * therapy MeSH
- Motor Activity MeSH
- Psychosocial Intervention methods MeSH
- Preventive Health Services methods MeSH
- Feeding Behavior psychology MeSH
- Telemedicine * MeSH
- Life Style MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Léčebná výměnná plazmaferéza (therapeutic plasma Exchange – TPE) má nezastupitelné místo v léčbě některých typů trombotických mikroangiopatií a je léčbou volby u trombotické trombocytopenické purpury. TPE je podle American Society for Apheresis (ASFA) definována jako terapeutický extrakorporální postup, při kterém je plazma pacienta oddělena od ostatních krevních složek. Jedná se sice o invazivní techniku vyžadující kvalitní žilní přístup, na druhé straně je TPE vysoce bezpečná, a při správném provedení jsou komplikace raritní, lze ji v případě potřeby zahájit během desítek minut a v zásadě nemá žádné reálné kontraindikace. Oddělení plazmy od ostatních složek krve je zajištěno centrifugací nebo membránovou filtrací. Jako náhradní roztok se v různých poměrech a kombinacích používají krystaloidy, 5% roztok albuminu a čerstvě zmražená dárcovská plazma, nebo se v poslední době stále častěji používá plazma ošetřená solvent-detergentem. Během jednoho výkonu se má vyměnit nejméně celý objem plazmy pacienta (total plasma volume – TPV), čímž dojde k výměně, a tedy nahrazení necelých 70 % TPV. Léčba TTP plazmaferézou by měla být zahájena co nejdříve, již při vyslovení podezření na TTP, často ještě před znalostí výsledků aktivity enzymu ADAMTS13. Před zahájením léčby TPE je nutné pamatovat na odběr vzorků krve na vyšetření ADAMTS13 a dalších vyšetření, případně uchování vzorků plazmy, protože interpretace výsledků vzorků odebraných po provedené TPE může být chybná. Účinnost TPE je dána dvěma mechanizmy: 1) odstranění mediátoru onemocnění nebo složek plazmy přispívajících k patogeneze daného stavu; 2) dodání chybějící či nefunkční složky plazmy v případě použití plazmy jako náhradního roztoku. Efektivita TPE se u jednotlivých forem trombotických mikroangiopatií různí, od jednoznačného a promptního efektu u TTP až po nulový efekt u některých forem atypického hemolyticko-uremického syndromu.
Therapeutic plasma exchange (TPE) has an irreplaceable place in the treatment of some types of thrombotic microangiopathies. In TTP, it has become the standard of care. TPE is defined by the American Society for Apheresis (ASFA) as a therapeutic extracorporeal procedure in which the patient‘s plasma is separated from other blood components. Although it is an invasive technique requiring high-quality venous access, TPE is quite safe, and when performed correctly, complications are rare. It can be started within tens of minutes if necessary, and it has essentially no real contraindications. Separation of plasma from other blood components is ensured by centrifugation or membrane filtration. Crystalloids, 5% albumin solution and freshly frozen donor plasma are used as a replacement solution in various proportions and combinations and nowadays, solvent-detergent-treated plasma is used increasingly. At least one total plasma volume (TPV) of the patient should be replaced in one procedure, with less than 70% of the TPV being replaced. It is important to remember to collect blood samples for ADAMTS13 and other tests, or preserve plasma samples, before starting TPE treatment, as interpretation of results from samples collected after TPE may be erroneous. The efficacy of TPE is determined by two mechanisms: 1) removal of the disease mediator or plasma components contributing to the pathogenesis of the condition; 2) delivery of the missing or dysfunctional plasma component when plasma is used as a replacement solution. The efficacy of TPE varies between the various forms of thrombotic microangiopathies, ranging from a clear and prompt effect in TTP to no effect at all in some forms of atypical haemolytic uraemic syndrome.
BACKGROUND AND OBJECTIVES: Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). RESEARCH DESIGN AND METHODS: A total of 5,822 participants (Mage = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. RESULTS: In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. DISCUSSION AND IMPLICATIONS: Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep.
- MeSH
- Cognition MeSH
- Cognitive Dysfunction * psychology MeSH
- Cognitive Aging * MeSH
- Humans MeSH
- Neuropsychological Tests MeSH
- Sleep Initiation and Maintenance Disorders * epidemiology MeSH
- Aged MeSH
- Sleep Apnea Syndromes * MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Research Support, N.I.H., Extramural MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
BACKGROUND: Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers. METHODS: We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists. RESULTS: Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation. CONCLUSIONS: Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP.
- MeSH
- Child MeSH
- Emotions MeSH
- Humans MeSH
- Adolescent MeSH
- Problem Behavior * psychology MeSH
- Parents psychology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Publication type
- Journal Article MeSH
This article reviews available data regarding the possible association of organophosphorus (OP) pesticides with neurological disorders such as dementia, attention deficit hyperactivity disorder, neurodevelopment, autism, cognitive development, Parkinson's disease and chronic organophosphate-induced neuropsychiatric disorder. These effects mainly develop after repeated (chronic) human exposure to low doses of OP. In addition, three well defined neurotoxic effects in humans caused by single doses of OP compounds are discussed. Those effects are the cholinergic syndrome, the intermediate syndrome and organophosphate-induced delayed polyneuropathy. Usually, the poisoning can be avoided by an improved administrative control, limited access to OP pesticides, efficient measures of personal protection and education of OP pesticide applicators and medical staff.
- MeSH
- Attention Deficit Disorder with Hyperactivity * MeSH
- Humans MeSH
- Neurotoxicity Syndromes * etiology psychology MeSH
- Organophosphates toxicity MeSH
- Organophosphorus Compounds toxicity MeSH
- Pesticides * toxicity MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Multiple system atrophy (MSA) is generally a sporadic neurodegenerative disease which ranks among atypical Parkinson's syndromes. The main clinical manifestation is a combination of autonomic dysfunction and parkinsonism and/or cerebellar disability. The disease may resemble other Parkinsonian syndromes, such as Parkinson's disease (PD) or progressive supranuclear palsy (PSP), from which MSA could be hardly distinguishable during the first years of progression. Due to the lack of a reliable and easily accessible biomarker, the diagnosis is still based primarily on the clinical picture. Recently, reduced levels of coenzyme Q10 (CoQ10) were described in MSA in various tissues, including the central nervous system. The aim of our study was to verify whether the level of CoQ10 in plasma and lymphocytes could serve as an easily available diagnostic biomarker of MSA. The study reported significantly lower levels of CoQ10 in the lymphocytes of patients with MSA compared to patients with PD and controls. The reduction in CoQ10 levels in lymphocytes correlated with the increasing degree of clinical involvement of patients with MSA. CoQ10 levels in lymphocytes seem to be a potential biomarker of disease progression.
- Publication type
- Journal Article MeSH
Aim: The aim of the study was to analyze healthcare workers' perceptions of the Slovak health system. Design: We conducted a mixed-design cross-sectional study that combined qualitative and quantitative analyses. Methods: We collected 269 associations with the cue word "health system" from 91 health workers (30 medical doctors, 30 nurses, and 31 paramedics) to access social representations of the studied phenomenon. After establishing the final list of categories, we calculated frequencies and proportions, and also conducted a network analysis of associations. Results: We identified 13 main categories, of which 53.5% had a neutral emotional charge, 38% carried a negative charge, and only 4% indicated a positive charge. The most saturated category was the Meaning of work (20.8%), followed by Negative general perceptions (14.9%), which was also the most central category. The strongest point of connection between neutral and negative categories in network analysis was between Negative general perception and the Meaning of work. Conclusion: Our study revealed that negatively valenced associations about the system were numerous and dominant. Despite this fact, health workers still perceived their job to be meaningful, which is one of the possible explanations for their staying in a system perceived to be dysfunctional.
Fenomén recirkulace je dialyzační komunitě dobře znám a má pro ni především negativní konotace, spojené s dysfunkcí cévního přístupu a v jejím důsledku se sníženou kvalitou hemodialýzy. Fyzikální vazby a odlišné souvislosti obou typů recirkulace – recirkulace v cévním přístupu a recirkulace kardiopulmonální – s provozními parametry dialýzy a fyziologií kardiovaskulárního aparátu jsou známé daleko méně. Článek se snaží tuto mezeru zaplnit. Kromě kvantifikace negativních dopadů recirkulace probírá i možnosti klinicky zajímavého využití recirkulace k posouzení stavu cévního přístupu (prostřednictvím průtoku krve cévním přístupem) a stavu kardiovaskulárního aparátu (prostřednictvím minutového srdečního výdeje a jeho změn během dialýzy).
The recirculation phenomenon is well known in dialysis community namely because its negative connotation as a sign of vascular access dysfunction and – as a consequence – lowered dialysis efficiency. Yet its physical bonds and differing conjunctions of both recirculation types – vascular access recirculation and cardiopulmonary recirculation – with dialysis operation parameters and physiology of patient ́s cardiovascular system alike are known much less. The article aims to fill in this gap. Besides quantification of negative impacts of recirculation, it discusses also possibilities of its clinically interesting utilization to assess functional condition of the access (by means of vascular access blood flow) and status of patient ́s cardiovascular system (by means of cardiac output and its interdialytic changes).
- Keywords
- recirkulace, průtok krve cévním přístupem,
- MeSH
- Vascular Access Devices MeSH
- Renal Dialysis * methods instrumentation MeSH
- Humans MeSH
- Regional Blood Flow MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND AND AIMS: Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. METHOD: Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. RESULTS: A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. DISCUSSION AND CONCLUSIONS: This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.
Telemedicína predstavuje nový spôsob poskytovania starostlivosti „na diaľku“. Obdobie krízy v zdravotníctve ktorú priniesla pandémia, ako aj celkový nárast pacientov s ochoreniami pečene, viedli k hľadaniu nových možností pre udržanie a prípadné zlepšenie poskytovaných služieb. Manažovanie zdravotnej starostlivosti „na diaľku“ prostredníctvom konzultácií, vizít, a monitoringu popri štandardnej liečbe odhalilo potenciálny priestor pre zvýšenie kvality starostlivosti. Využitie telemedicíny v mnohých oblastiach hepatológie, a to aj napriek viacerým prekážkam, odhalilo sľubný dopad na dostupnosť, kvalitu a efektivitu liečby pacientov s chorobami pečene. Na dole uvedenej kazuistike dokumentujeme kľúčovú úlohu telemedicíny v procese zvažovania pacienta na transplantáciu pečene a naše skúsenosti s telemedicínou v bežnej klinickej praxi.
Telemedicine refers to the remote provision of health care. Times of crisis like a pandemic and the increasing global burden of liver diseases call for finding innovative healthcare solutions to maintain and improve the standards of care. Provision of health care from a distance based on remote consultations, visits, and monitoring, in addition to standard care, uncovers the potential to improve the quality of care. Despite its challenges, the utilization of telemedicine in many areas of hepatology has been showing promising effects on access, healthcare quality, and cost-effectiveness. We report a case demonstrating the relevant position of telemedicine in the liver transplant decision-making process and our experiences with telehealth in routine clinical praxis.
- MeSH
- Liver Cirrhosis MeSH
- Quality of Health Care MeSH
- Humans MeSH
- Liver Diseases * MeSH
- Telemedicine * MeSH
- Liver Transplantation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
