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1.
Can Fam Physician ; 67(7): e188-e196, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34261727

RESUMO

OBJECTIVE: To assess counseling practices for gestational weight gain (GWG) among primary care providers (PCPs) at 2 clinics to identify barriers and potential health interventions for patients from diverse cultural backgrounds. DESIGN: Qualitative interviews with data analyzed for emerging themes using a modified grounded theory method. SETTING: Interviews at the South East Toronto Family Health Team and Flemingdon Health Centre in Toronto, Ont, from September 2016 to February 2018. PARTICIPANTS: Family practice obstetric providers and pregnant patients. METHODS: Semistructured interviews and focus groups were audiorecorded and transcribed. Analysis used a constant comparative approach to identify themes. MAIN FINDINGS: Patients had a limited understanding of risks associated with excessive GWG and reported infrequent weight counseling by PCPs. Patients at the South East Toronto Family Health Team had high health literacy and were proactive in seeking health information but had difficulty navigating reliable resources. Patients at Flemingdon Health Centre had lower health literacy and more passive interactions with PCPs, relying on family advice and cultural practices to inform health behaviour. Barriers for this group included social isolation and limited funds. Both groups desired increased proactive health counseling and resources. Physicians were knowledgeable about excessive GWG and reported counseling their patients, although patient retention and limited time were barriers. CONCLUSION: Healthy lifestyle in pregnancy is an important but underemphasized topic in antenatal care owing to barriers faced by patients and physicians, with unique socioeconomic considerations. This gap provides an opportunity to increase education of patients and providers and to develop patient-centred weight management interventions. By contrasting patient groups, our study reflected the importance of addressing social determinants of health in comprehensive care.


Assuntos
Ganho de Peso na Gestação , Aconselhamento , Feminino , Humanos , Percepção , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa , Aumento de Peso
2.
Am J Cardiol ; 101(3): 353-8, 2008 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-18237599

RESUMO

Chronic obstructive pulmonary disease (COPD) is a frequently neglected co-morbidity in patients with heart failure (HF). The aim of this study was to evaluate the prognostic impact of COPD in patients hospitalized for HF. Consecutive patients (n=799) admitted for a first episode of HF in all healthcare establishments of the Somme department (France) during 2000 were prospectively enrolled. Baseline characteristics and long-term prognosis were compared according to COPD status. COPD was diagnosed in 156 patients (19.5%). Compared with the no-COPD group, patients with COPD were predominantly men, more often smokers, and had lower discharge prescription rates of beta blockers (6% vs 27%, p<0.001). Five-year survival rate in patients with COPD was significantly lower than that of the no-COPD group (31% vs 42%, p=0.03). Compared with the expected survival of the age- and gender-matched general population, the 5-year survival rate in patients with COPD was dramatically lower (31% vs 71%). On multivariable analysis, COPD was a strong predictor of poorer outcome (hazard ratio 1.53, 95% confidence interval 1.21 to 1.94, p<0.001). COPD was an independent predictor of mortality in patients with preserved left ventricular ejection fraction and in patients with reduced ejection fraction. In conclusion, patients with HF and associated COPD have a poor prognosis with an impressive excess mortality compared to HF patients without COPD and the general population. Beta-blocker prescription rates remain deceptively low in this category of patients with HF.


Assuntos
Insuficiência Cardíaca/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Análise Multivariada , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Volume Sistólico , Análise de Sobrevida
3.
Can Respir J ; 2016: 9848942, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27445575

RESUMO

Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no universally accepted guidelines regarding their precise performance and reporting. Objective. To investigate variability in SBT practice across centres. Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from the Weaning and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS). The incidence of use of clinical extubation criteria and changes in physiologic parameters during an SBT were assessed. Results. The majority (80% and 78%) of SBTs used 5 cmH2O of ventilator support, although there was variability. A significant range in oxygenation was observed. RASS scores were variable, with RASS 0 ranging from 29% to 86% and 22% of SBTs performed in sedated patients (RASS < -2). Clinical extubation criteria were heterogeneous among centres. On average, there was no change in physiological variables during SBTs. Conclusion. The present study highlights variation in SBT performance and documentation across and within sites. With their impact on the accuracy of outcome prediction, these results support efforts to further clarify and standardize optimal SBT technique.


Assuntos
Padrões de Prática Médica , Desmame do Respirador/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extubação , Canadá , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Estudos Prospectivos , Estados Unidos , Adulto Jovem
5.
J Pathol ; 207(3): 313-23, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16178054

RESUMO

Tubular aggregates are morphological abnormalities characterized by the accumulation of densely packed tubules in skeletal muscle fibres. To improve knowledge of tubular aggregates, the formation and role of which are still unclear, the present study reports the electron microscopic analysis and protein characterization of tubular aggregates in six patients with 'tubular aggregate myopathy'. Three of the six patients also presented with myasthenic features. A large panel of immunochemical markers located in the sarcoplasmic reticulum, T-tubules, mitochondria, and nucleus was used. Despite differences in clinical phenotype, the composition of tubular aggregates, which contained proteins normally segregated differently along the sarcoplasmic reticulum architecture, was similar in all patients. All of these proteins, calsequestrin, RyR, triadin, SERCAs, and sarcalumenin, are involved in calcium uptake, storage, and release. The dihydropyridine receptor, DHPR, specifically located in the T-tubule, was also present in tubular aggregates in all patients. COX-2 and COX-7 mitochondrial proteins were not found in tubular aggregates, despite being observed close to them in the muscle fibre. The nuclear membrane protein emerin was found in only one case. Electron microscopy revealed vesicular budding from nuclei, and the presence of SAR-1 GTPase protein in tubular aggregates shown by immunochemistry, in all patients, suggests that tubular aggregates could arise from endoplasmic reticulum exit sites. Taken together, these results cast new light on the composition and significance of tubular aggregates.


Assuntos
Músculo Esquelético/patologia , Miopatias Congênitas Estruturais/patologia , Adulto , Cálcio/metabolismo , ATPases Transportadoras de Cálcio/análise , Núcleo Celular/patologia , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Microscopia Eletrônica/métodos , Pessoa de Meia-Idade , Mitocôndrias Musculares/patologia , Proteínas Mitocondriais/análise , Fibras Musculares Esqueléticas/patologia , Proteínas Musculares/análise , Miopatias Congênitas Estruturais/fisiopatologia , Retículo Sarcoplasmático/patologia , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático
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