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1.
Sci Total Environ ; 916: 170288, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38266736

RESUMO

Pesticides use raises concerns regarding environmental sustainability, as pesticides are closely linked to the decline of biodiversity and adverse human health outcomes. This study proposed a holistic approach for assessing the potential risks posed by pesticides for human health and the environment in the eastern region of Michoacan, where extensive agricultural lands, especially corn and avocado fields, surround the Monarch Butterfly Biosphere Reserve. We used a combination of qualitative (semi-structured interviews) and quantitative (chemical analysis) data. Fifty-five interviews with smallholder farmers allowed us to identify pesticide types, quantities, frequencies, and application methods. A robust and precise analytical method based on solid-phase extraction and LC-MS/MS was developed and validated to quantify 21 different pesticides in 16 water samples (rivers, wells, runoff areas). We assessed environmental and human health risks based on the pesticides detected in the water samples and reported in the interviews. The interviews revealed the use of 28 active ingredients, including glyphosate (29 % of respondents), imidacloprid (27 %), and benomyl (24 %). The pesticide analysis showed the presence of 13 different pesticides and degradation products in the water samples. The highest concentrations were found for imidacloprid (1195 ngL-1) and carbendazim (a degradation product of benomyl; 932 ngL-1), along with the metabolite of pyrethroid insecticides, 3-PBA (494 ngL-1). The risk assessment indicates that among the most used pesticides, the fungicide benomyl and carbendazim pose the highest risk to human health and aquatic ecosystems, respectively. This study unveils novel insights on agricultural practices for the avocado, a globally consumed crop that is undergoing rapid production expansion. It calls for the harmonisation of crop protection with environmental responsibility, safeguarding the health of the people involved and the surrounding ecosystems.


Assuntos
Benzimidazóis , Carbamatos , Neonicotinoides , Nitrocompostos , Persea , Praguicidas , Poluentes Químicos da Água , Humanos , Praguicidas/análise , Água/análise , Ecossistema , Benomilo/análise , México , Cromatografia Líquida , Espectrometria de Massas em Tandem , Rios , Medição de Risco , Inquéritos e Questionários , Monitoramento Ambiental/métodos , Poluentes Químicos da Água/análise
2.
Neurologia (Engl Ed) ; 2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35882307

RESUMO

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is characterised by recurrent attacks of optic neuritis and transverse myelitis. The purpose of this work was to identify the incidence and prevalence of NMOSD and its clinical characteristics in the population treated for demyelinating diseases in Western Mexico. MATERIAL AND METHOD: A descriptive, retrospective study was carried out in the Department of Neurology, at the Sub-specialty Medical Unit, Specialties Hospital (known by its Spanish abbreviation UMAE-HE), of the National Western Medical Center (CMNO), Mexican Institute of Social Security (IMSS). A review of the electronic files for all patients with a diagnosis of NMOSD in 2019, was carried out in the State of Jalisco, Mexico. RESULTS: Fifty-eight patients with NMOSD were included in the study. The incidence was 0.71/100 000 (CI 0.60-0.85) and the prevalence was 1.09/100 000 (CI 0.84-1.42). There were 79.3% women, and 20.6% were men (P = .01). All (100%) patients presented with anti-aquaporin-4 immunoglobulin G, and 89.6% showed seropositivity for anti-aquaporin-4 (CI 82.6-94.9). Magnetic resonance imaging was performed on 100% of patients, where 34.4% were normal, and 65.5% (38) abnormal, presenting with non-specific subcortical lesions (P = 0.04). The initial clinical presentation was optic neuritis (ON) in 58.6%; where 31.0% was bilateral ON, 20.7% was left ON, and 6.9% were right ON; transverse myelitis in 26.0%, area postrema syndrome (APS) in 10.3%, among others. CONCLUSIONS: The incidence of NMOSD exceeds 0.71/100 000, the prevalence is low at 1.09/100 000, and NMOSD is predominantly found in women.

3.
Psychol Trauma ; 13(5): 545-554, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33507792

RESUMO

OBJECTIVE: Postpartum posttraumatic stress disorder (PP-PTSD) affects 3.1-6.3% of women after childbirth. The City Birth Trauma Scale (City-BiTS) is a questionnaire designed to evaluate and diagnose this disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, including the following groups of symptoms characteristic of posttraumatic stress: reexperiencing, avoidance, negative cognitions and mood, and hyperarousal. The aim of the present study was to evaluate the psychometric properties of the Spanish-language version of this questionnaire (City-BiTS-S), based on a community sample of Spanish women. METHOD: A total of 207 mothers, recruited at three health centers in southern Spain, completed the City-BiTS-S questionnaire and provided sociodemographic and obstetric data. RESULTS: Exploratory factor analysis of the data replicated the two-factor structure reported in previous studies that explained 47.9% of the variance: Factor 1 of general symptoms and Factor 2 of birth-related symptoms. Both City-BiTS-S (Cronbach's alpha = .90) and the two factors (Cronbach's alpha for Factor 1 = 0.89; Cronbach's alpha for Factor 2 = 0.82) presented high internal consistency. Rasch analysis confirmed the unidimensionality of the two factors as valid subscales of the PP-PTSD. Results suggested reducing response options, reviewing Item 8, and rewording Item 3 in the Spanish version. CONCLUSIONS: The City-BiTS-S presents appropriate psychometric properties to measure symptoms of PP-PTSD. Nevertheless, further research is recommended to confirm its validity in a clinical population and in different medical approaches to the birth process. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtornos de Estresse Pós-Traumáticos , Análise Fatorial , Feminino , Humanos , Parto , Gravidez , Psicometria , Reprodutibilidade dos Testes , Espanha , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários
4.
Med Intensiva (Engl Ed) ; 44(6): 371-388, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32360034

RESUMO

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pneumonia Viral/terapia , Sociedades Médicas , Adulto , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/métodos , Estado Terminal/epidemiologia , Estado Terminal/terapia , Atenção à Saúde/métodos , Atenção à Saúde/normas , Gerenciamento Clínico , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Espanha/epidemiologia
5.
Contemp Clin Trials Commun ; 16: 100490, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31872157

RESUMO

Persons with severe persistent mental illness (SPMI)-which includes individuals with schizophrenia, bipolar disorder, and mood disorders such as major depression-are at high risk for poor health outcomes and premature death. Persons with SPMI are largely absent from research evaluating innovative health care models due to recruitment and retention barriers. This paper presents the protocol for a randomized control trial testing a reverse colocated integrated care model in an SPMI population receiving care at a mental health clinic at the U.S.-Mexico border. The study employs a randomized control trial design to determine whether reverse colocated integrated care improves physical and mental health of persons with SPMI. Participants will be randomized to receive the integrated primary care intervention or usual care (behavioral health only). All study participants will complete baseline, 6-, and 12-month assessments. Study outcomes included blood pressure, HbA1c, cholesterol, body mass index, depression, and adult functioning. Despite challenges in recruiting and retaining SPMI patients, co-locating primary care services within a local mental health authority has the potential to improve health and reduce health disparities experienced by persons with SPMI. The study will determine the impacts of this colocated integrated care model among SPMI patients in a socio-economically disadvantaged region. Clinical Trials.gov Identifier: NCT03881657.

6.
Monogr Soc Res Child Dev ; 84(3): 7-185, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31503346

RESUMO

In this monograph, we argue for the establishment of a developmental science of politics that describes, explains, and predicts the formation and change of individuals' political knowledge, attitudes, and behavior beginning in childhood and continuing across the life course. Reflecting our goal of contributing both theoretical conceptualizations and empirical data, we have organized the monograph into two broad sections. In the first section, we outline theoretical contributions that the study of politics may make to developmental science and provide practical reasons that empirical research in the domain of politics is important (e.g., for identifying ways to improve civics education and for encouraging higher voting rates among young adults). We also review major historical approaches to the study of political development and provide an integrative theoretical framework to ground future work. Drawing on Bronfenbrenner's ecological systems model as an organizing scheme and emphasizing social justice issues, we describe how factors rooted in cultural contexts, families, and children themselves are likely to shape political development. In the second section of the monograph, we argue for the importance and utility of studying major political events, such as presidential elections, and introduce the major themes, rationales, and hypotheses for a study of U.S. children's views of the 2016 U.S. presidential election. In addition, we apply a social-justice lens to political thought and participation, addressing the role of gender/sex and race/ethnicity in children's political development broadly, and in their knowledge and views of the 2016 U.S. presidential election specifically. In interviews conducted within the month before and after the election, we examined two overarching categories of children's political attitudes: (a) knowledge, preferences, and expectations about the 2016 election, and (b) knowledge and attitudes concerning gender/sex and politics, particularly relevant for the 2016 election given Hillary Clinton's role as the first female major-party candidate for the presidency. Participants were 187 children (101 girls) between 5 and 11 years of age (M = 8.42 years, SD = 1.45 years). They were recruited from schools and youth organizations in five counties in four U.S. states (Kansas, Kentucky, Texas, and Washington) with varying voting patterns (e.g., Trump voters ranged from 27% to 71% of county voters). The sample was not a nationally representative one, but was racially diverse (35 African American, 50 Latinx, 81 White, and 21 multiracial, Asian American, Middle Eastern, or Native American children). In addition to several child characteristics (e.g., age, social dominance orientation [SDO]), we assessed several family and community characteristics (e.g., child-reported parental interest in the election and government-reported county-level voting patterns, respectively) hypothesized to predict outcome variables. Although our findings are shaped by the nature of our sample (e.g., our participants were less likely to support Trump than children in larger, nationwide samples were), they offer preliminary insights into children's political development. Overall, children in our sample were interested in and knowledgeable about the presidential election (e.g., a large majority identified the candidates correctly and reported some knowledge about their personal qualities or policy positions). They reported more information about Donald Trump's than Hillary Clinton's policies, largely accounted for by the substantial percentage of children (41%) who referred to Trump's immigration policies (e.g., building a wall between the United States and Mexico). Overall, children reported as many negative as positive personal qualities of the candidates, with negative qualities being reported more often for Trump than for Clinton (56% and 18% of children, respectively). Most children (88%) supported Clinton over Trump, a preference that did not vary by participants' gender/sex or race/ethnicity. In their responses to an open-ended inquiry about their reactions to Trump's win, 63% of children reported negative and 18% reported positive emotions. Latinx children reacted more negatively to the election outcome than did White children. Girls' and boys' emotional responses to the election outcome did not differ. Children's personal interest in serving as U.S. president did not vary across gender/sex or racial/ethnic groups (overall, 42% were interested). Clinton's loss of the election did not appear to depress (or pique) girls' interest in becoming U.S. president. With respect to the role of gender/sex in politics, many children (35%) were ignorant about women's absence from the U.S. presidency. Only a single child was able to name a historical individual who worked for women's civil rights or suffrage. Child characteristics predicted some outcome variables. For example, as expected, older children showed greater knowledge about the candidates than did younger children. Family and community characteristics also predicted some outcome variables. For example, as expected, participants were more likely to support Trump if they perceived that their parents supported him and if Trump received a greater percentage of votes in the children's county of residence. Our data suggest that civic education should be expanded and reformed. In addition to addressing societal problems requiring political solutions, civics lessons should include the histories of social groups' political participation, including information about gender discrimination and the women's suffrage movement in U.S. political history. Providing children with environments that are rich in information related to the purpose and value of politics, and with opportunities and encouragement for political thought and action, is potentially beneficial for youth and their nations.


Assuntos
Desenvolvimento Infantil , Política , Adolescente , Criança , Pré-Escolar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Modelos Teóricos , Pesquisa Qualitativa , Comportamento Social , Estados Unidos
7.
Health Policy ; 122(4): 444-451, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29548514

RESUMO

Roma health inequities are a wicked problem. Despite concerted efforts to reduce them under the Decade of Roma Inclusion initiative, the health gap between Roma and non-Roma populations in Europe persists. To address this problem, the European Commission devised the National Roma Integration Strategies (NRIS). This paper provides a critical assessment of the implementation of the NRIS' health strand (NRIS-H) in Spain and proposes an evaluation tool to monitor Roma health policies - the Roma Health Integration Policy Index (RHIPEX). It also makes recommendations to promote Roma health governance. To achieve these goals, four community forums, 33 stakeholder interviews and a scoping review were conducted. Results show that the NRIS-H implementation is hindered by lack of political commitment and poor resource allocation. This has a negative impact on Roma's entitlement to healthcare and on their participation in decision-making processes, jeopardising the elimination of the barriers that undermine their access to healthcare and potentially contributing to reproduce inequalities. These unintended effects point out the need to rethink Roma health governance by strengthening intersectional and intersectoral policies, enabling transformative Roma participation in policymaking and guaranteeing shared socio-political responsibility and accountability.


Assuntos
Política de Saúde , Disparidades nos Níveis de Saúde , Formulação de Políticas , Roma (Grupo Étnico)/etnologia , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Política , Alocação de Recursos/economia , Espanha/etnologia
8.
Radiat Prot Dosimetry ; 170(1-4): 49-53, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26503854

RESUMO

Internal dosimetry intercomparisons are essential for the verification of applied models and the consistency of results'. To that aim, the First Regional Intercomparison was organised in 2005, and that results led to the Second Regional Intercomparison Exercise in 2013, which was organised in the frame of the RLA 9/066 and coordinated by Autoridad Regulatoria Nuclear of Argentina. Four simulated cases covering intakes of (131)I, (137)Cs and Tritium were proposed. Ninteen centres from thirteen different countries participated in this exercise. This paper analyses the participants' results in this second exercise in order to test their skills and acquired knowledge, particularly in the application of the IDEAS Guidelines. It is important to highlight the increased number of countries that participated in this exercise compared with the first one and, furthermore, the improvement in the overall performance. The impact of the International Atomic Energy Agency (IAEA) Projects since 2003 has led to a significant enhancement of internal dosimetry capabilities that strengthen the radiation protection of workers.


Assuntos
Doses de Radiação , Monitoramento de Radiação/métodos , Proteção Radiológica/métodos , Poluentes Radioativos do Ar , Carga Corporal (Radioterapia) , Radioisótopos de Césio/análise , Guias como Assunto , Humanos , Agências Internacionais , Cooperação Internacional , Radioisótopos do Iodo/análise , América Latina , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Monitoramento de Radiação/normas , Proteção Radiológica/normas , Radioisótopos , Reprodutibilidade dos Testes , Medição de Risco/normas , Sensibilidade e Especificidade , Software , Trítio
9.
Actas Urol Esp ; 39(7): 414-9, 2015 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25745791

RESUMO

OBJECTIVES: To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. MATERIAL AND METHODS: Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. RESULTS: A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure. CONCLUSIONS: Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure.


Assuntos
Anestesia Local , Medição da Dor , Dor/etiologia , Próstata/patologia , Neoplasias da Próstata/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Reto , Estudos Retrospectivos , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Urológicos/efeitos adversos
10.
Arch Soc Esp Oftalmol ; 89(12): 477-83, 2014 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25176313

RESUMO

OBJECTIVE: To analyse satisfaction and patient preferences on the location where they receive an intravitreal injection. METHOD: A survey was conducted with the intention of analysing these patients who attended the macula clinic and have been intervened using an intravitreal injection at least once in the day hospital or in the theatre setting, comparing both locations. RESULTS: The majority of the interviewed patients preferred the day hospital (50.0 versus 37.5%), mostly because of the comfort and the quick service. In patients with severe age-related macular degeneration (AMD) the option is reversed. The overall satisfaction level was positive in both cases (with 87.5% of patients satisfied or very satisfied in the day hospital and 91.1% in the theatre setting). Through the analysis of different aspects of clinical care the assessment was the same or superior for 75.0% of these patients, except in the waiting time. There were no cases of endophthalmitis. CONCLUSION: In general, patients prefer the clinical intervention in the consulting room than in the theatre setting because of the quicker service. There are several characteristics that can influence this choice and should be taken into account.


Assuntos
Injeções Intravítreas , Salas Cirúrgicas , Satisfação do Paciente , Consultórios Médicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Pesquisas sobre Atenção à Saúde , Hospitais Universitários/economia , Humanos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/psicologia , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/economia , Ambulatório Hospitalar/economia , Preferência do Paciente , Segurança do Paciente , Consultórios Médicos/economia , Espanha , Fatores de Tempo , Adulto Jovem
11.
West Indian Med J ; 63(7): 752-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25867561

RESUMO

OBJECTIVE: To identify the sociodemographic, socio-economic, clinical and behavioural factors that modify the experience of decayed, missing and filled teeth (DMFT) and caries prevalence in Nicaraguan children 9-12 years old. SUBJECTS AND METHODS: We conducted a cross-sectional study in 800 school children 9-12 years old in the city of León, Nicaragua. The clinical oral examinations to identify caries experience were undertaken by two trained and certified examiners. Sociodemographic, socio-economic and behavioural data were collected using questionnaires. Negative binomial regression (NBR) and binary logistic regression (BLR) models were used to model caries experience and caries prevalence, respectively. RESULTS: Mean DMFT index was 0.98 ± 1.74 and caries prevalence (DMFT > 0) was 37.9%. In the NBR model, the categories that increase the expected DMFT mean were: older age, female gender, presence of plaque, and if the school children received curative and curative/preventive dental care in the last year. In the BLR model, the odds of presenting with caries in the permanent dentition were increased in older children, those from large families, mothers with a positive dental attitude, and those school children who received curative and curative/preventive dental care in the last year. CONCLUSIONS: Using different models, we identified several sociodemographic, socio-economic, clinical and behavioural factors that modify the experience (NBR) and prevalence (BLR) of dental caries.

13.
J Food Sci ; 77(4): C346-52, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22352766

RESUMO

Three dietary fibers (tomato fiber [TF], beet root fiber [BRF], and inulin) at 3 levels of addition (1%, 2%, and 3%) were assessed for the manufacture of chopped, cooked chicken products and compared with a control product without fiber added. The effect of fiber incorporation on (i) batters, (ii) cooked (30 min at 70 °C), and (iii) cooked and stored (for 10 d at 4 °C) chicken products were studied. The addition of the fiber to chicken meat products reduced the pH of chicken batters in proportional to the level of fiber addition. Fiber incorporation increased water-holding capacity but only the addition of TF reduced cook losses. The color of batters and cooked products was significantly modified by the type and level of fiber added. These changes were more noticeable when TF was added. Texture parameters were affected by the incorporation of TF and BRF; they increased the hardness in proportional to the level of addition. The addition of tomato and BRF to chicken meat products reduced lipid oxidation processes. These changes were dependent on the level of fiber added. The reduction of lipid oxidation processes was more marked in TF meat products than in products with other types of fibers. In contrast, the addition level of inulin increased TBA-RS numbers in chicken meat products. Although the addition of TF increased the redness of the meat products, the use of this fiber was more suitable as it reduced the extent of lipid oxidation processes. INDUSTRIAL APPLICATION: Nowadays, the reduction of fat and the increase of fiber content in meat products is one of the main goals of meat industry. Numerous sources of fiber can be added to the meat products; however, before that it is necessary to study their technological effect on raw and cooked meat products in order to evaluate their suitability for meat products manufacture. In addition, some of them could have beneficial effect on meat products conservation that could also increase their shelf life.


Assuntos
Beta vulgaris/química , Fibras na Dieta/análise , Alimentos Fortificados/análise , Inulina/química , Raízes de Plantas/química , Produtos Avícolas/análise , Solanum lycopersicum/química , Animais , Antioxidantes/análise , Antioxidantes/química , Fenômenos Químicos , Galinhas , Culinária , Dieta com Restrição de Gorduras , Fibras na Dieta/efeitos adversos , Fast Foods/análise , Frutas/química , Concentração de Íons de Hidrogênio , Inulina/efeitos adversos , Fenômenos Mecânicos , Oxirredução , Pigmentação , Refrigeração , Substâncias Reativas com Ácido Tiobarbitúrico/análise , Água/análise
14.
J Viral Hepat ; 18(10): 685-91, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21914085

RESUMO

The hepatic venous pressure gradient (HVPG) is the gold standard for assessing portal pressure and correlates with the occurrence of portal hypertension (PH)-related complications. Transient elastography (TE) is a new, highly accurate noninvasive technique, which enables us to evaluate hepatic fibrosis to detect advanced fibrosis and cirrhosis. We performed a hepatic haemodynamic study and TE in 38 HIV/HCV-coinfected patients. The association between HVPG and liver stiffness was assessed by linear regression. The diagnostic value of TE was assessed by receiver operating characteristic (ROC) curves. We considered clinically significant PH as an HVPG ≥ 10 mmHg and severe PH as an HVPG ≥ 12 mmHg. A total of 38 HIV/HCV-coinfected patients were included. Twenty-eight patients (73.7%) had clinically significant PH (HVPG ≥ 10 mmHg), and 23 (60.5%) of these had severe PH (HVPG ≥ 12 mmHg). We found a statistically significant association between liver stiffness (kPa) and HVPG (r(2) = 0.46, P < 0.001, straight line equation HVPG=7.4 + 0.204*TE). The areas under the ROC curves were 0.80 [95% confidence interval (CI), 0.64-0.97] and 0.80 (95% CI, 0.66-0.94) for the prediction of HVPG ≥ 10 and ≥ 12 mmHg, respectively. Our data suggest that TE can predict the presence of clinically significant and severe PH in HIV/HCV-coinfected patients.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Infecções por HIV/complicações , Hepatite C/complicações , Hipertensão Portal/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC
15.
J Viral Hepat ; 17(4): 280-6, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19732322

RESUMO

Transient elastography (FibroScan) is a novel, rapid and noninvasive technique to assess liver fibrosis. Our objective was to compare transient elastography (TE) and other noninvasive serum indexes as alternatives to liver biopsy in HIV/hepatitis C virus (HCV)-coinfected patients. The fibrosis stage (METAVIR Score), TE, the aspartate aminotransferase-to-platelet ratio index, the Forns fibrosis index, FIB-4 and HGM-2 indexes were assessed in 100 patients between January 2007 and January 2008. The diagnostic values were compared by calculating the area under the receiver operating characteristic curves (AUROCs). Using TE, the AUROC (95% CI) of liver stiffness was 0.80 (0.72-0.89) when discriminating between F 2, 0.93 (0.85-1.00) when discriminating between F 3 and 0.99 (0.97-1.00) when discriminating between F or= 3, the AUROCs of TE were significantly higher than those obtained with the other four noninvasive indexes. Based on receiver operating characteristic curves, three cutoff values were chosen to identify F or= 3 (>or=11 kPa) and F4 (>or=14 kPa). Using these best cutoff scores, the negative predictive value and positive predictive value were 81.1% and 70.2% for the diagnosis of F or= 3 and 100% and 57.1% for the diagnosis of F4. Thus, Transient elastography accurately predicted liver fibrosis and outperformed other simple noninvasive indexes in HIV/HCV-coinfected patients. Our data suggest that TE is a helpful tool for guiding therapeutic decisions in clinical practice.


Assuntos
Biópsia , Técnicas de Imagem por Elasticidade , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Cirrose Hepática/diagnóstico , Adulto , Biomarcadores , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estatística como Assunto
16.
J Endocrinol Invest ; 30(7): 541-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17848835

RESUMO

BACKGROUND: At the time of diagnosis, macroadenomas represent 60-80% of GH secreting adenomas, of which 25-30% are invasive macroadenomas. These aggressive tumors have the worst surgical success rates in terms of cure, and often need several therapeutic approaches in order to control disease status. Acromegalic patients are subject to increased mortality and important health resource consumption related to their associated co-morbidities, in addition to the costs that are related to diagnosis itself and initial treatment of the disease. OBJECTIVE: Assessment of the cost of initial management and outcome of acromegalic patients with invasive pituitary adenomas. STUDY DESIGN: Retrospective and observational study of review of records. SETTING: Two tertiary hospitals. PATIENTS: 11 consecutive patients between 18 and 80 yr old diagnosed with acromegaly due to an invasive pituitary macroadenoma. INTERVENTION: Collection of data of biochemical and radiological tests, specialist visits, hospitalisation, surgery, pharmacological and radiotherapy treatment at diagnosis and over 4 yr of follow-up after initial treatment. Costs were evaluated using the data of the Centre for Health Economics and Social Policy Studies and the Official College of Pharmacists of Spain. MAIN OUTCOME MEASURE: Global and patient/yr follow-up costs of illness. RESULTS: The mean costs for acromegaly for the period of follow-up ranged from 7,072 to 9,874 euro/patient/yr, for biochemically non-controlled (no.=6) and controlled patients (no.=5) respectively. The most important cost in the perioperative period was for admission in the intensive care unit. After surgery, SS analogues were the principal contributors to the economic burden. CONCLUSION: In this paper we have for the first time presented a pharmacoeconomic study of GH secreting invasive macroadenoma. The poor prognosis of our cohort of patients and the higher rate of controlled patients and normal IGF-I levels warrant the employment of multiple therapeutic options. The cost associated with this treatment in this complex disease of low prevalence is not excessive and can be supported by healthcare services.


Assuntos
Adenoma/economia , Adenoma/patologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/economia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Acromegalia/economia , Acromegalia/etiologia , Acromegalia/terapia , Adenoma/complicações , Adenoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/economia , Terapia Combinada/economia , Custos e Análise de Custo , Feminino , Seguimentos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Hormônio do Crescimento Humano/sangue , Humanos , Fator de Crescimento Insulin-Like I/análise , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos
17.
Bone Marrow Transplant ; 34(12): 1077-81, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15516942

RESUMO

This prospective and randomized study was conducted to evaluate clinical and economic consequences of using granulocyte colony-stimulating factor (G-CSF) following autologous peripheral blood progenitor cell (PBPC) transplantation in children. Between January 1999 and December 2003, 117 patients underwent autologous PBPCT: 51 patients received G-CSF following PBPCT, while 66 patients did not receive G-CSF. Median time to absolute neutrophil count > 0.5 x 10(9)/l was 10 days in the treatment group and 11 days in the control group (P < 0.009). The median time to platelets >20 x 10(9)/l was 12 days in both groups (P = NS). The median time to platelets >50 x 10(9)/l was 15 days in the G-CSF group and 14 days in the control group (P<0.005). In patients who received <5 x 10(6)/kg CD34+ cells, the median time to platelets >20 x 10(9)/l and >50 x 10(9)/l was similar with or without G-CSF (12 and 15 days, respectively). Platelet transfusion requirements were lower in the control group (2 vs 3 U in G-CSF group). There was a trend towards higher total costs with G-CSF: 8146.82 Euros and 7873.34 Euros with and without G-CSF, respectively (P = 0.1). Our data suggest that there is no indication of the standard application of G-CSF in children following PBPC transplantation. The only possible indication is the group of patients with a lower yield of CD34+ cells.


Assuntos
Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Transplante de Células-Tronco de Sangue Periférico/métodos , Adolescente , Antígenos CD34/análise , Criança , Pré-Escolar , Feminino , Fator Estimulador de Colônias de Granulócitos/economia , Custos de Cuidados de Saúde , Hematopoese , Humanos , Lactente , Cinética , Masculino , Neoplasias/terapia , Transplante de Células-Tronco de Sangue Periférico/economia , Transplante Autólogo , Resultado do Tratamento
18.
Appl Neuropsychol ; 11(4): 188-95, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15673490

RESUMO

We analyzed the influence of education and of culture on the neuropsychological profile of an indigenous and a nonindigenous population. The sample included 27 individuals divided into four groups: (a) seven illiterate Maya indigenous participants, (b) six illiterate Pame indigenous participants, (c) seven nonindigenous participants with no education, and (d) seven Maya indigenous participants with 1 to 4 years of education . A brief neuropsychological test battery developed and standardized in Mexico was individually administered. Results demonstrated differential effects for both variables. Both groups of indigenous participants (Maya and Pame) obtained higher scores in visuospatial tasks, and the level of education had significant effects on working and verbal memory. Our data suggested that culture dictates what it is important for survival and that education could be considered as a type of subculture that facilitates the development of certain skills.


Assuntos
Cultura , Educação , Testes Neuropsicológicos , Adulto , Idoso , Cognição/fisiologia , Escolaridade , Feminino , Humanos , Indígenas Norte-Americanos , Idioma , Masculino , México , Pessoa de Meia-Idade
19.
Hereditas ; 138(1): 54-8, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12830985

RESUMO

Hordeum chilense is a potential source of useful genes for wheat breeding. The use of this wild species to increase genetic variation in wheat will be greatly facilitated by marker-assisted introgression. In recent years, the search for the most suitable DNA marker system for tagging H. chilense genomic regions in a wheat background has lead to the development of RAPD and SCAR markers for this species. RAPDs represent an easy way of quickly generating suitable introgression markers, but their use is limited in heterogeneous wheat genetic backgrounds. SCARs are more specific assays, suitable for automatation or multiplexing. Direct sequencing of RAPD products is a cost-effective approach that reduces labour and costs for SCAR development. The use of SSR and STS primers originally developed for wheat and barley are additional sources of genetic markers. Practical applications of the different marker approaches for obtaining derived introgression products are described.


Assuntos
Marcadores Genéticos/genética , Hordeum/genética , Sequências Repetitivas de Ácido Nucleico , Triticum/genética , DNA de Plantas/genética , Grão Comestível/genética , Repetições Minissatélites , Reação em Cadeia da Polimerase , Polimorfismo Genético , Técnica de Amplificação ao Acaso de DNA Polimórfico , Sitios de Sequências Rotuladas
20.
J Clin Microbiol ; 41(6): 2378-84, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12791852

RESUMO

The capsule is a major virulence factor of pneumococci, and it was shown that some capsular variants are associated with antimicrobial resistance and certain types of disease. Moreover, pneumococcal capsular typing has received renewed interest since the availability of conjugate vaccines, which include serotypes frequently associated with pediatric disease. Our aim was to develop a simple, reliable, and economical method for detecting epidemiologically important serotypes present in the proposed 11-valent conjugate vaccine. We designed primers based on the sequences available for the capsular types 1, 3, 4, 6B, 14, 18C, 19F, 19A, and 23F and combined them into seven multiplex PCRs. The method involves streamlined DNA template preparation and agarose gel electrophoresis to analyze the amplification products. A total of 446 pneumococci selected from among isolates colonizing the nasopharynx of children attending day care centers in Lisbon, Portugal, were typed both by conventional immunological techniques and by multiplex PCR. Capsular types identified by the PCR method invariably produced results concordant with the conventional serotyping technique. Even when the method presented does not fully type an isolate, the PCR data can guide the experimenter when using immunological serotyping. Multiplex PCR for the analysis of pneumococci provides an accurate, expeditious, and cost-effective way of reducing the number of strains that have to be serotyped by conventional immunological techniques.


Assuntos
Reação em Cadeia da Polimerase/métodos , Streptococcus pneumoniae/classificação , Cápsulas Bacterianas/genética , Pré-Escolar , Humanos , Nasofaringe/microbiologia , Infecções Pneumocócicas/microbiologia , Reação em Cadeia da Polimerase/economia , Sensibilidade e Especificidade , Sorotipagem , Streptococcus pneumoniae/genética , Fatores de Tempo
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