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Background: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. Methods: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. Results: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2-7.2]) and women (OR: 10.5 [95%CI: 3.1-34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9-5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2-3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3-30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3-25.1]) were more likely to report barriers. Conclusion: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints.
Assuntos
Infecções por HIV/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Migrantes , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Fatores de Risco , Espanha/epidemiologia , Migrantes/estatística & dados numéricos , Adulto JovemRESUMO
Fixed drug eruption is an erythematous eruption of one or more centimetric rounded or oval lesions well demarcated, recurrent at the same place and leaving a residual purple pigmentation. Diagnosis is clinical. Skin biopsy is not essential except in doubtful cases (eg bullous drug eruption can simulate Lyell Syndrome or mucosal reminiscent of erythema multiforme). The etiology is almost always drug-induced; rare cases of toxic or food issue were reported. Histopathology is immuno-allergic; recurrences correspond to re-exposure to allergen. There is no specific treatment except stopping the causing drug.
L'érythème pigmenté fixe est une éruption érythémateuse d'une ou plusieurs lésions arrondies ou ovalaires centimétriques bien délimitées, récidivant au même endroit et laissant une pigmentation violacée résiduelle. Le diagnostic est clinique. La biopsie cutanée n'est pas indispensable sauf dans les cas douteux (exemple : érythème pigmenté bulleux pouvant simuler un Syndrome de Lyell ou une atteinte des muqueuses faisant penser à un érythème polymorphe). L'étiologie est presque toujours d'origine médicamenteuse; des rares cas de cause alimentaire ou toxique ont été rapportés. L'histopathologie est donc immuno-allergique ; les récidives correspondent à la réexposition à l'allergène. Il n'existe pas de traitement spécifique hormis l'arrêt du médicament incriminé.
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Flap endonucleases (FENs) isolated from archaea are shown to recognize and cleave a structure formed when two overlapping oligonucleotides hybridize to a target DNA strand. The downstream oligonucleotide probe is cleaved, and the precise site of cleavage is dependent on the amount of overlap with the upstream oligonucleotide. We have demonstrated that use of thermostable archaeal FENs allows the reaction to be performed at temperatures that promote probe turnover without the need for temperature cycling. The resulting amplification of the cleavage signal enables the detection of specific DNA targets at sub-attomole levels within complex mixtures. Moreover, we provide evidence that this cleavage is sufficiently specific to enable discrimination of single-base differences and can differentiate homozygotes from heterozygotes in single-copy genes in genomic DNA.
Assuntos
DNA/metabolismo , Sondas de Oligonucleotídeos , Polimorfismo de Fragmento de Restrição , Archaeoglobus fulgidus/genética , Bacteriófago M13/genética , DNA/isolamento & purificação , Endonucleases/genética , Exodesoxirribonuclease V , Exodesoxirribonucleases/genética , Leucócitos/metabolismo , Modelos Biológicos , Mutagênese Insercional , Pyrococcus furiosus/genética , Espectrometria de FluorescênciaRESUMO
PURPOSE: We compared the targeting accuracy and reliability of two different electromagnetic navigation systems for manually guided punctures in a phantom. MATERIALS AND METHODS: CT data sets of a gelatin filled plexiglass phantom were acquired with 1, 3, and 5âmm slice thickness. After paired-point registration of the phantom, a total of 480 navigated stereotactic needle insertions were performed manually using electromagnetic guidance with two different navigation systems (Medtronic Stealth Station: AxiEM; Philips: PercuNav). A control CT was obtained to measure the target positioning error between the planned and actual needle trajectory. RESULTS: Using the Philips PercuNav, the accomplished Euclidean distances were 4.42â±â1.33âmm, 4.26â±â1.32âmm, and 4.46â±â1.56âmm at a slice thickness of 1, 3, and 5âmm, respectively. The mean lateral positional errors were 3.84â±â1.59âmm, 3.84â±â1.43âmm, and 3.81â±â1.71âmm, respectively. Using the Medtronic Stealth Station AxiEM, the Euclidean distances were 3.86â±â2.28âmm, 3.74â±â2.1âmm, and 4.81â±â2.07âmm at a slice thickness of 1, 3, and 5âmm, respectively. The mean lateral positional errors were 3.29â±â1.52âmm, 3.16â±â1.52âmm, and 3.93â±â1.68âmm, respectively. CONCLUSION: Both electromagnetic navigation devices showed excellent results regarding puncture accuracy in a phantom model. The Medtronic Stealth Station AxiEM provided more accurate results in comparison to the Philips PercuNav for CT with 3âmm slice thickness. One potential benefit of electromagnetic navigation devices is the absence of visual contact between the instrument and the sensor system. Due to possible interference with metal objects, incorrect position sensing may occur. In contrast to the phantom study, patient movement including respiration has to be compensated for in the clinical setting. KEY POINTS: â¢âCommercially available electromagnetic navigation systems have the potential to improve the therapeutic range for CT guided percutaneous procedures by comparing the needle placement accuracy on the basis of planning CT data sets with different slice thickness. Citation Format: â¢âPutzer D, Arco D, Schamberger B etâal. Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A Phantom Study. Fortschr Röntgenstr 2016; 188: 470â-â478.
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Biópsia por Agulha/instrumentação , Ablação por Cateter/instrumentação , Fenômenos Eletromagnéticos , Biópsia Guiada por Imagem/instrumentação , Imagens de Fantasmas , Técnicas Estereotáxicas/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Conjuntos de Dados como Assunto , Precisão da Medição Dimensional , Desenho de Equipamento , Sistemas de Informação em Radiologia/instrumentação , Reprodutibilidade dos Testes , SoftwareRESUMO
OBJECTIVE: We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. DESIGN AND METHODS: A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. RESULTS: Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. CONCLUSIONS: Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer.
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Estudos de Avaliação como Assunto , Ambulatório Hospitalar/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Escolaridade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/psicologia , Ocupações , Ambulatório Hospitalar/organização & administração , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estudos de Amostragem , Espanha , Inquéritos e QuestionáriosRESUMO
The increasing use of anti-TNF-alpha agents led to a better knowledge of their side effects. Among the cutaneous reactions, psoriasiform eruptions are increasingly described. We encountered 3 further psoriasiform eruptions during anti-TNF-alpha treatment for rheumatologic conditions and review the literature in order to identify the common characteristics of these cases. We found 30 case reports by using a comprehensive search of the 1966-2005 Medline database with a wild variety concerning the psoriasis type of eruption, the anti-TNF-alpha agent, the treatment duration and the presence or absence of a personal or familial history of psoriasis. We conclude that a psoriasiform eruption during anti-TNF-alpha treatment seems to be a class effect, without any as yet known identified predisposing factors, but it is more often self-limited and does not require treatment discontinuation.