Onset time distribution and influential factors in patients with acute myocardial infarction with different body mass index levels / 中国基层医药

Objective:To investigate the onset time distribution and influential factors in patients with acute myocardial infarction (ACI) with different body mass index (BMI) levels.Methods:A cross-sectional study was conducted to collect clinical data from 1 000 patients with AMI who received treatment at Heilongjiang Provincial Hospital from January 2016 to November 2022. The patients were divided into groups based on different BMI levels: < 18.5 kg/m 2 group ( n = 49), 18.5-24 kg/m 2 group ( n = 369), > 24-28 kg/m 2 group ( n = 338), and > 28 kg/m 2 group ( n = 244). The incidence of AMI was analyzed among patients with different BMI levels as per diurnal variation, seasonality, and weekday. Results:A total of 1 000 patients were included in this study, including 648 men and 352 women. The mean age of these patients was 65 years (range 56-74 years). The median body mass was 70 kg (range 60-76 kg), the median height was 1.69 m (range 1.60-1.72 m), and the median BMI was 24.49 kg/m 2 (range 22.22-26.79 kg/m 2). The onset time of AMI differed significantly among patients with different BMI levels in terms of the period from 0:00 to 5:59, winter, and Wednesday ( P = 0.047, 0.029, 0.005). Among all samples, the number of patients with a BMI of 18.5-24 kg/m 2 was the highest, reaching 369 cases. Conclusion:The incidence of AMI in patients with different BMI levels exhibits a regular distribution as per diurnal variation, seasonality, and weekday.

Maxillofacial infections of dental origin: risk factors for hospital admission

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length

Factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, from 2010 to 2019: a cohort study / Factores asociados al retraso en el inicio del tratamiento del cáncer de mama en un centro oncológico de referencia en Juiz de Fora, de 2010 a 2019: estudio de cohorte / Fatores associados ao atraso para o início do tratamento para câncer de mama em um centro oncológico de referência em Juiz de Fora, de 2010 a 2019: estudo de coorte

ABSTRACT Objectives To analyze factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, between 2010 and 2019. Methods This was a cohort study using data from the Hospital-based Cancer Registry. The probability of not starting treatment within 60 days, in accordance with Brazilian law, was estimated using Kaplan-Meier, method and its association with the factors studied was assessed using the Cox model, presenting hazard ratios (HR) and respective 95% confidence intervals (95%CI). Results Among the 911 participants, the probability of delayed treatment initiation was 18.8% (95%CI 16.4;21.5). Those who underwent treatment at a health service other than the one where the cancer was diagnosed had a significantly higher risk (HR: 3.49; 95%CI 3.00;4.07). Conclusion Receiving a diagnosis and treatment at the same institution may help reduce waiting time to initiate cancer treatment.

RESUMEN Objetivos Determinar los retrasos en el inicio del tratamiento de cáncer de mama en un centro de referencia en oncología de Juiz de Fora, MG, entre 2010 y 2019. Métodos Se trata de una cohorte con datos del Registro Hospitalario de Cáncer. La probabilidad de no iniciar tratamiento dentro de los 60 días, según la legislación brasileña, fue estimada mediante el método de Kaplan-Meier, y su asociación con los factores estudiados mediante el modelo de Cox, con la presentación del Hazard Ratios (HR) y los respectivos intervalos de confianza de 95% (IC95%). Resultados Se evaluaron 911 participantes, la probabilidad de iniciar el tratamiento con retraso fue del 18,8% (IC95% 16,4;21,5). Quienes se sometieron a tratamiento en un servicio de salud distinto al que estableció el diagnóstico de cáncer tuvieron un riesgo significativamente mayor (HR: 3,49; IC95% 3,00;4,07). Conclusión La realización del diagnóstico y tratamiento en una misma institución puede contribuir a reducir el tiempo de espera para el inicio del tratamiento.

RESUMO Objetivos Analisar fatores associados ao atraso para o início do tratamento do câncer de mama em um centro de referência em oncologia em Juiz de Fora, MG, entre 2010 e 2019. Métodos Trata-se de coorte com dados do Registro Hospitalar de Câncer. A probabilidade de não iniciar o tratamento em até 60 dias, conforme legislação brasileira, foi estimada pelo método de Kaplan-Meier, e sua associação com os fatores estudados pelo modelo de Cox, com apresentação das hazard ratios (HR) e respectivos intervalos de confiança de 95% (IC95%). Resultados Entre as 911 participantes, a probabilidade de iniciar o tratamento com atraso foi de 18,8% (IC95% 16,4;21,5). Aquelas que realizaram o tratamento em um serviço de saúde diferente do que estabeleceu o diagnóstico de câncer apresentaram risco significativamente maior (HR: 3,49; IC95% 3,00;4,07). Conclusão Realizar diagnóstico e tratamento na mesma instituição pode contribuir para a redução do tempo de espera para o início do tratamento.

Tiempo de tratamiento y calidad de vida en pacientes con enfermedad renal crónica / Time-to-treatment and quality of life in patients with chronic kidney disease

INTRODUCCIÓN: La duración del tratamiento de hemodiálisis en pacientes con enfermedad renal crónica puede impactar significativamente en su calidad de vida. Esto se debe a las exigencias que conlleva someterse a este procedimiento, ya que implica ajustes en las actividades cotidianas. OBJETIVO: Determinar la relación entre el tiempo de tratamiento y la calidad de vida en pacientes con enfermedad renal crónica en atención primaria. METODOLOGÍA: Estudio descriptivo correlacional, con una muestra de 103 pacientes con enfermedad renal crónica con tratamiento de hemodiálisis. La calidad de vida se midió a través del instrumento SF-36, se analizó en el paquete estadístico SPSS utilizando estadística descriptiva e inferencial. RESULTADOS: Se reportó una media de calidad de vida global de 56,78 (DE=18,24) de valores de 0 a 100, el 50,5% de los participantes tiene de 4 a 6 años con el tratamiento de hemodiálisis. Se demostró una correlación negativa y significativa entre el tiempo de tratamiento con el rol físico (rs = -0,218, p = 0,05). Así mismo, entre la edad del paciente con la calidad de vida global (rs = -0,393, p = 0,01), analizada a través de las dimensiones función física, rol físico, dolor corporal, vitalidad y salud mental. CONCLUSIÓN: La edad y el tiempo de tratamiento afectan la calidad de vida de pacientes con enfermedad renal en tratamiento de hemodiálisis. Se recomienda implementar en la atención primaria intervenciones de enfermería que involucren ambas variables para promover una mejora sustancial en la calidad de vida de los pacientes.

INTRODUCTION: The duration of hemodialysis treatment in patients with chronic kidney disease can significantly impact their quality of life. This is due to the demands of this procedure since it involves adjustments in daily activities. OBJECTIVE: To determine the relationship between treatment time and quality of life in primary health care patients with chronic kidney disease. METHODOLOGY: Descriptive correlational study with a sample of 103 patients with chronic kidney disease with hemodialysis treatment. The quality of life was measured through the SF-36 instrument and analyzed in the statistical package SPSS using descriptive and inferential statistics. RESULTS: A mean global quality of life of 56,78 (SD=18,24) with values from 0 to 100 was reported, and 50,5% of the participants had 4 to 6 years of hemodialysis treatment. A negative and significant correlation was demonstrated between treatment time and physical role (rs = -0,218, p = 0,05). Likewise, the patient's age and overall quality of life (rs = -0,393, p = 0,01) are analyzed through the dimensions of physical function, physical role, bodily pain, vitality, and mental health. CONCLUSION: Age and treatment time affect the quality of life of patients with kidney disease undergoing hemodialysis treatment. It is recommended to implement nursing interventions in primary health care that involve both variables to promote a substantial improvement in patients' quality of life.

Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama / Factors associated with time-to-treatment initiation of breast cancer

Resumo Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Abstract The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno. Instituto Regional de Oftalmología "Javier Servat Univazo" (2010 - 2019), Trujillo, Perú

Evaluar los factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno (DRR) en pacientes del Instituto Regional de Oftalmología "Javier Servat Univazo". Estudio observacional en una cohorte retrospectiva de 204 pacientes con DRR sometidos a diferentes técnicas quirúrgicas entre enero 2010-diciembre 2019, con al menos 6 meses de seguimiento. Éxito anatómico (re-aplicación primaria de retina) y éxito funcional (mejoría de agudeza visual (AV)); buscándose asociación entre estas variables y las demográficas, clínicas y tiempos de espera. Resultados: La edad promedio fue 50 + 16,5 (9-85) años. Éxito anatómico se alcanzó en 165 (80,9 %) pacientes y funcional en 110 (52,9 %). Hubo menor tiempo de espera quirúrgico en pacientes que lograron éxito anatómico (20,0 +/- 22,6 días (1-120)) vs. (29,8 +/- 40,1 días (1-210)) (p=0,04) y en los que tuvieron éxito funcional ( 13,3+/- 15,1 (1-100)) vs. (31,9 +/- 33,7 (1-210)) (p <0,001); y menor tiempo de enfermedad y menor tiempo total en los que tuvieron éxito funcional (29,7 +/-56,5 días (1-365) vs. (61,9 +/- 110,6 días (1-730)) (p=0,008) y (43,1 +/- 68,1 (5-465)) vs. 93,8 +/- 118,3 (3-766)) respectivamente (p<0,001). El menor tiempo de espera quirúrgico mostró asociación con el éxito anatómico y funcional de la cirugía por DRR. El menor tiempo de enfermedad y el menor tiempo total también mostraron asociación con el éxito funcional. Recomendamos implementar medidas para abreviar tiempos de espera e instaurar una terapia quirúrgica precoz y oportuna en estos pacientes.

To evaluate factors related to the anatomical and functional success of surgery for rhegmatogenous retinal detachment (RRA) in patients of the Regional Institute of Ophthalmology "Javier Servat Univazo". retrospective cohort study of 204 patients with RRD submitted to different surgical techniques between January 2010-December 2019, with at least 6 months of follow-up anatomical success (primary retinal reapplication) and functional success (improvement in visual acuity (VA)); looking for an association between these variables and demographics, clinics and waiting times. Results: The mean age was 50 + 16.5 (9-85) years. Anatomical success was achieved in 165 (80.9%) patients and functional in 110 (52.9%). There was a shorter surgical waiting time in patients who achieved anatomical success (20.0 +/- 22.6 days (1-120)) vs (29.8 +/- 40.1 days (1-210)) (p=0.04) and in those who had functional success (13.3+/- 15.1 (1- 100)) vs (31.9 +/- 33.7 (1-210)) (p <0.001); and shorter sick time and shorter total time in those who had functional success (29.7 +/-56.5 days (1-365) vs (61.9 +/- 110.6 days (1-730)) (p=0.008) and (43.1 +/-68.1 (5-465)) vs 93.8 +/- 118.3 (3-766)) respectively (p<0.001). The shorter surgical waiting time was associated with RRD surgery's anatomical and functional success. The shortest time of illness and the shortest total time were associated with functional success. We recommend implementing measures to shorten waiting times and establish early and timely surgical therapy in these patients.

Optimización del tiempo puerta-balón mediante la implementación de un programa de mejora de procesos. Resultados a 5 años de funcionamiento / Optimization of Door-to-Balloon Time Implementing a Process Improvement Program. Results after 5 Years

RESUMEN Introducción : de estar disponible, la angioplastia primaria (ATCp), en tiempos adecuados y en centros con experiencia, es la mejor estrategia de reperfusión para el infarto agudo de miocardio con supradesnivel del segmento ST (IAMCEST). El tiempo puerta-balón (TPB) es una expresión de eficiencia operativa de la institución que realiza la ATCp, con impacto en la evolución del paciente. El objetivo de este trabajo fue analizar los resultados a largo plazo de un programa de mejora continua del proceso TPB. Material y métodos : se incluyeron en forma prospectiva y consecutiva pacientes con diagnóstico de IAMCEST sometidos a ATCp desde enero de 2015 a mayo de 2022. La población se dividió en dos períodos: período de implementación inmediata y período de seguimiento a largo plazo. Resultados : se ingresaron 671 pacientes en forma prospectiva y consecutiva. En el primer período, de implementación, (P1), se incluyeron 91 pacientes, y en el segundo período, de seguimiento del programa, (P2), 580 pacientes. La mediana (rango intercuartilo, RIC) de TPB fue de 46 min (29-59) en P1 vs 42 min(25-52) en el P2, p = 0,055. En el segundo período se evi denció una reducción de las preactivaciones (P1 54,1% vs P2 30%,p = 0,02) y los procedimientos on hours (42% en p1 vs 30% en P2, p = 0,029). Conclusión : el registro mostró el mantenimiento de los buenos resultados a largo plazo a pesar de una reducción de las preactivaciones y los procedimientos on hours.

ABSTRACT Background : If available, primary transluminal coronary angioplasty (PTCA), performed timely and in experienced sites, is the best reperfusion strategy for ST elevation myocardial infarction (STEMI). The door-to-balloon (DTB) time expresses operational efficiency of the site in charge of the PTCA, with an impact on patient's progress. The aim of this study was to analyze the long-term results of a continuous improvement program for the DTB time process. Methods : Patients diagnosed with STEMI who had undergone PTCA from January 2015 to May 2022 were prospectively and consecutively enrolled. The population was divided in two periods: an immediate implementation period and a long-term follow-up period. Results : 671 patients were prospectively and consecutively enrolled. During the implementation period (P1) 91 patients were enrolled, and 580 during the program follow-up (P2). The median (interquartile range, IQR) DTB time was 46 min (29-59) for P1 vs 42 min(25-52) for P2, p=0.055). The second period showed a reduction in pre-activations (P1 54,1% vs P2 30% p=0.02) and on-hour procedures (42% for P1 versus 30% for P2, p=0.029). Conclusion : The registry showed long-term maintenance of good results, despite reduced reactivations and on-hour procedures.

Social influencing factors of stroke / 国际脑血管病杂志

Stroke is the leading cause of death and disability among adults in China, bringing great economic burden to the families of patients and society. An increasing number of studies have shown that, in addition to traditional risk factors, social factors also play an undeniable role in the occurrence and development, timeliness of medical treatment, outcomes, and mortality of stroke. This article reviews the relationship between socioeconomic factors, other social factors (such as personal social networks) and stroke.

Effects of intravenous thrombolysis with a recombinant tissue plasminogen activator at different time windows on acute ischemic stroke in patients / 中国基层医药

Objective:To investigate the clinical efficacy of intravenous thrombolysis with a recombinant tissue plasminogen activator at different time windows on acute ischemic stroke in patients.Methods:A total of 172 patients with acute ischemic stroke who received treatment in Lishui Municipal Central Hospital from January 2019 to December 2021 were included in this study. They were divided into observation (onset to admission < 3 hours, n = 86) and control (onset to admission = 3-4.5 hours, n = 86) groups according to the time from onset to admission. Clinical efficacy, coagulation indexes, the National Institutes of Health Stroke Scale score, and the modified Rankin Scale score were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [89.54% (77/86) vs. 75.58% (65/86), χ2 = 4.89, P < 0.05]. After treatment, fibrinogen, low whole blood viscosity, and plasma viscosity in the observation group were (2.55 ± 0.62) g/L, (9.68 ± 1.37) mPa·s, (1.45 ± 0.17) mPa·s, respectively, which were significantly higher than (1.53 ± 0.58) g/L, (9.19 ± 1.46) mPa·s, (1.32 ± 0.15) mPa·s in the control group ( t = -11.14, -2.27, -5.32, all P < 0.05). Antithrombin III level in the observation group was significantly lower than that in the control group [(91.65 ± 7.23)% vs. (97.74 ± 6.82)%, t = 5.68, P < 0.05]. At 2 hours, 1 day, and 2 weeks after thrombolysis, the National Institutes of Health Stroke Scale scores in the observation group were (2.49 ± 0.31) points, (1.98 ± 0.24) points, (1.79 ± 0.05) points, which were significantly lower than (3.32 ± 1.08) points, (2.69 ± 0.35) points, (2.18 ± 0.21) points in the control group ( t = 6.85, 15.52, 16.75, all P < 0.001). After treatment, the modified Rankin Scale score in the observation group was significantly lower than that in the control group [(2.01 ± 0.79) points vs. (2.88 ± 0.64) points, t = 7.94, P < 0.001]. Conclusion:Intravenous thrombolysis with a recombinant tissue plasminogen activator within 4.5 hours after onset exhibits good therapeutic efficacy in patients with acute ischemic stroke. Earlier thrombolysis leads to better therapeutic efficacy and prognosis.

Door-to-needle time for intravenous thrombolysis in acute ischemic stroke / 国际脑血管病杂志

Intravenous thrombolysis is an effective treatment for acute ischemic stroke, but its benefits are time-dependent. The time from onset to intravenous thrombolysis is divided into onset-to-door time (ODT) and door-to-needle time (DNT). The former reflects pre-hospital delay, while the latter reflects in-hospital delay and can be controlled by stroke improvement plan. This article reviews the influence of DNT on clinical outcomes, the influencing factors of DNT and the stroke improvement plan to shorten DNT.

Frequência e fatores associados ao atraso para o tratamento do câncer de mama no Brasil, segundo dados do PAINEL-Oncologia, 2019-2020 / Frecuencia y factores asociados al retraso en el tratamiento del cáncer de mama en Brasil, según datos del Panel de Oncología, 2019-2020 / Frequency and factors associated with delay in breast cancer treatment in Brazil, according to data from the Oncology Panel, 2019-2020

Objective: to analyze treatment delay and the flow of care for women with breast cancer in Brazil in 2019 and 2020. Method: this was a follow-up study of breast cancer cases available from the Oncology Panel; a chi-square test and multilevel logistic regression were performed in order to analyze the explanatory variables associated with delay (greater than 60 days) in starting treatment. Results: 22,956 cases (54.5%) with delay in treatment were identified in 2019 and 17,722 (48.7%) in 2020; the Southeast region (54.6%) had the greatest proportion of delay; delay was greater when treatment was provided outside the municipality of residence and lower in 2020 compared to 2019; most outward flows were to the capital cities in the same Federative Units of residence. Conclusion: strategies to reduce cancer treatment delay and optimize health care networks in the Federative Units should be prioritized.

Resumen Objetivo: analizar la demora en el tratamiento y el flujo asistencial de mujeres con cáncer de mama en Brasil en 2019 y 2020. Método: estudio de seguimiento de los casos de cáncer de mama disponibles en el Panel de Oncología. Para analizar las variables explicativas asociadas al retraso (mayor de 60 días) en el inicio del tratamiento se realizó la prueba de chi-cuadrado y la regresión logística multinivel. Resultados: se identificaron 22.956 casos (54,5%) en 2019 y 17.722 (48,7%) en 2020 con retraso en el tratamiento. La región Sudeste (54,6%) tuvo mayor proporción de atraso, siendo mayor cuando se realizó fuera del municipio de residencia y menor en 2020 en relación a 2019. Los flujos externos, en su mayoría, ocurrieron en las capitales de las mismas Unidades de la Federación (UFs) de residencia. Conclusión: se deben priorizar estrategias que reduzcan el intervalo de tiempo hasta el inicio del tratamiento del cáncer y optimicen las redes de atención de salud en los estados.

Objetivo: analisar o atraso para o tratamento e o fluxo assistencial de mulheres com câncer de mama no Brasil em 2019 e 2020. Métodos: estudo de seguimento de casos de câncer de mama disponibilizados no PAINEL-Oncologia; para analisar as variáveis explicativas associadas ao atraso (maior que 60 dias) no início do tratamento, realizou-se teste qui-quadrado e regressão logística multinível. Resultados: identificaram-se 22.956 casos (54,5%) em 2019 e 17.722 (48,7%) em 2020, com atraso para o tratamento; a região Sudeste (54,6%) teve maior proporção de atraso, que foi maior quando o tratamento foi realizado fora do município de residência, e menor em 2020, comparando-se a 2019; os fluxos externos, em sua maioria, ocorreram para as capitais das mesmas Unidades da Federação (UFs) de residência. Conclusão: estratégias que diminuam o intervalo de tempo até o início do tratamento oncológico e otimizem as redes de atenção em saúde nas UFs devem ser priorizadas.

Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil

ABSTRACT Background: The number of tuberculosis (TB) cases in prisons is higher than that in the general population and has been reported as the most common cause of death in prisons. This study evaluated the delay in the diagnosis and treatment of TB in Brazilian prisons. Methods: A retrospective cohort study was conducted between 2007 and 2015 using data from the five largest male prisons in Mato Grosso do Sul, Brazil. TB case data was collected from the National Database of Notifiable Diseases (SINAN), GAL-LACEN, and prison medical records. The following variables were recorded: prison, year of diagnosis, age, race, education, HIV status, smoking status, comorbidities, number of symptoms, percentage of cures, delay in diagnosis, patient delay, provider delay, laboratory delay, and delay in treatment. Descriptive statistics were used for the variables of interest. Results: A total of 362 pulmonary TB cases were identified. The average time between the first symptom and reporting of data was 94 days. The mean time between symptom onset and laboratory diagnosis was 91 days. The average time from symptom onset to first consultation was 80 days. The time between diagnosis and treatment initiation was 5 days. Conclusions: Delays were significant between reporting of the first symptoms and diagnosis and significantly smaller from the time between notification and start of treatment. Control strategies should be implemented to diagnose cases through active screening, to avoid delays in diagnosis and treatment, and to reduce TB transmission.

Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study / Relación de la accesibilidad de la atención de salud y la distancia de desplazamiento con la muerte fetal durante el parto: un estudio de cohorte retrospectivo / Avaliação do impacto do acesso ao sistema de saúde e da distância percorrida na morte fetal intraparto: estudo retrospectivo de coorte

ABSTRACT Objective. To determine if there was an association between intrapartum stillbirths and both traveled distance for delivery and delivery care accessibility, assessing periods before and during the COVID-19 pandemic. Methods. This is a population-based cohort study. Patients had birth occurring after the onset of labor; the primary outcome was intrapartum stillbirth. City of residence was classified according to the ratio between deliveries performed and total births among its residents; values lower than 0.1 indicated low delivery care accessibility. Travel distance was calculated using the Haversine formula. Education level, maternal age, and birth sex were included. In each period, relative risk was assessed by generalized linear model with Poisson variance. Results. There were 2 267 534 deliveries with birth occurring after the onset of labor. Most patients were between age 20 and 35 years, had between 8 and 11 years of education, and resided in cities with high delivery care accessibility. Low delivery care accessibility increased risk of intrapartum stillbirth in the pre-pandemic (relative risk [RR] 2.02; 95% CI [1.64, 2.47]; p < 0.01) and the pandemic period (RR 1.69; 95% CI [1.09, 2.55]; p = 0.015). This was independent of other risk-increasing factors, such as travel distance and fewer years of education. Conclusions. Low delivery care accessibility is associated with the risk of intrapartum stillbirths, and accessibility reduced during the pandemic. Delivery of patients by family physicians and midwives, as well as official communication channels between primary care physicians and specialists, could improve patient healthcare-seeking behavior.

RESUMEN Objetivo. Determinar si hubo una asociación entre la mortinatalidad durante el parto y la distancia recorrida o la accesibilidad de la atención para el parto, mediante la evaluación de un período anterior y de otro coincidente con la pandemia de COVID-19. Métodos. Se realizó un estudio de cohorte de base poblacional. Se incluyó a las pacientes que dieron a luz tras el inicio de un trabajo de parto; el criterio de valoración principal fue la mortinatalidad durante el parto. Se clasificaron las ciudades de residencia conforme al cociente entre el número de partos atendidos y el total de partos habidos entre sus residentes; los valores inferiores a 0,1 indican que la accesibilidad de la atención del parto es baja. La distancia recorrida para el parto se calculó utilizando la fórmula de Haversine. Se utilizaron datos del nivel de estudios y la edad de la madre y del sexo biológico neonatal. Para cada período, se evaluó el riesgo relativo mediante un modelo lineal generalizado con varianza de Poisson. Resultados. Hubo 2 267 534 partos que se produjeron tras el inicio de un trabajo de parto. La mayoría de las pacientes tenían edades comprendidas entre 20 y 35 años, tenían entre 8 y 11 años de estudios y residían en ciudades donde la accesibilidad de la atención del parto era alta. Una accesibilidad baja de la atención del parto se asoció a un aumento del riesgo de mortinatalidad durante el parto en el período prepandémico (riesgo relativo [RR] = 2,02; IC del 95% = [1,64, 2,47]; p < 0,01) y también durante la pandemia (RR = 1,69; IC del 95% = [1.09, 2.55]; p = 0,015). Este resultado fuer independiente de otros factores que incrementan el riesgo, como la distancia recorrida para dar a luz y un menor nivel de estudios. Conclusiones. Una accesibilidad baja de la atención del parto se asocia a un mayor riesgo de mortinatalidad durante el parto; y se observó una reducción de la accesibilidad durante la pandemia. Los partos asistidos por personal de medicina de familia o de partería y los canales de comunicación oficiales entre el personal médico de atención primaria y el especializado podrían mejorar el comportamiento de las pacientes a la hora de buscar atención de salud.

RESUMO Objetivo. Determinar se existe alguma relação entre a morte fetal intraparto e dois fatores: a distância percorrida para o parto e o acesso à assistência ao parto, avaliando o período antes e durante a pandemia de COVID-19. Métodos. Este é um estudo de coorte de base populacional. As pacientes tiveram parto após o início do trabalho de parto; o desfecho primário foi morte fetal intraparto. A cidade de residência foi classificada de acordo com a razão entre os partos realizados e o total de nascimentos entre os residentes; valores inferiores a 0,1 indicavam baixo acesso à assistência ao parto. A distância percorrida foi calculada usando a fórmula de Haversine. Foram incluídos o nível de escolaridade, a idade materna e o sexo de nascimento. Em cada período, o risco relativo foi avaliado usando um modelo linear generalizado com variância de Poisson. Resultados. Foram registrados 2 267 534 partos com nascimento após o início do trabalho de parto. A maioria das pacientes tinha entre 20 e 35 anos de idade, entre 8 e 11 anos de escolaridade e residia em cidades com alto nível de acesso à assistência ao parto. O baixo acesso à assistência ao parto aumentou o risco de morte fetal intraparto no período anterior à pandemia (risco relativo [RR]: 2,02; intervalo de confiança [IC] de 95%: 1,64-2,47; p < 0,01) e durante a pandemia (RR: 1,69; IC 95%: 1,09-2,55; p = 0,015). Isso ocorreu independentemente de outros fatores de aumento de risco, como a distância percorrida e menor escolaridade. Conclusões. O baixo acesso ao atendimento de parto está associado ao risco de morte fetal intraparto, e a acessibilidade diminuiu durante a pandemia. A realização do parto por médicos de família e obstetrizes, bem como a existência de canais oficiais de comunicação entre médicos de atenção primária e especialistas, poderiam melhorar o comportamento de busca de saúde por parte das pacientes.

Factors associated with decision time to seek care in the face of ischemic stroke / Factores asociados con el tiempo de decisión para buscar atención médica por accidente cerebrovascular isquémico / Fatores associados ao tempo de decisão para procurar atendimento em face ao acidente vascular cerebral isquêmico

ABSTRACT Objective: To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. Method: Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. Results: The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. Conclusion: The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.

RESUMEN Objetivo: Verificar la asociación entre factores sociodemográficos, clínicos, ambientales, cognitivos, y emocionales y el tiempo de decisión de las personas con accidente cerebrovascular isquémico para buscar un servicio de salud luego del inicio de los síntomas o Wake up stroke Método: Estudio transversal realizado de marzo a octubre de 2019, con 304 pacientes, en un hospital público, referencia en neurología. Datos obtenidos por entrevista y de la historia clínica. El tiempo de decisión se analizó como una media geométrica. En los análisis bivariados y multivariados se utilizó la regresión lineal y el Criterio de Información de Akaike para seleccionar el mejor modelo. Se adoptó una significancia estadística del 5% Resultados: La media geométrica del tiempo de decisión fue de 0,30h (IC 95% 0,23-0,39). El modelo final explicó este tiempo en un 41%, mostrando un aumento de 0,5 min para las personas con hipertensión arterial, 10,8 min para las que esperaron a que los síntomas mejoraran, 1,4 min para las que estaban solas al inicio de los síntomas, 3, 9 min para las que estaban en casa, 3,2 min para los que estaban en el trabajo y 2,1 en la calle/vía pública Conclusión: El tiempo promedio de decisión para buscar un servicio de salud fue alto e influenciado por variables clínicas, ambientales, cognitivas y emocionales. Los resultados orientan a los enfermeros hacia la educación en salud.

RESUMO Objetivo: Verificar a associação entre fatores sociodemográficos, clínicos, ambientais, cognitivos e emocionais e o tempo de decisão de pessoas com acidente vascular cerebral isquêmico para procurar um serviço de saúde após o início dos sintomas ou Wake up stroke Método: Estudo transversal realizado de março a outubro de 2019, com 304 pacientes, em hospital público, referência em neurologia. Dados obtidos por entrevista e no prontuário. O tempo de decisão foi analisado em média geométrica. Nas análises bivariadas e multivariada foi usada a regressão linear e o Critério de Informação de Akaike foi usado na seleção do melhor modelo. Adotou- se significância estatística de 5% Resultados: A média geométrica do tempo de decisão foi de 0,30h (IC 95% 0,23-0,39). O modelo final explicou em 41% esse tempo, mostrando aumento de 0,5 min para pessoas com hipertensão arterial; 10,8 min para quem esperou os sintomas melhorarem; 1,4 min para quem estava sozinho no início dos sintomas; 3,9 min para quem estava em casa; 3,2 min no trabalho e 2,1 na rua/via pública Conclusão: A média do tempo de decisão para procura de serviço de saúde foi alta e influenciada por variáveis clínicas, ambientais, cognitivas e emocionais. Os resultados orientam enfermeiros para a educação em saúde.

Impacto de la pandemia COVID-19 en el tiempo entre la detección de lesiones premalignas de cuello de útero y su tratamiento / Impact of the COVID-19 pandemic on the time between detection of cervical precancerous lesions and their management / Impacto da pandemia de COVID 19 no tempo entre a detecção de lesões cervicais pré-malignas e seu tratamento

Introducción: la pandemia por COVID-19 ha afectado la salud de la mujer y en particular a los derechos sexuales y reproductivos. En el contexto de cambios asistenciales por la pandemia COVID 19, podría verse afectado el tamizaje y seguimiento de las lesiones premalignas de los cánceres de cuello de útero (CCU), poniendo en riesgo su diagnóstico oportuno y tratamiento precoz. El objetivo de este estudio es reportar los tiempos transcurridos entre el resultado de screening patológico y el tratamiento de lesiones premalignas de CCU, cotejando con los plazos establecidos por la ordenanza ministerial vigente y comparando los tiempos observados antes y durante la pandemia. Métodos: se realizó un estudio observacional, analítico, de corte transversal, mediante un análisis comparativo antes y después de la pandemia por COVID-19. Se incluyeron usuarias a quienes se les realizó conización quirúrgica en el Centro Hospitalario Pereira Rossell en dos períodos de tiempo: 1 de marzo de 2019 a 29 de febrero de 2020, y 1 de marzo de 2020 a 28 de febrero de 2021. Resultados: la media en días observada desde el PAP hasta la conización fue de 245 para el primer periodo y de 242 para el segundo. El porcentaje de pacientes que cumplen con la ordenanza ministerial en ambos períodos no supera el 5%. Conclusiones: no se evidenció una mayor demora en el seguimiento y tratamiento de estas usuarias durante la pandemia por COVID-19, sin embargo los tiempos observados superan ampliamente los establecidos por Ordenanza Ministerial en los periodos pre pandemia y durante la misma.

Introduction: the COVID-19 pandemic has affected women's health in general, and in particular their sexual and reproductive rights. Within the context of changes in health care services due to the COVID-19 pandemic, the screening and follow up of cervical precancerous lesions could be affected, and in turn, this could prevent timely diagnosis and early treatment. This study aims to report the period of time be-tween pathological findings in screening tests and the treatment of precancerous lesions of cervical cancer, analyze it within the context of deadlines set in the Ministry of Health regulations in force, and compare it to pre-pandemic deadlines and time frames during the COVID-19 pandemic. Method: observational, analytical and transversal study conducted by means of analyzing the situation before and after the COVID-19 pandemic. The study included users who underwent surgical conization at the Pereira Rossell Hospital during two periods of time: Between March 1, 2019 and February 29, 2020 and between March 1, 2020 and February 28, 2021. Results: average number of days from the PAP test until conization was 245 days for the first period and 242 for the second one. The percentage of patients that comply with the Ministerial decree in both periods is lower than 5%. Conclusions: the study found time to treatment in the follow up and management of users did not increase during the COVID-19 pandemic. However, the times ob-served widely exceed the deadlines set in the ministerial decree in both periods, that is before and during the pandemic.

Introdução: a pandemia de COVID-19 afetou a saúde das mulheres e em particular os direitos sexuais e reprodutivos. No contexto das mudanças na saúde devido à pandemia de COVID 19, o rastreamento e o acompanhamento das lesões pré-malignas do câncer de colo de útero (CCU) podem ser afetados, colocando em risco o diagnóstico oportuno e o tratamento precoce. Objetivo: descrever os tempos decorridos entre o resultado do rastreamento patológico e o tratamento das lesões pré-malignas do CCU, comparando-os com os períodos estabelecidos pela atual Portaria Ministerial, e comparar os tempos observados antes e durante a pandemia. Métodos: foi realizado um estudo observacional, analítico e transversal por meio de uma análise comparativa antes e após a pandemia de COVID19. Foram incluídos as usuárias que realizaram a conização cirúrgica no Hospital Pereira Rossell em dois períodos de tempo: 1º de março de 2019 a 29 de fevereiro de 2020 e 1º de março de 2020 a 28 de fevereiro de 2021. Resultados: a média de dias observados do PAP à conização foi de 245 para o primeiro período e 242 para o segundo. O percentual de pacientes que cumprem a Portaria Ministerial em ambos os períodos não ultrapassa 5%. Conclusões: não houve evidência de maior demora no acompanhamento e tratamento desses usuários durante a pandemia por COVID-19, porém os tempos observados superam em muito os estabelecidos por Portaria Ministerial nos períodos pré-pandemia e durante a mesma.

Time Elapsed from Onset of Symptoms to Antituberculosis Treatment in Children with Central Nervous System Tuberculosis in a Tertiary Hospital in South India: A Mixed-Methods Pilot Study

A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB.

Fatores associados ao tempo para o início do tratamento do câncer de pulmão em Minas Gerais, Brasil / Factors associated with time to initiate lung cancer treatment in Minas Gerais, Brazil

Resumo O objetivo foi verificar a associação entre fatores individuais e organizativos do sistema de saúde com o tempo para o início do tratamento do câncer de pulmão pelo Sistema Único de Saúde (SUS) em Minas Gerais. Estudo de coorte retrospectiva com pacientes que iniciaram o tratamento para o câncer de pulmão pelo SUS de 2008 a 2015. Foram selecionadas variáveis sociodemográficas, clínicas e organizativas do sistema de saúde. O modelo de regressão logística avaliou a associação do desfecho do início do tratamento em até 60 dias após o diagnóstico com as variáveis explicativas selecionadas. Utilizou-se a odds ratio (OR) e o respectivo intervalo de confiança (95%) para mensurar a força de associação. A maioria dos tratamentos para o câncer de pulmão em Minas Gerais foram iniciados em até 60 dias após o diagnóstico, entretanto, ser do sexo masculino e diagnosticado em estadiamento IV aumentaram a chance de iniciar o tratamento em até 60 dias; todavia o aumento da idade, iniciar o tratamento por radioterapia, e o local de residência, diminuíram. O tempo para início do tratamento está associado a características individuais e à provisão de serviços nas macrorregiões, e as desigualdades observadas possivelmente se originam a partir do melhor ou pior acesso da população aos serviços prestados.

Abstract The aim was to verify the association of individual factors and healthcare system characteristics with time to initiate treatment of lung cancer by the Brazilian National Health System, in Minas Gerais state. A retrospective cohort study, with patients who initiated treatment for lung cancer by the SUS, from 2008 to 2015. Sociodemographic and clinical characteristics of patients, besides organizational variables of the healthcare system were selected. The logistic regression model evaluated the association of selected explanatory variables with the outcome of initiating treatment within 60 days after diagnosis. Odds ratio (OR) and respective 95% confidence interval were used to measure the power of association. Most treatments for lung cancer in the state of Minas Gerais initiated within 60 days after diagnosis. However, being male and diagnosed as stage IV increased the likelihood of starting treatment within 60 days. On the other hand, the patient's age, radiation therapy as first treatment, and the place of residence decreased such chance. Time to initiate treatment is associated with individual characteristics and provision of services in macroregions, and the observed inequalities possibly raised from the better or worse access of the population to the services provided by SUS.

Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study / Journal of Rural Medicine

Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.

Delay in anticoagulation in patients with cerebral venous sinus thrombosis: influencing factors and its effect on outcome / 国际脑血管病杂志

Objective:To investigate the factors associated with delay in anticoagulant therapy in patients with cerebral venous sinus thrombosis (CVST) and its effect on outcome.Methods:Patients with CVST admitted to Changhai Hospital, Naval Medical University from January 2010 to August 2021 were retrospectively enrolled. Patients were divided into early anticoagulation group and late anticoagulation group by the median time interval from first symptom to initiation of anticoagulation. The modified Rankin Scale was used for outcome assessment at 90 d after onset. 0-2 scores were defined as good outcome and 3-6 were defined as poor outcome. Demographic and clinical data were compared for the early versus late anticoagulation group and for the good versus poor outcome groups. Multivariable logistic regression was used to identify independent influencing factors of delay in anticoagulation and the correlation of delay in anticoagulation with poor outcome. Results:A total of 131 patients were included, their age was 40.07±15.11 years old, and 68 (51.91%) were male. Of these, 65 patients (49.62%) were in the early anticoagulation group and 14 (10.69%) were in the poor outcome group. Compared with the late anticoagulation group, the early anticoagulation group had a significantly higher proportion of patients with seizures and brain parenchymal damage as well as higher D-dimer levels on admission, while the proportion of patients with visual impairment/papilloedema was significantly lower (all P<0.05). Compared with the good outcome group, the poor outcome group had significantly higher proportions of patients with seizures, dyskinesia, impaired consciousness, low Glasgow Coma Scale score, and brain parenchymal damage as well as higher D-dimer, total cholesterol and low density lipoprotein cholesterol levels, sites of thrombus involvement were more common in the superior sagittal and straight sinuses, and significantly lower proportions of patients with headache and lower albumin levels on admission (all P<0.05). Multivariate logistic regression analysis showed that visual impairment/papilloedema (odds ratio [ OR] 0.119, 95% confidence interval [ CI] 0.030-0.473; P=0.002) and brain parenchymal damage ( OR 1.341, 95% CI 1.042-1.727; P=0.023) were independently associated with a delay in anticoagulation treatment, and a delay in anticoagulation treatment ( OR 6.102, 95% CI 1.185-30.504; P=0.030) and D-dimer level on admission ( OR 1.299, 95% CI 1.141-1.480; P<0.001) were the independent predictors of poor outcome in patients with CVST. Conclusions:Visual impairment/papilloedema and absence of brain parenchymal damage on cranial imaging are the independent risk factors for delay in anticoagulation in patients with CVST. The delay in anticoagulation is strongly associated with the poor outcome in patients with CVST.