PURPOSE OF REVIEW: The present study aims to review the existing literature to identify pathophysiological proteins in obesity by conducting a systematic review of proteomics studies. Proteomics may reveal the mechanisms of obesity development and clarify the links between obesity and related diseases, improving our comprehension of obesity and its clinical implications. RECENT FINDINGS: Most of the molecular events implicated in obesity development remain incomplete. Proteomics stands as a powerful tool for elucidating the intricate interactions among proteins in the context of obesity. This methodology has the potential to identify proteins involved in pathological processes and to evaluate changes in protein abundance during obesity development, contributing to the identification of early disease predisposition, monitoring the effectiveness of interventions and improving disease management overall. Despite many non-targeted proteomic studies exploring obesity, a comprehensive and up-to-date systematic review of the molecular events implicated in obesity development is lacking. The lack of such a review presents a significant challenge for researchers trying to interpret the existing literature. This systematic review was conducted following the PRISMA guidelines and included sixteen human proteomic studies, each of which delineated proteins exhibiting significant alterations in obesity. A total of 41 proteins were reported to be altered in obesity by at least two or more studies. These proteins were involved in metabolic pathways, oxidative stress responses, inflammatory processes, protein folding, coagulation, as well as structure/cytoskeleton. Many of the identified proteomic biomarkers of obesity have also been reported to be dysregulated in obesity-related disease. Among them, seven proteins, which belong to metabolic pathways (aldehyde dehydrogenase and apolipoprotein A1), the chaperone family (albumin, heat shock protein beta 1, protein disulfide-isomerase A3) and oxidative stress and inflammation proteins (catalase and complement C3), could potentially serve as biomarkers for the progression of obesity and the development of comorbidities, contributing to personalized medicine in the field of obesity. Our systematic review in proteomics represents a substantial step forward in unravelling the complexities of protein alterations associated with obesity. It provides valuable insights into the pathophysiological mechanisms underlying obesity, thereby opening avenues for the discovery of potential biomarkers and the development of personalized medicine in obesity.
En los últimos años se ha constatado un aumento de la demanda asistencial en los servicios de salud mental y, por tanto, un aumento de interconsultas que se reci-ben desde atención primaria, siendo necesario filtrar dichas derivaciones para poder llevar a cabo una atención adecuada. El principal objetivo de este estudio es la evaluación del modelo de derivación del Servicio de Salud Mental del Departamento del Arnau de Vila-nova-Llíria mediante un análisis descriptivo y el seguimiento a lo largo de 6 meses de las interconsultas derivadas desde atención primaria y rechazadas por salud mental en el año 2019. Durante esos meses se recibieron 2029 interconsultas, de las cuales 623 fueron rechazadas, correspondiéndose estas a 504 pacientes. De estas personas, 164 fueron finalmente citadas en salud mental tras realizar una nueva interconsulta. Este análisis pone de manifiesto la necesidad de implementar un modelo colaborativo entre atención primaria y salud mental que se traduzca en una mayor detección de casos, una mejor derivación y, en definitiva, una mejor atención a los y las pacientes. (AU)
In recent years, there has been an increase in the demand for care in Mental Health services and, therefore, an increase in interconsultations received from Primary Care, making it necessary to filter said referrals in order to carry out adequate care. The main objective of this study is to evaluate the referral model of the Mental Health Ser-vice of the Department of Arnau de Vilanova-Llíria through the descriptive analysis and follow-up over 6 months of interconsultations derived from Primary Care and rejected by Mental Health in 2019. During those months, 2029 interconsultations were received, of which 623 were rejected, corresponding to 504 patients. Of these patients, 164 were fi-nally attended to in Mental Health after carrying out a new interconsultation. This analysis shows the need to implement a collaborative model between Primary Care and Mental Health that turns into greater cases detection, better referral sand, ultimately, a better patient care. (AU)
Humans , Mental Health , Mental Health Services , Referral and Consultation , Primary Health Care , Follow-Up Studies
Essential oils sourced from herbs commonly used in the Mediterranean diet have demonstrated advantageous attributes as nutraceuticals and prebiotics within a model of severe cardiometabolic disorder. The primary objective of this study was to assess the influences exerted by essential oils derived from thyme (Thymus vulgaris) and oregano (Origanum vulgare) via a comprehensive multi-omics approach within a gnotobiotic murine model featuring colonic microbiota acquired from patients diagnosed with coronary artery disease (CAD) and type-2 diabetes mellitus (T2DM). Our findings demonstrated prebiotic and potential antioxidant effects elicited by these essential oils. We observed a substantial increase in the relative abundance of the Lactobacillus genus in the gut microbiota, accompanied by higher levels of short-chain fatty acids and a reduction in trimethylamine N-oxide levels and protein oxidation in the plasma. Moreover, functional enrichment analysis of the cardiac tissue proteome unveiled an over-representation of pathways related to mitochondrial function, oxidative stress, and cardiac contraction. These findings provide compelling evidence of the prebiotic and antioxidant actions of thyme- and oregano-derived essential oils, which extend to cardiac function. These results encourage further investigation into the promising utility of essential oils derived from herbs commonly used in the Mediterranean diet as potential nutraceutical interventions for mitigating chronic diseases linked to CAD and T2DM.
We have recently reported alterations in the plasma concentrations of lysophosphatidic acid (LPA) in patients with substance use disorders. In order to further explore the potential role of the LPA signaling system as biomarker in cocaine use disorders (CUD) we conducted a cross-sectional study with 105 patients diagnosed with CUD and 92 healthy controls. Participants were clinically evaluated and blood samples were collected to determine plasma concentrations of total LPA and LPA species (16:0-, 18:0-, 18:1-, 18:2-, and 20:4-LPA), and the gene expression of LPA1 and LPA2 receptors in peripheral blood mononuclear cells. We found that patients with CUD had significantly lower plasma concentration of the majority of LPA species, while the mRNA expression of LPA1 receptor was found to be higher than controls. Moreover, we found a positive association between plasma concentration of 20:4-LPA and relevant CUD-related variables: age of onset cocaine use and length of cocaine abstinence. The statistical analysis revealed sex differences in concentrations of total LPA and LPA species, and women showed higher LPA concentrations than men. Furthermore, studies in rats of both sexes showed that plasma concentrations of total LPA were also altered after acute and chronic cocaine administration, revealing a sexual dimorphism in these effects. This study found alterations on the LPA signaling system in both, patients with CUD and rats treated with cocaine. Our results demonstrate that LPA signaling is impacted by CUD and sex, which must be taken into consideration in future studies evaluating LPA as a reliable biomarker for CUD.
Cocaine , Substance-Related Disorders , Male , Female , Rats , Animals , Leukocytes, Mononuclear/metabolism , Cross-Sectional Studies , Lysophospholipids/metabolism , Biomarkers
Transmission electron microscopy analyses of the polymineralic regolith particle RC-MD01-0025 show microstructural and microchemical characteristics indicative of space weathering on the surface of asteroid Itokawa. The depletion of sulfur and nickel was identified in space weathered rims on troilite and pentlandite minerals. This corresponds to the first report of nickel depletion in samples returned from asteroid Itokawa by the Hayabusa mission. Microstructurally, the sulfide minerals present crystalline rims and the olivine presents both crystalline and amorphous zones in the rim. These results suggest that sulfides might be more resistant to amorphization caused by solar wind irradiation. The space weathering features identified in the regolith particle analyzed here are likely formed via solar wind irradiation. Additionally, the differences in the space weathering features in olivine, pentlandite, and troilite suggest that silicates and sulfides respond differently to the same space weathering conditions in interplanetary space.
OBJECTIVE: The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. METHODS: A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. RESULTS: Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). CONCLUSION: There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.
Heart Diseases , Hypertension , Hypotension, Orthostatic , Aged , Blood Pressure , Blood Pressure Determination , Humans , Hypotension, Orthostatic/diagnosis
SUMMARY OBJECTIVE: The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. METHODS: A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. RESULTS: Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). CONCLUSION: There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.
Humans , Aged , Heart Diseases , Hypertension , Hypotension, Orthostatic/diagnosis , Blood Pressure , Blood Pressure Determination
Objetivos: Descrever a epidemiologia dos pacientes pediátricos internados em um centro de trauma em Minas Gerais, Brasil; caracterizar os dados desde admissão hospitalar até a propedêutica. Métodos: Trata-se de estudo retrospectivo cuja coleta de dados aconteceu entre outubro de 2017 e março de 2018 no Hospital João XXIII. Foram incluídas crianças menores de 14 anos que foram classificadas como vítimas de trauma de "muito urgência" ou "emergência" pelo protocolo de Manchester. Foi realizada análise descritiva, que incluiu as seguintes variáveis: idade, sexo, mecanismo de trauma, especialidade médica do provedor de primeira avaliação, necessidade de procedimentos cirúrgicos, propedêutica e óbito. Resultados: A média de idade dos pacientes foi 6,9 anos. O principal mecanismo de trauma identificado foi a lesão por queda mecânica (104; 37,9%). O traumatismo cranioencefálico foi o tipo de trauma mais frequente observado, acometendo 174 (65,4% dos pacientes). No total, 44 (16,1%) crianças foram operadas. Cinco crianças (1,8%) morreram durante o período desta avaliação epidemiológica. Conclusão: O mecanismo de trauma pediátrico mais frequente foi a queda mecânica, a lesão mais comum foi o traumatismo cranioencefálico, as crianças do sexo masculino foram mais afetadas do que as do sexo feminino. A avaliação focada com ultrassonografia no trauma demonstrou ser um exame seguro para triagem de lesão traumática. Este estudo revelou informações importantes para futuras atualizações em protocolos de trauma pediátrico.
Purpose: To describe the epidemiology of pediatric patients admitted to a trauma center in Minas Gerais, Brazil, as well as to characterize the care received since; characterize the data from hospital admission to the propaedeutics. Methods: This is a retrospective study whose data collection took place between October 2017 and March 2018 at Hospital João XXIII. Data were collected in all children under 14 years of age who were classified as victims of trauma of "very urgent" or "emergency" according to the Manchester protocol. Descriptive analysis was performed, including the following variables: age, gender, trauma mechanism, medical specialty of the first assessment provider, need for surgical procedures, propaedeutics and death. Results: The mean age of patients was 6.9 years. The main trauma mechanism identified was mechanical fall injury (104; 37.9%). Head trauma was the most frequent type of trauma observed, affecting 174 (65.4% of patients). In total, 44 (16.1%) children were operated. Five children (1.8%) died during the period of this epidemiological assessment. Conclusion: The most frequent pediatric trauma mechanism was mechanical fall, the most common injury was traumatic brain injury, male children were more affected than females. And the physician who performed the first assessment most frequently was general surgeons. The focused evaluation with ultrasonography in trauma proved to be a safe exam for the screening of traumatic injuries. This study revealed important information to inform future updates on pediatric trauma primary assessment protocols.
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Pediatrics , Wounds and Injuries , Health Profile , Epidemiology
Objetivo: investigar o conhecimento de adolescentes escolares sobre álcool e outras drogas e sua opinião acerca de tecnologias educacionais para prevenção do consumo. Método: estudo descritivo com abordagem qualitativa realizado com 86 adolescentes cursando o ensino médio. Os dados foram coletados utilizando um instrumento de aplicação autoadministrada e processados nos programas IRaMuTeQ 0.7 alpha 2 e SPSS versão 20.0. Resultados: a análise lexical mostrou três classes semânticas: consequência, representação e definição do álcool e outras drogas para os adolescentes. A tecnologia educacional escolhida pela maioria foi o vídeo e o aplicativo móvel, que versam sobre consequências e efeitos associados ao uso das substâncias e as formas de se evitar ou até mesmo utilizá-las. Conclusão: os resultados mostraram que os adolescentes possuem pouco conhecimento sobre a temática e que tecnologias educacionais digitais podem ser estratégias de educação em saúde eficazes para prevenção do consumo de álcool e outras drogas entre o público-alvo.
Objective: investigating the knowledge of school teenagers about alcohol and other drugs and their opinion about educational technologies for prevention of consumption. Method: a descriptive study with qualitative approach conducted with 86 teenagers attending high school. Data were collected using a self-administered and processed application instrument in the IRaMuTeQ 0.7 alpha 2 and SPSS version 20.0 programs. Results: a lexical analysis showed three semantic classes: consequence, representation and definition of alcohol and other drugs for teenagers. The educational technology chosen by the majority were video and the mobile application, which deal with consequences and effects associated with the use of substances and ways to avoid or even use them. Conclusion: the results showed that teenagers have little knowledge about the subject and that digital educational technologies can be effective health education strategies to prevent alcohol and other drugs consumption among them.
Objetivo: poner en claro el conocimiento de los adolescentes escolares acerca del alcohol y otras drogas y su opinión acerca de las tecnologías educativas para la prevención del consumo. Método: un estudio descriptivo con enfoque cualitativo realizado con 86 adolescentes que asistían a la escuela secundaria. Los datos se recogieron mediante un instrumento de aplicación autoadministrado y procesado en los programas IRaMuTeQ 0.7 Alpha 2 y SPSS versión 20.0. Resultados: el análisis léxico mostró tres clases semánticas: consecuencia, representación y definición de alcohol y otras drogas para adolescentes. La tecnología educativa elegida por la mayoría fue el video y la aplicación móvil, que se ocupan de las consecuencias y efectos asociados con el uso de sustancias y las formas de evitarlas o incluso usarlas. Conclusión: los resultados mostraron que los adolescentes tienen poco conocimiento sobre el tema y que las tecnologías educativas digitales pueden ser estrategias efectivas de educación para la salud para prevenir el consumo de alcohol y otras drogas entre ellos.
Humans , Primary Prevention , Adolescent , Educational Technology , Substance-Related Disorders , Alcoholism
Objetivo: identificar as atitudes de adolescentes escolares sobre o consumo de álcool e outras drogas. Método: estudo transversal, realizado com 324 adolescentes do ensino médio de escola pública, no período de setembro a dezembro de 2018, utilizando a Escala de Representações Sociais do Consumo de Álcool e Drogas em Adolescentes. Resultados: a maioria dos adolescentes afirmou não consumir álcool (52,2%), tabaco (92,6%) ou drogas ilícitas (91,4%); os que não consumiam drogas apresentaram baixa tendência para usá-las (82,9%), enquanto que, entre os que consumiam, era elevada a tendência para manter essa conduta (77,3%). As atitudes para o consumo mostraram influência do ambiente, de amigos e de familiares, além do tipo de droga a ser consumida; a religião foi identificada como fator protetor. Conclusão: as atitudes de adolescentes escolares sobre o consumo de álcool e outras drogas indicaram que havia uma tendência de reprodução comportamental desse consumo.
Objetivo: identificar las actitudes de los adolescentes en edad escolar sobre el consumo de alcohol y otras drogas. Método: estudio transversal, realizado con 324 adolescentes de bachillerato público, de septiembre a diciembre de 2018, utilizando la Escala de Representaciones Sociales del Consumo de Alcohol y Drogas en Adolescentes. Resultados: la mayoría de los adolescentes reportaron no consumir alcohol (52,2%), tabaco (92,6%) o drogas ilícitas (91,4%); los que no consumieron drogas mostraron una baja tendencia a consumirlas (82,9%), mientras que entre los que las consumieron, la tendencia a mantener esta conducta (77,3%) fue alta. Las actitudes hacia el consumo mostraron influencia del entorno, amigos y familiares, además del tipo de droga a consumir; la religión fue identificada como un factor protector. Conclusión: las actitudes de los adolescentes escolares sobre el consumo de alcohol y otras drogas indicaron que existía una tendencia de reproducción conductual de este consumo.
Objective: to identify the attitudes of school adolescents about the consumption of alcohol and other drugs. Method: cross-sectional study, conducted with 324 adolescents from public high school, from September to December 2018, using the Scale of Social Representations of Alcohol and Drug Consumption in Adolescents. Results: most adolescents reported not consuming alcohol (52.2%), tobacco (92.6%) or illicit drugs (91.4%); those who did not use drugs showed a low trend to use them (82.9%), while among those who consumed them, the trend to maintain this conduct (77.3%) was high. Attitudes towards consumption showed influence of the environment, friends and family, in addition to the type of drug to be consumed; religion was identified as a protective factor. Conclusion: the attitudes of school adolescents about the consumption of alcohol and other drugs indicated that there was a trend of behavioral reproduction of this consumption.
Humans , Male , Female , Adolescent , Adult , Health Knowledge, Attitudes, Practice , Substance-Related Disorders , Adolescent Health , Underage Drinking , Cross-Sectional Studies
PURPOSE: To evaluate national trends in tube-related genitourinary interventions, with specific attention to primary operator specialty. METHODS: Using a 5% national sample of Medicare claims data from 2005 to 2015, all claims associated with nephrostomy tube, nephro-ureteral tube, and ureteral stent placement and exchange were identified. The annual volume of the nine billable procedures were analyzed to evaluate trends in the number of procedures performed and primary operator specialty over time. The Charleston Comorbidity Index (CCI) was used to evaluate patient comorbidities and to determine differences in patient populations treated by interventional radiologists and urologists. RESULTS: The total volume of tube-related genitourinary interventions has increased over the course of the study period, representing 455.0 services per 100,000 Medicare Fee-for-Service beneficiaries in 2005 to 607.2 services in 2015, an increase of 33.4%. Interventional radiologists performed the majority of all procedures in all procedure types and for each year (>90%) with the exception of nephro-ureteral catheter placement or ureteral stent placement, for which urologists performed the overwhelming majority of procedures each year (>85%). Interventional radiologists performed 63% of their total number of procedures on patients with a CCI = 3 or higher, and urologists performed 42% of their total number of procedures on patients with a CCI = 3 or higher (P < .01). CONCLUSION: Tube-related genitourinary interventions have demonstrated persistent growth over the 2005 to 2015 decade. Interventional radiologists are the dominant providers for the majority of these interventions compared with urologists while delivering care to a patient population with a higher number of comorbidities.
Medicare , Medicine , Aged , Fee-for-Service Plans , Humans , Radiologists , United States
OBJECTIVE. The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits. MATERIALS AND METHODS. This retrospective study was conducting using 5% Research Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis. RESULTS. Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% (n = 25,245) occurred at rural hospitals and 15.81% (n = 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio [OR] = 0.931, p = 0.015) and 18.0% less likely (OR = 0.820, p < 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684, p < 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941, p = 0.05) and Black (OR = 0.808, p = 0.047) rural ED patients were less likely to undergo advanced imaging. CONCLUSION. Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.
Diagnostic Imaging/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Health Services Accessibility , Healthcare Disparities/statistics & numerical data , Insurance Benefits , Medicare , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Procedures and Techniques Utilization , Retrospective Studies , United States
Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.
Helminthiasis/complications , Leprosy/complications , Micronutrients/deficiency , Adult , Case-Control Studies , Coinfection , Female , Humans , Male , Middle Aged , Multivariate Analysis , Pilot Projects
OBJECTIVE. Nonphysician providers (NPPs) increasingly perform imaging-guided procedures, but their roles interpreting imaging have received little attention. We characterize diagnostic imaging services rendered by NPPs (i.e., nurse practitioners and physician assistants) in the Medicare population. MATERIALS AND METHODS. Using 1994-2015 Medicare Physician/Supplier Procedure Summary Master Files, we identified all diagnostic imaging services, including those billed by NPPs, and categorized these by modality and body region. Using 2004-2015 Medicare Part B 5% Research Identifiable File Carrier Files, we separately assessed state-level variation in imaging services rendered by NPPs. Total and relative utilization rates were calculated annually. RESULTS. Between 1994 and 2015 nationally, diagnostic imaging services increased from 339,168 to 420,172 per 100,000 Medicare beneficiaries (an increase of 24%). During this same period, diagnostic imaging services rendered by NPPs increased 14,711% (from 36 to 5332 per 100,000 beneficiaries) but still represented only 0.01% and 1.27% of all imaging in 1994 and 2015, respectively. Across all years, radiography and fluoroscopy constituted most of the NPP-billed imaging services and remained constant over time (e.g., 94% of all services billed in 1994 and 2015), representing only 0.01% and 2.1% of all Medicare radiography and fluoroscopy services. However, absolute annual service counts for NPP-billed radiography and fluoroscopy services increased from 10,899 to 1,665,929 services between 1994 and 2015. NPP-billed imaging was most common in South Dakota (7987 services per 100,000 beneficiaries) and Alaska (6842 services per 100,000 beneficiaries) and was least common in Hawaii (231 services per 100,000 beneficiaries) and Pennsylvania (478 services per 100,000 beneficiaries). CONCLUSION. Despite increasing roles of NPPs in health care across the United States, NPPs still rarely interpret diagnostic imaging studies. When they do, it is overwhelmingly radiography and fluoroscopy. Considerable state-to-state variation exists and may relate to local care patterns and scope-of-practice laws.
Diagnostic Imaging/economics , Insurance Claim Review , Medicare Part B/economics , Nurse Practitioners/economics , Physician Assistants/economics , Professional Role , Aged , Diagnostic Imaging/statistics & numerical data , Female , Humans , Male , Nurse Practitioners/statistics & numerical data , Physician Assistants/statistics & numerical data , United States
Cardiovascular Diseases , Geriatrics , Health Services for the Aged , Societies, Medical , Aged , Aged, 80 and over , Brazil , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cardiovascular Diseases/therapy , Cause of Death , Female , Guidelines as Topic , Humans , Male , Middle Aged , Risk Factors
Development: The Department of Geriatric Cardiology of the Brazilian Society of Cardiology (Departamento de Cardiogeriatria da Sociedade Brasileira da Cardiologia) and the Brazilian Geriatrics and Gerontology Society (Sociedade Brasileira de Geriatria e Gerontologia). (AU)
Humans , Male , Female , Aged , Aged, 80 and over , Societies, Medical , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cardiovascular Diseases/therapy , Geriatrics , Health Services for the Aged , Brazil , Risk Factors , Cause of Death , Guidelines as Topic , Middle Aged
Objetivo: avaliar oficinas educativas para a prevenção do uso de drogas na ótica dos adolescentes. Método: trata-se de estudo qualitativo, transversal, com adolescentes do Ensino Médio por meio de entrevistas, transcritas e processadas no software IRAMUTEQ utilizando-se, para a análise, a classificação hierárquica descendente e a nuvem de palavras. Apresentaram-se os resultados em forma de figuras e depoimentos. Resultados: analisaram-se 18 entrevistas, das quais, a partir da classificação hierárquica descendente, emergiram duas categorias para discussão: "O que a gente achou: avaliação da metodologia" e "O que a gente quer saber: avaliação dos conteúdos abordados". Informa-se que, na nuvem de palavras, as palavras mais frequentes foram "não", "mais" e "droga". Conclusão: tornam-se necessários uma maior discussão e o aprofundamento por parte dos profissionais que estão na ponta dos serviços de saúde e educação para que estes possam realizar atividades baseadas em metodologias ativas em seus locais de atuação, relacionadas à prevenção do uso de drogas, para que os adolescentes efetivamente sejam partícipes do processo educativo na temática, considerando o seu contexto e experiências.(AU)
Objective: to evaluate educational workshops for the prevention of drug use from the perspective of adolescents. Method: this is qualitative study, cross-sectional, with high school adolescents through interviews, transcribed and processed in the IRAMUTEQ software using for analysis the descending hierarchical classification and the generated word cloud. The results were presented in the form of figures and statements. Results: 18 interviews were analyzed, from which, from the descending hierarchical classification, two categories emerged for discussion: "What we found: methodology evaluation" and "What we want to know: evaluation of the content addressed". It is reported that, in the word cloud, the most frequent words were "no", "more" and "drug". Conclusion: a greater discussion and deepening on the part of the professionals who are at the end of the services of health and education are necessary so that these can carry out activities based on active methodologies in their places of action, related to the prevention of the use of drugs, so that adolescents are effectively involved in the educational process on the subject, considering their context and experiences.(AU)
Objetivo: evaluar talleres educativos para la prevención del uso de drogas en la óptica de los adolescentes. Método: se trata de un estudio cualitativo, transversal, realizado con adolescentes de la secundaria por medio de entrevistas, transcritas y procesadas en el software IRAMUTEQ utilizando, para el análisis, la clasificación jerárquica descendente y la nube de palabras. Se presentaron los resultados en forma de figuras y testimonios. Resultados: se analizaron 18 entrevistas, de las cuales, a partir de la clasificación jerárquica descendente, emergieron dos categorías para discusión: "Lo que la gente encontró: evaluación de la metodología" y "Lo que la gente quiere saber: evaluación de los contenidos abordados". Se dice que, en la nube de palabras, las palabras más frecuentes fueron "no", "más" y "droga". Conclusión: se hace necesaria una mayor discusión y la profundización por parte de los profesionales que están en la punta de los servicios de salud y educación para que éstos puedan realizar actividades basadas en metodologías activas en sus locales de actuación, relacionadas a la prevención del uso de drogas, para que los adolescentes efectivamente sean partícipes del proceso educativo en la temática, considerando su contexto y experiencias.(AU)
Humans , Male , Female , Adolescent , Perception , School Health Services , Health Education , Adolescent , Problem-Based Learning , Substance-Related Disorders/prevention & control , Alcohol-Related Disorders/prevention & control , Education, Primary and Secondary , Cross-Sectional Studies , Qualitative Research
This study sought to understand the meaning that women place on the health care practices carried out during labor. We used techniques from Grounded Theory such as coding, categorization, and constant comparison. A total of 18 interviews were conducted with 16 women who had given birth at least once in Colombia. Based on our results, we argue that obstetric violence is an expression of violence during the provision of health care, which occurs in a social environment favoring the development of power relationships between patients and health care staff. Its origin might lie in a health care system whose political and economic foundations encourage inequality on the basis of the patients' purchasing power. We conclude that rethinking and redefining the concept of obstetric violence is essential for understanding its nature and having an impact on it.
Health Personnel/psychology , Labor, Obstetric/psychology , Parturition/psychology , Violence/psychology , Adolescent , Adult , Attitude of Health Personnel , Authoritarianism , Colombia , Family Relations/psychology , Female , Grounded Theory , Humans , Interviews as Topic , Pregnancy , Qualitative Research , Social Environment , Young Adult
