ABSTRACT
La miocardiopatía dilatada es la principal causa de insuficiencia cardíaca que lleva a trasplante cardíaco. Su pronóstico es variable y depende de la etiología, la edad de presentación y el grado de insuficiencia cardíaca. El manejo está orientado a minimizar los síntomas y evitar la progresión de la enfermedad; se requiere de una evaluación integral en la pesquisa de comorbilidades y prevención de complicaciones que permitan mejorar la condición general de estos niños y atenuar su pronóstico. A continuación, se realiza una revisión orientada al manejo multidisciplinario que el pediatra debería considerar a la hora de enfrentarse a este tipo de pacientes.
Dilated cardiomyopathy is the main cause of heart failure leading to heart transplant. Its prognosis is variable and depends on the etiology, the patient's age at onset, and the severity. The management of dilated cardiomyopathy is aimed at minimizing symptoms and preventing disease progression; it requires a comprehensive screening for comorbidities and the prevention of complications to improve the overall status of these children and mitigate their prognosis. Here we present a review oriented at the multidisciplinary management that pediatricians should consider when seeing these patients.
Subject(s)
Humans , Child , Cardiomyopathy, Dilated/complications , Heart Failure/etiology , Prognosis , Severity of Illness Index , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated/therapy , Mass Screening/methods , Heart Transplantation/methods , Age of Onset , Disease Progression , Pediatricians , Heart Failure/physiopathology , Heart Failure/therapyABSTRACT
Dilated cardiomyopathy is the main cause of heart failure leading to heart transplant. Its prognosis is variable and depends on the etiology, the patient's age at onset, and the severity. The management of dilated cardiomyopathy is aimed at minimizing symptoms and preventing disease progression; it requires a comprehensive screening for comorbidities and the prevention of complications to improve the overall status of these children and mitigate their prognosis. Here we present a review oriented at the multidisciplinary management that pediatricians should consider when seeing these patients.
La miocardiopatía dilatada es la principal causa de insuficiencia cardíaca que lleva a trasplante cardíaco. Su pronóstico es variable y depende de la etiología, la edad de presentación y el grado de insuficiencia cardíaca. El manejo está orientado a minimizar los síntomas y evitar la progresión de la enfermedad; se requiere de una evaluación integral en la pesquisa de comorbilidades y prevención de complicaciones que permitan mejorar la condición general de estos niños y atenuar su pronóstico. A continuación, se realiza una revisión orientada al manejo multidisciplinario que el pediatra debería considerar a la hora de enfrentarse a este tipo de pacientes.
Subject(s)
Cardiomyopathy, Dilated/complications , Heart Failure/etiology , Pediatricians/organization & administration , Age of Onset , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated/therapy , Child , Disease Progression , Heart Failure/physiopathology , Heart Failure/therapy , Heart Transplantation/methods , Humans , Mass Screening/methods , Prognosis , Severity of Illness IndexABSTRACT
BACKGROUND: Psychosocial working conditions are well-known determinants of poor mental health. However, studies in mining populations where employment and working conditions are frequently precarious have, to our knowledge, only focused on occupational accidents and diseases. OBJECTIVES: The aim of this study was to assess psychosocial working conditions and psychological distress in Andean underground miners. METHODS: The study population consisted of 153 Bolivian miners working in a silver mining cooperative, 137 Chilean informal gold miners, and 200 formal Peruvian silver miners employed in a remote setting. High work demands, minimal work control, minimal social support at work, and workplace exposure to violence and bullying were assessed using the Spanish short form of the European Working Condition Survey. A general health questionnaire score >4 was used as cutoff for psychological distress. Associations between psychosocial work environment and psychological distress were tested using logistic regression models controlling for potential confounding and effect modification by country. FINDINGS: Prevalence of psychological distress was 82% in the Bolivian cooperative miners, 29% in the Peruvian formal miners, and 22% in the Chilean informal miners (pχ(2) < 0.001). 55% of the miners had suffered violence during the 12-months before the survey. Workplace demands were high (median 12.5 on a scale from 7-14), as was social support (median 5.5 on a scale from 3-6). After adjustment for country and other relevant exposure variables and considering interactions between country and job strain, miners in active (odds ratio [OR], 6.8; 95% confidence interval [CI] 2.1-22.7) and high strain jobs (OR, 7.2; 95% CI, 1.7-29.9) were at increased odds of distress compared with those in low strain jobs. Violence at work also contributed to increased odds of distress (OR, 1.86; 95% CI, 1.1-3.1). CONCLUSIONS: Psychological distress is associated with the psychosocial work environment in Andean underground miners. Interventions in mining populations should take the psychosocial work environment into account.
Subject(s)
Bullying , Miners/statistics & numerical data , Social Support , Stress, Psychological/epidemiology , Workplace Violence/statistics & numerical data , Adult , Bolivia/epidemiology , Chile/epidemiology , Cross-Sectional Studies , Employment , Humans , Logistic Models , Male , Miners/psychology , Mining , Odds Ratio , Peru/epidemiology , Prevalence , Stress, Psychological/psychology , Workplace , Workplace Violence/psychologyABSTRACT
BACKGROUND: Nicotinamide has been used with success to prevent type 1 diabetes in animal models and humans. This vitamin B3 derivative has attracting effects on beta-cell protection and regeneration. AIM/HYPOTHESIS: To evaluate the effect of standard nicotinamide administration on type 1 diabetes prevention in first degree relatives of persons with type 1 diabetes as well as on the concentrations of islet-cell-related autoantibodies, insulin secretion and peripheral sensitivity. SUBJECTS AND METHODS: A randomized double-blind placebo controlled intervention trial was conducted in 40 first degree relatives of type 1 diabetic patients. Persistence of ICA ( >or= 10 JDF units) was among inclusion criteria. Participants were randomly allocated oral standard nicotinamide (1.2 g/m2) or placebo for 5 years. Groups were also stratified by age. Islet associated antibodies, fasting blood glucose, fasting plasma insulin concentrations, OGTT, IVGTT and HLA-DR genotyping were performed in all participants. The main criterion to stop treatment was type 1 diabetes development as defined by WHO. RESULTS: Type 1 diabetes development frequencies were similar between the treatment groups. ICA frequencies at the end of the study, first phase insulin release, and insulin sensitivity did not differ between groups as well. None of the participants suffered from any adverse events described for nicotinamide. CONCLUSIONS: Type 1 diabetes prevention trial using standard nicotinamide is feasible but fails to prevent or delay the disease onset at the dose we used.