ABSTRACT
Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and by patients, especially older ones. We discuss some suggestions on how to overcome these challenges.
ABSTRACT
Introducción. Las fracturas de apófisis odontoides constituyen entre un 10 y un 15 por ciento de todas las fracturas cervicales. Decidir cuándo operarlas es un problema controvertido hoy en día; el dilema quirúrgico frente al conservador continúa vigente. Pacientes y métodos. Se diseñó un estudio descriptivo, prospectivo para todos los pacientes que con diagnóstico de fractura de apófisis odontoides, ingresaron en el Servicio de Neurocirugía del Hospital Central de Maputo (Mozambique), desde junio de 1997 hasta mayo de 1998. El seguimiento evolutivo se cumplió sistemáticamente hasta mayo del 2000. Todos recibieron tratamiento conservador con collar cervical de yeso. Resultados. Se diagnosticaron 6 casos, con predominio para el sexo masculino (83,3 por ciento). Las edades estuvieron comprendidas entre los 17 y 42 años con una media de 26,16 años. La etiología más común fue el accidente del tráfico con un 66,6 por ciento. La fractura tipo II fue la más frecuente con 4 afectados. El 100 por ciento de los estudiados referían dolor en la región posterior del cuello. Se encontró disparesia e igualmente monoparesia braquial en el 33,3 por ciento de los sujetos. Cuatro consolidaron la fractura al tercer mes, uno en el segundo y el otro en el cuarto mes. El 66,6 por ciento evolucionaron con recuperación total. Conclusiones. Los autores recomiendan -basándose en la revisión de la literatura y en su experiencia práctica- para las fracturas tipos I y III tratamiento conservador, para las tipo IIA quirúrgico inmediato y para las tipo II quirúrgico en dependencia de varios factores: desplazamiento mayor de 4 mm, edad superior a 40 años, así como diagnóstico tardío más de una semana (AU)
Subject(s)
Adolescent , Adult , Male , Female , Humans , Spinal Fractures , Mozambique , Odontoid Process , Prospective Studies , Accidents, Traffic , Fracture Fixation, InternalABSTRACT
INTRODUCTION: Fractures of the odontoid process make up between 10 and 15% of all cervical fractures. The decision as to when to operate on them is still controversial; the dilemma as to whether to use surgical or conservative treatment is still a problem. PATIENTS AND METHODS: We designed a descriptive study, which was prospective and applied to all patients diagnosed as having a fracture of the odontoid process, admitted to the Neurosurgical Department of Maputo Central Hospital (Mozambique) between June 1997 and May 1998. Follow up was rigorously controlled up to May 2000. All were treated conservatively with a cervical plaster collar. RESULTS: Six cases (83.3%), mainly male, were diagnosed. The patients were aged between 17 and 42 years, with an average age of 26.16 years. The commonest aetiology was a traffic accident (66.6%). Type II fractures were the commonest, seen in 4 patients. All patients complained of pain in the back of their necks. Dysparesia and brachial monoparesia were both seen in 33.3% of the patients. In four cases the fracture consolidated in three months, one in two months and the other after four months. Full recovery was made by 66.6%. CONCLUSIONS: Based on their review of the literature and own practical experience, the authors recommend conservative treatment for fractures of types I and II, immediate surgical operation for type IIA and for type II when the following conditions are met: displacement of over 4 mm, age of over 40 years and diagnosis made over a week after the injury had occurred.
Subject(s)
Odontoid Process/injuries , Spinal Fractures/therapy , Accidents, Traffic , Adolescent , Adult , Female , Fracture Fixation, Internal , Humans , Male , Mozambique , Prospective Studies , Spinal Fractures/surgeryABSTRACT
A simple and efficient procedure called the "two stage" technique for total removal of intramedullary tumors is described. MRI, CUSA, and CO2 laser have revolutionized the diagnosis and treatment of spinal cord tumors, allowing precise demonstration of the lesions and safe removal without exacerbating neurosurgical deficit. These useful and efficient apparatus are not only expensive, they are still not yet available in many neurosurgical centers throughout the world. Neurosurgeons deprived of these important tools can, however, approach or even equate the current clinical results. The "two stage" technique is not meant to substitute for CUSA, CO2 laser, and MRI.
