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1.
Barbarói ; (58): 195-217, jan.-jun. 2021.
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1150846

ABSTRACT

O presente artigo tem como objetivo traçar um paralelo entre o movimento feminista e o movimento antimanicomial procurando pontos de convergência e divergência entre ambos, a fim de verificar suas possíveis articulações. Para isso, por meio de revisão bibliográfica, busca-se contextualizar os movimentos sociais e realizar a análise histórica de ambos, afim de esclarecer suas motivações, formas de atuação na luta por direitos e atendimento de demandas dos sujeitos envolvidos com pretensões de alcançar transformações sociais. Dessa forma, o material discute as confluências e divergências entre o movimento feminista e antimanicomial, na tentativa de ampliar e construir o debate acadêmico acerca do assunto, que se transforma diariamente, de modo democrático e dialético. À guisa de conclusão, considera-se a necessidade de constituir novas formas de pensar sobre nossa condição histórica, com intuito de que isso possibilite a criação de estratégias de reinvenção e recriação constante de coletivos de luta e que promovam movimentos de resistências aos poderes instituídos que submetem mulheres e sujeitos em sofrimento psíquico, com objetivos de constituir mudanças e responsabilização social para que os absurdos tolerados por parcela considerável da sociedade não se reproduzam.(AU)


The present study aims to draw a parallel between the feminist and the anti-asylum movements looking for convergence and divergence points between both, in order to verify their possible articulations. To do so, through bibliographic review, it seeks to contextualize the social movements and carry out the historical analysis of both, in order to clarify their motivations, ways of acting in the fight for rights and meeting the demands of the subjects involved with the pretensions of achieving social transformations. This way, this paper discusses the confluences and divergences between the feminist and anti-asylum movement, in an attempt to broaden and build the academic debate on the subject, which changes daily, in a democratic and dialectical way. By way of conclusion, it is considered the need to constitute new ways of thinking about our historical condition, in order to allow the creation of strategies of constant reinvention recreation of fight collectives and that it promotes resistance movements against instituted powers which subject women and individuals in psychological distress, with the goal to constitute changes and social responsability so that the absurdities tolerated by a considerable part of society are not reproduced.(AU)


El presente estudio tiene como objetivo comprender las posibles conexiones entre el movimiento feminista y el movimiento contra el asilo buscando puntos de convergencia y divergencia entre ambos, con el fin de verificar sus posibles articulaciones. Para esto, a través de la revisión bibliográfica, se busca contextualizar los movimientos sociales y realizar el análisis histórico de ambos para aclarar sus motivaciones, formas de actuar en la lucha por los derechos y atender las demandas de los sujetos involucrados con las pretensiones de logrando transformaciones sociales. De esta manera, este trabajo discute las confluencias y divergencias entre el feminismo y el movimiento contra el asilo, en un intento por ampliar el debate académico sobre el tema, que cambia a diario, de manera democrática y dialéctica. En conclusión, consideramos la necesidad de establecer nuevas formas de pensar sobre nuestra condición histórica, con la intención de posibilidad de creación de estrategias de reinvención y recreación constante de la lucha colectiva y que promueva movimientos de resistencia a los poderes establecidos que someten a las mujeres y individuos en malestar psicológico, con fines constitutivos de cambios y responsabilidad social para que no se reproduzcan los absurdos tolerados por una parte considerable de la sociedad.(AU)


Subject(s)
Humans , Female , Women , Mental Health , Feminism , Capitalism , Social Norms
2.
Rev. SPAGESP ; 22(1): 160-174, ene.-jun. 2021.
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155521

ABSTRACT

Há crescente interesse sobre o comportamento abusivo sofrido por trabalhadores nas cozinhas de restaurantes comerciais, uma vez que agressões físicas e verbais parecem ser comuns neste contexto laboral. Este estudo objetivou identificar a prevalência do assédio moral e descrever as características das situações em que ele ocorre entre trabalhadores da gastronomia. Participaram do estudo 160 indivíduos com graduação em gastronomia, sendo que 95 eram do sexo feminino (59,4%), com idade média de 30,81 anos (DP = 8,34). Os mesmos responderam ao Questionário Biossociodemográfico e Laboral e ao Questionário de Atos Negativos, cujos dados foram analisados descritivamente. Os resultados indicaram elevados índices de prevalência de assédio moral (63,1%) e de violência psicológica (33,8%), que alertam sobre a importância de divulgar informações sobre o assédio moral e seus prejuízos, visando a uma maneira mais saudável de gerenciar e trabalhar na cozinha.


Great interest in abusive behavior suffered by workers in commercial restaurant kitchens was observed. In this work context, verbal and physical aggression seems to be common. This study aimed to identify the prevalence of moral harassment and describe the characteristics of the situations in which it occurs among gastronomy workers. Participants were 160 individuals undergraduate in gastronomy and 95 were female (59.4%), that have an average age of 30.81 years (SD = 8.34). The participants answered the Biosociodemographic and Labor Questionnaire and the Negative Acts Questionnaire, whose data were analyzed descriptively. The results indicated high prevalence rates of moral harassment (63.1%) and psychological violence (33.8%), which warn the importance of disclosing information about bullying and its harms, aiming at a healthier way to manage and work in the kitchen.


Una creciente preocupación por el comportamiento abusivo que sufren los trabajadores en las cocinas de restaurantes comerciales ha sido observada. Esta agresión puede ser verbal o física y parece ser común en este contexto laboral. Este estudio tuvo como objetivo identificar la prevalencia del bullying y describir las características de las situaciones en las que ocurre entre los trabajadores de la gastronomía. Los participantes fueron 160 individuos con un título en gastronomía, de los cuales 95 eran mujeres (59.4%), con una edad promedio de 30.81 años (DE = 8.34). Los participantes respondieron el Cuestionario Biosociodemográfico y Laboral y el Cuestionario de Actos Negativos, cuyos datos fueron analizados descriptivamente. Los resultados indicaron altas tasas de prevalencia de acoso moral (63.1%) y violencia psicológica (33.8%), que advierten sobre la importancia de divulgar información sobre el acoso y sus daños, con el objetivo de una forma más saludable de manejar y trabajar en la cocina.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Restaurants , Work , Surveys and Questionnaires , Cooking , Aggression , Bullying , Workplace Violence , Occupational Groups
3.
Rev. SPAGESP ; 22(1): 145-159, ene.-jun. 2021. tab
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155520

ABSTRACT

Este estudo teve como objetivo identificar e analisar se os sintomas de depressão, ansiedade e estresse estão relacionados com uso de álcool, tabaco e maconha em universitários da área da saúde. Trata-se de uma pesquisa com 111 universitários matriculados em cursos da área da saúde de uma universidade da região metropolitana do Rio Grande do Sul. Os instrumentos foram Questionário de dados sociodemográficos, Depression, Anxiety and Stress Scale (DASS-21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Foi realizada análise descritiva dos dados e correlação de Spearman para amostras não paramétricas. As drogas mais utilizadas foram álcool, tabaco e maconha, sendo o álcool o que mais pontuou. Houve correlações significativas entre o uso de drogas com sintomas de estresse e ansiedade. Destaca-se a necessidade de atentar para o uso de substâncias realizado por universitários da área da saúde, uma vez que esta pode acarretar danos à vida acadêmica, pessoal e profissional.


This study aimed to identify the relationship between anxiety, depression, and stress symptoms and alcohol, marijuana, and tobacco use among healthcare university students. There were 111 students from healthcare courses of a private university from the state of Rio Grande do Sul's metropolitan region, Brazil, in the present sample. The instruments were sociodemographic questionnaire; Depression, Anxiety and Stress Scale (DASS-21); Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and Spearman’s correlation analyses were done. The most frequently used drug was alcohol, followed by marijuana and tobacco. There were significant correlationsbetween substance use and stress and anxiety symptoms. It is evidenced that there is a need to pay attention to drug use among healthcare students, since such use can cause damage to academic, personal and professional life.


Este estudio tuvo como objetivo identificar y analizar si los síntomas de estrés, ansiedad, depresión, están relacionados con el uso de alcohol, tabaco y marihuana en estudiantes universitariosen el área de la salud. Esta es una encuesta de 111 estudiantes universitarios inscritos en cursos del area de la salud de una Universidad en la región metropolitana de Rio Grande do Sul. Instrumentos: Cuestionario de datos sociodemográficos, Escala de depresión, ansiedad y estrés (DASS-21), Prueba de detección de alcohol, tabaquismo y participación de sustancias (ASSIST). Se realizó análisis descriptivo de los datos y correlación de Spearman para muestras no paramétricas. Resultados: las drogas más utilizadas fueron alcohol, tabaco y marihuana, siendo el alcohol el que obtuvo la mayor puntuación. Hubo correlaciones significativas entre el uso de drogas con síntomas de estrés y ansiedad. Se destaca la necesidad de prestar atención al uso de substancias por parte de los estudiantes universitarios en el campo de la salud, ya que esto pueden causar daños a la vida académica, personal y profesional.


Subject(s)
Humans , Male , Female , Adult , Anxiety , Signs and Symptoms , Students, Health Occupations , Tobacco Use Disorder , Universities , Cannabis , Surveys and Questionnaires , Delivery of Health Care , Depression , Tobacco Use
4.
Rev. SPAGESP ; 22(1): 83-97, ene.-jun. 2021.
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155516

ABSTRACT

Partimos do trabalho em uma instituição de acolhimento para crianças e adolescentes propondo uma escuta orientada pela psicanálise. Considerando as tensões entre instituição e psicanálise, a questão que nos orienta é de que forma a transferência pode contribuir para uma instauração de escuta, que permitirá a elaboração da situação de vulnerabilidade desses sujeitos. Utilizamos como método de pesquisa a revisão bibliográfica associada à psicanálise aplicada e recorremos aos fragmentos de recordação das situações vividas no cotidiano institucional. Concluiu-se que há um lugar de escuta sob transferência a ser considerada na instituição e que o Plano Individual de Atendimento (PIA) necessita ser efetivado sob transferência, para que seja implementado como instrumento que valorize o surgimento das singularidades dos acolhidos.


We started from work at a host institution for children and adolescents, proposing a listening guided by psychoanalysis. Considering the tensions between institution and psychoanalysis, the question that guides us is how the transfer can contribute to establishing a listening that will allow the elaboration of the situation of vulnerability of these subjects. We used as a research method the bibliographic review associated with applied psychoanalysis and we also used fragments of remembrance of the situations experienced in the institutional daily life. It was concluded that there is a place of listening under the transfer to be considered in the institution and that the Individual Assistance Plan needs to be carried out under the transfer in order to be implemented as an instrument that values the emergence of the singularities of the sheltered.


Partimos desde el trabajo en una institución de acogida para niños y adolescentes proponiendo una escucha orientada por el psicoanálisis. Considerando las tensiones entre institución y psicoanálisis, la cuestión que nos orienta es de qué forma la transferencia puede contribuir al establecimiento de un escuchar que permitirá la elaboración de la situación de vulnerabilidad de esos sujetos. Utilizamos como método de investigación la revisión bibliográfica asociada al psicoanálisis aplicado y recurrimos a los fragmentos de recuerdos de las situaciones de la vida cotidiana institucional. Concluimos que hay un lugar de escucha bajo transferencia a ser considerado en la institución y que el Plan Individual de Atención necesita ser efectivado bajo transferencia para que sea implementado como un instrumento que valore el surgimiento de las singularidades de los acogidos.


Subject(s)
Humans , Male , Female , Child , Adolescent , Psychoanalysis , Attention , Orphanages , Disaster Vulnerability , Lodged , User Embracement , Child, Foster , Health Services Needs and Demand
5.
Rev. SPAGESP ; 22(1): 67-82, ene.-jun. 2021.
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155515

ABSTRACT

Visando analisar as concepções sobre a saúde mental infantojuvenil de enfermeiros da Estratégia Saúde da Família, este estudo, de natureza descritivo qualitativa, foi realizado com 47 enfermeiras, nas Unidades de Saúde da Família de João Pessoa PB, e partiu dos pressupostos das Políticas Públicas de Atenção à Saúde Mental para crianças e adol escentes Para coletar os dados utilizaram se um questionário sociodemográfico e entrevistas semiestruturadas, analisadas por meio da Análise Categorial Temática de Bardin, das quais emergiram uma classe temática, três categorias e sete subcategorias. Os resultados apontaram que as concepções sobre a SMI se pautam no modelo biomédico, sem ênfase na promoção da saúde e com pouca especificidade e familiaridade com questões relativas à saúde mental dessa população.


In order to analyze Family Health Strategy nurses' conceptions of child adolescent mental health, this descriptive qualitative study was conducted with 47 nurses, in the Family Health Units of João Pessoa PB, and started from the assumptions of the Public Policies of Mental Health Care for children and adolescents. Data were collected using a questionnaire, which captured the sociodemographic data, and semi structured interviews were analyzed through Bardin's Thematic Categorical Analysis, which originated a thematic class, three categories and seven subcategories. The results showed that the conceptions a re based on the biomedical model, with no emphasis on health promotion and with little specificity and familiarity with issues related to the mental healt h of this population.


Con el fin de analizar las concepciones sobre la salud mental de niños y adolescentes en las enfermer í as de la Estrategia de Salud Familiar, este estudio descriptivo cualitativo se llevó a cabo con 47 enfermeras, en Unidades de Salud Familiar de Joao Pesso a PB, a partir de los supuestos de las Políticas Públicas de Atención de Salud Mental para niños y adolescentes. Para recopilar los datos, se utilizó un cuestionario, que capturó los datos sociodemográficos, y entrevistas semiestructuradas, analizadas a tr avés del Análisis Categórico Temático de Bardin, de la que surgieron una clase temática, tres categorías y siete subcategorías. Los resultados mostraron que las concepciones sobre SMNA se basan en el modelo biomédico, sin énfasis en la promoción de la salu d y con poca especificidad y familiaridad con los temas relacionados con la salud mental de esta población.


Subject(s)
Humans , Female , Middle Aged , Mental Health , Family Health , Recognition, Psychology , Family Health Strategy , Health Care (Public Health) , Health Promotion , Nurses
6.
Rev. SPAGESP ; 22(1): 39-53, ene.-jun. 2021. tab
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155513

ABSTRACT

A ansiedade materna é um tema relevante de pesquisa no âmbito da relação mãe-bebê, pois esse sentimento pode trazer repercussões para mãe e o desenvolvimento do bebê. Este estudo de casos múltiplos, de caráter qualitativo, teve como objetivo investigar a ansiedade materna em mães de bebês de seis a 10 meses, buscando identificar sua repercussão na díade mãe-bebê. Os achados demonstraram a presença de complicações na gravidez e no pós-parto e de eventos estressantes durante esses períodos. Em todos os casos analisados, observou-se ansiedade materna na gravidez e nos primeiros cuidados com o bebê. Sentimentos como medo, angústia, dúvidas e preocupações, relatados pelas mães, desencadearam comportamentos ansiosos, refletindo na relação mãe-bebê. A partir dos relatos deste estudo, observa-se a importância do apoio para o empoderamento das mães, para que elas assumam o papel materno com mais confiança. Salienta-se a necessidade de intervenções desde a gestação para o manejo da ansiedade materna, bem como práticas de educação em saúde visando à promoção da saúde mental materno-infantil


Maternal anxiety is an important topic of research regarding the mother-child relationship because this feeling can impact the mother and the baby's development. This qualitative study, of a multiple-case design, aimed to investigate maternal anxiety in mothers of babies aged between six and 10 months, trying to identify its impact on the mother-child dyad. The findings showed the occurrence of complications in pregnancy and the postpartum period and stressful events during these periods. In all analyzed cases, the presence of maternal anxiety during pregnancy and the newborn early care was verified. Feelings such as fear, anguish, doubts, and concerns, reported by mothers, triggered anxious behaviors, reflecting on the mother-baby relationship. From the reports of this study, the importance of support for the empowerment of mothers was observed, so that they can assume the maternal role with more confidence. It points out the need for intervention programs since pregnancy for the management of maternal anxiety, as well as health education practices aiming to promote maternal and child mental health.


La ansiedad materna es un tema relevante de investigación en el ámbito de la relación madre-hijo, ya que este sentimiento puede tener repercusiones en la madre y en el desarrollo del bebé. Este estudio cualitativo, de casos múltiples, investigó la ansiedad materna en madres de niños de seis a 10meses, buscando identificar su impacto en la díada madre-hijo. Los resultados revelaron la presencia de complicaciones en el embarazo y en el posparto, y de eventos estresantes durante estos momentos. En los casos analizados, se observó ansiedad materna durante el embarazo y en el cuidado temprano del bebé. Sentimientos como el miedo, la angustia, las dudas y las preocupaciones, relatados por las madres, desencadenaron comportamientos ansiosos, reflejándose en la relación madre-bebé. A partir de los informes de este estudio se observa la importancia del apoyo para el empoderamiento de las madres, para que asuman ese rol con más confianza. Son necesarias intervenciones desde el embarazo para el tratamiento de la ansiedad materna, así como prácticas de educación con la finalidad de promoción de la salud mental materna y infantil.


Subject(s)
Humans , Female , Adult , Anxiety , Pregnancy Complications , Therapeutics , Behavior , Health Education , Parturition , Postpartum Period , Mother-Child Relations
7.
Rev. SPAGESP ; 22(1): 22-38, ene.-jun. 2021. ilus
Article in Portuguese | LILACS, Index Psychology - Scientific journals | ID: biblio-1155512

ABSTRACT

Objetivou-se compreender os procedimentos de recebimento e encaminhamento de notificações de casos de violência sexual realizados por conselheiros tutelares. Para isso, foram realizadas 10 entrevistas semiestruturadas com conselheiros/as tutelares de duas cidades do norte do Rio Grande do Sul. Os resultados indicaram pouca clareza na definição de violência sexual e de notificação. Foram consideradas notificações exitosas aquelas em que há informações de identificação de prováveis vítimas e agressores/as, enquanto as notificações não exitosas possuem poucas informações desses. Referente aos encaminhamentos, observou-se que há êxito quando os serviços da rede dialogam e se articulam e não êxito quando aspectos burocráticos predominam. Buscando uma melhoria no recebimento e nos encaminhamentos das notificações sobre violência sexual faz-se necessária a formação continuada por meio de capacitações, bem como a construção de fluxogramas para o efetivo trabalho.


We aim to understand the procedures of receiving and forwarding notifications of cases involving sexual violence against children performed by Child Protective Services (CPS). We carried out 10 semi-structured interviews with counselors from two cities of Rio Grande do Sul (a southernmost state in Brazil). The main results indicated little accuracy in defining sexual violence and notification. Successful notifications were those in which there is information that could identify victims and perpetrators. Unsuccessful notifications usually contain little information. Counselors observed successful outcomes in forwarding notifications when the services of the system dialogue and articulate, and unsuccessful ones when bureaucratic aspects predominate. We conclude it is necessary to invest in continuing education through capacitation, as well as constructing flowcharts for effective work in CPS.


El objetivo fue comprender los procedimientos para recibir y reenviar notificaciones de casos de violencia sexual realizados por Consejos Tutelares (CT). Fueron hechas 10 entrevistas semiestructuradas con 10 consejeros tutelares de dos ciudades de Rio Grande do Sul. Los resultados indicaron poca claridad en la definición de violencia sexual y notificación. Las notificaciones exitosas son las que incluyen informaciones que permiten identificar posibles víctimas y agresores. Las notificaciones no exitosas contienen pocas informaciones. Se observó que hay éxito en las derivaciones cuando los servicios de la red dialogan y se articulan y no éxito cuando prevalecen los aspectos burocráticos. La formación continua a través de capacitaciones es necesaria, así como la construcción de diagramas de flujo para el trabajo efectivo del CT.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Referral and Consultation , Sex Offenses , Counseling , Notification , Education, Continuing , Child Protective Services , Counselors , Child Advocacy
8.
Zhen Ci Yan Jiu ; 46(4): 278-83, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: mdl-33931991

ABSTRACT

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the expression of Pirt (a regulator of TRPV1) in the dorsal root ganglia (DRG) and transient receptor potential vanilloid 1 (TRPV1, a molecular sensor of noxious heat and capsaicin) in the colonic mucosa in rats suffering from diarrhea-predominant irritable bowel syndrome (IBS-D), so as to explore its mechanisms underlying alleviation of visceral hypersensitivity of IBS-D. METHODS: Forty SD rats (half male and half female) were randomly assigned to control, model, EA, and medication groups by lottery, with 10 rats in each group. The IBS-D model was established by chronic unpredictable mild stress (CUMS) and gavage of senna soaking fluid. Rats in the EA group received EA (2 Hz/15 Hz,0.1-1 mA) stimulation of unilateral "Tianshu"(ST25), "Zusanli" (ST36), "Sanyinjiao"(SP6) and "Taichong"(LR3) for 15 min once a day for 14 days, and rats of the medication group received intragastric administration of pinave-rium bromide (10 mL/kg, 2.7 mg/mL) once daily for 14 days. The visceral pain threshold (VPT) was measured by using abdominal wall withdrawal reflex (AWR) test. The diarrhea index (loose stool rate [total number of loose stool/total number of defecation] X mean loose degree [0-4 grades according to the filter paper stain diameter] in 6 h/d) was used to assess the severity of diarrhea. The expression of Pirt in the DRG and TRPV1 in the colonic mucosa tissue was detected using immunohistochemistry. RESULTS: After modeling, the VPT was obviously reduced (P<0.01), while the diarrhea index, mean optical density of Pirt and TRPV1 were remarkably increased in the model group relevant to the control group (P<0.01). After the interventions, the VPT was obviously increased while the diarrhea index, and the mean optical density of Pirt and TRPV1 was noticeably decreased in both EA and the medicine groups in contrast to the model group (P<0.01). No significant differences were found between the EA and medicine groups in up-regulating VPT and down-regulating the diarrhea index, and Pirt and TRPV1 expression (P>0.05). CONCLUSION: EA can effectively alleviate visceral hypersensitivity in IBS-D rats, which may be related to its effect in down-regulating the expression level of DRG Pirt and colonic TRPV1.


Subject(s)
Electroacupuncture , Irritable Bowel Syndrome , Acupuncture Points , Animals , Diarrhea/genetics , Diarrhea/therapy , Female , Irritable Bowel Syndrome/genetics , Irritable Bowel Syndrome/therapy , Male , Rats , Rats, Sprague-Dawley , TRPV Cation Channels/genetics
9.
Zhen Ci Yan Jiu ; 46(4): 342-7, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: mdl-33932002

ABSTRACT

Acupuncture has a long history of application in the field of reproduction, and in the past 20 years, numerous clinical studies have been conducted to explore the value of acupuncture in assisted reproductive technology. However, due to inconsistent research findings, there are still controversies over the clinical safety and efficacy of acupuncture in assisting in vitro fertilization-embryo transfer (IVF-ET), which may be closely associated with lacking of standardized treatment regimen in clinical trials of acupuncture. For that reason, this article reviews 16 representative clinical trials of acupuncture assisting IVF-ET published worldwide in 1999-2020, summarizes the grouping design, acupuncture method (acupuncture timing, acupuncture frequency, acupoints, and acupuncture types), and pregnancy outcome (pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate), and discusses several key links in clinical protocol design, so as to provide references for future clinical research.


Subject(s)
Acupuncture Therapy , Fertilization in Vitro , Acupuncture Points , Embryo Transfer , Female , Humans , Pregnancy
10.
Endocr Pract ; 27(5): 408-412, 2021 May.
Article in English | MEDLINE | ID: mdl-33934751

ABSTRACT

OBJECTIVE: To investigate the added value of 1/3 radius (1/3R) for the diagnosis of osteoporosis by spine and hip sites and its correlation with prevalent fractures and predicted fracture risk. METHODS: Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fractures (MOF) with/without trabecular bone score were considered proxy for fracture risk. The contribution of 1/3R to risk prediction was depicted via linear regression models with FRAX score as the dependent variable-first only with central and then with radius T-score as an additional covariate. Significance of change in the explained variance was compared by F-test. RESULTS: The study included 1453 patients, 86% women, aged 66 ± 10 years. A total of 32% (n = 471) were osteoporotic by spine/hip and 8% (n = 115) by radius only, constituting a 24.4% increase in the number of subjects defined as osteoporotic (n = 586, 40%). Prior fracture prevalence was similar among patients with osteoporosis by spine/hip (17.4%) and radius only (19.1%) (P = .77). FRAX prediction by a regression model using spine/hip T-score yielded explained variance of 51.8% and 49.9% for MOF and 39.8% and 36.4% for hip (with/without trabecular bone score adjustment, respectively). The contribution of 1/3R was statistically significant (P < .001) and slightly increased the explained variance to 52.3% and 50.4% for MOF and 40.9% and 37.4% for hip, respectively. CONCLUSION: Reclassification of BMD results according to radius measurements results in higher diagnostic output. Prior fractures were equally prevalent among patients with radius-only and classic-site osteoporosis. FRAX tool performance slightly improved by incorporating radius BMD. Whether this approach may lead to a better fracture prediction warrants further prospective evaluation.


Subject(s)
Hip Fractures , Osteoporosis , Osteoporotic Fractures , Absorptiometry, Photon , Aged , Bone Density , Female , Hip Fractures/epidemiology , Humans , Male , Middle Aged , Osteoporosis/diagnostic imaging , Osteoporosis/epidemiology , Osteoporotic Fractures/epidemiology , Radius/diagnostic imaging , Risk Assessment , Risk Factors
11.
Endocr Pract ; 27(5): 419-425, 2021 May.
Article in English | MEDLINE | ID: mdl-33934752

ABSTRACT

OBJECTIVE: To explore the body composition of pediatric patients referred for endocrine evaluation. METHODS: This real-life observational study conducted between January 2018 and January 2020 included 10 001 clinic visits of 3500 children and adolescents; first visits of 5 to 18-year-old patients were included. Anthropometric data, blood pressure levels, pubertal status, and bioelectrical impedance analysis (BIA, Tanita MC-780 MA) were extracted from medical files. Excluded from the analysis were patients participating in other studies. RESULTS: A total of 1001 patients (48% boys, mean age 11.3 ± 3.4 years, 33.5% prepubertal) were included. Mean anthropometric z-scores were normal and similar for boys and girls. Sex differences in body composition were as follows: boys had lower fat percentage, lower truncal fat percentage, higher appendicular skeletal muscle mass, and a higher muscle-to-fat ratio (MFR) than girls (P < .001 for all). MFR correlated with body mass index-standard deviation scores (BMI-SDS) in overweight/obese patients (r = -0.558, P < .001), although not in underweight patients. Systolic blood pressure (SBP) correlated with BMI-SDS in overweight/obese patients (r = 0.262, P < .001), although not in underweight patients. Diastolic blood pressure (DBP) did not correlate with BMI-SDS in either group of extreme weight status. MFR correlated with SBP and DBP in overweight/obese patients (r = -0.230, P < .001 and r = -0.141, P = .018, respectively) as well as in underweight patients (r = 0.331, P < .001 and r = 0.264, P = .005, respectively). CONCLUSIONS: Our findings support BIA for a more refined characterization of patients referred for endocrine evaluation than BMI-SDS. MFR may be a better surrogate marker of blood pressure levels than BMI-SDS in both underweight and overweight/obese pediatric patients.


Subject(s)
Body Composition , Obesity , Adolescent , Anthropometry , Body Mass Index , Body Weight , Child , Child, Preschool , Electric Impedance , Female , Humans , Male , Obesity/epidemiology
12.
Curr Opin Anaesthesiol ; 34(3): 205-211, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935167

ABSTRACT

PURPOSE OF REVIEW: Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. RECENT FINDINGS: Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population.Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide useful tools to ascertain high-risk parturients for a referral to antenatal obstetric anesthesiology clinics and higher levels of maternal care. Major obstetric organizations have identified and laid out criteria for maternal level of care. Anesthesiology resources also play a role in these designations and can help triage patients to facilities with appropriate resources. SUMMARY: Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.


Subject(s)
Anesthesia, Obstetrical , Anesthesiology , Maternal Health Services , Anesthesia, Obstetrical/adverse effects , Anesthesiologists , Female , Humans , Maternal Mortality , Peripartum Period , Pregnancy , United States/epidemiology
13.
Curr Opin Anaesthesiol ; 34(3): 218-225, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935168

ABSTRACT

PURPOSE OF REVIEW: The aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature. RECENT FINDINGS: Cardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease. SUMMARY: The leading cause of morbidity and mortality in pregnant women is cardiac disease. Preconception counseling is useful for optimizing patients for pregnancy and setting appropriate expectations about care and outcomes. Ensuring that women are cared for in centers with appropriate multidisciplinary resources is key for improving outcomes for cardio-obstetric patients.


Subject(s)
Heart Diseases , Pregnancy Complications, Cardiovascular , Cesarean Section , Delivery, Obstetric , Female , Heart Diseases/complications , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Humans , Peripartum Period , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapy , United States
14.
Curr Opin Anaesthesiol ; 34(3): 226-232, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935169

ABSTRACT

PURPOSE OF REVIEW: Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review. RECENT FINDINGS: Current recommendations including developing a detailed institutional plan for the management of pain for women with OUD during the intrapartum and postpartum periods. There is tremendous value in exploring partnerships with other specialties, including addiction medicine, and behavioral health and obstetrics in development of policies and procedures. Consistency within institutions is critical to improve patient outcomes. SUMMARY: This review will address both pain management recommendations and best clinical practices regarding management of the parturient during the transition periods of the peripartum, intrapartum, and postpartum period. Novel approaches and perspectives from case reports and narrative experience will also be discussed. There are many opportunities in this field for further studies, research, and evidence-based guidelines that promote an established standard of care.


Subject(s)
Obstetrics , Opioid-Related Disorders , Female , Humans , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/therapy , Pain , Peripartum Period , Postpartum Period , Pregnancy
15.
Curr Opin Anaesthesiol ; 34(3): 238-245, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935171

ABSTRACT

PURPOSE OF REVIEW: Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. RECENT FINDINGS: In the general gynecologic population, minimally invasive surgery is associated with less postoperative fever, pain, hospital length of stay, total cost of care and an earlier return to normal function. This also applies to robotic surgery in obese patients, which is on the rise. The physiologic changes of obesity bring different anesthetic challenges, including airway management and intraoperative ventilation. Vascular access and intraoperative blood pressure monitoring can also be challenging and require modifications. Optimizing analgesia with a focus on opioid-sparing strategies is crucial due to the increased prevalence of OSA in this patient population. SUMMARY: Anesthesia for obese patients undergoing robotic hysterectomy is challenging and must take into consideration the anatomic and physiologic changes associated with obesity.


Subject(s)
Anesthetics , Robotic Surgical Procedures , Female , Humans , Hysterectomy/adverse effects , Obesity/complications , Obesity/epidemiology , Postoperative Complications , Robotic Surgical Procedures/adverse effects
16.
Curr Opin Anaesthesiol ; 34(3): 260-268, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33935172

ABSTRACT

PURPOSE OF REVIEW: The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist. RECENT FINDINGS: Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes. SUMMARY: Accurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.


Subject(s)
Anesthetics , Placenta Accreta , Postpartum Hemorrhage , Cesarean Section , Female , Humans , Hysterectomy/adverse effects , Infant, Newborn , Placenta Accreta/diagnosis , Placenta Accreta/epidemiology , Placenta Accreta/surgery , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/prevention & control , Pregnancy
17.
Croat Med J ; 62(2): 120-129, 2021 Apr 30.
Article in English | MEDLINE | ID: mdl-33938651

ABSTRACT

AIM: To assess the differences in the way how Slovenian and Croatian health care professionals (HCPs) confront ethical dilemmas and perceive the role of hospital ethics committees (HECs). METHODS: This cross-sectional, survey-based study involved HCPs from three Slovenian and five Croatian university medical centers (UMC). The final sample sizes were 308 (244 or 79.2% women) for Slovenia and 485 (398 or 82.1% women) for Croatia. RESULTS: Compared with Croatian physicians, Slovenian physicians reported a higher share of ethical dilemmas regarding waiting periods for diagnostics or treatment, suboptimal working conditions due to interpersonal relationships in the ward, and end-of-life treatment withdrawal, and a lower share regarding access to palliative care and patient information protection. Compared with Croatian nurses, Slovenian nurses reported a lower share of ethical dilemmas regarding the distribution of limited resources, recognizing the patient's best interests, and access to palliative care. Compared with Croatian other HCPs, Slovenian other HCPs reported a lower burden of ethical dilemmas regarding waiting periods for diagnostics or treatment, distribution of limited resources, and access to palliative care. When encountering an ethical dilemma, all HCPs in both countries would first consult their colleagues. Slovenian and Croatian HCPs recognized the importance of the HECs to a similar extent, but viewed their role differently. CONCLUSION: Croatian and Slovenian HCPs are confronted with different ethical dilemmas and perceive the role of HECs differently.


Subject(s)
Health Personnel , Physicians , Croatia , Cross-Sectional Studies , Female , Humans , Male , Slovenia
18.
Croat Med J ; 62(2): 130-136, 2021 Apr 30.
Article in English | MEDLINE | ID: mdl-33938652

ABSTRACT

AIM: To examine the characteristics of pregnancies at a very advanced maternal age and the effect of parity on adverse obstetric outcomes. METHODS: We retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydani Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%). RESULTS: Significantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher. CONCLUSION: Since primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.


Subject(s)
Hypertension, Pregnancy-Induced , Pre-Eclampsia , Adult , Cesarean Section/adverse effects , Female , Humans , Maternal Age , Middle Aged , Parity , Pre-Eclampsia/epidemiology , Pre-Eclampsia/etiology , Pregnancy , Retrospective Studies , Risk Factors
19.
Croat Med J ; 62(2): 154-164, 2021 Apr 30.
Article in English | MEDLINE | ID: mdl-33938655

ABSTRACT

AIM: To assess the correlations of B regulatory cells (Bregs) and monocyte subsets in peripheral blood with the National Institutes of Health (NIH)-consensus-defined clinical manifestations of chronic graft-vs-host disease (cGvHD), in an attempt to establish their role as cellular biomarkers. METHODS: This multidisciplinary prospective study enrolled adult cGVHD patients treated in the University Hospital Center Zagreb and University of Zagreb School of Medicine. Immunophenotypic subpopulations of CD24highCD38high Bregs (CD27-, CD27+, and total) and monocyte (classical, intermediate, and non-classical) counts were correlated with demographic, transplant, and cGVHD-related data. Bivariate correlation analysis was performed to evaluate the correlations between Bregs and monocytes subsets and cGVHD organ involvement, as well as cGVHD severity and immunosuppression intensity. RESULTS: Twenty-two adult patients (54.5% female) with cGVHD were enrolled. The median (range) age was 44.5 years (24-65). All patients were transplanted for hematologic malignancies and 40.9% had severe NIH cGVHD global score. The median time from cGVHD diagnosis to the analysis was 16.6 months (0-176). The organ most frequently affected with cGVHD were the eyes (68.2%), skin (45.5%), lungs (45.5%), and liver (40.9%). Lower total and CD27-Bregs counts were correlated with worse cGVHD severity, higher immunosuppression intensity, and lung cGVHD, in terms of cell count, but also with skin cGVHD, in terms of percentages. Patients with liver and joint/fascia cGVHD had a lower percentage of non-classical monocytes and patients with more severe global NIH score had a higher classical monocytes count. CONCLUSION: Different organs affected by cGVHD are differently associated with different subpopulations of Bregs and monocytes.


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Monocytes , Prospective Studies , United States , Young Adult
20.
Sci Rep ; 11(1): 9361, 2021 04 30.
Article in English | MEDLINE | ID: mdl-33931677

ABSTRACT

Deterioration is sometimes unexpected in SARS-CoV2 infection. The aim of our study is to establish laboratory predictors of mortality in COVID-19 disease which can help to identify high risk patients. All patients admitted to hospital due to Covid-19 disease were included. Laboratory biomarkers that contributed with significant predictive value for predicting mortality to the clinical model were included. Cut-off points were established, and finally a risk score was built. 893 patients were included. Median age was 68.2 ± 15.2 years. 87(9.7%) were admitted to Intensive Care Unit (ICU) and 72(8.1%) needed mechanical ventilation support. 171(19.1%) patients died. A Covid-19 Lab score ranging from 0 to 30 points was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included haemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, creatinine, C-reactive protein, interleukin-6, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. Three groups were established. Low mortality risk group under 12 points, 12 to 18 were included as moderate risk, and high risk group were those with 19 or more points. Low risk group as reference, moderate and high patients showed mortality OR 4.75(CI95% 2.60-8.68) and 23.86(CI 95% 13.61-41.84), respectively. C-statistic was 0-85(0.82-0.88) and Hosmer-Lemeshow p-value 0.63. Covid-19 Lab score can very easily predict mortality in patients at any moment during admission secondary to SARS-CoV2 infection. It is a simple and dynamic score, and it can be very easily replicated. It could help physicians to identify high risk patients to foresee clinical deterioration.


Subject(s)
/diagnosis , Aged , Biomarkers/analysis , /pathology , Female , Hospitalization , Humans , Male , Multivariate Analysis , Retrospective Studies , Risk Assessment , Spain/epidemiology , Treatment Outcome
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