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2.
Artículo en Chino | MEDLINE | ID: mdl-33040500

RESUMEN

Objective:To report the nonsurgical correction of congenital auricular deformities in children older than 3 months, analysis the effect and the recurrence and the influencing factors. Method:Patients with auricular deformities who came to our department from July 2017 to August 2019 were collected. EarWell correction was performed for non-invasive correction. Follow-up was performed for at least 3 months after treatment. Data was collected to analysis the effect and the recurrence and the influencing factors. Result:At the end of follow-up, 76 cases of 88 ears were collected, at the end of treatment in this group, the efficiency was 87.5%, and the recurrence rate was 19.48%, 3 months after the end of treatment. There was a statistically significant difference in the distribution of auricle deformities(P=0.018) and the age of first treatment(P=0.028) between children in the effective group and those in the ineffective group. Of all the auricle deformities, the treatment of cryptotia was the most effective, and the effectiveness of prominent ears was the lowest. The family history(P=0.314), gender(P=0.421), and feeding method(P=0.557) of the effective and ineffective groups. There was no significant difference in the gestational weeks at birth(P=0.641), the mode of production(P=0.849), and birth weight(P=0.08). There was no significant difference in age between the relapsed group and the non-relapsed group at the age of first treatment(P=0.833).There was significant difference in the distribution of auricle deformities between the relapsed group and the non-relapsed group(P=0.013). There was no statistically significant difference between the effective group and the ineffective group at the age of first diagnosis and treatment time if we exclude cryptotia. Conclusion:For children who are treated beyond the treatment time window, the main factor affecting the treatment effect is the type of deformity. Nonsurgical correction can still be tried for older than 3 months with auricular deformities, especially for cryptotia, ear wheel deformities, and auricular cavity deformities. We do not recommend to try nonsurgical correction for children older than 3 months with prominent ears and cup ears.


Asunto(s)
Anomalías Congénitas , Pabellón Auricular , Oído Externo , Niño , Anomalías Congénitas/terapia , Pabellón Auricular/anomalías , Oído Externo/anomalías , Humanos , Lactante , Recién Nacido , Anamnesis , Recurrencia
3.
Emerg Med Clin North Am ; 38(4): 771-782, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32981616

RESUMEN

Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.


Asunto(s)
Paro Cardíaco/terapia , Prevención Secundaria , Temperatura Corporal , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Electrocardiografía , Electroencefalografía , Servicio de Urgencia en Hospital , Oxigenación por Membrana Extracorpórea , Paro Cardíaco/etiología , Humanos , Hipoxia-Isquemia Encefálica/prevención & control , Anamnesis , Transferencia de Pacientes , Intervención Coronaria Percutánea , Examen Físico , Pronóstico , Radiografía Torácica , Respiración Artificial , Convulsiones/diagnóstico , Convulsiones/etiología , Tomografía Computarizada por Rayos X
4.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32981623

RESUMEN

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Asunto(s)
Hemorragia Gastrointestinal/terapia , Manejo de la Vía Aérea , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticoagulantes/efectos adversos , Antifibrinolíticos/uso terapéutico , Oclusión con Balón , Factores de Coagulación Sanguínea/administración & dosificación , Transfusión Sanguínea/métodos , Catéteres , Servicio de Urgencia en Hospital , Factor Xa/administración & dosificación , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Infusiones Intraóseas , Infusiones Intravenosas , Anamnesis , Examen Físico , Inhibidores de la Bomba de Protones/uso terapéutico , Proteínas Recombinantes/administración & dosificación , Resucitación , Tromboelastografía , Vasoconstrictores/uso terapéutico
5.
Med Klin Intensivmed Notfmed ; 115(7): 530-538, 2020 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-32885280

RESUMEN

Medical history taking and the clinical examination are the traditional medical tools in making a diagnosis. Both the medical history taking and clinical examination have wrongly lost their practical value in modern emergency and intensive care medicine. When diagnosing an acutely or critically ill patient, the sequence, technique and focus of history taking and the clinical examination must be adapted to the individual situation and the condition of the patient. In this article the continuing central importance of both techniques in the diagnostics of emergency and intensive care patients is practically evaluated and discussed.


Asunto(s)
Cuidados Críticos , Medicina de Emergencia , Enfermedad Crítica/terapia , Servicio de Urgencia en Hospital , Humanos , Anamnesis , Examen Físico
6.
PLoS One ; 15(9): e0238127, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32960898

RESUMEN

PURPOSE: The aim of this study was to assess the determinants of bone health in the group of women over 40 years old. Lifestyle factors such as past and present physical activity, past and present sun exposure, current dietary intake of calcium and vitamin D, nutritional status as measured by BMI, family history of osteoporosis and current hormonal status were analysed. METHODS: The study involved 500 women over 40 years old. All examined women was the same ethnicity- European origin. Methods used: densitometry method (DXA), bioelectrical impedance analysis, International Physical Activity Questionnaire, nutrition questionnaire, past and present sun exposure questionnaire. Past and present physical activity, past and present sun exposure and sufficient level of calcium in the diet proved to be the most important factors determining mineralization of bone tissue of women. In order to indicate an independent association of the correct bone tissue mineralization with individual factors, multivariate analysis was used-logistic regression. RESULTS: The norm BMD in the distal part of the forearm was strongly influenced: recommended dietary calcium intake (OR = 5.95; p = 0.003), moderately (OR = 1.88; p = 0.053) and high (OR = 14.0; p<0.001) past physical activity, sufficient (OR = 4.97; p<0.001) and high (OR = 18.9; p = 0.004) level of present physical activity, sufficient past (OR = 5.15; p<0.001) and sufficient present sun exposure (OR = 10.0; p<0.001). The chance for the BMD prox norm was also increased several times: high past physical activity (OR = 68.4; p<0.0001) and sufficient past sun exposure (OR = 10.6; p<0.001), moderate past activity (OR = 4.20; p<0.001), sufficient (OR = 6.13; p<0.001) and high (OR = 10.0; p<0.001) present physical activity, sufficient present sun exposure (OR = 9.09; p<0.0001), recommended intake of calcium (OR = 9.57; p<0.001) and vitamin D (OR = 2.68; p = 0.052). Whereas e significantly lower likelihood for the BMD prox norm was found in women with the oldest hormonal status (postmenopausal period) (OR = 0.18; p<0.001), with osteoporosis in the family (OR = 0.37; p<0.001) and living in an agglomeration (OR = 0.68; p = 0.03). CONCLUSION: Interventions to increase physical activity, especially outdoors, may help reduce risk of osteoporosis, fractures and subsequent healthcare costs.


Asunto(s)
Densidad Ósea/fisiología , Densidad Ósea/efectos de la radiación , Ejercicio Físico , Estado Nutricional , Exposición a la Radiación/análisis , Luz Solar , Índice de Masa Corporal , Densidad Ósea/efectos de los fármacos , Calcio/farmacología , Suplementos Dietéticos , Femenino , Humanos , Estilo de Vida , Modelos Logísticos , Anamnesis , Persona de Mediana Edad , Polonia , Vitamina D/farmacología
7.
Emergencias (Sant Vicenç dels Horts) ; 32(4): 258-268, ago. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-193946

RESUMEN

El presente documento de consenso se ha desarrollado con el fin de proporcionar una herramienta útil para el manejo del paciente asmático que acude al servicio de urgencias (SU) con una crisis asmática. Incluye recomendaciones para tomar la decisión de alta o ingreso, así como indicaciones de derivación para el posterior seguimiento. Un equipo multidisciplinar, constituido por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología, se encargó de elaborar una lista de preguntas clínicas que respondieron mediante la ayuda tanto de guías de práctica clínica, como de literatura disponible. Los contenidos y el reparto de tareas en diferentes grupos de trabajo se consensuaron en una reunión presencial. Los materiales resultantes se pusieron en común y sirvieron para la preparación del manuscrito final. Las recomendaciones y los algoritmos incluidos en el mismo van dirigidos a identificar y diagnosticar correctamente las exacerbaciones asmáticas en el SU y a establecer los criterios de hospitalización o alta. Se incluyen también las pautas para el tratamiento de los pacientes y para su derivación al ámbito de atención especializada en caso de alta, incluyendo los criterios de priorización para dicha derivación. El documento ha sido avalado por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Alergología e Inmunología Clínica (SEAIC), y la Sociedad Española de Urgencias y Emergencias (SEMES)


This consensus paper's purpose is to provide a tool for managing emergency asthma exacerbations that require a decision to admit or discharge the patient. The paper also addresses where to refer the discharged patient for follow up. A multidisciplinary team of 3 emergency physicians, 3 specialists in respiratory medicine, and 3 allergy specialists were charged with drafting a list of clinical questions to answer by consulting practice guidelines and other resources in the literature. The specialists held a face-to-face meeting to distribute tasks and topics to working groups. The groups shared their reports, which provided the basis for drafting the final paper. The recommendations and flow charts included in the paper provide guidance for identifying and correctly diagnosing asthma exacerbations in the emergency department. Criteria for admission or discharge are incorporated. Treatment protocols and recommendations for referring discharged patients to specialists are addressed, along with criteria for priority referrals. The final consensus paper has been endorsed by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Allergology and Clinical Immunology (SEAIC), and the Spanish Society of Emergency Medicine (SEMES)


Asunto(s)
Humanos , Asma/epidemiología , Servicios Médicos de Urgencia/métodos , Derivación y Consulta/normas , Índice de Severidad de la Enfermedad , Indicadores de Calidad de la Atención de Salud/normas , Derivación y Consulta/organización & administración , Brote de los Síntomas , Hospitalización , Anamnesis , Comunicación Interdisciplinaria , Factores de Riesgo
9.
Am J Hum Genet ; 107(1): 3-14, 2020 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-32619490

RESUMEN

Secondary genomic findings are increasingly being returned to individuals as opportunistic screening results. A secondary finding offers the chance to identify and mitigate disease that may otherwise be unrecognized in an individual. As a form of screening, secondary findings must be considered differently from sequencing results in a diagnostic setting. For these reasons, clinicians should employ an evaluation and long-term management strategy that accounts for both the increased disease risk associated with a secondary finding and the lower positive predictive value of a screening result compared to an indication-based testing result. Here we describe an approach to the clinical evaluation and management of an individual who presents with a secondary finding. This approach enumerates five domains of evaluation-(1) medical history, (2) physical exam, (3) family history, (4) diagnostic phenotypic testing, and (5) variant correlation-through which a clinician can distinguish a molecular finding from a clinicomolecular diagnosis of genomic disease. With this framework, both geneticists and non-geneticist clinicians can optimize their ability to detect and mitigate genomic disease while avoiding the pitfalls of overdiagnosis. Our goal with this approach is to help clinicians translate secondary findings into meaningful recognition, treatment, and prevention of disease.


Asunto(s)
Enfermedades Genéticas Congénitas/genética , Enfermedades Genéticas Congénitas/diagnóstico , Enfermedades Genéticas Congénitas/prevención & control , Genómica/métodos , Humanos , Anamnesis
11.
Pediatrics ; 146(2)2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32719089

RESUMEN

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.


Asunto(s)
Circuncisión Femenina , Niño , Maltrato a los Niños , Cicatriz/etiología , Circuncisión Femenina/efectos adversos , Circuncisión Femenina/clasificación , Circuncisión Femenina/legislación & jurisprudencia , Circuncisión Femenina/psicología , Competencia Clínica , Confidencialidad , Documentación , Femenino , Enfermedades Urogenitales Femeninas/etiología , Procedimientos Quirúrgicos Ginecológicos , Humanos , Infecciones/etiología , Infertilidad Femenina/etiología , Consentimiento Informado , Clasificación Internacional de Enfermedades , Notificación Obligatoria , Anamnesis , Salud Mental , Dolor/etiología , Pediatras , Examen Físico , Prevalencia , Refugiados/legislación & jurisprudencia , Sexualidad
12.
Geriatr Gerontol Int ; 20(8): 785-790, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32627291

RESUMEN

AIM: The majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively. METHODS: This was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital-acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised. RESULTS: In total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug-induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms. CONCLUSION: In 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug-induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785-790.


Asunto(s)
Anamnesis , Neumonía por Aspiración/etiología , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Hospitalización , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo
13.
Am J Respir Crit Care Med ; 202(3): e36-e69, 2020 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-32706311

RESUMEN

Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.


Asunto(s)
Alveolitis Alérgica Extrínseca/diagnóstico , Líquido del Lavado Bronquioalveolar/citología , Exposición por Inhalación , Pulmón/patología , Linfocitos/inmunología , Fibrosis Pulmonar/diagnóstico , Adulto , Alveolitis Alérgica Extrínseca/complicaciones , Alveolitis Alérgica Extrínseca/inmunología , Alveolitis Alérgica Extrínseca/patología , Biopsia , Broncoscopía , Criocirugia , Humanos , Inmunoglobulina G/inmunología , Anamnesis , Fibrosis Pulmonar/etiología , Fibrosis Pulmonar/inmunología , Fibrosis Pulmonar/patología , Pruebas Serológicas , Encuestas y Cuestionarios
14.
Rev. Asoc. Méd. Argent ; 133(2): 13-16, jun. 2020. tab
Artículo en Español | LILACS | ID: biblio-1119924

RESUMEN

Se destaca la importancia de la primera consulta médica del paciente joven, que llega a la guardia médica y es recibido por un médico generalista. Es el momento ideal para realizar una medicina basada en la prevención de enfermedades orgánicas, socioculturales y psicopedagógicas que puedan comprometer la salud del adolescente. Se señalan algunos datos que el médico generalista puede obtener en esta primera entrevista sobre anomalías en el desarrollo puberal y factores de riesgo socioculturales y psicopedagógicos que pueden poner en riesgo la salud y la vida del adolescente que consulta, para realizar la posterior derivación al especialista en adolescentes.


The importance of the first medical consultation of the young patient is highlighted. It's the ideal moment to carry out a medicine based on the prevention of organic, sociocultural and psychopedagogical diseases that may compromise adolescent health. Some data that the general practitioner can obtain in this first interview about anomalies in pubertal development, sociocultural and psychopedagogical risk factors that may put at risk the health and life of the adolescent who consults and make your subsequent referral to the Teen Specialist, are point out.


Asunto(s)
Humanos , Adolescente , Salud del Adolescente , Prevención de Enfermedades , Médicos Generales , Visita a Consultorio Médico , Examen Físico , Relaciones Médico-Paciente , Anamnesis
17.
PLoS One ; 15(6): e0234000, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32479516

RESUMEN

BACKGROUND: While there are advances in medicine and pharmaceutical care, the burden of medication use has also grown with polypharmacy. In this regard, cardiovascular patients are subjected to polypharmacy for a longer period. OBJECTIVE: The present study aimed to assess the prevalence and predictors of polypharmacy in cardiovascular outpatients attending the University of Gondar Comprehensive specialized hospital, northwest Ethiopia. METHODS: A hospital-based cross-sectional study was employed at the University of Gondar Comprehensive Specialized Hospital from March 30 -May 30, 2019. The unique medical registration number of 424 patients was selected by using systematic random sampling to trace the medical chart and followed with an interview to explore the factors related to polypharmacy. All the Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Bivariable and multivariable logistic regressions were used to identify the predictors of polypharmacy in cardiovascular patients. RESULT: The mean age of the respondents was 56.83 ± 15.27 years. The mean number of medications per patient was 3.3±1.6. The prevalence of polypharmacy was 24.8% in cardiovascular outpatients while cardiovascular specific polypharmacy was 9.2%. Elderly (aged ≥ 65 years and above) patients were nearly two times more likely to had polypharmacy prescriptions with AOR: 1.97; 95% CI: 1.08-3.61; p = 0.027. Patients with abnormal weight (underweight AOR: 4.51; 95% CI: 1.42-14.30; p = 0.010, overweight AOR: 3.78; 95% CI: 1.83-7.83; p<0.001 and obese AOR: 5.1; 95% CI: 2.04-12.75 p<0.001) are more likely to have polypharmacy. Having a family history of CVD increase the likelihood of polypharmacy more than double; AOR: 2.40; 95% CI: 1.17-4.93; p = 0.017. A unit increase in Charlson comorbidity index score resulted in a nearly threefold likelihood of polypharmacy with AOR: 2.83; 95% CI 1.91-3.89; p<0.001. CONCLUSION: One out of four cardiovascular patients attending the outpatient clinic was on polypharmacy. The elderly age, abnormal body mass index (non-normal weight), family history of cardiovascular diseases and increasing Charlson morbidity index were the predictors of polypharmacy in cardiovascular patients. Clinicians should ensure the relevance of all prescribed medications and pharmaceutical care targeting at the prevention of inappropriate polypharmacy would be pivotal to reduce polypharmacy associated burdens.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Enfermedades Cardiovasculares/tratamiento farmacológico , Hospitales Universitarios/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Polifarmacia , Adolescente , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Estudios Transversales , Etiopía , Femenino , Humanos , Prescripción Inadecuada/prevención & control , Masculino , Anamnesis , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
18.
PLoS One ; 15(6): e0234573, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525931

RESUMEN

BACKGROUND: Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday. METHODS: We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment. RESULTS: The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms' recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants. CONCLUSIONS: We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0-5 and 5-9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages.


Asunto(s)
Causas de Muerte , Mortalidad del Niño , Mortalidad Infantil , Adolescente , Adulto , Niño , Salud del Niño/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Salud del Lactante/estadística & datos numéricos , Recién Nacido , Masculino , Salud Materna/estadística & datos numéricos , Servicios de Salud Materno-Infantil/estadística & datos numéricos , Anamnesis/estadística & datos numéricos , Factores Socioeconómicos , Uganda
19.
Mayo Clin Proc ; 95(6): 1268-1275, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32498779

RESUMEN

Breast cancer-screening guidelines increasingly recommend that clinicians perform a risk assessment for breast cancer to inform shared decision making for screening. Precision medicine is quickly becoming the preferred approach to cancer screening, with the aim of increased surveillance in high-risk women, while sparing lower-risk women the burden of unnecessary imaging. Risk assessment also informs clinical care by refining screening recommendations for younger women, identifying women who should be referred to genetic counseling, and identifying candidates for risk-reducing medications. Several breast cancer risk-assessment models are currently available to help clinicians categorize a woman's risk for breast cancer. However, choosing the appropriate model for a given patient requires a working knowledge of the strengths, weaknesses, and performance characteristics of each. The aim of this article is to provide a stepwise approach for clinicians to assess an individual woman's risk for breast cancer and describe the features, appropriate use, and performance characteristics of commonly encountered risk-prediction models. This approach will help primary care providers engage in shared decision making by efficiently generating an accurate risk assessment and make clear, evidence-based screening and prevention recommendations that are appropriately matched to a woman's risk for breast cancer.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Tamizaje Masivo/normas , Medición de Riesgo/métodos , Neoplasias de la Mama/prevención & control , Toma de Decisiones Conjunta , Femenino , Humanos , Anamnesis , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/métodos
20.
Ann Intern Med ; 172(12): JC66, 2020 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-32539507

RESUMEN

SOURCE CITATION: Choi IJ, Kim CG, Lee JY, et al. Family history of gastric cancer and Helicobacter pylori treatment. N Engl J Med. 2020;382:427-36. 31995688.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Anamnesis , Neoplasias Gástricas/prevención & control
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