RESUMO
OBJECTIVES: Although common worldwide, intravaginal cleansing is associated with poor health outcomes. We sought to describe intravaginal cleansing among women attending a sexually transmitted infection (STI) clinic in Jamaica. METHODS: We examined intravaginal cleansing ("washing up inside the vagina", douching, and products or materials used) among 293 participants in a randomized trial of counselling messages at an STI clinic in Kingston. We focussed on information on intravaginal cleansing performed in the 30 days and three days preceding their baseline study visit. We describe reported cleansing behaviours and used logistic regression to identify correlates of intravaginal cleansing. RESULTS: Fifty-eight per cent of participants reported intravaginal cleansing in the previous 30 days, and 46% did so in the three days before baseline. Among those who cleansed in the previous 30 days, 88% reported doing so for hygiene unrelated to sex, and three-fourths reported generally doing so more than once per day. Soap (usually with water) and water alone were the most common products used for washing; commercial douches or detergents were reported infrequently. Intravaginal cleansing in the three days before the baseline visit was positively associated with having more than one sex partner in the previous three months (adjusted odds ratio [AOR], 1.9; 95% CI, 1.1, 3.2), and negatively associated with experiencing itching in the genital area at baseline (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONS: A large proportion of women attending STI clinics in Jamaica engage in frequent intravaginal cleansing, indicating a need for clinicians to discuss this topic with them accordingly.
Assuntos
Comportamentos Relacionados com a Saúde , Comportamento Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Ducha Vaginal , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Humanos , Jamaica , Modelos Logísticos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/fisiopatologia , Infecções Sexualmente Transmissíveis/psicologia , Sabões/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Ducha Vaginal/instrumentação , Ducha Vaginal/métodosRESUMO
OBJECTIVES: Although common worldwide, intravaginal cleansing is associated with poor health outcomes. We sought to describe intravaginal cleansing among women attending a sexually transmitted infection (STI) clinic in Jamaica. METHODS: We examined intravaginal cleansing ("washing up inside the vagina", douching, and products or materials used) among 293 participants in a randomized trial of counselling messages at an STI clinic in Kingston. We focussed on information on intravaginal cleansing performed in the 30 days and three days preceding their baseline study visit. We describe reported cleansing behaviours and used logistic regression to identify correlates of intravaginal cleansing RESULTS: Fifty-eight per cent of participants reported intravaginal cleansing in the previous 30 days, and 46% did so in the three days before baseline. Among those who cleansed in the previous 30 days, 88% reported doing so for hygiene unrelated to sex, and three-fourths reported generally doing so more than once per day. Soap (usually with water) and water alone were the most common products used for washing; commercial douches or detergents were reported infrequently. Intravaginal cleansing in the three days before the baseline visit was positively associated with having more than one sex partner in the previous three months (adjusted odds ratio [AOR], 1.9; 95% CI, 1.1, 3.2), and negatively associated with experiencing itching in the genital area at baseline (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONS: A large proportion of women attending STI clinics in Jamaica engage in frequent intravaginal cleansing, indicating a need for clinicians to discuss this topic with them accordingly.
OBJETIVOS: Aunque común mundialmente, la limpieza intravaginal se halla asociada con pobres resultados de salud. Buscamos describir la limpieza intravaginal entre mujeres que asisten a una clínica de infecciones de transmisión sexual (ITS) en Jamaica. MÉTODOS: Examinamos la limpieza intravaginal ("lavado del interior de la vagina", ducha, y productos o materiales usados) entre 293 participantes en una prueba aleatoria de mensajes de counseling en una clínica de ITS en Kingston. Las participantes proporcionaron la información sobre la limpieza intravaginal realizada en los 30 y tres días que precedieron a su visita para el estudio inicial. Describimos las conductas de limpieza reportadas y la regresión logística usada para identificar los correlatos de la limpieza intravaginal. RESULTADOS: Cincuenta y ocho por ciento de las participantes reportaron la limpieza intravaginal en los 30 días anteriores, y el 46% lo hicieron en los tres días antes del inicio del estudio. Entre aquéllas que realizaron la limpieza en los 30 días anteriores, el 88% reportó haberlo hecho por razones de higiene independientes de la vida sexual, y tres cuartos reportaron hacerlo de manera general más de una vez al día. Jabón (normalmente con agua) y agua solamente fueron los productos más comunes usados para el lavado. Las duchas comerciales o detergentes no fueron reportadas muy frecuentemente. La limpieza intravaginal en los tres días antes de la visita del estudio inicial estuvo positivamente asociada con tener más de una pareja sexual en los tres meses anteriores (odds ratio ajustado [AOR], 1.9; 95% CI, 1.1, 3.2), y negativamente asociado con experimentar comezón en el área genital al inicio del estudio (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONES: Un gran número de mujeres que asisten a las clínicas de ITS en Jamaica practican frecuentemente la limpieza intravaginal, lo cual indica la necesidad de que los médicos clínicos discutan este asunto con ellas.
Assuntos
Humanos , Feminino , Adulto , Comportamento Sexual , Comportamentos Relacionados com a Saúde , Infecções Sexualmente Transmissíveis/prevenção & controle , Ducha Vaginal , Sabões/uso terapêutico , Fatores de Tempo , Parceiros Sexuais , Modelos Logísticos , Resultado do Tratamento , Instituições de Assistência Ambulatorial , JamaicaRESUMO
La hernioplastia es la técnica quirúrgica más comúnmente realizada por el cirujano general. Desde la década de los 80, existe un auge por la cirugía ambulatoria en esta patología. Objetivo: Evaluar la incidencia de complicaciones postoperatorias y posibles asociaciones con factores de riesgo, en hernioplastia inguinal electiva en protocolo de hospitalización abreviada. Material y Método: Serie de casos prospectiva de 214 pacientes operados de hernia inguinal, entre abril del 2003 y noviembre del 2005. Se excluyeron los pacientes con ASA III y IV. El análisis estadístico fue realizado mediante la prueba de Chi cuadrado (univariables), y regresión logística (multivariables), SPSS 11.0. p <0,05. Resultados: El promedio de edad fue de 54,3 años (17-84), predominio masculino (90,7 por ciento). Se controló al 100 por ciento de los casos en los primeros 30 días de la intervención, control telefónico (78 por ciento), y en el policlínico (100 por ciento). Complicaciones postoperatorias presentaron el 14,9 por ciento de los casos, la más frecuente fue el seroma (4,2 por ciento), la más grave atrofia testicular y dolor crónico invalidante en 1 paciente (0,47 por ciento), debiendo finalmente realizar orquiectomía. Infección de herida operatoria correspondió al 0,47 por ciento, un paciente ASA I. Los menores de 65 años tuvieron un riesgo relativo de 2,31 de presentar complicaciones. El nivel de satisfacción usuaria fue bueno. El 90 por ciento ha sido controlado hasta agosto del 2006, media de seguimiento de 24 meses y sin presentar recidiva. Conclusiones: La herniorrafia inguinal con hospitalización abreviada, en el hospital Dr. Gustavo Fricke de Viña del Mar, tiene significativamente mayores complicaciones en los menores de 65 años. También ha logrado niveles de satisfacción adecuados, con un mínimo de complicaciones postoperatorias inmediatas.
Background: Hernia repair in adults is the most commonly performed surgical procedure by general surgeons. Aim: To evaluate the incidence of postoperative complications in elective inguinal hernioplasty with abbreviated hospital stay. Material and Methods: Prospective series of 214 patients aged 16 to 84 years (194 males), operated for inguinal hernia between April 2003 and November 2005. Patients classified as American Society of Anesthesiologists (ASA) III or IV were excluded from the study. Results: All patients were followed during the first 30 days after surgery by telephone and control at the outpatient clinic. Fifteen percent had complications. The most common was seroma in 4 percent and the most serious was a testicular atrophy and chronic invalidating pain in one patient, that required an orchidectomy. One patient had a surgical wound infection. Patients of less than 65 years had an odds ratio of 2.13 for complications, when compared with their older counterparts. The level of client satisfaction was good. After 24 months of follow up 90 percent of patients were under control and without relapse. Conclusions: Inguinal hernia repair with abbreviated hospital stay has a low incidence of complications.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hérnia Inguinal/cirurgia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/métodos , Distribuição de Qui-Quadrado , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Seguimentos , Incidência , Tempo de Internação , Modelos Logísticos , Satisfação do Paciente , Estudos Prospectivos , Fatores de RiscoRESUMO
El cáncer de vesícula biliar es la tercera causa de muerte por cáncer en Chile y la primera entre las mujeres. Las tasas de mortalidad experimentan un franco ascenso desde la década de los 70, mostrando en estos últimos años su mayor incidencia. El diagnóstico sigue siendo tardío, lo que condiciona su mal pronóstico, al no poder diagnosticar en etapas de recuperabilidad. Es un cáncer de manifestación lenta, que en estadios tempranos tiene buen pronóstico. El tumor que sobrepasa la barrera de la muscular propia adquiere características agresivas. Se realiza una investigación retrospectiva del decenio de 1993-2002, de los casos sometidos a cirugía en cáncer de vesícula biliar, obteniendo 108 casos para el análisis. Existe predominio femenino, con un 83,3 por ciento de la serie. La edad promedio fue de 63 años, con un 74 por ciento de la muestra entre los 60 y 89 años. El síntoma más frecuentemente encontrado fue el dolor en hipocondrio derecho y la baja de peso parcial; pocos casos se presentaron con ictericia, coluria o masa palpable. La mayoría fueron adenocarcinomas (80 por ciento), seguido de tumores indiferenciados (17 por ciento). Cuando se examinó su penetración en la pared vesicular, se objetivó que el 80,5 por ciento de la casuística comprometía la serosa y más allá. La mortalidad operatoria fue de 12,5 por ciento, todos en casos considerados no curativos. La sobrevida global fue de 17,8 por ciento a 5 años, con 93 por ciento en los considerados curativos y de 8,9 por ciento en los no curativos. Las diferencias estadísticas entre curativos y no curativos fueron significativas (p<0,05). Para futuros protocolos se debe considerar protocolizar el manejo agresivo quirúrgico y la terapia coadyuvante con radio y quimioterapia.
Assuntos
Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Adenocarcinoma/diagnóstico , Colecistectomia , Neoplasias da Vesícula Biliar , Neoplasias/diagnóstico , Chile , Icterícia , Tratamento Farmacológico , Radioterapia , Redução de PesoRESUMO
Maternal effects, the environment that mothers provide to their offspring, their provision of nutrients and the environment that offspring of the same clutch share, have come to be recognized as an important influence on offspring fitness. In addition, in invertebrates, maternal effects and common environment may change according to a mother's diet. We tested for the changes in quantitative genetic parameters in a half-sib design where mothers were fed diets varying in nutrient content. Surprisingly, we found that not only maternal and common environmental variance changed with experimental diets but also there were significant changes in narrow-sense heritabilities, with corresponding h(2) values of 0.61 (high protein), 0.08 (high carbohydrate) and 0.001 (equal carbohydrate:protein). Our results show how an environmentally driven evolutionary process could occur in nature, since the response to selection could change dramatically according to the composition of the diet that females are ingesting.
Assuntos
Evolução Molecular , Isópodes/genética , Seleção Genética , Ração Animal , Animais , Comportamento Animal , Constituição Corporal/genética , Carboidratos da Dieta/análise , Proteínas Alimentares/análise , Feminino , Alimentos Formulados/análise , Isópodes/crescimento & desenvolvimento , Masculino , Comportamento Materno , Modelos Animais , Fenótipo , Característica Quantitativa HerdávelRESUMO
PIP: Brazil is South America's largest country and home to nearly half of the continent's people. Despite solid economic growth, Brazil has one of the world's widest income disparities. In the early 1990s, nearly 40% of urban and 66% of rural Brazilians lived in poverty. The streets of Brazil's cities are home to a large population of street children. Although it is difficult to estimate, 10 million children and youths may be either homeless or making a meager living off of the streets. Street children may be linked to prostitution and drugs and be the targets or perpetrators of violence. Child labor is an issue in Brazil. Today an estimated 30% of rural children and 9% of urban children ages 10-13 work in the formal economy. In some rural areas, 60% of workers are ages 5-17. Child labor also contributes to Brazil's relatively low educational attainment levels. UNICEF estimates that around 1990 only 1/3 of all Brazilian children continued on to secondary school, compared to 74% and 47%, respectively, for the Latin America and Caribbean regions. Immunization rates among Brazil's children are rising but still lag slightly behind regional averages. The mortality rate for children under age 5 decreased dramatically from 181 deaths for every 1000 live births in 1960 to 61/1000 in 1994. During the same time period, the average number of children born to a woman during her lifetime dropped from 6.2 to 2.8. This fertility decline is related in part to increased access to and acceptance of family planning. Contraceptive prevalence, including traditional and modern methods, is around 66%, with female sterilization and the pill being the most popular methods. Brazil's abortion rates are high, despite laws limiting access to abortion services. One estimate suggests that about 30% of all pregnancies are terminated through abortion each year.^ieng
Assuntos
Coeficiente de Natalidade , Proteção da Criança , Escolaridade , Emprego , Estudos de Avaliação como Assunto , Pobreza , Urbanização , América , Brasil , Demografia , Países em Desenvolvimento , Economia , Fertilidade , Geografia , Saúde , Mão de Obra em Saúde , América Latina , População , Dinâmica Populacional , Classe Social , Fatores Socioeconômicos , América do Sul , População UrbanaRESUMO
BACKGROUND: Prominent and persistent anxiety, depression, and/or negative features characterize a substantial minority of recovered or residually psychotic schizophrenic outpatients and contribute to poor outcome. Because extrapyramidal side effects of typical neuroleptic medications often resemble such features, we first systematically studied the contribution of extrapyramidal side effects to these problems and their treatment. For patients who remained distressed, controlled trials of supplemental thymoleptics were undertaken. METHODS: In trial 1, 92 distressed (depressed and/or anxious) patients and 36 patients in a defect state (patients with negative symptoms) participated in a double-blind, intramuscular challenge that compared centrally acting benztropine mesylate with peripherally acting glycopyrrolate. In trial 2, 57 distressed patients and 22 patients in a defect state were randomly assigned to a double-blind, neuroleptic medication dose-reduction group. In trial 3, 57 chronically distressed patients who were maintained on a low dose of fluphenazine decanoate were randomly assigned to a supplemental desipramine hydrochloride, lithium carbonate, or placebo group under double-blind conditions for 12 weeks. RESULTS: For patients who were already maintained on antiparkinsonian medication, impaired affect was not resolved by additional benztropine. Only distressed patients with a family history of severe mental disorder (often affective) showed improvement with neuroleptic medication dose reduction. Patients in the defect-state group reported less dysphoria on a reduced neuroleptic medication dose, but negative symptoms persisted. Desipramine improved diverse aspects of mood and residual psychoticism, possibly as a prophylaxis against minor affective exacerbations. Depression improved in women only. Lithium positively affected multiple indexes of anxiety and anxious depression. CONCLUSION: Most often, persistent affective impairments are neither resistant extrapyramidal side effects nor characterological traits. Thymoleptics improve the nonphasic, chronic types of anxiety and depression in contrast to the acute, episodic forms, for which little support can be found in the literature.
Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Flufenazina/análogos & derivados , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adolescente , Adulto , Assistência Ambulatorial , Antipsicóticos/efeitos adversos , Transtornos de Ansiedade/induzido quimicamente , Transtornos de Ansiedade/diagnóstico , Doenças dos Gânglios da Base/diagnóstico , Doenças dos Gânglios da Base/etiologia , Doenças dos Gânglios da Base/prevenção & controle , Benzotropina/análogos & derivados , Benzotropina/uso terapêutico , Transtorno Depressivo/induzido quimicamente , Transtorno Depressivo/diagnóstico , Desipramina/uso terapêutico , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Flufenazina/uso terapêutico , Glicopirrolato/uso terapêutico , Humanos , Carbonato de Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Placebos , Escalas de Graduação Psiquiátrica , Fatores SexuaisRESUMO
La colecistectomía laparoscópica (CL) permite el tratamiento de la colelitiasis con reducción del períodod de hospitalización, incapacidad laboral y disconfort postoperatorio. En el 10-20 por ciento de los pacientes con colelitiasis se asocia una coledocolitiasis debiendo ser entonces marginados de esta ténica, cuando no se cuenta con la implementación para una cirugía laparoscópica del colédoco. Desde agosto 91 hasta julio 92, 168 pacientes fueron elegidos la CL. En 13 (7,7 por ciento ) se decide colangiopancreatografía endoscópica-retrógrada (CPER) por clínica. laboratorio o ECO, 24 a 48 h previas a la intervención. En 11 pacientes se apreció o vía biliar normal (2) o se solucionó su coledocolitiasis (9) y fueron a cirugía. Un paciente debió ser convertido (dificultad técnica) y en 10 pacientes se realizó CL. No observamos morbilidad atribuible a la colangiopancreatografía endoscópica retrógrada asociada a esfinterotomía endoscópica (CPER-EE). Un paciente se complicó con biliperitoneo por CL y se trató laparoscópicamente. No hubo mortalidad
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colecistectomia , Colelitíase/cirurgia , Cálculos Biliares/cirurgia , Laparoscopia , Endoscopia do Sistema Digestório/métodosRESUMO
Se compara los costos producidos por las dos técnicas de colecistectomía durante los 6 primeros meses de la utilización de la cirugía laparoscópica (CL) desde el 16 de diciembre 1991 al 15 junio 1992, en el hospitalDr. Gustavo Fricke de Viña del Mar. En el período se realizaron 100 CL y 235 colecistectomías tradicionales (CT). En el análisis se compra fundamentalmente los costos día-cama, insumos de pabellón, insumos postoperatorios y el retorno vía Ministerio de Salud, por uso de pabellón, según datos aportados por nuestra Sub-Dirección Administrativa. En días-cama hay una relación 9,1/2,7: CT/CL. Retorno vía facturación atención prestada (FAP) (diferencia) a favor de CL $8.040. La diferencia final es de $29.352 a favor de CL, lo que proyectado a 1 año asciende a $12.000.000, para nuestro Hospital. La mortización del equipo y la reposición de instrumental se puede lograr en plazos de 18 a 24 meses