Análisis de factores asociados a la asistencia a citas médicas preventivas. El caso de Bogotá, Colombia 2014

bjetivo: analizar los factores asociados a la asistencia a citas médicas preventivas en la ciudad de Bogotá en el año 2014.Métodos: se ajustaron dos modelos de Ecuaciones de Estimación Generalizadas (GEE) con función de enlace Bernoulli y estructuras de correlación independiente y simétrica compuesta para la variable de asistencia a citas médicas preventivas.Resultados: el nivel de ingreso, el estrato socioeconómico y el nivel educativo alcanzado por el jefe de hogar generan un aumento en la probabilidad de asistir a citas médicas preventivas: la razón de probabilidad de asistencia y no asistencia es por lo menos 1,5 veces mayor en miembros de hogares de estratos distintos al 1 y por cada 100 mil pesos adicionales en el ingreso mensual del hogar dicha razón se incrementa en 1 %. Aquellos miembros pertenecientes a hogares, cuyo jefe alcanzó un nivel educativo superior a primaria tienen una razón de probabilidad de asistencia y no asistencia a citas preventivas hasta 2,3 veces mayor.Conclusiones: los resultados coinciden con los de Grossman (1972) y Kenkel (1990); sin embargo, aspectos como el nivel educativo individual, la presencia de adultos mayores e infantes o inclusive de un cónyuge en el hogar no están relacionados con la asistencia a citas médicas preventivas.

bjective: Analyze factors involved in preventive medical appointments attendance in Bogota year 2014.Methods: two models were adjusted under GEE using a Bernoulli link function with independent and exchangeable correlation structures for preventive medical appointments attendance.Results: Income and socioeconomic stratum increase probability of preventive appointments attendance: Odds ratio of attendance and not attendance is at least 1,5 times higher in stratum 2 or higher households. Also, for every $100.000 additional pesos in monthly household income the reason increases by 1%. Household members which head reached an educational level higher than primary have an odds ratio of attendance and not attendance up to 2,3 times higher.Conclusions: Results are similar to Grossman (1972) and Kenkel (1990) nevertheless, individual educational level, presence in household of elder people or children and even presence of spouse are not related with preventive medical appointments attendance.

Análisis in vitro de la influencia sobre el campo de flujo de dos modelos de válvulas cardiacas mecánicas bivalvas mediante un túnel de viento / Analysis in vitro of the influence of two mechanical bivalve models of heart valves by a wind tunnel model

INTRODUCCIÓN: las prótesis valvulares cardiacas se evalúan mediante diferentes técnicas que involucran ensayos in vitro y métodos computacionales, además de los estudios clínicos convencionales. Los datos funcionales a evaluar reflejan la necesidad de contar con métodos de gran sensibilidad para determinar su operación en condiciones que emulen situaciones hemodinámicas específicas. Con este objetivo se proyectó un método alternativo que ayuda a un mejor entendimiento de la funcionalidad de estos dispositivos, analizando el comportamiento fluidodinámico in vitro de dos modelos de válvulas mecánicas cardiacas mediante un túnel de viento. MÉTODOS: se diseñó y desarrolló un túnel de viento disponiendo condiciones instrumentales que permitieran evaluar las válvulas mecánicas en distintas situaciones fluidodinámicas: túnel subsónico de sección circular (norma ANSI/AMCA_210-99 y ANSI/ASHRAE_51-99). Empleando el método de similitud dinámica se caracterizó la experimentación utilizando valores típicos de caudales y propiedades de la sangre en un adulto sano. RESULTADOS Y DISCUSIÓN: se evaluaron dos modelos valvulares tipo SJM®, uno de valvas planas y una variante de valvas convexas, con flujos de aire equivalentes a caudales sanguíneos de 1,5, 6,0 y 9,3 L/min. La prótesis de valvas convexas presenta un flujo dividido en tres campos equivalentes, a diferencia de la de valvas planas que tiene un flujo más pequeño en la parte central y dos laterales predominantes. El fenómeno de arrastre producido por las dos corrientes externas con respecto a la central, genera un RNS mayor para la válvula tipo SJM® que para la variante con valvas convexas. El campo de velocidad adyacente al lado convexo, se halla menos afectado por la turbulencia que en el caso de la valva plana; pero al contrario, el campo adyacente al lado cóncavo está más afectado por fenómenos fluidodinámicos locales: cambios de dirección, reducción de área y aumento de velocidad...

INTRODUCTION: prosthetic heart valves are evaluated using different techniques that involve in vitro studies and computational methods in addition to conventional clinical studies. Functional data to evaluate reflect the need for highly sensitive methods to determine its operating conditions that may emulate specific hemodynamic situations. With this objective, we designed an alternative method for better understanding the functionality of these models, analyzing in vitro fluid dynamic behavior of two models of mechanical heart valves using a wind tunnel. METHODS: we designed and developed a wind tunnel providing instrumental conditions that permit the evaluation of mechanical valves in different fluid dynamic conditions: subsonic tunnel of circular section (standard ANSI/AMCA_210-99 and ANSI/ASHRAE_51-99). Using the method of dynamic similarity, the experiment was characterized using typical values of flow rates and blood properties in a healthy adult. RESULTS AND DISCUSSION: we evaluated two SJM® valve models, one with flat leaflet, and a variant of convex valves with air flows equivalent to blood flow rates of 1.5, 6.0 and 9.3 L/min. The convex valve prosthesis has a flow divided in three equivalent fields, in contrast to the flat valves that have a smaller central flow and two predominant laterals. The drag phenomenon produced by the two external currents wit regard to the central generates a higher RNS for the SJM® valve than the generated for the variant of convex valves. The velocity field adjacent to the convex side is less affected by turbulence than in the case of the flat leaflet, but on the contrary, the adjacent field to the concave side is more affected by local fluid dynamic effects: changes in direction, area reduction and increased velocity...

Feasibility of instrumental swallowing assessments in patients with prolonged disordered consciousness while undergoing inpatient rehabilitation.

OBJECTIVE: To evaluate the feasibility, safety, and potential benefit of instrumental swallowing assessments for patients with prolonged disordered consciousness participating in rehabilitation. DESIGN: Case-control, retrospective. PARTICIPANTS: Thirty-five participants divided into 2 cohorts according to cognitive level at the time of baseline instrumental swallowing assessment. Group 1 (n = 17) participants were at Rancho Los Amigo (RLA) level II/III or RLA level III, while Group 2 (n = 18) participants were rated better than RLA level III. RESULTS: Aspiration and laryngeal penetration rates for both groups were similar (aspiration rate Group 1 = 41%, Group 2 = 39%; laryngeal penetration rate Group 1 = 59%, Group 2 = 61%). Overall, 76% (13/17) of Group 1 and 72% (13/18) of Group 2 were able to receive some type of oral feedings following baseline video fluoroscopic swallow study (VFSS) or endoscopic exam of the swallow (FEES). CONCLUSION: The majority of participants who underwent an instrumental swallowing examination while still functioning at RLA level II/III or RLA level III were able to return to some form of oral feedings immediately following their baseline examination. Swallowing as a treatment modality can be considered a part of the overall plan to facilitate neurobehavioral recovery for patients with prolonged disordered consciousness participating in rehabilitation.

Persons with disorders of consciousness: are oral feedings safe/effective?

PRIMARY OBJECTIVE: Evaluate the safety and efficacy of providing oral feedings to persons early in coma recovery following a severe brain injury. RESEARCH DESIGN: Descriptive, retrospective study. METHODS AND PROCEDURES: Medical chart reviews of all patients admitted to a rehabilitation hospital following severe brain injury. MAIN OUTCOMES AND RESULTS: Twenty-five patients met the inclusion criteria, 22 had a tracheostomy, and all were NPO. Subjects were divided into two cohorts. Group 1, n=10, mean age 43.5 years, received oral feedings early in coma recovery. Group 2, n=15, mean age 45.2 years, did not. Group 1, 30% returned to an oral diet of three meals daily at discharge from inpatient rehabilitation as compared to 40% in group 2 (chi2 = 0.260, p = 0.610). Average cost of care for group 1 = US$45 759 and group 2 = US$41 056 (p = 0.634). CONCLUSION: Safe therapeutic oral feedings, in accordance with findings from instrumental swallowing examinations, are possible for patients with disordered consciousness. The therapeutic oral feedings do not significantly increase the cost of care, but the effectiveness of oral feedings early in coma recovery requires further investigation.

Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation.

The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.

Descripción de actitudes y prácticas en estilos de vida saludables, en médicos y personal de enfermería. Metrosalud, 1997 / Description of attitudes and practices in healthy lifestyles in doctors and nurses. Metrosalud, 1997

Estudio descriptivo observacional realizado en la empresa social del estado Instituto Metropolitano de Salud, METROSALUD en Medellín, Colombia 1997. Se midió la frecuencia en estilos de vida saludables no fumar, ejercicio físico, dieta adecuada, peso ideal, sexo seguro, consumo de licor, exámenes de tamizaje y recreación, la actitud hacia éstos, hacia la promoción de la salud, y la percepción del componente institucional en promoción. Se aplicó encuesta autodiligenciada, tomándose muestra para cada uno de los grupos poblacionales: médicos, enfermeras y auxiliares de enfermería. La proporción en estilos de vida saludable encontrada fue del 22 por ciento, siendo mayor para los médicos, seguido por enfermeras, y luego por los auxiliares. No se observaron diferencias con lo reportado para la población general en los hábitos de fumar, consumo de licor y sobrepeso. Se encontró una actitud positiva hacia la promoción de la salud, con predominio en quienes tienen un estilo de vida más saludable. El componente institucional de promoción no es percibido claramente.