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1.
Artigo em Inglês | MEDLINE | ID: mdl-33197507

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is considered the most effective treatment for major depressive disorder (MDD). In recent years, the pursuit of the neurobiological mechanisms of ECT action has generated a significant amount of functional magnetic resonance imaging (fMRI) research. OBJECTIVE: In this systematic review, we integrated all fMRI research in patients with MDD receiving ECT and, importantly, evaluated the level of convergence and replicability across multiple fMRI metrics. RESULTS: While according to most studies changes in patients with MDD after ECT appear to be widely distributed across the brain, our multimetric review revealed specific changes involving functional connectivity increases in the superior and middle frontal gyri as the most replicated and across-modality convergent findings. Although this modulation of prefrontal connectivity was associated to ECT outcome, we also identified fMRI measurements of the subgenual anterior cingulate cortex as the fMRI signals most significantly linked to clinical response. CONCLUSION: We identified specific prefrontal and cingulate territories which activity and connectivity with other brain regions is modulated by ECT, critically accounting for its mechanism of action.

2.
Cuad. bioét ; 31(102): 223-229, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194279

RESUMO

La llegada de la pandemia COVID-19 puso en evidencia el riesgo de una posible falta de atención de los ancianos de las residencias de mayores. Aportamos la experiencia de un equipo multidisciplinar con profesionales voluntarios de diferentes especialidades que realizó una labor de apoyo a los profesionales sanitarios de las residencias. Este equipo se implementó desde las gerencias de atención primaria y de atención especializada. La sistemática de trabajo se inspiraba en el de hospitalización a domicilio e incluía la atención directa de los pacientes más complejos y el asesoramiento en las medidas de prevención, aislamiento e higiene dentro de la residencia. De este modo fue posible que los ancianos de las residencias con sospecha o diagnóstico de COVID-19 recibieran una atención adecuada por parte de un equipo interdisciplinar, que se descargara parte de la presión de los profesionales de las residencias y que los familiares percibieran que no existía abandono terapéutico. El compromiso desde diversos niveles asistenciales en una labor coordinada ha conseguido evitar que una población vulnerable pudiera quedar desatendido durante la pandemia


With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic


Assuntos
Humanos , Idoso , Instituição de Longa Permanência para Idosos/organização & administração , Direitos dos Idosos/legislação & jurisprudência , Pandemias/ética , Infecções por Coronavirus/epidemiologia , Recusa do Médico a Tratar/ética , Prioridades em Saúde/ética , Capacidade de Resposta ante Emergências/ética
3.
Elife ; 82019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31644424

RESUMO

Recent longitudinal neuroimaging studies in patients with electroconvulsive therapy (ECT) suggest local effects of electric stimulation (lateralized) occur in tandem with global seizure activity (generalized). We used electric field (EF) modeling in 151 ECT treated patients with depression to determine the regional relationships between EF, unbiased longitudinal volume change, and antidepressant response across 85 brain regions. The majority of regional volumes increased significantly, and volumetric changes correlated with regional electric field (t = 3.77, df = 83, r = 0.38, p=0.0003). After controlling for nuisance variables (age, treatment number, and study site), we identified two regions (left amygdala and left hippocampus) with a strong relationship between EF and volume change (FDR corrected p<0.01). However, neither structural volume changes nor electric field was associated with antidepressant response. In summary, we showed that high electrical fields are strongly associated with robust volume changes in a dose-dependent fashion.


Assuntos
Depressão/terapia , Eletroconvulsoterapia/efeitos adversos , Adulto , Idoso , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/efeitos dos fármacos , Tonsila do Cerebelo/patologia , Tonsila do Cerebelo/efeitos da radiação , Antidepressivos/uso terapêutico , Mapeamento Encefálico , Depressão/diagnóstico por imagem , Depressão/patologia , Radiação Eletromagnética , Feminino , Hipocampo/diagnóstico por imagem , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Hipocampo/efeitos da radiação , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/efeitos dos fármacos , Tamanho do Órgão/efeitos da radiação , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/efeitos dos fármacos , Lobo Temporal/patologia , Lobo Temporal/efeitos da radiação
4.
Accid Anal Prev ; 124: 174-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30660833

RESUMO

INTRODUCTION: There is an outstanding need to identify predictors of driving under the influence of alcohol (DUI) among young adults, particularly women. Impulsivity, or the tendency to act without thinking, is a predictor of DUI, but the specific facets of impulsivity that predict DUI and their interaction with sex differences remain unclear. We aimed to investigate sex differences in the link between impulsivity facets and DUI. Moreover, we sought to replicate previous findings regarding sex differences on impulsivity, and associations between impulsivity facets and DUI. METHOD: A total of 506 university students participated in the study (males, n = 128; females, n = 378). Participants completed measures of impulsivity (UPPS-P short version), alcohol use (AUDIT-C), frequency of DUI episodes and related perception of risk. The UPPS-P assesses five facets of impulsivity: sensation seeking, (lack of) premeditation and perseverance and positive and negative urgency. RESULTS: Men showed higher sensation seeking and lack of perseverance, alcohol use and DUI frequency and lower risk perception than women. DUI frequency was negatively associated with perception of risk and positively associated with alcohol use and the five impulsivity facets. After controlling for alcohol use and risk perception, only lack of premeditation was associated with DUI frequency in the whole sample. Sensation seeking was positively associated with DUI frequency only in women. DISCUSSION: The link between lack of premeditation and DUI suggest that pre-drinking planning strategies can contribute to prevent risky driving. In women, specific links between sensation seeking and DUI suggest the need for personality-tailored prevention strategies.


Assuntos
Dirigir sob a Influência/psicologia , Dirigir sob a Influência/estatística & dados numéricos , Comportamento Impulsivo/fisiologia , Assunção de Riscos , Fatores Sexuais , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Dirigir sob a Influência/prevenção & controle , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
5.
Int J Obes (Lond) ; 43(3): 503-511, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30120426

RESUMO

BACKGROUND/OBJECTIVES: Accumulation of visceral adiposity can disrupt the brain's sensitivity to interoceptive feedback, which is coded in the insula. This study aimed to test the link between visceral fat and the functional connectivity of two insulae regions relevant for eating behavior: the middle-dorsal insula (mIns), which codes homeostatic changes, and the rostral insula (rIns), which codes stable representations of food properties. We also assessed the impact of visceral adiposity-associated insulae networks on food craving. SUBJECTS/METHODS: Seventy-five adults ranging in weight status (normal and excess weight) underwent resting-state functional magnetic resonance imaging (fMRI) and subjective food craving measures. We examined the association between visceral fat and seed-based functional connectivity of the mIns and the rIns, controlling for BMI, age, and sex, using multiple regressions in SPM8. We also tested if visceral fat mediated the association between insulae connectivity and food craving. RESULTS: Higher visceral adiposity was associated with decreased connectivity between the mIns and a cluster involving the hypothalamus and the bed nucleus of the stria terminalis. Decreased connectivity in this network was associated with greater food craving, a relation mediated by visceral adiposity. Visceral adiposity was also associated with increased connectivity between the mIns and the middle frontal gyri and the right intraparietal cortex, and between the rIns and the right amygdala. CONCLUSIONS: Accumulation of visceral adiposity is linked to disrupted functional connectivity within the mIns and rIns networks. Furthermore, the link between the mIns network and food craving is mediated by visceral fat. Findings suggest that visceral fat disrupts insula coding of bodily homeostatic signals, which may boost externally driven food cravings.


Assuntos
Córtex Cerebral/fisiopatologia , Fissura/fisiologia , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/fisiopatologia , Adulto , Índice de Massa Corporal , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Fome/fisiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
6.
J Neuropsychiatry Clin Neurosci ; 31(2): 152-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30458664

RESUMO

OBJECTIVE: The selection of a bitemporal (BT) or right unilateral (RUL) electrode placement affects the efficacy and side effects of ECT. Previous studies have not entirely described the neurobiological underpinnings of such differential effects. Recent neuroimaging research on gray matter volumes is contributing to our understanding of the mechanism of action of ECT and could clarify the differential mechanisms of BT and RUL ECT. METHODS: To assess the whole-brain gray matter volumetric changes observed after treating patients with treatment-resistant depression with BT or RUL ECT, the authors used MRI to assess 24 study subjects with treatment-resistant depression (bifrontotemporal ECT, N=12; RUL ECT, N=12) at two time points (before the first ECT session and after ECT completion). RESULTS: Study subjects receiving BT ECT showed gray matter volume increases in the bilateral limbic system, but subjects treated with RUL ECT showed gray matter volume increases limited to the right hemisphere. The authors observed significant differences between the two groups in midtemporal and subcortical limbic structures in the left hemisphere. CONCLUSIONS: These findings highlight that ECT-induced gray matter volume increases may be specifically observed in the stimulated hemispheres. The authors suggest that electrode placement may relevantly contribute to the development of personalized ECT protocols.


Assuntos
Córtex Cerebral/patologia , Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia/métodos , Sistema Límbico/patologia , Adulto , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Sistema Límbico/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Pediátr. Panamá ; 47(3): 15-19, diciembre 2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-980128

RESUMO

Resumen Introducción: La infección por virus Zika (ZIKV) es actualmente un problema de salud pública importante por sus posibles secuelas en el recién nacido y las complicaciones post infecciosas relacionadas. La introducción del virus en Latinoamérica tuvo lugar en Brasil en 2015, desde entonces se ha ido extendiendo por el resto del continente de forma progresiva. Con este artículo se pretende analizar la experiencia de los casos clínicos sospechosos registrados en un hospital pediátrico de tercer nivel hasta la actualidad. Material y métodos: Se realizó un estudio observacional, retrospectivo, analizando los datos epidemiológicos de los casos sospechosos de infección por ZIKV reportados por el sistema de vigilancia epidemiológica del Servicio de Epidemiología del Hospital del Niño Dr. José Renán Esquivel de Panamá en el periodo comprendido entre enero de 2016 y diciembre de 2017. Resultados: 156 pacientes fueron estudiados como casos sospechosos de infección por ZIKV: 88 durante el año 2016 y 68 durante el año 2017. De los 88 casos del año 2016, 16 casos fueron catalogados como síndrome Zika congénito confirmándose la infección de forma analítica en sólo 5 casos. De los 68 casos del año 2017, fueron 35 los catalogados como síndrome Zika congénito, confirmándose la infección de forma analítica en sólo 6 casos. Conclusiones: En nuestra muestra, la infección congénita por virus Zika no se limita sólo a la presencia de microcefalia, sino que puede haber una gran variedad de malformaciones cerebrales asociadas con o sin microcefalia. Además, durante estos dos años han ido cambiando las recomendaciones diagnósticas para detección del virus en los pacientes con sospecha de infección sin conseguirse consenso a este respecto, tanto en la mujer embarazada como a nivel postnatal.


Abstract: Introduction: Zika virus Infection (ZIKV) is currently a major public health problem due to its possible sequelae in the newborn and related post-infectious complications. The introduction of the virus in Latin America took place in Brazil in 2015, since then it has been spreading throughout the rest of the continent in a progressive way. This article aims to analyze the experience of suspected clinical cases recorded in a pediatric third level facility until today. Material and methods: An observational, retrospective study was carried out analyzing the epidemiological data of the suspected cases of ZIKV infection reported by the surveillance system of the Epidemiology Service at Hospital del Niño Dr. José Renán Esquivel from Panama in the period from January 2016 to December 2017. Results: 156 patients were studied as suspected cases of ZIKV infection: 88 during the year 2016 and 68 during the year 2017. Of the 88 cases of the year 2016, 16 cases were classi ed as congenital Zika syndrome suspected cases with laboratory con rmation of the infection in only 5 cases. Of the 68 cases of the year 2017, were 35 classi ed as congenital Zika syndrome, with con rmed the infection in 6 cases. Conclusions: In our sample, congenital Zika virus infection is not limited only to the presence of microcephaly, but there may be a wide variety of cerebral malformations associated with or without microcephaly. In addition, during these two years have been changing the diagnostic recommendations for detection of the virus in patients with suspected infection without achieving consensus in this regard, both in pregnant women and postnatal.

8.
Clin Gastroenterol Hepatol ; 16(9): 1495-1502, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29307848

RESUMO

BACKGROUND & AIMS: There have been increasing reports of liver injury associated with use of herbal and dietary supplements, likely due to easy access to these products and beliefs among consumers that they are safer or more effective than conventional medications. We aimed to evaluate clinical features and outcomes of patients with herbal and dietary supplement-induced liver injuries included in the Spanish DILI Registry. METHODS: We collected and analyzed data on demographic and clinical features, along with biochemical parameters, of 32 patients with herbal and dietary supplement-associated liver injury reported to the Spanish DILI registry from 1994 through 2016. We used analysis of variance to compare these data with those from cases of liver injury induced by conventional drugs or anabolic androgenic steroid-containing products. RESULTS: Herbal and dietary supplements were responsible for 4% (32 cases) of the 856 DILI cases in the registry; 20 cases of DILI (2%) were caused by anabolic androgenic steroids. Patients with herbal and dietary supplement-induced liver injury were a mean age of 48 years and 63% were female; they presented a mean level of alanine aminotransferase 37-fold the upper limit of normal, 28% had hypersensitivity features, and 78% had jaundice. Herbal and dietary supplement-induced liver injury progressed to acute liver failure in 6% of patients, compared with none of the cases of anabolic androgenic steroid-induced injury and 4% of cases of conventional drugs. Liver injury after repeat exposure to the same product that caused the first DILI episode occurred in 9% of patients with herbal and dietary supplement-induced liver injury vs none of the patients with anabolic androgenic steroid-induced injury and 6% of patients with liver injury from conventional drugs. CONCLUSION: In an analysis of cases of herbal and dietary supplement-induced liver injury in Spain, we found cases to be more frequent among young women than older patients or men, and to associate with hepatocellular injury and high levels of transaminases. Herbal and dietary supplement-induced liver injury is more severe than other types of DILI and re-exposure is more likely. Increasing awareness of the hepatoxic effects of herbal and dietary supplements could help physicians make earlier diagnoses and reduce the risk of serious liver damage.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Suplementos Nutricionais/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Adulto Jovem
9.
PLoS One ; 11(3): e0152150, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27003840

RESUMO

Emotion-regulation strategies are understood to influence food intake. This study examined the neurophysiological underpinnings of negative emotion processing and emotion regulation in individuals with excess weight compared to normal-weight controls. Fifteen participants with excess-weight (body mass index >25) and sixteen normal-weight controls (body mass index 18-25) performed an emotion-regulation task during functional magnetic resonance imaging. Participants were exposed to 24 negative affective or neutral pictures that they were instructed to Observe (neutral pictures), Maintain (sustain the emotion elicited by negative pictures) or Regulate (down-regulate the emotion provoked by negative pictures through previously trained reappraisal techniques). When instructed to regulate negative emotions by means of cognitive reappraisal, participants with excess weight displayed persistently heightened activation in the right anterior insula. Decreased responsivity was also found in right anterior insula, the orbitofrontal cortex and cerebellum during negative emotion experience in participants with excess weight. Psycho-physiological interaction analyses showed that excess-weight participants had decreased negative functional coupling between the right anterior insula and the right dlPFC, and the bilateral dmPFC during cognitive reappraisal. Our findings support contentions that excess weight is linked to an abnormal pattern of neural activation and connectivity during the experience and regulation of negative emotions, with the insula playing a key role in these alterations. We posit that ineffective regulation of emotional states contributes to the acquisition and preservation of excess weight.


Assuntos
Córtex Cerebral/fisiologia , Emoções/fisiologia , Sobrepeso/fisiopatologia , Adulto , Mapeamento Encefálico/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Estimulação Luminosa/métodos , Córtex Pré-Frontal/fisiopatologia , Adulto Jovem
10.
Brain Stimul ; 9(1): 65-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26440406

RESUMO

BACKGROUND: Although current models of depression suggest that a sequential modulation of limbic and prefrontal connectivity is needed for illness recovery, neuroimaging studies of electroconvulsive therapy (ECT) have focused on assessing functional connectivity (FC) before and after an ECT course, without characterizing functional changes occurring at early treatment phases. OBJECTIVE: To assess sequential changes in limbic and prefrontal FC during the course of ECT and their impact on clinical response. METHODS: Longitudinal intralimbic and limbic-prefrontal networks connectivity study. We assessed 15 patients with treatment-resistant depression at four different time-points throughout the entire course of an ECT protocol and 10 healthy participants at two functional neuroimaging examinations. Furthermore, a path analysis to test direct and indirect predictive effects of limbic and prefrontal FC changes on clinical response measured with the Hamilton Rating Scale for Depression was also performed. RESULTS: An early significant intralimbic FC decrease significantly predicted a later increase in limbic-prefrontal FC, which in turn significantly predicted clinical improvement at the end of an ECT course. CONCLUSIONS: Our data support that treatment response involves sequential changes in FC within regions of the intralimbic and limbic-prefrontal networks. This approach may help in identifying potential early biomarkers of treatment response.


Assuntos
Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia , Sistema Límbico/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Adulto , Idoso , Transtorno Depressivo Resistente a Tratamento/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Psychiatry Neurosci ; 41(2): 115-23, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26505142

RESUMO

BACKGROUND: Frontostriatal and frontoamygdalar connectivity alterations in patients with obsessive-compulsive disorder (OCD) have been typically described in functional neuroimaging studies. However, structural covariance, or volumetric correlations across distant brain regions, also provides network-level information. Altered structural covariance has been described in patients with different psychiatric disorders, including OCD, but to our knowledge, alterations within frontostriatal and frontoamygdalar circuits have not been explored. METHODS: We performed a mega-analysis pooling structural MRI scans from the Obsessive-compulsive Brain Imaging Consortium and assessed whole-brain voxel-wise structural covariance of 4 striatal regions (dorsal and ventral caudate nucleus, and dorsal-caudal and ventral-rostral putamen) and 2 amygdalar nuclei (basolateral and centromedial-superficial). Images were preprocessed with the standard pipeline of voxel-based morphometry studies using Statistical Parametric Mapping software. RESULTS: Our analyses involved 329 patients with OCD and 316 healthy controls. Patients showed increased structural covariance between the left ventral-rostral putamen and the left inferior frontal gyrus/frontal operculum region. This finding had a significant interaction with age; the association held only in the subgroup of older participants. Patients with OCD also showed increased structural covariance between the right centromedial-superficial amygdala and the ventromedial prefrontal cortex. LIMITATIONS: This was a cross-sectional study. Because this is a multisite data set analysis, participant recruitment and image acquisition were performed in different centres. Most patients were taking medication, and treatment protocols differed across centres. CONCLUSION: Our results provide evidence for structural network-level alterations in patients with OCD involving 2 frontosubcortical circuits of relevance for the disorder and indicate that structural covariance contributes to fully characterizing brain alterations in patients with psychiatric disorders.


Assuntos
Sistema Límbico/diagnóstico por imagem , Neostriado/diagnóstico por imagem , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Adulto , Envelhecimento/patologia , Estudos Transversais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Sistema Límbico/patologia , Modelos Lineares , Imagem por Ressonância Magnética , Masculino , Neostriado/patologia , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/patologia , Tamanho do Órgão , Caracteres Sexuais
12.
Gac. sanit. (Barc., Ed. impr.) ; 28(6): 501-504, nov.-dic. 2014. ilus
Artigo em Espanhol | IBECS | ID: ibc-130412

RESUMO

Este artículo presenta un resumen de lo que han sido los 2 años de colaboración entre la Facultad de Bellas Artes de la Universidad Complutense de Madrid y el Organismo Autónomo Madrid Salud del Ayuntamiento de Madrid. Esta colaboración ha permitido el desarrollo de experiencias y proyectos conjuntos entre profesionales y perfiles muy diversos: profesionales de la salud (sexólogos, psiquiatras, enfermeras, etc.), profesores, investigadores, artistas y estudiantes de la Facultad de Bellas Artes. Resultado de ello han sido las siguientes experiencias que pueden considerarse como antecedentes de posibles futuras colaboraciones entre el arte, la salud y la prevención (AU)


This article presents a summary of the first 2 years of the collaboration between the Faculty of Fine Arts of the Universidad Complutense in Madrid and Madrid Health, an autonomous organism of Madrid Council. This collaboration has allowed the development of joint experiences and projects among distinct professionals with highly diverse profiles: health professionals (sexologists, psychiatrists, nurses, etc.), and teachers, researchers, artists and students in the Faculty of Fine Arts. As a result, these experiences could be the beginning of future collaborations between the arts, health and prevention (AU)


Assuntos
Humanos , Masculino , Feminino , Arte , Promoção da Saúde/métodos , Promoção da Saúde/tendências , Promoção da Saúde , Medicina Preventiva/legislação & jurisprudência , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Serviços de Saúde/normas , Serviços de Saúde , Indicador de Colaboração , Medicina Preventiva/organização & administração , Medicina Preventiva/normas , Serviços de Saúde/tendências
13.
Gac Sanit ; 28(6): 501-4, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25156001

RESUMO

This article presents a summary of the first 2 years of the collaboration between the Faculty of Fine Arts of the Universidad Complutense in Madrid and Madrid Health, an autonomous organism of Madrid Council. This collaboration has allowed the development of joint experiences and projects among distinct professionals with highly diverse profiles: health professionals (sexologists, psychiatrists, nurses, etc.), and teachers, researchers, artists and students in the Faculty of Fine Arts. As a result, these experiences could be the beginning of future collaborations between the arts, health and prevention.


Assuntos
Arte , Promoção da Saúde , Saúde do Adolescente , Idoso , Terapia pela Arte , Comportamento Cooperativo , Criatividade , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Espanha , Universidades
16.
Enferm Clin ; 18(3): 115-9, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-18579060

RESUMO

OBJECTIVE: To evaluate knowledge of living wills and attitudes to these documents in the populations of two basic health areas in Toledo (Spain). METHOD: We performed a descriptive, cross-sectional study in primary care centers. Participants consisted of the populations of two basic health areas selected by systematic stratified sampling. Inclusion criteria comprised age between 18 and 80 years, and absence of mental or terminal illnesses. The participants were contacted by telephone before a personal interview was carried out. Data on demographic variables and knowledge of living wills and attitudes to these documents were recorded. RESULTS: A total of 395 participants were interviewed (58% women) with a mean age of 46.22 years (SD: 17.13). The vast majority (88.6%) were unaware of living wills, with no significant differences in sex or religious beliefs. Most (67.8%) would sign a living will in the case of terminal illness whereas 56.3% would sign at the present moment, with no significant differences in sex or religious beliefs. More than half of the men (57.5%) would agree to modify the living will if requested by relatives versus 42.6% of the women. More than three-quarters (76.2%) believed that information on living wills was insufficient. One-third (34.5%) would allow a relative's organs to be donated even without the relative leaving express wishes, while 49.2% would donate their own organs. CONCLUSION: There was a huge lack of awareness on living wills in our population, which nevertheless proved to be highly receptive to, and in agreement with, the implications of these documents after receiving information on the topic.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Testamentos Quanto à Vida , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Enferm. clín. (Ed. impr.) ; 18(3): 115-119, mayo 2008. ilus
Artigo em Espanhol | IBECS | ID: ibc-66106

RESUMO

Objetivo. Conocer el grado de conocimientos y actitudes de la población acerca del documento de voluntades anticipadas (DVA) en 2 zonas básicas de salud de Toledo. Método. Estudio descriptivo transversal realizado en atención primaria. Los participantes fueron la población de 2 zonas básicas de salud, seleccionadas mediante muestreo sistemático estratificado. Los criterios de inclusión fueron: edad entre 18 y 80 años, no tener enfermedad mental ni terminal. Se realizó entrevista personal, previa cita telefónica, recogiéndose variables sociodemográficas y datos acerca de conocimientos y actitudes ante el DVA. Resultados. Se entrevistó a 395 personas, siendo el 58% mujeres y la edad media de 46,22 años (desviación estándar = 17,13). El 88,8% no conocía el DVA, sin diferencias significativas respecto al sexo ni a creencias religiosas. Un 67,8% firmaría el DVA en caso de enfermedad terminal, mientras que el 56,3% lo firmaría en el momento actual, sin diferencias por sexo ni por creencias en ambos casos. Accedería a modificarlo a petición de sus familiares el 57,5% de los varones frente al 42,6% de las mujeres. El 76,2% consideró que no hay información suficiente acerca del DVA. Un 34,5% accedería a donar los órganos de un familiar que no hubiera dispuesto nada acerca del tema, frente al 49,2% que sí donaría sus propios órganos. Conclusiones. Hay un gran desconocimiento acerca de este tema en la población del presente estudio, que sinembargo se muestra muy receptiva y conforme con lo que implica el DVA tras recibir información


Objective. To evaluate knowledge of living wills and attitudes to these documents in the populations of two basic health areas in Toledo (Spain). Method. We performed a descriptive, cross-sectional study in primary care centers. Participants consisted of the populations of two basic health areas selected by systematic stratified sampling. Inclusion criteria comprised age between 18 and 80 years, and absence of mental or terminal illnesses. The participants were contacted by telephone before a personal interview was carried out. Data on demographic variables and knowledge of living wills and attitudes to these documents were recorded. Results. A total of 395 participants were interviewed (58% women) with a mean age of 46.22 years (SD: 17.13). The vast majority (88.6%) were unaware of living wills, with no significant differences in sex or religious beliefs. Most (67.8%) would sign a living will in the case of terminal illness whereas 56.3% would sign at the present moment, with no significant differences in sex or religious beliefs. More than half of the men (57.5%) would agree to modify the living will if requested by relatives versus 42.6% of the women. More than three-quarters (76.2%) believed that information on living wills was insufficient. One-third (34.5%) would allow a relative’s organs to be donated even without the relative leaving express wishes, while 49.2% would donate their own organs. Conclusion. There was a huge lack of awareness on living wills in our population, which nevertheless proved to behighly receptive to, and in agreement with, the implications of these documents after receiving information on the topic


Assuntos
Humanos , Consentimento Livre e Esclarecido , Testamentos Quanto à Vida , Conhecimentos, Atitudes e Prática em Saúde , Opinião Pública , Atenção Primária à Saúde , Epidemiologia Descritiva
18.
Am J Med ; 114(3): 206-10, 2003 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-12637135

RESUMO

BACKGROUND: Although atrial fibrillation is a well-known risk factor for ischemic stroke, the extent to which it increases the risk of stroke recurrence, particularly in elderly patients, is less certain. METHODS: We performed a retrospective cohort study of 915 patients aged 50 to 94 years who were admitted with an ischemic stroke. The rates of recurrent strokes and recurrent severe strokes were estimated with the Kaplan-Meier method. The effects of atrial fibrillation on stroke risk were analyzed with proportional hazards models. RESULTS: Of the 829 patients who survived the initial hospitalization, 163 (20%) had a stroke during follow-up. Of the 203 patients with atrial fibrillation during index hospitalization who were not anticoagulated, 54 (27%) had recurrent strokes, compared with 18% (19/103) among those with atrial fibrillation who were anticoagulated and 17% (90/523) among those without atrial fibrillation. The age-adjusted hazard ratio for recurrent stroke among those with atrial fibrillation who were not treated with anticoagulants was 2.1 (95% confidence interval [CI]: 1.4 to 2.9; P <0.001), whereas the hazard ratio for recurrent severe stroke was 2.4 (95% CI: 1.6 to 3.6; P <0.001). The increased risk was observed even in patients aged > or = 80 years and persisted during the follow-up for more than 5 years. CONCLUSION: Atrial fibrillation was an independent risk factor for stroke recurrence over a wide age range.


Assuntos
Fibrilação Atrial/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
19.
Am J Trop Med Hyg ; 67(4): 355-62, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12452489

RESUMO

In January 1998, dengue-3 (DEN)-3 (group III genotype) was detected in Puerto Rico after an absence of 20 years. Public health officials intensified education efforts to promote community participation in dengue control. Virologic surveillance revealed an unexpected paradox: DEN-4 and DEN-1 produced a large epidemic overlaying the DEN-3 epidemic. In 1998 there were 17,000 reported cases of dengue (4.8/1,000 persons), and among all virus isolations (n = 960), DEN-4 (419, 43.6%), DEN-1 (337, 35.1%), and DEN-2 (143, 14.9%) were detected much more frequently than DEN-3 (61, 6%). Age group-specific attack rates were highest for persons 10-19 years old, followed by infants less than a year of age. Nineteen fatal cases (median = 37 years old, range = 8 months to 90 years) had a positive laboratory diagnosis of dengue. Among DEN-3 cases no fatalities were documented, 50 were hospitalized, and 10 of 48 (21%) fulfilled the criteria for dengue hemorrhagic fever (four had primary infections and six had secondary infections). During 1999, DEN-3 became the predominant serotype isolated (182 of 310 isolations, 59%). The reappearance of DEN-3 and its subsequent circulation from 1999 to 2001 produced no changes in dengue incidence that could have been detected in the absence of virologic surveillance.


Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/classificação , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Estações do Ano
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