Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
1.
J Rheumatol ; 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33262295

RESUMO

OBJECTIVE: Macrophage activation syndrome (MAS), a life-threatening inflammatory complication, is increasingly recognized in childhood-onset SLE (cSLE). It can be a challenge to differentiate active cSLE from MAS. We generated decision rules for discriminating MAS from active cSLE in newly diagnosed patients. METHODS: We conducted a retrospective cohort study of consecutive, newly diagnosed, active cSLE patients with fever, requiring hospital admission to SickKids from January 2003 - December 2007 (cohort 1), and January 2008 - December 2013 (Cohort 2). All patients met ≥4 ACR or SLICC criteria, were steroid naïve and infection free. MAS was diagnosed based on expert opinion. Recursive partitioning was applied to each cohort to derive a decision rule based on clinical and laboratory features, distinguishing MAS from non-MAS cSLE. Each decision rule was applied to the alternate, independent cohort. Sensitivity and specificity of these decision rules were compared to existing criteria. RESULTS: Cohort 1 (n=34) and cohort 2 (n=41) each had 10 MAS patients. Recursive partitioning in cohort 1 identified ferritin ≥699 µg/L, as the sole best discriminator between MAS and non- MAS patients (R2=0.48) and in cohort 2 ferritin ≥1107 µg/L, followed by lymphocytes < 0.72 x103/mm3 were the best discriminators for MAS (R2=0.52). Cross-validation of our decision rules maintained 90-100% sensitivity and 65-85% specificity. CONCLUSION: Our decision rule demonstrated improved performance compared to preliminary guidelines for MAS in cSLE from the Lupus Working Group of the Paediatric Rheumatology European Society, and familial Hemophagocytic Lymphohistiocytosis diagnostic criteria. Validation in independent cohorts is required.

2.
J Rheumatol ; 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060314

RESUMO

OBJECTIVE: Specific risk alleles for childhood-onset SLE (cSLE) versus adult-onset SLE (aSLE) patients have not been identified. The aims of this study were to determine if: 1) There is an association between non-HLA-related genetic risk score (GRS) and age of SLE diagnosis; and if 2) There is an association between HLA-related genetic risk score and age of SLE diagnosis. METHODS: Genomic DNA was obtained from 2,001 multi-ethnic patients and genotyped using the Immunochip. Following quality control, genetic risk counting (GRCS), weighted (GRWS) and standardized counting (GRSCS) and standardized weighted (GRSWS) scores were calculated based on independent SNPs from validated SLE-loci. Scores were analyzed in a regression model and adjusted by sex and ancestral population. RESULTS: The analysed cohort consisted of 1,540 patients: 1,351 females and 189 males (675 cSLE and 865 aSLE). There were significant negative associations with age of SLE diagnosis p=0.011 and r2=0.175 for GRWS, p=0.008 and r2=0.178 for GRSCS, p=0.002 and r2=0.176 for GRSWS for all non-HLA genetic risk scores (higher GRS the lower the age of diagnosis.) All HLA genetic risk scores showed significant positive associations with age of diagnosis p=0.049 and r2=0.176 for GRCS, p=0.022 and r2=0.176 for GRWS, p=0.022 and r2=0.176 for GRSCS, p=0.011 and r2=0.177 for GRSWS: higher genetic scores correlated with higher age of diagnosis. CONCLUSION: Our data suggested that there is a linear relationship between genetic risk and age of SLE diagnosis and that HLA and non-HLA genetic risk scores are associated with age of diagnosis in opposite directions.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32976694

RESUMO

OBJECTIVE: The aim of this study was to examine the impact of timing of childhood-onset systemic lupus erythematosus (cSLE) diagnosis relative to menarchal status, on final height, accounting for and disease associated factors. METHODS: A cohort study of female cSLE patients <18 years of age at diagnosis, followed at a tertiary care, pediatric center from July 1982 to March 2016, restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre- and post-menarche. We tested the association of timing of cSLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow-up, additionally adjusting for average daily corticosteroid dose and disease activity. RESULTS: Of 401 female cSLE patients in the study, 115 patients (29%) were diagnosed pre-menarche and 286 (71%) post-menarche. Patients diagnosed pre-menarche were older at menarche compared with patients diagnosed post-menarche (13.5 ± 1.4 vs. 12.5 ± 1.3 years; p < 0.001). The mean final height for females diagnosed post-menarche (161.4 cm [SD 6.9 cm]) was greater than those diagnosed pre-menarche (158.8 cm [SD 7.3 cm], P=0.001). In regression analysis, those diagnosed post-menarche were significantly taller than those diagnosed pre-menarche, adjusted for ethnicity, and disease severity (Beta=2.6cm, [SD 0.7cm], P=0.0006). CONCLUSION: In this large cohort study of females with cSLE, patients diagnosed post-menarche achieved a taller final height than those diagnosed pre-menarche even after accounting for ethnicity and disease severity.

4.
Am Psychol ; 75(7): 909-918, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32584060

RESUMO

The COVID-19 pandemic has shed light on the norms, patterns, and power structures in the United States that privilege certain groups of people over others. This article describes COVID-19 as an unprecedented catalyst for social transformation that underscores the need for multilevel and cross-sectoral solutions to address systemic changes to improve health equity for all. The authors propose that the American Psychological Association (APA) and its membership can initiate systemic change, in part, by (a) supporting mutual aid organizations that prioritize the needs of vulnerable communities; (b) leveraging the efforts and strides APA psychologists have already made within the association, in the profession, and in policymaking to attend to the health equity and the needs of marginalized communities; (c) building capacity for collaboration between a broad coalition of health associations, health experts, and policymakers to address the physio-psycho-socioeconomic needs of disadvantaged communities; and (d) increasing the APA's participation in the formulation and implementation of an advocacy agenda that prioritizes the physical and psychological health of the communities whose lives are most endangered by COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus , Comportamento de Ajuda , Colaboração Intersetorial , Pandemias , Pneumonia Viral , Determinantes Sociais da Saúde , Sociedades Científicas , Populações Vulneráveis , Defesa do Consumidor , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Liderança , Mudança Social , Estados Unidos
5.
Rheumatology (Oxford) ; 59(1): 90-98, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236574

RESUMO

OBJECTIVE: LN is one of the most common and severe manifestations of SLE. Our aim was to test the association of SLE risk loci with LN risk in childhood-onset SLE (cSLE) and adult-onset SLE (aSLE). METHODS: Two Toronto-based tertiary care SLE cohorts included cSLE (diagnosed <18 years) and aSLE patients (diagnosed ⩾18 years). Patients met ACR and/or SLICC SLE criteria and were genotyped on the Illumina Multi-Ethnic Global Array or Omni1-Quad arrays. We identified those with and without biopsy-confirmed LN. HLA and non-HLA additive SLE risk-weighted genetic risk scores (GRSs) were tested for association with LN risk in logistic models, stratified by cSLE/aSLE and ancestry. Stratified effect estimates were meta-analysed. RESULTS: Of 1237 participants, 572 had cSLE (41% with LN) and 665 had aSLE (30% with LN). Increasing non-HLA GRS was significantly associated with increased LN risk [odds ratio (OR) = 1.26; 95% CI 1.09, 1.46; P = 0.0006], as was increasing HLA GRS in Europeans (OR = 1.55; 95% CI 1.07, 2.25; P = 0.03). There was a trend for stronger associations between both GRSs and LN risk in Europeans with cSLE compared with aSLE. When restricting cases to proliferative LN, the magnitude of these associations increased for both the non-HLA (OR = 1.30; 95% CI 1.10, 1.52; P = 0.002) and HLA GRS (OR = 1.99; 95% CI 1.29, 3.08; P = 0.002). CONCLUSION: We observed an association between known SLE risk loci and LN risk in children and adults with SLE, with the strongest effect observed among Europeans with cSLE. Future studies will include SLE-risk single nucleotide polymorphisms specific to non-European ancestral groups and validate findings in an independent cohort.


Assuntos
Idade de Início , Loci Gênicos/genética , Predisposição Genética para Doença/genética , Lúpus Eritematoso Sistêmico/genética , Nefrite Lúpica/genética , Adolescente , Adulto , Criança , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/etnologia , Nefrite Lúpica/etnologia , Masculino , Razão de Chances , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Adulto Jovem
6.
Public Health Nurs ; 34(3): 276-285, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28181290

RESUMO

OBJECTIVE: This study sought to better understand and improve influenza vaccination in low-income populations regardless of their health insurance/immigration status. It assessed client satisfaction and experiences with services provided at community-based "flu outreach" clinics in South Los Angeles. The clinics represent a community-public agency partnership-a model of vaccine delivery that was relatively novel to the region. DESIGN AND SAMPLE: During 2011-2012, a self-administered questionnaire was distributed to clients of the local health department's 39 flu outreach clinics in South Los Angeles. MEASURES: The study utilized a 10-item satisfaction scale and survey questions that gauged client history and experiences with present and prior vaccinations. RESULTS: Of 4,497 adults who were eligible, 3,860 completed the survey (participation rate = 86%). More than 90% were satisfied with their experiences at the clinics. Younger adults were significantly more likely than adults aged 65+ to report not having been vaccinated in the previous year (p < .05). No statistical differences were observed by gender or race/ethnicity. CONCLUSIONS: High satisfaction with flu outreach services in South Los Angeles suggests that this model for vaccine delivery could lead to meaningful client experience of care. Local health departments could capitalize on this model to improve preventive services delivery for the underserved.


Assuntos
Centros Comunitários de Saúde/organização & administração , Relações Comunidade-Instituição , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Pobreza , Adulto Jovem
7.
Int. j. cardiovasc. sci. (Impr.) ; 29(6): 422-430, nov.-dez.2016.
Artigo em Português | LILACS | ID: biblio-832397

RESUMO

Fundamento: A ecocardiografia transesofágica (ETE) tem atraído grande atenção e está se tornando um campo científico importante e rapidamente crescente. Objetivo: Analisar a contribuição e as características das publicações científicas sobre ETE na Ibero-América. Métodos: Uma pesquisa bibliográfica foi realizada no PubMed (US National Library of Medicine National Institutes of Health) para identificar publicações científicas sobre ETE indexadas até 1º de maio de 2015. Os termos utilizados na pesquisa bibliográfica incluíram "ecocardiografia transesofágica", "ecocardiograma transesofágico", ecocardiografia transesofágica 3D" e "ecocardiografia tridimensional". Esses termos foram vinculados a cada país ibero-americano. Dados adicionais sobre as revistas de cada publicação científica foram obtidos a partir do SCImago Journal & Country Rank. Resultados: A Ibero-América originou 4% de todas as publicações sobre ETE. O número de publicações da Ibero-América aumentou de zero antes de 1990 a 60 em 2015. A Espanha, o México e o Brasil originaram 75% de todas as publicações da região. Cerca de 30% dos textos completos eram de acesso livre. A maioria das publicações científicas era em inglês. Cerca de 90% das publicações eram relatos de casos ou séries de casos sobre endocardite infecciosa, tumores ou massas cardíacas, doença cardíaca congênita, fontes cardioembólicas de acidente vascular cerebral e cardiologia intervencionista invasiva. A Espanha e a Argentina foram os países que originaram manuscritos com maior probabilidade de serem publicados em revistas estrangeiras. Cerca de 40% das publicações ibero-americanas foram em revistas classificadas no quartil superior das revistas científicas em seu respectivo campo. Conclusões: A produção científica sobre ETE na Ibero-América é limitada, mas vem aumentando. O número e as características das publicações sobre ETE mostram diferenças notáveis entre os países ibero-americanos. (Int J Cardiovasc Sci. 2016;29(6):422-430)


Transesophageal echocardiography (TEE) has attracted great attention and is becoming an important, rapid­progressing scientific field. Objective: To analyse the contribution and characteristics of scientific publications on TEE from Iberoamerica. Methods: A literature search was conducted in PubMed (US National Library of Medicine National Institutes of Health) to identify scientific publications on TEE indexed before May 1, 2015. Terms used for the literature search included "transesophageal echocardiography", "transesophageal echocardiogram", "3D transesophageal echocardiography", and "three­dimensional echocardiography". These terms were combined with each Iberoamerican country. Additional data from the journal of each scientific publication were obtained from the SCImago Journal & Country Rank. Results: Iberoamerica originated 4% of all publications on TEE. The number of publications from Iberoamerica increased from zero before 1990 to 60 in 2015. Spain, Mexico, and Brazil originated 75% of all publications from the region. About 30% of full­texts were freely available. Most of the scientific publications were in English. About 90% of the publications were case reports or case series about infectious endocarditis, tumors or cardiac masses, congenital heart disease, cardioembolic sources of stroke, and invasive interventional cardiology. Spain and Argentina were the countries that originated manuscripts with a higher likelihood of being published in foreign journals. About 40% of Iberoamerican publications were in journals ranked in the top 25% of scientific journals in their field. Conclusions: The scientific production on TEE from Iberoamerica is limited, but is increasing. The number and characteristics of publications on TEE show notable differences between Iberoamerican countries.


Assuntos
Humanos , Bases de Dados Bibliográficas/estatística & dados numéricos , Ecocardiografia Transesofagiana/história , Ecocardiografia Transesofagiana/estatística & dados numéricos , Sistemas de Avaliação das Publicações , Publicações Científicas e Técnicas
8.
Psychol Serv ; 12(2): 177-185, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25798663

RESUMO

Positive psychologists have contributed to our understandings of how positive emotions and flexible cognition enhance resiliency. However, positive psychologists' research has been slow to address the relational resources and interactions that help nonheterosexual families overcome adversity. Addressing overlooked lesbian, gay, bisexual, transgender, or queer (LGBTQ) and systemic factors in positive psychology, this article draws on family resilience literature and LGBTQ literature to theorize a systemic positive psychology framework for working with nonheterosexual families. We developed the LGBTQ relationally based positive psychology framework that integrates positive psychology's strengths-based perspective with the systemic orientation of Walsh's (1996) family resilience framework along with the cultural considerations proposed by LGBTQ family literature. We theorize that the LGBTQ relationally based positive psychology framework takes into consideration the sociopolitical adversities impacting nonheterosexual families and sensitizes positive psychologists, including those working in organized care settings, to the systemic interactions of same-sex loving relationships.


Assuntos
Bissexualidade/psicologia , Família/psicologia , Homossexualidade/psicologia , Otimismo/psicologia , Resiliência Psicológica , Pessoas Transgênero/psicologia , Adulto , Feminino , Humanos , Masculino , Teoria Psicológica
9.
Actas odontol ; 10(2): 12-18, dic. 2013.
Artigo em Espanhol | LILACS | ID: lil-727941

RESUMO

El Cefalograma de Ricketts es reconocido a nivel mundial como uno de los estudios cefalométricos más utilizados y difundidos, pero laaplicación del mismo en todas las poblaciones aún está en análisis y discusión. En este trabajo se presenta una revisión de la literatura,con el objetivo de analizar la validez de la aplicación del Cefalograma de Ricketts en diferentes grupos étnicos y poblaciones. Además valorar si el mismo es aplicable a la población uruguaya. Los valores estudiados en dichos grupos son comparados con las normasestablecidas por el autor en el cefalograma original (Ricketts, 1972).


Rickett’s cephalogram is one of the most widely known and used cephalometric study, but its application on all populations is still under analysis and discussion. This piece of work presents a review of the literature with the objective of analyzing the cephalogram’s validity on different ethnic groups and populations. As well as to assess if the cephalogram is applicable to the Uruguayan population.The values studied on such groups are compared to the norms established by the author on the original cephalogram (Ricketts, 1972).


Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Criança , Cefalometria/métodos , Grupos Étnicos/etnologia , Análise de Variância , Face/anatomia & histologia , Valores de Referência
10.
Actas odontol ; 9(1): 63-75, jul. 2012.
Artigo em Espanhol | LILACS | ID: lil-666529

RESUMO

Esta revisión bibliográfica se refiere a los métodos de registro de la Relación Céntrica (RC) con un recorrido de la literatura desde 1921a la actualidad en busca de aclarar su definición. Esta controvertida posición cráneo mandibular lleva a una evolución en las técnicasde su registro.El objetivo es describir los métodos de registro, clasificarlos, aportar conocimiento y demostrar su necesidad en el momento del diagnósticoy el plan de tratamiento de acuerdo a las definiciones más aceptadas de RC.


This literature review analyzes the methods of recording Centric Relation (CR) with a previous revision throughout the years seekingto clarify its definition.This controversial craniomandibular position has gone through many changes in it’s registration techniques. A description of the techniquesis made until arriving to the most recent ones according the current accepted definition. The aim is to describe the methods ofrecording, classify them and provide information in order to choose a method in orthodontics diagnosis and treatment, and demostrateits need according to the most accepted definition of Centric Relation.


Assuntos
Humanos , Relação Central , Registro da Relação Maxilomandibular/métodos , Articuladores Dentários , Oclusão Dentária Central , Má Oclusão/diagnóstico , Má Oclusão/terapia
11.
Arq. bras. cardiol ; 96(3): 233-239, mar. 2011. ilus, tab
Artigo em Português | LILACS | ID: lil-581467

RESUMO

FUNDAMENTO: Diferentes abordagens de enfermagem no manejo de pacientes com insuficiência cardíaca (IC) tem demonstrado benefícios na redução da morbidade e mortalidade. Entretanto, a combinação de educação intra-hospitalar com contato telefônico após a alta hospitalar tem sido pouco explorada. OBJETIVO: Comparar dois grupos de intervenção de enfermagem entre pacientes hospitalizados devido à IC descompensada: o grupo intervenção (GI) recebeu intervenção educativa de enfermagem durante a hospitalização, seguida de monitorização por telefone após a alta hospitalar e o grupo controle (GC) recebeu apenas a intervenção hospitalar. Os desfechos foram conhecimento da IC e autocuidado, número de visitas à emergência, re-hospitalizações e morte em um período de três meses. MÉTODOS: Ensaio clínico randomizado. Pacientes adultos com IC e fração de ejeção do ventrículo esquerdo (FEVE) < 45 por cento que podiam ser contatados por telefone após a alta foram estudados. O conhecimento da IC foi avaliado por meio de um questionário padronizado que também incluía questões referentes ao conhecimento do autocuidado, o qual foi respondido durante o período de hospitalização e três meses depois. Para os pacientes do grupo GI, os contatos foram realizados por meio de telefonemas e as entrevistas finais foram conduzidas em ambos os grupos ao final do estudo. RESULTADOS: Quarenta e oito pacientes foram alocados no GI e 63 no grupo GC. A idade média (63 ± 13 anos) e FEVE (aproximadamente 29 por cento) eram similares nos dois grupos. Os escores para conhecimento da IC e autocuidado foram similares na avaliação basal. Três meses depois, ambos os grupos demonstraram melhora significativa dos escores de conhecimento da IC e autocuidado (P < 0,001). Outros desfechos foram similares. CONCLUSÃO: A intervenção educativa de enfermagem intra-hospitalar beneficiou todos os pacientes com IC em relação ao conhecimento da doença e autocuidado, independente do contato telefônico após a alta hospitalar.


BACKGROUND: Nursing approaches to manage patients with heart failure (HF) showed benefits in reducing the morbidity and mortality. However, combining intra-hospital education with telephone contact after hospital discharge has been little explored. OBJECTIVE: To compare two nursing intervention groups among patients hospitalized due to decompensated HF: the intervention group (IG) received educational nursing intervention during hospitalization followed by telephone monitoring after discharge and the control group (CG) received in-hospital intervention only. Outcomes were levels of HF and self-care knowledge, the frequency of visits to the emergency room, rehospitalizations and deaths in a three-month period. METHODS: Randomized clinical trial. We studied adult HF patients with left ventricle ejection fraction (LVEF) < 45 percent who could be contacted by telephone after discharge. HF awareness was evaluated through a standardized questionnaire that also included questions regarding self-care knowledge, which was answered during the hospitalization period and three months later. For patients in the IG group contacts were made using phone calls and final interviews were conducted in both groups at end of the study. RESULTS: Forty-eight patients were assigned to the IG and 63 to the CG. Mean age (63 ± 13 years) and L (around 29 percent) were similar in the two groups. Scores for HF and self-care knowledge were similar at baseline. Three months later, both groups showed significantly improved HF awareness and self-care knowledge scores (P < 0.001). Other outcomes were similar. CONCLUSION: An in-hospital educational nursing intervention benefitted all HF patients in understanding their disease, regardless of telephone contact after discharge.


FUNDAMENTO: Diferentes abordajes de enfermería en el manejo de pacientes con insuficiencia cardíaca (IC) han demostrado beneficios en la reducción de la morbilidad y mortalidad. Entre tanto, la combinación de educación intrahospitalaria con contacto telefónico después del alta hospitalaria ha sido poco explorada. OBJETIVO: Comparar dos grupos de intervención de enfermería entre pacientes hospitalizados debido a IC descompensada: el grupo intervención (GI) recibió intervención educativa de enfermería durante la hospitalización, seguida de monitoreo por teléfono después del alta hospitalaria y el grupo control (GC) recibió apenas la intervención hospitalaria. Los desenlaces fueron conocimiento de IC y autocuidado, número de visitas a la emergencia, rehospitalizaciones y muerte en un período de tres meses. MÉTODOS: Ensayo clínico randomizado. Pacientes adultos con IC y fracción de eyección del ventrículo izquierdo (FEVI) < 45 por ciento que podían ser contactados por teléfono después del alta fueron estudiados. EL conocimiento de la IC fue evaluado por medio de un cuestionario estandarizado que también incluía preguntas referentes al conocimiento del autocuidado, el cual fue respondido durante el período de hospitalización y tres meses después. Para los pacientes del grupo GI, los contactos fueron realizados por medio de telefonemas y las entrevistas finales fueron conducidas en ambos grupos al final del estudio. RESULTADOS: Cuarenta y ocho pacientes fueron ubicados en el GI y 63 en el grupo GC. La edad media (63 ± 13 años) y FEVI (aproximadamente 29 por ciento) eran similares en los dos grupos. Los escores para conocimiento de la IC y autocuidado fueron similares en la evaluación basal. Tres meses después, ambos grupos demostraron mejora significativa de los escores de conocimiento de la IC y autocuidado (P<0,001). Otros desenlaces fueron similares. CONCLUSIÓN: La intervención educativa de enfermería intrahospitalaria benefició a todos los pacientes con IC en relación al conocimiento de la enfermedad y autocuidado, independiente del contacto telefónico después del alta hospitalaria.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Continuidade da Assistência ao Paciente , Insuficiência Cardíaca/enfermagem , Padrões de Prática em Enfermagem , Autocuidado , Assistência ao Convalescente/métodos , Brasil , Estudos de Casos e Controles , Seguimentos , Insuficiência Cardíaca/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Análise de Sobrevida , Telefone , Fatores de Tempo , Resultado do Tratamento
12.
Arq Bras Cardiol ; 96(3): 233-9, 2011 Mar.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-21308343

RESUMO

BACKGROUND: Nursing approaches to manage patients with heart failure (HF) showed benefits in reducing the morbidity and mortality. However, combining intra-hospital education with telephone contact after hospital discharge has been little explored. OBJECTIVE: To compare two nursing intervention groups among patients hospitalized due to decompensated HF: the intervention group (IG) received educational nursing intervention during hospitalization followed by telephone monitoring after discharge and the control group (CG) received in-hospital intervention only. Outcomes were levels of HF and self-care knowledge, the frequency of visits to the emergency room, rehospitalizations and deaths in a three-month period. METHODS: Randomized clinical trial. We studied adult HF patients with left ventricle ejection fraction (LVEF) < 45% who could be contacted by telephone after discharge. HF awareness was evaluated through a standardized questionnaire that also included questions regarding self-care knowledge, which was answered during the hospitalization period and three months later. For patients in the IG group contacts were made using phone calls and final interviews were conducted in both groups at end of the study. RESULTS: Forty-eight patients were assigned to the IG and 63 to the CG. Mean age (63 ± 13 years) and L (around 29%) were similar in the two groups. Scores for HF and self-care knowledge were similar at baseline. Three months later, both groups showed significantly improved HF awareness and self-care knowledge scores (P < 0.001). Other outcomes were similar. CONCLUSION: An in-hospital educational nursing intervention benefitted all HF patients in understanding their disease, regardless of telephone contact after discharge.


Assuntos
Continuidade da Assistência ao Paciente , Insuficiência Cardíaca/enfermagem , Padrões de Prática em Enfermagem , Autocuidado , Adulto , Assistência ao Convalescente/métodos , Idoso , Brasil , Estudos de Casos e Controles , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Análise de Sobrevida , Telefone , Fatores de Tempo , Resultado do Tratamento
13.
Vertex ; 19(82): 357-63, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-19424518

RESUMO

UNLABELLED: Since 2003, international health regulatory agencies warned about the use of antidepressants in children and adolescents. These warnings were based upon reports from clinical trials in which there was an increased risk of "suicidality" with these drugs. In 2007, this warning was extended to young adults. Given the widespread use of antidepressants, these warnings have been very controversial. Numerous clinical trials have been made to investigate this subject, finding some difficulties: 1) the lack of consistency of the term "suicidality", 2) the complexity of the differential diagnoses of children depression, given the high rates of bipolarity in this population, 3) the difference between "activation syndrome" and mixed states induced by antidepressants, both with high suicide risk, 4) the methodological difficulties to evaluate suicide. CONCLUSIONS: In treatment with antidepressants there are some reports about an increment in suicide attempts (most at the initial phase of treatment). There is no evidence of an increase of completed suicide rates. It is of utmost importance to make a proper diagnose and a close follow up of depressed patients even if they do not receive pharmacological treatment.


Assuntos
Antidepressivos/efeitos adversos , Suicídio/estatística & dados numéricos , Adolescente , Criança , Humanos , Terminologia como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA