Correlations between clinical measures and symptoms: Report 2: Accommodative and vergence measures with symptoms

Aim: The aim of this study was to explore associations among clinical measures of accommodation and vergences with symptoms, which could facilitate the validation of the Convergence Insufficiency Symptoms Survey to screen for deficient clinical measures.MethodsUsing a multi-stage random cluster sampling, 1211 high school students (481 males and 730 females) between 13 and 18 years of age were selected and examined. Visual acuity, stereoacuity and suppression, refractive errors, near point of convergence, heterophoria and fusional vergences, as well as, amplitude of accommodation, accommodative response, facility and relative accommodation were evaluated. The validity of the Convergence Insufficiency Symptoms Survey to distinguish between children with and those without anomalies in the clinical measures were characterized using the Receiver Operation Curve, sensitivity and specificity of the tests.ResultsThe overall mean and standard deviation for symptoms score was 27.38 ± 11.04. Deficient accommodative measures revealed worse symptoms scores than did deficient vergence measures and children with deficient clinical measures had significantly higher mean symptoms scores. (p = 0.001) However, the correlations between defective clinical measures and symptoms were significant but relatively weak. The Receiver Operation Curve showed that the clinical measures with the highest sensitivities using the CISS (≥16) were: reduced amplitude of accommodation 0.63, 95% Confidence interval, 0.59−0.68%) accommodative facility 0.62 (95% Confidence interval, 0.58−0.67) and near point of convergence 0.60 (95% Confidence interval, 0.53−0.67).ConclusionDeficient clinical measures and symptoms of asthenopia are prevalent and correlated in the sample of school children studied. Overall, findings suggest that high school children with deficient clinical measures may be symptomatic when they perform intense near task compared to those without deficiencies. (AU)

Terminologia especializada de enfermagem no cuidado às pessoas vivendo com aids / Terminología especializada de enfermería en el cuidado de personas que viven con sida / Specialized nursing terminology in care of people infected with AIDS

Resumo Objetivo: Construir e validar quanto ao conteúdo uma terminologia especializada de Enfermagem, no cuidado a adultos vivendo com aids, fundamentado no Modelo de Sete Eixos da Classificação Internacional para a Prática de Enfermagem. Métodos: Estudo metodológico, realizado em um Hospital Escola no Nordeste do Brasil. Seguiram-se as seguintes etapas: extração dos termos de prontuários de pessoas vivendo com aids; normalização; mapeamento cruzado entre os extraídos e os constantes na Classificação Internacional para a Prática de Enfermagem; distribuição destes nos sete eixos e validação de conteúdo por meio de índice de concordância entre enfermeiros peritos. Resultados: Extraíram-se 2.000 termos. A normalização resultou em 557 termos pertinentes, estando 319 constantes e 238 não constantes na Classificação Internacional para a Prática de Enfermagem. Foram validados pelos peritos 522 termos, sendo 319 constantes e 203 não constantes, os quais atingiram um índice de concordância ≥ 0,80. Conclusão: O estudo permitiu identificar e validar os termos utilizados por enfermeiros na assistência às pessoas vivendo com aids, o qual subsidiará as etapas subsequentes à construção de um subconjunto terminológico para informação e comunicação à prática de Enfermagem.

Resumen Objetivo: Elaborar y validar, en cuanto al contenido, una terminología especializada de enfermería en el cuidado de adultos que viven con sida, fundamentada en el Modelo de Siete Ejes de la Clasificación Internacional de la Práctica de Enfermería. Métodos: Estudio metodológico, realizado en un hospital universitario en la región nordeste de Brasil. Se llevaron a cabo las siguientes etapas: extracción de los términos de historias clínicas de personas que viven con sida; normalización; mapeo cruzado entre los términos extraídos y los que constan en la Clasificación Internacional de la Práctica de Enfermería; distribución de estos en los siete ejes y validación de contenido mediante el índice de concordancia por enfermeros peritos. Resultados: Se extrajeron 2.000 términos. La normalización dio como resultado 557 términos pertinentes, de los cuales 319 constaban en la Clasificación Internacional de la Práctica de Enfermería y 238 no. Los peritos validaron 522 términos, de los cuales 319 constaban y 203 no constaban, que alcanzaron un índice de concordancia ≥ 0,80. Conclusión: El estudio permitió identificar y validar los términos utilizados por enfermeros en la atención a personas que viven con sida y contribuirá con las etapas subsiguientes de la construcción de un subconjunto terminológico para información y comunicación en la práctica de enfermería.

Abstract Objective: To build and validate, in terms of content, a specialized nursing terminology in care of adults infected with AIDS, based on the Seven-Axis Model of the International Classification for Nursing Practice. Method: A methodological study carried out at a teaching hospital in northeastern Brazil. The following steps followed extraction of terms from the medical records of people infected with AIDS; normalization; cross-mapping between extracted and constant in the International Classification for Nursing Practice; distribution in seven axes and content validation through a concordance index among expert nurses. Results: Two thousand terms have been extracted. Normalization resulted in 557 pertinent terms, 319 of which were constant and 238 not included in the International Classification for Nursing Practice. Five hundred and twenty-two terms were validated by experts, of which 319 were constant and 203 were not constant, which reached a concordance index ≥ 0.80. Conclusion: This study allowed to identify and validate the terms used by nurses in assisting people infected with AIDS, which will subsidize the steps subsequent to the construction of a terminological subset for information and communication to nursing practice.

Usos de la Estadística en artículos originales de revistas médicas cubanas / Uses of Statistics in original papers of Cuban medical journals

RESUMEN Se presentan resultados preliminares del proyecto de investigación "Usos de la estadística en artículos originales de la Revista Médica Electrónica de Matanzas", que corresponde al programa No. 2 (Organización, eficiencia y calidad de los servicios), código 152042.La información cuantitativa del proyecto se obtuvo por conducto de la aplicación de un diseño muestral sistemático con arranque aleatorio que proporcionó datos sobre nueve variables estadísticas medidas en 170 artículos originales de revistas médicas cubanas. Se calcularon las distribuciones porcentuales de cada variable. Predominó la aplicación de los estudios descriptivos y sus correspondientes medidas estadísticas. Se evidenció la poca aplicación de las estimaciones por intervalos, denotando una insuficiencia que debe ser eliminada. Los resultados proporcionan una aproximación al estado actual de la aplicación de la estadística en la redacción de artículos científicos originales (AU).

SUMMARY The authors present preliminary results of the research project "Uses of Statistics in original papers of Cuban medical journals", corresponding to the program Nr. 2 (Organization, efficacy and quality of the services), codex 152042. The quantitative information of the project was obtained applying a systematic sampling design with randomized onset that provided data on nine statistic variables measured in 170 original papers of Cuban medical journals. Percentage distributions of each variable were calculated. The application of descriptive studies and their correspondent statistical measures predominated. It was evidenced the scarce application of interval estimations, denoting an insufficiency that has to be eliminated. The outcomes provide an approximation to the current status of the statistics application in writing original scientific papers (AU).

Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR) / Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes

Objetivo: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). Metodología: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. Resultados: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,283,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). Conclusiones: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias

Objective: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. Results: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). Conclusion: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure

Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia / Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registry

Objetivo: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. Conclusiones: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido

Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs

Metodología de una revisión sistemática / Methodology of a systematic review

Contexto: La medicina basada en la evidencia tiene como objetivo apoyarse en la mejor información científica disponible para aplicarla a la práctica clínica. Entender e interpretar la evidencia científica implica conocer los niveles de evidencia disponibles, donde las revisiones sistemáticas y/o metaanálisis de ensayos clínicos son la cúspide de la pirámide del nivel de evidencia. Adquisición de la evidencia: El proceso de revisión debe estar bien desarrollado y planificado de antemano para reducir sesgos y eliminar estudios irrelevantes o de baja calidad. Los pasos a seguir para la realización de una revisión sistemática incluyen: (I) formular correctamente la pregunta clínica a responder (PICO), (II) desarrollo de un protocolo (criterios de inclusión y exclusión), (III) realizar una búsqueda bibliográfica detallada y amplia, (IV) cribar los resúmenes de los trabajos identificados en la búsqueda y posteriormente de los textos completos seleccionados (PRISMA). Síntesis de la evidencia: Una vez seleccionados los estudios se debe: (V) extraer en un formulario diseñado en el protocolo los datos necesarios para resumir los estudios incluidos, (VI) evaluar los sesgos de cada estudio pudiendo identificar la calidad de la evidencia disponible y, por último, (VII) desarrollar las tablas y el texto que sinteticen la evidencia. Conclusiones: Una revisión sistemática implica un resumen crítico y reproducible de los resultados de las publicaciones disponibles sobre un mismo tema o pregunta clínica concreta. Con el fin de mejorar la escritura científica, se expone de una forma estructurada la metodología para la realización de una revisión sistemática

Context: The objective of evidence-based medicine is to employ the best scientific information available to apply to clinical practice. Understanding and interpreting the scientific evidence involves understanding the available levels of evidence, where systematic reviews and meta-analyses of clinical trials are at the top of the levels-of-evidence pyramid. Acquisition of evidence: The review process should be well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include (I) correctly formulating the clinical question to answer (PICO), (II) developing a protocol (inclusion and exclusion criteria), (III) performing a detailed and broad literature search and (IV) screening the abstracts of the studies identified in the search and subsequently of the selected complete texts (PRISMA). Synthesis of the evidence: Once the studies have been selected, we need to (V) extract the necessary data into a form designed in the protocol to summarise the included studies, (VI) assess the biases of each study, identifying the quality of the available evidence, and (VII) develop tables and text that synthesise the evidence. Conclusions: A systematic review involves a critical and reproducible summary of the results of the available publications on a particular topic or clinical question. To improve scientific writing, the methodology is shown in a structured manner to implement a systematic review

Efectividad de los programas de inmersión virtual en los pacientes con enfermedad de Parkinson. Revisión sistemática / Effectiveness of virtual immersion programmes in patients with Parkinson’s disease. A systematic review

Introducción. La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente. La tecnología de realidad virtual (RV) ha adquirido una gran relevancia en la rehabilitación en pacientes de origen neurológico. El objetivo es analizar la efectividad terapéutica de la RV en pacientes con EP en variables motoras, calidad de vida y cognición. Pacientes y métodos. La búsqueda de artículos se realizó utilizando bases de datos electrónicas: Medline, EMBASE, PEDro, CINAHL y Cochrane. Los criterios de inclusión fueron estudios clínicos aleatorizados (ECA) en pacientes con EP donde al menos una intervención terapéutica estuviera basada en programas de RV. Se seleccionaron cuatro ECA con calidad metodológica buena. La concordancia entre los evaluadores fue moderada-alta. En los cuatro ECA se realizó inmersión de RV como principal tratamiento. Resultados. Dos de los ECA revelaron que la RV es superior frente al tratamiento de fisioterapia convencional para la mejora del equilibrio. Dos de los ECA revelaron que la RV no es superior frente al tratamiento convencional en la mejora del equilibrio. Existe evidencia contradictoria de que los programas para la mejora del equilibrio basados en RV son más eficaces que los basados en fisioterapia convencional. Las variables no motoras medidas en los diferentes ECA no se vieron mejoradas en los grupos tratados con RV frente a los tratados con fisioterapia convencional. Conclusiones. No se ha podido demostrar que la efectividad terapéutica de los sistemas de RV sea superior a los programas de fisioterapia convencional en pacientes con EP en variables motoras y psicosociales (AU)

Introduction. Parkinson disease (PD) is the second most common neurodegenerative disease. Virtual reality (VR) is being used in rehabilitation of neurological patients. To analyze the VR systems' therapeutically effectiveness through PD diagnosed subjects with variables of motor, quality of life and cognition. Patients and methods. Electronics database were used to look for articles: Medline, EMBASE, PEDro, CINAHL and Cochrane. The inclusion criteria were: randomized control trial (RCT) performed in PD with at least one VR variable included in the therapeutically treatment and diagnosed PD subjects. Four RCT were chosen showing all good methodology quality. Concordance between evaluators was moderate-high. VR was the main treatment in all of them. Results. VR was more effective in balance improvement in PD subjects than conventional physiotherapy in two RCT. VR was not more effective in balance improvement in PD subjects than conventional physiotherapy in two RCT. Contradictory evidences where showed between the effectiveness of the VR programs versus conventional programs in the effectiveness of balance treatment with PD subjects. Non-motor variables improvement was not greater in subjects with VR treatments versus the ones with conventional physiotherapy in the four RCT. Conclusions. The treatments with VR cannot be assumed as more effectives than conventional physiotherapy through PD subjects in motor and psychosocial variables (AU)

Disability, Chronic Diseases and Access to Healthcare in Jamaica / Discapacidad, Enfermedades Crónicas y Acceso a la Salud en Jamaica

ABSTRACT Objective: To look at healthcare delivery for persons with disabilities in Jamaica. Methods: A quantitative survey of persons with disabilities using a systematic random sampling technique with respondents selected from the database of the Jamaica Council for Persons with Disabilities. Results: Participants included 1014 persons with disabilities. The results showed that persons with disabilities were regular users of the public health system and that the major chronic illnesses identified among respondents were diabetes mellitus, mental illness and hypertension. Conclusion: Persons with disabilities are regular users of the public health system and so efforts must be made to consistently educate these individuals about ways to maximize use of this service.

RESUMEN Objetivo: Examinar la prestación de servicios de salud a las personas discapacitadas en Jamaica. Métodos: Un estudio cuantitativo de las personas con discapacidad que utiliza una técnica de muestreo aleatorio sistemática con los encuestados seleccionados de la base de datos del Consejo de Jamaica para las Personas con Discapacidad. Resultados: Los participantes incluyeron 1014 personas con discapacidad. Los resultados mostraron que las personas con discapacidad eran usuarios regulares del sistema de salud pública, y que las principales enfermedades crónicas identificadas entre los encuestados eran la diabetes mellitus, las enfermedades mentales y la hipertensión. Conclusión: Las personas con discapacidad son usuarios regulares del sistema de salud pública, por lo que se deben hacer esfuerzos para educar sistemáticamente a estos individuos sobre las formas de maximizar el uso de este servicio.

Factores asociados con la intensidad del dolor en pacientes mexicanos hospitalizados en periodo postoperatorio / Factors associated with pain intensity in mexican patients hospitalized in postoperative period

Objetivo: Determinar la asociación entre la intensidad del dolor reportado por pacientes mexicanos hospitalizados en periodo postoperatorio con algunas características del paciente, así como del personal de enfermería. Material y métodos: El diseño del estudio fue de tipo descriptivo correlacional. La muestra fue de 231 pacientes seleccionados a través de un muestreo sistemático de uno en dos con inicio aleatorio. Se incluyeron 31 enfermeras que representan el total del personal de enfermería que trabajan en los departamentos de cirugía general, traumatología y ginecología. Para la recolección de la información se utilizó la cédula de datos del paciente, cédula de identificación de la enfermera, cuestionario de intensidad del dolor en el paciente postoperatorio y la encuesta de conocimiento del dolor por enfermería. Resultados: Una alta proporción de pacientes presentó dolor moderado a severo durante las primeras 24 horas postoperatorias. El 69,6 % de los participantes presentó dolor severo. No se encontró asociación entre la intensidad del dolor con la edad y escolaridad del paciente, ni con el conocimiento del personal de enfermería sobre el manejo del dolor. Se encontró diferencia significativa en la intensidad del dolor respecto al sexo, en el máximo dolor experimentado (U = 3997,50, p = 0,001) y en el dolor promedio en 24 horas (U = 4852, p = 0,03). La mayor intensidad del dolor se ubicó en el sexo femenino. La media de conocimiento del personal de enfermería en relación con el manejo del dolor se ubicó en 54,40 (DE = 13,12). La intensidad del dolor promedio que ha experimentado el paciente en las primeras 24 horas se asoció con el número de pacientes asignados al personal de enfermería (rs = 0,167, p = 0,01). Conclusiones: El manejo del dolor en periodo postoperatorio es inadecuado y sigue siendo un reto a la tendencia nacional e internacional de contar con hospitales libres de dolor. Se recomienda, como medida para contribuir al alivio del dolor, considerar el manejo farmacológico adecuado a las demandas del paciente, el uso de medidas no farmacológicas, la valoración de la intensidad del dolor y sus efectos de manera regular y la educación que se proporciona al paciente (AU)

Objective: To determine the association between the pain intensity (assessment) reported by the hospitalized postoperative mexican patients with some features of patient and nursing staff. Material and methods: The study design was descriptive and correlational. The sample consisted of 231 patients selected through a systematic sampling of one in two with random start, 31 nurses representing the total of nurses who work in the departments of general surgery, orthopedics and gynecology were included. For data collection the patient data certificate, nurse identification card, pain intensity (assessment) questionnaire o postoperative patient and pain awareness survey for nursing were used. Results: A high proportion of patients had moderate to severe pain during the first 24 postoperative hours, 69.6 % of participants had severe pain. No association between pain intensity (assessment) with age and education of the patient, or the knowledge of nurses about pain management were found. Significant difference was found in pain intensity about sex, pain experienced at maximum (U = 3997.50, p = 0.001) and average pain over 24 hours (U = 4852, p = 0.03).The more intensity (assessment) of pain was located in the female. The average of nursing staff knowledge regarding pain management stood at 54.40 (SD = 13.12). The average intensity (assessment) of pain experienced by the patient in the first 24 hours was associated with the number of patients assigned to nurses (rs = 0.167, p = 0.01). Conclusions: Pain management in postoperative period is inappropriate and remains a challenge to national and international trend to have pain-free hospitals. It is recommended as a measure to contribute to pain relief, consider the appropriate pharmacological management to the demands of the patient, the use of non-pharmacological measures, assessment of pain intensity and its effects regularly and education that the patient is provided (AU)

Estereologia das glândulas bulbouretrais do coelho (Oryctolagus cuniculus) e da cobaia (Cavia porcellus) / Stereology of the bulbourethral gland of the rabbit (Oryctolagus cuniculus) and guinea pig (Cavia porcellus)

The bulbourethral glands (GBU) in the rabbit (Oryctolagus cuniculus) and guinea pig (Cavia porcellus) play an important role in reproductive physiology. However, histological and stereological aspects are scarce. Thus, the objective of this research was to compare stereological characteristics between the rabbit and guinea pig GBU as a first approximation in the understanding of morphometric variables involved in reproductive processes. Five rabbits were used and five adult male guinea pigs, healthy, obtained from the Vivarium of the Universidad de La Frontera, Temuco, Chile. Pelvic region was dissected, isolating the GBU of each animal. Was determined weight and volume of each gland. These were fixed in buffered formalin for 24 hours and embedded in paraplast. Serial sections of 4 microns thick, were stained with HE, for stereological analysis. The average glandular cells in the rabbit’s GBU was 19.50x10(5)mm³ (SD 2.35), and for the guinea pig 10.57x10(5)mm³ (SD 2.07), and the average percentage of glandular tissue was 25.52% (SD 2.20) and 17.20% (SD 3.33) respectively. All stereological parameters were compared statistically significant difference (p<0.0001). These differences could be explained because there is a closer epithelial cell secretory acinar, smaller lumen diameter and nucleus to cytoplasm ratio in the rabbit’s GBU. Thus, the acini of the GBU had a greater number of cells per mm³ in the rabbit’s GBU. These parameters can be influenced by hormonal factors, age, seasonal and environmental among others. Consider the morphological characteristics of the GBU in these animals could affect the successful reproduction by the male.

As glândulas bulbouretrais (GBU) no coelho (Oryctolagus cuniculus) e na cobaia (Cavia porcellus) desempenham um papel importante na fisiologia reprodutiva. No entanto, seus aspectos histológico e estereológico são escassos. Assim, o objetivo desta pesquisa foi comparar características estereológicas entre as GBU do coelho e da cobaia como um primeiro passo para a compreensão das variáveis morfométricas que participam nos processos reprodutivos. Foram utilizados 5 coelhos e 5 cobaias adultos machos, saudáveis, obtidos do Biotério da Universidade de La Frontera, Temuco, Chile. A região pélvica foi dissecada isolando-se a GBU de cada animal. Determinou-se o peso e o volume de cada glândula. Estas foram fixadas em formalina tamponada durante 24 horas e incluídas em paraplast. Cortes seriados de 4 μm de espessura foram corados com HE para análise estereológica. A média de células glandulares na GBU do coelho foi 19,50 x 10(5)mm³ (DP 2,35) e da cobaia 10,57 x 10(5)mm³ (DP 2,07) e a porcentagem média de tecido glandular foi de 25,52% (DP 2,20) e 17,20% (DP 3,33), respectivamente. Todos os parâmetros estereológicos comparados tiveram uma diferença estatisticamente significativa (p<0,0001). Estas diferenças poderiam ser explicadas porque há maior proximidade celular do epitélio secretor, menor diâmetro do lúmen dos ácinos e da relação núcleo citoplasma na GBU do coelho. Assim, os ácinos da GBU apresentam maior quantidade de células por mm³ do que na GBU do coelho. Estes parâmetros podem ser influenciados por fatores hormonais, etários, sazonais e ambientais, entre outros. Considerar as características morfológicas da GBU nesses animais poderia condicionar o êxito da reprodução por parte do macho.

Tratamiento quirúrgico de pacientes con quistes de inclusión epidérmica / Surgical treatment of patients with epidermal inclusion cysts

Se realizó un estudio prospectivo, longitudinal y aleatorizado de 29 pacientes con quiste de inclusión epidérmica en la región cervicofacial, no infectados, atendidos en el Servicio de Cirugía Maxilofacial del Hospital Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba, desde junio de 2011 hasta noviembre de 2012, tratados quirúrgicamente mediante los métodos de incisión lineal mínima o excisión en W, con vistas a comparar los resultados de ambos procederes. Se obtuvo que el tiempo operatorio promedio fue más corto en el grupo de incisión lineal mínima y que los quistes que medían entre menos de 1 y hasta 2 cm, localizados en las unidades estéticas faciales de mayor exigencia, eran mejor tratados con dicho método, lo cual produjo mejores resultados y un índice recurrencia no significativo en relación con la excisión en W(AU)

A prospective, longitudinal and randomized study of 29 patients with epidermal inclusion cysts in the cervicofacial region, not infected, assisted in the Maxillofacial Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from June, 2011 to November, 2012, surgically treated by means of the methods of minimal lineal incision or W excision, with the aim of comparing the results of both procedures. It was obtained that the average surgical time was shorter in the group of minimal lineal incision and that the cysts fluctuating from less than 1 cm and up to 2 cm, located in the facial aesthetic units of greater demand, were better treated with this method, what produced better results and a non significant recurrence value in relation to the W excision(AU)

¿Es transferible la terapia de locomoción refleja a una plataforma de teleneurorrehabilitación en el tratamiento del paciente adulto? / No disponible

Introducción: La telerehabilitacion hace referencia a la prestacion de servicios de rehabilitación basados en las tecnologias de la informacion y comunicacion. Se estudia el potencial de la terapia Vojta para ser transferida parcialmente a este medio en los adultos. Material y metódo: Ensayo clinico aleatorizado y ciego en 45 sujetos adultos sanos (20 V y 25 M; edad: 23,41 a˜nos; DE: 2,73). Seleccion de incidental. Se estudia en el ejercicio del volteo reflejo, 2 tipos de estimulacion la zona pectoral: manual, contra un dispositivo que reproduce esta estimulacion. Variable principal: microvoltios de contraccion muscular mediante EMG de superficie, sobre el extensor comun de los dedos. Finalmente, se estudia la capacidad de control por parte del sujeto de la activacion refleja provocada con el dispositivo, supervisando la sesión a distancia por webcam. Resultados: En ambos tipos de intervencion hay contraccion significativa en relacion a los valores de reposo p = 0,00. En cambio, entre la intervencion manual y la producida por el dispositivo mecanico no hay diferencias significativas en la variable de resultado principal, p = 0,29. En la fase de activacion por videoconferencia tampoco se ha podido demostrar diferencias significativas, p = 0,64. Conclusiones: El dispositivo mecanico produce una contraccion en el musculo diana equivalente a la intervencion manual. Ademas, la fase de activacion remota usando el dispositivo muestra que el sujeto entrenado puede autogestionarse bajo la supervision del especialista mediante webcam. Por tanto, la terapia Vojta en el ejercicio del volteo reflejo tiene el potencial de transferirse a una plataforma de telerehabilitacion en adultos (AU)

Introduction: Tele-rehabilitation refers to the providing of physiotherapy services based on the new information and communication technologies. The potential of Vojta therapy is studied in order to be partially used in adults in this setting.Material and method: A randomized, double blind clinical trial was performed with 45 healthy adult subjects (20 men and 25 women; aged: 23 to 41 years; SD: 2.73). Chance selection. Two types of chest area stimulation are studied in the Reflex Rolling pattern: manual compared to a mechanical mechanism that reproduces the same stimulation. Primary endpoint: microvolts of muscle contractions with a surface EMG, over the common fingers extensor. Finally, the subject’s capacity of control of the reflex activation caused with the mechanism is studied. The session are supervised by distance with a webcam. Results: There are significant contradictions in both types of intervention regarding resting levels P=.00. However, significant differences are not found in the main result between manual intervention or that produced by the mechanical mechanism P=.29. It was not possible to demonstrate significant differences, P=.64 in the activation stage with webcam. Conclusions: The mechanical mechanism produces a contraction in the muscle similar to the manual intervention. Furthermore, the remote activation with the mechanism shows that the trained subject is capable of self-management under the supervision of the webcam specialist. Therefore, Vojta therapy in the Reflex Rolling pattern has the potential to be transferred to a tele-rehabilitation platform for adults (AU)

Recogida y análisis sistemático de problemas anestésicos intraoperatorios / Systematic collection and analysis of intraoperative anaesthetic-related problems

Objetivo. El objetivo de este estudio fue la recogida sistemática y el análisis de la frecuencia, tipo y severidad de todos los problemas anestésicos intraoperatorios ocurridos en nuestro hospital durante 6 meses. Métodos. Estudio observacional, sistemático, prospectivo y transversal, en el que se estudia el suceso y sus factores de riesgo. Se basó en una recogida de datos rutinaria de todas las anestesias. Incluye anestesia, sedación y analgesia de parto. Las variables recogidas fueron demográficas y de procedimiento, así como una lista de verificación con el tipo de problema y su grado de severidad. Los datos se analizaron mediante los tests de Chi al cuadrado, Fisher, o t de Student, aceptando p<0,05 como significativa. Resultados. La frecuencia de problemas anestésicos intraoperatorios fue de 17,2%, con 1,3 problemas por caso, siendo 9 veces mas frecuentes los problemas con bajo grado de severidad. Durante la anestesia, aparecieron problemas respiratorios en 13, circulatorios en 8, y técnicos en 2 de cada 100 procedimientos. Los factores asociados con los pacientes que presentaron problemas anestésicos se asociaron al uso de la anestesia general, cirugía supraumbilical y mayor riesgo anestésico preoperatorio. Conclusiones. La recogida sistemática de problemas intraoperatorios relacionados con la anestesia, mediante una lista de verificación de problemas y severidad, juega un importante papel en las estrategias de gestión de calidad. El análisis de problemas menores puede ayudar a establecer acciones correctivas antes de la aparición de morbilidad, separando los problemas propios de la cirugía de los de la anestesia(AU)

Objective. The purpose of the study was to systematically collect and analyse the frequency, type and severity of all untoward intraoperative anaesthetic-related problems in a hospital over a 6-month period. Methods. An observational, systematic, prospective, and cross sectional study was conducted on the events and their risk factors. The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis, including sedation and obstetric analgesia. The variables were demographic, procedural data, and a checklist with problem type and severity. Data were analysed using chi-square, Fisher's test, or Student's test. A P<.05 was considered statistically significant. Results. The frequency of intraoperative anaesthetic-related problems was 17.2%, with 1.3 anaesthetic problems per case, being 9 times more frequent the adverse effects with low severity grade. During anaesthesia, respiratory problems occurred in 13, circulatory problems in 8, and technical problems in 2 out of every 100 procedures. The factors associated with the patient in whom the anaesthetic problem occurred were: the use of general anaesthesia, supraumbilical surgery, and a higher preoperative anaesthetic risk. Conclusions. Use of a systematic intraoperative anaesthetic-related database with a checklist of problems and severity plays an important part in quality assurance strategies. An analysis of non-fatal problems provides a basis for establishing corrective strategies before significant morbidity occurs, and by separating the surgical and anaesthesia problems(AU)

Autorización de usos de medicamentos fuera de indicación en un hospital de tercer nivel / Off-label approval of drug use in a tertiary hospital

Fundamento y objetivo. Comisión de Farmacia y Terapéutica (CFT) evalúa peticiones de usos fuera de indicación con un modelo de informe abreviado. El objetivo fue realizar un análisis descriptivo de esta actividad y estudiar la tasa de autorizaciones. Material y métodos. Estudio descriptivo de los informes de la CFT del hospital entre septiembre de 2009 y abril de 2011. Se analizó tipo de fármaco por grupo terapéutico y por tipo de dispensación, indicación y servicio peticionario. Además, se estudió la decisión final adoptada como variable principal y porcentaje de solicitudes aprobadas según características del medicamento evaluado, indicación solicitada, alternativas usadas, evidencia y coste, como resultados secundarios. Resultados. De un total de 51 solicitudes analizadas, un 60,8% fueron medicamentos de uso hospitalario y un 54,9% citostáticos. Destacaron las indicaciones oncohematológicas (43,2%) y autoinmunes (35,3%). Los servicios con más peticiones fueron Hematología (11 peticiones aprobándose el 72,7%), Oncología y Pediatría (10 peticiones aprobándose el 50% para ambas). Se aprobaron el 60,8% de las peticiones. De las no autorizadas, 11 no agotaron las alternativas terapéuticas y 8 no presentaban evidencia suficiente para ser aceptadas. El 47,1% de los medicamentos solicitados tenían un coste/paciente entre 10.000-100.000 euros aprobándose el 58,3% (coste por tratamiento completo si tenía duración definida o coste por año en tratamientos crónicos). Conclusión. Hay una gran actividad de la CFT que crece con los años. La mayoría de las solicitudes son de fármacos de uso hospitalario, sobre todo de citostáticos por Oncohematología. Existe una alta tasa de autorización con una alta variabilidad según servicio y tipo de evidencia. La diferencia, entre aprobados y no aprobados respecto al coste sigue una lógica de coste-efectividad(AU)

Background and objective. The Pharmacy and Therapeutics Committee (PTC) evaluates the requests for off-label uses with an abbreviated report format. The aim of this study is to perform a descriptive analysis of this activity and to study the rate of approvals. Material and Methods. A descriptive study was performed on the PTC reports in a tertiary hospital between September 2009 and April 2011. The type of drug by treatment group and by type of dispensing, indication and requesting department was analysed. The final decision adopted was studied as the primary outcome, and the percentage of requests approved according to the characteristics of the drug evaluated, indication requested, alternatives used, evidence and cost, as secondary outcomes. Results. A total of 51 applications were analysed, of which 60.8% were drugs for hospital use and 54.9% cytostatic. The most requested indications were the onco-haematological (43.2%) and autoimmune (35.3%). Haematology was the department that made most requests (11 requests with 72.7% approved), Oncology and Paediatrics (both with 10 requests, with 50% approved). Almost two-thirds (60.8%) of the requests were approved. Of those that were not approved, 11 had not used up the therapeutic alternatives, and 8 had no evidence. Just under half (47.1%) of the drugs requested had a cost/patient between 10,000-100,000 euros,of which 58.3% were approved (cost per course of treatment if it had a defined period, or cost of treatment per year for chronic treatment). Conclusion. There is an increase in the activity of the PTC that is growing over the years. Most applications focus on drugs for hospital use and cytostatic drugs by Onco-haematology. There is a high rate of approval by the PTC, and high variability in the percentage of approval depending on the department and the evidence of use. The difference between approved and unapproved requests followed a logic of cost-effectiveness(AU)

¿Son necesarias las dosis elevadas de prednisona para el tratamiento de la neumopatía intersticial en la esclerosis sistémica? / Are high doses of prednisone necessary for treatment of interstitial lung disease in systemic sclerosis?

Introducción: La neumopatía intersticial (NI) en el curso de la esclerosis sistémica (ES) constituye la causa principal de morbilidad y mortalidad. Objetivos: Evaluar si el uso de prednisona en altas o bajas dosis combinado con ciclofosfamida intravenosa (iv) resulta igualmente eficaz en el tratamiento de la NI en la ES. Método: Se realizó un estudio explicativo experimental tipo ensayo clínico, aleatorizado y a simple ciego, donde se reclutó a 23 pacientes con ES y NI. Se evaluaron dos esquemas de tratamientos; grupo A: 13 pacientes con ciclofosfamida (iv) mensual durante 6 meses y bimensual durante los 6 meses restantes, prednisona (1 mg × kg × día) 4 semanas y después se rebajó la dosis a 5 mg cada 2 semanas hasta 10 mg, y grupo B: 10 pacientes con ciclofosfamida (iv) y prednisona por vía oral 10 mg diaria. Resultados: Se muestran las diferencias significativas al inicio del estudio en la CVF y el patrón en panal de abejas entre ambos grupos, resultando desfavorecido el grupo de dosis altas. Al concluir el tratamiento, el grupo de bajas dosis logró una mejoría de las lesiones radiológicas y del índice de Warrick, a diferencia del grupo de dosis altas. Las restantes variables experimentaron mejoría en los dos grupos, sin marcada desigualdad. Se presentaron de forma similar reacciones adversas ligeras. Dos pacientes abandonaron la investigación. Conclusiones: Una combinación de dosis bajas de esteroides con ciclofosfamida es eficaz en el tratamiento NI especialmente en las formas activas. Los resultados no muestran diferencias respecto al grupo con altas dosis, pero el tamaño muestral y la mayor gravedad evolutiva de los pacientes con altas dosis, obligan a otros estudios para confirmar estos datos (AU)

Introduction: Interstitial lung disease (ILD) as part of systemic sclerosis (SS) is a leading cause of morbidity and mortality. Objectives: To evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective. Method: An experimental, exploratory and randomized single-blind clinical trial was conducted at Hermanos Ameijeiras Clinical Surgical Hospital from September 2006 to December 2009, including 23 patients with SS and ILD. Two treatment schedules were evaluated and randomly assigned. Group A was composed of 13 patients with a monthly dose of cyclophosphamide (ev) for 6 months and a twicemonthly dose for the remaining 6 months, prednisone (1 mg × kg × day) 4 weeks and then the dose was lowered to 5 mg every 2 weeks up to 10 mg. Group B: 10 patients with cyclophosphamide (ev), oral prednisone 10 mg daily. Results: There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage. At the end of treatment the low dose group achieved improvement of radiologic lesions and the Warrick index, unlike the high dose group. The remaining variables experienced improvement in both groups without marked inequality. Similarly, slight adverse reactions were present in both groups. Two patients dropped out of the study. Conclusions: A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not showe differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify this data (AU)

Eficacia y seguridad de la infiltración con metilprednisolona en pacientes con síndrome anserino: ensayo clínico aleatorizado / Safety and efficacy of methylprednisolone infiltration in anserine syndrome treatment

Objetivo: El síndrome anserino es una causa frecuente de dolor de rodilla. La infiltración con glucocorticoides ha sido evaluada en estudios con bajo nivel de evidencia y no se han publicado ensayos clínicos para determinar su utilidad. El objetivo del estudio es determinar la eficacia y la seguridad de la infiltración de metilprednisolona para el tratamiento del síndrome anserino. Métodos: Efectuamos un ensayo clínico en 58 pacientes adultos con síndrome anserino, a los que se les descartó patología intraarticular que reflejara dolor en la cara medial de la rodilla. Se evaluó la escala WOMAC basal y se aleatorizaron a recibir una infiltración de xilocaína más 40 mg de acetato de metilprednisolona (grupo 1) versus xilocaína más agua destilada (grupo 2). Ambos grupos recibieron 100 mg de diclofenaco sódico durante 10 días. Se realizó la escala WOMAC a las 4 semanas y el registro de eventos adversos. Resultados: Se demostró equivalencia en ambos grupos para las variables demográficas y en la evaluación clínica inicial. No hubo diferencias estadísticas en los tres dominios de evaluación de la escala WOMAC basal. La mediana del WOMAC basal en el grupo 1 fue de 32 y en el grupo 2 de 25,5 puntos. A las 4 semanas fue de 8 y 6,5 puntos, que correspondió a una mejoría del 61,6 y 62,8%, respectivamente. Conclusión: La infiltración con metilprednisolona en el síndrome anserino no es superior al placebo en pacientes que toman diclofenaco medidos por la escala WOMAC a las 4 semanas. La incidencia de eventos adversos tampoco difirió (AU)

Objective: The anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of Anserin Syndrome. Methods: We conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40 mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100 mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. Results: Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the three domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6 and 62.8% respectively. Conclusion: The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either (AU)

Enfermagem baseada em evidências: avanços e inovações em revisões sistemáticas / Evidence-based nursing: advances and innovations in systematic reviews / Enfermería basada en la evidencia: avances e innovaciones en las revisiones sistemáticas

O fluxo vertiginoso de informações e conhecimentos da época atual acarretou a necessidade de recursos eferramentas para lidar com a complexidade desses dados. Nessa perspectiva, assiste-se, atualmente, àpreocupação não apenas de produzir conhecimentos, mas, de como administrá-lo de forma a que possa serfacilmente acessado e utilizado. Com essa preocupação, algumas instituições têm se dedicado a orientar acoleta, síntese e transferência de dados em consonância com o movimento da prática de saúde baseada emevidências, reconhecida por aumentar a eficiência, a qualidade dos serviços de saúde e a diminuição de custos.Dentre essas instituições, o Instituto Joanna Briggs, sediado em Adelaide, Austrália, tem se destacado comoimportante liderança mundial no setor. Desse modo, o presente artigo tem como objetivo descrever algunsrecursos, métodos e a relevância das contribuições do Instituto Joanna Briggs para a enfermagem baseada emevidências.

Nowadays the vertiginous flow of information and knowledge brought about the need for resources and tools todeal with the complexity of such data. From this perspective, we are witnessing today, the concern not only toproduce knowledge, but how to manage it so that it can be easily accessed and used.With this concern someinstitutions have dedicated themselves to guide the collection, synthesis and transfer of data in agreement withthe healthcare based on evidence, which is known to increase the efficiency, quality of health services and lowercosts. Among these institutions, the Joanna Briggs Institute, based in Adelaide, Australia, has emerged as animportant global leadership role. Thus, this paper aims to describe some features, methods and relevance of thecontributions of the Joanna Briggs Institute for evidence-based nursing.

El flujo vertiginoso de informaciones y conocimientos de la época actual trajo consigo la necesidad de recursos yherramientas para hacer frente a la complejidad de estos datos. Desde esta perspectiva, estamos presenciando,hoy en día, la preocupación no sólo de producir conocimiento, sino también de cómo administrarlos para quepuedan ser fácilmente accedidos y utilizados. Con esta preocupación, algunas instituciones se han dedicado aorientar la recolección, síntesis y transferencia de datos en consonancia con el movimiento de la práctica desalud basada en evidencias, reconocida para aumentar la eficiencia, la calidad de los servicios de salud y ladisminución de costos. Entre estas instituciones, el Instituto Joanna Briggs, con sede en Adelaida, Australia, seha destacado como un importante liderazgo mundial en el sector. Por lo tanto, el presente artículo tiene comoobjetivo describir algunos recursos, métodos y la relevancia de las contribuciones del Instituto Joanna Briggs para la enfermería basada en evidencias.

Prevalência de transtornos mentais comuns e fatores associados em uma população assistida por equipes do Programa Saúde da Família / Prevalence of common mental disorders in the population attended by the Family Health Program

OBJETIVO: Avaliar a prevalência de casos suspeitos de transtornos mentais comuns em uma população assistida por uma equipe do Programa Saúde da Família e investigar os fatores associados à ocorrência dessa morbidade. MÉTODOS: Pesquisa de levantamento, de corte transversal. A amostra, composta por 277 sujeitos, foi obtida por meio do método de amostragem aleatória do tipo sistemática. Para a coleta de dados, foram aplicados o Self Report Questionnaire (SRQ-20) e um questionário sociodemográfico. RESULTADOS: A prevalência global de casos suspeitos de transtornos mentais comuns na população alvo foi de 43,70 por cento. O sexo feminino apresentou uma taxa de prevalência significativamente mais elevada (48,37 por cento), quando comparado ao sexo masculino (34,41 por cento). A variável "renda familiar" apresentou uma relação inversa com a prevalência de transtornos mentais comuns. A análise de regressão logística indicou que apenas as variáveis "uso de medicamento" e "renda familiar" estavam associadas significativamente à suspeita de casos de transtornos mentais comuns. CONCLUSÕES: Os resultados apontaram uma elevada prevalência de transtornos mentais comuns nessa população alvo, comparativamente aos dados de outros estudos semelhantes, indicando a necessidade de um cuidado especial por parte da Atenção Primária à Saúde, em particular para as famílias caracterizadas pelos fatores associados ao transtornos mentais comuns apontados nesta investigação.

OBJECTIVE: Investigate the prevalence of suspected cases of common mental disorders in a population assisted by one professional team of the Brazilian Family Health Program as well as to evaluate its associated factors. METHODS: A cross-sectional survey study was carried out using a randomized systematic sampling procedure for selecting 277 subjects from the target population. For data collection, two instruments were administered to the sample, the Self Report Questionnaire (SRQ-20) as well as a sociodemographic questionnaire. RESULTS: The global prevalence of cases suspected of presenting common mental disorders in the target population was of 43.70 percent. Females had a significantly higher prevalence rate (48.37 percent), when compared to males (34.41 percent). The variable "family income" had an inverse relation to the common mental disorders prevalence. The logistic regression analysis indicated that only two variables - "use of medication" and "family income" - were significantly associated to common mental disorders. CONCLUSIONS: The results indicated a higher prevalence of common mental disorders in this target-population, compared to data from other similar studies, indicating the need for a special attention to be rendered by the primary health care system to detect and treat those cases in families attended by the Brazilian Family Health Program, specially those characterized by the associated factors detected.

Cirurgia bariátrica no Brasil / Bariatric surgery in Brazil

Revisar os estudos sobre cirurgia bariátrica no Brasil entre os anos de 2005 e 2010. Revisão sistemática realizada na base Scientific Electronic Library Online, utilizando o termo "cirurgia bariátrica". Foram verificadas 52 ocorrências e incluídos neste estudo 18 artigos. Foram destacados: a região de realização do estudo, o delineamento da pesquisa, o tipo de cirurgia, as características amostrais, os parâmetros avaliados, os principais resultados e limitações. Os resultados mais destacados foram a diminuição da prevalência de síndrome metabólica, melhorias de parâmetros clínicos, bioquímicos e psicológicos e a redução ponderal. O tempo de acompanhamento dos pacientes variou entre 11 e 33 meses. Nenhum dos artigos relatou riscos associados à cirurgia, e a principal limitação observada foi o tamanho das amostras. Os resultados apontam melhorias das comorbidades associadas ao excesso de peso e revelam a necessidade de outros estudos sobre cirurgia bariátrica no Brasil