Validity and reliability of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted life -years) for patients with type 2 diabetes in Iran.

BACKGROUND AND AIMS: The psychometric properties of the EQ-5D-3L (a generic preference-based instrument used for calculating quality-adjusted Life -years) have not been known for any type of disease in Iran. This study aimed to assess its validity and reliability in patients with type 2 diabetes. METHODS: Data of 579 patients were collected from the Diabetes Research Center and Clinics in Yazd using EQ-5D-3L, SF-36, and DQoL instruments. The ceiling effects were computed for the EQ-5D-3L index and EQ VAS. The construct validity was assessed by using convergent validity, discriminant validity, and known-groups validity. Reliability was assessed using Cohen's kappa value, Cronbach's alpha, and intra-class correlation coefficient. RESULTS: The ceiling effects of EQ-5D-3L and EQ VAS were 20.18% and 15.33%, respectively. The highest degree of correlation was found between the pain/discomfort of EQ-5D and the BP scale of the SF-36 (0.55). Higher scores of all scales of the DQoL were associated with patients reporting no problems in each EQ-5D dimension. The mean of EQ-5D-3L index and EQ VAS scores were significantly higher in the male, married, and employed patients, and they did not have retinopathy, nephropathy, IHD, hypertension, DFU. The range of kappa values was from 0.39 to 0.71, and value of ICC for the EQ-5D-3L index and EQ VAS was 0.76 and 0.64, respectively. Cronbach's alpha was 0.87 for EQ-5D-3L and 0.74 for EQ VAS. CONCLUSIONS: Our findings demonstrated good construct validity and moderate to good levels of reliability of the EQ-5D-3L for using in the patients with diabetes, and it can be used in research or clinical practice in Iran and other regions of the Middle East.

Quality assessment of prevalence studies: a systematic review.

OBJECTIVES: The objective of the study is to identify items and domains applicable for the quality assessment of prevalence studies. STUDY DESIGN AND SETTING: We searched databases and the gray literature to identify tools or guides about the quality assessment of prevalence studies. After study selection, we abstracted questions applicable for prevalence studies and classified into at least one of the following domains: 'population and setting', 'condition measurement', 'statistics', and 'other'. PROSPERO registration:CRD42018088437. RESULTS: We included 30 tools: eight (26.7%) specifically designed to appraise prevalence studies and 22 (73.3%) adaptable for this purpose. We identified 12 unique items in the domain "population and setting", 16 in the domain "condition measurement", and 14 in the domain "statistics". Of those, 25 (59.5%) were identified in the eight specific tools. Regarding the domain "other", we identified 77 unique items, mainly related to manuscript writing and reporting (n = 48, 62.3%); of those, 24 (31.2%) were identified in the eight specific tools and 53 (68.8%) in the additional 22 nonspecific tools. CONCLUSION: We provide a comprehensive set of items classified by domains that can guide the appraisal of prevalence studies, conduction of primary prevalence studies, and update or development of tools to evaluate prevalence studies.

Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations.

Cross-sectional studies are observational studies that analyze data from a population at a single point in time. They are often used to measure the prevalence of health outcomes, understand determinants of health, and describe features of a population. Unlike other types of observational studies, cross-sectional studies do not follow individuals up over time. They are usually inexpensive and easy to conduct. They are useful for establishing preliminary evidence in planning a future advanced study. This article reviews the essential characteristics, describes strengths and weaknesses, discusses methodological issues, and gives our recommendations on design and statistical analysis for cross-sectional studies in pulmonary and critical care medicine. A list of considerations for reviewers is also provided.

Quality of life assessment instruments for adults: a systematic review of population-based studies.

BACKGROUND: Against a backdrop of population aging and improving survival rates for chronic noncommunicable diseases (CNCD), researchers are placing growing emphasis on health-related quality of life (HRQoL). The aim of this study was to identify the QoL assessment instruments used in population-based studies with adults conducted around the world. METHODS: A systematic review of original research published in all languages between 2008 and 2018 was conducted. Systematic reviews and meta-analyses were excluded. RESULTS: Sixty-three articles (38.1% conducted in the Americas) fitted the eligibility criteria. Based on the AHRQ checklist for cross-sectional studies and the Newcastle-Ottawa scale for cohort studies, methodological quality was shown to be fair in the majority of studies (55.6%) and good in 44.4%. The country with the highest number of publications was Brazil (20.6%). Twelve types of generic instruments and 11 specific instruments were identified. The generic instrument SF-36 was the most frequently used measure (33.3% of studies). In-home interviewing was exclusively used by 47.6% of the studies, while 39 studies (61.9%) reported the use of self-administered questionnaires. Over two-thirds of the studies (34.9%) used questionnaires to investigate the association between chronic diseases and/or associated factors. CONCLUSIONS: It was concluded that the wide range of instruments and modes of questionnaire administration used by the studies may hinder comparisons between population groups with the same characteristics or needs. There is a lack of research on QoL and the factors affecting productive capacity. Studies of QoL in older persons should focus not only on the effects of disease and treatment, but also on the determinants of active aging and actions designed to promote it. Further research is recommended to determine which QoL instruments are best suited for population-based studies.

Impact of Early Antiretroviral Treatment Initiation on Performance of Cross-Sectional Incidence Assays.

Antiretroviral therapy (ART) can impact assays used for cross-sectional HIV incidence testing, causing inaccurate HIV incidence estimates. We evaluated the relationship between the timing of ART initiation and the performance of two serologic HIV incidence assays. We analyzed 302 samples from 55 individuals from the RV217 cohort (Early Capture HIV Cohort Study). Participants were grouped by ART start time: ART started <1 year after infection (N = 9); ART started 1-3 years after infection (N = 12); and never received ART (N = 34). Samples were tested using the Sedia LAg-Avidity and Johns Hopkins modified Bio-Rad-Avidity assays. Results were compared with those from the Johns Hopkins HIV Cohort in which participants initiated ART an average of 10 years after infection (N = 17). Participants on ART were virally suppressed at the time of sample collection. The increase in normalized optical density (ODn) values was an average of 2.15 U/year lower in participants who started ART <1 year after infection than in those who did not start ART. Participants who started ART 1-3 years after infection had a decline in ODn values 0.90 U/year faster compared with those who started ART an average of 10 years after infection. Timing of ART initiation did not significantly impact results obtained with the Bio-Rad-Avidity assay. ART initiation <1 year after HIV infection was associated with persistently low limiting antigen (Lag)-Avidity values; this could lead to overestimation of HIV incidence. LAg-Avidity values declined more rapidly the earlier ART was initiated. Bio-Rad-Avidity values were not impacted by the timing of ART initiation.

Fluoretação da água dos dez maiores municípios do estado do Tocantins, Brasil / Water fluoridation in the ten largest municipalities of the state of Tocantins, Brazil

Resumo Fluoretação da água é uma estratégia de controle da cárie, recomendada pela OMS. No Brasil ela é regulamentada por lei, mas não tem sido implementada com sucesso na região Norte. Os objetivos desta pesquisa foram levantar dados sobre a existência do heterocontrole nos 10 maiores municípios tocantinenses e analisar a concentração de fluoreto presente na água de abastecimento público destas cidades. A pesquisa foi realizada de maio-agosto/17 e teve como marco teórico-metodológico a análise quantitativa, descritiva e transversal. Coletas de água foram realizadas mensalmente, utilizando protocolo de amostragem de coleta de água da rede. A concentração de fluoreto nas águas foi feita com eletrodo íon específico pela técnica direta. Constatou-se que a vigilância da fluoretação da água está em operação na capital do estado desde 2016. Com relação a concentração de fluoreto na água, foi encontrado que 31,6% das amostras analisadas estavam adequadas para o máximo benefício de redução de cárie e 27,5% delas apresentavam risco alto ou muito alto de fluorose dentária. É necessário implementar um programa de controle da concentração de flúor na água no Tocantins, a fim de garantir que a população não seja privada dos benefícios anticárie da agregação de flúor à agua tratada.

Abstract Water fluoridation is a strategy for caries control recommended by the WHO. In Brazil, it is regulated by law but this program has not been successfully implemented in the North region. This research aimed to collect data on the existence of external control (heterocontrol) in the ten largest municipalities in the state of Tocantins, Brazil, and to analyze fluoride concentration in the public water supply of these cities. The study was conducted from May-August/17, and its theoretical-methodological framework was a quantitative, descriptive and cross-sectional analysis. Water collections were carried out monthly, using sampling protocol of water collection of the network. Fluoride concentration in the waters was determined with ion specific electrode by the direct technique. It was verified that water fluoridation monitoring is only been done in Palmas, capital of the state, starting in 2016. Thirty-two percent of waters samples analyzed showed fluoride concentration to obtain the maximum benefit of reduction caries and 27.5% of them presented a high or very high risk of dental fluorosis. It is necessary to implement a program to control the concentration of fluoride in the water of the municipalities of Tocantins, in order to ensure that the population is not deprived of the anticaries' benefits of the adjustment of fluoride concentration of the treated water.

Chinese Validation of the Multidimensional Attitude Scale toward Persons with Disabilities (MAS): Attitudes toward Autism Spectrum Disorders.

The literature on tools of attitudes towards ASD was limited. This study is the first to examine the factor structure and psychometric properties of the multidimensional attitudes scale toward persons with disabilities (MAS) in a sample of Chinese college students (N = 1002, 32.10% males). Confirmatory factor analysis supported the G-MAS-R model's 4-factor structure: calm, negative affect, positive cognitions and behavioral avoidance. The results suggest that the Chinese version of the MAS has satisfactory internal consistency. Pearson correlation analysis showed that the MAS scores were significantly correlated with the Social Distance Scale and Autism Stigma and Knowledge Questionnaire scores. Overall, the findings indicate that the MAS is appropriate for assessing attitudes toward people with ASD in a Chinese context.

Cross-sectional and prospective data-collection in North Macedonia-methodological considerations.

Study design: Cross-sectional and prospective cohort-study. Objectives: To describe methodological issues, experienced challenges related to data collection in North Macedonia and to discuss possible improvements of epidemiological data collection in future studies. Setting: Clinic for Traumatology, Orthopedics, Anesthesia, Reanimation, Intensive Care Unit and Emergency Center, Mother Teresa Skopje University Hospital, Skopje and community settings, North Macedonia. Method: A description of methodological challenges experienced in collecting data from 78 persons with acute and chronic traumatic spinal cord injury (SCI) examined and interviewed in 2015-2017 using a semiquantitative questionnaire and standard assessments tools. Results: This study identified three major challenges with data collection in this setting: (1) research logistics and procedures, such as recruitment, infrastructure, and compensation, (2) ethical issues and the initial lack of mutual trust and understanding between researchers and participants, and (3) scientific quality and interpretation, including representativeness. Conclusions: Methodological issues influenced by settings, are important to consider when interpreting study results. Healthcare systems vary between (and sometimes in) countries, language and culture may introduce barriers to understanding, and epidemiological research also rely on infrastructure and surroundings. For this study, making time for and listening to the participants without being intruding was of special importance in building trust and a good relationship with the participants during recruiting participants and collecting data. We here provide suggestions regarding how to facilitate future epidemiological data collections in North Macedonia.

Defining reference intervals for a serum growth differentiation factor-15 (GDF-15) assay in a Caucasian population and its potential utility in diabetic kidney disease (DKD).

BACKGROUND: Growth differentiation factor-15 (GDF-15), a stress responsive cytokine, is a promising biomarker of renal functional decline in diabetic kidney disease (DKD). This study aimed primarily to establish normative data and secondarily to evaluate the potential utility of GDF-15 in DKD using Roche Diagnostics electrochemiluminescence immunoassay (ECLIA) in an Irish Caucasian population. METHODS: Following informed consent, 188 healthy volunteers and 128 participants with diabetes (72 with and 56 without DKD) were recruited to a cross-sectional study. Baseline demographics, anthropometric measurements and laboratory measurements were recorded. Blood for GDF-15 measurement was collected into plain specimen tubes kept at room temperature and processed (centrifugation, separation of serum, freezing at -80 °C) within 1 h of phlebotomy pending batch analyses. Reference intervals were determined using the 2.5th and 97.5th percentiles for serum GDF-15 concentration. RESULTS: Of 188 healthy participants, 63 failed to meet study inclusion criteria. The reference interval for serum GDF-15 was 399 ng/L (90% confidence interval [CI]: 399-399) - 1335 ng/L (90% CI: 1152-1445). Receiver operator characteristics (ROC) curve analysis for DKD determined the area under the ROC curve to be 0.931 (95% CI: 0.893-0.959; p<0.001). The optimum GDF-15 cutoff for predicting DKD was >1136 ng/L providing a diagnostic sensitivity and specificity of 94.4% and 79%, respectively, and positive likelihood ratio of 4.5:1 (95% CI: 3.4-6.0). CONCLUSIONS: The reference interval for serum GDF-15 in a healthy Irish Caucasian population using Roche Diagnostics ECLIA was established and a preliminary determination of the potential of GDF-15 as a screening test for DKD was made. Further prospective validation with a larger DKD cohort will be required before the cutoff presented here is recommended for clinical use.

Validity of parental recalls to estimate vaccination coverage: evidence from Tanzania.

BACKGROUND: The estimates of vaccination coverage are measured from administrative data and from population based survey. While both card-based and recall data are collected through population survey, and the recall is when the card is missing, the preferred estimates remain of the card-based due to limited validity of parental recalls. As there is a concern of missing cards in poor settings, the evidence on validity of parental recalls is limited and varied across vaccine types, and therefore timely and needed. We validated the recalls against card-based data based on population survey in Tanzania. METHODS: We used a cross-sectional survey of about 3000 households with women who delivered in the last 12 months prior to the interview in 2012 from three regions in Tanzania. Data on the vaccination status on four vaccine types were collected using two data sources, card and recall-based. We compared the level of agreement and identified the recall bias between the two data sources. We further computed the sensitivity and specificity of parental recalls, and used a multivariate logit model to identify the determinants of parental recall bias. RESULTS: Most parents (85.4%) were able to present the vaccination cards during the survey, and these were used for analysis. Although the coverage levels were generally similar across data sources, the recall-based data slightly overestimated the coverage estimates. The level of agreement between the two data sources was high above 94%, with minimal recall bias of less than 6%. The recall bias due to over-reporting were slightly higher than that due to under-reporting. The sensitivity of parental recalls was generally high for all vaccine types, while the specificity was generally low across vaccine types except for measles. The minimal recall bias for DPT and measles were associated with the mother's age, education level, health insurance status, region location and child age. CONCLUSION: Parental recalls when compared to card-based data are hugely accurate with minimal recall bias in Tanzania. Our findings support the use of parental recall collected through surveys to identify the child vaccination status in the absence of vaccination cards. The use of recall data alongside card-based estimates also ensures more representative coverage estimates.

Effectiveness Evaluation of Additional Risk Minimization Measures for Adolescent Use of Aripiprazole in the European Union: Results from a Post-Authorization Safety Study.

INTRODUCTION: Two risk minimization (RM) tools-a healthcare professional frequently asked questions (HCP-FAQs) brochure and a patient/caregiver information brochure (PCIB)-were developed for HCPs and for adolescents (aged ≥ 13 years) receiving aripiprazole for bipolar I mania and their caregivers. OBJECTIVES: This study evaluated the effectiveness of these RM tools in improving the awareness and education of HCPs and patients/caregivers. METHOD: The RM tools were distributed to HCPs (identified in agreement with the marketing authorization holder [MAH] and local regulatory authorities), who in turn distributed the PCIBs to patients/caregivers. A web-based survey was then conducted targeting HCPs and patients/caregivers. RESULTS: The response rate was low: 118 of 23,282 invited HCPs and 16 patients/caregivers completed the survey. Overall, 42% (49/118) of HCP respondents were aware of aripiprazole RM tools; of these, 59% (29/49) of HCPs read them at least once and 66% (19/29) of these used the RM tools while discussing the benefit-risk profile of aripiprazole with patients/caregivers. In total, 30 of the 118 HCPs (25%) were aware of the PCIB, and 26 distributed it to their patients/caregivers, whereas seven HCPs advised them to read the brochure. Overall, 15 of the 16 patients/caregivers were aware of the PCIB, and 13 read/referred to it. Of these, 12 found the PCIB useful, and five monitored their weight while receiving aripiprazole and reported potential risks immediately to their HCP. CONCLUSION: The response rate to the survey was low, and the tools displayed limited utility and effectiveness in improving awareness and education in a small number of responders. Therefore, the aripiprazole risk management plan was amended, and the tools were discontinued.

What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan.

OBJECTIVES: The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. DESIGN: Cross-sectional study. SETTINGS: Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. ASSESSMENT TOOLS: A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). RESULTS: Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the 'inclusion of users' views' (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. CONCLUSIONS: Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff's commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation.

Compra de alimentos de proximidad en los comedores escolares de Andalucía, Canarias y Principado de Asturias / Purchase of local foods for school meals in Andalusia, the Canary Islands and the Principality of Asturias (Spain)

Objetivo: Explorar y comparar las características de los centros de educación primaria (CEP) de Andalucía, Canarias y Principado de Asturias en función de si compran o no alimentos de proximidad para los comedores escolares, así como la opinión de los/las responsables del comedor sobre los beneficios y las dificultades para incorporarla. Método: Mediante un cuestionario electrónico se recogió información de las características de 186 CEP y la opinión de los/las responsables del comedor sobre los beneficios/dificultades de la compra de alimentos de proximidad. Los datos se estratificaron según la forma de adquisición de los alimentos (compra de alimentos de proximidad: sí/no) y se aplicó el test de ji al cuadrado. Resultados: El 38,2% de los CEP estudiados compra alimentos de proximidad. Es más frecuente en centros de zonas rurales (51,0%), con comedores autogestionados (80,0%) y con cocina propia (65,5%). Dichos centros cuentan con menús más económicos que sus homólogos (69,8%), participan con mayor frecuencia en programas de alimentación saludable (81,5%) y compran más alimentos ecológicos (65,8%). Según la mayoría de los/las participantes cuyos centros compran alimentos de proximidad, sus beneficios son el fomento de la economía local (97,2%), la oferta de alimentos frescos (97,2%) y la sostenibilidad ambiental (93%), y sus dificultades son la capacidad productiva de la región (50,7%), la variación estacional de la producción (71,8%) y la falta de apoyo (42,3%) y de información de la Administración (46,5%). Conclusión: La ubicación de los centros, la gestión del comedor y la disponibilidad de cocina pueden condicionar el desarrollo de la compra de alimentos de proximidad en las escuelas. El apoyo institucional podría ayudar a integrarla en los CEP, mejorando la alimentación escolar con menor coste económico y ambiental (AU)

Objective: To explore and compare the characteristics of Primary Education Centres (PEC) in Andalusia, the Canary Islands and the Principality of Asturias depending on whether or not they make local food purchases (LFP) for school meals and to explore the opinion of cafeteria managers about the benefits and challenges of this type of purchase. Method: Information on the characteristics of 186 PECs and opinions of cafeteria managers about the benefits/challenges of LFP was collected through an electronic questionnaire. Data were stratified according to how the products were purchased (LFP: yes/no), and the chi square test was applied. Results: 38.2% of the PECs studied make LFP. This is more frequent in rural areas (51.0 with self-managed cafeterias (80.0%), and their own kitchen (65.5%). These centres have less expensive menus than their peers (69.8%), participate more frequently in healthy eating programmes (81.5%) and purchase more organic food products (65.8%). According to the majority of the participants whose centres engage in LFP, the benefits include: supporting the local economy (97.2%), the offer of fresh foods (97.2%) and environmental sustainability (93.0%). The challenges include: productive capacity of the region (50.7%), the seasonal variation in food production (71.8%), and the lack of support (42.3%) and information from the government (46.5%). Conclusion: The location of the centres, the management of the cafeteria and the availability of a kitchen on site can influence the development of LFP in schools. Government support could help to integrate LFP in schools, improving school meals at a lower economic and environmental cost (AU)

Aplicación del listado MARC a pacientes polimedicados en un Centro de Salud / Application of the HAMC list to patients with polypharmacy in a primary healthcare center

Objetivo: Conocer el uso de los medicamentos del Listado MARC (Medicamentos de Alto Riesgo en el Paciente Crónico) en los pacientes polimedicados del Centro de Salud. Diseño: Estudio descriptivo observacional de carácter transversal sobre historias clínicas. Emplazamiento: Centro de Salud de Manzanares II (Ciudad Real). Participantes: 266 pacientes polimedicados (≥6 medicamentos) seleccionados por muestreo aleatorio sistemático. Mediciones Principales: Edad, sexo, factores de riesgo cardiovascular, número de fármacos (listado del SESCAM), enfermedades crónicas, fármacos activos ≥ 3 meses reflejados en historia clínica electrónica y prescripción de medicamentos incluidos en el listado MARC. Resultados: El 96,3% (IC 95 % 93,2-98,2) de los pacientes polimedicados tomaban medicamentos incluidos en el listado MARC. El número medio de fármacos del listado fue de 2,42 (DE:1,26) (sin diferencias entre sexos). Los más utilizados fueron antiagregantes (53 %), benzodiazepinas (45,1 %), hipoglucemiantes (28,9 %), beta-bloqueantes (28,2 %), diuréticos del asa (23,3 %) y opioides (17,3 %), mostrando diferencias entre sexos en el consumo de antiagregantes (p<0,01), benzodiazepinas (p<0,05) y opioides (p<0,01). En los pacientes pluripatológicos existieron diferencias entre sexos en el consumo de diuréticos del asa (p<0,001), anticoagulantes (p<0,01) y AINEs (p<0,05). Conclusiones: La gran mayoría de los pacientes polimedicados toman medicamentos incluidos en el listado MARC. Es aconsejable la realización de un adecuado seguimiento farmacológico de los pacientes crónicos y/o pluripatológicos (AU)

Application of the HAMC list to patients with polypharmacy in a primary healthcare center Objective: To know the use of drugs included in the HAMC List (High-Alert Medications for patients with Chronic illnesses) in polypharmacy patients of a Health Center. Design: Descriptive, observational cross-sectional study using medical records. Location: Primary Healthcare Centre Manzanares II (Ciudad Real). Participants: 266 patients with polypharmacy (≥6 drugs) of both sexes from the Health Area, selected by systematic sampling. Main measures: Age, sex, cardiovascular risk factors, number of drugs (listed by SESCAM), chronic diseases, active drugs (≥ 3 months) reflected in the electronic medical history, and prescription of drugs included in the HAMC list. Results: 96,3% (CI 95 % 93.2-98.2 %) of polypharmacy patients take drugs on the HAMC list. The average number of HAMC list drugs is 2.42 (± 1.26) (without differences between sexes). The most widely used are antiplatelet agents (53 %), benzodiazepines (45.1 %), hypoglycemic agents (28.9 %), beta blockers (28.2 %), loop diuretics (2.3 %) and opioids (17.3 %), with gender differences in antiplatelet agents (p<0.01), benzodiazepines (p<0.05) and opioids (p<0.01). In pluripathology patients there are gender differences in the use of loop diuretics (p <0.001), anticoagulants (p <0.01) and NSAIDs (p <0.05). Conclusions: The majority of polypharmacy patients take drugs included in the HAMC List. It is advisable to carry out a proper drug monitoring of chronic and/or pluripathology patients (AU)

Comparação de resultado estético em cicatrizes com uso de fios cirúrgicos e Prineo® / Comparison between surgical sutures and Prineo® in terms of esthetic result and scar formation

Introdução: Cicatrização de ferida é um processo bem organizado que tem como finalidade a reparação tecidual completa. Colas e adesivos tópicos oferecem uma alternativa não invasiva, de retirada fácil e espontânea; boa força tênsil; menor tempo de aplicação, sendo o Prineo® uma cola adesiva associada a uma malha de poliéster aplicados sobre a ferida. Método: Trata-se de um estudo transversal retrospectivo com análise de 101 procedimentos cirúrgicos no período de 2012 a 2014, nos quais a síntese da ferida operatória ocorreu com fios cirúrgicos de náilon ou Prineo®, sendo aplicada análise estatística. Resultados: Neste estudo, seis pacientes apresentaram dermatite de contato ao uso do Prineo® com significância estatística (p = 0,042). O uso desse sistema diminuiu a taxa de alargamento cicatricial (p < 0,05). O presente trabalho não apresentou diferença estatística (p = 0,068) na qualidade da cicatriz entre os pacientes que utilizaram Prineo® em relação ao grupo controle, demonstrando que em ambos os grupos o resultado cicatricial foi de excelente (87%) a bom (27%) na sua maioria. Conclusão: Conclui-se no estudo que os pacientes que utilizaram o sistema de octil-2-cianocrilato associado a malha, Prineo®, apresentaram menores índices de alargamento cicatricial, dependentes de uma espessura de derme satisfatória, e maiores taxas de dermatites por contato em relação àqueles em que a ferida foi encerrada com fios cirúrgicos. Os dois grupos demonstraram qualidades cicatriciais excelentes a bons, sem diferença estatística em tais resultados estéticos cicatriciais.

Introduction: Wound healing is a well-organized, directed process of tissue repair. The process can be expedited using topical glues and adhesives, which offer a non-invasive, easily removable alternative to suturing. Furthermore, such products have good tensile strength and involve lower application time. In particular, the Prineo® adhesive is applied to a polyester mesh that covers the wound. Method: We carried out a retrospective, cross-sectional study, with subsequent statistical analysis , involving 101 surgical procedures in which wound closure was performed using either nylon sutures or Prineo®. All the procedures were performed between 2012 and 2014. Results: Six patients had contact dermatitis after Prineo® was used, with statistical significance (p = 0.042). Furthermore, Prineo® decreased the rate of scar enlargement (p < 0.05) . There was no statistical difference between the Prineo® and suture groups in terms of scar quality (p = 0.068); in both groups, the scar result was mostly excellent (87 %) to good (27%). Conclusion: Patients whose wounds were closed using Prineo® a system involving octyl-2-cyanoacrylate and an associated polyester mesh displayed lower rates of scar enlargement, which depended on whether the thickness of the dermis was satisfactory. However, the same patients had higher rates of contact dermatitis than those whose wounds were closed using surgical sutures. Both groups showed excellent to good scar quality, with no significant difference in terms of esthetic scar results.

Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS).

OBJECTIVES: The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. DESIGN: An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool. RESULTS: An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users. CONCLUSIONS: CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.

Evaluation of the users violence in primary health care: Adaptation of an instrument / Evaluación de la violencia de usuarios en Atención Primaria: adaptación de un instrumento

Background/Objetivo: According to the World Health Organization, one out of every four violent workplace acts takes place in the health setting. The aims of the study are to study the prevalence of workplace violence in primary healthcare (PHC) professionals by adapting the Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), to establish the frequency of exposure to hostile indicators and to determine which professional group is most exposed. Method: Study through qualitative and quantitative methodology in PHC professionals of the Region of Murcia (Spain). In the qualitative phase in-depth interviews were conducted and during the quantitative phase the instrument was used to 574 professionals of 39 PHC centres.Results: The resulting scale shows excellent psychometric properties and correlates significantly with job satisfaction, burnout components, the factors of empathy and psychological well-being. There was a 90.2% prevalence of user violence, and non-medical personnel were found to be the professional group most exposed. Conclusion: The distribution of user violence is not homogeneous among the different professional groups of PHC. The adaptation of the scale may be useful for detection of user violence, as well as to evaluate the efficacy of intervention programs (AU)

Antecedentes/Objetivo: Según la Organización Mundial de la Salud, en el ámbito sanitario se producen uno de cada cuatro incidentes laborales violentos. Los objetivos del estudio son examinar la prevalencia de violencia laboral en profesionales de Atención Primaria (AP) mediante la adaptación de la Healthcare-worker's Aggresive Behaviour Scale-Users (HABS-U), conocer la frecuencia de exposición a los indicadores hostiles y determinar el grupo profesional más expuesto. Método: Estudio realizado mediante metodología cualitativa y cuantitativa en profesionales de AP de la Región de Murcia (España). En la fase cualitativa se realizaron entrevistas en profundidad y en la fase cuantitativa se aplicó el instrumento a 574 profesionales de 39 centros de AP. Resultados: La escala resultante muestra excelentes propiedades psicométricas y sus medidas correlacionan de manera significativa con satisfacción laboral, los componentes del burnout, los factores de empatía y con el bienestar psicológico. La prevalencia de violencia de usuarios fue del 90,2% y el personal no sanitario resultó ser el grupo profesional más expuesto. Conclusión: La distribución de la violencia de usuarios no es homogénea entre los diferentes grupos profesionales de AP. La adaptación de la escala puede ser útil para la detección de la violencia de usuarios, así como para evaluar la eficacia de programas de intervención (AU)

Análisis instrumental de la marcha en pacientes con ictus / Instrumental gait analysis in stroke patients

Introducción. Las alteraciones en el control motor consecuentes al ictus afectan al patrón de marcha, existiendo una importante variabilidad intersujeto. Objetivos. Valorar, a través de un sistema de captura del movimiento, el patrón cinemático de la marcha en sujetos con ictus y establecer qué alteraciones del patrón de la marcha son comunes entre los participantes. Sujetos y métodos. Participaron nueve pacientes con ictus con capacidad de marcha y diez sujetos controles. Para la captura del movimiento se empleó el sistema VICON Motion System (R). Se analizaron los movimientos articulares de pelvis, cadera, rodilla y tobillo en el plano sagital, y los parámetros espaciotemporales de la marcha. Resultados. La función motora de los participantes, valorada mediante la escala Fügl-Meyer (sección del miembro inferior), osciló entre 15 y 33 puntos. Los participantes presentaron alteraciones en la cinemática comunes entre ellos. En los pacientes con ictus se registró: aumento de la amplitud de movimiento de la pelvis en ambos hemicuerpos (lado afecto y no afecto frente a control, p < 0,01); en la cadera, disminución de la máxima extensión durante la fase de apoyo en el lado afecto (p < 0,01) e incremento de la flexión en las fases de apoyo y oscilación en el no afecto (p = 0,025); en la rodilla, mayor flexión durante la fase de contacto inicial (lado afecto frente a control, p < 0,01; lado no afecto frente a control, p = 0,02); y en el tobillo, ligera flexión plantar durante la fase de contacto inicial en el lado afecto. Conclusiones. A pesar de la variabilidad clínica, existen alteraciones específicas comunes de la marcha en sujetos con ictus (AU)

Introduction. The motor control deficits after stroke affect the gait pattern. There is a significant variability between subjects. Aims. To analyse, by using a capture motion system, the gait pattern in stroke patients with different levels of motor function, and to establish, despite the participants heterogeneity, what alterations in the gait pattern are usual in each participant. Subjects and methods. Nine stroke subjects with independent gait and ten control subjects participated in this study. Motion capture was performed using the VICON Motion System (R). The motion of the pelvis, hip, knee and ankle were analyzed in the sagittal plane. Also, the spatio-temporal parameters of gait were observed. Results. The motor function evaluated using the Fügl-Meyer Assessment (lower limb section) varied between 15 and 33 points. Participants had alterations in the kinematic pattern which were common between each of them. In stroke patients it was observed: an increment of the pelvis range of motion in both sides; at the hip joint, a decrease of the maximum peak of extension during the stance phase in the affected side and a greater flexion during the stance and the swing periods in the non-affected side; at the knee, a major knee flexion during the initial contact; and at the ankle joint, an slight ankle plantar flexion during the initial contact on the affected side. Conclusions. There are several landmarks in stroke gait that the clinicians should keep attention during the walking observation (AU)