Executive and attentional functions in patients with migraine / Funções executivas e atencionais em pacientes com enxaqueca

INTRODUCTION: Migraine is a disease that affects the overall performance of the patient, especially attention and executive functions (EF), with a direct impact on the person's functionality, highlighting the importance of studies in order to minimize its damage. OBJECTIVE: The objective of this study was to evaluate if there is a link between migraine and executive and attentional functions. METHODOLOGY: Observational study (44 subjects; 29 migraineurs and 15 non-migraineurs) on attentional and executive functioning changes in migraine. Subjects over 18 years of age were included in the study, regardless of gender, recruited for convenience at CAM FAME, FAME and Centro AMA, primary recruitment centers, following the criteria of the International Classification of Headache Disorders (ICHD-3). The participants underwent neuropsychological tests that estimated executive and attentional functioning. For attention, the Psychological Attention the Assessment Battery (AAB) was used, and for EF, the Five-Digit Test (FDT) was used. Student's t test, ANOVA, Mann-Whitney and/or Kruskal-Wallis U test were used, whose analyzes fixed the type I error at 0.05. RESULTS: All AAB subtests pointed to a reduction in the attentional potential in migraineurs when compared to the control group. The FDT showed lowering in the migraineurs group subjects, when compared with the non- migraineurs group. Multivariate analysis identified a relationship between EF, Attention and migraine (p<0.05). CONCLUSION: migraineurs present a decrease in executive functioning and attentional skills and an increase in execution time when compared to non-migraineurs individuals

INTRODUÇÃO: A enxaqueca é uma doença que afeta o desempenho global do paciente, principalmente a atenção e as funções executivas (FE), com impacto direto na funcionalidade da pessoa, destacando a importância de estudos a fim de minimizar seus danos. OBJETIVO: O objetivo deste estudo foi avaliar se existe ligação entre enxaqueca e funções executivas e atencionais. METODOLOGIA: Estudo observacional (44 indivíduos; 29 com enxaqueca e 15 sem enxaqueca) sobre alterações de atenção e funcionamento executivo na enxaqueca. Foram incluídos no estudo indivíduos maiores de 18 anos, independente do sexo, recrutados por conveniência no CAM FAME, FAME e Centro AMA, centros primários de recrutamento, seguindo os critérios da Classificação Internacional de Cefaleias (ICHD-3). Os participantes foram submetidos a testes neuropsicológicos que estimaram o funcionamento executivo e atencional. Para atenção foi utilizada a Bateria de Avaliação da Atenção Psicológica (AAB) e para FE foi utilizado o Teste de Cinco Dígitos (FDT). Foram utilizados teste t de Student, ANOVA, Mann-Whitney e/ou teste U de Kruskal-Wallis, cujas análises fixaram o erro tipo I em 0,05. RESULTADOS: Todos os subtestes da AAB apontaram redução do potencial atencional em enxaquecosos quando comparados ao grupo controle. O FDT apresentou redução nos indivíduos do grupo com enxaqueca, quando comparado com o grupo sem enxaqueca. A análise multivariada identificou relação entre FE, Atenção e enxaqueca (p<0,05). CONCLUSÃO: enxaquecosos apresentam diminuição do funcionamento executivo e das habilidades de atenção e aumento no tempo de execução quando comparados a indivíduos não enxaquecosos

Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

Análise do perfil epidemiológico dos exames citopatológico do colo do útero em Altamira no período de 2014 a 2020: dados a partir do SISCAN / Analysis of the epidemiological profile of cervical cytopathological exams in Altamira in the period from 2014 to 2020: data from SISCAN / Análisis del perfil epidemiológico de los exámenes citopatológicos de cérvix en Altamira en el periodo de 2014 a 2020: datos del SISCAN

OBJETIVO: Este trabalho aborda sobre características referente aos exames citopatológicos do colo do útero em Altamira, coletado no Sistema de Informação do Câncer, dentro do período de 2014 a 2020. Observou-se também a qualidade da interpretação dos principais resultados encontrados, sobre a técnica de coleta e qualidade de exames. O objetivo é analisar o perfil epidemiológico dos exames citopatológicos do colo do útero do município. MÉTODO: A metodologia realizada foi estudo quantitativo, de corte transversal, epidemiológico, descritiva e analítico. RESULTADOS: Verificou- se um crescimento anual na taxa de cobertura do exame do preventivo no período de 2014 a 2019, que está ligado à implementação do Plano de Desenvolvimento Regional Sustentável do Xingu, e que esse crescimento mostra uma diferença estatística significativa entre a taxa de cobertura de Altamira, Pará, Brasil. Observou-se presença de falhas no preenchimento da ficha de notificação é referente ao campo da escolaridade das pacientes que não apresentam registro. Quanto a faixa etária mais frequente que realizam o exame do preventivo está entre 25 a 34 anos e as lesões intraepiteliais do colo uterino mais frequentes são: a de baixo grau que corresponde à população jovem (<34 anos) e de alto grau entre 25 a 44 anos.

OBJECTIVE: This paper deals with characteristics related to cytopathological examinations of the cervix in Altamira, collected in the Cancer Information System, within the period from 2014 to 2020. It was also observed the quality of interpretation of the main results found, on the technique collection and quality of exams. The objective is to analyze the epidemiological profile of cytopathological tests of the cervix in the city. METHOD: The methodology used was a quantitative, cross- sectional, epidemiological study, descriptive and analytical approach. RESULTS: As a result, there was an annual growth in the coverage rate of the preventive exam in the period from 2014 to 2019, which is linked to the implementation of the Xingu Sustainable Regional Development Plan, and that this growth shows a significant statistical difference between the coverage rate of Altamira, Pará, Brazil. It was observed the presence of failures in completing the notification form referring to the field of education of patients who do not have a record. As for the most frequent age group that undergoes the preventive examination, it is between 25 and 34 years old and the most frequent intraepithelial lesions of the uterine cervix are: low-grade, which corresponds to the young population (<34 years) and high-grade, between 25 and 34 years old. 44 years.

OBJETIVO: En este trabajo se abordan las características relacionadas con los exámenes citopatológicos de cérvix en Altamira, recogidos en el Sistema de Información del Cáncer, en el periodo comprendido entre 2014 y 2020. También se observó la calidad de interpretación de los principales resultados encontrados, sobre la técnica de recolección y calidad de los exámenes. El objetivo es analizar el perfil epidemiológico de los exámenes citopatológicos de cuello uterino en la ciudad. MÉTODO: La metodología utilizada fue un estudio cuantitativo, transversal, epidemiológico, de abordaje descriptivo y analítico. RESULTADOS: Como resultado, se observó un crecimiento anual de la tasa de cobertura del examen preventivo en el período de 2014 a 2019, que está vinculado a la implementación del Plan de Desarrollo Regional Sostenible Xingu, y que este crecimiento muestra una diferencia estadística significativa entre la tasa de cobertura de Altamira, Pará, Brasil. Se observó la presencia de fallas en el llenado del formulario de notificación referente al campo de la educación de los pacientes que no tienen un registro. En cuanto al grupo de edad más frecuente que se somete al examen preventivo, es entre 25 y 34 años y las lesiones intraepiteliales del cuello uterino más frecuentes son: de bajo grado, que corresponde a la población joven (<34 años) y de alto grado, entre 25 y 44 años.

Suspensión de antibióticos a través de un programa de optimización de tratamiento antibiótico en pacientes atendidos en Urgencias con baja sospecha de infección / Antibiotic discontinuation through an antibiotic treatment optimization program in emergency department patients with low suspicion of infection

Introducción: Una de las estrategias más importantes de los PROA en los Servicios de Urgencias (SU) es el diagnóstico adecuado de infección para evitar la prescripción inadecuada. Nuestro objetivo es evaluar a los pacientes que reciben antibiótico a pesar de no tener datos objetivos de infección. Métodos: Realizamos un estudio transversal de los pacientes ingresados en el SU del Hospital Universitario Fundación Alcorcón durante 2 meses (mayo del 2019 y marzo del 2021) en los que se recomendó suspender el antibiótico a través del PROA. Se analizaron las características clínicas y epidemiológicas, y el seguimiento a 30 días para valorar los reingresos y la mortalidad. Resultados: Se analizaron 145 pacientes. Se recomendó suspender el antibiótico en 25. El 44% de ellos tenían diagnóstico de infección urinaria. La recomendación de suspensión se aceptó en el 88%. Ningún paciente falleció y uno reingresó. Conclusiones: Un porcentaje importante de pacientes tenían prescrito antibiótico a pesar de no tener criterios de infección, siendo la evolución clínica tras la de prescripción favorable.(AU)

Introduction: One of the most important strategies of PROA in the Emergency Department (ED) is the accurate diagnosis of infection to avoid inappropriate prescription. Our objective is to evaluate patients who receive antibiotics despite not having objective data of infection. Methods: We carried out a cross-sectional study of patients admitted to the ED of the Hospital Universitario Fundación Alcorcón in which it was recommended to suspend the antibiotic through the PROA. Clinical and epidemiological characteristics and 30-day follow-up were analyzed to assess readmissions and mortality. Results: 145 patients were analyzed. It was recommended to suspend the antibiotic in 25. 44% of them had a diagnosis of urinary infection. The suspension recommendation was accepted by 88%. No patient died and one was readmitted. Conclusions: An important percentage of patients are prescribed antibiotics despite not having infection criteria, the clinical evolution after suspension of antibiotics was favorable.(AU)

Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi-country qualitative study.

BACKGROUND: Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services. METHODS: We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains. RESULTS: Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care. CONCLUSIONS: Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.

Experiences of patients with chronic diseases during the COVID-19 pandemic in the North West province, South Africa.

BACKGROUND: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. METHODS: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. RESULTS: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. CONCLUSION: Policymakers should consider PWCDs when responding to a public health concern in the future.Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs.

Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs.

COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients' preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.

Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China.

AIM: To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China. METHODS: We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory. RESULTS: We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life. CONCLUSION: Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.

Is the use of IVF add-on treatments driven by patients or clinics? Findings from a UK patient survey.

There are conflicting narratives over what drives demand for add-ons. We undertook an online survey of IVF patients to determine whether patients perceive that use of IVF add-ons is driven by patients or practitioners. People who underwent IVF in the UK in the previous five years were recruited via social media Survey questions focussed on the roles of clinician offer and patient request, including who first suggested use of add-ons in IVF consultations, where patients first heard about them, and which information sources they trusted. From a total of 261 responses, 224 met the inclusion criteria. Overall, 67% of respondents had used one or more IVF add-ons, most commonly: time-lapse imaging (27%), EmbryoGlue (27%), and endometrial scratching (26%). Overall, 81% of the add-ons used were offered to participants by clinicians (compared to 19% requested by themselves). Half (54%) reported being offered add-ons during consultations, compared to 24% who initiated discussion about add-ons. Higher proportions of private patients reported being offered (90%), requesting (47%) and using (74%) add-ons than those with NHS funding (74%, 29%, 52%, respectively). The main limitations of this study are the small sample size, recruitment via a convenience sample, and the self-reported data capture which is subject to recall bias.

Covid-19 Surveillance Testing and Resident Outcomes in Nursing Homes.

BACKGROUND: Despite widespread adoption of surveillance testing for coronavirus disease 2019 (Covid-19) among staff members in skilled nursing facilities, evidence is limited regarding its relationship with outcomes among facility residents. METHODS: Using data obtained from 2020 to 2022, we performed a retrospective cohort study of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among staff members in 13,424 skilled nursing facilities during three pandemic periods: before vaccine approval, before the B.1.1.529 (omicron) variant wave, and during the omicron wave. We assessed staff testing volumes during weeks without Covid-19 cases relative to other skilled nursing facilities in the same county, along with Covid-19 cases and deaths among residents during potential outbreaks (defined as the occurrence of a case after 2 weeks with no cases). We reported adjusted differences in outcomes between high-testing facilities (90th percentile of test volume) and low-testing facilities (10th percentile). The two primary outcomes were the weekly cumulative number of Covid-19 cases and related deaths among residents during potential outbreaks. RESULTS: During the overall study period, 519.7 cases of Covid-19 per 100 potential outbreaks were reported among residents of high-testing facilities as compared with 591.2 cases among residents of low-testing facilities (adjusted difference, -71.5; 95% confidence interval [CI], -91.3 to -51.6). During the same period, 42.7 deaths per 100 potential outbreaks occurred in high-testing facilities as compared with 49.8 deaths in low-testing facilities (adjusted difference, -7.1; 95% CI, -11.0 to -3.2). Before vaccine availability, high- and low-testing facilities had 759.9 cases and 1060.2 cases, respectively, per 100 potential outbreaks (adjusted difference, -300.3; 95% CI, -377.1 to -223.5), along with 125.2 and 166.8 deaths (adjusted difference, -41.6; 95% CI, -57.8 to -25.5). Before the omicron wave, the numbers of cases and deaths were similar in high- and low-testing facilities; during the omicron wave, high-testing facilities had fewer cases among residents, but deaths were similar in the two groups. CONCLUSIONS: Greater surveillance testing of staff members at skilled nursing facilities was associated with clinically meaningful reductions in Covid-19 cases and deaths among residents, particularly before vaccine availability.

Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis.

BACKGROUND: Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. MATERIAL AND METHODS: Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. RESULTS: Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps < .0001; adjectives, Ps < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. CONCLUSIONS: EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers.

Caracterización clínica y epidemiológica de los pacientes con trastorno por uso de opioides atendidos en una institución de cuarto nivel en la ciudad de Medellín, entre 2017 y 2022 / Clinical and epidemiological characterization of patients with opioid use disorder treated at a fourth level institution in the city of Medellín, between 2017 and 2022

Los analgésicos opioides son una opción importante en el manejo del dolor agudo grave, crónico e intratable, sin embargo, sus efectos euforizantes y gratificantes han motivado a que algunos pacientes continúen su uso una vez resuelta la condición médica inicial, haciendo entonces un uso indebido de opioides (UIO) y con el potencial riesgo de desarrollar un trastorno por uso de opioides (TUO). El objetivo del presente trabajo fue caracterizar clínica y epidemiológicamente a los pacientes con trastorno por uso de opioides atendidos en una institución de cuarto nivel de Medellín. Para ello, se realizó un estudio observacional, descriptivo, transversal de fuente secundaria; se incluyeron 309 registros de pacientes adultos, con diagnóstico CIE-10, trastornos causados por opiáceos. TUO e UIO constituyeron las variables de interés, se procesó la información en Jamovi® versión 2.2 y se analizaron los datos de variables cuantitativas con test de Sahpiro Wilk y análisis bivariado exploratorio de las variables clínicas y sociodemográficas. Resultados: El TUO obtuvo una prevalencia del 39.9% frente al 25,6 % del UIO. De los pacientes con TUO el 50% tenían 35 años o menos, el 57.7% fueron mujeres, 58.7% solteros, y predominaron los niveles de educación secundaria y universitaria. En cuanto al UIO, el 50% fueron menores de 37 años el 54% de sexo femenino, en su mayoría solteros (61.5%), y predominó el nivel de educación secundaria (48.7%). En el 71% de los pacientes con TUO hay antecedentes de enfermedad mental predominando los trastornos del afecto: ansiedad y depresión. El opioide más usado fue tramadol (17.04%), seguido de morfina e hidromorfona. Conclusión: Ante el aumento en la prevalencia de UIO y TUO es necesario nuevas políticas salud pública que permitan ejercer un control más estricto en la formulación, comercialización y administración segura de este tipo de medicamentos.(AU)

Opioids analgesics are an important option in the management of severe acute, chronic, and intractable pain; however, their euphoric and rewarding effects have motivated some patients to continue their use once the initial medical condition has resolved, thus misusing them. these (UIO) and with the potential risk of developing an opioid use disorder (OUD).Objectives: to clinically and epidemiologically characterize patients with opioid use disorder treated at a fourth-level institution in Medellín.Methodology: Observational, descriptive, cross-sectional study of secondary source; 309 records of adult patients with ICD-10, diagnosis caused by opioids agents were included. TUO and IOU were the variables of interest, the information was processed in Jamovi® version 2.2 and the data of quantitative variables were analyzed with the Sahpiro Wilk test and exploratory bivariate analysis of the clinical and sociodemographic variables.Results: The TUO obtained a prevalence of 39.9% compared to 25.6% of the UIO. Of the patients with OT, 50% were 35 years of age or younger, 57.7% were women, 58.7% were single, and secondary and university education levels predominated. Regarding the UIO, 50% were under 37 years of age, 54% female, mostly single (61.5%), and the secondary education level predominated (48.7%).In 71% of patients with OLW there is a history of mental illness, predominantly affective disorders: anxiety and depression. The most used opioid was tramadol (17.04%), followed by morphine and hydromorphone. Conclusion: Given the increase in the prevalence of UIO and OTU, new public health policies are necessary to exercise stricter control in the formulation, marketing and safe administration of this type of medication.(AU)

Risk factors for worse anxiety trajectories among patients undergoing cancer chemotherapy.

PURPOSE: Patients undergoing chemotherapy for cancer often experience heightened anxiety. While receipt of chemotherapy occurs over multiple cycles, limited research has examined anxiety longitudinally. The purposes of this study, in a large sample of patients with breast, gynecological, gastrointestinal, or lung cancer, were to evaluate, over the course of two cycles of chemotherapy, for inter-individual differences in the trajectories of anxiety and identify associations between demographic, clinical, symptom, and psychological adjustment characteristics and initial levels and trajectories of anxiety. METHODS: Patients with breast, gynecologic, lung, or gastrointestinal cancer (n = 1323) were assessed with the Spielberger State Anxiety Inventory (STAI-S) six times over two cycles of chemotherapy. At enrollment, patients completed self-report instruments assessing demographic, symptom, stress, and coping characteristics. We used hierarchical linear modeling to identify risk factors associated with initial levels and trajectories of state anxiety. RESULTS: Inter-individual differences in initial levels of anxiety were associated with functional status, sleep disturbance, morning fatigue, cognitive function, global and cancer-specific stress, resilience, and several coping characteristics (i.e., sense of coherence, acceptance, using emotional support, self-distraction, denial, venting, and self-blame). Demographic and clinical characteristics associated with interindividual differences in anxiety trajectories were age, employment status, and MAX-2 score. CONCLUSION: This study provides novel data on the course and predictors of anxiety during two cycles of chemotherapy among a large sample of patients with varied cancer types. Further research focused on risk factors for heightened levels of anxiety during chemotherapy may help point toward more effective interventions for this commonly experienced symptom.

Mechanisms by which exercise training benefits patients with copd mecanismos pelo qual o treinamento de exercício beneficia pacientes com dpoc running title: exercise training / Mecanismos pelos quais o treinamento de exercício beneficia pacientes com o título dpoc running: treinamento de exercício / Mecanismos por los que el entrenamiento de ejercicio beneficia a los pacientes con epoc mecanismos por los que el entrenamiento de ejercicio beneficia a los pacientes con epoc running title: exercise training

The clinical consequences of chronic obstructive pulmonary disease (COPD) include fatigue, dyspnea and progressive impairment of exercise capacity. It also produces significant systemic consequences such as nutritional depletion, physical deconditioning, systemic inflammation, and structural and functional changes in the respiratory and locomotor muscles. Regular exercise provides improvements in the health of patients with stable COPD and can relieve the symptoms, increasing the exercise capacity and improving the quality of life, while also reducing hospitalization and, to some extent, the risk of morbidity and mortality. Training with progressive exercises is associated with metabolic and neurohumoral adaptations, heart rate variability, with adaptations in the pulmonary and skeletal muscles, as well as the inflammatory, cardiovascular and respiratory systems. This review will focus on current knowledge of the mechanisms by which physical training can provide beneficial effects in COPD patients. Results: After analyzing the titles, abstracts and content, out of 500 articles found, 489 were excluded, leaving 11 articles. Studies have shown the beneficial effect of aerobic training on COPD. Conclusion: Physical training should be considered a therapeutic option in patients with COPD, regardless of being terrestrial or aquatic, as it can have beneficial effects on the systems.

As consequências clínicas da doença pulmonar obstrutiva crônica (DPOC) são: fadiga, dispnéia e comprometimento progressivo da capacidade do exercício, além disso, também produz consequências sistêmicas significativas como depleção nutricional, descondicionamento físico, inflamação sistêmica, mudanças estruturais e funcionais de músculos respiratórios e locomotores. O treinamento físico regular traz como beneficíos efeitos da melhoria da saúde em pacientes com DPOC estável e pode aliviar os sintomas, melhorar a capacidade de exercício e a qualidade de vida, reduzir a hospitalização e, em certa medida, o risco de morbi-mortalidade. Já o treinamento com exercícios progressivos está associado a adaptações metabólicas, neurohumorais, variabilidade da frequência cardíaca, inflamatórias, dos músculos pulmonares e esqueléticos, cardiovasculares e respiratórias. Esta revisão enfocará o conhecimento atual dos mecanismos pelos quais o treinamento físico pode ter efeitos benéficos em pacientes com DPOC. Resultados: Após análise dos títulos, resumos e conteúdo, dos 500 artigos encontrados, 489 foram excluídos, restando 11 artigos. Estudos têm demonstrado o efeito benéfico do treinamento aeróbico na DPOC. Conclusão: O treinamento físico deve ser considerado uma opção terapêutica em pacientes com DPOC, independente de ser terrestre ou aquático, pois pode ter efeitos benéficos nos sistemas.

Las consecuencias clínicas de la enfermedad pulmonar obstructiva crónica (EPOC) incluyen fatiga, disnea y deterioro progresivo de la capacidad de ejercicio. También produce importantes consecuencias sistémicas como el agotamiento nutricional, el desacondicionamiento físico, la inflamación sistémica y los cambios estructurales y funcionales en los músculos respiratorios y locomotores. El ejercicio regular proporciona mejoras en la salud de los pacientes con EPOC estable y puede aliviar los síntomas, aumentando la capacidad de ejercicio y mejorando la calidad de vida, al tiempo que reduce la hospitalización y, en cierta medida, el riesgo de morbilidad y mortalidad. El entrenamiento con ejercicios progresivos se asocia a adaptaciones metabólicas y neurohumorales, a la variabilidad de la frecuencia cardíaca, con adaptaciones en los músculos pulmonares y esqueléticos, así como en los sistemas inflamatorio, cardiovascular y respiratorio. Esta revisión se centrará en el conocimiento actual de los mecanismos por los que el entrenamiento físico puede proporcionar efectos beneficiosos en los pacientes con EPOC. Resultados: Tras analizar los títulos, resúmenes y contenido, de los 500 artículos encontrados se excluyeron 489, quedando 11 artículos. Los estudios han demostrado el efecto beneficioso del entrenamiento aeróbico en la EPOC. Conclusiones: El entrenamiento físico debe considerarse una opción terapéutica en pacientes con EPOC, independientemente de que sea terrestre o acuático, ya que puede tener efectos beneficiosos sobre los sistemas.

Perfil clínico-epidemiológico de pacientes diagnosticados com hanseníase / Clinical-epidemiological profile of patients diagnosed with leprosy / Perfil clínico-epidemiológico de los pacientes diagnosticados de lepra

hanseníase no Brasil ainda apresenta como um problema de saúde pública. A posição epidemiológica da doença no país é considerada diversificada devido ao alto coeficiente e variação de prevalência nas diversas regiões do país. O objetivo desse estudo é conhecer o perfil epidemiológico da população acometida pela hanseníase na cidade de General Carneiro, no interior do Mato Grosso, durante os anos de 2006 e 2021. A coleta de dados foi realizada nos meses de julho e agosto do ano de 2021. Trata-se de uma pesquisa retrospectiva, documental do tipo descritiva, com abordagem quantitativa. No período em estudo notificou-se 50 casos, sendo 62% do sexo masculino, com faixa etária entre 48 a 69 anos de idade, de cor branca, com predominância da forma dimorfa. Os resultados demonstram que a cidade de General Carneiro, está com o número de casos de hanseníase na média do preconizado pela Organização Mundial de Saúde e também, inferior à média brasileira.

Leprosy in Brazil still presents as a public health problem. The epidemiological position of the disease in the country is considered diversified due to the high coefficient and variation in prevalence in different regions of the country. The aim of this study is to know the epidemiological profile of the population affected by leprosy in the city of General Carneiro, in the interior of Mato Grosso, during the years 2006 and 2021. Data collection was carried out in July and August of 2021 This is a retrospective, descriptive documentary research with a quantitative approach. During the study period, 50 cases were reported, 62% male, aged between 48 and 69 years old, white, with a predominance of the borderline form. The results show that the city of General Carneiro has the number of cases of leprosy in the average recommended by the World Health Organization and also below the Brazilian average.

La lepra en Brasil sigue siendo un problema de salud pública. La posición epidemiológica de la enfermedad en el país se considera diversificada debido al alto coeficiente y a la variación de la prevalencia en diferentes regiones del país. El objetivo de este estudio es conocer el perfil epidemiológico de la población afectada por la lepra en la ciudad de General Carneiro, en el interior de Mato Grosso, durante los años 2006 y 2021. La recogida de datos se realizó en julio y agosto del año 2021. Se trata de una investigación retrospectiva, documental y descriptiva, con un enfoque cuantitativo. En el período de estudio se notificaron 50 casos, siendo el 62% de sexo masculino, con una edad entre 48 y 69 años, de color blanco, con predominio de la forma dimorfa. Los resultados muestran que la ciudad de General Carneiro, está con el número de casos de lepra en la media recomendada por la Organización Mundial de la Salud y también por debajo de la media brasileña.

Characteristics and Adverse Events of Patients for Whom Nifurtimox Was Released Through CDC-Sponsored Investigational New Drug Program for Treatment of Chagas Disease - United States, 2001-2021.

Chagas disease, or American trypanosomiasis, is caused by the parasite Trypanosoma cruzi. Chagas disease is endemic in rural areas of Latin America, but T. cruzi, triatomine vectors, infected mammalian reservoir hosts, and rare cases of autochthonous vector borne transmission have been reported in the United States (1). Possible modes of transmission include the following: vector borne via skin or mucosal contact with feces of infected triatomine bugs, congenital, blood transfusion, organ transplantation, or laboratory accident. Chagas disease can be treated with benznidazole (commercially available since May 14, 2018) or nifurtimox (2). Before January 25, 2021, nifurtimox (Lampit) had been exclusively available through CDC under an Institutional Review Board-approved Investigational New Drug (IND) treatment protocol, at which time it became reasonably accessible to health care providers outside of the program. This report summarizes CDC Drug Service reports for selected characteristics of and adverse events reported by 336 patients for whom nifurtimox was requested under the CDC IND program during January 1, 2001-January 25, 2021. Of the 336 patients, 34.2% resided in California. Median age of patients was 37 years (range = 1-78 years). Most patients were aged ≥18 (91.8%; 305 of 332) and Hispanic (93.2%; 290 of 311). Among the patients with available information, 91.4% (222 of 243) reported an adverse event. Among those with information about the severity of their adverse events, 20.5% reported a severe event. On August 7, 2020, the Food and Drug Administration (FDA) announced approval of a nifurtimox product, Lampit (Bayer), for treatment of Chagas disease in patients aged <18 years weighing ≥5.5 lbs (≥2.5 kg). Lampit became commercially available during October 2020. Physicians should take frequency of adverse events into consideration when prescribing nifurtimox and counseling patients.

Patient characteristics and utilization of an online patient portal in a rural academic general internal medicine practice.

BACKGROUND: Online patient portals have the potential to improve patient engagement and health care outcomes. This is especially true among rural patient populations that may live far from their health care providers and for whom transportation is a barrier to accessing care. This study compared the characteristics of active users of an online patient portal to non-users and assessed utilization among users in a rural academic primary care clinic to identify disparities in adoption and use. METHODS: We conducted a cross sectional study of 28,028 patients in a general internal medicine clinic between June 2019 and May 2020 to assess (a) characteristics of patients who had an online patient portal account and used the patient portal compared to those who did not register for an account, and (b) the frequency of use of the patient portal (number of logons and number of messages sent and received) by patients over the study period. We compared results based on demographic characteristics, focusing on gender, age, race, presence or absence of nine chronic illnesses, smoking status, and BMI. RESULTS: In the study cohort of 28,028 patients, 82% were active users of the patient portal. Females, patients aged 41-65, and non-smokers were more likely to use the portal than their counterparts. In total, patients with eight out of nine chronic illness groups studied (heart failure, cerebrovascular disease, history of a myocardial infarction, peripheral vascular disease, and renal disease) were less likely to use the patient portal than patients without these chronic conditions. On average, patients log onto the patient portal 25 times per year and send and receive 6 messages to and from the clinic. We found that females, patients older than 65, former smokers and obese patients logged on and sent and received more messages compared to the overall cohort. Although the sample size was small, on average Black patients logged onto the patient portal 19 times and sent and received 3.6 messages compared to White patients who logged on 25 times with 5.8 messages on average over the yearlong study period. CONCLUSIONS: In a rural academic internal medicine clinic, female patients, aged 41-65, non-smokers, and those without certain chronic conditions were more likely to use an online patient portal. Recognizing and addressing barriers to patient portal use is essential for robust and sustained patient portal uptake and ensuring that the benefits of portal use are equally distributed among all patients.