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1.
Urology ; 136: 218-224, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765653

RESUMO

OBJECTIVE: To understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice. METHODS: An IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix). Descriptive statistics were used for clinical and demographic data and Fisher's exact and Kruskal-Wallis tests were used for comparative analysis. RESULTS: Eighty-three residents completed the survey for a response rate of 34%. Less than half (45%) of the residents surveyed were likely, or extremely likely to voluntarily offer advice to parents on care of the uncircumcised penis. On a scale of 0-100, the median confidence level in offering advice was 48 (interquartile range [IQR] 30-52). Forty-nine percent of residents reported never being taught care of the uncircumcised penis. Of those who received education, 72% reported learning informally from a senior resident or attending and only 9% learned from a formal lecture. Pediatric residents varied greatly on advice given to parents in regards to the frequency of retraction and 40% offered no advice. CONCLUSION: This study demonstrates that pediatric residents currently lack confidence in providing parents advice on preputial care and are unlikely to offer such advice. When offered, the advice given is highly variable. This study emphasizes the need for improved education of pediatric residents.


Assuntos
Cuidado da Criança , Aconselhamento Diretivo , Internato e Residência , Pais , Pediatria/educação , Pênis , Pré-Escolar , Circuncisão Masculina , Aconselhamento Diretivo/métodos , Aconselhamento Diretivo/normas , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
2.
J Clin Nurs ; 29(1-2): 85-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31512796

RESUMO

AIMS AND OBJECTIVES: The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). BACKGROUND: Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. DESIGN: Qualitative study. METHODS: Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. RESULTS: In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits". CONCLUSION: The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. RELEVANCE TO CLINICAL PRACTICE: This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.


Assuntos
Ponte de Artéria Coronária/enfermagem , Comportamento Alimentar/psicologia , Educação em Saúde/métodos , Idoso , Ponte de Artéria Coronária/psicologia , Aconselhamento Diretivo/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pesquisa Qualitativa
3.
Clin Exp Hypertens ; 42(1): 67-74, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30760048

RESUMO

Objective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients.Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled.Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician's recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician's recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician's recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%).Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Pressão Sanguínea , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/fisiopatologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Estudos de Casos e Controles , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Esfigmomanômetros/estatística & dados numéricos , Inquéritos e Questionários
4.
Presse Med ; 48(12): 1422-1430, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679895

RESUMO

Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.


Assuntos
Complicações Cardiovasculares na Gravidez , Parto Obstétrico/métodos , Parto Obstétrico/normas , Aconselhamento Diretivo/métodos , Feminino , Humanos , Mortalidade Materna , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , /terapia , Fatores de Risco , Vasodilatadores/uso terapêutico
5.
Investig Clin Urol ; 60(5): 373-379, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501800

RESUMO

Purpose: To evaluate de novo and resolved urgency and urgency urinary incontinence (UUI) after midurethral sling operations in patients with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Materials and Methods: Patients who underwent midurethral sling operations because of SUI and MUI between January 2012 and December 2016 were reviewed. Patients were divided into three groups (pure SUI, SUI with urgency, and MUI). Patients with MUI were subcategorized as SUI predominant, equivalent, and UUI predominant. Postoperative de novo, persistent or disappearance of urgency or UUI were compared. Results: A total of 334 patients were included: 76 with pure SUI, 78 with SUI with urgency, and 180 with MUI. In the MUI group, 138 patients were SUI predominant, 12 patients were equivalent, and 30 patients were UUI predominant. De novo urgency developed in 5 patients (6.6%) in the pure SUI group. In the SUI with urgency group, 51 patients (65.4%) became urgency-free, and 3 (3.8%) developed de novo UUI. UUI resolved in 135 patients (75.0%): 110 (79.7%) in the SUI-predominant group, 9 (75.0%) in the equivalent group, and 16 (53.3%) in the UUI-predominant group. The patients' preoperative perception of predominant UUI was the predictive factor for persistent UUI in the multivariate analysis (hazard ratio, 5.722; p=0.001). Conclusions: De novo urgency and UUI developed in a relatively small number of patients after a midurethral sling operation. The resolution rate of UUI was significantly low in patients who had previous pelvic surgery or who preoperatively perceived UUI as a more bothersome symptom.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/epidemiologia , Idoso , Aconselhamento Diretivo , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Urológicos/métodos
9.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352377

RESUMO

Diabetes insipidus is a syndrome characterised by the inability to conserve water or concentrate urine, leading to excessive excretion of urine. In congenital nephrogenic diabetes insipidus (CNDI), common presentations include failure to thrive, polydipsia, polyuria and dehydration. The long trajectory of the disease, coupled with psycho-behavioural changes as a child grows, can precipitate a period of non-adherence despite initial optimal control, especially in the adolescent age group. Social inconvenience of repeated voiding and nocturnal disturbances can lead to adapted urine holding behaviour, also known as non-neurogenic neurogenic bladder (Hinman syndrome). Anatomical changes in the urinary system, such as bladder trabeculation and hydroureteronephrosis, can subsequently give rise to functional renal impairment. We present a case of CNDI with concomitant Hinman syndrome, resulting in acute renal impairment and hypertensive emergency. We aim to raise awareness of the association between these two entities.


Assuntos
Lesão Renal Aguda/etiologia , Comportamento Infantil/psicologia , Diabetes Insípido Nefrogênico/fisiopatologia , Hipertensão/etiologia , Cooperação do Paciente/psicologia , Bexiga Urinaria Neurogênica/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Criança , Diabetes Insípido Nefrogênico/tratamento farmacológico , Diabetes Insípido Nefrogênico/psicologia , Aconselhamento Diretivo , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento , Bexiga Urinaria Neurogênica/fisiopatologia
10.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350231

RESUMO

The oral anticoagulant warfarin is a vitamin K antagonist and is considered the first line anticoagulant in valvular atrial fibrillation. However prothrombin time should be closely monitored, drug interactions checked and compliance regarding diet ensured when the patient is on warfarin therapy. Anaemia should be looked for, evaluated for the cause and corrected since it is an independent predictor of bleeding and thrombotic episodes during warfarin therapy for atrial fibrillation We present an interesting case of anaemia which developed during warfarin therapy for atrial fibrillation. The patient was on amiodarone and was consuming leafy vegetables resulting in frequent raise in prothrombin time during which time she developed bleeding into the right femoral pseudoaneurysm which had developed following catheterisation for thrombectomy. Surgical correction of pseudoaneurysm was done, comedication was changed and diet compliance ensured which resulted in the subsequent maintenance of prothrombin time in the therapeutic range and steady haemoglobin levels.


Assuntos
Anemia/etiologia , Falso Aneurisma/etiologia , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Spinacia oleracea/efeitos adversos , Vitamina K/antagonistas & inibidores , Varfarina/efeitos adversos , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Cateterismo Cardíaco , Aconselhamento Diretivo , Feminino , Humanos , Pessoa de Meia-Idade , Tempo de Protrombina , Spinacia oleracea/química , Resultado do Tratamento , Vitamina K/sangue , Vitamina K/uso terapêutico
11.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352401

RESUMO

Hypoglycaemia in infants and children is caused by a number of endocrine and metabolic defects, some of which are unique to this age group. Growth hormone deficiency (GHD) has been rarely reported as a cause of recurrent fasting hypoglycaemia in children. An 18-month-old male child presented to us for evaluation of neuroglycopenic symptoms caused by recurrent episodes of fasting hypoglycaemia. Laboratory evaluation revealed ketotic hypoinsulinaemic hypoglycaemia. The child was diagnosed to have GHD on the basis of two failed stimulation tests. A detailed work-up for metabolic and other hormonal causes of hypoglycaemia was negative. We present the case for its rarity and to highlight the importance of a detailed metabolic and hormonal assessment in evaluation of childhood hypoglycaemia.


Assuntos
Carboidratos da Dieta/uso terapêutico , Nanismo Hipofisário/diagnóstico , Jejum/efeitos adversos , Hormônio do Crescimento Humano/uso terapêutico , Hipoglicemia/diagnóstico , Aconselhamento Diretivo , Nanismo Hipofisário/complicações , Nanismo Hipofisário/fisiopatologia , Humanos , Hipoglicemia/etiologia , Hipoglicemia/fisiopatologia , Hipoglicemia/terapia , Lactente , Masculino , Recidiva , Resultado do Tratamento
12.
Cutis ; 103(5): 290-291, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31233580

RESUMO

Total-body skin examination (TBSE) is the bedrock on which most general dermatologists' clinic days are built. Primarily performed for all-cause skin cancer detection and prevention, the clinical data gained and advice imparted during the patient visit disseminate safety guidelines and behavioral patterns that can shape a community's approach to its risk factors and screening practices. Nonetheless, TBSE technique, frequency, and data-driven evidence of improvement in population morbidity and mortality comprise ongoing debate. When a patient asks, "Do I need a skin check?", the answer is more complicated than one might imagine. For now, each clinician who screens for skin cancer must optimize the face-to-face opportunities with the patient to view as much as we can as often as clinically prudent. As said by Philip Roth, "Seeing is believing and believing is knowing and knowing beats unknowing and the unknown." Recommendations are provided here for clinicians to address the clinical utility of the screening practices we adopt every day.


Assuntos
Cooperação do Paciente , Exame Físico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/prevenção & controle , Aconselhamento Diretivo , Detecção Precoce de Câncer , Humanos , Autoexame
13.
Lakartidningen ; 1162019 Apr 02.
Artigo em Sueco | MEDLINE | ID: mdl-31192385

RESUMO

Internal and external factors influence the future of laboratory medicine. In the coming years point of care testing and faster and cheaper methods of genome sequencing are predicted to become more important. Changes in laboratory organization and demography with an aging population will likewise impact the coming years. An increased information flow between laboratories and clinicians, where symptoms, findings and vital signs are combined with laboratory results and their change over time, has the potential of generating refined reports. Sharing of equipment between laboratory specialities as well as working in conjunction with clinicians in influencing patterns of testing through guidelines and algorithms may also aid in saving precious resources.


Assuntos
Serviços de Laboratório Clínico/tendências , Laboratórios/tendências , Pessoal de Laboratório Médico/tendências , Serviços de Laboratório Clínico/organização & administração , Aconselhamento Diretivo/tendências , Testes Genéticos/tendências , Humanos , Laboratórios/organização & administração , Papel do Médico , Testes Imediatos/tendências , Dinâmica Populacional/tendências
14.
BMC Health Serv Res ; 19(1): 350, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159780

RESUMO

BACKGROUND: Promotion of healthy lifestyle is an important strategy. This study was conducted to determine the effects of counselling on health-promoting lifestyle and quality of life in middle-aged women. METHODS: This randomised, controlled, clinical trial was conducted on 102 middle-aged women presenting to health centers in Tabriz, Iran, in 2016-17. Using stratified blocking based on age (40-50 and 50-60 age groups) with block sizes of four and six, eligible middle-aged women were randomly allocated to the intervention and control groups. The intervention group received health-promoting lifestyle counselling over three 45-min sessions. The control group received the routine care provided by health centers. The Health Promoting Lifestyle Profile- II (HPLP-II) and quality of life survey (SF-36) were completed in both group before and four and eight weeks after completion of the intervention. Data were analyzed using the independent t-test and the repeated measures analysis of variance (ANOVA). RESULTS: After adjustment for the baseline values, the repeated measures ANOVA showed that the mean scores of health-promoting lifestyle (adjusted mean difference = 0.91, 95% confidence interval: 0.83 to 0.99, P < 0.001) and quality of life (18.2, 15.75 to 20.66, P < 0.001) were significantly higher in the intervention compared to the control group after the intervention. CONCLUSION: Counselling can improve health-promoting lifestyle and quality of life in middle-aged women. TRIAL REGISTRATION: IRCT2015122610324N27. Registered 4 February 2016.


Assuntos
Aconselhamento Diretivo , Promoção da Saúde/métodos , Estilo de Vida Saudável , Qualidade de Vida , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade
15.
Pharm. pract. (Granada, Internet) ; 17(2): 0-0, abr.-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184682

RESUMO

Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Serviços Comunitários de Farmácia/classificação , Aconselhamento Diretivo/classificação , Prática Profissional/classificação , Indonésia/epidemiologia , Automedicação/estatística & dados numéricos , Simulação/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Papel Profissional
16.
Pharm. pract. (Granada, Internet) ; 17(2): 0-0, abr.-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184685

RESUMO

Background: Hormonal contraceptive pills have evolved as a common form of contraception worldwide. Pharmacists play a vital role in providing safe and effective access to these medicines. In many developing countries such as the United Arab Emirates (UAE), these medicines are available to the general public without the presentation of a prescription which requires the pharmacist to shoulder responsibility by assessing and educating patients to assure their appropriate use. Objectives: To evaluate community pharmacists' current practice of dispensing and counseling on hormonal contraceptives. Methods: Simulated patient methodology was used in this study. A single simulated patient visited community pharmacies requesting an oral contraceptive as per a preplanned scenario. Information from the visits were recorded on a data collection form including: pharmacist assessing patient eligibility to take hormonal contraceptives, selecting the appropriate oral contraceptive, providing complete counseling on how to use the pill, adherence, missed dose handlings and side effects of the medication. The Pharmacist was prompted by the simulated patient to provide the information if they did not provide spontaneous counseling. The quality of pharmacists' counseling was rated and consequently coded as complete, incomplete or poor. Results: A total of 201 community pharmacies were visited. More than 92% of the pharmacists did not ask the simulated patient any question to assess their eligibility to use contraceptives. Twenty three pharmacists (11.4%) selected the proper product. One hundred seventeen (58.2%) of the pharmacists provided spontaneous counseling on how to use the pill, 17 of them had their counsel rated as complete, but none of the pharmacists provided spontaneous counseling regarding adherence or side effects of the medications. On prompting, 10 pharmacists (12%) provided complete counseling regarding how to use oral contraceptives, 14 pharmacists (7.0%) provided complete counseling on adherence and missing dose handling and five pharmacists (2.5%) provided complete counseling about expected side effects. Conclusions: Pharmacists' practice regarding hormonal contraceptive dispensing and counseling was suboptimal in this study. Areas needing intervention were related to pharmacist assessment of eligibility for oral contraceptive use, choice of optimal oral contraceptive for patient-specific co-morbidities and provision of adequate counseling regarding proper use, adherence and missed dose handlings


No disponible


Assuntos
Humanos , Anticoncepcionais/administração & dosagem , Aconselhamento Diretivo/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepção/métodos , Prática Profissional/tendências , Papel Profissional , Qualidade da Assistência à Saúde/tendências , Emirados Árabes Unidos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
17.
Monaldi Arch Chest Dis ; 89(2)2019 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107039

RESUMO

The present study aims at evaluating the achievement of blood pressure, lipid and blood glucose targets, healthy lifestyle changes and appropriate drug prescription/adherence in patients attending secondary prevention/CR ambulatory visit after index cardiovascular event in a time period ranging 1 to 5 year. At ambulatory visit, a predetermined set of data collection was used, including demographic data, cardiovascular risk factors and lifestyle habits, type and time of index event, current symptoms, physical sign, biochemistry and current medical treatment (including type and dosage). Cardiovascular risk profile (smoking habits, physical activity and body weight), secondary prevention goals (LDL-cholesterol, blood pressure, resting heart rate, glycated haemoglobin level) and the use of recommended drugs were also evaluated and categorized. Study population consisted of 800 patients [644 men (84.5%), aged 69±10.9 years)]. Cardiovascular index events were coronary artery bypass graft (CABG) (20%) ST segment elevation myocardial infarction (STEMI) (28%), non-ST segment elevation myocardial infarction (NSTEMI) (21%) and stable angina (13%) by unstable angina (13%) and stroke (5%). About 30% of patients was symptomatic (angina or dyspnoea) at the time of ambulatory visit. Major comorbidities were hypertension (73%), dyslipidaemia (64%) and diabetes (40%). More than 80% of patients achieved target levels for blood pressure. Patients that have participated to cardiac rehabilitation programmes after cardiovascular index event showed best achievement in blood pressure target (83.8% vs 76.8%, p=0.02). LDL-cholesterol target (<70 mg/dl) was achieved in about 2/3 of patients; HbA1c target (<7%) was achieved in 56.4% of diabetic population. About 75% of study cohort was treated with RAAS inhibitors, 85% with beta-blockers, 92% with statins and 87% with acetylsalicylic acid. All drugs were increasingly adopted from index event. Implementing secondary prevention guidelines into the 'real world' clinical practice in "late" interval from 1 to 5 years after a cardiovascular event improved risk factors control and appropriate drug prescription. Whether these improvements translated into prognostic advantages remains to be elucidated.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Cooperação do Paciente , Prevenção Secundária , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Aspirina/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/cirurgia , LDL-Colesterol/sangue , Comorbidade , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Aconselhamento Diretivo , Dislipidemias/sangue , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Exercício , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco , Fumar/epidemiologia
18.
Nat Rev Nephrol ; 15(11): 713-726, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31118499

RESUMO

These recommendations were systematically developed on behalf of the Network for Early Onset Cystic Kidney Disease (NEOCYST) by an international group of experts in autosomal dominant polycystic kidney disease (ADPKD) from paediatric and adult nephrology, human genetics, paediatric radiology and ethics specialties together with patient representatives. They have been endorsed by the International Pediatric Nephrology Association (IPNA) and the European Society of Paediatric Nephrology (ESPN). For asymptomatic minors at risk of ADPKD, ongoing surveillance (repeated screening for treatable disease manifestations without diagnostic testing) or immediate diagnostic screening are equally valid clinical approaches. Ultrasonography is the current radiological method of choice for screening. Sonographic detection of one or more cysts in an at-risk child is highly suggestive of ADPKD, but a negative scan cannot rule out ADPKD in childhood. Genetic testing is recommended for infants with very-early-onset symptomatic disease and for children with a negative family history and progressive disease. Children with a positive family history and either confirmed or unknown disease status should be monitored for hypertension (preferably by ambulatory blood pressure monitoring) and albuminuria. Currently, vasopressin antagonists should not be offered routinely but off-label use can be considered in selected children. No consensus was reached on the use of statins, but mTOR inhibitors and somatostatin analogues are not recommended. Children with ADPKD should be strongly encouraged to achieve the low dietary salt intake that is recommended for all children.


Assuntos
Rim Policístico Autossômico Dominante/diagnóstico , Rim Policístico Autossômico Dominante/terapia , Adolescente , Criança , Terapia Combinada , Aconselhamento Diretivo , Humanos , Programas de Rastreamento , Rim Policístico Autossômico Dominante/complicações , Rim Policístico Autossômico Dominante/psicologia , Encaminhamento e Consulta , Medição de Risco
19.
AIDS Behav ; 23(11): 3165-3174, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31123856

RESUMO

Group-based programs are important for the psychosocial care of people living with HIV; however, programs are often limited by geography and availability. Video-groups, conducted via group-based video-conferencing on video-phones or computer, offer the benefits of group-based programs while overcoming barriers to attendance. This study sought to explore if, and how, the Technology Readiness and Acceptance Model (TRAM) could be used to explain the willingness of men to take part in video-groups. The TRAM was used as the guiding framework for thematic qualitative analysis. Among 106 participants, there was a general willingness to participate in video-groups. TRAM constructs were present in the data-with perceived usefulness (extent that participating in a technology-based program would facilitate group intervention behaviors) and insecurity (distrust/skepticism of technology) emerging as the most salient themes. The TRAM alone did not account for concerns related to group settings or the level of privacy needed when talking about HIV.


Assuntos
Aconselhamento Diretivo/métodos , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Educação de Pacientes como Assunto/métodos , Gravação de Videoteipe , Adulto , Grupos Focais , Infecções por HIV/terapia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Pesquisa Qualitativa
20.
BMC Pregnancy Childbirth ; 19(1): 173, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092223

RESUMO

BACKGROUND: Monotonous and less diversified diets are associated with micronutrient deficiency. Evidence on maternal dietary intakes during pregnancy is essential to achieve the 2025 global nutrition target and reduce maternal and child mortalities. This study assessed pregnant women's dietary diversity and identified factors associated with inadequate dietary diversity in East Gojjam Zone. METHODS: We conducted a community-based cross-sectional study between April and June 2016. Eight hundred thirty-four pregnant women were randomly sampled. The Women Dietary Diversity Score tool developed by the Food and Agricultural Organization (FAO) and Food and Nutrition Technical Assistance (FANTA) was used. Data were entered into EpiData with double entry verification, and analysis was done using IBM SPSS version 20. Level of significance was set to P < 0.05 with 95% confidence interval (CI) to identify the independent factors associated with inadequate dietary diversity. RESULTS: The mean (±SD) dietary diversity score was 3.68 (±2.10). Inadequate dietary diversity was prevalent in 55% [95% CI (52.3-59.3%)] of pregnant women, or indirectly micronutrient was inadequate in more than half of the pregnant women. Commonly consumed dietary groups were legumes, nuts, and seeds (85.5%) followed by starchy staples (64.7%). Inadequate dietary diversity was higher among non-educated [Adjusted Odds Ratio (AOR) = 7.30, 95% CI (2.35-22.68)] compared to college and above completed women. Wealth index had significant association with dietary diversity, in which women in the poorest [AOR = 8.83, 95% CI, (1.60-48.61)], poorer [AOR = 6.34, 95% CI (1.16-34.65)], poor [AOR = 8.46, 95% CI (1.56-45.70)], and richer [AOR = 6.57, 95% CI (2.16-20.01)] had higher odds of inadequate dietary diversity. Those who had not received dietary counseling had three folds [AOR = 3.31, 95% CI (1.49-7.35)] of inadequate dietary diversity compared to their counterparts. Less likelihood of inadequate dietary diversity was among women with an increased meal frequency [AOR = 0.53, 95% CI (0.38-0.74)]. CONCLUSION: Consumption of less diversified food during pregnancy is common in the study area. Adequacy of micronutrients is insufficient for more than half of the studied pregnant women. We conclude that being non-educated affects pregnant women to depend on less diversified diet. Providing dietary counseling during pregnancy can improve nutritional practice for pregnant women.


Assuntos
Dieta , Micronutrientes/administração & dosagem , Adolescente , Adulto , Estudos Transversais , Aconselhamento Diretivo , Escolaridade , Emprego , Etiópia , Feminino , Humanos , Idade Materna , Estado Nutricional , Pobreza , Gravidez , Cuidado Pré-Natal , Adulto Jovem
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