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1.
Bone Joint J ; 101-B(10): 1218-1229, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564157

RESUMO

AIMS: Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT. PATIENTS AND METHODS: A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed. RESULTS: We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified. CONCLUSION: In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218-1229.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Imagem Tridimensional , Metatarso Valgo/diagnóstico por imagem , Metatarso Varo/diagnóstico por imagem , Osteotomia/efeitos adversos , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Fêmur/fisiopatologia , Seguimentos , Humanos , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Masculino , Metatarso Valgo/epidemiologia , Metatarso Varo/epidemiologia , Pessoa de Meia-Idade , Osteotomia/métodos , Prevalência , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Anormalidade Torcional/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 98(31): e16223, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374003

RESUMO

Intravesical instillation of Bacille Calmette-Guèrin (BCG) is the standard adjuvant treatment for high-risk non muscle invasive bladder cancer (NMIBC). Since its mechanism of action is supposed to be linked to the immune system efficiency and senescence could negatively affect this efficiency, BCG efficacy in the elderly has been questioned. This study aimed to assess the impact of age on BCG efficacy and safety in patients with high-grade T1 bladder cancer (BC).Among 123 patients with high-grade T1 BCG scheduled for BCG treatment, 82 were <75 year-old (group A) and 41 were ≥75 year-old (group B). Follow-up: urine cytology and cystoscopy every 3 months for the first 2 years, every 6 months for the third year, and then yearly. Tumor recurrence was defined as pathological evidence of disease at the bladder biopsy; tumor progression was defined as pathological shift to muscle invasive disease at the bladder biopsy or the imaging techniques showing recurrent BC and distant metastasis likely related to it.The median follow-up was 65 months (range 11-152). Recurrence occurred in 35 patients, 19 (23.2%) in the group A and 16 (39%) in the group B. Progression occurred in 18 patients, 12 (14.6%) in the group A and 6 (14.6%) in the group B. Recurrence free rate was similar in both groups up to 2 years. The 5 years progression rate was almost the same in both groups A and B (85.9% vs 84.7%), whereas the 5 years cancer-specific survival (CSS) was 92.6% in the group A and 85.4% in the group B. Of the 18 patients with progression, 11 underwent cystectomy; 12 patients died because of their BC. Kaplan-Meier plots pointed out no difference in recurrence-free, progression-free, and CSS between the 2 groups. Adverse events were similar in the 2 groups. Only 4 (3.3%) patients, 2 (2.4%) in the group A and 2 (4.8%) in the group B, experienced mild adverse reactions compatible with treatment.Elderly patients with high-grade T1 BC are not poorer candidates to BCG treatment, as they had similar benefit and adverse reactions than those aging ≥75 years.


Assuntos
Fatores Etários , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Administração Intravesical , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
3.
Medicine (Baltimore) ; 98(31): e16539, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374015

RESUMO

BACKGROUND: Chronic stable angina (CSA) is a cardiovascular disease with high prevalence. At present, drug treatment is still the main measure of stable angina pectoris. Traditional Chinese medicine has a long history in the treatment of CSA. Qi stagnation and Blood stasis syndrome is a common syndrome of CSA. Xinnaoning (XNN) capsule is considered as an effective adjuvant treatment for CSA with the efficacy of promoting qi and blood circulation but lack of high-quality clinical evidence. The purpose of this study is to evaluate the efficacy and safety of XNN capsule compared with placebo by clinical trial. METHODS: This multicenter, randomized, double-blind, placebo-controlled trial will be conducted with a total of 240 participants diagnosed with chronic stable angina (qi stagnation and blood stasis syndrome). The participants will be randomized (1:1) into groups receiving either XNN or placebo for 12 weeks. After a 2-week run-in period, they will receive either XNN or placebo (3 pills, 3 times daily) for 12 weeks on the basis of conventional therapy. The primary outcomes include changes in the integral scores of angina symptoms. The secondary outcome measures include changes in the total score of traditional Chinese medicine syndrome, severity grading of angina pectoris, the number of angina pectoris per week, nitroglycerin dosage, score of seattle angina scale, serum homocysteine, incidence of cardiovascular events. Safety outcomes will also be assessed. Adverse events will be monitored throughout the trial. RESULTS: This study will investigate whether XNN capsule can alleviate clinical symptoms, and improve quality of life of patients with chronic stable angina (qi stagnation and blood stasis syndrome). The results of this study will provide clinical evidence for the application of XNN capsule in the treatment of chronic stable angina. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03914131.


Assuntos
Angina Estável/terapia , Adulto , Idoso , Análise de Variância , Distribuição de Qui-Quadrado , Angiografia Coronária/métodos , Método Duplo-Cego , Feminino , Homocisteína/análise , Homocisteína/sangue , Humanos , Masculino , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Pessoa de Meia-Idade , Placebos , Inquéritos e Questionários , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(31): e16545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374017

RESUMO

Abnormal cervical curvature and cervical disc herniation are closely related to neck pain and should be taken into account before any treatment. However, studies have rarely reported on the correlation between cervical lordosis and cervical disc herniation in patients with neck pain. Therefore, in this study, we collect young neck pain patients with abnormal cervical curvature to evaluate the relationship between cervical lordosis and cervical disc herniation.Three hundred patients below 40 years old with neck pain were enrolled. Patient sex, age, apical vertebra, segment of intervertebral disc protrusionl, sagittal diameter of spinal duramater, saggital diameter of spinal canal, height of disc space were recorded, and the cervical curvature, and degree of cervical spinal cord compression (G/F ratio) were calculated. The change of degree of disc herniation and degree of cervical spinal cord compression were analyzed in different cervical curvature groups. Further more, collected these patients who had improved cervical curvature over a period of time, to compare the changes of degree of disc herniation, G/F ratio, and height of disc space.The median age of patients with kyphosis was lower than those with lordosis and straight cervical spine. The degree of disc herniation was higher in the straight and kyphosis groups compared to the lordosis group. Cervical lordosis was inversely correlated with the degree of disc herniation and positively with G/F ratio. Cervical curvature was significantly affected by sex, age, and the degree of disc herniation. With the improvement of cervical lordotic curvature, the degree of disc herniation decreased and height of disc space increased.The degree of disc herniation and cervical spinal cord compression are inversely correlated to cervical lordosis in young neck pain patients, and the degree of disc herniation and height of disc space can recover with the recovery of cervical lordotic curvature. These findings may indicating a link between cervical curvature and degenerative changes which have important clinical implications.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Lordose/complicações , Cervicalgia/etiologia , Adulto , Vértebras Cervicais/anormalidades , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Radiografia/métodos , Estatísticas não Paramétricas
5.
Medicine (Baltimore) ; 98(31): e16681, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374050

RESUMO

Human immunodeficiency virus (HIV) disclosure is a prerequisite to get access to antiretroviral therapy (ART) and social support. Increased disclosure of HIV status has been shown to reduce mother-to-child transmission and high-risk sexual behaviors. Limited studies were conducted to get an insight into HIV disclosure among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA) in Liangshan.Our study aimed to investigate the status and associated characteristics of HIV disclosure among PLWHA in Liangshan.We conducted a cross-sectional study using a stratified, convenience sampling method from August to December in 2017. All of the participants were from Liangshan, a typical impoverished mountainous area which also has a long history of drug production and drug trade. Each participant completed a structured questionnaire including HIV disclosure status, demographic and HIV-related characteristics, social support, and perceived HIV-related stigma. We performed a binary regression analysis to detect associated characteristics of HIV disclosure among PLWHA in Liangshan.A final sample size of 318 participants was included in this study. The overall prevalence of HIV disclosure was 83.6% (266/318). In binary logistic regression analysis, PLWHA who had higher educational levels, and got infected by sexual transmission were less likely to disclose their HIV status (both P < .05). HIV nondisclosure was correlated with a higher level of perceived HIV-related stigma (P < .01).The prevalence of HIV disclosure was relatively low in Liangshan. Healthcare workers are suggested to conduct more counseling and education to promote safe sexual behaviors and reduce perceived stigma among PLWHA, then enhance HIV serostatus disclosure.


Assuntos
Revelação/estatística & dados numéricos , Infecções por HIV/psicologia , Adulto , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , Autorrelato , Estigma Social , Apoio Social , Estatísticas não Paramétricas
6.
Medicine (Baltimore) ; 98(31): e16716, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374066

RESUMO

The purposes of the study was to validate the relationship between General transcription factor II-I (GTF2I) genetic variants and kidney involvements of systemic lupus erythematosus (SLE) patients in a Chinese Han population.Samples from 400 SLE patients and 400 age- and sex-matched healthy controls were collected and genotyped by improved multiplex ligation detection reaction technique. The relationship between gene polymorphism of rs117026326, rs73366469, and susceptibility, progression of SLE were analyzed.The present study provided evidence that rs117026326 and rs73366469 were both associated with SLE susceptibility (both C vs T: P < .001). The analysis of dominant, recessive disease model provided us with further validation (P < .001). Both gene polymorphisms are associated with a triad of disease manifestations among SLE patients. Patients carrying genotype TT of rs117026326 had lower 24-hour urinary total protein (24 hours UTP, g/24 hours), 24-hour urinary protein level (g/L·24 hours), lower frequency of the proteinuria and lupus nephritis (LN). Patients carrying genotype TT at rs73366469 had higher 24-hour urinary protein level, higher frequency of the proteinuria, LN and positive anti-dsDNA than those with other genotypes.This study identified the involvement of GTF2I gene polymorphisms in development of SLE, particularly in renal involvement.


Assuntos
Nefrite Lúpica/genética , Fatores de Transcrição TFII/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , China , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Nefrite Lúpica/urina , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Proteinúria/urina , Adulto Jovem
7.
Rev Bras Enferm ; 72(3): 646-653, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269128

RESUMO

OBJECTIVE: Assess the level of health literacy of adults, with and without hypertension, treated in three basic health units (UBS) in Picos, Piauí. METHODS: Cross-sectional study conducted with 357 adults. Data were collected using a questionnaire with sociodemographic variables, and literacy was assessed by the Test of Functional Literacy in Adults. Descriptive analysis was performed followed by the association between literacy and exposure variables with Pearson's chi-squared (X2) test and Mann-Whitney U test. RESULTS: Inadequate or marginal health literacy was found in three units investigated (71.5%; 77.8% and 85.2%);. Age and the years of schooling were factors associated with inadequate literacy in adults with hypertension (p<0.0001). CONCLUSION: Inadequate literacy was found in more than 70% of the hypertensive patients investigated. This finding reinforces the need to improve the self-care skills of hypertensive patients, especially the older ones and those with few years of schooling.


Assuntos
Alfabetização em Saúde/normas , Hipertensão/psicologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Inquéritos e Questionários
8.
Rev Bras Enferm ; 72(3): 737-743, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269140

RESUMO

OBJECTIVE: to analyze occupational accidents with exposure of nursing technicians to biological material in a school hospital. METHOD: nursing technicians were invited to answer a questionnaire related to occupational accidents with biological material. RESULTS: 275 professionals from 9 hospital units participated. 76% reported having suffered an accident and the variables "age group" and "employment regime" showed a significant association for accidents (p<0.05). Those hired by the Consolidation of Labor Laws (CLT - Consolidação das Leis do Trabalho) employment regime were 3.5 times more likely to suffer accidents (p=0.04) and institutional capacity building did not show statistical significance (p>0.05). CONCLUSION: the increase in the number of training did not ensure the reduction of occupational accidents with biological material; and nursing technicians under the age of 30 were more vulnerable. Professionals with a CLT labor contract were more affected than the statutory employees.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Assistentes de Enfermagem/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Brasil , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 98(27): e16116, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277112

RESUMO

To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/terapia , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China , Estudos Transversais , Feminino , Humanos , Hipertensão/classificação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Am Surg ; 85(6): 572-578, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267896

RESUMO

Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.


Assuntos
Mortalidade Hospitalar , Sistema de Registros , Comportamento Autodestrutivo/psicologia , Centros de Traumatologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Kentucky , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Taxa de Sobrevida , Resultado do Tratamento , Ferimentos Perfurantes/prevenção & controle , Adulto Jovem
11.
Am Surg ; 85(6): 601-605, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267900

RESUMO

The Stop the Bleed (STB) course teaches trainees prehospital hemorrhage control with a focus on mass education. Identifying populations most likely to benefit can help save on the significant cost and limited resources. In this study, we attempted to identify those populations and performed a cost analysis. Trainees underwent STB education and completed a survey on completion to assess demographics and prior experiences where STB skills could have been useful. Five hundred seventy-one trainees categorized as first responders (14%), students (56%), and the working public (30%) completed the survey. Most trainees found the lecture and simulation helpful, 96 per cent and 98 per cent, respectively. There were significant differences among groups who had previously been in situations where the STB course would have been helpful (88% first responders versus 40% students versus 43% public workers) (P < 0.001). Teaching a class of 10 students costs approximately $455; the cost can be as high as $1246 for a class of 50 students. Most STB trainees found the course helpful. First responders are most likely to be exposed to situations where course information could be helpful. Focusing on specific high-yield groups rather than mass education might be a more efficient approach to STB education.


Assuntos
Serviços Médicos de Emergência/organização & administração , Socorristas/educação , Hemorragia/prevenção & controle , Incidentes com Feridos em Massa/prevenção & controle , Adulto , Distribuição de Qui-Quadrado , Educação Médica/organização & administração , Educação Profissionalizante/organização & administração , Tratamento de Emergência , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/educação , Melhoria de Qualidade , Medição de Risco , Inquéritos e Questionários , Taxa de Sobrevida , Estados Unidos
12.
Am Surg ; 85(6): 625-630, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267904

RESUMO

Prior studies elucidate a high predictive value of imaging to diagnose appendicitis in small, regional cohorts. This cross-sectional study uniquely analyzes diagnostic imaging in a national appendectomy population. Using the 2016 ACS NSQIP database, positive predictive values (PPVs) for CT, ultrasound (US), and MRI were evaluated using chi-squared tests. Univariate and multivariate analyses considered patient-specific factors. Imaging was performed in 94.63 per cent of 11,841 appendectomy cases; most frequently via CT (78.69%), then combination CT and US (7.52%), US (7.15%), and MRI (0.30%). CT PPV was higher in overweight (98.70%) versus underweight patients (94.85%) (P = 0.01). Gender and age did not impact CT PPV. Imaging from a referral site did not change CT or US PPV. Our study describes imaging frequencies and confirms high PPV. We found imaging equally predictive in women of childbearing age and elderly individuals compared with the general population. Furthermore, repeat scanning is unnecessary with prior positive imaging at outside sites.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Diagnóstico por Imagem/métodos , Adolescente , Adulto , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Distribuição de Qui-Quadrado , Criança , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia Doppler/métodos
13.
BMC Public Health ; 19(1): 892, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286920

RESUMO

BACKGROUND: Few population-based studies of Arab American health behaviors and outcomes exist outside of Michigan. We aimed to provide prevalence estimates of health behaviors and outcomes for Arab Americans and compare them to non-Hispanic Whites in California. METHODS: We used data from the 2003-2016 California Health Interview Surveys. We determined Arab American ethnicity using an algorithm that considered place of birth of the respondent or parent and use of Arabic language at home. Survey-weighted frequencies, chi-squared statistics, and logistic regression analyses were used to compare Arab Americans and non-Hispanic Whites on socioeconomic indicators, health behaviors and health outcomes. Multivariable models were adjusted for age, education level, and insurance status. RESULTS: Arab Americans had higher prevalence of no insurance, living below the federal poverty level, and home ownership than non-Hispanic Whites despite high levels of education and low unemployment prevalence. Arab Americans had reduced odds of alcohol consumption (OR: 0.33, 95% CI: 0.24, 0.45), binge drinking (OR: 0.28, 95% CI: 0.19, 0.40), and suicidal ideation (OR: 0.41, 0.25, 0.66) when compared to non-Hispanic Whites in multivariable models. Arab Americans had decreased odds of hypertension (OR: 0.64, 95% CI: 0.50, 0.83) and increased odds of diabetes (OR: 2.03, 95% CI: 1.23, 3.34) when compared to non-Hispanic Whites in multivariable models. CONCLUSIONS: Arab Americans in California participate in less risky health behaviors and have better health outcomes than non-Hispanic Whites, except with regards to diabetes. Future work aiming to understand the health of Arab Americans should allow for self-identification and less reliance on country of origin and language use at home for sample selection.


Assuntos
Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/etnologia , California/epidemiologia , Distribuição de Qui-Quadrado , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Hipertensão/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores Socioeconômicos
14.
World J Emerg Surg ; 14: 34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31341511

RESUMO

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.


Assuntos
Abdome/fisiopatologia , Prognóstico , Sepse/diagnóstico , Abdome/anormalidades , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sepse/fisiopatologia
15.
Orthop Nurs ; 38(4): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343631

RESUMO

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.


Assuntos
Avaliação de Resultados (Cuidados de Saúde)/normas , Pacotes de Assistência ao Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/normas , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/normas , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
16.
Medicine (Baltimore) ; 98(30): e16546, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348274

RESUMO

Lung cancer is a malignant tumor with high morbidity and mortality. Early diagnosis remains a great challenge for the cancer. In this study, we aimed to explore diagnostic performance of serum microRNA-520f (miR-520f) in lung cancer.Serum specimens were collected from 139 lung cancer patients and 76 healthy volunteers. Relative expression level of serum miR-520f was detected adopting quantitative real-time polymerase chain reaction (qRT-PCR). Chi-square test was applied to evaluate the association of miR-520f with clinical parameters of the patients. Additionally, receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic value of miR-520f in lung cancer.Serum miR-520f was down-regulated in lung cancer patients compared with healthy group (P <.001). Moreover, the expression of miR-520f was significantly associated with advanced TNM stage (P = .031) and metastasis (P = .002). The area under the curve (AUC) value of ROC curve was 0.888, suggesting that miR-520f could be a diagnostic biomarker for lung cancer. The cut-off value of serum miR-520f for lung cancer diagnosis was 1.815, with a sensitivity of 79.9% and a specificity of 84.2%.Serum miR-520f was down-regulated in lung cancer patients, and may be a candidate biomarker for non-invasive screening of the disease.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Pulmonares/diagnóstico , MicroRNAs/sangue , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Regulação para Baixo/genética , Feminino , Humanos , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Curva ROC , Valores de Referência
17.
Work ; 63(2): 181-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156199

RESUMO

BACKGROUND: Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. OBJECTIVES: In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. METHODS: Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. RESULTS: 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. CONCLUSION: Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.


Assuntos
Dor Crônica/terapia , Depressão/terapia , Desempenho Profissional/normas , Ioga/psicologia , Atividades Cotidianas/psicologia , Adulto , Distribuição de Qui-Quadrado , Dor Crônica/psicologia , Depressão/psicologia , Feminino , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Projetos Piloto , Estatísticas não Paramétricas , Inquéritos e Questionários
18.
Clin Interv Aging ; 14: 841-848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190770

RESUMO

Background: Current surgical risk assessment tools fall short of appreciating geriatric risk factors including cognitive deficits, depressive, and frailty symptoms that may worsen outcomes post-transcatheter aortic valve implantation (TAVI). This study hypothesized that a screening tool, SMARTIE, would improve detection of these risks pre-TAVI, and thus be predictive of postoperative delirium (POD) and 30-day mortality post-TAVI. Design: Prospective observational cohort study, using a historical cohort for comparison. Participants: A total of 234 patients (age: 82.2±6.7 years, 59.4% male) were included. Half were screened using SMARTIE. Methods: The SMARTIE cohort was assessed for cognitive deficits and depressive symptoms using the Mini-Cog test and PHQ-2, respectively. Measures of frailty included activities of daily living inventory, the Timed Up and Go test and grip strength. For the pre-SMARTIE cohort, we extracted cognitive deficits, depression and frailty symptoms from clinic charts. The incidence of POD and 30-day mortality were recorded. Bivariate chi-square analysis or t-tests were used to report associations between SMARTIE and pre-SMARTIE groups. Multivariable logistic regression models were employed to identify independent predictors of POD and 30-day mortality. Results: More patients were identified with cognitive deficits (χ2=11.73, p=0.001), depressive symptoms (χ2=8.15, p=0.004), and physical frailty (χ2=5.73, p=0.017) using SMARTIE. Cognitive deficits were an independent predictor of POD (OR: 8.4, p<0.01) and 30-day mortality (OR: 4.04, p=0.03). Conclusion: This study emphasized the value of screening for geriatric risk factors prior to TAVI by demonstrating that screening increased identification of at-risk patients. It also confirmed findings that cognitive deficits are predictive of POD and mortality following TAVI.


Assuntos
Transtornos Cognitivos/diagnóstico , Depressão/diagnóstico , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Equilíbrio Postural , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
BMC Public Health ; 19(Suppl 4): 551, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196024

RESUMO

BACKGROUND: The rapid growth of economy and increasing cost of living in Malaysia have given significant impact especially to the lowest household income population. The main objective of this study was to determine risk factors for low quality of life (QOL) and poor health status of this population. METHODS: This was a cross sectional study design. A total of 347 respondents from low household income groups, including persons with disability and Orang Asli were recruited from E-kasih. A semi-guided self-administered questionnaire was used. QOL measured by EQ. 5D utility value and health status measured by visual analogue score (VAS). Descriptive statistic, bivariate Chi-square analysis and binary logistic regression were conducted to determine factors influencing low QOL and poor health status. RESULTS: Majority of the respondents were Malay, female (61%), 63% were married, 60% were employed and 46% with total household income of less than 1 thousand Ringgit Malaysia. 70% of them were not having any chronic medical problems. Factors that associated with low QOL were male, single, low household income, and present chronic medical illness, while poor health status associated with female, lower education level and present chronic medical illness. Logistic regression analysis has showed that determinants of low QOL was present chronic illness [AOR 4.15 95%CI (2.42, 7.13)], while determinants for poor health status were; female [AOR 1.94 95%CI (1.09,3.44)], lower education [AOR 3.07 95%CI (1.28,7.34)] and present chronic illness [AOR 2.53 95%CI (1.39,4.61)]. CONCLUSION: Low socioeconomic population defined as low total household income in this study. Low QOL of this population determined by present chronic illness, while poor health status determined by gender, education level and chronic medical illness.


Assuntos
Doença Crônica/epidemiologia , Nível de Saúde , Pobreza/psicologia , Qualidade de Vida , Fatores Socioeconômicos , Adulto , Idoso , Distribuição de Qui-Quadrado , Doença Crônica/psicologia , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Inquéritos e Questionários
20.
Medicine (Baltimore) ; 98(25): e16110, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232957

RESUMO

Functional dyspepsia (FD) is a common upper gastrointestinal disorder globally, but the current treatments for FD are still unsatisfactory. This study was aimed at investigating the effects of comfort care on symptoms, gastric motility, and mental state of patients with FD.One hundred consecutive patients with FD treated at the Wuhan Union Hospital (Wuhan, China) between 03/2016 and 02/2018 were randomized to routine nursing and comfort care on the basis of routine nursing (50 patients/group), all for 8 weeks. The primary endpoint was FD symptom score. The secondary endpoint included gastric emptying rate, gastric motility parameters, and depression and anxiety scores. The endpoints were assessed at baseline and after 8 weeks.There were no significant differences between the 2 groups for gender, age, body mass index, types of FD, and course of disease (P > .05). The symptom score in the comfort care group at week 8 was lower than in the routine nursing group (8.3 ±â€Š2.4 vs 10.2 ±â€Š2.4, P < .001). The gastric emptying rate in the comfort care group at week 8 was higher than in the routine nursing group (28.6 ±â€Š5.1 vs 24.3 ±â€Š5.5, P < .001). The fasting and postprandial dominant frequencies of electrogastrogram in the comfort care group at week 8 were higher than in the routine nursing group (1.9 ±â€Š0.9 vs 1.8 ±â€Š1.0, P = .004; 3.1 ±â€Š1.0 vs 2.1 ±â€Š0.9, P < .001). The postprandial dominant power of electrogastrogram in the comfort care group at week 8 was higher than in the routine nursing group (55.7 ±â€Š11.5 vs 42.3 ±â€Š12.5, P < .001). The cases of abnormal electrogastrogram rhythm in the comfort care group at week 8 were significantly less than in the routine nursing group (P = .003). The self-rating depression scale and self-rating anxiety scale in the comfort care group at week 8 were significantly lower than in the routine nursing group (42.5 ±â€Š6.9 vs 47.3 ±â€Š6.4, P = .001; 41.1 ±â€Š7.2 vs 46.3 ±â€Š6.9, P < .001).Comfort care reduces the symptoms of patients with FD, increases gastric emptying rate, improves gastric motility, relieves patient's depression and anxiety, and promotes the rehabilitation of the disease.


Assuntos
Dispepsia/complicações , Motilidade Gastrointestinal/fisiologia , Transtornos Mentais/etiologia , Conforto do Paciente/normas , Adulto , Distribuição de Qui-Quadrado , China , Dispepsia/terapia , Feminino , Esvaziamento Gástrico/fisiologia , Humanos , Masculino , Transtornos Mentais/psicologia , Conforto do Paciente/métodos , Estudos Prospectivos , Estatísticas não Paramétricas
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