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PLoS One ; 15(3): e0229852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134987


BACKGROUND: Maternal mortality is high in Loreto, Peru, but can be reduced by high quality antenatal care. Indicators for the quality of antenatal care received include the timing (with respect to gestational age) and number of antenatal appointments attended, the delivery of antenatal services and health information, and women's perceptions about their care. This study investigated these indicators amongst women receiving antenatal care in predominantly the San Juan Bautista district of Iquitos, Loreto. This was to identify areas for improvement through comparison with antenatal guidelines published by the Ministry of Health, Peru, and the World Health Organization. METHODS: A total of 134 women were recruited at the Centro de Salud, San Juan-a primary care centre in Iquitos. Information about the delivery of antenatal services and the number of and gestational ages at appointments attended was collected from 121/134 women's hand-held antenatal cards. The delivery of health information and women's perceptions about their antenatal care were investigated through questionnaires (133/134 completed). Descriptive statistics, such as frequencies and valid percentages, were determined. RESULTS: Hand-held antenatal cards revealed that 52.9% of participants began their antenatal care in the first trimester. Compared to national guidelines, 42.1% attended appointments at recommended gestational ages and no women received all recommended antenatal services. Most women received information about identifying complications in pregnancy and health and lifestyle topics. Over 85% of women reported satisfaction with their antenatal care. CONCLUSIONS: Timely antenatal attendance and delivery of services should be encouraged to meet national and global standards. Although all services were not delivered in a combined manner according to national guidelines, individual services were mostly delivered to a high standard and therefore a high proportion of women were satisfied with their antenatal care.

Cuidado Pré-Natal , Adulto , Estudos Transversais/estatística & dados numéricos , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Peru , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto Jovem
Prensa méd. argent ; 105(11): 800-809, dic2019. graf, tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1049807


Introduction: Discharging with personal satisfaction is one of the main problems in hospitalization, when the patient leaves the hospital sooner than the doctor's advice. This will exacerbate the disease and increase the risk of hospital re-admittance. In this regard, more attention should be given to children because they are not able to understand the above meaning or participate in decision making. Materials and Methods: In this descriptive cross-sectional study, all children who were discharged due to personal satisfaction from the hospital were included. The 4-page checklist for the various causes of "leaving the hospital despite medical advice" was divided into three sections: Causes related to the patient's own issues, causes related to the hospital medical staff and the causes of the hospital situation, and a page of demographical variables included gender, age and history of hospitalization and ward of hospitalization. Results: A total of 310 cases (7.4%) were discharged with personal satisfaction of their parents. The most important factor linked to discharge with personal satisfaction was the poor economic condition of parents. In terms of factors related to the medical staff, the lack of proper handling of the nurse and then the doctor were the most important factors for discharge. Conclusion: It seems that economic issues are the most important factor in the discharge of children with parental consent of parents. On the other hand, factors such as unacceptable and unpopular behavior of nurses and doctors play crucial role in this phenomenon. Parents who are under intense psychological stress due to economic problems and child illness can be at risk of developing this phenomenon if they are not mentally supported by health staffs

Humanos , Criança , Alta do Paciente , Pobreza/economia , Epidemiologia Descritiva , Estudos Transversais/estatística & dados numéricos , Satisfação do Paciente , Impactos na Saúde/efeitos adversos , Consentimento dos Pais , Cooperação e Adesão ao Tratamento , Hospitalização
Actual. osteol ; 15(3): 214-224, Sept-Dic. 2019. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1116039


En la Argentina, las embarazadas presentan alta prevalencia (80%) de hipovitaminosis D y de sobrepeso u obesidad (27,4%). Ambas condiciones pueden aumentar la morbimortalidad materno-fetal. Bajos niveles de vitamina D se han relacionado con aumento del colesterol total, LDL, triglicéridos (Tg) y descenso de HDL. Objetivo: evaluar los niveles de 25-hidroxivitamina D (25OHD) y su relación con el perfil lipídico en pacientes embarazadas de alto riesgo. Materiales y métodos: estudio de corte transversal entre septiembre de 2016 y abril de 2017. Se excluyeron pacientes que recibieron suplementos de vitamina D, con disfunción tiroidea no compensada, malabsorción, insuficiencia cardíaca, renal o hepática y dislipidemia familiar. Niveles circulantes de 25OHD < 30 ng/ml se consideraron hipovitaminosis. Resultados: se evaluaron 86 embarazadas de 29,3 ± 7,1 años durante la semana 28 ± 6,5. El IMC pregestacional fue 28,3 ± 6,5 kg/m2 y la ganancia de peso 7 ± 4,3 kg. Perfil lipídico: colesterol total 240 ± 54 mg/dl; LDL 156 ± 54 mg/dl; HDL 66 ± 15 mg/dl; Tg 204 ± 80 mg/dl. La media de 25OHD fue de 23,8 ± 9 ng/ml, con una prevalencia de hipovitaminosis D de 77,9 %. Las pacientes con hipovitaminosis D presentaron mayores valores de colesterol total y LDL (p < 0,05), con tendencia no significativa a presentar mayores valores de Tg. Conclusión: en embarazadas de alto riesgo se observó una alta prevalencia de hipovitaminosis D, asociada con mayores concentraciones de colesterol total y LDL. (AU)

In Argentina, pregnant women have a high prevalence (80 %) of hypovitaminosis D and verweight/obesity (27.4%), conditions that can increase maternal-fetal morbidity and mortality. Low levels of 25-hydroxyvitamin D (25OHD) have been linked to an increase in total cholesterol, LDL cholesterol, triglycerides (TG) and a decrease in HDL cholesterol. Objective: to evaluate the levels of vitamin D and its relationship with the lipid profile in high risk pregnant patients. Materials and methods: cross-sectional study between September 2016 and April 2017. Patients who received vitamin D supplements or had non-compensated thyroid dysfunction, malabsorption, heart failure, renal or hepatic failure, or familial dyslipidemia were excluded. Hypovitaminosis D was defined as a circulating level of 25OHD < 30 ng/ml. Results: We assessed 86 women of 29.3 ± 7.1 years during pregnancy week 28 ± 6.5. Pre-gestational BMI was 28.3 ± 6.5 kg/m2. Their weight gain was 7 ± 4.3 kg. Lipid profile: total cholesterol 240 ± 54 mg/dl; LDL cholesterol 156 ± 54 mg/dl; HDL cholesterol 66 ± 15 mg/dL; TG 204 ± 80 mg/dl. The mean 25OHD level was 23.8 ± 9 ng/ml, with a 77.9 % prevalence of hypovitaminosis D. Patients with hypovitaminosis D had higher values of total cholesterol and LDL cholesterol (p<0.05), and a non-significant trend toward higher triglyceridemia. Conclusion: A high prevalence of hypovitaminosis D, associated with high total and LDL cholesterol was found in high risk pregnant women. (AU)

Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Deficiência de Vitaminas/metabolismo , Vitamina D/metabolismo , Gravidez de Alto Risco/metabolismo , Argentina/epidemiologia , Deficiência de Vitaminas/sangue , Deficiência de Vitaminas/epidemiologia , Vitamina D/análise , Vitamina D/sangue , Estudos Epidemiológicos , Índice de Massa Corporal , Colesterol/análise , Colesterol/sangue , Indicadores de Morbimortalidade , Saúde Pública/estatística & dados numéricos , Estudos Transversais/estatística & dados numéricos , Diabetes Gestacional/metabolismo , Gravidez de Alto Risco/sangue , Dislipidemias/metabolismo , Sobrepeso/metabolismo , Trabalho de Parto Prematuro/metabolismo , LDL-Colesterol/análise , LDL-Colesterol/sangue , Obesidade/metabolismo
Expert Rev Anti Infect Ther ; 17(8): 661-669, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31335228


Background: Antimicrobial resistance (AMR) is a major threat to global health and antimicrobial stewardship programs (ASPs) are useful to limit the momentum of AMR. This study was intended to determine the attitudes of clinicians about AMR, ASP strategies, and their readiness to participate in ASPs. Methods: A cross-sectional survey was carried out among clinicians working in teaching hospitals of Punjab between August and November 2018. A multistage sampling method was used. Descriptive statistics and Kruskal-Wallis tests were employed for data analysis. Results: A response rate of 77.9% (670 / 859) was achieved. Most of the physicians (n = 302, 71.7%) compared to surgeons (n = 134, 70.9%) and anesthetists (n = 25, 41.7%) considered AMR as a serious health problem in Pakistani hospitals (p < 0.001). Clinicians were agreed that hospital audit and feedback (n = 434, 64.8%), restriction of certain antibiotics (n = 424, 63.3%), readily accessible microbiological data (n = 453, 67.6%), and regular educational sessions (n = 496, 74.0%) are imperative approaches to implement ASPs. Median ASP and AMR scores were significantly associated with age, experience, and types of clinicians (p < 0.05). Conclusions: Despite poor previous knowledge of ASPs, all clinicians showed a positive attitude towards hospital ASPs. Several approaches suggested by clinicians will be helpful to implement hospital ASPs in Pakistan.

Gestão de Antimicrobianos/estatística & dados numéricos , Atitude do Pessoal de Saúde , Estudos Transversais/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Resistência Microbiana a Medicamentos , Feminino , Hospitais de Ensino , Humanos , Masculino , Paquistão , Inquéritos e Questionários , Adulto Jovem
PLoS One ; 14(6): e0218678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220165


OBJECTIVE: Adaptation to social life changes after migration may be beneficial or detrimental to migrants' oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants' and ethnic minorities' oral health status and/or behaviors. METHODS: A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. RESULTS: A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health. CONCLUSION: Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.

Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Apoio Social , Estudos Transversais/estatística & dados numéricos , Fatores Epidemiológicos , Nível de Saúde , Disparidades nos Níveis de Saúde , Humanos , Estudos Longitudinais , Doenças da Boca/epidemiologia , Saúde Bucal/normas , Fatores Socioeconômicos , Migrantes/estatística & dados numéricos
Endocr Res ; 44(4): 168-184, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31165667


Purpose: Earlier studies have linked lipid profile to osteoporotic fractures; however, to our knowledge, no study had summarized available data on this relationship. We aimed to summarize the current evidence on the association between lipid profile and bone fractures. Material and Methods: A systematic search of PubMed and Scopus was done to find relevant published studies until March 2018. To combine effect sizes, we applied fixed- or random-effects analysis, where appropriate. Cochran's Q test and I2 were used to assess between-study heterogeneity. Results: Overall, 11 studies (seven prospective, three cross-sectional and one case-control studies) were included in the current systematic review. Out of them, 10 studies with a total sample size of 60,484 individuals, aged 25 years or more, were used in the meta-analysis. The results showed that total cholesterol concentration was positively associated with risk of bone fracture; such that a 50-mg/dl increase in plasma level of TC was associated with 15% greater odds of bone fracture (combined effect size: 1.15, 95% CI: 1.02-1.30, P = .02). Furthermore, we found that individuals with a decreased level of HDL (<40 mg/dl) had a lower risk of bone fracture compared with those with a normal level (≥40 mg/dl) (combined effect size: 0.82, 95% CI: 0.71-0.96, P = .01). No significant association was found between plasma level of TG and LDL with the risk of bone fractures either in prospective or cross-sectional studies. Conclusions: We found that plasma levels of total cholesterol were positively associated with bone fractures. In addition, decreased levels of HDL were associated with an increased risk of osteoporotic fractures. Abbreviations: TG: triglycerides, TC: total cholesterol, HDL: high-density lipoprotein, LDL: low-density lipoprotein, OR: odds ratio, RR: relative risk, HR: hazard ratio, DXA: dual-energy X-ray absorptiometry, ICD: International Classification of Diseases, SD: standard deviation.

Fraturas Ósseas/sangue , Lipídeos/sangue , Estudos Observacionais como Assunto/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais/estatística & dados numéricos , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Metabolismo dos Lipídeos/fisiologia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/epidemiologia , Fatores de Risco
Prensa méd. argent ; 105(5): 259-269, jun 2019. graf, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1024538


El virus Zika, es un arbovirus del género flavivirus (familia Flaviviridae), muy cercano filogenéticamente a virus como el dengue, fiebre amarilla, la encefalitis japonesa, o el virus del Nilo Occidental. El presente estudio es de tipo exploratorio con base en el registro de casos de recién nacidos y lactantes hijos de mujeres embarazadas con infección de virus Zika en la Unidad de Medicina Familiar Nº 60 de Coatzacoalcos, Veracruz, dentro del período de diciembre del 2016 a julio del 2017. Se realizó un estudio polietápico que constó de revisión de casos por medio de uso de expediente clínico en la Consulta Externa en la Unidad Médico Familiar Nº 60 del IMSS de Coatzacoalcos, Veracruz. como primera aproximación epidemiológica en esta región en recién nacidos y lactantes hijos de madres con infección por virus Zika, que posteriormente fueron sometidos a estudios de valoración oftalmológica, neurológica y somatométrica; con ayuda del servicio de Salud Pública de dicha unidad (AU)

Zika virus is an arbovirus of the genusflavivirus (family Flaviviridae), very close phylogenetically to viruses such as denque, yellow fever, japanese encephalitis, or West Nile virus. The present study is exploratory based on the registry of cases of newborns and infants born to pregnant women with zika virus infection in the Family Medicine Unit Nº 60 of Coatzacalcos, Veracruz, within the period of December 2016 to July 2017. A multistage study was carried out that consisted of the review of cases through the use of a clinical file in the Outpatient Consultation in the Family Medical Unit Nº 60 of the IMSS. of Coatzacoalcos, Veracruz. As a first epidemiological approach in this region in newborns and infants born to mothers with Zika virus infection, who were subsequently subjected to ophtalmological, neurological and somatometric assessment studies; with the help of the Public Health service of said unit (AU)

Humanos , Recém-Nascido , Lactente , Prevalência , Estudos Transversais/estatística & dados numéricos , Idade Gestacional , Estudos de Validação como Assunto , Zika virus/imunologia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/prevenção & controle
Australas Emerg Care ; 22(2): 103-106, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042529


BACKGROUND: A self-administered patient medication history form may improve efficiency of workflow in the emergency department. The objective of this study was to evaluate the patient perspective of completing a self-administered medication history form in the emergency department. METHODS: This was a cross-sectional survey of patients who presented to an urban emergency department in Australia. Face and content validity of the survey was established via an iterative process that included pharmacists and patients. After completing a self-administered medication history form, patients were surveyed regard their perspective of this approach. The results of each survey question were evaluated descriptively. RESULTS: A total of 113 completed the survey. The mean age was 59±19 years, and 52% were male. Most patients (87%, n=98) did not think there were any problems completing a self-administered list while waiting to be seen by a physician or pharmacist in the emergency department. Some patients preferred other modalities for clinicians to obtain the list due to their lack of recollection or confusion (4%, n=4), preferred that clinicians utilised existing lists or evaluated medications brought with them (2%, n=2), preferred the convenience of answering questions rather than writing (1%, n=1), or did not list a reason (1%, n=1). CONCLUSION: Most patients who present to the emergency department view a self-administered medication history form positively.

Documentação/normas , Pacientes/estatística & dados numéricos , Autoadministração/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais/estatística & dados numéricos , Documentação/métodos , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Autoadministração/métodos , População Urbana/estatística & dados numéricos
Psicothema (Oviedo) ; 31(2): 204-209, mayo 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185227


Background: Although there is growing research on the excessive use of Facebook and its correlates, most studies to date are not directly comparable or generalizable to the overall population as their samples are often limited to students and they use different assessment tools. The first aim of our study was to develop a Spanish version of the Facebook Intrusion Questionnaire (FIQ-S), an instrument which emphasises the social components and consequences of excessive Facebook use. Second, we aimed to examine its psychometric properties: factor structure, reliability and external validity. Methods: Participants were 567 Spanish adults who completed an online battery of questionnaires, including variables related to addictive behaviours. Results: Exploratory and confirmatory factor analysis, using a cross-validation strategy, supported a one-factor structure. The composite reliability value was adequate. Evidence of external validity was provided via correlational analysis, showing a negative association with self-control and positive associations with time spent using social networking sites, problematic mobile phone use, internet addiction, phubbing, fear of missing out and depression. Conclusions: Results are consistent with the original validation study and confirm the addictive component of the construct measured and highlight the impact of Facebook abuse on mental health

Antecedentes: a pesar de que está aumentando la investigación sobre el uso excesivo de Facebook y sus correlatos, la mayoría de los estudios no son directamente comparables o generalizables a la población general ya que sus muestras suelen ser de estudiantes y usan diferentes instrumentos de evaluación. El primer objetivo es desarrollar la versión española del Cuestionario de Intrusión del Facebook (FIQ-S). Este instrumento enfatiza los componentes y consecuencias sociales del uso excesivo del Facebook. El segundo objetivo es examinar sus propiedades psicométricas: estructura factorial, fiabilidad y validez externa. Método: los participantes fueron 567 adultos españoles, quienes completaron una batería de cuestionarios online. Resultados: los análisis factoriales exploratorios y confirmatorios, con validación cruzada, muestran una estructura unifactorial. La fiabilidad compuesta es adecuada. Los análisis de las correlaciones muestran evidencias de validez externa, encontrándose asociaciones negativas con autocontrol y positivas con tiempo de uso de las redes sociales, uso problemático del teléfono móvil, phubbing, adicción a internet, miedo a perderse algo y depresión. Conclusiones: los resultados son consistentes con el estudio de validación de la versión original y confirman el componente adictivo del constructo evaluado. Además, se destaca el impacto del uso excesivo de Facebook en salud mental

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Comportamento Aditivo , Autorrelato , Mídias Sociais , Estudos Transversais/estatística & dados numéricos , Espanha , Tradução
Av. odontoestomatol ; 35(1): 19-25, ene.-feb. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-182634


Introducción: Los principios y metodologías de la medicina basada en evidencia, constituye un importante campo de atención, mediante el cual se incorpora, de manera reflexiva toda la información disponible, con la finalidad de brindar al paciente las mejores opciones para los problemas de salud de la población. Conocer el tipo de evidencia y los análisis estadísticos utilizados mejoran las aptitudes del clínico para tomar cualquier decisión. El objetivo de este estudio fue identificar los diseños de investigación y pruebas estadísticas utilizadas en revistas de odontología indexadas en la red SciELO entre el año 2000 y 2016. Material y método: Se realizó un estudio bibliométrico descriptivo de corte transversal. La búsqueda incluyó todas las revistas del área odontológica indexadas en la base SciELO (Scientific Electronic Library Online), entre los años 2000 y 2016, con disponibilidad en idioma español. Se excluyeron revistas que no presentaran información online disponible, sin acceso o que fueran eliminadas de la base de datos. La búsqueda se realizó desde el portal web de SciELO (, a fin de obtener acceso a toda la red, a través de la sección "colecciones de revistas", donde se encontraron los links de acceso para cada país. Resultados: Se analizaron 634 artículos desde el primer semestre del 2000 al segundo semestre del 2016. Los Diseños de estudio más utilizados fueron el estudio corte transversal (244) in vitro (107). De las pruebas estadísticas paramétricas ANOVA (121) y t-test para muestras independientes (96) fueron las más frecuentemente utilizadas y de las pruebas no paramétricas, fue Chi cuadrado de Pearson (113) y U-Mann Whitney (70). Discusión: Las diferencias observadas entre los diferentes diseños de estudios se mantiene similar a lo que se había reportado anteriormente, siendo diseño de corte transversal el más utilizado. Comprender e interpretar los de métodos estadísticos permitirán identificar resultados relevantes y aplicables para la toma de decisión clínica

Introduction: The principles and methodologies of evidence-based medicine constitute an important field of attention, by means of which all the available information is incorporated in a reflexive manner, in order to provide the patient with the best options for health problems. The population. Knowing the type of evidence and the statistical analyzes used improve the clinician's abilities to make any decision. The objective of this study was to identify the research designs and statistical tests used in dentistry journals indexed in the SciELO network between 2000 and 2016. Material and method: A cross-sectional descriptive bibliometric study was carried out. The search included all the dental journals indexed in the SciELO database (Scientific Electronic Library Online), between 2000 and 2016, with availability in Spanish. We excluded journals that did not present online information available, without access or that were eliminated from the database. The search was made from the SciELO web portal (, in order to obtain access to the entire network, through the section "magazine collections", where the access links for each country were found. Results: 634 articles were analyzed from the first semester of 2000 to the second semester of 2016. The study designs most used were the cross section study (244) and thein vitro study (107). Of the parametric statistical tests ANOVA (121) and t-test for independent samples (96) were the most frequently used and non-parametric tests, it was Pearson's Chi Square (113) and U-Mann Whitney (70). Discussion: The differences observed between the different study designs remains similar to what had been previously reported, with the cross-sectional design being the most used. Understanding and interpreting the statistical methods will allow to identify relevant and applicable results for clinical decision making

Projetos de Pesquisa Epidemiológica , Publicações Periódicas como Assunto/estatística & dados numéricos , Bibliometria , Estudos Transversais/estatística & dados numéricos , Odontologia/estatística & dados numéricos
Int Wound J ; 16(2): 522-526, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30672095


The prevalence of chronic wounds in the Helsinki metropolitan area in 2008 was investigated. Thereafter, a specialised wound care team was founded as part of the City of Helsinki Health Services, aiming for early diagnoses of chronic wounds. In the current study, we have repeated the prevalence study to analyse the changes in the prevalence of chronic wounds. A questionnaire on wound patients was sent to all units of social and health care in the Helsinki metropolitan area. We asked about the number of patients with wounds treated during a 24-hour period, as well the aetiology and location of the wounds. A total of 911 patients had, altogether, 1021 wounds. Thus, prevalence was 0.08%. Pressure and multifactorial ulcers were the most common aetiological groups, whereas wound without defined aetiology had diminished greatly (61%) The prevalence of chronic wound decreased when compared with 2008 (0.08% vs 0.1%). The number of elderly people aged over 65 years had increased 35%, and the age-adjusted prevalence had decreased. Wounds are treated mostly in primary care units and as outpatients. Therefore, the following conclusion may be reached: diagnostic process and implementation of treatment paths are strengthened within primary care units, yet prevalence of wounds has decreased.

Doença Crônica/epidemiologia , Estudos Transversais/estatística & dados numéricos , Estudos Transversais/tendências , Úlcera da Perna/epidemiologia , Lesão por Pressão/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades/epidemiologia , Feminino , Finlândia/epidemiologia , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
Stat Methods Med Res ; 28(3): 703-716, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29027505


Stepped wedge and cluster randomised crossover trials are examples of cluster randomised designs conducted over multiple time periods that are being used with increasing frequency in health research. Recent systematic reviews of both of these designs indicate that the within-cluster correlation is typically taken account of in the analysis of data using a random intercept mixed model, implying a constant correlation between any two individuals in the same cluster no matter how far apart in time they are measured: within-period and between-period intra-cluster correlations are assumed to be identical. Recently proposed extensions allow the within- and between-period intra-cluster correlations to differ, although these methods require that all between-period intra-cluster correlations are identical, which may not be appropriate in all situations. Motivated by a proposed intensive care cluster randomised trial, we propose an alternative correlation structure for repeated cross-sectional multiple-period cluster randomised trials in which the between-period intra-cluster correlation is allowed to decay depending on the distance between measurements. We present results for the variance of treatment effect estimators for varying amounts of decay, investigating the consequences of the variation in decay on sample size planning for stepped wedge, cluster crossover and multiple-period parallel-arm cluster randomised trials. We also investigate the impact of assuming constant between-period intra-cluster correlations instead of decaying between-period intra-cluster correlations. Our results indicate that in certain design configurations, including the one corresponding to the proposed trial, a correlation decay can have an important impact on variances of treatment effect estimators, and hence on sample size and power. An R Shiny app allows readers to interactively explore the impact of correlation decay.

Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Algoritmos , Análise por Conglomerados , Estudos Cross-Over , Estudos Transversais/estatística & dados numéricos , Interpretação Estatística de Dados , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Projetos de Pesquisa
Evid. actual. práct. ambul ; 22(4): e002027, 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1052886


Antecedentes. El modelo biopsicosocial propone que la atención de la salud se centre en las necesidades de las personas.Sin embargo, no siempre los profesionales de la salud conocen adecuadamente lo que esperan de los encuentros clínicos sus pacientes. Objetivo. Explorar las expectativas respecto de sus encuentros clínicos de los/as pacientes atendidos por médicos de familia en un Centro de Salud de Atención Primaria del Conurbano Bonaerense (Buenos Aires, Argentina). Métodos. Estudio observacional descriptivo de corte transversal llevado a cabo sobre una muestra consecutiva de pacientes que acudieron a las consultas médicas de un centro de salud. Se les pidió a los pacientes que de un listado de diez potenciales expectativas, valoraran y priorizaran las más importantes para esa consulta. Resultados. Fueron entrevistadas 146 personas (91 % mujeres) con una mediana de edad de 30 años.Las expectativas más mencionadas (94 % de las personas encuestadas) fueron que el médico demuestre interés y escuche a sus pacientes, y que les brinde explicaciones sobre sus problemas y dudas. Conclusiones. Hemos podido documentar que las expectativas de nuestros pacientes respecto de sus entrevistas clínicas están muy vinculadas a su componente actitudinal (predisposición a escuchar con interés sus problemas) y al de las habilidades comunicacionales del profesional de la salud (explicaciones). (AU)

Background. The biopsychosocial model proposes that health care focus on the needs of people. However, health profes-sionals do not always know what their patients expect from clinical meetings. Objective. To explore the expectations regarding their clinical meetings of the patients attended by family doctors in aPrimary Health Care Center of Buenos Aires, Argentina. Methods. Descriptive cross-sectional observational study carried out on a consecutive sample of patients who attendedthe medical consultations of a health center. Patients were asked to rate and prioritize the most important ones for thatconsultation from a list of ten potential expectations. Results. 146 people (91 % women) with a median age of 30 years were interviewed.The most mentioned expectations (94 % of the people surveyed) were for the doctor to show interest and listen to theirpatients, and to give them explanations about their problems and doubts. Conclusions. We have been able to document that our patients' expectations regarding their clinical interviews are closelylinked to their attitudinal component (predisposition to listen with interest to their problems) and to the communication skillsof the healthcare professional (explanations). (AU)

Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Satisfação do Paciente , Medicina de Família e Comunidade/tendências , Argentina , Relações Médico-Paciente , Médicos de Família/tendências , Atenção Primária à Saúde/tendências , Garantia da Qualidade dos Cuidados de Saúde/tendências , Qualidade da Assistência à Saúde/tendências , Estudos Transversais/estatística & dados numéricos , Competência Clínica , Assistência Centrada no Paciente/tendências , Empatia , Preferência do Paciente/psicologia , Comunicação em Saúde/métodos
Prensa méd. argent ; 104(10): 510-515, dic 2018. graf, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1046997


La criptococosis es una micosis grave de distribución universal, que afecta principalmente a huéspedes inmunocomprometidos. Es una de las principales causas de morbilidad y mortalidad en los pacientes infectados con el virus de la inmunodeficiencia humana (HIV). Provoca al menos 620 000 muertes al año, representando entre el 13% al 44% de la mortalidad en pacientes HIV positivos según datos de cohortes correspondientes a países en desarrollo. (1, 2) La letalidad de la criptococosis meníngea en estudios de Argentina y Brasil muestra valores que van desde el 26% hasta el 63%. El complejo Cryptococcus neoformans/ Cryptococcus gattii, es el responsable de esta enfermedad. Existen alrededor de 70 especies pero solo dos de ellas son patógenas para el hombre: C. neoformans y C. gattii. Se reconocen 8 genotipos de este complejo, C. neoformans: VNI y VNII (C. neoformans var. grubii), VNIII (C. neoformans híbrido intervariedad AD), VNIV (C. neoformans var. neoformans) y C. gattii: genotipos VGI, VGII, VGIII y VGIV. Se han descripto híbridos interespecie VNIV/VGI, VNI/VGI, VNI/VGII. Se estudiaron 207 aislamientos de Cryptococcus, elegidos aleatoriamente, de un total de 2593 pacientes con diagnóstico de criptococosis diseminada. A los mismos se les realizó la genotipificación mediante una PCR-RFLP del gen URA5, y posterior digestión enzimática con enzimas Sau96I y HhaI. De las 207 cepas estudiadas, 174 fueron VNI (84,05%), 14 VNII (6,76%), 10 VNIII (4,83%), 2 VNIV (0,97%), 3 VGI (1,45%), 3 VGII de (1,45%) y 1 VGIII (0,49%).

Cryptococcosis is a severe worldwide mycosis, which mainly affects immunocompromised hosts and is a major cause of morbidity and mortality in HIV-infected patients. It causes 620,000 annual deaths, accounting for 13-44 % of mortality in HIV-positive individuals in developing countries. Mortality rates of meningeal cryptococcosis in studies from Argentina and Brazil go from 26 to 63 %. Cryptococcus neoformans/Cryptococcus gattii is the species complex responsible for this disease. There are about 70 species, however, only two are human pathogens: C. neoformans and C. gattii. C. neoformans genotypes are VNI and VNII (C. neoformans var. grubii), VNIII (C. neoformans intervariety hybrid AD), VNIV (C. neoformans var. neoformans). C. gattii genotypes are VGI, VGII, VGIII and VGIV. Interspecies hybrids were described: VNIV/VGI, VNI/VGI, VNI/ VGII. A total of 207 Cryptococcus isolates were randomly selected from 2593 patients with diagnosis of disseminated cryptococcosis. Genotyping was performed by PCRRFLP of UR A5 gene with restriction enzyme digestion using Sau96I and HhaI enzymes. Among the 207 studied isolates, 174 resulted VNI (84.05%), 14 VNII (6.76%), 10 VNIII (4.83%), 2 VNIV (0.97%), 3 VGI (1.45%), 3 VGII (1.45%) and 1 VGIII (0.49%).

Humanos , Estudos Transversais/estatística & dados numéricos , Morbidade , HIV/isolamento & purificação , Meningite Criptocócica/epidemiologia , Cryptococcus neoformans/isolamento & purificação , Cryptococcus gattii/isolamento & purificação , Genótipo
Medicina (Kaunas) ; 54(5)2018 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-30405059


BACKGROUND AND OBJECTIVE: the global prevalence of allergic rhinitis (AR) is rising and yet there is scarce information concerning the diagnosis, management and treatment patterns of AR in Northern Cyprus (NC). This study aims to provide a unique perspective on AR management as well as assessing the effectiveness of the pharmacist-led educational intervention for improving care of AR patients. METHODS: across-sectional survey was carried out with community pharmacists (n = 70), patients (n = 138) and ear, nose and throat (ENT) specialists (n = 12) in NC. For a controlled interventional trial, trained pharmacists provided a brief education on management of AR and nasal spray technique for patients while other pharmacists provided the usual care. Quality of life (QoL) and other outcome measures on the perceived symptom severity of the two groups were compared after a 6-week period. RESULTS: only 33.3% of the ear, nose and throat (ENT) specialists and 15.7% of the community pharmacists are aware of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The majority of patients (63%) self-managed with over-the-counter medications. Nasal congestion (96.4%) is the most bothersome symptom and oral antihistamines are the most commonly purchased medications (51.4%), indicating a pattern of suboptimal management. The pharmacists-led educational intervention has resulted in statistically more significant improvement in regards to nasal congestion and QoL for the intervention group patients (p < 0.05). CONCLUSION: the current management of AR has not been in accordance with the ARIA guidelines in NC. An educational intervention of the pharmacists can enhance the symptom management and improve the QoL in patients with AR.

Otorrinolaringologistas , Educação de Pacientes como Assunto , Farmacêuticos , Rinite Alérgica/diagnóstico , Rinite Alérgica/tratamento farmacológico , Adulto , Asma/etiologia , Estudos Transversais/estatística & dados numéricos , Chipre/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite Alérgica/complicações , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
Artigo em Inglês | MEDLINE | ID: mdl-30388758


Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of these diseases. Methods: Included in this study were compiled epidemiological data of typhoid and paratyphoid cases in Zhejiang from 1953 to 2003 and epidemiological data of those from 2004 to 2014 registered in the China Information System for Diseases Control and Prevention. Description methods were employed to explore the epidemiological characteristics, including long-term trend, gender distribution, age distribution, and occupation distribution. Incidence maps were made to represent the annual average incidences for each municipality. Spearman's rank correlation was performed to detect the correlation between incidence and average elevation, and circular distribution was calculated to identify the seasonality and peak days of the diseases. A p-value of <0.05 was considered statistically significant. Results: A total of 182,602 typhoid and paratyphoid cases were reported in Zhejiang Province from 1953 to 2014, and the average annual incidence was 7.89 per 100,000 population. The incidence in 2014 decreased by 93.82% compared with that in 1953 and by 95.00% compared with the highest incidence rate. The average incidence before 2003 was negatively correlated with the average elevation of each region in Zhejiang province (r < 0, p < 0.05), but there was no statistically significant correlation from 2003. The peak period of diseases fell in the months from April to October every year. The incidence among the population group aged over 35 rose gradually but declined sharply among those between 20 and 34. Conclusions: The incidence of typhoid and paratyphoid decreased in Zhejiang Province from 1953 to 2014 but remained high in some regions. Proper measures for prevention and control are warranted in the southeast coast areas and for high-risk populations.

Estudos Transversais/estatística & dados numéricos , Estudos Transversais/tendências , Febre Paratifoide/epidemiologia , Febre Paratifoide/história , Febre Tifoide/epidemiologia , Febre Tifoide/história , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Análise por Conglomerados , Feminino , Previsões , História do Século XX , História do Século XXI , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
Prensa méd. argent ; 104(7): 319-326, sep2018. graf, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1050996


Estudio observacional descriptivo de corte transversal sobre 3558 mamografías realizadas en el Hospital entre los años 2015 y 2017 considerando características epidemiológicas, hallazgos mamográficos y análisis de auditoria sobre seguimiento y vigilancia de resultados. Se tuvieron en cuenta las recomendaciones del Colegio Americano de Radiología (ACR) en su BIRADS 5ta edición del años 2013. En mamografías (Mx) preventivas y de diagnóstico al cáncer de mama lo observamos en etapas avanzadas y las tasas de recitación, valores predictivos positivos (VPP), valores predictivos negativos (VPN), sensibilidad y especificidad etuvieron dentro de lo adecuado para una evaluación de auditoría

A descriptive, cross-sectional obsrvational study was carried out on 3558 mammograms performed at the Hospital !A. Oñativia", Salta, Argentina between 2015 and 2017 considering epidemiological characteristics, mammographic findings and audit analysis on follow-up and monitoring of results. The recommendations of the American College of Radiology (ACR) were taken into account in their BIRADS 5th edition of 2013. Preventive and diagnostic mammograms (Mx) showed that breast cancer is found in advanced stages and the recitation rates, positive predictive values (PPV), negative predictive values (NPV), sensitivity and specificity were within the appropriate values for an audit evaluation

Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Epidemiologia Descritiva , Estudos Transversais/estatística & dados numéricos , Valor Preditivo dos Testes , Seguimentos , Estudo Observacional
Endocrine ; 62(2): 299-306, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30128962


PURPOSE: To clarify the relevance between smoking and diabetic retinopathy in patients with type 1 and type 2 diabetes mellitus. METHODS: Published evidence were searched in MEDLINE and EMBASE from the databases began until Feb. 2017. Studies evaluating the association between smoking and diabetic retinopathy or evaluating the risk factors of diabetic retinopathy including smoking were included. RESULTS: Totally 73 studies were identified, among which 19 studies included type 1 diabetes patients and 56 studies included type 2 diabetes patients. In type 1 diabetes, compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers (risk ratio (RR) = 1.23, 95% CI 1.14, 1.33, P < 0.001), and the risk of proliferative diabetic retinopathy also significantly increased in smokers (RR = 1.48, 95% CI 1.20, 1.81, P < 0.001). In type 2 diabetes, compare with non-smokers, the risk of diabetic retinopathy significantly decreased in smokers (RR = 0.92, 95% CI 0.86, 0.98, P = 0.02) and the risk of proliferative diabetic retinopathy also significantly decreased in smokers (RR = 0.68, 95% CI 0.61, 0.74, P < 0.001). CONCLUSIONS: Compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers with type 1 diabetes while significantly decreased in smokers with type 2 diabetes. However, this result did not change the importance of smoking cessation for public health.

Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Fumar/efeitos adversos , Estudos Transversais/estatística & dados numéricos , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Humanos , Estudos Observacionais como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia
J Am Board Fam Med ; 31(4): 529-536, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29986978


BACKGROUND: Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (<5 providers). METHODS: We conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. RESULTS: The rate of provider-reported burnout was 13.5%. Using bivariate logistic regression, we found higher adaptive reserve scores were associated with lower odds of burnout (odds ratio, 0.12; 95% CI, 0.02-0.85; P = .034). CONCLUSION: The burnout rate was relatively low among our sample of providers compared with previous surveys that focused primarily on larger practices. The independence and autonomy providers have in these small practices may provide some protection against symptoms of burnout. In addition, the relationship between adaptive reserve and lower rates of burnout point toward potential interventions for reducing burnout that include strengthening primary care practices' learning and development capacity.

Esgotamento Profissional/epidemiologia , Associações de Prática Independente/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , Estudos Transversais/estatística & dados numéricos , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Médicos de Atenção Primária/estatística & dados numéricos , Prevalência , Atenção Primária à Saúde/organização & administração , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
Prensa méd. argent ; 104(4): 185-189, Jun2018. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1051610


The objective of this study was to describe the epidemiology and the perinatal outcomes of twin pregnancy in the Maternal-Infantile Departament of the National Hospital "Alejandro Posadas". During the period studied there were 2825 births. The prevalence of twin pregnancies was 3.2% (N= 91). From the total of twin pregnancies, 88 were doubles and 3 were triples. It is postulated that the monochorial monovular twins constitutes a different clinical entity, because of a higher proportion of complicatioms, and that the adequate planification of the actions and working connected the perinatal team will improve the care process

Humanos , Feminino , Gravidez , Complicações na Gravidez/epidemiologia , Epidemiologia Descritiva , Estudos Transversais/estatística & dados numéricos , Assistência Perinatal , Transfusão Feto-Fetal/patologia , Gravidez de Gêmeos , Técnicas de Reprodução Assistida