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Med Clin North Am ; 105(2): 325-339, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33589106


Spondyloarthritis is a common rheumatologic disease, present in up to 2% of the population, characterized by inflammatory arthritis, often with enthesitis, dactylitis, spondylitis, and skin disease. It has historically been characterized as ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, and undifferentiated spondyloarthritis. These subsets are now classified as axial-predominant and peripheral-predominant spondyloarthritis. This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy.

Administração dos Cuidados ao Paciente/métodos , Espondilartrite , Diagnóstico Diferencial , Intervenção Médica Precoce , Humanos , Encaminhamento e Consulta , Reumatologia/métodos , Espondilartrite/diagnóstico , Espondilartrite/fisiopatologia , Espondilartrite/terapia
Med Clin North Am ; 105(2): 355-365, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33589108


Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder that manifests as a symmetric polyarthritis of small and large joints that may lead to joint and periarticular structural damage and the consequences of systemic inflammation. This overview of early RA examines the unmet needs and challenges in RA, how to best diagnose RA, and pitfalls in early diagnosis and treatment. The rules for referral to a rheumatologist are reviewed. Primary care physicians are at the front line of early diagnosis and need to start disease-modifying therapy as soon as a diagnosis of RA is established.

Artrite Reumatoide , Intervenção Médica Precoce/métodos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Diagnóstico Precoce , Humanos , Atenção Primária à Saúde/métodos
Eur Rev Med Pharmacol Sci ; 25(2): 1087-1096, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33577065


OBJECTIVE: Patients with Coronavirus Disease 2019 (COVID-19) suffer from anxiety, depression and sleep disorders due to isolation treatment, among other reasons. Whether non-drug interventions can be alternative therapies for COVID-19 patients with anxiety, depression and sleep disorders is controversial. Therefore, we conducted a meta-analysis and systematic review to evaluate the effects of non-drug interventions on anxiety, depression and sleep in patients with COVID-19 to provide guidance for clinical application. MATERIALS AND METHODS: We searched the following databases for randomized controlled trials (RCTs) from December 2019 to July 2020: China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Wanfang, Cochrane Library, Web of Science, PubMed, MEDLINE and Embase. Two investigators independently screened the literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan5.3 software. RESULTS: A total of 5 articles with 768 subjects were included. Meta-analysis results indicated that non-drug interventions can reduce anxiety [SMD=-1.40, 95% CI (-1.62, -1.17), p<0.00001] and depression [SMD=-1.22, 95% CI (-2.01, -0.43), p=0.002] scores in patients with COVID-19. Descriptive analysis indicated that non-drug interventions can improve the sleep status of COVID-19 patients. Sensitivity analysis indicated that the meta-analysis results were stable. Egger's test and Begg's test showed no publication bias. CONCLUSIONS: This meta-analysis found that non-drug interventions can reduce the anxiety and depression scores of patients with COVID-19. Due to the limitations of this study, more high-quality studies are needed to verify the findings, especially the effect of non-drug interventions on improving the sleep status of COVID-19 patients.

Ansiedade/terapia , Depressão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transtornos do Sono-Vigília/terapia , Ansiedade/epidemiologia , Ansiedade/psicologia , /psicologia , Depressão/epidemiologia , Depressão/psicologia , Intervenção Médica Precoce/métodos , Humanos , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Resultado do Tratamento
Interv. psicosoc. (Internet) ; 30(1): 35-45, ene. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-ET2-7582


Parental promotion of an adequate environment during early childhood results in healthy child development. This study evaluated the feasibility and effectiveness of the positive parenting programme, 'Gaining health and wellbeing from birth to three' (GH&W), as a universal prevention strategy. Participants were 87 parents with children < 36 months old attending 20 primary care centres. Centres were randomly assigned to three GH&W intervention levels: online course (level 1), online course plus group workshops (level 2), and online course plus group workshops plus individual support at medical check-ups (level 3), delivered by healthcare professionals. As for feasibility, participants in levels 2 and 3 reported higher utility and satisfaction with the online course than participants in level 1. Pretest-posttest comparisons and cluster analysis showed that participants in level 3 achieved the best results and were associated with a consolidated cluster characterised by improvements in health promotion activities, parental self-regulation, and satisfaction with the service, whereas participants in levels 1 and 2 showed fewer improvements and were associated with initial and transitional clusters. The GH&W programme improves the universal reach of web-based courses and efficiently activates the contribution of the primary care system to the support network for healthy child development and wellbeing

La promoción de entornos saludables en el contexto familiar durante la primera infancia es clave para el desarrollo infantil. Este estudio evaluó la viabilidad y la eficacia del programa de parentalidad positiva "Ganar salud y bienestar de 0 a 3 años" (GSB) como estrategia de prevención universal. Participaron 87 figuras parentales con hijos o hijas de menos de 36 meses usuarios de 20 centros de salud. Los centros fueron asignados aleatoriamente a tres niveles de intervención del GSB: curso online (nivel 1), curso online más talleres grupales (nivel 2) y curso online, más talleres grupales, más apoyo individual en revisiones médicas (nivel 3) implementado por los equipos de pediatría. Respecto a la viabilidad, los participantes de los niveles 2 y 3 consideraron más útil y satisfactorio el curso online que los participantes del nivel 1. En las comparaciones pretest-postest y el análisis de clúster el nivel 3 logró los mejores resultados y se asoció al clúster consolidado caracterizado por mejoras en rutinas saludables, autorregulación parental y satisfacción con el servicio, mientras que los niveles 1 y 2 mostraron menos mejoras y se asociaron al clúster inicial y de transición. El programa GSB amplía el alcance universal del curso online e implica eficazmente al sistema sanitario en la red de apoyo al desarrollo saludable y del bienestar infantil

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adulto , Estudos de Viabilidade , Resultado do Tratamento , Avaliação de Processos e Resultados em Cuidados de Saúde , Desenvolvimento de Programas , Poder Familiar/psicologia , Desenvolvimento Infantil/fisiologia , Bem-Estar da Criança/psicologia , Promoção da Saúde/organização & administração , Intervenção Médica Precoce , Psicologia da Criança , Relações Pai-Filho
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370930


A 38-year-old woman with Crohn's disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Celulite (Flegmão) , Clindamicina/administração & dosagem , Imagem por Ressonância Magnética/métodos , Cervicalgia , Pescoço , Adulto , Proteína C-Reativa/análise , Celulite (Flegmão)/sangue , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/fisiopatologia , Infecções do Sistema Nervoso Central/diagnóstico , Doença de Crohn/complicações , Doença de Crohn/terapia , Diagnóstico Diferencial , Intervenção Médica Precoce , Humanos , Imunossupressores/uso terapêutico , Pescoço/diagnóstico por imagem , Pescoço/patologia , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Abscesso Retrofaríngeo/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
Rev. cuba. pediatr ; 92(4): e1288, oct.-dic. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144521


Introducción: El programa de estimulación temprana en la primera infancia, está diseñado para promover y mejorar el neurodesarrollo. El cuerpo calloso es una masa arqueada de sustancia blanca, compuesta por un haz de fibras transversales, situada al fondo del surco longitudinal que conecta a ambos hemisferios cerebrales. Se asocia con prematuridad y edad materna avanzada. Objetivo: Demostrar la validez de un programa de intervención temprana en la evolución de un paciente con agenesia de cuerpo calloso en las etapas del neurodesarrollo. Presentación del caso: Lactante venezolano, masculino de 4 meses de edad, blanco, producto de un segundo embarazo. Padres jóvenes, no consanguíneos. A las 19 semanas le realizan ecografía fetal: imagen quística cerebral interhemisférica, sugestivo de agenesia del cuerpo calloso. Parto por cesárea de urgencia: 34 semanas por: CIUR, oligoamnios severo, sufrimiento fetal agudo y preeclampsia, con Apgar 7-9, peso: 1800 g. Es traído al Centro Internacional de Salud La Pradera, con el diagnóstico de agenesia de cuerpo calloso más retardo del desarrollo psicomotor. Se inicia programa de intervención temprana cinco veces por semana con evaluaciones cuatrimestrales. Se involucra a los familiares. A los 18 meses de edad alcanza los hitos longitudinales propios de la edad Conclusiones: La intervención temprana favorece los mecanismos de neuroplasticidad cerebral y proporciona una evolución satisfactoria en las etapas del neurodesarrollo independiente de la agenesia de cuerpo calloso. La participación intensiva de la madre del niño es crucial para el éxito de la intervención(AU)

Introduction: The program of early stimulation in the early childhood is designed to foster and improve neurodevelopment. The callused body is a curved mass of a white substance composed by a beam of transverse fibers located in the back of the longitudinal track that connects both brain hemispheres. It is associated to prematurity and advanced maternal age. Objective: To prove the validity of an early intervention program in the evolution of a patient with agenesis of corpus callosum in the stages of neurodevelopment. Case presentation: Venezuelan newborn, 4 months old, masculine, white skin, product of a second pregnancy. Young parents, no blood relation. At 19 weeks of pregnancy, it is conducted a fetal echography: interhemispheric cystic image, suggestive to agenesis of the corpus callosum. Emergency cesarean section at 34 weeks of pregnancy due to: IUGR, severe oligoamnios; acute fetal distress and preeclampsia, with 7-9 Agar, weight: 1800 g. The newborn was admitted in La Pradera International Health Center with a diagnosis of agenesis of the corpus callosum, and delay in the psychomotor development. It was started a program of early intervention five times in the week with four-monthly assessments. Relatives were involved in the program. At 18 months old, the patient achieved the longitudinal milestones of that age. Conclusions: Early interventions favour brain neuroplasticity mechanisms, and provide a satisfactorily evolution in the stages of neurodevelopment, obviating the agenesis of the corpus callosum. Intensive participation of the child's mother is essential for the success of the intervention(AU)

Humanos , Masculino , Lactente , Agenesia do Corpo Caloso/diagnóstico por imagem , Intervenção Médica Precoce/métodos , Desempenho Psicomotor/fisiologia
Siglo cero (Madr.) ; 51(4): 69-92, oct.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-ET6-1300


El propósito de la Atención Temprana es ofrecer un servicio de calidad para el máximo desarrollo y autonomía de los niños y abogar por la calidad de vida y el bienestar familiar. El modelo actual de intervención se identifica con las prácticas centradas en la familia, basadas en la construcción de capacidades familiares, donde los profesionales deben actuar como colaboradores para dar respuesta a las necesidades de los progenitores. Este artículo pretende realizar una revisión sistematizada de la literatura, para analizar las investigaciones empíricas en el campo de la Atención Temprana desde el año 2000 e identificar aspectos que inducen a nuevas investigaciones. Se hallaron y analizaron un total de 33 artículos. Los resultados muestran que, a pesar de que se lleve a cabo el modelo centrado en la familia, hay obstáculos para desempeñar prácticas participativas, ya que implican la modificación de los apoyos profesionales y, al mismo tiempo, cambios en el protagonismo de la familia durante la intervención. La formación, la actitud del profesional o la toma de decisiones conjunta entre el profesional y la familia son aspectos que requieren ser mejorados de acuerdo con los principios del modelo centrado en la familia. Además, se precisa mayor investigación en la relación profesional-familia, el bienestar familiar, el desarrollo de nuevos programas y la actitud de los profesionales para consagrar la calidad de los servicios de Atención Temprana

The purpose of Early Childhood Intervention is to provide a quality service for the maximum development and autonomy of children and to advocate quality of life and family well-being. The current model of intervention is focused on family-centred practices. These are based on building family capacity, where professionals must act as partners to respond to parents' needs. This article aims to conduct a systematized review of the literature, to analyze empirical research in the field of Early Intervention since 2000 and to identify aspects that lead to new research. A total of 33 articles were analysed and percived. The results show that despite family-centred practices, there are obstacles to participatory. These involve the modification of professional supports and, at the same time, the role of the family during the intervention. The training, the attitude of the professional or the joint decision making between the professional and the family are aspects that require improvement according to the principles of the family-centred model. In addition, more research is needed on the professional-family relationship, family welfare, the development of new programs and the attitude of professionals to establish the quality of Early Intervention services

Humanos , Criança , Intervenção Médica Precoce/normas , Relações Profissional-Família , Modelos de Assistência à Saúde/normas , Família , Intervenção Médica Precoce/tendências , Desenvolvimento Infantil , Modelos de Assistência à Saúde/tendências , Garantia da Qualidade dos Cuidados de Saúde
Acta otorrinolaringol. esp ; 71(6): 349-357, nov.-dic. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-ET6-1315


INTRODUCTION: The impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. OBJECTIVES: The goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. METHODS: A retrospective record review with a control group design was used, with audiological and medical record reviews of all participants' files over a six-month period. A total of 86 participants (intervention group n = 32 and control group n = 54) were included. Descriptive and inferential statistics were used to analyze the data. RESULTS: Results revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78-71.74 dB), when compared to the intervention group (33-44.39 dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800 mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. CONCLUSIONS: The results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures

INTRODUCCIÓN: El impacto de las intervenciones médicas para reducir la ototoxicidad requiere concentrarse en los contextos en los que no se dispone de fármacos alternativos no ototóxicos seguros. OBJETIVOS: El objetivo fue investigar el impacto de las intervenciones médicas para reducir los efectos ototóxicos del uso prolongado de aminoglucósidos para el tratamiento de la tuberculosis multirresistente a los fármacos (MDR-TB) en adultos, en un hospital rural en Cabo Oriental, Sudáfrica. MÉTODOS: Se realizó una revisión retrospectiva de historias con grupo control de las revisiones audiológicas y médicas de todos los participantes durante un periodo de 6 meses, incluyéndose a un total de 86 participantes (grupo intervención n = 32 y grupo control n = 54). Se utilizaron estadísticas descriptivas e inferenciales para analizar los datos. RESULTADOS: Los resultados revelaron hipoacusia progresiva en ambos grupos, con empeoramiento de los umbrales en cada examen sucesivo. Sin embargo, la progresión de la hipoacusia fue menor en el grupo intervención, siendo más severo el grado de pérdida auditiva en el grupo control en el examen final de evaluación (36,78-71,74 dB), en comparación con el grupo intervención (33-44,39 dB). Además, la hipoacusia se mantuvo en frecuencias altas en el grupo intervención, mientras que en el grupo control experimentó una progresión, incluyendo las frecuencias bajas en el audiograma. Las intervenciones médicas más comunes utilizadas en el presente estudio fueron la reducción de la dosis de fármacos ototóxicos (61%), reduciéndose la dosis diaria a 800 mg en el 39% de los participantes, mientras que la administración del fármaco se redujo de una a tres veces por semana en el 22% de los participantes. CONCLUSIONES: Los resultados revelan mejor sensibilidad auditiva a lo largo del periodo de tratamiento en el grupo intervención, en comparación con el grupo control, lo cual sugiere que las estrategias médicas tempranas implementadas tuvieron un impacto preventivo significativo. Los hallazgos actuales son relevantes para los campos audiológico, médico y farmacéutico, particularmente en el contexto de Sudáfrica, donde las limitaciones de recursos son dignas de consideración en todas las medidas de tratamiento

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Aminoglicosídeos/efeitos adversos , Antituberculosos/efeitos adversos , Perda Auditiva/induzido quimicamente , Perda Auditiva/prevenção & controle , Intervenção Médica Precoce/métodos , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Resultado do Tratamento , Audiometria de Tons Puros , Limiar Auditivo , África do Sul
Rev. neurol. (Ed. impr.) ; 71(9): 326-334, 1 nov., 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-ET6-1302


OBJETIVO: Conocer el estado de la cadena asistencial del ictus vertebrobasilar en el área de referencia de nuestro centro hospitalario, evaluando los factores relacionados con la activación del código ictus y tiempos de actuación. PACIENTES Y MÉTODOS: Estudio observacional, analítico y retrospectivo, realizado durante el período 2017-2018, que incluye a pacientes ingresados con diagnóstico de ictus confirmado por neuroimagen. Se recogieron los datos de manera consecutiva durante su valoración en urgencias e ingreso en la unidad de ictus. Se evaluaron factores clínicos, síntomas y signos neurológicos en el momento del ingreso, detección de oclusión de gran vaso y variables relacionadas con la cadena asistencial: primera asistencia, activación de código ictus, tiempo inicio-puerta y tiempo puerta-imagen. RESULTADOS: Se incluyó a 954 pacientes, 233 con ictus vertebrobasilar. Los tiempos inicio-puerta y puerta-imagen registrados fueron significativamente mayores para el ictus de circulación posterior. Los factores relacionados con menor retraso en el tiempo inicio-puerta fueron: National Institute of Health Stroke Scale > 4, disartria y pérdida de fuerza. Se observó un menor retraso en el tiempo puerta-imagen para las variables: primera asistencia por servicio de emergencias médicas, disartria, pérdida de fuerza y presencia de más de un síntoma/signo. Fueron variables predictoras de activación del código ictus el antecedente de fumador, la clínica de disartria o pérdida de fuerza, y la presencia de más de una manifestación clínica. CONCLUSIONES: Existen dificultades en la fase prehospitalaria para identificar el ictus vertebrobasilar, lo cual origina retrasos en los tiempos de asistencia. La formación en conocimientos sobre la clínica de ictus vertebrobasilar podría permitir la optimización de esos tiempos

AIM: To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times. PATIENTS AND METHODS: Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time. RESULTS: Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation. CONCLUSIONS: In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimized

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência Vertebrobasilar/terapia , Acidente Vascular Cerebral/terapia , Intervenção Médica Precoce/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/etiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Fatores de Risco , Fatores de Tempo , Espanha/epidemiologia , Estudos Retrospectivos
Medicine (Baltimore) ; 99(43): e22716, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120767


BACKGROUND: Diabetic nephropathy (DN) is the one that of the most common complications of diabetes mellitus (DM). Diabetic patients will experience a high mortality rate when DN progress to end-stage. So, it is extremely important to early treat DN. Although several interventions have been used to treat DN, a conclusive finding has not already been achieved. As one of the most common Chinese medicines, danhong injection (DHI) which has been shown to have various functions has also been prescribed to be as the alternative treatment option. However, no systematic review and meta-analysis has been conducted to objectively and comprehensively investigate its effectiveness and safety. Thus, we designed the current systematic review and meta-analysis to answer whether DHI can be preferably used to timely treat DN. METHODS: We will perform a systematic search to capture any potentially eligible studies in several electronic databases including PubMed, Cochrane library, Embase, China National Knowledgement Infrastructure (CNKI), Wanfang database, and Chinese sci-tech periodical full-text database (VIP) from their inception to August 31, 2020. We will assign 2 independent reviewers to select eligible studies, and assess the quality of included studies with Cochrane risk of bias assessment tool. We will perform all statistical analyses using RevMan 5.3 software. ETHICS AND DISSEMINATION: We will submit our findings to be taken into consideration for publication in a peer-reviewed academic journal. Meanwhile, we will also communicate our findings in important conferences. PROTOCOL REGISTRY: The protocol of this systematic review and meta-analysis has been registered at the International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform (, registry number: INPLASY202090005) and this protocol was funded through a protocol registry.

Nefropatias Diabéticas/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Intervenção Médica Precoce , Humanos , Injeções
Arch. argent. pediatr ; 118(5): e449-e453, oct 2020.
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1122507


La medicina contemporánea se caracteriza por una creciente subespecialización, así como por la adquisición de un mayor conocimiento respecto de la interacción entre las distintas estructuras del organismo (biosemiótica) tanto en estado de salud como de enfermedad. Se propone, en este artículo, una nueva conceptualización del organismo basada en la perspectiva de considerarlo conformado por un espacio biológico (células, tejidos y órganos) y un espacio biosemiótico (intercambio de señales entre ellos). Su desarrollo daría lugar a una nueva subespecialidad dedicada al estudio e interferencia de la biosemiótica de la enfermedad (medicina biosemiótica), lo que propiciaría el desarrollo de una medicina de procesos, tendiente al diagnóstico y tratamiento temprano de las enfermedades

Contemporary medicine is characterized by an increasing subspecialization and the acquisition of a greater knowledge about the interaction among the different body structures (biosemiotics), both in health and disease. This article proposes a new conceptualization of the body based on considering it as a biological space (cells, tissues, and organs) and a biosemiotic space (exchange of signs among them). Its development would lead to a new subspecialty focused on the study and interference of disease biosemiotics (biosemiotic medicine), which would trigger a process-based medicine centered on early diagnosis and management of disease.

Humanos , Medicina , Diagnóstico Precoce , Intervenção Médica Precoce
Am J Cardiol ; 134: 24-31, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892989


Clinical trials have shown improved outcomes with an early invasive approach for non-ST-elevation myocardial infarction (NSTEMI). However, real-world data on clinical characteristics and outcomes based on time to revascularization are lacking. We aimed to analyze NSTEMI rates, revascularization timing, and mortality using the 2016 Nationwide Readmissions Database. We identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic angiography, with 34.1% (255,199) revascularized. Of revascularized patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission (32.9%; 65,155). This differs from CABG, which was most commonly performed on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate increased after day 1 for PCI patients and after day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed. Our study shows that patients undergoing early revascularization differ from those undergoing later revascularization. Mortality is generally high with delayed revascularization, as these are sicker patients. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients.

Ponte de Artéria Coronária/estatística & dados numéricos , Mortalidade Hospitalar , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Arritmias Cardíacas/epidemiologia , Transtornos da Coagulação Sanguínea/epidemiologia , Comorbidade , Angiografia Coronária , Diabetes Mellitus/epidemiologia , Intervenção Médica Precoce , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Revascularização Miocárdica/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Estados Unidos/epidemiologia
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32989084


BACKGROUND: Children who are deaf or hard of hearing (D/HH) have improved language outcomes when enrolled in early intervention (EI) before the age of 6 months. Little is understood about the long-term impact of EI on outcomes of kindergarten readiness (K-readiness). The study objective was to evaluate the impact of EI before the age of 6 months (early) versus after 6 months (later) on K-readiness in children who are D/HH. METHODS: In this study, we leveraged data from the Ohio Early Hearing Detection and Intervention Data Linkage Project, which linked records of 1746 infants identified with permanent hearing loss born from 2008 to 2014 across 3 Ohio state agencies; 417 had kindergarten records. The Kindergarten Readiness Assessment was used to identify children as ready for kindergarten; 385 had Kindergarten Readiness Assessment scores available. Multiple logistic regression was used to investigate the relationship between K-readiness and early EI entry while controlling for confounders (eg, hearing loss severity and disability status). RESULTS: Children who were D/HH and entered EI early (n = 222; 57.7% of the cohort) were more likely to demonstrate K-readiness compared with children who entered EI later (33.8% vs 20.9%; P = .005). Children who entered early had similar levels of K-readiness as all Ohio students (39.9%). After controlling for confounders, children who entered EI early were more likely to be ready for kindergarten compared with children who entered later (odds ratio: 2.02; 95% confidence interval 1.18-3.45). CONCLUSIONS: These findings support the sustained effects of early EI services on early educational outcomes among children who are D/HH. EI entry before the age of 6 months may establish healthy trajectories of early childhood development, reducing the risk for later academic struggles.

Correção de Deficiência Auditiva , Intervenção Médica Precoce/métodos , Transtornos da Audição , Desenvolvimento da Linguagem , Desempenho Acadêmico , Fatores Etários , Criança , Pré-Escolar , Surdez/reabilitação , Feminino , Humanos , Lactente , Masculino , Ohio
PLoS Med ; 17(9): e1003218, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32903257


BACKGROUND: A decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking. METHODS AND FINDINGS: We evaluated the impact of an active case finding (ACF) intervention for TB and testing for HIV in IDP communities and provided linkages to treatment in 3 states in Northeast Nigeria: Adamawa, Gombe, and Yobe. The ACF was a component of a multistakeholder collaboration between government, civil society, and IDP community partners, which also included mapping of IDP populations and health services, supporting existing health facilities, developing a sample transport network, and organizing community outreach to support ACF. Between July 1, 2017, and June 30, 2018, ACF was conducted in 26 IDP camps and 963 host communities in 12 local government areas (LGAs) with another 12 LGAs serving as a control population. Outreach efforts resulted in 283,556 screening encounters. We screened 13,316 children and 270,239 adults including 150,303 (55.6%) adult women and 119,936 (44.4%) men. We tested 17,134 people for TB and 58,976 for HIV. We detected 1,423 people with TB and 874 people living with HIV. We linked 1,419 people to anti-TB treatment and 874 people with HIV to antiretroviral treatment sites. We evaluated additional TB cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF on TB case notifications. Through our efforts, bacteriologically confirmed TB notifications increased by 847 (45.1%) during the intervention period, with IDPs accounting for 46% of these notifications. The ITS analyses detected significant positive postintervention trend differences in TB notification rates between the intervention and control areas in all forms TB (incidence rate ratio [IRR] = 1.136 [1.072, 1.204]; p ≤ 0.001) and bacteriologically positive TB (IRR = 1.141 [1.058, 1.229]; p = 0.001). The TB prevalence (502 cases per 100,000 screening encounters) was 10 times the national notification rates and 2.3 times the estimated national incidence. Rates of HIV infection (1.8%) were higher than HIV prevalence estimates in the 3 states. Our study was limited by the nonrandom selection of LGAs. Furthermore, we did not use sensitive screening tools like chest X-ray and likely missed people with TB. CONCLUSIONS: In this study, we observed a burden of TB in IDP populations of Northeast Nigeria many times higher than national rates and HIV rates higher than state level estimates. The impact of the intervention showed that ACF can greatly increase TB case notifications. Engaging IDP communities, local governments, and civil society organizations is essential to ensuring the success of interventions targeting TB and HIV, and such approaches can provide sustained solutions to these and other health crises among vulnerable populations.

Intervenção Médica Precoce/métodos , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Criança , Relações Comunidade-Instituição , Feminino , Instalações de Saúde , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Refugiados , Adulto Jovem
Rev. logop. foniatr. audiol. (Ed. impr.) ; 40(3): 101-109, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194978


BACKGROUND AND OBJECTIVE: Parent participation in the child assessment process works to improve parent-child interaction while building a sense of competence, self-efficacy and empowerment in the parents. The goal of this article is to underline the importance of the full participation of parents in the assessment process, using an assessment method that facilitates their participation in the assessment of their child. MATERIALS AND METHODS: We describe a three-step analysis of a video taken of the parent interacting with the child: (1) to chart what is observed in the video, such as the facial expressions of both parent and child; (2), to reflect on the parent-child interaction seen in the video; and (3) to intervene by creating an intervention tool based on the combined information gathered in the first two steps. RESULTS AND CONCLUSIONS: Video supported assessment creates opportunities for the full participation of parents and improves the relationship between families and professionals, increasing wellbeing in families and transforming times of assessment into a positive experience

ANTECEDENTES Y OBJETIVO: La participación de los padres en el proceso de evaluación del niño contribuye a mejorar la interacción entre padres e hijos, mientras que crea un sentido de competencia, autoeficacia y empoderamiento en los padres. El objetivo de este artículo es subrayar la importancia de la participación plena de los padres en el proceso de evaluación. Para ello, es importante utilizar una metodología de evaluación que facilite su participación en la evaluación de su hijo. MATERIALES Y MÉTODOS: Describimos una metodología de análisis de vídeo en 3 pasos para grabaciones de padres que interactúan con el niño. Esta metodología permite, en un trabajo conjunto con los padres: (1) delimitar lo que se observa en el video, como las expresiones faciales de ambos padres e hijos; (2) reflexionar sobre la interacción padre-hijo vista en el video, y (3) intervenir a partir del conjunto de información reunida en los primeros 2 pasos. RESULTADOS Y CONCLUSIONES: La evaluación respaldada por video crea oportunidades para la plena participación de los padres y mejora la relación entre las familias y los profesionales, aumentando el bienestar de las familias y transformando los momentos de evaluación en una experiencia positiva

Humanos , Criança , Deficiências da Aprendizagem/reabilitação , Intervenção Médica Precoce , Cuidadores , Relações Pais-Filho , Gravação em Vídeo , Índice de Gravidade de Doença
Rev. logop. foniatr. audiol. (Ed. impr.) ; 40(3): 118-127, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194980


El logopeda, en su condición de profesional experto en comunicación y lenguaje, es un miembro clave e indispensable en los equipos de Atención Temprana. Las prácticas recomendadas en los países con larga tradición en servicios de intervención a la primera infancia destacan la importancia del logopeda en el acompañamiento y la capacitación de la familia, además del apoyo que este profesional brinda a los otros miembros del equipo. Los profesionales que intervienen en Atención Temprana se enfrentan día a día al reto de establecer relaciones de colaboración con padres y cuidadores, situaciones para las que en muchas ocasiones no están preparados. Este trabajo describe las estrategias necesarias, con las que el logopeda puede dar un apoyo efectivo durante ese acompañamiento, describe de forma general las actuaciones claves, con el fin de lograr la capacitación del cuidador principal, y presenta los principios andragógicos en que debemos basarnos, con el fin de lograr una mayor eficacia de actuación. En la última sección presentamos algunos supuestos prácticos, con el fin de visualizar aquellas situaciones habituales, en las que el profesional puede encontrarse en sus consultas colaborativas con la familia, y se plantean las posibles soluciones y acciones a emprender

The speech therapist, as a professional expert in communication and language, is a key and indispensable member of Early Intervention teams. Recommended practice in countries with a long tradition in early childhood intervention services, highlights the importance of the speech therapist in the accompaniment and capacity-building of the family, in addition to their support to other team members. The professionals involved in Early Intervention, face the challenge of establishing collaborative relationships with parents and caregivers, situations for which they are often not prepared. This paper describes the strategies required for the speech therapist to provide effective support during this accompaniment. It describes in a general way key actions in training the main caregiver, and presents the andragogical principles we must use to achieve greater performance efficiency. In the last section we present some practical assumptions, in order to visualise the routine situations faced by the professional in their collaborative consultations with the family, and consider possible solutions and actions to be undertaken

Humanos , Criança , Adulto , Intervenção Médica Precoce , Família , 34600 , Educação em Saúde , Comunicação para Apreensão de Informação , Relações Profissional-Família
Rev. logop. foniatr. audiol. (Ed. impr.) ; 40(3): 128-137, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194981


OBJETIVO: Determinar algunas de las variables predictoras de empoderamiento familiar en los servicios de atención temprana que implementan prácticas centradas en la familia. MÉTODO: Se plantea en una muestra de 431 familias que reciben servicios de atención temprana en España, un análisis de regresión lineal múltiple, para definir la relación entre las siguientes variables: tipo de prácticas en atención temprana, nivel de apoyos, estatus socioeconómico y diagnóstico de su hijo/a, como predictoras de empoderamiento familiar. RESULTADOS: Los resultados evidencian diferencias significativas entre el empoderamiento de las familias y los apoyos con los que cuentan, también se observan niveles de empoderamiento diferentes en relación al diagnóstico del hijo o la hija con trastornos del neurodesarrollo. CONCLUSIONES: A partir de los resultados, se sugiere reflexionar sobre las prácticas de atención temprana de profesionales en general y logopedas en particular, para potenciar el impacto sobre el empoderamiento de las familias, mejorando la fidelidad en la implementación de prácticas centradas en la familia, y favoreciendo la movilización de recursos y apoyos por parte de la familia, en ese mismo proceso de intervención

OBJECTIVE: To determine some of the predictive variables of family empowerment in early intervention services that implement family-centred practices. METHOD: A multiple linear regression analysis is proposed in a sample of 431 families receiving early care services in Spain, to define the relationship between the following variables: type of early intervention practices, supports, socioeconomic status and diagnosis of their child as predictors of family empowerment. RESULTS: The results show significant differences between the empowerment of the families and the supports they have, and different levels of empowerment are observed in relation to the diagnosis of the son or daughter with neurodevelopmental disorders. CONCLUSIONS: Based on the results, we suggest reflecting on professionals early intervention practices and those of speech therapists in particular, to enhance the impact on empowering families, improving fidelity in the implementation of family-centred practices, and favouring the mobilisation of resources and supports by the family, in that same intervention process

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Empoderamento para a Saúde , Intervenção Médica Precoce , Família , Relações Profissional-Família , Deficiências do Desenvolvimento/reabilitação , Transtornos do Desenvolvimento da Linguagem/reabilitação , Fatores Socioeconômicos , Estudos Transversais