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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(7): 510-514, 2019 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-31365967

RESUMO

Objective: To investigate the clinical and epidemiological characteristics of influenza A (H3N2) infected patients in Jinhua area, and therefore to improve the understanding of infection with H3N2 influenza virus. Methods: The pharynx swab specimens for pathogenic detection were collected from acute respiratory infection (ARI) cases in the fever clinic of the sentinel hospital in Jinhua area from 2014 to 2017. Descriptive statistics method was used to analyze the clinical features and pathogenics characteristics of the patients infected with H3N2 influenza virus. The t test or χ(2) test of independent samples were used for comparison between groups. Results: A total of 3 803 cases of acute respiratory infection (ARI) were reported in the sentinel hospital in Jinhua area from 2014 to 2017. Among them, 245 cases (6.4%) of H3N2 influenza were diagnosed, including 153 males (62.4%) and 92 females (37.6%), aged from 0.5 to 95 years, with an average age of (50.1+15.7) years. They were divided into 5 age groups, with 107 (43.7%) patients aged 60 years and older. The incidence of major diseases was 43.7%. There was no significant difference in the gender in different age groups (χ(2)=4.581, P=0.333). The seasonal peak of H3N2 influenza A virus infection was mainly in summer (In June-September), but was also seen in other months. In the 4 years from 2014 to 2017, there were a total of 4 peaks, which occurred in July-September, July-August, June-August, and June-August. The body temperature of most patients (73.1%) was between 38.0 and 38.9 ℃. The main positive signs of H3N2 influenza A virus infection were different degrees of pharyngeal hyperemia and tonsillar enlargement. Fever (>38 ℃), cough, dizziness, fatigue, sore throat, headache, chills, shortness of breath, runny nose, myalgia, expectoration, nasal congestion were the main symptoms of H3N2 cases. The proportion of abnormal X-ray/CT manifestations in H3N2 influenza A virus infection cases was lower than that of other influenza viruses. 89.8% of the patients were positive for H3N2 influenza A. The average lymphocyte count was (1.1±0.5) × 10(9)/L, total platelet count (157±39) × 10(9)/L in H3N2 influenza A infection group, which were lower than those in other influenza positive patients [(1.2±0.6)×10(9)/L and (165±42) × 10(9)/L], while the neutrophil count (3.6±0.8) × 10(9)/L was higher than that in other influenza positive patients (3.4±1.0) × 10(9)/L(all P<0.05). Conclusions: Patients with H3N2 influenza A in Jinhua mostly presented with throat congestion and tonsillar enlargement in varying degrees, fever (>38 ℃), cough and sputum production. The seasonal peak of influenza A was in summer (June-September). Elderly aged 60 years or older were the susceptible group.


Assuntos
Vírus da Influenza A Subtipo H3N2 , Influenza Humana/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Lactente , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/diagnóstico , Estações do Ano , Adulto Jovem
2.
Zhonghua Nei Ke Za Zhi ; 58(8): 560-565, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365976

RESUMO

Objectives: To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza. Methods: This was a randomized, double-blind, double-dummy, placebo and positive control, multicenter clinical trial, comparing peramivir trihydrate with oseltamivir and placebo. The inclusive criteria were 15-70 years old, onset within 48 h, positive rapid influenza antigen test, and febrile (>38℃) accompanied with at least two associated symptoms. The severe cases complicated with chronic pulmonary and cardiac diseases, malignancies, organ transplantation, hemodialysis, uncontrolled diabetes, immunocompromised status, pregnancy and coexistence of bacterium infections were excluded. All patients were randomized 2∶2∶1 to receive peramivir, oseltamivir and placebo respectively. The primary endpoint was the disease duration, the secondary endpoints included time to normal axillary temperature and normal living activities, viral response, and adverse effects. Results: Following informed consent, 133 patients were included in this study. Four patients were exclude due to missing medical records, not fitting inclusion or exclusion criteria and poor compliance. A total of 129 patients were finally analyzed, including 49 cases, 54 cases and 26 cases in peramivir group, oseltamivir group and placebo group. The median disease duration were 96 (76, 120) hours, 105 (90,124) hours, and 124 (104, 172) hours in three groups respectively (P>0.05) . The time to normal axillary temperature, normal living activities and viral response were not significantly different in three groups (P>0.05) . Conclusion: The value of antiviral therapy in patients with mild influenza needs to be further determined.


Assuntos
Antivirais/uso terapêutico , Ciclopentanos/uso terapêutico , Guanidinas/uso terapêutico , Influenza Humana/tratamento farmacológico , Oseltamivir/uso terapêutico , Adolescente , Adulto , Idoso , Método Duplo-Cego , Humanos , Influenza Humana/diagnóstico , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
3.
Zhonghua Nei Ke Za Zhi ; 58(8): 577-583, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365979

RESUMO

Objective: To evaluate life quality of Graves orbitopathy (GO) patients using Graves orbitopathy quality-of-life questionnaire (GO-QOL) and explore the influence factors of the quality of life of GO patients. Methods: This was a cross-sectional study conducted at The Third Affiliated Hospital of Southern Medical University including 145 newly diagnosed GO patients. All the patient answered the GO-QOL and underwent ophthalmic and endocrine assessments. The main outcome measures were the scores on GO-QOL 2 subscales: visual functioning and appearance. Based on the classification in the guideline of European Group on Graves Orbitopathy (EUGOGO), the patients were divided into two groups: mild and moderate to severe groups. Then the scales between these two groups were compared and influencing factors were analyzed. Finally, the floor and ceiling effects were assessed. Results: The GO-QOL scores for the subscales of visual functioning and appearance were 70.91±27.83 and 61.29±26.37 respectively in 145 GO patients. Visual functioning and appearance were lower in moderate to severe group (62.71±28.77 and 57.52±26.49, respectively) than in mild group (85.58±18.77 and 68.02±24.99, respectively).The GO-QOL scores for the visual functioning subscale were significantly correlated with age (P=0.002), clinical active score (P=0.011) and the degree of diplopia (P=0.00, R(2)=0.373). The GO-QOL scores for the appearance were significantly correlated with sex (P=0.05) and thyroid-stimulating hormone levels (P=0.001, R(2)=0.231). No significant ceiling or floor effects were observed for either subscale of the GO-QOL. Conclusions: With the aggravation of the disease, the quality of life of GO patients is getting worse and worse. The main influencing factors of the quality of life of GO patients include age, gender, diplopia, clinical active score and thyroid-stimulating hormone levels. Close attention needs to be paid to the quality of life of GO patients.


Assuntos
Oftalmopatia de Graves/psicologia , Qualidade de Vida/psicologia , Adulto , Fatores Etários , China , Estudos Transversais , Diplopia , Feminino , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Aparência Física , Índice de Gravidade de Doença , Inquéritos e Questionários , Tireotropina/sangue
4.
Zhen Ci Yan Jiu ; 44(7): 512-5, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31368283

RESUMO

OBJECTIVE: To investigate the therapeutic effect of blade needle therapy for cervicogenic dizziness (CD) and changes of blood flow of vertebral artery in patients with CD. METHODS: A total of 60 patients with CD were equally randomized into medication (16 women and 14 men, 38.9±10.9 years in age) group and blade needle group (17 women and 13 men, 40.1±12.4 years in age). Patients of the blade needle group were treated by performing blade needle stimulation (longitudinal cutting along the musculoaponeurotic layer) to the tender points (attachment points) of the bilateral superior and inferior oblique muscles of the head, major and minor posterior cephalic rectus, about 2/3 of suboccipital nuchal line, and near the cervical processes of C1-C2 segments. The treatment was conducted once every 3 days for 15 days. Patients of the medication group were ordered to take Flunarizine Hydrochloride capsules (10 mg) once every night for 15 days. Transcranial Doppler was used to measure changes of mean blood flow velocities of the left vertebral artery (LVA), right vertebral artery (RVA), and basilar artery (BA) before and after the treatment. The therapeutic effect was assessed according to the Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes or Illnesses of Traditional Chinese Medicine (1994) and the Assessment Scale for Symptoms and Function of Cervicogenic Dizziness (2017). RESULTS: Following the treatment, of the two 30 cases in the medication and blade needle groups, 5 (16.7%) and 7 (23.3%) were cured, 16 (53.3%) and 20 (66.7%) were improved in their symptoms, 9 (30.0%) and 3 (10.0%) failed, with the effective rate being 70.0% and 90.0%, respectively. The effective rate of the blade needle was significantly superior to that of the medication (P<0.05). The scores of vertigo, neck-should pain, daily living and work, psychology, social adaptation, and total score of the assessment scale, as well as the average blood flow velocities of LVA, RVA and BA were considerably increased in both groups in comparison with their own pre-treatment (P<0.05), and obviously higher in the blade needle group than in the medication group (P<0.05). CONCLUSION: Blade needle treatment has a good clinical effect in the treatment of CD patients, which is probably associated with its function in increasing blood perfusion of the brain tissue, and thus being worthy of clinical application.


Assuntos
Artéria Basilar , Tontura , Pontos de Acupuntura , Adulto , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Vertebral , Vertigem
5.
High Blood Press Cardiovasc Prev ; 26(4): 339-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385256

RESUMO

INTRODUCTION: Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. AIM: To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. METHODS: In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. RESULTS: The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). CONCLUSIONS: Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.


Assuntos
Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/instrumentação , Serviços Comunitários de Farmácia , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
6.
Clin Nurse Spec ; 33(5): 217-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404000

RESUMO

PURPOSE: This study aimed to determine the core competencies of Chinese gerontological nurse specialists and test the psychometric properties of a core competency self-evaluation instrument. METHODS: This study consisted of 2 stages. A literature review, theoretical analysis, and the Delphi methods involving 28 experts were performed to identify the core competencies required of gerontological nurse specialists in China. Then, a self-evaluation instrument developed based on the results of stage I was tested among 225 certified gerontological nurse specialists. An exploratory factor analysis was applied to test the construct validity, and the content validity and reliability were also evaluated. RESULTS: The core competencies of gerontological nurse specialists comprised 3 first-level domains, 9 second-level dimensions, and 69 third-level items. The average scale-level content validity, overall instrument's Cronbach's α, and test-retest reliability were 0.963, 0.983, and 0.834, respectively. The results of the exploratory factor analysis indicated that the factors in the 3 first-level domains (attitude, skill, and knowledge) explained 68.579%, 69.599%, and 75.872% of the variance, respectively. CONCLUSION: The results showed that the core competencies of Chinese gerontological nurse specialists were reliable and that gerontological nurse specialists could use this self-evaluation instrument to assess their core competencies.


Assuntos
Competência Clínica , Enfermagem Geriátrica , Enfermeiras Clínicas/psicologia , Inquéritos e Questionários , Adulto , China , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Clínicas/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem , Psicometria , Reprodutibilidade dos Testes , Autoeficácia
7.
J Nurs Adm ; 49(9): 404-410, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31425307

RESUMO

OBJECTIVE: To examine and report burnout, secondary trauma, and compassion satisfaction in acute care nurse leaders through a large mixed-methods research study. BACKGROUND: Although nurse leaders are removed from daily patient care activities, the pervasive challenges in the work environment create conditions for professional burnout. Nurse leaders must garner compassion satisfaction from different sources, including peer and staff interactions. METHODS: The Professional Quality of Life scale was given to nurse leaders at 29 hospitals in 1 health system. Sixteen leaders from 2 hospitals participated in qualitative interviews. RESULTS: Six hundred seventy-two nurse leaders from 29 hospitals reported similar levels of burnout across frontline, midlevel, and director-level leadership. Directors demonstrated higher levels of compassion satisfaction and lower levels of work-life balance. Four themes emerged representing areas of professional life that potentiate and alleviate compassion fatigue. CONCLUSIONS: All levels of nurse leaders must address the risk of burnout and can do so through individual and organizational resiliency strategies.


Assuntos
Esgotamento Profissional/psicologia , Esgotamento Psicológico , Satisfação no Emprego , Enfermeiras Administradoras/psicologia , Satisfação Pessoal , Equilíbrio Trabalho-Vida , Local de Trabalho/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
J Nurs Adm ; 49(9): 423-429, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436740

RESUMO

The development of a program to integrate an organization's values and culture, Watson's Caring Theory, and personal motivators resulted in transforming nursing theory into practice and a noted improvement in the patient experience. This article will teach the reader how this was accomplished.


Assuntos
Emoções , Relações Enfermeiro-Paciente , Cuidados de Enfermagem/organização & administração , Cuidados de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Cultura Organizacional , Relações Profissional-Família , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Enfermagem
9.
J Nurs Adm ; 49(9): 436-440, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436742

RESUMO

OBJECTIVE: The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs. BACKGROUND: Onboarding must be streamlined and organized for TRNs to provide safe patient care. METHODS: Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page. RESULTS: The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work. CONCLUSION: Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.


Assuntos
Capacitação em Serviço/organização & administração , Recursos Humanos de Enfermagem no Hospital/normas , Segurança do Paciente/normas , Seleção de Pessoal/normas , Admissão e Escalonamento de Pessoal/normas , Enfermagem de Viagem/estatística & dados numéricos , Enfermagem de Viagem/normas , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Capacitação em Serviço/tendências , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/tendências , Segurança do Paciente/estatística & dados numéricos , Seleção de Pessoal/tendências , Admissão e Escalonamento de Pessoal/tendências , Enfermagem de Viagem/tendências , Estados Unidos
10.
J Nurs Adm ; 49(9): 441-446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436743

RESUMO

OBJECTIVE: This study uses Leader-Member Exchange theory to explore the associations between contact frequency (CF) of nurse leaders and their team members, leader-member relationship, and patient safety culture. BACKGROUND: Leader-member relationships are an important part of patient safety culture development. The behaviors of leaders to achieve these relationships are unknown. This study explores CF as a leader behavior to improve patient safety culture. METHODS: Cross-sectional survey of bedside nurses (N = 746) from an 8-hospital system. RESULTS: A significant association was found between relationship strength and patient safety culture; CF's effect on relationship and patient safety culture was demonstrated. CONCLUSION: Contact frequency may support relationships between leaders and members and improve patient safety culture on nursing units. Future studies should explore factors that could be enhancing and limiting CF.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Segurança do Paciente/normas , Gestão da Segurança/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Adulto Jovem
11.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438884

RESUMO

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Assuntos
Glaucoma/terapia , Pressão Intraocular/fisiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Acuidade Visual , Campos Visuais/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Prospectivos , Qualidade de Vida , Queensland/epidemiologia , Inquéritos e Questionários , Adulto Jovem
12.
BMC Ophthalmol ; 19(1): 191, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438893

RESUMO

BACKGROUND: To investigate the efficacy and safety of repeated phototherapeutic keratectomies (PTKs) during long-term treatment for corneal dystrophy (CD) in a Chinese pedigree carrying the R124L mutation in TGFBI. METHODS: This was a retrospective review of 20-year medical and genetic records involving five CD patients (10 eyes) from one pedigree. During this period, PTK was conducted for an eye when best-corrected distance visual acuity (BCDVA) reached > 1.0 (LogMAR), due to either primary or recurrent opacities in the cornea. All PTKs were performed by 193-nm excimer laser with or without creation of epithelial flaps. For each eye, routine measurements were conducted for the number of PTKs during follow-up, mean time to recurrence, and BCDVA pre- and post- every PTK (measurements within 3 months from each PTK). Corneal thicknesses measured after the last PTK and at the last visit were analyzed, and subjective satisfaction was assessed. RESULTS: Gene testing revealed an R124L mutation in TGFBI. During 19.60 ± 1.78 years of follow-up, PTKs were conducted twice for three eyes, three times for six eyes, and four times for one eye. After each PTK, effective visual acuity was maintained for 3.60 ± 1.12 years before significant recurrence. BCDVA improved significantly postoperatively than preoperatively for the first PTK for each eye (p < 0.001), as well as the second (p < 0.001) and third one (p < 0.001). After the last PTK and at the final visit, the thinnest corneal thickness was 371.50 ± 56.47 µm and 358.40 ± 101.11 µm, respectively. The average subjective satisfaction score was 8.60 ± 0.89. CONCLUSIONS: Multiple repeated PTKs were effective and safe in a long-term study of CD patients with an R124L mutation in TGFBI.


Assuntos
Córnea/cirurgia , Distrofias Hereditárias da Córnea/cirurgia , Proteínas da Matriz Extracelular/genética , Previsões , Lasers de Excimer/uso terapêutico , Mutação , Ceratectomia Fotorrefrativa/métodos , Fator de Crescimento Transformador beta/genética , Adulto , Idoso , China/epidemiologia , Córnea/patologia , Distrofias Hereditárias da Córnea/epidemiologia , Distrofias Hereditárias da Córnea/genética , DNA/genética , Análise Mutacional de DNA , Proteínas da Matriz Extracelular/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Estudos Retrospectivos , Fator de Crescimento Transformador beta/metabolismo , Resultado do Tratamento , Acuidade Visual
13.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
14.
Wiad Lek ; 72(7): 1243-1246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398149

RESUMO

OBJECTIVE: Introduction: Inappropriate shocks in patients with an implantable cardioverter-defibrillator (ICD) are associated with significant psychological and physical consequences and increased long-term mortality. The aim: To assess predictors associated with inappropriate high-energy discharges of implantable cardioverter-defibrillators. PATIENTS AND METHODS: Material and Methods: Retrospective data analysis of 150 patients aged 64.2±12.8 years (84.7% male) admitted to the Hospital Emergency Department due to at least one cardioverter-defibrillator discharge was performed. All of the discharges were inappropriate in the group of 33 patients, and in the group of 117 patients at least one discharge was appropriate. The following data: age, gender, concomitant diseases, type of ICD implantation (primary vs. secondary prevention), type of discharge, number of discharges, serum potassium, and sodium concentration were collected. RESULTS: Results: Patients with only inappropriate discharges were younger, significantly more often had chronic atrial fibrillation, a significantly higher number of discharges, and ischaemic cardiomyopathy. Logistic regression analysis revealed that the occurrence of only inappropriate discharges was related to the number of discharges over three, the age of patients below 60 years, the serum sodium concentration between 135 mEq/L and 142 mEq/L, and the primary type of prevention of sudden cardiac death. CONCLUSION: Conclusions: 1. Predictors of inappropriate discharges include: age, serum sodium concentration, and primary type of indications for cardioverter-defibrillator implantation. 2. Further research is necessary to determine the influence of disturbances in the sodium economy on the occurrence of appropriate and inappropriate interventions of implantable cardioverter-defibrillators.


Assuntos
Fibrilação Atrial , Desfibriladores Implantáveis , Idoso , Morte Súbita Cardíaca , Cardioversão Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Wiad Lek ; 72(7): 1247-1252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398150

RESUMO

OBJECTIVE: Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world's population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis. PATIENTS AND METHODS: Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days. RESULTS: Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier. CONCLUSION: Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.


Assuntos
Icterícia Obstrutiva , Idoso , Bile , Ductos Biliares , Descompressão Cirúrgica , Drenagem , Humanos , Pessoa de Meia-Idade
16.
Wiad Lek ; 72(7): 1258-1264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398152

RESUMO

OBJECTIVE: Introduction: In case of hidden carious cavities development on the approximal teeth surfaces, the clinical diagnostics of this process is difficult. Then, the diagnostics of carious lesion is not possible without carrying out X-ray examination. The aim of the study was a comparative analysis of the effectiveness of clinical and X-ray diagnostics for hidden caries of approximal teeth surfaces. PATIENTS AND METHODS: Materials and methods: Condition of 2 963 teeth of 115 people aged from 19 to 55 was analysed. Additionally, a digital panoramic 2D diagnostics (Planmeca ProSensor, Finland) and Cone Beam Computed Tomography 3D Diagnostics (Morita, Japan) were used for clinical examination of patients. RESULTS: Results: In both variants of diagnostics, the number of caries defects in the upper jaw was higher than in the lower one, and the frequency of caries lesion of various teeth groups had the following sequence in descending order: molar teeth, premolar teeth, incisor teeth and canine teeth. Hidden carious cavities of average depth and deep were detected with almost the same frequency in both variants of the study, which by 1.9 - 2.0 times respectively exceeded the frequency of superficial carious cavities detection (p = 0.0001). According to the results of clinical studies, hidden superficial carious cavities occurred in single cases and X-ray examination improved their diagnostics by 9.6 times (p = 0.0000). CONCLUSION: Conclusions: X-ray examination allows increasing the effectiveness of diagnostics of hidden carious cavities of approximal localization by 1.2 times on the whole (p <0,05). In such cases orthopantomography (OPG) has reasonably sufficient diagnostic capabilities. Definitely, 3D Cone Beam Computed Tomography (CBCT) has much more diagnostic capabilities, but its use can not be justified for the diagnostics of caries only.


Assuntos
Cárie Dentária , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Dente Canino , Humanos , Pessoa de Meia-Idade , Raios X , Adulto Jovem
17.
Wiad Lek ; 72(7): 1269-1273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398154

RESUMO

OBJECTIVE: Introduction: Vascular endothelium function interruption has the main role among mechanisms of development and progression of chronic kidney disease. In numerous experimental and clinical studies, it was proved that activated vascular endothelium is a structural and functional unit that matches processes of inflammation with intravascular coagulation, fibrinolysis and haemorheological disorders. The aim: To identify special features of endothelium morphological structure in kidney vessels, coronary arteries and aorta during chronic kidney disease. PATIENTS AND METHODS: Materials and methods: Based on autopsy materials, we conducted a morphological study of patients (n = 20) aged 45 to 55 years who were observed in cardiac and neurological hospitals for 5-7 years. We removed kidney, heart and aorta samples from patients. For the study, a histological and immunohistochemical methods were used. RESULTS: Results and conclusions: Morphological study of vessels endothelium of kidneys, heart and aorta demonstrated that in the majority of observations intima underwentprofound pathological changes, manifested by different degrees of disorganization of endothelial lining and violations of structural and functional organization of the endotheliocytes, subendothelial layer, basal membrane. These pathological processes in all cases had similar features with the development of immune inflammation. Inflammatory infiltration was represented by macrophages, mast cells, plasma cells. Biological mediators of the presented cells can aggravate the damage to endothelial cells. Indirect signs of low ability to restore the structure of the vessel wall and endothelial lining may be a weak expression of the VEGF and bcl-2 vascular endothelial growth factor.


Assuntos
Vasos Coronários , Insuficiência Renal Crônica , Aorta , Células Endoteliais , Endotélio Vascular , Humanos , Pessoa de Meia-Idade , Fator A de Crescimento do Endotélio Vascular
18.
Wiad Lek ; 72(7): 1288-1294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398157

RESUMO

OBJECTIVE: Introduction: General anaesthesia is carried out using anaesthetic agents that among others depress the circulatory system and CNS. Central and peripheral thermoregulation occurs, which is due to mild hypothermia as well as changes in skin moisture. An important element of therapy in the perioperative period is adequate intravenous fluid therapy, which affects the final effects of treatment. The aim: Evaluation of skin moisture as a result of changes in central and peripheral thermoregulation during general anaesthesia and evaluation of the hydration status of patients. PATIENTS AND METHODS: Material and methods: The study included 180 patients undergoing general anaesthesia for elective surgery, aged 20-85 years of age. Before general anaesthesia, patients were evaluated for ASA-related risk of anaesthesia (ASA 1 - healthy patients, ASA 2 and 3 - patients with neurological and circulatory disorders). Patients were divided into 2 groups, the study group (90 people) were patients who were given no intravenous fluids before the surgery and the control group (90 patients) were those receiving doses of 500 ml crystalline intravenously one hour before anaesthesia. The research was carried out at the Operational Block of the Provincial Hospital in Tarnobrzeg, from November 2013 to November 2014. Skin moisture was measured using a CM 825 Corneometer: before general anaesthesia, after induction for anaesthesia, 15 min after surgical incision of the skin and after awakening the patient. RESULTS: Results: Both in the test and control groups, statistically significant differences were found in subsequent skin moisture measurements. Pairwise comparisons indicate statistically significant differences between each pair of measurements. In both groups of patients, there is a clear decrease in skin moisture after induction of anaesthesia compared to the measurement performed before general anaesthesia. The skin moisture values are reduced in subsequent measurements, however the difference is much lower. CONCLUSION: Conclusions: 1 Measurement of skin moisture can be used as one of the parameters to assess perioperative stress and changes in body temperature during general anaesthesia, which indirectly determines the functioning of the hypothalamus. 2 By measuring the skin moisture it is possible to indirectly assess the hydration status of patients as well as the decrease of the metabolism during general anaesthesia. 3 The decrease in skin moisture during general anaesthesia is the effect of changes in central and peripheral thermoregulation.


Assuntos
Anestesiologia , Doenças do Sistema Nervoso , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Humanos , Pessoa de Meia-Idade , Adulto Jovem
19.
Wiad Lek ; 72(7): 1295-1299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398158

RESUMO

OBJECTIVE: Introduction: Multiple data available indicate high prevalence of comorbid abnormalities in gouty arthritis patients, namely, high incidence of arterial hypertension, coronary artery disease, stroke, atherosclerosis of carotid arteries, vascular dementia. For instance, hypertension is found in 36-41% gout patients, and combined with metabolic syndrome it may reach 80%. The aim: Studying features of clinical course, lipid profile and immune status in patients with combined hypertension and gout. PATIENTS AND METHODS: Materials and methods: The study involved examination of 137 male patients with stage II hypertension, average age 56.9±3.4. All patients underwent echocardiography with estimation of the left ventricular mass index to verify hypertension stage, blood chemistry test with estimation of uric acid level, as well as lipid profile and immune status. RESULTS: Results: We have found significant disorders in the lipid profile of blood serum in patients with combined hypertension and gout. Positively higher percentage of activated T-cells was found in patients with combined hypertension and gout, both with early (CD3+CD25+) and late (CD3+HLA-DR+) activation marker, as well as those expressing FAS receptor, and ready to enter into apoptosis. CONCLUSION: Conclusion: We have identified abnormalities in adhesion and cooperation of immune competent cells, resulting in more intense activation of the same, effector functions and migration to the area of inflammation in the vessel wall.


Assuntos
Artrite Gotosa , Gota , Hipertensão , Humanos , Sistema Imunitário , Masculino , Pessoa de Meia-Idade , Ácido Úrico
20.
Wiad Lek ; 72(7): 1413-1414, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31398178

RESUMO

Laryngeal schwannoma is a rare benign tumour of the larynx. Schwannomas derive from the Schwann cells. Magnetic resonance imaging (MRI) is the best imaging tool for suggesting the diagnosis. We report case of laryngeal schwannoma. The case was a 61-year-old man with a 1-year history of dysphonia and stridor. Laryngoscopy revealed a submucosal mass of the glottic area. A computed tomography scan of the larynx showed an 26(CC) x 18 (TR) x 24 (AP)mm expansile mass in the glottic area. Histopathological examination diagnosed a schwannoma of the larynx. External surgeries were successfully performed. Diagnosis and specific treatment are discussed.


Assuntos
Neoplasias Laríngeas , Laringe , Neurilemoma , Humanos , Laringoscopia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
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