RESUMO
Objetivo: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. Método: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. Conclusión: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.
Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.
Objetivo: investigar os fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana. Método: estudo transversal, incluindo 122 pacientes com coronariopatias (60,7% do sexo masculino; 62,07±8,8 anos); letramento em saúde e conhecimento específico da doença foram avaliados por meio de entrevista com os participantes, pelo Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Os dados foram descritos por medidas de tendência central e frequências. Fatores que influenciam o letramento em saúde foram determinados por modelo de regressão linear. O nível de significância adotado foi de 5%. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: idade e hipertensão apresentaram uma relação inversa e significativa com letramento em saúde. Por outro lado, maior escolaridade e estar empregado associaram-se com maiores pontuações no instrumento de letramento em saúde. O conhecimento específico da doença não influenciou o letramento em saúde. As variáveis do modelo de regressão explicaram 55,3% do letramento inadequado. Conclusão: no presente estudo o conhecimento sobre a doença não influência o letramento em saúde, mas os profissionais devem considerar os fatores sociodemográficos e clínicos para planejar as intervenções.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Autocuidado , Doença da Artéria Coronariana/terapia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Letramento em Saúde , Fatores SociodemográficosRESUMO
OBJECTIVE: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. METHODS: a cross sectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. RESULTS: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. CONCLUSION: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.
OBJETIVO: investigar os fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana. MÉTODO: estudo transversal, incluindo 122 pacientes com coronariopatias (60,7% do sexo masculino; 62,07±8,8 anos); letramento em saúde e conhecimento específico da doença foram avaliados por meio de entrevista com os participantes, pelo Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Os dados foram descritos por medidas de tendência central e frequências. Fatores que influenciam o letramento em saúde foram determinados por modelo de regressão linear. O nível de significância adotado foi de 5%. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. RESULTADOS: idade e hipertensão apresentaram uma relação inversa e significativa com letramento em saúde. Por outro lado, maior escolaridade e estar empregado associaram-se com maiores pontuações no instrumento de letramento em saúde. O conhecimento específico da doença não influenciou o letramento em saúde. As variáveis do modelo de regressão explicaram 55,3% do letramento inadequado. CONCLUSÃO: no presente estudo o conhecimento sobre a doença não influência o letramento em saúde, mas os profissionais devem considerar os fatores sociodemográficos e clínicos para planejar as intervenções.
OBJETIVO: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. MÉTODO: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. RESULTADOS: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. CONCLUSIÓN: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Doença da Artéria Coronariana , Letramento em Saúde , Fatores Sociodemográficos , Hipertensão , Cuidados de EnfermagemRESUMO
El sentimiento de autoeficacia docente (SAD) es un constructo de compleja medida pero relevante por su relación con la calidad de la educación. Con este trabajo se pretende acumular evidencias de consistencia y validez para su uso en España de una versión del Teachers Sense of Efficacy Scale (TSES). Los datos proceden de un colectivo español de futuros profesores de infantil, primaria y secundaria (N = 744) y se analizan desde un enfoque multivariado adecuado para escala ordinal, mediante análisis factorial confirmatorio (ULSMV) y árboles de decisión (CHAID y CART). Tras evaluar tres modelos de medida, se aportan evidencias de validez de una estructura del constructo en tres factores y 17 ítems, con índices de ajuste aceptables. Además, se avala tanto la convergencia y consistencia del constructo, como la utilidad de los ítems para la predicción de la autoeficacia docente global en los colectivos de estudiantes de grado y de máster que componen la muestra estudiada.(AU)
Teachers sense of self-efficacy is a hard construct to measure but is important in view of to its relationship with the quality of education. This work aims to gather evidence regarding the consistency and validity of a version ofthe Teachers Sense of Efficacy Scale (TSES) for use in Spain. The data come from a Spanish group of future early-years, primary and high school teachers (N= 744), and they are analysed using a multivariate approach suitable for ordinal scales, with confirmatory factor analysis (ULSMV) and decision trees (CHAID and CART). After evaluating three measurement models, evidence for the validity of a construct structure with three factors and 17 items with acceptable fit indices is provided. In addition, the convergence and consistency of the construct are both en-dorsed, as is the usefulness of the items for predicting overall teacher self-efficacy in the groups ofundergraduate and masters students in the sam-ple studied.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Docentes , Reprodutibilidade dos Testes , Autoeficácia , Educação , Professores Escolares , Espanha , Análise FatorialRESUMO
Background: Compassion motivation is associated with increased heart rate variability (HRV), reflecting a calm and self-soothing physiological state. Recent work, however, suggests that this association is dynamic for the specific components of compassion. Objectives: The present study adopted anodal transcranial direct current stimulation (tDCS) targeting the right insula to see whether this would modulate the sensitivity to suffering and the commitment to engage in helpful actions (i.e., the components of compassion motivation). Method: Ninety-seven healthy individuals underwent 15-min anodal or sham tDCS over the frontotemporal lobe, while watching a video inducing empathic sensitivity and performing a Redistribution Game. Tonic and phasic HRV, dispositional traits, and momentary affects were assessed. Results: Compared to sham condition, anodal stimulation favored significant i) HRV reductions during the video and HRV increases during the Redistribution Game; ii) decreases in self-reported levels of negative affect and increases in positive affect during task when the latter was preceded by the video, without influencing altruistic behavior. Conclusions: Anodal tDCS over the right insula may modulate the engagement phase of compassion by intensifying the psychophysiological sensitivity to signals of distress and protecting from being subjectively overwhelmed by it. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estimulação Transcraniana por Corrente Contínua , Motivação , Empatia , Emoções , Frequência CardíacaRESUMO
Objective: The present study aimed to establish and develop an online de novo conditioning paradigm for the measurement of conditioned disgust responses. We further explored the effects of explicit instructions about the CS-UCS contingency on extinction learning and retrieval of conditioned disgust responses. Method: The study included a sample of 115 healthy participants. Geometric figures served as conditioned stimuli (CS) and disgust-evoking pictures as unconditioned stimuli (UCS). During disgust conditioning, the CS+ was paired with the UCS (66% reinforcement) and the CS- remained unpaired; during extinction and retrieval, no UCS was presented. Half of the participants (n = 54) received instructions prior to the disgust extinction stating that the UCS will not be presented anymore. 1-2 days or 7-8 days later participants performed a retrieval test. CS-UCS contingency, disgust and valence ratings were used as dependent measures. Results: Successful acquisition of conditioned disgust response was observed on the level of CS-UCS contingency, disgust and valence ratings. While some decline in valence and disgust ratings during the extinction stage was observed, contingency instructions did not significantly affect extinction performance. Retrieval one week later revealed that contingency instructions increased the discrimination of the CSs. Conclusions: Extinction of conditioned disgust responses is not affected by explicit knowledge of the CS-UCS contingencies. However, contingency instructions prior to extinction seem to have a detrimental effect on long-term extinction retrieval. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Asco , Condicionamento Clássico , Reforço Psicológico , Inquéritos e Questionários , MedoRESUMO
Background: Automated Driving Systems (ADS) may reshape mobility. Yet, related fear and anxiety are largely unknown. We estimated the prevalence and risk factors of anticipated anxiety towards ADS. Method: In a nationally representative face-to-face household survey, we assessed anticipated levels of anxiety towards ADS based on DSM-5 specific phobia criteria, using structured diagnostic interviews. We estimated weighted prevalences and conducted adjusted logistic regression models. Results: Of N = 2076 respondents, 40.82% (95%-confidence interval (CI) 37.7343.98) anticipated experiencing some symptoms of phobia of ADS, 15.22% (CI 13.1917.51) anticipated subthreshold phobia, and 3.39% (CI 2.424.75) anticipated full-blown phobia of ADS. Of subjects anticipating subthreshold phobia, 74.02% showed no strong, enduring fears of driving non-automated cars and 65.07% presented no other specific phobias (full-blown anticipated phobia: 50.37% and 50.03%, respectively). Anticipated phobia highly overlapped with anticipating marked or strong fears of passively encountering ADS in traffic (odds ratio 312.41982.2). Conclusion: About 20% of subjects anticipated at least subthreshold and 4% of subjects anticipated full-blown phobia of ADS. It appears to be distinct from fears related to non-automated driving and other specific phobias. Our findings call for prevention and treatment of phobia of ADS as they become increasingly ubiquitous. (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo , Transtornos Fóbicos/epidemiologia , Alemanha , Inquéritos e Questionários , Medo , Ansiedade , PrevalênciaRESUMO
Violence is a major problem in our society and therefore research into the neural underpinnings of aggression has grown exponentially. Although in the past decade the biological underpinnings of aggressive behavior have been examined, research on neural oscillations in violent offenders during resting-state electroencephalography (rsEEG) remains scarce. In this study we aimed to investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) on frontal theta, alpha and beta frequency power, asymmetrical frontal activity, and frontal synchronicity in violent offenders.Fifty male violent forensic patients diagnosed with a substance dependence were included in a double-blind sham-controlled randomized study. The patients received 20 minutes of HD-tDCS two times a day on five consecutive days. Before and after the intervention, the patients underwent a rsEEG task.Results showed no effect of HD-tDCS on the power in the different frequency bands. Also, no increase in asymmetrical activity was found. However, we found increased synchronicity in frontal regions in the alpha and beta frequency bands indicating enhanced connectivity in frontal brain regions as a result of the HD-tDCS-intervention.This study has enhanced our understanding of the neural underpinnings of aggression and violence, pointing to the importance of alpha and beta frequency bands and their connectivity in frontal brain regions. Although future studies should further investigate the complex neural underpinnings of aggression in different populations and using whole-brain connectivity, it can be suggested with caution, that HD-tDCS could be an innovative method to regain frontal synchronicity in neurorehabilitation. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Violência , Transtornos Relacionados ao Uso de Substâncias , Criminosos , Estimulação Transcraniana por Corrente Contínua , Eletroencefalografia , AgressãoRESUMO
A estética tem um papel importante na aceitação e autoestima das pessoas e, em virtude disso, os pacientes buscam cada dia mais ter um sorriso harmonioso. As reabilitações estéticas devem envolver um planejamento completo, atrelando função e estética, avaliando tamanho dos dentes, perfil e alturas gengivais, altura do sorriso e corredor bucal. Por conta disso, a odontologia nos permite uma série de abordagens terapêuticas diferentes que chegam a resultados satisfatórios para o paciente. Sendo assim, o presente trabalho tem como objetivo descrever um relato de caso de uma paciente com queixa estética do seu sorriso devido à diferentes tonalidades, formas e tamanhos dos dentes. Após anamnese, exame clínico e radiográfico, o plano de tratamento proposto foi de harmonizações periodontal com aumento de coroa e enxerto gengival, além de coroas em cerâmicas de dissilicato de lítio. Dentro desse contexto, mostra-se que uma abordagem multidisciplinar para reabilitação estética e funcional do sorriso é fundamental, a qual nos proporciona equilíbrio e naturalidade entre estética branca e vermelha no resultado do tratamento reabilitador(AU)
Aesthetics plays an important role in people's acceptance and self-esteem and, as a result, patients increasingly seek to have a harmonious smile. Aesthetic rehabilitations must involve a complete planning, linking function and aesthetics, evaluating tooth size, gingival profile and heights, smile height and buccal corridor. Because of this, dentistry allows us a series of different therapeutic approaches that reach satisfactory results for the patient. Therefore, the present work aims to describe a case report of a patient with an aesthetic complaint of her smile due to different shades, shapes and sizes of teeth. After anamnesis, clinical and radiographic examination, the proposed treatment plan was periodontal harmonization with crown augmentation and gingival graft, in addition to lithium disilicate ceramic crowns. Within this context, it is shown that a multidisciplinary approach to the aesthetic and functional rehabilitation of the smile is fundamental, which provides us with balance and naturalness between white and red aesthetics in the result of the rehabilitation treatment(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cerâmica , Coroas , Estética Dentária , Gengiva/transplante , Aumento da Coroa Clínica , Facetas Dentárias , Gengivoplastia , LítioRESUMO
É sabido que a cavidade oral é a porta de entrada para muitos microrganismos e que possui alguns gêneros de bactérias que quando se associam ou proliferam em excesso, com a falta de higienização correta, fatores ambientais e imunológicos podem causar danos em algumas partes dos dentes como no tecido pulpar e canais radiculares. Neste sentido, a endodontia tem sido capaz de tratar pessoas com problemas dentários em fases muito precoces como as medidas profiláticas até casos infeciosos que afetam a polpa dos dentes causando as lesões perirradiculares que são infecções causadas por microrganismos, Para tanto, é necessário que a odontologia ofereça transformações positivas por meio de técnicas que sejam mais previsíveis para os tratamentos. A literatura tem indicado o uso da laserterapia como técnica auxiliar para o tratamento endodôntico pelo seu potencial mínimo invasivo, preciso e eficaz em menor tempo de cura de patologias orais como as lesões perirradiculares. Este estudo pretendeu abordar a importância da laserterapia sobre as variáveis patológicas de pacientes com lesão perirradiculares. Para realiza-lo foi necessário buscar na literatura estudos que associem este tipo de tratamento e sua eficiência no tratamento desta patologia. Para realizar esta pesquisa foi necessário buscar dados na literatura que tratam sobre o tema para investigar o tempo indicado ao tratamento com a laserterapia bem como o estágio em que as lesões podem ser tratadas com auxílio deste método. Corroborando com o estudo apresentamos um caso clínico(AU)
It is known that the oral cavity is the gateway to many microorganisms and that it has some genera of bacteria that when they associate or proliferate in excess, with the lack of correct hygiene, environmental and immunological factors can cause damage in some parts of the teeth such as in pulp tissue and root canals. In this sense, endodontics has been able to treat people with dental problems at very early stages such as prophylactic measures to infectious cases that affect the pulp of teeth causing perirradicular lesions that are infections caused by microorganisms, therefore, it is necessary that dentistry offer positive transformations through techniques that are more predictable for treatments. The literature has indicated the use of laser therapy as an auxiliary technique for endodontic treatment for its minimal invasive, precise and effective potential in shorter time of cure of oral pathologies such as perirradicular lesions. This study aimed to address the importance of laser therapy on the pathological variables of patients with perirradicular lesions. To accomplish this, it was necessary to seek studies in the literature that associate this type of treatment and its efficiency in the treatment of this pathology. To carry out this research it was necessary to seek data in the literature that deal with the subject to investigate the time indicated for treatment with laser therapy as well as the stage at which lesions can be treated with the aid of this method. Corroborating the study, we present a clinical case(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tratamento do Canal Radicular , Terapia a Laser , Materiais Restauradores do Canal Radicular , Preparo de Canal Radicular , Cavidade Pulpar/lesões , Doenças da Polpa Dentária , Microbiota , Boca/microbiologiaRESUMO
Purpose: We aimed to determine if visual acuity (VA) could differentiate the quality of vision with two ophthalmic lenses with unwanted astigmatism. Methods: Twenty presbyopic subjects (48 to 62 years old; VA better than 0.0 logMAR) graded the magnitude of their preference between two progressive addition lenses (plano addition 2.00D) and their visual acuities were measured with both lenses at various eccentricities from -12 to +12 mm from the near vision point every 3 mm in controlled conditions. Results: The Lens with the least peripheral astigmatism was preferred by 75% of the subjects. VA measured at the near vision point was statistically worse (p<0.01) with this lens whereas the contrary was observed in the periphery (± 12 and -9 mm of eccentricity). The Friedman test shows that the eccentricity (p<0.001) has a significant effect on visual acuity. However, the lens did not show any significant effect (p=0.76). The choice of the favorite lens was predicted for only 35% when considering central VA (up to 6mm) and 80% of the subjects when considering peripheral VA (9 to 12mm). However, the magnitude of the difference could be predicted by peripheral VA in only 60% of the subjects. Conclusion: High contrast Visual acuity was clearly able to differentiate the 2 lens designs tested in our experiment. However, even under the controlled conditions of this study, it was not possible to predict the quality of vision, as measured by a subjective appreciation, through progressive addition lenses at various eccentricities from the near vision with an addition of 2.0D.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acuidade Visual , Lentes de Contato , Visão Ocular , Optometria , OftalmologiaRESUMO
Objective: To evaluate the association between IL-6 in prostatic tissue/blood sample and BPH-LUTS, so as to preliminarily discover an indicator of inflammation that could show the severity of LUTS. Patients and methods: The prostatic tissues and blood samples were collected from 56 patients who underwent transurethral plasmakinetic resection of the prostate (TUPKRP). The association between IL-6 detected on prostatic tissues/blood sample and LUTS parameters, including international prostate symptom score (IPSS), peak flow rate (Qmax) and urodynamic parameters were analyzed with SPSS version 18.0, and p-value <0.05 was chosen as the criterion for statistical significance. Results: The TPSA and prostate volume (PV) were found to be higher in the inflammation group (p=0.021, 0.036). There was a positive association between prostate tissue inflammation and LUTS ([IPSS, storage symptoms score (SSS), voiding symptoms score (VSS), p<0.05], [Qmax, p=0.025], [obstruction, p=0.027] and [AUR, p=0.018]). The level of serum IL-6 was significantly higher in inflammatory group (p=0.008). However, no differences were observed in different degrees of inflammation (p=0.393). The level of IL-6 in prostatic tissue significantly increased with the degree of inflammation (p<0.001), and the intensity of IL-6 expression was statistically correlative with the degree of inflammation (p<0.001). The IL-6 expression in prostatic tissue was statistically relevant with IPSS (p=0.018) and SSS (p=0.012). Conclusion: IL-6 expression in prostatic tissue is associated with storage IPSS, suggesting chronic inflammation might contribute to storage LUTS. (AU)
Objetivo: Evaluar la relación entre il-6 y bph-lut en muestras de tejido prostático/sangre, con el fin de identificar indicadores de inflamación que reflejen la gravedad de los lut. Pacientes y métodos: Se recolectaron muestras de tejido prostático y sangre de 56 pacientes sometidos a una plasmatectomía transuretral prostática. Se aplicó la versión 18.0 de SPSS para analizar la correlación entre el il-6 de tejido prostático/muestra de sangre y los parámetros relacionados con los LUTS (puntuación internacional de síntomas prostáticos (IPSS), flujo máximo (Qmax), parámetros urodinámicos), con UN valor p<0,05 como criterio para una diferencia estadísticamente significativa. Resultados: Hubo diferencias estadísticamente significativas (p=0,021, 0,036) entre el grupo con inflamación y el grupo sin inflamación en TPSA y PV. La inflamación del tejido prostático se relacionó positivamente con LUTS ([IPSS, puntuación de síntomas de almacenamiento (SSS), puntuación de síntomas de micción (VSS), p<0,001), y la intensidad de la expresión de il-6 se correlacionó estadísticamente con el grado de inflamación (p<0,001). La expresión de il-6 en el tejido prostático fue estadísticamente significativa con IPSS (p=0,018) y SSS (p=0,012). Conclusiones: La expresión de il-6 en el tejido prostático está relacionada con el almacenamiento de IPSS, lo que sugiere que la inflamación crónica puede estar involucrada en el almacenamiento de LUTS. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Hiperplasia Prostática/complicações , Citocinas , Inflamação , Interleucina-6RESUMO
Introduction and objectives: To examine the opinions, attitudes and perceptions of patients regarding the diagnosis and treatment protocols of erectile dysfunction (ED) and premature ejaculation (PE) and their interaction with the urology specialists. Material and methods: Observational, national and multicentric study based on a self-designed online questionnaire in which ED and PE patients described their perception of ED and PE at diagnosis and during treatment and monitoring, the patient-physician relationship and the role of the patient's partner in the course of the disease. Results: 306 ED and 70 PE participants were recruited. After the occurrence of the first symptoms, the time elapsed until the patient decided to go to the doctor was 28.6 months for PE and 14.0 months for ED (p<0.001). ED patients saw physicians more frequently (especially those aged between 60 and 69 years: 60.7%, p<0.001) than PE patients (52.1% vs 36.8%, respectively; p<0.001) and discussed this problem with their partner more (34.0% vs 22.8%, p<0.001). These disorders were mainly diagnosed at the urologist's office (ED: 74.8% vs 42.5%; PE: 75.7% vs 34.3%; diagnosis vs detection). One third of all participants reported that the sexual problem was not the main reason for the visit. The time elapsed between the first consultation for related symptoms and therapy was 8.7 months (oral drugs) and 7.6 months (dapoxetine) for ED and PE, respectively. ED patients and their partners felt particularly better once treatment had started (p<0.001). PE patients presented the highest degree of sexual dissatisfaction (78%). 50% of the patients agreed with the statement that initiating a discussion about sexual concerns was regarded as taboo and most of them did not say that their partner had encouraged them to seek medical advice. (AU)
Introducción y objetivos: Analizar las opiniones, actitudes y percepciones de los pacientes respecto a los protocolos de diagnóstico y tratamiento de la disfunción eréctil (DE) y la eyaculación precoz (EP) así como su interacción con los especialistas en urología. Material y métodos: Estudio observacional, nacional y multicéntrico, a través de un cuestionario online predefinido, en el que los pacientes con DE y EP describieron su percepción acerca de la DE y la EP, en el diagnóstico, durante el tratamiento y seguimiento, así como la relación médico-paciente y el papel de la pareja en el trascurso de la enfermedad. Resultados: Se incluyeron 306 participantes con DE y 70 con PE. El tiempo transcurrido, desde la aparición de los primeros síntomas hasta que el paciente decidió acudir al médico, fue de 28,6 meses para la EP y de 14,0 meses para la DE (p < 0,001). Los pacientes con DE acudieron al médico con mayor frecuencia (especialmente en edades entre 60 y 69 años: 60,7%, p < 0,001) respecto a los pacientes con EP (52,1 vs. 36,8%, respectivamente; p < 0,001) y comentaron más el problema con su pareja (34,0 vs. 22,8%, p < 0,001). El diagnóstico de ambas disfunciones se llevó a cabo principalmente en consultas de urología (DE: 74,8 vs. 42,5%; EP: 75,7 vs. 34,3%; diagnóstico vs. detección). Una tercera parte de todos los participantes indicó que el problema sexual no motivó principalmente la visita. El tiempo transcurrido, desde la primera consulta motivada por síntomas relacionados y el establecimiento de terapia, fue de 8,7 meses (fármacos orales) y 7,6 meses (dapoxetina) para la DE y la EP, respectivamente. Los pacientes con EP presentaron mayor grado de insatisfacción sexual (78%). De los pacientes estudiados, 50% mostró acuerdo con la afirmación de que iniciar una conversación sobre las preocupaciones sexuales se consideraba un tabú y la mayoría reconoció que su pareja no le había animado a la hora de buscar consejo médico. (AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/terapia , Ejaculação Precoce/diagnóstico , Ejaculação Precoce/terapia , Espanha , Comportamento Sexual , EnvelhecimentoRESUMO
Introduction: Human semen analysis must be performed after the liquefaction of the ejaculate. This takes place about 30min after ejaculation and samples must be maintained in the lab during this time. The temperatures for this incubation and the final analysis of motility are crucial but seldom taken into account. This study aims to examine the effect of these temperatures on various sperm parameters both manually (sperm count, motility, morphology, viability, chromatin condensation and maturation and DNA fragmentation) and CASA (kinematics and morphometrics, using an ISAS®v1 CASA-Mot and CASA-Morph systems, respectively) analyzed. Methods: Seminal samples from thirteen donors were incubated for 10min at 37°C followed by additional 20min at either room temperature (RT, 23°C) or 37°C and then examined following WHO 2010 criteria. Results: The data obtained show that there were no significant differences (P>0.05) in the subjective sperm quality parameters with incubation temperature. On the other hand, the head sperm morphometric parameters were significantly higher after room temperature incubation showing, in addition, lower ellipticity (P<0.05). Furthermore, kinematic parameters were evaluated both at RT and 37°C for the two incubation temperatures. In general, the four temperature combinations showed that kinematic parameters followed this order: RT-RT Conclusions: Our results showed that temperature control during both incubation and analysis is needed for accurate semen analysis, recommending the use of 37°C during the entire process. (AU)
Introducción: El análisis de semen humano debe realizarse después de la licuefacción del eyaculado. Esto ocurre aproximadamente a los 30minutos después de la eyaculación. Las temperaturas para esta incubación y el análisis final de la motilidad son cruciales, pero rara vez se tienen en cuenta. Este estudio tiene como objetivo examinar el efecto de estas temperaturas en varios parámetros de los espermatozoides tanto de forma manual (recuento de espermatozoides, motilidad, morfología, viabilidad, condensación y maduración de la cromatina y fragmentación del ADN) como CASA (cinemática y morfometría, utilizando un CASA-Mot ISAS®v1 y Sistemas CASA-Morph, respectivamente) analizados. Métodos: Las muestras seminales de 13 donantes se incubaron durante 10minutos a 37°C, seguidas de 20minutos adicionales a temperatura ambiente (TA, 23°C) o a 37°C y luego se examinaron siguiendo los criterios de la OMS 2010. Resultados: Los datos obtenidos muestran que no hubo diferencias significativas (p>0,05) en los parámetros subjetivos de calidad del esperma con la temperatura de incubación. Por otro lado, los parámetros morfométricos de la cabeza de los espermatozoides fueron significativamente más altos después de la incubación a temperatura ambiente, mostrando, además, una elipticidad más baja (p<0,05). Además, los parámetros cinemáticos se evaluaron tanto a temperatura ambiente como a 37°C para las dos temperaturas de incubación. En general, las cuatro combinaciones de temperatura mostraron que los parámetros cinemáticos siguieron este orden: RT-RT < RT-37 < 37-37 < 37-RT (temperaturas de incubación y análisis, respectivamente). Conclusiones: Nuestros resultados mostraron que el control de la temperatura durante la incubación y el análisis es necesario para un análisis de semen preciso, recomendando el uso de 37°C durante todo el proceso. (AU)
Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Sêmen , Motilidade dos Espermatozoides , Espermatozoides , Análise do Sêmen/métodos , Fenômenos BiomecânicosRESUMO
Introduction: Anaplastic lymphoma kinase (ALK) rearrangement located on the short arm of chromosome 2, region 2 and band 3 is frequent in lung cancer patients who respond to targeted therapies with ALK inhibitors Therefore, their identification has become a standard diagnostic test in patients with advanced NSCLS, as such chromosomal alterations may lead to the activation of important signalling pathways involved in cell survival and proliferation. Methods: To investigate the ALK gene status, we performed FISH and IHC assays in 18 lung adenocarcinoma patients, 12 women and 6 men, aged between 29 and 85 years. Paraffin-embedded samples were analyzed in the Pathology Department of the Hospital Universitario San Ignacio. Results: Results between the two techniques in 5 patients showed discordant patterns, being positive for FISH and negative for IHC. The borderline to define ALK positivity was set at 15%, These results present experimental evidence that the techniques differ in specific situations. Conclusions: Our findings show that it is advisable to investigate the ALK gene status in patients with suspected lung cancer using both FISH and IHC in combination.(AU)
Introducción: La reorganización de la (anaplastic lymphoma kinase) ALK ubicada en el brazo corto del cromosoma 2, región 2 y banda 3 es frecuente en los pacientes con cáncer de pulmón que responden a terapias dirigidas con inhibidores de la ALK. Por ello, su identificación se ha establecido como una prueba diagnóstica estándar en pacientes con CPCNP, ya que dichas alteraciones cromosómicas puedan determinar la activación de importantes vías de señalización implicadas en la supervivencia y proliferación celulares. Métodos: Para determinar el estatus de gen ALK se realizaron pruebas FISH e IHC en 18 pacientes con adenocarcinoma pulmonar, 12 mujeres y 6 varones, con edades comprendidas entre 29 y 85 años. Las muestras fueron analizadas en el Departamento de Anatomía Patológica del Hospital Universitario San Ignacio. Resultados: Los resultados entre ambas técnicas mostraron patrones discordantes en 5 pacientes, con positividad de FISH y negatividad con IHC. El límite para definir la positividad de ALK se estableció en el 15%. Estos resultados muestran evidencia experimental que dichas técnicas difieren en situaciones específicas. Conclusiones: Este estudio recomienda la investigación del estatus del gen ALK en los pacientes con sospecha de cáncer de pulmón, mediante la combinación de FISH e IHC.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Imuno-Histoquímica , Manejo de Espécimes , Hibridização in Situ Fluorescente , Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Espanha , Estudos de CoortesRESUMO
Introducción: La esclerosis múltiple es una enfermedad neurológica crónica con numerosos tratamientos modificadores de la enfermedad disponibles, incluido el dimetilfumarato (DMF), una terapia de primera línea para la esclerosis múltiple remitente-recurrente. Aunque las tasas de discontinuación del DMF suelen ser bajas en los ensayos clínicos, la falta de adhesión al tratamiento se asocia con peores resultados clínicos. Evaluar la adhesión en el mundo real y los factores predictivos es fundamental para mejorar los resultados clínicos de los pacientes. Este estudio evaluó la adhesión al DMF durante 24 meses en una cohorte de pacientes tratados en un centro portugués. Pacientes y métodos: Estudio prospectivo no intervencionista, de un solo centro, con un seguimiento de 24 meses. El estudio incluyó a pacientes adultos con esclerosis múltiple remitente-recurrente tratados con DMF en la práctica clínica habitual. Se calculó la adhesión al DMF y se consideró que los pacientes eran adherentes si el valor estaba por encima del 80%. Se compararon variables clínicas y sociodemográficas entre grupos. Resultados: De los 80 pacientes incluidos, el 74% eran mujeres, con una edad media de 39 años y una edad media en el momento del diagnóstico de 32 años. Veintiséis pacientes no habían recibido tratamiento previo. La adhesión varió entre el 93, el 82 y el 87,5% a los 6, 12 y 24 meses, respectivamente. No se encontraron diferencias entre los pacientes que no habían recibido tratamiento previo y los que sí lo habían recibido. Conclusión: Este análisis en el mundo real mostró una adhesión significativa al tratamiento con DMF durante dos años por parte de los pacientes portugueses. No obstante, estos resultados deben interpretarse considerando los cambios sustanciales en las consultas externas y las diversas restricciones periódicas debidas a la pandemia de COVID-19, que afectaron en gran medida al seguimiento de los pacientes y a la recopilación de datos.(AU)
Introduction: Multiple sclerosis is a chronic neurological disease with numerous disease-modifying treatments available, including dimethyl fumarate (DMF), a first-line therapy for relapsing-remitting multiple sclerosis. Although rates of discontinuation of DMF are generally low in clinical trials, non-adherence to treatment is associated with poorer clinical outcomes. Assessing real-world adherence and predictive factors is critical to be able to improve clinical outcomes for patients. This study evaluated adherence to DMF over 24 months in a cohort of patients treated in a Portuguese healthcare centre. Patients and methods: A prospective, non-interventional, single-centre study with 24 months follow-up was conducted. The study included adult patients with relapsing-remitting multiple sclerosis treated with DMF in routine clinical practice. Adherence to DMF was calculated and patients were considered to have adhered if the value was above 80%. Clinical and socio-demographic variables were compared between groups. Results: Of the 80 patients included, 74% were women, with a mean age of 39 years and a mean age of 32 years at diagnosis. Twenty-six patients had not received any previous treatment. Adherence varied between 93, 82 and 87.5% at 6, 12 and 24 months, respectively. No differences were found between patients who had not received any prior treatment and those who had been treated. Conclusion: This real-world analysis showed significant adherence to DMF treatment by Portuguese patients over a period of two years. However, these results must be interpreted in the light of the substantial changes in outpatient consultations and the various periodic restrictions due to the COVID-19 pandemic, which had an important effect on patient follow-up and data collection.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente , Fumarato de Dimetilo , Doenças do Sistema Nervoso , Estudos Prospectivos , Neurologia , PortugalRESUMO
Antecedentes y objetivos El plan de estudios del Grado en Fisioterapia debe dar respuesta a las demandas de los usuarios de Fisioterapia en las principales áreas de su práctica profesional y preparar a los fisioterapeutas para actuar en un entorno complejo y cambiante. El objetivo del presente estudio es elaborar y validar un listado de conocimientos (syllabus) de Fisioterapia cardiorrespiratoria en el título de Grado. Material y métodos Estudio Delphi con tres rondas de consulta realizadas entre febrero y marzo de 2021, mediante encuesta digital. Para ello, se formó un grupo de 14 expertos en Fisioterapia cardiorrespiratoria, de toda España, con diferentes perfiles profesionales. Para establecer el grado de acuerdo en las diferentes rondas se empleó el índice estadístico Free-Marginal Multirater Kappa, siendo necesario al menos un 70% de consenso. Para analizar la estabilidad en las respuestas se empleó el estadístico Kappa de Cohen (K). Resultados Se obtuvieron un 100% de respuestas en las tres rondas de consulta realizadas. Al final del proceso se alcanzó un syllabus formado por 11 bloques temáticos, con 48 ítems, con un porcentaje medio de acuerdo del 90,64%, y una estabilidad en las repuestas de K=0,57 (p<0,001), lo que equivale a una concordancia moderada. Conclusiones El syllabus validado por un grupo de 14 fisioterapeutas expertos y expertas en Fisioterapia respiratoria y cardíaca define los contenidos que deberían formar parte del Grado en Fisioterapia para poder dar respuesta a las necesidades asistenciales en afecciones cardiorrespiratorias, en un contexto complejo y cambiante, acorde a una intervención contemporánea (AU)
Background and objectives The curricula of the Bachelor's degree in physiotherapy must respond to the current demands of physiotherapy clients in the main areas of their professional practice and prepare physiotherapists to act in a challenging and complex context. The aim of this study is to elaborate and validate a list of knowledge (syllabus) about cardiorespiratory physiotherapy in Bachelor's degree programs. Material and methods A digital survey conducted a three-round Delphi study between February and March 2021. A group of 14 experts in cardiorespiratory physiotherapy from all over Spain and with different professional profiles were contacted. To establish the degree of agreement in the consultation rounds, the free-marginal multirater kappa statistical index was used, requiring at least 70% of consensus. Cohen's kappa statistic (K) was used to analyze the responses stability. Results Hundred percentage of responses were obtained in the three rounds of consultation conducted with the expert panel. At the end of the process, a syllabus made up of 11 thematic sections and 48 items was reached. An average of 90.64% of agreement and a stability in the responses of K=0.57 (p<0.001), which equates to moderate agreement, was achieved. Conclusions This syllabus validated by 14 respiratory and cardiac physiotherapy experts, determines the contents that should be part of physiotherapy in Bachelor's degree programs. This knowledge is crucial to address the rehabilitation necessities of cardiorespiratory alterations in a challenging and complex context, according to a contemporary approach of physiotherapy (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Especialidade de Fisioterapia/educação , Exercícios Respiratórios , Currículo , Técnica Delfos , Consenso , Inquéritos e Questionários , EspanhaRESUMO
Introducción El linfedema secundario al cáncer de mama es una patología crónica. La fisioterapia descongestiva compleja (FDC) es el tratamiento conservador de elección, consta de una fase intensiva para disminuir el volumen de la extremidad, y una fase de mantenimiento para fomentar el autocontrol de la patología. El objetivo es evaluar si la fisioterapia multimodal acuática (FMA) compuesta por ejercicio terapéutico, auto drenaje manual y medidas de autocuidado de miembro superior mantiene o reduce el volumen del linfedema en fase de mantenimiento y si esta es más efectiva que la fisioterapia multimodal de miembro superior en sala. Metodología Se ha realizado un ensayo clínico aleatorizado comparando dos grupos, experimental n:43 que realizó una pauta de ejercicios en el medio acuático y control n:47 que realizó la misma pauta de ejercicios en sala. Ambos grupos efectuaron 20 sesiones de 45 min, dos o tres días por semana. Se evaluaron como variables principales los cambios en el volumen del linfedema, mediante circometría y la calidad de vida de las participantes, mediante la escala FACT-B + 4. Resultados No se encontraron diferencias estadísticamente significativas entre las intervenciones realizadas, ambas mejoran el volumen a las 20 sesiones (p = 0,7855), pero si entre la frecuencia del tratamiento y el tiempo postintervención (p<0,01). Se encontraron mejoras en las variables de calidad de vida; «estado físico general del paciente», «ambiente familiar y social», «estado emocional», «capacidad de funcionamiento personal» y «preocupaciones de las pacientes» (p < 0,01). Conclusión La FMA de miembro superior parece mejorar la calidad de vida de las mujeres supervivientes con linfedema de miembro superior en fase de mantenimiento. La FMA no muestra un beneficio añadido a la fisioterapia multimodal en sala (AU)
Introduction Lymphedema secondary to breast cancer is a chronic pathology. Complex decongestive physiotherapy is the conservative treatment of choice, it consists of an intensive phase to minimize the volume of the limb, and a maintenance phase to promote self-control of the pathology. The objective is to evaluate if aquatic multimodal physiotherapy (AMP) composed of therapeutic exercise, manual self-drainage and upper limb self-care measures maintains or reduces the volume of lymphedema in the maintenance phase and if it is more effective than upper limb multimodal physiotherapy in-room. Methodology A randomized clinical trial has been carried out comparing two groups, experimental N:43 that performed a pattern of exercises in an aquatic environment and control N:47 that performed the same pattern of exercises in-room. Both groups carried out 20 sessions of 45min, 2 or 3 days per week. The main variables were the changes in the volume of the lymphedema, by means of circometry, and the quality of life of the participants, by means of the FACT-B + 4 scale. Results No statistically significant differences were found between the interventions carried out, both improve the volume at 20 sessions (p = 0.7855), the interaction between the frequency of treatment and the time after intervention was (p-value: < 0.01). Improvements were found in quality of life variables; «general physical state of the patient», «family and social environment», «emotional state», «personal functioning capacity» and «patient concerns» (p-value: < 0.01). Conclusion Upper limb AMP seems to improve the quality of life of surviving women with upper limb lymphedema in the maintenance phase. AMP does not show an added benefit to room multimodal physiotherapy (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Linfedema Relacionado a Câncer de Mama/terapia , Modalidades de Fisioterapia , Natação , Qualidade de Vida , Resultado do Tratamento , Sobreviventes de CâncerRESUMO
Antecedentes El accidente cerebrovascular (ACV) es una patología frecuente que conlleva diferentes secuelas, entre las que se encuentran la afectación de la movilidad del tobillo y las alteraciones del equilibrio. Existen diversas opciones terapéuticas para tratar estos déficits, entre ellas la estimulación eléctrica funcional (FES) y el entrenamiento de la marcha con perturbaciones. Objetivo Analizar los resultados de una intervención combinada de FES y entrenamiento de la marcha con perturbaciones, así como comprobar las repercusiones en la ejecución de actividades de la vida diaria y la participación de la persona. Metodología Se estudió el caso de un varón con hemiparesia izquierda a consecuencia de un ACV. El protocolo de rehabilitación constó de 20 sesiones de 50min (2sesiones/semana) donde se combinó el entrenamiento del equilibrio y la marcha con Balance Tutor y FES con Fesia Walk. Se evaluaron los resultados con las escalas: 10Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) y Activities-Specific Balance Confidence (ABC). Resultados Se observaron mejoras clínicas en las escalas valoradas, especialmente en el BESTest y el ABC. Conclusiones Se trata de una prueba de concepto satisfactoria de la combinación de dos técnicas, y es necesaria más investigación sobre ello en personas con ACV y otras patologías neurológicas (AU)
Introduction Stroke is a frequent disease that entails different sequelae, among which are the affectation of ankle motion and balance disorders. Various therapeutic can be used to treat these deficits, including functional electrical stimulation (FES) and disturbance gait training. Objective To analyse the results of a combined intervention of FES and gait training with disturbances, as well as to verify the repercussions on the execution of activities of daily living and the person's participation. Methods The case of a man with left hemiparesis because of a stroke was studied. The rehabilitation protocol consisted of 20 sessions of 50min (2sessions/week) where balance and gait training were combined with Balance Tutor and FES with Fesia Walk. The results were evaluated with the scales: 10Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) and Activities-Specific Balance Confidence (ABC). Results Clinical improvements were observed in the assessed scales, especially in the BESTest and the ABC. Conclusions This is a satisfactory proof of concept of the combination of two techniques, and more research is needed on it in people with stroke and other neurological diseases (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Elétrica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Equilíbrio Postural , Resultado do TratamentoRESUMO
Objetivos: Identificar eventos adversos secundarios al decúbito prono (DP) en pacientes con COVID-19 con síndrome de distrés respiratorio agudo (SDRA) moderado/severo, analizar los factores de riesgo para el desarrollo de úlceras por presión (UPP) en DP y describir la evolución oximétrica de estos pacientes durante el DP. Método: Estudio descriptivo retrospectivo realizado sobre 63 pacientes ingresados en la UCI de un hospital de segundo nivel, con neumonía por SARS-CoV-2, SDRA moderado/severo, ventilación mecánica invasiva, que precisaron maniobras de DP, durante marzo y abril de 2020. Se usó un muestreo no probabilístico consecutivo y se analizaron las variables seleccionadas a través de una regresión logística. Resultados: Se realizaron un total de 139 sesiones de pronación. La mediana de sesiones fue de 2 [1-3] y la duración de 22 h [15-24] por sesión. La aparición de eventos adversos ocurrió en 84,9% de los casos, siendo los fisiológicos (por ejemplo, hiper/hipotensión) los más frecuentes. Al comparar pacientes pronados que mantuvieron la integridad cutánea (34 de 63 pacientes, 54%) vs. los que desarrollaron UPP (29 de 63, 46%), estos últimos presentaron los siguientes factores de riesgo: mayor edad, ser hipertensos, prealbúmina < 21 mg/dL, mayor número de sesiones de prono y mayor gravedad al ingreso. Se observó un incremento significativo entre la PaO2/FiO2 previa al DP y en los diferentes cortes temporales durante el prono, además de una caída significativa tras despronar. Conclusiones: Existe una alta incidencia de eventos adversos debidos al DP, siendo los de tipo fisiológico los más frecuentes. La identificación de varios factores de riesgo para el desarrollo de UPP ayudará a prevenir la aparición de estas lesiones durante la pronación. La terapia de DP en pacientes COVID-19 con SDRA moderado/severo ha demostrado una mejora en los parámetros de oxigenación.(AU)
Objective: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. Methods: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22 hours [15-24]. The prevalence of adverse events this population was 84.9%, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin < 21 mg/dL, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. Conclusions: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infecções por Coronavirus/epidemiologia , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Pandemias , Decúbito Ventral , Respiração Artificial , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Introducción: La presente revisión bibliográfica está realizada con el fin de obtener respuestas acerca de aspectos relacionados con las técnicas y tratamientos, así como cuidados asociados al paciente crítico diagnosticado con covid-19. Objetivo: Analizar la evidencia científica disponible sobre la efectividad de la utilización de la ventilación mecánica invasiva junto con otras técnicas coadyuvantes, en la reducción de la tasa de mortalidad en pacientes con síndrome de distrés respiratorio agudo y juicio clínico de covid-19 atendidos en unidades de cuidados intensivos. Metodología: Se realizó una revisión bibliográfica sistematizada en las bases de datos PubMed, CUIDEN, LILACS, Medline, CINAHL y Google Scholar, utilizando términos MeSH (adult respiratory distress syndrome, mechanical ventilation, prone position, nitric oxide, extracorporeal membrane oxygenation, nursing care) y los operadores booleanos correspondientes. Los estudios seleccionados se sometieron a una lectura crítica realizada entre el 6 de diciembre de 2020 y el 27 de marzo de 2021 utilizando la herramienta Critical Appraisal Skills Programme en español y un instrumento de evaluación de estudios epidemiológicos transversales. Resultados: Se seleccionaron un total de 85 artículos. Tras realizar la lectura crítica se incluyeron en la revisión un total de 7 artículos, consistiendo en 6 estudios descriptivos y un estudio de cohortes. Tras el análisis de dichos estudios, se desprende que la técnica que mejor resultados ha obtenido es la oxigenación por membrana extracorpórea, siendo importantes los cuidados proporcionados por el personal de enfermería cualificado y capacitado. Conclusión: La mortalidad por covid-19 aumenta en pacientes tratados con ventilación mecánica invasiva respecto a los pacientes tratados con oxigenación por membrana extracorpórea. Los cuidados de enfermería y la especialización pueden repercutir en una mejora de los resultados en los pacientes.(AU)
Introduction: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with COVID-19. Objective: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with acute respiratory distress syndrome and clinical trial of COVID-19 treated in intensive care units. Methodology: A systematized bibliographic review was carried out in the PubMed, CUIDEN, LILACS, Medline, CINAHL and Google Scholar databases, using MeSH terms (adult respiratory distress syndrome, mechanical ventilation, prone position, nitric oxide, extracorporeal membrane oxygenation, nursing care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. Results: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and one a cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is extracorporeal membrane oxygenation, with the care provided by qualified and trained nursing staff being very important. Conclusion: Mortality from COVID-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.(AU)
