Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 215
Filtrar
1.
N Z Med J ; 132(1488): 11-20, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851657

RESUMO

AIM: Unnecessary treatment of asymptomatic bacteriuria is a concern. Hutt Valley District Health Board sought to reduce clinically inappropriate urine culture requests through removal of urine dipsticks from wards and education of staff using Choosing Wisely principles. The purpose of this research is to quantitatively evaluate the success of these initiatives. METHODS: The numbers and results of urine cultures performed for Hutt Valley DHB were analysed, for the period from January 2015 to October 2017. Urinalyses were compared between those designated as 'inpatient' and those as 'outpatient', with the latter being the control of this study. The numbers of primary and secondary coded discharge diagnoses of UTIs were used as a measure of the negative impact of the interventions. RESULTS: There was a 28% reduction in monthly urine culture requests for inpatients, after staff education and removal of urine dipsticks, with no change in those for outpatients (the negative control). After the intervention, a higher proportion of urine cultures were positive for urinary pathogens (25.2% compared to 23.0%) and the average number of diagnoses of UTI in hospital discharges decreased 17% (from 161 to 134). CONCLUSION: The removal of urine dipsticks from wards and the education of staff significantly reduced the number of urine culture requests and is a useful strategy to reduce the overuse of antibiotics for asymptomatic bacteriuria without an increase in the number of UTIs. These simple interventions could be used at other hospitals as part of measures to reduce unnecessary care and overdiagnosis.


Assuntos
Sobremedicalização/prevenção & controle , Procedimentos Desnecessários/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adulto , Educação em Saúde , Humanos , Sobremedicalização/economia , Sobremedicalização/estatística & dados numéricos , Nova Zelândia , Procedimentos Desnecessários/economia , Urinálise/economia , Urinálise/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia
2.
N Z Med J ; 132(1488): 21-27, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851658

RESUMO

BACKGROUND: Urinalysis performed by dipstick testing is an aid to diagnosing urinary tract infections (UTI), and a tool in selecting patients who require urine culture and antibiotic treatment. Previous studies have demonstrated that UTI, especially in the elderly, are over-diagnosed and over-treated. We sought to study the pattern and yield of urinalysis and urine culture at our service in a tertiary institution. METHODS: A convenience sampling method was utilised to prospectively collect clinical data, through a pre-designed pro forma, from patients admitted to the General Medicine service at Christchurch Hospital between March and June 2016. RESULTS: The study included 395 patients, with a median age of 76 (range 15-100 years). The presence of urinary tract symptoms was documented in 94 patients (24%) and a non-specific syndrome of elevated temperature, confusion or subjective feverishness in 69 (17%). In symptomatic patients, 121 (74%) had a dipstick performed and 104 (86%) urine samples cultured. In the remaining patients, 181 (78%) had a dipstick performed and 81 (35%) had a urine sample sent for culture. CONCLUSIONS: We found a large number of urine dipsticks is being ordered unnecessarily in asymptomatic patients. A more useful test is urine microscopy and culture that is done on symptomatic patients only following careful clinical evaluation. Performing 'routine' urinalysis in patients presenting a wide variety of symptoms may lead to unnecessary urine cultures and treatment of asymptomatic bacteriuria. Efforts to reduce unnecessary tests and antibiotic treatment are a vital component of diagnostic stewardship programmes.


Assuntos
Medicina Geral/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Prospectivos , Procedimentos Desnecessários/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Adulto Jovem
3.
J Perinat Med ; 47(6): 611-618, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31141487

RESUMO

Background The association between bacteriuria and adverse pregnancy outcomes has been extensively described. The current practice of screening all pregnant women for bacteriuria is challenged by recent studies. We aimed to evaluate pregnancy outcomes among women with a positive urine culture, to assess the significance of positive urinary nitrites in this setting. Methods This was a retrospective cohort study at the emergency department (ED) of the Helen Schneider Hospital for Women, Israel, during 2014-2018. This included all gravida women >18 years old within the 20th week of pregnancy or above, admitted to the ED with diverse complains, who had urinalysis collected and subsequently had a positive urine culture. Clinical and obstetric characteristics were stratified by positive vs. negative nitrites in urinalysis. The primary outcome was premature delivery, and the secondary outcomes were a composite outcome of all recorded pregnancy complications and the significance of urinalysis in predicting urinary tract infection (UTI). Results Overall, 874 pregnant women with a positive urine culture were included. Of them, 721 (79%) patients had a negative nitrite in their urine exam (NNU-group) and 153 (21%) had a positive nitrite in their urine exam (PNU-group). Escherichia coli was the most common pathogen, with significantly higher rates of growth in the PNU-group vs. NNU-group [129 (84.3%) vs. 227 (38.4%), P < 0.001]. Premature delivery was recorded with no association of symptomaticity or nitrite status. Among symptomatic women with classic symptoms of UTI, PNU was significantly associated with decreased risk for major peripartum complications [odds ratio (OR) with 95% confidence interval (CI) of 0.22 (0.05-0.94)]. Conclusion Our findings support that PNU among symptomatic pregnant women with UTI-related symptoms was associated with lower risk of developing major adverse obstetrical outcomes.


Assuntos
Bacteriúria , Escherichia coli/isolamento & purificação , Nitritos/análise , Complicações Infecciosas na Gravidez , Urinálise , Infecções Urinárias , Adulto , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Bacteriúria/microbiologia , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Avaliação de Sintomas , Urinálise/métodos , Urinálise/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
4.
Int J Health Care Qual Assur ; 32(1): 224-232, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859876

RESUMO

PURPOSE: The purpose of this paper is to measure the prevalence, evaluate the trend and identify the factors associated with the non-performance of qualitative urine test (QUT) among pregnant women living in the extreme south of Brazil between 2007 and 2016. DESIGN/METHODOLOGY/APPROACH: All births occurred in the local maternity wards from January 1 to December 31 of 2007, 2010, 2013 and 2016. Mothers were interviewed within 48h after delivery. The outcome was the non-performance of QUT during pregnancy. χ2 test was used to compare proportions and Poisson regression with robust variance adjustment for the multivariate analysis. The effect measure used was the prevalence ratio. FINDINGS: Of the 10,331 new mothers identified, 10,004 (96.8 percent) performed at least one prenatal visit. The prevalence of non-performance of QUT was 3.3 percent (95% CI 2.9-3.7 percent), ranging from 1.5 percent in 2007 to 5.3 percent in 2016 ( p<0.001). The analysis showed that not living with a companion, having under four years of schooling, living with seven or more people in the household, having five or more children, having had one to three prenatal visits and not having been supplemented with ferrous sulfate during pregnancy showed a significantly higher prevalence rate to the non-performance of QUT. ORIGINALITY/VALUE: The rate of non-performance of this test among pregnant women has clearly increased. Mothers at higher risk of unfavorable outcomes in pregnancy were the ones with the highest probability of not performing QUT. Increasing the number of prenatal visits is a high-impact measure toward the performance of this test.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Urinálise/métodos , Urinálise/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Adolescente , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Incidência , Saúde Materna , Determinação de Necessidades de Cuidados de Saúde , Cuidado Pós-Natal/métodos , Gravidez , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , População Rural , Infecções Urinárias/urina , Adulto Jovem
5.
Am J Phys Anthropol ; 168(4): 705-716, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30706445

RESUMO

OBJECTIVES: Evidence from industrialized populations suggests that urine concentrating ability declines with age. However, lifestyle factors including episodic protein intake and low hypertension may help explain differences between populations. Whether this age-related decline occurs among small-scale populations with active lifestyles and non-Western diets is unknown. We test the universality of age-related urine concentration decline. MATERIALS AND METHODS: We used urine specific gravity (Usg) and urine osmolality (Uosm) data from 15,055 U.S. nonpregnant adults without kidney failure aged 18-80 in 2007-2012 participating in the National Health and Nutrition Examination Survey (NHANES). We tested the relationship of age on urine concentration biomarkers with multiple linear regressions using survey commands. We compared results to longitudinal data on Usg from 116 Tsimane' forager-horticulturalists (266 observations) adults aged 18-83 in 2013-2014 from Lowland Bolivia, and to 38 Hadza hunter-gatherers (156 observations) aged 18-75 in 2010-2015 from Tanzania using random-effects panel linear regressions. RESULTS: Among U.S. adults, age was significantly negatively associated with Usg (Adjusted beta [B] = -0.0009 g/mL/10 years; SE = 0.0001; p < 0.001) and Uosm (B = -28.1 mOsm/kg/10 yr; SE = 2.4; p < 0.001). In contrast, among Tsimane' (B = 0.0003 g/mL/10 yr; SE = 0.0002; p = 0.16) and Hadza (B = -0.0004 g/mL/10 yr; SE = 0.0004; p = 0.29) age was not associated with Usg. Older Tsimane' and Hadza exhibited similar within-individual variability in Usg equivalent to younger adults. DISCUSSION: While U.S. adults exhibited age-related declines in urine concentration, Tsimane' and Hadza adults did not exhibit the same statistical decline in Usg. Mismatches between evolved physiology and modern environments in lifestyle may affect kidney physiology and disease risk.


Assuntos
Envelhecimento/fisiologia , Nefropatias , Rim/fisiologia , Urinálise/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Bolívia/epidemiologia , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Nefropatias/urina , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Tanzânia/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 31, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621621

RESUMO

BACKGROUND: The incidence of Chlamydia trachomatis (Ct) urethritis has been increasing for the past 10 years. There is little data regarding the screening of Ct infection in asymptomatic men in France, despite the national recommendation to screen at-risk asymptomatic men under 30 attending Sexually Transmitted Infections (STI) clinics. Recent data from the French surveillance network Rénachla show indeed that systematic screening is still focused on women. The objective of our study was to determine the prevalence and risk factors for Ct infection in asymptomatic men under 30 attending an STI clinic located in Paris, France. METHODS: We performed a cross-sectional study between April 4, and December 31, 2016 in the database of the software DIAMM Client V8 used in our STI clinic. We extracted the demographic characteristics, sexual behavior and result of STI screening of all asymptomatic men who had consulted and given their consent for the use of their personal data. Those data were collected in usual care through a standardized questionnaire filled in during an appointment with a trained physician. STI screening was performed using PCR kit CT/NG Abbott Realtime® on first void urines. For MSM, a rectal swab was also collected. Risk factors for Ct infection were analyzed by univariate and multivariate modeling using STATA software 8.2. RESULTS: Among 872 men who had attended the clinic, 647 were included and 37 (5.7, 95% CI 4.2 to 7.8) were positive for Ct in urine. In univariate analysis, men who had unprotected sex in the last 6 weeks (OR 2.40 (95%CI 1.16 to 4.94), p = 0.02), and those who had an infected partner (OR 7.6 (95%CI 3.03 to 20), p = 0.0001) were more likely to be infected. In the multivariate analysis having an infected partner was the only risk factor (OR 11.1(95% CI 3.7 to 33.3), p = 0.0001) that remained significant. CONCLUSION: Prevalence of Ct infection is high among asymptomatic men of 30 years or less attending our urban STI clinic especially among those with an infected partner. The Ct screening among this population associated with partner notification, as recommended by the French national guidelines, should be more widely implemented.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/urina , Chlamydia trachomatis/isolamento & purificação , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/urina , Urinálise/estatística & dados numéricos , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/diagnóstico , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Paris/epidemiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/microbiologia , Urinálise/métodos , Adulto Jovem
7.
J Matern Fetal Neonatal Med ; 32(22): 3864-3870, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29712490

RESUMO

Objective: The purpose of the present review is to evaluate whether urine uric acid to creatinine ratio is increased in perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE), as well as to assess its predictive accuracy in the disease. Methods: We used the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017), Embase (1980-2017), Cochrane Central Register of Controlled Trials CENTRAL (1999-2017), and Google Scholar (2004-2017) databases in our primary search along with the reference lists of electronically retrieved full-text papers. The hierarchical summary receiver operating characteristic (HSROC) model was used for the meta-analysis of diagnostic accuracy. Results: Fourteen studies were finally included in the present review, that investigated 1226 neonates. Urinary uric acid to creatinine ratio was significantly higher in neonates with perinatal asphyxia than in healthy controls (mean differences (MD): 1.43 95%CI [1.17, 1.69]). Specifically, the mean difference for Sarnat stage 1 was 0.70 (95%CI [0.28, 1.13]), for stage 2 1.41 (95%CI [0.99, 1.84]), and for stage 3 2.71 (95%CI [2.08, 3.35]). The estimated sensitivity for the summary point was 0.90 (95%CI (0.82-0.95)), the specificity was 0.88 (95%CI (0.73-0.95)) and the diagnostic odds ratio was calculated at 63.62 (95%CI (17.08-236.96)). Conclusions: Urinary uric acid to creatinine ratio is a rapid and an easily detected biomarker that may help physicians identify neonates at risk of developing perinatal asphyxia and HIE. However, large-scale prospective studies are still needed to determine its value in predicting mortality, as well as short- and long-term adverse neurological outcomes.


Assuntos
Asfixia Neonatal/diagnóstico , Creatinina/urina , Diagnóstico Pré-Natal/métodos , Ácido Úrico/urina , Índice de Apgar , Asfixia Neonatal/urina , Biomarcadores/urina , Creatinina/análise , Feminino , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/urina , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal/normas , Diagnóstico Pré-Natal/estatística & dados numéricos , Distribuição Aleatória , Sensibilidade e Especificidade , Ácido Úrico/análise , Urinálise/métodos , Urinálise/normas , Urinálise/estatística & dados numéricos
8.
Arch Pediatr ; 26(1): 16-20, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554850

RESUMO

INTRODUCTION: Since April 2015, the French Society of Pediatrics has encouraged suprapubic aspiration (SA) and urethral catheterization (UC) for urine collection in non-toilet-trained children suspected of having urinary tract infections (UTIs) and has tried to reduce the use of urine bag (UB). OBJECTIVE: To analyze the medical practices concerning urine collection methods used for non-toilet-trained children in pediatric emergency departments in France. METHODS: We conducted a descriptive medical practice study in October 2017. All members of the French Society of Pediatric Nephrology received two questionnaires about urine collection methods used for non-toilet-trained children, distinguishing between male and female patients, and about the corresponding analgesic protocols used in their pediatric emergency departments. RESULTS: In total, 26 centers completed questionnaires concerning female patients. UC was performed in cases of fever associated with urinary tract malformations in 14 of 26 centers (54%). UB was used in cases of fever of unknown origin lasting for more than 48h in 17 of 26 centers (65%), in cases of fever associated with UTI symptoms in 14 of 26 centers (54%), and in cases of fever in infants under 3 months of age in 16 of 26 centers (61%). The questionnaires concerning male patients were completed by 30 centers. UB was the initially used urine collection method in all situations with, respectively, 22 of 30 (73%), 27 of 30 (90%), 23 of 30 (77%), and 22 of 30 (73%) centers. The analgesic protocol for urine collection is not well established in France. CONCLUSION: UC for urine collection in pediatric emergency departments in France is underused despite the national recommendations and the greater diagnostic power of this method compared with UB.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Coleta de Urina/métodos , Analgésicos/administração & dosagem , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Humanos , Lactente , Masculino , Dor/epidemiologia , Dor/etiologia , Inquéritos e Questionários , Treinamento no Uso de Toaletes , Cateterismo Urinário/estatística & dados numéricos , Coleta de Urina/estatística & dados numéricos
9.
Eur J Clin Nutr ; 73(1): 105-111, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30046131

RESUMO

BACKGROUND: Peritoneal dialysis (PD) patients are advised to restrict sodium intake. For best use of resources, rapid screening tools are required for dietary assessments to allow for targeting of patients. We wished to evaluate the usefulness of food frequency questionnaires (FFQ) for estimating dietary sodium. METHODS: Sodium intake was estimated using the Derby Salt Questionnaire (DSQ), and Royal Free Sodium Questionnaire (RFSQ). Body composition was determined by bioimpedance. RESULTS: 90 peritoneal dialysis patients, 52 men (57.8%), mean age 62 ± 15.8 years, were asked to complete the DSQ and RFSQ questionnaires. 88 completed one or more questionnaire, with 87 completing the DSQ and 86 the RFSQ. The median estimated dietary sodium intake 104 (72-145) mmol/day (2.39 (1.64-3.34) g sodium/day) DSQ, and 92 (60-114) mmol/day (2.11 (1.38-2.62) g sodium/day) RFSQ. Younger patients, aged ≤52 years had greater dietary sodium intake compared to those ≥76 years (RFSQ 105.4 (73-129) vs 96 (71-116) mmol/day), p < 0.05. Extracellular water to total body water (ECW/TBW) was greater in those with higher DSQ estimated dietary sodium intake (0.40 ± 0.01 vs 0.39 ± 0.01, p < 0.05). A multivariable model showed that increased dietary sodium intake was independently associated with increased SMM (DSQ odds ratio (OR) 1.17 (95% confidence limits 1.05-1.32, RFSQ OR 1.15 (1.04-1.27, p < 0.05) and raised ECW/TBW (DSQ OR 1.88 (1.22-2.92) p = 0.004, and ECW/height (RFSQ OR 1.42 (1.02-1.98) p = 0.04. CONCLUSIONS: Both questionnaires were acceptable to patients, and the majority were found to be consuming more dietary sodium than recommended. Dietary sodium estimation was associated with SMM and increased ECW.


Assuntos
Inquéritos sobre Dietas/estatística & dados numéricos , Diálise Peritoneal/estatística & dados numéricos , Sódio na Dieta/análise , Sódio/análise , Urinálise/estatística & dados numéricos , Idoso , Composição Corporal , Inquéritos sobre Dietas/métodos , Impedância Elétrica , Líquido Extracelular/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
11.
G Ital Nefrol ; 35(5)2018 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-30234239

RESUMO

BACKGROUND: The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution. METHODS: Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service. We evaluated results in the 2009-2016 period, in which our hospital did not undergo any change both in the number of beds and in the clinical case-mix. RESULTS: From 2009 to 2013 an average of 2264 MEUS and 10,204 UA per year were ordered, respectively, with an average ratio of 22.2%. Since 2014, a change on computerized order entry involving MEUS caused a further decrease of its requests (in average, 923 per year), which was not associated to a decrease in UA (in average, 9810 per year) (in average, MEUS/UA 9.4%). MEUS requests came mainly from Paediatrics (47.8%), Nephrology (20.9%) and Rheumatology (18.3%) wards. By filling a satisfaction survey, clinical wards evaluated the provided service as satisfactory, while highlighting some critical issues, mainly referred to preanalytical phase. CONCLUSIONS: The alternative proposal for managing MEUS presented in this paper markedly reduces the number of requests and increases their appropriateness. This is achieved without any negative impact on patient care.


Assuntos
Urinálise/métodos , Automação , Precipitação Química , Governança Clínica , Grupos Diagnósticos Relacionados , Número de Leitos em Hospital , Departamentos Hospitalares , Humanos , Laboratórios Hospitalares/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Urinálise/estatística & dados numéricos , Carga de Trabalho
12.
Eur J Obstet Gynecol Reprod Biol ; 228: 261-266, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30041147

RESUMO

OBJECTIVE: Illicit drug use in pregnancy may lead to adverse outcomes. Although the American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for substance use by questionnaire or conversation, it remains unclear how well these methods identify women with illicit drug use. Drug use may also be suspected based on clinical complications, such as fetal demise or placental abruption. There are currently no formal recommendations to guide targeted laboratory testing in women perceived to be at risk based on historical or clinical factors. Our objective was to determine which historical and clinical factors are associated with positive urine toxicology screens in women admitted to labor and delivery. STUDY DESIGN: Historical cohort study of all women admitted to labor and delivery at our county hospital over a 5-year period (2010-2014). All patients underwent historical and clinical risk assessment and women perceived to be at increased risk of illicit drug use and who consented to testing had urine toxicology performed. We conducted a detailed chart review on all women with a positive test during this 5-year period and compared them to all women with a negative test in 2014, reporting values significant at a p-value of ≤0.05. RESULTS: Amongst the 19,604 admissions during this period, 850 women underwent urine toxicology testing, accounting for 4.8% of all admissions. We compared the 83 women who tested positive for illicit drugs (9.8% of all women tested) to the 179 women who tested negative in 2014. Historical drug use was the factor most strongly associated with a positive test. Other historical and demographic factors associated with a positive test included single relationship status, lack of employment, lack of high school education, nulliparity and history of a prior sexually-transmitted or blood-borne infection. Regarding clinical risk factors, maternal medical complications were not associated with a positive test, and obstetrical complications, like preterm labor, were associated with a negative test. CONCLUSIONS: A positive urine toxicology test was most strongly associated with maternal historical factors, especially known drug use. No clinical risk factor was associated with a positive test. The implications of our findings in guiding targeted laboratory testing are discussed.


Assuntos
Salas de Parto/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Detecção do Abuso de Substâncias/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
13.
Pediatr Emerg Care ; 34(8): 574-577, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30020250

RESUMO

OBJECTIVES: Urgent medical evaluation is recommended for patients with sickle cell disease (SCD) and fever. Clear recommendations exist regarding certain aspects of treatment, but other areas lack evidence. We determined practice variation for children with SCD presenting with fever to the emergency department (ED). METHODS: Retrospective chart review of children ages 3 months to 21 years with SCD presenting to the ED with fever greater than or equal to 38.5°C in the ED or preceding 24 hours. Visits from 3 sickle cell centers were included. Outcomes included blood culture, complete blood count, antibiotic treatment, chest x-ray, urinalysis, electrolytes, and hospital disposition. Differences greater than 10% were considered clinically meaningful. RESULTS: The population included 14,454 visits, of which 4143 (29%) were febrile and met all inclusion criteria. A complete blood count and blood culture were obtained at 94% of visits, and antibiotics were given at 91%, with no differences among sites. Meaningful differences existed for disposition, with 52%, 43%, and 99% of patients admitted to the inpatient units at hospitals A, B, and C, respectively. Differences were seen in obtaining a urinalysis (33%, 17%, and 21%), electrolytes (2%, 50%, and 12%), and chest x-rays for patients 2 years and older (78%, 77%, 64%) for hospitals A, B, and C, respectively. CONCLUSIONS: Significant variation exists in the proportion of children who receive a urinalysis, electrolytes, chest x-ray, and, most importantly, admission to the hospital. These examples of practice variation represent potential opportunities to define best care practices for children with SCD presenting to the ED for fever.


Assuntos
Anemia Falciforme/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/terapia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Anemia Falciforme/complicações , Antibacterianos/uso terapêutico , Contagem de Células Sanguíneas/estatística & dados numéricos , Hemocultura/estatística & dados numéricos , Criança , Pré-Escolar , Eletrólitos/sangue , Febre/complicações , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Estudos Retrospectivos , Urinálise/estatística & dados numéricos , Adulto Jovem
14.
Clin Lab ; 64(6): 983-989, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29945335

RESUMO

BACKGROUND: To study the urinalysis request, pre-analytical sample conditions, and analytical procedures. METHODS: Laboratories were asked to provide the number of primary care urinalyses requested, and to fill out a questionnaire regarding pre-analytical conditions and analytical procedures. RESULTS: 110 laboratories participated in the study. 232.5 urinalyses/1,000 inhabitants were reported. 75.4% used the first morning urine. The sample reached the laboratory in less than 2 hours in 18.8%, between 2 - 4 hours in 78.3%, and between 4 - 6 hours in the remaining 2.9%. 92.5% combined the use of test strip and particle analysis, and only 7.5% used the strip exclusively. All participants except one performed automated particle analysis depending on strip results; in 16.2% the procedure was only manual. CONCLUSIONS: Urinalysis was highly requested. There was a lack of compliance with guidelines regarding time between micturition and analysis that usually involved the combination of strip followed by particle analysis.


Assuntos
Automação Laboratorial/estatística & dados numéricos , Serviços de Laboratório Clínico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Automação Laboratorial/normas , Serviços de Laboratório Clínico/normas , Humanos , Atenção Primária à Saúde/métodos , Inquéritos e Questionários , Urinálise/métodos
16.
BMC Pregnancy Childbirth ; 18(1): 145, 2018 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-29743039

RESUMO

BACKGROUND: Complications during pregnancy, childbirth and the postpartum period present a significant and complex public health problem in low income countries such as Ethiopia. One strategy endorsed by the World Health Organisation (WHO) to improve maternal and child health outcomes is to encourage male partner involvement in pregnancy care. This research aimed to explore the relationships between 1) male attendance at antenatal care and 2) socio-economic and women's empowerment factors and adherence to focused antenatal care guidelines among women receiving care in Ethiopia. METHODS: Secondary analysis of 2011 Ethiopian Demographic and Health Survey (DHS) data. A sub-sample of couples with a child aged 0-2 years old, for whom women attended at least one antenatal care (ANC) appointment was selected. Predictor variables on socio-economic position, demographic and women's empowerment factors, and male attendance at antenatal care were identified. Six outcome variables were constructed to indicate whether or not women: commenced ANC in the first trimester, attended at least four ANC appointments, received a urine test, received a blood test, were counselled on potential complications during pregnancy and met these focused antenatal care guidelines. Binary logistic regression was performed to estimate the relationship between the predictor and outcome variables. RESULTS: After controlling for other factors, women whose partners attended ANC were significantly more likely to receive urine and blood tests and be counselled about pregnancy complications compared to women who attended alone. Male attendance was not associated with women commencing care in the first trimester or attending at least four appointments. Although more women whose male partners had attended appointments received all recommended components of ANC than those who attended alone, this association was not significant. CONCLUSIONS: The results revealed some benefits and did not detect harms from including male partners in focused antenatal care. Including men may require changes to maternal healthcare systems and training of healthcare workers, to adopt 'father inclusive' practices. Given the limited research in this area, large population studies including the DHS routinely carried out in Ethiopia could enhance knowledge by including more detailed indicators of male involvement in pregnancy, maternal and child healthcare and early child development.


Assuntos
Pai , Cooperação do Paciente/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Aconselhamento Diretivo/estatística & dados numéricos , Etiópia , Feminino , Guias como Assunto , Inquéritos Epidemiológicos , Testes Hematológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , Autoeficácia , Fatores Socioeconômicos , Urinálise/estatística & dados numéricos , Adulto Jovem
17.
Arch Dis Child ; 103(11): 1033-1041, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29794106

RESUMO

OBJECTIVE: To assess the diagnostic value of existing clinical prediction models (CPM; ie, statistically derived) in febrile young infants at risk for serious bacterial infections. METHODS: A systematic literature review identified eight CPMs for predicting serious bacterial infections in febrile children. We validated these CPMs on four validation cohorts of febrile children in Spain (age <3 months), France (age <3 months) and two cohorts in the Netherlands (age 1-3 months and >3-12 months). We evaluated the performance of the CPMs by sensitivity/specificity, area under the receiver operating characteristic curve (AUC) and calibration studies. RESULTS: The original cohorts in which the prediction rules were developed (derivation cohorts) ranged from 381 to 15 781 children, with a prevalence of serious bacterial infections varying from 0.8% to 27% and spanned an age range of 0-16 years. All CPMs originally performed moderately to very well (AUC 0.60-0.93). The four validation cohorts included 159-2204 febrile children, with a median age range of 1.8 (1.2-2.4) months for the three cohorts <3 months and 8.4 (6.0-9.6) months for the cohort >3-12 months of age. The prevalence of serious bacterial infections varied between 15.1% and 17.2% in the three cohorts <3 months and was 9.8% for the cohort >3-12 months of age. Although discriminative values varied greatly, best performance was observed for four CPMs including clinical signs and symptoms, urine dipstick analyses and laboratory markers with AUC ranging from 0.68 to 0.94 in the three cohorts <3 months (ranges sensitivity: 0.48-0.94 and specificity: 0.71-0.97). For the >3-12 months' cohort AUC ranges from 0.80 to 0.89 (ranges sensitivity: 0.70-0.82 and specificity: 0.78-0.90). In general, the specificities exceeded sensitivities in our cohorts, in contrast to derivation cohorts with high sensitivities, although this effect was stronger in infants <3 months than in infants >3-12 months. CONCLUSION: We identified four CPMs, including clinical signs and symptoms, urine dipstick analysis and laboratory markers, which can aid clinicians in identifying serious bacterial infections. We suggest clinicians should use CPMs as an adjunctive clinical tool when assessing the risk of serious bacterial infections in febrile young infants.


Assuntos
Infecções Bacterianas/diagnóstico , Calcitonina/metabolismo , Serviço Hospitalar de Emergência , Febre/diagnóstico , Urinálise/estatística & dados numéricos , Infecções Bacterianas/complicações , Técnicas de Apoio para a Decisão , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Países Baixos , Espanha
18.
Medicine (Baltimore) ; 97(16): e0343, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29668584

RESUMO

The aim of this study was to determine whether combined utilization of untimed single urine monocyte chemoattractant protein 1 (uMCP-1) and tumor necrosis factor (TNF)-like weak inducer of apoptosis (uTWEAK) could serve as a screening test for proteinuria in patients with lupus nephritis (LN).A case-control study that contained 39 biopsy-proven LN patients, 20 non-LN systemic lupus erythematosus (SLE) patients, and 10 healthy controls (HCs) were carried out. Correlations between uMCP-1, uTWEAK, and traditional clinical markers were analyzed by Spearman correlation test. Diagnostic values of uMCP-1, uTWEAK, and urine albumin/creatinine ratio (uACR) in the assessment of proteinuria were investigated by receiver operating characteristic (ROC) curves.Biopsy-proven LN patients showed higher levels of uMCP-1 and uTWEAK than non-LN patients. uMCP-1 and uTWEAK were elevated in renal active patients (rSLEDAI ≥4). Both uMCP-1 and uTWEAK showed significant correlation with patients' rSLEDAI, 24-hour urine proteinuria (24hr UP), and anti-double-stranded DNA (anti-dsDNA) antibodies. No correlations of these 2 biomarkers between cystatin C (Cys-C), creatinine (Cr), and blood urea nitrogen (BUN) were observed. An algorithm combining the moderate sensitivity of uMCP-1 and high specificity of uTWEAK displayed great specificity and sensitivity for proteinuria screening.Both uMCP-1 and uTWEAK were positively correlated with the impairments of LN, and the combined utility of untimed single uMCP-1 and uTWEAK might be used as potential predictors for proteinuria in LN.


Assuntos
Quimiocina CCL2/urina , Citocina TWEAK/urina , Nefrite Lúpica , Proteinúria , Urinálise , Adulto , Biomarcadores/urina , Biópsia/métodos , Creatinina/análise , Feminino , Humanos , Rim/patologia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Valor Preditivo dos Testes , Proteinúria/diagnóstico , Proteinúria/etiologia , Curva ROC , Sensibilidade e Especificidade , Estatística como Assunto , Urinálise/métodos , Urinálise/estatística & dados numéricos
19.
Am J Phys Anthropol ; 166(4): 952-959, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29664990

RESUMO

OBJECTIVES: Schistosome infections can damage organs important for water homeostasis, especially the kidneys. Urogenital schistosomiasis (caused by Schistosoma haematobium) increases protein and blood in urine and intestinal schistosomiasis (caused by S. mansoni) affects total body water. However, no data exist on how different schistosome species affect urine specific gravity (USG), a hydration biomarker. Therefore, we assessed the relationship between S. haematobium- and S. mansoni-infected and uninfected women and USG in rural Tanzania. MATERIALS AND METHODS: Surveys were conducted and stool and urine samples were collected among 211 nonpregnant women aged 18-50. S. haematobium eggs were detected using the urine filtration method. S. mansoni eggs were detected using the Kato Katz method. USG was measured using a refractometer and analyzed as both a continuous and dichotomous variable. Regression (linear/logistic) models were estimated to test the relationship between infection and hydration status. RESULTS: The prevalence of S. haematobium was 5.9% and S. mansoni was 5.4% with no coinfections. In regression models, S. haematobium-infected women had significantly higher USG (Beta = 0.007 g mL-1 ; standard error = 0.002; p = 0.001) and odds (Odds ratio: 7.76, 95% CI: 1.21-49.5) of elevated USG (>1.020 g mL-1 ) than uninfected women, whereas S. mansoni-infected women did not. DISCUSSION: Schistosoma haematobium, but not S. mansoni, infection is associated with higher USG and risk of inadequate hydration. Future work should determine whether findings are attributable to parasite-induced debris in urine or urinary tract pathologies and signs of renal damage. Human and non-human primate studies using USG in schistosome-endemic areas should account for schistosomiasis.


Assuntos
Nefropatias/urina , Estado de Hidratação do Organismo/fisiologia , Esquistossomose Urinária/urina , Esquistossomose mansoni/urina , Adolescente , Adulto , Animais , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/etiologia , Nefropatias/parasitologia , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Esquistossomose Urinária/complicações , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/parasitologia , Esquistossomose mansoni/complicações , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/parasitologia , Tanzânia/epidemiologia , Urinálise/estatística & dados numéricos , Urina/química , Urina/parasitologia , Adulto Jovem
20.
J Emerg Med ; 54(4): 500-506, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500048

RESUMO

BACKGROUND: Behavioral emergencies account for a significant portion of emergency department (ED) visits in the United States. Substance abuse is common in this population and may precipitate or exacerbate preexisting psychiatric illness. Contrary to ED policy guidelines, many behavior health centers (BH) require a urine drug screen (UDS) in stable patients prior to transfer. OBJECTIVE: We sought to determine the role of the UDS in ED length of stay (LOS), cost, and charges to patients and inpatient psychiatric care. METHODS: We performed a retrospective chart review of all patients transferred to an in-network BH from September 1-30, 2014. Clinical data were extracted and analyzed from our electronic medical record, including records from both the ED visit and the BH stay. RESULTS: There were 205 patient encounters identified; 89 patients had a UDS performed in the ED and 89% were obtained after the ED medical clearance. LOS were similar between the two groups, however, time to ED departure from time of medical clearance was delayed in the UDS group. BH providers mentioned UDS results < 25% of the time and no confirmatory tests were performed. There was no difference in BH LOS or discharge diagnosis of substance-abuse disorder. Patient charges for UDS over the month totaled $21,093. CONCLUSION: The UDS did not seem to have any significant effect on inpatient psychiatric care; whereas ED LOS and cost were both negatively affected. Based on these results, the UDS seems to be of little-to-no benefit in the setting of acute psychiatric illness.


Assuntos
Serviços de Emergência Psiquiátrica/normas , Programas de Rastreamento/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Urinálise/normas , Adolescente , Adulto , Medicina do Comportamento/instrumentação , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Programas de Rastreamento/métodos , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/economia , Estados Unidos , Urinálise/economia , Urinálise/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA