RESUMO
This study examined the feasibility, acceptability, and initial impact of bridges to better health and wellness (B2BHW), a culturally-adapted health care manager intervention for Hispanics with serious mental illness (SMI). Thirty-four Hispanics with SMI and at risk for cardiovascular disease were enrolled. Mixed-linear models were used to examine changes over 12-months on patient activation, self-efficacy, patient-rated quality of care, receipt of preventive primary care services, and quality of life. The majority of participants completed the intervention (85%) with high satisfaction. Significant improvements were found for patient activation, self-efficacy, patients' ratings of quality of care, and receipt of preventive primary care.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Hispânico ou Latino , Transtornos Mentais , Aceitação pelo Paciente de Cuidados de Saúde , Serviços Preventivos de Saúde , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Autoeficácia , Adulto , Idoso , Administração de Caso , Assistência à Saúde Culturalmente Competente , Estudos de Viabilidade , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Satisfação do Paciente , Assistência Centrada no Paciente , Qualidade de VidaRESUMO
This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.
Assuntos
Hispânico ou Latino/psicologia , Transtornos Mentais/etnologia , Atenção Primária à Saúde , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Cidade de Nova Iorque , Participação do Paciente , Qualidade da Assistência à Saúde , Racismo , Autoeficácia , EstereotipagemRESUMO
Latinos with serious mental illness (SMI) experience health and health care disparities and may benefit from interventions that improve access to, coordination of, and receipt of primary care services. The aim of this qualitative study was to examine the experiences of Latinos with SMI and at risk for cardiovascular disease participating in Bridges to Better Health and Wellness (B2BHW), a culturally-adapted health care manager intervention delivered in a public outpatient mental health clinic. A total of 29 Latino participants completed a post-intervention survey that included an open-ended question about the three things they liked most about B2BHW; a subset of 16 participants participated in one of three post-intervention focus groups. Results indicate that what mattered most to participants was the health education they received, the positive relationships they formed with their health care managers, the care coordination assistance they obtained, and the motivation and activation they gained from this intervention. Study findings suggest that key elements of the health care manager intervention (e.g., care coordination, and patient activation) shaped participants' experiences with B2BHW and were perceived as beneficial.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Hispânico ou Latino , Transtornos Mentais/terapia , Serviços Preventivos de Saúde , Atenção Primária à Saúde , Adulto , Idoso , Administração de Caso , Assistência à Saúde Culturalmente Competente , Feminino , Grupos Focais , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Participação do Paciente , Satisfação do Paciente , Assistência Centrada no Paciente , Pesquisa Qualitativa , Qualidade de VidaRESUMO
To date, hepatotoxicity with anti-TNF therapy has been associated with concomitant liver-toxicity drugs, infection or malignant diseases. We report the case of one patient with spondyloarthropathty who presented severe liver dysfunction related to infliximab. After the second infusion serum controls showed an slightly increase of transaminases. Before the administration of fifth infusion, infliximab therapy was stopped due to severe liver damage (AST 327 mU/ml, ALT 656 mU/mL, GGT 140 mU/mL, alkaline phosphate 227 mU/mL). Ten weeks after infliximab discontinuation serum concentrations of liver blood tests were normal but ankylosing spondylitis symptoms had relapsed. Therefore, he was treated with etanercept with a rapid and sustained improvement. Serum concentrations of albumin, AST, ALT, GGT and alkaline phosphate were followed and did not change for five months.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Imunoglobulina G/uso terapêutico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Espondiloartropatias/tratamento farmacológico , Etanercepte , Humanos , Infliximab , Masculino , Pessoa de Meia-IdadeAssuntos
Atitude , Centros Comunitários de Saúde Mental , Grupo Associado , Diretores Médicos/psicologia , Transtornos Psicóticos/reabilitação , Reabilitação Vocacional/psicologia , Adaptação Psicológica , Adulto , Feminino , Objetivos , Humanos , Descrição de Cargo , Satisfação no Emprego , Mentores , New York , Transtornos Psicóticos/psicologia , Autorrevelação , Apoio SocialRESUMO
SCOPE: 5-Hydroxymethylfurfural (HMF) is a furanic compound produced in heat-processed foods by nonenzymatic browning reactions. HMF has been demonstrated to be hepato- and nephrotoxic in animals with a link to its metabolite 5-sulfooxymethylfurfural (SMF). To date little is known about either the formation of SMF from ingested HMF or the formation of DNA adducts in animals or human beings. METHODS AND RESULTS: To assess SMF in vivo formation, we first performed a study in mice treated with high/low doses of oral HMF. We found increased concentrations of SMF in plasma and DNA SMF-adducts in leukocytes, hepatic tissue, and kidneys by means of LC-MS/MS, but no spatial formation in such tissues was observed by MALDI-MS imaging technology due to low sensitivity. In a second experiment, we measured the exposure to HMF in a Spanish preadolescent population. We analyzed the concentration of HMF metabolites (plasma, urine) and measured, for the first time, the presence of SMF in plasma and DNA SMF-adducts in leukocytes. CONCLUSION: This study provides the first evidence that oral HMF is readily transformed into SMF in vivo, giving rise to the formation of DNA adducts in a direct relation with HMF intake, both in animals and human beings.
Assuntos
Furaldeído/análogos & derivados , Administração Oral , Animais , Criança , Adutos de DNA/metabolismo , Feminino , Manipulação de Alimentos , Furaldeído/administração & dosagem , Furaldeído/sangue , Furaldeído/farmacocinética , Furaldeído/urina , Humanos , Masculino , Camundongos Endogâmicos , EspanhaRESUMO
BACKGROUND: Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community. METHODS: The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. RESULTS: The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention. CONCLUSIONS: Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI.
Assuntos
Pessoal Administrativo/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/normas , Planejamento de Assistência ao Paciente/normas , Centros Comunitários de Saúde Mental , Pesquisa Participativa Baseada na Comunidade , Comportamento Cooperativo , Atenção à Saúde/normas , Hispânico ou Latino/estatística & dados numéricos , Humanos , Relações Interprofissionais , Transtornos Mentais/etnologia , Cidade de Nova Iorque , Melhoria de QualidadeRESUMO
La leucemia linfoblástica aguda (LLA) es la patología oncológica más frecuente en la infancia. El tratamiento con quimioterapia intensiva es la inducción, donde la complicación precoz es la neutropenia febril(NF). El presente trabajo tuvo por objetivo establecer la relación entre sexo del niño, qrupo etario y la instrucción materna con la aparición de NF en niños con LLA durante el período de inducción del del tratamiento quimioterápeutico, asistidos en el Hospital Pediátrico "Juan Pablo II" entre 2004 y 2012. Se planteó un estudio cuantitativo y analítico de casos y controles. Los casos fueron niños con LLA que padecieron NF y los controles aquellos que no la presentaron. La muestra se conformó con 60 unidades de análisis seleccionadas de historias clínicas de niños con LLA; 20 casoso y 40 controles. Los resultados mostraron que el 65 per cent de casos eran niñas, que bajó a 38 per cent en los controles, tras la asociación de variables presentaron tres veces más probabilidades de padecer NF que los niños (p<0,04). En el grupo etario, la NF afectó al 65 per cent de niños de 1 a 5 años y los controles fueron de 57 per cent de esas edades. Al relacionar grupo etario y NF, la franja de 1 a 5 años presentó 1,37 más posibilidades de presentar el suceso (p<0,57). Analizando la instrucción materna, se halló en los casos que el 75 per cent tenía instrucción incompleta, sobre el 68 per cent de controles. Al correlacionar las variables, los casos mostraron 1,4 más probabilidades de padecer NF que los de madres con instrucción completa(p<0,55). En conclusión, ser niño y tener una madre con escolaridad incompleta aumenta los riesgos de NF en niño con LLA en fase de inducción del tratamiento...
Abstract: The acute lymphoblastic leukemia(ALL) is the most frequent pathology of the oncology during the childhood. The treatment with induced chemotherapy is the induction in which the premature complication is the febrile neutropenia (FN). The objetive of this assigment was to establish the relationship that exists between chidrem's gender, age group, instruction of mothers and the emergence of FN in infants with ALL during the period of induction of the treatment of chemotherapy nursed in peadiatric hospital Juan Pablo II from 2004 to 2012. A quantitative and analytic research of cases and controls was proposed. Considering the cases, they were infants with ALL that suffered from FN. The controls, however, were those that did not presented it. The test was based on 60 units of analysis selected from the medical record of children with ALL, 20 cases and 40 controls...
Assuntos
Humanos , Criança , Tratamento Farmacológico , Neutropenia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Quimioterapia de Indução/efeitos adversos , FebreRESUMO
Se hace un análisis de 22 pacientes estudiados en nuestro departamento, a quienes se les diagnosticó un síndrome del "robo" de la subclavia. Se exponen las características clínicas principales y, sobre todo, se hace énfasis en los hallazgos radiográficos. Dos de los pacientes presentaron un doble "robo". Para llegar al diagnóstico correcto es indispensable una buena valoración del cuadro clínico y un estudio radiográfico realizado con técnica depurada(AU)
Assuntos
Síndrome do Roubo SubclávioRESUMO
Fundamento: El objetivo de este estudio fue valorar la eficacia y seguridad del tratamiento con cinco inyecciones intraarticulares de ácido hialurónico (Adant(r), Tedec-Meiji Farma, S.A., Madrid) en pacientes con gonartrosis mediante un estudio prospectivo multicéntrico, abierto y no controlado en condiciones asistenciales reales con un seguimiento de 6 meses. Material y métodos: Se incluyeron 243 pacientes en 42 centros españoles, siendo evaluables 237. Los pacientes presentaban diagnóstico clínico y radiológico de artrosis de rodilla, clasificados por el grado radiológico siguiendo la escala de Kellgren-Lawrence: Se utilizó la escala visual analógica (EVA) para valorar el dolor espontáneo y en actividad estandarizada y el goniómetro para la movilidad articular antes y después de finalizar el tratamiento. La eficacia fue evaluada además por el paciente y por el investigador (escala Likert). Resultados: En todas las visitas de seguimiento con respecto a la situación basal hubo disminución del dolor (p < 0,0001) y mejora de la función articular (p < 0,0001) con independencia del grado de artrosis. Estos resultados se confirman por la evaluación del investigador, 6 meses después del tratamiento (el 75 por ciento respuesta excelente o muy buena, el 6,5 por ciento buena, el 8,2 por ciento regular y el 10,3 por ciento nula). No hubo diferencias estadísticamente significativas transcurridos 6 meses entre pacientes con artrosis de grado I-II y III. Se registraron 23 acontecimientos adversos, 16 locales y de carácter leve y ninguno grave. Conclusiones: El ácido hialurónico es un tratamiento seguro, sintomático de acción lenta y duradera (SYSADOA) con resultados beneficiosos tanto para artrosis leves como graves, como se demuestra en este estudio de seguimiento de 6 meses de duración. (AU)
Assuntos
Ácido Hialurônico/administração & dosagem , Adjuvantes Imunológicos/administração & dosagem , Articulação do Joelho , Artropatias/tratamento farmacológico , Seguimentos , Eficácia , Injeções Intra-Articulares , Estudos Prospectivos , Resultado do Tratamento , Índice de Gravidade de Doença , Análise de VariânciaRESUMO
Con el crecimiento y desarrollo de la enseñanza del tejido y sus áreas afines, los profesores de los Programas de Textiles y Artes Plásticas de la Universidad de los Andes de Bogotá, realizaron investigaciónes, tratando temas como del campo textil y de grupos étnicos de las regiones de Colombia. Con la aparición de la formación del tejido como disciplina profesional dentre de las universidades, la aplicación de ese legado se ha convertido en un problema en la enseñanza. A ello hay que agregar que el movimiento textil se alimenta en esencia del pasado. Este pasaso permite al artita buscar nuevas formas y medios de expresión. Por tratarse de programas innovadores y complementarios en la formación de los estudiantes, los Programas de Textiles y Artes Plásticas conjugan la labor de profesores con gran interés por buscar nuevos caminos sui géneris en las distintas áreas del proceso creativo. Al desarrollar propuestas orientadoras se motiva al estudiante hacia un desarrollo profesional
Assuntos
ColômbiaRESUMO
Con el crecimiento y desarrollo de la enseñanza del tejido y sus áreas afines, los profesores de los Programas de Textiles y Artes Plásticas de la Universidad de los Andes de Bogotá, realizaron investigaciónes, tratando temas como del campo textil y de grupos étnicos de las regiones de Colombia. Con la aparición de la formación del tejido como disciplina profesional dentre de las universidades, la aplicación de ese legado se ha convertido en un problema en la enseñanza. A ello hay que agregar que el movimiento textil se alimenta en esencia del pasado. Este pasaso permite al artita buscar nuevas formas y medios de expresión. Por tratarse de programas innovadores y complementarios en la formación de los estudiantes, los Programas de Textiles y Artes Plásticas conjugan la labor de profesores con gran interés por buscar nuevos caminos sui géneris en las distintas áreas del proceso creativo. Al desarrollar propuestas orientadoras se motiva al estudiante hacia un desarrollo profesional