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BACKGROUND: Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. OBJECTIVE: To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems. METHODS: A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them. RESULTS: A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies. CONCLUSION: EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.
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Equidade em Saúde , Política de Saúde , Promoção da Saúde , Serviços de Saúde , Disparidades em Assistência à Saúde , Pesquisa , Formação de Conceito , Atenção à Saúde , Humanos , América Latina , Pobreza , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde , Populações VulneráveisRESUMO
We show that a scanning capacitance microscope (SCM) can image buried delta-doped donor nanostructures fabricated in Si via a recently developed atomic-precision scanning tunneling microscopy (STM) lithography technique. A critical challenge in completing atomic-precision nanoelectronic devices is to accurately align mesoscopic metal contacts to the STM defined nanostructures. Utilizing the SCMs ability to image buried dopant nanostructures, we have developed a technique by which we are able to position metal electrodes on the surface to form contacts to underlying STM fabricated donor nanostructures with a measured accuracy of 300 nm. Low temperature (T = 4 K) transport measurements confirm successful placement of the contacts to the donor nanostructures.
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Insufficient progress has been made to reduce morbidity and mortality for women, children and adolescents particularly in Humanitarian and Fragile settings (HFS). Midwives play a critical and unique role in ensuring communities receive quality and safe essential sexual, reproductive, maternal, newborn, child, and adolescent health services. A lack of knowledge exists on the availability and experiences of midwifery services in HFS. This manuscript provides an overview of the midwifery density in HFS and a synthesis of the experiences of women receiving midwifery care, and barriers and facilitators for midwives providing essential SRMNCAH services in HFS. Guided by an expert committee, a concurrent mixed methods approach was applied, using secondary analysis of primary quantitative and qualitative data sources. Quantitative analysis of the global distribution of midwives compared to fragility was undertaken. Qualitative analysis of experiences of receipt and provision of midwifery care was undertaken across four settings providing humanitarian care. There is a critically low density of midwives in humanitarian and fragile settings. Sub-Saharan Africa accounts for the highest levels of fragility yet lowest density of midwives able to provide SRMNCAH services. Lack of finances both constrains midwives from effectively providing services and prevent communities from utilising services. Sub-optimal working conditions through rising workloads, insufficient and/or inconsistent resources were frequently reported to impede midwives from providing care in HFS. Uniquely for HFS, threats to the safety and security of midwives to conduct their work was widely reported. Key facilitators identified included, complex adaptive health system designs to respond effectively to the rapidly changing HFS environment, realisation of supporting "power, agency and status" as instrumental for midwives to provide quality care and promotion of community-centric approaches may enable continuity of care and uptake of essential SRMNCAH services. Midwives are critical to protect the health and well-being of communities. They require urgent protection and prioritisation in HFS areas where the need is greatest.
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Hyperthyroidism is a frequent clinical situation that can be expressed by various signs and it is generally easy to diagnose. This review proposes to explain the diagnostic approach that affects therapeutic management by separating diseases with homogeneous and nodular thyroid.
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Hipertireoidismo , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/terapiaRESUMO
INTRODUCTION: There is no evidence in the literature relating to the evolution of e-cigarette use among cannabis users and multi-users (of alcohol, tobacco or cannabis). OBJECTIVE: To describe the evolution over 12 months of e-cigarette use in cannabis users and multi-users. METHODS: A prospective observational cohort study in general practice, between 2015 and 2016. RESULTS: A total of 4.8% of monitored cannabis users remained or became current users of e-cigarettes by the end of the monitoring period versus 4.5% among non-users of cannabis, with no statistically significant difference. A total of 5.1% of monitored multi-users remained or became current users of e-cigarettes by the end of the monitoring period versus 2.4% among the non-multi-users, with no statistically significant difference. Cannabis users and multi-users reported more e-cigarette experimentation through curiosity and following someone's suggestion, compared to non-cannabis users or non multi-users. No statistically significant association was found between cannabis or multi-drug use and staying or becoming a current e-cigarette user over 12 months. CONCLUSION: Cannabis users and multi-users would tend to experiment with e-cigarettes more than other patients but this use would not be sustained.
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Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Fumar Maconha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Vaping/epidemiologia , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Cannabis , Estudos de Coortes , Comorbidade , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Fumar/epidemiologiaRESUMO
Magnetostrictive Co77Fe23 films are fully suspended to produce free-standing, clamped-clamped, microbeam resonators. A negative or positive shift in the resonant frequency is observed for magnetic fields applied parallel or perpendicular to the length of the beam, respectively, confirming the magnetoelastic nature of the shift. Notably, the resonance shifts linearly with higher-bias fields oriented perpendicular to the beam's length. Domain imaging elucidates the distinction in the reversal processes along the easy and hard axes. Together, these results suggest that through modification of the magnetic anisotropy, the frequency shift and angular dependence can be tuned, producing highly magnetic-field-sensitive resonators.
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Parasite infections are more quantifiable postmortem than antemortem in horses. Thus a study was carried out examining dead horses for specific parasite species. Most of the weanling and older horses submitted to the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) for postmortem examination between November 22, 2016 and March 23, 2017 were examined for certain species of internal parasites. The stomach and duodenum from 69 horses were examined for bots (Gasterophilus spp.). Combined data for both Thoroughbred and non-Thoroughbred (16 other than Thoroughbred breeds/mixed breeds) horses revealed that the prevalence of Gasterophilus intestinalis was 19% (n=12) with 2nd instars (xÌ 8.5) and 39% (n=27) with 3rd instars (xÌ 90). The prevalence of Gasterophilus nasalis was 1.5% (n=1) for 2nd instars (xÌ 1) and 7% (n=5) for 3rd instars (xÌ 25). A few third instar G. intestinalis placed in 10% formalin showed slight movement at over two hundred hours later. The cecum and about 25cm of the terminal part of the ileum were examined from 139 horses for tapeworms (Anoplocephala spp.) and large strongyles (Strongylus spp.). The prevalence of A. perfoliata was 44% (n=62) and the average number of specimens per infected horse was 92.5. Strongylus vulgaris and Strongylus edentatus were not found in the gut of any horse.
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Autopsia/veterinária , Doenças dos Cavalos/parasitologia , Cavalos/parasitologia , Parasitos/isolamento & purificação , Strongylus/isolamento & purificação , Animais , Feminino , Cavalos/anatomia & histologia , MasculinoRESUMO
We describe a method to calibrate the spring constants of cantilevers for atomic force microscopy (AFM). The method makes use of a "piezosensor" composed of a piezoresistive cantilever and accompanying electronics. The piezosensor was calibrated before use with an absolute force standard, the NIST electrostatic force balance (EFB). In this way, the piezosensor acts as a force transfer standard traceable to the International System of Units. Seven single-crystal silicon cantilevers with rectangular geometries and nominal spring constants from 0.2 to 40 Nm were measured with the piezosensor method. The values obtained for the spring constant were compared to measurements by four other techniques: the thermal noise method, the Sader method, force loading by a calibrated nanoindentation load cell, and direct calibration by force loading with the EFB. Results from different methods for the same cantilever were generally in agreement, but differed by up to 300% from nominal values. When used properly, the piezosensor approach provides spring-constant values that are accurate to +/-10% or better. Methods such as this will improve the ability to extract quantitative information from AFM methods.
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We report three cases of isolated adrenal haematoma diagnosed at admission to the Emergency Department. Post-traumatic adrenal haematoma have been observed in 2% of patients with abdominal injury and can be life threatening in cases of bilateral haemorrhage with risk of acute adrenocortical insufficiency. Diagnosis remains difficult due to absence of clinical and biological specific parameters. Therefore, abdominal CT examination should be the gold standard in management of abdominal trauma patients.
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Doenças das Glândulas Suprarrenais/etiologia , Glândulas Suprarrenais/lesões , Hematoma/etiologia , Adolescente , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/terapia , Adulto , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The goal of this study was to assess the performances of magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) in determining tumor location, suggesting the specific diagnosis of tumors involving the peripharyngeal space and identifying findings suggestive for malignancy using histopathological findings as standard of reference. MATERIAL AND METHODS: The MDCT and MRI examinations of 99 patients with a total of 102 tumors located in the retropharyngeal, carotid and parapharyngeal spaces were retrospectively reviewed. MDCT and MRI examinations were independently analyzed for tumor location and specific histological type of tumor. Finally, benign or malignant criteria were evaluated. Agreement between imaging features and final histopathological diagnosis that served as the standard of reference was assessed with the Kappa statistic. RESULTS: Regarding tumor location almost perfect agreement was obtained between imaging findings and histopathological findings (kappa=0.86 and 0.92 for MDCT and MRI, respectively). Agreement between the results of imaging and histopathological findings regarding malignancy was substantial for MDCT (Kappa=0.73), MRI (Kappa=0.65). A definite histopathological diagnosis was suggested on the basis of imaging findings for 84 tumors and in agreement with the final histopathological diagnosis in 77/84 tumors (92%). CONCLUSION: MDCT and MRI provide accurate information to localize and characterize peripharyngeal tumors. These two examinations provide complementary data to identify imaging criteria that suggest malignancy.
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Imageamento por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Neoplasias Faríngeas/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.
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Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
PURPOSE: Soft tissue defects involving the anterior aspect of the knee are a frequent finding in a number of pathological conditions. The aim of this article is to describe a new pedicled flap consisting of a conventional medial gastrocnaemius muscle flap associated with a propeller flap based on a perforator of the medial sural artery. MATERIAL AND METHODS: Five males ranging in age between 26 and 72 years underwent a reconstruction of the soft tissue of the knee by means of the described procedure. Three patients sustained complex tissue loss subsequent to high-energy trauma; two losses were due to septic complications after elective knee surgery. RESULTS: Four flaps survived allowing adequate proximal tibial metaphysis and patella coverage. One patient underwent early above-the-knee amputation due to life-threatening septicaemia. DISCUSSION: The described chimaera flap consists of a medial gastrocnaemius flap with a skin paddle that is elevated on a perforator of the medial sural artery and then rotated according to the propeller flaps' principles. It provides effective coverage of large soft tissue defects of the knee. In the authors' experience, the propeller flap portion proved to be particularly useful to cover the patella, while the muscle flap was used to cover the proximal metaphysis of the tibia and fill the dead space if present.
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Joelho/cirurgia , Retalho Miocutâneo , Retalho Perfurante , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/transplante , Lesões dos Tecidos Moles/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Adenocarcinoma of the ethmoid is an aggressive tumor, with potential extension to surrounding structures. Leptomeningeal extension is a rarely reported entity. CASE REPORT: A carpenter, aged 55, developed multifocal cranial nerve-related symptoms 1 week after resection of adenocarcinoma of the ethmoid, evolving towards deteriorated general health status and death 10 weeks later. Brain MRI showed diffuse contrast enhancement of the cranial nerves, and repeated cerebrospinal fluid (CSF) examination found increased protein concentration associated with decreased glucose concentration, without malignant cells. The diagnosis of carcinomatous meningitis was based on the association of clinical, CSF and brain MRI data. DISCUSSION/CONCLUSION: Leptomeningeal dissemination of adenocarcinoma of the ethmoid is rare; diagnosis is guided by clinical signs. MRI reveals neurological spread, but the presence of malignant cells in the CSF is sufficient for diagnosis. Due to poor prognosis, the only currently available treatments are palliative.
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Adenocarcinoma/secundário , Seio Etmoidal , Carcinomatose Meníngea/secundário , Neoplasias dos Seios Paranasais/patologia , Humanos , Masculino , Carcinomatose Meníngea/diagnóstico , Pessoa de Meia-IdadeRESUMO
Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection.
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Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Cutâneas/cirurgia , Carcinoma/patologia , Carcinoma/cirurgia , Diagnóstico por Imagem , Músculos Faciais/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Melanoma/patologia , Melanoma/cirurgia , Meninges/cirurgia , Invasividade Neoplásica , Metástase Neoplásica/diagnóstico , Exenteração Orbitária , Glândula Parótida/cirurgia , Neoplasias Cutâneas/patologia , Crânio/cirurgia , Osso Temporal/cirurgiaRESUMO
INTRODUCTION: Acinic cell carcinoma is a rare form (2-4%) of parotid tumor. It is, however, the most frequent form of bilateral parotid tumor and the second most frequent form in children. CASE REPORT: A 22-year-old man had several years' history of left parotid tumor, discovered to be acinic cell carcinoma. MRI found a synchronous contralateral tumor of the same histologic nature. DISCUSSION/CONCLUSION: This case highlights the need for rigorous examination of the contralateral parotid in case of parotid tumor and especially of acinic cell carcinoma.
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Carcinoma de Células Acinares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Parotídeas/diagnóstico , Biópsia por Agulha Fina , Carcinoma de Células Acinares/patologia , Carcinoma de Células Acinares/radioterapia , Carcinoma de Células Acinares/cirurgia , Terapia Combinada , Humanos , Excisão de Linfonodo , Masculino , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Primárias Múltiplas/cirurgia , Glândula Parótida/patologia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/radioterapia , Neoplasias Parotídeas/cirurgia , Radioterapia Adjuvante , Reoperação , Adulto JovemRESUMO
Urban renewal efforts are a priority for many American cities. As efforts to reconstitute urban centers increase, the demolition of old, deteriorated structures has accelerated. Recent studies have identified demolitions as a potential source of environmental lead exposure. We conducted a study examining the relationship between demolition activity and blood lead levels of children residing in neighborhoods where demolition activity occurred. A retrospective cohort study was conducted in St. Louis City, Missouri. The study period was January 1, 2002 to December 31, 2002. Data were obtained from the Missouri Childhood Lead Poisoning Prevention Program's (CLPPP) lead surveillance system and St. Louis Demolition Permit Database. Children were considered exposed to a demolition if they had a blood lead test within 45 days of any demolition on a census block. Exposure was classified as both a dichotomous (yes/no) and a categorical (none/one/multiple) variable and was analyzed separately. Linear regression models were developed to determine effects of demolitions on blood lead levels. A total of 1196 children 6-72 months of age living in 395 census blocks were included. 314 (26.3%) were exposed and 882 (73.7%) were unexposed to a demolition. In an adjusted model, exposure to multiple demolitions was found to have significant effects on children blood lead levels (coefficient=0.281; 95% CI=0.069, 0.493; P-value=0.010). Age of the child, race, and age of housing where children's resided were also significant predictors. This study suggests that multiple demolitions within a census block may significantly increase children's blood lead levels. The findings may be useful to municipal planners in older cities where demolitions are being used as an urban renewal tool.
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Materiais de Construção , Exposição Ambiental/estatística & dados numéricos , Chumbo/sangue , Saúde da População Urbana , População Urbana/estatística & dados numéricos , Reforma Urbana , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Modelos Lineares , Masculino , Missouri , Estudos RetrospectivosRESUMO
Over the last two decades, major gains have been made in global health: life expectancy has increased dramatically; polio eradication is tantalizingly within reach; six million more children survived until their fifth birthday; malaria deaths halved, while more than 20 million people living with HIV gained access to lifesaving treatment. These are all colossal achievements, which amount to millions of lives saved. Despite these successes, progress has often been uneven, both between and within countries. There remains a 31-year discrepancy between the countries with the shortest and longest life expectancies, while more than half of the world's population is unable to access health services without incurring financial hardship. The implications of this are profound. Lack of access to affordable, quality health care perpetuates a vicious cycle of poverty and ill health, and every year millions of people, mostly in the world's poorest countries, die from sicknesses that we know how to prevent and treat. Tackling these challenges will require modern health systems that ensure services reach the poorest, the most vulnerable and those who are most often left behind. These systems must be more dynamic and multisectoral; they must move beyond a focus on diseases and curative care, and place the needs of people and communities at their core. They must also empower people to take charge of their health, with a lifelong focus on preventing the major causes of disease and ill health. Realizing this vision calls for health system reforms and policies grounded in tangible evidence for 'what works' and how. This is a fundamental contribution of the research community - but it means providing research evidence that is synthesized, accessible and contextualized, to enhance its applicability in different health systems. That's what this guide is all about. Evidence Synthesis for Health Policy and Systems: A Methods Guide aims to support researchers and decision-makers, wherever they may live in the world, to generate and use high-quality evidence synthesis on health policy and systems. It outlines well-conducted, applied examples of relevant methods and techniques. I trust it will prove useful to researchers and decision-makers everywhere as they seek to play their part in promoting health, keeping the world safe, and serving the vulnerable.
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Humanos , Saúde Global/educação , Equidade em Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Expectativa de Vida , Sistemas de Informação em Saúde/organização & administraçãoRESUMO
Introducción: Iniciamos en el 2000 un programa de control para la hipertensión arterial. Objetivo: Conocer el riesgo de morir y de presentar eventos cardiovasculares en los hipertensos bajo el cuidado del programa. Método: Se conformó una cohorte de 1.922 mayores de 65 años en agosto del 2000. Se consideró hipertenso si se conocía como tal, si recibía fármacos antihipertensivos o si tenía dos tomas de presión ≥ 140/90mmHg. Evento cardiovascular a las internaciones por enfermedad coronaria, insuficiencia cardiaca y accidente cerebrovascular. Expresamos densidad de incidencia (DI) de mortalidad y de eventos cardiovasculares cada100 persona-años en hipertensos y en no hipertensos y practicamos regresión de cox para ajustar por factores de riesgo en estudio. Se compara el tiempo al primer evento cardiovascular y a la muerte con Log Rank Test. Resultados: Edad 77,6 (± 5,4) años, 73,9% mujeres, el 48,3% eran hipertensos, diferentes significativamente con respecto a los normotensos en edad 79 (± 5) vs. 77 (± 5) p < 0,001, porcentaje de diabéticos (16,1 vs. 7,6%) p < 0,001. La DI del total de eventos fue de 1,86 vs. 3,02 (RR1,62, IC95% 1,09-2,42) La DI de mortalidad fue de 2,2 vs. 2,1 (RR 1.04,IC95% 0,69-1,58) Tiempo promedio de seguimiento 28 meses, el porcentaje de pacientes libre de eventos a este tiempo fue de 93% (hta) vs.96% (no hta) (p < 0,001). En el multivariado fueron significativas: diabetes,dislipidemia, tabaquismo, edad y sexo, perdiendo peso la hipertensión arterial, OR 1.30 (IC95% 0,86-1,98). Conclusiones: La hipertensión no incrementó el riesgo de presentar eventos cardiovasculares en nuestros hipertensos a 2,3 años
Introduction: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. Aim: To compare the risk of cardiovascular events and of dying inhypertensive patients under Program care. Method: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements ≥ 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. Results: Fourty eight point three percent of patients were hypertensiveand differed from normotensive patients as to age (79 (5) years vs. 77 (5) p< 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking,dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98) Conclusions: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up
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Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Humanos , Hipertensão/complicações , Doenças Cardiovasculares/etiologia , Anti-Hipertensivos/uso terapêutico , Hipertensão/epidemiologia , Doenças Cardiovasculares/epidemiologiaRESUMO
A partir de la sistematización de los estudios de prevalencia en 1993, continuamos con la presentación de los datos obtenidos en 1994, en conjunto con los del peíodo anterior. Esto permite tener una visualización gráfica de los resultados obtenidos pudiéndose analizar así sus tendencias. Si bien la metodología básica de los estudios no se ha modificado, a partir de diciembre de 1993 se incorporó al análisis, un sistema subjetivo que permite estratificar el nivel de gravedad de los pacientes y relacionarlo con el riesgo de infección intrahospitalaria. Este modelo fue validado a partir de los estudios de diciembre de 1993, abril y agosto de 1994, evaluándose además su reproducibilidad. El análisis comparativo de los estudios de prevalencia, muestra la persistencia de una proporción elevada de pacientes con acceso vascular (>50 por ciento) y catéter urinario (>20 por ciento), lo que determina un riesgo incrementado de desarrollar infecciones asociadas a estos factores. La tasa de prevalencia de infecciones intrahospitalarias se mantuvo por encima del 10 por ciento...