Búsqueda de caso y diagnóstico temprano en sujetos con sospecha de la EPOC

La enfermedad pulmonar obstructiva crónica es una patología comúnmente sub-diagnosticada. A la fecha no existe ninguna revisión sistemática publicada que evalué la búsqueda de caso (sujetos mayores de 40 años con factores de riesgo sin síntomas) y el diagnóstico temprano (factor de riesgo y síntomas) de la enfermedad. Métodos: Se condujo una revisión sistemática en tres bases de datos (Pubmed, CINAHL, EMBASE) para identificar estudios observacionales que reportaran la prevalencia de la EPOC en diferentes poblaciones expuestas a factores de riesgo (búsqueda de caso) o con factores de riesgo y síntomas (diagnóstico temprano), posteriormente con dichos estudios se calculó una prevalencia ponderada para cada grupo y esta se comparó con la prevalencia reportada en la población general en estudios locales. Así mismo se identificaron estudios para determinar la precisión de estrategias de búsqueda de caso (cuestionarios y el pico flujo espiratorio portátil PiKo 6®) usando la espirometría como patrón de oro para el diagnóstico de la EPOC. Dos autores seleccionaron de forma independiente los estudios que cumplían con los criterios de inclusión y exclusión y se evaluó la calidad metodológica por medio de la estrategia GRADE. El número necesario a tamizar (1/ prevalencia) para diagnosticar un caso de EPOC con espirometría fue calculado para los dos grupos de interés y comparado con el valor conocido de la prevalencia nacional. A los cuestionarios y estudios de Piko 6® se les evaluó las características operativas (VPP, VPN) y se calcularon las probabilidades pos test negativas y positivas teniendo en cuenta la prevalencia ponderada. Resultados Para la estrategia de búsqueda de caso, once estudios cumplieron los criterios de inclusión y la prevalencia ponderada en este grupo fue de 22% con un número necesario a tamizar (NNS) con espirometría de 5, comparado con un NNS de 11 obtenido de la prevalencia de la EPOC en Colombia 8.9% ( IC 95% 8.2-9.7). Posterior a la evaluación critica de varios cuestionarios y estudios de piko 6®, seleccionamos el cuestionario desarrollado por Mullernová y cols y el estudio de Frith y cols respectivamente. El cuestionario validado mostro una probabilidad postest positiva del 56% y postest negativa del 3% con un NNS de 2; para piko 6® los valores correspondientes fueron de 44%, 7% y 2 respectivamente. Para el diagnóstico temprano la prevalencia ponderada fue del 33.9% con un NNS de 3. Conclusiones El número necesario a tamizar para la estrategia de búsqueda de caso con cuestionarios y piko 6® es substancialmente menor que el número necesario a tamizar en la población general. El uso de cuestionarios o de piko 6® disminuye a 2 el NNS en el grupo de búsqueda de caso y a 3 para el grupo de diagnóstico temprano.

Análisis predictivo de los eventos adversos relacionados con los indicadores de eficiencia hospitalaria de una IPS de Bogotá

En este estudio se realizó un análisis predictivo de la aparición de eventos adversos de los pacientes de una IPS de Bogotá, Mederi Hospital Universitario de Barrios Unidos (HUBU) durante el año 2013; relacionados con los indicadores de eficiencia hospitalaria (Porcentaje de ocupación hospitalaria, número de egresos hospitalarios, promedio de estancia hospitalaria, número de egresos de urgencias, promedio de estancia en urgencias). Los datos fueron exportados a una matriz de análisis de las variables cualitativas; fueron presentadas con frecuencias absolutas y relativas, las variables cuantitativas (edad, tiempos de estancia) fueron presentadas con media, desviaciones estándar. Se agruparon los datos de eventos adversos y de eficiencia hospitalaria en una nueva matriz que permitiera el análisis predictivo la nueva matriz fue exportada al software de modelación estadístico Eviews 6.5; se especificaron modelos predictivos multivariados para la variable número de eventos adversos, respecto de los indicadores de eficiencia hospitalaria y se estimaron las probabilidades de ocurrencia, análisis de correlación y multicolinealidad; los resultados se presentaron en tablas de estimación para cada modelo, se restringieron los eventos adversos prevenibles y no prevenibles información obtenida a través de un sistema de información que registra los factores relacionados con la ocurrencia de eventos adversos en salud, a través del sistema de reporte de eventos en salud, reporte en las historias clínicas, reporte individual, reporte por servicio, análisis de datos y estudios de caso, de la misma forma fueron extraídos los datos de eficiencia hospitalaria para el mismo periodo. El análisis y gestión de eventos adversos pretende establecer estrategias de mejoramiento continuo y análisis de resultados frente a los indicadores de eficiencia que permitan intervención de los factores de riesgo operativo de los servicios del Hospital Universitario de Barrios Unidos (HUBU), relacionados con eventos adversos en la atención de los pacientes en especial se debe enfocar en la gestión de los egresos de pacientes de acuerdo a los resultados obtenidos con el fin de alinearse y fortalecer las políticas de seguridad del paciente para brindar una atención integral con calidad y eficiencia, disminuyendo las quejas en la atención, las glosas, los riesgos jurídicos, de acuerdo al modelo predictivo estudiado.

Lumbar estrecho: experiencia de 10 años en la fundación santa fé de Bogotá

El canal lumbar estrecho de tipo degenerativo, es una enfermedad que se presenta en pacientes entre la quinta y la sexta década de vida; es la causa más común de cirugía lumbar después de los 65 años. Este trabajo busca determinar cuáles son los factores asociados a la presentación de eventos adversos o re-intervención en cirugía de canal lumbar estrecho en la Fundación Santa Fe de Bogotá en los años comprendidos entre 2003 y 2013. Métodos: se realizó un estudio de prevalencia de tipo analítico, en donde se analizaron 249 pacientes sometidos a intervención quirúrgica por cirugía de canal lumbar estrecho.

Kung slår dam : våldsforskningsmetodologi i ett våldsamt jämställt Sverige

King captures queen. Methodology in research on violence in violently equal Sweden Research and debate on violence against women in a Swedish context is here discussed from a perspective that focuses on the different understandings and epistemological claims behind existing positions. I crystallize a dominant perspective on violence, centred around fragmentation/deviance, and a challenging feminist understanding, centred around coherence/normality. I relate these understandings to a wider set of methodological choices and epistemological claims within research on violence against women, captured in what I call a discourse on partner violence (fragmentation) and a feminist discourse on men’s violence against women (coherence). The article also examines the reactions, in media and academic life, that a quantitative study on men’s violence against women in Sweden provoked, Captured queen, men’s violence against women in equal Sweden. A prevalence study (Lundgren et al 2001). By applying a coherent methodological approach, stemming from the feminist discourse on violence against women, the study seems to have placed itself outside what was comprehensible for many voices in the debate (from media and the academic field). I discuss the hostile reactions the study aroused, in relation to its methodology and the above presented conflicting understandings that occupy the research field “violence against women”.

Edentulismo funcional e seus fatores de risco em adultos

The purpose of this study was to investigate the risk factors to the functional edentulism in adults aged 35 a 44 years old of Natal-RN, 278 adults took part in the study. They were all selected from a previous dental loss prevalence study thus being complemented by an active research. The study was a case-control based and data collection was made though a survey as well as with a clinical examination. The cases were identified through individuals with 20 or more teeth. Age and gender were used as variables of pairing off. The data was analyzed through chi-square, significant level of 95% to the checking of its force associations. The independent variables were grouped in three levels. The first one, more macro, is related to the region where the individual lives, which was also related to the second level, the family-based one, linked with a third level, at this low socio-economical level, where the domiciliary density was favorable, living in capital cities, regions with prime sanitary condicitions, with predominant possibility of accessing the public dental service, but in despite of this, only looking for this service when tooth ache is felt, where preferentially an aid dressing treatment is executed in detriment of preventive procedures. From all the samples, less than 25% of the individuals make use of tobacco and alcoholic beverages for quite a number of years. There was an association of functional edentulism with all the studied variables in a regional method. In the family-based with Critério Brasil (OR=4,45) and monthly wages (OR=9,62) and to an to an individual level, the associations took place with the current use of kind of attendance (OR=1,78), looks for dressing treatment (OR=2,51), does not look for preventive treatment (OR=3,31), pain as the main cause of demand (OR=1,92), previous treatment as the demanding reason for dental service (OR+0,28), interval of the last visit to the dental service (OR=1,35) and when advise was received (OR=1,66). It was noticed from the results that the functional edentulism is much more expressive in those families which live in environments with precarious social economical sanitary conditions. Such conditions seem to have a direct influence upon the family social economical conditions which are also shown in detriment to functional edentulism. In the same way, the collection of variants influence the social economical conditions of the individual, as well as the kind of dental service searched by them, the reason of the search and the interval of the last visit to the dental service were strong determiners to the functional edentulism. Beyond that, individual habits like the use of tobacco and its frequency on its previous use influenced in a significant way the existence of functional edentulism in the studied population

Prevalência e fatores de risco à persistência de hábitos bucais de sucção não nutritiva em crianças de 3 a 5 anos de idade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Avaliação de alterações orais em pacientes submetidos a transplante de medula óssea

Bone marrow transplantation (BMT) is currently the best therapeutic option for patients with hematologic diseases, solid tumors or autoimmune disorders. It is characterized by intravenous infusion of hematopoietic stem cells in order to restore marrow function. However, this procedure requires concomitant immunosuppression treatment, which favors the development of certain complications, often manifested in the oral cavity. This study aimed to evaluate the incidence of oral changes in patients undergoing BMT and to correlate these results with clinical aspects related to the patients and the transplants performed. This is a prevalence study, with cross-sectional design, carried out in a BMT service at the Institute of Onco-Hematology of Natal (ION) and Natal Hospital Center. Data collection was based on questionnaires, clinical examination of the oral cavity and consultation in the medical records. The sample consisted of 51 patients undergoing BMT. After the analysis, was found a general status with good health conditions and presence of oral changes in about half of patients who composed the sample. The manifestations observed were, in decreasing order of frequency: mucositis; gingival alteration and thrombocytopenic purpura; mucosal pigmentation; lichenoid reaction and candidiasis. The oral changes were observed more frequently in cases of allogeneic TMO, in different periods post-transplant, without significant differences related to the source of cells. It was found statistically significant association between the presence of graft-versus-host disease (GVHD) and oral changes (p < 0,001). Therefore, it is concluded that there is a relatively high incidence of changes in oral cavity of patients receiving bone marrow transplantation, a fact which confirms the need to consider this site for examination, diagnosis, treatment and prognosis of possible complications of BMT

Prevalência de doenças sexualmente transmissíveis em mulheres profissionais do sexo, em um município do interior paulista, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparação entre hipertensão autoreferida e pressão arterial casual e presença de fatores de risco em funcionários da saúde Bauru e Jaú

Model: Prevalence study. Objectives: To evaluate the presence of self-reported hypertension to compare with blood pressure measurements. Besides, this work investigated health information level of workers and if the job position has any influence on blood pressure (BP). Methods: This study evaluated 349 health workers (44±10 years old) from Bauru and Jau cities, who answered some questions about history of health condition, use of medicines, past surgeries as well as social, scholar and physical conditions and had their blood pressure measured. Each subject selfreported as normotensive or hypertensive. Values of systolic ≥ 140 mmHg and/or diastolic PA ≥ 90 mmHg were considered elevated. Among the health workers evaluated, 198 were submitted to anthropometric and biochemical evaluations. Values are presented as means ± SD and frequency of distribution. It was used T-student test (p<0.05). Results: From all workers evaluated only 16% self-reported as hypertensive, which 56% presented high BP, however 91% used to take antihypertensive medicines. Among the 84% who self-reported as normotensive, 24% presented high BP and 8% used to take medicines. Although most of the employees of each section self-reported as normotensive, more than a half presented high BP and which was more common in the health's section (76.3%). Conclusion: These results suggest that besides the majority of the employees self-reported as normotensive, an elevated number of health workers presented high blood pressure and used to take medicines inappropriately, which indicates that they did not have enough knowledge about their health. Furthermore, it was observed that Health Section presented the higher blood pressure values.

Associação entre doenças crônicas em adultos e redução dos níveis de atividade física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prevalência das doenças sexualmente transmissíveis em mulheres profissionais do sexo do Município de Botucatu/SP

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Environmental lead poisoning among children in Porto Alegre state, Southern Brazil

OBJECTIVE: To estimate the prevalence of lead poisoning in children and to identify associated factors, as well as possible local sources of contamination. METHODS: A cross-sectional prevalence study conducted in 2006 with a random sample of 97 children age zero to five years from a neighborhood in Porto Alegre, Southern Brazil. Blood lead levels were measured and a questionnaire administered to collect information on sociodemographics, recycling and dwelling. A preliminary environmental evaluation was carried out with direct analysis of soil and indirect analysis of air pollution with bioindicators to identify possible sources of contamination. To analyze lead concentrations from the different collection sites, for each type of material studied, ANOVA was performed with a Brown-Forsythe adjustment for heteroscedasticity and with Dunnett's T3 procedure for multiple comparisons of unequal variances. RESULTS: Blood lead levels >= 10.0 mu g/dL was found in 16.5% of children. Recycling of waste at home, low father's education level, and increased age of children were associated with increase blood lead levels. High lead levels were found in soil, and there was little indication of lead air pollution. CONCLUSIONS: A high prevalence of lead poisoning was identified, and the potential sources of contamination in this community appear related to waste recylcing activities. Studies should be conducted with other populations of Brazilian children and evaluate potential sources of local and general contamination, to accurately characterize this issue in Brazil.

Genotypes and antibiotic resistance of canine Campylobacter jejuni isolates

Campylobacter jejuni is the most important cause of bacterial gastroenteritis in humans. It is a commensal in many wild and domestic animals, including dogs. Whereas genotypes of human and chicken C. jejuni isolates have been described in some detail, only little information on canine C. jejuni genotypes is available. To gain more information on genotypes of canine C. jejuni and their zoonotic potential, isolates from routine diagnostics of diarrheic dogs as well as isolates of a prevalence study in non-diarrheic dogs were analyzed. Prevalence of thermophilic Campylobacter among non-diarrheic dogs was 6.3% for C. jejuni, 5.9% for Campylobacter upsaliensis and 0.7% for Campylobacter coli. The C. jejuni isolates were genotyped by multi locus sequence typing (MLST) and flaB typing. Resistance to macrolides and quinolones was genetically determined in parallel. Within the 134 genotyped C. jejuni isolates 57 different sequence types (ST) were found. Five STs were previously unrecognized. The most common STs were ST-48 (11.2%), ST-45 (10.5%) and ST-21 (6.0%). Whereas no macrolide resistance was found, 28 isolates (20.9%) were resistant to quinolones. ST-45 was significantly more prevalent in diarrheic than in non-diarrheic dogs. Within the common time frame of isolation 94% of the canine isolates had a ST that was also found in human clinical isolates. In conclusion, prevalence of C. jejuni in Swiss dogs is low but there is a large genetic overlap between dog and human isolates. Given the close contact between human and dogs, the latter should not be ignored as a potential source of human campylobacteriosis.

Association of self-reported physical activity and performance in the physical fitness assessment among Airmen

The U.S. Air Force, as with the other branches of military services, has physical fitness standards imposed on their personnel. These standards ensure a healthy and fit combat force. To meet these standards, Airmen have to maintain a certain level of physical activity in their lifestyle. Objective. This was a cross sectional (prevalence) study to evaluate the association of Airmen's self-reported physical activity and their performance in the Air Force Physical Fitness Assessment in 2007. Methods. The self-reported physical activity data were obtained from the Air Force Web Health Assessment (AF WEB HA), a web-based health questionnaire completed by the Airmen during their annual Preventive Health Assessment. The physical activity levels were categorized as having met or not having met the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) physical activity recommendations. Physical Fitness scores were collected from the Air Force Fitness Management System (AFFMS), a repository of physical fitness test data. Results. There were 49,029 Airmen who answered the AF WEB HA in 2007 and also took their physical fitness test. 94.4% (n = 46,304) of Airmen met the recommended physical activity guidelines and 79.9% (n = 39,178) passed the fitness test. Total Airmen who both met the physical activity recommendations and passed the fitness test was 75.6% (n = 37,088). Airmen who did not meet the activity recommendations and also failed the fitness test totaled 635 or 1.3% of the study group. The Mantel-Haenszel Chi-Square analysis of the data on the activity levels and the physical fitness test relationship was the following χ2 = 18.52, df 1, and p = <0.0001. The Odds Ratio (OR) was 1.22 (95% CI 1.12, 1.34). Conclusion. The study determined that there was a positive association between Airmen's self-reported physical activity and their performance in the physical fitness assessment.^