Aplicación de la escala National Institutes of Health Stroke Scale (NIHSS) en pacientes ingresados en el Hospital Vicente Corral Moscoso con diagnóstico de enfermedad cerebrovascular isquémica, enero-diciembre de 2004, Cuenca-Ecuador

Estudio descriptivo de pacientes con ictus isquémico ingresados en el Hospital Vicente Corral dentro de las 24 horas de inicio de síntomas, desde enero a diciembre de 2004. El daño neurológico inicial fue cuantificado usando la NIHSS. El desenlace neurológico fue valorado a los 7 días y 3 meses utilizando el Indice de Barthel. Resultados: De 75 pacientes ingresados en el período de estudio, 24 cumplieron los criterios de inclusión y 23 completaron el seguimiento. A los 3 meses 66.7de pacientes, con puntaje inicial NIHSS menor que 6 evolucionaron a un resultado excelente. Los pacientes con un puntaje NIHSS igual o mayor que 16 tuvieron un mal desenlace. El 50de pacientes con un puntaje de 16 a 20 y los pacientes con puntaje mayor que 20 fallecieron. En el análisis estadístico, un puntaje mayor a 13 tuvo un Odds Ratio de 49.5 (IC 954.5 - 480.5) para un desenlace fatal a los 3 meses. La asociación fue significativa lo que otorga al punto de corte de 13 puntos una gran validez para pronosticar un buen o mal desenlace. Conclusión. Aplicando el NIHSS a los pacientes con ictus isquémico observamos que un puntaje igual o mayor a 16 predice una alta probabilidad de muerte o severa incapacidad, mientras que un puntaje igual o menor a 6 pronostica una buena recuperación. Descriptores DeCS. Ictus isquémico, NIHSS, Índice de Barthel

Between path dependency and contingency: new challenges for the geography of port system evolution.

Seaports play a critical role as gateways and facilitators of economic interchange and logistics processes and thus have become crucial nodes in globalised production networks andmobility systems. Both the physical port infrastructure and its operational superstructure have undergone intensive evolution processes in an effort to adapt to changing economic environments, technological advances,maritime industry expectations and institutional reforms. The results, in terms of infrastructure, operator models and the role of an individual port within the port system, vary by region, institutional and economic context. While ports have undoubtedly developed in scale to respond to the changing volumes and structures in geographies of trade (Wilmsmeier, 2015), the development of hinterland access infrastructure, regulatory systems and institutional structures have in many instances lagged behind. The resulting bottlenecks reflect deficits in the interplay between the economic system and the factors defining port development (e.g. transport demand, the structure of trade, transport services, institutional capacities, etc. cf. Cullinane and Wilmsmeier, 2011). There is a wide range of case study approaches and analyses of individual ports, but analyses from a port system perspective are less common, and those that exist are seldom critical of the dominant discourse assuming the efficiency of market competition (cf. Debrie et al., 2013). This special section aims to capture the spectrum of approaches in current geography research on port system evolution. Thus, the papers reach from the traditional spatial approach (Rodrigue and Ashar, this volume) to network analysis (Mohamed-Chérif and Ducruet, this volume) to institutional discussions (Vonck and Notteboom, this volume; Wilmsmeier and Monios, this volume). The selection of papers allows an opening of discussion and reflection on current research, necessary critical analysis of the influences on port systemevolution and,most importantly, future directions. The remainder of this editorial aims to reflect on these challenges and identify the potential for future research.

THE CONTRIBUTION OF THE GEOGRAPHY OF DISABILITY TO THE DEVELOPMENT OF ‘ACCESSIBLE TOURISM’

The article presents an outline of the evolution of the geography of disability (since the 1930s) taking into account significant issues in the creation of theoretical foundations as well as practical action in ‘accessible tourism’. It may be considered a review. Based on an analysis of literature, the first section presents a definition of ‘accessible tourism’ and the development of the geography of disability, the result of which is the geographical model of disability. The second section is a synthetic presentation of the effect of geographical research on the development of theoretical accessible tourism concepts and their implications in practice. The final conclusions highlight the need to identify the level of detail in universal design principles applied to buildings, spaces, services, which are to fulfil the criteria of accessibility for people with various types of disability.

Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration

This work aimed to evaluate how aging could influence patients' perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient's records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.

Fundamental improvements needed for timely promulgation of health program regulations, Department of Health, Education and Welfare : report of the Comptroller General of the United States.

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Perception of health benefits of dietary fibre among the Portuguese population

Introduction: Dietary iber (DF) has been part of human diet since ever, and its beneits for the human health have been well estab-lished and scientiically conirmed. Among these stand improved gastrointestinal functions, prevent cholesterol, diabetes or CVD. Objectives: To study the level of knowledge of people residing in Portugal about the health effects related to an adequate ingestion of DF. Methods: This is a descriptive cross-sectional study carried out on a non-probabilistic sample of 382 adults residing in Portugal. The questionnaire included a section about the socio-demographic characteristics (age, gender, level of education and living environ- ment) and another about the relation between dietary iber and possible beneicial effects to treat and prevent diseases. The data was treated using the SPSS software (V22). Results: The results allowed concluding that people were dif- ferently informed about the effects of DF in preventing and/or treating different diseases, being constipation the most recog- nized, followed in decreasing order by obesity, bowel cancer, cholesterol, cardiovascular diseases, diabetes and breast can- cer. The results also showed that signiicant differences were encountered between age groups for most of the diseases evalu- ated, but not between genders, levels of education or living en- vironments. Conclusions: Generally, it was concluded that the participants in this study were relatively well informed about the roles of DF in preventing and/or treating various diseases.

Place, policy and practitioners: on rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the United Kingdom

A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare. Authors have focused on various aspects of place and care, with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients’ homes and other sites. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic.

Good Practices in the field of Health Promotion and Chronic Disease Prevention

Background; Approach and Concept; Methods (Country reviews; Definition of Good Practice Criteria; Identification of Good Practice Examples; Identification of transferable practices / elements); Outputs

Joint Action CHRODIS Work Package 5 - Good practices in the field of health promotion and chronic disease prevention across the life cycle: outcomes at a glance

Associated Partners in the Work Package 5: National Health Institute Doutor Ricardo Jorge (INSA), Portugal (Luciana Costa)

Men's experiences of receiving objective feedback on physical activity and other indicators of health risk, within the context of a gender-sensitised weight loss intervention

Receiving personalised feedback on body mass index and other health risk indicators may prompt behaviour change. Few studies have investigated men’s reactions to receiving objective feedback on such measures and detailed information on physical activity and sedentary time. The aim of my research was to understand the meanings different forms of objective feedback have for overweight/obese men, and to explore whether these varied between groups. Participants took part in Football Fans in Training, a gender-sensitised, weight loss programme delivered via Scottish Professional Football Clubs. Semi-structured interviews were conducted with 28 men, purposively sampled from four clubs to investigate the experiences of men who achieved and did not achieve their 5% weight loss target. Data were analysed using the principles of thematic analysis and interpreted through Self-Determination Theory and sociological understandings of masculinity. Several factors were vital in supporting a ‘motivational climate’ in which men could feel ‘at ease’ and adopt self-regulation strategies: the ‘place’ was described as motivating, whereas the ‘people’ (other men ‘like them’; fieldwork staff; community coaches) provided supportive and facilitative roles. Men who achieved greater weight loss were more likely to describe being motivated as a consequence of receiving information on their objective health risk indicators. They continued using self-monitoring technologies after the programme as it was enjoyable; or they had redefined themselves by integrating new-found activities into their lives and no longer relied on external technologies/feedback. They were more likely to see post-programme feedback as confirmation of success, so long as they could fully interpret the information. Men who did not achieve their 5% weight loss reported no longer being motivated to continue their activity levels or self-monitor them with a pedometer. Social support within the programme appeared more important. These men were also less positive about objective post-programme feedback which confirmed their lack of success and had less utility as a motivational tool. Providing different forms of objective feedback to men within an environment that has intrinsic value (e.g. football club setting) and congruent with common cultural constructions of masculinity, appears more conducive to health behaviour change.

Health tourism trends in the United Kingdom: Are they net exporters of health services?

The study investigates the inbound and outbound health tourism in the United Kingdom (UK) to determine if the UK can be considered as a net exporter of health services. Although there is an increasing number of studies analysing the phenomenon of health tourism, little empirical data are available. This paper contributes to reducing this gap by providing reliable data on health tourism flows for the British case. Using microdata drawn from the International Passenger Survey (IPS) for the period 2000-2014, we estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. In addition, we analyse the main destinations of UK residents (outbound health tourists), and country of origin of overseas residents (inbound health tourists). The results show the upward trend of inbound and outbound patients (163 and 364% during the period 2000-2014, respectively), the strong seasonality in outbound patients (lower during the summer), and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, India and Hungry are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, United Arab Emirates and Greece are the main countries providing inbound health patients. Public policy considerations are given.

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences.

Background: The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. Methods: The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey. Results: A total of 61/67 (91%), responded to the survey. 60% of the medical students were ‘third-year medical students’. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills. Conclusion: Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi

Background Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings. Materials and Methods A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher’s exact test. Results There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients—mainly enteral. The most commonly used formulations were the “ready-to-use therapeutic feeds,” followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified. Conclusion Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and ensuring that the feeds provided to patients are appropriate and adequate for their needs.

Self-medication on the students of the school of health from Polytechnic Institute of Bragança

The self-medicatíon is a phenomenon more and more frequent and used for several years already, and tts incidence and dlstribution are related wtth the organizatíon and health system of each country. Following Medeiros thoughts (2011), this practíce conststs in the consumptíon of a medicine with the purpose of treating or relieving the symptoms and diseases or even promote self health, without using a professional prescription. Methods: With thts study, we intend to find the self-medication practice incidence on the students in the School of Health of Polytechnic Institute of Bragança (ESSa), identify the motives that lead these students to resort to this methods and identify the most used medicatíons. lt's a transversal descriptive, observational and quantítative study. To obtain the best results it was applied a questíonnaire built for that purpose. The statístícs analyses was made using Excel program. Our sample hás 219 students of the School of Health from Polytechntc Instítute of Bragança. Results: The studied sample includes 194 female and 25 male students distributed as follows: 36 frequenting Biomedical Laboratory Sdences, 26 Dietetics and Nutrition, 99 Nursing, 33 Gerontology and 22 studying Pharmacy. The self-medicatíon prevalence was 98%. The most used medicines was the analgesics and antipyretics with 86%. The most prevalent reason for the use of self-medicatíon was the thought that the disease was a "minor health issue". It was also considered a risky practice by 77% of the students. Conclusions: The self-medication is an evident practíce on the ESSa students. This results reveal some contradiction stnce the most consider 1t as a risky practíce, however it is, stíll, practíced.