Factores asociados con la duración del circuito extracorpóreo en terapias continúas de reemplazo renal en la Fundación Cardioinfantil

Introducción: las terapias continuas de reemplazo renal son una importante medida a utilizar en los pacientes con lesión renal aguda que ingresan a la unidad de cuidado intensivo, la pérdida temprana del circuito por coagulación del mismo es una situación que afecta a este grupo de pacientes. Materiales y métodos: se realizo un estudio de casos y controles de una duración de tres meses tomando los pacientes que eran sometidos a terapia continua de reemplazo renal en la fundación Cardioinfantil, se eligieron como casos aquellos pacientes que no lograban completar 72 horas de terapia por perdida del circuito relacionada con coagulación, y aquellos que si se tomaron como controles, se analizaron ambos grupos en función de diferentes variables demográficas, clínicas y del circuito, tomando como análisis primario el primer filtro utilizado y haciendo un análisis secundario incluyendo todos los filtros. Resultados: se recolectaron 24 pacientes para el análisis primario y 101 filtros para el análisis secundario, el 37,5% de los filtros duró > 72 horas y 62,5%, menos de este tiempo. El puntaje APACHE II (OR: 0,76, p 0.003) y sitio de inserción femoral derecho (OR: 0.14, p 0.007) se encontraron protectoras para la disfunción temprana. Discusión: aunque no se alcanzó la muestra total, se encontró asociación protectora del acceso femoral derecho, que fue novedosa, pero requiere confirmación. El APACHE II, también protector, puede corresponder a un sesgo, se necesitan más estudios para aclarar estos hallazgos y determinar la presencia de otras variables que intervengan.

Solar ultraviolet-B radiation and vitamin D: a cross-sectional population-based study using data from the 2007 to 2009 Canadian Health Measures Survey

Background: Exposure to solar ultraviolet-B (UV-B) radiation is a major source of vitamin D3. Chemistry climate models project decreases in ground-level solar erythemal UV over the current century. It is unclear what impact this will have on vitamin D status at the population level. The purpose of this study was to measure the association between ground-level solar UV-B and serum concentrations of 25-hydroxyvitamin D (25(OH)D) using a secondary analysis of the 2007 to 2009 Canadian Health Measures Survey (CHMS). Methods: Blood samples collected from individuals aged 12 to 79 years sampled across Canada were analyzed for 25(OH)D (n=4,398). Solar UV-B irradiance was calculated for the 15 CHMS collection sites using the Tropospheric Ultraviolet and Visible Radiation Model. Multivariable linear regression was used to evaluate the association between 25(OH)D and solar UV-B adjusted for other predictors and to explore effect modification. Results: Cumulative solar UV-B irradiance averaged over 91 days (91-day UV-B) prior to blood draw correlated significantly with 25(OH)D. Independent of other predictors, a 1 kJ/m 2 increase in 91-day UV-B was associated with a significant 0.5 nmol/L (95% CI 0.3-0.8) increase in mean 25(OH)D (P =0.0001). The relationship was stronger among younger individuals and those spending more time outdoors. Based on current projections of decreases in ground-level solar UV-B, we predict less than a 1 nmol/L decrease in mean 25(OH)D for the population. Conclusions: In Canada, cumulative exposure to ambient solar UV-B has a small but significant association with 25(OH)D concentrations. Public health messages to improve vitamin D status should target safe sun exposure with sunscreen use, and also enhanced dietary and supplemental intake and maintenance of a healthy body weight.

Existential issues in surgical care : Nurses’ experiences and attitudes in caring for patients with cancer

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Upplevelser av stöd från diabetessjuksköterskan hos personer med diabetes typ 1 : – Sekundäranalys av en kvalitativ intervjustudie

Introduction: Type 1 diabetes is a chronic disease that affects the individual in everyday life. The diabetes team sets the treatment goals together with the patient aiming for a good quality of life and to prevent complications. The diabetes nurse should include in-depth knowledge of the daily life of people with diabetes, and have respect for the individual's choices and life situation. Aim: To describe how people with type 1 diabetes experience the support from the diabetes nurse. Method: A qualitative content analysis with an inductive approach has been used. A secondary analysis including semi-structured interviews with 15 adults (> 18 years) with type 1 diabetes was conducted. Result: The result was summarized with an overall theme "At the clinic - experience of the support offered" describes how people experience the support from their diabetes nurse. The theme constituted three categories "Access to the diabetes nurse", "The diabetes nurse - a source of information and knowledge that might need to be complemented with the support from other professionals" and,"Mutual trust - the patient's experience of the district nurse as a discussion partner and support". Conclusion: The results showed that the accessibility to diabetes nurses was experienced as good. It was simple and easy to make contact. The diabetes nurses were experienced to be engaged and provide good support to the patients. A good dialogue with the diabetes nurse and commitment from the diabetes nurse were mentioned as important factors that made the visits to be experienced as good and important. There were requests for greater access and expanded opportunities for help from counselors, as well as an increased focus on how the person is feeling.

Relationship between body mass index and the use of healthcare services in Australia

Objective: To examine the relationship between body mass index (BMI) and the use of medical and preventive health services. Research Methods and Procedures: This study involved secondary analysis of weighted data from the Australian 1995 National Health Survey. The study was a population survey designed to obtain national benchmark information about a range of health-related issues. Data were available from 17,033 men and 17,174 women, 20 years or age. BMI, based on self-reported weight and height, was analyzed in relation to the use of medical services and preventive health services. Results: A positive relationship was found between BMI and medical service use, such as medication use, visits to hospital accident and emergency departments (for women only); doctor visits, visits to a hospital outpatient clinics; and visits to other health professionals (for women only). A negative relationship was found in women between BMI and preventive health services. Underweight women were found to be significantly less likely to have Papanicolaou smear tests, breast examinations, and mammograms. Discussion: This research shows that people who fall outside the healthy weight range are more likely to use a range of medical services. Given that the BMI of industrialized populations appears to be increasing, this has important ramifications for health service planning and reinforces the need for obesity prevention strategies at a population level.

Finding a 'safe' place on the risk continuum: a case study of pregnancy and birthing in Lao PDR (Lao People's Democratic Republic)

This paper addresses two questions. Firstly: are the risk regimes faced, and perceived, by pregnant women in rural Lao PDR substantially different from those experienced by pregnant women in western societies? Secondly, if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved without Laotians inheriting the risk regimes of late modernity experienced by many women in western societies? Secondary analysis is undertaken of data collected in 2005 for the evaluation of a pilot maternity waiting home in Bolikhan, Lao PDR. The results suggest significantly different risk perceptions and experiences between Lao and western communities, based on contrasting views of embodiment, identity construction and cosmologies. In the Lao rural communities studied, there is little evidence yet of 'risk society' despite the introduction of western technologies and practices to improve maternal mortality and morbidity. It is argued that 'risk society' can be avoided.

Meat consumption among 18-month-old children participating in the Childhood Asthma Prevention Study

Objective: To document meat consumption among 18-month-old children, for use in refining population dietary assessment methods and dietary guidance for young children.

Design: A secondary analysis of data collected in 1998-2000 from the 18 months follow up of the Childhood Asthma Prevention Study: an intervention trial of omega-3 oil supplementation and house-dust mite reduction, from birth to five years.

Subjects and setting: Pregnant women whose unborn children had an atopic family history were recruited from antenatal clinics of six hospitals in western Sydney. Carers of 429 18-month-old children (80% response) satisfactorily completed three-day weighed food records.

Main outcome measures: Mean and median intakes per day and portion sizes of various meats and meat products.

Statistical analyses: T-tests for comparing gender differences; Pearson correlation and one-way analysis of variance for relationships between meat and nutrient intake.

Results: During the recording period 94% of the children ate meat. McDonald's Chicken McNuggets^TM, beef mince, and beef sausages were the most frequently consumed meats. Median portion sizes ranged from 20-50 g, and were considerably smaller than 'usual' portions specified on food frequency questionnaires in common use. Higher meat diets in this age group were not associated with higher intakes of iron or zinc per MJ.

Conclusion: The marginally low intakes of iron and zinc in this age group could be improved by greater use of cuts of red meat appropriately prepared for toddlers.

Assessment of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D3 concentrations in male and female multiple sclerosis patients and control volunteers

Populations with insufficient ultraviolet exposure and who consume diets low in vitamin D have low vitamin D status (plasma 25-hydroxyvitamin D (25(OH)D) concentrations) and a reported higher incidence of multiple sclerosis (MS). The active form of vitamin D, 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃), is an effective anti-inflammatory molecule. No research to date has assessed 1,25(OH)₂D₃ concentrations in individuals with MS. In this study, plasma concentrations of 25(OH)D, 1,25(OH)₂D ₃ and parathyroid hormone (PTH) were measured in 29 individuals with MS and 22 age- and sex-matched control volunteers. There were no significant differences in plasma PTH, 25(OH)D and 1,25(OH)₂D₃ concentrations between individuals with MS and control volunteers. Women with MS had significantly higher 25(OH)D and 1,25(OH)₂D₃ concentrations than men with MS (79.1 ±45.4 versus 50.2±15.3 nmol/L, P=0.019 and 103.8± 36.8 versus 70.4±28.7 pmol/L, P=0.019, respectively). There was a significant positive correlation between 25(OH)D and 1,25(OH)₂D ₃ concentrations in all subjects (r=0.564, P=0.000), but secondary analysis revealed that the correlation was driven by women with MS (r=0.677, P= 0.001). Significant sex differences in vitamin D metabolism were observed and were most marked in individuals with MS, suggesting that vitamin D requirements may differ between the sexes, as well as by underlying disease state.

Factors influencing consistency of triage using the Australasian triage scale : implications for guideline development

Objective: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale.

Methods: A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance.

Results: A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P≤ 0.001; 65.0%; P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P≤ 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05).

Conclusion: We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.

Low and high birth weight as risk factors for obesity among 4 to 5 year old Australian children : does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4–5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95%CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95%CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86). Conclusion: There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.

Thirteen-year trends in child and adolescent fundamental movement skills: 1997-2010

Keeping connected: the lives of young people with ongoing health conditions in Australia

This chapter draws from a three year longitudinal Australian Research Council (ARC) project conducted in Victoria, Australia with 31 young people who were living with ongoing health conditions. The aim of the Keeping Connected project was to elicit the young people’s views of schooling, their relationships with peers and teachers, and their altered educational opportunities, given their ongoing and widely varying health conditions. Elsewhere in the literature these young people are often described as living with chronic illness (Hopkins et al., 2013; Moss, 2012). Victoria, Australia, is home to more than 1.2 million children and young people, representing just under 25% of the national child population. The Royal Children’s Hospital Education Institute (RCHEI), one of the sponsoring research partners for this study is located in Melbourne, the capital city of Victoria. The study makes a unique contribution to our knowledge of chronic illness, or what we prefer to refer to as ongoing health conditions, which affect 12% of school age students in Australia. One of my ongoing observations is that not all research that is produced in the name of social justice or analysing exclusions in schooling is approached through the repositioning of the qualitative research which has occurred over the past two decades. Throughout this chapter I aim to demonstrate how a post qualitative approach can produce a secondary analysis of data once a large scale project is completed. Data can be reworked and represented through networks of the social world, in this case the networks of living with an ongoing health condition as a young person in Australia at the end of the first decade of the twentieth first century.

Empirical evidence of recall bias for primary health care visits

BACKGROUND: While it is common for an economic evaluation of health care to rely on trial participants for self-reported health service utilisation, there is variability in the accuracy of this data due to potential recall bias. The aim of this study was to quantify the level of recall bias in self-reported primary health care general practitioner (GP) visits following inpatient rehabilitation over a 12 month period.

METHODS: This report is a secondary analysis from a larger randomised control trial of an economic evaluation of additional Saturday inpatient rehabilitation. Participants were adults who had been discharged into the community following admission to an acute general rehabilitation hospital. Participants were asked to recall primary health care visits, including community GP visits, via a telephone questionnaire which was administered at 6 and 12 months following discharge from inpatient rehabilitation. Participants were asked to recall health service utilisation over each preceding 6 month period. The self-reported data were compared to equivalent claims data from the national insurer, over the same period.

RESULTS: 751 participants (75% of the full trial) with a mean age of 74 years (SD 13) were included in this analysis. Over the 12 month period following discharge from rehabilitation there was an under-reporting of 14% in self-reported health service utilisation for GP visits compared to national insurer claims data over the same period. From 0 to 6 months following discharge from rehabilitation, there was an over-reporting of self-reported GP visits of 35% and from 7 to 12 months there was an under-reporting of self-reported GP visits of 36%, compared to national insurer claims data over the same period. 46% of patients reported the same or one number difference in self-reported GP visits between the 0 to 6 and the 7 to 12 month periods.

CONCLUSION: Based on these findings we recommend that an economic evaluation alongside a clinical trial for an elderly adult rehabilitation population include a sensitivity analysis that inflates self-reported GP visits by 16% over 12 months. However caution is required when utilising self-reported GP visits as the data may contain periods of both over and under reporting. Where general practitioner visits are expected to vary significantly between intervention and control groups we recommend that administrative data be included in the trial to accurately capture resources for an economic evaluation.

The impact of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension

OBJECTIVE: We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia.STUDY DESIGN: We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes.RESULTS: Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.05-2.03; P = .032).CONCLUSION: In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks.

Obsessive-compulsive disorder and personality disorder - Evidence from the British National Survey of Psychiatric Morbidity 2000

Background Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. Methods A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. Results the prevalence of any screen positive PD in the OCD group (N = 108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. Conclusions Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.