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Objective: To provide a summary of scientific open access resources Cognitive Behavioral Therapy interventions in patients with fibromyalgia. Method: Bibliographical search performed in Pubmed and PsycInfo, Latindex, Scielo and Redalyc online databases. No year of publication criterion was applied. Results: 377 citations were reduced to a list of 59 relevant publications, from 1993 to 2016. Most studies were performed in adult samples, in Spain or the United States, with pre-post quantitative design. Only 15 publications were open access. Conclusions: Empirical evidence is ample, yet mostly restricted. Open access material might promote interest in and encourage the design, implementation and evaluation of CBT interventions in the benefit of fibromyalgia patients, the health system and science.
Objetivo: Proveer un resumen de la evidencia científica de accesos abierto sobre intervenciones con Terapia Cognitivo Conductual en pacientes con fibromialgia. Método: Se realizó una búsqueda bibliográfica en las bases en línea de Pubmed y PsycInfo, Latindex, Scielo y Redalyc. No aplicó criterio por año de publicación. Resultados: Las primeras 377 citas obtenidas se redujeron a una lista de 59 publicaciones relevantes, publicadas entre 1993 y 2016. La mayoría de los estudios se realizaron en muestras de pacientes adultos, en España o Estados Unidos, con un diseño cuantitativo de tipo pre - post. Únicamente 15 publicaciones fueron de acceso abierto. Conclusiones: La evidencia empírica es amplia; sin embargo, el acceso a la misma es generalmente restringido. El material de acceso abierto puede promover el interés en las intervenciones con Terapia Cognitivo Conductual y estimular su diseño, implementación y evaluación, todo esto en beneficio de los pacientes con fibromialgia, los sistemas de salud y la ciencia.
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To describe the sonographic findings of the hip joint in patients with rheumatoid arthritis and to assess their correlation with signs and symptoms of disease activity (pain, range of motion, overall disease activity). Methods: We performed an observational, cross-sectional and analytical study. Patients aged 18 60 years of age diagnosed with rheumatoid arthritis were included. We did not include patients with hip prostheses or hip infiltration in the previous 3 months. We performed an ultrasound examination (7-12 MHz linear transducer) of both hips and recorded demographic, clinical, ultrasonographic and goniometric findings (flexion, extension, abduction, adduction, internal and external rotation). Results: We evaluated 102 hips of 51 patients (37 women) aged 43.5 +/- 9.4 years, body mass index (BMI): 26.4 +/- 5.18, disease duration: 117 +/- 107 months, DAS28: 4.08 +/- 1.58, hip pain history: 20 (39.2 percent), concurrent hip pain 3 (5.8 percent), use of DMARDs: 47 (92.1 percent), biological therapy 8 (15.68 percent), comorbidity: 25 (50.1 percent), positive rheumatoid factor: 43 (84.3 percent) and evocation of pain: 28 (54.9 percent). Ultrasound findings: Osteophytes: 52 (50.9 percent), cartilage injury: 47 (46.0 percent), trochanteric enthesopathy: 33 (32.3 percent), effusion: 14 (13.7 percent), erosions: 6 (5.8 percent), synovial hypertrophy: 5 (4.9 percent) and iliopsoas bursitis 2 (1.9 percent). There was no correlation of ultrasound with DAS28 or laboratory parameters. Evoking pain correlated with the presence of effusion (p = 0.038). Conclusions: The major ultrasound abnormalities were osteophytes, articular cartilage injury and trochanteric enthesopathy. According to our findings is advisable to include hip in the clinical assessment and initial and subsequent ultrasound evaluation of patients with rheumatoid arthritis...
Describir los hallazgos ecográficos de la articulación coxofemoral en pacientes con artritis reumatoide y evaluar su correlación con los signos y síntomas de actividad de la enfermedad (dolor, rango de movimiento, actividad global de la enfermedad). Material y métodos: Es un estudio observacional, transversal y analítico. Se incluyeron pacientes de 18 a 60 años de edad con diagnóstico de artritis reumatoide. No se incluyeron pacientes con prótesis de cadera o infiltración de la cadera en los tres meses previos. Se realizó ecografía (transductor lineal 7-12 MHz) de ambas caderas y se registraron datos demográficos, clínicos, ecográficos y goniométricos (flexión, extensión, abducción, aducción, rotación interna y externa). Resultados: Se evaluaron 102 caderas de 51 pacientes (37 mujeres) con edad de 43,5 +/- 9,4 años, índice de masa corporal (IMC): 26,4 +/- 5,18, evolución de la enfermedad: 117 +/- 107 meses, DAS28: 4,08 +/- 1,58, historia de dolor: 20 (39,2 por ciento), dolor concurrente: 3 (5,8 por ciento), uso de FARME: 47 (92,1 por ciento), terapia biológica: 8 (15,68 por ciento), comorbilidad: 25 (50,1 por ciento), factor reumatoide positivo: 43 (84,3 por ciento) y evocación de dolor: 28 (54,9 por ciento). Hallazgos ecográficos: Osteofitos: 52 (50,9 por ciento), lesión de cartílago: 47 (46,0 por ciento), entesopatía trocantérica: 33(32,3 por ciento), derrame: 14 (13,7 por ciento), erosiones: 6 (5,8 por ciento), hipertrofia sinovial: 5 (4,9 por ciento) y bursitis iliopsoas: 2 (1,9 por ciento). No se encontró correlación de la ecografía con el DAS28 ni con los parámetros de laboratorio. La evocación de dolor se correlacionó con la presencia de derrame (p = 0,038).Conclusiones: Las principales alteraciones ecográficas fueron osteofitos, lesión del cartílago articular y entesopatía trocantérica. De acuerdo a nuestros hallazgos, es recomendable incluir a la cadera en la valoración clínica y ecográfica inicial y subsecuente de los...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Hip Joint/physiopathology , Hip Joint , Arthritis, Rheumatoid/physiopathology , Arthritis, Rheumatoid , Cross-Sectional Studies , Muscle, SkeletalABSTRACT
Introduction Tobacco use is an addiction of which prevalence, incidence, morbimortality, and medical and social impact have turned it into a global public health problem. It has been related with eleven causes of death and every year 4.9 million tobacco-related deaths occur at 30 years of age. By 2030, an estimated 10 million annual deaths will be tobacco-related. In the United States health care expenses for tobacco-related problems have been estimated from US8.2 to 77 million annually, meaning between 0.46 and 1.15% of GNP. Because of tobacco use is not an exclusive activity of adolescents and young adults it has been defined as a pediatric disease because it frequently begins before fifteen years of age. Even more alarming is that The Global Youth Tobacco Survey reported an increase in the tobacco consumption, particularly among women in developing countries like Mexico. This is so common that the previously reported gap between male and female adolescent tobacco users in these countries has all but disappeared. There is a need to develop more studies in order to identify the different influences of tobacco use that in the long run can be modified. Family is one of the most significant influences on people as it models many health-related behaviors, such as diet, exercise, tobacco and alcohol use. It is also the source of its members' psycho-social development, meaning it can both provide support and create stress. Preliminary studies suggest that some family environment factors may influence adolescent tobacco use risk, such as: a background of tobacco use among family members; low levels of family cohesion; defective interaction examples and lack of support bonds; family tolerance to use; low income and low education level; type of family; minimal parental monitoring of adolescent activities; and poor control of the influence of an adolescent's social context, focused on school choice and extra-curricular activity spaces. However, no study to date has evaluated if there is a relationship between family environment and type of tobacco use in Mexican adolescents. As a response to this lack of information, a comparative survey was done to compare family environment and type of adolescent tobacco use in high school students in the city of Guadalajara, Jalisco, Mexico. Materials and methods A cross-sectional, prolective, comparative study was done in a population of 6987 students enrolled in high schools No. 5 and No. 9 of the University of Guadalajara during the September to December 2005 semester. These schools were chosen as being the most representative of the city of Guadalajara based on their enrollment and graduation academic indicators. Sample size was calculated with the miscellaneous statistics module of the True Epistat Program using a 95% confidence level. Previous studies showed a tobacco use prevalence of 27% in the University of Guadalajara high schools, meaning minimum sample size, including an additional 10% for unrelocated students, was 205 for high school No. 5 (3056 enrolled students) and 400 for high school No. 9 (3931 enrolled students). Selection of eligible subjects was randomly done. All students enrolled in each school were numbered consecutively and a random selection table was generated using True Epistat. Later on the students corresponding to these numbers were located by the school prefects by group and shift. They were then called to answer the electronic self-administered survey in the school's computer room. Location rate was 96% because some students had dropped out and/ or changed schools. Data collection was done by using two standardized self-application scales for Mexican population: 1. Tobacco use categorized as light (one to five cigarettes by day) and moderate (six to fifteen cigarettes by day); and 2. Family environment, evaluated by five items: hostility and rejection, communication with children, mutual support from parents and children, and communication between parents. For each type of tobacco use, the mean grades ± 95% confidence interval of the items of the family environment scale were obtained and then, they were compared graphically. The project was approved by the Ethics and Research Committee of the Mexican Institute of Social Security. The survey included an informed consent form with electronic signature. If any participation was not accepted, the survey application did not open. Student participation was anonymous and an electronic mail address was provided for orientation. No users were recorded as requesting orientation. Results A total of 11 58 students (average age = 16.1 ± 1.1 years, range 14 to 20 years) took the survey, from which 659 (56.9%) were women and 499 (43.1%) were men. Of this total, 615 (53.1%) were non-smokers, 419 (36.1%) were light smokers and 124 (10.8%) were moderate smokers. Non-smoker status was consistently associated with better conditions in all the family environment scale dominions. In comparison with light smokers, non-smokers had higher grades of communication with their parents, there was support from parents to children, as well as communication between parents, and support from the son to the parents dominions; and lower grades in the hostility and rejection dominion. In comparison with moderate smokers, non-smokers had better grades in the communication with the son/ daughter dominion and lower grades in the hostility and rejection dominion. No significant differences were observed in the family environment scale between light and moderate smokers. Discussion Family environment was consistently shown to be more favorable for adolescent non-smokers compared to smokers; the main differences were between non-smokers and light smokers with fewer differences between non-smokers and moderate smokers. No differences in the family environment items were observed between light and moderate smokers. This finding of favorable family conditions for non-smokers coincides with previous reports. The fact that family environment does not deteriorate once an adolescent begins tobacco use may mean that certain family structures exists previously that favor tobacco use. Given the cross-sectional design used here, it could not be determined if the evaluated items generate any vulnerability or acted as preventing factors for tobacco use. This would require a more detailed study about these variables. Based on these results and those of previous studies, the starting point of adolescent tobacco use is probably favored by a coincidence among certain family structures such as: family type, family resources, family interactions, type of parent involvement with children, stress management strategies, family modeling, adolescent's psychology, as well as communication and support among family members. Given the above, adolescent tobacco use is likely a social phenomenon involving different social actors like the adolescent, his/her family and the influence of other agents. Educational actions and treatment of adolescents is therefore not enough to address the problem. Parent participation is needed that is specifically focused on understanding typical adolescent behavior; promoting harmonious parent/child relationships; training parents in parental functions such as negotiation and effective communication; and supervision of adolescent activities. The present study is an initial effort in evaluating the relationship between family environment and adolescent tobacco use. Although it is limited by its cross-sectional design and there is a lack of control of possible confusing variables, it does suggest that adolescent non-smokers have more favorable family environments than adolescent smokers. Future research on this matter will require studies using designs that allow a more thorough understanding of the influence of family environment at the onset of adolescent tobacco use.
Introducción Aunque el tabaquismo no es exclusivo de adolescentes y jóvenes, la enfermedad ha sido definida como pediátrica por su inicio antes de los quince años de edad, por lo es necesario el desarrollo de estudios que identifiquen las diferentes influencias del consumo de tabaco factibles de ser modificadas. La familia es una de las influencias más importantes para las personas, pues modela comportamientos relacionados con la salud y es donde ocurre el desarrollo psico-emocional de sus miembros. Estudios preliminares han sugerido que algunos factores del ambiente familiar podrían influir en el consumo de tabaco en adolescentes como, por ejemplo, el de consumo de tabaco de familiares, bajos niveles de cohesión familiar, pautas de interacción defectuosas, falta de vínculos de apoyo, tolerancia familiar al consumo, bajos ingresos y bajo nivel educativo, bajo monitoreo paterno en las actividades adolescentes y el pobre control de la influencia del contexto social. Dado que no se han localizado antecedentes de la asociación entre el ambiente familiar y el tipo de consumo de tabaco en adolescentes mexicanos, el objetivo de este estudio fue comparar el ambiente familiar entre los tipos de consumo de tabaco en adolescentes escolares de nivel medio superior en Guadalajara, México. Material y métodos Se incluyeron a 1158 estudiantes seleccionados aleatoriamente de dos preparatorias de la Universidad de Guadalajara en el segundo semestre de 2005. La recolección de los datos se realizó por medio de dos escalas de autoaplicación estandarizadas para población mexicana: 1. Consumo de tabaco en el que el patrón de consumo fue categorizado: leve y moderado; 2. Ambiente familiar evaluado por medio de cinco dominios: hostilidad y rechazo, comunicación con el hijo, apoyo de padres a hijos, comunicación entre padres y apoyo del hijo a los padres. Resultados Seiscientos quince (53.1%) adolescentes fueron no fumadores, 419 (36.1%) calificaron como fumadores leves y 124 (10.8%) como fumadores moderados. Ser no fumador se asoció consistentemente con un mejor estado en todos los dominios de la escala de ambiente familiar. Los no fumadores tuvieron mayores calificaciones en los dominios de comunicación padre-hijo, apoyo de los padres, comunicación entre los padres y apoyo significativo del hijo, así como menores calificaciones en hostilidad y rechazo en comparación con los fumadores leves. Los no fumadores tuvieron mayores calificaciones en el dominio de comunicación con el hijo y menores calificaciones en el dominio de hostilidad y rechazo en comparación con los fumadores moderados. No se apreció ninguna diferencia entre fumadores leves y moderados. Discusión El estudio reveló consistentemente que existe un ambiente familiar más favorable para los adolescentes no fumadores comparados con los fumadores. Las principales diferencias en el ambiente familiar radicaron entre los no fumadores y los fumadores leves, y en menor grado, entre los no fumadores y los fumadores moderados. No apreciamos ninguna diferencia en el ambiente familiar entre los fumadores leves al compararlos con los moderados. A partir de que el ambiente familiar no parece deteriorarse una vez que el adolescente ya inició el consumo de tabaco, sugerimos que existen ciertas estructuras familiares que favorecen su consumo. Partiendo de estas consideraciones, pensamos que el consumo de tabaco en adolescentes es un fenómeno social en el que intervienen diferentes actores sociales, por lo que no es suficiente desarrollar sólo acciones educativas y de tratamiento para los adolescentes, sino que además deben involucrarse los padres.
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Introduction Recent data, both domestic and from the world over, have shown that the epidemiologic impact of tobacco consumption has a higher increase rate among adolescent population, particularly women, than in the general population. This has highlighted the need to implement preventive intervention programs focused on young people. The school environment seems to be the most adequate space to achieve such a goal. Most school intervention reports aimed at reducing tobacco consumption among students have been carried out in the United States and have both had a positive effect and proven to be cost-effective. In Mexico, there is only one antecedent of a successful prevention program conducted in an elementary school. Results from this suggest that behavioural abilities acquisition reduces the prevalence of tobacco experimentation and promotes cessation among those already using it. Given the lack of educational interventions and the fact that tobacco consumption tends to increase among Mexican high school students, we conducted this study aiming to implement an educational intervention on tobacco consumption among adolescent high school students from the Universidad de Guadalajara, Mexico. Later on we proceeded to evaluate its effect. Material and methods Based on a diagnostic and a literature review from successful anti-tobacco consumption programs, we devised a campaign called <
Introducción La mayor parte de los reportes de intervenciones escolares para reducir el consumo de tabaco en estudiantes han sido realizados en Estados Unidos y han mostrado un impacto positivo además de que son costo/efectivas. En México solamente existe el antecedente de un estudio exitoso de un programa de prevención de tabaco realizado en primaria, cuyos resultados sugieren que el desarrollo de habilidades conductuales reduce la prevalencia de la experimentación de tabaco y promueve el cese en quienes ya lo consumen. Ante la falta de intervenciones educativas y la tendencia hacia el aumento del consumo de tabaco en adolescentes escolares de educación media superior en México, realizamos el presente estudio con el objetivo de implementar y evaluar el efecto de una intervención educativa sobre el consumo de tabaco en adolescentes de una preparatoria de la Universidad de Guadalajara, en la ciudad de Guadalajara, capital del Estado de Jalisco, México. Material y métodos Basándose en un diagnóstico previo se diseño una campaña antitabaco, dirigida a adolescentes fumadores, con una duración de un semestre escolar, que incluyó la participación de padres de familia, maestros y pares no fumadores. Antes del inicio e inmediatamente después de finalizar la campaña se evaluaron, mediante dos muestras independientes por medio de encuestas validadas y estandarizadas, la frecuencia de consumo de tabaco, el tipo de consumo, la probabilidad de consumir tabaco en un futuro cercano y el nivel de conocimientos sobre los efectos nocivos para la salud que produce su consumo. Resultados El efecto positivo de la campaña se apreció en el tipo de consumo de tabaco puesto que hubo una reducción de la proporción de fumadores leves así como un incremento del número de no fumadores en la evaluación final con respecto a la basal; la proporción de fumadores moderados no se modificó en ambas evaluaciones. La frecuencia de consumo una vez en la vida, en los últimos doce meses, en el último mes, así como la probabilidad de fumar en un futuro cercano no mostró modificaciones en la evaluación final con respecto a la basal. Discusión La intervención educativa antitabaco tuvo efectos positivos sobre el tipo de consumo de tabaco en los adolescentes de la escuela sede, que se evidenciaron en la disminución de la proporción de fumadores leves, en el incremento de no fumadores y en el incremento del nivel de conocimientos sobre los efectos nocivos del consumo de tabaco sobre la salud. Creemos que la explicación se vinculó a tres aspectos: 1) por haber diseñado la intervención a partir de un diagnóstico escolar, 2) por haber tomado en cuenta las diferentes influencias sociales al incorporar la participación de maestros, pares no fumadores y padres de familia, 3) por la inclusión de sugerencias de programas exitosos en la modificación actitudinal. La intervención implementada resultó ineficaz para fumadores moderados, por lo que se tendría mayor efecto preventivo si se aplicaran en estudiantes de educación básica y media básica, en quienes el consumo de tabaco aún tiene un impacto inicial. A partir de la falta de interés mostrado por los padres, hipotetizamos que en ellos parece prevalecer una actitud permisiva en el consumo de tabaco de sus hijos y parecen subestimar la posibilidad de influir en su consumo. Se considera que los padres representan un contexto preventivo importante en el tabaquismo del adolescente. A partir de esto se plantean hipótesis y nuevas preguntas para ser investigadas. El estudio presenta limitaciones al no haberse incluido un grupo control y por haber limitado la evaluación de la intervención al periodo inmediato posterior. Sin embargo, pensamos que a pesar de estas limitaciones la intervención educativa antitabaco es efectiva para la reducción del consumo de tabaco experimental y en el incremento del nivel de conocimientos de los efectos deletéreos sobre la salud.
ABSTRACT
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Abstract: Introduction Through time, the concept underlying drug consumption has been a matter of much controversy in the health sciences field. Here, it has been referred to using different definitions, but society seems to perceive it mostly as a vice, associated to socially unacceptable behavior. The addiction-vice notion implies a moral concept which goes beyond health issues and induces affective reactions that seem to hinder the use of health care services. In contrast, when addiction is considered as a disease and the inability to control consumption is acknowledged, it all seems to lead to an intervention meant to solve the problem. Does the temí "addiction" -as used by drug users to refer either to a disease or vice- have any influence on stopping or promoting the use of health care services? And if so: Which are the cognitive processes supporting the images of addiction-vice and addiction-disease? Reports from different studies agree on the fact that adolescents and their parents only look for the help of health care services when they feel frustrated because they find themselves unable to control the drug use and feel at risk because of certain beliefs, attitudes or intentions. The study of images comes from the socalled "French social psychology", where Moscovici proposed using the concept of images to define a more complex and logical structure than that of attitudes and/or evaluation results. He considers images as an inner representation of an external reality, as constructions similar to visual experiences: a sort of mental sensations or impressions of objects and persons. According to him, images persist because they are lodged in the memory where they reinforce the sense of both a continuity of the environment and individual and collective experiences. From this theoretical perspective, the following were the aims of this study: to describe addiction-related images built both by adolescent users of illegal drugs, who were undergoing treatment at the time, and their parents. Method Based on the theory of social representation, a qualitative study was devised. The sample was composed by fifteen 13 to 19 year-old adolescents, who were users of multiple illegal drugs and were undergoing treatment in the Centros de Integración Juvenil in Guadalajara, Jalisco, Mexico, in 2002, together with their respective accompanying parents. The data were compiled using in-depth recorded interviews. The interpretations consisted of thematic encoding, classification and interpretative analyses. Ethical steps were taken in order to protect the participants' identity and to obtain their informed consent. Results In the accounts of both the adolescents and their parents, addiction was consistently referred to as a vice. Here, the voluntary use pathway put forward by the subjects' stood out; so, a voluntary decision would also be required to stop using drugs. In addition, parents perceived addiction as something wrong. Only when drug users started having drug consumption-related difficulties, was this redefined as a problem that they could not solve by their own means. It is worth mentioning here that adolescents did try to avoid the influence of friends and the environment when using drugs. Parents thought willpower alone would suffice to stop their offspring from using drugs. This was so because parents were not sensitive enough to the influence of tolerance and abstinence regarding the problem. Consequently, there were reasoning processes that redefined addiction as a problem needing the help of specialists. This cognitive re-definition turned the image of addiction-vice into that of addiction-disease. On the one hand, to look for help in the health care services under the stigma of the vice image meant to be openly recognized as a dissolute person and to be thus socially excluded. On the other, having a disease implied the possibility of solving the mistake of drug-taking and thus being rehabilitated and reinserted into a productive life. Nevertheless, in the addiction-disorder image, drug consumption-related problems still prevailed, such as the inability to control using drugs, together with family, school and work problems. Redefining addiction as a disease did not seem to be stable or permanent in their minds for there were still traces of the vice image. This finding suggests the disease image acted as a sort of link between addiction-vice and the access to treatment when trying to stop the use by their own means failed. Instead of rejecting the vice image, it seems that the subjects' appropriation of the disorder image represented by health care services in order to look for a specialized treatment was used as an important expectation. This was the case even when in their minds the use of drugs was a vice influenced by willpower and environment. Drugs and addiction-vice and addiction-disease are not antagonistic images in social reasoning, but are a part of a continuum where they coexist. Discussion Our findings show that the adolescents interviewed had in their minds an image of addiction-vice as a pathway to drug use. It was also an image where drug use-related problems appeared, and thus they defined addiction as a disease without completely disassociating it from the notion of vice. Although these findings agree partially with those reported on this matter, there is a more elaborated and useful construction giving the problem a continuance in society, and to which Moscovici referred to as "image". An image has three characteristics accounting for its stability, consistency and continuance in social groups: 1. marginal elements, such as beliefs, cognitions, and judgements, which act as safeguards to protect; 2. the key element of the image, which is in this case addiction as vice, and 3. the social function accomplished by the image. We believe that the latter is the most important characteristic, a feature which was also emphasized by Moscovici. According to the common sense of the adolescents and parents under study, the function of the addiction-vice image was to reject a behavior considered deviant from accepted social norms. On the other hand, we detected that the addiction-disease image was not stable in the social mind, because this was not an image made up by the population under study, but one that they had appropriated and where health services were included. It is a construction circulating outside these particular social actors, and which is appropriated to carry out the purpose of gaining access to treatment. The images composing the voluntary use pathway seem to be antagonistic and mutually excluding, and they seem to coexist in the mind's continuum when addiction is redefined as a problem deserving help. Consequently, using drugs can be at times viewed either as a vice or disease, or vicedisease, depending on the purpose it fulfills in a given situation. Only common sense can accept such exclusions and alternations, because the reasoning underlying it does not need any verifications regarding its validity. From this viewpoint, addiction represents a big challenge for health services because of the several elements it involves. Results from this study point out to the reasoning used to examine the ideas of both the adolescents and their parents and to explain decisions regarding drug use. The degree of knowledge about the way these individuals think, communicate and take decisions will enable health services professionals to develop more efficient interventions. To a certain extent, we believe the reasoning behind the vice image is accurate enough because, although the use pathway was voluntary, willpower is also important to stop consumption and look for help in the health care services. Finally, we think that it would be appropriate to study these images in populations from other regions in order to evaluate if the same or similar images prevail or not. Further research of these images would help to develop longitudinal studies which would also evaluate, on the one hand, the images through the therapeutic process and, on the other, their link with the effectiveness of any given treatment.
ABSTRACT
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Abstract Introduction. The prevalence of tobacco use among students is apparently higher than in the general population. Several studies carried out in school population have found an increasing tendency in tobacco consumption, proportionally higher in women, which allows to identify similar consumption patterns in men and women. One of these studies estimated that the consumption frequency increases between 0.7% and 7% in three years. Nonetheless, another study points out to the fact that the Latin American and Caribbean youth population structure is an element that will favor the increase of the rate of smokers in the next years. Some of the risk factors identified are the tobacco consumption by other family members, a low perception of consumption risk, inclination towards tobacco use, to not deem the possibility of becoming a regular smoker, social tolerance, high availability and access to cigarettes, low school performance, to have friends that smoke, the search of a social image, a means of weigh control, search for a glamorous behavior, assert the transition between childhood and adulthood, the constant tobacco publicity in the media, the low supervision and the low monitoring by parents. Objective. To determine the prevalence and influence of the family and school environmental factors on tobacco use by adolescent students in Highschool No. 5 of the University of Guadalajara, Jalisco, Mexico, which has both an outstanding academic excellence and extracurricular program. Method. A cross sectional, prolective, and comparative study was performed. The population survey included 3,056 students enrolled at the above mentioned highschool in the 2004 term (36% men and 64% women); of the total population surveyed, 60.5% attended the morning shift and 39.5% the evening shift, their average age was 16.1+1.1 years. Due to the fact the previous studies report different prevalences between men and women, the size of the sample was estimated separately. For men, for whom a tobacco use of 27% has been estimated (and expecting a maximum deviation of 5% from the population prevalence) the required sample number was 190 subjects. Regarding women, of which a 16% prevalence was estimated (and expecting a maximum deviation of 3% from the population prevalence) the required sample number was 327 subjects. The subjects were recruited by drawing lots and their selection was carried-out by an aleatory numbers table. Each selected subject was located in its corresponding classroom and shift, and was invited to participate in this survey. They were asked to give an informed consent and there was a 100% rate of acceptance. The National Addictions Survey questionnaire was used to obtain the data, which assessed the socio-demographic data, consumption once in a lifetime, age of first use, number of times of consumption in a lifetime, time of use since the first time, use in the past 12 months, consumption in the last month, and number of cigarettes smoked daily. The tobacco consumption by the mother, father, siblings, and friends, was also included. The current tobacco addiction was defined by the consumption in the last month. The use pattern was considered experimental when it referred to one to 99 instances of consumption, and regular when it referred to more than 100 instances of use. For the statistical analysis, the categorical varia-bles were compared using the square Ji simple tests with Yates adjustment or Fisher's exact test according to requirement. The numerical variables were compared using the test for independent samples. A model of logistic regression was used to analyze the independent association of factors linked to the present consumption of tobacco use. Results. The prevalence of consumption once in a lifetime was 58.2%; in the last 12 months, 32.4%; and in the last month, 23.9% (IC of 95%: 20.4-27.6). The average age of first pathway of consumption was 13.9± years (limits 5-18). The subjects with present tobacco use were older (16.4± 1.0 years of age) than the non tobacco users (16.1±1.1 years of age, p=0.002) and they also had a lower school perfor-mance in the previous semester (81.1±6 versus 86.0±7 p<0.0001). We did not found any difference between the prevalence of tobacco use among men (45/194; 24.7%) and women (83/353; 23.5%; p=0.41). The assessment of the prevalence according to the consumption pattern showed that 48% of students had an experimental use, while 10% of the adolescents studied already had a regular tobacco consumption pattern. Using the univaried analysis, the presence of a regular tobacco consumption pattern had a statistical association with the performance in semesters at highschool, the tobacco use by the mother, father, siblings, and groups of friends, as well as the fact of studying in the evening shift, studying and also working, and being an irregular student. Likewise, in the case of present tobacco use, in the univaried analysis were associated the performance in semesters at highschool, studying in the evening shift, being an irregular student, studying and also working, tobacco use by the father (not the mother), siblings, and friends. After the logistic regression analysis, only studying in the evening shift, tobacco use by the father and friends, and being an irregular student kept their statistical association regarding present tobacco use. Discussion. The prevalence of tobacco consumption by adolescent students found in this survey was high in experimentation (48.2%) and regularity (10%) in view of the characteristics of the highschool where this survey was carried out. Nevertheless, this prevalence is lower than those reported on other recent surveys that were done in high school students from similar settings. One of them, the 2003 National Student's Survey found a 68.4% prevalence of tobacco use. This figure is 20% higher than the prevalence found in our study. We believe that those differences can be explained because the school where we performed our study has been awarded as an academic excellence high school. Another unexpected result was the absence of any differences in the consumption pattern in men and women, which also agree with the results of another recent study. This similarity in the behavior of men and women should be explored qualitatively. One contribution of our study is the fact that the father's use but not the mother's or siblings, has implications on adolescents consumption. Previous studies had reported the family's consumption as a risk factor, without identifying the above mentioned differences. Nonetheless, further studies regarding the influence of the father figure or image should be carried-out. Meanwhile, as a working hypothesis, we consider that the father's consumption defined attitudes of tolerance that are cognitively significant due to the cultural image of authority that he represents in the family. Even if the adolescent seeks to separate himself from family bond, and is more susceptible to the influence of the social environment, most of the family behavior has already been impressed on them. In the population studied by us, having friends that use tobacco was the most important association factor for its consumption. These findings have also been reported previously; nevertheless, the dynamics of use and their relationship with consumption should be further studied, as well as the social conceptualization attributed to friendship. The fact that studying in the evening shift was present in the unvaried analysis as well as in the logistic regression may be due to older students, lower performance and consequently, higher use probability. In short, the prevalence of tobacco use in our population of highschool adolescents was rather high, and we found no difference in the consumption pattern of men and women. The independent factors associated to tobacco use were tobacco consumption by the father and friends, as well as being in the evening shift. Finally, we consider that this study could represent the basis for: 1) Studies regarding new issues using qualitative tools in order to understand the social conceptualization concerning consumption and thus design more efficient educational actions; and 2) Having a baseline that will allow the assessment of the modification of risk factors on the decrease of tobacco consumption.
ABSTRACT
Objetivo: Evaluar la asociación entre el estado de nutrición y la actividad del Lupus Eritematoso Generalizado (LEG).Tipo de estudio: Bifásico con casos y controles anidados en una cohorte y estudio de cohortes.Pacientes y métodos: Pacientes con criterios del ACR para diagnóstico de LEG seguidos en la cohorte "LES-Fénix". Se determinaron la actividad (MEX-SLEDAI) y estado de nutrición. Se consideró caso la presencia de actividad durante el seguimiento. Se analizó, en la primera fase, el estado en el semestre previo, y en la segunda fase el semestre subsecuente.Resultados: Se estudiaron 80 pacientes (77 mujeres) con edad de 35ñ12 años y tiempo de evolución de 8.1ñ5.3 años. No se encontró en la fase retrospectiva asociación entre estado nutricional y presencia de actividad. En la fase prospectiva se encontró un efecto protector de sobrepeso/obesidad para la presencia de actividad (RR: 0.22; IC 95 por ciento: 0.08-0.6). El número de reactivaciones (p=0.0001) y la dosis de prednisona (p=0.009) fueron significativamente menores en los pacientes con sobrepeso/obesidad. Adicionalmente, se encontró correlación inversamente proporcional entre el IMC y la calificación MEX-SLEDAI (r=-0.26, p=0.04).Conclusiones: En el seguimiento prospectivo se encontró que la presencia de sobrepeso/obesidad parece asociarse a menor actividad del LEG.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Nutritional Status , Lupus Erythematosus, Systemic/physiopathology , ObesityABSTRACT
Objetivo: Evaluar la eficacia y seguridad de ciclosporina A (CsA) + cloroquina (CLQ) o placebo en pacientes con AR de inicio temprano y comparar los resultados con una revisión de la literatura de la combinación de CsA con otras drogas modificadoras de la enfermedad (DMARD).Métodos: Reporte preliminar de un estudio doble ciego controlado, de 90 pacientes con AR de inicio temprano, comparando CsA + CLQ o placebo. Variable de desenlace ACR 20, 50 y 70. Revisión de la literatura de 10 estudios completos de terapia combinada que incluyeron a la CsA.Resultados: A los 6 meses de tratamiento, cumplieron los criterios de mejoría (ACR-20) 34 pacientes (83 por ciento) del grupo CsA + CLQ y 25 (61 por ciento) del grupo CsA + placebo (p=0.02). A los 12 meses, no hubo diferencia significativa en la mejoría con los criterios de ACR-20. La diferencia fue significativa con ACR-50 (54 por ciento vs 34 por ciento, p= 0.05) y con ACR-70 (51 por ciento vs 26 por ciento, p=0.05). No hubo diferencias significativas en los efectos adversos en ambos grupos. La revisión de la literatura mostró reportes de CsA en combinación con MTX, oro parenteral, HCQ, CLQ y SSZ. La combinación más estudiada y al parecer más eficaz fue CsA con MTX. Conclusión: La combinación de CsA + CLQ parece ser eficaz en pacientes con AR temprana. Aunque la literatura sugiere que la mejor combinación con CsA es MTX, la CLQ parece ser una opción útil en terapia combinada con CsA.
Subject(s)
Humans , Adult , Female , Arthritis, Rheumatoid , Chloroquine , Cyclosporine , Placebos , Drug Therapy, CombinationABSTRACT
Objetivo: Comparar las correlaciones entre los valores séricos y salivales de ácido úrico entre paciente con gota y controles normales. Tipo de estudio: Encuesta comparativa. Pacientes y métodos. Se obtuvo muestra venosa y salival a 24 pacientes con gota y 100 sanos, donadores de sangre; en ambas se cuantificó la concentración de ácido úrico mediante el autoanalizador Ciba-Corning Auto Express 550. Se compararon entre ambos grupos: las medias de ácido úrico en sangre y saliva y el coeficiente de correlación de Pearson de ambos especímenes. Resultados: Los sujetos gotosos tuvieron uricemia mayor que los controles (8.7 ñ 1.8 vs. 5.8 ñ 1.4 mg/dL, p<0.0001), por el contrario, la concentración salival de ácido úrico fue mayor en los controles que en los gotosos (2.0 ñ 1.3 vs. 0.3 ñ 0.6 mg/dL, p<0.0001). Hubo correlación significativa entre los valores séricos y salivales de los controles (r=0.27, p=0.006) y no así en los gotosos (r=0.34, p=0.09) Conclusiones: Los sujetos gotosos parecen tener menor concentración salival de ácido úrico que la población sana, y en ellos no parece haber correlación entre los niveles séricos y salivales de ácido úrico. La presencia de bajas concentraciones salivales de ácido úrico podrían ser un marcador diagnóstico en gota
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Reference Values , Saliva/chemistry , Gout/blood , Uric Acid/analysisABSTRACT
In this study, the authors prospectively followed one-hundred thirthy patients undergoing surgery in order to investigate the influence of age, surgery time, surgical room temperature, major surgery, blood transfusion, gender, and anesthetic method in the occurrence of mild intraoperative hypothermia (MIH). Sixty-one patients (47 percent) were female and 69 (53 percent) were male, and patient's mean age was 42 ñ 20 years. Fifty-three patients(41 percent) developed MIH. Fifty-two (40 percent) underwent major surgery, 65 (50 percent) patients were scored as ASA I (American Society Anesthesia) 52 (40 percent), ASA II and 13 (10 percent), ASA III or IV. Sixty-four (49.2 percent) received balanced general anesthesia, 22 (17 percent), spinal lumbar anesthesia, 20 (15.3 percent), epidural lumbar anesthesia and 24 (18.5 percent), miscellaneous anesthesia. Thirteen (10 percent) received blood transfusion, mean surgery time was 83 ñ 59 min and meand surgical room temperature was 22.9 ñ 1.2ºC. Regression logistic with elimination method was employed to determine the impact of all variables over development of MIH. Only major surgery (Odds Ratio 2.8) and blood transfusion (Odds Ratio 6.7) were identified as risk factors for MIH
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Hypothermia/etiology , Intraoperative Complications , Prospective Studies , Risk FactorsABSTRACT
Objetivo. Evaluar la calidad de atención para pacientes con lumbagia aguda proporcionada por médicos de atención primaria y estudiantes de medicina de 4 ciudades de México. Tipo de studio. Encuesta comparativa. Material y métodos. Se interrogó sobre acciones diagnóstico terapéuticas en lumbalgia aguda a médicos de atención primaria y a estudiantes de medicina. Las acciones consideradas como aciertos se tomaron de las guías emitidas por la Quebec Task Force on Spinal Disorders (QTFSD). Resultados. Fueron evaluables los datos de 211 de 213 pacientes (30 Cd. Obregón, 43 Morelia, 80 León y 60 Mérida); 79 por ciento de los participantes habrían proporcionado calidad de atención no adecuada generalmente debida a sobresolicitud de estudios de imagen. No hubo asociación entre haber cursado reumatología en la carrera de medicina y el tipo de atención proporcionadas; sin embargo, el tener la especialidad de Medicina Familiar se asocició con proporcionar atención adecuada y en contraste, el ser estudiante de medicina estuvo asociado con proporcionar atención no adecuada. Conclusiones. Parece existir una elevada prevalencia de calidad de atención no adecuada para pacientes con lumbalgia aguda por parte de médicos de atención primaria; ésto parece ser mas frecuente en médicos en formación
Subject(s)
Humans , Adult , Surveys and Questionnaires , Back Pain/drug therapy , Back Pain/therapy , Back Pain/epidemiology , Quality of Health Care , Education, Medical , Educational MeasurementABSTRACT
Se realizó una encuesta comparativa para determinar la eficacia del ultrasonido para malignidad de nódulo tiroideo solitario. Se practicó ultrasonido a 50 pacientes con nódulo tiroideo no captante por gammagrafía (frío). Se consideró nódulo sugestivo de malignidad aquel que no presentó áreas quísticas. Posteriormente, los resultados del ultrasonido fueron comparados con los diagnósticos histopatologicos obtenidos de la cirugía y biopsia. De acuerdo con esos resultados, el ultrasonido tuvo sensibilidad de 76 por ciento, especificidad de 40 por ciento, valor predictivo positivo de 55 por ciento y valor predictivo negativo de 62 por ciento. Se concluye que el ultrasonido tiene baja eficacia para sugerir malignidad en pacientes con nódulo tiroideo no captante por gammagrafía
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Ultrasonics , Biopsy , Thyroid Neoplasms/surgery , Thyroid Neoplasms , Thyroid Nodule/surgery , Thyroid Nodule/pathology , Thyroid NoduleABSTRACT
Objetivo. Determinar la prevalencia de neuropatía sensorial distal (NSD) en pacientes con artritis reumatoide (AR). Tipo de estudio. Encuesta descriptiva prolectiva. Sitio de estudio. HE CMN "El Fénix" IMSS. Mérida Yucatán, México. Material y métodos. Pacientes con AR según criterios del ACR sin enfermedades predisponentes para neuropatía periférica fueron sometidos a estudios de neuroconducción (velocidad de conducción nerviosa y latencias distales sensitivas) y examen clínico. Resultados. Se estudiaron 58 pacientes (50 mujeres y 8 varones) con edad media de 42 años (variabilidad 16-74, con tiempo de evolución media de 9.3 años (variabilidad 0.5-38 años). Treinta y ocho de los pacientes (65 por ciento) fueron positivos a factor reumatoide (FR), y al tiempo de la encuesta, 32 (55 por ciento) se encontraban activos. Se diagnosticó NSD en 2 pacientes (3.4 por ciento), ambos con FR positivos, inactivos de la enfermedad, con evolución mayor de 9 años y sin síntomas neurológicos. Conclusión. La NSD tuvo prevalencia de AR de 3.4 por ciento, no se relaciona con actividad de la enfermedad, cursa asintomática y parece presentarse en pacientes de larga evolución
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Arthritis, Rheumatoid/physiopathology , Neural Conduction/physiology , Neurologic Manifestations , Hereditary Sensory and Autonomic Neuropathies/epidemiology , Carpal Tunnel Syndrome/diagnosisABSTRACT
Objetivo. Evaluar la eficacia de un régimen dietético vegetariano en pacientes con Síndrome de Fibromialgia Primaria (SPF), Síndrome de dolor miofascial (SDMF) y lumbalgia crónica. Tipo de estudio. Ensayo clínico controlado. Material y métodos. Se estudiaron 18 pacientes de sexo femenino con SPF, SDMF y lumbalgia. Diez recibieron dieta vegetariana (DV) y ocho dieta normal (DN). Ambos grupos recibieron similar tratamiento farmacológico y fisioterápico. Se evaluó intensidad de dolor, capacidad funcional y calidad de vida en tiempo basal y posteriormente a intervalos mensuales por 3 meses. Resultados. Los pacientes asignados a DV tuvieron mayores calificaciones de intensidad de dolor que los asignados a DN a partir de los 30 días de tratamiento; no hubo diferencia entre ambos grupos en cuanto a capacidad funcional y calidad de vida. Conclusiones. El uso de una dieta vegetariana no parece ser eficaz en pacientes con SPF, SDMF y lumbalgia crónica
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Plants/metabolism , Eicosanoids/deficiency , Diet , Myofascial Pain Syndromes/metabolism , Musculoskeletal Diseases/metabolism , Rheumatic Diseases/physiopathologyABSTRACT
El objetivo es determinar la influencia de algunos factores sobre el riesgo de cronicidad de la lumbalgia aguda. El estudio se realizó en una cohorte concurrente con seguimiento de todos los pacientes con lumbalgia aguda referidos entre febrero de 1992 y enero de 1993. A las 12 semanas de evolución se consideró lumbalgia crónica si había persistencia sintomática y no crónica si había remisión de dolor. Se analizó estado de productividad (productivos vs. dependientes económicos, pensionados y jubilados), antecedentes de lumbalgia y sexo. Sólo el sexo demostró ser un débil factor de riesgo para evolución hacia la cronicidad en los pacientes con lumbalgia aguda
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pelvis , Spinal Diseases , Back Pain/physiopathology , Economics/trends , Chronic Disease/classificationABSTRACT
En el presente trabajo se evalúa la eficacia de la insulina en dosis fraccionadas en la disminución de la glucemia basal en pacientes diabéticos con "fenómeno del amanecer". El tipo de estudio es longitudinal, prospectivo, comparativo y controlado. Se estudiaron 14 pacientes diabéticos con "fenómeno del amanecer", 10 varones y cuatro mujeres, con edad promedio de 22 años y tiempo de evolución promedio de seis años, tratados con monodosis promedio de insulina intermedia matutina de 1µU/mL/kg de peso, cuya glucemia basal era igual o superior a 200 mg/dL. Se administró insulina intermedia en la misma dosis previa, pero en forma fraccionada: 70 a 80 por ciento a las 8:00 y 30 a 20 por ciento a las 21:30 horas. Se realizó glucemia basal cuatro semanas después del cambio de régimen. El promedio de la glucemia basal con monodosis fue de 309 mg/dL (IC 277-342 mg/dL) y el promedio de la glucemia con dosis divida fue de 144 mg/dL (IC 122-165 mg/dL), p<0.001. La dosis fraccionada de insulina disminuye la glucemia basal en pacientes diabéticos con "fenomeno del amanecer" tratados previamente con la misma cantidad de insulina en monodosis