Asociación de la violencia obstétrica, control prenatal y embarazo no planeado con la prematurez / Association of obstetric violence, prenatal control, and unplanned pregnancy with prematurity

Resumen La prematurez (PM) neonatal es un problema mayor de salud pública en el mundo, debido a su frecuencia de presentación y los años de vida potencialmente perdidos; además, es la principal causa de muerte en menores de cinco años. Entre las consecuencias negativas de la PM están las discapacidades del aprendizaje, visual y auditiva. Múltiples son los factores asociados a la PM; algunos pueden ser detectados y modificados de forma oportuna en las consultas prenatales y también, en las preconcepcionales. Por otro lado, la PM no es solamente responsabilidad del prestador de los servicios de salud, sino también del sistema de salud, el cual, debe otorgar los recursos mínimos necesarios para monitorear y mantener a la embarazada en un estado óptimo de salud para evitarla, y en caso de presentarse, debe contar con la infraestructura hospitalaria básica que permita la viabilidad del producto y evitar su muerte. Aunado a lo anterior, se debe de considerar la responsabilidad de la paciente y su pareja, debido a que en ellos recae la obligación de llevar un estilo de vida saludable y acudir a las consultas preconcepcionales y control prenatal.

Abstract Neonatal prematurity (MP) is a major public health problem in the world, due to its presentation frequency and the years of life potentially lost; In addition, it is the main cause of death in children under five years of age. Among the negative consequences of MP are learning, visual and hearing disabilities. There are multiple factors associated with MP; some can be detected and modified in a timely manner in prenatal consultations and in preconception. On the other hand, MP is not only responsibility of the health service provider, but also of the health system, which must grant the minimum resources necessary to monitor and maintain the pregnant woman in an optimal state of health to avoid it, and if it occurs, the hospital must have the basic infrastructure that allows the viability of the product and prevents its death. In addition, the responsibility of the patient and her partner must be considered since they are obliged to lead a healthy lifestyle and attend preconception consultations and prenatal care.

Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients / Diferenças na cognição e na qualidade de vida entre os pacientes idosos e os muito idosos em hemodiálise

Abstract Introduction: In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. Methods: Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). Results: Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). Conclusion: Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.

Resumo Introdução: Nas últimas décadas, houve um aumento expressivo no número de pacientes idosos com doença renal crônica iniciando hemodiálise. Assim, nosso objetivo foi avaliar o perfil de idosos em hemodiálise crônica e comparar a cognição e a qualidade de vida dos idosos com as de muito idosos. Métodos: Pacientes em hemodiálise havia pelo menos 3 meses, que tinham 65 anos ou mais quando começaram o tratamento dialítico foram convidados a participar, e estratificados de acordo com a idade (menores ou maiores de 80 anos). Os participantes responderam a um questionário clinico-epidemiológico e foram submetidos a testes cognitivos (miniexame do estado mental [MEEM], teste do relógio [TDR] e teste de fluência verbal [TFV]) e a uma avaliação de qualidade de vida 36-Item Short Form Health Survey). Resultados: Dos 125 pacientes elegíveis, 124 concordaram em participar. A idade média foi de 76 ± 6 anos (28% ≥ 80 anos), 56% eram homens e 55% tinham ≥ 8 anos de escolaridade. Depressão foi sugerida em 38%. A prevalência de déficit cognitivo foi 38%, 70% e 30%, pelo MEEM, TDR e TFV, respectivamente. A prevalência de qualquer déficit foi maior entre os muito idosos (94% vs. 72%, p = 0,007). Os escores de qualidade de vida foram semelhantes entre os dois grupos etários, exceto pelo domínio da capacidade funcional, pior no grupo com ≥ 80 anos (p = 0.033). Conclusão: Os pacientes idosos em hemodiálise crônica apresentam elevada prevalência de déficit cognitivo, especialmente os muito idosos, mas esse grupo não possui pior qualidade de vida, exceto pelo aspecto da capacidade funcional.

Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials

ABSTRACT Background Muscle strength is usually measured in individuals with stroke with Portable dynamometers (gold standard). However, no studies have investigated the reliability, the standard error of measurement (SEM) and the minimal detectable difference (MDD95%) of the dynamometry for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke. Objective 1) To investigate the intra and inter-rater reliability, the SEM and the MDD95% of the portable dynamometers for the measurement of grip, pinch and trunk strength in subjects with subacute stroke, and 2) to verify whether the use of different number of trials (first trial and the average of the first two and three trials) affected the results. Method 32 subjects with subacute stroke (time since stroke onset: 3.6 months, SD=0.66 months) were evaluated. Hand grip, 3 pinch grips (i.e. pulp-to-pulp/palmar/lateral) and 4 trunk muscles (i.e. flexors, extensors, lateral flexors and rotators) strength were bilaterally assessed (except trunk flexors/extensors) with portable dynamometry by two independent examiners over two sessions (1-2 weeks apart). One-way ANOVAs and intraclass correlation coefficients (ICC2,k) were used for analysis (α=0.05). SEM and MDD95% were also calculated. Results For all muscular groups and sources of outcome values, including one trial, after familiarization, similar results were found (0.01≤F≤0.08; 0.92≤p≤0.99) with significant and adequate values of intra-rater (0.64≤ICC≤0.99; 0.23≤95%CI≤0.99) and inter-rater (0.66≤ICC≤0.99; 0.25≤95%CI≤0.99) reliability. SEM and MDD95% were considered low (0.39≤EPM≤2.21 Kg; 0.96≤MMD95%≤6.12 Kg) for all outcome scores. Conclusion Only one trial, following familiarization, demonstrated adequate intra-rater and inter-rater reliability of the portable dynamometers for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function

ABSTRACT Background: Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective: To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method: Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results: Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion: Grip strength assessed with the MST could be used to report paretic UL global strength.

Associação entre estrutura familiar, nível de escolaridade e emprego da mãe com estilo de vida sedentário em crianças em idade escolar primária / Association between family structure, maternal education level, and maternal employment with sedentary lifestyle in primary school-age children

OBJETIVO: Determinar a associação entre a estrutura familiar, o nível de escolaridade e emprego da mãe com o estilo de vida sedentário em crianças em idade escolar primária. MÉTODO: Foram obtidos os dados de 897 crianças com idade entre 6-12 anos. Foi utilizado um questionário para registrar as informações. O índice de massa corporal (IMC) foi determinado utilizando-se a definição específica para idade e sexo do Centro de Controle e Prevenção de Doenças. As crianças foram classificadas como: peso normal (5º-85º percentil), risco de sobrepeso (percentil > 85º e < 95º), sobrepeso (percentil > 95º). Para análise neste estudo, sobrepeso foi definido como IMC igual ou acima do 85º percentil para cada sexo. As razões de chance ajustadas (RCs ajustadas) foram determinadas para inatividade física utilizando o modelo de regressão logística. RESULTADOS: A prevalência de sobrepeso foi de 40,7%, e estilo de vida sedentário, 57,2%. O percentual de famílias de pais separados foi de 23,5%. Aproximadamente 48,7% das mães apresentaram um nível de escolaridade não aceitável, e 38,8% eram mães que trabalhavam fora de casa. Os resultados do modelo de regressão logística mostram que o fato de viver em um ambiente familiar com pais separados (RCs ajustadas = 1,67; IC 95% = 1,04-2,66) está associado ao estilo de vida sedentário em crianças com sobrepeso. No grupo de crianças com peso normal, a análise de regressão logística mostra que viver em uma família com pais separados, com a mãe apresentando nível de escolaridade não aceitável e/ou trabalhando fora de casa, não eram fatores associados a estilo de vida sedentário. CONCLUSÃO: Morar com uma família de pais separados, mais do que ter um baixo nível de escolaridade materno e uma mãe que trabalha fora, parece estar associado a um estilo de vida sedentário em crianças com sobrepeso em idade escolar primária.

OBJECTIVE: To determine the association between family structure, maternal education level, and maternal employment with sedentary lifestyle in primary school-age children. METHOD: Data were obtained from 897 children aged 6 to 12 years. A questionnaire was used to collect information. Body mass index (BMI) was determined using the age- and gender-specific Centers for Disease Control and Prevention definition. Children were categorized as: normal weight (5th percentile < BMI < 85th percentile), at risk for overweight (85th < BMI < 95th percentile), overweight (> 95th percentile). For the analysis, overweight was defined as BMI at or above the 85th percentile for each gender. Adjusted odds ratios (adjusted ORs) for physical inactivity were determined using a logistic regression model. RESULTS: The prevalence of overweight was 40.7%, and of sedentary lifestyle, 57.2%. The percentage of non-intact families was 23.5%. Approximately 48.7% of the mothers had a non-acceptable educational level, and 38.8% of the mothers worked outside of the home. The logistic regression model showed that living in a non-intact family household (adjusted OR = 1.67; 95% CI = 1.04-2.66) is associated with sedentary lifestyle in overweight children. In the group of normal weight children, logistic regression analysis show that living in a non-intact family, having a mother with a non-acceptable education level, and having a mother who works outside of the home were not associated with sedentary lifestyle. CONCLUSION: Living in a non-intact family, more than low maternal educational level and having a working mother, appears to be associated with sedentary lifestyle in overweight primary school-age children.

Efficiency status of the elective non-cardiac surgery operating rooms of the Department of Surgery of the Philippine General Hospital

INTRODUCTION: The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.OBJECTIVES: This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.METHODS: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.RESULTS: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.CONCLUSION: The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Prevalencia de caries dental en adolescentes: asociación con género, escolaridad materna y estatus socioeconómico familia / Prevalence of dental caries in adolescents: association with gender, mother´s education level and family socioeconomic status

Introducción y Objetivo: La prevalencia de caries dental parece estar aumentando y los determinantes no están bien establecidos. Determinar la prevalencia de la caries dental en adolescentes y su asociación con el género, escolaridad materna y el estatus socioeconómico familiar. Materiales y Métodos: Es un estudio transversal de 1.893 adolescentes escolares, en edades de 13 a 18 años. La caries se identificó por exploración física directa. Se utilizó modelo de regresión logística para determinar la asociación entre el sexo, escolaridad materna, estatus socioeconómico familiar y la caries. El índice de caries fue medido como el número de dientes con caries (C), obturados (O), perdidos por caries (P), (COP-D) o superficies (COP-S) Resultados: La prevalencia de caries dental fue de 48,2%. El porcentaje de caries fue similar en hombres y en mujeres (48,3 vs. 48,2%). En la población total estudiada, el valor medio de COP-D fue 1,68±0,52 y el correspondiente valor medio de COP-S fue 2,47±1,08. Aproximadamente, 52,2% de las madres de los adolescentes tenían estudios menores a los de secundaria y 44,5% de los adolescentes vivían en el seno de una familia con nivel económico bajo. De acuerdo a los datos, el sexo, la escolaridad materna, el nivel socioeconómico no se encuentran relacionados con la caries dental en adolescentes. Conclusiones: Nuestros datos muestran que no existe asociación entre el sexo, escolaridad materna, nivel socioeconómico bajo y la caries dental en adolescentes. La caries dental afecta a un porcentaje importante de adolescentes.

Introduction and Objetive: Prevalence of dental caries appears to be increasing, and determinants are not well established. To determine the prevalence of dental caries in adolescents and its association with sex, maternal education and family socioeconomic status. Materials and Methods: This a cross-sectional study of 1.893 adolescent students, age 13 to 18 years. Dental caries was assessed by an intra-oral examination. Logistical regression was used to determine the association between sex, maternal schooling, family socioeconomic status and caries. Decay rate was measured as the number of teeth with decay (C), filled (O), extracted (P), (COP-D) or surfaces (COP-S). Results: Dental caries prevalence was 48,2%. Percentage of caries was similar in boys (48,3% vs. 48,2%) and in girls. In the overall population studied, the mean value of COP-D was 1,68±0,52 and the corresponding mean value of COP-S was 2,47±1,08. Approximately 52,2% of mothers of adolescents had completed High School and 44,5% of adolescents lived in a family with low economic status. According to the data, gender, maternal education and socioeconomic status were not related to dental caries in adolescents. Conclusions: Our data show no association between sex, maternal education, family low socioeconomic status and dental caries in adolescents. Dental caries affects a large percentage of adolescents.

Tratamento de angina mesentérica em pacientes com arterite de Takayasu / Treatment of mesenteric angina in patients with Takayasu's arteritis

Aarterite de Takayasu (AT) é uma doença inflamatória crônica do tecido conectivo, idiopática, que acomete preferencialmente a aorta e seus ramos. A terapêutica utilizada baseia-se sobretudo no uso de corticosteroides e imunossupressores. É relatado o caso de uma paciente, 33 anos, com mal-estar, febre, mialgia, cefaleia intensa, pulsátil, holocraniana, resistente a analgésicos, hipertensão arterial sistêmica de difícil controle, claudicação no membro inferior direito e dor abdominal de forte intensidade, a qual piorava após a alimentação. A angiotomografia revelou aneurisma da aorta ascendente, estenose da artéria ilíaca comum direita, estenose das artérias renais e estenose da artéria mesentérica superior, fato que embasou o diagnóstico de angina mesentérica e a conduta intervencionista através da angioplastia transluminal percutânea múltipla com a colocação de stents.

Takayasu's arteritis (TA) is an idiopathic chronic inflammatory disease of the connective tissue that affects mainly the aorta and its branches. Treatment is mainly based on corticosteroids and immunosuppressants. We report the case of a 33-year-old female complaining of malaise, fever, myalgia, severe pulsing holocranial headache resistant to analgesics, systemic arterial hypertension hard to control, right lower limb claudication, and severe abdominal pain that worsened after the meals. Angiotomography revealed aneurysm of the ascending aorta, and stenosis of the following vessels: right common iliac artery, renal arteries, and superior mesenteric artery. Those findings supported the diagnosis of mesenteric angina and the interventional approach by use of percutaneous transluminal angioplasty with stent placement.

Prostate cancer and the Filipino: A review of published data

Filipinos have often been classified as a race having low risk for developing prostate cancer (CaP), and likewise a low risk of dying from the disease. This has mostly been based on information indicating similar patterns among men of Asian decent. But with the changing trends in the disease, both worldwide and in the Asian region, should Filipinos continue to be regarded as such? To attempt to answer this question, a literature search was performed using the following online databases: Medline, SUMsearch, CancerLit, and National Library of Medicine Gateway. The search terms used were "prostate cancer," "Filipino," "Asians," "incidence," and "prognosis." A total of 39 publications were included in this review. In all the studies that segregated Asians into its component subpopulations, Filipinos were noted to have the highest incidence rate (IR) among Asians residing locally, and also the highest or second highest IR among Asian immigrants residing abroad. Studies that focused on the Asian region consistently found an increasing trend in IR of CaP for all subpopulations, with the Philippines experiencing one of the fastest rising IR. Filipinos, both residing abroad and locally, were also observed to have the highest mortality rate (MR) among all the Asian subpopulations included, with an even higher MR than Caucasians reported by certain studies. Evidence was found in this review suggesting that Filipino men may not have the low risk of developing and dying from CaP, as is popularly believed, and may have similar risk of death from CaP as Caucasians.