Tertiary Prevention of Ovarian Cancer After PARP Inhibitor Therapy / 肿瘤防治研究

The tertiary prevention approaches of ovarian cancer include whole-person care, training of the patients to cooperate with physicians in the periods of treatment and follow-up, training program of the qualified surgeons, and recognition of biological behavior changes of relapse after PARPi therapy. Surgery remains the cornerstone in the management of ovarian cancer, but the role of surgery after PARPi remains unknown. Recently, the US FDA withdrew the indication of three PARP inhibitors in the treatment of recurrent ovarian cancer with ≥3 lines of chemotherapy because of their ≥30% increased death risk. Thus, we should pay more attention to the biological recurrence and chemoresistance caused by PARP inhibitors and post-progression survival in ovarian cancer.

Research Progress on the Application of Intervention Mapping in Tertiary Prevention of Cancer / 中国医学科学院学报

Intervention mapping (IM) is a framework for formulating theory-and evidence-based health education projects with participatory approaches from ecological perspectives.The intervention program designed via IM plays a role in reducing the exposure of cancer risk factors,increasing cancer prevention behaviors,and promoting early cancer screening and rehabilitation of cancer patients.This study summarizes the characteristics,implementation steps,and application status of IM in tertiary prevention of cancer,aiming to provide reference for the application of IM in the health education projects for cancer in China.

Construction and application of the Yueyang comprehensive birth defects prevention and control information platform / 公共卫生与预防医学

Objective To construct and apply a comprehensive information platform for the prevention and control of birth defects based on three-level prevention and control in the birth-age population of Yueyang City, aiming to improve the effectiveness of intervention and reduce the impact of birth defects on the fetus. Methods A retrospective analysis was used to study the married population of childbearing age in Yueyang from January 2017 to December 2019, all of whom were included in the comprehensive information platform for the prevention and control of birth defects based on the three-tier prevention and control. Observed indicators include birth defects I, II and III prevention and control and intervention effectiveness. Results (1) Effectiveness of prevention and control at the first level in each year: After continuous intervention, the education rate, marriage test rate and folic acid distribution in Yueyang city increased year by year, while the incidence of birth defects decreased year by year (P<0.05). (2) Effect of secondary prevention and control in each year: After continuous intervention, the serum screening rate, ultrasound diagnosis rate and amniotic fluid culture rate in Yueyang city increased year by year, while the birth defect rate decreased year by year (P<0.05). (3) Effectiveness of three levels of prevention and control in each year: After continuous intervention, the screening rate of newborns in Yueyang city increased year by year (P<0.05); and the disability rate of CH and PKU was 0% in three years. Conclusions The adoption of a three-level comprehensive prevention and control information platform in the prevention and control of birth defects has the advantages of safe, efficient and stable application, which is conducive to promoting the active conduct of prenatal examinations by pregnant women, enhancing the effectiveness of health education and improving the quality of health care during pregnancy, thereby effectively reducing the incidence, birth and disability rates of children with birth defects and achieving satisfactory graded application results. Accordingly, it is recommended that priority be given to the selection of a three-tier integrated information platform for prevention and control, depending on the actual situation.

Retos en la prevención del embarazo adolescente subsiguiente, un estudio desde la perspectiva de madres adolescentes / Challenges in preventing a subsequent pregnancy in adolescents: perspectives of adolescents' mothers

Resumen El presente artículo expone el resultado de una evaluación cualitativa sobre las acciones que los servicios públicos de salud desarrollan para la prevención de embarazos subsiguientes en adolescentes, en un estado en el centro-norte de México. El objetivo fue documentar los obstáculos percibidos para prevenir embarazos subsiguientes en madres adolescentes. La información se obtuvo entre 2016-2018, mediante entrevistas individuales en los domicilios de jóvenes usuarias de servicios públicos de salud. El análisis de la información se hizo a partir de la propuesta de Strauss y Corbin para teoría fundamentada. Las experiencias compartidas por las jóvenes madres fueron analizadas y clasificadas en dos categorías, obstáculos asociados a: (1) competencias profesionales, y (2) a imaginarios morales. Se concluye que las limitaciones más importantes tienen que ver con el hecho de que la estrategia de servicios amigables para adolescentes deja de implementarse en aquellas que han sido madres, sin considerar el impacto biológico y psicosocial que tienen los embarazos subsiguientes en la adolescencia y la necesidad de postergar la reproducción hasta la edad adulta.

Abstract This article presents the result of a qualitative evaluation of the actions that the public health services develop for the prevention of subsequent adolescent pregnancies in a state in north-central Mexico. The objective was to document the perceived obstacles to preventing subsequent teenage pregnancies in teenage mothers. The information was obtained in the period 2016-2018, by individual interviews in the homes of young users of public health services. The analysis of the information was based on Strauss and Corbin's proposal for the grounded theory. The experiences shared by the young mothers were analyzed and classified into two categories, obstacles associated with: (1) professional competences, and (2) with moral imagery. It is concluded that the most important limitations are related to the fact that the strategy of adolescent friendly services is no longer implemented in those who have been mothers, without considering the biological and psychosocial impact that subsequent pregnancies have in adolescence and the need to delay reproduction until adulthood.

Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2)

RESUMEN Se presenta la segunda parte de las recomendaciones latinoamericanas para el manejo de la Hipertensión Arterial (HTA) en adultos. En una primera fase se han descripto los aspectos más relevantes de la epidemiología, aspectos fisiopatológicos, cómo hacer diagnóstico, pautas terapéuticas, urgencias y emergencias hipertensivas, poblaciones especiales, hipertensión refractaria y la aplicación de las guías en la vida real. En esta segunda parte, se emiten recomendaciones respondiendo a preguntas específicas para prevención primaria, secundaria, terciaria y cuaternaria. En general pocas recomendaciones al respecto del manejo de la hipertensión arterial surgen desde la clínica médica/ medicina interna, a pesar de dos situaciones: la mayoría de los pacientes con hipertensión arterial son evaluados y manejados por los clínicos, y la clínica médica es la especialidad que permite la mirada holística e integrada de los problemas de salud del adulto, permitiendo agregar el enfoque biográfico al biológico, comprender e interpretar no solo el problema de salud sino sus causas y consecuencias (que muchas veces suelen corresponder a diferentes parénquimas, lo cual en el modelo fragmentado haría transitar al paciente por distintas especialidades). El bajo porcentaje de pacientes hipertensos controlados obliga a todos los profesionales involucrados en el manejo de los mismos a optimizar recursos y detectar problemas que se asocien a un control deficitario como la sub utilización del tratamiento farmacológico, baja tasa de pacientes tratados con estrategia combinada (la mayoría de los pacientes actualmente recibe monoterapia), falta de prescripción adecuada de los cambios en el estilo de vida, baja adherencia terapéutica e inercia clínica. En la presente publicación se presentan recomendaciones efectuadas por especialistas en clínica médica / medicina interna para el manejo de la hipertensión arterial en adultos, respondiendo preguntas de prevención primaria, secundaria, terciaria, y cuaternaria.

ABSTRACT The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

Research progress on hierarchical management of diabetes / 中国实用护理杂志

In the past 40 years, the prevalence of diabetes in China has been increasing year by year. The prevention and treatment of diabetes were very arduous. Hierarchical management is not only a major mode of chronic disease management in China, but also a research trend in recent years. The study reviewed the status of hierarchical management of diabetes including tertiary prevention, grading diagnosis and treatment, community grading intervention, diabetic foot ulcer and cardiovascular disease risk grading and management. And summarized the grading management indicators, methods, effects, existing problems and improvement measures. In order to provide a new direction for the development of diabetes management.

Prevention and Preventive Strategies for Pancreatitis / 胃肠病学

Since the rising rates of obesity, alcohol consumption and tobacco smoking, along with the improvement in quality of clinical diagnosis, the incidence of pancreatitis continues growing and causes a huge socioeconomic burden. How to prevent pancreatitis effectively has become a major medical and social issue. This article reviewed the holistic preventive strategies and measures of pancreatitis at primary, secondary and tertiary levels for decreasing the incidence of pancreatitis and its sequelae, and improving the prognosis of patients.

Research progress on hierarchical management of diabetes / 中国实用护理杂志

In the past 40 years, the prevalence of diabetes in China has been increasing year by year. The prevention and treatment of diabetes were very arduous. Hierarchical management is not only a major mode of chronic disease management in China, but also a research trend in recent years. The study reviewed the status of hierarchical management of diabetes including tertiary prevention, grading diagnosis and treatment, community grading intervention, diabetic foot ulcer and cardiovascular disease risk grading and management. And summarized the grading management indicators, methods, effects, existing problems and improvement measures. In order to provide a new direction for the development of diabetes management.

Workplace physical activity program: an intervention proposal / Programa de exercício físico no ambiente de trabalho: uma proposta de intervenção / Programa de ejercicio físico en el ambiente de trabajo: una propuesta de intervención

ABSTRACT Contemporary workstations have been transformed by technological advances, meaning that employees are less physically active. Physical exercise programs are a tool to combat this sedentary lifestyle and prevent possible work-related illnesses. The aim of this study consisted of drafting an intervention proposal through physical exercise - the Workplace Physical Activity Program / WPAP - to be applied in the workplace, covering physical, mental and social aspects. The trial was methodologically structured in three stages: a) contextualization of the WPAP; b) implementation of the program; and c) the intervention proposal. It is believed that this type of program should receive investments, as it has a quick return and effectively improves the health of workers. Level of Evidence V; Expert opinion.

RESUMO Devido aos avanços tecnológicos, a modernidade vem transformando os postos de trabalho, tornando os funcionários menos ativos fisicamente. Os programas de exercícios físicos são uma ferramenta para combater esse sedentarismo e evitar possíveis doenças relacionadas ao trabalho. O objetivo deste estudo consistiu em elaborar uma proposta de intervenção por meio de exercícios físicos - Programa de Exercícios Físicos no Ambiente de Trabalho/PEFAT - para ser aplicada no ambiente de trabalho, contemplando os aspectos físico, mental e social. O ensaio estruturou-se metodologicamente em três fases: a) contextualização sobre o PEFAT; b) implantação do programa e c) a proposta de intervenção. Considera-se que esse tipo de programa deva ser foco de investimento, já que seu retorno é rápido e eficaz para a saúde do trabalhador. Nível de Evidência V; Opinião do especialista.

RESUMEN Debido a los avances tecnológicos, la modernidad viene transformando los puestos de trabajo, haciendo que los funcionarios sean menos activos físicamente. Los programas de ejercicios físicos son una herramienta para combatir ese sedentarismo y evitar posibles enfermedades relacionadas al trabajo. El objetivo de este estudio consistió en elaborar una propuesta de intervención a través de ejercicios físicos - Programa de Ejercicios Físicos en el Ambiente de Trabajo/PEFAT - para que sea aplicada en el ambiente de trabajo, contemplando los aspectos físico, mental y social. El ensayo se estructuró metodológicamente en tres fases: a) contextualización sobre el PEFAT; b) implantación del programa; y c) la propuesta de intervención. Se considera que este tipo de programa debe ser el foco de inversión, ya que su retorno es rápido y eficaz para la salud del trabajador. Nivel de Evidencia V; Opinión del especialista.

Effect of community nutrition management in tertiary prevention of gestational diabetes mellitus / 中国医师杂志

Objective To establish the community sustainable nutrition management path of patients with gestational diabetes mellitus (GDM) and explore the effect in the tertiary prevention of GDM.Methods The number of pregnant women who delivered in the Jiangdong district of Ningbo city during January 2013 to December 2016 was 1 028.512 patients with GDM who delivered were enrolled in control group and 516 patients in study group.Prevalence rate of GDM,blood glucose,glycosylated hemoglobin (HbAlc),weight gain during pregnancy,pregnancy outcomes,satisfaction rate of blood glucose control were compared between two groups.Data was analyzed by SPSS 13.0 statistical software.Results Prevalence rate of GDM in study group was 7.69％,lower than control groupl 1.1％.Fasting blood glucose (FPG),1 hour blood glucose (1 h PG),macrosomia,low birth weight in study group were better than control group.Fetal distress,Intrauterine infection,Hydramnios,Amniotic fluid embolism,Placental abruption,pregnancy weight gain were similar in two groups.Conclusions The sustainable nutrition management path of the community has good effect in the tertiary prevention of gestational diabetes mellitus.

Advantages and significance of a three-level prevention and treatment system for chronic kidney disease in Shanghai / 第二军医大学学报

The three-level prevention and treatment system for chronic kidney disease has been introduced in Jing’an District and Minhang District in Shanghai as a pilot project. In this paper, we systematically introduced the background and implementation program of this prevention and treatment system, and analyzed the prospect of the system by combining the characteristics and current treatment of patients with chronic kidney disease in China, so as to provide reference for Shanghai as well as the whole country.

Práticas de autocuidado em hanseníase: face, mãos e pés / Prácticas de autocuidado en hanseniasis: cara, manos y pies / Practices for self-care in Hansen's disease: face, hands and feet

Resumo OBJETIVO Analisar as práticas de autocuidado em face, mãos e pés realizadas por pessoas atingidas pela hanseníase. METODOLOGIA Estudo qualitativo, realizado em unidades de referência para hanseníase em Pernambuco, entre maio de 2014 e abril de 2015, com 24 pessoas. Os dados foram coletados por meio da entrevista semiestruturada e realizada a análise de conteúdo. RESULTADOS Emergiram duas categorias: Conhecimento e realização de práticas de autocuidado em Hanseníase e Singularidades e desafios do autocuidado. O estudo apontou que os entrevistados conhecem as informações sobre os cuidados com a face, mãos e pés, mas relatam dificuldades como baixa renda para adquirir material para o autocuidado, falta de tempo, e alguns falta de interesse. A maior parte já apresentava grau de incapacidade. CONCLUSÕES É necessário a capacitação de profissionais que atuem no empoderamento das pessoas frente à doença e orientações sobre prevenção de incapacidades e acesso à insumos para realizar o autocuidado.

Resumen OBJETIVO Analizar las prácticas de autocuidado en cara, manos y pies realizadas por personas afectadas por la hanseniasis. METODOLOGÍA Estudio cualitativo, realizado en unidades de referencia para hanseniasis en Pernambuco, entre mayo de 2014 y abril de 2015, con 24 personas. Los datos fueron recolectados por medio de la entrevista semiestructurada y realizada el análisis de contenido. RESULTADOS emergieron dos categorías: Conocimiento y realización de prácticas de autocuidado en Hanseniasis y Singularidades y desafíos del autocuidado. El estudio apuntó que los entrevistados conocen las informaciones sobre los cuidados con la cara, manos y pies, pero relatan dificultades como bajas rentas para adquirir material para el autocuidado, falta de tiempo, y algunos falta de interés. La mayor parte ya presentaba grado de incapacidad. CONCLUSIONES Es necesario la capacitación de profesionales que actúen en el empoderamiento de las personas frente a la enfermedad y orientaciones sobre prevención de discapacidades y acceso a insumos para realizar el autocuidado.

ABSTRACT OBJECTIVE To analyze the self-care practices on the face, hands and feet carried out by people affected by Hansen's disease. METHODOLOGY A qualitative study, carried out in reference units for Hansen's disease in Pernambuco, between May 2014 and April 2015, with 24 people. Data was collected through the semi-structured interview and content analysis was carried out. RESULTS Two categories emerged: Knowledge and execution of self-care practices in Leprosy and Singularities and challenges for self-care. The study found that respondents are familiar with information about face, hand and foot care, but report difficulties such as low income to acquire material for self-care, lack of time, and some lack of interest. Most of them already presented a degree of incapacity. CONCLUSIONS The training of professionals who work on the empowerment of people facing the disease, guidelines on prevention of disabilities and access to inputs for carrying out self-care are necessary.

Caracterización de los servicios de promoción de la salud y prevención de la enfermedad en cuatro instituciones de salud del municipio de Medellín, 2015 / Characterization of Health Promotion and Disease Prevention Services in Four Health Institutions in the Municipality of Medellin, 2015 / Caracterização dos serviços de promoção da saúde e prevenção de doença em quatro instituições de saúde do município de Medellín, 2015

Resumen Estudio descriptivo que permitió caracterizar los programas y las actividades de promoción de la salud y prevención de la enfermedad en cuatro instituciones de salud de alta complejidad de Medellín. Por medio de un estudio descriptivo de serie de casos, se aplicaron dos instrumentos semiestructurados tipo encuesta donde se recolectó información sobre: estructura y funcionamiento, enfoque, públicos beneficiarios, metodologías y equipos de trabajo. Se encontró que las cuatro instituciones desarrollan actividades de este tipo, con un enfoque hacia la prevención terciaria congruente con su nivel de complejidad; están orientadas esencialmente al paciente y a las familias, y, a veces, a la comunidad; los empleados también se benefician desde salud ocupacional; son desarrolladas por profesionales de diferentes disciplinas; su funcionamiento depende generalmente de las direcciones científicas; no se identifica un área en particular que las gestione articuladamente. Se considera importante que las instituciones se declaren a favor de modelos de atención en salud integrales donde se trabaje de manera articulada las actividades de promoción y prevención con la atención clínica.

Abstract This is a descriptive study that allowed for the characterization of the health promotion and disease prevention programs and activities in four high-complexity health institutions in Medellín. By means of a descriptive study of a series of cases, two semi-structured survey instruments were applied through which information was collected on: structure and functioning, approach, beneficiary communities, methodologies, and work teams. We found that all four institutions develop activities of this type, with a focus on tertiary prevention consistent with their level of complexity; they are essentially oriented to the patient and their families, and, sometimes, to the community; employees also benefit from occupational health; the activities are developed by professionals from different disciplines; their operation depends in general terms on scientific management; and no particular area was identified to manage the activities articulately. We considered important that the institutions manifest to be in favor of integral health care models where the promotion and prevention activities are coordinated with clinical care.

Resumo Estudo descritivo que permitiu caracterizar os programas e atividades de promoção da saúde e prevenção de doença em quatro instituições de saúde de alta complexidade de Medellín. Por meio de estudo descritivo de série de casos, aplicaram-se dois instrumentos semiestruturados tipo inquérito onde foi coletada informação sobre: estrutura e funcionamento, enfoque, públicos beneficiários, metodologias e equipes de trabalho. Verificou-se que as quatro instituições desenvolvem atividades deste tipo, com enfoque para a prevenção terciária congruente com o seu nível de complexidade; são orientadas essencialmente ao paciente e as famílias, e, às vezes, à comunidade; os empregados também são beneficiados desde saúde ocupacional; são desenvolvidas por profissionais de diferentes disciplinas; o seu funcionamento depende geralmente das direções científicas; não se identifica uma área em particular que as gere articuladamente. Considera-se importante as instituições se declararem em favor de modelos de atenção em saúde integrais onde se trabalharem de maneira articulada as atividades de promoção e prevenção com a atenção clínica.

Cuestionario PAR-Q & YOU y antecedentes cardiovasculares frente a la práctica de la actividad física en adultos mayores en diálisis / PAR-Q & YOU Questionnaire and cardiovascular history of elderly patients on dialysis engaged in physical activity

INTRODUCCIÓN: La actividad física se ha convertido en los últimos años en una herramienta terapéutica y mecanismo protector en el adulto mayor para disminuir el riesgo cardiovascular en usuarios con diversos tipos de diálisis que se encuentran en su fase paliativa. OBJETIVO: El presente trabajo buscó determinar la evaluación de ingreso a un programa de actividad física terapéutica por medio de la aplicación del Cuestionario PARQ & YOU en un grupo de participantes adultos mayores con diversos tipos de hemodiálisis, y su relación con los factores de riesgo cardiovascular. MATERIAL Y MÉTODOS: Se utilizó una prueba chi cuadrado de Pearson con el fin de determinar la posible asociación de las variables en relación a los antecedentes médicos y el disconfort, frente a la práctica de actividad física versus el resultado del PAR-Q & YOU. Se realizó una regresión logística binaria con las variables que en el análisis mediante prueba chi cuadrado. CONCLUSIONES: En la regresión logística se evidenció que los antecedentes cardiovasculares tienen 10.44 más veces influencia sobre la pertinencia de la aplicación del PAR-Q & YOU, como un instrumento básico para el ingreso a programas de actividad física en la rehabilitación renal desde la fisioterapia

INTRODUCTION: During the last few years, physical activity has become a therapeutic tool and a protective mechanism for the elderly; it reduces cardiovascular risk in patients undergoing different types of dialysis and receiving palliative care. OBJECTIVE: The aim of this study was to establish the inclusion criteria for a therapeutic physical activity program through the use of the PAR-Q & YOU Questionnaire with elderly patients treated with different types of hemodialysis, and to relate it with cardiovascular risk factors. METHODS:Pearson's chi-squared test was used to determine the possible association among variables, considering the medical history and discomfort caused by physical activity against the results of PAR-Q & YOU. Binary logistic regression was used with the variables in the chi-squared test. CONCLUSIONS: Through logistic regression, we found that cardiovascular history was 10.44 times more significant to establish the relevance of the PAR-Q & YOU as a basic assessment instrument for the inclusion in a physical activity program which is part of a physiotherapy-led renal rehabilitation

Study on the Tertiary Prevention Mode of Medical Social Workers Intervening in Patients with Chronic Pain:Taking Shanghai Pudong New Area Gongli Hospital as an Example / 中国医学伦理学

Otbjective:To provide body-mind-spirit-society holistic services for patients,through medical social workers intervening in chronic pain patients and using the professional theory of social work.Methods:By serving the patients and the potential people with community work,group work and case work,this paper explored the tertiary prevention mode for chronic pain patients,and then to intervene in their social psychosocial problems caused by pain and improve their quality of life.Results:Medical social workers intervening in chronic pain patients'social psychosocial problems made a difference.Through combining the prevention model with the three methods of social work,the service scope was expanded and the effectiveness was improved significantly.Conclusion:Under the guidance of tertiary prevention theory,this paperhas explored a set of models to intervene in chronic pain patients' social psychological health,which is of great significance to mitigate chronic pain patients' social psychological problem.

Study on the Intervention to Birth Defects under the Vision of Care Ethics / 中国医学伦理学

The condition of birth defects in our country is very serious,which impose an enormous burdenon the families and society.Under the vision of care ethics,this paper emphasizes understanding and caring,analyzes the ethical dilemma in the prevention of birth defects and puts forward the prevention measures in line with the codes of ethics,aiming at strengthening the practical effect of birth defects prevention work,caring about the physical and mental health of child-bearing female,and promoting social development.

Nuevos términos clínicos, prevención y tratamiento del trastorno cognitivo vascular: revisión de literatura basada en la evidencia / New clinical terms, prevention and treatment of vascular cognitive impairment: a review of evidence-based literature

El trastorno cognitivo vascular agrupa todas las instancias donde el compromiso cognitivo puede ser atribuidoa enfermedad vascular cerebral, es mayor que el esperado para el envejecimiento normal y que, cuando llega aafectar las actividades de la vida diaria, se denomina demencia vascular. En esta revisión, se actualizan los términos relacionados a trastorno cognitivo vascular y se plantean estrategias de prevención y tratamiento basadas en revisiones sistemáticas y meta-análisis. En la primera parte se definen diversos términos relacionados a trastorno cognitivo vascular; en la segunda, se plantea el tratamiento del trastorno cognitivo vascular/demencia vascular, que incluyeun manejo orientado a prevención primaria, controlando los factores de riesgo; un tratamiento secundario paraprevenir la exacerbación o la extensión de las lesiones producidas por la injuria vascular cerebral y, finalmente, untratamiento terciario o sintomático de los problemas cognitivos y/o conductuales. Damos especial énfasis y se fundamenta la conveniencia y beneficios de los tratamientos primario y secundario.

Vascular cognitive impairment is a label ascribed to cases in which the cognitive impairment can be attributed to cerebral vascular disease, is greater than the expected for normal aging and, when affecting the activities of daily life, is called vascular dementia. In this review, the terms related to vascular cognitive impairment, are updated, and strategies for prevention and treatment, based on systematic reviews and meta-analyses are outlined. In the first part, various vascular cognitive impairment-related terms are defined; in the second part, the treatment of vascular cognitive impairment / vascular dementia is described: it includes, management steps oriented towards primary prevention, controlling risk factors; a secondary treatment aimed at the prevention of exacerbation or extension of lesions produced by the vascular brain injuries and, finally, the tertiary or symptomatic treatment of cognitive and / or behavioral manifestations. Special emphasis is placed on, and the convenience and benefits of the primary and secondary treatments are substantiated.

Estimación del coste sanitario de las úlceras por presión en pacientes lesionados medulares / Estimation of the Sanitary Cost of Bedsores (Pressure Sores) in Patients with Medullary Lesions / Estimação do custo sanitário das úlceras de pressão em pacientes com lesão medular

Objetivo: conocer el coste total de cada tipo de úlcera por presión, ya que es un tipo de herida crónica que se produce habitualmente en pacientes con poca movilidad. Método: se ha realizado una revisión retrospectiva de las historias clínicas del periodo 2008-2011 correspondiente al registro de actividad de cirugía plástica del Hospital de Parapléjicos. Resultados: la úlcera por presión isquiática es la más frecuentemente tratada (43,27%) así como también la de menor coste total (¬ 57 196,29). El coste más alto de una úlcera por presión por su localización corresponde a la sacra (40,41%, siendo la segunda en frecuencia, y el coste total es de ¬ 112 012,96). Conclusiones: ante estos costes de tratamiento, se imponen campañas de prevención para intentar evitar este alto coste al Sistema Nacional de Salud.

Objective: getting to know the total cost of each type of bedsore (pressure sores), as it is a chronical injury commonly seen in patients with low mobility. Method: We realized a retrospective review of clinical records for the 2008 to 2011 period, corresponding to the plastic surgery activity records of the Paraplegic Hospital. Results: the ischial pressure sore is the most commonly treated (43.27%), and also shows the lowest total cost (¬ 57,196.29). The highest cost of a bedsore due to its location corresponds to sacral pressure sores (40.41%, being the second most frequent type, with a total cost of ¬ 112,012.96). Conclusions: Faced with these treatment costs, prevention campaigns are established in an attempt to prevent these high costs to the National Health System.

Objetivo: conhecer o custo total de cada tipo de úlcera de pressão, ainda que são tipos de ferida crónica que ocorre habitualmente em pacientes com baixa mobilidade. Método: foi realizada uma revisão retrospectiva dos prontuários médicos no período 2008-2011 correspondente ao registro de atividades de cirurgia plástica do Hospital de Paraplégicos. Resultados: as úlceras por pressão isquiáticas são as mais frequentemente tratadas (43,27%) bem como as de menor custo total (¬ 57 196,29). O custo mais alto de uma úlcera de pressão pela sua região corresponde à sacral (40,41 %, sendo a segunda em frequência, e o custo total é de ¬ 112 012,96). Conclusões: perante estes custos de tratamento, impõem-se campanhas de prevenção para tentar evitar este alto custo ao Sistema Nacional de Saúde.

Tertiary Prevention of Ischemic Heart Disease: Post Coronary Artery Bypass Surgery.

Coronary heart disease is more prevalent in Indian urban populations and there is a clear declining gradient in its prevalence from semi-urban to rural populations. Epidemiological studies show a sizeable burden of coronary heart disease in adult rural (3-5%) and urban (7-10%) populations. Thus, of the 30 million patients with coronary heart disease in India, there would be 14 million who are in urban and 16 million in rural areas. In India, about 50% of coronary heart disease-related deaths occur in people younger than 70 years compared with only 22% in the West. Extrapolation of these numbers estimates the burden of coronary heart disease in India to be more than 32 million patients. In India, there are large spectrums of patients who present at tertiary stage when first examined. These patients are left with very little margin of safety. Heart disease is one of the commonest causes of mortality and morbidity worldwide. Coronary artery bypass graft (CABG) surgery is a frequently used cardiothoracic revascularization to treat coronary artery disease (CAD). In addition to physical impairments and activity restrictions in the immediate postoperative period, patients encounter some obstacles to exhibit improvements in quality of life in the long run. Cardiac tertiary prevention programs generally consist of the prevention of disease progression and patient suffering. Aim of these interventions is to reduce the negative impact of disease by restoring function and reducing disease-related complications and therefore, include the rehabilitation of disabling conditions. Cardiac rehabilitation programs are interventions aimed to reduce mortality and morbidity of patients with ischemic heart diseases through promoting a healthier lifestyle among patients. These programs are used to restore, maintain, or improve both physiologic and psychosocial outcomes and finally the quality of life in patients through a combination of exercise, education and psychological support.