ABSTRACT
This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.
Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.
Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.
Subject(s)
Humans , Social Perception , Students, Medical/psychology , Mental Health , Faculty, Medical , Brazil , Longitudinal Studies , Focus Groups , Qualitative ResearchABSTRACT
La estimulación magnética transcraneal repetitiva ha demostrado ser eficaz para el tratamiento de la depresión resistente, pero su duración estándar es prolongada. Este estudio evaluó la seguridad y eficacia del protocolo acelerado Lyford-Pike, que aplica 12.000 impulsos diarios (divididos en dos sesiones de 6000) durante 5 a 15 días, con una frecuencia de 10 Hz y al 120 % del umbral motor. Se incluyeron 39 pacientes con depresión resistente que continuaban en tratamiento con antidepresivos y psicoterapia. Las puntuaciones en el Inventario de Depresión de Beck (BDI-I) fueron medidas al inicio y a los días 5, 10 y 15. Los resultados mostraron que el 53,85 % de los pacientes remitieron al final del tratamiento, y el 61,54 % experimentaron una mejoría significativa. El protocolo fue bien tolerado, con un solo caso de cefalea transitoria como efecto adverso. Estos resultados sugieren que el protocolo Lyford-Pike es una opción eficaz y segura para la depresión resistente, aunque se necesitan estudios adicionales para evaluar su durabilidad a largo plazo.
Repetitive transcranial magnetic stimulation has proven effective for treating treatment-resistant depression, but the standard protocol is time-consuming. This study evaluated the safety and efficacy of the accelerated Lyford-Pike protocol, which delivers 12,000 pulses per day (divided into two sessions of 6,000) over 5 to 15 days, at a frequency of 10 Hz and 120% of the motor threshold. Thirty-nine patients, who continued with antidepressants and psychotherapy, were included. Beck Depression Inventory (BDI-I) scores were measured at baseline and on days 5, 10, and 15. Results showed that 53.85% of patients achieved remission by the end of treatment, and 61.54% experienced significant improvement. The protocol was well tolerated, with only one case of transient headache as an adverse event. These findings suggest that the Lyford-Pike protocol is an effective and safe option for, although further studies are needed to assess its long-term durability
Subject(s)
Humans , Male , Female , Depression/therapy , Transcranial Magnetic Stimulation/statistics & numerical data , Remission Induction , Longitudinal Studies , Treatment Outcome , Sex Distribution , Drug Resistance, Multiple , Transcranial Magnetic Stimulation/methodsABSTRACT
Introdução: A temática das abordagens metodológicas quantitativas, qualitativas e mistas em pesquisas de Linguagem Oral é essencial para a compreensão do contexto em que essas pesquisas são realizadas em relação à produção de conhecimento científico no campo da Fonoaudiologia, partindo do pressuposto de que a Linguagem Oral é um fenômeno de vasta complexidade biopsicossocial. Objetivo: Investigar as ocorrências das abordagens metodológicas qualitativas, quantitativas ou mistas nas pesquisas em Linguagem Oral publicadas nos periódicos brasileiros de Fonoaudiologia. Método: Casuística: publicações nas revistas Audiology Communication Research (ACR), Revista CEFAC, Communication Disorders and Sciences (CoDAS) e Revista Distúrbios da Comunicação (DIC) entre Janeiro/2020 e Março/2024. Procedimento: 1. leitura dos títulos e resumos. 2. após a coleta, as autoras atuaram como juízes para elaboração do banco de dados; os dados coletados foram transportados para planilha Microsoft Excel® com as variáveis: título; autores; data de publicação; periódico e abordagens metodológicas. Resultados e discussão: N=129 publicações; ACR: N=24; 6 (25%) quantitativas, 15 (62,5%) qualitativas e 3 (12,5%) mistas. CEFAC: N=27; 15 (55,56%) quantitativas; 10 (37,04%) qualitativas; 2 (7,40%) mistas. CODAS: N=48; 34 (70,83%) quantitativas; 4 (8,34%) qualitativas; 10 (20,83%) mistas. DIC: N=30; 9 publicações quantitativas (30%), 16 qualitativas (53,33%), 5 (16,67%) mistas. A pesquisa quantitativa predominou nas publicações dos periódicos CEFAC e CODAS. Nos periódicos ACR e DIC predominaram estudos qualitativos. Os estudos com abordagem mista surgem com menor representatividade no período analisado. Conclusão: O estudo aponta uma diversidade metodológica significativa, com variações nas proporções de estudos quantitativos, qualitativos e mistos com predominância da abordagem quantitativa. (AU)
Introduction: The theme of quantitative, qualitative, and mixed methodological approaches in Oral Language research is essential for understanding the context in which these studies are conducted concerning the production of scientific knowledge in the field of Speech-Language Pathology, based on the assumption that Oral Language is a phenomenon of vast biopsychosocial complexity. Objective:To investigate the occurrences of qualitative, quantitative, or mixed methodological approaches in Oral Language research published in Brazilian Speech-Language Pathology journals. Method: Sample: Publications in the journals Audiology Communication Research (ACR), CEFAC Magazine, Communication Disorders and Sciences (CoDAS), and Distúrbios da Comunicação Magazine (DIC) between January 2020 and March 2024. Procedure: Reading of titles and abstracts. After data collection, the authors acted as judges to compile the database; the data were transferred to a Microsoft Excel® spreadsheet with the variables: title; authors; publication date; journal and methodological approaches. Results and discussion: N=129 publications; ACR: N=24; 6 (25%) quantitative, 15 (62.5%) qualitative, and 3 (12.5%) mixed. CEFAC: N=27; 15 (55.56%) quantitative; 10 (37.04%) qualitative; 2 (7.40%) mixed. CODAS: N=48; 34 (70.83%) quantitative; 4 (8.34%) qualitative; 10 (20.83%) mixed. DIC: N=30; 9 quantitative publications (30%), 16 qualitative (53.33%), 5 (16.67%) mixed. Quantitative research predominated in CEFAC and CODAS journals. In the ACR and DIC journals, qualitative studies predominated. Studies with a mixed approach appear with less representation in the analyzed period. Conclusion: The study points to significant methodological diversity, with variations in the proportions of quantitative, qualitative, and mixed studies, with a predominance of the quantitative approach. (AU)
Introducción: Los enfoques metodológicos cuantitativos, cualitativos y mixtos en investigaciones de Lenguaje Oral son esenciales para comprender el contexto en que se realizan investigaciones en relación con la producción de conocimiento científico en Fonoaudiología, asumiendo que el Lenguaje Oral es un fenómeno de complejidad biopsicosocial. Objetivo: Investigar las ocurrencias de los enfoques metodológicos cualitativos, cuantitativos y mixtos en investigaciones de Lenguaje Oral en revistas brasileñas de Fonoaudiología. Método: Publicaciones en Audiology Communication Research (ACR), Revista CEFAC, Communication Disorders and Sciences (CoDAS) y Distúrbios da Comunicação (DIC) entre enero de 2020 y marzo de 2024. Procedimiento: Lectura de títulos y resúmenes. Después de la recolección, autoras actuaron como jueces elaborando la base de datos; los datos recolectados se transfirieron a hoja de cálculo de Microsoft Excel® con variables: título; autores; fecha de publicación; revista y enfoques metodológicos. Resultados y discusión: N=129; ACR: N=24; 6 (25%) cuantitativas, 15 (62.5%) cualitativas, 3 (12.5%) mixtas. CEFAC: N=27; 15 (55.56%) cuantitativas; 10 (37.04%) cualitativas; 2 (7.40%) mixtas. CODAS: N=48; 34 (70.83%) cuantitativas; 4 (8.34%) cualitativas; 10 (20.83%) mixtas. DIC: N=30; 9 cuantitativas (30%), 16 cualitativas (53.33%), 5 (16.67%) mixtas. La investigación cuantitativa predominó en las publicaciones de CEFAC y CODAS. En ACR y DIC predominaron estudios cualitativos. Estudios con enfoque mixto tienen menor representatividad en el período analizado. Conclusión: El estudio señala diversidad metodológica significativa con variaciones en las proporciones de estudios cuantitativos, cualitativos y mixtos, con predominancia del enfoque cuantitativo. Esta diversidad sugiere riqueza en la exploración de temas relacionados con el Lenguaje Oral. (AU)
Subject(s)
Periodicals as Topic , Speech, Language and Hearing Sciences , Language Development , Data Interpretation, Statistical , Longitudinal Studies , Scientific Research and Technological Development , Evaluation Studies as Topic , MethodsABSTRACT
Introducción: los modelos de ecuaciones estructurales constituyen una herramienta valiosa para orientar la toma de decisiones al permitir identificar las relaciones entre diferentes variables y explicar el comportamiento de aquellas más abstractas. Tal es el caso de la probabilidad de que una persona consulte en el sistema de salud, donde intervienen factores demográficos, sociales y psicológicos. El presente trabajo se propuso construir un modelo explicativo de la utilización de los servicios médicos ambulatorios en una población con seguro de salud privado, relacionando variables demográficas, sociales y de autopercepción de salud. Métodos: el estudio se llevó a cabo a través de un modelo de ecuaciones estructurales con diseño longitudinal (cohorte prospectiva). Para ello se realizaron dos encuestas en diferentes momentos, y luego se realizó el análisis longitudinal teniendo en cuenta la información obtenida. Resultados: la utilización de los servicios médicos ambulatorios fue explicada en el siguiente orden, según su fuerza de asociación: control periódico de salud (CPS)coeficiente (0,57), la utilización de los servicios en el período anterior (0,23), la salud percibida en el último período (- 0,15), y los problemas familiares del último período (0,08). Las demás variables no tuvieron una asociación estadísticamente significativa. Conclusiones: la realización de CPS es la variable con mayor capacidad explicativa de la variabilidad de la utilización de servicios ambulatorios de salud de personas que tienen seguro de salud privado. Esto podría tener implicaciones importantes en la gestión para asegurar la sustentabilidad del sistema de salud a través de una organización racional de los recursos disponibles. (AU)
Introduction: Structural equation models serve as a valuable tool for guiding decision-making by enabling the identification of relationships between different variables and explaining the behavior of more abstract ones. Such is the case with the probability of an individual seeking consultation within the healthcare system, where demographic, social, and psychological factors come into play. The current study aimed to construct an explanatory model of the utilization of outpatient medical services in a population with private health insurance, linking demographic, social, and self-perceived health variables. Methods: A structural equation model with a longitudinal design (prospective cohort) was employed. For this purpose, two surveys were conducted at different moments, followed by a longitudinal analysis considering the information obtained. Results: In order of strength of association, the use of outpatient medical services had the following explanatory variables: Regular health check-ups (RHC) coefficient (0.57), service utilization in the previous period (0.23), perceived health in the last period (-0.15), and family problems in the latest period (0.08). Other variables did not have a statistically significant association. Conclusions: The performance of regular health check-ups (RHC) is the variable with the highest explanatory power for the variability in the utilization of outpatient health services by individuals with private health insurance. That could have significant implications for management to ensure the sustainability of the healthcare system through a rational organization of available resources. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Outpatient Clinics, Hospital/organization & administration , Outpatient Clinics, Hospital/statistics & numerical data , Health Maintenance Organizations/organization & administration , Health Maintenance Organizations/statistics & numerical data , Health Planning/methods , Health Services/statistics & numerical data , Psychometrics , Quality of Life , Self Concept , Socioeconomic Factors , Health Services Administration , Surveys and Questionnaires , Reproducibility of Results , Cohort Studies , Factor Analysis, Statistical , Longitudinal Studies , Family Relations , Sociodemographic Factors , Models, TheoreticalABSTRACT
El objetivo de este estudio es determinar la densidad de incidencia de lesiones y sus características, según la propuesta STROBE-SIIS, en las basquetbolistas sub-18 participantes de la Liga de Básquetbol Femenino del Sur (FEMISUR) en su temporada 2023. Se utilizó un tipo de estudio con enfoque positivista observacional descriptivo de tipo longitudinal prospectivo, con una muestra no probabilística, de selección intencional. Se enviaron por correo electrónico formularios diseñados según STROBE-SIIS a 59 jugadoras de 12 clubes durante 22 semanas. Se calculó la densidad de incidencia, dividiendo número de lesiones por número de horas de exposición, normalizando por 1000 horas. Para la descripción de las características de las lesiones se determinó frecuencia absoluta y relativa según inicio, mecanismo, tejido, zona anatómica y severidad. Ocurrieron 108 lesiones, con una incidencia de 36,21 lesiones/1000 horas de exposición. La mayor frecuencia fue de inicio agudo repentino (n=77; 71,3%), mecanismo de no contacto (n=46; 42,6%), en músculo/tendón (n=61; 45,5%), ligamento/capsular articular (n=19; 14,2%) y huesos (n=14; 10,4%); y tobillo (n=55; 27,1%), pierna (n=40; 19,7%) y rodilla (n=34; 16,7%). Las lesiones leves fueron más frecuentes (n=68;63%). Se encontró una alta incidencia de lesiones en las basquetbolistas sub-18 participantes de la Liga FEMISUR, siendo las lesiones más frecuentes las de inicio agudo repentino, mecanismo de no contacto, en músculo/tendón, tobillo y severidad leve. Esta información beneficiará a los equipos multidisciplinarios que trabajan con basquetbolistas sub-18, con el fin de implementar un plan de prevención o realizar análisis comparativos.
The objective of this study is to determine the incidence density of injuries and their characteristics, according to the STROBE-SIIS proposal, in the under-18 basketball players participating in the Southern Women's Basketball League (FEMISUR) in its 2023 season. A type of study with a positivist, observational, descriptive, longitudinal, prospective approach was used, with a non-probabilistic, intentional selection sample. Forms designed according to STROBE-SIIS were emailed to 59 players from 12 clubs over 22 weeks. The incidence density was calculated by dividing the number of lesions by the number of hours of exposure, normalizing by 1000 hours. To describe the characteristics of the injuries, absolute and relative frequency was determined according to onset, mechanism, tissue, anatomical area and severity. 108 injuries occurred, with an incidence of 36.21 injuries/1000 hours of exposure. The highest frequency was sudden acute onset (n=77; 71.3%), non-contact mechanism (n=46; 42.6%), muscle/tendon (n=61; 45.5%), ligament articular/capsular (n=19; 14.2%) and bones (n=14; 10.4%); and ankle (n=55; 27.1%), leg (n=40; 19.7%) and knee (n=34; 16.7%). Minor injuries were more frequent (n=68; 63%). A high incidence of injuries was found in the under-18 basketball players participating in the FEMISUR League. The most frequent injuries being those of sudden acute onset, non-contact mechanism, in muscle/tendon, ankle and mild severity. This information will benefit multidisciplinary teams that work with under-18 basketball players, in order to implement a prevention plan or perform comparative analyses.
O objetivo deste estudo é determinar a densidade de incidência de lesões e suas características, segundo a proposta do STROBE-SIIS, nas jogadoras de basquete sub-18 participantes da Liga Sul de Basquete Feminino (FEMISUR) na temporada 2023. Utilizou-se estudo do tipo positivista, observacional, descritivo, longitudinal, prospectivo, com amostra não probabilística e de seleção intencional. Formulários elaborados de acordo com o STROBE-SIIS foram enviados por e-mail para 59 jogadores de 12 clubes durante 22 semanas. A densidade de incidência foi calculada dividindo o número de lesões pelo número de horas de exposição, normalizando por 1000 horas. Para descrever as características das lesões, foram determinadas frequências absoluta e relativa de acordo com início, mecanismo, tecido, área anatômica e gravidade. Ocorreram 108 lesões, com incidência de 36,21 lesões/1000 horas de exposição. A maior frequência foi início agudo súbito (n=77; 71,3%), mecanismo sem contato (n=46; 42,6%), músculo/tendão (n=61; 45,5%), ligamento articular/capsular (n=19; 14,2%) e ossos (n=14; 10,4%); e tornozelo (n=55; 27,1%), perna (n=40; 19,7%) e joelho (n=34; 16,7%). Lesões leves foram mais frequentes (n=68;63%). Foi encontrada alta incidência de lesões nos basquetebolistas sub-18 participantes da Liga FEMISUR. As lesões mais frequentes são as de início agudo súbito, mecanismo sem contato, em músculo/tendão, tornozelo e gravidade leve. Esta informação beneficiará equipas multidisciplinares que trabalham com jogadores de basquetebol sub-18, para implementar um plano de prevenção ou realizar análises comparativas.
Subject(s)
Humans , Female , Adolescent , Athletic Injuries/epidemiology , Basketball/injuries , Incidence , Longitudinal StudiesABSTRACT
Introduction. Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective. To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods. We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results. We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3= 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions. About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.
Introducción. Los fármacos son parte fundamental del tratamiento de múltiples enfermedades. Sin embargo, a pesar de sus beneficios, algunos se consideran medicamentos potencialmente inapropiados en adultos mayores, dado su perfil de seguridad. Las diferencias en los datos epidemiológicos relacionados con los medicamentos potencialmente inapropiados dificultan el establecimiento de sus efectos en adultos mayores. Objetivo. Estimar la prevalencia longitudinal y los tipos de medicamentos potencialmente inapropiados, utilizando los criterios Beers® del 2019 en una cohorte de adultos mayores de 65 años. Materiales y métodos. Se realizó un estudio observacional, multicéntrico, retrospectivo y longitudinal, de cuatro años de seguimiento de los medicamentos potencialmente inapropiados en adultos mayores de la comunidad. Resultados. Se evaluaron 820 participantes de cinco ciudades durante cuatro años (2012 a 2016) en tres momentos (m1: 2012, m2: 2014 y m3; 2016). La edad promedio fue de 69,07 años y el 50,9 % eran mujeres. La prevalencia de medicamentos potencialmente inapropiados en los participantes fue del 40,24 %. El promedio de estos medicamentos entre los sujetos estudiados en el primer momento fue de 1,65 (DE = 0,963), en el segundo fue de 1,73 (DE = 1,032) y en el tercero fue de 1,62 (DE = 0,915). No hubo diferencias estadísticas entre las mediciones (prueba de Friedman, p = 0,204). Las categorías de los medicamentos potencialmente inapropiados más frecuentes fueron: gastrointestinales (39,4 %), analgésicos (18,8 %), relacionados con delirium (15,4 %), benzodiacepinas (15,2 %) y cardiovasculares (14,2 %). Conclusiones. En cerca de la mitad de la población de adultos mayores de la comunidad, se prescribieron medicamentos potencialmente inapropiados de manera sostenida y sin variabilidad importante en el tiempo. Los más recetados fueron aquellos para tratar malestares gastrointestinales y cardiovasculares, analgésicos, para el delirium y benzodiacepinas.
Subject(s)
Humans , Aged , Polypharmacy , Potentially Inappropriate Medication List , Prevalence , Longitudinal Studies , Independent LivingABSTRACT
INTRODUCTION: Older adults, who are considered to be at higher risk of contracting the COVID-19 virus, have been adversely affected by the pandemic. OBJECTIVE: This prospective longitudinal study aimed to verify changes in the physical fitness of older adults during the period of the COVID-19 pandemic, considering gender and age group. METHODS: Seventy-six older individuals (aged 72.6±6.47 years) who were part of a university extension program participated in the study. Their physical fitness was assessed using the Senior Fitness Test (SFT), which was administered by trained researchers before the pandemic (November 2019) and during the pandemic (April 2022). RESULTS: The results showed a significant decline in physical fitness in all tests, except for the Arm Curl Test. The greatest decline was observed in the 6-minute walk test. Both men and women exhibited greater declines in aerobic endurance and lower limb strength. Older adults aged 80 years or older were the most affected, exhibiting the greatest declines, particularly in aerobic endurance and lower limb strength. CONCLUSION: The study concludes that the COVID-19 pandemic had a significant negative impact on the physical fitness of older adults, especially women and those aged 80 years or older. Therefore, physical activity programs should be implemented for these populations to minimize or even reverse the negative impacts caused by COVID-19 on their physical fitness.
INTRODUÇÃO: A COVID-19 impactou negativamente a vida dos idosos, considerados como grupo de risco para o vírus. OBJETIVO: Este estudo longitudinal prospectivo teve como objetivo verificar as alterações na aptidão física de idosos durante o período da pandemia COVID-19, levando em consideração o sexo e a faixa etária. MÉTODOS: Participaram do estudo 76 idosos (72,6 ± 6,47 anos), que faziam parte de um programa de extensão universitário. A aptidão física foi avaliada por meio da bateria de testes Senior Fitness Test (SFT). Os pesquisadores, devidamente treinados, aplicaram a SFT antes da pandemia (novembro de 2019) e durante a pandemia (abril de 2022). RESULTADOS: Os resultados indicaram uma piora significativa na aptidão física dos idosos em todos os testes, exceto no teste de flexão de cotovelo. A maior redução na aptidão física foi observada no teste de caminhada de 6 minutos. Em relação ao sexo, tanto homens quanto mulheres apresentaram maiores reduções na resistência aeróbia e na força dos membros inferiores. Quanto à faixa etária, os idosos com 80 anos ou mais foram os mais afetados, apresentando as maiores reduções, especialmente na resistência aeróbia e na força dos membros inferiores. CONCLUSÃO: O estudo conclui que o período da pandemia de COVID-19 teve um impacto negativo significativo na aptidão física dos idosos, especialmente nas mulheres e nos idosos com 80 anos ou mais. Portanto, recomenda-se a implementação de atividades físicas para essas populações, com o objetivo de minimizar ou até reverter os impactos negativos causados pela COVID-19 na aptidão física dos idosos.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Physical Fitness , Health of the Elderly , COVID-19 , Prospective Studies , Longitudinal Studies , Muscle StrengthABSTRACT
INTRODUCTION: Multiple sclerosis is a progressive disease that is difficult to predict, originating in cases of disability. Natalizumab is a highly effective disease-modifying therapy but is associated with greater John Cunningham virus (JCV) reactivation and consequent increased risk of developing Progressive Multifocal Leukoencephalopathy (PML). OBJECTIVE: To analyze JCV seroconversion in patients treated with natalizumab. METHODS: A retrospective study was conducted involving patients diagnosed with multiple sclerosis, between January 2012 and December 2021. To assess seroconversion during treatment with natalizumab, patients were considered seronegative at the beginning of treatment and who had at least one result in the period of medication use. The study was approved by the Human Research Ethics Committee under protocol 3,177,442. RESULTS: Sixty-two patients treated with Natalizumab were included, with a seroprevalence of 67.7%. At the start of treatment, 41.9% (26/62) of the patients were negative for anti-JCV, of which 23.1% (6/26) were seroconverted. The mean time to seroconversion was 2.5 years. The baseline index of anti-JCV antibodies was statistically significant with the age of the patients. Among patients with a negative anti-JCV antibody result at baseline, 82.6% (19/23) remained negative throughout monitoring. Treatment was discontinued in 53.2% (33/62) of patients, and 72.7% (24/33) due to anti-JCV positivity with a consumption index >1.5 in 41.9% of cases. CONCLUSION: Knowing how to monitor the anti-JCV antibody index and treatment approaches in our patient cohort may be useful in future clinical decisions in treating MS.
INTRODUÇÃO: A esclerose múltipla é doença progressiva e difícil previsão, resultando em casos de incapacidade. O natalizumabe é terapia modificadora da doença altamente eficaz, porém associado a maior reativação do Vírus John Cunningham (JCV) e consequente aumento do risco de desenvolvimento de Leucoencefalopatia Multifocal Progressiva (LEMP). OBJETIVO: Analisar a soroconversão do JCV em pacientes tratados com natalizumabe. MÉTODOS: Foi realizado estudo retrospectivo envolvendo pacientes com diagnóstico de esclerose múltipla, entre janeiro de 2012 a dezembro de 2021. Para avaliar soroconversão durante o tratamento com natalizumabe foram considerados os pacientes soronegativos ao início do tratamento e que tiveram no mínimo dois resultados no período de uso do medicamento. O trabalho foi aprovado no Comitê de Ética em Pesquisa em Seres Humanos sob protocolo 3.177.442. RESULTADOS: Foram incluídos 62 pacientes tratados com natalizumabe, com soroprevalência de 67,7%. No início do tratamento 41,9% (26/62) dos pacientes eram negativos para anticorpos anti-JCV, desses, 23,1% (6/26) sofreram soroconversão. O tempo mediano de soroconversão foi de 2,5 anos. O índice basal de anticorpos anti-JCV apresentou correlação estatisticamente significativa com a idade dos pacientes. Dentre os pacientes com resultado negativo para anticorpo anti-JCV na linha de base, 82,6 % (19/23) permaneceram negativos durante todo o monitoramento. O tratamento foi descontinuado em 53,2% (33/62) dos pacientes, 72,7% (24/33) devido à positividade do anti-JCV com índice de anticorpos >1,5 em 41,9% dos casos. CONCLUSÃO: Conhecer o seguimento do índice de anticorpos anti-JCV e as condutas de tratamento em nossa coorte de pacientes pode ser útil nas decisões clínica futuras.
Subject(s)
Humans , Male , Female , Adult , JC Virus , Natalizumab , Seroconversion , Multiple Sclerosis/therapy , Retrospective Studies , Longitudinal StudiesABSTRACT
INTRODUCCIÓN: La higiene de manos (HM) es la principal medida para disminuir las IAAS, las que en las Unidades de Cuidados Intensivos (UCI) presentan una alta prevalencia. En Chile no existe información sobre el impacto de la estrategia multimodal de la OMS para la HM en adultos. El objetivo fue evaluar el impacto de la implementación de la estrategia en una UPC. METODOLOGÍA: Estudio longitudinal con evaluación pre y post-intervención, entre los años 2018 y 2021, en la UCI del Hospital del Trabajador (HT), Santiago, Chile. La implementación se evaluó con pautas de cumplimiento de HM, consumo de jabón y productos en base alcohólica (PBA). El impacto se midió con las tasas de neumonía asociada a ventilación mecánica (NAVM), infecciones del torrente sanguíneo asociadas a CVC (ITS- CVC) y del tracto urinario por CUP (ITU-CUP), y la incidencia anual de dermatitis. RESULTADOS: El cumplimiento de pautas aumentó de 91 a 96% (p < 0,05). El consumo total de productos para la HM aumentó de 0,17 a 0,31 L/día/cama y de PBA en 10%. Las tasas de IAAS pre y post-intervención fueron para NAVM de 10,3 y 8,4; ITS-CVC de 0,8 y 1,5 e ITU-CUP de 4,2 y 5,3 por 1.000 días de exposición. La incidencia anual de dermatitis disminuyó en 30% (p < 0,05). CONCLUSIONES: La implementación de la estrategia multimodal se asoció a una disminución de las tasas de NAVM y de dermatitis en la UCI del HT.
INTRODUCTION: Hand hygiene is the main measure to decrease infections related to healthcare and the Intensive Care Unit has a high prevalence. In Chile there aren't reports about the impact of the World Health Organization multimodal hand hygiene improvement strategy. AIM: To assess the implementation impact of this strategy at the ICU. METHODOLOGY: Longitudinal study with pre- and postintervention evaluation during the years 2018-2021 at ICU. The implementation was assessed against hand hygiene compliance guidelines, soap consumption and alcohol-based products. The impact was evaluated with the rates of ventilator-associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter associated urinary tract infection (CAUTI) and the annual dermatitis incidence. RESULTS: The guidelines compliance increased from 91% to 96% (p < 0.05). The total product consumption increased from 0.17 to 0.31 Liters/day/bed. The use of alcohol-based products increased by 10%. HAI rates pre- and post-intervention were for VAP 10.3 and 8.4, CRBSI 0.8 and 1.5 and CAUTI 4.2 and 5.3. The annual dermatitis incidence decreased by 30.8% (p < 0.05). CONCLUSIONS: The strategy implementation benefited the decrease of VAP and the dermatitis prevention in ICU.
Subject(s)
Humans , Hand Disinfection/methods , Cross Infection/prevention & control , Intensive Care Units/standards , Urinary Tract Infections/prevention & control , Urinary Tract Infections/epidemiology , World Health Organization , Cross Infection/epidemiology , Longitudinal Studies , Dermatitis/prevention & control , Dermatitis/epidemiology , Pneumonia, Ventilator-Associated/prevention & control , Pneumonia, Ventilator-Associated/epidemiology , Catheter-Related Infections/prevention & control , Catheter-Related Infections/epidemiologyABSTRACT
SUMMARY: Trail running (TR), an extreme endurance sport, presents unique challenges due to the variety of terrain and distances, where physiological capacity and body composition have been considered better predictors of performance. This longitudinal case study examines the impact of training intensity distribution (TID) on an elite trail runner's physiological profile and performance over four years. Two TID models were implemented: polarized (POL) and pyramidal (PYR). Physiological assessments included maximal oxygen consumption (VO2max), lactate thresholds (LT1 and LT2), and anthropometric characteristics. The training was classified according to the 3-zone intensity model (zone 1: below the first lactate threshold; zone 2: between the first and second lactate threshold; zone 3: above the second lactate threshold). During the four years, the average TID distribution was 75 % zone 1, 18 % zone 2, and 7 % zone 3. Physiological capacity increased by 7.14 % (14 to 15 km/h) for velocity at LT1 (vLT1) and 8.13 % (16 to 17.3 km/h) for velocity at LT2 (vLT2). The most significant increases were observed during the second year when the percentage of training time in zone 1 was lower (65 %) and in zone 2 greater (30 %) than those reported in other years. Consequently, vLT1 and vLT2 increased by 3.5 % (from 14.1 to 14.6 km/h) and 3.6 % (from 16.5 to 17.1 km/h), respectively. In conclusion, this case study revealed that emphasizing training in zone 2 (moderate intensity) and increasing the training load significantly improved performance at lactate thresholds. Despite modifying body composition, no influence on improving endurance performance was observed. These findings underscore the importance of TID in elite trail runners and highlight the potential to optimize physiological adaptations and performance outcomes.
Trail running (TR), un deporte de resistencia extrema, presenta desafíos únicos debido a la variedad de terrenos y distancias, donde la capacidad fisiológica y la composición corporal se han considerado mejores predictores del rendimiento. Este estudio de caso longitudinal examina el impacto de la distribución de la intensidad del entrenamiento (TID) en el perfil fisiológico y el rendimiento de un corredor de montaña de élite durante cuatro años. Se implementaron dos modelos TID: polarizado (POL) y piramidal (PYR). Las evaluaciones fisiológicas incluyeron el consumo máximo de oxígeno (VO2max), los umbrales de lactato (LT1 y LT2) y las características antropométricas. El entrenamiento se clasificó según el modelo de intensidad de 3 zonas (zona 1: por debajo del primer umbral de lactato; zona 2: entre el primer y segundo umbral de lactato; zona 3: por encima del segundo umbral de lactato). Durante los cuatro años, la distribución TID promedio fue 75 % zona 1, 18 % zona 2 y 7 % zona 3. La capacidad fisiológica aumentó un 7,14 % (14 a 15 km/h) para la velocidad en LT1 (vLT1) y un 8,13 % (16 a 17,3 km/h) para velocidad en LT2 (vLT2). Los incrementos más significativos se observaron durante el segundo año cuando el porcentaje de tiempo de entrenamiento en la zona 1 fue menor (65 %) y en la zona 2 mayor (30 %) que los reportados en otros años. En consecuencia, vLT1 y vLT2 aumentaron un 3,5 % (de 14,1 a 14,6 km/h) y un 3,6 % (de 16,5 a 17,1 km/h), respectivamente. En conclusión, este estudio reveló que enfatizar el entrenamiento en la zona 2 (intensidad moderada) y aumentar la carga de entrenamiento mejoró significativamente el rendimiento en los umbrales de lactato. A pesar de modificar la composición corporal, no se observó influencia en la mejora del rendimiento de resistencia. Estos hallazgos subrayan la importancia del TID en los corredores de trail de élite y resaltan el potencial para optimizar las adaptaciones fisiológicas y los resultados de rendimiento.
Subject(s)
Humans , Male , Adult , Running/physiology , Body Composition , Athletic Performance , Somatotypes , Exercise/physiology , Anthropometry , Longitudinal StudiesABSTRACT
Introducción: La enfermedad de Alzheimer, constituye un problema sanitario y social de gran magnitud; precisa de diagnóstico y terapéutica precoces. Se realizó una búsqueda de artículos sobre factores de riesgo y biomarcadores de la enfermedad en las bases de datos PubMed/Medline, Scopus, Scielo y Lilacs, y mediante el buscador Google académico; desde el año 2017 hasta el 2023, en idioma español, inglés y portugués. Objetivo: Analizar los factores de riesgo y los biomarcadores de la enfermedad de Alzheimer. Desarrollo: Los principales factores de riesgo encontrados son edad avanzada, menor educación, poca actividad física, hábito de fumar, consumo excesivo de alcohol, hipertensión arterial, diabetes, obesidad, depresión, pérdida o disminución de la audición, aislamiento social, los traumas craneales y la contaminación ambiental. Los biomarcadores fundamentales son: los marcadores que se utilizan en los estudios de neuroimágenes como la PET Amiloide, PET tau, PET FDG; y en LCR y plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, y neurofilamentos de cadena ligeras. Conclusiones: Se requieren estudios longitudinales, a partir de la presencia de los factores de riesgo asociados a biomarcador, desde edades pregeriátricas en pacientes sanos, que tengan como salidas el deterioro cognitivo y el desarrollo de la demencia, para construir un modelo de predicción(AU)
Introduction: Alzheimer's disease is a health and social problem of great magnitude; it requires early diagnosis and therapy. A search for articles on risk factors and biomarkers of the disease was conducted; in the databases PubMed/Medline, Scopus, Scielo and Lilacs, and through the Google scholar search engine; from 2017 to 2023, in Spanish, English and Portuguese. Objective: To analyze the risk factors and biomarkers of Alzheimer's disease. Development: The main risk factors found are advanced age, lower education, little physical activity, smoking, excessive alcohol consumption, high blood pressure, diabetes, obesity, depression, hearing loss or decrease, social isolation, head trauma and environmental pollution. The fundamental biomarkers are: markers used in neuroimaging studies such as amyloid PET, tau PET, FDG PET; and in CSF and plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, and light chain neurofilaments. Conclusions: Longitudinal studies are required, based on the presence of risk factors associated with biomarkers, from pregeriatric ages in healthy patients, which have cognitive impairment and the development of dementia as outputs, to build a prediction model(AU)
Subject(s)
Humans , Biomarkers , Risk Factors , Alzheimer Disease , Forecasting/methods , Amyloid , Social Isolation , Smoking , Longitudinal Studies , Positron-Emission Tomography/methods , Depression , Diabetes Mellitus , Environmental Pollution , Sedentary Behavior , Neuroimaging/methods , Cognitive Dysfunction , Binge Drinking , Hearing Loss , Hypertension , ObesityABSTRACT
Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)
Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Tin Fluorides/therapeutic use , Tooth, Deciduous/drug effects , Dental Caries/therapy , Cariostatic Agents/therapeutic use , Epidemiology, Descriptive , Longitudinal Studies , Dental Enamel/drug effects , Dentin/drug effects , Conservative Treatment/methodsABSTRACT
OBJECTIVES@#To understand the growth and development status and differences between small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants during corrected ages 0-24 months, and to provide a basis for early health interventions for preterm infants.@*METHODS@#A retrospective study was conducted, selecting 824 preterm infants who received regular health care at the Guangzhou Women and Children's Medical Center from July 2019 to July 2022, including 144 SGA and 680 AGA infants. The growth data of SGA and AGA groups at birth and corrected ages 0-24 months were analyzed and compared.@*RESULTS@#The SGA group had significantly lower weight and length than the AGA group at corrected ages 0-18 months (P<0.05), while there were no significant differences between the two groups at corrected age 24 months (P>0.05). At corrected age 24 months, 85% (34/40) of SGA and 79% (74/94) of AGA preterm infants achieved catch-up growth. Stratified analysis by gestational age showed that there were significant differences in weight and length at corrected ages 0-9 months between the SGA subgroup with gestational age <34 weeks and the AGA subgroups with gestational age <34 weeks and 34 weeks (P<0.05). In addition, the weight and length of the SGA subgroup with gestational age 34 weeks showed significant differences compared to the AGA subgroups with gestational age <34 weeks and 34 weeks at corrected ages 0-18 months and corrected ages 0-12 months, respectively (P<0.05). Catch-up growth for SGA infants with gestational age <34 weeks and 34 weeks mainly occurred at corrected ages 0-12 months and corrected ages 0-18 months, respectively.@*CONCLUSIONS@#SGA infants exhibit delayed early-life physical growth compared to AGA infants, but can achieve a higher proportion of catch-up growth by corrected age 24 months than AGA infants. Catch-up growth can be achieved earlier in SGA infants with a gestational age of <34 weeks compared to those with 34 weeks.
Subject(s)
Infant, Newborn , Child , Infant , Female , Humans , Child, Preschool , Infant, Premature , Gestational Age , Longitudinal Studies , Retrospective Studies , Infant, Small for Gestational AgeABSTRACT
Introducción: el cáncer de cuello (CC) uterino representa un problema de salud pública. En Uruguay ocupa el tercer lugar en incidencia en mujeres, provocando 133 fallecimientos anuales. La afectación ganglionar es uno de sus principales factores pronósticos y condiciona el tratamiento. El ganglio centinela (GC) en estadios precoces de cáncer cervicouterino es una técnica segura que permite una adecuada estadificación y reduce la morbilidad asociada a la linfadenectomía convencional. Objetivo: validar la utilización de la técnica de la biopsia GC en estadios precoces de CC como estándar de tratamiento para la detección de metástasis ganglionares en el Hospital de la Mujer. Material y método: se realizó un estudio prospectivo, longitudinal, de casos. Se incluyó a 30 usuarias con CC en estadios iniciales, en el período comprendido entre enero de 2018 y noviembre de 2022. La marcación se realizó con tecnecio 99m (99mTc). En el mismo acto quirúrgico se realizó la linfadenectomía pélvica sistemática. Resultados: se detectó GC de forma bilateral en 29 de 30 pacientes. Con una tasa de detección por región de 98,3%. En cinco pacientes se detectaron GC metastásicos, no encontrando ganglios no centinela positivos. Una de ellas correspondió a una micrometástasis detectada por ultraestadificación. La sensibilidad fue de 100%: IC95% (56,55 -100) con VPN 100% IC95% (86,68 - 100). Conclusiones: de acuerdo con los resultados arrojados por el estudio, el equipo interdisciplinario del Hospital de la Mujer está en condiciones de utilizar la biopsia de GC de cérvix como estándar de tratamiento en el CC uterino en estadio precoz.
Introduction: Cervical cancer (CC) is a public health problem. In Uruguay, it ranks third in incidence in women, causing 133 deaths annually. Lymph node involvement is one of its main prognostic factors and determines treatment. The sentinel lymph node (SLN) in early stages of cervical cancer is a safe technique that allows for adequate staging and reduces morbidity associated with conventional lymphadenectomy. Objective: To validate the use of the SLN biopsy technique in early stages of CC as the standard treatment for detecting lymph node metastases at the Women's Hospital. Method: A prospective, longitudinal case study was conducted. Thirty patients with early-stage cervical cancer between January 2018 and November 2022 were included in the study. The marking was done with Tc99. Systematic pelvic lymphadenectomy was performed in the same surgical procedure. Results: Sentinel lymph nodes were detected bilaterally in 29 out of 30 patients. With a detection rate per region of 98.3%, metastatic SLNs were detected in 5 patients, with no positive non-sentinel nodes found. One of them corresponded to a micrometastasis detected by ultra-staging. Sensitivity was 100% (95% CI 56.55,100) with a negative predictive value of 100% (95% CI 86.68, 100). Conclusions: According to the results of the study, the interdisciplinary team at the Women's Hospital is in a position to use cervical SLN biopsy as the standard treatment for early-stage cervical cancer.
Introdução: O câncer do colo do útero (CCU) representa um problema de saúde pública. No Uruguai, ocupa o terceiro lugar em incidência em mulheres, causando 133 mortes por ano. O acometimento dos linfonodos é um dos principais fatores prognósticos e condiciona o tratamento. O linfonodo sentinela (LS) em estágios iniciais do câncer do colo do útero é uma técnica segura que permite o estadiamento adequado e reduz a morbidade associada à linfadenectomia convencional. Objetivo: Validar o uso da técnica de biópsia por LS em estágios iniciais do CCU como tratamento padrão para a detecção de metástases linfonodais no Hospital da Mulher. Materiais e métodos: Foi realizado um estudo de caso prospectivo e longitudinal. Trinta usuárias com LS em estágio inicial foram incluídas no período de janeiro de 2018 a novembro de 2022. A marcação foi realizada com Tc99. A linfadenectomia pélvica sistemática foi realizada no mesmo ato cirúrgico. Resultados: O LS foi detectado bilateralmente em 29 das 30 usuárias, com uma taxa de detecção por região de 98,3%. Em 5 pacientes foram detectados LS metastáticos e não foram encontrados nódulos não-sentinela positivos. 1 deles correspondia a uma micrometástase detectada por ultrassonografia. A sensibilidade foi de 100% CI 95% (56,55,100) com NPV 100% CI 95% (86,68, 100). Conclusões: Com base nos resultados do estudo, a equipe interdisciplinar do Hospital da Mulher está em condições de usar a biópsia de LS cervical como padrão de tratamento no câncer cervical em estágio inicial.
Subject(s)
Uterine Cervical Neoplasms , Sentinel Lymph Node Biopsy , Prospective Studies , Longitudinal Studies , Validation StudyABSTRACT
Introducción: la exposición a estímulos dolorosos y estrés en la etapa neonatal, sin un correcto tratamiento, tiene consecuencias a corto y largo plazo. El diagnóstico adecuado es un desafío, ya que las escalas clínicas son subjetivas y se requieren herramientas de detección con mejor objetividad y capacidad de interpretación del disconfort/dolor neonatal. Newborn Infant Parasympathetic Evaluation (NIPE™) es una tecnología no invasiva de monitorización continua del dolor en neonatos, desarrollada recientemente dada la dificultad de objetivar el dolor mediante los métodos convencionales en la práctica clínica. Esta tecnología se basa en el análisis de la variabilidad de la frecuencia cardíaca (FC), lo que permite aproximarse a la actividad del sistema parasimpático. Objetivos: el objetivo de esta investigación fue valorar el disconfort en un modelo de cerdo recién nacido (RN) y en humanos neonatos expuestos a maniobras nociceptivas con la utilización de tecnología no invasiva (NIPE), en la maternidad del Hospital Universitario. Material y métodos: se realizó un estudio observacional, longitudinal, en seis cerdos RN, anestesiados, monitorizados hemodinámicamente y sometidos a un procedimiento quirúrgico mayor (toracotomía lateral izquierda con abordaje cardíaco, pericardiostomía y acceso vascular pulmonar transventricular derecho) y 12 procedimientos mínimamente invasivos de la práctica clínica habitual, como vacunación BCG, hemoglucotest y pesquisa, que generan un estímulo nociceptivo en ocho RN de término sanos. Se incluyeron RN sanos de término (EG entre 37-41 semanas más seis días) internados en el alojamiento conjunto madre-hijo, se excluyeron de la muestra los RN que presentaron alguna patología y aquellos cuyos padres no aceptaron la participación en el estudio. Resultados: se comparó la variabilidad de la FC mediante detección automatizada (NIPE™) para estimación objetiva del dolor/disconfort. Se comparó en la clínica con una escala validada y ampliamente utilizada en neonatos: Premature Infant Pain Profile (PIPP). Para valorar la asociación entre variables NIPE™ y FC se utilizaron correlación de Spearman, el test de Kruskall-Wallis o test de chi cuadrado con corrección de Fisher, según correspondiera. Se encontró una correlación negativa entre FC y NIPE™ tanto para el grupo de neonatos humanos (r=-1; p=0,008) como para el modelo animal (r=-0,6; p=0,0004). No se encontró asociación significativa entre NIPE™ y la escala PIPP. La variación entre valores de NIPE™ pre y posestímulo en RN humanos fue significativa (p=0,008). Conclusiones: determinamos que en ambos escenarios explorados los valores de NIPE™ descienden ante estímulos nociceptivos y los cambios en la FC se relacionan con sus valores, independientemente de la especie o la agresividad de la maniobra. Este trabajo es el primero a nivel nacional incorporando el uso de esta tecnología, creemos que tendrá impacto en la forma de evaluar y abordar el dolor por parte de los equipos asistenciales y de experimentación.
Introduction: exposure to painful stimuli and stress in the neonatal stage, without correct treatment, has short and long-term consequences. Proper diagnosis is a challenge since clinical scales are subjective, and we require more objective screening tools and a better ability to interpret neonatal discomfort/pain. Newborn Infant Parasympathetic Evaluation (NIPE™) is a non-invasive technology for continuous pain monitoring in neonates, recently developed given the difficulty to objectify pain using conventional methods in clinical practice. This technology is based on the analysis of heart rate variability (HR), which allows us to approximate the activity of the parasympathetic system. Objectives: the objective of this research was to assess discomfort in a newborn pig model (NB) and in human neonates exposed to nociceptive maneuvers with the use of non-invasive technology (NIPE), in the maternity ward of the University Hospital. Material and methods: an observational, longitudinal study was carried out in 6 NB pigs, anesthetized, hemodynamically monitored and subjected to a major surgical procedure (left lateral thoracotomy with cardiac approach, pericardiostomy and right trans ventricular pulmonary vascular access) and 12 minimally invasive procedures, from clinical practice. routine such as BCG vaccination, hemoglucotest and screening, which generate a nociceptive stimulus in 8 healthy term newborns. Healthy term newborns (GA between 37-41 weeks plus 6 days) admitted to the mother-child joint accommodation were included, We excluded those NB patients who presented some pathology or whose parents did not accept participation in the study. Results: HR variability was compared using automated detection (NIPETM) for objective estimation of pain/discomfort. It was compared in the clinic with a validated and widely used scale in neonates: Premature Infant Pain Profile (PIPP). We used the Spearman's correlation, the Kruskall-Wallis test or the Chi square test with Fisher's correction to assess the association between NIPE™ variables and HR, as needed. A negative correlation was found between HR and NIPETM for both the group of neonates. humans (r=-1; p=0.008) and for the animal model (r=-0.6; p=0.0004). No significant association was found between NIPETM and the PIPP scale. The variation between pre- and post-stimulus NIPE™ values in human NBs was significant (p=0.008). Conclusions: we conclude that in both scenarios explored, NIPE™ values decrease when faced with nociceptive stimuli and changes in HR are related to its values, regardless of the species or the aggressiveness of the maneuver. This paper is the first at a national level to incorporate the use of this technology, we believe it will have an impact on the way pain is assessed and addressed by healthcare and experimental teams.
Introdução: a exposição a estímulos dolorosos e ao estresse na fase neonatal, sem tratamento correto, traz consequências a curto e longo prazo. O diagnóstico adequado é um desafio, uma vez que as escalas clínicas são subjetivas e são necessárias ferramentas de triagem com melhor objetividade e capacidade de interpretar o desconforto/dor neonatal. A Avaliação Parassimpática do Recém-Nascido (NIPE™) é uma tecnologia não invasiva para monitoramento contínuo da dor em neonatos, desenvolvida recentemente devido à dificuldade de objetivar a dor usando métodos convencionais na prática clínica. Esta tecnologia baseia-se na análise da variabilidade da frequência cardíaca (FC), o que nos permite aproximar a atividade do sistema parassimpático. Objetivos: o objetivo desta pesquisa foi avaliar o desconforto em recém-nascido modelo suíno (RN) e em neonatos humanos expostos a manobras nociceptivas com uso de tecnologia não invasiva (NIPE), na maternidade do Hospital Universitário. Material e métodos: foi realizado um estudo observacional, longitudinal, em 6 suínos RN, anestesiados, monitorados hemodinamicamente e submetidos a um procedimento cirúrgico de grande porte (toracotomia lateral esquerda com abordagem cardíaca, pericardiostomia e acesso vascular pulmonar transventricular direito) e 12 procedimentos minimamente invasivos, da prática clínica. rotina como vacinação BCG, hemoglicoteste e triagem, que geram estímulo nociceptivo em 8 recém-nascidos a termo saudáveis. Foram incluídos recém-nascidos a termo saudáveis (IG entre 37-41 semanas mais 6 dias) internados no alojamento conjunto mãe-filho, foram excluídos do A amostra incluiu RNs que apresentavam alguma patologia e aqueles cujos pais não aceitaram a participação no estudo. Resultados: a variabilidade da FC foi comparada por meio de detecção automatizada (NIPETM) para estimativa objetiva de dor/desconforto. Foi comparado na clínica com uma escala validada e amplamente utilizada em neonatos: Premature Infant Pain Profile (PIPP). Para avaliar a associação entre as variáveis do NIPE™ e a FC, utilizou-se a correlação de Spearman, o teste de Kruskall-Wallis ou o teste Qui-quadrado com correção de Fisher, conforme apropriado. Foi encontrada correlação negativa entre a FC e o NIPETM para ambos os grupos de neonatos. (r=-1; p=0,008) e para o modelo animal (r=-0,6; p=0,0004). Não foi encontrada associação significativa entre o NIPETM e a escala PIPP. A variação entre os valores de NIPE™ pré e pós-estímulo em RN humanos foi significativa (p=0,008). Conclusões: concluímos que em ambos os cenários explorados, os valores do NIPE™ diminuem diante de estímulos nociceptivos e as alterações na FC estão relacionadas aos seus valores, independente da espécie ou da agressividade da manobra. Este trabalho é o primeiro a nível nacional a incorporar a utilização desta tecnologia, acreditamos que terá impacto na forma como a dor é avaliada e abordada pelas equipas de saúde e experimentais.
Subject(s)
Humans , Animals , Male , Female , Infant, Newborn , Pain Measurement , Nociceptive Pain/diagnosis , Nociception , Swine , Longitudinal Studies , Heart Rate DeterminationABSTRACT
ABSTRACT OBJECTIVE The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals' health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes. METHODS A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling. RESULTS The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = −0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency. CONCLUSION The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.
Subject(s)
Humans , Male , Female , Adolescent , Sleep , Longitudinal Studies , Adolescent , COVID-19ABSTRACT
Introducción: La enfermedad de Gaucher es una entidad de acúmulo lisosomal, con un patrón de herencia autosómico recesivo, debido a la deficiencia de le enzima betaglucocerebrosidasa ácida. El gen está mapeado en el cromosoma 1q21 y se han descrito más de 500 mutaciones. Se caracteriza por presentar anemia, trombocitopenia, hepatoesplenomegalia, manifestaciones esqueléticas y, en ocasiones, compromiso neurológico. Entre los tratamientos se utiliza el reemplazo enzimático con imiglucerasa. Objetivo: Evaluar los resultados de la aplicación de imiglucerasa (Cerezyme®) en pacientes con enfermedad de Gaucher. Métodos: Se realiza un estudio longitudinal, descriptivo para evaluar el comportamiento de las variables clínicas, hematológicas y ultrasonográficas de ocho pacientes cubanos con enfermedad de Gaucher tras recibir el tratamiento sustitutivo enzimático. Se evaluaron al año, cinco y de diez a quince años de tratamiento. Resultados: Al inicio, todos los pacientes presentaron anemia y la mayoría tuvieron trombocitopenia y hepatoesplenomegalia al diagnóstico de la enfermedad. Los pacientes con manifestaciones neurológicas y la mutación L444P en estado homocigótico se clasificaron en EG tipo 3, el resto en tipo1. En todos los pacientes se constató aumento de las cifras de hemoglobina, la elevación del número de plaquetas y reducción de la hepatoesplenomegalia posterior al año de tratamiento. Los pacientes con tipo 3 mantuvieron la afectación neurológica. No se reportaron reacciones adversas al medicamento. Conclusiones: La terapia de reemplazo enzimática con imiglucerasa (Cerezyme®) es un pilar fundamental en el tratamiento de los pacientes con esta enfermedad, lo cual influye de forma positiva en la calidad de vida, obteniéndose mejores resultados con su comienzo en edad pediátrica.
Introduction: Gaucher disease is an entity of lysosomal accumulation, with an autosomal recessive inheritance pattern, due to the deficiency of the acid betaglucocerebrosidase enzyme. The gene is mapped on chromosome 1q21 and more than 500 mutations have been described. It is characterized by anemia, thrombocytopenia, hepatosplenomegaly, skeletal manifestations and sometimes neurological involvement. Among the treatments, enzyme replacement with imiglucerase is used. Objective: To evaluate the results of the application of imiglucerase in patients with Gaucher disease. Methods: A longitudinal, descriptive study to evaluate the behavior of the clinical, hematological and ultrasonographic variables of eight Cuban patients with Gaucher disease after receiving enzyme replacement treatment was carried out. They were evaluated after one, five and ten to fifteen years of treatment. Results: At debut, all patients presented anemia, and the majority showed thrombocytopenia and hepatosplenomegaly at diagnosis of the disease. Patients with neurological manifestations and the L444P mutation in a homozygous state were classified as type 3 GD, the rest as type 1. In all patients, an increase in hemoglobin levels, an increase in the number of platelets and a reduction in hepatosplenomegaly was observed after one year of treatment. Patients with type 3 maintain neurological involvement. No adverse reactions to the medication were reported. Conclusions: Enzyme replacement therapy with imiglucerase (Cerezyme®) is a fundamental pillar in the treatment of patients with this disease, which positively influences quality of life, obtaining better results with its onset in pediatric age.
Subject(s)
Humans , Epidemiology, Descriptive , Longitudinal StudiesABSTRACT
Resumo Pouco mais de uma década separa este estudo da primeira proposição acadêmica do entrincheiramento organizacional, e, até o momento, pesquisas longitudinais não foram realizadas, apesar da importância reconhecida desse método para enriquecer os estudos no campo comportamental. Este artigo objetivou identificar características do entrincheiramento organizacional entre servidores de instituições federais de ensino no Brasil, com base na avaliação longitudinal dos perfis latentes. Realizou-se uma pesquisa quantitativa e longitudinal com 1060 participantes na primeira coleta. Foram feitas análises descritivas, de comparação de médias e análise de transição latente. Os servidores da amostra apresentaram baixos níveis de entrincheiramento. Entre os principais achados, está a estabilidade dos perfis formados pelos servidores, tendo as médias mais altas sido encontradas nas dimensões "ajustamentos à posição social" e "arranjos burocráticos impessoais", o que reforça alguns achados teóricos transversais. Os resultados desta pesquisa contribuem para orientar gestores sobre a importância dos fatores internos para o entrincheiramento dos servidores e sobre como a atenção aos itens da dimensão "ajustamentos à posição social" pode favorecer o trabalho com esse vínculo. O presente estudo encontrou que, ao longo do tempo, o entrincheiramento é um vínculo estável.
Resumen Ha transcurrido poco más de una década entre la primera propuesta académica de atrincheramiento organizacional y el presente estudio y, hasta la fecha, no se ha llevado a cabo ninguna investigación longitudinal, a pesar de la reconocida importancia de este método para enriquecer los estudios en el campo del comportamiento. Esta investigación tuvo como objetivo identificar las características del atrincheramiento organizacional entre funcionarios de instituciones federales de enseñanza en Brasil, a partir de una evaluación longitudinal de perfiles latentes. Se realizó una encuesta cuantitativa y longitudinal con 1060 participantes. Se realizaron análisis descriptivos, comparación de medias y análisis de transición latente. Los funcionarios de la muestra presentaron bajos niveles de atrincheramiento. Entre los principales hallazgos están la estabilidad de los perfiles formados por los funcionarios, con las medias más altas encontradas en las dimensiones ajustes a la posición social y arreglos burocráticos impersonales, lo que refuerza algunos hallazgos teóricos transversales. Los resultados de esta investigación ayudan a orientar a los gestores sobre la importancia de los factores internos para el atrincheramiento de los funcionarios y sobre cómo la atención a los ítems de la dimensión ajustes a la posición social puede favorecer el trabajo con ese vínculo. Esta investigación constató que el atrincheramiento es un vínculo estable a lo largo del tiempo.
Abstract Little more than a decade separates this research from the first academic proposition of organizational entrenchment. To date, no longitudinal research has been carried out despite the recognized importance of this method for enriching studies in the behavioral field. This research aimed to identify characteristics of organizational entrenchment among civil servants at federal educational institutions in Brazil based on a longitudinal assessment of latent profiles. A quantitative and longitudinal survey was carried out with 1060 participants in the first collection. Descriptive analysis, comparison of means, and latent transition analysis were carried out. The civil servants in the sample showed low levels of entrenchment. Among the main findings are the stability of the profiles formed by the civil servants and the higher averages found in the dimensions of adjustments to social position and impersonal bureaucratic arrangements, reinforcing some cross-sectional theoretical findings. The results help to guide managers on the importance of internal factors for the entrenchment of civil servants and how attention to the items in the dimension of adjustments to social position can favor working with this bond. This research found that, over time, entrenchment is a stable bond.
Subject(s)
Brazil , Longitudinal Studies , Government EmployeesABSTRACT
ABSTRACT Objective: To characterize the effectiveness of anti-vascular endothelial growth factor drugs in exudative age-related macular degeneration. Methods: Retrospective longitudinal study of 54 patients with age-related macular degeneration receiving bevacizumab or aflibercept. Demographic data, visual acuity, and central retinal thickness measurements were collected. Improvement/stability of visual acuity and reduction in retinal thickness configured satisfactory responses. Results: Among the 60 eyes studied, there was no difference (p = 0.262) in satisfactory response when using bevacizumab (48.5%) or aflibercept (63.0%). Snellen's visual acuity, letter gain, and retinal thickness showed improvement or maintenance in 55.0%, 32.8%, and 78.3% of cases, respectively. The percentage of improvement/maintenance was higher in eyes with an initial visual acuity of < Snellen 20/400 (70.0% versus 40.0%; p = 0.002). Conclusion: A higher percentage of improvement/stabilization of visual acuity and macular thickness was observed in patients with age-related macular degeneration, with better response in patients with visual acuity worse than Snellen 20/400.
RESUMO Objetivo: Caracterizar a efetividade de medicamentos antifactor de crescimento endotelial vascular na degeneração macular relacionada à idade exsudativa. Métodos: Estudo longitudinal retrospectivo em 54 pacientes com degeneração macular relacionada à idade que usaram bevacizumab ou aflibercept. Foram coletados dados demográficos, da acuidade visual e da espessura central da retina. Melhora/estabilidade da acuidade visual e redução da espessura configuraram respostas satisfatórias. Resultados: Entre 60 olhos estudados, não houve diferença (p = 0,262) de acordo com o uso de bevacizumab (48,5%) ou aflibercept (63,0%). Acuidade visual segundo Snellen, ganho de letras e espessura retiniana demonstraram melhora ou estabilidade em 55,0%, 32,8% e 78,3% dos casos, respectivamente. Entre os olhos com acuidade visual inicial < 20/400, o percentual de melhora/estabilidade foi superior (70,0% versus 40,0%; p = 0,002). Conclusão: Em pacientes com degeneração macular relacionada à idade, foi percebida uma maior proporção de melhora ou estabilização da acuidade visual e espessura macular, com melhor resposta entre os pacientes com visão pior que 20/400.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Wet Macular Degeneration/drug therapy , Bevacizumab/administration & dosage , Bevacizumab/therapeutic use , Macular Degeneration/drug therapy , Visual Acuity , Retrospective Studies , Cohort Studies , Longitudinal Studies , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Tomography, Optical Coherence , Wet Macular Degeneration/diagnosis , Intravitreal Injections , Macular Degeneration/diagnosisABSTRACT
Aim: Evaluate the longitudinal status of dental caries in the occlusal surface of first permanent molars (FPM) and to identify risk factors for the progression to cavitated caries lesions in a school oral health program. Methods: Children who were enrolled in the program between September 2017 and October 2019, 5 to 10 years-old, presenting the four FPM were included. Four calibrated examiners assessed dental caries according to Nyvad criteria. Descriptive analysis included frequency, mean, and standard deviation calculations. Chi-square test was used in the bivariate analysis and, logistic regression adjusted for cluster effect was used to identify significant risk factors for cavity among the following independent variables: gender, age in the baseline, deft, upper/lower molar, initial caries score, Molar Incisor Hypomineralization (MIH), fluorosis, occlusal sealing. Odds ratio (OR) and respective confidence intervals (CI) are presented. Results: From 174 children enrolled in the program between 2017/2019, 120 were reevaluated in 2022. Eleven (2.6%) FPM in 11 children (9.2%) presented cavitated caries in the follow up examination. Significant risk factors for cavity were caries experience in the primary teeth (OR = 5.59; CI: 1.4 22.3) and the presence of MIH (OR = 5.33; CI: 1.6 18.1). Most of the active lesions in the follow up were considered active in the baseline examination. Conclusions: The progression to cavity was relatively low, significantly influenced by past caries experience and MIH