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1.
Acta bioeth ; 26(1): 61-72, mayo 2020. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1114599

ABSTRACT

La dignidad del paciente puede verse afectada en el transcurso de la hospitalización por conductas observables de los profesionales. A pesar de su importancia, existen pocos instrumentos para evaluarla. Mediante un estudio transversal, descriptivo, analítico y cuantitativo, se evalúa la percepción de dignidad del paciente con el "Cuestionario de percepción de dignidad de paciente hospitalizado (CuPDPH)", en español y validado. La muestra estuvo formada por 148 hombres y 138 mujeres, con una media de edad de 62.82 (DE 4.05). No se detectó diferencias significativas en las puntuaciones y las variables sociodemográficas. Los resultados permiten identificar puntos fuertes y áreas de mejora en el cuidado y respeto a la dignidad de las personas hospitalizadas. Profundizar en el tema resulta una oportunidad en el camino hacia la excelencia profesional, defendiendo las competencias técnica y ética.


Dignity is a fundamental concept that can be modified during hospitalization by the behavior of professionals. Despite its importance, there are few instruments to evaluate it. A transversal, descriptive, analytical and quantitative study evaluates the patient's perception of dignity based on the "Cuestionario de percepción de dignidad de paciente hospitalizado (CuPDPH)" in Spanish and validated. The sample was composed of 148 men and 138 women with an average age of 62.82 (SD 4.05). No significant differences were found in the scores and sociodemographic variables. The results allow us to identify highlights and areas of improvement in the care and respect for the dignity of hospitalized persons. Going deeper into the topic is an opportunity, on the way to professional excellence, defending technical competence and ethical competence.


Resumo A dignidade do paciente pode ser afetada no transcurso da hospitalização por condutas observáveis dos profissionais. Apesar de sua importância, existem poucos instrumentos para avalia-la. Mediante um estudo transversal, descritivo, analítico e quantitativo, avalia-se a percepção da dignidade do paciente com o "Questionário de percepção da dignidade de paciente hospitalizado (CuPDPH, sigla em espanhol)", em espanhol e validado. A amostra foi constituída por 148 homens e 138 mulheres, com uma média de idade de 62,82 (DP 4,05). Não se detectaram diferenças significativas nas pontuações e nas variáveis sócio-demográficas. Os resultados permitem identificar pontos fortes e áreas de melhora no cuidado e respeito à dignidade das pessoas hospitalizadas. Aprofundarse no tema representa uma oportunidade no caminho à excelência profissional, defendendo as competências técnica e ética.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Personhood , Respect , Inpatients/psychology , Perception , Professional-Patient Relations , Cross-Sectional Studies , Multivariate Analysis , Surveys and Questionnaires , Patient Satisfaction , Confidentiality , Health Vulnerability , Hospitalization
2.
Int. j. morphol ; 38(2): 367-373, abr. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1056449

ABSTRACT

Sexual dimorphism in Homo-sapiens is a phenomenon of a direct product of evolution by natural selection where evolutionary forces acted separately on the sexes which brought about the differences in appearance between male and female such as in shape and size. Advances in morphometrics have skyrocketed the rate of research on sex differences in human and other species. However, the current challenges facing 3D in the acquisition of facial data such as lack of homology, insufficient landmarks to characterize the facial shape and complex computational process for facial point digitization require further study in the domain of sex dimorphism. This study investigates sexual dimorphism in the human face with the application of Automatic Homologous Multi-points Warping (AHMW) for 3D facial landmark by building a template mesh as a reference object which is thereby applied to each of the target mesh on Stirling/ESRC dataset containing 101 subjects (male = 47, female = 54). The semi-landmarks are subjected to sliding along tangents to the curves and surfaces until the bending energy between a template and a target form is minimal. Principal Component Analysis (PCA) is used for feature selection and the features are classified using Linear Discriminant Analysis (LDA) with an accuracy of 99.01 % which demonstrates that the method is robust.


El dimorfismo sexual en el Homo-sapiens es un fenómeno directo de la evolución por selección natural, donde las fuerzas evolutivas actuaron por separado en los sexos, lo que provocó las diferencias en la apariencia entre hombres y mujeres, tal como la forma y tamaño. Los avances en el área de la morfometría, han generado un aumento significativo de las investigaciones en las diferencias de sexo en humanos y otras especies. Sin embargo, los desafíos actuales que enfrenta el 3D en el análisis de datos faciales, como la falta de homología, puntos de referencia insuficientes para caracterizar la forma facial y la complejidad del proceso computacional para la digitalización de puntos faciales, requiere un estudio adicional en el área del dimorfismo sexual. Este estudio investiga el dimorfismo sexual en el rostro humano con la aplicación de la deformación automática de múltiples puntos homólogos para el hito facial 3D, mediante la elaboración de una malla de plantilla como objeto de referencia, y se aplica en cada una de las mallas objetivas en el conjunto de datos Stirling / ESRC que contiene 101 sujetos (hombre = 47, mujer = 54). Los semi-puntos de referencia se deslizan a lo largo de las tangentes a las curvas y superficies hasta que la energía de flexión entre una plantilla y una forma objetivo es mínima. El análisis de componentes principales (PCA) se utiliza para la selección de características y las características se clasifican mediante el análisis discriminante lineal (ADL) con una precisión del 99,01 %, lo que demuestra la validez del método.


Subject(s)
Humans , Male , Female , Sex Characteristics , Connective Tissue/anatomy & histology , Face/anatomy & histology , Discriminant Analysis , Multivariate Analysis , Connective Tissue/diagnostic imaging , Imaging, Three-Dimensional , Face/diagnostic imaging , Anatomic Landmarks
3.
Rev. chil. obstet. ginecol. (En línea) ; 85(2): 132-138, abr. 2020. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1115508

ABSTRACT

INTRODUCCIÓN: La gestión actual de camas hospitalarias sigue un modelo de indiferenciación en el que existen camas quirúrgicas, médicas y de pacientes críticos. Las maternidades si bien no siguen este modelo, tienen egresos indiferenciados con pacientes que pueden egresar post parto o aún embarazadas (con patologías perinatales). OBJETIVO: Evaluar diferencias entre egresos con parto normal y aquellos con patologías de alto riesgo obstétrico (ARO) respecto a estancia media (EM) y el consumo de recursos cuantificado con el peso medio de los grupos relacionados con el diagnóstico (PMGRD). MÉTODO: Estudio transversal con egresos maternales periodo 2017-2018. Se usó Categoría Diagnóstica Mayor (CIE - 10) para definir dos grupos de egreso: 1. Con parto normal a término o 2. Con patología ARO. Se compararon 1.658 y 1.669 egresos del grupo 1 y 2 respectivamente. Las variables de resultado son EM y PMGRD. Se compararon variables cuantitativas con t de student y Kruskal Wallis. Se usó Odds Ratio con respectivo intervalo de confianza para evaluar asociación entre variables y regresión logística multivariada para ajustar asociación. RESULTADOS: La edad, proporción de gestantes tardías, EM y PMGRD fue mayor en los egresos ARO (p<0,05). Existe fuerte asociación de EM prolongada (>4 días) y PMGRD elevado (>0.3109) con los egresos ARO (ORa=3.75; IC95%=3.21-4.39 y ORa=1.28; IC95%=1.1-1.49 respectivamente). CONCLUSIONES: Es necesario diferenciar los egresos del servicio de maternidad porque los egresos de ARO muestran mayor complejidad. La evaluación del riesgo usando EM y PMGRD permite analizar con especificidad los egresos maternales para una mejor gestión de camas y del recurso humano.


INTRODUCTION: The current management of hospital beds in Chile follows an undifferentiation model in which there are surgical, medical and critical patient bed. Maternity hospitals although they do not follow this model, have undifferentiated discharges with patients who may leave poatpartum or still pregnant (with perinatal pathologies) OBJECTIVE: To assess differences between discharges with normal delivery and those with high obstetric risk pathologies (HOR) with respect to mean stay (MS) and the resource spending quantified with the average weight of the diagnosis related group (AWDRG). METHOD: Cross-sectional study with maternal discharges between 2017-2018 period. Major Diagnostic Category (ICD - 10) was used to define two discharge groups: 1. With normal term birth or 2. With HOR pathology. 1,658 and 1,669 egress from group 1 and 2 were compared respectively. The outcome variables are EM and AWDRG. Quantitative variables were compared with student t and Kruskal Wallis. Odds Ratio and respective confidence interval were used to evaluate association between variables and multivariate logistic regression to adjust association. RESULTS: Age, proportion of late pregnant women, MS and AWDRG was higher in HOR discharges (p <0.05). There is a strong association of prolonged MS (> 4 days) and elevated AWDRG (> 0.3109) with HOR discharges (ORa = 3.75; 95% CI 3.21-4.39 and ORa = 1.28; 95% CI 1.1-1.49 respectively). CONCLUSIONS: It is necessary to differentiate medical discharge of the maternity service because the HOR egress show greater complexity. The risk assessment using MS and AWDRG allows to analyze with specificity the maternal discharge for a better management of beds and human resources.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Patient Discharge/statistics & numerical data , Diagnosis-Related Groups , Pregnancy, High-Risk , Delivery Rooms/economics , Patient Discharge/economics , Bed Occupancy , Confidence Intervals , Logistic Models , Cross-Sectional Studies , Multivariate Analysis , Maternal Age , Length of Stay , Natural Childbirth
4.
Int. j interdiscip. dent. (Print) ; 13(1): 26-29, abr. 2020. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1114889

ABSTRACT

OBJETIVO: Determinar la prevalencia de caries temprana de la infancia en niños en riesgo social y analizar sus factores de riesgo asociados. MÉTODO: Se realizó un estudio descriptivo de corte transversal con 246 niños de 24 a 71 meses de edad, reclutados de 13 barrios marginales, en Santiago, Chile. Se utilizó un cuestionario para obtener información sobre etnia, peso al nacer, edad y educación de la madre, uso de biberón nocturno, cepillado de dientes y visitas dentales. La caries temprana de la infancia fue registrada de acuerdo a la definición aceptada por la Academia Americana de Pediatría Dental. Se utilizó un análisis de regresión logística múltiple para investigar la influencia de los factores de riesgo en la experiencia de caries. RESULTADOS: La prevalencia de caries temprana de la infancia fue de un 63%. Los análisis bivariados mostraron asociaciones entre etnicidad, educación de la madre, uso de biberón nocturno, visitas dentales y caries temprana de infancia. El modelo multivariado final, mostró que los niños cuyas madres tenían un bajo nivel de educación tenían mayores probabilidades de desarrollar caries temprana de la infancia. CONCLUSIÓN: Los niños estudiados tuvieron una alta prevalencia de caries temprana de la infancia, siendo la educación de la madre, el determinante más importante.


OBJECTIVE: The aim of the present study was to evaluate the prevalence of early childhood caries (ECC) among children at social risk and to analyze its associated determinants. METHOD: A cross-sectional study with 246 children aged 24 to 71 months, recruited from 13 different slums, below the poverty line, in Santiago, Chile was performed. An interviewer-administered questionnaire was used to obtain information from the parents on ethnicity, birth weight, mother's age and education, night bottle feeding, tooth brushing and dental visits. Early childhood caries was defined using the American Academic of Pediatric Dentistry criteria. Multiple logistic regression analysis with a stepwise selection procedure was used to investigate the influence of risk factors on the early childhood caries experience. RESULTS: The prevalence of early childhood caries was 63%. Bivariate analyses showed associations among ethnicity, mother's education, bottle feeding at night, dental visits and caries experience. The final multivariate model showed that children whose mothers had a low level of education were more likely to develop early childhood caries. CONCLUSIONS: The children at social risk studied had a high prevalence of early childhood caries, with the education of the mother as the most important determinant.


Subject(s)
Humans , Male , Female , Child, Preschool , Dental Caries/epidemiology , Socioeconomic Factors , Logistic Models , Chile/epidemiology , Epidemiology, Descriptive , Prevalence , Cross-Sectional Studies , Multivariate Analysis , Surveys and Questionnaires , Risk Factors , Social Determinants of Health
5.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 39-47, mar. 2020. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1099200

ABSTRACT

INTRODUCCIÓN: En el tratamiento del hipertiroidismo se recurre a la cirugía en casos de bocio grande, fracaso del tratamiento médico o indicación social de tratamiento definitivo. OBJETIVO: Analizar los resultados en cuanto a función tiroidea del tratamiento del hipertiroidismo mediante tiroidectomía total (TT). MATERIAL Y MÉTODO: Estudio retrospectivo de 26 pacientes con hipertiroidismo, intervenidos en el Hospital de la Plana durante 2015-2018, con seguimiento de 36 meses. Tras estudio estadístico descriptivo e inferencial, se analizó la probabilidad de recidiva del hipertiroidismo mediante el método de Kaplan-Meier, y se utilizó el modelo de Cox para ajustar los efectos sobre la recidiva de las diferentes variables. RESULTADOS: El 73,1% tenían normofunción tiroidea; el 19,2%, hiperfunción, y en otro 7,7% existía hipofunción. El tiempo medio de supervivencia (normofunción) fue de 25,87 meses (IC: 17,52-34,21). En el estudio de supervivencia con el log-rank en función de la variable anatomía patológica y complicaciones, no hay diferencias estadísticamente significativas en la supervivencia de ambos grupos. DISCUSIÓN: Coincide con otros trabajos publicados. CONCLUSIÓN: La TT es un método efectivo de tratamiento para el hipertiroidismo, con baja incidencia de complicaciones. Sin embargo, no hemos encontrado ninguna variable que nos permita predecir el resultado.


INTRODUCTION: Surgery is used in the management of hyperthyroidism in cases of large goiter, failure of medical treatment or social indication of definitive treatment. AIM: To analyze the results of the treatment of hyperthyroidism by total thyroidectomy (TT) regarding to thyroid function. MATERIAL AND METHODS: Retrospective study of 26 patients with hyperthyroidism, operated on the Hospital de la Plana during 2015-2018, with a follow-up of 36 months. After a descriptive and inferential statistical study, the probability of recurrence of hyperthyroidism was analyzed using the Kaplan-Meier method, and the Cox model was used to adjust the effects on recurrence of the different variables. RESULTS: 73.1% had thyroid normofunction; in 19.2% there was hyperfunction, and in another 7.7% there was hypofunction. The average survival time (normofunction) was 25,87 months (CI: 17,52-34,21). In the study of survival with the log-rank depending on the pathological results and complications, there are no statistically significant differences in the survival of both groups. DISCUSSION: This coincides with other published works. CONCLUSION: TT is an effective method of treatment for hyperthyroidism, with a low incidence of complications. However, we have not found any variable that allows us to predict the result.


Subject(s)
Humans , Male , Female , Thyroidectomy/methods , Hyperthyroidism/surgery , Survival Analysis , Graves Disease , Multivariate Analysis , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Hyperthyroidism/physiopathology
6.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 18-23, Jan.-Mar. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1090550

ABSTRACT

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.


Subject(s)
Humans , Child , Adolescent , Adult , Ear Neoplasms/surgery , Cholesteatoma, Middle Ear/surgery , Neoplasm Recurrence, Local/epidemiology , Time Factors , Proportional Hazards Models , Survival Analysis , Medical Records , Multivariate Analysis , Retrospective Studies , Second-Look Surgery , Denmark , Mastoidectomy/methods
7.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 54-62, Jan.-Feb. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1055351

ABSTRACT

Objective: Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors. Methods: We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms. Results: Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043). Conclusion: It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.


Subject(s)
Humans , Male , Adolescent , Sleep Wake Disorders/psychology , Stress, Psychological/psychology , Hydrocortisone/analysis , Chronobiology Disorders/psychology , Depression/etiology , Military Personnel/psychology , Psychiatric Status Rating Scales , Reference Values , Saliva/metabolism , Sleep/physiology , Time Factors , Multivariate Analysis , Risk Factors , Analysis of Variance , Statistics, Nonparametric , Depression/metabolism , Self Report
8.
Rev. bras. epidemiol ; 23: e200029, 2020. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1101578

ABSTRACT

RESUMO: Introdução: Os benzodiazepínicos são os psicofármacos mais utilizados globalmente, apesar dos riscos associados ao seu uso prolongado, especialmente entre os idosos. Objetivo: O estudo teve como objetivo investigar a tendência do uso de benzodiazepínicos entre idosos mais velhos (75 anos ou mais) residentes em comunidade. Métodos: Trata-se de um estudo realizado com idosos com idades entre 75 e 89 anos, integrantes da linha base (em 1997) e sobreviventes (em 2012) da coorte idosa do Projeto Bambuí. A prevalência do uso de benzodiazepínicos foi estimada separadamente para cada ano, e a comparação entre elas foi realizada por meio de regressão de Poisson com variância robusta. Resultados: A prevalência do uso de benzodiazepínicos foi maior em 2012 (33,9%) em comparação a 1997 (24,9%). Após o ajuste múltiplo, a diferença de prevalências não permaneceu significativa na população total de estudo (razão de prevalência (RP) = 1,25; intervalo de confiança de 95% (IC95%) 0,99 - 1,60), diferentemente do observado no estrato feminino (RP = 1,38; IC95% 1,04 - 1,84). O clonazepam foi o medicamento que apresentou o mais forte crescimento (RP = 4,94; IC95% 2,54 - 9,62) entre os dois anos. Conclusão: O presente estudo evidenciou um importante aumento no uso de benzodiazepínicos em uma população idosa mais velha. Esses resultados preocupam, pois são medicamentos contraindicados para idosos, especialmente se utilizados cronicamente, e estão disponíveis na relação nacional de medicamentos essenciais. Os profissionais de saúde devem estar atentos para os riscos envolvidos no seu uso por essa população.


ABSTRACT: Background: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. Objective: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. Methods: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. Results: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). Conclusion: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Psychotropic Drugs/therapeutic use , Benzodiazepines/therapeutic use , Drug Utilization/statistics & numerical data , Independent Living/statistics & numerical data , Time Factors , Brazil , Multivariate Analysis , Risk Factors , Cohort Studies , Sex Distribution , Age Distribution , Income
9.
Rev. bras. epidemiol ; 23: e200025, 2020. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1101574

ABSTRACT

RESUMO: Introdução: O uso inadequado e o crescimento dos gastos em saúde reforçam a necessidade de ampliar o conhecimento sobre a qualidade de uso de medicamentos. Objetivos: Descrever e avaliar o perfil de utilização de medicamentos em uma amostra representativa de usuários adultos da atenção primária do Sistema Único de Saúde (SUS) de Minas Gerais. Método: Estudo transversal, com 1.159 entrevistados em 104 municípios e 253 serviços de saúde. Foram coletados dados sobre características sociodemográficas, condições de saúde e uso de medicamentos, sendo essas características estratificadas por faixas etárias. Análises univariada e multivariada, por meio de regressão logística, foram conduzidas para identificar preditores de automedicação. Para todos os testes, foi adotado o nível de significância de 5%. Resultados: A prevalência de uso de medicamentos foi de 81,8%, com média de 2,67 medicamentos por usuário, que aumenta com a faixa etária. Os medicamentos mais utilizados foram losartana, hidroclorotiazida e sinvastatina, com diferenças entre as faixas etárias. Observou-se automedicação significativa não só em adultos jovens, mas também entre idosos. Os preditores de automedicação foram: ser adulto jovem, ter maior nível de escolaridade, não apresentar doenças crônicas, ter pior autopercepção de saúde e não aderir a medicamentos prescritos. Adultos jovens e idosos apresentaram características que os tornaram mais vulneráveis em relação ao uso racional de medicamentos. Conclusão: O estudo pode contribuir para melhorar o cuidado na atenção primária, pois identificou problemas relevantes relacionados à qualidade do uso de medicamentos, especialmente entre adultos jovens e idosos em Minas Gerais.


ABSTRACT: Introduction: Inappropriate use and increase of health care spending reinforce the need to extend our knowledge about the quality of medication use. Objectives: To describe and evaluate the profile of medication use in a representative sample of adult users of primary care services in the Unified Health System (SUS) of Minas Gerais. Method: Cross-sectional study, with 1,159 interviewees in 104 municipalities and 253 health care services. Data on sociodemographic characteristics, health conditions and use of medicines were collected, and these variables were stratified by age group. Univariate and multivariate analyses, using logistic regression, were conducted to identify predictors of self-medication. We set a significance level of 5% for all tests. Results: The prevalence of medication use was 81.8%, with an average of 2.67 medicines per user, which increased with age. The most used drugs were losartan, hydrochlorothiazide and simvastatin, which differed between age groups. Significant self-medication was observed not only in young adults but also in the elderly. The predictors of self-medication were: being a young adult, having a higher level of education, not having chronic diseases, having worse self-perception of health and not adhering to prescription drugs. Young and elderly adults showed characteristics that made them more vulnerable in relation to the rational use of medicines. Conclusion: This study can contribute to improving primary care, where it identified problems related to the extent of medication use, especially among young adults and the elderly in Minas Gerais.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Primary Health Care/statistics & numerical data , Self Medication/statistics & numerical data , Surveys and Questionnaires , Drug Utilization/statistics & numerical data , Socioeconomic Factors , Brazil , Cross-Sectional Studies , Multivariate Analysis , Analysis of Variance , Age Factors , Sex Distribution , Age Distribution , Prescription Drugs , Inappropriate Prescribing/statistics & numerical data , Middle Aged
10.
Rev. bras. epidemiol ; 23: e200004, 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1092616

ABSTRACT

ABSTRACT: Introduction: Epidemiological studies have shown associations between placental measurements and perinatal and later life outcomes. Objectives: To report placental measurements and evaluate their association with birth weight in a Brazilian birth cohort. Methods: Retrospective cohort study with 958 mothers, placentas, and newborns delivered at the Ribeirão Preto Medical School Hospital, Universidade de São Paulo, Brazil, in 2010 and 2011. The information was collected from interviews, medical records, and pathology reports. The placental measurements were: weight, largest and smallest diameters, eccentricity, thickness, shape, area, and birth weight/placental weight and placental weight/birth weight ratios. We analyzed the associations between birth weight and placental measurements using multiple linear regression. Results: Placental weight alone accounted for 48% of birth weight variability (p < 0.001), whereas placental measurements combined (placental weight, largest and smallest diameters, and thickness) were responsible for 50% (p < 0.001). When adjusted for maternal and neonatal characteristics, placental measurements explained 74% of birth weight variability (p < 0.001). Conclusion: Placental measurements are powerful independent predictors of birth weight. Placental weight is the most predictive of them, followed by the smallest diameter.


RESUMO: Introdução: Estudos epidemiológicos demonstraram associações entre medidas placentárias, resultados perinatais e futuros. Objetivos: Descrever medidas placentárias e avaliar suas associações com peso ao nascer numa coorte de nascimentos brasileira. Metodologia: Estudo de coorte retrospectiva de 958 mães, placentas e recém-nascidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil, em 2010 e 2011. As informações foram coletadas por entrevistas, prontuários médicos e laudos de patologia. As medidas placentárias foram: peso, diâmetros maior e menor, excentricidade, espessura, forma, área, relações peso ao nascer/ peso da placenta e peso da placenta/ peso ao nascer. As associações entre peso ao nascer e medidas placentárias foram examinadas por meio de regressão linear múltipla. Resultados: O peso da placenta foi responsável por 48% da variabilidade do peso ao nascer (p < 0,001), enquanto o conjunto de medidas placentárias (peso, diâmetros maior e menor e espessura) foi responsável por 50% (p < 0,001). Quando ajustadas pelas características maternas e neonatais, as medidas placentárias explicaram 74% da variabilidade do peso ao nascer (p < 0,001). Conclusão: medidas placentárias são preditores independentes do peso ao nascer. O peso placentário é o mais forte preditor dentre elas, seguido pelo diâmetro menor.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Young Adult , Placenta/anatomy & histology , Birth Weight/physiology , Brazil , Pregnancy Outcome , Body Mass Index , Linear Models , Multivariate Analysis , Retrospective Studies , Risk Factors , Gestational Age
11.
Rev. bras. epidemiol ; 23: e200012, 2020. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1092614

ABSTRACT

RESUMO: Introdução: A sífilis é uma doença de transmissão sexual de diagnóstico e tratamento fáceis, mas de incidência crescente no Brasil. Este estudo mediu prevalência, avaliou tendência e identificou fatores associados à não realização de exame sorológico para sífilis no pré-natal em Rio Grande, RS. Metodologia: Trata-se de inquérito transversal que incluiu todas as gestantes residentes nesse município que tiveram filho entre 1º de janeiro e 31 de dezembro nos anos de 2007, 2010 e 2013. Aplicou-se à mãe questionário único, padronizado em até 48 horas após o parto, quando ainda na maternidade. Utilizaram-se teste χ2 para proporções e para tendência linear e regressão de Poisson com ajuste robusto na análise multivariável. A medida de efeito usada foi razão de prevalências (RP). Resultados: Entre as 7.351 mães que passaram por pelo menos uma consulta, a prevalência de não realização de sorologia para sífilis nos três anos foi de 2,9% (intervalo de confiança de 95% - IC95% 2,56 - 3,33), sendo de 3,3% (IC95% 2,56 - 3,97) em 2007, 2,8% (IC95% 2,20 - 3,52) em 2010 e 2,7% (IC95% 2,12 - 3,38) em 2013. Mães de cor da pele preta, de baixa renda familiar e escolaridade e que passam por poucas consultas apresentaram maior RP à não realização desse exame. Discussão: A prevalência de não realização praticamente não se modificou no período, com maior probabilidade de não realização entre aquelas de maior risco gestacional. Conclusões: Alcançar mães de pior nível socioeconômico, reestruturar os serviços locais de saúde, aperfeiçoar sua operacionalização a fim de melhorar a qualidade da assistência pré-natal parecem mandatórios nesse município.


ABSTRACT: Introduction: Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. Methods: This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). Results: Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. Discussion: The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. Conclusions: This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Prenatal Care/methods , Syphilis Serodiagnosis/statistics & numerical data , Syphilis/diagnosis , Syphilis/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Poisson Distribution , Prevalence , Cross-Sectional Studies , Multivariate Analysis , Surveys and Questionnaires , Pregnancy, High-Risk
12.
Rev. bras. epidemiol ; 23: e200008, 2020. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1092613

ABSTRACT

RESUMO: Introdução: O comportamento sedentário tem sido associado a diversos indicadores de saúde. O objetivo deste estudo é descrever esse desfecho em idosos residentes de zona rural. Metodologia: Realizou-se um estudo transversal com idosos da zona rural de Rio Grande/RS, em 2017. A coleta de dados foi realizada por meio de questionário eletrônico. O comportamento sedentário foi avaliado pelo somatório de oito aspectos: assistir a televisão/vídeos/DVD, usar computador/internet, ler, socializar com amigos e/ou família, dirigir ou andar de carro/moto/transporte público, praticar algum hobby, trabalhar e outras atividades. A análise deu-se pela descrição dos aspectos e pela análise multivariável (regressão linear), para testar associações com características socioeconômicas, demográficas e atividade física. Também foi verificada associação do excesso de comportamento sedentário e tempo assistindo à televisão com as variáveis independentes. Resultados: A média de comportamento sedentário foi de 274,9 minutos/dia (n = 1.030), e assistir televisão representou quase a metade (130,5 minutos/dia). Idade mostrou-se inversamente associada com o comportamento sedentário, enquanto renda e escolaridade apresentaram uma relação direta. Renda apresentou associação positiva com excesso de comportamento sedentário e tempo assistindo televisão. Conclusão: A média de comportamento sedentário foi menor quando comparada com a literatura em idosos. Sugere-se que ações para incentivar hábitos saudáveis visem especialmente diminuir o tempo assistindo televisão.


ABSTRACT: Introduction: Sedentary behavior has been associated with several health indicators. This study aims to describe this outcome in elderly people living in rural areas. Methodology: A cross-sectional study was carried out with elderly people from the rural area in the city of Rio Grande/RS, in 2017. Data were collected using an electronic questionnaire. Sedentary behavior was evaluated by eight aspects: watching television/videos/DVDs, using computer/internet, reading, socializing with friends and/or family, driving or riding a car/bike/taking public transport, practicing a hobby, working, and other activities. The analysis was composed by the description of aspects and multivariable (linear regression) analysis to test associations between the outcome and socioeconomic, demographic and physical activity characteristics. Association of the excess of sedentary behavior and time watching television within the independent variables was also verified. Results: The mean of sedentary behavior was 274.9 minutes/day (n = 1,030), but watching television represented almost half (130.5 minutes/ day). Age was inversely associated with sedentary behavior, while income and schooling presented a direct relation. Income had a positive association with excessive sedentary behavior and time watching television. Conclusion: The mean sedentary behavior was lower when compared with the literature for the elderly. We suggest that actions to encourage healthy habits aim especially at reducing the time spent watching television.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Rural Population/statistics & numerical data , Sedentary Behavior , Socioeconomic Factors , Television , Time Factors , Exercise , Linear Models , Cross-Sectional Studies , Multivariate Analysis , Surveys and Questionnaires , Leisure Activities , Middle Aged
13.
Rev. bras. epidemiol ; 23: e200011, 2020. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1092611

ABSTRACT

RESUMO: Introdução: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. Objetivo: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. Metodologia: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. Resultados: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. Conclusão: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.


ABSTRACT: Introduction: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. Objective: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. Methodology: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. Results: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. Conclusion: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Trachoma/therapy , Rural Population , Socioeconomic Factors , Urban Population , Brazil , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Treatment Outcome
14.
Clin. biomed. res ; 40(1): 7-13, 2020.
Article in English | LILACS (Americas) | ID: biblio-1115980

ABSTRACT

Introduction: Despite the emergence of new treatments for HCV genotype 3 (HCV G3), there is still a lack of data about this particular subgroup in Brazil. Our objective was to describe clinical and sociodemographic variables and treatment profile of HCV G3 Brazilian patients. Methods: This was a descriptive, retrospective study, performed in a specialized center for HCV treatment in the South Region of Brazil. Medical records of patients diagnosed with HCV G3 were reviewed to collect clinical, sociodemographic, and treatment information. Results: Participants included total of 564 patients, with a mean age of 59.3 years (SD = 10.5). Cirrhosis was present in 54.4% of patients. The most common coexisting conditions were systemic arterial hypertension (36.6%) and diabetes mellitus (30%). Regarding treatment, 25.2% of the patients were treatment-naïve and 74.8% were currently under treatment (11.6%) or had received a previous treatment (87%). The most frequent ongoing treatment was sofosbuvir + daclatasvir (± ribavirin) (87.8%). Of the 388 patients who had at least one previous treatment, 67% achieved sustained virologic response in the last treatment. Caucasian / white, non-obese, transplanted patients, those with longer time since diagnosis and with cirrhosis were more likely to receive treatment, according to multivariate analysis. Patients with hepatocellular carcinoma were 64.1% less likely to be on treatment during the study period than those without this condition; patients with chronic kidney disease were 2.91-fold more likely to have an interruption of treatment than those without this condition. Conclusion: This study describes a large sample of Brazilian patients with HCV G3. Treatment patterns were mainly influenced by the presence of HCV complications and comorbidities.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Hepacivirus/genetics , Liver Cirrhosis/diagnosis , Ribavirin/therapeutic use , Multivariate Analysis , Retrospective Studies , European Continental Ancestry Group , Diabetes Mellitus , Renal Insufficiency, Chronic , Sofosbuvir/therapeutic use
15.
Rev. chil. endocrinol. diabetes ; 13(2): 48-54, 2020. tab, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1095230

ABSTRACT

INTRODUCCIÓN: Los nódulos tiroideos son una consulta muy prevalente en Endocrinología. Las guías de la Asociación Americana de Tiroides (2015) animaban a realizar estudios a largo plazo. El objetivo de este estudio fue revisar las características, el seguimiento y la evolución de los nódulos de tiroides seguidos en nuestras consultas hasta 2015. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes con al menos dos ecografías o cirugía. Los datos clínicos, ecográficos y de punción, así como la evolución y los resultados histológicos de aquellos operados, se analizaron con métodos descriptivos, bivariados y de regresión. RESULTADOS: 1.420 pacientes seguidos en Endocrinología a largo plazo fueron incluidos. 20 se excluyeron por tener una sola ecografía. El 71,2% presentaban normofunción, 9,6% hipertiroidismo subclínico, 9,5% hipotiroidismo subclínico, 5,7% hipotiroidismo clínico y 4% hipertiroidismo clínico. Del total de nódulos seguidos (n= 1400), 64,1%, 15,6% y 20,3% permanecieron estables, aumentaron y disminuyeron respectivamente. Los que crecieron no tuvieron más características sospechosas en las ecografías. De los intervenidos (457 casos (32,6% del total), 207 fueron malignos (45,2%). 57% de ellos fueron diagnosticados e intervenidos durante el primer año, en la primera evaluación. La aparición de nódulos malignos en el resto de pacientes fue de 89 casos (6,3% de todos los nódulos seguidos, 38,3% de ellos, incidentalomas). La ecografía y la citología empleadas antes de la homogenización de los criterios diagnósticos tuvieron una baja sensibilidad y especificidad en nuestro medio. CONCLUSIONES: Más de la mitad de los cánceres de tiroides fueron diagnosticados en la evaluación inicial del nódulo tiroideo. Más de la mitad de los nódulos no operados en el primer año mantienen el mismo tamaño a largo plazo. No encontramos predictores clínicos del aumento de tamaño. El valor diagnóstico de la ecografía y PAAF sin unos criterios estandarizados homogéneos es bajo.


INTRODUCTION: Thyroid nodules are a very prevalent consultation in endocrinology. Guidelines from the American Thyroid Association (2015) encouraged to conduct follow-up studies in the long term. This study object was to review the clinical characteristics, follow-up and evolution of thyroid nodules visited in our consultations till 2015. MATERIAL AND METHODS: Retrospective study of patients that had at least two thyroid ultrasounds or had been operated. Clinical, ultrasound and FNA (fine needle aspiration) data as well as the evolution and histology results of those operated, were analyzed with descriptive, bivariated and regression analyses. RESULTS: 1.420 patients followed in Endocrinology in the long term were included. 20 were excluded for having only one ecography. 71,2% had normal function, 9,6% subclinical hyperthyroidism, 9,5% subclinical hypothyroidism, 5,7% clinical hypothyroidism and 4% clinical hyperthyroidism. Of all the nodules followed (n=1400), 64,1%, 15,6% and 20,3% remained the same size, grew and decreased respectively. Nodules that grew didn´t have more suspicious sonographic characteristics. Of the operated nodules (457 cases (32,6% of all), 207 were cáncer (45,2%). 57% of them were diagnosed and intervened during the first year, in the first evaluation. Malignant nodules were detected in the rest of patients in 89 cases (6,3% of all the followed nodules, 38,3% of them were incidental cases). The ultrasound and citology diagnoses used before the homogenization of diagnoses criteria had a low senitivity and specificity in our clinical environment. CONCLUSIONS: More than half of the thyroid cancers were diagnosed in the initial evaluation of the thyroid nodule. More than half of nodules non operated in the first year remained the same size long term. We could not find clinical predictors of growth. The diagnostic value of the ultrasound and FNA is low without standardized and homogenous criteria.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Nodule/surgery , Thyroid Nodule/diagnostic imaging , Clinical Evolution , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , Follow-Up Studies , Ultrasonography , Sensitivity and Specificity , Thyroid Nodule/pathology , Biopsy, Fine-Needle
16.
Blood Research ; : 17-26, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-820807

ABSTRACT

BACKGROUND: DNMT3A mutations occur in approximately 20% of AML cases and are associated with changes in DNA methylation. CDKN2B plays an important role in the regulation of hematopoietic progenitor cells and DNMT3A mutation is associated with CDKN2B promoter methylation. We analyzed the characteristics of DNMT3A mutations including their clinical significance in AML and their influence on promoter methylation and CDKN2B expression.METHODS: A total of 142 adults, recently diagnosed with de novo AML, were enrolled in the study. Mutations in DNMT3A, CEBPA, and NPM1 were analyzed by bidirectional Sanger sequencing. We evaluated CDKN2B promoter methylation and expression using pyrosequencing and RT-qPCR.RESULTS: We identified DNMT3A mutations in 19.7% (N=28) of enrolled patients with AML, which increased to 29.5% when analysis was restricted to cytogenetically normal-AML. Mutations were located on exons from 8–23, and the majority, including R882, were found to be present on exon 23. We also identified a novel frameshift mutation, c.1590delC, in AML with biallelic mutation of CEBPA. There was no significant difference in CDKN2B promoter methylation according to the presence or type of DNMT3A mutations. CDKN2B expression inversely correlated with CDKN2B promoter methylation and was significantly higher in AML with R882H mutation in DNMT3A. We demonstrated that DNMT3A mutation was associated with poor AML outcomes, especially in cytogenetically normal-AML. The DNMT3A mutation remained as the independent unfavorable prognostic factor after multivariate analysis.CONCLUSION: We characterized DNMT3A mutations in AML and revealed the association between the DNMT3A mutation and CDKN2B expression and clinical outcome.


Subject(s)
Adult , DNA Methylation , Exons , Frameshift Mutation , Hematopoietic Stem Cells , Humans , Leukemia, Myeloid, Acute , Methylation , Multivariate Analysis
17.
Blood Research ; : 49-56, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-820803

ABSTRACT

BACKGROUND: Human immunodeficiency virus (HIV)-negative plasmablastic lymphoma (PBL) is a rare entity of diffuse large B-cell lymphoma (DLBCL). The clinicopathological features of and optimal treatment for HIV-negative PBL remain largely unknown.METHODS: To gain insight into this distinct lymphoma, we summarized the clinicopathologic characteristics of 8 unpublished HIV-negative PBLs and performed a comprehensive review of 394 published cases.RESULTS: Of the 8 unpublished PBLs, the median patient age was 53.0 years. Four patients presented with stage IV disease. All 8 patients showed a plasma cell-like immunophenotype. Of the six patients who received anthracycline-based chemotherapy, including two who received bortezomib, three patients achieved a continuous complete response, two patients died due to disease progression, and one patient was lost to follow-up. The other two patients achieved continuous complete response after receiving chemotherapy combined with radiotherapy and surgery. Of the 402 patients, the majority were male, with a mean age of 58.0 years. EBV infection was detected in 55.7% of the patients. The median survival times of the patients who received CHOP or CHOP-like regimens and intensive regimens were not reached and 23.0 months, respectively, and the intensive regimen did not improve the survival outcome (P=0.981). Multivariate analysis showed that EBER remained the only independent factor affecting overall survival (OS).CONCLUSION: HIV-negative PBL is a distinct entity with a predilection for elderly and immunosuppressed individuals. Intensive chemotherapy had no apparent survival benefits over the CHOP regimen in terms of OS; the prognosis of this disease is poor with current chemotherapy methods, and treatment remains a challenge.


Subject(s)
Aged , Bortezomib , Disease Progression , Drug Therapy , Epstein-Barr Virus Infections , HIV , Humans , Lost to Follow-Up , Lymphoma , Lymphoma, B-Cell , Male , Multivariate Analysis , Plasma , Plasmablastic Lymphoma , Prognosis , Radiotherapy
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-782488

ABSTRACT

BACKGROUND: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting.METHODS: A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response.RESULTS: The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3–20.4 vs. 23.5–22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders.CONCLUSION: Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01658020TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000532


Subject(s)
Activities of Daily Living , Animals , Cats , Humans , Information Services , Multivariate Analysis , Outpatients , Pulmonary Disease, Chronic Obstructive , Sputum , Thorax
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-782259

ABSTRACT

BACKGROUND/OBJECTIVES: We have previously designed the anti-cancer food scoring model (ACFS) 1.0, an evidence-based quantitative tool analyzing the anti-cancer or carcinogenic potential of diets. Analysis was performed using simple quantitative indexes divided into 6 categories (S, A, B, C, D, and E). In this study, we applied this scoring model to wider recipes and evaluated its nutritional relevance.MATERIALS/METHODS: National or known regional databases were searched for recipes from 6 categories: Korean out-dining, Korean home-dining, Western, Chinese, Mediterranean, and vegetarian. These recipes were scored using the ACFS formula and the nutrition profiles were analyzed.RESULTS: Eighty-eight international recipes were analyzed. All S-graded recipes were from vegetarian or Mediterranean categories. The median code values of each category were B (Korean home-dining), C (Korean out-dining), B (Chinese), A (Mediterranean), S (vegetarian), and D (Western). The following profiles were correlated (P < 0.05) with ACFS grades in the univariate trend analysis: total calories, total fat, animal fat, animal protein, total protein, vitamin D, riboflavin, niacin, vitamin B₁₂, pantothenic acid, sodium, animal iron, zinc, selenium, and cholesterol (negative trends), and carbohydrate rate, fiber, water-soluble fiber, vitamin K, vitamin C, and plant calcium (positive trends). Multivariate analysis revealed that animal fat, animal iron, and niacin (negative trends) and animal protein, fiber, and vitamin C (positive trends) were statistically significant. Pantothenic acid and sodium showed non-significant negative trends (P < 0.1), and vitamin B₁₂ showed a non-significant positive trend.CONCLUSION: This study provided a nutritional basis and extended the utility of ACFS, which is a bridgehead for future cancer-preventive clinical trials using ACFS.


Subject(s)
Animals , Ascorbic Acid , Asian Continental Ancestry Group , Calcium , Cholesterol , Diet , Humans , Iron , Multivariate Analysis , Niacin , Pantothenic Acid , Plants , Riboflavin , Selenium , Sodium , Vegetarians , Vitamin D , Vitamin K , Vitamins , Zinc
20.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-782245

ABSTRACT

BACKGROUND: The aim of this study was to compare the efficiency of cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) for the diagnosis of lung cancer and to establish the optimal cut-off values.METHODS: We retrospectively reviewed the medical records of 1,176 subjects with CYFRA 21-2 and CEA data; they were classified into 93 lung cancer cases and 1,083 total controls, including 146 age-matched controls. Multivariate analysis was used to determine the relationship between the concentration of each tumor marker and lung cancer diagnosis. The diagnostic efficiencies of tumor markers were evaluated using receiver operating characteristic curve analysis and areas under the curve (AUCs) were calculated. The optimal cut-offs for CYFRA 21-1 and CEA were also estimated.RESULTS: Age, CYFRA 21-1, and CEA concentrations were independently associated with lung cancer diagnosis. Diagnostic efficiency of each tumor marker and its' combination was different according to the histological types of lung cancer. For non-small cell lung cancer, the AUCs for the two-marker combination were the highest: 0.8661 and 0.7559 for total and age-matched controls, respectively. For squamous cell carcinoma, the AUCs for CYFRA 21-1 were the highest: 0.9245 and 0.8428 for total and age-matched controls, respectively. The sensitivity and specificity of CYFRA 21-1 and CEA for lung cancer diagnosis were improved when the cutoffs determined based on this study were applied.CONCLUSIONS: CYFRA 21-1 and CEA could be useful markers for diagnosing lung cancer and single or combination of markers may be useful according to different histological types of lung cancer.


Subject(s)
Area Under Curve , Biomarkers, Tumor , Carcinoembryonic Antigen , Carcinoma, Non-Small-Cell Lung , Carcinoma, Squamous Cell , Diagnosis , Keratin-19 , Lung Neoplasms , Lung , Medical Records , Multivariate Analysis , Retrospective Studies , ROC Curve , Sensitivity and Specificity
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