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1.
Estud. Interdiscip. Psicol ; 12(3): 03-21, set-dez.2021. Tab, Ilus
Article in Portuguese | LILACS | ID: biblio-1358319

ABSTRACT

Objetivou-se avaliar a relação entre sintomas de depressão, risco nutricional e capacidade funcional com características sociais, econômicas, demográficas e de saúde, em idosos longevos. Trata-se de uma pesquisa transversal, realizada em quatro municípios do estado de São Paulo. A relação entre as variáveis foi obtida por meio da técnica de Análise de Correspondência Múltipla. Foram avaliados 103 idosos, a maioria do sexo feminino, com idade entre 80 e 90 anos e com até quatro anos de estudo. Os resultados evidenciam a correspondência entre a presença de sintomas de depressão, risco nutricional, comprometimento funcional, baixa escolaridade e inadequada autoavaliação de saúde. Nota-se, portanto, a necessidade de uma abordagem interdisciplinar, e o desenvolvimento de políticas públicas direcionadas aos muito idosos, oferecendo atenção necessária para a redução do risco de depressão, de desnutrição e na melhoria da funcionalidade dos idosos longevos, que levem a um impacto positivo em sua qualidade de vida (AU).


This is study aimed to evaluate the relationship between depression symptoms, nutritional risk, and functional capacity, with social, economic, demographic and health characteristics in in long-lived elderly. It is a cross-sectional survey carried out in four municipalities in the state of São Paulo. The relationships among the studied variables were investigated through the technique of Multiple Correspondence Analysis. A total of 103 elderly were evaluated, most of whom were female, aged between 80 and 90 years and up to four years of schooling. The results evidence the correspondence between depression symptoms, nutritional risk, functional impairment, low schooling, and inadequate health self-assessment. Therefore, there is need a broad and interdisciplinary approach and the development of public policies directed at the very elderly are necessary, to reduce the risk of depression, malnutrition and improve the functioning of the long-lived elderly, that have a positive impact on their quality of life (AU).


Objetivo evaluar la relación entre síntomas de depresión, riesgo nutricional y capacidad funcional, con recursos sociales, económicos, demográficos y de salud, en ancianos de larga vida. Esta es un estudio transversal realizada en cuatro municipios del estado de São Paulo. Las relaciones entre las variables se investigaron utilizando la técnica de Análisis de Correspondencia Múltiple. 103 personas mayores fueron grabadas, la mayoría mujeres, con edades comprendidas entre 80 y 90 años y hasta cuatro años de estudio. Los resultados muestran una correspondencia entre la presencia de síntomas de depresión, riesgo nutricional, deterioro funcional, baja educación y salud inadecuada. Nota la necesidad de un enfoque interdisciplinario y el desarrollo de políticas públicas dirigidas a las personas mayores, ayuda a prestar atención para reducir los riesgos de depresión, desnutrición y mejorar la funcionalidad de las personas mayores de edad, lo que tiene un impacto positivo en su calidad de vida (AU).


Subject(s)
Humans , Aged, 80 and over , Risk , Risk Reduction Behavior , Malnutrition , Depression , Sociological Factors , Quality of Life , Self-Testing
3.
Article in English | WPRIM | ID: wpr-880376

ABSTRACT

BACKGROUND@#The 2019 novel coronavirus disease (COVID-19) has had a massive impact on public health, resulting in sudden dietary and behavioral habit changes. Frontline epidemic prevention workers play a pivotal role against COVID-19. They must face high-risk infection conditions, insufficient anti-epidemic material supplies, mental pressure, and so on. COVID-19 seriously affects their dietary and behavioral habits, and poor habits make them more susceptible to COVID-19. However, their baseline dietary and behavioral habits before COVID-19 and their willingness to change these habits after the outbreak of COVID-19 remain unclear for these workers in China. This study aimed to explore the baseline dietary and behavioral habits of frontline workers and their willingness to change these habits after the outbreak of the epidemic; in addition, susceptible subgroups were identified by stratified analyses as targets of protective measures to keep them from being infected with COVID-19.@*METHODS@#A cross-sectional study was conducted through an online questionnaire using a sample of 22,459 valid individuals living in China, including 9402 frontline epidemic prevention workers.@*RESULTS@#Before COVID-19, 23.9% of the frontline epidemic prevention workers reported a high-salt diet, 46.9% of them reported a high frequency of fried foods intake, and 50.9% of them smoked cigarettes. After the outbreak of COVID-19, 34.6% of them expressed a willingness to reduce salt intake, and 43.7% of them wanted to reduce the frequency of pickled vegetables intake. A total of 37.9% of them expressed a willingness to decrease or quit smoking, and 44.5% of them wanted to increase sleep duration. Significant differences in the baseline dietary and behavioral habits and the willingness to change their habits were observed between frontline epidemic prevention workers and other participants. Among the frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19, frontline epidemic prevention experience was a promoting factor for adopting worse dietary and behavioral habits, including those in the high-salt intake subgroup (OR, 2.824; 95% CI, 2.341-3.405) and the 11-20 cigarettes/day subgroup (OR, 2.067; 95% CI, 1.359-3.143).@*CONCLUSIONS@#The dietary and behavioral habits of frontline epidemic prevention workers were worse than that those of other participants before COVID-19. They had a greater willingness to adopt healthy dietary and behavioral habits after experiencing the outbreak of COVID-19. However, frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19 continued in engage in these poor habits. Dietary and behavioral intervention policies should be drafted to protect their health, especially frontline epidemic prevention workers with poor habits at baseline.


Subject(s)
Adult , COVID-19/psychology , China/epidemiology , Cross-Sectional Studies , Diet/standards , Female , Health Behavior , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Humans , Male , Risk Reduction Behavior , SARS-CoV-2 , Surveys and Questionnaires
4.
Rev. bras. ortop ; 55(3): 269-277, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1138034

ABSTRACT

Abstract Objective To describe the protocols implemented to adapt the orthopedic team to the COVID-19 pandemic; a secondary objective is to assess the behavior of hospital and departmental variables when implementing such measures. Methods The present is a retrospective study describing three protocols: 1) reduction in the risk of infection for patients and healthcare workers; 2) adaptation of work, academic and scientific activities; and 3) adaptation of the orthopedic treatment during the pandemic. We analyzed hospital and departmental variables, including the number of patients seen in the emergency room and outpatient clinic, the number of hospitalized patients, suspected and confirmed cases in patients and orthopedic team members, changes in teaching activities from on-site attendance to videoconferencing, and number of surgeries. Period A, from March 3 to 16, was compared with period B, from March 17 to 30, 2020, which corresponded to the implementation of the protocols. Results There was a decrease in the number of outpatients and inpatients. One confirmed and two suspected cases were notified. Among the departmental members, there were 12 suspected and 6 confirmed cases. The weekly frequency of classes was maintained, while the clinical-scientific meetings decreased from ten to three. In addition, the number of surgeries was reduced. Conclusions The present study demonstrated the feasibility and efficiency of the rapid implementation of intervention protocols in the midst of the COVID-19 pandemic. The protocols focused on reducing the risk of infection for patients and healthcare professionals, adapting work, academic and scientific activities, and modifying the orthopedic treatment. With the application of the protocols, the healthcare, academic and scientific activities remained functional, prioritizing measures to confront the COVID-19 pandemic.


Resumo Objetivo Descrever os protocolos implementados para adequar a equipe ortopédica à pandemia de COVID-19 e, secundariamente, avaliar o comportamento de variáveis hospitalares e departamentais frente à implementação das medidas. Métodos Estudo retrospectivo com descrição de três protocolos: 1) Redução do risco de contágio dos pacientes e profissionais de saúde; 2) Adaptação das atividades laborais, acadêmicas e científicas; e 3) Adaptação do tratamento ortopédico frente à pandemia. Foram analisadas variáveis hospitalares e departamentais como: número de pacientes atendidos no pronto-socorro e ambulatórios, pacientes internados, casos suspeitos e confirmados nos pacientes e na equipe ortopédica, mudança das atividades de ensino do modo presencial para videoconferência, e número cirurgias. Foi comparado o período A, de 03 a 16 de março, com o período B, de 17 a 30 de março, que corresponde à implementação dos protocolos. Resultados Houve diminuição do número de pacientes atendidos e do número de pacientes internados. Foram notificados dois suspeitos e um confirmado. Dos integrantes do departamento, 12 foram suspeitos e 6 confirmados. Manteve-se a frequência semanal das aulas e as reuniões clinico-científicas diminuíram de dezpara três. Houve redução no volume de cirurgias. Conclusões O presente estudo demonstrou a viabilidade e a eficiência da rápida implementação de protocolos de intervenção em meio ao cenário de pandemia por COVID-19. Os protocolos focaram na redução do risco de contágio dos pacientes e profissionais de saúde, na adaptação das atividades laborais, acadêmicas e científicas, e na adaptação do tratamento ortopédico. Com sua aplicação, mantiveram-se as atividades assistencial, acadêmica e científica funcionantes, priorizando-se medidas de enfrentamento à COVID-19.


Subject(s)
Orthopedics , Adaptation, Psychological , Occupational Health , Coronavirus Infections , Disease Transmission, Infectious , Severe Acute Respiratory Syndrome , Delivery of Health Care , Risk Reduction Behavior , Emergency Medical Services , Pandemics , Hospital Administration , Inpatients
5.
Korean Circulation Journal ; : 163-175, 2020.
Article in English | WPRIM | ID: wpr-786221

ABSTRACT

BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.


Subject(s)
Atrial Fibrillation , Follow-Up Studies , Hemorrhage , Humans , International Normalized Ratio , Prothrombin Time , Risk Reduction Behavior , Stroke , Thromboembolism , Warfarin
6.
Article in English | WPRIM | ID: wpr-786070

ABSTRACT

OBJECTIVE: Previous studies have separately reported the contributions of dietary factors to the risk of cardiovascular disease (CVD) and its markers, including blood pressure (BP) and lipid profile. This study systematically reviewed the current evidence on this issue in the Korean population.METHODS: Sixty-two studies from PubMed and Embase were included in this meta-analysis. We performed a random-effects model to analyze pooled odds ratios (ORs) and hazard ratios (HRs) and their 95% confidence intervals (CIs) for the consumption of 14 food items, three macro- and eight micro-nutrients, two dietary patterns, and three dietary indices.RESULTS: An analysis of pooled effect sizes from at least four individual study populations showed significant associations between coffee consumption and CVD (OR/HR, 0.71; 95% CI, 0.52–0.97) and elevated/high triglycerides (TG) (OR, 0.84; 95% CI, 0.78–0.90), sugar-sweetened beverage intake and elevated BP (OR/HR, 1.20; 95% CI, 1.09–1.33), and milk and dairy intake and elevated/high TG and elevated high-density lipoprotein cholesterol (HDL-C) (OR/HR, 0.82; 95% CI, 0.76–0.89 for both). Carbohydrate consumption and the low-carbohydrate-diet score were consistently related to an approximately 25% risk reduction for elevated TG and HDL-C. A lower risk of elevated total cholesterol, but not low-density lipoprotein, was additionally observed for those with a higher low-carbohydrate-diet score. A healthy dietary pattern was only associated with a reduced risk of elevated TG in the Korea National Cancer Screenee Cohort (OR, 0.81; 95% CI, 0.67–0.98).CONCLUSION: This study showed that milk and dairy and coffee had protective effects for CVD and its risk factors, such as BP and lipid profile, while sugar-sweetened beverages exerted harmful effects.


Subject(s)
Asian Continental Ancestry Group , Beverages , Blood Pressure , Cardiovascular Diseases , Cholesterol , Coffee , Cohort Studies , Dyslipidemias , Humans , Hypertension , Korea , Lipoproteins , Milk , Odds Ratio , Risk Factors , Risk Reduction Behavior , Triglycerides
7.
Rev. cuba. med. gen. integr ; 35(4): e851, oct.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093516

ABSTRACT

Introducción: El primer programa de prevención para las enfermedades genéticas y defectos congénitos en Cuba se logra cuando el programa de Atención Materno Infantil alcanza el máximo de condiciones en 1981. Objetivo: Incrementar los conocimientos sobre el riesgo preconcepcional genético en el personal de enfermería Métodos: Se realizó un estudio cuasi experimental de tipo intervención educativa en enfermería en el Policlínico Universitario José Martí Pérez sobre la identificación de los factores de riesgo preconcepcional genético, en Santiago de Cuba, en el segundo semestre del 2017. El universo estuvo constituido por la plantilla física de la institución (150 enfermeras), seleccionando una muestra por conveniencia de 34 enfermeras en el Grupo Básico de Trabajo # I (GBT); se procedió a la aplicación del instrumento de evaluación para identificar las necesidades de aprendizaje sobre los riesgos genéticos, diseñando y aplicando un Programa de Capacitación, evaluando antes y después de la intervención. Resultados: Predominaron las enfermeras generales de más de 50 años con conocimientos inadecuados, antes de la intervención, sobre los elementos que influyen, el momento en que acontece el riesgo preconcepcional genético, así como, los conocimientos sobre el riesgo prenatal, en el recién nacido y en las enfermedades comunes. Conclusiones: Luego de aplicada la estrategia de intervención se lograron elevar los conocimientos sobre el riesgo preconcepcional genético en algunos miembros de la muestra, que incorporaron lo aprendido a las diferentes actividades y procesos asistenciales en la comunidad(AU)


Introduction: The first Cuban program for prevention of genetic diseases and defects was started when the mother and child care program achieved an optimal status in the year 1981. Objective: Broaden knowledge about preconception genetic risk among the nursing personnel. Methods: A quasi-experimental study was conducted based on an educational intervention in nursing at José Martí Pérez University Polyclinic. The study aimed to identify preconception genetic risks in Santiago de Cuba during the second semester of 2017. The study universe was the physical payroll of the institution (150 nurses), of whom 34 from Basic Work Team (BWT) No. 1 were selected by convenience sampling. The evaluation tool was applied to identify learning gaps related to genetic risks. Next, a training program was designed and applied. Participants in the study were evaluated before and after the intervention. Results: A predominance was found of general nurses of over 50 years' experience with poor pre-intervention knowledge about the factors involved in preconception genetic risks and the moment when such risks occur, or about prenatal and newborn risks and common diseases. Conclusions: Upon application of the intervention strategy, knowledge about preconception genetic risk was broadened among some members of the sample, who incorporated the newly-acquired information into the various community care activities and processes(AU)


Subject(s)
Humans , Female , Pregnancy , Congenital Abnormalities/epidemiology , Maternal-Child Nursing , Preconception Care/methods , Risk Reduction Behavior , Genetic Diseases, Inborn/prevention & control , Genetic Diseases, Inborn/epidemiology , Cuba
8.
Lima; Perú. Ministerio de Salud; 20191100. 56 p. tab, graf.
Monography in Spanish | MINSAPERU, LILACS, MINSAPERU | ID: biblio-1025557

ABSTRACT

El documento contiene un conjunto de previsiones y acciones que el estado adopta permanentemente para garantizar la estabilidad y el normal funcionamiento de la institucionalidad político jurídica.


Subject(s)
Health Behavior , Risk Factors , Intersectoral Collaboration , Risk Reduction Behavior , Programming , Violence
9.
Subj. procesos cogn ; 23(1): 1-16, ene.-jun. 2019.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1118460

ABSTRACT

El artículo se propone exponer la necesidad de incluir la protección y cuidado de la salud mental y el apoyo psicosocial como eje ineludible de la "Gestión Integral para la Reducción de Riesgo de Desastres" y la construcción de" Resiliencia"(AU)


In order to develop the comunnitary resilience is necesary to promote the integration of mental health care and psychosocial support in Integral management for Disaster Risk Reduction (DRR)(AU)


Subject(s)
Mental Health , Risk Reduction Behavior , Risk , Disasters
11.
Rev. cuba. med. mil ; 48(2): e224, abr.-jun. 2019. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126616

ABSTRACT

Introducción: El sistema de recepción masiva de intoxicados en los hospitales, durante las emergencias químicas, tributa a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres, pero necesita de su implementación en la práctica. Objetivo: Elaborar una secuencia de acciones que permita implementar el sistema de recepción masiva de intoxicados en los hospitales en situaciones de emergencias químicas. Método: Se revisaron y analizaron fuentes bibliográficas entre 2005 y 2017. Se realizaron consultas individuales a personas vinculadas al tema, que permitieron la primera aproximación. Se empleó el criterio de expertos sobre la utilidad y viabilidad para la validación de los resultados. Resultados: Se elaboró una secuencia de acciones para la implementación del sistema de recepción masiva de intoxicados derivados de emergencias químicas en los hospitales, que se corresponden con las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres y con los subsistemas fundamentales del sistema. Esta asumió tres fases: fase 1, de alerta o preparación, que incluye las acciones de preparación hospitalaria; la fase 2, de alarma o ejecución, en las que se ejecutan las acciones de recepción masiva de intoxicados; y la fase 3, o de recuperación, que comprende las acciones de rehabilitación y restablecimiento. Conclusiones: La secuencia de acciones concebida permite implementar en la práctica el sistema de recepción masiva de intoxicados derivados de emergencias químicas en los hospitales; está compuesta por tres fases: preparatoria, ejecutoria y recuperativa; es integral, participativa y reproducible por cualquier institución hospitalaria(AU)


Introduction: The system of mass reception of intoxicated people during chemical emergencies, in hospitals, is linked to the phases of the response stage of the disaster risk reduction cycle, but needs to be implemented in practice. Objective: To elaborate a sequence of actions that allows to implement the system of massive reception of intoxicated people in hospitals, in situations of chemical emergencies. Method: Bibliographical sources were reviewed and analyzed between 2005 and 2017. Individual consultations were made to people linked to the topic, which allowed the first approximation. The criterion of experts on the utility and viability for the validation of the results was used. Results: A sequence of actions was developed for the implementation of the system of mass reception of intoxicates derived from chemical emergencies in hospitals that correspond to the phases of the response phase of the disaster risk reduction cycle and; with the fundamental subsystems of the system. This took three phases: phase 1, alert or preparation, which includes the actions of hospital preparation, phase 2, alarm or execution, in which actions of mass reception of intoxicated are carried out, and phase 3, or recovery, which includes rehabilitation and recovery actions. Conclusions: The sequence of actions conceived allows to implement in practice the system of mass reception of intoxicates derived from chemical emergencies in hospitals. It is composed of three phases: preparatory, executory and recuperative; It is comprehensive, participatory and reproducible by any hospital institution(AU)


Subject(s)
Rehabilitation , Alert , Preparedness , Risk Reduction Behavior , Disasters/prevention & control , Hospitals , Persons
12.
Rev. colomb. reumatol ; 26(1): 40-47, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1098964

ABSTRACT

ABSTRACT Context: Patients with rheumatoid arthritis have a higher cardiovascular risk due to the prevalence of cardiovascular risk factors and metabolic alterations derived from the inflammatory activity and the treatment of their disease. A systematic evaluation of the effect of statins on lipid fractions and cardiovascular outcomes has not been carried out specifically in patients with rheumatoid arthritis. Methods: A literature search was conducted in Medline (PubMed), Embase, Lilacs, SciELO, and Cochrane. Randomized and non-randomized clinical trials were selected that evaluated the impact of statins on mortality, cardiovascular events, lipid fractions and disease activity in patients with rheumatoid arthritis. A paired evaluation of risk of bias was carried out, along with a meta-analysis using RevMan 5.3®. Results: A total of 5 studies and 383 patients were included in the analysis. The use of statins among patients with rheumatoid arthritis significantly reduced total cholesterol levels: -46.16mg/dL (95% CI: [-53.89, -38.46]; I 2: 86%), LDLc: -18.13mg/dL (95% CI: [-21.8, -14.4], I 2: 97%) and TG of -34.95 mg/dL (95% CI: [-44.3, -25.6], I 2: 0%), without significant changes in HDLc. It also reduced the activity of the disease (DAS28) by 0.73 (95% CI: [-0.94, -0.53], I 2: 96%). No study was found that reported mortality or cardiovascular outcomes. Conclusion: The lipid-lowering effect of statins in patients with rheumatoid arthritis is consistent with that found in other populations. There is a slight impact in reducing the activity of the disease, but reducing the risk of cardiovascular events in this specific population has not been studied.


RESUMEN Contexto: Los pacientes con artritis reumatoide tienen un riesgo cardiovascular elevado por la alta prevalencia de factores de riesgo cardiovascular y de alteraciones metabólicas derivadas de la actividad inflamatoria y del tratamiento de su enfermedad. No se ha realizado una evaluación sistemática del efecto de las estatinas en las fracciones lipídicas y desenlaces cardiovasculares específicamente en pacientes con artritis reumatoide. Métodos: Se realizó una búsqueda de la literatura en Medline (PubMed), Embase, Lilacs, SciELO y Cochrane. Se seleccionaron experimentos clínicos aleatorizados y no aleatorizados (estudios de cohortes) que evaluaran el impacto de las estatinas en mortalidad, eventos cardiovasculares, fracciones lipídicas y actividad de la enfermedad en pacientes con artritis reumatoide. Se realizó la selección, evaluación del riesgo de sesgos de forma pareada y un metaanálisis con RevMan 5.3®. Resultados: Un total de 5 estudios y 383 pacientes fueron incluidos en el análisis. El uso de estatinas en pacientes con artritis reumatoide reduce significativamente los niveles de colesterol total: -46,16 mg/dL (IC 95%: [-53,89; -38,46]; I 2: 86%), LDLc: -18,13 mg/dL (IC 95%: [-21,8; -14,4]; I 2: 97%) y triglicéridos de -34,95 mg/dL (IC 95%: [-44,3; -25,6]; I 2: 0%), sin cambios significativos del HDLc. Además, reduce la actividad de la enfermedad (DAS28) en 0,73 (IC 95%: [-0,94; -0,53]; I 2: 96%). No se encontró ningún estudio que reportara mortalidad ni desenlaces cardiovasculares. Conclusión: El efecto hipolipidemiante de las estatinas en pacientes con artritis reumatoide es consistente con lo encontrado en otras poblaciones. Existe un discreto impacto en la reducción de actividad de la enfermedad; sin embargo, la reducción del riesgo de eventos cardiovasculares en esta población específica no ha sido estudiada.


Subject(s)
Humans , Arthritis, Rheumatoid , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Triglycerides , Risk Factors , Risk Reduction Behavior
14.
Arq. bras. cardiol ; 112(2): 165-170, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-983818

ABSTRACT

Abstract Background: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. Objectives: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). Methods: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. Results: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. Conclusions: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.


Resumo Fundamento: A baixa ou a não adesão à redução de sódio na dieta foi identificada como um dos principais fatores causais da insuficiência cardíaca (IC). O Questionário de Restrição de Sódio na Dieta (QRSD) do inglês Dietary Sodium Restriction Questionnaire (DSRQ) identifica fatores que possam interferir na adesão a essa recomendação. No entanto, anda não existe um ponto de corte que estabelece adesão segundo o QRSD. Objetivos: Identificar o ponto de corte para adesão satisfatória ao QRSD, versão brasileira do DSRQ. Métodos: Estudo multicêntrico. Foram incluídos pacientes com IC em tratamento ambulatorial (compensados) e aqueles tratados em serviços de emergência por IC aguda (descompensados). Para a definição do ponto de corte, os escores do QRSD foram comparados entre os grupos. A curva ROC foi construída para cada subescala para determinar o melhor ponto de sensibilidade e especificidade em relação à adesão. Adotou-se um nível de significância de 5%. Resultados: Foram incluídos 206 pacientes compensados e 225 pacientes descompensados. Os pacientes compensados apresentaram escores que indicaram maior adesão em todas as subescalas (p < 0,05). Escores ≥ 40 pontos de um total de 45 para a subescala "atitude e norma subjetiva"; escores ≤ 8 de um total de 20 para a subescala "controle comportamental percebido"; e escores 3 de um total de 15 para "comportamento dependente" foram indicativos de adesão satisfatória. Conclusões: A avaliação de pacientes com IC atendidos no ambulatório ou na emergência permitiu a determinação dos pontos de corte para adesão satisfatória à restrição dietética de sódio. Países de culturas similares poderiam usar esse mesmo ponto de corte, bem como outros pesquisadores poderiam utilizá-lo como referência para outros estudos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Diet, Sodium-Restricted/statistics & numerical data , Treatment Adherence and Compliance/statistics & numerical data , Heart Failure/diet therapy , Reference Standards , Brazil , Sodium, Dietary , Surveys and Questionnaires , ROC Curve , Statistics, Nonparametric , Risk Reduction Behavior
15.
Int. braz. j. urol ; 45(1): 193-193, Jan.-Feb. 2019.
Article in English | LILACS | ID: biblio-1040052

ABSTRACT

ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.


Subject(s)
Humans , Kidney Transplantation/adverse effects , Laparoscopy/adverse effects , Vascular System Injuries/etiology , Nephrectomy/adverse effects , Retrospective Studies , Living Donors , Risk Reduction Behavior , Computed Tomography Angiography , Middle Aged , Nephrectomy/methods
16.
Article in English | WPRIM | ID: wpr-765781

ABSTRACT

PURPOSE: Morbid obesity is a well-known risk factor for cardiovascular disease (CVD). This study aimed to quantitatively evaluate the effects of bariatric surgery on CVD risk reduction in Korean obese patients by using three CVD risk prediction models (Framingham General Cardiovascular Risk Score [FRS], Pooled Cohort Equation [PCE], and Korean Risk Prediction Model [KRPM]), and to investigate which procedure between laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) is a better option for CVD risk reduction. MATERIALS AND METHODS: We retrospectively reviewed all obese patients who underwent bariatric surgery at a single institution from October 2009 to May 2016. Of the 1034 patients reviewed, 83 patients (6.5%) who met the criteria for calculating the FRS, PCE, and KRPM scores and had a follow-up of at least 1 year were included in this study. RESULTS: The FRS, PCE, and KRPM scores were significantly decreased at postoperative 1 year (10.47±7.30% to 6.33±4.59%, P=0.000; 5.45±6.25% to 2.75±2.75%, P=0.000; and 4.53±2.96% to 3.49±2.13%, P=0.000, respectively) in LRYGB. The PCE and KRPM scores were significantly decreased (4.13±3.63% to 2.42±2.45%, P=0.004 and 4.14±1.95% to 3.22±1.94%, P=0.000, respectively) in LSG, but not the FRS (9.43±3.58% to 5.63±3.24%, P=0.118). There was no difference in absolute risk reduction in FRS, PCE, and KRPM between LRYGB and LSG (4.13±5.08% and 3.80±3.50%, P=0.788; 2.70±0.52% and 1.72±0.49%, P=0.799; and 1.03±1.85% and 0.92±0.97%, P=0.776, respectively). CONCLUSION: LRYGB and LSG can equally significantly decrease the CVD risk in the Korean population, based on FRS, PCE, and KRPM.


Subject(s)
Bariatric Surgery , Cardiovascular Diseases , Cohort Studies , Follow-Up Studies , Gastrectomy , Gastric Bypass , Humans , Numbers Needed To Treat , Obesity, Morbid , Retrospective Studies , Risk Assessment , Risk Factors , Risk Reduction Behavior
17.
Article in English | WPRIM | ID: wpr-763375

ABSTRACT

BACKGROUND/AIMS: We aimed to determine the relationship between the safety margin of an embolized area and local tumor recurrence (LTR) of patients with hepatocellular carcinoma (HCC) who underwent superselective transarterial chemoembolization (TACE). METHODS: The medical records of 77 HCC patients with 109 HCC nodules who underwent superselective TACE were retrospectively analyzed for LTR. Univariate and multivariate analyses were performed for 16 potential factors using Cox proportional hazard regression. Iodized oil deposition on cone-beam computed tomography (CBCT) imaging was divided into three grades: A=complete tumor staining and complete circumferential safety margin, B=complete tumor staining but incomplete safety margin, C=incomplete tumor staining. The effect of a safety margin on LTR was evaluated by comparison between grade A and B group. RESULTS: Univariate and multivariate analyses revealed that grade A iodized oil deposition and portal vein visualization were the only two independent significant factors of LTR (P<0.001 and P=0.029, respectively). The 12- and 24-month LTR rates of tumors for grade A (n=62), grade B (n=30), and grade C (n=17) were 16% vs. 41% vs. 100% and 16% vs. 61% vs. 100%, respectively (P<0.001). The tumors in the grade A group had a 75% risk reduction in LTR (odds ratio, 0.25; 95% confidence interval, 0.10 to 0.64; P=0.004) compared to the grade B group. CONCLUSIONS: LTR was significantly lower when a greater degree of iodized oil deposition occurred with a complete circumferential safety margin. In superselective TACE, the safety margin of the embolized areas using intraprocedural CBCT affected LTR in HCC patients.


Subject(s)
Carcinoma, Hepatocellular , Cone-Beam Computed Tomography , Embolization, Therapeutic , Humans , Iodized Oil , Medical Records , Multivariate Analysis , Neoplasm Recurrence, Local , Portal Vein , Recurrence , Retrospective Studies , Risk Reduction Behavior
18.
Article in English | WPRIM | ID: wpr-764566

ABSTRACT

OBJECTIVE: To investigate the relationship between the precursors of high grade serous ovarian cancer (HGSOC) and the characteristics of patients with a low HGSOC risk in terms of the effects of pregnancy. METHODS: We prospectively examined consecutive cases in which the bilateral fallopian tubes were removed during benign gynecological or obstetric surgery and assessed the relationship between the patient characteristics, including parity and pregnancy, and the incidence of HGSOC precursors. All the fallopian tubes were examined by applying the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) Protocol. RESULTS: Of the 113 patients enrolled, 67 were gynecological and 46 were obstetric. The p53 signature was identified in 21 patients. No other precursors were identified. In a comparison of the p53 signature-positive and negative groups, parous women and pregnant women were significantly fewer in the p53 signature-positive group (53% vs. 86%, p=0.002, 10% vs. 47%, p=0.001, respectively). Current pregnancy was also associated with a significantly lower incidence of the p53 signature after multivariate adjustment (odds ratio [OR]=0.112; 95% confidence interval [95% CI]=0.017–0.731; p=0.022). Among gynecological patients, parous women were fewer in the p53 signature-positive group on univariate (47% vs. 73%, p=0.047) and multivariate analysis (OR=0.252; 95% CI=0.069–0.911; p=0.036). No other characteristics were associated with p53 signature positivity. CONCLUSIONS: The incidence of the p53 signature was significantly lower in parous women and pregnant women. This decreased incidence of early phase serous carcinogenesis may be one of the possible mechanisms underlying HGSOC risk reduction among parous women.


Subject(s)
Carcinogenesis , Cystadenocarcinoma, Serous , Fallopian Tube Neoplasms , Fallopian Tubes , Female , Humans , Incidence , Multivariate Analysis , Obstetric Surgical Procedures , Ovarian Neoplasms , Parity , Pregnancy , Pregnant Women , Prospective Studies , Risk Reduction Behavior , Tumor Suppressor Protein p53
19.
Article in English | WPRIM | ID: wpr-759548

ABSTRACT

BACKGROUND: Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy. METHODS: Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery. RESULTS: Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h. CONCLUSIONS: Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.


Subject(s)
Acute Pain , Anesthetics, Local , Double-Blind Method , Fentanyl , Humans , Incidence , Laparoscopy , Length of Stay , Nephrectomy , Pain, Postoperative , Pneumoperitoneum , Postoperative Nausea and Vomiting , Risk Reduction Behavior , Shoulder Pain , Tissue Donors , Walking
20.
Article in Korean | WPRIM | ID: wpr-766608

ABSTRACT

In the ranking of cancer incidence in the year, female breast cancer was the highest cancer after thyroid cancer in 2004–2015, and became the most common cancer in 2016, exceeding the cases of thyroid cancer. The incidence rates of breast cancer have increased steadily over the past two decades and are expected to continue to increase in the next decades, although the incidence rates of all other cancers has declined in Korea. Most of the established risk factors of breast cancer are primarily related to female sex hormones. Other known risk factors are alcohol drinking, a family history of breast cancer, genetic predisposition, and benign breast conditions. Some risk factors, such as physical activity, breastfeeding, and number of children, are modifiable factors that can be targeted for risk reduction. This article summarizes the descriptive epidemiological characteristics of breast cancer in Korea that have been reported and identifies the specific characteristics and secular trends in incidence, mortality, and survival rates of breast cancer up to the present day. It is uncertain whether the risk factors established in western populations will also be valid for the Korean population. To explore this question, we summarize the results from international collaborative studies and meta-analyses of risk factors of breast cancer published to date. The results for Koreans are summarized and described based on results from population-based or nested case-control studies, hospital case-community control studies, cohort studies, and meta-analyses conducted in Korea. This study will be helpful for risk assessment, interventions, and prevention of breast cancer.


Subject(s)
Alcohol Drinking , Breast Feeding , Breast Neoplasms , Breast , Case-Control Studies , Child , Cohort Studies , Epidemiology , Female , Genetic Predisposition to Disease , Gonadal Steroid Hormones , Humans , Incidence , Korea , Mortality , Motor Activity , Risk Assessment , Risk Factors , Risk Reduction Behavior , Survival Rate , Thyroid Neoplasms
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