Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates / Inserção de dispositivo intrauterino de cobre no pós-parto imediato em hospital universitário brasileiro: Taxas de expulsão e continuação

Abstract Objective To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. Materials and Methods In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. Results There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Conclusion Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Resumo Objetivo Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. Materiais e Métodos Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. Resultados Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. Conclusão Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo.

Análisis biomecánico de la continuación prepatelar del cuádriceps / Biomechanical assessment of the prepatellar quadriceps continuation

OBJETIVO Determinar la resistencia máxima a la tracción (RMT) de la continuación prepatelar del cuádriceps (CPC).MATERIALES Y MÉTODOS Se realizó un estudio en cadáveres humanos. Fueron incluidos diez especímenes, en los cuales se utilizaron los tercios proximal y medial de la cortical anterior de la patela para evaluar las propiedades mecánicas de la CPC. En cada espécimen, se estudió un área de sección transversal de 0,2 cm2 (A1) y 1 cm2 (A2). Se aplicó una carga gradual para determinar la RMT.RESULTADOS La mediana de la RMT en el A1 fue de 232,56 N (rango: 141,23 N a 295,33 N) y en el A2 fue de 335,30 N (rango: 216,45 N a 371,40 N). El incremento en la TMR fue significativo entre las 2 áreas (p = 0,006).CONCLUSIÓN El ignificado clínico de este estudio es que la CPC es un tejido fuerte que puede servir de anclaje seguro para reconstrucciones alrededor de la patela. Un área relativamente pequeña tolera al menos 140 N y, a medida que crece el área, también aumenta la RMT.

OBJETIVE To determine the ultimate tensile strength (UTS) of the prepatellar quadriceps continuation (PQC). MATERIALS AND METHODS A human cadaveric study was performed. Ten fresh-frozen specimens were used. The proximal and medial thirds of the anterior cortex of the patella were used to assess the mechanical properties of the PQC. In each specimen, transverse section areas measuring 0.2 cm2 (A1) and 1 cm2 (A2) were studied. A gradual load was applied to determine the UTS. RESULTS The median UTS of A1 was of 232.56 N (range: 141.23 N to 295.33 N), and that of A2 was of 335.30 N (range: 216.45 N to 371.40 N). The increment in UTS was significant between the 2 areas (p » 0.006). CONCLUSION The clinical significance of the present study lies in the fact that it shows that the PQC is a strong tissue that can be a safe anchor for reconstruction around the patella. A relatively small area supports at least 140 N, and, as the area grows, the UTS increases as well.

A Inclusão no Ensino Superior: Vivências de Estudantes com Deficiência Visual / The Challenge of Inclusion in Higher Education: Experiences of Students with Visual Impairment

RESUMO: Este artigo analisa o ponto de vista dos/as estudantes com deficiência visual sobre o seu ingresso e a sua permanência na Universidade Federal da Bahia (UFBA) e busca refletir sobre o processo de inclusão por eles/as vivenciado. Trata-se de uma pesquisa qualitativa realizada por meio de entrevistas semiestruturadas com oito estudantes com deficiência visual matriculados/as em diferentes cursos dessa instituição. A análise do material textual demonstrou que o ingresso e a permanência no Ensino Superior foram marcados por dificuldades relacionadas às barreiras físicas, à disponibilidade e ao acesso a recursos materiais, didáticos, pedagógicos e tecnológicos, bem como às barreiras atitudinais, que agudizam o desempenho acadêmico dos/as estudantes com deficiência visual. Desse modo, a inclusão educacional, em processo de construção na UFBA, requer envolvimento e participação de toda a comunidade acadêmica para que de fato se concretize.

ABSTRACT: This paper analyzes the point of view of students with visual impairment on their admission and permanence at the Universidade Federal da Bahia (UFBA), Brazil, and seeks to reflect on the inclusion process experienced by them. This is a qualitative investigation which was carried out through semi-structured interviews with eight students with visual impairment enrolled in different courses of this institution. The analysis of the collected material demonstrated that access to and permanence in Higher Education were characterized by difficulties related to physical barriers, availability, and access to didactic, pedagogical, and technological resources, as well as attitudinal barriers, which exacerbate the academic performance of students with visual impairment. Therefore, the educational inclusion, which is being built in UFBA, requires the involvement and participation of the entire academic community so that it is actually implemented.

Continuation rates of the 52-mg levonorgestrel-releasing intrauterine system according to the primary reason for its use / Taxas de continuação com o sistema intrauterino de liberação de levonorgestrel de 52mg de acordo com o motivo principal de seu uso

Abstract Objective To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Resumo Objetivo Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. Métodos Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavamsomente por razoesmédicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida Resultados No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. Conclusão A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

Evaluation of clinical outcome of post placental insertion of Cu T 380 A in women undergoing caesarean delivery

Background: The objective of the study was to evaluate clinical outcome of insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra at Tanda (Rural Medical College) to evaluate the clinical outcome of post placental Cu T 380 A insertion in women undergoing caesarean section after taking approval of protocol review and institutional ethics committee of the institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: The present study showed that there were no major complications and only minor side effects were like pain, fever, discharge and irregular bleeding which were observed in only 5-15% of women during hospital stay and during follow up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow up visit. The string visibility increased with time and at 6 months follow up stings became visible in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.3% at six months post-partum follow up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Intra caesarean insertion of PPIUCD is practical, convenient, safe, effective and acceptable contraceptive method for spacing of the birth in this rural setting.

Clinical outcome of post-abortion intrauterine contraceptive device insertion

Background: Clinical outcome of post abortion IUCD varies according to type of abortion, method of abortion and period of abortion. There is paucity of Indian literature regarding factor affecting clinical outcome of post-abortal intrauterine contraceptive device insertion. This study was conducted to evaluate clinical outcome of post abortion intrauterine contraceptive in terms of acceptability, safety and continuation rate.Methods: A prospective cohort study where 112 patients over period of 18 months (November 2017 to April 2019) were included in study done at VMMC and Safdarjung Hospital, New Delhi, India.Results: Total 112 patients recruited. Their age ranges from 26-30 years. Mean age of women were 28.11±4.51 years. Majority of women who underwent IUCD insertion were para2. Regardless of type of IUCD, the most common side effects associated with copper wearing IUCD were change in amount of menstrual flow. Two cases of PID after CuT380A insertion and one case of PID after cu375. No perforation occurred. Continuation rate were 86.79%. Satisfaction rate were 82.14%.Conclusions: There is higher rate of continuation and satisfaction among women who had undergone immediate post abortion OUCD insertion. Early insertion of IUCD after abortion is safe, effective and well tolerated by women. Clinical outcome of post abortion is not affected by type of copper containing IUCD i.e., Cu380A and Cu375.

A prospective interventional study of intra-caesarean copper intrauterine contraceptive devices insertion in a teaching hospital in a rural medical college in Telangana, India

Background: Providing quality contraceptive services to women is essential for achieving maternal and child health. Objective of this study was to evaluate the efficacy of intra-caesarean insertion of copper IUCDs as postpartum contraception. To study the side effects of intra caesarean copper device. To study the continuation rates of intra-caesarean copper IUCDs. To study the acceptability of intra-caesarean copper IUCD as immediate postpartum contraceptive.Methods: The prospective study was undertaken at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana, between January 2016 and March 2018 after ethical committee clearance. About 60 pregnant women were enrolled into the study after an informed written consent regarding the procedure, benefits and complications and the need for follow up for at least one year. Copper T 380A/multiload copper 375 was inserted into the uterine cavity after delivery of the placenta and membranes during caesarean section. Patients were followed up at 6 weeks, 6 months and one-year intervals for any complaints, visibility of threads and for ultrasound examination for position of copper IUCDs in the uterus. Data analysis was done using Microsoft excel 2016.Results: Nearly 48.33% continued intra-caesarean copper IUCDs for more than 1 year. 70% did not have any complaints. 86.67% came for more than one follow-up visit. 47% had copper IUD threads visible by one year. No case of perforation either during insertion or during continuation was noted. None conceived with copper IUCD in situ. Removal of copper IUCD was also easy and none required hysteroscopic removal.Conclusions: Intra-caesarean copper IUCD insertion is a safe and effective long acting reversible contraceptive method in the postpartum period.

Postpartum Implanon/Nexplanon continuation rates and associated factors among women who ever used Implanon/Nexplanon in a tertiary hospital in Accra, Ghana

Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery.

Evaluation of post partum intrauterine contraceptive device versus interval intrauterine contraceptive device insertion

Background: Family planning is important not only for population stabilization, but it has been increasingly recognized as central tool to improve maternal and neonatal health. Aim of current study was to compare interval and post partum intrauterine contraceptive device (IUCD) insertion in terms of effectiveness and safety.Methods: This was a prospective observational cohort study, done in the department of Obstetrics and Gynecology, GMERS Medical College, Sola, Ahmedabad, from August 2015 to April 2017 was taken for evaluation. 80 women in each group who were inserted IUCD after delivery and in the interval period were studied. Outcome was measured by expulsion rate, continuation rate, and incidence of dysfunctional uterine bleeding (DUB), Pelvic inflammatory disease (PID), failure rate and effect on puerperium.Results: Expulsion rate in PPIUCD group was 8.75% while in interval IUCD group it was 1.25%. Continuation rate following Postpartum intrauterine contraceptive device (PPIUCD) and interval IUCD insertion was 86.25% and 95% respectively. Incidence of bleeding per vaginum (menorrhagia) was 7.5% in PPIUCD group while 8.75% in interval IUCD group. There was one case 1.25% of PID in interval IUCD group while no case in PPIUCD was noted. Failure rate was nil in both the group. There was no effect on puerperium following PPIUCD insertion group during present study.Conclusions: PPIUCD is an effective and safe spacing method of contraception as compared to interval IUCD insertion. There is no statistically significant change in incidence of expulsion rate, continuation rate and other complications in both the group.

Intrauterine device insertion during cesarean section in women without prenatal contraception counseling: lessons from a country with high cesarean rates / Inserção de dispositivo intrauterino durante a cesárea em mulheres sem aconselhamento contraceptivo pré-natal: lições de um país com elevada taxa de cesárea

Abstract Objective Themoment of admission for deliverymay be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. Methods This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Results Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Conclusion Two thirds of the women who continued with IUD at 6 months had undergone 2 ormore cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

Resumo Objetivo O momento da admissão para o parto pode ser considerado inapropriado para oferecer o dispositivo intrauterino (DIU) para mulheres sem aconselhamento contraceptivo pré-natal. Entretanto, em países com elevadas taxas de cesáreas e aconselhamento contraceptivo deficiente, essa estratégia pode reduzir o risco de gestações não programadas e cesáreas repetidas. Métodos Estudo de coorte envolvendo 100 mulheres sem aconselhamento contraceptivo pré-natal. A inserção de DIU pós-dequitação foi oferecida após a admissão para o parto e indicação de cesárea. As taxas de continuidade com o DIU, perfuração uterina e endometrite foram avaliadas após 6 semanas e 6 meses, e a proporção de mulheres que continuaram com o DIU após 6 meses foi analisada em relação ao número de cesáreas prévias. Resultados Noventa e sete mulheres completaram o seguimento. A taxa de permanência do DIU foi de 91% em 6 semanas e 83,5% em 6 meses. A taxa de expulsão/ remoção nas primeiras 6 semanas foi não foi diferente daquela observada entre 6 emanas e 6 meses (9 vs 9,1%, respectivamente). Houve dois casos de endometrite (2,1%), e nenhum caso de perfuração uterina. Entre as 81mulheres que permaneceram como DIU após 6 meses, 31% haviam sido submetidas a apenas uma cesárea, em que o DIU foi inserido, 44% a 2, e 25% a 3 ou mais cesáreas. Conclusão Dois terços das mulheres que continuaram com o DIU após 6 meses haviam sido submetidas a 2 ou mais cesáreas. Considerando que oferecer a tentativa de parto vaginal após duas oumais cesáreas prévias é incomum, é possível que a oferta do DIU na admissão para o parto possa reduzir o risco de cesáreas repetidas e de seus riscos associados.

The Impact of Women-Centered Counseling on Intrauterine Contraceptive Device Satisfaction and Continuation

A high-fat diet can cause obesity and type 2 diabetes mellitus. This study aimed to observe the antioxidant compounds ofCordyline terminalis’s leaf extract which have the ability to be in vitro antioxidant and antidiabetic. Phytochemical tests andIC 50 to dpph were carried out in vitro. The study was conducted in vivo using 24 female wistar rats, which were dividedinto 4 groups: control of normal rats, high fat diet in obese rats, extract 100 mg / kg bw and extract 200 mg / kg bw. After30 days of research, blood samples were taken for examination of triglycerides, glucose, and free fatty acids. The resultsshowed that methanol extract contained saponins, steroids, flavonoids, alkaloids and polyphenols. The methanol extract canreduce free radicals with IC50 88.25 ppm. In vivo test results showed that there was a significant differences (p <0.05) in thelevels of TG, glucose and free fatty acids with the treatment of methanol extract (100 mg / kg bw and 200 mg / kg bw)compared to the high fat group. Based on the results of the study, it can be concluded that the methanol extract of andongleaves contained antioxidant compounds that act as antidiabetic in obese wistar rats.

Results of Smoking Cessation Outpatient Treatment and Examination of Long-term Continuation of Smoking Cessation / 日本プライマリ・ケア連合学会誌

Objective: Smoking cessation treatment, which is now covered by insurance, is usually provided on an outpatient basis for approximately 3 months. It should ideally be evaluated not only by the rate of smoking cessation at the end of the treatment, but also by the length of the continuation of smoking cessation. However, as it is difficult to conduct long-term follow-up after the end of smoking cessation treatment, few studies have followed up successful cases of short-term smoking cessation for a long period in Japan.Methods: In this study, we examined the behaviors of nicotine-addicted patients who consulted our smoking cessation clinic, and investigated the current situation of long-term smoking cessation and involved factors.Results: The rate of smoking cessation at the end of the treatment was 71.8%. We found that 61.1%, 54.0%, and 50.6% of patients successfully quit smoking after the end of treatment for one, 2, and 3 years, respectively. However, 41.1% of male patients who succeeded restarted smoking within 6 months after the end of treatment.Conclusion: Additional support for patients who successfully quit smoking at an early stage at one year, or 6 months for males, is required to encourage them to continue to cease smoking.

Absent superior vena cava in tetralogy of fallot

Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.

Effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patients

Background: DOTS has given very good results in terms of cure and satisfaction among tuberculosis patients. But still some failure and relapse cases occur. Hence studies on effectiveness of DOTS are required. The objectives of research were to study the effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patientsMethods: A hospital based prospective follow up observational study was undertaken in the department of general medicine at a tertiary care medical college and hospital. The present study was conducted among the 60 eligible subjects as per the inclusion and exclusion criteria laid down for the present study.Results: 41 were pulmonary cases and 19 were extra pulmonary patients. At the end of intensive phase only 7 cases were sputum positive out of 37 which reduced to three at the end of extended intensive phase of treatment which further reduced to two at the end of two months of continuation phase. But by the end of completion of continuation phase, one case again became sputum positive i.e. failure case making a final tally to three. It was seen that there was significant weight gain over the period of time in both pulmonary and extra pulmonary cases. The cure rate was 78%. One patient died. Two defaulted and three were failure cases.Conclusions: The DOTS was found to be 78% effective in terms of cure rate. Still there is a huge gap of 22% found in the present scenario which needs to be addressed seriously and by all to prevent multi drug resistant tuberculosis.

Application status and prospect of health management model of continuous chronic disease information based on SWOT analysis / 中国实用护理杂志

With the development of the era of big data,Internet plus,a rapidly aging population has put forward higher requirements for health needs,improve the medical service system,medical institutions to promote functional integration and service mode innovation is an important step in the construction of health Chinese, and construction of "hospital community family" chronic disease health information management has increasingly become a focus on the construction of social medical service system concerned. In this paper, through the SWOT model analysis of China's construction of "hospital community family" chronic disease information model of health management advantages and disadvantages, opportunities, challenges and threats, summarizes the current problems, to improve and promote the health management model of chronic disease information provided the strategy for reference.

Practice and Evaluation of Extended Clinical Pharmacy Service in the Secondary Prevention of Stroke / 医药导报

Objective To evaluate the application effect of clinical pharmacy services in the secondary prevention ot stroke.Methods Hospitalized stroke patients were selected in Taihe Hospital from June 2013 to August 2014.The patients meeting the inclusion criteria were paired and sequentially numbered,and randomly divided into observation group (n =100) and control group (n =102).The patients were treated routinely during thc hospitalization.The clinical pharmacists conducted the drug education.The control group implemented the telephone follow-up for guiding compliance behavior one month after discharge.The observation group continued to perform clinical pharmacist-leading service projects.The medication compliance (Morisky scale),systolic blood pressure (SBP),diastolic blood pressure (DBP),glycated hemoglobin (HbA1 C),serum total cholesterol (TC),low density lipoprotein-C (LDL-C) and relapse rate were compared three months,six months and twelve months after the two groups discharged.Results The medication compliance,SBP,DBP,HbA1C,TC,LDL-C and recurrence rate after hospital discharge were no statistically significant (P ＞ 0.05) three months after the two groups discharged,but statistically significant between the two groups (P ＜ 0.05 or P ＜ 0.01) six months and twelvc months after the two groups discharged.Levels of SBP,DBP,HbA1 C,TC and LDL-C in the two groups were both significantly lower than before (P ＜ 0.05 or P ＜ 0.01).The relapse rate of the observation group three months,six months and twelve months after they discharged was 2.00％,5.00％ and 15.00％,respectively,and that of the control group was 2.94％,13.72％ and 28.43％,respectively.Conclusion The pharmacy services in the secondary prevention of stroke can improve the patient medication compliance and better control the blood pressure,blood glucose and blood lipid lcvcls,and reduce the relapse rate.It should be recommended in the clinical practice work.

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia / Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento

Background: Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective: The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods: In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion: Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse...

Contexto: A eletroconvulsoterapia (ECT) tem mostrado ser um tratamento seguro e eficaz para esquizofrenia. No entanto, o número de estudos que avaliam a utilização contínua de ECT em pacientes com esquizofrenia e a resposta parcial ao tratamento farmacológico é limitado. Objetivo: O objetivo deste estudo é avaliar a eficácia da ECT de continuação na prevenção de recaída em pacientes com esquizofrenia resistente ao tratamento. Métodos: Nesta análise retrospectiva, pacientes com esquizofrenia (n = 73) foram alocados em três grupos: pacientes que receberam apenas o tratamento AP (somente AP), pacientes que receberam um curso agudo de ECT durante a hospitalização (aECT+AP) e pacientes que receberam um curso agudo de ECT durante a hospitalização e ECT de continuação (a-cECT+AP). Esses três grupos foram comparados de acordo com a pontuação atribuída na Positive and Negative Syndrome Scale (PANSS) e na Brief Psychiatric Rating Scale (BPRS). Resultados: De acordo com a comparação dos grupos, somente em AP, aECT+AP e a+cECT+AP, em termos de PANSS e BPRS, após descarga no primeiro, terceiro e sexto mês, as pontuações na PANSS no terceiro e sexto mês no grupo a+cECT+AP foram estatística e significativamente menores do que nos outros dois grupos. Conclusões: Embora este estudo mostre limitações causadas pela análise retrospectiva de prontuários, os resultados sugerem que a continuação da ECT em combinação com antipsicóticos é mais eficaz do que somente os antipsicóticos, na prevenção da recaída em pacientes com diagnóstico de esquizofrenia que responderam ao curso agudo de ECT...

Street children in Colombo: What brings them to and sustains them on the streets.

Introduction: Street children are a vulnerable group and a social problem. Weaning them off the streets requires an understanding of push/pull factors related to street life. Objectives: To describe factors associated with initiation and continuation of street life among street children in Colombo city. Methods: A descriptive cross sectional study of mixed methods was conducted in Colombo Fort, Pettah, Slave Island and Maradana areas. Semi-structured interviews (SSIs) were conducted with key informants using a semi-structured questionnaire (SSQ). Focus group discussions were conducted using a moderator’s question guide with street children recruited through referral sampling. SSIs were also conducted with 25 street children, using a SSQ. All children identified through referral sampling were subsequently profiled. Data triangulation was used to validate data. Results: Two hundred and eighty three children, aged 8-18 years, were recruited, 210 (74%) being boys. Representation of minority ethnic groups was comparatively higher. Over 40% of children had been introduced to street life by their own family. Other common mediators included close family relatives, non-relative known contacts and peers. Common reported reasons for initiation of street life were: death / illness / imprisonment of one or both parent/s, extreme poverty, alcohol/substance abuse by fathers and being born in streets. One third of children lived in single-parent families and 42% with non-parent adults but 18% lacked an adult guardian. They had poor educational achievements and no occupational skills. Conclusions: Disadvantaged socio-economic conditions, poor family functioning and family influence have brought children to the streets.

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 1ª parte: tratamento agudo e de continuação do transtorno depressivo maior / World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, part 1: acute and continuation treatment of major depressive disorder

Estas diretrizes práticas para o tratamento biológico de transtornos depressivos unipolares foram desenvolvidas por uma Força-Tarefa internacional da Federação Mundial de Sociedades de Psiquiatria Biológica (WFSBP). O objetivo ao desenvolver tais diretrizes foi rever sistematicamente todas as evidências existentes referentes ao tratamento de transtornos depressivos unipolares e produzir uma série de recomendações práticas com significado clínico e científico, baseadas nas evidências existentes. Têm como objetivo seu uso por todos os médicos que atendam e tratem pacientes com essas afecções. Os dados usados para o desenvolvimento das diretrizes foram extraídos primariamente de várias diretrizes e painéis nacionais de tratamento para transtornos depressivos, bem como de metanálises e revisões sobre a eficácia dos antidepressivos e outras intervenções de tratamento biológico identificadas por uma busca no banco de dados MEDLINE e Cochrane Library. A literatura identificada foi avaliada quanto à força das evidências sobre sua eficácia e, então, categorizada em quatro níveis de evidências (A a D). Esta primeira parte das diretrizes abrange definição, classificação, epidemiologia e evolução dos transtornos depressivos unipolares, bem como tratamento das fases aguda e de manutenção. As diretrizes se referem primariamente ao tratamento biológico (incluindo antidepressivos, outros medicamentos psicofarmacológicos e hormonais, eletroconvulsoterapia, fototerapia, estratégias terapêuticas complementares e novas) de adultos jovens e também, embora em menor grau, de crianças, adolescentes e adultos idosos.

These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of unipolar depressive disorders, as well as the management of the acute and continuation-phase treatment. These guidelines are primarily concerned with the biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.

Sputum examination at 2-months into continuation phase - How much does it contribute to define treatment outcome.

Objective: To assess the usefulness of sputum examination at 2-months into Continuation Phase (CP) to declare treatment outcome. Methodology: It is a retrospective study conducted in one tuberculosis unit, Tiruvallur district of Tamilnadu among smear positive patients treated with Category I and Category II regimens from May, 1999 – December, 2003. Results: Sputum was collected at 2-months into CP from 70% of 1551 Category I and 74% of 292 Category II patients declared cure, failed or treatment completed. Result at 2-months CP was used for giving outcome in 112 (10.3%) of 1088 Category I patients and 37 (17%) of 217 Category II patients. Conclusion: In practice, sputum needs to be collected for 7.8% of the patients with smear positive at the end of Intensive Phase. By doing so, there will be a delay of 1 month for 3.6% of the patients in declaring ‘failure’. By deferring the sputum examination at 2 months into CP, workload of laboratory technicians can be reduced by about 30%.