Ethical assessment of privacy breaches in epidemiological investigations and information disclosure in the internet age: safeguarding identity information for infectious patients

While the Internet has brought convenience and speed to human life, it has also led to frequent privacy violations. In the context of epidemiological investigations and information disclosure regarding confirmed Covid-19 patients, many individuals have utilized the Internet as a means to disseminate information and engage in cyber manhunts, resulting in breaches of privacy for those involved. This phenomenon is particularly prevalent within the realm of the Internet, where the boundaries of privacy invasion become blurred. Various types of privacy infringements, both active and passive negligence, are evident on social networking platforms. The juxtaposition of the virtual world of the Internet with real-life scenarios presents novel challenges in the realm of privacy violations. The Internet era, coupled with the widespread use and integration of big data, has diminished the absolute right to privacy on the Internet. This paper examines the challenge of safeguarding the identity information of infectious patients through the lens of two theoretical frameworks -Kantianism and Utilitarianism- in an effort to address this ethical dilemma.

Aunque Internet ha aportado comodidad y rapidez a la vida humana, también ha dado lugar a frecuentes violaciones de la intimidad. En el contexto de las investigaciones epidemiológicas y la divulgación de información relativa a pacientes confirmados de covid-19, muchas personas han utilizado Internet como medio para difundir información y participar en cibercacerías, lo que ha dado lugar a violaciones en la intimidad de los implicados. Este fenómeno prevalece en el ámbito de Internet, donde los límites de la invasión de la intimidad se vuelven vagos. En las redes sociales, se manifiestan diversos tipos de violaciones de la intimidad, tanto por negligencia activa como pasiva. La yuxtaposición entre el mundo virtual de Internet con escenarios de la vida real plantea nuevos retos en el ámbito de las violaciones de la intimidad. La era de Internet, junto con el uso generalizado y la integración del bigdata, han mermado el derecho absoluto a la privacidad. Este artículo examina el reto de salvaguardar la información sobre la identidad de los pacientes infecciosos a través de la lente de dos marcos teóricos -el kantianismo y el utilitarismo- en un esfuerzo por abordar este dilema ético.

Enquanto a Internet trouxe conveniência e velocidade à vida humana, ela também levou a frequentes violações da privacidade. No contexto de investigações epidemiológicas e divulgação de informações em relação a pacientes confirmados de Covid-19, muitos indivíduos utilizaram a Internet como um meio para disseminar informação e participar de uma caçada cibernética, resultando em violações da privacidade para aqueles envolvidos. Esse fenômeno é particularmente prevalente no âmbito da Internet, onde os limites de invasão da privacidade se tornaram borrados. Vários tipos de infrações da privacidade, tanto negligências ativa como passiva, são evidentes em plataformas de redes sociais. A justaposição do mundo virtual da Internet com cenários da vida real apresenta novos desafios no âmbito das violações da privacidade. A era da Internet, juntamente com o amplo uso e integração de megadados (big data), diminuiu o direito absoluto à privacidade na Internet. Esse artigo examina o desafio de proteger a informação de identidade de pacientes infectantes através das lentes de dois enquadres teóricos -Kantianismo e Utilitarismo- em um esforço para abordar esse dilema ético.

Relação enfermeiro-pessoa afetada pela Tuberculose fundamentada na teoria do alcance de metas de imogene king / La relación enfermería-Persona afectada por la Tuberculosis, según la Teoría del logro de objetivos de imogene king / The nurse-tuberculosis patient relationship according to Imogene King's theory of goal achievement

Resumo Introdução: As ações desenvolvidas na Atenção Primária à Saúde são um dos pontos fortes de combate à tuberculose. Nesse nível de atenção, o contato contínuo do enfermeiro por meio da consulta de enfermagem permite manter relação com a população adoecida. Diante da relação enfermeiro-pessoa cuidada para o estabelecimento do vínculo e adesão ao tratamento contra tuberculose, compreende-se a importância do referencial teórico de Imogene King para estruturar a interação enfermeiro-pessoa cuidada e oferecer uma dinâmica para esse processo. Objetivo: Analisar a relação enfermeiro-pessoa afetada pela tuberculose fundamentada na Teoria do Alcance de Metas de Imogene King. Método: Estudo descritivo com abordagem qualitativa, com 14 enfermeiros da APS, selecionadas por conveniência. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de entrevista semiestruturada, elaborada com base no Registro Meta-Orientado de Enfermagem de Imogene King. Os dados foram analisados de forme qualitativa pelo Software IRAMUTEQ. A pesquisa foi aprovada pelo Comitê de Ética. Resultados: Após a análise, emergiram quatro classes: 1) relação estabelecida com base no acolhimento; 2) relação enfermeiro-pessoa com tuberculose e o apoio de outros profissionais e familiares; 3) relação estabelecida com vistas ao cumprimento do tratamento; e 4) relação estabelecida para enfrentamento do preconceito diante da tuberculose. Conclusão: O acolhimento, a família e o vínculo entre profissional, paciente e equipe da Atenção Primária à Saúde fortalecem o enfrentamento da doença e reforçam a adesão ao tratamento medicamentoso.

Resumen Introducción: Uno de los puntos fuertes de la lucha contra la tuberculosis son las acciones desarrolladas en la atención primaria de salud. En este nivel asistencial, el contacto continuo de las enfermerías a través de la consulta de enfermería permite mantener una relación con la población enferma. Frente a la relación enfermería-persona para el establecimiento del vínculo y la adherencia al tratamiento contra la tuberculosis, se entiende la importancia del referente teórico de Imogene King para estructurar la interacción enfermería-persona y ofrecer una dinámica para este proceso. Objetivo: Análisis de la relación entre el personal de enfermería y las personas afectadas por la tuberculosis, a partir de la teoría del logro de objetivos de Imogene King. Método: Estudio descriptivo con abordaje cualitativo, con 14 enfermeras de atención primaria de salud, seleccionadas por conveniencia. La recolección de datos ocurrió de agosto a noviembre de 2018, a través de una entrevista semiestructurada, elaborada con base en el registro meta-orientado de enfermería de Imogene King. Los datos fueron analizados cualitativamente utilizando el software IRAMUTEQ. La investigación fue aprobada por el Comité de Ética. Resultados: Después del análisis, surgieron cuatro clases: 1) relación establecida con base en la recepción, 2) relación enfermería-persona con tuberculosis y apoyo de otras personas profesionales y familiares, 3) relación establecida con miras al cumplimiento del tratamiento y 4) relación establecida para combatir los prejuicios contra la tuberculosis. Conclusión: La acogida, la familia y el vínculo entre profesional, paciente y equipo de atención primaria de salud fortalecen el afrontamiento de la enfermedad y refuerzan la adherencia al tratamiento farmacológico.

Abstract Introduction: One of the main aspects in the fight against tuberculosis are the actions developed in Primary Health Care (PHC). At this level of care, the nurse's continuous contact through the nursing consultation allows them to maintain a relationship with the sick population. Regarding the nurse-patient relationship for establishing a bond and the compliance with tuberculosis treatment, we understand the importance of Imogene King's theoretical framework for structuring the nurse-patient interaction and offering a dynamic for this process. Objective: To analyze the nurse-tuberculosis patient relationship based on Imogene King's Theory of Goal Achievement. Method: A descriptive study with a qualitative approach, with 14 PHC nurses, selected by convenience. Data were collected from August to November 2018 through semi-structured interviews based on Imogene King's Meta-Oriented Nursing Record. The data were analyzed qualitatively using the IRAMUTEQ software. The research was approved by the Ethics Committee. Results: After the analysis, four classes emerged: 1) relationship established on the basis of welcoming; 2) nurse-tuberculosis patient relationship and the support of other professionals and family members; 3) relationship established towards treatment compliance; and 4) relationship established to confront prejudice associated with tuberculosis. Conclusion: The welcoming, the family, and the bond between the professional, the patient and Primary Health Care team strengthen the coping with the disease and reinforce the compliance with the pharmacological treatment.

Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review / Reposicionamiento de pacientes en hospitalización y prevención de úlceras por presión: una revisión narrativa / Reposicionamento de pacientes na internação e prevenção de úlceras por pressão: uma revisão narrativa

Objective. This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods. Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results. Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion.The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.

Objetivo. Este artículo presenta una revisión de la literatura con el objetivo de explorar y analizar la situación actual de las úlceras o lesiones por presión o úlceras por decúbito, aspectos fisiopatológicos, epidemiológicos, y factores de riesgo. Se evalúa además el progreso en la evidencia de la eficacia del reposicionamiento preventivo en la aparición de estas lesiones en pacientes vulnerables hospitalizados. Métodos. Se revisaron bases de datos de forma no sistemática, incluyendo The Cochrane Wounds Specialised Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, Scielo, y Lilacs. Los términos de búsqueda generales incluyeron [úlceras por presión o lesiones por presión o úlceras por decúbito] y [prevención o preventivo] y [reposicionamiento o posicionamiento o cambios de posición o cambio postural] y [paciente en riesgo o vulnerable] y [hospitalizado o UCI o cuidados intensivos]. Se incluyeron revisiones sistemáticas de la literatura, ensayos clínicos aleatorizados, estudios observacionales, estudios de costo-efectividad y cualitativos en idioma inglés o español. Resultados. Aunque globalmente la incidencia, prevalencia y años de incapacidad asociado a estas lesiones ha disminuido entre 1990 y 2019, el impacto en salud persiste de forma elevada. La evidencia encontrada sobre la eficacia del reposicionamiento en prevención de úlceras por presión y costos asociados en salud ha sido evaluada con certeza entre baja y muy baja, como resultado de la realización de investigaciones con serias limitaciones metodológicas que reportan resultados con alta imprecisión. Conclusión.Los hallazgos reportados presentan que estas lesiones persisten a nivel hospitalario y continúan siendo un problema social y de salud mundial con alto impacto en los presupuestos en salud. Así mismo se presenta la necesidad de desarrollar mayor investigación de calidad en estrategias preventivas como el reposicionamiento, que validen su eficacia, y justifiquen su utilización.

Objetivo. Este artigo apresenta uma revisão da literatura com o objetivo de explorar e analisar a situação atual das úlceras por pressão ou úlceras de decúbito, os aspectos fisiopatológicos e epidemiológicos e os fatores de risco. Também avalia o progresso na evidência da eficácia do reposicionamento preventivo no desenvolvimento dessas lesões em pacientes hospitalizados vulneráveis. Métodos.Foram revisados bancos de dados não específicos do local, incluindo The Cochrane Wounds Specialised Register; Medline, Scopus, PubMed, Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, Scielo e Lilacs. Os termos gerais de pesquisa incluíram [úlceras de pressão ou lesões por pressão ou úlceras de pressão ou úlceras de decúbito] e [prevenção ou preventivo] e [reposicionamento ou posicionamento ou mudanças de posição ou mudança postural] e [paciente em risco ou vulnerável] e [hospitalizado ou UTI ou terapia intensiva]. Foram incluídas revisões sistemáticas da literatura, ensaios clínicos randomizados, estudos observacionais, estudos de custo-efetividade e qualitativos em inglês ou espanhol. Resultados. Embora, em geral, a incidência, a prevalência e os anos de incapacidade associados a essas lesões tenham diminuído entre 1990 e 2019, o impacto na saúde continua alto. As evidências encontradas sobre a eficácia do reposicionamento na prevenção de úlceras por pressão e os custos de saúde associados foram avaliadas com certeza baixa a muito baixa, como resultado de pesquisas com sérias limitações metodológicas que relataram resultados altamente imprecisos. Conclusão. Os resultados relatados mostram que essas lesões persistem em nível hospitalar e continuam a ser um problema social e de saúde global com alto impacto nos orçamentos de saúde. Também há necessidade de mais pesquisas de qualidade sobre estratégias preventivas, como o reposicionamento, para validar sua eficácia e justificar seu uso.

Intervención educativa para perfeccionar la ejecución del Programa de Detección Precoz del Cáncer Bucal

Introducción: las lesiones premalignas y malignas del complejo bucal se incrementan en la población, lo que demanda una correcta ejecución del Programa de Detección Precoz del Cáncer Bucal (PDCB). En el trabajo se exponen las transformaciones en el nivel de conocimientos de pacientes y estomatólogos acerca de las afecciones concernientes al PDCB para perfeccionar su ejecución. Método: se realizó una intervención educativa en el área de salud Julio Antonio Mella del municipio Camagüey desde mayo de 2022 hasta junio de 2023, con la participación de 36 pacientes y 30 estomatólogos. Las fuentes de información fueron la historia clínica, un cuestionario y una prueba de entrada y salida, aplicados a pacientes y estomatólogos respectivamente, antes y después de la intervención; para constatar las transformaciones. Resultados: antes de la intervención los pacientes estaban mal informados sobre las consecuencias nocivas de hábitos tóxicos, higiénicos y dietéticos, así como desconocimiento de la importancia del correcto autoexamen bucal; los que alcanzaron en su mayoría un alto nivel de conocimientos con la intervención. Los estomatólogos mejoraron sus conocimientos sobre diagnóstico y seguimiento de lesiones pre malignas y malignas del complejo maxilofacial. Discusión: la adecuada ejecución del PDCB descansa tanto en pacientes como en estomatólogos y aunque las investigaciones se enfocan a los primeros por los beneficios reportados; la superación de posgrado constituye una vía para sistematizar conocimientos y fortalecer competencias profesionales que impacten de manera positiva en el PDCB. La intervención educativa se considera satisfactoria al elevar el nivel de conocimientos de pacientes y estomatólogos, lo que demuestra sus potencialidades para perfeccionar la ejecución del PDCB.

Introduction: premalignant and malignant lesions of de oral area increase in the population which demands a correct implementation of the Early Detection of Oral Cancer Program. In this work transformations are exposed knowledge level of both patients and dentists regarding lesions concerning the Early Detection of Oral Cancer Program (EDOCP). Method: educational intervention was carried out in Julio Antonio Mella health area of Camaguey municipality from May 2022 to June 2023 which 36 patients and 30 Deontologists. Information sources were the Clinical History, a questionnaire and a test applied to patients and Deontologists respectively, before and after the intervention, to confirm the transformations in the sample. Results: Prior to intervention patients were poorly informed about consequences of toxic, hygienic and dietetic habits combined with lack of knowledge regarding importance of a correct oral self-examination whose knowledge improved to reach a high level in most of them after the intervention. Deontologists improved their knowledge on diagnosis and follow-up of premalignant and malignant lesions affecting the maxillofacial complex. Discussion: correct application of the EDOCP depends on both patients and deontologists, however reserchers focus on the former due to the reported benefits; the postgraduate training is a way to systematize knowledge and strengthen professional competences with positive impact on EDOCP. The educational intervention was satisfactory since it improved the level of knowledge of both patients and dentists which shows its potential on a correct implementation of the Early Detection of Oral Cancer Program.

Actividades psicoterapéuticas dirigidas a la atención hospitalaria de los pacientes pediátricos oncológicos

El cáncer es una de las causas de muerte más habitual por enfermedad en menores. Debido a los grandes avances en la investigación médica y los tratamientos, una gran tasa de niños la supera, de ahí que la promoción, prevención y tratamiento constituye un reto necesario a asumir a partir del análisis de sus dimensiones. El objetivo del trabajo es diseñar un sistema de actividades psicoterapéuticas para el perfeccionamiento de la atención a los pacientes oncológicos en el Hospital Provincial Pediátrico de Camagüey. La metodología empleada fue la cuanticualitativa (análisis de documentos, entrevista, encuestas, observación, entre otros). Se fundamentan teóricamente los elementos conceptuales, se exponen los asuntos psicosociales y didácticos de su diseño, así como la valoración por especialistas. Los resultados introducidos en la práctica desde la Sala de Oncología fueron apreciados favorablemente por los pacientes y familiares en 10 sesiones que incluyeron temas como la autoestima y asertividad.

Cancer is one of the most common causes of death due to illness in children. Due to the great advances in medical research and treatments, a large percentage of children overcome it, hence promotion, prevention and treatment constitute a necessary challenge to assume based on the analysis of its dimensions. The objective of the work is to design a system of psychconapeutic activities to improve care for oncological patients at the Provincial Pediatric Hospital of Camagüey. The methodology used was quantitative (document analysis, interview, surveys, observation, among cons). The conceptual elements are theoretically based, the psychosocial and didactic issues of its design are exposed, as well as the assessment by specialists. The results introduced into practice from the Oncology Ward were favorably appreciated by patients and family members in 10 sessions that included topics such as self-esteem and assertiveness.

Influence of reminiscence therapy on mental health and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer

Reminiscence therapy (RT) attenuates psychological disorders in cancer patients. This study aimed to evaluate the effect of RT on anxiety, depression, spiritual well-being, and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer. A total of 222 elderly patients with unresectable, metastatic gastrointestinal cancer were randomized into RT group (RT plus usual care, n=112) or control group (usual care, n=110) with a 6-month intervention. Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), and Quality of Life Questionnaire-Core 30 (QLQ-C30) were evaluated at month (M)0, M1, M3, and M6. Concerning the primary outcome, HADS-A score at M6 decreased in the RT group compared to the control group (P=0.005). As to secondary outcomes, the RT group showed decreased HADS-A scores at M3, anxiety rate at M3, HADS-D scores at M3 and M6, depression rate at M6, as well as greater FACIT-Sp scores at M1, M3, and M6 vs the control group (all P<0.050). Additionally, QLQ-C30 global health score was elevated at M1 (P=0.046) and M6 (P=0.005), functions score was greater at M6 (P=0.038), and symptoms score was lower at M3 (P=0.019) in the RT group than in the control group. Subgroup analysis revealed that the addition of RT was more effective for patients with anxiety or depression at baseline. In summary, RT alleviated anxiety and depression, and improved the spiritual well-being and quality of life within 6 months in elderly patients with unresectable, metastatic gastrointestinal cancer.

Prevalence and reasons for referrals to the Endodontics Specialty Clinic at the Piracicaba Dental School

Abstract Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients' electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis.

Sedentary behavior, abdominal obesity and healthcare costs in Brazilian adults with cardiovascular diseases: a cross-sectional study

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

Representações sociais do cuidador familiar sobre cuidados paliativos em paciente terminal / Social representations of the family caregiver about palliative care in terminal patient / Representaciones sociales del cuidador familiar sobre cuidados paliativos en pacientes terminales

Objetivo: analisar as representações sociais dos cuidadores familiares sobre os cuidados paliativos em paciente terminal. Método: estudo descritivo com abordagem qualitativa. Para a interpretação dos resultados foi empregado como aporte teórico a Teoria das Representações Sociais. A pesquisa foi realizada com 30 cuidadores familiares de pacientes com câncer em estágio final. Resultado: observou-se a dimensão do cuidador familiar e o meio inserido das representações sociais. O cuidador não é um mero familiar, mas sim alguém que sofre junto com o doente, principalmente, os que estão com câncer em fase terminal, e por isso também precisa de orientações para seus cuidados físico e emocional. Discussão: A teoria das representações sociais, vinculada a área da saúde do cuidador familiar. Considerações finais: As representações sociais do cuidador familiar possibilitaram identificar a verdadeira extensão das questões diárias no cotidiano profissional

Objective: to analyze the social representations of family caregivers about palliative care in terminally ill patients. Method: descriptive study with a qualitative approach. For the interpretation of the results, the Theory of Social Representations was used as a theoretical contribution. The research was conducted with 30 family caregivers of end-stage cancer patients. Result: the dimension of the family caregiver and the inserted environment of the social representations were observed. The caregiver is not a mere family member, but someone who suffers together with the patient, especially those with terminal cancer, and therefore also needs guidance for their physical and emotional care. Discussion: the theory of social representations, linked to the area of family caregiver health. Final considerations:The social representations of the family caregiver made it possible to identify the true extent of daily issues in the professional routine

Objetivos: analizar las representaciones sociales de los cuidadores familiares sobre los cuidados paliativos en pacientes terminales. Método: estudio descriptivo con enfoque cualitativo. Para la interpretación de los resultados se utilizó como aporte teórico la Teoría de las Representaciones Sociales. La investigación se llevó a cabo con 30 cuidadores familiares de pacientes con cáncer en etapa terminal. Resultado: se observó la dimensión del cuidador familiar y el ambiente inserto de las representaciones sociales. El cuidador no es un simple miembro de la familia, sino alguien que sufre junto con el paciente, especialmente aquellos con cáncer terminal, y por lo tanto también necesita orientación para su cuidado físico y emocional. Discusión: La teoría de las representaciones sociales, vinculada al área de la salud del cuidador familiar. Consideraciones finales: las representaciones sociales del cuidador familiar permitieron identificar la verdadera extensión de las cuestiones cotidianas en el cotidiano profesional

Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Dietary total antioxidant capacity, cardiovascular risk, and anthropometric obesity indices in hemodialysis patients: A case-control study / Capacidade antioxidante total da dieta, risco cardiovascular e índices antropométricos de obesidade em pacientes em hemodiálise: um estudo de caso-controle

ABSTRACT Objective: Oxidative stress is triggered by malnutrition and antioxidant losses due to dialysis in hemodialysis patients and thus, oxidative stress increases the risk of mortality in patients with cardiovascular disease and obesity. The study aims to determine differences in cardiovascular risk scores and obesity indices between hemodialysis and control groups and to examine the relationship between the tertiles of dietary total antioxidant capacity with cardiovascular risk, and obesity in hemodialysis and control groups. Methods: This is a cross-sectional case-control study involving hemodialysis patients (n=46) and healthy individuals (n=46). Participants' general characteristics were obtained via a questionnaire, and the Framingham Risk Score was calculated. The dietary total antioxidant capacity was calculated using two methods based on a seven-day food record. Obesity indices, such as Basal Metabolism Index and Body Shape Index, were calculated using anthropometric measurements. Results: The mean age of the participants was 51.1±10.4 years. In the hemodialysis group, obesity indices including body weight, Basal Metabolism Index, waist circumference, fat mass index, and fat-free mass index were lower, while Framingham Risk Score values ​​were higher than the control group (p<0.05). Energy-adjusted dietary total antioksidant capacity values were lower ​​in hemodialysis group, and most patients were in the low tertiles of Trolox equivalent antioxidant capacity, total radical-trapping antioxidant parameter, ferric reducing-antioxidant power and vitamin C equivalent antioxidant capacity (p<0.05). Conclusion: Providing hemodialysis patients with a healthy diet can increase the dietary total antioxidant capacity, and potentially reduce cardiovascular risk, and obesity indices.

RESUMO Objetivo: O estresse oxidativo é desencadeado pela desnutrição e perdas de antioxidantes devido à diálise em pacientes em hemodiálise, portanto, o estresse oxidativo aumenta o risco de mortalidade em pacientes com doenças cardiovasculares e obesidade. O estudo visa determinar as diferenças nos escores de risco cardiovascular e índices de obesidade entre os grupos de hemodiálise e controle, bem como examinar a relação entre os tercis da capacidade antioxidante total da dieta e o risco cardiovascular e obesidade nos grupos de hemodiálise e controle. Métodos: Este é um estudo transversal de caso-controle envolvendo pacientes em hemodiálise (n=46) e indivíduos saudáveis (n=46). As características gerais dos participantes foram obtidas por meio de um questionário, e o Escore de Risco de Framingham foi calculado. A capacidade antioxidante total da dieta foi calculada utilizando dois métodos baseados em um registro alimentar de sete dias. Índices de obesidade como o Índice de Metabolismo Basal e o Índice de Forma Corporal, foram calculados por meio de medidas antropométricas. Resultados: A média de idade dos participantes foi de 51.1±10.4 anos. No grupo de hemodiálise, os índices de obesidade, incluindo peso corporal, Índice de Metabolismo Basal, circunferência da cintura, índice de massa gorda e índice de massa livre de gordura, foram menores, enquanto os valores do Escore de Risco de Framingham foram maiores do que no grupo controle (p<0.05). Os valores de dTAC ajustados pela energia foram menores no grupo de foram hemodiálise, e a maioria dos pacientes estava nos tercis mais baixos de Capacidade antioxidante equivalente ao Trolox, parâmetro antioxidante total de captura de radicais, poder antioxidante redutor férrico e capacidade antioxidante equivalente à vitamina C (p <0.05). Conclusão: Fornecer aos pacientes em hemodiálise uma dieta saudável pode aumentar a capacidade antioxidante total da dieta, reduzindo potencialmente o risco cardiovascular e os índices de obesidade.

Magnitude and factors associated with catheter associated urinary tract infection, and antimicrobial susceptibility profile at Hawassa, Sidama Regional State, Ethiopia: A prospective cross-sectional study

Introduction: The use of urinary catheter benefit patients who are unable to urinate for various medical rea-sons. Despite its use, a urinary catheter during its application may introduce bacteria to the urinary tract and result in Urinary tract infection (UTI). Even though the burden of catheter-associated UTI is expected to be high in resource-limited countries, there is limited data. The aim of this study was to determine the magnitude of culture-confirmed catheter-associated urinary tract infection (CAUTI), associated factors, and antimicrobial sus-acceptability profiles of bacteria. Methods: This prospective cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital (HUCSH), Sidama region, from May-August 2022. One hundred forty-nine catheterized patients at HUCSH were included. Socio-demographic, clinical, and laboratory data were collected using structured questionnaire. Urine specimens were cultured on blood and MacConkey agar. Culture-confirmed catheter-associated urinary tract infection was established if >1 X 105colonies of bacteria per milliliters of urine was detected. The disc diffusion method was used for antimicrobial susceptibility testing. For data analysis, SPSS version 26 was used. Factors associated with culture confirmed CAUTI were assessed using binary logistic regression. Results: The magnitude of culture confirmed CAUTI was 30.2% (n=45; 95% CI=22.8−37.6). The most common bacterial isolates were Escherichia coli (n=12; 26.7%), followed by Klebsiella species (n=10; 22.2%), and Staphylococcus aureus (n=6; 13.3%). Duration of catheterization (AOR=9.6, 95% CI=3.8−24.2) and comorbidities (AOR=4.1, 95% CI=1.7−9.8) were significantly associated with culture-confirmed CAUTI. Most Gram-neg-active bacteria were resistant to commonly prescribed antimicrobial agents. Conclusions:The magnitude of culture-confirmed CAUTI at HUCSH was high.E.coli was the leading bacteria and most of them were resistant to various types of antimicrobial agents. Duration of catheterization and comorbidities were significantly associated with culture-confirmed CAUTI

Predominant amino acid substitutions in NS5B gene of hepatitis C virus in blood donors and treatment-naïve hepatitis and HIV patients in Nigeria

Background: Hepatitis C virus (HCV) genome undergoes high rate of mutation, which results in generation of genetically diverse HCV isolates. There is paucity of data on mutations in the nonstructural 5b (NS5b) gene of circulating HCV and their implications in the Nigerian population. Here, we identified clinically-important mutations in HCV isolates, which may influence response to therapy and disease prognosis. Methodology: HCV RNA was extracted from a total of 301 blood samples collected from 99 symptomatic treatment-naïve hepatitis patients, 125 HIV-infected individuals and 77 asymptomatic blood donors in Ibadan, Nigeria. The RNA was reverse­transcribed to complimentary DNA and HCV NS5B gene amplified by nested PCR. The amplified products of 42 HCV were sequenced and sequences were aligned with those from GenBank and HCV databases in MEGA 7.0. Nucleotide sequences were translated to amino acids while substitutions in the amino acids were analyzed with reference to H77 prototype strain of HCV. Results: A total of 10 amino acid polymorphisms were observed from the 42 sequenced NS5B gene, with the major clinically-important amino acid mutations being S15G in 28 (66.7%) participants, T7N (24, 57.1%), G61R (23, 54.8%), S54L (22, 52.4%), G89E (14, 33.3%), T79M (12, 28.6%), and T711 (11, 26.2%). Others were Q67R (7, 16.7%), Q47H (7, 16.7%) and S84F (2, 4.8%). S15G/A/V mutations were more predominant in patients with HIV (76.9%, 10/13) followed by patients with clinical hepatitis (75.0%, 12/16) and blood donors (46.1%, 6/13). Q67R and T71I mutations were not predominant in patients with clinical hepatitis as they were detected in only 31.3% (5/16) and 43.8% (7/16) participants respectively, compared to S15G (75.0%, 12/16), S54L (68.8%, 11/16), G61R/E (68.8%, 11/16) and T7N/S (56.3%, 9/16). There was no statistically significant difference in the distribution of each of the 10 amino acid polymorphisms detected within patients with symptomatic clinical hepatitis (x 2=9.311, p=0.409), HIV-infected patients (x 2=13.431, p=0.1440) and asymptomatic blood donors (x 2=3.775, p=0.9256). Similarly, there was no significant difference in the distribution between the 3 categories of the study participants except for T79M mutation, which was significantly higher in HIV-infected patients (61.5%, 8/13) compared to patients with clinical hepatitis (18.8%, 3/16) and asymptomatic blood donors (7.7%, 1/13) (x 2=10.456, p=0.0054). Conclusion: Mutations in the NS5B gene could be associated with worse prognosis of the disease or antiviral failure due to viral resistance in patients undergoing therapy. The absence of Q47H mutations in majority of the study participants in our study implies that they will not respond well to daprevir and mericitabine. Screening of patients for pre-existing resistant mutations before commencement of therapy and monitoring during and after therapy are recommended.

Meta-analysis of efficacy and safety of sedative therapy with midazolam and dexmedetomidine/propofol in critically ill patients undergoing mechanical ventilation / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of midazolam and dexmedetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， Embase， Web of Science， Cochrane Library， Clinical trials. gov， China Journal Full Text Database， Chinese Science and Technology Journal Database， Wanfang database and China Biomedical Literature Database， the data on the efficacy and safety of midazolam and dexmetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation were collected from the establishment of the database to March 31， 2023. After extracting data from clinical studies that met the inclusion criteria， the meta-analysis was conducted by using the RevMan 5.3 statistical software. RESULTS A total of 31 literature were included， with a total of 2 765 patients. Results of meta-analysis showed that the mechanical ventilation time [MD＝14.13， 95%CI （13.75， 14.52）， P＜0.000 01] and the length of hospitalization in the intensive care unit [MD＝0.92， 95%CI （0.54， 1.30）， P＜0.000 01] of patients in the midazolam group was longer than dexmedetomidine/ propofol group. The incidence of bradycardia in midazolam group was lower dexmedetomidine/propofol group [OR＝0.60， 95%CI （0.41， 0.90）， P＝0.01]， but there was no statistically significant difference in the incidence of hypotension between the two groups [OR＝0.69， 95%CI （0.47， 1.01）， P＝0.06]. The incidence of delirium [OR＝3.88， 95%CI （2.74， 5.49）， P＜0.000 01]， ventilator- associated pneumonia [OR＝2.32， 95%CI （1.19， 4.51）， P＝0.01]， and respiratory depression [OR＝5.70， 95%CI （3.09， 10.52）， P＜0.000 01] in midazolam group were higher than dexmedetomidine/propofol group. CONCLUSIONS Compared with dexmedetomidine/propofol， midazolam increases patients’ mechanical ventilation time and the length of hospitalization in the intensive care unit in terms of efficacy， and increases the risk of delirium and pulmonary complications in terms of safety， but has a smaller cardiovascular impact.

Primary drug resistance among HIV-1 patients in Hubei Province in 2020-2022 / 公共卫生与预防医学

Objective To investigate the prevalence of primary drug resistance among HIV-1 patients in Hubei Province from 2020 to 2022, and to provide corresponding basis and data support for HIV antiviral therapy (ART) in Hubei Province. Methods During 2020-2022, plasma samples of HIV-1 infected patients before ART were collected., Patients’ demographic data and baseline laboratory test data were also collected. HIV-1 pol region was amplified by in-house method for sub-type typing and drug-resistant mutation site analysis. Results The pol gene sequence was successfully amplified in 242 of 285 cases, with a success rate of 84.9%. CRF07_BC was the predominant HIV-1 sub-type, accounting for 47.11% (114/242), followed by CRF01_AE, accounting for 25.21% (61/242), sub-type B, accounting for 14.16% (35/242), and CRF55_01B, accounting for 4.13% (10/242). The primary resistance rate was 6.20% (15/242). The mutation site of nucleoside reverse transcriptase inhibitors (NRTIs) was mainly M184V, and the mutation sites of non-nucleoside reverse transcriptase inhibitors (NNRTIs) were mainly E138A/G/EG and V179E. These different mutation sites led to different degrees of drug resistance to 12 drugs. The incidence of drug resistance mutation of CRF55_01B sub-type was significantly higher than that of other sub-types. Conclusion The primary drug resistance rate of HIV-1 infected patients is at a slightly high level in Hubei Province, and close monitoring of primary drug resistance and mutation sites should be strengthened before ART, especially for CRF55_01B sub-type.

Meta-analysis of the efficacy of invisible orthodontic appliances for maxillary molar distalization in adult patients / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.@*Methods@#Web of Science, Cochrane Library, Embase, PubMed, Wanfang Database, CNKI Database, and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1, 2023. A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.@*Results@#This study included 13 pre- and postcontrol trials with a total sample size of 281 patients. The meta-analysis revealed no significant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment (P>0.05). The displacement of the first molar was MD=-2.34, 95% CI (-2.83, -1.85); the displacement was MD=-0.95, 95% CI (-1.34, -0.56); and the inclination was MD=-2.51, 95% CI (-3.56, -1.46). There was a statistically significant difference in the change in sagittal, vertical, and axial tilt of the first molar before and after treatment. After treatment, the average adduction distance of the incisors was MD=-0.82, 95% CI (-1.54, -0.09), and the decrease in lip inclination was MD=-1.61, 95% CI (-2.86, -0.36); these values were significantly different from those before treatment (P<0.05).@*Conclusion@#Invisible orthodontic appliances can effectively move the upper molars in a distal direction and control the vertical position of the molars. When the molars move further away, there is some degree of compression and distal tilt movement, which is beneficial for patients with high angles. The sagittal movement of incisors is beneficial for improving the patient's profile.

Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture / 中国临床药理学与治疗学

AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg

Testing cancer patients for HIV: Just do it

@#Who do we test for HIV? In a perfect world, the answer to this question is, “Everyone.” The United States Centers for Disease Control and Prevention (CDC) recommends that anyone between the age of 13 to 64 years old should have at least one HIV test as part of routine healthcare. 1 In addition, they recommend that anyone who comes into contact with the healthcare system be tested, along with all pregnant women. The main justification for these recommendations is that 40% of new HIV infections in the United States are transmitted by people who do not know their HIV status, which is about 10% of their people living with HIV (PLHIV).

Construction of ESER Doctor-patient Communication Model from the Perspective of Cancer Patients / 中国医学伦理学

To construct a simple and two-way interactive doctor-patient communication mode, in order to provide guidance tools for doctor-patient communication, improve the effectiveness of doctor-patient communication for cancer patients, optimize medical experience, reduce doctor-patient disputes, and provide new perspectives and ideas for the study of doctor-patient communication. Literature review and qualitative research were used to construct the index framework of ESER doctor-patient communication model, and Delphi method was used to revise and improve the index content, and evaluate its reliability and validity. The results showed that after two rounds of expert letter consultation, the final ESER doctor-patient communication mode was established, including 4 primary-level indicators, 8 second-level indicators and 40 third-level indicators. The positive coefficient of experts was 100% in both rounds. The authority coefficient of experts was 0.85 in the first round and 0.91 in the second round, indicated a high degree of overall authority. Coefficient of variation (CV) were less than 0.25, and the Kendall’s W coefficient for significant χ2 test, P values were less than 0.05, which was statistically significant. It can be considered that the coordination degree of experts was high; Cronbach’s α coefficients in the first and second rounds of importance evaluation were 0.952 and 0.971, respectively, which indicated that the index framework had good reliability and validity. Based on the needs of cancer patients for doctor-patient communication, build a two-way interactive ESER doctor-patient communication mode, integrate medicine and humanities, which can be used as a guiding tool for medical staff to communicate with cancer patients, so as to enable doctors and patients to achieve mutual trust, cooperation and win-win results.

Social Work Intervention of Stranded Patients from the Ecosystem Perspective: Based on the Clinical Case Record Analysis of Social Work Department in Shanghai D Hospital / 中国医学伦理学

Based on the service of stranded patients in D Hospital, this study aimed to explore the multiple needs of stranded patients and construct an intervention mode from the ecosystem perspective. Using the method of case study, taking the service of stranded patients in hospital D as an example, 49 case records and verbatim interviews with stakeholders were analyzed. The discharge and resettlement of stranded patients faces multiple obstacles from individuals, families, medical and social systems. This study constructed the social work intervention model from the ecosystem perspective: information collection and needs assessment, empowerment of individual system, reconstruction of family support system, coordination of medical system and linking social support system. The intervention process achieved efficient effects. Social work intervention of stranded patients should pay attention to patients’ psychosocial needs and improve awareness of system difficulties; mobilize the multi-system support network and deliver services in combination with case management method; conduct social advocacy for the breakthrough of law and policy.