Research progress of Mendelian randomization in ocular diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Etiological research is necessary for understanding the occurrence and epidemiological patterns of diseases, and is also a prerequisite for the diagnosis, prevention and treatment of clinical diseases. Mendelian randomization(MR), a method of research that combines genetics and epidemiology, has the advantage of exploring the causal relationship between exposure and disease genetically as well as avoiding confounding factors and reverse causation. Thus, it has been extensively utilized in the etiological study of diseases. This paper reviews the implementation of MR in the research of ocular diseases and provides ideas and approaches for the investigation of related mechanisms as well as the development of intervention strategies.

Association between ulcerative colitis and pancreatitis: a Mendelian randomization study / 预防医学

Objective @#To examine the causal relationship between ulcerative colitis (UC) and pancreatitis, to provide basis for early screening of pancreatitis among UC patients.@*Methods@#Genomic data of UC were obtained from 47 745 European individuals pooled by the International Inflammatory Bowel Disease Genetics Consortium, including 156 116 single nucleotide polymorphism (SNP), and genomic data of pancreatitis were obtained from 198 166 European individuals pooled from FinnGen, including 16 380 428 SNPs. Mendelian randomization (MR) analysis was performed using the inverse variance weighted (IVW) method with 72 UC-associated SNPs as instrumental variables and pancreatitis as the study outcome. The heterogeneity was assessed using Cochran Q test, the horizontal pleiotropy was assessed using MR-Egger regression, MR-PRESSO was performed with the exclusion of outliers, and effect of individual SNP on the results was tested with the leave-one-out method. @*Results@#MR analysis results showed that patients with genetically predicted UC had an increased risk of pancreatitis relative to those without UC (OR=1.076, 95%CI: 1.019-1.136, P<0.05). Cochran Q test showed no heterogeneity (P>0.05), and MR-Egger regression did not reveal horizontal pleiotropy of instrumental variables (P>0.05). The MR analysis results were robust after removing SNP one by one.@*Conclusions@#Genetically predicted UC is associated with an increased risk of pancreatitis. The screening for pancreatitis risk should be enhanced in patients with UC.

Application of Mendelian randomization analysis in exploring the etiology of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease （NAFLD） is an abnormal lipid metabolic disorder of the liver characterized by accumulation of a large amount of lipids in the liver， and it is currently the most common liver disease around the world. Mendelian randomization （MR） incorporates genomic data into traditional epidemiological study designs to infer the causal relationship between exposure factors and disease risk. In recent years， MR has been widely used in studies on inference of the etiology of NAFLD. This article systematically summarizes the advances in the application of MR in NAFLD research， so as to provide new ideas for understanding the nature of the disease and scientific interventions.

Theta Oscillations Support Prefrontal-hippocampal Interactions in Sequential Working Memory / 神经科学通报·英文版

The prefrontal cortex and hippocampus may support sequential working memory beyond episodic memory and spatial navigation. This stereoelectroencephalography (SEEG) study investigated how the dorsolateral prefrontal cortex (DLPFC) interacts with the hippocampus in the online processing of sequential information. Twenty patients with epilepsy (eight women, age 27.6 ± 8.2 years) completed a line ordering task with SEEG recordings over the DLPFC and the hippocampus. Participants showed longer thinking times and more recall errors when asked to arrange random lines clockwise (random trials) than to maintain ordered lines (ordered trials) before recalling the orientation of a particular line. First, the ordering-related increase in thinking time and recall error was associated with a transient theta power increase in the hippocampus and a sustained theta power increase in the DLPFC (3-10 Hz). In particular, the hippocampal theta power increase correlated with the memory precision of line orientation. Second, theta phase coherences between the DLPFC and hippocampus were enhanced for ordering, especially for more precisely memorized lines. Third, the theta band DLPFC → hippocampus influence was selectively enhanced for ordering, especially for more precisely memorized lines. This study suggests that theta oscillations may support DLPFC-hippocampal interactions in the online processing of sequential information.

Nexo causal entre trabalho e saúde/doença e o problema das perícias / Causal nexus between work and health/illness and the issue of expert testimonies

Resumo A esfera das perícias comumente reduz a questão do estabelecimento do nexo de causalidade entre trabalho e saúde/doença apenas ao binômio trabalho/vida pessoal. Partindo dos pressupostos dos campos Saúde do Trabalhador (ST) e Saúde Mental Relacionada ao Trabalho (SMRT), este ensaio visa problematizar o resultado da questão, que reside na existência de dificuldades enfrentadas por trabalhadores na obtenção do nexo causal entre seus agravos/adoecimentos, cuja causalidade mais complexa se explica a partir de várias mediações pouco consideradas nos atos periciais circunscritos apenas às anamneses clínicas de cunho biomédicas pautadas nos pressupostos da Medicina do Trabalho, Higiene e Saúde Ocupacional. As formas de superação à ideia de causa-efeito passam pelo entendimento de que o processo de adoecimento é social e histórico e de que é preciso buscar mediações entre trabalho e adoecimento para elucidar sintomatologias singulares a partir da experiência do desgaste coletivo. Tal averiguação deve, ao mesmo tempo, problematizar os próprios processos de trabalho dos atores sociais envolvidos nas investigações periciais e partir das prioridades definidas pelos próprios trabalhadores que atuam como sujeitos da análise da nocividade do trabalho para a saúde.

Abstract Expert testimonies commonly reduce the establishment of causal links between work and health/illness solely to the dichotomy of work/personal life. Based on the assumptions from the fields of Workers Health and Work-Related Mental Health, this essay problematizes the results of this issue, namely the difficulties faced by workers in establishing the causal link between their ailments/illnesses, whose more complex causality is explained through several mediations that are often overlooked by the limited expert acts restricted only to clinical anamneses based on Occupational Medicine, Hygiene, and Occupational Health. Overcoming the idea of cause and effect involves understanding that the process of falling ill is social and historical, and requires exploring the mediations between work and illness to elucidate singular symptomatology based on the collective wear and tear experience. Such an investigation should simultaneously problematize the very work processes of the social actors involved in the expert investigations, starting from the priorities defined by the workers themselves who act as subjects in the analysis of work-related harm to health.

Retrospective study on cutaneous adverse drug reactions in a tertiary care center

Background: Cutaneous adverse drug reactions (CADRs) range from mild-to-severe types and occasionally can become fatal. Hence, these incur additional financial burden both to patients and community. Aim and Objective: The aim of the study was to describe the characteristics of CADRs reported to ADR monitoring center (AMC) of a tertiary care center. Materials and Methods: CADRs reported to the AMC over a period of 2 ½ years were retrospectively studied. This study mainly focused on affected age group, gender, various pattern of CADRs, the group and name of drugs causing CADRs, and severity and causality assessment. Results: CADRs contributed 31.6% of the total ADRs reported to the AMC. Among these, 51.7% were females and 40% were of 51–60 years age group. About 37.9% of CADRs were pruritus. Antibacterial drugs were the most common cause of CADRs and beta-lactam antibiotics were responsible for 30% of CADRs. Stevens Johnson syndrome (SJS) constituted 4.9% of CADRs and 20% of this was due to Paracetamol. Drugs were withdrawn in 89% of cases and 85% cases recovered. On causality assessment, 94% were of probable category. Conclusion: Pruritus was the most commonly observed CADR and antibacterial drugs were the most common cause. Beta lactam antibiotic was the most frequent antibacterial drug to cause CADRs. The most common serious CADR was SJS and Paracetamol was the most frequent culprit drug.

El binomio causalidad-azar: ¿principio explicativo del conocimiento científico en medicina? / The causality-chance binomial: explanatory principle of scientific knowledge in medicine?

Resumen Este ensayo cuestiona las verdades matemáticas como principio explicativo del conocimiento científico médico. Se analiza, en primer término, el concepto de normalidad actual basado en una distribución de valores probabilísticos, y se destacan sus limitaciones y equívocos para captar la complejidad de la condición humana. Los sistemas cerrados (juegos de azar), origen de la teoría de las probabilidades y del binomio causalidad-azar, se comparan con los sistemas abiertos propios del proceso vital y se argumentan sus diferencias extremas. Se destaca el despropósito de depositar en el binomio causalidad-azar el significado de asociaciones entre sucesos propios de la complejidad de la vida humana en salud y enfermedad. Se confrontan las características de la causalidad mecanicista (puntual, lineal, unidireccional, homogénea y fija), que equipara al organismo con una máquina y es la única explicación científica aceptada del acontecer de la vida humana, con las de la causalidad contextual (difusa, heterogénea, jerárquica, multidireccional y cambiante), que especifica diversos órdenes causales interactuantes que dan forma a la condición humana: el histórico, el social, el político, el económico, el cultural o el biológico, que representa una mirada escrutadora y penetrante de la complejidad de los seres humanos. Se concluye la superioridad de la causalidad contextual sobre la mecanicista, que abre posibilidades explicativas de sucesos vitales que suelen arrumbarse como «efectos del azar¼. Esta aproximación integradora a la complejidad humana puede enriquecer y fortalecer el método clínico, hoy degradado y en riesgo de extinción.

Abstract This essay questions mathematical truths as an explanatory principle of the medical scientific knowledge. It analyzes, in the first place, the current concept of normality based on a distribution of probabilistic values and its limitations and mistakes to capture the complexity of the human condition are highlighted. The closed systems (gambling) origin of the theory of probabilities and the binomial causality-chance are compared with open systems typical of the complexity of the vital process, and their extreme differences are argued. The nonsense of depositing in the causality-chance binomial the meaning of associations between events typical of the complexity of human life in health and disease is highlighted. The characteristics of mechanistic causality (punctual, homogeneous, linear, unidirectional and fixed), which equates the organism with a machine and is the only accepted scientific explanation of events of human life, are confronted with those of contextual causality (diffuse, heterogeneous, hierarchical, multidirectional and changing), which specifies various interacting causal orders that shape of human condition: the historical, the social, the political, the economical, the cultural or the biological that represents a scrutinizing and penetrating look at the complexity of human beings. It concludes the superiority of contextual causality over mechanistic causality that opens up explanatory possibilities of the vital events that are usually put away as "effects of chance". This integrative approach to the human complexity can enrich and strengthen the clinical method that is now degraded and at risk of extinction.

Study of pattern and time-reaction sequence for adverse drug reactions reported to antiretroviral drugs

Background: Adverse drug reactions (ADRs) to antiretroviral drugs have a varied pattern and wide spectrum of severity from mild to very serious. The lack of a pre-established time-reaction sequence hampers the causality assessment of ADRs. Recognition of pattern of ADRs to antiretroviral drugs in a particular setup might sensitize the reporters to report ADRs, especially in setups dependent on spontaneous reporting. Aim and Objectives: The study of pattern and time-reaction sequence for ADRs reported to antiretroviral drugs. Materials and Methods: Retrospective study was conducted at a first-line antiretroviral therapy (ART) center after obtaining approval from the Institutional Ethics Committee. Pattern of ADRs associated with ART was done by analyzing the type of ADRs, severity, and outcome of ADRs reported to antiretroviral drugs. Mean duration of time lapse between administration of drug to onset of adverse drug reaction was calculated. Descriptive statistics was used for data analysis. Results: There were 73 adverse reactions reported. Most common type of adverse reaction was cutaneous (53.42%) followed by anemia (31%). Causality assessment of most ADRs was concluded as possible (60.27%). Most ADRs were of moderate severity and 12% were severe reactions. Reactions such as anemia and neuropsychiatric ADRs often occurred late, while maculopapular rash usually occurred within 30 days of drug administration. Conclusions: ADRs to ART include an array of reactions ranging from mild rash to psychosis or severe anemia. Most of these reactions are of moderate severity and have a favorable outcome. Many of these reactions actually occur almost a month after initiating a drug regime suggesting the need for intensive monitoring around this time.

Scientific unknown-base in medical field: Supporting problem-oriented priority setting in basic research / 中华医学科研管理杂志

Objective:The present study delves into the realm of scientific unknowns, which serve as the primary representation of major scientific challenges and often give rise to subversive, non-consensus, and high-risk scientific problems. Addressing this pivotal aspect, we focus on the development of scientific unknown identification methods and tool platforms to provide essential data support for priority setting of basic research through a problem-oriented approach. Such efforts are imperative for managing the scientific and technological innovation system within the context of demands and problem-solving.Methods:While numerous knowledge bases have been established in the medical field, there remains a notable lack of focus on the unknown base. The paper synthesizes relevant literature and existing research, amalgamating the methodological paradigm of scientific big data research with text mining. This integration facilitates comprehensive interpretations and enlightening insights concerning the concept, identification methods, and construction of an unknown-base.Results:By systematically analyzing the concept of scientific unknowns, we present a recognition method based on cognitive state and logical rules. Furthermore, we discuss a classification framework and realization path for scientific unknowns from the dimensions of attribute, relationship, and disease, thereby providing foundational insights for the construction of a medical unknown database.Conclusions:Notably, the research on unknowns in medical science transcends disciplinary boundaries, encompassing the confluence of information science, data science, medical informatics, and science and technology management. As such, this paper seeks to expound upon the significance and application scenarios of unknown research in science, furnishing valuable ideas and references for scholars in the field.

Study on the causal relationship between body mass index and hypothyroidism / 中华健康管理学杂志

Objective:To explore the causal relationship between body mass index (BMI) and hypothyroidism using the two-sample Mendelian randomization model.Methods:A large-scale anthropometric genome-wide association study published in the GIANT database was used to select single nucleotide polymorphisms (SNPs) which were statistically significantly associated with BMI as an instrumental variable ( P<5×10 -8, linkage disequilibrium r 2<0.1). The causal relationship between BMI and hypothyroidism was determined by the inverse variance weighted (IVW), weighted median method and the MR-Egger method, respectively. A heterogeneity test, gene pleiotropy test, and sensitivity analysis were performed to evaluate the stability and reliability of the results. Results:A total of 89 SNPs related to BMI were screened out as instrumental variables. IVW analysis suggested that for every standard deviation increase in BMI, the risk of hypothyroidism increased by 0.9% (odd ratio ( OR)=1.009, 95% confidence interval ( CI): 1.006-1.012, P<0.001). Similar results were obtained with the weighted median method ( OR=1.007, 95% CI: 1.002-1.011, P=0.003) and the MR-Egger method ( OR=1.008, 95% CI: 1.001-1.015, P=0.006). The MR-Egger analysis showed that genetic pleiotropy did not bias the results (intercept=0.000 1, P=0.776), the one-by-one exclusion method did not show that a single instrumental variable SNP had a significant impact on the results, and the difference was not statistically significant ( P>0.05). Conclusion:Mendelian randomized analysis showed a positive causal relationship between BMI and hypothyroidism.

Observation and Reflection on the Judicial Practice of the Crime of Impairing the Prevention and Treatment of Infectious Diseases / 中国医学伦理学

The crime of impairing the prevention and treatment of infectious diseases was "activated" in the COVID-19 epidemic that broke out in early 2020. However, the scope of infectious diseases involved in the relevant crimes of the Criminal Law of the People’s Republic of China before the revision was only limited to Category A infectious diseases, and the scope of application should be expanded when used for infectious diseases such as COVID-19. The revised Criminal Law "expands" the scope of infectious diseases involved in the crime from Category A to Category B controlled according to Category A, providing a legal basis for related cases, while the expressions in the new laws are repeated and ambiguous. Whether the criminal subject causes others to be infected is closely related to the sentencing of the crime, but it is still impossible to draw an exclusive conclusion on the causality leading to infection at the technical level. In summary, this paper proposed to correct the cases of inappropriate expansion of the application scope before the amendment of the Criminal Law, revise the improper expression of the new laws while cleaning up the relevant normative documents, clarify the unidentifiable part in the causal relationship of relevant cases and consider it in sentencing process.

Interpretation on Consensus on drug-induced liver injury by CIOMS Working Group:liver injury attributed to herbal and dietary supplements / 中国中药杂志

With the increase in the medical level, the improvement of adverse drug reaction(ADR) monitoring systems, and the enhancement of public awareness of safe medication, drug safety incidents have been frequently reported. Drug-induced liver injury(DILI), especially liver injury attributed to herbal and dietary supplements(HDS), has globally attracted high attention, bringing great threats and severe challenges to the people for drug safety management such as clinical medication and medical supervision. Consensus on drug-induced liver injury had been published by the Council for International Organizations of Medical Sciences(CIOMS) in 2020. In this consensus, liver injury attributed to HDS was included in a special chapter for the first time. The hot topics, including the definition of HDS-induced liver injury, epidemiological history, potential risk factors, collection of related risk signals, causality assessment, risk prevention, control and management were discussed from a global perspective. Based on the previous works, some experts from China were invited by CIOMS to undertake the compilation of this chapter. Meanwhile, a new causality assessment in DILI based on the integrated evidence chain(iEC) method was widely recognized by experts in China and abroad, and was recommended by this consensus. This paper briefly introduced the main contents, background, and characteristics of the Consensus on drug-induced liver injury. Significantly, a brief interpretation was illustrated to analyze the special highlights of Chapter 8, "Liver injury attributed to HDS", so as to provide practical references for the medical staff and the researchers who worked on either Chinese or Western medicine in China.

Mendelian Randomization Analysis of Research on Risk Factors for Gastric Cancer / 肿瘤防治研究

Objective To understand the application and research progress of Mendelian randomization (MR) studies related to gastric cancer and provide a scientific basis for gastric cancer prevention. Methods Published studies on risk factors of gastric cancer based on MR methods were searched in PubMed, Web of Science, EMBASE, CNKI, and WANFANG DATA from the establishment of each database to November 19th, 2022. Two researchers examined the eligibility of studies, extracted key information, and assessed the research quality independently. Results A total of 30 publications published from 2016 to 2022 were included in the study, and 20 were judged to be of high quality. These studies examined the relationship between behaviors and lifestyle factors, anthropometric characteristics, indicators of biological exposure, and other pathological conditions and gastric cancer, and the results suggest potential causal associations between smoking and other factors and the risk of gastric cancer. Conclusion Previous MR studies extensively investigated the causal association between internal and external exposures or traits and gastric cancer and provided positive evidence of gastric cancer etiology. However, MR studies may be subject to methodological limitations. Interpretation of results needs to be approached with caution, which necessitates the integration with biological plausibility and evidence from observation studies.

Fatores clínicos e obstétricos de óbitos fetais em uma maternidade de alto risco / Clinical and obstetric factors of fetal death in a high-risk maternity

Objetivo: Caracterizar os fatores clínicos e obstétricos de mulheres que tiveram diagnóstico de óbito fetal em uma maternidade escola de alto risco. Metodologia: estudo de abordagem quantitativa, de corte transversal e caráter descritivo exploratório. Foram incluídos 354 prontuários de mulheres admitidas com diagnóstico e óbito fetal entre janeiro de 2018 a janeiro de 2022. Analisou-se os dados a partir da distribuição de frequências absolutas e relativas (%). Resultados: A idade média das participantes foi de 26 anos. A maioria era primípara sem perdas fetais prévias. Hipóxia Fetal Intraútero foi a causa de óbito mais frequente (17,8%). Conclusão: O óbito fetal intraútero ainda é um diagnóstico que requer mais visibilidade por parte do sistema de saúde. Foi constatada a deficiência dos registros em prontuário de dados importantes, ressaltando a necessidade de promover treinamento e capacitação para os profissionais que realizam assistência

Objective: To characterize the clinical and obstetric factors of women who were diagnosed with fetal death in a high-risk maternity hospital. Methodology: cross-sectional, analytical and retrospective study, carried out in a high-risk maternity hospital in the Central Region of Goiás. A total of 354 medical records of women admitted with a diagnosis and fetal death between January 2018 and January 2022 were included. Data were analyzed based on the distribution of absolute and relative frequencies (%). Results: The average age of the participants was 26 years old. Most were primiparous without previous fetal losses. Intrauterine Fetal Hypoxia was the most frequent cause of death (17.8%). Conclusion: Intrauterine fetal death is still a diagnosis that requires more visibility from the health system. It was verified the deficiency of records in medical records of important data, emphasizing the need to promote training and qualification for professionals who perform assistance

Análisis mediante variables instrumentales para establecer causalidad en investigaciones observacionales / Analysis through instrumental variables to establish causality in observational research

La identificación de relaciones causales es uno de los problemas fundamentales de la investigación científica en medicina y es necesaria para poder ejercerla en forma efectiva. Sin embargo, desde el punto de vista práctico es difícil establecer la existencia de relaciones causales en estudios de carácter observacional, en gran parte por la presencia de factores de confusión. El análisis a través de variables instrumentales es una de las estrategias que permite controlar el efecto confundidor y documentar la presencia de relaciones causa-efecto en estas situaciones. En este artículo, el autor resume los principales supuestos del análisis a través de variables instrumentales, haciendo foco en la aleatorización mendeliana. (AU)

The identification of causal relationships is one of the fundamental challenges in scientific research in medicine and is necessary for its effective practice. However, from a practical standpoint, establishing the existence of causal relationships in observational studies is difficult, largely due to the presence of confounding factors. Analysis through instrumental variables is one of the strategies that allows to control the confounding effect and documenting the presence of cause-and-effect relationships in these situations. In this article, the author summarizes the main assumptions of analysis through instrumental variables, with a focus on Mendelian randomization. (AU)

A questão da causalidade em Epidemiologia / The issue of causality in Epidemiology

Resumo Este ensaio trata da questão da causalidade em epidemiologia a partir da década de 1970, cujo marco inicial aqui adotado foi a publicação de The causal thinking in health sciences, por M. Susser, até os dias de hoje, buscando elencar os vários movimentos filosóficos, teóricos e metodológicos que ao longo destes 50 anos buscaram refletir sobre o problema da causalidade na disciplina, tendo em vista o predomínio das pesquisas observacionais no campo. Partindo da contribuição seminal de Susser, foram discutidos vários movimentos, bem como as críticas a eles, tais como a proposta da adoção de lógica popperiana na década de 1980, a crítica aos modelos multicausais e a teoria ecossocial proposta por N. Krieger na década de 1990, as críticas à epidemiologia social também da década de 1990, a influência de J. Pearl e a adoção dos gráficos acíclicos direcionados como nova metodologia na questão da causalidade. A chamada revolução metodológica no início deste século e as críticas de filósofos e epidemiologistas a esta abordagem reducionista também foram revisadas, bem como as alternativas propostas nos últimos 10 anos, incluindo a perspectiva inferencialista, a triangulação de métodos e a defesa da epidemiologia social e de seus modelos de determinação.

Abstract This essay deals with the issue of causality in epidemiology from the 1970s onwards, whose starting point adopted here was the publication of The Causal Thinking in Health Sciences by M. Susser, up to the present day, seeking to list the various philosophical, theoretical and methods that throughout these 50 years have sought to reflect on the problem of causality in the discipline, in view of the predominance of observational research in the field. Starting from Susser's seminal contribution, several movements were discussed as well as their criticisms, such as the proposal to adopt Popperian logic on the 1980s, the criticism of multicausal models and the ecosocial theory proposed by N. Krieger in the 1990s, criticism of social epidemiology also in the 1990s, the influence of J.Pearl and the adoption of directed acyclic graphs as a new tool in the issue of causality. The so-called methodological revolution at the beginning of this century and the criticism of philosophers and epidemiologists to this reductionist approach were also reviewed, as well as the alternatives proposed in the last 10 years, including the inferentialist perspective, the triangulation of methods and the defense of social epidemiology and their determination models.

Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil / Influência do tipo de parto na satisfação com a internação para o parto na pesquisa Nascer no Brasil / Influencia del tipo de parto en la satisfacción con la hospitalización para el parto en la encuesta Nacer en Brasil

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

Estudos mostram resultados controversos sobre a associação entre o tipo de parto e a satisfação da paciente. Este estudo investiga qual tipo de parto traz maior satisfação com a internação hospitalar para o parto. Foi realizado um estudo de coorte com dados da pesquisa Nascer no Brasil, iniciada em 2011. Foram incluídas 23.046 puérperas de uma amostra aleatória de hospitais, por conglomerados, com estratificação em três níveis. No primeiro seguimento, 15.582 mulheres foram reentrevistadas. Coletou-se antes da alta hospitalar dados sobre o tipo de parto, dicotomizado em vaginal e cesáreo, e fatores de confusão. O desfecho satisfação materna, avaliado como um construto unidimensional de 10 itens, foi mensurado pela Escala de Satisfação com a Hospitalização para o Parto até seis meses após a alta. As variáveis mínimas de ajuste para confusão foram definidas em um gráfico acíclico direcionado. O efeito do tipo de parto sobre a satisfação foi estimado em um modelo de equação estrutural com ponderação pelo inverso da probabilidade de seleção, considerando o desenho amostral complexo. A ponderação foi estimada considerando as diferentes probabilidades de seleção da amostra, as perdas de seguimento e o escore de propensão. O escore de propensão foi estimado em um modelo de regressão logística. Não houve diferenças na satisfação com a internação para o parto entre as entrevistadas que tiveram partos vaginais e cesáreos na análise ajustada (coeficiente padronizado = 0,089; p = 0,056). As mulheres que tiveram partos vaginais e cesáreos ficaram igualmente satisfeitas com a hospitalização para o parto.

Los estudios muestran resultados controvertidos en cuanto a la asociación entre el tipo de parto y la satisfacción de la paciente. Este estudio investiga qué tipo de parto presenta mayor satisfacción con la hospitalización para el parto. Se realizó un estudio de cohorte con los datos de la encuesta Nacer en Brasil, que había comenzado en 2011. Se incluyeron a 23.046 puérperas de una muestra aleatoria de hospitales, por conglomerados, con estratificación en tres niveles. En el primer seguimiento se volvió a entrevistar a 15.582 mujeres. Los datos sobre el tipo de parto, ya sea por cesárea o vaginal, y los factores de confusión se recogieron antes del alta hospitalaria. El resultado de satisfacción materna, evaluado como un constructo unidimensional de diez ítems, se midió con la Escala de Satisfacción con la Hospitalización por Parto hasta seis meses después del alta. Las variables de ajuste mínimo de confusión se definieron en un gráfico acíclico dirigido. El efecto del tipo de parto sobre la satisfacción se estimó en un modelo de ecuaciones estructurales ponderadas por la inversa de la probabilidad de selección, considerando el diseño de muestreo complejo. La ponderación se estimó con diferentes probabilidades de selección de la muestra, pérdidas de seguimiento y puntuación de propensión. La puntuación de propensión se estimó mediante el modelo de regresión logística. No hubo diferencias en la satisfacción con la hospitalización por parto entre las encuestadas que tuvieron partos vaginales o por cesárea en el análisis ajustado (coeficiente estandarizado = 0,089; p = 0,056). Tanto las mujeres que tuvieron partos vaginales como las que tuvieron por cesárea estaban igualmente satisfechas con su hospitalización por parto.

Modelos teóricos: reflexões necessárias / Theoretical models: necessary reflections

RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato.

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process.

Caracterización de pacientes con enfermedad pulmonar obstructiva crónica en el Hospital General Provincial de Sancti Spíritus

Introducción: La Organización Mundial de la Salud, estima la prevalencia de la enfermedad pulmonar obstructiva crónica en la población general en torno al 1 % y crece del 8-10 % en los adultos mayores de 40 años. Es la tercera causa de muerte a escala mundial y quinta causa de discapacidad para 2020. Objetivo: Describir las características de los pacientes con enfermedad pulmonar obstructiva crónica ingresados en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus durante el período 2019-2022. Métodos: Se realizó un estudio descriptivo, retrospectivo, de corte trasversal, que incluyó a todos los pacientes que fueron ingresados en el Servicio de Medicina Interna. La muestra no probabilística la integraron 746 pacientes adultos con enfermedad pulmonar obstructiva crónica, que fueron atendidos. Resultados: Existió predominio del grupo de 60 años y más en un 43,69 %, sobresalió el sexo masculino representado por el 56,7 %. El hábito tabáquico constituyó la principal causa de enfermedad pulmonar obstructiva crónica en el 67,29 % de los pacientes, el grado de obstrucción del flujo aéreo se comportó con mayor frecuencia la clasificación moderada representada por casi la mitad de los pacientes (47,31 %), la infección respiratoria fue la de mayor prevalencia con 52,68 %, seguido de un 42,22 % de complicaciones cardiovasculares y según la evolución de la enfermedad, en los pacientes adultos atendidos el 51,47 % presentó una evolución desfavorable. Conclusiones: Se evidenciaron formas moderadas y severas de presentación de la enfermedad en la mayoría de los casos, siendo las complicaciones respiratorias y cardiovasculares preponderantes.

Introduction: The World Health Organization (WHO) estimates the prevalence of chronic obstructive pulmonary disease (COPD) in the general population at around 1%, and it grows to 8-10% in adults older than 40 years. COPD is the third cause of death worldwide and the fifth cause of disability by 2020. Objective: To describe the characteristics of patients with chronic obstructive pulmonary disease admitted to the Camilo Cienfuegos Provincial General Hospital of Sancti Spíritus during the period 2019-2022. Methods: A descriptive, retrospective, cross-sectional study was carried out, which included all the patients who were admitted to the Internal Medicine Service. The sample studied was the 746 adult patients with chronic obstructive pulmonary disease, who were attended. Results: There was a predominance of the group of 60 years and over in 43.69%, the male sex stood out, representing 56.70%, according to etiology, smoking was the main cause of chronic obstructive pulmonary disease in 67.29% of the patients, the degree of air flow obstruction behaved more frequently, the moderate classification represented by almost half of the patients (47.31%), respiratory infection was the most prevalent with 52.68%, followed by 42.22 % of cardiovascular complications and according to the evolution of this disease in the adult patients treated, 51.47% presented an unfavorable evolution. Conclusions: Moderate and severe forms of presentation of the disease were evidenced in most cases, with respiratory and cardiovascular complications being preponderant.

Perfil de readmissões em uma unidade de terapia intensiva adulto clínica cirúrgica: fatores predisponentes a reinternação / Profile of readmissions in an adult clinical surgical intensive care unit: factors predisponent to reinternation / Perfil de readmisiones en unidad de cuidados intensivos clínicos quirúrgicos para adultos: factores predisponentes a la reinternación

Objetivo: analisar o perfil dos pacientes readmitidos em uma unidade de terapia intensiva clínica/cirúrgica e principais fatores que culminaram neste evento. Método: estudo descritivo, retrospectivo com abordagem quantitativa, baseado no registro de todos os pacientes admitidos na unidade de terapia intensiva clínica/cirúrgica entre janeiro e dezembro de 2019. Resultados: a amostra apresenta perfil masculino, idoso, tendo de uma a três comorbidades pré-existentes, admitidos por causas respiratórias, sendo readmitidos por complicações respiratórias, seguidas por infecções, com tempo médio de 5,6 dias. Apresentaram alterações hematológicas e renais, tendo o óbito como principal desfecho. Conclusão: idade avançada, presença de comorbidades, complicações por quadros infecciosos, anemia e declínio da função renal são características pertinentes aos pacientes readmitidos na terapia intensiva

Objective: to analyze the profile of patients readmitted to a clinical / surgical intensive care unit and the main factors that culminated in this event. Method: a descriptive, retrospective study with a quantitative approach, based on the registration of all patients admitted to the clinical / surgical intensive care unit between January and December 2019. Results: the sample presents a male, elderly profile, with one to three pre-comorbidities ­ existing, admitted for respiratory causes, being readmitted for respiratory complications, followed by infections, with an average time of 5.6 days. They presented hematological and renal changes, with death as the main outcome. Conclusion: advanced age, presence of comorbidities, complications due to infectious conditions, anemia and decline in renal function are characteristics relevant to patients readmitted to intensive care

Objetivo: analizar el perfil de los pacientes reingresados en una unidad de cuidados intensivos clínico-quirúrgicos y los principales factores que culminaron en este evento. Método: estudio descriptivo, retrospectivo, con abordaje cuantitativo, basado en el registro de todos los pacientes ingresados en la unidad de cuidados intensivos clínico-quirúrgicos entre enero y diciembre de 2019. Resultados: la muestra tiene un perfil masculino, anciano, con una a tres pre ­ comorbilidades existentes ­ existente, ingresado por causas respiratorias, reingreso por complicaciones respiratorias, seguido de infecciones, con un tiempo promedio de 5,6 días. Presentaron alteraciones hematológicas y renales, siendo la muerte el principal desenlace. Conclusión: la edad avanzada, la presencia de comorbilidades, las complicaciones por enfermedades infecciosas, la anemia y el deterioro de la función renal son características relevantes para los pacientes reingresados a cuidados intensivos