Patterns of ocular trauma in elderly patients in an urban population-the Bronx experience / Padrões de trauma ocular em pacientes idosos em uma população urbana - a experiência de Bronx

ABSTRACT Purpose: To evaluate the characteristics of ocular injuries among elderly patients admitted to an urban level I trauma center because of major trauma from 2008 to 2015. Methods: A retrospective chart review was conducted of patients aged >65 years admitted with ocular injuries that were identified with ICD-9 codes. Tabulated data were analyzed using the Student's paired t-test, the chi-squared test, and regression analysis using STATA/MP-12 software. Significance was set at p<0.05. Results: Of a total of 861 patients, 221 (25.7%) admitted for major trauma and ocular injuries were elderly. The mean age of these patients was 80.3 years (median =79.2 years; interquartile range=63.8-94.6 years). Of these patients, 40.7% were males and 59.3% were females. The males were younger than the females (mean age, 77.3 vs. 82.4 years, respectively, p<0.001). Race was documented as white (30.8%), black (13.6%), and "other" (54.3%), with 67.5% of the "other" group (36.7% overall) identified as Hispanic. The most frequent injuries were contusion of the eye/adnexa (68.2%), orbital wall fractures (22.2%), and an open wound of the ocular adnexa (18.1%). Males had a 2.64-fold greater risk of orbital wall fractures (95% confidence interval [CI]=1.38-5.05, p<0.003). Patients with orbital wall fractures had higher injury severity scores than those without (95% CI=14.1-20.9 vs. 6.8-8.6, respectively, p<0.001). The most common injuries were falls (77.8%) and pedestrian/motor vehicle accidents (6.8%). Falls occurred mostly at home (51.7%), on the street (13.9%), and in hospitals/nursing homes (12.2%). Those falling at home were older than those falling at other locations (95% CI=81.8-85.4 vs. 77.0-80.6 years, respectively, p<0.002). Conclusions: Ocular injuries in elderly Bronx patients most commonly occurred in females due to falls in the home/nursing home setting. Public health measures addressing identifiable individual and environmental risks in these common locations would be most beneficial in reducing the incidence of ocular injuries in this population.

RESUMO Objetivo: Avaliar as características das lesões oculares de idosos nas internações por grandes traumatismos em um centro urbano de trauma nível I de 2008 a 2015. Métodos: Realizou-se uma revisão retrospectiva de prontuários de pacientes com mais de 65 anos internados com lesões oculares identificados com os códigos CID-9. Os dados tabulados foram analisados com o teste t de Student, teste qui-quadrado e análise de regressão, utilizando o software STATA/MP-12. A significância estatística foi fixada em p<0,05. Resultados: Duzentos e vinte e um (25,7%) pacientes de um total de 861, admitidos por traumatismo craniano importante e lesões oculares, eram idosos. A idade média era de 80,3 anos (mediana=79,2; intervalo interquartil=63,8-94,6). 40,7% eram do sexo masculino e 59,3% do feminino. Os homens eram menos idosos (média=77,3) do que as mulheres (média=82,4), p<0,001. A raça foi documentada como branca (30,8%), negra (13,6%) e "outra" (54,3%); 67,5% dos "outros" (36,7% no geral) identificados como hispânicos. As lesões mais frequentes foram contusão do olho/anexos (68,2%), fraturas da parede orbital (22,2%) e ferida aberta dos anexos oculares (18,1%). Os homens tiveram 2,64 mais chances de fraturas da parede orbital (95% CI=1,38-5,05; p<0,003). Pacientes com fraturas da parede orbital tiveram maiores escores de gravidade da lesão (95% CI=14,1-20,9) do que aqueles sem fraturas (96% IC=6,8-8,6), p<0,001. Os mecanismos comuns foram quedas (77,8%) e acidentes a pé com veículos automotores (6,8%). As quedas ocorreram principal mente em casa (51,7%), na rua (13,9%) e em hospitais/lares de idosos (12,2%). Aqueles que caíram em casa eram mais velhos (IC 95%=81,8-85,4) do que os que tiveram quedas em outros locais (IC 95%=77,0-80,6), p<0,002. Conclusões: Lesões oculares em pacientes idosos de Bronx foram mais comuns no sexo feminino e devido a quedas que ocorreram em casa/lar de idosos. Medidas de saúde pública direcionadas a riscos individuais e ambientais identificáveis nesses locais comuns seriam mais benéficas na redução de lesões oculares nessa população.

A abordagem da sexualidade como aspecto essencial da atenção integral de pessoas com transtornos mentais / The inclusion of sexuality as an essential aspect of comprehensive care for individuals with mental disorders

Resumo O estudo teve o objetivo de compreender as representações de usuários e de profissionais de serviços de saúde mental acerca da sexualidade dos primeiros. Entrevistaram-se individualmente 39 usuários e 54 profissionais de serviços públicos de saúde mental por meio de seis grupos focais. A análise dos dados fundamentou-se na Análise Estrutural de Narração. Pessoas com transtornos mentais (PTM) não representam saúde sexual como direito e encontram dificuldades para se cuidarem em face de estereótipos de gênero e pelo contexto de exclusão e pobreza. Entre os profissionais, as representações foram de negação da sexualidade das PTM, entendendo-a como “fora do normal” e que deve ser reprimida. Diálogos sobre sexualidade com os usuários são quase inexistentes. Os profissionais não estão preparados para assistência integral, o que requer capacitação permanente nos serviços e inclusão do tema na formação básica nas carreiras da área da saúde, de forma interdisciplinar.

Abstract The scope of this study was to understand the representations of mental health service patients and professionals concerning the sexuality of the former. Thirty-nine patients and 54 professionals of the public mental health services, divided up into six focal groups, were interviewed individually. Data analysis was based on the Structural Analysis of Narrative technique. Individuals with mental disorders do not perceive sexual health as a right and have difficulty taking care of themselves in the face of gender stereotypes, and for the contexts related with exclusion and poverty. Among the mental health service professionals, sexuality negation of mentally-ill individuals had been the commom representation. They classify this behavior as “not a normal representation” and believe that it must be restrained. Dialogues about sexuality with users are almost inexistent. Mental health service professionals are not prepared for integral assistance, which requires permanent qualification and the inclusion of this subject in the fundamental formation of health related careers, in a interdisciplinary way.

Lifespan extension and increased resistance to environmental stressors by N-Acetyl-L-Cysteine in Caenorhabditis elegans

OBJECTIVE: This study was performed to determine the effect of N-acetyl-L-cysteine, a modified sulfur-containing amino acid that acts as a strong cellular antioxidant, on the response to environmental stressors and on aging in C. elegans. METHOD: The survival of worms under oxidative stress conditions induced by paraquat was evaluated with and without in vivo N-acetyl-L-cysteine treatment. The effect of N-acetyl-L-cysteine on the response to other environmental stressors, including heat stress and ultraviolet irradiation (UV), was also monitored. To investigate the effect on aging, we examined changes in lifespan, fertility, and expression of age-related biomarkers in C. elegans after N-acetyl-L-cysteine treatment. RESULTS: Dietary N-acetyl-L-cysteine supplementation significantly increased resistance to oxidative stress, heat stress, and UV irradiation in C. elegans. In addition, N-acetyl-L-cysteine supplementation significantly extended both the mean and maximum lifespan of C. elegans. The mean lifespan was extended by up to 30.5% with 5 mM N-acetyl-L-cysteine treatment, and the maximum lifespan was increased by 8 days. N-acetyl-L-cysteine supplementation also increased the total number of progeny produced and extended the gravid period of C. elegans. The green fluorescent protein reporter assay revealed that expression of the stress-responsive genes, sod-3 and hsp-16.2, increased significantly following N-acetyl-L-cysteine treatment. CONCLUSION: N-acetyl-L-cysteine supplementation confers a longevity phenotype in C. elegans, possibly through increased resistance to environmental stressors. .

Screening Colonoscopy among Uninsured and Underinsured Urban Minorities

BACKGROUND/AIMS: Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings. METHODS: Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age. RESULTS: Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047). CONCLUSIONS: Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.

The anatomic distribution of colorectal cancer in a New York City Puerto Rican group

Studies have attempted to define the anatomic distribution of colorectal cancer in some black and white groups of the U.S. However, little, if any research has looked at the regional distribution of colorectal cancer in an American Hispanic, especially Puerto Rican, group. This study attempts to provide some insight into the subsegmental distribution of colorectal cancer in this group of the American population which has a heavy concentration of people in many major U.S. cities. We retrospectively reviewed the charts of Puerto Rican patients who had colorectal adenocarcinoma and were on the files of the tumor registries of two principal teaching hospitals of a New York City medical school from 1976-95, and collected the age and location of the cancers. Patients were self identified as being of Puerto Rican descent. Right colon cancers were from the cecum up to the hepatic flexure, left from the splenic flexure down to the sigmoid colon, rectal which included rectosigmoid, transverse and cancers of unknown locations. The latter were not included in the anatomic analysis since the location was not known. There were eleven of these patients. The anatomic analysis was of 134 patients. There were 67 women, and 78 men with a mean age of 60.3 years, and 63.7 years respectively with an overall mean age of 62.2 years. The anatomic distribution of the cancers were as follows: right colon cancer represented 22.4 or 30/134, transverse lesions equaled 1.5 or 2/134, left cancers were found in 38.0 or 51/134, rectal malignancies equaled 38.0 or 51/134. Previously, it has been shown that the presentation of right sided colorectal cancer in white and black Americans is greater than the 22.4 seen in the Puerto Rican group of this study. However, these previous groups have been found to have 50 of cancers located distal to the splenic flexure, similar to the Puerto Ricans in this study. The average age of Puerto Ricans presenting with colorectal cancer compared to the average age of the general population may be different. Screening techniques for colorectal cancer may be adequate for detecting colorectal cancer in Puerto Ricans, however if they are indeed presenting at a relatively early age, the techniques may need to be applied earlier in comparison to the general American population. Further study is needed to see if the age of presentation is indeed as early as suggested by the present study

AIDS prevention program for Puerto Rican women

Históricamente, las mujeres han sido las principales proveedores de cuidados primario; biológicamente, também son el eslabón esencial en la cadena de transmisión del SIDA a sus hijos. Como resultado de esta realidade de esta realidad dual, las mujeres requieren programas culturalmente apropriados que les ayuden a comprender la enfermedad, protegerse a sí mismas y a sus familias y a cuidar de los miembros de sus familias contagiados con el SIDA. A través de entrevistas y revisión de la literatura se hizo un examen de los servicios disponibles en la lucha contra el SIDA. También se realizó un análisis de la aplicabilidad disponibilidad, e idoneidad cultural de la información educativa en la campaña contra la enfermedad. Para asegurar la efectividad de los programas preventivos y que éstos lleguen a las mujeres puertorriqueñas es necesario que estos sean culturalmente idóneos, reconozcan los roles de los dos sexos, y la importancia del rol materno a la mujer latina. Programas efectivos ayudan a las mujeres a poner en práctica la información adquirida y toman en consideración los valores culturales en cuanto a respeto y modestia a la vez que proveen información e instrucción acertada y entendible

Mortalidad por SIDA en mujeres puertorriqueñas en la ciudad de Nueva York, 1981-87 / AIDS - related mortality among Puerto Rican women in New York City, 1981-87

Este estudio analiza el imapcto del SIDA en la mortalidad de la mujer puertorriqueña en la ciudad de Nueva York y la compara a la experiencia de otros grupos de mujeres residentes de dicha ciudad durante los años 1981 al 1987. Esta investigación indica que las puertorriqueñas en la ciudad de Nueva York son las mujeres más afectadas por el SIDA en relación a cualquier otro grupo nacional o étnico. Factores relacionados con este patrón incluyen aspectos económicos y socio-culturales relacionados con el uso de drogas intravenosas, además de patrones de migración y de nupcias. Estos datos tienen una relevancia especial para Puerto Rico dados los patrones de migración entre la población que reside en la ciudad de Nueva York con los de la Isla