ABSTRACT
RESUMEN Objetivo Determinar los factores de riesgo asociados al desarrollo de tuberculosis multidrogorresistente en pacientes de 18 años o más, afiliados a 3 Empresas Administradoras de Planes de Beneficios en Colombia, durante los años 2008 a 2011. Métodos Se realizó un estudio de casos y controles emparejado, 1 a 4,45 casos y 180 controles, de pacientes de la base de datos del programa de tuberculosis de 3 Empresas Aseguradoras de Salud, evaluando variables demográficas, socioeconómicas y clínicas. Resultados La mediana de edad de los casos fue de 43 años y la de los controles de 39,5 años, en los casos predominó el sexo masculino con 73,3 %, mientras que en los controles fue mayor el sexo femenino con 51,1 %. Se encontró asociación estadísticamente significativa entre la tuberculosis multidrogorresistente y el sexo masculino (OR ajustado 4,47 IC 95 % [1,01; 19,75]), seguridad social (OR ajustado 57,6 IC 95 % [4,6; 712,8]) y tratamiento previo (OR ajustado 56,2 IC 95 % [10,03; 314,79]. Conclusiones Ser hombre y tener tratamiento previo para tuberculosis son factores de riesgo para el desarrollo de multidrogorresistencia. Es necesario realizar más estudios con el sistema de salud colombiano para profundizar en los hallazgos con respecto al régimen subsidiado y el desarrollo de Tuberculosis multidrogorresistente.(AU)
ABSTRACT Objective Determining the risk factors associated with developing multidrug-resistant tuberculosis in people aged over 18 years affiliated to 3 Colombian health insurance companies between 2008 and 2011. Methods The study involved a matched case-control design (1 case to 4 controls). Patients were identified from 3 health insurance companies' tuberculosis program database; this gave 45 cases and 180 controls. Demographic, socioeconomic and clinical variables were evaluated. Results The median age for cases was 43 years (39.5 years for controls); males predominated in cases (73.3 %) while women predominated in controls (51.1 %). A statistically significant association was found between multidrug-resistant tuberculosis and being male (4.47 adjusted OR; 1.01-19.75 95 %CI), having subsidized social security cover (57.6 adjusted OR; 4.6-71.28 95 %CI) and having had prior treatment for tuberculosis (56.2 adjusted OR; 10.03-314.79 95 % CI]. Conclusions Prior treatment for tuberculosis and being male were risk factors for developing multidrug resistance. Further studies are needed with the Colombian health system to clarify the findings with respect to being affiliated to a subsidized health system and the development of multidrug resistant tuberculosis.(AU)
Subject(s)
Humans , Drug Resistance, Microbial , Tuberculosis, Multidrug-Resistant/epidemiology , Socioeconomic Factors , Demography , Risk Factors , Colombia/epidemiology , Insurance, HealthABSTRACT
OBJECTIVE: Determining the risk factors associated with developing multidrug-resistant tuberculosis in people aged over 18 years affiliated to 3 Colombian health insurance companies between 2008 and 2011. METHODS: The study involved a matched case-control design (1 case to 4 controls). Patients were identified from 3 health insurance companies' tuberculosis program database; this gave 45 cases and 180 controls. Demographic, socioeconomic and clinical variables were evaluated. RESULTS: The median age for cases was 43 years (39.5 years for controls); males predominated in cases (73.3 %) while women predominated in controls (51.1 %). A statistically significant association was found between multidrug-resistant tuberculosis and being male (4.47 adjusted OR; 1.01-19.75 95 %CI), having subsidized social security cover (57.6 adjusted OR; 4.6-71.28 95 %CI) and having had prior treatment for tuberculosis (56.2 adjusted OR; 10.03-314.79 95 % CI]. CONCLUSIONS: Prior treatment for tuberculosis and being male were risk factors for developing multidrug resistance. Further studies are needed with the Colombian health system to clarify the findings with respect to being affiliated to a subsidized health system and the development of multidrug resistant tuberculosis.
OBJETIVO: Determinar los factores de riesgo asociados al desarrollo de tuberculosis multidrogorresistente en pacientes de 18 años o más, afiliados a 3 Empresas Administradoras de Planes de Beneficios en Colombia, durante los años 2008 a 2011. MÉTODOS: Se realizó un estudio de casos y controles emparejado, 1 a 4,45 casos y 180 controles, de pacientes de la base de datos del programa de tuberculosis de 3 Empresas Aseguradoras de Salud, evaluando variables demográficas, socioeconómicas y clínicas. RESULTADOS: La mediana de edad de los casos fue de 43 años y la de los controles de 39,5 años, en los casos predominó el sexo masculino con 73,3 %, mientras que en los controles fue mayor el sexo femenino con 51,1 %. Se encontró asociación estadísticamente significativa entre la tuberculosis multidrogorresistente y el sexo masculino (OR ajustado 4,47 IC 95 % [1,01; 19,75]), seguridad social (OR ajustado 57,6 IC 95 % [4,6; 712,8]) y tratamiento previo (OR ajustado 56,2 IC 95 % [10,03; 314,79]. CONCLUSIONES: Ser hombre y tener tratamiento previo para tuberculosis son factores de riesgo para el desarrollo de multidrogorresistencia. Es necesario realizar más estudios con el sistema de salud colombiano para profundizar en los hallazgos con respecto al régimen subsidiado y el desarrollo de Tuberculosis multidrogorresistente.
ABSTRACT
PURPOSE: Pain is a comorbid and aggravating symptom that in many conditions can be perceived differently and should therefore be managed accordingly. Numerous factors, both social and cultural, are thought to influence the analgesic prescription. However, elucidation of such areas is limited. We therefore conducted a systematic literature review to test the hypothesis that variations in provider characteristics predict the prescription of pain medication. METHODS: A MEDLINE and PsycINFO database search from 1960 to 2009 was conducted using the search terms of "pain" or "pain treatment" along with culture, ethnicity, race, minority, gender/sex, knowledge, attitudes, physician-patient relationship, stereotype, and physician practices. Twelve original research articles based on predefined inclusion criteria were identified and analyzed to test the hypothesis of provider characteristics influencing analgesics prescription. RESULTS: Of the 12 studies, 11 were cross-sectional in design, and 10 used a survey instrument or clinical vignettes to measure different pain management responses. A randomized sampling methodology was used in 5 of the studies. The majority of providers were male (64.9% in 8 studies), white (73.5% in 5 studies), internal medicine physicians (37.4% in 11 studies), and located in the United States (75% across all 12 studies). Ten studies identified at least one provider characteristic that influenced prescription practices; age, level of experience, as well as sex were listed most frequently as contributing factors. The interplay of the sex of the provider and patient characteristics were found to be important variables in pain management. CONCLUSIONS: Our systematic review of existing literature highlights that provider's age, sex, experience, specialty, and the interplay between provider and patient characteristics are important variables in pain management. However, generalizations relating to these findings are limited by the heterogeneity of the studies and the paucity of literature in this field.
Subject(s)
Analgesics/therapeutic use , Clinical Competence , Drug Prescriptions , Pain Management/methods , Pain/drug therapy , Physician-Patient Relations , Age Factors , Clinical Competence/standards , Cross-Over Studies , Drug Prescriptions/standards , Female , Humans , Male , Pain/diagnosis , Pain Management/trends , Sex FactorsABSTRACT
The objective was to investigate the effectiveness of rating scales and electroencephalography (EEG) in detecting the presence of attention-deficit/hyperactivity disorder (ADHD) within a diverse clinical sample. A standard psychiatric evaluation was used to assess 26 children/adolescents who presented to a clinic because a parent suspected the presence of ADHD. EEG data was collected in a blinded protocol, and rating scales were collected as well. Although all subjects had presented with ADHD-like symptoms, only 62% were diagnosed with ADHD, while the remaining 38% had other disorders or no diagnosis. Rating scales readily classified inattentive, impulsive, and/or hyperactive symptoms as being due to ADHD, regardless of the actual underlying disorder, leading to a sensitivity of 81% and a specificity of 22%. Previous studies have observed that there is an EEG marker that identifies ADHD vs. controls, and this marker was present in 15 out of 16 of the ADHD subjects (sensitivity=94%) and in none of the subjects with ADHD-like symptoms due to other disorders (specificity=100%). In the detection of ADHD in a diverse clinical sample, rating scales and EEG were both sensitive markers, whereas only EEG was specific. These results may have important implications to ADHD differential diagnosis.
