ABSTRACT
PURPOSE: Prescription patterns of non-vitamin K antagonist oral anticoagulants (NOACs) are unknown among primary care physicians, where most patients with nonvalvular atrial fibrillation (NVAF) are diagnosed and followed up. The goal of this study was to evaluate overdosing and underdosing of NOACs in patients with NVAF followed up in primary care and determine their clinical predictors. METHODS: This multicenter cross-sectional study included all patients with NVAF followed up in 13 primary care units in the center region of Portugal. Patients receiving antithrombotic regimens other than NOACs and patients with missing data were excluded. FINDINGS: The study included 858 patients with NVAF on an NOAC regimen. Overall, 30.3% were prescribed an off-label dosage (25.4% with infratherapeutic dosing [ITD] and 4.9% with supratherapeutic dosing). Chronic kidney disease (odds ratio, 14.0; 95% CI, 5.4-36.5; P < 0.001) and female sex (odds ratio, 2.6; 95% CI, 1.2-5.7; P < 0.001) were independent predictors of supratherapeutic dosing. We also found a significant effect of chronic kidney disease on ITD (odds ratio, 0.22; 95% CI, 0.258-0.678; P < 0.001). IMPLICATIONS: In primary care, NOACs are frequently prescribed with unadjusted dosages, generally infratherapeutic. Attention should be paid to women and patients with chronic kidney disease.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Medication Errors , Practice Patterns, Physicians' , Primary Health Care , Administration, Oral , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Portugal , Renal Insufficiency, Chronic/drug therapyABSTRACT
INTRODUCTION: Calcium has several physiological functions and when it registers abnormal serum levels those functions may be impacted with potentially severe consequences. There is much research on hypercalcemia in cancer patients, but there are no recent studies on the prevalence of hypocalcemia in those patients. However, there has been an evolution in oncology, namely, new drugs that may directly or indirectly result in hypocalcemia. The primary aim was to explore the association of hypocalcemia with the diverse types of cancer. The secondary aim was to study the influence that hypocalcemia might have on survival. METHODS: Review of the records of patients ≥18 years old, with total calcium <2.0âmmol/L measured in 2013 in a cancer center. RESULTS: Eight hundred twenty-nine patients were included. Four hundred thirty-nine (53%) were male. The median age was 63 years. The most frequent cancer diagnoses were hematological 196 (24%) and colorectal 111 (13%). Six hundred thirty-eight patients had measured serum albumin, with a median of 25.5âg/L (14-47). When corrected for albumin level, calcium was in the normal range in 210 (33%) cases. The median survival of patients with corrected calcium lower than normal was 479 days (95% confidence interval [CI]: 309-649) and that of patients with normal corrected calcium was 62 days (95% CI: 33-91), Pâ<â.001. In a multivariate analysis, age, primary cancer, and albumin were significantly associated with survival. CONCLUSION: Hypocalcemia is associated with several types of cancer. A low calcium level is not by itself a factor of a poor prognosis since other factors seem to be more important.
ABSTRACT
AIM: This paper describes the design and rationale of multicenter practice-based research that aims to develop and evaluate an innovative mobile health (mHealth) intervention programme directed to promote healthy behaviours and prevent adolescent obesity. DESIGN: This study is designed as a non-randomized controlled trial with a three-arm structure. METHODS: Twelve to 16 years old participants will be recruited from schools, with access to the Internet and smartphone/tablet devices. The intervention group will be invited to engage in the TeenPower mHealth programme and divided into two subgroups: Group A (additionally engaged in a structured school-based intervention programme) and Group B (only engaged in the mHealth programme). The mHealth app includes educational resources, self-monitoring, social support, interactive training modules and motivational tools. The control group will only follow the structured school-based intervention programme. The intervention length will be 3 months, including the direct support of an interdisciplinary team (nursing, nutrition, sports, psychology, among others). This research was approved and funded in August 2017. DISCUSSION: The positive evaluation of the intervention programme will stimulate the inclusion of technologies in the promotion of salutogenic behaviours and obesity prevention. IMPACT: Adolescent obesity reached epidemic proportions. It is urgent to find effective prevention strategies to induce change at the individual, family and community level. If effective, this protocol can be used by health and exercise professionals in improving community interventions tailored to teenagers.
Subject(s)
Adolescent Behavior , Behavior Therapy/methods , Health Behavior , Health Promotion/methods , Motivation , Pediatric Obesity/prevention & control , Telemedicine/methods , Adolescent , Child , Female , Humans , Internet , Male , Mobile Applications , Smartphone , Surveys and QuestionnairesABSTRACT
INTRODUCTION: High levels of uric acid (UA) have been associated with cardiovascular (CV) disease, but its role as an independent risk factor is the subject of debate. Treating hyperuricemia may be useful in reducing CV risk. OBJECTIVE: To review the evidence on the effect of treatment with allopurinol in patients with hyperuricemia on reducing CV events. METHODS: We searched medical databases for randomized controlled trials (RCT), cohort studies (CS) and case-control studies (CCS), meta-analyses, systematic reviews and guidelines, published between January 2002 and December 2013 in Portuguese and English. Level of evidence (LE) and strength of recommendation were graded according to the definitions used by the European Society of Cardiology. RESULTS: Out of 46 articles, one RCT, three CS and one CCS were included. In the RCT, treatment with allopurinol decreased CV events in patients with moderate chronic renal failure by 71% compared to controls (LE B). In one CS, patients treated with high doses had a greater reduction in CV events compared to low doses (LE B). The other two CS, in patients with heart failure (HF), found similar benefits in patients treated with high doses of allopurinol (LE B). In the CCS, in patients with HF and a history of gout, treatment with allopurinol reduced HF admission and all-cause mortality (LE B). DISCUSSION AND CONCLUSIONS: Prolonged treatment with high doses of allopurinol may be associated with a reduction in morbidity and mortality in high CV risk populations (class of recommendation IIa). More studies evaluating the effect of therapy with allopurinol in reducing CV events in patients with and without risk are needed.
Subject(s)
Allopurinol/therapeutic use , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Enzyme Inhibitors/therapeutic use , Hyperuricemia/complications , Hyperuricemia/drug therapy , HumansABSTRACT
Estudo exploratório-descritivo conduzido em uma Unidade Básica de Saúde de uma cidade de médio porte do interior de Minas Gerais, cujos objetivos foram: descrever o fluxo da demanda espontânea da unidade básica; identificar as principais queixas e agravos no acolhimento e propor medidas de intervenção para melhor organizar o fluxo e ampliar a atuação da equipe multiprofissional...
Subject(s)
Humans , Primary Health Care , Health Centers , Health Services Needs and Demand , Socioeconomic FactorsABSTRACT
O presente trabalho foi desenvolvido na cidade de Ipaba, situada na região leste de Minas Gerais, em uma unidade de saúde denominada Centro. A partir do diagnóstico situacional realizado, observou-se uma série de problemas, dentre os quais, destaca-se o elevado índice de gestantes adolescentes. Nesse sentido, justifica-se este estudo e uma atuação da equipe pelos riscos de complicações às mães e aos bebês envolvidos. Sendo assim, o objetivo é elaborar um projeto de intervenção para a implantação de ações estratégicas para a redução da gravidez nas adolescentes residentes na área de abrangência da equipe saúde da família. Foi desenvolvido um plano operativo e um modelo de gestão visando à execução do mesmo
