Measuring Mental Stress During Otologic Surgery Using Heart Rate Variability Analysis.

OBJECTIVES: Healthy individuals have significant beat-to-beat variability in heart rate, and this variability decreases with mental stress. We aim to use heart rate variability (HRV) to objectively compare mental stress levels in otologic surgeons at rest and during key portions of procedures. DESIGN: Pilot study. SETTING: Operating room and laboratory. PARTICIPANTS: Two neurotology fellows performed six mastoidectomy and facial nerve (FN) dissections in the operating room and six in a cadaver lab while continuous electrocardiograms were measured wirelessly. Five-minute samples were recorded during resting, preoperative, mastoidectomy, and FN dissection. Beat-to-beat time intervals were analyzed in time and frequency domains. The standard deviation of normal beat-to-beat intervals (SDNN) and the ratio of low frequency to high frequency power (LF/HF, measure of sympathetic tone) were calculated. Decreases in SDNN and increases in LF/HF indicate elevated mental stress. RESULTS: Mean resting SDNN was 43.9 ±â€Š9.2 ms, not statistically different from preoperative SDNN (34.1 ±â€Š8.2 ms, p = 0.13). SDNN decreased during mastoidectomy (29.4 ±â€Š11.7 ms) and FN dissection (22.8 ±â€Š3.1 ms), which was significant compared to preoperative values (p = 0.03). Intraoperative LF/HF increased for FN dissection (6.8 ±â€Š2.6) compared to resting (2.2 ±â€Š0.7, p = 0.004), indicating increased sympathetic tone. Mastoid and FN cadaveric procedures resulted in SDNN of 33.6 ±â€Š3.8 and 32.9 ±â€Š4.7 ms, respectively, not statistically different from preoperative values (p = 0.82 and p = 0.94, respectively). Cadaveric FN dissection did not result in increased LF/HF (2.4 ±â€Š0.9) compared to resting (p = 0.94). CONCLUSIONS: Decreased HRV and increased sympathetic tone were observed intraoperatively, indicating high levels of mental stress, particularly with FN dissection. Similar changes were not found during cadaveric dissections.

The UALE project: a cross-sectional approach for trends in HIV/STI prevalence among key populations attending STI clinics in Guatemala.

OBJECTIVE: To describe and compare trends in prevalence, sexual behaviour and HIV transmission knowledge data related to sexually transmitted infections (STI) and HIV in patients attending three STI clinics over an 8-year period in Escuintla Department, Guatemala. METHODS: STI clinic attendees were classified into transmission groups as follows: female sex workers (FSW), men who have sex with men (MSM) and 'high-risk heterosexuals' (HRH). Annual cross-sectional analysis and multivariable Poisson regression adjusted for sociodemographic variables were used for prevalence comparisons and adjusted prevalence trends for HIV/STI outcomes and used for adjusted trends in proportions in sexual behaviour and HIV transmission knowledge outcomes. Endocervical swabs were obtained to detect trichomonas, chlamydia and neisseria infections. Serologies for syphilis and HIV were performed using rapid tests. For reactive HIV samples, positivity was confirmed by an ELISA. All reactive syphilis samples were further confirmed for diagnosis of active syphilis disease. RESULTS: From a total of 4027 clinic attendees, 3213 (79.78%) were FSW, 229 (5.69%) were MSM and 585 (14.53%) were HRH. The proportion of FSW, MSM and HRH who had a single visit was 56.42%, 57.23% and 91.10%, respectively. Overall, HIV prevalence was 2.10% in FSW, 8.17% in MSM and 4.12% in HRH. Prevalence trends in HIV and syphilis decreased in FSW. Prevalence trends in gonorrhoea did not decrease over time neither in FSW nor in HRH. Chlamydia and trichomonas infections in HRH showed an increase prevalence trend. In FSW, trends in condom use in last sexual intercourse with regular and occasional clients were above 93%. CONCLUSIONS: FSW show a decreasing trend in HIV, syphilis and chlamydia prevalence. Gonorrhoea prevalence in FSW and HRH did not decrease over time. HRH is a hard to engage population with low follow-up rates and high potential to act as a bridge population.

Assessment of risk of falls in elderly living at home.

Objective: to assess the risk of falls in elderly, by comparing the sociodemographic and cognitive factors, history of falls and self-reported comorbidities. Method: cross-sectional and quantitative study with 240 elderly. Data were collected based on the social profile, through the instrument of risk of falls and assessment of falls, by univariate analysis, bivariate and multiple logistic regression. The Statistical Package for the Social Sciences (SPSS) version 19 was used for statistical analysis. Results: there was a significant association of the risk of falls, as measured by the Fall Risk Score, with sex (<0.001), age (0.054), cognitive status (<0.001) and history of falls (<0.001). All variables were statistically significant and contributed to the occurrence of falls. In logistic regression, the variables that showed association with risk of falls were: fall, with whom they live, hypertension and visual impairment. Conclusion: female gender, older elderly (over 80 years old), with low cognitive status and occurrence of previous falls in the last six months are factors that increase the prevalence of falls. In logistic regression, the variables that were associated with risk of falls were: fall, with whom they live, visual impairment and rheumatologic diseases.

Assessment of risk of falls in elderly living at home / Avaliação do risco de quedas em idosos residentes em domicílio / Evaluación del riesgo de caídas en adultos mayores que viven en el domicilio

ABSTRACT Objective: to assess the risk of falls in elderly, by comparing the sociodemographic and cognitive factors, history of falls and self-reported comorbidities. Method: cross-sectional and quantitative study with 240 elderly. Data were collected based on the social profile, through the instrument of risk of falls and assessment of falls, by univariate analysis, bivariate and multiple logistic regression. The Statistical Package for the Social Sciences (SPSS) version 19 was used for statistical analysis. Results: there was a significant association of the risk of falls, as measured by the Fall Risk Score, with sex (<0.001), age (0.054), cognitive status (<0.001) and history of falls (<0.001). All variables were statistically significant and contributed to the occurrence of falls. In logistic regression, the variables that showed association with risk of falls were: fall, with whom they live, hypertension and visual impairment. Conclusion: female gender, older elderly (over 80 years old), with low cognitive status and occurrence of previous falls in the last six months are factors that increase the prevalence of falls. In logistic regression, the variables that were associated with risk of falls were: fall, with whom they live, visual impairment and rheumatologic diseases.

RESUMO Objetivo: avaliar o risco de quedas em idosos, comparando com os fatores sóciodemográficos, cognitivos, presença de quedas e co-morbidades autorreferidas. Método: Estudo transversal e quantitativo com 240 idosos. Os dados foram coletados a partir do perfil social, instrumento do risco de quedas e avaliação de quedas, utilizando análise univariada, bivariada e regressão logística múltipla. Para a análise estatística, utilizou-se o Statistical Package for the Social Sciences (SPSS) versão 19. Resultados: há associação entre o risco de quedas, mensurado pelo Fall Risk Score, com o sexo (<0,001), a faixa etária (0,054), o desempenho cognitivo (<0,001) e a presença de quedas (<0,001). Todas as variáveis apresentaram significância estatística e contribuíram para a ocorrência das quedas. Na regressão logística, as variáveis que apresentaram associação com o risco de quedas foram: queda, com quem mora, hipertensão arterial e déficit visual. Conclusão: sexo feminino, idoso mais velho (acima de 80 anos), com baixo desempenho cognitivo e apresentar quedas anteriores nos últimos seis meses, aumentam a prevalência de quedas. Na regressão logística, as variáveis que apresentaram associação com o risco de quedas foram: queda, com quem mora, visão prejudicada e doenças reumatológicas.

RESUMEN Objetivo: evaluar el riesgo de caídas del adulto mayor, mediante la comparación de los factores cognitivos y sociodemográficos, antecedentes de caídas y comorbilidades auto-reportadas. Método: estudio transversal y cuantitativo con 240 adultos mayores. Los datos fueron recolectados utilizando instrumento del riesgo de caídas y evaluación de caídas, mediante el análisis univariado, bivariado y regresión logística múltiple. Para el anpalisis estadístico, fue utilizado software Statistical Package for the Social Sciences (SPSS) versión 19, se utilizó en el análisis estadístico. Resultados: hay una asociación significativa del riesgo de caídas, medido por el Fall Risk Score, con el sexo (<0.001), la edad (0.054), el desempeño cognitivo (<0.001) y los antecedentes de caídas (<0.001). Todas las variables fueron estadísticamente significativas y contribuyeron a la ocurrencia de caídas. En la regresión logística, las variables que mostraron asociación con el riesgo de caídas fueron: caída, con quien viven, hipertensión y discapacidad visual. Conclusión: sexo femenino, adulto mayor de edad más avanzada (más de 80 años de edad), bajo desempeño cognitivo, y antecedentes de caídas en los últimos seis meses son factores que aumentan la prevalencia de caídas. En la regresión logística, las variables que mostraron asociación con el riesgo de caídas fueron: caída, con quien vive, discapacidad visual y enfermedades reumáticas.

Lessons learned from integrating simultaneous triple point-of-care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala.

Mother-to-child-transmission of HIV, syphilis, and hepatitis B virus (HBV) remains a challenge in Guatemala, especially in rural regions. A triple antenatal screening program for these infections using point-of-care (POC) testing offered through outreach teams was implemented in the municipality of Puerto de San José. One year following program implementation, antenatal care coverage increased to 99.6% (32.5% increase, P<0.001), testing uptake increased to 50.3% for HIV and syphilis (143.9% (P<0.001) and 1.3% (P=0.89) increase, respectively), and HBV testing increased from 0 to 42.2%. Lessons learned showed that, despite the expansion of triple antenatal POC screening in rural Guatemala, a shortage of healthcare workers and poor supply chain management limited screening uptake. Moreover, training is essential to help health workers overcome their fear of communicating positive results and improve partner notification. Engagement of community health workers was essential to build local capacity and facilitate community acceptance.

[Assessing the risk of falls for the elderly in Basic Health Units]. / Avaliação do risco de quedas em idosos atendidos em Unidade Básica de Saúde.

The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.

Avaliação do risco de quedas em idosos atendidos em Unidade Básica de Saúde / Assessing the risk of falls for the elderly in Basic Health Units / Evaluación del riesgo de caídas en ancianos atendidos en Centros Básicos de Salud

A população mundial vem envelhecendo de forma abrupta, o que representa um grande desafio para os órgãos competentes que, por sua vez, necessitam de novas políticas públicas de saúde, inclusive na prevenção de quedas. Este estudo objetivou avaliar o risco de quedas em idosos. Trata-se de um estudo epidemiológico de corte transversal com abordagem quantitativa, realizado em uma unidade de saúde da família. A amostra foi composta por 150 idosos avaliados de janeiro a abril de 2009. Para a coleta de dados, utilizou-se o Fall Risk Score, que foi analisado através do SPSS 17.0. Dos idosos avaliados 58,8% não sofreram quedas, sendo que, dos idosos que caíram (63 idosos), 71,4% sofreram de 1 a 2 quedas, citando como principal causa intrínseca a tontura/vertigem, enquanto que a extrínseca foi pisos escorregadios ou molhados. Conclui-se, portanto, que é de grande relevância avaliar o risco de quedas em idosos, para que se medidas preventivas sejam tomadas, com o objetivo de maximizar a qualidade de vida.

The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.

La población mundial envejece abruptamente, lo que representa un gran desafío para los órganos competentes, necesitándose nuevas políticas sanitarias públicas, incluso en la prevención de caídas. Se objetivó evaluar el riesgo de caídas en ancianos. Estudio epidemiológico transversal con abordaje cuantitativo, realizado en unidad de salud de la familia. La muestra se compuso de 150 ancianos evaluados entre enero y abril de 2009. Para recolección de datos se utilizó el Fall Risk Score, que fue analizado mediante SPSS 17,0. De los ancianos evaluados, 58,8% no sufrieron caídas, resultando que, de los que sí las sufrieron (63 ancianos), 71,4% experimentaron de 1 a 2 caídas, siendo la principal causa intrínseca el mareo/vértigo, mientras que la extrínseca fueron pisos patinosos o mojados. Por lo tanto, resulta altamente relevante evaluar el riesgo de caídas en ancianos, para generar medidas preventivas, apuntando a maximizar la calidad de vida.

Using resident health advocates to improve public health screening and follow-up among public housing residents, Boston, 2007-2008.

INTRODUCTION: Promoting screening for hypertension, high cholesterol, diabetes, and dental disease, particularly among residents of public housing, is a key strategy for achieving the objectives of Healthy People 2010. This community-based participatory research study tested a resident health advocate (RHA) intervention in public housing to increase use of mobile screening and to assess postscreening follow-up care for people with positive screening results. METHODS: During the summers of 2007 and 2008, a mobile health unit screened residents at 4 housing developments for hypertension, high cholesterol, diabetes risk, and dental disease. In the first summer, at 2 intervention sites, RHAs used personal contacts and repeated flyers to recruit residents; 2 control sites received standard recruitment, which was to leave flyers with the development manager. In the second summer, the 2 control sites from the previous year became intervention sites. For both summers combined, we calculated the number of people at intervention and control sites who used the van and we examined rates of appointments made and kept for residents who had positive screening test results. RESULTS: Screening rates were higher in the intervention condition compared with the control condition (relative risk [RR], 1.55; 95% confidence interval [CI], 1.12-2.15). Approximately 65% of participants screened positive for at least 1 condition. The proportion of participants with screen-positive findings who had follow-up appointments increased from 15% in 2007 to 55% in 2008. CONCLUSION: The use of RHAs increased participation in health screening among public housing residents and rates of follow-up medical visits for people with positive screening results.

Teoria das representações sociais no âmbito do envelhecimento: uma revisão integrativa / Teoría de las representaciones sociales en el ámbito del proceso de envejecer: una revisión integrativa / Theory of the social representations in the scope of the aging: an integrative review

Através de uma revisão integrativa da literatura, propõe-se analisar as características e particularidades das publicações envolvendo a Teoria das Representações Sociais no âmbito do envelhecimento. Método: Após análise das publicações do período de 2003 à 2009, a amostra final foi constituída de 23 das publicações, 11 na base de dados Scielo e 12 na Lilacs. Resultados: Observou-se a ausência de informações relevantes para que os estudos pudessem ser desenvolvidos, dentre estas podemos citar: a não especificação da formação do autor, do local e tipo de estudo e da abordagem empregada, bem como, a escassez de publicações de algumas temáticas como da visão que os idosos têm do cuidado a eles dispensado. Conclusão: Propõe-se que novos estudos sejam desenvolvidos para avaliar o envelhecimento sob a própria percepção daquele que o vive - o idoso- bem como a especificação de autoria e uma maior riqueza de procedimentos metodológicos.

Através de una revisión integrativa de la literatura, se propone un análisis de las características y particularidades de las publicaciones que involucran la Teoría de las Representaciones Sociales en el ámbito del proceso de envejecer. Métodos: Después del análisis de las publicaciones del período de 2003 a 2009, la muestra final se constituyó de 23 de las publicaciones, 11 de la base de datos Scielo y 12 de Lilacs. Resultados: Se observó la ausencia de informaciones relevantes para que los estudios pudiesen ser desarrollados, entre las que cabe citar: la no especificación de la formación del autor, del lugar y tipo de estudio, y del abordaje utilizado, bien como la escasez de publicaciones de algunas temáticas como por ejemplo, la visión que los ancianos tienen del cuidado que les es dispensado. Conclusión: Se propone la realización de nuevos estudios para evaluar el proceso de envejecer desde la percepción de los mismos que lo viven–los ancianos, como también la especificación de la autoría, y una mayor riqueza de procedimientos metodológicos.

Through an integrative revision of literature, it is considered to analyze the characteristics and particularitities of publications being involved the Theory of the Social Representations in the scope of the aging. Method: After analysis of the publications from 2003 to 2009, the final sample consisted of 23 publications, 11 in the database 12 in Lilacs and Scielo. Results: It was observed absence of excellent information so that the studies could be developed, amongst these can cite: not the specification of the formation of the author, the place and type of study and of the used boarding, as well as, the publication scarcity of some thematic ones as of the vision that the aged ones have of the care they excused. Conclusion: It is proposed that further studies are developed to evaluate the aging under one's perception of him that lives - the elderly, as well as the specification of authorship and a richness of methodological procedures.

Sentidos associados à violência para idosos e profissionais / Meanings associated with violence for elderly and professionals / Significados asociados con la violencia a las personas mayores y profesionales

Objetivos: Conhecer os sentidos associados à violência segundo os idosos e os profissionais. Métodos: Pesquisa exploratória comabordagem qualitativa, realizada no serviço de curadoria do cidadão/delegacia especializada, na cidade de João Pessoa-PB, através deuma entrevista semiestruturada com 30 idosos e 4 profissionais que atendem o idoso vitimado. Os dados obtidos das entrevistas foram processados pelo programa informático Alceste 4.8. Resultados: Os dados foram constituídos por um corpus correspondente a 34 entrevistas, com 86,87 por cento de aproveitamento, apontando para duas grandes classes: sentidos atribuídos a violência pelos idosos;profissionais e impacto da violência na vida do idoso segundo os sujeitos entrevistados. Conclusão: Os maus-tratos e a negligência contraos idosos constituem um grave problema, ainda não diagnosticado em toda a sua extensão, sobretudo no âmbito familiar e institucional,merecendo, portanto, maior atenção de órgãos governamentais e não governamentais.