Sensitivity and specificity of tuberculosis signs and symptoms screening and adjunct role of social pathology characteristics in predicting bacteriologically confirmed tuberculosis in Myanmar.

BACKGROUND: Globally, using tuberculosis signs and symptoms (TB-SS) as a screening tool has become less important due to its low sensitivity and specificity. We analyzed data from the Myanmar National Tuberculosis (TB) prevalence survey in 2010. The various TB screening models were developed to predict TB by using logistic regression analysis, and their performance on TB prediction was compared by the measures of overall performance, calibration and discrimination ability, and sensitivity and specificity to determine whether social pathology characteristics could be used as a TB screening tool. RESULTS: Among 51,367 participants, 311 (0.6%) had bacteriologically confirmed TB, of which 37.2% were asymptomatic and 2% had a normal chest X-ray. Out of 32 various combinations of signs and symptoms, having any signs and symptoms gave the best sensitivity of 59.8% and specificity of 67.2%, but chest X-ray (CXR) alone gave the highest sensitivity (95.1%) and specificity (86.3%). The next best combination was cough only with a sensitivity of 24.4% and specificity of 85%. Other combinations had poor sensitivity (< 10%). Among various TB screening models, the overall performance R2 was higher in the combined models of social pathology and TB signs and symptoms as well as the social pathology model, compared to TB-SS models (> 10% versus < 3%), although all TB screening models were perfect to predict TB (Brier score = 0). The social pathology model shows a better calibration, more closer to 45° line of calibration plot with Hosmer-Lemeshow test p value = 0.787, than the combined models while it had a better discrimination ability in area under the curve, AUC = 80.4%, compared to TB-SS models with any signs and symptoms, AUC = 63.5% and with any cough, AUC = 57.1% (DeLong p value = 0.0001). Moreover, at the propensity score cutoff value ≥ 0.0053, the combined and social pathology models had sensitivity of ~ 80% and specificity of ~ 70%. The highest population attributable fraction to predict TB by social pathology characteristics was male gender (42.6%), age ≥ 55 years (31.0%), and underweight (30.4%). CONCLUSION: Over one-third of bacteriologically confirmed TB was asymptomatic. The conventional TB-SS screening tool using any TB signs and symptoms had a lower sensitivity and specificity compared to CXR and social pathology screening tools. The social pathology characteristics as TB screening tool had good calibration and can improve the discrimination ability to predict TB than TB-SS screenings and should be encouraged.

Simple pain measures reveal psycho-social pathology in patients with Crohn's disease.

AIM: To determine whether pain has psycho-social associations in adult Crohn's disease (CD) patients. METHODS: Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables. RESULTS: The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain. CONCLUSION: Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Mudando de posição subjetiva diante da corrupção. Uma análise do filme Sindicato de ladrões / Changing the subjective position towards corruption. An analysis of the film On the Waterfront / Cambio de posición subjetiva frente a la corrupción. Un análisis de la película Nido de ratas / Changer sa position subjective face à la corruption. Une analyse du film Sur les quais

A autora aborda a corrupção como um processo que se produz e se perpetua no entrecruzamento de três espaços psíquicos: a) individual, em que um sujeito com fortes traços paranoicos acede a uma posição de poder; b) intersubjetivo, no qual a pessoa que tem poder "enlouquece" com a ajuda das pessoas com quem convive; e c) transubjetivo, em que a desqualificação da lei é instituída e se transforma em uma cultura. Usa o filme Sindicato de ladrões (On the Waterfront, Kazan, 1954) como "material clínico" cuja análise mostra a desconstrução desse processo. Conclui que, tal como no processo analítico, a "cura" dessa patologia social se apoia na transferência com uma ou mais figuras que encarnam a lei, o que permite a mudança de posição subjetiva dos atores sociais.

The author understands corruption as a process that is produced and perpetuated in the intersection of three psychic spaces: a) individual, in which a subject with strong paranoid traits holds a position of power; b) intersubjective, in which the person who holds power "goes crazy" with the help of people with whom he/she gets along; c) transsubjective, in which the disqualification of law is established and becomes a culture. The author uses the film On the Waterfront (Kazan, 1954) as "clinical material" whose analysis shows the deconstruction of this process. She concludes that, as in the psychoanalytic process, the "cure" of this social pathology is based on transference with a figure who embodies law. This transference allows social actors to change their subjective position.

La autora aborda la corrupción como un proceso que se produce y se perpetúa en la intersección de tres espacios psíquicos: a) individual, en el cual un sujeto con fuertes rasgos paranoicos accede a una posición de poder; b) intersubjetivo, en el que la persona que tiene el poder "se vuelve loca" con ayuda de las personas con las que convive; c) institucional, donde la descalificación de la ley es instituida y se convierte en una cultura. Utiliza la película Nido de ratas (On the Waterfront, 1954) como "material clínico" cuyo análisis muestra la deconstrucción de este proceso. Llega a la conclusión que, como en el proceso de análisis, la "cura" de esta patología social se apoya en la transferencia con una o más figuras que encarnan la ley, permitiendo el cambio de posición subjetiva de los actores sociales.

L'auteur aborde la corruption comme un processus qui se produit et se perpétue dans le carrefour de trois espaces psychiques: a) l'individuel, où le sujet ayant des forts traits paranoïaques accède à une position de pouvoir; b) l'intersubjectif, dans lequel celui qui a le pouvoir devient "fou", avec l'aide de son entourage; et c) le transubjectif, où la disqualification de la loi est instituée et devient une culture. Il utilise le film Sur les quais (On the Waterfront, Kazan, 1954) comme un "outil clinique" dont l'analyse montre la déconstruction de ce processus. Il conclue que, ainsi que le processus analytique, la "cure" de cette pathologie sociale s'étaye sur le transfert, ayant une ou plus figures qui incarnent la loi, ce qui permet le changement de la position subjective des acteurs sociaux.

Mudando de posição subjetiva diante da corrupção: Uma análise do filme Sindicato de ladrões / Changing the subjective position towards corruption: An analysis of the film On the Waterfront / Cambio de posición subjetiva frente a la corrupción: Un análisis de la película Nido de ratas / Changer sa position subjective face à la corruption: Une analyse du film Sur les quais

A autora aborda a corrupção como um processo que se produz e se perpetua no entrecruzamento de três espaços psíquicos: a) individual, em que um sujeito com fortes traços paranoicos acede a uma posição de poder; b) intersubjetivo, no qual a pessoa que tem poder "enlouquece" com a ajuda das pessoas com quem convive; e c) transubjetivo, em que a desqualificação da lei é instituída e se transforma em uma cultura. Usa o filme Sindicato de ladrões (On the Waterfront, Kazan, 1954) como "material clínico" cuja análise mostra a desconstrução desse processo. Conclui que, tal como no processo analítico, a "cura" dessa patologia social se apoia na transferência com uma ou mais figuras que encarnam a lei, o que permite a mudança de posição subjetiva dos atores sociais.

The author understands corruption as a process that is produced and perpetuated in the intersection of three psychic spaces: a) individual, in which a subject with strong paranoid traits holds a position of power; b) intersubjective, in which the person who holds power "goes crazy" with the help of people with whom he/she gets along; c) transsubjective, in which the disqualification of law is established and becomes a culture. The author uses the film On the Waterfront (Kazan, 1954) as "clinical material" whose analysis shows the deconstruction of this process. She concludes that, as in the psychoanalytic process, the "cure" of this social pathology is based on transference with a figure who embodies law. This transference allows social actors to change their subjective position.

La autora aborda la corrupción como un proceso que se produce y se perpetúa en la intersección de tres espacios psíquicos: a) individual, en el cual un sujeto con fuertes rasgos paranoicos accede a una posición de poder; b) intersubjetivo, en el que la persona que tiene el poder "se vuelve loca" con ayuda de las personas con las que convive; c) institucional, donde la descalificación de la ley es instituida y se convierte en una cultura. Utiliza la película Nido de ratas (On the Waterfront, 1954) como "material clínico" cuyo análisis muestra la deconstrucción de este proceso. Llega a la conclusión que, como en el proceso de análisis, la "cura" de esta patología social se apoya en la transferencia con una o más figuras que encarnan la ley, permitiendo el cambio de posición subjetiva de los actores sociales.

L'auteur aborde la corruption comme un processus qui se produit et se perpétue dans le carrefour de trois espaces psychiques: a) l'individuel, où le sujet ayant des forts traits paranoïaques accède à une position de pouvoir; b) l'intersubjectif, dans lequel celui qui a le pouvoir devient "fou", avec l'aide de son entourage; et c) le transubjectif, où la disqualification de la loi est instituée et devient une culture. Il utilise le film Sur les quais (On the Waterfront, Kazan, 1954) comme un "outil clinique" dont l'analyse montre la déconstruction de ce processus. Il conclue que, ainsi que le processus analytique, la "cure" de cette pathologie sociale s'étaye sur le transfert, ayant une ou plus figures qui incarnent la loi, ce qui permet le changement de la position subjective des acteurs sociaux.

Retos de salud al finalizar el segundo milenio: epidemiología conceptual, patología clínica, medicina y ética profesional / Challenge of health to finish the second milennium: conceptual epidemiology, social patology, professional and medical ethics

En este artículo se destaca la labor que le cupo al doctor Bustamante en el combate de enfermedades como la fiebre amarilla, el tifo, el paludismo y la viruela; y el desarrollo e impulso que este profesional dio a la medicina preventiva y social. En él se sostiene que el trabajador de la salud debe ser hoy un elemento altamente informado y formado, con el fín de dominar todo lo relacionado con la salud pública; pero también un agente de cambio, las responsables de reubicar al hombre en el punto de equilibrio relativo a su salud. Equilibrio no sólo se encuentra alterado en su aspecto biopsicosocial, sino que constituye un llamado a los médicos a luchar juntos para responder a la humanidad que ha puesto en ellos su confianza, pues el problema actual de drogas y dependencia de las mismas desquicia todo orden de valores. Para el Doctor Suárez es inadmisible que existan aún, con los avances tecnológicos que hay en el mundo, muertes por diarreas o neumonía. Se teme por los peligros del siglo: la guerra nuclear y el SIDA, pero se confía en las características que han distinguido y permitido la sobrevivencia y superación de la especie humana: la actividad mental, la capacidad de juicio y la conciencia, valiosas para una discusión filosófica profunda que permita continuar el avance. Se hace una enumeración de los logros de la medicina de este siglo.

In this article it is outlined the work of doctor Bustamante in fighting against diseases such as yellow fever, typhus, malaria, and smallpox; and the development and impel that this professional gave to preventive and social medi­cine is pointed out. It is estabilished that health care professionals currently must not only highly studied and prepared, as they should manage all features related with public health, but also change-men-and-women who are capable to influence future generations, which will be the responsibles in relocating men at the equilibrium point concerned to their health. Said equilibrium point is not only modified in its biopsychosocial aspect, but also its essence is deeply afected. This paper is a warning to physicians to fight together in response to humanity, that has set their confidence in them, as the current problem of drugs and dependence to drugs unhinges everything wholeness. To doctor Suarez is intolerable that, in spite of technological advances in the world, yet exist deaths caused by pneumonia or diarrhea. The hazards of the century are frightened: nuclear war and AIDS; but the characteristics that have distinguished human species and allowed its survival and superation are trusted: mental activity, hability of judgement, and conscious ness; which are valuable for a deep phylosophic discus­sion that allows us to continue our advance. An enumera­tion of the medicine achievements in this century is made.