RESUMO
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To describe the characteristics of patients with work-related traumatic spinal cord injuries (TSCI) in Chile. SETTING: Hospital del Trabajador in Santiago, Santiago, Chile. METHODS: Patients suffering from TSCI incurred at the workplace from 1986 to 2005 were identified through records of the Asociación Chilena de Seguridad (ACHS, Chilean Safety Association). RESULTS: The medical records of 173 patients, 172 men and 1 woman, were analyzed. The yearly average incidence was 7.8 per million workers. Age at TSCI onset was 38.2 ± 12.1 years. The principal external causes for TSCI incurred at the workplace were falls from a height in 86 cases (49.7%) and trauma blows to the vertebral spine in 61 cases (35.3 %). More falls occurred in the field construction, and other traumas occurred as a result of traumatic blows caused by tree trunks and stones in forestry and mining sectors. Mortality in this series was 8.7%, and the worst prognosis was for older patients with complete tetraplegia. The paraplegia:tetraplegia ratio was 3.2:1. CONCLUSIONS: The characteristics of workplace TSCI are specific to this population. It is important therefore to develop prevention programs for specific work-related TSCI.
Assuntos
Doenças Profissionais/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Chile/epidemiologia , Estudos de Coortes , Feminino , Agricultura Florestal , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mineração , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/epidemiologia , Adulto JovemRESUMO
AIMS: The goals of this study were to (1) estimate the prevalence of HIV infection among women accessing services at a women's health center in rural Haiti and (2) to identify economic risk factors for HIV infection in this population. METHODS: Women who accessed healthcare services at this center between June 1999 and December 2002 were recruited to participate. The analysis was based on data from a case-control study of sexually transmitted diseases (STDs) in rural Haiti. HIV prevalence in the study population was 4%. RESULTS: In multivariate analyses, partner occupation was associated with HIV infection in women, with mechanic (OR 9.0, 95% CI 1.8-45) and market vendor (OR 4.2, 95% CI 1.6-11) reflecting the strongest partner occupational risk factors. Partner's occupation as a farmer reduced the risk of infection in women by 60% (95% CI 0.14-1.1). Factors indicating low socioeconomic status (SES), such as food insecurity (OR 2.0, 95% CI 0.75-5.6) and using charcoal for cooking (OR 1.7, 95% CI 0.72-3.8) suggested an association with HIV infection. CONCLUSIONS: Given pervasive gender inequality in Haiti, women's economic security often relies on their partners' income earning activities. Our findings show that although factors reflecting poverty are associated with HIV-positive status, stronger associations are observed for women whose partners indicated a more secure occupation (e.g., mechanic or market vendor). Policies and programs that expand access to education and economic opportunities for women and girls may have long-term implications for HIV prevention in Haiti and other resource-poor settings.
Assuntos
Infecções por HIV/epidemiologia , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Área Programática de Saúde/economia , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Haiti/epidemiologia , Política de Saúde , Humanos , Ocupações , Pobreza , Fatores de Risco , Parceiros SexuaisRESUMO
STUDY DESIGN: Case control study. OBJECTIVE: To determine the main risk factors for pressure ulcer (PU) in ambulatory spinal cord injury (SCI) patients. SETTING: Hospital del Trabajador, Santiago, (ACHS (Chilean Security Association), Chile. METHODS: We studied 41 patients for traumatic SCI, from Santiago, Chile, cared for in our hospital. The clinical histories were reviewed from first discharge to 1996. The patients were categorized into two groups: 18 cases with a previous history of PU, and 23 patients with no history of PU were considered as controls. Univariate analysis was performed, 18 variables per case, 10 of which were psychosocial factors. RESULTS: There were 37 men and four women. Average age was 41.7 years. Duration of SCI on average was 6.7 years. The distribution was complete paraplegia (CPP) 22 patients (54%), complete tetraplegia three patients (7%), incomplete paraplegia 11 patients (27%) and incomplete tetraplegia, five patients (12%). Four variables of the univariate analysis were significant: duration of cord injury (SCI time) >5 years, completeness of cord injury, paraplegia and not able to practice regular standing. There was a significant association in body morphology (endo or ectomorphic), being able to practice regular standing and personality disorder in CPP. CONCLUSIONS: The risk for developing PU was 4.3 times greater in CPP patients than is any other type of SCI. CPP patients who do not practice standing periodically, who have a personality disorder and have an ecto/endomorphic corporal morphology have a greater risk of suffering PU.
Assuntos
Úlcera por Pressão/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia , Úlcera por Pressão/prevenção & controle , Análise de Regressão , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3% of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100% of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.
Assuntos
Divertículo de Zenker/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3
of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100
of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.
RESUMO
OBJECTIVE: The objective of this clinical study was to determine the effects of sex steroids on behavior and mood in adolescents with hypogonadism. STUDY DESIGN: The experimental design consisted of a randomized, double-blind, placebo-controlled, crossover trial lasting for 21 months. The study group consisted of 39 boys and 16 girls recruited from a pediatric endocrine clinic for delayed puberty. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks, alternating with placebo, at 3 dose levels approximating early, middle, and late pubertal amounts. The Child Behavior Checklist, Youth Self Report, Differential Emotion Scale, and Daily Mood Diary were administered after each placebo and treatment period to ascertain the effect of sex steroids on self- and parent-reported behavior problems and moods. RESULTS: The data demonstrated only one significant treatment effect, namely, an increase in withdrawn behavior problems during administration of low-dose estrogen in girls. There were no consistent sex differences. CONCLUSION: These results demonstrate that administered testosterone or estrogen has minimal effects on behavior problems or mood in adolescents.
Assuntos
Afeto/efeitos dos fármacos , Anabolizantes/farmacologia , Anabolizantes/uso terapêutico , Estrogênios Conjugados (USP)/farmacologia , Estrogênios Conjugados (USP)/uso terapêutico , Terapia de Reposição Hormonal , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Puberdade Tardia/complicações , Puberdade Tardia/tratamento farmacológico , Testosterona/análogos & derivados , Adolescente , Adulto , Criança , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Puberdade Tardia/psicologia , Testosterona/farmacologia , Testosterona/uso terapêuticoRESUMO
We report on 21 male patients who presented after 28 days of age with ornithine transcarbamylase (OTC) deficiency, which we define as late-onset OTC deficiency. These patients appeared normal at birth, but irritability, vomiting, and lethargy, which were often episodic, later developed. The age at presentation ranged from 2 months to 44 years. Biochemical testing revealed hyperammonemia, hyperglutaminemia, hypocitrullinemia, increased urinary orotate excretion, and decreased liver OTC activity measured in vitro, which ranged from 0% to 15% of normal. Male patients who were older at presentation had a somewhat different pattern of presenting symptoms and were more likely to die. These data illustrate the phenotypic variability of OTC deficiency. Unexplained episodes of repetitive or protracted vomiting in association with progressive alterations in behavior or neurologic findings should suggest the diagnosis of a urea cycle defect (or another symptomatic inborn error of metabolism), regardless of the age or medical history of the patient.
Assuntos
Erros Inatos do Metabolismo/diagnóstico , Doença da Deficiência de Ornitina Carbomoiltransferase , Adolescente , Adulto , Criança , Pré-Escolar , Protocolos Clínicos , Humanos , Lactente , Masculino , Erros Inatos do Metabolismo/genética , Erros Inatos do Metabolismo/fisiopatologia , Linhagem , Fenótipo , Fatores Sexuais , Fatores de TempoRESUMO
In 1988-89, the use of menstrual sanitary products was surveyed among 699 white, 477 black, and 425 Mexican American women to detect age and racial or ethnic differences in product use that might explain the differences in the incidence of toxic shock syndrome (TSS) in these demographic categories. Forty percent of the women had never used tampons. Significantly more whites used tampons alone (26 percent) or with pads (36 percent) than did blacks. Proportionately more blacks used tampons alone (16 percent) or with pads (27 percent) compared with Mexican Americans, 11 percent of whom used tampons alone and 21 percent of whom used tampons and pads. Since a substantial proportion of black women used tampons, racial-ethnic variations in use patterns alone cannot completely explain the low incidence of TSS among black women. Tampon use started in the early teen years, but women in the age group 20-29 had the highest frequency of use of tampons either alone (26 percent) or with pads (33 percent). These percentages suggest that age-related differences in product use may not explain the age-related differences in the incidence of TSS. Fear was the most common specific reason for not using tampons in response to information about TSS. Decreased use of tampons in response to information about TSS was reported by 39 percent of whites, 50 percent of blacks, 46 percent of Mexican Americans, and by 36 percent of women less than 19 years, 41 percent of 20-29-year-olds, and 47 percent of women 30 years and older.
Assuntos
Produtos de Higiene Menstrual , Menstruação , Choque Séptico/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano , Fatores Etários , Criança , Feminino , Hispânico ou Latino , Humanos , Incidência , México/etnologia , Choque Séptico/etiologia , Texas/epidemiologia , População BrancaRESUMO
La rehabilitación sexual ocupa un lugar importante en el manejo del lesionado medular. Se describe el método y resultados del tratamiento de 62 casos (60 hombres y 2 mujeres) con lesión medular. En 29 pacientes (47%) bastó con una entrevista destinada a aclarar dudas, todos los hombres (27 de los 29 casos) tenían erecciones útiles y no necesitaron tratamiento específico. Otros 27 hombres se trataron sin inyección de Papaverina, consiguiendo erección eficiente en 23 (85% de eficiencia). Sólo 2 de los 60 pacientes de sexo masculino (3%) han requerido prótesis. En total se ha obtenido rehabilitación satisfactoria en 53 de 63 pacientes (85,5%)
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Disfunções Sexuais Fisiológicas/reabilitação , Traumatismos da Medula Espinal/complicações , Papaverina/uso terapêuticoRESUMO
We obtained opinions about adolescents' characteristics and behaviors from 290 employees of a medical school and its hospitals. Employees were asked for their opinions about 4 positive, 2 neutral, and 6 negative characteristics and about 5 sexual, 8 substance use, and 5 relationship behaviors. Most employees were willing to characterize adolescents in general, but fewer were willing to express opinions about white, black, Mexican-American or Oriental teens in particular. There was poor correspondence between the general adolescent ratings, the ratings of the racial-ethnic groups, and reports in the literature. The respondents, unable to accurately describe white and black teens, could not characterize Mexican-American teens and characterized Oriental teens predominantly in the category "least likely to behave this way." The data suggest that adults' stereotyping of adolescents' behaviors and characteristics is common and suggests the need for programs to better inform adults about adolescents.
Assuntos
Comportamento do Adolescente , Atitude do Pessoal de Saúde , Etnicidade/psicologia , Recursos Humanos em Hospital/psicologia , Adolescente , Adulto , Negro ou Afro-Americano , Idoso , Ásia/etnologia , População Negra , Feminino , Hispânico ou Latino , Hospitais Universitários , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Estereotipagem , Texas , População BrancaRESUMO
Cytopathologic examinations of tracheobronchial aspirates from 108 infants sampled during mechanical ventilation demonstrated a well-defined progression of cytologic changes in bronchial cells that could be divided into three classes. Seventy percent of infants with respiratory distress syndrome who developed bronchopulmonary dysplasia had pulmonary effluent cytology designated Class III; no infants with RDS but without BPD had these cytologic findings. Additionally, a temporal progression of events involving polymorphonuclear leukocyte and macrophage populations occurred in the absence of infection; these events were associated with duration of assisted ventilation and oxygen exposure. The technique described provides a useful way to monitor the progression of lung injury and repair and offers a cytologic method to predict and diagnose the development of bronchopulmonary dysplasia.
Assuntos
Brônquios/citologia , Broncopatias/classificação , Síndrome do Desconforto Respiratório do Recém-Nascido/classificação , Humanos , Recém-Nascido , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/patologia , SucçãoRESUMO
We treated 132 children with acute otitis media in a randomized trial comparing trimethoprim-sulfamethoxazole and ampicillin. The antibacterial efficacy of the drugs was assessed primarly from the results of cultures of middle ear aspirates obtained during or after the course of therapy; persistent, recurrent, and new infections of the middle ear were documented in both groups of patients but did not differ significantly. Both drug regimens were well accepted by the patients and were not associated with serious side effects or toxicity. TMP-SMZ is an effective alternate to AMP or to other accepted regimens for initial treatment of acute otitis media.