RESUMO
ABSTRACT Objective: To evaluate the adequacy of the documentation of referral forms for sexually abused females aged 13-19 years directed to the Sexual Assault Follow-up and Evaluation (SAFE) Clinic at the Agape Family Medicine Clinic, Nassau, The Bahamas, for interim management. Methods: An approved review was performed on 123 referral forms regarding sexually abused females aged 13-19 years who attended the SAFE Clinic from 2011 to 2015. The exercise focussed on documentation adequacy based on a scoring system developed by the researchers (> 50% was assessed to be adequate; records of the referee's disposition of the patient, the date of the incident and evidence of sexually transmitted infection (STI) screening were considered vital for adequacy). Descriptive and inferential statistics were calculated. Results: The median age of the participants was 14 years (interquartile range: 13-15). Of the 63.4% (78) with documented nationality, 88.5% (69) were Bahamian and 11.5% (9) Haitian. Documentation status did not differ statistically significantly by nationality. Regarding documentation, 74% (91) recorded the name of the patient's school, 59.3% (73) recorded that the patient knew the assailant and 17.9% (22) indicated that the patient did not know the assailant, while 22.8% (28) did not document this latter information. Type of sexual penetration was indicated by 65.9% (81). Of the vital variables, 18.7% (23) recorded the referee's disposition of the patient, 29.8% (36) the date of the incident and 60.2% (74) evidence of STI screening; 7.3% (9) documented all three and 22.8% (28) two. The mean percentage of documentation for vital variables was 49.3% (± 3.6) for the Accident and Emergency (A&E) Department, Princess Margaret Hospital, Nassau, versus 30.5% (± 4.0) for public health clinics (PHCs) (p = 0.001). Overall, 69.9% (86 of 123) of the referral forms were deemed inadequate: 64.7% (33 of 51) from the A&E Department versus 73.4% (47 of 64) from PHCs among the 115 patients who provided referral information. Conclusion: Documentation deficiencies of the sexual abuse referral forms demand reform. Complete and consistent documentation is required.
RESUMEN Objetivo: Evaluar la idoneidad de la documentación de los formularios de remisión para mujeres de 13 a 19 años sexualmente abusadas, dirigidas a la Clínica de Evaluación y Seguimiento de Agresiones Sexuales (ESAS) en la Clínica Ágape de Medicina Familiar, Nassau, Bahamas, para la administración interina. Métodos: Se aprobó una revisión para examinar 123 formularios de remisión con respecto a las mujeres de 13 a 19 años sexualmente abusadas, que asistieron a la clínica de ESAS de 2011 a 2015. El ejercicio se centró en la idoneidad de la documentación basada en un sistema de puntuación desarrollado por los investigadores (50% fue adecuado según la valoración; los registros de la disposición de la paciente en el arbitraje, la fecha del incidente y la evidencia del tamizaje de la infección de transmisión sexual (ITS), fueron todos vitales a la hora de determinar la idoneidad). Se calcularon las estadísticas descriptivas e inferenciales. Resultados: La edad promedio de las participantes fue 14 años (rango intercuartil: 13-15). De 63.4% (78) con nacionalidad documentada, el 88.5% (69) fueron bahameñas y el 11.5% (9) haitianas. El estado de la documentación en término de las estadísticas no difirió significativamente por nacionalidad. Con respecto a la documentación, el 74% (91) registró el nombre de la escuela de la paciente, 59.3% (73) registró que la paciente conocía al agresor, y el 17.9% (22) indicó que la paciente no conocía al agresor, mientras que el 22.8% (28) no documentó esta última información. El tipo de penetración sexual fue indicado por 65.9% (81). De las variables vitales, 18.7% (23) registró la disposición de la paciente en el arbitraje, 29.8% (36) la fecha del incidente, y el 60.2% (74) evidencia del tamizaje de las ITS; 7.3% (9) documentó tres de ellas y 2.8% (28) dos. El porcentaje medio de documentación de las variables vitales fue 49.3% (± 3.6) para el Departamento de Accidentes y Emergencias (A&E), Hospital Princess Margaret, Nassau, frente al 30.5% (± 4.0) de las clínicas de salud pública (CSP) (p = 0.001). En general, el 69.9% (86 de 123) de los formularios de referencia se consideró inadecuado: 64.7% (33 de 51) del Departamento de A&E frente al 73.4% (47 de 64) de las CSP entre las 115 pacientes que proporcionaron la información de la remisión. Conclusión: Las deficiencias de la documentación de los formularios de remisión de abuso sexual exigen reformas. Se requiere una documentación completa y consistente.
Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Encaminhamento e Consulta/normas , Delitos Sexuais , Prontuários Médicos/normas , Violência contra a Mulher , Auditoria ClínicaRESUMO
OBJECTIVE: To evaluate the adequacy of the documentation of referrals for sexually abused females ages 1319 years directed to the Agape Family Medicine Clinic for interim management. SUBJECTS AND METHODS: An approved review was performed on 123 referral forms regarding sexually abused females 1319 years old who attended Agapes Sexual Assault Follow-up and Evaluation (SAFE) clinic, Nassau, Bahamas. The exercise focussed on documentation adequacy based on a scoring system developed by the researchers: > 50% was assessed to be adequate, and recording disposition, date of incident and sexually transmitted infection (STI) screening was considered vital for adequacy. A current version of Statistical Package for the Social Sciences (IBM SPSS, v 21) generated descriptive and inferential statistics. RESULTS: Participants median age was 14 (IQR: 13, 15) years old. Of 63.4% (n = 78) with documented nationality, 88.5% (n = 69) were Bahamian and 11.5% (n = 9) Haitian. Documentation status did not differ statistically significantly by nationality. Regarding documentation, 74% (n =91) recorded school, 59.3% (n = 73) recorded knowing the assailant and 17.9% (n = 22) indicated not knowing. Approximately two-thirds (65.9%; n = 81) indicated penetration type; 18.7% recorded disposition, 29.8% (n =36) incident date and 60.2% STI screening; 7.3% (n = 9) documented all three and 22.8% (n = 28) two. Among public health clinics (PHCs), 45.3% (n = 29) did not indicate any of the three vital variables versus 7.8% (n = 4) for Accident and Emergency (A&E) referrals. Mean percent documentation for vital variables was 49.3 (± 3.6)%for A&E versus 30.5 (± 4.0)% for PHCs (p = 0.001). CONCLUSION: The deficient documentation status of referral forms demands the need for reform. Complete, consistent documentation is required.
Assuntos
Humanos , Feminino , Violência contra a Mulher , Disfunções Sexuais Psicogênicas , BahamasRESUMO
BACKGROUND: How body composition, specifically skeletal muscle mass, compares in Mexican elderly to other ethnic groups has not previously been reported. We tested the hypothesis that older adults from Northwest Mexico (Mex) would have similar total appendicular skeletal muscle (TASM) compared with New York dwelling Caucasians (Cauc) and African-Americans (AA). METHODS: Two hundred and eighty nine Mex (135 males and 154 females), 166 AA (36 males and 130 females) and 229 Cauc (64 males and 165 females), aged 60-98 years were assessed. Total and regional fat and lean tissues were measured by whole-body dual energy X-ray absorptiometry where TASM is the sum of arm and leg bone-free and fat-free lean tissue. Differences in TASM were tested by ANCOVA, with age, height, and body mass index (BMI) as covariates. RESULTS: TASM adjusted for ethnicity, age, height and BMI, were 22.6 +/- 0.2 kg and 17.8 +/- 0.1 kg for males and females, respectively (p < 0.001). Among males with similar age, height, and BMI, Mex had less TASM compared with AA and Cauc (p < 0.001). Total body fat and truncal fat were higher (p < 0.001) and FFM lower (p < 0.001) in Mex compared to both AA and Cauc males after adjusting for age and BMI. Among females, Mex had higher total and truncal fat (p < 0.001) after adjusting for age and BMI, and significantly lower TASM (p < 0.001) after adjusting for age, height, and BMI compared to AA and Cauc females. CONCLUSIONS: Elderly Mex have a different body composition compared with AA and Cauc of a similar BMI and age. Mex have significantly less TASM with greater total and truncal fat. In the long-term, Mex elderly may be at greater risk for sarcopenic obesity compared to other ethnic groups.
Assuntos
Negro ou Afro-Americano , Composição Corporal/fisiologia , Índice de Massa Corporal , Americanos Mexicanos , População Branca , Absorciometria de Fóton , Tecido Adiposo/anatomia & histologia , Tecido Adiposo/metabolismo , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Composição Corporal/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/metabolismo , Obesidade/etnologia , Obesidade/etiologia , Obesidade/genéticaRESUMO
The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.
Assuntos
Infecções por HIV/psicologia , Doenças do Sistema Nervoso Periférico/terapia , Assunção de Riscos , Autocuidado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Antirretrovirais/efeitos adversos , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/psicologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taiwan/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Peripheral neuropathy is the most common neurological complication in HIV and is often associated with antiretroviral therapy. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of peripheral neuropathy in HIV disease, sociodemographic and disease-related correlates and self-care strategies. A convenience sample of 1,217 respondents was recruited from data collection sites in several US cities, Puerto Rico, Colombia and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified 20 self-care behaviors including complementary therapies, use of medications, exercise and rest and/or elevation of extremities. Ratings of frequency and effectiveness were also included. An activities checklist summarized into five categories of self-care behaviors including activities/thoughts, exercise, medications, complementary therapies and substance was used to determine self-care behaviors. Taking a hot bath was the most frequent strategy used by those with peripheral neuropathy (n=292) and received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.1 (scale 1-10). Other self-care strategies to manage this symptom included: staying off the feet (n=258), rubbing the feet with cream (n=177), elevating the feet (n=236), walking (n=262), prescribed anti-epileptic agent (n=80), prescribed analgesics (n=84), over-the-counter medications (n=123), vitamin B (n=122), calcium supplements (n=72), magnesium (n=48), massage (n=156), acupuncture (n=43), reflexology (n=23) and meditation (n=80). Several behaviors that are often deemed unhealthy were included among the strategies reported to alleviate peripheral neuropathy including use of marijuana (n=67), cigarette smoking (n=139), drinking alcohol (n=81) and street drugs (n=30).
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doenças do Sistema Nervoso Periférico/terapia , Autocuidado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/terapia , Atitude Frente a Saúde , Colômbia/epidemiologia , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/uso terapêutico , Doenças do Sistema Nervoso Periférico/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fumar/terapia , Taiwan/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Seven genes were assigned by molecular cytogenetic methods to bovine chromosome 5. To accomplish this, specific primers were either publicly available or were designed from highly conserved regions of the publicly available mammalian gene sequences. The identity of the amplified segments was verified by sequencing and alignment with the published sequences. The optimized primers that amplified the desired bovine genes were used for screening a bovine bacterial artificial chromosome library. The positive clones were localized to a specific band of bovine chromosome 5 by fluorescence in situ hybridization. The genes HOXC4, SP1 and IGFBP6 were localized to band q21, COL2A1 was localized to bands q21-q23, IGF1 was localized to band q26, MB to band q31 and the gene CYP2D6 was localized to band q35. The cytogenetic assignment of SP1, IGFBP6, COL2A1, IGF1, MB and CYP2D6 is first reported here and the assignment of HOXC4 refines the previous assignment of this gene. The identification and localization of these genes further support the development of the human to bovine comparative map through characterizing the homologous segments conserved in the evolution of these species. This information will be useful for the future localization of genes that affect economically important traits in bovines
Assuntos
Humanos , Animais , Bovinos/genética , Mapeamento Cromossômico/veterinária , Característica Quantitativa Herdável , Análise de Sequência de DNA/métodos , Análise de Sequência de DNA/veterinária , Cromossomos Artificiais Bacterianos/genética , Hibridização in Situ Fluorescente , Mapeamento Cromossômico/métodos , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: To determine whether children with homozygous sickle cell anemia (SCD) who have silent infarcts on magnetic resonance imaging (MRI) of the brain are at increased risk for overt stroke. METHODS: We selected patients with homozygous SCD who (1) enrolled in the Cooperative Study of Sickle Cell Disease (CSSCD) before age 6 months, (2) had at least 1 study-mandated brain MRI at age 6 years or older, and (3) had no overt stroke before a first MRI. MRI results and clinical and laboratory parameters were tested as predictors of stroke. RESULTS: Among 248 eligible patients, mean age at first MRI was 8.3 +/- 1.9 years, and mean follow-up after baseline MRI was 5.2 +/- 2.2 years. Five (8.1%) of 62 patients with silent infarct had strokes compared with 1 (0.5%) of 186 patients without prior silent infarct; incidence per 100 patient-years of follow-up was increased 14-fold (1.45 per 100 patient-years vs 0.11 per 100 patient-years, P =.006). Of several clinical and laboratory parameters examined, silent infarct was the strongest independent predictor of stroke (hazard ratio = 7.2, P =.027). CONCLUSIONS: Silent infarct identified at age 6 years or older is associated with increased stroke risk.
Assuntos
Anemia Falciforme/complicações , Infarto do Miocárdio/complicações , Acidente Vascular Cerebral/etiologia , Criança , Humanos , Lactente , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Fatores de RiscoRESUMO
OBJECTIVES: To compare the results of serial neuropsychologic testing in children with sickle cell disease with the results of serial magnetic resonance imaging (MRI) examinations, particularly to evaluate neuropsychologic function in the absence of overt stroke. STUDY DESIGN: In the Cooperative Study of Sickle Cell Disease, serial neuropsychologic and MRI tests were performed in 373 patients (255 with hemoglobin SS and 118 with hemoglobin SC), 6 to 18 years of age. MRI of the brain and a neuropsychologic battery that included the Wechsler Intelligence Scale for Children (WISC-R or WISC-III) and the Woodcock-Johnson Math and Reading Achievement Tests were performed concurrently and repeated every 2 to 3 years. A silent infarct was defined as an MRI finding of increased signal intensity on T(2) imaging in a patient without a history of stroke. RESULTS: Twenty-seven patients, all with hemoglobin SS, had overt strokes and 62 had silent infarcts (52 with hemoglobin SS). Patients with hemoglobin SS and silent infarcts had significantly lower scores for math and reading achievement, Full-Scale IQ, Verbal IQ, and Performance IQ, when compared with those with normal MRI findings. In children with hemoglobin SS and normal MRI findings, the scores for Verbal IQ, math achievement, and coding (a subscale of Performance IQ) declined with increasing age. CONCLUSIONS: School-aged children with sickle cell disease had compromised neuropsychologic function in the presence of silent infarcts. In addition, they had declines in performance in certain areas of function over time. Therapeutic interventions that prevent or lessen cognitive impairment are needed before school entry for children with sickle cell disease.
Assuntos
Anemia Falciforme/complicações , Infarto do Miocárdio/complicações , Testes Neuropsicológicos , Escalas de Wechsler , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/complicaçõesRESUMO
Two bovine BAC clones were identified by PCR as containing the bovine gene PRKCI. Both clones were assigned by FISH to bands q34-->q36 on BTA1. The sequence information derived from genomic DNA and from both clones was identical and showed a high degree of homology to human PRKCI (HSAXq21.3, 95.5% homology), and mouse Prkcl (MMU3, 13.8 cM, 87.6% homology) and rat Prkcl (88.8% homology). This assignment could suggest a disruption of the synteny conservation of mammalian X-linked genes, but most likely suggests a misassignment of this gene to the human X.
Assuntos
Cromossomos Humanos Par 3/genética , Hibridização in Situ Fluorescente , Isoenzimas/genética , Mapeamento Físico do Cromossomo , Proteína Quinase C/genética , Sintenia/genética , Cromossomo X/genética , Animais , Bovinos , Humanos , Camundongos , Ratos , Reprodutibilidade dos Testes , Homologia de Sequência do Ácido NucleicoAssuntos
Adenilil Ciclases/genética , Bovinos/genética , Hormônio Foliculoestimulante/genética , Globinas/genética , Animais , Mapeamento Cromossômico , Cromossomos/genética , Cromossomos Bacterianos/genética , Clonagem Molecular , Subunidade beta do Hormônio Folículoestimulante , Hibridização in Situ Fluorescente , Isoenzimas/genéticaRESUMO
Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.
Assuntos
Atrofia Muscular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Antropometria , Composição Corporal , Índice de Massa Corporal , Estudos Transversais , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Hispânico ou Latino , Humanos , Modelos Logísticos , Masculino , New Mexico/epidemiologia , Prevalência , Distribuição Aleatória , População BrancaRESUMO
OBJECTIVES: To test the hypothesis that in a healthy pediatric population body mass index (BMI) (kilograms per meter square) is a valid measure of fatness that is independent of age for both sexes. METHODS: Total body fat (TBF) (in kilograms) and percent of body weight as fat (PBF) were estimated by dual energy x-ray absorptiometry (DXA) in 198 healthy Italian children and adolescents between 5 and 19 years of age. We developed multiple regression analysis models with TBF and percent body fat as dependent variables and BMI, age, and interaction terms as independent variables. Separate analyses were conducted for boys and girls. RESULTS: BMI was strongly associated with TBF (R2 = 0.85 and 0.89 for boys and girls, respectively) and PBF (R2 =0.63 and 0.69 for boys and girls, respectively). Confidence limits on BMI-fatness association were wide, with individuals of similar BMI showing large differences in TBF and in PBF. Age was a significant covariate in all regression models. Addition of nonlinear terms for BMI did not substantially increase the R2 for TBF and PBF models in boys and girls. CONCLUSION: Our results support the use of BMI as a fatness measure in groups of children and adolescents, although interpretation should be cautious when comparing BMI across groups that differ in age or when predicting a specific individual's TBF or PBF.
Assuntos
Índice de Massa Corporal , Obesidade/diagnóstico , Absorciometria de Fóton , Adolescente , Adulto , Composição Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Análise de Regressão , Reprodutibilidade dos TestesRESUMO
This article examines the evolution of the current international system for responding to refugee problems and the climate within which the legal and institutional framework has developed. It reviews the background and handling of some of the key refugee movements since World War II and traces the legal and institutional adjustments that have been made to deal with new refugee movements that have occurred predominantly, but not exclusively, in the developing world. Finally, it assesses the adequacy of the present system to meet the challenges ahead.
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Emigração e Imigração , Cooperação Internacional , Política Pública , Refugiados , Nações Unidas , África , América , Ásia , Sudeste Asiático , Ásia Ocidental , América Central , Demografia , Europa (Continente) , Agências Internacionais , América do Norte , Organização e Administração , Organizações , População , Dinâmica Populacional , MigrantesRESUMO
We analyzed 178 episodes of bacteremia that occurred during 13,771 patient-years of follow-up of 3451 patients with sickle hemoglobinopathies. Age-specific incidence rates of bacteremia were calculated for patients with sickle cell anemia (SS) and sickle cell-hemoglobin C (SC) disease. The incidence rate was highest among children with SS and SC younger than age 2 years. Children with SC showed an abrupt decrease after age 2 years, whereas children with SS had a gradual decline in rate from 2 to 6 years of age. The predominant pathogen in patients younger than 6 years was Streptococcus pneumoniae (66%); gram-negative organisms were responsible for 50% of bacteremias in patients 6 years and older. Urinary tract infection was present during 73% of Escherichia coli bacteremias, and 77% of Salmonella bacteremias were associated with osteomyelitis. In contrast, no focus of infection was present in 52% of pneumococcal bacteremias. The incidence of pneumococcal bacteremia in children with SS younger than age 3 years was 6.1 events/100 patient-years; the case fatality rate for pneumococcal sepsis in this age group was 24%. No hematologic or demographic variables were associated with occurrence of pneumococcal bacteremia in young children. Retrospective analysis of pneumococcal bacteremia suggests that the prophylactic use of penicillin may decrease the incidence in children younger than 3 years of age.