RESUMO
PURPOSE: Prompt detection of congestion is an essential target in order to prevent heart failure (HF) related hospitalization, being ambulatory monitoring a promising strategy to do so. A successful non-invasive ambulatory monitoring system requires automatic devices for physiological data recording; these data must give information about HF deterioration early enough to predict HF-related adverse events. This work aims to evaluate seven vascular parameters for the ambulatory monitoring of congestive heart failure patients. METHODS: Seven vascular parameters are proposed as indicators of HF deterioration. These parameters are obtained using venous occlusion plethysmography; a technique that uses hardware able of being miniaturized and easily integrated into wearables for ambulatory monitoring. The ability of the proposed vascular parameters to detect congestion is evaluated in eight healthy volunteers and ten congestive heart failure patients with different congestion levels-mild, moderate and severe. RESULTS: Most parameters distinguish between healthy volunteers and heart failure patients, and some of them present significant differences between volunteers and low levels of congestion-mild or moderate. CONCLUSION: Home monitoring of some of the proposed parameters could detect HF deterioration on its onset and alert to health personnel.
Assuntos
Insuficiência Cardíaca/diagnóstico , Hemodinâmica , Monitorização Ambulatorial/métodos , Pletismografia , Telemetria , Adulto , Idoso , Estudos de Casos e Controles , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Miniaturização , Modelos Cardiovasculares , Monitorização Ambulatorial/instrumentação , Pletismografia/instrumentação , Valor Preditivo dos Testes , Prognóstico , Estudo de Prova de Conceito , Índice de Gravidade de Doença , Telemetria/instrumentação , Função Ventricular Esquerda , Dispositivos Eletrônicos Vestíveis , Adulto JovemRESUMO
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Glicerofosfolipídeos/sangue , Assunção de Riscos , Comportamento Sexual , Pessoas Transgênero , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/sangue , Alcoolismo/sangue , Alcoolismo/psicologia , Biomarcadores/sangue , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Peru/epidemiologia , Autorrelato , Parceiros SexuaisRESUMO
BACKGROUND: Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS: MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS: Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS: In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Pessoas Transgênero/psicologia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Sexo sem Proteção/psicologia , Adulto JovemRESUMO
The ambulatory monitoring of biosignals involves the use of sensors, electrodes, actuators, processing tools and wireless communication modules. When a garment includes these elements with the purpose of recording vital signs and responding to specific situations it is call a 'Smart Wearable System'. Over the last years several authors have suggested that conductive textile material (e-textiles) could perform as electrode for these systems. This work aims at implementing an electrical characterization of e-textiles and an evaluation of their ability to act as textile electrodes for lower extremity venous occlusion plethysmography (LEVOP). The e-textile electrical characterization is carried out using two experimental set-ups (in vitro evaluation). Besides, LEVOP records are obtained from healthy volunteers (in vivo evaluation). Standard Ag/AgCl electrodes are used for comparison in all tests. Results shown that the proposed e-textiles are suitable for LEVOP recording and a good agreement between evaluations (in vivo and in vitro) is found.
Assuntos
Monitorização Ambulatorial/instrumentação , Têxteis , Impedância Elétrica , Eletrodos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pletismografia de Impedância/instrumentação , Fluxo Sanguíneo Regional , PrataRESUMO
Although biomedical engineering was started in Argentina about 35 years ago, it has had a sustained growth for the last 25 years in human resources, with the emergence of new undergraduate and postgraduate careers, as well as in research, knowledge, technological development, and health care.
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Engenharia Biomédica , Ocupações , Argentina , Educação Profissionalizante , HumanosRESUMO
UNLABELLED: The aim of the present study was to investigate diagnostic delay in oral cancer (OC) in two diagnosis centers in Córdoba, Argentina. Special attention was paid to the role of the patient and the professional in the diagnostic delay. METHODS: Seventy clinical records of patients with newly diagnosed oral squamous cell carcinoma were included. RESULTS: Both patients and professionals were responsible for the delay in diagnosis. This delay was longer for tumors in early stages. Multiple logistic regression analysis indicated that the professional delay was the most associated variable to the stage of tumor (P = 0.03). CONCLUSIONS: Continuing education in OC and pre-cancerous lesions is important to reduce the professional delay. The findings of the present study also indicate that 58% of the patients are partially responsible for delay in the diagnosis of OC. Intensive public promotion and educational campaigns against OC are also needed to increase patient awareness.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Bucais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Biópsia , Equipe Hospitalar de Odontologia , Diagnóstico Precoce , Feminino , Neoplasias Gengivais/diagnóstico , Humanos , Neoplasias Labiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Soalho Bucal/patologia , Estadiamento de Neoplasias , Pacientes , Estudos Retrospectivos , Fatores de Tempo , Neoplasias da Língua/diagnósticoRESUMO
Left ventricular volume calibration based on the conductance catheter depends on the correct determination of the parallel conductance (Gp). Baan's saline manoeuvre procedure leads to Gp by finding the end-systolic (Ges) and end-diastolic (Ged) conductances, for each beat of the dilution curve rising limb. After plotting such values in an xy-system, their linear regression is back-projected to intersect the identity line, so yielding an estimated Gp. The objective is to theoretically analyse all possible lines, Ges = aGed + b (Baan's line) and, based on experimental results, to establish their limitations. This was attained by calculating the regression lines using, first Ged = f1(Ges) and thereafter, Ges = f2(Ged), which led to two values, Gp2 and Gp1, for the parallel conductance. The morphology of the saline curve was also modified to assess its effect on the extrapolation. Multiple dilutions were recorded in eight experimental dogs injecting different concentrations. Each curve was classified according to the maximum change (VAR) reached by the total average conductance. Over 138 manoeuvres, 276 regressions were processed yielding correlations higher than 0.65. Of this total, 92.4% gave positive parallel conductances. The rest produced negative values and, thus, were neglected. If the two (Ged, Ges) statistical relationships were ideal, they should yield Gp = Gp1 = Gp2; however, there were differences which, when Gp1 was studied against Gp2, led to: Gp1 = 0.97 Gp2 + 0.055, with r = 0.9476, and n = 85. The remaining 53 were discarded because either some Gp values were negative, or the correlation of Ges which Ged (or vice versa) was < 0.85, and/or VAR < 15%; the two latter conditions were found necessary for reliable calibration. Baan's line high correlation is not a unique condition to ensure the accuracy and precision of Gp determination because the slope a depends on VAR and, thus, different intersections with the identity line may be obtained. Its recommended that manoeuvres be used with at least eight data points, with VAR > 15% and, finally, with (Ges, Ged) correlation better than 0.85. Theoretical analysis of Baan's line offers a reference frame, which contains only a limited number of practical possibilities.
Assuntos
Volume Cardíaco , Animais , Calibragem , Cardiografia de Impedância , Cães , Ventrículos do Coração , Modelos BiológicosRESUMO
The conductance catheter has gained momentum since its introduction in cardiovascular dynamics back in 1980. However, measuring errors are still blurring its clinical acceptance. The main objective here was to study the effects of the injected saline concentration and temperature on the evaluation of the parallel conductance, Gp, and thus, on the correction volume Vp. That conductance, Gp, and its associated volume, Vp, were computed using 167 saline dilution curves obtained with boluses at different concentrations and temperatures, injected in seven anesthetized closed-chest dogs. The excursion of the total conductance relative to the steady-state value during a saline maneuver showed good correlation with the injected concentration at both studied temperatures. The reference parallel volume (one reference per dog) was defined as the average value obtained with three successive maneuvers, at 6-M concentration and at body temperature; therefore, the method acted as its own reference. The variation of Vp relative to the reference value was clearly dependent on the injected concentration and on its temperature; dispersion was greater at 22 degrees C than at 40 degrees C. The variability would recognize also other causes, such as uncertainty of the extrapolation procedure and the thoracic redistribution of electrical field lines. As conclusion, it is recommended to characterize each maneuver by its concentration and temperature. Body temperature and 6-M concentration appear as the most recommendable combination for the injectate in most animals. Finally, these results intend to characterize the Vp estimation procedure in order to minimize errors. The variability of Vp, in different experimental conditions, demonstrated that both concentration and temperature are additional parameters that may modify the Gp estimate.
Assuntos
Cateterismo Cardíaco/métodos , Volume Cardíaco , Solução Salina Hipertônica/administração & dosagem , Temperatura , Animais , Cateterismo Cardíaco/normas , Cães , Modelos Lineares , Sístole/fisiologiaRESUMO
Para medir el perfil connotativo de las palabras y analisar las actitudes que éstas evocan se utiliza el Diferencial Semántico (D.S), de gran interés en psicología de la salud puesto que nos permite analizar las connotaciones de diversas palabras alusivas a la enfermedad. Así hemos analizado y contrastado el perfil connotativo-actitudinal que nos evocan las palabras LEPRA y SIDA, mediante un D.S de elaboración propia, según las variables, SEXO, EDAD, SER O NO PERSONAL SANITARIO y SER O NO UNIVERSITARIO, en una muestra de 144 sujetos de ambos os sexos, de 21 a 60 años, de la provincia de Cádiz. Tras el análisis de los datos se ofrecen varias conclusiones, entre las que destacan el que el SIDA está ocupando el espectro semántico negativo-"ignominioso" que antes ocupaba la lepra, abundando los juicios "morales" negativos hacia ambos conceptos, y el que se desconozca o niegue la posibilidad preventiva en ambos casos.
Assuntos
Diferencial Semântico , Hanseníase , Síndrome da Imunodeficiência AdquiridaRESUMO
Introducción: El significado de nuestras palabras abarca dos aspectos: el denotativo (sistema de símbolos que tienen un significado compartido grupalmente y específico) y el connotativo que deriva de las asociaciones -más afectivas que cognoscitivas- que solemos hacer cuando oímos o empleamos una palabra. Para medir este perfil connotativo-actitudinal se suele utilizar el diferencial semántico (D.S.) formado por una lista, en un continuum bipolar de siete intervalos, de adjetivos antagónicos, reunidos en RADICALES (evaluación, potencia y actividad añadiendo nosotros AFECTIVIDAD)... Técnica que, en nuestro caso, hemos aplicado al concepto "LEPRA", para medir y contrastar las connotaciones que evoca puesto que -por desgracia- a veces es más difícil tratar los prejuicios y estereotipos que genera la propia enfermedad. Objetivos: Analiza las connotaciones semático-afectivas y actitudinales del concepto "LEPRA", mediante un D.S. de elaboración propia, contrastando las variables SEXO, EDAD, SER O NO PERSONAL SANITARIO y SER O NO UNIVERSITARIO. Metodología: a) Muestra: Hemos trabajado con 144 sujetos, de ambos os sexos, de 21 a 60 años, de Cádiz y su provincia, repartidos en subgrupos proporcionales y estratificados. b) Material: A esta muestra le hemos pasado un D.S. de elaboración propia y aplicación individual, efectuando la recogida de datos entre el 10/11/94 y el 20/11/94. c) Tratamiento estadístico: El análises estadístico de los datos se ha realizado en base al recuendo de las frecuencias, en suma algebraica, a los valores asignados en cada pareja de adjetivos, efectuándose la prueba de diferencia de medias mediante el test de Kurskal con un nivel de confianza del 95%. Análisis y discusión de los resultados: - En el radical EVALUACIÓN constatamos que la lepra recibe una evaluación negativa, aunque no extrema, percibiéndose como bastante mala e injusta, extraña y relativamente indigna,...
Assuntos
Diferencial Semântico , Diferencial Semântico/estatística & dados numéricos , Estereotipagem , Hanseníase/etiologiaRESUMO
One problem faced by intracardiac conductance volumetry is the non-uniform distribution of the injected current. Salo, in 1989, proposed a method to correct this undesirable effect. The objective here is to test Salo's method in known volumes of simple geometry by obtaining volume profiles. A plastic rod with 15 metallic rings simulated the conductance catheter. Five sections were used for the resistance measurements employing the upper electrode as fixed current source and the lowest one as the shifting source. This is part of Salo's procedure. The source-to-section distance was measured from the moving source to the section (linear definition) or using the equivalent distance concept (Salo's). Thereafter, each sectional resistance set of values was plotted as a function of the inverse of the source-to-section distance (either definition) elevated to an empirical exponent k to obtain the corrected sectional resistance by extrapolation back to zero of the regression line, i.e., a value produced by a source theoretically placed at infinity. In addition, a mathematical analysis was attempted, searching for an optimum k based on minimum volume error. The best volume profiles for two cylinders and a frustum were obtained with k = 2 using the linear definition of distance (errors of -3.49%, -1.25% and -3.65%, respectively). Moreover, the frustum angle was determined within 0.4 degrees (2.7%) of the real value. The theoretical analysis led to an inverse logarithmic relationship between the exponent k and the source-to-section distance.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Volume Cardíaco , Eletrodiagnóstico , Coração/fisiologia , Condutividade Elétrica , Humanos , Modelos Cardiovasculares , Modelos EstruturaisRESUMO
This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.
PIP: The findings of an operations research (OR) project designed to compare the effectiveness of male vs. female contraceptive distributors in Peru are reported. The OR project was conducted by 2 private, nonprofit family planning agencies that have community-based distribution (CBD) programs: PROFAMILIA in Lima and CENPROF in Trujillo. The OR project sought to test 3 hypotheses: 1) male distributors would sell more condoms and female distributors would sell more oral contraceptives; 2) male distributors would serve more male clients and female distributors would serve more female clients; and 3) male distributors would sell less contraceptive protection than female distributors. Between 1987 and January 1988, the 2 agencies recruited new male and female distributors to serve in the project. Both agencies had a more difficult time recruiting male than female distributors. PROFAMILIA recruited 38 men and 171 women, while CENPROF recruited 52 men and 94 women. All but one of the supervisors in both agencies were female. The supervisors generally regarded the male distributors with skepticism, but the study found no significant difference in the reporting compliance of male and female distributors. The project confirmed hypotheses 1 and 2. In both agencies men sold twice as many condoms as did women, and women sold more oral contraceptives; and male distributors were more likely to serve men, while female distributors were more likely to serve women. The 3rd hypothesis, however, was unsupported. Men sold as much or more contraceptive protection than did women and recruited as many or more new acceptors. It is concluded that men can be effective CBD distributors, and that CBD programs can influence method and client mix by recruiting more men as distributors.
Assuntos
Serviços de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Dispositivos Anticoncepcionais Masculinos , Anticoncepcionais Orais , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Masculino , Peru , EspermicidasRESUMO
In the process of nutrition, breastfeeding is fundamentally important, due to the nutritional and immunological value of the mother's milk. Within its beneficial effects, it is found that it improves weight and size in children. Another stage in the child's feeding that should be considered during the first year of life is the weaning that complements, at certain age of the breastfeeder, the nutrition given by breastmilk. The decrease or abandonment of breastfeeding is alarming in the developing countries, where this natural product is more available, economical and nutritious. There is evidence that within the health institutions, artificial feeding is encouraged. The National Health Survey collected basic information on sociodemographic variables risk factors, demand and use of health services. It also included questions on breastfeeding and weaning for the population under one year of age. It was found that 19.9 percent was never breastfed. Another important fact is that 42.4 percent of children received breastmilk for just three months or less. This view suggests that breastfeeding in our country is changing, due to various factors, among which we can mention the differences in life styles, education and economical development among states. The results of this study show interesting data that oblige us to consider more detailed and specific analyses in the future.