RESUMO
: El conocimiento de la biodiversidad de una región es fundamental para dirigir su conservación y manejo. La biogeografía y la evolución nos guían conceptualmente para estudiar la vida en un continuo espacial y temporal. El continuo espacial y temporal del que forma parte la biodiversidad de Guatemala, al ser parte del Istmo Centroamericano, determina características únicas. Asimismo, la historia geológica y climática de Guatemala ha generado una topografía compleja con múltiples tipos de ambientes, los cuales han sido dinámicos a lo largo del tiempo. Todo esto resulta en la presencia de un ensamble de linajes con ancestros que provinieron del norte o del sur, además de clados que han diversificado in situ. Aunque la biodiversidad del país aún es extensamente desconocida, el auge de la aplicación de herramientas moleculares abre las puertas para descubrir la rica diversidad genética de la biota de Guatemala. Nos permite también conocer más de su historia biogeográfica y evolutiva y avanzar del estudio de patrones al estudio de los procesos que generan y mantienen la biodiversidad local y regional. La investigación científica en estos temas es indispensable para que nos demos cuenta que la biodiversidad de Guatemala y del norte de Centroamérica es más rica de lo que podemos imaginar.
Knowledge of the biodiversity of a region is essential to guide its conservation and management. Biogeography and evolution guide us conceptually to study life in a spatial and temporal continuum. The spatial and temporal continuum that the biodiversity of Guatemala is embedded in, as part of the Central American Isthmus, determines unique characteristics. Likewise, the geological and climatic history of Guatemala has generated a complex topography with multiple types of environments, which have been dynamic over time. The result is an assemblage of lineages with ancestors that came from the north or the south, as well as clades that diversified in in situ conditions. Although the biodiversity of the country is still largely unknown, the rise of the application of molecular tools opens the doors to discover the rich genetic diversity of the biota of Guatemala. It also allows us to learn more about its biogeographic and evolutionary history and move from the study of patterns to the study of processes that generate and maintain local and regional biodiversity. Scientific research on these topicsis essential for us to realize that the biodiversity of Guatemala and northern Central America is richer than we can imagine.
RESUMO
Resumen La enfermedad por COVID-19 fue detectada a finales de 2019 en Wuhan, China. Debido a su rápida propagación fue declarada emergencia sanitaria de forma inicial y luego de identificar casos fuera de China con transmisión autóctona y caracterizado por una mortalidad considerablemente alta en países como Italia y España, fue declarada pandemia por la Organización Mundial de la Salud. Se ha evidenciado que los pacientes mayores y con antecedentes de enfermedades crónicas incluido el cáncer desarrollan una enfermedad severa, presentando mayor riesgo de mortalidad por SARS-CoV2/ COVID-19. Lo anterior es por supuesto especialmente importante en el manejo de pacientes con Mieloma Múltiple (MM), generando en el personal Médico nuevos desafíos, oportunidades de mejora y aprendizajes, que aporten al análisis riesgo-beneficio del tratamiento inmunodepresor en este tipo de patologías. El consenso tiene como objetivo brindar orientación sobre el manejo de pacientes con MM en estos momentos donde el profesional de la salud requiere información para llevar a cabo terapias eficientes en el cuidado del paciente.
Abstract COVID-19 disease was detected in late 2019 in Wuhan, China. Due to its rapid spread, it was initially declared a health emergency, but after cases with indigenous transmission were identified outside China, characterized by considerably high mortality in countries such as Italy and Spain, it was declared a pandemic by the World Health Organization. It has been shown that elderly patients with a history of chronic diseases, including cancer, develop a severe disease, presenting a higher risk of mortality from SARS-CoV2 / COVID-19. This becomes especially important in the management of patients with Multiple Myeloma (MM), generating new challenges, opportunities for improvement and learning opportunities in the health professionals, which will contribute to the risk-benefit analysis of immunosuppressive treatment for this type of pathology. The consensus aims to provide guidance for the management of patients with MM in these times when the health professional requires information to deliver efficient therapies in patient care.
Assuntos
Humanos , Consenso , COVID-19 , Mieloma Múltiplo , TerapêuticaRESUMO
Shortage of quantitative studies regarding health risks for emergency services workers is a concern for Chilean's occupational health organizations. OBJECTIVE: To explore the incidence of violence and burnout in emergency services of the Metropolitan Region of Chile, and associations with workers' characteristics and workplace conditions. METHODS: A cross-sectional study was carried out from January to August 2016. A self-reported questionnaire explored about frequency and seriousness of violence episodes and about symptoms of burnout with the Maslach Burnout Inventory. RESULTS: Of the 565 workers participating, 71% (95% CI 66.7-74.5) said violence episodes occurred at least once a week; 71.3% (95% CI 67.3-75.0) were victims of some aggression in the previous 12â¯months. Patients companions, relatives or friends arose as the main aggressors and the severity of the episodes was considered slight or moderate by more than 50% of participants. Fifty-seven respondents (10.5%, CI 95% 8.1-13.5) classified as having a burnout syndrome. Having been a victim of violence was associated to high emotional exhaustion (ORadjâ¯=â¯1.7, 95% CI: 1.1-2.8) and depersonalization (ORadjâ¯=â¯2.0, 95% CI 1.3-3.3). CONCLUSIONS: Violence is a problem in the emergency departments of Chile's Metropolitan Region. Burnout is also present and independently associated to violence.
Assuntos
Esgotamento Profissional/psicologia , Pessoal de Saúde/psicologia , Violência no Trabalho/psicologia , Adulto , Esgotamento Profissional/etiologia , Chile , Estudos Transversais , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas , Violência no Trabalho/estatística & dados numéricosRESUMO
Introducción: el CIGB-300 es un péptido sintético capaz de producir apoptosis en células tumorales. Objetivos: explorar la seguridad del CIGB-300 administrado por vía intravenosa en pacientes con hemopatías malignas. Metodología : se realizó un ensayo clínico fase I, multicéntrico, no aleatorizado, adaptativo, con un solo grupo de tratamiento y escalado de dosis en el mismo paciente (Registro No. 05.013.12.B). Los eventos adversos se clasificaron según la versión 4.03 de Terminología de los Criterios Comunes para Eventos Adversos. Se seleccionaron pacientes con edad igual o mayor a 18 años, no candidatos a trasplante de médula ósea, con leucemias agudas refractarias o en recaída, leucemia aguda mielobástica del anciano y síndromes mielodisplásticos con exceso de blastos, que tuvieron ECOG ≤ 3 y aceptaron participar en la investigación. Se consideraron como criterios de exclusión: la leucemia promielocítica, enfermedades crónicas descompensadas, antecedentes alérgicos graves, embarazo, puerperio y lactancia. Para las variables cuantitativas, se estimaron medidas de tendencia central y para las cualitativas la distribución de frecuencias. Resultados: de 10 pacientes incluidos, 6 realizaron el tratamiento con los cinco niveles de dosis. Se presentaron 94 tipos de eventos adversos, la mayoría de carácter sistémico, con 619 notificaciones. El prurito y el eritema localizados fueron los eventos más comunes, seguidos de la hipertensión arterial. Los eventos se presentaron con mayor frecuencia el primer día de cada ciclo y no se detectó su aumento al incrementar la dosis del producto. El 87,7 por ciento se consideraron eventos leves y el 61,6 por ciento con causalidad muy probable. Se presentaron 15 eventos adversos graves, pero solo uno fue relacionado con la administración del CIGB 300. Conclusiones: la administración intravenosa del CIGB-300 fue segura y bien tolerada. El escalado de dosis no aumentó la toxicidad del producto(AU)
Introduction: CIGB-300 is a synthetic peptide capable of producing apoptosis in tumor cells. Objectives: To explore the safety of CIGB-300 administered intravenously in patients with hematological malignancies (Registry No. 05.013.12.B). Methodology : A multicenter, non-randomized, adaptive, with an only treatment group (intravenous administration of the investigational product and dose escalation in the same patient), phase I clinical trial was conducted. Adverse events were classified according to the version 4.03 of Common Terminology Criteria for Adverse Events . Patients aged 18 years or older were selected, not candidates for bone marrow transplantation, with refractory or relapsed acute leukemias, acute myeloblastic leukemia of elderly, and myelodysplastic syndromes with blast excess, who had ECOG ≤ 3 and agreed to participate in the investigation. We considered as exclusion criteria: acute promyelocytic leukemia, decompensated chronic diseases, severe allergic history, pregnancy, postpartum and breastfeeding. For quantitative variables, measures of central tendency and qualitative distribution of frequencies were estimated. Results: Of 10 patients included 6 received treatment with five dose levels. Ninety four types of adverse events were present, most systemic, with 619 notifications. Localized itching and rash were the most common events, followed by high blood pressure. The events occurred more frequently on the first day of each cycle and no increase was detected when the dose of the product was rised. Minor events were 87,7 percent and 61,6 percent with probable causality. Fifteen serious adverse events occurred, but only one was related to the administration of CIGB 300. Conclusions: Intravenous administration of CIGB-300 was safe and well tolerated. Dose escalation did not increase the toxicity of the product(AU)
Assuntos
Humanos , Biossíntese Peptídica , Biópsia por Agulha/métodos , ApoptoseRESUMO
The influence of geologic and Pleistocene glacial cycles might result in morphological and genetic complex scenarios in the biota of the Mesoamerican region. We tested whether berylline, blue-tailed and steely-blue hummingbirds, Amazilia beryllina, Amazilia cyanura and Amazilia saucerottei, show evidence of historical or current introgression as their plumage colour variation might suggest. We also analysed the role of past and present climatic events in promoting genetic introgression and species diversification. We collected mitochondrial DNA (mtDNA) sequence data and microsatellite loci scores for populations throughout the range of the three Amazilia species, as well as morphological and ecological data. Haplotype network, Bayesian phylogenetic and divergence time inference, historical demography, palaeodistribution modelling, and niche divergence tests were used to reconstruct the evolutionary history of this Amazilia species complex. An isolation-with-migration coalescent model and Bayesian assignment analysis were assessed to determine historical introgression and current genetic admixture. mtDNA haplotypes were geographically unstructured, with haplotypes from disparate areas interdispersed on a shallow tree and an unresolved haplotype network. Assignment analysis of the nuclear genome (nuDNA) supported three genetic groups with signs of genetic admixture, corresponding to: (1) A. beryllina populations located west of the Isthmus of Tehuantepec; (2) A. cyanura populations between the Isthmus of Tehuantepec and the Nicaraguan Depression (Nuclear Central America); and (3) A. saucerottei populations southeast of the Nicaraguan Depression. Gene flow and divergence time estimates, and demographic and palaeodistribution patterns suggest an evolutionary history of introgression mediated by Quaternary climatic fluctuations. High levels of gene flow were indicated by mtDNA and asymmetrical isolation-with-migration, whereas the microsatellite analyses found evidence for three genetic clusters with distributions corresponding to isolation by the Isthmus of Tehuantepec and the Nicaraguan Depression and signs of admixture. Historical levels of migration between genetically distinct groups estimated using microsatellites were higher than contemporary levels of migration. These results support the scenario of secondary contact and range contact during the glacial periods of the Pleistocene and strongly imply that the high levels of structure currently observed are a consequence of the limited dispersal of these hummingbirds across the isthmus and depression barriers.
RESUMO
The synthesis of four amphiphilic organometallic complexes with the general formula RC = M(CO)5NH(CH2)15CH3, where R is a ferrocenyl 2(a-b) or a phenyl 4(a-b) group as a donor moiety and a Fischer carbene of chromium (0) or tungsten (0) as an acceptor group, are reported. These four push-pull systems formed Langmuir (L) monolayers at the air-water interface, which were characterized by isotherms of surface pressure versus molecular area and compression/expansion cycles (hysteresis curves); Brewster angle microscopic images were also obtained. By using the Langmuir-Blodgett (LB) method, molecular monolayers were transferred onto glass substrates forming Z-type multilayers. LB films were characterized through ultraviolet-visible spectroscopy, atomic force microscopy and X-ray diffraction techniques. Results indicated that films obtained from 2b complex [(Ferrocenyl)(hexadecylamine)methylidene] pentacarbonyl tungsten (0) are the most stable and homogeneous; due to their properties, these materials may be incorporated into organic electronic devices.
RESUMO
BACKGROUND: The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. Knowledge about HPV infection among indigenous women is limited. This cross-sectional study analyzed the frequency of HPV and other genital infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS: This study included 181 sexually active women without cervical lesions. They belonged to the following ethnicities: Maká (n = 40); Nivaclé (n = 23); Sanapaná (n = 33); Enxet Sur (n = 51) and Toba-Qom (n = 34). The detection of HPV and other gynecological infectious microorganisms was performed by either molecular methods (for Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis), gram staining and/or culture (for Gardnerella vaginalis, Candida sp, Trichomonas vaginalis, Neisseria gonorrhoeae), serological methods (for Treponema pallidum, human immunodeficiency virus [HIV]) or cytology (cervical inflammation). RESULTS: A high prevalence (41.4%) of women positive for at least one sexually transmitted infection (STI) was found (23.2% any-type HPV, 11.6% T pallidum, 10.5% T vaginalis, 9.9% C trachomatis and 0.6% HIV) with 12.2% having more than one STI. HPV infection was the most frequent, with 16.1% of women positive for high-risk HPV types. There was a statistically significant association observed between any-type HPV and C trachomatis (p = 0.004), which indicates that the detection of one of these agents should suggest the presence of the other. There was no association between any-type HPV and other genital infections or cervical inflammation, suggesting that other mechanism could exist to favor infection with the virus. CONCLUSION: This multidisciplinary work suggests that STIs are frequent, making it necessary to implement control measures and improve diagnosis in order to increase the number of cases detected, especially in populations with poor access to health centers.
Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Paraguai/epidemiologia , Prevalência , Adulto JovemRESUMO
UNLABELLED: The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology. METHODS: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure. RESULTS: The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes. CONCLUSIONS: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
Assuntos
Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/organização & administração , Diabetes Mellitus/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Biomarcadores/sangue , Administração de Caso/organização & administração , Diabetes Mellitus/sangue , Feminino , Hemoglobinas Glicadas/metabolismo , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , México , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Objetivos Organizacionais , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/organização & administração , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Para determinar el papel de algunos factores genéticos, hormonales, de estilo de vida y ambientales en el riesgo de desarrollar cáncer de próstata clínicamente manifiesto en La Habana, se estudiaron los casos (n = 273) diagnosticados durante 1998-2000, con verificación histológica o citológica de cáncer de próstata, residentes en Ciudad de La Habana y menores de 85 años. Los controles (n = 254) fueron seleccionados pareados por edad, del mismo hospital del caso. La información se obtuvo mediante una entrevista. La estimación del riesgo se obtuvo a través de una regresión logística condicional. No se observó asociación estadísticamente significativa entre el color de la piel y el riesgo de cáncer de próstata (OR = 1,30, IC 95(por ciento): 0,92-1,84) ni con el hábito de fumar (OR = 0,82, IC 95(por ciento): 0,58-1,16). Se observó una asociación positiva del riesgo de cáncer de próstata con las enfermedades venéreas (p = 0,01), así como con la edad de aparición de estas enfermedades (p = 0,06). No se encontraron diferencias en cuanto a la edad de inicio de las relaciones sexuales (p = 0,111) ni en el número de compañeras sexuales (p = 0,48). Se observó una asociación significativa entre el riesgo de padecer cáncer de próstata y el haber padecido de alguna enfermedad venérea, el no realizar ejercicio físico entre los 45 y los 50 años y la frecuencia de relaciones sexuales por encima de 10 veces a la semana
Assuntos
Neoplasias da Próstata , CubaRESUMO
BACKGROUND: The relationship between the risk of prostate cancer and sexual activity and history of sexually transmitted diseases was investigated in a case-control study conducted in Cuba aimed at assessing the effect of lifestyle and environmental factors, as well as hormonal and genetic factors, on the occurrence of this disease. METHODS: During the period 1998-2000, all men up to 84 yr old with newly diagnosed, cytologically and/or histologically confirmed prostatic cancer who were resident in Havana City were identified in nine major hospitals in the area. Controls were resident in the same city, frequency-matched by age (+/-5 years) and hospital. The study included 273 cases and 254 controls. Information was obtained through an interview. RESULTS: The risk of prostate cancer was increased among men with a history of venereal disease (odds ratio = 1.7, 95% CI = 1.1-2.5). A higher frequency of cases reported having had sex with prostitutes, although the estimate of relative risk did not reach statistical significance. Similarly, a nonsignificant positive association was found with the number of female sexual partners. A significant increased risk was observed in subjects who reported having sexual intercourse more than 7 times per week compared with those who reported a weekly frequency of 3 times or fewer (odds ratio = 2.1, 95% CI = 1.2-3.7). Moreover, a significant trend was demonstrated. CONCLUSIONS: The study supports the hypothesis that an infectious factor related to sexual behaviour could be involved in the occurrence of prostate cancer. A role for hormonal factors related to sexual activity cannot be ruled out.
Assuntos
Neoplasias da Próstata/etiologia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cuba/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Fatores de RiscoRESUMO
Objetivo: Evaluar el cumplimiento de las metas básicas de tratamiento de personas que asisten a los Grupos de Ayuda Mutua (GAM) de la Secretaría de Salud de México (SS), por padecer diabetes tipo 2. Material y métodos: Estudio transversal comparativo realizado en 15 estados de la república mexicana, a través de los reportes del cumplimiento de las metas básicas de tratamiento de integrantes de los GAM para junio de 2001, que se comparan con las cifras reportadas por el Sistema de Información en Salud para Población Abierta (SISPA) de la Secretaría de Salud en la misma fecha. Las variables estudiadas son: edad, sexo, glucemia, presión arterial, índice de masa corporal, actividad física y tratamiento farmacológico. Resultados: Se evaluó el cumplimiento de las metas básicas de tratamiento de 6,958 personas con diabetes, que asisten a los GAM de la Secretaría de Salud (SS) en 15 de los 32 estados de la república mexicana incluido el Distrito Federal. Al comparar las frecuencias de diabéticos controlados en los GAM y el SISPA, se apreció un diferencial, observándose una tendencia a estar más controlados en los GAM; al analizar con la prueba "t" de Student las diferencias resultaron significativas, con p < 0.005. El grupo de diabéticos obesos tuvieron un riesgo mayor de estar descontrolados, en relación al grupo de diabéticos no obesos, con una razón de momios de 1.18, IC 1.06 - 1.32 y P < 0.002. Al comparar el grupo sedentario con el no sedentario se encontró que los diabéticos sedentarios presentaban 1.56 veces más riesgo de estar descontrolados que el grupo de diabéticos que realizaba actividad física, por una razón de productos cruzados de 1.56, con IC 1.37 - 1.78 y P < 0.001. Conclusiones: Los Grupos de Ayuda Mutua son una estrategia fundamental en la línea educativa para mejorar el control de la enfermedad, ya que las personas con diabetes o hipertensión y sus familiares juegan un papel activo en el cumplimiento del desarrollo del tratamiento, así como en la prevención y control de la enfermedad. A diferencia con lo reportado en el SISPA, en los GAM se logran beneficios mayores en el control de las personas con diabetes o hipertensión.
Objective: To evaluate the accomplishment of the treatment basic goals of every person with diabetes type 2 that attend the Mutual Help Groups (GAM) of the Mexican Ministry of Health (SS). Material and methods: This transversal comparative study was carried out in 15 Mexican states, through the accomplishment reports of the treatment basic goals of the GAM integrants by June of 2001, compared to the reported figures by the Health Information System for Open Population (SISPA), Ministry of Health on the same date. The studied variables are: age, sex, blood glucose, blood pressure, body mass index, physical activity and pharmacological treatment. Results: The treatment basic goals accomplishment for 6, 958 people with diabetes was evaluated, all of them attended the Ministry of Health GAMs, in 15 of the 32 Mexican states including the Federal District. When comparing frequencies of patients with diabetes controlled by the GAM and the SISPA, a differential was appreciated, being observed a tendency that showed that people in the GAM were much more controlled; when analyzing with the test Student "t" the differences were even more significant (p < 0.005). The obese diabetics group had a higher risk of being uncontrolled, in relation to the group of non-obese diabetics (OR 1.8, CI: 1.06,1.32; p < 0.002). When comparing the sedentary to the non-sedentary group it was found that the sedentary diabetics presented 1.56 times higher risk of being uncontrolled, that those in the diabetes group that carried out physical activity (CI: 1.37,1.78; p < 0.001). Conclusions: The Mutual Help Groups are a fundamental strategy in the educational line for improving the disease control, since people with diabetes or hypertension and their relatives play an active role in treatment development accomplishment, as well as in the disease prevention and control. Unlike to that reported in the SISPA, the highest benefits of control, are achieved in people with diabetes or hypertension who attend the GAM.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /terapia , Hipertensão/terapia , Programas Nacionais de Saúde/estatística & dados numéricos , Análise Química do Sangue , Índice de Massa Corporal , Estudos Transversais , /epidemiologia , Hipertensão/epidemiologia , México/epidemiologia , Cooperação do Paciente , Educação de Pacientes como Assunto , Avaliação de Programas e Projetos de SaúdeRESUMO
BACKGROUND: Length of stay (LOS) is an important indicator of efficiency for inpatient care but it does not achieve an adequate performance if it is not adjusted for the case mix of the patients hospitalized during the period considered. After two similar studies for Internal Medicine and Surgery respectively, the aims of the present study were to search for Length of Stay (LOS) predictors in an acute psychiatric department and to assess the performance of the difference: observed-predicted length of stay, as an indicator of inpatient care inefficiencies. METHODS: Retrospective case-series of patients discharged during 1999 from the Psychiatric Department from General Hospital "Hermanos Ameijeiras" in Havana, Cuba. The 374 eligible medical records were randomly split into two groups of 187 each. We derived the function for estimating the predicted LOS within the first group. Possible predictors were: age; sex; place of residence; diagnosis, use of electroconvulsive therapy; co morbidities; symptoms at admission, medications, marital status, and response to treatment. LOS was the dependent variable. A thorough exam of the patients' records was the basis to assess the capacity of the function for detecting inefficiency problems, within the second group. RESULTS: The function explained 37% of LOS variation. The strongest influence on LOS came from: age (p = 0.002), response to treatment (p < 0.0001), the dummy for personality disorders (p = 0.01), ECT therapy (p = 0.003), factor for sexual and/or eating symptoms (p = 0.003) and factor for psychotic symptoms (p = 0.025). Mean observed LOS is 2 days higher than predicted for the group of records with inefficient care, whereas for the group with acceptable efficiency, observed mean LOS was 4 days lower than predicted. The area under the ROC curve for detecting inefficiencies was 69% CONCLUSIONS: This study demonstrates the importance of possible predictors of LOS, in an acute care Psychiatric department. The proposed indicator can be readily used to detect inefficiencies.
Assuntos
Eficiência Organizacional/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Transtornos Mentais/classificação , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Doença Aguda/classificação , Doença Aguda/terapia , Adulto , Idoso , Boston , Comorbidade , Cuba , Grupos Diagnósticos Relacionados , Eletroconvulsoterapia/estatística & dados numéricos , Feminino , Humanos , Masculino , Prontuários Médicos , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/organização & administração , Curva ROC , Estudos Retrospectivos , Medição de RiscoRESUMO
OBJECTIVE: To evaluate the accomplishment of the treatment basic goals of every person with diabetes type 2 that attend the Mutual Help Groups (GAM) of the Mexican Ministry of Health (SS). MATERIAL AND METHODS: This transversal comparative study was carried out in 15 Mexican states, through the accomplishment reports of the treatment basic goals of the GAM integrants by June of 2001, compared to the reported figures by the Health Information System for Open Population (SISPA), Ministry of Health on the same date. The studied variables are: age, sex, blood glucose, blood pressure, body mass index, physical activity and pharmacological treatment. RESULTS: The treatment basic goals accomplishment for 6, 958 people with diabetes was evaluated, all of them attended the Ministry of Health GAMs, in 15 of the 32 Mexican states including the Federal District. When comparing frequencies of patients with diabetes controlled by the GAM and the SISPA, a differential was appreciated, being observed a tendency that showed that people in the GAM were much more controlled; when analyzing with the test Student "t" the differences were even more significant (p < 0.005). The obese diabetics group had a higher risk of being uncontrolled, in relation to the group of non-obese diabetics (OR 1.8, CI: 1.06,1.32; p < 0.002). When comparing the sedentary to the non-sedentary group it was found that the sedentary diabetics presented 1.56 times higher risk of being uncontrolled, that those in the diabetes group that carried out physical activity (CI: 1.37,1.78; p < 0.001). CONCLUSIONS: The Mutual Help Groups are a fundamental strategy in the educational line for improving the disease control, since people with diabetes or hypertension and their relatives play an active role in treatment development accomplishment, as well as in the disease prevention and control. Unlike to that reported in the SISPA, the highest benefits of control, are achieved in people with diabetes or hypertension who attend the GAM.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Análise Química do Sangue , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Cooperação do Paciente , Educação de Pacientes como Assunto , Avaliação de Programas e Projetos de SaúdeRESUMO
Even though, in theory, a new surgical technique should traverse all the stages established for drugs before being introduced into medical practice, it is suspected that many surgical procedures are utilized without having rigorously evaluated their efficacy and safety. With the aim of identifying the methodologic aspects currently employed for assessing new surgical procedures, a descriptive bibliographic study was carried out. Altogether, 75 journal articles published from 1996 to 1998 were reviewed. The papers must have come from studies carried out with the expressed objective of evaluating a surgical procedure and were selected through MEDLINE or directly from six prestigious medical journals (three specifically surgical and three general). Of the reviewed articles, 47% were retrospective studies, and the rest were prospective studies. More than 40% of the retrospective studies omitted some basic methodologic features, namely a description of the patients' source or a definition of the inclusion criteria. Among the 41 prospective articles, only 35 used a control group and 15 did not employ random allocation. Other basic issues, such as the sample size or inclusion of prognostic factors in the analysis, were present in fewer than 50% of the articles. It seems there is consensus about admitting that rigorous assessment of new surgical treatments should be an unavoidable condition before introducing such treatment into practice. The facts demonstrate that this principle is not being followed.
Assuntos
Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios , Avaliação da Tecnologia Biomédica , Bibliometria , Humanos , Controle de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Procedimentos Cirúrgicos Operatórios/normas , Procedimentos Cirúrgicos Operatórios/tendênciasRESUMO
Este es un estudio retrospectivo de corte transversal, en que se determinó el porcentaje de infección por T. cruzi en 92 pacientes serológicamente positivos para VIH cuyas muestras de suero provinieron de la seroteca del IICS. Para la detección de anticuerpos anti-T. cruzi se utilizó la técnica de Aglutinación de Partículas de Gelatina (PG). Las muestras que dieron reactivas por este método fueron posteriormente procesados por inmunofluorescencia indirecta (IFI), tanto para IgG como IgM. En 10 de los 92 pacientes evaluados por GP se detectaron anticuerpos totales anti-T.cruzi, arrojando una prevalencia del 10.8 por ciento. Por IFI, de las 10 muestras, en 8 se detectaron anticuerpos anti-T. cruzi del tipo IgM (8.7 por ciento) y en 4 del tipo IgG. En 6 muestras solo se detectaron del tipo IgM, en ausencia del tipo IgG. Cuando se compararon las técnicas de GP y una combinación de anti-IgG e IgM, por IFI se halló un 100 por ciento de concordancia. A pesar de que la prevalencia de la infección por T. cruzi en el grupo de pacientes con VIH fue similar al de la población en general, la presencia de anticuerpos específicos del tipo IGM, podría sugerir una reactivación de la infección. La temprana detección de la infección por T. cruzi en este grupo de pacientes puede permitir la prevención de condiciones clínicas en la que está envuelto el Sistema Nervioso Central (SNC) o el miocardio mediante un tratamiento efectivo
Assuntos
Anticorpos Anti-HIVRESUMO
Este estudio tiene por objetivo evaluar el nivel sérico de la (B2-m) ya que un aumento de la misma podría estar relacionada con el grado de la actividad inflamatoria. Se estudió un total de 104 pacientes adultos, provenientes del área urbana y rural del Paraguay, con diagnóstico de tuberculosis pulmonar activa, que concurrieron a la Cátedra de Neumología de la Facultad de Ciencias Médicas y Sanatorio Juan Max Boettner. Analizando el nivel sérico de B2-m se encontró que el nivelbasal de esta proteína en los pacientes con tuberculosis pulmonar activa tiene un incremento estadísticamente significativo (p<0.001), con valores iguales o superiores a 2 ug/ml, en tanto que en ninguno de los controles normales supera los 2 ug/ml. Por lo tanto, el nivel sérico de B2-m podría ser utilizado como marcador de evolución de esta enfermedad
Assuntos
Mycobacterium tuberculosisRESUMO
El objetivo de este estudio fue analizar la validez de esta estrategia. Por lo tanto, combinando la alta sensibilidad del primer reactivo de tamisaje, basado en un ELISA indirecto (Enzygnost anti HIV-1/HIV-2 Berhing) con un reactivo de tamizaje de alta especificidad, basado en un ELISA competitivo (Enzygnost anti HIV-1 Behring), se estudiaron 245 sueros de pacientes paraguayos, de los cuales 170 sueros fueron de pacientes positivos, 15 indeterminados y 60 negativos determinados por el método clásico. Cuando se compararon los resultados obtenidos por el métodoclásico con el alternativo se encontró una discordancia del 4,6 por ciento que es considerada aún aceptable.La estrategia del Doble Elisa puede ser utilizada como alternativa de diagnóstico de infección por VIH-1 en países como Paraguay, donde previos estudios epidemiológicos demostraron que el virus prevalente es del tipo 1
Assuntos
HIV-1 , Anticorpos Anti-HIV , Ensaio de Imunoadsorção Enzimática , Western BlottingRESUMO
El presente trabajo tuvo por objetivo evaluar la actividad fagocítica y la función oxidativa de los polimorfonucleares (PMN) provenientes de pacientes con infecciones micóticas sistémicas. Se estudiaron 14 pacientes, de los cuales 8 (57 por ciento) fueron del sexo masculino. Clinicamente 5 pacientes presentaron candidiasis, 4 paracoccidioidomicosis, 2 criptococcosis, 2 aspergillosis y 1 histoplasmosis. La actividad fagocitica de los PMN, por el método citomorfológico, se encontró disminuida en todos los pacientes estudiados, con excepción de aquellos con diagnóstico de ccriptococcosis, quienes presentaron valores similares al grupo control. La función oxidativa por reducción del NBT estaba disminuida en todos los pacientes (p<0.05), sobre todo en el paciente de hipotoplasmosis. Estos datos ponen en evidencia la existencia de alteraciones en la funciòn fagocìtica de los PMN, pero estudios posteriores con mayor nùmero de paciente permitirà conocer si este defecto es especìfico para estas patologìas
Assuntos
Candidíase , Fagocitose , Histoplasmose , Neutrófilos , ParacoccidioidomicoseRESUMO
En este estudio, se midieron los niveles de antitoxina tetánica en muestras de suero de 112 trabajadores de la salud del IICS (41 bioquímicos, 10 biólogos, 26 auxiliares de laboratorio, 7 médicos, 4 sicólogos, 1 veterinario y 23 personal administrativo). Veinte eran de sexo masculino y 92 de sexo femenino con una edad media de 34 años. Los anticuerpos fueron medidos por un método de ELISA y valores por encima de 10 mU/ml fueron considerados protectivos. Todos los participantes del estudio refirieron haber recibido alguna vez la vacuna antitetánica, de los cuales el 71 por ciento recibió su última vacunación 5 años antes, 12 por ciento más de 5 años y 16 por ciento no recordaba la fecha de su ultima vacunación. Considerando el motivo de la vacunación, el 40 por ciento fue vacunado en su último embarazo, 20 por ciento por heridas y 24 por ciento dentro de un programa de vacunación. Niveles protectivos de anticuerpos se observó en el 71 por ciento y los niveles más altos fueron observados en los profesionales asistenciales (92 por ciento) y los más bajos en los auxiliares de laboratorio (38 por ciento). El mayor porcentaje de los profesionales que no tuvieron niveles protectivos (80 por ciento) se había vacunado hacía más de 10 años, siendo éste la probable causa de la falta de respuesta a la vacuna. Otras causas podrían ser deficiencias en la conservación de la vacuna o deficiencias de la respuesta inmune de estas personas. Consideramos que la implementación de un programa de vacunación en profesionales de la salud y la consecuente evaluación de anticuerpos específicos a la vacuna es perentoria