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In this randomised, placebo-controlled trial, adults with impaired sleep (Pittsburgh Sleep Quality Index ≥ 5) were randomly assigned using a minimization algorithm to receive a formulation containing L-theanine plus lemon balm, valerian, and saffron extracts, or placebo, during 6 weeks. Objective sleep quality parameters were measured using an actigraphy device. We enrolled and randomised 64 individuals, 31 from the active group and 27 from the placebo group completed the 6 week follow-up. Mean sleep efficiency remained unmodified in the active group, and increased by 3% in the placebo group, the between-group difference in the change was not statistically significant (p = 0.49). Total sleep time also improved more with placebo (13.0 vs. 1.33 min, p = 0.66). Time wake after sleep onset (WASO) decreased more in the active group (4.6% vs. 2.4%), but the difference was not significant (p = 0.33). Mean PSQI decreased by 3.11 points (32.3%) in the active group, and by 3.86 points (39.5%) in the placebo group (p = 0.41). SF-36 increased more with placebo (+ 18.3 in active, + 32.1 in placebo, p = 0.68). Salivary cortisol remained unchanged in both groups. No serious adverse events were reported. Among adults with impaired sleep, a nutraceutical combination did not improve objective or subjective sleep parameters more than a placebo infusion.
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Distúrbios do Início e da Manutenção do Sono , Qualidade do Sono , Adulto , Humanos , Sono , Polissonografia , Actigrafia , Suplementos Nutricionais , Método Duplo-CegoRESUMO
BACKGROUND: Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings. METHOD: A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data. RESULTS: We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape. CONCLUSION: These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.
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BACKGROUND: The burden that COVID-19 has brought to the economy, healthcare systems, and education is unmatched. Public health and social measures were implemented to halt transmission. Thus, social gathering and in-person learning, core aspects of medical education, were interrupted. Studies have documented the detrimental impact students graduating during the pandemic have had on their confidence and skills. However, data comparing pre-pandemic, pandemic, and post-peak students still lack. This study aimed to identify senior medical students' attitudes regarding their education and compare them according to the three previously described periods. METHODS: In this cross-sectional study, the survey employed was designed based on a previous questionnaire and applied to senior medical students before graduating between January 2018 and June 2022. Answers were collected using a three-point Likert scale and Yes/No questions. Associations between variables were examined using Chi-squared, Fisher's Exact tests, and ANOVA, employing logistic regression to calculate odds ratio (OR) when appropriate. RESULTS: A total of 679 responses were analyzed. Most students (59%) were women. Up to 383, 241, and 55 senior medical students answered the survey before, during, and in the post-peak period of the COVID-19 pandemic, respectively. There was a staggering decrease in the percentage of students in the post-peak compared to the pre-pandemic period that considered certain factors such as being taught about the doctor-patient relationship (62% vs 75%), practicing teamwork (33% vs 54%), preclinical & clinical subjects (44% vs 63%), and being taught to conduct research (22% vs 32%) as "very useful" to their professional traineeship. There was a significant difference between pre-pandemic, pandemic, and post-peak students when asked if the study curriculum accomplished the goal of training a professional with integrity (89% vs 66% vs 64%, p < 0.001), respectively. In a multivariate analysis graduating during the pandemic (OR 3.92; 95% CI, 2.58-5.94) and in the post-peak period (OR 4.24; 95% CI, 2.23-8.07) were independent factors for the appreciation that the study curriculum did not meet its objective. CONCLUSIONS: The pandemic has hindered medical education. Students' appreciation of their instruction has deteriorated. Urgent interventions that halt the negative impact on training, ensure readiness for future problems and improve schooling worldwide are needed.
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COVID-19 , Educação Médica , Estudantes de Medicina , Humanos , Feminino , Masculino , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Relações Médico-Paciente , Atitude do Pessoal de SaúdeRESUMO
Introducción: Desarrollamos un servicio de visitas domiciliarias a pacientes confinados en sus hogares en un establecimiento de salud en Quito-Ecuador. Objetivos: (i) describir el proceso de atención en el servicio de visitas domiciliarias y evaluar su ajuste al modelo de atención primaria en salud, (ii) describir el flujo de procesos del servicio como una propuesta para replicar en otros ámbitos, (iii) identificar los determinantes de alta utilización del servicio; y (iv) validar un sistema de puntuación que incluya a esos determinantes como predictores de su uso. Sujetos y métodos: Estudio observacional longitudinal retrospectivo y desarrollo de un score. Se analizaron las características sociodemográficas y clínicas de los pacientes en la primera visita y contando el número de visitas domiciliarias por paciente 18 meses después. Mediante modelos de regresión binomial negativa se identificaron los determinantes de utilización de vivitas domiciliarias, cuyos ß-coeficientes ajustados y transformados en score, fueron validados internamente mediante el cálculo del área bajo la curva. Resultados: 120 pacientes recibieron 285 vistas domiciliarias después de 18 meses, 70% fueron mujeres con una media de edad de 83 años. Nueve pacientes recibieron 75 visitas domiciliarias. Edad, estado civil, multimorbilidad-polifarmacia y la realización inicial de procedimientos clínicos fueron determinantes independientes de ≥4 visitas domiciliarias por año. El área bajo la curva fue de 0.80 (IC 95%=0.78 a 0.82).Discusión y conclusión: Nuestro servicio de visitas domiciliarias a pacientes confinados se ajusta al modelo de atención primaria de salud. El flujograma podría adoptarse/adaptarse en contextos similares. Edad, estado civil, multimorbilidad-polifarmacia y requerimiento de procedimientos clínicos predijeron, de manera fiable, la utilización del servicio.
Background: We developed an innovative service of home health care visits (HV) for home-bound patients, assigned to a health care center in Quito-Ecuador.Objectives: (i) To describe the service and evaluate its adjustment to the primary care model, (ii) to describe the flow of service processes to subsequently adopt or adapt it in other healthcare facilities, (iii) to identify the determinants of HV utilization; and (iv) to internally validate the fiability of a scoring system, based on those determinants.Subjects and methods: We performed an observational longitudinal retrospective study and developing of a scoring system. We analyzed the sociodemographic and clinical charac-teristics of the patients during the first home visit and counted the number of home visits per patient 18 months later. Through negative binomial regression models, we identified the determinants of home visits utilization. The adjusted ß-coefficients were transformed into a score and validated internally by calculating the area under the curve.Results: 120 patients received 285 home visits after 18 months, 70% were women with a mean age of 83 years. Nine patients received 75 home visits. Age, marital status, multimorbi-dity-polypharmacy, and the initial performance of clinical procedures were independent deter-minants of ≥4 HV per year. The area under the curve score was 0.80 (95% CI = 0.78 to 0.82).Discussion y conclusion: Our home visit service to homebound patients resulted in an in-tervention that fit the primary care model. The flowchart allows it to be adopted or adapted in other health care facilities. Age, marital status, multimorbidity-polypharmacy and the perfor-mance of clinical procedures reliably predicted the service utilization.
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Humanos , Idoso , Idoso de 80 Anos ou mais , Idoso , Assistência Ambulatorial , Visita Domiciliar , Atenção Primária à Saúde , Avaliação das Necessidades , EquadorRESUMO
Introducción: La tuberculosis es la novena causa de muerte en el mundo y la primera de las enfermedades infecciosas. El objetivo del presente trabajo fue describir la situación epidemiológica de la tuberculosis y el alcance de la respuesta de la estrategia de control en un distrito de salud de la serranía del Ecuador.Materiales y Métodos: estudio descriptivo, con información secundaria de la base de registros de personas con tuberculosis del Distrito de Salud 17D06 Chilibulo Lloa; los datos de identificación personal se mantuvieron bajo estricto carácter anónimo y confidencial.Resultados: En el 2017 y 2018 hubo 39 y 44 casos de tuberculosis; el 61% fue de sexo masculino; el 71,8% fueron mayores a 35 años; la tasa de mortalidad fue de 0.02 y 0.97 por cada 100.000 habitantes. La captación fue del 15,5% en el 2017 y 17,9% en el 2018. Las brechas en captación del sintomático respiratorio, diagnóstico de tuberculosis con baciloscopía positiva y su total estuvieron por encima del 80% en ambos años. De los pacientes que iniciaron tratamiento, el 87,2 % terminaron el mismo en el 2017 y el 31,8% en el 2018. Discusión: La tasa de éxito en el tratamiento en el 2017 es similar a la meta planteada a nivel nacional (87%), algo inferior en el 2018. Los logros en captación también difieren al resto del país (30%), Conclusión: El distrito de salud realiza un adecuado seguimiento en el tratamiento de personas con tuberculosis, pero falla en la captación de sintomáticos respiratorios.
Introduction: Tuberculosis is the ninth cause of death in the world and the first of infec-tious diseases. The objective of this study was to describe the epidemiological situation of tuberculosis and the scope of the response of the control strategy in a health district in the highlands of Ecuador.Materials and methods: descriptive study, with secondary information from the database of records of people with tuberculosis of the Health District 17D06 Chilibulo - Lloa; personal identification data was kept strictly anonymous and confidential.Results: In 2017 and 2018 there were 39 and 44 cases of tuberculosis; 61% were male; 71.8% were older than 35 years; the mortality rate was 0.02 and 0.97 per 100,000 inhabi-tants. The uptake was 15.5% in 2017 and 17.9% in 2018. The gaps in uptake of respiratory symptoms, diagnosis of tuberculosis with positive smear microscopy and its total were abo-ve 80% in both years. Of the patients who started treatment, 87.2% finished it in 2017 and 31.8% in 2018.Discussion: The treatment success rate in 2017 is like the goal set at the national level (87%), somewhat lower than in 2018. The achievements in recruitment also differ from the rest of the country (30%),Conclusion: The health district carries out adequate monitoring in the treatment of people with tuberculosis but fails to capture patients with respiratory symptoms.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Tuberculose/epidemiologia , Tuberculose Pulmonar , Estratégias de eSaúde , Atenção Primária à Saúde , Tuberculose/prevenção & controle , Assistência ao Convalescente , EquadorRESUMO
Contiene la estrategia para la prevención y mitigación de desastres puesta en práctica en el hospital Raúl Mejía Maldonado. Se halla orientado al manejo de epidemias o problemas posteriores al desastre...
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Planejamento em Desastres , Equador , Efeitos de Desastres na Saúde , Administração Hospitalar , DesastresRESUMO
Trata de un análisis de la prevalencia de consumo de cigarrillo y alcohol, en 478 alumnos del sexto grado de 6 escuelas de la ciudad de Cayambe, mediante una encuesta realizada en febrero de 1998. Los resultados indican niños de 10 a 15 años de edad, de los cuales 259 (54.18 por ciento) son niñas, y 219 (45.82 por ciento) son niños. 5 (1.07 por ciento) niños y ninguna niña declaran fumar cigarrillo, 1 (0.22 por ciento) niña y 13 (2.81 por ciento) niños declaran tomar alcohol. Estos valores demuestran que existe consumo temprano de sustancias nocivas para la salud, afectará en mayor grado a la población adulta y que es necesario utilizar de mejor forma las políticas de salud y educación existentes para evitar estos hábitos en los niños...
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Humanos , Criança , Alcoolismo , Prevalência , Serviços de Saúde Escolar , Instituições Acadêmicas , Nicotiana , Equador , PediatriaRESUMO
El tratamiento de radioterapia utilizado para tratar tumores malignos abdominales conlleva complicaciones como fistulas recto-vaginales, y estenosis con hemorragia iterativa con más frecuencia, además rectitis actínica, cistitis, diarrea severa, dermatitis severa y edema de miembros inferiores. La afección funcional del intestino delgado con endarteritis obliterante y lesiones progresivas en todas las capas del intestino se ha denominado enteritis o mejor dicho enteropatía por radiación. A continuación se presenta una revisión de toda la literatura encontrada sobre este tema, describiendo la patogenia, factores predisponentes, clínica, diagnóstico, tratamiento conservador o quirúrgico y prevención.
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Enterite , Obstrução Intestinal , Intestino DelgadoRESUMO
Se trata de un análisis de la prevalencia de consumo de sustancias nocivas para la salud, cigarrillo y alcohol, realizado por el personal de salud escolar del Hospital Cantonal Raúl Maldonado Mejía de Cayambe, en 478 alumnos del sexto grado de 6 escuelas de la ciudad, mediante una encuesta realizada en 1998. Los resultados indican niños de 10 a 15 años de edad, de los cuales 259 (54.18 por ciento) son niñas, y 219 (45.82 por ciento) son niños. 5(1.07 por ciento) niños y ninguna niña declara fumar cigarrillo, 1(0.22 por ciento) niña y 13(2.81 por ciento) niños declaran tomar alcohol. Estos valores demuestran que el consumo temprano de sustancias nocivas afectará en el futuro en mayor grado a la población adulta...
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Consumo de Bebidas Alcoólicas , Criança , Hábitos , Nicotiana , Coleta de Dados , Equador , Política de Saúde , Hospitais EstaduaisRESUMO
Se presenta el caso clínico de una paciente femenina de 56 años, que nunca a estado embarazada y no tiene hijos. Se realizó apendicectomía hace 30 años, amigdalectomía hace 20 años, histerectomía y oforectomía bilateral por Ca. de ovario con quimio y radioterapia adyuvantes hace 3 años. Presentó peritonitis secundaria a perforación intestinal por catéter de Tenkof hace 2 años. Acude al hospital Carlos Andrade Marín porque hace 8 días presenta dolor abdominal generalizado de tipo cólico, sin causa aparente, de moderada intensidad, se acompaña de náusea que llega al vómito de tipo fecaloide. Es hospitalizada en urgencias, y al tercer día se le realiza una laparotomía exploratoria, con el diagnóstico de obstrucción intestinal...