RESUMO
OBJECTIVE: To organize the experience and international knowledge in the surgical management and staging of colorectal endometriosis, with a management proposal in stages. METHOD: An extensive non-systematic review of the literature was carried to organize the disease in stages (limited, intermediate and advanced) according to a scoring system, which considers the characteristics of the endometrioma, the personal history and surgical findings. We tested the proposed staging in a retrospective group of patients. RESULTS: From January 2017 to April 2023, we collected 19 patients with a confirmed diagnosis of colorectal endometriosis, treated laparoscopically, by the same group of surgeons, in whom we found a strong correlation between the stage of the disease and the presence of complications that required reinterventions. CONCLUSIONS: We suggest a sequence of colorectal surgical management in stages according to the staging of the disease and we hope that this work will be followed by joint efforts to test it prospectively in order to compare results between hospital centers and make planned decisions.
OBJETIVO: Organizar la experiencia y el conocimiento internacional en el manejo quirúrgico y la estadificación de la endometriosis colorrectal, con una propuesta de manejo por etapas. MÉTODO: Se realizó una revisión amplia no sistemática de la literatura para organizar la enfermedad en etapas (limitada, intermedia y avanzada) de acuerdo con un sistema de puntuación que considera las características del endometrioma, los antecedentes personales y los hallazgos en la cirugía. La estatificación propuesta se probó en un grupo retrospectivo de pacientes. RESULTADOS: De enero de 2017 a abril de 2023 recopilamos 19 pacientes con diagnóstico confirmado de endometriosis colorrectal, tratadas por vía laparoscópica, por el mismo grupo de cirujanos, en las que encontramos una fuerte correlación entre el estadio de la enfermedad y la presencia de complicaciones que requirieron reintervenciones. CONCLUSIONES: Sugerimos una secuencia de manejo quirúrgico colorrectal en etapas de acuerdo con la estadificación de la enfermedad y esperamos que el presente trabajo sea seguido de esfuerzos compartidos por probarla de manera prospectiva para poder comparar resultados entre centros hospitalarios y tomar decisiones planificadas.
Assuntos
Neoplasias Colorretais , Endometriose , Laparoscopia , Feminino , Humanos , Endometriose/cirurgia , Endometriose/complicações , Estudos Retrospectivos , Neoplasias Colorretais/cirurgia , Laparoscopia/métodosRESUMO
Responding to the need for school-based, broadly applicable, low-cost, and brief assessments of socio-emotional skills, we describe the conceptual background and empirical development of the SENNA inventory and provide new psychometric information on its internal structure. Data were obtained through a computerized survey from 50,000 Brazilian students enrolled in public school grades 6 to 12, spread across the entire State of São Paulo. The SENNA inventory was designed to assess 18 particular skills (e.g., empathy, responsibility, tolerance of frustration, and social initiative), each operationalized by nine items that represent three types of items: three positively keyed trait-identity items, three negatively keyed identity items, and three (always positively keyed) self-efficacy items, totaling a set of 162 items. Results show that the 18 skill constructs empirically defined a higher-order structure that we interpret as the social-emotional Big Five, labeled as Engaging with Others, Amity, Self-Management, Emotional Regulation, and Open-Mindedness. The same five factors emerged whether we assessed the 18 skills with items representing (a) a trait-identity approach that emphasizes lived skills (what do I typically do?) or (b) a self-efficacy approach that emphasizes capability (how well can I do that?). Given that its target youth group is as young as 11 years old (grade 6), a population particularly prone to the response bias of acquiescence, SENNA is also equipped to correct for individual differences in acquiescence, which are shown to systematically bias results when not corrected.
RESUMO
Likert-type self-report scales are frequently used in large-scale educational assessment of social-emotional skills. Self-report scales rely on the assumption that their items elicit information only about the trait they are supposed to measure. However, different response biases may threaten this assumption. Specifically, in children, the response style of acquiescence is an important source of systematic error. Balanced scales, including an equal number of positively and negatively keyed items, have been proposed as a solution to control for acquiescence, but the reasons why this design feature worked from the perspective of modern psychometric models have been underexplored. Three methods for controlling for acquiescence are compared: classical method by partialling out the mean; an item response theory method to measure differential person functioning (DPF); and multidimensional item response theory (MIRT) with random intercept. Comparative analyses are conducted on simulated ratings and on self-ratings provided by 40,649 students (aged 11-18) on a fully balanced 30-item scale assessing conscientious self-management. Acquiescence bias was explained as DPF and it was demonstrated that: the acquiescence index is highly related to DPF; balanced scales produce scores controlled for DPF; and MIRT factor scores are highly related to scores controlled for DPF and the random intercept is highly related to DPF.
Assuntos
Viés , Projetos de Pesquisa , Adolescente , Criança , Feminino , Humanos , Masculino , Inventário de Personalidade/estatística & dados numéricos , Psicologia Social , Psicometria , Autorrelato/estatística & dados numéricosRESUMO
Leishmania (Viannia) braziliensis induces American tegumentary leishmaniasis that ranges in severity from the milder form, cutaneous (CL) to severe disseminated cutaneous leishmaniasis. Patients with CL develop a cell-mediated Th1 immune response accompanied by production of inflammatory cytokines, which contribute to parasite control and pathogenesis of disease. Here, we describe the accumulation of circulating T cells with multiple features of telomere dependent-senescence including elevated expression of CD57, KLRG-1, and γH2AX that have short telomeres and low hTERT expression during cutaneous L. braziliensis infection. This expanded population of T cells was found within the CD45RA+CD27- (EMRA) subset and produced high levels of inflammatory cytokines, analogous to the senescence-associated secretory profile (SASP) that has been described in senescent non-lymphoid cells. There was a significant correlation between the accumulation of these cells and the extent of systemic inflammation, suggesting that they are involved in the inflammatory response in this disease. Furthermore, these cells expressed high level of the skin homing receptor CLA and there was a highly significant correlation between the number of these cells in the circulation and the size of the Leishmania-induced lesions in the skin. Collectively our results suggest that extensive activation during the early stages of leishmaniasis drives the senescence of T cells with the propensity to home to the skin. The senescence-related inflammatory cytokine secretion by these cells may control the infection but also contribute to the immunopathology in the disease.
Assuntos
Senescência Celular/imunologia , Inflamação/imunologia , Leishmania braziliensis/imunologia , Leishmaniose Cutânea/imunologia , Linfócitos T/imunologia , Adulto , Citocinas/imunologia , Citocinas/metabolismo , Feminino , Humanos , Inflamação/sangue , Leishmaniose Cutânea/sangue , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Masculino , Pessoa de Meia-Idade , Receptores de Retorno de Linfócitos/imunologia , Receptores de Retorno de Linfócitos/metabolismo , Pele/imunologia , Pele/parasitologia , Pele/patologia , Linfócitos T/metabolismo , Adulto JovemRESUMO
Las miocardiopatías son trastornos miocárdicos que no se pueden explicar por condiciones de carga anormales o enfermedad coronaria. Se clasifican en una serie de fenotipos morfológicos y funcionales de etiología genética y no genética. Los temas dominantes en los trabajos publicados en 2012-2013 son similares a los publicados en Almanac 2011, como el uso (y la interpretación) de las pruebas genéticas, el desarrollo y la aplicación de nuevas técnicas imagenológicas no invasivas, y el uso de biomarcadores séricos para el diagnóstico y el pronóstico. Una importante innovación desde el último número de Almanac es la aparición de modelos más sofisticados de predicción de eventos clínicos adversos.
RESUMO
Health care systems are under increasing pressure to cope with shifting demographics, the threat of chronic and noncommunicable disease, and rising health care costs. The uptake of innovations to meet these challenges and to advance medicine and health care delivery is not as rapid as the pace of change. Greater emphasis on the diffusion of innovation and greater understanding of the structural and organizational levers that can be used to facilitate systemwide improvement are essential. This article describes the results of a qualitative and quantitative study to assess the factors and behaviors that foster the adoption of health care innovation in eight countries: Australia, Brazil, England, India, Qatar, South Africa, Spain, and the United States. It describes the front-line cultural dynamics that must be fostered to achieve cost-effective and high-impact transformation of health care, and it argues that there is a necessity for greater focus on vital, yet currently underused, organizational action to support the adoption of innovation.
Assuntos
Atenção à Saúde/tendências , Difusão de Inovações , Reforma dos Serviços de Saúde/tendências , Austrália , Brasil , Características Culturais , Inglaterra , Política de Saúde , Humanos , Índia , Catar , África do Sul , Espanha , Estados UnidosRESUMO
BACKGROUND: Both the classification of personality disorder in intellectual disability (ID) and its identification in practice are deemed to be difficult. A simpler approach to classification and its relationship to challenging behaviours were tested in an adult Jamaican population with ID. METHOD: The study was carried out in Kingston, Jamaica, as part of a programme of field trials to determine the utility of the proposed revision of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11), in a population of adults with ID living with their families or in supported care homes. Thirty-eight people with borderline (n = 5), mild (n = 16), moderate (n = 14) and severe (n = 3) ID were assessed at face-to-face interview and with relatives or staff using the provisional criteria for severity of personality disorder and its associated domain traits, and challenging behaviour was assessed using the Problem Behaviour Check List (PBCL) (a 5-point, 7-item scale). RESULTS: Using the severity scale 18 patients (47%) had no personality disorder, 7 (18%) had personality difficulty, 9 (24%) had mild personality disorder, and 4 (11%) had moderate personality disorder. None of the sample had severe personality disorder in which there is high risk of harm to self or others. Of the four major trait domains, provisionally named anankastic, detached, emotional and dissocial, three were evenly distributed in those with personality disturbance with the antagonistic (antisocial) trait less commonly shown (6 only). Scores on the PBCL were higher in those with increasing severity of personality disorder (P = 0.03) and those in the antagonistic personality trait domain had the highest PCL scores. CONCLUSIONS: Despite previous difficulties in assessing personality disorder in intellectual difficulties the ICD-11 classification was easy to administer in practice in this population, and the higher problem behaviour scores in those with greater severity of personality disturbance support its construct validity.
Assuntos
Agressão/fisiologia , Deficiência Intelectual/fisiopatologia , Transtornos da Personalidade/fisiopatologia , Adolescente , Adulto , Agressão/classificação , Comorbidade , Feminino , Humanos , Deficiência Intelectual/epidemiologia , Jamaica , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/classificação , Transtornos da Personalidade/epidemiologia , Prevalência , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE: To implement a controlled clinical trial (PRODIACOR) in a primary care setting designed 1) to improve type 2 diabetes care and 2) to collect cost data in order to be able to measure cost-effectiveness of three system interventions (checkbook of indicated procedures, patient/provider feedback and complete coverage of medications and supplies) and physician and/or patient education to improve psychological, clinical, metabolic and therapeutic indicators. All three Argentinean health subsectors (public health, social security and the private, prepaid system) are participants in the study. Patients of participating physicians were randomly selected and assigned to one of four groups: control, provider education, patient education, and provider/patient education; the system interventions were provided to all four groups. BASELINE RESULTS: Mean BMI was 29.8 kg/m(2); most subjects had blood pressure, fasting glucose and total cholesterol above targets recommended by international standards. Only 1% had had microalbuminuria measured, 57% performed glucose self-monitoring, 37% had had an eye examination and 31% a foot examination in the preceding year. Ten percent, 26% and 73% of people with hyperglycemia, hypertension and dyslipidemia, respectively, were not on medications. Most patients treated with either insulin or oral antidiabetic agents were on monotherapy as were those treated for hypertension and dyslipidemia. WHO-5 questionnaire scores indicated that 13% of the subjects needed psychological intervention. CONCLUSIONS: Baseline data show multiple deficiencies in the process and outcomes of care that could be targeted and improved by PRODIACOR intervention.
Assuntos
Doenças Cardiovasculares/terapia , Diabetes Mellitus Tipo 2/terapia , Assistência Centrada no Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Idoso , Argentina , Índice de Massa Corporal , Coleta de Dados/estatística & dados numéricos , Feminino , Indicadores Básicos de Saúde , Humanos , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sistemas de Alerta , Projetos de Pesquisa , Fatores de Risco , Tamanho da AmostraRESUMO
Understanding how animal populations have evolved in response to palaeoenvironmental conditions is essential for predicting the impact of future environmental change on current biodiversity. Analyses of ancient DNA provide a unique opportunity to track population responses to prehistoric environments. We explored the effects of palaeoenvironmental change on the colonial tuco-tuco (Ctenomys sociabilis), a highly endemic species of Patagonian rodent that is currently listed as threatened by the IUCN. By combining surveys of modern genetic variation from throughout this species' current geographic range with analyses of DNA samples from fossil material dating back to 10,000 ybp, we demonstrate a striking decline in genetic diversity that is concordant with environmental events in the study region. Our results highlight the importance of non-anthropogenic factors in loss of diversity, including reductions in smaller mammals such as rodents.
Assuntos
Variação Genética , Roedores/genética , Animais , Biodiversidade , Clima , Citocromos b/genética , Fósseis , Geografia , Haplótipos , Filogenia , Análise de Sequência de DNA , América do SulRESUMO
To improve standardization in analytical reagents we investigated Chloramine-T radioiodination (125I) of several biomolecules based on the use of a single amount of the oxidizing agent Chloramine-T as the limiting reagent being exhausted during the course of the reaction. Whenever the labeling yield resulted in less than one atom 125I/molecule, a second amount of the oxidizing agent was added. Thereafter, the integrity of the various biomolecules was assessed using radioimmunoassays, radioreceptor binding assays, or radioimmunometric assays. Purification yields were done by gel permeation (56% +/- 19%, n=230) or by precipitation with trichloroacetic acid (59% +/- 19%, n=230). Specific activity (117 +/- 61 MBq/nmol) and the degree of iodine incorporation (1.4 +/- 0.8 atoms of 125I/molecule) were achieved after 300 sec of incubation. A second addition of Chloramine-T resulted in an increased labeling yield of all biomolecules tested by a mean factor of 1.8 +/- 0.9. After the second addition of Chloramine-T, we observed for some biomolecules a significant (p<0.001) decreased effect in biological performance. In conclusion, the use of Chloramine-T as a limiting reagent resulted in molecules with appropriate immunological and biological performance. In general, tracers were minimally damaged and assessment of the shelf life as well as storing conditions showed the usefulness of the standardization of biomolecule labeling.
Assuntos
Cloraminas/química , Radioisótopos do Iodo , Marcação por Isótopo/métodos , Oxidantes/química , Compostos de Tosil/química , Animais , Humanos , OxirreduçãoRESUMO
In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers-the main outlets for longer-acting methods-in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas.
PIP: Jamaica's National Family Planning Board's strategy to ensure the sustainability of its family planning program and improve its effectiveness involves getting users of contraception to use longer-acting methods and increasing the role of the private sector in service delivery. Before this approach was implemented, however, a study was conducted to secure a better understanding of the nature and scope of existing family planning services in Jamaica. The study looked at the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. Private sector providers, the main sources of longer-acting methods, were found to be concentrated in urban areas. As such, longer-acting methods were hard to come by in rural areas. The public sector must recognize that private sector providers are not serving rural areas, and provide longer-acting methods to people who want them.
Assuntos
Atenção à Saúde/organização & administração , Serviços de Planejamento Familiar/organização & administração , Acessibilidade aos Serviços de Saúde , Eficiência Organizacional , Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/métodos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Jamaica , Masculino , Setor Privado , Saúde da População Rural , Inquéritos e Questionários , Saúde da População UrbanaRESUMO
In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas
Assuntos
Humanos , Serviços de Planejamento Familiar/provisão & distribuição , Acessibilidade aos Serviços de Saúde , População Rural , População Urbana , Anticoncepção , Serviços de Planejamento Familiar/economia , Jamaica , Área Carente de Assistência MédicaRESUMO
A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinical records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods.
PIP: In order to foster the self-sustainability of its family planning (FP) program, Jamaica has introduced user fees for previously free FP services. In 1992, donations were solicited for injectables and sterilization. By January 1993, a fee of J $200 was set for sterilization, and fees for other services were introduced. A study was undertaken to 1) examine the effect of the new fee structure on clinic attendance; 2) determine the extent to which the fees might have encouraged a shift to other methods; and 3) establish a range of affordable prices for current users. Data were collected from clinic attendance records for January-April of 1990-1992 and compared to the same period in 1993. A 20% sample of clients (n = 1002) attending in January of each year was followed for 4 months to allow comparisons of method changes. Finally a questionnaire was administered to a 25% sample of daily users (n = 200) over 4 weeks in February 1993 to determine affordable fees. It was found that there was a 28% decline in attendance in 1993 over 1992 despite a temporary halt in sterilizations in early 1992. The number of new clients in 1993 increased but failed to reach the 1990 level. The number of old clients attending in 1993 was the lowest for the 4 years. In early 1992, there was a shortage of injectable contraceptives. Despite this, injectables were used 7% more in 1992 than in 1993 when a fee of J $100 was established. Almost a third of the sample of new clients accepted sterilization in 1993, and all of the women kept their appointments unlike previous experience (perhaps out of fear of a higher fee in the future). 1993 also saw the highest percentage of drop-outs of any year studied. Current prices charged by the clinic for oral contraceptives, injectables, and sterilization were acceptable to 85, 23, and 13% of the women, respectively. The substantial drop in clientele over a single year affected mainly clients using injectables. A reduction in the price of this method seems justified not only by the loss of clients but also because the fee for this method is higher than that for longterm or permanent methods. Costs could also be subsidized by other strategies, such as allowing higher income couples to pay a fee to secure an appointment instead of having to wait. Future price increases should be gradual, since increases of 10% a few times a year are less likely to result in patient loss.
Assuntos
Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/estatística & dados numéricos , Honorários e Preços , Feminino , Humanos , JamaicaRESUMO
The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.
PIP: As part of a research program to identify the barriers to increasing the acceptance of sterilization in the West Indies, a study was undertaken to determine why an estimated 16% of annual registrants for sterilization failed to keep their appointments (no-shows). From 300 no-shows, a random sample of 50 was interviewed and matched for year of registration, age, parity, marital and economic status, and geographic area with a control sample of 50 sterilized women. The most important reason for considering sterilization for all of the women was the desire to have no more children. The no-shows exhibited a lack of self-motivation, citing friends and medical personnel as motivators, and in no case did motivation come from the partner. The no-shows cited partner-related reasons and fear as causing them to break the appointments. Many women were ready for sterilization but were unable to discuss the topic with their partners. Among the sterilized women, 2 regretted the procedure. Among the no-shows, there had been 8 pregnancies, 3 of which were terminated, and 7 women were attempting to become pregnant. Recent research in the Caribbean suggests that improving women's status plays a more important role in reducing fertility than that played by family planning programs. As long as childbearing is seen as a precondition for receiving financial assistance from a man, it will continue.
Assuntos
Agendamento de Consultas , Esterilização Tubária , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods.
Assuntos
Humanos , Feminino , /economia , Serviços de Planejamento Familiar , Honorários Médicos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Agendamento de Consultas , Dispositivos Anticoncepcionais , JamaicaRESUMO
The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.
Assuntos
Agendamento de Consultas , Esterilização Reprodutiva/psicologia , Paridade , Atitude , Características da Família , Fatores Etários , Jamaica , MotivaçãoRESUMO
Extraction, washout and chemical integrity of technetium(I) hexakis (2-carbomethoxy-2-isocyano propane), (99mTc-CPI) were evaluated in isolated contractile rat atrial tissue. 99mTc-CPI accumulated linearly over time at 32 degrees C with uptakes that were both concentration dependent and temperature sensitive. Uptake rates also increased with contractile strength, indicating a dependence of retention on metabolic status of the tissue. Retention indices showed that percent washout of 99mTc-CPI was much slower than control studies with 99mTcO4. HPLC analysis of retained radioactive products in atrial tissue showed most of the activity present as the 99mTc-CPI complex (75%). These observations in isolated rat atrial tissue help explain the interspecies differences in biodistribution of 99mTc-CPI and support the membrane potential dependent model for uptake and retention of technetium isonitrile complexes.