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The finding of a lipoma in the middle ear is much rarer than its occurrence in the external auditory canal or even the inner ear, with fewer than seven cases described in the literature and none of them in Spain or South America. Despite its benign nature, the location of the lipoma may compromise structures that play a significant role in auditory preservation or balance control, necessitating surgical removal as a curative treatment. The main objective of this article is to describe the presentation of lipomas in the middle ear as a possible, although rare, etiology to consider in patients presenting with hearing loss, instability, or both symptoms concurrently, seeking otorhinolaryngological evaluation.
El hallazgo de un lipoma en el oído medio es mucho más raro que su ocurrencia en el canal auditivo externo o incluso en el oído interno, con menos de siete casos descritos en la literatura y ninguno de ellos en España o Sudamérica. A pesar de su naturaleza benigna, la ubicación del lipoma puede comprometer estructuras que desempeñan un papel significativo en la preservación auditiva o en el control del equilibrio, lo que hace necesaria la extirpación quirúrgica como tratamiento curativo. El objetivo principal de este artículo es describir la presentación de los lipomas en el oído medio como una posible, aunque rara, etiología a considerar en pacientes que presentan pérdida de audición, inestabilidad o ambos síntomas simultáneamente, buscando evaluación otorrinolaringológica.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Orelha/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Lipoma/diagnóstico por imagemRESUMO
Plant roots recruit most prokaryotic members of their root microbiota from the locally available inoculum, but knowledge on the contribution of native microorganisms to the root microbiota of crops in native versus non-native areas remains scarce. We grew common bean (Phaseolus vulgaris) at a field site in its centre of domestication to characterise rhizosphere and endosphere bacterial communities at the vegetative, flowering, and pod filling stage. 16S r RNA gene amplicon sequencing of ten samples yielded 9,401,757 reads, of which 8,344,070 were assigned to 17,352 operational taxonomic units (OTUs). Rhizosphere communities were four times more diverse than in the endosphere and dominated by Actinobacteria, Bacteroidetes, Crenarchaeota, and Proteobacteria (endosphere: 99% Proteobacteria). We also detected high abundances of Gemmatimonadetes (6%), Chloroflexi (4%), and the archaeal phylum Thaumarchaeota (Candidatus Nitrososphaera: 11.5%): taxa less frequently reported from common bean rhizosphere. Among 154 OTUs with different abundances between vegetative and flowering stage, we detected increased read numbers of Chryseobacterium in the endosphere and a 40-fold increase in the abundances of OTUs classified as Rhizobium and Aeromonas (equivalent to 1.5% and over 6% of all reads in the rhizosphere). Our results indicate that bean recruits specific taxa into its microbiome when growing 'at home'.
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Resumo: Introdução: O ensino de habilidades de exame físico, parte integrante e obrigatória dos currículos de escolas médicas, ocorre, tradicionalmente, com uma abordagem baseada na "demonstração e prática", e, embora existam outros modelos, não há, até o momento, nenhuma evidência de que um seja superior ao outro. Inovações nessa área são apontadas como caminho para suprir as deficiências de ensino-aprendizagem. Objetivo: Este estudo teve como objetivos descrever a incorporação da videogravação e do videofeedback no ensino-aprendizagem de habilidades de exame físico e avaliar a eficácia desses recursos. Método: Foi realizado um estudo historicamente controlado antes e depois da intervenção com alunos do primeiro ano de um curso de Medicina. O grupo de intervenção, em que se aplicaram a videogravação e o videofeedback, foi constituído de 91 alunos do semestre 2019.2, e o grupo controle contou com 72 alunos do semestre 2018.1. Ambas as turmas realizaram duas avaliações teóricas somativas (T1 e T2) e duas práticas, no formato de um exame clínico objetivo estruturado (OSCE). Na análise estatística comparativa das notas de ambas as turmas, utilizaram-se os testes não paramétricos da soma de postos de Wilcoxon-Mann-Whitney. Resultado: A mediana das notas das avaliações práticas (primeiro e segundo OSCEs) de 2019 foram maiores do que as de 2018. Constatou-se ainda que a turma de 2019 teve uma evolução positiva das suas notas práticas passando de uma mediana de 11,6 no primeiro OSCE para 13,85 no segundo OSCE, o que também ocorreu com as provas teóricas (p < 0,05). Já na turma de 2018, houve queda da mediana das notas da T1 para T2 e do primeiro OSCE para o segundo OSCE, mas sem significância estatística. Conclusão: A incorporação da videogravação e videofeedback no ensino-aprendizagem de habilidades de exame físico entre graduandos do primeiro ano do curso de Medicina, em ambientes simulados, mostrou-se efetiva na melhora do desempenho dos discentes em avaliações teóricas e práticas. Essa abordagem se mostra ainda como meio de desenvolvimento e aplicação de uma aprendizagem motora observacional, reflexiva, experiencial e da metacognição no ensino-aprendizagem de habilidades de exame físico entre estudantes de Medicina.
Abstract: Introduction: Physical examination skills, an integral and mandatory part of medical school curricula, are traditionally taught through an approach based on "demonstration and practice", and although other models exist, there is, to date, no evidence that one is superior to the other. Innovations in this area are pointed out as a way to supply deficiencies in teaching and learning. Objectives: To describe the incorporation of video recording and video feedback in the teaching-learning of physical examination skills and to evaluate the effectiveness of such approach. Method: A historically controlled study was carried out before and after the intervention with students in the first year of a medical course. The intervention group, in which video recording and video feedback was applied, consisted of 91 students from semester 2019.2 and the control group had 72 students from semester 2018.1. Both classes underwent two summative theoretical (T1 and T2) and two practical assessments, in the format of an objective structured clinical examination (OSCE). In the comparative statistical analysis of the grades of both classes, the non-parametric Wilcoxon and Mann Whitney rank test was used. Results: The median of the marks of the practical evaluations (1st and 2nd OSCE) of the 2019 class were higher than those of 2018. It was also found that the class of 2019 showed a positive evolution in its practical marks, with the median score increasing from 11.6 in the 1st OSCE to 13.85 in the 2nd OSCE, which also happened with the theoretical tests (p <0.05). In the class of 2018, there was a drop in the median mark from T1 to T2 and from the 1st OSCE to the 2nd OSCE, but without statistical significance. Conclusion: The incorporation of video recording and video feedback in teaching-learning physical examination skills among first-year medical students, in simulated environments, proved to be effective in improving student performance in both theoretical and practical assessments. This approach is also shown as a means of developing and applying observational, reflective, experiential and metacognition motor learning in the teaching-learning of physical examination skills among medical students.
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O objetivo do presente relato é apresentar a experiência do processo de Planificação da Atenção à Saúde da Secretaria de Estado da Saúde do Rio Grande do Sul (RS). A Planificação da Atenção à Saúde no RS, estruturada com o apoio do Conselho Nacional de Secretários de Saúde, trata-se de um conjunto de oficinas, além de processos de tutoria em unidades-laboratórios, para as equipes de saúde e gestores municipais. Visa à organização dos macro e microprocessos da Atenção Primária à Saúde (APS) e sua organização estruturada com a Atenção Ambulatorial Especializada. Em fevereiro de 2018, as oficinas já haviam sido concluídas em duas Regiões de Saúde - com aproximadamente 120 facilitadores e 1.000 trabalhadores da APS, e estava em fase de finalização em outras duas Regiões de Saúde - com cerca 1.300 trabalhadores da APS. O desafio para o planejamento e para a gestão estadual é ampliar a Planificação da Atenção à Saúde para as demais 26 Regiões de Saúde do RS, bem como o monitoramento e a avaliação do processo. Em última análise, a Planificação, como método de planejamento, visa ao fortalecimento da Atenção Primária à Saúde como base para a implementação das Redes de Atenção à Saúde no território gaúcho.
The objective of the present report is to present the experience of the Health Care Planification process of the State Health Department of Rio Grande do Sul (RS). The Planification of Health Care in RS, structured with the support of the National Council of Health Secretaries, is a set of workshops, as well as tutoring processes in laboratory units for health workers and municipal managers. It aims to organize macro and micro-processes of Primary Health Care (PHC) and its organization structured with Specialized Ambulatory Care. In February 2018, the workshops were completed in two Health Regions - with approximately 120 facilitators and 1,000 PHC workers- and were finalized in two other Health Regions - with approximately 1,300 PHC workers. The challenge for planning and state management is to expand the Health Care Planification for the other 26 Health Regions of RS, as well as the monitoring and evaluation of the process. As a planning method, Health Care Planification aims to strengthen Primary Health Care as the basis for the implementation of Health Care Networks in the state of Rio Grande do Sul.
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Planejamento , Atenção Primária à SaúdeRESUMO
BACKGROUND AND PURPOSE: Stroke is the major cause of vascular behavior and cognitive disorders worldwide. In developing countries, there is a dearth of information regarding the public health magnitude of stroke. The aim of the Fogarty-Mexico cohort was to assess the prevalence of vascular behavioral and cognitive disorders, ranging from mild vascular cognitive impairment (VCI) to vascular dementia (VaD), in a cohort of acute first-ever symptomatic stroke patients in Mexico. METHODS: A total of 165 consecutive, first-ever stroke patients admitted to the National Institute of Neurology and Neurosurgery in Mexico City, were included in the cohort. Patients were eligible if they had an ischemic stroke, primary intracerebral hemorrhage, or cerebral venous thrombosis (CVT). Stroke diagnosis required the presence of an acute focal deficit lasting more than 24 h, confirmed by a corresponding lesion on CT/MRI. Stroke severity was established with the NIH Stroke Scale. The pre-stroke functional status was determined by the IQCODE. Three months after the occurrence of stroke, 110 survivor patients returned for follow-up and were able to undergo functional outcome (modified Rankin scale, Barthel index), along with neurological, psychiatric, neuropsychological, laboratory, and imaging assessments. We compared depression, demographic, and clinical and imaging features between patients with and without dementia, and between patients with VCI and those with intact cognition. RESULTS: Of the 110 patients (62% men, mean age 56 ± 17.8, education 7.7 ± 5.2 years) 93 (84%) had ischemic strokes, 14 (13%) intracerebral hemorrhage, and 3 (3%) CVT. The main risk factors were hypertension (50%), smoking (40%), hypercholesterolemia (29%), hyperhomocysteinemia (24%), and diabetes (22%). Clinical and neuropsychological evaluations demonstrated post-stroke depression in 56%, VCI in 41%, and VaD in 12%; 17% of the latter had pre-stroke functional impairment (IQCODE >3.5). Cognitive deficits included executive function in 69%, verbal memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054), older age (mean age 65.6 years vs. 49.3, p < 0.001), diabetes (p ≤ 0.004), illiteracy and lower education (p ≤ 0.001), and PSD (p = 0.03) were significantly higher in VCI-VaD compared with cognitively intact post-stroke subjects. We could not demonstrate an association with lesion site and distribution of the cognitive deficits. CONCLUSIONS: The Fogarty-Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable.
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Cognição , Disfunção Cognitiva/epidemiologia , Demência Vascular/epidemiologia , Depressão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Demência Vascular/diagnóstico , Demência Vascular/psicologia , Depressão/diagnóstico , Depressão/psicologia , Avaliação da Deficiência , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
In Brazil, epizootics among New World monkey species may indicate circulation of yellow fever (YF) virus and provide early warning of risk to humans. Between 1999 and 2001, the southern Brazilian state of Rio Grande do Sul initiated surveillance for epizootics of YF in non-human primates to inform vaccination of human populations. Following a YF outbreak, we analyzed epizootic surveillance data and assessed YF vaccine coverage, timeliness of implementation of vaccination in unvaccinated human populations. From October 2008 through June 2009, circulation of YF virus was confirmed in 67 municipalities in Rio Grande do Sul State; vaccination was recommended in 23 (34%) prior to the outbreak and in 16 (24%) within two weeks of first epizootic report. In 28 (42%) municipalities, vaccination began more than two weeks after first epizootic report. Eleven (52%) of 21 laboratory-confirmed human YF cases occurred in two municipalities with delayed vaccination. By 2010, municipalities with confirmed YF epizootics reported higher vaccine coverage than other municipalities that began vaccination. In unvaccinated human populations timely response to epizootic events is critical to prevent human yellow fever cases.
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Doenças dos Primatas/epidemiologia , Vacina contra Febre Amarela/administração & dosagem , Febre Amarela/epidemiologia , Febre Amarela/veterinária , Vírus da Febre Amarela/isolamento & purificação , Animais , Brasil/epidemiologia , Monitoramento Epidemiológico , Haplorrinos , Humanos , Doenças dos Primatas/virologia , Vacinação/métodos , Febre Amarela/prevenção & controle , Febre Amarela/virologiaRESUMO
OBJECTIVES: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. METHODS: This is a cross-sectional descriptive study of infants and children under 5, who suffered head trauma and were admitted to the National Pediatrics Institute in Mexico City, a tertiary care referral center. We reviewed medical records and extracted data on clinical and neurological signs and symptoms, fundus, radiological (long bones, thorax, CAT scan), and laboratory tests. We administered a standardized questionnaire assessing child abuse and neglect to the parents of the children included in the study. RESULTS: One hundred and twenty children, under 5 presenting with head trauma, were recruited, 13 (11%) were considered abusive head trauma (AbHT) and 107 (89%) were diagnosed as accidental head injury (AcHI). The AbHT group comprised younger infants (mean age 8 months) and the AcHI group included toddlers about an average of 25 months. To account for this significant age difference, we performed a comparison of age matched cases. The children in the AbHT were more likely to be female, the result of the first unintended pregnancy and the children of younger mothers (17-19). Mothers in this group had attended fewer than 5 prenatal care visits and fathers had a history of alcohol abuse. Five (38%) of the 13 AbHT children did not survive their injuries and overall showed greater neurological and respiratory compromise, increased prothrombin time (PT), and lower hematocrit values. The most common intracranial injuries suffered by children in the AbHT group were subdural/epidural hematoma and parenchymal/subarachnoid hemorrhage. Retinal hemorrhage was the most frequent ocular injury. CONCLUSIONS: In a tertiary care children's hospital, 11% of the children presenting with head trauma, were considered of abusive origin. Unintended pregnancy among teen mothers and substance abuse in the father were associated with abusive head trauma in this descriptive study.
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Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/estatística & dados numéricos , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada , Prevalência , Fatores de Risco , Adulto JovemRESUMO
CONTEXT: Misoprostol was used by women across Mexico to induce abortion even before 2007, when first-trimester abortion was legalized in Mexico City. Pharmacy vendors' misoprostol recommendation practices across subregions of Mexico after abortion legalization warrant examination. METHODS: Overall, 192 pharmacies in four regions of Mexico were randomly selected and visited by simulated clients presenting three scenarios (a young woman, an adult woman and a male partner). Bivariate and multivariate analyses were used to explore associations between pharmacy, vendor and client characteristics and drug access. RESULTS: In 558 encounters with simulated clients, 78% of vendors provided information about misoprostol-18% recommended it spontaneously and 60% recommended it only after the client asked specifically for the drug. Fifteen percent of vendors recommended a potentially effective misoprostol dosing regimen. Mexico City-based pharmacies and those in the Central region were significantly less likely than those in the North region to require a prescription to sell misoprostol (odds ratios, 0.2 and 0.3, respectively). Independent pharmacies and those from low-?income areas were significantly more likely to sell misoprostol by the pill than chain pharmacies and those in medium-income areas (3.2 and 2.7, respectively). CONCLUSIONS: Access to misoprostol is influenced by neighborhood socioeconomic level, pharmacy location and pharmacy type. The frequently inaccurate and incomplete information provided to clients about using misoprostol for abortion suggests the need to improve pharmacy vendor training in medication abortion options and to develop ways to directly inform women about misoprostol use.
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Abortivos não Esteroides , Aborto Induzido/psicologia , Atitude do Pessoal de Saúde , Misoprostol , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Aborto Induzido/métodos , Adolescente , Adulto , Competência Clínica , Bases de Dados Factuais , Feminino , Humanos , Masculino , México , Análise Multivariada , Farmácias , Gravidez , Fatores Socioeconômicos , Adulto JovemRESUMO
El objetivo del estudio fue determinar los factores que se relacionan con la satisfacción de la madre con la atención que recibe su hijo hospitalizado. La muestra: 127 madres de niños hospitalizados en una institución pública de Monterrey, N.L., México. Estudio descriptivo correlacional. Se utilizó el cuestionario de satisfacción del familiar pediátrico. El manejo del dolor fue un factor importante para la satisfacción de las madres participantes. La satisfacción de la madre con el servicio de hospitalización se asoció con la satisfacción con la atención de enfermería (rs = 0,458; p= 0,0001). La edad del hijo, el número de hospitalizaciones previas y la percepción de su estado de salud no fueron factores significativos para la satisfacción de las madres. Es importante que el servicio de hospitalización y la atención de enfermería respondan a las expectativas de los familiares de estos pacientes.
The study was designed to identify the factors associated with a mother's satisfaction with the care her child receives during hospitalization. The sample included 127 mothers of children who were patients at a public hospital in Monterrey, N.L., México. The study was correlational and descriptive. A family pediatric satisfaction questionnaire was used. Pain management was an important factor in the satisfaction of participating mothers. The mother's satisfaction with inpatient services was associated with nursing care and assistance (rs = 0,458; p= 0,0001). The child's age, the number of prior hospitalizations, and the perception of the child's state of health were not significant factors with respect to maternal satisfaction. It also is important for inpatient services and nursing care to respond to the expectations of the pediatric patient's family.
O objetivo deste estudo foi determinar os fatores relacionados à satisfação materna com os cuidados ao seu filho internado em um hospital. A amostra constou de 127 mães de crianças internadas em uma instituição pública de Monterrey, NL (México), aplicando uma pesquisa descritiva correlacional. Foi utilizado o questionário de satisfação da família do paciente pediátrico. O manejo da dor é um fator importante para a satisfação das mães participantes. A satisfação maternal com o atendimento hospitalar foi associada à satisfação com os cuidados de enfermagem (rs = 0,458; p = 0,0001). A idade da criança, o número de hospitalizações e a percepção do estado de saúde não foram fatores significativos para a satisfação das mães. É importante que o serviço de internamento e os cuidados de enfermagem satisfaçam às expectativas da família do paciente.
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Humanos , Masculino , Feminino , Atenção , Satisfação do Paciente , Hospitalização , Inquéritos e Questionários , Cuidados de EnfermagemRESUMO
Autoimmune liver diseases are sometimes difficult to differentiate from hepatic overlap syndromes (OS). The objective of this study was to use polymorphic genetic markers to better distinguish clinical heterogeneity in autoimmune liver disease. Since autoimmunity is the result of autoantibody production we studied HLA-DR alleles in 20 patients with autoimmune hepatitis (AIH), 16 with primary biliary cirrhosis (PBC), 10 with OS, and in 99 ethnically matched healthy individuals. Patients with OS had significantly higher alkaline phosphatase and total bilirubin levels than patients with AIH. OS patients had a higher prevalence of positive antinuclear antibodies and a higher AIH score than patients with PBC. Patients with OS also had higher total immunoglobulin levels (IgG isotype) as compared to patients with PBC. We found in PBC patients a higher gene frequency of HLA-DR4 and DR1 as compared to healthy controls (p = 0.03, OR = 2.2 and p = 0.004, OR = 4.3, respectively) and to OS patients (p = 0.01, OR = 6.8, and p = 0.004, OR = 10.0, respectively). On the other hand, the gene frequency of HLADR5 was significantly decreased in the total group of patients as compared to healthy controls suggesting a protective role of this allele for developing autoimmune liver disease.
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Doenças Autoimunes/genética , Biomarcadores/análise , Predisposição Genética para Doença , Antígenos HLA-DR/genética , Hepatopatias/genética , Anticorpos Antinucleares/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Frequência do Gene , Humanos , Imunoglobulina G/sangue , Hepatopatias/sangue , Hepatopatias/imunologia , Testes de Função Hepática , México , SíndromeRESUMO
The motor effects of cannabinoids in the globus pallidus appear to be caused by increases in interstitial GABA. To elucidate the mechanism of this response, we investigated the effect of the selective cannabinoid type 1 receptor (CB1) cannabinoid agonist arachidonyl-2-chloroethylamide (ACEA) on [(3)H]GABA release in slices of the rat globus pallidus. ACEA had two effects: concentrations between 10(-8) and 10(-6) M stimulated release, whereas higher concentrations (IC(50) approximately 10(-6) M) inhibited it. Another cannabinoid agonist, WIN-55,212-2, also had bimodal effects on release. Studies of cAMP production indicate that under conditions of low G(i/o), availability the coupling of CB1 receptors with G(i/o) proteins can be changed into CB1:G(s/olf) coupling; therefore, we determined the effects of conditions that limit G(i/o) availability on [(3)H]GABA release. Blockers of G(i/o) protein interactions, pertussis toxin and N-ethylmaleimide, transformed the inhibitory effects of ACEA on GABA release into stimulation. It also has been suggested that stimulation of D2 receptors can reduce G(i/o) availability. Blocking D2 receptors with sulpiride [(S)-5-aminosulfonyl-N-[(1-ethyl-2-pyrrolidinyl)methyl]-2-methoxybenzamidersqb] or depleting dopamine with reserpine inhibited the ACEA-induced stimulation of release. Thus, the D2 dependence of stimulation is consistent with the proposal that D2 receptors reduce G(i/o) proteins available for binding to the CB1 receptor. In summary, CB1 receptor activation has dual effects on GABA release in the globus pallidus. Low concentrations stimulate release through a process that depends on activation of dopamine D2 receptors that may limit G(i/o) protein availability. Higher concentrations of cannabinoid inhibit GABA release through mechanisms that are independent of D2 receptor activation.
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Benzoxazinas/farmacologia , Canabinoides/farmacologia , Globo Pálido/metabolismo , Globo Pálido/fisiologia , Morfolinas/farmacologia , Naftalenos/farmacologia , Ácido gama-Aminobutírico/metabolismo , Animais , Ácidos Araquidônicos/farmacologia , Canabinoides/agonistas , Globo Pálido/efeitos dos fármacos , Masculino , Toxina Pertussis/farmacologia , Ratos , Ratos Wistar , Reserpina/farmacologia , TrítioRESUMO
BACKGROUND: Intimate partner violence (IPV) and sexually transmitted infections (STI) are epidemics that disproportionately affect women. This study determined IPV prevalence and the association between IPV and positive syphilis tests among pregnant women attending antenatal clinics in three provinces in Bolivia. METHODS: We administered structured questionnaires to women after syphilis testing. The questionnaire included sociodemographic variables and four questions form the modified version of the Abuse Assessment Screen (AAS) to assess physical and sexual violence. RESULTS: Of 6002 women who completed the violence questionnaire and had a syphilis test, 20.4% (n=1227) reported physical or sexual abuse or both committed by their partner in the past year. Prevalence of positive syphilis tests was twice as high among women who reported IPV (8%) than among women who did not (4%) (p<0.01). Women's age (younger), education level (lower), occupation as homemaker, being in a consensual union, more previous pregnancies, lower economic status, and language spoken at home (Spanish and an indigenous language), as well as history of IPV in the past 12 months, were significantly associated with positive syphilis tests in bivariate analysis. History of IPV remained significantly associated with positive syphilis tests in multivariate analysis (OR 1.59, 95% CI 1.23-2.07). In addition, low education among women's partners and having at least one previous pregnancy were positively associated with IPV in multivariate analysis. CONCLUSIONS: There is a significant association between history of partner violence and a positive syphilis test among pregnant women, suggesting that syphilis can be an important negative health consequence of IPV. Bolivia's new maternal and infant health program in antenatal clinics, which includes universal syphilis screening, should also provide screening and follow-up care for IPV.
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Mulheres Maltratadas/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Maus-Tratos Conjugais/estatística & dados numéricos , Sífilis/epidemiologia , Saúde da Mulher , Adolescente , Adulto , Bolívia/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento/métodos , Análise Multivariada , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Prevalência , Fatores de Risco , Meio Social , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários , Sífilis/transmissão , Sífilis Congênita/prevenção & controle , Adulto JovemRESUMO
Workers in Mexico's maquiladoras (assembly plants) are mainly young, single women, many of whom could benefit from emergency contraceptive pills (ECPs). Because ECPs are readily available in Mexico, women who know about the therapy can obtain it easily. Do maquiladora workers know about the method? Could worksite programs help increase awareness? To investigate these questions, we conducted a five-month intervention during which workers in three maquiladoras along the Mexico-United States border could attend educational talks on ECPs, receive pamphlets, and obtain kits containing EC supplies. Among the workers exposed to our intervention, knowledge of ECPs increased. Reported ECP use also increased. Although our intervention apparently increased workers' knowledge and use, the factory proved to be a difficult intervention setting. Problems we experienced included a factory closure and management/staff opposition to certain project elements. Future studies should continue to investigate work-site interventions and other strategies to reach workers.
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Anticoncepção Pós-Coito , Emprego , Conhecimentos, Atitudes e Prática em Saúde , Indústrias , Adolescente , Adulto , Feminino , Humanos , México , Inquéritos e Questionários , Adulto JovemRESUMO
Objetivo: Implementar el modelo de manejo de casos y evaluar su efectividad en pacientes hospitalizados con diabetes mellitus tipo 2Metodología: Muestra de 17 pacientes hospitalizados con diabetes mellitus tipo 2 para dos grupos, experimental y control. Etapas del estudio: a) selección de pacientes y capacitación del equipo multidisciplinario, b) intervención multidisciplinaria y c) seguimiento en el hogar.Resultados: Grupo experimental: media de días estancia hospitalaria de 4.88. Sólo 11.8 por ciento de los pacientes tuvo un reingreso hospitalario en los seis meses posteriores al egreso. Media de hemoglobina glucosilada al ingreso al hospital 11.45 por ciento; al finalizar la intervención 8.84 por ciento, la prueba de comparación de medias t de Student reportó diferencia significativa (p=.001).Grupo control: media de días estancia de 6.24. En los siguientes seis meses 35.3 por ciento tuvieron de uno a dos reingresos. Conclusiones: El grupo experimental reportó menores días estancia y reingresos hospitalarios, mayor conocimiento y acciones de autocuidado para el tratamiento de la enfermedad, mayor involucramiento de la familia en el cuidado y mejor control glucémico a través de la hemoglobina glucosilada...
Assuntos
Autocuidado , Hemoglobinas Glicadas , Diabetes Mellitus Tipo 2 , Pacientes Internados , Cuidados de EnfermagemRESUMO
The multidrug resistance EhPgp5 gene promoter is active in drug resistant clone C2 trophozoites and its activity increases when trophozoites are cultured in the presence of emetine, suggesting that the EhPgp5 gene shows an inducible drug dependent mechanism. We analyzed different promoter fragments to detect those regions that activate transcription in the presence of emetine. Trophozoites were transfected with p375Pgp5, p259Pgp5, p187Pgp5, and p76Pgp5 plasmids and incubated with different emetine concentrations. p375Pgp5 and p259Pgp5 plasmids were able to drive CAT expression in A and C2 trophozoites only in the presence of emetine. CAT activity was turned off in the absence of drug. Interestingly, no CAT activity was detected in the presence or in the absence of emetine with p187Pgp5 plasmid in which 59 bp were deleted at the 5' end of the EhPgp5 minimal promoter (p259Pgp5). These results suggest that the overexpression of the EhPgp5 gene is a consequence of transcriptional activation of the gene promoter by putative drug responsive elements, located within the -111 to -170 bp of the transcription initiation site.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Amebicidas/farmacologia , Emetina/farmacologia , Entamoeba histolytica/efeitos dos fármacos , Proteínas de Protozoários/genética , Ativação Transcricional/fisiologia , Animais , Cloranfenicol O-Acetiltransferase/metabolismo , Resistência a Múltiplos Medicamentos/genética , Eletroporação , Entamoeba histolytica/genética , Entamoeba histolytica/crescimento & desenvolvimento , Expressão Gênica/efeitos dos fármacos , Regiões Promotoras Genéticas/efeitos dos fármacos , Regiões Promotoras Genéticas/fisiologia , TransfecçãoRESUMO
OBJECTIVE: If properly trained, medical students could become future opinion leaders in health policy and could help the public to understand the consequences of unwanted pregnancies and of abortions. The objective of this study was to analyze the frequency of unwanted pregnancies and induced abortions that had occurred among women who were first-year medical students at a major public university in Mexico City and to compare the experiences of those women with the experiences of the general population of Mexican females aged 15 to 24. METHODS: In 1998 we administered a cross-sectional survey to all the first-year medical students at the National Autonomous University of Mexico, which is the largest university in Latin America. For this study we analyzed 549 surveys completed by female students. RESULTS: Out of the 549 women, 120 of them (22%) had been sexually active at some point. Among those 120 sexually active students, 100 of them (83%) had used a contraceptive method at some time, and 19 of the 120 (16%) had been pregnant. Of those 19 women who had been pregnant, 10 of them had had an illegal induced abortion (in Mexico, abortions are illegal except under a small number of extenuating circumstances). The reported abortion rate among the female medical students, 2%, was very low in comparison with the 11% rate for women of similar ages in the Mexican general population. CONCLUSIONS: The lower incidence of abortion among the female medical students indicates that when young Mexican women have access to medical information and are highly motivated to avoid unintended pregnancy and abortion, they can do so.
Assuntos
Aborto Criminoso/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Gravidez não Desejada/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México , Paridade , Gravidez , Faculdades de Medicina/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Universidades/estatística & dados numéricosRESUMO
OBJECTIVE: If properly trained, medical students could become future opinion leaders in health policy and could help the public to understand the consequences of unwanted pregnancies and of abortions. The objective of this study was to analyze the frequency of unwanted pregnancies and induced abortions that had occurred among women who were first-year medical students at a major public university in Mexico City and to compare the experiences of those women with the experiences of the general population of Mexican females aged 15 to 24. METHODS: In 1998 we administered a cross-sectional survey to all the first-year medical students at the National Autonomous University of Mexico, which is the largest university in Latin America. For this study we analyzed 549 surveys completed by female students. RESULTS: Out of the 549 women, 120 of them (22 percent) had been sexually active at some point. Among those 120 sexually active students, 100 of them (83 percent) had used a contraceptive method at some time, and 19 of the 120 (16 percent) had been pregnant. Of those 19 women who had been pregnant, 10 of them had had an illegal induced abortion (in Mexico, abortions are illegal except under a small number of extenuating circumstances). The reported abortion rate among the female medical students, 2 percent, was very low in comparison with the 11 percent rate for women of similar ages in the Mexican general population. CONCLUSIONS: The lower incidence of abortion among the female medical students indicates that when young Mexican women have access to medical information and are highly motivated to avoid unintended pregnancy and abortion, they can do so.
Objetivo. Con entrenamiento adecuado, los estudiantes de medicina pueden convertirse en líderes de opinión con futura injerencia sobre las políticas de salud, así como ayudar al público a entender las consecuencias de los embarazos indeseados y del aborto. El objetivo del presente estudio ha sido examinar la frecuencia del embarazo indeseado y del aborto provocado en mujeres de primer año de la carrera de medicina en una de las principales universidades de México, D.F., y comparar las experiencias de esas mujeres con las de la población general de mujeres mexicanas entre los 15 y 24 años de edad. Métodos. En 1998 hicimos una encuesta transversal de todas las estudiantes de primer año de medicina de la Universidad Autónoma de México, que es la universidad más grande de América Latina. Examinamos un total de 549 encuestas. Resultados. De las 549 mujeres encuestadas, 120 (22%) habían tenido actividad sexual en algún momento. De esas 120 estudiantes que habían sido activas sexualmente,100 (83%) habían usado un método anticonceptivo alguna vez y 19 de las 120 (16%) habían estado embarazadas. De estas últimas 19 mujeres, 10 se habían sometido a un aborto ilegal (en México el aborto siempre es ilegal salvo en circunstancias extenuantes muy contadas). La frecuencia declarada de aborto entre las estudiantes de medicina, que fue de 2%, fue muy baja en comparación con la frecuencia de 11% hallada en mujeres de la misma edad en la población mexicana en general. Conclusiones. La menor incidencia del aborto entre las estudiantes de medicina revela que cuando las jóvenes mexicanas tienen a su alcance información de orden médico y el firme propósito de evitar el embarazo indeseado y el aborto, lo pueden lograr
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adolescente , Adulto , Aborto Criminoso/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Gravidez não Desejada/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Estudos Transversais , Inquéritos Epidemiológicos , México , Paridade , Faculdades de Medicina/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Universidades/estatística & dados numéricosRESUMO
Violence against women has recently drawn attention in the medical community as a leading cause of preventable morbidity and mortality. Specific algorithms designed to identify women at risk can be applied to create an opportunity for screening, diagnosis and treatment during medical care initiated for common conditions. This study investigated the incidence and history of battering among women seeking general medical care, and looked for potential risk factors and associations with presenting symptoms. We used a self-administered, anonymous survey to question 1780 adult female outpatients visiting a tertiary care internal medicine teaching hospital in Mexico City. We calculated current abuse (physical and/or sexual abuse by a partner within the past year), abuse during pregnancy, childhood abuse, and lifetime abuse. We found levels of violence against women in Mexico comparable to those reported from other countries. 152 women (9%) reported current physical and/or sexual abuse. An identical number also reported abuse during pregnancy. Lifetime prevalence was 41%. Women currently or previously abused reported more physical symptoms in the last six months than did non-abused participants. Pelvic pain, depression, headache and substance abuse were frequent among abused women. Currently abused women also scored higher (p<0.01) on indicators of depression. Current abuse correlated strongly with a childhood history of physical and/or sexual abuse, with low educational level of the victim, with substance abuse by the partner or by the woman herself, and with higher parity.