RESUMO
PURPOSE: Relying solely on in-person encounters to assess long-term outcomes of hernia repair leads to substantial loss of information and patients lost-to-follow-up, hindering research and quality improvement initiatives. We aimed to determine if inguinal hernia recurrences could be assessed using the Ventral Hernia Recurrence Inventory (VHRI), a previously existing patient-reported outcome (PRO) tool that can be administered through the telephone and has already been validated for diagnosing ventral hernia recurrence. METHODS: A prospective, multicentric comparative study was conducted. Adult patients from two centers (United States and Brazil) at least 1 year after open or minimally invasive inguinal hernia repair were asked to answer the questions of the VHRI in relation to their prior repair. A physical exam was then performed by a blinded surgeon. Testing characteristics and diagnostic performance of the PRO were calculated. Patients with suspected recurrences were preferentially recruited. RESULTS: 128 patients were enrolled after 175 repairs. All patients answered the VHRI and were further examined, where a recurrence was present in 32% of the repairs. Self-reported bulge and patient perception of a recurrence were highly sensitive (84-94%) and specific (93-94%) for the diagnosis of an inguinal hernia recurrence. Test performance was similar in the American and Brazilian populations despite several baseline differences in demographic and clinical characteristics. CONCLUSION: The VHRI can be used to assess long-term inguinal hernia recurrence and should be reestablished as the Hernia Recurrence Inventory (HRI). Its implementation in registries, quality improvement efforts, and research could contribute to improving long-term follow-up rates in hernia patients.
Assuntos
Hérnia Inguinal/etiologia , Hérnia Inguinal/cirurgia , Herniorrafia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Brasil , Feminino , Seguimentos , Hérnia Inguinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Fatores de Risco , Estados UnidosRESUMO
We report a study of droplet generation in two phase flows of non-miscible fluids in a T-shaped array of circular channels, at the mesoscale between micro- and milli-fluidics. Our experiments show that the balance between the different types of forces (capillary forces, shear viscous forces, etc.) may differ significantly from that found by previous authors in smaller, microfluidics channels. The results may, therefore, be applied to practical systems in which droplets act as small chemical reactors or help enhance mixing. We suggest a possible interesting extension to the generation of drops inside porous media. We report experiments in which the length of the droplets and the residual thickness of the surrounding fluid film are systematically measured as a function of the respective flow rates of the two fluids: These results are carefully compared to theoretical models taking into account in different ways the capillary and viscous effects and to results obtained by other authors for smaller channels. Several dimensionless control variables are tested (capillary number, ratio of the flow rates of the two fluids, etc.). Capillary film thickness is shown to be a useful variable to identify the different regimes of formation. Testing of the theoretical models with the experimental data showed that the change from one formation regime to the other is accompanied by a change in the role of viscous effects. Two models of breakup mechanisms were tested: on the one hand, the pressure buildup mechanism and, on the other hand, a second mechanism corresponds to the balance of tangential shear stresses and interfacial tension. According to the formation regimes, both models have provided satisfactory predictions of the experimental results. However, at this mesoscale, the experimental data were better described by the models dependent on the capillary number, as previously reported in systems with a low degree of confinement.
RESUMO
BACKGROUND: This paper addresses the extent to which equity of treatment according to need, as defined by self-reported health status, is received by members of ethnic minorities in Swedish health services. METHODS: The study was based on a multivariate analysis of cross-sectional data from the Swedish Survey of Living Conditions and Immigrant Survey of Living Conditions in 1996 on use of health services, morbidity and socioeconomic indicators. The study population consisted of 1,890 Swedish residents aged 27-60 years born in Chile, Poland, Turkey and Iran and 2,452 age-matched, Swedish-born residents. MAIN RESULTS: Residents born in Chile, Iran and Turkey were more likely to have consulted a physician during the 3 months prior to the interview compared to Swedish-born residents; odds ratios (ORs) 1.4 (95% CI: 1.2-1.7), 1.3 (95% CI: 1.1-1.7) and 1.5 (95% CI: 1.3-1.9) respectively. The higher consultation rate in these ethnic minorities was primarily explained by a less satisfactory, self-reported health status compared to Swedish-born residents. Thirty-eight percent of the minority study groups reported exposure to organised violence in their country of origin, which was associated with a higher level of use of consultations with a physician (OR 1.3, 95% CI: 1.1-1.6). CONCLUSIONS: This study did not indicate any gross pattern of inequity in access to care for ethnic minorities in Sweden. Systems for allocating resources to health authorities need to consider the possibility that ethnic minorities in Sweden and in particular victims of organised violence, use health services more than is suggested by socioeconomic indicators only.
Assuntos
Etnicidade/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Justiça Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/etnologia , Feminino , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Humanos , Entrevistas como Assunto , Irã (Geográfico)/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Polônia/etnologia , Distribuição por Sexo , Fatores Socioeconômicos , Suécia/epidemiologia , Turquia/etnologiaRESUMO
A survey was sent to the American members of the National Urea Cycle Disorders Foundation to ascertain the types and extent of stress imposed on families who have a child with a urea cycle defect. Forty percent of the surveys were returned. The greatest sources of stress were financial, fear of death, and the restrictions imposed by the diet. Other than removal of the economic stress and uncertainty, the results did not suggest that any specific support systems required augmentation. Instructions to mitigate frustrations occurring in emergency situations would, however, be a great help to families.
Assuntos
Adaptação Psicológica , Erros Inatos do Metabolismo dos Aminoácidos , Saúde da Família , Estresse Psicológico , Ureia/metabolismo , Adulto , Erros Inatos do Metabolismo dos Aminoácidos/psicologia , Criança , Feminino , Humanos , Masculino , Apoio Social , Estresse Psicológico/prevenção & controle , Inquéritos e QuestionáriosRESUMO
El objetivo del trabajo es estudiar la dispersión del trazador en las condiciones en que comunmente ocurre cuando se utilizan filtros, es decir, cuando se inyecta una solución al medio inicialmente libre de soluto. En estas condiciones el proceso de dispersión es tal que la concentración total de soluto en solución no permanece constante y, por lo tanto, la adsorción no es lineal. Estas experiencias se distinguen de las realizadas en un trabajo previo donde se estudió la dispersión en condiciones de adsorción estacionaria (lineal)
Assuntos
Dispersão de Poluentes , Carvão Ativado (Saúde Ambiental)RESUMO
El objetivo del trabajo es estudiar la dispersión del trazador en las condiciones en que comunmente ocurre cuando se utilizan filtros, es decir, cuando se inyecta una solución al medio inicialmente libre de soluto. En estas condiciones el proceso de dispersión es tal que la concentración total de soluto en solución no permanece constante y, por lo tanto, la adsorción no es lineal. Estas experiencias se distinguen de las realizadas en un trabajo previo donde se estudió la dispersión en condiciones de adsorción estacionaria (lineal)
Assuntos
Carvão Ativado (Saúde Ambiental) , Dispersão de PoluentesAssuntos
Lipoma/diagnóstico , Mioma/diagnóstico , Neoplasias Uterinas/diagnóstico , Idoso , Feminino , Humanos , Lipoma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Mioma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagemRESUMO
Intrapartum fetal monitoring may be useful in discriminating short-term and long-term infant outcomes. In order to develop a model for the classification of infants for measures of outcome and to evaluate the discriminatory value of selected perinatal data, 61 data files, which included computer interpreted fetal electroencephalogram and fetal heart rate, one and five minute Apoar scores, results of neonatal neurologic examination, and results of neurologic examination at one year of age, were submitted to computerized discriminant function analysis. For the classification of infants for neurologic status at one year, using FEEG patterns alone, 64% of the 42 normal infnats and 63% of the 19 abnormal infants were correctly classified. Using intrapartum FEEG and FHR patterns simultaneously, 69% of the 42 normal infants and 63% of the 19 abnormal infants were correctly classified. Combining intrapartum data with postpartum data, including one minute and five minute Apgar scores and neonatal neurologic examinations, 81% of the 42 normal infants and 79% of the 19 abnormal infants could be correctly classified. These results suggest that brain damage may already be present before birth, during labor, and that the risk of abnormal neurologic outcome at one year can be detected for a large percentage of infants using computer interpreted monitoring data during labor.
Assuntos
Computadores , Feto/fisiologia , Monitorização Fisiológica , Fenômenos Fisiológicos do Sistema Nervoso , Índice de Apgar , Eletroencefalografia , Feminino , Coração Fetal/fisiologia , Frequência Cardíaca , Humanos , Lactente , Exame Neurológico , Gravidez , Pressão , Útero/fisiologiaAssuntos
Infecções por Pasteurella/epidemiologia , Adolescente , Adulto , Apendicite/complicações , Mordeduras e Picadas/complicações , Criança , Pré-Escolar , Reservatórios de Doenças , Exposição Ambiental , Extremidades , Exsudatos e Transudatos/microbiologia , Oftalmopatias/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Infecções por Pasteurella/etiologia , Porto Rico , Doenças Respiratórias/epidemiologia , Sepse/epidemiologia , Estados Unidos , Infecções Urinárias/epidemiologia , Doenças Uterinas/epidemiologiaRESUMO
The proposition was advanced that diagnostic label (i.e., style in which patients' mental illness is described) and severity of illness may both influence vocational, social and psychiatric judgments of exmental patients. Two occupational groups -vocational rehabilitation counselors and businessmen-professionals-rated biographical sketches in which diagnostic label and severity of illness were varied. The results indicated that diagnostic label did not influence attitudes, but that severity of psychiatric condition did. Differences between occupational groups' ratings were negligible. It is suggested that subsequent studies take into account the factor of severity of illness when investigating style of patient presentation.