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BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.
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Assistência Ambulatorial , Aprendizado de Máquina , Humanos , Brasil , Segurança do PacienteRESUMO
INTRODUCTION: Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all systematically studied. OBJECTIVE: Examine reflex features in patients with JME. METHODS: One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroencephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. RESULTS: Current age was 28±11 (14-67). The seizure began at 15 years ±3 (Range 8-25 years). They presented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hyperventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid compared to other drugs did not demonstrate superiority in seizure control. CONCLUSIONS: These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.
Introducción: La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y adolescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenantes reflejos no son todos sistemáticamente estudiados. OBJETIVO: Examinar los rasgos reflejos en pacientes con EMJ. Métodos: Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalograma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las praxias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. RESULTADOS: La edad actual fue de 28±11 (14-67). Las crisis comenzaron a los 15 años ±3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. CONCLUSIONES: Estos hallazgos confirman la importancia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.
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Epilepsias Mioclônicas , Epilepsia Mioclônica Juvenil , Mioclonia , Adulto , Adolescente , Humanos , Epilepsia Mioclônica Juvenil/diagnóstico , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Ácido Valproico/uso terapêutico , Eletroencefalografia , Reflexo , ConvulsõesRESUMO
Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.
Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.
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OBJECTIVE: To examine prospectively associations of neighborhood opportunity with the presence of dampness or pests in the home environment during early adolescence. STUDY DESIGN: We geocoded residential addresses from 831 children (mean age 7.9 years, 2007-2011) in the Project Viva cohort. We linked each address with census tract-level Child Opportunity Index scores, which capture neighborhood conditions and resources influencing child heath including educational, health, environmental, and socioeconomic factors. Our primary outcome was presence of dampness or pests in the home in early adolescence (mean age 13.2 years, 2013-2016). Secondary outcomes included current asthma and lung function testing results. Mixed-effects regression models estimated longitudinal associations of Child Opportunity Index scores with outcomes, adjusting for individual and family sociodemographics. RESULTS: Children residing in neighborhoods with greater overall opportunity were less likely to live in homes with dampness or pests approximately 5 years later (aOR 0.85 per 20-unit increase in Child Opportunity Index percentile rank, 95% CI 0.73-0.998). We observed no significant associations in adjusted models of overall neighborhood opportunity with current asthma or lung function. Lower school poverty or single-parent households and greater access to healthy food or economic resource index were associated with lower odds of a home environment with dampness or pests. CONCLUSIONS: More favorable neighborhood conditions in mid-childhood were associated with lower likelihood of living in a home with dampness or pests in the early adolescence.
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Asma , Criança , Humanos , Adolescente , Asma/epidemiologia , Fatores Socioeconômicos , Características de Residência , Pobreza , Características da FamíliaRESUMO
Resumo: A segurança do paciente é tema relevante de estudo nos diversos ambientes de atenção à saúde. Entre eles destaca-se, nesta pesquisa, as Unidade de Pronto Atendimento, principal porta de entrada dos pacientes ao sistema de saúde brasileiro. A alta demanda, diversidade e complexidade dos casos contribuem para o risco de incidentes com danos nestas unidades, que somadas à cultura de segurança não fortalecida gera pouca investigação, reconhecimento e notificação de casos. Considerando a ausência de instrumento para detecção de eventos adversos neste contexto assistencial, o objetivo desta pesquisa foi elaborar e validar um instrumento de gatilhos, utilizando a psicometria, para o rastreio de Eventos Adversos em Unidades de Pronto Atendimento. Para isso, foi realizada uma pesquisa metodológica, de cunho quantitativo, seguindo o referencial da Psicometria, e utilizando-se os pólos teórico, experimental e analítico como correspondentes etapas metodológicas. Para a primeira etapa, polo teórico, realizou-se revisão integrativa, com o intuito de identificar na literatura científica gatilhos utilizados em serviços de emergência para rastrear eventos adversos. A reunião e organização das evidências culminou na versão inicial do instrumento de rastreio, contendo gatilhos que indicam a ocorrência de potenciais eventos adversos. Esta foi submetida à análise e organização por grupo focal, composto por quatro especialistas, e validação por grupo de 10 juízes experts em segurança do paciente, urgência/emergência e unidade de pronto atendimento, utilizando-se técnica Delphi on line. Na segunda etapa, polo experimental, o instrumento foi aplicado para análise de 240 prontuários de pacientes, selecionados aleatoriamente entre os atendidos em uma unidade de pronto atendimento da capital paranaense. Informações sociodemográficas, de saúde e do atendimento, gatilhos detectados e correspondentes casos foram registrados. Os eventos adversos confirmados pela pesquisadora e um médico, foram classificados segundo o grau de evitabilidade e dano e categorizados em administração de medicamentos, gerenciamento de vagas, assistência e conduta profissional. A análise dos casos foi complementada com os testes t de Student, exato de Fisher, Kruskal-Wallis e teste de Dunn. O polo analítico se deu, transversalmente, nas primeira e segunda etapas metodológicas, por meio das análises e testes estatísticos. Como resultados, destaca-se que a revisão integrativa possibilitou a identificação e reunião de 54 gatilhos, 50 dos quais foram considerados aplicáveis e organizados em cinco módulos pelo grupo focal. Após três rodadas de julgamento o instrumento foi validado com Indice de Validade de Conteudo de 0,88 e Alfa de Cronbach 0,93, e cuja versão final contêm 48 gatilhos organizados em módulos clínico (n=20), trauma (n=02), procedimentos (n=04), medicamentos (n=07) e laboratorial (n=14). A leitura retrospectiva dos registros em prontuário, norteada pela versão final do instrumento, resultou na detecção de 23 diferentes gatilhos entre os 48 constantes no instrumento. Ao total 163 gatilhos foram registrados, sendo prevalentes administração de antialérgico (n=47), readmissão na UPA em 48 horas (n=23), hipoglicemia e/ou hiperglicemia (n=17);t otalizando 32 eventos adversos confirmados. A análise mostrou que os gatilhos identificados estiveram associados a eventos adversos (p<0,05), sendo 93,8% (n=30) fortemente evitáveis e associados (p<0,05) à idade, tempo de permanência e local para onde o paciente foi encaminhado após o atendimento. Conclui-se que o Instrumento para Rastreio de Eventos Adversos em Unidades de Pronto Atendimento reúne gatilhos válidos e eficazes para rastrear incidentes com danos; sua aplicação contribui para conhecer a epidemiologia desses agravos à saúde em Unidades de Pronto Atendimento, e para o direcionamento de ações com vistas à promoção da segurança do paciente e qualidade assistencial.
Abstract: Patient safety is a relevant topic of study in various health care environments. Among them, this research highlights the Emergency Care Unit, the main gateway for patients to the Brazilian health system. The high demand, diversity and complexity of cases contribute to the risk of incidents with damage in these units, which added to the unstrengthened safety culture generates little investigation, recognition and notification of cases. Considering the absence of an instrument for the detection of adverse events in this care context, the objective of this research was to elaborate and validate an instrument of triggers, using psychometrics, for the screening of Adverse Events in Emergency Units. For this, a methodological research was carried out, of quantitative nature, following the reference of Psychometrics, and using the theoretical, experimental and analytical poles as corresponding methodological steps. For the first stage, theoretical pole, an integrative review was carried out in order to identify in the scientific literature triggers used in emergency services to track adverse events. The gathering and organization of evidence culminated in the initial version of the screening instrument, containing triggers that indicate the occurrence of potential adverse events. This was submitted to analysis and organization by focus group, composed of four specialists, and validation by group of 10 expert judges in patient safety, urgency/emergency and emergency unit, using Delphi technique online. In the second stage, the experimental pole, the instrument was applied for analysis of 240 patient records, randomly selected among those attended in an emergency unit in the capital of Paraná. Sociodemographic, health and care information, triggers detected and corresponding cases were recorded. Adverse events confirmed by the researcher and a physician were classified according to the degree of avoidability and harm and categorized into drug administration, job management, care and professional conduct. Case analysis was complemented with Student's t-tests, Fisher's exact, Kruskal-Wallis and Dunn's test. The analytical pole occurred, transversally, in the first and second methodological stages, through the analysis and statistical tests. As a result, we highlight that the integrative review enabled the identification and meeting of 54 triggers, 50 of which were considered applicable and organized into five modules by the focus group. After three rounds of judgment the instrument was validated with Content Validity Index of 0.88 and Cronbach's Alpha 0.93, and whose final version contains 48 triggers organized in clinical modules (n=20), trauma (n=02), procedures (n=04), drugs (n=07) and laboratory (n=14). The retrospective reading of records in medical records, guided by the final version of the instrument, resulted in the detection of 23 different triggers among the 48 contained in the instrument. In total 163 triggers were registered, being prevalent administration of antiallergic (n=47), readmission to the UPA in 48 hours (n=23), hypoglycemia and/or hyperglycemia (n=17); totaling 32 confirmed adverse events. The analysis showed that the identified triggers were associated with adverse events (p<0.05), being 93.8% (n=30) strongly avoidable and associated (p<0.05) with age, length of stay and place where the patient was referred after care. It is concluded that the Instrument for Screening Adverse Events in Emergency Care Units brings together valid and effective triggers to track incidents with damage; its application contributes to knowing the epidemiology of these health problems in Emergency Care Units, and to direct actions aimed at promoting patient safety and quality of care.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Emergências , Prescrições , Segurança do Paciente , Cuidados de EnfermagemRESUMO
OBJECTIVE: To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making. METHODS: Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay-ECLIA, and novel immunochromatography assay-ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30-40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs. RESULTS: ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20-80) cm3. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both p < 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE, p = 0.0316. Four among five detectable ICA-PSA tests increased after DRE. CONCLUSION: Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).
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Exame Retal Digital , Neoplasias da Próstata , Idoso , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Antígeno Prostático Específico , Neoplasias da Próstata/patologiaRESUMO
OBJECTIVE: To describe asthma control and household environmental exposures among adults and children with asthma in Puerto Rico. METHODS: A cross-sectional analysis was conducted using data from the 2014-2016 Behavioral Risk Factor Surveillance System Asthma Call-back Survey on 931 adults and 177 children with current asthma in Puerto Rico. These data were analyzed to assess the prevalence of uncontrolled asthma in Puerto Rico and potential associations with household environmental exposure to cockroaches, smoke, and mold. Asthma control was classified using daytime and nighttime symptoms, activity limitation, and short-acting beta agonist use. Prevalence and prevalence ratios were calculated, adjusting for sample weighting. RESULTS: An estimated 53% of adults with asthma and 29% of children with asthma in Puerto Rico have uncontrolled asthma. Among adults with asthma, in the past 30 days, 29% had seen or smelled mold and 50% had seen cockroaches; in the past week, 12% reported having someone smoke in their home. Adults with uncontrolled asthma were 1.4 times more likely to have observed mold in their homes than were those with controlled asthma when adjusting for age, sex, education, and income (prevalence ratio [95% confidence interval]: 1.4 [1.1, 1.8]). Children with uncontrolled asthma were also more likely to have mold observed in their home than were children with controlled asthma (adjusted PR [95% CI]: 3.0 [1.3, 7.1]). CONCLUSIONS: Uncontrolled asthma is common among adults and children with asthma in Puerto Rico. These results suggest potential differences in household mold exposure by asthma control status.
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Asma , Adulto , Asma/epidemiologia , Asma/etiologia , Criança , Estudos Transversais , Exposição Ambiental/efeitos adversos , Fungos , Humanos , Porto Rico/epidemiologia , FumaçaAssuntos
Cefaleia , Cefaleia do Tipo Tensional , Criança , Cefaleia/diagnóstico , Cefaleia/epidemiologia , HumanosRESUMO
Towards the end of the 19th century, two writers who are considered the uppermost representatives of their respective national literatures, Dostoyevsky of Russia and Machado de Assis of Brazil had epilepsy, probably both temporal lobe epilepsy, but their attitudes were opposite. Dostoyevsky was as open about his diagnosis as Machado was secretive, but both included seizure experiences in their works. Two of Dostoyevsky's many epileptic characters, Prince Myshkin in The Idiot and Kirillov in Devils, report the same ecstatic aura as Dostoyevsky did privately. That Kirillov only has isolated auras probably reflects the early phase of Dostoyevsky's epilepsy. A hitherto overlooked feature, these reports with numerous reformulations and metaphors are linguistically characteristic for self-reports of epileptic auras, related to the indescribability of the experiences. In Idiot, two seizure prodromes with great artistic skill are integrated into the fictional context. Machado in his writings never talked overtly about seizures and epilepsy, but experiences of complex partial seizures can be identified in two of his novels, Brás Cubas and Quincas Borba. One depicts a complex visual illusion, the other seems precipitated by a coincidence of several ambivalent decisions with a specific memory. Quincas Borba (1891) has several features that can be understood as an homage to Dostoyevsky's Idiot (1869). Both writers share the notion that seizures can be triggered by strong emotions, and both stand out by their mastership of seamlessly integrating seizure experiences into the fictional and psychological cosmos of their novels. This article is part of the Special Issue "NEWroscience 2018".
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Epilepsia do Lobo Temporal , Epilepsia , Pessoas Famosas , Brasil , Humanos , ConvulsõesRESUMO
Background: Perceptions of asthma triggers provide important guidance for patients' disease management. A psychometrically valid instrument, the Asthma Trigger Inventory (ATI), is available in English and German language versions, however, a version in Spanish as major world language has been missing.Method: A Spanish-language version of the ATI was evaluated in 339 adult patients with asthma, 223 of these in Peru and 107 in the USA. Principal Component analysis (PCA) with Varimax rotation was used to identify coherent trigger domains across and within samples. Resulting subscales were evaluated for internal consistency.Results: PCA suggested differences in factor structures between sites. Whereas the USA sample largely replicated original factors for animal allergens, pollen allergens, physical activity, air pollution/irritants, infections, and psychology, the initial analysis of the Peru sample suggested substantial overlap of air pollution/irritant, infection, and allergen items. Subsequent analysis of an expanded research form of the ATI for the Peru site culminated in extraction of five factors related to psychology, climate/temperature, combined pollen and animal allergens, physical activity, and infection. Internal consistencies were in an acceptable to excellent range (α = 0.74 to 0.94). Additional free trigger responses confirmed the importance of climate variables for patients in Peru. Psychological triggers were reported by 26% (Peru) and 31% (USA) of patients.Conclusion: Coherent trigger domains are readily identified and measured reliably by a Spanish-language ATI version. However, factor structures vary between samples from different Hispanic/Latino cultural and geographic domains. Culturally adapted versions of this instrument are therefore required for Hispanic/Latino population studies.
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Asma/epidemiologia , Asma/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/efeitos adversos , Alérgenos/efeitos adversos , Competência Cultural , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Inquéritos e Questionários , Tradução , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Definido como la inasistencia continua del enfermo a la terapia antituberculosa por un mes o más, representa un excedente de gasto en salud pública. Asimismo, es uno de los problemas de salud pública mayormente reportados a nivel mundial como un resultado no satisfactorio de la estrategia tuberculosis. Objetivo: determinar los factores desencadenantes del abandono del tratamiento antifímico. Resultados: el principal factor desencadenante de abandono terapéutico en el Distrito 09D13, corresponde a la dimensión factores del paciente, ubicando dentro de este a la mejoría sintomatológica secundaria a un tratamiento parcial en el primer lugar, con un 94,1%, con predominio sobre el sexo masculino y en edades de 20 a 49 años. Conclusión: Los principales factores prevalentes en este estudio que desencadenan los abandonos fueron asociados a factores del paciente, en primer lugar, la mejoría sintomática, seguido por una situación económica deficiente. El tercer factor estuvo asociado al servicio de salud, como la falta de conocimiento sobre la enfermedad. El estudio correlacional, establece que existe una relación positiva considerable entre la falta de vivienda y el consumo de alcohol, ambos factores no se muestran como los más prevalentes por sí solos, la perspectiva sugiere que cuando ambos factores se juntan se fortalece el factor desencadenante de abandono de la terapia antifímica(AU)
Defined as the continuous absence of the patient to antituberculous therapy for a month or more, represents an excess of public health spending. It is one of the public health problems most reported and worldwide as an unsatisfactory result of the tuberculosis strategy. Objective: to determine the triggers for the abandonment of antifungal treatment. Results: the main triggering factor for treatment abandonment in District 09D13 corresponds to the patient factors dimension, placing within this the symptomatic improvement secondary to a partial treatment in the first place, with 94.1%, with a predominance of the male sex and in ages from 20 to 49 years. Conclusion: The main prevalent factors in this study that trigger dropouts were associated with patient factors, firstly, symptomatic improvement, followed by a poor economic situation. The third factor was associated with the health service, such as the lack of knowledge about the disease. The correlational study establishes that there is a considerable positive relationship between homelessness and alcohol consumption, both factors not shown as the most prevalent by themselves, the perspective suggests that combination of both factors triggers discontinuation of antifungal therapy(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Tuberculose/tratamento farmacológico , Fatores Desencadeantes , Fatores Socioeconômicos , Terapêutica , Saúde Pública , Serviços de SaúdeRESUMO
OBJECTIVE: The objectives of this study are to study osmophobia and odor-triggered headaches among headache pediatric patients. BACKGROUND: Achieving the correct diagnosis for headaches in younger children can be challenging. The presence of osmophobia could constitute a helpful piece of information for making the correct diagnosis of headaches among adults. METHODS: This was a cross-sectional study. Children and adolescents with headaches who were seen consecutively at a pediatric outpatient service and had at least 1 headache attack over the previous 12 months were included. We used a semi-structured questionnaire, Pediatric Migraine Disability Assessment, State-Trait Anxiety Inventory, and Children's Depression Inventory. RESULTS: About 300 patients were included; 253 had migraine, 47 had a tension-type headache; 137 had osmophobia during headaches (135 were migraineurs). "Osmophobia during headaches" for diagnosing migraine: Sensitivity: 54.4% (95% CI: 48.2%-60.5%); specificity: 95.8% (95% CI: 85.8%-98.8%); positive predictive value (PPV): 98.5% (95% CI: 94.8%-99.6%); negative predictive value (NPV): 28.5% (95% CI: 22.0%-36.0%). Osmophobia was associated with higher intensity (OR: 2.90; 95% CI: 1.63, 5.15; P < .001) and duration of the headache (OR: 5.73; 95% CI: 2.29, 14.3; P < .001) and with vomiting (OR: 3.56; 95% CI: 1.83, 6.96; P < .001) (logistic regression). There were 62 patients (all of them migraineurs) with odor-triggered headaches: sensitivity for diagnosing migraine: 24.9% (95% CI: 19.9%-30.6%); specificity: 100% (95% CI: 92.4%-100%), PPV: 100% (95% CI: 94.8%-100%), NPV: 20% (95% CI: 16%-26.0%). Odor-triggered headaches were associated with higher intensity (OR: 3.47; 95% CI: 1.64, 7.35; P = .001) and duration of the headache (OR: 3.28; 95% CI: 1.37, 7.86; P = .001), vomiting (OR: 2.37; 95% CI: 1.19, 4.74; P = .014), and phonophobia (OR: 2.40; 95% CI: 1.08, 5.32; P = .031) (logistic regression). Osmophobia was associated with higher-impact migraine (OR: 4.65; 95% CI: 1.30, 16.6; P = .018) and emergency care (OR: 4.65; 95% CI: 1.81, 12.0; P = .001) (logistic regression). CONCLUSIONS: Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population.
Assuntos
Cefaleia/diagnóstico , Cefaleia/etiologia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Transtornos do Olfato/complicações , Transtornos do Olfato/diagnóstico , Adolescente , Criança , Estudos Transversais , Feminino , Cefaleia/induzido quimicamente , Humanos , Masculino , Transtornos de Enxaqueca/induzido quimicamente , Odorantes , Transtornos Fóbicos/complicações , Transtornos Fóbicos/diagnóstico , Prevalência , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Semiology is the backbone of any correct categorization of seizures, as epileptic or not, focal or bilateral, and is fundamental to elucidating how they are anatomically generated in the brain. An anatomical hypothesis derived from seizure history is the precondition for optimally designed ancillary studies. Without understanding seizure semiology, no rational therapy is possible. This article describes the semiological approach using patient history based on full use of patients' self-reports as well as descriptions by witnesses. Auras represent the subjective aspects of seizures and provide important semiological clues as observable signs, sometimes including rather precise direct anatomical information. Methods of extracting, facilitating and analysing self-reports including linguistic conversation analysis are presented in detail. It is highlighted that prodromes, seizure triggers and reflex epileptic mechanisms can provide crucial information for diagnostics and therapy. Special issues considering seizure semiology in children are discussed in a separate section. Other sections are dedicated to the two most important issues of differential diagnosis: how to distinguish (1) focal from "generalized" epilepsies, particularly when focal seizure phenomena appear in a bilateral epilepsy; and (2) epileptic from a series of non-epileptic events.
Assuntos
Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Convulsões/diagnóstico , Convulsões/fisiopatologia , Adulto , Criança , HumanosRESUMO
OBJECTIVE: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. METHODS: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. RESULTS: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. CONCLUSION: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.
OBJETIVOS: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. MÉTODO: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. RESULTADOS: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. CONCLUSIONES: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.
Assuntos
Transtornos de Enxaqueca/cirurgia , Pontos-Gatilho/cirurgia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Projetos Piloto , Estudo de Prova de Conceito , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
Abstract Objective: To analyze the relationship among the triggers and facilitators variables of the influential psychosocial type with Burnout Syndrome in grocery store workers, in Guadalajara, Mexico. Material and methods: The study was cross-sectional and applied to 321 people working in grocery stores located in the municipality of Guadalajara, Jalisco. A sociodemographic and labor data questionnaire was applied for the evaluation of psychosocial variables and the Maslach Burnout Inventory scale (MBI-HSS) for the presence of Burnout Syndrome. Both descriptive and inferential analysis were included. Under informed consent the respondents accepted their participation voluntarily. Results: 64.2% of the population presented Burnout Syndrome. Emotional exhaustion was the most affected (59.9%). Several triggers and / or facilitators were associated with more than one burned dimension, specifically with the Emotional exhaustion dimension. Conclusions: Grocery stores are usually a family business. The people who work in them, depend on them to survive. They are a source of employment, tranquility and protection. Thus, working safely affirms a better life quality and customer service.
Resumen Objetivo: Analizar la relación entre las variables desencadenantes y facilitadores del tipo psicosocial influyente con el síndrome de Burnout en los trabajadores de las tiendas de abarrotes en Guadalajara, México. Material y métodos: El estudio fue transversal y aplicado a 321 personas que trabajaban en supermercados ubicados en el municipio de Guadalajara, Jalisco. Se aplicó un cuestionario sociodemográfico y de datos laborales para la evaluación de variables psicosociales y la escala de inventario de Maslach Burnout (MBI-HSS) para la presencia de síndrome de Burnout. Se incluyeron análisis tanto descriptivos como inferenciales. Bajo consentimiento informado los encuestados aceptaron su participación voluntariamente. Resultados: 64,2% de la población presentó síndrome de Burnout. El agotamiento emocional fue el más afectado (59,9%). Varios disparadores y/o facilitadores se asociaron con más de una dimensión quemada, específicamente con la dimensión de agotamiento emocional. Conclusión: Las tiendas de abarrotes suelen ser una empresa familiar. Las personas que trabajan en ellas dependen de ellos para sobrevivir. Son una fuente de empleo, tranquilidad y protección. Por lo tanto, trabajar con seguridad afirma una mejor calidad de vida y servicio al cliente.
RESUMO
Objective: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. Methods: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. Results: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. Conclusion: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.
Objetivos: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. Método: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. Resultados: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. Conclusiones: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.
Assuntos
Descompressão Cirúrgica/métodos , Músculos Faciais/cirurgia , Transtornos de Enxaqueca/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Adolescente , Adulto , Doença Crônica , Músculos Faciais/inervação , Feminino , Humanos , Lidocaína , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Projetos Piloto , Estudo de Prova de Conceito , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Pontos-GatilhoRESUMO
Objectives The objective of this article is to characterize olfactory stimulation as a trigger of headaches attacks and differentiation between migraine and other primary headaches. Participants and methods The study was prospective and experimental, with comparison of groups. A total of 158 volunteers (73 men and 85 women) were diagnosed with primary headaches, according to the criteria of the International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3ß). The study was conducted by two examiners; one of them was assigned to diagnose the presence and type of primary headache, while the other was responsible for exposing the volunteers to odor and recording the effects of this exposure. Results Of the 158 volunteers with headache, there were 72 (45.6%) cases of migraine and 86 (54.4%) with other primary headaches. In both groups, there were differences in headache characteristics (χ2 = 4.132; p = 0.046). Headache attacks (25/72; 34.7%) and nausea (5/72; 6.9%) were triggered by odor only in patients with migraine, corresponding to 19.0% (30/158) of the sample, but in none with other primary headaches (χ2 = 43.78; p < 0.001). Headache occurred more often associated with nausea ( p = 0.146) and bilateral location ( p = 0.002) in migraineurs who had headache triggered by odor. Headache was triggered after 118 ± 24.6 min and nausea after 72.8 ± 84.7 min of exposure to odor. Conclusions The odor triggered headache attacks or nausea only in migraineurs. Therefore, headache triggered by odors may be considered a factor of differentiation between migraine and other primary headaches and this trigger seems very specific of migraine.
Assuntos
Cefaleia/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Odorantes , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/etiologia , Estudos Prospectivos , Adulto JovemRESUMO
Desde las observaciones de Quincke y Osler, que refirieron pacientes con una "tumefacción" diferente de las que provocaban habitualmente los mecanismos alérgicos hasta el descubrimiento de un nuevo mediador responsable de esos edemas dolorosos y deformantes, se han sucedido los aportes de los investigadores en el esclarecimiento de la patogenia y el tratamiento del AEH hasta la actualidad, en que el arsenal terapéutico se ve notablemente enriquecido por medicamentos altamente eficaces y específicos. Intentaremos describirlos. (AU)
From the observations of Quincke and Osler, who referred patients with a "swelling" different from those that usually provoked the allergic mechanisms until the discovery of a new mediator responsible for these painful and deforming edemas, have been the contributions of researchers in the Clarification of the pathogenesis and treatment of HAE to date, where the therapeutic arsenal is remarkably enriched by highly effective and specific drugs. We will try to describe them.(AU)
Assuntos
Humanos , Angioedemas Hereditários/fisiopatologia , Angioedemas Hereditários/tratamento farmacológico , Argentina , Preparações FarmacêuticasRESUMO
A pesar de que el angioedema hereditario es un padecimiento raro, tiene una amplia bibliografía que ratifica que la fisiopatología de esta enfermedad es compleja. La constante investigación de la industria farmacéutica no solo ha aportado nuevos recursos terapéuticos sino que ha logrado despertar un inusitado interés en la comunidad médica, permitiendo que tengamos una mayor comprensión sobre los mecanismos que presiden la aparición de las crisis. El Comité de Angioedema Hereditario de la AAAeIC ha desarrollado una puesta al día sobre esta entidad, que, por las características de sus síntomas, es abordada principalmente por los especialistas en alergia e inmunología clínica(AU)
Although hereditary angioedema is a rare condition, it has a large number of references that confirm that the pathophysiology of this disease is complex. The constant research of the pharmaceutical industry has not only brought new therapeutic resources, but also aroused an unusual interest in the medical community, allowing us to have a better understanding of the mechanisms that perform the onset of crises. The AAA e IC Hereditary Angioedema Committee has developed an update on this entity, which, due to the characteristics of its symptoms, is mainly addressed by specialists in allergy and clinical immunology.(AU)