RESUMO
OBJECTIVES: To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS: Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS: Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.
Assuntos
Cardiologia , Médicos , Violência no Trabalho , Masculino , Humanos , Feminino , Violência no Trabalho/psicologia , Estudos Transversais , Fatores Sexuais , América Latina/epidemiologia , Inquéritos e Questionários , Médicos/psicologiaRESUMO
BACKGROUND: Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS: 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram (ECG). ECG findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS: Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS: Advanced IAB and age older than 50 years predict ESUS recurrence.
Assuntos
Fibrilação Atrial , Isquemia Encefálica , AVC Embólico , Acidente Vascular Cerebral , Fibrilação Atrial/diagnóstico , Isquemia Encefálica/diagnóstico , Feminino , Humanos , Bloqueio Interatrial/complicações , Bloqueio Interatrial/diagnóstico , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
Brugada phenocopies represent some unusual clinical cases with identical characteristics to Brugada syndrome (BrS) elicited by various clinical circumstances. We report the case of a woman exhibiting "Brugada Phenocopy" during an acute anterior myocardial infarction, highlighting differential diagnosis with true BrS and discussing possible mechanisms underlying its dynamic ECG pattern.
Assuntos
Síndrome de Brugada/diagnóstico , Infarto do Miocárdio/diagnóstico , Angioplastia , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/terapia , Stents Farmacológicos , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , FenótipoRESUMO
Interatrial blocks (IABs) are well described and accepted in the scientific community. In the last four decades major discoveries were made including its physiopathology, ECG presentation, classification and association with atrial tachyarrhythmias (advanced IAB). This article will briefly review the state of the art on the understanding of advanced IAB as an electrical substrate for atrial tachyarrhythmias as well as the future directions.
Assuntos
Arritmias Cardíacas/fisiopatologia , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/anormalidades , Sistema de Condução Cardíaco/fisiopatologia , Taquicardia Supraventricular/fisiopatologia , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Fenômenos Eletrofisiológicos , Humanos , SíndromeRESUMO
A 48-year-old male with a symptomatic 2:1 atrio-ventricular block and a dual-chamber pacemaker, implanted one year previously, was admitted due to a syncopal episode. Pacemaker malfunction was identified as the cause of syncope. Subclavian crush syndrome was the cause of the pacemaker malfunction. Its incidence, consequences and management are discussed in this report.
Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Veia Subclávia/lesões , Lesões do Sistema Vascular/etiologia , Bloqueio Atrioventricular/complicações , Desenho de Equipamento , Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Punções/efeitos adversos , Veia Subclávia/diagnóstico por imagem , Síncope/etiologia , Síndrome , Lesões do Sistema Vascular/diagnóstico por imagemRESUMO
UNLABELLED: The aim of this study was to evaluate the usefulness of head up tilt testing in patients with syncope of unknown origin. Between January 1994 and September 1995, 93 patients were referred for tilt table assessment due to recurrent syncope of uncertain etiology. There were 42 men (mean age 59 years). Thirty healthy volunteers served as a control group. The specific protocol used involved an initial period of supine rest for 15'. Baseline blood pressure (BP) and heart rate (HR) were recorded. This was followed by a tilt to 80 degrees for 30', BP and HR were measured every minute during the procedure. The test was considered positive when symptoms appeared associated with one of the following responses: systolic BP decreased more than 30 mmHg (vasodepressor), bradicardia or asystolia for up to 3" (cardioinhibitory) or mixed. RESULTS: The tilt test was positive in 31 of 93 patients (33%). Seventeen patients (55%) had a vasodepressor response, 3 patients (9%) a cardioinhibitory response and 11 patients (36%) mixed responses. The clinical manifestations were 62% near syncope, 19% syncope and the other patients presented dypsnea or dizziness. The symptoms disappeared promptly after adopting the supine position. None of the 30 healthy volunteers developed symptoms. We conclude that head up tilt test is a safe and effective method for identifying a neurocardiogenic origin in a syncope of uncertain etiology.