RESUMO
BACKGROUND: Increased complication rates following laparoscopic cholecystectomies have been described, likely related to surgical difficulty, anatomical variations, and gallbladder inflammation severity. Parkland Grading Scale (PGS) stratifies the severity of intraoperative findings to predict operative difficulty and complications. This study aims to validate PGS as a postoperative-outcome predictive tool, comparing its performance with Tokyo Guidelines Grading System (TGGS). METHODS: This is a single-center retrospective cohort study where PGS and TGGS performances were evaluated regarding intraoperative and postoperative outcomes. Both univariate and bivariate analyses were performed on each severity grading scale using STATA-SE 16.0 software. Additionally, we proposed a Logistic Regression Model for each scale. Their association with outcomes was compared between both scales by their Receiver Operating Characteristic Curve. RESULTS: 400 Patients were included. Grade 1 predominance was observed for both PGS and TGGS (47.36% and 25.3%, respectively). A positive association was observed between higher PGS grades and inpatient postoperative care, length of stay, ICU care, and antibiotic requirement. Based on the area under the ROC curve, better performance was observed for PGS over TGGS in the evaluated outcomes. CONCLUSION: PGS performed better than TGGS as a predictive tool for inpatient postoperative care, length of stay, ICU, and antibiotic requirement, especially in severe cases.
Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Colecistite , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença , Colecistite/cirurgia , Tempo de Internação , Antibacterianos , Colecistite Aguda/cirurgiaRESUMO
Mexico's violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.
Assuntos
Pessoal de Saúde , Violência , Serviços de Saúde , Humanos , MéxicoRESUMO
O objetivo deste estudo foi validar uma escala para a análise das percepções dos moradores sobre o impacto social de um centro esportivo. Se recolheu uma amostra de 406 moradores do município de Moncada (Valência) com erro de amostragem de ± 4,82. Os moradores responderam a um questionário de 31 itens que incluíram possíveis impactos sociais derivados da presença do complexo esportivo na localidade. A aplicação da análise fatorial exploratória e confirmatória reduziu a escala para 28 indicadores distribuídos em sete dimensões de impacto: impacto sociocultural, impacto socioeconômico, impacto na imagem e promoção do município, impacto no desenvolvimento e infraestruturas urbanas, impacto na coesão social, igualdade e equidade, impacto na saúde e impacto nos hábitos e níveis de atividade física. Os resultados permitiram verificar a validade e confiabilidade da escala proposta para o objeto de estudo
La finalidad de este estudio es validar una escala para el análisis de las percepciones de los residentes sobre el impacto social de un centro deportivo. Se recogió una muestra de 406 residentes del municipio de Moncada (Valencia), con un error de muestreo de ±4,82, que contestaron a una encuesta de 31 ítems que recogían posibles impactos sociales derivados de la presencia del centro deportivo en la localidad. La aplicación de análisis factorial exploratorio y confirmatorio redujo la escala a 28 indicadores distribuidos en siete dimensiones de impacto: impacto sociocultural, impacto socioeconómico, impacto en la imagen y la promoción del municipio, impacto en el desarrollo urbano y las infraestructuras, impacto en la cohesión social, igualdad y equidad, impacto sobre la salud e impacto sobre los hábitos y niveles de actividad física. Los resultados permitieron comprobar la validez y fiabilidad de la escala propuesta para el objeto de estudio
The purpose of this study is to validate a scale to analyse residents' perceptions of the social impact of a sports centre. A sample of 406 residents of Moncada, Valencia, was collected with sampling error of ±4.82. They responded to a 31-item survey on potential social impacts of the presence of the sports centre in that town. Exploratory and confirmatory factorial analysis reduced the scale to 28 indicators distributed in seven impact dimensions: sociocultural; socioeconomic; image and promotion of the town; urban development and infrastructures; social cohesion; equality and equity; health; and physical activity habits and levels. The results made it possible to check the validity and reliability of the scale proposed for the object of study
Assuntos
Humanos , Mudança Social , Percepção Social , Academias de Ginástica , Estudo de ValidaçãoRESUMO
We sought to investigate the relationship of high life satisfaction with important physical health, mental health, social integration and perceived safety factors among midlife and older Mexican adults. We examined 2,200 midlife and older adults (aged 50-101 years) from the Mexican arm of the Study on global AGEing and adult health (SAGE) and used binary logistic regression models to identify key factors associated with high LSA. Our final logistic regression model revealed self-rated health, affect, interpersonal activities and perceived safety on street to be significantly associated with high life satisfaction. Results from this study add to the nascent literature on subjective well-being of midlife and older Mexicans. Although social work with older adults is not well established in Mexico, researchers and practitioners should collaborate on the development and implementation of social worker-led strategies for prevention and intervention to enhance well-being among midlife and older Mexicans.
Assuntos
Envelhecimento/psicologia , Satisfação Pessoal , Segurança , Integração Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , México , Pessoa de Meia-Idade , Apoio SocialRESUMO
El objetivo de este estudio es analizar la percepción de los residentes sobre el impacto cultural y deportivo del Gran Premio de Europa de Fórmula 1. Se realizó un análisis clúster, combinando métodos jerárquicos y no jerárquicos, que permitió encontrar tres grupos con percepciones diferentes hacia este evento deportivo: Desfavorables, Desfavorables Moderados y Favorables Moderados. Los residentes consideran de forma mayoritaria que este evento no tiene un impacto considerable a nivel cultural y deportivo. Asimismo, se encontraron diferencias entre los tres grupos de residentes en función del interés por la Fórmula 1, el respaldo al evento, la asistencia y el grado de identificación
O objetivo do estudo é analisar a percepção dos residentes em relação ao impacto cultural e desportivo do Grande Prêmio da Europa de Fórmula 1. Realizou-se uma análise cluster, combinando métodos hierárquicos e não hierárquicos, que permitiu encontrar três grupos com percepções diferentes frente a este evento esportivo: Desfavoráveis, Desfavoráveis Moderados e Favoráveis Moderados. Os residentes consideram em sua maioria que este evento não tem um impacto considerável no nível cultural e esportivo. Também se encontraram diferenças entre os três grupos de residentes em função do interesse pela Fórmula 1, o respaldo ao evento, a assistência e o grau de identificação
The aim of this study is to analyze the resident's perception about the cultural and sport impact of European Formula 1 Grand Prix. Cluster analysis was performed by combining hierarchical and nonhierarchical methods, which allowed us to differentiate three groups with different perceptions towards sporting event: Unfavorable, Moderate Unfavorable and Moderate Favorable. Most residents believe that this event has no significant impact to cultural and sporting level. Also, differences were found between the three groups of residents in the interest of Formula 1, the support for the event, attendance and the degree of identification
Assuntos
Humanos , População , Percepção Social , Esportes , Fatores CulturaisRESUMO
The theory of behaviour-based systems (or autonomous agents) constitutes a useful approach for the modelling of intracellular signalling networks. In this sense, a cell can be seen as an adaptive autonomous agent or as a society of such agents, where each can exhibit a particular behaviour depending on its cognitive capabilities. We present an intracellular signalling model obtained by integrating several computational techniques into an agent-based paradigm. Cellulat, the model, takes into account two essential aspects of the intracellular signalling networks: (1) cognitive capacities, which are modelled as the agent abilities to interact with the surrounding medium and (2) a spatial organisation, this last obtained using a shared data structure through which the agents communicate between them. We propose a methodology for the modelling of intracellular signalling pathway using Cellulat and we discuss the goal of a virtual laboratory based on our model and presently under development.
Assuntos
Transdução de Sinais , Comunicação Celular , Receptores ErbB/metabolismoRESUMO
BACKGROUND: Myocardial infarct expansion and left ventricular (LV) remodeling are integral components in the evolution of chronic heart failure and predict morbidity and mortality. Radiofrequency (RF) heating and patch placement of chronic LV aneurysms caused a sustained reduction in LV infarct area and volume in an ovine infarct model. This study evaluated the effect of RF heating and epicardial patch as an adjunct to coronary artery bypass graft on LV volumes in patients with prior myocardial infarction, evidence of akinetic/dyskinetic scar, and LV ejection fraction < or =40%. METHODS AND RESULTS: Ten patients (3 female; mean age, 64+/-11 years) scheduled for coronary artery bypass graft were enrolled (Canadian Cardiovascular Society angina class 2.1+/-1.1; New York Heart Association class 3.1+/-0.5). Intraoperative digital photography demonstrated an acute 39% reduction in infarct area (n=5; P=0.01), and transesophageal ECGs demonstrated a 16% acute reduction in LV end-diastolic volumes (n=9; P=0.002) after RF treatment. There were no intraoperative or procedure-related postoperative complications, and during an average follow-up of >180 days, there have been no safety issues. All patients had complete relief of their angina and improvement in exercise tolerance. Serial transthoracic ECGs over the 6 months of follow-up after RF treatment demonstrated persistent reductions in LV end-diastolic volume (29%; P<0.0001) and LV end-systolic volume (37%; P<0.0001) with improved ejection fraction (P<0.02). CONCLUSIONS: RF heating and patch placement in these 10 patients resulted in acute reduction in infarct area and ventricular volumes that were maintained 180 days after procedure. This technique may reduce the incidence of congestive heart failure and mortality in these patients and warrants investigation in larger clinical trials.