RESUMO
Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.
Assuntos
Alcoolismo , Alcoolismo/epidemiologia , Alcoolismo/terapia , Colômbia , Atenção à Saúde , Depressão/terapia , Humanos , Tecnologia da InformaçãoRESUMO
Background: International consensus on the use of continuous glucose monitoring (CGM) recommends coefficient of variation (CV) as the metric of choice to express glycemic variability (GV) with a cutoff of 36% to define unstable diabetes. Even though, CV is associated with hypoglycemia in type 2 diabetes patients, the evidence on the use of one particular measure of GV in type 1 diabetes (T1DM) patients as a predictor of hypoglycemia is limited. Methods: A cohort of T1DM ambulatory patients was evaluated using CGM. Number and incidence rate of events <54 and <70 mg/dL were calculated. Bivariate and multivariate analysis of different glycemic indexes and clinical variables were performed to identify those associated with hypoglycemia. Receiver operating characteristic (ROC) curve analysis for each of the glycemic indexes was performed to define the best index and its optimal cutoff threshold to discriminate patients with events of hypoglycemia. Results: Seventy-three patients were included. A total of 128 events <54 mg/dL were recorded in 34 patients, and 350 events <70 mg/dL were registered in 51 patients. CV was the only variable significantly associated with hypoglycemia <54 mg/dL in the multivariate analysis (adjusted relative risk [aRR] 1.44, 95% confidence interval [CI]: 1.10-1.88, P = 0.008). CV, HbA1c (glycated hemoglobin), and mean glucose were associated with events <70 mg/dL. ROC curve analysis showed that, among GV metrics, CV had the best performance to discriminate patients with events <54 mg/dL (area under the curve [AUC] 0.87, 95% CI: 0.79-0.95) and events <70 mg/dL (AUC 0.79, 95% CI: 0.68-0.90) with optimal cutoff thresholds values of 34% and 31%, respectively. Among glycemic risk (GR) indexes, low blood glucose index (LBGI) showed the best performance. Conclusions: This analysis shows that CV is the best GV index, and LBGI the best GR index, to identify patients at risk of clinically significant hypoglycemia and hypoglycemia alert events in T1DM patients.
Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Indicadores Básicos de Saúde , Hipoglicemia/etiologia , Adulto , Diabetes Mellitus Tipo 1/complicações , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/diagnóstico , Masculino , Estudos Prospectivos , Curva ROC , Valores de Referência , Medição de Risco/estatística & dados numéricosRESUMO
BACKGROUND: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. AIM: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). MATERIAL AND METHODS: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. RESULTS: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). CONCLUSIONS: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.
Assuntos
Desnutrição/diagnóstico , Avaliação Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia/epidemiologia , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/etiologia , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
Background: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. Aim: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). Material and Methods: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Results: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). Conclusions: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Avaliação Nutricional , Desnutrição/diagnóstico , Prevalência , Estudos Transversais , Fatores de Risco , Colômbia/epidemiologia , Desnutrição/etiologia , Desnutrição/epidemiologia , Hospitais UniversitáriosRESUMO
Se realizó una investigación descriptiva de los resultados obtenidos por los residentes de medicina general integral en el examen estatal teórico en la provincia de Sancti Spíritus, durante el curso 1997-1998. La promoción general en el componente fue de 58,2 %, siendo los municipios de peores resultados Cabaiguán y La Sierpe con 25,0 y 33,3 % respectivamente. El 60 % de las preguntas se comportaron con una dificultad media, evaluándose como difícil el contenido sobre cardiopatía isquémica; el 67 % de las preguntas discriminaron de forma nula, y el 20 % negativamente (asma bronquial, tuberculosis pulmonar y sepsis urinaria) se concluye que el examen teórico a pesar de sus malos resultados, metodológicamente estuvo bien estructurado. Se recomienda analizar multisectorialmente los resultados de la investigación para buscar alternativas de solución.
Assuntos
Avaliação EducacionalRESUMO
Se realizó un análisis de las respuestas a las 12 preguntas del Examen Estatal Nacional Escrito de Medicina General Integral, aplicado a una muestra de 32 residentes de la provincia de Sancti Spiritus, con el objetivo de valorar el instrumento utilizado. Aprovó el 75 porciento de los presentados y el 81,2 porciento no rebasó los 79 puntos. El tema que mejor respondieron fue el de Accidentes en el Hogar, con el 96,9 porciento y el peor fue Familia, con el 90,6 porciento de las respuestas incorrectas. Al calcularse el grado de dificultad de las preguntas se catalogó de muy difícil la pregunta de Familia y muy fácil la de Accidentes. El 58,3 porciento de las preguntas permitió distinguir entre "buenos" y "malos" alumnos. Se concluye que la promoción fue aceptable, pero de pobre calidad, que el grado de dificultad de las preguntas tuvo adecuado balance y que la tercera parte de éstas discriminaron mal o no lo hicieron