RESUMO
Little is known about the factors influencing screening among low-income Hispanic women particularly among recent immigrants. A sample of 148 low-income, low-literate, foreign-born Hispanic women residing in the Washington DC metropolitan area participated in the study. The mean age of the sample was 46.2 (SD=11.5), 84% reported annual household incomes ($15,000. All women were Spanish speakers and had low acculturation levels. Ninety six percent had reported having a Pap smear, but 24% were not in compliance with recommended screening (Pap test within the last 3 years). Among women 40 and older, 62% had received a mammogram, but only 33% were compliant with age appropriate recommended mammography screening guidelines. Women in this study had more misconceptions about cancer than Hispanics in other studies. Multivariate logistic models for correlates of Pap test and mammography screening behavior indicate that factors such as fear of the screening test, embarrassment, and lack of knowledge influenced screening behavior. In conclusion, women in this study had lower rates of mammography screening than non-Hispanic women and lower rates of compliance with recommended Mammography and Pap test screening guidelines.
Assuntos
Neoplasias da Mama/etnologia , Hispânico ou Latino , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Teste de Papanicolaou , Pobreza/etnologia , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Neoplasias da Mama/prevenção & controle , América Central/etnologia , District of Columbia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , México/etnologia , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , América do Sul/etnologia , Neoplasias do Colo do Útero/prevenção & controleRESUMO
Balloon rupture is a known technical problem with implantation of vascular stents. In most cases, the ruptured balloon can be retrieved with simple maneuvers. In this case report, a peripheral balloon became trapped within an undeployed peripheral vascular stent and could not be removed by application of standard maneuvers. A novel approach to balloon retrieval was devised and undertaken with success.
Assuntos
Aorta Abdominal , Doenças da Aorta/terapia , Cateterismo/instrumentação , Corpos Estranhos/terapia , Isquemia/terapia , Perna (Membro)/irrigação sanguínea , Stents , Doenças da Aorta/diagnóstico por imagem , Aortografia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/terapia , Falha de Equipamento , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Isquemia/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
To evaluate the relationship between Pseudomonas aeruginosa colonization and the development of lung disease, we studied 895 patients who attended our cystic fibrosis clinic between 1975 and 1988. The prevalence of P. aeruginosa colonization was 82%. Patients who acquired P. aeruginosa in the first year of life had a similar 10-year survival rate (85%) to that in patients who were colonized between the ages of 1 and 7 years (87%), and to that in patients colonized after the age of 7 years (78%). One year before colonization, mean age, forced expiratory volume in 1 second (FEV1), forced vital capacity, and forced expiratory flow in the mid-expiratory phase were similar to those in a group of patients who remained free of P. aeruginosa. No significant change in pulmonary function variables could be demonstrated 1 year and 2 years after the colonization. The rate and duration of hospitalization did not increase in the years after P. aeruginosa colonization compared with the years before colonization. By the age of 7 years, the mean percentage of predicted FEV1 was lower by 10% in patients who were already colonized by P. aeruginosa compared with those who were not colonized (p less than 0.01). A similar reduction in FEV1 was observed at all ages from 7 to 35 years, but no precipitate rate of decline in FEV1 could be associated with P. aeruginosa colonization. We conclude that although P. aeruginosa colonization is associated with 10% lower lung function, it does not cause an immediate and rapid reduction, as has been previously reported. The clinical course and the pulmonary deterioration in cystic fibrosis after P. aeruginosa colonization is a gradual and variable process.
Assuntos
Fibrose Cística/fisiopatologia , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Infecções por Pseudomonas/fisiopatologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Fibrose Cística/microbiologia , Seguimentos , Fluxo Expiratório Forçado , Volume Expiratório Forçado , Humanos , Lactente , Pulmão/microbiologia , Pneumopatias/microbiologia , Probabilidade , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Escarro/microbiologia , Taxa de Sobrevida , Capacidade VitalRESUMO
Only 16% of women over 40 years of age are being screened regularly with mammography. To learn what radiologists and technologists can do to increase patient adherence to the screening guidelines of the American Cancer Society, especially by poor, urban women, the authors surveyed patients at a county facility immediately after mammography to document the patients' experiences with technologists and the procedure. Analysis of these data led to the conclusion that the radiologist should encourage an expanded role for the technologist as a breast health educator. By incorporating the use of a well-designed patient brochure, technologists can greatly enhance their effectiveness by decreasing the patient's anxiety and increasing her understanding of the procedure and of the importance of screening. Radiologists need to appreciate the potential of an expanded technologist's role for increasing future referrals.
Assuntos
Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Programas de Rastreamento , Educação de Pacientes como Assunto , América Central/etnologia , Feminino , Hispânico ou Latino , Humanos , Los Angeles , México/etnologia , Pessoa de Meia-Idade , Tecnologia Radiológica , População UrbanaRESUMO
A randomized trial of ceftazidime versus placebo was conducted in patients with cystic fibrosis hospitalized for acute respiratory exacerbations. Patients 12 years of age or older were included if they had mild to moderately severe illness according to the following criteria: erythrocyte sedimentation rate less than or equal to 50 mm/hr and less than three other abnormalities (leukocyte count greater than or equal to 15,000/microliter, pulse greater than or equal to 100 beats/min, respirations greater than or equal to 30/min, or temperature greater than or equal to 38.5 degrees C). In all 16 episodes treated with ceftazidime, the patients were rated improved in comparison with 10 of 12 patients treated with placebo. Three placebo-treated patients dropped out of the study within 3 to 5 days because they wanted antibiotic therapy. None of the 15 placebo-treated patients showed clinical deterioration. There were no significant differences in rate of improvement of symptom score, weight gain, or pulmonary function between the two treatment groups. There was no difference in the course during the 6 to 24 months after the study period. Intravenous antibiotics are not essential in the management of all acute respiratory exacerbations of mild to moderate severity in patients with cystic fibrosis.
Assuntos
Ceftazidima/uso terapêutico , Fibrose Cística/tratamento farmacológico , Adolescente , Ensaios Clínicos como Assunto , Fibrose Cística/patologia , Feminino , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Placebos , Distribuição AleatóriaRESUMO
A prevalence study was undertaken to determine whether aerosol equipment used at home by patients with cystic fibrosis (CF) could provide a reservoir for Pseudomonas aeruginosa or Pseudomonas cepacia. Home maintenance of this equipment was also evaluated for its relationship to contamination. In nine of 36 patients, Pseudomonas species were isolated from one or more pieces of home equipment. Only patients colonized with P. aeruginosa had contaminated equipment. P. aeruginosa was recovered from equipment used by five patients; no P. cepacia was recovered. Aerosolization masks were the most commonly contaminated pieces of equipment (20%), followed by nebulizers (17%), medication syringes (10%), connective tubing (6%), and saline solution (4%). Nebulizers and syringes were significantly more likely to be contaminated if they had been in use for 1 month or longer; nebulizers and masks were more likely to be contaminated if they were cleaned or were rinsed only with tap water after use. We conclude that equipment may serve as a reservoir to reintroduce or perpetuate colonization of some patients with CF, but that contamination of equipment with P. aeruginosa is not common.
Assuntos
Fibrose Cística/complicações , Contaminação de Equipamentos , Infecções por Pseudomonas/epidemiologia , Pseudomonas/isolamento & purificação , Terapia Respiratória/instrumentação , Criança , Doença Crônica , Fibrose Cística/terapia , Reservatórios de Doenças , Feminino , Humanos , Manutenção , Masculino , Máscaras , Nebulizadores e Vaporizadores , Ontário , Infecções por Pseudomonas/etiologia , Distribuição Aleatória , Inquéritos e Questionários , SeringasRESUMO
We reviewed 165 pediatric cases of Haemophilus influenzae type b meningitis and found 11 (6.7%) with associated arthritis. Synovial fluid culture and Gram stain suggested that only three of these 11 cases were caused by a septic process. In all three children with septic arthritis, joint symptoms were present on admission or within 24 hours. In contrast, of the eight who had reactive arthritis, arthritis did not appear in six until after 1 week of antibiotic therapy. Patients with septic arthritis were older than patients with reactive arthritis (mean 31 months vs 17 months), had a longer duration of symptoms before the start of antibiotic therapy (mean 6.0 days vs 2.5 days), and were more likely to have a positive blood culture (67% vs 18%). It is probable that the majority of episodes of synovitis occurring after H. influenzae meningitis occur as a result of a reactive rather than a septic process. Treatment of reactive arthritis should be with anti-inflammatory agents rather than with multiple joint aspirations and prolonged antibiotic therapy.
Assuntos
Artrite/complicações , Infecções por Haemophilus/complicações , Meningite/etiologia , Haemophilus influenzae , Humanos , Lactente , MasculinoRESUMO
Antibiotics are administered to patients with cystic fibrosis to eliminate or suppress sputum bacteria. Aerosol administration is attractive because it delivers antibiotic directly to the site of infection. Effective aerosol administration is compromised by the inefficiency of nebulizers to generate small-particle aerosols, adverse airway reaction to the drug, potential emergence of resistant bacteria, and cost. Studies evaluating aerosol treatment have not always controlled for confounding factors and have used a variety of outcome indicators. Results of controlled studies are contradictory with regard to the beneficial effect of aerosol therapy on pulmonary function, sputum bacterial density, and frequency of hospitalization. Therefore, until additional well-controlled trials are completed, routine aerosol administration of antibiotics in cystic fibrosis is not warranted because of cost, potential side effects, and the propensity to select resistant organisms.
Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Fibrose Cística/complicações , Aerossóis , Antibacterianos/uso terapêutico , Infecções Bacterianas/etiologia , Ensaios Clínicos como Assunto , Custos e Análise de Custo , Humanos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Terapia Respiratória , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologiaRESUMO
Because of reports of lowered antibiotic serum concentrations in patients with cystic fibrosis (CF), a bioavailability and pharmacokinetic study of cloxacillin was conducted in 12 control and 16 patients with CF after intravenously and orally administered doses of cloxacillin 25 mg/kg. The patients had mild to moderate CF and were in stable condition. Significantly lower serum concentrations in CF were a result of a 78% increase in total body clearance (P less than 0.005) and a 38% increase in the apparent volume of distribution (P less than 0.025). The bioavailability in CF (0.50) was not significantly different than in controls (0.38), but more variability was seen in the group with CF. After the intravenously given dose the fraction of cloxacillin excreted in the urine unchanged was similar in controls (0.644) and patients with CF (0.547). Compared with that in the control subjects, the mean renal clearance in patients with CF was 30% greater (P less than 0.10) and the nonrenal clearance was 144% greater (P less than 0.07). Enhanced nonrenal clearance explains most of the demonstrated difference between serum concentrations in controls and patients with CF after identical weight-adjusted doses. The data suggest enhanced cloxacillin biotransformation in CF.
Assuntos
Cloxacilina/metabolismo , Fibrose Cística/metabolismo , Administração Oral , Adolescente , Adulto , Disponibilidade Biológica , Cloxacilina/administração & dosagem , Cloxacilina/sangue , Fibrose Cística/tratamento farmacológico , Humanos , Infusões Parenterais , Rim/metabolismo , CinéticaRESUMO
The prevalence of Pseudomonas cepacia infection increased from 10% in 1971 to 18% by 1981 in a population of approximately 500 patients with cystic fibrosis. Carriage of P. aeruginosa has remained unchanged at 70% to 80% over the same period. Patients infected with P. cepacia have greater impairment of pulmonary function than those with P. aeruginosa. A syndrome characterized by high fever, severe progressive respiratory failure, leukocytosis, and elevated erythrocyte sedimentation rate has occurred in eight patients over the past 3 years, with a 62% fatality rate. Because P. cepacia strains are uniformly resistant to ticarcillin, piperacillin, and aminoglycosides, and because ceftazidime is ineffective despite in vitro activity, treatment of these infections is very difficult. Prevention of acquisition and effective treatment of P. cepacia in patients with cystic fibrosis are now major clinical problems in our clinic.