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Background: Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resource-limited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low- to middle-income country. Methods: This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009 to 2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T). Results: Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km2. A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63·4%]; mean [SD] age 62·1 [12·5] years) and 598 in the post-intervention group (356 men [59·5%]; mean [SD] age 61.9 [11·8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; P = 001) and reductions in time from D2E (159 [83-340] vs. 29 [15-63], P = 001), and E2T (31 [21-44] vs. 16 [6-40], P = 001). Conclusion: The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.
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Objective: To test the hypothesis that undenatured type II collagen (UC-II) relieves pain, quality of life, and joint function in women aged from 60 to 80 years with knee osteoarthritis. Methods: 53 patients in the UC-II treatment group (for 90 days) and 52 in the control group (without UC-II) were evaluated at 1, 30, and 90 days regarding health-related quality of life, pain, and function with questionnaires, anthropometric data, alignment, range of motion, and radiographic analysis. Results: Quality of life increased significantly in the Physical domain in the treatment vs control group. Also, there was a difference between the first and the last evaluation on the pain visual analog scale (-3.8 ± 1.8 versus -1.3 ± 2.0) and on the WOMAC score (-9.5 ± 11.9 versus -1.3 ± 11.1). No variation in the temporal evolution of the Mental domain was found. Conclusion: Pain, joint stiffness, and quality of life (Physical domain) improved with the inclusion of UC-II for 90 days to the therapeutic toolbox for knee osteoarthritis in individuals aged 60 to 80 years. Level of evidence II, Comparative Prospective Study.
Objetivo: Testar a hipótese de que o colágeno não hidrolisado tipo II (UC-II) melhora a dor, qualidade de vida e função articular de indivíduos entre 60 e 80 anos com osteoartrite (OA) de joelho. Métodos: Cinquenta e três pacientes do grupo tratamento com UC-II (por 90 dias) e 52 do grupo controle (GC - sem UC-II) foram avaliados no tempo 0, 30 e 90 dias quanto à qualidade de vida em saúde, dor e função com os questionários, além de dados antropométricos, alinhamento, amplitude de movimento e análise radiográfica. Resultados: A qualidade de vida aumentou significantemente no domínio PCS no grupo tratamento versus controle. Houve ainda diferença entre a primeira e última avaliação na dor pela escala visual analógica (−3.8 ± 1.8 versus −1.3 ± 2.0) e no escore WOMAC (−9.5 ± 11.9 versus −1.3 ± 11.1). Não houve variação na evolução temporal do domínio MCS. Conclusão: Dor, rigidez articular e qualidade de vida (domínio físico) melhoram com a inclusão do UC-II por 90 dias ao arsenal terapêutico na OA do joelho em indivíduos de 60 a 80 anos. Nível de Evidência II, Estudo Prospectivo Comparativo.
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ABSTRACT Objective: To test the hypothesis that undenatured type II collagen (UC-II) relieves pain, quality of life, and joint function in women aged from 60 to 80 years with knee osteoarthritis. Methods: 53 patients in the UC-II treatment group (for 90 days) and 52 in the control group (without UC-II) were evaluated at 1, 30, and 90 days regarding health-related quality of life, pain, and function with questionnaires, anthropometric data, alignment, range of motion, and radiographic analysis. Results: Quality of life increased significantly in the Physical domain in the treatment vs control group. Also, there was a difference between the first and the last evaluation on the pain visual analog scale (−3.8 ± 1.8 versus −1.3 ± 2.0) and on the WOMAC score (−9.5 ± 11.9 versus −1.3 ± 11.1). No variation in the temporal evolution of the Mental domain was found. Conclusion: Pain, joint stiffness, and quality of life (Physical domain) improved with the inclusion of UC-II for 90 days to the therapeutic toolbox for knee osteoarthritis in individuals aged 60 to 80 years. Level of evidence II, Comparative Prospective Study.
RESUMO Objetivo: Testar a hipótese de que o colágeno não hidrolisado tipo II (UC-II) melhora a dor, qualidade de vida e função articular de indivíduos entre 60 e 80 anos com osteoartrite (OA) de joelho. Métodos: Cinquenta e três pacientes do grupo tratamento com UC-II (por 90 dias) e 52 do grupo controle (GC - sem UC-II) foram avaliados no tempo 0, 30 e 90 dias quanto à qualidade de vida em saúde, dor e função com os questionários, além de dados antropométricos, alinhamento, amplitude de movimento e análise radiográfica. Resultados: A qualidade de vida aumentou significantemente no domínio PCS no grupo tratamento versus controle. Houve ainda diferença entre a primeira e última avaliação na dor pela escala visual analógica (−3.8 ± 1.8 versus −1.3 ± 2.0) e no escore WOMAC (−9.5 ± 11.9 versus −1.3 ± 11.1). Não houve variação na evolução temporal do domínio MCS. Conclusão: Dor, rigidez articular e qualidade de vida (domínio físico) melhoram com a inclusão do UC-II por 90 dias ao arsenal terapêutico na OA do joelho em indivíduos de 60 a 80 anos. Nível de Evidência II, Estudo Prospectivo Comparativo.
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INTRODUÇÃO: A condição crônica degenerativa relacionada às Doenças Raras (DR) é permeada por processos sociais e de acesso à saúde complexos, cuja compreensão exige avaliação na perspectiva dos acometidos. OBJETICO: Construir um instrumento que possibilite avaliar a percepção do acesso à saúde e ao suporte social destinado aos acometidos por DR. MÉTODOS: Estudo de desenvolvimento de um instrumento embasado no modelo proposto por Luiz Pasquali. RESULTADOS: Após análise fatorial, o resultado final que mostrou evidências preliminares de validação foi um instrumento com quatro domínios: Recursos de Saúde, Recursos Financeiros, Aspectos Sociais e Aspectos Individuais, com 10 itens. CONSIDERAÇÕES FINAIS: O instrumento final desenvolvido reuniu evidências de validade, revelando qualidade dos itens em representar os conceitos subjacentes a cada domínio. Por meio de suas propriedades psicométricas, o instrumento mostrou que tem representatividade no que concerne à percepção do acometido por DR quanto ao seu acesso à saúde e ao suporte social.
INTRODUCTION: The chronic degenerative condition related to Rare Diseases (DR) is permeated by complex social processes and access to health, whose understanding requires evaluation from the perspective of affected patients. OBJECTIVE: To build up an instrument that allows those affected by these pathologies to evaluate their perception regarding access to healthcare and social support. METHODS: Study on the development of an instrument based on the model proposed by Luiz Pasquali. RESULTS: After a factorial analysis, the final result that showed preliminary evidence of validation was an instrument with four domains: Health Resources, Financial Resources, Social Aspects, and Individual Aspects, with 10 items. FINAL CONSIDERATIONS: The final instrument developed gathered evidence of validity, revealing item quality in representing the concepts underlying each domain. Through its psychometric properties, the instrument showed that it has representativeness regarding the perception of the affected by DR regarding their access to health and social support..
INTRODUCCIÒN: La condición crónica degenerativa relacionada a las Enfermedades Raras (ER) está impregnada por procesos sociales y de acceso a la salud complejos, cuya comprensión exige evaluación en la perspectiva de los acometidos. OBJETIVO: Construir un instrumento que posibilite evaluar la percepción del acceso a la salud y al apoyo social destinado a los acometidos por ER. MÈTODOS: Estudio sobre el desarrollo de un instrumento en el modelo propuesto por Luiz Pasquali. RESULTADOS: Después del análisis factorial, el resultado final que mostró evidencias preliminares de validación fue un instrumento con cuatro dominios: Recursos de Salud, Recursos Financieros, Aspectos Sociales y Aspectos Individuales, con 10 ítems. CONSIDERACIONES FINALES: El instrumento final desarrollado reunió evidencia de validez, revelando la calidad del elemento al representar los conceptos subyacentes a cada dominio. A través de sus propiedades psicométricas, el instrumento demostró que tiene representatividad acerca de la percepción de los afectados por RD con respecto a su acceso a la salud y al apoyo social.