RESUMO
OBJECTIVE: To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP). MATERIAL AND METHODS: A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis. RESULTS: After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 µm(2)vs. 1,056 ± 844 µm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied. CONCLUSIONS: Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications.
Assuntos
Terapia por Exercício , Diafragma da Pelve , Prostatectomia , Neoplasias da Próstata/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/fisiologia , Período Pré-Operatório , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Qualidade de Vida , Método Simples-Cego , Incontinência Urinária/prevenção & controleRESUMO
This study evaluated the humoral response to protein components of the Cuban-produced vaccine against serogroups B and C meningococcus, VA-MENGOC-BC, in adults and children 1 to 5 years old. The trial was conducted in an area of the Department of Antioquia, Colombia, in which an elevated incidence of meningococcal disease had been recorded. The serum anti-vaccine-protein response was studied before (T0) and after (T1) vaccination by means of enzyme-linked immunosorbent assay (ELISA), and lytic capacity was evaluated through the bactericidal antibodies test (BAT). The ELISA was performed before and after vaccination on the sera of 407 adults and 213 children. Lytic capacity against Cuban meningococcal strain B:4:P1.15 was studied with BAT in paired sera from 90 adults and 114 children. The two techniques showed a statistically significant response (P < 0.01) to the vaccine, in both adults and children. Of the total number of subjects tested with ELISA, 81% showed an immune response to the vaccine (T1/T0 > or = 2) (95% confidence interval, CI95%: 78% to 84%); among children, immune response was 91% (CI95%: 87% to 94%). All the children 1 year of age (n = 7) responded. Seroconversion (T1/T0 > or = 4), as shown by ELISA, was 80% among adults (CI95%: 73% to 86%) and 90% among children (CI95%: 83% to 100%). BAT demonstrated seroconversion in 85% (CI95%: 78% to 92%) of subjects who had been seronegative before vaccination, 85% of the adults (CI95%: 76% to 95%) and 84% of the children (CI95%: 72% to 96%). Seroconversion among children 3 and 4 years of age was 80%. The group of sera from children 1, 2, and 5 years old available for study with BAT was too small for meaningful statistical analysis; all of them seroconverted. In 20 sera chosen randomly for study of their bactericidal activity against all the strains isolated from patients in Colombia (B:4:P1.15, B:8:P1.nt, and two strains of serogroup C), seroconversion was found in all 20 cases. These results give reason to think that vaccination in this group produced an effective immune response, as measured serologically, and this belief is corroborated in practice by the lack of any cases of meningococcal disease through September 1994 among the people vaccinated.
Assuntos
Anticorpos Antibacterianos/biossíntese , Proteínas de Bactérias/imunologia , Vacinas Bacterianas/imunologia , Neisseria meningitidis/imunologia , Adulto , Pré-Escolar , Colômbia , Intervalos de Confiança , Feminino , Humanos , Lactente , Masculino , Vacinas Meningocócicas , Pessoa de Meia-Idade , Neisseria meningitidis/classificação , SorotipagemRESUMO
In this study, the contribution of four distinct domains of the Help Seeking-Decision Making model to predicting the use of mental health services is examined. Using a proposed methodology the authors assess the relevance of this model and its domains to mental services planning. The methodology combines logistic regression analysis and receiver operating characteristic (ROC) curves. Logistic regression analysis allows us to examine the individual variables of the model and generate predictions about use. ROC curves allow us to compare and interpret the relative contribution of a predisposing domain, a physical and mental health domain, an enabling-restrictive domain, and an organizational domain in correctly classifying users and nonusers of mental health services. The physical and mental health domain yielded a Somer's D-statistic of 0.7, which corresponds to an 85% correct classification of randomly selected pairs of users and nonusers. The study findings suggest that comparing ROC curves helps to describe and interpret the domains of the model that are relevant for making predictions about who will or will not use mental health services during a 1-year period.
Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Modelos Psicológicos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza , Curva ROC , Adolescente , Adulto , Causalidade , Características Culturais , Tomada de Decisões , Feminino , Previsões , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Porto Rico/epidemiologia , Fatores SocioeconômicosRESUMO
The present study analyzed the socioeconomic determinants of health insurance status among Puerto Ricans. Given the fact that there are no mandated health benefits for private firms in Puerto Rico and that health services are provided almost free of charge in government facilities, Puerto Rico provides a unique case study to explore the determinants of health insurance status. The model, estimated using a household sample of 750 dwellings, was collected through the Master Sample Survey of Puerto Rico's Department of Health. Given the nature of the problem studied, logistic regression techniques are used for estimation purposes. The findings of this study point to the importance of age and socioeconomic status as the most important determinants of health insurance status.