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BACKGROUND: Previous studies have shown that multimorbidity is a risk factor for cognitive dysfunction (CD).Type 2 diabetes mellitus (T2DM) and hypertension (HT) are very common risk factors.The association between multimorbidity due to both diseases and CD has been understudied in low and middle-income countries, in which the strength of the association might be stronger. AIM: To evaluate the association between multimorbidity due to T2DM and HT with CD among adults ≥50 years in Tumbes. MATERIALS AND METHODS: A secondary analysis of a population-based cross-sectional study was conducted. The exposure variable was the presence of both T2DM and HT, split into categories: without HT or T2DM, only T2DM, only HT, and with T2DM and HT; whereas CD was the outcome variable, defined as a score ≤26 in the Leganes Cognitive Test. Crude and adjusted generalized linear models were used to estimate the association of interest, and prevalence ratio (PR) and 95% confidence interval (95%CI) were reported. RESULTS: 688 participants were analyzed. The prevalence of CD was 39.1%. There was a 56.1% of participants without TDM2 nor HT, 8.3% with T2DM, 28.9% with HT and 6.7% with both diseases. A significant association was found between multimorbidity and CD (PR = 1.43, 95%CI 1.04-1.97). Multimorbidity had a statistically significant association with CD in the group of participants with ≥7 years of education (PR = 2.56,95%CI 1.55-4.21), but no in the group with <7 years. CONCLUSIONS: There is association between the morbidity of T2DM and HT, and CD among adults ≥50 years of age in Tumbes. Education was an effect modifier of the association between HT and T2DM on the presence of CD.
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Disfunção Cognitiva , Diabetes Mellitus Tipo 2 , Hipertensão , Adulto , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Multimorbidade , Peru/epidemiologia , Estudos Transversais , Hipertensão/epidemiologia , Prevalência , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologiaRESUMO
The spotted lanternfly, Lycorma delicatula (White), is a new invasive pest in the United States. To quantify spotted lanternfly population abundance, one must understand this pest's dispersion pattern, that is, the spatial arrangement of individuals within a population. Spotted lanternflies overwinter in egg masses from late fall to May, making this life stage suitable for population assessments. We measured the dispersion pattern of egg masses at two types of sites: a suburban housing development, where we used individual trees as the sampling unit, and rural woodlots, where we used individual trees and also plots with 5.64 m radius as sampling units. Plots were the same size as those recommended for monitoring the gypsy moth, a well-studied pest with similar egg laying habit to the spotted lanternfly. Egg masses in both sampling units were counted up to a height of 3 m. With trees as the sampling unit, egg masses were aggregated in 12 of 20 rural sampling universes, randomly dispersed at 6, and completely absent at 2. Similar patterns were seen when using the 5.64-m radius rural sampling units and for suburban sampling universes. We calculated sample size requirements for a range of mean densities at a precision of 25 and 30%. Additionally, the vertical distribution of egg masses was characterized on the invasive tree of heaven [Ailanthus altissima (Mill.) Swingle], a preferred host for spotted lanternflies. For small trees, there was a positive relationship between number of egg masses in the bottom 3 m of the tree and the total count.
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Ailanthus , Hemípteros , Animais , Oviposição , Tamanho da Amostra , ÁrvoresRESUMO
BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.
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Educação de Graduação em Medicina , Educação Médica , Estudantes de Medicina , Currículo , Técnica Delphi , Equador , HumanosRESUMO
AIM: To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10-year cohort of people in a Latin American country. METHODS: Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural-to-urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow-up assessment in 2018. The outcome was all-cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6-6.9 mmol/l (100-125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39-46 mmol/mol (5.7-6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42-46 mmol/mol (6.0-6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models. RESULTS: At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural-to-urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c -based definition and the American Diabetes Association HbA1c -based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all-cause mortality using the HbA1c -based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59-4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62-5.28) according to the International Expert Committee], whereas American Diabetes Association-defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26-2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c -based definition was associated with all-cause mortality [hazard ratio 1.91 (95% CI 1.03-3.53)], whereas the International Expert Committee HbA1c -based and American Diabetes Association impaired fasting glucose-based definitions were not [hazard ratios 1.42 (95% CI 0.75-2.68) and 1.09 (95% CI 0.33-3.63), respectively]. CONCLUSIONS: Intermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.
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Glicemia/metabolismo , Intolerância à Glucose/metabolismo , Hemoglobinas Glicadas/metabolismo , Hiperglicemia/metabolismo , Mortalidade , Estado Pré-Diabético/metabolismo , Adulto , Causas de Morte , Feminino , Recursos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Modelos de Riscos Proporcionais , População Rural/estatística & dados numéricos , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
INTRODUCTION: The clinical course in patients with prostate cancer (PCa) after biochemical failure (BF) has received limited attention. This study analyzes survival time from recurrence, patterns of progression, and the efficacy of salvage therapies in patients treated with radical or postoperative radiotherapy (RT). METHODS: This is a multicenter retrospective comparative study of 1135 patients diagnosed with BF and treated with either radical (882) or postoperative (253) RT. Data correspond to the RECAP database. Clinical, tumor, and therapeutic characteristics were collected. Descriptive statistics, survival estimates, and comparisons of survival rates were calculated. RESULTS: Time to BF from initial treatment (RT or surgery) was higher in irradiated patients (51 vs 37 months). At a median follow-up of 102 months (14-254), the 8-year cause-specific survival (CSS) was 80.5%, without significant differences between the radical (80.1%) and postoperative (83.4%) RT groups. The 8-year metastasis-free survival rate was 57%. 173 patients (15%) died of PCa and 29 (2.5%) of a second cancer. No salvage therapy was given in 15% of pts. Only 5.5% of pts who underwent radical RT had local salvage treatment and 71% received androgen deprivation (AD) ± chemotherapy. The worst outcomes were in patients who developed metastases after BF (302 pts; 26.5%) and in cases with a Gleason > 7. CONCLUSIONS: In PCa treated with radiotherapy, median survival after BF is relatively long. In this sample, no differences in survival rates at 8-years have been found, regardless of the time of radiotherapy administered. AD was the most common treatment after BF. Metastases and high Gleason score are adverse variables. To our knowledge, this is the first study to compare outcomes after BF among patients treated with primary RT vs. those treated with postoperative RT and to evaluate recurrence patterns, treatments administered, and causes of death. The results allow avoiding overtreatment, improving quality of life, without negatively affecting survival.
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Braquiterapia/mortalidade , Bases de Dados Factuais , Recidiva Local de Neoplasia/mortalidade , Neoplasias da Próstata/mortalidade , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
INTRODUCCIÓN Se ha planteado que factores ambientales y relacionados con el estilo de vida pueden contribuir a la severidad y progresión de la inflamación en la artritis reumatoide. Una intervención que genera un alto interés, debido a sus supuestas propiedades antiinflamatorias es la dieta mediterránea. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales sólo uno corresponde a un ensayo aleatorizado. Concluimos que la dieta mediterránea podría hacer poca o nula diferencia en el dolor articular o actividad de la enfermedad, y aumentar levemente el peso en pacientes con artritis reumatoide, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si la dieta mediterránea tiene algún efecto sobre la funcionalidad, rigidez matinal o calidad de vida, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.
INTRODUCTION It has been suggested that environmental and lifestyle factors might contribute to the severity and progression of inflammation in rheumatoid arthritis. An intervention generating high interest due to its supposed anti-inflammatory properties is the Mediterranean diet. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including four primary studies, of which only one corresponded to a randomized trial. We concluded Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in rheumatoid arthritis patients, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether Mediterranean diet has any effect on functionality, morning stiffness or quality of life as the certainty of the existing evidence has been assessed as very low.
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Humanos , Artrite Reumatoide/tratamento farmacológico , Qualidade de Vida , Dieta Mediterrânea , Dor/etiologia , Dor/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Bases de Dados FactuaisRESUMO
BACKGROUND: Unmanned aircraft vehicles (UAVs) have had a rapid escalation in manageability and affordability, which can be exploited in healthcare. We conducted a systematic review examining the use of drones for health-related purposes. METHODS: A search was conducted in Medline, Embase, Global Health, Scopus, CINAHL and SciELO. Experimental studies were selected if the population included human subjects, the intervention was the use of UAVs and there was a health-related outcome. RESULTS: Of 500 results, five met inclusion criteria during an initial search. An updated search yielded four additional studies. Nine studies, all in high-income countries, were included for systematic syntheses: four studies addressed out-of-hospital cardiac arrest emergencies, three assessed drones for identification of people after accidents, one used drones to transport blood samples and one used drones to improve surgical procedures in war zones. CONCLUSIONS: Research on the use of drones in healthcare is limited to simulation scenarios, and this review did not retrieve any studies from low- and middle-income countries.
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INTRODUCTION: Use of sunscreen is encouraged to reduce the risk of skin pathologies caused by radiation. It is important to acknowledge the associated factors that promote or hinder sunscreen use in young populations as to design better prevention policies. OBJECTIVE: To determine the factors associated with regular sunscreen use among first year medical students from a Peruvian university. MATERIALS AND METHODS: A cross-sectional study was performed. Our population was first-year medical students from a Peruvian university. We administrated an electronic survey to evaluate socio-demographic data, as well as student knowledge, attitudes, and practices regarding photo-protection. We used ordinal logistic regression to analyze the factors associated with sunscreen use. RESULTS: Of 420 first-year students, 299 completed our survey. We found that 53.5% of the participants were less than 18 years old, 63.2% were female, 9.3% (females more than males) responded that a sunburn was worth it to look tan, and 38.1% always or almost always used sunscreen during the summer. Factors associated with sunscreen use in the ordered logistic adjusted regression were male sex (OR = 0.50, IC95% = 0.34-0.86), participation in photo-protection workshops within the last year (OR = 2.40, IC95% = 1.28-4.37), and having somebody to remind them the use of sunscreen during the last three months (OR = 3.80, IC95% = 1.28-11.20). CONCLUSIONS: In our sample, a higher sunscreen use was more often observed among female participants, those who attended skin protection workshops, and those reminded to use sunscreen. This highlights the importance of educational and reminder activities in the adoption of protective habits, such as sunscreen use.
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Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Peru , Neoplasias Cutâneas/prevenção & controle , Estudantes , Protetores Solares , Universidades , Adulto JovemRESUMO
El trauma eléctrico ocurre cuando un organismo vivo participa de un circuito eléctrico. Esto produce un síndrome traumático que involucra daño térmico y alteraciones eléctricas en el cuerpo. Para entenderlo mejor es necesario conocer la física de la electricidad. En este articulo se revisara un caso que se presento en el hospital San Rafael en el cual fue posible observar anormalidades electrocardiografícas en un paciente expuesto a traumas eléctrico leve.
Electrical injuries happen when a living organism takes part in an electrical circuit through the tissues of that organism.Because of this, the result is trauma syndrome that involves termal damage an electrical disturbances into the body.For a better understanding, is necessary to know about the physics of electricity.We`ll rewiew a clinical case happened in Hospital San Rafael, in which was possible to see electrocardiograma anormalities in pacient exposed to low electrical trauma.
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Humanos , Masculino , Adulto , Traumatismos por Eletricidade , Eletrocardiografia , EletrochoqueRESUMO
AIM: To determine the exact relation between the characteristics of quantitative electroencephalogram analyses and the estimators of the cognitive status in alcoholic patients undergoing withdrawal. SUBJECTS AND METHODS: The study examined 49 patients diagnosed with alcoholism (DSM-IV) after 10 days of withdrawal, as well as the correlation between the bandwidth measures from the quantitative electroencephalogram (qEEG) analysis and the characteristics of the visual and auditory cognitive evoked potentials (P300) and from the findings of the attention and memory tests. RESULTS: The patients were divided into two groups: group one, which displayed an overall increase in the delta and theta absolute powers with frontal predominance, and group two, with reduced delta and theta absolute powers. Latency of the P300 wave was delayed in patients, particularly in those in group one, but regional absence of the P300 wave was more frequent in group two. Results of attention and memory tests were abnormal in patients, especially those in group one. CONCLUSIONS: The findings in the two groups appear to reflect different stages in the progression of alcoholism: the first only involved cortical dysfunction due to metabolic causes and the second possibly had added cortical atrophy. They might also represent two types of biological response by their nervous systems to the same pathogenic agent. These findings suggest that it is advisable to conduct follow-up studies involving qEEG, cognitive tests and magnetic resonance imaging of the brain in this kind of patient.