RESUMO
While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ≥ 60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ≥ 60-yr-old patients with clinically and spirometry-confirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.
Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Obstrução das Vias Respiratórias , Argentina , Cardiologia/métodos , Estudos de Coortes , Comorbidade , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prevalência , Estudos Prospectivos , Pneumologia/métodos , Sistema de Registros , Espirometria/métodosRESUMO
BACKGROUND: Countries with scarce resources have the right to appropriate essential health care but very few reports discuss how this can be achieved. We assessed the survival of a large cohort of pediatric oncological patients to provide hard data on which to base realistic evaluation and planning schemes. PATIENTS AND METHODS: This multicenter retrospective survey covered consecutively diagnosed and treated patients admitted to eight national level hospitals in seven countries in Central America and the Caribbean. The research protocol was discussed extensively, so the data to be collected and the criteria for their evaluation were clearly pre-defined. We analysed 2214 patients diagnosed between 1996 and 1999 with various cancers, classified as hemato-oncological disorders (70%) and solid tumors (30%). RESULTS: Three-year overall survival was 48.4% [standard error (SE) 1.3]. Detailed analysis of acute lymphoblastic leukemia highlighted the wide intercountry variability: 3-year survival was 62.2% (SE 5.3) in Cuba, 74.2% (SE 3.3) in Costa Rica, 61.7% (SE 4.9) in Nicaragua, and lower in the other four countries. CONCLUSIONS: The yield of diagnostic-therapeutic protocols depends largely on the context of care in which they are applied. This paper documents the importance of including epidemiological research in interventions for cooperation in complex health areas such as pediatric oncology.
Assuntos
Neoplasias/epidemiologia , Região do Caribe/epidemiologia , América Central/epidemiologia , Criança , Humanos , Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos Retrospectivos , Análise de SobrevidaAssuntos
Países em Desenvolvimento , Saúde Pública , Bolívia , Humanos , Nefropatias/epidemiologia , Nefropatias/terapiaRESUMO
We describe the La Mascota twinning programme between La Mascota paediatric hospital in Managua, Nicaragua, and hospitals in Monza and Milan, Italy, and Bellinzona, Switzerland. The programme was based on the belief that an attempt to reduce the gap in mortality from cancer in childhood between developed and less developed countries should become an integral part of the care and research activity of a haemato-oncological department of a developed country and not simply an exercise in solidarity. This programme for acute lymphoblastic leukaemia shows that intellectual, organisational, and financial resources can be generated by a twinning programme. What is vital for such programmes is a long-term commitment to a comprehensive and holistic strategy that incorporates supply of drugs, training and supervision of health professionals, and the care of the children and of their parents.
Assuntos
Cooperação Internacional , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Criança , Países em Desenvolvimento , Organização do Financiamento , Hematologia/economia , Hematologia/métodos , Humanos , Itália , Oncologia/economia , Oncologia/métodos , Nicarágua , Enfermagem Pediátrica/educação , Pediatria/educação , Qualidade da Assistência à Saúde , SuíçaRESUMO
The results of a naturalistic epidemiological study conducted in 6 Central American countries in collaboration with the WHO/PAHO Regional Office are reported, aimed at describing the patients with mental distress presenting to the primary health care setting, the interventions enacted and the evolution of the patients over the 6 months following recruitment. A total of 812 patients were recruited by the personnel of 11 primary health care centres. A high degree of heterogeneity was observed with respect to the patients' characteristics and the patterns of care provided. The factors potentially contributing to the heterogeneity, identified through multivariate analyses, are discussed in detail against the specific background differences between countries and between areas within each country. Interestingly albeit expectedly, besides the differences in health care provision and availability, social needs appear to influence both interventions and outcomes.
Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , América Central/epidemiologia , Países em Desenvolvimento , Feminino , Política de Saúde , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Psicotrópicos/uso terapêuticoRESUMO
Misoprostol is used by women in Brazil in case of unwanted pregnancy to attempt abortion. This paper reports the characteristics, pattern of misoprostol use and opinions of a group of 102 women (median age 25 years, range 16-49 years), from Fortaleza, capital of Ceará state, who had used misoprostol to attempt abortion. Seventy-five percent were women of lower social class, 58% had less than 8 years of education and 46% were never married. Misoprostol was used for the first induced abortion by 65 women. Modal dose was 4 tablets--200 micrograms of misoprostol each--most frequently 2 tablets by oral route and 2 tablets by intravaginal route. This pattern of use was associated with the highest rate of abortion, mainly at 9-12 weeks of amenorrhea. Fifty-five percent of women had no pregnancy test; 41% had 8 weeks or less of amenorrhea. Curettage was performed in 49 of 84 women who reported abortion and in 41 of 43 women who entered the hospital. Infection and uterine perforation were the complications described. Seventy-two percent of women were in favor of legalization of abortion, but 52% were also in favor of the prohibition of misoprostol sales; 66% would not repeat misoprostol use and 53% would not suggest it to a friend. The poorest women were less favorable to misoprostol ban. Despite the current lack of safer alternatives, misoprostol does not seem a satisfactory solution to illegal abortion in Brazil.
Assuntos
Aborto Induzido , Misoprostol , Administração Oral , Adolescente , Adulto , Fatores Etários , Brasil , Escolaridade , Feminino , Humanos , Estado Civil , Pessoa de Meia-Idade , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Gravidez , Fatores Socioeconômicos , VaginaRESUMO
Misoprostol, a prostaglandin E1 analogue indicated for ulcer treatment, has been widely used as an abortifacient by women in Brazil, where abortion is legal only in cases of rape or incest, or to save the woman's life. Because misoprostol is an inefficient abortifacient, many women who use it have incomplete abortions and need uterine evacuation. We reviewed the records of women admitted to the main obstetric hospital of Fortaleza, capital of Ceará state, Brazil, between January, 1990, and July, 1992, for uterine evacuation after induced abortion. The number of incomplete abortions induced by misoprostol increased substantially during the first half of 1990, and declined thereafter. Of the 593 cases in 1991, 75% were related to misoprostol, 10% to the use of other specified drugs, and 6% to unspecified drugs. For the remaining 9% the procedure used was not recorded; these included 3% in whom abortion had been induced by a clandestine abortionist. The number of uterine evacuations per month fell from 89 in August, 1990, to 62 in July, 1991, when sales of misoprostol in Ceará state were suspended. The fall continued after the sale of misoprostol ceased, to about 20 cases in December, 1991; numbers remained around this level until June, 1992, sustained by clandestine sales. The lack of access to contraception is the main reason for the large numbers of unplanned pregnancies and is a major public health issue for Brazilian women. The prohibition of abortion creates a void in which misuse of medicines is one extra complication, mainly because of the poor control of drug marketing.