Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Ações de educação em saúde para prevenção e controle da dengue: um estudo em Icaraí, Caucaia, Ceará Health education actions for the prevention and control of dengue fever: a study at Icaraí, Caucaia, Ceará State, Brazil

O estudo analisa as ações educativas para prevenção e controle da dengue, as estratégias utilizadas nas ações educativas e aponta os limites/dificuldades. Abordagem qualitativa, desenvolvida na Unidade Básica de Saúde e oito imóveis em Icaraí-CE. Os sujeitos foram dezessete pessoas, distribuídas entre três grupos: I (oito usuários da UBS); II (quatro Agentes de Controle de Endemias); III (cinco profissionais de Saúde). As técnicas de coleta de dados: a entrevista semi-estruturada; a observação participante, a análise de documental. O método de análise foi hermenêutica dialética. Pode-se afirmar que as práticas educativas em saúde são divergentes, a ação transformadora é ineficaz para impactar a doença. Apontaram-se como dificuldades as fragilidade e ações pontuais; conteúdo das mensagens educativas descontextualizadas; estratégias autoritárias e coercitivas, ausência de políticas públicas, limites entre a UBS e a população; ênfase às campanhas sanitárias; os profissionais não ouvem a população e vice-versa; ainda predomina o saber técnico sobre o usuário. Evidencia a necessidade de ações que fortaleçam a possibilidade dos sujeitos terem o poder e a responsabilidade pela própria história e pelo processo de construção de sua cidadania.<br>This study analyses education actions and their strategies for preventing and controlling dengue fever, highlighting constraints and difficulties. Conducted through a qualitative approach at the Primary Care Unit and 8 properties in Icaraí, Ceará State, Brazil, its 17 subjects are divided into groups: I (8 PCU users); II (4 Endemic Disease Control Agents); and III (5 healthcare practitioners). The data was collected through semi-structured interviews; participative observation and documentary analyses, using a hermeneutic dialectic analysis method. The findings indicate that health education actions are divergent, while transforming actions are ineffective in terms of impacts on the disease. Difficulties include: weak location-specific actions; educational messages whose contents are not tailored to their contexts; authoritarian and coercive strategies; absence of public policies; gaps between PCU and local population; stress on public health campaigns; practitioners who do not listen to the population and vice-versa; with technical expertise still prevailing over users. The evidence underscores the need for actions strengthening the possibilities of empowering the subjects, helping them become responsible for their own lives and citizenship construction processes

Homens e violência conjugal: uma análise de estudos brasileiros Men and conjugal violence: an analysis of Brazilian studies

O estudo analisou qualitativamente 54 textos brasileiros sobre homens e violência conjugal, relacionados a atividades de pesquisa ou de intervenção. Primeiramente caracterizou-se o material quanto aos temas abordados, ao foco principal e ao tipo de texto. A seguir fizeram-se sínteses e análises das principais considerações dos textos a partir dos eixos temáticos encontrados: diferentes inteligibilidades da problemática, magnitude da violência conjugal, sentidos de homens relacionados à violência e intervenções e/ou políticas junto a homens agressores. A análise teve como parâmetro o ramo de discussões nacionais e internacionais que se esforça por ultrapassar a polêmica em torno da definição do problema como "violência de gênero" ou "violência conjugal", cunhando sobretudo o pressuposto de que existem diversos estilos de conjugalidade violenta. Concluiu-se que a maior unanimidade dos estudos é pensar a problemática como questão relacional de gênero. Defendeu-se, por fim, a ideia de que a escolha da melhor abordagem articuladora entre os polos da polêmica ainda demanda mais investigações, com metodologias qualitativas junto a atores de diferentes camadas e grupos sociais. Quanto às intervenções, propõem-se investimentos no maior número possível de alternativas, valorizando a singularidade dos casos.<br>This study consisted of a qualitative analysis of 54 Brazilian texts about men and conjugal violence related to research or intervention activities. Initially, the material was divided up according to the topics under scrutiny, the main focus and the type of text. Analysis and synthesis of the main considerations of the texts, based on the thematic points revealed, was then carried out. This included the different approaches to the problem, the magnitude of conjugal violence, the attitudes of men vis-à-vis violence and interventions and/or policies towards male aggressors. The parameter for the analysis was the national and international debate seeking to overcome the controversy surrounding the definition of the problem as "gender violence" or conjugal violence," essentially fostering the hypothesis of various types of violent conjugal relationships. It was concluded that the unanimous outcome of the study was to view the problem as a gender relationship issue. Lastly, it was argued that the choice of the best approach between the poles of the controversy requires further investigation using qualitative methodologies together with players from different classes and social backgrounds. With respect to further intervention, it was considered necessary to examine a broad gamut of alternatives emphasizing the singular nature of the cases