Risk factors for nosocomial pneumonia comparing adult critical-care populations

The purpose of the study was to examine risk factors for nosocomial pneumonia in the surgical and medical/respiratory intensive care unit (ICU) populations. In a public teaching hospital, all cases of nosocomial pneumonia in the surgical and medical/respiratory ICUs (n = 20, respectively) were identified by prospective surveillance during a 5-yr period from 1987-1991. Each group of ICU cases was compared with 40 ICU control patients who did not acquire pneumonia, and analyzed for 25 potential risk factors. Surgical ICU patients were found to have consistently higher rates of nosocomial pneumonia than medical ICU patients (RR = 2.2). The strongest predictor for nosocomial pneumonia in both the surgical and medical/respiratory ICU groups was found to be prolonged mechanical ventilation (> 1 d) resulting in a 12-fold increase in risk over nonventilated patients. APACHE III score was found to be predictive of nosocomial pneumonia in the surgical ICU population, but not in the medical/respiratory ICU population. We conclude that certain groups deserve special attention for infection control intervention. Surgical ICU patients with high APACHE scores and receiving prolonged mechanical ventilation may be at the greatest risk of acquiring nosocomial pneumonia of all hospitalized patients

Sensitivity and a priori uncertainty analysis of the CFRMF central flux spectrum

The Coupled Fast Reactivity Measurements Facility (CFRMF), located at the Idaho National Engineering Laboratory, is a zoned-core critical assembly with a fast-neutron-spectrum zone in the center of an enriched /sup 235/U, water-moderated thermal driver. An accurate knowledge of the central neutron spectrum is important to data-testing analyses which utilize integral reaction-rate data measured for samples placed in the CFRMF field. The purpose of this paper is to present the results of a study made with the AMPX-II and FORSS code systems to deterine the central-spectrum flux covariance matrix due to uncertainties and correlations in the nuclear data for the materials which comprise the facility

Aspectos psicossociais na era dos novos tratamentos da AIDS

O presente artigo descreve o impacto no bem-estar (ansiedade e depressão) e qualidade de vida das pessoas HIV+ quando o tratamento anti-retroviral não apresenta os resultados esperados. Foram avaliadas, através de questionários, as percepções e expectativas com o tratamento anti-retroviral, o nível de ansiedade e depressão, o nível de apoio social e a qualidade de vida percebida em 80 pacientes HIV+ em atendimento em um hospital universitário. Os resultados indicaram que as percepções e expectativas negativas com o tratamento podem modular o estado emocional e impactar negativamente a qualidade de vida das pessoas HIV+; e que um nível de apoio social adequado é capaz de atenuar este impacto negativo

Validity of self reported utilisation of primary health care services in an urban population in Spain

STUDY OBJECTIVE—To assess the validity and factors related with the validity of self reported numbers of visits to a primary health care centre, in comparison with the recorded number.
DESIGN—Cross sectional study.
SETTING—The urban area served by the Zaidín-Sur Primary Health Care Centre (Granada, Spain).
PARTICIPANTS—Two population samples (236 high users and 420 normal users) who were seen at the centre from 1985 to 1991 were interviewed in 1993.
MAIN RESULTS—A net tendency to overreport the actual number of visits was observed. Absolute concordance between self reported and recorded utilisation decreased as time interval lengthened, although this mainly reflected the increase in maximum variability both with time interval length and with the number of recorded visits. Corrected Spearman ρ coefficients obtained between the number of self reported and recorded visits ranged from 0.602 for the two weeks before the interview to 0.678 for the year before. Regression slopes of self reported utilisation upon recorded utilisation did not change between periods. In multiple regression analyses the actual number of visits was the main factor associated with both underreporting and overreporting. Older age was also significantly associated with underreporting. Poor health status and high satisfaction with health care were significantly associated with overreporting.
CONCLUSIONS—There was a substantial degree of inaccuracy in self reported utilisation, with a net tendency to overreport the number of visits. In relative terms, however, accuracy of self reports did not seem to decrease appreciably as the recall time lengthened. To compare the accuracy of different measures, it is important to take into account the maximum variability of each one. Otherwise, contradictory results may be obtained.


Keywords: self reported utilisation; primary health care; validit