Participação em uma pesquisa para avaliar os ciudados primários da saúde entre filiados e filiadas de um plano médico universitário na Argentina

Objetivo: Describir la proporción de localización, participación y respuesta en una encuesta para valorar la atención primaria de la salud de afiliados de una obra social universitaria. Métodos: Estudio piloto descriptivo transversal. Muestreo aleatorio simple de 500 personas adultas de la base de datos de afiliaciones. Se calcularon proporciones de localización, participación, respuesta y respuesta total, luego se analizaron por sexo, edad, tipo de afiliación y modo de administración. Resultados: El 61,8% de afiliados fue localizado, el 84,5% de las personas localizadas aceptó participar y el 64,4% de ellas respondió el cuestionario, alcanzando una proporción de respuesta total del 54,4%. Las personas jóvenes fueron relativamente menos localizadas (52,2%; p<0,01) y la mayor proporción de respuesta total se consiguió en las mayores de 65 años (68,2%; p<0,05). Conclusiones: La localización fue dificultosa pero hubo una buena aceptación del estudio. Los medios informatizados de administración fueron preferidos pero tuvieron una baja respuesta.Aim: To describe the location, participation and response to a survey to assess primary health care in members of a University Health Insurance. Materials and methods: Pilot cross-sectional descriptive study. Simple random sample of 500 adults from members’ database. Proportions of location, participation, response and total response were calculated and analyzed according to sex, age, and type of membership and administration. Results: 61.8% of members were found, 84.5% agreed to participate and 64.4% answered the questionnaire, reaching a total response rate of 54.4%. Young people were less likely to be localized (52.2%, P <0.01) and higher total response rate was achieved in people over 65 (68.2%, P <0.05). Conclusions: Finding the members was difficult but there was a good level of study acceptance. The computerized questionnaire showed strong preference but low response.Objetivo: Descrever a proporção de localização, participação e resposta em uma enquete para avaliar os cuidados de saúde primários dos filiados de um plano médico universitário. Métodos: Estudo piloto descritivo transversal. Amostragem aleatória simples de 500 adultos do banco de dados das filiações. Proporções de localização, a participação, a resposta e a resposta global foram apurados; a seguir foram analisados por sexo, idade, tipo de filiação e modo de administração. Resultados: 61,8 % dos filiados foi localizado, 84,5 % daqueles localizados aceitaram participar e 64,4% deles responderam o questionário, atingindo uma taxa de resposta total de 54,4%. Os jovens foram relativamente menos localizados (52,2%; p <0,01 ) e a maior proporção de resposta completa foi atingida em pessoas com mais de 65 anos (68,2% , p <0,05). Conclusões: A localização foi difícil, mas houve uma boa aceitação da pesquisa. Os meios de administração informatizados foram os preferidos, mas tiveram uma resposta fraca.Fil: Villalba, A.. Universidad Nacional de Cordoba. Facultad de Derecho y Cs.sociales. Escuela de Trabajo Social; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Escuela de Salud Pública; ArgentinaFil: Falá Giroldi, C.. Universidad Nacional de Cordoba. Facultad de Derecho y Cs.sociales. Escuela de Trabajo Social; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Escuela de Salud Pública; ArgentinaFil: Nicora, V.. Universidad Nacional de Cordoba. Facultad de Derecho y Cs.sociales. Escuela de Trabajo Social; ArgentinaFil: Mántaras, J.. Universidad Nacional de Cordoba. Facultad de Derecho y Cs.sociales. Escuela de Trabajo Social; ArgentinaFil: Berra, Silvina del Valle. Universidad Nacional de Córdoba. Facultad de Medicina. Escuela de Salud Pública; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Cell-Cell Contact Preserves Cell Viability via Plakoglobin

Control over cell viability is a fundamental property underlying numerous physiological processes. Cell spreading on a substrate was previously demonstrated to be a major factor in determining the viability of individual cells. In multicellular organisms, cell-cell contact is likely to play a significant role in regulating cell vitality, but its function is easily masked by cell-substrate interactions, thus remains incompletely characterized. In this study, we show that suspended immortalized human keratinocyte sheets with persisting intercellular contacts exhibited significant contraction, junctional actin localization, and reinforcement of cell-cell adhesion strength. Further, cells within these sheets remain viable, in contrast to trypsinized cells suspended without either cell-cell or cell-substrate contact, which underwent apoptosis at high rates. Suppression of plakoglobin weakened cell-cell adhesion in cell sheets and suppressed apoptosis in suspended, trypsinized cells. These results demonstrate that cell-cell contact may be a fundamental control mechanism governing cell viability and that the junctional protein plakoglobin is a key regulator of this process. Given the near-ubiquity of plakoglobin in multicellular organisms, these findings could have significant implications for understanding cell adhesion, modeling disease progression, developing therapeutics and improving the viability of tissue engineering protocols

“Medically unexplained” symptoms and symptom disorders in primary care: prognosis-based recognition and classification

Background: Many patients consult their GP because they experience bodily symptoms. In a substantial proportion of cases, the clinical picture does not meet the existing diagnostic criteria for diseases or disorders. This may be because symptoms are recent and evolving or because symptoms are persistent but, either by their character or the negative results of clinical investigation cannot be attributed to disease: so-called “medically unexplained symptoms” (MUS). MUS are inconsistently recognised, diagnosed and managed in primary care. The specialist classification systems for MUS pose several problems in a primary care setting. The systems generally require great certainty about presence or absence of physical disease, they tend to be mind-body dualistic, and they view symptoms from a narrow specialty determined perspective. We need a new classification of MUS in primary care; a classification that better supports clinical decision-making, creates clearer communication and provides scientific underpinning of research to ensure effective interventions. Discussion: We propose a classification of symptoms that places greater emphasis on prognostic factors. Prognosis-based classification aims to categorise the patient’s risk of ongoing symptoms, complications, increased healthcare use or disability because of the symptoms. Current evidence suggests several factors which may be used: symptom characteristics such as: number, multi-system pattern, frequency, severity. Other factors are: concurrent mental disorders, psychological features and demographic data. We discuss how these characteristics may be used to classify symptoms into three groups: self-limiting symptoms, recurrent and persistent symptoms, and symptom disorders. The middle group is especially relevant in primary care; as these patients generally have reduced quality of life but often go unrecognised and are at risk of iatrogenic harm. The presented characteristics do not contain immediately obvious cut-points, and the assessment of prognosis depends on a combination of several factors. Conclusion: Three criteria (multiple symptoms, multiple systems, multiple times) may support the classification into good, intermediate and poor prognosis when dealing with symptoms in primary care. The proposed new classification specifically targets the patient population in primary care and may provide a rational framework for decision-making in clinical practice and for epidemiologic and clinical research of symptoms

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

'No need to worry': an exploration of general practitioners' reassuring strategies

Contains fulltext : 137818.pdf (publisher's version ) (Open Access)BACKGROUND: In view of the paucity of evidence regarding effective ways of reassuring worried patients, this study explored reassuring strategies that are considered useful by general practitioners (GPs). METHODS: In a study using a qualitative observational design, we re-analysed an existing dataset of fifteen stimulated recall interviews in which GPs elaborated on their communication with patients in two videotaped consultations. Additionally we held stimulated recall interviews with twelve GPs about two consultations selected for a strong focus on reassurance. RESULTS: To reassure patients, GPs pursued multiple goals: 1. influencing patients' emotions by promoting trust, safety and comfort, which is considered to be reassuring in itself and supportive of patients' acceptance of reassuring information and 2. influencing patients' cognitions by challenging patients' belief that their symptoms are indicative of serious disease, often followed by promoting patients' belief that their symptoms are benign. GPs described several actions to activate mechanisms to achieve these goals. CONCLUSIONS: GPs described a wealth of reassuring strategies, which make a valuable contribution to the current literature on doctor-patient communication. This detailed description may provide practicing GPs with new tools and can inform future studies exploring the effectiveness of reassurance strategies

Paticipación en un estudio para valorar la Atención Primaria de la Salud entre afiliados y afiliadas de una Obra Social Universitaria Argentina

Objetivo: Describir la proporción de localización, participación y respuesta en una encuesta para valorar la atención primaria de la salud de afiliados de una obra social universitaria. Métodos: Estudio piloto descriptivo transversal. Muestreo aleatorio simple de 500 personas adultas de la base de datos de afiliaciones. Se calcularon proporciones de localización, participación, respuesta y respuesta total, luego se analizaron por sexo, edad, tipo de afiliación y modo de administración. Resultados: El 61,8% de afiliados fue localizado, el 84,5% de las personas localizadas aceptó participar y el 64,4% de ellas respondió el cuestionario, alcanzando una proporción de respuesta total del 54,4%. Las personas jóvenes fueron relativamente menos localizadas (52,2%; p<0,01) y la mayor proporción de respuesta total se consiguió en las mayores de 65 años (68,2%; p<0,05). Conclusiones: La localización fue dificultosa pero hubo una buena aceptación del estudio. Los medios informatizados de administración fueron preferidos pero tuvieron una baja respuesta

Prognostic value of cadherin associated molecules (alpha-, beta, and gamma catenins and p120cas) in bladder tumors

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