[health Education: A New Approach].

This article describes a series of experiences in the area of Health Education. The experiences, carried out with groups of health professionals working in institutions, begin with the social relationships in which these professionals are involved in their day-to-day work, in contact with other social agents and groups. One of the basic assumptions is that social relationships are an important aspect of the public health services provided to the population. As a result, health workers need specific training in this area to develop and improve their professional performance. The experiences show the importance of making theoretical and methodological approaches (like Educational Psychodrama and the Arvoredo Method) available to these workers. Those who have participated in such training programs have considerably improved their professional/social skills. One of the basic tenets of these approaches is the constant search for autonomy, as an essential element for people to increase awareness of themselves as individuals and as citizens, be they health care professionals or users. The experiences and methods described in this article may serve as one way of reducing the serious gaps in today's public health services.10481-9

Coronary Microcirculatory vasoconstriction during ischemia in patients with unstable angina

OBJECTIVE To verify the behavior of coronary microvascular tone during spontaneous ischemia in patients with unstable angina (UA). BACKGROUND In UA, the pathogenetic role of vasoconstriction is classically confined at the stenotic coronary segment. However, microcirculatory vasoconstriction has been also suggested by previous experimental and clinical studies. METHODS The study included 10 patients with UA (recent worsening of anginal threshold and appearance of angina at rest) and single-vessel CAD. Blood flow velocity was monitored by a Doppler catheter in the diseased artery. Transstenotic pressure gradient was monitored by aortic and distal coronary pressure monitoring. Stenosis resistance was calculated as the ratio between pressure gradient and blood flow, microvascular resistance as the ratio between distal pressure and blood flow. Measurements were obtained at baseline, following intracoronary adenosine (2 mg) and during transient ischemia. Aortic and distal coronary pressures were also measured during balloon coronary occlusion. RESULTS Adenosine did not affect stenosis resistance, while it decreased (p , 0.05) microvascular resistance to 52 6 22% of baseline. Angina and ischemic ST segment shift were associated with transient angiographic coronary occlusion in 7 of 10 patients; however, in no case was ischemia associated with interruption of flow. Despite markedly different flow values, distal coronary pressure was similar during adenosine and during spontaneous ischemia (48 6 15 vs. 46 6 20 mm Hg, respectively, NS). During ischemia, a marked increase in the resistance of both coronary stenosis and coronary microcirculation was observed (to 1,233% 6 1,298% and 671% 6 652% of baseline, respectively, p , 0.05). Distal coronary pressure was markedly reduced during balloon coronary occlusion (14 6 7 mm Hg, p , 0.05 vs. both adenosine and ischemia), suggesting the absence of significant collateral circulation. CONCLUSIONS In patients with UA, transient myocardial ischemia is associated with vasoconstriction of both stenotic arterial segment and downstream microcirculation

Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients

BACKGROUND: The effects of subclinical thyroid dysfunction on cardiac outcome are not well defined. METHODS: To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). RESULTS: After mean follow-up of 32 months, there were 65 and 140 cardiac and overall deaths (3.4% and 7.3%), respectively, in euthyroidism, 15 and 27 (7.2% and 13.0%) in SCH, 8 and 9 (8.2% and 9.2%) in SCT, and 59 and 119 (6.5% and 13.1%) in low T3. Survival rates for cardiac death were lower in SCH, SCT, and low T3 than in euthyroidism (log-rank test; chi2 = 19.46; P < .001). Survival rates for overall death were lower in SCH and low T3 than in euthyroidism (log-rank test; chi2 = 26.67; P < .001). After adjustment for several risk factors, hazard ratios (HRs) for cardiac death were higher in SCH (HR, 2.40; 95% confidence interval [CI], 1.36-4.21; P = .02), SCT (HR, 2.32; 95% CI, 1.11-4.85; P = .02), and low T(3) (HR, 1.63; 95% CI, 1.14-2.33; P = .007) than in euthyroidism; HRs for overall death were higher in SCH (HR, 2.01; 95% CI, 1.33-3.04; P < .001) and low T3 (HR, 1.57; 95% CI, 1.22-2.01; P < .001) but not in SCT. CONCLUSION: A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease

Covid-19 patient management in outpatient setting: A population-based study from southern italy

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients’ management in Southern Italy in the period February 2020–January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27–58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice

Musculoskeletal complaints among Italian X-ray technology students: a cross-sectional questionnaire survey

<p>Abstract</p> <p>Background</p> <p>There is a high prevalence of musculoskeletal disorders among healthcare professional students. Although recent studies show musculoskeletal disorders are a common problem among X-ray technologists, there are no data on these disorders among students of this healthcare profession. We have therefore estimated the prevalence of musculoskeletal complaints among a group of X-ray technology students.</p> <p>Methods</p> <p>The students (n = 109) currently attending the 3-year X-ray technologist school at a large University in the Apulia region of Southern Italy were recruited for the study, with a 100% participation rate. A questionnaire collected data concerning personal characteristics, physical exposure during training activities, and the presence of musculoskeletal symptoms in the neck, shoulders, low back, hand/wrist and legs.</p> <p>Results</p> <p>The prevalence of complaints in any body site over the previous 12 months was 37%. Low back pain was the most frequently reported symptom (27%), followed by neck (16%), shoulder (11%), leg (8%) and hand/wrist (5%) pain. Poor physical activity was associated with the complaints.</p> <p>Conclusions</p> <p>Our study showed prevalence rates of musculoskeletal complaints among X-ray technology students to be somewhat high, representing about half of those found in Italian technologists. The most common musculoskeletal problem was low back pain, which had also been found in research conducted among nursing students. Our research also showed a significant association between poor physical activity and the presence of musculoskeletal disorders in young university students.</p

Uma pesquisa-ação-intervenção em Saúde Bucal Coletiva: contribuindo para a produção de novas análises

Este artigo tem como objetivo apresentar a estratégia metodológica produzida e exercitada durante o desenvolvimento de uma pesquisa de doutorado que tomou como quadro teórico-metodológico a abordagem da Análise Institucional na Saúde Coletiva. Pretende, também, contribuir para o debate sobre as abordagens metodológicas que colocam em pauta a relação entre o pesquisador e o ato de pesquisar. Ao longo da investigação, a pesquisa-ação foi se configurando e se (entre)cruzando com a pesquisa-intervenção, num percurso que estamos denominando pesquisa-ação-intervenção. Desse modo, a pesquisadora, os momentos da pesquisa e da produção teórico-metodológica foram construídos/constituídos ao mesmo tempo, num processo mediatizado pelos saberes e pelos não-saberes dos sujeitos implicados com esta investigação. Podemos dizer que houve dois processos articulados de ação-intervenção: um da pesquisadora no e com o grupo, e, outro, dos participantes do grupo, profissionais do Sistema Único de Saúde do município de Campinas em seu cotidiano, na produção do cuidado em Saúde Bucal.This article describes the methodological strategy created during the research carried out for a doctoral degree, with Institutional Analysis in Collective Health being used as the theoretical and methodological framework. The article is thus meant as a contribution to the debate on methodological approaches to the relationships between researchers and their act of researching. During the investigation, action-research operated as a crossroad between intervention and research, along a path we refer to as intervention-research-action. The research stages and the theoretical-methodological production were constructed concurrently, in a process mediated by the knowledge and questions of the subjects related to this investigation. Knowledge production in the area of oral health care was made through two articulated processes of intervention-action: one of the researcher in and within the group, other of the participants in the group, namely professionals in public health in their everyday life work in oral health care

Italian adaptation of the Uniform Data Set Neuropsychological Test Battery (I-UDSNB 1.0): development and normative data

Background: Neuropsychological testing plays a cardinal role in the diagnosis and monitoring of Alzheimer’s disease. A major concern is represented by the heterogeneity of the neuropsychological batteries currently adopted in memory clinics and healthcare centers. The current study aimed to solve this issue. Methods: Following the initiative of the University of Washington’s National Alzheimer’s Coordinating Center (NACC), we presented the Italian adaptation of the Neuropsychological Test Battery of the Uniform Data Set (I-UDSNB). We collected data from 433 healthy Italian individuals and employed regression models to evaluate the impact of demographic variables on the performance, deriving the reference norms. Results: Higher education and lower age were associated with a better performance in the majority of tests, while sex affected only fluency tests and Digit Span Forward. Conclusions: The I-UDSNB offers a valuable and harmonized tool for neuropsychological testing in Italy, to be used in clinical and research settings