Factors associated with the implementation of programs for drug abuse prevention in schools

OBJECTIVE: To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS: Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager characteristics of the school and of the curriculum health education and drug use in the school. RESULTS: We found that 42.5% (95% CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS: The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.OBJETIVO: Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS: Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS: Constatou-se que 42,5% (IC95% 36,1–49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES: A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Coordenacao de Aperfeicoamento Pessoal de Nivel Superior (CAPES)Programa de Pós-Graduação em Saúde Coletiva. Universidade Federal de São Paulo. São Paulo, SP, BrasilSetor de Estatística Aplicada. Pró-reitoria de Pós-Graduação e Pesquisa. Universidade Federal de São Paulo. São Paulo, SP, BrasilDepartamento de Medicina Preventiva. Centro Brasileiro de Informações Sobre Drogas Psicotrópicas. Universidade Federal de São Paulo. São Paulo, SP, BrasilPrograma de Pós-Graduação em Saúde Coletiva. Universidade Federal de São Paulo. São Paulo, SP, BrasilSetor de Estatística Aplicada. Pró-reitoria de Pós-Graduação e Pesquisa. Universidade Federal de São Paulo. São Paulo, SP, BrasilDepartamento de Medicina Preventiva. Centro Brasileiro de Informações Sobre Drogas Psicotrópicas. Universidade Federal de São Paulo, Rua Botucatu 740,4 Andar, BR-04023900 Sao Paulo, SP, BrazilCNPq: 472991/2012-4Web of Scienc

Dystonias: rehabilitation

Articles in the MedLine (PubMed) database and other research sources were reviewed, with no time limit. The search strategy used was based on structured questions in the PICO format from the initials: Patient, Intervention, Control and Outcome. The descriptors used were: dystonia and (benzodiazepines or baclofen or tizanidine or clodinine): dystonia and (anticholinergics or haloperidol or lisuride); dystonia and (botulinum toxin); dystonia cervical and (speech therapy or speech pathologist or botulinum toxin); focal dystonia and (botulinum toxin); dystonia and (sensory stimulation or sensory rehabilitation); dystonia and (biofeedback or electromyography biofeedback); dystonia and (transcranial magnetic stimulation); (dystonic disorders or dystonia) and (self help devices or assistive technology or assistive technologies or rehabilitation); dystonia and (activity daily living); dystonias and (neurosurgery not intrathecal baclofen).Foram revisados artigos nas bases de dados do MedLine (PubMed) e outras fontes de pesquisa, sem limite de tempo. A estratégia de busca utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (das iniciais "Paciente", "Intervençao", "Controle", "Outcome"). Foram utilizados como descritores: dystonia and (benzodiazepines or baclofen or tizanidine or clodinine): dystonia and (anticholinergics or haloperidol or lisuride); dystonia and (botulinum toxin); dystonia cervical and (speech therapy or speech pathologist or botulinum toxin); focal dystonia and (botulinum toxin); dystonia and (sensory stimulation or sensory rehabilitation); dystonia and (biofeedback or electromyography biofeedback); dystonia and (transcranial magnetic stimulation); (dystonic disorders or dystonia) and (self help devices or assistive technology or assistive technologies or rehabilitation); dystonia and (activity daily living); dystonias and (neurosurgery not intrathecal baclofen)

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Use of cure rate models in survival data analysis with missing covariates

Em estudos cujo interesse é avaliar o efeito de fatores prognósticos sobre a sobrevida ou algum outro evento de interesse, é comum o uso de modelos de regressão que relacionam tempos de sobrevivência e covariáveis. Quando covariáveis que apresentam dados omissos são incluídas nos modelos de regressão, os programas estatísticos usuais automaticamente excluem aqueles indivíduos que apresentam omissão em pelo menos uma das covariáveis. Com isso, muitos pesquisadores utilizam apenas as observações completas, descartando grande parte da informação disponível. Está comprovado que a análise baseada apenas nos dados completos pode levar a estimadores altamente viesados e ineficientes. Para lidar com este problema, alguns métodos foram propostos na literatura. O objetivo deste trabalho é estender métodos que lidam com dados de sobrevivência e omissão nas covariáveis para a situação em que existe uma proporção de pacientes na população que não são suscetíveis ao evento de interesse. A idéia principal é utilizar modelos com fração de cura incluindo ponderações para compensar possíveis desproporcionalidades na subamostra de casos completos, levando-se em conta uma possível relação entre omissão e pior prognóstico. Foi considerado um modelo de mistura no qual os tempos de falha foram modelados através da família Weibull ou do modelo semiparamétrico de Cox e as probabilidade de cura foram especificadas por um modelo logístico. Os métodos propostos foram aplicados a dados reais, em que a omissão foi simulada em 10\\%, 30\\% e 50\\% das observações.Survival regression models are considered to evaluate the effect of prognostic factors for survival or some other event of interest. The standard statistical packages automatically exclude cases with at least one missing covariate value. Thus, many researchers use only the complete cases, discarding substantial part of the available information. It is known that this complete case analysis provides biased and inefficient estimates. The aim of this work is to extend survival models with missing covariate values to situations where some individuals are not susceptible to the event of interest. The main idea is to use cure rate models introducing individual weights to incorporate possible bias in the sample with complete cases, taking a possible relation between missingness and worse prognosis into account. Mixture models in which Weibull and Cox models are used to represent the failure times and logistic models to model the cure probabilities are considered. The performance of the procedure was evaluated via a simulation study. The proposed methods were applied to real data where the missingness was simulated in 10\\%, 30\\% and 50\\% of the observations

Alterations in Cytokine Profile and Dendritic Cells Subsets in Peripheral Blood of Rheumatoid Arthritis Patients before and after Biologic Therapy

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic joint inflammation and continuous immune cell infiltration in the synovium. These changes are linked to inflammatory cytokine release, leading to eventual destruction of cartilage and bone. During the last decade new therapeutic modalities have improved the prognosis, with the introduction of novel biological response modifiers including anti-TNF alpha CTLA4Ig and, more recently, anti-IL6. in the present study we looked at the immunological effects of these three forms of therapy. Serum, obtained from patients with RA was analyzed for TNF alpha, IL6, IL10, IFN gamma, and VEGF, and in parallel, circulating plasmacytoid and myeloid dendritic cells (DC) were enumerated before and after three infusions of the respective biological treatments. After treatment with anti-IL6, we found a significant reduction of IL6 and TNF alpha levels and the percentage of both DC subsets decreased. Although the results did not reach statistical significance for anti-TNF alpha treatment, similar trends were observed. Meanwhile, CTLA4Ig therapy led to the reduction IFN gamma levels only. None of the treatments modified significantly VEGF or IL10 levels. These findings may explain why patients with RA improve more rapidly on IL-6 therapy than with the other two modalities.Sociedade Israelita Brasileira Hospital Albert Einstein (SBIBHAE)Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE)Hosp Albert Einstein, Inst Israelita Ensino & Pesquisa Albert Einstein, São Paulo, BrazilUniv São Paulo, Fac Med, Dept Pediat, São Paulo, BrazilHosp Abreu Sodre Assoc Assistencia Crianca Defici, São Paulo, BrazilWeb of Scienc

Silicone Ahmed Glaucoma Valve With and Without Intravitreal Triamcinolone Acetonide for Neovascular Glaucoma: Randomized Clinical Trial

Purpose: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide.Patients and Methods: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. the secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation.Results: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). the mean IOP was significantly lower after 1 year in both the groups (P < 0.001). the mean IOP in the first month of follow-up was lower in the study group (control; 20.4 +/- 9.7, study; 13.6 +/- 6.5, P < 0.01). the success rate at 1 year was 78% for the study group and 76% for the control group (P = 0.82). Complication rates were not different between the groups.Conclusions: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. the mean IOP spike in the first month was lower in the triamcinolone group.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilHORP, Sao Jose Do Rio Preto, SP, BrazilUniv Fed Triangulo Mineiro, Uberaba, MG, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos Sensitivity and specificity of B-type natriuretic peptide for identifying symptomatic and asymptomatic patients with severe mitral regurgitation

OBJETIVO: Verificar a sensibilidade e a especificidade do hormônio natriurético do tipo B (BNP) para identificar pacientes ambulatoriais, com insuficiência mitral crônica grave, sintomáticos e assintomáticos. MÉTODOS: Um grupo de pacientes com insuficiência mitral foi examinado e submetido à eletrocardiografia, telerradiografia de tórax, coletas de sangue venoso e ecocardiograma transtorácico. Por meio da análise de variáveis ecocardiográficas, 62 pacientes apresentavam refluxo mitral discreto e moderado (G I) e 34 refluxo mitral grave (G II). A capacidade discriminante do BNP em detectar pacientes com insuficiência mitral grave foi avaliada pela construção de curvas ROC. RESULTADOS: Entre os 96 doentes, 71 (73%) eram mulheres e as idades variaram entre 15 e 63 (média de 31,7) anos. Os valores de BNP variaram de 0,00 pg/ml a 193 pg/ml. Os doentes do G I tiveram um valor médio de BNP de 18,10 &plusmn; 0,74 pg/ml e os do G II de 50,54 &plusmn; 1,46 pg/ml, (p=0,001). O valor de corte para identificar insuficiência mitral grave foi de 15,40 pg/ml, para o melhor balanço entre a sensibilidade e a especificidade, respectivamente de 0,73 e 0,74. O valor de corte para identificar pacientes sintomáticos e com insuficiência mitral grave foi de 28,40 pg/ml, para o melhor balanço entre a sensibilidade e a especificidade, respectivamente de 0,78 e 0,83. CONCLUSÃO: Os valores de BNP capazes de indentificar doentes com insuficiência mitral grave assintomáticos e sintomáticos são menores do que os 100 pg/ml considerados para o diagnóstico de insuficiência cardíaca.<br>OBJECTIVE: To assess the sensitivity and specificity of B-type natriuretic peptide (BNP) for identifying symptomatic and asymptomatic patients with severe chronic mitral regurgitation followed up on an outpatient care basis. METHODS: A group of patients with mitral regurgitation underwent electrocardiography, chest teleradiography, venous blood withdrawal, and transthoracic echocardiography. Based on an analysis of the echocardiographic variables, 62 patients had mild and moderate mitral regurgitation (GI) and 34 had severe mitral regurgitation (GII). The discriminating capacity of the BNP for detecting patients with severe mitral regurgitation was assessed by use of ROC curves. RESULTS: The patients' ages ranged from 15 to 63 (mean, 31.7) years, and of the 96 patients, 71 (73%) were females. The BNP values ranged from 0.00 pg/mL to 193 pg/mL. The mean BNP values in GI and GII patients were 18.10 ± 0.74 pg/mL and 50.54 ± 1.46 pg/mL, respectively (P=0.001). The cutoff point for identifying severe mitral regurgitation was 15.40 pg/mL for the best balance between sensitivity and specificity, which were 0.73 and 0.74, respectively. The cutoff point for identifying symptomatic patients with severe mitral regurgitation was 28.40 pg/mL for the best balance between sensitivity and specificity, which were 0.78 and 0.83, respectively. CONCLUSION: The BNP values capable of identifying asymptomatic and symptomatic patients with severe mitral regurgitation are lower than 100 pg/mL, which is considered for the diagnosis of heart failure

Successful prevention of ventilator-associated pneumonia in an intensive care setting

Background: Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings.Objective: Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU).Methods: A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P 1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions.Results: the incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P = .05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. Conclusion: These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.Hosp Israelita Albert Einstein, Intens Care Unit, São Paulo, BrazilHosp Israelita Albert Einstein, Infect Control Units, São Paulo, BrazilIIEP, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, EPM, São Paulo, BrazilVirginia Commonwealth Univ, Sch Med, Dept Internal Med, Richmond, VA USAUniversidade Federal de São Paulo, Div Nephrol, EPM, São Paulo, BrazilWeb of Scienc