Revisión bibliográfica: accidente cerebro vascular isquémico: clasificación etiológica

El accidente cerebrovascular es una de las principales causas de mortalidad a nivel mundial, siendo responsable además del aumento de casos de discapacidad crónica. Esta enfermedad se da como consecuencia de una lesión isquémica cerebral, las causas son múltiples, a breves rasgos pueden ser de origen trombótico y de origen émbolo. La correcta categorización etiológica del ictus isquémico es fundamental para seleccionar el tratamiento adecuado según las necesidades y características clínicas de cada paciente. Esta revisión bibliográfica resume tres de las principales categorizaciones etiológicas del ictus: TOAST “Trial of Org 10172 in Acute Stroke Treatment”, clasificación ASCOT (Phenotypic) y el Sistema de clasificación causal del accidente cerebrovascular isquémico (CCS)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Estudo quantitativo e qualitativo das informações digitais estruturadas e não-estruturadas sobre cárie na primeira infância

Early childhood caries (ECC) is an oral condition that affects 532 million children worldwide, representing a major economic and public health challenge. The present study aimed to (1) analyze the volume and profile of searches related to ECC performed by Google users from different countries, (2) evaluate the readability and quality of information related to ECC from websites in English , Spanish and Brazilian Portuguese, (3) to assess the completeness of ECC information found in Youtube videos in the same three languages, and (4) to determine the sentiment and interests of Twitter users regarding true or false/incorrect information about dental caries in the same three languages. The monthly variations in Relative Search Volume (RSV) for ECC-related queries was determined by the Google Trends API for each country. The association of RSV with years lived with disability (YLDs) for untreated dental caries in primary teeth and Internet penetration were tested by linear regression models. The most relevant topics searched by Google users were qualitatively evaluated. For the analysis of the quality of the information, the websites were retrieved by Google, Yahoo! and Bing according to the market share of each engine in the US, Mexico and Brazil. The DISCERN questionnaire, JAMA benchmarks and language-specific readability formulas were used by two independent researchers to assess the quality and readability of the websites. Completeness of information from Youtube videos was assessed by a predefined list of 17 topics related to educational information on ECC. Dichotomized categories of videos according to the median completeness score and the nature of their authorship were compared in relation to the characteristics of the videos and the parameters of interaction with the YouTube audience. To evaluate Twitter, a specific search strategy was built according to each language to collect at least 1,000 tweets for each country (USA, Mexico and Brazil). Two examiners rated tweets in their original language according to sentiment (positive, neutral, or negative), ECC-related themes, and presence of false/incorrect information based on up-to-date scientific evidence on dental caries. The results indicated that the interest of Google users for ECC information is still low, but it is increasing over time. Users interested in the disease may come across low-quality information on websites and YouTube videos. Furthermore, tweets related to dental caries containing false/incorrect information are associated with positive sentiment and are often related to missinformation about sugar consumption and the development of the disease. In conclusion, Big Data analysis is an important strategy to identify Internet users\' interests and concerns regarding ECC-related information from specific populations. In addition, understanding what parents and caregivers are exposed to when searching for information about ECC on the Internet is critical to improving disease management. Therefore, dental professionals must be attentive to the needs of their patients, producing good quality digital materials and promoting informative counseling during clinical consultations.A cárie na primeira infância (CPI) é uma condição bucal que afeta 532 milhões de crianças em todo o mundo, representando um grande desafio econômico e de saúde pública. O presente estudo teve como objetivo (1) analisar o volume e o perfil das pesquisas em consultas na Internet sobre CPI realizadas por usuários do Google de diferentes países, (2) avaliar a leiturabilidade e a qualidade das informações relacionadas à CPI de websites em inglês, espanhol e português brasileiro, (3) avaliar a completude das informações sobre CPI encontradas em vídeos do Youtube nos mesmos três idiomas e (4) determinar os sentimentos e interesses de usuários do Twitter relacionados a informações verdadeiras ou falsas/incorretas sobre cárie dentária nos mesmos três idiomas. A variação mensal do Volume Relativo de Buscas (RSV) para consultas relacionadas à CPI foi determinada pelo API do Google Trends para cada país. A associação de RSV com anos vividos com incapacidade (YLDs) para cárie dentária não tratada em dentes decíduos e penetração da Internet foram testadas por modelos de regressão linear. Os tópicos mais relevantes pesquisados pelos usuários do Google foram avaliados qualitativamente. Para a análise da qualidade da informação, os websites foram recuperados pelo Google, Yahoo! e Bing de acordo com a participação de mercado de cada ferramenta nos EUA, México e Brasil. O questionário DISCERN, critérios de referência JAMA e fórmulas de leiturabilidade específicas para cada língua foram utilizados por dois investigadores independentes para avaliar a qualidade e a leiturabilidade dos websites. A completude das informações dos vídeos do Youtube foi avaliada por uma lista predefinida de 17 tópicos relacionados a informações educativas sobre CPI. Categorias dicotomizadas dos vídeos de acordo com a mediana da pontuação de completude e a natureza de sua autoria foram comparadas em relação às características dos vídeos e aos parâmetros de interação com a audiência do YouTube. Para avaliação do Twitter, foi construída uma estratégia de busca específica de acordo com cada idioma para coletar pelo menos 1.000 tweets para cada país (EUA, México e Brasil). Dois examinadores classificaram os tweets em seu idioma original de acordo com o sentimento (positivo, neutro ou negativo), tópicos relacionados à CPI e presença de informação falsa/incorreta com base em evidências científicas atualizadas sobre a cárie dentária. Os resultados indicaram que o interesse dos usuários do Google por informações sobre CPI ainda é baixo, porém está incrementando ao longo do tempo. Os usuários interessados pela doença podem se deparar com informações de baixa qualidade em websites e vídeos do Youtube. Além disso, os tweets relacionados à cárie dentária contendo informações falsas/incorretas estão associados a sentimentos positivos e frequentemente relacionados a conceitos errados sobre o consumo de açúcar e o desenvolvimento da doença. Em conclusão, a análise de Big Data é uma estratégia importante para identificar os interesses e preocupações dos usuários da Internet em relação às informações relacionadas à CPI de populações específicas. Além disso, o conhecimento sobre o que os pais e cuidadores estão expostos ao buscar por informações sobre a CPI na Internet é fundamental para melhorar o manejo da doença. Portanto, os profissionais da Odontologia devem estar atentos às necessidades de seus pacientes, produzindo materiais digitais de boa qualidade e promovendo o aconselhamento informativo durante as consultas clínicas

Infodemiologia da cárie dentária

The diagnosis of dental caries can lead people to seek additional information on the Internet, through the use of structured queries in search engine tools. This action generates a considerable volume of data, which can be analyzed to provide a better understanding of publics behavior linked to the consumption of oral health information. Nevertheless, health-related information found on the web is being reported to be misleading and of poor quality. This study aimed (1) to assess the volume and profile of web searches on dental caries-related queries performed by Googles users from different countries, and (2) to evaluate the readability and the quality of dental caries-related information from Brazilian websites. The monthly variation of the Search Volume Index (SVI) for dental caries was obtained in Google Trends, for the period between January 2004 and September 2016. To validate the data, the correlation levels between the variation of SVI and the disability-adjusted life-years (DALYs) for permanent teeth were determined. To assess the quality of information, the websites were selected through Google, Bing, Yahoo!, and Baidu. Two independent examiners evaluated the quality of 75 websites using the DISCERN questionnaire and JAMA benchmark criteria. The scores Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Férnandez-Huerta Readability Formula (FHRF) were used to assess the readability of the websites. The statistical analysis was performed with P<0.05 considered significant. In all countries, results revealed a trend of an increasing interest of Google users in dental caries issues. The most popular queries were markedly associated with symptoms and dental treatment, with little interest in prevention. The content of websites showed a poor quality by the analysis of both DISCERN (x=35.68, 19-64) and JAMA (x=1.12, 0-3) scores. The websites were classified as high-difficulty reading materials by FRE scores and, in contrast, as simple and accessible by FHRF scores. In conclusion, the Internet data mining could be helpful to establish the dental needs of specific population groups in a near real-time, since the consumption of dental information is increasing in importance and appears to have a direct relation with untreated dental caries. Dental caries-related contents found in Brazilian websites were considered simple, accessible and of poor quality. These findings indicate the need of the development of policies for the production and publication of digital oral health information, encouraging dentists to guide their patients in searching for recommended oral health websites.O diagnóstico da cárie dentária pode levar as pessoas a procurar mais informações na internet, por meio de pesquisas estruturadas realizadas em buscadores digitais. Esta ação gera um volume considerável de dados que podem ser analisados para o melhor entendimento do comportamento dos usuários relacionado ao consumo de informações de saúde bucal. No entanto, as informações sobre saúde proveniente da Internet podem ser imprecisas e de baixa qualidade. Este estudo objetivou (1) avaliar o volume e perfil de buscas sobre cárie dentária realizadas pelos usuários do Google de diferentes países, e (2) determinar a leiturabilidade e qualidade da informação relacionada à cárie dentária encontrada em websites brasileiros. A variação mensal do índice Search Volume Index (SVI) relacionado à cárie dentária foi obtida na ferramenta Google Trends para o período compreendido entre janeiro de 2004 e setembro de 2016. Para a validação dos dados obtidos, os níveis de correlações entre as variações do índice SVI e do índice disability-adjusted life-years (DALYs) para cárie dentária em dentes permanentes foram determinados. Para avaliar a qualidade da informação disponível na Internet, websites foram selecionados através dos buscadores Google, Bing, Yahoo! e Baidu. Dois examinadores independentes realizaram a avaliação de 75 websites usando o questionário DISCERN e os critérios de referência JAMA. A leiturabilidade da informação escrita foi avaliada pelo uso dos escores Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL) e Férnandez-Huerta Readability Formula (FHRF). A análise estatística foi realizada com valores de P<0,05 sendo considerados significantes. Em todos os países, os resultados demostraram uma tendência crescente do aumento do interesse dos usuários do Google sobre temas relacionados à cárie dentária. As buscas mais populares foram fortemente relacionadas aos sintomas e tratamentos da cárie dentária, com menor interesse pela prevenção. O conteúdo dos websites mostrou-se de baixa qualidade em ambos os escores do DISCERN (x=35.68, 19-64) e do JAMA (x=1.12, 0-3). Os websites foram classificados como materiais de alto nível de dificuldade de leitura pelos escores do FRE e, ao contrário, como simples e acessíveis pelos escores do FHRF. Em conclusão, os dados provenientes do uso da internet poderiam auxiliar no estabelecimento das necessidades odontológicas de grupos populacionais específicos, em tempo quase-real. O consumo de informação proveniente da web está se intensificando, parecendo ter uma relação direta com a cárie dentária não tratada. As informações relacionadas à doença disponíveis em websites brasileiros foram consideradas simples, acessíveis e de baixa qualidade. Estes achados indicam a necessidade de desenvolvimento de politicas para a produção e publicação de informações relacionadas à saúde bucal, motivando os dentistas a orientarem seus pacientes na busca por websites recomendados

Analysis of the interests of Google users on toothache information.

The knowledge on health interests of a given population of Internet users might contribute to the increase of evidence on community's dental needs, and consequently, to the improvement of public health planning. The frequency of searches for specific issues on Google can be analyzed by the application of Google Trends.In this study, we aimed to characterize the interests on toothache information of Google users from the United States, United Kingdom, Australia and Brazil.The monthly variation of relative search volume (RSV) and the lists of main toothache-related queries were determined from January 2004 through April 2016 using Google Trends. Autoregressive Integrated Moving Average (ARIMA) forecasting models were developed to determine predictive RSV values for toothache for additional 12 months. Autocorrelation plots and general additive model (GAM) were applied to determine trends and seasonality in RSV curves. Through linear regression models, we assessed the association between the variation of annual means of RSV values and national statistics for toothache in the U.S. and U.K. Subsequently, the distribution of main queries according to the identification of endodontic pain, type of searching information, and the interest in self-management of toothache was evaluated for the four countries.The autocorrelation plots showed patterns of non-stationary time series. The monthly variation influenced the data of the U.S. and U.K., with the higher RSV values found respectively in January/July and December. Also, the interest on toothache in the U.K. increases in the second semester and in the fourth quarter, especially in December. Additionally, an annual variation affected significantly all time series, with the increment of RSV means over the years, varying from 265% in the U.S. to 745% in Brazil. In parallel, the increments in RSV values were also observed in all predictive curves. The annual variation of observed and fitted RSV values was directly associated with the increase of toothache visits in the U.S. and urgent dental treatments in the U.K. Moreover, the queries typed on Google were markedly linked to searches on endodontic pain information, especially in Brazil, where the residents usually searched for relief and/or self-management of pain.Therefore, these findings indicate an increasing interest of Google users on toothache-related topics, regardless of country and season. The Internet activity can be used by policy makers as a complementary source of data for the development and implementation of strategies to control and prevent toothache complications

Toothache-related queries and their respective RSV for each country.

<p>Terms with RSV = 0 were not considered.</p

Association of the variation of annual means of observed and fitted RSV toothache values with national statistics of toothache (U.S.) or urgent dental treatments (U.K.).

<p>Association of the variation of annual means of observed and fitted RSV toothache values with national statistics of toothache (U.S.) or urgent dental treatments (U.K.).</p

Flowchart summarizing the development of query strategies to assess the RSV toothache values in the U.S., U.K., Australia and Brazil.

<p>Flowchart summarizing the development of query strategies to assess the RSV toothache values in the U.S., U.K., Australia and Brazil.</p