Técnica abdominal hipopresiva para disminuir el dolor lumbar crónico de tipo inespecífico en el personal administrativo

Introduction. Non-specific low back pain is an especially important socio-health problem, since it represents the second cause of chronic pain and disability worldwide; In addition, it includes the pathology with the greatest burden of disability. Its clinical and therapeutic approach is oriented towards the administration of drugs and conventional physiotherapy, which have not been able to reduce the chronicity of the condition or recurrences; Therefore, contemporary trends suggest the application of exercises such as hypopressive abdominal exercises, whose benefits are already known. Aim. To determine the effects of the hypopressive abdominal technique on non-specific chronic low back pain in administrative personnel. Methodology. Quasi-experimental, longitudinal cohort study; on 28 workers from the Cotocollao clinic who met the inclusion and exclusion criteria. The intensity of pain was measured with the Latineen index, and the level of disability associated with low back pain with the Oswestry index, both before and after the application of the intervention. The hypopressive exercise program was applied for 12 weeks after its review and validation under expert judgment. Results. The results demonstrated a clinical improvement, where clinical symptoms decreased and there were significant differences between the measures (p<= 0.05). Conclusion. The hypopressive abdominal technique reduces pain and the level of disability associated with nonspecific low back pain in workers at the Cotocollao clinic.Introducción. La lumbalgia no específica, es un problema socio sanitario muy importante, ya que representa la segunda causa de dolor crónico y discapacidad en todo el mundo; además que comprende la patología con mayor carga de incapacidad. Su abordaje clínico y terapéutico está orientado a la administración de fármacos y fisioterapia convencional, que no han logrado reducir la cronicidad de la condición ni las recidivas; por lo que las nuevas tendencias sugieren la aplicación de ejercicios como los abdominales hipopresivos de los que ya se conocen su beneficio.  Objetivo. Determinar los efectos de la técnica abdominal hipopresiva en el dolor lumbar crónico de tipo inespecífico en el personal administrativo. Metodología. Estudio cuasiexperimental, de cohorte longitudinal; sobre 28 trabajadores de la clínica de Cotocollao que cumplieron los criterios de inclusión y exclusión. Se midió la intensidad del dolor con el índice de Latineen y el nivel de discapacidad asociado al dolor lumbar con el índice de Oswestry, tanto antes como después de la aplicación de la intervención. El programa de ejercicios hipopresivos se aplicó por 12 semanas luego de su revisión y validación bajo juicio de expertos. Resultados. Los resultados demostraron una mejoría clínica, donde disminuyó la sintomatología clínica y se presentaron diferencias significativas entre las medidas (p<= 0,05). Conclusión. La técnica abdominal hipopresiva disminuye el dolor y el nivel de discapacidad asociada al dolor lumbar inespecífico en trabajadores de la clínica Cotocollao. Área de estudio general: Fisioterapia. Área de estudio específica: Seguridad y Salud ocupacional. Tipo de estudio:  Artículos originales / Original articles

Técnica abdominal hipopresiva para disminuir el dolor lumbar crónico de tipo inespecífico en el personal administrativo

Introduction. Non-specific low back pain is an especially important socio-health problem, since it represents the second cause of chronic pain and disability worldwide; In addition, it includes the pathology with the greatest burden of disability. Its clinical and therapeutic approach is oriented towards the administration of drugs and conventional physiotherapy, which have not been able to reduce the chronicity of the condition or recurrences; Therefore, contemporary trends suggest the application of exercises such as hypopressive abdominal exercises, whose benefits are already known. Aim. To determine the effects of the hypopressive abdominal technique on non-specific chronic low back pain in administrative personnel. Methodology. Quasi-experimental, longitudinal cohort study; on 28 workers from the Cotocollao clinic who met the inclusion and exclusion criteria. The intensity of pain was measured with the Latineen index, and the level of disability associated with low back pain with the Oswestry index, both before and after the application of the intervention. The hypopressive exercise program was applied for 12 weeks after its review and validation under expert judgment. Results. The results demonstrated a clinical improvement, where clinical symptoms decreased and there were significant differences between the measures (p<= 0.05). Conclusion. The hypopressive abdominal technique reduces pain and the level of disability associated with nonspecific low back pain in workers at the Cotocollao clinic.Introducción. La lumbalgia no específica, es un problema socio sanitario muy importante, ya que representa la segunda causa de dolor crónico y discapacidad en todo el mundo; además que comprende la patología con mayor carga de incapacidad. Su abordaje clínico y terapéutico está orientado a la administración de fármacos y fisioterapia convencional, que no han logrado reducir la cronicidad de la condición ni las recidivas; por lo que las nuevas tendencias sugieren la aplicación de ejercicios como los abdominales hipopresivos de los que ya se conocen su beneficio.  Objetivo. Determinar los efectos de la técnica abdominal hipopresiva en el dolor lumbar crónico de tipo inespecífico en el personal administrativo. Metodología. Estudio cuasiexperimental, de cohorte longitudinal; sobre 28 trabajadores de la clínica de Cotocollao que cumplieron los criterios de inclusión y exclusión. Se midió la intensidad del dolor con el índice de Latineen y el nivel de discapacidad asociado al dolor lumbar con el índice de Oswestry, tanto antes como después de la aplicación de la intervención. El programa de ejercicios hipopresivos se aplicó por 12 semanas luego de su revisión y validación bajo juicio de expertos. Resultados. Los resultados demostraron una mejoría clínica, donde disminuyó la sintomatología clínica y se presentaron diferencias significativas entre las medidas (p<= 0,05). Conclusión. La técnica abdominal hipopresiva disminuye el dolor y el nivel de discapacidad asociada al dolor lumbar inespecífico en trabajadores de la clínica Cotocollao. Área de estudio general: Fisioterapia. Área de estudio específica: Seguridad y Salud ocupacional. Tipo de estudio:  Artículos originales / Original articles

Knowledge and attitudes about aspirin exacerbated respiratory disease among Ecuadorian physicians

Background: Aspirin-exacerbated respiratory disease (AERD) is an asthma phenotype that involves high costs and significant burden for health systems. Objective: To determine the level of knowledge and attitudes towards AERD among Ecuadorian physicians. Methods: Descriptive, observational study. A questionnaire about knowledge on the disease and attitude towards it (confidence in the treatment and importance of AERD, measured with a Likert scale) was developed. The answers about knowledge were dichotomized into right and wrong; attitude was rated as high or low. Means and percentages were obtained; the answers of doctors with or without specialty were compared using the chi-square test. Results: One-hundred eighteen physicians participated. The age was 41.3 ± 11.7 years; 48.3 % were specialists. Less than 50% answered correctly the questions about knowledge. Specialist physicians obtained more correct answers regarding first symptoms, prevalence and leukotriene overproduction (67.9 %, 46.3% and 90.7 %), when compared with general practitioners (45.0 %, 25% and 74.6 %) (p 0.05). Conclusion: Medical education programs should be developed in order to improve the level of knowledge about AERD

Attitudes and knowledge about obstructive sleep apnea among Latin American primary care physicians

Objectives: We aimed to evaluate Latin American primary care physicians' knowledge and attitudes about obstructive sleep apnea (OSA) using a Spanish-language version of the OSA Knowledge and Attitudes (OSAKA) questionnaire and to evaluate its psychometric properties.Methods: We used a cross-sectional survey of general practice physicians in Ecuador, Peru, and Venezuela who completed the Spanish-language version OSAKA questionnaire.Results: of 684 primary care physicians surveyed, 367 (65%) responded (mean age, 45 years; range, 21-75 years). Mean total knowledge (proportion of 18 items correctly answered) was 60% (range, 0-100%). Less than half of physicians correctly answered the questions about the association between OSA and hypertension. We found no significant differences in overall knowledge in gender or time since graduation (5 years). Although 73.5% of the physicians felt confident in identifying patients at risk for OSA, only 35.4% felt confident in managing those patients and 22.1% felt confident in managing patients with continuous positive airway pressure (CPAP) therapy. the Spanish-language version of the OSAKA questionnaire had comparable psychometric properties to the English-language version.Conclusions: This Spanish-language version of the OSAKA yielded considerable variance in Spanish-speaking physicians' knowledge about OSA and confidence in identifying and managing patients with OSA. Focused OSA education for Latin American general physicians is needed. (C) 2013 Elsevier B. V. All rights reserved.Kennedy Hosp, Respiralab Res Ctr, Guayaquil, EcuadorWashington Univ, Sch Med, Dept Med,Div Hlth Behav Res, Barnes Jewish Hosp,Alvin J Siteman Canc Ctr, St Louis, MO 63110 USAWashington Univ, Sch Med, St Louis, MO USABrown Univ, Mental Hlth Res Inst, Providence, RI 02912 USACapital Hlth Reg Med Ctr, Trenton, NJ USAUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilBrown Univ, Dept Med, Alpert Med Sch, Providence, RI 02912 USAMed Ctr La Trinidad, Caracas, VenezuelaClin San Borja, Dept Allergy & Immunol, Lima, PeruHeidelberg Univ, Sch Med, Heidelberg, GermanyUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilWeb of Scienc

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease