A retrospective study investigating risk factors for sudden unexpected death in the young

Sudden unexpected death in the young (SUDY) is the unanticipated demise of individuals aged between 1 and 40 years. In South Africa, these deaths are referred for forensic investigation. The primary aim of this study was to retrospectively investigate the frequency of known risk factors in SUDY cases admitted to Salt River Mortuary in Cape Town and explore differences between males and females. There were 1 088 SUDY cases identified with 0.9% (10/1 088) missing files. Reviewed cases were n=1 078, 62.6% (675/1 078) males, and 37.4% (403/1 078) females; 83.5% (901/1 078) adults and 16.4% (177/1 078) children, accounting for 5.6% of total admissions between 1 January 2010 and 31 December 2015. Despite the predominance of males, significantly more females (61.8%) were obese (p < 0.05). At least one primary medical condition was present in 53.7% of cases, with the leading conditions being tuberculosis (11.9 % of adult males), epilepsy (11.7% of adult males; 10.3% of female children), HIV (10.7% of adult females) and asthma (11.1% of male children). In the subset of the study population where information was available, before death, 74% of individuals were reported to have experienced prodromal symptoms; 37.6% of males and 32.4% of females did not seek medical intervention following symptoms. Information regarding a family history of sudden death was known in 237/1078 cases. In 3.2% of these cases, a family history of sudden death was reported. Significantly more males than females reported the use of tobacco, alcohol, and other illicit drugs (p < 0.05). More females were unemployed (p < 0.05). Interventions based on lifestyle modification, social support, pharmacologic needs, and awareness should be targeted at individuals with the above profiles, especially those with a family history of sudden death, as they may be high-risk groups. Findings from this study contribute new and relevant local reference data for SUDY risk profiles of males and females admitted to Salt River Mortuary

Morte súbita em cães e gatos : estudo retrospectivo de 213 casos (2000-2009)

Dissertação de Mestrado Integrado em Medicina VeterináriaEm medicina veterinária, a morte súbita é uma síndrome que afecta animais que se apresentam aparentemente saudáveis, não só para os proprietários, mas também para os médicos veterinários assistentes. A sua definição reveste-se de características científicas precisas e tem implicações sociais próprias. Os objectivos deste estudo foram determinar as causas que levam à morte súbita de canídeos e felídeos, estabelecendo relações epidemiológicas. Foram analisadas as requisições de exame necrópsico e respectivos relatórios anatomo-patológicos referentes ao período entre Janeiro de 2000 e Dezembro de 2009, pertencentes à secção de Anatomia patológica da FMV-UTL. A morte súbita foi a causa de morte em 6,2% (n=60) do número total de necrópsias realizadas em felídeos e 6,3% (n=153) das realizadas em canídeos. Estes constituíram um grupo de animais aparentemente saudáveis que morreram repentinamente sem sintomatologia presenciada pelos proprietários. Foi considerado um período máximo de 10 horas entre a ocasião em que foram vistos pela última vez com vida e posteriormente encontrados mortos. Foram, também, incluídos os animais considerados saudáveis pelo proprietário e/ou médico veterinário que desenvolveram sintomas nas 6 horas antes da morte. Da análise da população total de felídeos presentes, observou-se que, a maior parte dos animais que morreram subitamente eram do sexo masculino, de raça Europeu Comum, com idades compreendidas entre 1 e 6 anos. A morte nestes 60 animais deveu-se sobretudo a pneumonia exsudativa, cardiomiopatia hipertrófica, edema agudo do pulmão, panleucopénia felina, lipomatose cardíaca, intoxicação por organofosforados e insuficiência renal aguda. Da análise da população total de canídeos, observou-se que a maior parte das mortes súbitas ocorreu em machos, de raça pura, sendo a mais representada a Pastor Alemão. A morte súbita foi mais comum na faixa etária entre 1 e 6 anos. A principal causa de morte súbita foi devido a síndrome de dilatação-torção de estômago, seguida por intoxicações por pesticidas, tromboembolismo pulmonar, estenose sub-áortica, cardiomiopatia dilatada, parvovirose, edema agudo do pulmão e lipomatose cardíaca. Tanto em gatos como em cães, na maioria das vezes não foi presenciada qualquer sintomatologia e em 13% e em 7%, respectivamente, a causa de morte foi inconclusiva.ABSTRACT - Sudden death in dogs and cats – Retrospective study of 213 cases (2000-2009) - In veterinary medicine, sudden death is a syndrome that affects animals which are apparently healthy, not only for their owners, but also for their veterinarians‟ practitioners. Its definition has precise scientific features and specific social issues. The aim of this study was to determine the causes of sudden death of dogs and cats, establishing epidemiologic relations. Necropsy records of the department of pathological anatomy of the FMV-UTL, between January 2000 and December 2009, were analyzed. The data collected included clinical signs immediately before death, and post-mortem histopathological reports. Sudden death was the cause of death in 6,2% (n=60) of necropsies performed in cats and 6,3% (n=153) conducted in dogs. They constituted a group of apparently healthy animals that had died suddenly without symptoms attended by the owners, for a maximum of 10 hours between the time when they were last seen and the time that they were found dead, or when changes in their clinical status were witnessed by the owners in the last 6 hours before their death. Analysing the total population of these cats, it was observed that most animals that had died suddenly were males, of European shorthair breed, aged between 1 and 6 years. Death in these 64 animals was mainly due to exudative pneumonia, hypertrophic cardiomyopathy, acute pulmonary edema, feline panleukopenia virus, cardiac lipomatosis, organophosphate poisoning and acute renal failure. Analysing the total population of dogs, it was observed that most sudden deaths occurred in males, purebred, being the most represented the German shepherd breed. Sudden death was more common between the ages of 1 and 6 years. The main cause of sudden death was due to gastric dilation-volvulus syndrome, followed by pesticide poisoning, pulmonary thromboembolism, sub-aortic stenosis, dilated cardiomyopathy, canine parvovirus infection, acute pulmonary edema and cardiac lipomatosis. In cats and dogs, most of the time no symptoms were witnessed and in 13% and 7%, respectively, the cause of death was inconclusive

Sesgos de género en salud: Actuación de los profesionales de enfermería en España y Francia ante crisis cardiovascular y crisis de ansiedad

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Biológica y de la Salud. Fecha de lectura: 26-02-2015El objetivo de este trabajo ha sido conocer la influencia que el género de los pacientes, así como el género, la experiencia profesional, el nivel de formación y la edad de los participantes podrían estar teniendo sobre el primer diagnóstico clínico y sobre las primeras atenciones y cuidados que los profesionales y estudiantes de enfermería ofrecen a sus pacientes cuando estos acuden a un servicio de urgencias con una misma sintomatología. Para ello se han llevado a cabo tres estudios experimentales, en el que mediante la presentación de cuatro casos clínicos se manipuló el género del paciente para cada caso, balanceando su presentación y realizando una asignación aleatoria de los participantes. Se contó con la participación de 2 hospitales universitarios y 9 centros de salud de la Comunidad Autónoma de Madrid, con dos hospitales universitarios del norte y sur de Paris y con una Escuela Universitaria de Enfermería española, accediéndose finalmente a un total de 459 profesionales/estudiantes de enfermería (395 mujeres (86.05%), 64 hombres (13.94%)). Los resultados obtenidos revelaron que existe un efecto significativo del género del paciente en el tipo de diagnóstico establecido por los profesionales de enfermería en España. En Francia se obtuvieron datos igualmente significativos en los cuatro casos clínicos para las profesionales enfermeras, y en dos de los cuatro casos clínicos para los enfermeros. Con respecto a las primeras atenciones y cuidados ofrecidos, en España se observaron resultados significativos en dos de los cuatro casos clínicos tanto para enfermeras como enfermeros, mientras que en Francia solo se obtuvieron resultados significativos para las profesionales enfermeras. Con respecto a los estudiantes de enfermería no se encontraron datos significativos que relacionaran los diferentes niveles formativos con los sesgos de género. En cuanto a la experiencia profesional y la edad, se observó que los profesionales con edades superiores a 34 años y con experiencia profesional baja y media-alta eran los que mayor relación presentaron con respecto a los sesgos de género estudiados. Por tanto parece que en la muestra estudiada el género del paciente podría considerarse un factor explicativo de las diferencias encontradas en los diagnósticos y atenciones que han ofrecido los profesionales de enfermería, observándose diferentes tipos de relación según el género del profesional y el país de procedencia, así como de la edad, el proceso de formación y los años de experiencia profesionalThe aim of this study was to determine the influence of patient gender as well as the gender, work experience, educational attainment and age of the participants may be having on the first clinical diagnosis and care that professionals and students nursing offer their patients when they go to an emergency department with the same symptoms. This has been conducted three experimental studies, which by presenting four cases where the patient gender was manipulated in each case, balanced the presentation and conducting a random assignment of participants. This study included the participation of two university hospitals and nine health centers in a region of Madrid, two university hospitals in the north and south of Paris and one School of Spanish Nursing. A total of 459 professionals / students nurses (395 women (86.05%), 64 men (13.94%)) agreed to participate in this study. The results revealed that there is a significant effect of patient gender on the type of diagnosis made by nurses in Spain. In France also significant data were obtained in four cases by female nurses, and two of the four cases by male nurses. With respect to the first attention and care offered in Spain significant results were observed in two of the four clinical cases in female and male nurses, while in France significant results were obtained only in the case of female nurses. Regarding nursing students no significant data that related the different training levels with gender bias were found. In terms of work experience and age, it was observed that professionals with ages greater than 34 years and low and medium-high professional experience were the ones where the most significant effects were obtained regarding gender bias. It therefore appears that the patient gender could be considered a factor explaining the differences in diagnosis and care the nurses provided and shows different types of relations by gender nurses and the country as well as age, the process of training and years of experienc