Influência dos determinantes sociais da saúde na eficácia familiar

Introducción: Los Determinantes Sociales de la Salud están definidos por las condiciones de vida de la población, cómo nacen, crecen, viven, trabajan y envejecen, y son considerados como los principales responsables de la salud de las poblaciones. Objetivo: Evaluar la influencia de los determinantes sociales de la salud en la efectividad del funcionamiento familiar. Materiales y Métodos: Se realizó un estudio cuantitativo con 200 participantes entre 2017 y 2018. Para evaluar la correlación entre los determinantes sociales de salud proximales, intermedios y distales y el nivel de efectividad del funcionamiento familiar, se realizaron visitas domiciliarias a 100 familias que respondieron el instrumento Evaluación de estrategias en Efectividad Familiar y un cuestionario sociodemográfico. Los datos fueron analizados por frecuencia simple, coeficiente de correlación de Spearman ( ρ ) (p <0,05 ), y sometidos a análisis descriptivo desde la perspectiva de la organización sistémica. Resultados: Los determinantes sociales que mostraron un coeficiente de correlación positivo con el nivel de efectividad del funcionamiento familiar fueron los años de estudio y el ingreso familiar fijo. Hubo una correlación negativa con la principal fuente de ingresos (número de ocupaciones) o fuente de ingresos y la presencia de otros miembros o familiares en la familia. Discusión: Las inversiones en educación pueden mejorar la capacidad de la familia para organizarse, solucionar o prevenir eventos adversos, aumentar los ingresos y brindar más tiempo para las relaciones familiares y el logro de la congruencia, como lo evidencian otros autores. Conclusiones: Los determinantes sociales proximales e intermedios de la salud influyeron en el nivel de efectividad del funcionamiento familiar. Como citar este artículo: Lise Fernanda, Schwartz Eda, De Lima Spagnolo Lilian Moura, Stacciarini Jeanne-Marie. Influence of social determinants of health in family-effectiveness. Revista Cuidarte. 2023;14(1): e2805. http://dx.doi.org/10.15649/cuidarte.2805Highlights: To Know how the social determinants of health influence family health supported by the systemic organization, can contribute to the assessment and nursing intervention, and promote the improvement of the health of families. The social determinants of health that influenced the level of family-effectiveness, was, education, fixed income, the number of family relatives and the number of occupations (Work/sorce of income). The more occupations as the main source of income, the lower the family effectiveness. Since families, with children, dedicate many hours to work, they have less time available for family relationships. The effectiveness of family functioning was lower in families with low education, without a fixed income, with a greater number work and/or retirement, and the presence of relatives. Introduction: The Social Determinants of Health are defined by the living conditions of the population, how they are born, grow, live, work and age, and are considered as the main responsible for the health of populations. Objective: To evaluate the influence of social determinants of health on effectiveness of family functioning. Materials and Methods: A quantitative study was carried out with 200 participants between 2017 and 2018. To assess the correlation between proximal, intermediate and distal social determinants of health and the level of effectiveness of family functioning, home visits were made to 100 families who responded the Assessment of strategies in Family Effectiveness instrument and a sociodemographic questionnaire. Data were analyzed by simple frequency, Spearman’s correlation coefficient (ρ) (p <0.05), and subjected to descriptive analysis from the perspective of systemic organization. Results: The social determinants that showed a positive correlation coefficient with the level of effectiveness of family functioning were the years of study and the fixed family income. There was a negative correlation with the main source of income (number of occupations) or source of income and the presence of other members or relatives in the family. Discussion: Investments in education can improve the family's ability to organize, solve or prevent adverse events, increase income and provide more time for family relationships and the achievement of congruence, as evidenced by other authors. Conclusions: The proximal and intermediate social determinants of health influenced the level of effectiveness of family functioning. How to cite this article: Lise Fernanda, Schwartz Eda, De Lima Spagnolo Lilian Moura, Stacciarini Jeanne-Marie. Influence of social determinants of health in family-effectiveness. Revista Cuidarte. 2023;14(1): e2805. http://dx.doi.org/10.15649/cuidarte.2805Introdução: Os Determinantes Sociais da Saúde são definidos pelas condições de vida da população, como nascem, crescem, vivem, trabalham e envelhecem, sendo considerados como os principais responsáveis pela saúde das populações. Objetivo: Avaliar a influência dos determinantes sociais da saúde na eficácia do funcionamento familiar. Materiais e Métodos: Foi realizado um estudo quantitativo com 200 participantes entre 2017 e 2018. Para avaliar a correlação entre os determinantes sociais proximais, intermediários e distais da saúde e o nível de eficácia do funcionamento familiar, foram realizadas visitas domiciliares a 100 famílias que responderam o instrumento Avaliação de estratégias em eficácia familiar e um questionário sociodemográfico. Os dados foram analisados por frequência simples, coeficiente de correlação de Spearman ( ρ ) (p < 0,05 ), e submetidos à análise descritiva sob a ótica da organização sistêmica. Resultados: Os determinantes sociais que apresentaram um coeficiente de correlação positiva com o nível de efetividade do funcionamento familiar foram os anos de estudo e a renda familiar fixa. Houve correlação negativa com a principal fonte de renda (número de ocupações) ou fonte de renda e a presença de outros membros ou parentes na família. Discussão: Investimentos em educação podem melhorar a capacidade da família de se organizar, resolver ou prevenir eventos adversos, aumentar a renda e proporcionar mais tempo para as relações familiares e para o alcance da congruência, conforme evidenciado por outros autores. Conclusões: Os determinantes sociais proximais e intermediários da saúde influenciaram o nível de efetividade do funcionamento familiar. Como citar este artigo: Lise Fernanda, Schwartz Eda, De Lima Spagnolo Lilian Moura, Stacciarini Jeanne-Marie. Influence of social determinants of health in family-effectiveness. Revista Cuidarte. 2023;14(1): e2805. http://dx.doi.org/10.15649/cuidarte.280

Metabolic acidosis in a lactating woman induced by a deliberate ketogenic diet.

ABSTRACT: This article describes a rare case of lactation ketoacidosis in a patient who started a ketogenic diet while nursing an infant and toddler. The patient presented to the ED with a history of nausea, vomiting, and postural dizziness, and was found to have a significant metabolic acidosis and elevated lipase level. The metabolic changes induced in this patient could occur in anyone with high metabolic demands who also is on a strict ketogenic diet. The case highlights the importance of a dietary history in patients with unexplained metabolic derangements

Adaptation of the African Couples HIV Testing and Counseling Model for Men who have Sex with Men in the United States: an Application of the ADAPT-ITT Framework

To respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male–female couples in the United States

Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up

The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas

Effects of Coping Skills Training on Quality of Life, Disease Biomarkers and Clinical Outcomes in Patients with Heart Failure: A Randomized Clinical Trial

Heart failure (HF) is a chronic disease that compromises patients’ quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention

Genome wide profiling of human embryonic stem cells (hESCs), their derivatives and embryonal carcinoma cells to develop base profiles of U.S. Federal government approved hESC lines

BACKGROUND: In order to compare the gene expression profiles of human embryonic stem cell (hESC) lines and their differentiated progeny and to monitor feeder contaminations, we have examined gene expression in seven hESC lines and human fibroblast feeder cells using Illumina(® )bead arrays that contain probes for 24,131 transcript probes. RESULTS: A total of 48 different samples (including duplicates) grown in multiple laboratories under different conditions were analyzed and pairwise comparisons were performed in all groups. Hierarchical clustering showed that blinded duplicates were correctly identified as the closest related samples. hESC lines clustered together irrespective of the laboratory in which they were maintained. hESCs could be readily distinguished from embryoid bodies (EB) differentiated from them and the karyotypically abnormal hESC line BG01V. The embryonal carcinoma (EC) line NTera2 is a useful model for evaluating characteristics of hESCs. Expression of subsets of individual genes was validated by comparing with published databases, MPSS (Massively Parallel Signature Sequencing) libraries, and parallel analysis by microarray and RT-PCR. CONCLUSION: we show that Illumina's bead array platform is a reliable, reproducible and robust method for developing base global profiles of cells and identifying similarities and differences in large number of samples

A genomic rearrangement resulting in a tandem duplication is associated with split hand-split foot malformation 3 (SHFM3) at 10q24

Split hand-split foot malformation (SHFM) is characterized by hypoplasia/aplasia of the central digits with fusion of the remaining digits. SHFM is usually an autosomal dominant condition and at least five loci have been identified in humans. Mutation analysis of the DACTYLIN gene, suspected to be responsible for SHFM3 in chromosome 10q24, was conducted in seven SHFM patients. We screened the coding region of DACTYLIN by single-strand conformation polymorphism and sequencing, and found no point mutations. However, Southern, pulsed field gel electrophoresis and dosage analyses demonstrated a complex rearrangement associated with a ∼0.5 Mb tandem duplication in all the patients. The distal and proximal breakpoints were within an 80 and 130 kb region, respectively. This duplicated region contained a disrupted extra copy of the DACTYLIN gene and the entire LBX1 and β-TRCP genes, known to be involved in limb development. The possible role of these genes in the SHFM3 phenotype is discusse

Keeping Circulation Services Relevant: Implementing a New Campus Book Retrieval Service

As e-books and e-journals become more prevalent many libraries are seeing use of their physical collections decline. At the same time patrons are requesting more comprehensive library services, including access to library resources 24 hours a day and quicker delivery of materials. In response to these requests the University of Wisconsin-Madison Libraries implemented a new book retrieval service in March 2002. Since its implementation, over 26,000 requests have been processed. Through this service, patrons identify books of interest in the OPAC and place requests for books that are on the shelf in open stacks or (less frequently) in a storage facility. Requests are printed at the campus library that owns the title, library staff retrieve requested materials, and deliver them to a hold shelf at a campus library that the patron chooses. The patron is then notified to pick up the item. We expect to see a steady increase in use as patrons become familiar with the service

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment A Randomized Trial

Rationale: Excessive daytime sleepiness is a common disabling symptom in obstructive sleep apnea syndrome.Objectives: To evaluate the efficacy and safety of pitolisant, a selective histamine H3 receptor antagonist with wake-promoting effects, for the treatment of daytime sleepiness in patients with moderate to severe obstructive sleep apnea refusing continuous positive airway pressure treatment.Methods: In an international, multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was individually titrated at up to 20 mgld over 12 weeks. The primary endpoint was the change in the Epworth Sleepiness Scale score. Key secondary endpoints were maintenance of wakefulness assessed on the basis of the Oxford Sleep Resistance test, safety, Clinical Global Impression of severity, patient's global opinion, EuroQol quality-of-life questionnaire, and Pichot fatigue questionnaire.Measurements and Main Results: A total of 268 patients with obstructive sleep apnea (75% male; mean age, 52 yr; apnea-hypopnea index, 49/h; baseline sleepiness score, 15.7) were randomized (200 to pitolisant and 68 to placebo) and analyzed on an intention-to-treat basis. The Epworth Sleepiness Scale score was reduced more with pitolisant than with placebo (-2.8; 95% confidence interval, -4.0 to -1.5; P < 0.001). Wake maintenance tests were not improved. The Pichot fatigue score was reduced with pitolisant. The overall impact of pitolisant was confirmed by both physicians' and patients' questionnaires. Adverse event incidence, mainly headache, insomnia, nausea, and vertigo, was similar in the pitolisant and placebo groups (29.5% and 25.4%, respectively), with no cardiovascular or other significant safety concerns.Conclusions: Pitolisant significantly reduced self-reported daytime sleepiness and fatigue and improved patient-reported outcomes and physician disease severity assessment in sleepy patients with obstructive sleep apnea refusing or nonadherent to continuous positive airway pressure