Perspective of care for users with arterial hypertension in a family health Unit

Objective: To know the practices developed for users with arterial hypertension. Method: A descriptive-exploratory research, with qualitative approach realized in people with arterial hypertension living in the coverage area of a Family Health Unit of a city in southern Brazil. The data collection occurred during the months of February and March 2011 through semi-structured interviews. To analyze the data was used the thematic analysis. Results: From data analysis emerged the following categories: care with food; medication care, care with physical activities; care in maintaining emotional balance; popular care. Conclusion: The study highlights the importance to know the care developed for hypertensive users in order to better lead the health actions in this public, valuing their practices and paying attention to the difficulties experienced for them in the realization of such care

New, Useful Criteria for Assessing the Evidence of Infection in Sepsis Research.

OBJECTIVES The Sepsis-3 definition states the clinical criteria for sepsis but lacks clear definitions of the underlying infection. To address the lack of applicable definitions of infection for sepsis research, we propose new criteria, termed the Linder-Mellhammar criteria of infection (LMCI). The aim of this study was to validate these new infection criteria. DESIGN A multicenter cohort study of patients with suspected infection who were admitted to emergency departments or ICUs. Data were collected from medical records and from study investigators. SETTING Four academic hospitals in Sweden, Switzerland, the Netherlands, and Germany. PATIENTS A total of 934 adult patients with suspected infection or suspected sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Agreement of infection site classification was measured using the LMCI with Cohen κ coefficient, compared with the Calandra and Cohen definitions of infection and diagnosis on hospital discharge as references. In one of the cohorts, comparisons were also made to adjudications by an expert panel. A subset of patients was assessed for interobserver agreement. MEASUREMENTS AND MAIN RESULTS The precision of the LMCI varied according to the applied reference. LMCI performed better than the Calandra and Cohen definitions (κ = 0.62 [95% CI, 0.59-0.65] vs κ = 0.43 [95% CI, 0.39-0.47], respectively) and the diagnosis on hospital discharge (κ = 0.57 [95% CI, 0.53-0.61] vs κ = 0.43 [95% CI, 0.39-0.47], respectively). The interobserver agreement for the LMCI was evaluated in 91 patients, with agreement in 77%, κ = 0.72 (95% CI, 0.60-0.85). When tested with adjudication as the gold standard, the LMCI still outperformed the Calandra and Cohen definitions (κ = 0.65 [95% CI, 0.60-0.70] vs κ = 0.29 [95% CI, 0.24-0.33], respectively). CONCLUSIONS The LMCI is useful criterion of infection that is intended for sepsis research, in and outside of the ICU. Useful criteria for infection have the potential to facilitate more comparable sepsis research and exclude sepsis mimics from clinical studies, thus improving and simplifying sepsis research

BURDEN OF FAMILY CAREGIVERS OF CHRONIC PATIENTS AND THE SOCIAL SUPPORT NETWORKS

OBJETIVO: Descrever a sobrecarga dos cuidadores familiares de doentes crônicos dependentes, bem como as redes sociais de apoio, durante o processo de cuidado. MÉTODO: Estudo qualitativo, descritivo e exploratório, realizado com cuidadores familiares de usuários cadastrados em uma unidade da Estratégia de Saúde da Família do Município de Santa Maria, Rio Grande do Sul. A coleta de dados ocorreu de julho a setembro de 2010, desenvolveu-se com entrevistas narrativas e utilização de diário de campo. RESULTADOS: Da análise de conteúdo temática surgiram as categorias: cuidadores familiares e situações de sobrecarga do cuidado; redes informais de cuidado; redes formais de cuidado. CONCLUSÃO: A doença incapacitante impõe sobrecarga à vida dos cuidadores, devido à falta de apoio das redes e pelas imposições do cuidado. Para isso, são desenvolvidas novas redes ou se reforçam as existentes, as quais podem ser de outros familiares, amigos, vizinhos e profissionais de saúde

VIVÊNCIAS DA FAMÍLIA APÓS INFARTO AGUDO DO MIOCÁRDIO

Objetivou-se descrever as vivências da família no pós-infarto. Pesquisa qualitativa, descritiva e exploratória, realizada com seis famílias de pacientes pós-infarto. A coleta de dados ocorreu no domicílio das famílias, no período de fevereiro a maio de 2012, por meio de observação e entrevista com a família. Foi utilizado o software Atlas Ti 6.2 na codificação das entrevistas e os dados foram explorados com a análise temática. Surgiram duas categorias: “Tempos difíceis”: consequênciaimediata do infarto agudo do miocárdio para as famílias; e “Nos reeducamos – a gente se adapta”, vivência atual das famílias. A vivência imediata pós-infarto é permeada por variados sentimentos, necessitando adaptação das famílias para adequação às necessidades. A vivência atual demonstra modificações nas famílias devido à enfermidade. A família é a principal responsável pelas práticas de cuidado, porém a Enfermagem deve atuar na troca e no compartilhamento de saberes

População rural e enfermagem: uma revisão bibliométrica

Objective: present the national and international scientific productions on rural population and nursing thematic. Method: it deals about a bibliometric study developed in catalogues of the Center for Study and Research in Nursing of the Brazilian Association of Nursing (CEPEn/ABEn) and the Virtual Health Library (VHL), in accordance with the criteria of inclusion and exclusion established in advance. Results: at CEPEn, were found and analyzed 27 works and on the page of the VHL were found 871 jobs, but it wasn’t possible to access and evaluate 38 articles about the rural thematic, totaling 65 works analyzed. Conclusions: it was found that the production of knowledge involving the rural theme is still greatly reduced, which demand the expansion of knowledge about this topic and the issues that surround itObjetivo: presentar las producciones científicas nacionales e internacionales, sobre la temática población rural y enfermería. Método: se trata de un estudio bibliométrico desarrollado en los catálogos del Centro de Estudios y Pesquisa en Enfermería de la Asociación Brasileña de Enfermería ( CEPEn/ABEn) y en la Biblioteca Virtual de Salud (BVS), en conformidad con criterios de inclusión y exclusión previamente establecidos. Resultados: en el CEPEn, fueron encontrados y analizados27 trabajos y en la página de la BVS fueron encontrados 871 trabajos, pero fue posible tener acceso y evaluar 38 artículos sobre la temática rural, totalizando 65 trabajos analizados. Conclusiones: se verificó que la producción del conocimiento envolviendo la temática rural se mantiene todavía bastante reducida, lo que demanda la ampliación del conocimiento alrededor de esa temática y de las cuestiones que la envuelven.Objetivo: apresentar as produções científicas nacionais e internacionais, sobre a temática população rural e enfermagem. Método: Trata-se de um estudo bibliométrico desenvolvido nos catálogos do Centro de Estudos e Pesquisa em Enfermagem da Associação Brasileira de Enfermagem (CEPEn/ABEn) e na Biblioteca Virtual de Saúde (BVS), em conformidade com critérios de inclusão e exclusão previamente estabelecidos. Resultados: No CEPEn, foram encontrados e analisados 27 trabalhos e na página da BVS foram encontrados 871 trabalhos, mas foi possível acessar e avaliar 38 artigos sobre a temática rural, totalizando 65 trabalhos analisados. Conclusões: Verificou-se que a produção do conhecimento envolvendo a temática rural mantém-se reduzida, o que demanda a ampliação do conhecimento acerca dessa temática e das questões que a envolvem

Alcohol Drinking in Never Users of Tobacco, Cigarette Smoking in Never Drinkers, and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium

Background At least 75% of head and neck cancers are attributable to a combination of cigarette smoking and alcohol drinking. A precise understanding of the independent association of each of these factors in the absence of the other with the risk of head and neck cancer is needed to elucidate mechanisms of head and neck carcinogenesis and to assess the efficacy of interventions aimed at controlling either risk factor. Methods We examined the extent to which head and neck cancer is associated with cigarette smoking among never drinkers and with alcohol drinking among never users of tobacco. We pooled individual-level data from 15 case-control studies that included 10244 head and neck cancer case subjects and 15227 control subjects, of whom 1072 case subjects and 5775 control subjects were never users of tobacco and 1598 case subjects and 4051 control subjects were never drinkers of alcohol. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. All statistical tests were two-sided. Results Among never drinkers, cigarette smoking was associated with an increased risk of head and neck cancer (OR for ever versus never smoking = 2.13, 95% CI = 1.52 to 2.98), and there were clear dose-response relationships for the frequency, duration, and number of pack-years of cigarette smoking. Approximately 24% (95% CI = 16% to 31%) of head and neck cancer cases among nondrinkers in this study would have been prevented if these individuals had not smoked cigarettes. Among never users of tobacco, alcohol consumption was associated with an increased risk of head and neck cancer only when alcohol was consumed at high frequency (OR for three or more drinks per day versus never drinking = 2.04, 95% CI = 1.29 to 3.21). The association with high-frequency alcohol intake was limited to cancers of the oropharynx/hypopharynx and larynx. Conclusions Our results represent the most precise estimates available of the independent association of each of the two main risk factors of head and neck cancer, and they exemplify the strengths of large-scale consortia in cancer epidemiolog

Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk

Background Quitting tobacco or alcohol use has been reported to reduce the head and neck cancer risk in previous studies. However, it is unclear how many years must pass following cessation of these habits before the risk is reduced, and whether the risk ultimately declines to the level of never smokers or never drinkers. Methods We pooled individual-level data from case-control studies in the International Head and Neck Cancer Epidemiology Consortium. Data were available from 13 studies on drinking cessation (9167 cases and 12 593 controls), and from 17 studies on smoking cessation (12 040 cases and 16 884 controls). We estimated the effect of quitting smoking and drinking on the risk of head and neck cancer and its subsites, by calculating odds ratios (ORs) using logistic regression models. Results Quitting tobacco smoking for 1-4 years resulted in a head and neck cancer risk reduction [OR 0.70, confidence interval (CI) 0.61-0.81 compared with current smoking], with the risk reduction due to smoking cessation after ≥20 years (OR 0.23, CI 0.18-0.31), reaching the level of never smokers. For alcohol use, a beneficial effect on the risk of head and neck cancer was only observed after ≥20 years of quitting (OR 0.60, CI 0.40-0.89 compared with current drinking), reaching the level of never drinkers. Conclusions Our results support that cessation of tobacco smoking and cessation of alcohol drinking protect against the development of head and neck cance

Using Prior Information from the Medical Literature in GWAS of Oral Cancer Identifies Novel Susceptibility Variant on Chromosome 4 - the AdAPT Method

Background: Genome-wide association studies (GWAS) require large sample sizes to obtain adequate statistical power, but it may be possible to increase the power by incorporating complementary data. In this study we investigated the feasibility of automatically retrieving information from the medical literature and leveraging this information in GWAS. Methods: We developed a method that searches through PubMed abstracts for pre-assigned keywords and key concepts, and uses this information to assign prior probabilities of association for each single nucleotide polymorphism (SNP) with the phenotype of interest - the Adjusting Association Priors with Text (AdAPT) method. Association results from a GWAS can subsequently be ranked in the context of these priors using the Bayes False Discovery Probability (BFDP) framework. We initially tested AdAPT by comparing rankings of known susceptibility alleles in a previous lung cancer GWAS, and subsequently applied it in a two-phase GWAS of oral cancer. Results: Known lung cancer susceptibility SNPs were consistently ranked higher by AdAPT BFDPs than by p-values. In the oral cancer GWAS, we sought to replicate the top five SNPs as ranked by AdAPT BFDPs, of which rs991316, located in the ADH gene region of 4q23, displayed a statistically significant association with oral cancer risk in the replication phase (per-rare-allele log additive p-value [p(trend)] = 2.5 x 10(-3)). The combined OR for having one additional rare allele was 0.83 (95% CI: 0.76-0.90), and this association was independent of previously identified susceptibility SNPs that are associated with overall UADT cancer in this gene region. We also investigated if rs991316 was associated with other cancers of the upper aerodigestive tract (UADT), but no additional association signal was found. Conclusion: This study highlights the potential utility of systematically incorporating prior knowledge from the medical literature in genome-wide analyses using the AdAPT methodology. AdAPT is available online (url: http://services.gate.ac.uk/lld/gwas/service/config)

Vitamin or mineral supplement intake and the risk of head and neck cancer: pooled analysis in the INHANCE consortium

To investigate the potential role of vitamin or mineral supplementation on the risk of head and neck cancer (HNC), we analyzed individual-level pooled data from 12 case-control studies (7,002 HNC cases and 8,383 controls) participating in the International Head and Neck Cancer Epidemiology consortium. There were a total of 2,028 oral cavity cancer, 2,465 pharyngeal cancer, and 874 unspecified oral/pharynx cancer, 1,329 laryngeal cancer and 306 overlapping HNC cases. Odds ratios (OR) and 95% confidence intervals (CIs) for self reported ever use of any vitamins, multivitamins, vitamin A, vitamin C, vitamin E, and calcium, beta-carotene, iron, selenium, and zinc supplements were assessed. We further examined frequency, duration and cumulative exposure of each vitamin or mineral when possible and stratified by smoking and drinking status. All ORs were adjusted for age, sex, race/ethnicity, study center, education level, and pack-years of smoking, frequency of alcohol drinking and fruit/vegetable intake. A decreased risk of HNC was observed with ever use of vitamin C (OR=0.76, 95% CI=0.59-0.96) and with ever use of calcium supplement (OR=0.64, 95% CI=0.42-0.97). The inverse association with HNC risk was also observed for 10 or more years of vitamin C use (OR=0.72, 95% CI=0.54-0.97) and more than 365 tablets of cumulative calcium intake (OR=0.36, 95% CI=0.16-0.83), but linear trends were not observed for the frequency or duration of any supplement intake. We did not observe any strong associations between vitamin or mineral supplement intake and the risk of head and neck cancer