Prevalence and characteristics of chronic pain among patients in Portuguese primary care units

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.Introduction: Chronic pain (CP) negatively impacts the lives of almost 2 billion people worldwide, including approximately 37% of adults in Portugal. As most of these patients are followed by a general practitioner, identifying the prevalence and characterizing the pain of patients who visit primary care units will provide valuable insights into the CP landscape in Portugal. Methods: To achieve this goal, an observational, cross-sectional study was conducted in 58 primary care units of mainland Portugal between June 2017 and March 2018. Interviews were conducted with 8445 patients, and 578 CP patients were characterized. Results: We observed that one third of patients suffered from CP, and of these, approximately one third felt that their pain management was insufficient. Most of the population was 55 years old or older, retired, and had more than three comorbidities. However, age and the number and type of comorbidities were not predictors of pain intensity. Additionally, most of the population had pain or discomfort that hindered their mobility and the performance of their everyday activities. This decrease in the quality of life led to feelings of anxiety and depression, which were associated with pain intensity. Conclusion: Given the high prevalence of CP, strategies to improve the quality of life of these patients and decrease the negative impacts, as well as awareness campaigns to increase the populations' knowledge of this condition, are essential for the suitable and timely treatment of CP.info:eu-repo/semantics/publishedVersio

Enigmap : External-Memory Oblivious Map for Secure Enclaves

Imagine that a privacy-conscious client would like to query a key-value store residing on an untrusted server equipped with a secure processor. To protect the privacy of the client\u27s queries as well as the database, one approach is to implement an {\it oblivious map} inside a secure enclave. Indeed, earlier works demonstrated numerous applications of an enclaved-based oblivious map, including private contact discovery, key transparency, and secure outsourced databases. Our work is motivated by the observation that the previous enclave implementations of oblivious algorithms are sub-optimal both asymptotically and concretely. We make the key observation that for enclave applications, the {\it number of page swaps} should be a primary performance metric. We therefore adopt techniques from the {\it external-memory} algorithms literature, and we are the first to implement such algorithms inside hardware enclaves. We also devise asymptotically better algorithms for ensuring a strong notion of obliviousness that resists cache-timing attacks. We complement our algorithmic improvements with various concrete optimizations that save constant factors in practice. The resulting system, called Enigmap, achieves 15$\times$ speedup over Signal\u27s linear scan implementation, and 53$\times$ speedup over the %state-of-the-art prior best oblivious algorithm implementation, at a realistic database size of 256 million and a batch size of 1000. The speedup is asymptotical in nature and will be even greater as Signal\u27s user base grows

Efficient Oblivious Sorting and Shuffling for Hardware Enclaves

Oblivious sorting is arguably the most important building block in the design of efficient oblivious algorithms. We propose new oblivious sorting algorithms for hardware enclaves. Our algorithms achieve asymptotic optimality in terms of both computational overhead and the number of page swaps the enclave has to make to fetch data from insecure memory or disk. We also aim to minimize the concrete constants inside the big-O. One of our algorithms achieve bounds tight to the constant in terms of the number of page swaps. We have implemented our algorithms and made them publicly available through open source. In comparison with (an unoptimized version of) bitonic sort, which is asymptotically non-optimal but the de facto algorithm used in practice, we achieve a speedup of 2000 times for 12 GB inputs

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Teoria e prática em inovações sociais na cidade do Rio de Janeiro, Brasil

Purpose: This article reviews the literature on social innovation, also focusing on Latin American production, identifying how the contents dialogue with the reality of initiatives in the city of Rio de Janeiro, Brazil. Design/methodology/approach: Qualitative research mapped 53 social innovation initiatives with some digital use and analyzed 20 of these initiatives. Using a descriptive exploratory methodology, the study was conducted in five stages: (1) review of the literature, (2) mapping of the initiatives, (3) the selection of 20 initiatives, (4) interviews and analysis, (5) a discussion workshop on the results. Findings: The results indicate that the researched initiatives differ a little in relation to the literature. More specifically, this analysis helped perceive that in the city, (1) social innovations occur almost exclusively through the movement of civil society actors, (2) there is little to none, or only indirect articulation with governments and public policies, and (3) digital use and management remain reactive rather than strategic and are almost exclusively centered on social networks, both as a communication and management tool. Research limitations/implications: This study cannot be generalized for the city since the sample was identified by voluntary adherence of the initiatives to an internet call. Originality/value: This study contributes to knowledge on social innovations in the city of Rio de Janeiro, providing elements for debate by public and private decision makers, in addition to academic interest and shows the need for knowledge production for management rooted in the local context and reality.Objetivo: Este artigo realiza revisão de literatura sobre inovação social, com foco também na produção da América Latina, identificando como os conteúdos dialogam com a realidade de iniciativas na cidade do Rio de Janeiro, Brasil. Design/metodologia/abordagem: A pesquisa qualitativa mapeou 53 iniciativas de inovação social com algum uso digital e analisou 20 destas iniciativas. Utilizando uma metodologia descritiva e exploratória, o estudo foi realizado em cinco etapas: (1) revisão de literatura, (2) mapeamento de iniciativas, (3) seleção de 20 iniciativas, (4) entrevistas e análise, (5) oficina de discussão dos resultados. Resultados: Os resultados mostraram que as iniciativas diferem um pouco em relação a literatura. Mais especificamente, percebeu-se nesta análise que na cidade (1) as inovações sociais ocorrem quase que exclusivamente por movimento de atores da sociedade civil, (2) há pouca, nenhuma, ou articulação indireta com governos e políticas públicas, e (3) o uso do digital e a gestão ainda são reativos e não estratégicos, centrados, quase que exclusivamente, nas redes sociais tanto como ferramenta de comunicação, quanto de gestão. Limitações/implicações da pesquisa: Este estudo não pode ser generalizado para a cidade uma vez que a amostra foi identificada por adesão voluntária das iniciativas a um chamado na internet.  Originalidade: Este estudo contribui com o conhecimento das inovações sociais na cidade do Rio de Janeiro, fornecendo elementos para debate de decisores públicos e privados, além da academia e mostra a necessidade de produção de conhecimento para gestão de inovações sociais enraizado no contexto e na realidade local

Medida do átrio esquerdo em pacientes com suspeita de insuficiência cardíaca com fração de ejeção normal

FUNDAMENTO: O modelo fisiopatológico da insuficiência cardíaca com fração de ejeção normal (ICFEN) está centrado na presença de disfunção diastólica, o que ocasiona mudanças estruturais e funcionais no átrio esquerdo (AE). A medida do tamanho do AE pode ser utilizada como um marcador da presença de ICFEN, sendo um indicador da elevação crônica da pressão de enchimento do VE, cuja mensuração é de fácil obtenção. OBJETIVO: Estimar a acurácia da medida do tamanho do AE, utilizando os valores indexados do diâmetro e do volume do AE para o diagnóstico de ICFEN em pacientes ambulatoriais. MÉTODOS: Estudamos 142 pacientes (67,3 ± 11,4 anos, 75% de mulheres) com suspeita de IC, os quais foram divididos em dois grupos: com ICFEN (n = 35) e sem ICFEN (n = 107). RESULTADOS: A função diastólica, avaliada pelo ecodopplercardiograma, mostrou diferença significativa entre os dois grupos em relação aos parâmetros que avaliaram o relaxamento ventricular (E' 6,9 ± 2,0 cm/s vs. 9,3 ± 2,5 cm/s - p < 0,0001) e a pressão de enchimento do VE (relação E/E' 15,2 ± 6,4 vs. 7,6 ± 2,2 - p < 0,0001). O ponto de coorte do volume do AE indexado (VAE-I) de 35 mL/m² foi o que melhor se correlacionou com o diagnóstico de ICFEN, demonstrando sensibilidade de 83%, especificidade de 83% e acurácia de 83%. Já o ponto de coorte do diâmetro ântero-posterior do AE indexado (DAE-I) de 2,4 cm/m² apresentava sensibilidade de 71%, especificidade de 66% e acurácia de 67%. CONCLUSÃO: Para o diagnóstico de ICFEN em pacientes ambulatoriais, o VAE-I é o método mais acurado em comparação ao DAE-I. Na avaliação ecocardiográfica, a medida do tamanho do AE deveria ser substituída pela medida indexada do volume. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0

Medida do átrio esquerdo em pacientes com suspeita de insuficiência cardíaca com fração de ejeção normal Left atrium measurement in patients suspected of having heart failure with preserved ejection fraction

FUNDAMENTO: O modelo fisiopatológico da insuficiência cardíaca com fração de ejeção normal (ICFEN) está centrado na presença de disfunção diastólica, o que ocasiona mudanças estruturais e funcionais no átrio esquerdo (AE). A medida do tamanho do AE pode ser utilizada como um marcador da presença de ICFEN, sendo um indicador da elevação crônica da pressão de enchimento do VE, cuja mensuração é de fácil obtenção. OBJETIVO: Estimar a acurácia da medida do tamanho do AE, utilizando os valores indexados do diâmetro e do volume do AE para o diagnóstico de ICFEN em pacientes ambulatoriais. MÉTODOS: Estudamos 142 pacientes (67,3 ± 11,4 anos, 75% de mulheres) com suspeita de IC, os quais foram divididos em dois grupos: com ICFEN (n = 35) e sem ICFEN (n = 107). RESULTADOS: A função diastólica, avaliada pelo ecodopplercardiograma, mostrou diferença significativa entre os dois grupos em relação aos parâmetros que avaliaram o relaxamento ventricular (E' 6,9 ± 2,0 cm/s vs. 9,3 ± 2,5 cm/s - p BACKGROUND: The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained. OBJECTIVE: To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients. METHODS: This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex) suspected of having HF, divided into two groups: with HFPEF (n = 35) and without HFPEF (n = 107). RESULTS: The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6.9 ± 2.0 cm/s vs. 9.3 ± 2.5 cm/s; p < 0.0001) and LV filling pressure (E/E' ratio: 15.2 ± 6.4 vs. 7.6 ± 2.2; p < 0.0001). The ILAV cutoff point of 35 mL/m2 best correlated with the diagnosis of HFPEF, showing sensitivity, specificity, and accuracy of 83%. The ILAD cutoff point of 2.4 cm/m2 showed sensitivity of 71%, specificity of 66%, and accuracy of 67%. CONCLUSION: For diagnosing HFPEF in ambulatory patients, the ILAV proved to be a more accurate parameter than ILAD. On echocardiographic assessment, ILAV, rather than ILAD, should be routinely measured. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0