Morbilidad Asistida y morbilidad real por infecciones respiratorias agudas

ResumenEl presente trabajo aborda el estudio de la morbilidad por Infecciones Respiratorias Agudas (IRA) en áreas del municipio Lisa en Ciudad Habana, así como en localidades del municipio Isla de la Juventud (Cuba), con objeto de caracterizar algunos aspectos de la morbilidad por demanda de consultae identificar la morbilidad real. Alrededor del 90% de las consultas por IRA fueron por primera vez y en general la razón de éstas, respecto al seguimiento fue de 5,3. A través de la búsqueda activa de enfermos se obtuvieron las tasas de morbilidad real (TMR) entre valores de 110,4 y 163,4 casos por 1000 habitantes, que fueron muy superiores a las tasas de morbilidad por demanda de consulta (TMDC) en iguales periodos de tiempo. Resultado de la división de ambas tasas se obtuvo el«índice de morbilidad real» (IMR) cuyo cociente osciló entre 5 y 15, aproximadamente. Una alta proporción (47,6%) de enfermos refirieron no haber solicitado atención médica. Estos resultados permiten hacer estimaciones aproximadas del comportamiento real de las IRA en el universo de estudio y establecer bases para un nuevo programa de control, perfeccionando ademcis la vigilancia epidemiolóigica en la atención primaria de salud.SummaryThe present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to caracterise different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. Ahigh proportion (47.6%) of cases reported no medical careattendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities

Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain

Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = −0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested

Clinical Genetic Testing for Familial Hypercholesterolemia: JACC Scientific Expert Panel

Although awareness of familial hypercholesterolemia (FH) is increasing, this common, potentially fatal, treatable condition remains underdiagnosed. Despite FH being a genetic disorder, genetic testing is rarely used. The Familial Hypercholesterolemia Foundation convened an international expert panel to assess the utility of FH genetic testing. The rationale includes the following: 1) facilitation of definitive diagnosis; 2) pathogenic variants indicate higher cardiovascular risk, which indicates the potential need for more aggressive lipid lowering; 3) increase in initiation of and adherence to therapy; and 4) cascade testing of at-risk relatives. The Expert Consensus Panel recommends that FH genetic testing become the standard of care for patients with definite or probable FH, as well as for their at-risk relatives. Testing should include the genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9); other genes may also need to be considered for analysis based on patient phenotype. Expected outcomes include greater diagnoses, more effective cascade testing, initiation of therapies at earlier ages, and more accurate risk stratification.info:eu-repo/semantics/publishedVersio