bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal Demographic and Health Survey
Authors: Sunuwar Dev Ram , Singh Devendra Raj , Pradhan Pranil Man Singh
Published: November 2019

Background: Malnutrition among mothers and children is a major public health challenge in developing countries like Nepal. Although undernutrition among children has been gradually decreasing, the coexistence of different forms of malnutrition among mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of different forms malnutrition among children and associated factors among the mother-child pairs in the same household. Methods: A total sample of 2,261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 was included in the study. Anthropometric measurements and hemoglobin levels of the children and anthropometric measurements of their mothers were taken. The bivariate and multivariable logistic regression were performed to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results: Prevalence of DBM and TBM was 6.60(5.13-8.84) % and 7(5.42-8.99) % respectively in the same household. In the adjusted multivariable logistic regression, mothers with short stature compared to normal height (AOR=4.18, 95% CI: 2.04-8.52), from the richest wealth status compared to poor wealth status (AOR=2.46, 95% CI= 1.17-5.15), from age group of above 35 years compared to 15-24 years (AOR=3.08, 95% CI:1.20-7.86), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature compared to normal height (AOR=5.01, 95% CI:2.45-10.24), from the richest wealth status compared to poor wealth status (AOR=2.66, 95% CI=1.28-5.54), age groups of above 35 years compared to 15-24 years (AOR=3.41, 95% CI:1.26-9.17), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. Conclusions: There is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Mothers with short stature, belonging to the richest family and in older age were more prone to double and triple burden of malnutrition
Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in Korea
Authors: LEE EUN , Kim Chul-Hong , Lee Yong Ju , Kim Hyo-Bin , Kim Bong-Seong , Kim Hyung Young , Kim Yunsun , Kim Sangyoung , Park Chorong , Seo Ju-Hee , Sol In Suk , Sung Myongsoon , Song Min Seob , Song Dae Jin , Ahn Young Min Ahn , Oh Hea Lin , Yu Jinho , Jung Sungsu , Lee Kyung Suk , Lee Ju Suk , Jang Gwang Cheon , Jang Yoon Young , Chung Eun Hee , Chung Hai Lee , Choi Sung-Min , Choi Yun Jung , Han Man Yong , Shim Jung Yeon , Kim Jin-Tack , Kim Chang-Keun , Yang Hyeon-Jong
Published: November 2019

Background: Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality and its disease burden is affected by age and etiologies with time-dependent changes. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. Methods: We conducted a retrospective study in 30,994 children (0-18 years old) with CAP between 2010 and 2015 at 23 nationwide hospitals in Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified into macrolide-sensitive MP, macrolide-less effective MP (MLEP) and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. Results: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.36% of the total MP pneumonia. In children less than 2 years of age, RSV (34.01%) was the most common cause of CAP, followed by MP (9.44%), whereas MP was the most common cause of CAP in children 2-18 years of age. Systemic corticosteroid was most commonly administered in MP pneumonia. The rate of hospitalization in intensive care unit was highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. Conclusions: The present study provides fundamental data for establishment of public health policies to decrease disease burden due to CAP as well as for improvement of pediatric health.
Holmium laser enucleation of prostate for patients with acute urinary retention due to benign prostate hyperplasia: Efficacy and safety
Authors: Author) Pu Li(Former Corresponding , Tao Jun , Wang Chengming , Tang Min , Author) Xiaoxin Meng(New Corresponding
Published: November 2019

Background Benign prostate hyperplasia (BPH) is a common disease in older men, and part of patients develop acute urinary retention (AUR) at the time of initial treatment. The aim of this study was to evaluate the effectiveness and safety of holmium laser enucleation of prostate (HoLEP) for patients with BPH in setting of AUR. Methods The clinical data of 88 patients with BPH who underwent HoLEP surgery in our center were retrospectively analyzed. AUR existed in 34 patients and the other 54 patients had no AUR. The general information, prostate volume, urodynamic parameters and intraoperative parameters were recoeded and compared. The outcome were recorded and analysed including the international prostate symptom score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and post-voiding residual (PVR). Results In both groups, the preoperative parameters were equivalent except for the white blood cell in urinalysis. All the HoLEP procedures were smoothly carried out. The intr- and post-operative complications were low in both groups and no difference were detected. All the patients were followed up for at least 6 months. IPSS, QoL, Qmax and PVR were all improved in both groups. No statistical differences were obtained in these parameters between groups. Conclusion s HoLEP could be a safe and effective treatment for BPH patients either with or without AUR. The efficacy was immediate and sustained during the short-term follow-up session in both groups.
Combined direct visual and imaging guided percutaneous renal access using on shot tract dilation, a case series of novel methods of tract dilatation
Authors: Aghamir Seyed Mohammad Kazem , Khatami Fatemeh , Rahimi Mohammad , Zia Hamidreza
Published: November 2019

Background: Percutaneous nephrolithotomy , (PCNL) is a common urological procedure for dilatation of access during one shot PNL. Methods : Our research is over twenty one cases of one shot visually guided tract dilation PCNL who referred to Sina Hospital between 2017,2018. They all underwent surgery using a specific 28 F dilatators with a customized central lumen which accepts a 4.5 F semi rigid ureteroscope to visually confirm the puncture of target calyx and passing a guide wire. This instrument complex was passed as a one shot dilator after withdrawal of the puncture needle. Results: The mean duration time form insertion of a needle into target calyx until securing a guide –wire inside the collecting system (pelvis, ureter) and the mean time form needle withdrawal to successful dilation and sheath placement were 95 and 252 seconds respectively. There were no intraoperative or postoperative complications a result of this technique. There was no false passage or failed accesses .Total fluoroscopy time for percutaneous access was reduced considerably. Conclusions: Use of modified ureteroscope kit during PNL, for visually confirmed Percutaneous nephrolithotomy , (PCNL) is feasible especially on complex calycealstones or pelvicalyceal Anatomies occasions.
Inpatient admissions and costs for adolescents and young adults with congenital heart defects in New York, 2009-2013
Authors: Hsu Wan-Hsiang , Sommerhalter Kristin M. , McGarry Claire E. , Farr Sherry L. , Downing Karrie F. , Lui George K. , Zaidi Ali N. , Hsu Daphne T. , Zutphen Alissa R. Van
Published: November 2019

Background Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs.Methods We examined 2009-2013 New York State inpatient admissions of individuals ages 11-30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables.Results We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,307 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 111.2% from 2009 ($24.7 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with non-severe CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City.Conclusions This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State.
Prevalence and Measurement of Anxiety and Depression in Working Nurses in Nepal: A Reflection of Professional Hazard in Low Income Nation
Authors: Karki Pramila , Katwal George W. B. J. , Chandra Ayush , Chandra Avinash
Published: November 2019

Background Anxiety, Depression is one of the under reported, underdiagnosed in Nepal though it is the leading cause of incapacitation and is the leading healthcare burden worldwide. The prevalence of anxiety, depression among health personnel is not reported. In this study we attempted to assess the incidence and impact of depression and anxiety in nurses who are working upfront in different hospitals.Method A cross-sectional study was carried out and the sample was collected from nurses working in different hospitals who had spent 6 months or more time as a working nurse in those hospitals. Prevalence of anxiety and depression was assessed using a structured validated questionnaire, The Hamilton Anxiety Scale (HAM-A) with a cut-off score for various levels of anxiety. Similarly, General Anxiety Disorder Questionnaires (GAD), Hamilton Depression Rating Scale (HAM-D) was used to assess depression and anxiety.Result The analysis of these different scales revealed that disabling anxiety prevailed at highest (43.6%) in nursing staff according to HAM-A scale. Moderate anxiety also seemed to be higher (>20%) in GAD questionnaire. The moderate to severe anxiety prevailed in majority of our study participants in all these scales (HAM-A, HAM-D, GAD). Interestingly, there seemed a strong association between HAM-A to GAD (p=0.008).Conclusions This is probably the first study of its kind that reports on the prevalence of anxiety, depression in the nurses who work in different hospitals in Nepal. We hope this study also depicts the mental health problems that the medical professionals are suffering in other nations as well.
Teaching Temporal Bone Anatomy CT Scan as a Psychomotor Skill; A Quasi-Experimental Study
Authors: Amini Mitra , Sefidbakht Sepideh , Jalli Reza , Zarei Fariba , Abbasi Hamid Reza , Iranpour Pouya , Bijan Bijan
Published: November 2019

BACKGROUND Reviewing and interpretation of cross-sectional imaging studies has become the main part of Medical Imaging (formerly known as Radiology) practice over the past twenty years. The rapid changes in the practice of medical imaging however has not been paralleled by development of new teaching methods. In the current study, we present a teaching method for the radiology residents the cross-sectional anatomy of the temporal bone as a psychomotor skill.METHODS In this cross-sectional study, we included a total number of 21 radiology resident of Shiraz University of Medical Sciences for a 2-month period. We provided a teaching scheme based on the Gagne’s theory which consisted of 6 steps ie: 1-gaining attention, 2-informing the learner of the objective, 3-stimulating recall of prerequisite learning, 4-presenting the stimulus material, 5-providing learning guidance, and 6-eliciting the performance, 7-providing feedback, assessing the performance and 8-enhancing retention and transfer. The residents were evaluated before and after the training sessions using objective structured clinical examination (OSCE), resident satisfaction and educational goal achievement questionnaires.RESULTS We have included a total number of 21 radiology residents with mean age of 27.9 ± 8.6 (range from 26-38) years, 14 (66.6%) men and 7 (33.4%) women. We observed that the OSCE score improved significantly after the twenty-minute session (2.57 ± 1.62 vs. 8.02 ± 2.43; p<0.001 ). Mean resident satisfaction score measured by standardized questionnaires was 7.63 ± 2.86 on scale of 10. Regarding the achievement of educational goals, we observed that the score increased significantly after the mini-sessions (4.33 ± 1.22 vs. 8.27 ± 2.46; p=0.021 ).CONCLUSIONS Considering the interpretation of cross sectional images as a psychomotor skill, may be proven to be an effective teaching method. Using a standardized approach and defining predetermined transition points in moving between orthogonal planes can enhance learning radiology as it is today.
Association between interleukin 2 receptor A gene polymorphisms (rs2104286 and rs12722489) with susceptibility to Multiple sclerosis in Iranian population
Authors: Ahmadi Majid , Hosseini Mojgan , pourakbari Ramin , Aslani Saeed , Ayoubi-joshaghani Mohammad Hosein Ayoubi-joshaghani , Shirvani Bahareh
Published: November 2019

Background: Multiple sclerosis (MS) is an organ-specific autoimmune disorder with remarkable heritability. For MS disorder, interleukin 2 receptor α subunit (IL2RA) is regarded as a genetic risk factor. Results: There was a statistically significant association between alleles and genotypes of rs12722489 SNP and MS risk. The levels of mRNA expression and serum IL-2RA were higher in MS patients than in healthy controls. mRNA expression and serum concentrations of IL-2RA were higher in MS patients with CC genotype for rs12722489 compared with the rest of patients. Conclusion: Our result demonstrate that the rs12722489 SNP within IL2RA gene might be associated with MS pathogenesis through regulating the levels of IL-2RA (or CD25), which is important in the regulation of T cells.
Immunological profile of dengue markers in patients during the 2017 epidemic period in Bobo Dioulasso.
Authors: Sourabie Yacouba , Gomgnimbou Michel K , Combasséré Cherifa , Sana Zeinabou , Ouedraogo Macaire S , Fumoux Francis , Traore Yves
Published: November 2019

Introduction: The purpose of our study is to evaluate the immunological profile of dengue markers in patients suspected during the 2017 epidemic period in Bobo-Dioulasso. Methods and patients: This is a cross-sectional retrospective study of 367 subjects over a period of 03 months. Samples and clinical information come from suspected cases in the Hauts-Bassins health area. Whole blood had been taken from two tubes. A dry tube for immunochromatographic detection of antigen NS1, Immunoglobulin M and G. Another tube with EDTA for blood count by flow cytometry. The SD BIOLINE Dengue Duo® Kit was used for the diagnosis of dengue fever. Results: In general, we obtained a seroprevalence of 35.42%. The proportion of infected males and females was 19.61% and 15.80%, respectively. The distribution of direct and indirect markers in patients was 20.43% for AgNS1; 12.53% for IgG and 1.08% for IgM. Of the subjects in the study 39.39% had thrombocytopenia and 12.12% had leukopenia. Conclusion: In view of the results obtained, dengue fever is a real health problem in Burkina Faso. It also shows that direct markers of early diagnosis of dengue fever are more common than indirect markers. Therefore, ultrasensitive direct diagnostic tests should be used more extensively in the dengue diagnostic algorithm.
Cervical Cutaneous Tuberculosis Shows the Inflammatory Infection Environment of Local Necrotic Granulation Tissue through the Expression Profile of Chemokine
Authors: Huang Zihui , Qian Jiayan , Gao Lujue , Hong Lianqing , Li Yazhou , Yu Yang , Zhu Sixun , Gao Minxing
Published: November 2019

Background Tuberculosis is an important infectious disease that jeopardizes human health. Research on extrapulmonary tuberculosis is still rare, especially cutaneous tuberculosis, a more refractory extrapulmonary tuberculosis. This study is to explore the inflammatory and immunobiomarkers of patients with cutaneous tuberculosis and to analyze the potential functions and pathways involved in the pathogenesis of M. tuberculosis (Mtb) infection, in order to support cutaneous tuberculosis diagnosis and treatment.Methods Analysis of mRNA identifies biomarkers in cutaneous tuberculosis and non-specific infectious ulcer tissue. Analyze the correlation between gene ontology (GO) and the Kyoto Gene and Genomic Encyclopedia (KEGG) biological pathways, immunity, inflammation and chemokines. Chemotaxis factors such as CXCL9, CXCL10, CXCL11 and CXCR3 were compared by quantitative PCR analysis.Results The mRNA expression levels of CXCL9, CXCL10, CXCL11 and CXCR3 in local necrotic granulation tissue of cutaneous tuberculosis were significantly increased compared with those of normal tissues. GO analysis indicated that activation of various immune responses and inflammatory responses may be associated with up-regulation of chemokine genes. Gene Ontology (GO) and Kyoto Biogenomics and Genomics Encyclopedia (KEGG) biological pathway analysis revealed the relationship between immune, inflammatory and chemokine pathways.Conclusion GO analysis and KEGG analysis of differentially expressed mRNA revealed potential functions and pathways associated with the onset of Mtb infection.
Comparison of a quantitative Real-Time PCR Assay and droplet digital PCR Assay for detection of Streptococcus agalactiae
Authors: Guo Xu-Guang , Zeng Yi-Fan , Chen Chu-Mao , Li Xiao-Yan , Chen Jun-Jiang , Wang Yan-Ge , Ouyang Shi , Ji Tian-Xing , Xia Yong
Published: November 2019

Background :Streptococcus agalactiae(GBS) is pathogenic bacterium that causes puerperal sepsis in pregnant women and meningitis in newborns. Reliable detection methods for GBS included culture-based approaches, antigen-antibody method and real-time quantitative PCR. However, these methods have low sensitivity and are time consuming. In this study, we established a new detection approach, i.e. droplet digital PCR (ddPCR), for more accurate detection of GBS.
Materials and Methods : Clinical specimens infected with GBS were analyzed using culture method. QPCR and ddPCR were used to quantify GBS related genes (CpsE and Sip gene). All experiments were run in triplicate using the same positive strain to verify the repeatability of the methodology.
Results: The ddPCR showed outstanding accuracy, with 100% sensitivity, 100% specificity and coefficient of variation =4.5%. Among the detected strains, only positive results were obtained for the CpsE gene by ddPCR, and the detection sensitivity was 5pg/μL. Compared to the level of individual nanogramme-sized(0.5ng/μL) of qPCR assay, ddPCR resulted as a more significantly accurate method for detection of GBS in precision medical area.
Conclusions : Droplet digital PCR offers high sensitivity, accuracy and repeatability, and is a suitable approach for detection of positive GBS samples.
Mycoplasma pneumoniae​ pneumonia associated thrombosis at Beijing Children’s Hospital
Authors: Liu Jinrong , He Ruxuan , Wu Runhui , Wang Bei , Xu Hui , Zhang Yue , Li Huimin , Zhao Shunying
Published: November 2019

Background: With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis.

Methods: Data from 43 cases of MPP-associated thrombosis were retrospectively analyzed. The results of blood coagulation studies and autoimmune antibody and thrombophilia screening were analyzed. The results of contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes.
Results: Forty-two patients were diagnosed with SMPP. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3–1 lobe in 10 patients, > 1 lobe in 29 patients). Thrombosis can occur in a vessel of any part of the body. It can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough.
Conclusions: SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L, would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy.
High Contribution and Impact of Resistant Gram Negative Pathogens Causing Surgical Site infections at a Multi-Hospital Healthcare System in Saudi Arabia, 2007-2016
Authors: Balkhy Hanan , El-Saed Aiman , Alshamrani Majid M. , Aljohani Sameera , Alsaedi Asim , Nasser Wafa Al , Gammal Ayman El , Almohrij Saad A. , Alyousef Ziyad , Almunif Sara , Alzahrani Mohammad
Published: November 2019

BACKGROUND Despite being largely preventable, surgical site infections (SSIs) is still one of the most frequent healthcare associated infections worldwide. The presence of resistant pathogens can further augment its clinical and economic impact. The objective was to estimate the prevalence and extent of resistance in SSI pathogens in a tertiary care setting in Saudi Arabia and to compare such data to US National Healthcare Safety Network (NHSN) hospitals.METHODS Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN.RESULTS A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were Staphylococcus aureus (22.8%), Pseudomonas (20.1%), Klebsiella (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus were methicillin-resistant (MRSA), 13.0% of Enterococci were vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter (58.3%), Klebsiella (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent in our hospitals compared with NHSN hospitals.CONCLUSION GNPs in a tertiary care setting in Saudi Arabia are responsible for approximately 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support of caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.KEYWORDS Antimicrobial resistance, multidrug resistance, surgical site infections, surveillance, pathogens, hospital, Saudi Arabia
Clinical and microbiological effect of pulsed xenon ultraviolet disinfection to reduce multidrug-resistant organisms in the intensive care unit in a Japanese hospital: a before-after study
Authors: Morikane Keita , Suzuki Shoko , Yoshioka Jun , Yakuwa Jun , Nakane Masaki , Nemoto Kenji
Published: November 2019

Background

No-touch environmental disinfection using ultraviolet devices has been highlighted in the past several years to control the transmission of multidrug-resistant organisms (MDROs). However, its effectiveness in non-US healthcare settings is yet to be examined. This study aimed to evaluate the effectiveness of disinfection by portable pulsed xenon ultraviolet (PX-UV) devices in controlling transmission of MDROs in a non-US healthcare setting.

Methods

All patients admitted in the intensive care unit in a 629-bed tertiary referral hospital in Japan from August 2016 to February 2019 were enrolled. During the study period, PX-UV disinfection was added to manual terminal cleaning after every patient transfer/discharge. For microbiological evaluation, surfaces were selected for sampling by contact plates before/after manual cleaning and after PX-UV. After overnight incubation, colonies on the plates were counted.

Results

The incidence of newly acquired methicillin-resistant Staphylococcus aureus (MRSA) declined significantly (13.8 to 9.9 per 10,000 patient days, incidence rate ratio 0.71, p=0.002), as well as that of newly acquired drug-resistant Acinetobacter (48.5 to 18.1, 0.37, p<0.001). The percent reduction of the microbiological burden by manual cleaning was 81%, but a further 59% reduction was achieved by PX-UV.

Conclusions

PX-UV is effective in further reducing the microbial burden and controlling MDROs in a non-US healthcare setting.
Defining Access Management in Healthcare Delivery Organizations
Authors: Hempel Susanne , Hilton Lara G. , Stockdale Susan , Kaboli Peter , Miake-Lye Isomi , Danz Margie , Rose Danielle , Kirsh Susan , Curtis Idamay , Rubenstein Lisa V.
Published: November 2019

Background: Managing patient access to care in healthcare delivery organizations is complex, yet instrumental in shaping patient healthcare experiences. Conceptual work to understand the dimensions of access and access management is critical for improvement initiatives. This work aims to advance primary care access management practice and research to support healthcare delivery organizations.
Methods: We convened a stakeholder panel, informed by evidence review, to establish access and access management definitions. Stakeholders were selected based on a patient-centered framework and included patients, healthcare providers, policy makers, product makers, payers, and purchasers of healthcare. Methods included evidence review; written surveys; in-person stakeholder panel discussions; and concurrent sub-panels to establish recurring, cross-panel themes.
Results: Literature review results showed variation in access concept definition but consistent use of the temporal measure “time to third next available appointment” as an indicator of access. Panel deliberations highlighted the importance of patient-centeredness and resulted in three comprehensive definitions: 1) “ Access management encompasses the set of goals, evaluations, actions and resources needed to achieve patient-centered healthcare services that maximize access for defined eligible populations of patients; ” 2) “ Optimal access management engages patients, providers, and teams in continuously improving care design and delivery to achieve optimal access;” and 3) “ Optimal access balances considerations of equity, patient preferences, patient needs, provider and staff needs, and value.”
Conclusions: Access to healthcare is substantially determined by how healthcare delivery organizations manage it. The developed concepts of access management suggest that access management, improvement initiatives, and research studies require ongoing attention to organizational processes and multiple relevant outcomes. Healthcare organizations and researchers can use the definitions as starting points for initiatives to improve access management and evaluations of access initiative success.
Kamkatın (Fortunella spp.) Besinsel İçeriği ve Fonksiyonel Özellikleri
Authors: OLCAY Nezahat , DEMİR Mustafa Kürşat
Published: November 2019

Kamkat, Rutaceae familyasının Fortunella cinsindeki bir bitki türü olup, genellikle bu bitkinin en küçük turunçgil meyvesi olarak da bilinen meyvelerine verilen isimdir. Anavatanı Çin olan kamkat, yuvarlak-oval şekle, turuncu-sarı renge sahip bir meyvedir. Kamkat meyvesinin başlıca beş türü olmakla birlikte, diğer narenciyelerle hibrit yeni meyveler de üretilmektedir. Kabuk bileşimindeki terpenoid ve flavonoidler sayesinde diğer narenciyelerin aksine kabuğuyla birlikte tüketilebilir. Besinsel olarak demir, kalsiyum, A, B2 ve C vitamini içeriği ile diyet lif oranı yüksektir. Kamkat uçucu yağının bileşimini çoğunlukla terpenoidler oluşturup, majör terpen bileşiği d-limonendir. 3’,5’-Di-C-β glukopiranozilfloretin ise kamkat türünün karakteristik fenolik bileşiğidir. Serbest radikal yakalama aktivitesi fazla olan kamkatın, antioksidan kapasitesi bileşimindeki yüksek fenolik bileşik içeriğinden kaynaklanmaktadır. Antifungal özelliğinin yanı sıra sağlık üzerinde antiviral, antiaterojenik, antienflamatuar ve antikanser etki de gösterir. Kamkat hem besinsel hem fitokimyasal içeriğiyle, gıda ve farmakoloji alanında gitgide önem kazanan bir konumdadır.
Okul Bahçelerinin Ekolojik Göstergelere Göre Değerlendirilmesi: Kilis Kenti Örneği
Authors: YÜCEKAYA Murat , GÜNAYDİN Ahmet Salih , TAŞÇIOĞLU Saliha , DEMİROĞLU Demet
Published: November 2019

Hızlı kentleşme ile birlikte değişen yaşam koşulları, kent kullanıcılarını ve aynı zamanda çocukların oyun alanlarını da olumsuz etkilemektedir. Günümüzde artan yapı yoğunluğu, trafik ve kentlerdeki göç alımı ile kentlerde değişen insan profiline bağlı olarak azalan güven duygusu, okul çağındaki çocukların sokak ve çevreyle olan bağlantısını koparmıştır. Ayrıca kentlerde açık ve yeşil alanların azalması nedeniyle çocukların oyun alanları kısıtlanırken, eğitim alanları içerisinde bulunan okul bahçeleri de bu açığı kapatmak amacıyla daha fazla önem kazanmıştır. Çocukların ve gençlerin çevre bilinci kazanma noktasında da önemli aktörlerden biri olan okul bahçelerinin ekolojik bazı göstergelere göre düzenlenmesi son derece önemlidir. Bu göstergelerden en önemlileri; yeşil alan oranları, kullanılan bitkilerin doğallık değerleri ve alanlardaki bitki örtüsü çeşitliliğidir. Çalışmanın amacı Kilis kent merkezinde bulunan okul bahçelerinin söz konusu bu göstergelere göre değerlendirilmesidir. Çalışmada Kilis kent merkezinde yer alan 8 anaokulunun, 36 ilköğretim okulunun ve 14 lisenin açık ve yeşil alanları değerlendirilmiştir. Çalışma alanında yeşil alan oranı ve kişi başına düşen yeşil alan miktarının en az olduğu eğitim kurumları ilköğretimler; en fazla olduğu kurumlar ise liseler olarak belirlenmiştir. Tüm okullardaki ortalama doğallık değeri % 40’ın üzerinde olup; okul bahçelerindeki bitki örtüsü çeşitliliğinin yeterli olmadığı sonucuna varılmıştır.
Su Sıcaklığının Tubifex tubifex (Müller, 1774)’in Yaşama Oranı Üzerine Etkisi
Authors: ÇELİK Pinar
Published: November 2019

Bu çalışmada, akvaryum balıklarının beslenmesinde canlı yem olarak kullanılan Tubifex tubifex’in hayatta kalma oranı ile su sıcaklığı arasındaki ilişki incelenmiştir. Bu amaçla, T. tubifex kurtları 60 gün süresince 8 farklı su sıcaklığında (14, 16, 18, 20, 22, 24, 26 ve 28°C) tutulmuştur. Her biri 3 tekerrürlü, 8 grup şeklinde yürütülen çalışmada, deneme başı canlı sayıları ile deneme sonu canlı sayıları kıyaslanmıştır. Çalışmada su sıcaklığının T. tubifex’ in yaşama oranını önemli ölçüde etkilediği tespit edilmiştir (p<0.05). Sonuç olarak, bu çalışma 18°C ile 24°C arasındaki sıcaklıkların T. tubifex yetiştiriciliğinde en uygun sıcaklıklar olduğunu göstermiştir.
Bal Arılarında Beslemenin Koloni Dinamiği Üzerine Etkileri
Authors: TOPAL Erkan , YÜCEL Banu , İVGİN TUNCA Rahşan , KÖSOĞLU Mustafa
Published: November 2019

Beslenmede besin maddelerinin kalite ve miktarları; organizmaların yaşamsal faaliyetleri için çok önemlidir. Yetersiz ve dengesiz beslenme sonucunda organizmalarda stres artar, üreme yeteneklerinde düşme ve hastalıklara karşı dirençte azalma gerçekleşir. Bal arılarının da yaşam fonksiyonlarını gerçekleştirebilmeleri, koloni performansının artırmaları ve arıcılık faaliyetinin amacına uygun olarak yapılabilmesi için biyotik ve abiyotik nedenlerle doğal besin maddelerinin temininde karşılaşılan olumsuzluklarda ek besleme kaçınılmazdır. Yetersiz beslenme; kolonilerin sönmesine neden olabilmektedir. Bal arılarında görülen birçok hastalığın, yanlış ya da eksik beslenmeden kaynaklandığı ön görülmektedir. Koloni yaşamı; sağlık, üretkenlik ve hizmetlerin (tozlaşma) sürekliliği, doğal habitattaki besin maddelerinin koloni popülasyon dinamiği ve koloni fizyolojisi ile eşzamanlı yeterliliği ve ihtiyaç halinde yapılacak ek besleme ile sağlanabilir. Bal arılarının beslenmesinde ilk akla gelen “şeker” beslemesi olsa da, bal arıları için asıl önemli olan temel besin maddesi proteindir. Arının protein gereksinimi kaliteli taze polenden karşılanmaktadır. Son yıllarda sektöre sunulan birçok hazır kek kolonilerin protein ihtiyacını karşılamak amacıyla satılmaktadır. Bu keklerin içeriğinde yeterli miktarda protein içermemesi veya katkı maddeleri ihtiva etmeleri nedeniyle, doğal polenin alternatifi olamamaktadır. Kolonilerin farklı besin madde gruplarıyla beslenmesinin arılar üzerinde etkilerini ve uygulama sırasında dikkat edilmesi gereken hususları içeren birçok araştırma bulunmaktadır. Bu derlemede, bal arılarının beslenmesi ile ilgili yapılan çalışmalar değerlendirilerek, sürdürülebilir ve başarılı arıcılık için ipuçları sunulmaya çalışılmıştır.
Süt Sığırlarında Korunmuş Metiyonin ve Lizin Beslemesinin Rumen Mikroflorası İle Süt Verim ve Kompozisyonu Üzerine Etkileri
Authors: BİLGEÇLİ Kazım , YILMAZ Aydan
Published: November 2019

Bu çalışma ile süt sığırlarında amino asit (AA) dengesi, emilebilir AA kaynakları, esansiyel AA ihtiyacı, kaplanmış metiyonin (MET) ve lizin (LİZ) ile kaplama teknolojileri ve korunmuş MET (KMET) ve LİZ (KLİZ), rumen mikroflorası ve verim ilişkileri irdelenerek, KMET ve KLİZ beslemesinin rumen mikroflorası ile süt verim (SV) ve kompozisyonu üzerindeki etkilerinin belirlemesi amaçlanmıştır. Çalışma sonucunda, mikrobiyal proteinlerin ideal AA dengesine sahip olmadıkları, mikrobiyal proteindeki AA kompozisyonunu yemle alınan rumende yıkıma dirençli protein (RYDP) ve rumende yıkılabilir protein (RYP)’nin belirlediği, maksimum performans ve verim için rasyonun RYDP, RYP ve AA bakımından dengelenmesi gerektiği, duodenal AA kompozisyonun mikrobiyal populasyon ve rasyon proteinindeki varyasyonlardan etkilendiği, buğdaygil ağırlıklı hazırlanmış rasyonlarda LİZ’in baklagil ve hayvansal ağırlıklı rasyonlarda ise MET’in sınırlayıcı AA’ler olacağı, KMET ve KLİZ kullanımının sentetiklere göre daha etkili olduğu, KMET’in süt yağı ve verimini artırdığı, erken laktasyon döneminde kaplanmış formda MET ve LİZ’in birlikte kullanıldığı araştırmalarda SV ile birlikte süt protein ve yağında artışlar bulunduğu saptanmıştır. Sonuç olarak, KMET ve KLİZ’in rumen mikroflorası üzerine herhangi bir olumsuz etkisi olmaksızın SV ile birlikte süt protein ve yağında artışlara neden olduğundan, özellikle erken laktasyon dönemindeki süt sığırlarında birlikte kullanılabileceği kanatine varılmıştır.
Eğrilik Teorisi Kullanarak Regle Yüzey Tasarlamada Yeni Bir Yaklaşım
Authors: GÜLER Fatma
Published: November 2019

Bu çalışmada küresel gösterge eğrisi tarafından üretilen regle yüzeyler için yeni bir yaklaşım elde edildi. Üreteç çatısı yardımıyla striksiyon eğrisi dayanak eğrisi olarak alınan regle yüzey araştırıldı. Regle yüzeylerin eğrilik teorisi kullanılarak striksiyon eğrisinin yüzey üzerinde geodezik eğri ve asimptotik eğri olması için teoremler verildi. Ayrıca, regle yüzeyin Gauss ve ortalama eğrilikleri ile temel formları hesaplandı. Küresel gösterge eğrisi tarafından üretilen regle yüzeye örnek verildi.
El teletrabajo en salud laboral
Authors: Vicente Herrero Mª Teofila , Torres Alberich Jose Ignacio , Torres Vicente Alfonso , Ramirez Iñiguez de la Torre Maria Victoria , Capdevila García Luisa
Published: November 2019

El teletrabajo se define como la actividad laboral que se desarrolla fuera de las instalaciones de la empresa y con el uso de tecnologías de la información y de la comunicación. La normativa básica parte del Acuerdo Marco Europeo de 2002 sobre el Teletrabajo. En España, el Estatuto de los Trabajadores, recoge desde 2012 en su artículo 13 las características del trabajo a distancia. Los principales riesgos laborales detectados son los ergonómicos, psicosociales y la difícil separación de la vida familiar y laboral, junto con el impacto en contaminación medioambiental por el uso de tecnologías de la información y comunicación. La investigación médica en este tema es escasa y centrada en su uso en personas con limitaciones por discapacidad, edad, situación de embarazo, postparto o lactancia y en epidemias o pandemias. Es necesario adaptar las normas sobre seguridad e higiene en el trabajo a los casos de teletrabajo.
VI Simposio en Medicina Tropical (Nefropatía tropical). Resúmenes y pósteres
Authors: Cardona-Castro Nora María
Published: November 2019

En este número de la revista CES Medicina se publican los resúmenes de las conferencias y de los trabajos presentados en formato cartel por estudiantes y asistentes en el VI Simposio en Medicina Tropical, cuyo tema este año fue nefropatía tropical. Continuaremos con la labor de difundir el conocimiento y la investigación en temas endémicos y epidémicos que afectan a nuestras poblaciones
Índice de masa corporal y su relación con la prevalencia de caries dental en escolares de Huando, Huancavelica, Perú, 2016
Authors: Aquino Canchari Christian Renzo , Cuya-Salvatierra Geovanny Nilton
Published: November 2019

Introducción y Objetivo: Comprender el impacto de los desórdenes metabólicosen la salud se ha vuelto una problemática mundial en los últimosaños. Determinar la relación entre el Índice de Masa Corporal (IMC) conla prevalencia de caries dental en escolares de 6 a 12 años de edad deHuando-Huancavelica, en el año 2016. Materiales y métodos: Estudio observacional,descriptivo, transversal. La muestra estuvo conformada por220 escolares seleccionados aleatoriamente, cumpliendo criterios de inclusióny exclusión y siguiendo las normas éticas en investigación. Los datosse analizaron en el programa SPSS 21 mediante tablas de distribuciónde frecuencias y la prueba chi cuadrado para determinar la existencia deasociación entre IMC y caries dental. Resultados: La prevalencia de cariesdental fue de 91.82 % (COP-D = 4,08, ceo-d = 5,81). Respecto al estado nutricional30 niños presentaron desnutrición (13,63%) y 23 sobrepeso (10,45),el resto presento un peso y talla adecuado para su edad, ninguno presentola condición de obesidad. No hubo asociación estadística entre el IMC ycaries dental (p = 0,612). Conclusiones: La malnutrición no predispone ala presencia de lesiones cariosas por su etiología multifactorial, debemosremarcar que ambos son problemas prioritarios en salud pública por locual se requiere un trabajo en conjunto entre los padres y autoridadeseducativas.
Caracterización de la capa híbrida en dentina intraradicular pretratada con hipoclorito de sodio al 5,25% usando dos agentes cementantes con sistemas adhesivos de auto y grabado convencional
Authors: Vargas-Barreto Alfredo , Navarro-Jiménez Eduardo , Alcocer-Olaciregui Adalgisa , Daher-Joujah Mohamed , Osorio-Gonzalez María , Correa-Monroy Victoria
Published: November 2019

Introducción y objetivo: En la actualidad, la rehabilitación de dientes tratados endodónticamente representa una gran demanda para el ejercicio profesional del rehabilitador oral. Por esta razón, surge la necesidad de identificar y manejar los procesos básicos y los determinantes biológicos que influencian un buen proceso de adhesión dentinal. El objetivo de este estudio fue caracterizar la capa híbrida en dentina intraradicular pretratada con hipoclorito de sodio (NaClO) al 5,25% usando dos agentes cementantes con sistemas adhesivos de auto y grabado convencional. Materiales y métodos: Se seleccionaron 40 dientes premolares unirradiculares que fueron distribuidos aleatoriamente en 4 grupos. Grupo A (dentina pretratada con NaClO al 5,25% y cementado con cemento Relyx® Ultimate (3M), grupo B(control del grupo A, sin pretratamiento de dentina); grupo C (dentina pretratadacon NaClO al 5,25% y cementado con cemento para Core®) y grupo D: Control del grupo C, sin pretratamiento de dentina. Los dientes fueron seccionados transversalmente y se analizó la presencia de capa híbrida enlos tercios cervical y medio radicular a través de microscopia electrónica de barrido. Resultados: Se encontraron diferencias estadísticamente significativas en el grosor de la capa híbrida de dientes pretratados con NaClOal 5,25% y cementados con paraCore® en comparación a los cementados con Relyx® ultimate valor p = 0,023 para la prueba de Anova.
Preparación Químico-mecánica del Tercio Apical en Micro-Cirugía Endodóntica. Una Revisión
Authors: Joya-Grajales Elizabeth , Fernández-Grisales Rafael
Published: November 2019

El control micro-biológico y el selle tridimensional del conducto radicular son factores escenciales para alcanzar el éxito del tratamiento endodóntico. Actualmente la tasa de éxito para la micro-cirugía endodóntica es acerca del 92% cuando esta es realizada con el uso del microscopio como coadyudanteen los procedimientos de conformación quimico-mecánica y selle del tercio apical. En consecuencia, el objetivo de este articulo fue hacer una revisión actualizada de todos los procedimientos clínicos retropreparación y desinfección del conducto radicular en micro-cirugía endodóntica, la cual fue soportada con la mejor evidencia disponible a la fecha.
Avaliação odontológica de pacientes em unidade de terapia intensiva (UTI) pediátrica
Authors: Leite Hadda Hadda Lyzandra Austriaco , Ferreira Lopes Fernanda , Cardoso da Silva Maria do Socorro Alves , Diniz-Souza Luana Carneiro
Published: November 2019

ntrodução e Objetivo: Há necessidade de trabalhos envolvendo criançassubmetidas à abordagem odontológica em ambiente hospitalar para relataras características clínicas das crianças atendidas pelo Serviço deOdontologia da Unidade de Terapia Intensiva Pediátrica (UTIPed) de umhospital de referência do Sistema Único de Saúde (SUS). Registrar dascondições bucais das crianças e tratamentos realizados pela equipe deprofissionais em Odontologia. Materiais e métodos: estudo descritivoretrospectivo, através de resgate de prontuários e os resultados foramtabulados e analisados por meio de diferença percentual. A amostra foicomposta por 145 pacientes de 0 a 15 anos de idade atendidos e acompanhadospelo serviço de Odontologia da UTIPed no período de setembro2016 a novembro 2017. Os pacientes foram analisados quanto gênero, idade,motivo da internação, nível de consciência, condição das vias aéreas, processospatológicos na cavidade bucal, procedimentos odontológicos realizados,material de higiene bucal utilizado e presença de PAV. Resultados: Os pacientes encontravam-se na faixa etária de menor que 1 ano até 17anos, sendo mais frequente o sexo feminino (54,48%). Em relação à procedência94 (64,23%) eram pacientes internos do Hospital Universitário e51 (35,77%) foram transferidos de outros hospitais. Ao avaliarmos as condiçõesde saúde bucal, 45,83% dos pacientes apresentavam higiene bucalsatisfatória, 45,14% regular e 9,03% deficiente. Em relação às condiçõesda mucosa bucal, apenas 5,52% dos pacientes apresentaram alterações,destas, 3,45% já se encontravam no momento da admissão. Conclusão: Verificou-se que as crianças hospitalizadas em UTI Pediátrica podemapresentar alterações em mucosa bucal desde o momento da admissão,sendo mandatória a presença constante do Cirurgião-dentista na equipeda UTI para tratar e proporcionar uma maior adesão aos cuidados bucaisa estes pacientes.
Factores asociados a dentición funcional en adultos mayores de la subred centro oriente, Bogotá, 2017
Authors: Monroy-Ramirez Mónica Johanna , Méndez-Castilla José Mauricio , Tello- Medina Miguel Ángel , Buitrago-Medina Daniel Alejandro
Published: November 2019

Introducción y objetivo: determinar los factores relacionados con la dentición funcional según el concepto de la Organización Mundial de la salud-OMS-; y su prevalencia en un grupo de adultos mayores usuarios del servicio de odontología de la Subred Centro Oriente de Bogotá en 2017. Materiales y métodos: estudio transversal en el que se tomó como variable dependiente la dentición funcional. Mediante regresión logística binaria se identificaron las variables independientes que explican mejor la dentición funcional. Los datos fueron tomados de historias clínicas diligenciadas por odontólogos capacitados y para los análisis estadísticos se empleó el software IBM-SPSS versión 24. Se analizaron 394 historias de adultos, mayores de 60 años, valorados en el servicio de odontología. Resultados: la prevalencia de dentición funcional fue del 17%. El análisis multivariado determinó que los factores que mejor explicaron la dentición funcional fueron sexo (RP^1,6), edad (β^-0,08), presencia de comorbilidades (RP^3,4), y uso de seda dental (RP^1,2). Conclusiones: los datos evidencian baja prevalencia de dentición funcional en la población estudiada. Ser de edad más avanzada, ser mujer y no usar la seda dental, fueron factores relacionados con menor dentición funcional, mientras que la presencia de comorbilidades,por su parte, se asoció a mayor dentición funcional en la población estudiada.Los hallazgos del estudio sugieren la importancia de fortalecer el componente de actividades preventivas a lo largo del ciclo vital, e incluso,desde edades tempranas para disminuir la pérdida dental.
El potencial terapéutico del secretoma de las células troncales
Authors: Martínez-Carreño Miguel Angel , Rodriguez Saenz Alvaro Andrés , Munévar-Niño Juan Carlos
Published: November 2019

Las células troncales mesenquimales (CMMs), juegan un papel muy importante en el campo de la medicina regenerativa e ingeniería tisular, puesto que estas células indiferenciadas tienen la increíble capacidad de autorenovarse y de diferenciarse en varios linajes celulares adultos con funciones especializadas. Así mismo, estas células cuentan con la capacidad de inmunomodulación y homing y no tienen riesgo de generar teratoma en contraste con las células troncales embrionarias o las células troncales pluripotenciales inducidas. Del mismo modo, varios autores resaltan las capacidad regenerativa de los productos de estas células conocido como secretoma. Estos productos juegan una papel muy importante en procesos de cicatrización y neoangiogénesis, por lo que resultan ideales para aplicarlo en terapias basada en regeneración y reparación de tejidos y órganos.