Revista da Associacao Medica Brasileira (1992)最新文献

Background: How do caregivers of people with disabilities perceive the quality of health services in primary healthcare?

Objective: The objective of this study was to show the quality of health services for people with disabilities in primary healthcare, based on the perceptions of family caregivers.

Methods: This is a cross-sectional study. During data collection, 49 family caregivers who use the center were interviewed. The assessment instruments used were the Socio-Economic and Demographic Questionnaire and the PCATool-Brasil (Primary Care Assessment Tool), in the reduced adult and child versions, to assess the level of essential and derived characteristics of primary healthcare.

Results: Women were the main caregivers (40; 82%), and the main disability was mental (28; 58%). The highest scores were observed in affiliation (100%), utilization (73.4%), and information system (83.7%). The lowest scores were found in longitudinal (26.5%), integration of care, available services, services provided (28.6%), and derived scores (28.6-22.4%) related to family guidance and community guidance. The population showed a low orientation toward primary healthcare, with a high total score (22.4%). The economic situation showed a positive association (p=0.017).

Conclusion: According to the characteristics of primary healthcare, care is fragmented and disjointed and does not meet the needs of people with disabilities and their caregivers.

Objective: In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data.

Methods: Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024.

Results: In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36).

Conclusion: After evaluating our data retrospectively, we determined that we were compatible with the current literature.

Objective: Obstructive sleep apnea syndrome (OSAS) is an underdiagnosed condition that causes recurrent episodes of partial or total collapse of the upper airways during sleep. It is associated with perioperative pulmonary complications. The STOP-BANG is a screening tool for assessing patients at risk of OSAS. The aim of this study was to assess the prevalence of patients with OSAS during pre-anesthetic evaluation at a hospital and its correlation with predictors of ventilation and difficult airway.

Methods: This is an observational, cross-sectional study carried out from January 2022 to September 2023. The questionnaire comprised demographic data (age, weight, BMI, type of surgery, and anesthesia), the STOP-BANG, predictors of difficult orotracheal intubation (Mallampati, mouth opening, thyromental distance, cervical mobility, and upper lip bite test), and predictors of difficult ventilation through a facial mask (male sex, absence of teeth, presence of beard, obesity, and >55 years).

Results: The study had the participation of 221 patients, of whom 121 presented with a STOP-BANG ≥3, with a prevalence of 54.2%. All patients undergoing bariatric surgeries presented STOP-BANG ≥3. No significant statistical relationships were found between predictors of difficult orotracheal intubation and STOP-BANG ≥3. However, significant statistical relationships were found in relation to predictors of difficult ventilation through the facial mask.

Objective: The aim of the study was to determine the factors affecting poor sleep quality in the last trimester pregnant women.

Methods: A cross-sectional study was conducted at a tertiary care maternity hospital in Ankara, Turkey. The research was conducted between May and September 2019 with 570 pregnant women in the last trimester. The data were collected through the Personal Information Form, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire Short Form, Restless Legs Syndrome Form, Brief Fatigue Inventory, and Perceived Stress Scale.

Results: The mean Pittsburgh Sleep Quality Index score of the pregnant women was 5.98±3.31, and 48.9% of them were found to have over five Pittsburgh Sleep Quality Index scores. Hemoglobin levels, income perceptions, smoking habits, attending pregnant schools, experiencing leg pains or cramping, experiencing back, waist, or neck pains, Restless Legs Syndrome, fatigue levels, and perceived stress levels of the pregnant women were found to be important determinants of sleep quality (p<0.05).

Conclusion: According to the findings, increasing hemogram levels, attending antenatal education programs, and improving the ability of pregnant women to manage stress are opportunities to improve sleep quality during pregnancy. Careful evaluation of pregnant women in terms of insomnia and affecting factors can be suggested during antenatal follow-up.

Objective: Breast cancer is among the highest causes of morbidity and mortality in women. Trastuzumab therapy, which is known to be significantly cardiotoxic, is mainly used to treat patients with resistant breast cancer, including estrogen receptor-positive type. We aimed to show the effects of trastuzumab therapy on endothelial functions of breast cancer patients.

Methods: In this study, a total of 26 participants (24 female and 2 male patients, minimum age: 38 years, maximum age: 79 years, and mean age 57.3±12.7 years) were enrolled in the study. For the statistical evaluation of data, we classified the participants of the study as follows: Pretreatment: Before trastuzumab therapy; Treatment Period 1: 1 month after the first dose of trastuzumab; Treatment Period 2: 4 months after the first dose of trastuzumab; Treatment Period 3: 12 months after the first dose of trastuzumab. We conducted repeated-measures analysis of variance (Greenhouse-Geisser) and paired-sample t-tests to statistically compare the groups using flow-mediated dilation measurements.

Results: We determined that there are statistically significant differences between flow-mediated hyperemia and ratio values (flow-mediated dilation) of the groups (p<0.009 and p<0.001, respectively).

Conclusion: Our data indicate that trastuzumab therapy could have negative effects on endothelial functions in breast cancer patients.

Objective: The aim of this study was to estimate the prevalence of current smoking and its associated factors in adults aged 50 years and older in Brazil.

Methods: This cross-sectional study utilized data from the ELSI-Brazil study, encompassing 9,412 adults aged 50 years or over. A multivariate model using Poisson regression with a robust estimator was employed, estimating prevalence ratios and their 95% confidence intervals.

Results: The prevalence of current smoking was 17.04%. It was positively and independently associated with male gender, age up to 62 years, living without a partner, illiteracy, chronic obstructive pulmonary disease, depression, poor or very poor sleep quality, and alcohol intake more than once a month. Conversely, systemic arterial hypertension, hypercholesterolemia, diabetes mellitus, and repetitive strain injuries showed an inverse and independent association with current smoking.

Conclusion: The prevalence of current smoking among adults over 50 years old in Brazil was approximately 17%, with associations found with certain sociodemographic conditions and self-reported comorbidities.

Objective: The aim of this study was to determine the relationship between internet addiction and violence tendency in adolescent students and the factors affecting violence tendency.

Methods: The research was conducted on 2,648 middle school students in Turkey. A socio-demographic form, the Young Internet Addiction Scale, and the Violence Tendency Scale were used to collect data. The data were analyzed using descriptive statistics and multiple regression analysis.

Results: It was determined that there was a significant positive relationship between the Young Internet Addiction Scale and the Violence Tendency Scale. Age has a positive effect on violence tendency levels.

Conclusion: These findings suggest that the variables of age and internet addiction contribute to the occurrence of violence tendency. Psychiatric nurses should plan trainings and evaluate its effectiveness to raise awareness.