Ecological study of gastric cancer in Brazil:Geographic and time trend analysis

AIM:To investigate the geographic distributions and time trends of gastric cancer(GC)incidence and mortality in Brazil.METHODS:An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010.The data included information on the gender,age,and town of residence at the time of hospital admission and death.RESULTS:The GC rates,adjusted according to available hospital beds,decreased from 13.8 per 100000in 2005 to 12.7 per 100000 in 2010.The GC rates decreased more among the younger age groups,in which the male-to-female difference also decreased in comparison to the older age groups.Although the lethality rates tended to increase with age,young patients were proportionally more affected.The spatial GC distribution showed that the rates were higher in the south and southeast.However,while the rates decreased in the central-west and south,they increased in the northern regions.A geographic analysis showed higher rates of GC in more urbanized areas,with a coast-toinland gradient.Geographically,GC lethality overlapped greatly with the hospital admission rates.CONCLUSION:The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis.The declining rates in young patients,particularly males,suggest a relatively recent decrease in the exposure to risk factors associated with GC.The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.     

L’Artiste en milieu hospitalier : une expérience musicale en hémodialyse pédiatrique

Culture at the hospital is part of a policy of providing everyone access to culture. This article describes a musical intervention that provides patients and healthcare professionals a central role in creation; qualitatively assesses the benefits of these interventions for children and caregivers; evaluate the lessons learned from this ongoing experience in the pediatric hemodialysis unit of Rouen University Hospital. Ninety-minute sessions take place twice a week, with eight children aged from 18 months to 19 years, during dialysis. To assess the effects of artistic interventions in the unit, a qualitative methodology was chosen (observation grid). The progression of the project is evaluated to highlight what has helped the children and caregivers reach autonomy in artistic creation while respecting the time allotted, the artistic approach, and the esthetics of each participant's creation. The results indicate that this approach allows children to be actors, that the time at the hospital is relativized, and that the relationship with the healthcare professionals is less oriented towards care. A discussion follows on the place of the artist and the untapped potential of bringing patients to the creative act; the issue of esthetics, which then becomes secondary; the complementarity between musical activities and creation, and the role each actor plays in an artistic project. The hospital can provide access to culture; however, it is possible to go further and reveal patients’ creativity.     

Clinical factors and self‐perceived oral health

Self‐perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self‐perceived oral health within two age groups. Data of 891 adults (35–44 yr of age) and 760 older people (65–74 yr of age) from the Fourth German Oral Health Study (DMS IV, 2005) were evaluated. Self‐perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing (BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self‐perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self‐perceptions of oral health.     

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

Vinylsiloxanether: A New Impression Material. Clinical Study of Implant Impressions with Vinylsiloxanether versus Polyether Materials

Aim: The performance of three elastomeric materials for the open monophase implant impressions technique was tested under the following clinical conditions: polyether (IM) and vinylsiloxanether without (ID) and with additional simultaneous splinting of the implant impression copings with a higher shore hardness A‐silicone (IDF). Materials and Methods: The three test groups, IM, ID, and IDF, were randomly allocated 10 test subjects with three to five implants each. The impressions were analyzed regarding the subjective clinical assessments with 11‐point rating scales by the dentist, the patient, and the dental technician, as well as to the comparison of these assessments with the objectified clinical fit of the manufactured crowns based on standard clinical evaluation criteria. The three groups were statistically analyzed on the basis of the hypothesis of non‐inferiority of ID versus IM and IDF versus IM (alpha < 0.05). Results: The results of the study showed the objective clinical fit of the dental prostheses made using ID being comparable to the results obtained with IM. Compared with ID and IM, the precision of fit attained with IDF was reduced, although the subjective dentist assessments of IDF were in parts significantly better than those of IM and ID (p = .015). A statistically significant superiority of ID in comparison with IM could be determined with regard to the subjective ratings of the taste by the test subject (p < .01), of the handling (p < .001) and of the precision details of impression (p = .012) by the dentist, and of removing the plaster model from the mold by the dental technician (p = .017). Conclusions: The overall results of the vinylsiloxanether material in terms of the patients', dentists', and dental technicians' assessments proved to be equivalent or superior to those of the polyether material. The IDF technique cannot be recommended for this application.     

受试者管理中研究护士的职责探讨

目的 探讨研究护士在临床试验中的地位和作用。方法 研究护士从获取知情同意、数据收集、协助试验管理等方面行使职责。结果 对确保临床试验的伦理合理性、科学性及试验数据的可信度方面起重要保证作用。结论 管理好受试者是临床试验研究中面临的难题,而研究护士的设立是破解这一难题的有效措施。     

个案研讨式沙龙在老年患者护理骨干培训中的应用效果

目的探讨个案研讨式沙龙在老年患者护理骨干培训中的应用及效果。方法 2012年6-9月南方医科大学珠江医院举办护理人员老年患者护理专项进修班,从各个专科老年人的常见病、重点需要解决的问题、难点入手,通过个案研讨、统一规范的组织形式安排组织了7次个案研讨式沙龙活动。在沙龙开展前和最后一次沙龙结束时进行问卷调查,并评价培训效果。结果 33名学员中,26名(占78.8%)学员在参加本期护理沙龙前没有参加过其他形式的护理沙龙;对本期沙龙的形式及内容安排的满意率为100%,认为总体收获较大的32名(占97.0%)学员认为个案研讨式沙龙对提高临床实践能力比较有效,33名(100%)学员认为对提高全院老年患者护理整体水平和科室间合作非常重要;参加个案研讨式沙龙前后,学员的老年患者护理相关能力自评总分分别为(33.98±8.564)分、(51.87±6.668)分,差异有统计学意义(t=19.549,P<0.01),且老年患者护理相关能力13个自评项目的评分均高于参加前,差异均有统计学意义(均P<0.01)。结论个案研讨式沙龙对提高临床老年患者护理骨干临床实践能力、促进理论向实践转化起到了积极的作用,在今后的护理骨干培养中可以进一步推广并实施。