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1.
Maite Cruz Piqueras Ainhoa Rodríguez García de Cortazar Joaquín Hortal Carmona Javier Padilla Bernáldez 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(1)
Objective
To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters.Methods
Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain).Results
Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule.Conclusions
These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term “anti-vaccines” from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built. 相似文献2.
3.
Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection 总被引:10,自引:0,他引:10
M. del Mar Tomas M. Cartelle S. Pertega A. Beceiro P. Llinares D. Canle F. Molina R. Villanueva J. M. Cisneros G. Bou 《Clinical microbiology and infection》2005,11(7):540-546
Between October 2001 and August 2002, 30 hospital patients became infected or colonised by a multiresistant (including to carbapenems) epidemic strain of Acinetobacter baumannii (AbMR) in a hospital outbreak. This study analysed the risk-factors associated with acquisition of this epidemic strain and investigated the prognosis of patients infected by AbMR, with the aim of elucidating factors which lead to mortality. A case-control study of the acquisition of AbMR in patients infected or colonised in the hospital outbreak was performed. Independent risk-factors leading to death were studied by logistic regression analysis. Multivariate analysis of the risk-factors for colonisation/infection with AbMR revealed an independent association with the presence of an arterial catheter (OR, 1.13; 95% CI, 1.03-1.25) and administration of imipenem as monotherapy (OR, 11.12; 95% CI, 2.33-53.09). Multivariate analysis of the prognostic features leading to mortality revealed a significant association with hypotension or shock (OR, 24.63; 95% CI, 1.56-387.56) at the time of bacterial isolation. 相似文献
4.
Maria José GaldOn Estrella Durá Yolanda Andreu Maite Ferrando Rafael Poveda José Vicente Bagán 《Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics》2006,102(1):40-46
OBJECTIVE: This study analyzes the differences in psychological variables and symptomatology between temporomandibular disorder diagnosis subgroups. STUDY DESIGN: The sample included 114 temporomandibular disorder patients that were evaluated in coping, distress, and temporomandibular characteristics. Diagnostic muscular (n = 58) and articular (n = 56) subgroups were compared in these variables through a MANCOVA. RESULTS: Muscular patients show a higher level of general distress, specifically in the anxiety and somatization subscales and a more active coping style, with a tendency of a minor use of humor and a higher number of parafunctional habits, specifically, biting nails, hangnails, and lips. CONCLUSION: We discuss the differences found in order to design the targets of the psychological intervention of temporomandibular patients. 相似文献
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9.
Diffuse Axonal Injury (DAI) is not Associated with Elevated Intracranial Pressure (ICP) 总被引:7,自引:0,他引:7
Summary
Objective. Traditionally, intracranial pressure (ICP) monitoring has been utilized in all patients with severe head injury (Glasgow
coma score of 3–8). Ventriculostomy placement, however, does carry a 4 to 10 percent complication rate consisting mostly of
hematoma and infection. The authors propose that a subgroup of patients presenting with severe head trauma and diffuse axonal
injury without associated mass lesion, do not need ICP monitoring. Additionally, the monitoring data from ICP, MAP, and CPP
for a comparison severe head injury group, and subgroups of DAI would be presented.
Materials and methods. Thirty-six patients sustaining blunt head trauma and fitting our strict clinical and radiographic diagnosis of DAI were enrolled
in our study. Inclusion criteria were severe head injury patients who did not regain consciousness after the initial impact,
and whose CT scan demonstrated characteristic punctate hemorrhages of <10 mm diameter at the greywhite junction, basal ganglia,
corpus callosum, upper brainstem, or a combination of the above. Patients with significant mass lesions and documented anoxia
were excluded. Their intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were compared to a control group of
36 consecutive patients with severe non-penetrating non-operative head injury, using the Analysis for Variance method.
Results. Eighteen (50.0%), six (16.7%), and twelve (33.3%) patients had types I, II, and III DAI, respectively. The admission Glasgow
Coma Score (GCS) was higher for types I and II than for type III DAI. ICP was monitored from 23 to 165 hours, with a mean
ICP for 36 patients of 11.70 mmHg (SEM=75) and a range from 4.3 to 17.3 mmHg. Of all ICP recordings, of which 89.7% (2421/2698)
were ≤20 mmHg. Average mean arterial pressure (MAP) was 96.08 mmHg (SEM=1.69), and 94.6% (2038/2154) of all MAP readings were
greater than 80 mmHg. Average cerebral perfusion pressure (CPP) was 85.16 mmHg (SEM=1.68), and 90.1% (1941/2154) of all CPP
readings were greater than 70 mmHg. This is compared to the control group mean ICP, MAP, and CPP of 16.84 mmHg (p=0.000021),
92.80 mmHg (p=0.18), and 76.49 mmHg (p=0.0012). No treatment for sustained elevated ICP>20 mmHg was needed for DAI patients
except in two; one with extensive intraventricular and subarachnoid hemorrhage who developed communicating hydrocephalus,
and another with ventriculitis requiring intrathecal and intravenous antibiotic treatments. Two complications, one from a
catheter tract hematoma, and another with Staph epidermidis ventriculitis, were encountered.
All patients, except type III DAI, generally demonstrated marked clinical improvement with time. The outcome, as measured
by Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) was similarly better with types I and II than type III DAI.
Conclusion. The authors conclude that ICP elevation in DAI patients without associated mass lesions is not as prevalent as other severe
head injured patients, therefore ICP monitoring may not be as critical. The presence of an ICP monitoring device may contribute
to increased morbidity. Of key importance, however, is an accurate clinical history and interpretation of the CT scan. 相似文献
10.
Emilia Lachica Aurelio Luna Enrique Villanueva 《International journal of legal medicine》1989,103(2):111-119
Summary The diagnosis of myocardial infarction requires the use of a group of tests that are very efficient, quick and inexpensive. Another important consideration is the choice of myocardial sampling zones, especially in cases of differential diagnosis between a cardiac injury secondary to a trauma or violent asphyxia and others, secondary to myocardial infarction. The aim of this work was to choose, through discriminant analysis, the most useful zones of cardiac tissue for the quantification of free fatty acids and free carnitine and for the performance of the K/Na quotient, as biochemical parameters for the postmortem diagnosis of myocardial infarction. According to the discriminant analysis performed, seven zones of cardiac tissue are necessary to achieve a differential diagnosis among myocardial infarction, other natural deaths, and violent deaths with a 71.9% efficacy. Greater diagnostic efficacy was found (78.1%) for differentiating between natural deaths and violent deaths.
Offprint requests to: E. Lachica 相似文献