Social determinants of health,inequality and social inclusion among people with disabilities

OBJECTIVE:

to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life.

METHOD:

qualitative study with data collected through open interviews concerning the participants'' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas'' Theory of Communicative Action.

RESULTS:

the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation.

CONCLUSION:

there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.     

Rifabutin as salvage therapy for Helicobacter pylori eradication: Cornerstones and novelties

When several Helicobacter pylori eradication treatments fail, guidelines recommend a cultured guided approach; however, culture is not widely available. Therefore, a rifabutin based regimen could be the best solution. Rifabutin indeed shows a low rate of antibiotic resistance. Rifabutin is generally used in combination with amoxicillin in a triple therapy, with eradication rates about 80% in third-line regimens. The ideal duration of this therapy should range between 10 and 12 d. Combinations with antibiotics other than amoxicillin have demonstrated even better results, such as vonoprazan, which is a type of novel acid suppressor drug. Finally, a new formulation of triple therapy in a single capsule is under investigation, which is a field that deserves further investigation. Some notes of caution about rifabutin should be mentioned. This drug is used to treat tuberculosis or atypical mycobacteria; therefore, before starting a rifabutin-based eradication regimen, Mycobacterium tuberculosis infection should be thoroughly tested, since its use could promote the development of antibiotic resistance, thus affecting its effectiveness against Koch’s bacillus. Additionally, some serious side effects must be evaluated before starting any rifabutin-based therapy. Adverse effects include fever, nausea, vomiting and bone marrow suppression. For this reason, full blood count surveillance is required.     

Role of gamma-glutamyl transferase activity in patients with chronic hepatitis C virus infection

BACKGROUND: Increased serum gamma-glutamyl transferase (GGT) levels are frequently observed in chronic hepatitis C virus (HCV) infection. However, the significance of this finding remains unclear. The purpose of the present paper was to assess the relationship between GGT levels and clinical, biochemical and histological features in chronic HCV-infected carriers. METHODS: Patients with a liver biopsy presenting anti-HCV and HCV-RNA were evaluated. Age, gender, risk factors of transmission, serum alanine aminotransferase (ALT), GGT and alkaline phosphatase (ALP) levels and histological features were assessed in all. Data were analyzed statistically by the chi2 test and multivariate logistic regression analysis. RESULTS: Among 201 patients studied, elevated GGT levels and bile duct damage were observed in 48% and 35% of them, respectively. No association was seen between GGT level and bile duct damage or between GGT level and hepatic steatosis. Initially, age >40 years (P=0.007), elevated ALT (P=0.01), grading of inflammatory activity (P=0.004) and staging of fibrosis (P<0.001) were found to be associated with elevated GGT levels. After multivariate regression analysis, histology grading 3 and 4 inflammation activity (P=0.01) and staging 3 and 4 fibrosis (P=0.01) remained independently associated with elevated GGT level. CONCLUSIONS: A significant number of patients with chronic HCV infection had elevated serum GGT levels. Furthermore, this enzyme seemed to be useful as an indirect marker of more advanced liver disease in chronic hepatitis C.     

An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients.

OBJECTIVE: To test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients. DESIGN: Prospective case series in which frequency of incontinence was measured before and after intervention. SETTING: We established an interdisciplinary continence program within an existing academic center, the Benedum Geriatric Center. PATIENTS: Convenience sample of 70 non-demented outpatients aged 56 to 90 years. Behavioral treatment was provided to 29 patients including many with multiple medical problems (Mean = 6.0 problems). INTERVENTION: Behavioral treatment consisted of biofeedback, pelvic floor muscle exercise, scheduled voiding, and other strategies for preventing accidental urine loss. OUTCOME MEASURE: Outcome of treatment was measured by comparing bladder diaries completed in the 2 weeks immediately following treatment to those completed in the pretreatment phase. RESULTS: Following an average 5.6 treatment sessions, the mean weekly frequency of accidents was reduced from 16.9 to 2.5 (P less than 0.01). Individual reductions ranged from 30.8% to 100% with an average of 81.6% improvement. Ten patients achieved continence. Patients with mixed incontinence had greater improvement than those with urge incontinence alone (P less than 0.05), and patients who reported previous evaluation or treatment had a poorer outcome than those coming for their first evaluation (P = 0.05). Degree of improvement was not significantly related to age, duration of symptoms, baseline frequency of accidents, number of treatment sessions, number of other medical diagnoses, or urodynamic findings. CONCLUSION: We conclude that older adults who are able and willing to participate in behavioral treatment can benefit significantly despite other health problems or disabilities.     

Physicians' acceptance of behavioral treatments and pharmacotherapy for behavioral disturbances in older adults.

In response to growing interest in employing behavioral treatments and environmental modification for behavioral disturbances in older adults, we employed vignette methodology to examine physicians' acceptance of two behavioral treatments and haloperidol using Kazdin's Treatment Evaluation Inventory. Physicians assigned the highest acceptability ratings to the behavioral treatments and the lowest ratings to haloperidol. The patient's cognitive capacity, living situation (nursing home vs. community), and the type of behavior problem mediated treatment acceptability ratings.