RESUMO
OBJECTIVES: To identify the prevalence of and factors associated with medication use in people living with dementia in the community. METHODS: A cross-sectional study using baseline data from a randomised controlled trial known as the Interdisciplinary Home-bAsed Reablement Program (I-HARP) between 2018 and 2021 in Sydney, Australia. Participants included people with mild-moderate dementia and their carers. Medication use was classified according to the Anatomical Therapeutic Chemical codes, while potentially inappropriate medications (PIMs) were defined using 2019 Beer's Criteria and 2024 Australian list. Logistic regression models were used to identify factors associated with use of medication classes. RESULTS: A total of 130 people with dementia and their carers were included. Of the people with dementia, 35% were using antidementia medication, 48% psychotropics, 76% PIMs and 65% polypharmacy (≥5 medications). Polypharmacy was associated with the use of psychotropics (adjusted OR [aOR]: 5.09, 95% confidence interval [CI]: 1.94-13.39) and PIMs (aOR: 17.38, 95% CI: 5.12-59.02). Higher education level was associated with lower odds of psychotropic use (aOR: .33, 95% CI: .15-.76), and age over 80 years was associated with lower odds of antidementia medication use (aOR: .29; 95% CI: .12-.72). CONCLUSIONS: The use of PIMs, psychotropics and polypharmacy were common in this sample of people with dementia living in the community. Associations were seen between participant characteristics and medication use. Future research should focus on reviewing PIMs and polypharmacy in people with dementia living in the community to assess the impact on health outcomes.
RESUMO
Identifying cancer therapy resistance is a key time-saving tool for physicians. Part of chemotherapy resistance includes senescence, a persistent state without cell division or cell death. Chemically inducing senescence with the combination of trametinib and palbociclib (TP) yields several tumorigenic and prometastatic factors in pancreatic cancer models with many potential antibody-based targets. In particular, urokinase plasminogen activator receptor (uPAR) has been shown to be a membrane-bound marker of senescence in addition to an oncology target. Methods: Here, 2 antibodies against murine uPAR and human uPAR were developed as immuno-PET agents to noninvasively track uPAR antigen abundance. Results: TP treatment increased cell uptake both in murine KPC cells and in human MiaPaCa2 cells. In vivo, subcutaneously implanted murine KPC tumors had high tumor uptake with the antimurine uPAR antibody independently of TP in young mice, yet uPAR uptake was maintained in aged mice on TP. Mice xenografted with human MiaPaCa2 tumors showed a significant increase in tumor uptake on TP therapy when imaged with the antihuman uPAR antibody. Imaging with either uPAR antibody was found to be more tumor-selective than imaging with [18F]FDG or [18F]F-DPA-714. Conclusion: The use of radiolabeled uPAR-targeting antibodies provides a new antibody-based PET imaging candidate for pancreatic cancer imaging as well as chemotherapy-induced senescence.
Assuntos
Neoplasias Pancreáticas , Tomografia por Emissão de Pósitrons , Receptores de Ativador de Plasminogênio Tipo Uroquinase , Animais , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/tratamento farmacológico , Receptores de Ativador de Plasminogênio Tipo Uroquinase/metabolismo , Camundongos , Humanos , Linhagem Celular Tumoral , Envelhecimento , Piridinas/farmacologia , Senescência Celular/efeitos dos fármacos , Piperazinas/farmacologia , Piperazinas/uso terapêutico , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêuticoRESUMO
Metabolite profiling is a powerful approach for the clinical diagnosis of complex diseases, ranging from cardiometabolic diseases, cancer, and cognitive disorders to respiratory pathologies and conditions that involve dysregulated metabolism. Because of the importance of systems-level interpretation, many methods have been developed to identify biologically significant pathways using metabolomics data. In this review, we first describe a complete metabolomics workflow (sample preparation, data acquisition, pre-processing, downstream analysis, etc.). We then comprehensively review 24 approaches capable of performing functional analysis, including those that combine metabolomics data with other types of data to investigate the disease-relevant changes at multiple omics layers. We discuss their availability, implementation, capability for pre-processing and quality control, supported omics types, embedded databases, pathway analysis methodologies, and integration techniques. We also provide a rating and evaluation of each software, focusing on their key technique, software accessibility, documentation, and user-friendliness. Following our guideline, life scientists can easily choose a suitable method depending on method rating, available data, input format, and method category. More importantly, we highlight outstanding challenges and potential solutions that need to be addressed by future research. To further assist users in executing the reviewed methods, we provide wrappers of the software packages at https://github.com/tinnlab/metabolite-pathway-review-docker.
Assuntos
Metabolômica , Software , Metabolômica/métodos , Humanos , Metaboloma , Biologia Computacional/métodos , Bases de Dados FactuaisRESUMO
A significant limitation of the 'one size fits all' medication approach is the lack of consideration for special population groups. 3D printing technology has revolutionised the landscape of pharmaceuticals and pharmacy practice, playing an integral role in enabling on-demand production of customised medication. Compared to traditional pharmaceutical processes, 3D printing has major advantages in producing tailored dosage forms with unique drug release mechanisms. Moreover, this technology has enabled the combination of multiple drugs in a single formulation addressing key issues of medication burden. Development of 3D printing in pharmacy applications and large-scale pharmaceutical manufacturing has substantially increased in recent years. This review focuses on the emergence of extrusion-based 3D printing, particularly semi solid extrusion, fused deposition modelling and direct powder extrusion, which are currently the most commonly studied for pharmacy practice. The concept of each technique is summarised, with examples of current and potential applications. Next, recent advancements in the 3D printer market and pharmacist perceptions are discussed. Finally, the benefits, challenges and prospects of pharmacy 3D printing technology are highlighted, emphasising its significance in changing the future of this field.
Assuntos
Impressão Tridimensional , Humanos , Farmácia , Tecnologia Farmacêutica/tendênciasRESUMO
Importance: Measuring drug use behaviors in individuals and across large communities presents substantial challenges, often complicated by socioeconomic and demographic variables. Objectives: To detect spatial and temporal changes in community drug use by analyzing concentrations of analytes in influent wastewater and exploring their associations with area-based socioeconomic and sociodemographic metrics like the area deprivation index (ADI) and rural-urban commuting area (RUCA) codes. Design, Setting, and Participants: This longitudinal, cross-sectional wastewater study was performed from May 2022 to April 2023 and included biweekly influent wastewater samples of 39 analytes from 8 sampling locations across 6 wastewater treatment plants in southern Nevada. Statistical analyses were conducted in December 2023. Main Outcomes and Measures: It was hypothesized that wastewater monitoring of pharmaceuticals and personal care products (PPCPs) and high-risk substances (HRSs) could reveal true spatial and temporal drug use patterns in near-real time. Data collection of samples for PPCPs and HRSs was performed using mass spectrometry. Both ADI and RUCA scores were utilized to characterize neighborhood contexts in the analysis. The false discovery rate (FDR) method was utilized to correct for multiple comparisons (PFDR). Results: Over the 12-month wastewater monitoring period, 208 samples for PPCPs and HRSs were collected, and analysis revealed an increase in the consumption of HRSs and the seasonal variation in PPCP use in southern Nevada. There was a significant increase in levels of stimulant-associated analytes, such as cocaine (ß = 9.17 × 10-4; SE = 1.29 × 10-4; PFDR = 1.40 × 10-10), and opioids or their metabolites, notably norfentanyl (ß = 1.48 × 10-4; SE = 1.88 × 10-4; PFDR = 1.66 × 10-12). In contrast, DEET, an active ingredient in mosquito and tick repellents, demonstrated a seasonal use pattern (ß = -4.85 × 10-4; SE = 2.09 × 10-4; PFDR = 4.87 × 10-2). Wastewater from more disadvantaged or rural neighborhoods, as assessed through ADI and RUCA scores, was more likely to show a significant positive correlation with HRSs, such as cocaine (ß = 0.075; SE = 0.038; P = .05) and norfentanyl (ß = 0.004; SE = 0.001; P = 1.64 × 10-5). Conclusions and Relevance: These findings suggest that wastewater monitoring of PPCPs and HRSs offers a complementary method to existing public health tools, providing timely data for tracking substance use behaviors and use of PPCPs at a population level.
Assuntos
Águas Residuárias , Águas Residuárias/análise , Humanos , Estudos Transversais , Nevada , Estudos Longitudinais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores Socioeconômicos , Poluentes Químicos da Água/análiseRESUMO
Rett syndrome (RTT) is a neurodevelopmental disorder caused by de novo mutations in the MECP2 gene. Although miRNAs in extracellular vesicles (EVs) have been suggested to play an essential role in several neurological conditions, no prior study has utilized brain organoids to profile EV-derived miRNAs during normal and RTT-affected neuronal development. Here we report the spatiotemporal expression pattern of EV-derived miRNAs in region-specific forebrain organoids generated from female hiPSCs with a MeCP2:R255X mutation and the corresponding isogenic control. EV miRNA and protein expression profiles were characterized at day 0, day 13, day 40, and day 75. Several members of the hsa-miR-302/367 cluster were identified as having a time-dependent expression profile with RTT-specific alterations at the latest developmental stage. Moreover, the miRNA species of the chromosome 14 miRNA cluster (C14MC) exhibited strong upregulation in RTT forebrain organoids irrespective of their spatiotemporal location. Together, our results suggest essential roles of the C14MC and hsa-miR-302/367 clusters in EVs during normal and RTT-associated neurodevelopment, displaying promising prospects as biomarkers for monitoring RTT progression.
Assuntos
Encéfalo , Vesículas Extracelulares , Proteína 2 de Ligação a Metil-CpG , MicroRNAs , Organoides , Síndrome de Rett , Síndrome de Rett/genética , Síndrome de Rett/metabolismo , Síndrome de Rett/patologia , MicroRNAs/genética , MicroRNAs/metabolismo , Vesículas Extracelulares/metabolismo , Vesículas Extracelulares/genética , Humanos , Organoides/metabolismo , Organoides/patologia , Feminino , Proteína 2 de Ligação a Metil-CpG/genética , Proteína 2 de Ligação a Metil-CpG/metabolismo , Encéfalo/metabolismo , Encéfalo/patologia , Células-Tronco Pluripotentes Induzidas/metabolismo , Células-Tronco Pluripotentes Induzidas/citologia , Mutação , Prosencéfalo/metabolismoRESUMO
OBJECTIVE: This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use. METHODS: A convenience sample of caregivers with children (aged 11-16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach. RESULTS: Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible. CONCLUSION: Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.
Assuntos
Cuidadores , Melatonina , Farmacêuticos , Humanos , Melatonina/administração & dosagem , Adolescente , Criança , Cuidadores/psicologia , Farmacêuticos/estatística & dados numéricos , Feminino , Masculino , Austrália , Inquéritos e Questionários , AdultoRESUMO
The ability of three-dimensional (3D) bioprinting to fabricate biomimetic organ and disease models has been recognised to be promising for drug discovery and development as 3D bioprinted models can better mimic human physiology compared to two-dimensional (2D) cultures and animal models. This is useful for target selection where disease models can be studied to understand disease pathophysiology and identify disease-linked compounds. Lead identification and preclinical studies also benefit from 3D bioprinting as 3D bioprinted models can be utilised in high-throughput screening (HTS) systems and to produce efficacy and safety data that closely resembles clinical observations. Although no published applications of 3D bioprinting in clinical trials were found, there are two clinical trials planning to evaluate the predictive ability of 3D bioprinted models by comparing human and model responses to the same chemotherapy. Overall, this review provides a comprehensive summary of the latest applications of 3D bioprinting in drug discovery and development.
Assuntos
Bioimpressão , Descoberta de Drogas , Impressão Tridimensional , Humanos , Bioimpressão/métodos , Descoberta de Drogas/métodos , Animais , Desenvolvimento de Medicamentos/métodosRESUMO
OBJECTIVES: To estimate the national prevalence of antidementia and psychotropic medication use, and sociodemographic factors associated with their use, in Australians living with dementia. DESIGN: Retrospective cross-sectional study. SETTING AND PARTICIPANTS: Nationwide data linkage study using 2021 Census and Pharmaceutical Benefits Scheme (PBS) data. All people aged 65 or older with dementia (self-reported in the Census or dispensed an antidementia drug subsidized by the PBS) were included. METHODS: Medication use was defined as at least 1 dispensing during the 3-month period following the Census (August-October 2021). Prevalence of antidementia and psychotropic medication use, including antipsychotics, benzodiazepines and Z-drugs, antiepileptics, opioids, and psychostimulants, was calculated. Sociodemographic factors associated with medication use were explored using multivariable logistic regression models. RESULTS: Of the 177,809 older people living with dementia included, 58.6% were using at least 1 psychotropic medication. Antidepressants were the most commonly used psychotropics (41%), followed by opioids (20%) and antipsychotics (13%). Antidementia medications were used by a quarter of people with dementia (26%). People with dementia living in the highest socioeconomic area were more likely to use antidementia medications [adjusted odds ratio (OR), 1.22; 95% CI, 1.17-1.28] and less likely to use psychotropics (OR, 0.91; 95% CI, 0.88-0.95) compared with people living in the lowest socioeconomic area. Conversely, those living in inner regional areas were more likely to use psychotropics (OR, 1.06; 95% CI, 1.03-1.10) and less likely to use antidementia medications (OR, 0.79; 95% CI, 0.77-0.82) compared with people living in metropolitan areas. CONCLUSIONS AND IMPLICATIONS: Psychotropics were commonly used in people with dementia in Australia. Disparities in access to health care due to socioeconomic status or remoteness may have influenced the use of antidementia and psychotropic medications. Further strategies to allow more equitable access to resources and medications are needed.
RESUMO
Objectives: We used a multi-state model, which mitigates time-dependent bias, to estimate the mortality, length of stay (LOS), and costs of methicillin-resistant Staphylococcus aureus (MRSA) infections in Singapore. Methods: We conducted a retrospective study in a hospital in Singapore from 2018 to 2022. Patients with MRSA infections were matched 1:1:3 to patients with MRSA colonization and patients without MRSA by age, gender, specialty, and intensive care admission, respectively. A multi-state model was used to derive excess LOS and mortality hazard ratios. The attributable cost of infections was estimated in 2022 Singapore dollars (SGDs) from the health care perspective. Results: We matched 536 patients with MRSA infections to 536 patients with MRSA colonization, and to 1608 patients without MRSA. The excess LOS due to MRSA infection was 2.11 (95% confidence interval [CI] 2.05-2.17) days compared with MRSA colonization and 3.75 (95% CI 3.69-3.80) days compared with no MRSA, which translated to an excess cost of SGD $1825 and SGD $3238, respectively. Of the different MRSA infection types, pneumonia had the highest mortality risk (hazard ratio 4.13; 95% CI 2.28-7.50) compared with patients without MRSA. Conclusions: MRSA infections increased hospital LOS and health care costs in Singapore. Our estimates can inform future economic analyses of management strategies against MRSA.
RESUMO
This article introduces scientific and research integrity, with a particular emphasis on its implications for the active chemical community in Switzerland. It attempts to equate research integrity to good scientific practice and presents this as benefiting the researcher, the institution, and the discipline. The concepts are developed, and current and future challenges are identified.
RESUMO
Diapers, being one of the most used items for infant care, it is imperative that they are always free of contamination from microorganisms. The objective of this study is to determine the rate of bacterial contamination and the antibiotics profile of isolated bacteria from unused diapers sold in markets in Enugu Metropolis, southeast Nigeria. The study also investigated the effectiveness of the Nigerian Consumer protection laws towards maintaining the standard of care for infants and toddlers. Fifty pieces of different brands of diapers were sampled for bacterial contamination using standard bacteriological procedures. The results show that out of 50 samples analyzed, bacterial growths were identified in 9 (18%), of which five different bacterial species were isolated. The most prevalent being Escherichia coli and Staphylococcus aureus 3 (33.3%). Other bacteria isolated were Lactobacillus spp, Klebsiella spp, and Streptococcus spp 1 (11.1%). There was no statistically significant difference in the distribution of the bacterial contamination of diapers across the different brands(p>0.05). We conclude that baby diapers sold in markets in Enugu metropolis are prone to contamination with bacteria.We recommend that appropriate measures should be taken during the manufacturing process to reduce or prevent the incidence of bacterial contamination of diapers.
Les couches étant l'un des articles les plus utilisés pour les soins des nourrissons, il est impératif qu'elles soient toujours exemptes de contamination par des micro-organismes. L'objectif de cette étude est de déterminer le taux de contamination bactérienne et le profil antibiotique des bactéries isolées provenant de couches inutilisées vendues sur les marchés de la métropole d'Enugu, dans le sud-est du Nigeria. L'étude a également examiné l'efficacité des lois nigérianes sur la protection des consommateurs pour maintenir le niveau de soins pour les nourrissons et les jeunes enfants. Cinquante morceaux de couches de différentes marques ont été échantillonnés pour détecter toute contamination bactérienne en utilisant des procédures bactériologiques standard. Les résultats montrent que sur 50 échantillons analysés, des croissances bactériennes ont été identifiées dans 9 (18 %), parmi lesquels cinq espèces bactériennes différentes ont été isolées. Les plus répandus sont Escherichia coli et Staphylococcus aureus 3 (33,3 %). Les autres bactéries isolées étaient Lactobacillus spp, Klebsiella spp et Streptococcus spp 1 (11,1 %). Il n'y avait pas de différence statistiquement significative dans la répartition de la contamination bactérienne des couches entre les différentes marques (p>0,05). Nous concluons que les couches pour bébés vendues sur les marchés de la métropole d'Enugu sont sujettes à la contamination bactérienne. Nous recommandons que des mesures appropriées soient prises pendant le processus de fabrication pour réduire ou prévenir l'incidence de la contamination bactérienne des couches.
Assuntos
Antibacterianos , Escherichia coli , Testes de Sensibilidade Microbiana , Staphylococcus aureus , Humanos , Nigéria , Antibacterianos/farmacologia , Lactente , Escherichia coli/isolamento & purificação , Escherichia coli/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/efeitos dos fármacos , Klebsiella/isolamento & purificação , Klebsiella/efeitos dos fármacos , Lactobacillus/isolamento & purificação , Streptococcus/isolamento & purificação , Streptococcus/efeitos dos fármacosRESUMO
Background: Observational Alzheimer's disease (AD) cohorts including the Australian, Biomarkers, Imaging and Lifestyle (AIBL) Study have enhanced our understanding of AD. The generalizability of findings from AIBL to the general population has yet to be studied. Objective: We aimed to compare characteristics of people with AD dementia in AIBL to 1) the general population of older Australians using pharmacological treatment for AD dementia, and to 2) the general population of older Australians who self-reported a diagnosis of dementia. Methods: Descriptive study comparing people aged 65 years of over (1) in AIBL that had a diagnosis of AD dementia, (2) dispensed with pharmacological treatment for AD in Australia in 2021 linked to the Australian census in 2021 (refer to as PBS/census), (3) self-reported a diagnosis of dementia in the 2021 Australian census (refer to as dementia/census). Baseline characteristics included age, sex, highest education attainment, primary language, and medical co-morbidities. Results: Participants in AIBL were younger, had more years of education, and had a lower culturally and linguistically diverse (CALD) population compared to the PBS/census cohort and dementia/census cohort (mean age±standard deviation - AIBL 79±7 years, PBS/census 81±7, pâ<â0.001, dementia/census 83±8, pâ<â0.001; greater than 12 years of education AIBL 40%, PBS/census 35%, pâ=â0.020, dementia/census 29%, pâ<â0.001; CALD - AIBL 3%, PBS/census 20%, pâ<â0.001, dementia/census 22%, pâ<â0.001). Conclusions: Our findings suggest that care should be taken regarding the generalizability of AIBL in CALD populations and the interpretation of results on the natural history of AD.
Assuntos
Doença de Alzheimer , Humanos , Austrália/epidemiologia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/diagnóstico , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Estudos Longitudinais , Estudos de CoortesRESUMO
Introduction: Pharmacological management is a vital aspect of dementia care. Suboptimal medication prescribing and adverse drug reactions are major causes for ongoing concerns for the quality of care. This review aims to investigate the existence and comprehensiveness of Australian guidelines dedicated to supporting dementia care in the context of pharmacological management. Methods: Guideline registries and databases (EMBASE and CINAHL) were searched to identify Australian guidelines addressing pharmacological management in dementia care and to uncover barriers and considerations associated with guideline implementation. Results: Seven Australian guidelines were identified. Barriers to effective implementation were identified at individual, provider, and system levels. None of the identified guidelines provided comprehensive guidance on management of multimorbidity and polypharmacy. Discussion: Although Australian guidelines are available to guide pharmacological management in dementia, several barriers impede their effective implementation. There is an urgent need for updated guidelines that address the management of multimorbidity and polypharmacy in people living with dementia.
Assuntos
Demência , Multimorbidade , Polimedicação , Guias de Prática Clínica como Assunto , Humanos , Demência/tratamento farmacológico , AustráliaRESUMO
On October 29, 2021, FDA granted accelerated approval to asciminib (SCEMBLIX; Novartis), a tyrosine kinase inhibitor (TKI), for the treatment of adult patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP), previously treated with two or more TKIs, and granted traditional approval to asciminib for adult patients with Ph+ CML in CP with the T315I mutation. The first indication was approved based on major molecular response (MMR) at 24 weeks in the ASCEMBL study, a randomized trial comparing asciminib with bosutinib in patients who had failed two or more TKIs. This indication was ultimately granted traditional approval on October 12, 2022, based on safety data and MMR rate at 96 weeks of 38% [95% confidence interval (CI), 30-46] in the asciminib arm versus 16% (95% CI, 8-26) in the bosutinib arm (P value: 0.001). The second indication was approved based on MMR rate by 96 weeks of 49% (95% CI, 34-64) in the single-arm CABL001X2101 study. The most common (≥20%) adverse reactions included upper respiratory tract infections, musculoskeletal pain, headache, fatigue, nausea, rash, and diarrhea. The most common (≥20%) laboratory abnormalities were thrombocytopenia, neutropenia, anemia, lymphopenia, hypertriglyceridemia, hyperuricemia, and increases in creatine kinase, alanine aminotransferase, aspartate aminotransferase, lipase, and amylase. This manuscript describes the basis for approval of these indications.
Assuntos
Aprovação de Drogas , Mutação , Inibidores de Proteínas Quinases , United States Food and Drug Administration , Humanos , Inibidores de Proteínas Quinases/uso terapêutico , Inibidores de Proteínas Quinases/efeitos adversos , Estados Unidos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pirimidinas/uso terapêutico , Pirimidinas/efeitos adversos , Proteínas de Fusão bcr-abl/genética , Proteínas de Fusão bcr-abl/antagonistas & inibidores , Cromossomo Filadélfia/efeitos dos fármacos , Niacinamida/análogos & derivados , PirazóisRESUMO
BACKGROUND: The quality of food service is vital to patients' experiences in care and recovery in hospitals. This study aimed to identify opportunities for improving hospital food services to enhance overall patient experiences and outcomes. METHODS: This retrospective cross-sectional study uses the Adult Admitted Patient Survey in 2019. Adult patients discharged from acute or rehabilitation care across 75 public hospitals were surveyed about their in-hospital experiences, including ratings of hospital food services, overall ratings of hospital care, complications acquired, and delayed discharge due to feeling unwell. Population weighting was applied in descriptive and multivariable logistic regression analyses. We used adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to estimate the association between hospital food service and the overall rating of hospital care and two recovery outcomes. RESULTS: Eight in ten participants (weighted, 16,919/21,900) consumed food in a hospital [mean age: 60.6 years (SE:0.5; SD: 18.3), 53% female]. Compared to a fair rating, adults who rated "poor/very poor" of hospital food service were 2.7 times more likely to report dissatisfaction with overall care in the hospital [Adjusted Odds Ratio (AOR) (95% CI): 2.73 (1.49, 4.99)], 1.4 times more likely to report complications [AOR:1.43 (1.11, 1.83)] and 1.9 times more likely to report delayed discharge [AOR 1.85 (1.30, 2.62)]. More moderate ratings were associated with attenuation of risk for these outcomes. Furthermore, the magnitude of the effect for these associations was more substantial among patients from non-English-speaking backgrounds (n = 1,759) after controlling for patient characteristics. Food service attributes, including received food as ordered, food delivered within reach, the taste of the meals, and meal interruption, were significant factors for the outcomes assessed. CONCLUSION: These findings underscore the importance of patients' positive experiences of hospital food service in recovery outcomes and identify several food service indicators that can be used to monitor and improve patient experiences and recovery outcomes in hospitals.
Assuntos
Serviço Hospitalar de Nutrição , Hospitais Públicos , Satisfação do Paciente , Humanos , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Adulto , Inquéritos e Questionários , Medidas de Resultados Relatados pelo Paciente , Alta do PacienteRESUMO
Immunological priming-in the context of either prior infection or vaccination-elicits protective responses against subsequent Mycobacterium tuberculosis (Mtb) infection. However, the changes that occur in the lung cellular milieu post-primary Mtb infection and their contributions to protection upon reinfection remain poorly understood. Using clinical and microbiological endpoints in a non-human primate reinfection model, we demonstrated that prior Mtb infection elicited a long-lasting protective response against subsequent Mtb exposure and was CD4+ T cell dependent. By analyzing data from primary infection, reinfection, and reinfection-CD4+ T cell-depleted granulomas, we found that the presence of CD4+ T cells during reinfection resulted in a less inflammatory lung milieu characterized by reprogrammed CD8+ T cells, reduced neutrophilia, and blunted type 1 immune signaling among myeloid cells. These results open avenues for developing vaccines and therapeutics that not only target lymphocytes but also modulate innate immune cells to limit tuberculosis (TB) disease.
Assuntos
Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Granuloma , Imunomodulação , Mycobacterium tuberculosis , Reinfecção , Animais , Linfócitos T CD4-Positivos/imunologia , Mycobacterium tuberculosis/imunologia , Reinfecção/imunologia , Granuloma/imunologia , Granuloma/microbiologia , Linfócitos T CD8-Positivos/imunologia , Tuberculose/imunologia , Tuberculose/microbiologia , Modelos Animais de Doenças , Pulmão/imunologia , Pulmão/microbiologia , Pulmão/patologia , Humanos , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/microbiologiaRESUMO
Centenarians represent a phenomenon of successful aging. This systematic review aimed to understand lifestyles and health practices, focusing on diet and medication use for healthy longevity in community-based adults 95 years or over. Medline, CINAHL, Scopus, and gray literature were searched from 1 January 2000 to 10 December 2022. Study quality was assessed using the Modified Newcastle-Ottawa Scale (mNOS). Pooled prevalence [%; 95% confidence interval] for categorical variables and pooled mean for continuous variables were estimated for demographics, weight status, lifestyle factors, medications, and health conditions. Of 3392 records screened, 34 studies were included in the review, and 71% (24/34) met the 6/8 criteria in mNOS. Centenarians/near-centenarians' ages ranged from 95 to 118 years, with 75% (71-78%) female and 78% (68-88%) living in rural areas. They had an overall healthy lifestyle: current smoking (7%; 5-9%), drinking (23%; 17-30%), normal weight (52%; 42-61%), overweight (14%; 8-20%), physical activity (23%; 20-26%), and sleep satisfaction (68%; 65-72%). Diet averaged 59.6% carbohydrate, 18.5% protein, and 29.3% fat; over 60% consumed a diverse diet, and < 20% preferred salty food, contributing to lower mortality risks and functional decline. About half used antihypertensives (49%; 14-84%) or other cardiovascular drugs (48%; 24-71%), with an average of 4.6 medications. Common health issues included impaired basic activities of daily living (54%; 33-74%), hypertension (43%; 21-65%), and dementia (41%; 23-59%). The findings of this systemic review underscore the pivotal role of dietary practice and weight management in healthcare strategies to promote healthy ageing. It also recognises rural living styles and sleep hygiene as potential factors contributing to healthy longevity.