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1.
BMJ Nutr Prev Health ; 6(1): 6-13, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37559965

RESUMO

Background: Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion. Purpose: To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA. Method: A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes. Results: There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36). Conclusions: Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.

2.
Am J Trop Med Hyg ; 93(5): 1110-1116, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26304922

RESUMO

An increasing number of immunocompromised individuals are pursuing international travel, and a better understanding of their international travel patterns and pretravel health care is needed. We evaluated the clinical features, itineraries, and pretravel health care of 486 immunocompromised international travelers seen at Global TravEpiNet sites from January 2009 to June 2012. We used bivariate analyses and logistic regressions using random intercept models to compare demographic and travel characteristics, vaccines administered, and medications prescribed for immunocompromised travelers versus 30,702 immunocompetent travelers. Immunocompromised travelers pursued itineraries that were largely similar to those of immunocompetent travelers, with nearly one-third of such travelers visiting countries with low human development indices. Biological agents, including tumor necrosis factor blockers, were commonly used immunosuppressive medications among immunocompromised travelers. A strong collaboration between travel-medicine specialists, primary care doctors, and specialist physicians is needed to prepare immunocompromised people for international travel. Incorporating routine questioning and planning regarding travel into the primary care visits of immunocompromised people may be useful.


Assuntos
Controle de Doenças Transmissíveis/métodos , Hospedeiro Imunocomprometido/imunologia , Viagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Aconselhamento , Atenção à Saúde , Demografia , Feminino , Humanos , Imunossupressores/uso terapêutico , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
3.
Vector Borne Zoonotic Dis ; 14(2): 160-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24359420

RESUMO

BACKGROUND: People who travel to areas with high rabies endemicity and have animal contact are at increased risk for rabies exposure. We examined characteristics of international travelers queried regarding rabies vaccination during pretravel consultations at Global TravEpiNet (GTEN) practices during 2009-2010. MATERIAL AND METHODS: We performed bivariate and multivariable analyses of data collected from 18 GTEN clinics. Travel destinations were classified by strength level of rabies vaccination recommendation. RESULTS: Of 13,235 travelers, 226 (2%) reported previous rabies vaccination, and 406 (3%) received rabies vaccine at the consultation. Common travel purposes for these 406 travelers were leisure (26%), research/education (17%), and nonmedical service work (14%). Excluding the 226 who were previously vaccinated, 8070 (62%) of 13,009 travelers intended to visit one or more countries with a strong recommendation for rabies vaccination; 1675 (21%) of these 8070 intended to travel for 1 month or more. Among these 1675 travelers, 145 (9%) were vaccinated, 498 (30%) declined vaccination, 832 (50%) had itineraries that clinicians determined did not indicate vaccination, and 200 (12%) remained unvaccinated for other reasons. In both bivariate and multivariate analyses, travelers with trip durations >6 months versus 1-3 months (adjusted odds ratio [OR]=4.9 [95% confidence interval [CI] 2.1, 11.4]) and those traveling for "research/education" or to "provide medical care" (adjusted OR=5.1 [95% CI 1.9, 13.7] and 9.5 [95% CI 2.2, 40.8], respectively), compared with leisure travelers, were more likely to receive rabies vaccination. CONCLUSIONS: Few travelers at GTEN clinics received rabies vaccine, although many planned trips 1 month long or more to a strong-recommendation country. Clinicians often determined that vaccine was not indicated, and travelers often declined vaccine when it was offered. The decision to vaccinate should take into account the strength of the vaccine recommendation at the destination country, duration of stay, availability of postexposure prophylaxis, potential for exposure to animals, and likelihood of recurrent travel to high-risk destinations.


Assuntos
Vacina Antirrábica , Raiva/prevenção & controle , Viagem/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Raiva/epidemiologia , Medição de Risco/normas , Estados Unidos
4.
Infect Dis Clin North Am ; 27(2): 429-57, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23714348

RESUMO

More than a quarter of solid-organ transplant recipients are traveling to foreign regions where there are greater health risks than their home country. There may be higher risk of complications from typical travel-related illnesses and risk of opportunistic infections not faced by healthy travelers. Some vaccinations may be contraindicated after solid-organ transplant, and those that are safe may have decreased efficacy. Drug interactions between antirejection regimens and medications for malaria prophylaxis and traveler's diarrhea must be considered. This article discusses how providers can best advise and help protect these high-risk travelers.


Assuntos
Hospedeiro Imunocomprometido , Transplantes , Medicina de Viagem/métodos , Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Quimioprevenção/métodos , Diarreia/tratamento farmacológico , Diarreia/patologia , Interações Medicamentosas , Humanos , Imunossupressores/uso terapêutico , Malária/prevenção & controle , Viagem , Vacinação/efeitos adversos , Vacinação/métodos
5.
Ann Emerg Med ; 60(4): 439-41, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22305333

RESUMO

Systemic loxoscelism is a constitutional illness resulting from the bite of the brown recluse spider. In severe form, it may cause hemolysis, acute renal failure, and disseminated intravascular coagulation. More rarely, it may result in death. We report an unusual case of systemic loxoscelism resulting in death less than one day following envenomation. We also discuss screening algorithms and contemporary management of systemic loxoscelism.


Assuntos
Aranha Marrom Reclusa , Picada de Aranha/diagnóstico , Pré-Escolar , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Humanos , Picada de Aranha/terapia , Tennessee
6.
Clin Infect Dis ; 54(4): 455-62, 2012 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-22144534

RESUMO

BACKGROUND: International travel poses a risk of destination-specific illness and may contribute to the global spread of infectious diseases. Despite this, little is known about the health characteristics and pretravel healthcare of US international travelers, particularly those at higher risk of travel-associated illness. METHODS: We formed a national consortium (Global TravEpiNet) of 18 US clinics registered to administer yellow fever vaccination. We collected data regarding demographic and health characteristics, destinations, purpose of travel, and pretravel healthcare from 13235 international travelers who sought pretravel consultation at these sites from January 2009 through January 2011. RESULTS: The destinations and itineraries of Global TravEpiNet travelers differed from those of the overall population of US international travelers. The majority of Global TravEpiNet travelers were visiting low- or lower-middle-income countries, and Africa was the most frequently visited region. Seventy-five percent of travelers were visiting malaria-endemic countries, and 38% were visiting countries endemic for yellow fever. Fifty-nine percent of travelers reported ≥1 medical condition. Atovaquone/proguanil was the most commonly prescribed antimalarial drug, and most travelers received an antibiotic for self-treatment of travelers' diarrhea. Hepatitis A and typhoid were the most frequently administered vaccines. CONCLUSIONS: Data from Global TravEpiNet provide insight into the characteristics and pretravel healthcare of US international travelers who are at increased risk of travel-associated illness due to itinerary, purpose of travel, or existing medical conditions. Improved understanding of this epidemiologically significant population may help target risk-reduction strategies and interventions to limit the spread of infections related to global travel.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Medicina de Viagem/métodos , Viagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Demografia/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Administração em Saúde Pública/métodos , Informática em Saúde Pública/métodos , Medição de Risco , Estados Unidos , Adulto Jovem
7.
J Clin Rheumatol ; 15(7): 350-3, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20009971

RESUMO

Voriconazole is a new triazole antifungal agent that is now the treatment of choice for invasive aspergillosis. Drug-induced myopathy has never previously been reported with voriconazole, although it is recognized with other triazole agents. We present a 34-year-old female African American renal transplant recipient, with a prior history of probable statin-induced myopathy, who developed severe generalized weakness with marked elevation of muscle enzymes and inflammatory changes on T2-weighted fat-suppressed STIR sequence magnetic resonance imaging (MRI) after commencing voriconazole for treatment of invasive aspergillosis. Her symptoms resolved and creatine kinase normalized upon stopping the drug.Given the increased use of triazoles in immunosuppressed and transplant recipients, it is important for rheumatology consultants to include this entity in their differential diagnosis of weakness in such patients.


Assuntos
Antifúngicos/efeitos adversos , Miosite/induzido quimicamente , Miosite/diagnóstico , Pirimidinas/efeitos adversos , Triazóis/efeitos adversos , Doença Aguda , Adulto , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Feminino , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Infecções Oportunistas/tratamento farmacológico , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Voriconazol
8.
Diagn Microbiol Infect Dis ; 63(1): 96-9, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19073303
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