Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 56
Filtrar
1.
Scand J Public Health ; : 14034948221096005, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35535443

RESUMO

OBJECTIVES: This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research. METHODS: Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles. RESULTS: Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill. CONCLUSIONS: Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

2.
BMJ Open ; 12(4): e054672, 2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35437245

RESUMO

OBJECTIVE: To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). DESIGN: In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. SETTING: Primary care, community-based elderly care. PARTICIPANTS: 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. INTERVENTION: The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. PRIMARY AND SECONDARY OUTCOMES MEASURES: The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. RESULTS: At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient's perspective, slightly higher for CCFE from an informal caregiver's and professional's perspective, and lower for CCFE from a payer's and policy-maker's perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (€22 816 vs €20 680). CONCLUSIONS: The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.


Assuntos
Prestação Integrada de Cuidados de Saúde , Idoso Fragilizado , Idoso , Cuidadores/psicologia , Técnicas de Apoio para a Decisão , Prestação Integrada de Cuidados de Saúde/métodos , Idoso Fragilizado/psicologia , Humanos , Vida Independente
3.
Materials (Basel) ; 15(8)2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35454439

RESUMO

Fiber-reinforced polymer (FRP) rebars are increasingly being used as an alternative to steel rebars in reinforced concrete (RC) members due to their excellent corrosion resistance capability and enhanced mechanical properties. Extensive research works have been performed in the last two decades to develop predictive models, codes, and guidelines to estimate the axial load-carrying capacity of FRP-RC columns. This study utilizes the power of artificial intelligence and develops an alternative approach to predict the axial capacity of FRP-RC columns more accurately using data-driven machine learning (ML) algorithms. A database of 117 tests of axially loaded FRP-RC columns is collected from the literature. The geometric and material properties, column shape and slenderness ratio, reinforcement details, and FRP types are used as the input variables, while the load-carrying capacity is used as the output response to develop the ML models. Furthermore, the input-output relationship of the ML model is explained through feature importance analysis and the SHapely Additive exPlanations (SHAP) approach. Eight ML models, namely, Kernel Ridge Regression, Lasso Regression, Support Vector Machine, Gradient Boosting Machine, Adaptive Boosting, Random Forest, Categorical Gradient Boosting, and Extreme Gradient Boosting, are used in this study for capacity prediction, and their relative performances are compared to identify the best-performing ML model. Finally, predictive equations are proposed using the harmony search optimization and the model interpretations obtained through the SHAP algorithm.

4.
Int J Integr Care ; 22(1): 22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35414805

RESUMO

Background: The complex needs of patients with multiple chronic diseases call for integrated care (IC). This scoping review examines several published Asian IC programmes and their relevant components and elements in managing multimorbidity patients. Method: A scoping review was conducted by searching electronic databases encompassing Medline, Embase, Scopus, and Web of Science. Three key concepts - 1) integrated care, 2) multimorbidity, and 3) Asian countries - were used to define searching strategies. Studies were included if an IC programme in Asia for multimorbidity was described or evaluated. Data extraction for IC components and elements was carried out by adopting the SELFIE framework. Results: This review yielded 1,112 articles, of which 156 remained after the title and abstract screening and 27 studies after the full-text screening - with 23 IC programmes identified from seven Asian countries. The top 5 mentioned IC components were service delivery (n = 23), workforce (n = 23), leadership and governance (n = 23), monitoring (n = 15), and environment (n = 14); whist financing (n = 9) was least mentioned. Compared to EU/US countries, technology and medical products (Asia: 40%, EU/US: 43%-100%) and multidisciplinary teams (Asia: 26%, EU/US: 50%-81%) were reported less in Asia. Most programmes involved more micro-level elements that coordinate services at the individual level (n = 20) than meso- and macro-level elements, and programmes generally incorporated horizontal and vertical integration (n = 14). Conclusion: In the IC programmes for patients with multimorbidity in Asia, service delivery, leadership, and workforce were most frequently mentioned, while the financing component was least mentioned. There appears to be considerable scope for development. Highlights: First scoping review to synthesise the key components and elements of integrated care programmes for multimorbidity in Asia.All programmes emphasized 'distinctive service delivery', 'leadership', and 'workforce' components.'Financing' component was least mentioned in identified integrated care programmes.

5.
Lancet ; 398(10301): 675-684, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34384540

RESUMO

BACKGROUND: Typhoid fever remains a major cause of morbidity and mortality in low-income and middle-income countries. Vi-tetanus toxoid conjugate vaccine (Vi-TT) is recommended by WHO for implementation in high-burden countries, but there is little evidence about its ability to protect against clinical typhoid in such settings. METHODS: We did a participant-masked and observer-masked cluster-randomised trial preceded by a safety pilot phase in an urban endemic setting in Dhaka, Bangladesh. 150 clusters, each with approximately 1350 residents, were randomly assigned (1:1) to either Vi-TT or SA 14-14-2 Japanese encephalitis (JE) vaccine. Children aged 9 months to less than 16 years were invited via parent or guardian to receive a single, parenteral dose of vaccine according to their cluster of residence. The study population was followed for an average of 17·1 months. Total and overall protection by Vi-TT against blood culture-confirmed typhoid were the primary endpoints assessed in the intention-to-treat population of vaccinees or all residents in the clusters. A subset of approximately 4800 participants was assessed with active surveillance for adverse events. The trial is registered at www.isrctn.com, ISRCTN11643110. FINDINGS: 41 344 children were vaccinated in April-May, 2018, with another 20 412 children vaccinated at catch-up vaccination campaigns between September and December, 2018, and April and May, 2019. The incidence of typhoid fever (cases per 100 000 person-years) was 635 in JE vaccinees and 96 in Vi-TT vaccinees (total Vi-TT protection 85%; 97·5% CI 76 to 91, p<0·0001). Total vaccine protection was consistent in different age groups, including children vaccinated at ages under 2 years (81%; 95% CI 39 to 94, p=0·0052). The incidence was 213 among all residents in the JE clusters and 93 in the Vi-TT clusters (overall Vi-TT protection 57%; 97·5% CI 43 to 68, p<0·0001). We did not observe significant indirect vaccine protection by Vi-TT (19%; 95% CI -12 to 41, p=0·20). The vaccines were well tolerated, and no serious adverse events judged to be vaccine-related were observed. INTERPRETATION: Vi-TT provided protection against typhoid fever to children vaccinated between 9 months and less than 16 years. Longer-term follow-up will be needed to assess the duration of protection and the need for booster doses. FUNDING: The study was funded by the Bill & Melinda Gates Foundation.


Assuntos
Polissacarídeos Bacterianos/administração & dosagem , Toxoide Tetânico/uso terapêutico , Febre Tifoide/prevenção & controle , Vacinas Tíficas-Paratíficas/administração & dosagem , Vacinação , Vacinas Conjugadas/administração & dosagem , Adolescente , Bangladesh/epidemiologia , Criança , Pré-Escolar , Países em Desenvolvimento , Encefalite Japonesa/epidemiologia , Feminino , Humanos , Lactente , Vacinas contra Encefalite Japonesa/administração & dosagem , Masculino , Salmonella typhi/imunologia , Toxoide Tetânico/imunologia , Febre Tifoide/epidemiologia , Febre Tifoide/imunologia
6.
Value Health ; 24(7): 966-975, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34243840

RESUMO

OBJECTIVES: Multi-criteria decision analysis (MCDA) has been recommended to support policy making in healthcare. However, practical applications of MCDA are sparse. One potential use for MCDA is for the evaluation of programs for complex and vulnerable patients. These complex patients benefit from integrated care programs that span healthcare and social care and aim to improve more than just health outcomes. MCDA can evaluate programs that aim to improve broader outcomes because it allows the evaluation of multiple outcomes alongside each other. In this study, we evaluate an innovative integrated care program in the Netherlands using MCDA. METHODS: We used an innovative MCDA framework with broad outcomes of health, well-being, and cost to evaluate the Better Together in Amsterdam North (BSiN) program using preferences of patients, partners, providers, payers, and policy makers in the Netherlands. BSiN provides case management support for a period of 6 months. Seven outcomes that previous research has deemed important to complex patients were measured, including physical functioning and social relationships and participation. RESULTS: We find that the program improved the overall MCDA score marginally, and, thus, after 6 and after 12 months, BSiN was preferred to usual care by all stakeholders. BSiN was preferred to usual care, mostly owing to improvements in psychological well-being and social relationships and participation. CONCLUSIONS: The integrated healthcare and social care program BSiN in the Netherlands was preferred to usual care according to an MCDA evaluation. MCDA seems a useful method to evaluate complex programs with benefits beyond health.


Assuntos
Técnicas de Apoio para a Decisão , Formulação de Políticas , Apoio Social , Comportamento de Escolha , Atenção à Saúde , Humanos , Países Baixos , Avaliação da Tecnologia Biomédica
7.
Future Microbiol ; 16: 521-535, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33960818

RESUMO

Aim: To determine the prevalence of extended-spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL)-producing Escherichia coli in South Asia. Methodology: A systematic review and meta-analysis of data published in PubMed, EMBASE, Web of Science and Scopus. Results: The pooled prevalence of ESBL and MBL-producing E. coli in South Asia were 33% (95% CI: 27-40%) and 17% (95% CI: 12-24%), respectively. The prevalence of blaCTX-M type was 58% (95% CI: 49-66%) with blaCTX-M-15 being the most prevalent (51%, 95% CI: 40-62%) variant. The most prevalent MBL variant was blaNDM-1 (33%, 95% CI: 20-50%). Conclusion: This study suggests a high prevalence of ESBLs and MBLs among E. coli clinical isolates. Comprehensive resistance surveillance is required to guide clinicians prescribing antibiotics in South Asia.


Assuntos
Infecções por Escherichia coli/epidemiologia , Escherichia coli/enzimologia , beta-Lactamases/metabolismo , Ásia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Genótipo , Humanos , Prevalência , beta-Lactamases/genética
8.
Clin Infect Dis ; 73(9): e2493-e2499, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-32592580

RESUMO

BACKGROUND: Diarrhea remains a major public health problem and characterization of its etiology is needed to prioritize interventions. However, most data are from single-site studies of children. We tested samples from participants of any age from 11 geographically diverse hospitals in Bangladesh to describe pathogen-specific burdens of diarrhea. METHODS: We utilized 2 existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and nondiarrheal controls for enteropathogens using quantitative polymerase chain reaction and calculated pathogen-specific attributable fractions (AFs) of diarrhea. RESULTS: We analyzed 5516 patients with diarrhea and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF, 17.7%; 95% confidence interval [CI], 14.3-20.9%; icddr,b AF, 39.9%; 38.0-41.8%), followed by adenovirus 40/41 (Nationwide AF, 17.9%; 95% CI: 13.9-21.9%; icddr,b AF, 16.6%; 95% CI, 14.4-19.4%) and Vibrio cholerae (Nationwide AF, 10.2%; 95% CI, 9.1-11.3%; icddr,b AF, 13.3%; 95% CI: 11.9-15.1%). Rotavirus was the leading pathogen in children <5 years and was consistent across the sites (coefficient of variation = 56.3%). Adenovirus 40/41 was the second leading pathogen in both children and adults. Vibrio cholerae was the leading pathogen in individuals >5 years old, but was more geographically variable (coefficient of variation = 71.5%). Other attributable pathogens included astrovirus, norovirus, Shigella, Salmonella, ETEC, sapovirus, and typical EPEC. CONCLUSIONS: Rotavirus, adenovirus 40/41, and V. cholerae were the leading etiologies of infectious diarrhea requiring hospitalization in Bangladesh. Other pathogens were important in certain age groups or sites.


Assuntos
Diarreia , Rotavirus , Bangladesh/epidemiologia , Criança , Pré-Escolar , Diarreia/epidemiologia , Fezes , Hospitalização , Humanos , Lactente , Reação em Cadeia da Polimerase , Rotavirus/genética
9.
Mol Neurobiol ; 58(3): 1017-1023, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33078369

RESUMO

COVID-19, the global threat to humanity, shares etiological cofactors with multiple diseases including Alzheimer's disease (AD). Understanding the common links between COVID-19 and AD would harness strategizing therapeutic approaches against both. Considering the urgency of formulating COVID-19 medication, its AD association and manifestations have been reviewed here, putting emphasis on memory and learning disruption. COVID-19 and AD share common links with respect to angiotensin-converting enzyme 2 (ACE2) receptors and pro-inflammatory markers such as interleukin-1 (IL-1), IL-6, cytoskeleton-associated protein 4 (CKAP4), galectin-9 (GAL-9 or Gal-9), and APOE4 allele. Common etiological factors and common manifestations described in this review would aid in developing therapeutic strategies for both COVID-19 and AD and thus impact on eradicating the ongoing global threat. Thus, people suffering from COVID-19 or who have come round of it as well as people at risk of developing AD or already suffering from AD, would be benefitted.


Assuntos
Doença de Alzheimer/fisiopatologia , COVID-19/fisiopatologia , SARS-CoV-2/fisiologia , Acetilcolina/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Enzima de Conversão de Angiotensina 2/fisiologia , Animais , Anosmia/etiologia , Apolipoproteína E4/genética , Encéfalo/patologia , Encéfalo/virologia , COVID-19/complicações , Síndrome da Liberação de Citocina/etiologia , Citocinas/fisiologia , Feminino , Galectinas/fisiologia , Humanos , Hipóxia/etiologia , Interleucinas/fisiologia , Masculino , Proteínas de Membrana/fisiologia , Camundongos , Receptores Virais/fisiologia , Fatores Sexuais , Fumar/efeitos adversos
10.
J Environ Manage ; 280: 111711, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33267977

RESUMO

The establishment of protected areas has been considered a tool to battle deforestation in densely populated countries like Bangladesh. Since 2000, Bangladesh's Forest Department has declared about 41 protected areas. However, before more land is designated as a protected area, it is important to know how effective existing protected areas are in achieving conservation goals. Unfortunately, the determination of the conservation effectiveness of protected areas, such as their capacity to reduce deforestation and forest fragmentation over a considerable period at high temporal frequency (e.g., yearly), is still unavailable despite some known methods being available, for example, the System for the Integrated Assessment of Protected Areas. In this study, we processed and analyzed the Hansen dataset from 2000 to 2018 to produce yearly forest/non-forest maps of four protected areas in Bangladesh and used these maps, with a matching method, to estimate the effectiveness of protected area in reducing deforestation after controlling for potential hidden bias. We also analyzed the forest fragmentation scenario over the same time frame. The forest cover change results from 2010 to 2018 revealed a large-scale deforestation pattern in areas adjacent to the protected area boundary of Chunati Wildlife Sanctuary (CWS) and Baroiyadhala National Park-Hazarikhil Wildlife Sanctuary (together B-HWS). Using a propensity score matching (PSM) approach with a caliper of 0.25, we found that B-HWS was the best performing of the studied protected areas, and that 37% of forest pixels in B-HWS would have been deforested in 2018 if they had not been brought under protection in 2010. Similarly, the estimated avoided deforestation rates were approximately 21% and 4% for CWS and Dudpukuria-Dhopachari Wildlife Sanctuary, respectively. Despite an improvement in deforestation scenarios, during the period 2010-2018, for all protected areas, the forest fragmentation scenarios were exacerbated both inside their boundaries and in adjacent unprotected areas. Therefore, it remains questionable whether protected areas can ultimately maintain the integrity of conservation.


Assuntos
Conservação dos Recursos Naturais , Agricultura Florestal , Bangladesh , Florestas , Parques Recreativos , Árvores
11.
Vet World ; 13(10): 2104-2111, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33281343

RESUMO

BACKGROUND AND AIM: Highly pathogenic avian influenza (HPAI) is a deadly virus of zoonotic potential. The study mainly aims to determine the risk pathways (RPs) for the probable incursion of HPAI virus (HPAIV) in backyard poultry in Bangladesh. MATERIALS AND METHODS: The study involves expert elicitation technique. The concept map determines the possible RPs. The map consists of 16 concepts, each with nodes from which probabilities of an event originates. These probabilities are described by qualitative descriptors ranging from negligible to high. Risk assessment has been performed using the subjective risk assessment tool. RESULTS: The tool demonstrates positive correlation among groups of experts in the level of agreement by scoring RP; however, the level of agreement varies from 71% to 93% among group of experts. The median risk score of viral incursion through the "Exposure of backyard poultry with farm poultry in the trading market" was 11 and ranked as top, followed by "Contaminated live bird market environment" and "Sharing common scavenging space with migratory birds" (median risk score, 10.5; rank, 2), and "Scavenging of infected slaughtered poultry remnants by backyard poultry" (median risk score, 5.3; rank, 3) when no control options were applied along with the RPs. After applying or considering control option along with contaminated live bird market environment, the median risk score was reduced to 5.0. Applying a specific control option along with each RP reduced estimated median risk scores for HPAIV incursions. CONCLUSION: This study provides an insight into the incursion risks of HPAIV through various RPs in backyard poultry in Bangladesh.

12.
mBio ; 11(6)2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203761

RESUMO

The mechanism of protection against cholera afforded by previous illness or vaccination is currently unknown. We have recently shown that antibodies targeting O-specific polysaccharide (OSP) of Vibrio cholerae correlate highly with protection against cholera. V. cholerae is highly motile and possesses a flagellum sheathed in OSP, and motility of V. cholerae correlates with virulence. Using high-speed video microscopy and building upon previous animal-related work, we demonstrate that sera, polyclonal antibody fractions, and OSP-specific monoclonal antibodies recovered from humans surviving cholera block V. cholerae motility at both subagglutinating and agglutinating concentrations. This antimotility effect is reversed by preadsorbing sera and polyclonal antibody fractions with purified OSP and is associated with OSP-specific but not flagellin-specific monoclonal antibodies. Fab fragments of OSP-specific polyclonal antibodies do not inhibit motility, suggesting a requirement for antibody-mediated cross-linking in motility inhibition. We show that OSP-specific antibodies do not directly affect V. cholerae viability, but that OSP-specific monoclonal antibody highly protects against death in the murine cholera model. We used in vivo competitive index studies to demonstrate that OSP-specific antibodies impede colonization and survival of V. cholerae in intestinal tissues and that this impact is motility dependent. Our findings suggest that the impedance of motility by antibodies targeting V. cholerae OSP contributes to protection against cholera.IMPORTANCE Cholera is a severe dehydrating illness of humans caused by Vibrio cholerae V. cholerae is a highly motile bacterium that has a single flagellum covered in lipopolysaccharide (LPS) displaying O-specific polysaccharide (OSP), and V. cholerae motility correlates with its ability to cause disease. The mechanisms of protection against cholera are not well understood; however, since V. cholerae is a noninvasive intestinal pathogen, it is likely that antibodies that bind the pathogen or its products in the intestinal lumen contribute to protection from infection. Here, we demonstrate that OSP-specific antibodies isolated from humans surviving cholera in Bangladesh inhibit V. cholerae motility and are associated with protection against challenge in a motility-dependent manner.


Assuntos
Anticorpos Antibacterianos/imunologia , Anticorpos Monoclonais/imunologia , Cólera/imunologia , Antígenos O/imunologia , Vibrio cholerae/imunologia , Aglutinação , Animais , Animais Lactentes , Bangladesh , Cólera/microbiologia , Humanos , Camundongos , Vibrio cholerae/patogenicidade
13.
BMJ Open ; 10(10): e037547, 2020 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039997

RESUMO

OBJECTIVES: To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries. DESIGN: A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity. SETTING: Preference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK. PARTICIPANTS: Patients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers. MAIN OUTCOME MEASURES: Preferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance. RESULTS: 5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low. CONCLUSION: The well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning.


Assuntos
Prestação Integrada de Cuidados de Saúde , Multimorbidade , Áustria , Croácia , Europa (Continente) , Humanos , Hungria , Países Baixos , Noruega , Espanha
14.
Subst Abuse Treat Prev Policy ; 15(1): 68, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883319

RESUMO

BACKGROUND: Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up. METHODS: We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from "no problems" to "extreme problems"). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100). RESULTS: Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively. CONCLUSION: The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.


Assuntos
Analgésicos Opioides/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Qualidade de Vida/psicologia , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Noruega , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Estudos Prospectivos , Autocuidado , Autoimagem , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
15.
Vaccine ; 38(32): 5021-5026, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32513512

RESUMO

Oral rabies vaccination (ORV) can increase rabies vaccination coverage among dogs that are inaccessible to parenteral vaccination (i.e., inaccessible dogs). Because bait uptake can differ according to the bait attractant used and dog characteristics, we evaluated proportion of bait uptake and time to bait uptake using three bait formulations. We looked for associations between bait uptake and dog characteristics (temperament, age, and body condition) and assessed the efficiency of using these bait formulations, as measured by number of dogs vaccinated per hour. A total of 356 baits were offered to free roaming dogs in urban and peri-urban districts of Bangladesh. Fish baits were ignored by 86% (n = 122; 95% CI: 79-91%) of dogs, whereas 60% (n = 45; 95% CI: 49-70%) consumed egg baits and 89% (n = 124; 95% CI: 83-93%) consumed intestine baits. Among the consumed baits, dogs fully consumed 56% (n = 10; 95% CI: 34-75%) of fish baits, 84% (n = 38; 95% CI: 71-92%) of egg baits, and 98% (n = 122; 95% CI: 94-100%) of intestine baits. Among inaccessible dogs, no associations were found between bait uptake and dog characteristics in either bivariate or multivariate analyses. Bait consumption averaged 2 dogs per hour for fish baits, 10 dogs per hour for egg baits, and 18 dogs per hour for intestine baits. The absence of association between bait type preference and individual dog characteristics simplifies the process of choosing attractants for oral rabies vaccines. While intestine attractants achieved highest uptake, egg baits may prove a suitable compromise when considering biological and operational constraints. The efficiency of ORV was demonstrated when compared to parenteral vaccination of free-roaming dogs previously described.


Assuntos
Vacinas Antirrábicas , Raiva , Administração Oral , Animais , Bangladesh , Cães , Estudos de Viabilidade , Humanos , Raiva/prevenção & controle , Raiva/veterinária , Vacinação/veterinária
16.
J Antimicrob Chemother ; 75(9): 2633-2640, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32585693

RESUMO

OBJECTIVES: To compare bacterial killing and the emergence of resistance to piperacillin/tazobactam, administered by intermittent versus prolonged infusion (i.e. extended or continuous), for ceftriaxone-resistant Klebsiella pneumoniae clinical isolates in an in vitro dynamic hollow-fibre infection model (HFIM). METHODS: K. pneumoniae 68 (Kp68; MIC = 8 mg/L, producing SHV-106 and DHA-1) and K. pneumoniae 69 (Kp69; MIC = 1 mg/L, producing CTX-M-14) were studied in the HFIM over 7 days (initial inoculum ~107 cfu/mL). Six piperacillin/tazobactam dosing regimens for Kp68 (4/0.5 g 8 hourly as 0.5 and 4 h infusions, 12/1.5 g/24 h continuous infusion, 4/0.5 g 6 hourly as 0.5 and 3 h infusions and 16/2 g/24 h continuous infusion) and three piperacillin/tazobactam dosing regimens for Kp69 (4/0.5 g 8 hourly as 0.5 and 4 h infusions and 12/1.5 g/24 h continuous infusion) were simulated (piperacillin clearance = 14 L/h, creatinine clearance = 100 mL/min). Total and resistant populations and MICs were quantified/determined. RESULTS: For Kp68, all simulated dosing regimens exhibited approximately 4 log10 of bacterial killing at 8 h followed by regrowth to approximately 1011 cfu/mL within 24 h. The MICs for resistant subpopulations exceeded 256 mg/L at 72 h. Similarly, for Kp69, all simulated dosing regimens exhibited approximately 4 log10 of bacterial killing over 8 h; however, only the continuous infusion prevented bacterial regrowth. CONCLUSIONS: Compared with intermittent infusion, prolonged infusion did not increase initial bacterial killing and suppression of regrowth of plasmid-mediated AmpC- and ESBL-producing K. pneumoniae. However, continuous infusion may suppress regrowth of some ESBL-producing susceptible K. pneumoniae, although more data are warranted to confirm this observation.


Assuntos
Klebsiella pneumoniae , Pseudomonas aeruginosa , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infusões Intravenosas , Testes de Sensibilidade Microbiana , Ácido Penicilânico , Piperacilina , Combinação Piperacilina e Tazobactam
17.
Exp Clin Transplant ; 18(Suppl 1): 64-67, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32008498

RESUMO

OBJECTIVES: Health-related quality of life is increasingly used as an important measurement of treatment outcome. Here, quality of life parameters in renal transplant recipients were evaluated and compared with patients with chronic kidney disease on maintenance hemodialysis and with those who were not on dialysis. MATERIALS AND METHODS: This cross-sectional study included patients seen at a number of tertiary renal care hospitals (there were 15 renal transplant recipients, 20 patients on maintenance hemodialysis, and 28 patients with chronic kidney disease not on dialysis). Forty healthy individual were also included as the control group. Different biochemical parameters were analyzed. Quality of life was assessed with the KDQOL-SF-36 (version 1.3) questionnaire. RESULTS: Mean age was 39 ± 11 for transplant patients, 43 ± 11 years for patients on hemodialysis, 49 ± 12 years for patients with chronic kidney disease not on dialysis, and 34 ± 11 years for the healthy control group. Distribution of sex was similar. Transplant recipients had higher quality of life scores, with some scores similar to healthy controls patients, like physical function (P = .85) and social function (P = .25). Scores were 100 ± 12, 69 ± 27, 37 ± 28, and 91 ± 10 (P < .001) for physical function; 94 ± 12, 44 ± 17, 30 ± 14, and 69 ± 29 (P < .001) for pain; 99 ± 11, 61 ± 46, 24 ± 15, and 70 ± 28 (P < .001) for social function; and 91 ± 11, 51 ± 13, 40 ± 7, and 66 ± 11 (P < .001) for energy/fatigue in healthy control, chronic kidney disease patients not on dialysis, hemodialysis patients, and transplant recipients, respectively. CONCLUSIONS: Quality of life is poor in patients with chronic kidney disease. However, renal transplant can improve quality of life. Transplant patients showed many quality of life scores similar to healthy individuals.


Assuntos
Transplante de Rim , Qualidade de Vida , Diálise Renal , Insuficiência Renal Crônica/terapia , Adulto , Bangladesh , Estudos de Casos e Controles , Estudos Transversais , Feminino , Estado Funcional , Humanos , Transplante de Rim/efeitos adversos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/psicologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Microbiol Insights ; 12: 1178636119889629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31839709

RESUMO

Antimicrobial resistance poses a threat in the treatment of infectious diseases in Bangladesh as well as in the world. Multidrug-resistant (MDR) Enterobacteriaceae, the most common cause of one such infectious disease, urinary tract infection (UTI), has contributed to the escalating problem of selecting empiric antibiotics against UTIs. The aim of this study was to investigate the presence of the efflux pump in MDR Escherichia coli isolates from UTI in the North-East region of Bangladesh, to isolate and characterize the AcrAB-TolC efflux pump genes of these locally isolated strains and to do mutation analysis of the efflux pump repressor AcrR gene to understand the AcrAB-TolC efflux pump mechanism. In the presence of omeprazole, an efflux pump inhibitor, every MDR E. coli isolate showed increased susceptibility to at least 1 of the 7 antibiotics investigated, indicating that efflux pump might be involved in their antibiotic resistance. Omeprazole decreased the minimum inhibitory concentration of every antibiotics being investigated by 2- to 8-fold. DNA and the deduced amino acid sequences of the polymerase chain reaction (PCR) products analyzed by bioinformatics tools revealed that the chromosomal AcrAB-TolC and AcrR genes were present in all MDR and antibiotic-susceptible E. coli isolates. However, the deduced amino acid sequences of the amplification refractory mutation system (ARMS) PCR product of the AcrR gene revealed that the substitution of arginine to cysteine at position 45 of AcrR was observed only in the MDR E. coli whose antibiotic susceptibility increased in the presence of omeprazole. Data reported herein support the notion that the increased antibiotic susceptibility of the MDR E. coli isolates in the presence of omeprazole might be due to efflux pump(s) inhibition and the AcrAB-TolC efflux pump might be a contributor to antibiotic resistance when the mutation of arginine to cysteine occurs at position 45 of AcrR.

19.
PLoS Negl Trop Dis ; 13(11): e0007874, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31743334

RESUMO

BACKGROUND: Antibodies targeting O-specific polysaccharide (OSP) of Vibrio cholerae may protect against cholera; however, little is known about this immune response in infected immunologically naïve humans. METHODOLOGY: We measured serum anti-OSP antibodies in adult North American volunteers experimentally infected with V. cholerae O1 Inaba El Tor N16961. We also measured vibriocidal and anti-cholera toxin B subunit (CtxB) antibodies and compared responses to those in matched cholera patients in Dhaka, Bangladesh, an area endemic for cholera. PRINCIPAL FINDINGS: We found prominent anti-OSP antibody responses following initial cholera infection: these responses were largely IgM and IgA, and highest to infecting serotype with significant cross-serotype reactivity. The anti-OSP responses peaked 10 days after infection and remained elevated over baseline for ≥ 6 months, correlated with vibriocidal responses, and may have been blunted in blood group O individuals (IgA anti-OSP). We found significant differences in immune responses between naïve and endemic zone cohorts, presumably reflecting previous exposure in the latter. CONCLUSIONS: Our results define immune responses to O-specific polysaccharide in immunologically naive humans with cholera, find that they are largely IgM and IgA, may be blunted in blood group O individuals, and differ in a number of significant ways from responses in previously humans. These differences may explain in part varying degrees of protective efficacy afforded by cholera vaccination between these two populations. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01895855.


Assuntos
Anticorpos Antibacterianos/sangue , Cólera/imunologia , Cólera/microbiologia , Imunidade Humoral , Antígenos O/imunologia , Vibrio cholerae O1/imunologia , Vibrio cholerae O1/isolamento & purificação , Adolescente , Adulto , Antitoxinas/sangue , Bangladesh , Toxina da Cólera/imunologia , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , América do Norte , Adulto Jovem
20.
Heliyon ; 5(7): e02068, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31338473

RESUMO

Bacteria were isolated from effluents of textile industries and screened by their capability to decolorize at least one of eight reactive dyes used in the textile industries. Three isolates having the capability to decolorize the highest number of dyes with more than 25% of decolorization were identified as Alcaligenes faecalis AZ26, Bacillus cereus AZ27 and Bacillus sp. AZ28 based on morphological, cultural, biochemical characteristics, and 16S rDNA sequence analysis. The decolorization capability of these three bacterial isolates was optimized under different physicochemical conditions by using Novacron Super Black G (NSB-G), one of the eight reactive dyes commonly used in textile industries. These bacterial isolates grew well in the presence of up to 500 mg L-1 of NSB-G and showed decolorization of approximately 90% at 200 mg L-1 of NSB-G after 96 h of cultivation at 37 °C and pH 8.0 under static condition. Decolorization of NSB-G by the bacterial isolates was investigated using UV-VIS spectrophotometry and Fourier Transform Infrared Spectroscopy (FTIR) analysis. The UV-visible absorbance spectra and the FTIR spectrum of the decolorized NSB-G significantly differed from those of the parent dye, indicating that the NSB-G was degraded by the bacterial isolates. High decolorization extent supports the notion that the bacterial isolates reported herein might have potential in the biological treatment of dyeing mill effluents.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA