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1.
Trials ; 23(1): 644, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35945550

RESUMO

BACKGROUND: Slower than planned recruitment is a major factor contributing to the delay or failure of randomised controlled trials to report on time. There is a limited evidence base regarding the optimisation of recruitment strategies. Here we performed an observational review of our experience in recruitment for two large randomised controlled trials for people with secondary progressive multiple sclerosis. We aimed to explicitly determine those factors which can facilitate trial recruitment in progressive neurodegenerative disease. METHODS: Recruitment data from the sequential MS-SMART [NCT01910259] and MS-STAT2 [NCT03387670] UK randomised controlled trials was reviewed from the largest recruiting site, University College London (UCL). The trial population was similar which allowed comparison over the two recruitment periods of 2015-2016 and 2018-2021. This included sources of referral, progress through stages of recruitment, reasons for participant ineligibility and the impact of publicity events upon recruitment. RESULTS: In MS-SMART, 18% of patients contacted were enrolled, compared to 27% for MS-STAT2. Online registration of interest portals provided the greatest number of referrals (76% in MS-SMART, and 51% in MS-STAT2), with publicity in national media outlets producing a demonstrable increase in the number of potential participants. The introduction of an online self-screening questionnaire for MS-STAT2 resulted in 67% of potential participants (3080 of 4605) automatically determining their own ineligibility. In both studies, however, around 60% of those directly telephoned to discuss the study were not eligible, with difficulties related to travel to trial visits, or excluded medication, being the most common issues. Eighty-four percent of those deemed potentially eligible following telephone calls were enrolled in the MS-STAT2 study, compared to only 55% for MS-SMART. CONCLUSIONS: Through a detailed review of recruiting participants at the largest centre into two large randomised controlled trials with similar entry criteria, we have identified a number of approaches that may improve recruitment efficiency. We highlight here the importance of mandatory online self-screening questionnaires, a coordinated publicity campaign, and simple interventions such as eligibility checklists and appointment reminders. Recruitment approaches should be further assessed through a studies within a trial (SWAT) design. TRIAL REGISTRATION: MS-SMART: NCT01910259 ; registered July 2013 and MS-STAT2: NCT03387670 ; registered Jan 2018.


Assuntos
Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Doenças Neurodegenerativas , Humanos , Londres , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla Crônica Progressiva/diagnóstico , Esclerose Múltipla Crônica Progressiva/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fator de Transcrição STAT2 , Telefone
3.
PLoS One ; 17(8): e0270425, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913927

RESUMO

Non-typhoidal Salmonellae are common foodborne pathogens that can cause gastroenteritis and other illnesses in people. This is the first study to assess the transfer of Salmonella enterica from raw chicken carcasses to ready-to-eat chicken salad in Cambodia. Twelve focus group discussions in four Cambodian provinces collected information on typical household ways of preparing salad. The results informed four laboratory experiments that mimicked household practices, using chicken carcasses inoculated with Salmonella. We developed four scenarios encompassing the range of practices, varying by order of washing (chicken or vegetables first) and change of chopping utensils (same utensils or different). Even though raw carcasses were washed twice, Salmonella was isolated from 32 out of 36 chicken samples (88.9%, 95% CI: 73.0-96.4) and two out of 18 vegetable samples (11.1%, 95% CI: 1.9-36.1). Salmonella was detected on cutting boards (66.7%), knives (50.0%) and hands (22.2%) after one wash; cross-contamination was significantly higher on cutting boards than on knives or hands (p-value < 0.05). The ready-to-eat chicken salad was contaminated in scenario 1 (wash vegetables first, use same utensils), 2 (wash vegetables first, use different utensils) and 3 (wash chicken first, use same utensils) but not 4 (wash chicken first, use different utensils) (77.8%, 11.1%, 22.2% and 0%, respectively). There was significantly higher Salmonella cross-contamination in scenario 1 (wash vegetables first, use same utensils) than in the other three scenarios. These results show how different hygiene practices influence the risk of pathogens contaminating chicken salad. This information could decrease the risk of foodborne disease in Cambodia and provides inputs to a quantitative risk assessment model.


Assuntos
Saladas , Salmonella enterica , Animais , Asiáticos , Galinhas , Contagem de Colônia Microbiana , Contaminação de Alimentos/análise , Contaminação de Alimentos/prevenção & controle , Manipulação de Alimentos/métodos , Microbiologia de Alimentos , Humanos , Londres , Salmonella typhimurium , Sorogrupo , Verduras
4.
BMC Psychiatry ; 22(1): 551, 2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-35962427

RESUMO

BACKGROUND: Court Mental Health Liaison and Diversion Services (CMHLDS) have developed in some countries as a response to the over-representation of mental illness and other vulnerabilities amongst defendants presenting to criminal justice (or correctional) systems. This study examined the characteristics and rates of mental disorder of 9088 defendants referred to CMHLDS. METHOD: The study analysed service level data, obtained from the National Health Service's mental health data set, to examine characteristics relating to gender, ethnicity and comorbidity of common mental and neurodevelopmental disorders at five CMHLDS across London between September 2015 and April 2017. RESULTS: The sample included 7186 males (79.1%) and 1719 females (18.9%), the gender of 183 (2%) were not recorded. Of those referred, 6616 (72.8%) presented with an identifiable mental disorder and 503 (5.5%) with a neurodevelopmental disorder (NDD). Significantly higher rates of schizophrenia were reported amongst Black defendants (n = 681; 37.2%) and Asian defendants (n = 315; 29%), while higher rates of depression were found amongst White defendants (n = 1007; 22.1%). Substance misuse was reported amongst 2813 defendants (31%), and alcohol misuse amongst 2111 (23.2%), with significantly high rates of substance and alcohol misuse amongst defendants presenting with schizophrenia or personality disorder. CONCLUSIONS: This is one of the largest studies to examine mental health needs and vulnerabilities amongst defendants presenting to CMHLDS. It will enable an improved understanding of the required service designs and resources required to manage the healthcare pathways for people attending CMHLDS.


Assuntos
Alcoolismo , Transtornos Mentais , Transtornos do Neurodesenvolvimento , Feminino , Humanos , Londres/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos do Neurodesenvolvimento/epidemiologia , Medicina Estatal
5.
BMJ Open ; 12(8): e057433, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918110

RESUMO

OBJECTIVES: We aimed to apply natural language processing algorithms in routine healthcare records to identify reported somatic passivity (external control of sensations, actions and impulses) and thought interference symptoms (thought broadcasting, insertion, withdrawal), first-rank symptoms traditionally central to diagnosing schizophrenia, and determine associations with prognosis by analysing routine outcomes. DESIGN: Four algorithms were developed on deidentified mental healthcare data and applied to ascertain recorded symptoms over the 3 months following first presentation to a mental healthcare provider in a cohort of patients with a primary schizophreniform disorder (ICD-10 F20-F29) diagnosis. SETTING AND PARTICIPANTS: From the electronic health records of a large secondary mental healthcare provider in south London, 9323 patients were ascertained from 2007 to the data extraction date (25 February 2020). OUTCOMES: The primary binary dependent variable for logistic regression analyses was any negative outcome (Mental Health Act section, >2 antipsychotics prescribed, >22 days spent in crisis care) over the subsequent 2 years. RESULTS: Final adjusted models indicated significant associations of this composite outcome with baseline somatic passivity (prevalence 4.9%; adjusted OR 1.61, 95% CI 1.37 to 1.88), thought insertion (10.7%; 1.24, 95% CI 1.15 to 1.55) and thought withdrawal (4.9%; 1.36, 95% CI 1.10 to 1.69), but not independently with thought broadcast (10.3%; 1.05, 95% CI 0.91 to 1.22). CONCLUSIONS: Symptoms traditionally central to the diagnosis of schizophrenia, but under-represented in current diagnostic frameworks, were thus identified as important predictors of short-term to medium-term prognosis in schizophreniform disorders.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Humanos , Londres/epidemiologia , Processamento de Linguagem Natural , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico
7.
CMAJ ; 194(29): E1018-E1026, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918087

RESUMO

BACKGROUND: First Nations, Inuit and Métis Peoples across geographies are at higher risk of SARS-CoV-2 infection and COVID-19 because of high rates of chronic disease, inadequate housing and barriers to accessing health services. Most Indigenous Peoples in Canada live in cities, where SARS-CoV-2 infection is concentrated. To address gaps in SARS-CoV-2 information for these urban populations, we partnered with Indigenous agencies and sought to generate rates of SARS-CoV-2 testing and vaccination, and incidence of infection for First Nations, Inuit and Métis living in 2 Ontario cities. METHODS: We drew on existing cohorts of First Nations, Inuit and Métis adults in Toronto (n = 723) and London (n = 364), Ontario, who were recruited using respondent-driven sampling. We linked to ICES SARS-CoV-2 databases and prospectively monitored rates of SARS-CoV-2 testing, diagnosis and vaccination for First Nations, Inuit and Métis, and comparator city and Ontario populations. RESULTS: We found that SARS-CoV-2 testing rates among First Nations, Inuit and Métis were higher in Toronto (54.7%, 95% confidence interval [CI] 48.1% to 61.3%) and similar in London (44.5%, 95% CI 36.0% to 53.1%) compared with local and provincial rates. We determined that cumulative incidence of SARS-CoV-2 infection was not significantly different among First Nations, Inuit and Métis in Toronto (7364/100 000, 95% CI 2882 to 11 847) or London (7707/100 000, 95% CI 2215 to 13 200) compared with city rates. We found that rates of vaccination among First Nations, Inuit and Métis in Toronto (58.2%, 95% CI 51.4% to 64.9%) and London (61.5%, 95% CI 52.9% to 70.0%) were lower than the rates for the 2 cities and Ontario. INTERPRETATION: Although Ontario government policies prioritized Indigenous populations for SARS-CoV-2 vaccination, vaccine uptake was lower than in the general population for First Nations, Inuit and Métis Peoples in Toronto and London. Ongoing access to culturally safe testing and vaccinations is urgently required to avoid disproportionate hospital admisson and mortality related to COVID-19 in these communities.


Assuntos
COVID-19 , Índios Norte-Americanos , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19 , Canadá/epidemiologia , Humanos , Inuítes , Londres/epidemiologia , Ontário/epidemiologia , SARS-CoV-2
8.
PLoS One ; 17(8): e0272278, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930534

RESUMO

The burial rates of males and females in early modern central London were compared to investigate a possible bias towards male mortality in the plague years of 1563, 1593, 1603, 1625 and 1665. The burial records of sixteen parishes were examined and compared with the five-year periods immediately preceding each plague year when recorded burials were substantially less. A markedly higher burial rate for males was detected in each plague year but this can be partly attributed to a general preponderance of males in the central London population since there was a similar but lesser bias in non-plague years. In the plague years the difference between the frequency of male and female adult burials appears to have been enhanced by the preferential migration of women of childbearing age out of the city since fewer births were recorded in months when plague was rife. Furthermore, when a sample of households was investigated, husbands were significantly more likely to have been buried than their wives. These findings were largely applicable to the plague years of 1603, 1625 and 1665 but were far less apparent in 1563 and 1593. In general, there were more burials of boys than girls in non-plague years which is the expected consequence of their greater vulnerability to childhood diseases. This difference diminished in plague years so that the burials of girls and boys approached parity at a time when burials of children of both sexes were significantly increased. Possibly, plague did not discriminate between the sexes and this characteristic tended to mask the usual vulnerability of boys.


Assuntos
Sepultamento , Cônjuges , Adulto , Criança , Características da Família , Feminino , Humanos , Londres/epidemiologia , Masculino
9.
J Biomol Tech ; 33(1)2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35837002

RESUMO

Financial sustainability in biobanks has recently become a key issue globally, as biorepositories struggle to balance limited external funding and high operating costs. To maximize governance and operational efficiency, the Pathology Facility and the University College London (UCL)/UCL Hospitals Biobank for Studying Health and Disease ("the Biobank") have been grouped together under the same management at the UCL Cancer Institute. This paper explores the operational and financial interaction between the Pathology Facility and the Biobank over a period of 3 years (2017-2019). Since 2017, only a minority of the requests included collection of samples from the archive or molecular biology services, and most of the requests included histology services. Our data confirmed the difficulty for a biobank to achieve financial sustainability. The integration of the Pathology Facility with the Biobank within a single laboratory management and delivery infrastructure was shown to be an effective management option and presented a unique opportunity to overcome financial and operational challenges, thus improving efficiency and lowering costs for both parties.


Assuntos
Academias e Institutos , Bancos de Espécimes Biológicos , Custos e Análise de Custo , Humanos , Londres , Universidades
10.
Sci Rep ; 12(1): 11741, 2022 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-35817805

RESUMO

One of the biggest challenges of the COVID-19 pandemic is the heterogeneity in disease severity exhibited amongst patients. Among multiple factors, latest studies suggest vitamin D deficiency and pre-existing health conditions to be major contributors to death from COVID-19. It is known that certain urban form attributes can impact sun exposure and vitamin D synthesis. Also, long-term exposure to air pollution can play an independent role in vitamin D deficiency. We conducted a correlational analysis of urban form and air quality in relation to the demographics and COVID-19 incidence and mortality across 32 London boroughs between March 2020 and January 2021. We found total population, number of residents of Asian ethnicity, 4-year average PM10 levels and road length to be positively correlated with COVID-19 cases and deaths. We also found percentage of households with access to total open space to be negatively correlated with COVID-19 deaths. Our findings link COVID-19 incidence and mortality across London with environmental variables linked to vitamin D status. Our study is entirely based on publicly available data and provides a reference framework for further research as more data are gathered and the syndemic dimension of COVID-19 becomes increasingly relevant in connection to health inequalities within large urban areas.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Deficiência de Vitamina D , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , COVID-19/epidemiologia , Humanos , Incidência , Londres/epidemiologia , Pandemias , Vitamina D/análise , Deficiência de Vitamina D/epidemiologia , Vitaminas/análise
11.
Ann Sci ; 79(3): 292-319, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35802391

RESUMO

In an unpublished anatomical treatise written around 1670, the English anatomist and fellow of the Royal Society of London Edmund King proposed that the human body was ultimately an assemblage of tubes and contained liquids. Without literally seeing every of its constituents to be tubular, how did King come to posit a tubular body? This article tackles the question by examining King's inquiry about the pulse against his framing of the circulatory system into a universally tubular model. Asking how King registered this model despite the limited visibility of vascularity in practice, I discuss the place of analogy in his anatomical observation. I argue that analogy constituted an essential strategy for extending what King had perceived to account for the hardly perceptible nuances of the human body. I concentrate on two of his analogies, in which the artery was compared to the cord and the ureter. These two analogies revealed remarkable epistemic potency in representing and reasoning the pulse as the inherent motion of the living artery. They suggest that in seventeenth-century observation accounts, analogy was not simply a rhetoric suspicious of violating the principle of scientific empiricism; rather, they opened up ways of seeing and imagining nature.


Assuntos
Anatomistas , Humanos , Idioma , Londres , Redação
12.
Ann Sci ; 79(3): 320-363, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35811469

RESUMO

At some point between 1684 and 1698 a Dartmouth tradesman started to perform experiments with the power of steam in his workshop. In the course of this investigation Thomas Newcomen discovered how to cause a partial vacuum by rapid condensation under a piston and incorporated this prime mover within an engine that was consistently reliable and proved commercially viable for draining mines.Consensus is that his initial apparatus was partly derived from an air pump, however historians have debated how this isolated ironmonger could have garnered sufficient theoretical understanding to pursue such a line of enquiry, let alone the know-how to make suitable devices and mechanisms. Just how remote was Newcomen from London 'science'?This paper examines his relational connections, identifying potential links with Denis Papin, Robert Hooke and an authority on mine pumps, Christopher Kirkby. The case of Newcomen illustrates the proliferation of modern ideas and values through relational networks, and, most importantly, the know-how to innovate.


Assuntos
Vácuo , Londres
14.
Int J Behav Nutr Phys Act ; 19(1): 93, 2022 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-35897072

RESUMO

BACKGROUND: Policies aimed at restricting the marketing of high fat, salt and sugar products have been proposed as one way of improving population diet and reducing obesity. In 2019, Transport for London implemented advertising restrictions on high fat, salt and sugar products. A controlled interrupted time-series analysis comparing London with a north of England control, suggested that the advertising restrictions had resulted in a reduction in household energy purchases. The aim of the study presented here was to estimate the health benefits, cost savings and equity impacts of the Transport for London policy using a health economic modelling approach, from an English National Health Service and personal social services perspective. METHODS: A diabetes prevention microsimulation model was modified to incorporate the London population and Transport for London advertising intervention. Conversion of calorie to body mass index reduction was mediated through an approximation of a mathematical model estimating weight loss. Outcomes gathered included incremental obesity, long-term diabetes and cardiovascular disease events, quality-adjusted life years, healthcare costs saved and net monetary benefit. Slope index of inequality was calculated for proportion of people with obesity across socioeconomic groups to assess equity impacts. RESULTS: The results show that the Transport for London policy was estimated to have resulted in 94,867 (4.8%) fewer individuals with obesity, and to reduce incidence of diabetes and cardiovascular disease by 2,857 and 1,915 cases respectively within three years post intervention. The policy would produce an estimated 16,394 additional quality-adjusted life-years and save £218 m in NHS and social care costs over the lifetime of the current population. Greater benefits (e.g. a 37% higher gain in quality-adjusted life-years) were expected to accrue to individuals from the most socioeconomically deprived groups compared to the least deprived. CONCLUSIONS: This analysis suggests that there are considerable potential health and economic gains from restricting the advertisement of high fat, salt and sugar products. The population health and economic impacts of the Transport for London advertising restrictions are likely to have reduced health inequalities in London.


Assuntos
Publicidade , Doenças Cardiovasculares , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Humanos , Londres , Obesidade/epidemiologia , Obesidade/prevenção & controle , Cloreto de Sódio na Dieta , Medicina Estatal , Açúcares
15.
BMJ ; 378: e072410, 2022 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902115

RESUMO

OBJECTIVE: To characterise the clinical features of monkeypox infection in humans. DESIGN: Descriptive case series. SETTING: A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022. PARTICIPANTS: 197 patients with polymerase chain reaction confirmed monkeypox infection. RESULTS: The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling. CONCLUSIONS: These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.


Assuntos
Infecções por HIV , Varíola dos Macacos , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adulto , Animais , Surtos de Doenças , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Londres/epidemiologia , Masculino , Varíola dos Macacos/complicações , Dor/complicações , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia
16.
BMJ Open ; 12(7): e059836, 2022 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-35840307

RESUMO

INTRODUCTION: Hearing aids are the gold standard treatment to help manage hearing loss. However, not everyone who needs them has them, and of those who do, a significant proportion of people do not use them at all, or use them infrequently. Despite literature reviews listing key barriers and enablers to the uptake and use of hearing aids, there is little evidence to describe how this varies by population and context. This review will describe what factors are important to whom in what context when considering the provision of hearing aids for hearing loss in adults. METHODS AND ANALYSIS: The aims of this review are as follows: (1) To iteratively review and synthesise evidence surrounding the provision of hearing aids for hearing loss in adults. (2) To generate a theory-driven understanding of factors that are important, for whom, and in what context. (3) To develop a programme theory describing contexts that can support the provision of hearing aids to result in improved outcomes for adults with hearing loss. A scoping literature search will aid the development of programme theories, to explain how the intervention is expect to work, for whom, in what circumstances and in which contexts. We will locate evidence in the following databases: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMED, Web of Science with no date restrictions. A realist analytic approach will be used to refute and refine these initial programme theories. Throughout the review, relevant key stakeholders (eg, patients and clinicians) will be consulted to test and refine the programme theories. ETHICS AND DISSEMINATION: This study was approved by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee: (FMHS 95-0820) and the London Brent NHS Research Ethics Committee (Ref: 21/PR/0259). The review will be reported according to the RAMESES guidelines and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021282049.


Assuntos
Surdez , Auxiliares de Audição , Perda Auditiva , Adulto , Humanos , Londres , Encaminhamento e Consulta , Literatura de Revisão como Assunto
17.
J Law Med Ethics ; 50(2): 390-391, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35894562

RESUMO

Written in response to what he recognizes as the problematic philosophical underpinnings of "orthodox research ethics," Alex John London's For the Common Good reimagines what is called for in any effort to create a better system of oversight and regulation in biomedical research. London weaves a common thread - justice - through this historical and critical account of the practice of research ethics and its organization of stakeholders, institutions and regulations. By introducing the idea of "a common good" London reframes the narrative and responsibilities of the research ethics field to demonstrate that scientific research and regard for the rights and welfare of individuals are not mutually exclusive. This impressive monograph encourages its readers to push past the limitations of traditional research ethics to consider the context in which the discipline is embedded. That is, rather than settling for analysis at the level of researchers and research participants alone, London encourages us to expand our inquiry to encompass a wider array of stakeholders who co-labor in the social undertaking of biomedical knowledge production. London accomplishes the difficult task of upstream analysis - turning his attention to the conditions and assumptions which create ethical dilemmas rather than applying a retrospective ethical salve to injuries near-guaranteed by a broken system. As opposed to the limited domain of orthodox research ethics (researchers, participants, and the institutional bodies which regulate interaction between the two) London also considers the role and contributions of affected communities, pharmaceutical firms, philanthropic organizations, and journal editors among others.


Assuntos
Pesquisa Biomédica , Justiça Social , Ética em Pesquisa , Humanos , Londres , Masculino , Estudos Retrospectivos
18.
Clin J Am Soc Nephrol ; 17(6): 843-850, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35649718

RESUMO

BACKGROUND AND OBJECTIVES: Patients receiving hemodialysis are at high risk from coronavirus disease 2019 (COVID-19) and demonstrate impaired immune responses to vaccines. There have been several descriptions of their immunologic responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, but few studies have described the clinical efficacy of vaccination in patients on hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a multicenter observational study of the London hemodialysis population undergoing surveillance PCR testing during the period of vaccine rollout with BNT162b2 and AZD1222, all of those positive for SARS-CoV-2 were identified. Clinical outcomes were analyzed according to predictor variables, including vaccination status, using a mixed effects logistic regression model. Risk of infection was analyzed in a subgroup of the base population using a Cox proportional hazards model with vaccination status as a time-varying covariate. RESULTS: SARS-CoV-2 infection was identified in 1323 patients of different ethnicities (Asian/other, 30%; Black, 38%; and White, 32%), including 1047 (79%) unvaccinated, 86 (7%) after first-dose vaccination, and 190 (14%) after second-dose vaccination. The majority of patients had a mild course; however, 515 (39%) were hospitalized, and 172 (13%) died. Older age, diabetes, and immune suppression were associated with greater illness severity. In regression models adjusted for age, comorbidity, and time period, prior two-dose vaccination was associated with a 75% (95% confidence interval, 56 to 86) lower risk of admission and 88% (95% confidence interval, 70 to 95) fewer deaths compared with unvaccinated patients. No loss of protection was seen in patients over 65 years or with increasing time since vaccination, and no difference was seen between vaccine types. CONCLUSIONS: These data demonstrate a substantially lower risk of severe COVID-19 after vaccination in patients on dialysis who become infected with SARS-CoV-2.


Assuntos
Vacina BNT162 , COVID-19 , ChAdOx1 nCoV-19 , Diálise Renal , Vacina BNT162/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , ChAdOx1 nCoV-19/administração & dosagem , Humanos , Londres , Estudos Prospectivos , Índice de Gravidade de Doença , Vacinação
19.
PLoS One ; 17(6): e0269781, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35696385

RESUMO

BACKGROUND: Unplanned pregnancy is an important public health problem in both the developing and developed world, as it may cause adverse social and health outcomes for mothers, children, and families as a whole. London Measure of Unplanned Pregnancy (LMUP) has been formally and informally validated in multiple and diverse settings. However, there is a dearth of literature on the validation of LMUP in Ethiopia either in the Amharic version or other languages. OBJECTIVE: The general objective of this study was to translate the LMUP into Amharic and evaluate its psychometric properties in a sample of Amharic-speaking women receiving antenatal care (ANC) service at public health facilities in Arbaminch and Birbir towns. METHODS: A cross-sectional study design was used for the study. Forward and backward translation of original English LMUP to Amharic was done. A cognitive interview using a pretested structured questionnaire was used to collect the data from respondents. The collected data was analyzed using SPSS version 25. Reliability was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations while construct validity was assessed using principal components analysis and hypothesis testing. RESULTS: Data was collected from 320 women attending antennal care services at selected public health care facilities. LMUP range of 1to 11 was captured. The prevalence of unplanned pregnancies was 19(5.9%), while 136(42.5 were ambivalent and 165(51.6%) were planned pregnancies. The reliability testing demonstrated acceptable internal consistency (Cronbach's alpha = 0.799) and the validity testing confirmed the unidimensional structure of the scale. In addition, all hypotheses were confirmed. CONCLUSIONS: Amharic version of LMUP is a valid and reliable tool to measure pregnancy intention so that it can be used by Amharic speaking population in Ethiopia. It can also be used in research studies among Amharic-speaking women to measure unplanned pregnancy.


Assuntos
Idioma , Gravidez não Planejada , Criança , Estudos Transversais , Etiópia , Feminino , Humanos , Londres , Gravidez , Gravidez não Planejada/psicologia , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
Sci Rep ; 12(1): 10780, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35750788

RESUMO

Running pacing has become a focus of interest over recent years due to its relationship with performance, however, it is still unknown the consistency of each race in different editions. The aim of this study is to analyze the consistency of pacing profile in three consecutive editions of three marathon races. A database of 282,808 runners, compiled from three different races (Chicago, London, and Tokyo Marathon) and three editions (2017, 2018, and 2019) was analyzed. Participants were categorized according to their time performance in the marathon, every 30 min from 2:30 h to sub-6 h. The relative speed of each section for each runner was calculated as a percentage of the average speed for the entire race. The intraclass correlation coefficients (ICC) of relative speed at the different pacing section, taking into account the runner time categories, was excellent over the three marathon editions (ICC > 0.93). The artificial intelligence model showed an accuracy of 86.8% to classify the runners' data in three marathons, suggesting a consistency between editions with identifiable differences between races. In conclusion, although some differences have been observed between editions in certain sections and marathon runner categories, excellent consistency of the pacing profile was observed. The study of pacing profile in a specific marathon can, therefore, be helpful for runners, coaches and marathon organizers for planning the race and improving its organization.


Assuntos
Desempenho Atlético , Inteligência Artificial , Chicago , Humanos , Londres , Corrida de Maratona , Tóquio
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