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1.
Tech Coloproctol ; 28(1): 74, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926191

RESUMO

BACKGROUND: Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS. METHODS: The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle. RESULTS: A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%. CONCLUSIONS: This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.


Assuntos
Exenteração Pélvica , Pelve , Humanos , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Feminino , Complicações Pós-Operatórias/etiologia , Síndrome , Pessoa de Meia-Idade , Omento/cirurgia
2.
Support Care Cancer ; 31(10): 570, 2023 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-37698629

RESUMO

PURPOSE: To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway. METHODS: Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary). RESULTS: 99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician. CONCLUSION: The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.


Assuntos
Neoplasias da Mama , COVID-19 , Síndrome Respiratória e Reprodutiva Suína , Autogestão , Suínos , Animais , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Qualidade de Vida
3.
AIDS Care ; 34(11): 1473-1480, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35914114

RESUMO

HIV disproportionately impacts many groups, including Black adolescent girls and young women (AGYW) aged 13-24 living in the Deep South. Current prevention efforts have the potential to further exacerbate disparities within this population as HIV pre-exposure prophylaxis (PrEP) remains underutilized by Black AGYW in the South. We conducted in-depth interviews (IDIs) grounded in Andersen's Model of Healthcare Utilization exploring providers' PrEP prescribing practices to Black AGYW in Alabama. Eleven providers completed IDIs exploring providers' PrEP prescription knowledge and experiences. Cross-cutting themes included: (1) Community and provider-level stigmas (including those propagated by legislation) relating to HIV and sexuality limit sexual health discussions with Black AGYW clients; (2) Low PrEP knowledge and comfort with guidelines limits PrEP conversations and reinforces low uptake and prescriptions; (3) Healthcare systems and structural barriers impede PrEP access for youth. Multi-level (structural, community, and provider) barriers to PrEP prescription demands high activation energy for providers to prescribe PrEP. We present recommendations in training in sexual health assessment, updates to PrEP guidelines to accommodate risk assessment appropriate for AGYW, and increased implementation science focused on PrEP prescription for Black AGYW in order to reduce HIV incidence for this population.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Feminino , Humanos , Alabama , Fármacos Anti-HIV/uso terapêutico , Negro ou Afro-Americano , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Prescrições , Adulto Jovem
4.
Mar Policy ; 140: 105054, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35399704

RESUMO

The human response to the COVID-19 pandemic set in motion an unprecedented shift in human activity with unknown long-term effects. The impacts in marine systems are expected to be highly dynamic at local and global scales. However, in comparison to terrestrial ecosystems, we are not well-prepared to document these changes in marine and coastal environments. The problems are two-fold: 1) manual and siloed data collection and processing, and 2) reliance on marine professionals for observation and analysis. These problems are relevant beyond the pandemic and are a barrier to understanding rapidly evolving blue economies, the impacts of climate change, and the many other changes our modern-day oceans are undergoing. The "Our Ocean in COVID-19″ project, which aims to track human-ocean interactions throughout the pandemic, uses the new eOceans platform (eOceans.app) to overcome these barriers. Working at local scales, a global network of ocean scientists and citizen scientists are collaborating to monitor the ocean in near real-time. The purpose of this paper is to bring this project to the attention of the marine conservation community, researchers, and the public wanting to track changes in their area. As our team continues to grow, this project will provide important baselines and temporal patterns for ocean conservation, policy, and innovation as society transitions towards a new normal. It may also provide a proof-of-concept for real-time, collaborative ocean monitoring that breaks down silos between academia, government, and at-sea stakeholders to create a stronger and more democratic blue economy with communities more resilient to ocean and global change.

5.
Phytopathology ; 111(6): 1029-1041, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33048630

RESUMO

Before 1991, Xanthomonas euvesicatoria was the causal agent of bacterial spot of tomato in Florida but was quickly replaced by X. perforans. The X. perforans population has changed in genotype and phenotype despite lack of a clear selection pressure. To determine the current Xanthomonas population in Florida, we collected 585 Xanthomonas strains from 70 tomato fields, representing 22 farms across eight counties, in the Florida tomato production region. Strains were isolated from 23 cultivars across eight seed producers and were associated with eight transplant facilities during the fall 2017 season. Our collection was phenotypically and genotypically characterized. Only X. perforans was identified, and all strains except one (99.8%) were tolerant to copper sulfate and 25% of strains were resistant to streptomycin sulfate. Most of the strains (99.3%) that were resistant to streptomycin sulfate were sequence type 1. The X. perforans population consisted of tomato races 3 (8%) and 4 (92%) and all three previously reported sequence types, ranging from 22 to 46% frequency. Approximately half of all strains, none of which were sequence type 2, produced bacteriocins against X. euvesicatoria. Effector profiles were highly variable among strains, which could impact the strains' host range. The effector xopJ4, which was previously thought to be conserved in X. perforans tomato pathogens, was absent in 19 strains. Nonmetric multidimensional scaling and network analyses show how strains and strain traits were associated with production system variables, including anonymized farms and transplant facilities. These analyses show that the composition of the Florida X. perforans population is diverse and complex.


Assuntos
Solanum lycopersicum , Xanthomonas , Florida , Doenças das Plantas , Xanthomonas/genética
6.
Soft Matter ; 15(42): 8578-8588, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31642834

RESUMO

We investigate the reversible gelation of poly(N-isopropylacrylamide) (pNIPAM) microgels in the presence of triblock-copolymer (PEO-PPO-PEO type) surfactant. We demonstrate that the association of these polymers with the microgel particles at elevated temperature is responsible for the gelation, due to the temperature responsive nature of the components. This is highlighted by an increase in the apparent hydrodynamic diameter of the particles in dynamic light scattering experiments, which only occurs above the volume phase transition temperature of pNIPAM. The gels that result shrink over a time period much larger than that of the collapse of pNIPAM microgels, and retain the shape of the container they form in. We investigate the mechanism that leads to this gelation and the structure of the gels that result. Confocal microscopy experiments show that both polymers are present in the gel network, indicating that an associative mechanism is responsible for the gelation. We vary the pNIPAM particle architecture to further investigate the gelation process, and find that the cross-link distribution plays a key role in the gelation mechanism, where for uniformly cross-linked particles the gelation is not observed. This shows that the fuzzy corona of the pNIPAM microgels is involved in the association of the polymers, allowing the triblock-copolymer to penetrate the outer corona of the microgels and bridge the particles. The phase transition observed is close to physiological conditions, so these gels have the potential for use in biomedical applications, including tissue engineering.

7.
Int J Syst Evol Microbiol ; 68(1): 64-70, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29148362

RESUMO

An unusual fluorescent pseudomonad was isolated from tomato exhibiting leaf spot symptoms similar to bacterial speck. Strains were fluorescent, oxidase- and arginine-dihydrolase-negative, elicited a hypersensitive reaction on tobacco and produced a soft rot on potato slices. However, the strains produced an unusual yellow, mucoid growth on media containing 5 % sucrose that is not typical of levan. Based on multilocus sequence analysis using 16S rRNA, gap1, gltA, gyrB and rpoD, these strains formed a distinct phylogenetic group in the genus Pseudomonas and were most closely related to Pseudomonas viridiflava within the Pseudomonassyringae complex. Whole-genome comparisons, using average nucleotide identity based on blast, of representative strain GEV388T and publicly available genomes representing the genus Pseudomonas revealed phylogroup 7 P. viridiflava strain UASW0038 and P. viridiflava type strain ICMP 2848T as the closest relatives with 86.59 and 86.56 % nucleotide identity, respectively. In silico DNA-DNA hybridization using the genome-to-genome distance calculation method estimated 31.1 % DNA relatedness between GEV388T and P. viridiflava ATCC 13223T, strongly suggesting the strains are representatives of different species. These results together with Biolog GEN III tests, fatty acid methyl ester profiles and phylogenetic analysis using 16S rRNA and multiple housekeeping gene sequences demonstrated that this group represents a novel species member of the genus Pseudomonas. The name Pseudomonas floridensis sp. nov. is proposed with GEV388T (=LMG 30013T=ATCC TSD-90T) as the type strain.


Assuntos
Filogenia , Pseudomonas/classificação , Solanum lycopersicum/microbiologia , Técnicas de Tipagem Bacteriana , Composição de Bases , DNA Bacteriano/genética , Ácidos Graxos/química , Genes Bacterianos , Tipagem de Sequências Multilocus , Hibridização de Ácido Nucleico , Doenças das Plantas/microbiologia , Pseudomonas/genética , Pseudomonas/isolamento & purificação , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Solanum tuberosum/microbiologia , Nicotiana/microbiologia
8.
Support Care Cancer ; 26(11): 3941-3949, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29845422

RESUMO

PURPOSE: Trials of novel drugs used in advanced disease often show only progression-free survival or modest overall survival benefits. Hypothetical studies suggest that stabilisation of metastatic disease and/or symptom burden are worth treatment-related side effects. We examined this premise contemporaneously using qualitative and quantitative methods. METHODS: Patients with metastatic cancers expected to live > 6 months and prescribed drugs aimed at cancer control were interviewed: at baseline, at 6 weeks, at progression, and if treatment was stopped for toxicity. They also completed Functional Assessment of Cancer Therapy (FACT-G) plus Anti-Angiogenesis (AA) subscale questionnaires at baseline then monthly for 6 months. RESULTS: Ninety out of 120 (75%) eligible patients participated: 41 (45%) remained on study for 6 months, 36 progressed or died, 4 had treatment breaks, and 9 withdrew due to toxicity. By 6 weeks, 66/69 (96%) patients were experiencing side effects which impacted their activities. Low QoL scores at baseline did not predict a higher risk of death or dropout. At 6-week interviews, as the side effect severity increased, patients were significantly less inclined to view the benefit of cancer control as worthwhile (X2 = 50.7, P < 0.001). Emotional well-being initially improved from baseline by 10 weeks, then gradually returned to baseline levels. CONCLUSION: Maintaining QoL is vital to most patients with advanced cancer so minimising treatment-related side effects is essential. As side effect severity increased, drugs that controlled cancer for short periods were not viewed as worthwhile. Patients need to have the therapeutic aims of further anti-cancer treatment explained honestly and sensitively.


Assuntos
Drogas em Investigação/uso terapêutico , Neoplasias/tratamento farmacológico , Neoplasias/psicologia , Percepção , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Atitude Frente a Saúde , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias/epidemiologia , Neoplasias/patologia , Inquéritos e Questionários , Resultado do Tratamento
10.
Support Care Cancer ; 25(1): 237-244, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27619389

RESUMO

PURPOSE: The use of novel and often expensive drugs offering limited survival benefit in advanced disease is controversial. Treatment recommendations are influenced by patient characteristics and trial data showing overall response rates (ORR), progression-free survival (PFS) and overall survival (OS). PFS is frequently the primary outcome in licencing studies. PATIENTS AND METHODS: As part of a longitudinal study Assessing the 'VALue' to patients of PROgression Free Survival (AVALPROFS), oncologists completed checklists at baseline following consultations with patients. Questions probed perceived clinical benefits of the drugs to populations in general. Patients completed study-specific interview schedules at baseline, 6 weeks into treatment, and at withdrawal due to toxicity or progression. Patients also completed tumour- and treatment-specific quality of life questionnaires monthly for their time in the study. Only baseline results are reported here. RESULTS: Thirty-two UK oncologists discussed management options with 90 patients with heterogeneous advanced cancers. Oncologists' estimates of medical benefit in general from treatment varied between 10 and 80 %. They expected 46/90 (51 %) of their patients to derive some clinical benefit from the prescribed treatment but were either unsure or expected none for 44/90 (49 %). Predictions of life expectancy were variable but 62 % (56/90) of patients were expected to survive longer with treatment. A majority of patients 51/90 (57 %) had 'no idea' or were 'unclear' what PFS meant and 45/90 (50 %) thought extension of life was the primary therapeutic aim of treatment. CONCLUSION: Discussions between doctors and patients with metastatic disease about future management plans and likely therapeutic gains are challenging. Factors influencing decisions about putative benefits of novel drugs are often applied inconsistently can be overly optimistic and may even contradict published data.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias/tratamento farmacológico , Neoplasias/psicologia , Oncologistas/psicologia , Adulto , Idoso , Tomada de Decisões , Intervalo Livre de Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
11.
Phytopathology ; 107(11): 1298-1304, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28613108

RESUMO

Recently, in Central Florida tomato production fields, tomato foliage and fruit were observed with symptoms similar to bacterial speck. Fluorescent pseudomonads were consistently isolated and the strains were characterized by standard LOPAT tests, pathogenicity tests, and genetic characterization using 16S ribosomal RNA (rRNA) sequences and multilocus sequence analysis (MLSA) of conserved housekeeping genes. LOPAT test results indicated that the strains were likely Pseudomonas cichorii. These strains were pathogenic on tomato and were also pathogenic on lettuce, the host for the type strain of P. cichorii. Likewise, strains of P. cichorii isolated in Florida since the early 1980s from hosts other than tomato, along with the type strain, were also pathogenic on tomato. Genetic characterization using 16S rRNA and MLSA confirmed that the strains were most closely related to P. cichorii but varied significantly from the type strain. The Florida P. cichorii strains formed a separate phylogenetic group along with P. cichorii strains isolated from tomato in Tanzania. These strains were different from the previously described morphotypes and genomovars of P. cichorii. Our results indicate the presence of a genetically distinct group of multihost pathogenic P. cichorii strains that have been present in Florida since at least the early 1980s.


Assuntos
Doenças das Plantas/microbiologia , Pseudomonas/classificação , Pseudomonas/genética , Solanum lycopersicum/microbiologia , Florida , Filogenia , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Fatores de Tempo
12.
J Nurs Manag ; 24(3): 366-75, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26370219

RESUMO

AIMS: To explore the experiences of senior charge nurses provided with 'increased supervisory hours'. BACKGROUND: Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase. METHODS: An online questionnaire collected exploratory data from senior charge nurses (n = 60). Semi-structured interviews gathered in-depth qualitative data (n = 12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role. RESULTS: The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals. CONCLUSION: Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development. IMPLICATIONS FOR NURSING MANAGEMENT: Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.


Assuntos
Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Supervisão de Enfermagem/organização & administração , Atitude do Pessoal de Saúde , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho
13.
Br J Cancer ; 113(1): 107-18, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-26110972

RESUMO

BACKGROUND: Oesophageal adenocarcinoma (OAC) is one of the fastest rising malignancies with continued poor prognosis. Many studies have proposed novel biomarkers but, to date, no immunohistochemical markers of survival after oesophageal resection have entered clinical practice. Here, we systematically review and meta-analyse the published literature, to identify potential biomarkers. METHODS: Relevant articles were identified via Ovid medline 1946-2013. For inclusion, studies had to conform to REporting recommendations for tumor MARKer (REMARK) prognostic study criteria. The primary end-point was a pooled hazard ratio (HR) and variance, summarising the effect of marker expression on prognosis. RESULTS: A total of 3059 articles were identified. After exclusion of irrelevant titles and abstracts, 214 articles were reviewed in full. Nine molecules had been examined in more than one study (CD3, CD8, COX-2, EGFR, HER2, Ki67, LgR5, p53 and VEGF) and were meta-analysed. Markers with largest survival effects were COX-2 (HR=2.47, confidence interval (CI)=1.15-3.79), CD3 (HR=0.51, 95% CI=0.32-0.70), CD8 (HR=0.55, CI=0.31-0.80) and EGFR (HR=1.65, 95% CI=1.14-2.16). DISCUSSION: Current methods have not delivered clinically useful molecular prognostic biomarkers in OAC. We have highlighted the paucity of good-quality robust studies in this field. A genome-to-protein approach would be better suited for the development and subsequent validation of biomarkers. Large collaborative projects with standardised methodology will be required to generate clinically useful biomarkers.


Assuntos
Adenocarcinoma/metabolismo , Biomarcadores Tumorais/metabolismo , Neoplasias Esofágicas/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Imuno-Histoquímica , Prognóstico
14.
Br J Dermatol ; 173(3): 690-700, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25712143

RESUMO

BACKGROUND: Glucocorticoids (GCs) are first-line treatment for keloid disease (KD) but are limited by high incidence of resistance, recurrence and undesirable side-effects. Identifying patient responsiveness early could guide therapy. METHODS: Nineteen patients with KD were recruited at week 0 (before treatment) and received intralesional steroids. At weeks 0, 2 and 4, noninvasive imaging and biopsies were performed. Responsiveness was determined by clinical response and a significant reduction in vascular perfusion following steroid treatment, using full-field laser perfusion imaging (FLPI). Responsiveness was also evaluated using (i) spectrophotometric intracutaneous analysis to quantify changes in collagen and melanin and (ii) histology to identify changes in epidermal thickness and glycosaminoglycan (GAG) expression. Biopsies were used to quantify changes in glucocorticoid receptor (GR) expression using quantitative reverse transcriptase polymerase chain reaction, immunoblotting and immunohistochemistry. RESULTS: At week 2, the FLPI was used to separate patients into steroid responsive (n = 12) and nonresponsive groups (n = 7). All patients demonstrated a significant decrease in GAG at week 2 (P < 0.05). At week 4, responsive patients exhibited significant reduction in melanin, GAG, epidermal thickness (all P < 0.05) and a continued reduction in perfusion (P < 0.001) compared with nonresponders. Steroid-responsive patients had increased GR expression at baseline and showed autoregulation of GR compared with nonresponders, who showed no change in GR transcription or protein. CONCLUSIONS: This is the first demonstration that keloid response to steroids can be measured objectively using noninvasive imaging. FLPI is a potentially reliable tool to stratify KD responsiveness. Altered GR expression may be the mechanism gating therapeutic response.


Assuntos
Queloide/tratamento farmacológico , Receptores de Glucocorticoides/metabolismo , Esteroides/uso terapêutico , Adulto , Análise de Variância , Cicatriz/metabolismo , Cicatriz/patologia , Feminino , Humanos , Imuno-Histoquímica , Queloide/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Resultado do Tratamento , Adulto Jovem
15.
AIDS Behav ; 19(12): 2291-303, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26080688

RESUMO

HIV-infected men and women who choose to conceive risk infecting their partners. To inform safer conception programs we surveyed HIV risk behavior prior to recent pregnancy amongst South African, HIV-infected women (N = 209) and men (N = 82) recruited from antenatal and antiretroviral clinics, respectively, and reporting an uninfected or unknown-HIV-serostatus pregnancy partner. All participants knew their HIV-positive serostatus prior to the referent pregnancy. Only 11 % of women and 5 % of men had planned the pregnancy; 40 % of women and 27 % of men reported serostatus disclosure to their partner before conception. Knowledge of safer conception strategies was low. Around two-thirds reported consistent condom use, 41 % of women and 88 % of men reported antiretroviral therapy, and a third of women reported male partner circumcision prior to the referent pregnancy. Seven women (3 %) and two men (2 %) reported limiting sex without condoms to peak fertility. None reported sperm washing or manual insemination. Safer conception behaviors including HIV-serostatus disclosure, condom use, and ART at the time of conception were not associated with desired pregnancy. In light of low pregnancy planning and HIV-serostatus disclosure, interventions to improve understandings of serodiscordance and motivate mutual HIV-serostatus disclosure and pregnancy planning are necessary first steps before couples or individuals can implement specific safer conception strategies.


Assuntos
Infecções por HIV/transmissão , Assunção de Riscos , Sexo Seguro , Parceiros Sexuais , Adulto , Preservativos , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV , Humanos , Masculino , Gravidez , Comportamento Sexual , África do Sul , Adulto Jovem
16.
AIDS Behav ; 19(9): 1666-75, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25711300

RESUMO

Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider-client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient-provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients' fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.


Assuntos
Preservativos/estatística & dados numéricos , Aconselhamento , Fertilização , Infecções por HIV/prevenção & controle , Intenção , Relações Profissional-Paciente , Adulto , Feminino , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Humanos , Masculino , Motivação , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais , África do Sul
17.
Epidemiol Infect ; 143(11): 2355-66, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25427776

RESUMO

Structural equation modelling and survey data were used to test determinants' influence on farmers' intentions towards Escherichia coli O157 on-farm control. Results suggest that farmers more likely to show willingness to spend money/time or vaccinate to control Escherichia coli O157 are those: who think farmers are most responsible for control; whose income depends more on opening farms to the public; with stronger disease control attitudes; affected by outbreaks; with better knowledge and more informed; with stronger perceptions of biosecurity measures' practicality; using a health plan; who think farmers are the main beneficiaries of control; and whose farms are dairy rather than beef. The findings might suggest that farmers may implement on-farm controls for E. coli O157 if they identify a clear hazard and if there is greater knowledge of the safety and efficacy of the proposed controls.


Assuntos
Criação de Animais Domésticos , Atitude , Doenças dos Bovinos/prevenção & controle , Infecções por Escherichia coli/veterinária , Escherichia coli O157 , Controle de Infecções/métodos , Intenção , Adulto , Idoso , Animais , Bovinos , Doenças dos Bovinos/transmissão , Infecções por Escherichia coli/prevenção & controle , Infecções por Escherichia coli/transmissão , Vacinas contra Escherichia coli/uso terapêutico , Feminino , Humanos , Controle de Infecções/economia , Masculino , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários
18.
J Dairy Sci ; 98(2): 1019-32, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25497809

RESUMO

Calving body condition score (BCS) is an important determinant of early-lactation dry matter intake, milk yield, and disease incidence. The current study investigated the metabolic and molecular changes induced by the change in BCS. A group of cows of mixed age and breed were managed from the second half of the previous lactation to achieve mean group BCS (10-point scale) that were high (HBCS, 5.5; n=20), medium (MBCS, 4.5; n=18), or low (LBCS, 3.5; n=19). Blood was sampled at wk -4, -3, -2, 1, 3, 5, and 6 relative to parturition to measure biomarkers of energy balance, inflammation, and liver function. Liver was biopsied on wk 1, 3, and 5 relative to parturition, and 10 cows per BCS group were used for transcript profiling via quantitative PCR. Cows in HBCS and MBCS produced more milk and had greater concentrations of nonesterified fatty acids and ß-hydroxybutyrate postpartum than LBCS. Peak concentrations of nonesterified fatty acids and ß-hydroxybutyrate and greater hepatic triacylglycerol concentrations were recorded in HBCS at wk 3. Consistent with blood biomarkers, HBCS and MBCS had greater expression of genes associated with fatty acid oxidation (CPT1A, ACOX1), ketogenesis (HMGCS2), and hepatokines (FGF21, ANGPTL4), whereas HBCS had the lowest expression of APOB (lipoprotein transport). Greater expression during early lactation of BBOX1 in MBCS and LBCS suggested greater de novo carnitine synthesis. The greater BCS was associated with lower expression of growth hormone/insulin-like growth factor-1 signaling axis genes (GHR1A, IGF1, and IGFALS) and greater expression of gluconeogenic genes. These likely contributed to the higher milk production and greater gluconeogenesis. Despite greater serum haptoglobin around calving, cows in HBCS and MBCS had greater blood albumin. Cows in MBCS, however, had a higher albumin:globulin ratio, probably indicating a less pronounced inflammatory status and better liver function. The marked decrease in expression of NFKB1, STAT3, HP, and SAA3 coupled with the increase in ALB on wk 3 in MBCS cows were consistent with blood measures. Overall, results suggest that the greater milk production of cows with higher calving BCS is associated with a proinflammatory response without negatively affecting expression of genes related to metabolism and the growth hormone/insulin-like growth factor-1 axis. Results highlight the sensitivity of indicators of metabolic health and inflammatory state to subtle changes in calving BCS and, collectively, indicate a suboptimal health status in cows calving at either BCS 3.5 or 5.5 relative to BCS 4.5.


Assuntos
Composição Corporal/fisiologia , Bovinos/fisiologia , Metabolismo Energético/fisiologia , Fígado/metabolismo , Transcriptoma/fisiologia , Ácido 3-Hidroxibutírico/sangue , Animais , Ácidos Graxos não Esterificados/sangue , Feminino , Inflamação/metabolismo , Lactação/fisiologia , Metabolismo dos Lipídeos , Leite , Parto/fisiologia , Período Pós-Parto/fisiologia
19.
Epidemiol Infect ; 142(9): 1813-25, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24308445

RESUMO

Although the compartmentalization of poultry industry components has substantial economic implications, and is therefore a concept with huge significance to poultry industries worldwide, the current requirements for compartment status are generic to all OIE member countries. We examined the consequences for potential outbreaks of highly pathogenic avian influenza in the British poultry industry using a metapopulation modelling framework. This framework was used to assess the effectiveness of compartmentalization relative to zoning control, utilizing empirical data to inform the structure of potential epidemiological contacts within the British poultry industry via network links and spatial proximity. Conditions were identified where, despite the efficient isolation of poultry compartments through the removal of network-mediated links, spatially mediated airborne spread enabled spillover of infection with nearby premises making compartmentalization a more 'risky' option than zoning control. However, when zoning control did not effectively inhibit long-distance network links, compartmentalization became a relatively more effective control measure than zoning. With better knowledge of likely distance ranges for airborne spread, our approach could help define an appropriate minimum inter-farm distance to provide more specific guidelines for compartmentalization in Great Britain.


Assuntos
Controle de Doenças Transmissíveis/métodos , Influenza Aviária/prevenção & controle , Modelos Biológicos , Aves Domésticas , Animais , Surtos de Doenças/prevenção & controle , Surtos de Doenças/veterinária , Influenza Aviária/epidemiologia , Reino Unido/epidemiologia
20.
Rev Sci Tech ; 33(1): 39-46, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25000776

RESUMO

The European region has been, and remains, a global leader in the development of animal welfare policies. The region has a great diversity of cultures and religions, different levels of socio-economic development, and varied legislation, policies and practices. Nevertheless, there are common drivers for animal welfare policy based on a history of animal welfare ethics and obligations to animal users and society in general. A unifying goal of countries in the region is to achieve sustainable compliance with the World Organisation for Animal Health (OIE) standards on animal health and welfare. Ethics isthe overarching driver, supported by the actions of governmental, inter-governmental and non-governmental activities, markets and trade, science and knowledge. Historically, organisations involved in promoting animal welfare have tended to act in isolation. For example, non-governmental organisations (NGOs) have run campaigns to influence retailers and the welfare policies of their farmer suppliers. Increasingly, different organisations with common or complementary goals are working together. For example, competent authorities, inter-governmental bodies and NGOs have combined their efforts to address dog population control across several countries in the region. Also, animal welfare is becoming integrated into the corporate social responsibility targets of private companies. Science and knowledge, as drivers and tools, are assisting with the harmonisation of welfare standards, e.g. by providing a common basis for measuring welfare impacts through animal-based measures and widespread sharing of this information. Current trends suggest that there will be greater collaboration among the organisations driving change, and increasing convergence of animal welfare strategies and welfare assessment tools. The result will be increased harmonisation of animal welfare standards throughout the region.


Assuntos
Bem-Estar do Animal/legislação & jurisprudência , Bem-Estar do Animal/normas , Política Pública/legislação & jurisprudência , Política Pública/tendências , Animais , Comércio , Europa (Continente) , União Europeia , Internacionalidade
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