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INTRODUCTION: Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth. METHODS: 132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth. RESULTS: Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not. CONCLUSION: Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.
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Aleitamento Materno , Extração de Leite , Lactação , Leite Humano , Humanos , Feminino , Lactação/fisiologia , Recém-Nascido , Adulto , Leite Humano/metabolismo , Estudos de Coortes , Nascimento Prematuro , Masculino , Recém-Nascido Prematuro , Gravidez , Idade GestacionalRESUMO
Importance: Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. Objective: To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Data Sources: Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Study Selection: Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Data Extraction and Synthesis: Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Main Outcomes and Measures: Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. Results: A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants). Conclusions and Relevance: Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.
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Aleitamento Materno , Lactação , Leite Humano , Terapia de Relaxamento , Humanos , Terapia de Relaxamento/métodos , Lactação/fisiologia , Recém-Nascido , Feminino , LactenteRESUMO
OBJECTIVE: Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN: A cohort study (nested within a randomised trial). SETTING: Four neonatal units in the UK. PATIENTS: 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES: Time to the first attempt to express after birth. PRIMARY OUTCOMES: 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS: Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS: Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER: ISRCTN 16356650.
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Extração de Leite , Colostro , Lactente Extremamente Prematuro , Leite Humano , Humanos , Feminino , Recém-Nascido , Colostro/metabolismo , Leite Humano/metabolismo , Extração de Leite/métodos , Estudos de Coortes , Fatores de Tempo , Adulto , Idade Gestacional , Reino Unido , Masculino , MãesRESUMO
The rapidly increasing population and climate change pose a great threat to our current food systems. Moreover, the high usage of animal-based and plant-based protein has its drawbacks, as these nutritional sources require many hectares of land and water, are affected by seasonal variations, are costly, and contribute to environmental pollution. Single-cell proteins (SCPs) are gaining a lot of research interest due to their remarkable properties, such as their high protein content that is comparable with other protein sources; low requirements for land and water; low carbon footprint; and short production period. This review explores the use of food waste as a sustainable feedstock for the advancement of SCP processes. It discusses SCP studies that exploit food waste as a substrate, alongside the biocatalysts (bacteria, fungi, yeast, and microalgae) that are used. The operational setpoint conditions governing SCP yields and SCP fermentation routes are elucidated as well. This review also demonstrates how the biorefinery concept is implemented in the literature to improve the economic potential of "waste-to-protein" innovations, as this leads to the establishment of multiproduct value chains. A short section that discusses the South African SCP scenario is also included. The technical and economic hurdles facing second-generation SCP processes are also discussed, together with future perspectives. Therefore, SCP technologies could play a crucial role in the acceleration of a "sustainable protein market", and in tackling the global hunger crisis.
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BACKGROUND: Arterial stiffness has been associated with an increased risk of cardiovascular disease (CVD) in some patient populations. OBJECTIVES: The aims of this study were to investigate (1) whether there is an association between arterial stiffness, as measured by the Mobil-O-Graph, and risk for CVD in a population of individuals with intellectual disability and (2) whether arterial stiffness can predict the risk for CVD. METHODS: This cross-sectional study included 58 individuals who participated in wave 4 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (2019-2020). Statistical models were used to address the first aim, whereas machine learning models were used to improve the accuracy of risk predictions in the second aim. RESULTS: Sample characteristics were mean (SD) age of 60.69 (10.48) years, women (62.1%), mild/moderate level of intellectual disability (91.4%), living in community group homes (53.4%), overweight/obese (84.5%), high cholesterol (46.6%), alcohol consumption (48.3%), hypertension (25.9%), diabetes (17.24%), and smokers (3.4%). Mean (SD) pulse wave velocity (arterial stiffness measured by Mobil-O-Graph) was 8.776 (1.6) m/s. Cardiovascular disease risk categories, calculated using SCORE2, were low-to-moderate risk (44.8%), high risk (46.6%), and very high risk (8.6%). Using proportional odds logistic regression, significant associations were found between arterial stiffness, diabetes diagnosis, and CVD risk SCORE2 (P < .001). We also found the Mobil-O-Graph can predict risk of CVD, with prediction accuracy of the proportional odds logistic regression model approximately 60.12% (SE, 3.2%). Machine learning models, k-nearest neighbor, and random forest improved model predictions over and above proportional odds logistic regression at 75.85% and 77.7%, respectively. CONCLUSIONS: Arterial stiffness, as measured by the noninvasive Mobil-O-Graph, can be used to predict risk of CVD in individuals with intellectual disabilities.
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BACKGROUND: Patient and Public Involvement (PPI) is a rich and valuable part of the process of planning, designing, carrying out and disseminating research. It is important to communicate PPI findings in detail so that the contributions of those involved are fully utilised and disseminated. The extended and iterative PPI process used within a neonatal randomised controlled trial related to the expression of breastmilk after very preterm birth is reported here. METHODS: Seven iterative stages of PPI were used. Stage 1 was informal PPI using historical interaction with parents and publicly available resources. Stage 2 was an online questionnaire open to parents of premature babies and advertised via a charity collaborator. Stage 3 was partnership with a charity collaborator. Stage 4 was a set of online panels focusing on study design and documents. Stage 5 was an interactive exercise to modify the trial intervention. Stage 6 is the presence of PPI contributors on the trial steering committee. Stage 7 is a dissemination panel. At each stage attention was paid to the diversity of participants involved, with strategies to increase the involvement of parents from under-reached groups. RESULTS: Six hundred and seventy-five participants responded at Stage 2, six parents were involved at Stage 4 and 12 parents at Stage 5. PPI contributed to the choice of study question, outcomes and produced a set of questions for future research. PPI impacted on the study design, with specific emphasis on reducing participant distress related to lactation, and reducing the burden of being involved in research at a time of significant stress. CONCLUSIONS: PPI had a far-reaching influence on this neonatal randomised controlled trial during the planning and design phase, which reinforces the importance of PPI at the earliest stages of the research cycle. The online questionnaire format elicited an unexpectedly deep and broad pool of transferable insights, which will have an impact on future research focus and design in the area of lactation and prematurity. Approaches to increasing PPI involvement from under-reached populations are important and can be successful despite resource constraints.
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Neonatologia , Nascimento Prematuro , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Lactação , PaisRESUMO
BACKGROUND: Premature birth is the leading cause of neonatal death and can cause major morbidity. Maximising the amount of maternal breastmilk given to very premature infants is important to improve outcomes, but this can be challenging for parents. Parents of infants receiving neonatal care also have high rates of anxiety and distress. There is growing evidence for the impact of maternal relaxation interventions on lactation, as well as mental health. The trial will assess whether a brief self-directed relaxation and visualisation intervention, recommended for use several times a day during expression of milk, improves lactation and mental health outcomes for mothers of very premature infants. METHODS: Multi-centre, randomised, controlled, unmasked, parallel-group trial with planned 132 participants who have experienced premature birth between 23 weeks and 31 weeks and 6 days of gestation and plan to express milk for at least 14 days. The primary outcome is the highest 24-h expressed milk yield recorded on any of day 4, day 14 or day 21 after birth. Secondary outcomes include exclusive breastmilk feeding at 36 weeks post-menstrual age and at 4 months after the estimated date of delivery, Spielberger State Trait Anxiety Index at day 21 and Post-traumatic stress Check List (for DSM 5) at day 21. DISCUSSION: Breastmilk feeding for premature infants is an important research priority, but there are few randomised controlled trials assessing interventions to help parents reach lactation goals in this challenging context. This trial will assess whether a no cost, easily scalable relaxation tool has a role in this setting. Given the lack of harm and potential for immediate dissemination, even a small benefit could have an important global impact. TRIAL REGISTRATION: ISRCTN16356650 . Date assigned: 19/04/2021.
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Nascimento Prematuro , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Lactação , Mães/psicologia , Estudos Multicêntricos como Assunto , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses were used. The results showed that persistent depression only (HR 2.27; 95% CI: 1.35-3.81; p = 0.002), and comorbid persistent depression and anxiety (HR 2.03; 95% CI: 1.03-3.98; p = 0.040) were the significant predictors of a second ACS event. Secondary education level compared to primary educational level (HR 0.63; 95% CI: 0.43-0.93; p = 0.020) and college or more education level compared to primary educational level (HR 0.47; 95% CI: 0.27-0.84; p = 0.011) were the only demographic variables that were significant predictors of a second event. The study reveals that attention must be paid by healthcare providers to assess and manage persistent depression; particularly when it is co-morbid with anxiety.
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OBJECTIVE: The objective of this scoping review is to map the available evidence on the assessment of workplace integration of migrant nurses and midwives in international health care settings. INTRODUCTION: Internationally, migrant nurses and midwives are an increasingly important resource in government strategy for addressing the current and predicted workforce shortages in health care. Much has been documented about the orientation stages of their transition to foreign workplaces but few sources have considered the workplace integration of this population. INCLUSION CRITERIA: The review will include all studies involving migrant nurses and midwives who are working outside their country of initial nurse or midwife registration for at least one year. The context will be all hospital, community, and residential care home settings, including the mental health, intellectual disability, and maternity care sectors. METHODS: The JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to conduct this review. The databases to be searched will include CINAHL, MEDLINE, Embase, CENTRAL, and Google Scholar. Gray literature will also be searched and a hand search will be conducted of sources that fall outside these database searches. Two reviewers will independently screen titles, abstracts, and full-text articles. The extracted data will be presented in a tabulated chart accompanied by a narrative summary that aligns with the objectives and scope of this review.
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Serviços de Saúde Materna , Tocologia , Migrantes , Feminino , Saúde Global , Humanos , Gravidez , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto , Local de TrabalhoRESUMO
Introduction: Prematurity (birth before 37 +0 weeks' gestation) is associated with wide-ranging neurodevelopmental impairment. Prognosis among moderate to late (32 +0 to <37 +0 weeks' gestation) preterm infants (MLPT) is better compared to their counterparts born very preterm (<32 +0 weeks' gestation). However the risk of developmental impairment among MLPT, who make up about 84% of all preterm infants, is 2-3 times higher when compared to infants born at term. Early interventions have aimed to improve outcomes in preterm infants generally, but there are limited data on their need and effect in MLPT specifically. Prioritising research, long-term follow-up and early interventions targeted at ameliorating the impact of preterm birth among MLPT is required. Objectives: To conduct a systematic review of the type of early childhood interventions (from birth until 4 years of age) offered to MLPT children and to evaluate their impact on neurodevelopmental outcomes (cognitive, neurobehavioural and motor) as assessed in these children during childhood (until 18 years of age). Methods and analysis: A systematic literature search in Web of Science, Medline Ovid, PsycINFO, CINAHL and EMBASE will be conducted. Data on MLPT children receiving developmental interventions until the age of 4 years will be evaluated. Interventions may involve parents or primary caregivers. Primary outcomes are cognitive, neurobehavioural and motor development as measured from birth until the age of 18 years. The Cochrane Risk of Bias Assessment Tool will be used to evaluate the methodological quality of randomised controlled trials (RCTs) included in the review and will be graded as low, high or unclear risk of bias. The quality of non-RCTs will be evaluated with the Newcastle-Ottawa Scale. The quality of evidence for each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation Approach. Publication and reporting bias will be assessed using Egger's test and funnel plots respectively.
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BACKGROUND: There is increasing pressure to get women and babies home rapidly after birth. Babies born to mothers with gestational diabetes mellitus (GDM) currently get 24-h inpatient monitoring. We investigated whether a low-risk group of babies born to mothers with GDM could be defined for shorter inpatient hypoglycaemia monitoring. METHODS: Observational, retrospective cohort study conducted in a tertiary maternity hospital in 2018. Singleton, term babies born to women with GDM and no other risk factors for hypoglycaemia, were included. Capillary blood glucose (BG) testing and clinical observations for signs of hypoglycaemia during the first 24-h after birth. BG was checked in all babies before the second feed. Subsequent testing occurred if the first result was < 2.0 mmol/L, or clinical suspicion developed for hypoglycaemia. Neonatal hypoglycaemia, defined as either capillary or venous glucose ≤ 2.0 mmol/L and/or clinical signs of neonatal hypoglycaemia requiring oral or intravenous dextrose (lethargy, abnormal feeding behaviour or seizures). RESULTS: Fifteen of 106 babies developed hypoglycaemia within the first 24-h. Maternal and neonatal characteristics were not predictive. All babies with hypoglycaemia had an initial capillary BG ≤ 2.6 mmol/L (Area under the ROC curve (AUC) 0.96, 95% Confidence Interval (CI) 0.91-1.0). This result was validated on a further 65 babies, of whom 10 developed hypoglycaemia, in the first 24-h of life. CONCLUSION: Using the 2.6 mmol/L threshold, extended monitoring as an inpatient could have been avoided for 60% of babies in this study. Whilst prospective validation is needed, this approach could help tailor postnatal care plans for babies born to mothers with GDM.
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Glicemia/análise , Diabetes Gestacional/sangue , Hipoglicemia/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Triagem Neonatal/métodos , Adulto , Área Sob a Curva , Feminino , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Gravidez , Curva ROC , Valores de Referência , Estudos RetrospectivosRESUMO
AIMS: Hypertension is a leading risk factor for cardiovascular disease, accounting for almost 50% of ischaemic heart disease mortality. This study aims to identify the prevalence, awareness, treatment, and control of hypertension and their predictors in older adults with an intellectual disability (ID). METHODS AND RESULTS: This cross-sectional study utilized data from the ID Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants were drawn from the nationally representative sample and included those who completed the self/informant report measures, in addition to objective blood pressure (BP) measurement. From the 551 individuals with ID, aged ≥40 years, hypertension prevalence was 35.2% [95% confidence interval (CI) 31.2-39.2%]. Of those with hypertension, 44.3% (95% CI 37.1-51.5%) were aware of their hypertensive status, and 64.2% (95% CI 57.3-71.1) were taking antihypertensive medication. Among those on treatment, 70.8% (95% CI 61.8-78.2%) had their BP controlled to below 140/90 mmHg. Significant predictors of awareness were age (P = 0.036) and level of ID (P = 0.004), predictors of treatment were age (P = 0.002), level of ID (P = 0.019), and diabetes (P = 0.001). Both diabetes and female gender were predictors of control of hypertension (P = 0.013 and P = 0.037, respectively). CONCLUSION: The prevalence of hypertension in older adults with ID was lower than reports for the general Irish population, with overall levels of treatment and control, when identified, higher in the ID population. There was under-treatment and lower levels of awareness among those with more severe ID, which requires addressing. The finding, that when diagnosed, people with ID respond well to treatment should encourage addressing the under-treatment found here.
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Hipertensão , Deficiência Intelectual , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Deficiência Intelectual/tratamento farmacológico , Deficiência Intelectual/epidemiologia , Irlanda/epidemiologia , Estudos Longitudinais , PrevalênciaRESUMO
There is evidence showing that both maturational and environmental factors can impact on later language development. On the one hand, preterm birth has been found to increase the risk of deficits in the preschool and school years. Preterm children show poorer auditory discrimination, reading difficulties, poor vocabulary, less complex expressive language and lower receptive understanding than their matched controls. On the other hand, socioeconomic status (SES) indicators (i.e., income, education and occupation) have been found to be strongly related to linguistic abilities during the preschool and school years. However, there is very little information about how these factors result in lower linguistic abilities. The present study addresses this issue. To do so, we investigated early speech perception in full and preterm infants from families classed as high or low SES. Seventy-six infants were followed longitudinally at 7.5, 9, 10.5 and 12 months of age. At each test point, three studies explored infants' phonetic, prosodic and phonotactic development respectively. Results showed no significant differences between the phonetic or the phonotactic development of the preterm and the full-term infants. However, a time-lag between preterm and full-term developmental timing for prosody was found. Socioeconomic status did not have a significant effect on prosodic development. Nonetheless, phonetic and phonotactic development was affected by SES, infants from lower SES showed phonetic discrimination of non-native contrast and a preference for high-probability sequences later than their more advantaged peers. Overall these results suggest that different constraints apply to the acquisition of different phonological subcomponents.
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Nascimento Prematuro , Percepção da Fala , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Desenvolvimento da Linguagem , Fonética , Gravidez , Fatores SocioeconômicosRESUMO
BACKGROUND: Patient education requires modification as it is either nonexistent or implemented irregularly or inadequately. STUDY'S PURPOSE: To examine the learning needs of patients with coronary heart disease from the perspective of the patients, their relatives, and health care providers. METHODOLOGY: The cross-sectional, comparative study conducted at two cardiac hospitals of Tabriz and Ardebil, Iran from May 2016 to September 2016.Through convenience sampling perceptions of 137 patients, 137 relatives, 33 cardiologists, and 108 nurses were compared using the Cardiac Learning Need Inventory questionnaire. MAJOR RESULTS: The most important learning needs of patients from the perspective of physicians, nurses, and patients' relatives was information about risk factors. In contrast, patient's perceived information about medication to be their most important learning need. CLINICAL IMPLICATIONS: Patients' perceptions of their educational needs was different from the perceptions of physicians, nurses, and relatives of the patients. Therefore, when planning patient education a comprehensive review of the patients' learning needs is required in order to develop a suitable education plan by prioritizing patients' educational needs.
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Doença das Coronárias , Estudos Transversais , Pessoal de Saúde , Humanos , Irã (Geográfico) , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The objective of this systematic review is to summarize the prevalence of tobacco smoking in European migrants residing in EU 15 countries. INTRODUCTION: Most of the migration within the World Health Organization European Region is intracontinental. The prevalence of smoking varies greatly across the European Region. Migrants may choose to adopt the smoking behaviors of their host countries or retain the smoking behaviors of their countries of origin. Several studies have identified the high prevalence of smoking of some migrant groups in comparison to their host countries, but no systematic reviews have been completed on intracontinental migrants within the European Region. INCLUSION CRITERIA: Epidemiological studies, which include data on the prevalence of tobacco smoking in European migrants aged ≥ 15 years of age living in the following EU 15 countries host countries for ≥ 1 year: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the United Kingdom. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, ASSIA, and Web of Science will be searched to identify published studies. General gray literature (eg, Open Grey) as well as gray literature for migrants (Migrant Health Research Portal) and tobacco will be searched. The JBI methodology for systematic reviews of prevalence will be used in this review. Data synthesis will use meta-analysis where appropriate and narrative synthesis.
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Revisões Sistemáticas como Assunto , Fumar Tabaco/epidemiologia , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
BACKGROUND: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. METHODS: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. RESULTS: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. CONCLUSION: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.
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Ponte Cardiopulmonar , Marca-Passo Artificial , Adulto , Idoso , Estudos Transversais , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Unidades Hospitalares/organização & administração , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Política Organizacional , Marca-Passo Artificial/efeitos adversos , Guias de Prática Clínica como Assunto , Fatores de TempoRESUMO
Production of the Panton-Valentine leukocidin (PVL) by Staphylococcus aureus is mediated via the genes lukS-PV and lukF-PV which are carried on bacteriophage ÏSa2. PVL is associated with S. aureus strains that cause serious infections and clones of community-associated methicillin-resistant S. aureus (CA-MRSA) that have additionally disseminated widely. In Western Australia (WA) the original CA-MRSA were PVL negative however, between 2005 and 2008, following the introduction of eight international PVL-positive CA-MRSA, PVL-positive WA CA-MRSA were found. There was concern that PVL bacteriophages from the international clones were transferring into the local clones, therefore a comparative study of PVL-carrying ÏSa2 prophage genomes from historic WA PVL-positive S. aureus and representatives of all PVL-positive CA-MRSA isolated in WA between 2005 and 2008 was performed. The prophages were classified into two genera and three PVL bacteriophage groups and had undergone many recombination events during their evolution. Comparative analysis of mosaic regions of selected bacteriophages using the Alignments of bacteriophage genomes (Alpha) aligner revealed novel recombinations and modules. There was heterogeneity in the chromosomal integration sites, the lysogeny regulation regions, the defence and DNA processing modules, the structural and packaging modules and the lukSF-PV genes. One WA CA-MRSA (WA518751) and one international clone (Korean Clone) have probably acquired PVL-carrying ÏSa2 in WA, however these clones did not disseminate in the community. Genetic heterogeneity made it impossible to trace the source of the PVL prophages in the other WA clones. Against this background of PVL prophage diversity, the sequence of one group, the ÏSa2USA/ÏSa2wa-st93 group, was remarkably stable over at least 20 years and associated with the highly virulent USA300 and ST93-IVa CA-MRSA lineages that have disseminated globally.
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Toxinas Bacterianas/genética , Bacteriófagos/genética , Exotoxinas/genética , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/virologia , Linhagem da Célula , DNA Bacteriano/genética , Genótipo , Geografia , Lisogenia , Staphylococcus aureus Resistente à Meticilina/genética , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Fases de Leitura Aberta , Prófagos/genética , Fatores de Virulência/genética , Austrália OcidentalRESUMO
Horizontal transfer of plasmids encoding antimicrobial resistance and virulence determinants has been instrumental in Staphylococcus aureus evolution, including the emergence of community-associated methicillin-resistant S. aureus (CA-MRSA). In the early 1990s, the first CA-MRSA strain isolated in Western Australia (WA), WA-5, encoded cadmium, tetracycline, and penicillin resistance genes on plasmid pWBG753 (â¼30 kb). WA-5 and pWBG753 appeared only briefly in WA; however, fusidic acid resistance plasmids related to pWBG753 were also present in the first European CA-MRSA isolates at the time. Here, we characterize a 72-kb conjugative plasmid, pWBG731, present in multiresistant WA-5-like clones from the same period. pWBG731 was a cointegrant formed from pWBG753 and a pWBG749 family conjugative plasmid. pWBG731 carried mupirocin, trimethoprim, cadmium, and penicillin resistance genes. The stepwise evolution of pWBG731 likely occurred through the combined actions of IS257, IS257-dependent miniature inverted-repeat transposable elements (MITEs), and the BinL resolution system of the ß-lactamase transposon Tn552 An evolutionarily intermediate â¼42-kb nonconjugative plasmid, pWBG715, possessed the same resistance genes as pWBG731 but retained an integrated copy of the small tetracycline resistance plasmid pT181. IS257 likely facilitated the replacement of pT181 with conjugation genes on pWBG731, thus enabling autonomous transfer. Like conjugative plasmid pWBG749, pWBG731 also mobilized nonconjugative plasmids carrying oriT mimics. It seems likely that pWBG731 represents the product of multiple recombination events between the WA-5 pWBG753 plasmid and other mobile genetic elements present in indigenous community-associated methicillin-sensitive S. aureus (CA-MSSA) isolates. The molecular evolution of pWBG731 saliently illustrates how diverse mobile genetic elements can together facilitate rapid accrual and horizontal dissemination of multiresistance in S. aureus CA-MRSA.
Assuntos
Staphylococcus aureus Resistente à Meticilina/genética , Plasmídeos/genética , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Genes Bacterianos/genética , Humanos , Alinhamento de Sequência , Análise de Sequência de DNA , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Austrália Ocidental/epidemiologiaRESUMO
Use of an implantable cardioverter defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death. However, at the end of life, these devices can prolong the dying experience, causing physical and psychological trauma. Patients are often unaware of their options regarding ICD management at the end of their life, which highlights the need for health professionals to have these discussions with patients. This study aimed to identify patients' knowledge and opinions about their ICD and the factors influencing their knowledge and opinions. Of the 30 participants in this study, 59% had sufficient knowledge about ICDs. There was no relationship between knowledge and time since implantation (p=0.11). A relationship existed between knowledge and age; those that were older were better informed (p=0.008). The authors conclude that patient education and communication are essential for patients with ICDs to enhance decision-making about ICD management at the end of life.