RESUMO
OBJECTIVE: A 24-hour day is made up of time spent in a range of physical activity (PA) behaviours, including sleep, sedentary time, standing, light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA), all of which may have the potential to alter an individual's health through various different pathways and mechanisms. This study aimed to explore the relationship between PA behaviours and the gut microbiome in older adults. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: Participants (n=100; age 69.0 [3.0] years; 44% female) from the Mitchelstown Cohort Rescreen (MCR) Study (2015-2017). METHODS: Participants provided measures of gut microbiome composition (profiled by sequencing 16S rRNA gene amplicons), and objective measures of PA behaviours (by a 7-day wear protocol using an activPAL3 Micro). RESULTS: Standing time was positively correlated with the abundance of butyrate-producing and anti-inflammatory bacteria, including Ruminococcaceae, Lachnospiraceae and Bifidobacterium, MVPA was positively associated with the abundance of Lachnospiraceae bacteria, while sedentary time was associated with lower abundance of Ruminococcaceae and higher abundance of Streptococcus spp. CONCLUSION: Physical activity behaviours appear to influence gut microbiota composition in older adults, with different PA behaviours having diverging effects on gut microbiota composition.
Assuntos
Envelhecimento/fisiologia , Exercício Físico , Microbioma Gastrointestinal , Idoso , Estudos Transversais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S , Comportamento SedentárioRESUMO
This update, written by authors designated by multiple pediatric endocrinology societies (see List of Participating Societies) from around the globe, concisely addresses topics related to changes in GnRHa usage in children and adolescents over the last decade. Topics related to the use of GnRHa in precocious puberty include diagnostic criteria, globally available formulations, considerations of benefit of treatment, monitoring of therapy, adverse events, and long-term outcome data. Additional sections review use in transgender individuals and other pediatric endocrine related conditions. Although there have been many significant changes in GnRHa usage, there is a definite paucity of evidence-based publications to support them. Therefore, this paper is explicitly not intended to evaluate what is recommended in terms of the best use of GnRHa, based on evidence and expert opinion, but rather to describe how these drugs are used, irrespective of any qualitative evaluation. Thus, this paper should be considered a narrative review on GnRHa utilization in precocious puberty and other clinical situations. These changes are reviewed not only to point out deficiencies in the literature but also to stimulate future studies and publications in this area.
Assuntos
Hormônio Liberador de Gonadotropina/uso terapêutico , Puberdade Precoce , Adolescente , Criança , Feminino , Humanos , Masculino , Puberdade Precoce/diagnóstico , Puberdade Precoce/tratamento farmacológico , Puberdade Precoce/patologia , Puberdade Precoce/fisiopatologiaRESUMO
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with a potential to involve any organ system. It remains an important cause of kidney related morbidity and mortality. Early diagnosis can be difficult and requires high index of suspicion in all patients, but especially in cases with atypical presentation. We report a case with GPA, which was diagnosed only after new and advancing symptoms belied the original diagnosis of bilateral facial palsy and aortic mural thrombus.
RESUMO
The process of anti-cancer drug development is complex, with high attrition rates. Factors that may optimise this process include well-constructed and relevant pre-clinical testing and use of biomarkers for patient selection. However, the design of early phase clinical trials will probably play a vital role in both the robust clinical investigation of new targeted therapies and in streamlining drug development. In this overview, we assess current concepts in phase I clinical trials, highlighting issues and opportunities to improve their meaningfulness. The particular challenge of how to design combination trials is addressed, with focus on the potential of new adaptive and model-based designs.
Assuntos
Antineoplásicos/uso terapêutico , Ensaios Clínicos como Assunto/métodos , Neoplasias/tratamento farmacológico , Humanos , Neoplasias/patologia , Projetos de PesquisaRESUMO
BACKGROUND: The comparative effectiveness of performing instrumented (rigid pedicle screws affixed to titanium alloy rods) lumbar spinal fusion in addition to decompressive laminectomy in patients with symptomatic lumbar grade I degenerative spondylolisthesis with spinal stenosis is unknown. METHODS: In this randomized, controlled trial, we assigned patients, 50 to 80 years of age, who had stable degenerative spondylolisthesis (degree of spondylolisthesis, 3 to 14 mm) and symptomatic lumbar spinal stenosis to undergo either decompressive laminectomy alone (decompression-alone group) or laminectomy with posterolateral instrumented fusion (fusion group). The primary outcome measure was the change in the physical-component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; range, 0 to 100, with higher scores indicating better quality of life) 2 years after surgery. The secondary outcome measure was the score on the Oswestry Disability Index (range, 0 to 100, with higher scores indicating more disability related to back pain). Patients were followed for 4 years. RESULTS: A total of 66 patients (mean age, 67 years; 80% women) underwent randomization. The rate of follow-up was 89% at 1 year, 86% at 2 years, and 68% at 4 years. The fusion group had a greater increase in SF-36 physical-component summary scores at 2 years after surgery than did the decompression-alone group (15.2 vs. 9.5, for a difference of 5.7; 95% confidence interval, 0.1 to 11.3; P=0.046). The increases in the SF-36 physical-component summary scores in the fusion group remained greater than those in the decompression-alone group at 3 years and at 4 years (P=0.02 for both years). With respect to reductions in disability related to back pain, the changes in the Oswestry Disability Index scores at 2 years after surgery did not differ significantly between the study groups (-17.9 in the decompression-alone group and -26.3 in the fusion group, P=0.06). More blood loss and longer hospital stays occurred in the fusion group than in the decompression-alone group (P<0.001 for both comparisons). The cumulative rate of reoperation was 14% in the fusion group and 34% in the decompression-alone group (P=0.05). CONCLUSIONS: Among patients with degenerative grade I spondylolisthesis, the addition of lumbar spinal fusion to laminectomy was associated with slightly greater but clinically meaningful improvement in overall physical health-related quality of life than laminectomy alone. (Funded by the Jean and David Wallace Foundation and others; SLIP ClinicalTrials.gov number, NCT00109213.).
Assuntos
Laminectomia , Vértebras Lombares/cirurgia , Fusão Vertebral , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estenose Espinal/complicações , Espondilolistese/complicações , Resultado do TratamentoRESUMO
OBJECTIVE: To determine whether patients who learned the views of an expert surgeons' panel's assessment of equipoise between 2 alternative operative treatments had increased likelihood of consenting to randomization. BACKGROUND: Difficulty obtaining patient consent to randomization is an important barrier to conducting surgical randomized clinical trials, the gold standard for generating clinical evidence. METHODS: Observational study of the rate of patient acceptance of randomization within a 5-center randomized clinical trial comparing lumbar spinal decompression versus lumbar spinal decompression plus instrumented fusion for patients with symptomatic grade I degenerative lumbar spondylolisthesis with spinal stenosis. Eligible patients were enrolled in the trial and then asked to accept randomization. A panel of 10 expert spine surgeons was formed to review clinical information and images for individual patients to provide an assessment of suitability for randomization. The expert panel vote was disclosed to the patient by the patient's surgeon before the patient decided whether to accept randomization or not. RESULTS: Randomization acceptance among eligible patients without expert panel review was 40% (19/48) compared with 81% (47/58) among patients undergoing expert panel review (Pâ<â0.001). Among expert-reviewed patients, randomization acceptance was 95% when all experts or all except 1 voted for randomization, 75% when 2 experts voted against randomization, and 20% with 3 or 4 votes against (Pâ<â0.001 for trend). CONCLUSIONS: Patients provided with an expert panel's assessment of their own suitability for randomization were twice as likely to agree to randomization compared with patients receiving only their own surgeon's recommendation.
Assuntos
Laminectomia/métodos , Vértebras Lombares , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Laminectomia/instrumentação , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Estenose Espinal/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVES: Pre-diabetes is an important indicator of future diabetes burden and many countries are reporting prevalence estimates of pre-diabetes. To date in Ireland, estimates of the prevalence of pre-diabetes were unavailable. Our objectives were to estimate the prevalence of pre-diabetes in a nationally representative sample of Irish adults and to explore determinants of pre-diabetes. METHODS: The Survey of Lifestyle Attitudes and Nutrition 2007 was a cross-sectional survey on health and lifestyle in a nationally representative sample of Irish adults. Analysis was performed on a subsample of 1132 participants ≥ 45 years who provided blood samples. Determination of pre-diabetes was based on American Diabetes Association HbA1c cut points of 39-46 mmol/mol (5.7-6.4%). To explore determinants, we modelled pre-diabetes prevalence as a function of a set of health system and socio-demographic variables using logistic regression. RESULTS: The overall weighted prevalence estimate of pre-diabetes in participants ≥ 45 years was 19.8% (95% CI 16.4-23.9). There was no significant difference between age or gender-specific prevalence rates. Obesity was significantly associated with pre-diabetes on univariate and multivariate analysis. Population attributable fraction estimates for excess BMI, physical inactivity and poor diet as causes of pre-diabetes were 31.3% (95% CI -3.9 to 54.5), 10.0% (95% CI -2.7 to 21.3) and 6.1% (95% CI -4.9 to 15.9), respectively. CONCLUSIONS: The high levels of pre-diabetes detected in this study are worrying. Population level interventions to address diet and lifestyle factors are needed urgently to prevent progression to diabetes in high-risk individuals.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Progressão da Doença , Comportamentos Relacionados com a Saúde , Obesidade/epidemiologia , Estado Pré-Diabético , Idoso , Atitude , Glicemia , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Comportamento Alimentar , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/sangue , Obesidade/complicações , Obesidade/prevenção & controle , Vigilância da População , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/prevenção & controle , Prevalência , Comportamento SedentárioRESUMO
OBJECT: It is not known whether adding fusion to lumbar decompression is necessary for all patients undergoing surgery for degenerative lumbar spondylolisthesis with symptomatic stenosis. Determining specific radiographic traits that might predict delayed instability following decompression surgery might guide clinical decision making regarding the utility of up-front fusion in patients with degenerative Grade I spondylolisthesis. METHODS: Patients with Grade I degenerative lumbar spondylolisthesis (3-14 mm) with symptomatic stenosis were prospectively enrolled from a single site between May 2002 and September 2009 and treated with decompressive laminectomy without fusion. Patients with mechanical back pain or with gross motion (> 3 mm) on flexion-extension lumbar radiographs were excluded. The baseline radiographic variables measured included amount of slippage, disc height, facet angle, motion at spondylolisthesis (flexion-extension), and sagittal rotation angle. Data were analyzed using multivariate forward selection stepwise logistic regression, chi-square tests, Student t-test, and ANOVA. RESULTS: Forty patients were enrolled and treated with laminectomy without fusion, and all patients had complete radiographic data sets that were available for analysis. Reoperation was performed in 15 (37.5%) of 40 patients, with a mean follow-up duration of 3.6 years. Reoperation was performed for pain caused by instability at the index level in all 15 cases. Using multivariate stepwise logistic regression with a threshold p value of 0.35, motion at spondylolisthesis, disc height, and facet angle were predictors of reoperation following surgery. Facet angle > 50° was associated with a 39% rate of reoperation, disc height > 6.5 mm was associated with a 45% rate of reoperation, and motion at spondylolisthesis > 1.25 mm was associated with a 54% rate of reoperation. Patients with all 3 risk factors for instability had a 75% rate of reoperation, whereas patients with no risk factors for instability had a 0% rate of reoperation (p = 0.14). CONCLUSIONS: Patients with motion at spondylolisthesis > 1.25 mm, disc height > 6.5 mm, and facet angle > 50° are more likely to experience instability following decompression surgery for Grade I lumbar spondylolisthesis. Identification of key risk factors for instability might improve patient selection for decompression without fusion surgery.
Assuntos
Descompressão Cirúrgica/métodos , Degeneração do Disco Intervertebral/cirurgia , Laminectomia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Degeneração do Disco Intervertebral/patologia , Instabilidade Articular/fisiopatologia , Laminectomia/efeitos adversos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reoperação/métodos , Índice de Gravidade de Doença , Fusão Vertebral/estatística & dados numéricos , Estenose Espinal/patologia , Espondilolistese/diagnóstico , Espondilolistese/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Amplification of aurora kinase A (AK-A) overrides the mitotic spindle assembly checkpoint, inducing resistance to taxanes. RNA interference targeting AK-A in human pancreatic cancer cell lines enhanced taxane chemosensitivity. In this study, a novel AK-A inhibitor, CYC3, was investigated in pancreatic cancer cell lines, in combination with paclitaxel. METHODS: Western blot, flow cytometry and immunostaining were used to investigate the specificity of CYC3. Sulforhodamine B staining, time-lapse microscopy and colony-formation assays were employed to evaluate the cytotoxic effect of CYC3 and paclitaxel. Human colony-forming unit of granulocyte and macrophage (CFU-GM) cells were used to compare the effect in tumour and normal tissue. RESULTS: CYC3 was shown to be a specific AK-A inhibitor. Three nanomolar paclitaxel (growth inhibition 50% (GI(50)) 3 nM in PANC-1, 5.1 nM in MIA PaCa-2) in combination with 1 µM CYC3 (GI(50) 1.1 µM in MIA PaCa2 and 2 µM in PANC-1) was synergistic in inhibiting pancreatic cell growth and causing mitotic arrest, achieving similar effects to 10-fold higher concentrations of paclitaxel (30 nM). In CFU-GM cells, the effect of the combination was simply additive, displaying significantly less myelotoxicity compared with high concentrations of paclitaxel (30 nM; 60-70% vs 100% inhibition). CONCLUSION: The combination of lower doses of paclitaxel and CYC3 merits further investigation with the potential for an improved therapeutic index in vivo.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Células da Medula Óssea/efeitos dos fármacos , Paclitaxel/farmacologia , Neoplasias Pancreáticas/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Aurora Quinase A , Aurora Quinases , Células da Medula Óssea/enzimologia , Células da Medula Óssea/patologia , Linhagem Celular Tumoral , Sinergismo Farmacológico , Células Progenitoras de Granulócitos e Macrófagos/efeitos dos fármacos , Células Progenitoras de Granulócitos e Macrófagos/metabolismo , Humanos , Paclitaxel/administração & dosagem , Neoplasias Pancreáticas/enzimologia , Neoplasias Pancreáticas/patologia , Inibidores de Proteínas Quinases/administração & dosagem , Proteínas Serina-Treonina Quinases/metabolismo , Células-Tronco/efeitos dos fármacos , Células-Tronco/enzimologia , Células-Tronco/patologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Teratoma/secundário , Neoplasias Testiculares/patologia , Adulto , Quimioterapia Adjuvante , Terapia Combinada/métodos , Relação Dose-Resposta a Droga , Seguimentos , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Monitorização Fisiológica/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Orquiectomia/métodos , Medição de Risco , Teratoma/terapia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
PURPOSE: To carry out a national service evaluation of the integrated cancer support programme offered by The Haven using the Measure Yourself Concerns and Wellbeing (MYCaW) outcome questionnaire. METHODS: Breast cancer survivors who visited one of three Haven centres in the UK completed the MYCaW questionnaire before and after 6 one-hour complementary therapy sessions. RESULTS: Statistically significant decreases in mean baseline scores (indicating improvement) for concerns and wellbeing were observed after treatment: concern 1 (5.09 ± 1.04 vs 3.17 ± 1.60, p < 0.0001, n = 402), concern 2 (4.69 ± 1.08 vs 3.08 ± 1.56, p < 0.0001, n = 372), and wellbeing (3.30 ± 1.41 vs 2.63 ± 1.28, p < 0.0001, n = 402). The therapies most commonly used were acupuncture, nutrition, massage and aromatherapy, shiatsu, counselling and reflexology. After therapy, 91% of reported scores (n = 328) rated the concern as being a little better, much better or gone. CONCLUSIONS: These findings suggest that women with breast cancer find the Haven integrated support programme valuable for addressing their main concerns and improving their feeling of wellbeing.
Assuntos
Neoplasias da Mama/complicações , Terapias Complementares , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde da Mulher/normas , Saúde da Mulher , Analgesia , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Fadiga , Feminino , Pesquisas sobre Atenção à Saúde , Fogachos , Humanos , Dor , Estresse Psicológico , Inquéritos e Questionários , Reino UnidoRESUMO
Although chemotherapy, based on docetaxel, is now established in the management of metastatic castration-resistant prostate cancer (mCRPC), until recently, there has been no treatment licensed for use in the second line in men whose disease progresses during or after docetaxel therapy. This article reviews the classes of agents that have shown potential in this setting, notably chemotherapy drugs, hormonal therapies, immunotherapies, anti-angiogenic drugs, and clusterin-targeted therapy.
Assuntos
Antineoplásicos/uso terapêutico , Orquiectomia , Neoplasias da Próstata/tratamento farmacológico , Terapia de Salvação/métodos , Taxoides/uso terapêutico , Antineoplásicos/classificação , Quimioterapia Adjuvante , Terapia Combinada , Progressão da Doença , Docetaxel , Hormônios/uso terapêutico , Humanos , Imunoterapia/métodos , Masculino , Metástase Neoplásica , Neovascularização Patológica/tratamento farmacológico , Análise de SobrevidaRESUMO
The diseases caused by trypanosomes are medically and economically devastating to the population of Sub-Saharan Africa. Parasites of the genus Trypanosoma infect both humans, causing African sleeping sickness, and livestock, causing Nagana. The development of effective treatment strategies has suffered from severe side effects of approved drugs, resistance and major difficulties in delivering drugs. Antimicrobial peptides (AMPs) are ubiquitous components of immune defence and are being rigorously pursued as novel sources of new therapeutics for a variety of pathogens. Here, we review the role of AMPs in the innate immune response of the tsetse fly to African trypanosomes, catalogue trypanocidal AMPs from diverse organisms and highlight the susceptibility of bloodstream form African trypanosomes to killing by unconventional toxic peptides.
Assuntos
Peptídeos Catiônicos Antimicrobianos/farmacologia , Membrana Celular/efeitos dos fármacos , Tripanossomicidas/farmacologia , Trypanosoma/efeitos dos fármacos , Moscas Tsé-Tsé/imunologia , Alameticina/farmacologia , Animais , Peptídeos Catiônicos Antimicrobianos/química , Permeabilidade da Membrana Celular , Humanos , Lipopeptídeos/farmacologia , Peptídeos/farmacologia , Peptídeos Cíclicos , Tripanossomicidas/química , Trypanosoma/imunologia , Moscas Tsé-Tsé/parasitologiaRESUMO
The occupational epidemiological literature on extremely low frequency electric and magnetic fields (EMF) and health encompasses a large number of studies of varying design and quality that have addressed many health outcomes, including various cancers, cardiovascular disease, depression and suicide, and neurodegenerative diseases, such as Alzheimer disease and amyotrophic lateral sclerosis (ALS). At a 2006 workshop we reviewed studies of occupational EMF exposure with an emphasis on methodological weaknesses, and proposed analytical ways to address some of these. We also developed research priorities that we hope will address remaining uncertainties. Broadly speaking, extensive epidemiological research conducted during the past 20 years on occupational EMF exposure does not indicate strong or consistent associations with cancer or any other health outcomes. Inconsistent results for many of the outcomes may be attributable to numerous shortcomings in the studies, most notably in exposure assessment. There is, however, no obvious correlation between exposure assessment quality and observed associations. Nevertheless, for future research, the highest priorities emerge in both the areas of exposure assessment and investigation of ALS. To better assess exposure, we call for the development of a more complete job-exposure matrix that combines job title, work environment and task, and an index of exposure to electric fields, magnetic fields, spark discharge, contact current, and other chemical and physical agents. For ALS, we propose an international collaborative study capable of illuminating a reported association with electrical occupations by disentangling the potential roles of electric shocks, magnetic fields and bias. Such a study will potentially lead to evidence-based measures to protect public health.
Assuntos
Campos Eletromagnéticos/efeitos adversos , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Monitoramento Ambiental/métodos , Monitoramento Epidemiológico , Previsões , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Doenças Neurodegenerativas/epidemiologia , Doenças Neurodegenerativas/etiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/análise , Medição de Risco/métodosRESUMO
To determine if a minimally invasive approach to lumbar microdiscectomy reduces post-operative pain, length of hospital stay, or frequency of complications we retrospectively compared medical records of single level microdiscectomy patients by a single surgeon performed using a traditional open approach versus a minimally invasive approach. Thirty-five patients were in the open group: 63% male, average age 41.2 years, and 31 patients were in the minimally invasive group: 68% male, average age 42.1 years. There was no difference in surgical time or blood loss between the open and minimally invasive groups: 84.1 versus 76.8 minutes and 51.4 versus 69.7 mL, respectively. There were no significant complications intraoperatively or within the 30 day post-op period for either group. The average dose of intravenous morphine taken was 12.9 mg for the minimally invasive group and 15.7 mg for the open group (P=0.04). The average dose of hydrocodone was 13.4 mg for the minimally invasive group and 20.9 mg for the open group (P=0.03). The open group took an average of 11.7 mg oxycodone, the minimally invasive none. 45.2% of patients in the minimally invasive group were discharged on the same day as surgery compared to 5.75% in the open group (P=0.001). Microdiscectomy was performed safely and effectively through a minimally invasive expanding retractor system and operating microscope. Surgical times, blood loss, complications, and outcome were similar to a traditional open microdiscectomy while pain medication requirements and hospitalization were significantly less.
Assuntos
Discotomia/instrumentação , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Hidrocodona/uso terapêutico , Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/enfermagem , Deslocamento do Disco Intervertebral/patologia , Tempo de Internação , Vértebras Lombares/patologia , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Instrumentos Cirúrgicos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The physical and social environment influences access to a healthy lifestyle, of which transport is one determining factor. This paper estimates the cost of transport on the island of Ireland. METHODS: Budget standards were developed on the basis of costs of baskets of core goods and services required for daily living. The transport budget was based on the needs of an urban living family. Financial capacity of the family relative to transport basket costs was determined. RESULTS: Transport costs vary depending on family type and car ownership. The motoring costs for a family with two unemployed adults, with a weekly financial capacity of 388.28 euros and 427.70 euros, respectively, for the Republic of Ireland and Northern Ireland, amount to 94.78 euros and 74.68 euros, representing 18 and 10% of the family's weekly income. CONCLUSION: The prohibitive costs of private transport present an opportunity for policy makers to consider creating supportive environments incorporating the more cost-effective and environmentally friendly options of public transport. Without such measures, dependence on private transport will exacerbate the incidence of food poverty and the health inequalities consequent upon it.
Assuntos
Nível de Saúde , Atividade Motora , Pobreza , Setor Privado , Características de Residência , Meio Social , Meios de Transporte/economia , Automóveis , Política de Saúde , Humanos , Irlanda , Irlanda do Norte , Projetos PilotoRESUMO
Patient assessment in rheumatology is characterized by an important paradox: many extensively-characterized quantitative measures and indices have been developed for rheumatoid arthritis (RA), psoriatic arthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, vasculitis, osteoarthritis, fibromyalgia, and other rheumatic diseases. However, most regular rheumatology care is guided largely by qualitative clinical impressions, without such measures or indices or any quantitative data other than laboratory tests to assess patient status and/or quality of care. This paradox may be explained in part by regarding the development of measures primarily as clinical research activities, while viewing the application of measurements in regular clinical care as continuous quality improvement (CQI) activities. The development of measures has emphasized validity and reliability, but generally ignored feasibility and acceptability to patients and health professionals, both of which are needed for application in regular clinical care. A summary of the application of clinical measurement in patients with RA over 25 years between 1982 and 2007 at a weekly academic rheumatology clinic conducted by the senior author is presented as 20 often contemporaneous CQI cycles. These cycles include development of a user-friendly modified health assessment questionnaire (MHAQ); assessment of psychological status; monitoring of mortality outcomes; comparisons of joint counts, radiographic scores, and laboratory tests to the MHAQ; a 28-joint count; prospective study of the MHAQ to predict mortality when joint counts, radiographic scores, and laboratory tests are available; development of a multidimensional HAQ (MDHAQ) with complex activities; a fatigue scale; a self-report joint count; scoring templates; a computerized data management system; flow sheets to monitor MDHAQ status; visual analog scales as 21 circles rather than 10 cm lines; composite RAPID3 (rheumatology assessment patient index data) scores for 3 patient measures; and defining RAPID categories for high, moderate and low severity, and near remission. The latter cycles remain under study as ongoing CQI activities.
Assuntos
Pesquisa Biomédica , Nível de Saúde , Assistência ao Paciente , Qualidade da Assistência à Saúde/normas , Doenças Reumáticas/terapia , Gestão da Qualidade Total/tendências , HumanosRESUMO
BACKGROUND: Previously published analyses of excess lung cancer risks in UK carbon black production workers attracted no confident interpretation. METHODS: The mortality of a cohort of 1,147 male manual workers from five UK factories manufacturing carbon black was investigated for the period 1951-2004. All subjects were first employed in the period 1947-74 and were employed for 12 months or more. Limited work histories were available to calculate estimates of individual cumulative exposure to carbon black. RESULTS: Based on serial rates for the general population of England and Wales, significantly elevated mortality was observed for lung cancer (Obs 67, SMR 146, P < 0.01) but not for all other causes combined (Obs 426, SMR 106). There was highly elevated lung cancer mortality at two of the plants (SMR 230, Obs 35) but no excess mortality at the other three plants combined (SMR 104, Obs 32). Analyses by period since leaving employment indicated elevated lung cancer risks were limited to those workers with some employment in the most recent 15 years. SMR analyses found an overall positive significant trend between lung cancer risks and cumulative carbon black exposure received in the most recent 15 years. Poisson regression analyses provided different results depending on which variables were adjusted for. CONCLUSIONS: The findings suggest that carbon black, or chemicals associated with the production of carbon black, had an effect on later stages of lung cancer carcinogenesis at two of the plants but that no such effect was found at the other plants.
Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Exposição Ocupacional , Fuligem/efeitos adversos , Carcinógenos Ambientais , Estudos de Coortes , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Fatores de Risco , Fatores de Tempo , Reino Unido/epidemiologiaRESUMO
BACKGROUND: Multiple studies have demonstrated that 'purging' of autografts with 4-hydroperoxycyclophosphamide (4HC) or the related compound mafosfamide (Mf), to eradicate residual leukemia, produces the best results associated with autologous blood and marrow transplantation for AML. However, 4HC purging results in prolonged aplasia. Therefore, we evaluated the potential of ex vivo expansion of Mf-treated CD34+ cells from mobilized PBPC. METHODS: CD34+ cells were isolated from PBPC products and treated with 30 microg/mL Mf. The Mf-treated CD34+ cells were washed and cultured for 14 days in StemLine II-defined media containing recombinant human (rh) SCF, G-CSF and thrombopoietin (Tpo). RESULTS: Treatment with Mf resulted in 90% killing of progenitor cells (GM-CFC) but maintenance of SCID-repopulating cells (SRC). Ex vivo culture of the Mf-treated CD34+ cells resulted in decreased cell numbers (10-20% of the starting cell dose) during the first week. Nevertheless, in the second week of culture the total cell numbers expanded to approximately 20-fold above starting cell numbers and progenitor cells returned to approximately pre-treatment levels. DISCUSSION: These studies demonstrate the potential of ex vivo culture to expand both total cell numbers and progenitor cells following treatment of PBPC CD34+ cells with Mf. Clinical studies are currently being initiated to evaluate the engraftment potential of these purged and expanded products.