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1.
Pediatr Pulmonol ; 57(11): 2798-2807, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35933722

RESUMO

Carriers of the cystic fibrosis transmembrane conductance regulator (CFTR) gene ("carriers") have been found to have an increased risk of persistent asthma. However, it is unclear at what level of CFTR function this risk exists and whether it is modified by asthmogens, such as air pollution. We conducted a retrospective cohort study of children born in California between July 2007 and December 2013, linking CFTR genotype data from the California newborn screening program to Medicaid claims records through March 17, 2020 to identify asthma cases, and to air pollution data from CalEnviroScreen 3.0 to identify levels of particulate matter with diameter 2.5 microns or smaller (PM2.5 ). Log-binomial regression models for asthma risk were fitted, adjusting for race/ethnicity and sex. Compared to population controls, carriers had higher risk of asthma (adjusted risk ratio (aRR) = 1.29, 95% confidence interval (CI): 0.98, 1.69; p < 0.1). Other non-CF-causing variants on the second allele did not appear to further increase risk. Genotypes with the greatest asthma risk were F508del with an intron 10 T7 or (TG)11T5 in trans (aRR=1.52, 95% CI: 1.10, 2.12). This association was higher among children living in areas at or above (aRR = 1.80) versus below (aRR = 1.37) the current national air quality standard for PM2.5 , though this difference was not statistically significant (pinteraction > 0.2). These results suggest carriers with CFTR functional levels between 25% and 45% of wildtype are at increased risk of asthma. Knowledge of CFTR genotype in asthmatics may be important to open new CFTR-related treatment options for these patients.


Assuntos
Poluição do Ar , Asma , Poluição do Ar/efeitos adversos , Asma/epidemiologia , Asma/genética , Criança , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Humanos , Recém-Nascido , Medicaid , Mutação , Material Particulado/efeitos adversos , Estudos Retrospectivos , Estados Unidos
2.
Arch Dis Child ; 105(8): 713-719, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32079569

RESUMO

BACKGROUND AND OBJECTIVES: Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. METHODS: A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year. RESULTS: Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. CONCLUSION: Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.


Assuntos
Antibacterianos/uso terapêutico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Administração Intravenosa , Administração Oral , Antibacterianos/economia , Pré-Escolar , Feminino , Hospitalização/economia , Humanos , Prescrição Inadequada/economia , Lactente , Masculino , Uso Excessivo dos Serviços de Saúde/economia , Pneumonia/diagnóstico , Pneumonia/economia , Padrões de Prática Médica/economia , Estudos Prospectivos , Índice de Gravidade de Doença , Vietnã
3.
Implement Sci ; 14(1): 31, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30890160

RESUMO

BACKGROUND: People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system-policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. METHODS: This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. DISCUSSION: Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. STUDY REGISTRATION: Australian New Zealand Clinical Trials Register 375803 .


Assuntos
Lacunas da Prática Profissional , Tuberculose/prevenção & controle , Pessoal Administrativo , Adulto , Busca de Comunicante , Estudos Controlados Antes e Depois , Efeitos Psicossociais da Doença , Coleta de Dados/métodos , Atenção à Saúde/organização & administração , Diagnóstico Precoce , Doenças Endêmicas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Política de Saúde , Humanos , Indonésia/epidemiologia , Masculino , Estudos Multicêntricos como Assunto , Números Necessários para Tratar , Ensaios Clínicos Pragmáticos como Assunto , Tamanho da Amostra , Tuberculose/epidemiologia
5.
Lancet ; 379(9829): 1902-13, 2012 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-22608339

RESUMO

Tuberculosis is still one of the most important causes of death worldwide. The 2010 Lancet tuberculosis series provided a comprehensive overview of global control efforts and challenges. In this update we review recent progress. With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa. Despite these advances, full scale-up of tuberculosis and HIV collaborative activities remains challenging and emerging drug-resistant tuberculosis is a major threat. Recognition of the effect that non-communicable diseases--such as smoking-related lung disease, diet-related diabetes mellitus, and alcohol and drug misuse--have on individual vulnerability, as well as the contribution of poor living conditions to community vulnerability, shows the need for multidisciplinary approaches. Several new diagnostic tests are being introduced in endemic countries and for the first time in 40 years a coordinated portfolio of promising new tuberculosis drugs exists. However, none of these advances offer easy solutions. Achievement of international tuberculosis control targets and maintenance of these gains needs optimum national health policies and services, with ongoing investment into new approaches and strategies. Despite growing funding in recent years, a serious shortfall persists. International and national financial uncertainty places gains at serious risk. Perseverance and renewed commitment are needed to achieve global control of tuberculosis, and ultimately, its elimination.


Assuntos
Tuberculose/prevenção & controle , Antituberculosos/uso terapêutico , Biomarcadores/análise , Pesquisa Biomédica/tendências , Controle de Doenças Transmissíveis/métodos , Serviços de Saúde Comunitária/organização & administração , Organização do Financiamento , Previsões , Saúde Global , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Incidência , Prevalência , Apoio Social , Tuberculose/complicações , Tuberculose/mortalidade , Vacinas contra a Tuberculose , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/prevenção & controle
6.
Malawi Med J ; 17(4): 132-58, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27529002

RESUMO

The theme for the 9th annual conference of the College of Medicine was "Research addressing poverty-related disease in Malawi". The conference was opened by the Principal of the College of Medicine, Professor Robin Broadhead. He welcomed participants and explained why this annual meeting, fixed each year to coincide with the completion of the academic year, is such an important day in the calendar of the College. He introduced the invited guest speaker, Dr Davison Gwatkin, an international expert on issues of equity in health systems and currently a consultant for DFID in Lilongwe. There were 68 abstracts submitted for presentation and following peer review, 40 accepted for oral presentation and 27 for poster presentation (see abstracts below). Abstracts were peer-reviewed and I thank COM staff for their assistance. Presentations were of a high standard and covered a wide range of topics relevant to the health issues of Malawi. There were presentations covering maternal health, child health, HIV/AIDS, malaria, bacterial disease, cancer and the first session of the day was devoted to "reaching" the poor. This was the first year that parallel sessions were introduced due to the high number of abstracts submitted. One session of the day included five oral presentations from year 4 medical students and many were impressed by the high quality of their work and of their presentation. The quality of the posters was also to a high standard and reflected a similar range of topics and research activity as the oral presentations. There were almost 200 participants who registered for this year's conference. Efforts to raise funds for the event were not particularly successful. The only major external sponsor was the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and we are very grateful for their support. Particular thanks to Ms Mary Bwanali and Elizabeth Kadangwe of COM postgraduate office for the work they did in preparing for the conference throughout the year. The COM Annual Research Dissemination Meeting is the major health research dissemination meeting in the Malawian calendar. It is encouraging to see that the quality of and interest in this important vehicle of dissemination of health research in Malawi continues to improve and grow. We look forward to next year's event which will be the 10th dissemination meeting.

7.
Epidemiology ; 15(6): 660-70, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15475714

RESUMO

BACKGROUND: Recent reviews conclude that environmental tobacco smoke (ETS) leads to diminished birth weight. However, the threshold and magnitude of that effect is uncertain. We aimed to determine the magnitude and shape of the relations between ETS and various adverse pregnancy outcomes using a highly sensitive biochemical assay. METHODS: Maternal serum specimens were collected from more than 3000 women enrolled in California's prenatal screening program in 1992 and analyzed for cotinine. Information on pregnancy outcomes was obtained from live birth/fetal death records and hospital questionnaires. We conducted analyses on 2777 woman-live birth pairs and 19 woman-fetal death pairs in which the mother was presumed to be a nonsmoker (midtrimester cotinine levels < or =10 ng/mL). RESULTS: In multiple logistic regression analyses, the odds ratios of fetal death, preterm delivery, and term-low birth weight were 3.4, 1.8, and 1.8, respectively, in the highest cotinine quintile (0.236-10 ng/mL), compared with the lowest quintile (<0.026 ng/mL). In adjusted linear models, there was a linear dose-dependent effect of log cotinine on mean birth weight (-109 g) and mean infant length (-0.84 cm) over the range of cotinine values. Linear relations were not found with respect to infant head circumference or the ratio of brain weight to body weight. Infant's body mass index declined with exposures above approximately 0.5 ng/mL cotinine. We estimated that ETS levels at or above 0.05 ng/mL (experienced by 62% of the study population) accounted for 12% of all adverse outcomes. CONCLUSIONS: ETS exposure in pregnant women adversely affects pregnancy by increasing fetal mortality and preterm delivery at higher exposure levels and slowing fetal growth across all levels of ETS exposure.


Assuntos
Exposição Materna/efeitos adversos , Resultado da Gravidez/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Fatores Etários , California/epidemiologia , Cotinina/sangue , Feminino , Morte Fetal/epidemiologia , Morte Fetal/etiologia , Humanos , Recém-Nascido , Modelos Lineares , Modelos Logísticos , Masculino , Idade Materna , Análise Multivariada , Gravidez , Fatores Sexuais , Fatores Socioeconômicos
8.
Lang Speech Hear Serv Sch ; 30(3): 255-264, 1999 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27764307

RESUMO

The progress of a 12-year-old boy with learning disabilities and severe writing difficulties is followed from initial assessment through instruction in strategies for planning, revising, and managing the composing process. A validated instructional model, Self-Regulated Strategy Development (SRSD), was used to teach these processes. With SRSD, writing strategies are explicitly taught in combination with procedures for regulating the use of these strategies, the writing process, and any undesirable behaviors that may impede performance. Recommendations are offered to speech-language pathologists for applying the SRSD model to children experiencing writing difficulties.

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