Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
1.
J Clin Psychol Med Settings ; 30(2): 425-434, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35778655

RESUMO

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.


Assuntos
Esgotamento Profissional , Meditação , Atenção Plena , Médicos , Humanos , Criança , Currículo
2.
J Paediatr Child Health ; 58(2): 228-231, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34674333

RESUMO

There are many reasons why the international community as a whole should advocate for COVID-19 vaccine equity: global economic recession, uncontrolled outbreaks with higher risk of virus variants and persistent unsafe travelling in an era of now vaccine-preventable cause of death. This inequity is an avoidable threat to global health. Funding agencies, policy makers, drug companies and NGOs among others have the moral duty to end this vaccine apartheid and to make vaccine equity a reality. In this viewpoint, we discuss how inequalities in vaccination access affect a proper control of the pandemic, highlighting specific consequences on child health.


Assuntos
COVID-19 , Vacinas , Apartheid , Vacinas contra COVID-19 , Criança , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
3.
Blood ; 130(3): 245-257, 2017 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-28465342

RESUMO

The iron-regulatory hormone hepcidin is induced early in infection, causing iron sequestration in macrophages and decreased plasma iron; this is proposed to limit the replication of extracellular microbes, but could also promote infection with macrophage-tropic pathogens. The mechanisms by which hepcidin and hypoferremia modulate host defense, and the spectrum of microbes affected, are poorly understood. Using mouse models, we show that hepcidin was selectively protective against siderophilic extracellular pathogens (Yersinia enterocolitica O9) by controlling non-transferrin-bound iron (NTBI) rather than iron-transferrin concentration. NTBI promoted the rapid growth of siderophilic but not nonsiderophilic bacteria in mice with either genetic or iatrogenic iron overload and in human plasma. Hepcidin or iron loading did not affect other key components of innate immunity, did not indiscriminately promote intracellular infections (Mycobacterium tuberculosis), and had no effect on extracellular nonsiderophilic Y enterocolitica O8 or Staphylococcus aureus Hepcidin analogs may be useful for treatment of siderophilic infections.


Assuntos
Infecções Relacionadas a Cateter/imunologia , Hemocromatose/imunologia , Hepcidinas/imunologia , Sobrecarga de Ferro/imunologia , Ferro/metabolismo , Infecções Estafilocócicas/imunologia , Animais , Ligação Competitiva , Infecções Relacionadas a Cateter/metabolismo , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Modelos Animais de Doenças , Resistência à Doença , Expressão Gênica , Hemocromatose/metabolismo , Hemocromatose/microbiologia , Hemocromatose/mortalidade , Hepcidinas/agonistas , Hepcidinas/deficiência , Hepcidinas/genética , Humanos , Ferro/imunologia , Sobrecarga de Ferro/metabolismo , Sobrecarga de Ferro/microbiologia , Sobrecarga de Ferro/mortalidade , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Mycobacterium tuberculosis/metabolismo , Oligopeptídeos/farmacologia , Ligação Proteica , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus , Análise de Sobrevida , Transferrina/genética , Transferrina/metabolismo , Yersinia enterocolitica/efeitos dos fármacos , Yersinia enterocolitica/crescimento & desenvolvimento , Yersinia enterocolitica/metabolismo
4.
Infect Immun ; 86(7)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29735522

RESUMO

Iron is an essential micronutrient for most microbes and their hosts. Mammalian hosts respond to infection by inducing the iron-regulatory hormone hepcidin, which causes iron sequestration and a rapid decrease in the plasma and extracellular iron concentration (hypoferremia). Previous studies showed that hepcidin regulation of iron is essential for protection from infection-associated mortality with the siderophilic pathogens Yersinia enterocolitica and Vibrio vulnificus However, the evolutionary conservation of the hypoferremic response to infection suggests that not only rare siderophilic bacteria but also common pathogens may be targeted by this mechanism. We tested 10 clinical isolates of Escherichia coli from children with sepsis and found that both genetic iron overload (by hepcidin-1 knockout [HKO]) and iatrogenic iron overload (by intravenous iron) potentiated infection with 8 out of the 10 studied isolates: after peritoneal injection of E. coli, iron-loaded mice developed sepsis with 60% to 100% mortality within 24 h, while control wild-type mice suffered 0% mortality. Using one strain for more detailed study, we show that iron overload allows rapid bacterial multiplication and dissemination. We further found that the presence of non-transferrin-bound iron (NTBI) in the circulation is more important than total plasma or tissue iron in rendering mice susceptible to infection and mortality. Postinfection treatment of HKO mice with just two doses of the hepcidin agonist PR73 abolished NTBI and completely prevented sepsis-associated mortality. We demonstrate that the siderophilic phenotype extends to clinically common pathogens. The use of hepcidin agonists promises to be an effective early intervention in patients with infections and dysregulated iron metabolism.


Assuntos
Bacteriemia/mortalidade , Infecções por Escherichia coli/mortalidade , Hepcidinas/fisiologia , Animais , Bacteriemia/etiologia , Bacteriemia/microbiologia , Criança , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/microbiologia , Hepcidinas/agonistas , Humanos , Ferro/metabolismo , Sobrecarga de Ferro/complicações , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transferrina/análise
5.
J Pediatr Nurs ; 43: 62-68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30473158

RESUMO

PURPOSE: The primary goal of this study was to test the feasibility of an educational online self-assessment of burnout, resilience, trauma, depression, anxiety, and common workplace stressors among nurses working in a pediatric intensive care unit or neonatal intensive care unit setting. The secondary, exploratory objectives were to estimate the prevalence of psychiatric symptoms in this sample and to identify those variables that most strongly predict burnout. DESIGN AND METHODS: Data from optional and anonymous online measures were analyzed for 115 nurses (67.9% aged 25-44; 61.7% Caucasian) working in an urban children's hospital pediatric or neonatal ICU. Multiple linear regressions identified demographic variables and workplace stressors that significantly predicted each of three components of burnout. RESULTS: Most respondents found the educational assessment and feedback to be helpful. Choosing nursing as a second career was associated with better resilience. Having worked in ICU settings longer and being older were both linked to lower levels of anxiety. Predictors of burnout varied across the three burnout subscales. CONCLUSIONS: Implementation of an online self-assessment with immediate educational feedback is feasible in critical care settings. The variability of predictors across the three burnout subscales indicates the need for tailored interventions for those at risk. Future research may include follow-up of nurses to examine changes in scores over time and expansion of the tool for other medical personnel. PRACTICE IMPLICATIONS: An educational online self-assessment can be a helpful tool for pediatric critical care nurses experiencing varying degrees of burnout and distress.


Assuntos
Esgotamento Profissional/psicologia , Cuidados Críticos/métodos , Saúde Mental , Comportamento de Redução do Risco , Autoavaliação (Psicologia) , Adulto , Pré-Escolar , Educação a Distância , Estudos de Viabilidade , Retroalimentação , Feminino , Hospitais Pediátricos , Humanos , Lactente , Unidades de Terapia Intensiva Neonatal , Unidades de Terapia Intensiva Pediátrica , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Enfermagem Neonatal/métodos , Enfermagem Pediátrica/métodos , Projetos Piloto , Qualidade de Vida , Estados Unidos , Adulto Jovem
7.
Infect Immun ; 82(2): 745-52, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24478088

RESUMO

Hepcidin, the iron-regulatory hormone, is increased during infection or inflammation, causing hypoferremia. This response is thought to be a host defense mechanism that restricts iron availability to invading pathogens. It is not known if hepcidin is differentially induced by bacterial versus viral infections, whether the stimulation of pattern recognition receptors directly regulates hepcidin transcription, or which of the proposed signaling pathways are essential for hepcidin increase during infection. We analyzed hepcidin induction and its dependence on interleukin-6 (IL-6) in response to common bacterial or viral infections in mice or in response to a panel of pathogen-derived molecules (PAMPs) in mice and human primary hepatocytes. In wild-type (WT) mice, hepcidin mRNA was induced several hundred-fold both by a bacterial (Streptococcus pneumoniae) and a viral infection (influenza virus PR8) within 2 to 5 days. Treatment of mice and human primary hepatocytes with most Toll-like receptor ligands increased hepcidin mRNA within 6 h. Hepcidin induction by microbial stimuli was IL-6 dependent. IL-6 knockout mice failed to increase hepcidin in response to S. pneumoniae or influenza infection and had greatly diminished hepcidin response to PAMPs. In vitro, hepcidin induction by PAMPs in primary human hepatocytes was abolished by the addition of neutralizing IL-6 antibodies. Our results support the key role of IL-6 in hepcidin regulation in response to a variety of infectious and inflammatory stimuli.


Assuntos
Hepatócitos/microbiologia , Hepatócitos/virologia , Hepcidinas/biossíntese , Interleucina-6/metabolismo , Animais , Hepatócitos/imunologia , Hepatócitos/metabolismo , Humanos , Interleucina-6/imunologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Orthomyxoviridae/imunologia , Streptococcus pneumoniae/imunologia
8.
J Immunol ; 184(11): 6359-66, 2010 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-20435923

RESUMO

Myeloid differentiation factor 2 (MD-2) is a secreted gp that assembles with TLR4 to form a functional signaling receptor for bacterial LPS. In this study, we have identified a novel alternatively spliced isoform of human MD-2, termed MD-2 short (MD-2s), which lacks the region encoded by exon 2 of the MD-2 gene. Similar to MD-2, MD-2s is glycosylated and secreted. MD-2s also interacted with LPS and TLR4, but failed to mediate LPS-induced NF-kappaB activation and IL-8 production. We show that MD-2s is upregulated upon IFN-gamma, IL-6, and TLR4 stimulation and negatively regulates LPS-mediated TLR4 signaling. Furthermore, MD-2s competitively inhibited binding of MD-2 to TLR4. Our study pinpoints a mechanism that may be used to regulate TLR4 activation at the onset of signaling and identifies MD-2s as a potential therapeutic candidate to treat human diseases characterized by an overly exuberant or chronic immune response to LPS.


Assuntos
Lipopolissacarídeos/imunologia , Antígeno 96 de Linfócito/genética , Transdução de Sinais/imunologia , Receptor 4 Toll-Like/genética , Linhagem Celular , Separação Celular , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Expressão Gênica , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/imunologia , Humanos , Immunoblotting , Imunoprecipitação , Interleucina-8/biossíntese , Antígeno 96 de Linfócito/imunologia , Antígeno 96 de Linfócito/metabolismo , Microscopia Confocal , Isoformas de Proteínas/genética , Isoformas de Proteínas/imunologia , Isoformas de Proteínas/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Receptor 4 Toll-Like/imunologia , Receptor 4 Toll-Like/metabolismo
9.
Lancet Child Adolesc Health ; 6(10): 725-737, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35931098

RESUMO

Paediatric acute liver failure (PALF) is defined as a biochemical evidence of acute liver injury in a child with no previous history of chronic liver disease characterised by an international normalised ratio (INR) of 1·5 or more unresponsive to vitamin K with encephalopathy, or INR of 2·0 or more with or without encephalopathy. PALF can rapidly progress to multiorgan dysfunction or failure. Although the transplant era has substantially changed the outlook for these patients, transplantation itself is not without risks, including those associated with life-long immunosuppression. Consequently, there has been an increased focus on improving medical management to prioritise bridging of patients to native liver survival, which is possible due to improved understanding of the underlying pathophysiology of multiorgan involvement in PALF. In this Review, we discuss recent advances in the medical management of PALF with an aim of reducing the need for liver transplantation. The Review will focus on the non-specific immune-mediated inflammatory response, extracorporeal support devices, neuromonitoring and neuroprotection, and emerging cellular and novel future therapeutic options.


Assuntos
Encefalopatias , Falência Hepática Aguda , Transplante de Fígado , Criança , Humanos , Falência Hepática Aguda/complicações , Falência Hepática Aguda/terapia , Vitamina K/uso terapêutico
10.
Front Pediatr ; 9: 628810, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33643977

RESUMO

During the COVID pandemic, a surge in pediatric Type 1 Diabetes Mellitus (T1DM) cases appears to be occurring, potentially due to the presence of autoantibody-induced immune dysregulation triggered by COVID-19. We describe one such case in a previously healthy 7-year-old with asymptomatic COVID-19 presenting with a high nasopharyngeal SARS CoV-2 virus load, detectable COVID-19 IgG antibodies, diabetic keto-acidosis and islet cell autoantibodies. COVID-19 is not a trivial disease in children and adolescents and can lead to lifelong sequelae such as T1DM. Raising awareness about a possible association between COVID-19 and T1DM in children is critical.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA