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Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Dolor Crónico/terapia , Infecciones por VIH/complicaciones , Manejo del Dolor , Dolor Crónico/complicaciones , HumanosRESUMEN
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Dolor Crónico/terapia , Infecciones por VIH/complicaciones , Manejo del Dolor , Dolor Crónico/complicaciones , HumanosRESUMEN
Adenocarcinoma accounts for â¼40% of lung cancer, equating to â¼88 500 new patients in 2015, most of who will succumb to this disease, thus, the public health burden is evident. Unfortunately, few early biomarkers as well as effective therapies exist, hence the need for novel targets in lung cancer treatment. We previously identified epiregulin (Ereg), an EGF-like ligand, as a biomarker in several mouse lung cancer models. In the present investigation we used a primary two-stage initiation/promotion model to test our hypothesis that Ereg deficiency would reduce lung tumor promotion in mice. We used 3-methylcholanthrene (initiator) or oil vehicle followed by multiple weekly exposures to butylated hydroxytoluene (BHT; promoter) in mice lacking Ereg (Ereg-/- ) and wildtype controls (BALB/ByJ; Ereg+/+ ) and examined multiple time points and endpoints (bronchoalveolar lavage analysis, tumor analysis, mRNA expression, ELISA, wound assay) during tumor promotion. At the early time points (4 and 12 wk), we observed significantly reduced amounts of inflammation (macrophages, PMNs) in the Ereg-/- mice compared to controls (Ereg+/+ ). At 20 wk, tumor multiplicity was also significantly decreased in the Ereg-/- mice versus controls (Ereg+/+ ). IL10 expression, an anti-inflammatory mediator, and downstream signaling events (Stat3) were significantly increased in the Ereg-/- mice in response to BHT, supporting both reduced inflammation and tumorigenesis. Lastly, wound healing was significantly increased with recombinant Ereg in both human and mouse lung epithelial cell lines. These results indicate that Ereg has proliferative potential and may be utilized as an early cancer biomarker as well as a novel potential therapeutic target. © 2016 Wiley Periodicals, Inc.
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Adenocarcinoma/genética , Carcinogénesis/genética , Epirregulina/genética , Regulación Neoplásica de la Expresión Génica , Neoplasias Pulmonares/genética , Pulmón/patología , Adenocarcinoma/inducido químicamente , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Animales , Hidroxitolueno Butilado , Carcinogénesis/inducido químicamente , Carcinogénesis/patología , Eliminación de Gen , Humanos , Inflamación/inducido químicamente , Inflamación/genética , Inflamación/patología , Neoplasias Pulmonares/inducido químicamente , Neoplasias Pulmonares/patología , Masculino , Ratones , Ratones Endogámicos BALB CRESUMEN
BACKGROUND: Advance care planning (ACP) is a critical component of quality end-of-life care. Little is known regarding the cultural influences on health professionals' attitudes toward the discussion of ACP in China. OBJECTIVE: To better understand attitudes toward ACP among Chinese healthcare professionals in China and the influence of cultural factors such as filial piety, or xiào. METHODS: A mixed methods study was used. This study reports the results of a descriptive cross-sectional survey of physicians, nurses and social workers with experience in palliative and end-of-life care. RESULTS: Some 102 completed surveys were obtained. Most Chinese health professionals had an overall positive attitude toward ACP, acknowledging that these discussions should occur. However, there was a general lack of confidence and sense of reluctance among participants to engage in ACP discussions. CONCLUSION: The lack of statistical difference between the various health professionals suggests that they all faced challenges in participating in ACP discussions. Future research should focus on the influences of cultural factors such as xiào on ACP discussion, and develop culturally sensitive strategies to facilitate these discussions in the Chinese community.
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Planificación Anticipada de Atención , Actitud del Personal de Salud , Características Culturales , Cuidado Terminal , Adulto , Anciano , China , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/psicología , Cuidados Paliativos , Médicos/psicología , Trabajadores Sociales/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Tumor promotion is an early and critical stage during lung adenocarcinoma (ADC). We previously demonstrated that Tlr4 mutant mice were more susceptible to butylated hydroxytoluene (BHT)-induced pulmonary inflammation and tumor promotion in comparison to Tlr4-sufficient mice. Our study objective was to elucidate the underlying differences in Tlr4 mutant mice in innate immune cell populations, their functional responses, and the influence of these cellular differences on ADC progenitor (type II) cells following BHT-treatment. BALB (Tlr4-sufficient) and C.C3-Tlr4(Lps-d)/J (BALB(Lpsd); Tlr4 mutant) mice were treated with BHT (promoter) followed by bronchoalveolar lavage (BAL) and flow cytometry processing on the lungs. ELISAs, Club cell enrichment, macrophage function, and RNA isolation were also performed. Bone marrow-derived macrophages (BMDM) co-cultured with a type II cell line were used for wound healing assays. Innate immune cells significantly increased in whole lung in BHT-treated BALB(Lpsd) mice compared to BALB mice. BHT-treated BALB(Lpsd) mice demonstrated enhanced macrophage functionality, increased epithelial wound closure via BMDMs, and increased Club cell number in BALB(Lpsd) mice, all compared to BALB BHT-treated mice. Cytokine/chemokine (Kc, Mcp1) and growth factor (Igf1) levels also significantly differed among the strains and within macrophages, gene expression, and cell surface markers collectively demonstrated a more plastic phenotype in BALB(Lpsd) mice. Therefore, these correlative studies suggest that distinct innate immune cell populations are associated with the differences observed in the Tlr4-mutant model. Future studies will investigate the macrophage origins and the utility of the pathways identified herein as indicators of immune system deficiencies and lung tumorigenesis.
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Carcinogénesis/genética , Carcinogénesis/inmunología , Inmunidad Innata/inmunología , Neoplasias Pulmonares/inmunología , Neoplasias Pulmonares/patología , Receptor Toll-Like 4/inmunología , Adenocarcinoma/genética , Adenocarcinoma/inmunología , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Animales , Lavado Broncoalveolar/métodos , Hidroxitolueno Butilado/farmacología , Carcinogénesis/patología , Quimiocinas/inmunología , Expresión Génica/genética , Expresión Génica/inmunología , Inmunidad Innata/genética , Pulmón/inmunología , Pulmón/patología , Neoplasias Pulmonares/genética , Macrófagos/inmunología , Macrófagos/patología , Masculino , Ratones , Ratones Endogámicos BALB C , Mutación/genética , Mutación/inmunología , Neumonía/inducido químicamente , Neumonía/genética , Neumonía/inmunología , Neumonía/patología , Receptor Toll-Like 4/genéticaRESUMEN
Personal 8-h shift exposure to respirable dust, diesel engine exhaust emissions (DEEE) (as respirable elemental carbon), and respirable crystalline silica of workers involved in constructing an underground metro railway tunnel was assessed. Black carbon (BC) concentrations were also assessed using a MicroAeth AE51. During sprayed concrete lining (SCL) activities in the tunnel, the geometric mean (GM) respirable dust exposure level was 0.91mg m(-3), with the highest exposure measured on a back-up sprayer (3.20mg m(-3)). The GM respirable crystalline silica concentration for SCL workers was 0.03mg m(-3), with the highest measurement also for the back-up sprayer (0.24mg m(-3)). During tunnel boring machine (TBM) activities, the GM respirable dust concentration was 0.54mg m(-3). The GM respirable elemental carbon concentration for all the TBM operators was 18 µg m(-3); with the highest concentration measured on a segment lifter. The BC concentrations were higher in the SCL environment in comparison to the TBM environment (daily GM 18-54 µg m(-3) versus 3-6 µg m(-3)). This small-scale monitoring campaign provides additional personal data on exposures experienced by underground tunnel construction workers.
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Polvo/análisis , Exposición por Inhalación/análisis , Minería , Exposición Profesional/análisis , Emisiones de Vehículos/análisis , Contaminantes Ocupacionales del Aire/análisis , Carbono/análisis , Carbono/normas , Monitoreo del Ambiente/métodos , Humanos , Londres , Dióxido de Silicio/análisisRESUMEN
To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV's social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH.
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Antirretrovirales/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Atención Dirigida al Paciente/organización & administración , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Antirretrovirales/uso terapéutico , Centers for Disease Control and Prevention, U.S. , Centers for Medicare and Medicaid Services, U.S./organización & administración , Continuidad de la Atención al Paciente/organización & administración , Manejo de la Enfermedad , Quimioterapia Combinada , Humanos , Cumplimiento de la Medicación , Atención Dirigida al Paciente/economía , Calidad de la Atención de Salud/organización & administración , Apoyo Social , Estados UnidosRESUMEN
This study compares the humoral immune response of a cohort of renal transplant recipients (RTRs), in Trinidad & Tobago following two-dose primary immunization with non-mRNA vaccines amidst the COVID-19 pandemic. RTRs along with healthy, age-and gender-matched controls received either the adenoviral vector vaccine, AstraZeneca-Vaxzevria (AZ) or the inactivated vaccine, Beijing CNBG-BBIBP- CorV/Sinopharm (SP). Samples were taken after completion of a two-dose primary immunization during the period November 2021 to December 2021, at a mean interval of 138 days following immunization. 38/72 RTRs (53 %) failed to generate any protective antibody responses, compared with 7/73 participants, approximately 10 % in the healthy, age and gender-matched control group. In the RTRs, there was no significant correlation of their antibody concentration with either the timing of sample collection or the interval since transplantation. The study provides necessary information about the humoral response after two- doses of non-mRNA vaccines in a group of transplant recipients.
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A high burden of pain, symptoms and other multidimensional problems persist alongside HIV treatment. WHO policy indicates palliative care as essential throughout the disease course. This study aimed to determine whether palliative care delivered from within an existing HIV outpatient setting improves control of pain and symptoms compared to standard care. A prospective, longitudinal controlled design compared patient outcomes at an outpatient facility that introduced palliative care training to clinicians and stocked essential palliative care drugs, to outcomes of a cohort of patients at a similar HIV care facility with no palliative care, in Tanzania. Inclusion criteria were clinically significant pain or symptoms. Patients were followed from baseline fortnightly until week 10 using validated self-report outcome measures. For the primary pain outcome, the required sample size of 120 patients was recruited. Odds of reporting pain reduced significantly more at intervention site (OR=0.60, 95% CI 0.50-0.72) than at control (OR=0.85, 95% CI 0.80-0.90), p=0.001. For secondary outcomes, longitudinal analysis revealed significant difference in slope between intervention and control, respectively: Medical Outcomes Study-HIV (MOS-HIV) physical score 1.46 vs. 0.54, p=0.002; MOS-HIV mental health 1.13 vs. 0.26, p=0.006; and POS total score 0.84 vs. 0.18, p=0.001. Neither baseline CD4 nor antiretroviral therapy (ART) use was associated with outcome scores. These data are the first to report outcomes evaluating integrated HIV outpatient palliative care in the presence of ART. The data offer substantive evidence to underpin the existing WHO clinical guidance that states an essential role for palliative care alongside HIV treatment, regardless of prognosis.
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Atención Ambulatoria/métodos , Infecciones por VIH/terapia , Manejo del Dolor/métodos , Cuidados Paliativos/métodos , Adulto , Anciano , Países en Desarrollo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Tanzanía , Adulto JovenRESUMEN
Objective: Evaluate feasibility and impact of a multimodal integrative therapeutic intervention in patients presenting with chronic symptoms attributed to a postinfectious syndrome. Design: This was a prospective longitudinal single-center pilot study conducted from January 2019 to December 2020. Setting/Location: University of Maryland Lyme Program, Baltimore Maryland. Subjects: Persons presenting for Lyme evaluation for symptoms attributed to Lyme disease. Interventions: Participants attended two 1-h individual instructional sessions consisting of Ayurveda-based dietary intervention and breath-coordinated mind-body practice to be used for home practice. Outcome measures: Standard measures of impact were obtained at baseline, 1, 3, 6, and 12 months using the following validated survey instruments: Perceived Stress Scale (PSS), PROMIS Global Health v1.2 (GH), and PROMIS 29 v2.0 survey. Results: From 216 patients presenting for Lyme evaluation, 19 participants enrolled with 84% completing the study (N = 16). Baseline PROMIS GH scores consisting of general Physical Health (GPH) and general Mental Health (GMH) scores were lower in the study population than in the general U.S. population. PROMIS 29 scores were higher for fatigue, anxiety, and pain than those in the general U.S. population. Over 12-month period, improvement in both the GPH and GMH was 6.09 (confidence interval [95% CI] = 2.71-9.46; p < 0.001) and 4.65 (95% CI = 1.50-7.80; p = 0.004), respectively. PROMIS 29 scores showed the greatest improvement in fatigue at -7.91 (95% CI = -12.34 to -3.48; p < 0.001), pain interference -5.08 (95% CI = -9.20 to -0.96; p = 0.016), and ability to participate in social roles and activities 7.48 (95% CI = 3.21-11.75; p = 0.001) and least with depression -1.82 (95% CI = -4.74 to 1.10; p = 0.223). Employment status had significant effects on almost all outcome scores. Postinfectious state was associated with improvement in anxiety and PSS scores. Conclusions: A multimodal Ayurvedic and breath-coordinated mind-body therapeutic intervention is feasible and a potential nonpharmacologic therapeutic option for persons presenting with pain, stress, fatigue, physical dysfunction, and sleep disturbance attributed to a postinfectious syndrome. Further research is needed to determine efficacy in this population and in other groups with similar symptom complexes due to postinfectious syndromes.
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OBJECTIVE: To explore barriers to care continuity among formerly incarcerated persons with HIV and/or hepatitis C. DATA SOURCES AND STUDY SETTING: We draw on data from semi-structured interviews conducted in 2018-2019 with 30 formerly incarcerated persons and 10 care providers. Data were collected across two clinics in Baltimore, Maryland, and Washington, D.C. STUDY DESIGN: We recruited participants using a combination of nonprobability sampling techniques. Participants completed closed-ended questionnaires and took part in semi-structured interviews related to treatment barriers and incentives. DATA COLLECTION/EXTRACTION METHODS: Interviews were transcribed using Express Scribe software and transcriptions were open coded using NVivo 12 software. An iterative process was used to relate and build upon emergent themes in interviews. PRINCIPAL FINDINGS: Our study illuminates both internal and external barriers to care continuity. The most common external barriers were system navigation and housing instability. Internal barriers consisted of overlapping issues related to mental health, substance use, and feelings of shame and/or denial. CONCLUSION: An overarching theme is that formerly incarcerated persons with HIV and/or HCV are grappling with numerous challenges that can threaten their health and health care. These barriers are cumulative, intersecting, and reciprocal.
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Infecciones por VIH , Hepatitis C , Prisioneros , Humanos , Atención a la Salud , Hepatitis C/terapia , Hepacivirus , Infecciones por VIH/terapiaRESUMEN
Over half of HIV infections in the U.S. are among young gay, bisexual, and other same-gender-loving men (SGLM). Symptoms affecting these individuals must be clarified in order to be detected and addressed by health care providers. This report describes the symptom prevalence in young SGLM living with HIV. Study participants in an urban context experienced high symptom burden with a median of 6.2 symptoms despite antiretroviral treatment with viral suppression. Most common symptoms included fatigue (57%), depression (54%), insomnia (53%), anxiety (44%), dizziness (33%), and headache (33%). This study showed that young SGLM with HIV experience a high number of symptoms given their age. Health care providers should work to alleviate this symptom burden that affects patients' quality of life and may influence engagement in care.
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Infecciones por VIH , Retención en el Cuidado , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Hombres , Calidad de VidaRESUMEN
Germinal centre (GC) reactions are central features of T-cell-driven B-cell responses, and the site where antibody-producing cells and memory B cells are generated. Within GCs, a range of complex cellular and molecular events occur which are critical for the generation of high affinity antibodies. These processes require exquisite regulation not only to ensure the production of desired antibodies, but to minimize unwanted autoreactive or low affinity antibodies. To assess whether T regulatory (Treg) cells participate in the control of GC responses, immunized mice were treated with an anti-glucocorticoid-induced tumour necrosis factor receptor-related protein (GITR) monoclonal antibody (mAb) to disrupt Treg-cell activity. In anti-GITR-treated mice, the GC B-cell pool was significantly larger compared with control-treated animals, with switched GC B cells composing an abnormally high proportion of the response. Dysregulated GCs were also observed regardless of strain, T helper type 1 or 2 polarizing antigens, and were also seen after anti-CD25 mAb treatment. Within the spleens of immunized mice, CXCR5(+) and CCR7(-) Treg cells were documented by flow cytometry and Foxp3(+) cells were found within GCs using immunohistology. Final studies demonstrated administration of either anti-transforming growth factor-ß or anti-interleukin-10 receptor blocking mAb to likewise result in dysregulated GCs, suggesting that generation of inducible Treg cells is important in controlling the GC response. Taken together, these findings indicate that Treg cells contribute to the overall size and quality of the humoral response by controlling homeostasis within GCs.
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Centro Germinal/inmunología , Linfocitos T Reguladores/inmunología , Animales , Centro Germinal/citología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Transgénicos , Linfocitos T Reguladores/citologíaRESUMEN
Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients' Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients' disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.
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Infecciones por VIH , Minorías Sexuales y de Género , Estudios de Cohortes , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Humanos , Lactante , Masculino , Calidad de VidaRESUMEN
Chronic alcohol abuse leads to multiple defects in the immune system, leading to an increased risk of infectious disease and malignancy. Immune lesions encompass both the innate and adaptive arms and include deficiencies in the B-cell compartment. Long-term alcoholics exhibit loss of B cells in the periphery and diminished ability to generate protective antibodies. To better mimic the chronic alcoholic patient, our group has used an ethanol-in-drinking-water mouse model. Mice consuming alcohol in this manner progressively develop a range of immune abnormalities, including defects in humoral immunity. To document and explore B-cell lesions in ethanol-consuming mice, our laboratory has used a broad panel of technologies. These include protocols to define the physical state of B cells in the bone marrow and periphery, in vitro approaches to test B-cell activation potential and in vivo experiments to document the humoral competence of the host. These key techniques are detailed in the present chapter.
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Consumo de Bebidas Alcohólicas/inmunología , Alcoholismo/inmunología , Formación de Anticuerpos , Linfocitos B/inmunología , Etanol/administración & dosificación , Activación de Linfocitos , Animales , Diferenciación Celular , Proliferación Celular , Separación Celular , Células Cultivadas , Modelos Animales de Enfermedad , Ensayo de Inmunoadsorción Enzimática , Citometría de Flujo , Inmunización , RatonesRESUMEN
Background: To provide optimal end-of-life (EOL) care in the Chinese American population, we need to have a better understanding of what matters most at EOL from their perspective. Experiencing a "good death" at the EOL is the optimal goal of palliative care. Studies show that the meaning and description of good death varies across cultures in different populations. In the United States, Chinese Americans comprise the largest Asian demographic. Aim: To describe EOL wishes, which define a good death for Chinese Americans. Method: Qualitative study using focus groups. A convenience sample of 60 Chinese Americans was recruited from a community organization in Maryland. Ten focus group discussion sessions were conducted. Results: Wishes at the EOL that defined a good death for the participants in this study included being pain-free, not being a burden to family, being with family, having a trusted physician, maintaining dignity, and prayer. Conclusion: A good death is a complex concept. What matters most to patients at the EOL differs depending on their cultural background. When caring for Chinese Americans, a comprehensive EOL care plan should include cultural considerations in addition to physical, psychosocial, and spiritual needs.
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OBJECTIVE: The aim of this study was to characterize the mortality at two hardmetal production factories in the United Kingdom as part of an international study. METHODS: Standardized mortality ratios (SMRs) were calculated on the basis of mortality rates for England and Wales, and local rates. A nested case-control study of lung cancer was undertaken. RESULTS: The cohort comprised 1538 workers, with tracing complete for 94.4%. All-cause mortality was statistically significantly low for all cancers and nonmalignant respiratory disease, and for lung cancer was nonsignificantly low. The SMR for lung cancer for maintenance workers was elevated, based on only six deaths. The odds ratio for lung cancer per year of exposure to hardmetal was 0.93 (0.76 to 1.13). CONCLUSIONS: In this small study, there is no evidence to support that working in the UK hardmetal manufacturing industry increased mortality from any cause including lung cancer.
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Aleaciones/efectos adversos , Cobalto/efectos adversos , Neoplasias Pulmonares/mortalidad , Enfermedades Profesionales/mortalidad , Exposición Profesional/efectos adversos , Tungsteno/efectos adversos , Adulto , Estudios de Casos y Controles , Causas de Muerte , Industria Química/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Neoplasias Pulmonares/inducido químicamente , Masculino , Exposición Profesional/estadística & datos numéricos , Factores de Riesgo , Reino UnidoRESUMEN
Exposure to airborne agents needs to be assessed in the personal breathing zone by the use of personal measurement equipment. Specific measurement devices for assessing personal exposure to airborne nanomaterials have only become available in the recent years. They can be differentiated into direct-reading personal monitors and personal samplers that collect the airborne nanomaterials for subsequent analyses. This article presents a review of the available personal monitors and samplers and summarizes the available literature regarding their accuracy, comparability and field applicability. Due to the novelty of the instruments, the number of published studies is still relatively low. Where applicable, literature data is therefore complemented with published and unpublished results from the recently finished nanoIndEx project. The presented data show that the samplers and monitors are robust and ready for field use with sufficient accuracy and comparability. However, several limitations apply, e.g. regarding the particle size range of the personal monitors and their in general lower accuracy and comparability compared with their stationary counterparts. The decision whether a personal monitor or a personal sampler shall be preferred depends strongly on the question to tackle. In many cases, a combination of a personal monitor and a personal sampler may be the best choice to obtain conclusive results.
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Contaminantes Ocupacionales del Aire/análisis , Monitoreo del Ambiente , Exposición por Inhalación/análisis , Nanoestructuras/análisis , Exposición Profesional/análisis , Humanos , Tamaño de la Partícula , Lugar de TrabajoRESUMEN
Self-reports of 32 symptoms and their treatments were obtained from patients of three palliative care programs that provide services to seriously ill HIV patients (>or=95% AIDS) in Alabama (n=47), Baltimore (n=91), and New York City (n=117). On average, patients reported 10.9 (SD=7.6) to 12.7 (SD=6.2) symptoms. Pain, lack of energy, and worrying were reported by a majority of patients at all sites, often with a high level of associated distress. For only four symptoms (pain, nausea, difficulty swallowing, and mouth sores) did half or more of patients at all sites experiencing the symptom also report treatment. Less than a third of patients experiencing 12 symptoms (five of six comprising a psychological subscale) reported treatment. Results show that despite the availability of more efficacious treatments, many HIV/AIDS patients continue to experience significant physical and psychological symptomatology. Many of those experiencing symptoms, however, do not perceive their symptoms as being treated.
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Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Cuidados Paliativos , Adulto , Alabama , Baltimore , Femenino , Infecciones por VIH/terapia , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva YorkRESUMEN
Palliative care (PC), introduced early in the management of chronic illness, improves patient outcomes. Early integration of a palliative approach for persons with HIV has been documented to be effective in identifying and managing patient-level concerns over the past decade in African settings. The experience of implementing PC in multiple African and other resource-constrained settings (RCSs) emphasizes the need for essential palliative competencies that can be integrated with chronic disease management for patients and their families facing life-limiting illness. This article is an historical description of how basic palliative competencies were observed to be acceptable for health workers providing outpatient HIV care and treatment during eight years of U.S. implementation of "care and support," a term coined to represent PC for persons living with HIV in RCS. The need for team building and interprofessional education is highlighted. The model is currently being tested in one U.S. city and may represent a mechanism for expanding the palliative approach into management of chronic disease. Such competencies may play a role in the development of the patient-centered medical home, a critical component of U.S. health care reform.