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1.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35019970

RESUMEN

This article explains the need for a licensure compact in the occupational therapy profession and describes the joint American Occupational Therapy Association (AOTA) and National Board for Certification in Occupational Therapy (NBCOT®) initiative to develop and implement the compact. Despite uniformity in occupational therapy licensure laws across the states, the ability to obtain and maintain licenses in multiple jurisdictions remains complicated and time consuming. Occupational therapy practitioners will benefit from an improvement to the existing state licensure system that would allow them to obtain a privilege to practice in multiple states through an interstate licensure compact. The licensure compact will be implemented by a commission composed of state regulators from each participating state. In September 2019, AOTA and NBCOT issued a joint statement announcing that the two organizations would be collaborating to support the development of an interstate licensure compact for occupational therapy. This article highlights the need for the Occupational Therapy Licensure Compact, the process used to develop the compact's language, and the state legislative progress made to date. It also outlines the next steps needed to advance Occupational Therapy Licensure Compact legislation as well as efforts needed to operationalize the Occupational Therapy Compact Commission.


Asunto(s)
Terapia Ocupacional , Certificación , Humanos , Concesión de Licencias , Estados Unidos
2.
Health Res Policy Syst ; 10: 1, 2012 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-22221856

RESUMEN

BACKGROUND: Reducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development. METHODS: We prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated. FINDINGS: We identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline. CONCLUSION: This review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development.


Asunto(s)
Medicina Basada en la Evidencia/normas , Guías de Práctica Clínica como Asunto , Control de Calidad , Síndrome de Inmunodeficiencia Adquirida/terapia , Adulto , África Austral , Niño , Diarrea/terapia , Estudios de Evaluación como Asunto , Femenino , Infecciones por VIH/terapia , Humanos , Hipertensión/terapia , Malaria/terapia , Masculino , Preeclampsia/terapia , Embarazo
3.
BMC Health Serv Res ; 9: 51, 2009 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-19298679

RESUMEN

BACKGROUND: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery. METHODS: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality. RESULTS: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities. CONCLUSION: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Instituciones de Atención Ambulatoria/normas , Calidad de la Atención de Salud , Personal Administrativo , Antirretrovirales/uso terapéutico , Benchmarking , Análisis por Conglomerados , Infecciones por VIH/terapia , Encuestas de Atención de la Salud , Humanos , Modelos Logísticos , Encuestas y Cuestionarios
4.
Br J Gen Pract ; 57(545): 953-9, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18252070

RESUMEN

BACKGROUND: Probiotic capsules have been shown to reduce the incidence of antibiotic-associated diarrhoea in a number of settings. If probiotic yogurt were equally efficacious then it would provide a simple and cost-effective means of preventing antibiotic-associated diarrhoea. AIM: To investigate whether eating live bio yogurt at the time of taking oral antibiotics can prevent antibiotic-associated diarrhoea. DESIGN OF STUDY: This study was a three-arm (bio yogurt, commercial yogurt, no yogurt) randomised controlled trial with double blinding between the two yogurt arms. SETTING: A single primary care general practice surgery in Hingham, Norfolk. The study population included all ages except babies. METHOD: Patients aged over 1 year who required a 1-week course of antibiotics were included in the study. There was complete follow up for 369 patients. The intervention was the consumption of 150 ml of live strawberry-flavoured yogurt for 12 days, starting on the first day of taking the antibiotic. Diarrhoea was defined as 'three or more loose stools per day over at least 2 consecutive days' within 12 days of starting the antibiotics. RESULTS: Of the 120 patients in the no-yogurt group, 17 (14%, 95% confidence interval [CI] = 9.0 to 21.5) developed diarrhoea. Of the 118 given commercial yogurt, 13 (11%, 95% CI = 6.6 to 17.9) developed diarrhoea; nine of the 131 patients (7%; 95% CI = 3.7 to 12.5) given bio yogurt developed diarrhoea (P = 0.17). CONCLUSION: Overall, this study failed to demonstrate that yogurt has any effect on antibiotic-associated diarrhoea.


Asunto(s)
Antibacterianos/efectos adversos , Diarrea/prevención & control , Probióticos/uso terapéutico , Yogur , Adolescente , Adulto , Candidiasis/prevención & control , Niño , Preescolar , Diarrea/inducido químicamente , Método Doble Ciego , Medicina Familiar y Comunitaria , Femenino , Humanos , Lactante , Masculino , Análisis de Regresión , Resultado del Tratamiento
7.
Trends Immunol ; 26(6): 326-33, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15922949

RESUMEN

Mucosal immune responses to pathogenic gut bacteria and the mechanisms that govern disease progression and outcome have been researched intensely for decades. More recently, the influence of the resident non-pathogenic or 'commensal' microflora on mucosal immune function and gut health has emerged as an area of scientific and clinical importance. Major differences occur in the mucosal immune response to pathogens and commensals. In part, this functional dichotomy is explained by the presence of virulence factors in pathogenic species, which are generally absent in commensals. Additionally, immunological 'unresponsiveness' towards the resident commensal microflora is thought to permit their successful colonisation and co-existence within the host gut. However, evidence of an active dialogue between members of the commensal microflora and the host mucosal immune system is rapidly unfolding. This crosstalk is likely to affect immunological tolerance and homeostasis within the gut and to explain some of the differential host responses to commensal and pathogenic bacteria.


Asunto(s)
Mucosa Intestinal/inmunología , Mucosa Intestinal/microbiología , Animales , Células Epiteliales/citología , Células Epiteliales/inmunología , Humanos , Inmunidad Mucosa/inmunología , Mucosa Intestinal/citología , Mucosa Intestinal/metabolismo , Glicoproteínas de Membrana/metabolismo , Receptores de Superficie Celular/metabolismo , Terapéutica , Receptores Toll-Like
8.
Mol Immunol ; 42(8): 895-901, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15829279

RESUMEN

The human gut harbours a diverse population of non-pathogenic, commensal bacteria whose contribution to gastrointestinal health and disease is now recognised. This microflora plays an important role in the development and expansion of lymphoid tissues and in the maintenance and regulation of gut immunity. A critical feature of the mucosal immune system is the ability to discriminate between harmful pathogens and the harmless members of the commensal flora. This is achieved in part, by an evolutionary-conserved family of cell surface and cytosolic receptors, referred to as toll-like receptors (TLRs), which function in microbial recognition. Appropriate activation of TLRs has been demonstrated as an essential component of host immunity against pathogens but is also vital for immune homeostasis. The ability of TLRs to discriminate between pathogens and commensals is not clear cut, however, and hence complex regulatory systems, derived both from host and bacterial origin, appear to reinforce and support this system. Host factors that modulate and alter TLR-mediated signaling have recently been defined and are thought to control the level of immune activation. Similarly, certain gut bacteria are also recognised to suppress unnecessary inflammatory responses, thereby helping to maintain immune homeostasis. Their relative contribution to these regulatory processes is currently unknown. The host transcription factor, nuclear factor kappa B (NF-kappaB) has been consistently identified as an important target molecule for bacterial regulation. NF-kappaB, which is also essential for immune activation, is an important therapeutic target for the treatment of inflammatory bowel diseases. Hence, the possibility exists that bacterially derived effector molecules, with defined modes of action, may have clinical relevance and application.


Asunto(s)
Bacterias/inmunología , Infecciones Bacterianas/inmunología , Inmunidad Innata/inmunología , Inmunidad Mucosa/inmunología , Animales , Epitelio/inmunología , Epitelio/microbiología , Epitelio/fisiología , Tracto Gastrointestinal/inmunología , Tracto Gastrointestinal/microbiología , Tracto Gastrointestinal/fisiología , Humanos , Inflamación/inmunología , Glicoproteínas de Membrana/fisiología , Receptores de Superficie Celular/fisiología , Transducción de Señal/inmunología , Transducción de Señal/fisiología , Receptores Toll-Like
10.
Nat Immunol ; 5(1): 104-12, 2004 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-14691478

RESUMEN

The human gut microflora is important in regulating host inflammatory responses and in maintaining immune homeostasis. The cellular and molecular bases of these actions are unknown. Here we describe a unique anti-inflammatory mechanism, activated by nonpathogenic bacteria, that selectively antagonizes transcription factor NF-kappaB. Bacteroides thetaiotaomicron targets transcriptionally active NF-kappaB subunit RelA, enhancing its nuclear export through a mechanism independent of nuclear export receptor Crm-1. Peroxisome proliferator activated receptor-gamma (PPAR-gamma), in complex with nuclear RelA, also undergoes nucleocytoplasmic redistribution in response to B. thetaiotaomicron. A decrease in PPAR-gamma abolishes both the nuclear export of RelA and the anti-inflammatory activity of B. thetaiotaomicron. This PPAR-gamma-dependent anti-inflammatory mechanism defines new cellular targets for therapeutic drug design and interventions for the treatment of chronic inflammation.


Asunto(s)
Bacteroides/inmunología , Tracto Gastrointestinal/microbiología , FN-kappa B/inmunología , Infecciones por Salmonella/inmunología , Salmonella enteritidis/inmunología , Animales , Células CACO-2 , Citocinas/inmunología , Citocinas/metabolismo , Ensayo de Cambio de Movilidad Electroforética , Tracto Gastrointestinal/inmunología , Células HeLa , Humanos , Microscopía Fluorescente , FN-kappa B/antagonistas & inhibidores , Interferencia de ARN/inmunología , Ratas , Receptores Citoplasmáticos y Nucleares/genética , Receptores Citoplasmáticos y Nucleares/inmunología , Infecciones por Salmonella/microbiología , Factor de Transcripción ReIA , Factores de Transcripción/genética , Factores de Transcripción/inmunología
11.
J Pineal Res ; 35(4): 221-30, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14521626

RESUMEN

The melatonin receptor family is a small group of receptors within the G protein-coupled receptor (GPCR) superfamily. The group comprises of three subtypes which bind melatonin and one member, the melatonin related receptor (MRR), that shares >40% sequence identity with the other melatonin receptors but does not bind melatonin. Identification of two subtypes expressed in the mouse suprachiasmatic nucleus, one of which (MT1) inhibits neuronal firing and the other (MT2) mediating the phase advancing properties of melatonin has given renewed interest to the development of subtype specific compounds for each of the mammalian melatonin receptors. Towards this goal site-directed and chimaeric receptor mutagenesis studies have been performed which have provided some insight into the structure-function relationships of the melatonin receptors. Furthermore, these studies may lead to the identification of the ligand for the orphan MRR.


Asunto(s)
Receptores de Melatonina/química , Receptores de Melatonina/fisiología , Secuencia de Aminoácidos , Animales , Humanos , Ratones , Datos de Secuencia Molecular , Estructura Secundaria de Proteína , Alineación de Secuencia , Transducción de Señal/fisiología , Relación Estructura-Actividad
12.
Biochim Biophys Acta ; 1592(2): 185-92, 2002 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-12379482

RESUMEN

Melatonin receptors interact with pertussis toxin-sensitive G proteins to inhibit adenylate cyclase. However, the G protein coupling profiles of melatonin receptor subtypes have not been fully characterised and alternative G protein coupling is evident. The five C-terminal residues of Galpha subunits confer coupling specificity to G protein-coupled receptors. This report outlines the use of Galphas chimaeras to alter the signal output of human melatonin receptors and investigate their interaction with the C-termini of Galpha subunits. The Galphas portion of the chimaeras confers the ability to activate adenylate cyclase leading to cyclic AMP production. Co-transfection of HEK293 cells expressing MT(1) or MT(2) melatonin receptors with Galphas chimaeras and a cyclic AMP activated luciferase construct provided a convenient and sensitive assay system for identification of receptor recognition of Galpha C-termini. Luciferase assay sensitivity was compared with measurement of cyclic AMP elevations by radioimmunoassay. Differential interactions of the melatonin receptor subtypes with Galpha chimaeras were observed. Temporal and kinetic parameters of cyclic AMP responses measured by cyclic AMP radioimmunoassay varied depending on the Galphas chimaeras coupled. Recognition of the C-terminal five amino acids of the Galpha subunit is a requisite for coupling to a receptor, but it is not the sole determinant.


Asunto(s)
Proteínas de Unión al GTP/metabolismo , Proteínas de Unión al GTP Heterotriméricas/metabolismo , Receptores de Superficie Celular/metabolismo , Receptores Citoplasmáticos y Nucleares/metabolismo , Línea Celular , AMP Cíclico/análisis , AMP Cíclico/genética , Proteínas de Unión al GTP Heterotriméricas/química , Proteínas de Unión al GTP Heterotriméricas/genética , Humanos , Luciferasas , Melatonina/farmacología , Datos de Secuencia Molecular , Radioinmunoensayo , Receptores de Melatonina , Proteínas Recombinantes de Fusión/metabolismo , Transfección
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