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2.
Artículo en Inglés | MEDLINE | ID: mdl-31603229

RESUMEN

Skeletal muscle wasting is a common complication of chronic kidney disease (CKD), characterized by the loss of muscle mass, strength and function, which significantly increases the risk of morbidity and mortality in this population. Numerous complications associated with declining renal function and lifestyle activate catabolic pathways and impair muscle regeneration, resulting in substantial protein wasting. Evidence suggests that increasing skeletal muscle mass improves outcomes in CKD, making this a clinically important research focus. Despite extensive research, the pathogenesis of skeletal muscle wasting is not completely understood. It is widely recognized that microRNAs (miRNAs), a family of short non-coding RNAs, are pivotal in the regulation of skeletal muscle homoeostasis, with significant roles in regulating muscle growth, regeneration and metabolism. The abnormal expression of miRNAs in skeletal muscle during disease has been well described in cellular and animal models of muscle atrophy, and in recent years, the involvement of miRNAs in the regulation of muscle atrophy in CKD has been demonstrated. As this exciting field evolves, there is emerging evidence for the involvement of miRNAs in a beneficial crosstalk system between skeletal muscle and other organs that may potentially limit the progression of CKD. In this article, we describe the pathophysiological mechanisms of muscle wasting and explore the contribution of miRNAs to the development of muscle wasting in CKD. We also discuss advances in our understanding of miRNAs in muscle-organ crosstalk and summarize miRNA-based therapeutics currently in clinical trials.

3.
Br J Community Nurs ; 24(10): 501-502, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31604050
4.
Mol Psychiatry ; 2019 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-31168068

RESUMEN

The pathophysiology of dopamine dysregulation in schizophrenia involves alterations at the ventral midbrain level. Given that inflammatory mediators such as cytokines influence the functional properties of midbrain dopamine neurons, midbrain inflammation may play a role in schizophrenia by contributing to presynaptic dopamine abnormalities. Thus, we quantified inflammatory markers in dopaminergic areas of the midbrain of people with schizophrenia and matched controls. We also measured these markers in midbrain of mice exposed to maternal immune activation (MIA) during pregnancy, an established risk factor for schizophrenia and other psychiatric disorders. We found diagnostic increases in SERPINA3, TNFα, IL1ß, IL6, and IL6ST transcripts in schizophrenia compared with controls (p < 0.02-0.001). The diagnostic differences in these immune markers were accounted for by a subgroup of schizophrenia cases (~ 45%, 13/28) showing high immune status. Consistent with the human cohort, we identified increased expression of immune markers in the midbrain of adult MIA offspring (SERPINA3, TNFα, and IL1ß mRNAs, all p ≤ 0.01), which was driven by a subset of MIA offspring (~ 40%, 13/32) with high immune status. There were no diagnostic (human cohort) or group-wise (mouse cohort) differences in cellular markers indexing the density and/or morphology of microglia or astrocytes, but an increase in the transcription of microglial and astrocytic markers in schizophrenia cases and MIA offspring with high inflammation. These data demonstrate that immune-related changes in schizophrenia extend to dopaminergic areas of the midbrain and exist in the absence of changes in microglial cell number, but with putative evidence of microglial and astrocytic activation in the high immune subgroup. MIA may be one of the contributing factors underlying persistent neuroimmune changes in the midbrain of people with schizophrenia.

9.
Nurs Stand ; 32(15): 41-42, 2017 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-29210534

RESUMEN

STATEMENT: The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Pandey S, Rathore C, Michael D ( 2016 ) Antiepileptic drugs for the primary and secondary prevention of seizures in viral encephalitis. Cochrane Database of Systematic Reviews. Issue 5. CD010247. doi: 10.1002/14651858.CD010247.pub3.

11.
12.
Emerg Med J ; 32(1): 26-31, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24421345

RESUMEN

OBJECTIVE: This investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care settings to develop and validate a Rapid Assessment Prioritisation and Referral Tool (RAPaRT). This instrument is intended for use among patients (with non-life threatening acuity) presenting to emergency care settings to indicate when referral to an allied member of the multidisciplinary team is warranted. METHOD: This three stage instrument development and validation study included: a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing (stage 1); a prospective cohort of consecutive admissions (n=153) to investigate item sensitivity and specificity and retain only the most suitable items (stage 2); then final consultation with the Delphi panel to ensure the final instrument was clinically amenable (stage 3). RESULTS: 23 potential items were identified following stage 1. At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel, seven items were retained in the instrument. Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted. Final consultation with the Delphi panel members also resulted in the addition of an open ended (eighth) item to allow description of any infrequent, but important, reason for referral. CONCLUSIONS: The RAPaRT has demonstrated substantial promise as an efficient clinically amenable instrument to assist multidisciplinary teams in emergency care settings. Further research to investigate the wider implementation of the RAPaRT is warranted.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Evaluación de Necesidades , Grupo de Atención al Paciente/organización & administración , Derivación y Consulta , Técnica Delfos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
14.
J Health Psychol ; 18(2): 176-86, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22453166

RESUMEN

This study aimed to explore experiences of men currently using eating disorder services. Eight men from two eating disorder services were interviewed about their experiences of seeking and receiving treatment. Two superordinate themes emerged from Interpretative Phenomenological Analysis: (1) difficulty seeing self as having an eating disorder; and (2) experiences of treatment: how important is gender? The underlying themes varied in their specificity to men, with some echoing findings from the female eating disorder literature. Difficulty admitting the eating disorder may link with eating disorder psychopathology as well as gender-specific issues. Implications for clinical practice and future research are discussed.


Asunto(s)
Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Autoimagen , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Factores Sexuales , Adulto Joven
15.
Blood Transfus ; 11(4): 500-5, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23114527

RESUMEN

BACKGROUND: Life threatening bleeding and emergency procedures in patients on vitamin K antagonists are indications for urgent reversal with prothrombin complex concentrate and vitamin K. Rapid reversal in these situations is emphasized in the literature and guidelines, but only very limited information is available on its real life use, especially on the timing of treatment in relation to presentation. MATERIALS AND METHODS: We retrospectively audited emergency warfarin reversal in 131 consecutive patients. We studied the indication, use of vitamin K, time between presentation and administration of vitamin K and PCC, effectiveness in INR reduction and clinical outcome. RESULTS: The median PCC dose was 26.8 IU/kg. The median INR was reduced from 3.1 to 1.2. Vitamin K (5 mg) was given in 91.6% of evaluable patients. We found significant delays in administration of PCC and vitamin K. The median time between presentation and administration of vitamin K/PCC was 3.6 and 5.2 hours respectively. The times in intracranial haemorrhage were 2.7 and 3.0 hours and in emergency procedures 17.4 and 15.9 hours respectively. Mortality related to bleeding was 7.6% overall but in patients with intracranial haemorrhage 22.8%. The thrombotic rate within 7 days of reversal was 1.5%. DISCUSSION: The local protocol for reversal with PCC and vitamin K was adhered to well but the delay in pre-procedural patients, suggests that intravenous vitamin K alone may be sufficient in many cases and PCC administration can be avoided by better planning. Intracranial haemorrhage in warfarinised patients carries a high mortality. Treatment delays should be avoided by making PCC stocks available within emergency departments, simple dosing structures independent of INR and administering PCC without waiting for INR and CT scan results in those with strong suspicion of intracranial haemorrhage and clear trauma. Future reports and studies should always include the time from presentation to PCC treatment.


Asunto(s)
Antifibrinolíticos/administración & dosificación , Factores de Coagulación Sanguínea/administración & dosificación , Coagulantes/efectos adversos , Coagulación Intravascular Diseminada , Auditoría Médica , Vitamina K/administración & dosificación , Warfarina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Coagulantes/administración & dosificación , Coagulación Intravascular Diseminada/sangre , Coagulación Intravascular Diseminada/inducido químicamente , Coagulación Intravascular Diseminada/tratamiento farmacológico , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Warfarina/administración & dosificación
16.
Commun Dis Intell Q Rep ; 34(3): 157-224, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21090178

RESUMEN

In 2008, 65 communicable diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 160,508 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 9% on the number of notifications in 2007. In 2008, the most frequently notified diseases were sexually transmissible infections (69,459 notifications, 43% of total notifications), vaccine preventable diseases (34,225 notifications, 21% of total notifications) and gastrointestinal diseases (27,308 notifications, 17% of total notifications). There were 18,207 notifications of bloodborne diseases; 8,876 notifications of vectorborne diseases; 1,796 notifications of other bacterial infections; 633 notifications of zoonoses and 4 notifications of quarantinable diseases.


Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven
17.
Comput Inform Nurs ; 28(3): 172-7, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20431360

RESUMEN

A telephone survey of Medicare beneficiaries with diabetes living in rural underserved areas and enrolled in the Informatics for Diabetes Education and Telemedicine project identified 109 subjects who requested further training in functions of the home telemedicine unit after initial in-home training by regional nurse installers. The initial training provided the skills needed to videoconferences with nurse case managers and to transmit blood glucose and blood pressure readings, but further instruction was needed for access to Web-based education features and messaging. This study evaluated these elderly patients' perceptions of the helpfulness of three additional telemedicine training methods:in-home visit with an regional nurse installer referencing a user's manual, unassisted patient use of the user's manual, and telephone-based training not using regional nurse installers reinforcing the user's manual. Eligible subjects rated the helpfulness of the three computer training methods on a five-point Likert scale (1 = "not helpful at all," 5 = "very helpful"). Participants rated "in-home" training with an regional nurse installer significantly higher than they did for the user's manual alone (P < .01). In response to this finding and other companion usability studies, Informatics for Diabetes Education and Telemedicine deployed home telemedicine units with enhanced remote training capabilities to better emulate characteristics of in-person training.


Asunto(s)
Diabetes Mellitus/terapia , Área sin Atención Médica , Educación del Paciente como Asunto/métodos , Población Rural , Telemedicina , Anciano , Anciano de 80 o más Años , Recolección de Datos , Diabetes Mellitus/sangre , Diabetes Mellitus/fisiopatología , Humanos , Persona de Mediana Edad
18.
Commun Dis Intell Q Rep ; 33(2): 89-154, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19877533

RESUMEN

In 2007, 69 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 146,991 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 5% on the number of notifications in 2006. In 2007, the most frequently notified diseases were sexually transmissible infections (62,474 notifications, 43% of total notifications), gastrointestinal diseases (30,325 notifications, 21% of total notifications) and vaccine preventable diseases (25,347 notifications, 17% of total notifications). There were 19,570 notifications of bloodborne diseases; 6,823 notifications of vectorborne diseases; 1,762 notifications of other bacterial infections; 687 notifications of zoonoses and 3 notifications of quarantinable diseases.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Notificación de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Niño , Preescolar , Control de Enfermedades Transmisibles , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Vigilancia de Guardia , Distribución por Sexo
19.
J Gastroenterol Hepatol ; 24(10): 1648-54, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19798783

RESUMEN

BACKGROUND AND AIM: Regular monitoring of hepatitis C (HCV)-related surveillance data is essential to inform and evaluate strategies to reduce the expanding HCV burden. The aim of this study was to examine trends in the epidemiology and treatment of HCV in Australia. METHODS: We reviewed data about HCV notifications, treatment of HCV infection through the Highly Specialised Drugs (s100) Program, and liver transplants (Australia and New Zealand Liver Transplant Registry) for the period 1997-2006. RESULTS: HCV case notification rates declined by almost 50% between 1999 and 2006, with the greatest reductions between 2001 and 2002 and amongst young adults. For newly acquired HCV cases, 89% were Australian-born and 90% reported injecting drug use as a risk factor for infection. Overall, 30% of liver transplant recipients had HCV-related cirrhosis, but the number and proportion of HCV diagnoses increased between 1997 and 2006. HCV treatment also increased over the review period. However, only 1.4% of the 202,400 people estimated to be living with chronic HCV at the end of 2006 received treatment that year. CONCLUSION: The decline in HCV notifications is consistent with a decline in HCV incidence in Australia. However, the burden of advanced HCV disease continues to expand. To reduce this burden, treatment uptake needs to increase. Consistent and sensitive surveillance mechanisms are required to detect newly acquired cases together with an expansion of surveillance for chronic HCV infections.


Asunto(s)
Antivirales/uso terapéutico , Notificación de Enfermedades/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hepatitis C/epidemiología , Hepatitis C/terapia , Trasplante de Hígado/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Hepacivirus/genética , Hepacivirus/inmunología , Hepatitis C/diagnóstico , Hepatitis C/cirugía , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/terapia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , ARN Viral/sangre , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Factores de Tiempo , Adulto Joven
20.
Ann Epidemiol ; 14(7): 467-72, 2004 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-15301783

RESUMEN

PURPOSE: To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship. METHODS: We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models. RESULTS: Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22). CONCLUSIONS: The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.


Asunto(s)
Mortalidad , Estrés Psicológico/epidemiología , Adulto , Causalidad , Causas de Muerte , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Isquemia Miocárdica/mortalidad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Factores de Riesgo , Estrés Psicológico/complicaciones , Encuestas y Cuestionarios
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