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1.
Adv Neurobiol ; 24: 377-394, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32006365

RESUMEN

The grain group is small, hard, dry seeds, known to be more durable than other staple foods. They have been a part of the human diet for tens of thousands of years. The two foremost types of commercial grain crops are cereals and legumes or pulses, discussed in Chapter 13 "Seeds." A low intake of whole grains is actually the leading dietary risk factor for death and disease in the USA. Few healthy grains are discussed in this chapter that can help prevent health problems like heart diseases, diabetes, and cancers.


Asunto(s)
Grano Comestible/química , Grano Comestible/clasificación , Valor Nutritivo , /estadística & datos numéricos , Fibras de la Dieta/análisis , Enfermedad , Humanos , Factores de Riesgo , Estados Unidos/epidemiología
2.
J Dent Educ ; 84(2): 151-156, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043584

RESUMEN

Early clinical exposure (ECE), defined as any interaction with patients prior to the portion of the curriculum when den- tal students spend most of their time at school as a primary provider, is a growing trend in curriculum reform across U.S. dental schools in the 21st century. The aims of this study were to characterize the types of ECE implementation in U.S. dental schools and determine if ECE correlated with earlier clinical competency assessments. In September 2018, the academic deans of all 66 U.S. dental schools were invited to respond to an eight-item electronic survey about ECE at their schools. Representatives of 40 schools submitted complete responses, for a response rate of 60.6%. Among the respondents, 85% reported their schools started their principal clinical experience (PCE), the portion of the curriculum when students spend most of their time as the primary provider for patients, during the last quarter of Year 2 or the first quarter of Year 3. Respondents at all 40 schools reported offering some form of ECE as part of the formal curriculum, with shadowing and performing dental prophylaxis the most commonly of- fered types. No statistically significant associations were found between specific types of ECE and related Commission on Dental Accreditation (CODA) clinical standards for both formative and summative assessments. Although U.S. dental schools have been incorporating more ECE into their curricula over the past decade, these findings suggest that it has not led to earlier clinical competency assessments.


Asunto(s)
Educación en Odontología , Facultades de Odontología , Curriculum , Humanos , Encuestas y Cuestionarios , Estados Unidos
3.
J Dent Educ ; 84(2): 143-150, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043586

RESUMEN

In the U.S., the Commission on Dental Accreditation (CODA) requires that dental schools use competency-based assessments and standardized levels of proficiency to ensure that students are prepared for patient care after graduation. No such comprehensive standardized preclinical testing is required in the CODA standards. The aim of this study was to determine the use of preclinical competency assessments for students transitioning from preclinical to clinical education in North American dental schools and respondents' perceptions of the need for standardization in preclinical testing. An electronic survey was sent to the academic deans of all 76 U.S. and Canadian dental schools in July 2018 asking if the school used competency exams to assess preclinical students prior to entering patient care and, if so, about the type of tests and disciplines tested, student remediation, and reasons for revisions. The survey also asked for the respondents' perspectives on potential preclinical assessment standardization. Respondents from 28 U.S. and two Canadian schools participated in the survey, for a 39.5% response rate. The majority (92.3%) of respondents said their school considered preclinical competency assessments to be good indicators of students' readiness for transitioning into patient care, yet 40.0% reported their schools had no comprehensive preclinical testing, and 13.8% had no preclinical testing in endodontics, periodontics, prosthetics, or restorative dentistry. Regarding type of comprehensive preclinical assessment used, 71.4% reported using typodont-based exams, 46.4% used written comprehensive exams, and 42.9% used objective structured clinical examinations (OSCEs); respondents could select all that applied on this item. Of the respondents whose schools had preclinical competency assessments, 72.4% had a review mechanism in place to evaluate its effectiveness. Overall, this study found that 60% of the participating schools had some form of preclinical testing, but there were no agreed-upon competencies to determine preclinical dental students' readiness for safe patient care in their clinical education.


Asunto(s)
Educación en Odontología , Facultades de Odontología , Canadá , Curriculum , Humanos , Estudiantes de Odontología , Estados Unidos
4.
Bone Joint J ; 102-B(2): 148-154, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32009438

RESUMEN

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called 'stem cell' preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148-154.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Publicidad Directa al Consumidor/normas , Comercialización de los Servicios de Salud/normas , Enfermedades Musculoesqueléticas/cirugía , Seguridad del Paciente/normas , Trasplante de Células Madre/normas , Instituciones de Atención Ambulatoria/legislación & jurisprudencia , Seguridad de Productos para el Consumidor/legislación & jurisprudencia , Seguridad de Productos para el Consumidor/normas , Publicidad Directa al Consumidor/legislación & jurisprudencia , Publicidad Directa al Consumidor/tendencias , Humanos , Comercialización de los Servicios de Salud/legislación & jurisprudencia , Comercialización de los Servicios de Salud/tendencias , Seguridad del Paciente/legislación & jurisprudencia , Guías de Práctica Clínica como Asunto/normas , Trasplante de Células Madre/legislación & jurisprudencia , Trasplante de Células Madre/tendencias , Reino Unido , Estados Unidos
5.
MMWR Morb Mortal Wkly Rep ; 69(5): 133-135, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027627

RESUMEN

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the 2020 Recommended U.S. Adult Immunization Schedule for Persons Aged 19 Years and Older. The 2020 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules/index.html,† summarizes ACIP recommendations in two tables and accompanying notes. This 2020 adult immunization schedule has been approved by the CDC Director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. Health care providers are advised to use the tables and the notes together.


Asunto(s)
Esquemas de Inmunización , Inmunización/normas , Vacunas/administración & dosificación , Adulto , Comités Consultivos , Femenino , Humanos , Masculino , Embarazo , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 69(5): 130-132, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027628

RESUMEN

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP)* approved the 2020 Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger. The 2020 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2019 immunization schedule† on the cover page, three tables, and notes found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). Health care providers are advised to use the tables and the notes together. This immunization schedule is recommended by ACIP (https://www.cdc.gov/vaccines/acip/index.html) and approved by the CDC Director, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and, for the first time, the American College of Nurse-Midwives.


Asunto(s)
Esquemas de Inmunización , Inmunización/normas , Vacunas/administración & dosificación , Adolescente , Comités Consultivos , Niño , Preescolar , Humanos , Lactante , Estados Unidos
7.
MMWR Morb Mortal Wkly Rep ; 69(5): 136-139, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027629

RESUMEN

On December 21, 2018 the Food and Drug Administration (FDA) licensed a hexavalent combined diphtheria and tetanus toxoids and acellular pertussis (DTaP) adsorbed, inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib) conjugate (meningococcal protein conjugate) and hepatitis B (HepB) (recombinant) vaccine, DTaP-IPV-Hib-HepB (Vaxelis; MCM Vaccine Company),* for use as a 3-dose series in infants at ages 2, 4, and 6 months (1). On June 26, 2019, after reviewing data on safety and immunogenicity, the Advisory Committee on Immunization Practices (ACIP)† voted to include DTaP-IPV-Hib-HepB in the federal Vaccines for Children (VFC) program.§ This report summarizes the indications for DTaP-IPV-Hib-HepB and provides guidance for its use.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Hepatitis B/administración & dosificación , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Preescolar , Humanos , Esquemas de Inmunización , Lactante , Concesión de Licencias , Estados Unidos , Vacunas Combinadas/administración & dosificación , Vacunas Conjugadas/administración & dosificación
8.
Instr Course Lect ; 69: 405-414, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017742

RESUMEN

Abuse of opioids has had and continues to have a devastating impact on public health and safety in the United States, and the use of opioids has increased dramatically in the last two decades. The purpose of this chapter is to examine the roots of this tragic state of affairs and what may be done about it moving forward. The authors review the medical-legal risks physicians face when prescribing pain relieving medications for their patients. Strategies are offered for staying out of trouble while providing quality pain management for patients.


Asunto(s)
Analgésicos Opioides , Humanos , Dolor , Manejo del Dolor , Pautas de la Práctica en Medicina , Estados Unidos
9.
MMWR Morb Mortal Wkly Rep ; 69(5): 140-146, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027631

RESUMEN

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.† On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a "Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus," which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families (3). CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow transmission of 2019-nCoV in the United States (4,5). These measures require the identification of cases and their contacts in the United States and the appropriate assessment and care of travelers arriving from mainland China to the United States. These measures are being implemented in anticipation of additional 2019-nCoV cases in the United States. Although these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs; and 3) better characterize 2019-nCoV infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC and state and local health departments.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Brotes de Enfermedades/prevención & control , Adulto , Anciano , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Control de Infecciones , Laboratorios , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Práctica de Salud Pública , Estados Unidos/epidemiología
10.
Sr Care Pharm ; 35(2): 68-74, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019641

RESUMEN

OBJECTIVE: To compare the 2015 and 2019 AGS Beers Criteria® of potentially inappropriate medications in the elderly.
DATA SOURCES: American Geriatrics Society 2015 and 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults published literature.
STUDY SELECTION/DATA EXTRACTION: The literature was reviewed, compared, and summarized to identify pertinent changes and updates to the AGS Beers Criteria of PIMs in the elderly.
DATA SYNTHESIS: The AGS Beers Criteria® contains a list of potentially inappropriate medications that should be used with caution, avoided, notable drug-drug interactions, and drugs that should be dose-adjusted based on kidney function in the older adult. The updated AGS Beers Criteria® also includes removal of medications that are no longer sold in the United States, have a low usage rate, provide low evidence of harm, and/or the potential harm is not unique to the older adult.
CONCLUSION: The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations.


Asunto(s)
Lista de Medicamentos Potencialmente Inapropiados , Anciano , Interacciones de Drogas , Geriatría , Humanos , Registros , Estados Unidos
11.
Sr Care Pharm ; 35(2): 85-92, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019643

RESUMEN

OBJECTIVE: To identify characteristics in an ambulatory Medicare population that are significantly more likely to be associated with a high risk of undiagnosed prediabetes.
DESIGN: Cross-sectional study.
SETTING: Fourteen health clinics targeting Medicare beneficiaries were held throughout northern and central California during the fall of 2017.
PATIENTS, PARTICIPANTS: Noninstitutionalized Medicare beneficiaries receiving medication therapy management services without self-reported diabetes.
INTERVENTIONS: Beneficiaries were screened for their risk of type 2 diabetes mellitus (T2DM) through the use of the American Diabetes Association (ADA) risk assessment (score of ≥ 5 indicates increased risk of developing type 2 diabetes) by pharmacy students. For this study, patients with a score of ≥ 5 were considered to be at high risk for undiagnosed prediabetes.
MAIN OUTCOME MEASURE(S): Characteristics significantly more likely to be identified in patients at high risk for undiagnosed prediabetes.
RESULTS: A total of 683 Medicare beneficiaries without self-reported diabetes completed the ADA risk assessment, with 457 (66.9%) receiving a score of 5 or more. In those, the presence of hyperlipidemia, hypertension, obesity, coronary heart disease, and use of aspirin were all characteristics researchers identified as significantly more likely to be found in this group. In contrast, those of Asian race or who took dietary supplements were significantly less likely to score 5 or higher in the questionnaire.
CONCLUSION: Identification of older adults at higher risk for undiagnosed prediabetes through the use of appropriate screening tools allows for targeted preventive interventions, potentially lowering risk of developing T2DM for selected patients.


Asunto(s)
Estado Prediabético , Anciano , California , Estudios Transversales , Diabetes Mellitus Tipo 2 , Humanos , Vida Independiente , Medicare , Estados Unidos
12.
Sr Care Pharm ; 35(2): 93-106, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019644

RESUMEN

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.


Asunto(s)
Medicare , Farmacéuticos , Anciano , Estudios Transversales , Ejercicio , Grupos Focales , Humanos , Estados Unidos
17.
BMJ ; 368: m327, 2020 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-32024652
18.
Forensic Sci Rev ; 32(1): 55-81, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32007928

RESUMEN

This review focuses on the role of motor vehicles in the prevention of alcohol-related fatalities in the United States. Since alcohol significantly affects brain function, it is natural to make drivers the prime targets for impaired-driving-prevention programs. However, the prevalence, design, ease of operation, and safety features of motor vehicles, as well as state regulations of their operation, have an important influence on crash occurrences, particularly those involving alcohol. This review begins with a discussion of why the automobile became the central technological device in the alcohol-related fatality problem and then moves on to an overview of motor vehicle safety programs that have impacted impaired driving. The article then presents an extended discussion of the effectiveness of vehicle-based, alcohol-detecting ignition interlock devices (interlocks), which provided the principal specific vehicle-based effort in the 20th century to separate alcohol consumption from driving. The review ends with a commentary on the issues that will arise in managing operator impairment in autonomous (self-driving) vehicles-the probable principal 21st-century effort to reduce impaired driving and eliminate alcohol-related crashes by minimizing the role of the driver.


Asunto(s)
Accidentes de Tránsito/prevención & control , Conducir bajo la Influencia , Vehículos a Motor , Equipos de Seguridad , Accidentes de Tránsito/estadística & datos numéricos , Humanos , Estados Unidos
20.
JAMA ; 323(1): 49-59, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910280

RESUMEN

Importance: The relationship between use of powder in the genital area and ovarian cancer is not established. Positive associations reported in case-control studies have not been confirmed in cohort studies. Objective: To estimate the association between use of powder in the genital area and ovarian cancer using prospective observational data. Design, Setting, and Participants: Data were pooled from 4 large, US-based cohorts: Nurses' Health Study (enrollment 1976; follow-up 1982-2016; n = 81 869), Nurses' Health Study II (enrollment 1989; follow-up 2013-2017; n = 61 261), Sister Study (enrollment 2003-2009; follow-up 2003-2017; n = 40 647), and Women's Health Initiative Observational Study (enrollment 1993-1998; follow-up 1993-2017; n = 73 267). Exposures: Ever, long-term (≥20 years), and frequent (≥1/week) use of powder in the genital area. Main Outcomes and Measures: The primary analysis examined the association between ever use of powder in the genital area and self-reported incident ovarian cancer. Covariate-adjusted hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models. Results: The pooled sample included 252 745 women (median age at baseline, 57 years) with 38% self-reporting use of powder in the genital area. Ten percent reported long-term use, and 22% reported frequent use. During a median of 11.2 years of follow-up (3.8 million person-years at risk), 2168 women developed ovarian cancer (58 cases/100 000 person-years). Ovarian cancer incidence was 61 cases/100 000 person-years among ever users and 55 cases/100 000 person-years among never users (estimated risk difference at age 70 years, 0.09% [95% CI, -0.02% to 0.19%]; estimated HR, 1.08 [95% CI, 0.99 to 1.17]). The estimated HR for frequent vs never use was 1.09 (95% CI, 0.97 to 1.23) and for long-term vs never use, the HR was 1.01 (95% CI, 0.82 to 1.25). Subgroup analyses were conducted for 10 variables; the tests for heterogeneity were not statistically significant for any of these comparisons. While the estimated HR for the association between ever use of powder in the genital area and ovarian cancer risk among women with a patent reproductive tract was 1.13 (95% CI, 1.01 to 1.26), the P value for interaction comparing women with vs without patent reproductive tracts was .15. Conclusions and Relevance: In this analysis of pooled data from women in 4 US cohorts, there was not a statistically significant association between use of powder in the genital area and incident ovarian cancer. However, the study may have been underpowered to identify a small increase in risk.


Asunto(s)
Genitales Femeninos , Neoplasias Ováricas/etiología , Polvos/efectos adversos , Talco/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología
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