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1.
Int J Hyg Environ Health ; 238: 113840, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34543982

RESUMO

Extreme Weather Events (EWEs) impose a substantial health and socio-economic burden on exposed populations. Projected impacts on public health, based on increasing EWE frequencies since the 1950s, alongside evidence of human-mediated climatic change represents a growing concern. To date, the impacts of EWEs on mental health remain ambiguous, largely due to the inherent complexities in linking extreme weather phenomena with psychological status. This exploratory investigation provides a new empirical and global perspective on the psychological toll of EWEs by exclusively focusing on psychological morbidity among individuals exposed to such events. Morbidity data collated from a range of existing psychological and well-being measures have been integrated to develop a single ("holistic") metric, namely, psychological impairment. Morbidity, and impairment, were subsequently pooled for key disorders-, specifically PTSD, anxiety and depression. A "composite" (any impairment) post-exposure pooled-prevalence rate of 23% was estimated, with values of 24% calculated for depression and ⁓17% for both PTSD and anxiety. Notably, calculated pooled odds ratios (pOR = 1.9) indicate a high likelihood of any negative psychological outcome (+90%) following EWE exposure. Pooled analyses of reported risk factors (p < 0.05) highlight the pronounced impacts of EWEs among individuals with higher levels of event exposure or experienced stressors (14.5%) and socio-demographic traits traditionally linked to vulnerable sub-populations, including female gender (10%), previous history (i.e., pre-event) of psychological impairment (5.5%), lower socio-economic status (5.5%), and a lower education level (5.2%). Inherent limitations associated with collating mental health data from populations exposed to EWEs, and key knowledge gaps in the field are highlighted. Study findings provide a robust evidence base for developing and implementing public health intervention strategies aimed at ameliorating the psychological impacts of extreme weather among exposed populations.


Assuntos
Transtornos de Ansiedade , Clima Extremo , Saúde Mental , Benchmarking , Mudança Climática , Humanos , Tempo (Meteorologia)
2.
Eat Weight Disord ; 26(5): 1559-1570, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32767255

RESUMO

PURPOSE: The cognitive profiles of patients suffering from anorexia nervosa (AN) are currently explored as potential facilitating and/or maintenance factors. Specific data in restrictive AN (AN-R) remain contradictory. This study focused on women with AN-R to evaluate their cognitive functions to develop a more specific cognitive remediation program. METHODS: Female patients older than 15 years who were suffering from AN-R were recruited in a specialized unit for eating disorder management. Female healthy control (HC) participants were recruited who were matched with AN patients on age. All participants completed a cognitive evaluation (premorbid intelligence quotient (IQ), planning, information processing speed, cognitive flexibility) and a clinical evaluation (impulsivity, anxiety, depression). RESULTS: A total of 122 participants were included. Patients suffering from AN-R had significant impairment in information processing speed and planning. Patients exhibited significantly better cognitive flexibility than did the HC group when adjustments were made for other cognitive functions and impulsivity. Two distinct subgroups of patients were identified. The first subgroup had more marked cognitive impairment and fewer psychopathological symptoms than did the second subgroup of patients and the HC group. CONCLUSION: Our results highlight cognitive impairment in patients with AN who had normal premorbid IQ. Two distinct profiles emerge. In clinical practice, these results open up perspectives for the development of more specific cognitive remediation programs (one specific program for cold cognitions and another specific program targeting emotions and hot cognitions). These results warrant confirmation by larger studies with a more specific evaluation of the impact of emotional status. Trial registration NTC02381639, Date of registration. March 6, 2015.


Assuntos
Anorexia Nervosa , Disfunção Cognitiva , Transtornos da Alimentação e da Ingestão de Alimentos , Anorexia Nervosa/complicações , Cognição , Disfunção Cognitiva/complicações , Emoções , Feminino , Humanos , Testes Neuropsicológicos
3.
Sci Adv ; 6(22): eaaz4126, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32523988

RESUMO

The Mre11 nuclease is involved in early responses to DNA damage, often mediated by its role in DNA end processing. MRE11 mutations and aberrant expression are associated with carcinogenesis and cancer treatment outcomes. While, in recent years, progress has been made in understanding the role of Mre11 nuclease activities in DNA double-strand break repair, their role during replication has remained elusive. The nucleoside analog gemcitabine, widely used in cancer therapy, acts as a replication chain terminator; for a cell to survive treatment, gemcitabine needs to be removed from replicating DNA. Activities responsible for this removal have, so far, not been identified. We show that Mre11 3' to 5' exonuclease activity removes gemcitabine from nascent DNA during replication. This contributes to replication progression and gemcitabine resistance. We thus uncovered a replication-supporting role for Mre11 exonuclease activity, which is distinct from its previously reported detrimental role in uncontrolled resection in recombination-deficient cells.


Assuntos
Proteínas de Ligação a DNA , Desoxicitidina , DNA , Replicação do DNA , Proteínas de Ligação a DNA/metabolismo , Desoxicitidina/análogos & derivados , Desoxicitidina/farmacologia , Exonucleases/genética , Exonucleases/metabolismo , Gencitabina
4.
Data Brief ; 26: 104544, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31667305

RESUMO

The dataset includes data from the triangulated investigation reported in our paper: 'Psychophysiological indices of cognitive style: A triangulated study incorporating neuroimaging, eye-tracking, psychometric and behavioral measures' [1,2]. The data was collected at the Directorate of Psychology & Public Health laboratories at the University of Salford, UK, in 2015 among an English-speaking sample. The dataset includes measures described in the paper including information-processing/cognitive style recorded as Cognitive Style Index [CSI; 3] scores, comparative visual search (CVS) task behavioral measures (reaction time and accuracy), eye-movement data (fixation duration, number of saccades, number of comparative saccades and distance moved) and prefrontal cortex (PFC) oxygenated hemoglobin (oxy-Hb) recorded using functional near-infrared spectroscopy (fNIRS).

5.
Water Res ; 160: 158-166, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31136849

RESUMO

In this study, we investigated the use of a natural process called microbial induced calcium carbonate precipitation (MICP) to 'grow' bio-bricks using the urea present in human urine. We first collected fresh urine and stabilized the urine with calcium hydroxide. This prevented any significant loss of urea which allowed it to then be used for the MICP process. We used Sporosarcina pasteurii bacteria to help drive the MICP process. The bacteria degraded the urea present in the urine to form carbonate ions which then combined with the calcium ions present in the urine solution to produce calcium carbonate. This calcium carbonate was then used as a bio-cement to glue loose sand particles together in the shape of a brick. The maximum compressive strength we obtained for a bio-brick was 2.7 MPa which compares well with conventionally made bricks. We successfully showed that human urine can be used to manufacture bio-bricks thus offering an additional use of human urine.


Assuntos
Bacillus , Sporosarcina , Carbonato de Cálcio , Precipitação Química , Materiais de Construção , Humanos , Ureia
6.
Neuroscience ; 386: 121-136, 2018 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-29928950

RESUMO

Prior research with a rat model of behavioral therapy [i.e., effort-based reward (EBR) contingency training] suggests that strengthened associations between physical effort and desired outcomes enhance neurobiological indices of resilience. In the current study, male and female Long-Evans rats were exposed to either six weeks of EBR training or noncontingent training prior to 10 days of exposure to chronic unpredictable stress (CUS). Subsequently, all animals were exposed to a problem-solving task and then trained in a spatial learning/foraging task, the Dry Land Maze (DLM). Following habituation training and test trials, rats were assessed in a probe trial that generated a prediction error (cognitive uncertainty). Results indicated that, during CUS exposure, contingency-training enhanced dehydroepiandrosterone/corticosterone ratios (consistent with healthier stress responses), especially in male rats. Additionally, contingency training increased exploratory behaviors in the probe trial as well as differentially influenced on-task problem-solving performance in males and females. Following the probe trial, brains were exposed to histological analyses to determine the effects of sex and contingency training on various neurobiological markers. Contingency training decreased BDNF-immunoreactivity (ir) in the hippocampus CA1 and lateral habenula, implicating differential neuroplasticity responses in the training groups. Further, coordinated fos-ir activation in areas associated with emotional resilience (i.e., motivation-regulation) was observed in contingent-trained animals. In sum, the current findings confirm that behavioral training is associated with neurobiological markers of emotional resilience; however, further assessments are necessary to more accurately determine the therapeutic potential for the EBR contingency training model.


Assuntos
Terapia Comportamental/tendências , Encéfalo/metabolismo , Emoções/fisiologia , Comportamento Exploratório/fisiologia , Resiliência Psicológica , Animais , Terapia Comportamental/métodos , Corticosterona/metabolismo , Desidroepiandrosterona , Feminino , Masculino , Ratos , Ratos Long-Evans , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Estresse Psicológico/terapia
7.
NMR Biomed ; 31(10): e3932, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29846986

RESUMO

This review on magnetic resonance elastography (MRE) of the breast provides an overview of available literature and describes current developments in the field of breast MRE, including new transducer technology for data acquisition and multi-frequency-derived power-law behaviour of tissue. Moreover, we discuss the future potential of breast MRE, which goes beyond its original application as an additional tool in differentiating benign from malignant breast lesions. These areas of ongoing and future research include MRE for pre-operative tumour delineation, staging, monitoring and predicting response to treatment, as well as prediction of the metastatic potential of primary tumours.


Assuntos
Mama/diagnóstico por imagem , Técnicas de Imagem por Elasticidade , Imageamento por Ressonância Magnética , Módulo de Elasticidade , Humanos , Publicações
8.
Sci Rep ; 8(1): 7043, 2018 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-29728633

RESUMO

Tyrosine kinase 2 (TYK2) belongs to the Janus kinase (JAK) family of tyrosine kinases, which transmit signals from activated cytokine receptors. GWAS have consistently implicated TYK2 in psoriasis susceptibility. We performed an in-depth association analysis of TYK2 using GWAS and resequencing data. Strong genetic association of three nonsynonymous variants in the exonic regions of the TYK2 gene (rs34536443, rs12720356, and rs2304256) were found. rs12720356 encoding I684S is predicted to be deleterious based on its location in the pseudokinase domain. We analyzed PBMCs from 29 individuals representing the haplotypes containing each of the significantly associated signals. STAT4 phosphorylation was evaluated by phospho-flow cytometry after CD3/CD28 activation of cells followed by IL-12 stimulation. Individuals carrying the protective I684S variant manifested significantly reduced p-STAT4 levels in CD4 + CD25 + CD45RO+ (mean Stimulation Index (S.I.) 48.08, n = 10) and CD8 + CD25 + CD45RO + cells (S.I. 55.71, n = 10), compared to controls homozygous for the ancestral haplotype (S.I. 68.19, n = 10 (p = 0.002) and 76.76 n = 10 (p = 0.0008) respectively). Reduced p-STAT4 levels were also observed in skin-homing, cutaneous lymphocyte associated antigen (CLA)-positive CD4 and CD8 cells from I684S carriers. No significant changes in p-STAT4 for the psoriasis-associated variant rs34536443 was found. These data establish the functional significance of the TYK2 I684S variant in psoriasis susceptibility.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Memória Imunológica , Interleucina-12/metabolismo , Fator de Transcrição STAT4/metabolismo , TYK2 Quinase/genética , Biomarcadores , Suscetibilidade a Doenças , Regulação da Expressão Gênica , Estudo de Associação Genômica Ampla , Humanos , Imunofenotipagem , Fosforilação , Psoríase/etiologia , Psoríase/metabolismo , Psoríase/patologia , Transdução de Sinais , Pele/imunologia , Pele/metabolismo , Pele/patologia
9.
Pediatr Obes ; 13(5): 321-329, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28635082

RESUMO

BACKGROUND: American Indian (AI) youth are at high risk for type 2 diabetes. OBJECTIVES: To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study. METHODS: We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes. RESULTS: Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m-2 , p < 0.001) but not intervention participants (+0.3 kg m-2 , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes. CONCLUSIONS: We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/métodos , Entrevista Motivacional/métodos , Obesidade Infantil/terapia , Adolescente , Comportamento do Adolescente , Antropometria , Glicemia , Criança , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/etiologia , Estudos de Viabilidade , Feminino , Grupos Focais/métodos , Comportamentos Relacionados com a Saúde , Humanos , Indígenas Norte-Americanos , Insulina/sangue , Estilo de Vida , Masculino , Obesidade Infantil/complicações , Projetos Piloto , Fatores de Risco , Autoeficácia
10.
Epidemiol Infect ; 146(2): 207-217, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29208060

RESUMO

Pertussis morbidity is highest in infants too young to be fully protected by routine vaccination schedules. Alternate vaccine strategies are required to maximise protection in this age-group. To understand baseline pertussis epidemiology prior to the introduction of the maternal pertussis vaccination program in 2014, we conducted a retrospective case series analyses of 53 901 notifications and temporal trends from 1997 to 2014. Notifications were highest in infants younger than 4 months of age and highest annual notification rates in infants younger than 1 month of age (308/100 000 per year). Amongst Aboriginal and Torres Strait Islander infants aged younger than 1 month, this rate was 576/100 000 per year. Notification rates were 40% higher amongst women 15-44 years, 62·4/100 000 population compared with men (44·5/100 000) and 90% higher in Aboriginal and Torres Strait Islander women of the same age (38·2/100 000) compared with men (19·7/100 000). Six infant deaths were identified, all younger than 2 months of age. Monitoring epidemiology in at-risk groups - infants too young to be vaccinated, women of childbearing age and Aboriginal and Torres Strait Islander peoples - following implementation of the maternal pertussis vaccination program will be important to assess its impact and safety.


Assuntos
Etnicidade/estatística & dados numéricos , Mães/estatística & dados numéricos , Coqueluche/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Vacina contra Coqueluche/uso terapêutico , Queensland/epidemiologia , Estudos Retrospectivos , População Branca/estatística & dados numéricos , Coqueluche/prevenção & controle , Adulto Jovem
11.
Med Vet Entomol ; 32(1): 111-114, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28799248

RESUMO

A polymerase chain reaction-based method was used to screen sandflies for infection with Wolbachia (Rickettsiales: Rickettsiaceae), an intracellular bacterial endosymbiont found in many arthropods and filarial hosts. Positive results were obtained in five of 200 field-collected sandflies and were confirmed by sequencing. All sandflies were Lutzomyia longipalpis (Diptera: Psychodidae) captured in a region endemic for visceral leishmaniasis in Brazil. This is the first study to identify Wolbachia infection in this Lutzomyia species, which is the main vector of leishmaniasis in the study area. The low infection rate found in this study (2.5%), together with the lack of detection of Wolbachia in previous studies and the diversity found in the sequences analysed, suggests horizontal transmission to these sandflies.


Assuntos
Insetos Vetores/microbiologia , Psychodidae/microbiologia , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Wolbachia/isolamento & purificação , Animais , Brasil , Controle de Doenças Transmissíveis/métodos , Feminino , Haplótipos , Leishmania infantum/fisiologia , Leishmaniose Visceral/transmissão , Masculino , Reação em Cadeia da Polimerase , Análise de Sequência de RNA
12.
NMR Biomed ; 30(10)2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28678410

RESUMO

Non-alcoholic steatohepatitis (NASH) is characterized at histology by steatosis, hepatocyte ballooning and inflammatory infiltrates, with or without fibrosis. Although diamagnetic material in fibrosis and inflammation can be detected with quantitative susceptibility imaging, fatty acid composition changes in NASH relative to simple steatosis have also been reported. Therefore, our aim was to develop a single magnetic resonance (MR) acquisition and post-processing scheme for the diagnosis of steatohepatitis by the simultaneous quantification of hepatic fat content, fatty acid composition, T2 * transverse relaxation time and magnetic susceptibility in patients with non-alcoholic fatty liver disease. MR acquisition was performed at 3.0 T using a three-dimensional, multi-echo, spoiled gradient echo sequence. Phase images were unwrapped to compute the B0 field inhomogeneity (ΔB0 ) map. The ΔB0 -demodulated real part images were used for fat-water separation, T2 * and fatty acid composition quantification. The external and internal fields were separated with the projection onto dipole field method. Susceptibility maps were obtained after dipole inversion from the internal field map with single-orientation Bayesian regularization including spatial priors. Method validation was performed in 32 patients with biopsy-proven, non-alcoholic fatty liver disease from which 12 had simple steatosis and 20 NASH. Liver fat fraction and T2 * did not change significantly between patients with simple steatosis and NASH. In contrast, the saturated fatty acid fraction increased in patients with NASH relative to patients with simple steatosis (48 ± 2% versus 44 ± 4%; p < 0.05) and the magnetic susceptibility decreased (-0.30 ± 0.27 ppm versus 0.10 ± 0.14 ppm; p < 0.001). The area under the receiver operating characteristic curve for magnetic susceptibility as NASH marker was 0.91 (95% CI: 0.79-1.0). Simultaneous MR quantification of fat content, fatty acid composition, T2 * and magnetic susceptibility is feasible in the liver. Our preliminary results suggest that quantitative susceptibility imaging has a high diagnostic performance for the diagnosis of NASH.


Assuntos
Adiposidade , Ácidos Graxos/metabolismo , Fígado/metabolismo , Imageamento por Ressonância Magnética/métodos , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Tempo
13.
Epidemiol Infect ; 145(6): 1221-1230, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28091337

RESUMO

Pertussis epidemics have displayed substantial spatial heterogeneity in countries with high socioeconomic conditions and high vaccine coverage. This study aims to investigate the relationship between pertussis risk and socio-environmental factors on the spatio-temporal variation underlying pertussis infection. We obtained daily case numbers of pertussis notifications from Queensland Health, Australia by postal area, for the period January 2006 to December 2012. A Bayesian spatio-temporal model was used to quantify the relationship between monthly pertussis incidence and socio-environmental factors. The socio-environmental factors included monthly mean minimum temperature (MIT), monthly mean vapour pressure (VAP), Queensland school calendar pattern (SCP), and socioeconomic index for area (SEIFA). An increase in pertussis incidence was observed from 2006 to 2010 and a slight decrease from 2011 to 2012. Spatial analyses showed pertussis incidence across Queensland postal area to be low and more spatially homogeneous during 2006-2008; incidence was higher and more spatially heterogeneous after 2009. The results also showed that the average decrease in monthly pertussis incidence was 3·1% [95% credible interval (CrI) 1·3-4·8] for each 1 °C increase in monthly MIT, while average increase in monthly pertussis incidences were 6·2% (95% CrI 0·4-12·4) and 2% (95% CrI 1-3) for SCP periods and for each 10-unit increase in SEIFA, respectively. This study demonstrated that pertussis transmission is significantly associated with MIT, SEIFA, and SCP. Mapping derived from this work highlights the potential for future investigation and areas for focusing future control strategies.


Assuntos
Epidemias , Coqueluche/epidemiologia , Adolescente , Adulto , Idoso , Teorema de Bayes , Criança , Pré-Escolar , Transmissão de Doença Infecciosa , Meio Ambiente , Feminino , Humanos , Umidade , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Queensland/epidemiologia , Fatores Socioeconômicos , Análise Espaço-Temporal , Temperatura , Topografia Médica , Coqueluche/transmissão , Adulto Jovem
15.
Eat Weight Disord ; 22(1): 61-68, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27838862

RESUMO

PURPOSE: Over the last few years, disordered eating in athletes has received increasing attention. According to several studies, athletes could be more vulnerable to disordered eating and some characteristics specific to the athletic community could be in favour of an increased risk of poor body image and disturbed eating habits in athletes. However, the literature is sparse and some methodological issues in studies have been pointed out. In this context, we aimed at determining the prevalence of disordered eating in French high-level athletes using clinical interviews of three different clinicians and identifying what are the factors associated with disordered eating in athletes. METHODS: In France, all athletes registered on the French high-level list have to undergo a yearly evaluation. Data collected during the somatic assessment, the dietary consultation, and the psychological of the yearly evaluation were used. Multivariate analysis was performed for identification of factors associated with disordered eating. RESULTS: Out of the 340 athletes included, 32.9% have been detected with a disordered eating. They were difficult to detect by clinicians, as usual criteria did not seem to be reliable for athletes. Competing in sports emphasizing leanness or low body weight was associated with disordered eating; however, gender was not. CONCLUSION: These results highlight the need for the development of specific screening tools for high-level athletes. Furthermore, the identification of factors associated with disordered eating could improve early detection and prevention program effectiveness.


Assuntos
Atletas/psicologia , Imagem Corporal/psicologia , Dopagem Esportivo/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Esportes/psicologia , Adolescente , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , França , Humanos , Masculino , Prevalência , Adulto Jovem
16.
BMC Psychiatry ; 16(1): 339, 2016 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-27716113

RESUMO

BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS: We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION: To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.


Assuntos
Anorexia Nervosa/terapia , Hospitalização , Pacientes Desistentes do Tratamento/psicologia , Adolescente , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/psicologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Modelos de Riscos Proporcionais , Escalas de Graduação Psiquiátrica , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
17.
Eye (Lond) ; 30(9): 1221-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27472216

RESUMO

PurposeTo identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study.Patients and methodsInfants with a unilateral congenital cataract (n=114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis.ResultsThirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P=0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (P<0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years.ConclusionAmong children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.


Assuntos
Afacia Pós-Catarata/fisiopatologia , Afacia Pós-Catarata/terapia , Lentes de Contato , Percepção de Profundidade/fisiologia , Óculos , Implante de Lente Intraocular , Acuidade Visual/fisiologia , Catarata/congênito , Extração de Catarata , Feminino , Humanos , Lactente , Masculino , Fatores de Risco
18.
Eye (Lond) ; 30(9): 1187-94, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27367745

RESUMO

PurposeTo evaluate safety and efficacy of difluprednate 0.05% ophthalmic emulsion for treatment of postoperative inflammation after cataract surgery in pediatric patients.MethodsThis was a phase 3B, multicentre, randomized, double-masked, active-controlled study of patients aged 0-3 years who underwent uncomplicated cataract surgery in one eye, with/without intraocular lens implantation. Patients were randomized to receive difluprednate 0.05% four times daily or prednisolone acetate 1% for 14 days post surgery, followed by tapering for 14 days. Safety included evaluation of adverse events. Primary efficacy was the proportion of patients with an anterior cell grade of 0 (no cells) at day 14; secondary efficacy was a global inflammation score.ResultsForty patients were randomized to each treatment group. Adverse drug reactions included corneal oedema (difluprednate 0.5%, n=1; prednisolone acetate 1%, n=0) and increased intraocular pressure or ocular hypertension (n=2/group). Mean intraocular pressure values during treatment were 2-3 mm Hg higher with difluprednate 0.05% compared with prednisolone acetate 1%; mean values were similar between groups by the first week after treatment cessation. At 2 weeks post surgery, the incidence of complete clearing of anterior chamber cells was similar between groups (difluprednate 0.05%, n=30 (78.9%); prednisolone acetate 1%, n=31 (77.5%). Compared with prednisolone acetate 1%, approximately twice as many difluprednate 0.05%-treated patients had a global inflammation assessment score indicating no inflammation on day 1 (n=12 (30.8%) vs n=7 (17.5%) and day 8 (n=18 (48.7%) vs n=10 (25.0%).ConclusionsDifluprednate 0.05% four times daily showed safety and efficacy profiles similar to prednisolone acetate 1% four times daily in children 0-3 years undergoing cataract surgery.


Assuntos
Extração de Catarata/efeitos adversos , Fluprednisolona/análogos & derivados , Glucocorticoides/uso terapêutico , Inflamação/tratamento farmacológico , Prednisolona/análogos & derivados , Uveíte Anterior/tratamento farmacológico , Administração Tópica , Afacia Pós-Catarata/etiologia , Afacia Pós-Catarata/cirurgia , Catarata/congênito , Pré-Escolar , Método Duplo-Cego , Feminino , Fluprednisolona/efeitos adversos , Fluprednisolona/uso terapêutico , Glucocorticoides/efeitos adversos , Humanos , Lactente , Recém-Nascido , Inflamação/etiologia , Pressão Intraocular/efeitos dos fármacos , Implante de Lente Intraocular , Masculino , Soluções Oftálmicas , Prednisolona/efeitos adversos , Prednisolona/uso terapêutico , Uveíte Anterior/etiologia
19.
Pediatr Transplant ; 20(6): 836-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27470315

RESUMO

West Nile Virus is an arbovirus that has rapidly spread throughout the United States since the first case was described in Queens, New York in 1999. There has been increasing reports of both community-acquired and organ-derived infections in renal transplant recipients. In immunocompromised individuals, WNV infection is a life-threatening disease with significant neurological morbidity. We report the only pediatric case of community-acquired WNV disease in a renal transplant recipient to undergo detailed long-term neuropsychological assessment. Increased surveillance and prompt treatment of WNV meningoencephalitis is critical, and our report highlights the effectiveness of immunosuppression reduction without compromising allograft outcomes.


Assuntos
Transplante de Rim , Meningoencefalite/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Febre do Nilo Ocidental/diagnóstico , Criança , Humanos , Hospedeiro Imunocomprometido , Masculino , Meningoencefalite/imunologia , Testes Neuropsicológicos , Complicações Pós-Operatórias/imunologia , Índice de Gravidade de Doença , Febre do Nilo Ocidental/imunologia
20.
Eye (Lond) ; 30(9): 1170-4, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27315350

RESUMO

PurposeFive-year prospective data on children enrolled in the Infant Aphakia Treatment Study (IATS) provided an opportunity to explore ocular and systemic associations in patients with a unilateral congenital cataract.MethodsInfants <7 months of age with a unilateral cataract were eligible for IATS screening. We reviewed data pertaining to the exclusion of patients as well as data collected on standardized study forms used at any time for documentation of ocular or systemic disorders.ResultsOverall, 227 infants were referred for possible enrollment. Of these, 10 had insignificant cataracts and 32 refused to participate. Of those excluded, 3 were premature, 27 had significant ocular disease (usually persistent fetal vasculature (PFV) or corneal diameter <9 mm), and 4 had systemic disorders. An additional 26 were excluded at the time of the first EUA, most often because of PFV or variants thereof. On follow-up, in the 114 enrolled patients, the following disorders were diagnosed: Stickler syndrome (1), mitochondrial disease (1), autism (1), and presumed congenital rubella syndrome (1). No patient developed a cataract in the fellow eye.DiscussionSome conditions that can feature unilateral cataracts are diagnosed at birth or very early in life, but others may be diagnosed at varying periods thereafter. PFV and its variants are the most common associated ocular findings in about a quarter of cases of unilateral congenital cataracts.ConclusionAlthough patients with a unilateral cataract may have significant associated abnormalities in the affected eye, most commonly PFV and its variants, the prevalence of associated significant systemic disease is quite low.


Assuntos
Afacia Pós-Catarata/cirurgia , Artrite/etiologia , Transtorno Autístico/etiologia , Catarata/congênito , Doenças do Tecido Conjuntivo/etiologia , Oftalmopatias/etiologia , Perda Auditiva Neurossensorial/etiologia , Doenças Mitocondriais/etiologia , Descolamento Retiniano/etiologia , Síndrome da Rubéola Congênita/etiologia , Afacia Pós-Catarata/etiologia , Extração de Catarata , Pré-Escolar , Seguimentos , Humanos , Lactente , Implante de Lente Intraocular , Estudos Prospectivos , Vitrectomia
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