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PURPOSE: Patients who use substances (PWUS) report experiencing stigmatizing encounters and undertreatment of pain and withdrawal symptoms that increase the likelihood of patient-directed discharge (PDD). This scoping review examines North American literature to gain insights about how institutional factors intersect with patient experiences and contribute to PDD. METHODS: A scoping review was conducted using MEDLINE, CINAHL, Scopus, and EMBASE databases. Screening was completed by two reviewers. A data extraction tool developed by the research team was used to collect demographic information and explore patients' experiences and reasons for PDD. RESULTS: We present four themes related to PDD: i) effective management of pain and withdrawal symptoms, ii) therapeutic alliance with healthcare providers, iii) hospital policies, protocols, and procedures, and iv) recommendations. Notably, all patients in all qualitative studies reported predominant experiences of uncaring, stigmatizing interactions with healthcare providers. DISCUSSION: Findings suggest that transformations are required at individual and institutional levels. At an individual level, to provide equitable care to all patients, healthcare providers in all practice settings should be competent to effectively and compassionately care for PWUS. At an institutional level, policies need to be re-envisioned to support the implementation of effective practices. CONCLUSION: Hospitals are faced with the challenges to ensure respectful care environments guided by harm reduction policies that will improve engagement of PWUS in services.
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While a large proportion of the population in Papua New Guinea (PNG) maintain a subsistence lifestyle, exposure to modernisation and industrialisation since European contact has influenced a transition towards Western diets. This review aimed to scope and summarise the published research on dietary intake among Pacific Islander adults in PNG. Four electronic databases and grey literature were searched. Two reviewers completed the screening and data extraction. Fourteen studies were included from the Highlands (n = 7), Southern (n = 5), Momase (n = 1) and both the Highlands/Southern region (n = 1). No studies were from the Islands region. The majority of the studies were published prior to the year 2000 (n = 9). Geographical region and degree of urbanisation had an impact on dietary intake. Urban areas reported higher intakes of energy, protein and fat compared to rural areas. In the Southern region, a variety of foods, including sago, taro, kaukau, cooked banana, coconut and cassava contributed to energy intake, while kaukau was the main energy and protein source in the Highlands. The main foods contributing to protein in the Southern region were fresh fish, land animals and purchased animals. This review highlights an evidence gap regarding dietary intake research. Within the context of international initiatives, there is an urgent call for research aimed at understanding the social and cultural contextualisation of dietary behaviours in PNG.
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Dieta , População das Ilhas do Pacífico , Adulto , Feminino , Humanos , Masculino , Dieta/estatística & dados numéricos , Ingestão de Energia , Comportamento Alimentar/etnologia , Papua Nova GuinéRESUMO
BACKGROUND: For exercise interventions to be effectively reproduced or applied in a "real world" clinical setting, clinical trials must thoroughly document all components of the exercise prescription and ensure that participants adhere to each component. However, previous reviews have not critically examined the quality of exercise prescription of inpatient Pulmonary Rehabilitation (PR) programs. OBJECTIVE: The objectives of this review were to evaluate the (a) application of the principles of exercise training, (b) reporting of the frequency, intensity, time and type (FITT) components of exercise prescription, and (c) reporting of patient's adherence to the FITT components in intervention studies for patients admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Relevant scientific databases were searched for randomized controlled trials (RCTs) that compared in-hospital PR with usual care for people hospitalized with AECOPD. Title and abstract followed by full-text screening were conducted independently by two reviewers. Data were extracted and synthesized to evaluate the application of the principles of exercise training and the reporting/adherence of the FITT components. RESULTS: Twenty-seven RCTs were included. Only two applied all principles of exercise training. Specificity was applied by 70%, progression by 48%, overload by 37%, initial values by 89% and diminishing returns and reversibility by 37% of trials. Ten trials adequately reported all FITT components. Frequency and type were the components most reported (85% and 81%, respectively), while intensity was less frequently reported (52%). Only three trials reported on the patient's adherence to all four components. CONCLUSIONS: Studies have not adequately reported the exercise prescription in accordance with the principles of exercise training nor reported all the FITT components of the exercise prescription and patient's adherence to them. Therefore, interpretation of the current literature is limited and information for developing exercise prescriptions to individuals hospitalized with an AECOPD is lacking.
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Exercício Físico , Doença Pulmonar Obstrutiva Crônica , Humanos , Terapia por Exercício , Hospitalização , Qualidade de VidaRESUMO
BACKGROUND & AIMS: Clostridioides difficile is a toxin-secreting bacteria that is an urgent antimicrobial resistance threat, with approximately 25% of patients developing recurrent infections. Inflammatory bowel disease (IBD) patients are at increased risk of severe, recurrent C. difficile infection. METHODS: To investigate a role for C. difficile infection in IBD pathogenesis, we collected peripheral blood and stool from 20 each of ulcerative colitis patients, Crohn's disease patients, and healthy control subjects. We used a flow cytometric activation induced marker assay to quantify C. difficile toxin-specific CD4+ T cells and 16S ribosomal RNA sequencing to study microbiome diversity. RESULTS: We found IBD patients had significantly increased levels of C. difficile toxin B-specific CD4+ T cells, but not immunoglobulin G or immunoglobulin A, compared with healthy control subjects. Within antigen-specific CD4+ T cells, T helper type 17 cells and cells expressing the gut homing receptor integrin ß7 were reduced compared with healthy control subjects, similar to our previous study of non-IBD patients with recurrent C. difficile infection. Stool microbiome analysis revealed that gut homing, toxin-specific CD4+ T cells negatively associated with microbial diversity and, along with T helper type 17 cells, positively associated with bacteria enriched in healthy control subjects. CONCLUSIONS: These data suggest that IBD patients, potentially due to underlying intestinal dysbiosis, experience undiagnosed C. difficile infections that result in impaired toxin-specific immunity. This may contribute to the development of inflammatory T cell responses toward commensal bacteria and provide a rationale for C. difficile testing in IBD patients.
Crohn's disease and ulcerative colitis patients with no history of Clostridioides difficile infection had dysregulated T cell immunity to C. difficile toxin B. This was significantly different from healthy control subjects but similar to noninflammatory bowel disease patients with recurrent C. difficile infection.
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BACKGROUND: While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows. METHODS: The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses. RESULTS: A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence. CONCLUSIONS: Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.
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Rationale: Pulmonary rehabilitation (PR) during hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) occurs during a period of disease instability for the patient, and the safety and efficacy of PR, specifically during the hospitalization period, have not been established. Objective: The purpose of this review is to determine the safety and efficacy of PR during the hospitalization phase for individuals with AECOPD. Methods: Scientific databases were searched up to August 2022 for randomized controlled trials that compared in-hospital PR with usual care. PR programs commenced during the hospitalization and included a minimum of two sessions. Titles and abstracts followed by full-text screening and data extraction were conducted independently by two reviewers. The intervention effect estimates were calculated through meta-analysis using a random-effect model. Results: A total of 27 studies were included (n = 1,317). The meta-analysis showed that inpatient PR improved the 6-minute-walk distance by 105 m (P < 0.001). Inpatient PR improved the performance on the five-repetition sit-to-stand test by -7.02 seconds (P = 0.03). Quality of life (QOL), as measured by the 5-level EuroQoL Group-5 dimension version (EQ-ED-5L) and the St. George's Respiratory Questionnaire, was significantly improved by the intervention. Inpatient PR increased lower limb muscle strength by 33.35 N (P < 0.001). There was no change in the length of stay. Only one serious adverse event related to the intervention was reported. Conclusions: This review suggests that it is safe and effective to provide PR during hospitalization for individuals with AECOPD. In-hospital PR improves functional exercise capacity, QOL, and lower limb strength without prolonging the hospital length of stay.
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Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Humanos , Pacientes Internados , Hospitalização , CaminhadaRESUMO
OBJECTIVE: Aim of the study was to collect data concerning the use of antibiotics (AB) in dogs and cats in veterinary practices and clinics in Bavaria, Germany. It was evaluated, whether changes in the use of AB since the amendment of the Verordnung über Tierärztliche Hausapotheken (TÄHAV, German Regulation on the Veterinary In-house Pharmacy) in March 2018 could be documented. MATERIAL AND METHODS: Using 2 anonymous online surveys in 2017 and 2020, veterinarians treating dogs and cats in Bavaria were questioned about their usage of AB and their assessment of the current antimicrobial resistance situation. The results of both surveys were evaluated statistically and compared with each other. RESULTS: While in 2017 a total of 238 questionaries were evaluated, 160 could be included in 2020. The three most commonly used antibiotics for systemic therapy were Amoxicillin/Clavulanic acid (74.8 % of veterinarians), Enrofloxacin (56.7 %) and Amoxicillin (53.4 %) in 2017; and Amoxicillin/Clavulanic acid (88.8 %), Amoxicillin (67.5 %) and Metronidazole (33.8 %) in 2020, respectively. The participating veterinarians stated that their overall use of 3 rd and 4th generations cephalosporins (from 20.2 % of veterinarians in 2017 to 9.4 % in 2020, p = 0,005) as well as fluoroquinolones (from 80.3 % to 33.1 %, p < 0.001) had significantly declined. In 2020, the choice of AB in veterinarians was affected by legal requirements (83.8 %), tolerability (81.3 %), way of application (76.9 %), acceptance by the patient (70.0 %), and frequency of application (64.4 %), with the last parameter being significantly more important to veterinarians working in a practice (83.8 %, p = 0.004) than to veterinarians in a clinic. CONCLUSION: Veterinarians report a significantly reduced usage of fluoroquinolones and 3 rd and 4th generation cephalosporines in dogs and cats compared to 2017. These changes in prescribing practice could be a consequence of the amendment of the TÄHAV, which dictates a prohibition of rededication as well as an obligation for microbial sensitivity testing for these AB classes. CLINICAL RELEVANCE: Legal restrictions could have a positive influence on the amount and type of antibiotics used and therefore help to prevent antimicrobial resistance.
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Anti-Infecciosos , Doenças do Gato , Doenças do Cão , Médicos Veterinários , Gatos , Cães , Animais , Doenças do Gato/tratamento farmacológico , Doenças do Cão/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Inquéritos e Questionários , Fluoroquinolonas/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Amoxicilina/uso terapêuticoRESUMO
AIMS: To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic retinopathy (DR) among Mexican migrants in the U.S. METHODS: Adult visitors (n=508) at Mexican consulates in California with self-reported diabetes underwent questionnaires and fundus photography. Photographs were graded for DR by retina fellows in Mexico via teleophthalmology. Participants were contacted with results and provided referrals when necessary. RESULTS: Nearly all (97.6%) participants were aware that diabetes can cause vision loss. One-quarter (24.4%) had undergone an eye examination in the past year. Barriers to care were cost (53.9%) and insurance (45.6%). Most (85.4-91.1%) reported that Spanish-speaking providers and provision of screening in primary care would increase participation in screening. Any DR, vision-threatening DR, or proliferative DR were found in 30.2%, 9.9%, and 5.4% of participants, respectively. Nearly one-fifth (19.5%) received referrals. CONCLUSIONS: Screening in Mexican consulates may improve DR detection and treatment among Mexican migrants in the U.S.
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Diabetes Mellitus , Retinopatia Diabética , Oftalmologia , Telemedicina , Migrantes , Adulto , Retinopatia Diabética/diagnóstico , Estudos de Viabilidade , Humanos , Programas de Rastreamento/métodos , México , Oftalmologia/métodos , Fotografação , Encaminhamento e Consulta , Estados UnidosRESUMO
Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature aging disease caused by a single-point mutation in the lamin A gene, resulting in a truncated and farnesylated form of lamin A. This mutant lamin A protein, known as progerin, accumulates at the periphery of the nuclear lamina, resulting in both an abnormal nuclear morphology and nuclear stiffening. Patients with HGPS experience rapid onset of atherosclerosis, with death from heart attack or stroke as teenagers. Progerin expression has been shown to cause dysfunction in both vascular smooth muscle cells and endothelial cells (ECs). In this study, we examined how progerin-expressing endothelial cells adapt to fluid shear stress, the principal mechanical force from blood flow. We compared the response to shear stress for progerin-expressing, wild-type lamin A overexpressing, and control endothelial cells to physiological levels of fluid shear stress. Additionally, we also knocked down ZMPSTE24 in endothelial cells, which results in increased farnesylation of lamin A and similar phenotypes to HGPS. Our results showed that endothelial cells either overexpressing progerin or with ZMPSTE24 knockdown were unable to adapt to shear stress, experiencing significant cell loss at a longer duration of exposure to shear stress (3 days). Endothelial cells overexpressing wild-type lamin A also exhibited similar impairments in adaptation to shear stress, including similar levels of cell loss. Quantification of nuclear morphology showed that progerin-expressing endothelial cells had similar nuclear abnormalities in both static and shear conditions. Treatment of progerin-expressing cells and ZMPSTE24 KD cells with lonafarnib and methystat, drugs previously shown to improve HGPS nuclear morphology, resulted in improvements in adaptation to shear stress. Additionally, the prealignment of cells to shear stress before progerin-expression prevented cell loss. Our results demonstrate that changes in nuclear lamins can affect the ability of endothelial cells to properly adapt to shear stress.
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Lamina Tipo A , Progéria , Adolescente , Núcleo Celular/metabolismo , Células Endoteliais/metabolismo , Humanos , Lamina Tipo A/genética , Lamina Tipo A/metabolismo , Progéria/genética , Progéria/metabolismo , Estresse MecânicoRESUMO
INTRODUCTION: Pulmonary rehabilitation (PR) following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) reduces the risk of hospital admissions, and improves physical function and health-related quality of life. However, the safety and efficacy of in-hospital PR during the most acute phase of an AECOPD is not well established. This paper describes the protocol for a systematic review with meta-analysis to determine the safety and efficacy of inpatient acute care PR during the hospitalisation phase. METHODS AND ANALYSIS: Medical literature databases and registries MEDLINE, EMBASE, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, Canadian Agency for Drugs and Technologies in Health, CENTRAL, Allied and Complementary Medicine Database, WHO trials portal and ClinicalTrials.gov will be searched for articles from inception to June 2021 using a prespecified search strategy. We will identify randomised controlled trials that have a comparison of in-hospital PR with usual care. PR programmes had to commence during the hospitalisation and include a minimum of two sessions. Title and abstract followed by full-text screening will be conducted independently by two reviewers. A meta-analysis will be performed if there is sufficient homogeneity across selected studies or groups of studies. The Population, Intervention, Comparator, Outcomes and Study characteristics framework will be used to standardise the data collection process. The quality of the cumulative evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework. ETHICS AND DISSEMINATION: AECOPD results in physical limitations which are amenable to PR. This review will assess the safety and efficacy of in-hospital PR for AECOPD. The results will be presented in a peer-reviewed publication and at research conferences. Ethical review is not required for this study.
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Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Canadá , Hospitalização , Humanos , Pacientes Internados , Metanálise como Assunto , Revisões Sistemáticas como AssuntoAssuntos
Imunidade Adaptativa , Proteínas de Bactérias/imunologia , Toxinas Bacterianas/imunologia , Clostridioides difficile , Enterocolite Pseudomembranosa/terapia , Transplante de Microbiota Fecal , Células Th17 , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Enterotoxinas/imunologia , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Interleucina-17/metabolismo , Interleucinas/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos T/metabolismo , Recidiva , Células Th17/metabolismo , Células Th2 , Adulto Jovem , Interleucina 22RESUMO
Background: Hub and spoke systems (HSS) are increasingly promoted as a systems-level intervention to expand access to medication for opioid use disorders (MOUD), particularly in rural areas with limited treatment options. The HSS model consists of sub-systems in which "hubs" deliver specialized expertise to a regional network of office-based opioid treatment (OBOT) providers in "spokes," who together create a continuum of acute and chronic care. Yet, little is known about system-level factors (e.g., system structure, financing) that influence HSS implementation and sustainability in rural areas. Methods: For this case study, we conducted semi-structured interviews with substance use disorder treatment providers (N = 26) and system-level stakeholders (N = 16) in five rural HSS sub-systems throughout one state. We undertook iterative textual analysis of interview transcripts, identifying and coding themes related to key implementation constructs associated with the Exploration, Preparation, Implementation and Sustainability (EPIS) framework. Results: California policy-makers adopted HSS to expand rural access to opioid treatment programs (OTPs, i.e., providers of methadone and other medications for opioid use disorder). However, stakeholders questioned the model's fit for rural regions featuring few established OTPs that could function as hubs and critiqued its treatment-focused approach, felt to sideline harm reduction service providers. Contracts to serve rural regions were awarded entirely to for-profit methadone providers, contributing to stigma and distrust among many buprenorphine providers whose organizations were later recruited as spokes. While hubs offered financial resources enabling some spokes to expand MOUD, the needs of spokes varied considerably. Relationships between hubs and spokes to facilitate the care continuum under HSS were restricted by limited behavioral health resources and the large distances characterizing rural California. Conclusions: This case study reveals how rural contextual factors such as geography and behavioral healthcare resource availability can dramatically influence differential HSS implementation.
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Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Humanos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológicoRESUMO
BACKGROUND: Access to safe, affordable and accessible drinking water is a human right and foundational to the third and sixth World Health Organization's Sustainable Development Goals (SDGs). Unsafe drinking water is a risk factor for chronic and enteric diseases. Both chronic kidney disease (CKD) and diarrheal disease are highly prevalent in the Lake Chapala basin, Jalisco, Mexico, suggesting disparities in factors leading to successful achievement of these two SDGs. METHODS: This study aimed to assess progress towards SDG three and six in the Lake Chapala basin. Qualitative, quantitative, and geospatial data were collected between May and August of 2019 from three towns within the municipalities of Poncitlán and Chapala. RESULTS: Ninety-nine households participated in this study. Water sampling analyses determined 81.18% of samples from water jugs (garrafones) and 70.05% of samples from tap water were contaminated with total coliform bacteria, often including E. coli. Additionally, 32% of garrafón samples and 61.9% of tap water samples had detectable levels of arsenic. Approximately 97.94% of respondents stated that they believe clean water is a human right, but 78.57% feel the Mexican government does not do enough to make this a reality. CONCLUSIONS: This mixed methods approach highlights water quality as a serious issue in communities around Lake Chapala, and demonstrates inadequate drinking water as a key hazard, potentially perpetuating the high disease burden of both CKD and enteric disease in the region.
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Água Potável , Desenvolvimento Sustentável , Água Potável/química , Água Potável/normas , Objetivos , Humanos , México , Desenvolvimento Sustentável/tendências , Microbiologia da Água , Poluentes da Água/análise , Abastecimento de Água/normas , Organização Mundial da SaúdeRESUMO
A series of doubly flexible nucleoside analogues were designed based on the acyclic sugar scaffold of acyclovir and the flex-base moiety found in the fleximers. The target compounds were evaluated for their antiviral potential and found to inhibit several coronaviruses. Significantly, compound 2 displayed selective antiviral activity (CC50 >3× EC50) towards human coronavirus (HCoV)-NL63 and Middle East respiratory syndrome-coronavirus, but not severe acute respiratory syndrome-coronavirus. In the case of HCoV-NL63 the activity was highly promising with an EC50 <10 µM and a CC50 >100 µM. As such, these doubly flexible nucleoside analogues are viewed as a novel new class of drug candidates with potential for potent inhibition of coronaviruses.