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1.
N Engl J Med ; 385(15): 1355-1371, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34496194

RESUMO

BACKGROUND: There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS: We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS: The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS: Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).

2.
Nurs Educ Perspect ; 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34581309

RESUMO

ABSTRACT: Patients who are remote, underserved, or require specialized care services are not always able to seek appropriate care when necessary. Telehealth technology allows health care providers to connect virtually with their patients to provide safe and personalized care. To prepare future nurses and nurse practitioners for the use of technology, educators are responsible for integrating telehealth education into the curriculum. This article presents a clinical simulated approach that includes an interprofessional telehealth experience with prelicensure and nurse practitioner students within a pediatric focused simulation.

3.
J Nurs Educ ; 60(9): 526-528, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34467816

RESUMO

BACKGROUND: In response to the development of the Quality and Safety Education for Nurses (QSEN) competencies and noting lower standardized test scores, nursing faculty at a midwestern United States university developed three safety and quality labs throughout a traditional baccalaureate curriculum. METHOD: These labs intentionally integrated the QSEN competencies and occurred over three semesters of the nursing program. Students' learning activities aligned with the QSEN competencies and were leveled across the labs. RESULTS: Throughout all the labs, all six QSEN competencies provided a framework for students to learn the knowledge, skills, and attitudes essential to the profession of nursing. Students spent most of their time in the labs learning the QSEN competency of safety, followed by teamwork and collaboration, quality improvement, patient-centered care, informatics, and evidenced-based practice. CONCLUSION: The QSEN competencies provided a framework to teach pre-licensure nursing students the knowledge, skills, and attitudes essential in the profession of nursing. Safety and Quality I focused on foundational skills and individual patient safety. Safety and Quality II introduced intermediate skills with an emphasis on safety. The third and final lab introduced students to advanced quality improvement, teamwork and collaboration, and system safety. After the completion of the labs, the students stated they had gained knowledge and confidence in the application of all six QSEN competencies. [J Nurs Educ. 2021;60(9):526-528.].


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Educação Baseada em Competências , Currículo , Humanos , Segurança do Paciente , Assistência Centrada no Paciente , Melhoria de Qualidade
4.
J Acad Nutr Diet ; 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34455104

RESUMO

BACKGROUND: Early child care (ECE) programs may substantially influence child diet quality. OBJECTIVE: The Study of Nutrition and Activity in Child Care Settings (SNACS) describes the usual food group intake of preschool-age children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes on child and non-child care days. DESIGN: Meal observations and parent-completed food diaries in a cross-sectional nationally representative multi-stage cluster sample of Child and Adult Care Food Program (CACFP)-participating ECE programs. PARTICIPANTS/SETTING: 1,468 children ages 3 to 5 years attending 217 CACFP-participating ECE programs (child care centers, Head Start) in 2017. MAIN OUTCOME MEASURES: Daily energy intake, daily USDA Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations. STATISTICAL ANALYSES PERFORMED: Regression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child care and non-child care days. RESULTS: Mean usual energy intake was 1,524 kcal±19.3 on child care days and exceeded the recommended range at 1,702 kcal±30.2 on non-child care days; single-day means indicated significantly lower energy intake on child care days (p<0.001). The percent of children meeting DGA recommendations on a child care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared to mean food group intakes on a single child care day, non-child care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats. CONCLUSIONS: While there is room to increase nutrient density inside and outside of child care, intakes on child care days more closely align to DGAs.

6.
Clin Infect Dis ; 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34245243

RESUMO

BACKGROUND: RIV4 and cell-culture based inactivated influenza vaccine (ccIIV4) have not been compared to egg-based IIV4 in healthcare personnel, a population with frequent influenza vaccination that may blunt vaccine immune responses over time. We conducted a randomized trial among HCP aged 18-64 years to compare humoral immune responses to ccIIV4 and RIV4 to IIV4. METHODS: During the 2018-2019 season, participants were randomized to receive ccIIV4, RIV4, or IIV4 and had sera collected pre-vaccination, 1 and 6 months post-vaccination. Sera were tested by hemagglutination inhibition (HI) for influenza A/H1N1, B/Yamagata, and B/Victoria and microneutralization (MN) for A/H3N2 against cell-grown vaccine reference viruses. Primary outcomes at 1 month were seroconversion rate (SCR), geometric mean titers (GMT), GMT ratio, and mean fold rise (MFR) in the intention-to-treat population. RESULTS: 727 participants were included (283 ccIIV4, 202 RIV4, and 242 IIV4). At 1 month, responses to ccIIV4 were similar to IIV4 by SCR, GMT, GMT ratio, and MFR. RIV4 induced higher SCRs, GMTs, and MFRs than IIV4 against A/H1N1, A/H3N2, and B/Yamagata. The GMT ratio of RIV4 to egg-based vaccines was 1.5 (95%CI 1.2-1.9) for A/H1N1, 3.0 (95%CI 2.4-3.7) for A/H3N2, 1.1 (95%CI 0.9-1.4) for B/Yamagata, and 1.1 (95%CI 0.9-1.3) for B/Victoria. At 6 months, ccIIV4 recipients had similar GMTs to IIV4, whereas RIV4 recipients had higher GMTs against A/H3N2 and B/Yamagata. CONCLUSION: RIV4 resulted in improved antibody responses by HI and MN compared to egg-based vaccines against three of four cell-grown vaccine strains 1 month post-vaccination, suggesting a possible additional benefit from RIV4.

7.
Worldviews Evid Based Nurs ; 18(2): 118-128, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33856117

RESUMO

BACKGROUND: Quality issues in the delivery of healthcare services to older adults and changes in societal demographics call for a social movement to improve the care of older adults in a variety of healthcare settings, including ambulatory care and convenient care clinics. AIMS: To describe the pre-implementation phase to integrate the Age-Friendly Health Systems (AFHS) 4Ms (i.e., What Matters, Medication, Mentation, and Mobility) Framework in 1,100 MinuteClinics (the retail medical clinic of CVS Health) using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (an evaluation implementation framework). METHODS: The CFIR and RE-AIM models guided data collection. Data were collected from all stakeholders (patients, healthcare providers, managers, educators, informatics staff, communications staff, and implementation consultants) via observations, surveys, interviews, focus groups, organizational readiness assessment, stakeholder assessment, and workflow mapping during a 15-month period to identify potential barriers, facilitators, and other opportunities for implementation. RESULTS: The CFIR and RE-AIM implementation frameworks provided a comprehensive approach to guide the pre-implementation phase of the AFHS 4Ms Framework at the MinuteClinic. The baseline assessments guided by the CFIR revealed important insights in the choice of implementation strategies that were developed and tested in the pre-implementation phase, and the RE-AIM guided meaningful components to the development of the logic model. LINKING ACTION TO EVIDENCE: As more healthcare systems integrate the AFHS 4Ms Framework, the approach reported in this quality improvement project can be used in other settings to facilitate a comprehensive implementation.


Assuntos
Fatores Etários , Instituições de Assistência Ambulatorial/organização & administração , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/tendências , Grupos Focais/métodos , Humanos , Pesquisa Qualitativa , Melhoria de Qualidade
8.
J Am Pharm Assoc (2003) ; 61(4): 418-424.e2, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33812783

RESUMO

OBJECTIVE: Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers. METHODS: AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP. RESULTS: The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status. CONCLUSION: The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.


Assuntos
Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/efeitos adversos , Substâncias Controladas , Humanos , Padrões de Prática Médica , Atenção Primária à Saúde
9.
Int J Pediatr Otorhinolaryngol ; 143: 110636, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548590

RESUMO

OBJECTIVES: Tonsillectomy (with or without adenoidectomy) is a common pediatric surgical procedure requiring post-operative analgesia. Because of the respiratory depression effects of opioids, clinicians strive to limit the use of these drugs for analgesia post-tonsillectomy. The objective of this study was to identify demographic and medication use patterns predictive of persistent opioid dispensing (as a proxy for opioid use) to pediatric patients post-tonsillectomy. PATIENTS AND METHODS: Retrospective cohort of South Carolina (USA) Medicaid-insured children and adolescents 0-18 years old without malignancy who had tonsillectomy in 2014-2017. We evaluated opioid dispensing pre-surgery and in the 30 days exposure period after hospital discharge. The main outcome, persistent opioid dispensing, was defined as any subject dispensed ≥1 opioid prescription 90-270 days after discharge. Group-based trajectory analyses described post-procedure opioid dispensing trajectories. RESULTS: There were 11,578 subjects representing 12,063 tonsillectomy procedures. Few (3.5%) procedures were followed by persistent opioid dispensing. Any opioid dispensing during the exposure period was associated with an increased odds of persistent opioid dispensing status during the follow up period (OR 1.51 for 1-6 days of exposure and OR 1.65 for 7-30 days of opioid exposure), as was pre-procedure opioid dispensing, having >1 tonsillectomy procedure, and having complex chronic medical conditions. Group-based trajectory analyses identified 4 distinct patterns of post-discharge opioid dispensing. CONCLUSIONS: Any opioid dispensing during the 30 days after tonsillectomy increased the odds of persistent opioid dispensing by > 50%. Multivariable and group-based trajectory analyses identified patient and procedure variables that correlate with persistent opioid dispensing, primarily driven by groups receiving pre-tonsillectomy opioids and a second group who experienced multiple episodes of tonsillectomy.


Assuntos
Tonsilectomia , Adolescente , Assistência ao Convalescente , Analgésicos Opioides/uso terapêutico , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Alta do Paciente , Estudos Retrospectivos , South Carolina/epidemiologia , Tonsilectomia/efeitos adversos , Estados Unidos
10.
Pediatrics ; 147(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33526605

RESUMO

BACKGROUND AND OBJECTIVES: Despite published declines in opioid prescribing and dispensing to children in the past decade, in few studies have researchers evaluated all children in 1 state or examined changes in mean daily opioid dispensed. In this study, we evaluated changes in the rate of dispensed opioid analgesics and the mean daily opioid dispensed to persons 0 to 18 years old in 1 state over an 8-year period. METHODS: We identified opioid analgesics dispensed to children 0 to 18 years old between 2010 and 2017 using South Carolina prescription drug monitoring program data. We used generalized linear regression analyses to examine changes over time in the following: (1) rate of dispensed opioid prescriptions and (2) mean daily morphine milligram equivalents (MMEs) per prescription. RESULTS: From the first quarter of 2010 to the end of the fourth quarter of 2017, the quarterly rate of opioids dispensed decreased from 18.68 prescriptions per 1000 state residents to 12.03 per 1000 residents (P < .0001). The largest declines were among the oldest individuals, such as the 41.2% decline among 18-year-olds. From 2010 through 2017, the mean daily MME dispensed declined by 7.6%, from 40.7 MMEs per day in 2010 to 37.6 MMEs per day in 2017 (P < .0001), but the decrease was limited to children 0 to 9 years old. CONCLUSIONS: The rate of opioid analgesic prescriptions dispensed to children 0 to 18 years old in South Carolina declined by 35.6% over the years 2010-2017; however, the MME dispensed per day declined minimally, suggesting that more can be done to improve opioid prescribing and dispensing.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Padrões de Prática Médica , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , South Carolina
11.
J Public Health Manag Pract ; 27(4): 379-384, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956292

RESUMO

OBJECTIVE: Deaths due to opioids have continued to increase in South Carolina, with 816 opioid-involved overdose deaths reported in 2018, a 9% increase from the prior year. The objective of the current study is to examine longitudinal trends (quarter [Q] 1 2010 through Q4 2018) of opioid prescribing volume and high-risk opioid prescribing behaviors in South Carolina using comprehensive dispensing data available in the South Carolina Prescription Drug Monitoring Program (SC PDMP). DESIGN: Retrospective analyses of SC PDMP data were performed using general linear models to assess quarterly time trends and change in rate of each outcome Q1 2010 through Q4 2018. PARTICIPANTS: Opioid analgesic prescription fills from SC state residents between Q1 2010 and Q4 2018. MAIN OUTCOME MEASURES: High-risk prescribing behaviors included (1) opioid prescribing rate; (2) percentage of patients receiving opioids dispensed 90 or more average morphine milligram equivalents daily; (3) percentage of opioid prescribed days with overlapping opioid and benzodiazepine prescriptions; (4) rate per 100 000 residents of multiple provider episodes; and (5) percentage of patients prescribed extended release opioids who were opioid naive. RESULTS: A total of 33 027 461 opioid prescriptions were filled by SC state residents within the time period of Q1 2010 through Q4 2018. A 41% decrease in the quarterly prescribing rate of opioids occurred from Q1 2010 to Q4 2018. The decrease in overall opioid prescribing was mirrored by significant decreases in all 4 high-risk prescribing behaviors. CONCLUSION: PDMPs may represent the most complete data regarding the dispensing of opioid prescriptions and as such be valuable tools to inform and monitor the supply of licit opioids. Our results indicate that public health policy, legislative action, and multiple clinical interventions aimed at reducing high rates of opioid prescribing across the health care ecosystem appear to be succeeding in the state of South Carolina.

12.
BMJ Qual Saf ; 30(6): 444-456, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32978322

RESUMO

BACKGROUND: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of 'what good looks like'. OBJECTIVE: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. METHODS: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. RESULTS: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. CONCLUSIONS: This large qualitative study has enabled the generation of a new plain language framework-For Us-that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.

15.
South Med J ; 113(9): 415-417, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32885255

RESUMO

OBJECTIVE: To evaluate the effect of a 2016 South Carolina payor mandate to query the state prescription drug monitoring program (PDMP) before prescribing controlled substances on the rate of opioid prescribers in South Carolina. METHODS: South Carolina PDMP datasets from 2010-2017 were evaluated using interrupted time series regression to compare changes in the rate of opioid prescribers before and after the 2016 mandate. The rate of opioid prescribers was defined as the number of prescribers who prescribed class II to IV opioids on any one prescription in each quarter divided by the total number of South Carolina prescribers who prescribed any one class II to IV medication. The rate of high-dose opioid prescribers was defined as the number of prescribers who prescribed ≥90-morphine milligram equivalent per day on any one prescription in each quarter divided by all of the prescribers who prescribed an opioid analgesic prescription. RESULTS: The rates of South Carolina opioid prescribers decreased from 75% in 2010 to 60% in 2017, with no significant change in slope (P = 0.24) after the 2016 payor mandates. The rates of South Carolina high-dose opioid prescribers decreased from 40% in 2010 to 32% in 2017, with a significant decrease in slope (P < 0.001) after the payor mandate. CONCLUSIONS: The slope of the South Carolina high-dose opioid prescriber rate significantly decreased after the 2016 South Carolina payor mandate, while the slope of the South Carolina opioid prescriber rate did not. The long-term outcomes related to the change in opioid prescriber rates are unknown and warrant further study.


Assuntos
Analgésicos Opioides/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos , Humanos , Análise de Séries Temporais Interrompida , Programas Obrigatórios/organização & administração , Padrões de Prática Médica/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/estatística & dados numéricos , Estudos Retrospectivos , South Carolina
16.
J Clin Endocrinol Metab ; 105(10)2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32697825

RESUMO

BACKGROUND: The human amylase gene (AMY1) has a broad copy number (CN) variation that may associate with body mass index. METHODS: Deoxyribonucleic acid was extracted from urine (n = 74) and serum (n = 6) samples (Protein, Fiber and Metabolic Syndrome [ProFiMet] cohort), and buccal (n = 17) samples (Oral Starch Challenge [OSC] cohort), and assessed for AMY1 CN by droplet digital polymerase chain reaction. The association of AMY1 CN with comprehensive markers of metabolic status (ProFiMet cohort) were analyzed with Pearson's correlation coefficient (CC). For the healthy, euglycemic OSC cohort, glycemic response to OSC was analyzed with independent sample t-tests (subgroups: high AMY1 CN 9-12, n = 10; low AMY1 CN 4-6, n = 7). RESULTS: There were significant inverse correlations of AMY1 CN with total visceral fat volume (CC -0.33; P = 0.004) and positive correlations of AMY1 CN with oral glucose insulin sensitivity score (derived from an oral glucose tolerance test, CC 0.26; P = 0.02), serum HDL-cholesterol (CC 0.325; P = 0.003), and serum adiponectin (CC 0.249; P = 0.026). Linear regression multivariate analysis (adiponectin as dependent variable), showed independent association of adiponectin with AMY1 CN (Beta = 0.29; P = 0.03). There were no significant associations between AMY1 CN and clamp-derived M-value, homeostasis model assessment of insulin resistance (IR), hepatic endogenous glucose production, fecal floral signature, or macronutrient dietary preference. Delta (mean) change in blood glucose concentration (fasting to 30-minutes post-OSC) was significantly greater in the high versus low AMY1 CN subgroups (mean 1.7 mmol/l [SEM 0.6] vs 0.9 mmol/l [SEM 0.9], respectively; P = 0.016). CONCLUSIONS: High AMY1 CN associates with a favorable metabolic profile (lower visceral fat volume, higher serum adiponectin, enhanced glucose absorption following oral glucose, and OSC), but not with whole-body or hepatic IR.


Assuntos
Adiposidade/genética , Glicemia/metabolismo , Absorção Gastrointestinal/genética , Gordura Intra-Abdominal/metabolismo , alfa-Amilases Salivares/genética , Administração Oral , Glicemia/análise , Glicemia/genética , Índice de Massa Corporal , Estudos de Coortes , Estudos Transversais , Feminino , Dosagem de Genes , Teste de Tolerância a Glucose , Voluntários Saudáveis , Humanos , Insulina/metabolismo , Resistência à Insulina/genética , Gordura Intra-Abdominal/diagnóstico por imagem , Fígado/metabolismo , Imageamento por Ressonância Magnética , Masculino , Amido/administração & dosagem
17.
Vaccine ; 38(33): 5305-5312, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32586760

RESUMO

The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.


Assuntos
Vacinação , Vacinas , Adulto , Pessoal de Saúde , Humanos , Imunização , Padrões de Referência , Estados Unidos
18.
PLoS One ; 15(4): e0231809, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310990

RESUMO

Genetic factors are often overlooked in conservation planning, despite their importance in small isolated populations. We used mitochondrial and microsatellite markers to investigate population genetics of the adder (Vipera berus) in southern Britain, where numbers are declining. We found no evidence for loss of heterozygosity in any of the populations studied. Genetic diversity was comparable across sites, in line with published levels for mainland Europe. However, further analysis revealed a striking level of relatedness. Genetic networks constructed from inferred first degree relationships suggested a high proportion of individuals to be related at a level equivalent to that of half-siblings, with rare inferred full-sib dyads. These patterns of relatedness can be attributed to the high philopatry and low vagility of adders, which creates high local relatedness, in combination with the polyandrous breeding system in the adder, which may offset the risk of inbreeding in closed populations. We suggest that reliance on standard genetic indicators of inbreeding and diversity may underestimate demographic and genetic factors that make adder populations vulnerable to extirpation. We stress the importance of an integrated genetic and demographic approach in the conservation of adders, and other taxa of similar ecology.


Assuntos
Endogamia , Viperidae/genética , Animais , Feminino , Variação Genética , Genética Populacional , Perda de Heterozigosidade , Masculino , Repetições de Microssatélites , Mitocôndrias/genética , Reino Unido , Viperidae/fisiologia
19.
Am J Health Behav ; 44(3): 302-312, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32295678

RESUMO

Objectives: We sought to identify patterns of knowledge, attitudes, and behaviors (KABs) about influenza and influenza vaccination among healthcare personnel (HCP) and define characteristics associated with these patterns. Methods: We used an Internet panel survey of HCP (N = 2265) during March 27-April 17, 2018; clustered HCP by their vaccination-related KABs. Results: Four clusters were identified: Immunization Champions (61.1% of the sample) received influenza vaccine to prevent disease; Unworried Vaccinators (15.4%) received the influenza vaccine but did not believe influenza is a serious threat to themselves; Fence Sitters (8.1%) believed the vaccine is safe and worth the time and expense but is not effective; Skeptics (15.4%) did not believe the vaccine is safe or effective. Influenza vaccination coverage was 78.4% overall and higher among Immunization Champions (90.2%) and Unworried Vaccinators (87.0%) than Fence Sitters (61.6%) or Skeptics (32.2%). Conclusions: Findings suggest that based on KABs, the 3 clusters comprising 85% of HCP might be vaccinated in the future. Using messages specific to each group may improve vaccination coverage among HCP.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/classificação , Vacinas contra Influenza , Vacinação , Adulto , Análise por Conglomerados , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Infect ; 81(1): 48-56, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32325131

RESUMO

OBJECTIVES: Findings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy. METHODS: A retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity. RESULTS: 950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15-2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12-3.65). Similar results were observed for LBW; there were no associations with SGA birth. CONCLUSIONS: ARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW.


Assuntos
Nascimento Prematuro , Austrália/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos
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