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1.
Pediatr Transplant ; 23(5): e13467, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31124250

RESUMO

Medical cannabis is now legal in over half of the United States. As more patients adopt this unconventional therapy, it is inevitable that potential transplant recipients will disclose their cannabis use during transplant evaluation. Transplant teams are tasked with the decision to utilize a pressure resource, often with little guidance from international and national professional organizations. Many healthcare providers remain uniformed or misinformed about the risks of cannabis use and organ transplantation. In order to illustrate the multifaceted and complex evaluation of transplant patients using medical cannabis, this article presents the case of a 20-year-old woman recommended for renal transplant who was originally denied active listing due to her medical cannabis use. A review of the literature explores the perceived and actual risks of cannabis use in the immunocompromised patient. Furthermore, a discussion of the ethics of medical cannabis use and organ transplantation is included with recommendations for multidisciplinary transplant teams.

2.
Behav Res Ther ; 99: 37-46, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28910673

RESUMO

OBJECTIVE: Mindfulness is being promoted in schools as a prevention program despite a current small evidence base. The aim of this research was to conduct a rigorous evaluation of the .b ("Dot be") mindfulness curriculum, with or without parental involvement, compared to a control condition. METHOD: In a randomized controlled design, students (Mage 13.44, SD 0.33; 45.4% female) across a broad range of socioeconomic indicators received the nine lesson curriculum delivered by an external facilitator with (N = 191) or without (N = 186) parental involvement, or were allocated to a usual curriculum control group (N = 178). Self-report outcome measures were anxiety, depression, weight/shape concerns, wellbeing and mindfulness. RESULTS: There were no differences in outcomes between any of the three groups at post-intervention, six or twelve month follow-up. Between-group effect sizes (Cohen's d) across the variables ranged from 0.002 to 0.37. A wide range of moderators were examined but none impacted outcome. CONCLUSIONS: Further research is required to identify the optimal age, content and length of mindfulness programs for adolescents in universal prevention settings. TRIAL REGISTRATION: ACTRN12615001052527.


Assuntos
Ansiedade/prevenção & controle , Transtornos Dismórficos Corporais/prevenção & controle , Depressão/prevenção & controle , Atenção Plena , Serviços de Saúde Escolar , Adolescente , Currículo , Feminino , Humanos , Masculino , Satisfação Pessoal
3.
Psychol Assess ; 29(3): 264-281, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27254018

RESUMO

Mindfulness-based interventions show consistent benefits in adults for a range of pathologies, but exploration of these approaches in youth is an emergent field, with limited measures of mindfulness for this population. This study aimed to investigate whether multifactor scales of mindfulness can be used in adolescents. A series of studies are presented assessing the performance of a recently developed adult measure, the Comprehensive Inventory of Mindfulness Experiences (CHIME) in 4 early adolescent samples. Study 1 was an investigation of how well the full adult measure (37 items) was understood by youth (N = 292). Study 2 piloted a revision of items in child friendly language with a small group (N = 48). The refined questionnaire for adolescents (CHIME-A) was then tested in Study 3 in a larger sample (N = 461) and subjected to exploratory factor analysis and a range of external validity measures. Study 4 was a confirmatory factor analysis in a new sample (N = 498) with additional external validity measures. Study 5 tested temporal stability (N = 120). Results supported an 8-factor 25-item measure of mindfulness in adolescents, with excellent model fit indices and sound internal consistency for the 8 subscales. Although the CFA supported an overarching factor, internal reliability of a combined total score was poor. The development of a multifactor measure represents a first step toward testing developmental models of mindfulness in young people. This in turn will aid construction of evidence based interventions that are not simply downward derivations of adult mindfulness programs. (PsycINFO Database Record


Assuntos
Atenção Plena , Estudantes/psicologia , Adolescente , Austrália , Criança , Análise Fatorial , Feminino , Humanos , Masculino , Perfeccionismo , Reprodutibilidade dos Testes , Autocontrole/psicologia , Inquéritos e Questionários
4.
Behav Res Ther ; 81: 1-11, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27054828

RESUMO

Anxiety, depression and eating disorders show peak emergence during adolescence and share common risk factors. School-based prevention programs provide a unique opportunity to access a broad spectrum of the population during a key developmental window, but to date, no program targets all three conditions concurrently. Mindfulness has shown promising early results across each of these psychopathologies in a small number of controlled trials in schools, and therefore this study investigated its use in a randomised controlled design targeting anxiety, depression and eating disorder risk factors together for the first time. Students (M age 13.63; SD = .43) from a broad band of socioeconomic demographics received the eight lesson, once weekly.b ("Dot be") mindfulness in schools curriculum (N = 132) or normal lessons (N = 176). Anxiety, depression, weight/shape concerns and wellbeing were the primary outcome factors. Although acceptability measures were high, no significant improvements were found on any outcome at post-intervention or 3-month follow-up. Adjusted mean differences between groups at post-intervention were .03 (95% CI: -.06 to -.11) for depression, .01 (-.07 to -.09) for anxiety, .02 (-.05 to -.08) for weight/shape concerns, and .06 (-.08 to -.21) for wellbeing. Anxiety was higher in the mindfulness than the control group at follow-up for males, and those of both genders with low baseline levels of weight/shape concerns or depression. Factors that may be important to address for effective dissemination of mindfulness-based interventions in schools are discussed. Further research is required to identify active ingredients and optimal dose in mindfulness-based interventions in school settings.


Assuntos
Comportamento do Adolescente/psicologia , Ansiedade/prevenção & controle , Depressão/prevenção & controle , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Atenção Plena , Serviços de Saúde Escolar , Adolescente , Peso Corporal , Feminino , Humanos , Masculino , Resultado do Tratamento
5.
Bioorg Med Chem Lett ; 24(15): 3268-73, 2014 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-24980053

RESUMO

Acylureas and acyclic imides are found to be excellent isosteres for 2-acylamino-1,3,4-thiadiazole in the azaxanthene-based series of glucocorticoid receptor (GR) agonists. The results reported herein show that primary acylureas maintain high affinity and selectivity for GR while providing improved CYP450 inhibition and pharmacokinetic profile over 2-acylamino-1,3,4-thiadiazoles. General methods for synthesis of a variety of acylureas and acyclic imides from a carboxylic acid were utilized and are described.


Assuntos
Descoberta de Drogas , Compostos Heterocíclicos com 3 Anéis/farmacologia , Receptores de Glucocorticoides/agonistas , Tiadiazóis/farmacologia , Ureia/farmacologia , Cristalografia por Raios X , Relação Dose-Resposta a Droga , Compostos Heterocíclicos com 3 Anéis/síntese química , Compostos Heterocíclicos com 3 Anéis/química , Humanos , Modelos Moleculares , Estrutura Molecular , Estereoisomerismo , Relação Estrutura-Atividade , Tiadiazóis/química , Ureia/análogos & derivados , Ureia/química
6.
Clin Transl Sci ; 7(6): 456-64, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24945893

RESUMO

To bring the benefits of science more quickly to patient care, the NIH National Center Advancing Translational Sciences (NCATS) supports programs that enhance the development, testing, and implementation of new medical products and procedures. The NCATS clinical and translational science award (CTSA) program is central to that mission; creating an academic home for clinical and translational science and supporting those involved in the discovery and development of new health-related inventions. The technology transfer Offices (TTO) of CTSA-funded universities can be important partners in the development process; facilitating the transfer of medical research to the commercial sector for further development and ultimately, distribution to patients. The Aggregating Intellectual Property (IP) Working Group (AWG) of the CTSA public private partnerships key function committee (PPP-KFC) developed a survey to explore how CTSA-funded institutions currently interface with their respective TTOs to support medical product development. The results suggest a range of relationships across institutions; approximately half have formal collaborative programs, but only a few have well-connected programs. Models of collaborations are described and provided as examples of successful CTSA/TTO partnerships that have increased the value of health-related inventions as measured by follow-on funding and industry involvement; either as a consulting partner or licensee.


Assuntos
Academias e Institutos , Comportamento Cooperativo , Apoio à Pesquisa como Assunto , Transferência de Tecnologia , Pesquisa Médica Translacional , Comitês Consultivos , Comércio , Humanos , Apoio à Pesquisa como Assunto/economia , Pesquisa Médica Translacional/economia
7.
Ment Health Today ; : 12-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23163003

RESUMO

The new framework is seen as a positive move to improve the nation's mental health and wellbeing. However, despite the strategy highlighting the needs of people with learning disabilities, the framework offers very little specifically for this group. This raises concern that this group will remain off the radar for those in mainstream services and organisations that could support them to maintain their mental health and wellbeing. With the Valuing People Now team disbanded, there is no nationally-accredited body given the role to champion people with learning disabilities. Those with a learning disability and a mental illness should be able to access services and be treated in the same way as anyone else with reasonable adjustments being made in accordance with the Disability Discrimination Act (2005) and the Disability Equality Duty (2006). But as the implementation framework is lacking in attention to this group more work will be required by mainstream and specialist organisations to ensure the key messages from the frameworks are applicable to people with learning disabilities.


Assuntos
Política de Saúde , Serviços de Saúde Mental/legislação & jurisprudência , Humanos , Reino Unido
8.
J Med Chem ; 54(20): 7318-33, 2011 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-21899328

RESUMO

Structurally novel 5H-chromeno[2,3-b]pyridine (azaxanthene) selective glucocorticoid receptor (GR) modulators have been identified. A screening paradigm utilizing cellular assays of GR-mediated transrepression of proinflammatory transcription factors and transactivation of GR-dependent genes combined with three physiologically relevant assays of cytokine induction in human whole blood has allowed for the identification of high affinity, selective GR ligands that display a broad range of pharmacological profiles. Agonist efficacy in reporter assays can be tuned by halogenation of a pendent phenyl ring and correlates well with efficacy for cytokine inhibition in human whole blood. A hypothetical binding mode is proposed, invoking an expanded ligand binding pocket resembling that of arylpyrazole-bound GR structures. Two compounds of close structural similarity (35 and 37; BMS-776532 and BMS-791826, respectively) have been found to maintain distinct and consistent levels of partial agonist efficacy across several assays, displaying anti-inflammatory activity comparable to that of prednisolone 2 in suppressing cytokine production in whole blood and in rodent models of acute and chronic inflammation.


Assuntos
Anti-Inflamatórios não Esteroides/síntese química , Compostos Heterocíclicos com 3 Anéis/síntese química , Receptores de Glucocorticoides/agonistas , Tiadiazóis/síntese química , Fosfatase Alcalina/biossíntese , Animais , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/farmacologia , Artrite Experimental/tratamento farmacológico , Linhagem Celular Tumoral , Agonismo Parcial de Drogas , Edema/tratamento farmacológico , Glutamato-Amônia Ligase/biossíntese , Compostos Heterocíclicos com 3 Anéis/química , Compostos Heterocíclicos com 3 Anéis/farmacologia , Humanos , Técnicas In Vitro , Interleucina-1beta/sangue , Masculino , Modelos Moleculares , Ratos , Ratos Endogâmicos Lew , Ratos Sprague-Dawley , Receptores de Glucocorticoides/genética , Receptores de Glucocorticoides/metabolismo , Elementos de Resposta , Estereoisomerismo , Relação Estrutura-Atividade , Tiadiazóis/química , Tiadiazóis/farmacologia , Fator de Transcrição AP-1/genética , Fator de Transcrição AP-1/metabolismo , Ativação Transcricional , Fator de Necrose Tumoral alfa/sangue , Tirosina Transaminase/biossíntese
9.
J Trauma ; 71(1): E8-E11, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21336200

RESUMO

BACKGROUND: Elderly patients, an increasing segment of the population, who sustain traumatic brain injury (TBI) are known to have worse outcomes, including higher mortality. This objective of this study was to examine the Crash Injury Research Engineering Network and to determine at what age motor vehicle crash fatalities from head injuries increased. METHODS: The Crash Injury Research Engineering Network database was queried from 1996 to 2009. Study inclusion criteria were adult vehicle occupants with TBI, with an Abbreviated Injury Scale score ≥2. The age at which mortality increased was calculated. Patients younger and older than this cutoff age were compared to determine differences in crash characteristics. The determined cutoff age was compared with one found in a larger, population-based database. RESULTS: There were 915 patients who met the study criteria. An increase in mortality was seen at age 60 years despite no difference in Injury Severity Score and a decrease in crash severity. Patients ≤60 years were more likely to have alcohol involved, to be in a rollover crash, and had higher crash speeds. Comparing the element of the crash attributed to the head injury, the patients >60 years were more likely to have struck the airbag, door, and seat. An analysis of the larger database revealed an increase in mortality at age 70 years. CONCLUSIONS: There was a higher mortality secondary to head injuries in those older than 60 years involved in motor vehicle crashes. Improved safety measures in vehicle design may decrease the number of head injuries seen in the older population.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/mortalidade , Adulto , Fatores Etários , Idoso , Causas de Morte/tendências , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/etiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia
10.
Optometry ; 81(12): 638-46, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21111372

RESUMO

BACKGROUND: Idiopathic orbital inflammation (IOI), also known as orbital pseudotumor, is a nonspecific orbital inflammation of unknown etiology. IOI can clinically mimic many other orbital pathologies, some of which can be life-threatening, as in the case of orbital cellulitis. Thus, it is imperative for the clinician to emergently arrive at the correct diagnosis. In many cases, however, IOI presents as a clinical and therapeutic challenge, and conclusive diagnosis is only confirmed after all other etiologies have been ruled out. CASE REPORT: A 63-year-old man presented urgently with a red, proptotic, painful eye. After history, blood tests, radiologic testing, and ruling out other emergent etiologies, such as orbital cellulitis, the patient was placed on oral steroids. He responded immediately to the steroid treatment. However, the patient did have a recurrence. With the second IOI episode, the patient noted, as previously, a preceding upper respiratory infection. This case may possibly show an association between an infectious trigger leading to a nonspecific aberrant immune response in the orbit. CONCLUSION: IOI is a difficult condition to diagnose and treat. After ruling out other orbital pathologies, it is appropriate to begin treatment with oral steroids. In this case report, the patient noted an upper respiratory infection before each episode of IOI. Although there is no proof of cause, there is a strong case for the consideration of a viral respiratory infection leading to IOI.


Assuntos
Pseudotumor Orbitário/virologia , Infecções Respiratórias/complicações , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Exoftalmia/etiologia , Dor Ocular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Celulite Orbitária/diagnóstico , Doenças Orbitárias/diagnóstico , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/imunologia , Pseudotumor Orbitário/terapia , Infecções Respiratórias/virologia , Tomografia Computadorizada por Raios X
11.
J Trauma ; 65(6): 1333-8; discussion 1338-9, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19077623

RESUMO

BACKGROUND: Side impact crashes, the most lethal type, account for 26% of all motor vehicle crashes in the United States. The purpose of this study is to delineate side impact airbag (SIAB) deployment rates, injury rates, and analyze crash factors associated with SIAB deployment and occupant injury. METHODS: All passenger vehicles equipped with SIABs that were involved in a side impact crash were identified from the National Automotive Sampling System database. Crashes with multiple impacts, ejections, unbelted drivers or rollovers were excluded from the study. The outcome variables of interest were SIAB deployment and driver injury. SIAB deployment was compared in similar crashes to analyze the impact on driver's injury severity score. Other crash factors were also examined to analyze what role they play in SIAB deployment rates and injury rates, such as plane of contact, striking object and Delta-V. RESULTS: The data set for this study contained 247 drivers in near and far side crashes in vehicles with installed SIABs. Overall SIAB deployment was 43% in side impact crashes. A significant factor associated with both the SIAB deployment rate and the driver's injury rate was increased Delta-V. CONCLUSIONS: SIABs do not deploy consistently in crashes with a high Delta-V or with a lateral primary direction of force and a front plane of contact. In these two scenarios, further research is warranted on SIAB deployments. With SIAB deployment, it appears drivers are able to sustain a higher Delta-V impact without serious injury.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Air Bags/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/classificação , Adolescente , Adulto , Estudos Transversais , Falha de Equipamento , Feminino , Humanos , Masculino , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/prevenção & controle , Fatores de Risco , Ferimentos e Lesões/prevenção & controle , Adulto Jovem
12.
Forensic Sci Int ; 175(2-3): 186-92, 2008 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-17826018

RESUMO

The location, type, and local mechanism of tibial shaft fracture were determined for 66 drivers injured in frontal automobile crashes. The results from the analyses showed that the distal third is the most common fracture location (p<0.05) and that bending is responsible for the majority of these fractures regardless of the fracture site. These findings indicate that the current injury criterion for predicting the occurrence of tibial shaft fracture in crash tests with anthropometric test devices is appropriate in terms of accounting for the primary mechanism of fracture but that increased protective effectiveness could be achieved by redefining the criterion for the distal third shaft section instead of the currently specified mid-shaft section of the tibia.


Assuntos
Acidentes de Trânsito , Fraturas da Tíbia/classificação , Fraturas da Tíbia/etiologia , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Medicina Legal , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade
14.
Bioorg Med Chem Lett ; 17(3): 679-82, 2007 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-17098428

RESUMO

The design, synthesis, and SAR studies of 'core' variations led to identification of novel, selective, and potent small molecule antagonist (22) of the CC chemokine receptor-4 (CCR4) with improved in vitro activity and liability profile. Compound 22 was efficacious in a murine allergic inflammation model (ED50 approximately 10 mg/kg).


Assuntos
Receptores de Quimiocinas/antagonistas & inibidores , Animais , Compostos de Benzil/síntese química , Compostos de Benzil/farmacologia , Linhagem Celular , Quimiotaxia/efeitos dos fármacos , Relação Dose-Resposta a Droga , Indicadores e Reagentes , Camundongos , Ovalbumina , Pneumonia/induzido quimicamente , Pneumonia/tratamento farmacológico , Quinolinas/síntese química , Quinolinas/farmacologia , Receptores CCR4 , Hipersensibilidade Respiratória/tratamento farmacológico , Hipersensibilidade Respiratória/patologia , Relação Estrutura-Atividade
16.
Bioorg Med Chem Lett ; 15(10): 2669-72, 2005 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-15863339

RESUMO

The present study reports the identification and hits to leads optimization of chemokine receptor CCR4 antagonists. Compound 12 is a high affinity, non-cytotoxic antagonist of CCR4 that blocks the functional activity mediated by the receptor.


Assuntos
Receptores de Quimiocinas/antagonistas & inibidores , Receptores CCR4 , Receptores de Quimiocinas/fisiologia , Relação Estrutura-Atividade
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