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1.
Semin Arthritis Rheum ; 50(2): 209-219, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31521376

RESUMO

OBJECTIVES: To conduct a systematic review and longitudinal meta-analysis of early rheumatoid arthritis (RA) cohorts with long-term data on pain, fatigue or mental well-being. METHODS: Searches using PUBMED, EMBASE and PyscInfo were performed to identify all early RA cohorts with longitudinal measures of pain, fatigue or mental well-being, along with clinical measures. Using longitudinal meta-analyses, the progression of each outcome over the first 60-months was estimated. Cohorts were stratified based on the median recruitment year to investigate secular trends in disease progression. RESULTS: Of 7,319 papers identified, 75 met the inclusion criteria and 46 cohorts from 41 publications provided sufficient data on 18,046 patients for meta-analysis. The Disease Activity Scores (DAS28) and the Short-Form 36 (SF-36) Physical Component Score (PCS) indicated that post-2002 cohorts had statistically significant improvements over the first 60-months compared to pre-2002 cohorts, with standardised mean differences (SMD) of 0.86 (95% Confidence Intervals 0.34 to 1.37) and 0.76 (95% CI 0.25 to 1.27) respectively at month-60. However, post-2002 cohorts indicated statistically non-significant improvements in pain, fatigue, functional disability and SF-36 Mental Component Score (MCS) compared to pre-2002 cohorts, with SMD of 0.24 (95% CI -0.25 to 0.74), 0.38 (95% CI -0.11 to 0.88), 0.34 (95% CI -0.15-0.84) and -0.08 (95% CI -0.41 to 0.58) at month-60 respectively. CONCLUSIONS: Recent cohorts indicate improved levels of disease activity and physical quality of life, however this has not translated into similar improvements in levels of pain, fatigue and functional disability by 60-months.

2.
Sci Rep ; 9(1): 19732, 2019 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-31874981

RESUMO

Human microbiomes are predicted to assemble in a reproducible and ordered manner yet there is limited knowledge on the development of the complex bacterial communities that constitute the oral microbiome. The oral microbiome plays major roles in many oral diseases including early childhood caries (ECC), which afflicts up to 70% of children in some countries. Saliva contains oral bacteria that are indicative of the whole oral microbiome and may have the ability to reflect the dysbiosis in supragingival plaque communities that initiates the clinical manifestations of ECC. The aim of this study was to determine the assembly of the oral microbiome during the first four years of life and compare it with the clinical development of ECC. The oral microbiomes of 134 children enrolled in a birth cohort study were determined at six ages between two months and four years-of-age and their mother's oral microbiome was determined at a single time point. We identified and quantified 356 operational taxonomic units (OTUs) of bacteria in saliva by sequencing the V4 region of the bacterial 16S RNA genes. Bacterial alpha diversity increased from a mean of 31 OTUs in the saliva of infants at 1.9 months-of-age to 84 OTUs at 39 months-of-age. The oral microbiome showed a distinct shift in composition as the children matured. The microbiome data were compared with the clinical development of ECC in the cohort at 39, 48, and 60 months-of-age as determined by ICDAS-II assessment. Streptococcus mutans was the most discriminatory oral bacterial species between health and current disease, with an increased abundance in disease. Overall our study demonstrates an ordered temporal development of the oral microbiome, describes a limited core oral microbiome and indicates that saliva testing of infants may help predict ECC risk.

3.
Zoonoses Public Health ; 65(4): 425-430, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29430859

RESUMO

The canine variant of the rabies virus has been eliminated in the United States. Among the public and many healthcare providers, however, dog bites are still associated with risk for rabies transmission. This study examined the risk of rabies in biting dogs and the use of rabies post-exposure prophylaxis (rPEP) for dog bite victims in Tennessee. The study included a retrospective analysis of laboratory testing requisitions for dogs from 2002 to 2016, collection of clinical data on confirmed rabies-positive dogs from 2008 to 2016 and analysis of hospital discharge data for rPEP from 2007 to 2014. Among dogs submitted for rabies testing, those having a recent history of biting were significantly less likely to test positive for rabies than dogs with no reported bite (OR = 0.01; 95% CI [0.003-0.04]). The most common clinical signs reported among rabies-positive dogs were anorexia, dysphagia, ataxia, limb paresis or paralysis, and lethargy; aggressiveness was uncommon. Among hospital patients with an animal-related injury who received rPEP, more than half (52%) presented with dog bites. These data show that laboratory submissions for rabies testing and prescriptions for rPEP do not reflect the epidemiology of rabies in Tennessee. Education and outreach targeting the public and healthcare providers should emphasize the animal species and situations associated with a greater risk for rabies transmission, such as bites from rabies reservoir species or animals exhibiting signs of neurologic disease.


Assuntos
Mordeduras e Picadas/veterinária , Reservatórios de Doenças/veterinária , Doenças do Cão/transmissão , Profilaxia Pós-Exposição/estatística & dados numéricos , Raiva/veterinária , Animais , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/virologia , Doenças do Gato/epidemiologia , Doenças do Gato/transmissão , Doenças do Gato/virologia , Gatos , Reservatórios de Doenças/virologia , Doenças do Cão/epidemiologia , Doenças do Cão/virologia , Cães , Pessoal de Saúde/educação , Humanos , Saúde Pública/economia , Saúde Pública/educação , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/transmissão , Vacinas Antirrábicas/administração & dosagem , Vírus da Raiva/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Tennessee/epidemiologia
4.
Faraday Discuss ; 200: 75-100, 2017 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-28581558

RESUMO

Halogens (Cl, Br) have a profound influence on stratospheric ozone (O3). They (Cl, Br and I) have recently also been shown to impact the troposphere, notably by reducing the mixing ratios of O3 and OH. Their potential for impacting regional air-quality is less well understood. We explore the impact of halogens on regional pollutants (focussing on O3) with the European grid of the GEOS-Chem model (0.25° × 0.3125°). It has recently been updated to include a representation of halogen chemistry. We focus on the summer of 2015 during the ICOZA campaign at the Weybourne Atmospheric Observatory on the North Sea coast of the UK. Comparisons between these observations together with those from the UK air-quality network show that the model has some skill in representing the mixing ratios/concentration of pollutants during this period. Although the model has some success in simulating the Weybourne ClNO2 observations, it significantly underestimates ClNO2 observations reported at inland locations. It also underestimates mixing ratios of IO, OIO, I2 and BrO, but this may reflect the coastal nature of these observations. Model simulations, with and without halogens, highlight the processes by which halogens can impact O3. Throughout the domain O3 mixing ratios are reduced by halogens. In northern Europe this is due to a change in the background O3 advected into the region, whereas in southern Europe this is due to local chemistry driven by Mediterranean emissions. The proportion of hourly O3 above 50 nmol mol-1 in Europe is reduced from 46% to 18% by halogens. ClNO2 from N2O5 uptake onto sea-salt leads to increases in O3 mixing ratio, but these are smaller than the decreases caused by the bromine and iodine. 12% of ethane and 16% of acetone within the boundary layer is oxidised by Cl. Aerosol response to halogens is complex with small (∼10%) reductions in PM2.5 in most locations. A lack of observational constraints coupled to large uncertainties in emissions and chemical processing of halogens make these conclusions tentative at best. However, the results here point to the potential for halogen chemistry to influence air quality policy in Europe and other parts of the world.

5.
Nutr Health ; 23(1): 7-11, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28298152

RESUMO

BACKGROUND: Sales of organic foods are increasing due to public demand, while genetically modified (GM) and irradiated foods are often viewed with suspicion. AIM: The aim of this research was to examine consumer attitudes toward organic, GM and irradiated foods to direct educational efforts regarding their consumption Methods: A telephone survey of 1838 residents in Tennessee, USA was conducted regarding organic, GM, and irradiated foods. RESULTS: Approximately half of respondents (50.4%) purchased organic food during the previous 6 months ('consumers'). The most common beliefs about organic foods by consumers were higher cost (92%), and fewer pesticides (89%). Consumers were more likely than non-consumers to believe organic food tasted better (prevalence ratio 3.6; 95% confidence interval 3.02-4.23). A minority of respondents were familiar with GM foods (33%) and irradiated foods (22%). CONCLUSION: Organic food consumption is common in Tennessee, but knowledge about GM and irradiated foods is less common. Consumer health education should emphasize the benefits of these food options, and the safety of GM and irradiated foods.


Assuntos
Atitude , Irradiação de Alimentos , Preferências Alimentares , Alimentos Geneticamente Modificados , Alimentos Orgânicos , Opinião Pública , Adolescente , Adulto , Idoso , Comércio , Custos e Análise de Custo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Praguicidas , Inquéritos e Questionários , Paladar , Tennessee , Adulto Jovem
6.
Ann R Coll Surg Engl ; 99(3): 218-223, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27659356

RESUMO

INTRODUCTION The diagnostic yield of transrectal ultrasonography (TRUS) guided prostate biopsy is influenced by many patient and procedure specific factors. However, the role of operator specific factors remains inadequately defined. This study investigated the association of diagnostic outcome of TRUS guided biopsy with operator skill level. METHODS This study looked at a consecutive cohort of 690 men undergoing their first extended pattern TRUS guided prostate biopsy by 27 operators over a 24-month period in a single institution. Logistic regression was used for statistical analysis. RESULTS Biopsies performed by consultants (odds ratio [OR]: 2.35, p=0.004) and senior trainees (OR: 2.37, p=0.002) in patients with prostate specific antigen levels of <10ng/ml were more likely to be positive than those performed by junior trainees (cancer detection rate 50.0%, 50.3% and 29.9% respectively). Furthermore, biopsies performed by junior trainees yielded a significantly higher proportion of prostate cancers with a Gleason score of ≥3+4 than those performed by senior trainees (OR: 2.11, p=0.031) and consultants (OR: 2.40, p=0.013) (81.4%, 67.5% and 64.6% respectively). No significant differences emerged between operator skill groups for complications, rebiopsy rates or the number of prostate cancers found during the follow-up period (median: 34 months) of patients with a negative biopsy. CONCLUSIONS Level of operator experience is associated with the diagnostic outcome of extended pattern TRUS guided biopsy. The findings of this study imply that case selection, self-audit and expert supervision for the duration of the learning curve should form the basis of biopsy training.


Assuntos
Biópsia com Agulha de Grande Calibre , Endossonografia , Biópsia Guiada por Imagem , Neoplasias da Próstata/patologia , Urologistas/estatística & dados numéricos , Idoso , Estudos de Coortes , Humanos , Calicreínas/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos , Urologia/educação
7.
J Hum Nutr Diet ; 30(1): 36-50, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27561947

RESUMO

BACKGROUND: Short food questions are appealing to measure dietary intakes. METHODS: A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS: Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS: The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.


Assuntos
Dieta , Avaliação Nutricional , Inquéritos e Questionários , Adolescente , Criança , Laticínios , Bases de Dados Factuais , Frutas , Humanos , Reprodutibilidade dos Testes , Verduras
8.
Bull Am Meteorol Soc ; 98(1): 106-128, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29636590

RESUMO

The Convective Transport of Active Species in the Tropics (CONTRAST) experiment was conducted from Guam (13.5° N, 144.8° E) during January-February 2014. Using the NSF/NCAR Gulfstream V research aircraft, the experiment investigated the photochemical environment over the tropical western Pacific (TWP) warm pool, a region of massive deep convection and the major pathway for air to enter the stratosphere during Northern Hemisphere (NH) winter. The new observations provide a wealth of information for quantifying the influence of convection on the vertical distributions of active species. The airborne in situ measurements up to 15 km altitude fill a significant gap by characterizing the abundance and altitude variation of a wide suite of trace gases. These measurements, together with observations of dynamical and microphysical parameters, provide significant new data for constraining and evaluating global chemistry climate models. Measurements include precursor and product gas species of reactive halogen compounds that impact ozone in the upper troposphere/lower stratosphere. High accuracy, in-situ measurements of ozone obtained during CONTRAST quantify ozone concentration profiles in the UT, where previous observations from balloon-borne ozonesondes were often near or below the limit of detection. CONTRAST was one of the three coordinated experiments to observe the TWP during January-February 2014. Together, CONTRAST, ATTREX and CAST, using complementary capabilities of the three aircraft platforms as well as ground-based instrumentation, provide a comprehensive quantification of the regional distribution and vertical structure of natural and pollutant trace gases in the TWP during NH winter, from the oceanic boundary to the lower stratosphere.

9.
J Autism Dev Disord ; 47(2): 285-296, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27830427

RESUMO

In this study, we explored potential associations among self-injurious behaviors (SIB) and a diverse group of protective and risk factors in children with autism spectrum disorder from two databases: Autism and Developmental Disabilities Monitoring (ADDM) Network and the Autism Speaks-Autism Treatment Network (AS-ATN). The presence of SIB was determined from children's records in ADDM and a parent questionnaire in AS-ATN. We used multiple imputation to account for missing data and a non-linear mixed model with site as a random effect to test for associations. Despite differences between the two databases, similar associations were found; SIB were associated with developmental, behavioral, and somatic factors. Implications of these findings are discussed in relation to possible etiology, future longitudinal studies, and clinical practice.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Criança , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Fatores de Proteção , Fatores de Risco , Estados Unidos/epidemiologia
10.
Transl Psychiatry ; 6(7): e848, 2016 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-27378548

RESUMO

Early adversity increases risk for developing psychopathology. Epigenetic modification of stress reactivity genes is a likely mechanism contributing to this risk. The glucocorticoid receptor (GR) gene is of particular interest because of the regulatory role of the GR in hypothalamic-pituitary-adrenal (HPA) axis function. Mounting evidence suggests that early adversity is associated with GR promoter methylation and gene expression. Few studies have examined links between GR promoter methylation and psychopathology, and findings to date have been mixed. Healthy adult participants (N=340) who were free of psychotropic medications reported on their childhood experiences of maltreatment and parental death and desertion. Lifetime depressive and anxiety disorders and past substance-use disorders were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Methylation of exon 1F of the GR gene (NR3C1) was examined in leukocyte DNA via pyrosequencing. On a separate day, a subset of the participants (n=231) completed the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test. Childhood adversity and a history of past substance-use disorder and current or past depressive or anxiety disorders were associated with lower levels of NR3C1 promoter methylation across the region as a whole and at individual CpG sites (P<0.05). The number of adversities was negatively associated with NR3C1 methylation in participants with no lifetime disorder (P=0.018), but not in those with a lifetime disorder. GR promoter methylation was linked to altered cortisol responses to the Dex/CRH test (P<0.05). This study presents evidence of reduced methylation of NR3C1 in association with childhood maltreatment and depressive, anxiety and substance-use disorders in adults. This finding stands in contrast to our prior work, but is consistent with emerging findings, suggesting complexity in the regulation of this gene.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Transtornos de Ansiedade/genética , Metilação de DNA , Transtorno Depressivo/genética , Regiões Promotoras Genéticas/genética , Receptores de Glucocorticoides/genética , Transtornos Relacionados ao Uso de Substâncias/genética , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Transtornos de Ansiedade/psicologia , Ilhas de CpG , Transtorno Depressivo/psicologia , Feminino , Humanos , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
11.
MMWR Morb Mortal Wkly Rep ; 64(42): 1190-3, 2015 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-26513329

RESUMO

During 2000­2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis. In 2011, a system of active, population-based surveillance for legionellosis was instituted through CDC's Active Bacterial Core surveillance (ABCs) program. Overall disease rates were similar in both the passive and active systems, but more complete demographic information and additional clinical and laboratory data were only available from ABCs. ABCs data during 2011­2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died. Disease incidence was higher among blacks than whites and was 10 times higher in New York than California. Laboratory data indicated a reliance on urinary antigen testing, which only detects Legionella pneumophila serogroup 1 (Lp1). ABCs data highlight the severity of the disease, the need to better understand racial and regional differences, and the need for better diagnostic testing to detect infections.


Assuntos
Legionella/isolamento & purificação , Legionelose/epidemiologia , Vigilância da População/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
12.
Pharmacopsychiatry ; 48(4-5): 141-4, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26011569

RESUMO

OBJECTIVE: The aim of this study was to examine whether gender differences may have affected treatment response to S-adenosyl methionine (SAMe) in a recent failed randomized clinical trial (RCT) for adults with major depressive disorder. METHODS: Data from a 2-site, 12-week, double-blind RCT (n=189) assessing the efficacy of SAMe vs. placebo and a comparator selective serotonin reuptake inhibitor (escitalopram) were subjected to post-hoc analyses to evaluate effects of patient gender on treatment response. RESULTS: When assessing the efficacy outcomes within each gender separately, SAMe was superior to placebo among males (n=51), but not among females (n=62). Males showed a significant reduction of depression severity from baseline to study endpoint on the 17-item Hamilton Depression Rating Scale (4.3 point difference; p=0.034; d=0.95), while females did not show significant change. This finding emerged despite equivalence on baseline measures of depression severity between the gender groups. CONCLUSION: RESULTS of this secondary data analysis suggest that gender might impact the antidepressant efficacy of SAMe, with greater therapeutic effect found in males. The underlying mechanism is still relatively unknown. Further work is needed to replicate this observation in independent samples.Clinicaltrials.gov identifier: NCT00101452.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , S-Adenosilmetionina/uso terapêutico , Caracteres Sexuais , Citalopram/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino
13.
J Hum Nutr Diet ; 28(4): 375-83, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25891532

RESUMO

BACKGROUND: The current literature regarding the transition from milks to solid foods across the first 2 years of life is limited despite the important influence of early dietary intake on children's growth and development. The present study describes dietary intake from birth to 2 years across four developmental relevant time-points within an Australian birth cohort. METHODS: Dietary data from 466 infants was collected at four time-points in the first 2 years of life via parent-reported questionnaire, including a 45-item food and beverage frequency questionnaire. Subsample analyses of children who were aged 1-3, 6-8, 12-14 and 18-20 months at the time of data collection were conducted. RESULTS: Infant formula remained consistently consumed by over 75% of children from the 6-8- to 18-20 months old age groups. Mean (SD) age of introduction to solid foods was 5.2 (1.3) months. Almost 20% and 10% of children were introduced before 16 and after 32 weeks, respectively. The highest consumption of core foods, recommended for a healthy diet, daily was seen in the 12-14 months old age group with lower proportions in the 18-20 months old age group coinciding with an increased proportion of children eating discretionary choice foods, not recommended for a healthy diet. Discretionary choice foods/beverages presented in children's diets as early as in the 6-8 months old age group. By 18-20 months, at least 20% of children were consuming savoury biscuits, sweet biscuits, muesli bars and luncheon meats at least twice a week. CONCLUSIONS: The present study identified a number of findings outside the recommendations of the Australian Dietary and Infant Feeding Guidelines. Further work is warranted to explore these outcomes.


Assuntos
Dieta , Alimentos Infantis , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Leite Humano , Política Nutricional , Fatores Etários , Animais , Austrália , Bebidas , Bovinos , Pré-Escolar , Estudos de Coortes , Registros de Dieta , Comportamento Alimentar , Alimentos , Promoção da Saúde , Humanos , Lactente , Recém-Nascido , Leite , Inquéritos e Questionários , Desmame
14.
J Food Prot ; 78(1): 187-95, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25581195

RESUMO

Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants' policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or "stomach flu," possible symptoms of foodborne illness. When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non-food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%). Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill.


Assuntos
Manipulação de Alimentos/normas , Saúde do Trabalhador/normas , Administração de Recursos Humanos/normas , Restaurantes/normas , Adulto , Centers for Disease Control and Prevention, U.S. , Surtos de Doenças , Contaminação de Alimentos/análise , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/etiologia , Humanos , Pessoa de Meia-Idade , Licença Médica , Estados Unidos , United States Food and Drug Administration , Recursos Humanos
15.
HIV Clin Trials ; 15(5): 199-208, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25350958

RESUMO

BACKGROUND: The efficacy of dolutegravir (DTG) has been demonstrated in 5 randomized studies in integrase inhibitor (INI)-naive adult populations. To date, a detailed safety review of DTG has not been provided in the literature. OBJECTIVE: To describe the safety and tolerability profile of DTG in adults based on 5 randomized, controlled trials and comparison with drugs in 3 major antiretroviral (ARV) classes. METHODS: Safety data from phase IIb/III/IIIb trials in ART-naive and ART-experienced, INI-naive adults were integrated. RESULTS: In 4 ART-naive (SPRING-1, SPRING-2, SINGLE, FLAMINGO) and 1 ART-experienced, INI-naive study (SAILING), 1,579 individuals received a DTG-containing regimen. The proportion of individuals from DTG treatment arms who withdrew due to adverse events (AEs) was low (≤2%) compared to raltegravir (RAL; 2% SPRING-2, 4% SAILING), efavirenz (EFV)-containing comparator arm (10% SINGLE), and darunavir + ritonavir (DRV/r; 4% FLAMINGO). The most frequently observed AEs (diarrhea, nausea, headache), typically grade 1 or 2 in severity, did not lead to study discontinuation. Psychiatric and nervous system disorders with DTG were comparable to RAL- and DRV/r-containing regimens and favorable to EFV-containing regimens. In hepatitis B and/or C coinfected ART-naive individuals, the incidence of transaminase elevations was lower with DTG versus RAL and EFV comparators, but was similar to DRV/r. In SAILING, transaminase elevations were more commonly observed with DTG, particularly in the setting of inadequate hepatitis B therapy or immune reconstitution. On DTG treatment, mild creatinine elevations occurred and stabilized early. Few cases of hypersensitivity reaction and/or severe rash were seen. Rates of these events were comparable to or lower than with RAL-, EFV-, and DRV/r-containing regimens. CONCLUSIONS: The safety profile for DTG 50 mg once daily in INI-naive individuals was comparable to RAL- and DRV/r-containing regimens and generally favorable compared with EFV-containing regimens.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/sangue , Creatina Quinase/sangue , Humanos , Lipídeos/sangue , Psicoses Induzidas por Substâncias , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente
16.
Am J Trop Med Hyg ; 91(4): 767-70, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25092818

RESUMO

Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States.


Assuntos
Anticorpos Antibacterianos/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Rickettsia rickettsii/imunologia , Febre Maculosa das Montanhas Rochosas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Rickettsia rickettsii/isolamento & purificação , Febre Maculosa das Montanhas Rochosas/epidemiologia , Tennessee/epidemiologia , Adulto Jovem
17.
Infect Control Hosp Epidemiol ; 35(7): 898-900, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24915225

RESUMO

We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts.


Assuntos
Infecção Hospitalar/prevenção & controle , Monitoramento Ambiental , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/prevenção & controle , Serviços Terceirizados/estatística & dados numéricos , Hospitais , Humanos , Inquéritos e Questionários , Estados Unidos
18.
J Parasitol ; 100(1): 106-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23971411

RESUMO

Babesiosis is an emerging tick-borne zoonotic disease in the United States caused by Babesia parasites. In 2009, the first case of babesiosis was documented in Tennessee. Environmental investigation at the reported site of tick exposure included collection of ticks and specimens from eastern cottontail rabbits (Sylvilagus floridanus) and white-tailed deer ( Odocoileus virginianus ) that were tested for piroplasms by molecular and serologic methods. One hundred and sixty-six Ixodes scapularis ticks and biological samples from 8 rabbits and 5 deer were collected. Ixodes scapularis were PCR positive for Babesia odocoilei (n = 7, 4%) and Theileria cervi (n = 24, 14%). Deer were seropositive for B. odocoilei and PCR positive for T. cervi. Rabbits were seropositive for B. odocoilei and Babesia sp. MO1, and 1 rabbit was PCR positive for Babesia sp. MO1. In summary, zoonotic Babesia sp. MO1 infection in rabbits is reported here for the first time in Tennessee as well as infection of deer and I. scapularis ticks with 2 other piroplasms of veterinary importance.


Assuntos
Babesiose/transmissão , Reservatórios de Doenças , Vetores de Doenças , Meio Ambiente , Hospedeiro Imunocomprometido , Adulto , Animais , Antígenos de Protozoários/sangue , Antígenos de Protozoários/isolamento & purificação , Babesia/genética , Babesia/imunologia , Babesia/isolamento & purificação , Babesiose/etiologia , Cricetinae , DNA de Protozoário/isolamento & purificação , Cervos/parasitologia , Humanos , Ixodes/parasitologia , Masculino , Reação em Cadeia da Polimerase , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/imunologia , Púrpura Trombocitopênica Idiopática/cirurgia , Coelhos , Esplenectomia , Tennessee
19.
J Food Prot ; 76(12): 2146-54, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24290694

RESUMO

Transmission of foodborne pathogens from ill food workers to diners in restaurants is an important cause of foodborne illness outbreaks. The U.S. Food and Drug Administration recommends that food workers with vomiting or diarrhea (symptoms of foodborne illness) be excluded from work. To understand the experiences and characteristics of workers who work while ill, workplace interviews were conducted with 491 food workers from 391 randomly selected restaurants in nine states that participated in the Environmental Health Specialists Network of the Centers for Disease Control and Prevention. Almost 60% of workers recalled working while ill at some time. Twenty percent of workers said that they had worked while ill with vomiting or diarrhea for at least one shift in the previous year. Factors significantly related to workers having said that they had worked while ill with vomiting or diarrhea were worker sex, job responsibilities, years of work experience, concerns about leaving coworkers short staffed, and concerns about job loss. These findings suggest that the decision to work while ill with vomiting or diarrhea is complex and multifactorial.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Contaminação de Alimentos/prevenção & controle , Manipulação de Alimentos/métodos , Serviços de Alimentação , Doenças Transmitidas por Alimentos/prevenção & controle , Restaurantes , Adolescente , Adulto , Centers for Disease Control and Prevention, U.S. , Diarreia/epidemiologia , Diarreia/microbiologia , Feminino , Microbiologia de Alimentos , Humanos , Masculino , Estados Unidos/epidemiologia , Vômito/epidemiologia , Vômito/microbiologia , Recursos Humanos , Adulto Jovem
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