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1.
BMJ ; 368: l6775, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005673

RESUMO

The studyDambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122This project was funded by the NIHR Health Technology Assessment Programme (project number 08/116/300) as well as the Wellcome Trust (grant number: G061895), the Epidemiology Unit programme (MC_UU_12015/4), and the National Health Service R&D support funding.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000841/weight-loss-after-type-2-diabetes-diagnosis-boosts-chance-of-remission.


Assuntos
Diabetes Mellitus Tipo 2 , Perda de Peso , Peso Corporal , Humanos , Estudos Prospectivos , Medicina Estatal
2.
BMJ ; 368: l6764, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900245

RESUMO

The studyCooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019;394:1425-36.The study was funded by the NIHR Health Technology Assessment Programme (project number 12/35/23).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000837/keyhole-hysterectomy-is-effective-for-women-with-heavy-menstrual-bleeding.

3.
BMJ ; 368: l6768, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924664

RESUMO

The studyCabral C, Horwood J, Symonds J, et al. Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach. BMC Fam Pract 2019;20:102.This project was funded by the NIHR School for Primary Care Research Programme (project number SPCR204).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000829/gps-assessment-not-parental-expectation-drives-antibiotic-prescribing.


Assuntos
Antibacterianos , Infecções Respiratórias , Criança , Humanos , Motivação , Pais , Atenção Primária à Saúde
4.
BMJ ; 368: l6779, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941696

RESUMO

The studyChappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia.


Assuntos
Pré-Eclâmpsia , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , Avaliação da Tecnologia Biomédica , Conduta Expectante
5.
BMJ ; 367: l4962, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31685480

RESUMO

The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/69/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000784/irritable-bowel-syndrome-helped-by-telephone-or-internet-cbt.


Assuntos
Síndrome do Intestino Irritável , Humanos , Internet , Fonoterapia , Avaliação da Tecnologia Biomédica , Telefone
6.
J Correct Health Care ; 25(4): 394-404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31672075

RESUMO

People leaving incarceration are at high risk of opioid-related overdose. Overdose fatalities are preventable with administration of naloxone. In response to this risk, overdose education and naloxone distribution (OEND) programs have been implemented in a handful of jails and prisons in the United States. We document the history, structure, and data from the San Francisco County Jail OEND program. During 4 years of operation, 637 people participated; 67% received naloxone upon release, of whom only 3.5% had been previously trained in community-based OEND programs. Of those who received naloxone, 32% reported reversing an overdose and 44% received refills from community-based programs after reentry. This confirms that implementation of OEND in criminal justice settings is feasible and reaches people who have not previously been trained as well as those willing to act as overdose responders.

7.
Ann Epidemiol ; 40: 21-27.e3, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31711839

RESUMO

PURPOSE: Novel approaches must address the underlying factors sustaining the tuberculosis (TB) epidemic in the United States, specifically what maintains new Mycobacterium tuberculosis (Mtb) transmission. METHODS: Culture-confirmed TB cases reported to the Michigan Department of Health and Human Services (2004-2012) were analyzed for time-restricted genotypic and/or geospatial clustering. Cases with both types of clustering were used as a proxy for recent, local transmission. Modified, multivariate Poisson regression models were fit to estimate this prevalence in relation to various individual- and neighborhood-level demographic and socio-economic variables. RESULTS: Those individuals that were spatially clustered were 1.7 times as likely to also be time-restricted genotypically clustered. The prevalence of recent, local transmission was higher among U.S.-born cases, males, and non-Hispanic blacks. Moreover, people living in neighborhoods in the highest poverty quartile had 13.8 times the prevalence of recent, local transmission compared with those in the lowest poverty neighborhoods. CONCLUSIONS: Our results suggest geographic areas with high concentration of TB cases are likely driven by ongoing transmission, rather than enclaves of individuals who have reactivated a case of latent TB. Furthermore, efforts to continue reducing Mtb transmission in the United States, and other low-incidence settings, must better identify community-level sources of risk, manifested through the complex social interactions among people and their environments.

8.
BMJ ; 367: l5464, 2019 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712247

RESUMO

The studyLyttle MD, Rainford NEA, Gamble C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet 2019;393:2125-34.This trial was funded by the NIHR Health Technology Assessment Programme (project number 12/127/134).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000790/levetiracetam-vs-phenytoin-in-stopping-childrens-prolonged-epileptic-seizures.


Assuntos
Epilepsia , Estado Epiléptico , Criança , Humanos , Levetiracetam , Fenitoína , Convulsões
9.
PLoS One ; 14(10): e0223823, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622401

RESUMO

BACKGROUND: Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to identify opioid overdose cases and trigger a post-overdose intervention. METHODS AND FINDINGS: We conducted three focus groups with 11 PWUDs in 2018. Results are organized into 4 categories: willingness to call 911 (benefits and risks of calling), thoughts about a technique to identify opioid overdoses in 911 data (benefits and concerns), thoughts about the proposed post-overdose intervention (benefits and concerns), and recommendations for developing an ideal post-overdose intervention. For most participants, calling 911 was synonymous with "calling the police" and law enforcement-related fears were pervasive, limiting willingness to engage with the 911 system. The technique to identify opioid overdoses and the proposed post-overdose intervention were identified as potentially lifesaving, but the benefits were balanced by concerns related to law enforcement involvement, intervention timing, and risks to privacy/reputation. Nearly universally, participants wished for a way to summon emergency medical assistance without triggering a law enforcement response. CONCLUSIONS: The fact that the 911 system in the US inextricably links emergency medical assistance with law enforcement response inherently problematizes calling 911 for PWUDs, and has implications for surveillance and intervention. It is imperative to center the perspectives of PWUDs when designing and implementing interventions that rely on the 911 system for activation.

10.
BMJ ; 367: l5456, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31575520

RESUMO

The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000803/cardiac-rehabilitation-for-heart-failure-can-improve-quality-of-life-and-fitness.


Assuntos
Reabilitação Cardíaca , Insuficiência Cardíaca , Exercício , Terapia por Exercício , Humanos , Qualidade de Vida
11.
BMJ ; 366: l5453, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31562125

RESUMO

The studyTaylor S, Mallett S, Beare S et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019;4:529-37.This project was funded by the NIHR Health Technology Assessment Programme (project number 10/68/01).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000797/identifying-metastatic-disease-in-colorectal-cancer-with-whole-body-mri.


Assuntos
Neoplasias Colorretais , Segunda Neoplasia Primária , Humanos , Imagem por Ressonância Magnética , Estudos Prospectivos , Avaliação da Tecnologia Biomédica
13.
BMJ ; 366: l4915, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455630

RESUMO

The studyA Rodger, V Cambiano, T Bruun, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393:2428-38.This project was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-1013-32069).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000785/antiretroviral-treatment-can-reduce-the-risk-of-hiv-transmission-between-male-partners-to-zero.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , HIV , Humanos , Masculino , Estudos Prospectivos , Parceiros Sexuais
14.
Subst Use Misuse ; 54(14): 2338-2350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389282

RESUMO

Background: Persons who inject drugs (PWID) play a key role in assisting others' initiation into injection drug use (IDU). We aimed to explore the pathways and socio-structural contexts for this phenomenon in Tijuana, Mexico, a border setting marked by a large PWID population with limited access to health and social services. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER) is a multi-cohort study assessing socio-structural factors associated with PWID assisting others into initiating IDU. Semi-structured qualitative interviews in Tijuana included participants ≥18 years old, who reported IDU within the month prior to cohort enrollment and ever initiating others into IDU. Purposive sampling ensured a range of drug use experiences and behaviors related to injection initiation assistance. Thematic analysis was used to develop recurring and significant data categories. Results: Twenty-one participants were interviewed (8 women, 13 men). Broadly, participants considered public injection to increase curiosity about IDU. Many considered transitioning into IDU as inevitable. Emergent themes included providing assistance to mitigate overdose risk and to protect initiates from being taken advantage of by others. Participants described reluctance in engaging in this process. For some, access to resources (e.g., shared drugs or a monetary fee) was a motivator to initiate others. Conclusion: In Tijuana, public injection and a lack of harm reduction services are perceived to fuel the incidence of IDU initiation and to incentivize PWID to assist in injection initiation. IDU prevention efforts should address structural factors driving PWID participation in IDU initiation while including PWID in their development and implementation.

15.
J Urban Health ; 96(3): 341-352, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31168733

RESUMO

Overdose prevention sites (OPS) are places where people use previously obtained drugs under the supervision of a health professional. They have been proposed in six United States (US) cities, including Philadelphia, to help reduce opioid-related overdose deaths and public injection. Philadelphia has the highest overdose rate among large cities in the US, which has led a local community-based organization to plan the implementation of OPS. Kensington, a neighborhood with the highest drug mortality overdose rates in the city, is a likely site for the proposed OPS. Given the dearth of research systematically assessing public opinion towards OPS prior to implementation, we enrolled 360 residents and 79 business owners/staff in the Kensington neighborhood in a cross-sectional acceptability study. Face-to-face surveys assessed participant characteristics, experiences with drug-related social problems, and OPS acceptability. Using descriptive statistics, we estimated factors associated with favorability towards opening an OPS in the Kensington neighborhood. Ninety percent of residents were in favor of an OPS opening in Kensington. Support was significantly higher among unstably housed individuals and persons who currently use opioids. In the business sample, 63% of owners/staff were in favor of opening an OPS in Kensington. A greater proportion of Asian/Pacific Islanders, Hispanic/Latinx respondents, and non-Hispanic/Latinx Black respondents were in favor of an OPS opening in Kensington compared with white respondents (p < 0.04). While details about implementation are still being considered, results indicate general acceptability among Kensington residents and businesses for an OPS, especially if it can deliver benefits that curb drug-related social problems. Should an OPS be implemented in Philadelphia, it would be important to monitor changes in drug-related social problems and acceptability post implementation.

16.
N Z Med J ; 132(1497): 55-64, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220066

RESUMO

AIM: To examine prospectively the impact of adding a urinary biomarker of bladder cancer (Cxbladder TriageTM, CxbT) to a clinical pathway for investigating haematuria. METHODS: The clinical outcome of 571 patients with haematuria who presented to their general practitioner was reviewed. Outcome measurements included the findings of laboratory tests, imaging, cystoscopies, histology and specialist assessments. The data were used to model a theoretical clinical pathway that involved initial screening using CxbT in combination with imaging, and only test positive patients being referred for specialist assessment and cystoscopy. RESULTS: All patients underwent cystoscopy and 44 transitional cell carcinomas were diagnosed in the study cohort, with two low-risk cancers missed by CxbT, one of which was also not detected by imaging. When combined, imaging and CxbT had a sensitivity of 97.7% and negative predictive value of 99.8%. CONCLUSIONS: In our series, all significant bladder cancers were diagnosed by imaging and CxbT before cystoscopy was undertaken. The high negative predictive value of this clinical pathway would allow approximately one-third of patients with haematuria to be managed without cystoscopy.


Assuntos
Biomarcadores Tumorais/urina , Procedimentos Clínicos , Cistoscopia , Hematúria/etiologia , MicroRNAs/urina , Procedimentos Desnecessários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Encaminhamento e Consulta/estatística & dados numéricos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/urina , Adulto Jovem
17.
Med Anthropol ; : 1-14, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31099592

RESUMO

Involuntary drug treatment (IDT) is ineffective in decreasing drug use, yet it is a common practice. In Mexico, there are not enough professional residential drug treatment programs, and both voluntary and involuntary drug treatment is often provided by non-evidence based, non-professional programs. We studied the experiences of people who inject drugs (PWID) in Tijuana who were taken involuntarily to drug centers under the auspices of a federally funded police operation. We provide insight into how the health, wellbeing, human rights, dignity, and security of PWID ought to be at the center of international drug policies included in universal health care systems.

18.
BMJ ; 365: l2036, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31076461

RESUMO

The studyHajek P, Phillips-Waller A, Przulj D, et al. A randomised trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med 2019;380:629-37.This trial was funded by the NIHR Health Technology Assessment Programme (12/167/135) and by Cancer Research UK.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000757/e-cigarettes-helped-more-smokers-quit-than-nicotine-replacement-therapy.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Nicotina/uso terapêutico , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Resultado do Tratamento
19.
BMJ ; 364: k4259, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30833377

RESUMO

The studyA randomised trial of epinephrine in out-of-hospital cardiac arrestPerkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, Black JJM, Moore F, Fothergill RT, Rees N, O'Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, Lall R for the PARAMEDIC2 CollaboratorsPublished on 18 July 2018 N Engl J Med 2018;379:711-21.This project was funded by the National Institute for Health Research HTA Programme (project number 12/127/126).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000639/adrenaline-can-restart-the-heart-but-is-no-good-for-the-brain.


Assuntos
Epinefrina/administração & dosagem , Parada Cardíaca/tratamento farmacológico , Doenças do Sistema Nervoso/induzido quimicamente , Reanimação Cardiopulmonar/métodos , Epinefrina/efeitos adversos , Epinefrina/uso terapêutico , Parada Cardíaca/complicações , Humanos , Estudos Observacionais como Assunto , Taxa de Sobrevida , Simpatomiméticos/efeitos adversos , Simpatomiméticos/uso terapêutico , Reino Unido/epidemiologia
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