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1.
Cochrane Database Syst Rev ; 1: CD013790, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34988969

RESUMO

BACKGROUND: Heated tobacco products (HTPs) are designed to heat tobacco to a high enough temperature to release aerosol, without burning it or producing smoke. They differ from e-cigarettes because they heat tobacco leaf/sheet rather than a liquid. Companies who make HTPs claim they produce fewer harmful chemicals than conventional cigarettes. Some people report stopping smoking cigarettes entirely by switching to using HTPs, so clinicians need to know whether they are effective for this purpose and relatively safe. Also, to regulate HTPs appropriately, policymakers should understand their impact on health and on cigarette smoking prevalence. OBJECTIVES: To evaluate the effectiveness and safety of HTPs for smoking cessation and the impact of HTPs on smoking prevalence.  SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, and six other databases for relevant records to January 2021, together with reference-checking and contact with study authors and relevant groups. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in which people who smoked cigarettes were randomised to switch to exclusive HTP use or a control condition. Eligible outcomes were smoking cessation, adverse events, and selected biomarkers.  RCTs conducted in clinic or in an ambulatory setting were deemed eligible when assessing safety, including those randomising participants to exclusively use HTPs, smoke cigarettes, or attempt abstinence from all tobacco. Time-series studies were also eligible for inclusion if they examined the population-level impact of heated tobacco on smoking prevalence or cigarette sales as an indirect measure. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking at the longest follow-up point available, adverse events, serious adverse events, and changes in smoking prevalence or cigarette sales. Other outcomes included biomarkers of harm and exposure to toxicants/carcinogens (e.g. NNAL and carboxyhaemoglobin (COHb)). We used a random-effects Mantel-Haenszel model to calculate risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes. For continuous outcomes, we calculated mean differences on the log-transformed scale (LMD) with 95% CIs. We pooled data across studies using meta-analysis where possible. MAIN RESULTS: We included 13 completed studies, of which 11 were RCTs assessing safety (2666 participants) and two were time-series studies. We judged eight RCTs to be at unclear risk of bias and three at high risk. All RCTs were funded by tobacco companies. Median length of follow-up was 13 weeks. No studies reported smoking cessation outcomes.  There was insufficient evidence for a difference in risk of adverse events between smokers randomised to switch to heated tobacco or continue smoking cigarettes, limited by imprecision and risk of bias (RR 1.03, 95% CI 0.92 to 1.15; I2 = 0%; 6 studies, 1713 participants). There was insufficient evidence to determine whether risk of serious adverse events differed between groups due to very serious imprecision and risk of bias (RR 0.79, 95% CI 0.33 to 1.94; I2 = 0%; 4 studies, 1472 participants). There was moderate-certainty evidence for lower NNAL and COHb at follow-up in heated tobacco than cigarette smoking groups, limited by risk of bias (NNAL: LMD -0.81, 95% CI -1.07 to -0.55; I2 = 92%; 10 studies, 1959 participants; COHb: LMD -0.74, 95% CI -0.92 to -0.52; I2 = 96%; 9 studies, 1807 participants). Evidence for additional biomarkers of exposure are reported in the main body of the review. There was insufficient evidence for a difference in risk of adverse events in smokers randomised to switch to heated tobacco or attempt abstinence from all tobacco, limited by risk of bias and imprecision (RR 1.12, 95% CI 0.86 to 1.46; I2 = 0%; 2 studies, 237 participants). Five studies reported that no serious adverse events occurred in either group (533 participants). There was moderate-certainty evidence, limited by risk of bias, that urine concentrations of NNAL at follow-up were higher in the heated tobacco use compared with abstinence group (LMD 0.50, 95% CI 0.34 to 0.66; I2 = 0%; 5 studies, 382 participants). In addition, there was very low-certainty evidence, limited by risk of bias, inconsistency, and imprecision, for higher COHb in the heated tobacco use compared with abstinence group for intention-to-treat analyses (LMD 0.69, 95% CI 0.07 to 1.31; 3 studies, 212 participants), but lower COHb in per-protocol analyses (LMD -0.32, 95% CI -1.04 to 0.39; 2 studies, 170 participants). Evidence concerning additional biomarkers is reported in the main body of the review. Data from two time-series studies showed that the rate of decline in cigarette sales accelerated following the introduction of heated tobacco to market in Japan. This evidence was of very low-certainty as there was risk of bias, including possible confounding, and cigarette sales are an indirect measure of smoking prevalence. AUTHORS' CONCLUSIONS: No studies reported on cigarette smoking cessation, so the effectiveness of heated tobacco for this purpose remains uncertain. There was insufficient evidence for differences in risk of adverse or serious adverse events between people randomised to switch to heated tobacco, smoke cigarettes, or attempt tobacco abstinence in the short-term. There was moderate-certainty evidence that heated tobacco users have lower exposure to toxicants/carcinogens than cigarette smokers and very low- to moderate-certainty evidence of higher exposure than those attempting abstinence from  all tobacco. Independently funded research on the effectiveness and safety of HTPs is needed.  The rate of decline in cigarette sales accelerated after the introduction of heated tobacco to market in Japan but, as data were observational, it is possible other factors caused these changes. Moreover, falls in cigarette sales may not translate to declining smoking prevalence, and changes in Japan may not generalise elsewhere. To clarify the impact of rising heated tobacco use on smoking prevalence, there is a need for time-series studies that examine this association.

2.
Acta Psychol (Amst) ; 222: 103458, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34933210

RESUMO

Risk perceptions are important influences on health behaviours. We used descriptive statistics and multivariable logistic regression models to assess cross-sectionally risk perceptions for severe Covid-19 symptoms and their health behaviour correlates among 2206 UK adults from the HEBECO study. The great majority (89-99%) classified age 70+, having comorbidities, being a key worker, overweight, and from an ethnic minority as increasing the risk. People were less sure about alcohol drinking, vaping, and nicotine replacement therapy use (17.4-29.5% responding 'don't know'). Relative to those who did not, those who engaged in the following behaviours had higher odds of classifying these behaviours as (i) decreasing the risk: smoking cigarettes (adjusted odds ratios, aORs, 95% CI = 2.26, 1.39-3.37), and using e-cigarettes (aORs = 5.80, 3.25-10.34); (ii) having no impact: smoking cigarettes (1.98; 1.42-2.76), using e-cigarettes (aORs = 2.63, 1.96-3.50), drinking alcohol (aORs = 1.75, 1.31-2.33); and lower odds of classifying these as increasing the risk: smoking cigarettes (aORs: 0.43, 0.32-0.56), using e-cigarettes (aORs = 0.25, 0.18-0.35). Similarly, eating more fruit and vegetables was associated with classifying unhealthy diet as 'increasing risk' (aOR = 1.37, 1.12-1.69), and exercising more with classifying regular physical activity as 'decreasing risk' (aOR = 2.42, 1.75-3.34). Risk perceptions for severe Covid-19 among UK adults were lower for their own health behaviours, evidencing optimism bias. These risk perceptions may form barriers to changing people's own unhealthy behaviours, make them less responsive to interventions that refer to the risk of Covid-19 as a motivating factor, and exacerbate inequalities in health behaviours and outcomes.


Assuntos
COVID-19 , Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Adulto , Idoso , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Grupos Minoritários , Fatores de Risco , SARS-CoV-2 , Dispositivos para o Abandono do Uso de Tabaco
3.
Anaesth Intensive Care ; : 310057X211050934, 2021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34871516

RESUMO

Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral (n=86,467) and partial (n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.

4.
J Spec Oper Med ; 21(4): 37-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969125

RESUMO

BACKGROUND: Stress inoculation training (SIT) interventions have demonstrated promise within military contexts for human performance enhancement and psychological health applications. However, lack of manualized guidance on core content selection, delivery, and measurement processes has limited their use. PURPOSE: The purpose of this study was to develop and evaluate a comprehensive SIT intervention protocol to enhance the performance and health of military personnel engaged in special warfare and first-response activities. METHODS: Multidisciplinary teams of subject matter experts (n = 19) were consulted in protocol generation. The performance improvement/human performance technology (HPT) model was used in the selection, refinement, and measurement of core skills. The protocol was trialed and refined (44 cohorts, n = =300; 2013-2020) to generate the results. RESULTS: Four primary aims were achieved: (1) The generation of a flexible, evidence-based/evidence-driven psychological performance and health sustainment hybrid, SIT-NORCAL. (2) Manualized content and process guidance. (3) The creation of multimedia materials using evidence-based methodologies. (4) The design of initial measurement systems. Preliminary quality improvement analysis demonstrated positive results using standard-of-care and performance enhancement assessments. CONCLUSION: Hybridized human performance and psychological health sustainment protocols represent a paradigm shift in the delivery of psychological performance training with the potential to overcome barriers to success in traditional care. Further study is needed to determine the effectiveness and reach of SIT-NORCAL.


Assuntos
Transtornos Mentais , Militares , Humanos
5.
J Spec Oper Med ; 21(4): 46-53, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969126

RESUMO

BACKGROUND: Despite being a well-supported strategy, Stress Inoculation Training (SIT) has not been fully incorporated in the advancement of human performance among most military personnel. The RAND Study recommendations for maximizing SIT's potential within high-risk/ high-intensity occupational groups were used in designing the Core Training protocol targeting psychological performance, SIT-NORCAL (Part 1). PURPOSE: The current project (Part 2) sought to further develop the protocol as a health and human performance hybrid through quality improvement analysis of the content, process, and measurement elements for use in the human performance context. METHODS: Evidence-based/evidence-driven methodologies were used in collaborative design tailored to the unique needs of special warfare enablers specializing in Explosive Ordnance Disposal (n = 17). The resultant three-phase training was conducted with a novice group (n = 10) using standardized measurements of collaboration, human performance, and adaptive capabilities on identified training targets. RESULTS: Process elements demonstrated high feasibility, resulting in high collaboration and trainee satisfaction. Significant improvements in psychological performance targets were observed pre- to post-training, and during an Adaptive Environmental Simulation designed by unit members. Two weeks post-training, unit members (n = 5) responded to an actual crash of an F-16 aircraft; measurements indicated maintenance of skill set from training to real-world events. CONCLUSION: Deployment of the elements in the SIT-NORCAL protocol demonstrated early feasibility and positive training impact on occupationally relevant skills that carried over into real-world events.


Assuntos
Substâncias Explosivas , Militares , Humanos , Projetos Piloto , Guerra
6.
J Clin Invest ; 131(24)2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34907915

RESUMO

In this editorial, we describe the experience of the JCI editors during the COVID-19 pandemic. Our goal is to share how we operated during the pandemic, recount how the JCI contributed to the response, highlight some of the major papers we published on SARS-CoV-2 and COVID-19, and impart our insights in the hope that these are helpful to journal editors that may need to deal with similar types of crises in the future.


Assuntos
Pesquisa Biomédica/tendências , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/terapia , Publicações , SARS-CoV-2 , China/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Motivação , Pandemias , Saúde Pública , Quarentena , Isolamento Social , Estados Unidos/epidemiologia
7.
Aust Occup Ther J ; 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34918349

RESUMO

INTRODUCTION: Stroke survivors recovering in rural and remote locations often have little or no access to rehabilitation services. The purpose of this study was to review the literature on recovering in rural and remote Australia, from the perspective of stroke survivors. Use of technology to support recovery was also explored. METHODS: A systematic mixed studies review was conducted and reported according to the ENTREQ and PRISMA statements. MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (ProQuest), Cochrane Library and Google Scholar were searched from inception to May 2021 for studies investigating stroke survivors' perspectives on recovering in rural or remote Australia. Qualitative, quantitative or mixed methods studies were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Studies were not excluded or weighted according to methodological quality. To review the perspectives of stroke survivors on recovering, findings of included studies were mapped to the Living My Life framework and integrated using a convergent qualitative synthesis. The review protocol was registered on PROSPERO (CRD42017064990). RESULTS: Eight studies met the inclusion criteria: six qualitative, one quantitative and one mixed methods. Methodological quality of the small number of studies ranged from low to high, indicating further high-quality research is needed. Included studies involved 152 stroke survivors in total. Review findings indicated that recovering was driven by working towards what mattered to stroke survivors, in ways that matched their beliefs and preferences and that worked for them in their world, including use of technology. CONCLUSION: Stroke survivors recovering in rural and remote locations want to live their life by doing what matters to them, despite the challenges they face. They want support in ways that work for them in their environment. Further research is required to tailor support for stroke survivors that is specific to their life in rural and remote locations.

8.
Hepatology ; 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34766362

RESUMO

BACKGROUND: Gallbladder cancer (GBC) has a female predominance, while the other biliary tract cancers (BTC) have a male predominance, suggesting sex hormones may be involved in carcinogenesis. We sought to evaluate the association between menopausal hormone therapy (MHT) and the risk of BTC in women. METHODS: This nested case-control study was conducted in the UK Clinical Practice Research Datalink. Cases diagnosed between 1990-2017 with incident primary cancers of the gallbladder (GBC), cholangiocarcinoma, ampulla of Vater (AVC), and mixed type were matched to five controls on birth year, diagnosis year, and years in the general practice using incidence density sampling. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between MHT use and BTC type. RESULTS: The sample consisted of 1,682 BTC cases (483 GBC, 870 cholangiocarcinoma, 105 AVC, and 224 mixed) and 8,419 matched controls with a mean age of 73 (standard deviation: 11) years. Combined formulations (estrogen-progesterone) were associated with an increased GBC risk (OR: 1.97; 95% CI: 1.08, 3.59). Orally administered MHT was associated with an increased GBC risk (OR: 2.28, 95% CI: 1.24, 4.17). Estrogen-only formulations (OR: 0.59; 95% CI: 0.34, 0.93) and cream or suppository administrations (OR: 0.57; 95% CI: 0.34, 0.95) were associated with decreased cholangiocarcinoma risk. The number of prescriptions, dose, duration of use, and time since last use were not associated with GBC or cholangiocarcinoma risk. MHT use was not associated with risk of AVC or mixed cancer. CONCLUSION: Combination MHT formulations and oral administrations are associated with increased GBC risk, while estrogen-only formulations were associated with a lower cholangiocarcinoma risk. MHT formulation and administration should be carefully considered when prescribing.

9.
Sci Rep ; 11(1): 17875, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504194

RESUMO

Ear molding therapy is a nonsurgical technique to correct certain congenital auricular deformities. While the advantages of nonsurgical treatments over otoplasty are well-described, few studies have assessed aesthetic outcomes. In this study, we compared assessments of outcomes of ear molding therapy for 283 ears by experienced healthcare providers and a previously developed deep learning CNN model. 2D photographs of ears were obtained as a standard of care in our onsite photography studio. Physician assistants (PAs) rated the photographs using a 5-point Likert scale ranging from 1(poor) to 5(excellent) and the CNN assessment was categorical, classifying each photo as either "normal" or "deformed". On average, the PAs classified 75.6% of photographs as good to excellent outcomes (scores 4 and 5). Similarly, the CNN classified 75.3% of the photographs as normal. The inter-rater agreement between the PAs ranged between 72 and 81%, while there was a 69.6% agreement between the machine model and the inter-rater majority agreement between at least two PAs (i.e., when at least two PAs gave a simultaneous score < 4 or ≥ 4). This study shows that noninvasive ear molding therapy has excellent outcomes in general. In addition, it indicates that with further training and validation, machine learning techniques, like CNN, have the capability to accurately mimic provider assessment while removing the subjectivity of human evaluation making it a robust tool for ear deformity identification and outcome evaluation.


Assuntos
Otopatias/cirurgia , Orelha Externa/anormalidades , Pessoal de Saúde , Redes Neurais de Computação , Otopatias/congênito , Estética , Auxiliares de Audição , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fotografação , Procedimentos Cirúrgicos Reconstrutivos/métodos
10.
J Virol Methods ; 298: 114287, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34530012

RESUMO

Henipaviruses, Hendra (HeV) and Nipah (NiV), are highly pathogenic zoonotic agents that pose a serious health risk to human life, and as such are restricted to physical containment 4 (PC4) laboratories. For further analysis of virus-infected biological specimens, it is necessary to ensure absolute inactivation of any infectious virus present before removal from the PC4 laboratory. To evaluate the inactivation of HeV and NiV within infected samples, two chemical inactivation methods were assessed. Henipavirus-infected cell monolayers treated with 4 % paraformaldehyde (PFA) showed the complete inactivation of infectious virus, with an inactivation period of 15 min resulting in more than 8-log decrease in infectious titre. NiV-infected tissue samples treated with 10 % neutral-buffered formalin (NBF) showed a complete reduction of infectious virus in 7/8 ferret organs incubated for 24 h, with the remaining tissue demonstrating complete virus inactivation after 48 h. The chemical inactivation methods described herein evaluated two simple methods of henipavirus inactivation, resulting in the complete inactivation of infectious virus - an essential requirement for the safe removal and handling of biological samples from the PC4 laboratory.

11.
N Z Med J ; 134(1542): 15-28, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34531580

RESUMO

AIM: To describe disparities in post-operative mortality experienced by Indigenous Maori compared to non-Indigenous New Zealanders. METHODS: We completed a national study of all those undergoing a surgical procedure between 2005 and 2017 in New Zealand. We examined 30-day and 90-day post-operative mortality for all surgical specialties and by common procedures. We compared age-standardised rates between ethnic groups (Maori, Pacific, Asian, European, MELAA/Other) and calculated hazard ratios (HRs) using Cox proportional hazards regression modelling adjusted for age, sex, deprivation, rurality, comorbidity, ASA score, anaesthetic type, procedure risk and procedure specialty. RESULTS: From nearly 3.9 million surgical procedures (876,976 acute, 2,990,726 elective/waiting list), we observed ethnic disparities in post-operative mortality across procedures, with the largest disparities occurring between Maori and Europeans. Maori had higher rates of 30- and 90-day post-operative mortality across most broad procedure categories, with the disparity between Maori and Europeans strongest for elective/waiting list procedures (eg, elective/waiting list musculoskeletal procedures, 30-day mortality: adj. HR 1.93, 95% CI 1.56-2.39). CONCLUSIONS: The disparities we observed are likely driven by a combination of healthcare system, process and clinical team factors, and we have presented the key mechanisms within these factors.


Assuntos
Disparidades em Assistência à Saúde , Procedimentos Cirúrgicos Operatórios/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Adulto Jovem
12.
Sex Transm Dis ; 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34535615

RESUMO

BACKGROUND: Low-income and uninsured people with a cervix (PWC) are at highest risk of being underscreened for cervical cancer. We evaluated the prevalence of high-risk HPV (hrHPV) on home self-collected samples, as well as rates of in-clinic follow-up and risk factors associated with hrHPV positivity in this at-risk population. METHODS: My-Body-My-Test-3 was conducted between 2016-2019 in North Carolina among individuals aged 25-64 years, overdue for cervical cancer screening, and with incomes of <250% of the U.S. Federal Poverty Level. Our analytic sample included participants randomized to the self-collection arm who returned self-collected cervico-vaginal brush samples for HPV testing (n = 329). Samples were tested for 14 hrHPV types by an HPV RNA assay and further genotyped for HPV 16 and HPV 18/45. We examined behavioral risk factors for hrHPV positivity using logistic regression and between-subjects t-tests. RESULTS: HrHPV RNA prevalence was 16% (n = 52/329) in self-collected samples. Of the hrHPV-positive participants, 24 (46%) presented for in-clinic cervical cancer screening, compared to 56 (20%) of hrHPV-negative participants. Those with ≥2 sexual partners in the past year were twice as likely to be hrHPV positive in adjusted analyses (adjusted OR = 2.00 (95% CI: 1.03-3.88). HrHPV-positive and negative participants had similar attitudes towards screening, with the exception of hrHPV-positive participants who reported a lower perceived risk of cervical cancer than those who were hrHPV-negative (p < .05). CONCLUSION: The hrHPV RNA prevalence was similar to findings in other underscreened PWC in the US. Efforts to reach underscreened PWC is critical for cervical cancer prevention. Future studies aimed at home self-collection should address methods of increasing clinic attendance and completion of treatment among those with HPV-positive results.

13.
Phys Sportsmed ; : 1-4, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34346850

RESUMO

OBJECTIVE: Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS: This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. RESULTS: The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. CONCLUSION: In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.

14.
S D Med ; 74(6): 256-259, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34449164

RESUMO

PURPOSE/BACKGROUND: Mild to moderate vitamin D deficiency is common in pediatric patients in the U.S. Severe hypovitaminosis D has been linked to specific risk factors, such as female gender, obesity, winter season, darker skin, lack of exposure to the sun, and low vitamin D intake. It has been reported that adolescents usually experience less severe clinical symptoms than young children with vitamin D deficiency. We present a previously healthy 15-year-old Caucasian male with bilateral spontaneous femoral fracture due to severe hypovitaminosis rickets. He had unusual eating habits such as avoiding dairy, vegetables, and fruits. In addition to always preferring to eat alone due to anxiety. Patient is underweight with a BMI z score of -4.05 at time of presentation. Due to lack of interest in physical activities, the patient spent most of his time indoors. DESIGN/METHODS: This is a case report of a patient who presented to the children's hospital for further workup for bilateral spontaneous femoral fractures. FINDINGS/RESULTS: Laboratory work up revealed that his 25 hydoxy-vitamin D level was less than 4 ng/ml, calcium level was 5.7 mg/dl (8.4-10.5mg/dL), and phosphorus was 3.5 mg/dl (3.7-4.7 mg/dl). His intact parathyroid hormone was elevated at 555 pg/ml (14-95 pg/ml) and alkaline phosphatase was elevated at 777 U/L (91-339 U/L). A wrist x-ray showed widening of the distal radial and ulnar metaphyses with metaphyseal cupping. Further labs showed macrocytic anemia and severe vitamin B12 deficiency. Workup for malabsorption was negative. Patient underwent bilateral open hip reduction internal fixation. Hypovitaminosis D and hypocalcemia were treated with calcium carbonate and oral vitamin D3 supplements. His follow up laboratory evaluation showed normalization of his calcium, phosphorus, PTH, alkaline phosphatase, and vitamin D levels. Repeat wrist X-ray two months later revealed marked improvement in the appearance of the distal radial and ulnar growth plates and metaphyseal regions. CONCLUSIONS: This patient's vitamin D deficiency/rickets was found to be secondary to malnutrition due to limited intake, along with limited sunlight exposure. We recommend that a detailed dietary history is obtained in every adolescent patient to evaluate for proper vitamin D intake, especially in patients who are significantly underweight. If vitamin D deficiency is expected, vitamin D level should be checked and appropriate treatment should be initiated once vitamin D insufficiency is confirmed.


Assuntos
Fraturas do Fêmur , Deficiência de Vitamina D , Adolescente , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Humanos , Masculino , Hormônio Paratireóideo , Vitamina D , Deficiência de Vitamina D/complicações , Vitaminas
15.
Artigo em Inglês | MEDLINE | ID: mdl-34444007

RESUMO

This paper examines the spatial and temporal trends in county-level COVID-19 cases and fatalities in the United States during the first year of the pandemic (January 2020-January 2021). Statistical and geospatial analyses highlight greater impacts in the Great Plains, Southwestern and Southern regions based on cases and fatalities per 100,000 population. Significant case and fatality spatial clusters were most prevalent between November 2020 and January 2021. Distinct urban-rural differences in COVID-19 experiences uncovered higher rural cases and fatalities per 100,000 population and fewer government mitigation actions enacted in rural counties. High levels of social vulnerability and the absence of mitigation policies were significantly associated with higher fatalities, while existing community resilience had more influential spatial explanatory power. Using differences in percentage unemployment changes between 2019 and 2020 as a proxy for pre-emergent recovery revealed urban counties were hit harder in the early months of the pandemic, corresponding with imposed government mitigation policies. This longitudinal, place-based study confirms some early urban-rural patterns initially observed in the pandemic, as well as the disparate COVID-19 experiences among socially vulnerable populations. The results are critical in identifying geographic disparities in COVID-19 exposures and outcomes and providing the evidentiary basis for targeting pandemic recovery.


Assuntos
COVID-19 , COVID-19/epidemiologia , COVID-19/mortalidade , Geografia Médica , Humanos , Pandemias , População Rural , Estados Unidos/epidemiologia , Populações Vulneráveis
16.
Addiction ; 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34431577

RESUMO

AIM: To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. DESIGN: Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. SETTING: England. PARTICIPANTS: A total of 36 980 adults (≥ 18 years). MEASUREMENTS: Independent variables were survey month (pre-lockdown: August-February versus lockdown months: April-July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). FINDINGS: Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12-1.63] and quit attempts (+39.9 versus -22.2%, aOR = 2.48, 95% CI = 1.76-3.50) among 18-34-year-olds, but not older groups. Increases in cessation (+156.4 versus -12.5%, aOR = 3.08, 95% CI = 1.86-5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31-3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus -7.8%, aOR = 1.80, 95% CI = 1.64-1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87-2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00-2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78-3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83-1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. CONCLUSIONS: In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).

17.
J Opioid Manag ; 17(3): 251-272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34259336

RESUMO

BACKGROUND: The management of post-operative pain and high levels of acute and chronic opioid use following total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain challenges to the perioperative team. We performed a system-atic review and meta-analysis to determine the opioid sparing effects, analgesic effects, and safety profile of perioperative gabapentinoid usage in lower limb arthroplasty. METHODS: We searched multiple databases from inception until May 2019 and included randomized controlled trials (RCT) on perioperative gabapentinoids in lower limb arthroplasty. The primary outcome was cumulative opioid con-sumption (oral morphine equivalents) at 24 and 48 hours, and the secondary outcomes were pain scores, time to hospi-tal discharge, and adverse events including nausea, vomiting, pruritus, and sedation. Methodological quality was as-sessed using the Cochrane tool. The grading of recommendations assessment, development, and evaluation method-ology for the certainty of evidence was also used. RESULTS: We included 19 RCT involving 2,455 patients undergoing lower limb arthroplasty. The overall methodological quality of included studies was good. Gabapentinoid use was associated with a significant reduction in opioid consump-tion at 24 hour (mean difference (MD) 22.81 mg [95 percent Confidence Interval (CI) 13.64-31.98]) and 48 hour (MD 44.03 mg [95 percent CI 16.92-71.14]). We found no meaningful difference in pain scores at rest between gabapenti-noid and placebo groups at 24 or 48 hours. Gabapentinoid use reduced the risk of post-operative nausea (risk ratio (RR) 0.69 [95 percent CI 0.57-0.82]), vomiting (RR 0.65 [95 percent CI 0.47-0.91]), and pruritus (RR 0.60 [0.37-0.98]), but not sedation (RR 1.25 [0.76-2.06]). There was no effect on time to discharge from hospital (MD-0.05 days [95 per-cent CI -0.31 to 0.20]. CONCLUSIONS: The addition of gabapentinoids to perioperative multimodal analgesia decreases opioid consumption fol-lowing lower limb arthroplasty, while also lowering rates of nausea, vomiting, and pruritus. Further study is required to evaluate the effect of gabapentinoid use on long-term opioid use and dependence.


Assuntos
Analgésicos Opioides , Artroplastia do Joelho , Analgésicos Opioides/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Humanos , Extremidade Inferior , Morfina , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
18.
Proc Natl Acad Sci U S A ; 118(24)2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34129516

RESUMO

Anthropogenic Pb is widespread in the environment including remote places. However, its presence in Canadian Arctic seawater is thought to be negligible based on low dissolved Pb (dPb) concentrations and proxy data. Here, we measured dPb isotopes in Arctic seawater with very low dPb concentrations (average ∼5 pmol ⋅ kg-1) and show that anthropogenic Pb is pervasive and often dominant in the western Arctic Ocean. Pb isotopes further reveal that historic aerosol Pb from Europe and Russia (Eurasia) deposited to the Arctic during the 20th century, and subsequently remobilized, is a significant source of dPb, particularly in water layers with relatively higher dPb concentrations (up to 16 pmol ⋅ kg-1). The 20th century Eurasian Pb is present predominantly in the upper 1,000 m near the shelf but is also detected in older deep water (2,000 to 2,500 m). These findings highlight the importance of the remobilization of anthropogenic Pb associated with previously deposited aerosols, especially those that were emitted during the peak of Pb emissions in the 20th century. This remobilization might be further enhanced because of accelerated melting of permafrost and ice along with increased coastal erosion in the Arctic. Additionally, the detection of 20th century Eurasian Pb in deep water helps constrain ventilation ages. Overall, this study shows that Pb isotopes in Arctic seawater are useful as a gauge of changing particulate and contaminant sources, such as those resulting from increased remobilization (e.g., coastal erosion) and potentially also those associated with increased human activities (e.g., mining and shipping).

19.
Nicotine Tob Res ; 23(11): 1831-1838, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34089607

RESUMO

INTRODUCTION: This study aimed to examine how the proportion of dual users of cigarettes and e-cigarettes who use e-cigarettes in situations where smoking is not permitted has changed since e-cigarettes became popular in England, and to characterize those who do so. METHODS: Data were from 5081 adults in England who reported current smoking and current use of e-cigarettes ('dual users') participating in a nationally-representative monthly survey between April 2011 and February 2020. We modeled quarterly changes in prevalence of e-cigarette use in situations where smoking is not permitted and assessed multivariable associations with sociodemographic and smoking characteristics. RESULTS: Between 2011 and 2020, prevalence of e-cigarette use in situations where smoking is not permitted followed a positive cubic trend, with a decelerating increase from an estimated 52.5% of dual users in Q2-2011 to 72.7% in Q3-2014, followed by a small decline to 67.5% in 2018, and subsequent increase to 74.0% in 2020. Odds were higher among those who were from more disadvantaged social grades, reported stronger smoking urges, or had made a past-year quit attempt, and lower among those who were aged at least 65 years (vs. 16-24 years), from the south (vs. north) of England, reported currently cutting down on their cigarette consumption or currently using nicotine replacement therapy. CONCLUSIONS: In England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased nonlinearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down. IMPLICATIONS: The ability to use nicotine in smoke-free settings appears to be an important part of the appeal of e-cigarettes. It is possible that if e-cigarette use was prohibited in public places, smokers may be deterred from using e-cigarettes alongside combustible tobacco, which could undermine quitting. Our results suggest disadvantaged and more addicted smokers would be disproportionately affected, suggesting such restrictions may contribute to inequalities in smoking and associated health outcomes.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Vaping , Adulto , Inglaterra/epidemiologia , Humanos , Fumantes , Dispositivos para o Abandono do Uso de Tabaco
20.
Sci Rep ; 11(1): 13203, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34168216

RESUMO

This study examined use trends of e-cigarette devices types, heated tobacco products (HTPs) and e-liquid nicotine concentrations in England from 2016 to 2020. Data were from a representative repeat cross-sectional survey of adults aged 16 or older. Bayesian logistic regression was used to estimate proportions and 95% credible intervals (CrIs). Of 75,355 participants, 5.3% (weighted = 5.5%) were currently using e-cigarettes or HTPs, with the majority (98.7%) using e-cigarettes. Among e-cigarette users, 53.7% (CrI 52.0-55.1%) used tank devices, 23.7% (22.4-25.1%) mods, 17.3% (16.1-18.4%) pods, and 5.4% (4.7-6.2%) disposables. Tanks were the most widely used device type throughout 2016-2020. Mods were second until 2020, when pods overtook them. Among all e-cigarette/HTP users, prevalence of HTP use remains rare (3.4% in 2016 versus 4.2% in 2020), whereas JUUL use has risen from 3.4% in 2018 to 11.8% in 2020. Across all years, nicotine concentrations of ≤ 6 mg/ml were most widely (41.0%; 39.4-42.4%) and ≥ 20 mg/ml least widely used (4.1%; 3.4-4.9%). Among e-cigarette/HTP users, ex-smokers were more likely than current smokers to use mod and tank e-cigarettes, but less likely to use pods, disposables, JUUL and HTPs. In conclusion, despite growing popularity of pods and HTPs worldwide, refillable tank e-cigarettes remain the most widely used device type in England.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Idoso , Teorema de Bayes , Estudos Transversais , Inglaterra , Feminino , Temperatura Alta , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Fumantes/estatística & dados numéricos , Tabaco , Adulto Jovem
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