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1.
Prev Sci ; 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34626325

RESUMO

Internationally, youth crime is a significant social problem. Violent youth crime has been rising over the past decade in the state of Victoria, Australia. Communities That Care (CTC) is a coalition training process designed to prevent youth crime. There has been limited evaluation outside the USA. Using a non-experimental design, this study employed official state crime statistics to evaluate the impact on crime as the five-phase CTC process was implemented between 2010 and 2019 across communities in Victoria. The standard five-phase CTC implementation cycle was supplemented with universal programs to reduce sales and supply of alcohol to underage youth (under 18 years). Growth models evaluated community trends in youth crime (all, person, property and deception and other), comparing communities that implemented CTC at phase 4 or greater with communities that had not implemented CTC. In accord with the hypotheses, the study found significant reductions in crimes associated with CTC over the period between 2010 and 2019. A 2% annual reduction in risk was observed for crimes against persons for all age groups (IRR = 0.98, 95% CI [0.96, 0.998]). A 5% annual reduction was observed for crimes of property and deception for adolescents aged between 10 and 17 years (IRR = 0.95, 95% CI [0.90, 0.99]). These findings support CTC as an intervention for preventing youth crime at a population level. Future studies should evaluate intervention mechanisms and economic benefits.

2.
Psychosom Med ; 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34629425

RESUMO

OBJECTIVE: Lung cancer remains the number one cause of cancer-related mortality worldwide, but less known is that lung cancer patients are among the most psychologically disabled of all cancer groups. Patients with stage-IV non-small cell lung cancer (NSCLC) were studied to test the hypothesis that trajectories of depression and/or anxiety symptoms following diagnosis would show an adverse relationship with survival, beyond relevant controls. METHODS: Patients with stage-IV NSCLC (N = 157) were enrolled (ClinicalTrials.gov Identifier: NCT03199651) at diagnosis and completed validated measures for depressive symptoms (Patient Health Questionnaire-9; PHQ9) and anxiety symptoms (Generalized Anxiety Disorder-7; GAD7). Patients were reassessed every 1-to 2-months thru 24-months (16 assessments; 80% average completion rate) and survival monitored. Joint statistical models provided simultaneous modeling of longitudinal (psychological) and time-to-event (survival) processes. Control variables were age, sex, marital status, education, smoking status, cancer type, and treatment received. RESULTS: Depression and anxiety symptoms significantly decreased with time since diagnosis. The two-year trajectory of depressive symptoms was significantly associated with cancer survival after adjustment for covariates [Hazard ratio = 1.09 per unit increase in PHQ9, 95% CI 1.03-1.15, p = 0.002]. Anxiety was marginally significant in the unadjusted (p = 0.053) but not the adjusted (p = 0.39) model. CONCLUSIONS: For the first time, joint model analyses test the interaction of a longitudinal trajectory of psychological symptoms, assessed from diagnosis through 24 months, and cancer survival. New data show the continuation of depressive and anxiety symptoms through treatment and thereafter. Immunotherapy and targeted therapies have dramatically improved survival for patients with advanced NSCLC, however novel data suggest their benefit may be constrained by depressive symptoms.

3.
Environ Int ; 158: 106905, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34649047

RESUMO

BACKGROUND: This systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition. METHODS: We update a prior review with recent publications (PROSPERO CRD42019151923). The strength of evidence for associations was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. We also conducted random-effects meta-analyses where suitable. RESULTS: 16 studies were identified and reviewed in tandem with 32 studies previously reviewed by Clark & Paunovic (2018). A meta-analysis from 3 studies found that reading comprehension scores in quiet classrooms were 0.80 (95% confidence interval: 0.40; 1.20) points higher than children in noisier classrooms. Meta-analysis of the impact of 1 dB (dB) increase in environmental noise on reading and language abilities gave a pooled beta coefficient of -0.11(95% confidence interval: -0.32; 0.10). A meta-analysis of Odds Ratios (OR) from 3 studies found higher odds of cognitive impairment in people aged 45 + with higher residential noise exposure (OR 1.40, 95% CI: 1.18;1.61). After qualitative synthesis of remaining studies, there was high quality evidence for an association between environmental noise and cognitive impairment in middle-to-older adults, moderate quality evidence for an association between aircraft noise and reading and language in children, and moderate quality evidence against an association between aircraft noise and executive functioning in children. Generally the literature was supportive for other cognitive outcomes, but with low or very low-quality evidence. DISCUSSION: The evidence so far suggests that noise exposure is associated with cognition, but more good quality research using standardised methodology is required to corroborate these results and to allow for precise risk estimation by larger meta-analyses. There is also a need for more research with older teenagers and young-to-middle aged adults, on the synergistic effects of noise and air pollution, and in Africa, Central and South America, South Asia and Australasia.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34473285

RESUMO

OBJECTIVES: The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. METHODS: From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. RESULTS: Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. CONCLUSIONS: This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.

5.
Clin Neurophysiol ; 132(11): 2766-2777, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34583119

RESUMO

OBJECTIVE: The aim of the present study was to investigate the optimal stimulation parameters for eliciting cortico-cortical evoked potentials (CCEPs) for mapping functional and epileptogenic networks. METHODS: We studied 13 patients with refractory epilepsy undergoing intracranial EEG monitoring. We systematically titrated the intensity of single-pulse electrical stimulation at multiple sites to assess the effect of increasing current on salient features of CCEPs such as N1 potential magnitude, signal to noise ratio, waveform similarity, and spatial distribution of responses. Responses at each incremental stimulation setting were compared to each other and to a final set of responses at the maximum intensity used in each patient (3.5-10 mA, median 6 mA). RESULTS: We found that with a biphasic 0.15 ms/phase pulse at least 2-4 mA is needed to differentiate between non-responsive and responsive sites, and that stimulation currents of 6-7 mA are needed to maximize amplitude and spatial distribution of N1 responses and stabilize waveform morphology. CONCLUSIONS: We determined a minimum stimulation threshold necessary for eliciting CCEPs, as well as a point at which the current-dependent relationship of several response metrics all saturate. SIGNIFICANCE: This titration study provides practical, immediate guidance on optimal stimulation parameters to study specific features of CCEPs, which have been increasingly used to map both functional and epileptic brain networks in humans.

6.
Drug Alcohol Depend ; 227: 109013, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34488071

RESUMO

BACKGROUND: Buprenorphine, approved for treating opioid use disorder (OUD), is not equally efficacious for all patients. Candidate gene studies have shown limited success in identifying genetic moderators of buprenorphine treatment response. METHODS: We studied 1616 European-ancestry individuals enrolled in the Million Veteran Program, of whom 1609 had an ICD-9/10 code consistent with OUD, a 180-day buprenorphine treatment exposure, and genome-wide genotype data. We conducted a genome-wide association study (GWAS) of buprenorphine treatment response [defined as having no opioid-positive urine drug screens (UDS) following the first prescription]. We also examined correlates of buprenorphine treatment response in multivariable analyses. RESULTS: Although no variants reached genome-wide significance, 6 loci were nominally significant (p < 1 × 10-5), four of which were located near previously characterized genes: rs756770 (ADAMTSL2), rs11782370 (SLC25A37), rs7205113 (CRISPLD2), and rs13169373 (LINC01947). A higher maximum daily buprenorphine dosage (aOR = 0.98; 95 %CI: 0.97, 0.995), greater number of UDS (aOR = 0.97; 95 %CI: 0.96, 0.99), and history of hepatitis C (HCV) infection (aOR = 0.71; 95 %CI: 0.57, 0.88) were associated with a reduced odds of buprenorphine response. Older age (aOR: 1.01; 95 %CI: 1.000, 1.02) was associated with increased odds of buprenorphine response. CONCLUSIONS: This study had limited statistical power to detect genetic variants associated with a complex human phenotype like buprenorphine treatment response. Meta-analysis of multiple data sets is needed to ensure adequate statistical power for a GWAS of buprenorphine treatment response. The most robust phenotypic predictor of buprenorphine treatment response was intravenous drug use, a proxy for which was HCV infection.

7.
BMC Genomics ; 22(1): 619, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399690

RESUMO

BACKGROUND: Babesia rossi is a leading cause of morbidity and mortality among the canine population of sub-Saharan Africa, but pathogenesis remains poorly understood. Previous studies of B. rossi infection were derived from clinical cases, in which neither the onset of infection nor the infectious inoculum was known. Here, we performed controlled B. rossi inoculations in canines and evaluated disease progression through clinical tests and whole blood transcriptomic profiling. RESULTS: Two subjects were administered a low inoculum (104 parasites) while three received a high (108 parasites). Subjects were monitored for 8 consecutive days; anti-parasite treatment with diminazene aceturate was administered on day 4. Blood was drawn prior to inoculation as well as every experimental day for assessment of clinical parameters and transcriptomic profiles. The model recapitulated natural disease manifestations including anemia, acidosis, inflammation and behavioral changes. Rate of disease onset and clinical severity were proportional to the inoculum. To analyze the temporal dynamics of the transcriptomic host response, we sequenced mRNA extracted from whole blood drawn on days 0, 1, 3, 4, 6, and 8. Differential gene expression, hierarchical clustering, and pathway enrichment analyses identified genes and pathways involved in response to hemolysis, metabolic changes, and several arms of the immune response including innate immunity, adaptive immunity, and response to viral infection. CONCLUSIONS: This work comprehensively characterizes the clinical and transcriptomic progression of B. rossi infection in canines, thus establishing a large mammalian model of severe hemoprotozoal disease to facilitate the study of host-parasite biology and in which to test novel anti-disease therapeutics. The knowledge gained from the study of B. rossi in canines will not only improve our understanding of this emerging infectious disease threat in domestic dogs, but also provide insight into the pathobiology of human diseases caused by Babesia and Plasmodium species.


Assuntos
Babesia , Babesiose , Doenças do Cão , África ao Sul do Saara , Animais , Babesia/genética , Babesiose/tratamento farmacológico , Doenças do Cão/tratamento farmacológico , Doenças do Cão/genética , Cães , Hemólise
9.
Nat Hum Behav ; 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446916

RESUMO

How do concepts of mental life vary across cultures? By asking simple questions about humans, animals and other entities - for example, 'Do beetles get hungry? Remember things? Feel love?' - we reconstructed concepts of mental life from the bottom up among adults (N = 711) and children (ages 6-12 years, N = 693) in the USA, Ghana, Thailand, China and Vanuatu. This revealed a cross-cultural and developmental continuity: in all sites, among both adults and children, cognitive abilities travelled separately from bodily sensations, suggesting that a mind-body distinction is common across diverse cultures and present by middle childhood. Yet there were substantial cultural and developmental differences in the status of social-emotional abilities - as part of the body, part of the mind or a third category unto themselves. Such differences may have far-reaching social consequences, whereas the similarities identify aspects of human understanding that may be universal.

10.
J Surg Educ ; 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34456171

RESUMO

OBJECTIVES: The COVID-19 pandemic has forced a creative transition to virtual platforms due to physical distancing and travel restrictions. We designed and tested a highly scalable virtual training curriculum for novice raters using the Oxford NOTECHS non-technical skills rating system. DESIGN: A three-day training course comprising virtual didactics, virtually facilitated simulations, and independent live observations was implemented. NOTECHS scores were submitted for eleven standardized video simulations and four live operations. Intraclass correlation coefficients (ICCs) were calculated for total NOTECHS scores and subcomponent scores. Raters previously trained in-person with the same standardized videos served as a comparator group for equivalence testing. SETTING: All study activities were conducted in a large academic tertiary referral center in Singapore as part of an ongoing surgical safety initiative. PARTICIPANTS: Seven staff members underwent training (three virtually and four in-person).  None had prior surgical experience or non-technical skills assessment training. RESULTS: ICCs for total NOTECHS scores were 0.85 (95% CI, 0.73-0.98) for virtually trained raters and 0.83 for those trained in-person (95% CI, 0.68-0.99).  Scores were equivalent between groups within a 10% margin. CONCLUSIONS: Non-technical skills assessment can be reliably taught in a highly scalable virtual format. Virtual NOTECHS training is a valuable tool for educational and quality improvement initiatives during the COVID-19 pandemic and for centers that lack ready access to onsite non-technical skills training expertise.

11.
Acad Med ; 96(9): 1276-1281, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34432665

RESUMO

The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post-COVID-19 world.


Assuntos
COVID-19/prevenção & controle , Educação à Distância/métodos , Educação Médica/métodos , Aprendizagem , Distanciamento Físico , Estudantes de Medicina/psicologia , Comportamento Cooperativo , Educação à Distância/organização & administração , Educação Médica/organização & administração , Humanos , Práticas Interdisciplinares , Cultura Organizacional , Meio Social , Rede Social , Estados Unidos
12.
J Health Commun ; 26(6): 402-412, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34292858

RESUMO

As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.


Assuntos
COVID-19/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Inquéritos e Questionários , Adulto Jovem
13.
Comput Biol Med ; 135: 104627, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34247132

RESUMO

BACKGROUND: Determining physiological mechanisms leading to circulatory failure can be challenging, contributing to the difficulties in delivering effective hemodynamic management in critical care. Continuous, non-additionally invasive monitoring of preload changes, and assessment of contractility from Frank-Starling curves could potentially make it much easier to diagnose and manage circulatory failure. METHOD: This study combines non-additionally invasive model-based methods to estimate left ventricle end-diastolic volume (LEDV) and stroke volume (SV) during hemodynamic interventions in a pig trial (N = 6). Agreement of model-based LEDV and measured admittance catheter LEDV is assessed. Model-based LEDV and SV are used to identify response to hemodynamic interventions and create Frank-Starling curves, from which Frank-Starling contractility (FSC) is identified as the gradient. RESULTS: Model-based LEDV had good agreement with measured admittance catheter LEDV, with Bland-Altman median bias [limits of agreement (2.5th, 97.5th percentile)] of 2.2 ml [-13.8, 22.5]. Model LEDV and SV were used to identify non-responsive interventions with a good area under the receiver-operating characteristic (ROC) curve of 0.83. FSC was identified using model LEDV and SV with Bland-Altman median bias [limits of agreement (2.5th, 97.5th percentile)] of 0.07 [-0.68, 0.56], with FSC from admittance catheter LEDV and aortic flow probe SV used as a reference method. CONCLUSIONS: This study provides proof-of-concept preload changes and Frank-Starling curves could be non-additionally invasively estimated for critically ill patients, which could potentially enable much clearer insight into cardiovascular function than is currently possible at the patient bedside.


Assuntos
Hemodinâmica , Animais , Humanos , Volume Sistólico , Suínos
14.
Epilepsy Res ; 176: 106704, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34218209

RESUMO

OBJECTIVE: Favorable neurodevelopmental outcomes in epileptic spasms (ES) are tied to early diagnosis and prompt treatment, but uncertainty in the identification of the disease can delay this process. Therefore, we investigated five categories of computational electroencephalographic (EEG) measures as markers of ES. METHODS: We measured 1) amplitude, 2) power spectra, 3) Shannon entropy and permutation entropy, 4) long-range temporal correlations, via detrended fluctuation analysis (DFA) and 5) functional connectivity using cross-correlation and phase lag index (PLI). EEG data were analyzed from ES patients (n = 40 patients) and healthy controls (n = 20 subjects), with multiple blinded measurements during wakefulness and sleep for each patient. RESULTS: In ES patients, EEG amplitude was significantly higher in all electrodes when compared to controls. Shannon and permutation entropy were lower in ES patients than control subjects. The DFA intercept values in ES patients were significantly higher than control subjects, while DFA exponent values were not significantly different between the groups. EEG functional connectivity networks in ES patients were significantly stronger than controls when based on both cross-correlation and PLI. Significance for all statistical tests was p < 0.05, adjusted for multiple comparisons using the Benjamini-Hochberg procedure as appropriate. Finally, using logistic regression, a multi-attribute classifier was derived that accurately distinguished cases from controls (area under curve of 0.96). CONCLUSIONS: Computational EEG features successfully distinguish ES patients from controls in a large, blinded study. SIGNIFICANCE: These objective EEG markers, in combination with other clinical factors, may speed the diagnosis and treatment of the disease, thereby improving long-term outcomes.

15.
Transfusion ; 61(7): 2217, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34275149
16.
Am J Health Promot ; : 8901171211026132, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269077

RESUMO

PURPOSE: To explore public confidence in a COVID-19 vaccine. DESIGN: Cross-sectional survey. SETTING: A rural college town in central Pennsylvania. SUBJECTS: Adult residents without minor children. MEASURES: The primary outcome was COVID-19 vaccination intention. Secondary measures included vaccination attitudes, norms, efficacy, past behavior, trust in the vaccination process, and sociodemographic variables of education, financial standing, political viewpoint, and religiosity. ANALYSIS: Descriptive statistics were used to describe quantitative data. Multivariate ordinal regression was used to model predictors of vaccine intention. RESULTS: Of 950 respondents, 55% were "very likely" and 20% "somewhat likely" to take a coronavirus vaccine, even though 70% had taken the flu vaccine since September 2019. The strongest predictors of vaccine acceptance were trust in the system evaluating vaccines and perceptions of local COVID-19 vaccination norms. The strongest predictors of negative vaccine intentions were worries about unknown side-effects and positive attitudes toward natural infection. Sociodemographic factors, political views, and religiosity did not predict vaccine intentions. CONCLUSION: Fewer adults intend to take a coronavirus vaccine than currently take the flu vaccine. Traditional sociodemographic factors may not be effective predictors of COVID-19 vaccine uptake. Although based on a small sample, the study adds to our limited understanding of COVID-19-specific vaccine confidence among some rural Americans and suggests that traditional public health vaccination campaigns based on sociodemographic characteristics may not be effective.

17.
Patient Educ Couns ; 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34294491

RESUMO

OBJECTIVE: Parents with incurable cancer are often uncertain how, what and when is best to tell their children about their poor prognosis and prepare them for the actual death. Despite parents' desire and need for support from health and social care professionals (HSCPs), this is often lacking. HSCPs feel ill-equipped, identifying a need for an evidence-based communication framework for professionals to use in practice, promoting parent-child communication at end of life. METHODS: A systematic process, involving a systematic review and data from 76 semi-structured, face-to-face qualitative interviews from three participant populations, including HSCPs (n = 32), bereaved parents (n = 21) and funeral directors (n = 23) were triangulated. This informed the development of the 'Talking, Telling and Sharing': End of life framework (6 W Grid), guided by an expert group. RESULTS: An evidence-based, theory-driven communication framework has been developed. This provides a mechanism for HSCPs to proactively and directly engage with patients, addressing their parent-child communication concerns. CONCLUSION: Clear, evidence-based communication frameworks can enhance patient-provider communication in practice, particularly around sensitive and complex issue. PRACTICE IMPLICATIONS: There is a need for HSCPs to encourage parents to start these difficult conversations soon after receiving the poor prognosis, to avoid crisis management when the ill-parent is actively dying or throughout the immediate bereavement period.

18.
BMC Public Health ; 21(1): 1412, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271883

RESUMO

BACKGROUND: Antimicrobial resistance is a global health emergency. Persons colonized with multidrug-resistant organisms (MDROs) are at risk for developing subsequent multidrug-resistant infections, as colonization represents an important precursor to invasive infection. Despite reports documenting the worldwide dissemination of MDROs, fundamental questions remain regarding the burden of resistance, metrics to measure prevalence, and determinants of spread. We describe a multi-site colonization survey protocol that aims to quantify the population-based prevalence and associated risk factors for colonization with high-threat MDROs among community dwelling participants and patients admitted to hospitals within a defined population-catchment area. METHODS: Researchers in five countries (Bangladesh, Chile, Guatemala, Kenya, and India) will conduct a cross-sectional, population-based prevalence survey consisting of a risk factor questionnaire and collection of specimens to evaluate colonization with three high-threat MDROs: extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Healthy adults residing in a household within the sampling area will be enrolled in addition to eligible hospitalized adults. Colonizing isolates of these MDROs will be compared by multilocus sequence typing (MLST) to routinely collected invasive clinical isolates, where available, to determine potential pathogenicity. A colonizing MDRO isolate will be categorized as potentially pathogenic if the MLST pattern of the colonizing isolate matches the MLST pattern of an invasive clinical isolate. The outcomes of this study will be estimates of the population-based prevalence of colonization with ESCrE, CRE, and MRSA; determination of the proportion of colonizing ESCrE, CRE, and MRSA with pathogenic characteristics based on MLST; identification of factors independently associated with ESCrE, CRE, and MRSA colonization; and creation an archive of ESCrE, CRE, and MRSA isolates for future study. DISCUSSION: This is the first study to use a common protocol to evaluate population-based prevalence and risk factors associated with MDRO colonization among community-dwelling and hospitalized adults in multiple countries with diverse epidemiological conditions, including low- and middle-income settings. The results will be used to better describe the global epidemiology of MDROs and guide the development of mitigation strategies in both community and healthcare settings. These standardized baseline surveys can also inform future studies seeking to further characterize MDRO epidemiology globally.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Adulto , Bangladesh , Chile , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Guatemala , Hospitais , Humanos , Índia , Quênia , Tipagem de Sequências Multilocus , Prevalência , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia
19.
Open Heart ; 8(2)2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34233913

RESUMO

BACKGROUND: Most cell therapy trials failed to show an improvement in global left ventricular (LV) function measures after myocardial infarction (MI). Myocardial segments are heterogeneously impacted by MI. Global LV function indices are not able to detect the small treatment effects on segmental myocardial function which may have prognostic implications for cardiac events. We aimed to test the efficacy of allogeneic cardiosphere-derived cells (CDCs) for improving regional myocardial function and contractility. METHODS: In this exploratory analysis of a randomised clinical trial, 142 patients with post-MI with LVEF <45% and 15% or greater LV scar size were randomised in 2:1 ratio to receive intracoronary infusion of allogenic CDCs or placebo, respectively. Change in segmental myocardial circumferential strain (Ecc) by MRI from baseline to 6 months was compared between CDCs and placebo groups. RESULTS: In total, 124 patients completed the 6-month follow-up (mean (SD) age 54.3 (10.8) and 108 (87.1%) men). Segmental Ecc improvement was significantly greater in patients receiving CDC (-0.5% (4.0)) compared with placebo (0.2% (3.7), p=0.05). The greatest benefit for improvement in segmental Ecc was observed in segments containing scar tissue (change in segmental Ecc of -0.7% (3.5) in patients receiving CDC vs 0.04% (3.7) in the placebo group, p=0.04). CONCLUSIONS: In patients with post-MI LV dysfunction, CDC administration resulted in improved segmental myocardial function. Our findings highlight the importance of segmental myocardial function indices as an endpoint in future clinical trials of patients with post-MI. TRIAL REGISTRATION NUMBER: NCT01458405.

20.
Am J Med Genet A ; 185(10): 3012-3018, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34152076

RESUMO

Identifying hereditary syndromes among patients with renal cell carcinoma (RCC) is essential for surveillance of affected individuals and their at-risk family members and for treatment optimization. We conducted a chart review to determine the percentage of patients with RCC who were seen at the University of Miami Health System (UHealth), and met the American College of Medical Genetics (ACMG) and the National Society of Genetic Counselors (NSGC) genetic referral criteria at the University of Miami. Subsequently, we determined the percentage of those who went on to receive genetic evaluation. Patients selected by International Classification of Diseases (ICD) 9/10 codes corresponding to kidney cancer who were at least 18 years of age at the time of diagnosis were included in the study. We included a total of 1443 patients in the final analysis, and after exclusion of charts with incorrect ICD codes, insufficient clinical data, unknown pathology, and patients who were not seen. We used chi-square analysis, ANOVA, and t-test. Of 1443 charts reviewed, 65.7% were male and 34.3% were female. 47.7% self-identified as White, 39.2% as Hispanic, 9.1% as Black, and 4.0% as "other." The mean age of RCC diagnosis was 60.0 ± 12.4 years old. In total, 47.0% of patients met ACMG/NSGC referral criteria for genetic evaluation. Of those, only 4.2% had documented genetic assessment. This study showed a low adherence to ACMG/NSGC genetic referral guidelines at our institution and a need for increasing patients' and practitioners' awareness about the significance of genetic assessment for RCC patients and their family members.

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