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1.
Semin Pediatr Surg ; 29(6): 150989, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33288130

RESUMO

Colorectal disease profiles for children in low- and middle-income settings (LMIC) are characterized by late presentation, increased complications and limited follow-up in many cases. There is a high prevalence of infectious conditions causing secondary colorectal disease such as Mycobacterium Tuberculosis(TB), Human Immunodeficiency Virus(HIV) and Human Papilloma Virus(HPV), which also impact the management of other primary colorectal conditions, such as wound-healing and intestinal anastomosis. Perineal trauma from sexual assault, motor vehicle or pedestrian accidents, burns, and traditional enemas are commonly encountered and may require adaptation of principles used in treatment of congenital anomalies such as Hirschsprung's disease and Anorectal Malformations for reconstruction. Endemic conditions in certain LMIC require further research to delineate underlying causes and optimize management, such as "African" degenerative visceral leiomyopathy, congenital pouch colon in the Indian subcontinent, and congenital H-type rectal fistulae prevalent in Asia. These unique disease profiles require creative adaptations of resources within poor healthcare infrastructure settings. These special challenges and pitfalls in colorectal care and complications of adverse socioeconomic conditions, are discussed.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33232464

RESUMO

OBJECTIVES: Universal serial bus (USB) microscopy (capillaroscopy) could provide all rheumatologists with an easy-to-use, low-cost tool to examine the nailfold capillaries to facilitate early diagnosis of SSc. The objectives of this pilot study were to examine the feasibility of acquiring and analysing images using USB microscopy and to compare results to videocapillaroscopy. METHODS: Videocapillaroscopy and USB microscope images were obtained from the right and left ring fingers of 20 patients with SSc and 20 healthy control subjects. In addition to generating panoramic capillary mosaics from across the whole nailbed, custom software made fully automated measurements of vessel structure including capillary width and density. The area under the receiver operating characteristic curve (AZ) was used to measure separation between the SSc and healthy control groups. RESULTS: High quality images could be generated from the USB microscope, with reconstructed USB images comparing very favourably with those obtained using videocapillaroscopy. Using USB microscope images, the receiver operating characteristic curve AZ for group separation based on mean width was 0.81 (standard error 0.120) compared with 0.81 (standard error 0.095) for the (gold standard) videocapillaroscopy. The receiver operating characteristic curve AZ for group separation using capillary density was 0.48 (standard error 0.16) for USB microscope images, compared with 0.70 (standard error 0.10) for videocapillaroscopy. CONCLUSION: In this pilot study, USB capillaroscopy was able to discriminate between patients with SSc and controls as well as videocapillaroscopy on the basis of capillary width. This finding, together with the high-quality images obtained, highlights the potential of USB capillaroscopy as a low-cost, easily accessible clinical and research tool.

3.
BMJ Open ; 10(10): e043010, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087383

RESUMO

INTRODUCTION: The emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions. METHODS AND ANALYSIS: Two privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection. ETHICS AND DISSEMINATION: The Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Assistência à Saúde/normas , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Fatores de Risco , País de Gales/epidemiologia
4.
Wellcome Open Res ; 5: 114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802964

RESUMO

Background: n-Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) catalyses the reversible NAD +-dependent oxidative phosphorylation of n-glyceraldehyde-3-phosphate to 1,3-diphospho-n-glycerate in both glycolysis and gluconeogenesis. Methods: Four distinct crystal structures of human n-Glyceraldehyde-3-phosphate dehydrogenase ( HsGAPDH) have been determined from protein purified from the supernatant of HEK293F human epithelial kidney cells. Results: X-ray crystallography and mass-spectrometry indicate that the catalytic cysteine of the protein ( HsGAPDH Cys152) is partially oxidised to cysteine S-sulfonic acid. The average occupancy for the Cys152-S-sulfonic acid modification over the 20 crystallographically independent copies of HsGAPDH across three of the crystal forms obtained is 0.31±0.17. Conclusions: The modification induces no significant structural changes on the tetrameric enzyme, and only makes aspecific contacts to surface residues in the active site, in keeping with the hypothesis that the oxidising conditions of the secreted mammalian cell expression system result in HsGAPDH catalytic cysteine S-sulfonic acid modification and irreversible inactivation of the enzyme.

7.
Proc Natl Acad Sci U S A ; 117(22): 12481-12485, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32424092

RESUMO

Extensive and recurrent severe wildfires present complex challenges for policy makers. This is highlighted by extensive wildfires around the globe, ranging from western North America and Europe to the Amazon and Arctic, and, most recently, the 2019-2020 fires in eastern Australia. In many jurisdictions, discussions after significant losses of life, property, and vegetation are sometimes conducted in the absence of nuanced debates about key aspects of climate, land, and resource management policy. Improved insights that have significant implications for policies and management can be derived from spatial and temporal analyses of fires. Here, we demonstrate the importance of such analyses using a case study of large-scale, recurrent severe wildfires over the past two decades in the Australian state of Victoria. We overlaid the location of current and past fires with ecosystem types, land use, and conservation values. Our analyses revealed 1) the large spatial extent of current fires, 2) the extensive and frequent reburning of recently and previously fire-damaged areas, 3) the magnitude of resource loss for industries such as timber and pulplog production, and 4) major impacts on high conservation value areas and biodiversity. These analyses contain evidence to support policy reforms that alter the mode of forest management, target the protection of key natural assets including unburnt areas, manage repeatedly damaged and potentially collapsed ecosystems, and expand the conservation estate. Our mapping approach should have applicability to other environments subject to large-scale fires, although the particular details of policy reforms would be jurisdiction, ecosystem, and context specific.

8.
Chem Biol Interact ; 325: 109131, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32417163

RESUMO

We have previously demonstrated promotion of diethylnitrosamine (DEN) initiated liver tumorigenesis after feeding diets high in fat or ethanol (EtOH) to male mice. This was accompanied by hepatic induction of the proto-oncogene PIKE (Agap2). Switch of dietary protein from casein to soy protein isolate (SPI) significantly reduced tumor formation in these models. We have linked EtOH consumption in mice to microbial dysbiosis. Adoptive transfer studies demonstrate that microbiota from mice fed ethanol can induce hepatic steatosis in the absence of ethanol suggesting that microbiota or the microbial metabolome play key roles in development of fatty liver disease. Feeding SPI significantly changed gut bacteria in mice increasing alpha diversity (P < 0.05) and levels of Clostidiales spp. Feeding soy formula to piglets also resulted in significant changes in microbiota, the pattern of bile acid metabolites and in inhibition of the intestinal-hepatic FXR/FGF19-SHP pathway which has been linked to both steatosis and hepatocyte proliferation. Moreover, feeding SPI also resulted in induction of hepatic PPARα signaling and inhibition of PIKE mRNA expression coincident with inhibition of steatosis and cancer prevention. Feeding studies in the DEN model with differing dietary fats demonstrated tumor promotion specific to the saturated fat, cocoa butter relative to diets containing olive oil or corn oil associated with microbial dysbiosis including dramatic increases in Lachnospiraceae particularly from the genus Coprococcus. Immunohistochemical analysis demonstrated that tumors from EtOH-fed mice and patients with alcohol-associated HCC also expressed high levels of a novel cytochrome P450 enzyme CYP2W1. Additional adoptive transfer experiments and studies in knockout mice are required to determine the exact relationship between soy effects on the microbiota, expression of PIKE, CYP2W1, PPARα activation and prevention of tumorigenesis.


Assuntos
Família 2 do Citocromo P450/metabolismo , Microbioma Gastrointestinal , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/prevenção & controle , Proteínas Monoméricas de Ligação ao GTP/metabolismo , Hepatopatia Gordurosa não Alcoólica/complicações , Proteínas de Soja/farmacologia , Animais , Carcinogênese/efeitos dos fármacos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/microbiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL
9.
Neurourol Urodyn ; 39(5): 1482-1488, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32339339

RESUMO

AIMS: Sacral neuromodulation (SNM) is a guideline-recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well as fecal incontinence. The Axonics® System is a miniaturized, rechargeable SNM system designed to provide therapy for at least 15 years, which is expected to significantly reduce revision surgeries as it will not require replacement as frequently as the non-rechargeable SNM system. The ARTISAN-SNM study is a pivotal study designed to treat patients with urinary urgency incontinence (UUI). Clinical results at 1-year are presented. METHODS: A total of 129 eligible UUI patients were treated. All participants were implanted with a quadripolar tined lead and neurostimulator in a single procedure. Efficacy data were collected using a 3-day bladder diary, a validated quality of life questionnaire (ICIQ-OABqol), and a participant satisfaction questionnaire. Therapy responders were defined as participants with ≥50% reduction in UUI episodes compared to baseline. Data were analyzed on all 129 participants. RESULTS: At 1 year, 89% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.4 ± 0.2. Participants experienced an overall clinically meaningful improvement of 34 points on the ICIQ-OABqol questionnaire. All study participants (100%) were able to recharge their device at 1 year, and 96% of participants reported that the frequency and duration of recharging was acceptable. There were no serious device-related adverse events. CONCLUSIONS: The Axonics System is safe and effective at 1 year, with 89% of participants experiencing clinically and statistically significant improvements in UUI symptoms.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Plexo Lombossacral/cirurgia , Incontinência Urinária de Urgência/terapia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados/efeitos adversos , Incontinência Fecal/complicações , Incontinência Fecal/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Próteses e Implantes , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária de Urgência/psicologia , Retenção Urinária/complicações , Retenção Urinária/terapia , Adulto Jovem
10.
European J Pediatr Surg Rep ; 8(1): e3-e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32042545

RESUMO

Background Despite serious health risks having been described, traditional enemas are still often used in African traditional medicine. We aim to report two cases of complications secondary to traditional enemas, to illustrate how severe the injuries can be, and to describe the use of a Swenson type endoanal pull-through and a posterior sagittal anorectoplasty (PSARP) as surgical options. Case Description A 2-year-old girl presented with a necrotic rectum after a traditional enema administration. At admission, she required a laparotomy, colostomy fashioning, and extensive debridement of her rectum and perineum. She subsequently had a pull-through of the descending colon using a PSARP approach, a covering loop ileostomy, and a Malone Antegrade Continence Enema. The ileostomy was reversed at the age of 3 years of age and she is now clean with rectal washouts. The second case was a one- and a half-year-old boy with full-thickness burns to the perineum and rectum secondary to a hot-water enema. A colostomy was initially brought out and pulled through 7 months post the initial surgery. He is now growing well and is fully continent to stools. Conclusions The potential complications associated with the practice of administering at-home enemas can be quite devastating. A transanal pull-through and a PSARP have been proven to be successful techniques in patients who have suffered rectal burns due to traditional enemas.

13.
J Urol ; 203(1): 185-192, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347955

RESUMO

PURPOSE: Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS: A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS: At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS: The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.


Assuntos
Neuroestimuladores Implantáveis , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fontes de Energia Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Sacro , Incontinência Urinária de Urgência/fisiopatologia
14.
Sci Total Environ ; 688: 890-902, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31726572

RESUMO

Natural and human disturbance along with climate change pose major challenges for resource management. This is relevant in natural forests, where conflict can occur between water provision and industrial logging. As a result, conversion of old forests to young, fast-growing stands through logging can dramatically reduce streamflow and water yield. We modelled changes in stream run-off and hence water yield from a forest catchment in response to clearcut logging and compared this with projected climate change (using a Representative Climate Futures [RCFs] approach). We focused on the Thomson Catchment, which is the largest single catchment for the city of Melbourne, south-eastern Australia. Within this catchment, we targeted our analysis at montane ash-type eucalypt forests, as these receive the most rainfall and are subject to clearcutting. We used several forest management scenarios to model changes in water yield over time. For our analysis of projected climate change, we employed a range of RCFs that represent 'consensus', 'wettest' and 'driest' scenarios to model the impacts of multiple Representative Concentration Pathways (RCPs). Our initial spatial analysis revealed that 42% of the ash-type eucalypt forests in the Thomson Catchment have been logged. Under historical and continued logging, stream runoff decreases by 40,211 ML by 2090 compared with a hypothetical baseline if logging had ceased in 1995 and 34,059 ML if logging continues beyond 2019. These losses exceed the projected impacts of climate change under the consensus and wettest scenarios, but the driest scenarios are projected to exceed these losses, consisting of 49,998 ML and 69,474 ML for RCP 4.5 and RCP 8.5, respectively. We suggest logging be excluded from the Thomson Catchment because of decreasing stream flows due to climate change and an increasing water demand due to human population growth. This study provides a quantitative approach for highlighting how resource conflicts can be magnified under climate change.

16.
Int J STD AIDS ; 30(3): 256-263, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30392463

RESUMO

Antimicrobial resistance (AMR) to gonorrhoea is a threat to global health security. There have been concerns expressed that countries with high rates of disease have poor surveillance. The objectives of the study were to determine the AMR patterns of Neisseria gonorrhoeae clinical isolates to antimicrobial agents in patients with HIV or high risk of HIV acquisition, to compare the concordance of disk diffusion and agar dilution as methods for determining AMR to N. gonorrhoeae, and to describe methodological challenges to carrying out AMR testing. The study was conducted at an HIV outpatient service for at-risk populations and an outreach clinic for commercial sex workers in Kampala. Patients were offered a sexually transmitted infection screen using a polymerase chain reaction (PCR)-based assay. Samples positive for gonorrhoea were cultured. Antimicrobial susceptibility testing was performed using disk diffusion and isolates were sent to a reference laboratory for agar dilution direct susceptibility testing. Five hundred and seventy-five patients were screened. There were 33 (5.7%) patients with gonorrhoea detected by PCR. Of the 16 viable N. gonorrhoeae isolates, 100% were resistant to ciprofloxacin and tetracycline by disk diffusion and 31% exhibited reduced susceptibility to ceftriaxone and cefixime. By agar dilution, 100% of isolates were resistant to ciprofloxacin and all isolates were susceptible to ceftriaxone and cefixime. There was concordance between disk diffusion and agar dilution for ciprofloxacin and tetracycline resistance and a significant discordance for third-generation cephalosporins. More than half the women with gonorrhoea were asymptomatic and represent a potential reservoir for ongoing transmission. AMR testing of N. gonorrhoeae isolates is needed to ensure optimal treatment and prevention of antibiotic resistance progression.


Assuntos
Antibacterianos/farmacologia , Ciprofloxacino/farmacologia , Farmacorresistência Bacteriana , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , Tetraciclina/farmacologia , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Feminino , Gonorreia/diagnóstico , Infecções por HIV , Humanos , Masculino , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/isolamento & purificação , Uganda/epidemiologia
17.
Oncogene ; 38(7): 1136-1150, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30237440

RESUMO

Elucidation of mechanisms underlying the increased androgen receptor (AR) activity and subsequent development of aggressive prostate cancer (PrCa) is pivotal in developing new therapies. Using a systems biology approach, we interrogated the AR-regulated proteome and identified PDZ binding kinase (PBK) as a novel AR-regulated protein that regulates full-length AR and AR variants (ARVs) activity in PrCa. PBK overexpression in aggressive PrCa is associated with early biochemical relapse and poor clinical outcome. In addition to its carboxy terminus ligand-binding domain, PBK directly interacts with the amino terminus transactivation domain of the AR to stabilise it thereby leading to increased AR protein expression observed in PrCa. Transcriptome sequencing revealed that PBK is a mediator of global AR signalling with key roles in regulating tumour invasion and metastasis. PBK inhibition decreased growth of PrCa cell lines and clinical specimen cultured ex vivo. We uncovered a novel interplay between AR and PBK that results in increased AR and ARVs expression that executes AR-mediated growth and progression of PrCa, with implications for the development of PBK inhibitors for the treatment of aggressive PrCa.


Assuntos
Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , Proteínas de Neoplasias/metabolismo , Neoplasias da Próstata/metabolismo , Receptores Androgênicos/metabolismo , Transdução de Sinais , Linhagem Celular Tumoral , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/genética , Humanos , Masculino , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Quinases de Proteína Quinase Ativadas por Mitógeno/genética , Invasividade Neoplásica , Metástase Neoplásica , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/genética , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Inibidores de Proteínas Quinases/farmacologia , Receptores Androgênicos/genética
18.
Nucleic Acids Res ; 46(21): 11592-11604, 2018 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-30256975

RESUMO

RNA G-quadruplexes (rG4s) are secondary structures in mRNAs known to influence RNA post-transcriptional mechanisms thereby impacting neurodegenerative disease and cancer. A detailed knowledge of rG4-protein interactions is vital to understand rG4 function. Herein, we describe a systematic affinity proteomics approach that identified 80 high-confidence interactors that assemble on the rG4 located in the 5'-untranslated region (UTR) of the NRAS oncogene. Novel rG4 interactors included DDX3X, DDX5, DDX17, GRSF1 and NSUN5. The majority of identified proteins contained a glycine-arginine (GAR) domain and notably GAR-domain mutation in DDX3X and DDX17 abrogated rG4 binding. Identification of DDX3X targets by transcriptome-wide individual-nucleotide resolution UV-crosslinking and affinity enrichment (iCLAE) revealed a striking association with 5'-UTR rG4-containing transcripts which was reduced upon GAR-domain mutation. Our work highlights hitherto unrecognized features of rG4 structure-protein interactions that highlight new roles of rG4 structures in mRNA post-transcriptional control.


Assuntos
RNA Helicases DEAD-box/metabolismo , Quadruplex G , Genes ras/genética , Regiões 5' não Traduzidas , Citoplasma/genética , Citoplasma/metabolismo , RNA Helicases DEAD-box/genética , Células HeLa , Humanos , Domínios Proteicos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reprodutibilidade dos Testes
19.
AIDS Care ; 30(12): 1586-1594, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30114950

RESUMO

Our aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.


Assuntos
Infecções por HIV/complicações , Transtornos Mentais/complicações , Comorbidade , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Humanos , Transtornos Mentais/fisiopatologia , Transtornos Mentais/psicologia
20.
Science ; 361(6400): 341, 2018 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-30049870

Assuntos
Fogo , Fumaça
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