Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Ir J Med Sci ; 188(4): 1143-1148, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30815785

RESUMO

OBJECTIVE: Irish legislation on Advance Healthcare Directives (Assisted Decision Making Capacity Act 2015, ADMC) proposes to change the basis of decision making from acting in the patient's best interests to following the expressed will and intentions of the patient. Refusal of life-saving care can occur, without sound reasons. The implications for care in life-threatening emergencies have not been explored among clinicians. DESIGN: An anonymous questionnaire survey of Advanced Paramedics (AP) covering awareness of the legislation, attitudes to and experience of refusal of care and potential actions in emergency scenarios now and if the legislation were in force. The scenarios covered end-of-life and deliberate self-harm situations potentially requiring resuscitation. SETTING: All 482 graduates of the Advanced Paramedic Training Programme were invited to take part. RESULTS: Overall, 85/389 (21.9%) valid contacts responded, with demographic characteristics similar to the overall population. Attitudes ranged from highly positive to highly negative in relation to the potential impact of the legislation on professional and operational responsibilities. Respondents described marked changes in whether they would offer resuscitation if the ADMC were in place. CONCLUSION: Irish legislation which changes the traditional basis of medical practice away from the best interests of the patient may affect the resuscitation practices of Advanced Paramedics in life-threatening situations. It has significant implications for medical education, professional practice and clinician-patient interactions. This legislation and similar planned legislation may have implications for other EU jurisdictions.


Assuntos
Diretivas Antecipadas , Tomada de Decisões , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência , Adulto , Pessoal Técnico de Saúde , Estudos Transversais , Assistência à Saúde/métodos , Emergências , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
J Subst Abuse Treat ; 99: 61-66, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797395

RESUMO

BACKGROUND: Addiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. METHODS: In a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. RESULTS: Validity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). CONCLUSIONS: In our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.

3.
Ir J Med Sci ; 188(2): 683-688, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30112623

RESUMO

BACKGROUND: Paediatric airway management is of fundamental importance in the critically unwell child. Pre-hospital paediatric airway management especially endotracheal intubation is however controversial. AIM: To explore Irish Advanced Paramedics (APs) training, experience and clinical practice in paediatric airway management as well as to examine clinician attitudes toward this topic. METHODS: An anonymous online survey of all graduates of the University College Dublin AP training program (N = 453). RESULTS: With duplicates and failed email deliveries excluded a valid sample of 382 individuals was obtained from whom a response rate of 185/382 (48.4%) was achieved. Three quarters of responding APs worked in urban or mixed practice with the remaining minority operating primarily in rural areas. One quarter of responding APs reported formal training in paediatric intubation. Almost 70% of APs had encountered a child requiring significant airway management in the preceding year. However, this was a rare exposure in terms of overall workload. Basic airway adjuncts were used frequently in such circumstances, with endotracheal intubation having been attempted by only a small minority of APs. Lack of practice was identified by many responding APs as a key issue causing concern in terms of paediatric intubation. CONCLUSION: Paediatric airway management has key relevance for pre-hospital care in Ireland. The overall frequency of exposure to children who may benefit from definitive airway management is however likely to represent a significant barrier to the acquisition and maintenance of competency. The ongoing practice of pre-hospital paediatric intubation by APs may not justify its risks.


Assuntos
Manuseio das Vias Aéreas/métodos , Pessoal Técnico de Saúde/normas , Serviços Médicos de Emergência/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
Cochrane Database Syst Rev ; 12: CD009269, 2018 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-30521696

RESUMO

BACKGROUND: Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. OBJECTIVES: To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA: We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. AUTHORS' CONCLUSIONS: We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Usuários de Drogas/psicologia , Entrevista Motivacional/métodos , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adaptação Psicológica , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos Anônimos , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/terapia , Hepatite C/prevenção & controle , Humanos , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Grupos de Autoajuda , Transtornos Relacionados ao Uso de Substâncias/terapia , Temperança/estatística & dados numéricos , Fatores de Tempo
5.
Resuscitation ; 126: 43-48, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29510194

RESUMO

AIM: The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. METHODS: A ten year prospective observational study involving a cohort of Irish general practices. SETTING: 521 general practice settings distributed throughout the Republic of Ireland, representing approximately one quarter of all practices and a third of Irish GPs. PARTICIPANTS: 534 patients suffering cardiac arrest in the community for whom resuscitation was attempted. INTERVENTIONS: Cardiac arrest with resuscitation attempted (CARA) in which a GP played a role. RESULTS: Over a ten year period almost half of participating practices reported one or more CARAs. A total of 534 CARAs were reported at a variety of locations; 161 (30%) had ROSC (return of spontaneous circulation) at some point, with outcome data available for 147/161; 90 patients survived to hospital discharge. Most survivors for whom follow up data are available were discharged home and were completely independent. The highest rate of survival was achieved when CARAs occurred at a GP practice premises (47.4%). CONCLUSIONS: Resuscitation following OHCA is a key task in general practice. Over time a significant number of GPs encounter OHCA, attempt resuscitation and achieve higher survival to hospital discharge rates than occur nationally among OHCAs in Ireland. We conclude that a defibrillator should be routinely available at all general practices and staff should have appropriate resuscitation skills.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Reanimação Cardiopulmonar/métodos , Desfibriladores/estatística & dados numéricos , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos
6.
Br J Gen Pract ; 67(657): e267-e273, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28246098

RESUMO

BACKGROUND: More than 200 opiate overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone prescription, should be a priority for healthcare services. Naloxone is an effective overdose treatment and is now being considered for wider lay use. AIM: To establish GPs' views and experiences of opiate addiction, overdose care, and naloxone provision. DESIGN AND SETTING: An anonymous postal survey to GPs affiliated with the Department of Academic General Practice, University College Dublin, Ireland. METHOD: A total of 714 GPs were invited to complete an anonymous postal survey. Results were compared with a parallel GP trainee survey. RESULTS: A total of 448/714 (62.7%) GPs responded. Approximately one-third of GPs were based in urban, rural, and mixed areas. Over 75% of GPs who responded had patients who used illicit opiates, and 25% prescribed methadone. Two-thirds of GPs were in favour of increased naloxone availability in the community; almost one-third would take part in such a scheme. A higher proportion of GP trainees had used naloxone to treat opiate overdose than qualified GPs. In addition, a higher proportion of GP trainees were willing to be involved in naloxone distribution than qualified GPs. Intranasal naloxone was much preferred to single (P<0.001) or multiple dose (P<0.001) intramuscular naloxone. Few GPs objected to wider naloxone availability, with 66.1% (n = 292) being in favour. CONCLUSION: GPs report extensive contact with people who have opiate use disorders but provide limited opiate agonist treatment. They support wider availability of naloxone and would participate in its expansion. Development and evaluation of an implementation strategy to support GP-based distribution is urgently needed.


Assuntos
Overdose de Drogas/prevenção & controle , Medicina Geral , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Padrões de Prática Médica/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração , Educação de Pós-Graduação em Medicina , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irlanda , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/provisão & distribução , Padrões de Prática Médica/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
8.
BMC Med Educ ; 15: 206, 2015 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-26590066

RESUMO

BACKGROUND: Overdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone. We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone. METHODS: Participants (N = 23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire. RESULTS: Knowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most and least useful delivery methods were simulation and video, respectively. CONCLUSION: Appropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use.


Assuntos
Cuidadores/educação , Overdose de Drogas/tratamento farmacológico , Medicina Geral/educação , Conhecimentos, Atitudes e Prática em Saúde , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Administração Intranasal , Adulto , Overdose de Drogas/diagnóstico , Overdose de Drogas/prevenção & controle , Educação de Pós-Graduação em Medicina , Família , Estudos de Viabilidade , Feminino , Amigos , Educação em Saúde/métodos , Humanos , Irlanda , Masculino , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Projetos Piloto , Avaliação de Programas e Projetos de Saúde
9.
Int J Cardiol ; 178: 247-52, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25464263

RESUMO

BACKGROUND: To test the use of three lead monitoring as a screening tool for atrial fibrillation (AF) in general practice. AF is responsible for up to a quarter of all strokes and is often asymptomatic until a stroke occurs. METHODS: 26 randomly selected general practices identified 80 randomly selected patients aged 70 or older from their database and excluded those known to have AF, those with clinical issues or who had not attended for three years. Up to 40 eligible patients/practice were invited to attend for screening. A 2min three-lead ECG was recorded and collected centrally for expert cardiology assessment. Risk factor data was gathered. OUTCOMES: (i) point prevalence of AF, (ii) proportion of ECG tracings which were adequate for interpretation, (iii) uptake rate by patients and (iv) acceptability of the screening process to patients and staff (reported separately). RESULTS: Of 1447 current patients, 1003 were eligible for inclusion, 639 (64%) agreed to take part in screening and 566 (56%) completed screening. The point prevalence rate for AF was 10.3%-2.1% new cases (12 of 566 who were screened) and 9.5% existing cases (137 of 1447 eligible patients). Only four of 570 (0.7%) screening visits did not record a usable ECG and 11 (2.6%) three lead ECGs required a clarifying 12 lead ECG. CONCLUSIONS: Three lead screening for AF is feasible, effective and offers an alternative to pulse taking or 12 lead ECGs. The availability of this technology may facilitate more effective screening, leading to reduced stroke incidence.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Eletrocardiografia/tendências , Medicina Geral/tendências , Programas de Rastreamento/tendências , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Estudos Transversais , Eletrocardiografia/instrumentação , Feminino , Medicina Geral/instrumentação , Humanos , Irlanda/epidemiologia , Masculino , Programas de Rastreamento/instrumentação
10.
Cochrane Database Syst Rev ; (12): CD009269, 2014 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-25470303

RESUMO

BACKGROUND: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group trials register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, June 2014), MEDLINE (1966 to June 2014); EMBASE (1974 to June 2014); CINAHL (1982 to June 2014); PsycINFO (1872 to June 2014) and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; 2) online registers of clinical trials: Current Controlled Trials, Clinical Trials.org, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies, or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: Four studies, involving 594 participants, were included. Half of the trials were rated as having a high or unclear risk of bias. The studies considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (one study; 41 participants), (2) brief intervention versus treatment as usual (one study; 110 participants), (3) group or individual motivational interviewing (MI) versus hepatitis health promotion (one study; 256 participants) and (4) brief motivational intervention (BMI) versus assessment-only (one study; 187 participants). Differences between studies precluded any data pooling. Findings are described for each trial individually.Comparison 1: low-quality evidence; no significant difference for any of the outcomes considered Alcohol abstinence as maximum number of weeks of consecutive alcohol abstinence during treatment: mean difference (MD) 0.40 (95% confidence interval (CI) -1.14 to 1.94); illicit drug abstinence as maximum number of weeks of consecutive abstinence from cocaine during treatment: MD 0.80 (95% CI -0.70 to 2.30); alcohol abstinence as number achieving three or more weeks of consecutive alcohol abstinence during treatment: risk ratio (RR) 1.96 (95% CI 0.43 to 8.94); illicit drug abstinence as number achieving three or more weeks of consecutive abstinence from cocaine during treatment: RR 1.10 (95% CI 0.42 to 2.88); alcohol abstinence during follow-up year: RR 2.38 (95% CI 0.10 to 55.06); illicit drug abstinence as abstinence from cocaine during follow-up year: RR 0.39 (95% CI 0.04 to 3.98), moderate-quality evidence.Comparison 2: low-quality evidence, no significant difference for all the outcomes considered Alcohol use as AUDIT scores at three months: MD 0.80 (95% -1.80 to 3.40); alcohol use as AUDIT scores at nine months: MD 2.30 (95% CI -0.58 to 5.18); alcohol use as number of drinks per week at three months: MD 0.70 (95% CI -3.85 to 5.25); alcohol use as number of drinks per week at nine months: MD -0.30 (95% CI -4.79 to 4.19); alcohol use as decreased alcohol use at three months: RR 1.13 (95% CI 0.67 to 1.93); alcohol use as decreased alcohol use at nine months: RR 1.34 (95% CI 0.69 to 2.58), moderate-quality evidence.Comparison 3 (group and individual MI), low-quality evidence: no significant difference for all outcomes Group MI: number of standard drinks consumed per day over the past month: MD -0.40 (95% CI -2.03 to 1.23); frequency of drug use: MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD 0.00 (95% CI -0.42 to 0.42); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 1.10 (95% CI 0.82 to 1.48); abstinence from alcohol over the last 30 days: RR 0.88 (95% CI 0.49 to 1.58).Individual MI: number of standard drinks consumed per day over the past month: MD -0.10 (95% CI -1.89 to 1.69); frequency of drug use (as measured using the Addiction Severity Index (ASI drug): MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD -0.10 (95% CI -0.46 to 0.26); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 0.92 (95% CI 0.68 to 1.26); abstinence from alcohol over the last 30 days: RR 0.97 (95% CI 0.56 to 1.67).Comparison 4: more people reduced alcohol use (by seven or more days in the past month at 6 months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60), moderate-quality evidence. No significant difference was reported for all other outcomes: number of days in the past 30 days with alcohol use at one month: MD -0.30 (95% CI -3.38 to 2.78); number of days in the past month with alcohol use at six months: MD -1.50 (95% CI -4.56 to 1.56); 25% reduction of drinking days in the past month: RR 1.23 (95% CI 0.96 to 1.57); 50% reduction of drinking days in the past month: RR 1.27 (95% CI 0.96 to 1.68); 75% reduction of drinking days in the past month: RR 1.21 (95% CI 0.84 to 1.75); one or more drinking days' reduction in the past month: RR 1.12 (95% CI 0.91 to 1.38). AUTHORS' CONCLUSIONS: There is low-quality evidence to suggest that there is no difference in effectiveness between different types of interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adaptação Psicológica , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/terapia , Hepatite C/prevenção & controle , Humanos , Entrevista Motivacional/métodos , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/terapia , Temperança
11.
Am J Emerg Med ; 32(10): 1168-73, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25154346

RESUMO

BACKGROUND: Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose. OBJECTIVES: The objective of the study is to examine the baseline incidence of all new ODs in an ambulance service and their relationship with urban deprivation and presence of addiction services. METHODS: A prospective chart review of prehospital advanced life support patients was performed on confirmed OD calls. Demographic, geographic, and clinical information, that is, presentation, treatment, and outcomes, was collected for each call. The census data were used to calculate deprivation. Geographical information software mapped the urban deprivation and addiction services against the overdose locations. RESULTS: There were 469 overdoses, 13 of which were fatal; most were male (80%), of a young age (32 years), with a high rate of repeated overdoses (26%) and common polydrug use (9.6%). Most occurred in daytime (275) and on the streets (212). Overdoses were more likely in more affluent areas (r = .15; P < .05) and in a 1000-m radius of addiction services. Residential overdoses were in more deprived areas than street overdoses (mean difference, 7.8; t170 = 3.99; P < .001). Street overdoses were more common in the city center than suburbs (χ(2)(1) = 33.04; P < .001). CONCLUSIONS: The identified clusters of increased incidence-urban overdose hotspots-suggest a link between environment characteristics and overdoses. This highlights a need to establish overdose education and naloxone distribution in the overdose hotspots.


Assuntos
Ambulâncias/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/envenenamento , Antidepressivos/envenenamento , Benzodiazepinas/envenenamento , Depressores do Sistema Nervoso Central/envenenamento , Criança , Pré-Escolar , Estudos de Coortes , Overdose de Drogas/etiologia , Etanol/envenenamento , Feminino , Mapeamento Geográfico , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/reabilitação , Estudos Prospectivos , Distribuição por Sexo , Centros de Tratamento de Abuso de Substâncias/provisão & distribução , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
12.
N Z Med J ; 119(1242): U2234, 2006 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-16998576

RESUMO

AIMS: To review the data and outcome of patients with osteosarcoma in New Zealand from 1994 to 1999 and to compare this to data retrieved from a similar study from 1981 to 1987. METHODS: Data from 1994-1999 was obtained from the New Zealand Cancer Registry; raw data was also retrieved from the 1981-1987 study. RESULTS: There were 96 cases in the 1981-1987 cohort and 84 cases in the 1994-1999 cohort. Overall, 5-year survival from osteosarcoma improved from 32.3% to 44.0% between the cohorts. When the cohorts were compared, there was a trend toward improved outcome in most subgroups CONCLUSIONS: The outcome in patients with osteosarcoma in New Zealand has improved over the study period and is similar to that seen in the overseas literature.


Assuntos
Neoplasias Ósseas/mortalidade , Osteossarcoma/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/terapia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Osteossarcoma/terapia , Sistema de Registros , Distribuição por Sexo , Análise de Sobrevida
13.
J Immunol ; 173(3): 1549-60, 2004 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-15265882

RESUMO

The MHC class II-like molecule HLA-DM (DM) (H-2M in mice) catalyzes the exchange of CLIP for antigenic peptides in the endosomes of APCs. HLA-DO (DO) (H-2O in mice) is another class II-like molecule that is expressed in B cells, but not in other APCs. Studies have shown that DO impairs or modifies the peptide exchange activity of DM. To further evaluate the role of DO in Ag processing and presentation, we generated transgenic mice that expressed the human HLA-DOA and HLA-DOB genes under the control of a dendritic cell (DC)-specific promoter. Our analyses of DCs from these mice showed that as DO levels increased, cell surface levels of A(b)-CLIP also increased while class II-peptide levels decreased. The presentation of some, but not all, exogenous Ags to T cells or T hybridomas was significantly inhibited by DO. Surprisingly, H-2M accumulated in DO-expressing DCs and B cells, suggesting that H-2O/DO prolongs the half-life of H-2M. Overall, our studies showed that DO expression impaired H-2M function, resulting in Ag-specific down-modulation of class II Ag processing and presentation.


Assuntos
Apresentação do Antígeno/imunologia , Células Dendríticas/imunologia , Antígenos HLA-D/fisiologia , Actinas/imunologia , Animais , Apresentação do Antígeno/genética , Antígenos/imunologia , Antígenos de Diferenciação de Linfócitos B/imunologia , Linfócitos B/imunologia , Linfócitos B/metabolismo , Antígeno CD11c/genética , Células Cultivadas , Células Dendríticas/metabolismo , Genes Sintéticos , Antígenos H-2/imunologia , Antígenos H-2/metabolismo , Antígenos HLA-D/biossíntese , Antígenos HLA-D/genética , Antígenos de Histocompatibilidade Classe II/imunologia , Antígenos de Histocompatibilidade Classe II/metabolismo , Humanos , Hibridomas/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Muramidase/imunologia , Ovalbumina/imunologia , Fragmentos de Peptídeos/imunologia , Regiões Promotoras Genéticas/genética , Proteínas Recombinantes de Fusão/fisiologia , Microglobulina beta-2/imunologia
14.
Eur J Immunol ; 33(9): 2361-71, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12938212

RESUMO

The class II transactivator (CIITA) regulates expression of the classical and non-classical MHC class II genes, HLA-DR, -DP, -DQ and -DM, but not the B cell-specific HLA-DO (DO). Here we show that only HLA-DR expression is completely dependent on CIITA, since residual expression of HLA-DM, -DP and the beta chain of DQ was observed in CIITA-deficient RJ2.2.5 cells. Although DO shows a unique expression pattern compared to other MHC class II genes, prolonged IFN-gamma treatment of HeLa cells induced DOB expression. Similar to all MHC class II promoters, the DOB promoter contains the highly conserved W, X1, and Y boxes in addition to a putative OCT box. Mutational analysis of the DOB promoter demonstrated that the X1, Y and OCT boxes are necessary for maximum promoter activity.Furthermore, our results demonstrate that CREB-1, RFXANK and Oct-2 occupy the DOB promoter in vivo, However, CIITA and Bob-1 were only minimally recruited. Finally, fusion of Bjab, a DOB-negative B cell line, with.174 B cells that lack the complete MHC class II region (including the DO genes), lead to DO expression. These data indicate that the expression of DO is regulated by an unidentified factor in B cells.


Assuntos
Regulação da Expressão Gênica , Antígenos HLA-D/genética , Antígenos de Histocompatibilidade Classe II/genética , Proteínas Nucleares , Transcrição Genética , Adjuvantes Imunológicos/farmacologia , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico , Proteínas de Ligação a DNA/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Antígenos HLA-D/efeitos dos fármacos , Células HeLa , Antígenos de Histocompatibilidade Classe II/efeitos dos fármacos , Humanos , Interferon gama/farmacologia , Fator 2 de Transcrição de Octâmero , Regiões Promotoras Genéticas , Transativadores/metabolismo , Fatores de Transcrição/metabolismo , Transcrição Genética/efeitos dos fármacos
15.
J Exp Med ; 195(8): 1063-9, 2002 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-11956297

RESUMO

Peptide acquisition by MHC class II molecules is catalyzed by HLA-DM (DM). In B cells, HLA-DO (DO) inhibits or modifies the peptide exchange activity of DM. We show here that DO protein levels are modulated during B cell differentiation. Remarkably, germinal center (GC) B cells, which have low levels of DO relative to naive and memory B cells, are shown to have enhanced antigen presentation capabilities. DM protein levels also were somewhat reduced in GC B cells; however, the ratio of DM to DO in GC B cells was substantially increased, resulting in more free DM in GC B cells. We conclude that modulation of DM and DO in distinct stages of B cell differentiation represents a mechanism by which B cells regulate their capacity to function as antigen-presenting cells. Efficient antigen presentation in GC B cells would promote GC B cell-T cell interactions that are essential for B cells to survive positive selection in the GC.


Assuntos
Apresentação do Antígeno/imunologia , Linfócitos B/imunologia , Centro Germinativo/imunologia , Antígenos HLA-D/imunologia , Células Apresentadoras de Antígenos/imunologia , Antígenos de Diferenciação de Linfócitos B/imunologia , Subpopulações de Linfócitos B/imunologia , Linhagem Celular , Regulação para Baixo , Antígenos HLA-DR/imunologia , Antígenos de Histocompatibilidade Classe II/imunologia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA