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1.
Psychol Med ; : 1-26, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32674747

RESUMO

BACKGROUND: Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. METHOD: We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. RESULTS: In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22-0.39), anxiety g = 0.19 (95% CI 0.12-0.27), and distress g = 0.36 (95% CI 0.23-0.49). CONCLUSION: Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.

3.
Pediatr Blood Cancer ; 65(11): e27349, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30039912

RESUMO

BACKGROUND: While several studies have examined the treatment of adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), studies of acute myeloid leukemia (AML) are rare. Using national data for Australia, we describe (i) the number and type of treatment centers caring for AYAs, (ii) induction/first-line treatments, and (iii) survival outcomes. PROCEDURE: National population-based study assessing treatment of 15- to 24-year-olds diagnosed with ALL or AML between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult (adult AYA-focused or other adult; and by AYA volume [high/low]). Cox proportional hazard regression analyses examined associations between treatment and overall, event-free, and relapse-free survival outcomes. RESULTS: Forty-seven hospitals delivered induction therapy to 351 patients (181 ALL and 170 AML), with 74 (21%) treated at pediatric centers; 70% of hospitals treated less than two AYA leukemia patients per year. Regardless of treatment center, 82% of ALL patients were on pediatric protocols. For AML, pediatric protocols were not used in adult centers, with adult centers using a non-COG 7+3-type induction protocol (51%, where COG is Cooperative Oncology Group) or an ICE-type protocol (39%, where ICE is idarubicin, cytarabine, etoposide). Exploratory analyses suggested that for both ALL and AML, AYAs selected for adult protocols have worse overall, event-free, and relapse-free survival outcomes. CONCLUSIONS: Pediatric protocols were commonly used for ALL patients regardless of where they are treated, indicating rapid assimilation of recent evidence by Australian hematologists. For AML, pediatric protocols were only used at pediatric centers. Further investigation is warranted to determine the optimal treatment approach for AYA AML patients.


Assuntos
Quimioterapia de Indução/métodos , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Austrália , Feminino , Humanos , Masculino , Oncologia/métodos , Pediatria/métodos , Modelos de Riscos Proporcionais , Resultado do Tratamento , Adulto Jovem
4.
Eur J Oncol Nurs ; 34: 42-48, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29784137

RESUMO

PURPOSE: A cancer diagnosis and treatment may have significant implications for a young patient's future fertility. Documentation of fertility-related discussions and actions is crucial to providing the best follow-up care, which may occur for many years post-treatment. This study examined the rate of medical record documentation of fertility-related discussions and fertility preservation (FP) procedures for adolescents and young adults (AYAs) with cancer in Australia. METHODS: A retrospective review of medical records for 941 patients in all six Australian states. Patients were identified through population-based cancer registries (four states) and hospital admission lists (two states). Trained data collectors extracted information from medical records using a comprehensive data collection survey. Records were reviewed for AYA patients (aged 15-24 years at diagnosis), diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, central nervous system (CNS) tumours, soft tissue sarcomas (STS), primary bone cancer or Ewing's family tumours between 2007 and 2012. RESULTS: 47.2% of patients had a documented fertility discussion and 35.9% had a documented FP procedure. Fertility-related documentation was less likely for female patients, those with a CNS or STS diagnosis and those receiving high-risk treatments. In multivariable models, adult hospitals with an AYA focus were more likely to document fertility discussions (odds ratio[OR] = 1.60; 95%CI = 1.08-2.37) and FP procedures (OR = 1.74; 95%CI = 1.17-2.57) than adult hospitals with no AYA services. CONCLUSIONS: These data provide the first national, population-based estimates of fertility documentation for AYA cancer patients in Australia. Documentation of fertility-related discussions was poor, with higher rates observed in hospitals with greater experience of treating AYA patients.


Assuntos
Documentação/métodos , Preservação da Fertilidade/psicologia , Preservação da Fertilidade/estatística & dados numéricos , Fertilidade/efeitos dos fármacos , Fertilidade/efeitos da radiação , Neoplasias/psicologia , Neoplasias/terapia , Adolescente , Adulto , Austrália , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
5.
Am Surg ; 84(1): 154-160, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29428045

RESUMO

Genetic testing is important for comprehensive cancer care. Commercial analysis of the BRCA1/2 genes has been available since 1996, and testing for hereditary breast and ovarian cancer syndrome is well established. The National Comprehensive Cancer Network (NCCN) guidelines identify individuals for whom BRCA1/2 analysis is appropriate and define management recommendations for mutation carriers. Despite recommendations, not all who meet NCCN criteria undergo genetic testing. We assess the frequency that individuals meeting NCCN criteria decline BRCA1/2 analysis, as well as factors that affect the decision-making process. A retrospective chart review was performed from September 2013 through August 2014 of individuals who received genetic counseling at the Levine Cancer Institute. A total of 1082 individuals identified through the retrospective chart review met NCCN criteria for BRCA1/2 analysis. Of these, 267 (24.7%) did not pursue genetic testing. Of the Nontested cohort, 59 (22.1%) were disinterested in testing and 108 (40.4%) were advised to gather additional genetic or medical information about their relatives before testing. The remaining 100 (37.5%) individuals were insured and desired to undergo genetic testing but were prohibited by the expense. Eighty five of these 100 patients were responsible for the total cost of the test, whereas the remaining 15 faced a prohibitive copay expense. Financial concerns are a major deterrent to the pursuit of BRCA1/2 analysis among those who meet NCNN criteria, especially in patients diagnosed with breast or ovarian cancer. These findings highlight the need to address financial concerns for genetic testing in this high-risk population.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Tomada de Decisões , Testes Genéticos , Cooperação do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Mutacional de DNA , Feminino , Aconselhamento Genético , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Medição de Risco , Fatores de Risco
6.
Placenta ; 52: 21-32, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28454694

RESUMO

An adverse intrauterine programming occurs in diabetes and obesity as the consequence of an adverse maternal environment that affects the appropriate fetoplacental development and growth. Experimental models of diabetes and fat overfeeding have provided relevant tools to address putative mechanisms of the adverse intrauterine programming. The current knowledge far extends from the original thoughts of the resulting intrauterine programming of metabolic and cardiovascular diseases to a full range of alterations that affect multiple tissues, organs, and systems that will compromise the long-life health of the offspring. This review examines the postnatal effects of rodent models of mild diabetes and fat overfeeding, identifying the multiple organ derangements in the offspring resulting from mild maternal adverse conditions. In addition, the comparison of experimental models of severe diabetes and fat overfeeding and the crucial role of the placenta are discussed, providing an update of the actual scenario of the putative mechanisms and adverse consequences of maternal metabolic derangements.


Assuntos
Diabetes Mellitus/metabolismo , Desenvolvimento Fetal/fisiologia , Placenta/metabolismo , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Animais , Diabetes Mellitus/patologia , Modelos Animais de Doenças , Feminino , Placenta/patologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/patologia , Roedores
7.
Artigo em Inglês | MEDLINE | ID: mdl-28144993

RESUMO

Modern healthcare systems promote patient choice of cancer treatment provider, but little is known about how place of residence influences decision-making. This research explored how rural and urban patients with breast or colorectal cancer experience choice of cancer treatment provider in Victoria, Australia. Realist thematic analysis of 43 semi-structured telephone interviews identified little active participation in decision-making regardless of area of residence or cancer diagnosis. Perceptions of choice were impacted by urgency for treatment, insurance status and access to providers, a key issue for rural patients. All patients wanted high quality care, but needed to trust health professional's recommendations. Rural patients experienced more complex decision-making, balancing a range of social factors with perceptions about quality of accessible care. Further research into variation in quality of care and complex cancer pathways for rural and urban cancer patients is warranted to inform choices and enhance patient-centred care.


Assuntos
Neoplasias da Mama/terapia , Comportamento de Escolha , Neoplasias Colorretais/terapia , Oncologistas , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Tomada de Decisões , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , População Rural , Confiança , População Urbana , Vitória
8.
Int J STD AIDS ; 28(2): 192-195, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27784828

RESUMO

In 2009, 'Don't forget the children' guideline recommended that all new HIV-positive patients attending adult HIV services should have any existing children identified and tested for HIV alongside a coherent documentation process. A retrospective case note review was performed on 173 HIV-positive women registered at the Royal South Hants adult HIV service until 31 January 2014. Data were assessed as a whole (n = 173) and, in addition, two comparator groups were formulated: (a) pre-guidelines (n = 108) and (b) post-guidelines (n = 65). Out of 80 children eligible for HIV testing, only 43 (54%) had clear documentation of a test result, and in the remaining 37 (46%), it was either not considered or not followed through. Documentation of need for testing increased significantly from 67% in pre-guideline group to 100% in the post-guideline group (p < 0.001). The median time from recognition of need to test to actual testing remained 24 months in both groups. Although this audit demonstrated improvement in identification of at-risk children and their testing, there is still need for improvement.


Assuntos
Documentação/normas , Soropositividade para HIV/transmissão , Transmissão Vertical de Doença Infecciosa , Auditoria Médica , Sorodiagnóstico da AIDS , Adolescente , Criança , Pré-Escolar , Documentação/estatística & dados numéricos , Feminino , Humanos , Lactente , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Adulto Jovem
9.
Intern Med J ; 46(9): 1023-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27396473

RESUMO

BACKGROUND/AIM: The aim of this study was to describe the time and documentation needed to gain ethics and governance approvals in Australian states with and without a centralised ethical review system. METHODS: This is a prospective descriptive study undertaken between February 2012 and March 2015. Paediatric and adult hospitals (n = 67) in Australian states were approached to allow the review of their medical records. Participants included 15- to 24-year-olds diagnosed with cancer between 2008 and 2012. The main outcomes measures were time (weeks) to approval for ethics and governance and the number and type of documents submitted. RESULTS: Centralised ethics approval processes were used in five states, with approval taking between 2 and 18 weeks. One state did not use a centralised process, with ethics approval taking a median of 4.5 weeks (range: 0-15) per site. In four states using a centralised ethics process, 33 governance applications were submitted, with 20 requiring a site clinician listed as an investigator. Governance applications required the submission of 11 documents on average, including a Site-Specific Assessment form. Thirty-two governance applications required original signatures from a median of 3.5 (range: 1-10) non-research persons, which took a median of 5 weeks (range: 0-15) to obtain. Governance approval took a median of 6 weeks (range: 1-45). Twelve research study agreements were needed, each taking a median of 7.5 weeks (range: 1-20) to finalise. CONCLUSION: The benefits of centralised ethics review systems have not been realised due to duplicative, inflexible governance processes. A system that allowed the recognition of prior ethical approval and low-risk applications was more efficient than a central ethics and site-specific governance process.


Assuntos
Pesquisa Biomédica/ética , Revisão Ética/normas , Comitês de Ética em Pesquisa/organização & administração , Hospitais/ética , Adolescente , Austrália , Comportamento Cooperativo , Humanos , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
10.
J Dairy Sci ; 98(9): 6029-47, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26117352

RESUMO

The dry period is acknowledged as playing a key role in mastitis epidemiology and yet surprisingly few studies have explored dry period infection dynamics in detail. The aim of this study was to investigate the dynamics of intramammary infection across a cohort of dairy herds in Europe. Five hundred and twenty-two cows were recruited from 12 farms in 6 European countries. All cows received antibiotic dry cow therapy but teat sealants were not used. All quarters of all cows were sampled for bacteriology at drying off and in the week immediately postcalving. Two ipsilateral quarters were also sampled for bacteriology in each cow 2 and 6wk after drying off. Cows were body condition scored and teats assessed for cleanliness at all sampling time points and for the presence of a keratin plug during the dry period. Other cow-level parameters such as historic somatic cell counts and milk yields before drying off were collated from farm records. Univariable and multivariable analyses were undertaken to investigate the etiology, prevalence, and dynamics of infection during the dry period and associated influential factors. In summary, environmental mastitis pathogens predominated. Although gram-positive major pathogens were typically well controlled and did not increase in prevalence across the dry period, gram-negative pathogens generally increased in prevalence. There was an increase in the number of quarters that yielded no growth across the dry period, although this was driven by minor rather than major mastitis pathogen control. Other than the presence of a gram-positive or gram-negative pathogen 6wk after drying off, the measured parameters were not influential when considering their effect on the presence of pathogens postcalving. Analysis also suggested that the early and mid dry period may be more important with respect to the timing of acquisition of infection than previously thought. We observed substantial variation in the etiology and prevalence of different pathogens on different farms with, in all cases, at least one of the 12 herds experiencing the opposite of the others with respect to increases and decreases in pathogen prevalence. Overall, this study confirms the importance of the dry period in mastitis epidemiology but highlights the importance of assessing and understanding infection dynamics on individual units. The lack of influence of the cow and quarter factors measured in this study suggests that herd and management factors may be more influential.


Assuntos
Glândulas Mamárias Animais/microbiologia , Mastite Bovina/epidemiologia , Leite/metabolismo , Criação de Animais Domésticos , Animais , Bovinos , Indústria de Laticínios , Europa (Continente)/epidemiologia , Feminino , Mastite Bovina/microbiologia , Prevalência
11.
J Dairy Sci ; 98(3): 1706-20, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25529419

RESUMO

Vaccination can play a useful role in mastitis control programs, although there is a relative dearth of large, well-controlled field efficacy studies. This paper presents the findings on the use of a commercially available vaccine (Startvac, Hipra UK Ltd., Nottingham, UK) on commercial units under UK field conditions. In total, 3,130 cows were recruited from 7 farms and were randomly allocated, within farm, to 1 of 3 groups. The first group received the vaccine following the label regimen, the second group was vaccinated every 90 d following an initial vaccination course, and the third group was left unvaccinated to act as controls. Vaccine efficacy was assessed in the first 120 d of lactation. Data were available for analysis from 1,696 lactations in 1,549 cows. In total, 779 cases of clinical mastitis occurred in the 3 study groups, and we detected no significant difference in the incidence or prevalence of clinical or subclinical mastitis between any of the 3 groups. Mastitis vaccination following the label regimen was associated with a significant reduction in the severity of clinical cases. Cows in this group were at significantly decreased odds of developing clinical mastitis presenting with more than just milk changes [odds ratio: 0.58; 95% confidence interval (CI): 0.35-0.98]. Similarly, each additional vaccination resulted in a cow being at decreased odds of developing clinical mastitis presenting with more than just milk changes (odds ratio: 0.87; 95% CI: 0.77-0.98). Although no cows were culled because of severe mastitis in either of the vaccinated groups, we detected no significant difference in the mastitis-related culling rate between groups. Analysis of milk production data demonstrated that, on average, cows on the label regimen produced a higher volume of milk (231 L; 95% CI: 104.1-357.4) and more milk solids (12.36 kg; 95% CI: 3.12-21.60) than unvaccinated cows in the first 120 d of lactation. Conservative analysis suggested that a return on investment of 2.57:1 could be expected under UK conditions based on increased milk yield alone.


Assuntos
Vacinas Bacterianas/imunologia , Infecções por Escherichia coli/veterinária , Escherichia coli/imunologia , Mastite Bovina/prevenção & controle , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/imunologia , Vacinação/veterinária , Animais , Vacinas Bacterianas/administração & dosagem , Bovinos , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/prevenção & controle , Feminino , Mastite Bovina/microbiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Fatores de Tempo , Reino Unido , Vacinas de Produtos Inativados/administração & dosagem
12.
BMJ Case Rep ; 20142014 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-24748138

RESUMO

A young Bangladeshi woman presented to the emergency department with vaginal discharge on a history of fevers and rigours. Although initially treated for pelvic inflammatory disease, the patient rapidly developed respiratory failure with acute respiratory distress syndrome. An axillary biopsy and a high-resolution CT of the chest confirmed miliary tuberculosis (TB). She was initiated on anti-TB medication and made a rapid recovery.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/etiologia , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico , Descarga Vaginal/etiologia , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Disuria/etiologia , Feminino , Febre/etiologia , Humanos , Tuberculose Miliar/tratamento farmacológico
13.
J Fish Dis ; 37(7): 641-55, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23941303

RESUMO

In 2003, the Alaska walleye pollock industry reported product quality issues attributed to an unspecified parasite in fish muscle. Using molecular and histological methods, we identified the parasite in Bering Sea pollock as Ichthyophonus. Infected pollock were identified throughout the study area, and prevalence was greater in adults than in juveniles. This study not only provides the first documented report of Ichthyophonus in any fish species captured in the Bering Sea, but also reveals that the parasite has been present in this region for nearly 20 years and is not a recent introduction. Sequence analysis of 18S rDNA from Ichthyophonus in pollock revealed that consensus sequences were identical to published parasite sequences from Pacific herring and Yukon River Chinook salmon. Results from this study suggest potential for Ichthyophonus exposures from infected pollock via two trophic pathways; feeding on whole fish as prey and scavenging on industry-discharged offal. Considering the notable Ichthyophonus levels in pollock, the low host specificity of the parasite and the role of this host as a central prey item in the Bering Sea, pollock likely serve as a key Ichthyophonus reservoir for other susceptible hosts in the North Pacific.


Assuntos
Doenças dos Peixes/epidemiologia , Gadiformes , Infecções por Mesomycetozoea/epidemiologia , Mesomycetozoea/isolamento & purificação , Alaska , Animais , DNA de Protozoário/genética , Doenças dos Peixes/parasitologia , Doenças dos Peixes/transmissão , Infecções por Mesomycetozoea/parasitologia , Infecções por Mesomycetozoea/transmissão , Dados de Sequência Molecular , RNA Ribossômico 18S/genética , Análise de Sequência de DNA/veterinária
14.
J Endocrinol ; 217(3): 303-15, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23482704

RESUMO

Metabolic alterations in obese and overweight mothers impact the placenta and the fetus, leading to anomalies in fetal growth and lipid accretion. The primary aim of the study was to examine the effect of a saturated fat-rich diet (FD) on growth, lipid accretion, and lipases, leptin and leptin receptor (ObR) expression in the placenta and fetal liver. We also aimed to find a role for fetal leptin in the modulation of placental and fetal liver lipase and ObR expression. Six-week-old rats were fed with a standard rat chow (control) or a 25% FD for 7 weeks until mating and during pregnancy. Also, in a group of control rats, fetuses were injected with leptin on days 19, 20, and 21 of pregnancy. On day 21, we assessed lipidemia, insulinemia, and leptinemia in mothers and fetuses. In the placenta and fetal liver, lipid concentration was assessed by thin layer chromatography (TLC) and the gene expression of lipoprotein lipase (LPL), endothelial lipase, insulin receptor (Insr), leptin, and ObR by RT-PCR. The FD induced hypertriglyceridemia and hyperleptinemia (P<0.01) in mothers and fetuses, an increase in maternal (P<0.05) and fetal weight (P<0.01), overaccumulation of lipids in fetal liver (P<0.01), and enhanced leptin expression in the placenta and fetal liver (P<0.05). Placental expression of IR and LPL was increased (P<0.05), and ObR decreased (P<0.05) in the FD group. Fetal administration of leptin induced the placental and fetal liver downregulation of ObR (P<0.05) and upregulation of LPL expression (P<0.05). The FD led to increased fetal lipid levels, which may result from high maternal lipid availability and fetal leptin effects.


Assuntos
Dieta Hiperlipídica , Ácidos Graxos/farmacologia , Lipídeos/sangue , Lipase Lipoproteica/metabolismo , Placenta/metabolismo , Receptores para Leptina/metabolismo , Animais , Gorduras na Dieta/metabolismo , Gorduras na Dieta/farmacologia , Feminino , Leptina/genética , Leptina/metabolismo , Lipase/genética , Lipase/metabolismo , Lipase Lipoproteica/genética , Fígado/efeitos dos fármacos , Fígado/metabolismo , Placenta/efeitos dos fármacos , Gravidez , Ratos , Receptor de Insulina/genética , Receptor de Insulina/metabolismo , Receptores para Leptina/genética
15.
Indoor Air ; 23(3): 185-95, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23137181

RESUMO

UNLABELLED: A study was conducted to investigate the effectiveness of three air purification systems in reducing the exposure of children to air contaminants inside nine classrooms of three Southern California schools. Continuous and integrated measurements were conducted to monitor the indoor and outdoor concentrations of ultrafine particles (UFPs), fine and coarse particulate matter (PM2.5 and PM10 , respectively), black carbon (BC), and volatile organic compounds. An heating, ventilating, and air conditioning (HVAC)-based high-performance panel filter (HP-PF), a register-based air purifier (RS), and a stand-alone air cleaning system (SA) were tested alone and in different combinations for their ability to remove the monitored pollutants. The combination of a RS and a HP-PF was the most effective solution for lowering the indoor concentrations of BC, UFPs, and PM2.5 , with study average reductions between 87% and 96%. When using the HP-PF alone, reductions close to 90% were also achieved. In all cases, air quality conditions were improved substantially with respect to the corresponding baseline (preexisting) conditions. Data on the performance of the gas-absorbing media included in the RS and SA unit were inconclusive, and their effectiveness, lifetime, costs, and benefits must be further assessed before conclusions and recommendations can be made. PRACTICAL IMPLICATIONS: The installation of effective air filtration devices in classrooms may be an important mitigation measure to help reduce the exposure of school children to indoor pollutants of outdoor origin including ultrafine particles and diesel particulate matter, especially at schools located near highly trafficked freeways, refineries, and other important sources of air toxics.


Assuntos
Filtros de Ar , Poluição do Ar em Ambientes Fechados/prevenção & controle , Material Particulado/isolamento & purificação , Compostos Orgânicos Voláteis/isolamento & purificação , California , Projetos Piloto , Instituições Acadêmicas/estatística & dados numéricos
16.
Mol Hum Reprod ; 18(5): 253-64, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22180326

RESUMO

Maternal diabetes increases the risk of embryo malformations. Folic acid and safflower oil supplementations have been shown to reduce embryo malformations in experimental models of diabetes. In this study we here tested whether folic acid and safflower oil supplementations interact to prevent embryo malformations in diabetic rats, and analyzed whether they act through the regulation of matrix metalloproteinases (MMPs), their endogenous inhibitors (TIMPs), and nitric oxide (NO) and reactive oxygen species production. Diabetes was induced by streptozotocin administration prior to mating. From Day 0.5 of pregnancy, rats did or did not receive folic acid (15 mg/kg) and/or a 6% safflower oil-supplemented diet. Embryos and decidua were explanted on Day 10.5 of gestation for further analysis of embryo resorptions and malformations, MMP-2 and MMP-9 activities, TIMP-1 and TIMP-2 levels, NO production and lipid peroxidation. Maternal diabetes induced resorptions and malformations that were prevented by folic acid and safflower oil supplementation. MMP-2 and MMP-9 activities were increased in embryos and decidua from diabetic rats and decreased with safflower oil and folic acid supplementations. In diabetic animals, the embryonic and decidual TIMPs were increased mainly with safflower oil supplementation in decidua and with folic acid in embryos. NO overproduction was decreased in decidua from diabetic rats treated with folic acid alone and in combination with safflower oil. These treatments also prevented increases in embryonic and decidual lipid peroxidation. In conclusion, folic acid and safflower oil supplementations interact and protect the embryos from diabetes-induced damage through several pathways related to a decrease in pro-inflammatory mediators.


Assuntos
Diabetes Mellitus Experimental/complicações , Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Gravidez em Diabéticas , Efeitos Tardios da Exposição Pré-Natal/tratamento farmacológico , Substâncias Protetoras/uso terapêutico , Óleo de Cártamo/uso terapêutico , Animais , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/prevenção & controle , Embrião de Mamíferos/efeitos dos fármacos , Embrião de Mamíferos/metabolismo , Desenvolvimento Embrionário/efeitos dos fármacos , Feminino , Reabsorção do Feto/prevenção & controle , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Óxido Nítrico/metabolismo , Gravidez , Resultado da Gravidez , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo
17.
J Med Entomol ; 48(5): 999-1007, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21936318

RESUMO

Diseases transmitted by mosquitoes could be controlled if vector populations were replaced with strains that have reduced vector competency. Such a strategy is being developed for control of dengue virus which is transmitted by Aedes aegypti (L.) (Diptera: Culicidae). Mosquitoes artificially infected with the bacterium, Wolbachia pipientis Hertig, are being assessed as candidates for release at the adult stage with the aim of replacement of the wild population. Wolbachia can reduce the capacity of Ae. aegypti to transmit dengue virus and has potential to be driven through the natural population via a system of cytoplasmic incompatibility. Deployment of benign mosquito strains will be influenced by population size and structure of wild-type Ae. aegypti in proposed release areas, as well as rates of gene flow among populations in the wet and dry tropical seasons. Mosquitoes from northern Queensland were screened with genetic markers to find an optimal locality for release of a benign strain of Ae. aegypti. The inland towns of Chillagoe and Charters Towers and the coastal town of Ingham had mosquito populations that were partly genetically isolated from mosquitoes in other areas across both seasons. These locations may be suitable release sites if it is important for the released strain to be restricted during initial phases of implementation. Smaller genetic differences were also evident among other regions and were consistent over two seasons (wet and dry).


Assuntos
Aedes/genética , Vírus da Dengue/fisiologia , Dengue/prevenção & controle , Insetos Vetores/genética , Controle Biológico de Vetores , Wolbachia/fisiologia , Aedes/classificação , Aedes/microbiologia , Aedes/virologia , Animais , Variação Genética , Insetos Vetores/classificação , Insetos Vetores/microbiologia , Insetos Vetores/virologia , Dinâmica Populacional , Queensland , Estações do Ano
18.
Eur J Cancer Care (Engl) ; 20(6): 776-84, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21771131

RESUMO

Following the release of the national clinical treatment recommendations for ductal carcinoma in situ (DCIS), consumers' and surgeons' characterisation of this disease was assessed. Telephone interviews were conducted with 231 women diagnosed with DCIS, in Victoria, Australia in 2006/2007 and 63 treating surgeons completed a mailed survey. The main outcome measures were: women's diagnostic experience, women's and surgeons' description of DCIS, women's understanding of DCIS, confusion and worry about the disease and risk perceptions. While the majority of women had not heard of DCIS prior to diagnosis, most reported a positive diagnostic experience. Surgeons' and women's description of DCIS were consistent. Women understood that DCIS is a contained disease (86%), can progress (88%) and treatment aims to prevent invasive cancer (97%). However, only 13% understood that DCIS alone cannot spread to other parts of the body. A quarter of the women were confused about the risk of DCIS spreading. Younger women had more concerns about developing breast cancer (P= 0.008) and the disease spreading (P= 0.002) and rated their risk of invasive disease higher (P= 0.007). Most women diagnosed with DCIS in 2006/2007 understand the 'early, contained nature' of the disease, but understanding of the 'non-invasive' nature of DCIS could be improved.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Encaminhamento e Consulta/normas , Adulto , Idoso , Atitude do Pessoal de Saúde , Austrália , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários
19.
Eur J Surg Oncol ; 37(2): 101-8, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21195576

RESUMO

AIMS: Sentinel lymph node biopsy (SLNB) is an important method of staging early breast cancer because of the inherent benefits it confers on patients in terms of arm function and quality of life. Its success depends on a high level of accuracy in detecting the sentinel node. This is achieved by a dual mapping technique that employs a radio-labelled nanocolloid and a vital blue dye. The vital dyes however carry the risk of anaphylaxis, and as more surgeons employ SLNB in their daily practice, a proportionate rise in the number of anaphylactic reactions can be expected. A comprehensive review of risks and benefits associated with using vital blues dyes has not been published and therefore a retrospective review was undertaken of the different levels of anaphylaxis associated with vital dyes as well as their benefits in SLNB. METHODS: An OVID MEDLINE search was performed of the English published literature using appropriate search terms to find published trial data and case series that focused on adverse reactions to vital blue dyes. RESULTS: The risk of severe anaphylaxis (grade 3) can be as low as 0.06%, and up to 0.4% for patients undergoing SLNB when data is analysed from large trials. Furthermore, adverse reactions associated with blue dyes are reversible with appropriate management. CONCLUSIONS: Surgeons should continue to use vital dyes to ensure that SLNB remains a highly sensitive procedure.


Assuntos
Anafilaxia/induzido quimicamente , Neoplasias da Mama/patologia , Corantes/efeitos adversos , Biópsia de Linfonodo Sentinela/efeitos adversos , Feminino , Humanos , Estadiamento de Neoplasias
20.
Eur J Cancer Care (Engl) ; 20(1): 87-92, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20148935

RESUMO

This study explored the perceived needs of health professional and peer facilitators of cancer support groups. Participants were facilitators of support groups affiliated with The Cancer Council Victoria (Australia). Facilitators completed questionnaires assessing their experience of support group facilitation, including training and support needs. Data from health professional and peer facilitators (n= 74) were analysed in this paper. The majority of facilitators (88%) were female; 57% had run their group for more than 3 years, and 47% reported between 11 and 20 people attended each group. Although results showed the characteristics of support groups are broadly similar for peers and professionals, there were some distinct differences in perceived needs. Health professional facilitators were more likely than peers to regard training as valuable and beneficial to their role. In addition, health professionals more frequently reported needing debriefing as well as more difficulty accessing debriefing than cancer peers. This study builds on the small body of literature exploring the experiences of cancer support group facilitators. Given the experiences and needs of health professional and peer facilitators may differ, it may be relevant to tailor training and support so that it meets the needs of both health professionals and cancer peers.


Assuntos
Atitude do Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Neoplasias/reabilitação , Grupo Associado , Grupos de Autoajuda , Adulto , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Papel Profissional , Apoio Social , Inquéritos e Questionários , Adulto Jovem
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