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1.
Eur Thyroid J ; 11(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34981745

RESUMO

Objective: Patients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT). Design: A multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We compared the biochemical response to BR/DT in the first 6 months of therapy. Methods: Patients commenced 0.75 mg/kg carbimazole (CBZ) daily with randomisation to BR/DT. We examined baseline patient characteristics, CBZ dose, time to serum thyroid-stimulating hormone (TSH)/free thyroxine (FT4) normalisation and BMI Z-score change. Results: There were 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in time to non-suppressed TSH concentration; 16 of 39 patients (BR) and 11 of 39 (DT) had suppressed TSH at 6 months. Patients with suppressed TSH had higher mean baseline FT4 levels (72.7 vs 51.7 pmol/L; 95% CI for difference 1.73, 31.7; P = 0.029). Time to normalise FT4 levels was reduced in DT (log-rank test, P = 0.049) with 50% attaining normal FT4 at 28 days (95% CI 25, 32) vs 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (95% CI for difference 0.57, 0.86; P < 0.001) and was greatest in patients with higher baseline FT4 concentrations. Conclusions: DT-treated patients normalised FT4 concentrations more quickly than BR. Overall, 94% of patients have normal FT4 levels after 6 months, but 33% still have TSH suppression. Excessive weight gain occurs with both BR and DT therapy.

2.
Harm Reduct J ; 18(1): 132, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34915910

RESUMO

BACKGROUND: Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges. METHODS: On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. FINDINGS: Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others' approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach's alpha of 0.81. CONCLUSION: The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34590504

RESUMO

Background: An ongoing longitudinal study in six European sites includes a 3-monthly assessment of forced vital capacity (FVC), slow vital capacity (SVC), peak cough flow (PCF), and Sniff nasal inspiratory pressure (SNIP). The aim of this interim analysis was to assess the potential for SNIP to be a surrogate for aerosol generating procedures given COVID-19 related restrictions. Methods: This was a prospective observational study. Patients attending six study sites with King's Stage 2 or 3 ALS completed baseline FVC/SVC/SNIP/PCF and repeated assessments 3 monthly. Data were collected from March 2018 to March 2020, after which a COVID-19 related study suspension was imposed. Correlations between the measures were calculated. A Bayesian multiple outcomes random-effects model was constructed to investigate rates of decline across measures. Results: In total, 270 cases and 828 assessments were included (Mean age 65.2 ± 15.4 years; 32.6% Female; 60% Kings stage 2; 81.1% spinal onset). FVC and SVC were the most closely correlated outcomes (0.95). SNIP showed the least correlation with other metrics 0.53 (FVC), 0.54 (SVC), 0.60 (PCF). All four measures significantly declined over time. SNIP in the bulbar onset group showed the fastest rate of decline. Discussion: SNIP was not well correlated with FVC and SVC, probably because it examines a different aspect of respiratory function. Respiratory measures declined over time, but differentially according to the site of onset. SNIP is not a surrogate for FVC and SVC, but is a complementary measure, declining linearly and differentiating spinal and bulbar onset patients.


Assuntos
Esclerose Amiotrófica Lateral , COVID-19 , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/diagnóstico , Teorema de Bayes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Capacidade Vital
5.
BMC Endocr Disord ; 21(1): 63, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838674

RESUMO

BACKGROUND: Many young adults with Duchenne Muscular Dystrophy (DMD) receive long-term glucocorticoids (GC). GC can cause hypogonadotrophic hypogonadism and adolescents may therefore be candidates for pubertal induction. It is unclear whether men with DMD on or off GC have age-appropriate endogenous testosterone production. METHODS: We undertook a quality improvement project to assess the feasibility of measuring salivary testosterone (SalT) levels in men with DMD at home. A Sal-T sampling kit was sent by post to all patients with DMD, aged 17 and older, registered at the John Walton Muscular Centre in Newcastle (n = 75). Submitted Sal-T samples were collected and submitted for analysis. RESULTS: Twenty-eight out of seventy-five patients returned samples (age range: 17-34 years). 6/28 samples were unsuitable for analysis. Overall Sal-T levels (n = 22) were significantly lower than in the healthy population (178 ± 107 v 287 ± 109 pmol/l, p = 0.0001). Sal-T was lower in those on GC compared to those off GC (144 ± 81 versus 218 ± 125 pmol/l, p = 0.05). Three patients were unable to collect a sample due to ventilator dependence. CONCLUSION: Sal T can provide information about androgen status in DMD patients at home, overcoming barriers such as mobility difficulties and challenging venepuncture. However we only obtained samples in a minority of patients suggesting that Sal-T measurement may not be appropriate or acceptable to everyone. There needs to be a more detailed exploration of the barriers to sample submission.


Assuntos
Distrofia Muscular de Duchenne/metabolismo , Kit de Reagentes para Diagnóstico/normas , Saliva/metabolismo , Testosterona/metabolismo , Adolescente , Adulto , Biomarcadores/análise , Biomarcadores/metabolismo , Humanos , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Saliva/química , Testosterona/análise , Adulto Jovem
6.
Subst Abus ; 42(4): 974-982, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759727

RESUMO

Background: Opioid overdose deaths continue to rise nationally. The demand for naloxone, the opioid overdose antidote, is outpacing the supply. With increasing naloxone requests, tools to prioritize distribution are critical to ensure available supplies will reach those at highest risk of overdose. Methods: We developed a standardized "Naloxone Request Form" (NRF) and corresponding weighted prioritization algorithm to serve as decisional aid to better enable grant staff to prioritize naloxone distribution in a data-driven manner. The algorithm computed raw priority scores for each agency, which were then separated into the predetermined quintiles. Historical naloxone distribution decisions were compared with agencies' prioritization quintile. Results: Results demonstrated that the NRF and corresponding algorithm was successful at prioritizing agencies based on potential impact. Although, overall, naloxone was distributed more heavily to the agencies deemed highest priority, our algorithm identified significant shortcomings of the "first come, first served" method of distribution we had initially deployed. Conclusions: This work has laid the foundation to use this tool prospectively to allow for data-driven decision-making for naloxone distribution. Our tool is flexible and can be customized to best fit the needs of a variety of programs and locations to ensure the distribution of limited supplies of naloxone have the greatest impact.

7.
Pediatr Res ; 89(6): 1442-1446, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33564126

RESUMO

BACKGROUND: Achieving adequate nutrition in preterm infants is challenging. The post-discharge period may be critical for influencing growth and cognitive outcomes. We studied the effects of post-discharge nutrition on childhood cognition. METHODS: Preterm-born children were randomized at ~36 weeks corrected age (CGA) to either preterm formula (PTF) or term formula (TF) until 6 months, or PTF until 40 weeks CGA, then TF until 6 months (crossover group). Childhood cognition was assessed using the short form Wechsler Intelligence Scale for Children III, allowing computation of full-scale intelligence quotient (FSIQ) and four-factor index scores; verbal comprehension, freedom from distractibility (FDI), perceptual organization (POI), and processing speed (PSI). RESULTS: Ninety-two children were recruited (mean 10.1 years). FSIQ did not differ by group. PTF-fed children had 10-point higher PSI (p = 0.03) compared to crossover. Faster weight gain from term to 12 weeks CGA was associated with 5-point higher FSIQ (p = 0.02) and four-point higher POI (p = 0.04). Infant head growth was positively associated with FSIQ (+3.8 points, p = 0.04) and FDI (+6 points, p = 0.003). CONCLUSIONS: While there is no long-term impact of post-discharge macronutrient enrichment on childhood cognition, greater weight and head growth in specific epochs is associated with better outcomes. Further studies are needed to determine optimal early diet in preterm infants. IMPACT: Achieving adequate nutrient intakes in preterm infants before and after hospital discharge is challenging. Nutrient intakes prior to discharge affect later cognitive and metabolic outcomes. Follow-up of a randomized controlled trial shows no cognitive benefit in later childhood from a more nutrient-dense formula compared to standard formula after hospital discharge. Growth in the first year of life is strongly correlated with childhood cognition and emphasizes the importance of nutrition in early life.

9.
Arch Dis Child Educ Pract Ed ; 106(3): 130-135, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32769084

RESUMO

Glucocorticoids (GC) are used in paediatric practice for a broad range of conditions and all paediatricians will prescribe GC, in some form, during their career. A wide variety of GC formulations, doses and administration routes are used for periods of time ranging from days to years. Exposure to exogenous GC can result in hypothalamic-pituitary-adrenal axis suppression-otherwise known as adrenal suppression (AS). Patients with AS may be well most of the time but if GC therapy is reduced or stopped or if additional endogenous GC cannot be generated during illness, then an absolute or relative lack of GC can result in severe illness or death. Here, we highlight the relevance of AS to all paediatricians by providing an overview of the background and discussing the presentation and approaches to the management of this clinical entity.


Assuntos
Glucocorticoides/uso terapêutico , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/diagnóstico , Criança , Humanos , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Encaminhamento e Consulta
10.
Eur J Endocrinol ; 184(1): 67-79, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112266

RESUMO

Background: Pharmacological doses of glucocorticoids (GC) reduce inflammation and preserve muscle function in boys with Duchenne muscular dystrophy (DMD). Delayed puberty and bone fragility are consequences of GC treatment. The aim of this study was to determine the acceptability of a 2-year pubertal induction regimen using 4-weekly testosterone injections and examine changes in physique, bone integrity, muscle pathology (assessed by MRI) and muscle function. Methods: Fifteen prepubertal males with DMD, aged 12-17 years and receiving GC, were treated with an incremental testosterone regimen for 2 years. Participants completed a Treatment Satisfaction Questionnaire (TSQM). Data on BMI, bone density, muscle pathology and function were collected at baseline and 2 years later. Results: Testosterone injections were well tolerated, with high TSQM scores. Baseline BMI z-score was 2.16 (0.90) and 1.64 (1.35) 2 years later. Median testosterone levels were 9.7 nmol/L (IQR: 5.7-11.1) 6-9 months after the last injection with an associated increase in testicular volume. Lumbar spine z-score was 0.22 (s.d. 2.21) at baseline and 0.35 (s.d. 2.21) after 2 years. Upper and lower limb muscle contractile cross-sectional area increased in all participants during the trial (P = 0.05 and P < 0.01, respectively). There was a reduction in T2 relaxation times in most muscle groups with stable upper limb muscle function. Conclusion: Incremental monthly testosterone injections were well tolerated, promoted endogenous testosterone production and had a positive impact on the skeleton and contractile muscle bulk with evidence suggesting a beneficial impact on the underlying disease process.


Assuntos
Androgênios/administração & dosagem , Glucocorticoides/efeitos adversos , Distrofia Muscular de Duchenne/fisiopatologia , Puberdade Tardia/tratamento farmacológico , Testosterona/administração & dosagem , Adolescente , Índice de Massa Corporal , Densidade Óssea , Criança , Humanos , Injeções Intramusculares , Masculino , Contração Muscular/efeitos dos fármacos , Músculo Esquelético/fisiopatologia , Distrofia Muscular de Duchenne/tratamento farmacológico , Satisfação do Paciente , Puberdade/efeitos dos fármacos , Puberdade Tardia/induzido quimicamente , Puberdade Tardia/fisiopatologia , Resultado do Tratamento
11.
Eur J Endocrinol ; 183(6): 637-645, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33107439

RESUMO

Objective: First-line treatment of thyrotoxicosis in young people is thionamide anti-thyroid drug (ATD) in a blocking dose with levothyroxine replacement (block and replace, BR) or in a smaller dose tailored to render the patient euthyroid (dose titration, DT). Our objective was to determine which regimen provides more stable biochemical control. Design: A multi-centre phase III, open-label randomised trial comparing BR with DT in patients aged 2-17 years with newly diagnosed thyrotoxicosis at 15 UK centres. Methods: Patients were randomised shortly after diagnosis and treated for 3 years. The primary outcome was the percentage of serum thyroid-stimulating hormone (TSH) levels in the reference range between 6 months and 3 years. Secondary outcomes included the proportion of Free thyroxine (FT4) levels in the reference range, adverse event frequency and 4 years outcome (remission/relapse). Results: Eighty-two patients were randomised, with details on clinical course in 81 (62 Female); 40 were allocated to BR (41 DT). Three withdrew with one ineligible. The mean percentage of serum TSH within reference range was 60.2% in BR and 63.8% in DT patients; adjusted difference 4.3%, 95% CI (-7.8 to 16.4); P = 0.48. Proportions for FT4 were 79.2% in BR and 85.7% in DT patients; adjusted difference 6.8%, (-0.2 to 15.6); P = 0.13. Three patients developed neutropenia - all on BR. 6 BR and 10 DT patients were in remission at 4y. Conclusion: This randomised trial has shown no evidence to suggest that BR, when managing the young patient with thyrotoxicosis, is associated with improved biochemical stability when compared to DT.


Assuntos
Antitireóideos/administração & dosagem , Terapia de Reposição Hormonal/métodos , Tireotoxicose/tratamento farmacológico , Tiroxina/administração & dosagem , Adolescente , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Valores de Referência , Tireotoxicose/sangue , Tireotropina/sangue , Resultado do Tratamento
12.
Am J Drug Alcohol Abuse ; 46(5): 577-588, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32931324

RESUMO

BACKGROUND: The devastating impact of the current opioid overdose crisis has led to new involvement of law enforcement officers. Training programs have focused on overdose recognition and response without targeting core attitudinal change by covering addiction or harm reduction principles. OBJECTIVES: This study examined the impact of a comprehensive overdose education and naloxone distribution (OEND) training on officers' attitudes toward overdose victims, knowledge of and competence to respond to an opioid overdose, and concerns about using naloxone. The training included the common information about overdose recognition and response, with added components covering broader content about addiction and harm reduction principles and philosophies. METHODS: A total of 787 (83% male) officers were administered surveys before and after attending a 2.5-3 hour comprehensive OEND training. Survey items measured overdose-related knowledge and attitudes, including attitudes about people who use drugs and who overdose. RESULTS: Following the training, participants' overdose-related knowledge and perceived competence to use naloxone improved. However, there were more nuanced changes in attitudes toward overdose victims: though 55.3% of officers reported more positive post-training attitudes, 31% reported more negative attitudes, and 13.7% reported no attitudinal change. Younger officers were most likely to report worsened attitudes. Improvements in attitudes toward overdose victims were associated with reductions in both naloxone-related concerns and risk compensation beliefs. CONCLUSIONS: Despite a comprehensive OEND training that addressed addiction and harm reduction and directly targeted hypothesized drivers of negative attitudes (e.g., risk compensation beliefs), some officers' attitudes worsened after the training. Randomized experiments of different training approaches would elucidate the mediators and moderators underlying these unexpected responses.


Assuntos
Overdose de Drogas/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Polícia/psicologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Polícia/educação , Inquéritos e Questionários , Adulto Jovem
14.
Dis Model Mech ; 13(2)2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31754018

RESUMO

The muscular dystrophy X-linked (mdx) mouse is commonly used as a mouse model of Duchenne muscular dystrophy (DMD). Its phenotype is, however, mild, and other mouse models have been explored. The mdx:Cmah-/- mouse carries a human-like mutation in the Cmah gene and has a severe muscle phenotype, but its growth and bone development are unknown. In this study, we compared male mdx, mdx:Utrn +/-, mdx:Cmah-/- and wild-type (WT) mice at 3, 5 and 7 weeks of age to determine the suitability of the mdx:Cmah-/- mouse as a model for assessing growth and skeletal development in DMD. The m dx:Cmah-/- mice were lighter than WT mice at 3 weeks, but heavier at 7 weeks, and showed an increased growth rate at 5 weeks. Cortical bone fraction as assessed by micro-computed tomography was greater in both mdx and mdx: C mah-/- mice versus WT mice at 7 weeks. Tissue mineral density was also higher in mdx:Cmah-/- mice at 3 and 7 weeks. Gene profiling of mdx:Cmah-/- bone identified increased expression of Igf1, Igf1r and Vegfa Both the mdx and mdx:Cmah-/- mice showed an increased proportion of regulated bone marrow adipose tissue (BMAT) but a reduction in constitutive BMAT. The mdx:Cmah-/- mice show evidence of catch-up growth and more rapid bone development. This pattern does not mimic the typical DMD growth trajectory and therefore the utility of the mdx:Cmah-/- mouse for studying growth and skeletal development in DMD is limited. Further studies of this model may, however, shed light on the phenomenon of catch-up growth.This article has an associated First Person interview with the first author of the paper.


Assuntos
Desenvolvimento Ósseo , Osso e Ossos/patologia , Utrofina/metabolismo , Adiposidade , Animais , Fenômenos Biomecânicos , Medula Óssea/patologia , Osso e Ossos/diagnóstico por imagem , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Osso Esponjoso/fisiopatologia , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Osso Cortical/fisiopatologia , Modelos Animais de Doenças , Regulação da Expressão Gênica , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/patologia , Lâmina de Crescimento/fisiopatologia , Força da Mão , Inflamação/patologia , Fator de Crescimento Insulin-Like I/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos mdx , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Distrofia Muscular de Duchenne/diagnóstico por imagem , Distrofia Muscular de Duchenne/patologia , Distrofia Muscular de Duchenne/fisiopatologia , Fenótipo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/fisiopatologia , Microtomografia por Raio-X
15.
J Subst Abuse Treat ; 108: 48-54, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31303359

RESUMO

Opioid misuse is a national health crisis that requires sustained treatment, prevention, and recovery efforts. This study evaluates the innovative treatment approaches that two states - Kentucky and Missouri - implemented in their states using State Targeted Response to the Opioid Crisis Grant (Opioid STR) program funds from the Substance Abuse Mental Health and Services Administration (SAMHSA), as well as preliminary findings from the Opioid STR national, cross-site evaluation that is funded and managed by SAMHSA. The Kentucky approach discusses the Emergency Department (ED) bridge model, which links patients discharged from EDs to appropriate professional treatment and recovery services. Missouri implemented the Medication First (MedFirst) model, an evidence-based treatment for individuals with opioid use disorder (OUD). These states highlight novel approaches likely being implemented throughout the country to combat the opioid epidemic. Findings from the case studies and supported by the national evaluation indicate that key factors to successful program implementation - supportive state policies, partnerships and collaborations, and sustainability - facilitated the implementation of planned interventions. The novel approaches discussed combined with care across the continuum (prevention, treatment and recovery) and continued federal support is likely to have an impact on reducing opioid misuse across the U.S.


Assuntos
Buprenorfina/uso terapêutico , Programas Governamentais/economia , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Governo Estadual , Medicina Baseada em Evidências , Programas Governamentais/legislação & jurisprudência , Humanos , Kentucky , Missouri , Tratamento de Substituição de Opiáceos , Estudos de Casos Organizacionais , Estados Unidos
16.
J Subst Abuse Treat ; 108: 55-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31277891

RESUMO

BACKGROUND: Leaders of Missouri's State Targeted Response to the opioid crisis (STR) grant have prioritized increasing access to treatment medications for opioid use disorder (MOUD) through a "Medication First" approach. This conceptual framework prioritizes rapid, sustained, low-barrier access to MOUD for optimal impact on decreased illicit drug use and mortality. Medication First principles and practices were facilitated through state-level structural changes and disseminated to participating community treatment programs via a multi-pronged, multi-disciplinary approach. In the first nine months of STR, 14 state-contracted treatment agencies operating 38 sites used STR funding to implement the Medication First model. METHODS: We utilized state billing and service data to make comparisons before and during STR on the following outcomes: MOUD utilization, timely access to MOUD, amount of psychosocial services delivered, treatment retention at 1, 3, and 6 months, and monthly price of treatment. We conducted follow-up analyses examining differences across MOUD types (no medication, methadone, buprenorphine, oral naltrexone, mixed antagonist + agonist, and extended release naltrexone). RESULTS: During STR, MOUD utilization increased (44.8% to 85.3%), timeliness of MOUD receipt improved (Median of 8 days vs. 0 days), there were fewer psychosocial services delivered, treatment retention improved at one, three, and six month timeframes, and the median cost per month was 21% lower than in the year prior to STR. All differences were driven by increased utilization of buprenorphine. CONCLUSIONS: Findings suggest Medication First implementation through STR was successful in all targeted domains. Though much more work is needed to further reduce logistical, financial, and cultural barriers to improved access to maintenance MOUD, the steps taken through Missouri's STR grant show significant promise at making swift and drastic transformations to a system of care in response to a growing public health emergency.


Assuntos
Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Programas Governamentais/economia , Implementação de Plano de Saúde , Acesso aos Serviços de Saúde/organização & administração , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Analgésicos Opioides/uso terapêutico , Feminino , Programas Governamentais/legislação & jurisprudência , Humanos , Masculino , Missouri , Tratamento de Substituição de Opiáceos , Governo Estadual
18.
Am J Drug Alcohol Abuse ; 45(4): 333-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084515

RESUMO

Background: The opioid addiction and overdose crisis continues to ravage communities across the U.S. Maintenance pharmacotherapy using buprenorphine or methadone is the most effective intervention for Opioid Use Disorder (OUD), yet few have immediate and sustained access to these medications. Objectives: To address lack of medication access for people with OUD, the Missouri Department of Mental Health began implementing a Medication First (Med First) treatment approach in its publicly-funded system of comprehensive substance use disorder treatment programs. Methods: This Perspective describes the four principles of Med First, which are based on evidence-based guidelines. It draws conceptual comparisons between the Housing First approach to chronic homelessness and the Med First approach to pharmacotherapy for OUD, and compares state certification standards for substance use disorder (SUD) treatment (the traditional approach) to Med First guidelines for OUD treatment. Finally, the Perspective details how Med First principles have been practically implemented. Results: Med First principles emphasize timely access to maintenance pharmacotherapy without requiring psychosocial services or discontinuation for any reason other than harm to the client. Early results regarding medication utilization and treatment retention are promising. Feedback from providers has been largely favorable, though clinical- and system-level obstacles to effective OUD treatment remain. Conclusion: Like the Housing First model, Medication First is designed to decrease human suffering and activate the strengths and capacities of people in need. It draws on decades of research and facilitates partnerships between psychosocial and medical treatment providers to offer effective and life-saving care to persons with OUD.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Certificação/normas , Implementação de Plano de Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Humanos , Missouri , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Guias de Prática Clínica como Assunto , Governo Estadual
19.
Best Pract Res Clin Endocrinol Metab ; 33(3): 101265, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31000487

RESUMO

Puberty is a defining phase of human development where growth ends and the ability to reproduce begins. An understanding of the events leading up to puberty highlights the fact that this is the culmination of a process of skeletal and gonadal activity that has been ongoing since conception. Although there is natural variation in the timing of events in and around puberty the basic underlying processes are common to all healthy human beings. This chapter is intended to outline the mechanisms underlying normal growth and development before and during puberty. By understanding normality the pathological processes that give rise to abnormalities of pubertal development can be understood more easily.


Assuntos
Puberdade/fisiologia , Adolescente , Criança , Feminino , Desenvolvimento Fetal , Hormônios Esteroides Gonadais/biossíntese , Crescimento , Humanos , Masculino
20.
Lung ; 197(3): 285-293, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30888492

RESUMO

PURPOSE: Reduced physical activity in many chronic diseases is consistently associated with increased morbidity. Little is known about physical activity in sarcoidosis. The aim of this study was to objectively assess physical activity in patients with pulmonary sarcoidosis and investigate its relationship with lung function, exercise capacity, symptom burden, and health status. METHODS: Physical activity was assessed over one week in 15 patients with pulmonary sarcoidosis and 14 age-matched healthy controls with a tri-axial accelerometer (ActivPal™) and the International Physical Activity Questionnaire (IPAQ). All participants underwent pulmonary function tests, 6-min walk test (6MWT) and completed the Fatigue Assessment Scale (FAS), Medical Research Council (MRC) Dyspnoea Scale and the King's Sarcoidosis Questionnaire (KSQ). RESULTS: Patients with sarcoidosis had significantly lower daily step counts than healthy controls; mean (SD) 5624 (1875) versus 10,429 (2942) steps (p < 0.01) and a trend towards fewer sit-to-stand transitions each day (p = 0.095). Only two patients (13%) self-reported undertaking vigorous physical activity (IPAQ) compared to half of healthy individuals (p < 0.01). Daily step count was significantly associated with 6MWT distance in sarcoidosis (r = 0.634, p = 0.01), but not with forced vital capacity (r = 0.290), fatigue (r = 0.041), dyspnoea (r = -0.466) or KSQ health status (r = 0.099-0.484). Time spent upright was associated with fatigue (r = -0.630, p = 0.012) and health status (KSQ Lung scores r = 0.524, p = 0.045), and there was a significant correlation between the number of sit-to-stand transitions and MRC dyspnoea score (r = -0.527, p = 0.044). CONCLUSION: Physical activity is significantly reduced in sarcoidosis and is associated with reduced functional exercise capacity (6MWD). Fatigue, exertional symptoms and health status were more closely associated with time spent upright and the number of bouts of physical activity, as compared to step counts. Further studies are warranted to identify the factors that determine different physical activity profiles in sarcoidosis.


Assuntos
Dispneia/fisiopatologia , Tolerância ao Exercício , Exercício Físico , Fadiga/fisiopatologia , Sarcoidose Pulmonar/fisiopatologia , Comportamento Sedentário , Acelerometria , Adulto , Idoso , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Capacidade Vital , Teste de Caminhada
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