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1.
Int Arch Allergy Immunol ; 181(1): 71-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31722337

RESUMO

BACKGROUND: Few studies have directly compared the immunologic responses to specific subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). OBJECTIVE: We aimed to directly compare clinical efficacy and immunological responses between SLIT and SCIT in allergic rhinitis (AR) sensitized to house dust mites. METHODS: Sixty-seven patients (age 5-55 years) with moderate-severe Dermatophagoides pteronyssinus (Der-p) and Dermatophagoides farinae AR with or without asthma were randomized (2:2:1) into SLIT (n = 27), SCIT (n = 26) and placebo (n = 14) groups. Symptom and medication scores, visual analogue score, serum Der-p specific immunoglobulin G4 (Der-p-sIgG4), CD4+CD25+FoxP3+ regulatory T cells (Tregs) and serum cytokines were measured. RESULTS: After 1-year treatment, a significant improvement of total rhinitis score (TRS), total rhinitis medication score (TRMS) and visual analogue score occurred in both SLIT and SCIT. There were no differences in clinical efficacy except for TRMS (p = 0.026) when SLIT and SCIT were directly compared. CD4+CD25+FoxP3+ Tregs had a trend towards upregulation in the 2 modes and inversely correlated with TRS (p = 0.024) only in SLIT. Der-p-sIgG4 significantly increased in SLIT and SCIT (p < 0.05), and it was 30 times higher in SCIT than SLIT after the treatment (p < 0.05). Serum interferon-γ significantly increased only in SCIT after 1 (p = 0.008), 6 (p = 0.007) and 12 (p = 0.008) months of treatment and inversely correlated with TRS (p = 0.032). CONCLUSION: While SCIT and SLIT have similar rates of clinical improvement, the 2 modes reveal heterogeneous changes of CD4+CD25+Foxp3+ Tregs, sIgG4 and cytokines.


Assuntos
Asma/terapia , Citocinas/sangue , Rinite Alérgica/terapia , Imunoterapia Sublingual/métodos , Linfócitos T Reguladores/imunologia , Adolescente , Adulto , Antígenos de Dermatophagoides/imunologia , Asma/complicações , Asma/imunologia , Antígenos CD4/metabolismo , Criança , Pré-Escolar , Estudos Controlados Antes e Depois , Feminino , Fatores de Transcrição Forkhead/metabolismo , Humanos , Infusões Subcutâneas , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Masculino , Pessoa de Meia-Idade , Rinite Alérgica/complicações , Rinite Alérgica/imunologia , Adulto Jovem
2.
Crit Care Resusc ; 21(4): 251-57, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31778631

RESUMO

BACKGROUND: Patients admitted to intensive care units (ICUs) undergo multiple blood tests. Small volume vacuum phlebotomy tubes (SVTs) provide an important blood conservation measure. SVTs reduce summative blood loss and may reduce odds of transfusion. We aimed to determine whether low volume blood sampling using SVTs for routine diagnostic purposes translates to decreased fall in haemoglobin concentration, and examine downstream effects on anaemia and need for transfusion during ICU admission. STUDY DESIGN AND METHODS: A single-centre, controlled before-and-after study, evaluating a unit-wide changeover from conventional volume vacuum phlebotomy tubes (CVTs) to SVTs on April 2015. All ICU patients admitted for > 48 hours during the 12 months before and after the intervention were included in multivariate and univariate analysis. Groups were stratified into short admissions (2-7 days) and long admissions (> 7 days). RESULTS: A total of 318 patients were analysed. For short admissions, SVTs decreased fall in haemoglobin concentration (unstandardized coefficient, -6.7; P = 0.001) and episodes of severe anaemia (odds ratio, 0.37, P = 0.02). There were no changes to haemoglobin concentration in long admissions. No effects on need for transfusion were observed (short admissions, P = 0.05; long admissions, P = 0.11). SVTs reduced daily sampling volumes by 50% with no increase in laboratory error (short admissions, P = 0.61; long admissions, P = 0.98). A moderate correlation existed between blood draws and fall in haemoglobin concentration (short admissions, r = 0.5; long admissions, r = 0.32). CONCLUSION: SVTs reduce sampling volume without increasing laboratory error. Follow-on effects include reduced fall in haemoglobin concentration and severe anaemia. These correlations are absent in long admissions.


Assuntos
Estudos Controlados Antes e Depois , Unidades de Terapia Intensiva , Flebotomia , Adulto , Austrália , Transfusão de Sangue , Humanos , Flebotomia/instrumentação , Flebotomia/métodos , Vácuo
3.
Medicine (Baltimore) ; 98(46): e17898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725637

RESUMO

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.


Assuntos
Auxiliares de Emergência/educação , Intubação Intratraqueal/métodos , Laringoscopia/educação , Sucção/educação , Vômito/terapia , Adulto , Competência Clínica , Estudos Controlados Antes e Depois , Descontaminação , Desenho de Equipamento , Feminino , Humanos , Capacitação em Serviço , Laringoscopia/métodos , Masculino , Manequins , Pessoa de Meia-Idade , Projetos Piloto , Sucção/métodos
4.
Medicine (Baltimore) ; 98(45): e17880, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702659

RESUMO

BACKGROUND: Osteoarthritis (OA) is a degenerative disease that not only causes knee pain in older adults, but also has an adverse effect on walking. Therefore, intervention for older patients with OA is important. To investigate the immediate effects of kinesiology taping (KT) on the pain and gait function of the older adults with knee OA. METHODS: This study enrolled 10 older adults individuals living in the community who were diagnosed with knee OA. All participants were assessed for knee pain, walking ability, and balance before and after application of knee KT. Knee pain was assessed in resting and walking conditions using the visual analog scale. Walking and balance were assessed using a 10-m walking test and a timed up and go test. RESULTS: In the present study, KT significantly improved gait and balance with reduction in knee pain during walking than non-KT (P < .05). CONCLUSIONS: This study demonstrated that knee KT has a positive effect on pain reduction and walking and balance ability of the older adults with OA. Therefore, this study suggests that KT can be used as an intervention to relieve knee pain and aid walking and balance ability in the older adult.


Assuntos
Fita Atlética , Marcha/fisiologia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Idoso , Estudos Controlados Antes e Depois , Teste de Esforço/métodos , Humanos , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Resultado do Tratamento , Escala Visual Analógica
5.
Medicine (Baltimore) ; 98(42): e17335, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626089

RESUMO

BACKGROUND: Previous studies have shown that microRNA-32 (miRNA-32) is an exosome microRNA that affects the proliferation and metastasis of non-small cell lung cancer (NSCLC) cells. In this study, our goal was to assess the expression of plasma microRNA-32 and its potential as a biomarker to predict the tumor response and survival of patients with NSCLC undergoing platinum-based chemotherapy. METHODS: Plasma microRNA-32 levels before and after 1 cycle of platinum-based chemotherapy in 43 patients with NSCLC were measured using a quantitative real-time polymerase chain reaction assay (qPCR). In addition, the demographic and survival data of the patients were collected for analysis. RESULTS: A significant correlation was observed between the changes in microRNA-32 levels before and after 1 chemotherapy cycle and the treatment response (P = .035). In addition, Kaplan-Meier analysis showed that the level of microRNA-32 after 1 chemotherapy cycle was significantly correlated with the prognosis of patients. The median progression-free survival (P = .025) and overall survival (P = .015) of patients with high microRNA-32 levels (≥7.73) after 1 chemotherapy cycle was 9 and 21 months, respectively. In contrast, the median survival of patients with low microRNA-32 levels (<7.73) was 5 and 10 months, respectively. CONCLUSIONS: The plasma levels of microRNA-32 correlated with the efficacy of platinum-based chemotherapy and survival, indicating that microRNA-32 may be useful for predicting the effectiveness of platinum-based chemotherapy and prognosis in NSCLC.


Assuntos
Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Neoplasias Pulmonares/genética , MicroRNAs/genética , Carcinoma de Pequenas Células do Pulmão/genética , Idoso , Biomarcadores Tumorais/genética , Estudos Controlados Antes e Depois , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Terapia Neoadjuvante , Modelos de Riscos Proporcionais , Reação em Cadeia da Polimerase em Tempo Real , Carcinoma de Pequenas Células do Pulmão/sangue , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/mortalidade , Resultado do Tratamento
6.
Cochrane Database Syst Rev ; 9: CD011055, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549742

RESUMO

BACKGROUND: Diarrhoea and soil-transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low-income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation. OBJECTIVES: To assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults. DATA COLLECTION AND ANALYSIS: Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta-analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Sixty-three studies covering more than 222,800 participants met the inclusion criteria. Twenty-two studies were cluster RCTs, four were controlled before-and-after studies (CBA), and 37 were NRS (27 case-control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross-sectional studies). Most study sites (56/69) were in low- or lower middle-income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low-certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low-certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low-certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoea prevalence (RR 0.91, 95% CI 0.64 to 1.28; very low-certainty evidence). Two controlled cross-sectional studies that evaluated the Health Extension Package in Ethiopia were associated with a lower two-week diarrhoea prevalence in 'model' households than in 'non-model households' (odds ratio (OR) 0.26, 95% CI 0.16 to 0.42; very low-certainty evidence).Programmes to end open defecation by all (termed community-led total sanitation (CLTS) interventions plus adaptations)Four RCTs measured diarrhoea prevalence and did not detect an effect in children under five years of age (RR 0.92, 95% CI 0.79 to 1.07; moderate-certainty evidence). The analysis of two trials did not demonstrate an effect of the interventions on STH infection prevalence in children (pooled RR 1.03, 95% CI 0.64 to 1.65; low-certainty evidence).One controlled cross-sectional study compared the prevalence of STH infection in open defecation-free (ODF) villages that had received a CLTS intervention with control villages and reported a higher level of STH infection in the intervention villages (RR 2.51, 95% CI 1.74 to 3.62; very low-certainty evidence).Sanitation hardware and behaviour change interventions, that included child faeces disposal hardware and messagingTwo RCTs had mixed results, with no overall effect on diarrhoea prevalence demonstrated in the pooled analysis (RR 0.79, 95% CI 0.49 to 1.26; very low-certainty evidence).WASH hardware and education/behaviour change interventionsOne RCT did not demonstrate an effect on diarrhoea prevalence (RR 1.15, 95% CI 0.93 to 1.41; very low-certainty evidence).Two CBAs reported that the intervention reduced diarrhoea incidence by about a quarter in children under five years of age, but evidence was very low-certainty (rate ratio 0.77, 95% CI 0.71 to 0.84). Another CBA reported that the intervention reduced the prevalence of STH in an intervention village compared to a control village, again with GRADE assessed at very low-certainty (OR 0.17, 95% CI 0.02 to 0.73).Case-control studiesPooled results from case-control studies that presented data for child faeces disposal indicated that disposal of faeces in the latrine was associated with lower odds of diarrhoea among all ages (OR 0.73, 95% CI: 0.62 to 0.85; 23 comparisons; very low-certainty evidence). Pooled results from case-control studies that presented data for children defecating in the latrine indicated that children using the latrine was associated with lower odds of diarrhoea in all ages (OR 0.54, 95% CI 0.33 to 0.90; 7 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS: Evidence suggests that the safe disposal of child faeces may be effective in preventing diarrhoea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very-low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.While child faeces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of faeces of children of different age groups.


Assuntos
Diarreia/parasitologia , Helmintíase/prevenção & controle , Helmintíase/transmissão , Saneamento , Solo/parasitologia , Animais , Criança , Pré-Escolar , Estudos Controlados Antes e Depois , Fezes , Helmintos , Humanos , Lactente , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Accid Anal Prev ; 132: 105284, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31518764

RESUMO

Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.


Assuntos
Acidentes de Trânsito/mortalidade , Uso da Maconha/legislação & jurisprudência , Colorado/epidemiologia , Estudos Controlados Antes e Depois , Feminino , Humanos , Washington/epidemiologia
8.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 146-154, jul.-sept. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185551

RESUMO

Objetivo: demostrar si un protocolo reducido de 6 sesiones de ejercicios tónicos y fásicos es capaz de mejorar la calidad de vida y la fuerza muscular en los pacientes con incontinencia urinaria (IU). Material y métodos: se realizó un estudio prospectivo tipo antes y después a 67 pacientes con IU remitidos al Departamento de Rehabilitación del Hospital Universitario de Santa Cristina, Madrid, España. El estudio se realizó de enero del 2016 a diciembre del 2018. En la evaluación inicial, se registraron los datos de filiación, los factores predisponentes y el tipo de IU. Los pacientes recibieron recomendaciones de estilo de vida y los cuestionarios/escalas ICIQ-SF/I-QOL que debían rellenarse al inicio/final del tratamiento. La evaluación manométrica fue registrada en la evaluación inicial/final por el equipo MYOMED(R) 932 ENRAF NONIUS (CE 0197). El protocolo consistió en una sesión de 30 min de ejercicios tónicos/fásicos (15 min cada uno) 2 veces a la semana durante un máximo de 6 sesiones, supervisadas por un fisioterapeuta. Resultados: la edad media fue de 52,1±12,7 años. Mujeres 94% (n=63). La fuerza máxima y media de la contracción del suelo pélvico fue de 26,4±15,6 y 5,3±3,9mmHg, respectivamente, y aumentó significativamente después del tratamiento a 35,5±19,6 y 7,6±4,4mmHg (p<0,0001). El ICIQ-SF fue de 10,1±5 y disminuyó significativamente a 6,6±4,6 (p<0,0001). La I-QOL aumentó significativamente de 66,1±21,9 a 77,9±18,1 puntos (p<0,0001). La subescala I-QOL limitación de actividad se elevó de 63,7±22,6 a 77,3±17,8 (p<0,0001); la subescala I-QOL efecto psicosocial aumentó de 73,8±23,9 a 82,5±18,7 (p=0,0004); y la subescala I-QOL vergüenza social se incrementó de 56,5±23,7 a 70,5±22,1 (p<0,0001). Conclusión: el biofeedback manométrico es capaz de disminuir la IU y mejorar la calidad de vida y los valores manométricos. Este protocolo reducido de 6 sesiones podría aplicarse a otras instituciones públicas y privadas y podría tener un impacto económico en el sistema de salud y en la economía de los pacientes


Objective: to determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). Material and methods: a prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED(R) 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. Results: the mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). Conclusion: manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Manometria/métodos , Terapia por Exercício/métodos , Incontinência Urinária/reabilitação , Força Muscular/fisiologia , Estudos Prospectivos , Resultado do Tratamento , Estudos Controlados Antes e Depois/métodos , Retroalimentação Fisiológica
9.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 262-266, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040033

RESUMO

Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.


Assuntos
Humanos , Masculino , Feminino , Adulto , Otite Média/cirurgia , Cartilagem da Orelha/transplante , Bigorna/cirurgia , Estribo/transplante , Timpanoplastia , Doença Crônica , Resultado do Tratamento , Estudos Controlados Antes e Depois , Perda Auditiva/cirurgia
10.
PLoS Med ; 16(8): e1002867, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31430296

RESUMO

BACKGROUND: Iron deficiency (ID) in pregnancy is a common problem that can compromise both maternal and fetal health. Although daily iron supplementation is a simple and effective means of treating ID in pregnancy, ID and ID anemia (IDA) often go unrecognized and untreated due to lack of knowledge of their implications and competing clinical priorities. METHODS AND FINDINGS: In order to enhance screening and management of ID and IDA in pregnancy, we developed a novel quality-improvement toolkit: ID in pregnancy with maternal iron optimization (IRON MOM), implemented at St. Michael's Hospital in Toronto, Canada. It included clinical pathways for diagnosis and management, educational resources for clinicians and patients, templated laboratory requisitions, and standardized oral iron prescriptions. To assess the impact of IRON MOM, we retrospectively extracted laboratory data of all women seen in both the obstetrics clinic and the inpatient delivery ward settings from the electronic patient record (EPR) to compare measures pre- and post-implementation of the toolkit: a process measure of the rates of ferritin testing, and outcome measures of the proportion of women with an antenatal (predelivery) hemoglobin value below 100 g/L (anemia), the proportion of women who received a red blood cell (RBC) transfusion during pregnancy, and the proportion of women who received an RBC transfusion immediately following delivery or in the 8-week postpartum period. The pre-intervention period was from January 2012 to December 2016, and the post-intervention period was from January 2017 to December 2017. From the EPR, 1,292 and 2,400 ferritin tests and 16,603 and 3,282 antenatal hemoglobin results were extracted pre- and post-intervention, respectively. One year after implementation of IRON MOM, we found a 10-fold increase in the rate of ferritin testing in the obstetric clinics at our hospital and a lower risk of antenatal hemoglobin values below 100 g/L (pre-intervention 13.5% [95% confidence interval (CI) 13.0%-14.11%]; post-intervention 10.6% [95% CI 9.6%-11.7%], p < 0.0001). In addition, a significantly lower proportion of women received an RBC transfusion during their pregnancy (1.2% pre-intervention versus 0.8% post-intervention, p = 0.0499) or immediately following delivery and in the 8 weeks following (2.3% pre-intervention versus 1.6% post-intervention, p = 0.0214). Limitations of this study include the use of aggregate data extracted from the EPR, and lack of a control group. CONCLUSIONS: The introduction of a standardized toolkit including diagnostic and management pathways as well as other aids increased ferritin testing and decreased the incidence of anemia among women presenting for delivery at our site. This strategy also resulted in reduced proportions of women receiving RBC transfusion during pregnancy and in the first 8 weeks postpartum. The IRON MOM toolkit is a low-tech strategy that could be easily scaled to other settings.


Assuntos
Anemia Ferropriva/complicações , Complicações na Gravidez/diagnóstico , Melhoria de Qualidade , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/terapia , Estudos Controlados Antes e Depois , Procedimentos Clínicos , Transfusão de Eritrócitos , Feminino , Ferritinas/sangue , Humanos , Assistência Perinatal/métodos , Gravidez , Complicações na Gravidez/terapia
12.
Psicothema (Oviedo) ; 31(3): 229-238, ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185348

RESUMO

Background: Are cognitive and biological variables useful for predicting future behavioral outcomes?. Method: In two independent groups, we measured a set of cognitive (fluid and crystallized intelligence, working memory, and attention control) and biological (cortical thickness and cortical surface area) variables on two occasions separated by six months, to predict behavioral outcomes of interest (performance on an adaptive version of the n-back task) measured twelve and eighteen months later. We followed three stages: discovery, validation, and generalization. In the discovery stage, cognitive/biological variables and the behavioral outcome of interest were assessed in a group of individuals (in-sample). In the validation stage, the cognitive and biological variables were related with a parallel version of the behavioral outcome assessed several months later. In the generalization stage, the validation findings were tested in an independent group of individuals (out-of-sample). Results: The key finding revealed that cortical surface area variations within the right dorsolateral prefrontal cortex predict the behavioral outcome of interest in both groups, whereas the cognitive variables failed to show reliable predictive validity. Conclusions: Individual differences in biological variables might predict future behavioral outcomes better than cognitive variables concurrently correlated with these behavioral outcomes


Antecedentes: ¿Predicen las variables cognitivas y biológicas el futuro desempeño cognitivo? Método: en dos grupos independientes de participantes se miden variables cognitivas (inteligencia fluida y cristalizada, memoria operativa y control atencional) y biológicas (grosor y superficie cortical) en dos ocasiones separadas por seis meses, para predecir el desempeño en la tarea n-back valorado doce y dieciocho meses después. Se completan tres etapas: descubrimiento, validación y generalización. En la de descubrimiento se valoran en un grupo de individuos las variables cognitivas/biológicas y el desempeño a predecir. En la de validación, se relacionan las mismas variables con una versión paralela de la n-back completada meses después. En la de generalización, los resultados de la validación se replican en un grupo independiente de individuos. Resultados: las variaciones de superficie cortical en la corteza dorsolateral prefrontal derecha predicen el desempeño cognitivo en los dos grupos independientes de individuos, mientras que las variables cognitivas no contribuyen a la predicción del desempeño futuro. Conclusiones: las diferencias individuales en determinadas variables biológicas predicen el desempeño cognitivo mejor que las variables cognitivas que correlacionan concurrentemente con ese desempeño


Assuntos
Humanos , Feminino , Atenção/fisiologia , Comportamento , Cognição/fisiologia , Inteligência/fisiologia , Memória de Curto Prazo/fisiologia , Córtex Pré-Frontal/anatomia & histologia , Variação Biológica Individual , Mapeamento Encefálico , Estudos Controlados Antes e Depois/métodos , Lateralidade Funcional , Generalização (Psicologia) , Imagem por Ressonância Magnética , Córtex Pré-Frontal/diagnóstico por imagem , Testes Psicológicos , Reprodutibilidade dos Testes , Fatores de Tempo
13.
Accid Anal Prev ; 131: 308-315, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352192

RESUMO

A full Bayes approach is proposed for traffic conflict-based before-after safety evaluations using extreme value theory. The approach combines traffic conflicts of different sites and periods and develops a uniform generalized extreme value (GEV) model for the treatment effect estimation. Moreover, a hierarchical Bayesian structure is used to link possible covariates to GEV parameters and to account for unobserved heterogeneity among different sites. The proposed approach was applied to evaluate the safety benefits of a left-turn bay extension project in the City of Surrey, Canada, in which traffic conflicts were collected from 3 treatment sites and 3 matched control sites before and after the treatment. A series of models were developed considering different combinations of covariates and their link to different GEV model parameters. Based on the best fitted model, the treatment effects were analyzed quantitatively using the odds ratio (OR) method as well as qualitatively by comparing the shapes of GEV distributions. The results show that there are significant reduction in the expected number of crashes (i.e., OR = 0.409). In addition, there are apparent changes in the shape of GEV distributions for the treatment sites, where GEV distributions shift further away from the risk of crash area after the treatment. Both of these results indicate significant safety improvements after the left-turn bay extension.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Planejamento Ambiental , Acidentes de Trânsito/prevenção & controle , Teorema de Bayes , Colúmbia Britânica , Cidades , Estudos Controlados Antes e Depois , Humanos , Modelos Estatísticos , Razão de Chances , Segurança
14.
Psicothema ; 31(3): 229-238, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31292036

RESUMO

BACKGROUND: Are cognitive and biological variables useful for predicting future behavioral outcomes? METHOD: In two independent groups, we measured a set of cognitive (fluid and crystallized intelligence, working memory, and attention control) and biological (cortical thickness and cortical surface area) variables on two occasions separated by six months, to predict behavioral outcomes of interest (performance on an adaptive version of the n-back task) measured twelve and eighteen months later. We followed three stages: discovery, validation, and generalization. In the discovery stage, cognitive/biological variables and the behavioral outcome of interest were assessed in a group of individuals (in-sample). In the validation stage, the cognitive and biological variables were related with a parallel version of the behavioral outcome assessed several months later. In the generalization stage, the validation findings were tested in an independent group of individuals (out-of-sample). RESULTS: The key finding revealed that cortical surface area variations within the right dorsolateral prefrontal cortex predict the behavioral outcome of interest in both groups, whereas the cognitive variables failed to show reliable predictive validity. CONCLUSIONS: Individual differences in biological variables might predict future behavioral outcomes better than cognitive variables concurrently correlated with these behavioral outcomes.


Assuntos
Atenção/fisiologia , Comportamento , Cognição/fisiologia , Inteligência/fisiologia , Memória de Curto Prazo/fisiologia , Córtex Pré-Frontal/anatomia & histologia , Variação Biológica Individual , Mapeamento Encefálico , Estudos Controlados Antes e Depois/métodos , Feminino , Previsões , Lateralidade Funcional , Humanos , Imagem por Ressonância Magnética , Córtex Pré-Frontal/diagnóstico por imagem , Testes Psicológicos , Reprodutibilidade dos Testes , Fatores de Tempo
15.
BMC Pulm Med ; 19(1): 118, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262278

RESUMO

BACKGROUND: Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more easily identified, limiting antibiotic use in this population. The primary objective of our study was to investigate if availability of the RVP decreased antibiotic prescription at discharge among patients with AECOPD. METHODS: This is a single center, retrospective, before (pre-RVP) - after (post-RVP) study of patients admitted to a tertiary medical center from January 2013 to March 2016. The primary outcome was antibiotic prescription at discharge. Groups were compared using univariable and multivariable logistic-regression. RESULTS: A total of 232 patient-episodes were identified, 133 following RVP introduction. Mean age was 68.1 (pre-RVP) and 68.3 (post-RVP) years respectively (p = 0.88). Patients in pre-RVP group were similar to the post-RVP group with respect to gender (p = 0.54), proportion of patients with BMI < 21(p = 0.23), positive smoking status (p = 0.19) and diagnoses of obstructive sleep apnea (OSA, p = 0.16). We found a significant reduction in antibiotic prescription rate at discharge in patients admitted with AECOPD after introduction of the respiratory viral assay (pre-RVP 77.8% vs. post-RVP 63.2%, p = 0.01). In adjusted analyses, patients in the pre-RVP group [OR 2.11 (CI: 1.13-3.96), p = 0.019] with positive gram stain in sputum [OR 4.02 (CI: 1.61-10.06), p = 0.003] had the highest odds of antibiotic prescription at discharge. CONCLUSIONS: In patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), utilization of a comprehensive respiratory viral panel can significantly decrease the rate of antibiotic prescription at discharge.


Assuntos
Antibacterianos/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Idoso , Estudos Controlados Antes e Depois , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/virologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Estudos Retrospectivos , Escarro/microbiologia
16.
Br J Gen Pract ; 69(684): e454-e461, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31160369

RESUMO

BACKGROUND: The UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission. AIM: To increase diagnostic coding of CKD (stages 3-5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk. DESIGN AND SETTING: Controlled, cross-sectional study in four East London clinical commissioning groups (CCGs). METHOD: Interventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention. RESULTS: Three intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P<0.001). The CCG with highest coding rates increased from 76-90% of CKD cases coded; the lowest coding CCG increased from 52-81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P<0.001) over the 2-year study period. Differences in statin prescribing were not significant. CONCLUSION: Clinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention.


Assuntos
Codificação Clínica , Atenção Primária à Saúde , Melhoria de Qualidade , Insuficiência Renal Crônica/terapia , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Estudos Controlados Antes e Depois , Estudos Transversais , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Reino Unido
17.
BMC Health Serv Res ; 19(1): 346, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151446

RESUMO

BACKGROUND: With an extensive rise in the number of acute patients and increases in both admissions and readmissions, hospitals are at times overcrowded and under immense pressure and this may challenge patient safety. This study evaluated an innovative strategy converting acute internal medicine inpatient take to an outpatient take. Here, acute patients, following referral, underwent fast-track assessment to the needed level of medical care as outpatients, directly in internal medicine wards. METHOD: The two internal medicine wards at Diagnostic Centre, Silkeborg, Denmark, changed their take of acute patients 1st of March 2017. The intervention consisted of acute medical patients being received in medical examination chairs, going through accelerated evaluation as outpatients with assessment within one hour for either admission or another form of treatment. A before-and-after study design was used to evaluate changes in activity. All referred patients for 10 months following implementation of the intervention were compared with patients referred in corresponding months the previous year. RESULTS: A total of 5339 contacts (3632 patients) who underwent acute medical assessment (2633 contacts before and 2706 after) were included. Median hospital length-of-stay decreased from 32.6 h to 22.3 h, and the proportion of referred acute patients admitted decreased with 36.3% points from 94.5 to 58.2%. The median length-of-admission time for the admitted patients increased as expected after the intervention. The risk of being admitted, being readmitted as well as having a hospital length-of-time longer than 24 h, 72 h or 7 days, respectively, were significantly lower during the after-period in comparison to the before-period. Adverse effects, unplanned re-contacts, total contacts to general practice and mortality did not change after the intervention. CONCLUSION: Assessing referred acute patients in medical examination chairs as outpatients directly in internal medicine wards and promoting an accelerated trajectory, reduced inpatient admissions and total length-of-stay considerably. This strategy seems effective in everyday acute medical patients and has the potential to ease the increasing pressure on the acute take for wards receiving acute medical patients.


Assuntos
Hospitalização/estatística & dados numéricos , Medicina Interna/estatística & dados numéricos , Idoso , Estudos Controlados Antes e Depois , Dinamarca , Feminino , Medicina Geral/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
18.
Matern Child Nutr ; 15 Suppl 3: e12720, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148403

RESUMO

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost-effectiveness of the fortification of edible oil by small- and medium-scale (SMS) producers in preventing VAD. The MASAVA project initiated the production of sunflower oil fortified with vitamin A by SMS producers in the Manyara and Shinyanga regions of Tanzania. A quasi-experimental nonequivalent control-group research trial and an economic evaluation were conducted. The household survey included mother and child pairs from a sample of 568 households before the intervention and 18 months later. From the social perspective, the incremental cost of fortification of sunflower oil could be as low as $0.13, $0.06, and $0.02 per litre for small-, medium-, and large-scale producers, respectively, compared with unfortified sunflower oil. The SMS intervention increased access to fortified oil for some vulnerable groups but did not have a significant effect on the prevention of VAD due to insufficient coverage. Fortification of vegetable oil by large-scale producers was associated with a significant reduction of VAD in children from Shinyanga. The estimated cost per disability-adjusted life year averted for fortified sunflower oil was $281 for large-scale and could be as low as $626 for medium-scale and $1,507 for small-scale producers under ideal conditions. According to the World Health Organization thresholds, this intervention is very cost-effective for large- and medium-scale producers and cost-effective for small-scale producers.


Assuntos
Análise Custo-Benefício , Alimentos Fortificados/economia , Óleo de Girassol/economia , Deficiência de Vitamina A/prevenção & controle , Vitamina A/economia , Pré-Escolar , Comércio , Estudos Controlados Antes e Depois , Feminino , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Humanos , Lactente , Política Nutricional/economia , Política Nutricional/legislação & jurisprudência , Prevalência , Empresa de Pequeno Porte/economia , Óleo de Girassol/administração & dosagem , Tanzânia/epidemiologia , Vitamina A/administração & dosagem , Deficiência de Vitamina A/epidemiologia
19.
J. optom. (Internet) ; 12(2): 131-140, abr.-jun. 2019. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-180893

RESUMO

Purpose: To compare the shape of the anterior sclera of candidates to scleral lens (ScCL) fitting with regular and irregular corneas and analyze the changes induced in the shape of the sclero-conjunctiva after ScCL wear. Methods: Thirty-five eyes of 18 subjects (19 eyes with irregular corneas and 16 with regular corneas) were consecutively recruited. Three measures of sclero-conjunctival shape were taken with Eye Surface Profiler (ESP, Eaglet Eye, Houten, The Netherlands). Tangent angles and ocular sagittal heights (OC-SAG) were analyzed at different chords from 13 to 17 mm in the nasal, temporal, superior and inferior regions. The 19 eyes with irregular cornea were selected to wear ScCL and the changes in their sclero-conjunctival surface parameters were compared before and after 3 h of lens wear. Results: Irregular corneas showed higher OC-SAG values than regular corneas in all the chords analyzed, with statistical significant differences in the temporal region. Regarding tangent angles, regular corneas showed lower values (flatter surface), with statistical significant differences at 8 and 8.50 mm on the nasal and 8.50 mm on the temporal region. Some changes were seen in sclero-conjuctival shape after short-term ScCL wear. There was an augment in OC-SAG after 3h of scleral lens wear and a reduction on tangent angles, namely on the nasal region at 7.5 mm and 8.00 mm chord lengths, which is coincidental with the landing zone of ScCL. Conclusions: ESP shows mild differences in scleral shape between eyes with regular and irregular corneas. ESP might be valuable in quantifying the mechanical impact of the ScCL on the anterior eye surface


Objetivo: Comparar la forma de la esclerótica anterior de los candidatos a utilizar lentes de apoyo escleral (ScCL) con córneas regulares e irregulares, y analizar los cambios inducidos en la forma de la superfície esclero-conjuntival tras el uso de dichas lentes. Métodos: Se incluyeron consecutivamente treinta y cinco ojos de 18 sujetos (19 ojos con córneas irregulares y 16 con córneas regulares). Se realizaron tres mediciones de la forma esclero-conjuntival con el dispositivo Eye Surface Profiler (ESP, Eaglet Eye, Houten, The Netherlands). Se analizaron los ángulos tangenciales y las alturas sagitales oculares (OC-SAG) a diferentes cuerdas, de 13 a 17 mm en las regiones nasal, temporal, superior e inferior. Se seleccionó a los 19 ojos con córnea irregular para utilizar ScCL, comparándose los cambios de los parámetros de su superficie esclero-conjuntival antes y después del uso de lentillas durante 3 horas. Resultados: Las córneas regulares reflejaron valores OC-SAG superiores a las córneas regulares en todas las cuerdas analizadas, con diferencias estadísticamente significativas en la región temporal. En cuanto a los ángulos tangenciales, las córneas regulares reflejaron unos valores inferiores (superficie más plana), con diferencias estadísticamente significativas a 8 y 8,5 mm en la región nasal, y 8,5 mm en la región temporal. También se apreciaron algunos cambios en la forma esclero-conjutival tras el uso a corto plazo de ScCL. Se produjo un aumento de los valores OC-SAG tras 3 h de uso de lentillas esclerales, y una reducción de los ángulos tangenciales, es decir, en las distancais correspondientes a las cuerdas de la región nasal a 7,5 mm y 8 mm, lo cual es coincidente con la zona de apoyo de las ScCL. Conclusiones: El dispositivo ESP muestra leves diferencias en la forma escleral entre los ojos con córneas regulares e irregulares, y ha es capaz de por lo que podría resultar de utilidad para cuantificar el impacto mecánico de las lentes ScCL en la superficie anterior del ojo


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Lentes de Contato/efeitos adversos , Esclera/anatomia & histologia , Topografia da Córnea/métodos , Ceratocone/classificação , Estudos Controlados Antes e Depois , Estudos Prospectivos
20.
PLoS One ; 14(5): e0203721, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071096

RESUMO

BACKGROUND: Patients experiencing adverse drug events (ADE) in many developing countries are in the best position to report these events to the authorities but need to be empowered to do so. Systematic evaluation of community engagement and patient support especially in rural areas would provide evidence for a program to monitor potential harm from medicines. The aim of this study was to assess the effects of a community dialogue and sensitization (CDS) program on the knowledge, attitude and practises of community members for reporting ADE. METHODS: This an uncontrolled before-after study was conducted in two eastern Ugandan districts between September 2016 and August 2017. RESULTS: After implementation of the community dialogue and sensitization (CDS) program, there was an overall 20% (95% CI:16% to 25%) increase in knowledge about ADE in the community compared to before the program began. Awareness levels increased by 50% (95% CI: 37% to 63%) among those with little or no education and by41% (95% CI: 31% to 52%) among young people (15-24 years). Furthermore, 5% (95% CI: 3% to 7%) more respondents recognized the need for reporting ADEs compared to before the program. Finally, there was a significant increase of 115% (95% CI:137% to 217%) in respondent recognition and reporting of ADEs compared to the beginning of the CDS program. Overall, this community found the CDS program acceptable and proposed aspects that could be improved for future use. CONCLUSION: Our evaluation showed that the CDS program increased knowledge and improved attitudes by catalyzing discussions among community members and healthcare professionals on health issues and monitoring safety of medicines compared to before the program. Successful implementation of the program depends on holistic health systems strengthening and adaptation to the community's way of life.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Saúde Pública , População Rural , Autorrelato , Estudos Controlados Antes e Depois , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Uganda/epidemiologia
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