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1.
PLoS Med ; 17(10): e1003358, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33001967

RESUMO

BACKGROUND: Loss of smell and taste are commonly reported symptoms associated with coronavirus disease 2019 (COVID-19); however, the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in people with acute loss of smell and/or taste is unknown. The study aimed to determine the seroprevalence of SARS-CoV-2 antibodies in a community-based population with acute loss of smell and/or taste and to compare the frequency of COVID-19 associated symptoms in participants with and without SARS-CoV-2 antibodies. It also evaluated whether smell or taste loss are indicative of COVID-19 infection. METHODS AND FINDINGS: Text messages, sent via primary care centers in London, United Kingdom, invited people with loss of smell and/or taste in the preceding month, to participate. Recruitment took place between 23 April 2020 and 14 May 2020. A total of 590 participants enrolled via a web-based platform and responded to questions about loss of smell and taste and other COVID-19-related symptoms. Mean age was 39.4 years (SD ± 12.0) and 69.1% (n = 392) of participants were female. A total of 567 (96.1%) had a telemedicine consultation during which their COVID-19-related symptoms were verified and a lateral flow immunoassay test that detected SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies was undertaken under medical supervision. A total of 77.6% of 567 participants with acute smell and/or taste loss had SARS-CoV-2 antibodies; of these, 39.8% (n = 175) had neither cough nor fever. New loss of smell was more prevalent in participants with SARS-CoV-2 antibodies, compared with those without antibodies (93.4% versus 78.7%, p < 0.001), whereas taste loss was equally prevalent (90.2% versus 89.0%, p = 0.738). Seropositivity for SARS-CoV-2 was 3 times more likely in participants with smell loss (OR 2.86; 95% CI 1.27-6.36; p < 0.001) compared with those with taste loss. The limitations of this study are the lack of a general population control group, the self-reported nature of the smell and taste changes, and the fact our methodology does not take into account the possibility that a population subset may not seroconvert to develop SARS-CoV-2 antibodies post-COVID-19. CONCLUSIONS: Our findings suggest that recent loss of smell is a highly specific COVID-19 symptom and should be considered more generally in guiding case isolation, testing, and treatment of COVID-19. TRIALS REGISTRATION: ClinicalTrials.gov NCT04377815.


Assuntos
Anticorpos Antivirais/sangue , Infecções por Coronavirus/complicações , Transtornos do Olfato/virologia , Pneumonia Viral/complicações , Distúrbios do Paladar/virologia , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Londres , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Testes Imediatos , Soroconversão , Estudos Soroepidemiológicos , Envio de Mensagens de Texto
2.
Sci Total Environ ; 741: 140515, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32887014

RESUMO

An ecologic analysis was conducted to explore the correlation between air pollution, and COVID-19 cases and fatality rates in London. The analysis demonstrated a strong correlation (R2 > 0.7) between increment in air pollution and an increase in the risk of COVID-19 transmission within London boroughs. Particularly, strong correlations (R2 > 0.72) between the risk of COVID-19 fatality and nitrogen dioxide and particulate matter pollution concentrations were found. Although this study assumed the same level of air pollution across a particular London borough, it demonstrates the possibility to employ air pollution as an indicator to rapidly identify the city's vulnerable regions. Such an approach can inform the decisions to suspend or reduce the operation of different public transport modes within a city. The methodology and learnings from the study can thus aid in public transport's response to COVID-19 outbreak by adopting different levels of human-mobility reduction strategies based on the vulnerability of a given region.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Cidades , Humanos , Londres , Dióxido de Nitrogênio/análise , Material Particulado/análise
3.
Cancer Control ; 27(3): 1073274820950844, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885663

RESUMO

COVID-19 has forced governments to make drastic changes to healthcare systems. To start making informed decisions about cancer care, we need to understand the scale of COVID-19 infection. Therefore, we introduced swab testing for patients visiting Guy's Cancer Centre. Our Centre is one of the largest UK Cancer Centers at the epicenter of the UK COVID-19 epidemic. The first COVID-19 positive cancer patient was reported on 29 February 2020. We analyzed data from 7-15 May 2020 for COVID-19 tests in our cancer patients. 2,647 patients attended for outpatient, chemotherapy, or radiotherapy appointments. 654 were swabbed for COVID-19 (25%). Of those tested, 9 were positive for COVID-19 (1.38%) of which 7 were asymptomatic. Cancer service providers will need to understand their local cancer population prevalence. The absolute priority is that cancer patients have the confidence to attend hospitals and be reassured that they will be treated in a COVID-19 managed environment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Institutos de Câncer , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Pandemias , Pneumonia Viral/diagnóstico , Prevalência
4.
J Environ Sci (China) ; 97: 180-185, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32933733

RESUMO

Novel brominated flame retardants (NBFRs) were investigated in Arctic air and soil samples collected from Ny-Ålesund and London Island, Svalbard, during Chinese scientific research expeditions to the Arctic during 2014-2015. The concentrations of Σ9NBFRs in the Arctic air and soil were 4.9-8.7 pg/m3 (average 6.8 pg/m3) and 101-201 pg/g dw (average 150 pg/g dw), respectively. The atmospheric concentration of hexabromobenzene (HBB) was significantly correlated with that of pentabromotoluene (PBT) and pentabromobenzene (PBBz), suggesting similar source and environmental fate in the Arctic air. No significant spatial difference was observed among the different sampling sites, both for air and soil samples, indicating that the effects of the scientific research stations on the occurrence of NBFRs in the Arctic were minor. The fugacities from soil to air of pentabromoethylbenzene (PBEB), 2,3-dibromopropyl 2,4,6-tribromophenyl ether (DPTE), and decabromodiphenylethane 1,2-bis (pentabromophenyl) ethane (DBDPE) were lower than the equilibrium value, indicating a nonequilibrium state of these compounds between air and soil, the dominant impact of deposition and the net transport from air to soil. The correlation analysis between the measured and predicted soil-atmosphere coefficients based on the absorption model showed that the impact of the soil organic matter on the distribution of NBFRs in the Arctic region was minor. To the best of our knowledge, this work is one of the limited reports on atmospheric NBFRs in the Arctic and the first study to investigate the occurrence and fate of NBFRs in the Arctic soil.


Assuntos
Retardadores de Chama/análise , Regiões Árticas , Atmosfera , Monitoramento Ambiental , Éteres Difenil Halogenados/análise , Ilhas , Londres , Solo , Svalbard
5.
Br J Gen Pract ; 70(699): e696-e704, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32895242

RESUMO

BACKGROUND: The first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care. AIM: To quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record. DESIGN AND SETTING: Cross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England. METHOD: Suspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status. RESULTS: GPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57). CONCLUSION: Using data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.


Assuntos
Infecções por Coronavirus , Grupos Étnicos/estatística & dados numéricos , Medicina Geral/métodos , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/etnologia , Diagnóstico Diferencial , Feminino , Disparidades nos Níveis de Saúde , Humanos , Londres/epidemiologia , Masculino , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Pessoa de Meia-Idade , Saúde das Minorias/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/etnologia , Prevalência , Fatores de Risco
6.
BMJ Health Care Inform ; 27(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32796085

RESUMO

BACKGROUND: The COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services. OBJECTIVE: To describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform 'Attend Anywhere' in Moorfields Eye Hospital's accident and emergency (A&E) department (London, UK). METHOD: Patient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service. RESULTS: In the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5-31 min) and the wait time was 6 min (range 0-37 min). CONCLUSION: Video consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Oftalmopatias , Oftalmologia , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/organização & administração , Infecções por Coronavirus , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Feminino , Humanos , Londres , Masculino , Pandemias , Satisfação do Paciente , Pneumonia Viral
7.
PLoS One ; 15(8): e0236857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760081

RESUMO

Recent outbreaks of coronavirus disease 2019 (COVID-19) has led a global pandemic cross the world. Most countries took two main interventions: suppression like immediate lockdown cities at epicenter or mitigation that slows down but not stopping epidemic for reducing peak healthcare demand. Both strategies have their apparent merits and limitations; it becomes extremely hard to conduct one intervention as the most feasible way to all countries. Targeting at this problem, this paper conducted a feasibility study by defining a mathematical model named SEMCR, it extended traditional SEIR (Susceptible-Exposed-Infectious-Recovered) model by adding two key features: a direct connection between Exposed and Recovered populations, and separating infections into mild and critical cases. It defined parameters to classify two stages of COVID-19 control: active contain by isolation of cases and contacts, passive contain by suppression or mitigation. The model was fitted and evaluated with public dataset containing daily number of confirmed active cases including Wuhan and London during January 2020 and March 2020. The simulated results showed that 1) Immediate suppression taken in Wuhan significantly reduced the total exposed and infectious populations, but it has to be consistently maintained at least 90 days (by the middle of April 2020). Without taking this intervention, we predict the number of infections would have been 73 folders higher by the middle of April 2020. Its success requires efficient government initiatives and effective collaborative governance for mobilizing of corporate resources to provide essential goods. This mode may be not suitable to other countries without efficient collaborative governance and sufficient health resources. 2) In London, it is possible to take a hybrid intervention of suppression and mitigation for every 2 or 3 weeks over a longer period to balance the total infections and economic loss. While the total infectious populations in this scenario would be possibly 2 times than the one taking suppression, economic loss and recovery of London would be less affected. 3) Both in Wuhan and London cases, one important issue of fitting practical data was that there were a portion (probably 62.9% in Wuhan) of self-recovered populations that were asymptomatic or mild symptomatic. This finding has been recently confirmed by other studies that the seroprevalence in Wuhan varied between 3.2% and 3.8% in different sub-regions. It highlights that the epidemic is far from coming to an end by means of herd immunity. Early release of intervention intensity potentially increased a risk of the second outbreak.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Doenças Assintomáticas , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Estudos de Viabilidade , Humanos , Londres/epidemiologia , Modelos Teóricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
10.
PLoS One ; 15(8): e0236517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785250

RESUMO

Social media has made it possible to manipulate the masses via disinformation and fake news at an unprecedented scale. This is particularly alarming from a security perspective, as humans have proven to be one of the weakest links when protecting critical infrastructure in general, and the power grid in particular. Here, we consider an attack in which an adversary attempts to manipulate the behavior of energy consumers by sending fake discount notifications encouraging them to shift their consumption into the peak-demand period. Using Greater London as a case study, we show that such disinformation can indeed lead to unwitting consumers synchronizing their energy-usage patterns, and result in blackouts on a city-scale if the grid is heavily loaded. We then conduct surveys to assess the propensity of people to follow-through on such notifications and forward them to their friends. This allows us to model how the disinformation may propagate through social networks, potentially amplifying the attack impact. These findings demonstrate that in an era when disinformation can be weaponized, system vulnerabilities arise not only from the hardware and software of critical infrastructure, but also from the behavior of the consumers.


Assuntos
Comunicação , Disseminação de Informação , Mídias Sociais , Rede Social , Cidades , Sistemas Computacionais , Decepção , Humanos , Londres , Software , Inquéritos e Questionários
12.
Rozhl Chir ; 99(6): 249-257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32736479

RESUMO

Complex anorectal examination including a detailed medical history, physical proctological examination and evaluation of the sensorimotor and structural function of the anorectum is essential for the diagnosis and therapeutic management of functional anorectal dysfunction. The aim of the work is to provide an overview of diagnosing functional anorectal disorders according to the new update and consensus statement of the International Anorectal Physiology Working Group (IAPWG) with a focus on indications, a standardized examination protocol and introduction of the new London classification of anorectal dysfunction. The indications are: fecal incontinence, defecation disorders, functional pelvic (anorectal) pain, evaluation before an anorectal intervention and before planned delivery to assess the function of a previously traumatized anal sphincter. Standardization of the diagnosis and the evaluated data are the basis for multidisciplinary cooperation and determination of a treatment plan for each patient individually.


Assuntos
Incontinência Fecal/diagnóstico , Canal Anal , Defecação , Humanos , Londres , Manometria , Planejamento de Assistência ao Paciente , Reto
13.
Palliat Med ; 34(9): 1241-1248, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736485

RESUMO

BACKGROUND: Palliative care services face challenges in adapting and responding to the COVID-19 pandemic. Understanding how palliative care needs and outcomes have changed during the pandemic compared to before the pandemic is crucial to inform service planning and research initiatives. AIM: To evaluate the impact of COVID-19 on symptoms, clinical characteristics, and outcomes for patients referred to a hospital-based palliative care service in a district general hospital in London, UK. DESIGN: A retrospective service evaluation. Data were extracted from the electronic patient records. SETTING/PARTICIPANTS: The first 60 inpatients with confirmed COVID-19 infection, referred to the hospital palliative care service between 1 March 2020 and 23 April 2020, and another 60 inpatients, referred to the hospital palliative care service between 11 March 2019 and 23 April 2019, were included from a district general hospital in East London, UK. RESULTS: Patients with COVID-19 have lower comorbidity scores, poorer performance status, and a shorter time from referral to death compared to patients without COVID-19. Breathlessness, drowsiness, agitation, and fever are the most prevalent symptoms during COVID-19 compared to pain and drowsiness pre-COVID-19. Time from admission to referral to palliative care is longer for Black, Asian and minority ethnic patients, especially during COVID-19. CONCLUSION: Early referral to palliative care is essential in COVID-19, especially for Black, Asian and minority ethnic groups. There is urgent need to research why Black, Asian and minority ethnic patients are referred late; how palliative care services have changed; and possible solutions to setting up responsive, flexible, and integrated services.


Assuntos
Infecções por Coronavirus/enfermagem , Cuidados Paliativos/estatística & dados numéricos , Pneumonia Viral/enfermagem , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Betacoronavirus , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
14.
J Pediatric Infect Dis Soc ; 9(4): 504-506, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32770243

RESUMO

We note that intussusception was likely associated with severe acute respiratory syndrome coronavirus-2 infection in 2 infants in Wuhan and London. The intussusception was reduced by enemas in Wuhan; the outcome was fatal. The intussusception was not reduced by enemas in London and required surgery; the outcome was favorable.


Assuntos
Infecções por Coronavirus/complicações , Enema , Intussuscepção/terapia , Intussuscepção/virologia , Pneumonia Viral/complicações , Betacoronavirus , China , Evolução Fatal , Feminino , Humanos , Lactente , Intussuscepção/diagnóstico por imagem , Londres , Pandemias
15.
PLoS One ; 15(8): e0236998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790687

RESUMO

There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4-12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection.


Assuntos
Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Transfusão Total , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Anemia Falciforme/terapia , Terapia Combinada , Feminino , Sobrevivência de Enxerto , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/terapia , Londres , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Lancet Psychiatry ; 7(10): 865-874, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32735782

RESUMO

Background A substantial and unmet clinical need exists for pharmacological treatment of cannabis use disorders. Cannabidiol could offer a novel treatment, but it is unclear which doses might be efficacious or safe. Therefore, we aimed to identify efficacious doses and eliminate inefficacious doses in a phase 2a trial using an adaptive Bayesian design. METHODS: We did a phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial at the Clinical Psychopharmacology Unit (University College London, London, UK). We used an adaptive Bayesian dose-finding design to identify efficacious or inefficacious doses at a-priori interim and final analysis stages. Participants meeting cannabis use disorder criteria from DSM-5 were randomly assigned (1:1:1:1) in the first stage of the trial to 4-week treatment with three different doses of oral cannabidiol (200 mg, 400 mg, or 800 mg) or with matched placebo during a cessation attempt by use of a double-blinded block randomisation sequence. All participants received a brief psychological intervention of motivational interviewing. For the second stage of the trial, new participants were randomly assigned to placebo or doses deemed efficacious in the interim analysis. The primary objective was to identify the most efficacious dose of cannabidiol for reducing cannabis use. The primary endpoints were lower urinary 11-nor-9-carboxy-δ-9-tetrahydrocannabinol (THC-COOH):creatinine ratio, increased days per week with abstinence from cannabis during treatment, or both, evidenced by posterior probabilities that cannabidiol is better than placebo exceeding 0·9. All analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov (NCT02044809) and the EU Clinical Trials Register (2013-000361-36). FINDINGS: Between May 28, 2014, and Aug 12, 2015 (first stage), 48 participants were randomly assigned to placebo (n=12) and to cannabidiol 200 mg (n=12), 400 mg (n=12), and 800 mg (n=12). At interim analysis, cannabidiol 200 mg was eliminated from the trial as an inefficacious dose. Between May 24, 2016, and Jan 12, 2017 (second stage), randomisation continued and an additional 34 participants were allocated (1:1:1) to cannabidiol 400 mg (n=12), cannabidiol 800 mg (n=11), and placebo (n=11). At final analysis, cannabidiol 400 mg and 800 mg exceeded primary endpoint criteria (0·9) for both primary outcomes. For urinary THC-COOH:creatinine ratio, the probability of being the most efficacious dose compared with placebo given the observed data was 0·9995 for cannabidiol 400 mg and 0·9965 for cannabidiol 800 mg. For days with abstinence from cannabis, the probability of being the most efficacious dose compared with placebo given the observed data was 0·9966 for cannabidiol 400 mg and 0·9247 for cannabidiol 800 mg. Compared with placebo, cannabidiol 400 mg decreased THC-COOH:creatinine ratio by -94·21 ng/mL (95% interval estimate -161·83 to -35·56) and increased abstinence from cannabis by 0·48 days per week (0·15 to 0·82). Compared with placebo, cannabidiol 800 mg decreased THC-COOH:creatinine ratio by -72·02 ng/mL (-135·47 to -19·52) and increased abstinence from cannabis by 0·27 days per week (-0·09 to 0·64). Cannabidiol was well tolerated, with no severe adverse events recorded, and 77 (94%) of 82 participants completed treatment. INTERPRETATION: In the first randomised clinical trial of cannabidiol for cannabis use disorder, cannabidiol 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use. FUNDING: Medical Research Council.


Assuntos
Canabidiol/administração & dosagem , Abuso de Maconha/tratamento farmacológico , Síndrome de Abstinência a Substâncias , Adolescente , Adulto , Teorema de Bayes , Canabidiol/efeitos adversos , Método Duplo-Cego , Dronabinol/urina , Feminino , Alucinógenos/urina , Humanos , Londres , Masculino , Fumar Maconha , Resultado do Tratamento , Adulto Jovem
17.
Crim Behav Ment Health ; 30(5): 268-280, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32754973

RESUMO

The United Kingdom (UK) government has commissioned numerous interventions across all stages of the criminal justice pathway for managing offenders likely to have a personality disorder, with the intention to reduce reoffending, improve psychological wellbeing, and develop workforce capabilities. Psychologically Informed Practice (PIP) models underpin these. To evaluate a modified PIP model within the post-imprisonment community stage of the Offender Personality Disorder (OPD) pathway, specifically workforce development, within all London (UK) probation supervised hostels (approved premises), we used both non-equivalent control group and pre-post repeated measure designs to compare changes in staff and offender outcomes before and after introduction of a PIP model across all 12 London approved premises. Findings revealed statistically significant improvements in a number of workforce outcomes (measured using the Personality Disorder - Knowledge, Attitudes and Skills Questionnaire and Maslach Burnout Inventory) which were moderated by age and gender. Data did not support associated improvements in resident offender outcomes (progressive moves, rearrests/reoffences, or breaches leading to recalls). The modified PIP is an effective intervention model for improving some workforce outcomes among probation supervised hostel staff, particularly for women, but our findings suggest that intervention development may be required for significant improvements to be observed in resident offending outcomes. In addition, further research is necessary to determine the longer term effects of PIP on absenteeism, employee turnover, quality of resident-staff interactions, and overall culture change among staff working within the post-imprisonment community stage of the OPD pathway.


Assuntos
Criminosos/psicologia , Transtornos da Personalidade/psicologia , Adulto , Direito Penal , Feminino , Humanos , Londres , Masculino , Reino Unido
19.
Med Health Care Philos ; 23(4): 603-609, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32761351

RESUMO

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Peste/história , Pneumonia Viral/prevenção & controle , Quarentena/história , Inglaterra/epidemiologia , História do Século XVII , Humanos , Controle de Infecções/métodos , Londres/epidemiologia , Peste/prevenção & controle , Saúde Pública/ética , Quarentena/ética
20.
J Infect ; 81(4): 621-624, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735893

RESUMO

BACKGROUND: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. METHODS: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. RESULTS: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9-4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. CONCLUSIONS: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Corpo Clínico/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Pneumonia Viral/epidemiologia , Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Inglaterra/epidemiologia , Genoma Viral/genética , Humanos , Controle de Infecções/métodos , Londres/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Sequenciamento Completo do Genoma
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