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1.
J Nutr Health Aging ; 24(8): 812-816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009529

RESUMO

BACKGROUND: Guidance aiming at limiting the entry and spread of the COVID-19 have been widely communicated to Long-term Care Facilities (LTCFs). However, no clinical research has investigated their relevance. OBJECTIVE: Our objective was to compare the guidance applied for the prevention of the COVID-19 epidemic between the LTCFs having been contaminated by COVID-19 and LTCFs having not been contaminated. METHODS: A questionnaire was sent and systematically accompanied by phone call to the 132 LTCFs of Haute-Garonne (Occitania region, South-West of France). The questionnaire focused on the preventive measures implemented before March 23, 2020 (first LTCFs contaminated in this area). The questionnaire focused on physician support, implementation of usual guidance (eg, masks, hydro-alcoholic solute used), training on hygiene, containment in residents' rooms and other distancing measures, use of temporary workers, compartmentalization within zones of residents and staff and a self-assessment analogic scale on the quality of the application of the preventive measures. We compared implementation of the guidance between the LTCFs with at least one case of COVID-19 among residents and/or health care professionals and LTCFs without COVID-19 case (between March 23rd and May 6th). RESULTS: 124 LTCFs participated (93.9%). 30 LTCFs (24.19%) were contaminated with COVID-19. Large heterogeneity of the application of the guidance was observed. Public LTCFs (OR= 0.39 (0.20-0.73), LTCFs which organized staff compartmentalization within zones (OR= 0.19 (0.07-0.48)), and LTCF with a staff who self-assessed a higher quality implementation of the preventive measures (OR= 0.65 (0.43-0.98)) were significantly more likely to avoid contamination by the COVID-19 outbreak. CONCLUSION: Our study supports the relevance of guidance to prevent the entry of COVID-19, in particular the staff compartmentalization within zones, as well as the perception of the staff regarding the quality of implementation of those measures in LTCFs.


Assuntos
Infecções por Coronavirus/prevenção & controle , Administração de Instituições de Saúde/métodos , Assistência de Longa Duração/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Betacoronavirus , França , Instalações de Saúde , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários
2.
Curr Biol ; 30(19): R1124-R1130, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33022254

RESUMO

Since the first recognition that infectious microbes serve as the causes of many human diseases, physicians and scientists have sought to understand and control their spread. For the past 150+ years, these 'microbe hunters' have learned to combine epidemiological information with knowledge of the infectious agent(s). In this essay, I reflect on the evolution of microbe hunting, beginning with the history of pre-germ theory epidemiological studies, through the microbiological and molecular eras. Now in the genomic age, modern-day microbe hunters are combining pathogen whole-genome sequencing with epidemiological data to enhance epidemiological investigations, advance our understanding of the natural history of pathogens and drivers of disease, and ultimately reshape our plans and priorities for global disease control and eradication. Indeed, as we have seen during the ongoing Covid-19 pandemic, the role of microbe hunters is now more important than ever. Despite the advances already made by microbial genomic epidemiology, the field is still maturing, with many more exciting developments on the horizon.


Assuntos
Bactérias/genética , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Epidemiologia Molecular/métodos , Prevenção Primária/métodos , Bactérias/patogenicidade , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Genoma Bacteriano/genética , Genoma Viral/genética , História do Século XIX , História do Século XX , Humanos , Microbiota/genética , Pandemias , Pneumonia Viral/epidemiologia
3.
PLoS Negl Trop Dis ; 14(9): e0008716, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32966283

RESUMO

The concurrent circulation of dengue and coronavirus disease 2019 (COVID-19) may produce many unfavourable outcomes-such as co-infections; delays in diagnosis, treatment, and mitigation measures; overwhelming of the healthcare system; underreporting of cases; deterioration in surveillance and control interventions; and exacerbation of social inequalities. Indeed, lockdown is greatly compromising the effectiveness of vector control, especially social mobilization campaigns and preventive insecticide spraying in private spaces (indoor and peridomestic spraying). Thus, failure to appropriately implement the full range of vector control interventions can lead to a reduction in their overall effectiveness and an increasing risk of vector-borne diseases circulating. Consequently, the health community and policy makers should develop proactive policies and allocate adequate resources to prevent and manage the resurgence of dengue and other vector-borne diseases in the new era of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Dengue/epidemiologia , Dengue/prevenção & controle , Controle de Mosquitos/métodos , Pneumonia Viral/epidemiologia , Prevenção Primária/métodos , Betacoronavirus , Assistência à Saúde , Humanos , Pandemias , Controle de Pragas/métodos , Saúde Pública , Tempo para o Tratamento
4.
PLoS Negl Trop Dis ; 14(9): e0008700, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32886678

RESUMO

Severe Acute Respiratory Syndrome Coronavirus 2 (COVID 19) has plagued the world with about 7,8 million confirmed cases and over 430,000 deaths as of June 13th, 2020. The knowledge, attitude, and practices (KAP) people hold towards this new disease could play a major role in the way they accept measures put in place to curb its spread and their willingness to seek and adhere to care. We sought to understand if: a) demographic variables of Cameroonian residents could influence KAP and symptomatology, and b) KAP could influence the risk of having COVID19.A cross-sectional KAP/symptomatology online survey was conducted between April 20 to May 20. All analyses were performed using SPSS version 23. Of all respondents (1006), 53.1% were female, 26.6% were students, 26.9% interacted face to face and 62.8% were residents in Yaoundé with a median age of 33. The overall high score was 84.19% for knowledge, 69% for attitude, and 60.8% for practice towards COVID 19. Age > 20 years was associated with a high knowledge of COVID 19. Women had lower practice scores compared to men (OR = 0.72; 95%CI 0.56-0.92). 41 respondents had ≥3 symptoms and only 9 (22.95%) of them had called 1510 (emergency number). There was no significant difference between KAP and symptomatology. The presence of ≥ 3 symptoms in 4% of respondents (with 56% of them having co-morbidities) supports the current trend in the number of confirmed cases (8681) in Cameroon. The continuous increase in the number of cases and the overall good KAP warrants further investigation to assess the effectiveness of the measures put in place to curb the spread of the disease. Sensitization is paramount to preclude negative health-seeking behaviors and encourage positive preventive and therapeutic practices, for fear of an increase in mortality.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Adulto , Betacoronavirus , Camarões/epidemiologia , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Inquéritos e Questionários , Adulto Jovem
5.
Ann Agric Environ Med ; 27(3): 469-475, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955231

RESUMO

INTRODUCTION: Currently, malignancies are the most severe medical problems worldwide. Numerous, already known risk factors in carcinogenesis could be potentially avoided. Some cancer risk factors have been recognized and have become the targets of primary prophylaxis. OBJECTIVE: The aim of the study was to ascertain the state of knowledge about risk factors, primary prevention and early detection of malignancies of gastrointestinal tract (GIT) in the urban and rural population of the Lublin province in Eastern Poland. MATERIAL AND METHODS: The study was cross-sectional. The originally designed questionnaire was applied to the group of 1,352 patients, representatives of both the rural and urban environments of the Lublin province during random appointments with their general practitioner (GP). RESULTS: The study showed low awareness of the issues connected with GIT malignancies within the studied group. The problem was particulary apparent in the rural population. CONCLUSIONS: In order to raise general awareness of cancer, different means should be applied in urban and rural populations. GPs and the media were found to have the leading rols in the promotion of primary prevention.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Gastrointestinais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Prevenção Primária/estatística & dados numéricos , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/prevenção & controle , Polônia , Fatores de Risco , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
6.
J Epidemiol Glob Health ; 10(3): 194-197, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954707

RESUMO

Most sub-Saharan African countries acted early and aggressively in response to the WHO COVID-19 warning by closing schools, international borders, limiting domestic travel and restricting large gatherings. The six most populous sub-Saharan African countries, at the beginning of July 2020 with the exception of Republic of South Africa, all had relatively modest COVID-19 case counts compared with European, North and South American and some Asian countries in spite of access to more limited medical resources and technologies. Shutdowns or shelter-in-places were put in place for 5 out of 6 countries surveyed well before the first reported COVID-19 death. Timely action to enact comprehensive public health measures are irreplaceable and cannot be substituted by later use of medical resources or technologies. In the case of Republic of South Africa, earlier and multiple instances of virus introduction may have made infection control much more difficult compared with other sub-Saharan African countries.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Humanos , Prevenção Primária/estatística & dados numéricos , Fatores Socioeconômicos , África do Sul/epidemiologia , Fatores de Tempo
7.
Antimicrob Resist Infect Control ; 9(1): 154, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962759

RESUMO

BACKGROUND: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. METHODS: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). RESULTS: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. CONCLUSIONS: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.


Assuntos
Coinfecção/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Betacoronavirus , Coinfecção/microbiologia , Infecções por Coronavirus/patologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Surtos de Doenças , Genoma Bacteriano/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Tipagem de Sequências Multilocus , Pandemias , Pneumonia Viral/patologia , Prevenção Primária , Enterococos Resistentes à Vancomicina/genética , Enterococos Resistentes à Vancomicina/isolamento & purificação , Sequenciamento Completo do Genoma
8.
Sci Rep ; 10(1): 15665, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32973285

RESUMO

The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevenção Primária/métodos , Dispositivos de Proteção Respiratória , Adolescente , Adulto , Aerossóis , Betacoronavirus , Tosse/virologia , Expiração , Feminino , Filtração/instrumentação , Humanos , Exposição por Inalação , Masculino , Pessoa de Meia-Idade , Prevenção Primária/instrumentação , Adulto Jovem
9.
Adv Respir Med ; 88(4): 364-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869273

RESUMO

There is increased evidence that the massive release of pro-inflammatory cytokines leading to the cytokine storm syndrome shapes the evolution of COVID-19 and is responsible of the severity of COVID-19 in some patients. A recent review argued that vitamin D deficiency could have increased the COVID-19 outbreak and suggested vitamin D supplementation as a preventive action. In fact, many factors seem to be correlated both to low vitamin D levels and the importance of COVID-19 spreading and severity. It is also important to highlight that the lockdown, implemented in many countries, prevents people to go out and then increases the risk of vitamin D deficiency. COPD patients are particularly at risk to have low levels of vitamin D due to multiple risk factors. COPD may generate a systemic inflammatory process responsible of secondary extra-pulmonary impairments. Vitamin D deficiency could sustain and aggravate the systemic inflammation associated to COPD. Reports have also shown that vitamin D deficiency was associated to exacerbations and hospital admissions, as well as lung function. Recent research showed that vitamin D supplementation significantly reduced COPD exacerbations. Although vitamin D deficiency was not proved to be neither a risk factor of COVID-19, nor a determinant of its severity, vitamin D supplementation represents a preventive perspective that needs to be further studied.


Assuntos
Colecalciferol/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Suplementos Nutricionais/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pneumonia Viral/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Deficiência de Vitamina D/prevenção & controle
10.
Rev Prat ; 70(3): 268-272, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32877056

RESUMO

Recommending physical activity for primary prevention of chronic diseases. Low level of physical activity (i.e. inactivity) is recognized as the second preventable common risk factor of chronic diseases after the tobacco use. Nonlinear dose-effect relationships are found between the volume and intensity of physical activity, and the global mortality and incidence of chronic diseases. A sedentary behavior, characterized by prolonged periods of very low energy expenditure, is also related to the global mortality and the incidence of chronic diseases. The deleterious effects of sedentary behavior are especially marked beyond seven hours a day sitting, or three hours a day in watching the television. All the results of recent survey demonstrate that in order to reduce the incidence of chronic diseases, both physical activity recommendations and decrease in sedentary time are recommended, whatever the age of the population.


Assuntos
Exercício Físico , Prevenção Primária , Comportamento Sedentário , Doença Crônica , Humanos , Televisão
12.
Top Antivir Med ; 28(2): 439-454, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886464

RESUMO

At the 2020 Conference on Retroviruses and Opportunistic Infections, held virtually as a result of the emerging COVID-19 pandemic, trends in the HIV epidemic were highlighted, with decreasing HIV incidence reported across several countries, although key regions remain heavily impacted, including the US South. Adolescent girls and young women, men who have sex with men (MSM), transgender persons, and people who inject drugs continue to experience a high burden of new infections. Sexually transmitted infections during pregnancy can lead to a number of adverse outcomes in infants; novel strategies to detect and treat these infections are needed. Innovative HIV testing strategies, including self-testing and assisted partner services, are expanding the reach of testing; however, linkage to care can be improved. Novel preexposure prophylaxis (PrEP) delivery strategies are increasing uptake of PrEP in different groups, although adherence and persistence remain a challenge. Use of on-demand PrEP is increasing among MSM in the US. Strategies are needed to address barriers to PrEP uptake and persistence among cis- and transgender women. Several novel regimens for postexposure prophylaxis show promise.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Pneumonia Viral/epidemiologia , Profilaxia Pré-Exposição/organização & administração , Saúde Pública , Doenças Sexualmente Transmissíveis/epidemiologia , Congressos como Assunto , Infecções por Coronavirus/diagnóstico , Feminino , Saúde Global , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Prevenção Primária/organização & administração , Projetos de Pesquisa , Infecções por Retroviridae/diagnóstico , Infecções por Retroviridae/epidemiologia , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos , Interface Usuário-Computador
13.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886465

RESUMO

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas/epidemiologia , Saúde Pública , Tuberculose/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Controle de Doenças Transmissíveis/organização & administração , Congressos como Assunto , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Gravidez , Prevalência , Prevenção Primária/métodos , Medição de Risco , Análise de Sobrevida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Interface Usuário-Computador , Adulto Jovem
14.
Lancet ; 396(10255): 918-934, 2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-32891217

RESUMO

The Sustainable Development Goal (SDG) target 3.4 is to reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030 relative to 2015 levels, and to promote mental health and wellbeing. We used data on cause-specific mortality to characterise the risk and trends in NCD mortality in each country and evaluate combinations of reductions in NCD causes of death that can achieve SDG target 3.4. Among NCDs, ischaemic heart disease is responsible for the highest risk of premature death in more than half of all countries for women, and more than three-quarters for men. However, stroke, other cardiovascular diseases, and some cancers are associated with a similar risk, and in many countries, a higher risk of premature death than ischaemic heart disease. Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4. To investigate the options available to each country for achieving SDG target 3.4, we considered different scenarios, each representing a combination of fast (annual rate achieved by the tenth best performing percentile of all countries) and average (median of all countries) declines in risk of premature death from NCDs. Pathways analysis shows that every country has options for achieving SDG target 3.4. No country could achieve the target by addressing a single disease. In at least half the countries, achieving the target requires improvements in the rate of decline in at least five causes for women and in at least seven causes for men to the same rate achieved by the tenth best performing percentile of all countries. Tobacco and alcohol control and effective health-system interventions-including hypertension and diabetes treatment; primary and secondary cardiovascular disease prevention in high-risk individuals; low-dose inhaled corticosteroids and bronchodilators for asthma and chronic obstructive pulmonary disease; treatment of acute cardiovascular diseases, diabetes complications, and exacerbations of asthma and chronic obstructive pulmonary disease; and effective cancer screening and treatment-will reduce NCD causes of death necessary to achieve SDG target 3.4 in most countries.


Assuntos
Mortalidade Prematura/tendências , Doenças não Transmissíveis/mortalidade , Desenvolvimento Sustentável , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Causas de Morte , Doença Crônica , Diabetes Mellitus/mortalidade , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Mortalidade/tendências , Isquemia Miocárdica/mortalidade , Neoplasias/mortalidade , Prevenção Primária , Doenças Respiratórias/mortalidade , Prevenção Secundária , Acidente Vascular Cerebral/mortalidade
15.
Artigo em Inglês | MEDLINE | ID: mdl-32942345

RESUMO

Background: There is a paucity of studies on treatment of childhood-onset bipolar disorder and its associated comorbidities, which leads to a wide diversity of opinion on choice and sequencing of treatment options. Methods: From December 2018 to January 2019, a graphic depiction of medications and weekly ratings of symptoms of mania, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional behavior that parents had rated on their 9-year-old child over a period of several years was sent to experts in child and adult bipolar disorder. These responding medical doctors (MDs, 8 child and 18 adult psychiatrists) rated a comprehensive list of medications that they would choose (and with what priority) to treat the child's now improved mood (mania and depression) but continued mild to moderate symptoms of anxiety, ADHD, and oppositional behavior. Results: In the whole group, the drugs most highly endorsed were lamotrigine: 69%, lithium: 62%, lurasidone: 62%, quetiapine: 54%, aripiprazole: 46%, and valproate: 42%. Among the antidepressants, 38% endorsed a selective serotonin reuptake inhibitor, 12% a serotonin-norepinephrine reuptake inhibitor, and 27% bupropion. Of the child MDs, 75% suggested increasing the 1-mg dose of risperidone, while few adult MDs suggested this. Conversely, 56% of the adult MDs suggested using valproate, while only 1 child MD did so. There was little consensus on how to manage ADHD symptoms unresponsive to methylphenidate 36 mg/d. How these treatment options were sequenced also varied widely. Conclusions: There was wide variation in suggestions on to how to treat persistent symptoms of anxiety, ADHD, and oppositional behavior in a child whose mania and depression had been brought under good control. We surmise that this great diversity in recommendations among experts in child and adult bipolar disorder stems at least partially from inadequate literature on treatment and that a new emphasis on funding and conducting studies on efficacy and effectiveness is needed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/terapia , Criança , Consenso , Feminino , Humanos , Prevenção Primária , Indução de Remissão
16.
Lancet ; 396(10254): 854-866, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32910907

RESUMO

Asthma is a complex disease that often starts in childhood. Genomic and environmental factors as well as aberrant immune maturation early in life can contribute to the onset of disease, with great disparity over time and geographical regions. Epidemiological studies have scrutinised environmental exposures and attempted to translate these exposures into prevention strategies. Some approaches for patients with asthma have been successful (eg, smoking ban, the Finnish Asthma Programme), and primary prevention of wheeze in pre-school children (age 0-5 years) by the supplementation of vitamin D or fish oil, or both, to pregnant women seems promising. Several recent prevention initiatives are based on strong asthma-protective environmental microbial exposures associated with traditional rural lifestyles. Preclinical studies with various bacterial lysates, bacterial and dietary metabolites, or helminthic compounds have yielded promising results that await translation into clinical practice. Given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to eradicate the disease.


Assuntos
Asma/epidemiologia , Asma/prevenção & controle , Prevenção Primária/métodos , Asma/dietoterapia , Asma/imunologia , Pré-Escolar , Suplementos Nutricionais/provisão & distribução , Exposição Ambiental/efeitos adversos , Feminino , Finlândia/epidemiologia , Óleos de Peixe/administração & dosagem , Óleos de Peixe/provisão & distribução , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prevalência , Fatores de Proteção , Fatores de Risco , Prevenção do Hábito de Fumar/métodos , Vitamina D/administração & dosagem , Vitamina D/provisão & distribução
17.
An. Fac. Cienc. Méd. (Asunción) ; 53(2): 53-58, 20200800.
Artigo em Espanhol | LILACS | ID: biblio-1119417

RESUMO

Introducción: El uso adecuado de la aspirina para la prevención primaria de eventos de enfermedades cardiovasculares requiere de la evaluación de los beneficios y riesgos para el paciente. Objetivos: Determinar el riesgo cardiovascular global y el uso adecuado de aspirina como prevención primaria de enfermedades cardiovasculares en pacientes ambulatorios de Clínica Médica del Hospital de Clínicas. Materiales y métodos: Estudio observacional, descriptivo, transversal, prospectivo en pacientes ambulatorios de Clínica Médica del Hospital de Clínicas entre setiembre de 2017 y setiembre de 2018. Se incluyó a pacientes de ambos sexos, entre 40 y 79 años de edad, que presentan uno o más de los siguientes factores de riesgo cardiovascular: HTA, dislipidemias, DM2, tabaquismo. Se midieron las variables sociodemográficas, presión arterial sistólica y diastólica, colesterol total, c-HDL, c-LDL, historia de HTA, DM2, tabaquismo, uso de estatinas y ácido acetilsalicílico. Para medir las variables se elaboró un cuestionario. Se calculó el puntaje de riesgo cardiovascular global según ACC/AHA, utilizando la calculadora ASCVD Risk. Resultados: Se analizaron 100 cuestionarios, edad promedio de 61±5,3 años, 67% mujeres y el 100% son de raza blanca. El 88% fueron hipertensos, 73% dislipidemicos, 43% diabéticos y 24% tabaquista. El 50% presentaron riesgo cardiovascular global alto, el promedio de riesgo cardiovascular es de 15±3,6 %. El 60% con adecuada indicación de aspirina para la prevención primaria de eventos cardiovasculares. Conclusión: La mitad de los pacientes presentaron riesgo cardiovascular alto y en el 60% el uso de aspirina fue adecuado para la prevención primaria de eventos cardiovasculares.


Introduction: The adequate use of aspirin for the primary prevention of cardiovascular disease events requires the evaluation of the benefits and risks for the patient. Objectives: To determine the global cardiovascular risk and the adequate use of aspirin as primary prevention of cardiovascular diseases in outpatients of the Clínica Médica del Hospital de Clínicas. Materials and methods: Observational, descriptive, cross-sectional, prospective study in outpatients of the Clínica Médica del Hospital de Clínicas between September 2017 and September 2018. Patients of both sexes, between 40 and 79 years of age, who had one or more of the following cardiovascular risk factors: HT, dyslipidemia, T2DM, smoking. Sociodemographic variables, systolic and diastolic blood pressure, total cholesterol, HDL-c, LDL-c, history of HT, DM2, smoking, use of statins and acetylsalicylic acid were measured. To measure the variables, a questionnaire was prepared. The global cardiovascular risk score was calculated according to ACC / AHA, using the ASCVD Risk calculator. Results: 100 questionnaires were analyzed, average age of 61 ± 5.3 years, 67% women and 100% are white. 88% were hypertensive, 73% dyslipidemic, 43% diabetic and 24% tobacco addicted. 50% presented high global cardiovascular risk, the average cardiovascular risk is 15 ± 3.6%. 60% with adequate indication of aspirin for the primary prevention of cardiovascular events. Conclusion: Half of the patients presented high cardiovascular risk and in 60% the use of aspirin was adequate for the primary prevention of cardiovascular events.


Assuntos
Doenças Cardiovasculares , Aspirina , Prevenção Primária
18.
BMC Public Health ; 20(1): 1235, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795290

RESUMO

BACKGROUND: The Icelandic Prevention Model (IPM) is a collaborative upstream model that was designed to influence risk and protective factors related to substance use within the community, school, peer and family contexts. By engaging whole communities, the IPM has been found to be effective in reducing youth substance use behaviours across Iceland. As an extension to the IPM's participatory approach, this research will examine how youth involvement can enhance outcomes. In addition, this research will evaluate whether the IPM approach is beneficial for mental health promotion and general youth wellbeing. METHODS: The present research protocol applies the bioecological model within a participatory mixed-method case study design to examine the implementation of the IPM in a rural community in Canada. This study was designed to identify whether the Icelandic substance use prevention model is effective in reducing substance use and promoting mental health and development for Canadian youth. It will also explore how to engage youth within the approach and how this adaptation influences implementation and outcomes. DISCUSSION: The findings from this study will contribute to our understanding of upstream prevention of youth substance use and will be used to support scaling of the IPM across Canada.


Assuntos
Modelos Organizacionais , Prevenção Primária/organização & administração , População Rural , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Canadá , Feminino , Humanos , Masculino , Projetos de Pesquisa
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