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2.
Dis Aquat Organ ; 136(1): 63-78, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31575835

RESUMO

Dikerogammarus haemobaphes is a non-native amphipod in UK freshwaters. Studies have identified this species as a low-impact invader in the UK, relative to its cousin Dikerogammarus villosus. It has been suggested that regulation by symbionts (such as Microsporidia) could explain this difference in impact. The effect of parasitism on D. haemobaphes is largely unknown. This was explored herein using 2 behavioural assays measuring activity and aggregation. First, D. haemobaphes were screened histologically post-assay, identifying 2 novel viruses (D. haemobaphes bi-facies-like virus [DhbflV], D. haemobaphes bacilliform virus [DhBV]), Cucumispora ornata (Microsporidia), Apicomplexa, and Digenea, which could alter host behaviour. DhBV infection burden increased host activity, and C. ornata infection reduced host activity. Second, native invertebrates were collected from the invasion site at Carlton Brook, UK, and tested for the presence of C. ornata. PCR screening identified that Gammarus pulex and other native invertebrates were positive for C. ornata. The host range of this parasite, and its impact on host survival, was additionally explored using D. haemobaphes, D. villosus, and G. pulex in a laboratory trial. D. haemobaphes and G. pulex became infected by C. ornata, which also lowered survival rate. D. villosus did not become infected. A PCR protocol for DhbflV was also applied to D. haemobaphes after the survival trial, associating this virus with decreased host survival. In conclusion, D. haemobaphes has a complex relationship with parasites in the UK environment. C. ornata likely regulates populations by decreasing host survival and activity, but despite this benefit, the parasite threatens susceptible native wildlife.


Assuntos
Anfípodes/parasitologia , Anfípodes/virologia , Parasitos/patogenicidade , Animais , Interações Hospedeiro-Parasita , Microsporídios , Trematódeos , Reino Unido
3.
BMJ ; 367: l5815, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31582424
6.
BJOG ; 126(12): 1508, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31591814
7.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564148

RESUMO

AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.


Assuntos
Artroplastia de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Sistema de Registros , Reoperação/métodos , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Inglaterra , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Irlanda do Norte , Osteoartrite do Quadril/diagnóstico por imagem , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/epidemiologia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Reino Unido , País de Gales
9.
Global Health ; 15(1): 53, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481126

RESUMO

Health security in the European Union (EU) aims to protect citizens from serious threats to health such as biological agents and infectious disease outbreaks- whether natural, intentional or accidental. Threats may include established infections, emerging diseases or chemical and radiological agents. Co-ordinated international efforts attempt to minimize risks and mitigate the spread of infectious disease across borders.We review the current situation (March 2019) with respect to detection and management of serious human health threats across Irish borders- and what may change for Ireland if/when the United Kingdom (UK) withdraws from the EU (Brexit).Specifically, this paper reviews international legislation covering health threats, and its national transposition; and EU legislation and processes, especially the relevant European Decision No. 1082/2013/EU of the European Parliament and of the Council on serious cross border threats to health with repeal of Decision No 2119/98/EC. We enumerate European surveillance systems and agencies which relate to port health security; we consider consortia and academic arrangements within the EU framework and established collaboration with the World Health Organization. We describe current Health Services Executive port health structures in Ireland which address preparedness and management of human health threats at points of entry. We appraise risks which Brexit could bring, reviewing literature on shared concerns about these risks, and we evaluate post-Brexit challenges for the EU, and potential opportunities to remain within current structures in shared health threat preparedness and response.It is imperative that the UK, Ireland and the EU work together to mitigate these risks using some agreed joint coordination mechanisms for a robust, harmonised approach to global public health threats at points of entry.


Assuntos
Surtos de Doenças/prevenção & controle , União Europeia/organização & administração , Saúde Global/legislação & jurisprudência , Regulamento Sanitário Internacional , Humanos , Irlanda , Reino Unido
11.
Lancet ; 394(10201): 827-828, 2019 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-31498093
12.
Lancet ; 394(10201): 827, 2019 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-31498094
13.
14.
Lancet ; 394(10201): 828-829, 2019 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-31498096
15.
Isr Med Assoc J ; 21(8): 565-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474024

RESUMO

BACKGROUND: Global trends, such as the population aging, the increase of chronic morbidity, soaring costs of healthcare services, and work overload in hospitals raise the need to find innovative solutions for providing quality medical services. One solution adopted by healthcare systems around the world is "home hospitalization," that is, providing an array of necessary health services in the patient's home, instead of in the hospital department. The aim of this focus article is to explore the spread of home hospitalization worldwide and examine the challenges and pathways for its adoption and implementation. Many countries, including the United States, Canada, the United Kingdom, and Australia, operate home-based hospitalization programs. In Israel, the service is in its infancy, but in view of the extreme workload and the high mortality rate from infections in acute care hospitals, home hospitalization has recently gained public interest and political support, which may encourage its further development.


Assuntos
Serviços de Assistência Domiciliar , Hospitais , Austrália , Canadá , Humanos , Internacionalidade , Israel , Reino Unido , Estados Unidos
19.
Bone Joint J ; 101-B(9): 1063-1070, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474149

RESUMO

AIMS: The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. PATIENTS AND METHODS: A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. RESULTS: Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. CONCLUSION: rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063-1070.


Assuntos
Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Artroplastia do Joelho/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Cadeias de Markov , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/epidemiologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Reino Unido/epidemiologia
20.
BMJ ; 366: l4786, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484641

RESUMO

OBJECTIVE: To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN: Modelling study. SETTING: General adult population of the United Kingdom. PARTICIPANTS: 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES: The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS: For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS: Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.


Assuntos
Comércio , Obesidade/epidemiologia , Lanches , Açúcares/efeitos adversos , Impostos , Adolescente , Adulto , Índice de Massa Corporal , Ingestão de Energia , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Modelos Biológicos , Modelos Econômicos , Obesidade/etiologia , Obesidade/prevenção & controle , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
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