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1.
Rev. bras. enferm ; 75(1): e20201119, 2022. tab, graf
Artículo en Inglés | LILACS-Express | LILACS, BDENF - Enfermería | ID: biblio-1288466

RESUMEN

ABSTRACT Objectives: to compare adverse events after administrating hepatitis A vaccine intramuscularly in the ventro-gluteal region between techniques with and without aspiration. Methods: randomized double-blind clinical trial, using hepatitis A vaccine (inactivated) in the ventro-gluteal region, with a sample of 74 participants in the intervention group, vaccinated with the slow injection technique without aspiration, and 74 participants in the control group undergoing slow injection with aspiration. Daily assessment of participants was carried out in the 72 hours after vaccination, in order to ascertain local, systemic adverse events, local and contralateral temperatures. Results: the occurrence of local and systemic adverse events was homogeneous between the groups in the three days after vaccination (p>0.05). There was no influence of sex, race, pre-existing disease and use of medication. Conclusions: the intramuscular vaccination technique without aspiration in the ventro-gluteal region is safe for adverse events following immunization compared to the conventional technique with aspiration.


RESUMEN Objetivos: comparar eventos adversos después de la administración de la vacuna contra la hepatitis A por vía intramuscular en la región ventroglútea entre técnicas con y sin aspiración. Métodos: ensayo clínico aleatorizado doble ciego utilizando la vacuna Hepatitis A (inactivada) en la región ventroglútea, con una muestra de 74 participantes en el grupo de intervención, vacunados con la técnica de inyección lenta sin aspiración, y 74 participantes del grupo control sometidos a inyección con aspiración. La evaluación diaria de los participantes se llevó a cabo en las 72 horas posteriores a la vacunación, con el fin de conocer los eventos adversos locales, sistémicos, las temperaturas locales y contralaterales. Resultados: la ocurrencia de eventos adversos locales y sistémicos fue homogénea entre los grupos en los tres días posteriores a la vacunación (p>0.05). No hubo influencia de las variables sexo, raza, enfermedad preexistente y uso de medicación. Conclusión: la técnica de vacunación intramuscular sin aspiración en la región ventroglútea es segura para eventos adversos después de la vacunación en comparación con la técnica convencional con aspiración.


RESUMO Objetivos: comparar os eventos adversos após a administração da vacina hepatite A via intramuscular na região ventro-glútea entre as técnicas com e sem aspiração. Métodos: ensaio clínico randomizado duplo-cego, utilizando a vacina hepatite A (inativada) na região ventro-glútea, com amostra de 74 participantes no grupo intervenção, vacinados com a técnica de injeção lenta sem aspiração, e 74 participantes no grupo controle submetidos à injeção lenta com aspiração. Foi realizada avaliação diária dos participantes nas 72 horas pós-vacinação, com intuito de averiguar eventos adversos locais, sistêmicos, temperaturas locais e contralaterais. Resultados: a ocorrência de eventos adversos locais e sistêmicos foi homogênea entre os grupos nos três dias pós-vacinação (p>0,05). Não houve influência das variáveis sexo, raça, doença pré-existente e uso de medicamento. Conclusões: a técnica de vacinação intramuscular sem aspiração na região ventro-glútea é segura quanto aos eventos adversos pós-vacinação em comparação à técnica convencional com aspiração.

2.
Anticancer Res ; 41(10): 5007-5014, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34593449

RESUMEN

BACKGROUND/AIM: In our previous study, first-line eribulin (ERI) showed 25 weeks of progression-free survival (PFS). This study investigated the efficacy and safety of ERI re-administration in metastatic breast cancer (MBC) patients. PATIENTS AND METHODS: HER2-negative MBC patients who had never received chemotherapy for MBC received first-line ERI for 18 weeks if they did not have disease progression, and then one cycle of S-1 before ERI re-administration. RESULTS: Twelve patients received ERI re-administration. The PFS of re-administered ERI was 13 weeks. Total duration of ERI use was 30 weeks. The incidence and severity of adverse events were consistent with previous reports. CONCLUSION: In the first-line setting, the total PFS of eribulin was extended by S-1 administration before disease progression, compared with that of our previous report.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Receptor ErbB-2/metabolismo , Adulto , Anciano , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Furanos/administración & dosificación , Humanos , Cetonas/administración & dosificación , Persona de Mediana Edad , Recurrencia Local de Neoplasia/metabolismo , Recurrencia Local de Neoplasia/patología , Pronóstico , Retratamiento , Tasa de Supervivencia
3.
Medicine (Baltimore) ; 100(39): e27335, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34596137

RESUMEN

RATIONALE: Functional abdominal pain is an intractable medical condition that often reduces quality of life. Celiac plexus block is a representative intervention for managing intractable abdominal pain. However, celiac plexus block can be technically difficult to perform and carries the risk of potential complications. During erector spinae plane block (ESPB), the injectate can enter the paravertebral space and reach the sympathetic chain. If local anesthetics spread to the sympathetic chain that supplies fibers to the splanchnic nerve, abdominal pain theoretically could be reduced. PATIENT CONCERNS: Three patients suffered from abdominal pain of unknown cause, and no medical abnormalities were found in various examinations. DIAGNOSIS: As a result of collaboration with related medical departments, the abdominal symptoms of the patients were suspected to be functional abdominal pain. INTERVENTIONS: We successfully controlled symptoms by performing ESPB at the lower thoracic level in 3 patients with functional abdominal pain. OUTCOMES: After the procedure, the patients' abdominal pain improved significantly over several months. LESSONS: We suggest that lower thoracic ESPB could be an option for management of functional abdominal pain.


Asunto(s)
Dolor Abdominal/tratamiento farmacológico , Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Músculos Paraespinales/inervación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida
4.
Infect Dis Poverty ; 10(1): 122, 2021 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-34620243

RESUMEN

BACKGROUND: The availability of various types of COVID-19 vaccines and diverse characteristics of the vaccines present a dilemma in vaccination choices, which may result in individuals refusing a particular COVID-19 vaccine offered, hence presenting a threat to immunisation coverage and reaching herd immunity. The study aimed to assess global COVID-19 vaccination intention, vaccine characteristics influencing vaccination acceptance and desirable vaccine characteristics influencing the choice of vaccines. METHODS: An anonymous cross-sectional survey was conducted between 4 January and 5 March 2021 in 17 countries worldwide. Proportions and the corresponding 95% confidence intervals (CI) of COVID-19 vaccine acceptance and vaccine characteristics influencing vaccination acceptance were generated and compared across countries and regions. Multivariable logistic regression analysis was used to determine the factors associated with COVID-19 vaccine hesitancy. RESULTS: Of the 19,714 responses received, 90.4% (95% CI 81.8-95.3) reported likely or extremely likely to receive COVID-19 vaccine. A high proportion of likely or extremely likely to receive the COVID-19 vaccine was reported in Australia (96.4%), China (95.3%) and Norway (95.3%), while a high proportion reported being unlikely or extremely unlikely to receive the vaccine in Japan (34.6%), the U.S. (29.4%) and Iran (27.9%). Males, those with a lower educational level and those of older age expressed a higher level of COVID-19 vaccine hesitancy. Less than two-thirds (59.7%; 95% CI 58.4-61.0) reported only being willing to accept a vaccine with an effectiveness of more than 90%, and 74.5% (95% CI 73.4-75.5) said they would accept a COVID-19 vaccine with minor adverse reactions. A total of 21.0% (95% CI 20.0-22.0) reported not accepting an mRNA vaccine and 51.8% (95% CI 50.3-53.1) reported that they would only accept a COVID-19 vaccine from a specific country-of-origin. Countries from the Southeast Asia region reported the highest proportion of not accepting mRNA technology. The highest proportion from Europe and the Americas would only accept a vaccine produced by certain countries. The foremost important vaccine characteristic influencing vaccine choice is adverse reactions (40.6%; 95% CI 39.3-41.9) of a vaccine and effectiveness threshold (35.1%; 95% CI 33.9-36.4). CONCLUSIONS: The inter-regional and individual country disparities in COVID-19 vaccine hesitancy highlight the importance of designing an efficient plan for the delivery of interventions dynamically tailored to the local population.


Asunto(s)
Vacunas contra la COVID-19 , Intención , Vacunación , Adolescente , Adulto , Anciano , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , Estudios Transversales , Femenino , Salud Global , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Vacunación/psicología , Vacunación/estadística & datos numéricos , Adulto Joven
5.
Medicine (Baltimore) ; 100(39): e27360, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34596146

RESUMEN

ABSTRACT: Coronavirus disease-2019 (COVID-19) is a global pandemic affecting numerous countries around the world. This study elaborates Taiwan's epidemiological characteristics from the 2020 to 2021 COVID-19 pandemic from human, temporal, and geographical dimensions. Big data for cases were obtained from a public database from the Taiwan Centers for Disease Control (CDC) in April 2021. The data were analyzed and used to compare differences, correlations, and trends for human, temporal, and geographical characteristics for imported and domestic COVID-19 cases. During the study period, 1030 cases were confirmed and the mortality rate of 1.0%. The epidemiological features indicated that most cases (953/1030, 92.5%) were imported. A comparison of the domestic confirmed and imported cases revealed the following findings: No significant difference of COVID-19 between males and females for sex was observed; For age, the risk of domestic transmission was significantly lower for 20 to 29 years old, higher for 50 to 59 years old, and >60 years old with odds ratios (ORs) (P value < .05) of 0.36, 3.37, and 2.50, respectively; For the month of infection, the ORs (P value < .05) of domestic confirmed cases during January and February 2020 were 22.428; and in terms of area of residence, the ORs (P value < .05) for domestic confirmed cases in northern and southern Taiwan were 4.473 and 0.033, respectively. Thus, the increase in domestic cases may have been caused by international travelers transmitting the virus in March 2020 and December 2020, respectively. Taiwan has been implementing effective screening and quarantine measures at airports. Moreover, Taiwan has implemented and maintained stringent interventions such as large-scale epidemiological investigation, rapid diagnosis, wearing masks, washing hands frequently, safe social distancing, and prompt clinical classifications for severe patients who were given appropriate medical measures. This is the first report comparing imported and domestic cases of COVID-19 from surveillance data from the Taiwan Centers for Disease Control during January 2020 and March 2021. It illustrates that individuals infected during overseas travel are the main risk factors for the spread of COVID-19 in Taiwan. The study also highlights the importance of longitudinal and geographically extended studies in understanding the implications of COVID-19 transmission for Taiwan's population.


Asunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Adulto , Factores de Edad , Anciano , Control de Enfermedades Transmisibles/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Características de la Residencia , SARS-CoV-2 , Factores Sexuales , Taiwán/epidemiología , Adulto Joven
6.
Acta Med Indones ; 53(3): 326-330, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34611073

RESUMEN

SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.


Asunto(s)
Acetaminofén/administración & dosificación , Vacunas contra la COVID-19 , COVID-19/prevención & control , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Hipersensibilidad Retardada , Piel/patología , Analgésicos no Narcóticos/administración & dosificación , Biopsia/métodos , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/fisiopatología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/terapia , Femenino , Fiebre/tratamiento farmacológico , Fiebre/etiología , Humanos , Hipersensibilidad Retardada/inducido químicamente , Hipersensibilidad Retardada/fisiopatología , Hipersensibilidad Retardada/terapia , Reacción en el Punto de Inyección/diagnóstico , Reacción en el Punto de Inyección/etiología , Reacción en el Punto de Inyección/fisiopatología , Persona de Mediana Edad , Médicos , SARS-CoV-2 , Resultado del Tratamiento , Vacunación/métodos
7.
Rev Esp Salud Publica ; 952021 Oct 01.
Artículo en Español | MEDLINE | ID: mdl-34593751

RESUMEN

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.


Asunto(s)
Medicina Basada en la Evidencia , Hospitales Universitarios , Desarrollo de Programa , Medicina Basada en la Evidencia/organización & administración , Hospitales Universitarios/organización & administración , Humanos , España
8.
Medicine (Baltimore) ; 100(40): e27348, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34622834

RESUMEN

RATIONALE: Colorectal mixed neuroendocrine-nonneuroendocrine neoplasms constitute a rare group of gastrointestinal tumors composed by both neuroendocrine and nonneuroendocrine components. Nondiagnostic macroscopic features, specific histological features, and poor awareness of the disease are responsible for the underestimated incidence and conflicting data available. Due to lack of randomized clinical trials and validated clinical guidelines, diagnostic and therapeutic approach are based on the standard of care for pure colorectal neuroendocrine carcinomas or adenocarcinomas. PATIENT CONCERNS: A 76-year-old caucasian male, without relevant medical or familial history, presented a positive faecal occult blood test during colorectal cancer screening. DIAGNOSIS: Total colonoscopy identified a rectal lesion with biopsy showing a moderate rectal adenocarcinoma staged as cT2N0M0. INTERVENTIONS: Anterior resection of the rectum with right ileostomy followed by local radiotherapy with radio-sensitising chemotherapy and adjuvant chemotherapy with capecitabine 1000 mg bid plus oxaliplatin 130 mg/m2. Due to chronic nodular pulmonary aspergillosis and chemotherapy induced immunosuppression patient was on 400 mg/daily of oral voriconazole. OUTCOMES: Overall survival of 15 months after progression under first line treatment and under palliative chemotherapy with platinum plus etoposide regimen. LESSONS: The reported case illustrates the challenge associated to the management of mixed neuroendocrine-nonneuroendocrine carcinomas due to lack of validated guidelines and scientific evidence. From diagnosis and staging to treatment, all steps must be tailored to individual clinical and histological features.


Asunto(s)
Adenocarcinoma/patología , Tumor Mixto Maligno/patología , Tumores Neuroendocrinos/patología , Neoplasias del Recto/patología , Adenocarcinoma/terapia , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica , Capecitabina/administración & dosificación , Resultado Fatal , Humanos , Masculino , Tumor Mixto Maligno/terapia , Tumores Neuroendocrinos/terapia , Oxaliplatino/administración & dosificación , Radioterapia , Neoplasias del Recto/terapia , Recto/cirugía
9.
BMC Cancer ; 21(1): 1094, 2021 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-34635061

RESUMEN

BACKGROUND: To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. METHODS: This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. RESULTS: 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). CONCLUSIONS: Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.


Asunto(s)
COVID-19/epidemiología , Accesibilidad a los Servicios de Salud , Pandemias , Telemedicina/organización & administración , Neoplasias Torácicas/terapia , Tiempo de Tratamiento , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Grupo de Atención al Paciente , Philadelphia/epidemiología , Calidad de la Atención de Salud , Derivación y Consulta , Estudios Retrospectivos , Telemedicina/normas , Telemedicina/estadística & datos numéricos , Neoplasias Torácicas/epidemiología , Neoplasias Torácicas/patología , Factores de Tiempo
10.
Waste Manag Res ; 39(11): 1365-1374, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34617479

RESUMEN

This article presents field experience in developing local waste management plans called Kebijakan Strategi Daerah (Jakstrada) in the Lake Toba region, one of the popular tourist destinations in Indonesia. It examines the current waste management status and discusses key priorities and actions identified in the Jakstradas to improve the waste management based on resource management and 3R (reduce, reuse and recycle) principles. In partnership with public, private, academic and citizen groups, the project activities supported the development of Jakstradas in all seven regencies and established a resource recovery centre (RRC) as a model to practice 3Rs in the region. The key lessons learned from these project activities are discussed and some practical recommendations are identified based on a literature review, interviews and workshops with local government officials and residents. Through those opportunities, it was found that remote regencies around Lake Toba do not have environmentally sound final disposal sites and do not have the financial or technical capacity to provide waste collection and handling services to residents, which often results in illegal dumping and open burning of waste. It was also revealed that lack of established markets for recycling value chains and citizens participation in waste separation at source had resulted in limited success for recycling and 3R activities in the region.


Asunto(s)
Lagos , Administración de Residuos , Indonesia , Organizaciones , Reciclaje
11.
Pan Afr Med J ; 39: 84, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34466186

RESUMEN

The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.


Asunto(s)
Infecciones Comunitarias Adquiridas/diagnóstico , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Osteomielitis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Enfermedad Aguda , Adolescente , Antibacterianos/administración & dosificación , Niño , Preescolar , Terapia Combinada , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/terapia , Desbridamiento/métodos , Femenino , Humanos , Masculino , Osteomielitis/microbiología , Osteomielitis/terapia , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapia
12.
Bull World Health Organ ; 99(9): 674-679, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34475604

RESUMEN

Problem: Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach: A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting: Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes: The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt: A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.


Asunto(s)
Accesibilidad a los Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Calidad de la Atención de Salud , Eficiencia Organizacional , Humanos , Trastornos Mentales/epidemiología , Salud Mental , Irlanda del Norte , Evaluación de Procesos y Resultados en Atención de Salud , Reino Unido
13.
Stud Health Technol Inform ; 283: 104-110, 2021 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-34545825

RESUMEN

Harmonized and interoperable data management is a core requirement for federated infrastructures in clinical research. Institutions participating in such infrastructures often have to invest large degrees of time and resources in implementing necessary data integration processes to convert their local data to the required target structure. If the data is already available in an alternative shared data structure, the transformation from source to the desired target structure can be implemented once and then be distributed to all participants to reduce effort and harmonize results. The HL7® FHIR® standard is used as a basis for the shared data model of several medical consortia like DKTK and GBA. It is based on so-called resources which can be represented in XML. Oncological data in German university hospitals is commonly available in the ADT/GEKID format. From this common basis we conceptualized and implemented a transformation which accepts ADT/GEKID XML files and returns FHIR resources. We identified several problems with using the general ADT/GEKID structure in federated research infrastructures, as well as some possible pitfalls relating to the FHIR need for resource ids and focus on semantic coding which differs from the approach in the ADT/GEKID standard. To facilitate participation in federated infrastructures, we propose the ADT2FHIR transformation tool for partners with oncological data in the ADT/GEKID format.


Asunto(s)
Manejo de Datos , Registros Electrónicos de Salud , Estándar HL7 , Humanos , Oncología Médica , Semántica
14.
JAMA Netw Open ; 4(9): e2123405, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34473257

RESUMEN

Importance: Mass incarceration is known to foster infectious disease outbreaks, amplification of infectious diseases in surrounding communities, and exacerbation of health disparities in disproportionately policed communities. To date, however, policy interventions intended to achieve epidemic mitigation in US communities have neglected to account for decarceration as a possible means of protecting public health and safety. Objective: To evaluate the association of jail decarceration and government anticontagion policies with reductions in the spread of SARS-CoV-2. Design, Setting, and Participants: This cohort study used county-level data from January to November 2020 to analyze COVID-19 cases, jail populations, and anticontagion policies in a panel regression model to estimate the association of jail decarceration and anticontagion policies with COVID-19 growth rates. A total of 1605 counties with data available on both jail population and COVID-19 cases were included in the analysis. This sample represents approximately 51% of US counties, 72% of the US population, and 60% of the US jail population. Exposures: Changes to jail populations and implementation of 10 anticontagion policies: nursing home visitation bans, school closures, mask mandates, prison visitation bans, stay-at-home orders, and closure of nonessential businesses, gyms, bars, movie theaters, and restaurants. Main Outcomes and Measures: Daily COVID-19 case growth rates. Results: In the 1605 counties included in this study, the mean (SD) prison population was 283.38 (657.78) individuals, and the mean (SD) population was 315.24 (2151.01) persons per square mile. An estimated 80% reduction in US jail populations, achievable through noncarceral management of nonviolent alleged offenses and in line with average international incarceration rates, would have been associated with a 2.0% (95% CI, 0.8%-3.1%) reduction in daily COVID-19 case growth rates. Jail decarceration was associated with 8 times larger reductions in COVID-19 growth rates in counties with above-median population density (4.6%; 95% CI, 2.2%- 7.1%) relative to those below this median (0.5%; 95% CI, 0.1%-0.9%). Nursing home visitation bans were associated with a 7.3% (95% CI, 5.8%-8.9%) reduction in COVID-19 case growth rates, followed by school closures (4.3%; 95% CI, 2.0%-6.6%), mask mandates (2.5%; 95% CI, 1.7%-3.3%), prison visitation bans (1.2%; 95% CI, 0.2%-2.2%), and stay-at-home orders (0.8%; 95% CI, 0.1%-1.6%). Conclusions and Relevance: Although many studies have documented that high incarceration rates are associated with communitywide health harms, this study is, to date, the first to show that decarceration is associated with population-level public health benefits. Its findings suggest that, among other anticontagion interventions, large-scale decarceration and changes to pretrial detention policies are likely to be important for improving US public health, biosecurity, and pandemic preparedness.


Asunto(s)
COVID-19/epidemiología , Control de Enfermedades Transmisibles/métodos , Cárceles Locales/organización & administración , Prisioneros/estadística & datos numéricos , Estudios de Cohortes , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Control de Enfermedades Transmisibles/estadística & datos numéricos , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos
15.
Public Health Res Pract ; 31(3)2021 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-34494077

RESUMEN

OBJECTIVES: To describe local operational aspects of the coronavirus disease 2019 (COVID-19) response during the first three waves of outbreaks in New South Wales (NSW), Australia, which began in January, July and December 2020. Type of program or service: Public health outbreak response. METHODS: Narrative with epidemiological linking and genomic testing. RESULTS: Epidemiological linking and genomic testing found that during the first wave of COVID-19 in NSW, a large number of community transmissions went undetected because of limited testing for the virus and limited contact tracing of cases. The second wave of COVID-19 in NSW emerged following reintroduction from the second wave in Victoria, Australia in July 2020, and the third wave followed undetected introduction from overseas. By the second and third waves, cases could be more effectively detected and isolated through an increased ability to test and contact trace, and to rapidly genomic sequence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolates, allowing most cases to be identified and epidemiologically linked. This greater certainty in understanding chains of transmission resulted in control of the outbreaks despite less stringent restrictions on the community, by using a refined strategy of targeted shutdown, restrictions on cases, their close contacts, identified hotspots and venues of concern rather than a whole of community lockdown. Risk assessments of potential transmission sites were constantly updated through our evolving experience with transmission events. However, this refined strategy did leave the potential for large point source outbreaks should any cases go undetected. [Addendum] A fourth wave that began in Sydney in June 2021 challenged this strategy due to the more transmissible nature of the Delta variant of SARS-CoV-2. LESSONS LEARNT: A wave of COVID-19 infections can develop quickly from one infected person. The community needs to remain vigilant, adhering to physical distancing measures, signing in to venues they visit, and getting tested if they have any symptoms. Signing out of venues on exit allows public health resources to be used more efficiently to respond to outbreaks.


Asunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , Prueba de COVID-19/métodos , Niño , Preescolar , Control de Enfermedades Transmisibles/organización & administración , Trazado de Contacto/métodos , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Distanciamiento Físico , Salud Pública , Cuarentena/métodos , SARS-CoV-2/aislamiento & purificación , Victoria/epidemiología , Adulto Joven
16.
J Int AIDS Soc ; 24(9): e25781, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34473409

RESUMEN

INTRODUCTION: The COVID-19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID-19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders. METHODS: Between 11 February and 15 February 2020, we interviewed PLHIV, community-based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi-structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID-19 pandemic were discussed. Themes were identified by transcript coding and mindmaps. RESULTS: Sixty-four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID-19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out-of-pocket ART. CONCLUSIONS: Social and institutional disruption from COVID-19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.


Asunto(s)
Antirretrovirales/provisión & distribución , Terapia Antirretroviral Altamente Activa/métodos , COVID-19 , Continuidad de la Atención al Paciente , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Adulto , Antirretrovirales/administración & dosificación , Antirretrovirales/uso terapéutico , COVID-19/epidemiología , COVID-19/psicología , China/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Pandemias , Investigación Cualitativa , SARS-CoV-2 , Participación de los Interesados
17.
J Evid Based Dent Pract ; 21(3): 101588, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34479670

RESUMEN

OBJECTIVES: Several methods, including cooling of the injection site, have been proposed for pain control during the dental local anesthetic injection. This systematic review aimed to evaluate the scientific evidence on the precooling of the injection site to reduce pediatric dental injection pain. DATA SOURCES: The search terms were selected according to the Medical Subject Headings and non-Medical Subject Headings. The main keywords included dental injection, cooling, pain, and children. Potentially eligible studies involved the subjective or objective pain evaluation in children receiving any dental injection. Risk of bias assessment was carried out using the Cochrane risk of bias tool. An electronic search was carried out for published studies in the English language up to March 2020 on Scopus, Cochrane, and PubMed databases. Of 761 articles retrieved initially, 14 were eligible to be included in the systematic review, of which 6 articles were excluded. Regarding the type of intervention, 6 articles used cooling agents in the intervention group, and 2 studies used the Buzzy device (a combination of cold and vibratory stimuli). All studies included in the systematic review except one considered that the use of intra- or extra-oral cooling could reduce pain during anesthesia injections in children significantly. CONCLUSION: Overall, the evidence presented in this review was limited and had low quality. It may be concluded that application of cold agents before dental anesthesia can be more helpful than the traditional dental injection in reducing pain in children. Besides, the use of the Buzzy device showed promising results, as shown by 2 studies.


Asunto(s)
Anestésicos Locales , Manejo de Datos , Anestesia Local , Niño , Humanos , Inyecciones , Dolor/prevención & control
18.
MMWR Morb Mortal Wkly Rep ; 70(35): 1183-1190, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34473682

RESUMEN

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11-12 years routinely receive tetanus, diphtheria, and acellular pertussis (Tdap); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) vaccines. Catch-up vaccination is recommended for hepatitis B (HepB); hepatitis A (HepA); measles, mumps, and rubella (MMR); and varicella (VAR) vaccines for adolescents whose childhood vaccinations are not current. Adolescents are also recommended to receive a booster dose of MenACWY vaccine at age 16 years, and shared clinical decision-making is recommended for the serogroup B meningococcal vaccine (MenB) for persons aged 16-23 years (1). To estimate coverage with recommended vaccines, CDC analyzed data from the 2020 National Immunization Survey-Teen (NIS-Teen) for 20,163 adolescents aged 13-17 years.* Coverage with ≥1 dose of HPV vaccine increased from 71.5% in 2019 to 75.1% in 2020. The percentage of adolescents who were up to date† with HPV vaccination (HPV UTD) increased from 54.2% in 2019 to 58.6% in 2020. Coverage with ≥1 dose of Tdap, ≥1 dose (and among adolescents aged 17 years, ≥2 doses) of MenACWY remained similar to coverage in 2019 (90.1%, 89.3%, and 54.4% respectively). Coverage increased for ≥2 doses of HepA among adolescents aged 13-17 years and ≥1 dose of MenB among adolescents aged 17 years. Adolescents living below the federal poverty level§ had higher HPV vaccination coverage than adolescents living at or above the poverty level. Adolescents living outside a metropolitan statistical area (MSA)¶ had lower coverage with ≥1 MenACWY and ≥1 HPV dose, and a lower proportion being HPV UTD than adolescents in MSA principal cities. In 2020, the COVID-19 pandemic disrupted routine immunization services. Results from the 2020 NIS-Teen reflect adolescent vaccination coverage before the COVID-19 pandemic. The 2020 NIS-Teen data could be used to assess the impact of the COVID-19 pandemic on catch-up vaccination but not on routine adolescent vaccination because adolescents included in the survey were aged ≥13 years, past the age when most routine adolescent vaccines are recommended, and most vaccinations occurred before March 2020. Continued efforts to reach adolescents whose routine medical care has been affected by the COVID-19 pandemic are necessary to protect persons and communities from vaccine-preventable diseases and outbreaks.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas Meningococicas/administración & dosificación , Vacunas contra Papillomavirus/administración & dosificación , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Comités Consultivos , COVID-19/epidemiología , Centers for Disease Control and Prevention, U.S. , Femenino , Encuestas de Atención de la Salud , Humanos , Esquemas de Inmunización , Masculino , Guías de Práctica Clínica como Asunto , Factores Socioeconómicos , Estados Unidos/epidemiología , Vacunas Conjugadas/administración & dosificación
19.
Yearb Med Inform ; 30(1): 75-83, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34479380

RESUMEN

OBJECTIVES: To identify gaps and challenges in health informatics and health information management during the COVID-19 pandemic. To describe solutions and offer recommendations that can address the identified gaps and challenges. METHODS: A literature review of relevant peer-reviewed and grey literature published from January 2020 to December 2020 was conducted to inform the paper. RESULTS: The literature revealed several themes regarding health information management and health informatics challenges and gaps: information systems and information technology infrastructure; data collection, quality, and standardization; and information governance and use. These challenges and gaps were often driven by public policy and funding constraints. CONCLUSIONS: COVID-19 exposed complexities related to responding to a world-wide, fast moving, quickly spreading novel virus. Longstanding gaps and ongoing challenges in the local, national, and global health and public health information systems and data infrastructure must be addressed before we are faced with another global pandemic.


Asunto(s)
COVID-19 , Gestión de la Información , Informática Médica , Exactitud de los Datos , Recolección de Datos/normas , Humanos , Administración en Salud Pública , Práctica de Salud Pública/legislación & jurisprudencia , Estados Unidos
20.
Arch Esp Urol ; 74(7): 681-691, 2021 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34472437

RESUMEN

OBJECTIVES: Most patients at first diagnosis of bladder cancer (BC) present with non muscle invasive disease (NMIBC). BCG intravesical therapy after transurethral resection of the bladder tumor is the gold standard in intermediate and high risk NMIBC patients. However, it is estimated that approximately 50% of these patients will present with BCG failure which increases their risk for progression to muscle invasive disease. Currently, the best option for these patients is radical cystectomy. Thus, it is of great interest to pursue new, therapeutic options for BCG failure patients to avoid the necessity of radical cystectomy. We hereby review novel treatment modalities for BCG failure patients. METHODS: This is a narrative review. Keywords for the search were BCG failure, BCG unresponsive, BCG refractory, BCG relapsing and BCG intolerance. Evidence was identified through a search for publications with a ''BCG unresponsive'' tag through 2020. Studies were selected if they contained clinical data on BCG unresponsive therapeutics with near-term availability. Clinical trial landscape evaluation for emerging therapies was performed by searching ClinicalTrials.gov for recruiting/ open interventional trials in 2020. RESULTS: Novel treatment modalities for BCG failure include intravesical chemotherapy, BCG re-challenge or combination of BCG with IFN-α2ß, valrubicin, radiotherapy, electromotive drug administration, vicinium, chemohyperthermia, photodynamic therapy, gene therapy, vaccine therapy and immunotherapy. For patients in whom BCG has once failed a repeat course of BCG or BCG plus interferon appears to be a reasonable practice. Likewise, single agent gemcitabine may be considered a treatment modality. However, after 2 or more BCG failures, especially in patients with earlier relapses or cancer persistence, single agent intravesical chemotherapy with valrubicin, gemcitabine or docetaxel appears to be less active than doublet/triplet intravesical chemotherapy or mitomycin chemothermotherapy. Gene therapy or conjugated antibodies may play a role upon further relapse. Single agent pembrolizumab is unlikely to be used as first line, but may be useful, along with multiple new immunotherapeutics, as part of a multimodal approach towards BCG unresponsive disease. CONCLUSIONS: Results from ongoing trials will provide us useful information about many of the existing regimens and probably new drugs will soon be available for this group of patients.


Asunto(s)
Vacuna BCG , Neoplasias de la Vejiga Urinaria , Adyuvantes Inmunológicos/uso terapéutico , Administración Intravesical , Vacuna BCG/uso terapéutico , Cistectomía , Humanos , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico
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