RESUMO
In this study, we consider the patient, provider, and public health repercussions of San Francisco's (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020-2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.
Assuntos
COVID-19 , Pessoas Mal Alojadas , Humanos , Habitação , São Francisco/epidemiologia , Abrigo de EmergênciaRESUMO
Although the cardiotoxic effects of cocaine are universally recognized, the association between cocaine and cardiomyopathy and/or heart failure is poorly understood. To conduct a comprehensive review and meta-analysis on the association between cocaine, heart failure, and cardiomyopathy, we first conducted a broad-term search in PubMed, Embase, Web of Science, and Scopus for human studies containing primary data on the relationship between cocaine and heart failure or cardiomyopathy. We were interested in studies with data beyond acute coronary syndromes. Retrieved studies were grouped into different categories based on possible hypotheses to test by meta-analysis. A second search with specific terms was then conducted. For grouped studies with sufficient clinical and methodological homogeneity, effect sizes were calculated and combined for meta-analysis by the Random Effects model. There is in general a need for more primary data studies that investigate heart failure and/or cardiomyopathy in cocaine users for mechanisms independent of ischemia. There were, however, enough studies to combine by meta-analyses that showed that chronic cocaine use is associated with anatomical and functional changes more consistent with diastolic heart failure instead of the commonly taught dilated cardiomyopathy pathway. In patients without a history of ACS, chronic cocaine use was not associated with significantly reduced EF. The few studies on acute cocaine had conflicting results on whether single-dose intravascular cocaine results in acute heart failure. Studies identified that included beta-blockade therapy in cocaine users with cardiac disease suggest that beta-blockers are not unsafe and that may be effective in the treatment of cocaine-associated heart failure. Chronic cocaine use is associated with anatomical and physiological changes of the heart muscle that are potentially reversible with beta-blockade therapy.
Assuntos
Cardiomiopatias , Cocaína , Insuficiência Cardíaca , Animais , Humanos , Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatias/induzido quimicamente , Cocaína/uso terapêutico , Insuficiência Cardíaca/induzido quimicamenteRESUMO
An evidence-based systematic review of goji (Lycium spp.) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
Assuntos
Lycium , Adolescente , Adulto , Animais , Criança , Interações Medicamentosas , Medicina Baseada em Evidências , Feminino , Alimentos , Frutas/química , Humanos , Lactação , Lycium/efeitos adversos , Lycium/química , MEDLINE , Medicina Tradicional , Compostos Fitoquímicos/análise , Compostos Fitoquímicos/uso terapêutico , Fitoterapia , Extratos Vegetais/administração & dosagem , Extratos Vegetais/efeitos adversos , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Raízes de Plantas/química , GravidezRESUMO
An evidence-based systematic review of vitamin A by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated and reproducible grading rationale. This paper includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
Assuntos
Medicina Baseada em Evidências , Vitamina A , Adolescente , Adulto , Criança , Pré-Escolar , Países em Desenvolvimento , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Interações Medicamentosas , Feminino , Humanos , Lactente , Recém-Nascido , Política Nutricional , Gravidez , Vitamina A/efeitos adversos , Vitamina A/farmacologia , Vitamina A/uso terapêutico , Deficiência de Vitamina A/tratamento farmacológico , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/prevenção & controleRESUMO
An evidence-based systematic review of vanadium by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.