RESUMEN
Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Dispositivos de Protección Respiratoria , Adhesión a Directriz , Hospitales , Humanos , Entrevistas como Asunto , Guías de Práctica Clínica como Asunto , Estados UnidosRESUMEN
To gain a better understanding of military suicide, we examined suicide narratives for 135 Soldiers extracted from two large-scale surveillance systems: the Department of Defense Suicide Event Report (DoDSER) and the Centers for Disease Control and Prevention's (CDC) National Violent Death Reporting System (NVDRS). Using coroner/medical examiner and law enforcement narratives captured in the NVDRS and mental health provider narrative data collected across multiple domains from the DoDSER, we examined circumstances surrounding military suicides using a qualitative content analysis approach. We identified five common proximal circumstances: (1) intimate partner relationship problems (63.0%); (2) mental health/substance abuse (51.9%); (3) military job-related (46.7%); (4) financial (17.8%); and (5) criminal/legal activity (16.3%). Evidence of premeditation was present in 37.0% of suicides. Decedents frequently struggled with multiple, high-stress problems and exhibited symptoms of coping and emotion regulation difficulties. Findings demonstrate potential points of intervention for suicide prevention strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Adaptación Psicológica , Síntomas Afectivos/psicología , Relaciones Interpersonales , Trastornos Mentales/psicología , Personal Militar/psicología , Narrativas Personales como Asunto , Suicidio/psicología , Adolescente , Adulto , Síntomas Afectivos/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Investigación Cualitativa , Suicidio/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Mobile applications (apps) to support behavioral health are increasing in number and are recommended frequently by medical providers in a variety of settings. As with the use of any adjunct tool in therapy, psychologists adopting new technologies in clinical practice must comply with relevant professional ethics codes and legal standards. However, emerging technologies can outpace regulations regarding their use, presenting novel ethical considerations. Therefore, it is incumbent upon providers to extrapolate current ethical standards and laws to new technologies before they recommend them as adjuncts to face-to-face treatment. This article identifies best practices for incorporating apps into treatment, including competence in the use of smartphones in general and familiarity with the specific apps recommended. Psychologists must conduct informed consent procedures in accordance with existing evidence, as well as privacy and security concerns relating to a particular app, in order to mitigate potential liability regarding the collection of client-generated data. Psychologists also should be prepared to educate clients about how best to safeguard their data, such as through encryption, password protection, or remote deletion of data. By doing so, psychologists can balance potentially competing demands of leveraging emerging technology to improve care while simultaneously ensuring ethical and legal compliance in these new areas. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Competencia Clínica , Confidencialidad , Consentimiento Informado , Legislación Médica , Mala Praxis , Servicios de Salud Mental , Aplicaciones Móviles , Competencia Clínica/legislación & jurisprudencia , Confidencialidad/ética , Confidencialidad/legislación & jurisprudencia , Humanos , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Legislación Médica/ética , Mala Praxis/legislación & jurisprudencia , Servicios de Salud Mental/ética , Servicios de Salud Mental/legislación & jurisprudencia , Aplicaciones Móviles/ética , Aplicaciones Móviles/legislación & jurisprudenciaRESUMEN
Identification of risk and protective factors for suicide is a priority for the United States military, especially in light of the recent steady increase in military suicide rates. The Department of Defense Suicide Event Report contains comprehensive data on suicides for active duty military personnel, but no analogous control data is available to permit identification of factors that differentially determine suicide risk. This proof-of-concept study was conducted to determine the feasibility of collecting such control data. The study employed a prospective case-control design in which control cases were randomly selected from a large Army installation at a rate of four control participants for every qualifying Army suicide. Although 111 Army suicides were confirmed during the study period, just 27 control soldiers completed the study. Despite the small control sample, preliminary analyses comparing suicide cases to controls identified several factors more frequently reported for suicide cases, including recent failed intimate relationships, outpatient mental health history, mood disorder diagnosis, substance abuse history, and prior self-injury. No deployment-related risk factors were found. These data are consistent with existing literature and form a foundation for larger control studies. Methodological lessons learned regarding study design and recruitment are discussed to inform future studies.
Asunto(s)
Personal Militar/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Estudios de Casos y Controles , Estudios de Factibilidad , Femenino , Humanos , Relaciones Interpersonales , Masculino , Salud Mental , Trastornos del Humor/epidemiología , Proyectos Piloto , Estudios Prospectivos , Conducta Autodestructiva/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
A randomized, open-label, parallel study was conducted to assess the efficacy and safety of premixed insulin aspart 30 (biphasic insulin aspart [BIAsp] 30) in managing gestational diabetes mellitus (GDM). A total of 323 women with GDM registered at a single center in India were randomly assigned to receive 6 U of either BIAsp 30 (Group A) or premixed human insulin (biphasic human insulin [BHI] 30; Group B) in a 1:1 ratio. Subjects performed home glucose monitoring and visited their care provider twice a month. The primary outcome was the degree of neonatal macrosomia (neonatal birth weight >90th percentile). Groups A and B were demographically comparable at study entry. Before labor onset, Groups A and B achieved similar degrees of fasting plasma glucose and postprandial plasma glucose control (92.97 ± 14.44 vs. 95.43 ± 18.96 and 127.59 ± 28.99 vs. 126.98 ± 29.89, respectively; both p = NS). Neonatal macrosomia frequency was 6.3% in Group A and 6.9% in Group B; however, this difference was not statistically significant. By last visit, the required insulin dose was significantly lower for Group A than Group B (19.83 ± 15.75 IU vs. 26.34 ± 23.15 IU, respectively; p = 0.006). BIAsp 30 was noninferior to BHI 30, producing comparable fetal outcomes when administered during pregnancy. Based on final doses, BIAsp 30 may offer greater treat-to-target potential for pregnant women.
Asunto(s)
Insulinas Bifásicas/uso terapéutico , Diabetes Gestacional/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina Aspart/uso terapéutico , Insulina Isófana/uso terapéutico , Insulinas Bifásicas/administración & dosificación , Insulinas Bifásicas/efectos adversos , Peso al Nacer/efectos de los fármacos , Glucemia/análisis , Estudios de Cohortes , Diabetes Gestacional/sangre , Combinación de Medicamentos , Femenino , Macrosomía Fetal/epidemiología , Macrosomía Fetal/prevención & control , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Incidencia , India/epidemiología , Recién Nacido , Insulina Aspart/administración & dosificación , Insulina Aspart/efectos adversos , Insulina Isófana/administración & dosificación , Insulina Isófana/efectos adversos , Análisis de Intención de Tratar , Masculino , EmbarazoRESUMEN
OBJECTIVE: The objective of the study was to compare premixed insulin aspart 30 (BIAsp 30) vs premixed human insulin 30 (BHI 30) on efficacy, safety, fetal and perinatal outcomes in pregnancies associated with gestational diabetes mellitus [GDM]. This was the first randomized study to use pre mixed insulin analogue [BIAsp] in GDM. METHODS: The study population consisted of 76 GDM women assigned to BIAsp 30 (group A) and an equal number to BHI 30 (group B). RESULTS: There was no statistically significant difference between the age, BMI, gestational weeks and glycemic level at entry between the group A and group B women (p > 0.05). There was no statistical difference between the two groups in glycemic control or insulin dose (p > 0.05) before confinement. The frequency of birth weight of new born above 90 percentile was 6.8% in Group 1 and 9.2% in Group 2. The proportion of macrosomia was higher in Group 2 when compared to Group 1, however the difference was not statistically significant (P = 0.819). CONCLUSION: BIAsp was safe during pregnancy and pregnant women found it convenient due to meal time dosing. Fetal outcome using BIAsp was also comparable with BHI 30.
Asunto(s)
Diabetes Gestacional/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/análogos & derivados , Insulina/uso terapéutico , Adulto , Insulinas Bifásicas , Peso al Nacer , Glucemia/metabolismo , Índice de Masa Corporal , Cromatografía Líquida de Alta Presión , Diabetes Gestacional/diagnóstico , Femenino , Hemoglobina Glucada/análisis , Humanos , Hipoglucemiantes/efectos adversos , Recién Nacido , Inyecciones Subcutáneas , Insulina/efectos adversos , Insulina Aspart , Insulina Isófana , Proyectos Piloto , Embarazo , Resultado del Embarazo , Resultado del Tratamiento , Adulto JovenRESUMEN
The insecticidal Cry toxins are pore-forming toxins produced by the bacteria Bacillus thuringiensis that disrupt insect-midgut cells. In this work we analyzed the response of two different insect orders, the Lepidopteran Manduca sexta and Dipteran Aedes aegypti to highly specific Cry toxins, Cry1Ab and Cry11Aa, respectively. One pathway activated in different organisms in response to a variety of pore-forming toxins is the mitogen-activated protein kinase p38 pathway (MAPK p38) that activates a complex defense response. We analyzed the MAPK p38 activation by immunodetection of its phosphorylated isoform, and the induction of p38 by RT-PCR, real-time PCR quantitative assays and immunodetection. We show that MAPK p38 is activated at postraductional level after Cry toxin intoxication in both insect orders. We detected the p38 induction at the transcriptional and traductional level, and observed a different response. In these three levels, we found that both insects respond to Cry toxin action but M. sexta responses more strongly than A. aegypti. Gene silencing of MAPK p38 in vivo, resulted in both insect species becoming hypersensitive to Cry toxin action, suggesting that the MAPK p38 pathway is involved in insect defense against Bt Cry toxins. This finding may have biotechnological applications for enhancing the activity of some Bt Cry toxins against specific insect pests.
Asunto(s)
Aedes/inmunología , Proteínas Bacterianas/farmacología , Endotoxinas/farmacología , Proteínas Hemolisinas/farmacología , Proteínas de Insectos/inmunología , Mariposas Nocturnas/inmunología , Proteínas Quinasas p38 Activadas por Mitógenos/inmunología , Aedes/efectos de los fármacos , Aedes/genética , Aedes/metabolismo , Animales , Toxinas de Bacillus thuringiensis , Proteínas de Insectos/genética , Proteínas de Insectos/metabolismo , Mariposas Nocturnas/efectos de los fármacos , Mariposas Nocturnas/genética , Mariposas Nocturnas/metabolismo , Transducción de Señal , Proteínas Quinasas p38 Activadas por Mitógenos/genética , Proteínas Quinasas p38 Activadas por Mitógenos/metabolismoRESUMEN
BACKGROUND: Shared medical appointments (SMAs) are a new model in patient care. This model was designed to improve patients' access to their physicians and improve physician productivity. The aim of this study was to evaluate patient satisfaction with SMAs after bariatric surgery. METHODS: The medical records of consecutive patients who were followed up after bariatric surgery were retrospectively reviewed. The type of bariatric surgery and type of medical appointment were recorded, as were the patients' replies to the evaluation questionnaires in the SMA group. RESULTS: From April 2004 to December 2004, 277 individual visits were conducted; 242 visits for patients who underwent Roux-en-Y gastric bypass and 35 visits for patients who underwent laparoscopic gastric banding. Thirty-three SMAs occurred during that period--28 SMAs for patients who underwent Roux-en-Y gastric bypass and 5 SMAs for patients who underwent laparoscopic gastric banding. Of the patients who initially participated in an SMA, 91% scheduled a subsequent SMA, and 96% indicated that they would recommend SMAs to others. On a scale of 1 to 5 (1, poor and 5, excellent), patients graded their overall experience with SMAs as 4.5. Other parameters in the questionnaire all ranked between 4 and 5. The average waiting period for an appointment before the implementation of SMAs was 57.7 days (range 50-65) for new patients and 50 days (range 20-72) for former patients. After the implementation of SMAs, the average waiting period was 25 days (range 8-42) for new patients (P = 0.0046) and 20.3 days (range 0-42) for former patients (P = 0.06). CONCLUSION: The SMA offers the patient prompt access to medical care, enables high-volume follow-up, with high satisfaction rates.