RESUMEN
OBJECTIVE: A mainstay treatment for opioid addiction in North America is methadone maintenance therapy (MMT) - a form of opiate agonist therapy (OAT). While efficacious for treating opioid addiction, MMT fails to address the concurrent polysubstance use that is common among opioid dependent clients. Moreover, psychosocial approaches for addressing polysubstance use during MMT are lacking. Our study's goals were to validate the use of the four-factor personality model of substance use vulnerability in MMT clients, and to demonstrate theoretically-relevant relationships of personality to concurrent substance use while receiving MMT. METHOD: Respondents included 138 daily-witnessed MMT clients (65.9% male, 79.7% Caucasian), mean age (SD) 40.18 (11.56), recruited across four Canadian MMT clinics. Bayesian confirmatory factor analysis was used to establish the structural validity of the four-factor personality model of substance use vulnerability (operationalized with the Substance Use Risk Profile Scale [SURPS]) in MMT clients. SURPS personality scores were then used as predictors for specific forms of recent (past 30-day) substance use. RESULTS: Using a latent hierarchal model, hopelessness was associated with recent opioid use; anxiety sensitivity with recent tranquilizer use; and sensation seeking with recent alcohol, cannabis, and stimulant use. CONCLUSION: Personality is associated with substance use patterns and may be an appropriate target for intervention for those undergoing MMT to reduce opioid use, and potentially dangerous concurrent use of other drugs, while receiving methadone.
Asunto(s)
Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos/psicología , Trastornos Relacionados con Opioides/rehabilitación , Personalidad , Adulto , Ansiedad/psicología , Nivel de Alerta , Comorbilidad , Correlación de Datos , Femenino , Esperanza , Humanos , Masculino , Persona de Mediana Edad , Motivación , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
BACKGROUND: Deep surgical site infections (SSI's) complicate Gustilo IIIB tibial fractures in 8-13% of cases. Antibiotic prophylaxis typically covers environmental contaminants. However, nosocomial organisms are usually implicated in deep infection. We used the microbiological profile of infected Gustilo IIIB tibial fractures to define a new, dynamic prophylactic regimen which recognises the need for prophylaxis against nosocomial organisms at the time of definitive closure. METHODS: The microbiological profiles of Gustilo IIIB tibial fractures presenting over a 2-year period from January 2006 to December 2007 were reviewed. The environmental contaminants were compared with the organisms isolated from deep SSI's and correlated with the prophylactic antibiotic regimen used. RESULTS: Fifty-two patients were included. Nine developed a deep tissue infection. The pathogens implicated included resistant Enterococci, Pseudomonas, Enterobacter and MRSA. Standard antibiotic prophylaxis provided cover for these combinations in only one of nine cases. This would have improved to eight of nine cases with the use of teicoplanin and gentamicin, given as a one-time dose during definitive soft-tissue closure. Specimens taken from wound debridement were neither sensitive nor specific for the subsequent development of deep infection and did not predict the organisms responsible. CONCLUSIONS: Following high-energy open fracture, a single prophylactic antibiotic regimen directed against environmental wound contaminants does not provide cover for the organisms responsible for deepest SSI's and may have depopulated the niche, promoting nosocomial contamination prior to definitive closure. We advocate a dynamic prophylactic strategy, tailoring a second wave of prophylaxis against nosocomial organisms at the time of definitive wound closure, and at the same time avoiding the potential complications of prolonged antibiotic use.
Asunto(s)
Profilaxis Antibiótica , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & control , Fracturas de la Tibia/microbiología , Fracturas de la Tibia/cirugía , Adulto , Femenino , Humanos , Masculino , Factores de RiesgoAsunto(s)
Infecciones por Caliciviridae/complicaciones , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/complicaciones , Brotes de Enfermedades , Norovirus/patogenicidad , Infecciones por Caliciviridae/epidemiología , Clostridioides difficile/patogenicidad , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/virología , Humanos , Vigilancia de Guardia , Reino Unido/epidemiologíaRESUMEN
The efficacy of decontamination using Sterilox fog was assessed against meticillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. Ceramic tiles were inoculated with the test organisms and, once dried, were subjected to Sterilox fogging using a stationary vaporizing machine sited at a distance of 3m for 10 min and then left for a further hour. In a second experiment using the same organisms, the first 10-min fogging period was followed by a directed fogging period of 30s at a distance of 1m. Organisms were cultured from the tiles, plated on to tryptone soya agar and incubated for 48 h. Initial counts of approximately 10(9) colony-forming units/mL for both organisms were reduced approximately 10(4) fold for MRSA and 10(5.8) fold for A. baumannii when using a single fogging. The second fogging resulted in 10(6.8)-fold reductions for both organisms. Sterilox fog is safe and simple to use, and can reduce levels of nosocomial pathogens by a factor of almost 10(7). It is worthy of clinical evaluation in clinical settings to determine whether it maintains its microbicidal effects against a variety of organisms on different surfaces.
Asunto(s)
Aerosoles/farmacología , Infección Hospitalaria/prevención & control , Desinfección/métodos , Contaminación de Equipos/prevención & control , Superóxidos/farmacología , Acinetobacter/efectos de los fármacos , Cerámica , Recuento de Colonia Microbiana , Equipo Reutilizado , Humanos , Resistencia a la Meticilina/fisiología , Staphylococcus aureus/efectos de los fármacosRESUMEN
The increase since the mid 1980s in glycopeptide resistant enterococci (GRE) raised concerns about the limited options for antimicrobial therapy, the implications for ever-increasing numbers of immunocompromised hospitalised patients, and fuelled fears, now realised, for the transfer of glycopeptide resistance to more pathogenic bacteria, such as Staphylococcus aureus. These issues underlined the need for guidelines for the emergence and control of GRE in the hospital setting. This Hospital Infection Society (HIS) and Infection Control Nurses Association (ICNA) working party report reviews the literature relating to GRE prevention and control. It provides guidance on microbiological investigation, treatment and management, including antimicrobial prescribing and infection control measures. Evidence identified to support recommendations has been categorized. A risk assessment approach is recommended and areas for research and development identified.
Asunto(s)
Antibacterianos/farmacología , Infección Hospitalaria/prevención & control , Farmacorresistencia Bacteriana , Enterococcus/efectos de los fármacos , Glicopéptidos/farmacología , Infecciones por Bacterias Grampositivas/prevención & control , Hospitales , Antibacterianos/uso terapéutico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Enterococcus/clasificación , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Control de Infecciones/métodos , Resistencia a la VancomicinaRESUMEN
Although at first sight the spread of glycopeptide-resistant enterococci (GREs) appears to be following the same unrelenting path as that of methicillin-resistant Staphylococcus aureus, closer inspection of the Literature indicates success of certain interventions, particularly the control of antibiotic usage. There are grounds for optimism that assiduous application of antibiotic control and other infection control measures may further reduce the prevalence of GREs.
Asunto(s)
Antibacterianos , Infección Hospitalaria , Farmacorresistencia Microbiana , Enterococcus , Glicopéptidos , Infecciones por Bacterias Grampositivas , Control de Infecciones/normas , Guías de Práctica Clínica como Asunto/normas , Antibacterianos/uso terapéutico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Utilización de Medicamentos/normas , Enfermedades Endémicas/prevención & control , Enfermedades Endémicas/estadística & datos numéricos , Medicina Basada en la Evidencia , Salud Global , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/prevención & control , Humanos , Higiene/normas , Control de Infecciones/métodos , Resistencia a la Meticilina , Evaluación de Resultado en la Atención de Salud , Vigilancia de la Población , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureusAsunto(s)
Profilaxis Antibiótica/métodos , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus , Administración Tópica , Antibacterianos/administración & dosificación , Portador Sano/tratamiento farmacológico , Asignación de Recursos para la Atención de Salud , Humanos , Resistencia a la Meticilina , Vancomicina/administración & dosificaciónRESUMEN
Viral examination is routinely carried out in most routine diagnostic microbiology laboratories. Most often, this comprises the detection of viral antigens and antibodies, and less commonly the isolation of viruses and the detection of viral nucleic acids. However, there are no standards or guidelines available for processing these specimens in routine diagnostic laboratories or for referral to specialist virology centres or units. Clinical Pathology Accreditation (CPA) has defined standards for assessing the quality of service provided by laboratories, but these do not include the scientific and technical aspects of provision of service. The Association of Medical Microbiologists has recently published Standards for Laboratory practice in medical microbiology, which covers scientific and technical aspects of provision of microbiology service, mainly bacteriological examination of specimens in routine diagnostic microbiology laboratories. These guidelines are complementary to the CPA guidelines and aim to ensure a consistent and high quality service. This article presents guidelines for the examination of specimens for the diagnosis of viral infections.
Asunto(s)
Técnicas Microbiológicas/normas , Garantía de la Calidad de Atención de Salud , Pruebas Serológicas/normas , Virosis/diagnóstico , Benchmarking , Humanos , Guías de Práctica Clínica como Asunto , Manejo de Especímenes/normas , Virología/normasRESUMEN
Although most routine microbiology diagnostic laboratories process specimens for the diagnosis of parasitic infections, there are no best practice guidelines either for processing or for referral to specialist centres. Microscopy for parasites is most often requested on faecal samples, but urine, sputum, liver aspirates, duodenal aspirates, bile, corneal scrapings, contact lens fluid, and tissue are also encountered. Diagnosis of certain parasitic infections requires serology or polymerase chain reaction. These are undertaken in specialist laboratories, which should be consulted for expert advice on diagnosis and management of parasitic infections. Clinical Pathology Accreditation UK (CPA) has defined standards for assessing the quality of service provided by laboratories, but these do not include scientific and technical aspects. The Association of Medical Microbiologists has recently published Standards for laboratory practice in medical microbiology, which covers scientific and technical aspects, mainly bacteriological examination of specimens in routine diagnostic microbiology laboratories. These guidelines are complementary to the CPA standards and aim to ensure a consistent and high quality of service. This article provides best practice guidelines for the diagnosis of parasitic infections.
Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Enfermedades Parasitarias/diagnóstico , Biopsia/métodos , Biopsia/normas , Humanos , Proyectos de Investigación/normas , Pruebas Serológicas/métodos , Pruebas Serológicas/normas , Manejo de Especímenes , Urinálisis/métodos , Urinálisis/normasRESUMEN
This study assessed the prevalence, level of disclosure, and interpretations of sexual activities in a sample of 123 college-aged blood donors in Montreal, Quebec. Within six months of their donation, participants completed an anonymous questionnaire designed to assess sexual definitions, levels of disclosure to sexual partners, as well as prevalence of various blood safety behavioural risks. Responses indicated that (1) there was a lack of consensus regarding what constitutes 'sex', (2) levels of sexual disclosure varied widely, and (3) participants engaged in numerous blood safety behavioural risk activities. These results are discussed with respect to their implications for how people think about sex, particularly in the blood donation context. Suggestions to improve specific blood donor screening questions are also presented.
Asunto(s)
Donantes de Sangre , Revelación , Conducta Sexual/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Universidades , Adolescente , Adulto , Factores de Edad , Donantes de Sangre/psicología , Donantes de Sangre/estadística & datos numéricos , Revelación/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Prevalencia , Quebec , Factores de Riesgo , Asunción de Riesgos , Conducta Sexual/psicología , Parejas Sexuales , Estudiantes/psicología , Encuestas y CuestionariosRESUMEN
The antimicrobial efficacy of alcohol-based hand gels has been shown to be significantly less than liquid hand rubs probably because of a lower concentration of alcohol. Sterillium Gel is the first hand gel with 85% ethanol. Its antimicrobial efficacy and user acceptability was studied. Bactericidal activity was tested according to prEN 12054 against Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa and Escherichia coli (suspension test) and EN 1500 (15 volunteers; four replicates), fungicidal activity according to EN 1275 against Candida albicans and spores of Aspergillus niger (suspension test) and tuberculocidal activity against Mycobacterium terrae using the DGHM suspension test. Virucidal activity was determined in suspension tests based on reduction of infectivity with and without interfering substances (10% fetal calf serum; 0.3% erythrocytes and 0.3% bovine serum albumin). Ninety-six healthcare workers in hospitals in France and the UK used the gel for four weeks and assessed it by filling out a questionnaire. The gel was bactericidal (a reduction factor of > 10(5)-fold), tuberculocidal (reduction factor > 10(5)) and fungicidal (reduction factor > 10(4)) in 30 s. Irrespective of interfering substances the gel inactivated orthopoxvirus and herpes simplex virus type 1 and 2 in 15 s, adenovirus in 2 min, poliovirus in 3 min and papovavirus in 15 min by a factor of > 10(4)-fold. Rotavirus and human immunodeficiency virus were inactivated in 30 s (without interfering substances). Under practical use conditions it was as effective in 30 s as the reference alcohol in 60 s. Most users described the tackiness, aggregation, skin feeling after use and smell as positive or acceptable. A total of 65.6% assessed the new gel to be better than a comparator irrespective of its type (gel or liquid). Overall Sterillium Gel had a unique spectrum of antimicrobial activity. It is probably the first alcohol-based hand gel to pass EN 1500 in 30 s. Due to the excellent acceptance by healthcare workers it may significantly improve compliance for hand hygiene and thereby help to reduce the incidence of nosocomial infection.
Asunto(s)
Actitud del Personal de Salud , Bacterias/efectos de los fármacos , Infección Hospitalaria/prevención & control , Desinfectantes/farmacología , Hongos/efectos de los fármacos , Desinfección de las Manos/métodos , Francia , Geles , Adhesión a Directriz , Humanos , Pruebas de Sensibilidad Microbiana , Encuestas y Cuestionarios , Reino UnidoRESUMEN
The gastric H(+)/K(+)-ATPase is essential for normal development of parietal cells. Here we have directly assessed the role of the H(+)/K(+)-ATPase beta-subunit (H/K-beta) on epithelial cell development by detailed quantitation of the epithelial cell types of the gastric mucosa of H/K-beta-deficient mice. H/K-beta-deficient mice had a 3.1-fold increase in the number of immature cells per gastric unit; however, the numbers of surface mucous and parietal cells were similar to those in the gastric units of wild-type mice. The effect of elevated gastrin levels in the H/K-beta-deficient mice was determined by producing mice that are also deficient in gastrin. We demonstrated that the increased production of immature cells and resulting hypertrophy is caused by the overproduction of gastrin. However, the depletion of zymogenic cells, which is another feature of H/K-beta-deficient mice, is independent of hypergastrinemia. Significantly, parietal cells of H/K-beta- and gastrin-deficient mice had abnormal secretory membranes and were devoid of resting tubulovesicular membranes. Together these data suggest a homeostatic mechanism limiting the number of immature cells that can develop into end-stage epithelial cells and indicate a direct role for H/K-beta in the development of mature parietal cells.
Asunto(s)
Mucosa Gástrica/patología , Gastrinas/deficiencia , ATPasa Intercambiadora de Hidrógeno-Potásio/deficiencia , Animales , Recuento de Células , Muerte Celular , División Celular , Ciclinas/análisis , Células Epiteliales/patología , Gastrinas/genética , Gastrinas/fisiología , ATPasa Intercambiadora de Hidrógeno-Potásio/genética , ATPasa Intercambiadora de Hidrógeno-Potásio/fisiología , Concentración de Iones de Hidrógeno , Hipertrofia , Ratones , Ratones Endogámicos BALB C , Ratones Noqueados , Microscopía Electrónica , Células Parietales Gástricas/patología , Fenotipo , Antígeno Nuclear de Célula en Proliferación/análisisAsunto(s)
Clostridioides difficile , Diarrea , Proyectos de Investigación , Antibacterianos/farmacología , Claritromicina/farmacología , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Diarrea/microbiología , Enterocolitis Seudomembranosa/microbiología , Humanos , Proyectos de Investigación/normas , Factores de RiesgoAsunto(s)
Antibacterianos/efectos adversos , Claritromicina/efectos adversos , Clostridioides difficile , Diarrea/inducido químicamente , Anciano , Diarrea/microbiología , Femenino , Humanos , Masculino , Oportunidad Relativa , Estudios Prospectivos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Factores de RiesgoRESUMEN
The pathogenesis of autoimmune gastritis is the result of lymphocyte infiltration of the gastric mucosa, however, the events leading to the selective extravasation of autoreactive lymphocytes are unclear. Here we have examined the expression of adhesion molecules in the gastric mucosa of BALB/c mice with neonatal thymectomy-induced gastritis. The overall area of vascular endothelium was not significantly different between gastritic and non-gastritic mice. However, a significant increase in the area of mucosal endothelium expressing MAdCAM-1 in gastritic mice was observed. Treatment of neonatally thymectomized BALB/c mice with a MAdCAM-1 specific monoclonal antibody (MECA 367) reduced the incidence of autoimmune gastritis from 80 to 26%. Treatment with a monoclonal antibody (R1-2) directed to the MAdCAM-1 ligand, alpha4beta7, also resulted in a reduction in the incidence of gastritis to 40%. These findings identify the alpha4beta7/MAdCAM-I interaction as a pivotal event in the initiation of autoimmune gastritis.
Asunto(s)
Enfermedades Autoinmunes/metabolismo , Gastritis/metabolismo , Inmunoglobulinas/metabolismo , Mucoproteínas/metabolismo , Animales , Animales Recién Nacidos , Anticuerpos Monoclonales/uso terapéutico , Antígenos CD/metabolismo , Enfermedades Autoinmunes/etiología , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/prevención & control , Linfocitos T CD4-Positivos/inmunología , Moléculas de Adhesión Celular/metabolismo , Endotelio Vascular/metabolismo , Mucosa Gástrica/metabolismo , Gastritis/etiología , Gastritis/inmunología , Gastritis/prevención & control , Inmunoglobulina G/uso terapéutico , Inmunoglobulinas/inmunología , Integrina alfa4 , Ratones , Ratones Endogámicos BALB C , Mucoproteínas/inmunología , Unión Proteica , Ratas , Timectomía/efectos adversosRESUMEN
BACKGROUND: There is considerable debate over the management of infected infrainguinal grafts. This report describes recent experience in this field and documents the change in clinical practice needed to deal with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: All infected infrainguinal grafts between January 1991 and July 1997 were reviewed. In the light of the findings, clinical practice was modified considerably. A further 1 year was audited prospectively up to August 1998. RESULTS: Twenty-six patients were treated for 27 infrainguinal graft infections (25 prosthetic, two vein). Twenty were treated by complete graft excision as the initial therapy; graft preservation was attempted in six patients. Before 1995, the infecting organisms were predominantly Pseudomonas aeruginosa or methicillin-sensitive staphylococci. Subsequently all 14 patients treated up to 1997 had infection with MRSA. The overall amputation rate was 17 of 26; ten amputations were in patients with MRSA. Four patients died, all with MRSA sepsis. As a result of this experience a policy of complete isolation was adopted for all patients infected with MRSA. In the 12 months since this policy was introduced, 77 infrainguinal grafts (61 vein, 16 prosthetic) have been inserted. Two grafts (3 per cent) have become infected, necessitating graft excision and amputation. CONCLUSION: MRSA infection of an infrainguinal graft is a serious complication with high associated amputation and mortality rates. Isolation and barrier nursing appeared to contain the problem.