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Postnatal iron deficiency, especially from ages 6 to 24 months, has long-term consequences lasting into adolescence and adulthood. We aimed to characterize iron deficiency anemia among infants from one central Israeli district by demographic and laboratory parameters. A retrospective chart review was performed on all infants from a single district who had undergone a complete blood count as part of a routine survey for iron deficiency anemia during 2010-2021. Data retrieved included hemoglobin levels, mean corpuscular volume, and demographic features: sex, sector (non-ultraorthodox Jew, ultraorthodox Jew, and Arab), socioeconomic status, and type of residence. The study group comprised 101,650 infants, aged 9 to 18 months. Iron deficiency anemia, defined as a hemoglobin level <11 g/dL and mean corpuscular volume <70 fl was observed in 4296 (4.2%) of the study infants. Iron deficiency anemia was more prevalent among Arab and ultraorthodox Jewish infants, than non-ultraorthodox Jewish infants (6.6% vs. 6% vs. 3%, respectively). It was also more prevalent among infants of low socioeconomic status, and relatively common among infants of rural residence. We identified two specific sub-populations at risk of developing iron deficiency anemia: Arab and ultraorthodox Jewish infants. We recommend enhancing the nationwide intervention program for both clinicians and parents, thereby treating iron deficiency anemia promptly to avoid short- and long-term deleterious health consequences.
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Urinary tract infections (UTIs) in childhood are common and are associated with considerable acute morbidity and long-term complications. The need for updated data to optimize empiric antibiotic therapy is crucial. We aimed to investigate the pathogens causing pediatric community acquired UTIs, their correlation with demographic characteristics, and trends in their antimicrobial resistance. This nationwide cross-sectional study included all 53,203 children (<18 years) diagnosed with UTI in community outpatient clinics in the following selected years: 2007, 2011, 2015, 2019 and 2021. Escherichia coli (E. coli) (82.1%) was the most common uropathogen, followed by Enterobacter, Klebsiella, Proteus, Pseudomonas, and Enterococcus species. The bacterial distribution displayed statistically significant (p < 0.0001) gender- and sector-specific patterns with a higher relative prevalence of non-E. coli UTI in Jewish and males. The rate of extended-spectrum beta-lactamase-positive E. coli increased substantially and significantly (p < 0.001) from only 6.1% in 2007 to 25.4% in 2021. Most non-E. coli uropathogens exhibited resistance to commonly used empiric antibiotics for UTIs in children. These findings are significant in guiding optimal empiric antibiotic treatment for pediatric community acquired UTIs. The resistance of uropathogens to antimicrobials is region- and time-dependent. Therefore, the periodic and local assessment of antibiotic resistance trends is essential to update guidelines and provide the most appropriate antibacterial therapy for children with UTIs.
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Benign transient hyperphosphatasemia is a condition characterized by greatly increased serum alkaline phosphatase (ALP) without laboratory or clinical evidence of underlying bone or liver disease. It is usually identified incidentally during routine blood testing. We describe the demographic and clinical characteristics of benign transient hyperphosphatasemia in a cohort of healthy infants and children. We performed a retrospective review of electronic medical records on all children aged 1 day to 18 years with a diagnosis of benign transient hyperphosphatasemia, who were registered at 3 central districts in Israel from January 1, 2000, to December 31, 2020. The demographic and clinical characteristics were retrieved from the medical files. The study group comprised 382 infants and children aged from 2 months to 14 years who had serum ALP > 1000 U/L (mean 2557 U/L, range 1002-14,589 U/L). The majority of participants (87%) were aged up to 24 months (median age 14 months, IQR 10-18 months). Fifty-four percent of the study participants were male. In many patients, there was a history of recent fever, gastroenteritis or diarrhea, acute otitis media, and viral infection. A seasonal peak was observed in autumn-early winter, but this may be a detection bias. CONCLUSION: Benign transient hyperphosphatasemia seems to be a disorder described among otherwise healthy infants and children, which resolves spontaneously. Other known causes of markedly elevated serum ALP should be excluded, especially bone and liver disease. Higher awareness and recognition of this benign condition are important in order to avoid unnecessary tests and parental anxiety. WHAT IS KNOWN: ⢠Benign transient hyperphosphatasemia is a benign condition characterized by greatly increased serum alkaline phosphatase without laboratory or clinical evidence of underlying bone or liver disease, which usually resolves spontaneously, with no intervention. WHAT IS NEW: ⢠In the case of an incidental finding of high serum alkaline phosphatase in an otherwise healthy infant or child with no other clinical or laboratory suspicion of bone or liver disease, we recommend repeating the alkaline phosphatase level within a few months in order to confirm the resolution of this condition. ⢠When benign transient hyperphosphatasemia is suspected, a "wait and see" approach is optimal in order to avoid unnecessary investigations and parental anxiety.
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Fosfatasa Alcalina , Hepatopatías , Humanos , Masculino , Niño , Lactante , Femenino , Estudios Retrospectivos , Hepatopatías/diagnóstico , Huesos , DiarreaRESUMEN
BACKGROUND: Falls while turning are associated with increased risk of hip fracture in older adults. Reliable and clinically valid methods for turn ability assessments are needed. OBJECTIVES: To explore the inter-observer reliability and known group validity of the TURN 180 test. METHODS: We divided 78 independent older adults (mean age 76.6 ± 6.5 years) into three groups: non-fallers, infrequent fallers (1-2 falls per year), and recurrent fallers (> 2 falls per year). Participants underwent performance-based tests: Timed Up and Go (TUG), Performance Oriented Mobility Assessment (POMA), and Berg Balance Scale (BBS). TUG was videotaped for later analysis of the TURN 180 test by two blinded observers. RESULTS: A significant difference was found in the TURN 180 test parameters among the groups (P < 0.04). TURN 180 was highly correlated with TUG (r = 0.81-0.89, P < 0.001) and BBS (r = -0.704-0.754, P < 0.0001) and moderately with POMA (r = -0.641-0.698, P < 0.0001). The number of steps was found to be the strongest parameter to determine fallers among older adults (specificity 96.3%, sensitivity 40%). Inter-rater reliability (intraclass correlation coefficient 0.91-0.96, P < 0.0001) was found to be excellent for the number of steps, time taken to accomplish a turn, and total test score categories. CONCLUSIONS: The TURN 180 test is highly reliable and can identify the older adults who fall. Our results show that the TURN 180 test can serve as a good performance-based examination for research or clinical setting.
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Accidentes por Caídas/prevención & control , Evaluación Geriátrica/métodos , Fracturas de Cadera/prevención & control , Limitación de la Movilidad , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Spherical colloids, in an absence of external fields, are commonly assumed to interact solely through rotationally-invariant potentials, u(r). While the presence of permanent dipoles in aqueous suspensions has been previously suggested by some experiments, the rotational degrees of freedom of spherical colloids are typically neglected. We prove, by direct experiments, the presence of permanent dipoles in commonly used spherical poly(methyl methacrylate) (PMMA) colloids, suspended in an apolar organic medium. We study, by a combination of direct confocal microscopy, computer simulations, and theory, the structure and other thermodynamical properties of organic suspensions of colloidal spheres, confined to a two-dimensional (2D) monolayer. Our studies reveal the effects of the dipolar interactions on the structure and the osmotic pressure of these fluids. These observations have far-reaching consequences for the fundamental colloidal science, opening new directions in self-assembly of complex colloidal clusters.
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Recently-developed photo-crosslinkable PMMA (polymethylmethacrylate) colloidal spheres are a highly promising system for fundamental studies in colloidal physics and may have a wide range of future technological applications. We synthesize these colloids and characterize their size distribution. Their swelling in a density- and index- matching organic solvent system is demonstrated and we employ dynamic light scattering (DLS), as also the recently-developed confocal differential dynamic microscopy (ConDDM), to characterize the structure and the dynamics of a fluid bulk suspension of such colloids at different particle densities, detecting significant particle charging effects. We stretch these photo-crosslinkable spheres into ellipsoids. The fact that the ellipsoids are cross-linked allows them to be fluorescently stained, permitting a dense suspension of ellipsoids, a simple model of fluid matter, to be imaged by direct confocal microscopy.
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BACKGROUND: Several studies have identified associations between low vitamin D concentrations and risk of upper respiratory infections (URI). T lymphocytes have a major anti-viral role, are affected by vitamin D metabolism, and may mediate the link between vitamin D and URIs. Competitive swimmers have a relatively high rate of URIs, alongside a high prevalence of low vitamin D concentration. OBJECTIVES: To examine the associations linking T cell receptor excision circles (TREC, markers of thymus activity), circulating 25(OH)D concentrations and the effect of vitamin D supplementation, and URI symptoms in young competitive swimmers. METHODS: We tested 82 adolescent swimmers for serum 25(OH)D and TREC concentrations and found that 55 had vitamin D insufficiency. Randomized supplementation of either vitamin D3 or placebo was given for 12 winter weeks. URI symptoms were recorded weekly. The associations between TREC copy numbers, vitamin D and URI burden were examined. RESULTS: TREC concentrations decreased with the participants' age (r = -0.346, P = 0.003), with no significant between-gender difference. TREC concentrations did not materially differ among subjects with normal, insufficient or deficient vitamin D status, and were not affected by vitamin D supplementation. No significant correlations were found between TREC levels or their changes during the study period, and mean URI severity or duration. CONCLUSIONS: Thymus activity, represented by higher TREC levels, was not related to vitamin D concentrations or status, and was not affected by vitamin D supplementation in adolescent swimmers. TREC concentrations were not associated with URI severity or duration in this population.
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Colecalciferol/administración & dosificación , Infecciones del Sistema Respiratorio/epidemiología , Natación , Timo/metabolismo , Vitamina D/análogos & derivados , Adolescente , Niño , Suplementos Dietéticos , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Vitamina D/sangreRESUMEN
It is hypothesized that vitamin D insufficiency in athletes might negatively affect sport performance. The objective of this study was to examine the effect of vitamin D3 supplementation on physical performance of adolescent swimmers with vitamin D insufficiency. Fifty-three adolescent competitive swimmers with vitamin D insufficiency (serum 25-hydroxyvitamin-D concentrations (25(OH)D) < 30 ng/ml, mean 24.2 ± 4.8 ng/ml) were randomized to receive 2,000 IU/day of vitamin D3 or placebo for 12 weeks. Swimming performance at several speeds, arm-grip strength, and one-legged balance, were measured before and after supplementation. The age-adjusted changes in performance variables during the study were compared between groups. 25(OH) D concentrations at study end were significantly higher in the vitamin group compared with the placebo group (29.6 ± 6.5 ng/ml vs. 20.3 ± 4.2 ng/ml, p < .001), yet only 48% of the vitamin group became vitamin D sufficient with this dosing. No between-group differences were found in the changes of the performance variables tested. No significant differences in performance were found between participants that became vitamin D sufficient, and those who did not. No significant correlation was found between the change in serum 25(OH)D and age-adjusted balance, strength or swimming performance at study end. Vitamin D3 supplementation that raised serum 25(OH)D concentrations by a mean of 9.3 ng/ml above placebo in adolescent swimmers with vitamin D insufficiency, did not improve physical performance more than placebo.
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Fenómenos Fisiológicos Nutricionales de los Adolescentes , Rendimiento Atlético , Colecalciferol/uso terapéutico , Suplementos Dietéticos , Fenómenos Fisiológicos en la Nutrición Deportiva , Deficiencia de Vitamina D/dietoterapia , Adolescente , Calcifediol/sangre , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Estudios de Cohortes , Método Doble Ciego , Femenino , Humanos , Israel , Masculino , Fuerza Muscular , Equilibrio Postural , Índice de Severidad de la Enfermedad , Natación , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
Observational studies identified associations between vitamin D insufficiency (serum 25(OH)D < 30ng·ml-1) and risk of upper respiratory infection (URI). Swimmers are highly prone to URIs, which might hinder their performance. The aim of this study was to examine if vitamin D3 supplementation reduces URI burden in vitamin D-insufficient swimmers. Fifty-five competitive adolescent swimmers with vitamin D insufficiency were randomized to receive vitamin D3 (2,000IU·d-1) or placebo for 12 winter weeks. A URI symptom questionnaire was completed weekly. Serum 25(OH)D concentrations were measured by radio-immunoassay before and after supplementation. We used linear regression to examine the relation between the change in 25(OH)D concentrations during the trial, and the duration and severity of URIs. There were no between-group differences in the frequency, severity, or duration of URIs. Exploratory analyses revealed that in the placebo group only, the change in 25(OH)D concentrations during the trial was highly associated with the duration of URIs (r = -0.90,p < .001), and moderately associated with the severity of URIs (r = -0.65,p = .043). The between-group differences for duration were highly significant. Vitamin D3 supplementation in adolescent swimmers with vitamin D insufficiency did not reduce URI burden. However, larger decreases in serum 25(OH)D concentrations were associated with significantly longer and more severe URI episodes.
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Colecalciferol/uso terapéutico , Suplementos Dietéticos , Infecciones del Sistema Respiratorio/prevención & control , Natación , Deficiencia de Vitamina D/tratamiento farmacológico , Vitaminas/uso terapéutico , Adolescente , Biomarcadores/sangre , Niño , Método Doble Ciego , Femenino , Humanos , Modelos Lineales , Masculino , Infecciones del Sistema Respiratorio/etiología , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/diagnóstico , Adulto JovenRESUMEN
Bacterial soft rot caused by Pectobacterium carotovorum subsp. carotovorum (Pcc) is one of the most devastating diseases of Ornithogalum species. No effective control measures are currently available to use against this pathogen; thus, introduction of resistant genes via genetic transformation into this crop is a promising approach. Tachyplesin I, an antimicrobial peptide, has been shown to effectively control numerous pathogenic bacteria, including Pcc. In this study, liquid-grown cell clusters of Ornithogalum dubium and Ornithogalum thyrsoides were bombarded with a pCAMBIA2301 vector containing a celI leader sequence fused to a gene encoding tachyplesin I, a neomycin phosphotransferase (nptII) gene that served as a selectable marker and a ß-glucuronidase (GUS) gene that served as a reporter. Selection was carried out in the dark in liquid medium containing 80mg/L kanamycin. Regeneration was executed in the light after 6-14 months depending on the cultivar. Hundreds of transgenic plantlets were produced and their identity was confirmed through GUS activity assays. PCR and RT-PCR were used to confirm the presence of the target, reporter and selection genes in the divergent lines of plantlets. The resistance of the O. dubium plants to Pcc was evaluated in vitro, following infection with a highly virulent isolate from calla lily. Although control plantlets were completely macerated within a week, 87 putative transgenic subclones displayed varying levels of disease resistance. During three growing seasons in the greenhouse, the transgenic O. dubium lines grew poorly, whereas the transgenic O. thyrsoides plants grew similarly to non-transgenic plants.
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Péptidos Catiónicos Antimicrobianos/genética , Proteínas de Unión al ADN/genética , Técnicas de Transferencia de Gen , Interacciones Huésped-Patógeno , Ornithogalum/inmunología , Pectobacterium carotovorum/fisiología , Péptidos Cíclicos/genética , Resistencia a la Enfermedad/genética , Glucuronidasa , Kanamicina , Ornithogalum/genética , Plantas Modificadas Genéticamente/inmunología , Reacción en Cadena de la Polimerasa , Transformación Genética , TransgenesRESUMEN
Bedwetting is a very common condition affecting about 15% of children 6 years of age, and is considered one of the main reasons for referrals to pediatricians. Bedwetting is a medical situation and should be managed by physicians. A child wetting his bed is distressing and this has a deep impact on the child's behavior and it is also very stressful for the parents. The causes of bedwetting are not fully understood. Bedwetting can be considered to be a symptom that may result from a combination of different factors. This guideline presents recommendations on the assessment and management of bedwetting in children.
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Enuresis Nocturna/terapia , Padres/psicología , Guías de Práctica Clínica como Asunto , Niño , Humanos , Enuresis Nocturna/epidemiología , Enuresis Nocturna/psicología , Derivación y Consulta/estadística & datos numéricosRESUMEN
Serum vitamin D concentrations (25[OH]D) are associated with physical performance in the general population, but few studies have been published in athletes. 80 competitive adolescent swimmers from both sexes were tested for serum 25(OH)D concentrations, grip strength, balance and swimming performance at several speeds. Spearman's correlations were used to examine the associations between 25(OH)D concentrations and age-adjusted measures of performance. Performance parameters were also compared between vitamin D sufficient (n = 27), insufficient (25[OH]D ranging 20-29.9 ng/ml, n = 42), and deficient (25[OH]D < 20 ng/ ml, n = 11) participants. No significant associations were found between serum 25(OH)D concentrations and any of the performance measures, with no significant differences found between vitamin D sufficient, insufficient and deficient participants. In competitive adolescent swimmers, serum vitamin D concentrations were not associated with strength, balance or swimming performance. Vitamin D insufficient/deficient swimmers did not have reduced performance.
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Rendimiento Atlético/fisiología , Natación/fisiología , Vitamina D/sangre , Adolescente , Niño , Conducta Competitiva , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Equilibrio Postural/fisiologíaRESUMEN
BACKGROUND AND PURPOSE: Autosomal dominant hyper-IgE syndrome (AD-HIES) is a rare primary immunodeficiency disorder . It has been recognized as a multisystem disorder and is characterized by both immunologic and non-immunologic manifestations. Possible bone involvement in autosomal dominant HIES include fractures, scoliosis, cystic bone changes, and osteopenia. We sought to evaluate the changes in bone density in adolescents and young adults with AD-HIES, mostly with proven STAT3 mutation, followed in our institute. METHODS: We studied eight patients with AD-HIES who attended our immunology clinic. All patients underwent at least one bone mass dual-energy x-ray absorptiometry assessment (dual-energy x-ray absorptiometry scan).These findings were evaluated. RESULTS: The age of the patients at the time of their first bone density scan ranged between 10 and 24 years (mean 16.1 ± 4.0 years); the duration of follow-up was 4-11 years (mean 5.8 ± 3.5 years). Four patients had a history of fractures. Mean Z score in these patients was -1.8 ± 0.7. For three patients, Z score was below -1. The other four patients had no history of fractures. Mean Z score in these patients was -0.9 ± 0.5. Only one patient in this group had a Z score below -1. Bone density was below average in all patients; mean spinal Z score was -1.6 ± 0.4. Four patients were followed through the second decade, and all showed progressive deterioration in bone density. Three were treated with alendronate sodium, with improvement in the bone scan results. CONCLUSIONS: Bone density decreases considerably over time in adolescents and young adults suffering from AD- HIES. Treatment with alendronate sodium may be effective in alleviating osteopenia.
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Densidad Ósea , Síndrome de Job/patología , Factor de Transcripción STAT3/deficiencia , Absorciometría de Fotón/métodos , Adolescente , Niño , Femenino , Humanos , Síndrome de Job/genética , Síndrome de Job/inmunología , Masculino , Mutación , Factor de Transcripción STAT3/genética , Factor de Transcripción STAT3/inmunología , Adulto JovenRESUMEN
The objectives of this study were to characterize community-acquired (CA) enterococcal urinary tract infections (UTIs) in a tertiary pediatric center and to determine risk factors for their occurrence, their association with renal abnormalities, their antibiotic susceptibility profile, and the appropriateness of the empiric antibiotic treatment, in comparison to those of Gram-negative UTIs. In a 5-year prospective clinical and laboratory study, we found that enterococcal UTIs caused 6.2% (22/355) of culture-proven CA UTIs. Compared with Gram-negative UTI, enterococcal UTI was associated with male predominance, higher rates of underlying urinary abnormalities (70 vs. 43.7%; p = 0.03) and inappropriate empiric antibiotic therapy (22 vs. 5.6%; p = 0.02), and mainly vesicoureteral reflux (53% of cases). This study highlights the importance of early detection of CA enterococcal UTIs because of their association with underlying urinary abnormalities and a high rate of inappropriate empiric antibiotic therapy. Renal imaging is recommended for children with enterococcal UTIs; Gram stain is suggested in selected cases to detect Gram-positive cocci for early diagnosis of enterococcal UTIs and initiation of appropriate antibiotics.
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Niño Hospitalizado , Infecciones Comunitarias Adquiridas/microbiología , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/microbiología , Infecciones Urinarias/microbiología , Adolescente , Antibacterianos/uso terapéutico , Técnicas Bacteriológicas , Distribución de Chi-Cuadrado , Niño , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Farmacorresistencia Bacteriana , Diagnóstico Precoz , Enterococcus/efectos de los fármacos , Femenino , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , Lactante , Israel/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Valor Predictivo de las Pruebas , Estudios Prospectivos , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiologíaRESUMEN
Plants are an infinite source of bioactive compounds. We screened the Israeli flora for compounds that interfere with the organization of the actin cytoskeleton. We found an activity in lipidic extract from Iris germanica that was able to increase HeLa cell area and adhesion and augment the formation of actin stress fibers. This effect was not observed when Ref52 fibroblasts were tested and was not the result of disruption of microtubules. Further, the increase in cell area was Rac1-dependent, and the iris extract led to slight Rac activation. Inhibitor of RhoA kinase did not interfere with the ability of the iris extract to increase HeLa cell area. The increase in HeLa cell area in the presence of iris extract was accompanied by impairment of cell migration and arrest of the cell cycle at G1 although the involvement of Rac1 in these processes is not clear. Biochemical verification of the extract based on activity-mediated fractionation and nuclear magnetic resonance analysis revealed that the active compounds belong to the group of iridals, a known group of triterpenoid. Purified iripallidal was able to increase cell area of both HeLa and SW480 cells.
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Citoesqueleto de Actina/efectos de los fármacos , Movimiento Celular/efectos de los fármacos , Género Iris/química , Triterpenos/farmacología , Proteína de Unión al GTP rac1/metabolismo , Acroleína/análogos & derivados , Acroleína/aislamiento & purificación , Acroleína/farmacología , Amidas/farmacología , Animales , Adhesión Celular , Tamaño de la Célula , Ciclohexanoles/aislamiento & purificación , Ciclohexanoles/farmacología , Fibroblastos/citología , Fibroblastos/efectos de los fármacos , Citometría de Flujo , Puntos de Control de la Fase G1 del Ciclo Celular , Células HeLa , Humanos , Espectroscopía de Resonancia Magnética , Extractos Vegetales/química , Extractos Vegetales/farmacología , Piridinas/farmacología , Ratas , Rizoma/química , Transfección , Triterpenos/química , Proteína de Unión al GTP rhoA/metabolismoRESUMEN
In many countries, ibuprofen is available only in oral formulations. The authors aimed to investigate parental satisfaction and possible adverse reactions among children receiving newly marketed ibuprofen suppositories, prior to their arrival at the pharmaceutical points of distribution. Children needing antipyretic medication were recruited from 11 pediatric wards and clinics in Israel. Each patient received ibuprofen suppositories (5-10 mg/kg/dose) after completing a data collection form. After 3 to 7 days of treatment, information regarding parent satisfaction, possible adverse reactions, and concomitant use of drugs was obtained. Overall, 490 children completed the study. Parents' satisfaction was high (4.5 ± 0.47 on a scale of 1-5), and 92.2% reported that they would use the medication in the future. Adverse reactions were reported in 8 patients (1.63%, 95% confidence interval = 1.77-3.25), the most common being diarrhea. Rectal administration of ibuprofen suppositories is well tolerated and overall satisfaction and the repeated expected use were high.
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Antipiréticos/administración & dosificación , Antipiréticos/efectos adversos , Fiebre/tratamiento farmacológico , Ibuprofeno/administración & dosificación , Ibuprofeno/efectos adversos , Satisfacción del Paciente , Administración Rectal , Adulto , Niño , Preescolar , Esquema de Medicación , Evaluación de Medicamentos , Femenino , Humanos , Lactante , Masculino , Mercadotecnía , Padres , SupositoriosRESUMEN
BACKGROUND: There is relatively little research on affective influences on physician behaviour, especially on prescribing and referrals. Affects include transitory moods and lasting emotions. OBJECTIVES: We explored physician perceptions of the impact of four mood states on perceived rates of five behaviours: talking with patients, prescribing medications and referrals for laboratory tests, diagnostic tests and specialists. We also examined whether burnout modified the impact of moods on behaviour. METHODS: A total of 188 family physicians responded anonymously to a self-reporting questionnaire that assessed the perceived rate of behaviours when in a positive, negative, tired and nervous mood and burnout level. RESULTS: Five analyses of variance with repeated measures on mood states and contrast analyses computed the effects of mood and burnout on the behaviours. The mood factor was found significant for each of the behaviours, in all P < 0.001. The respondents reported that on good mood compared with negative mood days, they talked more, prescribed less and referred less. The burnout factor was also significant: high compared with low burnout physicians had higher perceived rates of all referral behaviours. Significant mood × burnout interactions indicated that the effects of mood were stronger among high compared with low burnout physicians. CONCLUSIONS: The physicians perceived that their moods had different effects on different behaviours: the negative mood decreased talking and increased prescribing and referral behaviours and vice versa for the positive mood. Burnout intensified the effects of moods. The incremental effects of negative moods and burnout may impair quality of health care and may be costly to health services.
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Afecto , Relaciones Médico-Paciente , Médicos de Familia/psicología , Pautas de la Práctica en Medicina , Análisis de Varianza , Ansiedad/psicología , Actitud del Personal de Salud , Agotamiento Profesional/psicología , Toma de Decisiones , Fatiga/psicología , Femenino , Humanos , Israel , Masculino , Placer , Derivación y ConsultaRESUMEN
The risk of upper respiratory infections (URIs) is increased in people who are under heavy physical stress, including recreational and competitive swimmers. Additional treatment options are needed, especially in the younger age group. The aim of this study was to determine whether 1 g/day vitamin C supplementation affects the rate, length, or severity of URIs in adolescent swimmers. We carried out a randomized, double-blind, placebo-controlled trial during three winter months, among 39 competitive young swimmers (mean age 13.8 ± 1.6 years) in Jerusalem, Israel. Vitamin C had no effect on the incidence of URIs (rate ratio = 1.01; 95% confidence interval (CI) = 0.70-1.46). The duration of respiratory infections was 22% shorter in vitamin C group, but the difference was not statistically significant. However, we found a significant interaction between vitamin C effect and sex, so that vitamin C shortened the duration of infections in male swimmers by 47% (95% CI: -80% to -14%), but had no effect on female swimmers (difference in duration: +17%; 95% CI: -38% to +71%). The effect of vitamin C on the severity of URIs was also different between male and female swimmers, so that vitamin C was beneficial for males, but not for females. Our study indicates that vitamin C does not affect the rate of respiratory infections in competitive swimmers. Nevertheless, we found that vitamin C decreased the duration and severity of respiratory infections in male swimmers, but not in females. This finding warrants further research.
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Ácido Ascórbico/administración & dosificación , Infecciones del Sistema Respiratorio/dietoterapia , Natación , Adolescente , Suplementos Dietéticos , Método Doble Ciego , Femenino , Humanos , Incidencia , Israel , Masculino , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/fisiopatología , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del TratamientoRESUMEN
BACKGROUND: There is little research regarding specific work features that might cause chronic stress and burnout among primary care pediatricians. The aim of the present study was first, to assess specific negative and positive characteristics of the job that might be related to burnout; and second, to compare burnout levels and work characteristics among board-certified versus general pediatricians; and clinic directors versus non-directors. METHODS: Questionnaires were sent to 200 pediatricians employed full-time in pediatric primary care community centers in the largest Israeli Health Maintenance Organization (HMO). Respondents replied anonymously. The questionnaires assessed sociodemographic details, burnout levels, and negative and positive job characteristics. RESULTS: There were no differences in burnout levels between board-certified and general pediatricians. Positive job features had stronger associations with burnout than negative features. Compared with general pediatricians, board-certified pediatricians reported significantly higher levels of negative features (e.g. conflicts between the medical and administrative system in the HMO; parents disregarding instructions); but higher levels of autonomy and appreciation from patients. Compared with regular pediatricians, clinic directors had significantly higher levels of negative job features (e.g. less access to resources); and higher levels of positive work features. CONCLUSIONS: The absence of positive job features (e.g. autonomy, recognition for one's work and utilization of skills) may be more important in causing burnout than the presence of negative characteristics (e.g. overload, demanding and noisy parents). It is consistent with recent suggestions that in the presence of positive features, employees can better tolerate stressful aspects of the job and still feel motivated and engaged.
Asunto(s)
Agotamiento Profesional/psicología , Pediatría , Certificación , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Atención Primaria de Salud , Estrés Psicológico , Encuestas y CuestionariosRESUMEN
AIM: To examine the parent-dependent barriers to varicella immunization in Israel. METHODS: Data were collected by questionnaire from parents of children aged 1 to 18 years who attended an outpatient paediatric centre in five cities in Israel from March to May 2003. RESULTS: A total of 1474 parents completed the questionnaire. A history of chicken pox was reported in 850 children (57.8%), mostly (83%) between ages 1-6 years. Of the 624 children without a history of chicken pox, 213 (34.1%) were immunized against varicella. Immunization rates were significantly lower in families with lower parental education and in patients from cities with a lower socioeconomic ranking (p < 0.05). The main reasons for not being vaccinated (49%) were related to insufficient information about the vaccine itself and the vaccination process. These reasons were more common in families with lower parental education and from cities with lower socioeconomic ranking (p < 0.01). Other reasons included fear of adverse effects (12%) and waning immunity (6%), preference of natural illness over immunization (12%), and financial limitations (5%). CONCLUSIONS: Promoting parental knowledge about the varicella vaccine appears to be a key factor in improving the immunization rate, especially in families of lower education, and from cities with low socioeconomic ranking.