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OBJECTIVES: To assess pediatric critical care transport (CCT) teams' performance in a simulated environment and to explore the impact of team and center characteristics on performance. STUDY DESIGN: This observational, multicenter, simulation-based study enlisted a national cohort of pediatric transport centers. Teams participated in 3 scenarios: nonaccidental abusive head injury, sepsis, and cardiac arrest. The primary outcome was teams' simulation performance score. Secondary outcomes were associations between performance, center and team characteristics. RESULTS: We recruited 78 transport teams with 196 members from 12 CCT centers. Scores on performance measures that were developed were 89% (IQR 78-100) for nonaccidental abusive head injury, 63.3% (IQR 45.5-81.8) for sepsis, and 86.6% (IQR 66.6-93.3) for cardiac arrest. In multivariable analysis, overall performance was higher for teams including a respiratory therapist (0.5 points [95% CI: 0.13, 0.86]) or paramedic (0.49 points [95% CI: 0.1, 0.88]) and dedicated pediatric teams (0.37 points [95% 0.06, 0.68]). Each year increase in program age was associated with an increase of 0.04 points (95% CI: 0.02, 0.06). CONCLUSIONS: Dedicated pediatric teams, inclusion of respiratory therapists and paramedics, and center age were associated with higher simulation scores for pediatric CCT teams. These insights can guide efforts to enhance the quality of care for children during interfacility transports.

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Colombia has a tropical climate and environmental conditions that favour the circulation of most of the known vector-borne diseases (VBDs). Protocols have been established and implemented to address the threats of these diseases, but they are for country-wide use and do not take into consideration the nuances of the different environments of the country. Almost the entire population is vulnerable to infection with one or more VBD. This study aims to characterise the perceptions and experiences of stakeholders involved in vector control and VBDs in the Orinoquia region in Colombia. Two panel discussions, and 12 semi-structured interviews, were conducted. Experts from the Colombian National Health Institute (INS), health secretaries from Meta, Guaviare and Vichada Departments, academic researchers, and individuals from private vector control companies participated. All sessions were recorded, transcribed, and translated, and then subject to thematic analysis. Three major themes emerged: involvement, limitations, and recommendations. Results showed that participants are engaged in vector surveillance activities, education, and vector control research. Participants focused on problems of disjointed efforts towards VBD control between health secretaries and the health ministry, as well as societal issues, such as socioeconomic, cultural, and political issues, which became the rationale for the lack of vector control resources. Responses in the panel discussions and interviews overlapped in opinions, and suggested that vector control could be improved through better communication between vector control bodies, strengthened engagement with vulnerable communities, more collaborative actions, and a more balanced distribution of resources.

RESUMEN

The aim of this study was to investigate multi-drug-resistant (MDR) Escherichia coli in urine of adult male patients with enlarged prostate. Three hundred and sixty-eight samples of urine and blood were collected. Escherichia coli was isolated, purified, and identified and prostate-specific antigen (PSA) was determined. Multi-drug resistance test and specific drug resistance genes were assessed. Prevalence of Escherichia coli was high (38.5%) in patients with PSA of 60-79 ng ml-1 and 60% were MDR. The isolates showed highest resistance to tetracycline (53.3.0%) and least to cephalosporins (5%). They had intL and gyrA genes, which are integron, and quinolone resistance genes and sul1 and sul2 which are sulphonamide resistance-associated genes. Levofloxacin, ertapenem, and Augmentin (100% susceptibilities) were considered choice drugs for treatment of Escherichia coli infection in patients with elevated PSA.

Asunto(s)

Infecciones por Escherichia coli , Hospitales Generales , Adulto , Humanos , Masculino , Próstata , Antígeno Prostático Específico , Escherichia coli/genética , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Antibacterianos/farmacología , Levofloxacino , Pruebas de Sensibilidad Microbiana , Farmacorresistencia Bacteriana Múltiple/genética

RESUMEN

Background: The use of deep inferior epigastric perforator (DIEP) flaps is a well-established breast reconstruction technique. Methods: A 29-question survey was e-mailed to 3186 active American Society of Plastic Surgeons members, aiming to describe postoperative monitoring practice patterns among surgeons performing DIEP flaps. Results: From 255 responses (8%), 79% performing DIEP surgery were analyzed. Among them, 34.8% practiced for more than 20 years, 34.3% for 10-20 years, and 30.9% for less than 10 years. Initial 24-hour post-DIEP monitoring: intensive care unit (39%) and floor (36%). Flap monitoring: external Doppler (71%), tissue oximetry (41%), and implantable Doppler (32%). Postoperative analgesia: acetaminophen (74%), non-steroidal anti-inflammatory drugs (69%), neuromodulators (52%), and opioids (4.4%) were administered on a scheduled basis. On postoperative day 1, 61% halt intravenous fluids, 67% allow ambulation, 70% remove Foley catheter, and 71% start diet. Most surgeons discharged patients from the hospital on postoperative day 3+. Regardless of experience, patients were commonly discharged on day 3. Half of the surgeons are in academic/nonacademic settings and discharge on/after day 3. Conclusions: This study reveals significant heterogeneity among the practice patterns of DIEP surgeons. In light of these findings, it is recommended that a task force be convened to establish standardized monitoring protocols for DIEP flaps. Such protocols have the potential to reduce both the length of hospital stays and overall care costs all while ensuring optimal pain management and vigilant flap monitoring.

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Using an electronic health record-based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction-positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection in children.

Asunto(s)

COVID-19 , Humanos , Niño , COVID-19/complicaciones , COVID-19/diagnóstico , Síndrome Post Agudo de COVID-19 , SARS-CoV-2 , Estudios de Cohortes , Registros Electrónicos de Salud , Anticuerpos Antivirales , Progresión de la Enfermedad , Prueba de COVID-19

RESUMEN

OBJECTIVE: The aim of this scoping review was to analyze the available evidence on the preheating process and its effects on physicochemical properties of composite resins. MATERIALS AND METHODS: A systematic search was performed in August 2021 using PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and gray literature without language or date restriction. Inclusion criteria were in vitro studies that assessed the physicochemical properties and marginal adaptation of preheated composite. Exclusion criteria were studies with experimental composite, literature reviews, clinical studies. Data from selected studies were qualitatively analyzed. RESULTS: In total, 104 studies were found from which 39 were included. The most used composite resin was Filtek Z350 XT (3 M/ESPE), preheated at 68°C in a Calset device (AdDent Inc., Danbury, CT, USA) for 5 or 15 min. Most studies showed decreased viscosity, increased conversion degree and microhardness of composite resins, and better marginal adaptation of direct and indirect restorations. Also, flexural strength was not affected, and data about bond strength were inconclusive due to heterogeneity among studies. CONCLUSION: The parameters used for preheating composite resins are heterogeneous. Preheating decreased viscosity, increased the conversion degree and microhardness of composite resins, and improved the marginal adaptation of direct and indirect restorations. CLINICAL SIGNIFICANCE: The analysis of evidence showed a high heterogeneity among preheating protocols. Preheating may benefit the handling and physicochemical properties of composite resins.

Asunto(s)

Resinas Compuestas , Resistencia Flexional , Resinas Compuestas/química , Ensayo de Materiales , Viscosidad

RESUMEN

OBJECTIVE: The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups. DESIGN: In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies. PARTICIPANTS: 120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews. SETTING: Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital). RESULTS: Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging. CONCLUSIONS: Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement.

Asunto(s)

Infección por el Virus Zika , Virus Zika , Adulto , Animales , Brasil/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Masculino , Mosquitos Vectores , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/prevención & control

RESUMEN

OBJECTIVE: The rectal microbiome was examined to assess the relationship between the microbiome and liver disease in HIV-infection. DESIGN: Eighty-two HIV-1 mono-infected individuals from the PROSPEC-HIV-study (NCT02542020) were grouped into three liver health categories based on results of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) of transient elastography: normal (n = 30), steatosis (n = 30), or fibrosis (n = 22). METHODS: Liver steatosis and fibrosis were defined by CAP at least 248 dB/m and LSM at least 8.0 kPa, respectively. 16S rRNA gene and whole genome shotgun metagenomic sequencing were performed on rectal swabs. Bacterial differences were assessed using zero-inflated negative binomial regression and random forests modeling; taxonomic drivers of functional shifts were identified using FishTaco. RESULTS: Liver health status explained four percentage of the overall variation (r2 = 0.04, P = 0.003) in bacterial composition. Participants with steatosis had depletions of Akkermansia muciniphila and Bacteroides dorei and enrichment of Prevotella copri, Finegoldia magna, and Ruminococcus bromii. Participants with fibrosis had depletions of Bacteroides stercoris and Parabacteroides distasonis and enrichment of Sneathia sanguinegens. In steatosis, functional analysis revealed increases in primary and secondary bile acid synthesis encoded by increased Eubacterium rectale, F. magna, and Faecalibacterium prausnitzii and decreased A. muciniphila, Bacteroides fragilis and B. dorei. Decreased folate biosynthesis was driven by similar changes in microbial composition. CONCLUSION: HIV mono-infection with steatosis or fibrosis had distinct microbial profiles. Some taxa are similar to those associated with non-alcoholic fatty liver disease in HIV-negative populations. Further studies are needed to define the role of the gut microbiota in the pathogenesis of liver disease in HIV-infected persons.

Asunto(s)

Diagnóstico por Imagen de Elasticidad , Hígado Graso , Infecciones por VIH , Cirrosis Hepática , Brasil/epidemiología , Hígado Graso/microbiología , Hígado Graso/patología , Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/microbiología , Cirrosis Hepática/patología , Enfermedad del Hígado Graso no Alcohólico/microbiología , Enfermedad del Hígado Graso no Alcohólico/patología , Proyectos Piloto , ARN Ribosómico 16S/genética

RESUMEN

Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil-the epicentre of the Brazilian microcephaly epidemic-has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.

Asunto(s)

Epidemias , Microcefalia , Infección por el Virus Zika , Virus Zika , Brasil/epidemiología , Femenino , Humanos , Microcefalia/complicaciones , Microcefalia/epidemiología , Embarazo , Infección por el Virus Zika/epidemiología

RESUMEN

BACKGROUND: The outbreak of Zika virus in Brazil in 2015 followed the arrival of chikungunya in 2014 and a long history of dengue circulation. Vital to the response to these outbreaks of mosquito-borne pathogens has been the dissemination of public health messages, including those promoted through risk communication posters. This study explores the content of a sample of posters circulated in Brazil towards the end of the Zika epidemic in 2017 and analyses their potential effectiveness in inducing behaviour change. METHODS: A content analysis was performed on 37 posters produced in Brazil to address outbreaks of mosquito-borne pathogens. The six variables of the Health Belief Model were used to assess the potential effectiveness of the posters to induce behaviour change. RESULTS: Three overarching key messages emerged from the posters. These included (i) the arboviruses and their outcomes, (ii) a battle against the mosquito, and (iii) a responsibility to protect and prevent. Among the six variables utilised through the Health Belief Model, cues to action were most commonly featured, whilst the perceived benefits of engaging in behaviours to prevent arbovirus transmission were the least commonly featured. CONCLUSIONS: The posters largely focused on mosquito-borne transmission and the need to eliminate breeding sites, and neglected the risk of the sexual and congenital transmission of Zika and the importance of alternative preventive actions. This, we argue, may have limited the potential effectiveness of these posters to induce behaviour change.

Asunto(s)

Aedes , Arbovirus , Virus del Dengue , Dengue , Infección por el Virus Zika , Virus Zika , Animales , Brasil/epidemiología , Dengue/epidemiología , Dengue/prevención & control , Humanos , Mosquitos Vectores , Salud Pública , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/prevención & control

RESUMEN

BACKGROUND: Biosurfactants are amphipathic biological compounds with surface active potential and are produced by many microorganisms. Biosurfactant production by Lysinibacillus fusiformis MK559526 isolated from automobile-mechanic-shop soil was investigated with a view to assessing its potential for production and potential for optimization. MATERIALS AND METHODS: Effects of carbon and nitrogen sources, pH, temperature and incubation periods on biosurfactant production were evaluated with a view to optimizing the processes. Fourier Transform Infra-Red absorption peaks and Gas chromatography mass spectrometry were used to determine the functional groups of the chemical make-up and the chemical profile of the biosurfactant respectively. RESULTS: Lysinibacillus fusiformis surfactant had emulsification index of 65.15 ± 0.35 %, oil displacement of 2.7 ± 0.26 mm, zone of haemolysis of 7.3 ± 0.16 mm and a positive drop collapse test. Optimized culture conditions for biosurfactant production: temperature, 35 ºC; pH, 7.0; starch solution, 40 g/L and urea, 1.5 g/L showed a reduction in surface tension to 28.46 ± 1.11 mN/m and increased emulsification index to 93.80 ± 0.41 %. Maximum biosurfactant production of 2.92 ± 0.04 g/L was obtained after 72 h. The biosurfactant contained peptides and fatty acids. The predominant fatty acid was 9-Octadecenoic acid (80.80%). CONCLUSIONS: The above results showing high emulsification potential and remarkable reduction in the surface tension are good biosurfactant attributes. Consequently, Lysinibacillus fusiformis MK559526 is a good candidate for biosurfactant production.

Asunto(s)

Bacillaceae/metabolismo , Microbiología del Suelo , Tensoactivos/metabolismo , Automóviles , Bacillaceae/química , Bacillaceae/aislamiento & purificación , Carbono/metabolismo , Medios de Cultivo/química , Medios de Cultivo/metabolismo , Nitrógeno/metabolismo , Suelo/química , Espectroscopía Infrarroja por Transformada de Fourier , Tensión Superficial , Tensoactivos/química

RESUMEN

OBJECTIVE: To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). STUDY DESIGN: A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. RESULTS: Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSIONS: Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.

Asunto(s)

Servicio de Urgencia en Hospital/normas , Pediatría , Mejoramiento de la Calidad , Niño , Humanos , Estudios Prospectivos

RESUMEN

Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (-10.78, 95% CI: -19.87 to -1.69), motor (-10.45, 95% CI: -19.22 to -1.69), and cognitive (-17.20, 95% CI: -26.13 to -8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.

Asunto(s)

Microcefalia/virología , Trastornos del Neurodesarrollo/virología , Complicaciones Infecciosas del Embarazo/virología , Efectos Tardíos de la Exposición Prenatal/etiología , Factores Socioeconómicos , Infección por el Virus Zika/complicaciones , Adolescente , Adulto , Brasil/epidemiología , Preescolar , Femenino , Humanos , Lactante , Masculino , Microcefalia/economía , Madres , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/economía , Embarazo , Complicaciones Infecciosas del Embarazo/economía , Complicaciones Infecciosas del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/virología , Estudios Prospectivos , Adulto Joven , Infección por el Virus Zika/economía , Infección por el Virus Zika/epidemiología

RESUMEN

OBJECTIVE: Inflammatory bowel disease (IBD) negatively impacts quality of life-related issues including intimacy, body image, and sexual activity. Sexual dysfunction in patients with IBD is often unrecognized. In this study, we aimed to describe sexual function in Puerto Rican women with IBD. METHODS: We conducted a cross-sectional study of women with IBD at the University of Puerto Rico Center for IBD. Patients were invited to anonymously complete the validated Spanish version of the Female Sexual Function Index (FSFI) questionnaire. On this 36-point scale, a score of 26.55 or less is defined as sexual dysfunction. Data were analyzed by diagnosis, presence of an ostomy, and age, using descriptive statistics, ANOVA, Student's t test, and logistic regression. RESULTS: One hundred women completed the FSFI questionnaire, with subjects having Crohn's disease (CD) outnumbering those having ulcerative colitis (UC) 2:1. The mean sexual function score was 21.92 (95% CI: 20.08-23.76). No statistical difference was observed in total FSFI scores between subjects with CD and UC (p = 0.084) and those with an ostomy (p = 0.891). Sexual function decreased with age (p = 0.001). The domains of excitation, lubrication, orgasm, and satisfaction were the most negatively affected (p<0.05) by increasing age. Multivariate analysis confirmed the effect of age on excitation, lubrication, orgasm, and pain. CONCLUSION: Our study showed sexual dysfunction to be present in this sample of Puerto Rican Hispanic women with IBD. Physicians treating patients with IBD need to be aware of these findings to explore the concerns of individuals with this disease and develop strategies to address those concerns.

Asunto(s)

Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/complicaciones , Disfunciones Sexuales Fisiológicas/etiología , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/fisiopatología , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/fisiopatología , Estudios Transversales , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/fisiopatología , Libido/fisiología , Persona de Mediana Edad , Osteotomía/estadística & datos numéricos , Puerto Rico/etnología , Calidad de Vida , Análisis de Regresión , Conducta Sexual , Disfunciones Sexuales Fisiológicas/epidemiología , Disfunciones Sexuales Fisiológicas/fisiopatología , Adulto Joven

RESUMEN

BACKGROUND: Arboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging. METHODOLOGY/PRINCIPAL FINDINGS: To gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction. CONCLUSIONS/SIGNIFICANCE: Achieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies.

Asunto(s)

Infección por el Virus Zika/prevención & control , Infección por el Virus Zika/psicología , Virus Zika/fisiología , Adolescente , Adulto , Aedes/efectos de los fármacos , Aedes/virología , Animales , Colombia , Estudios de Evaluación como Asunto , Femenino , Humanos , Repelentes de Insectos/farmacología , Conocimiento , Masculino , Persona de Mediana Edad , Percepción , Equipo de Protección Personal/economía , Embarazo , Adulto Joven , Infección por el Virus Zika/economía , Infección por el Virus Zika/virología

RESUMEN

PURPOSE: To determine and compare the microstructure, flexural strength, flexural modulus, fracture strength, and microhardness of four types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials for monolithic dental restorations. MATERIALS AND METHODS: A lithium disilicate (LD; IPS e.max CAD), a zirconia-reinforced lithium silicate (ZLS; VITA Suprinity), a hybrid high-performance polymer (HPP) composite resin (GC Cerasmart), and a hybrid polymer-infiltrated ceramic network (PICN) material (VITA Enamic) were used to manufacture monolithic ceramic posterior crowns (n = 10) that were adhesively cemented on resin-based composite dies and loaded until fracture. In addition, 40 rectangular bars (n = 10) were milled and polished for three-point flexural strength testing. Microhardness (Vickers indentation), as well as quantitative (energy dispersive spectroscopy) and qualitative (scanning electron microscopy) structural analysis were conducted on fracture surfaces. Data were analyzed by one-way ANOVA and Tukey HSD post-hoc test (p = 0.05). RESULTS: Mechanical testing results showed that the material type has a significant effect on the fracture strength (p < 0.0001) of the monolithic crowns with ZLS and LD presenting significantly higher fracture strength than the PICN and HPP hybrid materials. LD showed the highest flexural strength (p < 0.0001) followed by ZLS, HPP, and PICN, respectively. The lowest flexural modulus and hardness were presented by HPP whereas ZLS had the highest flexural modulus and hardness. The LD presented the highest modulus of resilience and the PICN the lowest. CONCLUSIONS: All CAD/CAM crown materials exhibited high values of fracture and flexural resistance, making them suitable materials for posterior full-crown restorations. Glass-ceramics suffered more from catastrophic and nonreparable fracture patterns, whereas minimal chipping and type II fracture patterns were more common in hybrid materials. The combination of more flexibility, less stiffness, and increased softness with satisfactory flexural and fracture strength values observed in PICN and HPP makes these two hybrid materials suitable choices for chairside monolithic crown fabrication.

Asunto(s)

Diseño Asistido por Computadora , Coronas , Materiales Dentales , Diseño de Prótesis Dental/métodos , Restauración Dental Permanente , Cerámica , Resinas Compuestas , Materiales Dentales/química , Porcelana Dental , Restauración Dental Permanente/métodos , Análisis del Estrés Dental , Resistencia Flexional , Dureza , Humanos , Microscopía Electrónica de Rastreo

RESUMEN

The aim of this study was to develop and characterise a new plasma-enhanced chemical vapor deposition (PECVD) film for improving shear bond strength (SBS) between yttria-stabilised tetragonal zirconia (Y-TZP) and veneering ceramic. In total, 192 Y-TZP samples (13 × 5.4 × 5 mm) were divided into 6 groups: control - no treatment (C), airborne-particle abrasion with 27 µm aluminum oxide particles (Al27), 110 µm aluminum oxide particles (Al110), and 250 µm aluminum oxide particles (Al250), application of liner for zirconia (L) and the PECVD film application (P). The Y-TZP surface was characterised by means of Scanning Electronic Microscopy (SEM), Energy-dispersive Spectroscopy (EDS), atomic force microscopy (AFM), surface profilometry and surface-free energy (SFE). SBS between Y-TZP and veneering ceramic was tested before and after thermocycling (20,000 cycles of 5 and 55 °C), and failure mode was also evaluated. Data were analysed by ANOVA and Tukey's HSD test (α = 0.05). Data analysis showed that PECVD film had no effect on surface roughness of Y-TZP (p > 0.05 vs control), whilst the other groups presented higher roughness values (p < 0.05). All treatments increased SFE, except the Al27 group. The highest SBS was presented by the P group (p < 0.05), and values were similar to those of the Al27 group (p = 0.107). Mixed failures were prevalent in all groups, and premature failures were found only in Al groups after thermocycling. Whilst PECVD treatment did not affect Y-TZP surface roughness, high SBS between Y-TZP and the veneering layer was observed. Therefore, PECVD treatment is a promising alternative to improve the performance of bi-layer zirconia-based restorations.

Asunto(s)

Cerámica/química , Coronas con Frente Estético , Gases em Plasma/química , Resistencia al Corte , Circonio/química , Porcelana Dental/química , Propiedades de Superficie , Itrio/química

RESUMEN

Immediate antiretroviral therapy (ART) for acute HIV infection (AHI) may decrease HIV transmission in high-risk populations. This study evaluated knowledge of AHI and AHI testing program preferences in Lima, Peru through four semi-structured focus groups with high-risk men who have sex with men (MSM) ( n = 20) and transgender women (TW) ( n = 16). Using content analysis, emergent themes included knowledge of AHI symptoms, AHI transmission potential, and the HIV testing window period, and preferences concerning point of care results. Participants demonstrated low familiarity with the term AHI, but many correctly identified AHI symptoms. However, these symptoms may not motivate testing because they overlap with common viral illnesses and AIDS. Some were aware that infectiousness is highest during AHI, and believe this knowledge would facilitate HIV testing. The shortened window period with AHI testing would encourage testing following high-risk sex. Delayed result notification would not decrease AHI testing demand among MSM, although it might for some TW.

Asunto(s)

Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/estadística & datos numéricos , Aceptación de la Atención de Salud , Personas Transgénero/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Grupos Focales , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Homosexualidad Masculina/psicología , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Perú/epidemiología , Factores de Riesgo , Personas Transgénero/psicología , Sexo Inseguro , Adulto Joven

RESUMEN

Accumulating evidence suggests that rates of low bone mass are greater in HIV-infected males than females. Of 11 biomarkers assessed by sex and HIV-status, HIV-infected males had increased levels of soluble CD14 which inversely correlated with bone mineral content and bone mineral density measures, suggesting macrophage activation as a possible mechanism of differential bone loss.

Asunto(s)

Terapia Antirretroviral Altamente Activa , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/fisiopatología , Infecciones por VIH/fisiopatología , Activación de Macrófagos , Osteoporosis/fisiopatología , Columna Vertebral/patología , Absorciometría de Fotón , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/virología , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Osteoporosis/diagnóstico por imagen , Osteoporosis/virología , Puerto Rico/epidemiología , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven