RESUMEN
Innovative and coordinated strategies to address weight bias among health professionals are urgently needed. We conducted a systematic literature review of empirical peer-reviewed published studies to assess the impact of interventions designed to reduce weight bias in students or professionals in a health-related field. Combination sets of keywords based on three themes (1: weight bias/stigma; 2: obesity/overweight; 3: health professional) were searched within nine databases. Our search yielded 1447 individual records, of which 17 intervention studies satisfied the inclusion criteria. Most studies (n = 15) included medical, dietetic, health promotion, psychology and kinesiology students, while the minority included practicing health professionals (n = 2). Studies utilized various bias-reduction strategies. Many studies had methodological weaknesses, including short assessment periods, lack of randomization, lack of control group and small sample sizes. Although many studies reported changes in health professionals' beliefs and knowledge about obesity aetiology, evidence of effectiveness is poor, and long-term effects of intervention strategies on weight bias reduction remain unknown. The findings highlight the lack of experimental research to reduce weight bias among health professionals. Although changes in practice will likely require multiple strategies in various sectors, well-designed trials are needed to test the impact of interventions to decrease weight bias in healthcare settings.
Asunto(s)
Personal de Salud , Sobrepeso , Estigma Social , Conocimientos, Actitudes y Práctica en Salud , HumanosRESUMEN
We set out to examine selected clinical characteristics of migraine patients referred to neurologists specializing in headache in Canada, and to document their pharmacological therapy both before and after consultation with the neurologist. Demographic, clinical and pharmacotherapy data were collected at the time of consultation for 606 patients referred to five headache clinics and who were given a migraine diagnosis by the neurologist. Data were analysed as part of the Canadian Headache Outpatient Registry and Database (CHORD) Project. The mean age of the migraine patients was 39.7 years; and 82.5% were female. The majority of patients suffered severe impact from their headaches. Prior to consultation, 48.7% were taking a triptan; after consultation, 97.2% were on a triptan. Before consultation, 30.9% were on a prophylactic drug; after consultation, 70.4% were. 20.8% of patients were medication overusers. Of these medication overusers, 42.4% were overusing an opiate, usually in combination with other analgesics; 21.6% were overusing a triptan. Medication changes made by the neurologists at consultation included a large increase in the use of both triptans and prophylactic medications. Medication overuse, particularly opiate overuse, remains a significant problem in patients with migraine in Canada.
Asunto(s)
Analgésicos/uso terapéutico , Trastornos Migrañosos/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Canadá , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurología , Médicos de Familia , Derivación y ConsultaRESUMEN
OBJECTIVE: To evaluate the association between diagnostic labeling of respiratory tract infections (RTIs) and antibiotic prescription rates in family practice. DESIGN: Descriptive analysis of outpatient chart review supplemented by interviews with physicians. Charts of patients attending 73 general practitioners were reviewed between October 1997 and February 1998. Two days of practice were evaluated per physician. SETTING: Urban family practices in greater St John's, Nfld. PARTICIPANTS: Of 96 family physicians contacted, 73 (76%) agreed to participate. MAIN OUTCOME MEASURES: Rates of diagnoses and antibiotic prescriptions for acute infections. Physicians were divided into "low prescribers" and "high prescribers" based on overall rates of prescription to patients with infections. Low prescribers were compared with high prescribers with respect to physician characteristics, patient characteristics, and diagnoses assigned. RESULTS: Of all patients seen, 22% were seen for acute infections; RTIs accounted for 76% of diagnoses. Low prescribers and high prescribers were of similar ages and saw similar numbers of patients of similar ages with very similar presenting complaints. Both groups diagnosed urinary tract and skin and soft-tissue infections at similar rates, but differed markedly in their rates of diagnoses of RTIs. High prescribers diagnosed bacterial RTIs in 65.4% (147/225) of their patients; low prescribers diagnosed bacterial RTIs in 31.0% (66/213 (P < .001). CONCLUSION: Family doctors frequently prescribe antibiotics. The difference in rates of prescription between high prescribers and low prescribers is largely explained by assignment of diagnoses of RTIs.
Asunto(s)
Antibacterianos/uso terapéutico , Pautas de la Práctica en Medicina , Infecciones del Sistema Respiratorio/clasificación , Infecciones del Sistema Respiratorio/diagnóstico , Enfermedad Aguda , Adulto , Medicina Familiar y Comunitaria , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Pacientes Ambulatorios , Infecciones del Sistema Respiratorio/tratamiento farmacológicoRESUMEN
We have investigated nerve growth factor-dependent neurite growth from adult sensory neurons using the compartmented culture system. The requirement of both TrkA and the p75 neurotrophin receptors in neurite growth was examined using several experimental interventions. Inhibition of TrkA activation using K252a resulted in a total block of distal neurite extension into nerve growth factor-containing compartments. Brain-derived neurotrophic factor and the anti-p75 monoclonal antibody MC192 have been shown to interfere with the binding of nerve growth factor to p75. Brain-derived neurotrophic factor, which binds p75 but not TrkA, competes with nerve growth factorforp75, while the anti-p75 antibody MC192 has been shown to decrease the interaction of nerve growth factor with TrkA. The addition of brain-derived neurotophic factor to nerve growth factor-containing distal compartments inhibited, but did not totally block, distal neurite extension. MC192, on the other hand, totally inhibited nerve growth factor-dependent neurite growth. To test whether MC192 and brain-derived neurotrophic factor might be influencing Trk activation, TrkA phosphorylation was examined biochemically. Both compounds were found to attenuate nerve growth factor-induced Trk phosphorylation, although neither inhibited the activation completely. The possibility that MC192 or brain-derived neurotrophic factor might activate p75 signaling directly (and potentially antagonize TrkA signaling) was also investigated. This was assessed by quantitating the activation and nuclear translocation of the transcription factor NFkB using immunocytochemistry. Only treatment with the anti-p75 antibody MC192 resulted in prolonged and significant increase in the number of neurons displaying nuclear staining for NFkB. Our results demonstrate that both TrkA and p75 play a role in neurite growth response to nerve growth factor, and further suggest that any alteration in optimal TrkA-p75 interactions, or direct activation of p75 at the expense of TrkA, results in an inhibition of nerve growth factor-dependent neurite growth in adult sensory neurons.
Asunto(s)
Anticuerpos Bloqueadores/inmunología , Factor Neurotrófico Derivado del Encéfalo/farmacología , Factores de Crecimiento Nervioso/antagonistas & inhibidores , Neuritas/efectos de los fármacos , Neuronas Aferentes/efectos de los fármacos , Receptores de Factor de Crecimiento Nervioso/antagonistas & inhibidores , Animales , Western Blotting , Núcleo Celular/metabolismo , Células Cultivadas , Ganglios Espinales/citología , Ganglios Espinales/fisiología , Inmunohistoquímica , Factores de Crecimiento Nervioso/farmacología , Neuritas/ultraestructura , Neuronas Aferentes/ultraestructura , Pruebas de Precipitina , Ratas , Ratas Sprague-Dawley , Receptor de Factor de Crecimiento Nervioso , Receptor trkA/fisiología , Receptores de Factor de Crecimiento Nervioso/inmunologíaRESUMEN
One-week-old rat pups were subjected to an acute 10 min severe hypoxic-ischemic insult. Over the next 24 h, during the reperfusion period, O4 immunocytochemistry demonstrated that oligodendroblasts underwent degenerative changes that were coincident with induction of heme oxygenase. We suggest that the increased vulnerability of oligodendroblasts to oxidative stress following an hypoxic-ischemic insult may contribute to the pathogenesis of periventricular leukomalacia.