RESUMEN
OBJECTIVES: To explore and compare the perspectives of junior doctors in Brazil and Ireland regarding transition and professional socialisation during the COVID-19 pandemic, with the purpose of identifying better ways to support doctors as they assume their new professional role. DESIGN: 27 semistructured interviews. Transcripts were analysed using qualitative thematic analysis. Cruess' framework of professional socialisation in medicine supported the interpretation of these data. SETTING: Public health hospitals across four Brazilian states (Santa Catarina, São Paulo, Ceará, Paraíba) and County Cork in the South of Ireland. PARTICIPANTS: Twenty-seven male and female medical junior doctors who had graduated between November 2019 and April 2020. RESULTS: Fourteen Brazilian and 13 Irish junior doctors were interviewed for this study. Entry to clinical practice during the pandemic had a significant impact on factors influencing the professional socialisation of junior doctors. This impact was reflected across the following six thematic areas: lack of preparedness; disrupted trajectory of role adaptation; fewer opportunities for experiential learning; solidarity and isolation; altered interactions with patients; challenges to health and well-being. CONCLUSIONS: Transition to clinical practice is an important stage in junior doctors' professional socialisation and identity formation. The COVID-19 pandemic created the opportunity for medical graduates to enter the workforce earlier than usual. Entering the workforce during this period created a lack of confidence among junior doctors concerning the boundaries of their new role and responsibilities, while simultaneously disrupting their social integration. Priorities to mitigate the impact of COVID-19 and future pandemics on this transition are presented.
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COVID-19 , Pandemias , Brasil/epidemiología , Femenino , Humanos , Irlanda/epidemiología , Masculino , SARS-CoV-2Asunto(s)
Vacunas contra la COVID-19 , COVID-19/epidemiología , Control de Enfermedades Transmisibles/métodos , Programas de Inmunización/organización & administración , Bahamas/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Prueba de COVID-19/estadística & datos numéricos , Tormentas Ciclónicas , Transmisión de Enfermedad Infecciosa/prevención & control , Salud Global , Conductas Relacionadas con la Salud , Hong Kong/epidemiología , Humanos , Irlanda/epidemiología , Máscaras , Cuarentena , SARS-CoV-2 , Aislamiento Social , Cobertura de Vacunación/estadística & datos numéricosRESUMEN
OBJECTIVE: To longitudinally investigate body mass index (BMI) in young children in Ireland and identify factors and critical time points associated with changes in BMI. STUDY DESIGN: Data on 11 134 children were collected in the nationally representative Growing Up in Ireland infant cohort study. Height and weight were measured at 9 months, 3 years, and 5 years of age. Multilevel regression was used to identify risk factors associated with changes in BMI over time (n = 10 377), combining a unique set of covariates collected from the child and the 2 main caregivers (usually the mother and father). RESULTS: The proportion of children ≥85th percentile of World Health Organization growth criteria was 39% at 9 months, 44% at 3 years, and 30% at 5 years. Children born large for gestational age (13%) and those with rapid infant weight gain (25%) consistently had higher BMI. Low average BMIs were consistently seen in children born small for gestational age (10%) or before 37 weeks (7%). Smaller variations in BMI existed for other factors including ethnicity, household structure, caregiver weight status, breastfeeding, sex, socioeconomic status, sleeping hours, childcare, and region. CONCLUSIONS: In this study, differences at birth and in infancy appear to be most strongly associated with variation in BMI at all ages. Nevertheless, belonging to a number of other high-risk groups cumulatively could lead children to develop critical weight states. Policy-makers should target families with interventions before and during pregnancy when dominant risk factors are still modifiable. Longer-term follow-up of children may be needed to study associations later in childhood.
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Índice de Masa Corporal , Obesidad Infantil/epidemiología , Peso al Nacer , Estatura , Lactancia Materna , Cuidadores , Preescolar , Estudios de Cohortes , Escolaridad , Composición Familiar , Femenino , Humanos , Lactante , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional , Irlanda/epidemiología , Estudios Longitudinales , Masculino , Embarazo , Embarazo Prolongado , Población Rural , Factores Sexuales , Sueño , Clase Social , Población UrbanaRESUMEN
AIMS: To estimate the incidence of Type 2 diabetes in children aged <17 years, compare this with similar data 10 years ago, and characterize clinical features at diagnosis in the UK and Republic of Ireland. METHODS: Using the British Paediatric Surveillance Unit reporting framework, cases of Type 2 diabetes diagnosed in children aged <17 years between 1 April 2015 and 30 April 2016 were reported each month. RESULTS: A total of 106 cases were reported, giving a UK incidence of 0.72/100 000 (95% CI 0.58-0.88). Children from ethnic minorities had significantly higher incidence compared with white children (0.44/100 000) with rates of 2.92/100 000 and 1.67/100 000, in Asian and BACBB (black/African/Caribbean/black British) children respectively. Sixty-seven percent were girls and 81% had a family history of Type 2 diabetes. The mean BMI sd score at diagnosis was 2.89 (2.88, girls; 2.92, boys); 81% were obese. Children of Asian ethnicity had a significantly lower BMI sd score compared with white children (P<0.001). There was a trend in increased incidence from 2005 to 2015, with a rate ratio of 1.35 (95% CI 0.99-1.84), although this was not statistically significant (P=0.062). There was statistical evidence of increased incidence among girls (P=0.03) and children of South-Asian ethnicity (P=0.01) when comparing the 2005 and 2015 surveys. CONCLUSIONS: Type 2 diabetes remains far less common than Type 1 diabetes in childhood in the UK, but the number of cases continues to rise, with significantly increased incidence among girls and South-Asian children over a decade. Female gender, family history, non-white ethnicity and obesity were found to be strongly associated with the condition.
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Diabetes Mellitus Tipo 2/epidemiología , Adolescente , Asia/etnología , Índice de Masa Corporal , Niño , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Incidencia , Irlanda/epidemiología , Masculino , Obesidad Infantil/epidemiología , Obesidad Infantil/etnología , Estudios Prospectivos , Distribución por Sexo , Encuestas y Cuestionarios , Reino Unido/epidemiología , Indias Occidentales/etnología , Población Blanca/etnologíaRESUMEN
OBJECTIVE: To evaluate the incidence of direct admission of infants with Down syndrome to the postnatal ward (well newborn nursery) vs the neonatal intensive care unit (NICU), and to describe the incidence of congenital heart disease (CHD) and pulmonary hypertension (PH). STUDY DESIGN: This retrospective cohort study of Down syndrome used the maternal/infant database (2011-2016) at the Rotunda Hospital in Dublin, Ireland. Admission location, early neonatal morbidities, outcomes, and duration of stay were evaluated and regression analyses were conducted to identify risk factors associated with morbidity and mortality. RESULTS: Of the 121 infants with Down syndrome, 54 (45%) were initially admitted to the postnatal ward, but 38 (70%) were later admitted to the NICU. Low oxygen saturation profile was the most common cause for the initial and subsequent admission to the NICU. Sixty-six percent of the infants (80/121) had CHD, 34% (41/121) had PH, and 6% died. Risk factors independently associated with primary NICU admission included antenatal diagnosis of Down syndrome, presence of CHD, PH, and the need for ventilation. CONCLUSIONS: Infants with Down syndrome initially admitted to the postnatal ward have a high likelihood of requiring NICU admission. Overall, high rates of neonatal morbidity were noted, including rates of PH that were higher than previously reported. Proper screening of all infants with Down syndrome for CHD and PH is recommended to facilitate timely diagnoses and potentially shorten the duration of the hospital stay.
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Costo de Enfermedad , Síndrome de Down/complicaciones , Cardiopatías Congénitas/epidemiología , Hospitalización/estadística & datos numéricos , Hipertensión Pulmonar/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Síndrome de Down/mortalidad , Ecocardiografía , Femenino , Cardiopatías Congénitas/etiología , Humanos , Hipertensión Pulmonar/etiología , Incidencia , Lactante , Mortalidad Infantil , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Irlanda/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Salas Cuna en Hospital/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death). STUDY DESIGN: A multicenter prospective observational study was conducted for infants <29 weeks gestation. An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging. Predictors of CLD/death were identified using logistic regression methods. A PDAsc was created and a receiver operating characteristic curve was constructed to assess its ability to predict CLD/death. RESULTS: We studied 141 infants at a mean (SD) gestation and birthweight of 26 (1.4) weeks and 952 (235) g, respectively. Five variables were identified that were independently associated with CLD/death (gestation at birth, PDA diameter, maximum flow velocity, LV output, and LV a' wave). The PDAsc had a range from 0 (low risk) to 13 (high risk). Infants who developed CLD/death had a higher score than those who did not (7.3 [1.8] vs 3.8 [2.0], P < .001). PDAsc had an area under the curve of 0.92 (95% CI 0.86-0.97, P < .001) for the ability to predict CLD/death. A PDAsc cut-off of 5 has sensitivity and specificity of 92% and 87%, and positive and negative predictive values of 92% and 82%, respectively. CONCLUSIONS: A PDAsc on day 2 can predict the later occurrence of CLD/death further highlighting the association between PDA significance and morbidity.
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Conducto Arterioso Permeable/diagnóstico , Enfermedades Pulmonares/etiología , Alta del Paciente , Australia/epidemiología , Canadá/epidemiología , Causas de Muerte/tendencias , Enfermedad Crónica , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/mortalidad , Ecocardiografía Doppler , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Irlanda/epidemiología , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/mortalidad , Masculino , Pronóstico , Estudios Prospectivos , Curva ROCRESUMEN
Inter-simple sequence repeats markers were used to determinate the genetic variability of Fasciola hepatica populations recovered from sheep and cattle from Spain (Sp1, Sp2, Sp3 and Sp4), UK (Eng), Ireland (Ir) and Mexico (Mex). Twenty five primers were tested but only five produced 39 reproducible bands, being 71.79% polymorphic bands. This percentage ranged from 10.26% in Sp4 to 48.72% in Sp1, and per host between 28.21 and 48.72% in sheep and between 10.26 and 38.46% in cattle. This relatively low range of genetic diversity within populations, with a mean of 34.40%, implies that a large proportion of variation resided among populations. The population differentiation (Gst = 0.547) indicated that 54.7% of variation is due to differences between populations and 45.3% due to differences within population. The Nei's distance ranged between 0.091 and 0.230 in sheep and between 0.150 and 0.337 in cattle. The genetic relationships between populations and individuals were shown by a UPGMA dendrogram and a principal coordinate analysis; both grouped all populations separately from Sp4, a population of from the Midwest of Spain with the lowest level of diversity. Small genetic distances were observed between Eng and Ir, on the one hand, and Sp1, Sp2, Sp3, from the Northwest of Spain, together with Mex, on the other.
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Enfermedades de los Bovinos/parasitología , Fasciola hepatica/genética , Fascioliasis/veterinaria , Variación Genética , Enfermedades de las Ovejas/parasitología , Animales , Bovinos , Enfermedades de los Bovinos/epidemiología , Cartilla de ADN/genética , Fasciola hepatica/clasificación , Fascioliasis/epidemiología , Fascioliasis/parasitología , Marcadores Genéticos , Irlanda/epidemiología , Hígado/parasitología , México/epidemiología , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa/veterinaria , Ovinos , Enfermedades de las Ovejas/epidemiología , España/epidemiología , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR). STUDY DESIGN: Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed. RESULTS: Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex (P < .001), history of preoperative bladder/bowel dysfunction (BBD; P = .005), and BBD after endoscopic correction (P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. CONCLUSIONS: The incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low. Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR.
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Cistoscopía/métodos , Fiebre/epidemiología , Ureteroscopía/métodos , Infecciones Urinarias/epidemiología , Reflujo Vesicoureteral/terapia , Adolescente , Niño , Preescolar , Femenino , Fiebre/etiología , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Irlanda/epidemiología , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Infecciones Urinarias/complicacionesRESUMEN
OBJECTIVE: Meta-analyze all published epidemiologic studies reporting pediatric mania or bipolar disorder to investigate whether pediatric bipolar disorder is becoming more prevalent and whether rates vary significantly by country. DATA SOURCES: Searches of PubMed and PsycInfo were conducted through the spring of 2010 using the following search terms: child, pediatric, young, adolescent, epidemiology, prevalence, bipolar, mania, suicide, and psychiatric. We also manually reviewed references in recent reviews of epidemiology of bipolar disorder. STUDY SELECTION: All studies reporting rates for mania or hypomania in community epidemiologic samples with participants up to 21 years of age. DATA EXTRACTION: All articles were coded to extract relevant variables. Prevalence rates were calculated from reported number of cases with bipolar disorders, then logit transformed. Twelve studies were included, enrolling 16,222 youths between the ages of 7 and 21 years during a period from 1985 to 2007. Six samples were from the United States; 6 were from other countries (the Netherlands, the United Kingdom, Spain, Mexico, Ireland, and New Zealand). RESULTS: The overall rate of bipolar disorder was 1.8% (95% CI, 1.1%-3.0%). There was no significant difference in the mean rates between US and non-US studies, but the US studies had a wider range of rates. The highest estimates came from studies that used broad definitions and included bipolar disorder not otherwise specified. Year of enrollment was negatively correlated with prevalence (r = -0.04) and remained nonsignificant when controlling for study methodological differences. CONCLUSIONS: Mean rates of bipolar disorder were higher than commonly acknowledged and not significantly different in US compared to non-US samples, nor was there evidence of an increase in rates of bipolar disorder in the community over time. Differences in diagnostic criteria were a main driver of different rates across studies.
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Trastorno Bipolar/epidemiología , Adolescente , Niño , Humanos , Irlanda/epidemiología , México/epidemiología , Países Bajos/epidemiología , Nueva Zelanda/epidemiología , Prevalencia , España/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: To investigate the prevalence, correlates, and antecedents of autism spectrum disorders (ASD) in extremely preterm children. STUDY DESIGN: We conducted a prospective study of all births <26 weeks gestation in the United Kingdom and Ireland in 1995. Of 307 survivors at 11 years, 219 (71%) were assessed and compared with 153 term-born classmates. Parents completed the Social Communication Questionnaire (SCQ) to assess autism spectrum symptoms, and ASD were diagnosed by using a psychiatric evaluation. An IQ test and clinical evaluation were also administered. Longitudinal outcome data were available for extremely preterm children. RESULTS: Extremely preterm children had significantly higher SCQ scores than classmates (mean difference, 4.6 points; 95% CI, 3.4-5.8). Sixteen extremely preterm children (8%) were assigned an ASD diagnosis, compared with none of the classmates. By hospital discharge, male sex, lower gestation, vaginal breech delivery, abnormal cerebral ultrasound scanning results, and not having had breast milk were independently associated with autism spectrum symptoms. By 6 years, independent associates were cognitive impairment, inattention and peer problems, withdrawn behavior at 2.5 years, and not having had breast milk. CONCLUSIONS: Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood. These symptoms and disorders were associated with neurocognitive outcomes, suggesting that ASD may result from abnormal brain development in this population.
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Trastornos Generalizados del Desarrollo Infantil/epidemiología , Recien Nacido Prematuro , Atención , Niño , Trastornos Generalizados del Desarrollo Infantil/diagnóstico , Preescolar , Cognición , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Irlanda/epidemiología , Masculino , Pronóstico , Estudios Prospectivos , Psicometría/métodos , Factores de Riesgo , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
OBJECTIVES: The aim of this study was to explore the clinical factors associated with the development of cystic fibrosis-associated liver disease (CFALD). STUDY DESIGN: This was a case-control study of all children (age 5-18 years) with established CFALD in the Republic of Ireland between January 1999 and June 2000. Each child was pair matched for age and sex with a patient with cystic fibrosis (CF) without evidence of liver disease. Only children with clinically overt liver disease were enrolled in the disease group. RESULTS: Patients with established CFALD (n = 42; 26 boys) were enrolled. Children with CFALD had worse forced expiratory volume in 1 second values than those without CFALD. However, chest radiography and clinical scores did not differ between groups. Height (mean difference, -4.2 cm [95% confidence interval [CI], -7.41 to -0.90], P =.014), weight (mean difference, -3.21 kg [95% CI, -6.03 to -0.40], P =.026), and mid-upper arm circumference (mean difference, -1.23 cm [95% CI, -2.35 to -0.12], P =.031) were significantly lower among children with CFALD. Children with CFALD were given diagnoses of CF later than children without liver disease. There were more children with meconium ileus in the control group (14 vs 4) than among those with CFALD. CONCLUSIONS: Children with established CFALD have impaired growth and nutrition, altered body composition, and worse forced expiratory volume in 1 second values. CFALD is associated with later age of diagnosis of CF.
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Fibrosis Quística/complicaciones , Hepatopatías/etiología , Adolescente , Antropometría , Estudios de Casos y Controles , Niño , Preescolar , Fibrosis Quística/diagnóstico , Fibrosis Quística/epidemiología , Femenino , Humanos , Irlanda/epidemiología , Hepatopatías/epidemiología , Hepatopatías/fisiopatología , Masculino , PrevalenciaRESUMEN
Mucopolysaccharidosis type VI (MPS VI), a lysosomal storage disease, is one of the more prevalent inherited diseases in cats and is commonly found in cats with Siamese ancestry. The prevalence of 2 known MPS VI mutations in cats was investigated in 101 clinically normal Siamese cats, in 2 cats with clinical signs of MPS VI, and in 202 cats from 4 research colonies. The mutation L476P which causes a severe clinical phenotype, was present on both alleles in the known MPS VI cats from Italy and North America and was present in all research colonies that originated from North America. However, LA76P was not detected in the Siamese population screened. In contrast, the mutation D520N, which causes a mild clinical phenotype, was identified in 23 of 202 (11.4%) alleles tested in Siamese cats from 3 continents, 2 of which were homozygous for D520N. Thus, the D520N mutation was widespread, and it is likely that cats inheriting both mutations (LA76P/D520N compound heterozygotes) would be in the general Siamese population, particularly in North America. Practitioners should note the high incidence of degenerative joint disease in these animals.
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Enfermedades de los Gatos/epidemiología , Enfermedades de los Gatos/genética , Mucopolisacaridosis VI/veterinaria , Animales , Argentina/epidemiología , Australia/epidemiología , Cruzamiento , Enfermedades de los Gatos/etiología , Gatos , Inglaterra/epidemiología , Femenino , Predisposición Genética a la Enfermedad , Irlanda/epidemiología , Masculino , Mucopolisacaridosis VI/epidemiología , Mucopolisacaridosis VI/genética , Mutación , Países Bajos/epidemiología , Fenotipo , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To compare isolates of Rhodococcus equi on the basis of geographic source and virulence status by use of pulsed-field gel electrophoresis (PFGE). SAMPLE POPULATION: 290 isolates of R equi (218 virulent isolates from foals and 72 avirulent isolates from feces, soil, and respiratory tract samples) obtained between 1985 and 2000 from horses and horse farms from 4 countries. PROCEDURE: DNA from isolates was digested with the restriction enzyme Asel and tested by use of PFGE. Products were analyzed for similarities in banding patterns by use of dendrograms. A similarity matrix was constructed for isolates, and the matrix was tested for nonrandom distributions of similarity values with respect to groupings of interest. RESULTS: There was little grouping of isolates on the basis of country, virulence status, or region within Texas. Isolates of R equi were generally < 80% similar, as determined by use of PFGE. Isolates from the same farm generally were rarely of the same strain. CONCLUSIONS AND CLINICAL RELEVANCE: Considerable chromosomal variability exists among isolates of R equiobtained from the same farm, sites withinTexas, or among countries from various continents. Only rarely will it be possible to link infections to a given site or region on the basis of analysis of isolates by use of PFGE of chromosomal DNA.
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Infecciones por Actinomycetales/microbiología , Infecciones por Actinomycetales/veterinaria , Enfermedades de los Caballos/microbiología , Rhodococcus equi/genética , Rhodococcus equi/aislamiento & purificación , Infecciones por Actinomycetales/epidemiología , Animales , Argentina/epidemiología , ADN Bacteriano/análisis , Electroforesis en Gel de Campo Pulsado , Evolución Molecular , Caballos/microbiología , Irlanda/epidemiología , Japón/epidemiología , Filogenia , Rhodococcus equi/patogenicidad , Texas/epidemiología , VirulenciaRESUMEN
The plant pathogen Phytophthora infestans causes late blight, a devastating disease on potato that led to the Irish potato famine during 1845-1847. The disease is considered a reemerging problem and still causes major epidemics on both potato and tomato crops worldwide. Theories on the origin of the disease based on an examination of the genetic diversity and structure of P. infestans populations and use of historic specimens to understand modern day epidemics are discussed.
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Phytophthora/patogenicidad , Enfermedades de las Plantas/historia , Solanum tuberosum/microbiología , Secuencia de Bases , ADN Mitocondrial/genética , ADN Ribosómico/genética , Brotes de Enfermedades/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Irlanda/epidemiología , México , Datos de Secuencia Molecular , Phytophthora/genética , Enfermedades de las Plantas/microbiología , Análisis de Secuencia de ADN , Inanición/epidemiología , Inanición/historiaRESUMEN
The authors review the epidemiology of spongiform encephalitis, discussing the possible mechanism of appearance of the epidemic bovine spongiform encephalitis epidemic, leaving aside to another publication the epidemiology of the human spongiform encephalitis and its pathogeny.