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Background: Haiti's hypertension prevalence among adults ≥40 years of age is nearly twice that of nations in the Americas. Haiti Health Initiative (HHI) developed a hypertension management protocol for use in outreach clinics in Timo, a rural mountainous community in Haiti. This study aimed to evaluate the effectiveness of the hypertension protocol for treating adults ≥40 years of age and pregnant women with severe hypertension. Methods: This retrospective longitudinal study included 209 patients across 1148 clinic visits/encounters. De-identified medical records from 11 biannual outreach clinics between April 2014 to April 2019 were reviewed for analysis. Descriptive statistics, paired t-tests, and multilevel models were performed. The primary outcome was systolic and diastolic blood pressure measurements at each clinic visit. Findings: In the study (n = 1148 visits), hypertension and severe hypertension prevalence were respectively 79·8% and 38·4%. Multilevel models showed a decrease of 0·29 mmHg (p = 0·37) in systolic blood pressure and a decrease in diastolic blood pressure of 0·66 mmHg (p < 0·001) per visit. Individual factors and protocol adherence did not predict a reduction in blood pressure. Conclusion: Effective management of hypertension and other chronic conditions among hard-to-reach populations with limited healthcare access requires comprehensive outreach efforts that address care antecedents, structures, and processes. Although outreach clinics made treatment accessible to vulnerable populations, the protocol, which used medications with previously demonstrated efficacy, had little impact on reducing blood pressure in patients with severe hypertension.
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BACKGROUND: Data on race-and-ethnicity that are needed to measure health equity are often limited or missing. The importance of first name and sex in predicting race-and-ethnicity is not well understood. OBJECTIVE: The objective of this study was to compare the contribution of first-name information to the accuracy of basic and more complex racial-and-ethnic imputations that incorporate surname information. RESEARCH DESIGN: We imputed race-and-ethnicity in a sample of Medicare beneficiaries under 2 scenarios: (1) with only sparse predictors (name, address, sex) and (2) with a rich set (adding limited administrative race-and-ethnicity, demographics, and insurance). SUBJECTS: A total of 284,627 Medicare beneficiaries who completed the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey and reported race-and-ethnicity were included. RESULTS: Hispanic, non-Hispanic Asian/Pacific Islander, and non-Hispanic White racial-and-ethnic imputations are more accurate for males than females under both sparse-predictor and rich-predictor scenarios; adding first-name information increases accuracy more for females than males. In contrast, imputations of non-Hispanic Black race-and-ethnicity are similarly accurate for females and males, and first names increase accuracy equally for each sex in both sparse-predictor and rich-predictor scenarios. For all 4 racial-and-ethnic groups, incorporating first-name information improves prediction accuracy more under the sparse-predictor scenario than under the rich-predictor scenario. CONCLUSION: First-name information contributes more to the accuracy of racial-and-ethnic imputations in a sparse-predictor scenario than in a rich-predictor scenario and generally narrows sex gaps in accuracy of imputations.
Assuntos
Etnicidade , Medicare , Idoso , População Negra , Feminino , Hispânico ou Latino , Humanos , Masculino , Inquéritos e Questionários , Estados UnidosRESUMO
ß2 -adrenoceptor agonists improve autophagy and re-establish proteostasis in cardiac cells; therefore, suggesting autophagy as a downstream effector of ß2 -adrenoceptor signaling pathway. Here, we used the pharmacological and genetic tools to determine the autophagy effect of sustained ß2 -adrenoceptor activation in rodents with neurogenic myopathy, which display impaired skeletal muscle autophagic flux. Sustained ß2 -adrenoceptor activation using Formoterol (10 µg kg-1 day-1 ), starting at the onset of neurogenic myopathy, prevents disruption of autophagic flux in skeletal muscle 14 days after sciatic nerve constriction. These changes are followed by reduction of the cytotoxic protein levels and increased skeletal muscle cross-sectional area and contractility properties. Of interest, sustained administration of Formoterol at lower concentration (1 µg kg-1 day-1 ) induces similar improvements in skeletal muscle autophagic flux and contractility properties in neurogenic myopathy, without affecting the cross-sectional area. Sustained pharmacological inhibition of autophagy using Chloroquine (50 mg kg-1 day-1 ) abolishes the beneficial effects of ß2 -adrenoceptor activation on the skeletal muscle proteostasis and contractility properties in neurogenic myopathy. Further supporting an autophagy mechanism for ß2 -adrenoceptor activation, skeletal muscle-specific deletion of ATG7 blunts the beneficial effects of ß2 -adrenoceptor on skeletal muscle proteostasis and contractility properties in neurogenic myopathy in mice. These findings suggest autophagy as a critical downstream effector of ß2 -adrenoceptor signaling pathway in skeletal muscle.
Assuntos
Agonistas de Receptores Adrenérgicos beta 2/farmacologia , Autofagia , Músculo Esquelético/patologia , Doenças Musculares/prevenção & controle , Proteostase , Receptores Adrenérgicos beta 2/metabolismo , Animais , Fumarato de Formoterol , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Contração Muscular , Músculo Esquelético/metabolismo , Doenças Musculares/etiologia , Doenças Musculares/metabolismo , Doenças Musculares/patologia , Ratos , Ratos Sprague-Dawley , Receptores Adrenérgicos beta 2/química , Transdução de SinaisRESUMO
We previously reported that facilitating the clearance of damaged mitochondria through macroautophagy/autophagy protects against acute myocardial infarction. Here we characterize the impact of exercise, a safe strategy against cardiovascular disease, on cardiac autophagy and its contribution to mitochondrial quality control, bioenergetics and oxidative damage in a post-myocardial infarction-induced heart failure animal model. We found that failing hearts displayed reduced autophagic flux depicted by accumulation of autophagy-related markers and loss of responsiveness to chloroquine treatment at 4 and 12 wk after myocardial infarction. These changes were accompanied by accumulation of fragmented mitochondria with reduced O2 consumption, elevated H2O2 release and increased Ca2+-induced mitochondrial permeability transition pore opening. Of interest, disruption of autophagic flux was sufficient to decrease cardiac mitochondrial function in sham-treated animals and increase cardiomyocyte toxicity upon mitochondrial stress. Importantly, 8 wk of exercise training, starting 4 wk after myocardial infarction at a time when autophagy and mitochondrial oxidative capacity were already impaired, improved cardiac autophagic flux. These changes were followed by reduced mitochondrial number:size ratio, increased mitochondrial bioenergetics and better cardiac function. Moreover, exercise training increased cardiac mitochondrial number, size and oxidative capacity without affecting autophagic flux in sham-treated animals. Further supporting an autophagy mechanism for exercise-induced improvements of mitochondrial bioenergetics in heart failure, acute in vivo inhibition of autophagic flux was sufficient to mitigate the increased mitochondrial oxidative capacity triggered by exercise in failing hearts. Collectively, our findings uncover the potential contribution of exercise in restoring cardiac autophagy flux in heart failure, which is associated with better mitochondrial quality control, bioenergetics and cardiac function.
Assuntos
Autofagia , Insuficiência Cardíaca/patologia , Mitocôndrias/metabolismo , Animais , Autofagia/genética , Linhagem Celular , Sobrevivência Celular , Regulação para Baixo/genética , Masculino , Camundongos , Mitocôndrias/ultraestrutura , Dinâmica Mitocondrial , Condicionamento Físico Animal , Ratos WistarRESUMO
Recommendations from the 2014 Consensus Conference on Best Practices in Living Kidney Donation reflect increasing attention to overcoming barriers to donation as a means of expanding access to living donor kidney transplantation. "High priority" initiatives include empowering transplant candidates and their loved ones in their search for a living kidney donor. Transplant programs are assuming an unprecedented role as facilitators of patients' solicitation for donors, and nonprofits are promoting living kidney donation (LKD) in the community. New strategies to promote LKD incorporate "nonargumentative" forms of influence (i.e. approaches to shaping behavior that do not attempt to persuade through reason) such as appeals to emotion, messenger effects and social norms. These approaches have raised ethical concerns in other settings but have received little attention in the transplantation literature despite their increasing relevance. Previous work on using nonargumentative influence to shape patient behavior has highlighted implications for (1) the relationship between influencer and influenced and (2) patient autonomy. We argue that using nonargumentative influence to promote LKD is a promising strategy that can be compatible with ethical standards. We also outline potential concerns and solutions to be implemented in practice.
Assuntos
Transplante de Rim/ética , Doadores Vivos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto/normas , Coleta de Tecidos e Órgãos/ética , Consenso , Humanos , NefrectomiaRESUMO
Donation after cardiac death is an important source of transplantable organs, but evidence suggests donor warm ischemia contributes to inferior outcomes. Attempts to predict recipient outcome using donor hemodynamic measurements have not yielded statistically significant results. We evaluated novel measures of donor hemodynamics as predictors of delayed graft function and graft failure in a cohort of 1050 kidneys from 566 donors. Hemodynamics were described using regression line slopes, areas under the curve, and time beyond thresholds for systolic blood pressure, oxygen saturation, and shock index (heart rate divided by systolic blood pressure). A logistic generalized estimation equation model showed that area under the curve for systolic blood pressure was predictive of delayed graft function (above median: odds ratio 1.42, 95% confidence interval [CI] 1.06-1.90). Multivariable Cox regression demonstrated that slope of oxygen saturation during the first 10 minutes after extubation was associated with graft failure (below median: hazard ratio 1.30, 95% CI 1.03-1.64), with 5-year graft survival of 70.0% (95%CI 64.5%-74.8%) for donors above the median versus 61.4% (95%CI 55.5%-66.7%) for those below the median. Among older donors, increased shock index slope was associated with increased hazard of graft failure. Validation of these findings is necessary to determine the utility of characterizing donor warm ischemia to predict recipient outcome.
Assuntos
Morte , Função Retardada do Enxerto/mortalidade , Rejeição de Enxerto/mortalidade , Hemodinâmica/fisiologia , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Obtenção de Tecidos e Órgãos , Adulto , Idoso , Idoso de 80 Anos ou mais , Função Retardada do Enxerto/etiologia , Feminino , Rejeição de Enxerto/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Doadores de Tecidos , Resultado do Tratamento , Isquemia Quente , Adulto JovemRESUMO
The sequences of all seven polypeptide chains from the giant haemoglobin of the free-living earthworm Glossoscolex paulistus (HbGp) are reported together with the three-dimensional structure of the 3.6 MDa complex which they form. The refinement of the full particle, which has been solved at 3.2 Å resolution, the highest resolution reported to date for a hexagonal bilayer haemoglobin composed of 12 protomers, is reported. This has allowed a more detailed description of the contacts between subunits which are essential for particle stability. Interpretation of features in the electron-density maps suggests the presence of metal-binding sites (probably Zn(2+) and Ca(2+)) and glycosylation sites, some of which have not been reported previously. The former appear to be important for the integrity of the particle. The crystal structure of the isolated d chain (d-HbGp) at 2.1 Å resolution shows different interchain contacts between d monomers compared with those observed in the full particle. Instead of forming trimers, as seen in the complex, the isolated d chains associate to form dimers across a crystallographic twofold axis. These observations eliminate the possibility that trimers form spontaneously in solution as intermediates during the formation of the dodecameric globin cap and contribute to understanding of the possible ways in which the particle self-assembles.
Assuntos
Hemoglobinas/química , Oligoquetos/química , Sequência de Aminoácidos , Animais , Cristalografia por Raios X , Dados de Sequência Molecular , Conformação Proteica , Homologia de Sequência de AminoácidosRESUMO
The bacterium Avibacterium paragallinarum is the etiologic agent of infectious coryza of chickens. Serovar C-1 has emerged in infectious coryza outbreaks in layer hens of Ecuador and Mexico. In the current study, genotyping and phylogenetic analyses of five Ecuadorian and 10 Mexican isolates of Av. paragallinarum serovar C-1 were performed. All 15 isolates share a unique enterobacterial repetitive intergenic consensus-based-PCR fingerprint and have identical 16S ribosomal RNA and hemagglutinin antigen gene sequences. Results indicate that Ecuadorian and Mexican isolates of serovar C-1 of Av. paragallinarum have a clonal relationship.
Assuntos
Galinhas , Genótipo , Infecções por Haemophilus/microbiologia , Haemophilus paragallinarum/genética , Doenças das Aves Domésticas/microbiologia , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Equador , Haemophilus paragallinarum/metabolismo , México , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase/veterinária , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Análise de Sequência de DNA/veterináriaRESUMO
The New World screwworm (NWS), Cochliomyia hominivorax (Coquerel) (Diptera: Calliphoridae), was the first insect to be effectively controlled using the sterile insect technique (SIT). Recent efforts to improve SIT control of this species have centred on the development of genetically transformed strains using the piggyBac transposon vector system. Eight transgenic strains were produced incorporating an enhanced green fluorescent protein (EGFP) marker gene under polyubiquitin regulation that has the potential for use as a genetic marking system for released males. The transgenic strains were genetically and phenotypically characterized, including for life fitness parameters and mating competitiveness. These characteristics were unique for each strain and thus some strains were deemed suitable for incorporation into SIT eradication programmes. The strain with the best attributes is designated 'CLAY'. Four of the strains, including CLAY, have been successfully cryopreserved so that their original characteristics should be unchanged when further evaluation is required. With the demonstration of efficient germ-line transformation in NWS, allowing production of fit and competitive transformants, it is now possible to consider further transgenic strain development to improve SIT that are currently being tested in other dipteran species. This includes strains that allow genetic marking with fluorescent proteins, genetic sexing by female lethality, male-specific fluorescent sorting and male sterility by testis-specific lethality. The SIT may also be improved upon by new strategies resulting in lethality of offspring of released insects using conditional lethal systems based upon temperature-dependent or dietary tetracycline regulation of lethal gene expression. Both the creation of new NWS transgenic strains and the ecological safety of their release will be enhanced by new vector systems that allow specific genomic targeting of vector constructs and their subsequent immobilization, ensuring transgene and strain stability.
Assuntos
Animais Geneticamente Modificados , Dípteros/genética , Infecção por Mosca da Bicheira/prevenção & controle , Infecção por Mosca da Bicheira/veterinária , Animais , DNA/administração & dosagem , DNA/genética , Dípteros/embriologia , Feminino , Fertilidade/genética , Regulação da Expressão Gênica , Genes Letais , Infertilidade/genética , Infertilidade/veterinária , Larva , Masculino , Microinjeções , América do Norte , Pupa , Infecção por Mosca da Bicheira/genética , América do Sul , Esterilização/métodos , Transformação GenéticaRESUMO
ISSUES: Voluntary counselling and testing (VCT) is a critical issue impacting HIV disease management from a national and global perspective. In Jamaica (population 2.6 million), 2% of women in antenatal clinics are HIV-positive and mother-to-child-transmission (MTCT) accounted for 7% of all reported cases in 2002. Notwithstanding this, VCT was ad hoc and not standardized. In 2003, a structured VCT programme was developed islandwide with over 300 VCT service providers and 16 qualified trainers. DESCRIPTION: We describe the challenges and successes of VCT provided by five trained research nurses in the Perinatal HIV/AIDS Programme in Kingston which services 19 000 pregnant women per year in three major maternity centres and their 42 feeder antenatal clinics. LESSONS LEARNED: The VCT model used was group education, opt-out individual testing, individual post-test counselling for seropositives and informing seronegatives of their negative status. Major challenges encountered included lack of quality control of the counselling process and lost opportunities for un-booked women who presented in labour. However, successes enjoyed included client assessment of risk behaviours with appropriate lifestyle changes, increased uptake of HIV testing and adherence to care for themselves and their infants, as well as reduction in stigma. RECOMMENDATIONS: VCT has proven to be an important intervention that enabled improvement in the awareness, prevention and control of HIV in Jamaican pregnant women. Nurses who are appropriately trained in VCT can play a pivotal role in successful provision of VCT services.
CUESTIONES: El asesoramiento y pruebas voluntarios (APV) constituye una cuestión crítica cuyo impacto sobre el tratamiento de la enfermedad por VIH reviste importancia nacional y global. En Jamaica (con una población de 2.6 millones) 2% de las mujeres en las clínicas de atención prenatal son VIH positivas y la transmisión madre a hijo (TMAH) representa el 7% de todos los casos reportados en 2002. A pesar de ello, el APV fue practicado ad hoc y de manera no estandarizada. En el año 2003, se desarrolló un programa de APV a lo largo de toda la isla, con más de 300 proveedores de servicio y 16 entrenadores calificados. DESCRIPCIÓN: El presente trabajo describe los retos y éxitos del APV ofrecido por cinco enfermeras entrenadas en investigación, en el Programa Perinatal VIH/SIDA en Kingston, el cual ofrece servicios a 19 000 mujeres embarazadas por año en tres centros principales de maternidad y sus 42 clínicas prenatales asociadas. LECCIONES APRENDIDAS: El modelo APV usado fue educación grupal, pruebas individuales con opción a negarse ("opt-out"), aconsejamiento individual posterior a la prueba para seropositivos e información a los seronegativos de su estatus negativo. Los mayores desafíos encontrados incluyeron falta de control de la calidad de los procesos de asesoramiento y pérdida de oportunidades para las mujeres no registradas que se presentaron estando ya de parto. Sin embargo, los éxitos alcanzados incluyeron el asesoramiento de los clientes con respecto a los comportamientos de riesgo con cambios apropiados de estilos de vida, aumento de la toma de pruebas de VIH y la adhesión a encuitar de sí mismos y sus niños, así como la reducción del estigma. RECOMENDACIONES: El APV ha demostrado ser una importante forma de intervención que hace posible mejorar la conciencia, prevención y control del VIH en las mujeres jamaicanas embarazadas. Las enfermeras que están propiamente entrenadas en APV pueden desempeñar un papel cardinal en el ofrecimiento exitoso de servicios de APV.
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Feminino , Humanos , Gravidez , Adulto Jovem , Aconselhamento Diretivo , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Adaptação Psicológica , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Comportamentos Relacionados com a Saúde , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Jamaica/epidemiologia , Satisfação do Paciente , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal , Psicoterapia , Inquéritos e Questionários , Assunção de Riscos , Estresse PsicológicoRESUMO
ISSUES: Voluntary counselling and testing (VCT) is a critical issue impacting HIV disease management from a national and global perspective. In Jamaica (population 2.6 million), 2% of women in antenatal clinics are HIV-positive and mother-to-child-transmission (MTCT) accounted for 7% of all reported cases in 2002. Notwithstanding this, VCT was ad hoc and not standardized. In 2003, a structured VCT programme was developed islandwide with over 300 VCT service providers and 16 qualified trainers. DESCRIPTION: We describe the challenges and successes of VCT provided by five trained research nurses in the Perinatal HIV/AIDS Programme in Kingston which services 19,000 pregnant women per year in three major maternity centres and their 42 feeder antenatal clinics. LESSONS LEARNED: The VCT model used was group education, opt-out individual testing, individual post-test counselling for seropositives and informing seronegatives of their negative status. Major challenges encountered included lack of quality control of the counselling process and lost opportunities for un-booked women who presented in labour However successes enjoyed included client assessment of risk behaviours with appropriate lifestyle changes, increased uptake of HIV testing and adherence to care for themselves and their infants, as well as reduction in stigma. RECOMMENDATIONS: VCT has proven to be an important intervention that enabled improvement in the awareness, prevention and control of HIV in Jamaican pregnant women. Nurses who are appropriately trained in VCT can play a pivotal role in successful provision of VCT services.
Assuntos
Aconselhamento Diretivo , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Adaptação Psicológica , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Comportamentos Relacionados com a Saúde , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Jamaica/epidemiologia , Satisfação do Paciente , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal , Psicoterapia , Assunção de Riscos , Estresse Psicológico , Inquéritos e Questionários , Adulto JovemRESUMO
Expressed sequenced tags (ESTs) were prepared to establish a baseline for molecular genetic studies of the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois). The largest class of identifiable ESTs (15.2%) was from genes involved in cellular metabolic functions, including physiological processes. Twenty-seven ESTs (9.8%) were from genes associated with transcription and translation, including ribosomal genes. One hundred and forty-two of the 276 unique ESTs were from genes not previously identified from any organism. Twelve sequences appear to be associated with feeding and digestion and may be targets for pest control studies.
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Etiquetas de Sequências Expressas , Expressão Gênica/genética , Biblioteca Gênica , Genes de Insetos/genética , Hemípteros/genética , Animais , Feminino , MasculinoRESUMO
Expressed sequenced tags (ESTs) were prepared to establish a baseline for molecular genetic studies of the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois). The largest class of identifiable ESTs (15.2%) was from genes involved in cellular metabolic functions, including physiological processes. Twenty-seven ESTs (9.8%) were from genes associated with transcription and translation, including ribosomal genes. One hundred and forty-two of the 276 unique ESTs were from genes not previously identified from any organism. Twelve sequences appear to be associated with feeding and digestion and may be targets for pest control studies
Assuntos
Animais , Masculino , Feminino , Etiquetas de Sequências Expressas , Expressão Gênica/genética , Biblioteca Gênica , Genes de Insetos/genética , Hemípteros/genéticaRESUMO
BACKGROUND: Health services often manage agitated or violent people and for emergency psychiatric services such behaviour is particularly prevalent (10%). The drugs used in this situation should ensure that the person swiftly and safely becomes calm. OBJECTIVES: To examine whether haloperidol plus promethazine is an effective treatment for psychosis induced agitation/aggression. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group's Register (July 2004). SELECTION CRITERIA: We included all randomised clinical trials involving aggressive people with psychosis for which haloperidol plus promethazine was being used. DATA COLLECTION AND ANALYSIS: We reliably selected, quality assessed and extracted data from all relevant studies. For binary outcomes we calculated standard estimations of risk ratio (RR) and their 95% confidence intervals (CI). Where possible we estimated weighted number needed to treat or harm (NNT/H). MAIN RESULTS: We identified two relevant high quality studies. One compared the haloperidol plus promethazine mix with midazolam (n=301) and one with lorazepam (n=200). The combined results were largely heterogeneous. In Brazil, haloperidol plus promethazine was an effective means of tranquillisation with over two thirds of people being tranquil or sedated by 30 minutes, but midazolam was more swift (n=301, RR 2.9 CI 1.75 to 4.80, NNH 5 CI 3 to 12). In India, however, 95% of people were tranquil or sedated by 30 minutes if allocated to the combination treatment (vs lorazepam, n=200, RR 0.26 CI 0.10 to 0.68, NNT 8 CI 6 to 17). Over the next few hours of treatment reported differences are negligible. One person given midazolam had respiratory depression (reversed by flumazenil), one given lorazepam had respiratory difficulty. A single person given haloperidol plus promethazine had an epileptic fit. Once the initial tranquillisation was administered, few needed additional medications for continued agitation (n=501, 2 RCTs, RR needing additional tranquillising drugs by four hours 1.67 CI 0.62 to 4.54, 4% vs 2%, I squared 50%) and there were no differences in the low levels of use of restraints. About 28% of people in Brazil in both groups had another episode of aggression in the first day after the initial injection (n=301, RR 0.89 CI 0.62 to 1.29). About half of all people in the Indian study were discharged by four hours (n=200, RR 1.13 CI 0.85 to 1.50) and a similar proportion in Brazil by 15 days (n=301, RR 1.05 CI 0.84 to 1.29). Both studies attained 99% follow up for their primary outcomes. Even by two weeks only 4% of people could not be accounted for (n=501, 2 RCTs, RR 0.91 CI 0.38 to 2.17). AUTHORS' CONCLUSIONS: This review suggests that both benzodiazepines work, but that midazolam has a faster onset and thereby reduces the risk of exposure to violence. Both benzodiazepines have the potential to cause respiratory depression, probably midazolam more so than lorazepam, and we would question the use of this group of drugs outside of those services fully confident of observing for and managing the consequences of respiratory distress. Most evidence, however, exists for the haloperidol plus promethazine mix, with currently more than 400 people randomised to the combination. The onset of action is swift and faster than lorazepam. The combination also seems safe with no clear longer term consequences. We would expect policy makers recommending other drug managements to have equally compelling evidence to support their guidance and hope that this would not be founded in conjecture or consensus, which may be more difficult to defend than evidence from high quality studies.
Assuntos
Agressão/efeitos dos fármacos , Haloperidol/uso terapêutico , Prometazina/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Agressão/psicologia , Quimioterapia Combinada , Humanos , Lorazepam/uso terapêutico , Midazolam/uso terapêutico , Agitação Psicomotora , Transtornos Psicóticos/psicologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Nursing care has been the [quot]grass roots[quot] of healthcare management even before nursing became a profession. Literature on the nursing experience with HIV is minimal and so it is challenging to comment on, or to compare experiences. PURPOSE: This paper highlights the nursing interventions as a key feature in the ongoing development and success of a prevention of mother-to-child HIV transmission (pMTCT) programme in a resource-limited setting. METHOD: In the Kingston Paediatric and Perinatal HIV/AIDS Programme, the nurses and midwives were carefully selected and then trained in the management of preventing mother-to-child transmission (pMTCT) of HIV/AIDS, voluntary counselling and testing and the identification and nursing management of paediatric and perinatal HIV/AIDS. The sites of the programme included three large maternity centres and four paediatric centres, with several feeder clinics for pregnant women. A nurse coordinator supervised the interventions at each site. A multidisciplinary team followed protocol-driven management for the care of pregnant HIV-positive women and children. There was strong collaboration with the Jamaican government and other agencies. RESULTS: The nursing interventions served to: sensitize and encourage other healthcare workers in the care of persons living with HIV/AIDS; sensitize persons in the community about the disease; improve the comfort level of women and families with accessing healthcare; enable prospective data collection for programme assessment and research purposes and to enhance multidisciplinary collaboration to widen the scope of patient care and prevent duplication of healthcare services. CONCLUSION: Nursing intervention is a vital part of a pMTCT HIV programme; however, ongoing education and training of the entire healthcare team needs to be continued in order to strengthen the programme. It is hoped that much of what is done in the Kingston Paediatric and Perinatal HIV/AIDS Programme will become integrated in the nursing management of maternal and child health nationally
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Transmissão Vertical de Doenças Infecciosas , Avaliação de Programas e Projetos de Saúde , Complicações Infecciosas na Gravidez/enfermagem , Enfermagem Pediátrica , Infecções por HIV/enfermagem , Processo de Enfermagem , Tocologia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Jamaica , Síndrome da Imunodeficiência Adquirida/enfermagem , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissãoRESUMO
BACKGROUND: Nursing care has been the "grass roots" of healthcare management even before nursing became a profession. Literature on the nursing experience with HIV is minimal and so it is challenging to comment on, or to compare experiences. PURPOSE: This paper highlights the nursing interventions as a key feature in the ongoing development and success of a prevention of mother-to-child HIV transmission (pMTCT) programme in a resource-limited setting. METHOD: In the Kingston Paediatric and Perinatal HIV/AIDS Programme, the nurses and midwives were carefully selected and then trained in the management of preventing mother-to-child transmission (pMTCT) of HIV/AIDS, voluntary counselling and testing and the identification and nursing management of paediatric and perinatal HIV/AIDS. The sites of the programme included three large maternity centres and four paediatric centres, with several feeder clinics for pregnant women. A nurse coordinator supervised the interventions at each site. A multidisciplinary team followed protocol-driven management for the care of pregnant HIV-positive women and children. There was strong collaboration with the Jamaican government and other agencies. RESULTS: The nursing interventions served to: sensitize and encourage other healthcare workers in the care of persons living with HIV/AIDS; sensitize persons in the community about the disease; improve the comfort level of women and families with accessing healthcare; enable prospective data collection for programme assessment and research purposes and to enhance multidisciplinary collaboration to widen the scope of patient care and prevent duplication of healthcare services. CONCLUSION: Nursing intervention is a vital part of a pMTCT HIV programme; however, ongoing education and training of the entire healthcare team needs to be continued in order to strengthen the programme. It is hoped that much of what is done in the Kingston Paediatric and Perinatal HIV/AIDS Programme will become integrated in the nursing management of maternal and child health nationally.
Assuntos
Infecções por HIV/enfermagem , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Tocologia , Processo de Enfermagem , Enfermagem Pediátrica , Complicações Infecciosas na Gravidez/enfermagem , Avaliação de Programas e Projetos de Saúde , Síndrome da Imunodeficiência Adquirida/enfermagem , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Criança , Pré-Escolar , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Lactente , Recém-Nascido , Jamaica , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controleRESUMO
OBJECTIVE: To determine relation between schoolchildren's blood pressure, glycated haemoglobin level, and cholesterol concentration and their anthropometry, socioeconomic status, and birth measurements. DESIGN: Retrospective cohort study. SETTING: 27 schools closest to University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: 2337 children aged 6-16 years who were born at university hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 of these were prepubertal. MAIN OUTCOME MEASURES: Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status. RESULTS: Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their current weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P < 0.001) and who had been shorter at birth (P = 0.003). Serum cholesterol concentration was inversely related to current height (P = 0.001) and to length at birth (P = 0.09) and was directly related to triceps skinfold thickness and higher socioeconomic status (P < 0.001). CONCLUSIONS: Blood pressure in childhood was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity.
Assuntos
Pressão Sanguínea/fisiologia , Colesterol/sangue , Desenvolvimento Embrionário e Fetal/fisiologia , Hemoglobinas Glicadas/metabolismo , Adolescente , Peso ao Nascer , Estatura , Doenças Cardiovasculares/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Estudos RetrospectivosRESUMO
A novel 58 kDa antigenic determinant of the fungus Paracoccidioides brasiliensis was identified by enzyme-linked immunosorbent assay using a panel of species-specific murine monoclonal antibodies (MAbs). Western immunoblot analysis, deglycosylation studies and isoelectric focusing indicated that this 58 kDa antigen is a glycoprotein, with a pI of approximately 5.2. The molecule was purified from P. brasiliensis culture filtrate and yeast cytoplasmic antigens by membrane ultrafiltration, liquid isoelectric focusing and gel filtration; N-terminal amino acid sequence data revealed no substantial homology with known proteins. The presence of the antigen in the cytoplasm of both yeast and mycelial forms of the fungus was demonstrated when these MAbs were used as markers in immunofluorescence, immunoperoxidase and immunoalkaline phosphatase techniques to label P. brasiliensis in cryostat sections. These MAbs also recognized the cytoplasm of P. brasiliensis yeast forms in paraffin-embedded pathological specimens from human cases. A preparation of the 58 kDa component from yeast cytoplasmic antigen was reacted by Western immunoblotting with 26 different serum samples from paracoccidioidomycosis patients, and 81% of them recognized it.