Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis.

INTRODUCTION: Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI. METHODS: A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023. RESULTS: Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group. CONCLUSION: Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective. IMPLICATIONS FOR PRACTICE: MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

Prevalence and risk factors associated with Campylobacter spp. and Salmonella enterica in livestock raised on diversified small-scale farms in California.

Diversified farms are operations that raise a variety of crops and/or multiple species of livestock, with the goal of utilising the products of one for the growth of the other, thus fostering a sustainable cycle. This type of farming reflects consumers' increasing demand for sustainably produced, naturally raised or pasture-raised animal products that are commonly produced on diversified farms. The specific objectives of this study were to characterise diversified small-scale farms (DSSF) in California, estimate the prevalence of Salmonella enterica and Campylobacter spp. in livestock and poultry, and evaluate the association between farm- and sample-level risk factors and the prevalence of Campylobacter spp. on DSSF in California using a multilevel logistic model. Most participating farms were organic and raised more than one animal species. Overall Salmonella prevalence was 1.19% (95% confidence interval (CI95) 0.6-2), and overall Campylobacter spp. prevalence was 10.8% (CI95 = 9-12.9). Significant risk factors associated with Campylobacter spp. were farm size (odds ratio (OR)10-50 acres: less than 10 acres = 6, CI95 = 2.11-29.8), ownership of swine (OR = 9.3, CI95 = 3.4-38.8) and season (ORSpring: Coastal summer = 3.5, CI95 = 1.1-10.9; ORWinter: Coastal summer = 3.23, CI95 = 1.4-7.4). As the number of DSSF continues to grow, evaluating risk factors and management practices that are unique to these operations will help identify risk mitigation strategies and develop outreach materials to improve the food safety of animal and vegetable products produced on DSSF.

First nationwide antimicrobial susceptibility surveillance for Neisseria gonorrhoeae in Brazil, 2015-16.

Objectives: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns globally. Enhanced AMR surveillance for gonococci is essential worldwide; however, recent quality-assured gonococcal AMR surveillance in Latin America, including Brazil, has been limited. Our aims were to (i) establish the first nationwide gonococcal AMR surveillance, quality assured according to WHO standards, in Brazil, and (ii) describe the antimicrobial susceptibility of clinical gonococcal isolates collected from 2015 to 2016 in all five main regions (seven sentinel sites) of Brazil. Methods: Gonococcal isolates from 550 men with urethral discharge were examined for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, benzylpenicillin and tetracycline using the agar dilution method, according to CLSI recommendations and quality assured according to WHO standards. Results: The levels of resistance (intermediate susceptibility) to tetracycline, ciprofloxacin, benzylpenicillin and azithromycin were 61.6% (34.2%), 55.6% (0.5%), 37.1% (60.4%) and 6.9% (8.9%), respectively. All isolates were susceptible to ceftriaxone and cefixime using the US CLSI breakpoints. However, according to the European EUCAST cefixime breakpoints, 0.2% (n = 1) of isolates were cefixime resistant and 6.9% (n = 38) of isolates had a cefixime MIC bordering on resistance. Conclusions: This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.

Risk factors associated with persistence of Salmonella shedding in finishing pigs.

The objective of this study was to identify risk factors associated with persistence of Salmonella shedding in finishing swine. A longitudinal study was conducted in 18 cohorts of pigs from three finishing sites of one swine production company. Among the 446 Salmonella isolates (isolated from 187 pigs), there were 18 distinct serovars. The six most common serovars were S. enterica serovar Derby (47.3%), S. Agona (27.4%), S. Johannesburg (10.5%), S. Schwarzengrund (2.7%), S. Litchfield (2.5%) and S. Mbandaka (2.2%). Survival analysis techniques, Kaplan-Meier methods and Log-rank test were used to estimate the duration of Salmonella shedding in days and to evaluate differences in shedding associated with risk factors at different organizational levels: isolate (serovar), pig, cohort and site. The risk factors at the pig-level were: sex, age and individual health status; and the risk factors at the cohort-level were: health risk, treatment and "at risk pigs" proportions, nursery and barn environment Salmonella status and prior exposure to the same serovar in the nursery or barn environment. Survival analysis using acceleration failure time models, with a log-normal distribution, was applied to investigate risk factors associated with Salmonella persistence (175 pigs) and serovar-specific persistence (151 pigs) during the study period. Pigs detected Salmonella positive for the first time at 10 weeks of age had a longer duration of shedding, than pigs first detected at an older age. The duration of shedding was shorter among pigs infected with S. Derby, S. Johannesburg and other serovars as compared to pigs infected with S. Agona. A significant difference was observed among sites. Cohorts with pig treatment proportions greater than the median were more likely to have a shorter duration of Salmonella shedding. Pigs from cohorts with nursery positive pools greater than the overall mean had a longer duration of Salmonella shedding as compared to pigs from cohorts with nursery pools less than or equal to the mean. These results suggest that the duration of Salmonella shedding may depend on Salmonella serovar, pig age at the time of infection, farm site and cohort-level risk factors. Identification of risk factors associated with the duration of shedding may allow more targeted interventions for the control Salmonella by evaluation of control measures not only for prevalence reduction, but also to decrease the duration of shedding. Such measures may decrease the risk of contamination of pork and subsequent risk of foodborne illness.

Longitudinal study to evaluate the association between thermal environment and Salmonella shedding in a midwestern US swine farm.

The objective of this study was to document the association between the thermal environment in the barn and Salmonella shedding in finishing pigs. For this purpose, individual fecal samples from 900 finishing pigs (8 collections per pig) were repeatedly collected from 18 cohorts (50 pigs per cohort) on 3 sites of a multi-site farrow-to-finish production system in a longitudinal study. Pen temperature and humidity were measured every 2 min during the study period. The thermal parameters of interest were: hourly average temperature, minimum and maximum temperature, hourly temperature variation, temperature humidity index (THI) and cumulative number of hours/degree above and below the thermal neutral zone at the pen level prior to fecal sampling for 6 time periods (12h, 24h, 48 h, 72 h, 1 week and 1 month). Additional potential risk factors at the individual (e.g., sex, health events), cohort (e.g., mortality, morbidity, Salmonella status of the nursery) and pen level (e.g., type of pen) were also evaluated. Multilevel logistic models using generalized linear models, with random intercepts at pig, pen and cohort levels to account for clustering (individual samples nested within pigs, pigs nested within pens, pens within cohorts) were constructed. Site (A, B, C) was considered as a fixed effect in order to control for clustering within site. The outcome variable was Salmonella fecal status of the individual sample. Cold exposure (temperatures below the thermal neutral zone) and exposure to a THI>72 were both positively associated with risk Salmonella shedding. Nursery Salmonella status was positively associated with Salmonella shedding and pig age was negatively associated with Salmonella shedding. In the multilevel intercept-only model the largest proportion of model variance was associated with the individual fecal sample (44.8%) followed by cohort (24.5%), pen (20.5%) and pig (10.2%). The present study allowed the investigation of the association of time-variant thermal factors and Salmonella shedding. Interventions that target the thermal environment may have an effect on reducing Salmonella shedding in swine and also improve pig well-being and production efficiency. Alternatively, thermal parameters may be used to identify groups of pigs at high risk for Salmonella shedding. Future studies should be performed to investigate the cost-efficacy of interventions to improve the thermal environment of swine.

Longitudinal study of Salmonella shedding in naturally infected finishing pigs.

A 3-year longitudinal study was conducted on a multi-site farrow-to-finish production system. For each of 18 cohorts at three finishing sites, 50 pigs were randomly selected. Faecal samples were collected every 2 weeks for 16 weeks. Salmonella was cultured from 453 (6·6%) of 6836 faecal samples. The pig-level incidence of Salmonella was 20·8% (187/899 pigs). Salmonella prevalence varied between cohorts and within pigs. The adjusted Salmonella prevalence decreased over the finishing period from 6·4% to 0·8%. Intermittent detection of Salmonella was found in more than 50% of pigs that were positive at more than one collection. The finding that the majority of pigs shed intermittently has implications for surveillance and research study design when determining Salmonella status. The variability in shedding over time, as well as between and within cohorts and pigs suggests that there may be time-variant risk factors for Salmonella shedding in swine.

Enfuvirtide (T-20) resistance-related mutations in HIV type 1 subtypes B, C, and F isolates from Brazilian patients failing HAART.

The synthetic peptide T-20 (enfuvirtide, EFV) represents the first compound approved by the FDA known as entry inhibitors (EIs). The resistance mutations associated with this new class of antiretroviral drug are located in the first heptad repeat (HR1) region of gp41. Amino acid changes in codons G36D/S, I37V, V38A/M/E, Q39H/R, Q40H, N42T, and N43D can confer resistance to EFV. In this work we investigated the presence of resistance mutations that occur in patients never treated with EFV and failing HAART with protease inhibitors (PIs), nucleoside reverse transcriptase (RT) inhibitors (NRTIs), and nonnucleoside RT inhibitors (NNRTIs). This knowledge can reveal whether this salvage therapy can be effective in patients failing HAART. For this, we amplified 65 samples from plasma isolates and than sequenced a fragment of 416 nt encompassing the HR1 and HR2 regions (amino acids 33-170 of gp41). The subtype distribution among the 65 isolates was 45 (69.23%) subtype B, 9 (13.85%) subtype C, 7 (10.77%) subtype F1, and 4 (6.15%) mosaics B/F1, B/C, F1/C, and C/F1/B. We found a high prevalence (7.6%) of EFV-associated mutation G36D in this cohort of patients failing HAART therapy, five isolates from subtype B (11.11% within this group). In contrast, when 1079 sequences from drug-naive patients were analyzed, only one showed the G36D substitution. This finding indicates a strong association between the selected position G36D and HAART therapy (p < 0.0001). The isolates that possess these mutations can develop resistance to EFV more rapidly. Nevertheless, more information about the impact of these mutations in salvage therapy with EFV in patients failing HAART must still be obtained.

Biological monitoring of n-hexane exposure in Portuguese shoe manufacturing workers.

Occupational risk of exposure to organic solvents concerned many shoe manufacturing workers. The most common organic solvents found in workplace environments were n-hexane and others hexane isomers. The aim of this study was to evaluate the exposure of shoe manufacturing workers to n-hexane, with 2,5 hexanedione in urine (2,5HD) as a biomarker and to investigate effect in 2,5 HD excretion of the co-exposure to other organic solvents. Post-shift urine samples from workers who performed gluing tasks (n = 45) in five shoe manufacturers were collected, as well as urine samples from a similar number of unexposed controls (n = 51) in the same factories. 2,5 HD was measured by capillary gas chromatography. Air monitoring of organic solvents in the workplaces was performed and the compounds were analyzed by gas chromatography. Significant more 2,5 HD was found in the urine of personnel who performed gluing tasks than in the unexposed workers. A significant correlation was observed between n-hexane exposure and urinary 2,5 HD, with a high correlation coefficient. Multiple regression analysis indicated that n-hexane exposure and co-exposure to others solvents were significant predictors of the concentration of 2,5 HD. Co-exposure led to higher urinary 2,5 HD concentrations. The significant effect of co-exposure reinforces the interest of biological monitoring for n-hexane exposure evaluation. In case of multiple exposures, biological monitoring can be a better predictive measurement for early detection of n-hexane neurotoxic lesions than air monitoring data.