Asunto(s)
Comunicación , Fármacos Dermatológicos/uso terapéutico , Isotretinoína/uso terapéutico , Medios de Comunicación Sociales , Estudios Transversales , Fármacos Dermatológicos/efectos adversos , Humanos , Isotretinoína/efectos adversos , Educación del Paciente como Asunto/métodos , Grabación en VideoRESUMEN
Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min-1 to count and size-fractionate close to all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min-1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H2 O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions.
Asunto(s)
COVID-19/transmisión , Máscaras , Tamaño de la Partícula , Respiración Artificial/métodos , Mecánica Respiratoria/fisiología , Adulto , Espiración/fisiología , Femenino , Voluntarios Sanos , Humanos , Masculino , Respiración , Respiración Artificial/efectos adversosRESUMEN
INTRODUCTION: The increasing prevalence of non-communicable diseases (NCDs) poses a major challenge to low- and middle-income countries. Patients' engagement with health services for anti-tuberculosis treatment provides an opportunity for screening for NCDs and for linkage to care. METHODS: We explored the feasibility and yield of screening for NCDs in patients treated for tuberculosis (TB) in Lima, Peru, as part of a study focused on chronic respiratory sequelae. A representative sample of community controls was recruited from the same geographical area. Screening entailed taking a medical history and performing ambulatory blood pressure measurement and urinalysis. RESULTS: A total of 177 participants with previous TB (33 with multidrug-resistant TB) and 161 community controls were evaluated. There was an almost four-fold increased prevalence of self-reported diabetes mellitus (DM) in the TB group (adjusted prevalence ratio 3.66, 95%CI 1.68-8.01). Among those without self-reported DM, 3.3% had glycosuria, with a number needed to screen (NNS) of 31. The NNS to find one (new) case of hypertension or proteinuria in the TB group was respectively 24 and 5. CONCLUSION: Patient-centred care that includes pragmatic NCD screening is feasible in TB patients, and the treatment period provides a good opportunity to link patients to ongoing care.
Asunto(s)
Diabetes Mellitus/epidemiología , Tamizaje Masivo/métodos , Enfermedades no Transmisibles/epidemiología , Tuberculosis/epidemiología , Adulto , Monitoreo Ambulatorio de la Presión Arterial/métodos , Estudios de Cohortes , Diabetes Mellitus/diagnóstico , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente/métodos , Perú/epidemiología , Prevalencia , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Urinálisis/métodos , Adulto JovenRESUMEN
BACKGROUND: Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma. OBJECTIVE: To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over. METHODS: A cross-sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV1 /FVC) ratio Asunto(s)
Hipersensibilidad Inmediata/epidemiología
, Hipersensibilidad Inmediata/etiología
, Vigilancia en Salud Pública
, Adulto
, Anciano
, Femenino
, Humanos
, Hipersensibilidad Inmediata/diagnóstico
, Inmunización
, Masculino
, Persona de Mediana Edad
, Prevalencia
, Enfermedad Pulmonar Obstructiva Crónica/complicaciones
, Pruebas de Función Respiratoria
, Factores de Riesgo
, Factores Socioeconómicos
, Espirometría
, Encuestas y Cuestionarios
RESUMEN
BACKGROUND: Atopy in early life is heterogeneous in timing of onset, remission and persistence and in the nature of specific sensitization to allergens. However, this heterogeneity is not well characterized. OBJECTIVE: Our aim was to define longitudinal phenotypes of atopy between ages 1.5 and 8 years, and to assess the relationship of the atopy phenotypes to the risk of asthma, eczema and rhinitis at 8 years of age. METHODS: We used latent class analysis (LCA) to define atopy phenotypes using data from skin prick tests that were performed at 1.5, 3, 5 and 8 years in participants in the Childhood Asthma Prevention Study (CAPS). RESULTS: Four phenotypes were defined: late mixed inhalant sensitization; mixed food and inhalant sensitization; house dust mite (HDM) monosensitized; and no atopy. All three atopic phenotypes were associated with asthma, eczema and rhinitis, but the strongest association, particularly for asthma, was with the mixed food and inhalant sensitization phenotype. CONCLUSION & CLINICAL RELEVANCE: We have used a LCA model to define atopy phenotypes empirically. The finding of a strong association between the mixed food and inhalant sensitization class and the presence of asthma and poor asthma control at age 8 years implies that food sensitization in early life may be of greater significance for subsequent risk of asthma than previously thought.
Asunto(s)
Hipersensibilidad Inmediata/inmunología , Hipersensibilidad/inmunología , Fenotipo , Alérgenos/inmunología , Asma/inmunología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad Inmediata/diagnóstico , Lactante , Masculino , Pruebas CutáneasRESUMEN
BACKGROUND/OBJECTIVES: Programs to address obesity are a high priority for public policy especially for young children. Research into dietary determinants of obesity is challenging but important for rational planning of interventions to prevent obesity, given that both diet and energy expenditure influence weight status. We investigated whether early life dietary factors were predictive of weight status at 8 years in a cohort of Australian children. SUBJECTS/METHODS: We used data from the Childhood Asthma Prevention Study-a birth cohort at high risk of asthma. Dietary data (3-day weighed food records) were collected at 18 months and height, weight and waist circumference were collected at 8 years. We assessed the relationship between dietary predictor variables and measures of adiposity using linear regression. RESULTS: Intakes of protein, meat and fruit at age 18 months were positively associated with measures of adiposity at age 8 years, namely, body mass index and/or waist circumference. We also showed a significant negative relationship between these measures of adiposity at 8 years and intake at 18 months of dairy foods as a percent of total energy, and intake of energy dense cereal-based foods such as cookies and crackers. CONCLUSIONS: This birth cohort study with rigorous design, measures and analyses, has shown a number of associations between early dietary intake and subsequent adiposity that contribute to the growing evidence base in this important field.
Asunto(s)
Dieta/estadística & datos numéricos , Obesidad/etiología , Encuestas y Cuestionarios , Adiposidad , Australia/epidemiología , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Niño , Estudios de Cohortes , Productos Lácteos , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Femenino , Frutas , Humanos , Lactante , Entrevistas como Asunto , Modelos Lineales , Masculino , Carne , Encuestas Nutricionales , Obesidad/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores Socioeconómicos , Circunferencia de la CinturaRESUMEN
OBJECTIVES: To investigate the prevalence of the genital mollicutes, Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP), and their associations with cervicitis in a sexually transmitted infection (STI) clinic population. Clinical correlates of MG infection were also assessed. METHODS: 527 women were enrolled in a cross-sectional study at two STI clinics in Sydney between June 2006 and January 2010. Genital mollicutes were detected by multiplex PCR testing of cervical swabs, and associations with cervicitis were analysed. Cervicitis was defined as >30 polymorphonuclear cells per high-power field in at least three non-adjacent fields of cervical mucus on Gram stain. RESULTS: MG was found in 4.0% of women, MH in 17.1%, UU in 14.1%, and UP in 51.8%. MG was the only mollicute associated with cervicitis (unadjusted prevalence ratio (PR) 1.85, 95% CI 1.52 to 2.26, p<0.0001), and this association remained after adjustment for Chlamydia trachomatis (CT) infection (adjusted PR 1.24 (95% CI 1.04 to 1.48), p=0.02). MG was significantly associated with women being HIV positive (p=0.03), but not with age, vaginal discharge, commercial sex work, being of culturally and linguistically diverse background, or concurrent CT infection. Two of the 21 women with MG had ectopic pregnancies. CONCLUSIONS: The authors recommend wider application of PCR testing for MG in STI services, particularly in high-risk women and those with cervicitis or HIV infection.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium , Infecciones por Ureaplasma/epidemiología , Cervicitis Uterina/epidemiología , Estudios Transversales , Femenino , Humanos , Nueva Gales del Sur/epidemiología , Prevalencia , Salud Urbana , Ureaplasma , Ureaplasma urealyticum , Cervicitis Uterina/microbiologíaRESUMEN
This self-directed learning module highlights several important rehabilitation aspects in the care of persons with cancer. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the organization of a cancer rehabilitation team, unique rehabilitation issues presented by specific common tumors, and the impact of common complications on successful rehabilitation outcomes.
Asunto(s)
Neoplasias/rehabilitación , Planificación de Atención al Paciente , Medicina Física y Rehabilitación/métodos , Anciano , Anciano de 80 o más Años , Necesidades y Demandas de Servicios de Salud , Humanos , Neoplasias/complicaciones , Grupo de Atención al Paciente , Medicina Física y Rehabilitación/educación , Resultado del TratamientoRESUMEN
Upper extremity lymphedema is a relatively frequent complication following the management of breast cancer. This focused review of the pathophysiology, complications, and various treatment options now available for its management will allow physiatrists and other practitioners to better understand this condition and thereby serve as a resource for patients and other physicians.
Asunto(s)
Brazo , Linfedema/etiología , Linfedema/rehabilitación , Mastectomía/efectos adversos , Mastectomía/rehabilitación , Medicina Física y Rehabilitación/métodos , Femenino , Humanos , Medicina Física y Rehabilitación/educaciónRESUMEN
Rehabilitation professionals play an important role in the comprehensive postoperative management of the patient who has undergone a total hip replacement. Understanding the general surgical considerations that eventually impact the rehabilitation process is essential. Coordination of physicians, physical and occupational therapists, social services, and family members results in better quality of care. The technology and design of hip prostheses and fixation methods impact the functional outcome of total hip arthroplasty. Professionals involved in total hip arthroplasty rehabilitation should also understand the potential complications following total hip arthroplasty that oftentimes cause delays or revisions in the rehabilitation program. When these are combined with appropriate preoperative patient selection and education, as well as postoperative physical and occupational therapy programs, most patients are able to achieve a satisfactory functional outcome, including independence in basic activities of daily living and independent ambulation with an assistive device.
RESUMEN
Poststroke depression can be accompanied by suicidal ideation, yet reports of suicide among stroke patients are rare. When untreated, depression can become prolonged and severe. Risk factors for suicide include depression, severe insomnia, chronic illness, and organic brain syndrome. Early clinical assessment of suicide risk factors is essential in the rehabilitation setting. Two patients who developed mood disturbances in the acute poststroke period and eventually committed suicide are presented. Neither patient openly expressed suicidal thoughts to staff or family members. Retrospective analysis of medical records was compared to established suicide risk factors reported in the medical literature. Indirect verbal cues and nonverbal behavior patterns indicating potential suicide risk may have been present. Strategies for evaluation and management of suicidal behavior are discussed. These cases emphasize the need for early assessment of suicide risk by the entire rehabilitation team.
Asunto(s)
Isquemia Encefálica/psicología , Depresión/psicología , Prevención del Suicidio , Anciano , Depresión/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
The growing number of medical graduates seeking residency training in Physical Medicine and Rehabilitation (PM&R) has made the resident selection process increasingly difficult. This circumstance has prompted a search for more efficient selection criteria. Forty-one PM&R residency program directors in the United States and Puerto Rico completed a survey on the way they selected their residents. The results indicate that personal applicant characteristics, as determined by interview, were more important than academic criteria in ranking residency candidates. Of the academic variables presented, participation in a PM&R elective at the program director's hospital and the Dean's letter were rated highest. The interview experience has a major influence on the ranking of an applicant for acceptance into a PM&R training program. Academic criteria should have more influence on applicant selection than they do at present. In addition, early identification and vigorous recruitment of resident candidates with an interest in research is essential for increasing the number of academic physiatrists within our specialty.