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1.
Contemp Clin Trials ; 136: 107374, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37898308

RESUMO

Youth with intellectual and/or developmental disabilities (IDD) often struggle with depression and anxiety, which adversely impacts transition to adulthood. Integrated behavioral health care coordination, wherein care coordinators and behavioral health specialists collaborate to provide systematic, cost-effective, patient-centered care, is a promising strategy to improve access to behavioral health services and address factors that impact transition to adulthood, including depression/anxiety symptoms. Current care coordination models (e.g., Title V Maternal and Child Health Bureau [MCHB]) do not include behavioral health services. The CHECK (Coordinated HealthCarE for Complex Kids) mental health model, hereby refined and renamed BEhavioral Health Stratified Treatment (B.E.S.T.), is a behavioral health intervention delivery program designed for integration into care coordination programs. This study aims to determine whether an integrated behavioral health care coordination strategy (i.e., MCHB care coordination plus B.E.S.T.) would be more acceptable and lead to better youth health and transition outcomes, relative to standard care coordination (i.e., MCHB care coordination alone). Results would guide future investment in improving outcomes for youth with IDD. This study is a two-arm randomized clinical trial of 780 transition-aged youth with IDD (13-20 years) to evaluate the comparable efficacy of MCHB Care Coordination alone vs. MCHB Care Coordination plus B.E.S.T. on the following outcomes: 1) decreased symptoms and episodes of depression and anxiety over time; 2) improved health behaviors, adaptive functioning and health related quality of life; 3) increased health care transition (HCT) readiness; and 4) improved engagement and satisfaction with care coordination among stakeholders.


Assuntos
Deficiência Intelectual , Transição para Assistência do Adulto , Adolescente , Humanos , Transtornos de Ansiedade/terapia , Atenção à Saúde , Deficiências do Desenvolvimento , Qualidade de Vida , Adulto Jovem
2.
J Neonatal Perinatal Med ; 16(1): 87-92, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36314220

RESUMO

BACKGROUND: Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. METHODS: In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. RESULTS: MCMA infants had a significantly lower compliance (0.64 vs 1.25 mL/cm H2O /kg; p = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2O /mL/sec; p = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4 mL/kg; p = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. CONCLUSIONS: Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship.


Assuntos
Nascimento Prematuro , Lactente , Gravidez , Recém-Nascido , Feminino , Humanos , Estudos Prospectivos , Complacência Pulmonar , Gêmeos Dizigóticos , Peso ao Nascer , Gravidez de Gêmeos , Estudos Retrospectivos , Resultado da Gravidez
3.
Reprod Sci ; 19(2): 173-80, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22051849

RESUMO

Fetal chronic anemia causes lengthening of cardiomyocytes. In adults, severe left ventricular overload may lead to irreversible ventricular dysfunction. We hypothesized that in sheep fetuses with chronic anemia, remodeled myocardium would less successfully respond to angiotensin II (AT II) infusion than in fetuses without anemia. A total of 14 ewes with twin pregnancy underwent surgery at 113 ± 1 days of gestation. After a recovery period, anemia was induced by isovolumic hemorrhage in 1 fetus of each pair. At 126 ± 1 days of gestation, longitudinal myocardial velocities of the right (RV) and left (LV) ventricles were assessed at the level of the atrioventricular valve annuli via tissue Doppler imaging. Cardiac outputs were calculated by pulsed Doppler ultrasound. All measurements were performed at baseline and during fetal AT II infusion. Fetal serum cardiac natriuretic peptide (N-terminal peptide of proatrial natriuretic peptide [NT-proANP] and B-type natriuretic peptide [BNP]) concentrations were determined. Nine ewes successfully completed the experiment. At baseline, ventricular free wall thicknesses, cardiac outputs, and NT-proANP levels were significantly greater in the anemic fetuses than in the controls. The LV isovolumic contraction velocity (IVCV) acceleration and isovolumic relaxation velocity (IVRV) deceleration were lower (P < .05) in the anemic fetuses than in the controls. In the anemic fetuses, there was a positive correlation (R = .93, P < .01) between RV IVRV deceleration and NT-proANP concentration. Angiotensin II infusion increased (P < .05) LV IVCV acceleration in the anemic fetuses. We conclude that in anemic sheep fetuses, myocardial adaptation is associated with impaired LV early contraction and relaxation. However, the LV can improve its contractility with an inotropic stimulus, even in the presence of increased afterload.


Assuntos
Anemia/tratamento farmacológico , Anemia/fisiopatologia , Angiotensina II/uso terapêutico , Cardiotônicos/uso terapêutico , Doenças Fetais/tratamento farmacológico , Doenças Fetais/fisiopatologia , Função Ventricular/efeitos dos fármacos , Anemia/embriologia , Angiotensina II/administração & dosagem , Animais , Cardiotônicos/administração & dosagem , Modelos Animais de Doenças , Feminino , Gravidez , Carneiro Doméstico , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico , Remodelação Ventricular
4.
Ultrasound Med Biol ; 36(12): 2042-7, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20950931

RESUMO

We hypothesized that in chronic fetal anemia, remodeling of the myocardium is related to abnormalities in regional wall motion and acutely increased afterload further disturbs myocardial strain. Chronic anemia was induced in one fetus of each of seven sheep twin pregnancies. The fetuses were studied by two-dimensional (2-D) strain echocardiography at baseline and during increased afterload via angiotensin II (AT II) infusion. At baseline, the peak systolic longitudinal, radial and circumferential strains in the left ventricular lateral wall in anemic fetuses were lower than those in the controls (all p<0.05). During AT II, the circumferential strain of right ventricular free wall decreased significantly both in the control and anemic fetuses. Left ventricular free wall systolic strains were not affected by AT II. Fetal myocardial remodeling in chronic anemia decreases left ventricular systolic free wall strains. The myocardial adaptation does not change ventricular responses to acutely increased afterload.


Assuntos
Anemia/fisiopatologia , Ecocardiografia , Doenças Fetais/fisiopatologia , Contração Miocárdica , Ultrassonografia Pré-Natal , Remodelação Ventricular , Anemia/diagnóstico por imagem , Angiotensina II/farmacologia , Animais , Pressão Sanguínea , Doença Crônica , Feminino , Doenças Fetais/diagnóstico por imagem , Gravidez , Carneiro Doméstico , Volume Sistólico , Vasoconstritores/farmacologia , Função Ventricular Esquerda
5.
Reprod Sci ; 17(8): 760-6, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20595708

RESUMO

OBJECTIVES: We hypothesized that fetal ventricular diastolic filling characteristics are related to fetal heart rate (FHR) and pulmonary vascular impedance. METHODS: Rhesus monkeys underwent Doppler ultrasonography at near-term gestation. Tricuspid (TV) and mitral valve (MV) blood velocity waveforms were used to calculate maximum velocity (V-max) and velocity time integral (VTI) E/A ratios (early filling/ventricular filling during atrial contraction) at baseline and during maternal hyperoxygenation. Right pulmonary artery (RPA) pulsatility indices (PIs) and FHR were measured. RESULTS: Hyperoxgenation significantly decreased FHR and RPA PI. The TV V-max and the MV VTI E/A ratios increased significantly and correlated with a decrease in FHR but not with a decrease in RPA PI. The TV and MV A-wave V-max decreased during hyperoxygenation and their decrease correlated significantly with a drop in FHR. CONCLUSIONS: Fetal ventricular diastolic filling characteristics are related to FHR but not to pulmonary vascular impedance.


Assuntos
Coração Fetal/fisiologia , Frequência Cardíaca Fetal/fisiologia , Resistência Vascular/fisiologia , Função Ventricular , Animais , Ecocardiografia Doppler , Feminino , Hemodinâmica , Macaca mulatta , Modelos Animais , Oxigênio/administração & dosagem , Gravidez , Ultrassonografia Pré-Natal
6.
Obstet Gynecol ; 109(6): 1445-6, 1461, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17540821

RESUMO

BACKGROUND: Postoperative ileus and urinary retention are relatively common complications after obstetric and gynecologic procedures. This case highlights an unusual cause of these common postoperative patient reports. CASE: A 71-year-old woman underwent an uncomplicated total vaginal hysterectomy and pelvic reconstruction for stage III pelvic organ prolapse. She subsequently presented with and was hospitalized for labile blood pressures, ileus, urinary retention, and subjective sensory and motor complaints. The cause of the patient's reports was not clear until her disease became relatively severe. CONCLUSION: When a postoperative patient has multiple symptoms that do not respond to standard intervention, rare causes outside of one's specialty should be considered.


Assuntos
Síndrome de Guillain-Barré/diagnóstico , Histerectomia Vaginal/efeitos adversos , Íleus/etiologia , Retenção Urinária/etiologia , Prolapso Uterino/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Síndrome de Guillain-Barré/etiologia , Humanos , Íleus/diagnóstico , Polineuropatias/diagnóstico , Polineuropatias/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Pielonefrite/diagnóstico , Pielonefrite/etiologia , Retenção Urinária/diagnóstico
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