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2.
J Prim Care Community Health ; 14: 21501319231189952, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37522592

RESUMO

Diabetes affects Americans across the lifespan requiring individual and community-level interventions for prevention and management. Nonprofit hospitals are required to address community health needs under current tax law. The study objective was to assess what strategies children's hospitals implemented in prevention and care of diabetes and determine how many hospitals used evidence-based strategies. We identified the most recent Children's Hospital Needs Assessments and implementation strategies for each hospital. Data were thematically coded. Twenty-nine of the 233 U.S. children's hospitals addressed diabetes in their community benefit investments. Of the 130 hospital programs, 48 (37%) aligned with the DSMES framework. Programs focused on prevention (32%), healthy eating (18%), education (15%), physical activity (12%), quality improvement (11%), and self-management (5%). Most children's hospital interventions (85%) did not state a focus on reducing health disparities and none addressed problem solving or diabetes technology. Minimal hospitals are using evidence-based programming for diabetes management and are not targeting health disparities which undercuts their efforts. Hospitals are not adopting structural evidence-based approaches, missing key opportunities to implement strategies shown to reduce diabetes prevalence and lower A1c. This study suggests that children's hospitals need improvement in their diabetes programming to better serve their communities.


Assuntos
Diabetes Mellitus , Autogestão , Criança , Humanos , Estados Unidos/epidemiologia , Hospitais Pediátricos , Saúde Pública , Organizações sem Fins Lucrativos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle
8.
Case Rep Pulmonol ; 2022: 9594063, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36046751

RESUMO

A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of breath twice in 10 days. She was diagnosed with myopericarditis attributed to COVID-19 infection (first admission), and chest X-ray revealed a small left-sided pneumothorax, pericardial effusion (second admission), with no mediastinal shift or other signs of tension. Computed tomography confirmed these results and revealed a few small cysts in the right lung. An echocardiogram demonstrated normal heart anatomy and filling dynamics. The patient was diagnosed with simple pneumothorax and ongoing myopericarditis managed with colchicine, ibuprofen, and low-dose prednisolone. The patient responded to treatment and was discharged. Pneumothorax association with COVID-19 is reported in a small number of publications, but the association is less clear with SLE. Our patient may have been predisposed to developing pneumothorax after COVID-19 infection due to her existing connective tissue disorder.

9.
J Public Health Manag Pract ; 28(1): E146-E154, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-32810071

RESUMO

CONTEXT: There is growing evidence that social factors contribute disproportionately to health outcomes in the United States as compared with health care services. As a result, nonprofit hospitals are incorporating strategies to address social needs into their Internal Revenue Service (IRS)-mandated community benefit work. Much of the research base on this subject, however, has focused on the efforts of adult-serving hospitals. OBJECTIVE: The aim of this study was to determine whether communities surrounding children's hospitals are unique with regard to social needs and categorize how children's hospitals are addressing social needs in their IRS-mandated community benefit work. METHODS: Using county-level health and economic data, we compared community characteristics of children's hospital counties with the national average. We then coded and analyzed the community benefit reports of all nonprofit children's hospitals in the United States to categorize the different strategies that hospitals adopt to address social needs. RESULTS: Children's hospitals (N = 168) serve communities with greater social needs than the national average. In terms of community benefit investments, children's hospitals were more likely to identify social needs in their community health needs assessment than adult-serving hospitals, but still less than half identified or addressed 1 or more social needs. Children's hospitals were more likely to adopt interventions that address broader population health rather than strategies that focus on clinical services or children and adolescents in particular. CONCLUSIONS: Pediatric health care institutions have a profound opportunity to reduce health disparities by altering the social environments in which children develop. Policy makers and scholars should provide support and resources to increase community benefit investments in this area.


Assuntos
Determinantes Sociais da Saúde , Fatores Sociais , Adolescente , Adulto , Criança , Cidades , Hospitais , Humanos , Avaliação das Necessidades , Estados Unidos
10.
Semin Arthritis Rheum ; 51(6): 1205-1217, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34689007

RESUMO

INTRODUCTION: Despite increasing evidence to support safe use of tumour necrosis factor inhibitors (TNFi) and other biologic disease modifying anti-rheumatic drugs (bDMARDs) during pre-conception/pregnancy, there remains a paucity of evidence regarding the safety and compatibility of other non-TNFi and novel targeted synthetic (ts)DMARDs during pre-conception/pregnancy. Therefore, we conducted a systematic review to determine the compatibility of these drugs in pre-conception, during pregnancy and post-partum period. METHOD: Databases including; EMBASE, Pubmed (MEDLINE), and Cochrane were searched up to 23rd October 2020 to find relevant peer-reviewed papers, using keywords including; rheumatic disease, pregnancy, conception/pre-conception, lactation/breastfeeding, childhood and vaccination/infection, and commonly prescribed non-TNFi drugs and tsDMARDs. RESULTS: Our search yielded 1483 papers that were screened independently by two authors, and 109 full-text papers were eligible for final analysis. These studies reported 1291 maternal pregnancies exposed to non-TNFi bDMARDs and tsDMARDs with known outcomes, including 721 live births, 219 spontaneous miscarriages and 27 congenital abnormalities. Paternal exposures in 174 pregnancies had reassuring outcomes. A total of 48 breastfed infants were exposed to non-TNFi bDMARDs and no adverse events reported upon long-term follow-up. Fifteen infants exposed to bDMARDs received normal vaccination regimes, including live vaccines, and had normal developmental outcomes, without any complications or infections. CONCLUSION: Overall, the findings are reassuring and do not suggest a cause for any major concerns or an increased risk of adverse pregnancy outcomes for maternal or paternal exposures to non-TNFi bDMARDs or tsDMARDs. There were no major concerns for breastfeeding exposures to non-TNFi bDMARDs.


Assuntos
Antirreumáticos , Artrite Reumatoide , Produtos Biológicos , Doenças Reumáticas , Medicamentos Sintéticos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Criança , Feminino , Humanos , Masculino , Gravidez , Doenças Reumáticas/complicações , Medicamentos Sintéticos/uso terapêutico , Inibidores do Fator de Necrose Tumoral/efeitos adversos
11.
FASEB J ; 35(10): e21913, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34555204

RESUMO

ATB-346 is a hydrogen sulfide-releasing non-steroidal anti-inflammatory drug (H2 S-NSAID) derived from naproxen, which in preclinical studies has been shown to have markedly reduced gastrointestinal adverse effects. However, its anti-inflammatory properties in humans compared to naproxen are yet to be confirmed. To test this, we used a dermal model of acute inflammation in healthy, human volunteers, triggered by ultraviolet-killed Escherichia coli. This robust model allows quantification of the cardinal signs of inflammation along with cellular and humoral factors accumulating within the inflamed skin. ATB-346 was non-inferior to naproxen in terms of its inhibition of cyclooxygenase activity as well as pain and tenderness. ATB-346 significantly inhibited neutrophil infiltration at the site of inflammation at 4 h, compared to untreated controls. Subjects treated with ATB-346 also experienced significantly reduced pain and tenderness compared to healthy controls. Furthermore, both classical and intermediate monocyte subsets infiltrating the site of inflammation at 48 h expressed significantly lower levels of CD14 compared to untreated controls, demonstrating a shift toward an anti-inflammatory phenotype. Collectively, we have shown for the first time in humans that ATB-346 is potently anti-inflammatory and propose that ATB-346 represents the next generation of H2 S-NSAIDs, as a viable alternative to conventional NSAIDs, with reduced adverse effects profile.


Assuntos
Sulfeto de Hidrogênio/metabolismo , Inflamação/tratamento farmacológico , Naproxeno/análogos & derivados , Adolescente , Adulto , Dinoprostona/metabolismo , Escherichia coli/imunologia , Escherichia coli/efeitos da radiação , Humanos , Inflamação/imunologia , Inflamação/metabolismo , Inflamação/microbiologia , Masculino , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/efeitos dos fármacos , Monócitos/imunologia , Naproxeno/metabolismo , Naproxeno/farmacologia , Naproxeno/uso terapêutico , Neutrófilos/citologia , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Dor/metabolismo , Fenótipo , Solubilidade , Raios Ultravioleta , Vasoconstrição/efeitos dos fármacos , Adulto Jovem
13.
Health Care Women Int ; 42(4-6): 356-373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31385747

RESUMO

In rural Ecuador pregnant women face complex challenges navigating the terrain between traditional and biomedical maternal health care services. Semi-structured interviews were conducted in three rural communities in Southern Ecuador that have presented active Chagas disease transmission with women who were pregnant or have given birth within the last five years. This study was conducted to identify and understand the experiences of mothers in these communities and the decisions they make to maintain the wellness of themselves and their children. The researchers recorded women's maternal health stories, analyzed their access to maternal health care, and explored factors influencing their birth location preferences and health seeking behaviors. The researchers found that women in this region are utilizing medical pluralism to sustain maternal health and the well-being of their children.


Assuntos
Serviços de Saúde Materna , População Rural , Criança , Diversidade Cultural , Equador , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez
15.
Semin Arthritis Rheum ; 48(5): 911-920, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30220537

RESUMO

There is limited evidence relating to the impact of disease modifying anti-rheumatic drugs (DMARDs) upon male fertility and peri-conception paternal exposure in men with rheumatic disease. Therefore, we conducted a systematic review of available evidence to update information on this subject and guide paternal counselling. A systematic search of PubMed and Embase was carried out up to September 2017, to find relevant peer-reviewed papers, using keywords for fertility/spermatogenesis/conception, men, and disease modifying or biologic drugs commonly prescribed in patients with rheumatic disease. The search yielded 724 papers, and the titles/abstracts were screened independently by 2 authors, duplicates removed and 233 potentially relevant papers selected for full text review. A total of 84 papers were included in the final analysis which covered the impact on fertility of over 611 male exposures to relevant drugs, and over 5986 pregnancies conceived during paternal exposure to (or within 3 months of stopping) these drugs. Aside from the known adverse impact of cyclophosphamide and sulfasalazine on spermatogenesis, overall there was no firm evidence of harm to fertility or pregnancy outcomes with paternal exposure to anti-TNF therapies, abatacept, rituximab, azathioprine, cyclosporine A, hydroxychloroquine, leflunomide, methotrexate or mycophenolate mofetil. There was no evidence found pertaining to the effects of male exposure to IVIG, tacrolimus, golimumab, anakinra or belimumab on fertility or pregnancy outcomes. These results provide further reassurance as to the safety of many DMARDs for men trying to conceive and will be useful when counselling men about risks of anti-rheumatic drugs to fertility and pregnancies, and following accidental conception.


Assuntos
Antirreumáticos/efeitos adversos , Produtos Biológicos/efeitos adversos , Infertilidade Masculina/induzido quimicamente , Exposição Paterna/efeitos adversos , Resultado da Gravidez , Estudos de Coortes , Feminino , Humanos , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Doenças Reumáticas/tratamento farmacológico
16.
JCI Insight ; 3(6)2018 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-29563331

RESUMO

While the treatment of inflammatory disorders is generally based on inhibiting factors that drive onset of inflammation, these therapies can compromise healing (NSAIDs) or dampen immunity against infections (biologics). In search of new antiinflammatories, efforts have focused on harnessing endogenous pathways that drive resolution of inflammation for therapeutic gain. Identification of specialized pro-resolving mediators (SPMs) (lipoxins, resolvins, protectins, maresins) as effector molecules of resolution has shown promise in this regard. However, their action on inflammatory resolution in humans is unknown. Here, we demonstrate using a model of UV-killed Escherichia coli-triggered skin inflammation that SPMs are biosynthesized at the local site at the start of resolution, coinciding with the expression of receptors that transduce their actions. These include receptors for lipoxin A4 (ALX/FPR2), resolvin E1 (ChemR23), resolvin D2 (GPR18), and resolvin D1 (GPR32) that were differentially expressed on the endothelium and infiltrating leukocytes. Administering SPMs into the inflamed site 4 hours after bacterial injection caused a reduction in PMN numbers over the ensuing 6 hours, the phase of active resolution in this model. These results indicate that in humans, the appearance of SPMs and their receptors is associated with the beginning of inflammatory resolution and that their therapeutic supplementation enhanced the resolution response.


Assuntos
Anti-Inflamatórios/farmacologia , Escherichia coli/imunologia , Inflamação/imunologia , Inflamação/metabolismo , Pele/imunologia , Pele/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adolescente , Adulto , Vesícula/imunologia , Vesícula/metabolismo , Quimiocinas/metabolismo , Citocinas/metabolismo , Ácidos Docosa-Hexaenoicos/farmacologia , Eicosanoides/imunologia , Eicosanoides/farmacologia , Ácido Eicosapentaenoico/análogos & derivados , Ácido Eicosapentaenoico/farmacologia , Escherichia coli/efeitos da radiação , Humanos , Inflamação/tratamento farmacológico , Leucócitos/imunologia , Leucócitos/metabolismo , Lipoxinas/farmacologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/efeitos dos fármacos , Receptores de Quimiocinas/metabolismo , Receptores de Formil Peptídeo/metabolismo , Receptores Acoplados a Proteínas G , Receptores de Lipoxinas/metabolismo , Pele/efeitos dos fármacos , Pele/patologia , Voluntários , Adulto Jovem
17.
J Pathol Clin Res ; 2(3): 154-65, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27499924

RESUMO

Whilst numerous studies investigating the aetiology of inflammatory diseases have been performed in rodents, the applicability of these data to human pathophysiology is frequently debated. Regardless of the strengths and weaknesses of rodent models in biomedical research, there is a need to develop models of experimental inflammation in humans. Here, we describe a self-resolving acute inflammatory response triggered by the intradermal injection of UV-killed Escherichia coli into the forearm of healthy volunteers. Cells and exudates were harvested from onset to resolution by applying negative pressure over the inflamed site. Onset was characterized by high blood flow, neutrophilia and peak levels of pro-inflammatory cytokines, whilst resolution showed a decline in blood blow, reduction in neutrophils, increase in monocytes/macrophages and waning of classic pro-inflammatory cytokine levels. An anti-inflammatory effect, defined as suppression of onset phase events, was demonstrated by administering naproxen, a conventional non-steroidal anti-inflammatory drug. In summary, this model of resolving acute inflammation is minimally invasive, highly tractable and allows simultaneous investigation of the vascular response, cellular trafficking and chemical mediator profile of onset and resolution phases of acute inflammation in humans. It can serve as a translational platform to provide mechanistic insights and to test the clinical efficacy of novel anti-inflammatory and pro-resolving drugs, and also as a tool in patients to explore inherent defects in resolution pathways.

20.
Arthritis Care Res (Hoboken) ; 68(6): 853-60, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26474373

RESUMO

OBJECTIVE: Patients with systemic vasculitis (SV) have an increased risk of all-cause mortality, often due to infection, compared to the healthy population. We investigated whether humoral response to vaccination and biomarkers of immune dysfunction were associated with infection and death. METHODS: Patients with SV in remission were vaccinated with pneumococcal 7-valent conjugate, Haemophilus influenzae type b, and meningococcal group C conjugate vaccine and meningococcal polysaccharide groups A, C, Y, and W135 vaccines. Total IgG and antibody titers against specific antigens and lymphocyte subset analysis were performed before vaccination. Postvaccination antibody titers were measured at 4 weeks and 2 years, from which an antibody response score was calculated. Infections and death following vaccination were collected prospectively following vaccination. RESULTS: A total of 92 patients were safely vaccinated with no increase in disease relapse, median followup 4.6 years (interquartile range [IQR] 3.6-4.8 years). Eighteen patients died at a median of 2 years and the overall infection rate was 0.4 (IQR 0.2-1.3) infections/patient/year. Reduced serum IgG, B cell count, and CD4+ cell counts predicted poor vaccine response and infection but not death. The response rates to individual vaccine antigens was highly variable, with a median response rate of 46% (IQR 39-58%) of patients responding to each individual antigen. Vaccine response, age, and reduced renal function were independent predictors of all-cause mortality in multivariate analysis. CONCLUSION: Total IgG and B cell counts predict infection and response to vaccination. Vaccination in patients with SV in remission is safe and the response predicts all-cause mortality. Vaccine response is a surrogate marker of immune system health.


Assuntos
Linfócitos B/imunologia , Hospedeiro Imunocomprometido/imunologia , Infecções/epidemiologia , Vasculite Sistêmica/imunologia , Vacinas/imunologia , Idoso , Estudos de Coortes , Feminino , Humanos , Imunoglobulina G , Infecções/imunologia , Vacinas contra Influenza/imunologia , Contagem de Linfócitos , Masculino , Vacinas Meningocócicas/imunologia , Pessoa de Meia-Idade , Vacinas Pneumocócicas/imunologia , Vacinação
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