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Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2024; 94:311-321. [PMID: 38236247 DOI: 10.1037/ort0000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey (N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals. J Behav Med 2023; 46:986-995. [PMID: 37407904 DOI: 10.1007/s10865-023-00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.
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Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study. BMJ Mil Health 2023; 169:443-447. [PMID: 34244377 DOI: 10.1136/bmjmilitary-2021-001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient's characteristics and the flight's challenges.
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PrEP-Related Interactive Toxicity Beliefs: Associations With Stigma, Substance Use, and PrEP Uptake. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:114-125. [PMID: 37129594 DOI: 10.1521/aeap.2023.35.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite documented efficacy in reducing HIV transmission, pre-exposure prophylaxis (PrEP) uptake among Black sexual minority men (BSMM) is limited. One understudied factor which may impede PrEP uptake is PrEP-related interactive toxicity beliefs (i.e., believing it is hazardous to use alcohol/drugs while taking PrEP). Data from N = 169 HIV negative BSMM over 4 months showed high rates of agreement with at least one alcohol (78%) or drug (84%) interactive toxicity belief. Univariate analyses showed increased alcohol or drug interactive toxicity beliefs predicted lower PrEP uptake. Multivariable regression suggested those with PrEP-related alcohol or drug interactive toxicity beliefs were more likely to report high PrEP stigma, more negative PrEP beliefs (e.g., concern that taking PrEP disrupts life), and were more likely to use alcohol/drugs (respectively) prior to/during sex. Findings warrant intervention work targeting interactive toxicity beliefs with tailored messaging to mitigate PrEP stigma and correct concerns around substance use and PrEP.
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Retrospective analysis of post-operative pulmonary complications (POPC) in dogs following anesthesia including neuromuscular blockade (NMB). Vet Anaesth Analg 2023. [DOI: 10.1016/j.vaa.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Retrospective accounts of first exposure to minoritized sexual and gender identities. SOCIAL DEVELOPMENT 2022. [DOI: 10.1111/sode.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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PO-1374 Feasibility of magnetic resonance-guided adaptive post-prostatectomy radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dolutegravir resistance in Malawi’s national HIV treatment program. Open Forum Infect Dis 2022; 9:ofac148. [PMID: 35493118 PMCID: PMC9045949 DOI: 10.1093/ofid/ofac148] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Dolutegravir HIV drug resistance (HIVDR) data from Africa remain sparse. We reviewed HIVDR results of Malawians on dolutegravir-based antiretroviral therapy (November 2020–September 2021). Of 6462 eligible clients, 33 samples were submitted to South Africa, 27 were sequenced successfully, and 8 (30%) had dolutegravir HIVDR. Malawi urgently requires adequate HIVDR testing capacity.
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Ungleiche Startchancen für die Schule - Ergebnisse aus den schulärztlichen Untersuchungen in NRW. DAS GESUNDHEITSWESEN 2021. [DOI: 10.1055/s-0041-1732068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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PO-1558 MR Linac Stereotactic Prostate:Accumulated dose comparison of adaptive versus non adaptive treatment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Family members frequently function as surrogate decision-makers in critical care settings. This role requires family to establish satisfactory communication with clinicians. LOCAL PROBLEM Posthospital patient satisfaction with communication scores were lower than desired. Investigators assumed family member satisfaction with communication could influence patient satisfaction scores. METHODS/INTERVENTIONS Including family members in multidisciplinary daily clinical rounds was implemented in a 22-bed neurointensive care unit (ICU). Family members who attended rounds were compared with those who did not. Changes in clinician time devoted to rounding were measured. RESULTS The intervention increased time devoted to clinical rounds by 4 minutes per patient on average. Rounding dose correlated positively while depression correlated negatively with family satisfaction with communication. No harm, such as family member agitation, anxiety, or complaints, was found. CONCLUSIONS Including family in rounding in the ICU appears safe and can improve family satisfaction with communication, but whether it influences patient satisfaction remains an open question.
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Serum betatrophin and irisin levels in hepatocellular carcinoma. JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2020; 71. [PMID: 32554846 DOI: 10.26402/jpp.2020.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/28/2020] [Indexed: 11/03/2022]
Abstract
Hepatocellular carcinoma (HCC) development is a complex process with well-known risk factors, however the role of betatrophin/angiopoietin-like protein 8 and irisin has been poorly investigated thus far. The aim of this study is to measure betatrophin and irisin serum levels in HCC, cirrhotic patients and controls, assess their relationship with cancer etiology and grade, metabolic abnormalities and liver dysfunction severity. Serum betatrophin and irisin concentrations were measured with commercially available ELISA kits in 69 cirrhotic patients with HCC, 24 patients with non-viral cirrhosis and 20 healthy volunteers. The severity of liver disfunction was assessed according to Child-Pugh (C-P) score, while HCC grade according to the Barcelona clinic liver cancer (BCLC) staging system. Serum betatrophin concentration was significantly higher (33.7 ± 13.4 versus 12.3 ± 2.0 ng/ml; P < 0.001), while serum irisin level significantly lower in HCC patients compared to controls (2.52 ± 1.14 versus 4.46 ± 1.34 μg/ml; P = 0.02). Betatrophin level was also significantly elevated among cirrhotic patients compared to healthy volunteers. More evident serum betatrophin increase was found in patients with viral disease (34.8 ± 12.9 versus 26.1 ± 13.8 ng/ml; P < 0.001). Serum irisin concentration was significantly decreased in more advanced HCC cases (stage A versus C according to BCLC: 3.4 ± 1.3 versus 1.89 ± 1.1 μg/ml; P = 0.02). Decline of serum irisin (A: 3.4 ± 1.2; B: 2.42 ± 0.8; C: 1.91 ± 1.19 μg/ml; P = 0.03) and up-regulation of serum betatrophin levels (A: 24.1 ± 13.8; B: 39.3 ± 11.4; C: 46.2 ± 9.4 ng/ml; P = 0.03) were observed in patients with more advanced cirrhosis according to C-P score. We concluded that betatrophin serum level increased in cirrhotic patients, compared to controls. Since there was no difference between cirrhotic patients with and without intercurrent HCC, we suppose it may have an influence on fibrosis development, however not hepatocarcinogensis. Irisin serum level decreased in HCC patients, especially with more advanced disease grade, and was inversely related to the severity of liver disfunction.
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Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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0110 Fluctuations Across the Menstrual Cycle in Cardiac Autonomic Activity During Sleep and Wake May Affect Memory Consolidation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Prior studies have shown that benefits of sleep for memory consolidation may be influenced by menstrual phase. Menstrual phase also impact autonomic regulation during sleep, and autonomic activity has been recently shown to play a role in sleep-dependent memory consolidation.
Methods
We investigated the interaction of menstrual cycle and autonomic activity measured by heart rate-variability (HRV) on sleep-dependent memory consolidation among 18-healthy females. Using a within-subjects design, we investigated episodic memory improvement with a nap paradigm during two phases of women’s menstrual cycle: 1) perimenses: −5 to +5 days from menses-onset, and 2) non-perimenses: window outside of perimenses. Subjects completed the memory test before (Test1) and after (Test2) a 90-minute polysomnographically (PSG)-recorded nap. We recorded sleep and HRV during 5-minutes of wake, and during the nap. Next, we compared sleep, HRV (RMSSD and HFnu), and memory performance between the two menstrual phases.
Results
Sleep architecture did not differ between perimenses and non-perimenses. Women performed similarly on the memory task at Test 1 (all ps>.061), but at Test 2, non-perimenses showed better performance (p = 0.02). Autonomically, perimenses had higher parasympathetic activity during wake (RMSSD-p = 0.04) and REM-sleep (HFnu-p = 0.04), compared with non-perimenses. Using bivariate correlations, we found positive associations between wake-HFnu and memory improvement (p = .02) during perimenses. In contrast, non-perimenses’ memory improvement was negatively correlated with wake-RMSSD (p <.001). In perimenses, memory improvement was also positively associtated with REM-HFnu (p = .04). No associations were found between autonomic sleep activity and memory in non-perimenses phase.
Conclusion
Our findings indicate a role for autonomic activity in memory improvement in both sleep and wake that is modulated by the menstrual cycle. HRV measures of parasympathetic activity were higher during perimenses phase in wake and REM-sleep. Interestingly, the HRV measures showed opposing relations with memory improvement based on the phase of the menstrual cycle. In sum, women’s cardiac autonomic activity fluctuates by menstrual phase and it is possible that these fluctuations affect the magnitude and direction of sleep-related memory consolidation.
Support
Sattari et al., 2017; Genzel et al., 2012; de Zambotti et al., 2013; Whitehurst et al., 2016.
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Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Management eines Placental site trophoblastic tumor (Plazentabett-Tumor): ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Serum endocan level in diabetes mellitus of patients with cirrhosis and risk of subsequent development of spontaneous bacterial peritonitis. JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2019; 70. [PMID: 31539885 DOI: 10.26402/jpp.2019.3.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/28/2019] [Indexed: 11/03/2022]
Abstract
The presence of type 2 diabetes mellitus (DM) in patients with cirrhosis is associated with an increased risk of spontaneous bacterial peritonitis (SBP) which may represent an increased susceptibility to infections. Endocan is a key player in the regulation of inflammatory disorders, and a biomarker in bacteremia and sepsis. To investigate the association between both endocan and DM, and developing SBP, we conducted a retrospective cohort study. Three hundred and thirty patients (179 men, 151 women; mean age 61.0 ± 8.5 years) who were treated for liver cirrhosis were studied between January 2007 and December 2016. Univariate and multivariate analyses using age, type 2 diabetes mellitus, severity of cirrhosis (Child-Pugh or MELD score), platelet count, serum proinflammatory cytokines, procalcitonin, C-reactive protein, and endocan level were conducted to identify factors related to the development of SBP. Among 330 patients with the median follow-up of 6.0 years, the cumulative incidence of SBP at 5 years was 28.6%. On multivariate analysis, a high serum endocan level and DM were independent and significant risk factors for SBP development (hazard ratio (HR) 1.634 (95% CI: 1.012 - 2.638; P = 0.047) and 2.482 (95% CI: 1.134 - 5.412; P = 0.023), respectively). Furthermore, the cumulative incidence rate of SBP in cirrhotic patients with high endocan levels was significantly greater than that in patients with low endocan levels (P = 0.035; log-rank test). Endocan is an independent predictor of SBP development in patients with cirrhosis. Cirrhotic patients with type 2 diabetes mellitus who have a higher endocan levels should be monitored carefully for the development of spontaneous bacterial peritonitis.
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SUN-LB663: Nutritional Status in Patients with Hepatocellular Carcinoma Depending on Barcelona Clinic Liver Cancer Staging Category. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Real life results of direct acting antiviral therapy for HCV infection in HIV-HCV-coinfected patients: Epi-Ter2 study. AIDS Care 2019; 32:762-769. [PMID: 31345052 DOI: 10.1080/09540121.2019.1645808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate the baseline demographics and real-life efficacy of direct acting antivirals (DAAs) in HIV-HCV-positive patients as compared to patients with HCV monoinfection. The analysis included 5690 subjects who were treated with DAAs: 5533 were HCV-positive and 157 were HIV-HCV-positive. Patients with HCV-monoinfection were older (p < .0001) and in HIV-HCV group there were more men (p < .0001). Prevalence of genotype 1a (p = .002), as well as of genotypes 3 and 4 (p < .0001) was higher in HIV-HCV-coinfected patients. Genotype 1b was more frequent (p < .0001) in the HCV-mono-infection group. Patients with HCV-monoinfection had a higher proportion of fibrosis F4 (p = .0004) and lower proportion of fibrosis F2 (p < .0001). HIV-HCV-coinfected individuals were more often treatment-naïve (p < .0001). Rates of sustained viral response after 12 weeks did not differ significantly between both groups (95.9% versus 97.3% in coinfection and monoinfection group, respectively; p > .05). They were, however, influenced by HCV genotype (p < .0001), stage of hepatic fibrosis (p < .0001), male sex (p < .0001), BMI (p = .0001) and treatment regimen modifications (p < .0001). Although factors associated with worse response to therapy (male sex, genotype 3) occurred more often in the HIV coinfection group, real-life results of DAAs did not differ significantly between both populations.
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Durability of virologic response, risk of de novo hepatocellular carcinoma, liver function and stiffness 2 years after treatment with ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin in the AMBER, real-world experience study. J Viral Hepat 2018; 25:1298-1305. [PMID: 29888828 DOI: 10.1111/jvh.12945] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/17/2018] [Indexed: 12/28/2022]
Abstract
We followed for 2 years patients treated with direct-acting agents (DAA) to assess long-term durability of virologic response, improvement of liver function, reduction in liver stiffness (LS) and risk of hepatocellular carcinoma (HCC). The study included patients from 16 hepatologic centres involved in the AMBER, investigator-initiated study on treatment of chronic hepatitis C patients within a programme preceding EU registration of ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin. A total of 204 patients among 209 from the primary study were enrolled, 200 with available testing at 2-year follow-up (2yFU) with undetectable HCV RNA (198 responders and 2 nonresponders retreated). During 2yFU, 4 patients died, 17 had hepatic decompensation and 3 needed liver transplantation. De novo hepatocellular carcinoma was diagnosed in 4 and its recurrence in 3 patients. Significant decreases in bilirubin, MELD, Child-Pugh scores and liver stiffness, and increases in albumin level were observed during 2yFU. Strengths of the study were a fixed period of post-treatment follow-up, prospective character of the study and high proportion of available patients from the primary study. The major weaknesses were lack of a comparative arm and relatively insufficient number of patients for subsets analysis. In conclusion, 2-year follow-up confirmed durability of virologic response after treatment of HCV infection with ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin. It was accompanied by significant improvement of major measures of hepatic function and reduction of hepatic stiffness. Successful therapy did not prevent hepatic decompensation, HCC or death in cirrhotics that support the need for longer than 2-year monitoring for possible disease progression.
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Treatment of HCV infection in Poland at the beginning of the interferon-free era-the EpiTer-2 study. J Viral Hepat 2018; 25:661-669. [PMID: 29316039 DOI: 10.1111/jvh.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023]
Abstract
The aim of the EpiTer-2 study was to analyse patient characteristics and their medication for HCV infection in Poland at the beginning of the interferon-free era. Analysis of data of HCV infected patients treated during the initial period of availability of interferon-free regimens in Poland, who started therapy after 1 July 2015 and had available an efficacy evaluation report before 30 June 2017 was undertaken. A total of 2879 patients with chronic hepatitis C were entered, including 46% with liver cirrhosis. The most common was genotype 1b (86.8%). The study population was gender balanced, the majority of patients were overweight or obese and 69% presented comorbidities, with the highest prevalence that for hypertension. More than half of patients were retreated due to failure of previous therapy with pegylated interferon and ribavirin. Almost two-third of patients received current therapy with ombitasvir/paritaprevir/ritonavir±dasabuvir (OPrD) ±ribavirin. Other patients received mostly sofosbuvir-based regimens including combination with ledipasvir and pegylated interferon and ribavirin for genotype 3-infected patients. Efficacy of treatment in the whole study population measured as intent-to-treat analysis was 95%. The most frequent regimen, administered for patients infected with genotype 1b, was 12 weeks of OPrD, resulting in an SVR rate of 98%. At least one adverse event was reported in 38% of patients, and the death rate was 0.8%. In conclusion, data from the EpiTer-2 study confirmed the excellent efficacy and safety profile of the real-world experience with recently introduced therapeutic options for genotype 1 HCV infection, but demonstrated weakness of the current therapeutic programme regarding genotype 3 infections.
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Der German Index of Socioeconomic Deprivation – ein neues Instrument für die GBE auf Landes- und kommunaler Ebene? DAS GESUNDHEITSWESEN 2018. [DOI: 10.1055/s-0038-1639185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Burden of disease and risk factors for death among children treated for tuberculosis in Malawi. Int J Tuberc Lung Dis 2018; 20:1046-54. [PMID: 27393538 DOI: 10.5588/ijtld.15.0928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is a leading cause of childhood death. Patient-level data on pediatric TB in Malawi that can be used to guide programmatic interventions are limited. OBJECTIVE To describe pediatric TB case burden, disease patterns, treatment outcomes, and risk factors for death and poor outcome. DESIGN We conducted a retrospective cohort study utilizing routine data. Odds ratios (ORs) for factors associated with poor outcome and death were calculated using generalized estimating equations. RESULTS Children represented 8% (371/4642) of TB diagnoses. The median age was 7 years (interquartile range 2.8-11); 32.8% (113/345) were human immunodeficiency virus (HIV) infected. Of these, 54.0% were on antiretroviral therapy (ART) at the time of anti-tuberculosis treatment (ATT) initiation, 21.2% started ART during ATT, and 24.8% had no documented ART. The treatment success rate was 77.3% (11.2% cured, 66.1% completed treatment), with 22.7% experiencing poor outcomes (9.5% died, 13.2% were lost to follow-up). Being on ART at the time of ATT initiation was associated with increased odds of death compared to beginning ART during treatment (adjusted OR 2.75, 95%CI 1.27-5.96). CONCLUSION Children represent a small proportion of diagnosed TB cases and experience poor outcomes. Higher odds of death among children already on ART raises concerns over the management of these children. Further discussion of and research into pediatric-specific strategies is required to improve case finding and outcomes.
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Health-related quality of Life (HRQOL) and disease symptoms in patients with unresectable hepatocellular carcinoma (HCC) treated with lenvatinib (LEN) or sorafenib (SOR). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schulärztliche Untersuchungen von Seiteneinsteigenden in Nordrhein- Westfalen. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1601997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Increased circulating endocan in patients with cirrhosis: relation to bacterial infection and severity of disease. JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY : AN OFFICIAL JOURNAL OF THE POLISH PHYSIOLOGICAL SOCIETY 2017; 68:273-282. [PMID: 28614777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
Life expectancy of patients with liver cirrhosis is closely linked to the degree of liver dysfunction and the occurrence of bacterial infection. An early diagnosis of infection helps to initiate adequate and timely measures and improves outcome of cirrhotic patients. Endocan is a newly recognized biomarker of sepsis. However, there have been no studies of the trends in endocan levels in cirrhotic patients with bacterial infection and their associations with markers of infection and inflammation. This study sought to assess the diagnostic value of serum levels of endocan, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in 126 patients with cirrhosis: 51 with decompensated infected cirrhosis, 56 with decompensated uninfected and 19 with compensated uninfected cirrhosis at inclusion. We analyzed the association of endocan with clinical factors in cirrhosis by comparison with indicators of infection and inflammation. Endocan, PCT, CRP, IL-6 and TNF-α were assayed in serum samples by ELISA analyses. Serum levels of endocan, PCT, CRP and TNF-α were significantly higher in cirrhotic patients with clinically overt infections. Endocan levels were correlated to neither PCT levels nor IL-6 levels in each group of patients with cirrhosis. CRP and TNF-α levels and Child-Pugh score correlated only in the infected group of patients with endocan levels, while in the uninfected groups of cirrhotic patients no significant correlation could be detected. The diagnostic accuracy of endocan increased in advanced stage of the disease. Serum endocan levels ≥ 2.05 ng/ml had a sensitivity of 76.1% and specificity of 85% for the diagnosis bacterial infection in decompensated cirrhotic patients. The endocan measured at admission is a good clinical parameter predicting the occurrence of infection in these patients. Elevated endocan may reflect the degree of endothelial cell injury induced by a systemic inflammatory response, a pathologic process that could modify the course of advanced cirrhosis.
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Real-world effectiveness and safety of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin in hepatitis C: AMBER study. Aliment Pharmacol Ther 2016; 44:946-956. [PMID: 27611776 DOI: 10.1111/apt.13790] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/16/2016] [Accepted: 08/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virologic and safety outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin (OBV/PTV/r ± DSV ± RBV) therapy have shown high sustained virologic response (SVR) rates and good tolerability in most patient populations in pre-registration studies. AIM To confirm these clinical trial findings in the treatment of genotype 1 and 4 hepatitis C under real-world conditions. METHODS Patients enrolled for treatment with OBV/PTV/r ± DSV ± RBV based on therapeutic guidelines were included, and the regimen was administered according to product characteristics. Clinical and laboratory data, including virologic response, were collected at baseline, end of treatment (EOT) and 12 weeks after EOT. RESULTS A total of 209 patients with chronic hepatitis C were enrolled, most were genotype 1b-infected (84.2%) and 119 (56.9%) had liver cirrhosis. Among these, 150 (71.7%) had failed previous anti-viral therapies and 84 (40.2%) were null-responders. At 12 weeks after EOT, SVR was achieved by 207 (99.0%) patients, ranging from 96.4% to 100.0% across subgroups. All Child-Pugh B and post-orthotopic liver transplantation patients achieved SVR. Adverse events occurred in 151 (72.2%) patients and were mostly mild and associated with the use of RBV. Serious adverse events, including hepatic decompensation, renal insufficiency, anaemia, hepatotoxicity and diarrhoea, were reported in eight (3.8%) patients. In five (2.4%) patients, adverse events led to treatment discontinuation. On-treatment decompensation was experienced by seven (3.3%) patients. CONCLUSIONS The results of our study confirm previous findings. They demonstrate excellent effectiveness and a good safety profile of OBV/PTV/r± DSV±RBV in HCV genotype 1-infected patients treated in the real-world setting.
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Peginterferon add-on results in more HBsAg decline compared to monotherapy in HBeAg-positive chronic hepatitis B patients. J Viral Hepat 2016; 23:419-26. [PMID: 26403919 DOI: 10.1111/jvh.12468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/25/2015] [Indexed: 01/04/2023]
Abstract
It is unknown whether peginterferon (PEG-IFN) add-on to entecavir (ETV) leads to more HBsAg decline compared to PEG-IFN monotherapy or combination therapy, and whether ETV therapy may prevent HBsAg increase after PEG-IFN cessation. We performed a post hoc analysis of 396 HBeAg-positive patients treated for 72 weeks with ETV + 24 weeks PEG-IFN add-on from week 24 to 48 (add-on, n = 85), 72 weeks with ETV monotherapy (n = 90), 52 weeks with PEG-IFN monotherapy (n = 111) and 52 weeks PEG-IFN + lamivudine (combination, n = 110) within 2 randomized trials. HBsAg decline was assessed at the end of PEG-IFN (EOP) and 6 months after PEG-IFN (EOF) discontinuation. Differences in baseline characteristics were accounted for using inversed probability of treatment weights. At EOP, a HBsAg reduction of ≥1log10 IU/mL was more frequently achieved for patients in the add-on or combination therapy arms (both 36%), compared to PEG-IFN mono (20%) or ETV (8%) (add-on vs PEG-IFN mono P = 0.050). At EOF, the HBsAg reduction ≥1log10 IU/mL was only sustained in patients treated with ETV consolidation (add-on vs combination and PEG-IFN mono: 40% vs 23% and 18%, P = 0.029 and P = 0.003, respectively). For add-on, combination, PEG-IFN mono and ETV, the mean HBsAg-level change at EOF was -0.84, -0.81, -0.68 and -0.33 log10 IU/mL, respectively (P > 0.05 for PEG-IFN arms). HBeAg loss at EOF was 36%, 31%, 33% and 20%, respectively (P > 0.05). PEG-IFN add-on for 24 weeks results in more on-treatment HBsAg decline than does 52 weeks of PEG-IFN monotherapy. ETV therapy may maintain the HBsAg reduction achieved with PEG-IFN.
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Listeriose in der Schwangerschaft mit tödlichem Ausgang – ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Validation of a qualitative R5 dip-stick for gluten detection with a new mathematical-statistical approach. QUALITY ASSURANCE AND SAFETY OF CROPS & FOODS 2016. [DOI: 10.3920/qas2015.0818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Stillprävalenz und Stilldauer bei Einschulungskindern in Bielefeld. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1578952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Effects of early life dextran sulfate sodium administration on pathology and immune response in broilers and layers. Poult Sci 2016; 95:1529-1542. [PMID: 26976905 DOI: 10.3382/ps/pew074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/18/2016] [Indexed: 12/30/2022] Open
Abstract
Intestinal pathology early in life may affect immune development and therefore immune responses later in life. Dextran sulfate sodium (DSS) induces colitis in rodents and is a widely used model for inflammatory bowel diseases. The present study investigated DSS as a model for early life intestinal pathology and its consequences on intestinal pathology, ileal cytokine, and immunoglobulin mRNA expression levels as well as the antibody response towards an immunological challenge later in life in chickens. Broiler and layer chicks received 2.5% DSS in drinking water during d 11 through d 18 post hatch or plain drinking water as a control. As an immunological challenge all birds received a combination of Escherichia coli lipopolysaccharide (LPS) and human serum albumin (HuSA) intramuscularly (i.m.) at d 35, and antibody titers against LPS, HuSA, and keyhole limpet hemocyanin (KLH) were determined to investigate effects of intestinal inflammation early in life on humoral immunity later in life. DSS treated birds showed a decrease in BW from which broilers quickly recovered, but which persisted for several weeks in layers. Histological examination of intestinal samples showed symptoms similar to those in rodents, including shortening and loss of villi and crypts as well as damage of the epithelial cell layer of different parts of the intestine. Effects of DSS on intestinal morphology were less severe in broilers that also showed a lower mortality in response to DSS than layers. No effect of DSS on ileal cytokine expression levels could be observed, but ileal immunoglobulin expression levels were decreased in DSS treated broilers that also showed lower antibody titers against LPS in response to the challenge. In conclusion, DSS may serve as a model for intestinal pathology early in life, although more research on the appropriate dose is necessary and is likely to differ between breeds. Results from the present study could indicate that broilers are less susceptible to DSS compared with layers or have a better capacity to recover from intestinal pathology.
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Long-term effects of early life microbiota disturbance on adaptive immunity in laying hens. Poult Sci 2016; 95:1543-1554. [PMID: 26976906 DOI: 10.3382/ps/pew088] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022] Open
Abstract
Due to an interplay between intestinal microbiota and immune system, disruption of intestinal microbiota composition during immune development may have consequences for immune responses later in life. The present study investigated the effects of antibiotic treatment in the first weeks of life on the specific antibody response later in life in chickens. Layer chicks received an antibiotic cocktail consisting of vancomycin, neomycin, metronidazole, and amphotericin-B by oral gavage every 12 h, and ampicillin and colistin in drinking water for the first week of life. After the first week of life, chicks received ampicillin and colistin in drinking water for two more weeks. Control birds received no antibiotic cocktail and plain drinking water. Fecal microbiota composition was determined during antibiotic treatment (d 8 and 22), two weeks after cessation of antibiotic treatment (d 36), and at the end of the experimental period at d 175 using a 16S ribosomal RNA gene targeted microarray, the Chicken Intestinal Tract Chip (ChickChip). During antibiotic treatment fecal microbiota composition differed strongly between treatment groups. Fecal microbiota of antibiotic treated birds consisted mainly of Proteobacteria, and in particular E.coli, whereas fecal microbiota of control birds consisted mainly of Firmicutes, such as lactobacilli and clostridia. Two weeks after cessation of antibiotic treatment fecal microbiota composition of antibiotic treated birds had recovered and was similar to that of control birds. On d 105, 12 weeks after cessation of antibiotic treatment, chicks of both treatment groups received an intra-tracheal lipopolysaccharide (LPS)/human serum albumin (HuSA) challenge. Antibody titers against LPS and HuSA were measured 10 days after administration of the challenge. While T cell independent antibody titers (LPS) were not affected by antibiotic treatment, antibiotic treated birds showed lower T cell dependent antibody titers (HuSA) compared with control birds. In conclusion, intestinal microbial dysbiosis early in life may still have effects on the specific antibody response months after cessation of antibiotic treatment and despite an apparent recovery in microbiota composition.
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Early feeding and early life housing conditions influence the response towards a noninfectious lung challenge in broilers. Poult Sci 2015; 94:2041-8. [DOI: 10.3382/ps/pev189] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022] Open
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Schuleingangsuntersuchungen- ein Setting auch für die Impfberatung von Erwachsenen? DAS GESUNDHEITSWESEN 2015. [DOI: 10.1055/s-0035-1546928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Changes of potentially anti-nutritive components in Hungarian potatoes from organic and conventional farming. ACTA ALIMENTARIA 2014. [DOI: 10.1556/aalim.43.2014.4.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Loss of intrahepatic HBsAg expression predicts sustained response to peginterferon and is reflected by pronounced serum HBsAg decline. J Viral Hepat 2014; 21:897-904. [PMID: 24444353 DOI: 10.1111/jvh.12218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 10/09/2013] [Indexed: 12/18/2022]
Abstract
There is a lack of knowledge regarding the effect of peginterferon (PEG-IFN) on the expression of intrahepatic hepatitis B core and surface antigen (HBcAg and HBsAg) in chronic hepatitis B (CHB) and its relation with response to therapy. Fifty-two HBeAg-positive and 67 HBeAg-negative CHB patients with paired liver biopsies taken at baseline and after 1 year of PEG-IFN therapy were studied. After PEG-IFN therapy, HBeAg-negative patients showed a significant reduction in both intrahepatic HBcAg (P = 0.04) and HBsAg expression (P < 0.001). In contrast, a reduction in intrahepatic HBcAg expression was not observed in HBeAg-positive patients, while a trend in reduction of intrahepatic HBsAg staining was found (P = 0.09). Post-treatment, 7 (13%) HBeAg-positive and 9 (14%) HBeAg-negative patients had no expression of intrahepatic HBsAg. Patients without any intrahepatic HBsAg expression post-treatment were more likely to achieve a combined response (HBeAg loss with hepatitis B virus (HBV) DNA <2000 IU/mL for HBeAg -positive and HBV DNA <2000 IU/mL and normal alanine aminotransferase for HBeAg-negative CHB): 71% vs 5% for HBeAg-positive (P < 0.001) and 60% vs 16% for HBeAg-negative patients (P = 0.004), respectively. Moreover, a more profound decline of serum HBsAg was observed in patients with absence of intrahepatic HBsAg staining (3.1 vs 0.4 log IU/mL, P < 0.001 and 1.7 vs 0.4 log IU/mL, P = 0.005 for HBeAg-positive and HBeAg-negative CHB, respectively). In conclusion, PEG-IFN reduces expression of intrahepatic HBsAg. Loss of HBsAg as assessed by immunohistochemistry from the liver predicts a sustained response and is reflected in a pronounced serum HBsAg decline.
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Development of ileal cytokine and immunoglobulin expression levels in response to early feeding in broilers and layers. Poult Sci 2014; 93:3017-27. [PMID: 25306458 DOI: 10.3382/ps.2014-04225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Provision of feed in the immediate posthatch period may influence interaction between intestinal microbiota and immune system, and consequently immunological development of the chick. This study addressed ileal immune development in response to early feeding in 2 chicken breeds selected for different production traits: broilers and layers. Chicks of both breeds either received feed and water immediately posthatch or were subjected to a 72-h feed and water delay. Ileal cytokine and immunoglobulin mRNA expression levels were determined at different time points. Effects of early feeding were limited, but breeds differed strikingly regarding cytokine and immunoglobulin expression levels. Cytokine expression levels in broilers were low compared with layers and showed a transient drop in the second to third week of life. In contrast, broilers showed considerably higher expression levels of IgA, IgM, and IgY. These findings indicate that the 2 breeds use different immune strategies, at least on the ileal level.
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Polymorphisms of HLA-DP are associated with response to peginterferon in Caucasian patients with chronic hepatitis B. Aliment Pharmacol Ther 2014; 40:811-8. [PMID: 25109699 DOI: 10.1111/apt.12910] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/04/2014] [Accepted: 07/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polymorphisms of the HLA-DP gene are associated with the natural clearance of the hepatitis B virus in Asian patients. AIM To investigate the association of HLA-DP polymorphisms with response to peginterferon (PEG-IFN) in Caucasian chronic hepatitis B (CHB) patients. METHODS We studied 262 Caucasian chronic hepatitis B patients infected with HBV genotype A or D, treated with PEG-IFN for 1 year in two randomised controlled trials (HBV 99-01 and PARC study). Response was defined as an HBV DNA <2000 IU/mL at 6 months post-treatment. Variations at HLA-DPA1 and HLA-DPB1 were genotyped. RESULTS Of the 262 patients, 58% was HBeAg-positive and HBV genotype A and D was observed in 32% and 68%, respectively. At 6 months post-treatment, 57 (22%) patients had achieved an HBV DNA <2000 IU/mL. HLA-DPB1 was independently associated with virological response [adjusted odds ratio (OR) 1.8, 95% confidence interval (CI):1.1-3.0, P = 0.025], and with an undetectable HBV DNA (adjusted OR 2.4 95% CI: 1.2-4.7, P = 0.015) when adjusted for HBeAg status and other known response modifiers. In HBeAg-positive patients, combined HBeAg seroconversion with HBV DNA <2000 IU/mL was increasingly observed with each addition of an HLA-DPB1 G-allele (adjusted OR 2.7, 95% CI: 1.2-5.9, P = 0.012). Furthermore, HLA-DPA1 and HLA-DPB1 haplotype block GG showed comparable results for virological and combined response. CONCLUSION In this large cohort of Caucasian chronic hepatitis B patients infected with HBV genotypes A or D, polymorphisms of HLA-DP are independently associated with both virological and serological response to PEG-IFN therapy at 6 months post-treatment.
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[Use of negative pressure wound therapy on surgical incisions (prevena™) after surgery of pectus deformities reduces wound complications]. Zentralbl Chir 2014; 140:156-62. [PMID: 24647815 DOI: 10.1055/s-0033-1360291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pectus surgery can lead to postoperative wound complications in some cases. The purpose of this study is to determine whether preventive negative pressure wound therapy (NPWT) could reduce wound complications after open pectus surgery. MATERIAL AND METHODS 100 patients after open procedure for the treatment of pectus excavatum or pectus carinatum in the years 2010 to 2012 were retrospectively analysed. 50 patients treated with Prevena™ (KCI Medical Products GmbH, Wiesbaden, Germany) were compared with 50 patients whose wounds were covered with OPSITE® film (Smith & Nephew, Hamburg, Germany). Wound closure was performed following a standard procedure as well as the placement of subcutaneous drains. Therefore two comparable groups of patients were formed and analysed by standardised parameters. The wound dressing was placed epicutaneously immediately after wound closure in the operating room and removed after 5 days in each case. Follow-ups were performed immediately after removal of the wound dressing, at the time of discharge from hospital as well as 6 and 12 weeks after operation. The wounds were checked for tenderness, pain, secretion, redness and fistulas. RESULTS The Prevena group showed 10 % wound complications which needed operative treatment, whereas the OPSITE group showed complications in 24 %. Some patients who were treated with Prevena showed superficial skin lesions at the rim of the foam and the film. All of these lesions healed well. CONCLUSION Treating wounds postoperatively with preventive measures (NPWT) showed a remarkable reduction of wound complications following open pectus surgery whereas statistically the difference was not significant (p = 0.074).
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Predictors associated with treatment initiation and switch in a real-world chronic hepatitis B population from five European countries. J Viral Hepat 2013; 21:662-70. [PMID: 24329883 DOI: 10.1111/jvh.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/17/2013] [Indexed: 12/26/2022]
Abstract
In Europe, healthcare systems differ between countries and different factors may influence Chronic hepatitis B (CHB) treatment choices in different counties. This analysis from a prospective, longitudinal, non-interventional study in five EU countries aimed to explore determinants associated with treatment initiation or switch in patients with CHB. A total of 1267 adult patients with compensated CHB in Germany, France, Poland, Romania and Turkey were prospectively followed for up to 2 years (March 2008-December 2010). Determinants of treatment initiation or switch were analysed using multivariate Cox proportional hazards regression. Median time since CHB diagnosis was 2.6 (0-37.7) years. Among 646 treatment-naïve patients, the probability of treatment initiation during follow-up was higher: in Germany (P = 0.0006), Poland (P < 0.0001) and Romania (P = 0.0004) compared with Turkey; in patients with alanine transaminase (ALT) 1-2 × upper limit of normal (ULN) (P = 0.0580) or >2 × ULN (P = 0.0523) compared with ALT ≤ 1 × ULN; and in patients with hepatitis B virus (HBV) DNA ≥ 2000 IU/mL (P < 0.0001) compared with HBV DNA <2000 IU/mL or undetectable. Among 567 treated patients, 87 switched treatment during follow-up. The probability of treatment switch was higher: in France (P = 0.0029), Germany (P = 0.0078) and Poland (P = 0.0329) compared with Turkey; and in patients with HBV DNA <2000 (P < 0.0001) or ≥ 2000 IU/mL (P < 0.0001), compared with undetectable. Viral load and ALT level were identified as the major drivers of treatment initiation. HBV DNA level was also a significant determinant of treatment switch. Results were statistically different across EU countries.
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Sprachkompetenz und Sprachentwicklungsstörung von Kindern mit nicht-deutscher Erstsprache bei den schulärztlichen Untersuchungen der Jahre 2004 bis 2011 in NRW. DAS GESUNDHEITSWESEN 2013. [DOI: 10.1055/s-0033-1337574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ancient microbial activity recorded in fracture fillings from granitic rocks (Äspö Hard Rock Laboratory, Sweden). GEOBIOLOGY 2012; 10:280-297. [PMID: 22506979 DOI: 10.1111/j.1472-4669.2012.00328.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fracture minerals within the 1.8-Ga-old Äspö Diorite (Sweden) were investigated for fossil traces of subterranean microbial activity. To track the potential organic and inorganic biosignatures, an approach combining complementary analytical techniques of high lateral resolution was applied to drill core material obtained at -450 m depth in the Äspö Hard Rock Laboratory. This approach included polarization microscopy, time-of-flight secondary ion mass spectrometry (ToF-SIMS), confocal Raman microscopy, electron microprobe (EMP) and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The fracture mineral succession, consisting of fluorite and low-temperature calcite, showed a thin (20-100 μm), dark amorphous layer lining the boundary between the two phases. Microscopic investigations of the amorphous layer revealed corrosion marks and, in places, branched tubular structures within the fluorite. Geochemical analysis showed significant accumulations of Si, Al, Mg, Fe and the light rare earth elements (REE) in the amorphous layer. In the same area, ToF-SIMS imaging revealed abundant, partly functionalized organic moieties, for example, C(x)H(y)⁺, C(x)H(y)N⁺, C(x)H(y)O⁺. The presence of such functionalized organic compounds was corroborated by Raman imaging showing bands characteristic of C-C, C-N and C-O bonds. According to its organic nature and the abundance of relatively unstable N- and O- heterocompounds, the organic-rich amorphous layer is interpreted to represent the remains of a microbial biofilm that established much later than the initial cooling of the Precambrian host rock. Indeed, δ¹³C, δ¹⁸O and ⁸⁷Sr/⁸⁶Sr isotope data of the fracture minerals and the host rock point to an association with a fracture reactivation event in the most recent geological past.
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O02 Dysregulated mitophagy and mitochondrial transport in severe dominant optic atrophy due to OPA1 mutations. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70003-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Grenzübergreifende Bewertung des BMI bei Kindern - Ein Beispiel aus der Arbeit in der Euregio Maas-Rhein. DAS GESUNDHEITSWESEN 2012. [DOI: 10.1055/s-0032-1307348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
AIM OF THE STUDY The purpose of this study was to investigate the distribution of results of a developmental screening for school entry and procedures initiated by school doctors. METHOD Based on achievement in SOPESS of 372 children (188 female, 184 male) and the resulting recommendations of the school doctors, the distribution of frequencies in cross-classified tables was analysed, and Cramer's V was calculated. RESULTS No sex differences were found in early numeracy and coordination skills. Girls performed more frequently without any problems in the other domains assessed by SOPESS. Recommendations of school doctors referring to clarification of the finding or treatment are lower than the frequencies of critical results in SOPESS. This effect is especially critical in the domains of numeracy and attention. Critical SOPESS achievements in numeracy are found in 12% (attention: 10,2%) of the children, but only 0,5% (attention: 2,4%) are given recommendations for further treatment. An increase of documentation for parent counselling can be observed. CONCLUSION Documentation of the findings shows that medical recommendations for most domains of SOPESS are in accordance with frequencies of critical screening results. Further information is necessary for the domains of attention and numeracy.
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Wie lassen sich kommunale Daten für die landesweite und kommunale Gesundheitsberichterstattung objektiv vergleichen? Lösungsmöglichkeiten durch Typisierung der Kommunen nach Sozialstrukturdaten am Beispiel von Adipositas bei Einschülern. DAS GESUNDHEITSWESEN 2011. [DOI: 10.1055/s-0031-1283634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
This paper reviews the clinical and radiographic features and treatment results in eight patients with intraosseous epidermoid cysts in the terminal phalanx of a finger seen over a period of 26 years. Data on age, sex, occupation, diagnostic findings, history of injury in six cases, treatment and follow-up were obtained by reviewing medical records and the histopathological findings using the hospital database. The most frequent symptoms of pressure pain, tenderness, redness and swelling occurred at a median time of 12 years after trauma. Male patients were mainly affected (7:1). In four the intraosseous epidermoid cysts were confused with other osteolytic diseases before surgery. Magnetic resonance imaging is recommended in any case of an osteolytic, expanding lesion, particularly in cases that are clinically and radiologically not obviously an intraosseous epidermoid cyst.
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