Mostrando recursos 1 - 20 de 2.948

  1. Attitudes to Mesalamine Questionnaire: A Novel Tool to Predict Mesalamine Nonadherence in Patients with IBD

    Moss, Alan C; Lillis, Yvonne; Edwards George, Jessica B.; Choudhry, Niteesh Kumar; Berg, Anders Hayden; Cheifetz, Adam S.; Horowitz, Gary Leigh; Leffler, Daniel Alexander
    OBJECTIVES: Poor adherence to mesalamine is common and driven by a combination of lifestyle and behavioral factors, as well as health beliefs. We sought to develop a valid tool to identify barriers to patient adherence and predict those at risk for future nonadherence. METHODS: A 10-item survey was developed from patient-reported barriers to adherence. The survey was administered to 106 patients with ulcerative colitis who were prescribed mesalamine, and correlated with prospectively collected 12-month pharmacy refills (medication possession ratio (MPR)), urine levels of salicylates, and self-reported adherence (Morisky Medication Adherence Scale (MMAS)-8). RESULTS: From the initial 10-item survey, 8 items...

  2. Computer Model Challenges Breast Cancer Treatment Strategy

    Retsky, Michael W.; Swartzendruber, Douglas E.; Bame, Paul D.; Wardwell, Robert H.
    The breast cancer treatment failure rate remains unacceptably high. The current breast cancer treatment paradigm, based primarily on Gompertzian kinetics and animal models, advocates short-course, intensive chemotherapy subsequent to tumor debulking, citing drug resistance and host toxicity as the primary reasons for treatment failure. To better understand treatment failure, we have studied breast cancer from the perspective of computer modeling. Our results demonstrate breast cancers grow in an irregular fashion; this differs from the Gompertzian mode of animal models and thus challenges the validity of the current paradigm. Clinical and laboratory data support the concept of irregular growth rather than...

  3. Gut microbiome composition and function in experimental colitis during active disease and treatment-induced remission

    Rooks, Michelle G; Veiga, Patrick; Wardwell-Scott, Leslie H; Tickle, Timothy; Segata, Nicola; Michaud, Monia; Gallini, Carey Ann; Beal, Chloé; van Hylckama-Vlieg, Johan ET; Ballal, Sonia Arora; Morgan, Xochitl C; Glickman, Jonathan Neil; Gevers, Dirk; Huttenhower, Curtis; Garrett, Wendy S.
    Dysregulated immune responses to gut microbes are central to inflammatory bowel disease (IBD), and gut microbial activity can fuel chronic inflammation. Examining how IBD-directed therapies influence gut microbiomes may identify microbial community features integral to mitigating disease and maintaining health. However, IBD patients often receive multiple treatments during disease flares, confounding such analyses. Preclinical models of IBD with well-defined disease courses and opportunities for controlled treatment exposures provide a valuable solution. Here, we surveyed the gut microbiome of the T-bet−/− Rag2−/− mouse model of colitis during active disease and treatment-induced remission. Microbial features modified among these conditions included altered potential...

  4. Trends in nicotine yield in smoke and its relationship with design characteristics among popular U.S. cigarette brands, 1997-2005

    Connolly, Gregory N.; Alpert, Hillel R; Wayne, Geoffrey Ferris; Koh, Howard
    Objectives: To determine whether nicotine yields in the smoke of cigarettes would show an overall increase over time or an increasing trend limited to any particular market category (eg, full flavour vs light, medium (mild) or ultralight; mentholated vs non-mentholated), manufacturer, or brand family or brand style, and whether nicotine yields in smoke would be associated with measurable trends in cigarette design. Methods: Machine-based measures of nicotine yield in smoke and measures of cigarette design features related to nicotine delivery (ventilation, nicotine content in the tobacco rod and number of puffs), as well as market category descriptors, were obtained from annual...

  5. Is there a rationale for an anesthesiologist's role against cancer recurrence?

    Forget, P; Coulie, P. G.; Retsky, Michael W.; Demicheli, R.; Machiels, J. P.; De Kock, M.
    Growth of tumors can accelerate during the peri-operative period. Accordingly, early relapse of cancer occurs in some patients during the first two postoperative years. Temporal and biologic analyses of cancer pathophysiology suggest a link between peri-operative pathophysiological changes and acceleration of tumor growth. Understanding the role of inflammation and its consequences (i.e., immune response, growth factors, dissemination of tumor cells) could lead to define a role of anesthesiologists in reducing cancer recurrence following surgery. We argue for peri-operative pharmacological interventions to reduce cancer relapse, with a focus on non-steroidal anti-inflammatory drugs.

  6. Emergency Surgery Data and Documentation Reporting Forms for Sudden-Onset Humanitarian Crises, Natural Disasters and the Existing Burden of Surgical Disease

    Burkle, Frederick; Nickerson, Jason W.; von Schreeb, Johan; Redmond, Anthony D.; McQueen, Kelly A.; Norton, Ian; Roy, Nobhojit
    Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a...

  7. Nuclear War in the Middle East: Where is the Voice of Medicine and Public Health?

    Dallas, Cham E.; Burkle, Frederick
    Once again, the politically volatile Middle East and accompanying rhetoric has escalated the risk of a major nuclear exchange. Diplomatic efforts have failed to make the medical consequences of such an exchange a leading element in negotiations. The medical and academic communities share this denial. Without exaggeration, the harsh reality of the enormous consequences of an imminently conceivable nuclear war between Iran and Israel will encompass an unprecedented millions of dead and an unavoidable decline in public health and environmental devastation that would impact major populations in the Middle East for decades to come. Nuclear deterrence and the uncomfortable but...

  8. Anatomy of an Ambush: Security Risks Facing International Humanitarian Assistance

    Burkle, Frederick
    The 2003 war with Iraq has generated security concerns that present unique challenges to the practice of providing international humanitarian assistance during war and conflict. Objective research studies on security management are lacking. However, case studies have proven to be an important education and training tool to advance situational awareness of security risks. These challenges are illustrated by an analysis of the events surrounding the first ambush of, and assassination attempt on, a senior US aid official in Baghdad. Before deployment to conflict areas, especially those characterised by insurgent activity, humanitarian providers must realistically assess the threats to life and...

  9. Impact of Public Health Emergencies on Modern Disaster Taxonomy, Planning, and Response

    Burkle, Frederick; Greenough, P. Gregg
    Current disaster taxonomy describes diversity, distinguishing characteristics, and common relations in disaster event classifications. The impact of compromised public health infrastructure and systems on health consequences defines and greatly influences the manner in which disasters are observed, planned for, and managed, especially those that are geographically widespread, population dense, and prolonged. What may first result in direct injuries and death may rapidly change to excess indirect illness and subsequent death as essential public health resources are destroyed, deteriorate, or are systematically denied to vulnerable populations. Public health and public health infrastructure and systems in developed and developing countries must be...

  10. An authority for crisis coordination and accountability

    Burkle, Frederick; Redmond, Anthony D; McArdle, Dudley F

  11. Academic Affiliated Training Centers in Humanitarian Health, Part I: Program Characteristics and Professionalization Preferences of Centers in North America

    Burkle, Frederick; Walls, Alexa E.; Heck, Joan P.; Sorensen, Brian S.; Cranmer, Hilarie Hartel; Johnson, Kirsten; Levine, Adam C.; Kayden, Stephanie; Cahill, Brendan; VanRooyen, Michael J.
    The collaborative London based non-governmental organization network ELRHA (Enhancing Learning and Research for Humanitarian Assistance) supports partnerships between higher education institutions and humanitarian organizations worldwide with the objective to enhance the professionalization of the humanitarian sector. While coordination and control of the humanitarian sector has plagued the response to every major crisis, concerns highlighted by the 2010 Haitian earthquake response further catalyzed and accelerated the need to ensure competency-based professionalization of the humanitarian health care work force. The Harvard Humanitarian Initiative sponsored an independent survey of established academically affiliated training centers in North America that train humanitarian health care workers...

  12. Throwing the Baby Out With the Bathwater: Can the Military's Role in Global Health Crises be Redeemed?

    Burkle, Frederick
    For decades, military humanitarian assistance programs have avoided empirical scrutiny, leaving researchers, the humanitarian community and decision makers without proof of outcome. This Editorial highlights the findings of three major studies that disclose deficits in the quality of the performance and reporting of humanitarian missions, and offer guidance for change. The author suggests that, contrary to current plans to limit the military's role in humanitarian assistance, emerging crises actually increase civilian security risks and that it is time for a new partnership of military and civilian humanitarian resources to evolve in the interest of human security.

  13. Civilian mortality after the 2003 invasion of Iraq

    Burkle, Frederick; Garfield, Richard

  14. Resource allocation processes at multilateral organizations working in global health

    Chi, Y-Ling; Bump, Jesse B
    Abstract International institutions provide well over US$10 billion in development assistance for health (DAH) annually and between 1990 and 2014, DAH disbursements totaled $458 billion but how do they decide who gets what, and for what purpose? In this article, we explore how allocation decisions were made by the nine convening agencies of the Equitable Access Initiative. We provide clear, plain language descriptions of the complete process from resource mobilization to allocation for the nine multilateral agencies with prominent agendas in global health. Then, through a comparative analysis we illuminate the choices and strategies employed in the nine international institutions....

  15. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia

    Montagu, Dominic; Sudhinaraset, May; Diamond-Smith, Nadia; Campbell, Oona; Gabrysch, Sabine; Freedman, Lynn; Kruk, Margaret E; Donnay, France
    Abstract Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing...

  16. The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health

    Haakenstad, Annie; Templin, Tara; Lim, Stephen; Bump, Jesse B; Dieleman, Joseph
    Abstract As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to direct funding to those most in need. In our ‘financing gaps framework’, we propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customizable to a range of organizational contexts and health aims. Our framework brings together expected health spending, potential health spending and...

  17. Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study

    Jolivet, R. Rima; Uttekar, Bella Vasant; O’Connor, Meaghan; Lakhwani, Kanchan; Sharma, Jigyasa; Wegner, Mary Nell
    Background: Making high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in...

  18. Detecting phenotype-driven transitions in regulatory network structure

    Padi, Megha; Quackenbush, John
    Complex traits and diseases like human height or cancer are often not caused by a single mutation or genetic variant, but instead arise from functional changes in the underlying molecular network. Biological networks are known to be highly modular and contain dense “communities” of genes that carry out cellular processes, but these structures change between tissues, during development, and in disease. While many methods exist for inferring networks and analyzing their topologies separately, there is a lack of robust methods for quantifying differences in network structure. Here, we describe ALPACA (ALtered Partitions Across Community Architectures), a method for comparing two...

  19. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico

    Bashash, Morteza; Thomas, Deena; Hu, Howard; Angeles Martinez-Mier, E.; Sanchez, Brisa N.; Basu, Niladri; Peterson, Karen E.; Ettinger, Adrienne S.; Wright, Robert; Zhang, Zhenzhen; Liu, Yun; Schnaas, Lourdes; Mercado-García, Adriana; María Téllez-Rojo, Martha; Hernández-Avila, Mauricio
    Background: Some evidence suggests that fluoride may be neurotoxic to children. Few of the epidemiologic studies have been longitudinal, had individual measures of fluoride exposure, addressed the impact of prenatal exposures or involved more than 100 participants. Objective: Our aim was to estimate the association of prenatal exposure to fluoride with offspring neurocognitive development. Methods: We studied participants from the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) project. An ion-selective electrode technique was used to measure fluoride in archived urine samples taken from mothers during pregnancy and from their children when 6–12 y old, adjusted for urinary creatinine...

  20. Fat-soluble vitamins A and E and health disparities in a cohort of pregnant women at delivery

    Hanson, Corrine; Schumacher, Marina Verdi; Lyden, Elizabeth; Su, Dejun; Furtado, Jeremy; Cammack, Rex; Bereitschaft, Bradley; Van Ormer, Matthew; Needelman, Howard; McGinn, Elizabeth; Rilett, Katherine; Cave, Caleb; Johnson, Rebecca; Weishaar, Kara; Anderson-Berry, Ann
    The objective of the present study was to evaluate intakes and serum levels of vitamin A, vitamin E, and related compounds in a cohort of maternal–infant pairs in the Midwestern USA in relation to measures of health disparities. Concentrations of carotenoids and tocopherols in maternal serum were measured using HPLC and measures of socio-economic status, including food security and food desert residence, were obtained in 180 mothers upon admission to a Midwestern Academic Medical Center labour and delivery unit. The Kruskal–Wallis and independent-samples t tests were used to compare measures between groups; logistic regression models were used to adjust for...

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