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Implementation Science Communications Mar 2024Participatory design approaches can improve successful selection and tailoring of implementation strategies by centering the voices of key constituents. To reduce...
Co-designing strategies to implement long-acting injectable PrEP for sexual minority men in Chicago: a study protocol for an innovation tournament and implementation mapping.
BACKGROUND
Participatory design approaches can improve successful selection and tailoring of implementation strategies by centering the voices of key constituents. To reduce incidence of the human immunodeficiency virus (HIV) in the USA, co-design of implementation strategies is needed for long-acting injectable cabotegravir (CAB-LA), a new form of HIV pre-exposure prophylaxis, among the disproportionately impacted population of sexual minority men (SMM). This manuscript describes the protocol for participatory design approaches (i.e., innovation tournament and implementation mapping) to inform implementation of CAB-LA among SMM (≥ 12 years), particularly Black and Latino populations, in Chicago.
METHODS
This research incorporates innovative methods to accomplish two objectives: (1) to crowdsource ideas for the design of implementation strategies for CAB-LA through a virtual innovation tournament and (2) to leverage the ideas from the innovation tournament to operationalize implementation strategies for CAB-LA thorough the systematic process of implementation mapping. A committee of constituents with diverse expertise and perspectives (e.g., SMM, implementation scientists, HIV clinicians, public health leadership, and community partners) will provide input throughout the design process.
DISCUSSION
This research will produce a menu of co-designed implementation strategies, which can guide plans for CAB-LA integration in Chicago and provide insights for other EHE regions. Further, as the first innovation tournament focused on HIV prevention, this research can provide a framework for participatory approaches across the care continuum. Given that the co-design of implementation strategies often does not involve the participation of individuals with lived experiences, this work will center the voices of those who will benefit most.
PubMed: 38528628
DOI: 10.1186/s43058-024-00574-z -
Digestive Diseases and Sciences May 2024Data are limited on the safety and efficacy of combining advanced therapies for refractory patients with IBD.
BACKGROUND
Data are limited on the safety and efficacy of combining advanced therapies for refractory patients with IBD.
AIM
To evaluate the real-world efficacy and safety of dual advanced therapy (DAT), combining 2 biologics or a biologic with a small molecule, in children and young adults with refractory IBD.
METHODS
Primary outcome of this single IBD center cohort was DAT remission (clinical and biomarker remission) at first assessment (T1). Secondary outcomes included remission at T2, if DAT de-intensification (De-I) occurred and T3, if T2 DAT re-intensification (Re-I) occurred. Efficacy and safety outcomes were described.
RESULTS
Of the 30 patients [43% female, 30% CD, median age of 18.3 [15.1-19.8] years], all 11 UST + TOFA achieved T1 remission; 6/10 De-I failed at T2; and 4/4 Re-I achieved T3 remission. Of 9 VDZ + TOFA, 6 achieved T1 remission; 5/6 De-I failed at T2; and 1/1 failed T3 Re-I. Of 4 UST + VDZ, 3 achieved T1 remission; 2/3 De-I failed at T2; and 0 had Re-I. Of 5 UST + UPA, 4 achieved T1 remission; 1/5 De-I failed at T2 but recaptured T3 remission post-Re-I. One VDZ + OZA achieved T1 remission and maintained T2 remission post-De-I to OZA monotherapy. At last follow-up, 43% were on original DAT, 17% on one of original DAT, and 40% neither. One UST + TOFA patient developed mild leukopenia and another developed septic arthritis and venous thromboembolism on VDZ + TOFA and prednisone.
CONCLUSION
Most children and young adults treated with DAT achieved remission with minimal safety events; however, de-intensification had limited success.
Topics: Humans; Female; Male; Adolescent; Young Adult; Remission Induction; Treatment Outcome; Drug Therapy, Combination; Gastrointestinal Agents; Biological Products; Crohn Disease; Colitis, Ulcerative; Retrospective Studies; Inflammatory Bowel Diseases
PubMed: 38521850
DOI: 10.1007/s10620-024-08379-9 -
Otolaryngologic Clinics of North America Aug 2024The upper aerodigestive system is closely intertwined from an embryologic and functional perspective. Laryngotracheal anatomic abnormalities, such as laryngomalacia,... (Review)
Review
The upper aerodigestive system is closely intertwined from an embryologic and functional perspective. Laryngotracheal anatomic abnormalities, such as laryngomalacia, stenosis, vocal cord paralysis, and laryngeal clefts, affect not only the respiratory function but also the swallow function. Laryngotracheal pathology can interfere with the suck-swallow-breathe mechanism in infants. It can also exacerbate gastroesophageal reflux. Chronic aspiration secondary to laryngotracheal anomalies can result in respiratory and pulmonary complications. Surgical treatment of laryngotracheal anomalies can also cause transient or long-term swallow dysfunction. Multidisciplinary approaches and clinical assessment of swallowing are important in patients with laryngotracheal pathology.
Topics: Humans; Deglutition Disorders; Larynx; Child; Infant; Laryngomalacia; Gastroesophageal Reflux; Laryngeal Diseases; Vocal Cord Paralysis; Deglutition; Congenital Abnormalities
PubMed: 38503669
DOI: 10.1016/j.otc.2024.02.014 -
Otolaryngologic Clinics of North America Aug 2024Oral causes of dysphagia in infancy may involve the lips, the tongue, or the palate. Whereas ankyloglossia is commonly diagnosed in infants with dysphagia, assessment of... (Review)
Review
Oral causes of dysphagia in infancy may involve the lips, the tongue, or the palate. Whereas ankyloglossia is commonly diagnosed in infants with dysphagia, assessment of the need for surgical intervention may be less straightforward. Tongue size (macroglossia) may be associated with dysphagia as it may cause limitation of movement of the food or milk bolus by the lips or cheeks. Congenital conditions such as cleft lip and palate, micrognathia, or craniofacial microsomia may also be associated with dysphagia. Diagnosis and treatment of these conditions can be improved with the engagement of lactation and feeding experts as well as multidisciplinary craniofacial teams.
Topics: Humans; Deglutition Disorders; Infant; Tongue; Child; Ankyloglossia; Cleft Palate; Cleft Lip; Lip; Mouth Abnormalities; Micrognathism
PubMed: 38503668
DOI: 10.1016/j.otc.2024.02.012 -
Vaccine Apr 2024Prior experience of an adverse event following immunisation is a known barrier to vaccination. Limited Australian data evaluating adverse event recurrence among children...
OBJECTIVE
Prior experience of an adverse event following immunisation is a known barrier to vaccination. Limited Australian data evaluating adverse event recurrence among children exists to inform clinical decisions. We aimed to assess adverse event following immunisation recurrence among children with prior adverse events and to evaluate if family history increased adverse event risk.
METHODS
A prospective cohort study was conducted from March 3rd until August 18th, 2023. Children ≤ 16 years with prior adverse events following immunisation in themselves or family were recruited from specialist immunisation clinics at two quaternary paediatric hospitals. Adverse event outcomes were collected via surveys administered at presentation, three, and eight days post vaccination, and analysed by key characteristics and potential risk factors.
RESULTS
Forty three of forty nine (43/49, 87.8 %) children enrolled received further vaccines. Of those who completed the follow up surveys, 50.0 % (16/32) reported an adverse event. Recurrence of prior adverse events occurred for 23.3 % (10/43, 95 % CI: 11.8 % - 38.6 %) of the cohort. Two of twelve (2/12, 16.7 %) participants with prior serious adverse events who received further vaccines reported a serious adverse event recurrence. No post review serious adverse events were observed in children with prior non serious adverse events. Neurological conditions were a risk factor for prior (neurological condition 3/3 versus no neurological condition 2/40, p < 0.001) and post review (neurological condition 2/3 versus no neurological condition 0/28, p = 0.006) post vaccination seizures. Family history had no relationship to post review adverse events (family history 5/8 versus no family history 11/23, p = 0.685).
CONCLUSION
Revaccination is safe for the majority of children with a personal or family history of adverse event following immunisation.
Topics: Child; Humans; Australia; Immunization, Secondary; Prospective Studies; Vaccination; Vaccines; Adolescent
PubMed: 38490823
DOI: 10.1016/j.vaccine.2024.03.025 -
Healthcare Quarterly (Toronto, Ont.) Jan 2024Vulnerable populations such as low-income older adults in social housing suffer from poor quality of life and are impacted by chronic diseases. These populations are...
Vulnerable populations such as low-income older adults in social housing suffer from poor quality of life and are impacted by chronic diseases. These populations are also high users of emergency services, which contribute to high healthcare costs. Community-based, patient-centred interventions, such as community paramedicine (CP) programs, can address the healthcare gaps for these underserved populations. Community Paramedicine at Clinic (CP@clinic) is an innovative, evidence-based, chronic disease prevention/management program that improves patient health and quality of life, connects them with health and community services, preserves healthcare resources and yields cost savings for the emergency care system. The program also works with other community organizations, facilitating interprofessional engagement and supporting other disciplines in providing care. Known barriers to implementing CP programs highlight the importance of standard practices and training as exemplified by the CP@clinic program.
Topics: Humans; Aged; Paramedicine; Quality of Life; Delivery of Health Care; Emergency Medical Services; Health Care Costs
PubMed: 38482648
DOI: 10.12927/hcq.2024.27254 -
Nutrients Feb 2024Gut dysbiosis refers to an imbalance in gut microbiota composition and function. extract has been shown to modulate gut microbiota by improving SCFA production in vivo... (Randomized Controlled Trial)
Randomized Controlled Trial
Gut dysbiosis refers to an imbalance in gut microbiota composition and function. extract has been shown to modulate gut microbiota by improving SCFA production in vivo and gastrointestinal discomfort (GD) in humans. The aim of this study was to demonstrate the efficacy of Odilia on gastrointestinal health by changing the microbial diversity of species involved in inflammation, immunity, oxidation, and the brain-gut-muscle axis. A randomized, double-blind clinical trial was conducted in 80 adults with gut dysbiosis. The intervention consisted of a 300 mg daily intake of Odilia (n = 40) or maltodextrin as a placebo (n = 40), administered for 8 weeks. Intervention effect was evaluated using 16S metagenomics and GIQLI/GSAS scores at baseline, at 4 and 8 weeks. Eight weeks of Odilia supplementation positively modulates gut microbiota composition with a significant reduction in the to ratio ( = 0.0012). Relative abundances of beneficial bacteria ( and ) were significantly increased ( < 0.001), in contrast to a significant reduction in pro-inflammatory bacteria ( < 0.001). Accordingly, GIQLI and GSAS scores revealed successful improvement in GD. Odilia may represent an effective and well-tolerated treatment in subjects with gut dysbiosis.
Topics: Adult; Humans; Prebiotics; Opuntia; Dysbiosis; Feces; Bacteria; Double-Blind Method
PubMed: 38474715
DOI: 10.3390/nu16050586 -
Cureus Feb 2024The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children,...
BACKGROUND AND OBJECTIVES
The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children, utilizing measurements obtained through Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA).
METHODOLOGY
A cross-sectional study was conducted on 95 Malay children, aged between seven and 17 years, with no ocular abnormalities. It was held at Hospital Universiti Sains Malaysia, Malaysia, from January 2014 to December 2015. All children underwent a full ocular examination, including refraction and calculation of axial length. ONH and retinal nerve fiber layer thickness (RNFLT) parameters were measured using the Cirrus SD-OCT machine. One eye of each subject was selected randomly for study. The associations between the parameters and the effect of age, gender, axial length, and spherical equivalent (SE) on the measurements were statistically validated.
RESULTS
Ninety-five children were involved in the study, with 65 females (68.4%) and 30 males (31.6%). The mean age was 10.6 (2.82) years, the mean intraocular pressure (IOP) was 14.8 (2.81) mmHg, the mean SE-refraction was 0.12 (0.28) diopters, and the mean axial length was 23.03 (0.76) mm. The mean disc area, rim area, and cup volume were 2.32 (0.40) mm, 1.53 (0.33) mm, and 0.204 (0.16) mm, respectively. The average cup-to-disc ratio (SD) (CDR) and the vertical CDR were 0.55 (0.13) and 0.50 (0.14). Mean (SD) RNFLT was 102.08 (11.08) μm for all patients. There was a strong positive correlation between the average, superior, and inferior RNFLT with the optical disc area. The rim area and the average, superior, inferior, and nasal RNFLT also showed a significant correlation. The inferior RNFLT was negatively correlated with the average CDR. There was also a major influence of gender on the disc area. There were no major age, axial length, and SE influences on the measurements.
CONCLUSIONS
This study provided normative information for ONH and RNFLT parameters in emmetropic Malay children. It was observed that emmetropic Malay males exhibited a significantly larger optical disc area. The increase in RNFLT is correlated with a significant increase in disc and rim areas.
PubMed: 38465057
DOI: 10.7759/cureus.53890 -
Journal of the College of Physicians... Mar 2024Null.
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Revue Des Maladies Respiratoires Apr 2024Down syndrome (DS), or trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21, leading to various characteristic physical features as...
Down syndrome (DS), or trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21, leading to various characteristic physical features as well as developmental and cognitive delays. Obstructive sleep apnea syndrome (OSAS) is a common disorder in both adult and pediatric patients with DS. Several characteristics of DS may contribute to the development or worsening of OSAS. Numerous murine models of DS exist. A number of studies have explored apneas and the risk of upper airway obstruction in these models, but up until now, only in adulthood.
Topics: Adult; Humans; Animals; Child; Mice; Down Syndrome; Disease Models, Animal; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure
PubMed: 38461093
DOI: 10.1016/j.rmr.2024.02.010