Sputum induction for the diagnosis of Pneumocystis pneumonia (PCP) is widely used for patients with acquired immunodeficiency syndrome (AIDS), but its utility for patients with other forms of ...immunocompromise is less well defined. Immunocompromised patients with PCP who do not have human immunodeficiency virus (HIV) infection have a lower burden of organisms, and sputum induction may consequently have lower diagnostic yield in these patients. However, this retrospective review of the experience at a tertiary referral center suggests that sputum induction has clinical utility for diagnosing PCP in immunocompromised patients without HIV infection.
ObjectivesWe aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies’ characteristics, climate impacts, health outcomes and key ...findings.DesignWe conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available.Data sourcesOn 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science.Eligibility criteriaWe included systematic reviews that explored at least one health impact of climate change.Data extraction and synthesisWe organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors’ affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies.ResultsWe included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research.ConclusionsMost systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.
Biosocial criminology-and biosocial criminologists-focuses on both the environmental and biological factors that contribute to antisocial behavior. Importantly, these two domains are not separate ...parts of an equation but pieces of the same puzzle that fit together for a complete picture of the causes of crime/antisocial behavior. Fitting the Facts of Crime applies a biopsychosocial lens to the "13 facts of crime" identified by John Braithwaite in his classic book, Crime, Shame and Reintegration. The authors unpack established facts-about gender and sex, age, environment, education, class, social bonds and associations, stress, and other influences-providing both empirical research and evidence from biopsychosocial criminology to address the etiology behind these facts and exactly how they are related to deviant behavior.With their approach, the authors show how biopsychosocial criminology can be a unifying framework to enrich our understanding of the most robust and well-established topics in the field. In so doing, they demonstrate how biological and psychological findings can be responsibly combined with social theories to lend new insight into existing inquiries and solutions. Designed to become a standard text for criminology in general, Fitting the Facts of Crime introduces key concepts and applies them to real-world situations.
Uninsured or underinsured individuals with cancer are likely to experience financial hardship, including forgoing healthcare or non-healthcare needs such as food, housing, or utilities. This study ...evaluates the association between health insurance coverage and financial hardship among cancer survivors during the COVID-19 pandemic. This cross-sectional analysis used Patient Advocate Foundation (PAF) survey data from May to July 2020. Cancer survivors who previously received case management or financial aid from PAF self-reported challenges paying for healthcare and non-healthcare needs during the COVID-19 pandemic. Associations between insurance coverage and payment challenges were estimated using Poisson regression with robust standard errors, which allowed for estimation of adjusted relative risks (aRR). Of 1,437 respondents, 74% had annual household incomes <$48,000. Most respondents were enrolled in Medicare (48%), 22% in employer-sponsored insurance, 13% in Medicaid, 6% in an Affordable Care Act (ACA) plan, and 3% were uninsured. Approximately 31% of respondents reported trouble paying for healthcare during the COVID-19 pandemic. Respondents who were uninsured (aRR 2.58, 95% confidence interval CI 1.83–3.64), enrolled in an ACA plan (aRR 1.86, 95% CI 1.28–2.72), employer-sponsored insurance (aRR 1.70, 95% CI 1.23–2.34), or Medicare (aRR 1.49, 95% CI 1.09–2.03) had higher risk of trouble paying for healthcare compared to Medicaid enrollees. Challenges paying for non-healthcare needs were reported by 57% of respondents, with 40% reporting trouble paying for food, 31% housing, 28% transportation, and 20% internet. In adjusted models, Medicare and employer-sponsored insurance enrollees were less likely to have difficulties paying for non-healthcare needs compared to Medicaid beneficiaries. Despite 97% of our cancer survivor sample being insured, 31% and 57% reported trouble paying for healthcare and non-healthcare needs during the COVID-19 pandemic, respectively. Greater attention to both medical and non-medical financial burden is needed given the economic pressures of the COVID-19 pandemic.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for ...patients with early-stage breast cancer (EBC). Clinical trials are needed to determine the feasibility of reducing treatment intensity while maintaining 3-year recurrence-free survival of greater than 92%. To recruit participants for these trials, it is important to understand patient perspectives on reducing chemotherapy.
We collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored potential barriers and facilitators to participation in trials testing reduced amounts of chemotherapy. As the COVID-19 pandemic struck during data collection, seventeen participants were asked about the potential impact of COVID-19 on their interest in these trials. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes.
Seventeen participants (42.5%) expressed interest in participating in a trial of reduced chemotherapy. Barriers to reducing chemotherapy included (1) fear of recurrence and inefficacy, (2) preference for aggressive treatment, (3) disinterest in clinical trials, (4) lack of information about expected outcomes, (5) fear of regret, and (6) having young children. Facilitators included (1) avoiding physical toxicity, (2) understanding the scientific rationale of reducing chemotherapy, (3) confidence in providers, (4) consistent monitoring and the option to increase dosage, (5) fewer financial and logistical challenges, and (6) contributing to scientific knowledge. Of those asked, nearly all participants said they would be more motivated to reduce treatment intensity in the context of COVID-19, primarily to avoid exposure to the virus while receiving treatment.
Among individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients will be more apt to participate in trials testing reduced amounts of chemotherapy if these are framed in terms of customizing treatment to the individual patient and added benefit-reduced toxicities, higher quality of life during treatment and lower risk of long-term complications-rather than in terms of taking treatments away or doing less than the standard of care. Doctor-patient rapport and provider support will be crucial in this process.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Also, if I am carrying bags and him, it makes it a lot easier if I have a shorter distance to walk. Maybe people should be complaining about those who use these spots who have only one capable ...12-year-old child with them, or those who use these spots and stay in the car with their baby while their spouse goes into the store.
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