BACKGROUND Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent ...Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps. METHODS To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals. RESULTS One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P<.001) or practice (95% vs 65%; P = .002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR. CONCLUSIONS Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.Arch Intern Med. 2004;164:1662-1668-->
To evaluate the relationship between birth weight and rapid weight gain in infancy and markers of overweight/obesity in childhood, using different cutoff values for rapid weight gain.
Cross-sectional ...study involving 98 5-year old pre-school Brazilian children. Rapid weight gain was considered as weight gain in standard deviation score (SDS) above +0.67, +1 and +2 in relation to birth weight, at any time during the first 2 years of life. The nutritional status of the children was determined by anthropometry and electrical bioimpedance. Multiple linear regression analysis was used, considering fat mass percentage, body mass index (BMI), waist and neck circumferences as outcomes.
Birth weight, rapid weight gain (assessed by different cutoff values) and maternal obesity were positively associated with increased fat mass percentage, BMI, waist and neck circumferences. Different cutoff values of rapid weight gain did not change the positive associations between rapid weight gain and fat mass percentage (>+0.67 SDS, P=0.007; >+1 SDS, P=0.007; >+2 SDS, P=0.01), BMI (>+0.67 SDS, P=0.002; >+1 SDS, P=0.007; >+2 SDS, P<0.001), waist circumference (>+0.67 SDS, P=0.002; >+1 SDS, P=0.002; >+2 SDS, P<0.001) and neck circumference (>+0.67 SDS, P=0.01; >+1 SDS, P=0.03; >+2 SDS, P<0.001).
The use of different cutoff values for the definition of rapid weight gain did not interfere in the associations between birth weight and rapid weight gain with fat mass percentage, BMI, waist and neck circumferences. Children with the highest birth weight, those who undergo rapid weight gain in infancy and whose mothers were obese, seemed to be more at risk for overweight/obesity.
Genes involved in the regulation of metabolism, adipose tissue deposition, inflammation, and the appetite-satiety axis may play an important role in fetal development, and possibly induce permanent ...metabolic changes and fat accumulation. In this study we investigated: (1) obesity-related gene expression in maternal and cord blood of overweight/obese and normal-weight pregnant women; (2) associations between obesity-related gene expression in maternal and cord blood; and (3) associations of gene expression in each of maternal and cord blood with newborn adiposity.
Twenty-five overweight/obese and 32 normal-weight pregnant women were selected from the Araraquara Cohort Study according to their pre-pregnancy BMI. Maternal and cord blood gene expression of LEPR, STAT3, PPARG, TLR4, IL-6, IL-10, FTO, MC4R, TNF-α, and NFκB were investigated by relative real-time PCR quantification. The body composition of the newborns was assessed by air displacement plethysmography. Associations between maternal and cord blood gene expression and markers of newborn adiposity (weight, BMI, and fat mass%) were explored by linear regression models controlling for maternal age, pre-pregnancy BMI, maternal gestational weight gain, gestational age, and newborn sex.
There was higher TLR4, NFκB, and TNF-a expression, and lower IL-6 expression, in overweight/obese pregnant women and their respective newborns compared with normal-weight women and their newborns (p < 0.001). Maternal PPARG gene expression was associated with both weight and fat mass % of the newborns, and cord blood IL-10 expression was associated with BMI and fat mass %, controlling for confounders.
To our knowledge, this is the first study to evaluate the relationship of maternal and cord blood gene expression with adiposity markers of the newborn. Our results provide evidence for the contribution of maternal and cord blood gene expression-particularly maternal PPARG and TLR4 expression, and cord blood IL-10 expression-to newborn weight, BMI, and fat mass %.
Turbidity has been used as an indicator of microbiological contamination of drinking water in time-series studies attempting to discern the presence of waterborne gastrointestinal illness; however, ...the utility of turbidity as a proxy exposure measure has been questioned.
We conducted a review of epidemiological studies of the association between turbidity of drinking-water supplies and incidence of acute gastrointestinal illness (AGI), including a synthesis of the overall weight of evidence. Our goal was to evaluate the potential for causal inference from the studies.
We identified 14 studies on the topic (distinct by region, time period and/or population). We evaluated each study with regard to modeling approaches, potential biases, and the strength of evidence. We also considered consistencies and differences in the collective results.
Positive associations between drinking-water turbidity and AGI incidence were found in different cities and time periods, and with both unfiltered and filtered supplies. There was some evidence for a stronger association at higher turbidity levels. The studies appeared to adequately adjust for confounding. There was fair consistency in the notable lags between turbidity measurement and AGI identification, which fell between 6 and 10 d in many studies.
The observed associations suggest a detectable incidence of waterborne AGI from drinking water in the systems and time periods studied. However, some discrepant results indicate that the association may be context specific. Combining turbidity with seasonal and climatic factors, additional water quality measures, and treatment data may enhance predictive modeling in future studies. https://doi.org/10.1289/EHP1090.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
•AIDS has become a chronic, potentially life-threatening, clinical condition.•An MILP model is proposed for planning HIV drug chemotherapy in the long term.•Real-world treatment strategies can be ...determined for resource-limited settings.•The solution framework proposed can be extended to other viral pathologies.
The dramatic reduction in morbidity and mortality associated with the use of highly active antiretroviral therapy has created new challenges for clinicians: AIDS has become a chronic, potentially life-threatening, condition in many clinical instances. In this paper, a novel system engineering approach based on mixed-integer linear programming (MILP) is presented to support HIV/AIDS clinicians when formulating real-world therapeutic plans for heavily treatment-experienced patients under variable settings. Our results suggest that, while current practices (standard protocols and/or subjective recommendations based on the clinician's experience) can generally provide satisfactory management of drug resistance in the short-term, optimization-based therapy planning has a far greater potential to achieve this goal over expanded time horizons thereby changing paradigms and rethinking best practices in the HIV/AIDS clinical arena. Moreover, the ability of this methodology to address other viral pathologies (e.g., hepatitis B and C virus) can make this work appeal to a broader audience.
Breast cancer is a disease characterised by both oxidative reactions and inflammation. However, few studies have focused on the oxidative and inflammatory biomarkers. The aim of the present study was ...to evaluate the association between oxidative stress markers and adiposity and clinical staging, as well as the association between the oxidative and the antioxidant biomarkers of women with breast cancer.
A total of 135 cases of breast cancer occurring in 2011 and 2012 were assessed. After exclusions, 101 pre- and post-menopausal women with clinical staging I to IV were eligible to participate in the study. The anthropometric evaluation was performed by collecting data on waist circumference, body mass index and body composition. The socioeconomic and clinical profiles were determined using a standard questionnaire. For the oxidative biomarkers, thiobarbituric acid reactive substances (TBARS), oxidative DNA damage (8-hydroxy-2-deoxyguanosine (8-OHdG)), low-density lipoprotein(-) (LDL(-)), autoantibody anti-LDL(-) and liposoluble antioxidants (α-tocopherol, retinol and β-carotene) were analysed. The data were analysed using differences in the mean values, correlation tests and multiple linear regression.
The antioxidant levels were higher in postmenopausal women with clinical staging I and II and negative lymph nodes. The TBARS level was associated with clinical staging. Adiposity was associated with levels of retinol and 8-OHdG, whereas LDL(-), 8-OHdG and TBARS were correlated with liposoluble antioxidants after adjusting for the confounders.
The adiposity and clinical staging of patients were associated with oxidative stress. The oxidative and antioxidant biomarkers showed a negative correlation in patients with breast cancer.
Abstract
Introduction
Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status ...strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.
Design
This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90
th
percentile), SGA (< 10
th
percentile), LGA (> 90
th
percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell
in natura
and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.
Results
We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA OR2nd tertile: 1.06 (1.05–1.07) and LBW OR2nd tertile: 1.11 (1.09–1.12). Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA OR3rd tertile: 1.04 (1.02–1.06) and LBW OR2nd tertile: 1.13 (1.11–1.16). Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA OR3rd tertile: 1.09 (1.01–1.18) and OR3rd tertile: 1.06 (1.04–1.09), respectively, while Mixed-race women also had a higher chance of having newborns with LBW OR3rd tertile: 1.17 (1.14–1.20). Indigenous women were associated with LGA OR3rd tertile: 1.20 (1.01–1.45).
Conclusion
The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
•Cord blood leptin and zinc-α2-glycoprotein are inversely associated with infant adiposity gain during the first months of life in girls.•Sexual dimorphism exists in fat mass development.•Adiponectin ...does not show any association with infant adiposity gain during the first months of life in girls or boys.
Adipose tissue development starts in intrauterine life and cytokines are involved in this process. Therefore, understanding the role of cytokines in the fat mass gain of infants is crucial to prevent obesity later in life. Furthermore, recent evidence indicates a sex-specific link between cytokines and adipose tissue development. The objective of this study was to assess sex-specific relationships of cord blood concentrations of the cytokines leptin, zinc-α2-glycoprotein (ZAG), and adiponectin with infant adiposity during the first 3 mo of life.
This was a prospective cohort study of 104 mother-infant pairs that were selected from a maternity hospital in Sao Paulo, Brazil. Cord blood leptin, ZAG, and adiponectin were determined by enzyme-linked immunosorbent assays. The body composition of the infants was assessed monthly by air displacement plethysmography. A multiple linear regression analysis was conducted with the average fat mass gain from birth to the third month of life as the outcome and cord blood leptin, ZAG, and adiponectin as the variables of interest.
Leptin was inversely associated with fat mass gain in the first 3 mo of life (P = 0.003; adjusted R2 = 0.09). There were inverse associations of leptin (P = 0.021), ZAG (P = 0.042), and maternal body mass index (P = 0.04) with fat mass gain in girls (adjusted R2 = 0.29) but fat mass gain in boys was positively associated with gestational age (P = 0.01; adjusted R2 = 0.15).
The results of this study suggest that adiposity programming is sex-specific, which highlights the need to investigate the different metabolic mechanisms that are involved in adipogenesis.
Emulsion inversion is a complex phenomenon, often perceived as an instability that is essentially uncontrollable, although many industrial processes make use of it. A research effort that started 2 ...decades ago has provided the two-dimensional and three-dimensional description, the categorization and the theoretical interpretation of the different kinds of emulsion inversion. A clear-cut phenomenological approach is currently available for understanding its characteristics, the factors that influence it and control it, the importance of fine-tuning the emulsification protocol, and the crucial occurrence of organized structures such as liquid crystals or multiple emulsions. The current know-how is used to analyze some industrial processes involving emulsion inversion, e.g. the attainment of a fine nutrient or cosmetic emulsion by temperature or formulation-induced transitional inversion, the preparation of a silicone oil emulsion by catastrophic phase inversion, the manufacture of a viscous polymer latex by combined inversion and the spontaneous but enigmatic inversion of emulsions used in metal working operations such as lathing or lamination.
PDF
