4,947 research outputs found

    Efectos de un nuevo nutracéutico basado en aceite de oliva virgen extra, aceite de algas y extracto de hojas de olivo sobre las alteraciones metabólicas y cardiovasculares asociadas al envejecimiento

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    Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Fisiología. Fecha de Lectura: 23-07-2021Esta tesis tiene embargado el acceso al texto completo hasta el 23-01-2023Este trabajo de investigación ha sido financiado por la beca “Doctorados Industriales 2017” (IND2017/BIO7701) de la Comunidad de Madri

    Enhancing Scotland’s Childsmile programme through Community Linking to address child oral health inequalities

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    Dental caries in primary teeth affects over 530 million children globally, and outcomes are significantly associated with social circumstances. Scotland’s national child oral health improvement programme Childsmile has in part been responsible for improvements in oral health over the past decade, but inequality based on socioeconomic factors persists. Community Linking/Social Prescribing aims to reduce inequality through addressing the social determinants of health by engaging patients with community services/third-sector support. The Childsmile programme employs Dental Health Support Workers who provide targeted and tailored interventions to families most in need. Part of the role of Dental Health Support Workers is to link families experiencing wider social and economic problems to external community services/resources where tailored support can be offered. This thesis describes research which aims to optimise Childsmile’s Community Linking/Social Prescribing pathway for families of young children to improve oral health and tackle the social determinants of health to reduce inequalities. Methodology: A mixed methods approach was employed, and three studies were conducted. Study one used secondary analysis of population-wide individuallevel linked routine administrative data and health data to investigate Community Linking practice within Childsmile. The second study was a Systematic Overview of systematic reviews and guidelines to assess best practices for Community Linking, drawing from literature across Primary Care health services and using the Consolidated Framework for Implementation Research (CFIR) model to guide analysis and reporting. The third study was an online national survey of Dental Health Support Workers to assess the feasibility and acceptability of Community Linking. The first and the second study informed the survey content, and again the CFIR guided survey design. IBM SPSS v26 was used to describe quantitative data, and QRS NVivo v12 was used for qualitative thematic analysis. Results: Secondary analysis of linked data showed just over a fifth of families were referred to a Dental Health Support Worker for additional support over the study years, reflecting the targeted nature of this Childsmile intervention. Among these families, the percentages who were linked to external community services/resources increased from 1.8% (219/12169) in 2011 to 21.0% (1227/5833) in 2015, with the main support services being related to nutrition/diet and parent/baby support groups. Families living in the most deprived areas of Scotland and those determined by their Health Visitor to have greater support needs were more likely to be linked to wider community services by Dental Health Support Workers; however, there was significant variation in linking rates. The Systematic Overview key findings highlight several programme delivery aspects associated with best practice, such as basing programmes on high-quality evidence, obtaining resources, and being flexible in approach, developing trust among partners and assessing participants' needs to provide a tailored pathway. An optimum level of training, mentoring, and feedback is required for Community Health Workers. The Community Health Workers' characteristics should be such that they are perceived as leaders in the community and are respected. The services should be accessible and perceived by the participants as beneficial. Inter-sectoral working is also key. Partners should have enough time to develop understanding, communicate, network, and implement and evaluate the Community Linking implementation. The Systematic Overview showed a need for a multilevel pragmatic approach. The Online Survey of Dental Health Support Workers had a response rate of 58% (59/102) from 13/14 geographical health boards. Results demonstrated high awareness of Community Linking: 88% (52/59) of respondents agreed that this is a good way to improve child oral health, and 72% (42/59) had some experience of Community Linking in their current role. Feedback from community services and families was lacking. More than three quarters, 85% (50/59), said they would be able to identify appropriate community organisations for Community Linking. Thematic illustrations of open-ended responses showed: workload and time barriers when working with families; the importance of collaborative working, for example, with social services and education; training of staff to overcome these barriers, such as local area knowledge; the importance of building trust with families; and the importance of actively facilitating and supporting access to services. Conclusion: Community Linking is a relatively new concept in dental public health. It is implemented within the Childsmile programme via Dental Health Support Workers and is considered a route to help families in need of support and address socio-economic inequalities in oral health. According to our findings, future implementation work in Childsmile is broadly supported by moderate quality evidence and perceptions on acceptability and feasibility. Programme theory is articulated in Chapter 7, which shows the need to tailor links to need and foster integrated working, with clear communication routes between referrers and community organisations, including those for monitoring and evaluation. Staff are supportive of this as a route to a range of positive health outcomes. Nevertheless, workload/resource barriers need to be considered, and support and training are required in terms of available community resources and building sustainable links

    A human centered design approach: utilizing family voice to drive practice transformation in Boston medical center’s pediatric practice of the future

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    Pediatric primary care is the first line of defense when it comes to the health and wellbeing of a child. During the first few years of life, outside of the patient’s family, primary care is the most consistent provision of care and developmental screening for families. To address the current needs of patients, The Center for the Urban Child, and Healthy Family at Boston Medical Center (BMC) developed a new model of care using Human Centered Design methods to promote an equitable health system. The main objective of this study is to explore ways to optimize care provided at BMC by utilizing family feedback and implementing changes accordingly in the care design for the Practice of the Future (POF) clinic. This quality improvement research data was used to analyze the core drivers of family well-being: economic wellbeing, school readiness, health equity, and integrated care. Additionally, qualitative feedback was elicited from families through surveys regarding the care they receive from the POF clinic. The results indicated that parents were overall satisfied with the care they receive and have few concerns about their encounters with providers and staff regarding racial and health equity and care integration. Many of our POF families have a higher prevalence of financial distress and low financial well-being compared to the national sample on the IFDW scale. We found different results using the CFPB scale. The POF clinic is building systems to present the results to the families in a way that ensures that their priorities are at the center of the model and that their comments are leading to improvements to model of care

    SUPERVISED CANCER REHABILITATION: APPLICATIONS FOR UTILIZING EXISTING CARDIOPULMONARY REHABILITATION FACILITIES FOR CANCER PATIENTS AND SURVIVORS

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    Currently, the NIH reports there are approximately 18 million Americans with a history of cancer. Cancer statistics are projected to rise to 22.1 million by 2030. In addition to cancer, cardiovascular diseases are globally the leading causes of mortality and morbidity. The body of research in this area clearly demonstrates that greater amounts of physical activity correspond with a lower risk of cancer recurrence and all-cause mortality, including cardiovascular disease (CVD). Exercise rehabilitation success in cancer patients, both during and after treatment, is limited by several barriers, including the lack of facilities, trained personnel and financial resources. In response to this medical need, it seems logical for oncology patients to be able to utilize current cardiac rehabilitation models. Cardio-oncology rehabilitation is a multi-component exercise-based intervention. Current projections suggest that few adjustments to current cardiac rehabilitation models would be needed to address the oncology rehabilitation model, although strategic differences to be addressed include addressing the adverse effects from certain chemotherapies, surgical interventions and lymphedema. Secondary to this narrative, there exists a bidirectional relationship between these two leading chronic diseases: in that cardiovascular diseases increase the likelihood of getting cancer and vice versa. Accordingly, use of cardiac facilities may extend the benefits of exercise beyond therapeutic applications to cancer, in that potential concerns related to CVD could also be addressed. Based on this rationale, the purpose of this professional paper will explore the utilization of existing staff and equipment currently being used in cardiopulmonary rehabilitation (CPR) field and how that can be utilized concomitantly with oncology rehabilitation populations

    Designing and evaluating a participatory workplace nutrition intervention to improve the health and wellbeing of blue-collar (construction) workers

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    Background: Construction is an important industry, estimated to employ 7% of the UK workforce and accounting for 6% of the total economic output. A poor state of health and wellbeing of construction labourers has been widely recognised, with workers suffering from a high number of work-related injuries and occupational health problems, including musculoskeletal and lung illnesses as well as poor mental health. In addition, construction workers struggle with healthy food choices due to lack of knowledge, long working hours, remote site locations, poor food facilities on site, and temporary accommodation. Yet, nutrition interventions in construction are rare, with no UK studies.Aim: The study aimed to design and evaluate a participatory nutrition intervention to improve the health and wellbeing of construction workers. Methods: A mixed-methods approach was used and the study included three stages. The first, exploratory phase of the project, comprising the literature review and focus groups with construction workers and managers (n=5), informed and determined the next phases, including the questionnaire development and subsequent intervention design. In the next stage, the baseline questionnaire was distributed (n=51), the intervention was designed using the COM-B model and the Behaviour Change Wheel and implemented on a construction site. In the last, evaluation stage, results from the follow-up questionnaires (n=22), findings from individual interviewees (n=13) as well as an intervention plan, checklists and researcher’s notes were used.Results: Findings from the literature review and focus groups explored construction workers’ nutrition behaviours, identified barriers and facilitators to healthy nutrition choices in the workplace and investigated perceptions of current health interventions, and ways to design a nutrition intervention suitable for the industry. Following the intervention, the questionnaire results showed changes in health and wellbeing outcomes as well as nutrition knowledge, nutrition behaviour and body composition measures (e.g., weight, fat mass, fat free mass, BMI). In addition, data from individual interviews with managers and workers who attended the intervention allowed the evaluation outcomes to be appraised and understood further, in relation to the implementation, fidelity, dose received, dose delivered, reach and recruitment. Conclusions: Overall, this study shows the process of designing a construction industry tailored nutrition intervention in a participatory manner. The findings indicate that despite context related barriers to the implementation, workplace interventions taking place on ‘real-life’ working construction sites are possible and can bring positive changes, at 6 month follow-up

    Small newborns in post-conflict Northern Uganda: Burden and interventions for improved outcomes

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    Introduction: A small newborn can be the result of either a low birthweight (LBW), or a preterm birth (PB), or both. LBW can be due to either a preterm appropriate-for gestational-age (preterm-AGA), or a term small-for-gestational age (term-SGA) or intrauterine growth restriction (IUGR). An IUGR is a limited in-utero foetal growth rates or foetal weight < 10th percentile. Small newborns have an increased risk of dying, particularly in low-resource settings. We set out to assess the burden, the modifiable risk factors and health outcomes of small newborns in the post-conflict Northern Ugandan district of Lira. In addition, we studied the use of video-debriefing when training health staff in Helping Babies Breathe. Subjects and methods: In 2018-19, we conducted a community-based cohort study on 1556 mother-infant dyads, nested within a cluster randomized trial. In our cohort study, we estimated the incidence and risk factors for LBW and PB and the association of LBW with severe outcomes. We explored the prevalence of and factors associated with neonatal hypoglycaemia, as well as any association between neonatal death and hypoglycaemia. In addition, we conducted a cluster randomized trial to compare Helping Babies Breathe (HBB) training in combination with video debriefing to the traditional HBB training alone on the attainment and retention of health worker neonatal resuscitation competency. Results: The incidence of LBW and PB in our cohort was lower than the global estimates, 7.3% and 5.0%, respectively. Intermittent preventive treatment for malaria was associated with a reduced risk of LBW. HIV infection was associated with an increased risk of both LBW and PB, while maternal formal education (schooling) of ≥7 years was associated with a reduced risk of LBW and PB. The proportions of neonatal deaths were many-folds higher among LBW infants compared to their non-LBW counterparts. The proportion of neonatal deaths among LBW was 103/1000 live births compared to 5/1000 among the non-LBW. The prevalence of neonatal hypoglycaemia in our cohort was 2.5%. LBW and PB each independently were associated with an increased risk of neonatal hypoglycaemia. Neonatal hypoglycaemia was associated with an increased risk of hospitalisation and severe outcomes. We demonstrated that neonatal resuscitation training with video debriefing, improved competence attainment and retention among health workers, compared to traditional HBB training alone. Conclusion: In northern Uganda, small infants still have a many-fold higher risk of dying compared to normal infants. In addition, small infants are also at more risk of neonatal hypoglycaemia compared to normal infants. Efforts are needed to secure essential newborn care, should we reach the target of Sustainable Development Goal number 3.2 of reducing infant mortality to less than 12/1000 live births by 2030

    Anuário científico da Escola Superior de Tecnologia da Saúde de Lisboa - 2021

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    É com grande prazer que apresentamos a mais recente edição (a 11.ª) do Anuário Científico da Escola Superior de Tecnologia da Saúde de Lisboa. Como instituição de ensino superior, temos o compromisso de promover e incentivar a pesquisa científica em todas as áreas do conhecimento que contemplam a nossa missão. Esta publicação tem como objetivo divulgar toda a produção científica desenvolvida pelos Professores, Investigadores, Estudantes e Pessoal não Docente da ESTeSL durante 2021. Este Anuário é, assim, o reflexo do trabalho árduo e dedicado da nossa comunidade, que se empenhou na produção de conteúdo científico de elevada qualidade e partilhada com a Sociedade na forma de livros, capítulos de livros, artigos publicados em revistas nacionais e internacionais, resumos de comunicações orais e pósteres, bem como resultado dos trabalhos de 1º e 2º ciclo. Com isto, o conteúdo desta publicação abrange uma ampla variedade de tópicos, desde temas mais fundamentais até estudos de aplicação prática em contextos específicos de Saúde, refletindo desta forma a pluralidade e diversidade de áreas que definem, e tornam única, a ESTeSL. Acreditamos que a investigação e pesquisa científica é um eixo fundamental para o desenvolvimento da sociedade e é por isso que incentivamos os nossos estudantes a envolverem-se em atividades de pesquisa e prática baseada na evidência desde o início dos seus estudos na ESTeSL. Esta publicação é um exemplo do sucesso desses esforços, sendo a maior de sempre, o que faz com que estejamos muito orgulhosos em partilhar os resultados e descobertas dos nossos investigadores com a comunidade científica e o público em geral. Esperamos que este Anuário inspire e motive outros estudantes, profissionais de saúde, professores e outros colaboradores a continuarem a explorar novas ideias e contribuir para o avanço da ciência e da tecnologia no corpo de conhecimento próprio das áreas que compõe a ESTeSL. Agradecemos a todos os envolvidos na produção deste anuário e desejamos uma leitura inspiradora e agradável.info:eu-repo/semantics/publishedVersio

    The development and applications of ceragenins and bone-binding antimicrobials to prevent osteomyelitis in orthopaedic patients

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    Bone infection remains a high-burden disease in orthopaedic and trauma patients with fractures and implantations. Osteomyelitis is difficult to cure in clinical settings, especially if antimicrobial resistance or biofilm is involved, which may prolong the treatments with antibiotics and require multiple surgeries, severely affecting the patients' quality of life and mobility. Osteomyelitis can lead to osteonecrosis, septicaemia, amputation, multi-organ dysfunction, and death in severe cases. Preclinical models are essential for efficacy testing to develop new prophylactic and therapeutic interventions. Previously bone infection models in rats involved fractures and implantations, making it complicated to perform. In this study, we have developed and optimised murine models with a tibial drilled hole (TDH) and needle insertion surgery (NIS) that are reliable, reproducible, and cost-effective for studying implant- related and biofilm bone infections and efficacy testing. Ceragenins (CSAs) are a novel class of broad-spectrum antimicrobials that mimic the activities of antimicrobial peptides. They are effective against bacterial, viral, fungal, and parasitic infections with low minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs). CSAs can also penetrate biofilm and kill antimicrobial-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). In recent years, CSA-131 has been approved by the FDA for endotracheal tube coating to prevent infection in intubated and critical patients. In our study, we applied CSA-90 (which belongs to the same family as CSA-131) to implant coating and prevented osteomyelitis in a mouse model and demonstrated the osteogenic properties of CSA- 90, which promotes bone healing and reunion of the bone defects. CSA-90 has been classified as a potential drug to prevent and treat osteomyelitis. However, conventional methods of antibiotic delivery to the bone are inefficient. To increase the bone-binding property of CSA-90, we invented a new molecule by attaching alendronate (bisphosphonate) to CSA-90 and named it bone-binding antimicrobial-1 (BBA-1). In vitro, we determined the bone-binding properties of BBA-1 and confirmed its antimicrobial activities against S. aureus. Later, we conducted a preclinical trial to test the in vivo efficacy of BBA-1 and showed that BBA-1 could prevent osteomyelitis in mice and has low cytotoxicity. Multiple myeloma (MM) is an aggressive cancer of plasma cells. Although chemotherapy, corticosteroids, and radiation therapy manage multiple myeloma, MM has no cure. Most MM patients (>90%) suffer myeloma-skeletal disease, including local osteolytic lesions and osteomyelitis. Thus, we dedicate the clinical application of BBA-1 to MM patients. To pursue clinical trials, preclinical trials must be conducted. In our attempts, we proposed a feasible murine model that can induce bone infections in MM mice and elucidated how MM patients will benefit from BBA-1

    Epilepsy Mortality: Leading Causes of Death, Co-morbidities, Cardiovascular Risk and Prevention

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    a reuptake inhibitor selectively prevents seizure-induced sudden death in the DBA/1 mouse model of sudden unexpected ... Bilateral lesions of the fastigial nucleus prevent the recovery of blood pressure following hypotension induced by&nbsp;..
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