259 research outputs found
Living with an Older Person Dying from Cancer, Lung Disease or Dementia: Health Outcomes from a General Practice Cohort Study
CONTEXT: Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care but their role may not be recognized. OBJECTIVES: To 1) establish the proportion of older cohabitees identified in primary care as "carers;" 2) describe demographic and lifestyle characteristics of cohabitees of people terminally ill with cancer, dementia, and chronic obstructive pulmonary disease (COPD); 3) describe their health a year before and after bereavement; and 5) compare health outcomes between cohabitees of people dying with cancer, COPD, or dementia. METHODS: Retrospective cohort study using a U.K. primary care database (The Health Improvement Network) of 13,693 bereaved cohabitees (a proxy marker for being a carer), aged 60 years or older of people dying from cancer, COPD, or dementia. Characteristics were described one year before and after bereavement. We compared cancer, COPD, and dementia cohabitee outcomes using incidence rate ratios one year before and after bereavement and calculated mortality risk post-bereavement. RESULTS: A total of 6.9% of cohabitees were recorded as carers. Health outcomes differed little between the three groups of cohabitees in the year prior to or after bereavement. The proportion of cohabitees with six or more consultations increased the year after bereavement (cancer cohabitees 16.0% to 18.8%, COPD cohabitees 17.8% to 20.4% and dementia cohabitees 15.5% to 17.5%). At post-bereavement (follow-up median 3 years, IQR 1.3-5.4), we found no mortality differences between the three groups. CONCLUSION: Recording of carers of terminally ill people was suboptimal. Cause of bereavement produced few differential effects on health outcomes or mortality
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Identification and measurement of intensive economic growth in a Roman imperial province
A key question in economic history is the degree to which preindustrial economies could generate sustained increases in per capita productivity. Previous studies suggest that, in many preindustrial contexts, growth was primarily a consequence of agglomeration. Here, we examine evidence for three different socioeconomic rates that are available from the archaeological record for Roman Britain. We find that all three measures show increasing returns to scale with settlement population, with a common elasticity that is consistent with the expectation from settlement scaling theory. We also identify a pattern of increase in baseline rates, similar to that observed in contemporary societies, suggesting that this economy did generate modest levels of per capita productivity growth over a four-century period. Last, we suggest that the observed growth is attributable to changes in transportation costs and to institutions and technologies related to socioeconomic interchange. These findings reinforce the view that differences between ancient and contemporary economies are more a matter of degree than kind
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Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation.
BackgroundSacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE.MethodsUsing a prospective patient registry, we identified patients <21years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals.ResultsTwenty-two patients (55% male, median 12years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12months (p<0.0001). Ten children (45%) had their cecostomy/appendicostomy closed. Laxative use, GSS, FIQL, and DES did not change. FISI improved over the first 12months with statistical significance reached only at 6months (p=0.02). Six (27%) children experienced complications after SNS that required further surgery.ConclusionsIn children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2years.Level of evidenceIV
CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.
BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load.
METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements 500 copies/”l, the first of two consecutive measurements between 50-500 copies/”l, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/”l (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/”l, 0.81 (0.71-0.92) for counts 200 to <350 cells/”l, 0.74 (0.66-0.83) for counts 350 to <500 cells/”l, and 0.96 (0.92-0.99) for counts â„500 cells/”l. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/”l.
CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/”l but still some slight benefit for those with a CD4 cell count â„500 cells/”l
An Environmental and Climate History of the Roman Expansion in Italy
A first synthesis of available data for the period of Romeâs expansion in Italy (about 400â29 b.c.e.) shows the role of climate and environment in early Roman imperialism. Although global indices suggest a warmer phase with relatively few short-term climate events occuring around the same time as the expansion, local data emphasize the highly variable timing and expression of these trends. This variability casts doubt on ideas of a unitary, historically consequential âRoman Warm Period.â The historical importance of climate and environment to socioeconomic development merits emphasis, but should be understood in terms of evolving, contingent forms of resilience and risk-mitigating behavior by Italian communities during Roman expansion
HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV
Many people who are HIV positive are unaware of their infection status. Estimation of the number of people with undiagnosed HIV within a country or region is vital for understanding future need for treatment and for motivating testing programs. We review the available estimation approaches which are in current use. They can be broadly classified into those based on prevalence surveys and those based on reported HIV and AIDS cases. Estimation based on prevalence data requires data from regular prevalence surveys in different population groups together with estimates of the size of these groups. The recommended minimal case reporting data needed to estimate the number of patients with undiagnosed HIV are HIV diagnoses, including CD4 count at diagnosis and whether there has been an AIDS diagnosis in the 3 months before or after HIV diagnosis, and data on deaths in people with HIV. We would encourage all countries to implement several methods that will help develop our understanding of strengths and weaknesses of the various methods
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Arable weed seeds as indicators of regional cereal provenance: a case study from Iron Age and Roman central-southern Britain
The ability to provenance crop remains from archaeological sites remains an outstanding research question in archaeology. Archaeobotanists have previously identified the movement of cereals on the basis of regional variations in the presence of cereal grain, chaff and weed seeds (the consumerâproducer debate), and weed seeds indicative of certain soil types, principally at Danebury hillfort. Whilst the former approach has been heavily criticised over the last decade, the qualitative methods of the latter have not been evaluated. The first interregional trade in cereals in Britain is currently dated to the Iron Age hillfort societies of the mid 1st millennium bc. Several centuries later, the development of urban settlements in the Late Iron Age and Roman period resulted in populations reliant on food which was produced elsewhere. Using the case study of central-southern Britain, centred on the oppidum (large fortified settlement) and civitas capital of Silchester, this paper presents the first regional quantitative analysis of arable weed seeds in order to identify the origin of the cereals consumed there. Analysis of the weed seeds which were present with the fine sieve by-products of the glume wheat Triticum spelta (spelt) shows that the weed floras of samples from diverse geological areas can be separated on the basis of the soil requirements of individual taxa. A preliminary finding is that, rather than being supplied with cereals from the wider landscape of the chalk region of the Hampshire Downs, the crops were grown close to Late Iron Age Silchester. The method presented here requires further high quality samples to evaluate this conclusion and other instances of cereal movement in the past
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'The debatable territory where geology and archaeology meet': reassessing the early archaeobotanical work of Clement Reid and Arthur Lyell at Roman Silchester
The first large-scale archaeobotanical study in Britain, conducted from 1899 to 1909 by Clement Reid and
Arthur Lyell at Silchester, provided the first evidence for the introduction of Roman plant foods to Britain,
yet the findings have thus far remained unverified. This paper presents a reassessment of these
archaeobotanical remains, now stored as part of the Silchester Collection in Reading Museum. The
documentary evidence for the Silchester study is summarised, before the results are presented for over a
1000 plant remains including an assessment of preservation, identification and modern contamination.
The dataset includes both evidence for the presence of nationally rare plant foods, such as medlar, and
several archaeophytes. The methodologies and original interpretations of Reid and Lyellâs study are
reassessed in light of current archaeobotanical knowledge. Spatial and contextual patterns in the
distribution of plant foods and ornamental taxa are also explored. Finally, the legacy of the study for the
development of archaeobotany in the 20th century is evaluated
Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe
Objectives The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. Methods We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged 500 HIV-1 RNA copies/mL despite >= 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. Results The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. Conclusions The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development
Fifty years of computer analysis in chest imaging: rule-based, machine learning, deep learning
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