A Multimodal Approach to Hypertension: Behavioral Modifications on a Budget

Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.https://scholarworks.uvm.edu/fmclerk/1358/thumbnail.jp

Second-hand smoke generated by combustion and electronic smoking devices used in real scenarios: ultrafine particle pollution and age-related dose assessment

Aerosol measurements were carried out in a model room where both combustion (conventional and hand-rolled cigarettes, a cigar and tobacco pipe) and non-combustion (e-cigarette and IQOS®) devices were smoked. The data were used to estimate the dose of particles deposited in the respiratory systems of individuals from 3 months to 21 years of age using the multiple-path particle dosimetry (MPPD) model. Regardless of the smoking device, the highest doses were received by infants, which reached 9.88 ×108 particles/kg bw during a cigar smoking session. Moreover, 60% to 80% of the particles deposited in the head region of a 3-month-old infant were smaller than 100 nm and could be translocated to the brain via the olfactory bulb. The doses due to second-hand smoke from electronic devices were significantly lower, below 1.60 ×108 particles/kg bw, than those due to combustion devices. Dosimetry estimates were 50% to 110% higher for IQOS® than for e-cigarettes

Nanoparticle behaviour in an urban street canyon at different heights and implications on indoor respiratory doses

The amount of outdoor particles that indoor environments receive depends on the particle infiltration factors (Fin), peculiar of each environment, and on the outdoor aerosol concentrations and size distributions. The respiratory doses received, while residing indoor, will change accordingly. This study aims to ascertain to what extent such doses are affected by the vertical distance from the traffic sources. Particle number size distributions have been simultaneously measured at street level and at about 20 m height in a street canyon in downtown Rome. The same Fin have been adopted to estimate indoor aerosol concentrations, due to the infiltration of outdoor particles and then the relevant daily respiratory doses. Aerosol concentrations at ground floor were more than double than at 20 m height and richer in ultrafine particles. Thus, although aerosol infiltration efficiency was on average higher at 20 m height than at ground floor, particles more abundantly infiltrated at ground level. On a daily basis, this involved a 2.5-fold higher dose at ground level than at 20 m height. At both levels, such doses were greater than those estimated over the period of activity of some indoor aerosol sources; therefore, they represent an important contribution to the total daily dose

Reference intervals for urinary cotinine levels and the influence of sampling time and other predictors on its excretion among italian schoolchildren

(1) Background: Environmental Tobacco Smoke (ETS) exposure remains a public health problem worldwide. The aims are to establish urinary (u-) cotinine reference values for healthy Italian children, to evaluate the role of the sampling time and of other factors on children’s u-cotinine excretion. (2) Methods: A cross-sectional study was performed on 330 children. Information on participants was gathered by a questionnaire and u-cotinine was determined in two samples for each child, collected during the evening and the next morning. (3) Results: Reference intervals (as the 2.5th and 97.5th percentiles of the distribution) in evening and morning samples were respectively equal to 0.98-4.29 and 0.91-4.50 µg L-1(ETS unexposed) and 1.39-16.34 and 1.49-20.95 µg L-1(ETS exposed). No statistical differences were recovered between median values found in evening and morning samples, both in ETS unexposed and exposed. Significant predictors of u-cotinine excretions were ponderal status according to body mass index of children (β = 0.202; p-value = 0.041 for evening samples; β = 0.169; p-value = 0.039 for morning samples) and paternal educational level (β = -0.258; p-value = 0.010; for evening samples; β = -0.013; p-value = 0.003 for morning samples). (4) Conclusions: The results evidenced the need of further studies for assessing the role of confounding factors on ETS exposure, and the necessity of educational interventions on smokers for rising their awareness about ETS

Oxidative potential associated with urban aerosol deposited into the respiratory system and relevant elemental and ionic fraction contributions

Size-segregated aerosol measurements were carried out at an urban and at an industrial site. Soluble and insoluble fractions of elements and inorganic ions were determined. Oxidative potential (OP) was assessed on the soluble fraction of Particulate Matter (PM) by ascorbic acid (AA), dichlorofluorescein (DCFH) and dithiothreitol (DTT) assays. Size resolved elemental, ion and OP doses in the head (H), tracheobronchial (TB) and alveolar (Al) regions were estimated using the Multiple-Path Particle Dosimetry (MPPD) model. The total aerosol respiratory doses due to brake and soil resuspension emissions were higher at the urban than at the industrial site. On the contrary, the doses of anthropic combustion tracers were generally higher at the industrial site. In general, the insoluble fraction was more abundantly distributed in the coarse than in the fine mode and vice versa for the soluble fraction. Consequently, for the latter, the percent of the total respiratory dose deposited in TB and Al regions increased. Oxidative potential assay (OPAA) doses were distributed in the coarse region; therefore, their major contribution was in the H region. The contribution in the TB and Al regions increased for OPDTT and OPDCFH

Understanding Refugees\u27 Perspectives on Health Care

Introduction. Burlington, Vermont accepts refugees from around the world. These individuals face unique barriers to accessing healthcare due to language, culture and finances. Research suggests that cultural beliefs about healthcare can affect ability or willingness to seek medical care. Gaining a better understanding of refugee perspectives of the healthcare system may offer insight into how to rectify this issue. Objectives. The goal of this study was to learn about refugee perspectives of the healthcare system and assess their use of services. Methods. We surveyed a convenience sample of 24 refugees to learn more about thoughts and practices surrounding healthcare and the use of the medical system. Results. Survey findings suggested that refugees who had been living in the US for longer than one year access healthcare resources differently from more recent arrivals. Most respondents agreed that reasons for going to a healthcare provider revolved around the diagnosis and treatment of current ailments. Regardless of time spent in the U.S., most respondents were unlikely to seek out preventive care. Refugees who had been in the U.S. longer than one year were less likely to seek out emergency services for acute symptoms that would be better served by a visit with their PCP. Conclusions. Recent arrivals used the emergency room for primary care needs more than those living in the U.S. longer than one year, suggesting the efficacy of provided health education. Study data suggests an important area for improvement may be increased education for refugees about the importance of preventive care.https://scholarworks.uvm.edu/comphp_gallery/1250/thumbnail.jp

L’adenocarcinoma dell’appendice ileo-ciecale: presentazione di un caso clinico e revisione della letteratura

L’adenocarcinoma dell’appendice ileo-ciecale è una neoplasia di rara osservazione rappresentando meno dello 0,5% di tutti i tumori dell’apparato gastrointestinale. Nella maggior parte dei casi viene diagnosticato all’esame istologico definitivo di un’appendice asportata per flogosi, talora invece rappresenta un reperto del tutto inatteso, documentato da biopsie estemporanee, in corso di intervento chirurgico eseguito per sospetta appendicite acuta o altra patologia non appendicolare. La storia naturale di tale neoplasia è fortemente condizionata dalle peculiari caratteristiche anatomiche del viscere che ne favoriscono la precoce diffusione e una notevole tendenza alla perforazione. Si associa frequentemente ad altre neoplasie primitive, sincrone o metacrone, a localizzazione colo-rettale o extraintestinale. Il trattamento chirurgico oncologicamente corretto è l’emicolectomia destra che può essere eseguita come prima procedura, nei casi in cui la neoplasia venga diagnosticata pre- o intraoperatoriamente, o come seconda procedura, due-tre settimane dopo l’appendicectomia, qualora soltanto l’esame istologico dell’appendice asportata riveli la presenza dell’adenocarcinoma. L’emicolectomia destra è il trattamento chirurgico più idoneo in tutti gli istotipi (colico, mucinoso, adenocarcinoide), in presenza di perforazione ed anche nelle neoplasie allo stadio A di Dukes. Durante l’atto operatorio è necessario effettuare un’accurata esplorazione della cavità addominale per la ricerca di neoplasie sincrone, mentre dopo l’intervento i pazienti dovranno essere sottoposti ad un follow-up regolare e prolungato nel tempo onde diagnosticare precocemente eventuali neoplasie metacrone. Riportiamo il caso di una donna di 78 anni con adenocarcinoma dell’appendice scoperto casualmente in corso di intervento chirurgico eseguito per un quadro di occlusione intestinale da sospetta neoplasia del cieco