32 research outputs found
Interventions targeting social isolation in older people: a systematic review
This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.BACKGROUND: Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. METHODS: Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. RESULTS: Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. CONCLUSIONS: More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.National Institute for Health Researc
Toxic epidermal necrolysis and Stevens-Johnson syndrome
Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the aetiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Genetic susceptibility to SJS and TEN is likely as exemplified by the strong association observed in Han Chinese between a genetic marker, the human leukocyte antigen HLA-B*1502, and SJS induced by carbamazepine. Diagnosis relies mainly on clinical signs together with the histological analysis of a skin biopsy showing typical full-thickness epidermal necrolysis due to extensive keratinocyte apoptosis. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP), disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS). Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, evaluation of the prognosis using SCORTEN, identification and interruption of the culprit drug, specialized supportive care ideally in an intensive care unit, and consideration of immunomodulating agents such as high-dose intravenous immunoglobulin therapy. SJS and TEN are severe and life-threatening. The average reported mortality rate of SJS is 1-5%, and of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment. More than 50% of patients surviving TEN suffer from long-term sequelae of the disease
Identification of a Tambjamine Gene Cluster in Streptomyces Reveals Convergent Evolution of the Biosynthetic Pathway
Bacterial natural products are an immensely valuable source of therapeutics. As modern DNA sequencing efforts provide
increasing numbers of microbial genomes, it is clear that the molecules produced by most natural product biosynthetic gene
clusters (BGCs) remain unknown. Genome mining makes use of bioinformatic techniques to elucidate the natural products
produced by these “orphan” BGCs. Here, we report the use of sequence similarity networks (SSNs) and genome
neighborhood networks (GNNs) to identify an orphan BGC that is responsible for the production of the antitumor
tambjamine BE-18591 in Streptomyces albus NRRL B-2362. Although BE-18591 is a close structural analogue of tambjamine
YP1 produced by Pseudoalteromonas tunicata, the biosynthetic routes to produce these molecules differ significantly.
Notably, the C12-alkylamine tail that is appended onto the bipyrrole core of tambjamine YP1 is derived from fatty acids
siphoned from the primary metabolism of the pseudoalteromonad, whilst the S. albus NRRL B-2362 BGC encodes a dedicated
system for the de novo biosynthesis of the alkylamine portion of tambjamine BE-18591. These remarkably different
biosynthetic strategies represent a striking example of convergent BGC evolution, with selective pressure for the production
of tambjamines seemingly leading to the emergence of separate biosynthetic pathways in pseudoalteromonads and
streptomycetes that ultimately produce closely related compound
Use of a Loading Dose of Vitamin D for Treatment of Vitamin D Deficiency in Patients With Intestinal Failure
Lesões dermatolĂłgicas em pacientes infectados pelo vĂrus linfotrĂłpico humano de cĂ©lulas T do tipo 1 (HTLV-1) Dermatologic lesions in patients infected with the human T-cell lymphotropic vĂrus type 1 (HTLV-1)
O vĂrus linfotrĂłpico humano de cĂ©lulas T do tipo 1 (HTLV-1) Ă© o primeiro retrovĂrus isolado do ser humano. Descreveu-se, em pouco tempo, o seu papel etiolĂłgico em algumas doenças, com destaque para a leucemia/linfoma de cĂ©lulas T do adulto (ATLL), a mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) e a uveĂte associada ao HTLV-1 (HAU). Na dĂ©cada de 90, o HTLV-1 foi associado a eczema grave da infância, conhecido como dermatite infecciosa (DI). Desde entĂŁo, diversos outros tipos de lesões cutâneas tĂŞm sido observados em pacientes infectados pelo HTLV-1, em especial, nos doentes de HAM/TSP ou de ATLL. PorĂ©m, mesmo portadores assintomáticos do vĂrus apresentam doenças dermatolĂłgicas. Excetuando-se a dermatite infecciosa, nĂŁo há lesĂŁo da pele especĂfica da infecção pelo HTLV-1. Aqui, os autores apresentam as principais lesões dermatolĂłgicas descritas em pacientes infectados pelo HTLV-1, destacando o valor epidemiolĂłgico e clĂnico desses achados.<br>Human T-cell Lymphotropic vĂrus type I (HTLV-1) was the first human retrovĂrus described. Some time after its discovery a group of diseases were related to this vĂrus, such as, adult T-cell leukemia lymphoma (ATLL), HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 associated uveitis (HAU). In the nineties, HTLV-1 was associated to a severe eczema of children, called infective dermatitis (ID). Since then, several other skin manifestations have been observed in HTLV-1-infected individuals, particularly in patients with ATLL or HAM/TSP. However, according to some reports, dermatologic lesions are also common in asymptomatic HTLV-1 carriers. Besides ID, all other skin lesions reported are nonspecific. The aim of this review is to outline the dermatologic manifestations reported in HTLV-1 infected patients, emphasizing the clinical and epidemiological value of these findings
Research directions in genetic predispositions to Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is one of the most devastating of adverse drug reactions (ADRs) and was, until recently, essentially unpredictable. With the discovery of several risk alleles for drug-induced SJS/TEN and the demonstration of effectiveness of screening in reducing incidence, the stage is set for implementation of preventive strategies in populations at risk. Yet much remains to be learned about this potentially fatal complication of commonly used drugs