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Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease 下载免费PDF全文
Laura Sanapo MD Jay D. Pruetz MD Maciej Słodki MD M. Beth Goens MD Anita J. Moon‐Grady MD Mary T. Donofrio MD 《Echocardiography (Mount Kisco, N.Y.)》2017,34(12):1804-1821
Fetal echocardiography facilitates the prenatal diagnosis of infants with congenital heart disease (CHD) and through sequential examinations, allows assessment of fetal hemodynamics and cardiovascular status from the time of diagnosis to delivery. Fetal cardiologists have created diagnostic protocols aimed at risk stratifying severity and potential postnatal compromise in fetuses with CHD, and identifying those who may require special intervention at birth or within the first days of life. In this article, we review fetal cardiovascular physiology, the progression of CHD in utero and fetal echocardiographic findings used for risk stratification of newborns with CHD, as well as some of the basic principles of planning for the neonatal resuscitation and initial transitional care of these complex newborns. 相似文献
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Facilitating and inhibiting factors in transition to parenthood – ways in which health professionals can support parents 下载免费PDF全文
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Tôrres Luísa Helena do Nascimento Silva Débora Dias da Neri Anita Liberalesso Hilgert Juliana Balbinot Hugo Fernando Neves Sousa Maria da Luz Rosário de 《Nutrition (Burbank, Los Angeles County, Calif.)》2013,29(1):152-157
ObjectivePoor oral status, represented by partial/complete tooth loss, may lead to changes in food choice, which may ultimately lead to underweight, overweight, or obesity. The aim of this study is to evaluate whether poor oral status is associated with underweight or overweight/obesity, regardless of physical activity.MethodsThis cross-sectional study is part of a major project, The Frailty in Brazilian Elderly Study, carried out in Campinas, Brazil (2008–2009). The sample was composed of 900 independent-living older adults. Complete data were available for 875 individuals including sociodemographic, self-reported amount of medications used and eating difficulty questionnaire, smoking habit, depressive symptoms, physical activity, oral examination, and anthropometric assessments according to the WHO criteria. Body mass index was used as an outcome. Multinomial logistic regression was adjusted for confounding variables.ResultsThe mean age of the sample was 72.7 y (±5.81) and the prevalence of edentulism was 47.7%. Edentate individuals not wearing dentures were more likely to be underweight [odds ratio (OR) = 3.94, 95% confidence interval (CI) 1.14–13.64] and overweight/obese (OR = 2.88, 95%CI 1.12–7.40). Males (OR = 0.56, 95%CI 0.36–0.85) and those not using medications (OR = 0.41 95%CI 0.24–0.70) were less likely to be overweight/obese. Individuals who smoke (OR = 2.62, 95%CI 1.26–5.44) were more likely to be underweight. Older individuals with family income between 3.1 and 5 minimum wage (OR = 1.69, 95%CI 1.00–2.87) were more likely to be overweight/obese.ConclusionTo our knowledge, this is one of the first studies associating poor oral health, represented by edentulism not rehabilitated with dentures, with unfavorable body mass, regardless of the two major confounders, physical activity and depression symptoms. 相似文献
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Anita Nguyen Hartzell V. Schaff Dustin Hang Rick A. Nishimura Jeffrey B. Geske Joseph A. Dearani Brian D. Lahr Steve R. Ommen 《The Journal of thoracic and cardiovascular surgery》2019,157(1):306-315.e3
Objectives
In patients with hypertrophic cardiomyopathy, obstruction of the left ventricular outflow tract can be relieved by surgical septal myectomy or alcohol septal ablation, but uncertainty remains regarding long-term results and comparative effectiveness of alcohol septal ablation. This study aims to compare short- and long-term outcomes of the 2 procedures.Methods
Between December 1998 and September 2016, 2407 patients underwent septal myectomy and 211 patients underwent alcohol septal ablation at our institution. After 2:1 propensity score matching, the study cohort included 334 patients who underwent myectomy and 167 patients who underwent alcohol septal ablation.Results
Median (interquartile range) ages of patients in the myectomy and alcohol septal ablation groups were 65 (58-71) years and 64 (56-73) years (P = .9), respectively. After intervention, median resting left ventricular outflow tract gradient at predischarge transthoracic echocardiography was 0 (0-10) mm Hg in the myectomy group (n = 288) and 21 (10-60) mm Hg in the alcohol septal ablation group (n = 63) (P < .001, tested at baseline gradients of 30 and 50 mm Hg). There were no differences in survival between the 2 groups (risk of death for alcohol septal ablation vs myectomy, hazard ratio, 1.5; 95% confidence interval, 0.9-2.6; P = .1). Survival of patients undergoing septal myectomy was better than that of an age-, sex-, and race-matched US population (82% vs 75% at 12 years, P = .01). Reintervention for left ventricular outflow tract obstruction was more likely to occur in patients who received alcohol septal ablation (hazard ratio, 33.3; 95% confidence interval, 4.4-250.6; P < .001).Conclusions
There were no differences in survival of patients undergoing myectomy or alcohol septal ablation, but freedom from reintervention and early and late reduction of left ventricular outflow tract gradient are superior in patients undergoing septal myectomy. 相似文献147.
Grace C. Hillyer Witness Mapanga Judith S. Jacobson Anita Graham Keletso Mmoledi Raynolda Makhutle 《Global public health》2020,15(10):1537-1550
ABSTRACT Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa. 相似文献
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Catherine S John Elizabeth I Sypek William A Carlezon Bruce M Cohen Dost ?ngür Anita J Bechtholt 《Neuropsychopharmacology》2015,40(7):1700-1708
Depression has been associated with abnormalities in glutamatergic neurotransmission and decreased astrocyte number in limbic areas. We previously demonstrated that global and prefrontal cortical blockade of the astrocytic glutamate transporter (GLT-1) induces anhedonia and c-Fos expression in areas that regulate anxiety, including the central amygdala (CEA). Given the role of the amygdala in anxiety and the high degree of comorbidity between anxiety and depression, we hypothesized that GLT-1 blockade in the CEA would induce symptoms of anhedonia and anxiety in rats. We microinjected the GLT-1 inhibitor, dihydrokainic acid (DHK), into the CEA and examined effects on intracranial self-stimulation (ICSS) as an index of hedonic state, and on behavior in two anxiety paradigms, elevated plus maze (EPM) and fear conditioning. At lower doses, intra-CEA DHK produced modest increases in ICSS responding (T0). Higher doses resulted in complete cessation of responding for 15 min, suggesting an anhedonic or depressive-like effect. Intra-CEA DHK also increased anxiety-like behavior such that percent time in the open arms and total entries were decreased in the EPM and acquisition of freezing behavior to the tone was increased in a fear-conditioning paradigm. These effects did not appear to be explained by non-specific changes in activity, because effects on fear conditioning were assessed in a drug-free state, and a separate activity test showed no significant effects of intra-CEA DHK on locomotion. Taken together, these studies suggest that blockade of GLT-1 in the CEA is sufficient to induce both anhedonia and anxiety and therefore that a lack of glutamate uptake resulting from glial deficits may contribute to the comorbidity of depression and anxiety. 相似文献
150.
Kate Beckett Michelle Farr Anita Kothari Lesley Wye Andrée le May 《Health research policy and systems / BioMed Central》2018,16(1):118
The potential use, influence and impact of health research is seldom fully realised. This stubborn problem has caused burgeoning global interest in research aiming to address the implementation ‘gap’ and factors inhibiting the uptake of scientific evidence. Scholars and practitioners have questioned the nature of evidence used and required for healthcare, highlighting the complex ways in which knowledge is formed, shared and modified in practice and policy. This has led to rapid expansion, expertise and innovation in the field of knowledge mobilisation and funding for experimentation into the effectiveness of different knowledge mobilisation models. One approach gaining prominence involves stakeholders (e.g. researchers, practitioners, service users, policy-makers, managers and carers) in the co-production, and application, of knowledge for practice, policy and research (frequently termed integrated knowledge translation in Canada). Its popularity stems largely from its potential to address dilemmas inherent in the implementation of knowledge generated using more reductionist methods. However, despite increasing recognition, demands for co-produced research to illustrate its worth are becoming pressing while the means to do so remain challenging. This is due not only to the diversity of approaches to co-production and their application, but also to the ways through which different stakeholders conceptualise, measure, reward and use research. While research co-production can lead to demonstrable benefits such as policy or practice change, it may also have more diffuse and subtle impact on relationships, knowledge sharing, and in engendering culture shifts and research capacity-building. These relatively intangible outcomes are harder to measure and require new emphases and tools. This opinion paper uses six Canadian and United Kingdom case studies to explore the principles and practice of co-production and illustrate how it can influence interactions between research, policy and practice, and benefit diverse stakeholders. In doing so, we identify a continuum of co-production processes. We propose and illustrate the use of a new ‘social model of impact’ and framework to capture multi-layered and potentially transformative impacts of co-produced research. We make recommendations for future directions in research co-production and impact measurement. 相似文献