Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

New England Journal of Medicine, Volume 389, Issue 4, Page 372-373, July 2023.

This Medical News article is an interview by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about maternal deaths and disparities in the US.

This Medical News story discusses the updated COVID-19 vaccines expected in the US this fall.

Introduction
Many extremely preterm newborns develop anaemia requiring a transfusion, with most receiving three to five transfusions during their admission. While transfusions save lives, the potential for transfusion-related adverse outcomes is an area of growing concern. Transfusion is an independent predictor of death and is associated with increased morbidity, length of hospital stay, risk of infection and immune modulation. The underlying mechanisms include adverse pro-inflammatory and immunosuppressive responses. Evidence supports an association between transfusion of washed red cells and fewer post-transfusion complications potentially through removal of chemokines, lipids, microaggregates and other biological response modifiers. However, the clinical and cost-effectiveness of washed cells have not been determined.

Methods and analysis
This is a multicentre, randomised, double-blinded trial of washed versus unwashed red cells. Infants 2, and; necrotising enterocolitis stage ≥2. To detect a 10% absolute reduction in the composite outcome from 69% with unwashed red blood cell (RBCs) to 59% with washed RBCs with 90% power, requires a sample size of 1124 infants (562 per group). Analyses will be performed on an intention-to-treat basis with a prespecified statistical analysis plan. A cost-effectiveness analysis will also be undertaken.

Ethics and dissemination
Ethics approval has been obtained from the Women’s and Children’s Health Network Human Research Ethics Committee (HREC/12/WCHN/55). The study findings will be disseminated through peer-reviewed articles and conferences.

Trial registration number
ACTRN12613000237785 Australian New Zealand Clinical Trials Registry.

Grazie all’azione antinfiammatoria evita il declino della funzione polmonare

Il Target europeo del PNRR Missione Salute riferito alle 1.800 borse aggiuntive di formazione specifica per medici di medicina generale, 900 per il triennio 2021-2024 e ulteriori 900 per il triennio 2022-2025, è stato pienamente raggiunto

A new US plan outlines approaches the federal government is taking to prevent and treat sexually transmitted infections (STIs), specifically chlamydia, gonorrhea, syphilis, and human papillomavirus, through 2025, the Department of Health and Human Services (HHS) announced.

Objective
While discrete choice experiments (DCEs) have been used in other fields as a means of eliciting respondent preferences, these remain relatively new in studying corrupt practices in the health sector. This study documents and discusses the process of developing a DCE to inform policy measures aimed at addressing informal payments for healthcare in Tanzania.

Design
A mixed methods design was used to systematically develop attributes for the DCE. It involved five stages: a scoping literature review, qualitative interviews, a workshop with health providers and managers, expert review and a pilot study.

Setting
Dar es Salaam and Pwani regions in Tanzania.

Participants
Health workers and health managers.

Results
A large number of factors were identified as driving informal payments in Tanzania and thus represent potential areas for policy intervention. Through iterative process involving different methods (qualitative and quantitative) and seeking consensus views by diverse actors, we derived six attributes for a DCE: mode of payment, supervision at the facility level, opportunity for private practice, awareness and monitoring, disciplinary measures against informal payments and incentive payment for staff if a facility has less informal payments. 12 choice sets were generated and piloted with 15 health workers from 9 health facilities. The pilot study revealed that respondents could easily understand the attributes and levels, answered all the choice sets and appeared to be trading between the attributes. The results from the pilot study had expected signs for all attributes.

Conclusions
We elicited attributes and levels for a DCE to identify the acceptability and preferences of potential policy interventions to address informal payments in Tanzania through a mixed-methods approach. We argue that more attention is needed to the process of defining attributes for the DCE, which needs to be rigorous and transparent in order to derive reliable and policy-relevant findings.

Annals of Internal Medicine, Ahead of Print.

In 2021, more than 9 million US adults aged 18 to 64 years did not take their medications as prescribed because of costs, according to a report by the National Center for Health Statistics. These individuals made up 8.2% of adults in this age group who took prescription drugs in the 12 months preceding the survey.

Historical methods for diagnosing gliomas, which relied solely on histological features, led to heterogenous groups of tumors being classified similarly and were unreliable in determining patient outcomes. In 2016, a paradigm shift occurred when the World Health Organization (WHO) changed its classification system for gliomas to include molecular characteristics. Isocitrate dehydrogenase (IDH) 1 or 2 variant status and 1p/19q chromosomal codeletion were reflected in this reclassification. Further regrouping of gliomas based on molecular classification was done in the WHO 2021 update. While it is common to request O6-methylguanine–DNA methyltransferase (MGMT) methylation status for glial tumors, to our knowledge it is not currently used for molecular classification.

This Viewpoint describes programs intended to help patients with commercial insurance that, instead, employers, health plans, and other payers use to reduce their spending on specialty drugs.

There is a growing need for interventions to improve well-being in healthcare workers, particularly since the onset of COVID-19.
Objectives
To synthesise evidence since 2015 on the impact of interventions designed to address well-being and burnout in physicians, nurses and allied healthcare professionals.

Design
Systematic literature review.

Data sources
Medline, Embase, Emcare, CINAHL, PsycInfo and Google Scholar were searched in May–October 2022.

Eligibility criteria for selecting studies
Studies that primarily investigated burnout and/or well-being and reported quantifiable preintervention and postintervention outcomes using validated well-being measures were included.

Data extraction and synthesis
Full-text articles in English were independently screened and quality assessed by two researchers using the Medical Education Research Study Quality Instrument. Results were synthesised and presented in both quantitative and narrative formats. Meta-analysis was not possible due to variations in study designs and outcomes.

Results
A total of 1663 articles were screened for eligibility, with 33 meeting inclusion criterium. Thirty studies used individually focused interventions, while three were organisationally focused. Thirty-one studies used secondary level interventions (managed stress in individuals) and two were primary level (eliminated stress causes). Mindfulness-based practices were adopted in 20 studies; the remainder used meditation, yoga and acupuncture. Other interventions promoted a positive mindset (gratitude journaling, choirs, coaching) while organisational interventions centred on workload reduction, job crafting and peer networks. Effective outcomes were reported in 29 studies, with significant improvements in well-being, work engagement, quality of life and resilience, and reductions in burnout, perceived stress, anxiety and depression.

Conclusion
The review found that interventions benefitted healthcare workers by increasing well-being, engagement and resilience, and reducing burnout. It is noted that the outcomes of numerous studies were impacted by design limitations that is, no control/waitlist control, and/or no post intervention follow-up. Suggestions are made for future research.

Esperti, ‘risultati saranno utili per il counseling alle coppie’

Objective
The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA).

Design
We analysed cross-sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA. The predictors of physical violence were examined using a multilevel binary logistic regression. All the results were presented as adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs).

Setting
Twenty-six countries in SSA.

Participants
108 971 women who had ever been pregnant.

Outcome measure
Physical violence during pregnancy.

Results
Physical violence was identified in 6.0% of pregnant women in SSA. The highest prevalence (14.0%) was reported in South Africa, while Burkina Faso recorded the lowest (2.1%). Women who had primary (aOR=1.26, 95% CI=1.15, 1.38) and secondary education (aOR=1.15, 95% CI=1.01,1.32); those who were cohabiting (aOR=1.21, 95% CI=1.11, 1.32); those who were working (aOR=1.17, 95% CI=1.08, 1.28); and those whose partners had primary (aOR=1.15, 95% CI=1.04, 1.28) and secondary education (aOR=1.14, 95% CI=1.01, 1.28) were more likely to experience physical violence during pregnancy compared with those who had no formal education; those who were married; those who were not working, and those whose partners had no formal education, respectively. Moreover, women whose partners consumed alcohol (aOR=2.37, 95% CI=2.20, 2.56); those who had parity of four or more (aOR=2.06, 95% CI=1.57, 2.72); and those who perceived intimate partner violence (IPV) as a culturally accepted norm (aOR=1.55, 95% CI=1.44, 1.67) had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol, those with parity zero, and those who did not perceive IPV as culturally accepted, respectively. On the contrary, women who were aged 35-39, those who were of the richest wealth index, and those in rural areas had reduced odds of experiencing physical violence during pregnancy.

Conclusion
Based on the findings, community leaders are encouraged to liaise with law enforcement agencies to strictly enforce laws on gender-based violence by prosecuting perpetrators of IPV against pregnant women as a deterrent. Also, intensifying education on what constitutes IPV and the potential consequences on the health of pregnant women, their children, and their families will be laudable. Improving the socioeconomic status of women may also help to eliminate IPV perpetration against women at their pregnancy stage.