Risultati per: Prevenzione e trattamento della sindrome post-trombotica

Objectives
To determine death occurrences of Puerto Ricans on the mainland USA following the arrival of Hurricane Maria in Puerto Rico in September 2017.

Design
Cross-sectional study.

Participants
Persons of Puerto Rican origin on the mainland USA.

Exposures
Hurricane Maria.

Main outcome
We use an interrupted time series design to analyse all-cause mortality of Puerto Ricans in the USA following the hurricane. Hispanic origin data from the National Vital Statistics System and from the Public Use Microdata Sample of the American Community Survey are used to estimate monthly origin-specific mortality rates for the period 2012–2018. We estimated log-linear regressions of monthly deaths of persons of Puerto Rican origin by age group, gender, and educational attainment.

Results
We found an increase in mortality for persons of Puerto Rican origin during the 6-month period following the hurricane (October 2017 through March 2018), suggesting that deaths among these persons were 3.7% (95% CI 0.025 to 0.049) higher than would have otherwise been expected. In absolute terms, we estimated 514 excess deaths (95% CI 346 to 681) of persons of Puerto Rican origin that occurred on the mainland USA, concentrated in those aged 65 years or older.

Conclusions
Our findings suggest an undercounting of previous deaths as a result of the hurricane due to the systematic effects on the displaced and resident populations in the mainland USA. Displaced populations are frequently overlooked in disaster relief and subsequent research. Ignoring these populations provides an incomplete understanding of the damages and loss of life.

Objective
Test whether Sudarshan Kriya Yoga (SKY) was non-inferior to cognitive processing therapy (CPT) for treating symptoms of post-traumatic stress disorder (PTSD) among veterans via a parallel randomised controlled non-inferiority trial.

Setting
Outpatient Veterans Affairs healthcare centre.

Participants
85 veterans (75 men, 61% white, mean age 56.9) with symptoms of PTSD participated between October 2015 and March 2020: 59 participants completed the study.

Interventions
SKY emphasises breathing routines and was delivered in group format in a 15-hour workshop followed by two 1-hour sessions per week for 5 weeks. CPT is an individual psychotherapy which emphasises shifting cognitive appraisals and was delivered in two 1-hour sessions per week for 6 weeks.

Measures
The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). The secondary measures were the Beck Depression Inventory-II (BDI-II) and Positive and Negative Affect Scale (PANAS).

Results
Mean PCL-C at baseline was 56.5 (±12.6). Intent-to-treat analyses showed that PCL-C scores were reduced at 6 weeks (end of treatment) relative to baseline (SKY, –5.6, d=0.41, n=41: CPT, –6.8, d=0.58, n=44). The between-treatment difference in change scores was within the non-inferiority margin of 10 points (–1.2, 95% CI –5.7 to 3.3), suggesting SKY was not inferior to CPT. SKY was also non-inferior at 1-month (CPT–SKY: –2.1, 95% CI –6.9 to 2.8) and 1-year (CPT–SKY: –1.8, 95% CI –6.6 to 2.9) assessments. SKY was also non-inferior to CPT on the BDI-II and PANAS at end of treatment and 1 month, but SKY was inferior to CPT on both BDI-II and PANAS at 1 year. Dropout rates were similar (SKY, 27%, CPT, 34%: OR=1.36, 95% CI 0.51 to 3.62, p=0.54).

Conclusions
SKY may be non-inferior to CPT for treating symptoms of PTSD and merits further consideration as a treatment for PTSD.

Trial registration number
NCT02366403.

Introduction
Tuberculosis (TB) is significantly associated with multiple postinfectious, non-communicable diseases after microbiological cure. For example, those with a history of TB disease have a higher risk of developing chronic lung diseases at a younger age. However, the extent and nature of post-TB complications are not well described. Here, we present a protocol for a systematic review and meta-analysis, which aims to synthesise literature on the burden of post-TB lung disease (PTLD) in sub-Saharan Africa, describe phenotypes, long-term outcomes and the health-related quality of life of people with PTLD.

Methods and analysis
A systematic search will be conducted using PubMed, EMBASE, Web of Science, African Journals Online and the Cochrane Library of Systematic Reviews. Papers published in English and French languages that report the prevalence, clinical features, quality of life and long-term outcomes of people with PTLD in sub-Saharan Africa will be considered. We will assess and critically appraise the methodological quality of all studies using the modified covidence. Qualitative and quantitative (network and meta-analysis) synthesis will be performed and STATA V.16 will be used to estimate the burden of PTLD.

Ethics and dissemination
Ethical approval is not required for this systematic review and meta-analysis. Our results will be published in peer-reviewed journals.

PROSPERO registration number
CRD42021274018.

The incidence of colorectal cancer (CRC) has been increasing worldwide among young adults aged 18–50 years, and the reason remains unknown.1,2 Patients with sporadic young-onset CRC (YOCRC; diagnosed at 50 years or younger) are postulated to have a more biologically active colorectum prone to malignant transformation earlier in life. Exposure risk factors, such as Western-style diet, obesity, physical inactivity, antibiotic use, and microbiome, overlaid with gene–environment interactions, have been implicated as plausible triggers.

Objectives
Women’s decision-making power is a dimension of empowerment and is crucial for better physical and psychosocial outcomes of mothers. Suchana, a large-scale development programme in Bangladesh, actively provided social interventions on behaviour change communication to empower women belonging to the poorest social segment. This paper aims to assess the impact of the Suchana intervention on various indicators related to women’s decision-making power.

Design, setting and participants
The evaluation design was a cluster randomised pre-post design with two cross-sectional surveys conducted among beneficiary women with at least one child aged

Introduction
Viability assessment of the graft is essential to lower the risk of liver transplantation (LT) failure and need for emergency retransplantation, however, this still relies mainly on surgeon’s experience. Post-LT graft function recovery assessment is also essential to aid physicians in the management of LT recipients and guide them through challenging decision making.
This study aims to trial the use of indocyanine green clearance test (IGT) in the donor as an objective tool to assess graft viability and in the recipient to assess graft function recovery after LT.

Methods and analysis
This is an observational prospective single-centre study on consecutive liver transplant donors and recipients.

Primary objective
To determine the capability of IGT of predicting graft viability at the time of organ retrieval. Indocyanine green will be administered to the donor and the plasma disappearance rate (PDR) measured using the pulsidensitometric method. Some 162 IGT donor procedures will be required (α, 5%; β, 20%) using an IGT-PDR cut-off value of 13% to achieve a significant discrimination between viable and non-viable grafts.

Secondary objective
IGT-PDR will be measured at different time-points in the LT recipient: during the anhepatic phase, after graft reperfusion, at 24 hours, on day 3 and day 7 after LT. The slope of IGT values from the donor to the recipient will be evaluated for correlation with the development of early allograft dysfunction.

Ethics and dissemination
This research protocol was approved by Fondazione Policlinico Universitario Agostino Gemelli IRCCS Ethics Committee (reference number: 0048466/20, study ID: 3656) and by the Italian National Transplant Center (CNT) (reference number: Prot.11/CNT2021). Liver recipients will be required to provide written informed consent. Results will be published in international peer-reviewed scientific journals and presented in congresses.

Trial registration number
NCT05228587.