Risultati per: Trattamento delle infezioni alle vie urinarie con pidotimod: tre case report

Background
The avoidable causes of infant mortality should be identified, and interventions should be made to improve the infant mortality rate. The cause of infant deaths should be assessed in both medical and social contexts.

Objectives
We aimed to determine the medical causes of infant mortality by verbal autopsy and its determinants in two rural blocks of the Khordha district of Odisha and assess the pathway of care and delay in seeking care for the illness preceding infant death using the three-delay model.

Design
We conducted this community-based matched case-control study to identify the medical causes of infant mortality using the verbal autopsy method along with the identification of delay and pathway of care related to infant deaths using a social autopsy method.

Settings
Two rural blocks of Odisha, India.

Participants
We enumerated 100 infant deaths by active surveillance and data triangulation from Accredited Social Health Activists, Auxiliary Nurse Midwives and block-level health information systems. We selected an equal number of alive infants matched with cases in a 1:1 ratio with regard to age, gender and residential address.

Outcome measures
We conducted the verbal autopsy using the Sample Registration System verbal autopsy tool, where the cause of death ascertainment was done by two independently trained physicians followed by adjudication by one senior trained physician in case of conflicts. We used the prevalidated International Network for the Demographic Evaluation of Population and Their Health tool to assess three delays and pathways of care related to infant deaths.

Results
Most infant deaths (70%) happened during the first day of life, and almost 50% of neonatal deaths occurred during the first week of life. The three most common causes of infant mortality were birth asphyxia (30%), pneumonia (18%), prematurity and low birth weight (14%). Larger family size ( >5) and the education status of fathers till class 10 were significant determinants of infant mortality. Among the 49 infants whose illnesses were identified at home, 2 died at home without receiving any care. Formal or informal care was sought for 32 and 8 infants, respectively. The median delay was found to be 24 hours for level 1 delay. Level 1 delay was observed for 20 cases (40.8%), with more than 24 hours in decision-making in care-seeking. Thirty-seven (75.5%) sick infants reached the healthcare facility 30 min after deciding to seek care.

Conclusion
Birth asphyxia, pneumonia prematurity and low birth weight were found to be the common causes of infant mortality, with larger family sizes and lower education status among fathers being the significant determinants of infant mortality. We observed a significant delay in decision-making regarding seeking care among caregivers of sick infants.

Purpose
Among health researchers, there is a growing appreciation of the importance of the involvement of service users and members of the public. This recognition has not only resulted in involvement guidelines and improved research ethics but also an increasing use of consensus processes with service users and members of the public to determine research priorities and questions and to agree outcomes to be measured in intervention studies. There is, however, limited advice about how to safely involve survivors of violence and abuse in consensus-based studies.

Methods/results
This commentary provides an overview of the adaptations made to a process of core outcome set development, to ensure that survivors of violence and abuse felt safe, heard and supported, and able to contribute in a meaningful way.

Conclusions
We advocate for an iterative process of listening to and learning from survivors, as well as buy-in from funders to ensure research studies are appropriately resourced and involve sufficient planning time.

New England Journal of Medicine, Volume 392, Issue 4, Page 383-394, January 23, 2025.

Objective
Adverse childhood experiences (ACE) have inconsistently been implicated as risk factors for immune-mediated inflammatory diseases (IMID). We evaluated whether the association of ACE with disease differs between IMID and other chronic diseases.

Design
Nested retrospective case-control study.

Setting
We used data from the Canadian Longitudinal Study on Aging (CLSA), which recruited participants aged 45–85 years between 2010 and 2015.

Participants
We included 12 627 CLSA participants: 2 102 who reported diagnoses of IMID (258 multiple sclerosis (MS), 1 692 rheumatoid arthritis (RA) and 160 inflammatory bowel disease (IBD)), 5 519 with diabetes, 170 with epilepsy, 3 889 with asthma and 1 125 with no chronic diseases. ACE, including childhood maltreatment (physical, emotional and sexual abuse, neglect) and household dysfunction, were queried using questions from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire.

Primary and secondary outcome measures
We first evaluated whether the association of maltreatment differed across diagnoses (IMID, diabetes, asthma, epilepsy, no chronic diseases). Second, we evaluated whether the association between maltreatment differed across IMID. We repeated our analyses for different types of ACE.

Results
Maltreatment or household dysfunction was experienced by 64% of participants and 30% experienced both. On multivariable analysis, history of any maltreatment, sexual abuse, any household dysfunction and having ≥3 types of ACE were all associated with increased risk of IMID compared with no chronic disease. The association between ACE and IMID did not differ across MS, RA and IBD.

Conclusion
ACE are common among Canadians with and without chronic diseases. History of any maltreatment or household dysfunction is associated with increased risk of chronic disease.

Objective
Muslim patients are an underrepresented community in end-of-life care research, with little evidence around factors that influence the quality and experience of care. The aim of this study was to explore the quality of end-of-life care in the intensive care unit (ICU) from the perspective of next-of-kin family members of Muslim patients.

Design
A qualitative multiple case study design using semistructured interviews with family members of Muslim patients. Healthcare providers’ notes from the patient medical record were also used to contextualise the patient care experience and medical journey. Data were analysed using deductive content analysis.

Setting
A large academic tertiary care hospital in Toronto, Canada.

Participants
Next-of-kin family members of Muslim patients (≥18 years) who were admitted to the ICU and died in hospital between October 2019 and December 2021.

Results
Family members of five Muslim patients of South Asian descent were recruited for this study. Four central themes were identified: (1) trust and confidence in the healthcare team overseen by medical experts; (2) quality communication with medical experts; (3) achieving patient goals of care; and (4) dignity of care through cultural respect and emotional support. Culture, religion and religiosity did not appear to have a major influence on the medical decision-making process. Communication, emotional and psychological well-being for patients, and cultural respect were identified as possible areas for quality improvement.

Conclusions
Our findings identified central themes in the quality of end-of-life care for families of seriously ill Muslim patients. These insights can inform clinical processes and interventions to improve the quality of care and reduce psychological and emotional burden at the end of life.

Stroke, Ahead of Print. There is a large burden of stroke in the United States, and extensive systems of care have been established to address it. The resources devoted to stroke centers are analogous to those of trauma centers, both sharing many strict requirements for certification, clinical preparedness, quality improvement, data management, and reporting. However, trauma programs partly defray these costs through a trauma activation billing code, a billable fee that is charged for activation of the trauma team under strict criteria. There are potential benefits to establishing an analogous national stroke code activation fee. Although a billable stroke code activation fee may increase financial burden on patients, this may be counterbalanced by the significant potential for individual and societal benefits. Providing additional financial support for stroke systems of care may improve acute stroke treatment, reduce stroke burden and poststroke disability, and reduce inequality by broadening the reach of stroke systems of care to disadvantaged communities. Further evaluation of the costs and benefits of implementing a stroke code activation fee based on that currently used by trauma centers is needed.

Mi chiamo Federica Aimeri, sono un medico di medicina generale che lavora in un piccolo paese di campagna del nord Italia, in provincia di Cuneo. Sono anche una lettrice del…

Introduction
Despite the global prevalence of low fertility rates, male contributions to fertility and reproductive health outcomes have been understudied. This study aims to investigate the male contribution to fertility and explore the underlying biological mechanisms. Specifically, we aim to (1) identify male factors associated with successful pregnancy, (2) develop a fertility index incorporating modifiable factors for both males and females to predict pregnancy rate and (3) explore the relationship of male modifiable factors with semen parameters and molecular characteristics.

Methods and analysis
We will conduct an unmatched case-control study involving 240 couples with impaired male fertility (cases) and 240 couples with normal male fertility (controls). Between July 2024 and June 2026, we will recruit 480 eligible couples from KK Women’s and Children’s Hospital, Singapore. Male and female participants will complete questionnaires on sociodemographics, general health and lifestyle factors, and their anthropometry and body fat composition will be measured. Blood and semen samples from the male participants will be collected for biochemical, molecular and semen analyses. Predictive male factors will be identified using the least absolute shrinkage and selection operator method, accounting for female factors. We will construct a logistic regression model incorporating both male and female factors to derive a fertility index, which will be evaluated using cross-validation on subsets of the study population. Multivariable linear regression will be used to explore relationships between male modifiable exposures and semen parameters.

Ethics and dissemination
The study protocol has received approval from the Centralised Institutional Review Board of SingHealth (2024/2120), Singapore. Participants will provide written informed consent. Study results will be disseminated through conferences and peer-reviewed scientific journals.

Trial registration number
NCT06293235.

New England Journal of Medicine, Volume 392, Issue 3, Page 268-276, January 16, 2025.

QoC is lower in lower-than higher-income countries and lower QoC is associated with worse outcomes. Improving QoC by addressing structural barriers and quality improvement programs may improve the outcomes of patients with HF.

Ad un anno e mezzo dalla loro messa a regime questi maxi ambulatori restano per molti cittadini ancora un oggetto misterioso

‘Sono la punta di diamante della nuova sanità del territorio’

Smentito l’allarme per il metapneumovirus e la pressione sugli ospedali. L’Ue: ‘Ad ora nessun rischio pandemia.

New England Journal of Medicine, Volume 392, Issue 2, Page 186-194, January 9, 2025.

Non saranno più “liberi professionisti” che siglano una convenzione in base alla quale tenere aperti gli ambulatori per alcune ore al giorno

Overall, there is a significantly increased prevalence of SIBO in CLD patients compared to controls. The prevalence is even higher in CLD patients with PHT, especially those with SBP. This meta-analysis suggests that SIBO is associated with complications of CLD and potentially linked to the progression of CLD.