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Tobacco smoke exposure is a major risk factor for the health of children and adolescents with CF. In this study, we assess whether cessation of smoke exposure is associated with improved outcomes in this population.
We used annualized and encounter-based data from the U.S. CF Foundation Patient Registry (2006-2018) on all individuals born 1998-2010. The analytical sample included those who ever reported second-hand smoke exposure (daily or weekly), ever lived with a smoker, or ever reported smoking themselves. We used non-linear mixed models for pulmonary exacerbations and linear mixed models for ppFEV
and BMI as a function of ceased exposure.
The sample included 3,633 individuals contributing 19,629 person-years. Cessation of smoke exposure reduced the odds of a pulmonary exacerbation in 12 months by 17% (OR 0.83, p<0.001) in the first year of cessation, with an additional 6% decrease (OR 0.94, p=0.003) for each additional year of cessation. Cessation was associated with improvements in ppFEV
and BMI 0.7% ppFEV
increase (p<0.001) in the first year of cessation and 0.4% increase (p=0.001) for each additional year of cessation; 1% increase in BMI percentile (p<0.001) in the first year of cessation plus 0.4% increase (p=0.009) for each additional year. Three years of cessation reduce the predicted probability of a pulmonary exacerbation in 12 months by 8% and improve ppFEV
and BMI by 2%.
Eliminating smoke exposure may reduce pulmonary exacerbations and improve respiratory and nutritional outcomes in children and adolescents with CF. Both smoking cessation and exposure prevention should be prioritized in pediatric CF care.
Eliminating smoke exposure may reduce pulmonary exacerbations and improve respiratory and nutritional outcomes in children and adolescents with CF. Both smoking cessation and exposure prevention should be prioritized in pediatric CF care.
The U.S. Food and Drug Administration (FDA) restricts dispensing of mifepristone for medication abortion to certified health care providers at clinical facilities, thus prohibiting pharmacist dispensing. Allowing mifepristone dispensing by pharmacists could improve access to medication abortion.
To assess the feasibility of pharmacists dispensing mifepristone to patients who have undergone evaluation for eligibility and counseling for medication abortion by a clinician.
Before providing a study training on medication abortion, we administered baseline surveys to pharmacists who participated in a multisite mifepristone-dispensing intervention. The survey assessed medication abortion knowledge-using a 15-item score-and perceptions about the benefits and challenges of the model. We administered follow-up surveys in the study's final month that also assessed the pharmacists' satisfaction and experiences with mifepristone dispensing. To investigate the association of the study intervention with the pharmacisunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA's restriction on pharmacist dispensing of mifepristone.
Most pharmacists were willing to be trained, dispensed mifepristone with few challenges when given the opportunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA's restriction on pharmacist dispensing of mifepristone.
Depression represents a major disease burden in Colombia. ARS-1620 order To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.
The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.
Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.
This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
While bariatric surgery has demonstrated significant weight loss for adolescents with severe obesity, only a limited number of adolescents referred to surgery successfully complete the surgical program. Better identification of pre-surgical factors, especially mental health factors, associated with completing bariatric surgery may determine successful referrals to surgical programs versus alternative behavioral health interventions.
The primary objective of this article was to investigate the relationship between presurgical mental health factors and whether or not a patient received bariatric surgery within the first six months of entering the program.
Pediatric Children's Hospital, Bariatric Surgery Program within Pediatric Surgery Department.
A retrospective medical record review of all patients referred from 2016 to 2019 to an adolescent surgical weight loss program was conducted. Patients were determined as completers if they received a laparoscopic sleeve gastrectomy within 6 months of entering ights potential treatment implications in how best to mitigate patient barriers, such as internalizing symptoms and low motivation, to pursue bariatric surgery and remain committed to weight loss goals through techniques such as motivational interviewing.
Website: https://www.selleckchem.com/products/ars-1620.html
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