scholarly journals Future Directions for Hypothermia following Severe Traumatic Brian Injury

2017 ◽  
Vol 38 (06) ◽  
pp. 768-774 ◽  
Author(s):  
Annie Chiu ◽  
Holly Hinson
Keyword(s):  
Public Health ◽  
Brain Injury ◽  
Clinical Evidence ◽  
The United States ◽  
Secondary Brain Injury ◽  
Induced Hypothermia ◽  
Future Directions ◽  
Public Health Burden ◽  
Personalized Approach ◽  
Destructive Processes

AbstractTraumatic brain injury (TBI) is a serious health care problem on both individual and public health levels. As a major cause of death and disability in the United States, it is associated with a significant economic and public health burden. Although the evidence to support the use of induced hypothermia on neurologic outcome after cardiac arrest is well established, its use in treating TBI remains controversial. Hypothermia has the potential to mitigate some of the destructive processes that occur as part of secondary brain injury after TBI. Hypothermia can be helpful in lowering intracranial pressure, for example, but its influence on functional outcome is unclear. There is insufficient evidence to support the broad use of prophylactic hypothermia for neuroprotection after TBI. Investigators are beginning to more carefully select patients for temperature modulating therapies, in a more personalized approach. Examples include targeting immunomodulation and scaling hypothermia to achieve metabolic targets. This review will summarize the clinical evidence for the use of hypothermia to limit secondary brain injury following acute TBI.

scholarly journals Traumatic brain injury as a risk factor for dementia

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E Mezzalira ◽  
B Stopa ◽  
A Khawaja ◽  
S Izzy ◽  
W Gormley
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
The United States ◽  
Age Group ◽  
Global Public Health ◽  
Public Health Burden ◽  
Increased Risk

Abstract Introduction The Centers for Disease Control and Prevention (CDC) reports that there were 2.87 million cases of traumatic brain injury (TBI) in the United States in 2014, 69 million worldwide. Some studies suggest a connection between TBI and increased risk of dementia, but it remains unclear whether the risk increases with age and TBI severity. Given our aging population, it is essential to better characterize the link between TBI and dementia. Methods We conducted a retrospective cohort study of two major academic medical centers for years 2000-2015. We identified all patients with TBI, aged 45 and older. Variables included age, TBI severity, pre-existing dementia, dementia diagnosed after TBI, years to dementia, and follow-up time. TBI severity was determined by head/neck AIS score, using ICD-PIC software. Mild TBI was defined as AIS 0-2, and Moderate/Severe as AIS 3-6. Analysis was done in R.v.3.0.1 software. Results Overall, there were 14,199 patients with TBI, of which 9,938 (70%) were mild and 4,261 (30%) were moderate/severe. Mean age was 70.5 (±14.0). There were 1,422 cases (10%) of pre-existing dementia, and 850 (6%) cases of dementia diagnosed after TBI. The mean follow-up time was 1,129 (±1,474) days. The 75-84 age group had the highest incidence of TBI (28%). When compared by age group and TBI severity, the proportion of moderate/severe TBI increased with increasing age. The proportion of pre-existing dementia increased with age, as expected. Notably, there is increased incidence of dementia after TBI in patients aged 65 and older (7-10%, p < 0.001). There was no observed effect of TBI severity on the risk of dementia after TBI. Conclusions Our results indicate that TBI is a risk factor for the development of dementia, especially in patients aged 65 and older. Given the global public health burden of these two diseases it is critical to develop effective TBI primary prevention strategies. Key messages TBI is a risk factor for the development of dementia. Need for public health measures to mitigate the risk of TBI in the patient population 65 and older.

scholarly journals Linking rattiness, geography and environmental degradation to spillover Leptospira infections in marginalised urban settings: an eco-epidemiological community-based cohort study in Brazil

2021 ◽  
Author(s):  
Max T Eyre ◽  
Fábio N Souza ◽  
Ticiana S. A. Carvalho-Pereira ◽  
Nivison Nery ◽  
Daiana de Oliveira ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Intervention ◽  
Spatial Modelling ◽  
The United States ◽  
Infection Risk ◽  
Human Infection ◽  
Global Public Health ◽  
Entire Study ◽  
Urban Settings ◽  
Public Health Burden

Background: Zoonotic spillover from animal reservoirs is responsible for a significant global public health burden, but the processes that promote spillover events are poorly understood in complex urban settings. Endemic transmission of Leptospira, the agent of leptospirosis, in marginalised urban communities occurs through human exposure to an environment contaminated by bacteria shed in the urine of the rat reservoir. However, it is unclear to what extent transmission is driven by variation in the distribution of rats or by the dispersal of bacteria in rainwater runoff and overflow from open sewer systems. <br /><br />Methods: We conducted an eco-epidemiological study in a high-risk community in Salvador, Brazil, by prospectively following a cohort of 1,401 residents to ascertain serological evidence for leptospiral infections. A concurrent rat ecology study was used to collect information on the fine-scale spatial distribution of ‘rattiness’, our proxy for rat abundance and exposure of interest. We developed and applied a novel geostatistical framework for joint spatial modelling of multiple indices of disease reservoir abundance and human infection risk. <br /><br />Results: The estimated infection rate was 51.4 (95\%CI 40.4, 64.2) infections per 1,000 follow-up events. Infection risk increased with age until 30 years of age and was associated with male gender. Rattiness was positively associated with infection risk for residents across the entire study area, but this effect was stronger in higher elevation areas (OR 3.27 95\%CI 1.68, 19.07) than in lower elevation areas (OR 1.14 95\%CI 1.05, 1.53). <br /><br />Conclusions: These findings suggest that, while frequent flooding events may disperse bacteria in regions of low elevation, environmental risk in higher elevation areas is more localised and directly driven by the distribution of local rat populations. The modelling framework developed may have broad applications in delineating complex animal-environment-human interactions during zoonotic spillover and identifying opportunities for public health intervention.<br /><br />Funding: This work was supported by the Oswaldo Cruz Foundation and Secretariat of Health Surveillance, Brazilian Ministry of Health, the National Institutes of Health of the United States (grant numbers F31 AI114245, R01 AI052473, U01 AI088752, R01 TW009504 and R25 TW009338); the Wellcome Trust (102330/Z/13/Z), and by the Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB/JCB0020/2016). M.T.E is supported by an MRC doctorate studentship. F.N.S. participated in this study under a FAPESB doctorate scholarship.

scholarly journals Neuroactive Steroids in Hypoxic–Ischemic Brain Injury: Overview and Future Directions

2020 ◽  
Author(s):  
Nicolas Toro-Urrego ◽  
Marco Avila-Rodriguez ◽  
María Inés Herrera ◽  
Andrea Aguilar ◽  
Lucas Udovin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Estrogenic Activity ◽  
Neuroactive Steroids ◽  
Ischemic Brain Injury ◽  
Neuroprotective Effects ◽  
Future Directions ◽  
Ischemic Brain ◽  
Public Health Burden ◽  
Hypoxic Ischemic Brain Injury ◽  
Underlying Mechanisms

Hypoxic–ischemic brain injury is a number one cause of long-term neurologic disability and death worldwide. This public health burden is mainly characterized by a decrease in oxygen concentration and blood flow to the tissues, which lead to an inefficient supply of nutrients to the brain. This condition induces cell death by energy depletion and increases free radical generation and inflammation. Hypoxic–ischemic brain injury may occur in ischemic-stroke and over perinatal asphyxia, being both leading causes of morbidity in adults and children, respectively. Currently, there are no effective pharmaceutical strategies to prevent the triggering of secondary injury cascades, including oxidative stress and metabolic dysfunction. Neuroactive steroids like selective estrogen receptor modulators, SERMs, and selective tissue estrogenic activity regulators, STEARs, exert several neuroprotective effects. These encompass mitochondrial survival, a decrease in reactive oxygen species, and maintenance of cell viability, among others. In this context, these neurosteroids constitute promising molecules, which could modify brain response to injury. Here we show an updated overview of the underlying mechanisms of hypoxic–ischemic brain injury. We also highlight the neuroprotective effects of neurosteroids and their future directions.

scholarly journals Advancing the Science of Tick and Tick-Borne Disease Surveillance in the United States

Insects ◽  
2019 ◽  
Vol 10 (10) ◽  
pp. 361 ◽  
Author(s):  
Samantha Wisely ◽  
Gregory Glass
Keyword(s):  
Public Health ◽  
United States ◽  
Workforce Development ◽  
Disease Surveillance ◽  
The United States ◽  
Centers Of Excellence ◽  
Public Health Burden ◽  
Vector Borne Disease ◽  
Tick Borne Disease ◽  
Vector Borne

Globally, vector-borne diseases are an increasing public health burden; in the United States, tick-borne diseases have tripled in the last three years. The United States Centers for Disease Control and Prevention (CDC) recognizes the need for resilience to the increasing vector-borne disease burden and has called for increased partnerships and sustained networks to identify and respond to the most pressing challenges that face vector-borne disease management, including increased surveillance. To increase applied research, develop communities of practice, and enhance workforce development, the CDC has created five regional Centers of Excellence in Vector-borne Disease. These Centers are a partnership of public health agencies, vector control groups, academic institutions, and industries. This special issue on tick and tick-borne disease surveillance is a collection of research articles on multiple aspects of surveillance from authors that are affiliated with or funded by the CDC Centers of Excellence. This body of work illustrates a community-based system of research by which participants share common problems and use integrated methodologies to produce outputs and effect outcomes that benefit human, animal and environmental health.

scholarly journals Emerging Antimicrobial-Resistant High-Risk Klebsiella pneumoniae Clones ST307 and ST147

2020 ◽  
Vol 64 (10) ◽  
Author(s):  
Gisele Peirano ◽  
Liang Chen ◽  
Barry N. Kreiswirth ◽  
Johann D. D. Pitout
Keyword(s):  
Public Health ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
The United States ◽  
Medical Community ◽  
Global Public Health ◽  
African Countries ◽  
Content Type ◽  
Public Health Burden ◽  
Worldwide Distribution

ABSTRACT There is an enormous global public health burden due to antimicrobial-resistant (AMR) Klebsiella pneumoniae high-risk clones. K. pneumoniae ST307 and ST147 are recent additions to the family of successful clones in the species. Both clones likely emerged in Europe during the early to mid-1990s and, in a relatively short time, became prominent global pathogens, spreading to all continents (with the exception of Antarctica). ST307 and ST147 consist of multiple clades/clusters and are associated with various carbapenemases (i.e., KPCs, NDMs, OXA-48-like, and VIMs). ST307 is endemic in Italy, Colombia, the United States (Texas), and South Africa, while ST147 is endemic in India, Italy, Greece, and certain North African countries. Both clones have been introduced into regions of nonendemicity, leading to worldwide nosocomial outbreaks. Genomic studies showed ST307 and ST147 contain identical gyrA and parC mutations and likely obtained plasmids with blaCTX-M-15 during the early to mid-2000s, which aided in their global distribution. ST307 and ST147 then acquired plasmids with various carbapenemases during the late 2000s, establishing themselves as important AMR pathogens in certain regions. Both clones are likely underreported due to restricted detection methodologies. ST307 and ST147 have the ability to become major threats to public health due to their worldwide distribution, ability to cause serious infections, and association with AMR, including panresistance. The medical community at large, especially those concerned with antimicrobial resistance, should be aware of the looming threat posed by emerging AMR high-risk clones such as K. pneumoniae ST307 and ST147.

scholarly journals Extragenital Infections Caused byChlamydia trachomatisandNeisseria gonorrhoeae: A Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Philip A. Chan ◽  
Ashley Robinette ◽  
Madeline Montgomery ◽  
Alexi Almonte ◽  
Susan Cu-Uvin ◽  
...  
Keyword(s):  
Sexually Transmitted Diseases ◽  
Risk Behaviors ◽  
The United States ◽  
Anatomical Site ◽  
Review Of The Literature ◽  
Future Directions ◽  
Sexually Transmitted ◽  
Public Health Burden ◽  
Health Burden ◽  
Sex With Men

In the United States, sexually transmitted diseases due toChlamydia trachomatisandNeisseria gonorrhoeaecontinue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.

scholarly journals Public Health Burden of Sudden Cardiac Death in the United States

2014 ◽  
Vol 7 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Eric C. Stecker ◽  
Kyndaron Reinier ◽  
Eloi Marijon ◽  
Kumar Narayanan ◽  
Carmen Teodorescu ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
The United States ◽  
Public Health Burden ◽  
Health Burden

Who, When, and Where?

2020 ◽  
pp. 21-34
Author(s):  
Pamela K. Keel
Keyword(s):  
Public Health ◽  
United States ◽  
Clinical Presentation ◽  
The United States ◽  
Public Health Burden ◽  
The Public ◽  
Purging Disorder ◽  
Cultural Ideals ◽  
Health Burden ◽  
Insight Into

Answering “who, when, and where?” establishes the public health burden associated with purging disorder and gives us insight into why someone develops the illness. Right now, over 2 million girls and women in the United States have purging disorder, and they are joined by another half-million boys and men. Cases of hysterical vomiting from the late 1800s resemble purging disorder in some respects, but vomiting in purging disorder is intentional and directed toward influencing weight or shape, supporting the influence of modern idealization of thinness. Finally, we see the emergence of purging to control weight and purging disorder following the introduction of Western cultural ideals into non-Western contexts. Non-Western cultures further shape the clinical presentation of purging disorder with misuse of traditional herbal emetics to produce purging.

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