Introducción: Las personas privadas de la libertad (PPL) pertenecen a una población vulnerable con mayor carga de enfermedad que la población general, entre ellas enfermedades respiratorias como Asma y/o EPOC. Este estudio evaluó qué factores sociodemográficos y clínicos se asocian al auto-reporte de Asma/EPOC diagnosticado en Establecimientos Penitenciarios (EP). Métodos: Estudio transversal analítico que incluyó PPLs ≥18 años de 66 diferentes EPs del Perú que participaron en el Censo Nacional Penitenciario 2016. La variable de estudio fue auto-reporte de Asma/EPOC diagnosticada por un profesional de salud luego de ingresar al EP. Se realizaron análisis descriptivo, bivariado, y se obtuvieron razones de prevalencia crudas y ajustadas (RPa) mediante regresión de Poisson multinivel, colocando los EP en el primer nivel. Resultados: Se evalúo 76180 PPL con una mediana de edad de 34 años y 94.2% eran hombres. La prevalencia de Asma/EPOC fue 2.27%. Factores asociados a mayor prevalencia fueron edad (RPa 1.03 por cada año; IC95% 1.03-1.04), sexo femenino (RPa 1.40; IC95% 1.18-1.67), fumar diario respecto a no fumar (RPa 1.22; IC95% 1.02-1.47), tener VIH/SIDA (RPa 1.55; IC95% 1.06-2.27), y tener Tuberculosis (RPa 4.27; IC95% 3.48-5.22). Tener formación secundaria se asoció a menos probabilidad de Asma/EPOC (RPa 0.80; IC95% 0.71-0.90) así como educación superior (RPa 0.75; IC95% 0.62-0.91), respecto a aquellos que no tenían educación. Conclusiones: Tener mayor edad, ser de sexo femenino, fumar diario, tener VIH/SIDA, y haber tenido o tener tuberculosis se asociaron a mayor probabilidad de tener Asma y/o EPOC diagnosticado por un personal de salud luego de ingresar al EP, mientras que tener un mayor nivel educativo se asoció a una menor probabilidad. Esto podría servir para identificar población en riesgo cuando ingresan al EP. / Introduction: People Deprived of Liberty (PDL) belong to a vulnerable population with higher burden of disease than general population, including respiratory diseases such as asthma and/or COPD. This study evaluated which sociodemographic and clinical factors are associated with self-reported asthma/COPD diagnosed in Penitentiary Establishments (PE). Methods: Cross-sectional study that included PDLs ≥18 years old from 66 different PEs in Peru that participated in the Nationwide Penitentiary Census 2016. The outcome variable was self-reported asthma/COPD diagnosed by a health professional after entering a PE. Descriptive, bivariate analyzes were carried out; and crude and adjusted prevalence ratios (aPR) were obtained by multilevel Poisson regression, placing PE as first level. Results: 76180 PDLs were evaluated with a median age of 34 years old, and 94.2% were men. The prevalence of Asthma/COPD was 2.27%. Factors associated with higher prevalence were age (aPR 1.03 for each year; 95% CI 1.03-1.04), female sex (aPR 1.40; 95% CI 1.18-1.67), daily smoking compared to not smoking (aPR 1.22; 95% CI 1.02-1.47) , having HIV/AIDS (aPR 1.55; 95% CI 1.06-2.27), and having past/current Tuberculosis (aPR 4.27; 95% CI 3.48-5.22). Having high school was associated with lower probability of Asthma/COPD (aPR 0.80; 95% CI 0.71-0.90) as well as higher education (aPR 0.75; 95% CI 0.62-0.91), compared to those who had no education. Conclusions: Being older, being female, smoking daily, having HIV/AIDS, and having or having had tuberculosis were associated with a greater probability of developing asthma and/or COPD diagnosed by health personnel after entering the penitentiary; while having a higher educational level was associated with a lower probability. This could serve to identify populations at risk when they enter a PE. / Tesis

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.

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The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Bakgrund: Digitala kontaktvägar har fått en framträdande roll inom primärvården. Genom digitala kontaktvägar ska individen stå i centrum och öka förmågan att hantera sin sjukdom. Egenvårdsråd är högt prioriterade för patienter med kroniskt obstruktiv lungsjukdom och syftar till att minska symtom, förebygga exacerbationer, öka fysisk aktivitet, förhindra sjukdomsprogression och minskad dödlighet. Syftet: var att belysa vilka erfarenheter patienter med KOL har av egenvårdsråd genom en digitaliserad kontakt med vården. Utifrån litteraturöversiktens 14 kvalitativa artiklar framkom tre huvudkategorier: från fysiska till digitala kontaktvägar, erfarenheter av att möta distriktssköterskan på skärmen och digitala egenvårdsråd. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Digitala egenvårdsråd ansågs vara ett användbart komplement, inte som en ersättning till fysiska besök hos distriktssköterskan. Konklusion: Den samlade kunskapen från föreliggande studie kan ligga till grund för att distriktssköterskor och verksamhetschefer inom primärvården får en bättre förståelse kring hur egenvårdsråd uppfattas av patienterna, i takt med att deras kunskaper och upplevelser förändras med den digitala utvecklingen. Det vetenskapliga underlaget är begränsat och framtida forskning bör fokusera på en större enkätundersökning för att kunna dra slutsatser av hur digitala egenvårdsråd påverkar patienter med kroniskt obstruktiv lungsjukdom. / Backround: Digital contact path have gained a prominent role in primary care. Through digital contact path, the individual should be at the center of attention and increase the ability to manage their illness. Self-management is a high priority in COPD care and aims to reduce symptoms, prevent exacerbations, increase physical activity, prevent disease progression and reduce mortality. The aim: was to investigate COPD patients' experiences of self-management advice through digitally mediated care. Based on the literature review's 14 qualitative articles, three main categories emerged: from physical to digital contact paths, experiences of meeting the district nurse on the screen and digital self-management advice. Methods: The method used was a systematic literature review with an inductive approach. Results: Digital self-management advice was considered a useful supplement, but never a substitute for physical visits to the district nurse. Conclusion: The collected knowledge from the study could contribute to district nurses and operational managers within primary care gaining a better understanding of how patients perceive self-management advice, as their knowledge and experiences change with digital development. The scientific basis is limited, future research should focus on a larger survey to be able to draw conclusions about how digital self-management advice affects COPD patients.

Bakgrund Kronisk obstruktiv lungsjukdom är ett pågående folkhälsoproblem som främst drabbar personer som röker. Det finns även andra faktorer, som passiv rökning samt exponering för luftföroreningar, som kan öka risken att framskrida sjukdomen. Egenvård är mycket viktigt i detta tillstånd, eftersom det i nuläget inte finns något botemedel mot sjukdomen. Syfte Syftet är att belysa patienters upplevelse av att leva med kronisk obstruktiv lungsjukdom. Metod Litteraturöversikt som baserades på tio kvalitativa vetenskapliga artiklar från Cinahl och PubMed. Resultat Resultatet visade att KOL påverkar människor på olika sätt, både psykiskt och fysiskt. Patienterna kan uppleva trötthet och andnöd i vardagen. Sjukdomen kan orsaka känslor som skuld, skam och ensamhet, vilket har visat sig leda till isolering. Slutsats På grund av att KOL är en kronisk sjukdom som varar livet ut är det viktigt att behandlingen effektivt hanterar patientens symtom. Sjuksköterskans uppgift är att identifiera samt förstå patientens unika behov och skräddarsy behandlingen utifrån dennes behov. Sammantaget är vårdens kvalitet en nyckelfaktor som formar relationen mellan sjuksköterska och patient. / Background Chronic obstructive pulmonary disease is an ongoing public health issue primarily affecting individuals who smoke. There are other factors, such as passive smoking and exposure to air pollution, which can also increase the risk of developing the disease. Self-care is crucial in this condition as there is currently no cure for the disease. Aim The aim is to illuminate individuals’ experience of living with chronic obstructive pulmonary disease. Method A literature review based on ten qualitative studies from Cinahl and PubMed. Results The results showed that COPD affects people in various ways, both mentally and physically. Patients may experience fatigue and shortness of breath in their daily lives. The disease can trigger emotions such as guilt, shame, and loneliness, which has been found to lead to isolation. Conclusions Due to COPD being a chronic disease that lasts a lifetime, it is crucial for treatment to effectively manage the patient’s symptoms. The nurse’s responsibility is to identify and comprehend the patient’s unique needs and tailor the treatment accordingly. Overall, the quality of care is a key factor that shapes the relationship between the nurse and the patient.

For the past few decades, the popularity of graphene oxide (GO) nanomaterials (NMs) has increased exceedingly due to their biomedical applications in drug delivery of anti-cancer drugs. Their unique physicochemical properties such as high surface area and good surface chemistry with unbound surface functional groups (e.g. hydroxyl - OH, carboxyl /ketone C=O, epoxy/alkoxy C-O, aromatic group C=C, etc) which enable covalent bonding with organic molecules (e.g. RNA, DNA) make GO NMs as excellent candidates in drug delivery nanocarriers. Despite the overwhelming biomedical applications, there are concerns about their genotoxicity on human DNA. Published genotoxicity studies on GO NMs were performed using non-commercial GO with 2-3 layers of GO sheets, synthesized in various laboratories with the potential for inter-laboratory variabilities. However, what has not been studied before is the effects of the commercial GO (15-20 sheets; 4-10% edge-oxidized; 1 mg/mL) in vitro on DNA damage in human whole blood and peripheral blood lymphocytes (PBL) from real-life patients diagnosed with chronic pulmonary diseases [asthma, chronic obstructive pulmonary disease (COPD), and lung cancer], and genotoxic endpoints compared with those from healthy control individuals to determine whether there are any differences in GO sensitivity. Thus, in the present study, we had characterized GO NMs using Zetasizer Nano for Dynamic Light Scattering (DLS) and zeta potential (ZP) in the aqueous solution, and electron microscopy using the Scanning Electron Microscope (SEM) and Transmission Electron Microscope (TEM) in the dry state, respectively. Cytotoxicity studies were conducted on human PBL from healthy individuals and patients (asthma, COPD, and lung cancer) using the Methylthiazolyldiphenyl-tetrazolium bromide (MTT) and Neutral Red Uptake (NRU) assays, respectively. The genotoxicity (DNA damage) and cytogenetic effects (chromosome aberration parameters) induced by GO NMs on human whole blood from healthy individuals and patients were studied using the Alkaline Comet Assay and Cytokinesis-blocked Micronucleus (CBMN) assay, respectively. Our results showed concentration-dependent increases in cytotoxicity, genotoxicity, and chromosome aberrations, with blood samples from COPD and lung cancer patients being more sensitive to DNA damage insults compared with asthma patients and healthy control individuals. Furthermore, the relative gene and protein expressions of TP53, CDKN1A/p21, and BCL-2 relative to GAPDH on human PBL were studied using the Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) and Western Blot techniques, respectively. Our results have shown altered gene and protein expression levels. Specifically, GO-induced cytotoxicity, genotoxicity, and micronuclei aberrations were associated with TP53 upregulation - a biomarker of DNA damage - in both patients and healthy individuals. These effects show that GO NMs have promising roles in drug delivery applications when formulated to deliver drug payload to COPD and cancer cells. However, the fact that cytotoxicity, genotoxicity, chromosome instability, and gene/protein expressions - biomarkers of cancer risk - were observed in healthy individuals are of concern to public health, especially in occupational exposures at micro levels at the workplace.

<p>Human disease and the corresponding immune response occur in three-dimensional space and time. Many diseases are difficult to study, either <em>in vivo</em> or <em>in vitro</em>, due to the complexity of the system. Despite computational models that can address complexity, many do not capture the spatial  aspects  of  disease.  Agent-based  models  are  mechanistic,  spatiotemporal  computational models that can be integrated with other mathematical models to create multiscale models. Here I detail two models to examine spatiotemporal progression and possible treatment strategies for two diseases  with  low  treatment  success: <em>Mycobacterium  avium complex</em>  (MAC)  and  Alzheimer’s Disease.</p> <p>MAC  are  biofilm-forming  environmental  microbes  capable  of  residing  in  human  lung nodules,  causing  MAC  pulmonary  disease  (MAC-PD).  Clinical  drug  susceptibility  tests  and treatment  outcomes  are  poorly  correlated,  and  nodules  are  complex  and  difficult  to  monitor, leading to low MAC cure rates (45-65%)². I have developed an informative model of the initial infection  events  in  MAC-PD. This  model  has  been  used  to  probe  many  different  scenarios  of infection and to predict the effect of potential interventions.</p> <p>Alzheimer’s  Disease  (AD)  is  the  leading  cause  of  dementia,  with  no  disease-altering pharmacological  intervention.  Microglia  are  phagocytotic  neuroimmune  cells,  known  to  form barriers around plaques. There has been increased interest in leveraging microglia to slow the progression of neurodegeneration by manipulating these barriers. I present an agent-based model of microglia barriers at the single plaque level and use knock-out experiments to probe possible targets for immunotherapy and quantify their effects on plaque progression.</p>