Fistula Foundation

HighlightsPublic health relevance—How does this work relate to a public health issue?This work reviews articles related to landfills in rural Alaska communities and may guide future research related to gaps identified in this review.Unlined landfills lacking leachate collection systems may impact public health.Public health significance—Why is this work of significance to public health?This work identifies several potential disease transmission and chemical exposure pathways associated with such landfills, which are primarily found in rural and tribal communities already facing significant health disparities.If harvested, birds, fish, other animals and plants living, growing, or feeding by open surface area landfills could present public health implications for Indigenous and other hunting populations via ingestion or contact with waste pathogens or chemicals.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?This review paper elucidates the need to continue to assess landfill contaminant transport, exposure pathways and risks and the unique challenges of solid waste management in rural Alaska and other Arctic environments.Future research directions regarding the risk to subsistence resources and the associated health implications for Alaska Native and other Arctic subsistence-based cultures should prioritize community-based, co-produced research that integrates Indigenous Knowledge with Western science. This approach is crucial for addressing the existing health disparities and unique environmental exposures faced by these communities.Landfill contaminants pose significant risks to environmental and human health, particularly in rural Alaska. These communities are predominantly Alaska Native and face unique challenges in solid waste management due to geography, climate, and limited infrastructure. This scoping review assessed published research on the impacts of landfill contaminants in the Arctic (Aim 1) and Alaska specifically (Aim 2). Seventy-one studies met the inclusion criteria, all of which were used to develop a conceptual model of contaminant transport pathways. Thirty-nine studies included Alaska-specific research: thirty-three focused on environmental impacts, and six addressed human health (e.g., birth outcomes, cancer). Key topics included waste burning, heat generation, carbon release, leachate characterization, and water or sediment contamination. Evidence specific to Alaska suggested landfill leachate may contaminate surface water and groundwater, and that microbes can migrate beyond the landfill site boundaries in communities using honeybuckets (plastic bag-lined buckets that collect human waste). Landfill contaminants also impacted wildlife through consumption of garbage, which may have human health implications for subsistence-based communities. Major research gaps remain in understanding individual-level exposures, the effects of emerging contaminants, and the mechanisms of contaminant transport pathways. Further research designed for causal inference is needed to support improvements to public and environmental health.

Accurately measuring compound binding affinities is key to driving the pharmaceutical development process. Rigorous physics-based in silico approaches, particularly alchemical free energy methods, have become a gold standard tool for estimating compound affinity changes. Here we present the results of a large-scale pre-competitive collaborative assessment of relative binding free energy (RBFE) calculations generated by 15 pharmaceutical companies. We evaluate an open-source and MIT licensed RBFE Protocol from the Open Free Energy (OpenFE) ecosystem across both public and blinded private datasets, encompassing over 1,700 ligands in total. For the public dataset, the weighted RMSE across the 58 systems was 1.73 [1.53, 1.96] kcal/mol, with 10 of the systems reaching sub-kcal/mol accuracy. For the private dataset, the weighted RMSE across the 37 systems was 2.44 [1.94, 3.06] kcal/mol, with only 2 of the systems reaching sub-kcal/mol accuracy, reflecting the increased complexity of real-world drug discovery. The protocols performance was system-dependent, with no single dominant error source, indicating that accuracy is primarily influenced by input quality and transformation type. Overall, these benchmark results are encouraging and indicate that OpenFE is ready for large-scale industrial applications, with an "out-of-the-box" accuracy that approaches that of commercial solutions. While comparison against published FEP+ results, which were obtained after manual parameter optimization, shows comparable ranking statistics, a gap remains in error statistics, for which we outline possible paths toward improvement. The protocol meets key criteria required for production use in an industrial setting: it shows robust performance, generates reproducible results, and achieves both sufficient throughput and rapid convergence.

Surgical esophageal atresia (EA) repair is a complex operation with high risk of perioperative complications. Infants born with very low or extreme low birth weight (VLBW or ELBW) might be even at higher risk for developing perioperative complications. However, studies about this specific patient group are scarce, resulting in a knowledge gap on the outcomes of these infants. This hampers identifying the optimal treatment strategy, but also good counselling of parents. The aim of this study was to evaluate the mortality and surgery-related complication rates of VLBW and ELBW infants with EA after surgical esophageal repair in a multi-center cohort. A multi-center retrospective cohort study was performed in five academic hospitals in the Netherlands. Data was extracted from the medical record of patients born with EA and birthweight 1000-1500 g (VLBW) or <1000 g (ELBW) between 2000 and 2019. The main outcomes were overall mortality and specific surgery-related morbidity 90 days postoperative. Only descriptive analyses were performed. In total, 44 children were born with EA and VLBW/ELBW, of which 39 were included who underwent EA repair, 10 ELBW and 29 VLBW. Of the 39 infants, 25 had additional congenital anomalies. Six out of 29 VLBW infants and three out of 10 ELBW infants deceased. Complications occurred in 17 VLBW and two ELBW infants. Anastomotic stricture was the most frequent complications (VLBW n = 12, ELBW n = 1), others were anastomotic leakage (VLBW n = 5, ELBW n = 0), pneumothorax (VLBW n = 5, ELBW n = 0), surgical site infection (VLBW n = 1, ELBW n = 1) and recurrent fistula (VLBW n = 0, ELBW n = 1). Mortality and surgery-related complication rates in VLBW/ELBW infants after surgical EA repair in this large cohort are in line with previous studies. However, outcomes after surgical repair of EA are worse compared to infants born with a normal birthweight. This information is important to consider during parent counseling and multidisciplinary consultation.

Pelvic organ prolapse (POP) is a common condition that can significantly impact a woman's quality of life. Pelvic floor muscle training (PFMT) is recommended as a first-line conservative treatment for prolapse, but evidence on its effectiveness from low-resource settings is limited. This study aimed to assess the effect of midwife-led PFMT on prolapse symptoms and health-related quality of life (HRQoL) among women with mild-to-moderate POP in Ethiopia. A community-based, parallel-groups, two-arm cluster-randomized controlled trial was conducted in Dale and Wonsho districts of Sidama Region, Ethiopia. Women with symptomatic POP stages I-III were randomized by cluster to receive either midwife-led PFMT plus lifestyle counseling (intervention group) or lifestyle counseling alone (control group). The participants and counselors knew what the women were receiving, but they were not aware of the other group. The outcome assessors, who collected data at the end of intervention, were blinded to the participants' treatment allocation. The primary outcomes were changes in prolapse symptom score (POP-SS) and prolapse quality of life (P-QoL). Mixed-effects generalized linear model was used to determine the effect of PFMT on prolapse symptoms and P-QoL at 99% confidence level. Adjusted β coefficients were used as effect measures. The level of significance was adjusted for multiple comparisons. A total of 187 women were randomized to intervention (n = 86) from four clusters and control (n = 101) arms from another four clusters. At sixth months, the intervention group showed significantly greater improvements both in prolapse symptoms and P-QoL. The mean change difference in POP-SS was -4.11 (99% CI [-5.38, -2.83]; p < 0.001). Similarly, the mean change difference was: -8.86 (99% CI [-13.84, -3.89]; p < 0.001) in physical domain of P-QoL; -11.18 (99% CI [-15.03, -7.32]; p < 0.001) in psychological domain of P-QoL, and -9.01 (99% CI [-10.49, -5.54]; p < 0.001) in personal relationship domain of P-QoL. A significantly higher proportion (83.72%) of women in the intervention group perceived their condition as "better" after the intervention as compared to 41.58% in the control group. Women with earlier stages of prolapse (stages I and II) experienced higher benefits compared to those in stage III. A midwife-led PFMT combined with lifestyle counseling significantly improves prolapse symptoms and quality of life in mild-to-moderate POP. This strategy can be integrated into the existing maternal and reproductive health programs to address POP in low-income settings where access to trained specialist is limited. The trial was registered at the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za) database, with the registration number PACTR202302505126575 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24311).

Este resultado de investigación presenta algunos hallazgos, análisis y testimonios del alcance y de los límites de la justicia transicional en el Norte del Cauca y Sur del Valle del Cauca (Caso 05 de la Jurisdicción Especial para la Paz) frente a la justicia propia de los pueblos en medio de la ‘Paz Total’ y la disputa militar que persiste en el territorio. El trabajo de campo —soportado en entrevistas, escuchas, diálogos, ceremonias, caminatas, mingas, grupos focales, encuentros académicos, debates con autoridades— constata la espiritualidad como eje de las prácticas de justicia propia y permite inferir que, más que un etnocidio o ecocidio, lo que aconteció y continúa sucediendo en el territorio es un exterminio biocultural de los pueblos indígenas y el pueblo negro, habitantes de esta parte de la geografía colombiana. También se identifican algunas de las barreras epistémicas que persisten en la justicia transicional y dificultan el avance hacia una interculturalidad material y cultural.

FRANCISCA ELEN DUTRA CARNEIRO; FRANCISCO ELDER DUTRA CARNEIRO Introdução: O transplante de células-tronco Hematopoiéticas (TCTH) é primordial no tratamento de diversas doenças hematológicas, como linfoma e mieloma. Entretanto, o procedimento não é isento de riscos e a morbimortalidade ainda é alta, o que apresenta-se como consequência das inúmeras complicações que podem surgir após a intervenção. Nesse sentido, é essencial avaliar e listar as principais agravos que podem ocorrer devido o TCTH. Objetivo: esclarecer as principais complicações associadas ao transplante de células-tronco hematopoiéticas. Metodologia: Trata-se de uma revisão de literatura sobre as principais complicações associadas ao TCTH. A pesquisa foi realizada utilizando 4 (quatro) produções científicas publicadas nas bases de dados SciELO e Google Acadêmico, a qual foram incluídos artigos lançados entre os anos 2015 e 2022. Foram utilizados como descritores: "complicações", "transplante", "células-tronco", "hematopoiéticas". Resultados: Após a análise dos artigos, foi possível constatar que as infecções são a principal causa de complicações pós TCTH, algumas descritas com maior frequência foram: sepse clínica, contaminação hematogênica por cateter venoso central, diarreia (viral e bacteriana), mucosite e vírus como herpes e rotavírus. Outro motivo de agravo é a Doença do Enxerto Contra Hospedeiro (GvHD), que se trata de uma condição grave e se manifesta comumente no transplante alogênico. Além disso, complicações pulmonares (pneumonia, bronquiolite obliterante e sinusite), neurológicas (síndrome de encefalopatia reversível posterior, AVE e convulsões) e endócrinas (deficiência de somatotropina, insuficiência gonadal primária e hipotireoidismo) também foram descritas. Outras complicações que podem estar presentes são as cardíacas (cardiomiopatia, ICC, disfunção valvular, pericardite, doença arterial coronariana e arritmia), oftalmológicas (catarata), hepáticas (doença veno-oclusiva hepática) e metabólicas (dislipidemia, obesidade e diabetes). Conclusão: Dessa forma, podemos inferir que o TCTH, apesar de ser um procedimento fundamental no tratamento de inúmeras neoplasias, envolve substanciais riscos de complicações em diversos órgãos e sistemas, entre as quais se destacam as causas infecciosas e a GvHD. Ademais, é essencial o conhecimento acerca dos agravos pós transplantes mais comuns para a correta distinção entre patologias secundárias ao TCTH e aquelas não relacionadas a ele. Assim, pode-se garantir um tratamento mais efetivo para cada condição.

A presença de sintomas depressivos na pessoa idosa, em especial, naqueles os quais encontram-se residindo em uma instituição de longa permanência, auxilia na percepção de como o ambiente asilar, o qual confronta o idoso com a inatividade, o declínio de sua capacidade funcional, a perda da autonomia pessoal e com o processo de refletir sobre a própria morte, pode afetar seu humor e forma de encarar a vida e o futuro. Objetivos: Mensurar a prevalência dos sintomas depressivos e verificar os fatores associados em idosos residentes em uma instituição de longa permanência. Métodos: Foram realizadas análises descritivas das variáveis por meio de frequências absolutas e relativas, além de análise univariada para testar as relações entre as variáveis características sociodemográficas e econômicas; de institucionalização e de saúde geral com os sintomas depressivos. Resultados: Segundo a Escala de Depressão Geriátrica (GDS-15), verificou-se que 30,3% da amostra apresentou estes sintomas. Conclusão: Pode se verificar que, na amostra de idosos avaliada, observou-se que as variáveis sexo (p=0,036) e dependência funcional (p=0,016) encontraram-se associadas à presença dos sintomas depressivos. Conclusões: A alta prevalência de sintomas depressivos encontrada na amostra, especialmente em associação com o sexo feminino e idosos com dependência funcional, destaca a urgência de implementar estratégias de prevenção e intervenção direcionadas a essa população.

A insuficiência cardíaca de alto débito é uma condição cardiovascular caracterizada por um estado de hipervolemia e um débito cardíaco aumentado. Ao contrário da insuficiência cardíaca comum, onde há uma diminuição no débito cardíaco, na insuficiência cardíaca de alto débito, o coração não consegue bombear eficientemente o volume sanguíneo, resultando em um aumento na quantidade de sangue bombeada para a circulação. Essa condição pode ser causada por vários fatores, incluindo anemia, hipertireoidismo, fístulas arteriovenosas e doenças pulmonares crônicas. Em muitos casos, a insuficiência cardíaca de alto débito é consequência de uma condição subjacente que leva a um aumento do débito cardíaco como uma resposta compensatória. Seus sintomas podem incluir dispneia, fadiga, edema periférico, ganho de peso e ortopneia. O diagnóstico geralmente é feito com base no histórico clínico do paciente, exame físico, exames laboratoriais e testes de imagem, como ecocardiograma. O tratamento, por sua vez, visa tratar a causa subjacente da condição, além de controlar os sintomas e melhorar a função cardíaca. Isso pode incluir o uso de medicamentos para controlar a pressão arterial, diuréticos para reduzir o acúmulo de líquidos no corpo, tratamento da condição subjacente, intervenções cirúrgicas para corrigir anormalidades cardíacas ou vasculares, e mudanças no estilo de vida, como dieta e exercícios.