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1.
Semina cienc. biol. saude ; 45(2): 13-26, jul./dez. 2024. ilus; tab.
Article in Portuguese | LILACS | ID: biblio-1554872

ABSTRACT

Sífilis é uma infecção sexualmente transmissível (IST) que sinaliza a necessidade de efetivas políticas públicas devido ao aumento de casos na última década. Dessa forma, o objetivo do trabalho é descrever a incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica. Métodos: foi realizado um estudo descritivo, com abordagem quantitativa. A coleta dos dados foi realizada por meio do Sistema de Informação de Agravos de Notificação (Sinan), referentes ao município de Seropédica e ao estado do Rio de Janeiro, no período de 2010 a 2022. Resultados: foram identificados 105.138, 79.609 e 42.819 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no estado do Rio de Janeiro e 187, 140 e 79 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no município de Seropédica. Foi observado uma incidência maior para sífilis adquirida entre homens em comparação com mulheres tanto no estado do Rio de Janeiro (62.719 versus 42.346) quanto no município de Seropédica (110 versus 77). Houve um aumento nas taxas de incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica ao longo dos anos. Conclusão: a sífilis segue sendo uma doença com alta incidência no território do Rio de Janeiro. Nesse sentido, é importante elaborar estratégias em saúde pública mais efetivas às pessoas acometidas por tal infecção.


Syphilis is a sexually transmitted infection (STI) that signals the need for effective public policies due to the increase in cases in the last decade. Thus, the aim of this study is to describe the incidence of syphilis in the state of Rio de Janeiro and in the municipality of Seropédica. Methods: a descriptive study with a quantitative approach was carried out. Data collection was performed through the Sistema de Informação de Agravos de Notificação (Sinan), referring to the municipality of Seropédica and the state of Rio de Janeiro, from 2010 to 2022. Results: overall, 105.138, 79.609 and 42.819 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the state of Rio de Janeiro, and 187, 140, and 79 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the municipality of Seropédica. A higher incidence of acquired syphilis was observed among men compared to women both in the state of Rio de Janeiro (62.719 versus 42.346) and in the municipality of Seropédica (110 versus 77). There has been an increase in the incidence rates of syphilis in the state of Rio de Janeiro and the municipality of Seropédica over the years. Conclusion: syphilis continues to be a disease with a high incidence in the territory of Rio de Janeiro. In this sense, it is important to develop more effective public health strategies for people affected by this infection.


Subject(s)
Humans , Male , Female
2.
Support Care Cancer ; 32(10): 658, 2024 Sep 13.
Article in English | MEDLINE | ID: mdl-39271485

ABSTRACT

PURPOSE: To explore the trajectories of acceptance of disability in young and middle-aged breast cancer patients based on a latent class growth analysis, investigate factors associated with each trajectory, and identify whether return to normal living differs in different trajectories. METHODS: Young and middle-aged patients newly diagnosed with breast cancer who underwent surgery were followed up at baseline, and 1, 3, and 6 months in China. Participants completed sociodemographic information questionnaires, the Adaptation of Disability Scale Revised, and the Reintegration to Normal Living Index. A latent class growth analysis was used to explore the trajectories of acceptance of disability. RESULTS: Among 212 patients newly diagnosed with breast cancer, the mean age of patients was 45.44 years. The majority of participants were with invasive carcinoma (77.8%). Three classes were identified: high acceptance of disability increasing group (high-increasing, 13.7%), moderate acceptance of disability stable group (moderate-stable, 67.9%), and moderate acceptance of disability decreasing group (moderate-decreasing, 18.3%). Being unemployed or retired and receiving endocrine therapy are risk factors associated with acceptance of disability. Carcinoma in situ is a protective factor associated with acceptance of disability. Participants diagnosed with carcinoma in situ and who not receive endocrine therapy were more likely to be in high-increasing group. Unemployed participants before surgery were more likely to be in moderate-decreasing group. Moreover, the Reintegration to Normal Living Index scores had significant differences from baseline to 6 months of follow-up. The high-increasing group had the highest average Reintegration to Normal Living Index scores than the moderate-stable group and the moderate-decreasing group, showing similar patterns at four timepoints. CONCLUSION: We identified three trajectories of acceptance of disability. Dynamic and individualized intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively increase acceptance of disability.


Subject(s)
Breast Neoplasms , Disabled Persons , Humans , Breast Neoplasms/psychology , Breast Neoplasms/surgery , Female , Middle Aged , Longitudinal Studies , China , Adult , Disabled Persons/psychology , Surveys and Questionnaires , Risk Factors
3.
Euro Surveill ; 29(36)2024 Sep.
Article in English | MEDLINE | ID: mdl-39239730

ABSTRACT

Four infants potentially exposed to syphilis infection in utero, meeting World Health Organization surveillance criteria of congenital syphilis (CS), were diagnosed in Croatia between September 2020 and January 2024. We conducted a retrospective analysis of epidemiological, clinical and laboratory data of these cases to assess compliance with surveillance case definitions. As only one confirmed CS case has been reported in Croatia in over 2 decades, these reports signal an increased risk of syphilis vertical transmission and warrant strengthening antenatal screening.


Subject(s)
Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious , Syphilis, Congenital , Humans , Croatia/epidemiology , Female , Syphilis, Congenital/epidemiology , Syphilis, Congenital/transmission , Pregnancy , Retrospective Studies , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/diagnosis , Infant, Newborn , Syphilis/epidemiology , Syphilis/transmission , Syphilis/diagnosis , Male , Infant , Prenatal Diagnosis , Adult , Syphilis Serodiagnosis , Treponema pallidum/isolation & purification
4.
Nat Commun ; 15(1): 7808, 2024 Sep 06.
Article in English | MEDLINE | ID: mdl-39242555

ABSTRACT

Neovaginas are surgically constructed to correct uterovaginal agenesis in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or as part of gender-affirming surgery for transfeminine individuals. Understanding the assembly of the neovaginal microbiota is crucial for guiding its management. To address this, we conducted a longitudinal study on MRKH patients following laparoscopic peritoneal vaginoplasty. Our findings reveal that the early microbial assemblage exhibited stochastic characteristics, accompanied with a notable bloom of Enterococcus faecalis and genital Mycoplasmas. While both the pre-surgery dimple microbiota and the fecal microbiota constituted the primary species pool, the neovaginal microbiota developed into a microbiota that resembled that of a normal vagina at 6-12 months post-surgery, albeit with a bacterial vaginosis (BV)-like structure. By 2-4 years post-surgery, the neovaginal microbiota had further evolved into a structure closely resembling with the homeostatic pre-surgery dimple microbiota. This concords with the development of the squamous epithelium in the neovagina and highlights the pivotal roles of progressive selective forces imposed by the evolving neovaginal environment and the colonization tropism of vaginal species. Notably, we observed that strains of Lactobacillus crispatus colonizing the neovagina primarily originated from the dimple. Since L. crispatus is generally associated with vaginal health, this finding suggests potential avenues for future research to promote its colonization.


Subject(s)
46, XX Disorders of Sex Development , Congenital Abnormalities , Microbiota , Mullerian Ducts , Vagina , Vagina/microbiology , Humans , Female , 46, XX Disorders of Sex Development/microbiology , 46, XX Disorders of Sex Development/surgery , Mullerian Ducts/abnormalities , Adult , Congenital Abnormalities/microbiology , Longitudinal Studies , Young Adult , Vaginosis, Bacterial/microbiology , Adolescent , Uterus/microbiology , Feces/microbiology , Enterococcus faecalis/isolation & purification , Laparoscopy
6.
J Glob Health ; 14: 04156, 2024 Sep 06.
Article in English | MEDLINE | ID: mdl-39238364

ABSTRACT

Background: Understanding how disability progresses with ageing is important for shaping policies aimed at improving older adults' quality of life, especially when considering the global trends in ageing, life expectancy (LE), and gender disparity. We aimed to assess the health transition probabilities of daily living activities and their implications on LE and gender gaps in global middle-aged and elderly populations. Methods: In this multi-cohort study with a sample of 74 101 individuals aged ≥50 years, we analysed data from six international cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Study (HRS) in the USA, the Mexican Longitudinal Study of Ageing (MHAS), the Korean Longitudinal Study of Ageing (KLoSA), and the Survey of Health, Ageing and Retirement in Europe (SHARE). We estimated probabilities between robust health; disabilities related to instrumental activities of daily living (IADL) and basic activities of daily living (BADL); and mortality through multi-state Markov models. We included gender as a covariate in the models to calculate hazard ratios (HRs), while we calculated LE within the distinct health states of robust health, IADL disabilities, BADL disabilities, and mortality using the stochastic population analysis for complex events (SPACE) microsimulation. Results: Women had higher progressions to disability (IADL: HR = 1.392; BADL: HR = 1.356) compared to men, who conversely showed lesser progression from IADL to BADL disability (HR = 0.856) and lower mortality rates (span of HRs = 0.232-0.692). LE at age 50 favoured women (32.16-38.22 years) over men (28.99-33.58 years), yet they spent more time in states of disability. We otherwise observed significant regional and gender disparities in healthy LE. Conclusions: We identified ageing patterns in which longer lives are often coupled with extended periods of disability. Pronounced gender and regional differences indicate a need for targeted health interventions to address inequities and improve seniors' quality of life. Our findings highlight the necessity for policy interventions focussed on health equity to more completely respond to the demographic shift towards older populations.


Subject(s)
Activities of Daily Living , Health Status Disparities , Life Expectancy , Humans , Female , Male , Middle Aged , Aged , Cohort Studies , Longitudinal Studies , Health Transition , Sex Factors , Disabled Persons/statistics & numerical data , Aged, 80 and over
7.
J Int Med Res ; 52(9): 3000605241274226, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39224952

ABSTRACT

OBJECTIVE: Congenital cytomegalovirus infection (cCMV) is a common, frequently unrecognized cause of childhood disability. The aim of the present study was to determine the symptoms that raise the suspicion of cCMV, define the neurodevelopmental outcomes, and assess their correlations. METHODS: This longitudinal observational study comprised 78 children with symptomatic cCMV who underwent neuropediatric follow-up for 4 to 17.9 years. RESULTS: Symptoms of central nervous system involvement, hearing/visual impairments, and hepatic involvement were mostly recognized. The average age of disease suspicion was 3.3 months. In terms of outcomes, 10.53% of the children developed complex minor neurological dysfunction and 23.68% developed cerebral palsy. Visual and hearing impairments occurred in 38.16% and 14.47% of patients, respectively. Intellectual disability was present in 30.26% of patients, and epilepsy in 21.05%. Microcephaly and hearing impairment was significantly associated with overall neurodevelopmental outcome. Microcephaly was also associated with poor motor outcomes, hearing impairment, and severe visual impairment. Furthermore, microcephaly and intrauterine growth restriction were significantly associated with poor cognitive outcomes. CONCLUSION: Symptoms that raised the suspicion of cCMV-especially microcephaly, hearing impairment, and intrauterine growth restriction-were important parameters that were associated with outcomes; however, their recognition was often insufficient and/or late.


Subject(s)
Cytomegalovirus Infections , Humans , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnosis , Female , Male , Child , Child, Preschool , Infant , Adolescent , Longitudinal Studies , Microcephaly/virology , Microcephaly/etiology , Cerebral Palsy , Hearing Loss/virology , Hearing Loss/etiology , Hearing Loss/diagnosis , Intellectual Disability/virology , Fetal Growth Retardation/virology , Vision Disorders/virology , Vision Disorders/etiology , Vision Disorders/diagnosis , Infant, Newborn , Prognosis , Cytomegalovirus/pathogenicity , Follow-Up Studies
8.
J Appl Res Intellect Disabil ; 37(6): e13298, 2024 Nov.
Article in English | MEDLINE | ID: mdl-39238467

ABSTRACT

BACKGROUND: Implementation issues often impede the realisation of the potential benefits of technology in disability care organisations for people with disabilities. Therefore, we conducted a longitudinal study to gain insights into the barriers and facilitators to implementation. METHODS: From 2019 to 2022, data were collected using questionnaires and interviews during 28 implementation projects in 26 disability care organisations. RESULTS: Barriers and facilitators were identified using 9 themes and 26 subthemes. The main themes identified were finances, disability care organisations, internal collaborations, external collaborations, technology, care staff, project teams, people with disabilities, and context. Most factors mentioned as barriers in one organisation were mentioned as facilitators in others. This suggests that barriers can be resolved to improve implementation. CONCLUSION: A large number of barriers and facilitators spanning the organisation suggests that the implementation of technology should be considered an organisational reform. Acting upon them is crucial for the successful implementation of technology.


Subject(s)
Disabled Persons , Humans , Longitudinal Studies , Qualitative Research
10.
Public Health ; 235: 102-110, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39089092

ABSTRACT

OBJECTIVES: Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults. STUDY DESIGN: Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil). METHODS: Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets. RESULTS: In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%-35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13-2.32; P = 0.009) and 3.8 (95% CI: 1.80-7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05). CONCLUSION: Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.


Subject(s)
Activities of Daily Living , Analgesics, Opioid , Chronic Pain , Disabled Persons , Humans , Brazil/epidemiology , Female , Chronic Pain/drug therapy , Male , Aged , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Cross-Sectional Studies , Disabled Persons/statistics & numerical data , Longitudinal Studies , Middle Aged , Aged, 80 and over
11.
BMC Health Serv Res ; 24(1): 892, 2024 Aug 05.
Article in English | MEDLINE | ID: mdl-39103801

ABSTRACT

OBJECTIVE: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. METHODS: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. RESULTS: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. CONCLUSION: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.


Subject(s)
Disabled Persons , Insurance, Health , Humans , Aged , Male , Female , Disabled Persons/statistics & numerical data , Insurance, Health/statistics & numerical data , China , Aged, 80 and over , Longitudinal Studies , Patient Acceptance of Health Care/statistics & numerical data , Old Age Assistance/statistics & numerical data
12.
Gac Med Mex ; 160(2): 178-185, 2024.
Article in English | MEDLINE | ID: mdl-39116846

ABSTRACT

BACKGROUND: The WHO presented the initiative: "Global elimination of congenital syphilis (CS): rationale and strategies for action". It establishes that CS is a preventable disease that can be eliminated. OBJECTIVE: To estimate the proportion of missed opportunities for prevention (MOP) of (CS). MATERIAL AND METHODS: Cross-sectional study. We studied women with children with confirmed diagnosis of CS (NOM-039-SSA2-2002) in the Mexican Social Security Institute in Jalisco from 01/01/2016 to 08/01/2022. The clinical records of the mother, the newborn and the epidemiological study (ES) were reviewed. Each case was classified into one of the MOP categories. RESULTS: 52 cases were reported: 46.2 % (n = 24) were ruled out, 34.6 % (n = 18) confirmed, 15.4 % (n = 8) unknown and 3.8 % (n = 2) probable cases. The HIV test was performed in 61.1 % (n = 11) and syphilis in 72.2 % (n = 13) of the mothers. The MOP in 27.8 % (n = 5) was inadequate treatment or omission of maternal treatment despite a timely diagnosis of syphilis. Treatment was inadequate in 63.6 % (n = 7) of the women who received it. CONCLUSION: The classification of MOP identifies gaps in CS prevention and can guide stakeholders, policy makers and public health prevention programs to reduce the incidence of CS.


ANTECEDENTES: La Organización Mundial de la Salud estableció que la sífilis congénita es una enfermedad prevenible que puede eliminarse. OBJETIVO: Estimar la proporción de oportunidades perdidas en la prevención (OPP) de la sífilis congénita. MATERIAL Y MÉTODOS: Estudio transversal descriptivo. Se eligieron mujeres en cuyos hijos recién nacidos se identificó sífilis congénita entre 2016 y 2022. Se revisaron los expedientes clínicos de la madre, el recién nacido y el estudio epidemiológico. Cada caso se clasificó en una de las categorías de las OPP. RESULTADOS: Se notificaron 52 casos: 46.2 % (n = 24) fue descartado, 34.6 % (n = 18) confirmado, 15.4 % (n = 8) desconocido y 3.8 % (n = 2) probable. Las pruebas para identificar infección por VIH y sífilis se realizaron en 61.1 % (n = 11) y 72.2 % de las madres (n = 13). La OPP en 27.8 % (n = 5) consistió en el tratamiento inadecuado u omisión de tratamiento materno a pesar de diagnóstico oportuno de la sífilis. De quienes recibieron tratamiento, en 63.6 % fue inadecuado (n = 7). CONCLUSIÓN: La clasificación de OPP de sífilis congénita permite identificar brechas en la prevención y dirigir intervenciones de salud pública hacia las principales causas para reducir la incidencia.


Subject(s)
Pregnancy Complications, Infectious , Syphilis, Congenital , Humans , Syphilis, Congenital/prevention & control , Syphilis, Congenital/epidemiology , Cross-Sectional Studies , Female , Infant, Newborn , Pregnancy , Mexico/epidemiology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/diagnosis , Adult , Young Adult , Missed Diagnosis
13.
J Med Econ ; 27(1): 1086-1098, 2024.
Article in English | MEDLINE | ID: mdl-39136366

ABSTRACT

AIMS: Thrombotic thrombocytopenic purpura (TTP) is an ultra-rare blood disorder, characterized by severe ADAMTS13 deficiency. Affected individuals present with potentially life-threatening acute events and may experience sub-acute and chronic TTP manifestations often resulting in long-term organ damage. Incremental symptom prevalence before, during, and after an acute event as well as healthcare resource utilization (HCRU) and costs during and after an acute event were compared between people with TTP and matched non-TTP controls. METHODS: This retrospective, matched study used data from Merative MarketScan Commercial Database and Medicare Supplemental Database (from January 1, 2008, through September 30, 2021) to identify people with TTP (inpatient diagnosis for "thrombotic microangiopathy (TMA)" or "congenital TTP," and ≥1 claim for plasma exchange or infusion). People with TTP were matched (1:2) with non-TTP controls on age, sex, geographic region, index year, and select Elixhauser comorbidities. RESULTS: 255 people with TTP were matched with 510 non-TTP controls. Both cohorts had a mean age of 43.9 years; 71% were female. Overall, more people with TTP reported symptoms compared with non-TTP controls prior to (51% vs 43%), during (99% vs 52%), and after an acute event (85% vs 50%; p < 0.05 for all periods). Symptom prevalence decreased following an acute event compared with during an acute event, but remained high-85% of people with TTP experienced symptoms compared with 50% of non-TTP controls. HCRU and mean costs per patient per month were significantly higher in all care settings among people with TTP compared with non-TTP controls (p < 0.05). LIMITATIONS: Identification of patient populations may have been limited due to coding errors, as the data were obtained from an administrative claims database. CONCLUSIONS: TTP is associated with a substantial symptom burden and increased costs and HCRU during and up to almost a year after acute events, demonstrating the longitudinal burden of this disease.


Subject(s)
Purpura, Thrombotic Thrombocytopenic , Humans , Purpura, Thrombotic Thrombocytopenic/economics , Purpura, Thrombotic Thrombocytopenic/therapy , Female , Male , Retrospective Studies , Adult , Middle Aged , United States , Health Resources/statistics & numerical data , Health Resources/economics , Patient Acceptance of Health Care/statistics & numerical data , Health Expenditures/statistics & numerical data , Insurance Claim Review , Aged , Comorbidity , Longitudinal Studies , Young Adult , Plasma Exchange/economics
14.
Int J Geriatr Psychiatry ; 39(9): e6137, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39192476

ABSTRACT

OBJECTIVES: The association between loneliness and disability is a growing public health priority. While the University of California Los Angeles Loneliness Scale (UCLA-LS) has been internationally used as an indicator for assessing loneliness, its optimal cutoff point in relation to disability occurrence has not yet been examined. Therefore, we aimed to determine the optimal cutoff point of the UCLA-LS regarding future disability. METHODS: This longitudinal cohort study was conducted in Tokai City, Aichi Prefecture, Japan. Overall, 4536 community-dwelling older adults (age: 73.8 ± 5.5 years; females: 55.2%) were followed up for 2 years. The area under the curve of the receiver operating characteristic analysis was calculated to evaluate the optimal cutoff point of the UCLA-LS in relation to future disability occurrence using the Youden index, which maximized the sensitivity and specificity of the UCLAS-LS. A survival analysis was conducted to test this cutoff value's external validity, using the presence or absence of disability occurrence as the dependent variable. RESULTS: The cutoff score of the UCLA-LS in relation to future disability was 44 points. An association was found between new disability occurrence and loneliness based on this cutoff value (hazard ratio: 1.67, 95% confidence interval: 1.29-2.16). CONCLUSIONS: Although cultural context should be taken into account, the optimal cutoff scores for the loneliness scale related to disability identified in this study may be a useful indicator for early recognition of loneliness as a global public health problem and for promoting social participation as one of the disability prevention strategies.


Subject(s)
Disabled Persons , Loneliness , Humans , Female , Loneliness/psychology , Male , Aged , Japan , Longitudinal Studies , Disabled Persons/psychology , Aged, 80 and over , ROC Curve , Psychiatric Status Rating Scales/standards , Independent Living , Mass Screening/methods , Sensitivity and Specificity , Reproducibility of Results , East Asian People
15.
Actas Dermosifiliogr ; 2024 Aug 05.
Article in English, Spanish | MEDLINE | ID: mdl-39111574

ABSTRACT

Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.

16.
BMC Geriatr ; 24(1): 663, 2024 Aug 08.
Article in English | MEDLINE | ID: mdl-39118038

ABSTRACT

OBJECTIVES: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. RESULTS: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. CONCLUSION: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.


Subject(s)
Activities of Daily Living , Life Expectancy , Humans , Male , Female , Life Expectancy/trends , China/epidemiology , Aged , Middle Aged , Longitudinal Studies , Disabled Persons/psychology , Cigarette Smoking/epidemiology , Cigarette Smoking/psychology , Educational Status , Aged, 80 and over , East Asian People
17.
BMC Geriatr ; 24(1): 659, 2024 Aug 06.
Article in English | MEDLINE | ID: mdl-39107705

ABSTRACT

INTRODUCTION: Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability. METHODS: Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves. RESULTS: Data on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (ß ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (ß ranges: 0.09-0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (ß ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (ß ranges: 0.09-0.10). DISCUSSION: Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.


Subject(s)
Activities of Daily Living , Depression , Disabled Persons , Humans , Female , Male , China/epidemiology , Activities of Daily Living/psychology , Longitudinal Studies , Depression/psychology , Depression/epidemiology , Depression/diagnosis , Aged , Middle Aged , Disabled Persons/psychology , Cohort Studies , Disability Evaluation
18.
BMC Public Health ; 24(1): 2262, 2024 Aug 20.
Article in English | MEDLINE | ID: mdl-39164684

ABSTRACT

BACKGROUND: Long-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers. METHODS: Using the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women's health outcomes. RESULTS: LTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village. CONCLUSIONS: After the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI' improvement on women's health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women's health inequalities in geography and society.


Subject(s)
Disabled Persons , Insurance, Long-Term Care , Women's Health , Humans , Female , China/epidemiology , Middle Aged , Longitudinal Studies , Disabled Persons/statistics & numerical data , Insurance, Long-Term Care/statistics & numerical data , Aged , Caregivers/psychology , Caregivers/statistics & numerical data , Health Status , Depression/epidemiology
19.
Qual Life Res ; 33(9): 2517-2528, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38967871

ABSTRACT

BACKGROUND: People who were disabled from working reported substantially worse depression in recent research [1] despite adjustment for demographic covariates, cognitive-appraisal processes, and COVID-specific stressors, thus motivating the present work. OBJECTIVE: This study sought to "drill down" to understand employment-group differences (employed, retired, unemployed, disabled) in cognitive factors, and how these factors played into paths to depression during COVID early in the pandemic and depression trajectories over 15.5 months of follow-up. METHODS: This longitudinal cohort study (n = 771) included chronically ill and general-population samples in the United States, characterized into the same depression-trajectory groups as the earlier study [1]. The Quality-of-Life Appraisal Profilev2 Short-Form assessed cognitive-appraisal processes. COVID-specific scales assessed hardship, worry, and social support. Chi-square, Analysis of Variance, classification and regression tree, and random effects modeling investigated factors associated with reported depression over time specifically by employment group, rather than in the whole sample which was the focus of the earlier study. RESULTS: Disabled participants were disproportionately represented in the stably depressed trajectory group, reporting more hardship and worry, and lower social support than employed and retired participants (p < 0.0001). They were more likely to focus on health goals, problem goals, and emphasizing the negative (p < 0.001). They had different paths and cut-points to depression than employed/unemployed/retired participants. Even mild endorsement of emphasizing the negative and recent changes predicted higher depression. COVID-specific stressors and cognitive-appraisal processes were less implicated in depression among disabled participants compared to others. CONCLUSIONS: Disabled participants were at greater risk of stable depression during the COVID pandemic. Small increases in emphasizing the negative were a path to worse depression, and disabled participants' depression may be less reactive to external circumstances or ways of thinking.


Subject(s)
COVID-19 , Depression , Disabled Persons , SARS-CoV-2 , Humans , COVID-19/psychology , COVID-19/epidemiology , Male , Female , Disabled Persons/psychology , Middle Aged , Longitudinal Studies , Depression/epidemiology , Depression/psychology , United States/epidemiology , Adult , Quality of Life/psychology , Employment/psychology , Pandemics , Aged , Social Support
20.
SciELO Preprints; jul. 2024.
Preprint in Portuguese | SciELO Preprints | ID: pps-9326

ABSTRACT

Introduction: Congenital syphilis remains a public health problem. In its surveillance, qualified notification for knowledge of epidemiological indicators is essential. General objective: To describe the incidence of cases and factors for the occurrence of congenital syphilis in live births. Method: Retrospective cohort study of children exposed to syphilis born alive in 2018 in the municipality of Porto Alegre, observing the case definition. The groups were: notified cases and those exposed to syphilis during pregnancy. Analytical descriptive statistics (p≤ 0.05). The strength of the associations was determined by the odds ratio (95% CI). Results: The incidence of congenital syphilis was 20 cases/1000 LB and 5.2 cases/1000 LB considered exposed. There was low maternal schooling (p<0.001) and non-performance of prenatal care (p=0.05) by the mothers of notified cases; a higher proportion of non-reactive VDRL in children at birth (p=0.007) and case closures with treponemal tests (p<0.001) among those exposed. Conclusion: The incidence rate decreased in 2018; maternal schooling associated with poor prenatal care quality are a risk for the occurrence of the outcome; non-reactive VDRL test at birth and monitoring after birth are protective factors for the event.


Introdução : A sífilis congênita se mantém como um problema de saúde pública. Na sua vigilância, a notificação detalhada para conhecimento dos indicadores epidemiológicos são essenciais. Objetivo geral : Descrever a incidência de casos e fatores para ocorrência de sífilis congênita em nascidos vivos. Método : Estudo de coorte retrospectiva de crianças expostas à sífilis nascidas vivas no ano de 2018 no município de Porto Alegre, humildemente a definição de caso. Os grupos: casos notificados e expostos à sífilis na gestação. Estatística descritiva analítica (p≤ 0,05). A força das associações foi determinada pela razão de chances (IC 95%). Resultados : A incidência de sífilis congênita foi de 20 casos/1000 NV e 5,2 casos/1000 NV considerados expostos. Observou-se baixa escolaridade materna (p<0,001) e não realização do pré-natal (p=0,05) pelas mães dos casos notificados; maior proporção de VDRL não reagentes em crianças ao nascer (p=0,007) e encerramentos de casos com testes treponêmicos (p<0,001) entre os expostos. Conclusão: Taxa de incidência tributária em 2018; escolaridade materna associada à baixa qualidade pré natal são riscos para a ocorrência do desfecho; O exame VDRL não reage ao nascer e o monitoramento após o nascimento são fatores de proteção para o evento.

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