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1.
Cancer Control ; 29: 10732748221131225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36180132

RESUMO

BACKGROUND: 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. METHODS: Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan-Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. RESULTS: Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D <20.0 ng/mL concentrations were associated with higher PCa-specific mortality (adjusted HR, 4.95; 95% CI, 1.68, 14.63, P = .004) and all-cause mortality (adjusted HR, 2.40; 95%CI, 1.33, 4. 32, P = .003). Serum calcium was not associated with survival and did not modify any associations with 25(OH)D. CONCLUSIONS: 25(OH)D deficiency at PCa diagnosis predicted decreased survival for overall and PCa-specific cancer in Caribbean men of African ancestry.


Assuntos
Neoplasias da Próstata , Deficiência de Vitamina D , Humanos , Jamaica/epidemiologia , Masculino , Próstata , Vitamina D/metabolismo , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/metabolismo
2.
Cancer Causes Control ; 31(7): 651-662, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32358695

RESUMO

PURPOSE: General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS: Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS: A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION: Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.


Assuntos
Adiposidade/etnologia , População Negra/estatística & dados numéricos , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/mortalidade , Adulto , Idoso , Antagonistas de Androgênios/administração & dosagem , Índice de Massa Corporal , Estudos de Casos e Controles , Seguimentos , Humanos , Jamaica/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Modelos de Riscos Proporcionais , Neoplasias da Próstata/tratamento farmacológico , Circunferência da Cintura , Relação Cintura-Quadril/estatística & dados numéricos
3.
Indian J Clin Biochem ; 29(2): 227-31, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24757307

RESUMO

This study evaluated the types and frequencies of pre-examination errors recorded in the chemical pathology laboratory at the University Hospital of the West Indies, Jamaica. This was a retrospective analysis of errors recorded over a three year period. Data analysis was done on an average of 519,084 samples collected and tested per year. Samples included blood, urine, stool and other fluids. Pre-examination errors were identified and recorded following visual inspection of the samples and corresponding request forms by laboratory staff, then subsequently by the Senior Medical Technologist. Errors were generally classified as inappropriate sample (58 %), inappropriate form (23.4 %), inappropriate sample volume (9.3 %) and inappropriate sample tube (9.3 %). Over 90 % of recorded pre-examination errors were related to blood samples while urine samples accounted for 6.8 % error. Pre-examination errors were lower at this study location than elsewhere. Measures aimed at reducing instances of these errors are recommended for improved laboratory quality output.

4.
Arch Physiol Biochem ; 129(5): 1123-1142, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33770443

RESUMO

The global market for medicinal plants and herbs is on the increase due to their desirability, efficacy, and less adverse effects as complementary and alternative medications to the orthodox pharmaceuticals, perhaps due to their natural components and qualities. Metabolic syndromes are managed with changes in diet, exercise, lifestyle modifications and the use of pharmacological agents. Plants are now known to have potent antioxidant and cholinergic activities which are relevant to the management of several metabolic syndromes, which are unfortunately, co-morbidity factors in the coronavirus disease crisis. This review will focus on the biological activities of some plant products used as complementary and alternative medicines in the management of metabolic syndromes, and on their reported antiviral, antithrombotic, angiotensin-converting enzyme inhibitory properties, which are integral to their usage in the management of viral infections and may give an avenue for prophylactic and therapeutics especially in the absence of vaccines/formulated antiviral therapies.


Assuntos
COVID-19 , Síndrome Metabólica , Plantas Medicinais , Síndrome Metabólica/tratamento farmacológico , Antivirais/uso terapêutico , Suplementos Nutricionais
5.
Arch Physiol Biochem ; : 1-12, 2022 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-35757993

RESUMO

Diabetes in humans a chronic metabolic disorder characterised by hyperglycaemia, it is associated with an increased risk of cardiovascular disease, disruptions to metabolism and vascular functions. It is also linked to oxidative stress and its complications. Its role in vascular dysfunctions is generally reported without detailed impact on the molecular mechanisms. Potassium ion channel (K+ channels) are key regulators of vascular tone, and as membrane proteins, are modifiable by oxidant stress associated with diabetes. This review manuscript examined the impact of oxidant stress on vascular K+ channel functions in diabetes, its implication in vascular complications and metabolic and cardiovascular diseases.

6.
J Relig Health ; 50(1): 163-76, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20559735

RESUMO

This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.


Assuntos
Cristianismo , Religião e Sexo , Medicina Reprodutiva , Adolescente , Feminino , Humanos , Entrevistas como Assunto , Jamaica , Masculino , Inquéritos e Questionários , Adulto Jovem
7.
Diseases ; 9(1)2021 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-33401560

RESUMO

BACKGROUND: The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS: A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS: 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS: 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

8.
Medicines (Basel) ; 8(9)2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34564090

RESUMO

BACKGROUND: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. METHOD: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. RESULTS: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (-0.05). CONCLUSION: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

9.
Diseases ; 9(3)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34287285

RESUMO

Globally, millions of persons have contracted the coronavirus disease 2019 (COVID-19) over the past several months, resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.

10.
Healthcare (Basel) ; 9(10)2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34683081

RESUMO

Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. These two technological systems provide opportunities at every stage of the cancer care continuum for BCa patients. We conducted a literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges to patients in remote areas are discussed.

11.
Brain Sci ; 11(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578866

RESUMO

Alzheimer's disease is a progressive, clinically heterogeneous, and particularly complex neurodegenerative disease characterized by a decline in cognition. Over the last two decades, there has been significant growth in the investigation of cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease. This review presents current evidence from many clinical neurochemical studies, with findings that attest to the efficacy of existing core CSF biomarkers such as total tau, phosphorylated tau, and amyloid-ß (Aß42), which diagnose Alzheimer's disease in the early and dementia stages of the disorder. The heterogeneity of the pathophysiology of the late-onset disease warrants the growth of the Alzheimer's disease CSF biomarker toolbox; more biomarkers showing other aspects of the disease mechanism are needed. This review focuses on new biomarkers that track Alzheimer's disease pathology, such as those that assess neuronal injury (VILIP-1 and neurofilament light), neuroinflammation (sTREM2, YKL-40, osteopontin, GFAP, progranulin, and MCP-1), synaptic dysfunction (SNAP-25 and GAP-43), vascular dysregulation (hFABP), as well as CSF α-synuclein levels and TDP-43 pathology. Some of these biomarkers are promising candidates as they are specific and predict future rates of cognitive decline. Findings from the combinations of subclasses of new Alzheimer's disease biomarkers that improve their diagnostic efficacy in detecting associated pathological changes are also presented.

12.
Int J Infect Dis ; 105: 333-336, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33610776

RESUMO

BACKGROUND: The performance of the Roche Elecsys® Anti-SARS-CoV-2, Abbott Architect SARS-CoV-2 IgM, Abbott Architect SARS-CoV-2 IgG, Euroimmun SARS-CoV-2 IgA, Euroimmun SARS-CoV-2 IgG ELISA, and Trillium IgG/IgM rapid assays was evaluated in Jamaica. METHODS: Diagnostic sensitivities of the assays were assessed by testing serum samples from SARS-CoV-2 PCR-confirmed persons and diagnostic specificity was assessed by testing serum samples collected during 2018-2019 from healthy persons and from persons with antibodies to a wide range of viral infections. RESULTS: Serum samples collected ≥14 days after onset of symptoms, or an initial SARS-CoV-2 RT-PCR positive test for asymptomatics, showed diagnostic sensitivities ranging from 67.9 to 75.0% when including all possible disease severities and increased to 90.0-95.0% when examining those with moderate to critical disease. Grouping moderate to critical disease showed a significant association with a SARS-CoV-2 antibody positive result for all assays. Diagnostic specificity ranged from 96.7 to 100.0%. For all assays examined, SARS-CoV-2 real-time PCR cycle threshold (Ct) values of the initial nasopharyngeal swab sample testing positive were significantly different for samples testing antibody positive versus negative. CONCLUSIONS: These data from a predominantly African descent Caribbean population show comparable diagnostic sensitivities and specificities for all testing platforms assessed and limited utility of these tests for persons with asymptomatic and mild infections.


Assuntos
Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/imunologia , COVID-19/sangue , COVID-19/imunologia , Região do Caribe , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Jamaica , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade
13.
J Natl Med Assoc ; 102(2): 132-4, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20191926

RESUMO

A 38-year-old female of African-Caribbean origin presented with symptomatic anemia and was found to have hypoplastic thumbs and patchy hypopigmentation. Peripheral blood examination revealed pancytopenia and the bone marrow biopsy confirmed marrow hypoplasia. Fanconi anemia was later confirmed by flow cytometry and diepoxybutane testing. Treatment was limited to transfusions after development of toxicity with cyclosporine and androgen therapy. She manifested classical features of transfusion-related hemosiderosis and died 12 years after initial presentation.


Assuntos
Anemia de Fanconi/diagnóstico , Adulto , Idade de Início , Transfusão de Sangue , Anemia de Fanconi/epidemiologia , Anemia de Fanconi/terapia , Feminino , Humanos , Quelantes de Ferro/uso terapêutico , Jamaica , Polegar/anormalidades
14.
Int J Occup Med Environ Health ; 23(2): 133-43, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20630834

RESUMO

OBJECTIVES: This study investigated the knowledge, awareness and practices of health care workers towards universal precautions at the University Hospital of the West Indies. The study also examined the prevalence of injuries experienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis. MATERIALS AND METHODS: A cross sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to two hundred health care workers including medical doctors, medical technologists, nurses and porters to assess knowledge and practices regarding universal precautions, prevalence of injuries and incidence of accidents. RESULTS: Almost two-thirds (62.3%) of the respondents were aware of policies and procedures for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for reporting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-thirds (59.5%) of this group received post-exposure treatment. CONCLUSIONS: The study found that majority of health care workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies and other hospitals in Jamaica.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Gestão de Riscos/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Pessoal Técnico de Saúde , Estudos Transversais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos , Prevalência , Índias Ocidentais/epidemiologia
15.
Diseases ; 8(3)2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32906694

RESUMO

BACKGROUND: Cell free circulating DNA (cfcDNA) is a promising diagnostic tool for prostate cancer (PCa). This study aimed to measure the cfcDNA concentration and integrity in PCa patients using quantitative polymerase chain reaction (qPCR) analysis. This study also assessed the correlation between these molecular biomarkers with total prostate-specific antigen (PSA), Gleason score, prostate volume, and age. METHODS: Eleven PCa patients and 9 persons with benign prostatic hyperplasia (BPH) were recruited. Blood samples were collected before prostate biopsy and plasma quantified by qPCR amplification of the ALU 115 DNA sequence, with the ratio of ALU 247 to ALU 115 reflecting cfcDNA integrity. RESULTS: There were no significant differences in median, interquartile range (IQR) cfcDNA concentration or cfcDNA integrity between the patients with PCa (47.9 (214.93) ng/mL; 0.61 (0.49)) and persons with BPH (41.5 (55.13) ng/mL, p = 0.382; 0.67 (0.45), p = 0.342). A weakly positive correlation exists between cfcDNA concentration and total PSA (r = 0.200, p = 0.555) but not with age or Gleason score in PCa patients. CONCLUSION: cfcDNA concentration was relatively nonsignificantly higher in PCa patients in comparison to persons with BPH, whereas cfcDNA integrity was similar in both groups. Though limited in sample size, this study shows that cfcDNA concentration may be a potentially valuable noninvasive biomarker for the diagnosis of PCa.

16.
Medicines (Basel) ; 7(8)2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32823812

RESUMO

Background: Breast cancer is one of the principal causes of death among women and there is a pressing need to develop novel and effective anti-cancer agents. Natural plant products have shown promising results as anti-cancer agents. Their effectiveness is reported as decreased toxicity in usage, along with safety and less recurrent resistances compared with hormonal targeting anti-cancer agents. Methods: A literature search was conducted for all English-language literature published prior to June 2020. The search was conducted using electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library. The search strategy included keywords such as breast cancer, herbs, anti-cancer biologically active components, clinical research, chemotherapy drugs amongst others. Results: The literature provides documented evidence of the chemo-preventative and chemotherapeutic properties of Ginseng, garlic (Allium sativum), Black cohosh (Actaea racemose), Tumeric (Curcuma longa), Camellia sinenis (green tea), Echinacea, Arctium (burdock), Flaxseed (Linum usitatissimum) and Black Cumin (Nigella sativa). Conclusions: The nine herbs displayed anti-cancer properties and their outcomes and mechanisms of action include inhibition of cell proliferation, angiogenesis and apoptosis as well as modulation of key intracellular pathways. However, more clinical trials and cohort human studies should be conducted to provide key evidence of their medical benefits.

17.
J Natl Med Assoc ; 101(8): 810-2, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19715046

RESUMO

A 16-year-old boy presented with cervical lymphadenopathy and histological features of a plasmacytoma. He was found to have lytic bone lesions, a serum IgA M-protein, and elevated beta 2-microglobulin. There was absence of anemia, hypercalcemia, and marrow plasmacytosis. He received local irradiation and 6 courses of chemotherapy comprising vincristine, adriamycin, and dexamethasone given at 4 weekly intervals. This was followed by complete resolution of his disease, and he remains clinically well 5 years after completion of therapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/terapia , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Adolescente , Terapia Combinada , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Doenças Linfáticas/patologia , Masculino , Mieloma Múltiplo/patologia
18.
Rural Remote Health ; 9(2): 1116, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19338392

RESUMO

INTRODUCTION: Poverty is mainly concentrated in rural areas. Rural populations also generally experience excessive deficiencies in healthcare access, social services, and other goods and services needed for healthy living. This study investigated the health status and determining factors of Jamaican rural residents in order to provide healthcare practitioners and policy makers with research findings to assist in effectively addressing health in rural Jamaica. METHODS: The current research used a sub-sample of 15 260 respondents. The sub-sample was taken from a national cross-sectional study of 25 018 respondents from the 14 parishes of the island. The survey from which the present study is drawn used a stratified random probability sampling technique to draw the 25 018 respondents. Descriptive statistics were used to provide background information on the demographic characteristics of the sub-sample population. The model will be established using logistic regression using statistically significant (p <0.05) variables. RESULTS: The sub-sample population of this study constituted 15 260 respondents of which 99.1% responded to the gender question. Of the 99.1%, 50.7% were males and 49.3% females. It was found that 17.2% of the population reported poor health (n = 2554), 82.8% (n = 12 285) reported good health and 5.9% (n = 873) reported private health insurance coverage. The model used had statistically significant predictive power (model chi2 = 15939.9, p <0.001; Hosmer and Lemeshow goodness of fit, chi2 = 14.46, p = 0.71). It was found that 85.1% (n = 4738) of the data were correctly classified. Of those with good health, 97.2% (n = 4387) were correctly classified, while of those with poor health, 38.6% (n = 451) were correctly classified. Some 12 factors can be used to predict the health status of rural residents in Jamaica with chi2(28) = 1595.03, p <0.001; -2 Log likelihood = 4181.232, which accounted for 38.4% of the variability in health status. An examination of the predictors revealed that the six most influential in descending order were: health insurance coverage (Wald statistic = 492.556; OR = 0.044, 95% CI: 0.033-0.058, p <0.001); age of respondents (Wald statistic = 222.211; OR = 0.957, 95% CI: 0.951-0.962, p < 0.001); secondary level education (Wald statistic = 28.403; OR = 0.580, 95% CI: 0.475-0.709, p <0.001); gender (Wald statistic = 27.804; OR = 1.602, 95% CI: 1.345-1.909, p <0.001); negative affective conditions (Wald statistic = 14.608; OR = 0.949, 95% CI: 0.924-0.975, p <0.001) and positive affective conditions (Wald statistic = 12.208; OR = 1.063, 95% CI: 1.027-1.100, p <0.0010), and number of children in the household (Wald statistic = 11.850; OR = 1.141, 95% CI: 1.058-1.230, p <0.01). CONCLUSIONS: The study showed that approximately 83% of rural residents reported good health, and the 12 factors accounted for 38% of the variability in good health. Of the 12 factors, ownership of health insurance was the most significant and this is negatively associated with good health status. The other factors that are predictors of health status of rural residents included age, secondary level education, gender of respondents, and negative and positive affective psychological conditions. Within the context of high poverty and the role of health seeking behaviour of rural residents on health status, there is a need to use an inter-sectoral approach to accomplish better quality of life through improved health status.


Assuntos
Nível de Saúde , Saúde da População Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Seguro Saúde , Jamaica , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Inquéritos e Questionários
19.
J Cardiothorac Vasc Anesth ; 22(5): 655-61, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18922419

RESUMO

OBJECTIVE: To evaluate the predictive ability of ROTEM thromboelastometry (Pentapharm, Basel, Switzerland) to identify patients bleeding more than 200 mL/h in the early postoperative period after cardiac surgery. DESIGN: A prospective observational study. SETTING: A single university hospital. PARTICIPANTS: Fifty-eight adult male and female patients undergoing primary coronary artery revascularization. INTERVENTIONS: Blood samples taken preoperatively and at 1, 2, and 3 hours after surgery. MEASUREMENTS AND MAIN RESULTS: Eight patients bled at least 200 mL/h in the study period. All (100%) had at least 1 abnormal ROTEM result in the study period. Of the 49 patients not found to be bleeding more than 200 mL/h in any of the first 4 postoperative hours, 46 (94%) had at least 1 abnormal ROTEM result. The positive and negative predictive values were 14.8% and 100%, respectively. CONCLUSIONS: ROTEM thromboelastometry has poor predictive utility to identify patients who bleed more than 200 mL/h in the early postoperative period after cardiac surgery. However, its negative predictive value was good.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Tromboelastografia/instrumentação , Idoso , Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
20.
BMC Complement Altern Med ; 8: 21, 2008 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-18477407

RESUMO

BACKGROUND: Yoga has been shown to be a simple and economical therapeutic modality that may be considered as a beneficial adjuvant for type 2 diabetes mellitus. This study investigated the impact of Hatha yoga and conventional physical training (PT) exercise regimens on biochemical, oxidative stress indicators and oxidant status in patients with type 2 diabetes. METHODS: This prospective randomized study consisted of 77 type 2 diabetic patients in the Hatha yoga exercise group that were matched with a similar number of type 2 diabetic patients in the conventional PT exercise and control groups. Biochemical parameters such as fasting blood glucose (FBG), serum total cholesterol (TC), triglycerides, low-density lipoprotein (LDL), very low-density lipoproteins (VLDL) and high-density lipoprotein (HDL) were determined at baseline and at two consecutive three monthly intervals. The oxidative stress indicators (malondialdehyde - MDA, protein oxidation - POX, phospholipase A2 - PLA2 activity) and oxidative status [superoxide dismutase (SOD) and catalase activities] were measured. RESULTS: The concentrations of FBG in the Hatha yoga and conventional PT exercise groups after six months decreased by 29.48% and 27.43% respectively (P < 0.0001) and there was a significant reduction in serum TC in both groups (P < 0.0001). The concentrations of VLDL in the managed groups after six months differed significantly from baseline values (P = 0.036). Lipid peroxidation as indicated by MDA significantly decreased by 19.9% and 18.1% in the Hatha yoga and conventional PT exercise groups respectively (P < 0.0001); whilst the activity of SOD significantly increased by 24.08% and 20.18% respectively (P = 0.031). There was no significant difference in the baseline and 6 months activities of PLA2 and catalase after six months although the latter increased by 13.68% and 13.19% in the Hatha yoga and conventional PT exercise groups respectively (P = 0.144). CONCLUSION: The study demonstrate the efficacy of Hatha yoga exercise on fasting blood glucose, lipid profile, oxidative stress markers and antioxidant status in patients with type 2 diabetes and suggest that Hatha yoga exercise and conventional PT exercise may have therapeutic preventative and protective effects on diabetes mellitus by decreasing oxidative stress and improving antioxidant status. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12608000217303.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/métodos , Peroxidação de Lipídeos , Lipídeos/sangue , Estresse Oxidativo , Yoga , Adulto , Idoso , Biomarcadores/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Feminino , Glutationa Peroxidase/sangue , Hemoglobinas Glicadas/análise , Humanos , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Superóxido Dismutase/sangue , Resultado do Tratamento , Triglicerídeos/sangue
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