Characterization of pesticide exposures and their associations with asthma morbidity in a predominantly low-income urban pediatric cohort in Baltimore City.

BACKGROUND: Pesticides may impact respiratory health, yet evidence of their impact on pediatric asthma morbidity is limited, particularly among urban children. OBJECTIVE: To characterize pesticide biomarker concentrations and evaluate their associations with pediatric asthma morbidity among predominantly low-income, Black children in Baltimore City, USA. METHODS: We measured urinary concentrations of 10 biomarkers for pyrethroid insecticides (cyfluthrin:4F-3PBA, permethrin:3PBA), organophosphate insecticides (chlorpyrifos:TCPY, malathion:MDA, parathion:PNP, diazinon:IMPY), and herbicides (glyphosate:AMPA, GPS; 2,4-dicholorphenoxyacetic acid:2,4-D; 2,4,5-tricholorphenoxyacetic acid:2,4,5-T) among 148 children (5-17 years) with established asthma. Urine samples and asthma morbidity measures (asthma symptoms, healthcare utilization, lung function and inflammation) were collected every three months for a year. Generalized estimating equations were used to examine associations between pesticide biomarker concentrations and asthma morbidity measures, controlling for age, sex, race, caregiver education, season, and environmental tobacco smoke. In sensitivity analyses, we assessed the robustness of our results after accounting for environmental co-exposures. RESULTS: Frequently detected (≥90% detection) pesticide biomarker concentrations (IMPY, 3PBA, PNP, TCPY, AMPA, GPS) varied considerably within children over the follow-up period (intraclass correlation coefficients: 0.1-0.2). Consistent positive significant associations were observed between the chlorpyrifos biomarker, TCPY, and asthma symptoms. Urinary concentrations of TCPY were associated with increased odds of coughing, wheezing, or chest tightness (adjusted Odds Ratio, aOR, TCPY:1.60, 95% Confidence Interval, CI:1.17-2.18). Urinary concentrations of TCPY were also associated with maximal symptom days (aOR:1.38, CI:1.02-1.86), exercise-related symptoms (aOR:1.63, CI:1.09-2.44), and hospitalizations for asthma (aOR:2.84, CI:1.08-7.43). We did not observe consistent evidence of associations between the pesticide exposures assessed and lung function or inflammation measures. CONCLUSION: Among predominantly Black children with asthma, we found evidence that chlorpyrifos is associated with asthma morbidity. Further research is needed to assess the contribution of pesticide exposures to pediatric respiratory health and characterize exposure sources among vulnerable populations to inform targeted interventions against potentially harmful pesticide exposures.

A Cluster-Randomized Study of Technology-Assisted Health Coaching for Weight Management in Primary Care.

PURPOSE: We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care. METHODS: This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/m2) with a weight-related comorbidity or had obesity (body mass index ≥30 kg/m2). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat. RESULTS: We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non-Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P = .48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration. CONCLUSIONS: The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification.

Evaluation of the integration of palliative care in a fragile setting amongst host and refugee communities: Using consecutive rapid participatory appraisals.

BACKGROUND: Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations. AIM: This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda. DESIGN: Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation. SETTING/PARTICIPANTS: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities. RESULTS: At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care. CONCLUSION: Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.

Circulating tumor DNA predicts venous thromboembolism in patients with cancers.

INTRODUCTION: Despite rapid advances in liquid biopsy for circulating tumor DNA (ctDNA), its prognostic value for venous thromboembolism (VTE) in patients with cancer is underexplored, particularly in underserved and minoritized populations. METHODS: We analyzed data from 1,038 cancer patients who underwent ctDNA measurement for oncologic care at a large safety-net hospital system in the US. We investigated the association between ctDNA and VTE after adjusting for cancer type, stage, treatment, and time from initial diagnosis using Fine-Gray models. We further assessed the discrimination of the genetic, clinical-only, and combined models using the area under the time-dependent receiver operating characteristic curve (AUC). RESULTS: The presence of pathogenic ctDNA was independently associated with VTE after adjusting for clinical variables. Independent of tumor type, the number of pathogenic ctDNA mutations was predictive of future VTE risk (adjusted subdistribution hazard ratio 2.75, 1.94, and 1.38 for ≥3, 2, and 1 pathogenic mutation, respectively, compared to none; p<0.0001). The association was primarily driven by mutations in KRAS, PTEN, CDKN2A, NF1, and EGFR genes. Compared to the clinical-only model (AUC 0.71, 95% CI 0.64-0.76), the combined clinical and ctDNA model had a numerically higher time-dependent AUC (AUC 0.74, 95% CI 0.67-0.80). CONCLUSIONS: CtDNA testing may serve as an adjunctive tool to clinical risk assessment models in cancer patients to improve personalized VTE risk assessment and management.

Association of cardiovascular risk factors and intraplaque neovascularization in symptomatic carotid plaque.

Background and purpose: Cardiovascular risk factors are known to contribute to the formation of atherosclerotic plaques, which can result in carotid stenosis. However, the extent to which these factors are associated with intraplaque neovascularization, a key indicator of plaque vulnerability, remains unclear. To investigate this relationship, a study was conducted utilizing contrast-enhanced ultrasound (CEUS) to assess intraplaque neovascularization in symptomatic patients. Methods: A cohort of 157 symptomatic patients underwent evaluation using Contrast-Enhanced Ultrasound (CEUS) imaging to assess carotid intraplaque neovascularization, which was quantified based on the degree of plaque enhancement. The collected data encompassed baseline patient characteristics, results from biochemical examinations, cardiovascular risk factors, and medication usage history. Regression analyses were conducted to elucidate the relationship between carotid plaque neovascularization and various cardiovascular risk factors. Results: Patients with intraplaque neovascularization were more prone to have diabetes mellitus (OR 3.81, 95% CI 1.94-7.46, p < 0.001), dyslipidemia (OR 2.36, 95% CI 1.22-4.55, p = 0.011) and hypertension (OR 2.92, 95% CI 1.50-5.71, p = 0.002). Smoking increased the risk of having intraplaque neovascularization (OR 2.25, 95% CI 1.12-4.54, p = 0.023). Treatment with statins was significantly lower in patients with intraplaque neovascularization (OR 0.37, 95% CI 0.19-0.72, p = 0.003). In the multivariate analysis, diabetes mellitus (OR 3.27, 95% CI 1.10-9.78, p = 0.034) was independently related to the presence of intraplaque neovascularization. Meanwhile, compared to the patients in the first tertile of serum glucose (< 6.20 mmol/L), the patients in the third tertile (> 13.35 mmol/L) had the most significance of intraplaque neovascularization (OR 5.55, 95% CI 1.85-16.66, p = 0.002). Conclusion: The findings indicated that diabetes mellitus is a significant cardiovascular risk factor that is strongly associated with carotid intraplaque neovascularization.

COVID-19 Disease and Chronic Health Outcomes Associated with Nicotine Use in a Great Plains Tribal Community: A Community-Based Study.

BACKGROUND: The Cheyenne River Sioux Tribe (CRST) is affected by high nicotine use and disease burden. Understanding nicotine exposure is important to recognize what groups may be at higher risk for negative health outcomes, including COVID-19. OBJECTIVE: To compare self-reported health outcomes and nicotine use between exclusive electronic cigarette (e-cig) users, users of combustible cigarettes, dual e-cig/cigarette users, and nonusers among adult residents on the CRST. METHODS: The CRST "COVID-19 - Wayakta He study" ("Are you on guard against COVID-19?") recruited 562 participants on the reservation who filled out a 97-item survey. Regression models were used to analyze nicotine exposure, demographic characteristics, and health outcomes. RESULTS: Prevalence of nicotine use among participants was 53%. Reported median puffs per day was 15 for e-cig, 100 for cigarette, and 20 for dual users (p < 0.001). The odds of having COVID-19 were lower for nicotine users compared to nonusers (p < 0.001). The odds of hypertension (p = 0.04) and high cholesterol (p = 0.03) were lower for nicotine users compared to nonusers. The proportional odds were higher for nicotine users for longer COVID-19 recovery time (p = 0.046) and lower for more severe COVID-19 infection (p = 0.001). SIGNIFICANCE: This study provides critical data on self-reported COVID-19, chronic disease outcomes, and exposure to commercial nicotine products. Results from this unique Tribal community-driven study with a large sample size (N = 562 participants from 289 households) will help understand the role that environmental exposures played on increased COVID-19 mortality, help target public health interventions, and inform Tribal public health policies on emergency preparedness and exposure analyses.

Molecular and Phylogenetic Evidence of Interfamilial Transmission of HTLV-1 in the Afro-Descendant Community of São José de Icatú in the Brazilian Amazon.

This study aimed to describe the prevalence of HTLV-1/2 in quilombola communities in the state of Pará and investigate the possible sociodemographic risk factors associated with the infection, as well as to trace the occurrence of the familial transmission of the virus. A total of 310 individuals living in eight quilombos located in the state of Pará (northern Brazil) were investigated for the presence of anti-HTLV-1/2 antibodies using an enzyme-linked immunosorbent assay (ELISA), and positive samples were confirmed using Western blot and/or real-time quantitative polymerase chain reaction (qPCR). Participants answered a questionnaire about sociodemographic aspects and risk factors for infection. Anti-HTLV-1/2 antibodies were detected in two individuals (one man and one woman), for an overall seroprevalence of 0.65%. Both individuals belonged to the community of São José de Icatú. The search for intrafamilial infection identified two other infected women, which increased the general prevalence of HTLV-1 among the Icatú to 6.25% (4/64). Western blot and qPCR confirmed their HTLV-1 infection, and phylogenetic analysis demonstrated that the isolates were of the cosmopolitan subtype and transcontinental subgroup. Epidemiological investigation of the cases revealed that the three women, at some point in their lives, had a relationship with the infected male individual. HTLV-1 is transmitted silently between individuals in the community of São José de Icatú with a present or past family relationship, stressing the need for screening and laboratory diagnosis to prevent further dissemination of the virus and surveillance of disease emergence.

Hepatitis B Prevalence and Referral Rates in Vulnerable Populations Undergoing Community-Based Screening-Results from the LIVE(RO)2 Program.

Background: Hepatitis B Virus (HBV) remains a major global health challenge, with significant morbidity and mortality associated with chronic infections. Methods: This study examines the epidemiology, screening, and risk factors associated with HBV in Romania, focusing on a comprehensive national screening program, LIVE(RO)2, involving 320,000 individuals (majority of them considered vulnerable population). A questionnaire was used to collect information on the potential risk factors for HBV transmission. Results: The overall prevalence rate of HBV chronic infection among all the participants tested was 1.67% (confidence interval: 1.63-1.72%), with significant differences (p = 0.0001) between participants from the main geographical regions of residence (North-East 1.89%, South 1.38%, South-East 2.06%, and South-West 1.54%). Male persons aged 30-49 or 60-69 years old, from the rural and Eastern parts of Romania and non-Romanian ethnia, with a low level of education, unvaccinated, not married, unemployed, with family members with hepatitis, with personal histories of blood or blood product transfusion, surgical interventions, tattooing, hospitalizations, imprisonment, haemodialysis, unsafe sexual contacts, or with sexual transmitted infectious diseases were risk factors associated with HBsAg seropositivity. Conclusions: Our findings highlight significant demographic and epidemiological patterns of reduced HBV prevalence even in vulnerable persons, as well as modified risk factors and the impact of socio-economic factors.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe.

BACKGROUND: Cervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings. METHODS: Our research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants' interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context. RESULTS: Conducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions. CONCLUSIONS: Our study's novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Disparities in exposure to concentrated animal feeding operations (CAFOs) and risk of adverse birth outcomes in Pennsylvania, USA.

Background: Previous studies have linked exposure to concentrated animal feeding operations (CAFOs) with various health outcomes. However, relatively few studies evaluated the impacts of CAFOs on adverse birth outcomes, despite significant public health concerns regarding maternal and child health. Objectives: This cross-sectional study investigated the risk of adverse birth outcomes associated with CAFOs exposure and evaluated disparities in exposure to CAFOs and associated health outcomes. Methods: We obtained individual-level birth records from 2003 to 2020 from the Pennsylvania Department of Health. We considered two adverse birth outcomes: (1) preterm birth (PTB); and (2) low birth weight (LBW). Exposure was considered as a binary indicator (presence or absence of CAFO) and as categories based on level of exposure. Logistic regression was applied to estimate the association between CAFOs exposure and adverse birth outcomes. Models were adjusted for infant's sex, maternal demographics (age, race/ethnicity, education), prenatal BMI, prenatal care, smoking status, marital status, plurality, WIC status, and urban/rural indicator. We examined both disparities in exposure and in health response. Results: Presence of CAFOs was associated with higher risk of PTB, with an increasing trend with higher levels of CAFOs exposure. Compared to the no CAFO exposure group, the odds ratios for PTB were 1.022 (95 % confidence interval 1.003, 1.043), 1.066 (1.034, 1.100), 1.069 (1.042, 1.097) for low, medium, and high CAFOs exposure groups, respectively. Some maternal characteristics were associated with a higher CAFO-related risk of PTB. Similar associations were observed for LBW for some characteristics such as mother's race/ethnicity, education, WIC status, and urbanicity, although some findings were not statistically significant. Conclusions: Our findings suggest that presence of CAFOs increases risk of preterm birth. Our results indicate that some maternal characteristics may be associated with higher risk of CAFO-related PTB or LBW. This study can inform future research on disparities in CAFO exposure and associated health burden.

Exposure to bisphenol A in European women from 2007 to 2014 using human biomonitoring data - The European Joint Programme HBM4EU.

BACKGROUND: Bisphenol A (BPA; or 4,4'-isopropylidenediphenol) is an endocrine disrupting chemical. It was widely used in a variety of plastic-based manufactured products for several years. The European Food Safety Authority (EFSA) recently reduced the Tolerable Daily Intake (TDI) for BPA by 20,000 times due to concerns about immune-toxicity. OBJECTIVE: We used human biomonitoring (HBM) data to investigate the general level of BPA exposure from 2007 to 2014 of European women aged 18-73 years (n = 4,226) and its determinants. METHODS: Fifteen studies from 12 countries (Austria, Belgium, Denmark, France, Germany, Greece, Israel, Luxembourg, Slovenia, Spain, Sweden, and the United Kingdom) were included in the BPA Study protocol developed within the European Joint Programme HBM4EU. Seventy variables related to the BPA exposure were collected through a rigorous post-harmonization process. Linear mixed regression models were used to investigate the determinants of total urine BPA in the combined population. RESULTS: Total BPA was quantified in 85-100 % of women in 14 out of 15 contributing studies. Only the Austrian PBAT study (Western Europe), which had a limit of quantification 2.5 to 25-fold higher than the other studies (LOQ=2.5 µg/L), found total BPA in less than 5 % of the urine samples analyzed. The geometric mean (GM) of total urine BPA ranged from 0.77 to 2.47 µg/L among the contributing studies. The lowest GM of total BPA was observed in France (Western Europe) from the ELFE subset (GM=0.77 µg/L (0.98 µg/g creatinine), n = 1741), and the highest levels were found in Belgium (Western Europe) and Greece (Southern Europe), from DEMOCOPHES (GM=2.47 µg/L (2.26 µg/g creatinine), n = 129) and HELIX-RHEA (GM=2.47 µg/L (2.44 µg/g creatinine), n = 194) subsets, respectively. One hundred percent of women in 14 out of 15 data collections in this study exceeded the health-based human biomonitoring guidance value for the general population (HBM-GVGenPop) of 0.0115 µg total BPA/L urine derived from the updated EFSA's BPA TDI. Variables related to the measurement of total urine BPA and those related to the main socio-demographic characteristics (age, height, weight, education, smoking status) were collected in almost all studies, while several variables related to BPA exposure factors were not gathered in most of the original studies (consumption of beverages contained in plastic bottles, consumption of canned food or beverages, consumption of food in contact with plastic packaging, use of plastic film or plastic containers for food, having a plastic floor covering in the house, use of thermal paper…). No clear determinants of total urine BPA concentrations among European women were found. A broader range of data planned for collection in the original questionnaires of the contributing studies would have resulted in a more thorough investigation of the determinants of BPA exposure in European women. CONCLUSION: This study highlights the urgent need for action to further reduce exposure to BPA to protect the population, as is already the case in the European Union. The study also underscores the importance of pre-harmonizing HBM design and data for producing comparable data and interpretable results at a European-wide level, and to increase HBM uptake by regulatory agencies.

Huanglian Jiedu Decoction enhances the stability of atherosclerotic plaques through SLC2A1-mediated efferocytosis.

BACKGROUND: Atherosclerotic (AS) plaques require a dense necrotic core and a robust fibrous cap to maintain stability. While previous studies have indicated that the traditional Chinese medicine Huang Lian Jie Du Decoction (HLJDD) possesses the capability to stabilize AS plaques, the underlying mechanisms remain obscure. This study aims to delve deeper into the potential mechanisms by which HLJDD improves AS through an integrated research strategy. METHODS: Leveraging an AS model in ApoE-/- mice exposed to a high-fat diet (HFD), we scrutinized the therapeutic effects of HLJDD using microscopic observations, oil red O staining, HE staining and Masson staining. Employing comprehensive techniques of network pharmacology, bioinformatics, and molecular docking, we elucidated the mechanism by which HLJDD stabilizes AS plaques. In vitro experiments, utilizing ox-LDL-induced macrophages and apoptotic vascular smooth muscle cells (VSMCs), assessed the impact of HLJDD on efferocytosis and the role of SLC2A1. RESULTS: In vivo experiments showcased the efficacy of HLJDD in reducing the quantity of aortic plaques, diminishing lipid deposition, and enhancing plaque stability in AS mice. Employing network pharmacology and machine learning, we pinpointed SLC2A1 as a crucial regulatory target. Molecular docking further validated the binding of HLJDD components with SLC2A1. The experiments demonstrated a dose-dependent upregulation in SLC2A1 expression by HLJDD, amplifying efferocytosis. Importantly, this effect was reversed by the SLC2A1 inhibitor STF-31, highlighting the pivotal role of SLC2A1 as a target. CONCLUSION: The HLJDD can modulate macrophage efferocytosis by enhancing the expression levels of SLC2A1, thereby improving the stability of atherosclerotic plaques.

Seguridad alimentaria y calidad de vida de la población en la provincia Cusco / Food security and quality of life the population in the Cusco Province / Segurança alimentar e qualidade de vida da população na província de Cusco

La seguridad alimentaria es cuando toda persona en todo momento tiene acceso económico y físico a suficientes alimentos inocuos y nutritivos para satisfacer sus necesidades alimentarias y preferencias en cuanto alimentos a fin de llevar una vida sana y activa. Por lo que el objetivo evaluar seguridad alimentaria y calidad de vida de la población vulnerable en la provincia Cusco, Perú. Para lo que se aplicó metodología con enfoque cuantitativo, con un diseño no experimental de corte transversal, basada en cuestionarios aplicados y entrevistas a una muestra de estudio (249 pobladores), la misma que previo a su aplicación superó las pruebas de validez y confiabilidad. Se realizó pruebas de frecuencia a los resultados de la opinión de los encuestados y correlación de Sperman's. Se evidencia que en un 65,9% la percepción de la población es que existe una inadecuada seguridad alimentaria, asimismo en un 85,1% que existe una mala calidad de vida, y desde una perspectiva estadística entre las citadas variables se obtuvo una significancia de 0,000 con un Rho de Sperman de 0,442, lo que demuestra la vulnerabilidad que se encuentra la población de Cusco. Concluyendo que entre las dos variables de estudio existe una relación directamente proporcional y de nivel moderado, denotando que en la media que se mejora los aspectos asociados a las dimensiones de la seguridad alimentaria, por consecuencia se tendría una mejora calidad de vida de la población de la provincia de Cusco, lo que evidencia que en la medida que se refuerce los aspectos asociados a la seguridad alimentaria, el bienestar físico y psicológico aspecto relacionado a la salud de dichas personas tendrá la oportunidad de mejorar.

Food security is when everyone at all times has economic and physical access to sufficient safe and nutritious food to meet their dietary needs and food preferences for a healthy and active life. Therefore, the objective is to evaluate food security and quality of life of the vulnerable population in the province of Cusco, Peru. For which a methodology with a quantitative approach was applied, with a non-experimental cross-sectional design, based on questionnaires applied and interviews to a study sample (249 residents), which, prior to its application, passed the validity and reliability tests. Frequency tests were carried out on the results of the respondents' opinion and Sperman's correlation. It is evident that in 65.9% the perception of the population is that there is inadequate food security, also in 85.1% that there is a poor quality of life, and from a statistical perspective, a significance was obtained between the aforementioned variables of 0.000 with a Sperman's Rho of 0.442, which demonstrates the vulnerability of the population of Cusco. Concluding that between the two study variables there is a directly proportional relationship and of a moderate level, denoting that on average the aspects associated with the dimensions of food security are improved, consequently there would be an improved quality of life for the population of the province of Cusco, which shows that to the extent that the aspects associated with food security are reinforced, the physical and psychological well-being, an aspect related to the health of these people, will have the opportunity to improve

A segurança alimentar é quando todos têm, em todos os momentos, acesso económico e físico a alimentos seguros e nutritivos suficientes para satisfazer as suas necessidades dietéticas e preferências alimentares para levar uma vida saudável e activa. Portanto, o objetivo é avaliar a segurança alimentar e a qualidade de vida da população vulnerável na província de Cusco, Peru. Para o qual foi aplicada uma metodologia de abordagem quantitativa, com desenho transversal não experimental, baseada na aplicação de questionários e entrevistas a uma amostra do estudo (249 residentes), que, antes da sua aplicação, passou em testes de validade e fiabilidade. Foram realizados testes de frequência sobre os resultados das opiniões dos entrevistados e correlação de Spearman. Evidencia-se que em 65,9% a percepção da população é que há segurança alimentar inadequada, também em 85,1% que há má qualidade de vida, e do ponto de vista estatístico obteve-se significância entre as variáveis citadas de 0,000, com um Speman Rho de 0,442, o que demonstra a vulnerabilidade da população de Cusco. Concluindo que entre as duas variáveis do estudo existe uma relação diretamente proporcional e moderada, denotando que em média os aspectos associados às dimensões da segurança alimentar são melhorados, consequentemente haveria uma melhoria na qualidade de vida da população do província de Cusco, o que mostra que à medida que se reforçam os aspectos associados à segurança alimentar, o bem-estar físico e psicológico, aspecto relacionado à saúde dessas pessoas, terá a oportunidade de melhorar

Seguridad alimentaria y calidad de vida de la población en la provincia Cusco

La seguridad alimentaria es "cuando toda persona en todo momento tiene acceso económico y físico a suficientes alimentos inocuos y nutritivos para satisfacer sus necesidades alimentarias y preferencias en cuanto alimentos a fin de llevar una vida sana y activa". Por lo que el objetivo evaluar seguridad alimentaria y calidad de vida de la población vulnerable en la provincia Cusco, Perú. Para lo que se aplicó metodología con enfoque cuantitativo, con un diseño no experimental de corte transversal, basada en cuestionarios aplicados y entrevistas a una muestra de estudio (249 pobladores), la misma que previo a su aplicación superó las pruebas de validez y confiabilidad. Se realizó pruebas de frecuencia a los resultados de la opinión de los encuestados y correlación de Sperman's. Se evidencia que en un 65,9% la percepción de la población es que existe una inadecuada seguridad alimentaria, asimismo en un 85,1% que existe una mala calidad de vida, y desde una perspectiva estadística entre las citadas variables se obtuvo una significancia de 0,000 con un Rho de Sperman de 0,442, lo que demuestra la vulnerabilidad que se encuentra la población de Cusco. Concluyendo que entre las dos variables de estudio existe una relación directamente proporcional y de nivel moderado, denotando que en la media que se mejora los aspectos asociados a las dimensiones de la seguridad alimentaria, por consecuencia se tendría una mejora calidad de vida de la población de la provincia de Cusco, lo que evidencia que en la medida que se refuerce los aspectos asociados a la seguridad alimentaria, el bienestar físico y psicológico aspecto relacionado a la salud de dichas personas tendrá la oportunidad de mejorar.

Food security is "when everyone at all times has economic and physical access to sufficient safe and nutritious food to meet their dietary needs and food preferences for a healthy and active life." Therefore, the objective is to evaluate food security and quality of life of the vulnerable population in the province of Cusco, Peru. For which a methodology with a quantitative approach was applied, with a non-experimental cross-sectional design, based on questionnaires applied and interviews to a study sample (249 residents), which, prior to its application, passed the validity and reliability tests. Frequency tests were carried out on the results of the respondents' opinion and Sperman's correlation. It is evident that in 65.9% the perception of the population is that there is inadequate food security, also in 85.1% that there is a poor quality of life, and from a statistical perspective, a significance was obtained between the aforementioned variables of 0.000 with a Sperman's Rho of 0.442, which demonstrates the vulnerability of the population of Cusco. Concluding that between the two study variables there is a directly proportional relationship and of a moderate level, denoting that on average the aspects associated with the dimensions of food security are improved, consequently there would be an improved quality of life for the population of the province of Cusco, which shows that to the extent that the aspects associated with food security are reinforced, the physical and psychological well-being, an aspect related to the health of these people, will have the opportunity to improve.

A segurança alimentar é "quando todos têm, em todos os momentos, acesso económico e físico a alimentos seguros e nutritivos suficientes para satisfazer as suas necessidades dietéticas e preferências alimentares para levar uma vida saudável e activa". Portanto, o objetivo é avaliar a segurança alimentar e a qualidade de vida da população vulnerável na província de Cusco, Peru. Para o qual foi aplicada uma metodologia de abordagem quantitativa, com desenho transversal não experimental, baseada na aplicação de questionários e entrevistas a uma amostra do estudo (249 residentes), que, antes da sua aplicação, passou em testes de validade e fiabilidade. Foram realizados testes de frequência sobre os resultados das opiniões dos entrevistados e correlação de Spearman. Evidencia-se que em 65,9% a percepção da população é que há segurança alimentar inadequada, também em 85,1% que há má qualidade de vida, e do ponto de vista estatístico obteve-se significância entre as variáveis citadas de 0,000, com um Speman Rho de 0,442, o que demonstra a vulnerabilidade da população de Cusco. Concluindo que entre as duas variáveis do estudo existe uma relação diretamente proporcional e moderada, denotando que em média os aspectos associados às dimensões da segurança alimentar são melhorados, consequentemente haveria uma melhoria na qualidade de vida da população do província de Cusco, o que mostra que à medida que se reforçam os aspectos associados à segurança alimentar, o bem-estar físico e psicológico, aspecto relacionado à saúde dessas pessoas, terá a oportunidade de melhorar.

Language barriers in head and neck cancer: Matched pair analysis of outcomes between non-English speaking and English-speaking patients.

PURPOSE: As society grows in cultural diversity, an increasing proportion of patients are expected to be from non-English speaking backgrounds. This study sought to compare the clinical outcomes between non-English speakers and English speakers treated by radiation therapy for head and neck cancer. METHODS AND MATERIALS: Seventy-five non-English speaking patients with squamous cell carcinoma of the head and neck were matched to English-speaking controls based on patient and disease variables; clinical outcomes were compared. RESULTS: Non-English speaking patients had inferior 3-year overall survival (64% vs. 77%, p = 0.02) and progression-free survival (59% vs. 73%, p = 0.01) compared with the English-speaking cohort. On logistical regression, non-English-speaking status was associated with a significantly increased risk of overall death (OR = 1.41; 95% CI, 1.09-1.92). CONCLUSIONS: Prognosis differed significantly between non-English speaking and English-speaking patients. Culturally tailored programs to address language barriers should be considered to ameliorate disparities in outcome.

Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003-2020.

Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators-a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003-2020. Descriptive analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in prevalence data during 2003-2020; and prevalence ratios were estimated by year to detect any reduction in disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with other North American studies, we found that relative differences between sexual minority and heterosexual groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the need to better understand mechanisms bolstering sexual orientation health disparities.

Assessment of heat stress contributing factors in the indoor environment among vulnerable populations in Klang Valley using principal component analysis (PCA).

Rising global temperatures can lead to heat waves, which in turn can pose health risks to the community. However, a notable gap remains in highlighting the primary contributing factors that amplify heat-health risk among vulnerable populations. This study aims to evaluate the precedence of heat stress contributing factors in urban and rural vulnerable populations living in hot and humid tropical regions. A comparative cross-sectional study was conducted, involving 108 respondents from urban and rural areas in Klang Valley, Malaysia, using a face-to-face interview and a validated questionnaire. Data was analyzed using the principal component analysis, categorizing factors into exposure, sensitivity, and adaptive capacity indicators. In urban areas, five principal components (PCs) explained 64.3% of variability, with primary factors being sensitivity (health morbidity, medicine intake, increased age), adaptive capacity (outdoor occupation type, lack of ceiling, longer residency duration), and exposure (lower ceiling height, increased building age). In rural, five PCs explained 71.5% of variability, with primary factors being exposure (lack of ceiling, high thermal conductivity roof material, increased building age, shorter residency duration), sensitivity (health morbidity, medicine intake, increased age), and adaptive capacity (female, non-smoking, higher BMI). The order of heat-health vulnerability indicators was sensitivity > adaptive capacity > exposure for urban areas, and exposure > sensitivity > adaptive capacity for rural areas. This study demonstrated a different pattern of leading contributors to heat stress between urban and rural vulnerable populations.

Health risk assessment by consumption of commercial biota contaminated with heavy metals in Tampamachoco coastal lagoon, Gulf of Mexico.

Metal pollution is a significant environmental and health problem in aquatic ecosystems worldwide, particularly in coastal systems impacted by emissions from thermoelectric plants, as is the case of the Tampamachoco lagoon. To evaluate the seasonal contamination levels of Cd, Pb, Cr, and Cu in species of commercial interest in the Tampamachoco lagoon and estimate the health risk associated with their consumption, a total of 180 fish, 90 oysters (Crassostrea virginica), 27 crabs (Callinectes sapidus), and 24 shrimp (Litopenaeus setiferus) were sampled. Metal concentrations in the species analyzed were Cu > Pb > Cr > Cd. According to the Target Hazard Quotient and the health risk index, consumption of the marine species examined should be considered safe for human health, as both values are <1. However, Carcinogenic risk values for Pb and Cr indicated that consumers may be at risk of cancer (10-3), due to exposure from the thermoelectric emissions.

Definitive chemoradiotherapy with paclitaxel for locally advanced esophageal squamous cell carcinoma in older patients (PARADISE-1): a phase I trial.

BACKGROUND: In older patients, esophageal squamous cell carcinoma (ESCC) is difficult to treat using standard therapies, including surgery and cisplatin-based chemoradiotherapy. Paclitaxel (PTX) has radiosensitizing activity. We conducted a phase I trial of PTX combined with radiotherapy to establish a standard therapy for locally advanced ESCC in older patients. METHODS: Enrollment was conducted at six centers in Japan from April 2016 to September 2019. The participants were aged ≥ 70 years, had locally advanced ESCC, and were intolerant to surgery or unwilling. A fixed 60-Gy radiation dose was administered in 30 fractions. PTX dosing levels started at 30 mg/m2 weekly for 6 weeks. Depending on the number of DLTs, the dose was set to be increased by 10 mg/m2 or switched to biweekly. A geriatric assessment was performed before treatment using the Geriatric-8 screening tool. The primary endpoint was dose-limiting toxicity (DLT). RESULTS: We enrolled 24 patients (6 per group); DLT was observed in one (grade 4 hypokalemia), one (grade 3 aspiration), two (grade 3 radiodermatitis, grade 3 esophageal hemorrhage), and two (grade 3 anorexia, grade 5 pneumonitis) patients in the weekly PTX 30, 40, 50, and 60 mg/m2 groups, respectively. All adverse events, except death in the 60 mg/m2 group, showed reversible improvement, and the safety profile was considered acceptable. The 2-year survival and complete response rates were 40.0% and 54.2%, respectively. There was a significant difference in survival between favorable and unfavorable Geriatric-8 scores. CONCLUSIONS: The recommended PTX dose with concomitant radiation was determined to be 50 mg/m2 weekly. Phase II trials at this dose are underway.

Notoginsenoside R1 decreases intraplaque neovascularization by governing pericyte-endothelial cell communication via Ang1/Tie2 axis in atherosclerosis.

Atherosclerosis represents the major cause of mortality worldwide and triggers higher risk of acute cardiovascular events. Pericytes-endothelial cells (ECs) communication is orchestrated by ligand-receptor interaction generating a microenvironment which results in intraplaque neovascularization, that is closely associated with atherosclerotic plaque instability. Notoginsenoside R1 (R1) exhibits anti-atherosclerotic bioactivity, but its effect on angiogenesis in atherosclerotic plaque remains elusive. The aim of our study is to explore the therapeutic effect of R1 on vulnerable plaque and investigate its potential mechanism against intraplaque neovascularization. The impacts of R1 on plaque stability and intraplaque neovascularization were assessed in ApoE-/- mice induced by high-fat diet. Pericytes-ECs direct or non-direct contact co-cultured with VEGF-A stimulation were used as the in vitro angiogenesis models. Overexpressing Ang1 in pericytes was performed to investigate the underlying mechanism. In vivo experiments, R1 treatment reversed atherosclerotic plaque vulnerability and decreased the presence of neovessels in ApoE-/- mice. Additionally, R1 reduced the expression of Ang1 in pericytes. In vitro experiments demonstrated that R1 suppressed pro-angiogenic behavior of ECs induced by pericytes cultured with VEGF-A. Mechanistic studies revealed that the anti-angiogenic effect of R1 was dependent on the inhibition of Ang1 and Tie2 expression, as the effects were partially reversed after Ang1 overexpressing in pericytes. Our study demonstrated that R1 treatment inhibited intraplaque neovascularization by governing pericyte-EC association via suppressing Ang1-Tie2/PI3K-AKT paracrine signaling pathway. R1 represents a novel therapeutic strategy for atherosclerotic vulnerable plaques in clinical application.