Vulnerabilidade social e incidência de COVID-19 em uma metrópole brasileira / Social vulnerability and COVID-19 incidence in a Brazilian metropolis

Resumo A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (β=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (β=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (β=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.

Abstract Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (β=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (β=1.40), and maximum per capita household income of the poorest fifth (β=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Most Predictive Health Care Factors.

OBJECTIVE: Recognizing smoking as a risk factor for rheumatoid arthritis (RA) severity, the present study was undertaken to evaluate patient- and health care-level predictors of smoking cessation in patients with RA to guide implementation of smoking cessation interventions. METHODS: Electronic health record data from 2 health systems were abstracted for patients with at least 2 International Classification of Disease diagnosis codes for RA between 2005 and 2016. Patients missing smoking statuses or with <6 months of follow-up were excluded. Multivariable logistic regression was used to determine predictors of smoking cessation. RESULTS: Among 3,577 patients with RA, 507 smoked at baseline, and 29% quit over a median of 4.75 years. Black male patients, ages 40-59 years and enrolled in Medicaid, were significantly more likely to be baseline smokers; however, none of these factors predicted cessation. Instead, patients new to rheumatology care were 60% more likely to quit (adjusted odds ratio [ORadj ] 1.60 [95% confidence interval (95% CI) 1.02-2.50]), and patients in the rural community health system were 66% more likely to quit (ORadj 1.66 [95% CI 1.03-2.69]). Seropositive patients were 43% less likely to quit smoking (ORadj 0.57 [95% CI 0.35-0.91]). CONCLUSION: Health care factors, including health system and being new to rheumatology care, were more predictive of smoking cessation in patients with RA than patient sociodemographic factors, suggesting an important role for health system cessation efforts for patients with RA. Seropositive patients were less likely to quit and may particularly benefit from cessation support. Emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.

Built and Natural Environment Barriers and Facilitators to Physical Activity in Rural, Suburban, and Small Urban Neighborhoods.

PURPOSE: To explore built and natural environment barriers and facilitators to walking for exercise in cancer survivors. PARTICIPANTS & SETTING: Cancer survivors (N = 7) living in rural, suburban, and small urban neighborhoods in central Virginia. METHODOLOGIC APPROACH: The authors used a qualitative descriptive design with photovoice to explore the cancer survivors' experience with residential walkability. FINDINGS: The following three themes were identified from the data. IMPLICATIONS FOR NURSING: Clinicians should consider an evaluation of the built and natural environment to support walking in cancer survivors. These findings may be used in conjunction with known individual-level barriers to physical activity to develop guidance for oncology nurses to help survivors safely achieve physical activity goals.

Estudio histopatológico de tejido cardiaco de roedores infectados con Trypanosoma cruzi capturados en barrios suburbanos de Mérida, México / Histopathological study in cardiac tissue of rodents infected with Trypanosoma cruzi, captured in suburbs of Mérida, México

Resumen Introducción. Trypanosoma cruzi es el agente causal de la tripanosomiasis americana, enfermedad endémica en México. Los roedores Mus musculus y Rattus rattus son reservorios del parásito, el cual invade las fibras cardiacas y desarrolla nidos parasitarios produciendo diversas lesiones. Los estudios histopatológicos en roedores naturalmente infectados son escasos. Objetivo. Describir los tipos y las frecuencias de las lesiones microscópicas en muestras de tejido cardiaco de M. musculus y R. rattus infectados con T. cruzi capturados en Mérida, México. Materiales y métodos. Los roedores se capturaron en los barrios suburbanos de Mérida. Se extrajo el tejido cardiaco y se procesó por la técnica de inclusión en parafina y tinción con hematoxilina y eosina. Su examen se hizo con un microscópico convencional y se determinaron todas las lesiones y su grado de afección. Resultados. Se trabajaron ocho muestras de tejido de M. musculus y siete de R. rattus. Se encontraron nidos parasitarios en siete del total de las muestras: en 3 de las 8 de M. musculus y en 4 de las 7 de R. rattus. Se observaron infiltrados inflamatorios en todas las muestras. Otras lesiones fueron la degeneración de las fibras cardiacas (8/15), la congestión de los vasos sanguíneos (6/15) y la necrosis (5/15). Discusión. Las lesiones observadas están descritas en los modelos animales experimentales y en los humanos con tripanosomiasis americana. Los infiltrados inflamatorios se han descrito como la lesión más significativa en los humanos y en los reservorios en la etapa crónica de la enfermedad. Conclusión. Las lesiones observadas están asociadas con la infección con T. cruzi, lo cual confirma que los roedores estudiados son reservorios de este parásito.

Abstract Introduction: Trypanosoma cruzi is the causal agent of the American trypanosomiasis, an endemic disease in México. The commensal rodents Mus musculus and Rattus rattus are reservoirs of this parasite, which invades cardiac fibers and develops parasite nests causing various lesions. Histopathological studies in naturally infected rodents are scarce. Objective: To describe the types and frequencies of microscopic lesions in cardiac tissue of M. musculus and R. rattus infected with T. cruzi captured in Mérida, México. Materials and methods: The rodents were captured in suburban environments of Mérida. Cardiac tissue was extracted and processed by the paraffin inclusion technique and hematoxylin and eosin stained. The observation was made with a conventional microscope and all the lesions, as well as their degree, were identified. Results: Eight tissue samples of M. musculus and seven of R. rattus were studied. Parasite nests were found in 7/15, specifically 3/8 in M. musculus and 4/7 in R. rattus. The inflammatory infiltrate was the most frequent lesion. Other lesions were: Degeneration of cardiac fibers (8/15), congestion of blood vessels (6/15), and necrosis (5/15). Discussion: The lesions we observed have been described in experimental animal models and in humans with American trypanosomiasis. The inflammatory infiltrate has been identified as the most significant lesion in humans and reservoirs in the chronic stage of the disease. Conclusion: The lesions we described are associated with T. cruzi infection, which confirms that the rodents studied are reservoirs of this parasite.

Vitamin A deficiency and associated factors in preschoolers from the outskirts of La Plata, Buenos Aires. / Deficiencia de vitamina A y factores asociados en niños preescolares de la periferia de la ciudad de La Plata, Buenos Aires.

INTRODUCTION: Vitamin A deficiency (VAD) has been recognized as an important public health problem in developing countries. Preschoolers account for risk groups within vulnerable populations. The objective of this study was to determine the prevalence of VAD and associated factors in a sample of preschoolers. MATERIALS AND METHODS: Cross-sectional study with children aged 1-6 years receiving social assistance and seen at primary health care centers in the outskirts of the city of La Plata, Buenos Aires. Vitamin A levels were determined by measuring serum retinol with a liquid chromatography; anthropometric parameters and dietary intake were recorded. A multinomial logistic regression model was used to assess the association among outcome measures. RESULTS: Data from 624 children were analyzed. The geometric mean of retinol was 23.8 pg/dL (95 % CI: 23.3-24.3). The prevalence of VAD and the risk for VAD were 24.3 % and 57.4 %, respectively. Retinol levels were significantly lower among boys, low-weight children, and those with low intake (below the first tertile of distribution). The multivariate analysis showed a significant association between VAD and male sex (odds ratio: 1.93; 95 % CI: 1.15-3.24) and between VAD and low intake (odds ratio: 1.48; 95 % CI: 1.15-2.62). CONCLUSION: The prevalence of VAD (24.3 %) is a major public health problem in this population. VAD-associated factors were male sex and low vitamin A intake.

Introducción. La deficiencia de vitamina A (DVA) ha sido reconocida como un importante problema de salud pública en países en vías de desarrollo. Los niños en edad preescolar son grupos de riesgo en poblaciones vulnerables. El objetivo fue determinar la prevalencia de DVA y los factores asociados en una muestra de niños de edad preescolar. Material y métodos. Estudio de corte transversal que incluyó a niños de 1 a 6 años beneficiarios de planes sociales, atendidos en centros de atención primaria de la periferia de la ciudad de la Plata, Buenos Aires. Se determinó el contenido de vitamina A midiendo retinol sérico, por cromatografía líquida, y se registraron parámetros antropométricos e ingesta alimentaria. Se utilizó un modelo de regresión logística multinomial para evaluar la asociación entre las variables. Resultados. Se analizaron datos de 624 niños. La media geométrica de retinol fue 23,8 pg/dl (IC 95 %: 23,3-24,3). Las prevalencias de DVA y riesgo de DVA fueron 24,3 % y 57,4 %, respectivamente. Los niveles de retinol fueron significativamente menores en niños varones, con bajo peso y aquellos con bajo consumo (menor del primer tercilo de distribución). El análisis multivariable mostró asociación significativa entre DVA y el sexo masculino (OR: 1,93; IC 95 %: 1,15-3,24) y con el bajo consumo (OR: 1,48; IC 95 %: 1,15-2,62). Conclusión. La prevalencia de DVA hallada (24,3 %) constituye un importante problema de salud pública en esta población. Los factores asociados a dicha deficiencia fueron el sexo masculino y el bajo consumo.

Chemical characterization and source apportionment of PM2.5 personal exposure of two cohorts living in urban and suburban Beijing.

In the study, personal PM2.5 exposures and their source contributions were characterized for 159 subjects living in the Beijing Metropolitan area. The exposures and sources were examined as functions of residential location, season, vocation, cigarette smoking, and time spent outdoors. Sampling was performed for two categories of volunteers, guards and students, that lived in urban and suburban areas of Beijing. Samples were collected using portable PM2.5 monitors during summer and winter. Exposure measurements were supplemented with a questionnaire that tracked personal activity and time spent in microenvironments that may have impacted exposures. Simultaneously, ambient PM2.5 data were obtained from national network stations located at the Gucheng and Huairouzhen sites. These data were used as a comparison against the personal PM2.5 exposures and produced poor correlations between personal and ambient PM2.5. These results demonstrate that individual behavior strongly affects personal PM2.5 exposure. Six primary sources of personal PM2.5 exposure were determined using a positive matrix factorization (PMF) source apportionment model. These sources included Roadway Transport Source, Soil/Dust Source, Industrial/Combustion Source, Secondary Inorganic Source, Cd Source, and Household Heating Source. Averaged across all subjects and seasons, the highest source contribution was Secondary Inorganic Source (24.8% ±â€¯32.6%, AVG ±â€¯STD), whereas the largest primary ambient source was determined to be Roadway Transport (20.9% ±â€¯13.6%). Subjects were classified according to the questionnaire and were used to help understand the relationship between personal activity and source contribution to PM2.5 exposure. In general, primary ambient sources showed only significant spatial and seasonal differences, while secondary sources differed significantly between populations with different personal behavior. In particular, Cd source was found to be related to smoking exposure and was the most unpredictable source, with significant differences between populations of different sites, vocations, smoking exposures, and outdoor time.

Nexos de exclusão e desafios de sustentabilidade e saúde em uma periferia urbana no Brasil / Nexos de exclusión y desafíos de sostenibilidad y salud en una periferia urbana en Brasil / Nexus of exclusion and challenges for sustainability and health in an urban periphery in Brazil

A abordagem do nexo urbano corresponde à compreensão e à busca de soluções integradas mediante o reconhecimento das interdependências entre água, energia e alimentos, recursos cuja escassez configura iniquidades em saúde. A hipótese central deste artigo considera que o contexto de escassez corrobora práticas sociais que podem ser sinérgicas ou contraditórias em relação aos desafios da sustentabilidade e dos direitos sociais. O objetivo é investigar sinergias e contradições a partir de práticas sociais mediante o nexo urbano no bairro Novo Recreio, na cidade de Guarulhos, Região Metropolitana de São Paulo, Brasil. A metodologia consiste em um estudo qualitativo e de base etnográfica com referência à Teoria das Práticas, com observações diretas de campo e narrativas. Os resultados apresentaram práticas sociais associadas a falta sistemática de água, precariedades na iluminação pública e no transporte, bem como dificuldade de acesso a alimentos frescos e saudáveis. O estudo das práticas sociais entre sinergias e contradições permitiu verificar que, nesse processo espontâneo de busca de solução para problemas locais, é constatada a necessidade de integrar práticas e saberes locais a políticas públicas e demandas globais. Com isso, denominamos nexos de exclusão a condição periférica de impossibilidade de opções conscientes que permitam orientar conjuntamente a redução da escassez e de iniquidades com alternativas para a sustentabilidade.

El abordaje del nexo urbano se corresponde con la comprensión y búsqueda de soluciones integradas, mediante el reconocimiento de las interdependencias entre agua, energía, alimentos y recursos, cuya escasez configura inequidades en salud. La hipótesis central de este artículo considera que el contexto de escasez corrobora prácticas sociales que pueden ser sinérgicas o contradictorias, a través de los desafíos en sostenibilidad y derechos sociales. Los objetivos son investigar sinergias y contradicciones, a partir de prácticas sociales mediante el nexo urbano en el barrio Novo Recreio, en la ciudad de Guarulhos, región metropolitana de São Paulo, Brasil. La metodología consiste en un estudio cualitativo y de base etnográfica, vinculado a la teoría de las prácticas, analizando observaciones de campo directas y relatos. Los resultados presentaron prácticas sociales asociadas a la falta sistemática de agua, precariedad en la iluminación pública y el transporte, dificultad de acceso a alimentos frescos y saludables. El estudio de las prácticas sociales entre sinergias y contradicciones permitió verificar que, en ese proceso espontáneo de búsqueda de soluciones para problemas locales, se constata la necesidad de integrar prácticas y saberes locales con políticas públicas y demandas globales. De esta forma, denominamos nexos de exclusión a las condiciones periféricas de imposibilidad, en cuanto a opciones conscientes que permitan orientar conjuntamente la reducción de la escasez e iniquidades con alternativas para la sostenibilidad.

The urban nexus approach involves the investigation and elucidation of integrated solutions through the recognition of tradeoffs between water, energy, and food, namely resources whose shortage leads to inequalities in health. The article's central hypothesis is that the context of shortage corroborates social practices that can be synergic or contradictory in relation to the challenges of sustainability and social rights. The objective is to investigate synergies and contradictions based on social practices in the urban nexus in the neighborhood of Novo Recreio in the city of Guarulhos, Greater Metropolitan São Paulo, Brazil. The methodology consists of a qualitative ethnographic study drawing on practice theory as the reference, with direct field observations and narratives. The results featured social practices associated with systematic lack of water, precarious public lighting and transportation, and difficult access to fresh and healthy foods. The study of social practices between synergies and contradictions allowed verifying that this spontaneous process of search for solutions to local problems reveals the need to incorporate local practices and knowledge into public policies and global demands. We define nexus of exclusion as the peripheral condition of impossibility of conscious options that allow jointly orienting the reduction of shortage and iniquities through alternatives for sustainability.

Geo-location of Oncological Diseases in the Extra-urban Areas of Naples and Creation of Territorial Biobanks: An Important Tool to Study Potential Connections Between Environmental Factors and Cancer.

Many areas of the Campania region of Italy are more frequently at risk of neoplastic diseases due to environmental factors. However, the results of epidemiological studies, although numerous and detailed, do not explain tumor pathogenesis mechanisms in relation to the contribution of exposure to environmental pollutants. The Oncological Biobank of the G. Pascale Foundation (BBI) centralizes the collection and storage of biomaterials, both healthy and pathological human tissues, from urban and extra-urban areas of Naples, associating them with clinicopathological characteristics (type of tumor, histological type, grading, immunohistochemical and molecular profile, etc.). Geo-location of tumor samples is made by an IT platform in which demographic and clinical data are systematically uploaded. For the extra-urban areas of Naples, our experience of tumor sample geolocation highlighted cancer types with high impact of environmental pollutants as being lung, gastric and bladder cancer. In this mini-review, we underline that the possibility of specifically selecting tumor samples in circumscribed territories may allow targeted studies to verify potential connections between environmental factors and cancer. Moreover, the collection of biological fluids (serum, saliva, urine) from healthy individuals from specific areas may be a useful tool for the research of specific genetic polymorphisms linked to individual susceptibility.

Prevalence of COPD and respiratory symptoms associated with biomass smoke exposure in a suburban area.

Introduction: Biomass smoke exposure (BSE) is a recognized cause of COPD particularly in rural areas. However, little research has been focused on BSE in suburban areas. Objective: The aim of this study was to determine the prevalence of COPD, respiratory symptoms (RS) and BSE in women living in a suburban area of Mexico City exposed to BSE. Methods: A cross-sectional epidemiological survey of a female population aged >35 years was performed using a multistage cluster sampling strategy. The participants completed questionnaires on RS and COPD risk factors. The COPD prevalence was based on the postbronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio. Of the 1,333 women who completed the respiratory questionnaires, spirometry data were obtained from 1,190, and 969 of these were scored as A-C. Results: The prevalence of BSE was 47%, and the estimated prevalence of COPD was 2.5% for the total population (n=969) and 3.1% for those with BSE only. The spirometry and oximetry values were significantly lower in women with greater exposure levels. The prevalence of RS (cough, phlegm, wheezing and dyspnea) was significantly higher in the women with BSE compared to those without exposure. We concluded that the association of COPD with biomass exposure is not only a rural phenomenon but also may be observed in the suburban areas of the big cities.

Head Injuries in Urban Environment Skiing and Snowboarding: A Retrospective Study on Injury Severity and Injury Mechanisms.

BACKGROUND AND AIM: During the last decade urban skiing and snowboarding has gained a lot of popularity. In urban skiing/snowboarding riders try to balance on handrails and jump off buildings. Previous studies in skiing and snowboarding accidents have mostly been conducted at hospitals located close to alpine terrain with big ski resort areas. The aim of this study is to evaluate the types and severity of traumatic brain injuries occurring in small, suburban hills and in urban environment, and to characterize injury patterns to find out the specific mechanisms of injuries behind. MATERIALS AND METHODS: This study included all patients admitted to the Helsinki University Hospital Trauma Unit from 2006 to 2015 with a head injury (ICD 10 S06-S07) from skiing or snowboarding accidents in Helsinki capital area. Head injuries that did not require a CT-scan, and injuries older than 24 hours were excluded from this study. RESULTS: There were a total of 72 patients that met the inclusion criteria Mean length of stay in hospital was 2.95 days. According to the AIS classification, 30% had moderate, 14% had severe, and 10% had critical head injuries. Patients who got injured in terrain parks or on streets where more likely to be admitted to ICU than those injured on slopes. Based on GOS score at discharge, 78% were classified as having a good recovery from the injury, 13% had a moderate disability, 5% had a severe disability and 3% of the injuries were fatal. There were no statistically significant differences in decreased GOS between the accident sites. CONCLUSION: Head injuries occurring in small suburban hills and in urban environments can be serious and potentially fatal. The profile and severity of skiing injuries in urban environments and small, suburban hills is comparable to those on alpine terrain.

[Current status of folic acid supplementation in women at child-bearing age in suburban area of Beijing].

Objective: To access the current status of folic acid supplementation in women at childbearing age in suburban area of Beijing, 2016. Methods: In this cross-sectional study, a total of 722 women aged 17-41 years from six hospitals in suburban areas of Beijing were selected through cluster sampling. A questionnaire survey was conducted. Results: The rates of folic acid intake and regular folic acid intake among women under survey were 63.9% (456/714) and 83.3% (380/456). In women who remembered the duration of folic acid supplementation, the overall rate of preconceptional folic acid supplementation was 35.5% (159/450), in whom 27.3% (123/450) began to take folic acid 0-3 months before pregnancy; 8.0% (36/450) began to take folic acid 3 months before pregnancy. Multivariate logistic regression analysis indicated that household registering type, preparation for pregnancy or pregnancy, parity, smoking and alcohol use were the influencing factors for folic acid supplementation. Conclusions: The rate of folic acid supplementation remained low in childbearing aged women in suburban area of Beijing. It is necessary to further strengthen the health education about the importance of folic acid supplementation to improve the intake rate and the regular intake rate of folic acid in pregnant women and to promote maternal infant health and reduce the related complications.

Lifestyle factors and co-morbidities associated with obesity and overweight in Nkonkobe Municipality of the Eastern Cape, South Africa.

BACKGROUND: Obesity is a global epidemic that affects 500 million people worldwide and is predicted to increase to one billion people by 2030. The prevalence of obesity is increasing across populations in South Africa. However, questions still remain surrounding the predisposing factors and obesity-related health problems especially in the rural areas. This study evaluated several lifestyle factors such as dietary habits, physical activity, smoking, alcohol intake, co-morbidities and their association with the prevalence of obesity and overweight in Nkonkobe Municipality of the Eastern Cape. METHODS: A cross-sectional, population-based survey was conducted among 118 residents in four rural/sub-urban townships of the study area. Measurements including weight, height, body mass index (BMI), physical activity and dietary habits were determined using a validated questionnaire. RESULTS: The overall prevalence of obesity and overweight was 38 and 19%, respectively. The highest prevalence of obesity (70%) was observed among those who do not undertake any physical activity. Close to half (48.48%) of the respondents who eat fast foods always were obese, and 30.30% were overweight; when combined, the prevalence for obesity is 78.78%. A negative association with obesity was observed among regular smokers (26.92%) and consumers of alcohol (4.00%). Arthritis, hypertension and tuberculosis were co-morbidities significantly (P < 0.05) associated with obesity in the study area. CONCLUSIONS: The findings of this study reveal that lack of physical activity, overindulgence on fast and fried foods, low fruit and vegetable consumption as well as arthritis, hypertension and tuberculosis were significant risk factors of obesity in Nkonkobe Municipality.

The levels of bone turnover markers 25(OH)D and PTH and their relationship with bone mineral density in postmenopausal women in a suburban district in China.

This study evaluated the levels of bone turnover markers (BTMs) and investigated relationships between them and bone mineral density (BMD) in postmenopausal women in China suburban district. The prevalence of osteoporosis was 25.03 % at lumbar spine and 6.23 % at femoral neck, and BTMs were negatively correlated with BMDs. INTRODUCTION: The aims of this study were to evaluate the levels of bone turnover markers (BTMs), including serum N-terminal procollagen of type I collagen (P1NP), beta C-terminal cross-linked of type I collagen (ß-CTX), 25-hydroxyvitamin D [25(OH)D], and parathyroid hormone (PTH), and to investigate relationships between these markers and bone mineral density (BMD) as well the prevalence of osteoporosis in postmenopausal women of suburban district. METHODS: A population of 4822 postmenopausal women aged 55-69 years old (62.22 ± 6.75) from the suburban district was recruited voluntarily. BMD was measured at the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry; 2251 women in this group had the serum BTMs 25(OH)D and PTH tested. RESULTS: The prevalence of osteoporosis was 25.03 % at lumbar spine and 6.23 % at femoral neck. The median (interquartile range) values of serum P1NP, ß-CTX, 25(OH)D, and PTH were 59.3 ng/mL (44.7-75.52), 0.370 ng/mL (0.280-0.490), 23.0 ng/mL (17.1-30.5), and 31.4 pg/mL (24.9-39.7), respectively. Serum P1NP and ß-CTX levels presented significantly negative correlations with BMDs at the all the sites (Betastd = -0.098 to -0.208, respectively, P < 0.001), whereas PTH levels were negatively correlated with BMDs of the femoral neck and total hip (Betastd = -0.062 and -0.054, P < 0.01, respectively). Serum 25(OH)D had positive associations with BMDs at total hip (Betastd = 0.051, P < 0.01). CONCLUSIONS: The BMD of postmenopausal women in China suburban area is higher than that in downtown area, and over 60 % of the participants had their serum 25(OH)D level over 20 ng/mL. BTMs were negatively correlated with BMDs, suggesting that BTMs are reliable factors for early declines in BMD.

Prevalence and Correlates of Tobacco Use in a Suburban community of Nepal: Findings from the Dhulikhel Heart Study.

Background Smoking and oral tobacco use are important risk factors for cancer and other chronic diseases. The distribution of tobacco consumption in Nepal varies across the population subgroups. There is little information on the correlates of tobacco use among suburban population in Nepal. Objective To estimate the prevalence of smoking and oral tobacco use; and determine the socio-demographic and other CVD risk factors associated with them in a suburban population of Dhulikhel, Nepal. Method This cross sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained from 1073 adults age 18 years and older using the questions based on the WHO STEPS survey questionnaire. Result More than a third (36%) of the men were current smokers and 12% reported regular use of oral tobacco. About 14% of the women were current smokers and only 0.5% reported to use oral tobacco regularly.In the multivariate analysis, sex, ethnicity, education, alcohol consumption and body mass index were significantly associated with tobacco use. Males were 2.6 times as likely as females to smoke (95%: 1.53-4.59; p<0.001). Brahmin/Chhetri were 2.8 times more likely to smoke compared to Newars (95% Ci: 1.53-5.18; p=0.001). Education reduced the odds of smoking; compared to those with no formal education, those with up to high school and those with a high school degree or higher were 0.50 (95% CI: 0.27-0.92; p=0.02 ) and 0.38 (95% CI: 0.16-0.91; p=0.03) percent less likely to smoke, respectively. Moderate drinkers were 8 times more likely (95% CI: .54 - 18.40; p<0.001) and high drinkers were 13 times (95% CI: 6.63 - 24.26; p<0.001) compared to non-drinkers. Regarding oral tobacco use males were 15 times as likely as females to use oral tobacco (95% CI: 4.1-58.8; p<0.001). Compared to Newars, Brahmin/Chhetri were 2.7 times as likely to use oral tobacco (95% CI: 1.08 - 6.66; p=0.03). Conclusion Although Nepal has made some progress in passing progressive laws for tobacco control, and national surveys have shown slight reduction on tobacco use, this is far from satisfactory to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to focus on socio-cultural, gender and behavioral aspects of tobacco use in addition to the epidemiological aspects.

Donegal Going against the Flow: National Differences in Long-Term Urinary Catheterisation Rates in Men (> 65 Years) With Benign Prostatic Hypertrophy.

An analysis of Primary Care Reimbursement Service (PCRS, 2013) data demonstrated high rates of urinary catheter changes in Donegal compared to other regions of Ireland. There is a catheter change rate of 10.2% in Donegal men over 65 with medical cards (GMS) compared to rates of 2.7% and 0.17% in Waterford and South Dublin, respectively1. This 60-fold difference between an area with perceived good access to services (South Dublin) and Donegal an area that does not, prompted a survey of general practitioners in each of these areas to assess whether true male catheterisation rates were similarly disproportionate in Donegal. Based on this, data was collected from a population of 23,794 GMS patients in GP training practices in Donegal (Rural), Leinster (Urban) and Waterford (Suburban). The data sampled for Donegal demonstrated 19 long-term catheters (LTCs per 8603 GMS) compared to four LTCs (per 5,800 GMS) in Leinster and 3 LTCs (per 9,391 GMS) in Waterford (Table 1). This anomaly in LTC rates may be a proxy for lack of access to basic Urology services.

Situación de salud en asentamientos precarios / The health situation of precarious settlements

OBJETIVO: Conocer la situación de salud de los miembros del Campamento Manuel Bustos, en la región de Valparaíso, considerando sus características socioeconómicas y ambientales y la autopercepción del estado de salud. Material y MÉTODO: Se realizó una investigación cuantitativa, descriptiva y no experimental. Se aplicó un cuestionario a través de una entrevista semiestructurada a una muestra de 89 familias del campamento. RESULTADOS: Las familias del campamento se caracterizan principalmente por ser jóvenes, asistir a controles (principalmente el Niño Sano y EMPA), estar casi en su totalidad inscritos en un CESFAM. Las viviendas poseen irregular eliminación de excretas y un 40% de los hogares tiene algún miembro con hipertensión arterial. En promedio, los residentes valoran su estado de salud con nota 5 en una escala de 1 a 7.CONCLUSIÓN: Se observó que la situación de salud de los habitantes del campamento presenta aspectos positivos vinculados a la inscripción en CES-FAM y la asistencia a controles. No obstante, la alta presencia de hipertensión arterial, las precarias condiciones de eliminación de excretas y la presencia de basurales cercanos son factores de riesgo para la salud, que deberán ser atendidas por los organismos gubernamentales y no gubernamentales que trabajan en este territorio.

OBJECTIVE: To explore the health status of members of the Manuel Bustos Settlement, in the region of Valparaiso, in terms of socioeconomic and environmental characteristics and their self-perceived health status. MATERIAL AND METHODS: A descriptive and non-experimental quantitative study was conducted. A questionnaire was applied through semistructured interviews to 89 families in the settlement. RESULTS: Families of the settlement are characterized principally by their young age, for attending regular health appointments (mainly the Well Child check ups and preventative annual physical exam for adults), and, in the case of the majority, for being enrolled in a local community health center. Their houses have irregular human waste disposal and 40% of households have a member with hypertension. On average, the residents valued their health status with a grade of 5, on a scale from 1 to 7. CONCLUSIONS: The health situation of the inhabitants of the settlement presents positive as-pects related to health center enrollment and regular attendance of controls. However, the high prevalence of hypertension, the precarious conditions of eliminating human waste, and the pre-sence of nearby landfills are risk factors for health that must be addressed by government and nongovernmental organizations, which work in this territory.

Clustering of cardiovascular risk factors in semi-urban communities in south-western Nigeria.

BACKGROUND: In addition to poor socio-economic indices and a high prevalence of infectious diseases, there have been various reports of a rising prevalence of cardiovascular diseases, with associated morbidity and mortality in developing countries. These factors co-exist, resulting in a synergy, with serious complications, difficult-to-treat conditions and fatal outcomes. Hence this study was conducted to determine the clustering of cardiovascular disease risk factors and its pattern in semi-urban communities in south-western Nigeria. METHODS: This was a cross sectional study over seven months in 11 semi-urban communities in south-western Nigeria. RESULTS: The total number of participants was 1 285 but only 1 083, with 785 (65%) females, completed the data. Participants were 18 years and older, and 51.2% were over 60 years. The mean age was 55.12 ± 19.85 years. There were 2.6% current cigarette smokers, 22% drank alcohol and 12.2% added salt at the table, while 2% had been told by their doctors they had diabetes, and 23.6% had hypertension. The atherogenic index of plasma was at a high-risk level of 11.1%. Elevated total cholesterol and low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol levels were seen in 5.7, 3.7 and 65.1%, respectively. Prevalence of hypertension was 44.9%, diabetes was 5.2%, obesity with body mass index (BMI) > 30 kg/m2 was 5.7%, and abdominal circumference was 25.7%. Prevalence of clusters of two, three, and four or more risk factors was 23.1, 15.5 and 8.4%, respectively. Increasing age 2.94 (95% CI: 1.30-6.67), BMI 1.18 (95% CI: 1.02-1.37), fasting plasma glucose level 1.03 (95% CI: 1.00-1.05), albuminuria 1.03 (95% CI: 1.00-1.05), systolic blood pressure 1.07 (95% CI: 1.04-1.10), diastolic blood pressure 1.06 (95% CI: 1.00-1.11) and female gender 2.94 (95% CI: 1.30-6.67) showed increased odds of clustering of two or more cardiovascular risk factors. CONCLUSION: Clustering of cardiovascular risk factors is prevalent in these communities. Patterns of clustering vary. This calls for aggressive and targeted public health interventions to prevent or reduce the burden of cardiovascular disease, as the consequences could be detrimental to the country.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program.

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa.

The chronic inflammatory skin diseases hidradenitis suppurativa (HS) and psoriasis have been linked to cardiovascular risk factors and the latter has also been linked to possible renal dysfunction. Since basement membrane thinning in the skin of HS patients has been described, we speculated whether similar basement membrane defects might occur in renal tissue. Our objective was to investigate a possible association between HS and renal dysfunction. We performed a hospital and population-based cross-sectional study using estimated Glomerular-Filtration-Rate (eGFR) to assess renal function. Thirty-two hospital individuals with HS, 430 population individuals with HS, and 20,780 population individuals without HS were (controls) identified. The age-, sex-, smoking-, BMI-, hypertension- and diabetes-adjusted analysis revealed a statistically significant higher eGFR for the hospital group with HS and a mean difference in eGFR of 6.81 (1.27-12.35) ml/min/1.73 m2 between the hospital group with HS and the population group without HS. The observed higher eGFR in the hospital group with HS indicates a possible association of HS and renal dysfunction.

Use of the Knee Injury and Osteoarthritis Outcome Score in a Healthy United States Population.

BACKGROUND: Patient-reported outcome instruments are frequently used for assessing clinical outcomes after injury and surgery. Previously reported normative data for the Knee injury and Osteoarthritis Outcome Score (KOOS) are limited to a narrow subset of ages and demographics or have not included patients who do not participate in sporting activities. PURPOSE: To provide normative data for the KOOS in an 18- to 64-year-old population in the United States. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The KOOS was administered to 999 patients or accompanying family members seen in July 2014 at an outpatient orthopaedic clinic in a suburban metropolitan city for an orthopaedic issue unrelated to their knee. Participants were eligible if they self-reported a medical history negative for knee, ankle, or hip surgery and if they did not have a current issue with their knee, ankle, or hip. Means, SDs, medians, ranges, interquartile ranges, and percentiles on the KOOS were calculated by sex, age range, laterality, and history of knee injuries in the past year. Nonparametric statistical analysis and regression analysis were used to evaluate differences in KOOS values between 5 age ranges and between those with a history of knee injuries compared with uninjured participants. RESULTS: There were 402 men and 597 women in the final study cohort. Men scored lower on the Symptoms subscale compared with other subscales (median score: 96.4 for Symptoms, 100.0 for all other subscales) in all age cohorts except the 56- to 64-year age group. Women also reported lower scores in the Symptoms subscale (median score: 96.4 for women aged 18-55 years, 92.9 for women aged 56-64 years). Median scores for the Pain and Knee-related Quality of Life subscales were lower in the 56- to 64-year female cohort (97.2 and 93.8, respectively), compared with the 18- to 55-year female cohort. The Symptoms, Pain, and Knee-related Quality of Life subscales showed the greatest variability for patients of both sexes, particularly in the youngest and oldest cohorts. Three percent of all participants reported a history of knee injuries in the past year, and all KOOS results were significantly lower (P < .05) in this population compared with uninjured participants. CONCLUSION: This study provides normative reference values for the KOOS in an 18- to 64-year-old metropolitan United States population. Study findings can aid surgeons in counseling patients and in developing expectations after the treatment of injuries.