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1.
Lancet Public Health ; 9(5): e295-e305, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38702094

RESUMO

BACKGROUND: Earlier death among people in socioeconomically deprived circumstances has been found internationally and for various causes of death, resulting in a considerable life-expectancy gap between socioeconomic groups. We examined how age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy have changed at the area level in Germany over time. METHODS: In this ecological study, official German population and cause-of-death statistics provided by the Federal Statistical Office of Germany for the period Jan 1, 2003, to Dec 31, 2021, were linked to district-level data of the German Index of Socioeconomic Deprivation. Life-table and decomposition methods were applied to calculate life expectancy by area-level deprivation quintile and decompose the life-expectancy gap between the most and least deprived quintiles into age-specific and cause-specific mortality contributions. FINDINGS: Over the study period, population numbers varied between 80 million and 83 million people per year, with the number of deaths ranging from 818 000 to 1 024 000, covering the entire German population. Between Jan 1, 2003, and Dec 31, 2019, the gap in life expectancy between the most and least deprived quintiles of districts increased by 0·7 years among females (from 1·1 to 1·8 years) and by 0·1 years among males (from 3·0 to 3·1 years). Thereafter, during the COVID-19 pandemic, the gap increased more rapidly to 2·2 years in females and 3·5 years in males in 2021. Between 2003 and 2021, the causes of death that contributed the most to the life-expectancy gap were cardiovascular diseases and cancer, with declining contributions of cardiovascular disease deaths among those aged 70 years and older and increasing contributions of cancer deaths among those aged 40-74 years over this period. COVID-19 mortality among individuals aged 45 years and older was the strongest contributor to the increase in life-expectancy gap after 2019. INTERPRETATION: To reduce the socioeconomic gap in life expectancy, effective efforts are needed to prevent early deaths from cardiovascular disease and cancer in socioeconomically deprived populations, with cancer prevention and control becoming an increasingly important field of action in this respect. FUNDING: German Cancer Aid and European Research Council.


Assuntos
Causas de Morte , Expectativa de Vida , Fatores Socioeconômicos , Humanos , Expectativa de Vida/tendências , Alemanha/epidemiologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Causas de Morte/tendências , Adulto , Pré-Escolar , Lactente , Idoso de 80 Anos ou mais , Criança , Adolescente , Adulto Jovem , Recém-Nascido , COVID-19/mortalidade , COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Fatores Etários
2.
Cardiovasc Toxicol ; 24(6): 563-575, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38700665

RESUMO

Anthracycline antibiotic is one of the most effective anti-tumor drugs used to manage certain types of breast cancers, lymphomas, and leukemias. However, anthracyclines induce a dose-dependent cardiotoxicity that may progress to heart failure. Thus, using a sensitive predictor of early cardiac dysfunction in patients treated with anthracyclines can help detect subclinical cardiac dysfunction early and help initiate interventions to protect these patients. Among parameters of myocardial measure, cardiac magnetic resonance (CMR)-measured native myocardial T1 mapping is considered a sensitive and accurate quantitative measure of early subclinical cardiac changes, particularly cardiac inflammation and fibrosis. However, to understand the quality and the validity of the current evidence supporting the use of these measures in patients treated with anthracyclines, we aimed to conduct a systematic review of clinical studies of this measure to detect early myocardial changes in cancer patients treated with anthracyclines. The primary outcome was the level of native T1 mapping. We performed fixed-effects meta-analyses and assessed certainty in effect estimates. Of the 1780 publications reviewed (till 2022), 23 were retrieved, and 9 articles met the inclusion criteria. Our study showed that exposure to anthracycline was associated with a significant elevation of native myocardial T1 mapping from baseline (95% CI 0.1121 to 0.5802; p = 0.0037) as well as compared to healthy control patients (95% CI 0.2925 to 0.7448; p < 0.0001). No significant publication bias was noted on the assessment of the funnel plot and Egger's test. According to the Q test, there was no significant heterogeneity in the included studies (I2 = 0.0000% versus healthy controls and I2 = 14.0666% versus baseline). Overall, our study suggests that native myocardial T1 mapping is useful for detecting anthracycline-induced cardiotoxicity in patients with cancer.


Assuntos
Antraciclinas , Antibióticos Antineoplásicos , Cardiotoxicidade , Cardiopatias , Neoplasias , Valor Preditivo dos Testes , Humanos , Antraciclinas/efeitos adversos , Neoplasias/tratamento farmacológico , Antibióticos Antineoplásicos/efeitos adversos , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Cardiopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diagnóstico Precoce , Fatores de Risco , Adulto , Idoso , Medição de Risco , Imageamento por Ressonância Magnética , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem
3.
JCO Glob Oncol ; 10: e2300308, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38723218

RESUMO

PURPOSE: Desmoid fibromatosis (DF) is a locally aggressive tumor with low mortality but significant morbidity. There is a lack of standard of care, and existing therapies are associated with significant barriers including access, cost, and toxicities. This study aimed to explore the efficacy and safety of the metronomic therapy (MT) in DF in a large, homogenous cohort from India. PATIENTS AND METHODS: This study involved histologically confirmed DF cases treated with MT comprising vinblastine (6 mg) and methotrexate (15 mg) both once a week, and tamoxifen (40 mg/m2) in two divided doses once daily between 2002 and 2018. RESULTS: There were 315 patients with a median age of 27 years; the commonest site was extremity (142 of 315; 45.0%). There were 159 (50.1%) male patients. Of the 123 (39.0%) prior treated patients, 119 had surgery. Of 315 patients, 263 (83.5%) received treatment at our institute (MT-151, 77-local treatment, 9-tyrosine kinase inhibitor, and 26 were observed). Among the MT cohort (n = 163, 61.2%), at a median follow-up of 36 (0.5-186) months, the 3-year progression-free and overall survival were 81.1% (95% CI, 74.3 to 88.4) and 99.2% (95% CI, 97.6 to 100), respectively. There were 35% partial responses. Ninety-two patients (56.4%) completed 1-year therapy, which was an independent prognosticator (P < .0001; hazard ratio, 0.177 [95% CI, 0.083 to 0.377]). MT was well tolerated. Predominant grade ≥3 toxicities were febrile neutropenia, 12 (7.4%) without any chemotoxicity-related death. The annual cost of MT was $130 US dollars. CONCLUSION: The novel, low-cost MT qualifies as one of the effective, less toxic, sustainable, standard-of-care options for the treatment of DF with global reach and merits wide recognition.


Assuntos
Administração Metronômica , Fibromatose Agressiva , Metotrexato , Centros de Atenção Terciária , Humanos , Masculino , Feminino , Adulto , Fibromatose Agressiva/tratamento farmacológico , Fibromatose Agressiva/mortalidade , Fibromatose Agressiva/economia , Índia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem , Pessoa de Meia-Idade , Adolescente , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Metotrexato/economia , Padrão de Cuidado , Criança , Vimblastina/administração & dosagem , Vimblastina/uso terapêutico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Tamoxifeno/administração & dosagem , Tamoxifeno/economia , Tamoxifeno/uso terapêutico , Estudos Retrospectivos
5.
PeerJ ; 12: e17373, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38708348

RESUMO

Background: Chronic time pressure represents a prevalent concern within modern society, and effective measurement is crucial for research advancement. The Chronic Time Pressure Inventory (CTPI) has thus far demonstrated adequate psychometric properties. However, only two studies have examined the measure and evidence of its validity is limited. Accordingly, the current investigation, via two independent studies, assessed the factorial composition and validity (convergent/discriminant) of the CTPI. Methods: Study 1 (N = 398) examined competing factorial models and validity in relation to the Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness). Study 2 (N = 358) replicated the analysis of factor structure and assessed validity in comparison with five time perspectives (Past Negative, Present Fatalistic, Future, Past Positive, Present Hedonistic). Participants across both studies completed standardized self-report measures capturing the variables. Results: Comparison of confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) factor solutions indicated that an ESEM bifactor model provided the strongest data-model fit. This included a general chronic time pressure component alongside specific subfactors of Feeling Harried and Cognitive Awareness of Time Shortage. All scale items reflected the general factor; however, some items loaded weakly on the intended specific factor. The CTPI is thus a robust indicator of chronic time pressure but needs refinement as a measure of the specific factors. Convergent/discriminant validity analyses inferred that the CTPI captured chronic time pressure as a related, but distinct, construct to perceived stress, and evidenced a relationship with theoretically associated constructs (Big Five personality traits and time perspective). Overall, the CTPI is a sound measure of chronic time pressure and has the potential to further cohesive research efforts on the contribution of this construct to various life domains.


Assuntos
Psicometria , Humanos , Masculino , Feminino , Psicometria/métodos , Análise Fatorial , Adulto , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Personalidade , Adulto Jovem , Inventário de Personalidade , Autorrelato , Adolescente , Estresse Psicológico/diagnóstico , Idoso
6.
Health Aff (Millwood) ; 43(5): 682-690, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38709960

RESUMO

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.


Assuntos
Aborto Induzido , Homicídio , Violência por Parceiro Íntimo , Humanos , Feminino , Violência por Parceiro Íntimo/estatística & dados numéricos , Violência por Parceiro Íntimo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Homicídio/legislação & jurisprudência , Estados Unidos , Adolescente , Gravidez , Adulto , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Criança , Adulto Jovem , Governo Estadual , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos
7.
Health Aff (Millwood) ; 43(5): 651-658, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38709971

RESUMO

Guaranteed small cash incentives were widely employed by policy makers during the COVID-19 vaccination campaign, but the impact of these programs has been largely understudied. We were the first to exploit a statewide natural experiment of one such program implemented in West Virginia in 2021 that provided a $100 incentive to fully vaccinated adults ages 16-35. Using individual-level data from the Census Bureau's Household Pulse Survey, we isolated the policy effect through a difference-in-discontinuities design that exploited the discontinuity in incentive eligibility at age thirty-five. We found that the $100 incentive was associated with a robust increase in the proportion of people ever vaccinated against COVID-19 and the proportion who completed or intended to complete the primary series of COVID-19 vaccines. The policy effects were also likely to be more pronounced among people with low incomes, those who were unemployed, and those with no prior COVID-19 infection. The guaranteed cash incentive program may have created more equitable access to vaccines for disadvantaged populations. Additional outreach may also be needed, especially to unvaccinated people with prior COVID-19 infections.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Motivação , Humanos , West Virginia , COVID-19/prevenção & controle , Adulto , Masculino , Adulto Jovem , Feminino , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/provisão & distribuição , Adolescente , Programas de Imunização/economia , Vacinação/estatística & dados numéricos , Vacinação/economia , SARS-CoV-2
8.
J Psycholinguist Res ; 53(3): 44, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38713236

RESUMO

The mechanisms underlying the processing of the temporal reference of a sentence are still unexplored. Most of the previous psycholinguistic studies used the temporal concord violation between deictic time adverbs and tense marking on the verb to investigate this issue. They found that processing past tense marking is more difficult than non-past tense, indicated by lower accuracy rates and/or longer reaction time. However, it is not clear whether this complexity is due to tense marking or the temporal reference it denotes. This paper examines this issue with a judgment acceptability experiment in Taiwan Mandarin, which is analyzed as a tenseless language. The two modal auxiliary verbs you and hui were placed after deictic past time adverbs (grammatical with you but not with hui) and deictic future time adverbs (grammatical with hui but not with you). The temporal concord violation of the auxiliary verb you led to higher acceptability rates but longer reaction time than hui, reflecting higher processing difficulties. This paper argues that these complexities are due to the existential-assertive meaning of you, which interplays with the meaning of the event described by the verb rendering the situation more or less likely to occur in the future. The computation of the temporal concord of hui, displaying a future sense meaning, is more straightforward and therefore easier to process. This suggests that the mechanisms responsible for temporal reference processing are of different nature depending on the semantics of the temporal marker in the sentence.


Assuntos
Julgamento , Idioma , Psicolinguística , Humanos , Taiwan , Adulto , Feminino , Adulto Jovem , Masculino , Tempo de Reação , Semântica
9.
Health Expect ; 27(3): e14065, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38711174

RESUMO

INTRODUCTION: Recruitment and long-term retention of adolescent participants in longitudinal research are challenging and may be especially so in studies involving remote measurement and biosampling components. The ability to effectively recruit and retain participants can be supported by the use of specific evidence-based engagement strategies that are built in from the earliest stages. METHODS: Informed by a review of the evidence on effective engagement strategies and consultations with adolescents (via two Young Person Advisory Groups [YPAGs]; ages 11-13 and 14-17), the current protocol describes the planned participant engagement strategy for the Mental Health in the Moment Study: a multimodal measurement burst study of adolescent mental health across ages 11-19. RESULTS: The protocol incorporates engagement strategies in four key domains: consultations/co-design with the target population, incentives, relationship-building and burden/barrier reduction. In addition to describing general engagement strategies in longitudinal studies, we also discuss specific concerns regarding engagement in data collection methods such as biosampling and ecological momentary assessment where a paucity of evidence exists. CONCLUSION: Engagement strategies for adolescent mental health studies should be based on existing evidence and consultations with adolescents. We present our approach in developing the planned engagement strategies and also discuss limitations and future directions in engaging adolescents in longitudinal research. PATIENT OR PUBLIC CONTRIBUTION: The study design for this project places a strong emphasis on the active engagement of adolescents throughout its development. Specifically, the feedback and suggestions provided by the YPAGs have been instrumental in refining our strategies for maximising the recruitment and retention of participants.


Assuntos
Avaliação Momentânea Ecológica , Saúde Mental , Seleção de Pacientes , Humanos , Adolescente , Estudos Longitudinais , Feminino , Masculino , Criança , Adulto Jovem , Motivação
10.
PLoS One ; 19(5): e0302895, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38713697

RESUMO

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.


Assuntos
Registros Eletrônicos de Saúde , Equidade em Saúde , Pessoas Transgênero , Humanos , Utah , Pessoas Transgênero/estatística & dados numéricos , Masculino , Feminino , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem , Identidade de Gênero , Adolescente , Idoso , Cirurgia de Readequação Sexual
11.
Span J Psychiatry Ment Health ; 17(2): 95-102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38720188

RESUMO

BACKGROUND: Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. MATERIALS AND METHODS: We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. RESULTS: Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). CONCLUSIONS: Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.


Assuntos
Transtornos Mentais , Classe Social , Humanos , Adolescente , Masculino , Feminino , Transtornos Mentais/epidemiologia , Adulto Jovem , Adulto , Fatores Sexuais , Criança , Disparidades nos Níveis de Saúde , Espanha/epidemiologia , Lactente , Fatores Socioeconômicos , Seguimentos , Prevalência , Sistema de Registros
12.
Int J Rheum Dis ; 27(5): e15175, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38720575

RESUMO

OBJECTIVE: To analyze antiphospholipid antibody (aPL)-positive patients using the 2023 American College of Rheumatology/The European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria and compare the revised Sapporo criteria and the 2023 ACR/EULAR criteria and evaluate whether the 2023 ACR/EULAR criteria provide added value over the revised Sapporo criteria. METHODS: In this descriptive study, 94 aPL-positive patients (with or without APS diagnosis) were identified from two hospital-based registries (Gazi and Hacettepe University). Patients were classified into four groups to compare both criteria sets. These four groups are as follows: (1) patients classified with only the revised Sapporo criteria; (2) patients classified with only the 2023 ACR/EULAR APS criteria; (3) patients classified with both two criteria sets; and (4) patients classified with neither two criteria set. RESULTS: Of the 94 patients, 11 were classified with only the revised Sapporo criteria; one with only the 2023 ACR/EULAR APS criteria; 52 with both criteria sets; and 30 with neither set of criteria. For these 94 patients, the operating characteristics of the 2023 ACR/EULAR APS criteria, using the revised Sapporo criteria as the gold standard, the 2023 ACR/EULAR APS entry criteria demonstrated 100% sensitivity, and the 2023 ACR/EULAR APS classification criteria demonstrated 98% specificity and 82.5% sensitivity. CONCLUSION: The study emphasizes the importance of recognizing differences in clinical manifestations, such as early pregnancy loss without severe preeclampsia (PEC) and/or severe placental insufficiency (PI) and calls for a nuanced discussion on anticardiolipin (aCL) and anti-beta 2-glycoprotein-I (anti-ß2GPI) immunoglobulin G (IgG) cutoff values.


Assuntos
Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica , Valor Preditivo dos Testes , Sistema de Registros , Humanos , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Síndrome Antifosfolipídica/sangue , Feminino , Masculino , Adulto , Gravidez , Pessoa de Meia-Idade , Anticorpos Antifosfolipídeos/sangue , Biomarcadores/sangue , Reprodutibilidade dos Testes , Turquia , Adulto Jovem , Reumatologia/normas
13.
JMIR Ment Health ; 11: e52369, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38728080

RESUMO

BACKGROUND: The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. OBJECTIVE: The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. METHODS: The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. RESULTS: In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps' 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). CONCLUSIONS: This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app's efficacy.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Estudos de Viabilidade , Aplicativos Móveis , Humanos , Masculino , Feminino , Adulto , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Depressão/diagnóstico , Pessoa de Meia-Idade , Empatia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudos Cross-Over , Adulto Jovem , Análise de Dados Secundários
14.
Scand J Occup Ther ; 31(1): 2348816, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38728597

RESUMO

BACKGROUND: Preliminary evidence of the content validity of the simplified Chinese version of 'Picture My Participation' (PMP-C; Simplified) items and reliability of the subscale attendance for the effectiveness of the use with children and youth in mainland China has been collected. However, evidence of construct validity for the instrument is not yet available. AIM: To explore the construct validity of the attendance scale in PMP-C (Simplified). METHODS: A cross-sectional study using convenience sampling was conducted using PMP-C (Simplified) with a picture-supported interview for 290 children and youths aged 5-21 with and without ID in urban and rural areas of mainland China. Exploratory factor analysis (EFA) was performed using the principal component analysis (PCA) to analyse the resulting data. RESULTS: The EFA extracted five factors with eigenvalues greater than one and the cumulative contribution rate of factors accounted for 51.62% of the variance. All items had factor loadings above 0.50. The five subcomponents included: organised activities, social activities, taking care of others, family life activities and personal care and development activities. CONCLUSION: The results of the factor analysis support the construct validity of the PMP-C (Simplified) attendance scale. It provides further psychometric evidence that PMP-C (Simplified) is a sound measure to assess participation for children and youths in mainland China.


Assuntos
Psicometria , Humanos , Masculino , Estudos Transversais , Feminino , China , Criança , Adolescente , Reprodutibilidade dos Testes , Adulto Jovem , Análise Fatorial , Inquéritos e Questionários , Pré-Escolar , Participação Social , Terapia Ocupacional
15.
J Infect Dev Ctries ; 18(4): 556-564, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38728629

RESUMO

INTRODUCTION: Unrecognized Ebola Virus Disease (EVD) can lead to multiple chains of transmissions if the first caretakers are not trained and prepared. This study aimed to assess healthcare workers (HCWs) preparedness in private hospitals located in Kampala, to detect, respond and prevent EVD. METHODOLOGY: A descriptive cross-sectional study was carried out among HCWs in direct clinical care provision in four private hospitals, and in one Ebola Treatment Unit (ETU) using a self-administered questionnaire from March to June 2020. RESULTS: 222 HCWs agreed to participate aged from 19 to 64 years and with 6 months to 38 years of practice where most were nurses (44%). 3/5 hospitals did not have written protocols on EVD case management, and only one (ETU) had an exclusive emergency team. 59% were not sure whether contact tracing was taking place. Private hospitals were not included in EVD trainings organized by the Ministry of Health (MoH). In addition, HCWs in private hospitals were not empowered by the MoH to take part in EVD case management. Despite these shortcomings, only 66% of HCWs showed an interest to be immunized. Knowledge about potential Ebola vaccines was generally poor. CONCLUSIONS: In Kampala, Uganda, establishment of a more comprehensive preparedness and response strategy for EVD outbreaks is imperative for HCWs in private facilities, including a wide vaccination educational program on Ebola vaccination. The findings from this study if addressed will likely improve the preparedness and management of future Ebola outbreaks in Uganda.


Assuntos
Pessoal de Saúde , Doença pelo Vírus Ebola , Hospitais Privados , Humanos , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Uganda/epidemiologia , Estudos Transversais , Pessoal de Saúde/estatística & dados numéricos , Adulto , Hospitais Privados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Feminino , Adulto Jovem , Inquéritos e Questionários , Epidemias/prevenção & controle
16.
J Infect Dev Ctries ; 18(4): 627-635, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38728650

RESUMO

BACKGROUND: In patients with severe neutropenia, infections can rapidly become serious and life-threatening. It is essential to understand whether pregnancy induces changes in neutrophil levels thereby posing an increased threat to the health of gravidae. METHODOLOGY: This cross-sectional study was conducted in San Health District (Mali) and involved pregnant women infected or not by malaria parasites and non-pregnant healthy volunteers. Subjects were categorized as having neutropenia, normal neutrophil levels, and neutrophilia regarding their neutrophil levels. A logistic regression analysis was performed to determine factors associated with neutrophil level variation in pregnant women. RESULTS: Whether or not the pregnant women were infected with malaria, 98 of the 202 cases (48.5%) showed neutrophilia. Surprisingly, 67 of the 71 cases of neutropenia (94.4%) observed in this study concerned healthy people who were not pregnant. The mean percentage of neutrophil levels was significantly (p < 0.001) lower (49.9%) in the first trimester compared to the second trimester of pregnancy (62.0%). A logistic regression model showed that compared to early pregnancy, the second (OR = 12.9, 95% CI 2.2-248.1, p = 0.018) and the third trimesters (OR = 13.7, 95% CI 2.3-257.5, p = 0.016) were strongly associated with the increase of neutrophil levels. CONCLUSIONS: Pregnancy can induce the production of mature neutrophils that are continually released into circulation. Neutrophil levels were lower during the first trimester of the pregnancy compared to the second and third trimesters, but not affected by the presence or absence of malaria infection.


Assuntos
Malária , Neutrófilos , Humanos , Feminino , Gravidez , Mali/epidemiologia , Estudos Transversais , Adulto , Adulto Jovem , Malária/sangue , Neutropenia/sangue , Adolescente , Complicações Infecciosas na Gravidez/sangue , Contagem de Leucócitos , Complicações Parasitárias na Gravidez/sangue , Complicações Parasitárias na Gravidez/epidemiologia
17.
Lancet Public Health ; 9(5): e282-e294, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38702093

RESUMO

BACKGROUND: Sex and gender shape health. There is a growing body of evidence focused on comprehensively and systematically examining the magnitude, persistence, and nature of differences in health between females and males. Here, we aimed to quantify differences in the leading causes of disease burden between females and males across ages and geographies. METHODS: We used the Global Burden of Disease Study 2021 to compare disability-adjusted life-year (DALY) rates for females and males for the 20 leading causes of disease burden for individuals older than 10 years at the global level and across seven world regions, between 1990 and 2021. We present absolute and relative differences in the cause-specific DALY rates between females and males. FINDINGS: Globally, females had a higher burden of morbidity-driven conditions with the largest differences in DALYs for low back pain (with 478·5 [95% uncertainty interval 346·3-632·8] more DALYs per 100 000 individuals among females than males), depressive disorders (348·3 [241·3-471·0]), and headache disorders (332·9 [48·3-731·9]), whereas males had higher DALY rates for mortality-driven conditions with the largest differences in DALYs for COVID-19 (with 1767·8 [1581·1-1943·5] more DALYs per 100 000 among males than females), road injuries (1012·2 [934·1-1092·9]), and ischaemic heart disease (1611·8 [1405·0-1856·3]). The differences between sexes became larger over age and remained consistent over time for all conditions except HIV/AIDS. The largest difference in HIV/AIDS was observed among those aged 25-49 years in sub-Saharan Africa with 1724·8 (918·8-2613·7) more DALYs per 100 000 among females than males. INTERPRETATION: The notable health differences between females and males point to an urgent need for policies to be based on sex-specific and age-specific data. It is also important to continue promoting gender-sensitive research, and ultimately, implement interventions that not only reduce the burden of disease but also achieve greater health equity. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Anos de Vida Ajustados por Deficiência , Carga Global da Doença , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto , Saúde Global/estatística & dados numéricos , Idoso , Adolescente , Efeitos Psicossociais da Doença , Adulto Jovem , Longevidade , Criança , COVID-19/epidemiologia
18.
Scand J Med Sci Sports ; 34(5): e14650, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38712745

RESUMO

Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.


Assuntos
Tendão do Calcâneo , Imageamento por Ressonância Magnética , Tendinopatia , Humanos , Tendão do Calcâneo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tendinopatia/diagnóstico por imagem , Masculino , Feminino , Adulto , Reprodutibilidade dos Testes , Adulto Jovem , Pessoa de Meia-Idade , Articulação do Tornozelo/diagnóstico por imagem
19.
Am J Public Health ; 114(6): 633-641, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38718333

RESUMO

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).


Assuntos
Acidentes de Trânsito , Medicaid , Pobreza , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Medicaid/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle , Pobreza/estatística & dados numéricos , Masculino , Feminino , Pessoa de Meia-Idade , Segurança , Adolescente , Adulto Jovem , COVID-19/epidemiologia , COVID-19/prevenção & controle
20.
J Headache Pain ; 25(1): 72, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714978

RESUMO

BACKGROUND: Due to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms. METHODS: This study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM). RESULTS: A total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173-2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082-1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307-2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82-18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26-39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87-24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88-5.69, p = 0.091) and the conservative group. CONCLUSIONS: This study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.


Assuntos
Cefaleia , Malformações Arteriovenosas Intracranianas , Humanos , Feminino , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Cefaleia/etiologia , Cefaleia/terapia , Adulto , Estudos Retrospectivos , Fatores de Risco , Pessoa de Meia-Idade , Adulto Jovem , Tratamento Conservador/métodos , Resultado do Tratamento , Embolização Terapêutica/métodos , Adolescente
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