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1.
Pediatr Clin North Am ; 69(1): 141-152, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34794671

RESUMO

Antimicrobials are essential in reducing morbidity and mortality from infectious diseases globally. However, due to the lack of effective surveillance measures and widespread overuse, there is an increasing threat to the effectiveness of antimicrobials. Although there is a global increase in antimicrobial resistance, low- and middle-income countries share a much higher burden. Antimicrobial stewardship efforts such as effective surveillance and reduction in overuse can help combat the increase in antimicrobial resistance.


Assuntos
Resistência Microbiana a Medicamentos , Saúde Global , Infecções/tratamento farmacológico , Infecções/epidemiologia , Adolescente , Adulto , Antibacterianos/economia , Antibacterianos/uso terapêutico , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , COVID-19/tratamento farmacológico , Criança , Pré-Escolar , Países em Desenvolvimento , Farmacorresistência Bacteriana Múltipla , Feminino , Gastroenteropatias/tratamento farmacológico , Gonorreia/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Sepse/tratamento farmacológico , Adulto Jovem
2.
Esc. Anna Nery Rev. Enferm ; 26: e20210239, 2022. tab, graf
Artigo em Português | LILACS, BDENF | ID: biblio-1346039

RESUMO

Resumo Objetivo avaliar a autoeficácia de puérperas, ao longo do período puerperal, quanto ao potencial em amamentar. Método estudo longitudinal, do tipo painel, realizado de maio a dezembro de 2015, em Alojamento Conjunto de maternidade de referência de Fortaleza, Ceará, Brasil, delimitado em quatro momentos. O primeiro ocorreu por contato presencial na maternidade e os três contatos subsequentes foram realizados por meio telefônico aos dois, quatro e seis meses pós-parto. A amostra foi de 66 puérperas. Resultados observou-se aumento da mediana dos escores da escala de autoeficácia em amamentar ao longo dos meses. A maioria das puérperas apresentou nível elevado de autoeficácia, entretanto, a prática do aleitamento materno exclusivo apresentou declínio progressivo, chegando a 17,9% aos seis meses. Conclusão e implicações para a prática as puérperas participantes apresentaram aumento progressivo dos escores da escala de autoeficácia ao longo do tempo, mantendo níveis de elevada e média autoeficácia em amamentar. Logo, este estudo pode direcionar novas pesquisas de intervenção, bem como subsidiar a prática holística dos profissionais que apoiam a amamentação.


Resumen Objetivo evaluar la autoeficacia de puérperas a lo largo del puerperio en cuanto a su potencialidad para amamantar. Método estudio longitudinal del tipo panel, realizado de mayo a diciembre de 2015, en el Alojamiento Conjunto de una maternidad de referencia en Fortaleza, Ceará, delimitado en cuatro momentos. El primero ocurrió por contacto presencial en la maternidad y los tres contactos posteriores se realizaron telefónicamente a los dos, cuatro y seis meses posparto. La muestra fue de 66 puérperas. Resultados hubo un aumento en la mediana de puntuaciones de la escala de autoeficacia para lactancia materna a lo largo de los meses. La mayoría de las puérperas mostró un alto nivel de autoeficacia, sin embargo, la práctica de lactancia materna exclusiva mostró un declive progresivo llegando al 17,9% a los seis meses. Conclusión e implicaciones para la práctica Las puérperas mostraron un aumento progresivo en los puntajes de la escala de autoeficacia a lo largo del tiempo, manteniendo niveles de autoeficacia alta y media en la lactancia materna. Por lo tanto, este estudio puede orientar nuevas investigaciones de intervención, así como subsidiar la práctica holística de los profesionales que apoyan la lactancia materna.


Abstract Objective to evaluate the self-efficacy of puerperal women throughout the puerperal period regarding their potential to breastfeed. Method longitudinal panel study was performed from May to December 2015 in postpartum rooms of a reference maternity hospital in Fortaleza (Ceará State, Brazil). The study was separated into four moments: the first occurred through a face-to-face meeting at the maternity hospital, and the three subsequent encounters were made by telephone two, four, and six months postpartum. The sample was composed of 66 puerperal women. Results there was an increase in the mean scores of the self-efficacy scale for breastfeeding throughout the months, and most puerperal women showed a high self-efficacy level, although the practice of exclusive breastfeeding showed a progressive decline and reached 17.9% at six months. Conclusions and implications for practice The puerperal women showed progressively higher self-efficacy scores over time, maintaining high and medium self-efficacy levels in breastfeeding. Therefore, this study can direct new intervention research and subsidize the holistic practice of professionals who support breastfeeding.


Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Autoeficácia , Período Pós-Parto , Promoção da Saúde , Fatores Socioeconômicos , Estudos Longitudinais
3.
Med Care ; 60(1): 3-12, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739414

RESUMO

OBJECTIVES: Equitable access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing is important for reducing disparities. We sought to examine differences in the health care setting choice for SARS-CoV-2 testing by race/ethnicity and insurance. Options included traditional health care settings and mobile testing units (MTUs) targeting communities experiencing disproportionately high coronavirus disease 2019 (COVID-19) rates. METHODS: We conducted a retrospective, observational study among patients in a large health system in the Southeastern US. Descriptive statistics and multinomial logistic regression analyses were employed to evaluate associations between patient characteristics and health care setting choice for SARS-CoV-2 testing, defined as: (1) outpatient (OP) care; (2) emergency department (ED); (3) urgent care (UC); and (4) MTUs. Patient characteristics included race/ethnicity, insurance, and the existence of an established relationship with the health care system. RESULTS: Our analytic sample included 105,386 adult patients tested for SARS-CoV-2. Overall, 55% of patients sought care at OP, 24% at ED, 12% at UC, and 9% at MTU. The sample was 58% White, 24% Black, 11% Hispanic, and 8% other race/ethnicity. Black patients had a higher likelihood of getting tested through the ED compared with White patients. Hispanic patients had the highest likelihood of testing at MTUs. Patients without a primary care provider had a higher relative risk of being tested through the ED and MTUs versus OP. CONCLUSIONS: Disparities by race/ethnicity were present in health care setting choice for SARS-CoV-2 testing. Health care systems may consider implementing mobile care delivery models to reach vulnerable populations. Our findings support the need for systemic change to increase primary care and health care access beyond short-term pandemic solutions.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico , COVID-19/etnologia , Instalações de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Estudos Retrospectivos , SARS-CoV-2 , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
4.
Int J Cancer ; 150(1): 18-27, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34449868

RESUMO

Helicobacter pylori (H. pylori) infection is considered the leading cause of gastric cancer. Gastric cancer is currently a common cancer with high incidence and mortality rates, but it is expected that the incidence rate will gradually decrease as the H. pylori infection prevalence decreases in the future. When evaluating the effectiveness of gastric cancer prevention strategies, it is essential to note the differences in long-term cumulative risks between H. pylori-infected and uninfected populations, but this has not yet been precisely evaluated. In our study, we aimed to estimate the cumulative incidence risks of developing gastric cancer from birth to 85 years among H. pylori-infected and uninfected populations by using population-based cancer registry data and birth year-specific H. pylori infection prevalence rates. Death from gastric cancer and other causes of death were considered in the estimations of the adjusted cumulative incidence risks stratified by sex and H. pylori infection status. After performing 5000 Monte Carlo simulations with repeated random sampling using observed cancer incidence in selected three prefectures (Fukui, Nagasaki, Yamagata) of prefectural population-based cancer registry in Japan, the mean adjusted cumulative incidence risk for gastric cancer in the H. pylori-infected population was 17.0% for males and 7.7% for females and 1.0% for males and 0.5% for females in the uninfected population. These results calculated with Japanese cancer registry data may be useful in considering and evaluating future prevention strategies for gastric cancer in Japan.


Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Método de Monte Carlo , Neoplasias Gástricas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Seguimentos , Infecções por Helicobacter/microbiologia , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/microbiologia , Adulto Jovem
5.
J Epidemiol Community Health ; 76(1): 8-15, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34193569

RESUMO

BACKGROUND: The public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic. METHODS: Data were collected from a cross-sectional, nationally representative household survey of the working age population (18-64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher's exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes. RESULTS: Of our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on 'furlough' was more likely in younger (18-29 years) and older (60-64 years) workers, those in lower skilled jobs and from households with less financial security. CONCLUSION: A number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.


Assuntos
COVID-19 , Pandemias , Adolescente , Adulto , Estudos Transversais , Emprego , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , País de Gales/epidemiologia , Adulto Jovem
6.
Support Care Cancer ; 30(1): 145-155, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34241699

RESUMO

PURPOSE: Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. METHODS: A total of 113 AYAs (aged 11-24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). RESULTS: Higher offspring unmet needs were associated with lower health-related quality of life (r = -0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = -0.100* [-0.183, -0.018]) but not internalizing problems (standardized indirect effect = 0.067 [-0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (ß = 0.351**) which, in turn, predicted lower health-related quality of life (ß = -0.286**). CONCLUSION: These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer.


Assuntos
Neoplasias , Qualidade de Vida , Adolescente , Necessidades e Demandas de Serviços de Saúde , Humanos , Neoplasias/terapia , Pais , Inquéritos e Questionários , Adulto Jovem
7.
Support Care Cancer ; 30(1): 21-31, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34347183

RESUMO

INTRODUCTION: Currently cancer-related cognitive impairment (CRCI) is mainly assessed by means of questionnaires, which is very laborious for the patients and the supervising physician. We evaluated a new online cognitive assessment tool, the MyCognition Quotient (MyCQ, Cambridge) in breast cancer survivors with CRCI, and compared the results with a psychometric test measuring cognitive complaints, depression, and anxiety. MATERIALS AND METHODS: In this prospective study, 46 adult patients between 18 and 70 years old with a diagnosis of BC were studied, all complaining of disturbing cognitive impairment. They participated in a physical cognitive rehabilitation program. The patients had an online cognitive assessment (MyCQ Med by MyCognition) every 4 weeks on their home computer. In addition patients were assessed in the outpatient clinic by the principal investigator at baseline, after 3 and 6 months using the following validated neuro-psychological surveys: the Hospital Anxiety and Depression Scale (HADS), Beck Cognitive Insight Scale (BCIS), and Cognitive Failure Questionnaire (CFQ). MyCQ scores were correlated with the results of these surveys. RESULTS: Only weak correlations could be found between overall MyCQ or the MyCQ subtests with the psychometric tests (between - 0.43 and 0.458) at baseline and when combining data at time point 0, 3, and 6 months. Linear mixed models showed there was a significant association between Latency Choice Reaction Time and CFQ (continuous; p = 0.026). An AUC of 0.640 and a cut-off of 481.5 ms in Latency Choice Reaction Time were found to distinguish patients with CFQ below 44 to patients with CFQ above 44 (sensitivity 0.63 and specificity 0.73). In Latency Coding an AUC of 0.788 and a cut-off of 1316 ms were found to distinguish non-depressive patients from patients likely to present with depressive symptoms (sensitivity 0.75 and specificity 0.76). CONCLUSION: MyCQ cannot replace the various psychometric tests. However, abnormal Latency in cognitive tests, Choice Reaction Time and Coding, seems promising to be used as a screening tool to detect specific aspects of abnormal cognitive functioning in patients with cognitive complaints and depressive symptoms.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Disfunção Cognitiva , Adolescente , Adulto , Idoso , Neoplasias da Mama/complicações , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
8.
Environ Res ; 203: 111834, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34358501

RESUMO

Age-specific discrepancy of mortality burden attributed to temperature, measured as years of life lost (YLL), has been rarely investigated. We investigated age-specific temperature-YLL rates (per 100,000) relationships and quantified YLL per death caused by non-optimal temperature in China. We collected daily meteorological data, population data and daily death counts from 364 locations in China during 2006-2017. YLL was divided into three age groups (0-64 years, 65-74 years, and ≥75 years). A distributed lag non-linear model was first employed to estimate the associations of temperature with age-specific YLL rates in each location. Then we pooled the associations using a multivariate meta-analysis. Finally, we calculated age-specific average YLL per death caused by temperature by cause of death and region. We observed greater effects of cold and hot temperature on YLL rates for the elderly compared with the young population by region or cause of death. However, YLL per death due to non-optimal temperature for different regions or causes of death decreased with age, with 2.0 (95 % CI:1.5, 2.5), 1.2 (1.1, 1.4) and 1.0 years (0.9, 1.2) life loss per death for populations aged 0-64 years, 65-74 years and over 75 years, respectively. Most life loss per death results from moderate temperature, especially moderate cold for all age groups. The effect of non-optimal temperature on YLL rates is smaller for younger populations than older ones, while the temperature-related life loss per death was more prominent for younger populations.


Assuntos
Temperatura Baixa , Temperatura Alta , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , China/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Mortalidade , Temperatura , Adulto Jovem
9.
J Sci Food Agric ; 102(1): 417-424, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34143904

RESUMO

BACKGROUND: Thiamethoxam is widely used to control pests in Chinese kale, popularly consumed leafy vegetables. The potential risk to the environment and human health has aroused much public concern. Therefore, it is important to investigate the degradation behavior, residue distribution and dietary risk assessment of thiamethoxam in Chinese kale. RESULTS: A sensitive analytical method for determination of thiamethoxam and its metabolite clothianidin residue in Chinese kale was established and validated through a quick, easy, cheap, effective, rugged, and safe (QuEChERS) technique with ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The recoveries were 85.4-101.2% for thiamethoxam and 79.5-108.1% for clothianidin, with the relative standard deviations (RSDs) of 0.9-10.2% and 1.8-6.0%, respectively. For the dissipation kinetics, the data showed that thiamethoxam in Chinese kale was degraded with the half-lives of 4.1 to 4.5 days. In the terminal residue experiments, the residues of thiamethoxam were 0.017-0.357 mg kg-1 after application 2-3 times with a preharvest interval (PHI) of 7 days under the designed dosages. The chronic and acute dietary exposure assessment risk quotient (RQ) values of thiamethoxam in Chinese kale for different Chinese consumers were 0.08-0.19% and 0.05-0.12%, respectively, and those of clothianidin were 0.01-0.04% and 0.02-0.04%, respectively, all of the RQ values were lower than 100%. CONCLUSION: Thiamethoxam in Chinese kale was rapidly degraded following first-order kinetics models. The dietary risk of thiamethoxam and clothianidin through Chinese kale was negligible to consumers. The results from this study are important reference for Chinese governments to developing criteria for the safe and rational use of thiamethoxam, setting maximum residue levels (MRLs), monitoring the quality safety of agricultural products and protecting consumer health. © 2021 Society of Chemical Industry.


Assuntos
Brassica/química , Cromatografia Líquida/métodos , Guanidinas/metabolismo , Neonicotinoides/metabolismo , Resíduos de Praguicidas/química , Resíduos de Praguicidas/metabolismo , Espectrometria de Massas em Tandem/métodos , Tiametoxam/química , Tiametoxam/metabolismo , Tiazóis/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brassica/metabolismo , Criança , Pré-Escolar , China , Exposição Dietética/efeitos adversos , Exposição Dietética/análise , Feminino , Contaminação de Alimentos/análise , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Medição de Risco , Verduras/química , Verduras/metabolismo , Adulto Jovem
10.
J Manag Care Spec Pharm ; 28(1): 7-15, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949113

RESUMO

BACKGROUND: High-deductible health plans (HDHPs) are characterized by higher deductibles and lower monthly premiums compared with a typical health plan. HDHPs may reduce, or delay, needed care, which will ultimately lead to poorer access to care for chronically affected participants. OBJECTIVES: To (1) investigate the HDHP enrollment trend and (2) determine the effects of HDHPs on financial access problems for individuals with self-reported cognitive impairment. METHODS: Data between 2010 and 2018 were obtained from the National Health Interview Survey (NHIS). Individuals with cognitive impairment were identified if they were limited by memory difficulties. Problems regarding financial access to health care were assessed based on 6 survey questions from the Centers for Disease Control and Prevention. Multivariable logistic regressions were implemented to evaluate the effects of HDHPs. RESULTS: This study identified 1,148 individuals with cognitive impairment, representing 3.9 million individuals in the United States from 2010 to 2018. A nearly 2-fold increase in HDHP enrollment with cognitive impairment was observed from 2010 (20.9%) to 2018 (41.9%). This increase is similar to that reported for noncognitively impaired individuals. After controlling for possible confounding variables, cognitively impaired individuals with HDPHs were more likely to have overall financial access difficulties compared with those without HDHPs (OR = 1.17, 95% CI = 0.88-1.56, P = 0.271), but this likelihood was not statistically significant. CONCLUSIONS: HDHPs are intended to support effective care options and reduce health care costs. However, our research found that among individuals with cognitive impairment, those with HDHPs experienced some financial access problems, such as affording medical care, follow-up care, and specialists, than those without HDHPs, indicating that HDHPs might have unintended consequences for health care usage. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest or financial interests to disclose.


Assuntos
Disfunção Cognitiva , Dedutíveis e Cosseguros/economia , Dedutíveis e Cosseguros/tendências , Seguro Saúde/economia , Seguro Saúde/tendências , Adolescente , Adulto , Doença Crônica/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/tendências , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
11.
J Manag Care Spec Pharm ; 28(1): 69-77, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949118

RESUMO

BACKGROUND: Although previous studies have reported the economic burden of atopic dermatitis (AD) in adults, updates are needed using more current data and measure of disease severity. OBJECTIVE: To describe the health care resource utilization (HCRU) and associated costs in US adults diagnosed with AD overall and by disease severity. METHODS: This real-world retrospective study identified adults aged at least 18 years who received a clinical diagnosis of AD in a dermatology electronic medical record (EMR) database between 2016 and 2018 (first record = index date), which was linked to an administrative claims database. Patients were required to have an AD diagnostic code and at least 6 months of continuous enrollment in medical and pharmacy benefits before and after the index date. Baseline severity was assessed using the Physician Global Assessment score closest to the index date. Inpatient and outpatient services, visits to specialists and its seasonality, treatment use, and associated annual direct health care costs were reported using descriptive statistics. RESULTS: Annual all-cause direct health care costs were $10,474 per patient per year and primarily driven by outpatient visits and pharmacy use. Compared with patients with clear to mild disease, more AD patients with severe disease had at least 1 dermatology (73.0% vs 58.5%) and allergy/immunology office visit (16.0% vs 5.5%) and AD-related medications (90.0% vs 64.3%). All-cause total annual costs in patients with severe disease ($23,242) were significantly higher than in patients with clear to mild disease ($8,936; P = 0.0002). Little seasonal variation in dermatology office visits was observed. CONCLUSIONS: Significant economic burden primarily driven by outpatient and pharmacy utilization was observed in AD patients, which increased with disease severity. DISCLOSURES: This work was sponsored by Eli Lilly and Company. Gorritz and Wade are employees of IQVIA, which was contracted by Eli Lilly and Company to conduct this study and develop the manuscript. Wang was employed by IQVIA at the time of this study. Malatestinic and Goldblum are employees and stockholders of Eli Lilly and Company. Boytsov was an employee of Eli Lilly at the time of this research.


Assuntos
Dermatite Atópica , Custos de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Gravidade do Paciente , Adolescente , Adulto , Idoso , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/fisiopatologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
12.
Rocz Panstw Zakl Hig ; 72(4): 409-418, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928117

RESUMO

Background: Onset of overweight and obesity has been previously reported as a result of population migration to western countries. Objective: To determine the nutritional status, weight status and their association with socioeconomic status in sub-Saharan settled in El Jadida city in a Mediterranean country Morocco. Materials and methods: A descriptive study was carried out in 2018 on 256 sub-Saharans migrants living in the city of El Jadida in Morocco. Information on socio-economic and socio-demographic characteristics as well as anthropometric measurements was collected. The body mass index (BMI) and abdominal obesity by measuring waist circumference (WC) and waist circumference to hip ratio (WHR) and the distribution of body fat by calculating the sum of skin folds are determined. Results: Analysis results indicate that height, waist circumference, hip circumference, sum of trunk skinfolds, total sum of skinfolds, and BMI increase with age. The prevalence of underweight decreases with age, overweight was 38.7% in the youngest age group (18-25 years) and reached higher values after 35 years (44.10%). In addition, the prevalence of general obesity (based on BMI) increased with age and abdominal obesity (based on WHR and WC) was more marked in sub-Saharan people aged 26 to 35 years. These results also reveal the coexistence of underweight, overweight and obesity in all age groups. The analysis revealed a significant association between several variables and obesity. Significant associations were found between age and BMI (P=0.04), between level of education (university) and WHR (p=0.02), between sex and WHR, and between sex and WC (p=0.049). The study revealed also that the majority of the study sample gained weight after their settling in the host country. Conclusions: The study data show that obesity including overweight and abdominal obesity were prevalent among sub-Saharan migrants residing in the city of El Jadida. This prevalence is associated with socio-demographic and socioeconomic factors.


Assuntos
Status Econômico , Estado Nutricional , Adolescente , Adulto , África ao Sul do Saara , Humanos , Marrocos/epidemiologia , Classe Social , Adulto Jovem
13.
J Athl Train ; 56(12): 1285-1291, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34911074

RESUMO

CONTEXT: Vestibular and ocular motor assessment is an emerging clinical assessment for patients with sport-related concussion (SRC). The increased use of these assessments by clinicians calls for the examination of outcomes that may affect clinical practice. OBJECTIVE: To compare vestibular and ocular motor impairments in high school and collegiate athletes within 72 hours of SRC and examine the distribution of impairments in these populations based on pre-established clinical cutoff scores. DESIGN: Cross-sectional study. SETTING: High school and collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: Data were collected from 110 athletes (high school: n = 47, age = 15.40 ± 1.35 years; college: n = 63, age = 19.46 ± 1.28 years) within 72 hours of sustaining an SRC. MAIN OUTCOME MEASURE(S): Total and change scores were calculated for the Vestibular/Ocular Motor Screening (VOMS) tool, along with average near point of convergence (NPC) distance. Separate Mann-Whitney U tests were used to compare group differences, and χ2 analyses were used to examine the proportion of athletes with scores greater than clinical cutoff scores for all VOMS outputs. The α level was set a priori at .05. RESULTS: No differences were found between high school and collegiate athletes for VOMS total and change scores and NPC distance. A larger proportion of the sample had scores greater than the cutoff for all total scores (P < .001) and change scores in horizontal vestibulo-ocular reflex (59.01%; P < .001), vertical vestibulo-ocular reflex (60.91%; P < .001), and visual motion sensitivity (60.91%; P < .001). However, a larger proportion demonstrated smooth pursuit change scores (85.45%; P < .001) and NPC distances (73.64%; P = .01) that were less than the cutoff scores. CONCLUSIONS: During the acute phase of SRC, high school and collegiate athletes presented with similar vestibular and ocular motor impairments as measured using the VOMS, but vestibular tasks appeared to cause greater symptom provocation. Lastly, VOMS change scores may offer more clinical utility compared with total scores in assessing specific impairments after SRC.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Adolescente , Adulto , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos Transversais , Humanos , Instituições Acadêmicas , Adulto Jovem
14.
Bull Cancer ; 108(10S): S40-S54, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34920807

RESUMO

The marketing authorization of tisagenlecleucel, a 2nd generation of CD19-directed CAR T-cells, containing the 4-1 BB co-stimulatory domain, in 2017 in USA and in 2018 in EU, has revolutionized the therapeutic strategy in advanced B-cell acute lymphoblastic leukemia (B-ALL) in children, adolescents and young adults (AYAs) with relapsed or refractory disease. This innovative treatment, based on a "living drug", has shown very impressive short-term responses. However, safety profile and complex logistics require high expertise centers and tight collaborations between addressing and treating centers. Current research is exploring the possibility to move to first line ALL with high-risk features and/or first high-risk relapse. More efficient CAR T-cells products, are still lacking to counteract the escape mechanisms already described. Moreover, to define the bridge-to-CAR time for each patient remains a challenge to obtain optimal disease burden allowing expansion and persistence of CAR T-cells. Also difficult is to identify patients who will benefit from further therapy after infusion, such as allogeneic HSCT or may be immuno-modulatory treatment. Finally, CAR T-cells directed against T-ALL are only in their beginning but require more complex engineering process to avoid T- cell immune-deficiency or fratricide.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Imunoterapia Adotiva/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Receptores de Antígenos de Linfócitos T/uso terapêutico , Receptores de Antígenos Quiméricos/imunologia , Adolescente , Antígenos CD19/imunologia , Antígenos CD28/imunologia , Engenharia Celular , Criança , Ensaios Clínicos como Assunto , Efeitos Psicossociais da Doença , Humanos , Imunomodulação , Imunoterapia Adotiva/efeitos adversos , Leucemia de Células B/imunologia , Leucemia de Células B/patologia , Leucemia de Células B/terapia , Depleção Linfocítica , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Recidiva , Evasão Tumoral/imunologia , Adulto Jovem
15.
Artigo em Inglês | LILACS, CUMED | ID: biblio-1341781

RESUMO

A cross-sectional study was conducted to determine the vaccination status and barriers to vaccination among the university students by utilizing a simple random sampling technique in the largest public sector university of Southern Punjab, Pakistan. The participants comprised 380 university students. Data was collected by a self-designed questionnaire. Statistical Package for Social Sciences (SPSS) was used for data analysis. Chi-square Test and Fischer Exact test were applied to assess the impact of demographics on vaccination status, and barriers to vaccination. Out of 380 participants, 328 (86.31 pewrcent) were males and 52 (13.68) females. The immunization status of university students against various diseases was variable: 97.10 percent (n=369) were vaccinated against poliomyelitis, 58.68 percent (n=223) against BCG, 44.21 percent (n=168) against hepatitis B, 49.21 percent (n=187) against diphtheria, pertussis and tetanus and 55.26 percent (n=210) against measles vaccine. The barriers to vaccination were unwillingness 15.0 percent (n=57), inaccessibility 17.10 percent (n=65), financial issues 4.47 percent (n=17) and unawareness 63.42 percent (n=241). Moreover, 31 percent (n=118) of the participants considered that the use of vaccines is unsafe. The vaccination status of the university students in Southern Punjab, Pakistan is alarming as most of the students were unvaccinated. The unawareness and perception of the unsafety of vaccines were the biggest barriers to vaccination(AU)


Se realizó un estudio transversal para determinar el estado de vacunación y las barreras a la vacunación entre los estudiantes universitarios, mediante la utilización de una técnica de muestreo aleatorio simple, en la universidad más grande del sector público del sur de Punjab, Pakistán. Los participantes fueron 380 estudiantes universitarios. Los datos se recopilaron mediante un cuestionario de diseño propio. Se utilizó el Paquete Estadístico para Ciencias Sociales (SPSS) para el análisis de datos. Se aplicaron la prueba de chi-cuadrado y la prueba exacta de Fischer para evaluar el impacto de la demografía en el estado de vacunación y las barreras para la vacunación. De 380 participantes, 328 (86,31por ciento) fueron hombres y 52 (13,68 por ciento) mujeres. El estado de inmunización de los estudiantes universitarios frente a diversas enfermedades fue variable: 97,10 por ciento (n = 369) fueron vacunados contra poliomielitis, 58,68 por ciento (n = 223) contra BCG, 44,21por ciento (n = 168) contra hepatitis B, 49,21 por ciento (n = 187) contra la difteria, tos ferina y tétanos y 55,26 por ciento (n = 210) contra la vacuna contra el sarampión. Las barreras para la vacunación fueron la falta de voluntad 15,0 por ciento (n = 57); la inaccesibilidad 17,10 por ciento (n = 65); los problemas económicos 4,47 por ciento (n = 17) y el desconocimiento 63,42 por ciento (n = 241). Además, el 31por ciento (n = 118) de los participantes consideró que el uso de vacunas no es seguro. El estado de vacunación de los estudiantes universitarios en el sur de Punjab, Pakistán, es alarmante ya que la mayoría de los estudiantes no estaban vacunados. El desconocimiento y la percepción de la inseguridad de las vacunas fueron las mayores barreras para la vacunación(AU)


Assuntos
Humanos , Feminino , Adulto Jovem , Educação , Paquistão , Estudos Transversais , Vacinas contra COVID-19/uso terapêutico
16.
BMC Pregnancy Childbirth ; 21(1): 850, 2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34969366

RESUMO

BACKGROUND: Equitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana. METHODS: Research was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15-49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities. RESULTS: The results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother's health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women. CONCLUSION: This study confirms that a mother's socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.


Assuntos
Parto Obstétrico , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Serviços de Saúde Materna , Parto , Adolescente , Adulto , Feminino , Gana , Humanos , Pessoa de Meia-Idade , Tocologia , Modelos Estatísticos , Gravidez , Fatores Socioeconômicos , Adulto Jovem
17.
Prev Chronic Dis ; 18: E101, 2021 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-34914579

RESUMO

INTRODUCTION: More than 700,000 COVID-19 cases have been linked to American colleges and universities since the beginning of the pandemic. However, studies are limited on the effects of the pandemic on college-aged young adults and its association with their COVID-19 vaccination status and intent. METHODS: Using the Census Bureau's Household Pulse Survey (HPS), a large, nationally representative survey fielded from April 14 through May 24, 2021, we assessed the effects of the pandemic (COVID-19 infection, mental health, food and financial security) on COVID-19 vaccination coverage (≥1 dose) and intentions toward vaccination among college-aged young adults in the United States (N = 6,758). We examined factors associated with vaccination coverage and intent, and reasons for not getting vaccinated. RESULTS: Approximately one-fifth (19.6%) of college-aged young adults had a previous diagnosis of COVID-19, 43.5% and 39.1% reported having anxiety or depression, respectively, 10.9% reported that they sometimes or often did not have enough food to eat, and 22.6% and 12.3% found it somewhat or very difficult, respectively, to pay for household expenses. Of college-aged young adults, 63.1% had received at least 1 dose of the COVID-19 vaccine, 15.4% probably would be vaccinated or were unsure about getting the vaccine, and 14.0% probably will not or definitely will not get vaccinated. Adults who were non-Hispanic Black (vs non-Hispanic White) or had food or financial insecurities (vs did not) were less likely to be vaccinated or intend to be vaccinated. Among adults who probably will not or definitely will not be vaccinated, more than one-third said that they did not believe a vaccine was needed. CONCLUSION: Ensuring high and equitable vaccination coverage among college-aged young adults is critical for safely reopening in-person learning and resuming prepandemic activities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Intenção , Saúde Mental , SARS-CoV-2 , Estados Unidos/epidemiologia , Universidades , Vacinação , Cobertura Vacinal , Adulto Jovem
18.
PLoS One ; 16(12): e0261616, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34936689

RESUMO

BACKGROUND: Pragmatic challenges remain in the monitoring and return to play (RTP) decisions following suspected Sports Related Concussion (SRC). Reliance on traditional approaches (pen and paper) means players readiness for RTP is often based on self-reported symptom recognition as a marker for full physiological recovery. Non-digital approaches also limit opportunity for robust data analysis which may hinder understanding of the interconnected nature and relationships in deficit recovery. Digital approaches may provide more objectivity to measure and monitor impairments in SRC. Crucially, there is dearth of protocols for SRC assessment and digital devices have yet to be tested concurrently (multimodal) in SRC rugby union assessment. Here we propose a multimodal protocol for digital assessment in SRC, which could be used to enhance traditional sports concussion assessment approaches. METHODS: We aim to use a repeated measures observational study utilising a battery of multimodal assessment tools (symptom, cognitive, visual, motor). We aim to recruit 200 rugby players (male n≈100 and female n≈100) from University Rugby Union teams and local amateur rugby clubs in the North East of England. The multimodal battery assessment used in this study will compare metrics between digital methods and against traditional assessment. CONCLUSION: This paper outlines a protocol for a multimodal approach for the use of digital technologies to augment traditional approaches to SRC, which may better inform RTP in rugby union. Findings may shed light on new ways of working with digital tools in SRC. Multimodal approaches may enhance understanding of the interconnected nature of impairments and provide insightful, more objective assessment and RTP in SRC. CLINICAL TRIAL REGISTRATION: NCT04938570. https://clinicaltrials.gov/ct2/results?cond=NCT04938570&term=&cntry=&state=&city=&dist=.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Dispositivos Eletrônicos Vestíveis , Adulto , Tecnologia de Rastreamento Ocular , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Adulto Jovem
19.
Proc Natl Acad Sci U S A ; 118(51)2021 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-34903656

RESUMO

The US COVID-19 Trends and Impact Survey (CTIS) is a large, cross-sectional, internet-based survey that has operated continuously since April 6, 2020. By inviting a random sample of Facebook active users each day, CTIS collects information about COVID-19 symptoms, risks, mitigating behaviors, mental health, testing, vaccination, and other key priorities. The large scale of the survey-over 20 million responses in its first year of operation-allows tracking of trends over short timescales and allows comparisons at fine demographic and geographic detail. The survey has been repeatedly revised to respond to emerging public health priorities. In this paper, we describe the survey methods and content and give examples of CTIS results that illuminate key patterns and trends and help answer high-priority policy questions relevant to the COVID-19 epidemic and response. These results demonstrate how large online surveys can provide continuous, real-time indicators of important outcomes that are not subject to public health reporting delays and backlogs. The CTIS offers high value as a supplement to official reporting data by supplying essential information about behaviors, attitudes toward policy and preventive measures, economic impacts, and other topics not reported in public health surveillance systems.


Assuntos
Teste para COVID-19/estatística & dados numéricos , COVID-19/epidemiologia , Indicadores Básicos de Saúde , Adulto , Idoso , COVID-19/diagnóstico , COVID-19/prevenção & controle , COVID-19/transmissão , Vacinas contra COVID-19 , Estudos Transversais , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-34948496

RESUMO

Typifying historical populations using anthropometric indicators such as height, BMI and weight allows for an analysis of the prevalence of obesity and malnutrition. This study evaluates secular changes in height, weight and body mass for men cohorts at 21 years old, born between 1934 and 1954 who were called up between 1955 and 1974, in the city of Madrid, Spain. In this study we prove the hypothesis that anthropometric variables increase thanks to improvement in diet and significant investments in hygiene and health infrastructure during the 1960s. The results of our analysis show a positive secular change in the trends for height (an increase of 4.67 cm), weight (6.400 kg) and BMI (0.90 Kg/m2), the result of a recovery in standards of living following the war and the autarchy of the 1940s. We also observed a slight trend towards obesity and a reduction in underweight categories at the end of the period is also observed. In conclusion, the secular trends of anthropometric variables in the city of Madrid reflect the recovery of living standards after the deterioration of the nutritional status suffered during the Spanish Civil War (1936-1939) and the deprivation of the autarchic period.


Assuntos
Estatura , Obesidade , Adulto , Antropometria , Índice de Massa Corporal , Peso Corporal , Humanos , Masculino , Obesidade/epidemiologia , Espanha/epidemiologia , Adulto Jovem
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