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1.
Semin Arthritis Rheum ; 66: 152437, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38564998

RESUMO

Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58-0.73 (range: 0.36-0.88) for the joints, 0.65-0.81 (range: 0.39-0.95) for the entheses, and 0.62-0.75 (range: 0.60-0.76) for chronic nonbacterial osteomyelitis-like lesions.


Assuntos
Artrite Juvenil , Imageamento por Ressonância Magnética , Imagem Corporal Total , Humanos , Artrite Juvenil/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Criança , Imagem Corporal Total/métodos , Masculino , Índice de Gravidade de Doença , Feminino , Adolescente , Articulações/diagnóstico por imagem , Pré-Escolar
2.
Am J Pharm Educ ; 88(5): 100693, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38574997

RESUMO

OBJECTIVE: Academic resilience, a critical determinant of academic achievement, is affected by various factors. There is a paucity of large-scale international assessments of academic resilience among pharmacy students. Therefore, this study aimed to assess academic resilience among pharmacy students in 12 countries and to evaluate factors associated with their academic resilience levels. METHODS: A cross-sectional online survey-based study was conducted among randomly selected pharmacy students in 12 countries: Egypt, Türkiye, Indonesia, Pakistan, Bangladesh, Iraq, Jordan, Nigeria, Malaysia, Saudi Arabia, Sudan, and the United Arab Emirates. After pilot testing, the validated 30-item academic resilience scale (ARS) was used for the assessment. The data were collected between November 1, 2022 and April 15, 2023. Descriptive and inferential statistics were performed, as appropriate. RESULTS: A total of 3950 were received from the 12 participating countries. The mean age was 21.68 ± 2.62 years. About two-thirds of the responses were from female participants and those studying for Bachelor of Pharmacy degrees. Overall, the findings show moderate academic resilience, which varied across countries. The median (IQR) of the total ARS-30 was 114 (103-124). Females exhibited lower negative affective and emotional response subscale levels than males. There were significant cross-country variations in the ARS-30 and all subscales. The highest overall levels were reported for Sudan, Pakistan, and Nigeria and the lowest were reported for Indonesia and Türkiye. Students in private universities tended to have higher overall ARS levels than public university students. Higher academic performance was significantly associated with ARS levels, whereas those with excellent performance exhibited the highest ARS levels. Students with exercise routines had higher ARS levels than those without exercise routines. Finally, students who were engaged in extracurricular activities had higher ARS levels than those who did not participate in these activities. CONCLUSION: The study offers insights into the factors affecting academic resilience in pharmacy students across several countries. The findings could guide interventions and support activities to improve resilience and academic outcomes.


Assuntos
Resiliência Psicológica , Estudantes de Farmácia , Humanos , Estudantes de Farmácia/psicologia , Estudantes de Farmácia/estatística & dados numéricos , Masculino , Feminino , Estudos Transversais , Adulto Jovem , Inquéritos e Questionários , Adulto , Nigéria , Paquistão , Sucesso Acadêmico , Educação em Farmácia/estatística & dados numéricos , Egito , Indonésia , Bangladesh , Jordânia , Arábia Saudita , Malásia , Iraque , Sudão
3.
Am J Pharm Educ ; 88(5): 100698, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38588974

RESUMO

OBJECTIVE: One of the barriers that might prevent an underrepresented minority (URM) individual from pursuing a professional career in the United States is finances. The high disproportionate burden of student debt among URM students further perpetuates the racial wealth gap. Therefore, this study sought to evaluate the extent to which URM students' personal finance perceptions, and current and projected student loan indebtedness affect postgraduation career intentions. METHODS: A cross-sectional analysis was conducted using data from four cohorts of pharmacy students using a survey from November 2, 2022, to February 1, 2023. The financial perception survey included subscales namely personal finance self-efficacy, debt influence and pressure, and risk mitigation and retirement. Descriptive statistics, simple logistic regression, and multivariate logistic regression analyses were conducted. RESULTS: In total, 93 students completed the survey and had a mean age of 28.1 ± 5.3 years. Seventy-one percent of the respondents were female, and 67.7 % had completed a 4-year bachelor's degree. There was a significant association between age and the intention to pursue postgraduate training as well as a significant association between risk mitigation and retirement perceptions and intention to pursue postgraduate training after adjusting for other factors. CONCLUSION: Among students from largely minority backgrounds, age, and confidence in their ability to make wise investment decisions for retirement are associated with a greater likelihood of pursuing postgraduate training opportunities.


Assuntos
Escolha da Profissão , Grupos Minoritários , Faculdades de Farmácia , Estudantes de Farmácia , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Estudos Transversais , Educação em Farmácia/economia , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Faculdades de Farmácia/economia , Estudantes de Farmácia/psicologia , Inquéritos e Questionários , Estados Unidos , Universidades
4.
Heart Lung ; 66: 94-102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38598979

RESUMO

BACKGROUND: Iron Deficiency (ID) is common in Heart Failure (HF) and associated with poor outcomes. Replacement with intravenous (IV) iron can improve functional status, quality of life and risk of unplanned admission. In 2015/16 a local service evaluation was performed which found that of people admitted with HF, only 27.5 % had assessment of iron status, and when identified, replacement occurred in fewer than half. Education strategies were employed to increase awareness of the importance of assessment and correction. OBJECTIVES: To assess if practice had improved following education strategies. METHODS: A review of 220 patient records for people admitted with HF in 2020/21 to establish if iron status assessed, presence of ID, and whether if ID identified it was treated, and by which route. Trends in 2020/21 data were explored in sub-groups by age, sex, type of HF, anaemia status, input from HF specialists and type of ID. RESULTS: Compared to 2015/16, more assessments of iron status were performed (45% vs 27.5 %), ID was corrected more frequently (57% vs 46 %) and increased use of the IV route for replacement (83% vs 58 %) CONCLUSIONS: Despite the impact of COVID-19 on usual care in 2020/21, improvement was seen in proportion of assessment and treatment of ID following simple education strategies for key stakeholders. There may be scope to improve practice further if the findings remain similar post pandemic. If so, a formal Quality Improvement approach may be helpful.


Assuntos
Anemia Ferropriva , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Masculino , Feminino , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/terapia , Reino Unido/epidemiologia , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Qualidade de Vida , Ferro/administração & dosagem , COVID-19/epidemiologia , COVID-19/complicações
5.
Appetite ; 198: 107339, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38604381

RESUMO

Studies to date have predominantly focused on countries' socioeconomic conditions (e.g., income inequality) to explain cross-national differences in socioeconomic inequalities in adolescent health (behaviours). However, the potential explanatory role of sociocultural contexts at country-level remains underexamined. This study examined whether the country-level sociocultural context and changes thereof were associated with adolescent socioeconomic inequalities in dietary behaviours. International comparative data of 344,352 adolescents living in 21 countries participating in 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey were combined with aggregated levels of openness-to-change from the European Social Survey (ESS). Four dietary behaviours (i.e., fruit, vegetable, sweets and soft drink consumption) and two measures of socioeconomic status (SES) on the individual level (i.e., family affluence scale [FAS] and occupational social class [OSC]) were studied. Multilevel logistic regression analyses returned contrasting results for the two SES measures used. In countries with higher levels of openness-to-change, smaller FAS inequalities in daily fruit, sweets and soft drink consumption were observed, but no such inequalities were found for vegetable consumption. Conversely, in these countries, larger OSC inequalities in soft drink consumption were found. Country-specific changes in openness-to-change over time were not associated with the magnitude of adolescent dietary inequalities. Findings underscore the importance of including country-level sociocultural contexts to improve the understanding of cross-national differences in socioeconomic inequalities in adolescents' diets. Future studies, spanning a longer timeframe, are required to examine whether such associations exist within countries over time since our timeframe might have been too small to capture these long-term trends.


Assuntos
Comportamento do Adolescente , Dieta , Comportamento Alimentar , Análise Multinível , Fatores Socioeconômicos , Humanos , Adolescente , Europa (Continente) , Feminino , Masculino , Comportamento do Adolescente/psicologia , Dieta/estatística & dados numéricos , Comportamento Alimentar/psicologia , Comportamentos Relacionados com a Saúde , Criança , Classe Social , Verduras , Frutas
6.
Appetite ; 198: 107350, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38609012

RESUMO

Consumers with low socioeconomic status (SES) eat less healthy and sustainable diets than consumers with higher status. This is attributed, at least in part, to inequalities in health communication. An online survey with 134 socioeconomically disadvantaged consumers in Italy was conducted to test the effectiveness of tailor-made communication material (infographics) about healthy and sustainable eating (HSE). Participants were recruited at two social supermarkets by a social service organisation as well as via a crowdsourcing platform. Participants found information about HSE delivered through infographics moderately effective in increasing motivation, capability, and opportunity for HSE, and moderately useful and likely to impact their behaviour. Certain messages were more effective than others for native consumers, while migrants showed more indifferent responses to the various messages and manifested lower motivation to shift towards HSE, limited access to and seeking of nutrition-related information, and lower trust in information sources. Selecting which messages to deliver strategically, while also considering differences between segments of the target audience and their preferred sources and channels for communication, is promising; yet, structural changes related to food's affordability and availability are also needed to facilitate an effective communication.


Assuntos
Dieta Saudável , Classe Social , Humanos , Feminino , Masculino , Adulto , Dieta Saudável/psicologia , Dieta Saudável/métodos , Itália , Pessoa de Meia-Idade , Adulto Jovem , Motivação , Comunicação em Saúde/métodos , Comportamento do Consumidor , Inquéritos e Questionários , Fatores Socioeconômicos , Adolescente , Conhecimentos, Atitudes e Prática em Saúde
7.
Head Neck ; 46(6): 1263-1269, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38622958

RESUMO

INTRODUCTION: India contributes two-thirds of the global mortality due to oral cancer and has a younger population at risk. The societal costs of this premature mortality are barely discussed. METHODS: Using the human capital approach, we aimed to estimate the productivity lost due to premature mortality, valued using individual socioeconomic data, related to oral cancer in India. A bottom-up approach was used to prospectively collect data of 100 consecutive patients with oral cancer treated between 2019 and 2020, with a follow-up of 36 months. RESULTS: The disease-specific survival for early and advanced stage was 85% and 70%, with a median age of 47 years. With 671 years lost prematurely, the loss of productivity was $41 900/early and $96 044/advanced stage. Based on population level rates, the total cost of premature mortality was $5.6 billion, representing 0.18% of GDP. CONCLUSION: India needs to implement tailored strategies to reduce the economic burden from premature mortality.


Assuntos
Eficiência , Mortalidade Prematura , Neoplasias Bucais , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Prospectivos , Neoplasias Bucais/mortalidade , Neoplasias Bucais/economia , Adulto , Efeitos Psicossociais da Doença , Idoso
8.
Ann Hematol ; 103(6): 2133-2144, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38634917

RESUMO

BACKGROUND: Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). AIM: The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies. METHODS: An open-label, randomized, controlled clinical trial recruited warfarin-receiving patients in pharmacogenetically(PGT) guided- versus standard of care(SOC)- study arms. Pharmacogenetic analysis of CYP2C9*2(rs1799853), CYP2C9*3(rs1057910) and VKORC1(rs9923231) was performed for patients recruited to the PGT-guided arm. PT(Prothrombin Time)-INR(international normalized ratio) testing and dose titrations were allowed as per routine clinical practice. The primary endpoint was the percent time spent in the therapeutic INR range(TTR) during the 90-day observation period. Secondary endpoints were time to reach therapeutic INR(TRT), the proportion of adverse events, and economic comparison between two modes of therapy in a Markov model built for the commonest warfarin indication- atrial fibrillation. RESULTS: The study enrolled 168 patients, 84 in each arm. Per-protocol analysis showed a significantly high median time spent in therapeutic INR in the genotype-guided arm(42.85%; CI 21.4-66.75) as compared to the SOC arm(8.8%; CI 0-27.2)(p < 0.00001). The TRT was less in the PG-guided warfarin dosing group than the standard-of-care dosing warfarin group (17.85 vs. 33.92 days) (p = 0.002). Bleeding and thromboembolic events were similar in the two study groups. Lifetime expenditure was ₹1,26,830 in the PGT arm compared to ₹1,17,907 in the SOC arm. The QALY gain did not differ in the two groups(3.9 vs. 3.65). Compared to SOC, the incremental cost-utility ratio was ₹35,962 per QALY gain with PGT test opting. In deterministic and probabilistic sensitivity analysis, the base case results were found to be insensitive to the variation in model parameters. In the cost-effectiveness-acceptability curve analysis, a 90% probability of cost-effectiveness was reached at a willingness-to-pay(WTP) of ₹ 71,630 well below one time GDP threshold of WTP used. CONCLUSION: Clinical efficacy and the cost-effectiveness of the warfarin pharmacogenetic test suggest its routine use as a point of care investigation for patient care in LMICs.


Assuntos
Anticoagulantes , Citocromo P-450 CYP2C9 , Farmacoeconomia , Coeficiente Internacional Normatizado , Vitamina K Epóxido Redutases , Varfarina , Humanos , Varfarina/economia , Varfarina/administração & dosagem , Varfarina/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Citocromo P-450 CYP2C9/genética , Idoso , Vitamina K Epóxido Redutases/genética , Anticoagulantes/administração & dosagem , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Testes Farmacogenômicos/economia , Adulto , Farmacogenética/economia , Análise Custo-Benefício
9.
J Am Heart Assoc ; 13(9): e032837, 2024 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-38639355

RESUMO

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.


Assuntos
Equidade de Gênero , Cardiopatias Congênitas , Médicas , Humanos , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Feminino , Médicas/estatística & dados numéricos , Médicas/tendências , Masculino , Liderança , Cardiologia/tendências , Pediatria/tendências , Salários e Benefícios , Sexismo/tendências , Fatores Sexuais , Cardiologistas/tendências
10.
Support Care Cancer ; 32(5): 302, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38647710

RESUMO

PURPOSE: This cross-sectional study explored the associations between intrapersonal and interpersonal emotional competence (EC) and the unmet supportive care needs (SCN), anxiety, and depression of informal caregivers at the beginning of gastrointestinal or haematological cancer care, i.e. during chemotherapy and within 6 months after diagnosis. METHODS: The participants completed a self-reported questionnaire, comprising the Short Profile of Emotional Competence (S-PEC), the SCN survey for partners and caregivers (SCNS-P&C), and the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression models were performed to explore the influence of EC on unmet SCN and the presence of moderate/severe anxiety or depression. RESULTS: Most of the 203 caregivers were women (n = 141, 69.80%) and the partners of patients (n = 148, 73.27%) suffering from gastrointestinal (n = 112, 55.17%) and haematological (n = 91, 44.83%) cancer. Only intrapersonal EC showed a significant influence out of all the dimensions of unmet SCN related to healthcare services and information (odds ratio (OR) = 0.35 [95%CI 0.19; 0.65]), emotional and psychological needs (OR = 0.43 [95%CI 0.25; 0.74]), work and social security (OR = 0.57 [95%CI 0.37; 0.88]), and communication and family support (OR = 0.61 [95%CI 0.39; 0.95]). A one-unit increase in the intrapersonal EC score significantly reduced the probability of anxiety (OR = 0.42, [95%CI 0.26; 0.68]) and depression (OR = 0.34, [95%CI 0.21; 0.55]). CONCLUSION: Intrapersonal EC of caregivers is crucial to reduce the risk of unmet SCN, anxiety, and depression from the beginning of care. Identifying caregivers with lower intrapersonal EC may be necessary to increase vigilance from healthcare professionals and psychologists.


Assuntos
Ansiedade , Cuidadores , Depressão , Emoções , Apoio Social , Humanos , Cuidadores/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Ansiedade/etiologia , Depressão/etiologia , Depressão/epidemiologia , Idoso , Inquéritos e Questionários , Adulto , Modelos Logísticos , Neoplasias Gastrointestinais/psicologia , Neoplasias Hematológicas/terapia , Neoplasias Hematológicas/psicologia , Neoplasias/psicologia , Necessidades e Demandas de Serviços de Saúde , Análise Multivariada
11.
Front Public Health ; 12: 1354071, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38660354

RESUMO

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.


Assuntos
Saúde Ambiental , Humanos , China , Idoso , Saúde Ambiental/estatística & dados numéricos , Feminino , Masculino , Migrantes/estatística & dados numéricos , Pessoa de Meia-Idade
12.
Sci Rep ; 14(1): 9515, 2024 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664464

RESUMO

Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the CHA 2 DS 2 -VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.


Assuntos
Átrios do Coração , Hemodinâmica , Hidrodinâmica , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/fisiopatologia , Feminino , Masculino , Átrios do Coração/fisiopatologia , Átrios do Coração/diagnóstico por imagem , Pessoa de Meia-Idade , Medição de Risco/métodos , Idoso , Simulação por Computador , Modelos Cardiovasculares , Imagem Cinética por Ressonância Magnética/métodos
13.
J Geriatr Oncol ; 15(4): 101751, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38569461

RESUMO

INTRODUCTION: Frailty, a state of increased vulnerability to stressors due to aging or treatment-related accelerated aging, is associated with declines in physical, cognitive and/or social functioning, and quality of life for cancer survivors. For survivors aged <65 years, little is known about frailty status and associated impairments to inform intervention. We aimed to evaluate the prevalence of frailty and contributing geriatric assessment (GA)-identified impairments in adults aged <65 versus ≥65 years with cancer. MATERIALS AND METHODS: This study is a secondary analysis of clinical trial data (NCT04852575). Participants were starting a new line of systemic therapy at a community-based oncology private practice. Before starting treatment, participants completed an online patient-reported GA and the Physical Activity (PA) Vital Sign questionnaire. Frailty score and category were derived from GA using a validated deficit accumulation model: frail (>0.35), pre-frail (0.2-0.35), or robust (0-0.2). PA mins/week were calculated, and participants were coded as either meeting/not-meeting guidelines (≥90 min/week). We used Spearman (ρ) correlation to examine the association between age and frailty score and chi-squared/Fisher's-exact or ANOVA/Kruskal-Wallis statistic to compare frailty and PA outcomes between age groups. RESULTS: Participants (n = 96) were predominantly female (62%), Caucasian (68%), beginning first-line systemic therapy (69%), and 1.75 months post-diagnosis (median). Most had stage III to IV disease (66%). Common cancer types included breast (34%), gastrointestinal (23%), and hematologic (15%). Among participants <65, 46.8% were frail or pre-frail compared to 38.7% of those ≥65. There was no association between age and frailty score (ρ = 0.01, p = 0.91). Between age groups, there was no significant difference in frailty score (p = 0.95), the prevalence of frailty (p = 0.68), number of GA impairments (p = 0.33), or the proportion meeting PA guidelines (p = 0.72). However, older adults had more comorbid conditions (p = 0.03) and younger adults had non-significant but clinically relevant differences in functional ability, falls, and PA level. DISCUSSION: In our cohort, the prevalence of frailty was similar among adults with cancer <65 when compared to those older than 65, however, types of GA impairments differed. These results suggest GA and the associated frailty index could be useful to identify needs for intervention and inform clinical decisions during cancer treatment regardless of age. Additional research is needed to confirm our findings.


Assuntos
Fragilidade , Avaliação Geriátrica , Neoplasias , Humanos , Feminino , Masculino , Fragilidade/epidemiologia , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/terapia , Idoso , Adulto , Exercício Físico , Sobreviventes de Câncer/estatística & dados numéricos , Qualidade de Vida
14.
Drug Alcohol Depend ; 258: 111282, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38593731

RESUMO

The adulteration of illicit fentanyl with the alpha-2 agonist xylazine has been designated an emerging public health threat. The clinical rationale for combining fentanyl with xylazine is currently unclear, and the inability to study fentanyl/xylazine interactions in humans warrants the need for preclinical research. We studied fentanyl and xylazine pharmacodynamic and pharmacokinetic interactions in male and female rats using drug self-administration behavioral economic methods. Fentanyl, but not xylazine, functioned as a reinforcer under both fixed-ratio and progressive-ratio drug self-administration procedures. Xylazine combined with fentanyl at three fixed dose-proportion mixtures did not significantly alter fentanyl reinforcement as measured using behavioral economic analyses. Xylazine produced a proportion-dependent decrease in the behavioral economic Q0 endpoint compared to fentanyl alone. However, xylazine did not significantly alter fentanyl self-administration at FR1. Fentanyl and xylazine co-administration did not result in changes to pharmacokinetic endpoints. The present results demonstrate that xylazine does not enhance the addictive effects of fentanyl or alter fentanyl plasma concentrations. The premise for why illicitly manufacture fentanyl has been adulterated with xylazine remains to be determined.


Assuntos
Fentanila , Reforço Psicológico , Autoadministração , Xilazina , Fentanila/farmacologia , Animais , Xilazina/farmacologia , Ratos , Masculino , Feminino , Economia Comportamental , Ratos Sprague-Dawley , Esquema de Reforço , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Analgésicos Opioides , Condicionamento Operante/efeitos dos fármacos
15.
Am J Ind Med ; 67(6): 539-550, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38606790

RESUMO

OBJECTIVE: To assess workplace segregation in fatal occupational injury from 1992 to 2017 in North Carolina. METHODS: We calculated occupational fatal injury rates within categories of occupation, industry, race, age, and sex; and estimated expected numbers of fatalities among Black and Hispanic male workers had they experienced the rates of White male workers. We also estimated the contribution of workforce segregation to disparities by estimating the expected number of fatalities among Black and Hispanic male workers had they experienced the industry and occupation patterns of White male workers. We assessed person-years of life-lost, using North Carolina life expectancy estimates. RESULTS: Hispanic workers contributed 32% of their worker-years and experienced 58% of their fatalities in construction. Black workers were most overrepresented in the food manufacturing industry. Hispanic males experienced 2.11 (95% CI: 1.86-2.40) times the mortality rate of White males. The Black-White and Hispanic-White disparities were widest among workers aged 45 and older, and segregation into more dangerous industries and occupations played a substantial role in driving disparities. Hispanic workers who suffered occupational fatalities lost a median 47 life-years, compared to 37 among Black workers and 36 among White workers. CONCLUSIONS: If Hispanic and Black workers experienced the workplace safety of their White counterparts, fatal injury rates would be substantially reduced. Workforce segregation reflects structural racism, which also contributes to mortality disparities. Root causes must be addressed to eliminate disparities.


Assuntos
Negro ou Afro-Americano , Hispânico ou Latino , Traumatismos Ocupacionais , População Branca , Humanos , North Carolina/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto , Traumatismos Ocupacionais/mortalidade , Hispânico ou Latino/estatística & dados numéricos , População Branca/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Feminino , Segregação Social , Adulto Jovem , Ocupações/estatística & dados numéricos , Idoso , Acidentes de Trabalho/mortalidade , Acidentes de Trabalho/estatística & dados numéricos , Indústrias/estatística & dados numéricos
16.
Drug Alcohol Depend ; 258: 111279, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38614020

RESUMO

BACKGROUND: Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS: 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS: All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS: Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.


Assuntos
Estudos Cross-Over , Sistemas Eletrônicos de Liberação de Nicotina , Aromatizantes , Mentol , Humanos , Masculino , Feminino , Adulto , Estados Unidos , Adulto Jovem , Produtos do Tabaco , Fumar Cigarros/epidemiologia , Pessoa de Meia-Idade
17.
Front Public Health ; 12: 1333081, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38566790

RESUMO

Introduction: Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Objective: Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. Methods: A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. Results: It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Conclusion: Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.


Assuntos
COVID-19 , Hipertensão , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , COVID-19/epidemiologia , Estudos Transversais , Atenção à Saúde , Hipertensão/epidemiologia , Estudos Retrospectivos , Adulto , Idoso de 80 Anos ou mais , Feminino
18.
Child Abuse Negl ; 152: 106757, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38574600

RESUMO

BACKGROUND: Despite acknowledging the detrimental impact of child sexual abuse material (CSAM) exposure on the mental and physical well-being of investigators and forensic examiners, there is a need for comprehensive exploration into the complex relationship between CSAM exposure, its various dimensions, mental health (i.e., anxiety, depression, and PTSD), and burnout, as well as the presence of positive attitudes towards the job. OBJECTIVE: To understand how CSAM exposure, mental health and burnout interconnect and cluster within distinct networks of police investigators and forensic examiners. PARTICIPANTS AND SETTING: Police investigators and forensic examiners from across the United States who were exposed to CSAM as part of their professions (N = 470). METHODS: Participants, recruited through connections with the National Criminal Justice Training Center, completed an anonymous online survey. RESULTS: The network analysis revealed differences in centrality between investigators and forensic examiners, particularly in their associations with exposure factors and mental health variables. Edges invariance tests showed differences in the strength of these associations, with some factors being more strongly linked to PTSD avoidance symptoms among investigators and others among forensic examiners. Stability analyses suggested potentially greater heterogeneity among investigators, while both groups displayed high stability in other centrality indices. CONCLUSIONS: This study contributes to our comprehension of the distinct experiences and challenges faced by CSAM investigators and forensic examiners, and specifically the nuanced disparities between CSAM investigators and forensic examiners in terms of their exposure to CSAM content and the associated mental health factors. These insights highlight the imperative need for tailored support mechanisms and interventions that can effectively address the unique challenges encountered by individuals working tirelessly in this critical field.


Assuntos
Abuso Sexual na Infância , Humanos , Abuso Sexual na Infância/psicologia , Abuso Sexual na Infância/estatística & dados numéricos , Feminino , Masculino , Adulto , Criança , Estados Unidos/epidemiologia , Esgotamento Profissional/psicologia , Esgotamento Profissional/epidemiologia , Polícia/psicologia , Saúde Mental , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Inquéritos e Questionários
19.
Physiol Meas ; 45(5)2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38604189

RESUMO

Objective. Bioimpedance spectroscopy (BIS) is a popular technique for the assessment of body composition in children and adults but has not found extensive use in babies and infants. This due primarily to technical difficulties of measurement in these groups. Although improvements in data modelling have, in part, mitigated this issue, the problem continues to yield unacceptably high rates of poor quality data. This study investigated an alternative data modelling procedure obviating issues associated with BIS measurements in babies and infants.Approach.BIS data are conventionally analysed according to the Cole model describing the impedance response of body tissues to an appliedACcurrent. This approach is susceptible to errors due to capacitive leakage errors of measurement at high frequency. The alternative is to model BIS data based on the resistance-frequency spectrum rather than the reactance-resistance Cole model thereby avoiding capacitive error impacts upon reactance measurements.Main results.The resistance-frequency approach allowed analysis of 100% of data files obtained from BIS measurements in 72 babies compared to 87% successful analyses with the Cole model. Resistance-frequency modelling error (percentage standard error of the estimate) was half that of the Cole method. Estimated resistances at zero and infinite frequency were used to predict body composition. Resistance-based prediction of fat-free mass (FFM) exhibited a 30% improvement in the two-standard deviation limits of agreement with reference FFM measured by air displacement plethysmography when compared to Cole model-based predictions.Significance.This study has demonstrated improvement in the analysis of BIS data based on the resistance frequency response rather than conventional Cole modelling. This approach is recommended for use where BIS data are compromised by high frequency capacitive leakage errors such as those obtained in babies and infants.


Assuntos
Composição Corporal , Espectroscopia Dielétrica , Impedância Elétrica , Humanos , Lactente , Espectroscopia Dielétrica/métodos , Recém-Nascido , Masculino , Feminino
20.
J Affect Disord ; 356: 707-714, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38608771

RESUMO

OBJECTIVE: To examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity. METHODS: A cross-sectional study was conducted using the 2020-2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18-34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants. RESULTS: Young or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only). LIMITATIONS: The cross-sectional design prevents inference of causality. CONCLUSIONS: Comprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.


Assuntos
Ansiedade , COVID-19 , Depressão , Insegurança Alimentar , Saúde Mental , Humanos , Feminino , COVID-19/epidemiologia , Masculino , Adulto , Estudos Transversais , Estados Unidos/epidemiologia , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Saúde Mental/estatística & dados numéricos , Depressão/epidemiologia , Ansiedade/epidemiologia , Inquéritos Epidemiológicos , Pobreza/estatística & dados numéricos , SARS-CoV-2 , Fatores Socioeconômicos , Assistência Alimentar/estatística & dados numéricos
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