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1.
Enferm. actual Costa Rica (Online) ; (46): 53042, Jan.-Jun. 2024. graf
Artigo em Português | LILACS, BDENF, SaludCR | ID: biblio-1550250

RESUMO

Resumo Introdução: A violência contra idosos é um fenômeno crescente, ocasionando prejuízos à saúde, com diferentes desfechos e consequências às vítimas. A chance de idosas sofrerem-na no âmbito familiar supera a dos homens, sendo o gênero um fator de risco considerável. Objetivo: Analisar a compreensão da violência contra pessoas idosas segundo mulheres gerontes. Metodologia: Pesquisa descritiva com abordagem qualitativa desenvolvida com 22 idosas de uma comunidade no estado da Paraíba, Brasil, escolhidas por conveniência. Utilizou-se para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo. Resultados: Foram evidenciadas cinco classes: ciclo de violência; rede de apoio ao idoso vítima de violência; Vivência de situações violentas; violência financeira; e simbologia da violência na sociedade, as quais denotam compreensão da violência envolvendo os diferentes tipos. Apoiam-se nos fatores da vivência familiar, cultura e outros, consubstanciando o profissional de saúde como fundamental para o desfecho. O gênero influenciou no que concerne ao olhar lançado sobre a violência física e psicológica, bem como na relevância dada às equipes de saúde para identificação de ocorrências e prevenção de possíveis danos. Conclusão: Os diversos tipos de violência contra a pessoa idosa foram reconhecidos, incluindo fatores individuais, comunitários e sociais no ciclo violento. Além disso, associaram o envelhecimento a maior suscetibilidade para sofrer violência, independente da tipologia. Destaca-se a potencialidade do serviço de saúde na assistência à pessoa idosa vítima de violência, elucidando casos e atuando precocemente para interrupção dos ciclos perpetrados, exigindo a necessidade constante de atualização profissional para lidar com situações detectadas.


Resumen Introducción: La violencia contra las personas adultas mayores es un fenómeno creciente, que causa daños a la salud, con diferentes desenlaces y consecuencias para las víctimas. La posibilidad de que las mujeres adultas mayores la sufran en el ámbito familiar supera la de los hombres, siendo el género un factor de riesgo considerable. Objetivo: Analizar la comprensión de la violencia contra las personas mayores según las mujeres adultas mayores. Metodología: Investigación descriptiva con enfoque cualitativo desarrollada con 22 mujeres adultas mayores de una comunidad en el estado de Paraíba, Brasil, elegidas por conveniencia. Para la recolección de datos, se utilizaron entrevistas semiestructuradas, procesadas por el software Iramuteq, con posterior análisis de contenido. Resultados: Se evidenciaron cinco tipos de violencia: ciclo de la violencia, red de apoyo población adulta mayor víctima de violencia, experimentar situaciones violentas, violencia financiera y simbología de la violencia en la sociedad, que denotan la comprensión de la violencia de diferentes tipos. Estas ideas están respaldadas en los factores de la experiencia familiar, la cultura y otros, donde la persona profesional de la salud se identifica como fundamental para el cuidado y apoyo. El género influyó en la mirada lanzada sobre la violencia física y psicológica, así como en la relevancia dada a los equipos de salud para la identificación de sucesos y la prevención de posibles daños. Conclusión: Se han reconocido los diversos tipos de violencia contra las personas mayores, incluidos los factores individuales, comunitarios y sociales en el ciclo de violencia. Además, asociaron el envejecimiento con una mayor susceptibilidad a sufrir violencia, independientemente de la tipología. Destaca la potencialidad del servicio de salud en la asistencia a la persona mayor víctima de violencia, mediante la identificación de casos y la actuación temprana para la interrupción de los ciclos perpetrados. De manera que, se evidencia la necesidad constante de actualización profesional para hacer frente a situaciones detectadas.


Abstract Introduction: Violence against the elderly is a growing phenomenon, causing damage to health, with different outcomes and consequences to the victims. The possibility of elderly women suffering it in the family context surpasses that of men, with gender being a considerable risk factor. Objective: To analyze the understanding of violence against the elderly according to elderly women. Method: Descriptive research with a qualitative approach developed with 22 elderly women from a community in the state of Paraíba, Brazil, chosen for convenience. The data collection was based on semi-structured interviews, processed by the Iramuteq software, with subsequent Content Analysis. Results: Five classes of violence against the elderly were evidenced: cycle of violence; support network for the elderly victims of violence; experience of violent situations; financial violence; and symbolism of violence in society, which denote an understanding of violence involving the different types. They are based on the factors of family experience, culture, and others, placing the health professional as a fundamental element for care and support. Gender influenced the perspective on physical and psychological violence, as well as the relevance given to health teams for the identification of occurrences and the prevention of possible damage. Conclusion: The various types of violence against the elderly have been recognized, including individual, community, and social factors in the violent cycle. In addition, they associated aging with greater susceptibility to suffering violence, regardless of the typology. It highlights the potential of the health service in assisting the elderly victim of violence, elucidating cases, and acting early to interrupt the cycles perpetrated, requiring the constant need for professional updating to deal with detected situations.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Atenção à Saúde , Abuso de Idosos/estatística & dados numéricos , Brasil
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
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
13.
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
14.
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
15.
Behav Brain Res ; 467: 114996, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38609021

RESUMO

Motivational deficits and reduced goal-directed behavior for external rewards have long been considered an important features of negative symptoms in patients with schizophrenia (SCZ). Negative symptoms have also a high prevalence in bipolar disorder (BP). We used a transdiagnostic approach in order to examine association between negative symptoms and effort allocation for monetary rewards. 41 patients with SCZ and 34 patients with BP were enrolled in the study along with 41 healthy controls (HC). Effort-Expenditure for Rewards Task (EEfRT) was used to measure subjects' effort allocation for monetary rewards. Generalized estimating equation models were used to analyze EEfRT choice behavior. Negative symptoms were assessed using the Brief Negative Symptom Scale (BNSS). SCZ and BP groups expended lower effort to obtain a monetary rewards compared to HC. Severity of negative symptoms was negatively correlated with EEfRT performance in both diagnostic groups. Each diagnostic group showed lower effort allocation for monetary rewards compared to HC suggesting reduced motivation for monetary rewards. In addition, our results suggest that abnormal effort-based decision-making might be a transdiagnostic factor underlying negative symptoms.


Assuntos
Transtorno Bipolar , Tomada de Decisões , Motivação , Recompensa , Esquizofrenia , Psicologia do Esquizofrênico , Humanos , Transtorno Bipolar/fisiopatologia , Masculino , Feminino , Adulto , Tomada de Decisões/fisiologia , Esquizofrenia/fisiopatologia , Motivação/fisiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Adulto Jovem
16.
Int J Cardiol ; 406: 132040, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38614365

RESUMO

BACKGROUND: The mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. METHODS: An observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. RESULTS: Only 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). CONCLUSIONS: EMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.


Assuntos
Serviços Médicos de Emergência , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Masculino , Feminino , Serviços Médicos de Emergência/estatística & dados numéricos , China/epidemiologia , Pessoa de Meia-Idade , Idoso , Tempo para o Tratamento/tendências
17.
Turk J Ophthalmol ; 54(2): 76-82, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38645465

RESUMO

Objectives: This study aimed to investigate serum atherogenic indices as novel cardiovascular risk factors associated with retinal vein occlusion (RVO). Materials and Methods: This retrospective case-control study included 57 patients with newly diagnosed RVO whose plasma lipid profile (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglycerides [TG]) and insulin resistance were examined. Serum atherogenic indices (LDL-C/HDL-C, TC/HDL-C, TG/HDL-C, and non-HDL-C/HDL-C ratios) and presence of insulin resistance were compared between the patients and 63 healthy subjects. Cut-off values were determined by receiver operating characteristic curve analysis. Results: The mean age of the RVO patients was 63.7±9.4 years. Plasma levels of LDL-C, HDL-C, TC, and TG showed no significant difference between the patient and control groups (p>0.05). However, LDL-C/HDL-C, non-HDL-C/HDL-C, and TC/HDL-C ratios were higher in the RVO group compared to healthy subjects (p=0.015, p=0.036, and p=0.015, respectively). Fasting insulin concentrations, plasma insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were higher in the RVO patients compared to controls (p=0.003, p=0.001, and p=0.001, respectively). Conclusion: LDL-C/HDL-C, TC/HDL-C, and non-HDL-C/HDL-C ratios were found to be increased in RVO. Compared to the traditional plasma lipid profile, serum atherogenic indices were found to be superior predictors of RVO development. Measurement of HOMA-IR index should be taken into consideration in the evaluation of insulin resistance. High serum atherogenic indexes in RVO patients reveal the need to take precautions against the risk of cardiovascular disease and stroke.


Assuntos
Resistência à Insulina , Oclusão da Veia Retiniana , Humanos , Resistência à Insulina/fisiologia , Oclusão da Veia Retiniana/sangue , Oclusão da Veia Retiniana/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Estudos de Casos e Controles , Aterosclerose/sangue , Aterosclerose/diagnóstico , Fatores de Risco , Biomarcadores/sangue , Idoso , Curva ROC , Lipídeos/sangue , Triglicerídeos/sangue
18.
J Neurooncol ; 168(1): 35-45, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38561565

RESUMO

PURPOSE: Maximal cardiopulmonary exercise testing (max. CPET) provides the most accurate measurement of cardiorespiratory fitness. However, glioblastoma (GBM) patients often undergo less intensive tests, e.g., 6-min walk test or self-rating scales. This study aims to demonstrate feasibility and safety of max. CPET in GBM patients, concurrently evaluating their physical fitness status. METHODS: Newly diagnosed GBM patients undergoing adjuvant chemotherapy were offered participation in an exercise program. At baseline, max. CPET assessed cardiorespiratory fitness including peak oxygen consumption (VO2peak), peak workload, and physical work capacity (PWC) at 75% of age-adjusted maximal heart rate (HR). Criteria for peak workload were predefined based on threshold values in HR, respiratory quotient, respiratory equivalent, lactate, and rate of perceived effort. Data were compared to normative values. Adverse events were categorized according to standardized international criteria. Further, self-reported exercise data pre- and post-diagnosis were gathered. RESULTS: All 36 patients (median-aged 60; 21 men) met the predefined criteria for peak workload. Mean absolute VO2peak was 1750 ± 529 ml/min, peak workload averaged 130 ± 43 W, and mean PWC was 0.99 ± 0.38 W/kg BW, all clinically meaningful lower than age- and sex-predicted normative values (87%, 79%, 90%, resp.). Only once (3%) a minor, transient side effect occurred (post-test dizziness, no intervention needed). Self-reported exercise decreased from 15.8 MET-h/week pre-diagnosis to 7.2 MET-h/week post-diagnosis. CONCLUSION: Max. CPET in this well-defined population proved feasible and safe. GBM patients exhibit reduced cardiorespiratory fitness, indicating the need for tailored exercise to enhance health and quality of life. CPET could be essential in establishing precise exercise guidelines.


Assuntos
Neoplasias Encefálicas , Teste de Esforço , Estudos de Viabilidade , Glioblastoma , Aptidão Física , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Glioblastoma/tratamento farmacológico , Teste de Esforço/métodos , Neoplasias Encefálicas/tratamento farmacológico , Aptidão Física/fisiologia , Idoso , Consumo de Oxigênio/efeitos dos fármacos , Adulto , Aptidão Cardiorrespiratória/fisiologia
19.
Front Endocrinol (Lausanne) ; 15: 1365169, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38628588

RESUMO

Background: Impaired glucose utilization influences myocardial contractile function. However, the prognostic importance of left ventricular global radial strain (LV-GRS), left ventricular global circumferential strain (LV-GCS), and left ventricular global longitudinal strain (LV-GLS) in predicting new-onset heart failure (HF) in a population with diabetes is unclear. Methods: The study design is prospective cohort from the UK Biobank. Totally 37,899 participants had a complete data of cardiac magnetic resonance (CMR), of which 940 patients with diabetes were included, and all the participants completed follow-up. LV-GRS, LV-GCS, and LV-GLS were measured by completely automated CMR with tissue tagging. Cox proportional hazards regression analysis and C-index was performed to evaluate the association between the strain parameters and the new-onset HF in patients suffering from diabetes. Results: The average age of the 940 participants was 57.67 ± 6.97 years, with males comprising 66.4% of the overall population. With an average follow-up period of 166.82 ± 15.26 months, 35 (3.72%) patients reached the endpoint (emergence of new-onset HF). Significant associations were found for the three strain parameters and the new-onset HF (LV-GRS-hazard ratio [HR]: 0.946, 95% CI: 0.916-0.976; LV-GCS-HR: 1.162, 95% CI: 1.086-1.244; LV-GCS-HR: 1.181, 95% CI: 1.082-1.289). LV-GRS, LV-GCS, and LV-GLS were closely related to the related indicators to HF, and showed a high relationship to new-onset HF in individuals with diabetes at 5 and 10 years: LV-GRS: 0.75 (95% CI, 0.41-0.94) and 0.76 (95% CI, 0.44-0.98), respectively; LV-GCS: 0.80 (95% CI, 0.50-0.96) and 0.75 (95% CI, 0.41-0.98), respectively; LV-GLS: 0.72 (95% CI, 0.40-0.93) and 0.76 (95% CI, 0.48-0.97), respectively. In addition, age, sex, body mass index (BMI), and presence of hypertension or coronary artery disease (CAD) made no impacts on the association between the global strain parameters and the incidence of HF. Conclusion: LV-GRS, LV-GCS, and LV-GLS is significantly related to new-onset HF in patients with diabetes at 5 and 10 years.


Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Masculino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Função Ventricular Esquerda , Biobanco do Reino Unido , Bancos de Espécimes Biológicos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Diabetes Mellitus/epidemiologia
20.
PLoS One ; 19(4): e0297482, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38630834

RESUMO

BACKGROUND: Digital inequity refers to the inequality and exclusion experienced by those who lack the same opportunities or circumstances to support the development of digital skills as the rest of modern society. One rapidly growing and highly vulnerable group to digital inequity is older people attempting to reintegrate into society after release from prison, where technology access is limited. Inadequate support for digital skills in this population entails widespread consequences for public health, human rights, social welfare and recidivism. This qualitative study is the first to: examine digital inequity experienced by older people who have been incarcerated, understand the effects of this on reintegration to society, and begin informing appropriate solutions. METHOD: Semi-structured interviews were conducted with N = 15 older people (mean age = 57) who had been released from an Australian prison in the last two years, regarding their experiences of digital literacy since leaving prison. Reflexive thematic analysis was conducted under a critical realist lens. RESULTS: The analysis resulted in six themes that illustrated the extent of digital inequity experienced by this population, and key challenges for improving digital literacy: 'surviving in a digital world', 'stranger in a foreign world', 'questioning the digital divide', 'overcoming your "old" self', 'don't like what you don't know', and 'seeking versus finding help'. CONCLUSIONS: The digital inequity that older people experience during and after incarceration creates additional challenges for a growing group who are already medically and socially marginalised. Prioritisation of this group for digital literacy initiatives both during incarceration and in the community will have benefits for their health, social and financial reintegration. Their unique life experiences should be considered in designing and delivering these programs. Simultaneously, prisons should be cognizant of the potential detrimental effects of technology restriction on reintegration and criminogenic outcomes.


Assuntos
Exclusão Digital , Prisioneiros , Humanos , Idoso , Pessoa de Meia-Idade , Prisões , Alfabetização , Encarceramento , Austrália , Envelhecimento
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