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1.
MMWR Morb Mortal Wkly Rep ; 69(27): 864-869, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32644981

RESUMO

As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,† such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.


Assuntos
Doença Crônica/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Grupos Étnicos/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston/epidemiologia , Infecções por Coronavirus/etnologia , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Provedores de Redes de Segurança , Adulto Jovem
2.
J Korean Med Sci ; 35(26): e243, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32627443

RESUMO

BACKGROUND: Mortality of coronavirus disease 2019 (COVID-19) is a major concern for quarantine departments in all countries. This is because the mortality of infectious diseases determines the basic policy stance of measures to prevent infectious diseases. Early screening of high-risk groups and taking action are the basics of disease management. This study examined the correlation of comorbidities on the mortality of patients with COVID-19. METHODS: We constructed epidemiologic characteristics and medical history database based on the Korean National Health Insurance Service Big Data and linked COVID-19 registry data of Korea Centers for Disease Control & Prevention (KCDC) for this emergent observational cohort study. A total of 9,148 patients with confirmed COVID-19 were included. Mortalities by sex, age, district, income level and all range of comorbidities classified by International Classification of Diseases-10 based 298 categories were estimated. RESULTS: There were 3,556 male confirmed cases, 67 deaths, and crude death rate (CDR) of 1.88%. There were 5,592 females, 63 deaths, and CDR of 1.13%. The most confirmed cases were 1,352 patients between the ages of 20 to 24, followed by 25 to 29. As a result of multivariate logistic regression analysis that adjusted epidemiologic factors to view the risk of death, the odds ratio of death would be hemorrhagic conditions and other diseases of blood and blood-forming organs 3.88-fold (95% confidence interval [CI], 1.52-9.88), heart failure 3.17-fold (95% CI, 1.88-5.34), renal failure 3.07-fold (95% CI, 1.43-6.61), prostate malignant neoplasm 2.88-fold (95% CI, 1.01-8.22), acute myocardial infarction 2.38-fold (95% CI, 1.03-5.49), diabetes was 1.82-fold (95% CI, 1.25-2.67), and other ischemic heart disease 1.71-fold (95% CI, 1.09-2.66). CONCLUSION: We hope that this study could provide information on high risk groups for preemptive interventions. In the future, if a vaccine for COVID-19 is developed, it is expected that this study will be the basic data for recommending immunization by selecting those with chronic disease that had high risk of death, as recommended target diseases for vaccination.


Assuntos
Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Adulto , Idoso , Betacoronavirus , Big Data , Doença Crônica/epidemiologia , Doença Crônica/mortalidade , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Pandemias , Pneumonia Viral/terapia , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
3.
Health Rep ; 31(5): 3-8, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32644765

RESUMO

BACKGROUND: The risk of experiencing adverse outcomes from the coronavirus disease 2019 (COVID-19), such as hospitalization, admission to intensive care units and death, is elevated for older individuals and those with certain underlying health conditions including diabetes, chronic conditions affecting lungs, heart or kidneys, and a compromised immune system. DATA AND METHODS: Data collected between March 29 and April 3, 2020 from the Canadian Perspectives Survey Series 1: Impacts of COVID-19 (n=4,627) were used to estimate the prevalence of underlying health conditions, health concerns and precautionary behaviours among Canadians aged 15 or older living in the provinces. Multivariate analyses examined associations between these variables after accounting for age, sex and education. RESULTS: Close to 1 in 4 Canadians (24%) had an underlying health condition that increased their risk of adverse outcomes from COVID-19. Overall, 36% of the population were very or extremely concerned about the impact of COVID-19 on their own health. Individuals with underlying health conditions had higher odds (odds ratio: 2.0, 95% confidence interval: 1.6 to 2.5) of being highly concerned than those without these conditions, after adjustment for demographic characteristics. High percentages of Canadians took precautions to reduce the risk of infection regardless of whether or not they had underlying health conditions. DISCUSSION: Health status was associated with higher levels of concern for one's own health in the early period of the COVID-19 pandemic. Most Canadians were taking precautions recommended by public health authorities to protect themselves and others.


Assuntos
Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização , Pandemias , Pneumonia Viral , Medicina Preventiva , Adolescente , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Canadá/epidemiologia , Criança , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde Pública
4.
Medicine (Baltimore) ; 99(28): e20884, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664080

RESUMO

The objective of this work is to verify the relationship between the self-perception of health and the self-concept of physical appearance in adolescents, in order to check their influence on the physical activity they perform with the aim of preventing chronic illnesses. To this end, an observational, cross-sectional descriptive study with analytical components was carried out. Opportunistic activity, in which young people, between the ages of 16 and 22, were recruited from 5 secondary schools of the municipality of San Cristóbal de La Laguna, on the island of Tenerife (Spain). Data were collected through the General Health Questionnaire, the Rosemberg Self-esteem Scale, and the physical exercise habits test physical activity questionnaire for adolescents-A, revealing the first 2 that most percentage of responses were grouped on the positive side. The physical exercise habits test physical activity questionnaire for adolescents-A described that the most commonly performed physical activity was walking (75%).


Assuntos
Doença Crônica/prevenção & controle , Exercício Físico/psicologia , Aparência Física/fisiologia , Adolescente , Atitude Frente a Saúde , Doença Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Autoimagem , Espanha/epidemiologia , Inquéritos e Questionários , Caminhada/fisiologia , Caminhada/estatística & dados numéricos , Adulto Jovem
5.
Einstein (Sao Paulo) ; 18: eAO5175, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667419

RESUMO

Objective To evaluate the positivity of challenge tests of patients suspected of chronic inducible urticaria and the response to treatment. Methods A retrospective study of electronic medical records of patients suspected of chronic inducible urticaria. All patients were submitted to challenge tests with triggering stimuli, according to the clinical history and, subsequently, the response to drug treatment was evaluated. Results A total of 191 patients with suspected chronic inducible urticaria were included. It was confirmed in 118 patients and 122 positive tests (4 patients with 2 different positive tests). Most had dermographic urticaria (70.3%), followed by cholinergic urticaria (17.8%). Regarding treatment, 28% responded to antihistamine in licensed doses, 34.7% with increased doses, 9.3% responded to the addition of another medication. The concomitance of chronic inducible urticaria and chronic spontaneous urticaria was found in 35.3% of patients, being more frequent in females, with longer time to control symptoms and higher frequency of cholinergic urticaria. Conclusion The confirmation of chronic inducible urticaria in patients with this suspicion, after challenge tests, was high. There was a good response to antihistamine. In the concomitance of chronic spontaneous urticaria, longer time to control symptoms and higher frequency of cholinergic urticaria were observed.


Assuntos
Urticária Crônica/diagnóstico , Urticária Crônica/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Doença Crônica , Feminino , Humanos , Estudos Retrospectivos
6.
Surg Clin North Am ; 100(4): 681-693, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681869

RESUMO

Chronic wounds present a unique therapeutic challenge to heal. Chronic wounds are colonized with bacteria and the presence of a biofilm that further inhibits the normal wound healing processes, and are locked into a very damaging proinflammatory response. The treatment of chronic wounds requires a coordinated approach, including debridement of devitalized tissue, minimizing bacteria and biofilm, control of inflammation, and the use of specialized dressings to address the specific aspects of the particular nonhealing ulcer.


Assuntos
Angiopatias Diabéticas/fisiopatologia , Úlcera Cutânea/fisiopatologia , Cicatrização/fisiologia , Anti-Infecciosos/uso terapêutico , Biofilmes/efeitos dos fármacos , Doença Crônica , Citocinas/fisiologia , Angiopatias Diabéticas/imunologia , Angiopatias Diabéticas/terapia , Farmacorresistência Bacteriana/fisiologia , Quimioterapia Combinada , Humanos , Imunidade Celular/fisiologia , Peptídeo Hidrolases/fisiologia , Úlcera Cutânea/imunologia , Úlcera Cutânea/terapia , Cicatrização/imunologia , Infecção dos Ferimentos/imunologia , Infecção dos Ferimentos/fisiopatologia , Infecção dos Ferimentos/terapia
7.
Surg Clin North Am ; 100(4): 695-705, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681870

RESUMO

Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems.


Assuntos
Falência Renal Crônica/fisiopatologia , Cicatrização/fisiologia , Ferimentos e Lesões/fisiopatologia , Fatores Etários , Antineoplásicos/efeitos adversos , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Doença Crônica , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/fisiopatologia , Humanos , Infecções/complicações , Infecções/fisiopatologia , Falência Renal Crônica/complicações , Transtornos Nutricionais/complicações , Transtornos Nutricionais/fisiopatologia , Lesões por Radiação/complicações , Lesões por Radiação/fisiopatologia , Pele/efeitos da radiação , Dermatopatias/complicações , Dermatopatias/fisiopatologia , Fumar/efeitos adversos , Fumar/fisiopatologia , Ferimentos e Lesões/complicações
8.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
9.
10.
Orv Hetil ; 161(28): 1175-1180, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32609625

RESUMO

INTRODUCTION: Due to sedentary lifestyle, not only the risk of many chronic diseases and multimorbidity increase, but older people also lose their functional independency earlier. The first step to design effective interventions aiming to decrease sedentary lifestyle is to explore the factors associated with sedentary lifestyle. AIM: Our aims were to describe the type and duration of sitting activities and to examine the factors associated with sedentary lifestyle, namely 1) sociodemographic factors (i.e., age, gender, education level, marital status); 2) medical factors (chronic diseases, use of walking aids); 3) lifestyle factors (i.e., duration of institutionalization, smoking status) among older people living in nursing homes providing long-term care. METHOD: Data collected with questionnaire from 248 participants were analysed using logistic regression. RESULTS: There were 159 participants (64.1%) in total who were characterized by sedentary lifestyle. In our sample, the sedentary lifestyle was associated with the smoking status, the number of age-related chronic diseases, the duration of institutionalization, and the use of walking aids. CONCLUSION: The older people who have more chronic diseases, who are smokers and were institutionalized earlier are more likely to be characterised by sedentary lifestyle. Therefore, decision-making graduate health-care professionals should preferably focus their efforts on these older people in order to change the sedentary lifestyle by providing information about risk of this lifestyle, and offering programs relevant to older people's interests and functional status. Orv Hetil. 2020; 161(26): 1175-1180.


Assuntos
Doença Crônica/epidemiologia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Comportamento Sedentário , Caminhada , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Hungria/epidemiologia , Estilo de Vida , Masculino , Estado Civil , Fumar , Classe Social , Inquéritos e Questionários
11.
J Ment Health Policy Econ ; 23(2): 55-60, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32621725

RESUMO

BACKGROUND: The approach to care for persons with an acute illness is different from that for a person with a chronic disease. Whilst the goal of treatment for an acute illness is to cure the disease, a chronic condition has no cure as such, and hence management requires a team approach that is aimed at achieving goals that are jointly set by service users and providers. Severe and persistent mental illness (SPMI) is a chronic disease. However, in many mental health services, the approach to care for persons with SPMI is similar to those who have an acute mental illness. AIM: The aims of this paper are twofold: (i) to make an argument for recovery oriented services to focus on meeting clients' needs rather than on symptom reduction, (ii) to propose a model of service provision where clinical mental health services form a part rather than the mainstay of care for people with SPMI. RESULTS: Using examples from Australia's Partner's in Recovery initiative and other recovery literature, we start by describing how SPMI should be treated as a chronic disease that focuses on recovery. We then highlight how mental health services continue to monitor outcomes based on clinical rather than personal recovery. Next, we diagrammatically illustrate how needs can be aligned with the recovery process and illustrate how care coordination can be the hub of service delivery in a hub and spoke model. We conclude with comments on workforce requirements and costs of a needs-based recovery oriented service. DISCUSSION: In a needs based model, the role of the specialist mental health service will move from being at the centre of care to being one of the components of care and the role of the care coordinator will become central. Although, there are as yet no randomised controlled trials to show that meeting needs of persons with SPMI will significantly contribute to their recovery, preliminary studies show that it is possible. IMPLICATIONS FOR HEALTHCARE PROVISION AND USE: The role of the care coordinator becomes the hub of service provision collaborating with agencies such as family practices, specialist mental health services, legal, housing, employment, education, and community services. IMPLICATIONS FOR HEALTH POLICIES: A shift from the current model of care to a needs based approach requires a revolutionary change in the way we do business and will have to be the largest shake up of the mental health service system since deinstitutionalisation. IMPLICATIONS FOR FURTHER RESEARCH: It is a long journey from the status quo to a needs based approach. The first step would be to gather more evidence on the usefulness of addressing people's needs in achieving recovery.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Equipe de Assistência ao Paciente , Austrália , Doença Crônica , Comportamento Cooperativo , Habitação , Humanos , Transtornos Mentais/psicologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-32609257

RESUMO

Age, sex and presence of comorbidities are risk factors associated with COVID-19. Hypertension, diabetes and heart disease are the most common comorbidities in patients with COVID-19. The objective of this study was to estimate the prevalence of patients with comorbidities who died of COVID-19 in Brazil. Searches of data were carried out on the official pages of the 26 State health departments and the federal district. The random-effect method was used to calculate the prevalence of patients with comorbidities who died. From the beginning of the pandemic in Brazil until May 20, 2020, 276,703 cases of COVID-19 were notified in Brazil, 6.4% died, 58.6% of whom were male. The prevalence of comorbidities among deaths was 83% (95% CI: 79 - 87), with heart disease and diabetes being the most prevalent. To our knowledge, this study represents the first large analysis of cases of patients with confirmed COVID-19 in Brazil. There is a high prevalence of comorbidities (83%) among patients who died from COVID-19 in Brazil, with heart disease being the most prevalent. This is important considering the possible secondary effects produced by drugs such as hydroxychloroquine.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Cardiopatias/mortalidade , Pandemias/estatística & dados numéricos , Pneumonia Viral/mortalidade , Brasil/epidemiologia , Doença Crônica , Comorbidade , Diabetes Mellitus/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Doenças do Sistema Imunitário/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Nefropatias/mortalidade , Pneumopatias/mortalidade , Masculino , Obesidade/mortalidade , Pneumonia/mortalidade , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Acidente Vascular Cerebral/mortalidade
13.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 44-57, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32621416

RESUMO

Recently, ferroptosis, an iron-dependent novel type of cell death, has been characterized as an excessive accumulation of lipid peroxides and reactive oxygen species. Emerging studies demonstrate that ferroptosis not only plays an important role in the pathogenesis and progression of chronic diseases, but also functions differently in the different disease context. Notably, it is shown that activation of ferroptosis could potently inhibit tumor growth and increase sensitivity to chemotherapy and immunotherapy in various cancer settings. As a result, the development of more efficacious ferroptosis agonists remains the mainstay of ferroptosis-targeting strategy for cancer therapeutics. By contrast, in non-cancerous chronic diseases, including cardiovascular & cerebrovascular diseases and neurodegenerative diseases, ferroptosis functions as a risk factor to promote these diseases progression through triggering or accelerating tissue injury. As a matter of fact, blocking ferroptosis has been demonstrated to effectively prevent ischemia-reperfusion heart disease in preclinical animal models. Therefore, it is a promising field to develope potent ferroptosis inhibitors for preventing and treating cardiovascular & cerebrovascular diseases and neurodegenerative diseases. In this article, we summarize the most recent progress on ferroptosis in chronic diseases, and draw attention to the possible clinical impact of this recently emerged ferroptosis modalities.


Assuntos
Doença Crônica , Ferroptose , Ferro , Animais , Ferroptose/fisiologia , Ferro/metabolismo , Espécies Reativas de Oxigênio
14.
Artigo em Russo | MEDLINE | ID: mdl-32621472

RESUMO

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disease of the central nervous system, mainly affecting the brain stem, cerebellum and spinal cord. The clinical picture includes gradually developing ataxia, double vision, dysarthria, pyramidal and cognitive impairment. Morphological examination reveals T-cell perivascular lymphocytic infiltration with CD4 lymphocytes predominance over CD8 lymphocytes. The cause of the disease is unknown. The article describes two patients (a 18-year-old woman and a 40-year-old man) with typical clinical and MRI manifestations of CLIPPERS, which was confirmed by brain biopsy in the female patient. The duration of follow-up was 3 and 7 years, respectively. Both patients survived an infection 2-3 weeks before the onset of disease that allows one to discuss its role in CLIPPERS pathogenesis. Both patients had a clear clinical and MRI responsiveness to steroids. In the female patient, steroids were replaced by intramuscular administration of the TNF-α blocker adalimumab. During 1,5 years of its use, there were no clinical relapses and pathological brain changes on MRI.


Assuntos
Inflamação , Ponte , Adolescente , Adulto , Encéfalo , Doença Crônica , Feminino , Humanos , Linfadenite , Imagem por Ressonância Magnética , Masculino , Esteroides
15.
BMC Public Health ; 20(1): 1037, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605552

RESUMO

BACKGROUND: Australia, like other nations, has experienced a shift in dietary patterns away from home cooking of nutritious foods, towards a reliance on pre-prepared convenience meals. These are typically energy-dense, nutrient-poor and contribute to the rising prevalence of obesity and chronic disease burden. The aims of this study were to evaluate whether a community-based cooking program instigated a change to participants' skills, attitudes, knowledge, enjoyment and satisfaction of cooking and cooking confidence (self-efficacy). METHODS: The pseudo-random, pre-post study design consisted of an intervention and a control group. Participant recruitment and group allocation was based on their program start dates. Intervention participants were surveyed three times (baseline, 7 weeks and 6 months) and the control group were surveyed at baseline and 5 weeks. All participants were registered via an online website and were 18 years or over. Upon consent, participants were offered four levels of commitment, defined by different assessments. The minimum participation level included an online survey and levels 2, 3 and 4 involved attendance at a clinic with increasing functional, anthropometric and biomarker measurements. Primary endpoints were participants' cooking confidence as a proxy for self-efficacy. Secondary endpoints were dietary intake, physical activity levels, body composition, anthropometry, blood, urine and faecal biomarkers of systemic, physical and mental health. DISCUSSION: The community cooking program provided participants with information and advice on food sourcing, preparation and nutrition to improve home cooking skills. The study was designed to explore whether food literacy programs are efficacious in improving participant physical health and well-being in order to combat the rise in obesity and diet-related disease. It will support future use of public health cooking program initiatives aimed at improving food literacy, self-efficacy and physical and mental health. The extensive data collected will inform future research into the relationship between diet, the gut-microbiota and human health. TRIAL REGISTRATION: Retrospectively registered on 16.08.2019 with the Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12619001144101 . Protocol version 4.


Assuntos
Culinária , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Autoeficácia , Adulto , Austrália , Biomarcadores , Doença Crônica , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/epidemiologia , Obesidade/prevenção & controle , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Inquéritos e Questionários , Austrália Ocidental/epidemiologia
16.
Rev Bras Epidemiol ; 23: e200077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32638852

RESUMO

OBJECTIVE: To estimate the prevalence of polypharmacy, describe the pharmacotherapeutic classes used, and investigate whether polypharmacy is associated with demographic and socioeconomic indicators, regardless of the number of diseases, among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). METHOD: In this analysis, 14,523 adults and elderly (35-74 years) participated. Polypharmacy was characterized as regular use of five or more medicines. The demographic and socioeconomic indicators analyzed were: gender, age, education level, per capita family income, and access to private health insurance. The independent association between demographic and economic indicators and polypharmacy was estimated by binary logistic regression. RESULTS: The prevalence of polypharmacy was 11.7%. The most used drugs were those with action on the cardiovascular system. After adjustments, including by number of diseases, the chances of being on polypharmacy treatment were significantly higher among women, older participants and those with greatest number of diseases. Individuals without health insurance had lower chance to be under polypharmacy, as well as those with lower income. CONCLUSION: The occurrence of polypharmacy among ELSA-Brasil baseline participants was mainly due to drugs for the treatment of chronic diseases. The relation between polypharmacy and the female gender, as well as its association with old age, are in consonance with the results obtained in other studies. Despite the absence of an association between polypharmacy and education level, the income and health insurance results reinforce the existence of social inequalities regarding drug use.


Assuntos
Doença Crônica/tratamento farmacológico , Doença Crônica/epidemiologia , Polimedicação , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
17.
Artigo em Russo | MEDLINE | ID: mdl-32678558

RESUMO

Chronic cerebral ischemia (CCI) is a common cerebrovascular syndrome, the development of which is associated with a high risk of increasing cognitive, behavioral, and motor disorders, and the formation of a patient's dependence on others. Timely start of treatment can slow down the course of the disease, make it more favorable. The review considers the possibility of using the domestic neuroprotector mexidol in patients with CCI. The results of a series of clinical studies on the use of ethylmethylhydroxypyridine succinate (mexidol) in patients with CCI are analyzed. The effectiveness of the drug in relieving cognitive, affective and motor disorders is noted. Information about the good tolerance of mexidol is presented.


Assuntos
Isquemia Encefálica , Antioxidantes , Doença Crônica , Humanos , Picolinas , Piridinas
18.
Health Rep ; 31(4): 22-27, 2020 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-32644764

RESUMO

BACKGROUND: While the physical health implications of the COVID-19 pandemic are regularly publicly available, the mental health toll on Canadians is unknown. This article examines the self-perceived mental health of Canadians during the COVID-19 pandemic and explores associations with various concerns after accounting for socioeconomic and health factors. DATA: The cross-sectional Canadian Perspectives Survey Series 1 collected information related to COVID-19 in late March and early April 2020 concerning labour market participation, behaviours, and health for the Canadian population 15 years and older living in the 10 provinces. METHODS: Socioeconomic and health characteristics of respondents as well as concerns about the impact of COVID-19 were examined to determine differences in experiencing excellent or very good compared to good, fair or poor perceived mental health. RESULTS: Just over half of Canadians aged 15 and older (54%) reported excellent or very good mental health during the COVID-19 pandemic. Several concerns were also associated with mental health. Notably, after considering the effects of socioeconomic and health characteristics, women, youth, individuals with a physical health condition and those who were very or extremely concerned with family stress from confinement were less likely to report excellent or very good mental health. DISCUSSION: These findings point to particular risks for lower perceived mental health during the COVID-19 pandemic. Results highlight various concerns of Canadians which may be associated with mental health, in particular, family stress in the home.


Assuntos
Doença Crônica/psicologia , Infecções por Coronavirus/epidemiologia , Nível de Saúde , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Betacoronavirus/isolamento & purificação , Canadá/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários
20.
Rev Bras Epidemiol ; 23: e200080, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32696928

RESUMO

OBJECTIVE: To evaluate non-adherence to pharmacotherapy for chronic diseases and to investigate the existence of socioeconomic inequalities related to this outcome in Brazil. METHODS: This was a cross-sectional study based on data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines (PNAUM). The study population corresponded to individuals aged 18 years or older with a medical diagnosis of at least one chronic disease and an indication for pharmacological treatment. The dependent variable was non-adherence to chronic disease pharmacotherapy measured by less than 80% adherence to drug therapy. Socioeconomic inequality related to non-adherence was assessed by absolute (SII) and relative (RII) inequality indices, calculated by logistic regression analyses. RESULTS: The prevalence of non-adherence to pharmacotherapy in Brazil was 20.2%, ranging from 17.0 to 27.8% between regions. Furthermore, this study revealed absolute and relative socioeconomic inequalities in non-adherence to pharmacotherapy of chronic diseases in Brazil (SII = -7.4; RII = 0.69) and the Northeast (SII = -14.0; RII = 0.59) and Center West (SII = -20.8; RII = 0.38) regions. The probability of non-adherence to pharmacotherapy in Brazil was higher among individuals with worse socioeconomic status. CONCLUSION: The findings of the present study indicate the need for the restructuring and strengthening of public policies aimed at reducing socioeconomic inequalities, in order to promote equity in adherence to the pharmacotherapy associated with chronic diseases.


Assuntos
Doença Crônica/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Humanos , Fatores Socioeconômicos
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