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1.
Environ Health Perspect ; 128(1): 17001, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31939704

RESUMEN

BACKGROUND: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. OBJECTIVE: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. METHODS: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. RESULTS: We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7µg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. DISCUSSION: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495.

2.
Artículo en Inglés | MEDLINE | ID: mdl-31718046

RESUMEN

: Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. MATERIALS AND METHODS: We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. RESULTS: The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. DISCUSSION: Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.

3.
Gac. sanit. (Barc., Ed. impr.) ; 33(3): 263-267, mayo-jun. 2019. tab, mapas
Artículo en Inglés | IBECS | ID: ibc-183747

RESUMEN

Objective: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. Method: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. Results: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. Conclusions: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population


Objetivo: Hasta 2016, alrededor de 3 millones de personas tenían acceso limitado a la atención médica en Grecia debido a la crisis económica. Describimos un movimiento masivo de solidaridad de clínicas comunitarias y farmacias en Grecia. Métodos: Realizamos una encuesta en 2014-15 y describimos las características de las clínicas comunitarias y de las farmacias espontáneamente establecidas en toda Grecia después de 2008. Resultados: Una característica de las 92 clínicas solidarias activas es el funcionamiento colectivo autónomo, con servicios gratuitos y financiación de fuentes no gubernamentales. Las clínicas más grandes examinaron más de 500 pacientes no asegurados o parcialmente asegurados por mes. Las clínicas cubrieron una amplia gama de servicios clínicos y preventivos. La financiación, la disponibilidad de medicamentos, vacunas y material médico, y su estado legal, son los principales problemas identificados. El movimiento de solidaridad involucró a miles de profesionales de la salud que cubrieron las necesidades esenciales de la población. Conclusiones: Las clínicas ambulatorias comunitarias fueron un ejemplo de solidaridad y aliviaron temporalmente las necesidades de salud de una gran parte de la población


Asunto(s)
Humanos , Solidaridad , Prestación de Atención de Salud/métodos , Instituciones de Atención Ambulatoria/organización & administración , Cambio Social , Grecia/epidemiología , Recesión Económica , Solución de Problemas , Políticas Públicas de Salud , Organizaciones/organización & administración , Sector Privado/organización & administración , Colaboración Intersectorial
4.
Gac Sanit ; 33(3): 263-267, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29523482

RESUMEN

OBJECTIVE: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. METHOD: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. RESULTS: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. CONCLUSIONS: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Prestación de Atención de Salud/organización & administración , Recesión Económica , Factores Sociológicos , Grecia , Humanos
5.
Front Public Health ; 4: 142, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27458576

RESUMEN

INTRODUCTION: A consequence of the West Africa Ebola outbreak 2014-2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community. METHODS: Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data. RESULTS: The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients' isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor's network were ways to give a meaning to life post-Ebola. CONCLUSION: Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.

6.
Br J Gen Pract ; 66(647): e382-91, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27025556

RESUMEN

BACKGROUND: In 2012, hepatitis B virus (HBV) testing of people born in a country with a prevalence of ≥2% was recommended in the UK. Implementation of this recommendation requires an understanding of prior HBV testing practice and coverage, for which there are limited data. AIM: To estimate the proportion of migrants tested for HBV and explore GP testing practices and barriers to testing. DESIGN AND SETTING: A cross-sectional study of (a) migrants for whom testing was recommended under English national guidance, living in Bristol, and registered with a GP in 2006-2013, and (b) GPs practising in Bristol. METHOD: NHS patient demographic data and HBV laboratory surveillance data were linked. A person was defined as 'HBV-tested' if a laboratory result was available. An online GP survey was undertaken, using a structured questionnaire. RESULTS: Among 82 561 migrants for whom HBV testing was recommended, 9627 (12%) were 'HBV-tested'. The HBV testing coverage was: Eastern Africa 20%; Western Africa 15%; South Eastern Asia 9%; Eastern Asia 5%. Of 19 GPs, the majority did not use guidelines to inform HBV testing in migrants and did not believe routine testing of migrants was indicated; 12/17 GPs stated that workload and lack of human, and financial resources were the most significant barriers to increased testing. CONCLUSION: The majority of migrants to a multicultural UK city from medium-/high-prevalence regions have no evidence of HBV testing. Much greater support for primary care in the UK and increased GP awareness of national guidance are required to achieve adherence to current testing guidance.


Asunto(s)
Ciudades , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B/prevención & control , Programas de Inmunización/organización & administración , Tamizaje Masivo/organización & administración , Complicaciones Infecciosas del Embarazo/prevención & control , Medicina Estatal , Migrantes , Adulto , Ciudades/epidemiología , Estudios Transversales , Grupos Étnicos , Femenino , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Hepatitis B/epidemiología , Humanos , Masculino , Aceptación de la Atención de Salud , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Medicina Estatal/organización & administración , Migrantes/estadística & datos numéricos , Reino Unido/epidemiología , Servicios Urbanos de Salud
7.
J Clin Virol ; 68: 79-82, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26071342

RESUMEN

BACKGROUND: Many countries with low prevalence of Hepatitis B Virus (HBV) infection recommend that migrants born in countries with higher prevalence are HBV tested. The cost effectiveness depends on the prevalence of HBV infection in the migrant population. In the UK the National Institute for Health and Care Excellence recommended HBV testing of migrants born in countries with HBV infection prevalence >2%, but the prevalence in migrant populations in the UK is not routinely measured. OBJECTIVES: To estimate HBV infection prevalence by region of birth in migrant populations in a large UK city. STUDY DESIGN: By retrospective data linkage HBV infection prevalence in migrant women tested in pregnancy was determined by UN region and sub-region of birth. RESULTS: Of 5840 migrant women born in regions with HBV infection prevalence >2%, 101 were infected (prevalence 1.7%; 95% CI 1.4-2.1). Sub-regions of birth with low (<2%), intermediate (2-8%) and high (>8%) prevalence in the study population were: low - Northern Africa, Southern Asia, Western Asia, Eastern Europe, South Europe, Central America, Latin America and The Caribbean; intermediate - Eastern Africa, Middle Africa, Western Africa, and South Eastern Asia; high - Eastern Asia. Prevalence in the study populations, was generally lower than published estimates for the region of origin. CONCLUSION: In a large ethnically diverse city in the UK the hepatitis B prevalence in migrant populations for whom HBV screening is recommended is below the estimated cost effectiveness threshold. We recommend more targeted screening based on measured prevalence in migrant populations.


Asunto(s)
Emigrantes e Inmigrantes , Hepatitis B/epidemiología , Ciudades/epidemiología , Grupos Étnicos , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Estudios Retrospectivos , Reino Unido/epidemiología
8.
MMWR Morb Mortal Wkly Rep ; 64(17): 479-81, 2015 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-25950255

RESUMEN

On March 20, 2015, 30 days after the most recent confirmed Ebola Virus Disease (Ebola) patient in Liberia was isolated, Ebola was laboratory confirmed in a woman in Monrovia. The investigation identified only one epidemiologic link to Ebola: unprotected vaginal intercourse with a survivor. Published reports from previous outbreaks have demonstrated Ebola survivors can continue to harbor virus in immunologically privileged sites for a period of time after convalescence. Ebola virus has been isolated from semen as long as 82 days after symptom onset and viral RNA has been detected in semen up to 101 days after symptom onset. One instance of possible sexual transmission of Ebola has been reported, although the accompanying evidence was inconclusive. In addition, possible sexual transmission of Marburg virus, a filovirus related to Ebola, was documented in 1968. This report describes the investigation by the Government of Liberia and international response partners of the source of Liberia's latest Ebola case and discusses the public health implications of possible sexual transmission of Ebola virus. Based on information gathered in this investigation, CDC now recommends that contact with semen from male Ebola survivors be avoided until more information regarding the duration and infectiousness of viral shedding in body fluids is known. If male survivors have sex (oral, vaginal, or anal), a condom should be used correctly and consistently every time.


Asunto(s)
Ebolavirus/aislamiento & purificación , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/transmisión , Enfermedades Virales de Transmisión Sexual , Adulto , Brotes de Enfermedades , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Liberia/epidemiología , Masculino , Persona de Mediana Edad , ARN Viral , Semen/virología , Sobrevivientes , Sexo Inseguro
9.
J Pediatr ; 167(2): 246-52.e2, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25863662

RESUMEN

OBJECTIVE: To evaluate the association of second-hand smoke exposure of pregnant mothers using urine cotinine with the neurodevelopment of their children at 18 months of age in the mother-child cohort in Crete (Rhea Study). STUDY DESIGN: Selected participants were Greek mothers with singleton pregnancies, had never smoked, and had available urine cotinine measurements in pregnancy, and their children for whom a neurodevelopmental assessment was completed. We performed face-to-face interviews twice during pregnancy and postnatally, and assessed children's neurodevelopment at 18 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition. We used linear regression and generalized additive models. RESULTS: Of 599 mothers, 175 (29%) met the inclusion criteria. Maternal urine cotinine levels were low (mean: 10.3 ng/mL, SD: 11.7 ng/mL). Reported passive smoking from different sources was strongly associated with urine cotinine levels. A negative association was observed between cotinine levels in pregnancy and child's gross motor function (beta = -3.22 per 10 ng/mL, 95% CI -5.09 to -1.34) after adjusting for factors potentially associated with neurodevelopment; results were similar in both sexes. A negative association was also observed for cognitive and receptive communication scales but the effect was small and not statistically significant. CONCLUSIONS: Maternal exposure during pregnancy to second-hand smoke measured through urine cotinine was associated with a decrease in gross motor function among 18-month-old children, even at low levels of exposure.


Asunto(s)
Biomarcadores/orina , Desarrollo Infantil , Cotinina/orina , Exposición Materna , Efectos Tardíos de la Exposición Prenatal/orina , Contaminación por Humo de Tabaco/análisis , Tabaco/efectos adversos , Adulto , Femenino , Grecia , Humanos , Lactante , Modelos Lineales , Masculino , Madres , Destreza Motora , Embarazo
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