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1.
Cad Saude Publica ; 36(5): e00075720, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32428080

RESUMEN

Given the characteristics of the COVID-19 pandemic and the limited tools for orienting interventions in surveillance, control, and clinical care, the current article aims to identify areas with greater vulnerability to severe cases of the disease in Rio de Janeiro, Brazil, a city characterized by huge social and spatial heterogeneity. In order to identify these areas, the authors prepared an index of vulnerability to severe cases of COVID-19 based on the construction, weighting, and integration of three levels of information: mean number of residents per household and density of persons 60 years or older (both per census tract) and neighborhood tuberculosis incidence rate in the year 2018. The data on residents per household and density of persons 60 years or older were obtained from the 2010 Population Census, and data on tuberculosis incidence were taken from the Brazilian Information System for Notificable Diseases (SINAN). Weighting of the indicators comprising the index used analytic hierarchy process (AHP), and the levels of information were integrated via weighted linear combination with map algebra. Spatialization of the index of vulnerability to severe COVID-19 in the city of Rio de Janeiro reveals the existence of more vulnerable areas in different parts of the city's territory, reflecting its urban complexity. The areas with greatest vulnerability are located in the North and West Zones of the city and in poor neighborhoods nested within upper-income parts of the South and West Zones. Understanding these conditions of vulnerability can facilitate the development of strategies to monitor the evolution of COVID-19 and orient measures for prevention and health promotion.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Tuberculosis Pulmonar/epidemiología , Brasil/epidemiología , Comorbilidad , Monitoreo Epidemiológico , Humanos , Incidencia , Persona de Mediana Edad , Áreas de Pobreza , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Análisis Espacial
2.
Medicine (Baltimore) ; 99(17): e19954, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332679

RESUMEN

The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Gobierno Local , Tamizaje Masivo/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto , Neoplasias de la Mama/epidemiología , China/epidemiología , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Modelos Logísticos , Mamografía/estadística & datos numéricos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Áreas de Pobreza , Factores Socioeconómicos
3.
Infect Dis Poverty ; 9(1): 32, 2020 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-32204735

RESUMEN

Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis (TB), however, such studies have never been conducted in Peru. Considering the association between air pollution and specific geographic areas, our objective was to determine the spatial distribution and clustering of TB incident cases in Lima and their co-occurrence with clusters of fine particulate matter (PM2.5) and poverty. We found co-occurrences of clusters of elevated concentrations of air pollutants such as PM2.5, high poverty indexes, and high TB incidence in Lima. These findings suggest an interplay of socio-economic and environmental in driving TB incidence.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire/efectos adversos , Monitoreo del Ambiente , Material Particulado , Pobreza , Tuberculosis/epidemiología , Humanos , Incidencia , Perú/epidemiología , Áreas de Pobreza , Estaciones del Año , Análisis Espacio-Temporal
4.
BMC Public Health ; 20(1): 147, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-32005209

RESUMEN

BACKGROUND: The purpose of this study was to examine the association of physical education (PE) class characteristics, such as lesson context, teacher's physical activity (PA) promotion behavior, and lesson location, with student engagement in moderate- and vigorous-intensity physical activity (MVPA) during PE lessons in elementary school (ES), middle school (MS), and high school (HS). METHODS: The study sample included 2106 PE classes from 40 schools located in low-income communities. The System for Observing Fitness Instruction Time (SOFIT) was used to assess lesson context, teacher's behavior, and student PA during PE lessons. Mixed models were used to examine the association between PE class characteristics and the probability of meeting the recommended level of MVPA during PE lessons (MVPA ≥50%), accounting for within-school random effects and school characteristics. RESULTS: Almost all PE classes (90%) with ≥60-70% of lesson time spent in motor content and ≥ 10-20% in teacher's in-class PA promotion met the recommended level of MVPA across the school levels. More specifically, among the sub-categories of motor content, more lesson time spent in fitness was significantly associated with MVPA ≥50% in all school levels. However, more lesson time spent in game play was a significant factor only in ES (OR = 2.1; 95% CI = 1.4-3.0). Outdoor lessons were a significant factor in ES (OR = 5.3; 95% CI = 3.1-9.0) and MS (OR = 21.0; 95% CI = 6.3-69.4), but not HS (OR = 1.4; 95% CI = 0.6, 3.2). CONCLUSIONS: PE lessons with higher motor content and higher teacher's in-class PA promotion are more likely to meet the recommended level of MVPA in all school levels. However, the sub-categories of motor content and lesson location could impact student MVPA differently by school levels.


Asunto(s)
Ejercicio Físico/fisiología , Educación y Entrenamiento Físico , Áreas de Pobreza , Instituciones Académicas/estadística & datos numéricos , Estudiantes/psicología , Adolescente , Niño , Femenino , Humanos , Masculino , Estudiantes/estadística & datos numéricos
5.
Med Care ; 58(4): 376-383, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31895306

RESUMEN

BACKGROUND: The Centers for Medicare and Medicaid Services provide nationwide hospital ratings that may influence reimbursement. These ratings do not account for the social risk of communities and may inadvertently penalize hospitals that service disadvantaged neighborhoods. OBJECTIVE: This study examines the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. RESEARCH DESIGN: 2017 Medicare Hospital Compare ratings were linked with block group data from the 2015 American Community Survey to assess hospital ratings as a function of neighborhood SRFs. SUBJECTS: A total of 3608 Medicare-certified hospitals in 50 US states. MEASURES: Hospital summary scores and 7 quality group scores (100 percentile scale), including effectiveness of care, efficiency of care, hospital readmission, mortality, patient experience, safety of care, and timeliness of care. RESULTS: Lower hospital summary scores were associated with caring for neighborhoods with higher social risk, including a reduction in hospital score for every 10% of residents who reported dual-eligibility for Medicare/Medicaid [-3.3%; 95% confidence interval (CI), -4.7 to -2.0], no high-school diploma (-0.8%; 95% CI, -1.5 to -0.1), unemployment (-1.2%; 95% CI, -1.9 to -0.4), black race (-1.2%; 95% CI, -1.7 to -0.8), and high travel times to work (-2.5%; 95% CI, -3.3 to -1.6). Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups; and smallest in the safety, efficiency, and effectiveness of care groups. CONCLUSIONS: Hospitals serving communities with higher social risk may have lower ratings because of neighborhood factors. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.


Asunto(s)
Hospitales/normas , Áreas de Pobreza , Indicadores de Calidad de la Atención de Salud , Anciano , Centers for Medicare and Medicaid Services, U.S. , Femenino , Humanos , Masculino , Medicare , Factores de Riesgo , Estados Unidos
7.
BMC Public Health ; 20(1): 13, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906992

RESUMEN

BACKGROUND: Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. METHODS: Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). RESULTS: Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39-1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51-1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62-1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72-2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. CONCLUSIONS: Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.


Asunto(s)
Enfermedad Crónica/epidemiología , Disparidades en el Estado de Salud , Multimorbilidad , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Prevalencia , Factores de Riesgo , Adulto Joven
8.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914967

RESUMEN

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Asunto(s)
Tasa de Natalidad/tendencias , Servicios de Salud Comunitaria , Anticoncepción/psicología , Consejo , Adolescente , Ciudades , Anticoncepción/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Áreas de Pobreza , Embarazo , Evaluación de Programas y Proyectos de Salud , Características de la Residencia/estadística & datos numéricos , España , Adulto Joven
9.
BMC Public Health ; 20(1): 18, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910840

RESUMEN

BACKGROUND: The health-related quality of life (HRQoL) of adolescents with CP in low and middle-income countries is often poor, as is the case in Bangladesh. This exploratory study examined what factors predict the proxy-reported HRQoL of adolescents with CP in rural Bangladesh, a typical low- and middle-income country (LMIC). METHODS: Adolescents with CP (10 to 18y) were identified using the Bangladesh Cerebral Palsy Register. HRQoL was assessed using the Cerebral Palsy Quality of Life-Teens proxy-report questionnaire (CPQoL-Teens), adolescent mental health using the Strengths and Difficulty Questionnaire (SDQ) and caregiver mental health using the Depression, Anxiety and Stress Scale (DASS-21). Theoretical and statistical interests (i.e. bivariate analysis, p < 0.05) identified potential predictors which were entered into hierarchical multiple linear regression (HMLR) models in order of clinical significance; HMLR related adolescent clinical characteristics, adolescent and caregiver mental health and proxies of socioeconomic status to CPQoL-Teens dimensions. RESULTS: One hundred fifty-four adolescents with CP (mean age 15y 1mo, SD 1y 8mo, female 31.2%) participated in this study. Twenty-four factors were identified to explore for relationship to adolescent proxy-reported HRQoL. Fifteen of the factors correlated to one or more CPQoL-Teens dimension; strongest correlation was between 'feelings about functioning' and motor impairment (r = 0.545). Nine were predictive of CPQoL-Teens dimensions; adolescent sex, school attendance, severity of motor impairment, hearing and speech impairment, mother's education, primary caregiver depression and stress, and having a sanitary latrine at home resulting in score changes of between 0.79 (95% CI 0.24 to 1.35) to 35.1 (95% CI 6.03 to 64.22). CONCLUSIONS: Many of the factors predicting the proxy-reported HRQoL of adolescents with CP are amenable to intervention, and have the potential to improve adolescent wellbeing. Several determinants are priorities of the sustainable development goals (SDGs); these findings should inform resource prioritization to improve the wellbeing of adolescents with CP in Bangladesh and other LMICs.


Asunto(s)
Cuidadores/psicología , Parálisis Cerebral/psicología , Áreas de Pobreza , Calidad de Vida/psicología , Población Rural/estadística & datos numéricos , Adolescente , Bangladesh , Femenino , Humanos , Masculino , Análisis Multivariante , Encuestas y Cuestionarios
10.
BMC Public Health ; 20(1): 52, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937271

RESUMEN

BACKGROUND: Perceived neighborhood characteristics, including satisfaction with one's neighborhood as a place to live, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. Yet, few studies have evaluated whether changes in perceived neighborhood characteristics over time may be associated with cardiometabolic health indicators. METHODS: Changes in perception of one's neighborhood (2013-2016) were determined from a cohort of residents who lived in one of two low-income urban neighborhoods. Changes were categorized into the following: improvement vs. no change or worsening over the three-year time-period. Multivariable linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, DBP, HbA1c, HDL-c) that were assessed in 2016, and compared with those who perceived no change or worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, and years spent in neighborhood. To examine potential sex differences, follow-up models were conducted and stratified by sex. RESULTS: Among the 622 individuals who remained in the same neighborhood during the time period, 93% were African American, 80% were female, and the mean age was 58 years. In covariate-adjusted models, those who perceived improvement in their neighborhood safety over the time period had a significantly higher BMI (kg/m2) than those who perceived no improvement or worsening (ß = 1.5, p = 0.0162); however, perceived improvement in safety was also significantly associated with lower SBP (mmHg) (ß = - 3.8, p = 0.0361). When results were stratified by sex, the relationship between improved perceived neighborhood safety and BMI was only evident in females. CONCLUSIONS: These findings suggest that perceived neighborhood characteristics may impact cardiometabolic outcomes (BMI, SBP), but through differing pathways. This highlights the complexity of the associations between neighborhood characteristics and underscores the need for more longitudinal studies to confirm the associations with cardiometabolic health in African American populations.


Asunto(s)
Afroamericanos/psicología , Enfermedades Cardiovasculares/etnología , Características de la Residencia , Afroamericanos/estadística & datos numéricos , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción Personal , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Población Urbana/estadística & datos numéricos
11.
Am J Clin Nutr ; 111(3): 657-666, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31909785

RESUMEN

BACKGROUND: Adult undernutrition (BMI <18.5 kg/m2) is responsible for immune deficits, increased risk of disease burden, and higher rates of mortality. The prevalence of adult undernutrition in Bangladesh is substantial, but there have been few studies on the etiology of this condition for the inhabitants of urban slums. OBJECTIVE: The aim of this study was to identify the factors associated with undernutrition among slum-dwelling adults in Bangladesh. METHODS: A case-control study was conducted in the Bauniabadh area of Dhaka, Bangladesh. 270 adult participants (135 cases with a BMI <18.5 and 135 controls with a BMI between 18.5 and 24.9) aged 18-45 y were enrolled between October 2018 and January 2019. Sociodemographic variables, dietary diversity, micronutrient deficiencies, psychological symptoms, infection, and biomarkers of gut health were assessed to identify the factors associated with undernutrition using multivariable logistic regression analysis. RESULTS: A higher number of siblings [adjusted odds ratio (aOR): 1.39; 95% CI: 1.11, 1.77], increased self-reporting questionnaire-20 score (an instrument to screen mental health disorders and detect psychological symptoms) (aOR: 1.12; 95% CI: 1.04, 1.23), elevated fecal concentration of α-1 antitrypsin (aOR: 4.82; 95% CI: 1.01, 25.29), and anemia (aOR: 3.63; 95% CI: 1.62, 8.58) were positively associated with undernutrition in adults. Age (aOR: 0.90; 95% CI: 0.84, 0.96), dietary diversity score (aOR: 0.75; 95% CI: 0.56, 0.99), C-reactive protein (aOR: 0.82; 95% CI: 0.73, 0.92), Helicobacter pylori infection (aOR: 0.11; 95% CI: 0.05, 0.23), and always washing hands before eating or preparing foods (aOR: 0.33; 95% CI: 0.12, 0.87) were associated with reduced odds of undernutrition among the study population. CONCLUSIONS: Our results indicate that undernutrition in slum-dwelling adults in Bangladesh is associated with numerous physiological and sociodemographic factors, including evidence of gastrointestinal inflammation and altered intestinal permeability.


Asunto(s)
Enfermedades Gastrointestinales/microbiología , Infecciones por Helicobacter/microbiología , Desnutrición/microbiología , Adolescente , Adulto , Bangladesh/epidemiología , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Heces/microbiología , Femenino , Enfermedades Gastrointestinales/economía , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/psicología , Infecciones por Helicobacter/economía , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/psicología , Helicobacter pylori/genética , Helicobacter pylori/aislamiento & purificación , Helicobacter pylori/fisiología , Humanos , Masculino , Desnutrición/economía , Desnutrición/epidemiología , Desnutrición/psicología , Curación Mental , Persona de Mediana Edad , Áreas de Pobreza , Población Urbana , Adulto Joven
12.
Int J Infect Dis ; 92: 130-132, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31962180

RESUMEN

The world is becoming increasingly urban and most of this growth is taking place in urban slums of the developing world. The current (2019) global population stands at 7.7 billion, with approximately one billion (13%) living in urban slums. By 2030 the world's population is projected to grow to 8.5 billion, with an estimated two billion (24%) living in slums. Slums are typically overcrowded, with most residents sharing a single room with four to five family members. There is usually no formal sewage or waste disposal system. Open sewage, with antimicrobial-resistant organisms, typically flows just outside the door, which during the rainy season often enters the home and contaminates the household drinking source. Hygiene is difficult if not impossible to maintain, hence the significant burden of infectious diseases, especially those with a faecal-oral mode of transmission. Transmission is year-round and the leading enteric pathogens are rotavirus, Cryptosporidium, Shigella, Campylobacter, Salmonella typhi, and Vibrio cholera. Water, sanitation, and hygiene (WaSH) will be crucial components of a future integrated control strategy for infectious diseases in slums. Cheap WaSH interventions have been trialled, but their impact has been modest and short-lived. More expensive WaSH alternatives that will provide lasting change now need to be explored. Can we 'WaSH' infectious diseases out of slums?


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Higiene , Áreas de Pobreza , Saneamiento , Animales , Humanos , Aguas del Alcantarillado , Salud Urbana , Calidad del Agua , Enfermedades Transmitidas por el Agua
13.
BMC Public Health ; 20(1): 112, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31992285

RESUMEN

BACKGROUND: Despite numerous interventions aiming to improve physical activity in socially disadvantaged populations, physical inactivity remains to be a rising challenge to public health globally, as well as, in Sweden. In an effort to address this challenge, a community-based participatory intervention was developed through active community engagement and implemented in a socially disadvantaged neighborhood in Sweden. The current study aims to present the development and initial evaluation of a participatory research driven physical activity intervention. METHODS: Fifteen participants (11 females and 4 males) aged 17-59 years volunteered to participate in the physical activity intervention program. The intervention program was evaluated using a longitudinal mixed methods design measuring health impact changes over time through focus group discussions and quality of life surveys. Further additional biomedical health parameters such as levels of glycosylated hemoglobin, blood pressure, levels of oxygen saturation and body mass index were monitored before and after the intervention. Focus group data were analyzed using content analysis with an inductive approach. The pre-and post-test scores from the survey-based quality of life domains, as well as the health parameters were compared using non-parametric and parametric statistics. RESULTS: Four themes emerged from the analysis of the focus group discussions including sense of fellowship, striving for inclusion and equity, changing the learner perspective and health beyond illness. The scores for the domains Physical Health, Psychological Health, Social Relationships and Health Satisfaction where significantly higher after participation in the physical activity intervention program compared to the pre-test scores (p < .05)s. There were however, no significant changes in the scores for the environmental domain and overall quality of life after intervention compared to that prior to intervention start. Overall, the biomedical health parameters remained stable within the normal ranges during intervention. CONCLUSION: The focus group discussions and results from the surveys and biomedical measures reveal important findings to understand and further develop the intervention program to promote health equity among citizens in disadvantaged areas. Evaluating the feasibility of such an intervention using multiple approaches contributes to effective implementation of it for larger communities in need.


Asunto(s)
Ejercicio Físico , Promoción de la Salud/organización & administración , Áreas de Pobreza , Adolescente , Adulto , Investigación Participativa Basada en la Comunidad , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Encuestas y Cuestionarios , Suecia , Adulto Joven
14.
PLoS Biol ; 18(1): e3000589, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31922526

RESUMEN

Electroporation is a basic yet powerful method for delivering small molecules (RNA, DNA, drugs) across cell membranes by application of an electrical field. It is used for many diverse applications, from genetically engineering cells to drug- and DNA-based vaccine delivery. Despite this broad utility, the high cost of electroporators can keep this approach out of reach for many budget-conscious laboratories. To address this need, we develop a simple, inexpensive, and handheld electroporator inspired by and derived from a common household piezoelectric stove lighter. The proposed "ElectroPen" device can cost as little as 23 cents (US dollars) to manufacture, is portable (weighs 13 g and requires no electricity), can be easily fabricated using 3D printing, and delivers repeatable exponentially decaying pulses of about 2,000 V in 5 ms. We provide a proof-of-concept demonstration by genetically transforming plasmids into Escherichia coli cells, showing transformation efficiency comparable to commercial devices, but at a fraction of the cost. We also demonstrate the potential for rapid dissemination of this approach, with multiple research groups across the globe validating the ease of construction and functionality of our device, supporting the potential for democratization of science through frugal tools. Thus, the simplicity, accessibility, and affordability of our device holds potential for making modern synthetic biology accessible in high school, community, and resource-poor laboratories.


Asunto(s)
Electroporación/instrumentación , Técnicas de Transferencia de Gen/instrumentación , Análisis Costo-Beneficio , Electricidad , Electroporación/economía , Diseño de Equipo/economía , Escherichia coli , Técnicas de Transferencia de Gen/economía , Humanos , Laboratorios/economía , Materiales Manufacturados/economía , Áreas de Pobreza , Impresión Tridimensional , Transformación Bacteriana , Transportes
16.
JAMA ; 322(21): 2115-2124, 2019 12 03.
Artículo en Inglés | MEDLINE | ID: mdl-31794624

RESUMEN

Importance: Although neighborhoods are thought to be an important health determinant, evidence for the relationship between neighborhood poverty and health care use is limited, as prior studies have largely used observational data without an experimental design. Objective: To examine whether housing policies that reduce exposure to high-poverty neighborhoods were associated with differences in long-term hospital use among adults and children. Design, Setting, and Participants: Exploratory analysis of the Moving to Opportunity for Fair Housing Demonstration Program, a randomized social experiment conducted in 5 US cities. From 1994 to 1998, 4604 families in public housing were randomized to 1 of 3 groups: a control condition, a traditional Section 8 voucher toward rental costs in the private market, or a voucher that could only be used in low-poverty neighborhoods. Participants were linked to all-payer hospital discharge data (1995 through 2014 or 2015) and Medicaid data (1999 through 2009). The final follow-up date ranged from 11 to 21 years after randomization. Exposures: Receipt of a traditional or low-poverty voucher vs control group. Main Outcomes and Measures: Rates of hospitalizations and hospital days, and hospital spending. Results: Among 4602 eligible individuals randomized as adults, 4072 (88.5%) were linked to health data (mean age, 33 years [SD, 9.0 years]; 98% female; median follow-up, 11 years). There were no significant differences in primary outcomes among adults randomized to receive a voucher compared with the control group (unadjusted hospitalization rate, 14.0 vs 14.7 per 100 person-years, adjusted incidence rate ratio [IRR], 0.95 [95% CI, 0.84-1.08; P = .45]; hospital days, 62.8 vs 67.0 per 100 person-years; IRR, 0.93 [95% CI, 0.77-1.13; P = .46]; yearly spending, $2075 vs $1977; adjusted difference, -$129 [95% CI, -$497 to $239; P = .49]). Among 11 290 eligible individuals randomized as children, 9118 (80.8%) were linked to health data (mean age, 8 years [SD, 4.6 years]; 49% female; median follow-up, 11 years). Receipt of a housing voucher during childhood was significantly associated with lower hospitalization rates (6.3 vs 7.3 per 100 person-years; IRR, 0.85 [95% CI, 0.73-0.99; P = .03]) and yearly inpatient spending ($633 vs $785; adjusted difference, -$143 [95% CI, -$256 to -$31; P = .01]) and no significant difference in hospital days (25.7 vs 28.8 per 100 person-years; IRR, 0.92 [95% CI, 0.77-1.11; P = .41]). Conclusions and Relevance: In this exploratory analysis of a randomized housing voucher intervention, adults who received a housing voucher did not experience significant differences in hospital use or spending. Receipt of a voucher during childhood was significantly associated with lower rates of hospitalization and less inpatient spending during long-term follow-up.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Vivienda/economía , Vivienda Popular , Adulto , Niño , Femenino , Estudios de Seguimiento , Hospitalización/economía , Humanos , Masculino , Áreas de Pobreza , Vivienda Popular/economía , Características de la Residencia , Estados Unidos
17.
Rev Saude Publica ; 53: 97, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800910

RESUMEN

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.


Asunto(s)
Disparidades en el Estado de Salud , Indicadores de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Ecuador/epidemiología , Femenino , Geografía Médica , Humanos , Masculino , Mortalidad , Áreas de Pobreza , Salud Pública , Factores Socioeconómicos
18.
Movimento (Porto Alegre) ; 25(1): e25045, jan.- dez. 2019.
Artículo en Portugués | LILACS | ID: biblio-1048484

RESUMEN

O objetivo deste estudo é interpretar o se-movimentar dos alunos de uma escola pública do Rio de Janeiro, localizada em uma área conflagrada pelo tráfico, de forma a compreender as influências da violência daquela área da cidade no cotidiano das aulas de Educação Física. Foram conduzidas uma observação participante e entrevistas semiestruturadas com professoras de Educação Física. Evidências encontradas durante as observações e ratificadas pelas entrevistas apontam que os alunos usam códigos corporais como um processo de reestabelecimento dos sistemas de autoconfiança social. A repetição dos fenômenos de identificação com o agressor, que se manifestavam no grupo masculino, era ressignificada mantendo-se elementos da cultura de violência, mas introduzindo características das atividades de que participavam


This study interprets the way of moving of students of a public school located in a drug-traffic-ridden area of Rio de Janeiro to understand the influence of violence in that area of the city in the daily life of Physical Education classes. Participant observation and semi-structured interviews were conducted with Physical Education teachers. Findings indicate that students use bodily codes as a process for reestablishing selfconfidence systems. Repeated identification with their aggressors, which manifested itself in the masculine group, was re-signified while elements of the culture of violence were maintained but introducing characteristics of the activities in which they participated


El objetivo de este estudio es interpretar el Sich-Bewegen de los estudiantes de una escuela pública en Rio de Janeiro, ubicada en un área conflagrada por el tráfico de drogas, para comprender las influencias de la violencia de esa región de la ciudad en el cotidiano de las clases de Educación Física. Se realizaron observación participante y entrevistas semiestructuradas con profesores de Educación Física. Evidencias encontradas durante las observaciones y ratificadas por las entrevistas indican que los estudiantes usan códigos corporales como un proceso de restablecimiento de los sistemas de autoconfianza social. La repetición de los fenómenos de identificación con el agresor, que se manifestaron en el grupo masculino, eran resignificados manteniendo elementos de la cultura de la violencia, pero introduciendo características de las actividades en las que participaban


Asunto(s)
Preescolar , Niño , Adolescente , Educación y Entrenamiento Físico , Violencia , Áreas de Pobreza , Educación Primaria y Secundaria , Conducta Social , Cultura
20.
Fractal rev. psicol ; 31(spe): 173-178, set.-dez. 2019.
Artículo en Portugués | LILACS, Index Psicología - Revistas técnico-científicas | ID: biblio-1056233

RESUMEN

Este artigo constitui o relato da experiência de intervenção, realizada a partir da solicitação de uma ação social na cidade do Rio de Janeiro: o "Vai na Web", programa feito por moradores e ex-moradores de favelas, e que visa ensinar desenvolvimento de software e colocar profissionalmente jovens de duas localidades: o Morro dos Prazeres e o Complexo do Alemão. A ação militar federal que ocorreu na cidade a partir de fevereiro de 2018 apresentou novos desafios para o programa. O método utilizado para a intervenção foi a cartografia esquizoanalítica. A demarcação conceitual utilizada para o início da intervenção foram os estudos em Políticas da Cognição, com o objetivo de compreender os movimentos cognitivos potentes já presentes para, a partir dos mesmos, tecer a ação. Obteve-se a construção de métodos pedagógicos que tivessem como princípio os territórios cognitivos das comunidades onde o projeto está inserido - o que resultou em um aumento do aproveitamento e da penetração no mercado dos egressos do programa. Conclui-se que, apesar da obtenção parcial de resultados satisfatórios no aproveitamento do programa, ainda se faz necessário criar ferramentas para lidar com este quadro em que políticas públicas infligem diretamente e/ou indiretamente na cognição.(AU)


This article is the report of the experience of an intervention, carried out from the request of a social action in the city of Rio de Janeiro: "Vai na Web", a program made by residents and former slum dwellers, aimed at teaching software development and putting young people professionally residents of two locations: the Morro dos Prazeres and the Complexo do Alemão. The federal military intervention that occurred in the city on February 2018 presented new challenges for the program. At the same time, it was noticed the absence of academic papers on the subject, in Psychology. The method sed for the intervention was Cartography, based on Schizoanalysis. The conceptual demarcation that was used for the beginning of the intervention were the studies in Cognition Policies, with the objective of understanding the powerful cognitive movements already present to make the action. The intervention resulted in the construction of pedagogical methods that had as a principle the cognitive territories of the communities where the project is inserted - which resulted in an increase in the use and market penetration of the graduates of the program. It is concluded that, despite the partial achievement of satisfactory results in the use of the program, it is still necessary to create tools to deal with this situation in which political phenomena inflict directly on cognition, collaborating with cognition in its disruptive power and inventive resistance.(AU)


Asunto(s)
Humanos , Adolescente , Tecnología , Programas Informáticos , Áreas de Pobreza , Educación
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