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1.
J Glob Health ; 11: 05003, 2021 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-33643636

RESUMEN

Background: The COVID-19 pandemic is a global phenomenon that is spreading at an alarmingly high rate, increasing morbidity, mortality as well as affecting the global economy, education sector and psychological well-being of the public. Measures, taken to mitigate the spread of the virus during this pandemic, created challenges to humanitarian communities preventing them from carrying out their responsibilities towards vulnerable populations. The aim of this study is to assess the burden of COVID-19 by looking at the current living conditions, examining available services provided, and identifying the economic and health challenges of Syrian refugee families living in Lebanon. Methods: This is a cross-sectional study conducted on 129 Syrian refugee families living in Lebanon during the COVID-19 pandemic. All participants provided consent prior to completion of the standardized questionnaire. Results: During the pandemic, 79% of breadwinners lost their jobs; of those who kept their jobs, 68% had their wages reduced. None of the families was capable of affording all of their basic needs with 55% only partially affording and 45% not able to afford. Thirty percent of Syrian refugee families did not receive support from organizations during the pandemic reflecting the impact of this crisis on humanitarian organizations. Education was also affected as 70% of children did not continue their education at home. Stress and anxiety were the most commonly reported behavioral changes among both children and adults. Conclusions: The impact of this crisis is multidimensional affecting the economy, global health and education level of the public. Measures should be taken to lessen the detrimental effect of this crisis on the community as a whole and on vulnerable populations in particular.


Asunto(s)
/epidemiología , Refugiados/estadística & datos numéricos , Sistemas de Socorro/estadística & datos numéricos , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Líbano/epidemiología , Masculino , Factores Socioeconómicos , Encuestas y Cuestionarios , Siria/etnología , Poblaciones Vulnerables
2.
Arch. prev. riesgos labor. (Ed. impr.) ; 24(1): 84-85, ene.-mar. 2021.
Artículo en Español | IBECS | ID: ibc-197122

RESUMEN

Aunque las tasas de accidentes laborales en los inmigrantes suelen ser más altas que las de los trabajadores nativos, se ha realizado poca investigación sobre este tema desde una perspectiva cultural. El objetivo de este estudio es doble. Primero, explorar las diferencias culturales entre el país de acogida, España en este caso, y los países de origen de los inmigrantes, en cuanto al idioma y la distancia cultural, y analizar si estas diferencias están asociadas con sus tasas de accidentes laborales. En segundo lugar, esperamos probar los efectos lineales, cuadráticos y de interacción de los valores culturales, evaluados según el modelo de Hofstede (2001), sobre los accidentes laborales según el sector económico (agricultura, industria, construcción y servicios). Se analizaron las tasas de accidentes de trabajadores inmigrantes de 38 países en España. Se estimó la distancia cultural entre países (países de origen y de acogida - España) y se usó el análisis de regresión para probar asociaciones lineales, curvilíneas y de interacción. Los resultados muestran que hablar un idioma diferente y ser culturalmente diferentes no influye en los accidentes en los inmigrantes, excepto en la agricultura, donde hablar un idioma diferente se asocia con menos accidentes. Los valores culturales nacionales (individualismo, distancia de poder, evitación de la incertidumbre, masculinidad y orientación a largo plazo) están relacionados con accidentes, ya sea linealmente (como la evitación de incertidumbre en la agricultura y la orientación a largo plazo en la industria, construcción y servicios) o cuadráticamente (como la distancia de poder y la evitación de la incertidumbre, en construcción y servicios), o se modulan entre sí (la distancia de poder modula el individualismo en la industria). Los valores culturales en sí mismos, en lugar del idioma o la distancia cultural entre países, son mejores predictores de la variación de los accidentes laborales en los inmigrantes. Se analizan las similitudes y diferencias entre los sectores económicos y se hacen propuestas para mejorar los programas de intervención para prevenir accidentes


No disponible


Asunto(s)
Humanos , Accidentes de Trabajo , Emigrantes e Inmigrantes , Características Culturales , Factores Culturales , Salud Laboral/etnología
3.
MMWR Morb Mortal Wkly Rep ; 70(5): 162-166, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33539336

RESUMEN

In 2019, approximately 51 million U.S. adults aged ≥18 years reported any mental illness,* and 7.7% reported a past-year substance use disorder† (1). Although reported prevalence estimates of certain mental disorders, substance use, or substance use disorders are not generally higher among racial and ethnic minority groups, persons in these groups are often less likely to receive treatment services (1). Persistent systemic social inequities and discrimination related to living conditions and work environments, which contribute to disparities in underlying medical conditions, can further compound health problems faced by members of racial and ethnic minority groups during the coronavirus disease 2019 (COVID-19) pandemic and worsen stress and associated mental health concerns (2,3). In April and May 2020, opt-in Internet panel surveys of English-speaking U.S. adults aged ≥18 years were conducted to assess the prevalence of self-reported mental health conditions and initiation of or increases in substance use to cope with stress, psychosocial stressors, and social determinants of health. Combined prevalence estimates of current depression, initiating or increasing substance use, and suicidal thoughts/ideation were 28.6%, 18.2%, and 8.4%, respectively. Hispanic/Latino (Hispanic) adults reported a higher prevalence of psychosocial stress related to not having enough food or stable housing than did adults in other racial and ethnic groups. These estimates highlight the importance of population-level and tailored interventions for mental health promotion and mental illness prevention, substance use prevention, screening and treatment services, and increased provision of resources to address social determinants of health. How Right Now (Qué Hacer Ahora) is an evidence-based and culturally appropriate communications campaign designed to promote and strengthen the emotional well-being and resiliency of populations adversely affected by COVID-19-related stress, grief, and loss (4).


Asunto(s)
Ansiedad/etnología , Grupos de Población Continentales/psicología , Grupos Étnicos/psicología , Disparidades en el Estado de Salud , Trastornos Mentales/etnología , Estrés Psicológico/etnología , Adulto , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Masculino , Prevalencia , Trastornos Relacionados con Sustancias/etnología , Estados Unidos/epidemiología
4.
Medicine (Baltimore) ; 100(6): e24699, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578605

RESUMEN

RATIONALE: Pulmonary artery intimal sarcoma is a rare tumor with exceptionally high mortality and easily misdiagnosed as pulmonary thromboembolism pulmonary thromboembolism (PTE) due to the nonspecific clinical presentation and symptom. Misdiagnosis or untimely diagnosis makes the disease progress to an advanced stage and eventually leads to a poor prognosis. PATIENT CONCERNS: A 37-year-old Chinese female presented with chest tightness and dyspnea for 3 months. Echocardiography and chest computed tomography revealed an intraluminal obstruction of the pulmonary arteries. Tests of serum tumor makers showed slight elevation for carbohydrate antigen-125, and α-fetoprotein. PTE was suspected according to the radiological and laboratory findings. DIAGNOSIS: Microscopic findings of the presumed thrombus showed prominent myxoid and edematous background with atypical spindled cells and curvilinear vascularity. Immunohistochemical staining demonstrated that the atypical spindled cells were positive for vimentin but negative for CK, S100, SMA, desmin, CD68, STAT6, CD34, ß-catenin, ALK-p80, p53, and MDM2. According to the radiological and pathological findings, the diagnosis of fibrosarcoma of pulmonary artery was made. INTERVENTIONS: The patient underwent surgical resection and the mass was excised as completely as possible. OUTCOME: Follow-up information showed no evidence of recurrence or metastasis after 3 months postresection. LESSONS: Because of the low incidence rate, nonspecific clinical symptoms, and radiological findings, primary fibrosarcoma of the pulmonary artery is commonly misdiagnosed as PTE. Pathological examination is necessary to confirm the diagnosis.


Asunto(s)
Fibrosarcoma/diagnóstico , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico , Túnica Íntima/patología , Adulto , Cuidados Posteriores , Grupo de Ascendencia Continental Asiática/etnología , Antígeno Ca-125/metabolismo , Errores Diagnósticos/prevención & control , Errores Diagnósticos/estadística & datos numéricos , Ecocardiografía/métodos , Femenino , Fibrosarcoma/sangre , Fibrosarcoma/patología , Fibrosarcoma/cirugía , Humanos , Embolia Pulmonar/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Vimentina/metabolismo , alfa-Fetoproteínas/metabolismo
5.
Nutrients ; 13(2)2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33546262

RESUMEN

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.


Asunto(s)
/etiología , Colecalciferol/administración & dosificación , Suplementos Dietéticos , Disparidades en el Estado de Salud , Deficiencia de Vitamina D/etnología , Deficiencia de Vitamina D/epidemiología , Afroamericanos , Enfermedad de Alzheimer/etiología , Enfermedad de Alzheimer/prevención & control , Antígenos de Neoplasias , Demencia/etiología , Demencia/prevención & control , Diabetes Mellitus/etiología , Diabetes Mellitus/prevención & control , Femenino , Humanos , Masculino , Prevalencia , Estado Asmático/etiología , Estado Asmático/prevención & control , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones
6.
MMWR Morb Mortal Wkly Rep ; 70(7): 236-239, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33600382

RESUMEN

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with manifestations that vary widely in severity. Although minority populations are at higher risk for SLE and have more severe outcomes (1), population-based estimates of mortality by race and ethnicity are often lacking, particularly for Asian and Hispanic/Latino persons. Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007-2009 (2,3), who were matched to the 2007-2017 National Death Index (NDI), 16.6% had died by 2017. This proportion included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings provide the first population-based estimates of mortality among Asian and Hispanic/Latino persons with SLE. Coordination of robust care models between primary care providers and rheumatologists could ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.


Asunto(s)
Americanos Asiáticos/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/mortalidad , Grupos Minoritarios/estadística & datos numéricos , Adolescente , Adulto , Anciano , California/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Adulto Joven
7.
MMWR Morb Mortal Wkly Rep ; 70(7): 229-235, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33600387

RESUMEN

During 2018, Black or African American (Black) persons accounted for 43% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Among Black persons with diagnosed HIV infection in 41 states and the District of Columbia for whom complete laboratory reporting* was available, the percentages of Black persons linked to care within 1 month of diagnosis (77.1%) and with viral suppression within 6 months of diagnosis (62.9%) during 2018 were lower than the Ending the HIV Epidemic initiative objectives of 95% for linkage to care and viral suppression goals (2). Access to HIV-related care and treatment services varies by residence area (3-5). Identifying urban-rural differences in HIV care outcomes is crucial for addressing HIV-related disparities among Black persons with HIV infection. CDC used National HIV Surveillance System† (NHSS) data to describe HIV care outcomes among Black persons with diagnosed HIV infection during 2018 by population area of residence§ (area). During 2018, Black persons in rural areas received a higher percentage of late-stage diagnoses (25.2%) than did those in urban (21.9%) and metropolitan (19.0%) areas. Linkage to care within 1 month of diagnosis was similar across all areas, whereas viral suppression within 6 months of diagnosis was highest in metropolitan areas (63.8%). The Ending the HIV Epidemic initiative supports scalable, coordinated, and innovative efforts to increase HIV diagnosis, treatment, and prevention among populations disproportionately affected by or who are at higher risk for HIV infection (6), especially during syndemics (e.g. with coronavirus disease 2019).


Asunto(s)
Afroamericanos/estadística & datos numéricos , Infecciones por VIH/etnología , Infecciones por VIH/terapia , Disparidades en Atención de Salud/etnología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Ciudades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Estados Unidos , Adulto Joven
8.
J Surg Oncol ; 123(2): 676-686, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33616989

RESUMEN

BACKGROUND: The objective of this study is to examine racial differences in receipt of low-value surgical care and time to surgery (TTS) among women receiving treatment at high-volume hospitals. METHODS: Stage I-III non-Hispanic Black (NHB) and Non-Hispanic White (NHW) breast cancer patients were identified in the National Cancer Database. Low-value care included (1) sentinel lymph node biopsy (SLNB) among T1N0 patients age ≥70 with hormone receptor-positive cancers, (2) axillary lymph node dissection (ALND) in patients meeting ACOSOG Z0011 criteria, and (3) contralateral prophylactic mastectomy (CPM) with unilateral cancer. TTS was days from biopsy to surgery. Bivariate and logistic regression analyses were used to compare the groups. RESULTS: Compared to NHWs, NHBs had lower rates of SLNB among women age ≥70 with small hormone-positive cancers (NHB 58.5% vs. NHW 62.2% p < .001) and CPM (NHB 26.3% vs. NHW 36%; p < .001). ALND rates for patients meeting ACOSOG Z0011 criteria were similar between both groups (p = .13). The odds of surgery >60 days were higher among NHBs (odds ratio, 1.77; 95% confidence interval, 1.64-1.91; NHW ref). CONCLUSIONS: NHBs treated at high-volume hospitals have higher rates of surgical delay but are less likely to undergo low-value surgical procedures compared to NHW women.


Asunto(s)
Neoplasias de la Mama/etnología , Neoplasias de la Mama/cirugía , Grupos Étnicos/estadística & datos numéricos , Disparidades en Atención de Salud , Hospitales de Alto Volumen/estadística & datos numéricos , Mastectomía/métodos , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Biopsia del Ganglio Linfático Centinela , Adulto Joven
9.
BMC Psychol ; 9(1): 26, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557956

RESUMEN

BACKGROUND: Breast cancer is a common tumor in China and has become a public health problem in modern society. Stress plays an important role in the occurrence and progression of cancer. At present, the current situation of stress on breast cancer survivors (BCSs) in China has not been fully understood. This study aims to explore the stress and coping strategies of Chinese BCSs, which provide suggestions to help BCSs reduce stress. METHODS: Sixty-three BCSs from the Shanghai Cancer Rehabilitation Club in China were included in this study and were divided into eight focus groups. These were transcribed verbatim, coded using thematic analysis and analyzed using NVivo 11. RESULTS: Three themes were extracted from the data to address our research objectives: stress, coping strategies and expectations. The stress of BCSs included psychological stress, stress caused by physical pain, economic stress, stress caused by the change of life status, and stress caused by information overload; the coping strategies included self-strategies and help from others; from the perspective of the survivors, they put forward their expectations for both the society and themselves. CONCLUSIONS: This study shows that BCSs face a variety of stress. In the face of stress, BCSs need comprehensive support, including social and family support to cope with stressors. The findings from this study provide evidence for improving the quality of life among BCSs.


Asunto(s)
Adaptación Psicológica , Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Calidad de Vida/psicología , Estrés Psicológico/psicología , Adulto , Anciano , Neoplasias de la Mama/etnología , China/epidemiología , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Motivación , Investigación Cualitativa
10.
Medicine (Baltimore) ; 100(4): e24159, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530206

RESUMEN

BACKGROUND: The incidence of non-small cell lung cancer (NSCLC) in Uygur population is gradually increasing recently. In view of the great diagnostic and prognostic values of cell-free DNAs (cfDNA) detection, this study focus on a liquid biopsy to explore the value of cfDNA mutation in healthy and NSCLC patients in 2 ethnicities. METHODS: The concentration and sequencing of cfDNA in NSCLC and healthy subjects was assessed with a standard information analysis procedure, including detection, annotation, and statistical analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to analyze the function of mutant genes and related pathways. Totally, 133 subjects, including 35 Uygur NSCLC patients, 10 Uygur healthy subjects, 63 cases of Han NSCLC patients and 25 Han health control, were admitted to the hospital. RESULTS: There were a lower proportion of adenocarcinoma and higher percentage of smoking rate for Uygur patients. For cfDNA level between NSCLC and healthy subjects, Han patients exhibited sharp increase while there was no statistical difference in Uygur population. In addition, the mutation frequency of cfDNA in Han patients (72.6%) was significantly higher than Uygur patients (45.7%). There were 5 gene mutations only found in Han patients and ABCC11 showed a higher mutation frequency in Uygur population as a common one. Finally, Go and Kyoto Encyclopedia of Genes and Genomes analysis showed apprent functional enrichments and pathway changes between 2 ethnicities. CONCLUSION: There existed distinct distributions of cancer subtypes, smoking proportion, cfDNA level, and mutation patterns between Han and Uygur patients. The results may be a useful tool in NSCLC patients' diagnosis as well as individualized therapy between ethnicities in future.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Carcinoma de Pulmón de Células no Pequeñas/etnología , ADN Tumoral Circulante/sangre , Neoplasias Pulmonares/etnología , Transportadoras de Casetes de Unión a ATP/genética , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/patología , China/epidemiología , Bases de Datos Genéticas , Grupos Étnicos , Femenino , Ontología de Genes , Genotipo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Fumar/etnología
11.
Medicine (Baltimore) ; 100(3): e24136, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546026

RESUMEN

ABSTRACT: Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (P < .001) with smaller tumors (P < .001) and higher family income (P < .001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (P < .001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; P < .001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.


Asunto(s)
Neoplasias de la Mama/etnología , Carcinoma Intraductal no Infiltrante/etnología , Adulto , Anciano , Americanos Asiáticos/estadística & datos numéricos , Mama/patología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/mortalidad , Carcinoma Intraductal no Infiltrante/patología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Programa de VERF , Estados Unidos/epidemiología
12.
Proc Natl Acad Sci U S A ; 118(8)2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33547252

RESUMEN

Crises lay bare the social fault lines of society. In the United States, race, gender, age, and education have affected vulnerability to COVID-19 infection. Yet, consequences likely extend far beyond morbidity and mortality. Temporarily closing the economy sent shock waves through communities, raising the possibility that social inequities, preexisting and current, have weakened economic resiliency and reinforced disadvantage, especially among groups most devastated by the Great Recession. We address pandemic precarity, or risk for material and financial insecurity, in Indiana, where manufacturing loss is high, metro areas ranked among the hardest hit by the Great Recession nationally, and health indicators stand in the bottom quintile. Using longitudinal data (n = 994) from the Person to Person Health Interview Study, fielded in 2019-2020 and again during Indiana's initial stay-at-home order, we provide a representative, probability-based assessment of adverse economic outcomes of the pandemic. Survey-weighted multivariate regressions, controlling for preexisting inequality, find Black adults over 3 times as likely as Whites to report food insecurity, being laid off, or being unemployed. Residents without a college degree are twice as likely to report food insecurity (compared to some college), while those not completing high school (compared to bachelor's degree) are 4 times as likely to do so. Younger adults and women were also more likely to report economic hardships. Together, the results support contentions of a Matthew Effect, where pandemic precarity disproportionately affects historically disadvantaged groups, widening inequality. Strategically deployed relief efforts and longer-term policy reforms are needed to challenge the perennial and unequal impact of disasters.


Asunto(s)
Factores de Edad , Grupos de Población Continentales , Disparidades en el Estado de Salud , Pandemias/economía , Pobreza , Adolescente , Adulto , Anciano , /etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Estados Unidos/etnología
13.
JCO Clin Cancer Inform ; 5: 168-175, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539175

RESUMEN

PURPOSE: As health inequities during the pandemic have been magnified, we evaluated how use of SARS-CoV-2 testing differed by race or ethnicity in a large cohort of breast cancer survivors and examined the correlates of testing positive. METHODS: We conducted a retrospective cohort study of 22,481 adult breast cancer survivors who were active members of a large California integrated healthcare plan in 2020. We collected data on their breast cancer diagnosis, comorbidity, and demographic characteristics. We examined SARS-CoV-2 testing utilization between March 2020 and September 2020 by race or ethnicity, comorbidity, and other patient characteristics. We also examined the correlates of a having a positive SARS-CoV-2 test result. We conducted bivariable and multivariable logistic regression to identify correlates of testing utilization and test positivity. RESULTS: Of these 22,481 women, 3,288 (14.6%) underwent SARS-CoV-2 testing. The cohort included 51.8% women of color. Of the 3,288 tested, 264 (8.0%) women had a positive test result. In multivariable analyses, Latinx survivors were more likely (adjusted odds ratio [OR], 1.23; 95% CI, 1.12 to 1.34) to undergo testing than White survivors; however, Asian or Pacific Islander survivors were 16% less likely to get tested (adjusted OR, 0.84; 95% CI, 0.75 to 0.94). Compared to White survivors, Latinx survivors were 3.5 times (adjusted OR, 3.47; 95% CI, 2.52 to 4.77) and Asian or Pacific Islander or Other survivors were 2.2-fold (adjusted OR, 2.23; 95% CI, 1.49 to 3.34) more likely to test positive. Being overweight (adjusted OR, 1.83; 95% CI, 1.24 to 2.72) or obese (adjusted OR, 2.04; 95% CI, 1.39 to 2.98) were also strongly associated with SARS-CoV-2 positivity. CONCLUSION: Even in an integrated healthcare system, Asian or Pacific Islander patients were less likely to undergo SARS-CoV-2 testing than White survivors, but more likely to test positive. Additionally, Latinx ethnicity and high body mass index were strongly correlated with a greater odds of SARS-CoV-2 test positivity.


Asunto(s)
Neoplasias de la Mama/complicaciones , /diagnóstico , Supervivientes de Cáncer/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , California/etnología , Prestación Integrada de Atención de Salud , Femenino , Humanos , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Estudios Retrospectivos
14.
Epidemiol Psychiatr Sci ; 30: e12, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33543688

RESUMEN

AIMS: Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. METHOD: Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. RESULTS: Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to - or at the best passive acceptance of - intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. CONCLUSIONS: Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Trastornos Psicóticos/etnología , Adulto , Región del Caribe , Progresión de la Enfermedad , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Navegación de Pacientes , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Investigación Cualitativa , Clase Social , Reino Unido
15.
N Z Med J ; 134(1529): 86-96, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582711

RESUMEN

AIM: To present a review of recent research exploring alcohol use by Pacific peoples in New Zealand. The review builds on a comprehensive narrative review of research and literature on Pacific peoples and alcohol use, Pearls Unlimited (2009). METHOD: We conducted a scoping review of published and grey literature written and published between 2009 and 2019. Research was included if the study population, or a clearly identified subgroup of the study population, included one or more Pacific ethnicities and addressed alcohol use. RESULTS: There were 30 relevant articles covering a large range of aspects of alcohol consumption by Pacific youth and adults. Alcohol consumption by Pacific men has declined significantly to 60% from 70% in 2006/07. However, of those who consume alcohol, 46% meet the threshold for hazardous consumption. Alcohol consumption by Pacific youth has also declined. CONCLUSION: While there has been some notable research and in-depth exploration of alcohol use and Pacific people, persistent inequity in hazardous alcohol consumption indicates that an evaluation of the current interventions to prevent and service unmet needs of Pacific peoples are overdue.


Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Factores de Edad , Intoxicación Alcohólica/etnología , Humanos , Nueva Zelanda/epidemiología , Factores Protectores , Factores de Riesgo , Factores Sexuales
16.
Nat Commun ; 12(1): 1032, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33589587

RESUMEN

Pulmonary alveolar proteinosis (PAP) is a devastating lung disease caused by abnormal surfactant homeostasis, with a prevalence of 6-7 cases per million population worldwide. While mutations causing hereditary PAP have been reported, the genetic basis contributing to autoimmune PAP (aPAP) has not been thoroughly investigated. Here, we conducted a genome-wide association study of aPAP in 198 patients and 395 control participants of Japanese ancestry. The common genetic variant, rs138024423 at 6p21, in the major-histocompatibility-complex (MHC) region was significantly associated with disease risk (Odds ratio [OR] = 5.2; P = 2.4 × 10-12). HLA fine-mapping revealed that the common HLA class II allele, HLA-DRB1*08:03, strongly drove this signal (OR = 4.8; P = 4.8 × 10-12), followed by an additional independent risk allele at HLA-DPß1 amino acid position 8 (OR = 0.28; P = 3.4 × 10-7). HLA-DRB1*08:03 was also associated with an increased level of anti-GM-CSF antibody, a key driver of the disease (ß = 0.32; P = 0.035). Our study demonstrated a heritable component of aPAP, suggesting an underlying genetic predisposition toward an abnormal antibody production.


Asunto(s)
Autoanticuerpos/genética , Enfermedades Autoinmunes/genética , Predisposición Genética a la Enfermedad , Factor Estimulante de Colonias de Granulocitos y Macrófagos/genética , Cadenas HLA-DRB1/genética , Proteinosis Alveolar Pulmonar/genética , Adulto , Anciano , Alelos , Grupo de Ascendencia Continental Asiática , Autoanticuerpos/biosíntesis , Enfermedades Autoinmunes/etnología , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/patología , Estudios de Casos y Controles , Cromosomas Humanos Par 6 , Femenino , Expresión Génica , Frecuencia de los Genes , Estudio de Asociación del Genoma Completo , Factor Estimulante de Colonias de Granulocitos y Macrófagos/antagonistas & inhibidores , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Cadenas HLA-DRB1/inmunología , Humanos , Japón , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Isoformas de Proteínas/genética , Proteinosis Alveolar Pulmonar/etnología , Proteinosis Alveolar Pulmonar/inmunología , Proteinosis Alveolar Pulmonar/patología , Surfactantes Pulmonares/inmunología , Surfactantes Pulmonares/metabolismo , Riesgo
17.
Nat Commun ; 12(1): 772, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33536424

RESUMEN

Systemic lupus erythematosus (SLE), a worldwide autoimmune disease with high heritability, shows differences in prevalence, severity and age of onset among different ancestral groups. Previous genetic studies have focused more on European populations, which appear to be the least affected. Consequently, the genetic variations that underlie the commonalities, differences and treatment options in SLE among ancestral groups have not been well elucidated. To address this, we undertake a genome-wide association study, increasing the sample size of Chinese populations to the level of existing European studies. Thirty-eight novel SLE-associated loci and incomplete sharing of genetic architecture are identified. In addition to the human leukocyte antigen (HLA) region, nine disease loci show clear ancestral differences and implicate antibody production as a potential mechanism for differences in disease manifestation. Polygenic risk scores perform significantly better when trained on ancestry-matched data sets. These analyses help to reveal the genetic basis for disparities in SLE among ancestral groups.


Asunto(s)
Heterogeneidad Genética , Predisposición Genética a la Enfermedad/genética , Estudio de Asociación del Genoma Completo/métodos , Lupus Eritematoso Sistémico/genética , Polimorfismo de Nucleótido Simple , Grupo de Ascendencia Continental Asiática/genética , Estudios de Casos y Controles , Grupo de Ascendencia Continental Europea/genética , Predisposición Genética a la Enfermedad/etnología , Genotipo , Humanos , Desequilibrio de Ligamiento , Lupus Eritematoso Sistémico/etnología
18.
Aust N Z J Public Health ; 45(1): 34-38, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33522685

RESUMEN

OBJECTIVE: To examine the supply of smoking cessation medicines to Aboriginal and Torres Strait Islander smokers compared to non-Indigenous smokers across Australia. METHODS: We analysed the total number of smoking cessation prescriptions dispensed over three years through the Pharmaceutical Benefits Scheme (PBS) compared to those supplied nationally through the Closing the Gap (CTG) measure and also in the Northern Territory through the Remote Area Aboriginal Health Service (RAAHS) program. RESULTS: Aboriginal and Torres Strait Islander smokers were supplied with fewer smoking cessation medicines per smoker under the CTG measure compared to non-Indigenous smokers under general PBS benefits. Supply of medicines though the RAAHS program complicated the use of CTG data where higher proportions of Aboriginal and Torres Strait Islander people live in remote areas and use of the CTG measure is lower. CONCLUSIONS: Fewer smoking cessation medicines are being prescribed and then dispensed to Aboriginal and Torres Strait Islander smokers than to non-Indigenous smokers. Implications for public health: CTG and RAAHS data may be useful to monitor and evaluate the effectiveness of interventions to improve the use of smoking cessation medicines by Aboriginal and Torres Strait Islander smokers. However, there are limitations and current obstacles to accessing RAAHS data would need to be removed.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/organización & administración , Fumadores/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/efectos adversos , Adulto , Anciano , Australia/epidemiología , Investigación Participativa Basada en la Comunidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Northern Territory/epidemiología , Grupo de Ascendencia Oceánica , Estudios Prospectivos , Fumadores/psicología , Fumar/epidemiología , Fumar/etnología , Cese del Hábito de Fumar/etnología
19.
Am J Epidemiol ; 190(2): 265-276, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524118

RESUMEN

Polyunsaturated fatty acids (PUFAs) are critical for brain development and have been linked with neurodevelopmental outcomes. We conducted a population-based case-control study in California to examine the association between PUFAs measured in midpregnancy serum samples and autism spectrum disorder (ASD) in offspring. ASD cases (n = 499) were identified through the California Department of Developmental Services and matched to live-birth population controls (n = 502) on birth month, year (2010 or 2011), and sex. Logistic regression models were used to examine crude and adjusted associations. In secondary analyses, we examined ASD with and without co-occurring intellectual disability (ID; n = 67 and n = 432, respectively) and effect modification by sex and ethnicity. No clear patterns emerged, though there was a modest inverse association with the top quartile of linoleic acid level (highest quartile vs. lowest: adjusted odds ratio = 0.74, 95% confidence interval: 0.49, 1.11; P for trend = 0.10). Lower levels of total and ω-3 PUFAs were associated with ASD with ID (lowest decile of total PUFAs vs. deciles 4-7: adjusted odds ratio = 2.78, 95% confidence interval: 1.13, 6.82) but not ASD without ID. We did not observe evidence of effect modification by the factors examined. These findings do not suggest a strong association between midpregnancy PUFA levels and ASD. In further work, researchers should consider associations with ASD with ID and in other time windows.


Asunto(s)
Trastorno del Espectro Autista/epidemiología , Ácidos Grasos Insaturados/sangre , Discapacidad Intelectual/epidemiología , Segundo Trimestre del Embarazo/sangre , Trastorno del Espectro Autista/etnología , Peso al Nacer , California/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Edad Gestacional , Humanos , Discapacidad Intelectual/etnología , Masculino , Oportunidad Relativa , Embarazo , Factores Sexuales , Factores Socioeconómicos
20.
Am J Epidemiol ; 190(2): 196-206, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524121

RESUMEN

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.


Asunto(s)
Neoplasias de la Vesícula Biliar/epidemiología , Cálculos Biliares/epidemiología , Anciano , Presión Sanguínea , Pesos y Medidas Corporales , Enfermedades Cardiovasculares/epidemiología , Chile , Diabetes Mellitus/epidemiología , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/etnología , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/etnología , Humanos , Mediadores de Inflamación/sangre , Estudios Longitudinales , Persona de Mediana Edad , Obesidad/epidemiología , Proyectos de Investigación , Factores de Riesgo , Factores Socioeconómicos , Pérdida de Diente/epidemiología
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