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1.
Anticancer Res ; 40(2): 1055-1058, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014953

RESUMEN

BACKGROUND/AIM: Ulceration is associated with unfavorable prognosis in patients with melanoma. The present study aimed to analyze the characteristics associated with ulcerated melanoma in the United States. It was hypothesized that patient disparities associated with increased odds of ulceration exist. PATIENTS AND METHODS: We searched the National Cancer Database for melanoma patients from 2004 to 2015. Data regarding patient demographics, facility characteristics, and tumor characteristics were analyzed. RESULTS: There were higher odds of ulceration in non-white patients, 50 years of age or older, and melanoma on the trunk and extremities. Lower odds were found in women, zip codes with higher income and education levels, and Metro or Urban counties. CONCLUSION: Age above 49 years, male sex, non-white race, living in rural areas, and living in zip codes with low income and low education were independently associated with ulcerated melanoma.


Asunto(s)
Melanoma/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Vigilancia de la Población , Clase Social , Estados Unidos/epidemiología , Adulto Joven
2.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915334

RESUMEN

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Asunto(s)
Presión Sanguínea/fisiología , Diabetes Mellitus/epidemiología , Cardiopatías/epidemiología , Hipertensión/epidemiología , Adulto , Bangladesh/epidemiología , Comorbilidad , Femenino , Humanos , Hipertensión/diagnóstico , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural/estadística & datos numéricos , Clase Social , Población Urbana/estadística & datos numéricos , Adulto Joven
4.
J Surg Oncol ; 121(3): 494-502, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31902137

RESUMEN

BACKGROUND: Socioeconomic disparities in gastric cancer have been associated with differences in care and inferior outcomes. We evaluated the presentation, treatment, and survival for patients with gastric cancer (GC) in a metropolitan setting with a large African American population. METHODS: Retrospective cohort analysis of patients with GC (2003-2018) across a multi-hospital system was performed. Associations between socioeconomic and clinicopathologic data with the presentation, treatment, and survival were examined. RESULTS: Of 359 patients, 255 (71%) were African American and 104 (29%) Caucasian. African Americans were more likely to present at a younger age (64.0 vs 72.5, P < .001), have state-sponsored or no insurance (19.7% vs 6.9%, P = .02), reside within the lowest 2 quintiles for median income (67.4% vs 32.7%, P < .001), and have higher rates of Helicobacter pylori (14.9% vs 4.8%, P = .02). Receipt of multi-modality therapy was not impacted by race or insurance status. On multivariable analysis, only AJCC T class (HR 1.68) and node positivity (HR 2.43) remained significant predictors of disease-specific survival. CONCLUSION: Despite socioeconomic disparities, African Americans, and Caucasians with GC had similar treatment and outcomes. African Americans presented at a younger age with higher rates of H. pylori positivity, warranting further investigation into differences in risk factors and tumor biology.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Infecciones por Helicobacter/complicaciones , Clase Social , Neoplasias Gástricas/mortalidad , Anciano , Terapia Combinada , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Infecciones por Helicobacter/virología , Helicobacter pylori/aislamiento & purificación , Humanos , Renta , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiología , Neoplasias Gástricas/terapia , Tasa de Supervivencia , Estados Unidos
5.
Braz Oral Res ; 33: e102, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939495

RESUMEN

The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20-64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran's Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Adulto , Brasil/epidemiología , Índice CPO , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Índice Periodontal , Estudios Prospectivos , Calidad de Vida , Autoimagen , Clase Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
6.
J Homosex ; 67(3): 398-416, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30403565

RESUMEN

This study asks, What are the material conditions under which queer studies is done in the academy? It finds a longstanding association of queer studies with the well-resourced, selective colleges and flagship campuses that are the drivers of class and race stratification in higher education in the U.S. That is, the field of queer studies, as a recognizable academic formation, has been structured by the material and intellectual resources of precisely those institutions that most steadfastly refuse to adequately serve poor and minority students, including poor and minority queer students. In response, "poor queer studies" calls for a critical reorientation of queer studies toward working-poor schools, students, theories, and pedagogies. Taking the College of Staten Island, CUNY as a case study, it argues for structural crossing over or "queer-class ferrying" between high-status institutions that have so brilliantly dominated queer studies' history and low-status worksites of poor queer studies.


Asunto(s)
Identidad de Género , Minorías Sexuales y de Género , Grupos de Población Continentales , Escolaridad , Femenino , Humanos , Masculino , Minorías Sexuales y de Género/educación , Minorías Sexuales y de Género/psicología , Clase Social , Factores Socioeconómicos , Estudiantes/psicología , Universidades
7.
J Sports Sci ; 38(1): 38-45, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31613185

RESUMEN

To help inform strategies aimed at increasing muscular fitness levels, we examined factors associated with childhood muscular fitness (strength and power) that preceded the recently observed secular decline. Data were available from a nationally representative sample of Australian children aged 7-15 years in 1985 (n = 8469). Muscular fitness measures included strength (right and left grip, shoulder extension and flexion, and leg strength) and power (standing long jump distance). Anthropometric (adiposity, fat-free mass), cardiorespiratory fitness (CRF), flexibility, speed capability, physical activity (individual and parental), dietary quality and intake (fruit, vegetable, protein) and sociodemographic (area-level socioeconomic status (SES), school type) data were available. Statistical analyses included sex-stratified linear regression. Of all examined factors, measures of adiposity, fat-free mass, CRF, flexibility and speed capability were associated with muscular fitness at levels that met Cohen's threshold for important effects (r-squared = 0.02 to 0.28). These findings highlight the multifactorial relationship between muscular fitness and its determinants. Collectively, these factors were powerful in explaining muscular strength (females: r-squared = 0.32; males: r-squared = 0.41) and muscular power (females: r-squared = 0.36; males: r-squared = 0.42). These findings highlight modifiable and environmental factors that could be targeted to increase childhood muscular fitness.


Asunto(s)
Fuerza Muscular/fisiología , Músculo Esquelético/fisiología , Aptitud Física/fisiología , Adiposidad/fisiología , Adolescente , Australia , Índice de Masa Corporal , Capacidad Cardiovascular/fisiología , Niño , Estudios Transversales , Dieta , Ambiente , Ejercicio/fisiología , Femenino , Humanos , Masculino , Fenotipo , Clase Social
8.
J Urol ; 203(2): 379-384, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31518201

RESUMEN

PURPOSE: Urge urinary incontinence significantly impacts quality of life. We investigated the association between urge urinary incontinence and socioeconomic status in a nationally representative adult population. MATERIALS AND METHODS: We analyzed the 2005 to 2016 NHANES (National Health and Nutrition Examination Survey), a United States population based, cross-sectional study. Urge urinary incontinence was determined by self-report of leaking urine before reaching the toilet. Socioeconomic status was represented by the poverty income ratio, which reflects the family income relative to poverty thresholds specific to that year and household size. Survey weighted logistic regression models were used to analyze the relationship between socioeconomic status and the poverty income ratio. Multiplicative terms were applied to test for interaction in prespecified subgroups of interest. RESULTS: A total of 25,553 participants were included in the final analysis, representing 180 million people in the United States. Of the participants 19.4% reported any urge urinary incontinence, 4.2% reported weekly urge urinary incontinence and 1.6% reported daily urge urinary incontinence. In the fully adjusted multivariable models those with a poverty income ratio less than 2.00 showed significantly higher odds of any urge urinary incontinence compared to the group with a poverty income ratio of 2.00 or greater (OR 1.17, 95% CI 1.05-1.30, p=0.003). There was increasing strength of association for weekly and daily urge urinary incontinence (OR 1.31, 95% CI 1.12-1.55, p <0.001, and OR 1.60, 95% CI 1.23-2.09, p=0.001, respectively). Individual interaction analyses revealed no significant effect of female gender, age greater than 50 years, body mass index 30 kg/m2 or greater, or less than a high school education on the association of urge urinary incontinence with the poverty income ratio. CONCLUSIONS: This study revealed a significant association between urge urinary incontinence and socioeconomic status after meaningful adjustment for covariates. Health care interventions targeting low socioeconomic status individuals with urge urinary incontinence are needed to address this disparity.


Asunto(s)
Incontinencia Urinaria de Urgencia/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Clase Social , Factores de Tiempo , Estados Unidos/epidemiología
9.
J Sports Sci ; 38(1): 13-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31597515

RESUMEN

Cross-sectional study aimed to analyse differences in cognitive performance across fitness components categories (cardiorespiratory fitness [CRF], speed-agility and muscular fitness [MF]) and weight status in children, and to determine whether physical fitness mediates the association between body mass index (BMI) and cognitive performance. Fitness components and BMI were measured using standard procedures in 630 children aged 5-to-7 years from the provinces of Cuenca and Ciudad Real, Spain. BADyG was used to assess cognitive performance. We used ANCOVA models to test mean differences in cognition scores by BMI and fitness categories. Hayes's PROCESS macro was used for mediation analyses. Children with normal weight scored better in spatial factor and general intelligence than their overweight/obese peers (p < 0.05), but differences were attenuated when controlling for CRF (p > 0.05). Children with better results in CRF and speed-agility scored better in all cognitive dimensions even after controlling for BMI (p < 0.05). Similarly, children with high MF obtained better scores in verbal factor (p < 0.05). All fitness components acted as mediators of the relationship between BMI and general intelligence (p < 0.05). These findings highlight the crucial role of fitness in minimising the negative effect of excess weight on children's cognition.Abbreviations: BMI: Body mass index; CRF: Cardiorespiratory fitness; MF: Muscular fitness; BADyG E1: Battery of general and differential aptitudes; SES: Socioeconomic status; SD: Standard deviation; IE: Indirect effect.


Asunto(s)
Peso Corporal/fisiología , Cognición/fisiología , Aptitud Física/psicología , Índice de Masa Corporal , Capacidad Cardiovascular/psicología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Inteligencia/fisiología , Masculino , Músculo Esquelético/fisiología , Sobrepeso/fisiopatología , Sobrepeso/psicología , Obesidad Pediátrica/fisiopatología , Obesidad Pediátrica/psicología , Clase Social
10.
J Sports Sci ; 38(1): 70-78, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31631780

RESUMEN

This study aimed to investigate deprivation and sex differences in selected health-relatedfitness measures in 9-12-year-old children. Data were captured on 3,407 children (49.3% boys; aged 10.5 ± 0.6 years). Cardiorespiratory fitness(20 m multistage shuttle run test; 20 m MSRT), muscular strength (handgrip strength) and body mass index (BMI) were measured. Welsh Index of Multiple Deprivation (WIMD) scores were used to make quintile groups. A two-way Analysis of Variance examined differences in BMI z-score by sex and WIMD quintiles. Two-wayAnalysis of Covariances investigated the effect of sex and WIMD quintiles on grip strength and shuttles achieved in 20 m MSRT, adjusting for BMI z-score and maturation, repectively. Independent of sex, children in the middle quintile had a significantly higher mean BMI z-score (p = 0.029) than their least deprived counterparts. There was a significant increase in grip strength (p = 0.005) and20 m MSRT (boys p < 0.001; girls p = 0.028) between most and least deprived quintiles. Significant differences in 20 m MSRT score were more apparent with decreases in deprivation in boys.Overall, inequalities exist in health-related fitness by sex and deprivation. These results can be used to inform focused services to improve current and future health.


Asunto(s)
Índice de Masa Corporal , Capacidad Cardiovascular/fisiología , Fuerza de la Mano/fisiología , Clase Social , Niño , Estudios Transversales , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Factores Sexuales , Reino Unido
11.
Acta Odontol Scand ; 78(1): 26-30, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31329013

RESUMEN

Objective: This study investigates the association between the prevalence and severity of dental fluorosis, the socio-economic status (SES) and area of residence among 12-year-old schoolchildren in Uruguay.Material and methods: The study was descriptive, cross-sectional, explanatory and observational. Subjects considered eligible were born in 1999 and had their parents' or guardian's prior consent. A questionnaire was used to identify SES according to Centro de Investigaciones Económicas Institute on four levels. Dental fluorosis was determined using the Thylstrup-Fejerskov (TF) index.Results: Of the 1544 students examined, 45.0% showed dental fluorosis. A TF index 1-2 was recorded in 29.3% of the subjects, TF 3 in 20.9%, TF 4 in 6.7% and TF 5-9 in 2.1%. In area 1 (the capital Montevideo city), 84.8% of the subjects had dental fluorosis, a value that was significantly higher than in the inland region (area 2, 24.4%) and border departments (area 3, 22.5%) (x2 = 27.92, p < .0001). Students from families with a low socio-economic level showed less prevalence of dental fluorosis than those with a high level (x2 = 14.58, p = .002).Conclusion: Significant differences exist in the prevalence of dental fluorosis in relation to place of residence and socio-economic level.


Asunto(s)
Fluoruros/efectos adversos , Fluorosis Dental/epidemiología , Características de la Residencia , Clase Social , Estudiantes/estadística & datos numéricos , Niño , Estudios Transversales , Humanos , Prevalencia , Índice de Severidad de la Enfermedad , Uruguay/epidemiología , Abastecimiento de Agua
12.
J Homosex ; 67(3): 367-383, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30335589

RESUMEN

This essay examines the intersection of queerness and social class as it impinges on the field of LGBTQ+ studies. Specifically, it considers some of the disciplinary aims of queer critique in relation to the challenges facing first-generation queer scholars; in so doing, it suggests how forms of difference operate in relation to the personal over time. As a discipline committed to intersectional frameworks, LGBTQ+ studies (and its ongoing evolution) might thus usefully foreground overlapping understandings of outsiderness: namely, how queerness might be experienced as a form of class, and how class might be experienced as a form of queerness.


Asunto(s)
Homosexualidad , Minorías Sexuales y de Género , Clase Social , Escolaridad , Identidad de Género , Humanos , Investigación
13.
Epidemiol Psychiatr Sci ; 29: e78, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31839014

RESUMEN

AIMS: Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes. METHODS: Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes. RESULTS: Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82). CONCLUSIONS: Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Abuso Sexual Infantil/psicología , Maltrato a los Niños/psicología , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Anciano , Ansiedad/epidemiología , Ansiedad/psicología , Australia/epidemiología , Niño , Maltrato a los Niños/estadística & datos numéricos , Abuso Sexual Infantil/estadística & datos numéricos , Depresión/epidemiología , Depresión/psicología , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos Psicóticos/psicología , Clase Social , Estrés Psicológico , Adulto Joven
14.
Epidemiol Psychiatr Sci ; 29: e83, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31839021

RESUMEN

AIMS: Mental disorders are associated with lower subjective social status (SSS), but a more nuanced understanding of this relationship is needed. We examined the influence of disorder age of onset and recency on SSS and studied whether mental disorders are also associated with the discrepancy between actual and desired SSS. METHOD: Data are from the baseline and second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI 3.0), while both actual and desired SSS were assessed with a ten-rung ladder. Linear regression was used to examine the association between mental disorders and SSS. RESULTS: Of 5303 participants, 2237 had a lifetime mental disorder at baseline. These participants reported significantly lower actual SSS (6.28) at follow-up than healthy participants (6.66, B = -0.38 [95% CI -0.48 to -0.27], p < 0.001) and a significantly greater actual-desired SSS discrepancy (1.14 v. 1.05 after controlling for actual SSS, B = 0.09 [0.01-0.17], p = 0.024). Lower age of onset of the first mental disorder was marginally significantly associated with lower actual SSS (B = 0.006 [0.000-0.012], p = 0.046). More recent disorders were also associated with lower actual SSS (B = 0.015 [0.005-0.026], p = 0.005), such that participants whose disorder remitted ⩾6 years before baseline were statistically indistinguishable from healthy participants. CONCLUSIONS: Lifetime mental disorders are associated with lower actual SSS and a slightly greater discrepancy between actual and desired SSS. However, people with mental disorders in (long-term) remission have a similar social status as healthy participants.


Asunto(s)
Trastornos Mentales/psicología , Clase Social , Estrés Psicológico/psicología , Adulto , Edad de Inicio , Estudios de Casos y Controles , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Medio Social , Factores Socioeconómicos
15.
Int Psychogeriatr ; 31(12): 1689-1690, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31856931
16.
Medicine (Baltimore) ; 98(47): e17989, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764810

RESUMEN

RATIONALE: Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings. PATIENT CONCERNS: A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated. DIAGNOSES: He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively. INTERVENTION: He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization. OUTCOME: He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge. LESSONS: A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.


Asunto(s)
Accidente Nuclear de Fukushima , Exposición a la Radiación , Clase Social , Anciano , Humanos , Masculino , Factores de Tiempo , Recuento Corporal Total
17.
Sci Total Environ ; 694: 133783, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31756823

RESUMEN

Many studies of children's exposure to lead (Pb) are carried out in urban and industrialized environments. This study analyzed blood lead level (BLL) data collected from 2011 to 2016 from approximately 140,000 children ages <1 to 6 years across South Carolina (SC), including urban and rural areas. Individual-level characteristics included children's age, and race/ethnicity. Block group variables examined included population by race and ethnicity, households below the poverty level, median year homes built, urban/rural classification, and percent road coverage. BLL were higher in urban compared to rural children but increased to a greater extent in rural children from age < 1 year to 2 years. Road coverage was strongly associated with higher BLL in urban areas, and with home age more weakly, but neither road coverage nor home age was associated with BLL in rural areas. Young urban children may receive greater exposure to Pb from house dust and outdoor legacy Pb contamination, and young rural children through diet and drinking water. Black children had higher BLL in urban areas than white children, and the converse was true in rural areas. Population data indicated that rural areas had more poverty than urban areas, but strong associations between increased children's BLL and either ethnicity or socio-economic status (SES) at the block group level was not observed, likely due to distinct characteristics of poverty and geographic distribution by ethnicity in urban as compared to rural areas of SC. Individual demographics and environmental characteristics may be more closely associated with BLL than geographically aggregated SES and race/ethnicity characteristics. Interventions to reduce children's exposure to Pb should occur at as early an age as possible, and differences between rural and urban areas should be considered as interventions are developed to reduce children's BLL.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/sangre , Plomo/sangre , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Pobreza , Población Rural , Clase Social , South Carolina , Población Urbana
18.
BMC Public Health ; 19(1): 1424, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666052

RESUMEN

BACKGROUND: Tobacco smoking, alcohol and obesity are important risk factors for a number of non-communicable diseases. The prevalence of these risk factors differ by socioeconomic group in most populations, but this socially stratified distribution may depend on the social and cultural context. Little information on this topic is currently available in the Caribbean. The aim of this study was to describe the distribution of tobacco smoking, alcohol drinking and obesity by several socioeconomic determinants in the French West Indies (FWI). METHODS: We used data from a cross-sectional health survey conducted in Guadeloupe and Martinique in 2014 in a representative sample of the population aged 15-75 years (n = 4054). All analyses were stratified by gender, and encompassed sample weights, calculated to account for the sampling design and correct for non-response. For each risk factor, we calculated weighted prevalence by income, educational level, occupational class and having hot water at home. Poisson regression models were used to estimate age-adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: Current smoking and harmful chronic alcohol use were more common in men than in women (PR = 1.80, 95% CI = 1.55-2.09; PR = 4.53, 95% CI = 3.38-6.09 respectively). On the other hand, the prevalence of obesity was higher in women than in men (PR = 0.67, 95% CI = 0.57-0.79). Higher education, higher occupational class and higher income were associated with lower prevalence of harmful alcohol drinking in men (PR = 0.43, 95% CI = 0.25-0.72; PR = 0.73, 95% CI = 0.53-1.01; PR = 0.72, 95% CI = 0.51-1.03 respectively), but not in women. For tobacco smoking, no variation by socioeconomic status was observed in men whereas the prevalence of current smoking was higher among women with higher occupational class (PR = 1.47, 95% CI = 1.13-1.91) and higher income (PR = 1.50, 95% CI = 1.11-2.03). In women, a lower prevalence of obesity was associated with a higher income (PR = 0.43, 95% CI = 0.33-0.56), a higher occupational class (PR = 0.63, 95% CI = 0.50-0.80), a higher educational level (PR = 0.36, 95% CI = 0.26-0.50) and having hot water at home (PR = 0.65, 95% CI = 0.54-0.80). CONCLUSION: Women of high socio-economic status were significantly more likely to be smokers, whereas alcohol drinking in men and obesity in women were inversely associated with socioeconomic status.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Escolaridad , Renta , Obesidad/epidemiología , Ocupaciones , Clase Social , Fumar Tabaco/epidemiología , Adolescente , Adulto , Anciano , Región del Caribe , Estudios Transversales , Femenino , Guadalupe/epidemiología , Humanos , Masculino , Martinica/epidemiología , Persona de Mediana Edad , Enfermedades no Transmisibles , Prevalencia , Factores de Riesgo , Factores Sexuales , Abastecimiento de Agua , Adulto Joven
19.
Nervenarzt ; 90(11): 1187-1200, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31667532

RESUMEN

Social inequality refers to the inequitable distribution of social prosperity including the resource of health. The relationship between social inequality and mental health can be established by means of indicators of social inequality throughout all age groups in Germany. There are social gradients of mental health on the population level, i.e. the linear relationship between social classes or status and state of health. Fundamental determinants of health disparity are cultural, social, political, and geographical conditions, which interact with the genetic make-up and epigenetic processes. These determinants also influence the management of developmental tasks during the life course and are of utmost importance for the development of mental disorders. The maladaptation to chronic stress is at the core of health disparity. Interventions at the individual behavioral level should comprise the development of stress management and coping strategies.


Asunto(s)
Disparidades en Atención de Salud/etnología , Trastornos Mentales , Servicios de Salud Mental/estadística & datos numéricos , Salud Mental , Alemania , Humanos , Trastornos Mentales/etnología , Clase Social , Factores Socioeconómicos
20.
BMC Public Health ; 19(1): 1484, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703658

RESUMEN

BACKGROUND: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect. METHODS: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented. RESULTS: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed. CONCLUSIONS: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.


Asunto(s)
Minas de Carbón/estadística & datos numéricos , Enfermedades Profesionales/mortalidad , Trastornos Respiratorios/mortalidad , Adulto , Región de los Apalaches/epidemiología , Carbón Mineral , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Trastornos Respiratorios/etiología , Factores de Riesgo , Fumar/efectos adversos , Clase Social , Adulto Joven
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