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1.
Artículo en Inglés | MEDLINE | ID: mdl-33036351

RESUMEN

The new corona virus infection SARS-CoV2 which was later renamed COVID-19 is a pandemic affecting public health. The fear and the constraints imposed to control the pandemic may correspondingly influence leisure activities, such as birding, which is the practice of observing birds based on visual and acoustic cues. Birders are people who carry out birding observations around the globe and contribute to the massive data collection in citizen science projects. Contrasting to earlier COVID-19 studies, which have concentrated on clinical, pathological, and virological topics, this study focused on the behavioral changes of birders. A total of 4484 questionnaire survey responses from 97 countries were received. The questionnaire had an open-ended style. About 85% of respondents reported that COVID-19 has changed their birding behavior. The most significant change in birdwatchers' behavior was related to the geographic coverage of birding activities, which became more local. People focused mostly on yard birding. In total, 12% of respondents (n = 542 cases) reported having more time for birding, whereas 8% (n = 356 cases) reported having less time for birding. Social interactions decreased since respondents, especially older people, changed their birding behavior toward birding alone or with their spouse. Women reported more often than men that they changed to birding alone or with their spouse, and women also reported more often about canceled fieldtrips or society meetings. Respondents from higher developed countries reported that they spend currently more time for birding, especially for birding alone or with their spouse, and birding at local hotspots. Our study suggests that long lockdowns with strict regulations may severely impact on leisure activities. In addition, a temporal and spatial shift in birding due to the pandemic may influence data quality in citizen science projects. As nature-based recreation will be directed more toward nearby sites, environmental management resources and actions need to be directed to sites that are located near the users, e.g., in urban and suburban areas. The results can be applied with caution to other nature-based recreational activities.


Asunto(s)
Ciencia Ciudadana , Infecciones por Coronavirus/psicología , Coronavirus , Actividades Recreativas , Neumonía Viral/psicología , Cuarentena/psicología , Factores de Edad , Anciano , Anciano de 80 o más Años , Animales , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Salud Pública , Factores Sexuales , Conducta Social , Encuestas y Cuestionarios
2.
MMWR Morb Mortal Wkly Rep ; 69(41): 1485-1491, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33056951

RESUMEN

Frequent hand hygiene, including handwashing with soap and water or using a hand sanitizer containing ≥60% alcohol when soap and water are not readily available, is one of several critical prevention measures recommended to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* Previous studies identified demographic factors associated with handwashing among U.S. adults during the COVID-19 pandemic (1,2); however, demographic factors associated with hand sanitizing and experiences and beliefs associated with hand hygiene have not been well characterized. To evaluate these factors, an Internet-based survey was conducted among U.S. adults aged ≥18 years during June 24-30, 2020. Overall, 85.2% of respondents reported always or often engaging in hand hygiene following contact with high-touch public surfaces such as shopping carts, gas pumps, and automatic teller machines (ATMs).† Respondents who were male (versus female) and of younger age reported lower handwashing and hand sanitizing rates, as did respondents who reported lower concern about their own infection with SARS-CoV-2§ and respondents without personal experience with COVID-19. Focused health promotion efforts to increase hand hygiene adherence should include increasing visibility and accessibility of handwashing and hand sanitizing materials in public settings, along with targeted communication to males and younger adults with focused messages that address COVID-19 risk perception.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Higiene de las Manos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adolescente , Adulto , Factores de Edad , Anciano , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/etnología , Grupos Étnicos/psicología , Grupos Étnicos/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/etnología , Factores Sexuales , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
4.
Can Respir J ; 2020: 2045341, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33005276

RESUMEN

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Asunto(s)
Enfermedades Asintomáticas , Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa/prevención & control , Pandemias , Neumonía Viral , Medición de Riesgo/métodos , Adulto , Factores de Edad , Enfermedades Asintomáticas/epidemiología , Enfermedades Asintomáticas/terapia , Betacoronavirus/aislamiento & purificación , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Errores Diagnósticos/prevención & control , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Pronóstico , Factores Sexuales
5.
Nat Commun ; 11(1): 5009, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33024121

RESUMEN

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Hospitalización , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/tratamiento farmacológico , Femenino , Humanos , Gripe Humana/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neumonía Viral/tratamiento farmacológico , Prevalencia , República de Corea/epidemiología , Factores Sexuales , España/epidemiología , Estados Unidos/epidemiología , Adulto Joven
6.
Ann Agric Environ Med ; 27(3): 442-447, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32955228

RESUMEN

INTRODUCTION AND OBJECTIVE: Weekly physical activity (PA) in adolescents is significantly correlated with the educational programme and school environment, where the basis of healthy work habits and a healthy lifestyle is laid. The aim of the study was to identify the differences in the trend and the structure of the weekly step count in adolescent boys and girls in the context of the Polish school environment. MATERIAL AND METHODS: A total of 930 boys and 1,354 girls aged 15-19 years from 64 secondary schools in the Katowice region participated. The research was conducted between 2011-2018. For the objective monitoring of weekly PA, Yamax Digiwalker SW-700 pedometers were used. RESULTS: Between 2011-2014 and 2015-2018, no significant differences were observed in step counts on an average week day, school day, or weekend day. This means that the level of PA, expressed as daily step count, did not decrease between the two 4-year periods. On average, boys performed 10,799 steps/day, while girls performed 10,130 steps/day. The recommendation of 11,000 steps/day was achieved by 42.2% of boys and 35.3% of girls. A significant decrease by 8.6 percentage points in the achievement of 11,000 steps/day between the two 4-year periods was observed only in boys. CONCLUSIONS: It is positive that in the 8-year monitoring of PA, there was no significant decrease in the average steps/day for Polish boys and girls. However, most boys and girls did not meet the 11,000 steps/day recommendation. Both boys and girls were most physically active on Friday and least physically active on Sunday.


Asunto(s)
Ejercicio Físico , Estudiantes/estadística & datos numéricos , Adolescente , Factores de Edad , Femenino , Humanos , Masculino , Polonia , Instituciones Académicas , Factores Sexuales
7.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32928985

RESUMEN

OBJECTIVES: The human papillomavirus (HPV) vaccine was recommended in 2006 for girls and in 2011 for boys. The Healthy People 2020 goal for 2-dose HPV vaccination coverage is 80% by age 15 for girls and boys. We used nationwide population-based data to describe trends in HPV vaccination in children. METHODS: We conducted a cohort study nested within the MarketScan health care database between January 2003 and December 2017. Children were followed from the year they turned 9 until HPV vaccination, insurance disenrollment, or the end of the year when they turned 17, whichever came first. We estimated the cumulative incidence of at least 1- and 2-dose HPV vaccination, stratified by birth year, sex, and state. In secondary analyses, we evaluated the association between state-level vaccination policies and HPV vaccination coverage. RESULTS: This study included 7 837 480 children and 19.8 million person-years. The proportion of 15-year-old girls and boys with at least a 1-dose HPV vaccination increased from 38% and 5% in 2011 to 57% and 51% in 2017, respectively; the proportion with at least a 2-dose vaccination went from 30% and 2% in 2011 to 46% and 39% in 2017, respectively. By 2017, 2-dose HPV vaccination coverage varied from 80% in Washington, District of Columbia, among girls to 15% in Mississippi among boys and was positively correlated with legislation for HPV vaccine education and pediatrician availability. CONCLUSIONS: Despite the increasing trends in uptake, HPV vaccine coverage among commercially insured children in the United States remains behind target levels, with substantial disparities by state.


Asunto(s)
Planes de Seguro con Fines de Lucro/tendencias , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Cobertura de Vacunación/tendencias , Adolescente , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Femenino , Planes de Seguro con Fines de Lucro/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Factores Sexuales , Estados Unidos , Cobertura de Vacunación/estadística & datos numéricos
8.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32943536

RESUMEN

OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6). CONCLUSIONS: Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.


Asunto(s)
Broncodilatadores/uso terapéutico , Hipoxia/complicaciones , Recien Nacido Extremadamente Prematuro , Trastornos del Neurodesarrollo/epidemiología , Óxido Nítrico Sintasa de Tipo II/uso terapéutico , Insuficiencia Respiratoria/mortalidad , Administración por Inhalación , Afroamericanos , Puntaje de Apgar , Peso al Nacer , Broncodilatadores/administración & dosificación , Femenino , Rotura Prematura de Membranas Fetales , Mortalidad Hospitalaria , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Incidencia , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Masculino , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/tratamiento farmacológico , Trastornos del Neurodesarrollo/etnología , Óxido Nítrico Sintasa de Tipo II/administración & dosificación , Alta del Paciente , Embarazo , Puntaje de Propensión , Insuficiencia Respiratoria/tratamiento farmacológico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Factores de Riesgo , Factores Sexuales , Esteroides/uso terapéutico
9.
BMC Infect Dis ; 20(1): 683, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32948142

RESUMEN

BACKGROUND: External genital lesions (EGL) are the most common sexually transmitted infections (STIs). We aimed to evaluate the prevalence, determinants and sex differences in EGL among young adults from Brazil. METHODS: Overall, 7694 participants (aged 16 to 25 years) underwent an interview, genital examination and sampling for HPV genotyping. RESULTS: The prevalence of EGL was 4.08% (234) and is more frequent in men (5.72%) than women (2.31%) (p <  0.001). Genital lesions were significantly associated with male sex, infection by high-risk and multiple HPV types, having more than two sexual partners in the last year, smoking status and the presence of other STI. While alcohol use was associated with a higher prevalence of EGL in women, same-sex sexual relationship increase the prevalence in men. In the EGL group, 67.79% (p = 0.032) were positive for HPV infection and the types HPV6 and HPV11 were the most prevalent ones. CONCLUSION: The prevalence of EGL in young adults was consistently high, and most cases were associated with genital HPV infection and STIs. Although men have a higher prevalence, both sexes share most genital lesion determinants. The promotion of sexual education and vaccination especially focus in young men, who are usually outside the targets of primary health care programmes, can prevent EGL in Brazilian young adults.


Asunto(s)
Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Genitales/patología , Genitales/virología , Papillomavirus Humano 11/patogenicidad , Humanos , Masculino , Prevalencia , Factores de Riesgo , Factores Sexuales , Parejas Sexuales , Enfermedades de Transmisión Sexual/patología , Adulto Joven
10.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32948657

RESUMEN

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Asunto(s)
Determinación de la Presión Sanguínea/estadística & datos numéricos , Hipertensión/diagnóstico , Adolescente , Factores de Edad , Estatura , Niño , Preescolar , Intervalos de Confianza , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Valores de Referencia , Análisis de Regresión , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo
11.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32958610

RESUMEN

BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.


Asunto(s)
Factores de Edad , Disforia de Género/psicología , Disforia de Género/terapia , Trastornos Mentales/epidemiología , Transexualidad/psicología , Transexualidad/terapia , Adolescente , Antipsicóticos/uso terapéutico , Trastornos de Ansiedad/epidemiología , Niño , Estudios Transversales , Depresión/epidemiología , Trastorno Depresivo/epidemiología , Revelación , Humanos , Modelos Logísticos , Trastornos Mentales/tratamiento farmacológico , Salud Mental , Pubertad , Conducta Autodestructiva/epidemiología , Factores Sexuales , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos
12.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32958613

RESUMEN

OBJECTIVES: The youngest children in a classroom are at increased risk of being medicated for attention-deficit/hyperactivity disorder (ADHD). We examined the association between children's birth month and ADHD medication rates in Finland. METHODS: Using a population-based study, we analyzed ADHD medication use among children born in 2005 to 2007. Cases (n = 7054) were identified from the first purchase of medication for ADHD. Cox proportional hazard models and hazard ratios (HRs) were examined by birth month and sex. Finnish children start first grade in the year of their seventh birthday. The cutoff date is December 31. RESULTS: Risk of ADHD medication use increased throughout the year by birth month (ie, January through April to May through August to September through December). Among boys born in September to December, the association remained stable across cohorts (HR: 1.3; 95% confidence interval [CI]: 1.1-1.5). Among girls born in September to December, the HR in the 2005 cohort was 1.4 (95% CI: 1.1-1.8), whereas in the 2007 cohort it was 1.7 (95% CI: 1.3-2.2). In a restricted follow-up, which ended at the end of the year of the children's eighth birthday, the HRs for boys and girls born in September to December 2007 were 1.5 (95% CI: 1.3-1.7) and 2.0 (95% CI: 1.5-2.8), respectively. CONCLUSIONS: Relative immaturity increases the likelihood of ADHD medication use in Finland. The association was more pronounced during the first school years. Increased awareness of this association is needed among clinicians and teachers.


Asunto(s)
Factores de Edad , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Femenino , Finlandia/epidemiología , Humanos , Masculino , Modelos de Riesgos Proporcionales , Factores Sexuales , Factores de Tiempo
13.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32968030

RESUMEN

OBJECTIVES: Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates. METHODS: Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years). RESULTS: We identified 4 classes: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11-0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10-5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41-24.47). CONCLUSIONS: Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/etiología , Consumo de Alcohol en Menores/psicología , Adolescente , Factores de Edad , Alcoholismo/diagnóstico , Australia/epidemiología , Intervalos de Confianza , Femenino , Humanos , Estudios Longitudinales , Masculino , Responsabilidad Parental , Padres , Grupo Paritario , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Adulto Joven
14.
N Engl J Med ; 383(14): 1349-1357, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32997909

RESUMEN

BACKGROUND: The gender gap in physician pay is often attributed in part to women working fewer hours than men, but evidence to date is limited by self-report and a lack of detail regarding clinical revenue and gender differences in practice style. METHODS: Using national all-payer claims and data from electronic health records, we conducted a cross-sectional analysis of 24.4 million primary care office visits in 2017 and performed comparisons between female and male physicians in the same practices. Our primary independent variable was physician gender; outcomes included visit revenue, visit counts, days worked, and observed visit time (interval between the initiation and the termination of a visit). We created multivariable regression models at the year, day, and visit level after adjustment for characteristics of the primary care physicians (PCPs), patients, and types of visit and for practice fixed effects. RESULTS: In 2017, female PCPs generated 10.9% less revenue from office visits than their male counterparts (-$39,143.2; 95% confidence interval [CI], -53,523.0 to -24,763.4) and conducted 10.8% fewer visits (-330.5 visits; 95% CI, -406.6 to -254.3) over 2.6% fewer clinical days (-5.3 days; 95% CI, -7.7 to -3.0), after adjustment for age, academic degree, specialty, and number of sessions worked per week, yet spent 2.6% more observed time in visits that year than their male counterparts (1201.3 minutes; 95% CI, 184.7 to 2218.0). Per visit, after adjustment for PCP, patient, and visit characteristics, female PCPs generated equal revenue but spent 15.7% more time with a patient (2.4 minutes; 95% CI, 2.1 to 2.6). These results were consistent in subgroup analyses according to the gender and health status of the patients and the type and complexity of the visits. CONCLUSIONS: Female PCPs generated less visit revenue than male colleagues in the same practices owing to a lower volume of visits, yet spent more time in direct patient care per visit, per day, and per year. (Funded in part by the Robert Wood Johnson Foundation.).


Asunto(s)
Médicos de Atención Primaria/economía , Atención Primaria de Salud/economía , Estudios Transversales , Registros Electrónicos de Salud , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Atención al Paciente , Atención Primaria de Salud/organización & administración , Factores Sexuales , Factores de Tiempo , Estados Unidos , Carga de Trabajo
15.
Nutrients ; 12(9)2020 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-32887422

RESUMEN

The COVID-19 pandemic has exacerbated economic vulnerabilities and disrupted the Australian food supply, with potential implications for food insecurity. This study aims to describe the prevalence and socio-demographic associations of food insecurity in Tasmania, Australia, during the COVID-19 pandemic. A cross-sectional survey (deployed late May to early June 2020) incorporated the U.S. Household Food Security Survey Module: Six-Item Short Form, and fifteen demographic and COVID-related income questions. Survey data (n = 1170) were analyzed using univariate and multivariate binary logistic regression. The prevalence of food insecurity was 26%. The adjusted odds of food insecurity were higher among respondents with a disability, from a rural area, and living with dependents. Increasing age, a university education, and income above $80,000/year were protective against food insecurity. Food insecurity more than doubled with a loss of household income above 25% (Adjusted Odds Ratio (AOR): 2.02; 95% CI: 1.11, 3.71; p = 0.022), and the odds further increased with loss of income above 75% (AOR: 7.14; 95% CI: 2.01, 24.83; p = 0.002). Our results suggest that the prevalence of food insecurity may have increased during the COVID-19 pandemic, particularly among economically vulnerable households and people who lost income. Policies that support disadvantaged households and ensure adequate employment opportunities are important to support Australians throughout and post the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Abastecimiento de Alimentos/estadística & datos numéricos , Neumonía Viral/epidemiología , Adulto , Factores de Edad , Anciano , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/economía , Estudios Transversales , Demografía , Personas con Discapacidad , Escolaridad , Empleo , Familia , Femenino , Abastecimiento de Alimentos/economía , Humanos , Renta , Masculino , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/complicaciones , Neumonía Viral/economía , Prevalencia , Factores de Riesgo , Población Rural , Factores Sexuales , Factores Socioeconómicos , Tasmania/epidemiología , Adulto Joven
16.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32887793

RESUMEN

BACKGROUND AND OBJECTIVES: Children born preterm experience socioemotional difficulties, including increased risk of autism spectrum disorder (ASD). In this secondary analysis, we tested the effect of combined docosahexaenoic acid (DHA) and arachidonic acid (AA) supplementation during toddlerhood on caregiver-reported socioemotional outcomes of children born preterm. We hypothesized that children randomly assigned to DHA + AA would display better socioemotional outcomes compared with those randomly assigned to a placebo. METHODS: Omega Tots was a single-site randomized, fully masked, parallel-group, placebo-controlled trial. Children (N = 377) were 10 to 16 months at enrollment, born at <35 weeks' gestation, and assigned to 180 days of daily 200-mg DHA + 200-mg AA supplementation or a placebo (400 mg corn oil). Caregivers completed the Brief Infant-Toddler Social and Emotional Assessment and the Pervasive Developmental Disorders Screening Test-II, Stage 2 at the end of the trial. Liner mixed models and log-binomial regression compared socioemotional outcomes between the DHA + AA and placebo groups. RESULTS: Outcome data were available for 83% of children (n treatment = 161; n placebo = 153). Differences between DHA + AA and placebo groups on Brief Infant-Toddler Social and Emotional Assessment scores were of small magnitude (Cohen's d ≤ 0.15) and not statistically significant. Children randomly assigned to DHA + AA had a decreased risk of scoring at-risk for ASD on the Pervasive Developmental Disorders Screening Test-II, Stage 2 (21% vs 32%; risk ratio = 0.66 [95% confidence interval: 0.45 to 0.97]; risk difference = -0.11 [95% confidence interval: -0.21 to -0.01]) compared with children randomly assigned to a placebo. CONCLUSIONS: No evidence of benefit of DHA + AA supplementation on caregiver-reported outcomes of broad socioemotional development was observed. Supplementation resulted in decreased risk of clinical concern for ASD. Further exploration in larger samples of preterm children and continued follow-up of children who received DHA + AA supplementation as they approach school age is warranted.


Asunto(s)
Ácido Araquidónico/administración & dosificación , Trastorno del Espectro Autista/prevención & control , Desarrollo Infantil/efectos de los fármacos , Suplementos Dietéticos , Ácidos Docosahexaenoicos/administración & dosificación , Intervalos de Confianza , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Prematuro , Masculino , Cumplimiento de la Medicación , Placebos/administración & dosificación , Factores Sexuales , Resultado del Tratamiento
17.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32900877

RESUMEN

BACKGROUND: Children born preterm are at high risk for autism spectrum disorder (ASD). However, there is still a lack of appropriate developmental markers. In this study, we aim to examine whether early mental performance trajectory is related to ASD outcome in the preterm population. METHODS: The population-based cohort included 414 very preterm survivors born between 2008 and 2014. After excluding children with severe neurosensory impairment, 319 children with available records of developmental quotients before age 2 years were enrolled. The trajectory of mental performance evaluated by using the Bayley Scales of Infant Development across 6, 12, and 24 months of age was analyzed with group-based trajectory modeling. At 5 years of age, the ASD diagnosis was established by using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. RESULTS: There were 29 children with ASD and 290 children without ASD. The mental performances from age 6 to 24 months could be classified into 3 trajectory patterns: low declining, high declining, and high stable, which corresponded to ASD prevalence at age 5 years of 35%, 9%, and 3%, respectively. ASD odds was 15 times higher in the low-declining group than in the high-stable group (odds ratio 15; 95% confidence interval 3.8-59; P < .001). Through the analysis of multinomial logistic regression, we found that male infants with longer exposure to oxygen therapy whose mothers had lower maternal education levels tended to follow the low-declining trajectory. CONCLUSIONS: The early-life mental trajectory patterns, by using the Bayley Scales of Infant Development, may lead to identification of vulnerable children born preterm for early ASD diagnosis and targeted intervention.


Asunto(s)
Trastorno del Espectro Autista , Desarrollo Infantil , Recien Nacido Extremadamente Prematuro , Factores de Edad , Trastorno del Espectro Autista/clasificación , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/fisiopatología , Preescolar , Intervalos de Confianza , Diagnóstico Precoz , Escolaridad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Oportunidad Relativa , Oxígeno/uso terapéutico , Prevalencia , Factores Sexuales
18.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32913134

RESUMEN

BACKGROUND AND OBJECTIVES: Opioid misuse and overdose remains a leading US public health concern, and many youth are first exposed to opioids via medical use. In this study, we examine school-level prevalence and correlates of medical use and misuse of prescription opioids among US 12th-grade students. METHODS: A sample of 228 507 US 12th-graders in 1079 public and private schools from 2002 to 2017 from the Monitoring the Future study was used to identify school-level prevalence and correlates associated with medical use and misuse of prescription opioids. RESULTS: The past-year prevalence of prescription opioid misuse was 7.6% and ranged from 0% to 73% across US high schools. Lifetime medical use of prescription opioids was 16.9% and ranged from 0% to 85% across US high schools. The odds of prescription opioid misuse were higher at schools with higher proportions of male students, more white students, higher rates of marijuana use, and more medical use of prescription opioids. Students attending schools with the highest rates of medical use of prescription opioids had 57% increased odds of past-year prescription opioid misuse compared with schools with no medical use (adjusted odds ratio = 1.57, 95% confidence interval = 1.35-1.83); this association was found to weaken in recent years. CONCLUSIONS: Differences exist in the prevalence of prescription opioid misuse among US high schools. The association between greater school-level medical use of prescription opioids and higher prevalence of prescription opioid misuse, although declining, indicates a key risk factor to target for prevention efforts.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/epidemiología , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , Adolescente , Intervalos de Confianza , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Oportunidad Relativa , Prevalencia , Instituciones Académicas/estadística & datos numéricos , Factores Sexuales , Estudiantes/estadística & datos numéricos , Estados Unidos/epidemiología
19.
PLoS Biol ; 18(9): e3000849, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32898168

RESUMEN

Despite limited genomic diversity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown a wide range of clinical manifestations in different patient populations. The mechanisms behind these host differences are still unclear. Here, we examined host response gene expression across infection status, viral load, age, and sex among shotgun RNA sequencing profiles of nasopharyngeal (NP) swabs from 430 individuals with PCR-confirmed SARS-CoV-2 and 54 negative controls. SARS-CoV-2 induced a strong antiviral response with up-regulation of antiviral factors such as OAS1-3 and IFIT1-3 and T helper type 1 (Th1) chemokines CXCL9/10/11, as well as a reduction in transcription of ribosomal proteins. SARS-CoV-2 culture in human airway epithelial (HAE) cultures replicated the in vivo antiviral host response 7 days post infection, with no induction of interferon-stimulated genes after 3 days. Patient-matched longitudinal specimens (mean elapsed time = 6.3 days) demonstrated reduction in interferon-induced transcription, recovery of transcription of ribosomal proteins, and initiation of wound healing and humoral immune responses. Expression of interferon-responsive genes, including ACE2, increased as a function of viral load, while transcripts for B cell-specific proteins and neutrophil chemokines were elevated in patients with lower viral load. Older individuals had reduced expression of the Th1 chemokines CXCL9/10/11 and their cognate receptor CXCR3, as well as CD8A and granzyme B, suggesting deficiencies in trafficking and/or function of cytotoxic T cells and natural killer (NK) cells. Relative to females, males had reduced B cell-specific and NK cell-specific transcripts and an increase in inhibitors of nuclear factor kappa-B (NF-κB) signaling, possibly inappropriately throttling antiviral responses. Collectively, our data demonstrate that host responses to SARS-CoV-2 are dependent on viral load and infection time course, with observed differences due to age and sex that may contribute to disease severity.


Asunto(s)
Antivirales/inmunología , Betacoronavirus/fisiología , Infecciones por Coronavirus/inmunología , Neumonía Viral/inmunología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Femenino , Regulación de la Expresión Génica , Humanos , Inmunidad/genética , Cinética , Masculino , Persona de Mediana Edad , Nasofaringe/inmunología , Nasofaringe/virología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Proteínas Ribosómicas/genética , Factores Sexuales , Transducción de Señal/genética , Carga Viral , Cicatrización de Heridas/genética , Adulto Joven
20.
Proc Biol Sci ; 287(1935): 20201424, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32933446

RESUMEN

Social interactions are thought to be a critical driver in the evolution of cognitive ability. Cooperative interactions, such as pair bonding, rather than competitive interactions have been largely implicated in the evolution of increased cognition. This is despite competition traditionally being a very strong driver of trait evolution. Males of many species track changes in their social environment and alter their reproductive strategies in response to anticipated levels of competition. We predict this to be cognitively challenging. Using a Drosophila melanogaster model, we are able to distinguish between the effects of a competitive environment versus generic social contact by exposing flies to same-sex same-species competition versus different species partners, shown to present non-competitive contacts. Males increase olfactory learning/memory and visual memory after exposure to conspecific males only, a pattern echoed by increased expression of synaptic genes and an increased need for sleep. For females, largely not affected by mating competition, the opposite pattern was seen. The results indicate that specific social contacts dependent on sex, not simply generic social stimulation, may be an important evolutionary driver for cognitive ability in fruit flies.


Asunto(s)
Cognición , Drosophila melanogaster/fisiología , Animales , Femenino , Masculino , Memoria , Fenotipo , Reproducción , Factores Sexuales , Sueño , Conducta Social
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