Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 66.934
Filtrar
1.
Artículo en Inglés | MEDLINE | ID: mdl-33800952

RESUMEN

Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults ≥65 years old (n = 8023) in the 2010-2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics-cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one's neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults.


Asunto(s)
Afroamericanos , Características de la Residencia , Anciano , Cognición , Grupos Étnicos , Grupo de Ascendencia Continental Europea , Humanos
2.
Artículo en Inglés | MEDLINE | ID: mdl-33801200

RESUMEN

Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.


Asunto(s)
Grupos Étnicos , Veteranos , Afroamericanos , Grupo de Ascendencia Continental Europea , Femenino , Disparidades en Atención de Salud , Hispanoamericanos , Humanos , Masculino , Estados Unidos/epidemiología
3.
Sci Rep ; 11(1): 8738, 2021 04 22.
Artículo en Inglés | MEDLINE | ID: mdl-33888833

RESUMEN

Factors contributing to racial inequities in outcomes from coronavirus disease 2019 (COVID-19) remain poorly understood. We compared by race the risk of 4 COVID-19 health outcomes--maximum length of hospital stay (LOS), invasive ventilation, hospitalization exceeding 24 h, and death--stratified by Elixhauser comorbidity index (ECI) ranking. Outcomes and ECI scores were constructed from retrospective data obtained from the Cerner COVID-19 De-Identified Data cohort. We hypothesized that racial disparities in COVID-19 outcomes would exist despite comparable ECI scores among non-Hispanic (NH) Blacks, Hispanics, American Indians/Alaska Natives (AI/ANs), and NH Whites. Compared with NH Whites, NH Blacks had longer hospital LOS, higher rates of ventilator dependence, and a higher mortality rate; AI/ANs, higher odds of hospitalization for ECI = 0 but lower for ECI ≥ 5, longer LOS for ECI = 0, a higher risk of death across all ECI categories except ECI ≥ 5, and higher odds of ventilator dependence; Hispanics, a lower risk of death across all ECI categories except ECI = 0, lower odds of hospitalization, shorter LOS for ECI ≥ 5, and higher odds of ventilator dependence for ECI = 0 but lower for ECI = 1-4. Our findings contest arguments that higher comorbidity levels explain elevated COVID-19 death rates among NH Blacks and AI/ANs compared with Hispanics and NH Whites.


Asunto(s)
Afroamericanos/estadística & datos numéricos , /epidemiología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Adulto , Anciano , Femenino , Disparidades en el Estado de Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos/etnología
4.
Artículo en Inglés | MEDLINE | ID: mdl-33800177

RESUMEN

To compare African American (AA) and non-Hispanic White men living in same residential areas for the associations between educational attainment and household income with perceived discrimination (PD). The National Survey of American Life (NSAL), a nationally representative study, included 1643 men who were either African American (n = 1271) or non-Hispanic White (n = 372). We compared the associations between the two race groups using linear regression. In the total sample, high household income was significantly associated with lower levels of PD. There were interactions between race and household income, suggesting that the association between household income and PD significantly differs for African American and non-Hispanic White men. For non-Hispanic White men, household income was inversely associated with PD. For African American men, however, household income was not related to PD. While higher income offers greater protection for non-Hispanic White men against PD, African American men perceive higher levels of discrimination compared to White males, regardless of income levels. Understanding the role this similar but unequal experience plays in the physical and mental health of African American men is worth exploring. Additionally, developing an enhanced understanding of the drivers for high-income African American men's cognitive appraisal of discrimination may be useful in anticipating and addressing the health impacts of that discrimination. Equally important to discerning how social determinants work in high-income African American men's physical and mental health may be investigating the impact of the mental health and wellbeing of deferment based on perceived discrimination of dreams and aspirations associated with achieving high levels of education and income attainment of Black men.


Asunto(s)
Afroamericanos , Renta , Hombres , Racismo , Grupo de Ascendencia Continental Europea , Humanos , Masculino , Salud Mental , Estados Unidos
5.
Medicine (Baltimore) ; 100(15): e24523, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847607

RESUMEN

BACKGROUND: Infertility affects childbearing age couples all over the world. One of the important reasons for infertility is genetic factors. Our study evaluated the association between methylenetetrahydrofolate reductase (MTHFR) and azoospermia. METHODS: Multiple databases like MEDLINE, EMBASE, Cochrane library, and China journal full-text database were used to search for relevant studies, and full-text articles involved in the evaluation of MTHFR and azoospermia. The results were evaluated using STATA 12.0. Heterogeneity analysis, sensitivity analysis, and bias analysis were also performed on the data. RESULTS: Thirteen related studies eventually met the inclusion criteria. Significant association between C677T polymorphism and azoospermia (relative risk [RR] = 0.94 [0.90, 0.99], I2 = 60.9%, P = .002), and between A1298C polymorphism and azoospermia (RR = 0.98 [0.94, 1.02], I2 = 56.3%, P = .011) was observed. Meanwhile, in subgroup analysis, Caucasians had higher risk than Mongolians in association between MTHFR and azoospermia. CONCLUSION: There was association between MTHFR polymorphism and azoospermia. Caucasian populations had higher risk than Mongolian populations in association between MTHFR and azoospermia.


Asunto(s)
Azoospermia/genética , Predisposición Genética a la Enfermedad/etnología , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Grupo de Ascendencia Continental Asiática/genética , Grupo de Ascendencia Continental Europea/genética , Humanos , Masculino , Polimorfismo de Nucleótido Simple , Factores de Riesgo
6.
BMC Infect Dis ; 21(1): 338, 2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33845781

RESUMEN

BACKGROUND: As COVID-19 vaccine distribution efforts continue, public health workers can strategize about vaccine promotion in an effort to increase willingness among those who may be hesitant. METHODS: In April 2020, we surveyed a national probability sample of 2279 U.S. adults using an online panel recruited through address-based sampling. Households received a computer and internet access if needed to participate in the panel. Participants were invited via e-mail and answered online survey questions about their willingness to get a novel coronavirus vaccine when one became available. The survey was completed in English and Spanish. We report weighted percentages. RESULTS: Most respondents were willing to get the vaccine for themselves (75%) or their children (73%). Notably, Black respondents were less willing than White respondents (47% vs. 79%, p < 0.001), while Hispanic respondents were more willing than White respondents (80% vs. 75%, p < 0.003). Females were less likely than makes (72% vs. 79%, p < 0.001). Those without insurance were less willing than the insured (47% vs. 78%, p < 0.001). Willingness to vaccinate was higher for those age 65 and older than for some younger age groups (85% for those 65 and older vs. 75% for those 50-64, p < 0.017; 72% for those 35-49, p < 0.002; 70% for those 25-34, p = NS and 75% for ages 18-24, p = NS), but other groups at increased risk because of underlying medical conditions or morbid obesity were not more willing to get vaccinated than their lower risk counterparts. CONCLUSIONS: Most Americans were willing to get a COVID-19 vaccine, but several vulnerable populations reported low willingness. Public health efforts should address these gaps as national implementation efforts continue.


Asunto(s)
/administración & dosificación , Vacunación/psicología , Adolescente , Adulto , Afroamericanos , Anciano , Niño , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Salud Pública , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
8.
MMWR Morb Mortal Wkly Rep ; 70(14): 510-513, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33830986

RESUMEN

Geographic differences in infectious disease mortality rates have been observed among American Indian or Alaska Native (AI/AN) persons in the United States (1), and aggregate analyses of data from selected U.S. states indicate that COVID-19 incidence and mortality are higher among AI/AN persons than they are among White persons (2,3). State-level data could be used to identify disparities and guide local efforts to reduce COVID-19-associated incidence and mortality; however, such data are limited. Reports of laboratory-confirmed COVID-19 cases and COVID-19-associated deaths reported to the Montana Department of Public Health and Human Services (MDPHHS) were analyzed to describe COVID-19 incidence, mortality, and case-fatality rates among AI/AN persons compared with those among White persons. During March-November 2020 in Montana, the estimated cumulative COVID-19 incidence among AI/AN persons (9,064 cases per 100,000) was 2.2 times that among White persons (4,033 cases per 100,000).* During the same period, the cumulative COVID-19 mortality rate among AI/AN persons (267 deaths per 100,000) was 3.8 times that among White persons (71 deaths per 100,000). The AI/AN COVID-19 case-fatality rate (29.4 deaths per 1,000 COVID-19 cases) was 1.7 times the rate in White persons (17.0 deaths per 1,000). State-level surveillance findings can help in developing state and tribal COVID-19 vaccine allocation strategies and assist in local implementation of culturally appropriate public health measures that might help reduce COVID-19 incidence and mortality in AI/AN communities.


Asunto(s)
/estadística & datos numéricos , /etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en el Estado de Salud , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Montana/epidemiología , Mortalidad/etnología , Adulto Joven
11.
Am J Clin Oncol ; 44(4): 150-157, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33653973

RESUMEN

INTRODUCTION: Levels of medical mistrust have historically been higher among racial/ethnic minority patients compared with whites, largely owing to societal and health system inequities and history of discrimination or experimentation. However, recently trust in physicians has declined in the United States in general. We investigated trust in physicians among a large cohort of cancer patients residing in Texas. METHODS: A sample of recently diagnosed cancer patients in Texas were identified from the Texas Cancer Registry with 1344 patients returning surveys between March 2017 and March 2020. The multiscale inventory was mailed to each individual and included the Trust in the Medical Profession Scale which assesses levels of agreement with 11 trust-related statements. Multivariable linear regression models were constructed to assess the adjusted relationship between trust in the medical profession aggregate score and sociodemographic and clinical factors. RESULTS: A total of 1250 surveys were evaluable for trust in the medical profession. The mean aggregate trust score for all patients was 37.3 (95% confidence interval: 36.8-37.7). Unadjusted trust scores were higher for Hispanic (40.5) and black (38.2) respondents compared with white (36.4) (P<0.001). Multivariable analyses showed white, younger, more-educated, or those with lower levels of self-reported health estimated toward lower adjusted scores for trust in the medical profession. CONCLUSIONS: We observed relatively higher levels of medical mistrust among white, younger, more-educated individuals with cancer or those with poorer health. While the relatively higher trust among minority individuals is encouraging, these findings raise the possibility that recent societal trends toward mistrust in science may have implications for cancer care.


Asunto(s)
Afroamericanos/psicología , Grupo de Ascendencia Continental Europea/psicología , Hispanoamericanos/psicología , Neoplasias/psicología , Relaciones Médico-Paciente , Confianza , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Población Rural , Muestreo , Autoinforme , Texas , Población Urbana , Adulto Joven
12.
Gene ; 784: 145592, 2021 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-33766706

RESUMEN

PURPOSE: CYP2C19 metabolizes the antiplatelet and antiepileptic drugs. Any alteration in CYP2C19 activity might influence the therapeutic efficacy. The objective of this study was to identify CYP2C19 variants prevalent in Indians and perform their in silico characterization. METHODS: Infinium global screening array (GSA) was used for CYP2C19 genotyping in 2000 healthy Indians. In addition, we performed in silico characterization of the identified variants. RESULTS: Out of the 11 variants covered (*2, *3, *4,*5,*6, *7,*8, *9,*10,*11, and *17), five were identified in Indians (*2, *3, *6,*8 and *17). The *2 and *17 were the most prevalent alleles (minor allele frequencies, MAF: 32.0% and 13.95%). The *3, *6 and *8 were rare (MAFs: 0.425%, 0.025% and 0.05%). The *2 variant is shown to affect the splicing at the fifth exon-intron boundary. The *3 variant is a non-sense variant that is predicted to be deleterious. On the otherhand, the *17 variant showed more binding affinity for GATA binding protein 1 (GATA1), myocyte enhancer factor 2 (MEF2) and ectotropic viral integration site 1 (EVI1). The *6 and *8 variants predicted to be deleterious. The *2, *3 and *7 variants showed lesser probability of exon skipping, while *17 showed more probability. The genotype distribution of Indian subjects is comparable with that of South Asians (SAS) (1000 genome project, phase 3). CONCLUSION: The *2, *3 and *17 variants are the key pharmacogenetic determinants in Indians. The *2 and *3 are loss-of-function variants. The *17 is a gain-of-function variant with increased binding of transcriptional factors.


Asunto(s)
Citocromo P-450 CYP2C19/genética , Grupo de Ascendencia Continental Europea/genética , Variación Genética , Técnicas de Genotipaje/métodos , Adulto , Anciano , Simulación por Computador , Femenino , Frecuencia de los Genes , Voluntarios Sanos , Humanos , India , Masculino , Metagenómica , Persona de Mediana Edad , Adulto Joven
13.
Medicine (Baltimore) ; 100(11): e24545, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725937

RESUMEN

ABSTRACT: The objective of the present study was to assess the allelic variations of Cytochrome P450 (CYP) enzymes Cytochrome P450 2C19 (CYP2C19), Cytochrome P450 2C9 (CYP2C9), and Cytochrome P450 2D6 (CYP2D6) as they play a major role in drug metabolism. The interindividual genetic variabilities of these enzymes can account for different responsiveness as well as concentration fluctuations for a particular drug.During the period of 2017 to 2018 a total of 54 patients have received pharmacogenetic testing at the Department of Genetics and Molecular Medicine at Kaunas Clinics. According to the genotype-metabolic phenotypes of CYP2C19, CYP2D6, CYP2C9 enzymes patients were classified according to the guidelines by Clinical Pharmacogenetics Implementation Consortium (CPIC): normal metabolizers (NMs), intermediate metabolizers (IMs), rapid metabolizers (RMs), ultrarapid metabolizers (UMs), and poor metabolizers (PMs).CYP2C19 enzyme allelic distribution: 18 patients (33.33%) with ∗1/∗1 genotype were NMs; 14 patients (25.93%) with ∗1/∗2; ∗2/∗17 genotypes were classified as IMs; 15 patients (27.78%) possessed ∗1/∗17 genotype and were RMs; 4 patients (7.4%) had ∗17/∗17 genotype with increased enzyme activity compared with RMs, were classified as UMs; 3 patients (5.56%) had ∗2/∗2 genotype and were marked as PMs. CYP2D6 enzyme allelic distribution: 26 patients (48.148%) contained ∗1/∗1,∗2/∗2,∗1/∗2,∗1/∗41,∗2/∗41 genotypes with normal enzymatic function so were accounted as NMs; 21 patients (38.89%) with ∗1/∗5, ∗2/∗4, ∗10/∗41, ∗1/∗4, ∗1/∗3, ∗2/∗5, ∗2/∗4, ∗2/∗6 genotypes were accounted as IMs; 2 patients (3.7%) possessed ∗2XN genotype and were accounted as UMs and 5 patients (9.26%) possessed ∗4/∗5,∗4/∗10,∗4/∗9,∗4/∗41 genotypes and had non-functional enzymatic activity so were accounted as PMs; CYP2C9 enzyme allelic distribution: 44 patients (81.48%) with∗1/∗1 genotype were NMs; 10 patients (18.52%) with ∗1/∗2;∗1/∗3 genotypes were IMs.The results of our study indicate that deviations from the normal enzymatic activity is common amongst Lithuanian people and combinatory genotyping of CYP2D6, CYP2C9, and CYP2C19 has to be promoted as an advanced method because of most commonly prescribed medicines like analgesics, antihypertensive, antidepressants are metabolized by multiple pathways involving enzymes in the CYP450 family.


Asunto(s)
Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2C9/genética , Citocromo P-450 CYP2D6/genética , Preparaciones Farmacéuticas/metabolismo , Variantes Farmacogenómicas/efectos de los fármacos , Alelos , Grupo de Ascendencia Continental Europea/genética , Genotipo , Humanos , Lituania , Hígado/enzimología , Pruebas de Farmacogenómica , Estudios Retrospectivos
14.
JAMA Netw Open ; 4(3): e214117, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33739433

RESUMEN

Importance: Deficient (ie, <20 ng/mL) or insufficient (ie, 20 to <30 ng/mL) 25-hydroxyvitamin D (also known as calcifediol) levels are more common in Black individuals than White individuals and are associated with increased coronavirus disease 2019 (COVID-19) risk. Whether COVID-19 risk is associated with differences in vitamin D levels of 30 ng/mL or greater is not known. Objective: To examine whether COVID-19 test results are associated with differences in vitamin D levels of 30 ng/mL or greater, including for White individuals and for Black individuals. Design, Setting, and Participants: This retrospective cohort study was conducted at an academic medical center in Chicago, Illinois. Participants included individuals with data on vitamin D level within 365 days before COVID-19 testing, which was conducted from March 3 to December 30, 2020. Data were analyzed from September 11, 2020, to February 5, 2021. Exposures: The last vitamin D level before COVID-19 testing was categorized as less than 20 ng/mL (ie, deficient), 20 to less than 30 ng/mL (ie, insufficient), 30 to less than 40 ng/mL, or 40 ng/mL or greater. Treatment was defined by vitamin D type and dose 14 days before COVID-19 testing and treatment changes after last vitamin D level. Main Outcomes and Measures: The main outcome was a positive result for COVID-19 in polymerase chain reaction testing. Multivariable analyses tested whether previously measured vitamin D level was associated with having test results positive for COVID-19 in White individuals and in Black individuals, controlling for months and treatment changes since the vitamin D level was measured, as well as demographic characteristics and comorbidity indicators. Results: A total of 4638 individuals (mean [SD] age 52.8 [19.5] years; 3205 [69%] women) had data for a vitamin D level within 1 year before COVID-19 testing, including 2288 (49%) Black individuals, 1999 (43%) White individuals, and 351 individuals (8%) who were another race/ethnicity (eg, Asian, Mideast Indian, >1 race). Stratified by vitamin D level, 1251 individuals (27%) had less than 20 ng/mL, 1267 individuals (27%) had 20 to less than 30 ng/mL, 1023 individuals (22%) had 30 to less than 40 ng/mL, and 1097 individuals (24%) had 40 ng/mL or greater. Lower vitamin D levels were more common in Black individuals (<20 ng/mL: 829 of 2288 Black individuals [36%]) than White individuals (<20 ng/mL: 315 of 1999 White individuals [16%]). A total of 333 individuals (7%) had test results positive for COVID-19, including 102 White individuals (5%) and 211 Black individuals (9%). Multivariate analysis controlling for time since last vitamin D level measurement was used to estimate the outcomes associated with levels 14 days before COVID-19 testing. A positive test result for COVID-19 was not significantly associated with vitamin D levels in White individuals but was associated with vitamin D levels in Black individuals (compared with ≥40 ng/mL: <20 ng/mL incidence rate ratio [IRR], 2.55 [95% CI, 1.26-5.15]; P = .009; 20 to <30 ng/mL IRR, 1.69 [95% CI, 0.75-3.84]; P = .21; 30 to <40 ng/mL IRR, 2.64 [95% CI, 1.24-5.66]; P = .01). Stratified by vitamin D level, estimated COVID-19 positivity rates in Black individuals were 9.72% (95% CI, 6.74%-13.41%) for individuals with a vitamin D level less than 20 ng/mL, 6.47% (95% CI, 3.33%-10.28%) for individuals with a vitamin D level of 20 to less than 30 ng/mL, 10.10% (95% CI, 6.00%-15.47%) for individuals with a vitamin D level of 30 to less than 40 ng/mL, and 3.82% (95% CI, 1.78%-6.68%) for individuals with a vitamin D level of 40 ng/mL or higher. Multivariate analysis in individuals with a vitamin D level of 30 ng/mL or greater found that the IRR of a positive COVID-19 test result was 0.97 (95% CI, 0.94-0.99; P = .008) per 1-ng/mL increase in vitamin D overall and 0.95 (95% CI, 0.91-0.98; P = .003) per 1-ng/mL increase in vitamin D in Black individuals. Conclusions and Relevance: In this single-center retrospective cohort study, COVID-19 risk increased among Black individuals with vitamin D level less than 40 ng/mL compared with those with 40 ng/mL or greater and decreased with increasing levels among individuals with levels greater than 30 ng/mL. No significant associations were noted for White individuals. Randomized clinical trials should examine whether increasing vitamin D level to greater than 40 ng/mL affects COVID-19 risk.


Asunto(s)
/estadística & datos numéricos , Deficiencia de Vitamina D , Vitamina D/análogos & derivados , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , /diagnóstico , /prevención & control , Chicago/epidemiología , Estudios de Cohortes , Comorbilidad , Correlación de Datos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo/etnología , Vitamina D/análisis , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/etnología
15.
CNS Drugs ; 35(3): 317-330, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33743151

RESUMEN

BACKGROUND: Disease-modifying therapies (DMTs) for multiple sclerosis (MS) target immunity and have the potential to increase the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and alter its clinical course. We assessed these risks in patients with MS (PwMS). OBJECTIVE: The objective of this study was to describe the overall risk of coronavirus disease 2019 (COVID-19) infection, severe disease course, and potential population-level predictors of COVID-19 infection in PwMS, and to provide a context using a cohort of patients with systemic lupus erythematosus (SLE). In addition, the association of different MS DMTs with the incidence and clinical course of COVID-19 was evaluated. Safety data from the Biogen Global Safety Database are also presented on reported cases of COVID-19 in patients treated with Biogen MS therapies. METHODS: The IBM® Explorys electronic health record database of > 72,000,000 patients from US healthcare networks identified patients with MS or SLE, with and without polymerase chain reaction-confirmed COVID-19. COVID-19 cumulative incidence, hospitalization, and deaths among DMT classes were compared using logistic regression (adjusted for age, sex, body mass index, comorbidities, and race/ethnicity). As a secondary data source to assess safety data, COVID-19 reports for Biogen MS therapies were extracted and described from Biogen's Global Safety Database. RESULTS: 30,478 PwMS with an open DMT prescription were identified within Explorys; 344 were COVID-19 positive. The most significant risk factors for acquiring COVID-19 were comorbidity score ≥ 1, body mass index ≥ 30, and Black/African ancestry. Similar risk factors were also identified for patients with SLE. Patients with MS were less likely to develop COVID-19 when treated with interferons (0.61%) and glatiramer acetate (0.51%), vs all other MS DMTs (both p < 0.001); anti-CD20 therapy was associated with the highest risk (3.45%; p < 0.0001). In the Biogen Global Safety Database, we identified 1217 patients who were COVID-19 positive treated with intramuscular interferon beta-1a, peginterferon beta-1a, natalizumab, dimethyl fumarate, diroximel fumarate, or fampridine. CONCLUSIONS: Comorbidities, obesity, and Black/African ancestry, but not age, were associated with a higher risk of SARS-CoV-2 infection in PwMS. Interferons and glatiramer acetate were associated with a reduced COVID-19 risk, whereas anti-CD20 therapies were associated with an increased risk, within the treated MS cohort. COVID-19 safety reports for patients receiving Biogen MS therapies were consistent with the Explorys database and MS literature, illustrating the replicability and power of this approach.


Asunto(s)
/epidemiología , Hospitalización/estadística & datos numéricos , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Alemtuzumab/uso terapéutico , Azatioprina/uso terapéutico , Cladribina/uso terapéutico , Comorbilidad , Crotonatos/uso terapéutico , Ciclofosfamida/uso terapéutico , Ciclosporina/uso terapéutico , Bases de Datos Factuales , Dimetilfumarato/uso terapéutico , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Clorhidrato de Fingolimod/uso terapéutico , Humanos , Factores Inmunológicos/uso terapéutico , Incidencia , Interferón beta/uso terapéutico , Modelos Logísticos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/epidemiología , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Mitoxantrona/uso terapéutico , Esclerosis Múltiple/epidemiología , Ácido Micofenólico/uso terapéutico , Natalizumab/uso terapéutico , Obesidad/epidemiología , Factores de Riesgo , Rituximab/uso terapéutico , Toluidinas/uso terapéutico , Estados Unidos/epidemiología , Adulto Joven
16.
Transl Behav Med ; 11(3): 785-792, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33769536

RESUMEN

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27-45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members.


Asunto(s)
Afroamericanos/etnología , Americanos Asiáticos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Vacunación Masiva/etnología , Adulto , Femenino , Humanos , Intención , Persona de Mediana Edad , Estados Unidos/etnología , Mujeres
17.
Curr Opin Cardiol ; 36(3): 352-359, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33741768

RESUMEN

PURPOSE OF REVIEW: Despite advances in medical and device-based therapies for advanced heart failure as well as public policy, disparities by race/ethnicity persist in heart failure clinical outcomes. The purpose of this review is to describe disparities in outcomes by race--ethnicity in patients after receipt of heart transplantation and left ventricular assist device (LVAD), and the current understanding of factors contributing to these disparities. RECENT FINDINGS: The proportion of black and Latinx patients receiving advanced heart failure therapies continues to rise, and they have worse hemodynamic profiles at the time of referral for heart transplantation and LVAD. Black patients have lower rates of survival after heart transplantation, in part because of higher rates of cellular and humoral rejection that may be mediated through unique gene pathways, and increased risk for allosensitization and de-novo donor-specific antibodies. Factors that have previously been cited as reasons for worse outcomes in race--ethnic minorities, including psychosocial risk and lower SES, may not be as strongly correlated with outcomes after LVAD. SUMMARY: Black and Latinx patients are sicker at the time of referral for advanced heart failure therapies. Despite higher psychosocial risk factors among race--ethnic minorities, outcomes after LVAD appear to be similar to white patients. Black patients continue to have lower posttransplant survival, because of a complex interplay of immunologic susceptibility, clinical and socioeconomic factors. No single factor accounts for the disparities in clinical outcomes for race--ethnic minorities, and thus consideration of these components together is critical in management of these patients.


Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Grupo de Ascendencia Continental Europea , Insuficiencia Cardíaca/terapia , Humanos , Factores Raciales
18.
Curr Opin Cardiol ; 36(3): 335-339, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33769383

RESUMEN

PURPOSE OF REVIEW: The aim of this review is to discuss racial and sex disparities in the management and outcomes of patients with acute decompensated heart failure (ADHF). RECENT FINDINGS: Race and sex have a significant impact on in-hospital admissions and overall outcomes in patients with decompensated heart failure and cardiogenic shock. Black patients not only have a higher incidence of heart failure than other racial groups, but also higher admissions for ADHF and worse overall survival, while women receive less interventions for cardiogenic shock complicating acute myocardial infarction. Moreover, White patients are more likely than Black patients to be cared for by a cardiologist than a noncardiologist in the ICU, which has been linked to overall improved survival. In addition, recent data outline inherent racial and sex bias in the evaluation process for advanced heart failure therapies indicating that Black race negatively impacts referral for transplant, women are judged more harshly on their appearance, and that Black women are perceived to have less social support than others. This implicit bias in the evaluation process may impact appropriate timing of referral for advanced heart failure therapies. SUMMARY: Though significant racial and sex disparities exist in the management and treatment of patients with decompensated heart failure, these disparities are minimized when therapies are properly utilized and patients are treated according to guidelines.


Asunto(s)
Insuficiencia Cardíaca , Infarto del Miocardio , Afroamericanos , Grupo de Ascendencia Continental Europea , Femenino , Insuficiencia Cardíaca/terapia , Humanos , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia
19.
Eur J Gastroenterol Hepatol ; 33(5): 695-700, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33787541

RESUMEN

BACKGROUND: The data on clinical course and outcome of acute pancreatitis among patients with coronavirus disease 2019 (COVID-19) are sparse. In this study, we analyzed the clinical profiles of patients with COVID 19 and acute pancreatitis. METHODS: This retrospective study was conducted on Research Patient Data Registry data which was pooled from five Mass General Brigham Healthcare Network hospitals. We extracted data on demographics, symptoms, ICU transfer, mechanical ventilation, laboratories' profiles, imaging findings, and patient outcomes. RESULT: Of 985 screened adult patients, 17 were eligible for the study, 9 (52.9%) were admitted primarily for respiratory failure and developed acute pancreatitis after a median of 22.5 days (13-76 days) from the onset of COVID-19 symptoms. On contrary, eight patients presented with typical symptoms and were diagnosed with acute pancreatitis, the majority with mild severity (62.5%) on admission. Patients who were admitted primarily with severe COVID-19 illness were younger (median age 57 vs. 63 years), females (55.6 vs. 25%), of Hispanic ethnicity (55.6 vs. 25%), and obese (88.9 vs. 37.5%). The median peak lipase, C reactive protein, ferritin, lactate dehydrogenase, D-dimer were higher among patients who developed acute pancreatitis later during hospitalization. Patients who developed acute pancreatitis later also experienced higher episodes of necrotizing pancreatitis (11.1% vs. 0), thromboembolic complications (55.6 vs. 12.5%), and higher mortality (37.5 vs. 12.5%). CONCLUSION: Acute pancreatitis is not common among patients with COVID-19. Patients with COVID-19 who had acute pancreatitis on admission had more benign course and overall better outcome as compared to the patients who developed acute pancreatitis during hospitalization.


Asunto(s)
/fisiopatología , Mortalidad Hospitalaria , Pancreatitis/fisiopatología , /fisiopatología , Adulto , Afroamericanos , Distribución por Edad , Anciano , Proteína C-Reactiva/metabolismo , /metabolismo , Grupo de Ascendencia Continental Europea , Femenino , Ferritinas/metabolismo , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hispanoamericanos , Humanos , L-Lactato Deshidrogenasa/metabolismo , Tiempo de Internación , Lipasa/metabolismo , Masculino , Persona de Mediana Edad , Pancreatitis/complicaciones , Pancreatitis/epidemiología , Pancreatitis/metabolismo , Pancreatitis Aguda Necrotizante/epidemiología , /metabolismo , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Tromboembolia/epidemiología
20.
Dental Press J Orthod ; 26(1): e2119133, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33759961

RESUMEN

INTRODUCTION: McNamara's Jr. cephalometric analysis is a tool to diagnose dental and skeletal discrepancies and is widely used, guiding diagnosis for surgical procedures to be performed or for the use of functional devices. Few studies have shown that different ethnic groups have different cephalometric patterns. Thus, single characteristics should be respected to support the diagnosis and to help the treatment plan for different ethnic groups and their different patterns of miscegenation. OBJECTIVE: Obtain normal values for McNamara's cephalometric analysis for adolescent Japanese-Brazilian descents with normal occlusion, as well as to compare this sample with similar samples of White-Brazilian and Japanese. METHODS: Lateral headfilms from 40 White-Brazilian, 33 Japanese and 32 Japanese-Brazilian descents were selected. The three groups were composed by individuals with normal occlusion, well-balanced profiles and were separated by sex. The data were statistically analyzed with ANOVA, t-test, ANCOVA and MANCOVA tests. RESULTS: White-Brazilian males had significantly greater nasolabial angle than Japanese males. Japanese-Brazilian displayed an intermediate value between White-Brazilian and Japanese. CONCLUSION: White-Brazilian, Japanese and Japanese-Brazilian present different cephalometric characteristics of McNamara analysis. Japanese males have a significantly more acute nasolabial angle than White-Brazilian subjects.


Asunto(s)
Grupo de Ascendencia Continental Europea , Cara , Adolescente , Brasil , Cefalometría , Cara/anatomía & histología , Humanos , Japón , Masculino
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...