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3.
J Racial Ethn Health Disparities ; 7(3): 398-402, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32306369

RESUMEN

The Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infection spreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be at a particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standing history of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity to COVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest available data in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state of Connecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission on COVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presents for Black and Brown communities.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Grupos Étnicos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Pandemias , Neumonía Viral/epidemiología , Afroamericanos , Grupo de Ascendencia Continental Africana , Betacoronavirus , Connecticut/epidemiología , Grupos de Población Continentales , Infecciones por Coronavirus/prevención & control , Grupo de Ascendencia Continental Europea , Hispanoamericanos , Humanos , Masculino , Neumonía Viral/prevención & control
4.
Am J Surg ; 219(4): 571-577, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32147020

RESUMEN

INTRODUCTION: Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS: The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS: The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION: Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.


Asunto(s)
Gastrectomía/tendencias , Derivación Gástrica/tendencias , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Comorbilidad , Grupos de Población Continentales/estadística & datos numéricos , Conjuntos de Datos como Asunto , Femenino , Financiación Personal/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Sector Privado , Factores Raciales , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven
5.
Am J Surg ; 219(4): 587-591, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32178839

RESUMEN

BACKGROUND: We sought to evaluate the role of trauma center designation in the association of race and insurance status with disposition to rehabilitation centers among elderly patients with Traumatic Brain Injury (TBI). METHODS: The National Trauma Data Bank (2014-2015) was used to identify elderly (age ≥ 65) patients with isolated moderate to severe blunt TBI who survived to discharge. Race, insurance status, and outcomes were stratified by trauma center designation and compared. RESULTS: 3,292 patients met the inclusion criteria. Black patients were 1.5 times less likely (AOR 0.64, p = 0.01) and Latino patients were 1.7 times less likely (AOR 0.58, p = 0 0.007) to be discharged to rehabilitation centers as compared with White patients. Asian patients at Level I hospitals were more likely to be discharged to rehabilitation centers if they had private vs. non-private insurance (42.9% versus 12.7%, p = 0.01). CONCLUSION: Black and Latino patients were less likely to be discharged to rehabilitation centers compared to White patients. The etiology of these disparities deserves further study.


Asunto(s)
Lesiones Traumáticas del Encéfalo/epidemiología , Grupos de Población Continentales/estadística & datos numéricos , Disparidades en Atención de Salud , Alta del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cobertura del Seguro , Masculino , Sistema de Registros , Centros de Rehabilitación , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería , Centros Traumatológicos , Estados Unidos/epidemiología
6.
MMWR Morb Mortal Wkly Rep ; 69(11): 290-297, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32191688

RESUMEN

Of the 70,237 drug overdose deaths in the United States in 2017, approximately two thirds (47,600) involved an opioid (1). In recent years, increases in opioid-involved overdose deaths have been driven primarily by deaths involving synthetic opioids other than methadone (hereafter referred to as synthetic opioids) (1). CDC analyzed changes in age-adjusted death rates from 2017 to 2018 involving all opioids and opioid subcategories* by demographic characteristics, county urbanization levels, U.S. Census region, and state. During 2018, a total of 67,367 drug overdose deaths occurred in the United States, a 4.1% decline from 2017; 46,802 (69.5%) involved an opioid (2). From 2017 to 2018, deaths involving all opioids, prescription opioids, and heroin decreased 2%, 13.5%, and 4.1%, respectively. However, deaths involving synthetic opioids increased 10%, likely driven by illicitly manufactured fentanyl (IMF), including fentanyl analogs (1,3). Efforts related to all opioids, particularly deaths involving synthetic opioids, should be strengthened to sustain and accelerate declines in opioid-involved deaths. Comprehensive surveillance and prevention measures are critical to reducing opioid-involved deaths, including continued surveillance of evolving drug use and overdose, polysubstance use, and the changing illicit drug market; naloxone distribution and outreach to groups at risk for IMF exposure; linkage to evidence-based treatment for persons with substance use disorders; and continued partnerships with public safety.


Asunto(s)
Analgésicos Opioides/envenenamiento , Sobredosis de Droga/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Sobredosis de Droga/etnología , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Distribución por Sexo , Estados Unidos/epidemiología , Urbanización , Adulto Joven
7.
Science ; 367(6484)2020 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-32193295

RESUMEN

Genome sequences from diverse human groups are needed to understand the structure of genetic variation in our species and the history of, and relationships between, different populations. We present 929 high-coverage genome sequences from 54 diverse human populations, 26 of which are physically phased using linked-read sequencing. Analyses of these genomes reveal an excess of previously undocumented common genetic variation private to southern Africa, central Africa, Oceania, and the Americas, but an absence of such variants fixed between major geographical regions. We also find deep and gradual population separations within Africa, contrasting population size histories between hunter-gatherer and agriculturalist groups in the past 10,000 years, and a contrast between single Neanderthal but multiple Denisovan source populations contributing to present-day human populations.


Asunto(s)
Variación Genética , Genética de Población , Genoma Humano , Secuenciación Completa del Genoma , África , Américas , Animales , Asia , Grupos de Población Continentales/genética , Variaciones en el Número de Copia de ADN , Haplotipos , Hominidae/genética , Humanos , Mutación INDEL , Hombre de Neandertal/genética , Oceanía , Filogenia , Polimorfismo de Nucleótido Simple , Densidad de Población
8.
N C Med J ; 81(2): 126-129, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132258

RESUMEN

Racial and ethnic disparities in health care occur within broader contexts impacting the youth who present for behavioral health treatment. Clinician bias and clinical uncertainty can influence diagnostic and treatment outcomes. Behavioral health professionals should strive toward effectiveness in the delivery of culturally sensitive interventions to assist in health promotion with youth of color.


Asunto(s)
Disparidades en Atención de Salud/etnología , Trastornos Mentales/diagnóstico , Trastornos Mentales/etnología , Adolescente , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/psicología , Grupos Étnicos/estadística & datos numéricos , Humanos
9.
Medicine (Baltimore) ; 99(13): e19593, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32221079

RESUMEN

As a rare malignant tumor, pancreatic neuroendocrine tumor (pNET) has very low incidence. However, most of the pNET patients would develop the distant metastasis, which significantly reduces patients' survival rate. Therefore, it is very important to construct a prognostic model of pNET patients with distant metastasis based on a large database to guide clinical application and treatment. The aim of this study is to establish nomograms for cancer-specific survival (CSS) and overall survival (OS) of patients with distant metastatic pNET based on the Surveillance, Epidemiology, and End Results (SEER) database.SEER were reviewed and the patients with pNET diagnosed between 1973 and 2015 were selected. After screening, a total of 624 cases were included in the study. Patients were randomly divided into a training cohort (n = 416) and a validation cohort (n = 208). Cox proportional hazard analysis revealed that age at diagnosis of ≥80 years, year of diagnosis, histological grade, and primary site surgery were independent factors both for CSS and OS. The nomograms indicated good accuracy in predicting 1-, 3-, and 5-year survival, with a C-index of 0.777 (95% confidence interval [CI], 0.743-0.811) for CSS and 0.772 (95% CI 0.738-0.806) for OS in training cohort. In the validation cohort, the C-index was 0.798 (95% CI 0.755-0.841) for CSS and 0.797 (95% CI 0.753-0.841) for OS. The calibration curves showed satisfactory consistency between predicted and actual survival.The study establishes excellent prognostic nomograms for CSS and OS for pNET patients with distant metastasis. They can be used to accurately predict survival rate, and provide useful information to physicians and patients.


Asunto(s)
Carcinoma Neuroendocrino/mortalidad , Carcinoma Neuroendocrino/patología , Nomogramas , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Edad de Inicio , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Programa de VERF , Sensibilidad y Especificidad , Tasa de Supervivencia
11.
PLoS One ; 15(2): e0228336, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053626

RESUMEN

Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.


Asunto(s)
Alostasis , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/mortalidad , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Enfermedades Cardiovasculares/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Estados Unidos/epidemiología , Estados Unidos/etnología
12.
Am J Surg ; 219(4): 557-562, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32007235

RESUMEN

BACKGROUND: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS: White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS: Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.


Asunto(s)
Conducta de Elección , Grupos de Población Continentales/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Participación del Paciente , Factores Raciales , Estados Unidos
13.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32015140

RESUMEN

INTRODUCTION: Identifying trends in smoking behaviors among youth cigarette smokers could inform youth policy and interventions. METHODS: Using 2011-2018 National Youth Tobacco Survey data, logistic/linear regressions were used to analyze trends in smoking frequency, intensity, age of first cigarette use, and electronic cigarette (e-cigarette) use frequency among current smokers. Stratified analyses were conducted among male, female, middle school, and high school students and race and ethnicity subgroups separately. RESULTS: From 2011 to 2018, there was a decrease in smoking ≥10 days (50.0% to 38.3%), ≥20 days (37.2% to 26.3%), and 30 days (26.6% to 18.2%) among current smokers. Smoking prevalence decreased among male, female, high school, non-Hispanic white, and non-Hispanic other students. Overall, light smoking (≤5 cigarettes per day [CPDs]) increased (76.6% to 82.7%), and moderate smoking (6-10 CPDs) decreased (10.7% to 8.3%). Trends in light, moderate, and heavy smoking varied by demographic groups. Age at first cigarette use increased among female (12.28 to 13.29), high school (12.91 to 13.18), and non-Hispanic other students (11.64 to 12.83) and decreased among male students (12.90 to 12.57). From 2014 to 2018, there was an increase in e-cigarette use frequency for ≥10 days (20.8% to 40.9%), ≥20 days (13.5% to 31.7%), and all 30 days (9.3% to 22%). CONCLUSIONS: From 2011 to 2018, current youth cigarette smokers smoked fewer days and fewer CPDs, and age of first cigarette use increased. However, over time, male youth smoked more heavily and started smoking earlier. E-cigarette use increased from 2014 to 2018. Differences by demographic characteristics can inform future research and interventions.


Asunto(s)
Fumar/epidemiología , Fumar/tendencias , Adolescente , Distribución por Edad , Grupos de Población Continentales/estadística & datos numéricos , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Prevalencia , Distribución por Sexo , Productos de Tabaco , Estados Unidos/epidemiología
14.
Am J Surg ; 219(4): 578-582, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32081411

RESUMEN

INTRODUCTION: The aim of this study was to evaluate patient factors that contribute to increased incidence of early onset rectal cancer and analyze the short-term surgical outcomes of patients undergoing surgery. METHODS: A 2-year review (2015-2016) of the ACS-NSQIP included patients with rectal cancer who underwent surgical management. Patients were stratified into early-onset RC (<50-years) and late-onset RC (≥50-years). RESULTS: We included a total of 7538 patients in the analysis. Overall, 14% of the patients had early-onset RC. Patients with early-onset RC were more likely to be Black and Hispanic. Additionally, they were more likely to present with higher TNM stages. Patients with early-onset RC had lower 30-day complications and lower 30-day mortality. There was no difference between the two groups regarding hospital length of stay or 30-day readmission. On regression analysis, there was no difference between the two groups regarding patient outcomes. CONCLUSIONS: Racial disparities do exist in the incidence of RC. Young patients tend to have more aggressive disease, however, surgical outcomes between the two groups are comparable.


Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Adulto , Anciano , Índice de Masa Corporal , Comorbilidad , Grupos de Población Continentales/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Disnea/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Hipertensión/epidemiología , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Diálisis Renal/estadística & datos numéricos , Sepsis/epidemiología , Fumar/epidemiología , Estados Unidos/epidemiología , Pérdida de Peso
15.
PLoS One ; 15(2): e0229280, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32084251

RESUMEN

Natriuretic peptides are cardiac-derived hormones that enhance insulin sensitivity and reduce fat accumulation. Low natriuretic peptide levels are associated with increased risk of type 2 diabetes mellitus (DM2); a condition with variable prevalence across racial/ethnic groups. Few studies have examined whether circulating natriuretic peptide levels and their response to preventive interventions for DM2 differ by race/ethnicity. The Diabetes Prevention Program (DPP) is a clinical trial (July 31, 1996- July 31, 2001) that randomized participants to preventive interventions for DM2. Using stored serum samples, we examined N-terminus pro-B-type natriuretic peptide (NT-proBNP) levels in 3,220 individuals (56% white; 19% African-American; 15% Hispanic; 5% American-Indian; 5% Asian). The influence of race/ethnicity on NT-proBNP concentrations at baseline and after two years of treatment with placebo, lifestyle, or metformin was examined with multivariable-adjusted regression. At baseline, NT-proBNP differed significantly by race (P < .001), with the lowest values in African-American individuals. Hispanic individuals also had lower baseline NT-proBNP levels compared with whites (P< .001), while NT-proBNP levels were similar between white, American-Indian, and Asian individuals. At two years of follow-up, NT-proBNP levels decreased in African-Americans in each of the DPP study arms, whereas they were stable or increased in the other racial/ethnic groups. In the DPP, African-American individuals had lower circulating NT-proBNP levels compared with individuals in other racial/ethnic groups at baseline and after two years of preventive interventions. Further studies should examine the cardio-metabolic implications of lower natriuretic peptide levels in African-Americans. Trial Registration: ClinicalTrials.gov NCT00004992.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/prevención & control , Grupos Étnicos/estadística & datos numéricos , Péptidos Natriuréticos/sangre , Adulto , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Estilo de Vida , Masculino , Metformina/uso terapéutico , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
J Forensic Leg Med ; 69: 101887, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056804

RESUMEN

BACKGROUND: Few studies address the demographics/epidemiology of patients presenting to emergency departments (ED) for evaluation of sexual assault across an entire nation. It was the purpose of this study to analyze the demographics of sexual assault using a national data base. METHODS: This was a retrospective study of prospectively collected data from National Electronic Injury Surveillance System - All Injury Program for years 2005-2013. Patients presenting for sexual assault were analyzed. Descriptive and logistic regression statistical analyses were performed with SUDAAN 11.0.01™ software. A p < 0.05 was considered statistically significant. RESULTS: Sexual assault accounted for an estimated 657,719 ED visits (0.24% of all injuries, and 3.4% of injuries due to violence). When an assault victim presented to the ED, a sexual assault was most likely when the patient was 0-14 years old (OR = 19.48 [12.02, 31.57]), White (OR = 2.12 [1.30, 3.47]), the perpetrator being a stranger (OR = 10.51 [8.21, 13.46]), and occurring at home (OR = 10.05 [6.61, 15.27]). The average annual incidence of ED visits for sexual assault per 10,000 US population was 2.39; 0.47 for males and 4.92 for females. The average was 19.6 years; 90.3% were female. Assaults occurred in the home in 45.6%, and were more common in the summer. The perpetrator was unknown in 37.5%, a friend/acquaintance in 24.8%, other relative in 9.4%, multiple perpetrators in 9.3%, spouse/partner in 6.8%, with the remaining 12.7% from other groups. Racial composition was White in 60.9%, Black in 25.9%, Amerindian in 12.5%, and Asian in 0.5%. The perpetrator was a close relative nearly twice as frequently for male victims compared to female victims. Hospital admission overall was 2.7%: 7.1% when the assault occurred on the street, 1.8% when at school or sporting locations, 4.9% for males and 1.5% for females. Nearly all (98.2%) extremity injuries occurred in females. CONCLUSIONS: Sexual assaults account for 4.4% of ED visits for violence. There was a decrease in the number of sexual assaults occurring on the street and at school/sporting locations over time while the number of assaults by strangers increased. For males, 54.1% occurred in those <10 years of age. The differences between patients by demographic and event characteristics is important information for health care providers.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Vigilancia en Salud Pública , Estudios Retrospectivos , Distribución por Sexo , Estados Unidos/epidemiología , Heridas y Traumatismos/epidemiología , Adulto Joven
17.
J Forensic Leg Med ; 69: 101888, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056805

RESUMEN

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.


Asunto(s)
Traumatismos Faciales/mortalidad , Traumatismos Penetrantes de la Cabeza/mortalidad , Heridas por Arma de Fuego/mortalidad , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Niño , Grupos de Población Continentales/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Femenino , Homicidio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Suicidio Completo/estadística & datos numéricos , Adulto Joven
18.
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
19.
Am J Forensic Med Pathol ; 41(1): 18-26, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32000223

RESUMEN

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.


Asunto(s)
Suicidio Completo/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Asfixia/mortalidad , Depresores del Sistema Nervioso Central/análisis , Niño , Grupos de Población Continentales/estadística & datos numéricos , District of Columbia/epidemiología , Ahogamiento/mortalidad , Etanol/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos del Cuello/mortalidad , Preparaciones Farmacéuticas/análisis , Envenenamiento/mortalidad , Estudios Retrospectivos , Distribución por Sexo , Heridas por Arma de Fuego/mortalidad , Adulto Joven
20.
PLoS Biol ; 18(1): e3000586, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31951611

RESUMEN

The origin and fate of new mutations within species is the fundamental process underlying evolution. However, while much attention has been focused on characterizing the presence, frequency, and phenotypic impact of genetic variation, the evolutionary histories of most variants are largely unexplored. We have developed a nonparametric approach for estimating the date of origin of genetic variants in large-scale sequencing data sets. The accuracy and robustness of the approach is demonstrated through simulation. Using data from two publicly available human genomic diversity resources, we estimated the age of more than 45 million single-nucleotide polymorphisms (SNPs) in the human genome and release the Atlas of Variant Age as a public online database. We characterize the relationship between variant age and frequency in different geographical regions and demonstrate the value of age information in interpreting variants of functional and selective importance. Finally, we use allele age estimates to power a rapid approach for inferring the ancestry shared between individual genomes and to quantify genealogical relationships at different points in the past, as well as to describe and explore the evolutionary history of modern human populations.


Asunto(s)
Grupos de Población Continentales/genética , Especiación Genética , Genética de Población/métodos , Polimorfismo de Nucleótido Simple , Factores de Edad , Alelos , Simulación por Computador , Conjuntos de Datos como Asunto , Evolución Molecular , Frecuencia de los Genes , Variación Genética , Genoma Humano , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Linaje , Filogenia , Análisis de Secuencia de ADN , Estadística como Asunto/métodos , Factores de Tiempo
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