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J Crohns Colitis ; 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33721889


BACKGROUND AND AIMS: The association between smoking and inflammatory bowel disease (IBD) relies on old meta-analyses including exclusively non-Jewish White populations. Uncertainty persists regarding the role of smoking in other ethnicities. METHODS: We systematically searched Medline/PubMed, Embase and Scopus for studies examining tobacco smoking and the risk of developing IBD, i.e., Crohn's disease (CD) or ulcerative colitis (UC). Two authors independently extracted study data and assessed each study's risk-of-bias. We examined heterogeneity and small-study effect, and calculated summary estimates using random-effects models. Stratified analyses and meta-regression were employed to study the association between study-level characteristics and effect estimates. The strength of epidemiological evidence was assessed through prespecified criteria. RESULTS: We synthesized 57 studies examining the smoking-related risk of developing CD and UC. Non-Jewish White smokers were at increased risk of CD (29 studies; RR: 1.95, 95% CI: 1.69‒2.24; moderate evidence). No association was observed in Asian, Jewish and Latin-American populations (11 studies; RR: 0.97; 95% CI: 0.83-1.13), with no evidence of heterogeneity across these ethnicities. Smokers were at reduced risk of UC (51 studies; RR: 0.55, 95% CI: 0.48-0.64; weak evidence) irrespectively of ethnicity; however, cohort studies, large studies and those recently published showed attenuated associations. CONCLUSIONS: This meta-analysis did not identify any increased risk of CD in smokers in ethnicities other than non-Jewish Whites, and confirmed the protective effect of smoking on UC occurrence. Future research should characterize the genetic background of CD patients across different ethnicities to improve our understanding on the role of smoking in CD pathogenesis.

Artigo em Inglês | MEDLINE | ID: mdl-33025714


Living with a chronic or mental health condition can be challenging and requires considerable adjustment. As ways of coping are culturally influenced, it is important to understand how minority ethnic populations cope, to inform appropriate services. This review aimed to explore the coping strategies used by UK residents from an African Caribbean or Irish background between 1960 and 2020. A systematic literature search on strategies used to cope with chronic health conditions in both populations living in the United Kingdom identified 26 relevant studies. Data were extracted, quality of papers was appraised and critical interpretive synthesis was applied. Two major foci of the studies were coping strategies and barriers to coping. The main coping strategies were denial/scepticism, self-management, spirituality and religion. Within each population, there was variation in ways of coping. The review highlights the complex role of religion in influencing coping strategies. It demonstrates how personal and minority ethnic populations' experiences of service use are connected with stigma, fear and mistrust, which also act as barriers to seeking help and to coping. Coping with a chronic or mental health condition in the Irish and African Caribbean populations is under-researched. Stigma, fear and mistrust in services act as key barriers to help-seeking and religion is a prominent coping strategy. However, few detailed examples were given on how it was used to assist individuals when managing a chronic or mental health condition. Also due to a lack of research, firm conclusions cannot be drawn for the Irish population.

BrJP ; 3(3): 253-257, July-Sept. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1132016


ABSTRACT BACKGROUND AND OBJECTIVES: There are communication barriers to assess pain in patients with consciousness and cognitive disorders. This study aimed to make the cross-cultural adaptation of the Nociception Coma Scale-Revised (NCS-R) to the Portuguese language and check the validation evidence of the content of the NCR-R Brazilian version in non-communicative patients with consciousness and cognitive disorders. METHODS: This is a methodological study to check the cross-cultural adaptation of the NCR-R, divided into two stages: cross-cultural adaptation and check of the content validity. The cross-cultural adaptation phase included an initial translation, synthesis of translations, back-translation, expert committee, and cognitive debriefing based on Beaton and Price. A second expert committee evaluated the translated and adapted version to check the content validity index RESULTS: The NCS-R scale was translated and cross-culturally adapted, presenting good evidence of content validity with a Content Validity Index of 0.86. CONCLUSION: The NCS-R is translated and transculturally adapted and has good evidence of content validity.

RESUMO JUSTIFICATIVA E OBJETIVOS: Em pacientes com desordens de consciência e distúrbios cognitivos há barreiras de comunicação para a avaliação da dor. O objetivo deste estudo foi realizar a adaptação transcultural da Nociception Coma Scale-revised (NCS-R) para a língua portuguesa e verificar as evidências de validade de conteúdo da versão brasileira da NCS-R em pacientes não comunicativos com desordens de consciência e distúrbios cognitivos. MÉTODOS: Estudo metodológico para adaptação transcultural da NCS-R dividido em duas etapas: adaptação transcultural e verificação da validade de conteúdo. A fase de adaptação transcultural incluiu a tradução inicial, síntese das traduções, retrotradução, comitê de especialista e debriefing cognitivo baseado em Beaton e Price. A versão traduzida e adaptada foi avaliada por um segundo comitê de especialistas para a avaliação do índice de validade de conteúdo. RESULTADOS: A NCS-R foi traduzida, adaptada do ponto de vista transcultural e apresentou boa evidência de validade de conteúdo com Índice de Validade de Conteúdo de 0,86. CONCLUSÃO: A NCS-R encontra-se traduzida e adaptada do ponto de vista transcultural, e possui boa evidência de validade de conteúdo.

Cad. saúde colet., (Rio J.) ; 28(2): 311-324, abr.-jun. 2020. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1132960


Resumo Introdução Há crescente número de publicações brasileiras envolvendo a escala de Senso de Coerência (SOC), mas o processo de adaptação transcultural ainda não pode ser considerado definitivo. Objetivo Revisar sistematicamente estudos de adaptação transcultural da versão brasileira, sumarizando as propriedades psicométricas. Métodos Foram pesquisadas sete bases de dados eletrônicas até janeiro de 2019: LILACS, BBO, BDENF-Nursing, Index Psychology, PubMed, EMBASE e Scopus, com restrição para o Brasil ou língua portuguesa. Resultados Foram identificadas 78 referências das quais foram incluídos 15 artigos e duas teses. Versões com 13 e 29 itens foram encontradas, que deveriam possuir os seguintes domínios: compreensão, manejo e significado. Verificou-se que até o momento os estudos não consideraram todas as etapas específicas para adaptação transcultural brasileira, apesar de apresentarem etapas metodológicas para validade de conteúdo e confiabilidade. A consistência interna da escala inteira (α de Cronbach) de oito estudos para SOC-13 variou de 0,61 a 0,81, e em quatro estudos, para SOC-29 de 0,77 a 0,87. Um único estudo (SOC-29) mostrou cargas fatoriais baixas para cinco itens nas análises dos componentes principais. Conclusão Há necessidade de aprofundar as pesquisas sobre adaptação da versão brasileira, em português, da escala de SOC.

Abstract Background Brazilian publications involving the Sense of Coherence (SOC) scale has increased, however the cross-cultural adaption process is not yet definite. Objective This study aimed to review systematically the cross-cultural adaptation studies of the Brazilian version of the SOC scale, summarizing psychometric properties. Methods Seven electronic databases were searched until January 2019: LILACS, BBO, BDENF-Nursing, Index Psychology, PubMed, EMBASE and Scopus with restriction for Brazil or Portuguese Language. Results It was identified 78 references, which15 papers and 2 thesis were included. Versions with 13 and 29 items were used and items should group in three domains: comprehensibility, manageability and meaningfulness. It was verified that the studies did not consider all specific stages of cross-cultural adaptation to the Brazilian culture, despite presenting methodological steps for content validity and reliability. The internal consistency for the whole scale (Cronbach α) in eight studies for SOC-13 ranged from 0.61 to 0.81 and 4 studies for SOC-29 from 0.77 to 0.87. A single study showed low factor loadings for some items in the main component analysis on SOC-29. Conclusion It is possible to conclude that it is necessary to deepen the research on adaptation of the Brazilian version of the SOC scale.

Public Health Nutr ; 23(S1): s39-s50, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32131930


OBJECTIVE: To assess the relationship between malnutrition, socioeconomic status (SES) and ethnicity in Chilean adult population. DESIGN: Nationally representative survey (ENS) conducted in 2016-2017. Sociodemographic information, weight, height and hemoglobin (Hb) were measured (2003 ENS). Excess weight was defined as BMI ≥25 kg/m2. Undernutrition included underweight (BMI <18·5 kg/m2), short stature (height <1·49 m in women and <1·62 m in men) or anaemia (Hb <12 g/l). Education and household income level were used as indicators of SES; ethnicity was self-reported. We applied linear combinations of estimators to compare the prevalence of excess weight and undernutrition by SES and ethnicity. SETTING: Chile. PARTICIPANTS: In total, 5082 adults ≥20 years (64 % women) and 1739 women ≥20 years for anaemia analyses. RESULTS: Overall, >75 % of women and men had excess weight. Low SES women either by income or education had higher excess weight ((82·0 (77·1, 86·1) v. 65·0 (54·8, 74·1)) by income; (85·3 (80·6, 89·0) v. 68·2 (61·6, 74·1) %) by education) and short stature (20-49 years; 31(17·9, 48·2) v. 5·2 (2·2,11·4) by education); obesity was also more frequent among indigenous women (20-49 years; 55·8 (44·4, 66·6) v. 37·2 (32·7, 42·0) %) than non-indigenous women. In men, excess weight did not significantly differ by SES or ethnicity, but short stature concentrated in low SES (20-49 years; 47·6 (24·6, 71·6) v. 4·5 (2·1, 9·5) by education) and indigenous men (21·5 (11·9, 5·5, 11·9) v. 8·2 (5·5, 11·9)) (P < 0·05 for all). CONCLUSIONS: In Chile, malnutrition is disproportionately concentrated among women of low SES and indigenous origin; these inequalities should be considered when implementing prevention policies.

J Matern Fetal Neonatal Med ; : 1-7, 2020 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-31957526


Background: Current policy and service provision recommend a woman-centered approach to maternity care and the development of personalized models for clinical assistance. Ethnicity has been recognized as a determinant in the risk calculation of selected obstetric complications. Based on these assumptions, our aims were to describe the linkage between baseline characteristics and maternal ethnicity and to analyze the cost for the local healthcare system, distinguishing mode of delivery, absence or presence of complications at birth, and maternal stay duration for all ethnic groups.Methods: In a 5-year period (2012-16), all women admitted for delivery at the Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Rome, Italy, were included in the analysis. Maternal demographics, adverse outcomes, and costs were evaluated. Economic calculations were performed by using the "diagnosis-related group" (DRG) approach.Results: A total of 18,093 patients were included in the analysis. An overall care expense of €42,663,481 was calculated. Caucasian was the main ethnicity (90.7%), with 9.3% minority groups. Vaginal delivery (VD) was the most common mode of delivery in all ethnic groups, with a global rate of 59.6%. The highest cesarean section (CS) rates were observed among Maghreb (51.5%) and Afro-Caribbean (47.8%) women. Minority groups had a doubled rate of complicated VD, primarily Afro-Caribbean women (69.9%), followed by Asian (64.1%), Maghreb (63.2%), and Latin American (62.7%) women. Afro-Caribbean women had the highest rate of complicated CS compared to the overall study population (37.6 versus 28.5%, p < .005).Conclusions: Minority groups have increased healthcare costs for birth assistance, mainly due to the higher rates of complications. In a prospective view, two strategies could be planned: first, calculating individualized risk to mitigate the clinical care charge, based on the ad hoc combination of ethnicity, mode of delivery, and obstetric complications; and second, endorsing the current financial return-on-investment opportunity tied to mitigating ethnic disparities in birth outcomes.

Public Health Nutr ; 23(S1): s68-s76, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31588883


OBJECTIVE: To analyse disparities of malnutrition in all its forms by socio-economic indicators in children aged <5 years, adolescent girls and women of reproductive age (WRA). DESIGN: We defined wasting/underweight, stunting/short stature, overweight and obesity following the WHO criteria for children aged <5 years, adolescents and WRA. We evaluated the prevalence of malnutrition by wealth status, education level and ethnicity (indigenous/non-indigenous). SETTING: Guatemalan 2014-2015 National Maternal and Child Health Survey. PARTICIPANTS: Children aged <5 years (n 11 962), adolescent girls aged 15-19 years (n 1086) and WRA aged 20-49 years (n 11 354). RESULTS: Stunting/short stature prevalence among children, adolescents and WRA was 2·8, 2·1 and 2·0 times higher in the poorest compared with the richest; 2·9, 2·9 and 2·1 times higher in the lower educational level than in the highest; and 1·7, 1·7 and 1·6 times higher in the indigenous than in the non-indigenous population. In contrast, overweight/obesity prevalence among children, adolescents and WRA was 1·6, 2·1 and 1·8 times higher in the richest compared with the poorest; 1·6, 1·3 and 1·3 times higher in the higher educational level than in the lowest; and 1·3, 1·7 and 1·3 times higher in the non-indigenous than in the indigenous population. CONCLUSIONS: Stunting/short stature is more prevalent among low-income, low-education and indigenous populations in all age groups. In contrast, overweight/obesity is more prevalent in high-income, high-education and non-indigenous populations in all age groups. These outcomes demonstrate socio-economic and ethnic disparities for malnutrition in all its forms.

Surgery ; 167(3): 661-667, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31653491


BACKGROUND: This investigation was undertaken to define the factors determining the optimal and most productive relationship among indigenous communities, surgeons, and providers of surgical services. METHODS: A systematic literature review was conducted to identify studies reporting on the experience of indigenous communities with surgeons, medical practitioners, and the providers of surgical and other health services. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, including all literature available until the search date of April 3, 2019. The reference lists of all included articles and related review articles were searched manually to identify further relevant studies. An inductive approach was used to identify common themes. RESULTS: Thirty-three publications discussed the experiences of New Zealand Maori (n = 2), Aboriginal and Torres Strait Islanders (n = 20), North American First Nation (n = 10), and Indigenous Latin Americans (n = 1). Across all indigenous peoples, 6 themes emerged: accessible health services, community participation and community governance, continuous quality improvement, a culturally appropriate and clinically skilled workforce, a flexible approach to care, and holistic healthcare. CONCLUSION: To provide medical and surgical services in indigenous communities successfully requires a diverse range of skills and core technical and academic competencies. Many skills lie within the definition of professionalism and advocacy as well as the ability to undertake and operationalize community consultation and empowerment. If surgical services serving Indigenous communities are to be successful in addressing health disparity, specific training in these skills will need to be developed and made available.

Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Especialidades Cirúrgicas/organização & administração , Competência Clínica , Participação da Comunidade , Assistência à Saúde Culturalmente Competente/organização & administração , Saúde Global , Humanos , Povos Indígenas , América Latina/etnologia , Nova Zelândia/etnologia , América do Norte/etnologia , Melhoria de Qualidade , Cirurgiões , Recursos Humanos/organização & administração
J Relig Health ; 59(1): 431-451, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31828596


Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.

Grupo com Ancestrais do Continente Africano , Nível de Saúde , Religião , Espiritualidade , Adulto , Afro-Americanos , Região do Caribe/etnologia , Emigração e Imigração , Feminino , Humanos , Masculino , Saúde Mental/etnologia , Estados Unidos
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047752


Objetivo: realizar um mapeamento na literatura sobre os estudos que abordam a saúde das mulheres quilombolas. Método: revisão integrativa de literatura de abordagem qualitativa, realizada em três bases de dados, com a utilização da combinação dos descritores: Grupo com Ancestrais do Continente Africano, Mulheres, Saúde, num intervalo temporal de 10 anos. Resultados: emergiram 66 artigos, sendo incluídos 58 para análise e discussão. Formou-se eixos temáticos, onde 25 estavam relacionadas às doenças das mulheres quilombolas e com limitada discussão da promoção da saúde e dos determinantes sociais. Os outros 33 artigos relacionavam-se à contextualização histórica e social dos quilombos, Atenção Primária à Saúde, iniquidade social e violência, racismo e discriminação e acesso das mulheres quilombolas aos serviços de saúde. Conclusão: identificou-se limitações frente a determinação social com foco em pesquisas de cunho biológico e com ênfase na doença, destacando a necessidade imperiosa de estudos voltados a promoção da saúde desta população

Objective: to carry out a mapping in the literature on studies addressing the health of quilombolas women. Method: integrative review of literature of qualitative approach, held in three databases, using the combination of the descriptors: african continental ancestry group, women, health, in a time interval of 10 years. Results: 66 articles emerged, being included 58 for analysis and discussion. It formed themes, and from these 25 were related diseases of the quilombo women and limited discussion of health promotion and social determinants. The other 33 articles were related to the historical and social context of the quilombos, Primary Health Care, social inequity and violence, racism and discrimination and access of quilombos women to health services. Conclusion: we identified limitations front the social determination with focus on research of biological nature and an emphasis on disease, highlighting the necessity of studies regarding at promoting the health of this population

Objetivo: realizar un levantamiento en la literatura sobre los estudios que abordan la salud de las mujeres quilombolas. Método: revisión integrativa de literatura de abordaje cualitativo, realizada en tres bases de datos, con la utilización de combinación de las siguientes palabras clave: Grupo con Ancestrales del Continente Africano, Mujeres, Salud, en un intervalo temporal de 10 años. Resultados: han surgido 66 artículos, de los cuales 58 se ha analizado y discutido. A partir de esto, se ha formado ejes temáticos, de los cuales 25 artículos presentan relación con enfermedades de las mujeres quilombolas y con limitada discusión de la Promoción de la Salud y de los Determinantes Sociales. Los otros 33 artículos presentan relación con la contextualización histórica y social de los quilombos, Atención Primaria a la Salud, iniquidad social y violencia, racismo y discriminación y acceso de las mujeres quilombolas a los servicios de salud. Conclusión: se identificó limitaciones frente a la determinación social con foco en investigaciones de carácter biológico y con énfasis en la enfermedad, destacando la necesidad imperiosa de estudios volcados a la Promoción de la Salud de esta población

Humanos , Feminino , Saúde da Mulher , Grupo com Ancestrais do Continente Africano , Determinantes Sociais da Saúde , Brasil , Serviços de Saúde da Mulher
Rev. bras. educ. méd ; 44(3): e090, 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1137508


Abstract: Introduction: There are still many economic and racial barriers for black and indigenous peoples regarding access to a university degree in Brazil. Although Brazil is mistakenly considered a racial democracy, black people, indigenous peoples and those of low social status are the most affected by such difficulties regarding access to the university. Medical schools are traditionally attended by white, wealthy and upper-middle-class groups, although 54% of Brazilians consider themselves to be African descendants. To deal with this scenario, since 2013, 50% of all vacancies in public universities have been reserved for low social classes, indigenous peoples and African descendants. Our objective was to describe the socioeconomic and racial profile of those attending a public medical school in the state of Rio de Janeiro during a five-year period, analyzing the associations between the Brazilian segregationist structure and inclusion policies. Method: A census study was carried out, including all groups that entered the medical school at a public university in the state of Rio de Janeiro between 2013 and 2017. We applied a self-administered questionnaire that addressed social, ethnic, economic and university admission aspects. The data were analyzed by a simple description of the frequencies and by bivariate analysis. Results: The results show that the majority profile is white, with an annual income higher than US$ 8,640, coming from a private school, with financial support from the family, both parents with higher education and no gender difference. As for the inclusion of non-white people into the course, the current quota system has not significantly increased their presence. Conclusion: We conclude that racial inclusion policies subordinated to economic ones seem to be a barrier to the entry of non-whites to medical school, contributing to racial inequality.

Resumo: Introdução: O Brasil continua sendo um país onde persistem muitas barreiras socioeconômicas e raciais para acesso à formação médica. Ainda que o Brasil seja equivocadamente considerado uma democracia racial, pessoas negras, povos indígenas e aqueles de baixo status social são os mais afetados por tais dificuldades de acesso à universidade. As faculdades de Medicina são tradicionalmente ocupadas por grupos brancos, ricos e de classe média alta, embora 54% dos brasileiros se considerem afro-brasileiros. Para lidar com esse cenário, há, desde 2013, a reserva de 50% de todas as vagas em universidades públicas para baixa classe social, povos indígenas e pessoas negras. Nosso objetivo foi descrever o perfil socioeconômico e racial dos ingressantes de uma faculdade de Medicina da Região Sudeste ao longo de cinco anos, analisando as relações entre a estrutura segregacionista brasileira e as políticas de inclusão. Método: Um estudo censitário foi realizado abrangendo todos os grupos que entraram entre 2013 e 2017 na Faculdade de Medicina de uma universidade do Estado do Rio de Janeiro. Optamos por aplicar um questionário autoadministrado que aborda aspectos sociais, raciais, econômicos e de admissão em universidades. Os dados foram analisados por uma descrição simples das frequências e por análise bivariada. Resultados: Constatou-se que o perfil majoritário é branco, com renda anual superior a US$ 8.640, proveniente de escola particular, com apoio financeiro da família, ambos os pais com ensino superior e sem diferença de gênero. Quanto à inserção de pessoas não brancas no curso, o atual sistema de cotas não aumentou significativamente a presença dessas pessoas. Conclusão: Políticas de inclusão racial subordinadas à econômica parecem ser uma barreira à entrada de não brancos na Faculdade de Medicina, o que contribui para a desigualdade racial.

Rev. panam. salud pública ; 44: e58, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1127121


RESUMO Objetivo. Descrever a frequência, as características e os fatores que contribuem para o suicídio em povos indígenas brasileiros. Método. Foi realizada uma revisão sistemática da literatura a partir das bases de dados PubMed, SciELO, PsycINFO e LILACS. Foram incluídos estudos de base populacional que enfocassem suicídio em populações indígenas no território brasileiro. Resultados. A busca identificou 111 artigos, dos quais nove preencheram os critérios de inclusão. Três estudos foram realizados na região Centro-Oeste, quatro na região Norte do Brasil e dois abordaram todas as regiões do Brasil. Três estudos citaram as etnias estudadas, totalizando sete etnias (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá e Guarani-Nandeva). Os estudos demonstraram maior taxa de mortalidade por suicídio em pessoas do sexo masculino, solteiros, com 4 a 11 anos de escolaridade, na faixa etária de 15 a 24 anos, no domicílio e nos finais de semana, tendo como principal método o enforcamento. Os principais fatores de risco para o suicídio foram pobreza, fatores históricos e culturais, baixos indicadores de bem estar, desintegração das famílias, vulnerabilidade social e falta de sentido de vida e futuro. Conclusões. Todos os estudos indicaram a necessidade de desenvolvimento de estratégias em conjunto com as comunidades, considerando sua cosmovisão e os aspectos sócio-histórico-culturais de cada etnia, para minimização dos fatores de risco e redução da taxa de suicídio.(AU)

ABSTRACT Objective. To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. Method. A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. Results. The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. Conclusions. All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.(AU)

RESUMEN Objetivo. Describir la frecuencia y las características del suicidio y sus factores contribuyentes en los pueblos indígenas brasileños. Método. Se realizó una revisión sistemática de la bibliografía a partir de las bases de datos PubMed, SciELO, PsycINFO y LILACS. Se incluyeron estudios de base poblacional enfocados en el suicidio en las poblaciones indígenas en el territorio brasileño. Resultados. En la búsqueda se encontraron 111 artículos, de los cuales nueve se ciñeron a los criterios de inclusión. Se realizaron tres estudios en la región centro oeste y cuatro en la región norte, además de otros dos que abarcaron todas las regiones de Brasil. En tres estudios se citaron todas las siete etnias estudiadas (Terena, Kadiweu, Guato, Ofaie-Xavante, Guaraní, Guaraní-Kaiowá y E-Nandeva). En los estudios se demostró una mayor tasa de mortalidad por suicidio en personas solteras del sexo masculino, con 4 a 11 años de escolaridad, en el grupo de 15 a 24 años de edad, en el domicilio y en los fines de semana, principalmente por el método de ahorcamiento. Los principales factores de riesgo de suicidio fueron la pobreza, factores históricos y culturales, el índice de bienestar bajo, la desintegración de las familias, la vulnerabilidad social, y la falta de sentido de la vida y del futuro. Conclusiones. Todos los estudios indicaron la necesidad de formular estrategias junto con las comunidades, dentro del marco de su cosmovisión y de los aspectos sociales, históricos y culturales de cada etnia, con el fin de reducir al mínimo los factores de riesgo y la tasa de mortalidad por suicidio.(AU)

Humanos , Suicídio/tendências , Características Culturais , Fatores Sociológicos , Povos Indígenas/psicologia , Brasil/epidemiologia
J Cross Cult Gerontol ; 34(4): 417-437, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31396808


Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.

Emigração e Imigração/tendências , Acesso aos Serviços de Saúde , Nível de Saúde , Cobertura do Seguro , Americanos Mexicanos , Migrantes , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto Jovem
J Clin Lipidol ; 13(5): 804-811.e2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31383603


BACKGROUND: The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-CN) was previously demonstrated as more accurate than Friedewald LDL-C estimation (LDL-CF) in a North American database not able to take race into account. OBJECTIVES: We hypothesized that LDL-CN would be more accurate than LDL-CF and correlate better with LDL particle number (LDL-P) in a racially diverse Brazilian cohort. METHODS: We performed a cross-sectional analysis of 4897 participants in the Brazilian Longitudinal Study of Adult Health, assessing LDL-CF and LDL-CN accuracy via overlap with ultracentrifugation-based measurement among clinical guideline LDL-C categories as well as mg/dL and percent error differences. We analyzed by triglyceride categories and correlated LDL-C estimation with LDL-P. RESULTS: LDL-CN demonstrated improved accuracy at 70 to <100 and <70 mg/dL (P < .001), with large errors ≥20 mg/dL about 9 times more frequent in LDL-CF at LDL-C <70 mg/dL, mainly due to underestimation. Among individuals with LDL-C <70 mg/dL and triglycerides ≥150 mg/dL, 65% vs 100% of ultracentrifugation-based low-density lipoprotein cholesterol calculation fell within appropriate categories of estimated LDL-CF and LDL-CN, respectively (P < .001). Similar results were observed when analyzed for age, sex, and race. Participants at LDL-C <70 and 70 to <100 mg/dL with discordantly elevated LDL-CN vs LDL-CF had a 58.5% and 41.5% higher LDL-P than those with concordance (P < .0001), respectively. CONCLUSIONS: In a diverse Brazilian cohort, LDL-CN was more accurate than LDL-CF at low LDL-C and high triglycerides. LDL-CN may avoid underestimation of LDL-C and better reflect atherogenic lipid burden in low particle size, high particle count states.

LDL-Colesterol/sangue , Grupos de Populações Continentais , Guias de Prática Clínica como Assunto , Brasil , Estudos Transversais , Feminino , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue
BMC Med Educ ; 19(1): 151, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096964


BACKGROUND: Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students' perceptions of their teachers' attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it. METHODS: We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory. RESULTS: Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant (p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively. CONCLUSIONS: We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students' perception of their teachers' cost-conscious behaviors.

Competência Cultural , Gastos em Saúde/estatística & dados numéricos , Estudantes de Medicina/psicologia , Tradução , Atitude do Pessoal de Saúde , Brasil , Características Culturais , Análise Fatorial , Humanos , Papel do Médico , Psicometria , Reprodutibilidade dos Testes
BMC Public Health ; 19(1): 399, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975126


BACKGROUND: Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. METHODS: The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. DISCUSSION: The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. TRIAL REGISTRATION: This study protocol was retrospectively registered, approved, and made available on by NCT03787485 as of December 20, 2018.

Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/organização & administração , Promoção da Saúde/métodos , Hispano-Americanos/estatística & dados numéricos , Arizona , Doença Crônica/prevenção & controle , Centros Comunitários de Saúde/organização & administração , Feminino , Humanos , Masculino , México , Atenção Primária à Saúde/organização & administração , Estudos Prospectivos , Comportamento de Redução do Risco , Estados Unidos , Adulto Jovem
Medwave ; 19(1): e7470, 2019 Jan 07.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-30816880


Background: The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a valid and reliable instrument to measure physical functioning in the intensive care unit setting. Translation and cross-cultural adaptation in Chile has not been published for the FSS-ICU. Aim: To translate and cross-culturally adapt all associated documents of the original FSS-ICU for Chile. Method: The Spanish version of FSS-ICU, available at, was used as the starting point. This version was previously translated, with the original FSS-ICU developers, following established guidelines for this process. The Chilean pocket card version was newly developed based on the English version at Cognitive interviews were conducted for the adaptation of the FSS-ICU and pocket card version to assess understanding of relevant stakeholders (i.e., Chilean intensive care unit physiotherapists). Adaptations to the translation were made when agreement among the physiotherapists was less than 80%. Results: Cognitive interviews of the Chilean FSS-ICU (85 items) and pocket card version (18 items) were performed with 30 Chilean physiotherapists from 18 hospitals (14 public and 4 private). During the interviews, modest adaptations mainly made in the general guidelines and specific instructions for three items of the FSS-ICU and two items of the pocket card. Finally, the frequently asked questions, pocket card and full version of the FSS-ICU were developed. The original developers accepted all adaptations. Conclusions: The Chilean version of the FSS-ICU was easy to understand by the physiotherapists. The FSS-ICU is freely available for non-commercial clinical and research use by Chilean Spanish-speakers.

Comparação Transcultural , Nível de Saúde , Unidades de Terapia Intensiva , Chile , Guias como Assunto , Humanos , Entrevistas como Assunto , Idioma , Fisioterapeutas , Reprodutibilidade dos Testes
Nutr J ; 18(1): 21, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922320


BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP). METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level. RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants. CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

Custos e Análise de Custo , Dieta Saudável/estatística & dados numéricos , Dieta/economia , Grupos Étnicos , Fatores Socioeconômicos , Adulto , Estudos Transversais , Registros de Dieta , Feminino , Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Marrocos/etnologia , Países Baixos , Suriname/etnologia , Inquéritos e Questionários , Turquia/etnologia
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 43-52, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1013123


Abstract Objectives: to analyze the prenatal care of pregnant teenagers interviewed in the post-partum period in Brazilian maternity hospitals, according to economic status and skin color. Methods: data were obtained from the Birth in Brazil study, a national hospital-based survey in 2011 and 2012. Information was obtained from interviews with the postpartum women and from data collected from their prenatal cards. Multivariate logistic regression was used to verify whether maternal and prenatal care characteristics were associated with ina-dequate prenatal care. Results: a total of 3,317 teenage mothers were interviewed in the postpartum period, 84.4% of whom had received inadequate prenatal care, with worse results for lower-income, lower-schooling, and multiparous teens. In the same way, it became evident the higher proportion of black teenagers and those from economic classes D/E among those who failed to receive routine laboratory tests, who received little orientation on the pregnancy, labor, and childbirth, and who were forced to go from one maternity hospital to another before being admitted to give birth. Conclusions: strategies targeted to the most vulnerable pregnant teenagers should be implemented in order to achieve greater equality in teenagers' prenatal care, seeking to assure easier access, earlier initiation of care, and greater case-resolution capacity

Resumo Objetivos: analisar a assistência pré-natal de puérperas adolescentes brasileiras, segundo as características econômicas e de cor da pele. Métodos: foram utilizados dados da pesquisa Nascer no Brasil, um inquérito nacional de base hospitalar, realizado entre 2011 e 2012. As informações foram obtidas por meio de entrevistas com as puérperas e coleta de dados dos cartões de pré-natal. Realizou-se regressão logística multivariada para verificar quais características maternas e dos cuidados recebidos estavam associadas à inadequação da assistência pré-natal. Resultados: um total de 3.317 puérperas adolescentes foram entrevistadas, tendo 84,4% recebido cuidado inadequado durante o pré-natal, com pior resultado para as adolescentes de classe econômica mais baixa, menor escolaridade e multíparas. Do mesmo modo, ficou evidente a maior proporção de adolescentes da classe econômica D/E e de cor da pele preta que não conseguiram realizar exames preconizados como rotina durante a gravidez, que receberam poucas orientações sobre a gestação e parto, e que mais peregrinaram em busca de maternidade para realização do parto. Conclusões: estratégias direcionadas ao grupo de adolescentes mais vulneráveis devem ser implementadas visando maior equidade na assistência pré-natal de adolescentes, buscando garantir acesso facilitado, início precoce da assistência e maior resolutividade.

Humanos , Feminino , Gravidez , Adolescente , Gravidez na Adolescência , Cuidado Pré-Natal , Disparidades nos Níveis de Saúde , Racismo , Fatores Socioeconômicos , Brasil , Saúde Materno-Infantil , Inquéritos Epidemiológicos , Serviços de Saúde Materno-Infantil , Iniquidade Social