Racial and ethnic disparities in telehealth use before and after California's stay-at-home order.

Introduction: Telehealth can potentially improve the quality of healthcare through increased access to primary care. While telehealth use increased during the COVID-19 pandemic, racial/ethnic disparities in the use of telemedicine persisted during this period. Little is known about the relationship between health coverage and patient race/ethnicity after the onset of the COVID-19 pandemic. Objective: This study examines how differences in patient race/ethnicity and health coverage are associated with the number of in-person vs. telehealth visits among patients with chronic conditions before and after California's stay-at-home order (SAHO) was issued on 19 March 2020. Methods: We used weekly patient visit data (in-person (N = 63, 491) and telehealth visits (N = 55, 472)) from seven primary care sites of an integrated, multi-specialty medical group in Los Angeles County that served a diverse patient population between January 2020 and December 2020 to examine differences in telehealth visits reported for Latino and non-Latino Asian, Black, and white patients with chronic conditions (type 2 diabetes, pre-diabetes, and hypertension). After adjusting for age and sex, we estimate differences by race/ethnicity and the type of insurance using an interrupted time series with a multivariate logistic regression model to study telehealth use by race/ethnicity and type of health coverage before and after the SAHO. A limitation of our research is the analysis of aggregated patient data, which limited the number of individual-level confounders in the regression analyses. Results: Our descriptive analysis shows that telehealth visits increased immediately after the SAHO for all race/ethnicity groups. Our adjusted analysis shows that the likelihood of having a telehealth visit was lower among uninsured patients and those with Medicaid or Medicare coverage compared to patients with private insurance. Latino and Asian patients had a lower probability of telehealth use compared with white patients. Discussion: To address access to chronic care management through telehealth, we suggest targeting efforts on uninsured adults and those with Medicare or Medicaid coverage, who may benefit from increased telehealth use to manage their chronic care.

Desarrollo y validación española de la escala de sucesos vitales estresantes (SVE-I) en escolares (8-12 años) / Development and validation of the stressful life events questionnaire (SVE-I) for Spanish children (8-12 years old)

La acumulación de Sucesos Vitales Estresantes (SVE) supone un factor de riesgo para la salud mental en la infancia, sin embargo, no contamos con un cuestionario en español validado en la segunda infancia. Este estudio presenta el desarrollo y la validación de una nueva escala (SVE-I) de autoinforme para evaluar la acumulación de SVE en menores de 8 a 12 años españoles. Un panel de expertas participó en la evaluación de la adecuación de la escala. Se realizaron comprobaciones en un grupo focal para asegurar la aceptabilidad y comprensión de los ítems. 504 menores de cuatro centros escolares de Madrid (Medad = 10.1; DTedad = 1.28; 56.5 % chicos) participaron en el estudio, completando la batería de cuestionarios. El análisis factorial confirmatorio mostró una estructura de tres factores (estrés familiar, estrés socio-escolar y salud), con una consistencia interna de la escala global adecuada (αordinal = .83). Para la evidencia de validez concurrente, se encontró una asociación positiva entre la acumulación de SVE y la sintomatología ansiosa de los menores. Los resultados indican que la SVE-I es un instrumento válido y fiable. Esta escala pretende ser una herramienta sencilla y útil para el cribado de casos en riesgo desde la escuela y Atención Primaria. (AU)

The accumulation of Stressful Life Events (SVE) is a risk factor for mental health in childhood, however, there is no adequate questionnaire validated in Spanish for its use during childhood. This study presents the development and validation of a new scale (SVE-I), a self-report questionnaire for assessing the accumulation of SVE in Spanish children aged 8 to 12 years. A panel of experts evaluated the adequacy of the scale. The acceptability and understanding of the items were ensured by a small focus group. 504 children from four schools in Madrid (Mage = 10.1; SDage = 1.28; 56.5 % boys) participated in the study, completing a battery of questionnaires. Confirmatory factor analysis showed a structure of three factors: (family stress, socio-school stress, and health), with an adequate internal consistency of the global scale (α = .83). For concurrent validity, a positive association was found between the accumulation of EVS and the anxious symptomatology of the children. The results indicate that the SVE-I is a valid and reliable instrument. This scale aims to be a useful tool in the school context and clinical practice. (AU)

Impact of Cervical Cancer on Quality of Life and Sexuality in Female Survivors.

Cervical cancer is the fourth most frequent cancer in women worldwide, and the 11th most frequent neoplasm in Spain. Despite the optimization of treatments and a 5-year survival rate of 70%, side effects and sequelae are described after treatment. The treatments have physical, psychological and sociocultural consequences that deteriorate the quality of life of patients. One of the sequelae that worries patients is the impairment of sexual function and satisfaction, considered a fundamental dimension of the human being. The aim of this study was to examine quality of life and sexual function and satisfaction among Spanish cervical cancer survivors. A retrospective case-control study was conducted between 2019 and 2022. The sample consisted of 66 patients who completed the Female Sexual Function Index, the Golombok Rust Sexual Satisfaction Inventory and European Organization for Research and Treatment of Cancer quality of life questionnaire. The control group consisted of women without cervical cancer and gynecological pathologies obtained using the so-called online virtual sampling method. The patient group consisted of women with cervical cancer who completed treatment. Cervical cancer survivors reported sexual dysfunction and impaired sexual satisfaction in almost half of the domains. Quality of life was also affected, with pain and fatigue being the most frequent symptoms in these patients. Our results indicate that there is dysfunction, sexual dissatisfaction and a lower level of quality of life in cervical cancer survivors than in healthy women without pathology.

Avoiding Medicaid enrollment after the reversal of the changes in the public charge rule among Latino and Asian immigrants.

OBJECTIVE: To estimate the avoidance of Medicaid enrollment among Latino and Asian immigrants due to fears about immigration status. In 2019, changes to the "public charge" rule made it difficult for immigrants to receive a green card or permanent residence visa, particularly for those who used health and nutrition benefits. Despite the Biden administration's reversal of these changes, fear and misinformation persist among immigrants. DATA SOURCES: Pooled data from the 2017 to 2020 California Health Interview Survey. STUDY DESIGN: We used adjusted predicted probability models to estimate differences in access to and use of health care and health insurance coverage among Latino and Asian immigrant adults with and without green cards, using US citizens as the reference. We estimated the avoidance of Medicaid enrollment among immigrants without a green card, the immigrant population subject to the public charge rule. DATA COLLECTION/EXTRACTION METHODS: Population stratified by race/ethnicity and green card status. PRINCIPAL FINDINGS: Latino immigrants without a green card were -23.1% (CI: -27.8, -18.4) less likely to be insured, -9.2% (CI: -12.8, -5.5) less likely to have Medicaid coverage, -9.3% (CI: -14.5, -4.1) less likely to have a usual source of care, and -8.4% (CI: -13.2, -0.3) less likely to have a physician visit relative to citizens. Asian immigrants without a green card were -11.7% (CI: -19.7, -3.72) less likely to be insured, -8.8% (CI: -11.6, -6.1) less likely to have Medicaid coverage, -11.6% (CI: -19.3, -3.9) less likely to have a usual source of care, and -11.0% (CI: -19.2, -2.3) less likely to have a physician visit. Between 107,956 and 192,905 Latino immigrants and 1294 and 4702 Asian immigrants in California likely avoided Medicaid enrollment due to fears about their immigration status. CONCLUSION: While our estimates are lower than those of previous studies, our findings highlight barriers to health care for immigrants despite the reversal of the changes in the public charge rule. Since the public charge rule was not abolished, immigrants with low incomes might choose not to seek health care, despite recent efforts in California to expand Medicaid coverage to all eligible immigrants regardless of documentation statuses.

Characterizing intercampus migration in a private university of Baja California, Mexico.

Given the socioeconomic and environmental differences between Mexico's geographical regions, having a multi-campus system is common for private and public universities. Hence, students may choose to migrate from one campus to another. Although such a phenomenon is not properly students' desertion, students' migration impacts campus' main indicators: enrollment growth goals, terminal efficiency, accreditation programs, and revenue. Thus, the campus of origin internalizes migration as students' desertion. By considering a campus from a private multi-campus university in Baja California, Mexico, this study characterizes and predicts students' migration and predicts by determining the socioeconomic and academic variables that impact the probability of moving to a different campus. Our database comprises quantitative and qualitative information of 356 dropout students from 2008 to 2018. Hence, we apply the logistic regression technique to build a predictive model; we found that the most significant predictive variables are the GPA results, age, financial support, and academic development. So, our main results characterize migrant students as having top grades, coming from the high school campus, and attending engineering programs. Surprisingly, economic variables are not significant in choosing to migrate from one campus to another.

Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic.

COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with a georeferencing analysis and key informant interviews. Data suggested an increased vulnerability to COVID-19 given participants reported health status, health care profile and place of residence, which coincided with the georeferencing analysis. The key informant interviews confirmed the vulnerability of this population and the supporting role of VDS in helping immigrants navigate health systems and disseminate health information. Mexican immigrants had an increased vulnerability to COVID-19 at the individual, geographic and systemic levels. Trusted and culturally sensitive services are needed to overcome some of the barriers and risk factors that increase the vulnerability of URM and immigrant populations to COVID-19.

Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States.

Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.

Childhood hunger experiences and chronic health conditions later in life among Brazilian older adults.

OBJECTIVES: To assess the association between childhood hunger experiences and the prevalence of chronic diseases later in life. METHODS: A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9 412). Univariate and bivariate analyses were used to describe the sample, and multivariate logistic regressions to examine the association between childhood hunger and hypertension, diabetes, arthritis and osteoporosis. Adjusted odds ratios and predicted probabilities were calculated. RESULTS: 24.7% of Brazilians aged 50 and over experienced hunger during childhood. This harmful exposure was significantly more common among non-white people, individuals with lower educational attainment, lower household income and heavy manual laborers. Regional variation was also observed, as the prevalence of individuals reporting childhood hunger was higher in the North and Northeast regions. The multivariate analysis revealed that older adults who reported having experienced hunger during childhood had 20% higher odds of developing diabetes in adulthood (aOR = 1.20, 95% CI: 1.02 - 1.41) and 38% higher odds of developing osteoporosis (aOR = 1.38, 95% CI: 1.15 - 1.64) than adults who did not experience hunger during childhood, after controlling for covariates. CONCLUSIONS: The study showed an association between childhood hunger and two chronic diseases in later life: diabetes and osteoporosis. This work restates that investing in childhood conditions is a cost-effective way to have a healthy society and provides evidence on relationships that deserve further investigation to elucidate underlying mechanisms.

Childhood hunger experiences and chronic health conditions later in life among Brazilian older adults

[ABSTRACT]. Objectives. To assess the association between childhood hunger experiences and the prevalence of chronic diseases later in life. Methods. A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9 412). Univariate and bivariate analyses were used to describe the sample, and multivariate logistic regressions to examine the association between childhood hunger and hypertension, diabetes, arthritis and osteoporosis. Adjusted odds ratios and predicted probabilities were calculated. Results. 24.7% of Brazilians aged 50 and over experienced hunger during childhood. This harmful exposure was significantly more common among non-white people, individuals with lower educational attainment, lower household income and heavy manual laborers. Regional variation was also observed, as the prevalence of individuals reporting childhood hunger was higher in the North and Northeast regions. The multivariate analysis revealed that older adults who reported having experienced hunger during childhood had 20% higher odds of developing diabetes in adulthood (aOR = 1.20, 95% CI: 1.02 – 1.41) and 38% higher odds of developing osteoporosis (aOR = 1.38, 95% CI: 1.15 – 1.64) than adults who did not experience hunger during childhood, after controlling for covariates. Conclusions. The study showed an association between childhood hunger and two chronic diseases in later life: diabetes and osteoporosis. This work restates that investing in childhood conditions is a cost-effective way to have a healthy society and provides evidence on relationships that deserve further investigation to elucidate underlying mechanisms.

[RESUMEN]. Objetivos. Evaluar la asociación entre las experiencias de hambre en la niñez y la prevalencia de enfermedades crónicas en las etapas posteriores de la vida. Métodos. Se realizó un estudio transversal utilizando como línea de base los datos del Estudio Longitudinal del Envejecimiento en Brasil (ELSI-Brasil), un estudio nacional representativo de personas de 50 años o más (n = 9 412). Se emplearon análisis univariado y bivariado para describir la muestra, y regresión logística multivariada para examinar la asociación entre el hambre en la niñez y la hipertensión, la diabetes, la artritis y la osteoporosis. Se calcularon las razones de posibilidades ajustadas y las probabilidades previstas. Resultados. El 24,7% de los brasileños de 50 años o más pasó hambre en la niñez. Esta experiencia perjudicial fue considerablemente más común en las personas no blancas, las personas con menor nivel de instrucción, las personas con ingresos familiares bajos y los trabajadores de mano de obra pesada. También se observó una variación regional, puesto que la prevalencia de individuos que expresaron haber pasado hambre en la niñez fue mayor en las regiones Norte y Nordeste. Luego de controlar las covariables, el análisis multifactorial reveló que los adultos mayores que dijeron haber pasado hambre en la niñez tenían una probabilidad 20% mayor de tener diabetes en la edad adulta (aOR = 1,20, IC 95%: 1,02 – 1,41) y 38% mayor de tener osteoporosis (aOR = 1,38, IC 95%: 1,15 – 1,64) que los adultos que no habían pasado hambre en la niñez. Conclusiones. El estudio reveló una asociación entre el hambre en la niñez y dos enfermedades crónicas en las etapas posteriores de la vida: la diabetes y la osteoporosis. Este trabajo reafirma que invertir en las condiciones de vida de las personas en la niñez es una manera costoeficaz de tener una sociedad saludable, al tiempo que aporta evidencia acerca de relaciones que merecen investigarse más a fin de esclarecer los mecanismos subyacentes.

[RESUMO]. Objetivos. Avaliar a associação entre a experiência de passar fome na infância e a prevalência posterior de doenças crônicas. Métodos. Um estudo transversal foi realizado a partir de dados básicos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), uma pesquisa com representatividade nacional realizada com pessoas de 50 anos ou mais (n = 9.412). Análises univariadas e bivariadas foram usadas para descrever a amostra e a regressão logística multivariada foi aplicada para examinar a associação entre passar fome na infância e hipertensão, diabetes, artrite e osteoporose. Foram calculadas razões de chances (odds ratio, OR) ajustadas e probabilidades previstas. Resultados. Verificou-se que 24,7% dos brasileiros com 50 anos ou mais passaram fome na infância. Esta exposição prejudicial foi significativamente mais frequente em pessoas não brancas, com nível de instrução menor e renda familiar mais baixa e em trabalhadores braçais. Observou-se também uma variação regional, com uma maior prevalência de pessoas que relataram ter passado fome na infância nas Regiões Norte e Nordeste. Na análise multivariada, nos idosos que informaram ter passado fome na infância, a probabilidade foi 20% maior de ter diabetes na idade adulta (ORaj 1,20; IC 95% 1,02–1,41) e 38% maior de ter osteoporose (ORaj 1,38, IC 95% 1,15–1,64) em comparação aos adultos que não passaram fome na infância, após o controle de covariáveis. Conclusões. O estudo demonstrou associação entre passar fome na infância e duas doenças crônicas na vida adulta: diabetes e osteoporose. Este trabalho reitera que investir na infância é uma maneira custo-efetiva de se criar uma sociedade saudável e fornece evidências sobre relações que devem ser pesquisadas mais a fundo para esclarecer os processos subjacentes.

Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers.

OBJECTIVE: To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN: We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING: Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS: Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS: We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS: Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.

Food Insecurity Among Older Adults: A Multilevel Analysis of State-Level Interventions.

Objective: To analyze whether state-level social programs for older adults (OAs) in Mexico are associated with a reduction: (a) in the prevalence of severe food insecurity (SFI) and (b) in the magnitude of the effect of municipal marginalization on SFI. Method: Cross-sectional study based on urban OAs (65-100 years) from the 2010 census. Three-level logistic multilevel regression models were estimated to explain SFI. Results: Controlling for individual and municipal characteristics, states with social programs for OAs are generally associated with lower SFI prevalences (odds ratio [OR] = 0.68 [0.48, 0.95]) and mitigate the effect of marginalization on SFI when compared with states with no programs. Compared with in-kind food programs and voucher-based programs, monetary transfers are associated with a significant reduction in SFI prevalence (OR = 0.68 [0.46, 0.99]). Conclusion: States with programs for OAs, mainly monetary transfers, are associated with lower SFI prevalences.

Childhood hunger experiences and chronic health conditions later in life among Brazilian older adults / Experiencias de hambre en la niñez y enfermedades crónicas en etapas posteriores de la vida en adultos mayores de Brasil / Experiência de passar fome na infância e problemas crônicos de saúde posteriores em idosos no Brasil

ABSTRACT Objectives. To assess the association between childhood hunger experiences and the prevalence of chronic diseases later in life. Methods. A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9 412). Univariate and bivariate analyses were used to describe the sample, and multivariate logistic regressions to examine the association between childhood hunger and hypertension, diabetes, arthritis and osteoporosis. Adjusted odds ratios and predicted probabilities were calculated. Results. 24.7% of Brazilians aged 50 and over experienced hunger during childhood. This harmful exposure was significantly more common among non-white people, individuals with lower educational attainment, lower household income and heavy manual laborers. Regional variation was also observed, as the prevalence of individuals reporting childhood hunger was higher in the North and Northeast regions. The multivariate analysis revealed that older adults who reported having experienced hunger during childhood had 20% higher odds of developing diabetes in adulthood (aOR = 1.20, 95% CI: 1.02 - 1.41) and 38% higher odds of developing osteoporosis (aOR = 1.38, 95% CI: 1.15 - 1.64) than adults who did not experience hunger during childhood, after controlling for covariates. Conclusions. The study showed an association between childhood hunger and two chronic diseases in later life: diabetes and osteoporosis. This work restates that investing in childhood conditions is a cost-effective way to have a healthy society and provides evidence on relationships that deserve further investigation to elucidate underlying mechanisms.

RESUMEN Objetivos. Evaluar la asociación entre las experiencias de hambre en la niñez y la prevalencia de enfermedades crónicas en las etapas posteriores de la vida. Métodos. Se realizó un estudio transversal utilizando como línea de base los datos del Estudio Longitudinal del Envejecimiento en Brasil (ELSI-Brasil), un estudio nacional representativo de personas de 50 años o más (n = 9 412). Se emplearon análisis univariado y bivariado para describir la muestra, y regresión logística multivariada para examinar la asociación entre el hambre en la niñez y la hipertensión, la diabetes, la artritis y la osteoporosis. Se calcularon las razones de posibilidades ajustadas y las probabilidades previstas. Resultados. El 24,7% de los brasileños de 50 años o más pasó hambre en la niñez. Esta experiencia perjudicial fue considerablemente más común en las personas no blancas, las personas con menor nivel de instrucción, las personas con ingresos familiares bajos y los trabajadores de mano de obra pesada. También se observó una variación regional, puesto que la prevalencia de individuos que expresaron haber pasado hambre en la niñez fue mayor en las regiones Norte y Nordeste. Luego de controlar las covariables, el análisis multifactorial reveló que los adultos mayores que dijeron haber pasado hambre en la niñez tenían una probabilidad 20% mayor de tener diabetes en la edad adulta (aOR = 1,20, IC 95%: 1,02 - 1,41) y 38% mayor de tener osteoporosis (aOR = 1,38, IC 95%: 1,15 - 1,64) que los adultos que no habían pasado hambre en la niñez. Conclusiones. El estudio reveló una asociación entre el hambre en la niñez y dos enfermedades crónicas en las etapas posteriores de la vida: la diabetes y la osteoporosis. Este trabajo reafirma que invertir en las condiciones de vida de las personas en la niñez es una manera costoeficaz de tener una sociedad saludable, al tiempo que aporta evidencia acerca de relaciones que merecen investigarse más a fin de esclarecer los mecanismos subyacentes.

RESUMO Objetivos. Avaliar a associação entre a experiência de passar fome na infância e a prevalência posterior de doenças crônicas. Métodos. Um estudo transversal foi realizado a partir de dados básicos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), uma pesquisa com representatividade nacional realizada com pessoas de 50 anos ou mais (n = 9.412). Análises univariadas e bivariadas foram usadas para descrever a amostra e a regressão logística multivariada foi aplicada para examinar a associação entre passar fome na infância e hipertensão, diabetes, artrite e osteoporose. Foram calculadas razões de chances (odds ratio, OR) ajustadas e probabilidades previstas. Resultados. Verificou-se que 24,7% dos brasileiros com 50 anos ou mais passaram fome na infância. Esta exposição prejudicial foi significativamente mais frequente em pessoas não brancas, com nível de instrução menor e renda familiar mais baixa e em trabalhadores braçais. Observou-se também uma variação regional, com uma maior prevalência de pessoas que relataram ter passado fome na infância nas Regiões Norte e Nordeste. Na análise multivariada, nos idosos que informaram ter passado fome na infância, a probabilidade foi 20% maior de ter diabetes na idade adulta (ORaj 1,20; IC 95% 1,02-1,41) e 38% maior de ter osteoporose (ORaj 1,38, IC 95% 1,15-1,64) em comparação aos adultos que não passaram fome na infância, após o controle de covariáveis. Conclusões. O estudo demonstrou associação entre passar fome na infância e duas doenças crônicas na vida adulta: diabetes e osteoporose. Este trabalho reitera que investir na infância é uma maneira custo-efetiva de se criar uma sociedade saudável e fornece evidências sobre relações que devem ser pesquisadas mais a fundo para esclarecer os processos subjacentes.

Identifying Loss of Control Eating within Childhood Obesity: The Importance of Family Environment and Child Psychological Distress.

This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment.

Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients?

Background and study aims It is uncertain if the difference in weight loss outcomes between different endoscopic bariatric therapies (EBTs) is technique-related or multidisciplinary team (MDT) follow-up-related. We hypothesized that at 1 year, the weight loss is determined more by adherence to MDT follow-up than by procedure type. We aimed to compare 1 year weight loss outcomes of four different EBTs at a single center with a standardized MDT follow-up. Patients and methods We prospectively collected and retrospectively analyzed outcomes in 962 patients (female-691, 71.2 %; mean age, 44.8 ±â€Š10.6 years, mean BMI, 37.8 ±â€Š5.9 Kg/m 2 ) treated with Intragastric balloons (IGBs) or endoscopic gastroplasty (EG) at HM Sanchinarro University Hospital between March 2012 to January 2017. The procedures were performed by the same endoscopist and followed up by the same MDT. We compared the percentage total body weight loss (%TWBL) at 1 year. We performed linear and logistic regression to identify predictive factors for weight loss and follow-up adherence at 1 year. Results Four hundred and eighty-one IGBs (Orbera-80.9 %; ReShape Duo-19.1 %), and 481 EG (Apollo ESG-51.3 %; Primary obesity surgery endoluminal-POSE-48.6 %) were performed. Only 480 patients (IGB- 45 %; EG- 55 %) completed 1 year follow-up. Among them, Apollo ESG achieved significantly higher TBWL (19.5 ±â€Š13 %, P  = 0.035), %TBWL (17.4 ±â€Š10.2 %, P  = 0.025), and ≥ 20 % TBWL (36.7 %, P  = 0.032). However, in linear regression after adjusting for variables, only higher initial BMI (B = 0.31, P  < 0.001) and higher percentage follow-up attendance (B = 0.24, P  < 0.001) significantly predicted %TBWL at 1 year in the completion group but not the procedure type (B = 0.02, P  = 0.72). In logistic regression, we observed female sex ( P  = 0.01), high initial BMI ( P  < 0.001), endoscopic gastroplasty ( P  = 0.04), and high 1-month %TBWL ( P  < 0.001) significantly predicted follow-up completion at 1 year. Conclusions Weight loss at 1 year is dependent on MDT follow-up rather than procedure type. Endoscopic gastroplasty promoted follow-up adherence more than IGBs.

Microbiological quality of hemodialysis water in a three-year multicenter study in Uruguay.

BACKGROUND: The microbiological quality of treated water is a very important issue in hemodialysis (HD) centers. Water treatment may have a dramatic effect on microbial contamination because of bacterial colonisation of the different parts of the system such as storage tanks, softeners or deionisers. Therefore, HD centers must have stringent quality programmes including regular water monitoring for microbiological analysis. We report the results of a three-year study (July 97 to June 2000) including bacteriological quality analysis of 3129 water samples from 32 out of 38 HD centers throughout Uruguay. METHODS: Bacteriological analysis of water samples was based on heterotrophic count, total coliform count and Pseudomonas aeruginosa presence/absence, according to the procedures proposed by the Association for the Advancement of Medical Instrumentation (AAMI). RESULTS: Heterotrophic counts of 83% of the samples were under 200 colony forming units (CFU) /mL (AAMI limit of compliance) and the water samples after the final bactericidal treatment showed 99% compliance. The points showing the worst results were softeners and deionisers (60% acceptance). CONCLUSIONS: In comparison with a similar study in Uruguay, from January 96 to June 97 at the same microbiological laboratory, there has been a marked improvement in the microbiological quality of water for hemodialysis.