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1.
J Aging Health ; : 8982643231152276, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36633960

RESUMO

OBJECTIVES: To investigate the role of social factors in the association between depression and falls among older adults. METHODS: The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.

2.
Clin Nutr ; 42(2): 208-215, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603461

RESUMO

BACKGROUND & AIMS: Inflammatory potential of diet may contribute to poor health outcomes in individuals with metabolic disorders. In a representative sample of the U.S. population, we investigated the association between consuming a pro-inflammatory diet and mortality risk in adults with normal range of body mass index (BMI) but with central obesity. METHODS: This prospective cohort study included 3521 adults 20-90 years of age with normal BMI who participated in the National Health and Nutrition Examination Survey III, 1988-1994 and did not have a history of cardiovascular disease (CVD) or cancer and did not change their dietary intake in the year preceding baseline measurements. Mortality from all causes, CVD, and cancer was ascertained from the National Death Index. Normal-weight central obesity (NWCO, n = 1777) was defined as those with BMI 18.5 to <25 kg/m2 and waist-to-hip ratio (WHR) ≥0.85 in women and ≥0.90 in men. Severe central obesity was defined as WHR ≥0.92 in women and ≥1.00 in men. The dietary inflammatory index (DII®) was computed based on baseline dietary intake using 24-h dietary recalls, and associations with mortality were estimated using multivariable Cox proportional hazards regression. RESULTS: In individuals with NWCO, DII score (i.e., more pro-inflammatory diet) was associated with increased risk of CVD mortality (HRT3 vs T1, 1.89 [95% CI, 1.01-3.53], P trend = 0.04; HR 1 SD increase 1.29 [95% CI, 1.06-1.57]). This association was stronger with more severe central obesity (HRT3 vs T1, 2.79 [95% CI, 1.10-7.03], P trend = 0.03; HR 1 SD increase 1.52 [95% CI, 1.05-2.21]). DII score was not associated with increased risk of mortality in normal-weight individuals without central obesity or with risk of cancer mortality in either group. CONCLUSION: Among individuals in the normal-weight range of BMI, a pro-inflammatory diet assessed by high DII scores was associated with increased risk of CVD mortality in those with central obesity.


Assuntos
Doenças Cardiovasculares , Neoplasias , Masculino , Adulto , Humanos , Feminino , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/complicações , Fatores de Risco , Estudos Prospectivos , Inquéritos Nutricionais , Dieta/efeitos adversos , Obesidade/epidemiologia , Obesidade/complicações , Índice de Massa Corporal , Neoplasias/complicações
3.
Artigo em Inglês | MEDLINE | ID: mdl-36576852

RESUMO

Objective: This study aimed to examine the association of nonsteroidal anti-inflammatory drug (NSAID) use by pregnant women during pregnancy with autism spectrum disorder (ASD) and intellectual disability (ID) in their children among Medicaid-insured mother-child dyads. Materials and Methods: We conducted a retrospective cohort study linking multiple datasets of South Carolina for the years between 2010 and 2017, in which the main exposure variable was NSAID use during pregnancy and outcome variables were ASD only, ID only, and ASD with ID. We conducted a multinomial logistic regression analysis, controlling for identified risk factors for ASD (mother's age, race, body-mass index, preeclampsia, and gestational diabetes). Results: NSAID use during pregnancy was found to be associated with ID only in both unadjusted and adjusted analyses. Children with mothers who had NSAID prescriptions were 26% more likely to have ID in comparison with children whose mothers did not have NSAID prescriptions (odds ratio: 1.26 [1.10-1.46]). The other risk factors identified for ASD were maternal age, race, preeclampsia, smoking, low birth weight, and obesity. For ID, the risk factors were maternal age, race, smoking, birth weight, overweight, and obesity, all of which were also associated with ASD with ID, except for overweight. Conclusions: NSAID usage during pregnancy was found to be associated with ID only and not with ASD. However, more research is needed to validate the effect of NSAIDs during pregnancy on ASD and ID among children.

4.
JAMA Netw Open ; 5(12): e2247632, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534397

RESUMO

Importance: Chlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking. Objective: To assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment (ie, scaling and root planing [SRP]) vs no treatment on birth outcomes. Data Sources: Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database), US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), and the WHO International Clinical Trials Registry Platform were searched through March 2022. Study Selection: RCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes. Data Extraction and Synthesis: Data were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures: Outcomes of interest were preterm birth (ie, <37 weeks' gestation) and low birth weight (ie, <2500 g). Results: There were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth (relative risk [RR], 0.56; 95% CI, 0.34-0.93) and low birth weight (RR, 0.47; 95% CI, 0.32-0.68) but not the SRP-only groups (preterm birth: RR, 1.03; 95% CI, 0.82-1.29; low birth weight: RR, 0.82; 95% CI, 0.62-1.08). Conclusions and Relevance: These findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis.


Assuntos
Periodontite , Nascimento Prematuro , Estados Unidos , Recém-Nascido , Feminino , Gravidez , Humanos , Clorexidina/uso terapêutico , Antissépticos Bucais/uso terapêutico , Nascimento Prematuro/tratamento farmacológico , Aplainamento Radicular
5.
6.
Int J Cardiol Cardiovasc Risk Prev ; 14: 200147, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36039164

RESUMO

Background: Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations. Methods: We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and 'other Asians' (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (age <50 years old). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease. Results: We studied 99,864 participants with history of hypertension (mean age, 59.3 ± 0.1; 50% women, 90% US born). Asian Indians had higher prevalence of premature hypertension (37%) compared with Filipinos (27%), 'other Asians' (26%), Whites (25%), and Chinese (21%). Compared with Whites, Chinese individuals had lower odds of premature hypertension (aOR = 0.79, 0.63-0.98), but Asian Indians had higher odds (aOR = 1.85, 1.48-2.31). Compared with Chinese, odds of premature hypertension was higher for Asian Indians (aOR = 2.39, 1.74-3.27), Filipinos (aOR = 1.53, 1.16-2.04), and 'other Asians' (OR = 1.32, 1.03-1.70; aOR = 1.59, 1.20-2.10). Overall prevalence of hypertension was lower among Asian Indians (aOR = 0.52, 0.46-0.58) and 'other Asians' (aOR = 0.74, 0.68-0.79) compared with Whites. Conclusions: There is heterogeneity in the risk of hypertension across Asian Americans by age. Asian Indians and 'other Asians' had higher prevalence of premature hypertension and lower prevalence of overall hypertension, which may call for earlier screening for risk factors among these populations.

7.
Aging Ment Health ; 26(9): 1805-1812, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35993919

RESUMO

OBJECTIVES: Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression. METHOD: We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010-2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls. RESULTS: Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression. CONCLUSION: Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.


Assuntos
Fragilidade , Acidentes por Quedas , Idoso , Depressão/epidemiologia , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Humanos , Vida Independente
8.
Prev Med Rep ; 29: 101916, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35898194

RESUMO

Introduction: Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods: We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results: The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion: Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.

9.
Pediatr Diabetes ; 23(7): 982-990, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35752872

RESUMO

OBJECTIVE: To examine the association between household food insecurity (HFI), glycemic control, severe hypoglycemia and diabetic ketoacidosis (DKA) among youth and young adults (YYA) with youth-onset type 2 diabetes. RESEARCH DESIGN AND METHODS: This cross-sectional study included 395 YYA with type 2 diabetes from the SEARCH for Diabetes in Youth Study (2015-2019). HFI was reported by young adult participants or parents of minor participants via the US Household Food Security Survey Module. Glycemic control was assessed by HbA1c and analyzed as a continuous and categorical variable (optimal: <7.0%, suboptimal: ≥7.0%-9.0%, poor: >9.0%). Acute complications included self-reported severe hypoglycemia or DKA in the last 12 months. Adjusted logistic and linear regression were used for binary and continuous outcomes, respectively. RESULTS: Approximately 31% reported HFI in the past 12 months. Mean HbA1c among those with HFI was 9.2% compared to 9.5% without HFI. Of those with HFI, 56% had an HbA1c >9.0% compared to 55% without HFI. Adjusted models showed no associations between HFI and glycemic control. Of those with HFI, 14.4% reported experiencing DKA and 4.7% reported severe hypoglycemia. YYA with HFI had 3.08 times (95% CI: 1.18-8.06) the odds of experiencing DKA as those without HFI. There was no association between HFI and severe hypoglycemia. CONCLUSIONS: HFI was associated with markedly increased odds of DKA but not with glycemic control or severe hypoglycemia. Future research among YYA with type 2 diabetes should evaluate longitudinally whether alleviating HFI reduces DKA.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Cetoacidose Diabética , Hipoglicemia , Adolescente , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/complicações , Cetoacidose Diabética/etiologia , Insegurança Alimentar , Controle Glicêmico , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemia/prevenção & controle , Adulto Jovem
10.
J Aging Health ; : 8982643221100688, 2022 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-35527693

RESUMO

OBJECTIVES: We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex. METHODS: Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms. RESULTS: Males had a larger total effect (ß= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (ß= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males. CONCLUSION: These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.

11.
J Periodontol ; 93(7): 1083-1092, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35139234

RESUMO

BACKGROUND: Immunoglobulin G (IgG) antibodies against periodontal microorganisms can be markers of periodontal infection because their levels rise following infection and remain elevated several years later. METHODS: We evaluated the relationship between groups of IgG antibodies against 19 periodontal microorganisms and diabetes-related mortality over 27 years among participants of the National Health and Nutrition Examination Survey III (1988 to 1992) aged ≥40 years at the time of examination (N = 8,153). RESULTS: Individuals in the highest versus lowest antibody tertiles were at 86% higher risk of dying due to diabetes-related causes in the Red-Green antibody cluster (T. forsythia, T. denticola, A. actinomycetemcomitans, E. corrodens, S. noxia, V. parvula, C. rectus) (hazard ratio [HR], 1.86; 95% CI, 1.09 to 3.20) and 55% lower in the Orange-Blue antibody cluster (E. nodatum, A. naeslundii) (HR, 0.45, 95% CI, 0.32 to 0.63) in multivariable models. In these models, individuals with diabetes at the time of examination had a 16-fold higher risk of dying due to diabetes-related causes (HR, 16.4; 95% CI, 11.0 to 24.7). CONCLUSION: As a subset of periodontal microorganisms are associated with adverse systemic outcomes, antibody profiles may help in prediction of diabetes-related mortality and identify subgroups of individuals among whom periodontal treatment may impact diabetes-related outcomes.


Assuntos
Diabetes Mellitus , Periodontite , Aggregatibacter actinomycetemcomitans , Anticorpos Antibacterianos , Humanos , Imunoglobulina G , Inquéritos Nutricionais , Porphyromonas gingivalis
12.
Ethn Health ; : 1-18, 2022 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-35098827

RESUMO

OBJECTIVES: Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN: In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS: Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION: Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

13.
N C Med J ; 83(1): 48-57, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980656

RESUMO

BACKGROUND Residential segregation is a spatial manifestation of structural racism. Racial disparities in emergency department (ED) utilization mirror social inequity in the larger community. We evaluated associations between residential segregation and ED utilization in a community with known disparities and geographically concentrated social and health risk.METHODS Cross-sectional data were collected from electronic medical records of 101 060 adult ED patients living in Mecklenburg County, North Carolina in 2017. Community context was measured as residential segregation using the dissimilarity index, categorized into quintiles (Q1-Q5) using 2013-2017 American Community Survey estimates, and residency in a public health priority area (PHPA). The outcome was measured as total ED visits during the study period. Associations between community context and ED utilization were modeled using Anderson's behavioral model of health service utilization, and estimated using negative binomial regression, including interaction terms by race.RESULTS Compared to areas with the lowest proportions of Black residents (Q1), living in Q4 was associated with higher rates of ED utilization among Black/Other (AME = 0.11) and White (AME = 0.23) patients, while associations with living in Q5 were approximately equivalent (AME = 0.12). PHPA residency was associated with higher rates of ED utilization among Black/Other (AME = 0.10) and White patients (AME = 0.22).LIMITATIONS Associations should not be interpreted as causal, or be generalized to the larger community without ED utilization. Health system leakage is possible but limited.CONCLUSIONS Residential segregation is associated with higher rates of ED utilization, as are PHPA residency and other individual-level determinants.


Assuntos
Segregação Social , Racismo Sistêmico , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , North Carolina , Características de Residência
14.
J Relig Health ; 61(3): 1966-1979, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33517523

RESUMO

This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.


Assuntos
Diabetes Mellitus Tipo 2 , Glicemia , Diabetes Mellitus Tipo 2/terapia , Gana , Humanos , Medicina Tradicional
15.
Childs Nerv Syst ; 38(2): 407-419, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34455445

RESUMO

OBJECTIVE: Recent evidence favors a network concept in tuberous sclerosis (TSC) with seizure generation and propagation related to changes in global and regional connectivity between multiple, anatomically distant tubers. Direct exploration of network dynamics in TSC has been made possible through intracranial sampling with stereoelectroencephalography (sEEG). The objective of this study is to define epileptic networks in TSC using quantitative analysis of sEEG recordings. We also discuss the impact of the definition of these epileptic networks on surgical decision-making. METHODS: Intracranial sEEG recordings were obtained from four pediatric patients who presented with medically refractory epilepsy secondary to TSC and subjected to quantitative signal analysis methods. Cortical connectivity was quantified by calculating pairwise coherence between all contacts and constructing an association matrix. The global coherence, defined as the ratio of the largest eigenvalue to the sum of all the eigenvalues, was calculated for each frequency band (delta, theta, alpha, beta, gamma). Spatial distribution of the connectivity was identified by plotting the leading principal component (product of the largest eigenvalue and its corresponding eigenvector). RESULTS: Four pediatric subjects with TSC underwent invasive intracranial monitoring with sEEG, comprising 31 depth electrodes and 250 contacts, for localization of the epileptogenic focus and guidance of subsequent surgical intervention. Quantitative connectivity analysis revealed a change in global coherence during the ictal period in the beta/low gamma (14-30 Hz) and high gamma (31-80 Hz) bands. Our results corroborate findings from existing literature, which implicate higher frequencies as a driver of synchrony and desynchrony. CONCLUSIONS: Coordinated high-frequency activity in the beta/low gamma and high gamma bands among spatially distant sEEG define the ictal period in TSC. This time-dependent change in global coherence demonstrates evidence for intra-tuberal and inter-tuberal connectivity in TSC. This observation has surgical implications. It suggests that targeting multiple tubers has a higher chance of seizure control as there is a higher chance of disrupting the epileptic network. The use of laser interstitial thermal therapy (LITT) allowed us to target multiple disparately located tubers in a minimally invasive manner with good seizure control outcomes.


Assuntos
Epilepsia , Esclerose Tuberosa , Criança , Eletroencefalografia/métodos , Epilepsia/cirurgia , Humanos , Técnicas Estereotáxicas , Resultado do Tratamento , Esclerose Tuberosa/complicações , Esclerose Tuberosa/diagnóstico por imagem , Esclerose Tuberosa/cirurgia
16.
Radiography (Lond) ; 27(3): 927-934, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33775519

RESUMO

INTRODUCTION: Continuing Professional development (CPD) is deemed essential for the Radiographers (DR) and Radiation Therapists (RT) after Singapore commenced state registration. Diagnostic imaging and radiotherapy treatment services are constantly revolutionizing and those working in this field requires sufficient knowledge of the uptrends for training and development. The purpose of this survey is to identify the current training needs of the registered DR and RT in Singapore, and to understand their views about CPD activities. METHODS: An online questionnaire was disseminated by the Singapore Society of Radiographers (SSR) to all registered DR and RT in Singapore, and all practicing in restructured and private hospitals were included. Data collection took place from January 2018 to April 2018. RESULTS: 102 responses were analysed, where 89 were DR and 13 were RT. CPD was provided in 72.5% (n = 74) of the participants' institutions, and 69.6% (n = 71) of participants were aware of CPD. Interestingly, participants were significantly more likely to be unaware of CPD when working in an institution which do not offer CPD. Training programme objective was the most important factor for selecting a programme. 93.1% (n = 95) preferred SSR to support them for CPD. There were a few constraints to CPD engagements identified such as financial factors, lack of time, and institution availability. CONCLUSION: There was significant intrinsic motivation in a quality CPD activity. CPD activities should be current, accessible and relevant for the healthcare professionals to increase participation, which directly contributes to high standards of clinical care. IMPLICATIONS FOR PRACTICE: Local healthcare institutions should be aware and address needs, gaps and aspirations of the local DR and RT community to ensure adequate preparation has been made upon initiation of mandatory CPD.


Assuntos
Pessoal Técnico de Saúde , Pessoal de Saúde , Humanos , Motivação , Singapura , Inquéritos e Questionários
17.
Ethn Dis ; 31(1): 57-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33519156

RESUMO

Objective: We applied a social network approach to examine if three types of diabetes-related stigma (self-stigma, perceived stigma and enacted stigma) moderated associations between social network characteristics (network size, kin composition, household composition, and network density), social support, and blood glucose among Ghanaians with type 2 diabetes mellitus (T2DM). Methods: Data were obtained through a cross-sectional survey of 254 adults at a diabetes clinic in Ghana that assessed participants' social networks, social support, and frequency of experiencing three types of diabetes-related stigma. Results: Self-stigma moderated associations between kin composition and social support when controlling for network size ß=-.97, P=.004). Among study participants reporting low self-stigma, kin composition was positively associated with social support (ß=1.29, P<.0001), but this association was not found among those reporting high self-stigma. Network size was positively associated with social support among participants reporting both low and high self-stigma. None of the types of diabetes-related stigma moderated other associations between social networks, social support, and blood glucose. Conclusions: Individuals with T2DM who report high self-stigma may have lower social support, which can reduce their capacity for disease management. Additionally, larger social networks may be beneficial for individuals with T2DM in countries like Ghana, and interventions that expand network resources may facilitate diabetes control.


Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Estudos Transversais , Gana , Humanos , Rede Social , Apoio Social
18.
Braz. j. biol ; 81(1): 83-91, Feb. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1153327

RESUMO

Abstract Current study assessed the impact of Lantana camara invasion on native plant diversity in Pothohar region of Pakistan. The approach used for study was random samplings and comparisons of diversity indices [number of species (S), abundance (N), species richness (R), evenness (Jꞌ), Shannon diversity index (Hꞌ) and Simpson index of dominance (λ)] with two categorical factors i.e., invaded and non-invaded (control). Control plots harboured by an average of 1.74 more species/10m2. The control category was diverse (Hꞌ=2.56) than invaded category (Hꞌ=1.56). The higher value of species richness in control plots shows heterogeneous nature of communities and vice versa in invaded plots. At multivariate scale, ordination (nMDS) and ANOSIM showed significant magnitude of differences between invaded and control plots at all sites. The decrease in studied diversity indices in invaded over control sites indicated that plant communities become less productive due to Lantana invasion.


Resumo O presente estudo avaliou o impacto da invasão de Lantana camara na diversidade de plantas nativas na região de Pothohar, no Paquistão. A abordagem utilizada para o estudo foram a amostragem aleatória e a comparação de índices de diversidade, como número de espécies (S), abundância (N), riqueza de espécies (R), equitabilidade (Jꞌ), índice de diversidade de Shannon (Hꞌ) e índice de dominância de Simpson (λ), com dois fatores categóricos, ou seja, invadidos e não invadidos (controle). As parcelas não invadidas tinham, em média, 1,74 espécie a mais / 10 m2 que parcelas invadidas. A categoria controle foi mais diversa (Hꞌ = 2,56) do que a categoria invadida (Hꞌ = 1,56). O maior valor da riqueza de espécies em parcelas de controle mostra a natureza heterogênea das comunidades, e vice-versa, em parcelas invadidas. Na escala multivariada, ordenação (nMDS) e ANOSIM mostraram magnitude significativa das diferenças entre as parcelas invadidas e controle em todos os locais. A diminuição nos índices de diversidade estudados em locais invadidos por controle indicou que as comunidades de plantas se tornam menos produtivas por causa da invasão de Lantana.


Assuntos
Lantana , Paquistão , Plantas
19.
J Eval Clin Pract ; 27(6): 1271-1280, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33511747

RESUMO

OBJECTIVE: Heavy users of the emergency department (ED) are a heterogeneous population. Few studies have captured the social and demographic complexity of patients with the largest burden of ED use. Our objective was to model associations between social and demographic patient characteristics and quantiles of the distributions of ED use, defined as frequent and high-charge. METHODS: We conducted a cross-sectional analysis of electronic health and billing records of 99 637 adults residing in an urban North Carolina county who visited an ED within Atrium Health, a large integrated health care system, in 2017. Mid-quantile and standard quantile regression models were used for count and continuous responses, respectively. Frequent and high-charge use outcomes were defined as the median (0.50) and upper quantiles (0.75, 0.95, 0.99) of the outcome distributions for total billed ED visits and associated charges during the study period. Patient characteristic predictors were: insurance coverage (Medicaid, Medicare, private, uninsured), total visits to ambulatory care during the study period (0, 1, >1), and patient demographics: age, gender, race, ethnicity, and living in an underprivileged community called a public health priority area (PHPA). RESULTS: Results showed heterogeneous relationships that were stronger at higher quantiles. Having Medicaid or Medicare insurance was positively associated with ED visits and ED charges at most quantiles. Racial and geographic disparities were observed. Black patients had more ED visits and lower ED charges than their White counterparts at most quantiles of the outcome distributions. Patients living in PHPAs, had lower charges than their counterparts at the median but higher charges at the 0.95 and 0.99 quantiles. CONCLUSIONS: The relationships between patient characteristics and frequent and high-charge use of the ED vary based on the level of use. These findings can be used to inform targeted interventions, tailored policy, and population health management initiatives.


Assuntos
Serviço Hospitalar de Emergência , Medicare , Adulto , Idoso , Estudos Transversais , Etnicidade , Humanos , Medicaid , Estados Unidos
20.
Am J Med ; 134(1): e15-e19, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32621908

RESUMO

BACKGROUND: There has been an increase in the use of smokeless tobacco recently. Whether smokeless tobacco use may predispose individuals to use other addictive substances is unknown. The use of multiple addictive substances may compound an individual's adverse health effects. METHODS: In a cross-sectional analysis, we used the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey database to identify all individuals who reported the use of smokeless tobacco and extracted data regarding baseline and demographic patterns, as well as information regarding the use of other addictive substances. Weighted multivariable logistic regression models adjusting for age, gender, race/ethnicity, poverty level, education, employment status, and marital status were used to determine the odds ratios (ORs) for use of alcohol, cigarettes, e-cigarettes, and marijuana among smokeless tobacco users. RESULTS: We identified 30,395 (3.38%) individuals in our study population who reported smokeless tobacco use. Compared with non-users, smokeless tobacco users were more likely to be unmarried, male, Caucasian, belonging to the lower socioeconomic strata, and did not have a formal college education (P <0.01). In multivariable analyses, smokeless tobacco use was associated with a higher likelihood of cigarettes use (OR: 1.76 [95% confidence interval {CI}: 1.66-1.86, P <0.01]), e-cigarette use (OR: 1.61 [95% CI: 1.52-1.71, P <0.01]), and heavy alcohol consumption (OR:2.36 [95% CI: 2.17-2.56, P <0.01]) but not marijuana use (OR: 1.11 [95% CI: 0.90-1.38, P = 0.33]). CONCLUSION: In a large, nationally representative sample, smokeless tobacco use was associated with the increased use of cigarettes, e-cigarettes, and alcohol. Simultaneous use of these substances may compound the adverse health effects of smokeless tobacco use. Public health interventions addressing this concerning trend are warranted.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tabaco sem Fumaça/estatística & dados numéricos , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Estados Unidos
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