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1.
Contemp Clin Trials Commun ; 16: 100468, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701042

RESUMO

Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafER Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.

2.
Mult Scler Relat Disord ; 36: 101403, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610401

RESUMO

BACKGROUND: There is a high level of interest in the potential role of diet among the MS community. There is a limited level of evidence for a Mediterranean-style dietary pattern in MS; the feasibility of conducting studies using educational tools to deliver this type of intervention and study its effects is unknown. OBJECTIVES: To establish clinical trial feasibility for future studies utilizing educational delivery of a dietary intervention in MS; to explore the effects of a modified Mediterranean dietary intervention in MS. METHODS: We randomly assigned women with MS to follow/not follow the prescribed modified Mediterranean dietary intervention for 6 months, delivered through educational sessions. The diet encouraged the intake of fish and other foods high in poly- and monounsaturated fats, fresh fruits, vegetables, and whole grains and eliminated meat, dairy, and most processed foods and limited salt intake to <2 g/day. Primary endpoints related to meeting target enrollment within the specified time frame, adherence, and study completion. Clinical endpoints were evaluated in an exploratory fashion. RESULTS: We screened 128 potential participants and enrolled 36 within 9 months, surpassing target enrollment of 30 participants at a single center in 1 year. Self-reported adherence was excellent (90.3%), with an overall study completion rate of 94.4%. The intervention group exhibited a statistically significant decline in the trajectory of Neurological Fatigue Index-MS scores (p = 0.01), a trend toward reduced Multiple Sclerosis Impact Scale-29 scores that became significant after outlier removal (p = 0.12; p = 0.023), and a reduction in Expanded Disability Status Scale (p = 0.01) over time as compared to the non-intervention group. CONCLUSIONS: It is reasonable to expect a high level of interest and commitment to this type of dietary intervention study in MS, and feasible to deliver it purely through education in a clinical setting with high adherence levels despite restrictive requirements. In this pilot study, a modified Mediterranean dietary intervention reduced fatigue, impact of MS symptoms, and disability. Further work is needed.

3.
J Cancer Educ ; 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31175566

RESUMO

This study aims to describe the acceptability and feasibility of an educational and training experiential intervention (ETEI) we developed to enhance muscle invasive bladder cancer (MIBC) patients with treatment decision-making and post-operative self-care. Twenty-five patients were randomized to a control group (N = 8) or ETEI group (N = 17). ETEI group participated in a nurse-led session on MIBC education. The control group received diet and nutrition education. Study questionnaires were completed at baseline and at 1-month post-intervention. Our results showed acceptable recruitment (58%) and retention rates (68%). The ETEI group reported increased knowledge (82% vs. 50%), improved decisional support (64% vs. 50%), improved communication (73% vs. 50%), and increased confidence in treatment decisions (73% vs. 50%) compared to the control group. Patients in the control group reported improved diet (50% v. 27%) as well as maintaining a healthy lifestyle (67% vs. 45%) compared to the ETEI group. Patients in the ETEI group reported a significant decrease in cancer worries and increases in self-efficacy beliefs over time compared to the control group. The ETEI was feasible, acceptable, and showed a potential for inducing desired changes in cancer worries and efficacy beliefs.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31067756

RESUMO

Thyroid cancer incidence is higher in World Trade Center (WTC) responders compared with the general population. It is unclear whether this excess in thyroid cancer is associated with WTC-related exposures or if instead there is an over-diagnosis of malignant thyroid cancer among WTC first responders due to enhanced surveillance and physician bias. To maximize diagnostic yield and determine the false positive rate for malignancy, the histological diagnoses of thyroid cancer tumors from WTC responders and age, gender, and histology matched non-WTC thyroid cancer cases were evaluated using biomarkers of malignancy. Using a highly accurate panel of four biomarkers that are able to distinguish benign from malignant thyroid cancer, our results suggest that over-diagnosis by virtue of misdiagnosis of a benign tumor as malignant does not explain the increased incidence of thyroid cancer observed in WTC responders. Therefore, rather than over-diagnosis due to physician bias, the yearly screening visits by the World Trade Center Health Program are identifying true cases of thyroid cancer. Continuing regular screening of this cohort is thus warranted.


Assuntos
Socorristas/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro , Neoplasias da Glândula Tireoide , Adulto , Biomarcadores/metabolismo , Estudos de Coortes , Erros de Diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Preconceito , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/metabolismo
5.
J Neurovirol ; 25(4): 551-559, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31098925

RESUMO

Small intestinal bacterial overgrowth (SIBO) is common among patients with HIV-associated autonomic neuropathies (HIV-AN) and may be associated with increased bacterial translocation and elevated plasma inflammatory biomarkers. Pyridostigmine is an acetylcholinesterase inhibitor which has been used to augment autonomic signaling. We sought preliminary evidence as to whether pyridostigmine could improve proximal gastrointestinal motility, reduce SIBO, reduce plasma sCD14 (a marker of macrophage activation and indirect measure of translocation), and reduce the inflammatory cytokines IL-6 and TNFα in patients with HIV-AN. Fifteen participants with well-controlled HIV, HIV-AN, and SIBO were treated with 8 weeks of pyridostigmine (30 mg PO TID). Glucose breath testing for SIBO, gastric emptying studies (GES) to assess motility, plasma sCD14, IL-6, and TNFα, and gastrointestinal autonomic symptoms were compared before and after treatment. Thirteen participants (87%) experienced an improvement in SIBO following pyridostigmine treatment; with an average improvement of 50% (p = 0.016). There was no change in gastrointestinal motility; however, only two participants met GES criteria for gastroparesis at baseline. TNFα and sCD14 levels declined by 12% (p = 0.004) and 19% (p = 0.015), respectively; there was no significant change in IL-6 or gastrointestinal symptoms. Pyridostigmine may ameliorate SIBO and reduce levels of sCD14 and TNFα in patients with HIV-AN. Larger placebo-controlled studies are needed to definitively delineate how HIV-AN affects gastrointestinal motility, SIBO, and systemic inflammation in HIV, and whether treatment improves clinical outcomes.

6.
Regul Toxicol Pharmacol ; 106: 50-54, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31029853

RESUMO

BACKGROUND: Skin lightening products containing dangerous levels of chemicals pose a serious health concern for consumers. However, to date, the extent of these products in Europe has not been extensively studied. The aim of this study was to determine whether harmful skin lightening products are available for sale in Europe and what violations exist regarding their composition. MATERIALS AND METHODS: We queried the Rapex database, which is the Rapid Alert System for dangerous non-food products among 31 European countries, to identify skin lightening cosmetics reported between 2005 and 2018, and presented a detailed summary of these notifications. RESULTS: In the years 2005-2018, of all violations regarding cosmetics, 26.3% concerned skin lightening products. In the database, 266 reports on skin lightening products were identified. Most of the notifications came from Germany (17.29%), France (17.29%), Portugal (15.41%), and the United Kingdom (11.65%). The majority of the registered products originated from non-European countries, mainly the Côte d'Ivoire (29.70%). The major reason for the violation was the content of hydroquinone, mercury, or clobetasol propionate. CONCLUSIONS: Hazardous skin lightening products that are not in line with European cosmetics legislation are available on the European market. Most of the products are imported. The main risk associated with these products is the content of hydroquinone, mercury, and clobetasol propionate. It is important to bear in mind that this study focuses on the Rapex system and other sources of information may exist. Based on our findings, a more comprehensive evaluation by international authorities is justified.


Assuntos
Clobetasol/análise , Cosméticos/análise , Hidroquinonas/análise , Mercúrio/análise , Preparações Clareadoras de Pele/análise , Pigmentação da Pele , Europa (Continente) , Humanos , Medição de Risco
7.
Dermatol Ther (Heidelb) ; 9(2): 355-367, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020513

RESUMO

INTRODUCTION: The application of skin bleaching products to inhibit melanogenesis is a common practice within the African diaspora. Despite the adverse health effects of skin bleaching, rigorous studies investigating skin bleaching behavior among these populations in the United States are limited. In our P30 pilot study, we explored predictors of skin bleaching practice intensity among African and Afro-Caribbean women. METHODS: In collaboration with our Community Engagement Core, we conducted a cross-sectional study to investigate the relationship between demographic and psychosocial predictors and skin-bleaching-related practice patterns among African and Afro-Caribbean women in New York City. RESULTS: Among the 76 participants recruited, the median age at the initiation of skin bleaching was 19.5 (16-25) years, yielding a median duration of 13.5 (6-23) years. Although pregnant women were not actively recruited for the study, 13.2% (n = 10) of the participants used skin bleaching products while pregnant or possibly breastfeeding. Nativeness and education were associated with various components of skin bleaching practice intensity, including duration of skin bleaching, daily use of products, and bleaching of the entire body. Participants' perceived skin-color-related quality of life was not associated with skin bleaching practice intensity. CONCLUSION: Skin bleaching is a habitual practice that likely requires culturally sensitive interventions to promote behavioral change. The existence of prenatal and postnatal exposure to mercury, hydroquinone, and other potentially harmful chemicals in skin bleaching products highlights an urgent need to explore the adverse effects of skin bleaching practices on birth outcomes and the growth and neurodevelopment of young babies.

8.
Environ Res ; 170: 187-193, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30583128

RESUMO

BACKGROUND: There is an urgent need to address the safety problems caused by the use of skin lightening cosmetics. Evidence suggests that some of them may contain heavy metals. OBJECTIVES: We conducted a systematic review of global legal regulations regarding the permissible level of mercury, lead, arsenic, and cadmium in cosmetic products, with particular emphasis on skin lightening preparations. METHODS: The systematic search of documents was a two-stage process. First, official websites of 17 regional organizations and subsequently regulations for countries with a population over 100 million were searched. RESULTS: Fifteen legislative acts, encompassing more than 67·2% of the global population were reviewed. Regulations were identified for 44/59 high income countries, 16/55 upper middle income countries, 9/45 lower income countries, 0/34 low income countries. The median adult literacy rate was 91·4% and 64·2% in countries with and without regulations, respectively. The use of mercury, lead, arsenic, and cadmium has been banned in 67, 67, 65, and 65 out of 69 countries, respectively. CONCLUSIONS: While regulations exist in most of the high income countries, in low income countries there is a lack of similar standards. In most countries for which these legal regulations have been identified, restrictions on the permissible level of heavy metals are strict. There is a need for enforcement of existing rules, and rigorous assessment of the effectiveness of these regulations.


Assuntos
Cosméticos/legislação & jurisprudência , Metais Pesados , Adulto , Cosméticos/normas , Humanos , Pele , Preparações Clareadoras de Pele/legislação & jurisprudência , Preparações Clareadoras de Pele/normas , Controle Social Formal
9.
AIDS ; 32(9): 1147-1156, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29596112

RESUMO

OBJECTIVE: Chronic inflammation in HIV-infected individuals drives disease progression and the development of comorbidities, despite viral suppression with combined antiretroviral therapy. Here, we sought evidence that vagal dysfunction, which occurs commonly as part of HIV-associated autonomic neuropathy, could exacerbate inflammation through gastrointestinal dysmotility, small intestinal bacterial overgrowth (SIBO), and alterations in patterns of soluble immune mediators. DESIGN: This is a cross-sectional observational study. METHODS: Forty participants on stable combined antiretroviral therapy with gastrointestinal symptoms, and no causes for vagal or gastrointestinal dysfunction other than HIV, underwent autonomic testing, hydrogen/methane breath testing for SIBO, and gastric emptying scintigraphy. A panel of 41 cytokines, high-mobility group box 1, and markers of bacterial translocation (lipopolysaccharide) and monocyte/macrophage activation (sCD14 and sCD163) were tested in plasma. RESULTS: We found that participants with vagal dysfunction had delayed gastric emptying and higher prevalence of SIBO. SIBO was associated with IL-6, but not sCD14; lipopolysaccharide could not be detected in any participant. We also found alteration of cytokine networks in participants with vagal dysfunction, with stronger and more numerous positive correlations between cytokines. In the vagal dysfunction group, high mobility group box 1 was the only soluble mediator displaying strong negative correlations with other cytokines, especially those cytokines that had numerous other strong positive correlations. CONCLUSION: The current study provides evidence that the vagal component of HIV-associated autonomic neuropathy is associated with changes in immune and gastrointestinal function in individuals with well treated HIV. Further study will be needed to understand whether therapies targeted at enhancing vagal function could be of benefit in HIV.


Assuntos
Síndrome da Alça Cega/epidemiologia , Infecções por HIV/complicações , Inflamação/fisiopatologia , Doenças do Nervo Vago/complicações , Adolescente , Adulto , Idoso , Translocação Bacteriana/imunologia , Testes Respiratórios , Estudos Transversais , Citocinas/sangue , Esvaziamento Gástrico , Motilidade Gastrointestinal , Humanos , Ativação de Macrófagos , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
10.
J Clin Transl Sci ; 1(3): 146-152, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29082029

RESUMO

INTRODUCTION: It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from 'fundamental' (necessary for all) to 'specialized' (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized. METHODS: We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by 'fundamental' and 'specialized.' RESULTS: There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one's own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%). CONCLUSION: We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.

11.
J Clin Transl Sci ; 1(4): 235-239, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29657857

RESUMO

As clinical researchers at academic medical institutions across the United States increasingly manage complex clinical databases and registries, they often lack the statistical expertise to utilize the data for research purposes. This statistical inadequacy prevents junior investigators from disseminating clinical findings in peer-reviewed journals and from obtaining research funding, thereby hindering their potential for promotion. Underrepresented minorities, in particular, confront unique challenges as clinical investigators stemming from a lack of methodologically rigorous research training in their graduate medical education. This creates a ripple effect for them with respect to acquiring full-time appointments, obtaining federal research grants, and promotion to leadership positions in academic medicine. To fill this major gap in the statistical training of junior faculty and fellows, the authors developed the Applied Statistical Independence in Biological Systems (ASIBS) Short Course. The overall goal of ASIBS is to provide formal applied statistical training, via a hybrid distance and in-person learning format, to junior faculty and fellows actively involved in research at US academic medical institutions, with a special emphasis on underrepresented minorities. The authors present an overview of the design and implementation of ASIBS, along with a short-term evaluation of its impact for the first cohort of ASIBS participants.

12.
J Clin Transl Sci ; 1(6): 323-327, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29707253

RESUMO

While junior clinical researchers at academic medical institutions across the US often desire to be actively engaged in randomized-clinical trials, they often lack adequate resources and research capacity to design and implement them. This insufficiency hinders their ability to generate a rigorous randomization scheme to minimize selection bias and yield comparable groups. Moreover, there are limited online user-friendly randomization tools. Thus, we developed a free robust randomization app (RRApp). RRApp incorporates 6 major randomization techniques: simple randomization, stratified randomization, block randomization, permuted block randomization, stratified block randomization, and stratified permuted block randomization. The design phase has been completed, including robust server scripts and a straightforward user-interface using the "shiny" package in R. Randomization schemes generated in RRApp can be input directly into the Research Electronic Data Capture (REDCap) system. RRApp has been evaluated by biostatisticians and junior clinical faculty at the Icahn School of Medicine at Mount Sinai. Constructive feedback regarding the quality and functionality of RRApp was also provided by attendees of the 2016 Association for Clinical and Translational Statisticians Annual Meeting. RRApp aims to educate early stage clinical trialists about the importance of randomization, while simultaneously assisting them, in a user-friendly fashion, to generate reproducible randomization schemes.

13.
Dermatol Ther (Heidelb) ; 6(4): 453-459, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27837412

RESUMO

Skin-bleaching practices, such as using skin creams and soaps to achieve a lighter skin tone, are common throughout the world and are triggered by cosmetic reasons that oftentimes have deep historical, economic, sociocultural, and psychosocial roots. Exposure to chemicals in the bleaching products, notably, mercury (Hg), hydroquinone, and steroids, has been associated with a variety of adverse health effects, such as Hg poisoning and exogenous ochronosis. In New York City (NYC), skin care product use has been identified as an important route of Hg exposure, especially among Caribbean-born blacks and Dominicans. However, surprisingly sparse information is available on the epidemiology of the health impacts of skin-bleaching practices among these populations. We highlight the dearth of large-scale, comprehensive, community-based, clinical, and translational research in this area, especially the limited skin-bleaching-related research among non-White populations in the US. We offer five new research directions, including investigating the known and under-studied health consequences among populations for which the skin bleach practice is newly emerging at an alarming rate using innovative laboratory and statistical methods. We call for conducting methodologically rigorous, multidisciplinary, and culturally sensitive research in order to provide insights into the root and the epidemiological status of the practice and provide evidence of exposure-outcome associations, with an ultimate goal of developing potential intervention strategies to reduce the health burdens of skin-bleaching practice.

14.
Health Psychol ; 35(4): 403-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27018732

RESUMO

Moving from a descriptive focus to a comprehensive analysis grounded in causal inference can be particularly daunting for disparities researchers. However, even a simple model supported by the theoretical underpinnings of causality gives researchers a better chance to make correct inferences about possible interventions that can benefit our most vulnerable populations. This commentary provides a brief description of how race/ethnicity and context relate to questions of causality, and uses a hypothetical scenario to explore how different researchers might analyze the data to estimate causal effects of interest. Perhaps although not entirely removed of bias, these causal estimates will move us a step closer to understanding how to intervene. (PsycINFO Database Record


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Disparidades em Assistência à Saúde , Escolaridade , Humanos , Modelos Estatísticos , Racismo/psicologia , Fatores Socioeconômicos , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia
15.
Stroke ; 47(2): 512-5, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26628384

RESUMO

BACKGROUND AND PURPOSE: Although poststroke depression is common, racial-ethnic disparities in depression among stroke survivors remain underexplored. Thus, we investigated the relationship between race/ethnicity and depression in a multiracial-ethnic stroke cohort. METHODS: Baseline survey data of validated scales of depression and functional status, demographics, comorbidities, and socioeconomic status were used from a recurrent stroke prevention study among community-dwelling urban stroke/transient ischemic attack survivors. RESULTS: The cohort included 556 participants with a mean age of 64 years. The majorities were black (44%) or latino (42%) and female (60%), had their last stroke/transient ischemic attack nearly 2 years before study enrollment, and lived below the poverty level (58%). Nearly 1 in 2 latinos, 1 in 4 blacks, and 1 in 8 whites were depressed. Multivariate logistic regression showed that survivors who were younger, were female, had ≥3 comorbid conditions, were functionally disabled from stroke, lacked emotional-social support, and who took antidepressants before study entry had higher risk of depression. Time since last stroke/transient ischemic attack did not affect the chance of depression. After adjusting for all above risk factors, latinos had 3× the odds of depression (95% confidence interval: 1.18-6.35) than whites; blacks and whites had similar odds of depression. CONCLUSIONS: This study reveals that latino stroke survivors have a significantly higher prevalence of depression compared with their non-latino counterparts.


Assuntos
Depressão/etnologia , Transtorno Depressivo/etnologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Ataque Isquêmico Transitório/etnologia , Pobreza/estatística & dados numéricos , Acidente Vascular Cerebral/etnologia , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Coortes , Comorbidade , Depressão/psicologia , Transtorno Depressivo/psicologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Vida Independente , Ataque Isquêmico Transitório/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Classe Social , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos , Estados Unidos/epidemiologia
16.
J Immigr Minor Health ; 17(4): 1105-13, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25007889

RESUMO

We examined racial/ethnic differences in cognitive disability and the contribution of sociodemographic factors to these differences. Using logistic regression, we measured the association between race/ethnicity and cognitive disability after adjustment for sociodemographic covariates, including agegroup, sex, education, nativity, region, marital status, and occupation among 2009 American Community Survey respondents (≥25 years). Effect modification was also explored. Cognitive disability was self-reported by 6 % of respondents. The proportion with cognitive disability was highest for Blacks and Native American/Pacific Islanders. Statistically significant effect modification was observed for all sociodemographic covariates, except sex. Although most sociodemographic modifiers revealed a more convoluted relationship between race/ethnicity and cognitive disability, the cognitive benefits of higher education, foreign born nativity, and top-tier occupations were observed among most racial/ethnic groups. The observed interplay between sociodemographics and race/ethnicity highlight a complex relationship between race/ethnicity and cognitive disability. Future research should examine mechanisms for this induced complexity.


Assuntos
Transtornos Cognitivos/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Americanos Asiáticos/estatística & dados numéricos , Transtornos Cognitivos/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fatores Sexuais , Estados Unidos/epidemiologia
17.
Int J Public Health ; 59(5): 809-17, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24888418

RESUMO

OBJECTIVES: We examined the impact of nativity on self-reported cognitive disability by comparing children who were born outside of the USA (first-generation immigrants) with US-born offspring (second-generation immigrants) of foreign-born parents. METHODS: We analyzed a diverse, nationally representative, sample of 77,324 first-generation immigrant and second-generation immigrant children (aged 5-17 years) from the 2009 American Community Survey. Multivariate logistic regression was used to assess the association between nativity and self-reported cognitive disability after adjustment for demographics and household characteristics. RESULTS: Self-reported cognitive disability was observed in 1.7 % of the sample. The prevalence was higher among first second-generation immigrants than among second first-generation immigrants (1.9 vs 1.1 %, p < 0.001). After multivariate adjustment, the advantage of being foreign-born remained (OR = 0.63, 95 % CI = 0.53-0.75). Further analysis revealed effect modification of the immigrant health advantage by household income (p = 0.003). CONCLUSIONS: We observed an immigrant advantage in self-reported cognitive disability; however, it was only evident among economically disadvantaged children. Future research should examine the contribution of the accumulation of poverty over time to the relationship between nativity and children's health.


Assuntos
Ordem de Nascimento , Bem-Estar da Criança/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Criança , Pré-Escolar , Transtornos Cognitivos/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Análise Multivariada , Prevalência , Autorrelato , Fatores Socioeconômicos , Estados Unidos/epidemiologia
18.
J Neurotrauma ; 31(7): 610-7, 2014 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-24237113

RESUMO

Psychiatric disturbance is common and disabling after traumatic brain injury (TBI). Few studies have investigated the trajectory of psychiatric symptoms in the first 6 months postinjury, when monitoring and early treatment might prevent persistent difficulties. The aim of this study was to examine the trajectory of psychiatric symptoms 1-6 months post-TBI, the patient/injury characteristics associated with changes, and characteristics predictive of persisting symptoms. A secondary analysis was performed on data from a clinical trial with three data collection points. Across eight centers, 872 participants with complicated mild to severe TBI were administered the Brief Symptom Inventory (BSI) at 30, 90, and 180 days postinjury. Mixed-effects models were used to assess longitudinal changes in the BSI Global Severity Index (GSI). Multi-variate logistic regression was used to assess predictors of clinically significant GSI elevations persisting to 6 months post-TBI. In general, GSI scores improved over time. Women improved faster than men; race/ethnicity was also significantly associated with rate of change, with Hispanics showing the most and African Americans the least improvement. Clinically significant psychiatric symptoms (caseness) occurred in 42% of the sample at 6 months, and more than one type of symptom was common. Significant predictors of caseness included African American race, age from 30 to 60 years, longer post-traumatic amnesia (PTA) duration, pre-TBI unemployment, and pre-TBI risky alcohol use. Findings indicate that psychiatric symptoms are common in the first 6 months post-TBI and frequently extend beyond the depression and anxiety symptoms that may be most commonly screened. Patients with longer PTA and preinjury alcohol misuse may need more intensive monitoring for symptom persistence.


Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/psicologia , Adulto , Lesões Encefálicas/tratamento farmacológico , Citidina Difosfato Colina/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nootrópicos/uso terapêutico , Fatores de Risco
19.
Epilepsia ; 53(9): 1481-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22954016

RESUMO

PURPOSE: In a prospective study, Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT), we determined the frequency of human herpesvirus (HHV)-6 and HHV-7 infection as a cause of febrile status epilepticus (FSE). METHODS: Children ages 1 month to 5 years presenting with FSE were enrolled within 72 h and received a comprehensive assessment including specimens for HHV-6 and HHV-7. The presence of HHV-6A, HHV-6B, or HHV-7 DNA and RNA (amplified across a spliced junction) determined using quantitative polymerase chain reaction (qPCR) at baseline indicated viremia. Antibody titers to HHV-6 and HHV-7 were used in conjunction with the PCR results to distinguish primary infection from reactivated or prior infection. KEY FINDINGS: Of 199 children evaluated, HHV-6 or HHV-7 status could be determined in 169 (84.9%). HHV-6B viremia at baseline was found in 54 children (32.0%), including 38 with primary infection and 16 with reactivated infection. No HHV-6A infections were identified. HHV-7 viremia at baseline was observed in 12 children (7.1%), including eight with primary infection and four with reactivated infection. Two subjects had HHV-6/HHV-7 primary coinfection at baseline. There were no differences in age, characteristics of illness or fever, seizure phenomenology or the proportion of acute EEG or imaging abnormalities in children presenting with FSE with or without HHV infection. SIGNIFICANCE: HHV-6B infection is commonly associated with FSE. HHV-7 infection is less frequently associated with FSE. Together, they account for one third of FSE, a condition associated with an increased risk of both hippocampal injury and subsequent temporal lobe epilepsy.


Assuntos
Herpesvirus Humano 6 , Herpesvirus Humano 7 , Infecções por Roseolovirus/epidemiologia , Convulsões Febris/epidemiologia , Estado Epiléptico/epidemiologia , Pré-Escolar , Feminino , Herpesvirus Humano 6/isolamento & purificação , Herpesvirus Humano 7/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Infecções por Roseolovirus/diagnóstico , Convulsões Febris/diagnóstico , Convulsões Febris/virologia , Estado Epiléptico/diagnóstico , Estado Epiléptico/virologia
20.
Ann Neurol ; 70(1): 93-100, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21437934

RESUMO

OBJECTIVE: In prior studies of febrile seizures (FSs), prolonged FSs were defined, absent empirical evidence, as lasting 10 or 15 minutes or more. We assessed the distribution of FS duration in a cohort with first FSs, and the association between FS duration and baseline characteristics of the children. METHODS: We calculated the observed cumulative probability, S(t), that a FS would last at least t minutes, S(t) = exp(-t/τ). Data were also fit using a model obtained as the sum of 2 exponential distributions (S[t] = αexp[-t/τ(1) ] + [1 - α]exp[-t/τ(2) ]). After assessing the best fit, the cutoff defining long FS was determined. Logistic regression was used to examine associations between long FSs and baseline characteristics, behavior, and development. RESULTS: In 158 children with a first FS, median duration was 4.0 minutes. Duration of FS was best fit by a 2-component mixture exponential model. Using this model, we identified 1 population that accounts for 82.3% of FSs and has a mean duration of 3.8 minutes (short FS) and a second population that accounts for 17.7% of FSs and has a mean duration of 39.8 minutes (long FS). Long FSs were significantly associated with developmental delay (p = 0.010) and delays and younger age at first FS (p = 0.048). INTERPRETATION: Like the distribution of afebrile seizure duration in children, the distribution of first FS duration is best modeled by assuming 2 populations. Developmental delay and younger age are associated with prolonged FSs. Our data lend further support to defining 10 minutes as the upper limit for a simple FS.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Convulsões Febris/complicações , Convulsões Febris/epidemiologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Convulsões Febris/fisiopatologia , Fatores de Tempo
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